Post on 14-Jan-2016
The ElbowThe Elbow
Ulnar Collateral Ligament Ulnar Collateral Ligament SprainSprain
Elbow DislocationElbow DislocationUlnar Nerve IrritationUlnar Nerve Irritation Emily Gavlick
Bone Anatomy of ElbowBone Anatomy of Elbow
Involved bones:Involved bones: – HumerusHumerus– UlnaUlna– RadiusRadius
General Joint Type: hingeGeneral Joint Type: hinge– Movement allowed in only one Movement allowed in only one
planeplane
Bone Anatomy of the ElbowBone Anatomy of the Elbow
Joint Actually Comprised of 3 AreasJoint Actually Comprised of 3 Areas
1. 1. Humeroulnar JointHumeroulnar Joint: flexion and extension: flexion and extension
2.2. Proximal Radioulnar JointProximal Radioulnar Joint: supination and : supination and pronation of handpronation of hand
3. 3. Humeroradial JointHumeroradial Joint: arthrodial joint (only : arthrodial joint (only a slight gliding motion)a slight gliding motion)
Ligament Anatomy of ElbowLigament Anatomy of Elbow
Ulnar Collateral Ligament (UCL):Ulnar Collateral Ligament (UCL): medial medial side of the elbowside of the elbow
Radial Collateral Ligament (RCL):Radial Collateral Ligament (RCL): lateral lateral side of the elbowside of the elbow
Annular Ligament:Annular Ligament: wraps around the wraps around the radial head and holds it tight against radial head and holds it tight against the ulnathe ulna– annularannular means ring-shaped means ring-shaped
Ligament Anatomy of ElbowLigament Anatomy of Elbow
Muscle Anatomy of ElbowMuscle Anatomy of Elbow
Anterior:Anterior:– BicepsBiceps
Posterior: Posterior: – Triceps BrachiiTriceps Brachii
Lateral:Lateral:– SupinatorSupinator
Medial:Medial:– Flexor Carpi Flexor Carpi
UlnarisUlnaris
Tendon Anatomy of ElbowTendon Anatomy of Elbow
Anterior:Anterior:– biceps tendonbiceps tendon
Posterior:Posterior:– triceps tendontriceps tendon
Lateral:Lateral:– common tendon common tendon
of origin of the of origin of the Extensor musclesExtensor muscles
Medial:Medial:– common tendon common tendon
of origin of the of origin of the Flexor musclesFlexor muscles
Muscle / Tendon Anatomy of Muscle / Tendon Anatomy of ElbowElbow
Muscle / Tendon Anatomy of Muscle / Tendon Anatomy of ElbowElbow
Elbow InjuriesElbow Injuries
Ulnar Collateral Ligament Ulnar Collateral Ligament SprainSprain
What is it?What is it? Stretch or tear of the UCLStretch or tear of the UCL
Involved Structures:Involved Structures: The UCLThe UCL The HumerusThe Humerus The UlnaThe Ulna
Location:Location: Medial side of elbowMedial side of elbow
Ulnar Collateral Ligament Ulnar Collateral Ligament SprainSprain
Mechanism of Injury:Mechanism of Injury:
Force bends elbow inward toward Force bends elbow inward toward midlinemidline
most commonly occurs in throwing most commonly occurs in throwing activitiesactivities
Ulnar Collateral Ligament Ulnar Collateral Ligament SprainSprain
General Signs and Symptoms:General Signs and Symptoms: (specific (specific symptoms depend on severity of sprain)symptoms depend on severity of sprain)
PainPain Popping / tearing sensation Popping / tearing sensation TendernessTenderness SwellingSwelling BruisingBruising
Ulnar Collateral Ligament Ulnar Collateral Ligament SprainSprain
Grades: (as with any sprain)Grades: (as with any sprain)
Grade I: partial tear of a ligamentGrade I: partial tear of a ligament– Mild tenderness and swellingMild tenderness and swelling– Slight or no functional loss Slight or no functional loss – No mechanical instabilityNo mechanical instability
Ulnar Collateral Ligament Ulnar Collateral Ligament SprainSprain
Grade II: incomplete tear of a Grade II: incomplete tear of a ligament with moderate ligament with moderate functional impairmentfunctional impairment
– Moderate pain and swellingModerate pain and swelling– Mild to moderate bruisingMild to moderate bruising– Tenderness over involved structuresTenderness over involved structures– Some loss of motion and function Some loss of motion and function – Mild to moderate instabilityMild to moderate instability
Ulnar Collateral Ligament Ulnar Collateral Ligament SprainSprain
Grade III: complete tear and loss Grade III: complete tear and loss of integrity of a ligamentof integrity of a ligament
– Severe swellingSevere swelling– Severe bruisingSevere bruising– Loss of function and motion Loss of function and motion – Mechanical instabilityMechanical instability
Ulnar Collateral Ligament Ulnar Collateral Ligament SprainSprain
Testing for InjuryTesting for Injury
