This document provides an overview of common fractures and injuries to the forearm, including: - Fractures of the radial head and neck are more common in adults and children respectively. Radial head fractures can be small chips or large with displacement. - Ulna shaft fractures usually result from direct blows and Monteggia fractures involve the proximal radioulnar joint. - Olecranon fractures occur from falls on the elbow and are pulled by triceps contraction. - Lateral epicondylitis causes tennis elbow pain over the lateral epicondyle radiating down the forearm from repetitive wrist flexion and extension. - Synovial cysts sometimes appear on the back of

1. • Anatomy:Clinical correlation of forearm
by
• Dr.liban ahmed ali siad (dr.al-beydhar)
Benadir unuversity

2. Fracture of the Radial Head and Neck
• Fractures to the proximal radius often involve
either the head or the neck of the radius.
These fractures can result from a
• fall on an outstretched hand (indirect trauma)
or a direct blow to the elbow.

3. Cont……
• Fracture of the radial head is more common
in adults.
whereas fracture of the neck is more common
in children.

4. Cont….
• There are three types of radial head fructure
a. Small chip fracture of radial head.
b. Large fracture of radial head with
displacement.
c. Comminuted fracture of radial head.

5. 3 types of fructural head

6. Fracture of radial neck is more common in children

7. Fracture of the Ulna Shaft
• Usually, a direct blow to
or forced pronation of
the forearm is the most
common cause of a
fracture of the shaft of
the ulna.
• Fracture of the ulna
with dislocation of the
proximal radioulnar
joint is termed a
Monteggia fracture.

8. Fracture of the Ulna Shaft

9. Fracture of the Olecranon
• Fracture of the olecranon, called a fractured
elbow by laypersons, is common because the
olecranon is subcutaneous and protrusive.
• The typical mechanism of injury is a fall on the
elbow combined with sudden powerful
contraction of the triceps.
• The fractured olecranon is pulled away by the
active and tonic contraction of the triceps.

10. Fracture of the Olecranon
Normal olecranon Fractured olecranon

11. Elbow Tendinitis or Lateral Epicondylitis
• Elbow Tendinitis or Lateral Epicondylitis
• Elbow tendinitis (tennis elbow) is a painful
musculoskeletal condition that may follow
repetitive use of the superficial extensor
muscles of the forearm.
• Pain is felt over the lateral epicondyle and
radiates down the posterior surface of the
forearm

12. • People with elbow
tendinitis often feel pain
when they open a door or
lift a glass. Repeated
forceful flexion and
extension of the wrist
strain the attachment of
the common extensor
tendon, producing
inflammation of the
periosteum of the lateral
epicondyle (lateral
epicondylitis).

13. Synovial Cyst of the Wrist
• Sometimes a non-tender cystic
swelling appears on the hand,
most commonly on the dorsum of
the wrist
• The thin-walled cyst contains
clear mucinous fluid.
• The cause of the cyst is unknown,
but it may result from mucoid
degeneration (Salter, 1999).
• Flexion of the wrist makes the
cyst enlarge, and it may be
painful.
• Anatomically, a ganglion refers to
a collection of nerve cells
• Clinically, this type of swelling is
called a ganglion

14. Synovial cyst
Extensor
tendons
Synovial
sheaths
(purple)

15. High Division of the Brachial Artery
• Sometimes the brachial artery divides at a
more proximal level than usual.
• The musculocutaneous and median nerves
commonly communicate as shown in this
illustration.

16. Cont…
• In this case, the ulnar
and radial arteries begin
in the superior or
middle part of the arm,
and the median nerve
passes between them .
Brachial
artery
Ulnar
Artery
Median
Nerve
Radial
Artery
Medial
epicondy
le

17. Variations in the Origin of the Radial
Artery
• The origin of the radial
artery may be more
proximal than usual; it
may be a branch of the
axillary artery or the
brachial artery.
Sometimes the radial
artery is superficial to
the deep fascia instead
of deep to it.

18. Superficial Ulnar Artery
• In approximately 3% of people, the ulnar
artery descends superficial to the flexor
muscles.
• This variation must be kept in mind when
performing venesections for withdrawing
blood.

