1. The Elbow and Forearm

2. The Elbow
A hinge joint performing flexion, extension, pronation, and supination
Anatomy
Humerus
Lateral/Medial Epicondyle
Olecranon Fossa

3. The Elbow Anatomy Radius Ulna lateral bone of the forearm
Radial Tuberosity
Radial Styloid process
Ulna
Medial border of the forearm
Semilunar notch
Olecranon process

4. The Elbow Articulations Flexion and Extension Supination and Pronation
Humeroulnar joint
Humeroradial joint
Supination and Pronation
Superior and inferior Radioulnar joints

5. The Elbow Ligamentous support Ulnar collateral Lig. (UCL)
Divided into sections
Anterior Oblique band
Transverse Oblique band
Posterior oblique band

6. The Elbow Ligamentous Support Lateral Ulnar collateral Lig. (LUCL)
Radial Collateral Lig. (RCL)
Annular Ligament
Interosseus Membrane

7. The Elbow Supporting Structures Types Static Structure
Dynamic Structure

8. Static Structures Includes Fibrous Capsule Collateral Ligaments
Synovial membrane
Fat pads
At the Olecranon Fossa (largest)
Over the radial and coronoid fossae (2 small fat pads)

9. Dynamic Structures
Supinator muscle - supports lateral joint and serves as false ligament
Other muscle around elbow joint

10. Cubital Fossa Passing within the fossa is the
Brachial artery
Median Nerve
Biceps Tendon
Musculocutaneous Nerve
This is called the Triangular Space

11. Carrying Angle The way the forearm goes outward when at ones side.
Caused by the size of the trochlea.
Valgus (outward angulation) of 5-15 degrees is normal
being greater in females.
Cubitus Valgus/Varus
Gunstock deformity
A deformity of the elbow, resulting from condylar fracture at the elbow in which the forearm deviates toward the midline of the body when extended.

12. Isoceles Triangle
Medial and lateral epicondyles, Olecranon process. Forms a triangle in flexion and lines up in extension
Boarded laterally by the Brachioradialis and medially by the pronator teres

13. Eating Angle
Due to the carrying angle hand goes straight to the mouth when elbow is flexed.

14. Observation Note the carrying angle Note Cubitus valgus and/varus
excessive swelling
Look for normal bony and soft tissue contours
Functional position
90 degrees of flexion with hand in neutral

15. Range of Motion AROM Flexion - 135-145 degrees
Extension degrees
Supination - 90 degrees
Pronation degrees

16. Circulation Brachial Artery
The pulse of the brachial artery can be felt directly medial to the biceps tendon insertion

17. Peripheral Nerve Injuries
Median Nerve (C6-C8,T1) innervates wrist & finger flexors & pronates forearm
Pinched or compressed as it passes under the Lig. of Struther
Weakness of the pronator teres, and motor and sensory loss
Referred as Humerus Supracondylar Process Syndrome

18. Peripheral Nerve Injuries
Pronator Teres Syndrome
As the median nerve passes through the two heads of the pronator teres it can be compressed
In this case the pronator teres remains normal and the other muscles supplied by the median nerve become involved down the median nerve’s motor distribution.
The motion of pronation is possible but weak
Tested with Pronator Teres Syndrome Test: + sign is tingling or paresthesia in the median nerve distribution of the forearm and hand

20. Pronator Teres Syndrome Test
The patient stands with the elbow in 90 degrees of flexion.
The practitioner then places one hand on the client's elbow for stabilization and the other hand grasps the client's hand in a handshake position.
The client holds this position as the practitioner attempts to supinate the client's forearm (forcing the client to contract the pronator muscles).
While holding the resistance against pronation, the practitioner extends the client's elbow
If the client's pain or discomfort is reproduced, there is a good chance of median nerve compression by the pronator teres

21. Pronator Teres Syndrome
Pronator Teres Syndrome Test: In 90 degrees of elbow flexion the pronator teres muscle is weaker: a positive test is indicated by tingling or parenthesis in the median nerve distribution

22. Peripheral Nerve Injuries
Anterior Interosseus Nerve- Pinch Deformity
Sometimes pinched or entrapped as it passes the pronator teres, leading to impairment of
Flexor pollicis longus
Flexor digitorum profundus (lateral half)
Pronator Quadratus
Anterior Interosseous Nerve Syndrome or Kiloh-Nerin Syndrome- exhibited by pinch deformity: + sign is touching finger pulp-to-pulp instead of finger tip to finger tip
AIS causes no sensory loss because the AIN is a motor nerve

23. Peripheral Nerve Injuries
Ulnar Nerve (C7-C8, T1)- innervates flexors of wrist & finger, intrinsics of the fingers and thumb
Likely to be compressed or stretch in the Cubital tunnel
Compressed by
The Cubital Tunnel
Between the two heads of the flexor carpi ulnaris muscle

24. Peripheral Nerve Injuries
Radial Nerve (C5-C8, T1) innervates triceps, brachiolis, brachioradialis, supinator ,& extensor muscles of wrist and fingers
May be injured as it winds around behind the Humerus in the Radial Groove.
Damage can occur at time of injury or later when the nerve gets caught in the callus of fracture healing
The extensor muscle of the arm are supplied by the radial nerve and only the triceps get spared with this injury

25. Peripheral Nerve Injuries
Posterior Interosseous Nerve
Radial Tunnel Syndrome
The PIN can be compressed as it passes b/t the two head of the Supinator in the Arcade or Canal of Frohse.
Compression leads to functional involvement of forearm extensor muscles and drop wrist
No sensory deficit and may mimic tennis elbow

26. Elbow Pathology Lateral Epicondylities/Radiohumeral Bursitis
Location: extensor carpi radialis brevis tendon or the extensor commounis tendon
Signs & Symptoms:
Pain & tenderness on the outer side of elbow
Pain or weakness with gripping activities
Pain with twisting motions of the wrist ( playing tennis, using a screwdriver, opening a door or jar)
Pain with lifting objects

27. Lateral Epicondylitis
Causes:
Chronic repetitive stress and strain to the muscles and tendons that attach the forearm muscles to the elbow
Sudden change in activity level or intensity
Incorrect grip
Incorrect grip size of racquet (often to large)
Incorrect hitting position or technique ( usually backhand; leading with the elbow
Using a racket that is too heavy

28. Radial Head Fractures MOI: FOOSH injury Elbow Dislocation
Direct Blow to the area

29. Radial Head Fractures Three Types or Classifications:
Type I: Nondisplaced
Type II Marginal radial fractures that are displaced
Type III: Comminuted Fractures involving the entire radial head

30. Elbow Dislocation Very common in children and athletes
MOI: FOOSH injury
Direct blow or twisting injury to the elbow
Posterior Dislocations are most common(98%)
Seldom occur in isolation – are associated with fracture of the radial head (occur in 10%), Neurovascular involvement including brachial artery and median nerve

31. Elbow Dislocations Signs and Symptoms:
Extreme pain, swelling, and inability to bend the elbow
Deformity with olecranon protruding posteriorly and inferiorly
Loss of elbow function
Severe pain when attempting to move the elbow
Numbness or paralysis in the forearm or hand below the dislocation from pinching , stretching, or pressure on the blood vessels or nerves
Decrease or absent pulse at the wrist

32. Olecranon Bursitis
Inflammation of the bursa located b/t the skin and tip of the ulna
Common in contact sports such as wrestling, football, volleyball

33. Olecranon Bursitis Signs and Symptoms
Pain, tenderness, swelling, warmth, or redness over the olecranon process
Crepitaiton ( a crackling sound) on movement or touch
Fever when infected
Often painless swelling of the bursa