1. Anatomy and Injuries of Elbow

2. What motions occur at the elbow?

3. Elbow
Elbow
The elbow

4. Bony Anatomy of the Elbow
Humerus
Lateral Epicondyle
Medial Epicondyle
Olecronon Process
Trochlea
Capitulum
Ulna
Radius
Left pic is back of elbow, right pic is front

5. Elbow Articulations Joints Humeroradial Humeroulnar
Radial head w/ capitulum of humerus
Humeroulnar
Olecranon process of ulna w/ trochlea of humerus
Proximal Radioulnar
Radial head w/ radial notch of ulna
Articulation literally means the state of being joined together

6. Muscles – Flexors and Supinators
Biceps Brachii Brachialis Brachioradialis
Brachialis- reflex tendon

7. Muscles of the Elbow
Triceps Brachii Anconeus

8. Muscles of the Elbow and Forearm
Supinator Pronator Quadratus Pronator Teres

10. Nerves and Blood Supply
Nerves – 3 primary nerves at the elbow
Median nerve- middle of elbow- C7
Ulnar nerve- “funny bone”- C8
Radial nerve- thumb and pinky- C6
Arteries
Brachial- middle
Splits into radial and ulnar
Medial- medial
Veins
Superficial
Close to the skin in front of the elbow

11. Elbow Ligaments A capsule surrounds each joint in the body
Medial (ulnar) collateral ligament
Medial epicondyle to olecranon
Prevents valgus force
Lateral (radial) collateral ligament
Radius up to lateral epicondyle head
Prevents varus force
Annular ligament
Radial head to ulna
Keeps radial head in place (rotation)

12. Ligaments of Elbow

13. Elbow Injuries
Elbow Injuries
Elbow injuries

14. Elbow Trauma

16. Sprains Ligament/Capsule under ↑ stress Excessive motion Partial tear
Hyperextension
Valgus
Varus
Partial tear
Types
Falling on an extended arm
Injury to anterior capsule
UCL
Injury to primary stabilizing unit of elbow
Tommy John Surgery
Complete tear
Torn UCL makes more probable for dislocation or fracture.

17. Strains S/S: Partial tear of muscle fibers Result from:
Point tenderness
↑ pain w/ passive elbow extension and resisted elbow flexion
weakness
Partial tear of muscle fibers
Result from:
Inadequate warm-up
Excessive training past point of fatigue
Inadequate rehabilitation of previous muscular injuries

18. Epicondylitis
Common injury, chronic condition
MOI: overuse injury
Prolonged stress may result in stress or avulsion fracture
Pattern of injury:
Poor technique
Fatigue
Overuse
Two types:
Medial
Lateral

19. Medial Epicondylitis Management A.k.a Golfer’s Elbow
Ice/NSAIDs
Immobilization for 2-3 weeks w/ wrist in slight flexion
EMS, US
Work early ROM
Gentle ROM isometric→isotonic
Wrist flexors
Bracing
A.k.a Golfer’s Elbow
Repeated, medial, tension/lateral compression (valgus) forces placed on the arm
During acceleration phase
S/S:
Swelling/pain
Possible ecchymosis
Pt. tenderness over humeroulnar joint
Pain over medial epicondyle
↑ pain w/ resisted wrist flexion and forearm pronation
↑ pain w/ valgus stress at 30° flexion
S/S: point tenderness over the medial epicondyle and muscle/tendons that attach there
Management – wear counter force or Neoprene elbow sleeve

20. Lateral Epicondylitis
A.k.a. Common Extensor Tendinitis/Tennis Elbow
Most common overuse injury
Eccentric loading of extensor muscles
Predominately Extensor carpi radialis brevis
During deceleration phase
Faulty mechanics
Leading w/ elbow
Off-center hits in racquet sports
Poorly fitted equipment
Handle size
String tension
S/S:
Pain anterior or just distal to lateral epicondyle
Radiating pain into extensors
Pain comes and goes
Comes back more severe w/ repitition
Pain increases w/ resisted wrist extension
Management
Same as Medial epicondylitis
Increase strength, endurance, and flexibility of extensor muscle
Wear counterforce/neoprene elbow sleeve
CC: pain over the lateral epicondyle, dec grip strength, and pain with gripping
S/S: swelling/pain and pain with passive stretching.
Management: avoid activities that cause symptoms. Stretch and strengthen the elbow flexors and focus on wrist extension. **Find the cause of the cause

21. Olecranon Bursitis Tx: NO COMPRESSION! Cryotherapy NSAIDS
Inflammation of the subcutaneous olecranon bursa
Acute/Chronic
Largest bursa in elbow
Facilitates smooth gliding of the skin over the olecranon process during elbow flexion and extension
Superficial
Predisposed to direct macrotrauma or cumulative microtrauma
Tx:
NO COMPRESSION!
Cryotherapy
NSAIDS
Olecranon bursa lies between the olecranon and the skin. Cushions olecranon process during normal flexion/extension of the elbow.
MOI: usually direct trauma/injury to bursa
Can become septic (infection gets into blood and spreads throughout body) – in which case, refer to physician.

