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ANATOMY AND INJURIES
OF ELBOW
WHAT MOTIONS OCCUR AT THE
ELBOW?
THE ELBOW
BONY ANATOMY OF THE ELBOW
Humerus
Lateral Epicondyle
Medial Epicondyle
Olecronon Process
Trochlea
Capitulum
Ulna
Radius
ELBOW ARTICULATIONS
 Joints

Humeroradial


Humeroulnar


Radial head w/
capitulum of humerus
Olecranon process of
ulna w/ trochlea of
humerus
Proximal Radioulnar

Radial head w/ radial
notch of ulna
MUSCLES – FLEXORS AND SUPINATORS
Biceps Brachii
Brachialis
Brachioradialis
MUSCLES OF THE ELBOW
Triceps Brachii
Anconeus
MUSCLES OF THE ELBOW AND FOREARM
Supinator
Pronator Quadratus
Pronator Teres
NERVES AND BLOOD SUPPLY
 Nerves – 3 primary nerves at the elbow
Median nerve- middle of elbow- C7
 Ulnar nerve- “funny bone”- C8
 Radial nerve- thumb and pinky- C6

 Arteries

Brachial- middle


Splits into radial and ulnar
Medial- medial
 Veins
Superficial
 Close to the skin in front of the elbow

ELBOW LIGAMENTS

A capsule surrounds each joint in the body

Medial (ulnar) collateral ligament



Lateral (radial) collateral ligament



Medial epicondyle to olecranon
Prevents valgus force
Radius up to lateral epicondyle head
Prevents varus force
Annular ligament


Radial head to ulna
Keeps radial head in place (rotation)
LIGAMENTS OF ELBOW
ELBOW INJURIES
ELBOW TRAUMA
http://www.youtube.com/watch?v=d4os7Wa8gtM
SPRAINS

Ligament/Capsule under ↑ stress
 Excessive motion
 Hyperextension
Valgus
 Varus

Partial tear
 Types
 Hyperextension

Falling on an extended
arm
 Injury to anterior capsule


UCL
Injury to primary stabilizing
unit of elbow
 Tommy John Surgery

 Complete
tear
STRAINS

Partial tear of muscle fibers

Result from:

Inadequate warm-up

Excessive training past
point of fatigue

Inadequate rehabilitation
of previous muscular
injuries
 S/S:

Point tenderness

↑ pain w/ passive elbow
extension and resisted
elbow flexion

weakness
EPICONDYLITIS
 Common injury, chronic condition
 MOI:
overuse injury
 Prolonged stress may result in stress or avulsion fracture
 Pattern of injury:
 Poor technique
 Fatigue
 Overuse
 Two types:
 Medial
 Lateral
MEDIAL EPICONDYLITIS

A.k.a Golfer’s Elbow

Repeated, medial, tension/lateral
compression (valgus) forces placed
on the arm


During acceleration phase
S/S:

Swelling/pain

Possible ecchymosis

Pt. tenderness over
humeroulnar joint

Pain over medial epicondyle

↑ pain w/ resisted wrist flexion
and forearm pronation

↑ pain w/ valgus stress at 30°
flexion

Management

Ice/NSAIDs

Immobilization for 2-3
weeks w/ wrist in slight
flexion

EMS, US

Work early ROM

Gentle ROM
isometric→isotonic


Wrist flexors
Bracing
LATERAL EPICONDYLITIS

A.k.a. Common Extensor
Tendinitis/Tennis Elbow

Most common overuse injury

Eccentric loading of extensor
muscles



Predominately Extensor carpi
radialis brevis

During deceleration phase

Pain anterior or just distal to lateral
epicondyle
 Radiating pain into extensors
 Pain comes and goes
 Comes back more severe w/
repitition
 Pain increases w/ resisted wrist
extension

Faulty mechanics

Leading w/ elbow

Off-center hits in racquet sports
Poorly fitted equipment

Handle size

String tension
S/S:

Management
Same as Medial epicondylitis
 Increase strength, endurance, and
flexibility of extensor muscle
 Wear counterforce/neoprene elbow
sleeve

OLECRANON BURSITIS

Inflammation of the
subcutaneous olecranon bursa

Acute/Chronic

Largest bursa in elbow


Facilitates smooth
gliding of the skin over
the olecranon process
during elbow flexion and
extension
Superficial

Predisposed to direct
macrotrauma or
cumulative microtrauma
 Tx:
 NO COMPRESSION!
 Cryotherapy
 NSAIDS

DISLOCATION
Most common
traumatic injury

Longitudinal traction of an extended and pronated upper extremity



i.e. Small child swung by arms

Immature/weakened annular ligament

Outstretched hand w/ elbow in a position of hyperextension or severe twist while
in a flexed position
Associated fractures:

Medial epicondyle

Radial head

Coronoid process

Olecranon process
Ulna/radius displacement

Posteriorly (most common for both)

Anteriorly

Laterally
DISLOCATIONS

S/S:

Obvious deformity, loss of
ROM

 Management

EMERGENCY!!!!
Rupturing and tearing
stabilizing ligamentous
tissue

Ice, compression, sling,
and refer to physician
IMMEDIATELY!!!

