there are several nerve injuries that may happen at the elbow and form region um the first one that I want to uh introduce you is the PIN syndrome um but before that uh let me do a quick Anatomy review so that um you know how um what to look for when we do the evaluation well first of all um so this is the radio uh bone I've taken out um some of extensor car by um radialis longus and bravic that to show uh the deeper muscles right here so you can see the humor bones here and this is the radial or radius or radial bone right here you can see uh at this part this is the U radial nerve and just pass um the humoral uh bone right here uh the radial nerve split into uh superficial uh Branch that's um that's for the sensation fiber and then uh another one um is posterior enosis nerve uh AKA pin and pin is Pur purely a molor and you can see that this pin nerve kind of penetrate uh the superator um so here um we can expect that um when uh a client um got injured uh at this uh region uh most likely uh when they have the pin syndrome uh they will show weakness in molor uh in um um deficit especially innovated by the pin um so which are superator wrist extensors and finger extensors and please be uh reminded um the radial side of the wrist extensors are uh extensor car by uh um radialis longus and bravis they are innovated by the radial nerve so um our client may show a little bit a rist uh radial side of a wrist extension but uh the rest of it the aler side or the finger extension they're not able U to uh show some kind of motor function um it is uh also very common that people show uh this radio uh tunnel syndrome okay let me go back to the previous slide here so basically this is a uh radio tal right here so um when people show uh R radiot Tel syndrome basically they show the pen but they don't um demonstrate any uh pulsy or mod loss so that shows that it's it's uh primarily the uh um sensory fiber that got injured not the motor fiber okay um um at the at at at the Forum region uh medium nerve May uh be compressed or um kind of um um injured and then we call it uh perator syndrome pator syndrome so um it's R the nerve medium nerve uh compr ression um injury um the medium nerve kind of passes the pator Terrace and uh for for those um um individuals uh who had pet syndrome they will show U pain um in the form of region and um and then the wrists and some uh sensory uh disturbance around the medium nerve uh distribution you may think that it is very similar to kernal syndrome right yes um one thing uh that we can differentiate uh between peror syndrome and then uh the carotenal syndrome is Comal syndrome they don't have any symptoms in the form it's uh nerve compression at at the wris so above the wrist they're okay so when people show symptoms in the form that shows that it's and for the medium nerve uh distribution area that that is a pronator syndrome right here um to evaluate petor syndrome we can ask our client to have uh to pronate The Forum and then we apply resistance to prevent them uh from pronate pronating the forarm and then and then we can uh U slowly extend the elbow when they show on the symptoms that would be indicative for a pet symtom you can also do U some other uh provocative tests for example we can ask our client to um Bend uh their elbow and then ex um and then we can U apply a resistance that if they show some kind of symptoms that would be indicative or we can do um we can have their um uh index uh sorry M middle finger U bend their middle fingers and then we apply resistance at the PIP flexion that's basically indicated for U the flexor digitorum superficialis if uh they show some kind of symptoms that would also indicate uh a perer uh syndrome uh the most commonly uh used test is the resisted form pronation and elbow extension but also there are therapists who are using um other provocative test for a pator uh syndrome another um medium nerve compression uh injury um is called anterior interus syndrome um so you can um see that um medium nerve uh innovates the flexor Pocus longus uh flexor digor U profundus and prator quadrus and what shows is well basically U medium n kind of control the med uh the thumb and the index finger right so when we ask our client to like pick up the pin on the table that so basically the fingers the index finger and the thumb finger form an O if they fail to form an O but instead they show this kind of hyper extension um that would be Indica for anterior inis U syndrome okay and what about the AL nerve um at the elbow yeah on the nerve compression injury at um at the elbow it's the second common uh nerve injury um um in this region the the the most common one is kotal syndrome which is the medium nerve compression at the wrist and the second common nerve injury is cupido Turnal syndrome which is the all nerve compression at the elbow um as um as you can see here kind of on the nerve kind of go posteriorly um Below on the humorus and then kind of innovates um the um the hand muscles but before the in the nerve innovates the hand muscles you can see that kind of uh pass through a lot of uh muscles what that means is overuse of the elbow or overuse of the muscle or you know some bodybuilder they uh train too much the muscle cannot get get to poy the pressure will U um increase the pressure within this cupital Turnal that will cause some kind of uh compression uh symptoms for U in this region and then we call it cubital Turnal okay to um to evaluate a cubit Turnal uh we can do a tenal side tenal side basically we just like you know like how say um T touching um the region of the on nerve and when they show some kind of nerve symptoms like shooting or numers that will be a positive sign another way that we can do is uh elbow flexion test basically we ask our client to uh Flex fully of the elble and then uh superate the form fully and then do wrist extension and hold in this position for over 60 uh seconds and for and up to 3 minutes when they show symtoms around the uh on the nerve kind of area that would be a positive sign for uh cubor Turnal syndrome