The Elbow Chapter 17

Anatomy Major Bones - humerus, radius, ulna, and the olecranon. -The distal end of the humerus becomes wider forming the medial and lateral epicondyles. Soft Tissue - Articular capsule, annular ligament, triceps tendon, Radial Collateral Ligament, Ulnar Collateral Ligament.

Preventing Elbow Injuries Most injuries at the elbow joint are due to overuse. - repetitive movements and stresses delivered to the wrist and elbow over a long period of time. - eventually breaks down the tissue, causing chronic inflammation and pain. Athletes strengthen biceps and triceps but fail to condition some of the smaller muscles (wrist flexors and extensors). Using proper equipment. After using the elbow for a long amount of time the athlete should do alternative activities and rest it.

Treating Ligaments Injuries Ulnar collateral ligament sprain - More prone to sprain (especially for throwing athletes). - Stretching of the medial aspect of the elbow. - Direct blow may cause a disruption of the Ulnar Collateral Ligament. - Characterized by medial elbow pain and swelling, joint laxity. - Treat with PRICE – elastic bandage works well for elbow swelling and support. - Moderate to severe may need to be splinted and refer to physician if necessary. - Should be observed for any ulnar nerve damage when the medial collateral ligament is injured. - When rehabilitating it is essential to strengthen wrist flexor muscles with wrist curls and grip strengthening.

Treating Lig. Injuries Con’t Radial Collateral Ligament Sprains - Usually rare. - Same characteristics as Ulnar Collateral Ligament except pain is on lateral aspect instead. Rehabilitations should focus more on wrist extension musculature. -These muscles cross the joint line at the lateral elbow and can provide dynamic stability to an elbow that has suffered a sprain of the lateral Collateral Ligament.

Muscle and Tendon Injuries Elbow flexor strain - Caused by a loaded movement that includes the elbow and shoulder together. - Minor strains are characterized by discomfort at the anterior aspect of the elbow and minimal, if any swelling, weakness, and discomfort when elbow flexion is resisted. -Moderate strain will have mild to moderate amounts of swelling and have weakness when testing strength -Initial treatment is PRICE until swelling is gone. Then perform mild stretching and strengthening exercises. -With more tissue damage the slower progress will be -Complete muscle or tendon ruptures or suspected avulsion injuries should be referred to a physician.

- Excessive resistance to the triceps muscle will cause tissue damage. -MOI=athlete falls and attempt to break the fall with an outstretched arm. -Assess carefully because the triceps tendon can often pull a bit of bone away. -Characteristics are the same as for a flexor injury, except pain will be at the posterior aspect of the upper arm, more pain when resists elbow extension. -Treat with PRICE after swelling has gone should be mildly stretched and strengthened as tolerated. Elbow Extensor Strain

-P-Pain over the medial epicondyle of the humerus or the front of the foreman. -R-Result in excessive resistance during wrist flexion movements or from over all use. -T-Treat with PRICE and modify activity. Mild stretching and doing wrist curls and grip strengthening. Wrist Extensor Strain -P-Pain over the lateral epicondyle of the humerus. -R-Result from excessive resistance during wrist extension movements. -T-Treat with PRICE and modify activity. Mild stretching - doing reverse wrist curls. Wrist Flexor Strain

- M ore frequent, a result of poor mechanics and continual use over long a period, it then become inflamed also known as Tennis Elbow. -Characterized by pain over lateral epicondylitis of the humerus and minimal swelling. -Treat by reducing pain and inflammation, PRICE and tennis elbow strap, limit activity, mild stretching of extension tendon, muscle strengthen and endurance should be impaired as tolerated. Gradually participate in any activity. Lateral Epicondylitis

- N ot as common, result from repetitive throwing. - Inflammation of the wrist flexor tendons where they attach to the humerus. -Some refer to Medial Epicondylitis as Little League Elbow-separation of the epiphysis at the medial aspect of the humerus in younger athletes as a result of throwing. -Treatment is similar to lateral epicondylitis, PRICE, athlete needs to decrease amount of throwing and strengthen the wrist flexor muscles. -ATC must do a complete evaluation because there could be a compression of the ulnar nerve at the joint, especially when the medial elbow is injured. -Send to Physician if possible fracture or athlete feels numbness, tingling, or excessive pain. Medial Epicondylitis

Bone Injuries Epiphyseal and Avulsion Fractures -More common on medial epicondyle or olecranon aspect of the elbow. -Expected when athlete has swelling, pain, and loss of movement. -Severe pain and deformity indicates an avulsion fracture. -Refer to Physician.

-One of the most common dislocated joints. -The Ulna hooks onto the end of the humerus making it a stable joint. -Take a traumatic injury to dislocate. -Violent hyperextension or severe blow to the lateral aspect of the elbow will cause a dislocation; most often posteriorly. - There will be obvious deformity. -Splint the arm in position and send to emergency room to a Physician to re- place the elbow. Ulna Dislocation

Other Common Injuries An athlete can fall on an outstretched arm or receives a blow that causes the elbow to be hyperextended. This can result in one of three problems: Sprain the ligaments at the anterior aspect of the elbow. Strain the musculature at the anterior aspect of the elbow. Receive a painful bony compression if the olecranon process impacts the humerus. Treat with PRICE, more severe conditions need to be referred to a Physician. After improving, ROM should be reestablished and strengthening of the elbow flexor muscles should be improved. Need to wear an elbow hyperextension tape application when returning to play.

Common Injuries Con’t Contusions should be treated with PRICE, wear padding to protect the elbow. Olecranon process contusion -O-Olecranon bursa may become irritated. -C-Causes fluid to build up at the “tip” of the elbow. -A-Apply compression wrap and if condition persists see a Physician to drain the fluid. -P-Protect the elbow to avoid further contusions.