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� Review anatomy of the elbow� Discuss the physical exam
› Inspection› Palpation› ROM› Provocative Tests
� Recognize common elbow injuries� Learn some common causes of elbow
pain
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Biceps
Flexor-pronatorbundle
Extensor-supinatororiginBrachioradialis
Brachialis
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Triceps
Flexor-pronatorbundle
Supinator
Extensors
Brachialis
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� Inspection� Palpation� Range of Motion
› Active› Passive› Resisted
� Provocative Tests
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� Bruising� Swelling� Carrying angle� Masses
› Biceps tendon rupture› Rheumatoid nodules
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Medial Epicondyle
Lateral Epicondyle
Radial head
Olecranon
Capitellum
Flexor-pronatorcomplex
Extonsor-supinatorcomplex
Triceps tendon
Ulnarnerve
Ulnarcollateral ligament
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� Elbow› Flexion› Extension
� Radio-ulnar/wrist› Supination› Pronation
� Wrist› Flexion› Extension
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� Valgus stress: stability of UCL› Increased opening› Milking maneuver
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� Beware of normal ossification
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� Supracondylar fractures› Mechanism: FOOSH or direct trauma› Risk on neurovascular injury if displaced› Imaging findings: fat pad, sail sign, assess
anterior humeral line
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� Monteggia fracture› Ulnar fracture with radial head dislocation› Radius should align with capitellum
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� Posteriolateral most common
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� Can be traumatic or from prolonged pressure; can be infected
� Associated with rheumatoid arthritis or gout
� Swelling at posterior elbow� Treatment: protection,
NSAIDs, drainage and/or steroid injection
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� Injuries depend on age and bone maturity› Children: medial epicondyle apophysitis› Adolescents: medial epicondyle avulsion› Young adults: UCL tear
� Symptoms: medial elbow pain, decreased throwing velocity
� Positive pain +/- laxity with valgus stress, positive milking maneuver
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� Compression of the ulnar nerve as it travels across the elbow› From prolonged elbow flexion or leaning on
elbow› Compression from bone spur, cyst, or swelling
� Symptoms: ulnar nerve tingling/numbness or weakness of hand muscles
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� Exam: positive tinnel’s over cubital tunnel� Treatment: NSIADs, splints, cortisone
injections, splints� Surgery: cubital tunnel release, ulnar
nerve transposition
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� Most commonly in the capitellum� Occurs in adolescents, associated with
overuse (throwers and gymnasts)
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� Symptoms: pain, mechanical� Exam: lateral pain, swelling, loss of ROM� Treatment: conservative vs. surgical
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� Aka Tennis elbow� Mechanism: repetitive
pronation and supination with elbow in extension
� Microtears of extensor muscles at their origin (most commonly ECRB)
� May involve radial nerve
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� Symptoms: pain with wrist extension or grip, decreased grip strength
� Exam: pain over or just distal to lateral epicondyle, pain with resisted wrist extension with elbow in extension, pain with finger extension
� Treatment: modify activity (looser strings on racket, larger grip), NSAIDs, PT, steroid injections, strap, surgery
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� Remember anatomy as you think through a differential
� Use your physical exam to determine the location and provocation of the pain
� Keep in mind normal development
� Questions!