[Injuries of the distal forearm and hand].
Explore the source record for details and available documents.
Forearm Injuries↗
SEARCH · Search PubMed
Results for “Forearm Injuries”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Epidemiology of elbow, forearm, and wrist injuries in the athlete.
Upper extremity injuries in athletes cause pain, impairment of function, and time loss from sport participation. This article briefly discusses the epidemiology of elbow, forearm, and wrist injuries in various athletic endeavors. Included is an overview of the epidemiology of nerve dysfunction, tendon ruptures, fractures about the wrist and forearm, ligamentous injuries of the wrist, distal radioulnar joint injuries, and overuse injuries.
Athletic Injuries↗
Elbow, forearm and wrist injuries in the athlete.
Competitive and recreational athletes sustain a wide variety of soft tissue, bone, ligament, tendon and nerve damage to their upper extremities. Most such injuries are related to direct trauma or repetitive stress, and account for a significant amount of 'down time' for athletes participating in a wide range of sports, particularly those in which the arm is utilised for throwing, catching or swinging. Overuse injuries to the elbow include musculotendinous injuries, ulnar nerve injuries and ligamentous injuries. Osteochondrol lesions of the capitellum and posterior impingement injuries in the joint are frequently seen in athletes as well. Acute traumatic injuries to the elbow include tendon ruptures, elbow dislocations and intra-articular fractures. Forearm overuse injuries in athletes include fracture of the carpal scaphold, fracture of the hook of the hamate, Kienbock's syndrome and pisoquetral syndromes. ligamentous injuries include scapholunate, lunotriquetral and midcarpal instability injuries. Injuries to the distal radio-ulnar joint and triangular fibrocartilage are also quite common in athletes, and require careful evaluation and treatment.
Athletic Injuries↗
The radioulnar joints and forearm axis: surgeons' perspective.
Forearm injuries are common and can vary in complexity. The fractures are easily diagnosed, but the associated soft tissue injuries may not be as obvious. Treatment results are dependent not only on the fracture healing but on the return of normal relationships about the distal radioulnar joint, the interosseous membrane, and the proximal radioulnar joint. Alteration in any of these elements can result in permanent loss of forearm rotation and stability. Recent anatomic and biomechanical studies have increased our knowledge of these structures and their role in forearm function. The findings from these studies may lead to earlier repair of soft tissue injuries about the radioulnar joints and the interosseous membrane. Further follow-up of these procedures will be needed to validate their indications.
Biomechanical Phenomena↗
Work-related chronic injuries of the forearm and hand: their specific diagnosis and management.
Work-related chronic injuries occur in muscles, tendons, and nerves. Epidemiological, histological, and physiological data confirm their often disputed physical basis. Terms such as repetitive strain injury and cumulative trauma disorder, when used as a diagnosis, have obscured the issue for they are really statements of causation. Definitive diagnosis is required both to treat and prevent such injuries. Precise terminology that identifies the tissue and its pathology is required. A detailed assessment methodology is described that allows a precise diagnosis. A clear relationship to work stress is necessary both to establish the cause and formulate prevention strategies. Treatment must begin early and be appropriate to the tissue and the nature of the injury. Examples are presented and discussed. Early treatment begins before too much damage has been done and yields better results.
Cumulative Trauma Disorders↗
Pediatric hand injuries. Types and general treatment considerations.
Growth arrests may occur after fractures, burns, and frostbite injuries, but children generally have a better prognosis from most hand and forearm injuries than adults. Stiffness is less frequent, open wounds heal faster, remodeling of angular deformities may occur, and nerve recovery following repair is significantly better than adults. Parents should be aware of potential problems and the need for follow-up care for evaluating growth and scar development. Perhaps the greatest challenge for nurses as both parents and as members of society is the prevention of traumatic hand injuries. Children should be placed in seat belts when riding in motor vehicles, and toys and play areas should be geared toward the child's developmental age and abilities. Despite careful attention to a child's surroundings, some children will require emergency care for traumatic hand injuries. Health care workers must provide emotional support for parents who may feel guilty about their child's injury. They also must be prepared to give skilled clinical care guided by the child's development and the needs of the family members.
Child↗
Injuries to the elbow, forearm, and hand.
Explore the source record for details and available documents.
