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Two smaller feeding appendages are situated below the 3 pairs of maxillipeds: the first maxilla (or maxilla) and second maxilla (or maxillules). Finally, the mouth is bordered by a pair of well-calcified, jaw-like and highly modified appendages, the mandibles. The 5 pairs of locomotory appendages of a crab (the pereiopods) are made up of a pair of usually powerful chelipeds (legs carrying a chela or pincer) and normally of 4 pairs of walking (or ambulatory) legs. For the present contribution, the first appendage is referred to as the cheliped and the last 4 appendages (walking legs) as legs. The claw (or chela) itself consists of a palm (or manus) and 2 fingers, one of which is movable (the dactylus or movable finger), whereas the other one (pollex) is fixed. In some families the last pair or all walking legs are modified for swimming or burrowing, as seen in the Portunidae and the Matutidae. Adult male and female crabs are easily distinguished by the shape of their abdomen. In males, the abdomen is triangular to broadly T shaped, whereas in females it is broad, usually semicircular, often covering most of the ventral surface. Almost all crabs have 7 abdominal segments (although the seventh segment or telson is actually not a true segment), but in a number of families, several segments are partially or completely fused. Many crab species show a sexual dimorphism, with the males usually being larger or possessing special or excessively developed structures. Males possess 2 pairs of gonopods, that is, modified pleopods specifically adapted for copulation (most crabs practice internal fertilization). The pleopods (abdominal appendages) of females are branched, setose and serve to carry the eggs: fertilized eggs are exuded, attached to the setose pleopods of females, and kept there for several weeks until the planktonic larvae (zoeae) hatch out. Many species of crabs possess pubescence to varying degrees on their body and appendages. The hair (or more appropriately called setae) may be soft or stiff, simple or plumose (plume-like), or so short that it becomes pile-like, sometimes even short and dense, giving a velvet-like appearance. The setae may sometimes be hard and spine-like, especially on the propodus and dactylus of legs. Majids often possess hook-like setae that attach to sponges, algae and debris (similar in action to velcro), supporting the camouflage of the crab. Carapace types (after Ng, 1998) the shape of the carapace is often used as a descriptive character in many guides and keys. Unfortunately, a large variety of terms have been introduced in the past, not always applied with exactly the same meaning. Therefore, an approximate categorization has been provided here and those carapace types which belong to a respective category are illustrated below. It should be remembered, however, that there are sometimes no clear lines separating the different carapace types, and so the designation of a particular type may be somewhat subjective in certain cases. Nevertheless, the use of carapace shapes is still a useful character in many instances. Merus of third maxillipeds distinctly triangular; opening for afferent respiratory current at base of chela, no canal present along sides of buccal cavern even when third maxillipeds pushed aside. Male abdominal segments 3 to 5 fused, functionally immovable, but sutures still visible. Last pair of legs with distal 2 segments wider and more flattened than these segments of previous legs, in most species the dactylus is oval and paddle-shaped, adapted for swimming purposes, none of the dactyli with conspicuous spines. Second gonopod in males longer than first; distal part of second gonopod developed into filiform flagellum. Male abdomen elongate and narrow, with segments 3 to 5 fused, covering most of sternite 4. Front broader than eyes, usually without teeth, if teeth or lobes are present these are even in number.

