Krass Realities of Arm Rotation and RI

Mr. E. J.
Krass, SoH
Just Call Me - Galileo II/Founder of the Unified College of Medicine Spokesperson for THE TRUTH BASED FREE Society and Its Realm
RE: Distribution of my withheld thesis paper through public domain To Everyone: In March 2001, I first distributed my thesis paper founded upon self evident Truth, observations of comparative x-ray images and application of centripetal mechanics. In May 2004, under Full Disclosure, the appeals commission for the WCB alberta affirmed that it has always acted as a devils advocate in my matters just as the WCB administration has done since November 1, 1998 several months before I was injured: Exhibit K on File No.
PO-001 with The Defender of The Faith.

In Exhibit Q on File No. PO-001 with The Defender of The Faith , it was discovered that the administration was the source of devils advocacy across Canada since 1982 and the corruption is contained in all quasi-judicial tribunal decisions since April 17, 1982. Canadas Charter of Rights and Freedoms is devils advocacy because s. 3 exists in defiance of The Supremacy of God and Rule: Petition to The Defender of The Faith - formerly Petition to the monarch when BAD FAITH is acknowledged: administration has NO RIGHT to exist under The Rule of The Supremacy of God and its Petition to The Defender of The Faith!. With the release of Exhibit K on File No. PO-001 with The Defender of The
Faith, the reality of Mr. Smith Goes To Washington was revealed concerning administration. The
correction of corruption was not though because changing the system to THE FREE Society of Equals and Its Realm as dictated by objectively supported Truth through dismissal of administration once and for all and forevermore could not have been presented as it is the embodiment of The Holy Spirit. Once a false step is taken away from The Truth, the administration MUST maintain the corruption through lies, deceit and deception - the role of devils advocate. All administration is PO Box 1041 STN MAIN, DAWSON CREEK BC V1G 4H9
Mr. E. J. Krass, SoH

Just Call Me - Galileo II/Founder of the Unified College of Medicine Spokesperson for THE TRUTH BASED FREE Society and Its Realm a lie as my thesis paper confirms because tennis elbow is a serious and significant PHYSICAL injury that can be easily prevented but not if everyone is devoted to mammon and the pursuit of wealth. Deuteronomy 22:19 reads as follows: Thou shalt not lend upon usury - mammon - from the era of Jesus Christ/the pursuit of wealth for today and since the 1200's AD. (The beast that was and is, yet is not is exposed.) Those choosing to Do Right including existentialists or those following moral conscience can only find THE FREE Society of Equals and Its Divine Existence through dismissal of usury/mammon/the pursuit of wealth which is a belief system or religion based on corruption. As my thesis paper and the path that I was ordered to follow based upon devils advocacy/administration is beyond dispute by anyone reading these documents, I am now releasing my 2000 thesis paper entitled The Krass Realities of Upper Extremity Rotation and Rotatory Instability as a public domain document along with the Preamble to it as written for The Defender of The Faith and as wholly unified document that they truly are. Review the x-ray images and centripetal mechanics and you will realize that I was not wrong but the system hid this document from public consumption and my legal documents through the application of the corrupt constitutional questions act because my documents are imbued with The Truth/The Holy Spirit and they ultimately throw out everything that mankind has done for millennia build civilizations built upon false gods and false promises of administration and their ideals. Fortunately, God showed me how to dismiss everything under Rule: Petition to The Defender of The Faith. Take care and leave those cities for living with God now that you know that your civilizations are about to be dismissed and replaced with the 4 Primary Laws of THE FREE Society of Equals contained on pages 168 through 191 of The August 2009 Peremptory Order. In this universe, there is Doing Right as supported by the objectively supported Truth/The Holy Spirit with all else being wrong! PO Box 1041 STN MAIN, DAWSON CREEK BC V1G 4H9

Sincerely,

Author of The Treatise on The Petition to the Court Due Legal Process Galileo II/Spokesperson for THE TRUTH BASED FREE SOCIETY Founder of the Unified College of Medicine Petitioner on File No. PO-001 with The Defender of The Faith
For The Record: the term radiocapitellar joint is the same as the radiohumeral joint in Grays Anatomy and my thesis paper. The newer term is reflective of the fact that the hidden part of medicine accepts that the radiocapitellar joint is the primary joint of the elbow but without the political ramifications of this change in understanding. To understand everything easily, just note that there can be only one mature, healthy standard for the upper extremity. But, there are only 2 option to sort through: radiocapitellar joint centric or ulno-humeral joint centric. The medical community in 1901 went with the latter and has refused to correct its standards because it rewrites everything pertaining to human anatomy. T h e x - r a y i m a g e s p r o v i d e d a t https://skydrive.live.com/self.aspx/Public/Objective%20x-ray%20evidence%2 0for%20MANDAMUS?cid=76d01868d933a2ac&sc=documents make it clear that the medical standards for human anatomy is 100% wrong as the arm upper extremity complies fully with the engineering standards of centripetal mechanics along with torsion along solid objects which defines the lateral/side ligaments of ginglymus joints as load bearing and unifier of the arm for force distribution up and down the arm. The answer was always the fact that the upper extremity is radiocapitellar joint centric but, once a path that is wrong is taken by administration, it is impossible to correct simply as the entire understanding of medicine must now be dismissed as IT IS WRONG! The medical community has made that point abundantly clear as it hid my factually supported thesis paper for no other reason than it repudiated the current approach to medicine. PO Box 1041 STN MAIN, DAWSON CREEK BC V1G 4H9

Just Call Me - Galileo II/Founder of the Unified College of Medicine Spokesperson for THE TRUTH BASED FREE Society and Its Realm June 25, 2011
The Defender of The Faith, Queen of England/the british monarchy Buckingham Palace London SW1A 1AA ENGLAND
RE: The simple reality of the mature, healthy and kinetic human body and the corruption keeping it from coming out cc: Everyone via the internet
To Everyone, 1. After years of having my 2000 thesis paper kept hidden from everyone, it was put in
my head that the reason for the corrupt response to the simple discoveries, that the radiocapitellar joint of the elbow is the ginglymus joint of the elbow and it employs centripetal mechanics through flexion and extension plus the discovered load bearing lateral ligaments make the elbow function like an universal joint in the drive trains for front engine/rear wheel drive cars, was because the system could not bear to accept that its way of functioning was/is corrupt and has been forever. Basically, God given change of manmade theories and educated presumptions cannot be imposed by the objective facts/self evident Truth because the only way to effect change with The Supremacy of God/Holy Spirit/Mandate of Heaven is to dismiss the corruption that is administration and start anew without administration. 2. Fortunately, the british empire, although founded upon corruption in the form of
aristocracy, retained the title of The Defender of The Faith to whom the disenfranchised can petition for the dismissal of administration by democracy which merely took over the administrative practices of the aristocracy while imposing mammon: i.e. the pursuit of wealth both as an ideal as well as the
PO Box 1041 STN MAIN, DAWSON CREEK BC V1G 4H9

Just Call Me - Galileo II/Founder of the Unified College of Medicine Spokesperson for THE TRUTH BASED FREE Society and Its Realm imposition of everyone having to earn a living if you are not part of the elites with the majority of the wealth; you must be taught to pursue wealth in your daily lives for the beast, that is mammon, to continue to exist which means that NOBODY has the right to life, liberty and security of person and the right not to be deprived of these God Given Rights except in accordance with The Principles of Fundamental Justice. 3. Whenever God Weighs In with objective evidence that dictates a singular outcome
and path that dismisses all else, the administration then uses due processes to deny the disenfranchised from The Truth and its consequences who then has the right and obligation To Petition The Defender of The Faith not just to gain redress for the personal misfortune caused by the administration and its ruling through the letter of the laws but also for the establishment of the proper simple acceptance of The Truth once and for all and forevermore. 4. In this world, there are only 2 types of people: those who accept and abide by The
Truth without exception and which results in us seeing the mosaic that pure facts create when not denied by the administration and its creation and use of due process that were put in place merely to stall the arrive of The Truth, i.e. the administration plays devils advocate against not just The Truth but also those touched by it while the others are those willing to lie in order to keep The Truth from impacting everything and shattering the illusion that has been made real through countless lies and institutional decision making historically and currently whose sole reason for existing is to play false god over everyone else!
The Brick Wall

5. The medical communitys administration is as corrupt as before because clinical
studies look at diseases and eradication of the disease through biochemistry or, now, manipulation of DNA, etc. The ability to cure diseases by studying their growth is a path that will bear limited

Just Call Me - Galileo II/Founder of the Unified College of Medicine Spokesperson for THE TRUTH BASED FREE Society and Its Realm fruit because the human anatomy from the mature, healthy and kinetic body, needing to be advanced and all human activity being based around maintaining the mature, healthy and kinetic human body and its environmental needs, remains un-imposed through The Supremacy of God by the system due to it having chosen the WRONG path since the 1970s. 6. I found the objective evidence concerning the function of the radiocapitellar joint and
the arm as a whole unit/drive train based around the fact that ginglymus joint produce drive trains just as the Mayo Clinic did in the 1970's and just as was predictable given The Supremacy of God. Just as now and since 1999, those in the medical community who found this Truth had their facts relegated to insignificance status by other academics as happened with me where cause-and-effect was purposely and unethically shunted to the side because changing human anatomy and the policy of studying diseases with the intention of eradicating them was too intrenched to be dismissed even though it has proven ineffectual for the large part and mankind has become sicker in the rich realm rather than healthier. 7. The means by the College of Physicians and Surgeons to negate The Truth and the
self evident demand of fundamental shift back to advancing our understanding of human anatomy, which is done from reconciling the effects of overuse in MRIs to x-ray images and the current axioms of engineering like centripetal mechanics, is applying the term natural to injuries or using the machines to make a legitimate injury appear fictitious when they are not and then forcing the patient to repeat the logical process of reconciliation against the wishes of the administration. This due process is unacceptable and is therefore grounds for the dismissal, once and for all and forevermore, of the College of Physicians and Surgeons along with clinical studies especially since all Colleges of Physicians and Surgeons are agents of the provincial and state governments NOT objective evidence and its dictates! 8. When reverse onus/devils advocacy is established in the administrative policies,
dismissal of the administration is demanded which includes the College of Physicians and Surgeons. PO Box 1041 STN MAIN, DAWSON CREEK BC V1G 4H9
3

The Truth
9. Self Evident Truth/The Holy Spirits/The Mandate of Heaven does not need a
spokesperson unless and only unless the administration has returned to the policy of playing devils advocate and using reverse onus to challenge those disenfranchised by denial of The Truth to figure out how to effect the change discovered in the self evident Truth: learn to dismiss administration through The Petition to The Defender of The Faith as the monarch gave royal ascent over the centuries to everything and the title, Defender of The Faith, obliges The Defender of The Faith to dismiss that which has been repudiated over the passage of time upon Petition from the disenfranchised.
Personal Experience and The Self Evident Truth

10. In 2000, I produced a medical thesis paper where I simply looked at the x-ray images
from a mature, healthy and kinetic radiocapitellar joint and discovered the self evident Truth that NONE of the characteristics of hinges were present anywhere - in both the mature, healthy and kinetic human body and the films of the dyskinetic elbow. Therefore, the human anatomy standards currently ARE wrong! 11. In June 1991 upon intake into a rehabilitation center in Edmonton, my right elbow
was noted to have an abnormal laxity compared to my left when distraction was applied to both elbows. My lack of right arm function remained disabled by discharge in July when my condition had gotten worse. Then, in October 1991, a similar test was undertaken and a x-ray film taken of the bent elbow from its side was shot. This postero-lateral rotatory instability x-ray still shows my radial head was dislocated just as the technician noted when backward force was applied to my right elbow and, with the technician standing directly behind the elbow, she stated right away that she saw my right elbow dislocate. 12. In 1995, I reviewed a set of comparative x-ray images of my elbows and discovered PO Box 1041 STN MAIN, DAWSON CREEK BC V1G 4H9
4

Just Call Me - Galileo II/Founder of the Unified College of Medicine Spokesperson for THE TRUTH BASED FREE Society and Its Realm a significant deviation between the alignments which Dr. Rob Lloyd-Smith confirmed at the AllanMcGavin Sports Center at the University of British Columbia at our next appointment. This deviation of forearm alignment from the normal healthy valgus alignment is still present in all comparative x-rays - dyskinetic to the mature, healthy and kinetic elbow/arm - as the medical communities across Canada are hiding the reality that lateral epicondylitis is a serious and significant injury to the soft tissues at the radiocapitellar joint which affect the entire arm rather than tennis elbow being a simple pain management issue, i.e. the problem is psychological. 13. On July 4, 1995, a comparative CT scan was performed and purposely not
interpreted correctly to try and dissuade me from getting to The Truth just mentioned. In the comparative CT scan, it is patently obvious that the radial head of the radius at the lateral epicondyle in my right arm was varusly aligned and had a significant abnormal gap at my right elbows lateral epicondyle that exists across several slices unlike the valgus aligned, mature, healthy and kinetic elbow in my left arm. 14. On March 7, 1997, I attended the Kerlan-Jobe Orthopaedic clinic and was shocked
by the response of the surgeon to my ongoing case of overuse syndrome. In our discussion, the surgeon asked me what I had been doing with myself as I was unable to use my right ARM which is consistent with overuse syndrome patients like pitchers or quarterbacks which the Kerlan-Jobe Orthopaedic Clinic treats. My response was, Surviving with the help of my family. This survival has gone on since 1997 through today and through the application of reverse onus on the part of administration across Canada and the british commonwealth has become more obtuse and vicious against those knowing The Truth concerning elbow injuries, consequently, the Order within the commonwealth must be dismissed with prejudice by the disenfranchised through Rule: Petition to The Defender of The Faith in order for Fundamental Justice to be allowed its course, i.e. the self evident Truth to take hold and be all that is left going forward. PO Box 1041 STN MAIN, DAWSON CREEK BC V1G 4H9
5

Just Call Me - Galileo II/Founder of the Unified College of Medicine Spokesperson for THE TRUTH BASED FREE Society and Its Realm 15. Finally, on August 4, 1998 (yes, that is correct - 17 months after the requisition was
issued and AGAINST the wishes of Canadas medical colleges across Canada), the Gadolinium enhanced MRI on my elbow was done and affirmed that my right elbows radiocapitellar joints lateral soft tissue complex had been destroyed from the overuse syndrome encountered on the Gordondale job site as was predicted given that my person had been allowed to mature before encountering overuse syndrome, i.e. the forced abnormal contraction of the mislabeled pronator teres muscle that causes the bicipital tuberosity of the radius to act like a fulcrum and place abnormal force on the load bearing soft tissue structures at the lateral epicondyle of my right elbows radiocapitellar joint. 16. In 1999, I bought a Grays Anatomy book and read about elbow and ginglymus joints.
To my horror, I discovered that the ligament structures of the elbow were completely different from that of hinge characteristics. 17. Then, after applying centripetal mechanics, I concluded quite rightly that the drive
trains of all bodies distribute force from the trunk out - the ball joints of shoulders and hips outward and the ginglymus joints structures then function like universal joints in the drive train of front engine/rear drive vehicles: the strongest muscles on the human body exist at the shoulders and hips for a reason. 18. In 1999, I took a simple thing like a clothes line pulley and modified it in my mind
to make the force external of the pulley and the pulley itself remaining fixed to the bone like the humeral capitellar head. Then, I used the side ligaments found in all ginglymus joints to control force making them load bearing. So, in the radiocapitellar joint, the lateral ligaments are the radial ligament at the lateral complex while the internal ligament was over the spine of the olecranon right beside the radiocapitellar joint which allowed the ulna to rotate under the bicipital tuberosity as the Sigmoid Cavity has a spine just like the hull of a boat and the backside of the Bicipital Tuberosity has cartilage that facilitates a small amount of rotation of the ulna within it. PO Box 1041 STN MAIN, DAWSON CREEK BC V1G 4H9
6

Just Call Me - Galileo II/Founder of the Unified College of Medicine Spokesperson for THE TRUTH BASED FREE Society and Its Realm 19. After producing my 2000 thesis paper, that was derived from a review of the ligament
structures and observations of a mature and healthy outstretched arm performing hand pronation and supination, I was shocked at the visceral denial of The Truth which is undeniable according to The Truth, The Principles of Fundamental Justice and scientific principles where the objective reality dictates and demands all changes in theories regardless of the consequences rather than the system knowingly providing false contradictory opinions and using the medical machine to compromise the integrity of science! (According to legalise, the actions of the administrators of the colleges of physicians and surgeons constitute bearing false witness against the job injured or any injured with an elbow injury - perjury. Plus, those performing CT scans and bone scans where the imagery is being done incorrectly so as to refute illegitimately a correct and indisputable Gadolinium enhanced MRI determines that the system has absolutely NO MORALS nor conscience when it comes to Doing No Harm!) 20. The basic premise of my 2000 thesis paper and my findings along with those of the
legitimate medical community, that is now fully supported and beyond reproach, is that tennis elbow/lateral epicondylitis/overuse syndrome/repetitive stress produce serious injury to your person rather than the longstanding and repudiated medical standard that these conditions are merely a pain management problem - a psychological problem of the person. 21. The confusion arose around the fact that the human body and everyone can override
the safety features of the person and redirect electrical impulses across the wrong nerves to cause dyskinesis, i.e. abnormal contraction of the mislabeled pronator teres muscle, unbeknownst to the general public. 22. The consequences of continuing not to listen to the human body and impose injury
prevention is that nothing changes nor gets resolved and people then get injuries to shoulders, wrists, hands, necks, ribs, across the upper body elastic band to the other hand and hips and legs which are really complications of the insufficiency of the load bearing lateral radiocapitellar joints PO Box 1041 STN MAIN, DAWSON CREEK BC V1G 4H9
7

Just Call Me - Galileo II/Founder of the Unified College of Medicine Spokesperson for THE TRUTH BASED FREE Society and Its Realm soft tissue structures that were never resolved nor prevented. 23. For over a decade now, the medical community and the administrative authorities
including the mass media have covered up my discoveries that were also made all the way back through the 1970's by the Mayo Clinic based upon the new evidence - centripetal mechanics - and the administration is now disavowing its responsibility to everyone which is to provide you with The Truth so that change MUST no longer be forestalled by due processes established to hinder those touched by The Truth and The Truth from coming out. 24. Currently, changing such a simple item at the base level of knowledge is impossible
because the system used linear logic to construct the illusion made real of today where reality could not impact on the devotion of the administrators to mammon: nobody has the right to earn a livelihood because not one form of motion was every built around the mature, healthy and kinetic human body; furthermore, nobody has the right to impose servitude to the pursuit of
wealth/mammon that has become standard in the rich nations. 25. All that has gone on in the industrialized world since WWI is create devotion to
mammon in everyone while the Christians and their leaders refused to use the law of Luke 16:13 to reverse the corruption of Christianity that was formalized back in the 1200's AD and which was actually imposed by The Holy Roman Empire and the Pope where the Jews were used to circumvent the law of Luke 16:13 in Venice because Jews were not restricted from making a profit off of all other non-Jews in defiance of The Truth: either everyone serves God/Allah/The Great Spirit/The Holy Spirit/The Mandate of Heaven/etc. every moment of our lives or you are serving mammon and giving 3 hours of your life to produce an appearance of loyalty to God by preparing to go to weekly services and then merely attending these services and paying a tithe.

The modified pulley system

death is not an option

Just Call Me - Galileo II/Founder of the Unified College of Medicine Spokesperson for THE TRUTH BASED FREE Society and Its Realm For the record: just means that I was first there and that fact needs to be recognised by everyone. 26. Until recently, I used to draw the modified pulley system but with the radiographic
films having been scanned and put online, this step is no longer necessary. 27. To understand, the modified pulley system just remember that the force runs parallel
to the bones or alongside them and on their outsides. So, in Mandamus Evidence Package doc. no. 0124, the x-ray film taken from the side of the healthy bent elbow, it is clear that the radius and forearm is pulled up by biceps contraction. Also, the bicipital tuberosity is rotated upwards from the ulna during biceps contraction: this does not mean that the radial ligament is being expanded from the flow of joint fluid from one side of the joint to the other like other non-load bearing joint ligaments but, as the radial ligament is solid and load bearing, the radial rotation means that the radial ligament is functioning like a typical windshield wiper on a north american car where the upper ligament attachment forces the radius to rotate in a circular motion relative to the Humeral Capitellum. Now, as the radial ligament is so small, this arcing is basically done as a point in basic geometry rather than over a larger circles circumference. 28. In the reversal position of the forearm from biceps contraction, i.e. with triceps
contraction, Mandamus Evidence Package doc. no. 0127 or where the arm is fully outstretched and the image taken from the side, the mature, healthy and kinetic arm/elbow is tight with a noticeable rotation of the humerus unlike the bones in the unhealthy arm which are un-rotated and lose as determined by the lack of overlap between the ulna and radius. To get the outstretched position from the biceps contracted position, electrical stimulation was sent to the various heads of the triceps as outlined in my 2000 thesis paper. 29. The common union for this motion is the Humeral Capitellum or upper condyle for
all other ginglymus joint - the convex end of the upper bone. So, with biceps and triceps contraction, the Radial Head is pulled up against the Humeral Capitellum and the force is kept in linear alignment
10

Just Call Me - Galileo II/Founder of the Unified College of Medicine Spokesperson for THE TRUTH BASED FREE Society and Its Realm with the upper bone by the lateral load bearing ligaments of ALL ginglymus joints not just those found on everyones persons but those on animals and now extinct animals like dinosaurs or the dodo bird or the Tasmanian Devil, etc. 30. This functionality of the convex end of the upper bone correlates to the pulley on a
clothes line but one where the pulley remains stationary as it is fixed to the upper bone. Get a hold of a clothes line pulley and you will instantly see the correlation when the attachment end remains loose/motionary and unfixed to any object - the correlate is the lower portion of the ginglymus joint as well as the load bearing ligaments at the sides of the ginglymus joints. 31. It is important to note the rotation of the radius through the location of its Bicipital
Tuberosity in the modified pulley system. From biceps contraction, the Bicipital Tuberosity is away from the ulna but, in full extension, this bone extension is tight against the ulna. So, biceps contraction obviously rotates the radius but how does the reverse rotation take place? 32. The triceps heads attach to the ulna and not the radius. So, the reverse rotation of the
radius cannot in any way be related to triceps contraction. Obviously then, the only muscle capable of reverse rotating the radius through arm extension has to be the mislabeled pronator teres. 33. To prove that the pronator teres only rotates the radius to the point where the Bicipital
Tuberosity reside on top of the ulna, first, place your fully outstretched arms in front of you at 90 degrees to your chest and at shoulder height. Now, with the arm remaining fully outstretched, place the hand in the supine or palm up position and then pronate the hand without much force. BAM, the medial epicondyle moves downward through hand pronation which means that the humerus has rotated at the shoulder and this also means that full supination required shoulder muscle contraction which I outlined in my 2000 thesis paper. 34. Now, putting the arm down and bending the elbow, supinate and pronate the hand.
Obviously, the humerus does not move but the range of hand supination and pronation is greatly
11

Just Call Me - Galileo II/Founder of the Unified College of Medicine Spokesperson for THE TRUTH BASED FREE Society and Its Realm decreased. This observation determines that the biceps is rotating the radius in counter contraction to the contractions of the mislabeled pronator teres because the majority of hand pronation in this instance is done by contraction of the muscles attached to common head of the extensors at the lateral epicondyle, i.e. the hands backside is being pulled up rather than the thumb being pulled down! 35. Obviously then, the interosseous membranes are actually ligaments that anchor force
to the radius which is the main bone for the forearm in mature, healthy and kinetic upper extremity functionality, i.e. the arm is NOT ulno-humeral centric but rather radiocapitellar joint centric! 36. This reality explains why, just after suffering a sharp sudden pain at the lateral
epicondyle, i.e. when the radial head is suddenly displaced laterally while the bicipital tuberosity is pulled into the ulno-radial joint at the elbow and the radiocapitellar joints soft tissue structure becomes split longitudinally and, with continued use of the offending motions, the lower or proximal forearm, wrist and hand swell dramatically: the soft tissue of the previously mature, healthy and kinetic person in the forearm/wrist/hand are now being exposed to dyskinetic force that causes the swelling which increased day after day. 37. 38. But, now, comes the good stuff pertaining the modified pulley system! As is now known, force has to be tied in some fashion to the bones above the
ginglymus joints or else the modified pulley system which is valid does not exist. 39. In the mature, healthy and kinetic human body, the anchoring of the force of muscle
contractions create not just healthy bones but those lovely things inside bone marrow like a persons auto-immune system, stem cells and the auto-regenerative system. The loss of the radiocapitellar joints lateral complex means that that person will die but this point also means that maintaining this lateral complex is paramount to the lifestyle for living perpetually. 40. When Sir Isaac Newtons 3rd Law of Motion - for every action there is and equal and
12

Just Call Me - Galileo II/Founder of the Unified College of Medicine Spokesperson for THE TRUTH BASED FREE Society and Its Realm opposite reaction - is applied to bones, one discovers that there is a mature, healthy and dynamic tension to bones. So, when the radiocapitellar joints lateral complex is destroyed from overuse or longer term repetitive stress - strong and weak contraction of the mislabeled pronator teres, ultimately this results in destruction of health. 41. With it now known that there is a Way to live that will promote health and allow the
human body to defend itself from mutating viruses and other age related diseases now easily shown to be complications of living with a dyskinetic human body, s. 7 of Canadas Charter of Rights and Freedoms and Amendment 14 in the United States can be upheld as grounds for dismissal of not just administration but also ideology especially electing rulers or imposing the pursuit of wealth. 42. Obviously, all I did was observe both the dyskinetic human body as well as the
mature, healthy and kinetic human body and apply the proper engineering to the mature, healthy and kinetic human body across all time which led me to dismiss Grays Anatomy and the current approach to medicine which is to study diseases rather than advance human anatomy to that of the current engineering standards. 43. In response, the administration and its collusionary bodies, made so by extension of
the rule of law and passed enactments, have sat on my 2000 thesis paper, denied The Truth on countless occasions and become obstinate to the point where The Truth seemed impossible to get out - it is easier for Heaven and earth to pass away than for one stroke of the letter of the law to fail. Fortunately, by noting the means for reversing fortune under mala fides, it dawned on me that change within the system that destroys the system as the self evident Truth dictates as much, cannot be done through the system but by dismissal of the system by the Rule: Petition to The Defender of The Defender of The Faith which is the only means to do so under the british system and, according to The Supremacy of God when reverse onus/devils advocacy is being used by administration. 44.
We, the people, unified and indivisible under God in the british
13

Just Call Me - Galileo II/Founder of the Unified College of Medicine Spokesperson for THE TRUTH BASED FREE Society and Its Realm empire DO have someone to petition with the evidence of wrongdoing, corruption and malfeasance at the administrative level: The Defender of The Faith as the monarchy owns what is going on through it having granted royal ascent to the laws enacted by legislatures and parliaments and on advice of parliaments, legislatures and senates or The House of Lords. Unfortunately, those in other nation states dont have this corrective due process nor the resulting ability to dismiss the administration and governance based upon denial of Truth. 45. So, please, put the information from this document and the scanned version of my
2000 thesis paper now online through your CAD programs and you will learn The Truth but you will also learn that there is no way that I can get a patent for this because it deals with the mature, healthy and kinetic human body that is God Given! (This point determines that patents and any other name for creative thought like Intellectual Thought is, always has been and always will be a fictional standard that is of no effect relative to discoveries and ownership of all thought that is derived from The Truth and the mosaic of The Truth which are the only standards.)
Ramifications
46. With the application of new evidence - centripetal mechanics - and the acceptance
that the upper extremity is a drive train that is radiocapitellar joint centric, fully functional arms and hands can now be build but without patents because this is a God Given discovery. 47. Furthermore, with materials that the human body can absorb and replicate into bones,
muscles, nerves, the circulatory system, there is no end to repairing the human body but only if with dismiss that which is doing harm and living the lifestyle of the mature, healthy and kinetic body. Without harm prevention, everything that has been presented is a waste.
14

Just Call Me - Galileo II/Founder of the Unified College of Medicine Spokesperson for THE TRUTH BASED FREE Society and Its Realm Please, check out the attachments and send me an email reply at the sites/profiles noted if you re-affirm the patently obvious or if you see The Truth right off and want to help getting The Truth out!
Sincerely,

Author of The Treatise on The Petition to the Court Due Legal Process Galileo II/Spokesperson for THE TRUTH BASED FREE SOCIETY Founder of the Unified College of Medicine Petitioner on File No. PO-001 with The Defender of The Faith
The internet cloud addresses for my now public domain thesis paper on Arm Rotation and Rotatory Instability are: http://www.scribd.com/doc/59698513/Krass-Realities-of-Arm-Rotation-and-RI and https://skydrive.live.com/self.aspx/Public/My%202000%20Thesis%20Paper?cid=76d01868d933 a2ac&sc=documents
This reality will forever change your minds about how THE FREE Society of Equals and Its Realm is organized; almost everybody got it wrong until now.
Attached: page of 2 images
15

Contraction of the back muscles attached to the scapula, inside and out, are the major cause of arm rotation including hand pronation and supination.
TrtE Knass RnzurtnS" oF UppEn ExrnEMrrY Rorl.uoN

AI.{D
Ror^LroRY lxsrannrrY
(Mt E. J. KraR)
Copy
# ou
for RUDIKMSS
THE Knas^s Rn,qLITIES" oF

UppER ExrREMrrY RorATrof{
AND RoTAToRY
IxsrABrLrrY
CopJ
# ool
for RUDI KRASS
Copyright O 2000 by E. J. KraB
All rights reserved. No parl of this publication may be reproduced, translated, stored in a retrieval system, or transmitted, in any form or by any means electronic, mechanical, photocopying, recording or otherwise, without the prior written permission of the author and copyright holder.
Requests
forpermissionto make copies of any paft of the work should be mailed to:
Permissions E. J. Krass PO Box 654 POUCE COUPE
BC
VOC zCO
CANADA
Printed in Canada
Contents
Sucrrox
1.
I:
Trre Kuss Rnlr,rry or Uppnn Exrnrnrrry Rornrron

FoR
Rlrronlr,n
Nnw TnnoRrEs oN Suprnlrrox lxn Pnoxnrrox
f,
2. Tnn Nnw TnnonrEs FoR Sr;prxarrox 3. Uppnn Extnomrry

SuprN,rrrnn
lxo Pnoxlrrox
10
10
Mootrrrns Enpr,rclrno
l0
t2
Fr,rxrox lNo Suprxlrno Exrnnsron
Supinated Flexion Supinated Extension
*ExrrNonn Anrvr SurmATroN uvo PnoNlrron*
t2
T4
Extended Upper Extremity Pronation Extended Upper Exhemity Supination
16 18
Pnoxlrnn Fr,nxron luo Pnoxlrno Exrnxsron

Pronated Flexion Pronated Extension
r9
21
90 Dncnns Ft,exno Elsow SuprnerroN lNo Pnonlrrox 90 Degree Flexed Elbow Pronation 90 Degree Flexed Elbow Supination 4. Coxcr,usrou
23 24
25
27 l-l)
t
Appnxurx: Su*rrrlany
SrcrroN
If:
Tno Knlss REALrry oF LATERAL

Uppnn
Exrnnurry RouroRy INsrABrLrry

35
1. Basrcs
or Larnur, Uprnn Exrnnrrtry Rorlrony fxsrlnrr,rry
2. Trrn Tnurq ABour
Llrnnlr,
Uppnn
Exrnnurry Rorarony lxsrumr,rry
37
37 39
39 42
Er,row
BAsED
Lrrnnc.L Urrnn Exrnrnnrry Rourony fxsu,nn-rry
3. PlrnourcrrANrcs or Er,now BAsED L,lrnrur, Rourony lxsrlmr.rry
Instability Due To Tiaumas To An Outstretched Upper Extremity Repetitive Moderate Trauma: the Cumulative Effect Repetitive Overuse Syndromes Gender Based Lateral Rotatory Instability Old Age (Men more so than Women) Lateral Rotatory Instability
4. Svuprouor,ocy or L.lrurur, Rourony Ixsmmr,rry
44
45 48
49
49 54 56
Elbow Symptoms Wrist and Lower Forearm Symptoms Long Term Complications
CopJ
# ool
for RUDI KRASS
5. DUcNosTICS FoR Larnml RoruroRy

Knass PnoxarroN Tnsr
Insmrnrry
59 63
6. TnnATMENT FoR L,rrgRAl RornroRy fnsrnBrlrry

Physiotherapy Reconstructive Lateral Epicondylar Surgery Post Operative Treatment Ineffective and Compliment ary (Current) Tfeatments 7. PnEvENTToN oF LATSRAT, RomroRy lNsmBrt,rry
65
6s
66 69 70
73 79
8. CoNCLUSToN
'AppEttDIX: ScruNTrFrc Pnoor FoR
Ersow Baspn Lnrnnnl RorEroRY
fNsrnBrlrry l-lil
SrcrroN
III:
THr KnAss Runlrry oF SHouLDER Blssn f]rpnn ExrREMrry RornroRy lNsraBrr,rry

Blssn Uppnn Exrnnrr,rrry Romrony lNsrlnrr,rry
BASED
1. Snoulosn
92 93
93
2. PrrsomncHANrcs or Sgour,nnR
RornroRy Insrlnrr,rrrns
94
Instability Due To Anterior Rotator CuffInsufficiency Instability Due To Superior Rotator CuffInsufficiency
3. Svurrouor,ocy oF Snour,orn
BASED
Rourony Ixsrlnrr,rry
96 96
96
Anterior Shoulder Rotatory Instability Symptoms Superior Shoulder Rotatory Instability Symptoms
4.
Drlcxosrrcs
FoR Snoulonn BAsED
Romronv lNsrnenrry
97 98
97
Anterior Shoulder Rotatory Instability Superior Shoulder Rotatory Instability

5. TnnrtrvrnNT FoR Snour,onn Ixsunnrcroxcm,s
Physiotherapy
100
100 100
Reconstructive Surgeries Post Operative Treatment 6. PnrvrxrloN oF Ssour,prn BAsED Rouronv
102
fxsumury
104
Exonore & BrsrrocRAPrrY
105
CopJ
# ool
for RUDI KRASS
I: Trm Kness RntuN" oF

SncrroN
LIpPER ExrREMrrY RoTATIoN
Copy
ou
far RUDIIGASS
N.Elr TnEoruns ow
Since 1989, I have been suffering from an injury to my right elbow and wrist that the medical professionals in westem Canada could not diagnose and fieat. Emly
in I99l,T encountered another patien!
referred to as Joe, with a similar symptomolory. In 1997,I finally discovered a nzrme for Joe's medical
condition -posterolateral rotatory instability (PLRI). Over the yearc, since I first met this individual,
had the good fortune
for the advancement of the lateral upper extremity rotatory instability condition
that is
ofbeing able to study 47 individuals with similar symtomology to Joe and myself. However, not
all of the 47 cases arose from the same cause but acfually arose from 5 different causes. The unique
feature to all these causes was the long-term symptomology which eventually became EXACTLY the
same after several years of attempted arm usage. To me, this fact meant that lateral epicondylitis was
more of a symptomto some uniform an4 asyet, understood cause.
Atpresent, PLRIisdefined as an insufficiency ofthe elbow's lateral collateral ligamentand its widely known cause is limited to a trauma to the hand similm to one trying to brace one's fall with your
arm after sltpping on some ice. However, the Kerlan-Jobe fttropaedic Clinic in Los Angeles teats patients, mainly basebalt pitchers, whose common etctensor tendon is tom right down the middle of the tendon from the patient's activity, which obviously is repetitive overhand throwing. Although this latter
cause of
PIRI
is known to the orthopaedic surgeons at the pre-eminent clinics studying the causes
of
lateral epicondylitis, it is not seen as a viable second cause amongst the general orthopaedic surgical
community
as the
thorough medical explanation for repetitive overuse has not been determined meaning
that there are no definitive medical papers on
it.
Both forms of lateral upper extremity rotatory instabillateral epicondylitis.

as yet, no medical
fp, though, do exhibit the same early symptom
This begs the question: What exactly is lateral epicondylitis which,

has
professional
fully explained? Simply, lateral epicondytitis is merely strain on the common extensor tendon fuom
repetitive forced pronation or strain on this tendon due to an under$ing insufficiency of the radial collateral ligament determining lateral epicondylitis to be just a symptom ofthese conditions. This definition though does not conform to the prese,nt medical paradign conceming supination and pronation demonstrating exactly why this thesis is being written
to CHANGE the present medical understanding
of
pronation and supination so that it is brought into alignment with physical reality.
CopJ
# aol
for RUDI KRASS
In the infancy of the medical profession, a couple of centuries ago, doctors created theses based on
cadavers and how the musculature looked as well as how they interpreted the
activity. For supination and
pronation, the doctors saw that there was a muscle Soup which crisscrossed the anterior forearm and
attached to the medial epicondyle. The male doctors looked at their own anns pronated them and mistak-
enly determined that this activrty involved just the forearm and that the radius was being pulled over by this muscle group. Thus, the narne of pronator teres was given to
it.
This mistaken interpretation
of
pronation is why the medical community has been unable to confirm that lateral epicondylitis represelts
an abnormal
stain being placed on the common extensor tendon and the radial collateral ligament.
In the present medical paradigm conceming pronation" the pronator teres is actually supposed to
contact and stengthen from repetitive pronation which means that there has to be some movement ofthe
radius at the lateral epicondyle as it is mistakenly assumed to be pulled over the ulna. This false conclusion led to the mistaken medical belief that there normally is a natural laxity at the lateralepicondyle in order to facilitate the present medical interpretation of pronation
Unfortunately, there was a complimentary set of muscle groups attachedto the lateral side ofthe
radius which are also connected to the lateral epicondyle and which led to the mistaken assumption that
the radius is rotated back across the ulna through supinatiorq i.e. the changing ofthe position of the hand
from palm down to palm up. These muscle groups were labeled the supinator longus and supinator
brevis. However, there was a slight glitch even at the inception ofthe supination axiom as another very
small muscle group was discovered at the lateral epicondyle whose purpose the medical community could
not explain but summarily concluded was of little importance
as the physicians had suffrcient muscles
to
conclude their theory. Consequently, this medically misunderstood muscle was not glven a supinator tabel instead being labeled the anconeus and whose functionality remained a mystery until the compila-
tion of this book.

