Introduction This section will be divided into abnormalities that occur on the flexor side and those that occur on the extensor side of the fingers. Each section will deal separately with disorders of tendons and ligaments and retinacula. The flexor and extensor tendons of the hand are divided into zones to help describe and plan the treatment of injuries. The extensor zones are numbered 1 to…

Introduction Like the wrist, most patients with finger pathology are examined seated opposite the examiner. Interventional procedures can be carried out with the patient prone and their hand extended above their head if there is anxiety or fainting risk. Position 1: Base of Thumb Imaging Goals 1. Identify the scaphotrapeziotrapezoid joint (STTJ) and the first carpometacarpal joint (CMCJ). 2. Locate the ulnar collateral ligament (UCL) and…

Forearm Anatomy The anatomy of the forearm in one sense is as straightforward as the arm in that there are only two compartments, flexor and extensor, separated by an interosseous membrane. It is made a little trickier, however, as the flexor and extensor muscles begin medially and laterally respectively and then rotate as they are followed distally. In the midforearm, the flexor compartment occupies the anterior…

Introduction The differential diagnosis of pain in the posterior elbow includes olecranon bursitis, joint disease, triceps disease, as well as less common causes, including olecranon stress fractures and posterior impingement syndromes. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Introduction The principal structures of interest in the anterior elbow are the biceps and brachialis tendons. The biceps tendons form from its two muscle bellies and each inserts, close to one another, on the radial tuberosity. The two muscle heads can easily be distinguished from one another but the tendons are grouped close together, although the two components become more separate as the tendon approaches its…

Common Flexor Origin Enthesopathy Tendinopathy of the common flexor origin (CFO) is less common than its extensor counterpart. The presenting features are similar, although the sporting and occupational associations are different. There is a particular sporting association with golf and the term golfer's elbow has come into common use. Other names, such as medial tennis elbow and flexor–pronator sprain, are also applied. Key Point Flexor–pronator sprain…

Lateral Elbow Common Extensor Origin Epicondylalgia The commonest cause of pain in the lateral aspect of the elbow is tendinopathy or enthesopathy of the common extensor origin (CEO). The term ‘tennis elbow’ originates from early descriptions of this condition and it has largely stuck, passing into common usage. Despite the name, the condition occurs much more commonly in nontennis players and a wide variety of occupations…

Arm Anatomy The anatomy of the arm is generally best understood by considering two compartments: flexor and extensor. In each, there are proximal and distal configurations roughly delimited by the level of the deltoid insertion on the lateral aspect of the mid humerus. Position 1: Anterior Compartment Proximal The neurovascular bundle on the medial aspect of the arm provides a useful landmark to begin to view…

Bone Disease Around the Shoulder Bony Irregularity in the Humeral Head Many bony abnormalities will be encountered whilst performing rotator cuff ultrasound. Some of these are common traumatic lesions, including fractures of the greater tuberosity and Hill–Sachs lesions, others are less well understood. The location of the lesion on the humeral head can sometimes be a clue to the underlying cause. A bone defect in the…

Subacromial Subdeltoid Bursitis Anatomy and Clinical The subacromial subdeltoid (SASD) bursa is one of the largest bursae in the body and plays an important role in patients with subacromial impingement. It is likely that much of the discomfort felt during arm abduction in patients with this clinical problem is due to inflammation within the bursa. Arm abduction, particularly between 30 and 60°, typically reproduces pain that…

Introduction Shoulder pain is one of the commonest orthopaedic presentations in the general population and subacromial impingement is a common underlying cause. The glenohumeral joint is an intrinsically unstable joint and the tendons of the rotator cuff play an important role in stabilizing it ( Fig. 2.1 ). The supraspinatus tendon (SST), the most important component of the rotator cuff, lies along the superior aspect of…

Overview The important bony landmarks in the evaluation of the supraspinatus tendon are the humeral head, the coracoid, the clavicle and acromium, joined at the acromioclavicular joint. The glenohumeral joint is an inherently unstable joint and depends on the surrounding soft tissues for stabilization. Soft tissue stabilizers are divided into intrinsic and extrinsic. The most important extrinsic soft tissues are the supraspinatus tendon superiorly, infraspinatus posteriorly…