The Elbow Ulnar Collateral Ligament Sprain Elbow Dislocation Ulnar Nerve Irritation Emily Gavlick

The ElbowThe Elbow

Ulnar Collateral Ligament Ulnar Collateral Ligament SprainSprain

Elbow DislocationElbow DislocationUlnar Nerve IrritationUlnar Nerve Irritation Emily Gavlick

Bone Anatomy of ElbowBone Anatomy of Elbow

Involved bones:Involved bones: – HumerusHumerus– UlnaUlna– RadiusRadius

General Joint Type: hingeGeneral Joint Type: hinge– Movement allowed in only one Movement allowed in only one

planeplane

Bone Anatomy of the ElbowBone Anatomy of the Elbow

Joint Actually Comprised of 3 AreasJoint Actually Comprised of 3 Areas

1. 1. Humeroulnar JointHumeroulnar Joint: flexion and extension: flexion and extension

2.2. Proximal Radioulnar JointProximal Radioulnar Joint: supination and : supination and pronation of handpronation of hand

3. 3. Humeroradial JointHumeroradial Joint: arthrodial joint (only : arthrodial joint (only a slight gliding motion)a slight gliding motion)

Ligament Anatomy of ElbowLigament Anatomy of Elbow

Ulnar Collateral Ligament (UCL):Ulnar Collateral Ligament (UCL): medial medial side of the elbowside of the elbow

Radial Collateral Ligament (RCL):Radial Collateral Ligament (RCL): lateral lateral side of the elbowside of the elbow

Annular Ligament:Annular Ligament: wraps around the wraps around the radial head and holds it tight against radial head and holds it tight against the ulnathe ulna– annularannular means ring-shaped means ring-shaped

Ligament Anatomy of ElbowLigament Anatomy of Elbow

Muscle Anatomy of ElbowMuscle Anatomy of Elbow

Anterior:Anterior:– BicepsBiceps

Posterior: Posterior: – Triceps BrachiiTriceps Brachii

Lateral:Lateral:– SupinatorSupinator

Medial:Medial:– Flexor Carpi Flexor Carpi

UlnarisUlnaris

Tendon Anatomy of ElbowTendon Anatomy of Elbow

Anterior:Anterior:– biceps tendonbiceps tendon

Posterior:Posterior:– triceps tendontriceps tendon

Lateral:Lateral:– common tendon common tendon

of origin of the of origin of the Extensor musclesExtensor muscles

Medial:Medial:– common tendon common tendon

of origin of the of origin of the Flexor musclesFlexor muscles

Muscle / Tendon Anatomy of Muscle / Tendon Anatomy of ElbowElbow

Muscle / Tendon Anatomy of Muscle / Tendon Anatomy of ElbowElbow

Elbow InjuriesElbow Injuries


What is it?What is it? Stretch or tear of the UCLStretch or tear of the UCL

Involved Structures:Involved Structures: The UCLThe UCL The HumerusThe Humerus The UlnaThe Ulna

Location:Location: Medial side of elbowMedial side of elbow


Mechanism of Injury:Mechanism of Injury:

Force bends elbow inward toward Force bends elbow inward toward midlinemidline

most commonly occurs in throwing most commonly occurs in throwing activitiesactivities


General Signs and Symptoms:General Signs and Symptoms: (specific (specific symptoms depend on severity of sprain)symptoms depend on severity of sprain)

PainPain Popping / tearing sensation Popping / tearing sensation TendernessTenderness SwellingSwelling BruisingBruising


Grades: (as with any sprain)Grades: (as with any sprain)

Grade I: partial tear of a ligamentGrade I: partial tear of a ligament– Mild tenderness and swellingMild tenderness and swelling– Slight or no functional loss Slight or no functional loss – No mechanical instabilityNo mechanical instability


Grade II: incomplete tear of a Grade II: incomplete tear of a ligament with moderate ligament with moderate functional impairmentfunctional impairment

– Moderate pain and swellingModerate pain and swelling– Mild to moderate bruisingMild to moderate bruising– Tenderness over involved structuresTenderness over involved structures– Some loss of motion and function Some loss of motion and function – Mild to moderate instabilityMild to moderate instability


