1. Elbow Flexors and Extensors

2. Elbow Anatomy - Bones Humerus Medial Epicondyle Lateral Epicondyle
Radius
Ulna
Olecranon Process

3. The Ulna Ulnar Tuberosity Radial notch Trochlear Notch
Olecranon Process
Radial notch
Trochlear Notch
Coronoid Process
Ulnar Tuberosity
Styloid Process
Head

4. The Radius Head Neck Styloid Process Radial Tuberosity
Ulnar Notch on medial surface

5. Humerus Lateral View
Humeroulnar Joint
Ulna, lateral view

6. Elbow Anatomy - Ligaments
Lateral Collateral Ligament
Ulna and radius to humerus
Medial Collateral Ligament
Ulna to humerus
Keep the elbow stable

7. Lateral Collateral Ligament

8. Medial Collateral Ligament

9. Radioulnar joint
Radius, lateral view
Ulna, lateral view

10. Nerves Three primary nerves of the humerus, radius, ulna, and wrist:
Radial Nerve
Innervates the triceps brachii and provides sensation to dorsal side of thumb, index, middle, and half of ring finger
Ulnar Nerve
Palmar side of the little finger and half of the ring finger
Median Nerve
Palmar side of thumb, index , and half of ring finger

11. Arteries
Brachial artery travels across the crease of the elbow and splits into two branches below the elbow
Ulnar and Radial Artery

12. Elbow Anatomy Muscles Elbow Flexors (3 B’s) Biceps Brachii
Long and Short head
Brachioradialis
Brachialis
Elbow Extensors
Triceps Brachii
Anconeus

13. Biceps Brachii Forearm Supination Assists in Shoulder Flexion
O: Short head: Coracoid process of scapula
Long head: Supraglenoid tubercle of scapula
I: Radial tuberosity
A: Elbow Flexion
Forearm Supination
Assists in Shoulder
Flexion

14. Integrated Function of Biceps Brachii
Assists in deceleration of elbow extension
Assists in deceleration of forearm pronation
Assists in deceleration of shoulder extension
Assists in dynamic stabilization of the humeral head during head during functional movements

15. Brachialis O: Anterior surface of distal humerus I: Ulnar tuberosity
A: Elbow flexion
Integrated Function:
Assists in deceleration of elbow extension
Assists in dynamic stabilization of elbow

16. Brachioradialis O: Lateral supracondylar ridge of humerus
I: Styloid process of radius
A: Elbow flexion
Assists in supination when forearm
is pronated
Assists in pronation when forearm
is supinated
Integrated Function: Assists in
deceleration of elbow extension
Assists in dynamic stabilization of
elbow

17. Elbow Flexors
The biceps brachii is most powerful when elbow supination is maintained throughout the exercise (it pulls on the radius to rotate it). Both heads work together-very hard to isolate long or short head separately
The brachialis is a strong elbow flexor regardless of whether the forearm is pronated or supinated (it cannot rotate the ulna)
The brachioradialis is strongest in a neutral position (between pronation and supination)

18. Carrying Angle
When the forearm is supinated the humerus, radius, and ulna are not perfectly aligned
The typical carrying angle is 5 to 15 degrees which allows the forearm to clear the hips during ambulation
In females a wider carrying angle is due to a wider pelvic girdle
Carrying angle influences how people hold objects
Individuals with extreme carrying angles tend to pronate

19. Preacher Curls-Ouch!
Common Mistake Made: External/Internal rotation the shoulder joint.
Possible Negative Effect: When you sit at the machine or bench you place your shoulders in an unnatural position which puts strain on your biceps tendon. Also, the bench or machine does not allow natural shoulder flexion that is created by the biceps brachii during a curl.
Avoid preacher curls! There are more effective ways to train your forearm flexors.

20. Triceps Brachii O: Long head - Infraglenoid tubercle of scapula
Lateral - Posterior humerus
Medial - Posterior humerus
I: Olecranon process of ulna
A: Elbow extension
Assists in shoulder extension (long head)

21. Integrated Function of Triceps Brachii
Assists in deceleration of elbow flexion
Assists in deceleration of shoulder flexion
Assists in dynamic stabilization of the glenohumeral joint

22. Anconeus O: Lateral epicondyle of humerus I: Olecranon process &
upper posterior ulna
A: Assists in extension
of elbow
Stabilizes elbow
Integrated Function: Assists in deceleration of elbow flexion

23. Triceps Brachii
The medial head (deep) of the triceps is the most active but the lateral head is the strongest
Both lateral and long heads have 60% Type II Fast Twitch Muscle Fibers
Medial head has 60% Type I Slow Twitch Muscle Fibers
The triceps are not affected by grip position

24. Golfer’s Elbow and Tennis Elbow
Medial Epicondylitis
Tennis Elbow:
Lateral Epicondylitis

25. Medial Epicondylitis Golfer's elbow
Most common overuse injury on the medial epicondyle of humerus
It is the inflammation of the wrist and finger flexor tendons that attach onto the medial epicondyle of the humerus
This causes micro tearing of tendons, hemorrhage, inflammation, scarring, degeneration and shortening of the tendons

