1. Elbow Anatomy

2. Bones of the Elbow Humerus –Medial and Lateral Epicondyle Ulna –Olecranon Process Radius –Head

3. Elbow Anatomy Joint –Humeroulnar Actions –Flexion and Extension Ligaments –Lateral Collateral Ulna and radius to humerus –Medial Collateral Ulna to humerus –Keep elbow stable

4. Lateral and Medial Collateral Ligaments

5. Muscles of the Elbow Elbow Flexors (3 B’s) –Biceps Brachii Long and Short head –Brachioradialis –Brachialis Elbow Extensors –Triceps Brachii –Anconeus

6. Biceps Brachii 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

7. 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

8. 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

9. 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

11. 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)

12. Carrying Angle When the elbow is extended and the forearm is supinated, the humerus, radius and ulna are not perfectly aligned. This is called Carrying Angle This angle allows the elbow to be tucked into the waist depression above the iliac crest; it increases when a heavy object is being lifted 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

14. Preacher Curls-Ouch! Common Mistake Made –Medially or laterally rotating the shoulder 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 elbow flexors

15. 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)

17. 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

18. Triceps Brachii The medial head (C) of the triceps is the most active but the lateral head (B) is the strongest Both lateral and long heads (A) 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

19. 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

21. Golfer’s Elbow and Tennis Elbow Tennis Elbow –Lateral Epicondylitis Golfer’s Elbow –Medial Epicondylitis

22. Lateral Epicondylitis Tennis elbow Overuse injury on the lateral epicondyle of humerus –Tennis, raquetball, squash, painting Caused by overuse of the wrist extensors, primarily the extensor carpi radialis brevis which attaches to the lateral epicondyle of the humerus

23. Medial Epicondylitis Golfer's elbow Overuse injury on the medial epicondyle of humerus –Pitching, golfing, gardening, typing, bricklaying Caused by overuse of the wrist flexors that attach onto the medial epicondyle of the humerus

24. Lateral and Medial Epicondylitis Symptoms –Pain and tenderness on the medial or lateral epicondyle of the humerus Pain during –Grasping, pushing, pulling or squeezing of objects Shaking hands Carrying a briefcase Writing Lifting objects Steering a car

25. Lateral and Medial Epicondylitis Treatment –Diagnosis by physician –RICE Rest : Avoid activities that aggravate the injury Absolute rest should be avoided as it encourages muscle atrophy 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 5-10 minutes Compress and Elevate if appropriate to assist venous return and minimize swelling

26. Lateral and Medial Epicondylitis Treatment –Stretch Wrist flexors and extensors Strengthen: –Rotator cuff muscles –Scapular muscles –Forearm pronators and supinator muscles –Wrist extensors and flexor muscles –Finger flexor and extensor muscles

27. Gentle stretching of wrist flexors and extensors The elbow should be extended and not flexed to increase the amount of stretch Hold each stretch for 30 seconds Perform 5-10 reps, at least twice a day Vigorous stretching should be avoided - do not stretch to the point of pain

28. Strengthening Exercises Support forearm and wrist on table Perform wrist extension and wrist flexion with one pound weights Perform 3 sets of 10 reps with 60 sec rest intervals

29. Strengthening Exercises Support forearm on edge of table or thigh Use a wrench or hammer Perform forearm pronation and supination Perform 3 sets of 10 reps with 60 sec rest intervals

30. Strengthening Exercises Finger Extension Place a rubber band around all five finger tips Abduct fingers for 3 sets of 20 reps with 60 sec rest intervals For increased resistance, add a second rubber band or use a rubber band of greater thickness Ball Squeeze Squeeze a tennis ball, piece of foam or sponge for 3 sets of 20 reps with 60 sec rest intervals