Forearm muscles. Muscles of the forearm: anatomy Pronator teres

ENCYCLOPEDIA OF MEDICINE

ANATOMICAL ATLAS

Forearm movements

The possibility of rotational movements of the forearm - pronation and supination - significantly expands the range of movements and provides extreme

flexibility of the upper limb.

The terms "pronation" and "supination" have specific reference to forearm movements. To pronate the forearm means to turn the palm down (or back if the arm is extended along the body). To supinate the forearm means to turn it with the palm up (forward).

Pronation and supination are caused by muscle contractions that rotate the radius around the relatively stationary ulna, with the upper and lower ends of the bones acting as rotation points.

PRONATOR MUSCLES

■ Pronator teres. The muscle is located on the anterior surface of the bones of the forearm and performs the function of pronation and flexion at the elbow joint. Starts with two heads

from the coronoid process of the ulna and the medial epicondyle of the humerus (the bony protrusion on the inside of the elbow). It is directed downward and outward to the middle of the outer edge of the radius, where it has maximum impact on the bone.

■ Pronator quadratus. A small muscle that connects the lower portions of the radius and ulna bones. Along with

with participation in the pronation of the forearm, together with the interosseous membrane, it performs an auxiliary function of holding the bones in close relationship.

Supination (turn the palm up) Pronation (turn the palm down)

Lateral epicondyle

Start location

arch support.

Radius

Connected to the ulna through the pronator quadratus muscle and the interosseous membrane (not shown).

Medial Lateral epicondyle epicondyle

A bony protrusion on the outside of the elbow joint.

Arch support-

Lies behind the bones of the forearm just below the elbow joint.

Pronator teres

Participates in pronation of the forearm and flexion of the arm at the elbow joint.

Elbow bone

The main stabilizing bone of the forearm.

Pronator quadratus

Connects the lower parts of the radius and ulna bones, keeping them in close relationship, and is also involved in pronation of the forearm.

Medial epicondyle

attachments

round

pronator

Radius

Rotates around the relatively stationary ulna.

Muscles involved in forearm rotation

Supination of the forearm

Forearm pronation

Brachial bone

Radius

Elbow bone

Radius

The muscles responsible for pronation and supination of the forearm lie in the deep muscle layers under the muscles responsible for the movements of the hand and fingers. The muscles that provide supination of the forearm include:

■ Arch support. The muscle lies deep on the back of the forearm directly below the elbow. It originates from the outer edge of the elbow joint and the elevation of the body of the ulna - the crest of the supinator. Then goes

< Если предплечье пронирова-но, то есть ладонь обращена вниз, супинация достигается сокращением глубоких мышц, которые поворачивают лучевую кость вокруг локтевой.

downwards, spreading over the outer edge of the radius, and is attached to the upper third of its body.

■ Biceps brachii muscle. The main function of this powerful muscle is to flex the arm.

at the elbow. However, it is also involved in supination of the forearm when greater force is required, for example, when tightening a screw.

■ Brachioradialis muscle.

Starting from the humerus above the elbow joint, it passes down to the outer surface of the lower end of the radius. When it contracts, the forearm is pulled into an intermediate position between pronation and supination.

Diagnosis of pain in the muscles of the forearm

Due to the nonspecificity of symptoms, the diagnosis of pain in the muscles of the forearm should first of all be differential. The easiest way to determine a traumatic injury to the arm is a dislocation, a fracture, since their signs are obvious, and an x-ray confirms the injury.

Unfortunately, a diagnostic standard - a system of “red pain flags” for the forearm has not been developed; the doctor has to rely on his own experience and use all possible methods to determine the root cause of the symptom.

First of all, cardiovascular diseases are excluded - angina pectoris, heart attack, especially if the patient complains of pain in the left arm. It is also necessary to exclude or confirm radicular syndrome, in which pain in the forearm may be secondary, referred.

The main research methods that involve the diagnosis of pain in the forearm are as follows:

• Questioning the patient, including clarification of provoking occupational factors to determine possible muscle strain syndrome. The characteristics of pain are also determined - intensity, sensations, localization, duration and dependence on changes in body posture and hand movements that the patient notices.
• Visual examination of the patient's upper body, not only the sore forearm, but also the second arm is examined.
• Assessment and examination of neurological status, palpation of the sore arm, segmented areas of the spine.
• Study of rotational movements - in the elbow and wrist joint.
• X-ray of the spinal column. The cervical region is examined with functional tests.
• To clarify the diagnosis, it is possible to prescribe a computed tomography or MRI to specify the nature of compression injuries (protrusion, hernia).
• Electromyography, which assesses the bioelectric potential of muscle tissue and the level of its conductivity (the speed of pain signal).

Diagnosis of pain in the forearm muscles directly depends on the clinical signs and their specificity, so the doctor often conducts various motor tests, which are especially effective for identifying carpal tunnel syndrome, epicondylitis, tendovaginitis, and rheumatic joint lesions.

Little knowledge of muscle syndromes, too variable terminology describing a pain symptom in the muscles, and the lack of verification standards in the clinical diagnosis of muscle diseases make it extremely difficult for a doctor to act. That is why diagnostic measures for myalgia affecting the forearm are carried out according to schemes similar to the diagnosis of periarticular pathologies in the shoulder area. Fortunately, medicine of the 21st century has an excellent arsenal of various modern diagnostic technologies that make it possible to provide a three-dimensional image of any structure of the human body and determine almost all its characteristics. If all the signs are clarified, identifying the root cause of pain helps determine the tactics of effective therapy, according to the well-known medical proverb

“Qui bene diagnoscit – bene curat” - whoever diagnoses correctly treats correctly.

ilive.com.ua
Definition. Pronator teres tunnel syndrome (PT) is a complex of sensory, motor, and autonomic symptoms that occurs when there is a disruption in the supply of the trunk of the median nerve (MN) in the upper third of the forearm in the fibromuscular canal formed by the ulnar and humeral heads of the CP due to compression and (or) overstretching , as well as SN slip disorders. Dynamic carpal tunnel syndrome is a subtype of carpal tunnel syndrome in which symptoms are usually triggered by exercise or specific limb positioning (symptoms of carpal tunnel syndrome subside when the precipitating factor ceases and return with repeated movements; neurological examination and nerve conduction studies performed at rest are usually not detect changes).

Etiology. KP syndrome often develops after repeated forced pronation-supination of the forearm and hand, and simultaneous clenching of the fingers into a fist, for example, when using a screwdriver, when squeezing out laundry, etc., during the professional activities of a massage therapist, chiropractor, dentist, guitarist, etc. As a result, swelling begins in the tissues of the PC, fibrous adhesions are formed, and the SN can adhere to the surrounding tissues; in this case, the SN is fixed between the bellies of the PC. Constant jerking distal to the site of fixation of the SN during everyday movements of the hand and arm in general can lead to irritation of the SN.