19. Cont..
• or making intravenous injections.
• If an aberrant ulnar artery is mistaken for a
vein, it may be damaged and produce
bleeding.
• If certain drugs are injected into the aberrant
artery, the result could be fatal

20. Cont..
• Pulsations of a
superficial ulnar artery
can be felt and may be
visible
Superficial
ulnar artery

21. Measuring Pulse Rate
• The common place for measuring the pulse
rate is where the radial artery lies on the
anterior surface of the distal end of the radius,
lateral to the tendon of the FCR.
• Here the artery is covered by only fascia and
skin.
• The artery can be compressed against the
distal end of the radius, where it lies between
the tendons of the FCR and APL.

22. Count…
When measuring the radial pulse rate, the
pulp of the thumb should not be used
because it has its own pulse, which could
obscure the patient’s pulse.
If a pulse cannot be felt, try the other wrist
because an aberrant radial artery on one side
may make the pulse difficult to palpate.
A radial pulse may also be felt by pressing
lightly in the anatomical snuff box.

23. wrist radial artery pulsation

24. Median Nerve Injury
• When the median nerve is severed in the elbow
region, flexion of the proximal interphalangeal
joints of the 1st–3rd digits is lost and flexion of
the 4th and 5th digits is weakened.
• Flexion of the distal interphalangeal joints of the
2nd and 3rd digits is also lost.
• Flexion of the distal interphalangeal joints of the
4th and 5th digits is not affected because the
medial part of the FDP, which produces these
movements, is supplied by the ulnar nerve.

25. • The ability to flex the metacarpophalangeal
joints of the 2nd and 3rd digits is affected
because the digital branches of the median
nerve supply the 1st and 2nd lumbricals.
• Thenar muscle function (function of the
muscles at the base of the thumb) is also lost,
as in carpal tunnel syndrome “Carpal Tunnel
• Syndrome”

26. • Thus, when the person
attempts to make a fist,
the 2nd and 3rd fingers
remain partially
extended (“hand of
benediction”)
• Inability to flex distal
interphalangeal joint of
index finger.

27. Injury of ulnar nerve at elbow and in
forearm
• More than 27% of nerve lesions of the upper limb
affect the ulnar nerve (Rowland, 2005).
• Ulnar nerve injuries usually occur in four places:
• (1) posterior to the medial epicondyle of the humerus,
• (2) in the cubital tunnel formed by the tendinous arch
connecting the humeral and ulnar heads of the FCU,
• (3) at the wrist, and
• (4) in the hand.
• Ulnar nerve injury occurs most commonly where the
nerve passes posterior to the medial epicondyle of the
humerus

28. • Any lesion superior to the medial epicondyle will
produce paresthesia of the median part of the
dorsum of the hand.
• Ulnar nerve injury usually
• produces numbness and tingling (paresthesia) of
the medial part of the palm and the medial one
and a half fingers.
• Ulnar nerve injury can result in extensive motor
and sensory loss to the hand.
• An injury to the nerve in the distal part of the
forearm denervates most intrinsic hand muscles

29. • Ulnar nerve injury
usually
produces numbness and
tingling (paresthesia) of
the medial part of the
palm and the medial
one and a half fingers.
Palmar
digital
branches

30. Injury of Radial Nerve in Forearm
(Superficial or Deep Branches)
• The radial nerve is usually injured in the arm
by a
• fracture of the humeral shaft.
• This injury is proximal to the motor branches
to the long and short extensors of the wrist
from the (common) radial nerve, and so wrist-
drop is the primary clinical manifestation of an
injury at this level “Injury to the Radial Nerve
in Arm”

31. • Injury to the deep branch of the radial nerve
may occur when wounds of the posterior
forearm are deep (penetrating)

32. • Severance of the deep
branch results in an
inability to extend the
thumb and the
metacarpophalangeal
(MP) joints of the other
digits.

33. • Test:Thus the integrity
of the deep branch may
be tested by asking the
person to extend the
MP joints while the
examiner provides
resistance

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