Do Now Draw or trace the bony anatomy of the elbow on page 111 (Figure 11.1). Identify: Humerus Medial epicondyle Lateral epicondyle (not labeled in figure 11.1) Radius Ulna

Elbow and Forearm

Anatomy Preview Bones Simple: three bones Muscles: Complex: 7 major muscles that move the elbow; 9 muscles that move the wrist and hand. Ligaments: Present throughout the elbow, but the medial ligaments are the most relevant to sports medicine Anatomy Video

Bones Humerus (distal portion) Medial and lateral epicondyles Radius (thumb side) Ulna (pinky side) Olecranon (posterior ulna) “Elbow bone”

Anatomy Type of Joint: Hinge joint Range of motion (ROM) Flexion (aka “bending”) up to about 150° Extension (aka “straightening”) to 0°, but my have hyperextension to -10°

Pronation and Supination Pronation and supination occur at the radioulnar joint, not the elbow Radius has to cross over the ulna to produce pronation

Muscles

Biceps (anterior) = elbow flexor Triceps (posterior) = elbow extensor Anterior View Posterior View

Wrist Flexors Originate on medial epicondyle of humerus Insert onto anterior hand/wrist

Wrist Extensors Originate on lateral epicondyle of humerus Insert onto posterior hand/wrist

Ligaments Many ligaments necessary to provide stability. Medial: The ulnar collateral ligament (UCL) is most commonly discussed in sports medicine UCL sprain/tear may lead to “Tommy John” surgery, especially for overhead athletes.

Ligaments Lateral Important for stability of radioulnar joint, especially with pronation

Group Assignment (5 pts) Groups of up to 3 people (you can work independently). One sheet of printer paper per group. You can use the book, your notes, or internet/cell phone to complete this assignment. Draw, color, and identify anatomical landmarks of the elbow. Choose from one of the following groups (pick one): Anterior and posterior bony anatomy. ID 10 different landmarks. Any view of the elbow muscle mass (Medial, lateral, anterior, or posterior view of muscles). ID 5 muscles. Write which view you used. Lateral and medial view of elbow ligaments. ID 5 ligaments. Points: Anatomically accurate drawing (2 pts) Details added to drawing (color, shading, etc) (1/2 pt) Accurate labeling of anatomical structures (2 pt) Identified the appropriate number of structures(1/2 pt)

Quiz on Thursday Identify the following three bones: The olecranon is the posterior portion of which bone? Anterior View

Quiz # 1-3. Identify the following three bones. 4. The olecranon is the posterior portion of which bone? Anterior View

Remember H.O.P.S.? History How did the injury occur? (MOI) Where does it hurt? (Injury location) What activities increase the pain? How long has the injury bothered you? (Acute vs. chronic) Describe the pain. (Sharp, dull, shooting pain?) Observation Look for anything unusual around the elbow as well as down to the hand/wrist. Palpation Feeling for anything unusual around the elbow. Special tests To help determine the injury (will be discussed with some injuries)

Elbow Dislocation Occurs when the olecranon (posterior ulna) no longer articulates (attaches) to the humerus. MOI: In sports, usually due to hyperextension from FOOSH. Video

Elbow Dislocation s/s: Severe pain Obvious deformity Lack ROM (unable to flex/extend) Loss of feeling into hand and fingers Possible nerve damage Patient states that elbow is “out” and felt a “pop”

Treatment Call if: No radial pulse or capillary refill (finger nail) is present Possible injury to the artery Numbness or tingling is present in hand Possible nerve damage Patient cannot get to the ER immediately The athletic trainers is not able to safely move the patient from the site of injury E.g. unstable fracture is also suspected or the patient is does not want to move from the site

Treatment On-field treatment: Splint in the position that is most comfortable for the patient. Apply sling (if possible) Non-Steroidal Anti-inflammatory (NSAID) Immediate referral to orthopedist or hospital. Ortho/ER: X-ray (to rule-out fracture) Reduce the dislocation Splint Surgery may be necessary to repair damaged ligaments and joint capsule Reduction

Hyperextension Tape Demo Video

Olecranon Bursitis Bursa: fluid-filled sacs that provide a buffer between bones, tendons, and ligaments. Many present throughout the body’s joints MOI: In athletics, usually direct impact to the elbow (e.g. fall or hit with helmet or by a baseball).

