Elbow Anatomy Medial Epicondyle Lateral Epicondyle Trochlea and Capitulum Olecranon Process Ulna and Radius Radial Head Interosseus Membrane http://www.courses.vcu.edu/DANC291003/elbow_jt.jpg - Pic of Bony Anatomy © 2007 McGraw-Hill Higher Education. All rights reserved. Elbow Anatomy http://images.main.uab.edu/healthsys/ei_0153.jpg Elbow Anatomy (2) Humeroulnar joint ______________ Trochlea of humerus _______________ Flexion (0 – 150) Extension (0)-some hyperextension(-5 to -15) Ligaments: _________________________ _________________________ Elbow Anatomy (3) Radioulnar Not joint part of elbow but associated with __________________________ Supported by the annular ligament which binds the head of the radius to the radial notch of the ulna forming the joint ___________________________ Muscular Anatomy ______________________ Brachioradialis (flexion with arm neutral) Brachialis (flexion w/ pronation) ______________________ Pronator Group (pronation) ______________________ http://images.main.uab.edu/healthsys/ei _0153.jpg - biceps attachment Bursa, Blood and Nerve Supply Bursa- _____________________ Blood supply Brachial artery ___________ ___________ Nerve supply Brachial plexus extends into the radial and ulna nerve*** Prevention of Injuries General muscular condition Restrict pitching/ teach proper form Make sure equipment is proper (ie: racquet)- grip size, racquet weight Teach shoulder roll method of fallingexample volleyball players rolling after a dig Contusions MOI: Direct contact HOPS __________________________________ Limited range of motion TX Rule out fracture first Ice, wrap and pad area Avoid aggressive stretching and strengthening Watch for ectopic bone formation ________________________________ Olecranon Bursitis Olecranon bursa is largest in elbow MOI: fall on bent arm, leaning on elbow for long periods, infection HOPS ____________________________ Tx: ice, compression, pad area If associated with fever: refer _____________________________ http://www.aafp.org/afp/971101 ap/salzfig3.jpg http://www.physsportsmed. com/issues/2000/03_00/mcf arland4.gif Elbow Sprains (1 – UCL) MOI: valgus force, repetitive stress HOPS: Pain over medial joint especially in cocking phase or acceleration phase of throwing Point tenderness over joint line ____________________________________ ____________________________ Tx: rest, general strengthening of flexors/ pronators; _________________________ ________________________________ Elbow Dislocations MOI: ____________________________ ______________________________, falling on outstretched hand HOPS Obvious deformity Snapping or cracking sensation Severe pain Forearm in flexion and appears shortened Tx: immobilize and refer MED EMERGENCY Check neurovascular status -http://www.worldortho.com/database/introtrauma/pics/img0123.jpg http://www.angelfire.com/sc2/seahawksportsmed/injpi x.html Medial Epicondylitis ______________________________ MOI: repetitive tension or valgus forces on the arm HOPS Swelling, ecchymosis over medial epicondyle Pain aggravated by pronation and resisted flexion of wrist _________________________________ Tx: RICE, Strengthening/Stretching, look at technique http://www.esportmed.com/smrn/figures/Golfer ElbowInjury.gif Lateral Epicondylitis __________________ Most common overuse injury in the adult elbow MOI: _______________________ ______________________ Precursor: too large tennis racquet, gripping racket too tightly, excessive string tension, faulty mechanics Lateral Epicondylitis (2) HOPS Pain over lateral epicondyle Pain with resisted wrist extension + tennis elbow test Tx RICE __________________________________ _________________________ Counter force brace Impingement of Ulnar nerve Ulnar nerve passes behind humerus in ulnar groove _______________ HOPS _________________ Can be caused from a medial elbow injury “crazy bone” or “funny bone” Tingling and numbness in ring and little finger __________________ Refer if chronic Strength Testing Elbow flexion Elbow extension Wrist flexion and extension Pronation Supination Stress Tests (UCL)/Varus (RCL) stress test – Positive Sign is laxity Tennis Elbow test-(Lateral Epicondylitis) - Positive Sign is increased pain Tinel’s sign (Ulnar nerve) – Numbness, Tinkling into Ulnar nerve region. Valgus