1. THE ELBOW
Unit 21

2. The elbow is a hinge joint Composed of three bones: - Humerus - Radius
I. ELBOW ANATOMY
A. Bones
The elbow is a hinge joint
Composed of three bones:
- Humerus
- Radius
- Ulna
L Pic: Ulna left, radius right
R pic: radius left, ulna right

3. I. ELBOW ANATOMY
1. The Radius is the forearm bone on the thumb side
a. It rotates over the ulna and therefore allows pronation and supination

4. 2. The Ulna lies on the side if the little finger
a. Proximally it is hooked into the humerus
b. The pointy part of our elbow is the most proximal part of the ulna, called the Olecranon Process

5. B. Ligaments There are 3 major ligaments
The ulnar or medial collateral ligament
Ulnar Collateral lig. = top picture...prevents valgus stress, if sprained the 2 smaller fingers tingle due to stretching of the ulnar nerve (=funny bone) ... Radial collateral lig. (= botom pic) Prevents varus force...annular ligaments connect radius and ulna (sorry, no pic)... There are a ton of ligaments in the elbow, all together making up the joint capsule, so these are only the main 3.

6. The radial or lateral collateral ligament
The annular ligament (connects radius and ulna)

7. C. Muscles Main muscles of the elbow region include:
Triceps Brachii (elbow extension)
Biceps Brachii (elbow flexion and forearm supination)

8. The proximal attachment for the wrist flexors is the medial epicondyle of the humerus
The muscle shown in illustration is the flexor digitorum (=finger) superficialis(=lays on top of another muscle, flexor digitorum profundus). The action of the illustrated muscle is flexion of the wrist and the 2 proximal joints of the fingers...it therefore flexes everything but the finger tips... The photo shows the same muscle group with its tendons together with a vein (squiggely line with blue dot). Underneith the vein lies an artery and a nerve (Ulnar Nerve, I think). These three always run together in one sheith (artery, vein and nerve). It‘s a little deep here...so just for your info.

9. The proximal attachment for the wrist extensors is the lateral epicondyle of the humerus
Both pics show the same muscle (tendon)...the bottom is a disected cadaver...notice how the human body is unfortunately not as nicely color schemed as the illustrations we see in books.

10. I. ELBOW ANATOMY
D. A number of blood vessels and nerves run through the little spaces of the elbow joint
Top pic = Illustration of Nervous tissue crossing the elbow joint...Bottom Pic = same of blood vessels

11. 1. Radial Nerve
2. Median Nerve
3. Ulnar Nerve („ Funny Bone“)
4. Brachial Artery

12. II. ELBOW INJURIES

13. A. Ligamentous Inuries

14. 1. Ulnar Collateral Ligament Sprain
a. Most injured ligament in the elbow
b. Can be injured as a result of repetitive stress (baseball pitching, tennis forehand) or direct trauma (wrestler supporting weight on one arm and being rolled on from the lateral aspect of the elbow)
FB Quaterback having an opponent run into his arm as he throws a pass (Alex F. 2 seasons ago...since his growth plate was not closed by the time he avulsed the ligament out of the attachment rather than spraining it, but same mechanism)

15. Signs and Symptoms
1. Pain and point tenderness over medial joint line
2. Swelling
3. Athlete may or may not have felt a pop
4. Joint laxity (depending on degree of injury)
5. Athlete with an elbow injury will carry the forearm at ~ 45° flexion

16. Treatment
1. PRICE
2. Check for circulation and sensation
3. For grade 2 and 3 send to physician for further evaluation
4. Tape/ brace when returning to competition

17. 2. Radial Collateral Ligament Sprain
a. Less common than Ulnar collateral ligament sprain
Signs and Symptoms
Same as ulnar Collateral Lig. Sprain, except point tenderness on lateral joint line
Treatment
Same as Ulnar Collateral lig. Sprain

18. B. Muscle and Tendon Injuries

19. 1. Strains
a. Strains can occur to all muscles or muscle groups of the elbow
b. Usually occur as a result of a sudden excessive resistive force (catching a heavy object when it is falling down (spotting in weight lifting)) or of hyperextension

20. Signs and Symptoms
1. Same as all muscle strains
2. (Pain; swelling, loss of function, and ROM dependent on degree of injury)
Treatment
1. PRICE
2. 3rd ° strains send to physician for surgical repair

21. The elbow is prone to overuse conditions that create chronic inflammation
Common sites are the medial and lateral epicondyles of the humerus

22. 2. Medial Epicondylitis (Little League Elbow)
a. Inflammation of the wrist flexor tendons where they attach to the medial epicondyle
Look at the thrower‘s elbow...there is an incredible amount of stress placed on the elbow as he forcefully pulls the ball forward and snaps his wrist to release the ball

23. b. Often a result of repetitive throwing
c. In young athletes (12 years and younger) the continious stress can avulse the epiphysis (growthplate)
... therefore the name Little League Elbow

24. Signs and Symptoms:
1. Pain ,Point tenderness, and swelling over the medial epicondyle of the humerus
2. Increased pain with wrist flexion and pronation

25. Treatment
1. Ice
2. decrease throwing activity
strengthen wrist flexors gradually
3. Tape or brace

26. 3. Lateral Epicondylitis (Tennis Elbow)
a. Wrist extensor tendons become chronically inflamed where they atach to the lateral epicondyle of the humerus

27. b. Often a result of faulty mechanics and continual use in racket sports (backhand stroke), therefore the name Tennis elbow

28. Signs and Symptoms
Same as medial epicondylitis, except it affects the lateral epicondyle and the wrist extensors and supinators
Treatment
Same as medial epicondylitis

29. C. Bone Injuries
Fractures in the elbow region usually occur in form of

30. 1. Epiphyseal and Avulsion Fractures
a. Most common on medial epicondyle and olecranon process
b. In growing athletes an avulsion fracture usually involves the epiphysis

31. Signs and Symptoms
1. Severe pain and point tenderness
2. Rapid swelling & possible deformity
3. Difficulty/inability to move the elbow
4. Decreased grip strength
Treatment
Splint, ice, and send to physician

32. 2. Elbow Dislocation
Usually occurs by falling on an outstretched hand with the elbow in a position of hyperextension or as a result of a severe twist while it is in a flexed position

34. Signs and Symptoms
1. Severe pain
2. Obvious deformity
3. Possibly tingling or numbness in hand
4. Possibly shock

35. Treatment
1. Check sensation and circulation
2. Splint in position found
3. Call 911
4. Care for signs of shock

36. 3. Contusions b. Can occur to the bony or soft tissue
a. Are likely to occur due to the lack of natural padding
b. Can occur to the bony or soft tissue
c. If the olecranon process is contused, the olecranon bursa can become irritated causes a lot of fluid build-up at the tip of the elbow sometimes the size of a golf ball

37. Signs and Symptoms
1. Point tenderness
2. Big bump
Treatment
1. Ice and firm compression
2. Protective Padding before returning to competition