Functional Anatomy & Clinical Presentation
Elbow Anatomy
 What movements occur at the elbow?
 What type of joint is the elbow?
Bony Anatomy
 Upper Arm
 Humerus
 Forearm
 Ulna (medial)
 Radius (lateral)
Bony Anatomy
 Anterior
 Supracondylar ridge
 Lateral epicondyle
 Medial epicondyle
 Radial head
 Coronoid fossa
 Capitulum
 Trochlea
Bony Anatomy
 Posterior
 Olecranon fossa
 Olecranon
 Groove for ulnar nerve
Ligaments
 Annular ligament
 360 degrees around
radial head
 Keeps the radial head in
contact with the radial
notch of the ulna
Ligaments
 Ulnar Collateral Ligament
 Medial side of elbow

Connects medial epicondyle
to coranoid & olecranon
processes
Ligaments
 Radial (Lateral)Collateral Ligament
 Lateral side of elbow

Connects the lateral
epicondyle to the annular
ligament
Bony Palpations












Supracondylar ridge
Lateral epicondyle
Radial (lateral) collateral ligament
Radial head/annular ligament
Radius
Olecranon process
Olecranon fossa
Medial epicondyle
Proximal end of ulna
Ulna
Ulnar groove
Ulnar collateral ligament
Soft Tissue Anatomy
 Anterior
 Biceps brachii
 Brachioradialus
 Brachialis
 Pronator Teres
Soft Tissue Anatomy
 Biceps Bracii
 Origin
 Shoulder
 Insertion
 Radius
 Action
 Flexes forearm, supinates forearm
Soft Tissue Anatomy
 Brachioradialus
 Origin

Lateral supracondylar ridge
 Insertion

Styloid process of radius
 Action

Flexes forearm
Soft Tissue Anatomy
 Brachialis
 Origin

Anterior, distal humerus
 Insertion

Coronoid process of ulna
 Action

Flexes the elbow
Soft Tissue Anatomy
 Pronator Teres
 Origin


Medial epicondyle of humerus
Coronoid process of ulna
 Insertion

Middle of lateral surface of shaft of ulna
 Action

Pronates the elbow
Soft Tissue Anatomy
 Posterior
 Triceps
 Supinator
Soft Tissue Anatomy
 Triceps
 Origin

Shoulder (3 origins)
 Insertion

Olecranon process of ulna
 Action

Extends elbow
Soft Tissue Anatomy
 Supinator
 Origin

Lateral epicondyle of humerus
 Insertion

Proximal, lateral shaft of radius
 Action

Supinates the elbow
Soft Tissue Anatomy
 Medial
 Wrist flexors

Originate off medial epicondyle
Soft Tissue Anatomy
 Lateral
 Wrist extensor muscles

Originate off lateral epicondyle
Soft Tissue Anatomy
 Lateral
 Anconeus



Origin
 Posterior part of lateral epicondyle of humerus
Insertion
 Later olecranon process, posterior ulna
Action
 Extends forearm (helps triceps last few degrees)
Soft Tissue Palpations
 Anterior
 Biceps brachii
 Brachialis
 Brachioradialis
 Pronator teres
 Posterior
 Triceps
 Supinator
 Medial
 Wrist flexor muscles
 UCL
 Lateral
 RCL
 Wrist extensor muscles
Range of Motion
 Assesses the motion of the joint bilaterally
 (compared to the other side)
 Active Range of Motion (AROM) vs Passive Range of
Motion (PROM)
 Normal joint motion @ elbow
 Flexion: 150 - 160
 Extension: 0
 Pronation: 70
 Supination: 85
Measuring R.O.M.
Moving
arm
 Goniometer
Fulcrum
Stationary arm
Measuring R.O.M.
 Elbow Flexion
 Fulcrum

Lateral epicondyle
 Stationary arm

Midline of humerus
 Moving arm

In line with radial styloid process
Resisted Range of Motion (RROM)
 Elbow Flexion
 Put elbow in flexion
 Place one hand one the shoulder being tested
 Other hand on the anterior forearm
RROM
 Elbow Extension
 Pt is seated
 Elbow slightly flexed
 One hand supports the elbow
 Other hand applies pressure to the proximal wrist\

Trying to push the arm into flexion
RROM
 Pronation
 Pt is seated
 Palm is facing down
 One hand stabilizes below the forearm
 Other “shakes patient’s hand”, tries to make hand
supinate.
RROM
 Supination
 Pt is seated
 Palm is facing up
 One hand stabilizes below the forearm
 Other “shakes patient’s hand”, tries to make hand
pronate.
Injuries of the Elbow
 Bone Injuries
 MOI?