Athletic Injuries↗
Elbow, forearm, wrist, and hand injuries among sport rock climbers.
OBJECTIVES: Sport rock climbing with its repetitive high-torque movements in gaining the ascent of a rock face or wall, often in steep overhanging positions, is associated with a unique distribution and form of upper limb injuries. In this article, we review the biomechanical aspects of sport rock climbing and the types of injuries commonly encountered in the forearm, wrist, and hand regions of elite sport rock climbers. Because elbow, forearm, wrist, and hand injuries predominate, representing 62% of the total injuries encountered, these anatomical areas have been selected for review. DATA SOURCES: The predominant source of data are the published work of Bollen et al. The remaining sources were obtained through electronic search of the Medline and Current Contents Databases (last searched May 1995). German and French articles were included in the search criteria. STUDY SELECTION: Only studies dealing with acute soft tissue and overuse injuries amongst sport rock climbers were selected. DATA EXTRACTION: Data were extracted directly from the sourced articles. DATA SYNTHESIS: The following injuries have been described in detail with regard to their presentation, diagnosis, treatment, and prevention amongst sport rock climbers: medial epicondylitis, brachialis tendonitis, biceps brachii tendonitis, ulnar collateral ligament sprain of the elbow, carpal tunnel syndrome, digital flexor tendon pulley sheath tears, interphalangeal joint effusions, fixed flexion deformities of the interphalangeal joints, and collateral ligament tears of the interphalangeal joints. CONCLUSION: Many of the injuries are specific to the handhold types used by the rock climber. Accurate diagnosis and effective treatment of these unique injuries will be facilitated by a wider understanding of the biomechanical aspects of rock climbing and an awareness of the patterns and incidence of injuries in this sport.
Arm Injuries↗
[The results of nerve repair in combined nerve-tendon injuries of the forearm].
BACKGROUND: We evaluated the clinical and functional results of nerve repair in patients with combined tendon-nerve injuries of the forearm. METHODS: The study included 68 patients (58 males, 10 females; mean age 33.5 years; range 5 to 48 years) with combined tendon-nerve injuries of the forearm. A total of 96 nerves were repaired. Patients with nerve defects were excluded. Both median and ulnar nerves were injured in 17 patients; median and ulnar nerve injuries were detected in 17 patients and 34 patients, respectively. The mean time to operation was four hours (range 20 min to 24 h). Primary nerve repair was performed in 60 patients, and secondary repair was performed in eight patients. The interfascicular technique was employed in 18 patients, and epiperineural suture in 50 patients. Rehabilitation included early motion using the Washington regimen. A modified MRC (Medical Research Council) motor and sensory classification system was used for postoperative evaluation. The mean follow-up was at least two years. RESULTS: The modified MRC results were as follows: of 17 patients with median nerve injuries, 10 had excellent, seven had good results. Of 34 patients with ulnar nerve injuries, the results were excellent in nine, very good in 10, good in 10, and fair in five patients. Of those with median and ulnar nerve injuries, four, seven, and six patients had excellent, very good, and good results, respectively. Overall, 61 patients (89.7%) had satisfactory results. A significant correlation was found between age and the MRC results (p=0.016). CONCLUSION: Primary nerve repair followed by early motion results in substantial rates of excellent and satisfactory results in patients with combined nerve-tendon injuries.
Adolescent↗
Complications of plate fixation of forearm fractures.
Sixty-four adult patients (87 diaphyseal forearm fractures) were treated by plating. Thirty-nine percent of the fractures were classified as single bone fractures (16% radius, 23% ulna); 43% were both radial and ulnar fractures, and 19% were Galeazzi or Monteggia fracture-dislocations. A major complication occurred in 18 (28%) patients. Nonunion occurred in six patients: three of 18 bones treated with four screws (17%), but only three of 69 bones fixed with five or more screws (4.3%), a nonunion rate four times higher for bones plated with four screws. Screws loosened in three fractures, all involving the ulna. Radioulnar synostosis occurred in seven forearms, and in five of these the forearm injuries were associated with multiple system trauma involving head injury. Two patients had osteomyelitis. Both were victims of massive crush injury and delayed internal fixation, and both required removal of the implant; but eventually the fractures healed. Plate fixation of forearm fractures can have a high complication rate. Meticulous attention to surgical technique and the use of plates long enough to provide secure fixation can not be overemphasized. An increased incidence of synostosis in polytrauma, head-injured patients was noteworthy.