Pronator teres muscle of the forearm(Musculus pronator teres) - the most proximal muscle innervated by the SN (action of the PC: the main pronator of the forearm). The branches to this muscle arise from the SN in the lower part of the shoulder before passing the SN between the two heads of the CP. There are two heads in it (i.e. in the CP muscle): the large humeral head (lat. caput humerale), which starts from the medial epicondyle of the humerus, the medial intermuscular septum of the shoulder and the fascia of the forearm, and the smaller ulnar head (lat. caput ulnare ), lying underneath and originating from the medial edge of the tuberosity of the ulna. Both heads form a somewhat flattened abdomen from front to back, which passes into a narrow tendon. The muscle runs obliquely from the inside to the outside and is attached to the middle third of the lateral surface of the body of the radius. CH passes between two gearbox heads; in this case, the ulnar head is behind the nerve, and the humeral head is above it. In some individuals, the HF passes through the humeral head.

read also the article: Four tunnels for the median nerve
Clinic. KP syndrome is characterized by forearm pain and hypoesthesia rather than paresthesia. The pain syndrome is caused by both compression of the SN and musculofascial pain syndrome caused by the presence of musculofascial trigger points. In the CP, trigger points are most often localized at the insertion of the humeral head, slightly superior and lateral to the medial epicondyle of the humerus. When palpating this area, pain is reflected in the area of ​​the elbow joint, distally in the radial side of the forearm and hand, and in some patients - proximally in the biceps area. Neuropathic pain from the trunk of the heart failure is usually dull, aching, cerebral in nature, felt in the depths of the forearm, the thenar region, as well as in the area of ​​the wrist joint. Palpation tenderness in the thenar area increases with active pronation of the forearm with resistance and with passive maximum supination of the forearm.

Sensory disorders in patients with PC syndrome extend to the entire zone of innervation of the SN, including the thenar region, in contrast to compression in the carpal tunnel area, when sensory disorders are determined only in the distal phalanges of the thumb, index, middle and half of the ring fingers, but not in the thenar area. This is due to the fact that the SN, before entering the hand area, gives off a sensitive branch - the palmar cutaneous branch, which goes superficially in the carpal tunnel area (or rather, outside the canal) and branches over the proximal part of the radial half of the palm, especially in the thenar area (however, it should Remember that symptoms of carpal tunnel syndrome may begin in the terminal nerve fibers of the fingers, which may lead to a misdiagnosis of carpal tunnel syndrome).

If the SN is damaged (compression or overextension) at the level of the CP, manual muscle testing determines the functional weakness of all muscles innervated by the SN, with the exception of the CP itself. All muscles innervated by the SN can be divided into three groups: muscles innervated by the general SN before the anterior interosseous nerve leaves it (pronator teres of the forearm, flexor carpi radialis, palmaris longus, flexor digitorum superficialis); muscles innervated by the anterior interosseous nerve (flexor digitorum profundus for the second and third fingers, flexor pollicis longus, pronator quadratus); the muscles of the eminence of the thumb (thenar muscles), are innervated by the median nerve after passing through the carpal tunnel (abductor pollicis brevis, flexor pollicis brevis, oppons pollicis muscle) ...

… more details in the article “Dynamic pronator teres tunnel syndrome: manual diagnosis and treatment” by A.V. Stefanidi, Irkutsk State Medical Academy of Postgraduate Education - branch of the Federal State Budgetary Educational Institution of Further Professional Education "Russian Medical Academy of Continuing Professional Education" (magazine "Manual Therapy" No. 1 (65), 2017)
read also the article: Dynamic carpal tunnel syndrome and computer mouse stress test(at laesus-de-liro.livejournal.com)

laesus-de-liro.livejournal.com

The nerve contains motor, sensory and autonomic fibers.

Contents [Show]

Clinic for neuritis

Motor disorders are manifested by the inability to pronate and flex the first three fingers of the hand. As the muscles of the eminence of the thumb atrophy, the hand begins to resemble a monkey's hand. Since the patient cannot bend the first three fingers, this resembles the position of the hand of a gynecologist during a vaginal examination. Therefore, such a hand is sometimes called the “obstetrician’s hand.”

A number of tests are used to identify movement disorders. During the Deco test, the patient is asked to stretch a piece of paper between the bent fingers I and II of the affected hand. With pathology of the median nerve, the patient cannot bend the finger, but brings it to the index finger. When clenching your hands into a fist, the thumb and index fingers do not bend. The patient cannot scratch the table with the nail of his index finger.

Movement disorders: there is a decrease or loss of sensitivity on the palmar surface of the 1st, 2nd, 3rd finger and the radial side of the 4th finger.

Autonomic disorders: the color of the skin of the entire hand, especially the first three fingers, changes. The skin becomes marbled and covered with red and white spots. Often the skin becomes thinner and acquires a glossy shine. Nails lose their shine, become matte, and crumble. Skin temperature may be increased or decreased.

Our neurologists also successfully practice treatment of: - radial neuritis

Neuritis of the femoral nerve
- brachial plexus neuritis (brachial plexitis)
- neuritis of the sciatic nerve
- ulnar nerve neuritis

Causes of median nerve neuritis. Damage levels

The nerve may be compressed in the shoulder by a spur that is located a few cm above the medial epicondyle. X-ray allows you to see the bony process on the humerus. In the forearm, the nerve may be compressed as it passes through the pronator teres. The most common cause is traumatic injury, which causes pronation of the forearm and strained flexion of the fingers. This often happens when using a screwdriver for a long time or squeezing out laundry. It can also occur with prolonged compression of the upper third of the forearm, such as when feeding a child or sleeping with a partner. It can also occur in musicians who press the instrument tightly against the forearm. With pronator teres syndrome, pain occurs in the upper half of the palmar surface of the forearm, the pain can radiate further down. Doing work increases the pain, but it goes away with rest. With palpation and percussion in the area of ​​the pronator teres, the pain intensifies.

One of the most common syndromes in neurological practice is carpal tunnel syndrome. Excessive physical activity leads to its development. It also develops in endocrinological diseases such as myxedema, diabetes mellitus, and acromegaly. Often the disease occurs due to hormonal disorders associated with menopause, pregnancy, and breastfeeding. The disease may occur with rheumatoid arthritis. The disease occurs more often in women, as they often have congenital narrowness of the carpal tunnel. Carpal tunnel syndrome is characterized by a feeling of painful numbness in the first three fingers at night and in the morning. In 40% of cases, symptoms are bilateral. Less commonly, the disease involves the entire hand and can spread to the forearm. As the disease progresses, the numbness becomes permanent. Staying with your arms raised for a long time increases the numbness. With palpation and percussion in the carpal tunnel, the pain begins to radiate to the hand. In later stages of the disease, the muscles of the eminence of the thumb begin to atrophy, and difficulty occurs when squeezing between the thumb and index finger. The patient finds it difficult to fasten buttons, watches, and tie a tie.