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Abdominal bracing stabilizes the lower lumbar segments during a functional squat motion. The patient stands with the lumbar spine in neutral, hips and knees slightly fexed. Sitting removes the need to coordination the pelvis Resistance can be with elastic bands or a bar attached to a and lower limbs with back stabilization required in standing double pulley. The patient sits with the pelvis rotated anterior to achieve a neutral lumbar spine. Cable rowing or elastic resistance is used for a rowing motion for the upper limbs while the lumbar spine maintains a neutral position. Motion and directions From the standpoint of tissue tolerance and pain, the basic motions of Stage 1 are progressed in terms of range of motion and by adding the directions that were avoided. A forward lunge is performed and coordination are the goal of Stage 2, allowing with the back in neutral, the back knee remains in extension. Initial exercises are progressed in be true for strength training in isolation for the terms of range of motion and/or body position. Lying down postures should be progressed to reduce the load, allowing for coordination and to partial weight bearing, then sitting or standing, endurance training, reducing the early fatigue of the with an emphasis on continued improvement in lumbar extensors. Examples of more aggressive exercise are listed below, but many To adjust the amount of resistance with back options are possible. Progression of motion and extension exercises the axis of motion can be set direction is a continuum of low-level tissue training more cranial. The peak angle of the table is set more toward the end stage functional demand, and are cranial on the trunk to reduce the amount of body therefore dictated by the individual patient. The arms can be placed behind the back shifts Extension more body weight caudally, reducing the load, or Back extension exercises, whether with active behind the head (as pictured) to increase the load. An alternative approach to reducing a classic exercise for training the lumbar extensor weight is to adjust the table more vertically. The Roman chair exercise has been utilized in both the clinic and health club settings for back training. This exercise does not isolate the lumbar extensors, but is coupled with the hip extensors. Even the biceps femoris muscles are connected via the sacrotuberous ligament and thoracolumbar fascia (Vleeming et al. The importance of the gluteus maximus and the biceps femoris to the force production during trunk movement has been Figure 5. Internal rotation of the lower limbs will emphasize lumbar extensor muscles, studied the recruitment patterns of the lumbar while external rotation will increase the contribution of the and hip extensors as it relates to fatigue during gluteal muscles. Modifed Roman chair extension: to reduce Roman chair extension, finding that the maximal contribution from the hip extensors, more specifcally the biceps femoris, the fxating roll can be moved to the upper degree of lumbar muscle activation to be around 85 thigh. This statement may recruitment did not change with different hip page 333 positioning. Hip rotation can easily be adjusted for cranial extension exercises, with internal rotation emphasizing back muscles, while external rotation will emphasize the hip musculature. Prone extension is performed as above, but one arm is held out to the side to place a rotational moment on the spine. This progression is not necessary for all patients, but those returning to athletic performance or heavier lifting work may beneft from this strength training approach. If concern exists over minimizing the contribution of the hip extensors during lumbar extension, changing to a sitting position is an effective option. Sitting significantly increases the compression to the lumbar discs, and is therefore not recommended early in rehabilitation of acute disc pathology. Prone until Stage 3 or 4 training to utilize sitting postures extension is performed as above, but one arm is held out to for cranial extension training. The right arm to the side produces a left rotation moment that must be stabilized during the primary motion of extension. The patient must be able to dynamically control the lumbar extension moment with the abdominal muscles. The towel can also be placed on the opposite side with the patient instructed to push down into the towel to fx the lower abdominals prior to lifting the leg. A roll is placed in the lower abdomen to increase the reversal of the lumbar lordosis in the fexed position. Extension begins cranially from the upper thoracic spine with a segmental progression to the lower lumbar spine.

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Basic Cardiac Life Support (Refer to current American Heart Association guidelines) 1. Automated external defibrillation (Refer to current American Heart Association guidelines) A. Advanced Life Support Refer to the current American Heart Association guidelines A. Special arrest and peri-arrest situations Refer to the current American Heart Association guidelines A. Postresuscitation support Refer to the current American Heart Association guidelines A. Transport Page 242 of 385 Trauma Trauma Overview Paramedic Education Standard Integrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression to implement a comprehensive treatment/disposition plan for an acutely injured patient. Guidelines for Field Triage of Injured Patients: Recommendations of the National Expert Panel on Field Triage. When practical, log roll the supine patient on their side to allow for an appropriate assessment of the posterior body. Location of normal bronchovesicular and bronchial breath sounds in the chest and the meaning of abnomal locations. Transfer of patients to the most appropriate hospital Page 246 of 385 Trauma Bleeding Paramedic Education Standard Integrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression to implement a comprehensive treatment/disposition plan for an acutely injured patient. Unable to maintain +90% investigate cause (tension pneumothorax) Page 251 of 385 4. Fluid choice a) Types of fluid (Refer to American College of Surgeons guidelines) i) Advantages ii) Disadvantages iii) Role of hydrostatic pressure iv) Role of colloid oncotic pressure b) Blood substitute products c) Blood administration in the field c. Review knowledge from previous levels Page 253 of 385 Trauma Chest Trauma Paramedic Education Standard Integrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression to implement a comprehensive treatment/disposition plan for an acutely injured patient. Loss of lung adhesion to chest wall due to loss of surface tension collapse of lung Page 256 of 385 2. Some low velocity wounds self-seal not allow atmospheric air into the chest but air from inspiration into the chest can occur in the same patient. With large holes air enters both the trachea and the hole rapidly collapsing the lung g. Delayed or improper treatment will lead to tension pneumothorax with large open wounds 2. Fluid replacement (see Trauma: Bleeding: Pediatric considerations Respiratory distress symptoms 3. Geriatric considerations in chest trauma Page 260 of 385 Trauma Abdominal and Genitourinary Trauma Paramedic Education Standard Integrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression to implement a comprehensive treatment/disposition plan for an acutely injured patient. Internal venous bleeding may be more severe because arterial bleeds can occlude the lumen of the artery. Most patients with penetrating abdominal injury have underlying solid and hallow organ injures (cover elsewhere) 3. Large amounts of intra-abdominal bleeding may occur without much external evidence 8. Geriatrics Page 265 of 385 Trauma Orthopedic Trauma Paramedic Education Standard Integrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression to implement a comprehensive treatment/disposition plan for an acutely injured patient. Traction control hemorrhage by apply pressure on internal bleeding within muscles wrapped by muscle sheaths.

