Elbow supination restriction

The elbow and wrist differ from most other joints in that certain movements (pronation/supination) are inextricably linked. This is accomplished by the mobile radius rotating around the static ulna. Proxi-mally, the radial head articulates with the radial notch on the lateral aspect of the coronoid process of the ulna. Distally, the ulnar notch of the radius rotates around the head of the ulna. In addition, the shafts of the bones are linked by the interosseous membrane. Damage to any of these structures may restrict pronation or supination. In adults, angulation or malrotation of more than 10 can result in restricted rotation of the forearm. For this reason, adult fractures are usually managed by open reduction and internal fixation. In children, the potential for remodelling is good around the wrist and more deformity can be accepted. 

The radial head is palpated by flexing and extending the elbow. The physician grasps the radial head and moves it in an anterior direction and in a posterior direction, noting any restriction to either motion. Posterior glide of the radius is coupled with pronation/extension and anterior glide is coupled with supination/flexion. 

The most common articular somatic dysfunction at the elbow involves the head ofthe radius. Restriction in anterior or posterior motion is tested by moving the radial head in an anteroposterior direction. This condition often mimics the pain of tennis elbow. The anterior slide of the radial head is coupled with supination-flexion, and the posterior slide with pronation-ex-... 

Examination of the shoulder revealed no bruising, swelling, or inflammation. Motion of the right shoulder was restricted in comparison to the left in flexion, abduction, extension, and external rotation, both passively and actively. He was unable to perform the Apley scratch test fully. Muscle strength was relatively normal, although it was difficult to test because of pain. The neck, elbow, and wrist were normal on examination. There was marked tenderness to palpation ofthe biceps tendon and some tenderness of the supinator tendon. There was no tenderness or swelling of the bursa of the shoulder. 

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