kinesioterapia

2007 McGraw-Hill Higher Education. All rights reserved.6-*Chapter 6 The Elbow and Radioulnar Jointshttp://www.youtube.com/watch?v=wRUkpGoiUZ8

http://www.youtube.com/watch?v=g1naC1z9Ymg

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2007 McGraw-Hill Higher Education. All rights reserved.6-*The Elbow & Radioulnar JointsMost upper extremity movements involve the elbow & radioulnar jointsUsually grouped together due to close anatomical relationshipElbow joint movements may be clearly distinguished from those of the radioulnar jointsRadioulnar joint movements may be distinguished from those of the wrist

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2007 McGraw-Hill Higher Education. All rights reserved.6-*BonesUlna is much larger proximally than radiusRadius is much larger distally than ulna Scapula & humerus serve as proximal attachments for muscles that flex & extend the elbowUlna & radius serve as distal attachments for these same muscles

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2007 McGraw-Hill Higher Education. All rights reserved.6-*BonesScapula, humerus, & ulna serve as proximal attachments for muscles that pronate & supinate the radioulnar jointsDistal attachments of radioulnar joint muscles are located on radiusBony landmarksmedial condyloid ridgeolecranon processcoranoid processradial tuberosity

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2007 McGraw-Hill Higher Education. All rights reserved.6-*BonesKey bony landmarks for wrist & hand musclesmedial epicondylelateral epicondylelateral supracondylar ridge

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2007 McGraw-Hill Higher Education. All rights reserved.6-*JointsGinglymus or hinge-type jointAllows only flexion & extension2 interrelated jointshumeroulnar jointradiohumeral joints

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2007 McGraw-Hill Higher Education. All rights reserved.6-*JointsElbow motionsprimarily involve movement between articular surfaces of humerus & ulnaspecifically humeral trochlear fitting into ulna trochlear notchradial head has a relatively small amount of contact with capitulum of humerusAs elbow reaches full extension, olecranon process is received by olecranon fossa increased joint stability when fully extended

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2007 McGraw-Hill Higher Education. All rights reserved.6-*JointsAs elbow flexes 20 degrees or more, its bony stability is unlocked, allowing for more side-to-side laxityStability in flexion is more dependent on the lateral (radial collateral ligament) & the medial or (ulnar collateral ligament)

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2007 McGraw-Hill Higher Education. All rights reserved.6-*JointsUlnar collateral ligament is critical in providing medial support to prevent elbow from abducting when stressed in physical activityMany contact sports & throwing activities place stress on medial aspect of joint, resulting in injury

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2007 McGraw-Hill Higher Education. All rights reserved.6-*JointsRadial collateral ligament provides lateral stability & is rarely injuredAnnular ligament provides a sling effect around radial head for stability

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2007 McGraw-Hill Higher Education. All rights reserved.6-*JointsElbow moves from 0 degrees of extension to 145 to 150 degrees of flexion

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2007 McGraw-Hill Higher Education. All rights reserved.6-*JointsRadioulnar joint Trochoid or pivot-type jointRadial head rotates around at proximal ulnaDistal radius rotates around distal ulnaAnnular ligament maintains radial head in its joint

From Seeley RR, Stephens TD, Tate P: Anatomy & physiology, ed 7, New York, 2006, McGraw-Hill; Shier D, Butler J, Lewis R: holes human anatomy & physiology, ed 9, New York, 2002, McGraw-Hill.

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2007 McGraw-Hill Higher Education. All rights reserved.6-*JointsRadioulnar joint Supinate 80 to 90 degrees from neutralPronate 70 to 90 degrees from neutral

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2007 McGraw-Hill Higher Education. All rights reserved.6-*JointsRadioulnar joint Joint between shafts of radius & ulna held tightly together between proximal & distal articulations by an interosseus membrane (syndesmosis)substantial rotary motion between the bones

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2007 McGraw-Hill Higher Education. All rights reserved.6-*JointsSynergy between glenohumeral, elbow, & radioulnar joint musclesAs the radioulnar joint goes through its ROM, glenohumeral & elbow muscles contract to stabilize or assist in the effectiveness of movement at the radioulnar jointsEx. when tightening a screw with a screwdriver which involves radioulnar supination, we tend to externally rotate & flex the glenohumeral & elbow joints, respectfully

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2007 McGraw-Hill Higher Education. All rights reserved.6-*JointsSynergy between glenohumeral, elbow, & radioulnar joint musclesConversely, when loosening a tight screw with pronation, we tend to internally rotate & extend the elbow & glenohumeral joints, respectfullywe depend on both the agonists and antagonists in the surrounding joints to assist in an appropriate amount of stabilization & assistance with the required task