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Radiography without contrast provides noninvasive imaging examinations of the bones and joints and is usually the first choice in initial examinations for non-trauma cases. Fluoroscopy is used to guide both diagnostic and interventional procedures and nuclear medicine examinations provide information about a wide range of conditions. Radiation therapy is used as primary, adjunct, and palliative treatment for malignant musculoskeletal diseases. Decisions regarding the appropriate selection of imaging modalities for trauma patients with possible musculoskeletal injuries are quite controversial. Decisions regarding the choice of which imaging modality to use in general skeletal assessment and trauma care are often dictated by institutional polices and often restricted by availability of various equipment and the patient status, etc. In any case, imaging examinations of the upper or lower extremity should demonstrate the portion(s) of the extremity or the area of clinical interest requested and should be repeated if the image quality is insufficient. Computed tomography of the foot and ankle is useful for the evaluation of complex fractures and tarsal coalition. The final images are created from a large series of images produced by a single axis of rotation. In the examination a volume of data is produced, which can be manipulated, through a process known as windowing, in order to demonstrate various structures based on their ability to attenuate x-rays. Cropping subcutaneous fat can result in the loss of valuable information, especially in patients undergoing evaluation for malignancies or nonspecific abdominal 1 pain for which the abnormality may be within the subcutaneous tissues. Patients who have predominantly intraperitoneal or retroperitoneal fat have improved visualization of internal organ structures compared with patients with less intraperitoneal fat due to 1 increased delineation of internal organ structures by the fat. Solutions to 1 decrease noise involve increasing kVp to 140 and increasing the effective mAs. Although both of these solutions improve 1 the image quality, they increase the radiation dose to the patient. Radiologists, technologists, and staff members should be able to assist with procedures, patient monitoring, and patient support. Appropriate emergency equipment and medications must be immediately 4 available to treat adverse reactions associated with administered medication. The equipment, medications, and other emergency support must also be appropriate for the range of ages and/or sizes in the patient population. A written policy should be in place 4 for dealing with emergency situations such as cardiopulmonary arrest. Additional information concerning radiation protection is provided later in this course. Magnetic Resonance Imaging Felix Bloch of Stanford University and Edward Purcell of Harvard University conducted the first successful nuclear magnetic resonance experiment to study chemical compounds in 1956. The most obvious advantage to the positive correlation is to reinforce treatment decisions, which in the case of labral tears, could include no surgical 5 intervention or surgery. The basic types of pulse sequences are: proton (spin) 131 2 density, T1 relaxation time, and T2 relaxation time. Each type of pulse sequence demonstrates the anatomy differently and helps differentiate between normal and abnormal structures. For a complete diagnostic evaluation, a combination of these pulse 2 sequences is usually required. The brighter the area on the image, the greater the concentration of hydrogen protons. Those who are claustrophobic may require high doses of weight-based sedative medications, which may put certain individuals at risk for respiratory depression. Additionally, before entering a high magnetic field, individuals should be screened for contraindications including biomedical devices/implants or a device that is electronically, magnetically, or mechanically activated such as pacemakers, cochlear implant, certain intracranial aneurysm clips, and orbital metallic foreign bodies. These devices may move or undergo a torque effect in the magnetic field, overheat, produce an artifact on the image, or become damaged or functionally altered. Its wide availability and lack of radiation exposure makes this method appealing for the evaluation of children. Nuclear Medicine Imaging In 1896, Henri Becquerel was investigating phosphorescence in uranium salts when he discovered a new phenomenon, which came to be called radiosensitivity.

