1. Functional Anatomy & Clinical Presentation
The Elbow
Functional Anatomy & Clinical Presentation

2. Elbow Anatomy What movements occur at the elbow?
What type of joint is the elbow?

3. Bony Anatomy
Upper Arm
Humerus
Forearm
Ulna (medial)
Radius (lateral)

4. Bony Anatomy Anterior Supracondylar ridge Lateral epicondyle
Medial epicondyle
Radial head
Coronoid fossa
Capitulum
Trochlea

5. Bony Anatomy Posterior Olecranon fossa Olecranon
Groove for ulnar nerve

6. Ligaments Annular ligament 360 degrees around radial head
Keeps the radial head in
contact with the radial
notch of the ulna

7. Ligaments Ulnar Collateral Ligament Medial side of elbow
Connects medial epicondyle
to coranoid & olecranon
processes

8. Ligaments Radial (Lateral)Collateral Ligament Lateral side of elbow
Connects the lateral
epicondyle to the annular
ligament

9. Bony Palpations Supracondylar ridge Lateral epicondyle
Radial (lateral) collateral ligament
Radial head/annular ligament
Radius
Olecranon process
Olecranon fossa
Medial epicondyle
Proximal end of ulna
Ulna
Ulnar groove
Ulnar collateral ligament

10. Soft Tissue Anatomy Anterior Biceps brachii Brachioradialus Brachialis
Pronator Teres

11. Soft Tissue Anatomy Biceps Bracii Origin Insertion Action Shoulder
Radius
Action
Flexes forearm, supinates forearm

12. Soft Tissue Anatomy Brachioradialus Origin Insertion Action
Lateral supracondylar ridge
Insertion
Styloid process of radius
Action
Flexes forearm

13. Soft Tissue Anatomy Brachialis Origin Insertion Action
Anterior, distal humerus
Insertion
Coronoid process of ulna
Action
Flexes the elbow

14. Soft Tissue Anatomy Pronator Teres Origin Insertion Action
Medial epicondyle of humerus
Coronoid process of ulna
Insertion
Middle of lateral surface of shaft of ulna
Action
Pronates the elbow

15. Soft Tissue Anatomy
Posterior
Triceps
Supinator

16. Soft Tissue Anatomy Triceps Origin Insertion Action
Shoulder (3 origins)
Insertion
Olecranon process of ulna
Action
Extends elbow

17. Soft Tissue Anatomy Supinator Origin Insertion Action
Lateral epicondyle of humerus
Insertion
Proximal, lateral shaft of radius
Action
Supinates the elbow

18. Soft Tissue Anatomy Medial Wrist flexors
Originate off medial epicondyle

19. Soft Tissue Anatomy Lateral Wrist extensor muscles
Originate off lateral epicondyle

20. Soft Tissue Anatomy Lateral Anconeus Origin Insertion Action
Posterior part of lateral epicondyle of humerus
Insertion
Later olecranon process, posterior ulna
Action
Extends forearm (helps triceps last few degrees)

21. Soft Tissue Palpations
Anterior
Biceps brachii
Brachialis
Brachioradialis
Pronator teres
Posterior
Triceps
Supinator
Medial
Wrist flexor muscles
UCL
Lateral
RCL
Wrist extensor muscles

22. Range of Motion Assesses the motion of the joint bilaterally
(compared to the other side)
Active Range of Motion (AROM) vs Passive Range of Motion (PROM)
Normal joint elbow
Flexion:
Extension: 0
Pronation: 70
Supination: 85

23. Measuring R.O.M.
Moving
arm
Goniometer
Fulcrum
Stationary arm

24. Measuring R.O.M. Elbow Flexion Fulcrum Stationary arm Moving arm
Lateral epicondyle
Stationary arm
Midline of humerus
Moving arm
In line with radial styloid process

25. Resisted Range of Motion (RROM)
Elbow Flexion
Put elbow in flexion
Place one hand one the shoulder being tested
Other hand on the anterior forearm

26. RROM Elbow Extension Pt is seated Elbow slightly flexed
One hand supports the elbow
Other hand applies pressure to the proximal wrist\
Trying to push the arm into flexion

27. RROM Pronation Pt is seated Palm is facing down
One hand stabilizes below the forearm
Other “shakes patient’s hand”, tries to make hand supinate.

