presented by Ann Porretto-Loehrke
Why do my patients with distal radius fractures seem to have so much difficulty regaining forearm rotation? Understanding the complexity of the forearm and how distal radius fractures can have a profound effect on forearm rotation is of the utmost importance. This presentation gives an overview of the bony and ligamentous support of the proximal and distal radioulnar joints, including an in-depth look at the role of the interosseous membrane. Therapists will be presented with a systematic approach to addressing forearm rotation issues, including expected outcomes.
Ann Porretto-Loehrke is a skilled clinician and dynamic instructor. She is the therapy manager of a large department at the Hand to Shoulder Center. Ann is a Certified Hand Therapist (CHT) and a Certified Orthopedic Manual Therapist (COMT) for treatment of the upper quadrant through the International Academy of Orthopedic Medicine (IAOM). She has extensive training in the evaluation and treatment of the upper quadrant. Ann completed a post-professional Doctorate in Physical Therapy (DPT) degree from Drexel University with a specialty in hand and upper quarter rehabilitation. Most recently, Ann has become certified in dry needling through Myopain Seminars, as a Certified Myofascial Trigger Point Therapist (CMTPT). She previously served as the Vice-Chair of the Examination committee for the Hand Therapy Certification Commission (HTCC). Ann also previously served as the Northeast District chair for the Wisconsin Physical Therapy Association from 2004 to 2008. She is a lead instructor who developed the Hand & Upper Extremity Track through IAOM, a set of six manual therapy courses designed specifically for hand and upper extremity specialists. Ann has presented at American Society of Hand Therapists (ASHT) annual conferences, Canadian Hand Conferences, Philadelphia meeting, and Teton Hand Conference.
Having an appreciation for the interosseous membrane and the interplay between the proximal and distal radioulnar joints is imperative when determining what structure is limiting forearm rotation. This chapter covers the anatomy of the forearm, including the interosseous membrane and key structures about the distal radioulnar joint, as well as the kinematics with forearm pronation and supination.
How do I know if my patient’s DRUJ is stable and in good alignment? This chapter reviews the testing of key ligamentous structures at the triangulofibrocartilage complex (TFCC) and provides guidance with appropriate treatment intervention.
Most distal radius fractures occur as a result of a fall on an outstretched hand. Increased loading of the radial head can sometimes result in stiffness at the PRUJ. This chapter covers how to manually assess the PRUJ, which can contribute to stiffness with forearm rotation.