Elbow
Sports med 2
Movements
• Carrying angle
– Females 10-15 degrees, Males 5 degrees
• Flexion
– 145 degrees
• Extension
• Pronation
– 90 degrees
• Supination
– 90 degrees
Articulations
• Consists of 3 separate joints
– Humeroulnar
– Humeroradial
– Proximal radioulnar
Ligaments and Bursae
• Ulnar collateral ligament
– Prevents valgus forces
• Radial collateral ligament
– Prevents varus forces (uncommon)
• Annular ligament
– Stabilizes head and neck of radius (strong)
• Olecranon bursa
– Between olecranon process and skin
Musculature
• Biceps Brachii, Brachialis, brachioradialis
– Elbow flexion
• Triceps brachii, anconeus
– Elbow extension
• Pronator teres, supinator
– Pronation and supination
Nerve/Blood Supply
• Median Nerve
• Radial Nerve
• Ulnar Nerve
– Funny bone
• Radial Artery
• Ulnar Artery
Assessment
• History
– Land on tip of bent elbow? (most common MOI)
– Overuse from throwing?
– Over extension?
– Location and duration of pain?
– Positions that increase or decrease pain?
– Previous elbow injuries?
– Locking or crepitation w/movement?
Assessment
• Observations
– Deformities, swelling
– Carrying angle
• Too great or little could = epiphyseal fx
– Decreased flexion or extension
– 45 degree angle, posterior observation of
epicondyles and olecranon process to make
isosceles triangle
Assessment
• Bony Palpations
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–
–
–
–
–
Medial epicondyle
Lateral epicondyle
Olecranon process
Radial head
Radius
ulna
• Soft tissue palpations
– Anterior
•
•
•
•
Biceps brachii
Brachialis
Brachioradialis
Pronater teres
– Posterior
• Triceps
• supinator
– Medial
• Ulnar collateral ligament
– Lateral
• Radial collateral ligament
• Annular ligament
Strains
• MOI
– FOOSHA = hyperextension
• S/S
– AROM or RROM= pain
– Point tender
• TX
– RICE possibly a sling
– Cryotherapy, US, rehab
– X-ray if severe
Elbow Dislocation
• MOI
– FOOSHA, or severe twist with flexion
– Ulna and radius are pushed posterior (most common)
• S/S
– Severe pain, swelling and disability
– Deformity
– Probable radial head fx
• TX
– Ice, sling, check circulation
– Refer for x-ray and reduction
Elbow Fractures
• MOI
– FOOSHA, or direct blow
• S/S
– Possible visible deformity
– Hemorrhage, muscle spasm, and swelling
• TX
– Stabilize, monitor distal pulse
– Refer for x-ray, splint 6-8 weeks
Elbow MMTs
•
•
•
•
Flexion
Extension
Pronation
Supination
http://youtu.be/pN_x3X3PNrs
http://youtu.be/3NGbZ2lUdDI
UCL sprain
• MOI
– Valgus force from repetitive trauma
– Tennis, golfing, throwing
• S/S
– Pn. On medial aspect of elbow
– Parasthesia, and laxity
• TX
– Rest, NSAIDs, strengthening, correct form
Valgus Test
• Procedure
– Athlete sits with elbow
flexed at 20 degrees.
Evaluator grasps athletes
wrist and lateral elbow
applying a valgus force.
• Positive Test
– Pn at the medial aspect
of elbow, laxity
– Ulnar (medial) collateral
ligament sprain
Varus Test
• Procedure
– Athlete sits with elbow
flexed at 20 degrees.
Evaluator grasps
athletes wrist and
medial elbow applying a
varus force.
• Positive test
– Lateral elbow pn, and
laxity
– Radial (lateral) collateral
ligament sprain
Volkmann’s
Contracture
• MOI
– Complication of serious elbow injury
– Muscle spasm, swelling, or bone pressure on the
brachial artery
• S/S
– Pn. In the forearm that is worse when fingers are
passively extended
– Decreased or absent brachial and radial pulses
• TX
– Removal of constricting casts, wraps or braces, elevation
– Can become permanent
Tinel’s sign
• Procedure
– Patient is seated, elbow in flexion
– Evaluator grasps wrist and taps the ulnar notch with
reflex hammer
• Positive Test
– Athlete complains of tingling sensation along forearm,
hand and fingers
– Indicates ulnar nerve compromise
http://www.medvideo.us/watch_video.php?v=A2YU3N5
2O8ON
Epicondylitis
• MOI
– Lateral (tennis elbow)
• Tennis, baseball, swimming, golfing
• Repeated forearm flexion and extension
– Medial (pitchers or golfers elbow)
• Repetitive wrist flexion, valgus stress on elbow
• S/S
– Aching pn. During and after activity
– decreased ROM
– hand weakness
• TX
– RICE, NSAIDS
– ROM, PRE, Deep friction massage
– Elbow sleeve or band just below the bend of the elbow
Epicondylitis Tests
• Procedure
– Elbow is flexed to 45
degrees
– Wrist extension is resisted,
increases pn at lateral
epicondyle
– Wrist flexion is resisted,
increases pn at medial
epicondyle
• Positive Test
– Pn at either epicondyle
Olecranon Bursitis
• MOI
– Direct blow
• S/S
– Pain, severe swelling, point tenderness
• TX
– Acute= ice, compression
– Chronic = compression, modalities, aspiration
– Padding for play