Regardless of all these labels, the medical community's axioms concerning supination andpronaiion
are utterly incorrect and were anived at
illogically given science's present level of knowledge and diag-
nostic imagery. The error in logic arose from the original doctors using DEAD human bodies to formulate a theory and then not having the diagnostic means available to determine from a live human being
EXACTLY what happens internally d*i"g pronation and supination. There were no radiographic
machines, CT scanners or MRI machines available to the initial doctors and the present medical commu-
nity never thought that these axioms needed to be re-confirmed even though not all the muscle groups
conformedto these axioms orthat lateral epicondylitis remains to this day undefmd unexplained and,
now very common.
Copy
au
IoTRUDIKRASS
Suqwarleu ANn Pnowarlor*r

Instead of starting my exploration of supination and pronation from the present medical axioms,
I started
from the fact that I hqd a confirmed common extensor tendon injury which had been caused from excessive
and exfremely heavy pronation. Basically, in order to explain the resulq I had to reverse engineertheprocess
in order to determine how repetitive and heavy pronation caused my common extensor tendonto become torn longitudinally from its insertion
at the lateral epicondyle almost all the way down my
right arm's upper fore-
arm. So, I had to determine how a process that could not conceivably cause the injury, pronation, had actually
done
it. To do this, I postulated
thatthe pronator teres wasnot pronating and that the supfuntors were not
supinating and I devised a simple experiment which would either confirm this axiom or refute it. To my surprise, the results of this simple experiment did just what I expected and confirmed, without a
shadow of a doubq that the supinator andprorntor muscle groups of the forearm are actually improperly
labeled. This experiment also exposed that supination and pronation are not actions limited to the forearm but
actually include the upper arm bong the humerus. Essentially, the experiment exposed the fact that supination
and pronation are actually a set of very complex processes comprised of a sequence of muscle contractions
extending from the shoulder down through the forearm muscle groups as far as thepalmaris brevis. Trying to explain how the forearm muscle groups contract to perform supination and pronation though
was complicated because, as I had discovered earlier this year, biceps and triceps confiactions were not the
only muscle contractions utilized to raise and lower the forearm. So, before the supination and pronation
processes can even be explained, understanding, which muscle groups acfually have to contract in order
for
the upper extremity, i.e. the long drive train to the wrist from the shoulder, to pronate and supinate, has to be determined generally to start. The way in which I leamed how pronation and supination were performed was by fully extending my arm
in front ofme while it was perpendicular to my body. Then I studied the medial epicondyle of the humerus to
determine how the upper exffemity moved as the arm went slowly from fully supinated to fully pronated with
stop points being at the vertical and horizontal positions. (In a circulm description, the left hand's thumb
would be at the 10 o'clock position, to start, with stop points being at the 12 and 3 o'clock positions or, on the right hand the start position would be at the 2 o'clock position with the stop positions being 12 and 9
o'clock.)
The best way to view the rotation of the medial
epiconfle though
is not &om the anterior but from the
posterior or backside. To get this view, it is best to place a large mirror behind the anq being studied so that,
when you look over the upper ann and into the minor as the arm slowly rotates from supination to full prona-
tion, you get the best view of the bone sfuctures through this motion.
CopJ
# ool for RUDI KRASS
From this visual experiment, henceforth referred to as the ,1"' Krass experiment, it became evident that
indeed the humerus was moving through supination and pronation determining that these activities me not
forearm activities at all but rather full arm activities. Also, from the motion of the humerus through pronation
as
well
as the principle that bones move towmds the force that arises from muscle conkaction,
it is clear that
it
is impossible for the pronator teres ot pronator quadratus to be confracting through pronation as the humerus
is rotating in a direction completely contrary to what the muscle contraction
principle drdlrztes. Ergo, the
lateral and posterior muscles of the upper extremity must be contracting through pronation instead of the
pronators.
Another experiment that I recently
devisd
to be referred to as the
Krass experiment, confirms that,
from
fully supinated position through pronation, the humerus is part of the motion. This corroborating test is
a basic set
fm more definitive because it involves
of elbow radiographs which clemly define the initial and
ending bone positions and their motion through pronation from a fully supinated starting position or vice versa,'depending on which radiograph one looks at first.
Normally, when a set of elbow radiographs are taken, it consists of 3 fikns: one where the arm is fully
extended and supinated; another where the fi.rlly extended arm is pronated to the horizontal position of the hand; the final one being where the arm is flexed at the elbow to about 90 degrees from extension and the xray taken from the lateral side of the arm. As can be seen, the first two radiographic images correspond rather
well with my second experiment and these films clearly demonstrate that the humerus is following the rotation
of the hand and forearm confirming that the upper exhemity pronates and supinates as a "full unif' or like a drive train found on rear wheel drive vehicles.
The coordinated rotation of the humerus with the hand directly confradicts the present medical theory that
supination and pronation are shictly forearm activities arising from rotation of the radial head at the capitel-
lum. The x-ray films also corroborate that the direction of the upper exhemity through both supination and
pronation is completely opposite to the medically assumed muscle contractions which led to the present
muscle labels, i.e. the pronator teres and pronator Etadratus cannot be contracting through pronation and the
supinotor brevis and longus cannot, as well, be confiacting through supination. With the medical axioms that supination and pronation is a forearm activity caused by contraction of the like named muscle groups utterly obliterated by the two experiments and the fact that the upper extemity is moving clockwise in the left arm
and counterclockwise in the right arm, it is now possible to postulated accurately the roles of the upper ex-
tremity muscle groups from the shoulder down to the hand. However, before this discussion can be started, how the elbow exactly works through flexion and extension has to be determined. From my injury and the 1992 intemet paper on PLRI, it is clear that the anterior and radial eollateral
Iigaments of the elbow actually form a set of pins for the role of the radiohwneral
the'tinge'motion
of the elbow. This realrty e4plains
joint quite easily
because these pins actuirlly allow the radial head to arc over the
humeral capitellum through flexion and extension. This process is confirmed when one actually attempts to
Copy
flex the arm when it is nearly fully extended with the forearm pronated. During this process, the radiohurneral portion of the arm acfirally rotates backward to the point where the radial head can glide in
a natural arc over
the capitellum. This motion is similar to drawing a large circle with a string which is tied tightly to the center
of the circle where the radial head's medial and lateral pins function like the string, the humeral attachments as
the center and the radial head is the pencil.
Another more correct analogy is a "modified pulley" where, instead of a wheel rotating freely around a
centerpoint established by two stationary and isolated arrs, the wheel is stationary, the humeral capitellur4
and the rope, muscles, attached to the top and bot0om of an objecg the radial hea4 and
it is pulled up by the
top muscle and down by the back muscle. To keep the force going on this same plane are two pins which attach at either side of this plane, i.e. at the medial and lateral sides of the radiohurneral joint wherr looking
from overtop ofthe joint..

The discovery that the radiohurneral
jornl is solid and pinned atthe radial collateral
and anterior
liga-
ments has serious ramifications for more present false medical theories. The most notable ones being that the
ulno-humeral joinl is solid" which it isn't and which will be proven when supination is discussed in this paper,
and that the radius is dependent on the ulrn-hurneral
jointwhich is quite conftary to the truth. In fact, the ulna
is dependent on the solid nature of the rdiohurneral
joint and its functionality arises from the latter explaining
why I wilt be referring to
the
joint formed by the radius and the ulna as Ihe ulno-radial
joint-it
is an accurate
portrayal ofthe structure rather than vice versa as is the present inaccurate medical designation.
CopJ
ou for RUDIKRASS
From my two tests and the position of the of the humerus through pronated flexiorl it is demonstrated that
there are 8 motions, excluding the raising and lowering of the humerus and its circular motion, that need to be accounted for when defining the role of muscle contactions in the upper extremity: supinated flexion and supinated extension motions; extended arm supination and pronation; pronated flexion and pronated exten-
sion; forearm pronation and supination motions with the elbow bent to 90 degrees.
Imnortant Note: the soft tissue labels used in this book are taken fuom Gray's Anatomy,
1901
edition
SupnqA,rED
Frsruot\
AND SupmrarnD E>rrnNSroN
Supinated Flexion
This motion seems straight forward: the biceps muscle contracts causing the forearrn bones to arc towmds
the humerus. This understanding is incomplete because,
if supinated flexion were this simply, you would find
that the ligament sheath across the anterior aspect of the tochlea and the medial arc pins would be severely and easily stressed causing inflammation. This process does not mise often because supinated upper exhemity
flexion is considerably more complex-when you place a small weight, say 10 lbs. in your hand and flex the
biceps, the firll extent of muscle contractions is exposed.
Looking at the radial biceps attachmentposition, it is clearthat, when the biceps contacts, the radial head
should rotate upwards mound the humeral capitellum. Such rotation does not occur though which means that
this contractive force has to be mitigated. The first possible mitigating muscle contactionto biceps contrac-
tion has to be the supinator brevis which
attiaches to the ulna and radius in a manner that surrounds the
Bicipi-
tal Tuberosity. However, contraction ofthis muscles which does occur during both types of upper exfemity flexion, supinated or pronated hand, cannot mitigate the rotative force created by the biceps because the
wpirntor brevis does not attach to the humerus
at the anterior hochlea or the medial epicondyle. Actually, the
wpinator brevis attaches to the humerus at the lateral epicondyle so confoaction of it actually augments the
upward rotation of the biceps confaction while aiding in the raising of the radius and ulna and the unification
ofthe forearm as a unil the supinator brevis attaches to both aspects of the ulna on either side ofthe radius so
confaction of this muscle causes the ulna to remain tight to the radius while its latnral attachment applies a
complimentary forearm raising force to the biceps contraction over the radial collateral ligament
one of the
radial head's lateral arc pins. Thus, the theory that contraction ofthe supinator brevis contradicts the upward rotative force created by confaction of the biceps is eliminated.
CopJ
ou
for RUDIKRASS
IO
The next muscle groups attached to the radius but slightly further down that could mitigate the anterior
rotative force ofttre biceps isthepronator teres andflexor sublfunis digitorum. Both of these muscle groups
attach to the medial epicondyle but the former attaches to the top of the radius just beyond its superior line
while the latter attaches to the medial side ofthe radius. Withbiceps contraction, contaction ofthe 2 aforementioned muscles is clemly defined by radial attachment to colmteftrct naturally the rotative force generated
upwmd over the medial arc
pin.
So, the reason for a lack of swelling along the anterior
tochlea line and in
the radial head's anterior ligament with biceps contraction has been discovered as well as the reason, the
anterior angle remains constant though flexion.

So, basic muscle contraction for upper
exfemity flexion consists of biceps, supirmtor brevis, pronator
teres andJlexor sublimis digitonnn confactions over the radius which balance themselves out rotatively and side-to-side causing the main fwce of biceps the radial head's medial and lateral arc
and,
ntpinator brevis confactions to be applied upwmds and over
pins. The complimentary basic forearm lifting force applied to the
ulna
ii
created by the brachialis antictts. This contraction augments the contraction of the supirator brevis
which raises the ulna in unison with the radius, thus eliminating any potential for swelling within this muscle not over working. The brachialis anticus is itself mitigatedby the pronator teres andflacor sublimis
digitorum contractions
as they reside in the line of the ulna causing the ulna o'to
hinge" at the anterior of the
trochlea throughout upper exfemity flexion.
In flexion of a supinated forearm, these basic muscle contractions are augmented by contractions within
the palmaris longts,
flexor carpi radialis, supinator longus
and extensor
carpi radialis longior. The first two
muscle groups add to the function ofthe medial arc pin while the final two's force adds to the stability of the lateral arc pin allowing for large weights to be lifted when the hands and forearms are supinated. During the
latter stages of supinated flexion, though, the clavicle portion of the pectoralis major and subscapularis
contract to counterbalance the natural anterior rotation of the humerus that arises wheia the biceps, supinator
brevis, brachialis anticus, tlexor carpi radialis andpalmaris longrc contractions become too strong to be controlled by the contractions of the pronator teres andflexor sublimis digitorum affecting the medial hu-
merus'position.
Note for weight
lifters:
using a sfraight bar for flexion is not recommended because it places an abnormal stain on the radial collateral ligament and common extensor tendon throughout the motion because the arm does not usually'lvorlC'with the anterior trochlear line remaining at the horizontal line. This portion of the humerus usually remains around the 4 o'clock position on the left and 8 o'clock on the right - angled down by at least 30 degrees from the horizontal plane. If you do feel that a straight bar works best for you through flexion, then you either have naturally la:< joints or are suffering from an insufficie'ncy of the radial head's
lateral arcpins.
CopJ
ou for RUDIKRASS
II
Supinated Extension
Extension of the arm while the forearm is supinated utilizes the internal triceps head nthe upper arm
withthe pectoralis major contacting to courterbalance the natural posterolateral rotational force created by
the original contractions. The forearm muscle contactions that make the force uniform throughout the upper
extremity me the exteraor ossis metacarpi pollieis, extensor carpi radialis brevior, extensor communis
digitorum, extensor minimi digiti and exterxor indicis. These contractions are necessary to keep the Greater
Sigmoid Cavity tight up to the radial head and trochlea while extending the elbow to 180 degrees and sucking
it of the ulna into the olecranon depression at the posterior of the humerus
ligaments pertaining ta the ulno-humeral joint are not tight which
the endpoint of extension. (Th"
will be fully exposed in the explanation of
the supination and pronation motions. Also, the arrconeus does not conftact through supinated extension.) The contractions ofthe aforementionedextensormtrccle groups comprise a shong and complimentary force to the intemal triceps head's contaction. However, in the new realrty of elbow functionality, the
posterior force has to be placed almost directly over the medial and lateral arc pins of the radial head. The
ONLY muscle capable of doing this is the supinator brevis which does not confiact through supinated extension. Fortunately though, in order for this muscle group to provide this direct downward force to these pins
it
doesn't have to be conhacted. Normally, the supinator brevis is never subjected to any force that causes it to
become weak or lax in any way so, as the ulna is rotated downward by contraction ofthe 5 aforementioned extensor muscle groups, the supirntor brevis and the annular ligament act like a tight strap placed over the radius and right over top of the radial head's arc
pin. Naturally, this muscle's and ligament's
placement
transfers the posterior confactive force produced to the superior, medial and lateral aspects of the radius
uniformly. Now, it is exposed how the radius is lowered in unison with the ulna through supinated extension.
Upper extremity extension with a supinated hand isn't half as complicated as upper extremif llexion
with the hand being supinated mainly due to the fact that the motion is merely
a reversal
of the flexion proccss
which is very complicated indeed. The only necessary information to remember though is that both motions
are actually performed throughout the upper
exfemity like a drive train and that almost all upper exffemity
motions impact on the shoulder via the o'solid" radiohumeral
joint
andthe radial head's lateral andmedial arc
pr'ns. Now, the more interesting actions ofpronation and supination can be explored.
*E:<rgNDnu ARM Supnslrrox
lrro PnoNlrrox*
The motions ofpronation and supination are the most significantly altered by the discovery that the
radiohumeral
joint isthe most solid unit within
the upper extremity and especially the elbow. It is important
to reiterate that the ulno-hwneral jolnr is significantly less solid than previously thought by the medical community and that it actually facilitates the motions by moving between the trochlea and the lateral epi-
CopJ
ou
for Rt,iiDIKRASS
I2
condyle depending on the motion. The motion of the ulna is proven tnre because, with the concrete evidence
that the radius does not rotate through extended supination and pronation, there is no other conclusion that can be derived based on the reality that the wrist and hand is changing position through pronation and supination.
Confirming this logical conclusion is easily done when one thinks about it for a second. ln both Krass experiments, it was easily determined that both supination and pronation undeniably
involve the upper ann or humerus. Now, flexion of a supinated arm confirms that the anterior of the ulno-
humeralioinf is made functionalh stationary through this activity. Through simple geometry, with the elbow
hinged at its anterior and the arm at 90 degrees, this means that the posterior of the ulna must be displaced relative to the humerus, i.e. a wedge shaped gap forms between the ulna and humerus with the larger portion being at the most posterior point of both bones. This reality allows the displacement to be accurately calculated when dissected from a side view ofthe arm.
Using geometic a:<ioms, the 90 degrees of bend at the anterior of the hinge can be hansferred to the posterior or opposite angle: opposite angles are always equal. Also, the thickness ofthe ffochlea and the ulna
are almost identical. (The Greater Sigmoid Cavity has
little impact on the calculations because the ligament
line is above it on the olecranon.) With these figures, it is easy to calculate the circular distance at the poste-
rior of the ulno-humeral
joint:
thethickness of the tochlea and the ulna is the radius of the circle, r, and so all
that needs to be done is to plug this number into the formula for the circumference of a circle, 2nr, anddivide
it by 4 (360190:4). The numerical result from this is the arc distance taveled by the Greater Sigmoid Cavity
and the posterior ulna relative to the trochlea or humerus.
This figure can be translated into a linem distance by applying the Pythagorean theory which is permissible given the fact that the hinge angle is 90 degrees. So, with the thickness ofthe ulna and the trochlea known to be equal, the need to determine the angles is eliminated: actually, the angles at the posterior
of
the trochlea and the ulna relative to the hypotenuse is 45 degrees as the triangle that is formed within the
posterior of the "hinge" joint is an isosceles triangle meaning that the angles formed at the ends of the hypotenuse have to be equal or 45 degrees. Now, just plug the thickness of the bones, x, into the Sthagorean
theory and the numeric result will be the linear distance that the Greater Sigmoid Cavity and posterior ulna has
to travel from the frochlea during supinated flexion.
Both numeric calculations confirm, without any doubt, that the ligaments at the posterior of the ulrnhumeral joints are naturally lax which means that these joints cannot be as solid as the present medical para-
digms for the elbow state. This fact was also used by the medical community to determine the erroneous
supposition that the radius rotates around the capitellum instead of how the radiohumeral
joint actually
functions
the elbow's radial collateral and anterior ligaments act as radii pins fbr the natural arc of the
forearm through upper extremity flexion and extension causing the radial head to'oglide" up and down the
humeral capitellum from frontto back.
Both Krass experiments also demonshate that the humerus is involved with supination and pronation
CopJ
# ool
for RUDI KRASS
I3
of the upper extnemity but they do NOT clearly demonstrate the fact that the ulna moves around the radius through these actions. The true value of the Krass experiments wasn'ttn determine the ulna's motion relative
to the radius but to present an accurate means of analyzing how supination and pronation is actually performed
relative to the humerus----conJirmation that the ulna moves mound the radial head at the elbow will be presented in the discussion ofpronated flexion and extension.
The.trirass experiments clearly demonstrate beyond their original mandate though that when the upper exfemity is fully extended it becomes a "solid
unif' from the shoulder down to the hand. This fact is
easily proven because the Greater Sigmoid Cavity of the ulna locks into the olecranon depression at the
posterior humenrs. From this final interlocking of the forearm structures to the humen:s, it can be determined
that the elbow when the arm is extended then functions like a'bniversal
joint" on the drive tain of a front
urgine rear-wheel drive vehicle. This functionality of the elbow, i.e. universal
joint,
when the arm
is extended through the last 30 degrees which becomes very important when applied to pronated extension and
rotatory instability. From the Krass experimenls,l also discovered that there me 3 main positions through both pronation
and supination motions which account for a change in muscle contractions. The positions are full supination, the neutral position (12 o'clock or vertical), and the fully pronated hand position (5 o'clock for the left arm and 7 o'clock for the right arm) with the thumb representing the reference point to these clock or degree
position. To better understand pronation and supination, it is better to discuss the full process with breaks at
these positions rather than discuss both processes simultaneously from position to position.
Extended Upper Extremity Pronation

Starting with pronation from extreme supination to the neutral, 12 o'clock, position, there is very little
contraction because supination beyond the neutral position is mainly a forced or abnormal activity when the
arm is firlly extended. So, when the contractions for supination are stopped, the arm instinctively seeks to
eliminate this trnnatural state. To do this, the subseapulmis and the clavicular portion of the pectoralis major
snap back to their normal
s2e: a good analog, would be like stretching
these two muscle groups like an
elastic band whiclr, when the force applied to stretch them is removed, they revert to their normal size.
This assessment of muscle activity it easily confirmed. It is known that the radiohumeral stuctures forms a natural angle along the anterior side of the elbow of about 120 degrees which, from physical observa-
tion and the x-ray films, has been determined to remain static. When supination beyond the upper exremity's
neutral position occrlrs, it has to be done through an abnormal rotational force applied to the humerus' oppos-
ing muscle groups through supination or pro,nation. This means tha! during the final portions of pronation or
supination, the humeral rotation noted is occuning not just through muscle contraction but also a strong
stetching activity in the muscle groups those that are relaned and attach to the upper humerus and its head.
Corroboration of this assessment of the final stages of both supination and pronation is deterrnined by extemal
CopJ
ou for RUDIKRASS
r4
observation of the medial epicondyle: the supination example of this principle is that the left arm's medial
epicondyle leaves its normal position of around the 4 o'clock to rise up to the 3 o'clockposition or approximately 30 degrees circularly through the latter portion of rotational motion. Furthermore, the anterior portion of the shoulder demonstrates some discomfort mourd the Coracoid Process which indicates that the muscles
at this part of the shoulder are being subjected to a stretching procss.
Anottrer way of confirming that the subscapularis and the clavicular porti on of the pectoralis major
are merely "reflectively contracting" through to the neutral position from extreme supination is the reality that
the radius in the forearm merely retums to its normal position, 12 o'clock" and the medial epicondyle reverts to its normal position of 4 o'clock. The positional changes of the radius and medial epicondyle are consistent
with the natural and static angulation of the anterior radiohumeral joint line when the humerus is not rotated
beyond its natural position
the lateral epicondyle is at it proper position across from the medial arc
pin. This
position revercal of the upper exffemity not only once again confirms that the radiohtmteral jor'nt is the pivot
for supinateO flexion but also affirms that the radius is definitely not rotating around the capitellum.
This medical theory was actually derived from the humeral head which rotates relatively circulmly at the shoulder. This motion resulted in the general theory that atl circularparts of bones are rotated about by the adjoining bone or rotate within the adjoining bone. Proof that this approach is mistaken
is: if the radius were
rotating around the capitellum, then the anterior radiohumeral jointlnewould not reside permane'ntly at 120
degrees and the radial head would
ALWAYS separate from the capitellum when subjected to pronation forces
which it does not. Unforhrnately, this incorrect theory about rounded bone endings was never challenged
since the advent of radiography and radiolory and this means that many medical problems conceming non-
rotating circular portions of the anatomy have remained undiagnosed and completely misunderstood by the medical community- case in
poinl
lateral epicondylitis.
Retuming to the pronation motion, from the neuffal position to the fully pronated position is actually a combination of actions: using the left as my reference, the medial epicondyle is seen to be rotating posteriorly,
cloclorise on the reference atm or counterclochrise on the right while the arm goes to either 2 o'clock or 10 o'clock, respectively; then, the dorsal part of the reference arm is seen to rotate clockwise, counterclockwise
on the right; with full pronation being completed by the lateral portion of the back of the hand rotating upward on both sides. This motion from the neuhal position to full pronation is best exposed when you look at your arm from the back in a mirror.
So, the muscle conhactions for pronation from the neuffal position has to be thus: upper arm poste-
rior and anterior shoulder with rotation of the hand at the wrist so ttrat its back and lateral portion goes from
the vertical position to facing upwards; then, anterior shoulder confractions continue through to the point where the anterior side ofhumeral head rotates downward and is stopped by the coraco-humeral ligcnnent. The muscles that correspond to these actions, respectively
, ate: the subscapularis
and teres
major which
rotate the elbow's medial epicondyle downwmd through to its final position; then, the ulna in the lower
CopJ
# oal
fioTRUDIKRASS
t5
portion ofthe forearm is rotated around the radial by contaction of the anconeus, extensor carpi ulnaris,
extensar minimi digiti, flexor carpi radialis, palmaris longus, qctensor longus pollicis and extensor indicis. The motion of the ulna is facilitated by the Lesser Sigmoid
Cnitybeing curved which facilitates the ulna's
positional rotation around the radial and which is expressed by the handos rotation to an horizontal line.
With the hand now horizontal, i.e. parallel to the floor beneath
i!
and palm
dowq the subscapularis,
teres major, the claviculm portion of the pectoralis major andthe external triceps head c,ontact in conjunc-
tion with the anconerc, the portion of the extensor
o.ssl:s
metacarpi pol&bis between its radial and ulnm
attachments, the extensor carpi ulnaris, extensor minimi digiti, extensor commwis digitorurn, flexor carpi
radialis
and,
finally the palmaris longus and brevis. The first 4 muscle conhactions anteriorly rotate the
humeral head so that it ends up below its normal position in the shoulder and at the point where the coraco-
humeral ligamentbecomes taunt ceasing any further anterior humeral rotation. The contraction of the 4lateral forearm extensor muscle groups rotates the ulnm side of the wrist and hand upwards mound the radius. The 2 medial side forearm contractions plusthe palmaris brevis contraction pull the anterior radial side of the hand
around the thumb, downward complimenting the rise in the ulnar side of the lower forearm and hand. The ulnar rotation around the radial head isn't large in nature because the Greater Sigmoid Cavity remains snugly in the olecranon depression throughout pronation of a fully extended arm. However, this
interaction of the ulna and humerus creates a pivot point for the rotational motion of the lower forearm portion of the ulna which is observed to occur from the neutral position of pronation to the raising of the back of the
hand to the horizontal line.
Extended Upper Extremify Supination

With pronation of a fully extended upper extremity fully explained, the discussion pertaining to
supination can begin. Similar to the initial 60 degrees ofpronation, to the neutral positio4 the humerus is
slightly over rotated due to the exffeme contractions of the teres major
these muscle groups allows the coraco
and subscapularis, so any relaxing
of
brachialis,
and teres minor, which are stretched like an
elastic ban4 to conffact autonomically and rotate the humerus so that the medial epicondyle moves back to the 6 o'clock position and the lateral epicondyle posteriorly, backwards, to its natural 'heutral" position.
Following the initial and natural reverse humeral rotation from full pronation, the next portion of the
upper extremity to supinate from its pronated position is the hand and lower forearm. This motion is accom-
plished by the ulnarportion of the lower forearm and hand being rotated anteriorly downwmd undemeath the
radius through conftaction of the prorntor quadratus, Jlexor carpi uln4ris, flexor longus pollicis and palmaris
brevis. (Ihese contractions and the fact that the ulna normally rotates underneath the radius at the
wrist becomes invaluable in explaining carpal tunnel syndrome
oro as
I refer to this mistaken condition,
carpal tunnel complications of lateral upper &remity rotatory instabitity.) The final position of the hand
CopJ
# aol
for RUDI KRASS
t6
from these contractions is at the vertical midpoint of supination, i.e. it lies in a line running from the 12
o'clock position of the thumb sfizight down through the 6 o'clock position
the forearm's basic neuftal
lowerportion of theflexor sublimis digitorum. Now, the lower forearm and hand portion of the upper extremity is at its locked position for supination but also their neutral positions which means that, if all contractions were stoppe4 there would be no
autonomic muscle contractions and, if the arm remained in this position and were used" there would be no
negative effects on the tendons, ligarnents, nerves and blood
flow.
The next 30 degrees of supination is simple
and occurs due to coraco brachialis contraction. This fact is easily proven and results directly from the reality that the anterior radiohumeral line ALWAYS remains at a constant 120 degrees. By observation, it is noticed that, as the hand rotates to 30 degrees behind its neutual position,
1l o'clock for
the left or 1 o'clock for the
right the medial epicondyle rotates from
5 o'clock to its normal position of 4 o'clock on the left or 7 to 8 an expression of the medial
o'cloik on the right uniformly with the lower forearm and hand motion making it
epicondyle or humeral rotation.
The next 45-60 degrees though is exFemely complicated as a plethora of muscles conhact to cause
this frnal upper exfremity, or drive tain, backward rotation. From 11 o'clock on my reference arm, left, or
o'clock on the right, to full supination, the medial epicondyle is fist raised to the horizontal line, i.e. 3 o'clock
on the left or 9 o'clock on the
right. This is followed by a further rotation of the lateral portion of the humerus
downward and then supination is completed with a further posterior rotation of the radial portion of the
forearm/trand and upward rotation of the hypotlrcrnr cleft. The first portion of the motion is accomplished by
{irttrer contraction of
the coraco
brachialis, teres minor
and
infraspinahn This humeral rotation is also

ofthe anterior rises
expressed at the posterior side of the humeral head which posteriorly reduces and the top
to the point where the coraco-humeral ligament resides in
vertical line above the Coracoid Process.
The forearmfrand completion of supination is just as interesting mainly because it's a rotation of the hand at the
wris! scaphoid and semilunm, within the wist end of the radius which the medical community
never thought possible until now when it is confirmed to be occurring
Tlne
lrypothenar clefi'srise, ulnar hand
rotation upwards, is accomplished by continued contraction of the lower portion of theflexor sublimis digitorum, pronator quadratus, flexor carpi ulnnris, flexor longus pollicis and palmaris brevis which also
observed complimentary posterior thumb rotation results &om the contraction of the lower portion of the
extensor ossis metacarpi potticis andthe extensor brevis pollicis muscles. This rotation of the posterior ofthe thumb backwards is, in turr4 complimented by conffaction of the extensor longus pollicls and the extensor
indicis--these contractions don't conhadict the anterior muscles contractions because they use them
foundation for the thumb's posterior rotation.
as a
CopJ
I7
PnoxarnD FrE:aoN Ar[D Pnoxarnr] E>rrsNSroN