Diagnosis of median nerve neuritis

To identify the disease it is necessary consultation with a neurologist, who will collect anamnesis, conduct an examination, perform specific tests and, if necessary, prescribe additional studies.

www.nevrolog-spb.ru

The forearm is the part of the upper limb from the elbow to the wrist. It is based on the radius and ulna bones. The muscles responsible for the movements of the hand and fingers are attached to the bones of the forearm at the back and front.

Pain receptors are located in most tissues of the forearm: in the periosteum and muscles, ligaments and tendons, blood vessels, as well as the surrounding tissues. Hence, forearm pain may be caused by damage to any of the listed structures.

In what situations does pain in the forearm occur? 1. Damage to the muscles of the forearm:

• inflammatory processes;
• physical stress;
• muscle spasms and cramps;
• sprains;
• muscle tears;
• compartment syndrome;
• spontaneous muscle hematoma.

2. Lesions of the ligaments and tendons of the forearm:

• tendon inflammation;
• diffuse fasciitis.

3. Lesions of the bones and joints of the forearm:

• dislocations;
• fractures;
• osteomyelitis;
• arthritis;
• osteoarthritis.

4. Lesions of blood vessels and nerves of the forearm:

• insufficiency of arterial vessels;
• venous thrombosis;
• postthrombophlebitic syndrome;
• “trap” syndromes of the forearm;
• damage to nerve fibers;
• osteochondrosis and spinal hernia;
• plexit.

5. Other conditions that lead to forearm pain:

• disturbances of water-salt balance;
• inflammation of subcutaneous fatty tissue;
• pathologies of the cardiovascular system;
• gout.

Pain in the forearm with muscle lesions Myositis

The main clinical symptom of myositis is local

muscle pain

Its intensity increases when the muscle is compressed, or when it works associated with loads during movements. This leads to protective tension in the affected muscle, which increases pain and can cause limited mobility in the elbow joint. In addition, redness of the skin is noted over the inflamed area. Pain during myositis can appear not only during movements, but also spontaneously - at night, at rest, or due to weather changes.

As the disease develops, muscle weakness gradually increases, which ultimately causes the development of partial or complete atrophy of the muscles of the upper limb.

More about myositis

Physical overexertion One of the most common reasons why the arm hurts in the forearm is prolonged or repeated stress on the muscle system.

Pain with such lesions is first observed just below the elbow, on the outside of the forearm. They intensify with movement, rotation of the forearm, or lifting heavy objects. If the load does not stop, the pain begins to spread to the inside of the forearm, as well as down to the hand. Its intensity increases as muscle damage progresses.

Chronic overstrain of the forearm muscles, for example, associated with professional activities, often causes the development of degenerative processes. This is manifested by aching pain, which intensifies when the fingers are clenched into a fist and movements in the wrist joint.

Pain in the shoulder and forearm due to muscle spasms (cramps)

A cramp, or spasm, is an involuntary contraction of one muscle, or an entire group of them. Most often, this pathology occurs in the lower extremities, but sometimes the muscles of the shoulder or forearm can be affected. The cause of this condition lies in various disorders

metabolism

Poor circulation in the arm or severe muscle fatigue. Main

symptom convulsions are caused by acute, almost unbearable pain and cramping muscle tension. Such spasms almost always occur suddenly.

Read more about muscle spasms

Forearm Strains Forearm strains can occur with fast, forceful movements of the arms and hands, such as during active sports such as tennis. The first pain sensations may appear immediately after unusually high or very sudden muscle loads, for 12-24 hours. The forearm muscles look swollen, tense and heavy. Patients complain of pain, sometimes quite pronounced when palpated. In some cases, swelling is associated with the stretching, which is accompanied by an increase in the size of the forearm. Pain and tenderness persist for several days, and sometimes even weeks, intensifying with movement, especially in the wrist joint.
Forearm muscle tears

Flexion and extension of the wrist joint are associated, respectively, with contraction and stretching of the muscles of the forearm. If such movements in the joint are performed too sharply, suddenly and with excessive force, the result can be a tear in the muscles of the forearm. Typically, such damage involves a small area of ​​the muscle in the area where it connects to the tendon. But in some, especially severe cases, a fairly large gap may be observed, and sometimes even a complete separation of the muscle from the tendon.

A muscle tear is always accompanied by severe sudden pain in the forearm. There is a sensation reminiscent of a direct blow to the arm. The pain may subside for a while, but then it returns, becomes constant, and begins to increase as muscle spasms develop and the hematoma increases.

When you feel the injured forearm, local pain is observed. By touch you can sometimes detect swelling caused by hemorrhage. With a total rupture (complete separation of the muscle from the tendon), it is sometimes possible to feel the gap that appears between the tendon and the muscle. Such injuries are always accompanied by massive swelling in the area of ​​the damaged muscle and a pronounced limitation in range of motion.

Muscle compression syndrome (crash syndrome)

Long-term soft tissue compression syndrome is a very serious pathology that develops as a result of strong and/or prolonged pressure on the forearm. A short pain-free period is followed by massive internal hemorrhage into the damaged and crushed muscles. The resulting hematoma compresses blood vessels and nerve fibers, thereby exacerbating the degree of impairment. The forearm becomes hot to the touch, swollen, and severe pain appears in it.

The most serious complication that is possible with this syndrome is irreversible damage to muscle tissue and nerve fibers. In these cases, there is destruction of muscle tissue and functional failure of the muscles (sagging hand). A person loses the ability to bend and straighten the hand and fingers, which makes normal use of the limb impossible.

Nagging pain in the forearm with spontaneous muscle hematomas

Sometimes in those receiving therapy

anticoagulants

Sudden hemorrhages in the muscles of the forearm may occur. They are accompanied by nagging and aching pain, as well as an increase in the size of the forearm. Such

hematomas

occur without previous injuries, or as a result of the most minor injuries.

Pain in the forearm due to damage to the ligaments and tendonsInflammation of the tendons

Tendinitis, or tendinosis, is a whole group of inflammatory lesions of the tendons. If the pathology affects not only the ligament itself, but also the surrounding membrane, then they speak of the development of tenosynovitis. Both of these disorders are accompanied by pain and dysfunction of the upper limb.

Tenosynovitis and tendinitis often occur simultaneously because they have similar causes. It is quite difficult to distinguish between them, but in most cases there is no such need, since the treatment methods are also virtually identical. When a tendon becomes inflamed, its strength decreases, creating an increased risk of rupture.

Symptoms of tendon inflammation:

• pain during active movements involving the affected tendon;
• almost painless similar passive movements;
• pain when feeling the inflamed tendon;
• local increase in temperature and redness of the skin over the area of ​​the affected tendon;
• characteristic crepitation (crunching) when the tendon moves.

