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The Elbow Ulnar Collateral Ligament Sprain Elbow Dislocation Ulnar Nerve Irritation Emily Gavlick.

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Presentation on theme: "The Elbow Ulnar Collateral Ligament Sprain Elbow Dislocation Ulnar Nerve Irritation Emily Gavlick."— Presentation transcript:

1 The Elbow Ulnar Collateral Ligament Sprain Elbow Dislocation Ulnar Nerve Irritation Emily Gavlick

2 Bone Anatomy of Elbow  Involved bones: –Humerus –Ulna –Radius  General Joint Type: hinge –Movement allowed in only one plane

3 Bone Anatomy of the Elbow  Joint Actually Comprised of 3 Areas 1. Humeroulnar Joint: flexion and extension 2.Proximal Radioulnar Joint: supination and pronation of hand pronation of hand 3. Humeroradial Joint: arthrodial joint (only a slight gliding motion)

4 Ligament Anatomy of Elbow  Ulnar Collateral Ligament (UCL): medial side of the elbow  Radial Collateral Ligament (RCL): lateral side of the elbow  Annular Ligament: wraps around the radial head and holds it tight against the ulna –annular means ring-shaped

5 Ligament Anatomy of Elbow

6 Muscle Anatomy of Elbow  Anterior: –Biceps  Posterior: –Triceps Brachii  Lateral: –Supinator  Medial: –Flexor Carpi Ulnaris

7 Tendon Anatomy of Elbow  Anterior: –biceps tendon  Posterior: –triceps tendon  Lateral: –common tendon of origin of the Extensor muscles  Medial: –common tendon of origin of the Flexor muscles

8 Muscle / Tendon Anatomy of Elbow

9

10 Elbow Injuries

11 Ulnar Collateral Ligament Sprain What is it?  Stretch or tear of the UCL Involved Structures:  The UCL  The Humerus  The Ulna Location:  Medial side of elbow

12 Ulnar Collateral Ligament Sprain Mechanism of Injury:  Force bends elbow inward toward midline  most commonly occurs in throwing activities

13 Ulnar Collateral Ligament Sprain General Signs and Symptoms: (specific symptoms depend on severity of sprain)  Pain  Popping / tearing sensation  Tenderness  Swelling  Bruising

14 Ulnar Collateral Ligament Sprain Grades: (as with any sprain) Grade I: partial tear of a ligament –Mild tenderness and swelling –Slight or no functional loss –No mechanical instability

15 Ulnar Collateral Ligament Sprain Grade II: incomplete tear of a ligament with moderate functional impairment –Moderate pain and swelling –Mild to moderate bruising –Tenderness over involved structures –Some loss of motion and function –Mild to moderate instability

16 Ulnar Collateral Ligament Sprain Grade III: complete tear and loss of integrity of a ligament –Severe swelling –Severe bruising –Loss of function and motion –Mechanical instability

17 Ulnar Collateral Ligament Sprain Testing for Injury  Valgus stress testing: –Pain –Instability  Radiographs: –loose bodies –traction spurs (protrusion of bone / cartilage)  MRI: –partial and complete tears –not usually necessary

18 Ulnar Collateral Ligament Sprain Treatment for Injury:  Prevention –Long-term strengthening and conditioning appropriate for sport. –Warm up before practice or competition. –Tape vulnerable joints before practice or competition

19 Ulnar Collateral Ligament Sprain Treatment for Injury  Grade I Sprain: –PRICE –Possible application of a cast, tape, elastic bandage or sling –If no device is applied, icepacks, whirlpool therapy, and massage may be used –Recovery time: 2-6 weeks

20 Ulnar Collateral Ligament Sprain Treatment for Injury  Grade II Sprain: –PRICE –Application of cast, tape, elastic bandage or sling –Possible physical therapy –Recovery time: 6-8 weeks

21 Ulnar Collateral Ligament Sprain Treatment for Injury  Grade III Sprain: –PRICE –Application of cast, tape, elastic bandage or sling –Physical therapy –Surgery –Recovery time: 8-10 weeks, with potential for prolonged disability

