disengagement of forearm fascial compartment syndromes€¦ · disengagement of forearm fascial...

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Disengagement of Forearm

Fascial Compartment

Syndromes

Disassociation and disengagement of fascial compartmentsof forearm to achieve pressure response

Anatomy source: Netters :

1. Plate #423: Forearm: Serial Cross Section2. Plate # 435: Bursae, Spaces and Tendon Sheaths of

Hands

For all of the segments below:Step 1.

Step 2.

Grasp the length of the first ray (thumb) including the thenar eminence. Pull the thumb into longitudinal distraction with very gentle force.See Location. See Hand Placement. Place one palm on Location with Hand Placement and Press perpendicular INTO the body TOWARDS the ulna. Note variations.

forearm fascial compartment IMT, 4/28/17 2 of 15 Copyright © 2017 Ayelet Connell

Forearm: Superior Third

Structure / Tissue:1. Brachioradialis Muscle

Location: Hand Placement: Press: Position:

Four human inches inferior to lateral aspect of radiohumeral joint Specific, quarter radiusmedial towards ulna90 degrees flexion, no pronation or supination

2. Extensor Carpi Radialis Longus MuscleLocation: Hand Placement: Press: Position:

Posterior, middle of olecranonspecific, quarter radiusinferior90 degrees flexion, no pronation or supination

3. Extensor Carpi Radialis Brevis MuscleLocation:

Hand Placement: Press: Position:

3 human inches inferior from the lateral aspect of the proximal radial headspecific, quarter radiusmedial towards ulnar90 degrees flexion, no pronation or supination

4. Extensor Digitorum MuscleLocation:


inferior third of posterior olecranon process, lateral ½; 90 degrees elbow flexionspecificity, quarter radiustowards the distal ulnar head90 degrees flexion, no pronation or supination

5. Extensor Digiti Minimi MuscleLocation: Hand Placement: Press: Position:

3 human inches inferior to the medial epicondyle specificityinferior towards the middle of the distal ulnar head 90 degrees flexion, no pronation or supination


Structure / Tissue:6. Extensor Carpi Ulnaris Muscle

Location:


7. Anconeus MuscleLocation: Hand Placement: Press: Position:

4 human inches inferior to the posterior aspect of the middle of the ulnahumeral jointsspecificityinferior towards the distal third, medial aspect of ulna90 degrees flexion, no pronation or supination

posterior aspect of the superior 4th of radiusspecificitymedial towards ulna90 degrees flexion, no pronation or supination

8. Flexor Digitorum Profundus MuscleLocation:


horizontal width of ulna plus radius, posterior aspect, distal 4th of forearmtotal width , use edge of index fingerinferior towards middle of distal ulna head90 degrees flexion, no pronation or supination

9. Flexor Carpi Ulnaris MuscleLocation: Hand Placement: Press: Position:

anterior aspect, superior 5th of ulnawidth of medial forearminferior towards distal head of ulna90 degrees flexion, no pronation or supination

10. Flexor Digitorum Superficialis Muscle (Humeroulnar head)Location: Hand Placement: Press: Position:

anterior aspect, 4 human inches inferior from the coronoid process width of coronoid processinferior towards distal head of ulna90 degrees flexion, no pronation or supination


Structure / Tissue: 11. Palmaris Longus Muscle

Location:


anterior aspect, 3 human inches inferior from the proximal radioulnar jointspecificityinferior towards the distal ulna head90 degrees flexion, no pronation or supination

12. Flexor Carpi Radialis MuscleLocation:


anterior aspect , 2 human inches inferior from the proximal radial headspecificityinferior towards the distal ulna head90 degrees flexion, no pronation or supination

13. Flexor Pollicis Longus MuscleLocation:


anterior aspect, very lateral; 1 human inch inferior from the proximal radial headspecificityinferior, towards the distal ulna head90 degrees flexion, no pronation or supination

