{"id":653,"date":"2021-06-09T01:02:00","date_gmt":"2021-06-09T01:02:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=653"},"modified":"2025-10-01T11:42:41","modified_gmt":"2025-10-01T19:42:41","slug":"omm-question-of-the-day-upper-extremity-hvla-radial-head","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-upper-extremity-hvla-radial-head","title":{"rendered":"OMM Question of the Day: Upper Extremity &#8211; HVLA (Radial Head)"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-upper-extremity-hvla-radial-head\/#The_correct_answer_to_todays_OMM_Question_is%E2%80%A6\" >The correct answer to today&#8217;s OMM Question is&#8230;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-upper-extremity-hvla-radial-head\/#D_Pronate_his_wrist_and_flex_the_elbow_rapidly_while_you_thrust_posteriorly_at_the_radial_head\" >D. Pronate his wrist and flex the elbow rapidly while you thrust posteriorly at the radial head<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-upper-extremity-hvla-radial-head\/#Incorrect_answer_explanations\" >Incorrect answer explanations<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-upper-extremity-hvla-radial-head\/#A_Extend_his_wrist_while_he_resists_by_trying_to_flex_his_wrist\" >A. Extend his wrist while he resists by trying to flex his wrist<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-upper-extremity-hvla-radial-head\/#B_Flex_his_wrist_while_he_resists_by_trying_to_extend_his_wrist\" >B. Flex his wrist while he resists by trying to extend his wrist<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-upper-extremity-hvla-radial-head\/#C_Supinate_his_wrist_while_he_resists_by_trying_to_pronate_his_wrist\" >C.&nbsp;Supinate his wrist while he resists by trying to pronate his wrist<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-upper-extremity-hvla-radial-head\/#E_Supinate_his_wrist_and_extend_the_elbow_rapidly_while_you_thrust_anteriorly_at_the_radial_head\" >E. Supinate his wrist and extend the elbow rapidly while you thrust anteriorly at the radial head<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-upper-extremity-hvla-radial-head\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-upper-extremity-hvla-radial-head\/#Major_Takeaway\" >Major Takeaway<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-upper-extremity-hvla-radial-head\/#Want_to_learn_more_about_this_topic\" >Want to learn more about this topic?<\/a><\/li><\/ul><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>Today&#8217;s OMM question involves a 21-year-old man who fell backward on his outstretched left hand.&nbsp;<\/em><\/strong><strong><em>Which maneuver would correctly treat the somatic dysfunction at his elbow?<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 21-year-old man presents to the emergency department with one day of left&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Anatomy_clinical_correlates:_Arm,_elbow_and_forearm\" target=\"_blank\" rel=\"noreferrer noopener\">elbow pain<\/a>. He fell backward on his outstretched left hand yesterday while skateboarding. He describes the pain as a dull ache and rates it at 5\/10 on a 10-point scale. It does not radiate anywhere and is not associated with numbness or tingling of the left forearm or hand. His past medical history is non-contributory, and he takes no medications. His temperature is 37.3 \u00baC (99.1 \u00baF), pulse is 90\/min, respirations are 18\/min,&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Blood_pressure,_blood_flow,_and_resistance\" target=\"_blank\" rel=\"noreferrer noopener\">blood pressure<\/a>&nbsp;is 136\/79 mmHg. On physical examination there is tenderness to palpation at the&nbsp;<a href=\"https:\/\/www.osmosis.org\/learn\/Anatomy_of_the_elbow_joint\" target=\"_blank\" rel=\"noreferrer noopener\">left lateral elbow<\/a>. The left forearm is restricted in pronation. X-rays of the left shoulder, elbow and wrist show no dislocation or fracture.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Which of the following would correctly treat the somatic dysfunction at his elbow?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Extend his wrist while he resists by trying to flex his wrist<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Flex his wrist while he resists by trying to extend his wrist<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C.\u00a0Supinate his wrist while he resists by trying to pronate his wrist<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Pronate his wrist and flex the elbow rapidly while you thrust posteriorly at the radial head<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Supinate his wrist and extend the elbow rapidly while you thrust anteriorly at the radial head<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\">Scroll down for the correct answer!<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-rich is-provider-embed-handler wp-block-embed-embed-handler wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Osmosis.org at King&#039;s College London\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/baM02CmOKp8?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_OMM_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s OMM Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Pronate_his_wrist_and_flex_the_elbow_rapidly_while_you_thrust_posteriorly_at_the_radial_head\"><\/span>D. Pronate his wrist and flex the elbow rapidly while you thrust posteriorly at the radial head<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the&nbsp;<strong>Main Explanation<\/strong>, let&#8217;s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_answer_explanations\"><\/span>Incorrect answer explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Extend_his_wrist_while_he_resists_by_trying_to_flex_his_wrist\"><\/span>A. Extend his wrist while he resists by trying to flex his wrist<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Rationale: <\/strong>This could be used to treat an extension restriction and\/or lateral epicondylitis. Given the fall and difficulty with pronation, an anterior radial head dysfunction is much more likely.