Adolescent↗
The interosseous membrane in radio-ulnar dissociation.
In severe forearm injuries, the diagnosis of disruption of the interosseous membrane is frequently delayed and sometimes missed, giving difficulties in the salvage of forearm stability. We studied the structure and function of the interosseous membrane in 11 cadaver preparations, using mechanical and histological analysis. Seven of the specimens tested in uniaxial tension sustained a mid-substance tear of the central band of the membrane at a mean peak load of 1038 +/- 308 N. The axial stiffness was 190 +/- 44 N/mm with elongation to failure of 10.34 +/- 2.46 mm. These results provide criteria for the evaluation of reconstructive methods. A preliminary clinical investigation of the use of ultrasound suggests that this may be of value in the screening of patients with complex fractures of the forearm, and for investigating the natural history of tears of the interosseous membrane.
Adult↗
[Plate osteosynthesis in humeral shaft fractures. Indications and results].
Non operative management of humeral shaft fractures is well recognized as the standard of care for uncomplicated injuries. Operative treatment of humeral fractures may be performed when limited indications are present as in patients with multiple trauma including ipsilateral forearm injuries, arterial injury or primary radial nerve palsy. 18 patients with humeral shaft fractures underwent open reduction and internal fixation (ORIF) using the AO plating technique at the Kantonsspital Chur from 1980 to 1986. Follow-up was available for 17 patients of whom 16 suffered from multiple injury trauma. The broad DC plate combined with lag screws was used in most cases. Two brachial artery transections were repaired at the time of primary osteosynthesis by the same surgeons with full functional recovery. Concomitant nerve injuries were repaired primarily in one case and postprimarily in 3 more cases. The overall result was excellent in 9 patients, good in 5 patients, fair in 2 patients and poor in one patient with complete brachial plexus injury. Bone healing was uneventful in all 17 patients. No infection and no delayed union or pseudarthrosis has been observed.
Adult↗
Forearm torque strengths and discomfort profiles in pronation and supination.
This experiment investigated maximum forearm pronation and supination torques and forearm discomfort, for intermittent torque exertions in supine and prone forearm angles for the right arm. Twenty-two subjects participated in the study that comprised two parts, the first of which involved measurement of maximum forearm torque in both twisting directions at five forearm angles including neutral. This was followed by endurance tests at 50% maximum voluntary contraction (MVC) in both directions. The second part of the study involved subjects performing 5-min duration of intermittent isometric torque exercises at 20% MVC in both directions at 11 forearm angles. Regression equations were developed that accurately predict torques as a function of forearm angle expressed as a percentage of maximum motion. Analysis of the discomfort data for the intermittent isometric torque exertions indicated that both forearm angle and twisting direction significantly affected forearm discomfort (p < 0.001). A significant two-way interaction (p < 0.01) was identified between forearm angle and direction for supine forearm angles only. The results provide important strength and discomfort models for the design of tasks involving static or repetitive forearm twisting. Such tasks have a strong association with forearm injuries including lateral and medial epicondylitis. These results provide needed data on the risk factors associated with these injuries so they can be prevented.
Adult↗
Contribution of the interosseous membrane to distal radioulnar joint constraint.
PURPOSE: Although forearm injuries are accompanied frequently by rupture to the interosseous membrane (IOM) diagnosis of the extent of IOM injury is difficult. In this study we evaluated distal radioulnar joint (DRUJ) laxity caused by both partial and complete IOM disruption and compared these quantitative measurements with the common clinical manual evaluation of DRUJ laxity and dislocatability. METHODS: Human cadaveric forearms (n = 8) were used in this study. Skin, muscles, and tendons were removed. The specimens were mounted on an experimental apparatus that allowed the radius to move freely about the fixed ulna. Tests were performed in neutral rotation, 60 degrees pronation, and 60 degrees supination. Under various conditions of IOM sectioning testing was performed by volary and dorsally translating the radius relative to the ulna in the coronal plane of the radius. Testing was performed both qualitatively as would be performed in the clinic and quantitatively with an instrumented probe. RESULTS: Our results show that dorsal dislocation of the radius relative to the ulna strongly suggests distal IOM rupture. Disengagement of the radius from the DRUJ indicated injury to the distal and middle IOM. The distal IOM constrained volar and dorsal laxity of the radius at the DRUJ in all forearm rotation positions. The midportion of the IOM constrained laxity except in the volar direction of the pronated forearm. The proximal IOM did not constrain the proximal radius except dorsally for the pronated forearm position. CONCLUSIONS: The IOM, in particular the distal IOM, plays an important role in constraining dorsal dislocation of the radius at the DRUJ.
