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Download Anatomy and Injuries of Elbow
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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