Before the discussion on these two motions can be initiated how the upper extremity bones move through these actions has to be determined through observation. While looking directly into a minornot over the anrl place your fully extended arm into
a pronated
position so that the hand is fully pronated.
Without any sfenuous confactions, flexthe armtowards the shoulder while keeping the hand pronated. You will immediately notice that the humerus rotates quickly backwards to the normal position for flexion, i.e. back to where the medial epicondyle resides 30 degrees below the pin plane established by
the anterior andradial collateral ligammts.
As the humerus rotates backwmds, it is also observed that the radial and ulnm sides of the hand
do not just follow the backward motion of the radiohumeral
joinl but also reflects
the anterior motion
of
the trochlea and medial epicondyle. This hand and medial epicondylm motion once again clearly demonstrate that the radiohumeralioint is solid with no rotation around the capitellum as is presently theorized
by the medical community: the ulna portion of the hand and forearm motion is only caused by the humerus and the radiohumeral
joint rctatrngaround
cenfal axis which affects both the medial and lateral
epicondyles equally. At the shoulder, the humeral head is advancrng to its anterior midpoint ofrotatiorq i.e. the coraco-humeral ligamml goes from its downward vertical position to the horizontal position.
Now, you will notice that through the process ofpronated flexiorq your left forearm actually
flexes inward at about 70 degrrees from the horizontal in the upper right quadranf when the radiohumeral
pins, i.e, the anterior and radial collateral ligaments,are used as a horizontal reference line and the
vertical being the middle of the radial head. This line of motion is the normal line of flexion not just in
pronated flexion but also supinated flexion: remernber, theradiohumeral permanent anterior angle for the trochlea and the medial radial
joint is solid and
creates a
line. This fact is subsequently corrobo-
rated by the fact that, once the initial humeral rotation of pronated flexion occurs, the medial epicondyle
and the radius are in the exact satne location as those presented in supinated
flexion-the only difference
is the position of the ulna relative to the radius and the position of the pakn" down or up.
Qt is possible to make the forearm rise through
flefon
at 90 degrees rather than 70 degrees but
this really isn't natural. As can be deduce4 with the reality that the radiohumeral
joint
plane is the basis
for all motion within the upper exhemity, this abnormal flexion line is facilitated by the humerus rotating
even firther anteriorly around its cental axis at the start of the motion causing the pronated or supinated forearm to flex upwmd while the anterior fochlear line resides perfect$ horizontal. Such action and the
body's response has already been addressed in the previous Note to weight hrters.)
CopJ
# ool
for RUDI KRASS
I8
Pronated Flexion
Pronated flexion is easily broken down into processes, or stages, for muscle conffaction because
of
the previous observations. Using the fact that the humerus rotates anteriorly to the point where the medial
epicondyle resides at 4 o'clock and the radiohtmeral pins are horizontal, pronated flexion is broken down into
two distinct ranges of motion: going from the fully pronated and fully extended position to the point where
the humerus is at
ie normal position; the other is flexion ofthe upper exhemity and how the forearm is moved
through this motion. To accomplish the initial stage is actually quite simple once one thinks about
it. Initially,
the humerus
must be rotated with muscle contractions along both the posterior and medial aspects of the humerus as it is rotated around the center of the (lower) humerus. This humeral rotation naturally brings the radial portion
of
the forearm backwards relative to the ulna whiclr, in tum, shifts forward as the trochle4 medial epicondyle, advances in this same direction relative to the cenfial anis and the radiohurneral joint that the humenrs also
. It is important to note
drifu noticeably laterally from its initial fully pronated and extended position. In
muscular terms, pronated flexion is initiated with coraco brachialis contuaction which shifu the medial
epicondyle anteriorly 60 degrees to its normal position. Then, the humerus is rotated baclavards with confrac-
tion of the ffiaspinafin and teres minor at the posterior humeral head which accounts for backward movement ofthe radiohwneral
joint,the forearm's radial side and the humerus.
Often, the initial stage of pronated flexion, as observed and explained, isn't norrnally observed
because pronated flexion is usually started after the hand has been pronated just to its horizontal position and
not from its fullypronated position where the thumb resides 60 degrees below the horizontal line which is the
approximate point where the initial stage ends. Then, people drop their elbows causing them to miss the fact that the coraco brachialis contracts to maintain the medial epicondyle's position as the posterior ofthe humerus is rotated backwmds by contraction of fhe infraspirntus utdteres
mirnr.
So, the general population
and the medical community miss the important facts that the shifting ofthe elbow downward is actually a shoulder based action and that the radiolrumeral
joint's rotation
and position change is actually an effect
of
this shoulder rotation allowing the elbow motion to be inaccuratel), described as rotation of the radial head
around the humeral capitellum.
Furttrer conclusive proof that the present understanding about radiohwneral joint firnctionality through ttre initial stage of flexion with
a
pronated hand is the effects on the hand as the elbow of a semi-
pronated hand is dropped down when at shoulder height. By observation of this activity, the radial portion the hand moves upwards and back as the elbow
of
falls. Using physics, the thumbs motion clearly is a represen-
tation of the posterior humeral rotation at the shoulder: when you place a board over a small straight object
such that one end of the board is significantly closer to the fulcrum and you step down on the shorter end
of
the board, the opposite and longer end rises by the same degree of circulm rotation even though the distance
Copy
au
for RUDIIGASS
1g
traveled by the longer end ofthe board is noticeably greater-the distance traveled can be calculated using a
simple physics equation. The motion of the ulnar side of the hand also indicates that the ulna is not as solid asthe radio-
humeral side ofthe elbow and forearm because it remains stationary as the elbow and upperportion ofthe arm
is lowered relative the hand. This lac.k of motion by the ulnar side ofthe hand demonstrates that there has to be some compensation at the frochlea which accounts for it not moving upwards and backwards in unison
with the radial side of the hand asthe radiohumeral joint and humerus rotate posteriorly. Upon inspection
the trochlea and the uln4 it is quite easy to determine that the Coronoid Process and the Greater Sigmoid
of
Cavity of the ulna are capable of sliding within the ftochlear notch. This "sliding'o is how the ulna compensates for the humeral position change through the
initial stage of upper extremity flexion with a pronated hand.
Rotation of the humerus and consequently the radiohumeral jointfromthe arm's initial FULLY
pronated and extended position facilitates the raising of the forearm through pronated flexion pronated flexion
final stage
of
in almost the same manner as flexion of the arm with a supinated forearm. This reality
arises from the fact that the humerus and the radiohwneral
joint
now reside in the same position that is used
by the arm in supinated flexion. The only difference is that the hand is now palm down rather than palm up
which impacts on what muscle contractions occur beyond the basic muscles used in supinated flexion-as a
reminder, these muscles are the biceps, supirntor brevis, pronotor teres, Jlexor sublimis digitorum and brachialis anticus.
The secondary contactions that are different than those of supinated flexion occur in the supinator
Iongus, extensor carpi radialis longiar and/lexor carpi radialiswhich do confact through pronated flexion even though such actions seem to be counter productive, i.e. rotate the thumb backwards, due to their new
position. This backwards rotation though is eliminated due to muscle contracts along the lateral side ofthe
ulna. The muscles that contract to eliminate the backward rotation of the hand at the thumb and which either
bind the forearm into a pronated unit or raise the ulna are: the extensor carpi ulnaris; extensor minimi digiti;
extensor indicis; extensor longus pollicis; extensor ossis metacarpi
pollicis. All
these muscle groups attach to
the majority portion ofthe lateral side ofthe ulnawhich means that contraction of them has to raise not just the forearm but also the ulnar side ofthe forearm and hand. The extensor brevis which is attached to the lateral side of the radius andthe palmaris longus do not
conffact through pronated flexion. Also, the clavicle portion of thepectoralis major and the subscapularis do not contract towards the end of pronated flexion. The reason for the latter two muscle groups not confracting
is because the contactions within the brachialis antictn, flexor carpi radialis and supirntor longus arc
significantly less than those produced in flexion of a supinated hand. Furthermorg the lateral conffactions
impact over top of the radial collateral ligamentwhich increases the lateral stability ofthe humerus eliminating need for contracti on of thepectomlis major and subscapularis, i.e. the natural anterior rotation of the
humerus that occurs only in supinated flexion.
Copy
# oot for RUDI KRASS
20
(It is important to note that, for pronated flexion to be done through its latter stage, one's fingers must
NOT be wrapped around the weight or an attachment to the object being moved as this forces theflexor
profundus digitorwn andflexor longus potticis to contract. These forces directly conftadict the muscle contractions at the dorsal aspect and anterior side of the forearm making the process extremely difficult but still
possible. Doing
cantly.)
so, thougtr, reduces the effectiveness
ofthe biceps and brachialis antictts conftactions signifi-
Thus, the discussion for the final, or normally observed stage of pronated flexion is complete'
Pronated Extension
With this upper extremity activity being the reverse of the pronated flexion, there has to
stages to this action that need to be analyzed: pronated flexion to the start
be
just two
ofthe humerus being rotated
clockwise for the left arm or counterclockwise for the right; the rotation process of the humerus through to its
original fully pronated and extended state. The frst part of pronated extension is quite sftaight forward but the
latter is considerably more complicated and needs to be included even though most people don't do it regularly when extending apronated arm. In the initiat stage of pronated extension, the starting position for the arm
is
just past the 90 degree
point of pronated flexion which indicates ilrat, in order to extend the upper extremity at the elbow, the muscle
groups connected to the hypothenar
dert arc4the base of the palm of the hand,
and the medial epicondyle,
those along the anterior and medial sides of the radius and the posterior of the upper exftemity must confract. The major difference between pronated extension and supinated extension is the pronated position of the hand around the radius which diminishes the conftactive force generated over the medial epicondyle that lowers the
forearm. To compensate for this, the external triceps head contacts along with the internal triceps headto
produce the main extensive force in the upper extremity.
To compliment these upper arm contractions through the initial stage of pronated extension and to
ensure that this force is transferred uniformly to the forearm thereby reducing the possibility of soft tissue
ftauma at the elbow and in the forearm, theflexor carpi ulraris, flexor profurtdus digitorurn, extensor carpi
uhnris
and extersor minimi
digiti contract The first two muscle groups' contractions,theflexors, directly

ftnctions like tight strap placed
correlates to the linear extensive force being applied to the ulna by confraction of the aforementioned triceps
heafu. As in supinated exiension,
the supfuator brevis and'annular ligament
over the radius and tied to both sides of the ulna causing the radial head to arc downward over the humeral
capitellum.
The conffaction
ofthe latter2muscle groups, the qcternors,
acts more like a counterbalance to the 2
flexar mvscle contractions which normally
cause downward and anterior ulna rotation around the
radius-
obviously, this does not occur through pronated extension. However, the contraction of the two aforemen-
Copy
ou
for RUDIKRASS
2t
tioned extensor muscles do perform a significant function through pronated extension which is to keep the arc motion ofthe radius along its normal line. (If the flexor muscle conffactions were not counterbalanced beyond
the lateral line of the radius, then the radius would be subjected, at the wrist, to medial force throughout pronated extension which would be significant enough to bring the radius inward and cause weakness in the extensor muscle groups allowing for the radial head's lateral pins, the radial collateral ligament and the comrnon extensor tendon,to become damaged and/or weakened through normal usage.)
Contraction ofthe 2 triceps heads, the 2 aforementionedflexor muscles and the 2 aforementioned
extensor muscles persist until the forearm and upper arm create a 150 degree angle at which point the second
stage ofpronated flexion starts. Through physical observation
ofthe pronated hand and upper exfremity
as the
ann goes to full or 180 degree extension from the 150 degree position, it is observed that the humerus is
subjected to an anterior rotative force as the thumb moves significantly downward from its initial position.
Again,
as in pronated
flexioq the hand motion is really an effect of the humeral rotation at its head which
meaffi that it doesn't need to be explained beyond the fact that its motion is permitted by cessation of any forearm contractions along the medial side ofthe forearm. To accomplish the observed anterior humeral rotation of the final stage of pronated extension, the
teres major, subscapularis and the clavicular portion of thepectoralis major contract together and in conjunc-
tion with the still confracting interrnl andexternal triceps heads andthe now confracting anconeus. The first
three muscle contractions along the upper and anterior aspect ofthe humerus perform the anterior rotation
of
the humerus and the radiohurneral joinl causing the radial portion of the hand and forearm to surge forward in equal proportion to the humerus. The contraction of the 2 triceps heads mdthe anconeuscause the ulna to extend downward until the Greater Sigmoid Cavity resides in the olecranon depression ofthe humerus. These conffactions are not the only ones applicable to the last 15 degrees of extension because ulnm
motion has to be complimented at the posterior ofthe ulnar side of the forearm and hand so as to eliminate the
possibility of soft tissue trauma in this region of the body. The muscles that contract to perform this compli
mentary duty are the ertensor ossis metacarpi pollicis, the extensor minimi
digiti
and the extensor carpi
ulrnris. These conkactions
are confirmed by feeling the top
ofthe ulnar side of the forearm especially in

ossis metacarpi
men-this part of the forearm is solid indicating muscle contraction. The entire ertensor
pollicis does not contract though
as only the portion residing between this rnuscles radial and ulnar attach-
ments is exposed to stimulation. (The fact that the extensor ossis metacarpi pollicis is able to function like
two muscles astheJlexor sublimis digitorum does will become invaluable in the next section.) Now, all muscle contractions for upper exhemity exteirsion with
a pronated hand are defined
allowing
the discussion of upper exfemity mobility to move on to the next set of complimentary actions.
CopJ
# ool
for RTIDI KRASS
22
90 Dncnrn
Flumo Elnow
SupnvarroFr axo PRoNlrroN
Supination and pronation of the forearm while the elbow resides at a flexed position of 90 degrees are
easily examined and explained. When the upper extremity is flexed to about the 90 degrees and the hand is rotated so that your palm is down at its exfreme without rotating the humerus to make it go finttrer
this is 90
degree pronation or the starting position for flexed arm supination. Maintaining the humeral position
while
reversing the hand positiorq so that your palm faces up, changes the position of the forearm and hand from the
initial supinated position, pakn face down and thumb 60 degrees below the horizontal plane, to the end point of supination where the hand and forearm me rotated 180 degrees from the start.
Employing the reverse mirror observation method and focusing on the posterior of the olecranon and lower humerus tlrrough this supination process and it reverse process, one notices that the area around the posterior humerus bulges towards the
e,nd
point of supination and that this bulge dissipates through pronation.
This posterior bulging and conftacting of the ulrc-humeral joint atitsposterior can actually be felt when you
place your fingers at the back of the humerus around the olecranon depression and then supinate and pronate the hand. This visual observation and tactile test fully confirm that the ulna is moving within the trochlea not
only reaffnming that the posterior ligaments of the ulno-humeral joint are naturally la:i but also confirming
that the anterior ligaments ofthis joint lax as well.
This reality about the ligaments on both sides of the ulrn-hwneral

that the radiohumeral
joinl
is consistent with the realrty
joinl
is the primary joint of the upper extremity with NO la:<ity within its medial and
lateral pins which allows them to perform as the radii for the forearm arc through upper extremity flexion and
extension. The rigidity of the radial head's medial and lateral ligament pins also leads to the conclusion that a portion of the 90 degree supination and pronation has to be accomplished with slight humeral rotations that, in this instance, compliment the hand and wrist rotation around the radius. This assumption is reflected in the fact that there is never a cross over ofthe forearm bones at any point throughout either supination or pronation of the forearm while the elbow is flexed to 90 degrees. (Take a look at the ulna and you will find that the bone is built so ttrai it can be rotated around and
within the radius: the outward bow in the bone; the shape of the Lesser Sigmoid Cavity;the spinal rise in the
Greater Sigmoid Cavity; the ulnar head.
All
these factors combine to account for 90 degrees of supination and
pronation when the ulna is rotated around the radius at the forearm or pulled from one face side of the Greater Sigmoid Cafity to the other, at the elbow, which coordinates respectively with the rotation of the ulna within
the radius at the wrist. To prove this reality, follow the instructions of this 3il Krass experiment closely: put an old ulna bone
tight into its radius correlate and rotate the formerwhile holding the radius steady. As you rotate the ulnar
head within the lower end of the radius, you
will notice that
the Lesser Sigmoid Cavity rotates nicely around
the radial head. When the radius is placed in its normal vertical positiorl it
will
be noticed that the ulna rotates
CopJ
ou
for R[/DI KRASS
23
to the neutral and horizontal hand stop positions ofpronation and supination, noted earlier. As indicate4 the
remaining portion of these actions, posteriorly beyond the neutral position through supination or anterior$
beyond the horizontal position, occur in either the wrist or at the humeral head. This perfect alignment
these
of
facs lead to the conclusion that the flnctionality presented in this book is inefutable.)
90 Degree Flexed Elbow Pronation

From the end position of supination, one notices that the fuipothenar dert, the portion of the palm just
above the ulna, falls backwards to the neuffal
6 o'clock
position which is the initial 30 to 45 degrees
of
forearm pronation. The remaining 120 degrees ofpronation, to the 4 o'clock position on the left or 8 o'clock on the
right is caused by the ulna being further rotated mound the radius along the entire forearm and into the
elbow until the hand is horizontal and then the remainder of the hand motion is a reflection of a minor rotation ofthe.humerus at the capitellum.
So, the
initial45 degrees ofpronation is not caused by any forearm muscle contactions
as the hand
and the ulnar portion of the wrist fall downward due to the previously mentioned elastic principle of the
forearm muscle groups which were strekhed due to the exfeme muscle contractions that took the thumb
beyond the vertical
line. The remainder of 90 degree bent elbow pronation must therefore result from the fulfill
contractions within the rnuscles attached to the posterolateral portion of the ulna and attached to either the lateral portion of the back of the hand or the lateral epicondyle. The muscles that
these requirements
and which cause the ulna portion of the hand to rise so that it resides along a horizontal plwrc arethe an-
coneus,the portion of the ertensor ossis metacarpi pollicis thattesides between this muscles radial and ulnar
at&achments, the exteruor carpi ulnaris and extensor minimi digiti.
The latter stage of pronation

and hand
from the horizontal plane upwards tbr the ulna portion of the forearm
is caused by continued strong confaction of the aforementioned posterolateral muscle groups as
well
as contraction
of the palmaris brevis, supirntor longts and extensor catpi radialis longior. The first
muscle combines with the extensor mrJscle contactions to rotate the thumb downwards. This downwmd
motion of the radial side of the hand causes the supinator longus andextensor carpi radialk to contract in
order to rotate the radiohumeral
joint sliglrtly medially
thus avoiding the transference of any rotative force
from the hand to the radial head's lateral pins. All these muscle conffactions actually define ttrat the lateral portions of the hand and wrist don't really rise during the latter part of 90 ddgree pronation so much as the thumb is brought downwards with sufficient complimentary muscle contractions to bring the lateral side of the
humerus forwmd which the structure of lhe radiohumeralioint demands. The process
of90
degree flexed elbow forearm pronation finally ceases at about the 5 o'clock posi-
tion for the left or 7 o'clock for the right.
CoW
# ool
IoTRUDIKRASS
24
90 Degree Flexed Elbow Supination With the forearm now at its end position for pronation of the hand, the discussion for the revefiie
action" 90 degree flexed elbow supination, can begin. Be wamed though that although pronafion ofthe forearm on an elbow that resides flexed at 90 degrees was rather staight forward, its reverse motion, supination ofthe hand and forearm on an arm flexed to 90 degrees is very complex as you
will
soon
discover. The first stage of this type of supination brings the ulna portion ofthe hand back to the horizontal, then, the
fue
process offorearm supination with muscle confraction begins. This process occurs
in
two significant stages: the first is moving the lower forearm and handto the vertical line or its neuftal
position of 12 o'clock; the second being rotation ofthe hand and forearm to the exheme supinated position or end point ofthe process which is about 60 degrees posteriorly beyond the vertical line.
lnitially, flexed elbow supination is a process caused by the elastic contraction principle, described tnthe Extended Arm Supination And Pronation section of this book, which shifts the hand to the
horizontal line. From this new position, flexed elbow supination proceeds through trvo stages: the first
stage takes the hypothenar
clefi fromits horizontal position down to the 6 o'clock or vertical position; the
second stage, pulls the thumb posteriorly and the palm and hypothenar clefi upwafis. The first stage is rather straight forward and is performed by contractionof the pronator quadratus which rotates the ulnm
head anteriorly within the radius. This initial 90 degrees of supination is complimented with confactions
of theflacor longus pollicis,flacor carpi ulnaris, the lowerportion of thefletcor sublimis digitorum and
the palmaris brevis which create a solid unit the
ofthe wrist and hand
as it rotates anteriorly in unison
with
uln4 bringing the palm to the vertical line and raising the thumb along with it. To bring the ulna
around the radius at the
elboq
the upper portion of
theflaor sublimis digitorum contracts but to a lesser
degree which nafurally brings the Greater Sigmoid Cavity around from behind the radius to below it.
The final stage of flexed elbow supination occurs over approximately 60 degrees anteriorly for
the palm and posteriorly for the thumb from the vertical
line-it
is this portion
ofthis type of supination
that is the most complicated. Such a large rotation though may not seem possible by the natural position of the humerus which is at 4 o'clock on the left or 8 o'clock on the right and this bone remains fixed
throughout flexed elbow supination
including exfrerne supination. Furlher hindering the process though
is the structure of the radius just below the elbow
the
Bicipital Tuberosity. This part ofthe radius in
conjunction with the fochlea jams the force applied to the ulna bringrng it into full contact with them
stopping the upper ulnar rotation abruptly at 30 degrees anteriorly Ueyon9 the neufral position or vertical
line. In sho( the final portion of flexed elbow supination cannot include rotation ofthe humerus beyond
30 degrees from the vertical line. Fortunately, wrist rotation within the end ofthe radius can be used to
explain the discrepancy between the final flexed elbow position and the anterior rotational limit of humerus.
CopJ
ou
IoTRUDIKRASS
25
To complete the first 30 degrees of flexed elbow supination beyond the vertical line,the prorntor
quadratus, flexor carpi ulnaris,the lower portionof fheflacor sublimis digitorum,theflacor tongus
pollicis wrdpalmaris brevis continue to contract pulling
the ulna forward to its anterior
limit. Through
the final 30 degrees of flexed elbow supination, these confiactions are complimented with conhaction
the a,ctensor brevis pollicfs, the lower portion of the actensor ossis metacarpi
of
pollicis,the extensor longus
pollicis
and actensor
indicis. The first two qteraor muscle groups provide the primary posterior rotative
force applied to the thumb due to their attachment to the lateral side ofthe radius. The other 2 extensor muscle groups compliment this force which is permitted given the fact that they are conhacting against the shonger muscle contactions on the anterior side of the wrist in order to created a posterior rotative force on the hand. Thus, the posterior rotation ofthe wrist and thumb is fully explained concluding the discussion of supinafion and pronation of the forearm while the elbow is flexed to 90 degrees. This also completes the analysis of all the major upper exkemity articulations and defining how the muscles actu-
ally conhact to perform these articulations based on the reality that the radiohumeral joint is achaally
o'solid"
and does not rotate through either supination or pronation.
CopJ
# ool
for RUDIKRASS
26
Coxcrustonr
From this understanding of supination and pronation, it is easy to produce a firll thesis on rotatory
instability: the second part of this document whictr" to date, the medical community has been unable to do. The
main reason for this is now fully exposed: the physicians have adheredo without question, to the illogical and
unscientific stance that their theories conceming pronation and supination of the upper exfemity are beyond
reproach--if it ain't broke, don't fix
it.
The medical stance is unacceptable for the millions of patients suffering
from carpal tunnel syndrome, wrist tendinitis, anterior rotator cuffswelling or subluxations within the shoulder,
bicipital and lateral epicondylitis and, in the long term, osteoarthritis in the elbow and shoulder. With the sheer number of unexplained and unfieated
cases of these medical problems that arise
from
repetitive overuse of the upper extremity and lower forearm in fashions that they were not meant to be used,
according to my findings, comes the question: At what point will the medical community finally admit that their theories about upper extremity functionality and its rotations are broke and therefore change them so that the
previously mentioned conditions canbe fullyundentood allowing themto be resolved quickly andwithout a long hard battle with our physicians?
It is imperative that the medical community move quickly to accept that the majority of hand and
forearm rotations are actually conducted like a drive fiain on a rear car meaning that the majority of rotation occurs at the shoulder and not at the humeral capitellum. From this realtty, the functionality of the elbow and forearms also have to change in order to understand flrlly upper exfrcmity and extremity functionality.
At
presen! it is falsely presumed that the elbow is a "hinge" joint with the ulno-humeral jointberngthe "hinge." Well, 200 years agq I could
see
this being accepted, however, in this day and age with vector mechanics and a
complete knowledge of rotational force in physics, the centuries old simplistic approach to extremity motion can no longer be supported especially with the massive amounts of misunderstood upper exffemity medical problerns.
This book's first Section firlly elaborated on how the muscle confactions ofthe forearm and upper arm work with the new skeletal and ligamentous sftuctures of the elbowo wrist and shoulder. As I wrote this Section, it was eerie how well the muscle contactions fit into the articulations of the wrisf elbow and shoulder without a
shaggler here or there as exists presently in the medical axioms, i.e. the anconeus. In my opiniorl the way that the muscle contractions adhere to the joint and ligament structures alone should lead to the acceptance of the fact that the elbow is basically like a'trniversal joint" tansfening force between the forearm/trand and the shoulder
and vice versa as well as making the upper extremity
a'lvhole unit." The elbowos basic functionality is based
on the length of the medial and lateral ligament arc pins, i.e. the anterior andradial collateral ligaments respec-
tively.
Shoulder rotation is created not so much by the rotator cuffmuscles either, as the medical community presently assumes. The rotator cuffmuscles along the anterior and posterior sides of the humeral head do play a
Copy
ou for RUDIKRASS
27
significant role in upper extremity pronation but in a far more engineered fashion than is assumed by the medical
community. As either side of the rotator cuff muscles confact and the other muscles rela& the rotative motion
has to caused by a fulcrum , the Glenoid Cavity,and a limiter to this contraction so that the opposing muscle
groups can conilact without sfain, the coraco-hwneral ligament. This ligament also contols the humeral rotation, noticed at the medial and lateral epicondyles,
the Coracoid Process is represented in the circular
motion of the humerus
it is the 'benter point." This realrty determines that the arc of the coraca-humeral
ligament is actually represented in the humeral rotation of its lower portion by its circular rotation around this
center
point the Coracoid Process. (All the circular humeral references are determined from
a slice though the
elbow like those produced by a MRI or CT scan on film or computer monitor.) Not to be forgotten, though, is the wrist and hand. These parts of the upper entremity rotate around the now determined non-moving radial head to complete extreme pronation and supination. Also, the entire foreamr, from the tips of the frngers thtough to the humeral portion of the ulno- andradiohurneral joints, form a cohesive unit or subsystem of the lower humeral end.
Interestingly enough, much of what I discovered about the radiohumeral joint, i.e. that it fimctions like
a '?nodified
pulley" where, instead of
wheel rotating freely around a center point established by two stationary
and isolated arms or radii, the wheel itself is stationary, the humeral capitellum, and the rope, opposing muscles, attaches to the top and bottom of an object, the radial hea4 and it is pulled up by the top muscle and down by the
back muscle, arose fuamreverse engineering. This'tnodifiedpulley''keeps the force stable on avertical plane down plane with trvo pins which attach at either side of this plane, i.e. at the medial and lateral sides of the
radiohurneral jointwhen looking from overtop ofthe joint. This functionality can be applied to the knuckles of the hands and toes
as
well
as
the knee.
All of these
joints are '?nodified pulleys" bul instead of a stop point made out of bone
the Greater Sigtnoid Cavity,the
capitellums are actually formed in such a manner that the arc of motion occurs towards the range of flexion.
This reality means that, when the bones are firlly extended, the medial and lateral arc pins and the side of the capitellum away from the bend no longer facilitate any firther extensive motion. (The knee actually finctions
almost the sarne as the elbow through flexion, i.e. with a few basic confuactive rrurscle towards the upper poste-
rior ofthe lower leg. This reality is reflected inthe "cramping'that linemen inAmerican style football suffer
from towards the latter skges of the games.)
lrcalue that the axioms
are rather complex and may be
difficult to follow with the muscle contoactions
being totally different than their present labels. However, when first reading this boolq don't dally
tying to
understand wholly the motion and muscular contactions presented in this section at first brush because the basis
for this section is clearly established in the following sections: elbow problems like lateral epicondylitis fully
understood, at last. This section is the culmination of this undersknding which arose fromreverse engineering this condition's main cause in society overthe last few decades-repetitive overuse syndrome. So, move on and come back to e4pand fully your understanding of elbow functionality and upper extremity motion!
Copy
28
AppENpxt Suulwnnv
A simple e4periment confirme{ without a shadow of a doubt that the supinator urdpronator muscle groups of the forearm are actually improperly labeled and also e4posed that supination and pronation are not actions limited to the forearm but actually include the upper arm boneo the humerus. Essentially, the experiment concretely exposed the fact that supination and pronation are actually a set of very complex processes comprised of a sequence of muscle contractions extending from the shoulder down through the forearm muscle groups as far as base of the palm of the hand making the upper exhemity function fundamentally like a
drive frain on a rear wheel car.

Tlre anterior and radial collateral ligaments actually form a set of mc pins for the raising and lowering motion of the elbow explaining the role of the radiohwneral joint quitn easily because these pins actually allow the radial head to arc over the humeral capitellum through flexion and extension. This motion is similar to drawing a large circle with a sring which is tied tightly to the midpoint of the circle where the radial head's medial and lateral pins function like the sting, the humeral attachments as the midpoints and ttre radial head is the pencil.
Another more correct analogy is a'?nodified pulley" where, instead of a wheel rotating freely around a centir point established by two stationary and isolated arms, the wheel is stationary, the humeral capitellurn, and the ropeo muscles, attach to the top and bottom of an object the radial head, and it is pulled up by the top muscles and down by the back muscles. To keep the force going on this same plane are two pins which atafrh at either side of this moving object, the radial head - i.e. at the medial and lateral sides of the radiohwneral joint when looking from over top of the joint. Both analogies determine that the radiohumeral joizr is solid and pinned atthe radial collateral and anterior ligaments. The drive train principle determines that the irfraspirntus, teres mfuror, subscapularis, teres major andpectoralis major play a significant role in supination and pronation. This also determines that the Glenoid Cavrty acts like a the fulcrum for humeral rotation through supination and pronation with the coraco-huneral ligamenl functioning as the limiter of humeral rotation. It is important to note that the muscle names were taken from the 1901 edition of Gray's Anatorny, 6P printing, but the functionality does not comply with what is presented in this book because the elbow and upper exhemity do not function as the medical community presumes, i.e. hand rotation is strictly a forearm activrty and that the radial head rotates around the humeral capitellum.
SupnqArnn FrE)iloN At\D SupnurEn E>rrnNSIoN

Supinated Flexion
T
Basic muscle confiaction for upper extremity flexion: biceps, supinator brevis, brachialis antictn, pronator teres,flexor sublimis digitorum
->
In flexion of a supinated foreanrl basic muscles augme,lrted with contactions in: palmaris longus,Jlexor carpi radialis, nryinator longus, extensor carpi radialis longior
-> ->
Latter stages of supinated flexion add: claviculm portion of the pctoralis maior, subscaprtlaris
CoW
# ool
for RUDIKRASS
Supinated Extension
Initial and main muscle contactions for lowering a supinated forearrn: internal triceps ltead,pectoralis maior
-> -)
Complimentary forearm muscle contractions: extensor ossis metacarpt pollicis, extensor earpi radialis brevior, extensor commtmis digitorurn, ertensor minimi digiti, qctensor indicis
Supinated flexion is merely a reversal of the supinated flexion process, the primary motion like all bending motions ofjoints. The only necessary information to remember is that both motions are actually performed throughout the upper extremity like a drive train and that almost all upper extremity motions impact on the shoulder via ttre "solido' radiohwneral joint and the radial head's lateral and medial arc pins.
*E>rrBnonu ARN,I Supnraflox nvo

Important
horurnox*
less solid than previously thought by the medical
Note:
the ulno-hwneral
joint is considerably
community especially since it actually facilitates extended supination and pronation by allowing the olecranon to move easily between the frochlea and the lateral epicondyle.
There are 3 main positions ttrough both pronation and supination motions which account for a change in muscle conftactions: full supination; the neufral (12 o'clock or vertical) position; the fully pronated hand position (5 o'clock for the left ann and 7 o'clock for the right ann) with the thumb representing the reference
point forthese clock or degree positions.
Extended Upper Extremity Pronation

Pronation from extrerne supination to the neutral there is no contaction, elastic bandprinciple
---> subscapularis, clavicular portion of the pctoralis major act as stretched elastic bands
From the neutral position to the fully pronated position: downward rotation of the medial epicondyle
-> ->
subscapulctris, teres rnajor
ulna rotated around the radial in the lower forearm arrconeus, extensor carpi ulnaris, ertensor minimi digiti, flacor carpi radialis, palmaris longn, extensor longts pollicis, etctensor indicis
Withthe handnow horizontal andpalm down clavicularportion ofthepeetoralis major, extennl triceps head -> subscapularis, teres major, portion of the extensor ossis metacwpi pollicisbetweenits radial and ulnm attash-> anconeas, ments, extensor carpi ulrnris, extensor minimi digiti, extensor communis digitorurn,flexor carpi radialk, palmaris longus and brevis
CoW
ou
for RUDIKRASS
Extended Upper Extremity Supination

Supination from the final position to the horizontal line: there is no contraction, elastic band principle corcrco brachialis, infraspirntus, teres minor act as stretched elastic bands
->
Rotation of the ulna taking the palm from its horizontal line to the vertical and neutal position: prorwtor quadrahn, flexor caryi ulruris, flexor longts pollicis, palmaris brevis, the lower portion of the/lacor sublimis digitorum
->
The next 30 degrees ofsupination:
->
The
coraco brachialis
The final 60 degrees:
frst portion of the motion:

furtlrer confiaction of the coraco brachialis, teres rninor, infraspirnhx
->
The forearm/hand completion of supination - rotation of the scaphoid and semilunar within the wrist end of the radius: the lower portion of theflexor sublimis digitorum, trtronator quadrattu, flexor carpi ubaris, flexor longw pollicis, palrnaris brevis - replaces the improperly assumed contraction of the pronator quadrafus
->
complimentary posterior thumb rotation the lower portion of the extensor ossis metacarpi pollicis, extensor brevis pollicis, ertensor longw pollicis, extensor fudicis
hoNlrEn
FLn>iloN ANp
holvarnn E)ffExsrou
Pronated Flexion
Pronated flexion is broken down into two distinct ranges of motion:
going from the fully pronated and fully extended position to the point where the humerus is at its normal position
the other is flexion ofthe upper exfemity
The initial stage ofpronated flexion:
-)
g6vqs6 brachialis, infraspirntus, teres minor
Rotation of the humerus and consequently the radiohumeral joint from the arm's initial FULLY pronated and extended position facilitates the raising of the forearm through pronated flexion - final stage of pronated flexion - in almost the same manner as flexion of the arm with a supinated forearm. The major difference is that the hand is now palm down rather than palm up which impacts on what muscle conhactions occtr beyond
the basic muscles used in supinated flexion.
Copy
# ou
for RUDIKMSS
Basic muscle contraction for upper exftemity flexion: biceps, npirwtor brevis, brachialis antictu, pronator teres, flexor sublimis digitorum
->
Secondary contractions:
->
supirator longw, ertensor carpi radialis longior,flexor carpi radialis, actensor carpi ulrwris, extensor ninimi digiti, extensor indicis, extensor longus pollicis, extensor ossis metacarpi pollicis
Pronated Extension
There are equally two stages to this action: pronated flexion to the start of the humenrs being rotated the rotation process of the humerus ttrough to its original The initial stage ofpronated extension:
fu!!
pronated and extended state
*>
/Iexor carpi uharis, flexor
profun&*
exteraor catpi ulnaris, extensor minimi digiti
produce complimentary forearm contactions
As in supinated extension" the supinntor brevis and the anrurlar ligarnent fwrctions like a tight stap placed over the radius and tied to both sides of the ulna which causes the radial head to mc downward over the
humeral capitellum due to the extensive force applied to the ulna.
The final stage ofpronated extension:
anterior humeral rotation teres major, mbscapularis, clavicular portion of frrc pectoralis major, lmcorletlt, internal and actenal heads of the triceps
*>
fmal hand and forearmpronation
-)
extensor minimi digiti, extensor carpi ulruris, portion of the actensor ossis metacarpi pollicis between its radial and ulnar attachmeirts (the extensor ossis metacarpi pollicis is able to fiurction like two muscles just lketheflexor sublimis digitorum does)
90 Dncnnn Fr,nrmo Er,sow SupNATroN ANp PRoxlfloN

Looking at the ulna you will find that the bone is built so that it can be rotated around the radius at the wrist but within the radius a third the way down from the elbow: the outwmd bow in the bone; the shape of the
Lesser Sigmoid Cavrty; the spinal rise in the Greater Sigmoid Cavrty; the ulnar head. All these factors combine to account for 90 degrees of supination and pronation whe,n the ulna is rotated around the radius at the forearm or pulled from one face side of the Greater Sigmoid Cavrty to the other, at the elbow, which coordinates respectively with the rotation of the ulnar head within the radius at the wrist.
CoW
ou
for RUDIKRASS
iv
90 Degree Flexed Elbow Pronation

The initial 45 degrees of pronation: there is no contaction, elastic band principle 90 degree pronation to the horizontal: attachments, extensor carpi ubaris, extensor minimi
digiti
The latter stage ofpronation: Complimentary contractions to the previous ones which continue me:
->
palmaris brevis, supirwtor longn, extensor carpi radialis longior
90 Degree Flexed Elbow Supination

This process occurs in truo significant stages: moving the lower forearm and hand to the vertical line or its neutral position
then, rotation of the hand and forearm to the end point of the process
Initial flexed elbow supination:

there is no conffaction, elastic band pririciple
Supination of the lrypotlrcnar ckrt from its horizontal position down to the vertical position; pronator quadrahn, flexor longus pollicis, flexor carpi ulrwris, the lower portion of theflexor sublimis digitonnn, palmaris brevis
->
The next 30 degrees of flexed elbow supination beyond the vertical line: pronntor quadratus,flexor carpi ulrwris, the lowerportion ofthe flexor sublimis digitorutn, flacor longus pollicis, palmaris brevis
->
The final 30 degrees offlexed elbow supination: the previous muscle contactions are complimented with contractions of:
-)
actensor brevis pollicis, the lowerportion of the extensor ossls metacarpi pollicis, extensor longus pollicis, extensor indicis
All this restructuring of muscular contractions within the upper extremity did not mise out ofthin air but from the discovery that lateral epicondylitis should not occur given the present medical a<ioms for upper exfemity
fi.rnctionality yet it does occur and quite often over the last 10-12 years. Through reverse engineering, I was able to decipher the process cause of lateraal epicondylitis and then reconfigure how the upper extremity rotates while being faithful to the physics of the radiohurneral joint. lnaedibly, everything fit with no loose ends like presently exist within the medical axioms. Thus, I know that these modalities and several complimentary theories which adhere to physics are the actual way in which the hand becomes pronated.
CopJ
ou
IoTRUDIKRASS
SncrroN II: TnE Kmss Rn,auN" oF LITERAL IIpPER ExrREMrrY RoTAToRY IxsTABrLrrY
CoW
# ool
for RUDI KRASS
Basrcs qF L+rrRar UpprR Exrnrurry RoTArpnv IxsrAsrl.rTY

