Transcript The Elbow
Functional Anatomy & Clinical Presentation
Elbow Anatomy
What movements occur at the elbow?
What type of joint is the elbow?
Bony Anatomy
Upper Arm
Humerus
Forearm
Ulna (medial)
Radius (lateral)
Bony Anatomy
Anterior
Supracondylar ridge
Lateral epicondyle
Medial epicondyle
Radial head
Coronoid fossa
Capitulum
Trochlea
Bony Anatomy
Posterior
Olecranon fossa
Olecranon
Groove for ulnar nerve
Ligaments
Annular ligament
360 degrees around
radial head
Keeps the radial head in
contact with the radial
notch of the ulna
Ligaments
Ulnar Collateral Ligament
Medial side of elbow
Connects medial epicondyle
to coranoid & olecranon
processes
Ligaments
Radial (Lateral)Collateral Ligament
Lateral side of elbow
Connects the lateral
epicondyle to the annular
ligament
Bony Palpations
Supracondylar ridge
Lateral epicondyle
Radial (lateral) collateral ligament
Radial head/annular ligament
Radius
Olecranon process
Olecranon fossa
Medial epicondyle
Proximal end of ulna
Ulna
Ulnar groove
Ulnar collateral ligament
Soft Tissue Anatomy
Anterior
Biceps brachii
Brachioradialus
Brachialis
Pronator Teres
Soft Tissue Anatomy
Biceps Bracii
Origin
Shoulder
Insertion
Radius
Action
Flexes forearm, supinates forearm
Soft Tissue Anatomy
Brachioradialus
Origin
Lateral supracondylar ridge
Insertion
Styloid process of radius
Action
Flexes forearm
Soft Tissue Anatomy
Brachialis
Origin
Anterior, distal humerus
Insertion
Coronoid process of ulna
Action
Flexes the elbow
Soft Tissue Anatomy
Pronator Teres
Origin
Medial epicondyle of humerus
Coronoid process of ulna
Insertion
Middle of lateral surface of shaft of ulna
Action
Pronates the elbow
Soft Tissue Anatomy
Posterior
Triceps
Supinator
Soft Tissue Anatomy
Triceps
Origin
Shoulder (3 origins)
Insertion
Olecranon process of ulna
Action
Extends elbow
Soft Tissue Anatomy
Supinator
Origin
Lateral epicondyle of humerus
Insertion
Proximal, lateral shaft of radius
Action
Supinates the elbow
Soft Tissue Anatomy
Medial
Wrist flexors
Originate off medial epicondyle
Soft Tissue Anatomy
Lateral
Wrist extensor muscles
Originate off lateral epicondyle
Soft Tissue Anatomy
Lateral
Anconeus
Origin
Posterior part of lateral epicondyle of humerus
Insertion
Later olecranon process, posterior ulna
Action
Extends forearm (helps triceps last few degrees)
Soft Tissue Palpations
Anterior
Biceps brachii
Brachialis
Brachioradialis
Pronator teres
Posterior
Triceps
Supinator
Medial
Wrist flexor muscles
UCL
Lateral
RCL
Wrist extensor muscles
Range of Motion
Assesses the motion of the joint bilaterally
(compared to the other side)
Active Range of Motion (AROM) vs Passive Range of
Motion (PROM)
Normal joint motion @ elbow
Flexion: 150 - 160
Extension: 0
Pronation: 70
Supination: 85
Measuring R.O.M.
Moving
arm
Goniometer
Fulcrum
Stationary arm
Measuring R.O.M.
Elbow Flexion
Fulcrum
Lateral epicondyle
Stationary arm
Midline of humerus
Moving arm
In line with radial styloid process
Resisted Range of Motion (RROM)
Elbow Flexion
Put elbow in flexion
Place one hand one the shoulder being tested
Other hand on the anterior forearm
RROM
Elbow Extension
Pt is seated
Elbow slightly flexed
One hand supports the elbow
Other hand applies pressure to the proximal wrist\
Trying to push the arm into flexion
RROM
Pronation
Pt is seated
Palm is facing down
One hand stabilizes below the forearm
Other “shakes patient’s hand”, tries to make hand
supinate.