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2007 McGraw-Hill Higher Education. All rights reserved.6-*MovementsFlexionmovement of forearm to shoulder by bending the elbow to decrease its angleExtensionmovement of forearm away from shoulder by straightening the elbow to increase its angle

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2007 McGraw-Hill Higher Education. All rights reserved.6-*MovementsPronationinternal rotary movement of radius on ulna that results in hand moving from palm-up to palm-down positionSupinationexternal rotary movement of radius on ulna that results in hand moving from palm-down to palm-up position

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2007 McGraw-Hill Higher Education. All rights reserved.6-*MusclesElbow flexorsBiceps brachiiBrachialisBrachioradialisWeak assistance from Pronator teresElbow extensorTriceps brachiiAnconeus provides assistance

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2007 McGraw-Hill Higher Education. All rights reserved.6-*MusclesRadioulnar pronators Pronator teresPronator quadratusBrachioradialisRadioulnar supinatorsBiceps brachiiSupinator muscleBrachioradialis

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2007 McGraw-Hill Higher Education. All rights reserved.6-*MusclesTennis elbow" - common problem usually involving extensor digitorum muscle near its origin on lateral epicondyleknown lateral epicondylitisassociated with gripping & lifting activitiesMedial epicondylitissomewhat less commonknown as golfer's elbowassociated with medial wrist flexor & pronator group near their origin on medial epicondyleBoth conditions involve muscles which cross elbow but act primarily on wrist & hand

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2007 McGraw-Hill Higher Education. All rights reserved.6-*MusclesAnteriorPrimarily flexion & pronationBiceps brachiiBrachialisBrachioradialisPronator teresPronator quadratus

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2007 McGraw-Hill Higher Education. All rights reserved.6-*MusclesPosteriorPrimarily extension & supinationTriceps brachiiAnconeusSupinator

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2007 McGraw-Hill Higher Education. All rights reserved.6-*

1. Medial Elbow Injuries The Ulnar Collateral Ligament. From the cocked position shown in the picture below, the ulnar collateral ligament or "UCL" - pulls the forearm forward with the rotating upper arm. The tremendous tension produced in the relatively small UCL is close to its limit. When improper mechanics are used or arm muscles become fatigued, the load placed on the UCL may be increased to more than it can withstand, causing small "micro"-tears in the UCL. Microtears in muscles or ligaments can heal when given enough recovery time. In fact, microtears during exercise followed by healing is how muscles become bigger and stronger. However, when a pitcher continues to tear his UCL without allowing enough time for it to heal, the microtears add up to be one large tear in the ligament. Pitchers with UCL injuries often describe feeling or hearing a "pop" in the elbow on one particular pitch. These types of stories lead many people to believe that a pitcher blows out his UCL on one bad pitch such as the first pitch on a cold day or a poorly thrown breaking pitch. Really, this is usually not the case. Quite frequently the one bad pitch was really just "the straw that broke the camels back" and was the final microtear that led a series of microtears to become a large tear

From asmi.org

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Lateral Elbow Injuries- A pitcher rotates his arm back to the cocked position shown in the picture, and then rotates it forward to throw the ball. Compression between the forearms bone (the radius) and the upper arms bone (the humerus) helps the forearm stop cocking back and start rotating forward. This large crushing force on tiny bone surfaces sometimes results in small bone chips breaking off. These bone chips float in the elbow joint and may result in pain, loss of elbow motion, and diminished pitching performance.

From asmi.org

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Posterior Elbow Injuries "Valgus Extension Overload"

From the arm-cocked position shown in the picture, the arm rapidly rotates forward at the shoulder and straightens out at the elbow. The elbow straightens out in less than a tenth of a second (0.1 sec). The combination of this rapid elbow extension and the forceful forward rotation of the upper arm and humerus can cause a grinding injury in the posterior-medial elbow (the "funny bone" area of the elbow). Small bone chips can break off and float in the elbow joint, which may result in pain, loss of motion, and diminished pitching performance.From asmi.org

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2007 McGraw-Hill Higher Education. All rights reserved.6-*Biceps Brachii MuscleFlexion of elbowSupination of forearmWeak flexion of shoulder joint Weak abduction of shoulder joint when externally rotated

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2007 McGraw-Hill Higher Education. All rights reserved.6-*Brachialis MuscleTrue flexion of elbow

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2007 McGraw-Hill Higher Education. All rights reserved.6-*Brachioradialis MuscleFlexion of elbowPronation from supinated position to neutralSupination from pronated position to neutral

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2007 McGraw-Hill Higher Education. All rights reserved.6-*Triceps Brachii MuscleLong head:extension of shoulder joint; adduction of shoulder joint;horizontal abductionAll heads: extension of elbow

