1. Copyright © 2013. F.A. Davis Company Part IV: Exercise Interventions by Body Region Chapter 18 The Elbow and Forearm Complex

2. Copyright © 2013. F.A. Davis Company STRUCTURE AND FUNCTION OF THE ELBOW AND FOREARM

3. Copyright © 2013. F.A. Davis Company  Humeroulnar Articulation  Humeroradial Articulation  Ligaments of the Elbow – Medial (ulnar) collateral ligament – Lateral (radial) collateral ligament Elbow Joint Characteristics and Arthrokinematics

4. Copyright © 2013. F.A. Davis Company  Proximal (superior) Radioulnar Articulation  Distal (inferior) Radioulnar Articulation Forearm Joint Characteristics and Arthrokinematics

5. Copyright © 2013. F.A. Davis Company  Primary Actions at the Elbow – Elbow flexion Brachialis Biceps brachii Brachioradialis – Elbow extension Triceps brachii Anconeus Muscle Function at the Elbow and Forearm

6. Copyright © 2013. F.A. Davis Company  Primary Actions at the Forearm – Forearm supination Supinator Biceps brachii Brachioradialis – Forearm pronation Pronator teres Pronator quadratus Muscle Function at the Elbow and Forearm (cont'd)

7. Copyright © 2013. F.A. Davis Company  Relationship of Wrist and Hand Muscles to the Elbow – Wrist flexor muscles – Wrist extensor muscles Muscle Function at the Elbow and Forearm (cont'd)

8. Copyright © 2013. F.A. Davis Company  Common Sources of Referred Pain into the Elbow Region  Nerve Disorders in the Elbow Region – Ulnar nerve – Radial nerve – Median nerve Referred Pain and Nerve Injury in the Elbow Region

9. Copyright © 2013. F.A. Davis Company MANAGEMENT OF ELBOW AND FOREARM DISORDERS AND SURGERIES

10. Copyright © 2013. F.A. Davis Company  Related Pathologies and Etiology of Symptoms  Common Structural and Functional Impairments – Acute stage – Subacute and chronic stages  Common Activity Limitations and Participation Restrictions Joint Hypomobility: Nonoperative Management

11. Copyright © 2013. F.A. Davis Company  Management: Protection Phase – Educate the patient – Reduce effects of inflammation or synovial effusion and protect the area – Maintain soft tissue and joint mobility – Maintain integrity and function of related areas Joint Hypomobility: Nonoperative Management (cont'd)

12. Copyright © 2013. F.A. Davis Company  Management: Controlled Motion Phase – Increase soft tissue and joint mobility – Improve joint tracking of the elbow – Improve muscle performance and functional abilities Joint Hypomobility: Nonoperative Management (cont'd)

13. Copyright © 2013. F.A. Davis Company  Management: Return to Function Phase – Improve muscle performance – Restore functional mobility of joints and soft tissues – Promote joint protection Joint Hypomobility: Nonoperative Management (cont'd)

14. Copyright © 2013. F.A. Davis Company  Indications for Surgery – Contraindications to surgery  Procedure – Background Selection of procedure Implant designs, materials, and fixation – Overview of operative procedure Radial Head Excision or Arthroplasty

15. Copyright © 2013. F.A. Davis Company  Complications  Postoperative Management – Immobilization – Exercise: maximum protection phase – Exercise: moderate and minimum protection phases  Outcomes Radial Head Excision or Arthroplasty (cont'd)

16. Copyright © 2013. F.A. Davis Company  Indications for Surgery  Procedure – Background Implant design and selection considerations Materials and fixation – Operative overview  Complications Total Elbow Arthroplasty (TEA)

17. Copyright © 2013. F.A. Davis Company  Postoperative Management – Immobilization – Exercise: maximum protection phase – Exercise: moderate and minimum protection phases  Outcomes Pain relief and patient satisfaction ROM and functional use of the upper extremity Total Elbow Arthroplasty (TEA) (cont'd)

18. Copyright © 2013. F.A. Davis Company  Definition: Formation of bone in atypical locations in the body – Synonymous with heterotopic bone formation  Etiology of Symptoms  Management Myositis Ossificans

19. Copyright © 2013. F.A. Davis Company  Related Pathologies – Lateral elbow tendinopathy (tennis elbow) – Medial elbow tendinopathy (golfer’s elbow)  Etiology of Symptoms  Common Structural and Functional Impairments  Common Activity Limitations and Participation Restrictions Overuse Syndromes: Repetitive Trauma Syndromes

20. Copyright © 2013. F.A. Davis Company  Decrease Pain, Edema, or Spasm  Develop Soft Tissue and Joint Mobility  Maintain Upper Extremity Function Nonoperative Management of Overuse Syndromes: Protection Phase

21. Copyright © 2013. F.A. Davis Company  Increase Muscle Flexibility and Scar Mobility  Restore Joint Tracking of the RU Joint  Improve Muscle Performance and Function  Patient Education Nonoperative Management: Controlled Motion and Return to Function Phases

22. Copyright © 2013. F.A. Davis Company EXERCISE INTERVENTIONS FOR THE ELBOW AND FOREARM

23. Copyright © 2013. F.A. Davis Company  Manual, Mechanical, and Self-Stretching Techniques – To increase elbow extension – To increase elbow flexion – To increase forearm pronation and supination Exercise Techniques to Increase Flexibility and Range of Motion (ROM)

24. Copyright © 2013. F.A. Davis Company  Self-Stretching Techniques: Muscles of the Medial and Lateral Epicondyles – To stretch the wrist extensor muscles (from the lateral epicondyle) – To stretch the wrist flexor muscles (from the medial epicondyle) Exercise Techniques to Increase Flexibility and ROM (cont'd)

25. Copyright © 2013. F.A. Davis Company  Isometric Exercises – Multiple-angle isometric exercises – Angle-specific training – Alternating isometrics and rhythmic stabilization Exercises to Develop and Improve Muscle Performance and Functional Control

26. Copyright © 2013. F.A. Davis Company  Dynamic Strengthening and Endurance Exercises – Elbow flexion – Elbow extension – Long head of the triceps with elbow extension – Pronation and supination – Wrist flexion and extension Exercises to Develop and Improve Muscle Performance and Functional Control (cont'd)

27. Copyright © 2013. F.A. Davis Company  Functional Progression for the Elbow and Forearm – Diagonal patterns – Combined pulling motions – Combined pushing motions – Plyometric training (stretch-shortening drills) – Simulated tasks and activities Exercises to Develop and Improve Muscle Performance and Functional Control (cont'd)

28. Copyright © 2013. F.A. Davis Company  Critical Thinking and Discussion  Laboratory Practice  Case Studies Independent Learning Activities