Download Elbow

Unit 4:Understanding AthleticRelated Injuries to the Upper
Extremity
Elbow Injuries
David Smith
Objectives
Describe the basic anatomy of the
arm and elbow
Explain common arm and elbow
injuries that occur with athletic
participation
Identify common signs and
symptoms of arm and elbow injuries
Explain common tx parameters
performed by an ATC for elbow
injuries
Anatomy of the elbow
Hinge joint involving three major
bones
– Humerus, ulna, and radius
Ulna is hooked to humerus to form a
tight joint
Radius rests against the humerus
and is able to rotate
– Allowing for pronation and supination
Ligaments
Joint capsule
– Like shoulder, surrounds the elbow
Gives general stability
Ulnar collateral ligament
– Helps stabilize medial aspect of elbow
Radial collateral ligament
– Helps stabilize the lateral aspect of
elbow
Ligaments cont.
Ligaments cont...
Annular ligament
– Helps hold radius and ulna together
near elbow joint
Interosseus membrane
– Joins the radius and ulna together,
keeps bones from separating
Muscles
Triceps brachii
– Elbow extension
Biceps brachii
– Elbow flexion
Wrist flexors
– Attach at medial epicondyle of humerus
Wrist extendors
– Attach at lateral epicondyle of humerus
Muscles cont...
Very important to check distal pulse
and sensations to check for blood
vessel or nerve damage
– Several small nerves run through the
small spacesand grooves around the
elbow on their way to the hand
Distal Radial Pulse
Preventing Elbow Injuries
Not frequently injured
Usually overuse injuries
– chronic inflammation and pain
Tennis and baseball common sports
Strengthen and stretch larger
muscles, ignore smaller muscles
– Wrist flexors and extensors
Preventing Elbow Injuries
Proper equipment
– Excessive stress on elbow musculature
can result in using a racket with a grip
that is too small
Alter activities
– Taking breaks after long throwing days
if playing baseball
Treating Elbow Injuries and
Conditions
Ligament Injuries
– 1-3° Sprains
Ulnar collateral ligament
Radial collateral ligament
Ligament Injuries
Ulnar Collateral Ligament Sprain
– Most commonly injured due to stress
placed on elbow by hitting tennis ball
– Direct blow may also cause disruption pf
UCL
Ligament Injuries
Valgus Stress
– medial part of joint would separate or
spread apart as the forearm moves
laterally
Common in contact sports or if falling on
outstretched arm
Sprain characterized by medial elbow pn
and swelling, laxity.
– Tx: RICE, splinting, r/o fx by referral for
x-ray. Rehab includes strengthening
wrist flexors- help to provide stability
Ligament Injuries
Radial Collateral Ligament Sprain
– Rare
– Characteristics same as UCL sprain but
on the lateral aspect
– TX: Focus on strengthening the wrist
extensors, provide dynamic stability
Muscle and Tendon Injuries
Caused by excessive resistive forces
or overuse
Muscle and Tendon Injuries
Elbow Flexor Strain
– Loaded movement, elbow and shoulder
together
Two joint muscle- movement created at
more than one joint
– Characterized by pain and swelling,
weakness
– TX: RICE, mild stretching and
strengthening
Muscle and Tendon Injuries
Elbow Extensor Strain
– Excessive resistance to the triceps
Falling and attempting to break fall with an
outstretched arm
– Assess carefully, can be an avulsion fracture of
ulna
– TX: Same as elbow flexor strain
Muscle and Tendon Injuries
Wrist flexor strain
– Can result from excessive resistance
during wrist flexion movements or
overuse
– Pain over medial epicondyle or humerus
or in the front of the forearm
– TX: RICE and modified activity,
stretching and strengthening
Muscle and Tendon Injuries
Wrist extensor strains
– Excessive resistance during wrist
extension or overuse
– Pain over lateral epicondyle of humerus
– TX: Same as wrist flexion
Muscle and Tendon Injuries
Lateral epicondylitis
– Tennis elbow
result of poor mechanics and continual use
over a long period of time
– wrist extensor tendons at lateral epicondyle of the
humerus become chronically inflamed
Pain over lateral epicondyle and minimal
swelling
TX: reduce pain and inflammation, RICE,
support, limiting activity, mild stretching
and strengthening, medication
Muscle and Tendon Injuries
Medial Epicondylitis
– Little League Elbow
– Inflammation of wrist flexor tendons
result of repetitive throwing
– Pain over medial epicondyle
– TX: Same as lateral epicondylitis and
decrease throwing
monitor ulnar nerve- watch for
numbness, tingling, or excessive pain
Bone Injuries
Bone fx to distal end of humerus
– Not common
– Due to very powerful mechanisms of injury
hand planted on ground and someone forcing the
arm into excessive side bending
– Wrestling?
Fx between condyles
– Direct impact
BOTH ARE A MEDICAL EMERGENCY DUE TO
COMPRESSION ON NERVE OR ARTERY
Fracture Distal end of Humerus
Fracture of Condyles
Bone Injuries
Epiphyseal and Avulsion fx
– More common on medial epicondyle or
olecranon aspect
Severe pn and deformity- avulsion fx
Ulna Dislocation
– Fairly tight joint
– Very traumatic
– Violent hyperextension or a severe blow
Obvious deformity, medical emergency
Avulsion Fracture
Bone Fragment in Elbow Joint
Other common injuries
Hyperextension
– Fall on outstretched arm or receive blow
to elbow
Problems:
– Sprain the ligaments at the anterior aspect of
elbow
– Strain the musculature at the anterior aspect of
elbow
– Receive a painful bony compression if the
olecranon process impacts the humerus
– TX: RICE, or referral, hyperextension
tape job
Other common injuries
Olecranon Bursitis
– fluid to build up at the tip of the elbow
from a traumatic force (usually a blunt
blow to tip of elbow)
– TX: Compression wraps, massage, stim,
US, protect with padding,
MD to drain the fluid (???)
Elbow Dislocation
Reduce if medical personnel is
available
If no medical personnel present
needs to ER for x-rays and reduction
May compromise nerves and
arteries.
Check distal pulse after reduction