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The hormone whose action resembles stimulation through the sympathetic division of the autonomic nervous system is (a) epinephrine, (b) cortisol, (c) androgens, (d) aldosterone, (e) melatonin. Secretion of which hormone would be increased in the case of an iodine-deficiency goiter The basal metabolic rate can reflect dysfunction of (a) the pituitary gland, (b) the parathyroid glands, (c) the adrenal gland, (d) the thyroid gland, (e) the pancreas. A symptom of diabetes mellitus is (a) glyconemia, (b) polydipsia, (c) weight gain, (d) hypoglycemia. Through negative feedback, a hormone may shut off the secretion of an anterior pituitary hormone by (a) stimulating the release of a (hypothalamic) releasing hormone, (b) inhibiting the release of a (hypothal amic) inhibiting hormone, (c) inhibiting the release of a (hypothalamic) releasing hormone, (d) all of the preceding. These impulses result in (a) synthesis and release of prolactin from the posterior pituitary, (b) release of lactogenic hormone from the anterior pituitary, (c) release of oxytocin from the posterior pituitary, (d) release of prolactin-inhibiting factor. Choose the true statement about a person with type I (insulin-dependent) diabetes mellitus. Inhibition or stimulation of transport across the cell membrane is one of the major hormonal actions. The major mode of action of steroid hormones is to increase protein synthesis in specific target organ cells. The cells of a parathyroid gland respond directly to the glucose concentration in the blood. Aldosterone, secreted from the posterior pituitary, is involved in the regulation of sodium and potassium. Hormones that cross the cell membrane are said to be, whereas those that cannot are. The gland and the function together as an integrated unit. The technical name of the posterior pituitary is, and the tech nical name of the anterior pituitary is. Developmentally, the anterior pituitary is formed from an invagination of the pharyngeal epithelium known as. Hyperthyroid secretion in infants and children is known as. Sex hormones, in addition to being produced in the ovaries and testes, are also produced in minimal amounts in the. A tumor of the chromaffin cells of the adrenal medulla is known as a. A 40-year-old man complained to his physician of polyuria, nocturia, and polydipsia. A 50-year-old man visited a clinic complaining of dry skin and hair, constipation, intolerance to cold, and diminished vigor. However, local hormones may be transported in extra cellular fluid, across synapses, or in external excretions (pheromones). False; aldosterone is secreted from the adrenal cortex, not the posterior pituitary. Blood is a fluid connective tissue that is pumped by the heart through the vessels (arteries, arte Survey rioles, capillaries, venules, and veins) of the cardiovascular system. Blood transports oxygen and nutrients to the body tissues and carbon dioxide and waste mate rials from the tissues to the organs of excretion. Blood functions to control respiratory acidosis (low pH) or alkalosis (high pH) through the bicarbonate buffer system. High levels of hydrogen ions combine with bicarbonate to form carbonic acid, which dissociates immediately to form carbon dioxide and water; as carbon dioxide is exhaled, blood becomes less acidic, and pH levels stabilize. Under conditions of hyperthermia, the blood carries excess heat to the body surface for temperature regulation.

