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Elbow AnatomyMedial EpicondyleLateral EpicondyleTrochlea and CapitulumOlecranon ProcessUlna and RadiusRadial Head Interosseus Membrane
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Elbow Anatomy http://images.main.uab.edu/healthsys/ei_0153.jpg
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Elbow Anatomy (2) Humeroulnar joint
Hinge joint Trochlea of humerus Trochlear fossa of ulna
Flexion (0 – 150) Extension (0)-some hyperextension(-5 to -15) Ligaments:
Medial (ulnar) collateral (UCL) Lateral (radial) collateral (RCL)
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Elbow Anatomy (3)Radioulnar joint
Not part of elbow but associated with supination and pronation
Supported by the annular ligament which binds the head of the radius to the radial notch of the ulna forming the joint
Radius Rolls over the ulna
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Muscular AnatomyBiceps (flexion w/ supination)Brachioradialis (flexion with arm neutral)Brachialis (flexion w/ pronation)Triceps (extension)Pronator Group (pronation)Supinator (supination)
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Bursa, Blood and Nerve Supply
Bursa- major one is olecranon bursaBlood supply
Brachial artery Radial artery Ulnar artery
Nerve supply Brachial plexus extends into the radial and
ulna nerve***
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Prevention of InjuriesGeneral muscular condition- FS 9-1Restrict pitching/ teach proper formMake sure equipment is proper (ie:
racquet)- grip size, racquet weightTeach shoulder roll method of falling-
example volleyball players rolling after a dig
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Contusions MOI: Direct contact HOPS
Swelling, heat, discoloration or ecchymosis Limited range of motion
TX Rule out fracture first Ice, wrap and pad area Avoid aggressive stretching and strengthening Watch for ectopic bone formation
Ectopic = in a place other than normal
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Olecranon BursitisOlecranon bursa is largest in elbowMOI: fall on bent arm, leaning on elbow
for long periods, infectionHOPS
Heat, redness, and rapid swelling Tx: ice, compression, pad area
If associated with fever: referAspiration or draining may be needed
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http://www.physsportsmed.com/issues/2000/03_00/mcfarland4.gif
http://www.aafp.org/afp/971101ap/salzfig3.jpg
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Elbow Sprains (1 – UCL) MOI: valgus force, repetitive stress HOPS:
Pain over medial joint especially in cocking phase or acceleration phase of throwing
Point tenderness over joint line + valgus stress test (increasing with degree 1st-
3rd) Tx: rest, general strengthening of flexors/
pronators; Rule out ulnar nerve damage (numbness in little finger)
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Elbow Dislocations MOI: hyperextension, sudden, violent force driving
ulna posterior, falling on outstretched hand HOPS
Obvious deformity Snapping or cracking sensation Severe pain Forearm in flexion and appears shortened
Tx: immobilize and refer MED EMERGENCY Check neurovascular status
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-http://www.worldortho.com/database/intro-trauma/pics/img0123.jpg http://www.angelfire.com/sc2/seahawksportsmed/injpix.html
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Medial Epicondylitis “little league elbow, golfer’s elbow” MOI: repetitive tension or valgus forces on
the arm HOPS-Box 9-1
Swelling, ecchymosis over medial epicondyle Pain aggravated by pronation and resisted flexion
of wrist Tingling and numbness in 4th and 5th fingers
Tx: See Field Strategy 9.3
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http://www.esportmed.com/smrn/figures/GolferElbowInjury.gif
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Lateral Epicondylitis “tennis elbow”Most common overuse injury in the
adult elbowMOI: eccentric loading on wrist
extensors during decelerationPrecursor: too large tennis raquet,
gripping racket too tightly, excessive string tension, faulty mechanics
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Lateral Epicondylitis (2) HOPS
Pain over lateral epicondyle Pain with resisted wrist extension + tennis elbow test
Tx RICE Increase strength, power, endurance of wrist
extensors Counter force brace
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Impingement of Ulnar nerve Ulnar nerve passes behind humerus in ulnar
groove Lies under UCL HOPS
Pain along medial elbow Can be caused from a medial elbow injury “crazy bone” or “funny bone” Tingling and numbness in ring and little finger Grip strength weak
Refer if chronic
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ROM testingSee p 173 Fig 9-23
Elbow flexion Elbow extension Wrist flexion and extension Pronation Supination
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Stress TestsValgus (UCL)/Varus (RCL) stress test –
Positive Sign is laxityTennis Elbow test-(Lateral Epicondylitis)
- Positive Sign is increased painTinel’s sign (Ulnar nerve) – Numbness,
Tinkling into Ulnar nerve region.