Forcing arm into bending
Fall on an outstretched hand
 Importance of prompt treatment?
Damage to blood vessels and nerves could cause cell death.
 Epiphyseal & avulsion fractures
 Ulnar dislocations
Epiphyseal & Avulsion Fractures
 More common on the medial epicondyle or the olecranon.
 Growing athletes are more likely to have an epiphyseal
fracture.
 S/S
 Epiphyseal – pain, swelling, loss
of motion
 Avulsion – severe pain and
deformity
Elbow Dislocation
 MOI?
 Fall on an outstretched hand
 Violent hyperextension
 Severe blow to the lateral elbow
http://www.youtube.com/watch?v=r9rywfbwC8E
 Most common dislocation?
 Posterior
 S/S (What is observed?)
 Gross deformity
 Olecranon process extends posteriorly
 Swelling, bruising
Elbow Dislocation
 Potential complications?
 Damage to the median & radial nerves
 Damage to blood vessels
 Treatment/management
 Splint as you found it
 Send to emergency room for
relocation.
Muscle & Tendon Injuries
 Elbow flexor strains
 Elbow extensor strains
 Medial & lateral epicondylitis
Elbow Flexor Strain
 MOI?
 Often includes both the shoulder & elbow (biceps)
 Excessive resistance elbow & shoulder flexion
 S/S
 Depends on grade… (think of sprains and strains chart)



Grade 1?
Grade 2?
Grade 3?
 Pain over anterior elbow and the biceps tendon
Elbow Flexor Strain
 Evaluation will find…
 Weakness
 Extra discomfort with elbow flexion


AROM, RROM
PROM? (pain decreases with PROM)
 Grades 1 & 2

RICE, rehabilitation
 Grade 3

Refer to physician/ER
Elbow Extensor Strain
 MOI
 Same as flexor strain
 Trying to break a fall
 Pain with active elbow extension
 Be sure to check for avulsion fractures at the olecranon
process.
Medial & Lateral Epicondylitis
 Chronic inflammation of either the medial or lateral
epicondyles.
 Lateral Epicondylitis (Tennis Elbow)
 Inflammation of the extensor tendons.
 S/S
 Minimal swelling over lateral epicondyle

Pain will also be present
Medial Epicondylitis
 AKA Little League Elbow
 Result of repetitive throwing
 Inflammation of the wrist flexors
 Pitch counts in Little League?
 S/S
 Same as lateral epicondylitis
UCL/RCL Sprains
 Ulnar collateral ligament is more prone to injury
 MOI?
 UCL – valgus force (force from the lateral side)
 RCL – varus force (force from the medial side)
 S/S
 Pain
 Swelling
 Possibly joint laxity

Special tests
Scenario 1
 A basketball player goes up for a lay up and has his feet
taken out from under him, and tries to catch himself
with an outstretched hand. He falls to the floor and
does not get up, but is holding his elbow in pain.
When you get there you notice that his olecranon
process is protruding posteriorly and there is already a
considerable amount of swelling.
Scenario 1 Answer
 Posterior Dislocation
 Splint as you found it, and refer to ER
Scenario 2
 A wrestler is trying to escape from a move. His hand is
planted on the mat when his opponent strikes the
lateral side of his elbow. He feels a small pop on the
medial side, but finishes the match. After the match
he approaches you with pain in both his medial and
lateral elbow. He has a moderate amount of swelling
over his medial epicondyle and has some laxity with a
valgus stress test.
Scenario 2 Answer
 UCL Sprain (Grade 2)
 Follow up with physician
 Discontinue activities
 PRICES
Scenario 3
 A tennis player approaches you with elbow pain. You
notice a minimal amount of swelling over her lateral
epicondyle. While palpating you notice that most of
her pain is over the lateral epicondyle and into the
wrist extensors. She does not remember doing
anything to that elbow, but says it has been bothering
her for about a week.
Scenario 3 Answer
 Lateral Epicondylitis
 Tape for relief
 Ice after practice
 NSAIDS