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Flex_his_wrist_while_he_resists_by_trying_to_extend_his_wrist\"><\/span>B. Flex his wrist while he resists by trying to extend his wrist<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Rationale: <\/strong>This could be used to treat a flexion restriction and\/or medial epicondylitis. Given the fall and difficulty with pronation, an anterior radial head dysfunction is much more likely.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Supinate_his_wrist_while_he_resists_by_trying_to_pronate_his_wrist\"><\/span>C.&nbsp;Supinate his wrist while he resists by trying to pronate his wrist<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Rationale: <\/strong>He is restricted in pronation, meaning supination is a motion of ease for him. This technique would not help his somatic dysfunction.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Supinate_his_wrist_and_extend_the_elbow_rapidly_while_you_thrust_anteriorly_at_the_radial_head\"><\/span>E. Supinate his wrist and extend the elbow rapidly while you thrust anteriorly at the radial head<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Rationale: <\/strong>This HVLA maneuver is used to treat a posterior radial head. His radial head has an anterior dysfunction.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Radial head dysfunctions are common after falls on an outstretched hand. Normally, the radial head moves anteriorly during supination and posteriorly during pronation. The opposite occurs at the distal radius. Falls forward on an outstretched hand force the radial head posteriorly and can cause restriction in supination. Falls backward on an outstretched hand force the radial head anteriorly and can cause restriction in pronation. Recall the \u201cSAPP\u201d mnemonic (Supination is the motion of ease for an Anterior radial head, and Pronation is the motion of ease for a Posterior radial head).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This patient\u2019s restriction is in posterior motion and pronation, implying he has an anterior radial head dysfunction. Treatment with HVLA involves flexing and pronating the elbow quickly while applying a posteriorly directed thrust at the anterior radial head.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">An anterior radial head dysfunction presents with a restriction in both posterior glide of the radial head and pronation. It can occur after a fall backward on an outstretched hand. HVLA treatment involves flexing the elbow and pronating while thrusting posteriorly at the radial head.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Want_to_learn_more_about_this_topic\"><\/span>Want to learn more about this topic?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Watch the Osmosis video:<\/strong> <strong><a href=\"https:\/\/www.osmosis.org\/learn\/Approach_to_extremity_injury:_Clinical_sciences\">Approach to extremity injury: Clinical sciences<\/a><\/strong><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/create\" target=\"_blank\" rel=\"noreferrer noopener\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/08\/1.png?w=700\" alt=\"Osmosis sign up ad\" class=\"wp-image-288\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/08\/1.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/08\/1.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Want more OMM Questions as well as practice questions for USMLE\u00ae Step 1 and Step 2 CK?<\/strong><\/em> <em><strong>\u00a0Try Osmosis today! Access your\u00a0<a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a>\u00a0and find out why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Explore today&#8217;s OMM question focusing on elbow somatic dysfunction and learn the correct treatment technique for a patient with a radial head issue.<\/p>\n","protected":false},"author":202,"featured_media":655,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,10,20,34,16],"tags":[825,829,265,827,645,828,149,824,826,830],"class_list":["post-653","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-clinical-skills","category-exam-prep","category-omm","category-do","tag-clinical-education","tag-elbow-pain","tag-healthcare-training","tag-musculoskeletal-assessment","tag-omm","tag-osteopathic-manipulation","tag-patient-care","tag-radial-head-dysfunction","tag-somatic-dysfunction","tag-treatment-strategies"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>OMM Question of the Day: Upper Extremity - HVLA (Radial Head) - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-upper-extremity-hvla-radial-head\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"OMM Question of the Day: Upper Extremity - HVLA (Radial Head) - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Explore today&#039;s OMM question focusing on elbow somatic dysfunction and learn the correct treatment technique for a patient with a radial head issue.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.osmosis.org\/blog\/omm-question-of-the-day-upper-extremity-hvla-radial-head\" \/>\n<meta property=\"og:site_name\" content=\"Osmosis Blog\" \/>\n<meta property=\"article:published_time\" content=\"2021-06-09T01:02:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2025-10-01T19:42:41+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/26.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1080\" \/>\n\t<meta property=\"og:image:height\" content=\"1080\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"author\" content=\"Marina Horiates Kerekes, MD &amp; 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