Aged↗
Radial sensory nerve entrapment in the forearm.
A group of 51 patients with complaints related to entrapment of the superficial sensory branch of the radial nerve is described. Symptoms included altered sensibility over the dorsoradial aspect of the hand and dorsoradial cutaneous pain with ulnar flexion of the wrist or with gripping and pinching. Pertinent history included compressive or crushing forearm injuries, work activities requiring frequent pronation and wrist hyperextension, and associated illnesses, such as diabetes. Physical examination included abnormal touch perception, abnormal moving two-point discrimination over the dorsoradial area of the hand, a positive Tinel sign in the forearm, and aggravation of the patient's symptoms with forced forearm pronation and wrist ulnar flexion. Seven (37%) of 19 patients treated with nonoperative modalities after a mean of 28 months from the onset of symptoms or their injury were improved. Of the 32 patients treated with surgery with a mean follow-up of 10 months (range of 6 to 29 months), there has been excellent subjective improvement in 37%, good subjective improvement in 49%, and fair subjective improvement in 6%, and 8% were not improved. Of this group of surgically treated patients, 43% have returned to their regular jobs, and 22% are in either vocational rehabilitation or working at a different job.
Adult↗
An uncommon peripheral nerve injury after penetrating injury of the forearm: the importance of clinical examination.
A 22 year old woman presented to the accident and emergency department with a self inflicted stab wound to the radial side of the volar aspect of the left forearm caused by a pen knife. Her wounds were sutured on the day of injury. Over the course of next three weeks her wounds healed well but she noticed difficulty in using the hand. She therefore attended her general practitioner who suspected a possible nerve injury and referred the patient back to the A&E department. On follow up examination, she was noticed to have a loss of finger and thumb extension and weakness of thumb abduction. Active extension of the wrist (with radial deviation) was intact. There was no sensory deficit. Posterior interosseous nerve (PIN) palsy was diagnosed and the patient was referred to the regional hand surgery unit where she underwent exploration of the wound. A complete transection of the PIN in the supinator canal was found and repaired with good functional outcome. This case reflects the importance of clinical examination in uncommon peripheral nerve injuries and appropriate referral to a specialist department in case of doubtful penetrating wound that pose a threat to an underlying important structure.
Adult↗
Hoffmann pelvic stabilization for injuries to the hand and wrist.
We have used the pelvic Hoffmann technique successfully on two patients requiring flap coverage and have had no difficulty with its management nor complications with the pelvic pin fixation. We feel that this type of fixation provides significant advantages for the treatment of hand and forearm injuries requiring flap coverage for avulsing injuries to the hand and wrist.
Adult↗
[Surgery of acute injuries of the forearm and hand].
Wound of the hand must be treated surgically. The order of priority in management of wounded hand is explained. Vascular injuries with ischemia of the extremity or of the parts are of the very few absolute indications for imediate surgery. Though wound excision, stabilization of skeleton, and skin cover, should be done in the first few hours after injury. It is ideal that the tendons and nerves are repaired at the same procedure. Repair of tendons and nerves requires the utmost insight skill and attention to details; and for nerve repair microsurgical technique is required. When there are factors adverse to primary healing (excessive contamination of reduced tissue vitality) and no provision for expert surgery repair of tendons and nerves should be deferred. Primary or deferred primary repair of tendons three or four days after surgery, and primary and deferred surgery of nerves two or three weeks is discussed. Prevention of infection, prevention of oedema in po-operative treatment and proper joint position during imobilization are the main measures to prevent stiffness of the hand. Mechanism, symptoms and early treatment of impending ischemic leasion is explained.
Forearm Injuries↗