10Nerves Three primary nerves of the humerus, radius, ulna, and wrist: Radial NerveInnervates the triceps brachii and provides sensation to dorsal side of thumb, index, middle, and half of ring fingerUlnar NervePalmar side of the little finger and half of the ring fingerMedian NervePalmar side of thumb, index , and half of ring finger
11ArteriesBrachial artery travels across the crease of the elbow and splits into two branches below the elbowUlnar and Radial Artery
12Elbow Anatomy Muscles Elbow Flexors (3 B’s) Biceps Brachii Long and Short headBrachioradialisBrachialisElbow ExtensorsTriceps BrachiiAnconeus
13Biceps Brachii Forearm Supination Assists in Shoulder Flexion O: Short head: Coracoid process of scapulaLong head: Supraglenoid tubercle of scapulaI: Radial tuberosityA: Elbow FlexionForearm SupinationAssists in ShoulderFlexion
14Integrated Function of Biceps Brachii Assists in deceleration of elbow extensionAssists in deceleration of forearm pronationAssists in deceleration of shoulder extensionAssists in dynamic stabilization of the humeral head during head during functional movements
15Brachialis O: Anterior surface of distal humerus I: Ulnar tuberosity A: Elbow flexionIntegrated Function:Assists in deceleration of elbow extensionAssists in dynamic stabilization of elbow
16Brachioradialis O: Lateral supracondylar ridge of humerus I: Styloid process of radiusA: Elbow flexionAssists in supination when forearmis pronatedAssists in pronation when forearmis supinatedIntegrated Function: Assists indeceleration of elbow extensionAssists in dynamic stabilization ofelbow
17Elbow FlexorsThe biceps brachii is most powerful when elbow supination is maintained throughout the exercise (it pulls on the radius to rotate it). Both heads work together-very hard to isolate long or short head separatelyThe brachialis is a strong elbow flexor regardless of whether the forearm is pronated or supinated (it cannot rotate the ulna)The brachioradialis is strongest in a neutral position (between pronation and supination)
18Carrying AngleWhen the forearm is supinated the humerus, radius, and ulna are not perfectly alignedThe typical carrying angle is 5 to 15 degrees which allows the forearm to clear the hips during ambulationIn females a wider carrying angle is due to a wider pelvic girdleCarrying angle influences how people hold objectsIndividuals with extreme carrying angles tend to pronate
19Preacher Curls-Ouch!Common Mistake Made: External/Internal rotation the shoulder joint.Possible Negative Effect: When you sit at the machine or bench you place your shoulders in an unnatural position which puts strain on your biceps tendon. Also, the bench or machine does not allow natural shoulder flexion that is created by the biceps brachii during a curl.Avoid preacher curls! There are more effective ways to train your forearm flexors.
20Triceps Brachii O: Long head - Infraglenoid tubercle of scapula Lateral - Posterior humerusMedial - Posterior humerusI: Olecranon process of ulnaA: Elbow extensionAssists in shoulder extension (long head)
21Integrated Function of Triceps Brachii Assists in deceleration of elbow flexionAssists in deceleration of shoulder flexionAssists in dynamic stabilization of the glenohumeral joint
22Anconeus O: Lateral epicondyle of humerus I: Olecranon process & upper posterior ulnaA: Assists in extensionof elbowStabilizes elbowIntegrated Function: Assists in deceleration of elbow flexion
23Triceps BrachiiThe medial head (deep) of the triceps is the most active but the lateral head is the strongestBoth lateral and long heads have 60% Type II Fast Twitch Muscle FibersMedial head has 60% Type I Slow Twitch Muscle FibersThe triceps are not affected by grip position
24Golfer’s Elbow and Tennis Elbow Medial EpicondylitisTennis Elbow:Lateral Epicondylitis
25Medial Epicondylitis Golfer's elbow Most common overuse injury on the medial epicondyle of humerusIt is the inflammation of the wrist and finger flexor tendons that attach onto the medial epicondyle of the humerusThis causes micro tearing of tendons, hemorrhage, inflammation, scarring, degeneration and shortening of the tendons
26Symptoms of Medial Epicondylitis There is pain and tenderness on the medial (middle) aspect of the elbow on the medial epicondyle.Painful activities include:Grasping or squeezing a handle, a golf club or a tennis racquet.Shaking hands.Carrying a briefcaseWritingLifting objectsSteering a car
27Common Causes of Medial Epicondylits Occupational overuseWeak grip strengthPoor fitting equipment– grip size or weight of club or racquetCervical spine nerve pinchingElbow hyperextension, "double jointed".Overuse in a sporting or daily activityImproper techniqueDirect traumaUntreated past injury of the upper extremity or fracture
28Lateral Epicondylitis Tennis elbowMost common overuse injury on the lateral epicondyle of humerusIt is the inflammation of the wrist and finger extensor tendons that attach onto the lateral epicondyle of the humerusThis causes micro tearing of tendons, hemorrhage, inflammation, scarring, degeneration and shortening of the tendons
29Symptoms of Lateral Epicondylitis Pain or tenderness on the outer side of the elbowPain when you straighten or raise your wrist and handPain made worse by lifting a heavy objectPain when you make a fist, grip an object, shake hands, or turn door handlesPain that shoots from the elbow down into the forearm or up into the upper arm.
