The Elbow Sports Medicine John Hardin, Instructor

Anatomy of Elbow and Forearm Humerus Humerus Ulna Ulna Radius Radius

Humerus Medial & lateral epicondyles Medial & lateral epicondyles Olecranon fossa Olecranon fossa Trochlea Trochlea Capitulum Capitulum

Ulna Olecranon process Olecranon process Articulates with trochlea and olecranon fossa of humerus Articulates with trochlea and olecranon fossa of humerus

Radius Head of radius Head of radius Articulates w/ the capitulum of the humerus Articulates w/ the capitulum of the humerus

Joints Humeroulnar joint Humeroulnar joint  Flexion/extension Humeroradial joint Humeroradial joint  Flexion/extension Radioulnar joint Radioulnar joint  Supination/pronation  3 articulations—superior, middle, distal

Ligaments Joint capsule surrounds joint Joint capsule surrounds joint Ulnar collateral Ulnar collateral Radial collateral Radial collateral Annular ligament Annular ligament Interroseus membrane Interroseus membrane

Muscles Flexors of the elbow Flexors of the elbow  Biceps brachii  Brachialis  Brachioradialis  Forearm flexors  Forearm extensors

Extensors of the elbow Triceps brachii Triceps brachii  Long head  Lateral head  Medial head

Pronators Pronator teres Pronator teres Pronator quadratus Pronator quadratus

Supinators Biceps brachii Biceps brachii Supinator Supinator

Forearm muscles Forearm flexors attach to the medial epicondyle Forearm flexors attach to the medial epicondyle Forearm extensors attach to the lateral epicondyle Forearm extensors attach to the lateral epicondyle

Other structures Nerves Nerves  Ulnar, radial, median

Landmarks Cubital fossa Cubital fossa Olecranon process Olecranon process Olecranon fossa Olecranon fossa Medial and lateral epicondyles Medial and lateral epicondyles Radial head Radial head

Olecranon Bursitis

Another view?

Mechanism Direct blow Direct blow Falling on elbow Falling on elbow May appear spontaneously without heat and pain May appear spontaneously without heat and pain

Signs & symptoms Pain Pain Swelling Swelling POT POT Heat Heat

Treatment Cold Cold Compression Compression Rarely will be aspirated by physician Rarely will be aspirated by physician Protect with padding when competing Protect with padding when competing May recur with repeated blows May recur with repeated blows

Elbow Sprains

Mechanism Hyperextension or a force that bends or twists the lower arm outward Hyperextension or a force that bends or twists the lower arm outward Valgus stress Valgus stress

Signs & Symptoms Pain Pain Inability to throw or grasp an object Inability to throw or grasp an object POT (usually over UCL) POT (usually over UCL)

Treatment Ice Ice Compression Compression Sling for 90 degrees Sling for 90 degrees Progress to full ROM and strength Progress to full ROM and strength

Lateral Epicondylitis Tennis elbow Tennis elbow

Mechanism Backhand stroke involving overextending of wrist Backhand stroke involving overextending of wrist Repetitive extension of the wrist Repetitive extension of the wrist

Signs & Symptoms POT over lateral epicondyle POT over lateral epicondyle Pain over lateral epicondyle during and after activity Pain over lateral epicondyle during and after activity Pain gradually increases resulting in weakness in hand and wrist Pain gradually increases resulting in weakness in hand and wrist Pain with resistive hyperextension of wrist and full extension of elbow Pain with resistive hyperextension of wrist and full extension of elbow

Treatment RICE RICE NSAIDS NSAIDS Analgesics Analgesics Heat Heat Deep friction massage Deep friction massage

Treatment (cont’d) Rehab Rehab  ROM exercises  stretching  PRE’s  strengthening  Hand grasping while in supination  Avoid pronation movements

Medial epicondylitis Pitcher’s elbow Pitcher’s elbow Racquetball elbow Racquetball elbow Golfer’s elbow Golfer’s elbow Javelin-thrower’s elbow Javelin-thrower’s elbow

Mechanism Repeated forceful forearm flexion Repeated forceful forearm flexion Excessive throwing Excessive throwing

Signs & Symptoms Aching pain around the medial epicondyle especially during forceful wrist flexion Aching pain around the medial epicondyle especially during forceful wrist flexion Pain during and after activity—progressing to constant pain Pain during and after activity—progressing to constant pain POT POT Mild swelling Mild swelling

Treatment RICE RICE NSAIDS NSAIDS Ultrasound Ultrasound Analgesics Analgesics Brace Brace Exercises for ROM and strengthening Exercises for ROM and strengthening

Dislocation of Elbow

Mechanism of injury Fall on outstretched arm Fall on outstretched arm Hyperextension Hyperextension Severe twist with elbow in flexed position Severe twist with elbow in flexed position Blow to posterior humerus with fixed radius/ulna Blow to posterior humerus with fixed radius/ulna

Signs & Symptoms Ulna and/or radius displaced posteriorly, w/ olecranon process sitting posteriorly Ulna and/or radius displaced posteriorly, w/ olecranon process sitting posteriorly Severe swelling/bleeding Severe swelling/bleeding Disability Disability LOM LOM Extreme pain Extreme pain

Treatment Immobilize in position you find it Immobilize in position you find it ER ER Treat for shock Treat for shock Immobilized after reduction for about 3 weeks Immobilized after reduction for about 3 weeks

Fracture of elbow

Mechanism Fall on outstretched arm Fall on outstretched arm Direct blow to elbow Direct blow to elbow

Signs & symptoms Possible deformity Possible deformity Swelling/bleeding Swelling/bleeding Muscle spasm Muscle spasm Pain Pain POT POT

Treatment Immobilize Immobilize Ice Ice ER ER

Injuries to forearm Contusions Contusions Forearm strain Forearm strain fractures fractures

Contusion

Mechanism Direct blow to forearm Direct blow to forearm Repeated blows to forearm Repeated blows to forearm

Signs & Symptoms Pain Pain Swelling Swelling Discoloration Discoloration Hematoma Hematoma

Treatment RICE RICE Protective padding Protective padding Modify activity if necessary Modify activity if necessary

Forearm strain

Mechanism Hyperextension or hyperflexion Hyperextension or hyperflexion Fall on outstretched hand Fall on outstretched hand

Signs & Symptoms Pain along extensors or flexors Pain along extensors or flexors POT POT Pain with motion Pain with motion Inability to grip Inability to grip swelling swelling

Treatment RICE RICE Modify activity Modify activity Restore ROM and strength Restore ROM and strength Tape for protection Tape for protection

Fractures Radius Radius Ulna Ulna Both bones Both bones

Mechanism Direct blow Direct blow Fall on outstretched arm Fall on outstretched arm

Signs & Symptoms Possible deformity Possible deformity Pain Pain POT POT Swelling Swelling Unable to use arm Unable to use arm “+” compression/percussion test “+” compression/percussion test

Treatment Immobilize Immobilize Ice Ice ER ER