As I stated early on in the preceding thesis, my discovery that the upper exhemity was radiohurneral
joint md coraco-hwneral ligamenl centric tnj*ies
mose primarily from my having reverse engineeredmy
nitial
and their cause. This process also led me to the realization that supination and pronation are not
forearm specific actions but rather whole arm activities. I knew that my initial wrist and elbow injuries arose from activities that required repetitive hand pronation with high torque as well as constant elbow flexion with high weight. I also knew that I had suffered a sharp sudden pain at my right or dominant elbow's lateral
epicondyle prior to the onset of lack of sensation within my ring and middle fingers and extensive swelling
of
my lower foreanrl wrist and hand. These symptoms arose quickly after the initial elbow injury
a8 hours
which resulted from my having continued to perform the same activities that caused the lateral epicondylitis
and then activities requiring more extensive use of my arm with flexion and extension. From pre- and post
elbow pain activities, I could only deduce that pronation of the forearm had caused the problems in my wrist Essentially, I discovered" from reverse engineering, that repetitive high weight use of my right affn through pronation was strengthening my pronator teres catasingwrist tendinitis as well as lateral epicondylitis.
So,
I could only conclud etlntthepronator teresdoes not confract at all atany point throughout pronation
as the medical theories
which, in turq means that the radiohwneral joinl does not rotak around the capitellum
about supination and pronation present$ and falsely contend. This conclusion led to the present medical thesis about upper exfemity rotation, i.e. basically that the ulna rotates around the radius throughout both
supination and rotation and that the ulno-humeral joinr is solid and the basis for the entire upper extremity.
Knowing this, I devised

that the radiohuneral
a simple
experiment the
1o
Krass experiment, which would confirm not only
joint
was in fact solid throughout supination and pronation but also tha! what the
medical community was claiming in its theories about supination and pronation, was utterly wrong. This realrty is confirmed by so many ofthe upper extremity's injuries being highly misunderstood and especially their causes. The experiment that I devised was prese,nted in the preceding thesis but I knew that in order for
the medical community to accept this thesis, I would have to re-confirm this with some form of film images. The images I needed were simply deduced to be a sequence of radiographs of a health elbow that demonstrated the initial and ending position of all the bones within the upper extremity,
fully supinated and f,rlly
pronated-the
Krass experimmt.
Both Krass experiments confirmed that supination and pronation are a whole exffemity activity and
that tlrc radial head does not rotate around the capitellum. These tests also proved that when the radius acted
CoW
# ool IoTRUDIKMSS
35
in the mannerpresentlyprescribedby
the medical communitythat it actually was performing in an incorrect
fashion. Further confirmation of both facts were the 47 other individuals that I knew were suffering with cluonic lateral epicondylitis and carpal tunnel syndrome. Although the causes of these
cases varied
widely,
the long term symptoms were remarkably similar including shoulder crepitus and, when I applied my theories
about lateral rotatory instability,
LM, to the causes, it was confirmed that atl the
cases, to
which I had been
exposd
arose from the inalienable facts that I had discovered about how the upper exftemity actually rotates
and reverse rotates, i.e. pronates and supinates, and that these activities revolve around a solid radiohwneral
joint
and coraco-hwneral ligament.
ALL the
I
cases of soft tissue insuffrciency at the lateral epicondyle that

Ore
I stumbled onto over the last
I years arose from either forced pronation with weight beyond
han4 from repetitive use of the forearrn while the ann was extended e.g.
while it was pronated to the horizontal plane or from

use of the arm in an attempt to stop a
a trauma to the hand
fall from shpping on a patch of ice. The frst two causes clearly demoncontactingin order to bring the radius over the ulna
sfratd that the problem was due to the pronator teres
rather than the conect way which is to rotate the humerus posteriorly and the ulna under the radius. The third and most medically known cause is more complicated
bul under scrutiny, can be determined to have the
same
affect on the forearm and upper elftemity. This book's section will, by its end, demonstrate how all the causes are actually different
pathomechanics to a comnon soft tissue insufficiency at the lateral epicondyle or both.
either tendinous, ligamentous
CoW
ou for RUDIKRASS
36
LaTEnar. [Jppnn Exrnnruury
Before this discussion can be started it has to be disclosed that there are basically two distinct types of lateral upper extremity rotatory instability: cases arising from a soft tissue insufficiency at the lateral epicondyle; cases arising from a soft tissue insufficiency at the anterior rotator cuff. The latter case thouglq
with repetitive pronation, actually cauies the large volume of cases among female workers of lateral rotatory
tustability,
LN. It is important to start the discussion aboutZR/with
the first t5ipe, elbow based
leaving the
discussion about the second type, shoulder based, for last.
Laruml
IJppEn ExTnrr*nrrv
Rou,rony INsrAgtrlT.Y
The following section
will indicate the causes of elbow
based
ZRlof the upper exremity
as
well
as
how it causes the soft tissue insufificiency at the lateral epicondyle. Basically, all the causes of lateral upper
extremity rotatory instability adheres to the reality that the radius and the anterior medial epicondyle are pulled
together by contraction of the pronator teres when it naturally is meant to be relar<ed and when the medial
aspect
ofthe humerus remains stationary due to contraction of the brachialis anticus and coraco brachialis
muscles. The reduction ofthe natwal anterior angle ofthe radiohtnneral
joint,120
degrees, is what causes
lateral epicondylitis or the sftetching to the point of tearing of the common extensor tendon. (The 120 degrees
is demonstrated when one adds the degrees from the natural horizontal line that is create4 when looking at the
front of the humeral capitellum, by drawing a line that passes through the humeral attachments of the anterior
and radial collateral ligaments, i.e. the base of the radial arc ligamentous pins, and by drawing a perpendicu-
lm line to this natural horizontal line at the midpoint of the capitellum. So, with the 90 degrees established,
the remaining 30 degrees of the 120 degrees is accounted for by the position of the anterior trochlear line
which is 30 or so degrees downward from the aforementioned horizontal. As has
bee,n demonshated" the
natural position for the medial epicondyle (men) is at approximately 4 o'clock on the left or 8 o'clock on the
right which confirms that the humerus is naturally rotated downward some 30 degrees from the horizontal for CoW
# ool
for RUDIKRASS
37
women. Thus, the natural anterior angle of the radiohwneral joint is I20 degree.)
The fact about the anterior angle of the radiolnnneral
joinl
is unknown to the medical community
because, when an x-ray of an extended arm is takerU the medial epicondyle or ftochlear line is raised to the
horizontal line. So, when the film is processd all that is seen is the natural valgus alignment of the radiohumeral
joint which is consistent with looking at the joint which
has been rotated backwards 30 degrees.
In
short, the film is not a true example of the natural alignment of the forearm and humeral bones because it is not taken from directly on top of the radiohwneral
joint, i.e. it is not taken along the perpendicular line will become very impor-
established earlier. The information about the position of the radius to the humerus
tant when devising techniques for diagnosing cases of lateral elbow based soft tissue insuffrciencies. Once the radial collateral ligament and cotnmon extensor tendonhave been comrpted this 120 degree angle
will continue to be reduced by improper contraction of
the pronator teres andupper portion
of
theJlexor sublimis digitonnn. So, once epicondylitis has been detected in individuals (men) who work with high torque values at the hand or (women) who use their hands in a pronated position religiously
day-in and
day-out the living nightnare has begun.
CoW
ou
for RUDIKRASS
38
Over the past 9 years, I have come across numerous individuals with an ide,ntical upper extremity symptomology as myself. HowweE due to the varied causes, I was unable to collate them until I knew exactly
how epicondylitis, carpal tunnel and wrist tendinitis were caused. Once this was done, I was further able to
include anterior rotator cuff problems.
The causes of elbow based lateral rotatory instability,
LN,
to which I've been exposed are: taumas
to a nearly but not fully extended arm at the elbow; repetitive and moderate traumas like hockey players being
constantly bunped in the comers or boxers
basically a cumulative effect on ttre radiohumeral
joint similu to
the more violent trauma cases; repetitive overuse syndrome, which includes pitchers and labourers in one sub-
group and then computer users and race car drivers in the other sub-group; old age; gender.
Instability Due To Traumas To An Outstretched Upper Extremify

This cause is unique even though most orttropaedic surgeons are aware ofthe relationship between this cause and the resulting radial collateral ligament insuffrciency. The problem is that a trauma like bracing your fall with an outsffetched arm can also result in several other medical outcomes: broken or crushed radial
head or wrist; strained or sprained wrist; lateral epicondylitis; damaged anterior rotator
cuff
So, how can the
same causalgia result in these ditrerent medical problems and is there any way to determine exactly the
differ-
ent results? When the bracing upper extemity is partially extended that is when soft tissue taumas to the
wrist, elbow and shoulder occur. When this arm is fully extended, then damage to the bones at either the
elbow, wrist orhand occurs. Before the mechanics ofthese individual actions can be exposed" the relationship
between the lower forearm, hand and wrist has to be discussed.
Atpresent the medical community
sees the
han4 wrist, lower forearm
as a separate entity aside
from
the elbow even though the entire forearm down tlrough the finger tips from the hume,rus, i.e. the tuochlea and
capitellum, can easily be shown to be a complete unit by the results of the force applied to the hand. This force often cau{ies problems in the elbow and shoulder- conclusivelyproven since the development of magnetic resonance imagery
which contradicts the medical thesis ofthe lower forearm through the finger tips
being a distinct and "sepmate entity'within the upper extremity and from the elbow joint and the upper arm.
The present medical thesis conceming the lower forearm and hand leads to the conclusion that all resulting
problems of the force at the hand would have to be limited to the lower forearm, wrist and hand. The fact that
a considerable sum ofproblems that arise from a hand based force are not located within the aforementioned
CoW
ou
for RUDIKMSS
39
medically defined'tmif' demonsfrates that the basis for this designation is utterly wrong. The medical community didn't catch this break in their logic, though. In reality, the unit that exists is from the capitellum and tochlea down through the tips of the fingers. This is a natural unit because the bones in the hand and forearm run perpendicular to the lower face of the
humenrs with the wrist being a conglomeration of small bones weakly held together with a single lo< ligament
which allows for its articulations and rotation within the lower exfemity ofthe radius. So, when force is
applied to the base of the palm and the hand is bent baclavards, the sfiuchres of the wrist and forearm act just
like
a nail
in fact, when one isolates the bones of the forearm and places the wrist on top, the separate
structures bare a remarkable resemblance to a dull upside down nail.
As we all know, when a nail is hit cleanly upon its head, the whole nail goes into the wood or soft
stnrcture beneath. This transference of force is exactly what happens to the force applied to the hand: it ends up being transfened to the elbow via the radius and ulna. However, there are different results mainly due to
what is happening with the hand and wrist. When the wrist and hand is held together either by taping or
sfrong contractions within the muscles attached to the te,ndons that surround and support the
wrist the force
applied to the elbow is greater and, when the wrist and hand is not solidifie4 then the effects of the force may be limited to the hand and
wrist. With the knowledge that the natural forearm unit
ends at the elbow and more
specifically the radiohumeral joint as it is the foundation for the remaining elbow joints, ubn-hwneral wrd
ulrn-radial,the discussion of how a significant and sudden force received at the hand causes soft tissue
problems at the elbow and shoulder can be initiated.
Soft tissue frauma at the lower face of the humerus occrlrs when the elbow is pmtially flexed because
all the bones at the elbow are not locked together. When the elbow is flexed and a sudden significant force is
applied to the upper exhemity at the han4 the lack of rigidity at the elbow allows for the force to be applied to the radial collateral ligament. Essentially, this force revenie rotates the humerus, i.e. it rotates the lateral
epicondyle area bachvards, and becaus e the anterior ligament renains
soli{
'livot
point" is created at the
medial side of the radial head. So, the greater the sudden force applied to the arm at the hand the greater the
damage to both the radial collateral ligament and common extensor tendon. Now, these structures are
insuffi-
cient to act as the lateral pin for not just the radial arcing motion utilized through flexion and extension but also to pin the radiohnneral
joinl through supination
and pronation, i.e. keep the upper exffemity's 'hniversal
joint" tight.
The lack of proper lateral pins for the radial head will not however show up when one applies the
present standardized medical examinations for ranges of motion in the elbow because the soft tissue insuffrciencies at the lateral pin do not
ffibit
these motions.
All, the lack of lateral pins does, is force the humerus
to rotate frrttrer posteriorly before the elbow flexes and causes the radial head to rotate instead of the ulna through supination and pronation. It is quite clear then that the medical examinations of the elbow to determine whether or not the joint is dysftrnctional have to be changed--{ris will be address nthe Diagnostic
CopJ
# ou
for RUDIKRASS
40
chapter ofthis section ofthis book.
With it now understood that when the elbow is not in its locked position, i.e. when the arm is flexed
beyond 30 degrees from the fully extended arm position, the sudden force applied to the hand actually causes
posterior displacemeirt of the radiolrumeral joint at the lateral epicondyle as well as rotates the humerus clockwise for the right arm or countercloclarise for the left, i.e. contrary to the upper arm's normal rotation in general. This sudden contrary humeral rotation places stain on the anterior rotator culf of the shoulder which
is manifest as swelling while the elbow problem is manifest as lateral epicondylitis. Wrist Strain or sprained
wrist results from the radius being thrust into tlre wrist
as the abnormal radial displacement at the lateral
epicondyle in a typically solid and unmoving area has to go downward especially when the ulna is capable
of
"sliding" backwards in the trochlea. The rotator cuffswelling is caused by the coraco-humeral ligament and
supporting coracoid tendons stopping the abnormal posterior humeral rotation which arises in a complimentary fashion to the radial head's advancement in the wrist due to the radial head's medial arc pins acting as a
pivot
ioint.
This reality means thag when either wrist strain/sprain or swelling at the anterior of the
a physician, regmdless of their cause, the lateral
shoulder around the Coracoid Process are presented to
epicondyle soft tissues must be assessed: the Bresence of either of these sJmptoms demonstrates that an
undiagnosed insufficiency of either the radial collateral ligament or common extensor tendanmay be present.
With it known that bracing
fall with your hand with
partially exte,nded elbow causes soft tissue
traumas throughout the upper extuemity, then obviously, bracing your fall with a futly extended elbow causes skeletal damage within the foreann, wrist, hand or at the radial head. These resul8 arise because the force is
kept linear and when the arm is straighl the shoulder joint is strong enough to withstand this type of force and its amount. But, the shoulder isn't capable of stopping rotatory force mainly because this process is soft tissue based whereas linear force is skeletal in nahrre.
The humerus is not usually damaged from a ftauma to an outstretched arm mainly because it is the largest and most solid bone within the upper extremity. The wrist and hand
carpal and metacarpal, respec-
tively
bones are the more likely to be shattered or broken as they are the smallest within the upper extremity:
wrist when the force is taken at the base of the palm of the hand; hand bones when force is received with a
loosely clenched fist. Damage to the bones of the hand and wrist mainly occur when the upper extremity is
within 10 degrees or less of the exfeme locked or extendedposition of the elbow. From 10 to 20 degrees
from the exteme locked elbow position, the arm has to be considered fully extended not just because the
bones of the elbow are still within their interlocked stage but because this means that the musculaflre necessary to combat the lateral displacement of the radial head, i.e. the muscles that conftact during the final stages
ofelbow extension in the forearm and the internal triceps, are still tense enough to stop the lateral radial head
displacement with the aid of the slightly interlocked elbow bones. Nowo all aspects of trauma to an outstretched arm have been examined and the reason for soft tissue damage as opposed to damaged bones have been correlated respectively.
Copy
# ou
for RUDIKRASS
4I
Repetitive Moderate Trauma: the Cumulative Effect

The same ultimate effect ciency of both
on the radial collateral ligarnent andcomrnon exteraor tendon -tn insuffi-
occurs with repetitive mild to moderate force on the elbows. This type of force occurs mainly
when the force to the partially outsfetched arm is mitigated. This occurs most often in sports especially those
where the individual is often put in a position where he has to stop himself from hitting a solid object, i.e. the boards in hockey, indoor soccer, indoor football, indoor
tack events like the 60 meters or tripping suddenly

a garne
from a pereonos normal height especially tall basketball playen during
this time their height worla
against them. The athlete often sees the event a sudden stop, before it occurs and sfretches out his ann to brace for the impact.
To mitigate the force of suddenly stopping with the outstretched anru this person flexes the elbow upon impact which merely reduces the negative humeral rotation before the radial head's natural arc motion
takes over allowing the forearm to come in towards the humerus. This process isn't harmfirl, per say,
if and
only if this occurs once or twice and then the arm isn't used significantly for several days following the event
as often happens in the 60 meter events at indoor track meets. (This process is
firther helped along by thick
and soft mats being placed in front of the wall at the impact areas.) This break in usage often allows any damage to the soft tissue structures at the lateral epicondyle to be repaired by natural healing and the training techniques used by these athletes.
With hockey, indoor soccer, indoor football, squash, racquetball and sports in confined spaces, the walls are not padded and the arms are used more significantly without diagnosis of lateral upper actremity rotatory instability and proper treatne,nt. This lack of diagnosis and featnent results in
a repetitive force
being applied to the participant's lateral soft tissue elbow structures which leads to a net result of increased
lateral torque tothe radiohumeral
joint:
torque
: force x distance, where the distance increases following
significant force that created an initial nominal stretch tothe radial collateral ligarnent and common extensor
tendon, thus, allowing the lateral radiohurneral gap to grow in these athletes. Although participants of these sports may not notice the lateral elbow problem initially, they often complain of soreness of the shoulder
anterior rotator cuff, elbow, forearm and wrist stiffiress and soreness later on down the season or tlrc next morning when the high adrenaline effects wear
off. (All of these non-elbow problems will
be proven to be
symptoms of an insuffrciency of either the common extermor tendon or radial collateral ligament rnthe
Symptomologt chapter of this section of this book.) If the mild permanent insufficiency at the lateral epicondyle grows to a moderate level and" in some cases, ultimately an exfreme level without being diagnosed, the problems no longer remain limited to just the ligament and tendon of the lateral elbow but
will also include
the cartilage at either or both the shoulder and elbow, depending on how long the elbow has been used and
how forcefully following the onset of a moderate level ofZRl.
An interesting group of athletes whose radial collateral ligatnent and/or cornrnon extensor tendon is
CopJ
ou
for RUDIKRASS
42
damaged is boxers. In the early days ofpugilism, there was a large number ofparticipants who ended up
b,reaking ttre bones of their hands which is consistent with the principles of
fully extended and outsfretched
arms receiving force. The short-sighted solution adopted by the boxing community was to tape the hands so that the sudden stopping of the significant force behind the hard punches no longer broke the bones in the
hand. The unforeseen consequences of this taping for the boxers were that the wrists now began becoming swerely sore and/or swollen with the occasional broken bone at the lower exfremity of the radius. These new
sypmtoms resulted in ttre taping being extended further upwards from the hand through to the lower forearm.
This incteased taping of the wrist and surrounding forearm however only really stopped the forces being
applied to the bones of the wrist and the inferior ulno-radial connect to the
joint
the portion of the two forearm bones that
wrist. The force of the blow
on the hand is thus better ftansferred to the elbow an4 in particu-
lar, the radiohumeral
joint. However,the full
force ofthe punch is mitigated although not by flexion ofthe
arm and elbow as in sports performed within an enclosed environmen! but by the fact that the boxer isn't
punching a solid object: essentially, the opponent's body receives the force ofthe punches by either compression of his soft tissues like the muscles ofthe stomach, moving ofthe head backrvards with the punch or
breaking of the bones in the area of the body receiving the punch
* usually the ribs or face.

as the
It is usually punches to the ribs which results in damage to the lateral soft tissues of the elbow
force is now contained in the puncher's arm especially when the ribs don't break-this is predictable given the
assessment of force previously preseirted in the discussion of partially extended arms. One hard punch doesn't cause the
full problem of LRI, but repetitive use of someone else's body to stop suddenly your arm's force
cause a mild ligamentous and tendinous insuffrciency at the lateral epicondyle. When this
will, at some point
lateral insufficiency occuts, continued use of the arm in such a forceful manner will have more of a negative effect on the puncher than on the recipient. In this scenario, towards the latter rounds of a fight, the small
lateral radiohumeral gapwill have grown significantly
as the
full force of the punches cause continued
outward torque atthe radial colhteral ligament in the same nunner as presented emlier, i.e. once a mild insuffrciency appears and remains untreated, the next bout or round insufficiency due to the calculation of torque and momentum. (Interestingly, Karate and other forms of martial arts repetitiously train their students to complete a punch once the elbow's extension process has started, i.e. less than 30 degrees from full extension and going in this direction. This means thag even though the punch may land while the upper exffemity is partially extende4 the martial arts ftainee is capable of completely extending and properly pronating the striking exnemity due to repetitive practice. Such repetitve training makes the extension process of the upper exfern-
will
cause a further expansion of this
ity exfremely autonomic in nature and has already strengthened the proper upper exftemity muscle groups to
complete the punch. Such training often causes students of the martial arts to suffer more knuckle problems
with liule or no lateral radial head displacement problems like boxers if they wer apply their knowledge to
hand-to-hand combat in a toumament setting or the breaking of boards or solid objects.)
CopJ
# au
for RUDIKRASS
43
The effects of repetitive mild to moderate tauma to an outstretched arm is not limited to
can be applied to work case sceriarios or hobbies beyond
sports-it
this. An example of this, of which there are many, is
by carpenters. Often carpenters complain of soreness in the shoulder, wrists or elbows on the hammering arm and many are forced to attempt changing ttreir profession due to chronic pains in these joints.
Now, the physics of ZRl and the knowledge of how the radiolnmteral joint frluly functions allow us to determine the rationale behind the pain. The lateral ligament pin and the tendon above it can only take so much
strain before they become unable to function normally and keep the radial head tight to the capitellum. When the problem isn't detected or understood, as presently is the case, the individual with the problem continues
doing the same activities that qeated the initial mild soft tissue insufficiencies and some soreness and stiftress in the shoulders, elbow or wrists. The continuation of these offending activities, in turn, exacerbates the mild insuffrciencies at the lateral epicondyle. Unfortunately, thougfu the damage to the soft tissue at ttre lateral epicondyle is often missed because the insufficiencies arises not from a complete dislocation as at the shoulder
or
hip. The other main problem to diagnosing the problems at the early
stages is the present inaccurate medi-
cal theories concerning elbow and upper extremity firnctionality and the diagnostic techniques built around
this misleading knowledge base.
Repetitive Oyeruse Syndromes

This portion of the Patlnmechsnics chapter deals with actions which should be eliminated because they lead to serious complications within both gender's upper extremities. Repetitive overuse deals with two distinct classes of actions with the more strenuous type afflicting men and the less sftenuous afflicting women.
There are legitimate reasons for these unique effects which
will be dealt wittr simultaneously in this section.
Strenuous overuse occurs in actions used by pitchers or a labourer doing undisturbed long term
shoveling. In these two examples, the upper extremity is exposed to be an unharmonious action: the anterior
muscle groups of the arm are strengthened without cessation causing the lateralmuscle groups to be substan-
tially weakened, thus eliminating their ability to counteract the opposing improper level of force applied to the
elbow. This reality is corroborated by examining the processes used in the following two example activities.
When an overhand (major league type) pitch is thrown, the shoulder has to bring the arm around which means that the cardco
brachialis
continuously. Then, the forearm is brought forward and
over the upper portion of the arm which is accomplished by contaction of the brachialis anticas,
ptorntor
teres and upper portion of theflexor sublimis digitorwn around the elbow. This is followed by the radial
portion of the hand being brought over with confraction of theflexor carpi radialis andpalmaris longw.
From this examination of the overhand pirching motion, it is clear that the radius is being brought over the ulna and the medial epicondyle is either stationary in an abnormal position or is advancing in the opposite direction to the normal motion ofpronation which is actually caused by contraction of ttre lateral muscles
the upper exfiemity.
of
44
CopJ
ou
for RUDIKRASS
In shoveling, the hand closer to the head of the shovel is used to raise the high torque load-the
torque on the elbow has to be calculated by using the distance from the load to the elbow and not the length
of
the forearm. So, the brachialis anticus and coraco brachialis are contracted while moving the load. To shed the load from the shovel, the forearm rotates against the confracted upper ann muscle groups which means that the radius is once again being brought over the locked in ulna and anterior tochlear line by contraction of the
upperportion of theflexor sublimis digitorwn, tlrc pronator teres,flexor carpi radialis andpalmaris longw. As is known from Sectionl of this book, dealing with upper exfremity rotation, some of these contractions and
the radius motion are improper. When this muscle contraction examination technique is applied to tennis, squash or racquetball players suffering from tennis elbow or sawmill labourers suffering from clronic lateral epicondylitis whose
job was to ensure that the cut boards didn't become jammed along the conveyer line, it becomes clear that all
these sftenuous actions, which cause the numerous cases of lateral epicondylitis, result from the medial
epicoridyle remaining locked throughout the forced and repetitive pronation, i.e. ultimafely rising 30 degrees
to the 3 o'clock position on the left arm or 9 o'clock position on the right. Normally, this locking occtlls
following an initial sharp pain at the lateral epicondyle and then, the person continues using the afflicted arm.
This connection amongst the various actions, noticed by me, means that the medically theorized process
of
pronation is actually the cause of lateral epicondylitis and which unequivocally confirms that there is abso-
lutel]'no way for the normal process of pronation to be caused by confraction of the pronator teres and prorwtor Erdratus.
The sharp pain which occuts from long and continuous use of the arm doing these activities arises
from the lateral portion of the radial head being pushed through the soft tissue sfuctures at the lateral epicondyle, resulting in a tom cotnmon extensor tendon and tom radial collateral ligament It is important to remernber that the shength in the lateral muscle groups has been diminished throughout this procss which
actually allows the radial head to sublux instantaneously once the radial collateral ligarnent and the common
extensar tendonare made insufficient to perform their normal functions. As stated earher, these activities
actually occur more often amongst males which is partially due to men actually doing these abnormal activities but also because of the nature of the upper attachments of the shoulder
they are tighter in men than women,
generally speaking. This fact will become important in the discussion of less strenuous repetitive oven$e
syndromes as well as ZRlarising from an insufficiency at the anterior rotator cuff.
Gender Based Lateral Rotatory Instability

This grouping of activities cotrld also be labeled the less strenuous forms of repetitive overuse of the
upper extremity or forearm. Basically, gender based instability arises from using the hand in vihat can best be described as a serni-pronated position, i.e. where the hand remains at or around the horizontal line with the pakn
down. CopJ
au
IoTRUDIKMSS
4s
As I stated earlier, all Zfilcases arise from the 120 degree angle formed by the medial radial line and
the kochlear line along the humeral face
visible in CT or MRI slices of the elbow
being reduced. In the
preceding sectiono it was inffoduced how the body causes the reduction of Ihe radio-trochlear angulation:
conffaction of theflexor sublimis digitorum, pronator teres, flexor carpi radialis andpalmaris longus muscles at
the wrong times which causes the radius to be pulled over the ulna and towards the medial epicondyle, the attachment of the contracting forearm muscle groups. It was also shov,'n how the lateral soft tissue sftuctures become damaged from the sfenuous overuse of this abnormal activity especially when the offending activity is
performed continuously. This section looks at how mild improper conhaction of the anterior forearm muscle goups causes ZRI without the radial collateral ligament and cornmon actelwor tendon showing that they were damaged and which
can only be e4posed presenfly through enhanced diagnostic images, like a Gadolinium enhanced STIR
MRI or
ar.ttroscopy. The activities that constitute mild overuse syndromes and which cause the soft tissue insufficiencies described are tSping whether it be data enby at a large corporation or that done by a cashier at your favourite
grocer or departrnent store
its all the sarne as the hand is pronated to the horizontal line.
At first, one would assume that women suffer most from these activities because they do these activities
in far greater numbers. This is not the truth though whictr can
be proven by examination of statistics
which
show that men who do these same activities show lesser arnounts per capita ofthe symptomologr of repetitive overuse at the wrist, i.e. tendinitis or carpal tunnel. This fact means that there are unique features within women that would account for the higher instances of overuse complications within the wrists. It has to be reiterated that the activities which cause soft tissue insufficiencies at the elbow, that, at present are not easily detected, arise from abnormal activities for the upper
exfernf an4 as suctr" they
should be abolished regardless of the
initial complications.
There are two causes that account for gender based lateral rotatory instability frommild and improper overuse of the forearm. The first is that the ligament structues within women are prone to stretching without teming when exposed to force-4ris best example of this unique feature is child birth. The other unique feature
for women is the natural length of their ligaments which is represented by the natural rotational position of the humerus. The length of the coraco-hurneral ligament is longer in women than in men so, as this ligament is the
basis for the neunal position for the humerus, a woman's anteriorly rotated resting position for the medial
epicondyle, while the arm is extended" compared to a man's clearly confirms that the femaleos coraco-hurneral ligament is nahrally longer than a man's. Demonstrating this exha length in the real terms is easily done simply by pulling baclanmds on an arm along the shoulder height plane. In women, the range of posterior motion for the upper exremity is significantly larger than that of a men confirming that the coraco-humeral ligament,i.e. the center point for humeral rotation, is longer among women lateral humeral rotation at the elbow. The result of these differences is that, when women use their arms in a semi-pronated position, the
greater arc at the humeral head creates greater
Copl
# ooL for RUDI KRASS
46
humerus resides at this rmnatural position without causing the swelling or pain at the lateral epicondyle that
normally occurs in men. This lack of soft tissue fiauma at the lateral epicondyle is not a good thing though
because, the aforementioned anterior muscles are allowed to confract and create insufficiencies in the radial
head's lateral soft tissue pins without all the waming signs. These abnormal mild forearm pronation activities do, over the long terrn though, cause problems which can now be deemed as bonafide symptoms medical complications are wrist tendinitis and carpal tunnel complications.
ofZR/. These
(LN
lrnmen tends to be more
typically anterior rotator cuffand/or medial, bicipital and lateral epicondylitis problems with wrist sprains and sfrains: the difference in symptomolory arises not just from the types of activities producing the problem which
are mostly split down gender activity lines but also the anterior ligament stuctures at, surprise, the shoulders.)
In short when the forearm is abnormally pronated by women, the radial collateral ligament and
comrnon extensor tendon stetch rather than snap when subjected to the mild lateral displaceme'nt of the radial
head at the lateral epicondyle explaining why this elbow problem has never discovered until
now. This fact is
confirined because the resulting wrist tendinitis is due in part to the mimicked lengthening of the radius as its new improper position becomes more and more advanced within the wris! i.e. the radial head rides firther and finther up the surface ofthe humeral capitellum. This displacement ofthe radius at the radiohumeral joint
causes a fleeting misalignme,nt
ofthe carpal bones sunounding the radius
at the wrist naturally impacting
negatively on the tendons of the wrist sunounding the lower extremity of the radius as well as its ligaments.
Also, the wrist and hand articulations are negatively affected by the fact that the central focus for
supination and pronation of the hand and wrist now suddenly starts moving due to the contractions at the medial
epicondyle. This rotation of the radius throws offthe normal contractions for supination and pronation which
are radial
centic. Now, all the forearm muscle but especially
those that overlap the radius start to contact
improperly causing fauma which surfaces as swelling in the lower wrist, forearm and hand. The swelling from improper supination and pronation and the mimicked le,ngthening of the radius which have just been proven to
be caused by elbow problems bring into question the need for
lnnd specialists within the orttropaedic commu-
nity
as most
hand problems arise from arc pin damage at the elbow.
Carpal tunnel as a complication is a little more complicated but it arises mainly from the lack of proper articulations within the wrist as well as the improper contraction of the pronator qrcdratus. As the ulna is no longer being pulled backwards during pronation by contaction of the forearm extensor mvscle groups, as defined tn Section
I of this boolg
the role of the pronator qrndrahn changes and starts confiacting to compli-
ment the impropet flmor muscle contractions. With no prop et extensor mlrscle confactions to weaken this
contaction, thepronator qrndratus remains contracted, the
ffirior
ulrc-radial
joifi
becomes anteriorly
subluxed and remains so until thepronator qrnfuatta conmction abates which usually means rest and anti-
inflammatories. Now, it is already knor,vn that the carpal bones of the wrist are being subjected to radial displacement from the elbow
bu! withthe pronator
quadrarras connacting in a fashion which
will only compress
the carpal tunnel, it appears that the causes of this complication have been firlly discovered and e4lained.
Copy
ou
IoTRUDIKRASS
47
However, when thepronator qutdratus remains stongly and improperly confracted the thickness ofthis muscle
group also impinges on the carpal tunnel passage through the wrist which adds another cause to the problem.
So, the impingement of the median nerve through the carpal firnnel, presently referred to as carpal
funnel syndrome, has to be atEibuted to downward radial displacement created at the elbow, a collapsing of the
natnral linear alignment of the carpal bones due to improper pronator quadratw conhaction as well as this muscle's mass, during its improper conhactio4 compressing internally onto the displaced carpal tunnel. (It is interesting to note that none of this can be seen with a present day mdiograph of the wrist because they are onl5r
take,n when the hand is
fully supinated and from above it-there are nonnally no side view x-mys taken of the
wrist and ffirior ulno-radial
joint.)
Ttre complimentary posterior radial nerve impingemenf tingling
ofthe
thumb, then has to be due to the fiapezium bone being slightly displaced posterior$ by the improper pronator
qtndrafin conhactions
as
well
as
the lateral extensor muscles running over the radial nerve at the wrist being
pulled abnormally taunt over it as it passes beireath these muscle on its way down to the thumb.
.
Old Age (Men more so than WomeQ Lateral Rotatory Instability

This is an interesting cause ofZRl amongst the male population. It arises from the reduced levels
of
testosterone found in men over 50. The results of lower testostrone levels, however, does not immediately impact on the individual but, over several years, the humerus becomes anteriorly rotated at the medial epi-
condyle. This humeral rotation arises fromthe Wctoralis major, teres major andsubscapularis no longerbeing
capable of maintaining the humerus rotated to 30 degrees below the horizontal line, or the 4 o'clock position on
the left arm and the 8 o'clock position on the right, with the high strength levels attained tltrough a man's youth. Consistently, using the arm at this stage in life like men did in their youth causes many of the wrist problems noted earlier in the forearm with possible rotator cuffproblems.
At present though, many of the latter
stage problems among men,
I suspect mose from the long term
improper use of their upper exfemities in constuction positions or blue collar jobs which, until the early 1990s, were dominated by males. With the reduced testosterone level of advanced age, the effects become readily
apparent in the upper exhemities. Fortunately, most lafier stage middle-aged merl older than say 45, no longer
push their bodies as strongly and unwisely as they did in their youth: the cause of all the youthfirl and early stage middle-aged upper exfemity aches and pains in men has been disclosed in this book.
Unfortunately, by using their upper extremities recklessly in youtlU men pay the price with their health in old age.
CopJ
ou
fioTRUDIKRASS
48
LlTrnAr Romlonv INsrasLgY