30Common Causes of Lateral Epicondylitis Repetitive movementStrain or the overuse of forearm and wrist extensor musclesIncorrect grips, poor hitting positions, using a metal framed tennis racquet, improperly carrying a briefcase or other heavy object, or spending too much time using isolated muscle groups in the elbow area.Golfers, computer users, machinists, carpenters, mechanics, painters…
31Factors of Lateral Epicondylitis Poor Posture:In an EMG study of computer operating office workers, they found that in a slumped posture with foreword head,the tension in the wrist extensors rose approximately 25%. If gently tapping on a keyboard with faulty posture had such a dramatic effect, can you imagine what lifting weights would do?Shoulder Flexibility:Flexibility deficits in shoulder rotation may lead to elbow problems
32Factors of Lateral Epicondylitis Rotator Cuff StrengthStrengthening of the rotator cuff and scapular stabilizing muscles - in addition to the wrist extensors - is very important. Any weakness in this kinetic chain can cause Lateral Epicondylitis. If there is no scapular stability, posture will suffer If the rotator cuff fatigues, the wrist extensors will often compensate Both of these situations result in increased forces at the elbow joint and can eventually lead to Lateral Epicondylitis or a reoccurrence of it
33Treatment for Epicondylitis Diagnosis by DoctorRICE:Rest : Avoid activities that aggravate the injury.Absolute rest should be avoided as it encourages muscle atrophy, deconditions tissue, and decreases blood supply to the areaIce- Place an ice bag or a bag of frozen veggies on your elbow 3 times a day for 20 to 30 minutes and for 15 min after active use of your arm. You may also run an ice cup directly on the elbow for minutes.Compress and Elevate if appropriate to assist venous return and minimize swelling.
34Treatment for Epicondylitis Stretching:Will help prevent stiffness by breaking down any scar tissue that may result from the inflammationStrengtheningBracePhysical Therapy/Occupational Therapy
35Gentle stretching exercises including wrist flexion, extension and rotation. The elbow should be extended and not flexed to increase the amount of stretch as requiredThese stretches should be held for seconds and repeated 5-10 times, at least twice a day.Vigorous stretching should be avoided - do not stretch to the point of pain that reproduces your symptoms.
36Strengthening Exercises With the elbow bent and the wrist supported perform the following exercises:Wrist Extension-Place 1 lb. weight in hand with forearm pronated; support forearm at the edge of a tableExtend wrist slowly (concentric contraction), and flex slowly (eccentric contraction).
37Strengthening Exercises Wrist Flexion:Place 1 lb. weight in hand with forearm supinated support forearm at the edge of a tableFlex wrist up slowly (concentric), then extend slowly (eccentric).
38Strengthening Exercises Combined Flexion/Extension:Attach one end of a string to a cut broom stick or similar device, attach the other end to a weight.In standing, extend your arms and elbows straight out in front of you.Roll the weight up from the ground by turning the wrists.Flexors are worked with the palms facing upward. Extensors are worked with the palms facing downward.
39Strengthening Exercises Forearm Pronation/Supination Grasp hammer (wrench, or some similar device) in hand with forearm supported. Rotate hand to palm down position, return to start position (hammer perpendicular to floor), rotate to palm up position, repeat. To increase or decrease resistance, by move hand farther away or closer towards the head of the hammer
40Strengthening Exercises Finger ExtensionPlace a rubber band around all five finger tips.Spread fingers 25 times, repeat 3 times.If resistance is not enough, add a second rubber band or use a rubber band of greater thickness which will provide more resistance.Ball SqueezePlace rubber ball or tennis ball in palm of hand, squeeze 25 times, repeat 3 times.If pain is reproduced squeeze a folded sponge or piece of foam