Aseptic tendovaginitis, that is, not associated with the penetration of infections, occur during hard, monotonous work. In this case, the extensors of the fingers are more often affected, which is manifested by pain in the forearm when moving the fingers. Crepitant tendovaginitis occurs in polishers, sanders, ironers, carpenters, etc. Burning pain in the forearm is aggravated during work, swelling and soreness are noted both in the muscle itself and at the site of its attachment to the bone.

Purulent tendovaginitis are often a complication of phlegmon of the hand or panaritium. They are accompanied by purulent melting of tissue with breakthroughs of pus into the area between the bones of the forearm (Pirogov's space). In this case, high body temperature, swelling and redness of the skin, as well as sharp pain in the forearm when palpated are observed. Movement in the fingers of the hand is limited or completely absent.

Diffuse fasciitis

Diffuse fasciitis is an inflammatory process that affects the connective tissue membrane of the forearm muscles. It causes limited mobility, the appearance of nagging pain and a decrease in the strength of contractions in the hand and fingers of the affected limb.

Also, this pathology is characterized by modification of the skin of the affected forearm. There is a roughening of the skin and loss of its elasticity. It takes on an “orange peel” appearance. By palpating such modified skin, one can often determine the presence of small areas of compaction.

Pain in the forearm with lesions of the bones and joints of the upper extremitiesArticular dislocations

The appearance of dislocations is associated with sprains or

ligament tears

and joint capsule. In such cases, one of the bones that forms the joint becomes displaced. The articular surfaces are partially (

subluxation

) or completely (complete dislocation) cease to touch each other. In any case, there are opportunities for disruption of the integrity of nerves and blood vessels. Such injuries often occur in the elbow or wrist joint, and are necessarily accompanied by the development of pain.

A dislocation is characterized by a change in the appearance of the joint: the displaced head of the bone forms a subcutaneous tubercle next to the joint, and a depression is observed in its normal location. Joint mobility is also sharply limited: severe pain prevents even minor movements. As a result of damage to blood vessels and hemorrhages in the joint capsules, swelling develops.

More about joint dislocations

Bone fractures Stress fracture A stress fracture is a consequence of constant overload. This pathology occurs in cases where the hand and forearm are exposed to constant stressful physical influences, and gradually lose the ability to compensate for them. Most often, such injuries occur in athletes due to violations of the training regimen.

Traumatic fracturesSigns of a forearm fracture are divided into two groups:1. Likely:

• pain that increases with any movement;
• the presence of swelling and edema in the injured area;
• limited mobility of the upper limb;
• presence of subcutaneous hemorrhages.

Reliable:

• unnatural hand position;
• its pathological mobility in those areas where there are no joints;
• determination of the crunch of rubbing bone fragments;
• the presence of visible fragments in open fractures (in such cases, the patient’s condition is complicated by bleeding and traumatic shock).

Fractures of the olecranon They occur more often as a result of falls on the elbow, blows to the elbow area, or a sharp contraction of the muscle that extends the forearm (triceps). The area of ​​the elbow joint is swollen, deformed, and acquires a bluish tint. The patient's straightened arm hangs down, and when trying to make movements, sharp pain occurs in it. If the fracture is associated with displacement of fragments, then the patient is not able to straighten the forearm independently.

Fracture of the coronoid process This injury often occurs when falling on a bent elbow. A hematoma and swelling in the area of ​​the ulnar fossa are visually determined. The flexion of the forearm is limited, and sharp pain is detected in the area of ​​the ulnar fossa upon palpation.

Fracture of the head and neck of the radius The cause of this defeat is a fall on a straight arm. Swelling and tenderness appear just below the elbow joint. The function of forearm flexion is limited, and sharp pain occurs when it rotates outward.

Fracture of the ulna body The most common mechanism for this injury to occur is a direct blow to the forearm. The patient complains of swelling of the forearm, its deformation, and sharp pain when touched, loaded, or compressed from the sides of the forearm.

Fracture of the body of the radius It also occurs with direct blows to the forearm. Symptoms of this injury are deformation and swelling of the forearm, and the mobility of bone fragments is often determined. Sharp pain occurs when you feel the injury site, or when you put stress on your arm. Active rotation of the forearm is almost impossible.

Fracture of both forearm bones

This is one of the most common injuries. It occurs due to direct (a blow to the forearm) or indirect injuries (a fall on the hand). Almost always with such fractures displacement of fragments is observed. Due to the contraction of the connective tissue membrane located between the bones, the fragments of the ulna and radius bones move closer to each other. This causes shortening and deformation of the forearm. The patient usually holds the injured limb with his healthy hand. The mobility of fragments and sharp pain when palpating the area of ​​damage or under load are also determined. Pain also occurs with lateral compression of the forearm, even far from the fracture site itself.

Monteggia fracture This is a combined injury combining a fracture of the ulna and dislocation of the head of the radius. Often, with such an injury, the branches of the ulnar nerve are also damaged. A similar fracture occurs when falling on the arm, or when hitting the raised and bent forearm. A Montage fracture is characterized by shortening of the damaged forearm, as well as the presence of protrusion on the side of the radius and retraction on the side of the ulna. When attempting to passively flex the arm, spring resistance is determined.

Galeazzi's fracture Another combined injury, including a fracture of the radius in the lower third combined with dislocation of the head of the ulna. Most often it is a consequence of a blow to the forearm or a fall on a straight arm. With such a fracture, the head of the ulna moves towards the palm, and fragments of the radius move forward. A protrusion on the forearm from the side of the palm, and a notch from the side of the back, are visually determined. When palpated, the head of the ulna is located in the area of ​​the wrist joint on the ulnar side. With some pressure, it can be straightened, but when the pressure stops, it dislocates again.

Fractures of the radius in a “typical location” This damage is so widespread that even the area where it occurs has received a self-explanatory name—a “typical place.” Most often it affects older women. The causes of such an injury in most cases are a fall on a straightened arm while resting on the palm or, less commonly, on the back of the hand. The bone fracture is localized at a point located 2-3 cm above the wrist joint.

There are extension and flexion fractures of the radius in a typical location, with the former being more common. Symptoms of this injury are cyanosis, swelling and deformation of the forearm above the wrist joint. When palpating or putting pressure on the arm, sharp pain occurs. If the fracture is accompanied by damage to the branches of the radial and median nerve, then sensory disturbances and limited movement in the fourth finger may be observed.

More about fractures

Pain in the left and right forearm with osteomyelitis Osteomyelitis is a purulent-necrotic process that develops in the bone, bone marrow and surrounding soft tissues. The reason for its occurrence is the entry into the body of microbes that produce pus. Often, osteomyelitis can become a complication of other bone pathologies, especially with open fractures.

