The Elbow
Chapter 23
Elbow Anatomy
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http://www.elsevier.com/homepage/sab/eia/v2
d3/frame.html
Bones
Articulations
Ligaments and Capsule
– Capsule is covered by biceps anteriorly and
triceps posteriorly
– Capsule reinforced by radial (does not attached to
radius) and ulnar collateral ligaments
– Annular ligament stabilizes radial head (encircles
radius)
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Synovium and Bursa
– Bicipital tuberosity – most important bursae
– Olecranon bursae
Elbow Anatomy
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Musculature
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Biceps brachii, brachialis, brachioradialis (flexion)
Triceps brachii (extension)
Biceps brachii and supinator (supination)
Pronator teres and pronator quadratus (pronation)
Nerve Supply
– C5-T1 stems; musculocutaneous, radial & median
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Blood Supply
– Brachial and median arteries
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Functional Anatomy
– Flexion and extension – sagital plane
– Supination and pronation – transverse plane
Preventing/Assessing
Elbow Injuries
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History
Observation
– 45degree flexion, epicondyles and olecranon should form
triangle)
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Palpation (bony and soft tissue)
Special Tests
– Tinel sign- taps ulnar notch
– Test for capsular injury – elbow 45 degrees flexion, wrist
flexed then extended; pos. if pain in elbow
– Valgus (MCL)and Varus(LCL) tests
– Medial and Lateral Epicondylitis Test- elbow 45 degrees
flexion; lateral: pain with resisted wrist extension;
medial: pain with resisted wrist flexion
– Pinch Grip Test- thumb & index finger; inability to do so
= entrapment interroseous nerve b/t pronators
¯ Pronator Test syndrome test- resisted pronation with
elbow flexed 45 degrees
Functional Evaluation
Recognition and Management of
Injuries
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Contusion
– Etiology (direct blow)
– Signs and Symptoms(rapid swelling,ROM pain)
– Management (RICE, X-ray r/o fx)
Olecranon Bursitis
– Etiology (direct blow)
– Signs and Symptoms
– Management (RICE, rehab, aspiration)
Strains
– Etiology (FOA with hyperextension)
– Signs and Symptoms (A & RROM painful)
– Management (RICE, sling, rehab)
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Recognition and Management of
Injuries
Elbow Sprains
– Etiology (hyperextension or valgus force)
– Signs and Symptoms (pain, inability to
throw/grasp, point tender)
– Management (RICE, sling, ROM)
• Concern- bone proliferation if too agressive
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Lateral Epicondylitis
– Etiology (repetitive motion, hyperextension)
– Signs and Symptoms (pain, point tenderness)
– Management (RICE, NSAIDs, rehab, bracing)
Recognition and Management
of Injuries
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Medial Epicondylitis
– Etiology (rep. microtrauma with wrist flexion)
– Signs and Symptoms (pain, point tenderness)
– Management (RICE, NSAIDs, rehab, bracing)
Elbow Osteochondritis Dissecans
– Etiology (unknown; impaired blood supply =
fragmentation & joint separation of
radiocapitular joint; repetitive motions)
common in 10-15yrs old
– Signs and Symptoms (pain, locking of joint,
crepitus, swelling)
– Management (restricted activity, NSAIDs,
Splint, surgical removal of loose bodies)
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Recognition and Management of
Injuries
Little League Elbow
– Etiology (repetitive throwing; includes many
disorders of growth)
– Signs and Symptoms(gradual onset; flexion
contracture, locking/catching sensation,
decrease ROM
– Management (RICE, NSAIDs, gentle stretching,
surgical removal of loose bodies PRN)
Cubital Tunnel Syndrome
– Etiology Traction from valgus force, irregular
tunnel, ulnar nerve subluxation, progressive
compression of nerve)
– Signs and Symptoms(paresthesia, pain
medially)
Recognition and Management of
Injuries
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Elbow Dislocation
– Etiology (FOA with hyperextension or twist
with flexion)
– Signs and Symptoms (may displace anterior,
posterior, lateral)
• rupture most stabilizing structures, complications:
median and radial nerve and blood vessels, radial
head fracture common
– Management (RICE, Sling, referral to doctor for
reduction)
• DO NOT TRY TO REDUCE!!!!!
• If you did, it would be traction and passively flex or
attempt pronation - debated
Recognition and Management of Injuries
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Fracture of the Elbow
– Etiology (FOA, elbow flexion, direct blow)
• Gunstock deformity:condylar fracture at elbow
resembles gunstock when extended)
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– Signs and Symptoms (visible deformity,
swelling hemorrhage, muscle spasm)
– Management (surgery, splint)
Volkmann’s Contracture
– Etiology (ischemic necrosis of forearm
muscles and tissue caused by damaged blood
flow
– Signs and Symptoms (pain in forearm with P
extension of fingers, cessation of pulses)
– Management (monitor closely, wrap/cast,
elevation)
Rehabilitation Principles for
the Elbow
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General Body Conditioning
Joint mobilization
Flexibility
Strengthening
Functional Progression
Return to Activity
Protective Taping and Bracing