Most ofthe symptoms have already been discussed as well
as its rationale
for existence
as prese,lrted
in the preceding Patlnmeclwnics chapter. It is important though for these problerns to be collected into one
area as well as other complications that mise from a lifetime of living with an insufficiency of the soft tissue
stnrctures at the lateral epicondyle
* radial collateral ligament utd
common aclensor tendon.
Starting at the shoulder, all rotator cuff problems that cannot be attributed to a frauma direct$ impacting on the shoulder, i.e. all force applied to the shoulder via an outstnetched arm or the sudden impact
the body being stopped by the clavicle, when it is not broken, and the arm flails forward uncontrollably like
of
when a snowmobiler is thrown from his machine and lands head first in a semi-solid snow bank, should be viewed as a complication
ofZRL As forthe rationale ofthe
aforementioned shoulder exceptions, referto the
Instability Due To Trawna section of Section
III
of this book.
Elbow Symptoms
Moving down the arm, Iateral epicondytitis has already been discussed in both the Traurna and
Repetitive Trauma sections of the preceding chaper. Medial epicondylitis arises from the patient attempting to use his arm even though it is suffering from ZRlwithout him wen knowing that he has a dysfunctional
elbow. In this instance, the brachialis anticas over strengthens in the body's attempt to create a stable "hinging" process bu! because this action is abnormal and the anterior trochlear ligaments me not soli4
as is
presently and incorrectly presumed by the medical community, these ligaments are exposed to forces that they
are incapable of supporting so they become swollen as the ulna is repetitively brought anteriorly through the
hochlearnotch of the humerus. Thus, medial epicondylitis is fully explained. (With insufficiencies inthe
radial head's lateral pins, the radius can rotate both ways e4pecially when the biceps are stengthened more so
than the muscles that created the insufficiencies
see
bicipital epicondylitis later in this section)
Abnormal anterior advancement of the Cororcid Process in the hochlea also causes decreased blood
flow beyond the elbow down into the forearm and hand. A result of this is that the hand becomes cold easily
and is
dfficult to warm up once it becomes cold. The problem of abnormally cold hands and forearm
usually only occurs in patients who are attempting to use the arm at amildly moderate to high activity level which uses a lot of flexion. As the artery is impacted at the anterior hochlear region due ta Coronoid Process
advancement and subsequent ligament and tendinous swelling it stands to reason that the patient may also be
suffering from decreased nerve sensation in the forearm because the median nerve p:tsses through this same
passage. (A byproduct of this problems is just getting a median nerve reading :rcross the anterior of the elbow
Copy
# ool
for RUDI KRASS
4e
which is made diffrcult from the median nerve sheath being displaced by the anterior Corornid Process
advancement and by it being swollen.
During the initial physical examination of the entire upper exfemity, one may also encounter a
throbbing or spasming common &ensot tendon.
\\is
symptom arises mainly in men who have been doing
exceedingly heavy pronation activities on the job and is due to the person at0empting to work through the
lateral epicondylitis. The spasm within the common extelaor tendon is due to it having been split longitudinally from its attachment downward. The tear can be any length from
cm. up to thg point where the ertensor
carpi ulnaris and extensor minimi digiti joninto *re common extensor tendon. The bause of this tear is the
lateral portion of the radius being pulled beyond the radial collateral ligarnent's natural boundary from the
unnatural contraction of the upper portion of theflacor sublimis digitorum andpronator teresowlichkeep the radial head displaced when they remain conhacted. The continued use ofthe arm, doing the same activities that caused the problem, only exacerbates the tem as the unnatural anterior upper forearm contractions remain unopiosed increasing the strength and permanency of the improper contactions. lnterestingly, the subluxa-
tion of the radius at the lateral epicondyle is also represeirted by a complimentary reduction of the elbow's
natural anterior angle.
Once the initial diagnosis of lateral epicondylitis is made and cessation ofthe offending activities is
undertake4 the radial head's anterior ligarnent may also become traumatized due to the biceps contuactions no
longer being held in check by the srryinator brevis which is now being subjected to abnormal forces that weaken
it.
So, whan biceps contraction is initiated in the treatnent prograr& the anterior ligament is exposed
to anterior rotatory force as the position of the biceps attachment is located on the lower medial aspect of the
radius. This anterior rotatory force results rnthe anterior ligarnentbecoming swollen from it being faumatiznd,i.e. exposed to the significant and abnormal radial rotation. Bicipital epicondylitis is the medical term
applied to this swelling of the anterior ligament of the radius.
All of the
lateral soft tissue ailments, swelling
nthe radial collateral ligament andthe comrnon
extensor tendon, arise from the lateral displacement of the radius at the elbow which causies fxations within the ranges of motion of the
radius-this often occurs in chiropractors
and physiotherapists that practice re-
alignment ofjoints throughout the body. The ffeafinent is usually a chiropractic adjustnent to the radius to push it anteriorly while also rotating the humerus, medial epicondyle, bachroards and the forearm valgusly.
Although the adjustment is productive, it doe not address the root problenr-for this, read fhe Prqention
chapter in this section of this book.
The improper contraction of theflacor carpi ubaris, which becomes more permanent with increased
use
ofthe afflicted arm especially at higher activity levels, explains the varus alignpslf, inward pointing
a radiograph
positioning of the forearm bones at the elbow in
film of individuals suffering from ZRL This
complication of the forearm bones is already known to the orthopaedic surgeons stu$yngpsterolateral
rotatory instability
initial physician's label for insufficiency of the lateral collateral ligament complex due to CoW
ou
for RUDIKRASS
50
significant applied force to an outstretched arm. (The varusly aligned forearm bones in a radiograph of a
person having an insuffrciency of the lateral pins is contary to the natural valgus alignment outward pointing
positioning, of the forearm bones at the elbow noticed in a radiograph of a healthy man's arm. (This fact
be more thoroughly discussed
will
nthe Diagrnsfics chapter.)
A symptom arising from the improperly varus alignment of the forearm bones - particularly the ulna
is ulnar nerve impairment at the ulnar notch. The amount of the vanrs shift determines the amount of nerve
sheath trauma. With the ulna being forced to flex as the main pivot rather than in relation to the radial arc, the
underlying nerve sheath is exposed to abnormal force. By the forearm bones residing inward to their normal positions, the olecrarnn and Greater Sigmoid
Cnity actually move outward
or towards the lateral epicondyle
by an equal axnount. So, when the varusly aligned arm is flexed, the ulna nerve sheath and posterior ligament
become exposed to abnormal force as the distance taveled by the aforementioned portion of the upper ulna is
actually significantly greater than when the forearm resides in its normal valgus alignment. This swelling
the nei.nre sheath results in ulna nerve impingement.
of
Once an insufficiency of the lateral pins of the radius exists, using the arm while it is fully extended
creates the real elbow pains that have baffled all my specialists - most notably the orthopaedic surgeons
of
westem Canada. The pains that arise at the lateral epicondyle, commonly referred to as lateral epicondylitis,
me caused by gavtty and the loss of normal valgus forearm alignment as a result. In reality, when the arm is
by one's side and fully extended with the insufficiencies at the lateral epicondyle present the arm in fact
becomes nothing more than
a'flumb bob"
that carpenters
use: the hand and lower forearm musculature and
skeletal structures act like the heavy bob or weight at the end of the string but, in this instance, on the arm at the elbow. Examples of
this'llumb bob"
sce,nario are simply walking or even worse carrying something as
innocuous as a 5 pound bag of groceries home from your neighbourhood store. In the first example, the elbow loses its normal valgus alignment from the force of gravrty on the hand and lower forearm which causes the radius to sublux laterally which produces discomfort at the elbow and shoulder. This discomfort is easily
eliminated by forced extension of the arrn with posterior rotation of the medial epicondyle which should
produce
a'!op"
at the lateral epicondyle. Unfortunately, this process is often necessary over a half hour wallg
every 5 minutes or less.
In the second example
carrying a weight when the afflicted arm is fully extended, the problems
become even wonrc. In the first example, the arm is merely subluxed to the point where elbow pain is felt and
rectified by the sufferer. This second example takes the subluxation to its ma:<imum and, if the amount
of
lateral pin insufficiency is to the point where the radius can dislocate or even just reside on top of the humeral
capitellum, the radius
will
either dislocate or reach the point of maximum subluxation prior to dislocation and
remain there. Either way, the arm is no longer capable of bending at the elbow without severe pain. As I had
this happen to me several times before I made changes in how I bought my groceries, I discovered that, by leaving the arm for several minutes and then pushing on my medial epicondyle stongly with my good arm
CopJ
ooL for RUDI KRASS
5l
while I attempted to bend my arm, I discovered that the elbow lock could be eliminated and ttrat the high lwel of elbow pain associated with this mo<imal subluxation would dissipate over several minutes. A dislocation
cannot be resolved in this manner as it requires either a chiropractic adjusfinent or a resetting
ofthejoint,
as
the physicians describe the process. Resetting the joint often by a medical professional or oneself has to be
followed up with the reconstructive surgical heatneirt, discussed tnthe Treatment clnpter, for the lateral soft
tissue insufficiencies which permiued the lateral radial head subluxation or full dislocation.
If a comparative grip strength test is done on a fully extended upper extremrty having insufficiencies
at the lateral epicondyle and prior to any ptrysiotherapy being applied to the elbow and upper extremity, not
only will the grip strength be significantly weaker on the afflicted arm than the healthy arm but, dwing the gnp test, the arm
will begin to shake violently. This response
to the test arises because the muscular con-
tractions have not yet been modified from the nonn so as to compensate somew.hat for the lack of lateral pins
at the elbow
An interesting discovery ofmine is tha! when the afflicted arm is flexed from full extension while the
hand is pronated, there is a noticeable clunk towards the middle portion of flexion inthe radiohumeral
joint.
The aforementioned clunking occurs wery time the process is repeated without cessation. This noise is described
noticeable because it can be heard easily by any individual within 6 to 9 feet, when the afflicted
flexes his ann as described given that the process is done in a quiet examination room. To date, not one
medical offrcer has been able to explain this clunb but, with this book and especially Section I, the explana-
tion for it becomes quite clem easily: with the loss of the lateral pins to the 'tnodified pulley'' system employed in the elbow, the radial head is subluxed laterally through flexion. Also, remernber that the otnterior Iigamenf is acting like a
'livot poinf'
tnL/d,,but don't forget that the lateral radial head is surrounded by soft
tissue structures. So, the clunk that is heard has to be due to the radial head frnally and suddenly being re-
tumed to its normal position from its subluxed state once the lateral soft tissue structures become sufficiently
shetched to counterbalance the abnormal radiohumeral gap. The explanation of the clunk has another bonus though as it is useful in undentanding the long term
symptom in the elbow of osteoarthritis
the constant abnormal motion of the radial head over the capitellum
naturally wears down the cartilage which ultimately results in the bones rubbing against each other once the cartilage is gone. This is a problem that often occuni in the ball joints of cars which are improperly maintained
or the seal fails allowing the greasg lubricant, to squeeze out. The resulting lack of lubricant allows the metal parts to rub against each other which they are not meant to do creating the need for them to be replaced. There is also far more crepitus, clicking and
cracking in the elbow reported by individuals suffer-
ing from a lack of a lateral arc pin and often there doesn't have to be any pain associated with
or cracking
at most,
it. The clicking
will
be reported to occur following the patient having written or typed for a long period of time
l0 to
15
minutes. This activity will cause a sufferer ofZRIto begin to feel discomfort in the lateral
side of the arm around the elbow as well as the wrist prior to the person extending the afflicted arm. This
CoW
ou
for RUDIKRASS
52
motion should result in a loud crack or snapping sound which is followed by the discomfort subsiding. If the
activity is resumed then obviously the cycle of discomfort-and-release will need to be repeated.
The discomfort in the arm arises from the position of the forearm as well as the lack of the lateral pins
of the radial head. The forearm position
pronated
is caused by mild improper confaction of the pronator
teres andvpper portion of theflexor sublimis digitorum muscles. As the 10-15 minute time frame elapses,
these improper muscle contractions continue but, due to the position of the forearm, it is impossible to rotate the radial head any furttrer. So, the improper muscle contractions actually raise the medial epicondyle due to
anterior humeral rotation which causes the lateral subluxation of the radial head and the iritation of the soft
tissue surrounding the area. This mild and fixated subluxation then requires release which is done by extend-
ing the arm which produces the sharp and loud snap or crack at the lateral epicondyle. The discomfort and
snap/crack pattern from using the arm in a semi-flexed position with the hand and wrist pronated is explained.
'
As a follow-up to the previous paragaph, continued use of the arm through this pain pattem over
an extended period of time but intermittentty, e.g. typing every second day for 2 hours over several weeks,
will result in full blown epicondylitis. The reason for this
is the cumulative effect. By typing for several
hotrs
and having released a fixated subluxation 6-7 times per how, the soft tissues at the lateral epicondyle have been mildly traumatizd, i.e. exposed to forces that they are not meant to be repetitively. Continuously doing
this every second day is insufficient time for the tissues to reverse the trauma to them especially since all other daily activities
will
continue to cause subluxations. So, in reality, the tauma accumulates without cessation
causing the soft tissues to swell without control and without any relief from anti-inflammatories or very short
term relief, 2.3 days, from a cortisone shot. So, chronic epicondylitis and uncontrolled epicondylitis has to
be declared merely another symptom of the lack of lateral pins for the radial head or
LN.
Another problem mising &om an insufficiency ofthe radial head's lateral pins is the immediate impact on the mnges of motion through which the upper exremity remains pain free when used. An early
restriction placed on all sufferers of this medical problem is to stop using the arm at shoulder height or
higher. The reason for this is all the force is directed strictly to the now improperly functioning radiohwneral
joint wfuchcauses the force to remain within

joint
the elbow's subsystem. During normal use for me,n and when
there is no insuffrciency to the radial head's lateral pins, this hand based force is transferred up to the shoulder
as the upper exfremity is a
fully functional single unit
explaining the large shoulder and upper arm
musculature on men who do a lot of lifting varied with other heavy labourer work.
With an insuffrciency ofthe radial head's lateral pins, thougft the torque created by, say, lifting a full
2 litre bottle of pop
offof
a shelf overhead is no longer transferred all the way up the arm to the deltoid and
posterior rotator cuffmuscles. Instea4 the torque ends up being stopped at the elbow especially the radial
head an4 due to the lack of a lateral pin, a sudden and sharp pain occurs at the lateral epicondyle. This result
is predictable, given the principle of "a chain or drive ffain is a strong as its weakest link
" which infers that

53
CoW
# aol for RUDI KRASS
the lack of lateral pins, which normally cause the torque, generated at the hand by the
full bottle of pop, to

forearm bones to
be transferred to the shoulder, suddenly become the end point of the torque facilitating the
move suddenly into the improper yarus alignment position mentioned earlier as well as subluxed for the radial head: for future reference, varus alignmeirt: radial head subluxation. The resulting sudden and intense level of pain at the lateral epicondyle has to be resolved by cessation of any use of the arm and ifpossible,
release of the subluxation by the sufferer or by a medical practitioner like a doctor, chiropractor or physi-
otherapist. The pain
will
subside gradually over the next several minutes.
Prolonged use of the arm in this manner causes chronic and often permanent crcpitus to rise
quickly not just in the elbow but also in the shoulder. To demonstate the grinding that mises in the shoulder from usage of an arm without latorl,lpins, place the patient's
tm
at 60 degrees sideways from the body and
have the patient rotate his thumb side of the hand downwards while bringing his arm slightly forwmd. (The
ginding atthe shoulder can also be demonsftated by movingthe upper efremity backwmds from a slightly
anteribr position whilst the forearm is in a fully pronated position and least 60 degrees laterally from the
body.) This crepitus in the shoulder will also lead to osteoarthritis in the shoulder
as
well
to be discussed
nthe Long Term Complications section of this chapter.
Wrist and Lower Forearm Symptoms

All the symptoms in the lower portion of the upper extremity arise from the fact that iL all the way
down to the tips of the fingers, is a subsystem of the elbow
actually of the humeral face of the elbow. This
realrty is reflected in the results of the subsystem being used with an insufficiency of the lateral pins of the
radius: when the arm is used even through sedentary activities, this subsystem's skeletal and soft tissues
structures are being subjected to abnormal forces solely because it is being improperly
pronated-initially
performed by improper conftaction of the upper portion of theflexor sublimis digitorurn andpronator teres
and their subsequently followed by contraction of the lowerportion of theflacor sublimis digitonnn,the
pronator quadratw and the qetensot muscles that terminate with
a tendon in the thumb.
The result of improper pronation in the lower forearm/trand was touched on tnthe Patlnmechanics
section vnder Gender Based Interal Rotatory Instability. To summarize, though, wrist/trand complications
include: wrist tendinitis; significant wealaness in the lateral actensor forearm complex
as
well as in the grip
stength; carpal tunnel syndrome; radial nerye impinge at the wrist, i.e. tingling in the thumb; soreness and
crepitus within the hand and be innoduced. The initial improper muscle contractions used by the body to pronate the lower forearm/hand cause the radial head to ride up the humeral capitellum which mimics a lengthening of the radius. This added radial
wrist.
These problems
will
be further elaborated on in this section and others
will
length from the shape of the humeral capitellum pushes the radius into the wrist infrastructure causing a mild
CopJ
ou
IoTRUDIKRASS
s4
trauma to the soft tissues at the lower end of the radial head
- represented with mild swelling of the tendons ligaments of the wrist. This mild displacernent of the radius also weakens the soft tissue structwes sad
wrist and hand.
which normally stop the prorwtor qtndratus ftom contracting at the wrong time. This weakening of soft
tissue wrist sfuctures without resolution of the root cause results in laxities in the The body's initial response to the improper contraction
of the pronntor grndratus is further swelling
throughout the wrist as the carpal bones are now being displaced posteriorly causing the anterior portion of the
wrist to collapse like an accordian
as the normally
stationary radius now begins to be pulled medially through
pronation. This improper "accordion like" motion at the anterior wrist and inferior ulrc-radial joint then
leads to mild to severe neural impingement at the carpal funnel depending on the amount that the forearm is
pronated post-rqiury and the diffrculty of this wrisffrand usage. When improper pronation is performed
sfrongly, i.e. with aheavy load in the hand, the caxpal tunnel totally collapses at the anterior wrist which is confirmed by a total loss of sensation in the fingers and hand as happened with me. At this poinl the
prorntor qrndratus and'Jlexor sublimis digitonnn are permanently and improperly contracted which results in a subluxed inferior ulno-radial joint. this condition remains as long as the aforementioned muscle remain
locked or until intervention to relax the improperly conftacted muscles is initiated, i.e. cessation of all activity
and antlinflammatorieso as well as the fixation or subluxation is adjusted. Also, a neural impingement
ofthe
radial nerve which runs down the posterior of the thumb from the posterior of the wrist results from the carpal
bones being shifted posteriorly into the radial nerve due to the anterior inferior ulrn-radial
joint foldng-
carpal tunnel syndrome, radial nerve impingement andinferior utnuradiat jointsubluxations delineated.
The improper functionality of the elbow's subsystem through pronation also leads to a reduced size
of the hypothenar clefr,themea of the palrn directly above the ulna. The reason for the lack of muscle mass
is not disuse but rather a reflection of the improper contractions now used to supinate and pronate the fore-
arm. The size ofthe muscles of the lgtpothenar clefi asll.nl$ arise from the latter stages ofproper forearnr/
hand supination andpronation.
Bu! with insuffrciencies in the radial head's lateral pins,
these muscles are no
longer used properly and as forcefirlly so their muscle mass drops to the appropriate size for their new usage. This results tnthe palmus brevis and ab&rctor minimi digitibe,comiirg significantly smaller in size which can actually be measured as well as visually discemed.
The weakening effects onthe forearm muscle groups can be overcome with physiotherapy heaftnents that focus on strengthening these muscle groups through limited rulges ofmotions for the upper extremity,s
joints so as to accept the improper usage: the brain will restructure its contraction impulses in order to adjust
ot evolve to the present dysfunctional condition of the forearm. In reality though, the best that physiotherapy,
strength training
and'!ain managemenfo
can produce is limited by the degree of insufficiency within the
radial head's lateral pins and the dedication of the patient to the treatnent program. Ultimately though, the
increases in forearm activity
will reverse themselves quickly - 10-14 days - following discontinuation of the

CopJ
ou
IoTRUDIKRASS
55
strength training program and any other treatnents applied to mitigate a legitimate pain caused by an untreated and misunderstood patholory.
Long Term Complications

As was already indicate4 osteoarthritis arises in both the radiohumeral and glenrhumeral joinE, over 5 or more years. This long term complication is due to the radiohwneral
joint notremaining in proper
contact throughout flexion and pronation and then the radial head and humerus re-aligning themselves through the latter 30 degrees of extension as well as supination. These processes mean that the cartilage on both the
bones but mainly the capitellum is subjected to forces ttrat it was not meant to receive---explaining why the
cartilage breals down and then bone-on-bone rubbing begins. The degree of radiohumeral osteoarthritis depends on the types of activities that the sufferer performs post
injury:
those that require a lot of repetitive
pronation and use of the hand in a semi-pronated positioq i.e. at the horizontal plane position to 70 degrees
above it for both hands, cause significant repetitive improper bone rubbing atthe radiohuneral
joint resulting
in vmious degrees of osteoarthritis-4epending on the amount of time from the initial rqiury that the afflicted
arm has been used.
Osteoarthritis at the shoulder occurs because, without the lateral pins of the radial head the humenxi is allowed to rotate posteriorly, counterclockwise on the left arrn and clockwise for the right, and reside in this improper position. With the humerus being rotated posteriorly, the soft tissues of the Coracoid Process
are subjected to improper forces when the shoulder muscles c,ontract to raise, lower, bring forward or pull baclnvmds the upper
exfemity. Essentially, the humeral
head remains posteriorly rotated over the
Glercid
Cntty causing the former to move in a severely restricted range of motion which nafurally
causes the cartilage
towearsawaytothepointwherethehumeralheadandthe GlenoidCavity starttorubtogetherosteoafthrtfis. Ifthe insufficiency of the radial head's lateral pins is not caught early enough and surgically
treate4 this is the inevitable outcome.
The improper posterior position for the humerus results in another symptom in the arm just above the
radiohwneral
joint. this
humeral rotation places an abnormal force on the supinator longus and the extensor
carpi radialis longior tendons at the lower humerus. Normally, these muscles work in unison with the radioIumeral joint in order to rotate the humerus through the various extension and flexion motions see
Section
of this book. However, since the radius is no longer working in conjunction with the rotational forces generated at the humeral head
n Lkl,
the muscles of the lateral portion of the lower humerus are forced to attempt
to pull it over through pronation. As the anterior angle of the elbow has been significantly reduced with
improper contaction of the coraco-brachialis, brachialis anticus,the upperpoftionof fheflexor sublimis
digitorwn,the/lexor catpi radialis andprorwtor teres,the two lateral upper:ilm muscle groups are attempting
to do the impossible which results in trauma tothe supinator longus' and esdensor carpi radialis longus'
CoW
# ool
for RUDIKRASS
56
tendons, i.e. swelling and soreness to touch. (This problems is most cornmon in basketball players and young
pirchers but not exclusive to them.)
Osteoarthritis in the hands has not been discussed to this point because it is such a long term
condition and also because it aJflicts mainly women especially those in their elder years. The main reason for
such a selective group of sufferers is due to the reality that women have joints that me more lax relative to men
which is ge,netic in nature. The otlrer reason for elderly women suffering from this condition" more so than
merq is that women have traditionally done copious amounts of activities like crocheting, knitting and other
handicrafls which require a lot of repetitive pronation/supination and flexion of the fingers and thumbs with
minimal extension.
The most important factor for osteoarthritis in the hands being more prevalent in women is the
longstanding missed diagnosis of insufficiency at the radial head's lateral pins and Coracoid Process. These natural laxities facilitate the subluxation of radiohwneral joint and often tendinitis of the wrist (women) when
the foiearm is usedredomiUgntly inpronatedpositions and they also cause the natural and noticeable weakness
in the extensormuscle groups and grp strength that most young women and womerl in general, endure
atl their lives relative to most men**explaining a man's ability to open tightly sealed jars which women
cannot open without the use of an aid or a special technique.
Prior to a women's weakness inher erctensormuscles causing osteoarthritis in the hands, it leads to
hags hands disease or permanent flexion of the fingers. This complaint, also far more common in elderly females, arises from all the pronation and finger flexion that these women have done in their lives. With little
sftength in the forearm and hands qcterlsor muscles, the effects on the fngerflexors is that the unbalanced
contactions of frteflacors ultimately shortens their tendons within the fingers themselves: don't forget that
this process takes more thanjust a few years--it actually accumulates over several decades. (Women have
been referenced mainly due to the fact thar they make up the largest portion of suffers of this condition. Permanent partial flesion of the furgers does occur in men but mainly in those who have joints which are laner than most males. In these case, this condition occurs in much the same way as it does in women or as a result
of their work place activities which probably demanded repetitive pronation and/or use of the forearms in
semi-pronated position for long durations as well as repetitive sfrong grpping of heavy objects like sledge hammers.) The resolutions to this condition
will
be discussed in the Treatrnent and Prevention sections that
follow.
With the finger flexors now beginning to shorten due to perpetual finger flexion without pgqBer
extension, the cartilage in the knuckles of the fingers shrinks in thickness due to disuse as the portion of the
fnger beyond that knuckle is actually moving over less and less of the joint cartilage. Consequently, the
knuckle's cartilage reduces to the point where the knuckle bones end up rubbing against each other. Unfortunately, by the time osteoartltritis is detecte4 the use ofthe fingers, tlrumb and hand
will already have been
impaired beyond the point of recovery and not because of the arthritis. Rather, theflexor tendons running
Copy
ou
for RUDIKRASS
s7
down through the fingers will have shrunk to the point where any surgical attempt to eliminate the insufficiency in the radial head's lateral pins will be far too diffrcult on the patient----remember by this poing osteoarthritis should not only be present in the elbow and shoulder but be at such a severe state that the
body's natural recuperative ability is incapable of reversing the effect. (Ponder this bold type for awhile!)
Cop)
# ool
for RUDI KRASS
58
Llrnnal Rqrarpny lxqrnsntTY

In March 1991,
a
team of orlhopaedic specialists introduced the lateral pivot-shifi test, /psr, into the
as
medical world in order to confirm the existence of the medical condition that the team designated
pstero-
lateral rotatory instability, PLRI asthe medical commurity now refers to
it. I was able
to access an internet
report on PLN, that I discovered late in 1997 , inwhich the lateral pivot-shifi test was very well explained by
the report's author as well a^sthe
PLN
condition and its immediate effects on the elbow and forearm
see the
Bibliograplry. To date, this /psr has been seen as an excellent diagnostic technique amongst orthopaedic
surgeons who suspect insuffrciencies of the radial head's lateral pins in their patieirts. The lpst is a very exacting and conclusive test that made the patholog of PLRI easy to confirm so the
condition was easily accept by the medical community. But wen though the test is a good starting point for
the discussion of insufficiencies ofthe radial collateral ligament, it has been strictly applied to person's who
adhered to the designated cause ofPZR.I, i.e. patients having received a trauma to an outstretched arm. As a
consequenc of this limited application of the lpst, PLNhas been declared an uncommon condition and the test is not normally applied to the predominantly male patients suffering from lateral epicondylitis whose
condition's origin could not be fraced back to
tauma to an outstretched arm. So, the discussion of PLN and
any possible flaws with the /psf was prematurely ended by the medical profession including the founders
of
PLN andthe
lpst.
Fortunately thougtr, the Kerlan-Jobe facility was researching the other cause for epicondylitis in men:
pirchers which are a sub-group of cases originating from a repetitive oven$e syndrome ofthe elbow or, as I have designated this cause, Repetitive
Impropr Pronation or NP,my designation. This facility's diagnostic
technique though is not limited to the /psf but rather a Gadolinium enhanced STIR MRI which this facility has used extensively in diagnosing the cause of a patient's lateral epicondylitis since prior to the lpst's inception in
March 1991. This MRI diagnostic test makes use of elbow brace.
There have been diagnosed cases of
a special dye injected into ttre person as
well
as a special
PLN or more aptly described
as cases where the
symptomolory
for PZRlwas present
anterior$ rotated humerus, varus misalignmeirt of the forearm bones at the elbow,
damaged common ertensor tendon,damaged radial collateral ligament and the presence of significant disorgalrtizrd scar tissue within the
joint capsule and also beneath the common extensor tendon - but the result of MRI confary to the medical
the/psfwasnegativeaswellasthecausebeingdeterminedtoberepetitiveovenrse orNP andnotatraumato

an outstretched arm. These positive results from the Gadolinium enhanced STIR
understanding of
PLN andthe /pst results
means that both conditions needed to be more comprehensively
researched and explained and that a better test for insufficiencies in the radial head's lateral pins needs to be
CoW
au
IoTRUDIKMSS
59
developed-both the test and the explanation me obviously intrinsically interlinked. As I have already explained the processes causing ZRI, it seems that it is time for the new test to be disclosed. Prior to ttre introduction of the new test to dekrmine insufficiencies in the radial head's lateral pins though, it is necessary to establish the faulB in the lpst and how these relate to the bigger picture of diagnosing
ALL
cases of this problem accurately and
quickly-this
means cases from 25-30 years ago as well as newly
developed cases. As was written earlier, the lpstwas only applied to cases of epicondylitis that could be determined to have arisen from a trauma or significant force to an outstretched arm. This approach by the
medical community was tenable even though the more sound approach should have been to apply the test to
all cases of lateral epicondylitis
as the
original orttropaedic surgeons had declared :rl.1992 that (chronic)
epicondylitis should be treated with some form of reconstructive

cause).
lateral
surgery (regardless
of
(It sounds ridiculous but, even today, most orthopaedic surgeons declare that there are two distinct
types 0f (chronic) lateral epicondylitis: one, caused by a trauma to the arm, which means that the problem receives surgical resolution; the other not being caused by a trauma which means pain management and living the remainder of your life with worsening and debilitating upper exhemity pain is the recommended treaffnent rather than the surgical solution. I know the latter to be factual because it is the main reason that I was forced to write this book.
The surgeons that I have seen in western Canada between June 1989 to date have been unable to
relate my medicallyrecorded and confirmed case ofZR/to my
NP injuries of June
1989 as all cases of lateral
epicondylitis and severe forearm problems are not yet seen as being symptoms of insufficiencies of the radial
collateral ligament and the common extensor tendorc-matnly because these symptoms, shangely enough, don't adhere to the PZ,Rlparadigm. However, the Kerlan-Jobe orttropaedic surgeon that I have
since 1997
seen
twice
once to recommend the Gadolinium enhanced STIR MRI which unequivocally confirmed the
existence of PLKI type problems and then the second time to recommend a surgical resolution to my problems
has seen this condition numerous times among the pitchers that he and the other elbow specialists at this
facility freat. Unfortunately, the Kerlan-Jobe Clinic has been unable to understand the correlation ofrepetitive
overuse (elbow) syndrome to lateral epicondylitis and also PLRI
explaining my findings and thus this book.
(For the scientific proof of correlation see the Scientific Proof appendix at the end of this section.))
Applying the /psr Uictly to cases of late,ral epicondylitis that arose from
a trauma demonstrates
conclusively exactly what types of lateral elbow soft tissue insuffrciencies, it was developed to confirm
extreme or substantial cases. These cases are exactly what the lpst determnes today because almost all orthopaedic surgeons no longer make an x-ray film of the arm at about 30 degrees of flexion: the rationale for this change tothe lpst is understandable given that,
if a radiograph were taken for wery
case of lateral epicondyli-
tis, then the surgeons would be subjected to numerous low levels of radiation over a year let alone a career. Another problem which was exposed by my enhanced STIR MRI is that the
lpt
c,omes back negative when
CopJ
ou
for RUDIKRASS
60
there is significant scar tissue present in the joint capsule at the lateral epicondyle.
So, the 3 main problems
with the lpt
as
it is presently performed have now been exposed: the need
for assisted and stressed radiographs; when these x-ray films are not made, the lpst only detects cases where
the lateral soft tissue insuffrciencies are significant in size, not the smaller cases; when there is scartissue
within the joint capsule at the lateral epicondyle, the result of the lpst is a false negative. Knowing the failings of the lpst aids in the development of the new diagnostic techniques conceming insufficiencies of the radial
head's lateral pins by defining exactly what these new diagnostics need to determine better than the previous test.
As has already been stipulats4 there is a superior test for diagnosing insufficiencies in the radial
head's lateral pins and it is a Gadolinium enhanced STIR
as
MRI. This test though has some
serious limitations,
well, but these are not in the results of the images. The problems with either a Gadolinium enhanced or
basic STIR MRI, which uses an elbow rotation brace, is the present level of availability world wide for this diagnostic imagery considering that, in many parts of the world, x-ray technolory is seen as a luxury given that
these areas don't even have running water let alone electricity.
If either a Gadolinium
enhanced or basic STIR MRI is available then by all means use it, but there are
cheaper and equally competent diagnostic images possible and they only require an x-ray machine. Before
these new imaging techniques can be infroduced, it is necessary to understand the positive aspects of the
lpt.
This test was effect because it reversed the body's means of absorbing the soft tissue insufficiencies at the lateral epicondyle: i.e. the first step to was reveftie the humeral rotation and then reverse the varus positioning of the forearm structwes which, of courseo isolated the insuffrciencies back to their point of origin, the lateral epicondylar area ofthe radial head. From this understanding of the lpst, whenever an image captures either a rotated humerus
or
forearm bones residing varusly to the elbow, i.e. residing close to a line directly downward from the
humerus, then the image demonstates conclusively the presence of insufficiencies of the radial head's lateral
pins as both ofthese bone positions demonstrate how the upper exfremity nahrally absorbs the damage to the
soft tissue at the lateral epicondyle. This reality though has been overlooked by the medical community
because physicians do not see the position of bones on x-ray
filns to be highly relevant or pertinent to the
injury: only bone structure - broken, damaged by osteoarttritis or fully dislocated * in an x-ray film are grounds for the x-ray to be declared anomalous. (As a result, the medical community still
discussion of disease or
clings to the belief that the main joint of the elbow isthe ulrn-humeralwhichhas resulted in the elbow being
erroneously defined
humeral capitellum.)
as a'hingeoo
join!
the ulna at the ffochle4 and that the radial head rotates around the
So, using the fact that varus alignment of the elbow is a clear sign that the radial head's lateral pins are suffering from an insuffrciency, all that is needed is a radiograph which demonsftates that the forearm
bones are residing in this position relative to the humerus. Such an image is easily obtained with a slight
Copy
# aol
for RUDI KRASS
6I
modification of the present overhead x-ray. The change to this type of x-ray is that the forearm bones be
placed under shess applied at the lateral side of a supinated wrist by either a second technician, a physician or
a strap across the plate table which must also immobilizes the forearm on the lateral side while the patie,nt pushes against this stop either at the body or just above the elbow on the humerus with his other hand. (Be
warne4 this force can cause significant pain!) Now, because the x-ray image is actually taken from 30 degrees medially from the vertical line ofthe
joint, the film will clearly show
a separation of the ulna and the radius around the biceps attaclnnent
onthe
latter. This gap will be eve,n more evident when the patiurt has been using the arm at a moderate level especially through the improper pronation technique used by an arm suffering from insufficiencies at the lateral
epicondyle. This widening of the ulrn-radial joint gap is due to the pronator teres andthe upper portion
of
tkeflexor sublimis digitorwn being strengthened to the point where they are actually able to rotate the radius'
Bicipital Tuberosity further baclarards through the ulno-radial joint.
T,llirs
rotation of the radius, which
normrilly does not occur through propr pronation, forces the ulna medially from its normal alignment as well
as rotates the ulna's medial portion baclavards
- just like
an accordion
with one strap attached. Thus, it is
proven that the abnormal radial rotation causes not onlythe impropervmus alignment demonstrated in the film but also a slight rotation in the ulna as well.
With the knowledge that radial rotation causes ulno-radial joinl separation and that greater use of the
arm through pronation causes incneased separation, it is easy to produce a conclusive result in all cases of
LN:
prior to having the x-ray done, have the patient do stictly forearm pronation strengthening exercises for an
aftemoon or day which, in cases of
LN,will
cause an easily noticeable ulrn-radial
joint gap.
These two facts
also lead to the conclusion tha! with prolonged e4posure to strate some of these effects in a normal overhead x-ray film.
LV,the forearm bone positions
should demon-
ohormal" or unafflicted joint on my body, As I was fortunate enough to have a
I rcalircdemly
on that
I would be able to do a proper comparison betwee'n both an upper extremity suffering from insufficiencies to
the radial head's lateral pins and one without. From my images
CT scan both arms pronated and compara-
tive x-ray films, I found that it is easier to understand the bone positioning in these films when one has a
comparative joint to use as it creates an individual standard for the bone positions at the elbow. The most notable change and easiest to see in a standard overhead x-ray film of an pronated elbow is that the overlap of the ulna and the radius is noticeable reduced-the intense white where the two bones
overlap is significantly smaller in thickness on upper extremities suffering from LM. Also, from the radial rotation, an abnormal gap appears just beyond the Bicipital Tuberosity towrds the wrist and the radial head is noticeably thicker in compmison with a fihn of a normal forearm/elbow: the latter is due to the fact that the
radius has rotated posteriorly making its representation in the film image thicker by fact. The most notable changes for comparative CT scans ofpronated forearms are the musculature is
thicker around the unstable elbow and it is oval or circular in shape whereas a normal elbow's musculature is
CopJ
# ool
foTRUDIKRASS
62
very rectangular in shape and noticeably reduced in size when compared to an unstable elbow's image. Interestingly, due to the pronated position of the forearms over the patient's head for the images, a small but
noticeable gap arises at the lateral portion of the rodiohumeral
joint.
This gap should persist over two or more
slice images and is demonstrated by a gradually increasing radial head image that finally becomes circular like its counterpart on the healthy arm which should remain circular through all the images slices of
it. (If a
comparative and healthy limb is not presented, then take a radiographic image of the elbow while under varus stess, as outlined earlier.)
If the diagnosing physician
does not have available an x-ray machine to create any of these diagnostic
images, the problem of insufficiencies of the radial head's lateral pins can still be diagnosed relatively easily.
To do this though, it is important to remember that the presqrt range of motion tests that medical practitioners
use today are oufinoded as their results come back as negative even though the upper exfremity is pronating
a manner
in
which is abnormal. The reason present basic physical testing does not expose the fact that the elbow
is dysfunctional is that there are actually two ways of performing forearm pronation: the erroneous and
medically accepted way, i.e. by rotation of the radius around the humeral capitellum making it strictly a forearm activity, and the proper physical way, i.e. rotation of the entire upper extremrty through both pronation
and supination with the radiohwneral
jointbengsolid and the main joint making the upper exfremity
a single
unit and rotation of the wrist/hand within the lower exhemity of the radius possible without swelling and
tendinitis. (As has been presented, repetitively and through numerous images and tests, the rotational process,
presented in the
frst
section of this boolg is the true way of obtaining rotation ofthe hand!)
The new non-imagery means of determining whether or not the patient is capable of pronating the
arn
as a
unit is srmply by placing the forearm in a supinated position and at 30 degrees of flexion from full
extension. With the tester standing face to face with the subject place the same ann as is being tested on the
inside of the humerus just above the elbow. Now, with the tester's free hand placed on the lateral side of the
radius at the wrist and lightly gripping the forearmo push inward on the forearm and pull back while using the
arm placed on the humerus to keep this portion ofthe arm stationary. I am calling this physical examination
the Krass pronation test, Kpt.
A positive result will be the fact that the forearm is capable of moving back and forth
then back to its normal valgus alignment position
inward and
along the 30 degree of flexion plane. This forearm motion
along the horizontal plane is a clear indication that the lateral radial head's pins are insufficient to keep the
radial head's canilage tight against the capitellum's.
With the Krass pronation test,fhe radiograph analysis presented
as
well
as the STIR
MRI results, the
diffrcult lateral pivot-shirt /est, which is not always accurate in determining insufficiencies in the radial head's
lateral pins, can be replaced with these far more accurate tests. So, diagnosing insufficiencies within the radial
head's lateral pins can easily be done with
positive result produced by the Krass pronation /esf and then,
if
63
x-ray technologr is available, this test can be confirmed with either avmusly stressed radiographic image
CoW
ou
for RUDIKMSS
demonsfiating an unusually small overlap of the radius and ulna as well as a possible "gap" between the ulno-
radial jointbones
at the
elbow. A more e4pensive mqms of diagnosing lateral rotation instability is a set of
comparative CT films where the forearms are pronated in which the radial head demonsfrates a smallbut confirmable gap at the lateral portion of the radiohumeral
joint
The most expe,nsive but very reliable diag-
nostic image is either a basic STIR MRI or Gadolinium enhanced STIR MRI rotational elbow brace.
both use the posterolateral
It is importantto addthat a simple MRI of the armwithout abrace is NO LONGER acceptable