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2007 McGraw-Hill Higher Education. All rights reserved.6-*Anconeus MuscleExtension of elbow

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2007 McGraw-Hill Higher Education. All rights reserved.6-*Pronator Teres MusclePronation of forearm Weak flexion of elbow

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2007 McGraw-Hill Higher Education. All rights reserved.6-*Web SitesAmerican Family Physicianhttp://www.aafp.org/afp/20000201/691.htmlEvaluation of Overuse Elbow Injuries

Medical Multimedia Groupwww.healthpages.org/AHP/LIBRARY/HLTHTOP/CTD/A Patient's Guide to Cumulative Trauma Disorder(CTD)

Lecture Topics in Kinesiologyhttp://moon.ouhsc.edu/dthompso/namics/elbow.htmDescribes motions caused by the muscles.

Huei Ming Chaiwww.pt.ntu.edu.tw/hmchai/Kines04/KINupper/Elbow.htmFunctions, stability and joint structure of elbow complex; kinematics, muscle action and common injuries of the elbow.

Southern California Orthopedic Institutewww.scoi.com/teniselb.htmTennis elbow information

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2007 McGraw-Hill Higher Education. All rights reserved.6-*Web SitesNational Aeronautics and Space Administrationhttp://rehabworks.ksc.nasa.gov/education/protocols/basicwristelbow.phpBasic Wrist and Elbow Rehabilitation

UpToDatehttp://patients.uptodate.com/topic.asp?file=bone_joi/7086Physical Therapy for Elbow Tendinitis

American Sports Medicine Institutewww.asmi.org/asmiweb/mpresentations/mmp.htmBiomechanics of the Elbow during Throwing

American Academy of Orthopaedic Surgeonshttp://orthoinfo.aaos.org/category.cfm?topcategory=HandPatient Education Library on the Elbow

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2007 McGraw-Hill Higher Education. All rights reserved.6-*Web SitesAmerican Physical Therapy Associationhttp://www.apta.org/AM/Template.cfm?Section=Home&CONTENTID=20403&TEMPLATE=/CM/HTMLDisplay.cfmTaking Care of Your Hand, Wrist, and Elbow

The Physician and Sportsmedicinehttp://www.physsportsmed.com/issues/1996/05_96/nirschl.htmAssessment and Treatment Guidelines for Elbow Injuries

The Physician and Sportsmedicinehttp://www.physsportsmed.com/issues/1999/06_99/whiteside.htmElbow Injuries in Young Baseball Players

Radiologic Anatomy Browserhttp://radlinux1.usuf1.usuhs.mil/rad/iong/index.html This site has numerous radiological views of the musculoskeletal system.

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2007 McGraw-Hill Higher Education. All rights reserved.6-*Web SitesUniversity of Arkansas Medical School Gross Anatomy for Medical Studentshttp://anatomy.uams.edu/anatomyhtml/grossresources.htmlDissections, anatomy tables, atlas images, links, etc.

Loyola University Medical Center: Structure of the Human Bodywww.meddean.luc.edu/lumen/MedEd/GrossAnatomy/GA.htmlAn excellent site with many slides, dissections, tutorials, etc., for the study of human anatomy

Wheeless Textbook of Orthopaedicswww.wheelessonline.com/This site has an extensive index of links to the fractures, joints, muscles, nerves, trauma, medications, medical topics, lab tests, and links to orthopedic journals and other orthopedic and medical news.

Arthroscopy.Comwww.arthroscopy.com/sports.htm Patient information on various musculoskeletal problems of the upper and lower extremity

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2007 McGraw-Hill Higher Education. All rights reserved.6-*Web SitesPremiere Medical Search Enginehttp://www.medsite.com/Default.asp?bhcp=1This site allows the reader to enter any medical condition and it will search the net to find relevant articles.

Virtual Hospitalwww.vh.orgNumerous slides, patient information, etc.

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2007 McGraw-Hill Higher Education. All rights reserved.6-*NervesRadial nerve - originates from C5, C6, C7, & C8Triceps brachiiBrachioradialisSupinator (posterior interosseous nerve)Anconeus Sensation to posterolateral arm, forearm, & hand

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2007 McGraw-Hill Higher Education. All rights reserved.6-*NervesMedian nerve - derived from C6 & C7Pronator teresPronator quadratus (anterior interosseus nerve) Sensation to palmar aspect of hand & first three phalanges, palmar aspect of radial side of fourth finger, dorsal aspect of index & long fingers

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2007 McGraw-Hill Higher Education. All rights reserved.6-*NervesMusculotaneous nerve - branches from C5 & C6 Biceps brachiiBrachialis

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