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Attachment site of the surface forming the anterior aspect of the cal peroneus brevis muscle. D dial aspect of the navicular bone, for attach ment of the tibialis posterior muscle. Distal or ter 14 Most medial of the cuneiform bones, located minal nail-bearing bone of the toe. D 18 Most lateral cuneiform bone located between the navicular and 3rd metatarsal bones. Wormian tween the calcaneus and the fourth and fifth bones embedded in tendons or ligaments. C D regularly occur below the head of the first 20 metatarsal on both sides of the tendon of the 13 Groove for tendon of peroneus longus. Bony elevation on the inferior aspect 23 of the cuboid bone proximal to the groove for the peroneus longus. Theinferiorseg ment of the proximal articular surface projects 25 upwardly and obliquely to support the cal caneus. D Bones 53 6 1 1 2 2 3 2 3 4 3 6 5 4 6 A Right calcaneus, B Right calcaneus, 7 superior view lateral view 28 8 27 9 26 23 10 23 25 11 31 12 20 30 32 20 29 13 20 14 19 16 17 17 17 16 17 15 17 18 18 16 18 18 21 9 10 17 11 18 9 22 11 10 18 12 22 7 13 14 19 7 12 15 8 50. The median suture situated between the right and left 20 Ethmoidomaxillary suture. It is lo orbitconnectingtheorbitalplateoftheethmoid cated between the occipital bone and the two bone and the maxilla. Sutureat the nasal septum connecting the Smooth suture that extends flatly upward and sphenoidbone and the vomer. In the skull, it joins the frontal bone and nectingthegreaterwingofthesphenoidandzy 9 the lesser wing of the sphenoid bone. Inconstant suture connecting the ptery 10 noidale that connects the body of the sphenoid goid process and the maxillae lateral to the and the ethmoid. Suture connecting the zygomatic portion of the temporal bone and the greater processofthetemporalboneandthezygomatic 12 wing of the sphenoid. Ante andthemaxillasituatedposteriorlyintheorbit rior line of junction between the frontal and andonthelateralwallofthenasalcavity. E nects the nasal portion of the frontal bone and 24 thefrontalprocessofthemaxilla. Cartilaginous union between the sphenoid and petrous bones in the lateral 18 Ligamentum nuchae. Sagittal extension of the 5 continuation of the foramen lacerum, for trans supraspinalligamentsintheupperneckregion. It fuses with the tectorial membrane from the 3rd 9 chondrosisintra-occipitalisposterior]. B mental synchondrosis between the posterior andlateralossificcentersoftheoccipitalbone. Connection between the sacrum and coc A cyx;itisfrequentlyatruejoint, butoftenoccurs 11 6 Anterior intraoccipital synchondrosis. D beginning at the anterior circumference of the 23 Deep dorsal sacrococcygeal ligament. Disappears during the 6th sacrococcygeum posterius (dorsale) profun year of life. It lies in front of the apical liga elastic plate consisting of ring-shaped fibrous mentofthedens. B 19 lamellae, fibrocartilage, andacentralgelatinous 28 Anterior atlanto-occipital ligament. Mem 21 obliquely oriented connective tissue fibers ar brana atlanto-occipitalis posterior. Gelatinous, semifluid mass bone situated in the posterior wall of the verte forming the central core of an intervertebral bralcanal.

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Once the patient is in position, the radiographer should gently abduct the extended arm and then internally rotate the arm 94 for the first projection and then for the second projection, the arm should be gently externally rotated. This projection is also useful for demonstrating a Hill-Sachs defect, an anterior dislocation of the humeral head resulting in a compression fracture of the articular surface of the humeral head. If the patient cannot abduct the arm fully, the x-ray tube angle should be decreased to 15 to 20 degrees. There are several additional special projections of the shoulder that may be acquired to demonstrate specific anatomy. Both the Hobbs and Clements modification projections require manipulation of the arm and shoulder joint and should not be attempted when a fracture or dislocation is suspected. The Grashey method is used when the desired outcome is to visualize the glenoid cavity without superimposition of the humeral head. The patient 95 should be asked to suspend respiration during the exposure, Figure 3-18. A transthoracic lateral projection of the shoulder may be obtained when fracture or dislocation of the shoulder is suspected. Although a transthoracic lateral projection may be obtained in the supine position, the erect position may be easier for the patient to assume. Because a transthoracic projection of either the humerus or shoulder is obtained by imaging the part through the thorax, there is always a concern about superimposition of the ribs and lung structures. For patients who cannot adequately drop the injured shoulder and elevate the uninjured shoulder high enough to avoid superimposition, the radiographer may angle the x-ray tube 10 to 15 degrees cephalad to achieve the desired effect. Scapula the scapula forms the posterior portion of the shoulder girdle and is a flat triangular bone with three borders, three angles, and two surfaces that pose certain positioning challenges to the radiographer. The erect position is usually more comfortable for the patient and often easier for the radiographer to manage. Each patient will present with a unique body habitus so the radiographer must palpate the scapular borders to determine the exact degree of rotation necessary to move the scapula into a true lateral position. The ideal result will be an image that demonstrates the thin body of the scapula with superimposition. There are numerous special or additional projections that may be used to demonstrate specific anatomic areas of the humeral head, glenoid cavity, and the scapula. These are generally associated with suspected trauma and require various x ray tube angulations to visualize specific anatomic details. Radiographers are advised to consult available radiographic positioning references to gain competency in the many available special or additional projections for the shoulder and humerus. The basic positions may be obtained with the patient in either an erect or supine position. The radiographer should ask the patient to place their arms at the sides, chin raised, and looking straight ahead. After review of the image, if no injury is evident, the examination with weights may be performed.

