1. Elbow/Wrist/Hand Unit
Chapter 22
Advance Sports Medicine

2. Anatomy Of The Elbow/Wrist/Hand
1. Navicular (scaphoid)
2. Lunate
3. Triquetral
4. Pisiform
5. Hamate
6. Capitate
7. Trapezoid
8. Trapezium
9. Ulnar styloid
10. Radial Styloid

3. Anatomy cont. Bones of the elbow 1 Olecranon 2 Capitulum- 3 Trochlea
4 Lateral epicondyle
5 Medial epicondyle

4. Muscles and Ligaments of the forearm/elbow
Ligaments of elbow
11.Extensor carpi ulnaris
12. Extensor carpi radialis
13. Flexor digitorum
14. Extensor digitorum
15. Thumb-
16. Flexor pollicis longus/brevis
17. Extensor pollicis longus/brevis
18. Abductor pollicis
19. Adductor pollicis
20. Opponens pollicis
21. Opponens digiti minimi (5th phalange
Ulnar collateral
Radial collateral
Annular lig.- attaches to ulna/radius of the elbow
Muscles
4. Biceps brachii
5. Tricep brachii
6. Brachial radialis
7. Supinator
8. Pronator teres
9. Flexor carpi radialis
10. Flexor carpi ulnaris

5. Thenar And Hypothenar Eminence
Thenar eminence: thumb side
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
Hypothenar eminence: pinky side
Opponens digiti minimi
Abductor digiti minimi
Flexor digiti minimi brevis

6. Injuries to elbow Contusions Olecranon bursitis Strains
May swell rapidly after an irritation of the olecranon bursa or the synovial membrane
R I C E
Olecranon bursitis
Most frequently injured bursa in the elbow.
Pain, point tenderness, severe swelling
Ice and compression and possibility of aspiration
Strains
Usually caused by falling on an outstretched arm or hyperextension. Test the biceps, triceps, brachialis, pronators, supinators

7. Elbow Injuries cont. Sprains Lateral epicondylitis
Caused by hyperextension or valgus forces. Point tender of the ulnar collateral lig.
Ice, compression and sling with the elbow in 45 degrees of flexion
Lateral epicondylitis
Chronic, or called tennis elbow, caused by repetitive microtrauma to the insertion of the extensor muscles, Hyperpronation is the primary action.
RICE, and NSAID’s
Medial epicondylitis
same as above but most common in pitching, wrist flexors

8. Elbow injuries cont. Osteochondritis Dissecans Little League elbow
Loose body in the joint, young athletes yrs old.
Sudden pain and locking of the joint
RICE, NSAID’s, possible surgery
Little League elbow
Occurs in 10-25% of young pitchers, Injury onset is usually slow, may have joint tightness and triceps weakness, decreased ROM in pronation and supination
RICE,NSAID’s and throwing is stopped.
Cubital tunnel syndrome
Ulnar nerve tunnel, traction injury from valgus force, irregularities within the tunnel, subluxation of the ulnar nerve because of a lax ligament, or a progressive compression of the ligament on the nerve.

9. Posterior Elbow dislocation

10. Elbow Dislocation Elbow Injuries cont.
Fall on an outstretched hand with elbow in a hyperextension or twisted position
Deformity with olecranon extending backward beyond its normal alignment
Rupture most of the stabilizing ligaments
Profuse swelling, pain and disability
Complications can include injury to major nerves and blood vessels
Rx: splint and refer to Dr. immediately for reduction as soon as possible.

11. Elbow Injuries cont.
Elbow Fracture
Etiology: fall on an outstretched arm or a direct blow to the olecranon.
Fracture site: just above the epicondyles of the humerus
S/S: may or may not have visible deformity, will have hemorrhage, swelling, muscle spasm
Rx: splint, ice and send to Dr. One complication is decreased ROM

12. Volkmann’s contracture
humeral supracondylar fx, which cause muscle spasm, swelling, or bone pressure on the brachial artery, inhibition blood circulation to the forearm, wrist, and hand
S/S: pain in the forearm which becomes greater when the fingers are passively extended. Brachial/radial pulses diminish which produce cold hands
Rx: remove bandages and elevate to relieve the pressure. Dr.

13. Eval. Of elbow History: Observation Palpation
Is it caused by direct trauma, throwing type of an inj?, look for internal organ problem or ulnar nerve impingement, is there is a feeling of locking or crepitation?
Observation
Carrying angle, see if the bony prominence form an isosceles triangle with the elbow at 45 degrees.
Palpation
Special tests: see Handout

14. Rehab of the elbow Stage 1 Stage 3 Stage 2 Maintain CV RICE
Early splinting and Interferential for the pain along with NSAID’s
Stage 2 Maintain CV
Early ROM exercises
Joint mobilizations for increase ROM
Closed kinetic chain exercises
PNF exercises
Strengthening exercises after full ROM is obtained
Stage 3
Functional progression
Open kinetic chain ex. W/controlled ROM
Open kinetic chain ex. Through pain free ROM
PNF/closed kinetic ex.
Sports specific exercises.