1. The Elbow
Ulnar Collateral Ligament Sprain Elbow Dislocation Ulnar Nerve Irritation
Emily Gavlick

2. Bone Anatomy of Elbow Involved bones: General Joint Type: hinge
Humerus
Ulna
Radius
General Joint Type: hinge
Movement allowed in only one plane

3. Bone Anatomy of the Elbow
Joint Actually Comprised of 3 Areas
1. Humeroulnar Joint: flexion and extension
Proximal Radioulnar Joint: supination and
pronation of hand
3. Humeroradial Joint: arthrodial joint (only a slight gliding motion)

4. Ligament Anatomy of Elbow
Ulnar Collateral Ligament (UCL): medial side of the elbow
Radial Collateral Ligament (RCL): lateral side of the elbow
Annular Ligament: wraps around the radial head and holds it tight against the ulna
annular means ring-shaped

5. Ligament Anatomy of Elbow

6. Muscle Anatomy of Elbow
Anterior:
Biceps
Posterior:
Triceps Brachii
Lateral:
Supinator
Medial:
Flexor Carpi Ulnaris

7. Tendon Anatomy of Elbow
Anterior:
biceps tendon
Posterior:
triceps tendon
Lateral:
common tendon of origin of the Extensor muscles
Medial:
common tendon of origin of the Flexor muscles

8. Muscle / Tendon Anatomy of Elbow

9. Muscle / Tendon Anatomy of Elbow

10. Elbow Injuries

11. Ulnar Collateral Ligament Sprain
What is it?
Stretch or tear of the UCL
Involved Structures:
The UCL
The Humerus
The Ulna
Location:
Medial side of elbow

12. Ulnar Collateral Ligament Sprain
Mechanism of Injury:
Force bends elbow inward toward midline
most commonly occurs in throwing activities

13. Ulnar Collateral Ligament Sprain
General Signs and Symptoms: (specific symptoms depend on severity of sprain)
Pain
Popping / tearing sensation
Tenderness
Swelling
Bruising

14. Ulnar Collateral Ligament Sprain
Grades: (as with any sprain)
Grade I: partial tear of a ligament
Mild tenderness and swelling
Slight or no functional loss
No mechanical instability

15. Ulnar Collateral Ligament Sprain
Grade II: incomplete tear of a ligament with moderate functional impairment
Moderate pain and swelling
Mild to moderate bruising
Tenderness over involved structures
Some loss of motion and function
Mild to moderate instability

16. Ulnar Collateral Ligament Sprain
Grade III: complete tear and loss of integrity of a ligament
Severe swelling
Severe bruising
Loss of function and motion
Mechanical instability

17. Ulnar Collateral Ligament Sprain
Testing for Injury
Valgus stress testing:
Pain
Instability
Radiographs:
loose bodies
traction spurs (protrusion of bone / cartilage)
MRI:
partial and complete tears
not usually necessary

18. Ulnar Collateral Ligament Sprain
Treatment for Injury:
Prevention
Long-term strengthening and conditioning appropriate for sport.
Warm up before practice or competition.
Tape vulnerable joints before practice or competition

19. Ulnar Collateral Ligament Sprain
Treatment for Injury
Grade I Sprain:
PRICE
Possible application of a cast, tape, elastic bandage or sling
If no device is applied, icepacks, whirlpool therapy, and massage may be used
Recovery time: 2-6 weeks

20. Ulnar Collateral Ligament Sprain
Treatment for Injury
Grade II Sprain:
PRICE
Application of cast, tape, elastic bandage or sling
Possible physical therapy
Recovery time: 6-8 weeks

21. Ulnar Collateral Ligament Sprain
Treatment for Injury
Grade III Sprain:
PRICE
Application of cast, tape, elastic bandage or sling
Physical therapy
Surgery
Recovery time: 8-10 weeks, with potential for prolonged disability