does not produces humeral as well as radial rotation. Also,
as
it
if the patient has a healthy joint on his other anrL
then the quickest way to diagnose the problem is a comparotive Kruss prunation test.
CopJ
ou
fioTRUDIKRASS
64
TnnlrurNr ron
LlrEnAr Romronv INsrasr.rTY
Contrary to current medical practices, there me only 3 proper fteatrnents for lateral rotatory instability,
LN,
due to insuffrciencies of the radial head's lateral
pins: physiotherapy, adjusted to the new reality of
how the upper exkemity actually functions through all its motions; reductive surgery to both the lateral pins,
the radial
collderal ligament and the common efrensor tendon;prevention, changes to the way in which
human beings use their upper extemities. The first two freatnents
will be examined in this chapter while the

as to
final foeatnent will be presented in its own chapter, Preventiono so

enormity of this process which will be massive.
try and present some semblance of the
Physiotherapy
The key to determining the tneafnent counie depends on how quickly
IRl
is diagnosed from ttre injury
and the type of activity that caused this condition. In cases where women and some times men are suffering
from mild to moderate levels of wrist tendinitis and carpal hrnnel complications from repetitive activities like typing, data input, cutting hair in
a
busy salon or standing at a grocnry store cash register not just for long
periods of time but for short time frames repetitiously over the work weeks, the recommended fteatrnent has to
be
physiotherapy. In men and occasionally women, when lateral epicondylitis is present as well
as some
form
of wrist complication BUT these cases ofZR/complications were not preceded by a sudden and shaqp pain at
the lateral side ofthe elbow, fhen once again physiotherapy must be the treatnent rendered.
As the understanding of how the elbow joint system works has to change, so does the nature and types of treafinent to recover the proper functionality. The type of trednent that remains is obviously reducing the swelling at the wrist and elbow with ice and heat accordingly. The types of exercises to stengthen the muscles
that interact with the joint are different initially as they must be focused on those that reside on the lateral side
of
the arm above the lateral epicondyle. Also, once these muscles ate strong, given their size, the manner in which the upper extemity is use4 rotating at the shoulder rather than the elbow, has to be re-enforced not just in the ann usage, but in the brain.
This repetitive practice fraining is accomplished initially with the patient grpping
wooden dowel
with his lateral 3 fingers and swinging the dowel up laterally from the 6 o'clock position---rcounterclockwise for
the right arm and clockwise for the
left. This exercise should
be done 3 times in repetitions of 30 and repeated
34
times a day for several days. From there, the patient should be moved onto light shengthening of the
pectoralis major, actually the clavicular portion, with dumbbells using the standard sfrengthening regime of 30 repetitions in sets of 3. This pectoral exercise should be done twice a day minimum until the patient reaches about 15-20 pounds per ann and is capable of doing this weight without sfain from start to finish.
Copy
ou
for RUDIKRASS
65
Once this activity level is reache{ then sfrengthening of the biceps, deltoid and supraspinatus muscle groups should be initiated. This activity must be done with light dumbbell weights and progressing to moderate weights as well as continuing the rotation exercises with a weight bar and exhemely light
weight-l
pound of weight at 12 inches from the fulcrum creates quite the torque which means the force necessary to
move that
1
pound weight is much lmger than suspected and realized. Once moderate weight for the shoulder
muscle groups is attained" the rotational exercise is no longer necessary if the patient continues to work out
with moderate to sfrong weight naining.
All this teatnent will be for naught if the patient returns to a work environment which is designed
around the illusion that hand and forearm rotation occurs at the elbow and not the shoulder. Without changes to the way in which society demands we use are arms, the patient
will
be back time and again but the amount
of patients being treated will continue to grow without end unless the changes outlined tn Prevention are not
undertaken
immediately
Reconstructive Laterol Epicondylar Surgery
I{
at any
point
the physiotherapy treatnents, the lateral epicondylitis or wrist complica-
tions return or are not diminishe4 then the only way to teat the patientis reconstructive lateral epiconfulo,
surgeryto the radial head's lateral pins.
If, initially, the complications
at the wrist are sevetre, both carpal tunnel and tendinitis, and which may
include soreness and crepitus at the shoulder, then reconstnrctive lateral epicondylar surgery is required to
resolve the underlying pathologr causing these problems.
Beyond this symptomolory, if the patient mostly men, suffered a sudden and severe pain at the onset
of lateral epicondylitis othenrecorutnrctive lateral epicondylar surgery is necessary to resolve the patient's condition. Surgical treatnent is easily diagnoseable because the cause of the sudden pain at the lateral epicondyle ofthe elbow is usually due to intense repetitive strairl i.e. like shoveling large amounts of dirt incessantly, pitching a baseball, excessive training to pitch orplay tennis, repetitive high intensity ratchet use by mechanics, administering chiropractic adjustnents orphysiotherapy requiring resistance force orjoint manipu'
lation by the physiotherapis! etc. In these exanrples, the actions cause a sudden improper strengthening
of
both theprorntion teres andupper portion of theflacor sublimis digitonnn. As a resull patients whose lateral
pins are of normal lengttr to keep the radiolrumeral jornl tight through extension and flexion have a sudden tearing of the radial head's lateral pins elbow.
accounting for the suddsn and sharp pain at the lateral side of the
Ifthere me fixations, initially within the wrist and elbow and initial teatment includes, or included,
an adjustnent to the elbow, meaning that the radiohumeral
joint wasput into proper alignmen! then
reconstntctive lateral epicondylar surgery is the only means to correct the damage to the radial head's lateral
CopJ
# ou
for RUDIKRASS
66
pins without question. This quick prognosis arises from the fact that the fixations can only be due to continuing to work at a high arm activity level following a sudden and severe pain at the lateral epicondyle or a
trauma to an outstretched arm. In either case, the radial head's lateral pins are damaged far beyond the body's natural recuperative
ability-a
fact ttlat
will
be borne out by the failure of
ANY physiotherapy or chiropractic
treaftnent to resolve completely or pennanently the effects in the upper extemity that arise from
LN.
Unfortunately, I can only outline the objectives ofthe reconstrtrctive lateral epicondylar surgery. As
to the exact surgical processes that
will
accomplish the surgical objectives, I
will
leave that in the capable
hands of the Mayo Clinic's Head of OrtlCIpaedic Swgery and his team as well as the orthopaedic surgeon's at the Kerlan-Jobe Orttropaedic Clinic in Los Angeles that specialize in elbow and upper exfremity surgeries. The following is just my insights into ttre objectives of recowtnrctive lateral epicondylar surgery. The main objectives of this reconstructive surgery lateral pins,
will
be to reduce the length of the radial head's

cases where the
i.g the damaged radial collateral ligament AND the common exteraor tendon. In
tendoir seerns fme but the ligament is damaged" the tendon has been damaged as well and needs to be short-
ened. The rationale behind this assessment is the fact that the tendon supports or works together with the radial collateral ligament in adults
more so in men than women
to reduce the vulnerability ofthe lateral
pin. (This fact about tendons supporting the ligament pins ofjoint
joint from the side.)
arcs also applies to the finger and toe
knuckles and the knee explaining the most common cause of dislocations and ligament damage in these joints
a frauma to the
About the actual surgical process, I do know that reconstructive lateral epicondylar surgery is only
possible by actually opening up the skin over the lateral epicondyle for about 6-8 inches and not with the use
of arthroscopic surgery. This fact means that there will be a sizeable scm at the outside of the arm upon completion of the surgery. Reduction in the visibility of the scar and healing of the skin can be done by using
the Montreal protocol of incision closing, i.e. using medical tape with porous glue to close and formulate a connect between the incised skin. Once the
joint
and common extension tendon are exposed
following the skin incision and separation,

the kndon lengthwise orre-opening
the tendon has to be cut across it and not longitudinally along

a
it. Cutting
previously healed tongitudinal tear, usually occuning in pitchers but not exclusive to thenU is the worst
means of exposing the lateral portion of the radiohwneral
joint and the dorsal portion of the lateral epi
condyle. The explanation for eliminating a longitudinal cut ofthe common acterwor tendonto e4pose the radial collateral ligament is that
a torn tendon only occurs when the radius has been exposed to a
stong and
sudden IMPROPER rotatory force so, replicating this alfect on a healthy or previously healed common exten-
sor tendononly weakens or re-weakens
it.
Ergo, creating a flap of the cornrnon qctensor tendonand the
forearm muscles that attach to it is the only means to expose the joint with minimal negative affect on the soft
tissues requiring reconstruction. (This fact has already been borne out by the success rates for the respective
surgical procedures when used to remove scar tissue from undemeath the tendon.)
CoW
ou
for RUDIKRASS
67
The most intriguing part of the surgical discussion is the fact that, when the radial collateral ligament is exposed, the lateral
piwt-shifi motion, lpsm, should
be used to determine, the amount of ligament insufft-
ciency that is present through a visual inspection of the fully exposed joint as this motion is applied. The
intriguing part is that the result of ttris tesf performed on an exposed joinq will be the foundation for the new
reductive ligament surgry which
will
supplant the strgical procedure recommended by the /psr's founder: in
effect, the body's response tnthe lpsm, i.e. the /psf less flexion, actually demonstrates the exact amount
of
ligament insufficiency that needs to be removed by reversing the body's meaffr of absorbing these insufficiencies. Presently, once the radial collateral ligament is e4posed, a graft of the palmaris
longn ta the dorsal
aspect of the lateral epicondyle is performed. When this tendon graft is examined with physics, it becomes
evident that it actually mimics the reversal effects of the lpsm or a proper reduction of the radial head's lateral
pins. Instead of mimicking the effects with such an invasive procedure, the benefits of actually performing a
propef reduction of the radial head's insuffrciencies demonstrates the rationalizaionfor it over the preseirt
tendon release surgery especially when it conforms completely with the realrty of how the elbow and upper
exfemity really firnction. Prior to performing the lpsrn andsurgical reduction of the radial head's lateral pins
though, all disorgani z.ed or clumped scm tissue inside the joint capsule and that between the common extensor tendon and radial collateral ligarnent mtstbe removed.
lf
the radial collateral ligament
istom, it would be
advantageous to use that point to gain enty to the scar tissue--I adhere to the policy of keeping the amount
of
cutsto aminimum.
Once scm tissue removal has been completed, the elbow can be prepared for reduction
nthe radial
collateral ligamentby implementing the lateral pivot-shirt mofion: the /psf minus forced flexion which rotates
the humerus poskriorly, counterclockwise for the right arm and clockwise for the left, and then pulls the lateral portion of the radial head back into position over the capitellum and lateral epicondyle. This arm
position must be maintained throughout the ligament reconstnrction which dernands either a brace be developed which
will allow easy and unimpeded access to the joint stuctures or, initially, two surgeons or a surgiwill have to be present-*one person to manipulate and hold the arm while the other performs the
cal asssistant
surgical reduction of the ligament.
With the lpsm appliedto the arm, in
cases where the ligament was
torn, the radial collateral ligament
area can be cleaned up and then sealed so that it is retumed to a normal or near normal size. To achieve the same effect on a stretched but not torn radial collateral ligament, it should be cut and shortened at the radial
head attachment and not at the humeral attachment. With the radial collateral ligament now being the proper lengttr, the ligament can be re-attached to the radial head with porous glue first being placed on the radial head attachment.
To test the strength of the attachmen! the lpsm should be released. Using a mild force with the Krass
pronation test,thereshould, once again, be no discemable medial forearm motion confirming that the ligaCoW
ou
for RUDIKRASS
68
ment surgery was a success. Obviously, motion within the forearm sfructures during the.fi?ass pronation test
would mean that the ligament needs further reduction. This motion
will
once again be visible at the lateral
epicondyle as the radial head will still lose its alignment to the capitellum and the lateral epicondyle.
With the radial collateral ligament reduced to its normal or near normal size and its attachment soli4
the common extensor tendon can be reduced by several millimetres and then re-attached in the same manner as the radial collateral
ligament-porous glue placed on the epicondylar attachment and then the shortened
common extensor tendonre-placed over its humeral attachmen! i.e. the lateral epicondyle. Then, to close the incision, put porous glue on one side of the cut and then use strategically placed pieces of medical tape to close the wound nicely and strengthen the incision seal with porous glue over both the incision and medical tape. It is important to determine which medical tapes the patient may or may not be
allergic to as the medical tape remains attached until cellular regeneration causes the skin to shed the tape.
With the surgery completed, the patient should remain in
a secondary post operative bed
until the glue
dries fnaking certain that ABSOLUTELY nothing comes in contact with the glued area due to the incredible stickiness and bond strength ofporous glue. Also, acupuncture can be used to neutralize the neural stimula-
tion of the upper exffemity instead of a local anaesthetic throughout the surgical procedure.
Post Operative Treatment

Post operative care
will require NO
use of the upper extremity for 4-6 weeks. This means that the
elbow needs to be placed in a cast which will keep the arm FULLY extended and which extends from the finger tips to the midpoint of the humerus. This cast length is necessary to ensure that there will be NO
BENDING OF THE ELBOW and no contractions in any forearm muscle groups which naturally impact on
the healing radial collateral ligament. This time frame permis the ligament and tendon time to establish an actual cellular bond as well as grving the body time to reduce any post-operative swelling
anti-
inflammatories may be used reduce this effec! but I don't recommend this.
Following removal of the cast, physiotherapy with no weight for l-2 months will need to follow.
During this time, the arm cannot be used for almost everything in order to allow the radial head's lateral pins
to bond fully with cellulm regeneration of the attachments. At the end of these months, the elbow can now be bent but WITHOUT any significant weight in the hand or in the forearm as the soft tissue stuctures at the
lateral epicondyle should be fully healed but very weak. Now, the treafrnent process described nthe Pfusiotherapy section can be initiated.
It is important to realize that the treatnent has to be tailoredta the patient. This means that the
weights will not be increased until the patient demonstrates COMPLETE competence with the weight and the weights should start at
1
pound per arm and very gradually increase to moderate weights per arm/shoulder-
making certain to focus on correct use of the arm throughout all the exercises rather than rush to increase the
Copy
# ool
for RUDI KRASS
69
weight especially towards the end of the treabnent. Also, a rule of thumb that should be used to d*ermine whether or not to include ffeatneirts for the shoulder: when shoulder crepitus cases, if it existed at all, then
ttre
joint is ready for inclusion in the fteatnentprogram.

Tailoring the physiotherapy treatnents also means being prepared to use up to 2.5 years to treat not
just the wound and all physical upper extremity rotatory complications but also the mental aspects of this condition. Don't forget that, in long term
cases, the autonomic
portion of the mind has been'qfained" for
decades, in some cases, to rrse one or both arms that are improperly rotating which makes the nzural feedback and extremity inputs convoluted and improper. Essentially the brain has tried to work around the pain in the arm and, in so doing, has created an improper ner.ral connectivity to this extrenrity which makes having a
fully
functional upper exfiemity with
ppg
neural inputs from it a distant memory or myth for the brain.
From personal e4perience, I can say that it is diffrcult for me, a l2year sufferer of LRI, even to remernberhow my right arm felt during the years when I used my dominant arm freely and without fearof
causirtg a debilitating pain in it, often requiring rest and relocation of the forearm bones to resolve these
problems. For persons suffering with this syndrome longer than myself, I beliwe that they've given up all
hope of ever
having'!ain free" upper exffernities especially after having been constantly bombarded by
medical specialists' opinions indicating permanent impairment and impossible to cure or, possibly, being sent to a pain management clinic. A surgical solution finally being presented for all cases ofZRl, decades after the fact, is going to seem like a miracle.
I hope that, if, after the orthopaedic surgeons at both the Mayo Clinic and the KerlanJobe Clinic have
read this boolq they present and distribute their constructive changes to the surgical process quickly and have
,Rl
instituted as a serious medical syndrome of epidemic proportions dating back to at least the 1960s. Such
action
will make reviewing cases of previously undiagnosed upper extremrty pains from 1960 to today mandacases
to{v. In tum, the surgical community will be inundated with tens of millions of prwiously undiagnosed
requiring surgical resolution because cases of lateral npper extremity rotatory iratabilitytnve actually increased exponentially since 1960 due to the massive growth in the global economy and especially the North
American economy.
Ineffective and Complimentary (Cunent) Treatments

Before moving onto Prevention of
LN, it is important to discuss teatnents for epicondylitis
and
forearm complications that need to be eliminated and the rationale for this. The heatnents that need to be eliminated are: res! proliferent injection, cortico-steroid injections, sfraps and prolonged use of nothing but anti-inflammatories.
Rest needs to be eliminated as a fteatnent because all this does is allows the pronator teres andupper
portion of theflacor sublimis digitorum to weaken through a lack of improper contaction. This lack
of
70
activity reduces the strain on the radial head's lateral pins which causes the lateral epicondylitis to reduce. CoW
ou IoTRUDIKRASS
However, without refaining the mind to pronate and supinate the upper exfremity atthe shoulder, the symptomolory is bound to re-occur when the upper exfemity is e4posed to activities that require repetitive pronation of the forearm and/or anterior humeral rotation.
An occasionally used freafrnent for lateral epicondylitis is prolifereirt injection. However, this line
treatnent can clearly be seen as inelevant because lateral epicondylitis can no longer be deemed a viral or bacterial infection or even responsive swelling to either of these problems. As has already
beer-r
of
indicated, the
soft tissue ftaumas that occur in the wrist, hand and elbow are intrinsically linked and arise from the upper
extremity being used in fashions which causethepronator teres tocontract at the wrong time, i.e. make
it
function according to its present and improper medical designation causing a biomechanical breakdown in the radiohumeral
joint effectrngforce distribution
at the radial head's lateral pins.
A nastv treatnent, if ever there was one, is cortico-steroid injections into the radial head's lateral pins.
Not only can this treafrnent be seen to be ineffective given the nature of lateral epicondylitis, but it has a
negative long term effect on the soft tissue stuctures--it weakens them at the cellular level. If the patient
received numerous rounds of cortisone injections prior to a surgical resolution to his lateral epicondylitis, this
will
impact negatively on the probability of success because both the ligament and tendons
will
be prone to
stretch rather than sfrengthen during the lattr stages of physiotherapy.
Bracing of the elbow, forearm straps and wrist splints or taping which aid in many sports to reduce
the amount of lateral epicondylitis
will
be unnecessary once preventative steps, i.e. changes to the use of the
upper exhemities, are forced upon and undertaken by commercial enterprises that presently demand vigorous
improper shengthening of the pronator teres and the upper portion of theflacor sublimis digitonnn muscles.
Proper reconstruetive lateral epicondylar surgerywillbe useless in cases where the patients decide to con-
tinue or retum to using their arms improperly due to their own frnancial benefits, highly paid professional
athletes, after the surgical freabnent has been rendered. Forearm straps do provide some benefit by partially binding the forearm bones together which mimics
an healthy elbow where the radiohwneral
jointis solid
causing the upper extrernity to rotate at the shoulder
rather than the wrist through supination and pronation. The limiting factor to a sfap is the fact that it is applied to the outside of the arm rather than at the actual skeletal level, so the musculature inhibits or effectiveness of the strap considerably.
limis the
Treating chronic and repetitive cases of lateral epicondylitis with nothing more than antiinflammatories is useless. All this
t51pe
of treatrnent does is reduce the swelling while doing nothing to combat
the underlying biomechanical dysfunction caused by repetitive improper strain placed on the radial head's lateral pins.
In artt;erliy, this teatnent is counterproductive
because it may actually eliminate the swelling
with high enough doses bul once the use of anti-inflammatories is stopped, the radial collateral ligament and
the common extensor tendon
will be stretched to the point where the lateral epicondylitis and any wrist com-
plications cannot be treated with physiotherapy but rather reconstntctive lateral epiconfular surgery.
CopJ
# ool
for RUDI KRASS
7I
Three treatments that are ofvalue
as complimentar.v treatnents during physiotherapy are
electostimulatioq acupuncture and ultrasound. The first will be very effective when, during physiotherapy, light weights me infoduced to the treabnent program. The benefits though will be best achieved when the
pads are placed over the lateral forearm muscle groups and the ENTIRE upper exfremity is either
FULLY
pronated i.e. aposition beyond the horizontal line

supinated position, i.e. paln
3 o'clock on the left and 9 o'clock on the
righl or in the
up. This upper exfemity position will focus the muscle contractions and
strengthening effects on the forearm muscles when there is no natual counter conffactive force applied to the humerus.
Acupuncture has not only benefits for reduction of the lateral soft tissue swelling bu! for patients with
some minor neural complications especially at the lateral epicondyle, this freatnent would be better than anti-
inflammatories to reduce post operative swelling because acupuncture has some neurological benefits that
have yet to be understood. So, two birds can be killed with one stone.
'
Ulhasound has been proven to be invaluable in reducing scm tissue build up around incisions. In
some cases, like mine, 3 incisions
will
be made and closed almost on top of each other so reducing the amount
of scm tissue buildup through recover will be a priority.
Copy
# ool foTRUDIKRASS
72
Llrnnar Reraronv IxsrnBntw

The is mentioned nosed cases
frst
will
image that many
will
create at this point when prevention of lateral rotatory instabilily,
LN,
be reconstructive lateral epicondylar surgery and mainly for the large portion of undiag-
- women.
I would like to dispel this notion right offthe bat because I do NOT want to be seen as
recommending this approach. Although it is certainly true that women make up the larger body of sufferers from this condition strictly due to the reality that ligaments within women are set by genetics, to be laxer than their male counterpmts-this has a lot to do with the female's body ability to bem children.
(f female liga-
ments were as tight as males, then children would be brought into this world by cesarian section rather than
through the cervix as it would not be able to expand to facilitate the passing of a child through it.)
'
It is exactly this child birthing and nursing ability which demands that the use of reconstnrctive
as a pfg14g4tali\iilUga$Ag be eliminated
lateral epicondylar surgery
for pre-menopausal women. It
will
obviously be necessary for women who fall within this age group and who are suffering from severe wrist tendinitis and carpal tunnel complications from ZRl to be treated wifh reconstnrctive lateral epicondylar
surgery. However, these women must also be informed that this ffeatnent has the likelihood of effecting their ability to have
a natural
childbirttr and their ability to nurse the child following its birth. So,
a{i
you can see,
txe of reconstructive lateral epicondylar surgery as a preventative measure in pre-menopausal women NOT demonsfiating ZRl complications must not be considered.
Now, certain segments of North American society will attenryttn take the preceding paragraphs out
context and say that I am discriminating against women and presenting an outdated view of a woman's role.
of
Although my body defines me
as male, this false interpretation of the preceding paragraphs was never
my
intention. The real objective of this section is to demonsfate the pervasive improper upper exfremity use that
ALL human beings
are exposed to through their work, play and everyday survival activities.
The reality concerning female health issues having arisen at a greater rate than men's over the past 3
decades is due to the medical community's failure to acknowledge or even suspect that
joints play a greater

as it presently
role in body functionality than bones do. This fact will be proven in my next book because,
stands,
I am physically incapable of presenting all the theories and correlating data which confirm that men
suffered a great deal more from ZRlthan was previously thought and" by becoming a part of this malicious
work environment, women were exposed to these same deleterious effects however women's injuries surfaced
quicker because their joints me laxer-you have to wait for this boolq though. As I mentioned, all aspects of human life, i.e. worlg play and basic survival activities, involve a
degree of improperuse of the upper extremity. This means ttntthepronator teres andupperportion
ofthe
well
as
Jlexor sublimis digitorwn are exposed to different degrees of improper contractive force activities
as
CopJ
au
for RUDIKRASS
73
improper and unnecessary anterior medial humeral rotation. Examples of improper usage of the anffi are
easily found now that how the upper extremity ac'tualty works is known
- like a'rmodified pulley" at-
tached at the radiohumeral joint rather tlnn a "hinge" joint specific to the ulno-humeral
Possibly the earliest example of human training that contradicts the fundamental and natural function-
ality of the elbow and upper extremity is teaching our children to write or pgnt. These actions are performed
with a slightly pronated forearm which can only be achieved witli slight improper contaction of the pronntor
teres andupper portion of theflexor sublinis digitonnn. To achieve beuer writing and printing skills, contol of these improper muscle contractions is increased ttrough continuous and repetitive practice. Due to the
female body having larer joints, better writing and printing skills are achieved faster and in a greater percentage of female
students-its little wonder that male children find learning basic writing and printing difficult with diffrcult to read sctibbles on paper. These mild improper contractions used
and the large majority end up
to write or print are exposed through hand cramping up during long periods of writing-improper bone alignrnent in the wrist caused by mild radial bone advancement witttin the forearm subsystem. (Solution:
redesign pens and pencils so that the hand does not pronate beyond 10-15 degrees from its neuhal position.)
Improper pronation is taken to its limit, thougtL in qping on current keyboard designs. By pronating
at least 60 degrees beyond the hand and forearm's neutral position
the 12 o'clock position for both hands,
the improper contractive force of the pronator teres and upper portion of theflexor sublimis digitorwn is increased significantly. These improper contractions are complimented by contractions within the ir{raspina-
tus and teres minor muscle groups that attach at the back of the humenrs at the shoulder. These secondary contractions arise after the radial head's lateral pins have been stretched significantly in meir but are already
resident in women due to thetr coraco-hnneral ligamentbernglonger than
men's. As a result of this facf
typing will produce wrist tendinitis and mild carpal tunnel more quickly in women but merely soreness over
the lateral epicondyle, at the anterior of the shoulder and in the hands of men. Following permanent damage to the radial head's lateral pins in men, the symptoms
will then
be the same as those found in womeq i.e.
carpal tunnel and wrist tendinitis, but with the additional elbow symptom of lateral epicondylitis.
Work activities that actually cause tearing of the lateral pins, are mainly dominated by men and
include professions like mechanics, labowers that do excessive shoveling or manual jack harnmering heavy
equipment operator, sawmill lineman, caq)enters, etc.
All
these positions require use
ofthe upper extremities
wherethe forearms and hands are pronated with extreme force especiallywhenthe distance fromthe elbow is
lengthened with a shovel, piclq ratche! screwdriver or hammer. Most of these types
oflRlcases will mise
with either a sudden sharp pain,
a sudden bout
of severe lateral epicondylitis or a severe case of wrist tetdini-
tis and carpal tunnel ifthe bout of epicondylitis does not cause immediate cessation of all arm activity. (From this paper, lateral epicondylitis must now be seen as a very serious medical injury requiring immediate treatment rather than an inconvenience that should be worked through which is still the medical line in some
jurisdictions worldwide. The latter represents the attitude that I held in 1989 which was common for that time Copy
74
and still is in the misinformed.)
Zftldoes not arise solely from work activities, thougtq as improper muscular conhaction and humeral
rotation is not limited to just these activities but also includes humanity's leisure activities
sports and arts
come to mind right away. Most of the sports activities rwolve around throwing a ball with a bent arm, like
handball, baseball (male hardball) and football. The most detrimental of these activities for the soft tissues
of
the lateral epicondyle is baseball, especially pitching, because the objective is to throw the ball the hardest and
with the greatest accuracy. To do this,
a pitcher practices daily
while starting out and
as the improper
contac-
tions become more controllable, the individual starts tluowing hmder which leads to an even greater improper muscular contractions at the anterior of the elbow. Although teming of the radial head's lateral pins, especially the common extensor tendano was recently discovered to be a common medical problem among pitchers,
thanks to better diagrrostic imagery of the elbow, professional baseball made changes quickly and started to count pitches thrown rather than innings pitched in order to reduce the amount of torn cornrnon extensor tendotts amongst its pitchers. The phenomena remained misunderstood though.
From the reality of how the upper extremity and elbow really worlg it is easy to elplain the injuries,
now. Prior to a game, a pitcher has ONLY
so many pitches
within his arm and this amount actually varies
depending on the amount of rest and taining that the pitcher undertook since the last game that he pitched.
So, every time a pitch is thrown, the pitcher reduces his number of remaining pirches until the effects
of
improper pronstor teres andJlexor sublimis digitorum confaction is no longer counterbalanced by the strength of his posterolateral muscles. Once this point is reached, the common actensor tendore and sometimes
the radial collateral
ligamentwill suddenly snap allowing the radial bone to sublux or even dislocate
posterolaterally. Unfortunately, the damage is done which requires reconstnrctive lateral epicondylar surgery.
A similar situation exists with racquet sports that include balls like tennis, squash and racquet ball. In
these sports, unwittingly, a participant uses an extension which automatically increases the torque force at the
top of the elbow subsystem. But, with improper contractions of the muscles located at the anterior of the elbow, the participant leams that he can generate "ball spin" causing the ball to bounce differently than anticipated by his opponent and usually resulting in a point. With practice, the pmticipants forearm contractions become stronger and sfionger until lateral epicondylitis occurs. Fortunately, the contractive force is usually less significant than that of a pitcher which means that, in many cases, treafrnent includes re-training for tennis players so that the raquet and hand rotation used to retum a ball is generated at the shoulder which,
until now, is exactly how the upper extremity naturally works. In other cases, if the epicondylitis is sudden
and severe, the patient actually needs surgery prior to leaming to use the upper extremity properly again. Sports me not the only activity which causes LRl among our recreational activities. It is easily deduced how long periods of crocheting, knitting and similar handicrafts or repetitive periods of these activities over long time frames cause the complications of
LN a
arise in people who partake of these
activities75
CoW
ou
for RUDIKRASS
these activities may relax the mind, but at a severe cost to the soft tissue structures in the upper exffernity.
LRI
in these cases is due to improper and incessant confractions of the pronator teres andthe upper portion of the
flexor sublimis digitonnn with mild force. Treannent, then, for these cases, if they are caught early enough is
simply physiotherapy, retraining of the arm to its proper functionality, and buying a machine to produce the endproduct, i.e. stop the activities or redesign the needles so that the hands are not pronated beyond the neuftal position.
Other recreational and possible cmeer activities are leaming to play and playing certain instruments
for long time frames. The easiest example to discern has to be playrng apiano
as this
activity uses the hands
in a 60 degree pronation position just like typing at a keyboard. A not so easily discernable example is playing
a guitar and this is mainly for professional artists. The easy pmt to understand is the picking hand which does a lot of mild pronation for all songs. The not so easily understood part is how the hand at the neck of the
guitm suffers from "tRl complications like wrist tendinitis. This realrty is easily disclosed by watching when a
bare armed player first puts on a shoulder strapped guitar if they me standing. At this point, the cord hand is
brought to the neck of the guitar with an anterior rotation of the humerus
the medial epicondyle rotates
forward. This improper humeral rotation is the activity which
causes
ZRlcomplications in the cord hand.
To demonstate exact$ how pervasive improper uppper exnemity rotation is, one need only look at
the earliest form of human training which contradicts the upper extremity's natural functionality
table
manners. As a child I was always taught to keep my elbow tucked in by my sides while eating. I'm sorry but this position breaches the neutral or resting position for the humerus relative to the body which is actually at
30 degree laterally from the body like a tepee,
a pronated hand and so the process of
roo{ etc. Now, the child
is taught to use his knife and fork
with
taining
an individual to use his arm in a manner that is contrary to its
natural rotational processes has begun.
All
that these examples do is demonsfrate how pervasive improper arm rotation actually is. As has
been showr\ improper pronation techniques are taught to us as children and then the problem becomes progressively worse as geater and greater demands are placed on us to increase the amount of productivity from
our anns that are being improperly used. Eventually, the human body fails whether it be with the ZRl complications exposed in this book or with other more insidious complications which I just am too physically incapa-
ble ofpresenting at this time. (If I were to present just the complication without its scientific proof and
experiments, the medical community would have gounds to dismiss this book because too many statsments
would be uncorroborated. This is not what society and its individuals need at this point: we need concrete
and undisputable theories which
will
demand changes in the medical community without hesitation! By the
end of the booh this objective
will be fulfilled concerning proper upper extremity and elbow functionality and
the symptoms of their intrinsic opposite, rotatory instability or a dysfunctional upper extremity.)
So, when whoever looks at all upper afin activities and not just the aforementioned ones, they
will
have the job of determining whether or not the activity can be modified to the human body's natural upper
CoW
ou
for RUDIKRASS
76
extremity functionality, not vice versa
as presently exists
with keyboards. If the activity cannot be altered to
eliminate improper contraction of the pronator teres andupper portion of theflexor sublimis digitonnn and
anterior humeral rotation prior to forearm pronation, then it must be abolished and, if possible, replaced with
an activity that actually results in the same objective but
with sit having been accomplished in a totally ditrer-
ent manner ttrat won't cause ZR.L
To explain this process of activity evolution, some examples have to be presented and explained.
have chosen table manners, engineered rac,e car cockpits and typing at keyboards. As indicated earlier, the
main problem with table manners is the pulling of the elbow inwards to the side of the body. By allowing the arms to reside at their natural state, at an angle of approximately 30 degrees outward, the amount ofhand
pronation is reduced to the point where the muscle contractions within the prorator /eres and the upper portion of theflexor sublimis digitorum become negligible. These contractions can be firttrer reduced by modifications to either the shape of utensils or the nranner in which the utensils are held: the result of these
changbs
will
be to ensure that the hand position does not go beyond 30 degrees from its vertical position.
A couple ofyears ago, it was publicly disclosed that many of the engineered race car drivers experienced carpal tunnel complications atthe end of a race which subsided over time once the driver was removed
from the restrictions of the car's cockpit. I added the latter clause as I have reviewed the size of the cockpit
and the restrictions placed upon an engineered race cm drivers' arms. In this instance, the cocllpit forces the
driver to rotate his humeral bone anteriorly
improperly timed coraco brachialis contraction, whiclr, as is
already known, is an improper motiorq prior to the pronation of his forearms and hands as he goes to grip the steering wheel. Due to the first action, the second can only be accomplished with a significant conftaction the pronator teres andupper portion of theJlexor sublimis digitonnn an4 as this position is maintained
of
throughout a race of more than2 hours, the forearm, wrist and hand lose bone alignment SLOWLY: attempt to relocate these posterolaterally subluxed radiohumeral joints andthe driver
will indicate an immediate relief
following the adjustnent.