Valgus stress testing:Valgus stress testing:– PainPain– InstabilityInstability
Radiographs: Radiographs: – loose bodiesloose bodies– traction spurs (protrusion of bone / cartilage)traction spurs (protrusion of bone / cartilage)
MRI:MRI:– partial and complete tearspartial and complete tears– not usually necessarynot usually necessary
Ulnar Collateral Ligament Ulnar Collateral Ligament SprainSprain
Treatment for Injury:Treatment for Injury:
PreventionPrevention– Long-term strengthening and Long-term strengthening and
conditioning appropriate for sport. conditioning appropriate for sport. – Warm up before practice or competition. Warm up before practice or competition. – Tape vulnerable joints before practice or Tape vulnerable joints before practice or
competition competition
Ulnar Collateral Ligament Ulnar Collateral Ligament SprainSprain
Treatment for InjuryTreatment for Injury
Grade I Sprain:Grade I Sprain:– PRICEPRICE– Possible application of a cast, tape, elastic Possible application of a cast, tape, elastic
bandage or slingbandage or sling– If no device is applied, icepacks, whirlpool If no device is applied, icepacks, whirlpool
therapy, and massage may be usedtherapy, and massage may be used– Recovery time: Recovery time: 2-6 weeks2-6 weeks
Ulnar Collateral Ligament Ulnar Collateral Ligament SprainSprain
Treatment for InjuryTreatment for Injury
Grade II Sprain:Grade II Sprain:– PRICEPRICE– Application of cast, tape, elastic Application of cast, tape, elastic
bandage or slingbandage or sling– Possible physical therapyPossible physical therapy– Recovery time: Recovery time: 6-8 weeks6-8 weeks
Ulnar Collateral Ligament Ulnar Collateral Ligament SprainSprain
Treatment for InjuryTreatment for Injury
Grade III Sprain:Grade III Sprain:– PRICEPRICE– Application of cast, tape, elastic Application of cast, tape, elastic
bandage or slingbandage or sling– Physical therapyPhysical therapy– SurgerySurgery– Recovery time: Recovery time: 8-10 weeks8-10 weeks, with , with
potential for prolonged disabilitypotential for prolonged disability
Ulnar Collateral Ligament Ulnar Collateral Ligament SprainSprain
Ramon Ramirez: Colorado Rockies pitcherRamon Ramirez: Colorado Rockies pitchermissed 23 games with an elbow sprain in April 2007missed 23 games with an elbow sprain in April 2007
Elbow DislocationElbow Dislocation
What is it?What is it? The radius and ulna move out of place compared The radius and ulna move out of place compared
with the humerus with the humerus
Involved Structures:Involved Structures: The RadiusThe Radius The HumerusThe Humerus The UlnaThe Ulna Surrounding tissuesSurrounding tissues
Location:Location: Elbow jointElbow joint
Elbow DislocationElbow Dislocation
General Signs and Symptoms:General Signs and Symptoms: (specific (specific symptoms depend on severity of dislocation)symptoms depend on severity of dislocation)
TendernessTenderness SwellingSwelling DeformityDeformity BruisingBruising Poor blood flow to the lower arm and Poor blood flow to the lower arm and
handhand
Elbow DislocationElbow Dislocation
Signs / Symptoms:Signs / Symptoms:– pain pain – Refuse to use injured armRefuse to use injured arm– Holding elbow slightly bentHolding elbow slightly bent
Nursemaid’s / Babysitter’s Elbow•Partial or radial dislocation (subluxation)•Common in children•Caused when child is lifted by arm
Elbow DislocationElbow Dislocation
SimpleSimple radius and ulna become dissociated from radius and ulna become dissociated from
the humerus without associated fracturethe humerus without associated fracture
ComplexComplex simple dislocation combined with fracture simple dislocation combined with fracture
of the humerus, radius, ulna or a of the humerus, radius, ulna or a combination of all three bonescombination of all three bones
Elbow DislocationElbow Dislocation
Mechanism of Injury:Mechanism of Injury: Force sent through ulna/radius to Force sent through ulna/radius to
elbowelbow Often accompanied by a twisting Often accompanied by a twisting
forceforce Usually occurs when a person Usually occurs when a person
attempts to break a fall or cushion an attempts to break a fall or cushion an impactimpact
Elbow DislocationElbow Dislocation
Signs / Symptoms:Signs / Symptoms: Severe pain Severe pain DeformityDeformity SwellingSwelling Inability to bend armInability to bend arm In some cases:In some cases:
– NumbnessNumbness– Lack of pulse Lack of pulse
Elbow DislocationElbow Dislocation