Profuse hemorrhage and
swelling

NEVER reduce

Severe pain and disability

Injury to median and radial
nerves, major blood vessels
and arteries
http://www.youtube.com/watch?v=k_mw704tezU
http://vids.myspace.com/index.cfm?fuseaction=vids.individual&videoID=968875930
http://www.youtube.com/watch?v=XZiLPZXjZd4

Olecranon fossa, olecranon process, medial
epicondyle, lateral epicondyle, cubital tunnel,,
radius, ulna, humerus, bicep, tricep, flexor
muscles, extensor muscles, brachioradialis
PALPATIONS
OLECRANON FOSSA
OLECRANON PROCESS,
BICEP, TRICEP, LAT
EPICONDYLE
MEDIAL EPICONDYLE
CUBITAL TUNNEL
RADIUS
ULNA
FLEXOR MUSCLES
EXTENSOR MUSCLES
HUMERUS
BRACHIORADIALIS

AROM Flexion, AROM Extension, AROM
Pronation, AROM Supination, MMT Flexion, MMT
extension, MMT pronation, MMT Supination
ROM

Steps
Athlete is sitting

Examiner stabilizes the involved elbow while palpating along the
lateral epicondyle

With closed fist, the athlete pronates and radially deviates the
forearm and extends the wrist against the examiner's resistance

Positive Test

Pain along the lateral epicondyle region of the humerus or
objective muscle weakness as a result of complaints of
discomfort

Positive Test Implications

Lateral epicondylitis

https://www.youtube.com/watch?v=ehYTeDN4usc
LATERAL EPICONDYLITIS
TEST/RESISTIVE TENNIS ELBOW
TEST/COZEN'S TEST

Steps
Athlete is sitting with elbow fully
extended

Examiner passively pronates the forearm and
flexes the athlete's wrist

Positive Test

Pain along the lateral epicondyle region of the
humerus

Positive Test Implications

Lateral epicondylitis
LATERAL EPICONDYLITIS
TEST/PASSIVE TENNIS ELBOW TEST

Steps
Athlete is sitting or standing and makes a fist with the
involved side

Examiner faces the athlete and palpates along the medial
epicondyle with one hand and grasps the athlete's wrist with the
other hand

Examiner passively supinates the forearm and extends the elbow,
wrist and fingers

Positive Test

Complaints of discomfort along the medial aspect of the elbow

Positive Test Implications

Medial epicondylitis

https://www.youtube.com/watch?v=7rBCpk3jFaQ
MEDIAL EPICONDYLITIS
TEST/GOLFER'S ELBOW TEST

Steps
Athlete is sitting or standing

Athlete maximally flexes the elbow and holds the position for 3 to
5 minutes

Positive Test

Radiating pain into the median nerve distribution in the athlete's
arm and/or hand

Positive Test Implications

Cubital fossa syndrome

https://www.youtube.com/watch?v=wMIlm9SULvo
ELBOW FLEXION TEST

Steps
Athlete is sitting with elbow flexed to 20 to 30 degrees

Examiner stands with the distal hand around the athlete's wrist
(laterally) and the proximal hand over the athlete's elbow joint
(medially)

Examiner stabilizes the wrist and applies a varus stress to the
elbow with the proximal hand

Positive Test

Lateral elbow pain and/or increased varus movement with
diminished or absent endpoint

Positive Test Implications

Radial (lateral) collateral ligament sprain

https://www.youtube.com/watch?v=jUKxFwh5QjU
VARUS STRESS TEST

Steps
Athlete is sitting with the elbow flexed to 20 to 30
degrees

Examiner stands with distal hand around the athlete's wrist
(medially) and the proximal hand over the athlete's elbow joint
(laterally)

Examiner stabilizes the wrist and applies a valgus stress to the
elbow with the proximal hand

Positive Test

Medial elbow pain and/or increased valgus movement with a
diminished or absent endpoint

Positive Test Implications: Ulnar (medial) collateral ligament
sprain

https://www.youtube.com/watch?v=KXQxH0UTn-8
VALGUS STRESS TEST

Steps
Athlete is sitting with the elbow in slight flexion

Examiner grasps athlete's wrist (laterally) with distal hand

Examiner stabilizes the wrist and taps on the ulnar nerve in the
ulnar notch with the index finger

Positive Test

Tingling along the ulnar distribution of the forearm, hand and
fingers

Positive Test Implications

Ulnar nerve compromise

https://www.youtube.com/watch?v=CPJpT_C0I4k
TINEL'S SIGN TEST

Steps
Athlete is sitting or standing

Examiner instructs athlete to pinch the tips of the thumb and
index finger together

Positive Test

Inability to touch the tips of the thumb and index finger
together or touching the pads of the thumb and index finger
together

Positive Test Implications

Pathology of the anterior interosseous nerve between the two
heads of the pronator muscle
PINCH GRIP TEST