1. Elbow Anatomy  Medial Epicondyle  Lateral Epicondyle  Trochlea and Capitulum  Olecranon Process  Ulna and Radius  Radial Head  Interosseus Membrane

2. Elbow Anatomy  http://images.main.uab.edu/healthsys/ei_0153.jpg

3. Elbow Anatomy (2)  Humeroulnar joint  Hinge joint  Trochlea of humerus  Trochlear fossa of ulna  Flexion (0 – 150)  Extension (0)-some hyperextension(-5 to -15)  Ligaments:  Medial (ulnar) collateral (UCL)  Lateral (radial) collateral (RCL)

4. Elbow Anatomy (3)  Radioulnar joint  Not part of elbow but associated with supination and pronation  Supported by the annular ligament which binds the head of the radius to the radial notch of the ulna forming the joint  Radius Rolls over the ulna

5. Muscular Anatomy  Biceps (flexion w/ supination)  Brachioradialis (flexion with arm neutral)  Brachialis (flexion w/ pronation)  Triceps (extension)  Pronator Group (pronation)  Supinator (supination)

6. Bursa, Blood and Nerve Supply  Bursa- major one is olecranon bursa  Blood supply  Brachial artery  Radial artery  Ulnar artery  Nerve supply  Brachial plexus extends into the radial and ulna nerve***

7. Prevention of Injuries  General muscular condition- FS 9-1  Restrict pitching/ teach proper form  Make sure equipment is proper (ie: racquet)- grip size, racquet weight  Teach shoulder roll method of falling- example volleyball players rolling after a dig

8. Contusions  MOI: Direct contact  HOPS  Swelling, heat, discoloration or ecchymosis  Limited range of motion  TX  Rule out fracture first  Ice, wrap and pad area  Avoid aggressive stretching and strengthening  Watch for ectopic bone formation  Ectopic = in a place other than normal

9. Olecranon Bursitis  Olecranon bursa is largest in elbow  MOI: fall on bent arm, leaning on elbow for long periods, infection  HOPS  Heat, redness, and rapid swelling  Tx: ice, compression, pad area If associated with fever: refer Aspiration or draining may be needed

10. http://www.physsportsmed. com/issues/2000/03_00/mcf arland4.gif http://www.aafp.org/afp/971101 ap/salzfig3.jpg

11. Elbow Sprains (1 – UCL)  MOI: valgus force, repetitive stress  HOPS:  Pain over medial joint especially in cocking phase or acceleration phase of throwing  Point tenderness over joint line  + valgus stress test (increasing with degree 1st- 3rd)  Tx: rest, general strengthening of flexors/ pronators; Rule out ulnar nerve damage (numbness in little finger)

13. Elbow Dislocations  MOI: hyperextension, sudden, violent force driving ulna posterior, falling on outstretched hand  HOPS  Obvious deformity  Snapping or cracking sensation  Severe pain  Forearm in flexion and appears shortened  Tx:  immobilize and refer MED EMERGENCY  Check neurovascular status

14. -http://www.worldortho.com/database/intro- trauma/pics/img0123.jpghttp://www.worldortho.com/database/intro- trauma/pics/img0123.jpg http://www.angelfire.com/sc2/seahawksportsmed/injpi x.html http://www.angelfire.com/sc2/seahawksportsmed/injpi x.html

15. Medial Epicondylitis  “little league elbow, golfer’s elbow”  MOI: repetitive tension or valgus forces on the arm  HOPS-Box 9-1  Swelling, ecchymosis over medial epicondyle  Pain aggravated by pronation and resisted flexion of wrist  Tingling and numbness in 4 th and 5 th fingers  Tx:  See Field Strategy 9.3

16. http://www.esportmed.com/smrn/figures/Golfer ElbowInjury.gif

17. Lateral Epicondylitis  “tennis elbow”  Most common overuse injury in the adult elbow  MOI: eccentric loading on wrist extensors during deceleration  Precursor: too large tennis raquet, gripping racket too tightly, excessive string tension, faulty mechanics

18. Lateral Epicondylitis (2)  HOPS  Pain over lateral epicondyle  Pain with resisted wrist extension  + tennis elbow test  Tx  RICE  Increase strength, power, endurance of wrist extensors  Counter force brace

20. Impingement of Ulnar nerve  Ulnar nerve passes behind humerus in ulnar groove  Lies under UCL  HOPS  Pain along medial elbow  Can be caused from a medial elbow injury  “crazy bone” or “funny bone”  Tingling and numbness in ring and little finger  Grip strength weak  Refer if chronic

21. ROM testing  See p 173 Fig 9-23  Elbow flexion  Elbow extension  Wrist flexion and extension  Pronation  Supination

22. Stress Tests  Valgus (UCL)/Varus (RCL) stress test – Positive Sign is laxity  Tennis Elbow test-(Lateral Epicondylitis) - Positive Sign is increased pain  Tinel’s sign (Ulnar nerve) – Numbness, Tinkling into Ulnar nerve region.