ANATOMI TERAPAN

REGIO ELBOW

Rakhmad Rosadi,SST.FT

What Is Palpation?

• Palpation is as much an act of the mind

as it is of the palpating fingers. Sensory

stimuli entering through the therapist's

• hands must be correlated with a

knowledge base of anatomy.

How to Palpate

Move Slowly

Moving too quickly or

frenetically jumping around the client's body does not allow

for effective and mindful palpation.

Use Appropriate Pressure

1. most new therapists use too little pressure, prob

ably because they are afraid of hurting the client

2. With a stronger knowledge base of the underlying anatomand

more hands-on experience, this fear usually recedes

How to Learn Palpation

A long-standing exercise to learn palpation is to take a hair

and place it under a page of a textbook without seeing where

you placed it. With your eyes closed, palpate for the hair until you

find it.

Functional Characteristics of Muscle Tissue

normal resting length

Irritability

Contractility

Extensibility

Elasticity

Length-Tension Relationship

in Muscle Tissue

Types of Muscle Contraction

Muscle types. Cardiac, smooth, and skeletal muscles

are the three types in the human body. Each has a unique

structure and location reflecting its function.

TYPES OF SYNOVIAL JOINTS

Ball and socket

Hinge

PivotNumber of

Planes/Axes

Movement

possible

examples

Uniaxial Rotation Atlantoaxial

joint

Radioulnar

joints

Ellipsoid/condyloidNumber of

Planes/Ax

es

Movement

possible

examples

Biaxial Flexion

Adduction

Atlantoocci

pital joint

Extension Metacarpo

phalangeal

joints

Abduction Radiocarp

al joints

(or lateral

flexion in

spine)

Saddle

Number of

Planes/Axes

Movement

possible

examples

Biaxial Flexion 1 st

Carpometacarp

al

joint (thumb)

extension

abbduction

adduction

GidingNumber

of

Planes/A

xes

Moveme

nt

possible

example

s

Nonaxial N/A Acromioc

lavicular

joint

Intercarp

al joints

Movement Muscles Nerve Supply Nerve Root

Brachialis Musculocutaneous C5 C6 (C7)

Biceps brachii Musculocutaneous C5 C6

Elbow flexion Brachioradialis Radial C5 C6 (C7)

Pronator teres Median C6 C7

Flexor carpi ulnaris Ulnar C7 C8

Elbow Triceps Radial C6 C7 C8

extension Anconeus Radial C7 C8 (T1)

Forearm

supination

Supinator Posterior interosseous (radial) C5 C6

Biceps brachii Musculocutaneous C5 C6

Forearm Pronator quadratus Anterior interosseous (median) C8 T1

pronation Pronator teres Median C6 C7

Flexor carpi radialis Median C6 C7

Wrist flexion Flexor carpi radialis Median C6 C7

Flexor carpi ulnaris Ulnar C7 C8

Extensor carpi radialis longus Radial C6 C7

Wrist

extension

Extensor carpi radialis brevis Posterior interosseous (radial) C7 C8

Extensor carpi ulnaris Posterior interosseous (radial) C7 C8

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Muscles

• Anterior

• Primarily flexion &

pronation

• Biceps brachii

• Brachialis

• Brachioradialis

• Pronator teres

• Pronator quadratus

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Muscles

• Posterior

• Primarily extension

& supination

• Triceps brachii

• Anconeus

• Supinator

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Biceps Brachii MuscleFlexion of elbow

Supination of forearm

Weak flexion of shoulder joint

Weak abduction of shoulder joint when externally rotated

Palpation of the

biceps brachii with the forearm fully supinated

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Brachialis MuscleTrue

flexion

of elbow

Palpation of the brachialis with the forearm

fully

Palpation of the brachialis with the forearm

fully

pronated

Palpation of the brachialis with the forearm fully

pronated

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Brachioradialis MuscleFlexion of elbow

Pronation from supinated position to neutral

Supination from pronatedposition to neutral

Palpation of the brachioradialis with

the forearm halfway between full supination and full

pronation.

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Triceps Brachii Muscle

Long head:

extension of shoulder joint;

adduction of shoulder joint;horizontal abduction

All heads: extension of elbow

Palpation of the belly of the right triceps brachii as

the client extends the forearm against resistance

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Anconeus MuscleExtension of elbow

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Pronator Teres Muscle

Pronation of forearm

Weak flexion of elbow

Palpation of the right pronator teres as the client

pronates the forearm at the radioulnar joints against resistance.

