Unit 4:Understanding Athletic-Related Injuries to the Upper Extremity Elbow Injuries David Smith

Objectives Describe the basic anatomy of the arm and elbow Explain common arm and elbow injuries that occur with athletic participation Identify common signs and symptoms of arm and elbow injuries Explain common tx parameters performed by an ATC for elbow injuries

Anatomy of the elbow Hinge joint involving three major bones Humerus, ulna, and radius Ulna is hooked to humerus to form a tight joint Radius rests against the humerus and is able to rotate Allowing for pronation and supination

Ligaments Joint capsule Ulnar collateral ligament Like shoulder, surrounds the elbow Gives general stability Ulnar collateral ligament Helps stabilize medial aspect of elbow Radial collateral ligament Helps stabilize the lateral aspect of elbow

Ligaments cont.

Ligaments cont... Annular ligament Interosseus membrane Helps hold radius and ulna together near elbow joint Interosseus membrane Joins the radius and ulna together, keeps bones from separating

Muscles Triceps brachii Biceps brachii Wrist flexors Wrist extendors Elbow extension Biceps brachii Elbow flexion Wrist flexors Attach at medial epicondyle of humerus Wrist extendors Attach at lateral epicondyle of humerus

Muscles cont... Very important to check distal pulse and sensations to check for blood vessel or nerve damage Several small nerves run through the small spacesand grooves around the elbow on their way to the hand

Distal Radial Pulse

Preventing Elbow Injuries Not frequently injured Usually overuse injuries chronic inflammation and pain Tennis and baseball common sports Strengthen and stretch larger muscles, ignore smaller muscles Wrist flexors and extensors

Preventing Elbow Injuries Proper equipment Excessive stress on elbow musculature can result in using a racket with a grip that is too small Alter activities Taking breaks after long throwing days if playing baseball

Treating Elbow Injuries and Conditions Ligament Injuries 1-3° Sprains Ulnar collateral ligament Radial collateral ligament

Ligament Injuries Ulnar Collateral Ligament Sprain Most commonly injured due to stress placed on elbow by hitting tennis ball Direct blow may also cause disruption pf UCL

Ligament Injuries Valgus Stress medial part of joint would separate or spread apart as the forearm moves laterally Common in contact sports or if falling on outstretched arm Sprain characterized by medial elbow pn and swelling, laxity. Tx: RICE, splinting, r/o fx by referral for x-ray. Rehab includes strengthening wrist flexors- help to provide stability

Ligament Injuries Radial Collateral Ligament Sprain Rare Characteristics same as UCL sprain but on the lateral aspect TX: Focus on strengthening the wrist extensors, provide dynamic stability

Muscle and Tendon Injuries Caused by excessive resistive forces or overuse

Muscle and Tendon Injuries Elbow Flexor Strain Loaded movement, elbow and shoulder together Two joint muscle- movement created at more than one joint Characterized by pain and swelling, weakness TX: RICE, mild stretching and strengthening

Muscle and Tendon Injuries Elbow Extensor Strain Excessive resistance to the triceps Falling and attempting to break fall with an outstretched arm Assess carefully, can be an avulsion fracture of ulna TX: Same as elbow flexor strain

Muscle and Tendon Injuries Wrist flexor strain Can result from excessive resistance during wrist flexion movements or overuse Pain over medial epicondyle or humerus or in the front of the forearm TX: RICE and modified activity, stretching and strengthening

Muscle and Tendon Injuries Wrist extensor strains Excessive resistance during wrist extension or overuse Pain over lateral epicondyle of humerus TX: Same as wrist flexion

Muscle and Tendon Injuries Lateral epicondylitis Tennis elbow result of poor mechanics and continual use over a long period of time wrist extensor tendons at lateral epicondyle of the humerus become chronically inflamed Pain over lateral epicondyle and minimal swelling TX: reduce pain and inflammation, RICE, support, limiting activity, mild stretching and strengthening, medication

Muscle and Tendon Injuries Medial Epicondylitis Little League Elbow Inflammation of wrist flexor tendons result of repetitive throwing Pain over medial epicondyle TX: Same as lateral epicondylitis and decrease throwing monitor ulnar nerve- watch for numbness, tingling, or excessive pain

Bone Injuries Bone fx to distal end of humerus Fx between condyles Not common Due to very powerful mechanisms of injury hand planted on ground and someone forcing the arm into excessive side bending Wrestling? Fx between condyles Direct impact BOTH ARE A MEDICAL EMERGENCY DUE TO COMPRESSION ON NERVE OR ARTERY

Fracture Distal end of Humerus

Fracture of Condyles

Bone Injuries Epiphyseal and Avulsion fx Ulna Dislocation More common on medial epicondyle or olecranon aspect Severe pn and deformity- avulsion fx Ulna Dislocation Fairly tight joint Very traumatic Violent hyperextension or a severe blow Obvious deformity, medical emergency

Avulsion Fracture

Bone Fragment in Elbow Joint

Other common injuries Hyperextension Fall on outstretched arm or receive blow to elbow Problems: Sprain the ligaments at the anterior aspect of elbow Strain the musculature at the anterior aspect of elbow Receive a painful bony compression if the olecranon process impacts the humerus TX: RICE, or referral, hyperextension tape job

Other common injuries Olecranon Bursitis fluid to build up at the tip of the elbow from a traumatic force (usually a blunt blow to tip of elbow) TX: Compression wraps, massage, stim, US, protect with padding, MD to drain the fluid (???)

Elbow Dislocation Reduce if medical personnel is available If no medical personnel present needs to ER for x-rays and reduction May compromise nerves and arteries. Check distal pulse after reduction