14. Flexor Digitorum Superficialis Muscle (Radial head)Location:

Hand

Placement:

Press: Position:

anterior aspect, 1 human inch inferior from the proximal radial head, total width of soft tissue over radius and including interosseous membranetotal width of soft tissue over radius and including interosseous membraneinferior towards the distal ulna head90 degrees flexion, no pronation or supination

15. Pronator Teres MuscleLocation:


anterior aspect, just inferior to the proximal radial head, the width of the anterior aspect of the forearmthe width of the anterior aspect of the forearminferior towards the distal ulna head90 degrees flexion, no pronation or supination


Structure / Tissue: 16. Supinator Muscle

Location:


17. RadiusLocation: Hand Placement: Press: Position:

18. UlnaLocation: Hand Placement: Press: Position:

posterior aspect, just superior to the proximal head of radius, including the radiohumeral joint spacespecificityinferior toward the distal ulna head90 degrees flexion, no pronation or supination

lateral aspect, length of superior third of radiustotal lateral soft tissue of the length of superior third of radius inferior towards the distal ulna head90 degrees flexion, no pronation or supination

medial aspect, length of superior 1/4 of ulnatotal medial soft tissue of the length of superior 1/4 of ulna inferior towards the distal ulna head90 degrees flexion, no pronation or supination


Forearm: Middle Third

Structure / Tissue: 1. Flexor Carpi Radialis Muscle


anterior aspect, middle third of forearm, over radius specificityinferior towards the distal ulna head PLUS hypothenar eminence 30 degrees flexion, no pronation of supination

2. Brachioradialis MuscleLocation:

Hand Placement: Press:

Position:

anterior / lateral aspect, 5 human inches inferior from the proximal head of radiusspecificityinferior, towards the distal ulna head PLUS the hypothenar eminence30 degrees flexion, no pronation of supination

3. Flexor Pollicis Longus MuscleLocation:


Position:

anterior aspect, 6 human inches inferior from the proximal head of radiusspecificityinferior, towards the distal ulna head PLUS the hypothenar eminence30 degrees flexion, no pronation of supination

4. Extensor Carpi Radialis Muscle and TendonLocation:


Position:

posterior aspect, 5 human inches inferior from the proximal head of radiusspecificityinferior, towards the distal ulna head PLUS the hypothenar eminence30 degrees flexion, no pronation of supination

5. Extensor Carpi Radialis Brevis Muscle and TendonLocation: Hand

Placement:

Press: Position:

posterior aspect. 6 human inches inferior from the proximal head of radiusinferior, towards the distal ulna head PLUS the hypothenar eminenceinferior, towards the distal ulna head PLUS the hypothenar eminence30 degrees flexion, no pronation of supination


Structure / Tissue: 6. Abductor Pollicis Longus Muscle

Location:


Position:

lateral aspect, 5 human inches inferior from the proximal radius headspecificityinferior, towards the distal ulna head PLUS the hypothenar eminence30 degrees flexion, no pronation of supination

7. Extensor Digitorum MuscleLocation: Hand

Placement:

Press: Position:

posterior aspect, 5 human inches distal from the elbow joint line, total width of posterior aspect of forearm total width of posterior aspect of forearm, use length of index fingerinferior, towards the distal ulna head PLUS the hypothenar eminence30 degrees flexion, no pronation of supination

8. Extensor Digiti Minimi MuscleLocation:


Position:

posterior aspect, 5 human inches inferior from the medial epicondylespecificityinferior, towards the distal ulna head PLUS the hypothenar eminence30 degrees flexion, no pronation of supination

9. Extensor Carpi Ulnaris MuscleLocation:


Position:

posterior aspect, 6 human inches inferior from the elbow joint, total width of ulna and interosseous membranetotal width of ulna and interosseous membraneinferior, towards the distal ulna head PLUS the hypothenar eminence30 degrees flexion, no pronation of supination

10. Palmaris Longus MuscleLocation: Hand

Placement:

