Clinical Chiropractic: The Elbow and Forearm

Clinical Chiropractic: The Elbow and Forearm

The Chiro.Org Blog

We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.

This is Chapter 8 from RC’s best-selling book:

“Clinical Chiropractic: Upper Body Complaints”

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 8:   The Elbow and Forearm

CLINICAL BRIEFING

Functional Considerations

The arm and forearm are joined by a joint that serves as both a hinge and a pivot. The semilunar notch of the ulna is hinged with the hyperboloid trochlea of the humerus. The proximal head of the radius pivots with the spherical capitulum of the humerus and glides against both the proximal and distal ends of the ulna.

The distal end of the humerus can be viewed as two columns: a larger one medially that articulates with the semilunar notch of the ulna, and a smaller one laterally that articulates with the head of the radius. The pulley-like trochlea apparatus has:

(1) a depression at the front that lodges the coronoid process of the ulna and

(2) a depression at the rear that holds the olecranon process of the ulna when the elbow is extended.

The olecranon process restricts hyperextension of the elbow and protects the ulnohumeral articulation posteriorly. The concave head of the radius glides against the spherical capitulum of the humerus. The capitulum and trochlea are separated by a bony crest that fits into the opening between the proximal ulna and the radius and serves as a fixed rudder to guide elbow motion. The elbow flexors originate from the medial epicondyle, and the extensors originate from the lateral epicondyle. This structural arrangement should be visualized during examination to discriminate normal from abnormal articular motion.

The basic range of elbow joint motion involves elbow flexion (135°) and extension (0°), and forearm supination (90°) and pronation (90°). If a motion block is found in active motion, passive motion should be checked and the type of restriction and its degree noted.

Clinical Analysis

The elbow joint was not made to be used as an organic battering ram, but it often is: purposefully in sports; by accident in falls. For this reason, the vast majority of elbow disorders has trauma as their origin or precipitating factor.

The common causes of arm, elbow, and forearm pain are shown in Table 8.1. Note that many neurologic etiologies manifest referred symptoms such as in a cervical IVD syndrome or subluxation complex, scalenus anticus syndrome, thalamic syndrome, or trigger-point phenomena.

Inflammatory disorders of the elbow and forearm are frequently seen. The cause will usually be attributed to trauma. Olecranon bursitis, tennis elbow, tenosynovitis, Kienboeck’s disease, and brachialis calcification may or may not be the result of extrinsic injury. Less frequently seen are nerve compression syndromes. These may occur at either the elbow (musculospiral, radial, ulnar) or the wrist (median, ulnar). Deformities of the elbow and forearm are rarely seen. When present, the cause is usually an effect of severe trauma -or rarely the result of acromegaly or rickets.

Motion restriction during pronation can suggest a lesion in the elbow, the radioulnar articulation at the wrist, or (rarely) the forearm proper. Restriction during supination may be related to either a disorder at the elbow or in the distal radioulnar articulation. Scars and thickened tissues may cause compression symptoms. Nerve injury is generally secondary to severe trauma or epicondyle fracture.