To resolve the LNthatarises from working in an engineered race car cockpit, resize the portion
of
the cockpit that forces the arms inward to the point where it allows the upper portion of the driver's arm to reside at its natural neutral position
toed outward beyond the shoulder. Then, redesign the steering wheel so
that the driver's hands remain in their natural neutral position
the vertical
line. (Actually the whole steering
apparatus has to change so that comering is obtained not from rotating a steering wheel but from either contuaction of the biceps or triceps.) The final example is typing. In this day and age, typing means at a keyboard not the old standard of a
typewdter but the same principles apply to this design. As I indicated earlier, carpal tunnel and wrist tendinitis
arise mainly from the improper contractive force of the pronator teres and upper porti on of the flexor sublimis
digitonnn and complimentary improper secondary contractions within the infraspinatus and teres minor
muscles. So, naturally, these confractions need to be eliminated which is accomplished by retuming the upper
CoW
ou
for RUDIKRASS
77
arm's position to its neutral position as well as the hand to its neutral (vertical) position throughout the typing
process. In order to accomplish this though, new keyboardos need to be designed that adhere to the rule that
the machine has to be adjustable to the operator and not the current rule which is causing all the problems---the operator has to adjust to the position of the computer's components, i.e. height and position of the monitor relative to the seated position of the typis! the absolutely improper FDGD desrgn of the present
generation ofkeyboards and the poorly adjustable chair. Due to the unique nature of all human bodies, all keyboard's should be specific to the user which
means that they should be independent of the computer and the possession of the user as it needs to be fitted to
the individual. If this recommendation is not adhered to, then
I fem for the childre,lr who
are being more
significantly exposed, during their bodies' formative school years, to the most detrimental of all forces, far
worse that
writing typing. Be very aware of this fact as the consequences of today will be felt 20 years into will be suffering
the future when almost everyone in North America adults who were the children of today,
from dny or all of the aforementioned ZRl complications. From my own life experience, I discovered that for exercise, the more structwed forms of martial
arts, like T'ai Chi, Qi Gong Karate, Judo, etc., stress perfect functionality ofjoints in all their motions.
It
wasn't until now, when I learned how the joints of the extremities worlg that I was able to see this. The only explanation for the structured martial arts being so advanced has to have arisen from the masters always
stressing that, during the learning process, the student or even the master
tying to perfect his art respect pain if a motion caused
and not just work through it like in western sports. To the master, this ideal meant tha!
chronic pain or bouts of pain in himself or the students, then the motion was being done wrong and the process had to be altered so that
it could be performed without causing pain. Pain from haining to
a martial artist
should not occur----only mild muscle pain should occur initially because the body is adapting to this perfect use
of the body whereas, until 7 years ago, the mantra for Westem athletics was "No pain, No gain!" This understanding of the martial arts explains the old adage often used by the masters who state that being a true martial artist is a 'Way of
a true matter
Life.'
This means seeking perfection in practice so that, only when it is
of life and deatlU the maximum amount of force and activity can be applied with total conviction
by the student that it is all that he has. The reason ttrat martial arts are so advanced though is the longevity
of
this approach to body motion
several millennium makes for a high degree of reftnement! Now, the Westem
or scientific approach to motion can finally catch up to the Eastem world because now the functionality of the exhemity joints are fully understood: '?nodified pulley" systems with the medial and lateral arc pirx providing the rigidity to our exfremities equal to, if not greater, than that of our skeletal stuctures so that our anns
and legs work as whole units from their nails all the way up to the tomo.
Copy
# ool
for RUDI KRASS
78
With this booh the tue functionality of the upper exfremity has been clearly establishe4 Section I, while the main causes of lateral upper extremity rotatory instability,presented tn Section II, were demon-
shted to be intrinsically linked to this new reality ofupper extremity rotation unequivocally confirming the
new upper offemity functionality. In essence, these two sections demonstrate aperfectly enclosed functional
and dysfunctional system for the upper extremrty with no exffaneous facets as presently exist in the illusionary
medical theories concerning upper exffemity rotation and the copious amounts of unexplained medical problems in the upper exhemity. This reality begs the question: Why wasn't this functionality discovered sooner? The only response to this question is that the medical community assumed, without question, that their numerous theories pertaining to the upper exfemity actually reflected the
milner in which it functioned. In

a
reality, though" the medical community built what is tantamount to a 'house of cardso' upon
poorly conceived
analysis of the extremities' and their joints' functionalities. The main problem, which I eluded to at the outset
of Section I, was that the medical community started its theoretical assessmer$ of muscle and joint functionality from the outside inwards. To put it another way, the medical community started its assessment from
looking at the joints at the skin level which is when the elbow appears to function like a'hinge,o'
a c,ommon
term and understood function used considerably 200 hundred yeffs ago. From this initial and dubious assessment of the elbow, the surgeons dissected dead bodies to elpose the musculature whose functionality was interpreted prior to dissection downward beyond this level to the joint level. This process gave rise to the false labels that many of the muscles bear today. At this poing tlte joints were dissected
an{ to my resent shock
when reading up on the term "hinge" joint in Gray's anatomy,t the soft tissues, whose true functionality
theorized prior to reading this section of this book, were discovered but not properly interpreted as
a'tnodified
pulley system:" hence, the present and inaccurate medical label of 'hinge
joinf' forthe
knuckles ofthe toes
and fingers, the knees and elbows. Unfortunately for the billions ofpatients worldwide and historically to date over the last 200 years, the medical analysis from the outside in conducted 200 years ago and upheld today by the medical community is illogical and without merit.
As this book proves and the burgeoning cases of misunderstood medical conditions particularly
within the upper exhemity over the 1990s to date, the analysis of the exhemities' fimctionality should have
started at the joint level and then have the muscles labeled according to their contractions once they were determined relative to bone motion at the
joints. This analysis was not possible up until about
100 years when
radiologr and radiography arose from the discovery of x-rays and the process of making radiographic images
on plate
films. As a result, the'tnodified pulley system," employed in the knees, elbows, toes and fingers, was
mistakenly labeled as being a ohinge" when there was no evidence to confirm this assessment other than
society was unaware of any other way of understanding the firnctionality of the structures discovered from the dissection ofthe human body.
Copy
ou
IoTRUDIKRASS
79
Disheartingly, the medical community, since the advent ofradiography, never saw the need to con-
firm their theories pertaining to the extremities and their joints mainly because there was a seemingly good
consistency between top down analysis ofthe extremities and the underlying musculature. The false faith, that the medical community had in its muscle contraction and joint functionality theories, did present suffrcient inconsistencies though that a vigilant specialist should have perceived. From this realization, a more accurate analysis of the medical theories pertaining to joint functionality would have been done discovering that the
tlrcories and the logic behind them were wrong. Unfortunately, not one specialist to date has noticed the lack
of correlation of motion of the bones and the present medical theories even thouglq over the last 13 or more
years, ailments within the upper extemity have risen exponentially as work and society have demanded greater and greater improper use of the upper exhemity. The rise in soft tissue upper sxtremity problems were never conclusively demonstrated by the medical
community to be the result of massive increased arm usage among the general work force so the medical
comrn"unity remained oblivious to the reality that, at the base level, their
INVALID theories pertaining to the

a
exfemities are actually causing their patients to injure themselves without
valid means of resolution. The
reliance of society's constifuents, i.e. its citizens, on improper medical theories has led to the worst breakdown in health since the Black Death plague of the Middle Ages if not even worse. As the number of worldwide
sufferers of repetitive ovenrse syndrome or repetitive stress injuries have arisen since the mid-1980s, the
medical community's response has been inconsistent with the principles of science and their own Hippocratic
Oath.
It is understandable that the medical community did not fathom what was going on beyond their
offrces until now since it mainly arose from a lack of vigilance. The keeping of a database of all cases
of
repetitive stress injuries that arose from the early to mid-1980s, which the medical community did not do,
would have facilitated the correlation of the rise in upper extremrty rqjuries to the differing and shifting work
standards from previous work history over this time frame. Over the years, many people have pointed out that typing was done by secretaries yet they did not
suffer from repetitive overuse syndrome or repetitive stress injuries. The reality as to why few secretaries
suffered from repetitive stress injtnies is due to several factorso but mainly the reality that a secretary had a
varied work load, like taking dictatioq making coffee,
filing
some typing,
etc. Basically, these women did
not sit at a typewriter all day and every day like a data entry clerk or an operator in a call center which
do. So,
of
the compmison between a secretary and present day office and clerical positions which have a high risk causing repetitive stress injuries just isn't
feasible-it is like comparing

a
apples to oranges.
In the 1950s to late 1970s, there was
position which did record the problems encountered by many
suffers of repetitive strain: this was a typist in a typing pool that remained there for many years. The individu-
al's who filled these positions were women as employment during this time was gender specific. However, not
many companies to 1970 had a typing pool so the condition was most definitely viewed as rare or uncornmon.
CoW
# oot fioTRUDIKMSS
80
The factors that made the carpal tunnel syndrome and wrist tendinitis even more uncommon was the fact that,
ofterq the women did not remain in this position for long either due to advancement or marriage, at which
point, the women became stay at home motherso homemakers and wives.
Today though, women often do not advance in a company as easily because computers have reduced
significantly the amount of clerical and secretarial positions within most companies, do more with less, and fewer and fewer working women are becoming housewives: present-day married women remain working in
orderto make ends meet
as their spouse no
longerbrings home sufficient income to support anon-working
wife let alone a child or trvo. So, any break from duties causing repetitive stress injuries that arose from
marriage in the past has dissipated over the last 25-30 years. The pressure for women to remain working in our present work place environment takes its toll rapidly on women Gender Based Lateral Rotatory Instability section.
Just as computers have led to significantly increased wor{doads and
with the results being those in the
limikd the ability for advance-
ment out
of
data
enty and typing positions for women, the increased consumer demand in all products has
lead to numerous positions which, prior to 10 years ago, did not exist. Often, the shifting of industries to mass
production of an atypically limited production indus@ has created numerous positions which breach upper extremity functionality ,
see
Sectionll/
as
well. This shifting to mass production, especially in the United
States but also worldwide, has led to the weakest people being put into jobs which cause repetitive stress
injuries after just a few months in the pro-dominantly female work force-the best example of this is the female line workers in the chicken factories ofDelawme and Maryland. In reality thougfi it is not female
physiolory which cause the debilitating arm problems in these employment positions but the constant pronated
forearm work which not even a man could do for long without tearing his elbow's latoal pins.
The medical community did not realize all this because all they knew was that there were injuries, on
mass, which could not be explained and therefore could not be properly
teated. Instead of accurately deter-
mining the microcosmic cause-and-effect relationship, repetitive pronation of the han4 wrist, forearng elbow
and shoulder, and then reverse engineering the problems to determine the actual process, the medical conrmu-
nity responded by either: going straight to
phgmraceptica! response to eliminate the trauma within the arm's
soft tissue structures; declaring the patient's soft tissue arm problem to be permanent, still undiagnosed though, and requiring'!ain managemenf' so that the patient could attempt to live and work with the debilitating lnjury; or treat the complications with unnecessary surgeries which had proven beneficial in some cases
but not permanently so. The first treatnent response was already negated as a viable teatnent due to the soft tissue problems being caused by a biomechanical dysfunction of the lateral radiohumeral pins
nthe Ineffie-
tive and Complimentary (Cwrent) Treatments section of theTreatment chaptsr of this book. By ttre medical community deciding to create a new branch of medicine, psychonewoimmunologt,to
deal with the
'pain"
aspects rather than scientifically source the problems out demonsffates the lengths to
which the medical community is willing to go in order to deiry that medicine's original founders were wrong
CoW
# ou
for RUDIKRASS
8I
in their analytical determination ofjoint, exfemity and muscle functionality. The institutionalization of
managemento' is vicious because the major thesis of this new branch of medicine is that
'!ain
ALL pain
is psycho-
logical in nature rather than physiological. Essentially, this makes the problems of the suffers of repetitive
stress injuries psyclnlogical ones ralher than legitimate physiological ones.
This medical theory statement was freated as fact which resulted in all Workers Compensation Boards
and medical insurance companies ofNorth America as well as federal, provincial and state governments being absolved of the legal responsibility conceming the continued cost of treaftnent for those suffering from repeti-
tive ovenrse and repetitive stress injuries. With this boolq though, the aforementioned entities will no longer
be able to hide behind improper medical opinions or even use them to asses the patient's until they have been educated in the new and proper functionality of the extremities.
As I stated earlier in this chapter, the vast majority of medical information has been built upon the
present inaccurate medical understanding of the firnctionality of the upper extremities and the extremities, in
generirl. This fact means that the vast majority of medical knowledge has to be seen as invalid because its
under pinnings are no longer
valid. Given this reality
and the fact that this information was used to date means
that all medical cases of problems within the soft tissue and nerves of the upper extremity have to be reviewed
once the medical personnel have become educated in the new ftnctionality of the upper extremity, its muscles and its
joints. This massive review
has to include cases where that suffererwas deemed permanently disabled
with soft tissue upper extremity problems and advised to change jobs. (IIow could this person change jobs
when all jobs require further improper pronation of the upper exremity? Obviously, this approach was misguided.)
The other medical files that need to be reviewed me those in which the patient received what can only
be described as unnecessary and ill-advised medical treafinent for some of the complications of elbow based
lateral rotatory instability. Most certainly
cases treated
with carpal tunnel surgery, whether outlet surgery or
the new e4perimental surgery, radial nerve ftansference atthe elbow, biceps attachmenttransference surgery,
lateral epicondylar (release) surgeries, etc., have to be included in this review because improperly treating the elbow causes numerous long term complications that were too complex to include in this book even though
am acutely awme of them: don't forget that
I'm one of the multitude being told that my elbow problems are
as
not a result of my activities because they don't
yet constitute a valid and documented cause within the
medical community of westem Canada, especially the orthopaedic surgical community. I also am the ONLY
penion who knows how the upper extremity and its joints properly work which also has given me a substantial head start which
will never be caught up by the medical community.
This book essentially conJirms that lateral epicondylitis is a very serious injury contadicting the longstanding misconception in society and among policy makers. This realrty allows for lateral rotatory
instability of the upper extremity to declared

assessment
a medical problem
of epidemic prooortions at present. This
will permit the full force of the medical community to be directed to the eradication of the problem
CoW
# ool
for RUDIKRASS
82
not just in the patients but in all environments, i.e. workplaceo leisureo self-employed professions like farming,
table manners, etc. The latter has to be done by retraining the entire medical profession, including
kinesiologists, physiotherapist, chiropractors, nurses, Occupational Safety and Health Agency inspectors,
policy makers, etc., to understand the new functionality and its correlate lateral upper extremity rotatory
fustability so that ALL environments and activities can be evaluated and corrected. This correction may take
the form of an elimination of the activity, a redesign of the machine used to perform the task or a minor
alteration of the activity. I want to state that, even though the proposition of re-evaluation of all activities of our upper exfemrty usage to eliminate improper pronation may seem enoflnous and devastating to the present industrial economies, it
will
be
transitory. Aftff 25 to 30 years, the backlog should be eliminated with a minimal amount
of new cases occurring. So, the tens of trillions of currency spent to rectiS the upper exfemity problems, which have been building for at least 40 years,
will shrink to probably
less than millions worldwide.
'
will
The
rwiew will have more benefits than permitting all citizens in the industrialized nations to live a
healthy life beyond 150 to 200 years-*imagine your children living to see2200 A.D. and possibly beyond,
cease the massive
it
profit making worldwide offthe ill health of the workers
as
well
as
facilitating the now
older generations, i.e. beyond 45, getting the chance to see 125-150 years of age. (Once my next book is published and all the symptoms of elbow based lateral rotatory instability are e4posd everyone will be able to glimpse the vision of the future society that dominates my thoughts right now and keeps me going on even
though the complications are sever in me from the writing of this book.) Examples ofprofits being made the
off
ill health of its workers
are sawmill line, chicken factory and the new large scale beef and pork slaughter
house workers. In all cases, it was cheap enough to merely replace the workers because Workers Compensa-
tion Board benefits and costs were minimal once an individual was injured
as the injured
worker often had
total temporary benefie cut offafter 4-6 months even though the problem was never resolved. Actually, this
approach strould never have been tolerated by both the Worker Compensation Boards, their medical depanments and rwiewing bodies including the govemment as these industries should have been forced a long time ago to mechanize the line and the offending job duties that were causing the problems when a cause-and-
effect relationship was easily established-4re medical community failed the claimants, their families and future employees. The policy of not penalizing the offending industy unduly wen though the amount
of
injured works annually was unacceptable and staggering when you factor out the supervisory staffdriving up
the ratio of employees to injuries.
In Alberta
lgg2,the Workers Compensation Board was looking at an underfunded liabitity
of
over (CDN) $722 million. Yet, within 18 months and following a change in its presidency, thrs underfinrded
liabilitylnd disappeared and the Workers Compensation Board was working with a surplus. This massive
turnaround was all due to a simple policy change which was to cut
offall injured workers
after 6 months from
total temporary benefits and force ttrem to work with whatever remaining unresolved medical conditions, they Copy
ou
for RUDIKMSS
83
had. This approach was established by the new President of the Alberta Workers Compensation Board and
was endorsed by the medical deparhnent of the Workers Compensation Board the
policy
i.e. the
Government of Alberta, and the Appeals Commission even though it is not evn a remotely valid medical and
societal approach to the problem of soft tissue tauma in the upper extremity and shoulder. Consequently, the $722 million unresolved deficit
will balloon to over (CDN) $10 billion in Alberta alone. Subsquent under
funded liabilities, i.e. skeletons, for Workers Compensation Boards and insurance companies that have been hidden across North America since the late 1980s and emly 1990s, have to come out of the closets and finally
be dealt with
now! The populous has to bc assured that there will living make
be no more sacrificing of our bodies, long
term health and lives just so that we can earn a
a life and keep the economy going.
Returning back to the medical domain, Section
I of this book
introduced the concep of most joints in
the exhemities functioning like'tnodified pulleys" whose lateral and medial pins contol the arc of the bones beyond the upper bone of the specific
joint. This section
of the book also merely alluded to the reality that
these same ligaments also create the functioning unit of either the lower extremity, the legs, or the upper
extremity, the arms. This reality makes these particular ligaments invaluable in understanding the units
created as well as cartilage damage. When the joints are lax, i.e. permit motion along a plane perpendicular to
the arc ligaments in question, the principle of the Krass pronation test, the jonts ultimately
will suffer from
asteoarthritis as has been demonstrated. Beyond this, these la:rjoints will suffer from significantly more torn
cartilage problems and ruptured ligaments from a hauma force rather that strains or sprainso which normally
occur in men. (Now, the medical community knows where to look to explain tom cartilage anilor a ruptured ligaments.)
The difference in female ligaments which cause more stretching from mild repetitive strain then their
male counterparts is their estrogen levels. Estrogen acts like cortisone in its affects on the soft tissue structures, i.e. at a cellular level, which would subsequently facilitate child birthing. Testosterone does not permit
this sffiching explaining the more significant arnount of tom cornrnon extensor tendons rnelbow based
lateral rotatory fuwtability among men. Even though the musculm confractions me greater in males from the
testosterone, the ligaments normally do not stretch but rather they, the tendons and/or muscles tear. Essen-
tially, the estrogen /evels ofwomen and the naffial ladty that exists in some of theirjoints establish the fact
that male and female bodies are fundamentally distinct and not the same as has been accepted by and en-
hsnched in North American society over the last several decades.

There is a new equation in the medical mix as a result of this
book Not only
are male and female
extremities fundamentally different even though they share relatively the same bones, but this new medical
equation or reality has to factor in the fact that la,r joints can also exist in men as a small percentage of this
population which creates a similarity in some of their long term medical problems to those of women
most
notably of these conditions is osteoporosis. (The scientific proof is hidden in this book but will be presented in my next book which
will expound on the complication

CoW
s of
lateral upper extremity rotatory instability.)

84
ou
for RUDIKRASS
This book will also car$e a significant change in society through the value structure of
ig citizens
which has to be leamed with the change's rationale in childhood. People have been given a very serious
choice to make: use our bodies in less violent and abusive ways to preserve our health and increase our
longevity to 200 yearso at leasl without significant problerns in the later years OR continue to abuse our bodies
in ouryouthful leisure pursuits and work activities and continue to die prematurely. This means not just
changing sports but also developing non-abusive joint sports of which T'ai Chi and Qi Gong are a
few. (I
the
believe that Jesus Christ foretold of this decision as Christian doctine claims that the meek
earth
slnll inherit
Matthew 5:5 of the New Testament.) In making your decision, you can't depend on the medical community not just because their medical
knowledge base has been proven incorrect but also because ofthe thought processes eschewed by the present system: it is very shallow and rather unscientific in its response to problems. (This process is changing
because viable and proper scientific research has started to lead the way in advances concerning many
differ-
ent specialities like cancer, viral infections, bacterial infections, immuno-response, etc.
All
these advances
though are based mainly on a change in thinking from just obseruing a cause-and-effect relationship but
further
injuries on
a
to define the process, a stage in medical logic that has been missing for the longest time.)
major example of the presentfa the problem quickly witlnut understanding the root cau.se approach to physical level was the broken ankle syndrome while skiing of the late 1970s.
Prior to present full ankle ski boots, downhill ski boots went up only as far as the top of the ankle and
were not solid like they are now. The new design of ski boots to resolve all the broken ankles of the late
1970s was not questioned by the orttropaedic surgical community in the early 1980s and still has not been
condemned to date. Instead, the sugical response was to devise better surgical techniques to treat the now
pro-dominantly tom anterior crucial ligament The medical response should have been a move to ban the new design of ski boots because, wen though surgical techniques for the anterior cnrcial ligamenthave
advanced significanfly, one tear ofthis lieament is one too many as the surgical reconstruction doesnot come close to making the joint function anywhere near an undamaged knee. The long term complications from ski injuries to the knees, whose numbers
will
start to surge as the
skiers of the 1980s and 1990s tum 40 and 50 years old" me obviously osteoarthritis, possibly tom cartilage
problems and stiftress in ttre
joint.
The medical community did not rcalizp that a broken ankle is a rather mild
problem that the human body can deal with even in the long term due to the structure of the joint and its functionality whereas ligament damage to the knees are truly not repairable. So, the appropriate medical
response for the new ski boot design was never been put forward allowing hundreds ofthousands of people to
suffer a tom anterior erucial ligament and be left with a future filled with pain in their 60s and 70s, if they are lucky enough to live that long Another improper medical response to a legitimate medical problem that I was exposed to, by way
of
the klevision, is some psychoneuroimmunolgists' response to chronic elbow or upper exFemity pain in their
CopJ
85
patients. In the Canadian science program's 1999-2000 seasor\ the
'!ain"
doctor performed brain surgery and
implanted a device into the brain of a woman who, 20 years prior, had been hit by a car and had suffered
lateral epicondylitis ever since then. According to the information onposterolateral rotatory instability,this
wonmn was a classic case and, had the lateral pivot-shifi testbe.enprforme4 I'm certain that it would have
demonshated that the treatnent that this individual needed was reconstrtrctive lateral epicondylar wrgery not
having her head cut open in a vain attenrpt to eliminate the chronic pain she had. (If the lirass pronation test were done now, the new reconstructive lateral epicondylar surgical treatnent contained in this book and
corrected by the Mayo and the Kerlan-Jobe Clinics could be applied meaning that the brain implants must be rernoved and the brain surgery stopped.) I am confident that this woman's czne was not reviewed to see
if it
fell within the guidelines of posterolateral rotatory instabilitythat were established in 1991, though, because
the medical community does not do this when new diagnoses me made especially when the person is being helped by a different speciality, mainly pain managernent specialists.
'
The ver.v political and unscientific approach to medicine that presently exists especially amongst the
specialists leads me to conclude, withotrt hesitation, that if this book were not produced today it could be
written 20 or 30 years down the road and still be as poignant and ground breaking in the future today. This is
a very sad statement especially since
as
it is
it can be substantiated. At present, the orthopaedic,
radiological, kinesiolory and general medical community's theories about the physical body do not comply
with the very basic theories of physics: all present day knowledge of physics has never even been applied to exfiemity functionality at the bone level including Sir Isaac Newton's basic theories of motion. This explains
why the joints were mislabeled as 'tringe" joints when they actually function like '?nodified pulleys." (The
ligamentous structures exposed centuries ago from dissection bare an incredible resernblance to pulleys rather than a hinge
solid at either the anterior or posterior side while the other end opens with a gap and then closes
by eliminating this gap.) Further corroboration of the statement that the findings in this book would never be discovered are all
the body's sigtts,langwge, wetre missed and/or misinterpreted: 'tnicro tears" can only exist in something that is being exposed to improper force or force to which a solid and stationary object, i.e. radial collateral liga-
ment,isnot normally exposed; there is NO gap between the radial head and the humeral capitellum when the
arm is flexed as is demanded in a hinge. Then, when x-ray films continuously demonstated that the ulna resided behind the Bicipital Tuberosity of the radius, had the principles of physics been employed, it would have been realundthat it is impossible for the radius to rotate around the humeral capitellum through prona-
tion with the ulna residing directly in the way of the Bicipital Tuberosity's line of motion. These facts never
were understood or presented by any orthopaedic surgeon, radiologist, kinesiologist, chiropractor, or physician
in any speciality or in general practice and especially the founden of posterolateral rotatory instability
1991, the closest that the medical community ever came to understanding the proper functionality of the
extremities and their'lnodified pulley" joints.
CopJ
ou
for RUDIKRASS
86
When I started this book in the spring of last year, it was to corroborate that the injuries recorded in
my 1998 Gadolinium enhanced MRI arose from my June 1990 injury
so that
I could finally get the surgical
resolution to my right elbow's confirmed problems. Basically, this book was meant to be a refutation of the Albertan orttropaedic advice of January and April, 2000. However, as this book progressed, I was infioduced
to the fi,rll and accurate functionality ofthe upper exremity as well as it impact on society. This knowledge dealt with the present for the longest time but recent$ it has expanded into the future something that the
medical community does not factor into its decision making processes. I am now firlly awme of the full enormity of not just this book but my next one
society, in general, and its structures.
the portion of the iceberg below the water line
on medicine,
I hope that I have given enough information in the filst ffito Sections of this book to bring the frnctionality of the upper extremity and its 'tnodified pulley'' joints concisely into focus. If you did
as
I requested
nthe Conclusion of Sectionland moved on quickly to this section of the boolg go on and read the next
sectioh as it is a short one. Therl re-read Section
aganas this should make the functionality much clearer as
its rationale has been fully introduced to your conscious mind. Once you've done this and the new proper functionality of the upper extremity and its joints are
understood I hope that you will re-read this chapter so that you will realize that the changes that I've desctibed
will
encompass the entire globe and
all its citizens. When acknowledging this change, also realize
that this is a golden opportunity for all because new sports
will have to be developed, new ways of doing
things
will
also be needed as
will new devises to eliminate any improper pronation. With the right mind se!
anyone and everyone
will benefit regmdless of where you live or your education level!
Note: This book
it is such a small problem relative to lateral upper qctremity rotatory instability and it is easily understood once the pfqper functionality of the elbow is accepted. Wherr you golf, play broomball or polo, you strike an object with your arms fully outstretched and the force to the medial side of the arm. When this motion is not blocked, there is no problem. When the full force of this motion is blocked at or beyond the bottom of the swing, by say an opponent in broomball or the earth in polo or golf, then the force goes directly to the elbow's anterior ligcnnent cansngit to sftetch or tear. Tlte biceps tendon may also be tom or damaged in the process. Now, all that needs to be done is defining reconsbuctive medial radial head pin surgery which is easy when the orthopaedic surgeons think about it. (Don't forget that all wrist problems demonstrate an elbow rnjury due to the nature of the
does not mention medial upper extremity rotatory instabilitybecause
elbow's subsytem, the forearm and wrist/trand bones.
CoW
ou
for RUDIKRASS
87
crEr{TrFrc PnooF roR
I-gfn nar
urpf n E>rrnnvrrry
Ra[A,Tq.Ry INs IAB r r=.rTv

When I started this medical joumey, Iwas nnive and falsely believed that the medical comnnmity actually had a good grasp of how the upper extremity worked. I now know that the msdical community knows absolutely nothing about how the upper exftemity functions because the ann functions at its most basic level in a manner that completely contadicb the present medical community's theories conceming it. Early in 1997,Iwas exposed viamy appoinfinent in Los Angeles to the equation ofhow lateral epicondylitis arises according to the orthopaedic surgical community. In Dece,rnber of that year, I was exposed to the abridged
but full medical theory pertaining to posterolateral rotatory instabilitythatwas and still is posted on the intemet http:/www.nmis.com/onm/trtnV
PLRI * tis
x:
lateral epicondyli-
(C ause
-and-effect for PLRI)
re
lati onship
(C ause
-and-effect lateral epi.
re
lationship
for x)
PLRI:
:r
ets95 lateral_collateralelbow.hnn. In the summer of 1998, I had the Gadolinium enhanced STIR MRI whicb when finalized in October, confirmed that I had the same conditions which apply not just ta PLN butalso'litcher's elbod' - tarn radial collateral ligatnent and cotwnon extensor tendon, This meant not only that the medical equation relayedto me ftom the Los Angeles orthopaedic surgeon was correct
ergo, PLM = x
buttlnt PLN and repetitive oven$e
are fundamentally the same.
Now, the medical community only does cause-and-effect research and e4pends noresources to determine how the'tnicro-tears" of the common actensor tendon and radial collateral ligament werc caused. So, as far as the medical
community was concemd its responsibilities had been fulfilled by merely noting the causes of lateral epicondylitis. By applying the most medically written about cause of lateral epicondylitis to datl - PLN,I was no further along with the process of o<plaining how the causes actually created the effect. But" by subjecting the repetitive oven$e actions to scrutiny, I was able to determine that repetitive pronation was the root cause of lateral epicondylitis. This discovery lsad to the conclusion that pronation was not caused by confraction of the pronator teres and its compliment in the wrist, the prorator Endrahn. With this theory, an e4periment and/or a diagnostic image would be required to confirm that indeed the contractions of the pronator teres and
->
lateral epicondylitis
process explained and defined

as
repetitive improper
pronetion,
NP
Physical test, lo Krass eJcperiment,to confirm

pronation is not performed by contract ion of pr onator muscles discovered
Radiographic test, ?d Kras s qcperiment, confirming pronation is not

performed by confiaction pr onstor muscles discovered
of
prorutor quadraus werr misunderstood. Knowing this, I viewed the oosterior of ttre elbow as it pronated and supinated tlrc lil Krass eryrcriment,to determine exactly how the medial epicondyle moved and discovered that it moved posteriorly through pronation and antoiorly ttnough supination. This motion confirmed that the prorator muscle groups were indeed not contacting through pronation. I then confirmed this assessment on my radiographic films, the P Krass experiment. I compared the location of the medial epicondyle and the position of the humerus from a supinated to pronated x-ray film and confirmed that indeed the humenrs was rotating through supination and pronation. This fact about the hume,nrs not only confirmed that the pronator teres andprorwtor
Coyn
Nt foTRWIKMSS
Radi ohumer al j oint established as primar,v joint of the
elbow
Elbow demonsffated to fimction like a "modified pulley" with the opposing flexion and extension muscle groups acting like ropes tied
to the radial head
Radiographic confirmation of this "modified pull ey' system

at
work
rqdiohumeral joint, defined as o'ate pins" forearm
Soft tissue radii pins, lateral and medial sides of the
- lateral epi.fully explained as is the reahty that RIP and PLkl are caused the same way although through two seemingly different
kIP + PLM
causes
quadratus were not contracting as the medical community has theorized but also that the radius was not rotating around the humeral capitellwn as was also theorized. The fikns from my improperly interpreted comparative CT scans from 1996 demonstated that the radiohwneral jointwas actually the most important and solid of the elbow's two humeral joints. This fact was also confirmed by the lateral pivot-shifi test for PLN which was fully described at the aforementioned internet site and which indicated that the radial head dislocates/subluxes over the capitellum and towmds the radial collateral ligament. I was now able to present exactly how the elbow firnctions through flexion and extension which was necessary because supination and pronation are actually processes that extend from the hand up to the shoulder viathe elbow. Flexion and extension could only be performed if the radiohumeral jotnt functioned like a '?nodified pulley." In this instance, instead of the radius for the motion being attached to a solid objecl the radii would have to be attached to the lateral and medial sides of the radial heod andthe base of the capitelhnn. These radii pins would then keep the radial head in constant contact with the capitellum as the radius moved from full extension to full contraction. This meant that the extension and flexion muscles were like rope tied to the radius. This new theory about elbow finctionality meant that lateral x-ray films would demonstrate that, atextensioq the radiohwneral line would be straight and this line would change much like the degree lines on a protractor as it went from 180 degrees extension to anywhere up to 90 degrees flexion. When radiographic images are taken from the lateral side of a healthy elbow, this circular relationship is conclusively demonsfrated. (At this poinL the full functionality ofthe elbow section ofthis book became apparent and was recorded.) With the elbow being proven to work like a'tnodified pulley" with the medial and lateral pins ofthe radial lreadprovento conffol the mc motion ofthe foreamr through flexion, it was easy to deduce how lateral epicondylitis was caused in cases which mose from repetitive improper pronation, i.e. pronating the hand by strengthentngthe prorntor teres. Such activities had to be rotating the radial head at the capitellum which has now been proven to be biomechanically inconect and which would explain the swelling of the radial head's latsralpins, the radial collueral ligament and the common extensor tendon. This firnctionality had to be hansposed to cases where a frauma to an outstretched ann was its cause in order for it to be vali4 though--te equation indicates that the two causes must be relatively the same in process. The proper ftrnctionality of the elbow allowed for this fiansference because, when the elbow is subjected to force while it is slightly bent then the radial head pushes backwards on the medial side of the radiohumeral joint'sbones, forming a pivot ro1 and placing a sudden and abnormal force on the radial head's lateral pins. Thus, a gap forms at the lateral side of the radiohwneral joint and expands depending on the severity of the force transferred from the hand through the elbow's subsystem to the medial pivot point, i.e. the medial side of the radiohumeral
joint.
Now, both c:xes were in agreement with the new functionality of the elbow and" although the two causes seemed fundamentally differenq both were
CopJ
fi
demonstrated to be having the exact same effect on the radial head's lateral pins, the radial eollateral ligament andthe cornmon extensor tendon. This reality also lead to the proper definition of '?nicro tearo'as athe body's way of demonstrat-
Muscle groups in forearm functionahty proven to be misunderstood and misla belled
ing a biomechanical dysfunction at that joint. The final piece of the ptzzle for the immediate abolition of the present medical theory of how the elbow and upper exfremity work came from the placement of the Bicipital Tuberosity and the fact that the ulna resides sigruficantly within this bone extension and the ulno-radial joint fits snugly together. These facg indicak that the radius could not rotate inward without displacing the ulna but this does not occur through pronation. This lack of 'toom to rotatfr" clearly confirms that the radial head does not rotate AT ALL around the humeral capitellum when the radial head's lateral pins are not damaged which is consistent with the 'tnodified pulley systent" discovered by me as well as the realrty of ligament and tendon'tnisro-tears."
CoW
ou
for RUDIKRASS
ilI
SNCTION
III:
TrrE KR4ss Rn,auN" oF L SnotLDER Besnn

UpPER ExTREN{rrY
RoTATORY IxSTABILITIE,S
Copy
ou
for RUDIKMSS
Srtournnn Blsnp uppEn ExrnEl,urr
Although it has already been demonshated that
portion of this branch of rotatory instability results
from long term use of an arm suffering from insuffrciencies at the lateral epicondyle, there are several other
ways that shoulder based rotatory instability can be caused. This section
will expand on this realrty by expos-
ing the other causes of anterior shoulder based upper exffemity rotatory instability, basically Coracoid Process insufficiencies, and then rotator cuffinjuries to the cres! i.e. the supraspirntus, of the shoulder.
(It is important to note that using an arm with an insufftciency atthe Coracoid Process often leads to
insufficiencies within the radial head's lateral pins howwer using their arms in
a
pfu,
e.g. women initially do not have problems at their lateral
pronated fashion creats these problems more insidiously than those of a

a naturally lax Coracoid Process or a produced insuffrciency and
man. The main problem arising from
extended usage of the hand while it is pronated even at mild activities is that this arm configuration places an
inordinate amount of force on both the radial collateral ligament and the common extensor tendon. Theq the disposition of women's ligaments to stretch allows the radial collateral ligament to do so creating all the gender based symptomolory in the wrisf defined rn Section
// of this boolq which me also reproduced in men
who damage their shoulders and do not get freatnent but then have to use their arms in sedentary pronated fashions.)
CopJ
# ooI for RUDI KRASS
92
Pnrupr,nEcHaNrcs or SHgurnnn sesun
Instability Due To Anterior Rotator CuffInsufficiency