Press: Position:

anterior aspect, 6 human inches inferior to the elbow joint, middle third of width of anterior aspect of forearmmiddle third of width of anterior aspect of forearm, use length of index fingerinferior, towards the distal ulna head PLUS the hypothenar eminence30 degrees flexion, no pronation of supination


Structure / Tissue: 11. Flexor Digitorum Superficialis Muscle

Location:


Position:

anterior aspect, 6 human inches inferior from the elbow joint line, total width of forearmtotal width of forearm, use length of index fingerinferior, towards the distal ulna head PLUS the hypothenar eminence30 degrees flexion, no pronation of supination

12. Flexor Carpi Ulnaris MuscleLocation:


Position:

anterior aspect, 6 human inches inferior from the coronoid process, just over ulnaspecificityinferior, towards the distal ulna head PLUS the hypothenar eminence30 degrees flexion, no pronation of supination

13. Flexor Digitorum Profundus MuscleLocation:


Position:

anterior aspect, 6 human inches inferior from the elbow joint line, total width of anterior forearmtotal width of anterior forearm, use length of index finger inferior, towards the distal ulna head PLUS the hypothenar eminence30 degrees flexion, no pronation of supination

14. Extensor Pollicis Longus MuscleLocation:


Position:

posterior aspect, 6 human inches inferior to the elbow joint line, total width of posterior forearmtotal width of posterior forearm, use length of index finger inferior, towards the distal ulna head PLUS the hypothenar eminence30 degrees flexion, no pronation of supination


Structure / Tissue: 15. Radius Location:

Hand Placement:Press:

Position:

16. Ulna Location:Hand Placement:Press:

Position:

posterior aspect, length of middle third of radiuslength of middle third of radiusinferior, towards the distal ulna head PLUS the hypothenar eminence30 degrees flexion, no pronation of supination

anterior aspect, length of middle third of ulnalength of middle third of ulnainferior, towards the distal ulna head PLUS the hypothenar eminence30 degrees flexion, no pronation of supination


Forearm: Inferior Third

Structure / Tissue: 1. Flexor Carpi Radialis Tendon

Location:


anterior aspect, 3 human inches superior from the superior proximal carpal row, over radiusspecificitytowards the hypothenar eminence and the 5th metacarpal joint elbow anatomic neutral (not flexed but not locked in extension), no pronation or supination

2. Brachioradialis TendonLocation:


lateral aspect, 4 human inches superior from the proximal head of 1st metacarpal headspecificitytowards the hypothenar eminence and the 5th metacarpal joint elbow anatomic neutral (not flexed but not locked in extension), no pronation or supination

3. Flexor Pollicus Longus MuscleLocation:


anterior aspect, 3 human inches superior from the wrist joint line, lateral 1.2 of anterior radiusspecificitytowards the hypothenar eminence and the 5th metacarpal joint elbow anatomic neutral (not flexed but not locked in extension), no pronation or supination

4. Abductor Pollicus Longus TendonLocation:


lateral aspect, 3 human inches superior from the proximal head of the 1st metacarpalspecificitytowards the hypothenar eminence and the 5th metacarpal joint elbow anatomic neutral (not flexed but not locked in extension), no pronation or supination


Structure / Tissue: 5. Extensor Pollicus Brevis Tendon

Location:


posterior aspect, 3 human inches superior from the wrist joint line, lateral ½ of posterior radiusspecificitytowards the hypothenar eminence and the 5th metacarpal joint elbow anatomic neutral (not flexed but not locked in extension), no pronation or supination

6. Extensor Carpi Radialis Longus TendonLocation:


posterior aspect, 2 human inches superior to the wrist joint line, medial ½ of posterior radiusspecificitytowards the hypothenar eminence and the 5th metacarpal joint elbow anatomic neutral (not flexed but not locked in extension), no pronation or supination

