The Elbow

Chapter 23

http://www.elsevier.com/homepage/sab/eia/v2d3/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) Synovium and Bursa

– Bicipital tuberosity – most important bursae– Olecranon bursae

Elbow Anatomy

Elbow Anatomy Musculature

– 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

Blood Supply– Brachial and median arteries

Functional Anatomy– Flexion and extension – sagital plane– Supination and pronation – transverse plane

Preventing/AssessingElbow Injuries

History Observation

– 45degree flexion, epicondyles and olecranon should form triangle) 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

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)

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

Lateral Epicondylitis– Etiology (repetitive motion, hyperextension)– Signs and Symptoms (pain, point tenderness)– Management (RICE, NSAIDs, rehab, bracing)

Recognition and Management of Injuries

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)

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)– Management (rest, immobilization, NSAIDs)

Recognition and Management of Injuries

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 Fracture of the Elbow

– Etiology (FOA, elbow flexion, direct blow)• Gunstock deformity:condylar fracture at elbow

resembles gunstock when extended)

– 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

General Body Conditioning Joint mobilization Flexibility Strengthening Functional Progression Return to Activity Protective Taping and Bracing