Elbow Sports med 2 Movements Carrying angle Females

Elbow Sports med 2

Movements • Carrying angle – Females 10 -15 degrees, Males 5 degrees • Flexion – 145 degrees • Extension • Pronation – 90 degrees • Supination – 90 degrees

Articulations • Consists of 3 separate joints – Humeroulnar – Humeroradial – Proximal radioulnar

Ligaments and Bursae • Ulnar collateral ligament – Prevents valgus forces • Radial collateral ligament – Prevents varus forces (uncommon) • Annular ligament – Stabilizes head and neck of radius (strong) • Olecranon bursa – Between olecranon process and skin

Musculature • Biceps Brachii, Brachialis, brachioradialis – Elbow flexion • Triceps brachii, anconeus – Elbow extension • Pronator teres, supinator – Pronation and supination

Nerve/Blood Supply • Median Nerve • Radial Nerve • Ulnar Nerve – Funny bone • Radial Artery • Ulnar Artery

Assessment • History – Land on tip of bent elbow? (most common MOI) – Overuse from throwing? – Over extension? – Location and duration of pain? – Positions that increase or decrease pain? – Previous elbow injuries? – Locking or crepitation w/movement?

Assessment • Observations – Deformities, swelling – Carrying angle • Too great or little could = epiphyseal fx – Decreased flexion or extension – 45 degree angle, posterior observation of epicondyles and olecranon process to make isosceles triangle

Assessment • Bony Palpations – – – Medial epicondyle Lateral epicondyle Olecranon process Radial head Radius ulna • Soft tissue palpations – Anterior • • Biceps brachii Brachialis Brachioradialis Pronater teres – Posterior • Triceps • supinator – Medial • Ulnar collateral ligament – Lateral • Radial collateral ligament • Annular ligament

Strains • MOI – FOOSHA = hyperextension • S/S – AROM or RROM= pain – Point tender • TX – RICE possibly a sling – Cryotherapy, US, rehab – X-ray if severe

• MOI Elbow Dislocation – FOOSHA, or severe twist with flexion – Ulna and radius are pushed posterior (most common) • S/S – Severe pain, swelling and disability – Deformity – Probable radial head fx • TX – Ice, sling, check circulation – Refer for x-ray and reduction

Elbow Fractures • MOI – FOOSHA, or direct blow • S/S – Possible visible deformity – Hemorrhage, muscle spasm, and swelling • TX – Stabilize, monitor distal pulse – Refer for x-ray, splint 6 -8 weeks

Elbow MMTs • • Flexion Extension Pronation Supination http: //youtu. be/p. N_x 3 X 3 PNrs http: //youtu. be/3 NGb. Z 2 l. Ud. DI

UCL sprain • MOI – Valgus force from repetitive trauma – Tennis, golfing, throwing • S/S – Pn. On medial aspect of elbow – Parasthesia, and laxity • TX – Rest, NSAIDs, strengthening, correct form

• Procedure Valgus Test – Athlete sits with elbow flexed at 20 degrees. Evaluator grasps athletes wrist and lateral elbow applying a valgus force. • Positive Test – Pn at the medial aspect of elbow, laxity – Ulnar (medial) collateral ligament sprain

Varus Test • Procedure – Athlete sits with elbow flexed at 20 degrees. Evaluator grasps athletes wrist and medial elbow applying a varus force. • Positive test – Lateral elbow pn, and laxity – Radial (lateral) collateral ligament sprain

Volkmann’s Contracture • MOI – Complication of serious elbow injury – Muscle spasm, swelling, or bone pressure on the brachial artery • S/S – Pn. In the forearm that is worse when fingers are passively extended – Decreased or absent brachial and radial pulses • TX – Removal of constricting casts, wraps or braces, elevation – Can become permanent

Tinel’s sign • Procedure – Patient is seated, elbow in flexion – Evaluator grasps wrist and taps the ulnar notch with reflex hammer • Positive Test – Athlete complains of tingling sensation along forearm, hand fingers – Indicates ulnar nerve compromise http: //www. medvideo. us/watch_video. php? v=A 2 YU 3 N 52 O 8 ON

Epicondylitis • MOI – Lateral (tennis elbow) • Tennis, baseball, swimming, golfing • Repeated forearm flexion and extension – Medial (pitchers or golfers elbow) • S/S • Repetitive wrist flexion, valgus stress on elbow – Aching pn. During and after activity – decreased ROM – hand weakness • TX – RICE, NSAIDS – ROM, PRE, Deep friction massage – Elbow sleeve or band just below the bend of the elbow

Epicondylitis Tests • Procedure – Elbow is flexed to 45 degrees – Wrist extension is resisted, increases pn at lateral epicondyle – Wrist flexion is resisted, increases pn at medial epicondyle • Positive Test – Pn at either epicondyle

Olecranon Bursitis • MOI – Direct blow • S/S – Pain, severe swelling, point tenderness • TX – Acute= ice, compression – Chronic = compression, modalities, aspiration – Padding for play