Testing for Injury:Testing for Injury: Evaluation of tenderness, swelling, Evaluation of tenderness, swelling,
deformity, sensation, and circulationdeformity, sensation, and circulation X-rayX-ray CT scan may help evaluate fracturesCT scan may help evaluate fractures Angiogram may be done if arterial Angiogram may be done if arterial
injury is suspectedinjury is suspected
Elbow DislocationElbow Dislocation
Treatment for Injury:Treatment for Injury: Nursemaid’s / Babysitter’s ElbowNursemaid’s / Babysitter’s Elbow
– Closed Reduction: manipulating arm; the Closed Reduction: manipulating arm; the annular ligament and radial head return annular ligament and radial head return to their normal anatomic positionsto their normal anatomic positions
immobilize elbow and palpate region of immobilize elbow and palpate region of radial headradial head
apply axial compression at wrist while apply axial compression at wrist while supinating forearm and flexing elbow supinating forearm and flexing elbow
a click or snap can be felt at the radial heada click or snap can be felt at the radial head
Elbow DislocationElbow Dislocation
Treatment for Treatment for InjuryInjury
Simple Dislocation:Simple Dislocation:
– Closed ReductionClosed Reduction– SplintingSplinting– 24-hour hospital 24-hour hospital
observation if observation if nerve / artery injury nerve / artery injury is suspectedis suspected
– Possible physical Possible physical therapytherapy
Elbow DislocationElbow Dislocation
Treatment for InjuryTreatment for Injury Complex Dislocation:Complex Dislocation:
– Reconstructive Surgery (open reduction)Reconstructive Surgery (open reduction)
Elbow DislocationElbow Dislocation
Partial Simple
Radial Complex
Ulnar Nerve IrritationUlnar Nerve Irritation
What is it?What is it? The ulnar nerve, one of the The ulnar nerve, one of the
3 main nerves that 3 main nerves that innervate the hand, is innervate the hand, is affectedaffected
The Funny BoneThe Funny Bone
Location:Location: runs from the shoulder to runs from the shoulder to
the hand the hand
Ulnar Nerve IrritationUlnar Nerve Irritation
Two ways to irritate the ulnar nerve:Two ways to irritate the ulnar nerve:
1.1. Impingement (pinching)Impingement (pinching)– Cubital Tunnel SyndromeCubital Tunnel Syndrome
2.2. Entrapment (stuck to surrounding Entrapment (stuck to surrounding tissue)tissue)
Location: Posterior elbow jointLocation: Posterior elbow joint
Ulnar Nerve IrritationUlnar Nerve Irritation
Mechanism of Injury:Mechanism of Injury: – Genetic, natural build Genetic, natural build – Frequent bending of elbow jointFrequent bending of elbow joint– Fracture of nearby boneFracture of nearby bone– Blow to cubital tunnelBlow to cubital tunnel
Cubital tunnel:Cubital tunnel: tunnel of muscle, tunnel of muscle, ligament, and bone on the inside of the ligament, and bone on the inside of the elbow allows the Ulnar nerve to travel elbow allows the Ulnar nerve to travel over the elbow over the elbow
Ulnar Nerve IrritationUlnar Nerve Irritation
Signs / Symptoms:Signs / Symptoms:– Numbness on the inside of the Numbness on the inside of the
hand and in the ring and little hand and in the ring and little fingers fingers
– Pain Pain – Weak GripWeak Grip– Muscle WastingMuscle Wasting
Ulnar Nerve IrritationUlnar Nerve Irritation
Testing for Injury:Testing for Injury:– Physical examination to confirm locationPhysical examination to confirm location
– MRI / CT scan to check for bone spurs or MRI / CT scan to check for bone spurs or arthritisarthritis
– Nerve Conduction Velocity (NCV) test: measures Nerve Conduction Velocity (NCV) test: measures speed of impulses traveling along the nervespeed of impulses traveling along the nerve
– Electromyogram (EMG). sometimes used; tests Electromyogram (EMG). sometimes used; tests whether the muscles are working properly.whether the muscles are working properly.
Ulnar Nerve IrritationUlnar Nerve Irritation
Treatment for Injury:Treatment for Injury:– Conservative: discontinue irritating Conservative: discontinue irritating
action, anti-inflammatory medications, action, anti-inflammatory medications, nighttime splint / elbow pad, and/or nighttime splint / elbow pad, and/or physical therapyphysical therapy
– Surgical: ulnar nerve transposition, or Surgical: ulnar nerve transposition, or removing medial epicondyle on medial removing medial epicondyle on medial elbow elbow
Ulnar Nerve IrritationUlnar Nerve Irritation
Ulnar Nerve Transposition