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Pronator Quadratus Muscle

Pronation of forearm

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Supinator Muscle

Supination of forearm

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Elbow Flexion• Ex. Biceps curl

• Agonists

• Biceps brachii

• Brachialis

• Brachioradialis

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Elbow Extension• EX. Push-up

• Agonists

• Triceps brachii

• Anconeus

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Radioulnar Pronation

• Agonists

• Pronator teres

• Pronator quadratus

• Brachioradialis

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Radioulnar Supination

• Ex. Tightening a screw

• Agonists

• Biceps brachii

• Supinator muscle

• Brachioradialis

Epicondylitis

• Overuse condition caused by repeated overload of the

musculotendinous units attaching to one of the epicondyles

• Also due to: faulty techniques/mechanics, weak muscle groups,

inappropriate equipment

• Lateral

• Tennis elbow

• Medial

• Golfer’s elbow

• Thrower’s elbow

• Pitcher’s elbow

Lateral Epicondylitis

Medial Epicondylitis

Epicondylitis—Signs & Symptoms

• Local tenderness over involved epicondyle

• Pain on use of involved muscles

• Swelling

• Resisted wrist motion often reproduces

pain

Epicondylitis—Treatment

• Preventative measures:

• Proper technique

• Use of appropriate equipment

• Limited stress

• Proper/adequate warm-up

• Stretch to maintain flexibility

• RICE

• Modify activities that aggravate condition

• Decrease amount, frequency, or intensity of

activity

Sprains of the Elbow

• Result from:

• Hyperextension

• Valgus/varus force

• Signs/Symptoms

• “click” or “pop”

• Sharp pain at time of injury

• Point tenderness

• Localized swelling

• Paint with attempt to

reproduce MOI

• Extension may be limited

• Treatment

• Special tests

• Progressive rehab

• Bracing

• Depends on degree of injury

Elbow Dislocations

• Second most frequently dislocated major joint

• Posterior displacement of ulna and radius in relationship to humerus

most common

• Result of FOOSH with elbow in extension

• Collateral ligament will be severely stretched or ruptured

Elbow Dislocation

Signs & Symptoms

• Obvious deformity

• Loss of elbow function

• PAIN

• Check for:

• Circulation

• Nerve function

• Properly immobilized

• Refer immediately

Treatment

• Prompt reduction important

• Rehab based on injury

Fractures of the Elbow and Forearm

• Result of:

• Direct trauma

• Indirect stresses transmitted through UE (FOOSH)

• Excessive forces associate with throwing and swinging activities

• Most frequent in children and skeletally immature athletes

Volkmann’s Contracture

• Occurs in absence of blood flow (ischemia) to forearm

• Caused by increased pressure due to:

• Swelling

• Trauma

• fracture

• Blood vessels compress, decreasing blood flow to arm

• ® injury to muscles, causing it to shorten

• Pulls on joint at end of muscle just as it would if it were normally

contracted

Volkmann’s Contracture

• Wrist remains flexed and cannot be straightened

• Causes fingers to form fist and flex the wrist

• Muscles involved are on palm side of forearm

• Three levels of severity:

• Mild—two/three fingers only; no or limited loss of sensation

• Moderate—all fingers flexed; thumb stuck in palm; wrist stuck in

flexion; usually loss of some sensation

• Severe—all muscles in forearm involved; completely disabling

Volkmann’s ContractureSigns & Symptoms

• Severe pain with passive movement

• Forearm tensely swollen and shiny

• Pain when forearm squeezed

• Pain not improve with rest

• Continue to get worse over time

• If condition not corrected:

• Decreased sensation

• Weakness

• Paleness of skin

Injury to the Ulnar Nerve

• Passes through cubital tunnel in the

posterior aspect of medial epicondyle

• Vulnerable to compression forces and

tension stresses due to:

• Repetitive movement in cubital tunnel

• Relative lack of bony protection

• Repetitive throwing and/or swinging can

irritate, compress or entrap the nerve

• aka cubital tunnel syndrome

Injury to the Ulnar Nerve

Injury to the Radial Nerve• Passes anteriorly to the lateral epicondyle and lies in a tunnel formed

by several muscles and tendons

• Repetitive pronation/supination can cause entrapment

• aka radial tunnel syndrome

• Differentiate from lateral epicondylitis

Injury to the Radial Nerve• Pain over lateral aspect of elbow

• Tenderness present over anterior radial head

• Symptoms reproduced by:

• Resisting supination with elbow at 90

• Resisting extension of middle finger with elbow extended

• Failed treatment of lateral epicondylitis may be radial nerve

Injury to the Median Nerve

• Crosses anterior elbow and passes between the

heads of the pronator teres muscle just distal to

the joint

• Entrapment caused by:

• Hypertrophy of the pronator teres

• Activities that involve repetitive pronation

• aka pronator teres syndrome

Injury to the Median Nerve

• Pain radiating down the anterior forearm

• Numbness & tingling in

thumb, index, and

middle fingers

• Increases pain with

resistive pronation