7. Extensor Carpi Radialis Brevis TendonLocation:


2 human inches superior to the wrist joint line, lateral ½ of posterior radius specificitytowards the hypothenar eminence and the 5th metacarpal joint elbow anatomic neutral (not flexed but not locked in extension), no pronation or supination

8. Extensor Pollicus Longus TendonLocation:


posterior aspect, 3 human inches superior from the wrist joint line, over radiusspecificitytowards the hypothenar eminence and the 5th metacarpal joint elbow anatomic neutral (not flexed but not locked in extension), no pronation or supination


Structure / Tissue: 9. Extensor Digitorum Tendons

Location:


posterior aspect, 3 human inches superior from the wrist joint line, total width of posterior forearmtotal width of posterior forearm, use length of index finger towards the hypothenar eminence and the 5th metacarpal joint elbow anatomic neutral (not flexed but not locked in extension), no pronation or supination

10. Extensor Indices Muscle and TendonLocation:


posterior aspect, 3 human inches superior from the proximal head of the 2nd metacarpalspecificitytowards the hypothenar eminence and the 5th metacarpal joint elbow anatomic neutral (not flexed but not locked in extension), no pronation or supination

11. Pronator Quadratus Muscle and Interosseous MembraneLocation:

Hand Placement:

Press: Position:

posterior aspect, width of posterior forearm, from the wrist joint line through the inferior 20% of the forearmwidth of posterior forearm, from the wrist joint line through the inferior 20% of the forearm, use proximal and middle phalanges of 2nd, 3rd, 4th fingerstowards the hypothenar eminence and the 5th metacarpal joint elbow anatomic neutral (not flexed but not locked in extension), no pronation or supination

12. Extensor Carpi Ulnaris TendonLocation:


posterior aspect, 3 human inches superior from the wrist joint line, medial ½ of posterior ulnaspecificitytowards the hypothenar eminence and the 5th metacarpal joint elbow anatomic neutral (not flexed but not locked in extension), no pronation or supination


Structure / Tissue: 13. Flexor Digitorum Profundus Muscle and Tendons

Location:


2 human inches superior from the wrist joint line, total width of anterior forearmtotal width of anterior forearm, use length of index finger towards the hypothenar eminence and the 5th metacarpal joint elbow anatomic neutral (not flexed but not locked in extension), no pronation or supination

14. Flexor Carpi Ulnaris Muscle and TendonLocation:


anterior aspect, 2 human inches superior to the pisiformis, medial ½ of the anterior ulnaspecificitytowards the hypothenar eminence and the 5th metacarpal joint elbow anatomic neutral (not flexed but not locked in extension), no pronation or supination

15. Flexor Digitorum Superficialis Muscle and TendonsLocation:


anterior aspect, 3 human inches superior from the wrist joint line, total width of anterior forearmtotal width of anterior forearmtowards the hypothenar eminence and the 5th metacarpal joint elbow anatomic neutral (not flexed but not locked in extension), no pronation or supination

16. Palmaris Longus TendonLocation:

Hand Placement:

Press: Position:

anterior aspect, 3 human inches superior to wrist joint line, over the medial edges of both radius and ulna and covering the interosseous spaceover the medial edges of both radius and ulna and covering the interosseous spacetowards the hypothenar eminence and the 5th metacarpal joint elbow anatomic neutral (not flexed but not locked in extension), no pronation or supination


Structure / Tissue:17. Radius


18. UlnaLocation: Hand Placement: Press: Position:

posterior aspect, length of distal third of radiuslength of distal third of radiustowards the hypothenar eminence and the 5th metacarpal joint elbow anatomic neutral (not flexed but not locked in extension), no pronation or supination

anterior aspect, length of distal third of ulnalength of distal third of ulnatowards the hypothenar eminence and the 5th metacarpal joint elbow anatomic neutral (not flexed but not locked in extension), no pronation or supination


disengagement of forearm fascial compartment syndromes€¦ · disengagement of forearm fascial...

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