22. Ulnar Collateral Ligament Sprain
Ramon Ramirez: Colorado Rockies pitcher
missed 23 games with an elbow sprain in April 2007

23. Elbow Dislocation What is it? Involved Structures: Location:
The radius and ulna move out of place compared with the humerus
Involved Structures:
The Radius
The Humerus
The Ulna
Surrounding tissues
Location:
Elbow joint

24. Elbow Dislocation
General Signs and Symptoms: (specific symptoms depend on severity of dislocation)
Tenderness
Swelling
Deformity
Bruising
Poor blood flow to the lower arm and hand

25. Elbow Dislocation Nursemaid’s / Babysitter’s Elbow Signs / Symptoms:
Partial or radial dislocation (subluxation)
Common in children
Caused when child is lifted by arm
Signs / Symptoms:
pain
Refuse to use injured arm
Holding elbow slightly bent

26. Elbow Dislocation Simple Complex
radius and ulna become dissociated from the humerus without associated fracture
Complex
simple dislocation combined with fracture of the humerus, radius, ulna or a combination of all three bones

27. Elbow Dislocation Mechanism of Injury:
Force sent through ulna/radius to elbow
Often accompanied by a twisting force
Usually occurs when a person attempts to break a fall or cushion an impact

28. Elbow Dislocation Signs / Symptoms: Severe pain Deformity Swelling
Inability to bend arm
In some cases:
Numbness
Lack of pulse

29. Elbow Dislocation Testing for Injury:
Evaluation of tenderness, swelling, deformity, sensation, and circulation
X-ray
CT scan may help evaluate fractures
Angiogram may be done if arterial injury is suspected

30. Elbow Dislocation Treatment for Injury:
Nursemaid’s / Babysitter’s Elbow
Closed Reduction: manipulating arm; the annular ligament and radial head return to their normal anatomic positions
immobilize elbow and palpate region of radial head
apply axial compression at wrist while supinating forearm and flexing elbow
a click or snap can be felt at the radial head

31. Elbow Dislocation Treatment for Injury Simple Dislocation:
Closed Reduction
Splinting
24-hour hospital observation if nerve / artery injury is suspected
Possible physical therapy

32. Elbow Dislocation Treatment for Injury Complex Dislocation:
Reconstructive Surgery (open reduction)

33. Elbow Dislocation
Partial Simple
Radial Complex

34. Ulnar Nerve Irritation
What is it?
The ulnar nerve, one of the 3 main nerves that innervate the hand, is affected
The Funny Bone
Location:
runs from the shoulder to the hand

35. Ulnar Nerve Irritation
Two ways to irritate the ulnar nerve:
Impingement (pinching)
Cubital Tunnel Syndrome
Entrapment (stuck to surrounding tissue)
Location: Posterior elbow joint

36. Ulnar Nerve Irritation
Mechanism of Injury:
Genetic, natural build
Frequent bending of elbow joint
Fracture of nearby bone
Blow to cubital tunnel
Cubital tunnel: tunnel of muscle, ligament, and bone on the inside of the elbow allows the Ulnar nerve to travel over the elbow

37. Ulnar Nerve Irritation
Signs / Symptoms:
Numbness on the inside of the hand and in the ring and little fingers
Pain
Weak Grip
Muscle Wasting

38. Ulnar Nerve Irritation
Testing for Injury:
Physical examination to confirm location
MRI / CT scan to check for bone spurs or arthritis
Nerve Conduction Velocity (NCV) test: measures speed of impulses traveling along the nerve
Electromyogram (EMG). sometimes used; tests whether the muscles are working properly.

39. Ulnar Nerve Irritation
Treatment for Injury:
Conservative: discontinue irritating action, anti-inflammatory medications, nighttime splint / elbow pad, and/or physical therapy
Surgical: ulnar nerve transposition, or removing medial epicondyle on medial elbow

40. Ulnar Nerve Irritation
Ulnar Nerve Transposition