1. Lecture 8 The Elbow

2. Anatomy Review The elbow is made up of three joints -Humeroulnar jointFlexion / Extension -Humeroradial jointFlexion / Extension -Superior radioulnar joint Pronation / supination

3. Humeroulnar joint Trochlea of the humerous and trochlear fossa of the ulna Uniaxial hindge joint – synovial Leads to the carrying angle of the elbow Resting position 70 degrees of elbow flexion Forearm supinated 10 degrees

4. Humeroradial joint Capitulum of humerus and head of radius Uniaxial hinge joint – synovial (gliding) Resting position – full extension and fully supinated

6. Elbow Ligaments Ulnar collateral ligament (medial) – fan shaped Radial collateral ligaments (lateral) - cord like Ulna nerve passes through the cubital tunnel

8. Superior radioulnar joint Uniaxial pivot joint – synovial Head of radius articulates with the ulna Resting position 35 degrees supination and 70 degrees flexion Head of radius held in position by Annular ligament

9. Rom of Elbow / End Feels Flexion/Extension Pronation /Supination Muscles?

10. Functionally the elbow is an integral part of the kinetic chain Daily functions need 140 degrees of elbow flexion to reach the head

11. Special Tests

12. Valgus MCL – UCL Elbow slightly flexed examiner pushes in (medially) on the elbow (should do at different angles) Positive test - pain and medial laxity http://www.youtube.com/watch?v=f6YvPS Vk6G8&feature=PlayList&p=C38CC3815C 1A2523&index=10 http://www.youtube.com/watch?v=f6YvPS Vk6G8&feature=PlayList&p=C38CC3815C 1A2523&index=10

13. Varus RCL – LCL Elbow slightly flexed examiner pushes out (laterally) on the elbow ( should do at different angles) Positive test - pain and lateral laxity http://www.youtube.com/watch?v=jUKxFw h5QjU&feature=PlayList&p=C38CC3815C 1A2523&index=9 http://www.youtube.com/watch?v=jUKxFw h5QjU&feature=PlayList&p=C38CC3815C 1A2523&index=9

14. Lateral Epicondylitis (Tennis Elbow) Extensors of the elbow Forearm is pronated Athlete is asked to make a fist and to extend their wrist Examiner tries to push wrist into a flexed position Positive test is - pain and weakness in the area of the lateral epicondyle http://www.youtube.com/watch?v=futWq8mXzUo&fe ature=PlayList&p=C38CC3815C1A2523&index=8 http://www.youtube.com/watch?v=futWq8mXzUo&fe ature=PlayList&p=C38CC3815C1A2523&index=8

15. Medial Epicondylitis (Golfers Elbow) Flexers of elbow Forearm is supinated Athlete is asked to make a fist and to flex their wrist Examiner tries to push wrist into a extended position Positive test - is pain and weakness in the area of the medial epicondyle

16. Tinnels Sign Ulnar nerve Examiner taps between the olecranon process and the medial epicondyle in the cubital tunnel Positive test - tingling sensation down into the hand (medial half of forth and all of fifth finger)

17. Sport Specific Functional Tests Elbow is the middle of the upper kinetic chain must function properly to position the hand for daily activities, combing hair brushing teeth…or sports activities.. throwing, lifting, pushing..