Olecranon Bursitis Signs and Symptoms (s/s) Posterior elbow pain. Noticeable swelling Point tenderness: severe pain with palpation Warmth and redness if infection is present

Olecranon Bursitis Treatment Initially: Ice bag or ice cup Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Ibuprofen (Advil), Naproxen Sodium/ Naproxen (Aleve), Aspirin Elbow pad Modify activities to prevent direct pressure to elbow If unresponsive to treatment: Aspiration (remove with needle) Corticosteroid injection

Video Aspiration and corticosteroid injection

Lateral & Medial Epicondylitis A.k.a. Lateral = “Tennis Elbow” Medial = “Golfer’s Elbow” MOI: repetitive microtrauma of the wrist extensor/flexor muscles.

Lateral & Medial Epicondylitis History: a chronic condition (effects are persistent or long- lasting) Onset of injury: insidious (gradual pain and dysfunction) s/s: aching pain that worsens over time and with activity Weakness in hand and wrist Pain with palpation near lateral/medial epicondyle

Lateral & Medial Epicondylitis Initial treatment is conservative: Rest Ice NSAIDs Heat (before activity) Forearm Strap To provide a counterforce Effective at treating symptoms Can use pre-wrap

Lateral & Medial Epicondylitis Active Therapy Stretch wrist extensors and flexors Deep tissue massage Therapeutic Ultrasound Provides deep tissue heating Electric Stimulation For pain control Strengthening Flexors Extensors

Distal Biceps Tendon Tear/Rupture Biceps tendon tears near the attachment site of the biceps tendon MOI: Elbow is forced into extension against resistance

Distal Biceps Tendon Tear/Rupture Most often seen in football with arm tackles

Distal Biceps Tendon Tear/Rupture s/s Reports feeling “pop” Decrease elbow flexion strength Edema (“swelling”) and Ecchymosis (“discoloration”) Obvious deformity of biceps, especially when compared bilaterally (both sides) Appears balled-up

Distal Biceps Tendon Tear/Rupture Treatment: Tear Ice and compression NSAIDs Progressive ROM Rupture Usually responds best to surgerysurgery ROM after 1 week Submaximal strengthening about 4 weeks post-op

UCL Sprain UCL = Ulnar Collateral Ligament A tear to at least one of the three ligaments of the UCL.

UCL Sprain MOI: in sports, due to overload of the medial elbow, usually with overhand throwing Onset: Insidious or acute (recently occurring, due to a traumatic event)

UCL Sprain Palpation: Pain over UCL, but probably no deformity s/s Edema (swelling) may be present Pain and weakness with throwing/ overhand motion Diagnosis Valgus Stress Test MRI

UCL Sprain Treatment: Conservative RICE (Rest, Ice, Compression, Elevation) NSAIDs No overhand motion for 4 to 6 weeks for partial tears Treatment: Aggressive Athletes and doctors are now opting for reconstructive surgery for partial and full tears due to its high success rate. reconstructive surgery Commonly known as “Tommy John Surgery”

Lab 1.Valgus and Varus Stress Tests 2.Goniometry 3.Pre-wrap tendinosis strapping 4.TENS unit demonstration

Tommy John Epidemic in MLB? In Little Leaguers 30 for 30 Shorts

Quiz Review Quiz on Friday 1/ Questions with 15 terms listed in the word bank Some terms will not be used. No term will be used more than once.

What you should know: What type of joint is the elbow? What is the primary elbow flexor and extensor muscles? Which muscle group originates from the medial epicondyle of the humerus? How about the lateral epicondyle? What is lateral epicondylitis also know as?

What you should know: What is “Tommy John Surgery” used to repair? Common MOI for an elbow dislocation? Know chronic vs. acute. What is a bursa?

What you should know: Which injury is this?