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

2. 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

3. 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

6. 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

7. Ligaments cont.

8. 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

12. 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

17. 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

18. Distal Radial Pulse

19. 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

20. 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

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

22. 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

23. 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

24. 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

25. Muscle and Tendon Injuries
Caused by excessive resistive forces or overuse

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. Fracture Distal end of Humerus

34. Fracture of Condyles

35. 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

36. Avulsion Fracture

37. Bone Fragment in Elbow Joint

38. 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

40. 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 (???)

42. 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