Acute osteomyelitis occurs more often in childhood. It begins with a sharp increase in overall body temperature to 39-40oC. The patient's condition is rapidly deteriorating, which is explained by the development of massive intoxication of the body. The following symptoms are also characteristic of osteomyelitis:

• headache;
• chills;
• repeated vomiting;
• loss of consciousness and delirium;
• sometimes jaundice.

During the first few days, quite severe pain appears in the forearm. The affected limb assumes a forced position, as a result of which painful contractures develop. Active movements in the hand are completely absent, and passive movements are severely limited. In addition, soft tissue swelling rapidly increases. The skin over the lesion becomes red, hot and tense, and a pronounced venous pattern can often be seen on it. In the future, inflammation of adjacent joints may occur.

When the pathology transitions to chronic form the patient's general condition improves somewhat, the severity of the pain syndrome decreases, and the pain becomes aching. Signs of intoxication in the body also decrease, and body temperature returns to relative normal. In the area of ​​the lesion, fistulas are formed, producing a light purulent discharge. Several such fistulas can form a network of subcutaneous channels, which sometimes open at a fairly significant distance from the pathological focus. Subsequently, immobility of the joints, shortening of the affected limb and curvature of its bones develop.

More about osteomyelitis

Arthritis Arthritis is an acute or chronic inflammatory process in the joint and adjacent tissues. It is characterized by the appearance of pain and a feeling of stiffness in the joint. With arthritis of the shoulder and wrist joints, symmetrical pain syndrome also affects the forearms.

In addition to pain, arthritis is manifested by the following symptoms:

• change in joint shape;
• limitation of limb mobility;
• unnatural crunching in the joint during exercise;
• redness of the skin.

More about arthritis Osteoarthrosis Osteoarthrosis is a name for degenerative-dystrophic disorders in the joint that develop as a result of damage to the cartilage tissue on the articular surfaces. In the initial stage, pain occurs only periodically, after intense physical activity, and quickly disappears with rest. As the degree of impairment progresses, the intensity of pain increases, they cease to disappear after rest, and begin to appear at night.

Also clinical manifestations of osteoarthritis are:

• limitation of range of limb movements;
• morning stiffness;
• painful points and compactions along the edge of the joint space;
• crunching in the joint.

Read more about osteoarthritisPain in the forearm due to damage to nerves and blood vessels Insufficiency of arterial circulationPain in the forearm can occur when there is narrowing or blockage of the arteries that supply blood to the upper extremities. The main cause of such damage to the arterial vessels of the hands is deposits of calcium, cholesterol and other substances on their inner wall. This process is called atherosclerosis. The vessels of the lower extremities are more often susceptible to such diseases, but in some cases, atherosclerotic changes can also be observed in small vessels of the forearms.

The narrowing of the lumen in the vessel leads to a decrease in the amount of blood flowing to the muscles of the forearms and hands, which is manifested by a gradually increasing pain syndrome. It becomes most pronounced during physical activity. At the same time, the level of blood supply can be maintained at rest. With acute blockage of the arteries, the pain occurs suddenly and may intensify when palpating the forearm.

The following manifestations are characteristic of chronic arterial insufficiency:

• cold and pale extremities, especially the hand and fingers;
• the pulse is very difficult to feel;
• decreased muscle strength in the arms;
• numbness and loss of sensitivity in the upper extremities;
• the appearance of slowly healing ulcers on the skin.

Venous thrombosis This pathology is caused by blockage of the veins with the occurrence of an obstruction to normal blood flow, and inflammation of the vascular wall along with the surrounding tissues. The most common clinical signs of venous thrombosis are pain in the forearm, tenderness on palpation, and the appearance of swelling.

Pain during venous thrombosis does not have any characteristic features. They can be aching or convulsive, sharp or dull, strong or moderate. Often the pain intensifies when lifting weights and other active activities with the arm. And it decreases when you raise your hand up.

The most dangerous complication of venous thrombosis of the upper extremities is the detachment of a blood clot from the vessel wall and its entry with the bloodstream into the lungs, brain or heart.

Postthrombophlebitic syndrome

Postthrombophlebitic syndrome is a complex of symptoms that combines various disorders in the limbs that occur after venous thrombosis. For a long time, patients with postthrombophlebitis syndrome have noted pain and swelling in the forearm, appearing after prolonged arm strain or physical activity. Some patients complain of paroxysmal intensification of these symptoms, which is combined with pain in the forearm when palpated, and with hardening of the soft tissues. Just as with thrombosis, pain subsides when you raise your arm up.

"Trap" syndromes of the forearm

This name includes pain in the forearm that occurs as a result of compression of the ulnar, radial, median and cutaneous nerves of the upper extremities. With neurogenic pain, there is no increase in the size of the limb, but the pain itself appears suddenly and increases with movements that are associated with stretching of the affected nerve.

Forearm pain due to cubital tunnel syndrome Cubital tunnel syndrome is a pathology caused by compression of the ulnar nerve in the ulnar (cubital) tunnel. Narrowing of this canal occurs due to microtrauma of the articular bones, or due to the individual characteristics of the anatomical structure in this area.

The main symptoms of cubital tunnel syndrome are pain in the elbow accompanied by numbness and/or tingling in the skin. In the initial stage of the pathology, pain is noted only on the inner surface of the elbow joint. In addition, sensory disturbances and pain can spread down to the forearm, and even to the hand - to the little finger and fourth finger. In the early stages of the disease, pain is felt only when pressing on the elbow, or when it is bent for a long time. As the pathology progresses, pain and sensory disturbances in the elbow and forearm become permanent.

Another sign of cubital tunnel syndrome is weakness in the affected limb. Patients complain of a loss of “confidence” in their hand: objects suddenly begin to fall out of it spontaneously when performing habitual actions. With a long course of the disease, the forearm and hand on the affected arm lose weight, and clearly visible pits form between the bones, as a consequence of muscle atrophy.

Forearm pain due to carpal tunnel syndrome

Carpal tunnel syndrome manifests itself in pinching, pinching and swelling of the median nerve of the forearm as a result of its compression in the anatomically narrow spaces of the wrist between the bone and muscle tendons. This pathology is also called

tunnel (carpal) syndrome

This disorder is often observed against the background of serious hormonal and endocrine changes in the body:

• menopause;
• pregnancy;
• diabetes mellitus, etc.

The disease begins with numbness, tingling, burning and pain in the middle, index and thumb fingers, as well as in the palm. Often the pain spreads up the arm, to the forearm, sometimes even reaching the back of the head. The pain occurs mainly at night or in the morning. Gradually, the pain syndrome turns into a pronounced decrease in the sensitivity of the skin of the forearm, fingers and palm. Shaking and massaging the hand brings relief only at first. In the morning, patients complain of a feeling of swelling in the hand, as well as difficulty in fine movements of the fingers for several hours after waking up.