Grade III: complete tear and loss Grade III: complete tear and loss of integrity of a ligamentof integrity of a ligament

– Severe swellingSevere swelling– Severe bruisingSevere bruising– Loss of function and motion Loss of function and motion – Mechanical instabilityMechanical instability


Testing for InjuryTesting for Injury

Valgus stress testing:Valgus stress testing:– PainPain– InstabilityInstability

Radiographs: Radiographs: – loose bodiesloose bodies– traction spurs (protrusion of bone / cartilage)traction spurs (protrusion of bone / cartilage)

MRI:MRI:– partial and complete tearspartial and complete tears– not usually necessarynot usually necessary


Treatment for Injury:Treatment for Injury:

PreventionPrevention– Long-term strengthening and Long-term strengthening and

conditioning appropriate for sport. conditioning appropriate for sport. – Warm up before practice or competition. Warm up before practice or competition. – Tape vulnerable joints before practice or Tape vulnerable joints before practice or

competition competition


Treatment for InjuryTreatment for Injury

Grade I Sprain:Grade I Sprain:– PRICEPRICE– Possible application of a cast, tape, elastic Possible application of a cast, tape, elastic

bandage or slingbandage or sling– If no device is applied, icepacks, whirlpool If no device is applied, icepacks, whirlpool

therapy, and massage may be usedtherapy, and massage may be used– Recovery time: Recovery time: 2-6 weeks2-6 weeks



Grade II Sprain:Grade II Sprain:– PRICEPRICE– Application of cast, tape, elastic Application of cast, tape, elastic

bandage or slingbandage or sling– Possible physical therapyPossible physical therapy– Recovery time: Recovery time: 6-8 weeks6-8 weeks



Grade III Sprain:Grade III Sprain:– PRICEPRICE– Application of cast, tape, elastic Application of cast, tape, elastic

bandage or slingbandage or sling– Physical therapyPhysical therapy– SurgerySurgery– Recovery time: Recovery time: 8-10 weeks8-10 weeks, with , with

potential for prolonged disabilitypotential for prolonged disability


Ramon Ramirez: Colorado Rockies pitcherRamon Ramirez: Colorado Rockies pitchermissed 23 games with an elbow sprain in April 2007missed 23 games with an elbow sprain in April 2007

Elbow DislocationElbow Dislocation

What is it?What is it? The radius and ulna move out of place compared The radius and ulna move out of place compared

with the humerus with the humerus

Involved Structures:Involved Structures: The RadiusThe Radius The HumerusThe Humerus The UlnaThe Ulna Surrounding tissuesSurrounding tissues

Location:Location: Elbow jointElbow joint


General Signs and Symptoms:General Signs and Symptoms: (specific (specific symptoms depend on severity of dislocation)symptoms depend on severity of dislocation)

TendernessTenderness SwellingSwelling DeformityDeformity BruisingBruising Poor blood flow to the lower arm and Poor blood flow to the lower arm and

handhand


Signs / Symptoms:Signs / Symptoms:– pain pain – Refuse to use injured armRefuse to use injured arm– Holding elbow slightly bentHolding elbow slightly bent

Nursemaid’s / Babysitter’s Elbow•Partial or radial dislocation (subluxation)•Common in children•Caused when child is lifted by arm


SimpleSimple radius and ulna become dissociated from radius and ulna become dissociated from

the humerus without associated fracturethe humerus without associated fracture

ComplexComplex simple dislocation combined with fracture simple dislocation combined with fracture

of the humerus, radius, ulna or a of the humerus, radius, ulna or a combination of all three bonescombination of all three bones


Mechanism of Injury:Mechanism of Injury: Force sent through ulna/radius to Force sent through ulna/radius to

elbowelbow Often accompanied by a twisting Often accompanied by a twisting

forceforce Usually occurs when a person Usually occurs when a person

attempts to break a fall or cushion an attempts to break a fall or cushion an impactimpact


Signs / Symptoms:Signs / Symptoms: Severe pain Severe pain DeformityDeformity SwellingSwelling Inability to bend armInability to bend arm In some cases:In some cases:

