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ELBOW DISLOCATIONS ELBOW DISLOCATIONS When discussing elbow dislocations, we talk about the direction that the ulna exited from under the humerus. POSTERIOR DISLOCATION HYPEREXTENSION FRACTURED HUMERUS Brachial Artery Median Nerve HYPEREXTENSION INITIAL ASSESSMENT OF THE ELBOW (Deformity) • Check radial pulse and instrinsics of the hand. • Palpate supracondylar ridge of humerus. Deformity of the Elbow (2) • Be aware of shock. • Call ambulance (if you stand them they go vaso-vagal). • Give the athlete space. SPRAINS OF THE ELBOW Valgus stress affecting the medial collateral ligaments. Varus stress affecting the lateral collateral ligaments. MUSCLE FUNCTION AROUND THE ELBOW Medial Epicondyle: Pronation of the forearm, wrist flexion, elbow flexion. Lateral Epicondyle: Supination of the forearm, wrist extension, elbow flexion. LATERAL EPICONDYLITIS TENNIS ELBOW LATERAL ASPECT THE ELBOW Lateral Epicondyle Common Extensor Attachment OF TENNIS ELBOW Signs and Symptoms: • Pain before, during and after activity. • Pain on palpation. • Pain on grasping, squeezing and pinching. INITIAL TREATMENTS • Ice massage to the area. • Stretching. • Strengthening. • Modification of activity. • Changes in equipment. Pronate forearm, extend the elbow, flex the wrist, (flex the fingers). With palm down grasp a light weight (2-4 kg.). Extend the wrist. 3 sets of 15 reps; then increase weight. Reduce Elbow Stress Medial Epicondylitis (Golfer’s Elbow) MEDIAL EPICONDYLITIS Pronation, wrist flexion and elbow flexion. SIGNS AND SYMPTOMS • Pain on use of affected muscles. • May have slight swelling. • Activity makes it worse. INITIAL TREATMENTS • Icing or ice massage. • Stretching. • Strengthening. • Equipment change or modification. Extend the fingers, extend the wrist and extend the elbow. Grasp the weight with the palm up. Flex the wrist to the maximum and let it down into extension. (3 set of 15 reps starting with 4 kg.) BRACES ? FRACTURED RADIUS FRACTURED RADIUS • Pain on radial side of forearm. • Local tenderness. • Passive forearm pronation painful. • Swelling? FRACTURED SCAPHOID Scaphoid Fracture Fall on the extended wrist P.O.P. in anatomical snuffbox, may have swelling Reduced painful wrist extension Pain on radial deviation of the hand. Ulnar Collateral Ligament of the first metacarpalphalangeal joint. FORCED VALGUS MALLET FINGER F O R C E Avulsion of Extensor Digitorum Longus Tendon. MALLET FINGER Distal phalanx falls into flexion; unable to hold the finger straight when passively extended. Pain on palpation of the finger nail bed. Medical referral.