The Elbow Ulnar Collateral Ligament Sprain Elbow Dislocation Ulnar Nerve Irritation Emily Gavlick

Bone Anatomy of Elbow Involved bones: General Joint Type: hinge Humerus Ulna Radius General Joint Type: hinge Movement allowed in only one plane

Bone Anatomy of the Elbow Joint Actually Comprised of 3 Areas 1. Humeroulnar Joint: flexion and extension Proximal Radioulnar Joint: supination and pronation of hand 3. Humeroradial Joint: arthrodial joint (only a slight gliding motion)

Ligament Anatomy of Elbow Ulnar Collateral Ligament (UCL): medial side of the elbow Radial Collateral Ligament (RCL): lateral side of the elbow Annular Ligament: wraps around the radial head and holds it tight against the ulna annular means ring-shaped

Ligament Anatomy of Elbow

Muscle Anatomy of Elbow Anterior: Biceps Posterior: Triceps Brachii Lateral: Supinator Medial: Flexor Carpi Ulnaris

Tendon Anatomy of Elbow Anterior: biceps tendon Posterior: triceps tendon Lateral: common tendon of origin of the Extensor muscles Medial: common tendon of origin of the Flexor muscles

Muscle / Tendon Anatomy of Elbow

Muscle / Tendon Anatomy of Elbow

Elbow Injuries

Ulnar Collateral Ligament Sprain What is it? Stretch or tear of the UCL Involved Structures: The UCL The Humerus The Ulna Location: Medial side of elbow

Ulnar Collateral Ligament Sprain Mechanism of Injury: Force bends elbow inward toward midline most commonly occurs in throwing activities

Ulnar Collateral Ligament Sprain General Signs and Symptoms: (specific symptoms depend on severity of sprain) Pain Popping / tearing sensation Tenderness Swelling Bruising

Ulnar Collateral Ligament Sprain Grades: (as with any sprain) Grade I: partial tear of a ligament Mild tenderness and swelling Slight or no functional loss No mechanical instability

Ulnar Collateral Ligament Sprain Grade II: incomplete tear of a ligament with moderate functional impairment Moderate pain and swelling Mild to moderate bruising Tenderness over involved structures Some loss of motion and function Mild to moderate instability

Ulnar Collateral Ligament Sprain Grade III: complete tear and loss of integrity of a ligament Severe swelling Severe bruising Loss of function and motion Mechanical instability

Ulnar Collateral Ligament Sprain Testing for Injury Valgus stress testing: Pain Instability Radiographs: loose bodies traction spurs (protrusion of bone / cartilage) MRI: partial and complete tears not usually necessary

Ulnar Collateral Ligament Sprain Treatment for Injury: Prevention Long-term strengthening and conditioning appropriate for sport. Warm up before practice or competition. Tape vulnerable joints before practice or competition

Ulnar Collateral Ligament Sprain Treatment for Injury Grade I Sprain: PRICE Possible application of a cast, tape, elastic bandage or sling If no device is applied, icepacks, whirlpool therapy, and massage may be used Recovery time: 2-6 weeks

Ulnar Collateral Ligament Sprain Treatment for Injury Grade II Sprain: PRICE Application of cast, tape, elastic bandage or sling Possible physical therapy Recovery time: 6-8 weeks

Ulnar Collateral Ligament Sprain Treatment for Injury Grade III Sprain: PRICE Application of cast, tape, elastic bandage or sling Physical therapy Surgery Recovery time: 8-10 weeks, with potential for prolonged disability

Ulnar Collateral Ligament Sprain Ramon Ramirez: Colorado Rockies pitcher missed 23 games with an elbow sprain in April 2007

Elbow Dislocation What is it? Involved Structures: Location: The radius and ulna move out of place compared with the humerus Involved Structures: The Radius The Humerus The Ulna Surrounding tissues Location: Elbow joint

Elbow Dislocation General Signs and Symptoms: (specific symptoms depend on severity of dislocation) Tenderness Swelling Deformity Bruising Poor blood flow to the lower arm and hand

Elbow Dislocation Nursemaid’s / Babysitter’s Elbow Signs / Symptoms: Partial or radial dislocation (subluxation) Common in children Caused when child is lifted by arm Signs / Symptoms: pain Refuse to use injured arm Holding elbow slightly bent

Elbow Dislocation Simple Complex radius and ulna become dissociated from the humerus without associated fracture Complex simple dislocation combined with fracture of the humerus, radius, ulna or a combination of all three bones

Elbow Dislocation Mechanism of Injury: Force sent through ulna/radius to elbow Often accompanied by a twisting force Usually occurs when a person attempts to break a fall or cushion an impact

Elbow Dislocation Signs / Symptoms: Severe pain Deformity Swelling Inability to bend arm In some cases: Numbness Lack of pulse

Elbow Dislocation Testing for Injury: Evaluation of tenderness, swelling, deformity, sensation, and circulation X-ray CT scan may help evaluate fractures Angiogram may be done if arterial injury is suspected

Elbow Dislocation Treatment for Injury: Nursemaid’s / Babysitter’s Elbow Closed Reduction: manipulating arm; the annular ligament and radial head return to their normal anatomic positions immobilize elbow and palpate region of radial head apply axial compression at wrist while supinating forearm and flexing elbow a click or snap can be felt at the radial head

Elbow Dislocation Treatment for Injury Simple Dislocation: Closed Reduction Splinting 24-hour hospital observation if nerve / artery injury is suspected Possible physical therapy

Elbow Dislocation Treatment for Injury Complex Dislocation: Reconstructive Surgery (open reduction)

Elbow Dislocation Partial Simple Radial Complex

Ulnar Nerve Irritation What is it? The ulnar nerve, one of the 3 main nerves that innervate the hand, is affected The Funny Bone Location: runs from the shoulder to the hand

Ulnar Nerve Irritation Two ways to irritate the ulnar nerve: Impingement (pinching) Cubital Tunnel Syndrome Entrapment (stuck to surrounding tissue) Location: Posterior elbow joint

Ulnar Nerve Irritation Mechanism of Injury: Genetic, natural build Frequent bending of elbow joint Fracture of nearby bone Blow to cubital tunnel Cubital tunnel: tunnel of muscle, ligament, and bone on the inside of the elbow allows the Ulnar nerve to travel over the elbow

Ulnar Nerve Irritation Signs / Symptoms: Numbness on the inside of the hand and in the ring and little fingers Pain Weak Grip Muscle Wasting

Ulnar Nerve Irritation Testing for Injury: Physical examination to confirm location MRI / CT scan to check for bone spurs or arthritis Nerve Conduction Velocity (NCV) test: measures speed of impulses traveling along the nerve Electromyogram (EMG). sometimes used; tests whether the muscles are working properly.

Ulnar Nerve Irritation Treatment for Injury: Conservative: discontinue irritating action, anti-inflammatory medications, nighttime splint / elbow pad, and/or physical therapy Surgical: ulnar nerve transposition, or removing medial epicondyle on medial elbow

Ulnar Nerve Irritation Ulnar Nerve Transposition