Copyright © F.A. Davis Company Part IV: Exercise Interventions by Body Region Chapter 18 The Elbow and Forearm Complex
Copyright © F.A. Davis Company STRUCTURE AND FUNCTION OF THE ELBOW AND FOREARM
Copyright © F.A. Davis Company Humeroulnar Articulation Humeroradial Articulation Ligaments of the Elbow – Medial (ulnar) collateral ligament – Lateral (radial) collateral ligament Elbow Joint Characteristics and Arthrokinematics
Copyright © F.A. Davis Company Proximal (superior) Radioulnar Articulation Distal (inferior) Radioulnar Articulation Forearm Joint Characteristics and Arthrokinematics
Copyright © F.A. Davis Company Primary Actions at the Elbow – Elbow flexion Brachialis Biceps brachii Brachioradialis – Elbow extension Triceps brachii Anconeus Muscle Function at the Elbow and Forearm
Copyright © F.A. Davis Company Primary Actions at the Forearm – Forearm supination Supinator Biceps brachii Brachioradialis – Forearm pronation Pronator teres Pronator quadratus Muscle Function at the Elbow and Forearm (cont'd)
Copyright © F.A. Davis Company Relationship of Wrist and Hand Muscles to the Elbow – Wrist flexor muscles – Wrist extensor muscles Muscle Function at the Elbow and Forearm (cont'd)
Copyright © F.A. Davis Company Common Sources of Referred Pain into the Elbow Region Nerve Disorders in the Elbow Region – Ulnar nerve – Radial nerve – Median nerve Referred Pain and Nerve Injury in the Elbow Region
Copyright © F.A. Davis Company MANAGEMENT OF ELBOW AND FOREARM DISORDERS AND SURGERIES
Copyright © F.A. Davis Company Related Pathologies and Etiology of Symptoms Common Structural and Functional Impairments – Acute stage – Subacute and chronic stages Common Activity Limitations and Participation Restrictions Joint Hypomobility: Nonoperative Management
Copyright © F.A. Davis Company Management: Protection Phase – Educate the patient – Reduce effects of inflammation or synovial effusion and protect the area – Maintain soft tissue and joint mobility – Maintain integrity and function of related areas Joint Hypomobility: Nonoperative Management (cont'd)
Copyright © F.A. Davis Company Management: Controlled Motion Phase – Increase soft tissue and joint mobility – Improve joint tracking of the elbow – Improve muscle performance and functional abilities Joint Hypomobility: Nonoperative Management (cont'd)
Copyright © F.A. Davis Company Management: Return to Function Phase – Improve muscle performance – Restore functional mobility of joints and soft tissues – Promote joint protection Joint Hypomobility: Nonoperative Management (cont'd)
Copyright © F.A. Davis Company Indications for Surgery – Contraindications to surgery Procedure – Background Selection of procedure Implant designs, materials, and fixation – Overview of operative procedure Radial Head Excision or Arthroplasty
Copyright © F.A. Davis Company Complications Postoperative Management – Immobilization – Exercise: maximum protection phase – Exercise: moderate and minimum protection phases Outcomes Radial Head Excision or Arthroplasty (cont'd)
Copyright © F.A. Davis Company Indications for Surgery Procedure – Background Implant design and selection considerations Materials and fixation – Operative overview Complications Total Elbow Arthroplasty (TEA)
Copyright © F.A. Davis Company Postoperative Management – Immobilization – Exercise: maximum protection phase – Exercise: moderate and minimum protection phases Outcomes Pain relief and patient satisfaction ROM and functional use of the upper extremity Total Elbow Arthroplasty (TEA) (cont'd)
Copyright © F.A. Davis Company Definition: Formation of bone in atypical locations in the body – Synonymous with heterotopic bone formation Etiology of Symptoms Management Myositis Ossificans
Copyright © F.A. Davis Company Related Pathologies – Lateral elbow tendinopathy (tennis elbow) – Medial elbow tendinopathy (golfer’s elbow) Etiology of Symptoms Common Structural and Functional Impairments Common Activity Limitations and Participation Restrictions Overuse Syndromes: Repetitive Trauma Syndromes
Copyright © F.A. Davis Company Decrease Pain, Edema, or Spasm Develop Soft Tissue and Joint Mobility Maintain Upper Extremity Function Nonoperative Management of Overuse Syndromes: Protection Phase
Copyright © F.A. Davis Company Increase Muscle Flexibility and Scar Mobility Restore Joint Tracking of the RU Joint Improve Muscle Performance and Function Patient Education Nonoperative Management: Controlled Motion and Return to Function Phases
Copyright © F.A. Davis Company EXERCISE INTERVENTIONS FOR THE ELBOW AND FOREARM
Copyright © F.A. Davis Company Manual, Mechanical, and Self-Stretching Techniques – To increase elbow extension – To increase elbow flexion – To increase forearm pronation and supination Exercise Techniques to Increase Flexibility and Range of Motion (ROM)
Copyright © F.A. Davis Company Self-Stretching Techniques: Muscles of the Medial and Lateral Epicondyles – To stretch the wrist extensor muscles (from the lateral epicondyle) – To stretch the wrist flexor muscles (from the medial epicondyle) Exercise Techniques to Increase Flexibility and ROM (cont'd)
Copyright © F.A. Davis Company Isometric Exercises – Multiple-angle isometric exercises – Angle-specific training – Alternating isometrics and rhythmic stabilization Exercises to Develop and Improve Muscle Performance and Functional Control
Copyright © F.A. Davis Company Dynamic Strengthening and Endurance Exercises – Elbow flexion – Elbow extension – Long head of the triceps with elbow extension – Pronation and supination – Wrist flexion and extension Exercises to Develop and Improve Muscle Performance and Functional Control (cont'd)
Copyright © F.A. Davis Company Functional Progression for the Elbow and Forearm – Diagonal patterns – Combined pulling motions – Combined pushing motions – Plyometric training (stretch-shortening drills) – Simulated tasks and activities Exercises to Develop and Improve Muscle Performance and Functional Control (cont'd)
Copyright © F.A. Davis Company Critical Thinking and Discussion Laboratory Practice Case Studies Independent Learning Activities