1. Chapter 23: The Elbow

3. Anatomy Bones Ligaments Muscle action Humerus Radius Ulna
Radial collateral
Ulnar collateral
Annular
Muscle action
Flexion (biceps)
Extension (triceps)
Supination (supinator and biceps)
Pronation (pronator teres)

4. Bony Anatomic Landmarks
Coronoid Process
Radial Head
Capitellum
Trochlea
Lateral Humeral Epicondyle
Medial Humeral Epicondyle
Coronoid Fossa
Radial Fossa

5. Anatomy Modified hinge with three articulations Ulnotrochlear
Radiocapitellar
Proximal radioulnar
All contained within a single synovial lining

6. Ligament Anatomy Anterior

7. Ligament Anatomy Medial

8. Ligament Anatomy Lateral

11. Vascular Structures (continued)
Radial artery
Originates at radial head, emerges from antecubital fossa between brachioradialis and pronator teres muscles
Continues laterally along forearm deep to brachioradialis muscle

12. Neurological Structures (continued)
Ulnar nerve
Courses in cubital tunnel posterior to medial epicondyle
Superficial and susceptible to compression or entrapment
Courses down medial forearm to hand/wrist distribution
Sensory distribution is pad of little finger

13. Functional Anatomy
Complex that allows for flexion, extension, pronation and supination
145 degrees of flexion and 90 degrees of supination and pronation
Bony limitations, ligamentous support and muscular stability at the elbow help to protect it from overuse and traumatic injuries
Elbow demonstrates a carrying angle due to distal projection of humerus
Normal in females is degrees, males 5 degrees
Critical link in kinetic chain of upper extremity

14. Carrying Angle/Cubitus Valgus
Formed by long axis of humerus and midline of forearm
Male norms – degrees
Female norms – degrees
Larger angles are considered abnormal

15. Gunstock Deformity/Cubitus Varus
Usually develops secondary to condylar humerus fracture

16. HOPS for the elbow History Observation Palpation Special tests
Questions????
Related to throwing
Observation
Dominant arm (muscles/joint)
Cubitus valgus/varus/recurvatus
Triangle (epicondyles and olecranon process
Palpation
Bony
Soft tissue
Nerves (radial and ulnar)
Can’t actually touch everything (general area)
Special tests
Very big part

17. Special tests Range of motion Muscle testing Joint instability
Passive, active-assisted, active
Muscle testing
Joint instability
Circulatory and neurological
Nerves (sensation)

18. Special tests Tinel’s sign Determine ulnar nerve pathology
Put athlete in slight elbow flexion
Tap on the ulnar notch between the olecranon process and medial epicondyle with a reflex hammer or index finger
Positive sign: athlete complains of a tingling sensation along the forearm, hand, and fingers

19. Valgus and varus stress test
To test integrity of medial and lateral collateral ligaments of the elbow
Test the same as knee collateral ligaments
Make sure you have a good fulcrum
What am I testing for??? (positive sign)

20. Valgus/Varus Stress Test
Assess injury to the medial and lateral collateral ligaments, respectively
Looking for gapping or complaint of pain

21. Lateral and medial epicondlyitis test

22. Resist wrist extension--lateral
Resist wrist flexion--medial

23. Recognition and Management of Injuries to the Elbow
Subject to injury due to broad range of motion, weak lateral bone structure, and relative exposure to soft tissue damage
Many sports place excessive stress on joint
Locking motion of some activities, use of implements, and involvement in throwing motion make elbow extremely susceptible

24. Etiology of Elbow Injuries