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Anterior and impingement syndrome occurs during the acceleration inferior dislocations account for 95% of dislocations (59). In golfers and in a variety of other activities that use the over a rapid throw, the long head of the biceps brachii may head pattern (40). The rotator cuff, subacromial bursa, also be responsible for tearing the anterosuperior portion and biceps tendon are compressed against the anterior of the glenoid labrum. Irritation to the biceps tendon is undersurface of the acromion and coracoacromial liga manifested in a painful arc syndrome similar to that of the ment (51) (. Despite the high probability ion or abduction and is most common in such activities of injury, successful rehabilitation after surgery is quite as the tennis serve, throwing, and the butterfly and crawl common. If an athlete maintains the flexibility of the musculature surrounding the shoulder shoulder joint in an internally rotated position, impinge complex because there is considerable dependence on the ment is more likely to occur. It is also commonly injured musculature and soft tissue for support and stabilization. The supraspinatus muscle, lying in the subacromial space, is compressed and the Elbow and Radioulnar Joints can be torn with impingement, and with time, calcific deposits can be laid down in the muscle or tendon. Tendons of biceps brachii: Long head Another injury that is a consequence of impingement Short head is subacromial bursitis. This injury results from an irri tation of the bursae above the supraspinatus muscle and underneath the acromion process (29). It also develops in wheelchair propulsion because of greater-than-normal pressures in the joint and abnormal distribution of stress in the subacromial area (9). Finally, the tendon of the long head of the biceps brachii can become irritated when the arm is forcefully abducted and rotated. Bicipital tendinitis develops as the biceps tendon is subluxated or irritated within the bicipital groove. Because the biceps brachii acts on the shoulder damage to the rotator cuff, subacromial bursa, or the biceps tendon. There are actually two radioulnar articulations, the elbow is considered a stable joint, with structural the superior in the elbow joint region and the inferior near integrity, good ligamentous support, and good muscu the wrist. The elbow has three joints allowing another fibrous connection between the radius and the ulna, motion between the three bones of the arm and forearm recognized by some as a third radioulnar articulation. Movement between the the superior or proximal radioulnar joint consists of forearm and the arm takes place at the ulnohumeral and the articulation between the radial head and the radial radiohumeral articulations, and movements between the fossa on the side of the ulna. The radial head rotates in radius and the ulna take place at the radioulnar articula a fibrous osseous ring and can turn both clockwise and tions (73). Landmarks on the radius and ulna and the counterclockwise, creating movement of the radius rela ulnohumeral, radiohumeral, and proximal radioulnar tive to the ulna (12). As the radius Ulnohumeral Joint crosses over in pronation, the distal end of the ulna moves the ulnohumeral joint is the articulation between the laterally. This fascia increases union between the spool-like trochlea on the distal end of the area for muscular attachment and ensures that the the humerus and the trochlear notch on the ulna. On the radius and ulna maintain a specific relationship with each front of the ulna is the coronoid process, which makes other. Eighty percent of compressive forces are typically contact in the coronoid fossa of the humerus, limiting applied to the radius, and the interosseous membrane flexion in the terminal range of motion. Likewise, on the transmits forces received distally from the radius to the posterior side of the ulna is the olecranon process, which ulna. These are promi tend at the elbow joint may have a small olecranon process nent landmarks on the medial and lateral sides of the or a large olecranon fossa, which allows more extension humerus. The modates the medial ligaments and the forearm flexors and trochlea is covered with articular cartilage over the pronators (1). These extensions of the humerus are also anterior, inferior, and posterior surfaces and is asym common sites of overuse injury.