28. RROM Supination Pt is seated Palm is facing up
One hand stabilizes below the forearm
Other “shakes patient’s hand”, tries to make hand pronate.

29. Injuries of the Elbow Bone Injuries MOI?
Forcing arm into bending
Fall on an outstretched hand
Importance of prompt treatment?
Damage to blood vessels and nerves could cause cell death.
Epiphyseal & avulsion fractures
Ulnar dislocations

30. Epiphyseal & Avulsion Fractures
More common on the medial epicondyle or the olecranon.
Growing athletes are more likely to have an epiphyseal fracture.
S/S
Epiphyseal – pain, swelling, loss
of motion
Avulsion – severe pain and
deformity

31. Elbow Dislocation MOI? Most common dislocation?
Fall on an outstretched hand
Violent hyperextension
Severe blow to the lateral elbow
Most common dislocation?
Posterior
S/S (What is observed?)
Gross deformity
Olecranon process extends posteriorly
Swelling, bruising

32. Elbow Dislocation Potential complications? Treatment/management
Damage to the median & radial nerves
Damage to blood vessels
Treatment/management
Splint as you found it
Send to emergency room for
relocation.

33. Muscle & Tendon Injuries
Elbow flexor strains
Elbow extensor strains
Medial & lateral epicondylitis

34. Elbow Flexor Strain MOI? S/S
Often includes both the shoulder & elbow (biceps)
Excessive resistance elbow & shoulder flexion
S/S
Depends on grade… (think of sprains and strains chart)
Grade 1?
Grade 2?
Grade 3?
Pain over anterior elbow and the biceps tendon

35. Elbow Flexor Strain Evaluation will find… Weakness
Extra discomfort with elbow flexion
AROM, RROM
PROM? (pain decreases with PROM)
Grades 1 & 2
RICE, rehabilitation
Grade 3
Refer to physician/ER

36. Elbow Extensor Strain MOI Pain with active elbow extension
Same as flexor strain
Trying to break a fall
Pain with active elbow extension
Be sure to check for avulsion fractures at the olecranon process.

37. Medial & Lateral Epicondylitis
Chronic inflammation of either the medial or lateral epicondyles.
Lateral Epicondylitis (Tennis Elbow)
Inflammation of the extensor tendons.
S/S
Minimal swelling over lateral epicondyle
Pain will also be present

38. Medial Epicondylitis AKA Little League Elbow
Result of repetitive throwing
Inflammation of the wrist flexors
Pitch counts in Little League?
S/S
Same as lateral epicondylitis

39. UCL/RCL Sprains Ulnar collateral ligament is more prone to injury MOI?
UCL – valgus force (force from the lateral side)
RCL – varus force (force from the medial side)
S/S
Pain
Swelling
Possibly joint laxity
Special tests

40. Scenario 1
A basketball player goes up for a lay up and has his feet taken out from under him, and tries to catch himself with an outstretched hand. He falls to the floor and does not get up, but is holding his elbow in pain. When you get there you notice that his olecranon process is protruding posteriorly and there is already a considerable amount of swelling.

41. Scenario 1 Answer Posterior Dislocation
Splint as you found it, and refer to ER

42. Scenario 2
A wrestler is trying to escape from a move. His hand is planted on the mat when his opponent strikes the lateral side of his elbow. He feels a small pop on the medial side, but finishes the match. After the match he approaches you with pain in both his medial and lateral elbow. He has a moderate amount of swelling over his medial epicondyle and has some laxity with a valgus stress test.

43. Scenario 2 Answer UCL Sprain (Grade 2) Follow up with physician
Discontinue activities
PRICES

44. Scenario 3
A tennis player approaches you with elbow pain. You notice a minimal amount of swelling over her lateral epicondyle. While palpating you notice that most of her pain is over the lateral epicondyle and into the wrist extensors. She does not remember doing anything to that elbow, but says it has been bothering her for about a week.

45. Scenario 3 Answer Lateral Epicondylitis Tape for relief
Ice after practice
NSAIDS