The Elbow

The Elbow

The Elbow Functional Anatomy & Clinical Presentation Elbow Anatomy What movements occur at the elbow? What type of joint is the elbow? Bony Anatomy Upper Arm Humerus

Forearm Ulna (medial) Radius (lateral) Bony Anatomy Anterior Supracondylar ridge Lateral epicondyle Medial epicondyle Radial head Coronoid fossa

Capitulum Trochlea Bony Anatomy Posterior Olecranon fossa Olecranon Groove for ulnar nerve Ligaments Annular ligament

360 degrees around radial head Keeps the radial head in contact with the radial notch of the ulna Ligaments Ulnar Collateral Ligament Medial side of elbow Connects medial epicondyle

to coranoid & olecranon processes Ligaments Radial (Lateral)Collateral Ligament Lateral side of elbow Connects the lateral epicondyle to the annular ligament Bony Palpations

Supracondylar ridge Lateral epicondyle Radial (lateral) collateral ligament Radial head/annular ligament Radius Olecranon process Olecranon fossa Medial epicondyle Proximal end of ulna Ulna Ulnar groove

Ulnar collateral ligament Soft Tissue Anatomy Anterior Biceps brachii Brachioradialus Brachialis Pronator Teres Soft Tissue Anatomy Biceps Bracii

Origin Shoulder Insertion Radius Action Flexes forearm, supinates forearm Soft Tissue Anatomy Brachioradialus

Origin Lateral supracondylar ridge Insertion Styloid process of radius Action

Flexes forearm Soft Tissue Anatomy Brachialis Origin Anterior, distal humerus

Insertion Coronoid process of ulna Action Flexes the elbow Soft Tissue Anatomy

Pronator Teres Origin Medial epicondyle of humerus Coronoid process of ulna Insertion Middle of lateral surface of shaft of ulna

Action Pronates the elbow Soft Tissue Anatomy Posterior Triceps Supinator Soft Tissue Anatomy

Triceps Origin Shoulder (3 origins) Insertion Olecranon process of ulna

Action Extends elbow Soft Tissue Anatomy Supinator Origin Lateral epicondyle of humerus

Insertion Proximal, lateral shaft of radius Action Supinates the elbow

Soft Tissue Anatomy Medial Wrist flexors Originate off medial epicondyle Soft Tissue Anatomy Lateral Wrist extensor muscles Originate off lateral epicondyle Soft Tissue Anatomy

Lateral Anconeus Origin Posterior part of lateral epicondyle of humerus Insertion Later olecranon process, posterior ulna Action Extends forearm (helps triceps last few degrees)

Soft Tissue Palpations Anterior Biceps brachii Brachialis Brachioradialis Pronator teres Posterior Triceps Supinator

Medial Wrist flexor muscles UCL Lateral RCL Wrist extensor muscles Range of Motion Assesses the motion of the joint bilaterally (compared to the other side)

Active Range of Motion (AROM) vs Passive Range of Motion (PROM) Normal joint motion @ elbow Flexion: 150 - 160 Extension: 0 Pronation: 70 Supination: 85 Measuring R.O.M.

Moving arm Goniometer Fulcrum Stationary arm Measuring R.O.M. Elbow Flexion Fulcrum

Lateral epicondyle Stationary arm Midline of humerus Moving arm In line with radial styloid process Resisted Range of Motion (RROM) Elbow Flexion

Put elbow in flexion Place one hand one the shoulder being tested Other hand on the anterior forearm RROM Elbow Extension Pt is seated Elbow slightly flexed One hand supports the elbow Other hand applies pressure to the proximal wrist\

Trying to push the arm into flexion RROM Pronation Pt is seated Palm is facing down One hand stabilizes below the forearm Other shakes patients hand, tries to make

hand supinate. RROM Supination Pt is seated Palm is facing up One hand stabilizes below the forearm Other shakes patients hand, tries to make hand pronate.

Injuries of the Elbow Bone Injuries MOI? Forcing arm into bending Fall on an outstretched hand Importance of prompt treatment? Damage to blood vessels and nerves could cause cell death. Epiphyseal & avulsion fractures

Ulnar dislocations Epiphyseal & Avulsion Fractures More common on the medial epicondyle or the olecranon. Growing athletes are more likely to have an epiphyseal fracture. S/S Epiphyseal pain, swelling, loss

of motion Avulsion severe pain and deformity Elbow Dislocation MOI? Fall on an outstretched hand Violent hyperextension Severe blow to the lateral elbow Most common dislocation? Posterior S/S (What is observed?) Gross deformity Olecranon process extends posteriorly Swelling, bruising Elbow Dislocation Potential complications?

Damage to the median & radial nerves Damage to blood vessels Treatment/management Splint as you found it Send to emergency room for relocation. Muscle & Tendon Injuries Elbow flexor strains Elbow extensor strains

Medial & lateral epicondylitis Elbow Flexor Strain MOI? Often includes both the shoulder & elbow (biceps) Excessive resistance elbow & shoulder flexion S/S Depends on grade (think of sprains and strains chart) Grade 1? Grade 2?

Grade 3? Pain over anterior elbow and the biceps tendon Elbow Flexor Strain Evaluation will find Weakness Extra discomfort with elbow flexion AROM, RROM PROM? (pain decreases with PROM)

Grades 1 & 2 RICE, rehabilitation Grade 3 Refer to physician/ER Elbow Extensor Strain MOI Same as flexor strain

Trying to break a fall Pain with active elbow extension Be sure to check for avulsion fractures at the olecranon process. Medial & Lateral Epicondylitis Chronic inflammation of either the medial or lateral epicondyles.

Lateral Epicondylitis (Tennis Elbow) Inflammation of the extensor tendons. S/S Minimal swelling over lateral epicondyle Pain will also be present Medial Epicondylitis AKA Little League Elbow Result of repetitive throwing Inflammation of the wrist flexors Pitch counts in Little League?

S/S Same as lateral epicondylitis UCL/RCL Sprains Ulnar collateral ligament is more prone to injury MOI? UCL valgus force (force from the lateral side) RCL varus force (force from the medial side)

S/S Pain Swelling Possibly joint laxity Special tests Scenario 1 A basketball player goes up for a lay up and has his feet taken out from under him, and tries to catch himself with an outstretched

hand. He falls to the floor and does not get up, but is holding his elbow in pain. When you get there you notice that his olecranon process is protruding posteriorly and there is already a considerable amount of swelling. Scenario 1 Answer Posterior Dislocation Splint as you found it, and refer to ER Scenario 2

A wrestler is trying to escape from a move. His hand is planted on the mat when his opponent strikes the lateral side of his elbow. He feels a small pop on the medial side, but finishes the match. After the match he approaches you with pain in both his medial and lateral elbow. He has a moderate amount of swelling over his medial epicondyle and has some laxity with a valgus stress test.

Scenario 2 Answer UCL Sprain (Grade 2) Follow up with physician Discontinue activities PRICES Scenario 3 A tennis player approaches you with elbow pain. You notice a minimal amount of swelling over her lateral epicondyle. While

palpating you notice that most of her pain is over the lateral epicondyle and into the wrist extensors. She does not remember doing anything to that elbow, but says it has been bothering her for about a week. Scenario 3 Answer Lateral Epicondylitis Tape for relief Ice after practice NSAIDS

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