The Elbow and Forearm Complex Chapter 18 Part

STRUCTURE AND FUNCTION OF THE ELBOW AND FOREARM Copyright © 2013. F. A. Davis

Elbow Joint Characteristics and Arthrokinematics § Humeroulnar Articulation § Humeroradial Articulation § Ligaments of the Elbow – Medial (ulnar) collateral ligament – Lateral (radial) collateral ligament Copyright © 2013. F. A. Davis Company

Forearm Joint Characteristics and Arthrokinematics § Proximal (superior) Radioulnar Articulation § Distal (inferior) Radioulnar

Muscle Function at the Elbow and Forearm § Primary Actions at the Elbow – Elbow flexion • Brachialis • Biceps brachii • Brachioradialis – Elbow extension • Triceps brachii • Anconeus Copyright © 2013. F. A. Davis Company

Muscle Function at the Elbow and Forearm (cont'd) § Primary Actions at the Forearm – Forearm supination • Supinator • Biceps brachii • Brachioradialis – Forearm pronation • Pronator teres • Pronator quadratus Copyright © 2013. F. A. Davis Company

Muscle Function at the Elbow and Forearm (cont'd) § Relationship of Wrist and Hand

Referred Pain and Nerve Injury in the Elbow Region § Common Sources of Referred Pain into the Elbow Region § Nerve Disorders in the Elbow Region – Ulnar nerve – Radial nerve – Median nerve Copyright © 2013. F. A. Davis Company

MANAGEMENT OF ELBOW AND FOREARM DISORDERS AND SURGERIES Copyright © 2013. F. A. Davis

Joint Hypomobility: Nonoperative Management § Related Pathologies and Etiology of Symptoms § Common Structural and Functional Impairments – Acute stage – Subacute and chronic stages § Common Activity Limitations and Participation Restrictions Copyright © 2013. F. A. Davis Company

Joint Hypomobility: Nonoperative Management (cont'd) § Management: Protection Phase – Educate the patient – Reduce effects of inflammation or synovial effusion and protect the area – Maintain soft tissue and joint mobility – Maintain integrity and function of related areas Copyright © 2013. F. A. Davis Company

Joint Hypomobility: Nonoperative Management (cont'd) § Management: Controlled Motion Phase – Increase soft tissue and joint mobility – Improve joint tracking of the elbow – Improve muscle performance and functional abilities Copyright © 2013. F. A. Davis Company

Joint Hypomobility: Nonoperative Management (cont'd) § Management: Return to Function Phase – Improve muscle performance – Restore functional mobility of joints and soft tissues – Promote joint protection Copyright © 2013. F. A. Davis Company

Radial Head Excision or Arthroplasty § Indications for Surgery – Contraindications to surgery § Procedure – Background • Selection of procedure • Implant designs, materials, and fixation – Overview of operative procedure Copyright © 2013. F. A. Davis Company

Radial Head Excision or Arthroplasty (cont'd) § Complications § Postoperative Management – Immobilization – Exercise: maximum protection phase – Exercise: moderate and minimum protection phases § Outcomes Copyright © 2013. F. A. Davis Company

Total Elbow Arthroplasty (TEA) § Indications for Surgery § Procedure – Background • Implant design and selection considerations • Materials and fixation – Operative overview § Complications Copyright © 2013. F. A. Davis Company

Total Elbow Arthroplasty (TEA) (cont'd) § Postoperative Management – Immobilization – Exercise: maximum protection phase – Exercise: moderate and minimum protection phases § Outcomes • Pain relief and patient satisfaction • ROM and functional use of the upper extremity Copyright © 2013. F. A. Davis Company

Myositis Ossificans § Definition: Formation of bone in atypical locations in the body – Synonymous with heterotopic bone formation § Etiology of Symptoms § Management Copyright © 2013. F. A. Davis Company

Overuse Syndromes: Repetitive Trauma Syndromes § Related Pathologies – Lateral elbow tendinopathy (tennis elbow) – Medial elbow tendinopathy (golfer’s elbow) § Etiology of Symptoms § Common Structural and Functional Impairments § Common Activity Limitations and Participation Restrictions Copyright © 2013. F. A. Davis Company

Nonoperative Management of Overuse Syndromes: Protection Phase § Decrease Pain, Edema, or Spasm § Develop Soft Tissue and Joint Mobility § Maintain Upper Extremity Function Copyright © 2013. F. A. Davis Company

Nonoperative Management: Controlled Motion and Return to Function Phases § § Increase Muscle Flexibility and Scar Mobility Restore Joint Tracking of the RU Joint Improve Muscle Performance and Function Patient Education Copyright © 2013. F. A. Davis Company

EXERCISE INTERVENTIONS FOR THE ELBOW AND FOREARM Copyright © 2013. F. A. Davis Company

Exercise Techniques to Increase Flexibility and Range of Motion (ROM) § Manual, Mechanical, and Self-Stretching Techniques – To increase elbow extension – To increase elbow flexion – To increase forearm pronation and supination Copyright © 2013. F. A. Davis Company

Exercise Techniques to Increase Flexibility and ROM (cont'd) § Self-Stretching Techniques: Muscles of the Medial and Lateral Epicondyles – To stretch the wrist extensor muscles (from the lateral epicondyle) – To stretch the wrist flexor muscles (from the medial epicondyle) Copyright © 2013. F. A. Davis Company

Exercises to Develop and Improve Muscle Performance and Functional Control § Isometric Exercises – Multiple-angle isometric exercises – Angle-specific training – Alternating isometrics and rhythmic stabilization Copyright © 2013. F. A. Davis Company

Exercises to Develop and Improve Muscle Performance and Functional Control (cont'd) § Dynamic Strengthening and Endurance Exercises – Elbow flexion – Elbow extension – Long head of the triceps with elbow extension – Pronation and supination – Wrist flexion and extension Copyright © 2013. F. A. Davis Company

Exercises to Develop and Improve Muscle Performance and Functional Control (cont'd) § Functional Progression for the Elbow and Forearm – Diagonal patterns – Combined pulling motions – Combined pushing motions – Plyometric training (stretch-shortening drills) – Simulated tasks and activities Copyright © 2013. F. A. Davis Company