RROM
Supination
Pt is seated
Palm is facing up
One hand stabilizes below the forearm
Other “shakes patient’s hand”, tries to make hand
pronate.
Injuries of the Elbow
Bone Injuries
MOI?
Forcing arm into bending
Fall on an outstretched hand
Importance of prompt treatment?
Damage to blood vessels and nerves could cause cell death.
Epiphyseal & avulsion fractures
Ulnar dislocations
Epiphyseal & Avulsion Fractures
More common on the medial epicondyle or the olecranon.
Growing athletes are more likely to have an epiphyseal
fracture.
S/S
Epiphyseal – pain, swelling, loss
of motion
Avulsion – severe pain and
deformity
Elbow Dislocation
MOI?
Fall on an outstretched hand
Violent hyperextension
Severe blow to the lateral elbow
http://www.youtube.com/watch?v=r9rywfbwC8E
Most common dislocation?
Posterior
S/S (What is observed?)
Gross deformity
Olecranon process extends posteriorly
Swelling, bruising
Elbow Dislocation
Potential complications?
Damage to the median & radial nerves
Damage to blood vessels
Treatment/management
Splint as you found it
Send to emergency room for
relocation.
Muscle & Tendon Injuries
Elbow flexor strains
Elbow extensor strains
Medial & lateral epicondylitis
Elbow Flexor Strain
MOI?
Often includes both the shoulder & elbow (biceps)
Excessive resistance elbow & shoulder flexion
S/S
Depends on grade… (think of sprains and strains chart)
Grade 1?
Grade 2?
Grade 3?
Pain over anterior elbow and the biceps tendon
Elbow Flexor Strain
Evaluation will find…
Weakness
Extra discomfort with elbow flexion
AROM, RROM
PROM? (pain decreases with PROM)
Grades 1 & 2
RICE, rehabilitation
Grade 3
Refer to physician/ER
Elbow Extensor Strain
MOI
Same as flexor strain
Trying to break a fall
Pain with active elbow extension
Be sure to check for avulsion fractures at the olecranon
process.
Medial & Lateral Epicondylitis
Chronic inflammation of either the medial or lateral
epicondyles.
Lateral Epicondylitis (Tennis Elbow)
Inflammation of the extensor tendons.
S/S
Minimal swelling over lateral epicondyle
Pain will also be present
Medial Epicondylitis
AKA Little League Elbow
Result of repetitive throwing
Inflammation of the wrist flexors
Pitch counts in Little League?
S/S
Same as lateral epicondylitis
UCL/RCL Sprains
Ulnar collateral ligament is more prone to injury
MOI?
UCL – valgus force (force from the lateral side)
RCL – varus force (force from the medial side)
S/S
Pain
Swelling
Possibly joint laxity
Special tests
Scenario 1
A basketball player goes up for a lay up and has his feet
taken out from under him, and tries to catch himself
with an outstretched hand. He falls to the floor and
does not get up, but is holding his elbow in pain.
When you get there you notice that his olecranon
process is protruding posteriorly and there is already a
considerable amount of swelling.
Scenario 1 Answer
Posterior Dislocation
Splint as you found it, and refer to ER
Scenario 2
A wrestler is trying to escape from a move. His hand is
planted on the mat when his opponent strikes the
lateral side of his elbow. He feels a small pop on the
medial side, but finishes the match. After the match
he approaches you with pain in both his medial and
lateral elbow. He has a moderate amount of swelling
over his medial epicondyle and has some laxity with a
valgus stress test.
Scenario 2 Answer
UCL Sprain (Grade 2)
Follow up with physician
Discontinue activities
PRICES
Scenario 3
A tennis player approaches you with elbow pain. You
notice a minimal amount of swelling over her lateral
epicondyle. While palpating you notice that most of
her pain is over the lateral epicondyle and into the
wrist extensors. She does not remember doing
anything to that elbow, but says it has been bothering
her for about a week.
Scenario 3 Answer
Lateral Epicondylitis
Tape for relief
Ice after practice
NSAIDS