Even though an injury to the anterior rotator cuff was prwiously discus sedtn Section.I/ of this booh
an equally common cause of insuffrciencies of the tendon and ligament at the anterior rotator
cuffis tying to
lift a heavy load with
fully extended arm and the forearm subsystem in a supinated position. The reason, this
particulm arm and forearm position cause tendon and ligament insuffrciencies at the Coracoid Process,the
anterior rotator cuffas I refer to it, is because, when the weight is applied to the hand, it forces the e,ntire arm
to actiike
a'!lum bob."
Now, it is known that the forearm bones me aligned toed outwar4 valgusly, due to the interior and
exterior radial mc pins. So, with the forearm fully supinated, the downward force on the hand by the heavy object causes the humeral head and the humerus to rotate, clockwise on the right and counterclockwise on the left when looking downwmds towards the hand as the forearm seeks a natural and gravity forced vertical
alignment. This sudden humeral rotation places abnormal force on the short biceps head's and coraco brachialis' coracoid tendons and the coraco-humeral ligamenr-the latter being far more important than
previously thought. When the downwmd force or reverse gravitational force, leg lifting of a heavy object is exceptionally
stong, the humeral head will dislocate or sublux to near dislocation in an anterior and downward direction.
Examples of activities that regularly cause this humeral dislocation or severe subluxation are heavy lifting
with the legs from
a crouched or semi-crouched position
while the supinated hands are holding onto an objecL with hands mistakenly
e.g. a gumey with a patient in
i!
a heavily weighted bar used in weight training but
supinated, carching a heavy object with a supinated hand or snagging the
paln side of a work glove on a
gravity propelled object among others.
A similar
means of causing severe damage tothe short biceps' and coraco brachialis' coracoid
tendons and the coraco-hurneral ligamenr is pulling on someone else's arm when, once again, his hand is supinated bu! this time, the arm is over his head. This action causes the recipient of the force to have his humerus, once agairl rotated anteriorly due to the force applied to the hand creating a "plumb bob" but this
time with the body and not at the hand. In this activity, the full weight ofthe body is applied downward at the Coracoid Process causing the shoulder to separate as the upper extremity, humeruso once again rotates anteri-
orly beyond the tendons' and ligament's limits. An example of this activity is when someone comes to the aid of someone else below them on stqls, over a ledge or in CoW
a hole and who needs a
lift up. (The amount of

93
# ool
IaTRUDIKRASS
rotational force in these instances can be easily calculated with a simple gravitational physics equation because
the gravitational force is equal to the rotational force.)
It is important to state that the hand has to be supinated while the arm is also FULLY extended. The
latter point is pararnount because, in this positiorl it is impossible to counteract the rotational forces applied to the CoracoidProcess through the humerus with muscle contraction. When the elbow is partially beirt,
full
biceps conffaction and contraction of the posterior and superior forearrn muscles can counteract the plumb bob
effect and stabilize the humerus.
Anterior rotator cuffcomplications arising from either trauma or repetitive and untreated mild traumas to an outstretched partially extended elbow
the causes of lqteral rotatory instability at the elbow
is
again similar to the 2 previous causes of direct improper force placed on the Coracoid Process. This fact is
confrnned by examination of these cases and how the force ends up being applied to the radiohumeral joint.
In both cases, once the radial head's lateral pins are damaged - either suddenly or gradually, upwardly directed
force is applied to the anterior side of the radiohumeral
joint whichcauses the humenrs
to rotate anteriorly.
(Although the force at the humeral capitellum is backwards, the real effect on the humerus is anterior rotation which is seen by the medial epicondyle rotating forward.) Now, all
cases
of anterior rotator cuffinjury are actually seen to be almost exactly the same in nature
on a microcosmic scale.
Instability Due To Stryraspinatzs fnsufficiency

Prior to discussing rotator cuffproblems based at the crest of the shoulder in a meaningful manner, how the shoulder functions at shoulder height or above needs to be examined. Firstly, everyone knows thag
when the deltoid muscle contacts, the arm is raised. However, raising the humerus is a little more complicated than thought because the deltotd conhaction only applies force to the mid-point ofthe humerus. This
reality means that the humeral head needs to be rotated upwmd in conjunction with the fultoid's contractive force in order not to produce soft tissue trauma at the crest of the shoulder from any upwmd displacement
of
the humerus. The muscle that works in conjunction with the deltoid isthe rupraspinatus which attaches to the
Greater Tuberosity of the humerus. Another important point about the shoulder that has not been calculated into the incorrect motions which cause tearing and swelling nthe supraspinatus is the placement of fhe biceps
tendons not just at the elbow but at the shoulder. The biceps muscle group is quite unique in that it does not attach to trry partof the humerus even
though all of its conffactions have an affect on this very important bone. So, when the arm is raised to shoulder height, the supraspinatus is confacted, and then the humerus is brought forward in a throwing or basic
swimming motion, the slnrt head of the biceps and coraco brachialis conract forcefully. This motion causes
a problem because the supraspirwtus does not relax af any point tluoughout the
throwing motion and, towards
CopJ
e4
the end of the forward arm motio4 the
slnrt head of the biceps
and the coraco brachialis ar now near
full
contraction which places
posterior force on the fulb rotated humeral head. Now, you have two muscle
ldr'e biceps
contactions fighting against one another----not complimenting each other

and quadriceps,
andtriceps ar hamstrings
etc. So, the smaller of the two muscles will nahnally be damaged because it is incapable of
maintaining its contraction against the opposing force. The muscle group that fails then has to be the suprasp inatus which has been discovered through diagnostic imagerl,.
At fust, the stpraspirntus will suffer from swelling from some minortearing of its tendon fibres.
Without cessation ofthe activity and application ofknown non-surgical treatments, the swelling and pain in
the mpraspinatw
will
get worse and the te,ndon may begin to tear starting at the posterior of the crest of the
shoulder, i.e. the back part of the supraspinatus. If treafrnent is rendered and the activity is resumed follow-
ing a break in usage, and the swelling and pain returns, don't jump to the conclusion that surgery is necessary
to treat the
injury! Before making this
assessment and having an
MRI done, ALWAYS check the radial
head'i lateral pins with the Krass prorntion test for insufficiencies! In
cases where srrgery has been determined to treat the superior rotator
cuffinjury, still check the
elbow for insufficiencies in the lateral radial head's arc pins. From my information, when insufficiencies are
noted in the radial collateral ligament and common extensor tendon at the lateral epicondyle and ttre person
used the anrg especially pitching, without having the elbow problem diagnosed for quite some time, the
anterior shoulder pins coracoid tendors
the coraco-humeral ligamert, the short head of the biceps' and the coraco brachialis'
have been lengthened as
well. This added length to the anterior shoulder pins means that
the humeral head can be further displaced posteriorly by at least 50 percent which makes the sudden force on the contracted, stpraspiratus far greater causing a more serious tear to its humeral tendon. Once again, Iateral rotatory irxtability at the elbow is demonstrated to have a serious deleterious
effect on an adioining
Section
joint-tlrc wrist was
conclusively demonstrated to be negatively affected by LRl in the
II
ofthis book.
CopJ
au
for RUDIKRASS
95
SvupTomelocv or
Anterior Shoulder Rotatory Instability Symptoms

The symptoms forproblems with the coraco-hurneral ligament,the coraco brachialis' andthe short
bicpes head's tendons are basically swelling and tendemess mound the Coracoid Process.
Ifthe humeral head is
subluxed or dislocated, then obviously the shoulder
will
be deformed at the anterior side of shoulder and painful.
(If this deformity is detected and
radiographic film dernonsfates ttre anterior dislocation or subluxation, then
it
will require
a resetting
ofthe shoulder joint.)
.
is either
Chronic or persistent swelling and soreness al the anterior portion of the shoulder will be present if there
a
permanent insufficiency of the soft tissue attached lo the Coracoid Process, which usually occurs
a dislocation or repetitively dislocating humeral head, or an insufficiency of the radial head's lateral arc
following
pins and the arm is being used or abused by ourpresent ann usage.
Both ofthese cases of upper extremity rotatory instability also produce palpable clicking and popping in
the shoulder when it is raised and lowered to its exfieme ranges of motion either by the patient or by a medical profesSional manipulating the shoulder
Superior Shoulder Rotatory Instability Symptoms

Most ofthe symptoms pertaining to this form of instability, commonly referred to as either pitcher's
shoulder or swimmer's shoulder, revolve around the supraspinatus. So, the basic symptoms for superior shnulder rotatory instability are swelling or tearing of the supraspinnlers tendon over the humeral head. Exteriorly, the shoulder may have a bump over the humerus at the top ofthe shoulder which arises from severe swelling witftin the tendon beneafh the deltoid. These symptoms are usually accompanied by pain at the top of the shoulder when attempting to raise the arm from the body's side. Also, when the arm is raised, it is painftl for the patient to maintain the height of the arm and it begins to fall slowly and painfully after the medical practitioner releases it to the effects of gravity. The shoulder pain elicits a response from the patient when mild pressure is applied to this part ofthejoint.
For more information about this condition's symptoms and you have access to the interne! do a search
using the phases: pitcher's shoulder, swimmer's shoulder orjaveler's shoulder. Superior shoulderrotator
cuff
injury is a well documented although highly misunderstood condition
as
knowledge ofthe cause-and-effect on
the body have been known to the orthopaedic surgical community since the mid-1980s. The main hindrance to
the medical community understanding the process was its lack of knowledge of how the upper extremity actually rotates and
it is this knowledge around which all subsequent upper extremity rotatory instability revolves.
Copy
ou for RUDIKRASS
96
*$HoUI.pER.
snsrn
Anterior Shoulder Rotatory Instabilify

Diagnosing anterior shoulder rotatory instability should start with a physical examination of the Coracoid Process which will demonstrate
a
palpable tendemess around the front side of the shoulder. As
indicated emlier in this section, the te,ndemess, pain and swelling at the anterior of the shoulder can be either a complication of an undiagnosed elbow based lateral rotatory instability or directly attributed to an anterior dislocation of the humeral head. So, determining the cause should be done with a review of the patient's activities but this diagnosis should be confirmed with either a physical stress test of the shoulder and elbow, a CT scan or MRI of the shoulder if the latter 2 diagnostics are available.
The.fiirass anteriar shoulder stress test, Kasst,
will quickly
establish whether or not the anterior
shoulder swelling and discomfo* is due to a dislocating or swerely subluxing humeral head or not. The Kasst
is performed with the physician standing behind the patient so that he is facing the back and afflicted shoulder
of the patient. With the arm attached to the patient's painful shoulder raised to shoulder height and the physi-
cian's lateral arm lightly grpped underneath the lower humerus mound the medial epicondyle and his other
hand lightly glpped over top of the humeral head are4 the physician pushes anteriorly and slightly downward
with his medial hand while pulling simultaneously backwmds on his lower humeral hand the physician's
lateral hand. This process creates a potential anterior dislocating force on the humeral head with the physi-
cian's medial hand actually functioning like a fulcrum. For an anteriorly dislocating or severely subluxing shoulder, the humeral head
will
dislocate when
mild force isused in the Kass/ and the patient should not readily be able to eliminate the dislocation or severe
subluxatior-a radiographic image
at this point
will confirm
the dislocation or severe subluxation. A positive
result from the Krass anterior shoulder stress /esf determines tltat reconstrtrctive coracoid surgery may need
to be applied to the shoulder
buf only without a negative result on the
Krass pronation test. Reconstructive
lateral epicondylar surgery to the radial head's lateral pins should not be ruled out which" if discovered to
exisl especially in men, must

originally occur.
be performed prior to any shoulder surgery provided that a dislocation did not
Shoulder laxity in young men
will most likely
be naturally eliminated following the surgical elimina-
tion of the elbow problem, but women will most definitely not because thek cocaco-hwneral ligament is
longer to start with than a men's creating the following rules:
CopJ
ou
IoTRUDIKMSS
97
Following an anterior dislocation in women and it is diagnosed forthwith, reconstructive coracoid surgery must be performed;
If the dislocation has not been treated with reconstructive coracoid surgery, i.e. the shoulder is used considerably prior to recgiving surgery and the shoulder has continued to dislocate over this time frame, more than likely both reconstructive coracoid andreconstnrctive lateral epicondylar surgery will be necessary - womeir mainly, but not exclusive to them. @oth r?ass diagnostic fesfs will be
positive.)
If the humeral head does not dislocate or sublux tluough the Krass anterior shoulder stress test,then
definitely the Krass pronation /esl needs to be performed. This test will probably confirm that the anterior
shoulder pain is actually a complication of insufficiencies in the radial head's lateral soft tissue pins.
If the
Krass pronation test is positive, this means that reconstnrctive lateral epicondylar surgery should resolve the shoulder problem without the need for reconstructive coracoid surgery.
It is very important at this juncture in time NEVER to assume that the patient is not suffering from a
previously undiagnosed elbow based lateral rotatory instability rcgmdless of the Krass anterior slnulder
stress test.
Superior Shoulder Rotatory Instability

As this form of shoulder based rotatory instabitityis soft tissue based, it cannot be demonsfrated on a radiographic film which makes the means of confirming the condition either a CT scan or preferably a MRL Prior to either of these tests being done, the patient must express, as
a
problun" the ability to raise his arm
laterally upwards. The shoulder of a person suffering with this condition may also demonstrate a deformation
at the top of the shoulder over the supraspfumhn which is very sensitive to touch.
Once superior shoulder instability is suspected" the following physical tests should be used to confirm the suspicions. First, have the patient raise his arm laterally, if possible, and have him tell you how it feels
when doing so. If the patient is actually able to raise the arm even though it is difficult, then there is no need
for surgery. But, ifthe MRI or CT scan confirms swelling tnthe supraspinatus,thenrepetitive improperuse
of the shoulder has to be diagnosed and the activity causing the problem stopped. Once again, the elbow has
to be tested with either a STIR MRI (brace) where available or the.trirass pronation test to detilfftine whether the activities, which caused the swelling in the shoulder
mainly Westem based sports activities, had not
wknowingly damaged the radial head's lateral soft tissue pins prior to the onset of the dorsal shoulder problems. The reason for this test is that, following the creation of insufficiencies in the radial collateral ligament
and common extensor tendon, the humerus naturally rotates posteriorly at the lateral epicondyle and"
following
usage of the damaged arm, the anterior soft tissues attached to the Coracoid Process from the upper exhemity
will become lax at their upper attachments allowing greater tearing force to be applied to
while it may be contracted i.e. raising the arm. CopJ
the supraspinatus
ou
IoTRUDIKRASS
98
Interestingly enough, the complication at the superior of the shoulder is presently treated with cessa-
tion of the activity which does not resolve the elbow problem but it does eliminate the swelling at the shoulder giving a false belief that the problem has been resolved. Instead, the weakness in the the supraspinatw
relative to the biceps
will
cause the swelling in the superior shoulder to retum once the offending activity is
resumed. However, this time, the patient will adjust his process motions slightly to account for the shoulder's weakness. Consequently, the athlete will end up strengthening the coraco brachialis and the short biceps
headta keep the humerus improperly rotated when doing the initial offending activity. Now, when the athlete
resumes training at a high level, the humerus
will suddenly
snap posterolaterally at the top of its humeral head
but even further this time than before and significantly so. With the supraspinatus silongly contracted, this muscle's humeral tendon does not just become swollen from'?nicro tears" due to a biomechanical dysfunction but literally tears starting from the back and extending forwmd depending on the pain tolerance of the athlete
or the drugs administered to him allowing the patient to use his arm beyond the initial tear.
Confirming that the patient has preferably a Gadolinium enhanced
partially tom supraspinattn tendon is easily done with a CT scan or

most cases of superior shoulder instability occur in athletes
MRI. As
competing in Westem athletics, like baseball, javelin, swimming, etc., so these types of diagnostic images
be readily available to confirm the supraspinatus
will
'tom humeral tendon.
If
these diagnostic tests are not available though, the following physical test
will suffice. Ask
the
patient to attempt to raise his arm from his side, if the person is unable to do so due to the pain and weakness,
then he is suffering from a partially tom supraspirntus (humeraD tendon. Another confirmation of this diagnosis
will
be the patient's inability to maintain the arm laterally at shoulder height once you have released
a
it after having raised the arm. A patient zuffering liom

to maintain the arm at shoulder height and the arm
partially tam supraspinatw tendon will not be able

to ttre patient's side as the patient complains
will slowly fall
of severe pain at the top of the shoulder. Due to tltis tendon being torn, you should be able to detect an
involuntary spasm at the top of the shoulder after the test has been administered.
As superior shoulder instability requires either
a CT scan or a
MRI to provide an absolutely irrefiila-
ble confirmation of the problem, it is fortunate that the problem is rarely seen in the general population because many parts of dweloping countries or poorly populated areas in industrialized countries do not have
ready access to such diagnostics. Fortunately, the indigenous populations of these regions do not employ the
activities that cause the problem and most assuredly they do not overtrain in the intrinsically improper arm activities that Western athletes do.
CopJ
au for RUDIKRASS
99
$HpurnFR lr.rsurFrqrnxcrEs
Physiotherapy
The role ofphysiotherapy conceming anterior and superior rotator cuff problems
will
be mainly
follow-up treat following reconstructive coracoid surgery. The other

otherapy are cases where the supraspinatus is swollen but not torn.
cases that
will
be treated by physi-
In these non-surgical cases, physiotherapy has to be applied mainly to reduce the swelling of the
supraspinatus which means heat andlor ice packs. This freafrnent
will
be complimented by cessation of the
offending shoulder activity. Following the reduction of swelling at the top of the shoulder, PROPER and
progressive light weight training to strengthen the supraspiratus and the deltoid muscles should be added to the treafrnent prograrn.
In cases of anterior rotator cuffswelling not following an anterior dislocation, i.e.
cases where the
swelling mound fhe Coracoid Process is a complication of elbow based lateral rotatory irxtability, physiotherapy
will not be beneficial until the reconstructive lateral epicondylar swgery
is performed and its
treatment'is completed. Towards the end of the post operative elbow physiotherapy though, light weight
fuaining for the muscles that attach to the Coracoid Process
will have to included into the treahnent program.
This simplistic approach should be sufficient to reduce the swelling and larity atthe Coracoid Process that
was created by the long term case of elbow based lateral rotatory instability.
At this poin! the concems presented inthe Prevention
se,ction of this book's Section
II, pertaining to
re-occurence of the problem with society's prevalent and improper upper exfremrty usage, apply and
determine the next course of action.
will
Reconstructive Surgeries
Before the objectives of reconstrtrctive coracoid swgery are presented, it is important to understand
why evenjust one anterior shoulder dislocation is one too many. There are two main reasons which explain
why the humeral head must never dislocate anteriorly-gravity and the location of the humeral attachment
the subscapularis. Both these factors make recovery from an anterior dislocation impossible. Conceming
of
gavl$,
the arm and all its weight is held in ctreck by the upper arm muscle attachments to the Coracoid
Process as well as the coraco-hwneral ligarnent- So, once these soft tissue attachments are stretched, they never regain their normal length because all day the gravitational force created by the weight of the arm while
we are standing is now placed on the damaged soft tissue upper extremity coracoid attachments-a sling only temporarily and sliehtlv mitigates ttre gravitational force problem.
CopJ
# oal for RUDI KRASS
rco
Now, the subscapularis further complicates the matter of anterior rotator cuffrecovery from
dislo-
cation because the coraco-hwneral ligamentwas the soft tissue pivot point for contactions of the rotator cuff muscles. So, when the soft tissue pirts determining humeral rotational force me damaged, the subscapularis confraction becomes uncontrolled and uses the new length of the coraco-humeral ligament pnas its stop point permanently. The contraction of fhe subscapularis is ofparticulm interest because it is the longest arc
segment traveled once the soft tissue pins
of
the
Coracoid Processhave been lengthened. Thus, both Savlty
and continued rotation of the humerus me demonskated as the unconhollable forces that they are which makes
full recovery from a dislocation or sevre subluxation impossible without recbnstructive coracoid surgery.
Quite frankly, it is impossible to provide and maintain an environment which will perrnit the body's recupera-
tive abilities to shrink the short biceps head's
and coraco
brachialis coracoid tendozs
as
well asthe coraco-
huneral ligament once the humeral head anteriorly dislocates or severely subluxes. I must once again reiterate that I am not an orthopaedic ,*g"on which means that I cannot state
exactli' how reconstnrctive coracoid ntrgery willbe done. The true surgical outline will be presented by the
Mayo Clinic and the Kerlan-Jobe Orthopaedic Clinics following their review of this book. As I know more
about the proper functionality of the shoulder and elbow joints, I can make viable recommendations which must be addressed in the forthcoming papers though.
Reconstructive coracoid surgery has to start with an incision from about 2 inches above the clavicle
and directly above the midpoint of the clavicular tendon of the deltoid going downward and toward the
Coracoid Process. The incision should stop far enough beyond the Coraeoid Process down the upper arm in
order to allow for the anterior portion of the deltoidmvscle to be released from the clavicle and folded out the way so as to expose the Caracoid Processto visual inspection. (Note: It is important that no muscle groups or tendons ever be cut longitudinally in order to gain access to the deep muscle attachments and bones beneath
of
if another option
is possible as muscles rarely bind themselves properly from these types ofwounds or
incisions.)
With the Coracoid Process and its soft tissue attachments now exposed,the slnrt biceps tendon can
also be cut which
will
be followed by the coraco brachialis tendon. As both tendons attach to the bottom
of
the Coracoid Process, they should be incised so as to allow for re-attachment after 2-5 rilns., or so, of tendon
has been removed, depending on the patient. This reduction should be removed from the tendon portion that
is still attached to the
slnrt biceps andcoraco brachialismuscles. This reduction can be done immediately

or just
following the removal of these tendons from the Coracoid Process

Once the
prior to their being re-attached.
slnn
biceps lrcad's and coraco brachiolis' tendon have been severed, these muscles can be
left to drop out of the way exposing the capsular ligament as well as the coraco-humeral ligatnent. Beforc attempting to reduce the latter ligament, relocate the humeral head whileplacing the arm close to the body, no further than 30 degrees from the body, and making certain that the medial epicondyle is at about 45 degrees downwards from the horizontal line, both right and left arms. Now, the excess of coraco-humeral ligament
CopJ
ou for RUDIKRASS
rot
will
be exposed facilitating its removal either by stapling orpreferably by cutting and then re-attachment
with
either sutures orporous glue. When the ligament is finished being reconstructed, the tendon attachments for the short head of the biceps and the coraco-brachialis canbe re-at0ached once they have been shortened if this was not done upon
removal from the Coracoid Process. My preference again is to use porous glue to form the bond for reattachment but sutures can be used as and
well. (Remember, sewing is an activity that
uses the arms improperly
will have to be ultimately eliminated!) Once the
deep tendons are re-attachedrthe anterior
dehoidflap
can be repositioned and re-attached to the clavicle and the skin can be sealed with the closing procedure described tnthe Treatment section of Section
II
of this boolg i.e. the Montreal Protocol.
Torn srqraspindus tendon surgery can be done either with arthroscopic surgery or by gaining
access tothe supraspinntus by way of the aforementioned anterior deltoidflap technique and then fusing the
tendon with porous glue, sutures or laser. Both surgical techniques
will fail ifthe
humeral head is not rotated
posteriorly and raised slightly laterally during the re-attachment. This humeral motion facilitates the unifica-
tion of the tendon body by eliminating the separation of the two sides of the tom tendon which becomes
exposed when the humerus is brought forward--{tris separation is even more apparent when the arm is raised
laterally and brought forward.

There isn't much more to say about tom rotator cuffsurgery as this condition and its surgical treatment have been known to the orthopaedic surgical community for over a decade. The only problem has been understanding the process causing the injury. This book has provided this as well as dispels the present and erroneous medical theories established to explain the condition.
It is important to re-iterate thaf, prior to an:y rotator cuff surgery the elbow has to be examined so as
to eliminate the presence of an undiagnosed elbow based lateral rotatory instabilitywhich can cause the torn
rotator cuffespecially if the arm is used for pitching or throwing.
Post Operative Treatment

For tom rotator cuffsurgery, ttrere really isn't anything more to be done than possibly diathermy and
cryo-therapy in conjunction with cessation of the offending activity. This treaftnent plan will reduce the swelling prior to the start of a light weight ffeafrnent program. However, the offending activity has to be permanently eliminated from the individual's lifestyle, see Prevention. Fot reconstnrctive eoracoid surgetT,the arm has to be immobilized in a manner which does not place
any or minimal force on the anterior side ofthe shoulder for 6-8 weeks to allow the soft tissue struchres to
heal. Once the arm is removed from either the cast or brace which is to be wom24 hours per day, physiotherapy has to be initiated.
CopJ
# ou for RUDIKRASS
IA2
At first, physiotherapy freatnent will consist of ultrasound, to reduce the amount of scartissue, and
heat and ice, to reduce the post casVbrace swelling that
will
occur with first use of the arm. Once the post
cast/brace swelling is gone, then light strength training of the deltoid and supraspinatus muscles
will be
initiated. After these shoulder muscles have reached a light to moderate strength, the pronation strengthening
technique, described tnthe Treatment clnpter of Section IIof this book, needs to be added to the workout.
Once pronation reaches a plateau sion can be added
lwel - maybe 34 pounds for several days, light weight flexion and extento the workout. At the end of physiotherapy, the workout should consist of moderate to
raiseso
light-high weights for lateral arm
deltoid
and supraspinatrc, a minimum
of
5 pounds for the dowel type
pronation fraining technique and moderate weights for upper exremity extension and flexion, i.e. 15-20
pounds per ann ma:rimum.
CopJ
# aol for RUDI KRASS
r03
Ssourngn Blsun RoraroRy lx$rannrry

Coracoid based rotatory instability is easily eliminated by merely changing the position ofthe hand
and forearm when lifting is done. As it has been proven that fully supinated forearms in cor{unction with the
lifting or raising of heavy objects cause damage to the soft tissues that attach to the Coracoid Process and,
having the forearms in pronated positions through lifting can cause damage to the radial head's lateral pins,
the only logical position then for the hands and forearms through lifting must be the forearm's neutral position or the 12 o'clock position
Superior shoulder instability or supraspirwtw injuries can be eliminated by the cessation
of strong
arm motions forward and above the shoulder. This means that overhead pitching as Norttr Americans pres-
ently performed in professional and amateur baseball must cease. (In reality, this book confirms that the proper medical way of looking at pitching is not my findings, it is only a matter of time before
a
"if'
a pitcher
will
suffer problems but ohhen." According to
pitcher sufilers either from elbow based lateral rotatory
instability, shoulder based rotatory instability or both.)
ALL
overhead use of the arms must stop especially if the action is used to lift heavy objects. The
rationale for this is because heavy or repetitive lifting from over one's head is another major cause of superior rotator cuffproblems and this section of the book explains the process that causes the
problem-it
is frmda-
mentally the sarne as a pitcher's shoulder. (To raise the armo the dehoid and supraspirwtus contract while a
heavy load is placed on the overhead arm. This added weight pushes the humeral head backwards against the contracted supraspinatus causing it to either physically tear or '?nicro tear" depending on the extent of the
conilaction and the weight. Either way, the crest of the shoulder swells with either mild to extreme pain
present.)
By implementing all these changes, within 25 years, all cases of improper usage c{Nes leading to
damage to either the Coracoid Process and the supraspinatus
will
be eliminated making the reconsfructive
surgical techniques and diagnostics for these conditions almost totally irrelevant excryt for orthopaedic specialists and the occasional rare case.
As advice, remember that both reconstructive lateral epicondylar surgery and reconstructive coracoid
surgery should only be applied in women who have demonstrated the need for them and not as preventitve
measure. Work has to be changed to adapt to the real truth ofupper exfemity functionality!
CoW
ou for RUDIKRASS
r04
EnJnote
1 Gray, Dr. Henry, The Unabridged Running Press Edition of the American Classic Gray's
Anatomy, Anatomy, Descriptive and Surgical, ed. Dr. T. Pickering Pick, Dr. Robert Howden, 1901
edition, 60th printing (Philadelphia: Courage Books,
$7$
p.220
Fibli"e'eph]'
Morrey, Dr. Bemard F., Lateral Unar Collateral Ligament: Evaluatian & Treatment,
http://wwwnmis.com/onm/htnl/ets95 lateral_collateralelbow.htm O'Driscoll, Dr. SW; Bell, Dr. DF; Morrey, Dr. Bemard F.: Posterolateral rotatory instability of the elbow
JBJS : 73 (3 ) : 440 -6, 1 99
1
(http ://www.medmedia.com/lib7 / 50.htm\
Gray, Dr. Henry, The Unabridged Running Press Edition of the American Classic Gray's Anatomy, Anatomy, Descriptive and Surgical, Ed. Pick, Dr. T. Pickering, Howden, Dr. Robert. 1901 edition 60th. printing Philadelphia: Courage Books, 1974
Copy
ou
for RUDIKRASS
ro5
Major Change to the thesis "Krass Realitie{M of Upper Extremity Rotation and Rotatory Instahility:"
Treatment:
The most effective means of treatment for lateral upper extremity rotatory instability cases where there are no torn radial collateral ligaments or disorganised scar tissue within the joint capsule
at the lateral epicondyle and signs has to be put on when the hand is
of a healing/tearing radial collateral ligament is casting. The cast
fully supinated, thumb perpendicular to the hand and the radial head
has been re-aligned to its normal valgus position relative to the humerus - a common chiropractic
adjustrnent used today - and the arm is fully extended. The process of casting has to start at the elbow and then move down to the wristhand with the
intervening forearm bone portion of the cast being done last. In the end, the cast will extend from
about the middle of the humerus on a fully extended ann down to the tips of the fingers on the supinated hand with extended fingers and a thumb pointing outward from the hand.
In cases caught early, the cast should need to be on for 2-4 weeks. ln longer term cases,
where scar tissue is not detected within the elbow's joint capsule at the lateral epicondyle,
Gadolinium enhanced STIR MRI and the Krass pronation test is positive, the arm has to remain cast
for anywhere from 6-8-10 weeks. To determine whether or not the arm needs to be re-cast is the
Krass pronation test which, when negative, means that post operative physiotherapy can be initiated.
presenf the orthopaedic surgical community has become very reluctant to use casts
because they "reduce the ranges of motion at the
joints." This assessment is a complete
misunderstanding of the effects of casting because the medical community does not yet realise that
It is true that casting reduces the ranges of motion of the joints, but the only ranges of motion
that is lost is the improperly ones that society has forced us from childhood to incorporate into our
lives - see the following Prevention chapter. This reality means that casting re-introduces the individual to their extremities' normal functionality as this is what is re-established in the soft tissue
structures of the joints from the casting treatment. (Physiotherapy and anti-inflammatories to reduce the soft tissue trauma in joints as well as
mitigate any neural and blood flow complications in the upper exhemity is no longer necessary.)
Copyright
2001
Any treatment of lateral upper exhemity rotatory instability, that is not complimented with the
massive changes to the way in which we use our upper exffemities through all aspects of out lives,
will be futile because the true
cause of the problem has not been resolved, i.e. elirnination of repetitive
improper pronation - see the Prevention chapter for an overview of this undertaking.
(The surgical information from the Mayo Clinic and the Kerlan-Jobe Orthopaedic Clinic are effectly made almost obsolete and nearly irrelevant because the vast majonty of persons suffering from lateral upper extremity rotatory instability will only need to be treated with casts rather than surgery. Unfortunately, I just happen to be one of the minority that will need surgery.
Copyright @ 2001

Krass Realities of Arm Rotation and RI

Transféré par

Informations du document

Copyright

Formats disponibles

Partager ce document

Partager ou intégrer le document

Options de partage

Avez-vous trouvé ce document utile ?

Ce contenu est-il inapproprié ?

Droits d'auteur :

Formats disponibles

Krass Realities of Arm Rotation and RI

Transféré par

Droits d'auteur :

Formats disponibles

Mr. E. J.

PO-001 with The Defender of The Faith.

Mr. E. J. Krass, SoH

Mr. E. J. Krass, SoH

Mr. E. J. Krass, SoH

Mr. E. J. Krass, SoH

PO Box 1041 STN MAIN, DAWSON CREEK BC V1G 4H9

Mr. E. J. Krass, SoH

The Brick Wall

PO Box 1041 STN MAIN, DAWSON CREEK BC V1G 4H9

Mr. E. J. Krass, SoH

Mr. E. J. Krass, SoH

Personal Experience and The Self Evident Truth

Mr. E. J. Krass, SoH

Mr. E. J. Krass, SoH

Mr. E. J. Krass, SoH

Mr. E. J. Krass, SoH

PO Box 1041 STN MAIN, DAWSON CREEK BC V1G 4H9

Mr. E. J. Krass, SoH

The modified pulley system

PO Box 1041 STN MAIN, DAWSON CREEK BC V1G 4H9

Mr. E. J. Krass, SoH

PO Box 1041 STN MAIN, DAWSON CREEK BC V1G 4H9

Mr. E. J. Krass, SoH

PO Box 1041 STN MAIN, DAWSON CREEK BC V1G 4H9

Mr. E. J. Krass, SoH

PO Box 1041 STN MAIN, DAWSON CREEK BC V1G 4H9

Mr. E. J. Krass, SoH

Mr. E. J. Krass, SoH

PO Box 1041 STN MAIN, DAWSON CREEK BC V1G 4H9

Mr. E. J. Krass, SoH

Mr. E. J. Krass, SoH

Attached: page of 2 images

PO Box 1041 STN MAIN, DAWSON CREEK BC V1G 4H9

Mr. E. J. Krass, SoH

PO Box 1041 STN MAIN, DAWSON CREEK BC V1G 4H9

TrtE Knass RnzurtnS" oF UppEn ExrnEMrrY Rorl.uoN

THE Knas^s Rn,qLITIES" oF

for RUDI KRASS

Copyright O 2000 by E. J. KraB

Trre Kuss Rnlr,rry or Uppnn Exrnrnrrry Rornrron

Nnw TnnoRrEs oN Suprnlrrox lxn Pnoxnrrox

2. Tnn Nnw TnnonrEs FoR Sr;prxarrox 3. Uppnn Extnomrry

Fr,rxrox lNo Suprxlrno Exrnnsron

Supinated Flexion Supinated Extension

*ExrrNonn Anrvr SurmATroN uvo PnoNlrron*

Extended Upper Extremity Pronation Extended Upper Exhemity Supination

Pnoxlrnn Fr,nxron luo Pnoxlrno Exrnxsron

Tno Knlss REALrry oF LATERAL

Exrnnurry RouroRy INsrABrLrry

or Larnur, Uprnn Exrnnrrtry Rorlrony fxsrlnrr,rry

2. Trrn Tnurq ABour

Exrnnurry Rorarony lxsrumr,rry

Lrrnnc.L Urrnn Exrnrnnrry Rourony fxsu,nn-rry

3. PlrnourcrrANrcs or Er,now BAsED L,lrnrur, Rourony lxsrlmr.rry

for RUDI KRASS

5. DUcNosTICS FoR Larnml RoruroRy

6. TnnATMENT FoR L,rrgRAl RornroRy fnsrnBrlrry

Ersow Baspn Lnrnnnl RorEroRY

THr KnAss Runlrry oF SHouLDER Blssn f]rpnn ExrREMrry RornroRy lNsraBrr,rry

FoR Snoulonn BAsED

Anterior Shoulder Rotatory Instability Superior Shoulder Rotatory Instability

Reconstructive Surgeries Post Operative Treatment 6. PnrvrxrloN oF Ssour,prn BAsED Rouronv

Exonore & BrsrrocRAPrrY

ExrrNonn Anrvr SurmATroN uvo PnoNlrron