Elbow InjuriesElbow Injuries

• Critical link in kinetic chain of upper extremityCritical link in kinetic chain of upper extremity

• Extremely susceptible to injuryExtremely susceptible to injury

– Big range of motionBig range of motion

– Weak lateral bone structureWeak lateral bone structure

– Boney anatomy prominent causing soft tissue damageBoney anatomy prominent causing soft tissue damage

– Excessive stress on joint from sportsExcessive stress on joint from sports

– Locking motion of some activitiesLocking motion of some activities

– Use of implementsUse of implements

– Throwing motionThrowing motion

OlecranonOlecranon

Head of radiusHead of radius

Neck of radiusNeck of radius

Styloid ProcessStyloid Process

Neck of radiusNeck of radiusHead of radiusHead of radius

OlecranonOlecranon

Radial notchRadial notch

Tuberosity of radiusTuberosity of radius

Styloid ProcessStyloid Process

UlnaUlnaRadiusRadius

Interosseous Interosseous MembraneMembrane

Styloid ProcessStyloid Process

Styloid ProcessStyloid Process

Anterior ViewAnterior View Posterior ViewPosterior View

Posterior AlignmentPosterior Alignment

• Extended Elbow Extended Elbow • Straight line formedStraight line formed

• Flexed ElbowFlexed Elbow

• IsoscolesTriangleIsoscolesTriangle

Elbow ROMElbow ROM

SupinationSupination PronationPronation

PronationPronation SupinationSupinationExtension 0ºExtension 0ºFlexion 150ºFlexion 150º

Supination 90ºSupination 90ºPronation 90ºPronation 90º

Carrying Angle of ElbowCarrying Angle of Elbow

Normal AngleNormal Angle– Females 10-15 ºFemales 10-15 º

– Males 5 ºMales 5 º

Hyperextended ElbowHyperextended Elbow

HumerusHumerus

Triceps TendonTriceps Tendon

Joint CapsuleJoint Capsule

Olecrenon BursaOlecrenon Bursa

Coronoid ProcessCoronoid Process

Medial ViewMedial View

Annular LigamentAnnular Ligament

Biceps TendonBiceps Tendon(cut)(cut)

RadiusRadius

UlnaUlna

Ulnar Collateral LigamentUlnar Collateral Ligament

Ulnar Collateral LigamentUlnar Collateral Ligament

Valgus Stress TestValgus Stress Test

Ulnar Collateral LigamentUlnar Collateral Ligament

Radial Collateral LigamentRadial Collateral Ligament

Varus Stress TestVarus Stress Test

Valgus StressValgus Stress

Stabilize

Apply Stress

• EtiologyEtiology

– Valgus force Valgus force

– Repetitive traumaRepetitive trauma

– Related injuries Related injuries

• Ulnar nerve inflammationUlnar nerve inflammation

• Wrist flexor tendinitisWrist flexor tendinitis

• Overuse flexor/pronator strainOveruse flexor/pronator strain

• Elbow flexion contractures Elbow flexion contractures

• InstabilityInstability

Ulnar Collateral Ligament SprainsUlnar Collateral Ligament Sprains

Ulnar Collateral Ligament SprainsUlnar Collateral Ligament Sprains

• Signs and SymptomsSigns and Symptoms

– Pain Pain

• Medial aspect of elbowMedial aspect of elbow

• UCLUCL

• Valgus stress test at 20 degreesValgus stress test at 20 degrees

– End-point laxityEnd-point laxity

– ParesthesiaParesthesia

• Positive Tinel’s signPositive Tinel’s sign

• Signs and Symptoms (con’t)Signs and Symptoms (con’t)

– Positive X-ray Positive X-ray

• Bone spursBone spurs

• Calcification w/in UCLCalcification w/in UCL

• Loose bodiesLoose bodies

• Posterior impingementPosterior impingement

• ManagementManagement

– Conservative treatment Conservative treatment

• RICE RICE

• NSAID’sNSAID’s

– W/ resolutionW/ resolution

• Strengthening Strengthening

• Analysis of the throwing motionAnalysis of the throwing motion

– Surgical intervention Surgical intervention

• ReconstructionReconstruction

• (Tommy John procedure) (Tommy John procedure)

• Return to activity 22-26 weeks post opReturn to activity 22-26 weeks post op

Lateral EpicondylitisLateral EpicondylitisTennis Elbow

– EtiologyEtiology• Repetitive microtrauma Repetitive microtrauma

• Insertion of extensor/supinator muscle/s Insertion of extensor/supinator muscle/s

• Lateral epicondyleLateral epicondyle

– Signs and SymptomsSigns and Symptoms• Aching pain after activityAching pain after activity

• Pain w/ resistive wrist extensionPain w/ resistive wrist extension

• Weakness in wrist and hand Weakness in wrist and hand

• Elbow decreased ROMElbow decreased ROM

Resisted Resisted Eccentric Eccentric

ContractionContraction

• RICERICE

• NSAID’sNSAID’s

• AnalgesicsAnalgesics

• RehabilitationRehabilitation– ROM exercisesROM exercises

– PREPRE

– Deep friction massageDeep friction massage

– Stretching in pain free ROMStretching in pain free ROM

• Mechanics trainingMechanics training

• BracingBracing– Counter force brace Counter force brace

– Neoprene sleeveNeoprene sleeve

AssessmentAssessment ManagementManagement

Olecrenon BursitisOlecrenon Bursitis• Superficial location Superficial location

• Extremely susceptible to injury Extremely susceptible to injury

• EtiologyEtiology

– Direct blowDirect blow

– Irritation to bursaIrritation to bursa

• Chronic irritationChronic irritation

– Production of fluidProduction of fluid

– Increased capillary permeabilityIncreased capillary permeability

– Fluids and exudates flow into the bursaFluids and exudates flow into the bursa

– Bursal wall thickens over timeBursal wall thickens over time

– May have irregular areas of scar tissueMay have irregular areas of scar tissue

• Feels like loose joint cartilage (joint mice) Feels like loose joint cartilage (joint mice)

• Calcium depositsCalcium deposits

– Acutely injured jointAcutely injured joint

• Blood may fill the bursaBlood may fill the bursa

• Risk of infectionRisk of infection