– NumbnessNumbness– Lack of pulse Lack of pulse


Testing for Injury:Testing for Injury: Evaluation of tenderness, swelling, Evaluation of tenderness, swelling,

deformity, sensation, and circulationdeformity, sensation, and circulation X-rayX-ray CT scan may help evaluate fracturesCT scan may help evaluate fractures Angiogram may be done if arterial Angiogram may be done if arterial

injury is suspectedinjury is suspected


Treatment for Injury:Treatment for Injury: Nursemaid’s / Babysitter’s ElbowNursemaid’s / Babysitter’s Elbow

– Closed Reduction: manipulating arm; the Closed Reduction: manipulating arm; the annular ligament and radial head return annular ligament and radial head return to their normal anatomic positionsto their normal anatomic positions

immobilize elbow and palpate region of immobilize elbow and palpate region of radial headradial head

apply axial compression at wrist while apply axial compression at wrist while supinating forearm and flexing elbow supinating forearm and flexing elbow

a click or snap can be felt at the radial heada click or snap can be felt at the radial head


Treatment for Treatment for InjuryInjury

Simple Dislocation:Simple Dislocation:

– Closed ReductionClosed Reduction– SplintingSplinting– 24-hour hospital 24-hour hospital

observation if observation if nerve / artery injury nerve / artery injury is suspectedis suspected

– Possible physical Possible physical therapytherapy


Treatment for InjuryTreatment for Injury Complex Dislocation:Complex Dislocation:

– Reconstructive Surgery (open reduction)Reconstructive Surgery (open reduction)


Partial Simple

Radial Complex

Ulnar Nerve IrritationUlnar Nerve Irritation

What is it?What is it? The ulnar nerve, one of the The ulnar nerve, one of the

3 main nerves that 3 main nerves that innervate the hand, is innervate the hand, is affectedaffected

The Funny BoneThe Funny Bone

Location:Location: runs from the shoulder to runs from the shoulder to

the hand the hand


Two ways to irritate the ulnar nerve:Two ways to irritate the ulnar nerve:

1.1. Impingement (pinching)Impingement (pinching)– Cubital Tunnel SyndromeCubital Tunnel Syndrome

2.2. Entrapment (stuck to surrounding Entrapment (stuck to surrounding tissue)tissue)

Location: Posterior elbow jointLocation: Posterior elbow joint


Mechanism of Injury:Mechanism of Injury: – Genetic, natural build Genetic, natural build – Frequent bending of elbow jointFrequent bending of elbow joint– Fracture of nearby boneFracture of nearby bone– Blow to cubital tunnelBlow to cubital tunnel

Cubital tunnel:Cubital tunnel: tunnel of muscle, tunnel of muscle, ligament, and bone on the inside of the ligament, and bone on the inside of the elbow allows the Ulnar nerve to travel elbow allows the Ulnar nerve to travel over the elbow over the elbow


Signs / Symptoms:Signs / Symptoms:– Numbness on the inside of the Numbness on the inside of the

hand and in the ring and little hand and in the ring and little fingers fingers

– Pain Pain – Weak GripWeak Grip– Muscle WastingMuscle Wasting


Testing for Injury:Testing for Injury:– Physical examination to confirm locationPhysical examination to confirm location

– MRI / CT scan to check for bone spurs or MRI / CT scan to check for bone spurs or arthritisarthritis

– Nerve Conduction Velocity (NCV) test: measures Nerve Conduction Velocity (NCV) test: measures speed of impulses traveling along the nervespeed of impulses traveling along the nerve

– Electromyogram (EMG). sometimes used; tests Electromyogram (EMG). sometimes used; tests whether the muscles are working properly.whether the muscles are working properly.


Treatment for Injury:Treatment for Injury:– Conservative: discontinue irritating Conservative: discontinue irritating

action, anti-inflammatory medications, action, anti-inflammatory medications, nighttime splint / elbow pad, and/or nighttime splint / elbow pad, and/or physical therapyphysical therapy

– Surgical: ulnar nerve transposition, or Surgical: ulnar nerve transposition, or removing medial epicondyle on medial removing medial epicondyle on medial elbow elbow


Ulnar Nerve Transposition

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The Elbow Ulnar Collateral Ligament Sprain Elbow Dislocation Ulnar Nerve Irritation Emily Gavlick