In addition, the occurrence of carpal tunnel syndrome may be due to working conditions. Previously, this pathology was widespread among typists, but in the modern world it often affects people who work at a computer for a long time. Constant static loads on the same muscle group, as well as awkward placement of the hands when working with the keyboard or mouse, cause pinched nerves.

Learn more about carpal tunnel syndrome

Damage to nerve fibers Ulnar nerve neuritis The cause of pain in the forearm can be inflammation of the ulnar nerve. The pain is aching, monotonous, and is often accompanied by numbness of the fingers and sensory disturbances.

This disease often occurs with injuries to the upper limb, compression of the ulnar nerve in anatomically narrow areas, its friction against bone formations (valgus elbow), after hypothermia, etc. In addition to pain, patients often complain of awkwardness when moving the hand. The weakness of the small wrist muscles, which are innervated by the ulnar nerve, gradually progresses.

Radial neuritis The radial nerve is also in most cases affected in the area of ​​the elbow joint. Its injury is associated with the occurrence of epicondylitis (“tennis elbow”), which usually develops as a result of overexertion of the muscles of the hand and forearm. The first symptom of inflammation of the radial nerve is acute pain on the outer surface of the elbow joint. In case of damage to the superficial branches of the radial nerve, pain occurs both in the elbow region and in the forearm. With repeated injuries and incessant physical stress on the arm, the pain becomes constant. At rest, it has less pronounced intensity and is aching in nature.

Polyneuropathy Polyneuropathy refers to multiple disorders in the peripheral nerves, which are manifested by flaccid paralysis of the muscles of the forearm, disturbances in its sensitivity and vascular disorders.

The development of this pathology is most often associated with serious systemic diseases such as diabetes mellitus. In addition, pain with forearm neuropathies is typical for patients who abuse smoking.

Osteochondrosis and spinal hernia

Quite often, pain in the forearm is referred, and its source is damaged segments of the cervical and thoracic spine. Such referred pain will not be accompanied by visual manifestations in the form of changes in the appearance of the forearm. In addition, in such cases, the mobility of the elbow and wrist joints is fully preserved.

The main differences between such pains are in their nature:1. Firstly, pain caused by spinal injuries bothers the patient not only when moving his arm, but also at rest, and sometimes can even wake him up at night.

2. Secondly, pain is not observed strictly in the forearm area, but spreads into it from the upper limbs, shoulder blades or neck, as if penetrating the entire arm.

The cause of such pain lies in the infringement of nerve fibers emerging from the spinal column due to intervertebral hernias or osteochondrosis. In order for pain to radiate down the arm to the forearm, the spinal lesion must

located in the fifth or sixth cervical, or first or second thoracic vertebrae.

In addition to pain, these diseases manifest themselves as follows:

• impaired elbow flexion;
• changes in skin sensitivity on the surface of the forearm;
• development of atrophy of the biceps brachii muscle.

PlexitisPlexitis is an inflammation of the brachial nerve plexus, the most common cause of which is trauma. Clinically, this disease is manifested by motor and sensory disorders of the upper limb, as well as tissue nutritional disorders. Lesions of the brachial plexus can be complete or partial, in which only individual branches of the nerves are damaged. In addition, plexite can be either unilateral or bilateral.

There are two stages in the development of plexitis - neuralgic and paralytic. The first is characterized by the occurrence of spontaneous pain, which intensifies with movements in the shoulder joint or compression of the plexus, and spreads lower - into the shoulder and forearm. In the paralytic stage, peripheral paresis and paralysis of those muscles that are innervated by the branches of the affected plexus begin to develop. In addition, the deep reflexes of the upper limb are reduced, and all types of sensitivity are disrupted. The nutrition of tissues in the affected area suffers. This is manifested by swelling of the hand, vascular disorders in it, etc.

Other conditions that cause pain in the forearmImpaired water-salt balance

Pain in the forearm can be caused by a decrease in the content of certain mineral salts in the blood. A similar condition occurs with long-term use of diuretics,

or abundant

Which cause

dehydration

body.

The main sign of water-salt imbalance is a constant feeling of thirst and multiple swelling. In addition, there is a decrease in blood pressure, heart rhythm disturbances and spontaneous palpitations.

Inflammation of subcutaneous fat tissue

Cellulite- This is an acute diffuse purulent inflammation of the subcutaneous fatty tissue. The occurrence of this pathology is associated with the penetration of pathogenic microorganisms into fatty tissue through damaged skin. In addition to forearm pain,

cellulite

also manifests itself sharply

increase in temperature

body, the appearance of severe general weakness and other symptoms of intoxication of the body.

Panniculitis– repeated inflammation of the subcutaneous adipose tissue, which has a nodular nature. With this disease, painful round nodes form in the fatty tissue, which then quickly increase in size to 3-4 cm. The skin of the forearm above them is red and swollen. Such rashes are usually multiple in nature, and when closely located, they can merge.

The nodes exist for from 1-2 weeks to several months, and sometimes even years. After disappearance, small depressions remain in their place, as well as atrophied and darkened skin. In addition, the disintegration or opening of such nodes is possible. In this case, a small amount of oily fluid is released, and then slowly healing ulcerations form.

In addition to the above symptoms, panniculitis is accompanied by:

• weakness;
• fever;
• malaise;
• nausea and vomiting;
• loss of appetite.

Myocardial infarctionPain in the forearm can be caused by pathologies of the cardiovascular system, in particular such an acute disease as myocardial infarction. A sign of this pathology is severe pain, which is localized mainly behind the sternum. But quite often it spreads to the neck, stomach, left shoulder blade or arm, up to the forearm, and sometimes lower - into the fingers.

In addition to acute pain, myocardial infarction also manifests itself:

• sudden appearance of pallor;
• sensations of heaviness and compression in the chest;
• development of shortness of breath;
• dizziness;
• loss of consciousness.

Myocardial infarction differs from an attack of angina in that the pain does not disappear after taking nitroglycerin.

If you experience aching pain in your left forearm, you should definitely consult a cardiologist to rule out possible cardiac pathology.

More about myocardial infarction

Gout Gout is a disease associated with impaired purine metabolism. It is characterized by an increase in the content of uric acid in the blood plasma and the deposition of its salts, the so-called urates, on the surface of the joints. With lesions of the elbow and wrist joints, patients complain of burning, excruciating pain that spreads to the forearm.

A typical gout attack begins with pain in the joints of the big toe. As the disease progresses, more and more joints are involved in the pathological process, which leads to the development of polyarthritis. Gout attacks begin mainly at night, and occur with rapid redness and an increase in the temperature of the skin around the affected joint. In addition, its pain and swelling sharply increases. Inflammation gradually affects soft tissues, which is manifested by the clinical picture of cellulite or phlebitis. In especially severe cases, an attack of gout is accompanied by an increase in overall body temperature. The duration of a gout attack ranges from several days to several weeks. After its completion and the disappearance of symptoms, the affected joints return to their normal shape.

