The Elbow

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The Elbow

• Chapter 23

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Elbow Anatomy

• http//www.elsevier.com/homepage/sab/eia/v2d3/fram
  e.html
• Bones
• Articulations
• Ligaments and Capsule
• Capsule is covered by biceps anteriorly and
  triceps posteriorly
• Capsule reinforced by radial (does not attached
  to radius) and ulnar collateral ligaments
• Annular ligament stabilizes radial head
  (encircles radius)
• Synovium and Bursa
• Bicipital tuberosity most important bursae
• Olecranon bursae

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Elbow Anatomy

• Musculature
• Biceps brachii, brachialis, brachioradialis
  (flexion)
• Triceps brachii (extension)
• Biceps brachii and supinator (supination)
• Pronator teres and pronator quadratus (pronation)
• Nerve Supply
• C5-T1 stems musculocutaneous, radial median
• Blood Supply
• Brachial and median arteries
• Functional Anatomy
• Flexion and extension sagital plane
• Supination and pronation transverse plane

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Preventing/AssessingElbow Injuries

• History
• Observation
• 45degree flexion, epicondyles and olecranon
  should form triangle)
• Palpation (bony and soft tissue)
• Special Tests
• Tinel sign- taps ulnar notch
• Test for capsular injury elbow 45 degrees
  flexion, wrist flexed then extended pos. if pain
  in elbow
• Valgus (MCL)and Varus(LCL) tests
• Medial and Lateral Epicondylitis Test- elbow 45
  degrees flexion lateral pain with resisted
  wrist extension medial pain with resisted wrist
  flexion
• Pinch Grip Test- thumb index finger inability
  to do so entrapment interroseous nerve b/t
  pronators
• Pronator Test syndrome test- resisted pronation
  with elbow flexed 45 degrees
• Functional Evaluation

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Recognition and Management of Injuries

• Contusion
• Etiology (direct blow)
• Signs and Symptoms(rapid swelling,ROM pain)
• Management (RICE, X-ray r/o fx)
• Olecranon Bursitis
• Etiology (direct blow)
• Signs and Symptoms
• Management (RICE, rehab, aspiration)
• Strains
• Etiology (FOA with hyperextension)
• Signs and Symptoms (A RROM painful)
• Management (RICE, sling, rehab)

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Recognition and Management of Injuries

• Elbow Sprains
• Etiology (hyperextension or valgus force)
• Signs and Symptoms (pain, inability to
  throw/grasp, point tender)
• Management (RICE, sling, ROM)
• Concern- bone proliferation if too agressive
• Lateral Epicondylitis
• Etiology (repetitive motion, hyperextension)
• Signs and Symptoms (pain, point tenderness)
• Management (RICE, NSAIDs, rehab, bracing)

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Recognition and Management of Injuries

• Medial Epicondylitis
• Etiology (rep. microtrauma with wrist flexion)
• Signs and Symptoms (pain, point tenderness)
• Management (RICE, NSAIDs, rehab, bracing)
• Elbow Osteochondritis Dissecans
• Etiology (unknown impaired blood supply
  fragmentation joint separation of
  radiocapitular joint repetitive motions) common
  in 10-15yrs old
• Signs and Symptoms (pain, locking of joint,
  crepitus, swelling)
• Management (restricted activity, NSAIDs, Splint,
  surgical removal of loose bodies)

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Recognition and Management of Injuries

• Little League Elbow
• Etiology (repetitive throwing includes many
  disorders of growth)
• Signs and Symptoms(gradual onset flexion
  contracture, locking/catching sensation, decrease
  ROM
• Management (RICE, NSAIDs, gentle stretching,
  surgical removal of loose bodies PRN)
• Cubital Tunnel Syndrome
• Etiology Traction from valgus force, irregular
  tunnel, ulnar nerve subluxation, progressive
  compression of nerve)
• Signs and Symptoms(paresthesia, pain medially)
• Management (rest, immobilization, NSAIDs)

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Recognition and Management of Injuries

• Elbow Dislocation
• Etiology (FOA with hyperextension or twist with
  flexion)
• Signs and Symptoms (may displace anterior,
  posterior, lateral)
• rupture most stabilizing structures,
  complications median and radial nerve and blood
  vessels, radial head fracture common
• Management (RICE, Sling, referral to doctor for
  reduction)
• DO NOT TRY TO REDUCE!!!!!
• If you did, it would be traction and passively
  flex or attempt pronation - debated

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Recognition and Management of Injuries

• Fracture of the Elbow
• Etiology (FOA, elbow flexion, direct blow)
• Gunstock deformitycondylar fracture at elbow
  resembles gunstock when extended)
• Signs and Symptoms (visible deformity, swelling
  hemorrhage, muscle spasm)
• Management (surgery, splint)
• Volkmanns Contracture
• Etiology (ischemic necrosis of forearm muscles
  and tissue caused by damaged blood flow
• Signs and Symptoms (pain in forearm with P
  extension of fingers, cessation of pulses)
• Management (monitor closely, wrap/cast,
  elevation)

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Rehabilitation Principles for the Elbow

• General Body Conditioning
• Joint mobilization
• Flexibility
• Strengthening
• Functional Progression
• Return to Activity
• Protective Taping and Bracing