26. Symptoms of Medial Epicondylitis
There is pain and tenderness on the medial (middle) aspect of the elbow on the medial epicondyle.
Painful activities include:
Grasping or squeezing a handle,  a golf club or a tennis racquet.
Shaking hands.
Carrying a briefcase
Writing
Lifting objects
Steering a car

27. Common Causes of Medial Epicondylits
Occupational overuse
Weak grip strength
Poor fitting equipment– grip size or weight of  club or racquet
Cervical spine nerve pinching
Elbow hyperextension, "double jointed".
Overuse in a sporting or daily activity
Improper technique
Direct trauma
Untreated past injury of the upper extremity  or fracture

28. Lateral Epicondylitis
Tennis elbow
Most common overuse injury on the lateral epicondyle of humerus
It is the inflammation of the wrist and finger extensor tendons that attach onto the lateral epicondyle of the humerus
This causes micro tearing of tendons, hemorrhage, inflammation, scarring, degeneration and shortening of the tendons

29. Symptoms of Lateral Epicondylitis
Pain or tenderness on the outer side of the elbow
Pain when you straighten or raise your wrist and hand
Pain made worse by lifting a heavy object
Pain when you make a fist, grip an object, shake hands, or turn door handles
Pain that shoots from the elbow down into the forearm or up into the upper arm.

30. Common Causes of Lateral Epicondylitis
Repetitive movement
Strain or the overuse of forearm and wrist extensor muscles
Incorrect grips, poor hitting positions, using a metal framed tennis racquet, improperly carrying a briefcase or other heavy object, or spending too much time using isolated muscle groups in the elbow area.
Golfers, computer users, machinists, carpenters, mechanics, painters…

31. Factors of Lateral Epicondylitis
Poor Posture:
In an EMG study of computer operating office workers, they found that in a slumped posture with foreword head,the tension in the wrist extensors rose approximately 25%. 
If gently tapping on a keyboard with faulty posture had such a dramatic effect, can you imagine what lifting weights would do?
Shoulder Flexibility:
Flexibility deficits in shoulder rotation may lead to elbow problems    

32. Factors of Lateral Epicondylitis
Rotator Cuff Strength
Strengthening of the rotator cuff and scapular stabilizing muscles - in addition to the wrist extensors - is very important. 
Any weakness in this kinetic chain can cause Lateral Epicondylitis. 
If there is no scapular stability, posture will suffer 
If the rotator cuff fatigues, the wrist extensors will often compensate 
Both of these situations result in increased forces at the elbow joint and can eventually lead to Lateral Epicondylitis or a reoccurrence of it 

33. Treatment for Epicondylitis
Diagnosis by Doctor
RICE:
Rest : Avoid activities that aggravate the injury.
Absolute rest should be avoided as it encourages muscle atrophy, deconditions tissue, and decreases blood supply to the area
Ice- Place an ice bag or a bag of frozen veggies on your elbow 3 times a day for 20 to 30 minutes and for 15 min after active use of your arm. You may also run an ice cup directly on the elbow for minutes.
Compress and Elevate if appropriate to assist venous return and minimize swelling.

34. Treatment for Epicondylitis
Stretching:
Will help prevent stiffness by breaking down any scar tissue that may result from the inflammation
Strengthening
Brace
Physical Therapy/Occupational Therapy

35. Gentle stretching exercises including wrist flexion, extension and rotation.
The elbow should be extended and not flexed to increase the amount of stretch as required
These stretches should be held for seconds and repeated 5-10 times, at least twice a day.
Vigorous stretching should be avoided - do not stretch to the point of pain that reproduces your symptoms.

36. Strengthening Exercises
With the elbow bent and the wrist supported perform the following exercises:
Wrist Extension-Place 1 lb. weight in hand with forearm pronated; support forearm at the edge of a table
Extend wrist slowly (concentric contraction), and flex slowly (eccentric contraction).

37. Strengthening Exercises
Wrist Flexion:
Place 1 lb. weight in hand with forearm supinated support forearm at the edge of a table
Flex wrist up slowly (concentric), then extend slowly (eccentric).

38. Strengthening Exercises
Combined Flexion/Extension:
Attach one end of a string to a cut broom stick or similar device, attach the other end to a weight.
In standing, extend your arms and elbows straight out in front of you.
Roll the weight up from the ground by turning the wrists.
Flexors are worked with the palms facing upward. Extensors are worked with the palms facing downward.

39. Strengthening Exercises
Forearm Pronation/Supination Grasp hammer (wrench, or some similar device) in hand with forearm supported. Rotate hand to palm down position, return to start position (hammer perpendicular to floor), rotate to palm up position, repeat. To increase or decrease resistance, by move hand farther away or closer towards the head of the hammer

40. Strengthening Exercises
Finger Extension
Place a rubber band around all five finger tips.
Spread fingers 25 times, repeat 3 times.
If resistance is not enough, add a second rubber band or use a rubber band of greater thickness which will provide more resistance.
Ball Squeeze
Place rubber ball or tennis ball in palm of hand, squeeze 25 times, repeat 3 times.
If pain is reproduced squeeze a folded sponge or piece of foam