The Elbow Chapter 23 Elbow Anatomy n n

The Elbow Chapter 23

Elbow Anatomy n n http: //www. elsevier. com/homepage/sab/eia/v 2 d 3/frame. 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) n Synovium and Bursa – Bicipital tuberosity – most important bursae – Olecranon bursae

Elbow Anatomy n Musculature – – n Biceps brachii, brachialis, brachioradialis (flexion) Triceps brachii (extension) Biceps brachii and supinator (supination) Pronator teres and pronator quadratus (pronation) Nerve Supply – C 5 -T 1 stems; musculocutaneous, radial & median n Blood Supply – Brachial and median arteries n Functional Anatomy – Flexion and extension – sagital plane – Supination and pronation – transverse plane

Preventing/Assessing Elbow Injuries n n History Observation – 45 degree flexion, epicondyles and olecranon should form triangle) n n n 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

Recognition and Management of Injuries n n n 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)

n 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 n Lateral Epicondylitis – Etiology (repetitive motion, hyperextension) – Signs and Symptoms (pain, point tenderness) – Management (RICE, NSAIDs, rehab, bracing)

Recognition and Management of Injuries n n 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 -15 yrs old – Signs and Symptoms (pain, locking of joint, crepitus, swelling) – Management (restricted activity, NSAIDs, Splint, surgical removal of loose bodies)

n n 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)

Recognition and Management of Injuries n 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

Recognition and Management of Injuries n Fracture of the Elbow – Etiology (FOA, elbow flexion, direct blow) • Gunstock deformity: condylar fracture at elbow resembles gunstock when extended) n – Signs and Symptoms (visible deformity, swelling hemorrhage, muscle spasm) – Management (surgery, splint) Volkmann’s 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)

Rehabilitation Principles for the Elbow n n n n General Body Conditioning Joint mobilization Flexibility Strengthening Functional Progression Return to Activity Protective Taping and Bracing