A characteristic symptom of gout is the appearance of tophi, foci of pathological compaction of the subcutaneous tissue. Most often, these nodules are localized in the following places:

• surfaces of affected joints;
• ears;
• extensor surface of the forearms, legs or thighs;
• Achilles tendons.

Read more about gout Treatment of pain in the forearm If pain occurs in the forearm without obvious reasons, such as physical fatigue or increased stress, you should in any case consult a doctor. Only a qualified specialist can conduct an examination, accurately establish a diagnosis and prescribe adequate treatment. If you have pain in the forearm, you need to visit a traumatologist or neurologist.

ATTENTION! The information posted on our website is for reference or popular information and is provided to a wide range of readers for discussion. Prescription of medications should be carried out only by a qualified specialist, based on the medical history and diagnostic results.

They start from the shoulder girdle and shoulder and attach to the bones of the forearm.

1.Anterior muscle group (flexors):

Biceps brachii muscle (Produces flexion at the radial and elbow joints, supinates the forearm.)

Brachialis (flexes the forearm.)

Coracobrachialis muscle (attaches to the humerus) (Bends the shoulder and pulls it towards the medial plane.)

2. Posterior muscle group (extensors):

Triceps brachii (Extends the forearm at the elbow joint.)

Elbow muscle (Extends the forearm at the elbow joint.)

Forearm muscles:

The muscles of the forearm surround the radius and ulna on all sides, most of them being long muscles. The muscle bellies of such muscles are located proximally, the long tendons are located distally. Most of the flexors originate from the medial epicondyle of the humerus, and most of the extensors originate from the lateral epicondyle of the humerus. The muscles of the forearm are attached to the bones of the metacarpus and the phalanges of the fingers. They act on the wrist, proximal and distal radioulnar joints, and hand joints. Bend and straighten the wrist and fingers.

1. Anterior muscle group (flexors and pronators):

Surface layer:

Brachioradialis muscle (Flexes the forearm and sets the radius in a mid-position between pronation and supination.)

Pronator teres (Pronates the forearm and is involved in its flexion.)

Flexor carpi radialis (Produces palmar flexion of the hand.)

Flexor carpi ulnaris (Bends and adducts the hand.)

Palmaris longus muscle (Bends the hand, strains the palmar aponeurosis.)

Deep layer:

Superficial flexor of the fingers (Bends the middle phalanges of the II-V fingers and the hand.)

Flexor pollicis longus (Flexes the distal phalanx of the thumb.)

Flexor digitorum profundus (Bends the distal phalanges of the fingers.)

Pronator quadratus (Rotates the radius inward.)

2. Posterior muscle group (extensors and supinators):

Surface layer:

Extensor carpi radialis longus (Extends and abducts the hand.)

Extensor carpi radialis brevis (Extends the hand.)

Extensor digitorum (Extends fingers II-V.)

Extensor of the little finger (Extends the fifth finger.)

Extensor carpi ulnaris (Extends and adducts the hand.)

Deep layer:

Arch support (Rotates the radius outward.)

Abductor pollicis longus muscle (Adducts the thumb.)

Extensor pollicis brevis (Extends the thumb.)

Extensor pollicis longus (Extends the thumb.)

Extensor index finger (Extends the second finger.)

Muscles of the hand:

Muscles of the eminence of the thumb (Lateral group. Functions correspond to the name of the muscles.)

Abductor pollicis brevis muscle

Flexor pollicis brevis

Muscle that opposes the thumb to the hand

Adductor pollicis muscle

Muscles of the eminence of the little finger (Medial group. Functions correspond to the name of the muscles.)

Abductor digiti minimi muscle

Flexor digiti brevis

Opponus little finger muscle

Muscles of the palmar cavity (Middle group. Functions: lumbricals flex the proximal phalanges of the II-V fingers; palmar interosseous bring the fingers together; dorsal move the fingers apart.)

Vermiform muscles

Palmar and dorsal interosseous muscles

In the forearm area there are two muscle groups: anterior and posterior. The flexors and pronators are located in the anterior, and the extensors and supinators are located in the posterior. The muscles of the anterior and posterior groups form a superficial and deep layer

The muscles of the forearm are divided into posterior and anterior groups, each of which has a superficial and deep layer.

Front group

Surface layer

Pronator teres (m. pronator teres) pronates the forearm (rotates it forward and inward so that the palm turns posteriorly (downward) and the thumb inward toward the median plane of the body) and participates in its flexion. A thick and short muscle consisting of two heads. The large, humeral head (caput humerale) begins from the medial epicondyle of the humerus and the medial intermuscular septum of the brachial fascia, and the small, ulnar head (caput ulnare) begins from the coronoid process of the ulnar tuberosity. Both heads, connecting, form a flattened abdomen. The attachment point is the middle third of the radius.

Brachioradialis muscle (m. brachioradialis) flexes the forearm and takes part in both pronation and supination of the forearm (rotates it in such a way that the palm turns anteriorly (upward) and the thumb outward from the median plane of the body) of the radius. The muscle has a fusiform shape, starts from the humerus above the lateral epicondyle and from the lateral intermuscular septum of the brachial fascia, and is attached at the lower end of the body of the radius.

Radial flexor of the hand (m. flexor carpi radialis) bends and partially pronates the hand. A long, flat, bipennate muscle, the proximal part of which is covered by the aponeurosis of the biceps brachii muscle. Its point of origin is located on the medial epicondyle of the humerus and fascia of the forearm, and its attachment point is on the base of the palmar surface of the second metacarpal bone.

Long palmar muscle (m. palmaris longus) stretches the palmar aponeurosis and takes part in flexion of the hand.

A characteristic feature of the muscle structure is a short fusiform abdomen and a long tendon. It begins on the medial epicondyle of the humerus and fascia of the forearm, medially to the flexor carpi radialis, and is attached to the palmar aponeurosis (aponeurosis palmaris).

Flexor carpi ulnaris (m. flexor capiti ulnaris) bends the hand and takes part in its adduction. Characterized by a long abdomen, thick tendon and two heads. The humeral head has its origin at the medial epicondyle of the humerus and the fascia of the forearm, and the ulnar head has the olecranon and the upper two-thirds of the ulna. Both heads are attached to the pisiform bone, some of the bundles are attached to the hamate and V metacarpal bones.

Superficial flexor of the fingers (m. flexor digitorum superficialis) bends the middle phalanges of the II–V fingers. This broad muscle is covered by the flexor carpi radialis and palmaris longus muscles and consists of two heads. The humeroulnar head (caput humeroulnare) starts from the medial epicondyle of the humerus and ulna, the radial head (caput radiale) - from the proximal part of the radius. The heads form a single abdomen with four tendons, which pass onto the hand and are each attached by two legs to the base of the middle phalanges of the II–V fingers of the hand.