22 Ulnar Collateral Ligament Sprain Ramon Ramirez: Colorado Rockies pitcher missed 23 games with an elbow sprain in April 2007

23 Elbow Dislocation What is it?  The radius and ulna move out of place compared with the humerus Involved Structures:  The Radius  The Humerus  The Ulna  Surrounding tissues Location:  Elbow joint

24 Elbow Dislocation General Signs and Symptoms: (specific symptoms depend on severity of dislocation)  Tenderness  Swelling  Deformity  Bruising  Poor blood flow to the lower arm and hand

25 Elbow Dislocation  Signs / Symptoms: –pain –Refuse to use injured arm –Holding elbow slightly bent Nursemaid’s / Babysitter’s Elbow Partial or radial dislocation (subluxation) Common in children Caused when child is lifted by arm

26 Elbow Dislocation Simple  radius and ulna become dissociated from the humerus without associated fracture Complex Complex  simple dislocation combined with fracture of the humerus, radius, ulna or a combination of all three bones

27 Elbow Dislocation Mechanism of Injury:  Force sent through ulna/radius to elbow  Often accompanied by a twisting force  Usually occurs when a person attempts to break a fall or cushion an impact

28 Elbow Dislocation Signs / Symptoms:  Severe pain  Deformity  Swelling  Inability to bend arm  In some cases: –Numbness –Lack of pulse

29 Elbow Dislocation Testing for Injury:  Evaluation of tenderness, swelling, deformity, sensation, and circulation  X-ray  CT scan may help evaluate fractures  Angiogram may be done if arterial injury is suspected

30 Elbow Dislocation Treatment for Injury:  Nursemaid’s / Babysitter’s Elbow –Closed Reduction: manipulating arm; the annular ligament and radial head return to their normal anatomic positions  immobilize elbow and palpate region of radial head  apply axial compression at wrist while supinating forearm and flexing elbow  a click or snap can be felt at the radial head

31 Elbow Dislocation Treatment for Injury  Simple Dislocation: –Closed Reduction –Splinting –24-hour hospital observation if nerve / artery injury is suspected –Possible physical therapy

32 Elbow Dislocation Treatment for Injury  Complex Dislocation: –Reconstructive Surgery (open reduction)

33 Elbow Dislocation Partial Simple RadialComplex

34 Ulnar Nerve Irritation What is it?  The ulnar nerve, one of the 3 main nerves that innervate the hand, is affected  The Funny Bone Location:  runs from the shoulder to the hand

35 Ulnar Nerve Irritation Two ways to irritate the ulnar nerve: 1. Impingement (pinching) –Cubital Tunnel Syndrome 2. Entrapment (stuck to surrounding tissue)  Location: Posterior elbow joint

36 Ulnar Nerve Irritation  Mechanism of Injury: –Genetic, natural build –Frequent bending of elbow joint –Fracture of nearby bone –Blow to cubital tunnel  Cubital tunnel: tunnel of muscle, ligament, and bone on the inside of the elbow allows the Ulnar nerve to travel over the elbow

37 Ulnar Nerve Irritation  Signs / Symptoms: –Numbness on the inside of the hand and in the ring and little fingers –Pain –Weak Grip –Muscle Wasting

38 Ulnar Nerve Irritation  Testing for Injury: –Physical examination to confirm location –MRI / CT scan to check for bone spurs or arthritis –Nerve Conduction Velocity (NCV) test: measures speed of impulses traveling along the nerve –Electromyogram (EMG). sometimes used; tests whether the muscles are working properly.

39 Ulnar Nerve Irritation  Treatment for Injury: –Conservative: discontinue irritating action, anti- inflammatory medications, nighttime splint / elbow pad, and/or physical therapy –Surgical: ulnar nerve transposition, or removing medial epicondyle on medial elbow

40 Ulnar Nerve Irritation Ulnar Nerve Transposition


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