**4. Medial flexor pronator muscles strain) medial flexor pronator strain**

This is an injury that occurs on the inside of the elbow after either direct trauma as in wrestling or baseball or from valgus strain in golf or football soccer.

The injury occurs to the forearm muscles that attach to the inside (medial) aspect of the elbow; the first indication of injury is pain, swelling, or even in an acute hematoma may be present.

Physical examination should determine the exact location of the injury according to pain (using digital palpation). The maneuvers to be performed include:

Ask patient to perform wrist flexion and pronation. Pain is often referred into the affected area (figure 7a).

With the elbow at 45° of flexion, movements of flexion, extension, pronation, and valgus stress are carried to determine the location and magnitude of the injury.(figure 7c)

These maneuvers should be done on the contralateral elbow as well to see how great is the difference in pain intensity and location as well as motion between the two joints.

Another maneuver that can be used to assess pain is forced flexion of the wrist against resistance (figure 7b).

**Figure 7.** a) Ask the patient to flex the wrist; b) Ask the patient flex the wrist against resistance; c) Apply force to the lateral side of the elbow to take it to a valgus position

You can define three grades of injury:

**Figure 6.** With the elbow at 90° and the palm facing down ask the patient straighten the elbow against resistance

**4. Medial flexor pronator muscles strain) medial flexor pronator strain**

or baseball or from valgus strain in golf or football soccer.

digital palpation). The maneuvers to be performed include:

(figure 7a).

140 Muscle Injuries in Sport Medicine

resistance (figure 7b).

This is an injury that occurs on the inside of the elbow after either direct trauma as in wrestling

The injury occurs to the forearm muscles that attach to the inside (medial) aspect of the elbow; the first indication of injury is pain, swelling, or even in an acute hematoma may be present.

Physical examination should determine the exact location of the injury according to pain (using

Ask patient to perform wrist flexion and pronation. Pain is often referred into the affected area

With the elbow at 45° of flexion, movements of flexion, extension, pronation, and valgus stress

These maneuvers should be done on the contralateral elbow as well to see how great is the

Another maneuver that can be used to assess pain is forced flexion of the wrist against

are carried to determine the location and magnitude of the injury.(figure 7c)

difference in pain intensity and location as well as motion between the two joints.

First.-There is damage to a small fraction of muscle fibers.

Second.-This can include an avulsion of the muscles insertion

Third.-There is a broader breakdown of muscle fibers. There may also be the presence of an avulsion fracture cause by detachment of the tendon in the affected area.

One complication may be an injury to the ulnar nerve. If this happens the sensitivity of the little finger and the ring finger are affected [5] to be sure to perform a small sensitivity neurological examination (figure 8).

**Figure 8.** Test the sensitivity neurological area of the little finger using a small needle
