elbow injuries critical link in kinetic chain of upper extremitycritical link in kinetic chain of...
TRANSCRIPT
Elbow InjuriesElbow Injuries
• Critical link in kinetic chain of upper extremityCritical link in kinetic chain of upper extremity
• Extremely susceptible to injuryExtremely susceptible to injury
– Big range of motionBig range of motion
– Weak lateral bone structureWeak lateral bone structure
– Boney anatomy prominent causing soft tissue damageBoney anatomy prominent causing soft tissue damage
– Excessive stress on joint from sportsExcessive stress on joint from sports
– Locking motion of some activitiesLocking motion of some activities
– Use of implementsUse of implements
– Throwing motionThrowing motion
OlecranonOlecranon
Head of radiusHead of radius
Neck of radiusNeck of radius
Styloid ProcessStyloid Process
Neck of radiusNeck of radiusHead of radiusHead of radius
OlecranonOlecranon
Radial notchRadial notch
Tuberosity of radiusTuberosity of radius
Styloid ProcessStyloid Process
UlnaUlnaRadiusRadius
Interosseous Interosseous MembraneMembrane
Styloid ProcessStyloid Process
Styloid ProcessStyloid Process
Anterior ViewAnterior View Posterior ViewPosterior View
Posterior AlignmentPosterior Alignment
• Extended Elbow Extended Elbow • Straight line formedStraight line formed
• Flexed ElbowFlexed Elbow
• IsoscolesTriangleIsoscolesTriangle
Elbow ROMElbow ROM
SupinationSupination PronationPronation
PronationPronation SupinationSupinationExtension 0ºExtension 0ºFlexion 150ºFlexion 150º
Supination 90ºSupination 90ºPronation 90ºPronation 90º
Carrying Angle of ElbowCarrying Angle of Elbow
Normal AngleNormal Angle– Females 10-15 ºFemales 10-15 º
– Males 5 ºMales 5 º
Hyperextended ElbowHyperextended Elbow
HumerusHumerus
Triceps TendonTriceps Tendon
Joint CapsuleJoint Capsule
Olecrenon BursaOlecrenon Bursa
Coronoid ProcessCoronoid Process
Medial ViewMedial View
Annular LigamentAnnular Ligament
Biceps TendonBiceps Tendon(cut)(cut)
RadiusRadius
UlnaUlna
Ulnar Collateral LigamentUlnar Collateral Ligament
Ulnar Collateral LigamentUlnar Collateral Ligament
Valgus Stress TestValgus Stress Test
Ulnar Collateral LigamentUlnar Collateral Ligament
Radial Collateral LigamentRadial Collateral Ligament
Varus Stress TestVarus Stress Test
Valgus StressValgus Stress
Stabilize
Apply Stress
• EtiologyEtiology
– Valgus force Valgus force
– Repetitive traumaRepetitive trauma
– Related injuries Related injuries
• Ulnar nerve inflammationUlnar nerve inflammation
• Wrist flexor tendinitisWrist flexor tendinitis
• Overuse flexor/pronator strainOveruse flexor/pronator strain
• Elbow flexion contractures Elbow flexion contractures
• InstabilityInstability
Ulnar Collateral Ligament SprainsUlnar Collateral Ligament Sprains
Ulnar Collateral Ligament SprainsUlnar Collateral Ligament Sprains
• Signs and SymptomsSigns and Symptoms
– Pain Pain
• Medial aspect of elbowMedial aspect of elbow
• UCLUCL
• Valgus stress test at 20 degreesValgus stress test at 20 degrees
– End-point laxityEnd-point laxity
– ParesthesiaParesthesia
• Positive Tinel’s signPositive Tinel’s sign
• Signs and Symptoms (con’t)Signs and Symptoms (con’t)
– Positive X-ray Positive X-ray
• Bone spursBone spurs
• Calcification w/in UCLCalcification w/in UCL
• Loose bodiesLoose bodies
• Posterior impingementPosterior impingement
• ManagementManagement
– Conservative treatment Conservative treatment
• RICE RICE
• NSAID’sNSAID’s
– W/ resolutionW/ resolution
• Strengthening Strengthening
• Analysis of the throwing motionAnalysis of the throwing motion
– Surgical intervention Surgical intervention
• ReconstructionReconstruction
• (Tommy John procedure) (Tommy John procedure)
• Return to activity 22-26 weeks post opReturn to activity 22-26 weeks post op
Lateral EpicondylitisLateral EpicondylitisTennis Elbow
– EtiologyEtiology• Repetitive microtrauma Repetitive microtrauma
• Insertion of extensor/supinator muscle/s Insertion of extensor/supinator muscle/s
• Lateral epicondyleLateral epicondyle
– Signs and SymptomsSigns and Symptoms• Aching pain after activityAching pain after activity
• Pain w/ resistive wrist extensionPain w/ resistive wrist extension
• Weakness in wrist and hand Weakness in wrist and hand
• Elbow decreased ROMElbow decreased ROM
Resisted Resisted Eccentric Eccentric
ContractionContraction
• RICERICE
• NSAID’sNSAID’s
• AnalgesicsAnalgesics
• RehabilitationRehabilitation– ROM exercisesROM exercises
– PREPRE
– Deep friction massageDeep friction massage
– Stretching in pain free ROMStretching in pain free ROM
• Mechanics trainingMechanics training
• BracingBracing– Counter force brace Counter force brace
– Neoprene sleeveNeoprene sleeve
AssessmentAssessment ManagementManagement
Olecrenon BursitisOlecrenon Bursitis• Superficial location Superficial location
• Extremely susceptible to injury Extremely susceptible to injury
• EtiologyEtiology
– Direct blowDirect blow
– Irritation to bursaIrritation to bursa
• Chronic irritationChronic irritation
– Production of fluidProduction of fluid
– Increased capillary permeabilityIncreased capillary permeability
– Fluids and exudates flow into the bursaFluids and exudates flow into the bursa
– Bursal wall thickens over timeBursal wall thickens over time
– May have irregular areas of scar tissueMay have irregular areas of scar tissue
• Feels like loose joint cartilage (joint mice) Feels like loose joint cartilage (joint mice)
• Calcium depositsCalcium deposits
– Acutely injured jointAcutely injured joint
• Blood may fill the bursaBlood may fill the bursa
• Risk of infectionRisk of infection