22. Dislocation Most common traumatic injury Associated fractures:
Longitudinal traction of an extended and pronated upper extremity
i.e. Small child swung by arms
Immature/weakened annular ligament
Outstretched hand w/ elbow in a position of hyperextension or severe twist while in a flexed position
Associated fractures:
Medial epicondyle
Radial head
Coronoid process
Olecranon process
Ulna/radius displacement
Posteriorly (most common for both)
Anteriorly
Laterally

24. Dislocations Management EMERGENCY!!!!
Ice, compression, sling, and refer to physician IMMEDIATELY!!!
NEVER reduce
S/S:
Obvious deformity, loss of ROM
Rupturing and tearing stabilizing ligamentous tissue
Profuse hemorrhage and swelling
Severe pain and disability
Injury to median and radial nerves, major blood vessels and arteries

26. Olecranon fossa, olecranon process, medial epicondyle, lateral epicondyle, cubital tunnel,, radius, ulna, humerus, bicep, tricep, flexor muscles, extensor muscles, brachioradialis
Palpations

27. Olecranon Fossa
Olecranon Process, Bicep, Tricep, Lat Epicondyle

28. Medial Epicondyle
Cubital Tunnel

29. Radius
Ulna

30. Flexor Muscles
Extensor Muscles

31. Humerus
Brachioradialis

32. AROM Flexion, AROM Extension, AROM Pronation, AROM Supination, MMT Flexion, MMT extension, MMT pronation, MMT Supination
ROM

33. Lateral Epicondylitis Test/Resistive Tennis Elbow Test/Cozen's Test
Steps Athlete is sitting
Examiner stabilizes the involved elbow while palpating along the lateral epicondyle
With closed fist, the athlete pronates and radially deviates the forearm and extends the wrist against the examiner's resistance
Positive Test
Pain along the lateral epicondyle region of the humerus or objective muscle weakness as a result of complaints of discomfort
Positive Test Implications
Lateral epicondylitis
Lateral Epicondylitis Test/Resistive Tennis Elbow Test/Cozen's Test

34. Lateral Epicondylitis Test/Passive Tennis Elbow Test
Steps Athlete is sitting with elbow fully extended
Examiner passively pronates the forearm and flexes the athlete's wrist
Positive Test
Pain along the lateral epicondyle region of the humerus
Positive Test Implications
Lateral epicondylitis
Lateral Epicondylitis Test/Passive Tennis Elbow Test

35. Medial Epicondylitis Test/Golfer's Elbow Test
Steps Athlete is sitting or standing and makes a fist with the involved side
Examiner faces the athlete and palpates along the medial epicondyle with one hand and grasps the athlete's wrist with the other hand
Examiner passively supinates the forearm and extends the elbow, wrist and fingers
Positive Test
Complaints of discomfort along the medial aspect of the elbow
Positive Test Implications
Medial epicondylitis
Medial Epicondylitis Test/Golfer's Elbow Test

36. Elbow Flexion Test Steps Athlete is sitting or standing
Athlete maximally flexes the elbow and holds the position for 3 to 5 minutes
Positive Test
Radiating pain into the median nerve distribution in the athlete's arm and/or hand
Positive Test Implications
Cubital fossa syndrome
Elbow Flexion Test

37. Steps Athlete is sitting with elbow flexed to 20 to 30 degrees
Examiner stands with the distal hand around the athlete's wrist (laterally) and the proximal hand over the athlete's elbow joint (medially)
Examiner stabilizes the wrist and applies a varus stress to the elbow with the proximal hand
Positive Test
Lateral elbow pain and/or increased varus movement with diminished or absent endpoint
Positive Test Implications
Radial (lateral) collateral ligament sprain
Varus Stress Test

38. Steps Athlete is sitting with the elbow flexed to 20 to 30 degrees
Examiner stands with distal hand around the athlete's wrist (medially) and the proximal hand over the athlete's elbow joint (laterally)
Examiner stabilizes the wrist and applies a valgus stress to the elbow with the proximal hand
Positive Test
Medial elbow pain and/or increased valgus movement with a diminished or absent endpoint
Positive Test Implications: Ulnar (medial) collateral ligament sprain
Valgus Stress Test

39. Steps Athlete is sitting with the elbow in slight flexion
Examiner grasps athlete's wrist (laterally) with distal hand
Examiner stabilizes the wrist and taps on the ulnar nerve in the ulnar notch with the index finger
Positive Test
Tingling along the ulnar distribution of the forearm, hand and fingers
Positive Test Implications
Ulnar nerve compromise
Tinel's Sign Test

40. Pinch Grip Test Steps Athlete is sitting or standing
Examiner instructs athlete to pinch the tips of the thumb and index finger together
Positive Test
Inability to touch the tips of the thumb and index finger together or touching the pads of the thumb and index finger together
Positive Test Implications
Pathology of the anterior interosseous nerve between the two heads of the pronator muscle
Pinch Grip Test