Elbow Anatomy Medial Epicondyle Lateral Epicondyle Trochlea and Capitulum Olecranon Process Ulna and Radius Radial Head Interosseus Membrane http://www.courses.vcu.edu/DANC291-003/elbow_jt.jpg - Pic of Bony Anatomy

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Elbow Anatomy http://images.main.uab.edu/healthsys/ei_0153.jpg

Elbow Anatomy (2) Humeroulnar joint Flexion (0 – 150) ______________ Trochlea of humerus _______________ Flexion (0 – 150) Extension (0)-some hyperextension(-5 to -15) Ligaments: _________________________

Elbow Anatomy (3) Radioulnar joint Not 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 Pronator Teres and Quadratus

Bursa, Blood and Nerve Supply 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 falling- example volleyball players rolling after a dig

Contusions MOI: Direct contact HOPS TX __________________________________ 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/971101ap/salzfig3.jpg http://www.physsportsmed.com/issues/2000/03_00/mcfarland4.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/intro-trauma/pics/img0123.jpg http://www.angelfire.com/sc2/seahawksportsmed/injpix.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/GolferElbowInjury.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 Valgus (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.