Download structure and function of the elbow and forearm

The Elbow and Forearm
Complex
Chapter 18
Part IV: Exercise Interventions by Body
Region
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STRUCTURE AND FUNCTION OF THE
ELBOW AND FOREARM
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Elbow Joint Characteristics and
Arthrokinematics
 Humeroulnar Articulation
 Humeroradial Articulation
 Ligaments of the Elbow
– Medial (ulnar) collateral ligament
– Lateral (radial) collateral ligament
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Forearm Joint Characteristics and
Arthrokinematics
 Proximal (superior) Radioulnar Articulation
 Distal (inferior) Radioulnar Articulation
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Muscle Function at the Elbow and
Forearm
 Primary Actions at the Elbow
– Elbow flexion
• Brachialis
• Biceps brachii
• Brachioradialis
– Elbow extension
• Triceps brachii
• Anconeus
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Muscle Function at the Elbow and
Forearm (cont'd)
 Primary Actions at the Forearm
– Forearm supination
• Supinator
• Biceps brachii
• Brachioradialis
– Forearm pronation
• Pronator teres
• Pronator quadratus
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Muscle Function at the Elbow and
Forearm (cont'd)
 Relationship of Wrist and Hand Muscles to the
Elbow
– Wrist flexor muscles
– Wrist extensor muscles
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Referred Pain and Nerve Injury in
the Elbow Region
 Common Sources of Referred Pain into the
Elbow Region
 Nerve Disorders in the Elbow Region
– Ulnar nerve
– Radial nerve
– Median nerve
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MANAGEMENT OF ELBOW AND
FOREARM DISORDERS AND
SURGERIES
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Joint Hypomobility:
Nonoperative Management
 Related Pathologies and Etiology of Symptoms
 Common Structural and Functional
Impairments
– Acute stage
– Subacute and chronic stages
 Common Activity Limitations and Participation
Restrictions
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Joint Hypomobility:
Nonoperative Management (cont'd)
 Management: Protection Phase
– Educate the patient
– Reduce effects of inflammation or synovial
effusion and protect the area
– Maintain soft tissue and joint mobility
– Maintain integrity and function of related areas
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Joint Hypomobility:
Nonoperative Management (cont'd)
 Management: Controlled Motion Phase
– Increase soft tissue and joint mobility
– Improve joint tracking of the elbow
– Improve muscle performance and functional
abilities
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Joint Hypomobility:
Nonoperative Management (cont'd)
 Management: Return to Function Phase
– Improve muscle performance
– Restore functional mobility of joints and soft
tissues
– Promote joint protection
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Radial Head Excision or
Arthroplasty
 Indications for Surgery
– Contraindications to surgery
 Procedure
– Background
• Selection of procedure
• Implant designs, materials, and fixation
– Overview of operative procedure
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Radial Head Excision or
Arthroplasty (cont'd)
 Complications
 Postoperative Management
– Immobilization
– Exercise: maximum protection phase
– Exercise: moderate and minimum protection
phases
 Outcomes
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Total Elbow Arthroplasty (TEA)
 Indications for Surgery
 Procedure
– Background
• Implant design and selection considerations
• Materials and fixation
– Operative overview
 Complications
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Total Elbow Arthroplasty (TEA)
(cont'd)
 Postoperative Management
– Immobilization
– Exercise: maximum protection phase
– Exercise: moderate and minimum protection
phases
 Outcomes
• Pain relief and patient satisfaction
• ROM and functional use of the upper extremity
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Myositis Ossificans
 Definition: Formation of bone in atypical
locations in the body
– Synonymous with heterotopic bone formation
 Etiology of Symptoms
 Management
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Overuse Syndromes: Repetitive
Trauma Syndromes
 Related Pathologies
– Lateral elbow tendinopathy (tennis elbow)
– Medial elbow tendinopathy (golfer’s elbow)
 Etiology of Symptoms
 Common Structural and Functional
Impairments
 Common Activity Limitations and Participation
Restrictions
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Nonoperative Management of
Overuse Syndromes: Protection Phase
 Decrease Pain, Edema, or Spasm
 Develop Soft Tissue and Joint Mobility
 Maintain Upper Extremity Function
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Nonoperative Management: Controlled
Motion and Return to Function Phases




Increase Muscle Flexibility and Scar Mobility
Restore Joint Tracking of the RU Joint
Improve Muscle Performance and Function
Patient Education
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EXERCISE INTERVENTIONS FOR THE
ELBOW AND FOREARM
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Exercise Techniques to Increase
Flexibility and Range of Motion (ROM)
 Manual, Mechanical, and Self-Stretching
Techniques
– To increase elbow extension
– To increase elbow flexion
– To increase forearm pronation and supination
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Exercise Techniques to Increase
Flexibility and ROM (cont'd)
 Self-Stretching Techniques: Muscles of the
Medial and Lateral Epicondyles
– To stretch the wrist extensor muscles (from the
lateral epicondyle)
– To stretch the wrist flexor muscles (from the
medial epicondyle)
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Exercises to Develop and Improve Muscle
Performance and Functional Control
 Isometric Exercises
– Multiple-angle isometric exercises
– Angle-specific training
– Alternating isometrics and rhythmic stabilization
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Exercises to Develop and Improve Muscle
Performance and Functional Control (cont'd)
 Dynamic Strengthening and Endurance
Exercises
– Elbow flexion
– Elbow extension
– Long head of the triceps with elbow extension
– Pronation and supination
– Wrist flexion and extension
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Exercises to Develop and Improve Muscle
Performance and Functional Control (cont'd)
 Functional Progression for the Elbow and
Forearm
– Diagonal patterns
– Combined pulling motions
– Combined pushing motions
– Plyometric training (stretch-shortening drills)
– Simulated tasks and activities
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Independent Learning Activities
 Critical Thinking and Discussion
 Laboratory Practice
 Case Studies
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