Elbow AnatomyMedial EpicondyleLateral EpicondyleTrochlea and CapitulumOlecranon ProcessUlna and RadiusRadial Head Interosseus Membrane

Elbow Anatomy http://images.main.uab.edu/healthsys/ei_0153.jpg

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)

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

Muscular AnatomyBiceps (flexion w/ supination)Brachioradialis (flexion with arm neutral)Brachialis (flexion w/ pronation)Triceps (extension)Pronator Group (pronation)Supinator (supination)

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***

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

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

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

http://www.physsportsmed.com/issues/2000/03_00/mcfarland4.gif

http://www.aafp.org/afp/971101ap/salzfig3.jpg

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)

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

-http://www.worldortho.com/database/intro-trauma/pics/img0123.jpg http://www.angelfire.com/sc2/seahawksportsmed/injpix.html

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

http://www.esportmed.com/smrn/figures/GolferElbowInjury.gif

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

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

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

ROM testingSee p 173 Fig 9-23

Elbow flexion Elbow extension Wrist flexion and extension Pronation Supination

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.