Elbow Sports Medicine

Movements Carrying angle Flexion Extension Pronation Supination Females 10-15 degrees, Males 5 degrees Flexion 145 degrees Extension Pronation 90 degrees Supination

Articulations Consists of 3 separate joints Humeroulnar Humeroradial Proximal radioulnar

Ligaments and Bursae Ulnar collateral ligament Prevents valgus forces Radial collateral ligament Prevents varus forces (uncommon) Annular ligament Stabilizes head and neck of radius (strong) Olecranon bursa Between olecranon process and skin

Musculature Biceps Brachii, Brachialis, brachioradialis Elbow flexion Triceps brachii, anconeus Elbow extension Pronator teres, supinator Pronation and supination

Nerve/Blood Supply Median Nerve Radial Nerve Ulnar Nerve Radial Artery Funny bone Radial Artery Ulnar Artery

Assessment History Land on tip of bent elbow? (most common MOI) Overuse from throwing? Over extension? Location and duration of pain? Positions that increase or decrease pain? Previous elbow injuries? Locking or crepitation w/movement?

Assessment Observations Deformities, swelling Carrying angle Too great or little could = epiphyseal fx Decreased flexion or extension 45 degree angle, posterior observation of epicondyles and olecranon process to make isosceles triangle

Assessment Soft tissue palpations Bony Palpations Anterior Posterior Biceps brachii Brachialis Brachioradialis Pronater teres Posterior Triceps supinator Medial Ulnar collateral ligament Lateral Radial collateral ligament Annular ligament Bony Palpations Medial epicondyle Lateral epicondyle Olecranon process Radial head Radius ulna

Strains MOI S/S TX FOOSHA = hyperextension AROM or RROM= pain Point tender TX RICE possibly a sling Cryotherapy, US, rehab X-ray if severe

Elbow Dislocation MOI S/S TX FOOSHA, or severe twist with flexion Ulna and radius are pushed posterior (most common) S/S Severe pain, swelling and disability Deformity Probable radial head fx TX Ice, sling, check circulation Refer for x-ray and reduction

Elbow Fractures MOI S/S TX FOOSHA, or direct blow Possible visible deformity Hemorrhage, muscle spasm, and swelling TX Stabilize, monitor distal pulse Refer for x-ray, splint 6-8 weeks

Elbow MMTs Flexion Extension Pronation Supination http://youtu.be/pN_x3X3PNrs http://youtu.be/3NGbZ2lUdDI

UCL sprain MOI S/S TX Valgus force from repetitive trauma Tennis, golfing, throwing S/S Pn. On medial aspect of elbow Parasthesia, and laxity TX Rest, NSAIDs, strengthening, correct form

Valgus Test Procedure Positive Test Athlete sits with elbow flexed at 20 degrees. Evaluator grasps athletes wrist and lateral elbow applying a valgus force. Positive Test Pn at the medial aspect of elbow, laxity Ulnar (medial) collateral ligament sprain

Varus Test Procedure Positive test Athlete sits with elbow flexed at 20 degrees. Evaluator grasps athletes wrist and medial elbow applying a varus force. Positive test Lateral elbow pn, and laxity Radial (lateral) collateral ligament sprain

Volkmann’s Contracture MOI Complication of serious elbow injury Muscle spasm, swelling, or bone pressure on the brachial artery S/S Pn. In the forearm that is worse when fingers are passively extended Decreased or absent brachial and radial pulses TX Removal of constricting casts, wraps or braces, elevation Can become permanent

Tinel’s sign Procedure Positive Test Patient is seated, elbow in flexion Evaluator grasps wrist and taps the ulnar notch with reflex hammer Positive Test Athlete complains of tingling sensation along forearm, hand and fingers Indicates ulnar nerve compromise http://www.medvideo.us/watch_video.php?v=A2YU3N52O8ON

Epicondylitis MOI S/S TX Lateral (tennis elbow) Tennis, baseball, swimming, golfing Repeated forearm flexion and extension Medial (pitchers or golfers elbow) Repetitive wrist flexion, valgus stress on elbow S/S Aching pn. During and after activity decreased ROM hand weakness TX RICE, NSAIDS ROM, PRE, Deep friction massage Elbow sleeve or band just below the bend of the elbow

Epicondylitis Tests Procedure Positive Test Elbow is flexed to 45 degrees Wrist extension is resisted, increases pn at lateral epicondyle Wrist flexion is resisted, increases pn at medial epicondyle Positive Test Pn at either epicondyle

Olecranon Bursitis MOI S/S TX Direct blow Pain, severe swelling, point tenderness TX Acute= ice, compression Chronic = compression, modalities, aspiration Padding for play