1. Elbow
Sports Medicine

2. Movements Carrying angle Flexion Extension Pronation Supination
Females degrees, Males 5 degrees
Flexion
145 degrees
Extension
Pronation
90 degrees
Supination

3. Articulations Consists of 3 separate joints Humeroulnar Humeroradial
Proximal radioulnar

4. 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

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

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

7. 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?

8. 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

9. 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

10. 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

11. 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

12. 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

13. Elbow MMTs Flexion Extension Pronation Supination

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

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