Deep layer

Flexor pollicis longus (m. flexor pollicis longus) flexes the distal phalanx of the first (thumb) finger. A long, flat, unipennate muscle, its origin is the upper two-thirds of the anterior surface of the radius, the interosseous membrane (membrana interossea) between the radius and ulna, and partly the medial epicondyle of the humerus. Attached at the base of the distal phalanx of the thumb.

Flexor digitorum profundus (m. flexor digitorum profundus) flexes the entire hand and the distal phalanges of the II–V fingers. It is characterized by a highly developed flat and wide abdomen, the origin of which is located on the upper two-thirds of the anterior surface of the ulna and the interosseous membrane. The attachment point is located at the base of the distal phalanges of the II–V fingers.

Square pronator (m. pronator quadratus) rotates the forearm inward (pronates). The muscle is a thin quadrangular plate located in the area of ​​the distal ends of the bones of the forearm. It begins on the medial edge of the body of the ulna and attaches to the lateral edge and anterior surface of the radius.

Back group

Surface layer

Extensor carpi radialis longus (m. extensor carpi radialis longus) flexes the forearm at the elbow joint, extends the hand and takes part in its abduction. The muscle has a spindle-shaped shape and is distinguished by a narrow tendon, significantly longer than the abdomen. The upper part of the muscle is covered by the brachioradialis muscle. Its point of origin is located on the lateral epicondyle of the humerus and the lateral intermuscular septum of the brachial fascia, and its attachment point is on the dorsal surface of the base of the second metacarpal bone.

Extensor carpi radialis brevis (m. extensor carpi radialis brevis) extends the hand, retracting it slightly. This muscle is slightly covered by the extensor carpi radialis longus, originates from the lateral epicondyle of the humerus and the fascia of the forearm, and is attached to the dorsum of the base of the third metacarpal bone.

Anterior muscle group, superficial layer

Anterior muscle group, deep layer

Posterior muscle group, superficial layer

Posterior muscle group, deep layer

(CH) in the upper third of the forearm in the fibromuscular canal formed by the ulnar and humeral heads of the joint due to compression and (or) overextension, as well as impaired sliding of the CH. Dynamic tunnel syndrome is a subtype of carpal tunnel syndrome in which symptoms are usually triggered by exercise or specific limb positioning ([ !!! ] the symptoms of CP tunnel syndrome subside when the provoking factor ceases and return when the movements are repeated; neurological examination and nerve conduction studies performed at rest are usually normal).

Etiology. KP syndrome often develops after repeated forced pronation-supination of the forearm and hand, and simultaneous clenching of the fingers into a fist, for example, when using a screwdriver, when squeezing out laundry, etc., during the professional activities of a massage therapist, chiropractor, dentist, guitarist, etc. As a result, swelling begins in the tissues of the PC, fibrous adhesions are formed, and the SN can adhere to the surrounding tissues; in this case, the SN is fixed between the bellies of the PC. Constant jerking distal to the site of fixation of the SN during everyday movements of the hand and arm in general can lead to irritation of the SN.

Pronator teres muscle of the forearm(Musculus pronator teres) - the most proximal muscle innervated by the SN (action of the PC: the main pronator of the forearm). The branches to this muscle arise from the SN in the lower part of the shoulder before passing the SN between the two heads of the CP. In it (i.e. in the CP muscle) two heads are distinguished: [ 1 ] large humeral head (lat. caput humerale), which starts from the medial epicondyle of the humerus, the medial intermuscular septum of the shoulder and the fascia of the forearm, and [ 2 ] smaller ulnar head (lat. caput ulnare), lying under it and originating from the medial edge of the tuberosity of the ulna. Both heads form a somewhat flattened abdomen from front to back, which passes into a narrow tendon. The muscle runs obliquely from the inside to the outside and is attached to the middle third of the lateral surface of the body of the radius. CH passes between two gearbox heads; in this case, the ulnar head is behind the nerve, and the humeral head is above it. In some individuals, the HF passes through the humeral head.

read also the article: Four tunnels for the median nerve(to the website)

Clinic. KP syndrome is characterized by forearm pain and hypoesthesia rather than paresthesia. The pain syndrome is caused by both compression of the SN and musculofascial pain syndrome caused by the presence of musculofascial trigger points. In the CP, trigger points are most often localized at the insertion of the humeral head, slightly superior and lateral to the medial epicondyle of the humerus. When palpating this area, pain is reflected in the area of ​​the elbow joint, distally in the radial side of the forearm and hand, and in some patients - proximally in the biceps area. Neuropathic pain from the trunk of the heart failure is usually dull, aching, cerebral in nature, felt in the depths of the forearm, the thenar region, as well as in the area of ​​the wrist joint. Palpation tenderness in the thenar area increases with active pronation of the forearm with resistance and with passive maximum supination of the forearm.

Sensory disorders in patients with PC syndrome extend to the entire zone of innervation of the SN, including the thenar region, in contrast to compression in the carpal tunnel area, when sensory disorders are determined only in the distal phalanges of the thumb, index, middle and half of the ring fingers, but not in the thenar area. This is due to the fact that the SN, before entering the hand area, gives off a sensitive branch - the palmar cutaneous branch, which goes superficially in the carpal tunnel area (or rather, outside the canal) and branches over the proximal part of the radial half of the palm, especially in the thenar area (however, it should Remember that symptoms of carpal tunnel syndrome may begin in the terminal nerve fibers of the fingers, which may lead to a misdiagnosis of carpal tunnel syndrome).

If the SN is damaged (compression or overextension) at the level of the CP, manual muscle testing determines the functional weakness of all muscles innervated by the SN, with the exception of the CP itself. All muscles innervated by the SN can be divided into three groups: [ 1 ] muscles innervated by the common SN before the anterior interosseous nerve leaves it (pronator teres, flexor carpi radialis, palmaris longus, flexor digitorum superficialis); [ 2 ] muscles innervated by the anterior interosseous nerve (flexor digitorum profundus for the second and third digits, flexor pollicis longus, pronator quadratus); [ 3 ] the muscles of the eminence of the pollicis (thenar muscles), innervated by the median nerve after passing through the carpal tunnel (abductor pollicis brevis, flexor pollicis brevis, oppons pollicis muscle) ...

… more details in the article “Dynamic pronator teres tunnel syndrome: manual diagnosis and treatment” by A.V. Stefanidi, Irkutsk State Medical Academy of Postgraduate Education - branch of the Federal State Budgetary Educational Institution of Further Professional Education "Russian Medical Academy of Continuing Professional Education" (magazine "Manual Therapy" No. 1 (65), 2017) [read]

read also the article: Dynamic carpal tunnel syndrome and computer mouse stress test(to the website)

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