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The Elbow
Sports MedicineSports Medicine
John Hardin, InstructorJohn Hardin, Instructor
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Anatomy of Elbow and Forearm
HumerusHumerus UlnaUlna RadiusRadius
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Humerus
Medial & lateral epicondylesMedial & lateral epicondyles Olecranon fossaOlecranon fossa TrochleaTrochlea CapitulumCapitulum
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Ulna
Olecranon processOlecranon process Articulates with trochlea and olecranon Articulates with trochlea and olecranon
fossa of humerusfossa of humerus
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Radius
Head of radiusHead of radius Articulates w/ the capitulum of the humerusArticulates w/ the capitulum of the humerus
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Joints
Humeroulnar jointHumeroulnar joint Flexion/extensionFlexion/extension
Humeroradial jointHumeroradial joint Flexion/extensionFlexion/extension
Radioulnar jointRadioulnar joint Supination/pronationSupination/pronation 3 articulations—superior, middle, distal3 articulations—superior, middle, distal
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Ligaments
Joint capsule surrounds jointJoint capsule surrounds joint Ulnar collateral Ulnar collateral Radial collateral Radial collateral Annular ligamentAnnular ligament Interroseus membraneInterroseus membrane
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Muscles
Flexors of the elbowFlexors of the elbow Biceps brachiiBiceps brachii BrachialisBrachialis BrachioradialisBrachioradialis Forearm flexorsForearm flexors Forearm extensorsForearm extensors
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Extensors of the elbow
Triceps brachiiTriceps brachii Long headLong head Lateral headLateral head Medial headMedial head
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Pronators
Pronator teresPronator teres Pronator quadratusPronator quadratus
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Supinators
Biceps brachiiBiceps brachii SupinatorSupinator
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Forearm muscles
Forearm flexors attach to the medial Forearm flexors attach to the medial epicondyleepicondyle
Forearm extensors attach to the lateral Forearm extensors attach to the lateral epicondyleepicondyle
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Other structures
NervesNerves Ulnar, radial, medianUlnar, radial, median
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Landmarks
Cubital fossaCubital fossa Olecranon processOlecranon process Olecranon fossaOlecranon fossa Medial and lateral epicondylesMedial and lateral epicondyles Radial headRadial head
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Olecranon Bursitis
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Another view?
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Mechanism
Direct blowDirect blow Falling on elbowFalling on elbow May appear spontaneously without heat and May appear spontaneously without heat and
painpain
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Signs & symptoms
PainPain SwellingSwelling POTPOT HeatHeat
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Treatment
ColdCold CompressionCompression Rarely will be aspirated by physicianRarely will be aspirated by physician Protect with padding when competingProtect with padding when competing May recur with repeated blowsMay recur with repeated blows
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Elbow Sprains
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Mechanism
Hyperextension or a force that bends or Hyperextension or a force that bends or twists the lower arm outward twists the lower arm outward
Valgus stressValgus stress
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Signs & Symptoms
PainPain Inability to throw or grasp an objectInability to throw or grasp an object POT (usually over UCL)POT (usually over UCL)
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Treatment
IceIce CompressionCompression Sling for support @ 90 degreesSling for support @ 90 degrees Progress to full ROM and strengthProgress to full ROM and strength
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Lateral Epicondylitis
Tennis elbowTennis elbow
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Mechanism
Backhand stroke involving overextending Backhand stroke involving overextending of wristof wrist
Repetitive extension of the wristRepetitive extension of the wrist
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Signs & Symptoms
POT over lateral epicondyle POT over lateral epicondyle Pain over lateral epicondyle during and Pain over lateral epicondyle during and
after activityafter activity Pain gradually increases resulting in Pain gradually increases resulting in
weakness in hand and wristweakness in hand and wrist Pain with resistive hyperextension of wrist Pain with resistive hyperextension of wrist
and full extension of elbowand full extension of elbow
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Treatment
RICERICE NSAIDSNSAIDS AnalgesicsAnalgesics HeatHeat Deep friction massageDeep friction massage
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Treatment (cont’d)
RehabRehab ROM exercisesROM exercises
stretchingstretching PRE’sPRE’s
strengtheningstrengthening Hand grasping while in supinationHand grasping while in supination Avoid pronation movementsAvoid pronation movements
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Medial epicondylitis
Pitcher’s elbowPitcher’s elbow Racquetball elbowRacquetball elbow Golfer’s elbowGolfer’s elbow Javelin-thrower’s elbowJavelin-thrower’s elbow
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Mechanism
Repeated forceful forearm flexionRepeated forceful forearm flexion Excessive throwingExcessive throwing
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Signs & Symptoms
Aching pain around the medial epicondyle Aching pain around the medial epicondyle especially during forceful wrist flexionespecially during forceful wrist flexion
Pain during and after activity—progressing Pain during and after activity—progressing to constant painto constant pain
POTPOT Mild swellingMild swelling
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Treatment
RICERICE NSAIDSNSAIDS UltrasoundUltrasound AnalgesicsAnalgesics BraceBrace Exercises for ROM and strengtheningExercises for ROM and strengthening
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Dislocation of Elbow
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Mechanism of injury
Fall on outstretched armFall on outstretched arm HyperextensionHyperextension Severe twist with elbow in flexed positionSevere twist with elbow in flexed position Blow to posterior humerus with fixed Blow to posterior humerus with fixed
radius/ulnaradius/ulna
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Signs & Symptoms
Ulna and/or radius displaced posteriorly, w/ Ulna and/or radius displaced posteriorly, w/ olecranon process sitting posteriorlyolecranon process sitting posteriorly
Severe swelling/bleedingSevere swelling/bleeding DisabilityDisability LOMLOM Extreme painExtreme pain
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Treatment
Immobilize in position you find itImmobilize in position you find it ER ER Treat for shockTreat for shock Immobilized after reduction for about 3 Immobilized after reduction for about 3
weeksweeks
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Fracture of elbow
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Mechanism
Fall on outstretched armFall on outstretched arm Direct blow to elbowDirect blow to elbow
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Signs & symptoms
Possible deformityPossible deformity Swelling/bleedingSwelling/bleeding Muscle spasmMuscle spasm PainPain POTPOT
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Treatment
ImmobilizeImmobilize IceIce ERER
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Injuries to forearm
ContusionsContusions Forearm strainForearm strain fracturesfractures
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Contusion
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Mechanism
Direct blow to forearmDirect blow to forearm Repeated blows to forearmRepeated blows to forearm
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Signs & Symptoms
PainPain SwellingSwelling DiscolorationDiscoloration HematomaHematoma
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Treatment
RICERICE Protective paddingProtective padding Modify activity if necessaryModify activity if necessary
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Forearm strain
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Mechanism
Hyperextension or hyperflexionHyperextension or hyperflexion Fall on outstretched handFall on outstretched hand
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Signs & Symptoms
Pain along extensors or flexorsPain along extensors or flexors POTPOT Pain with motionPain with motion Inability to gripInability to grip swellingswelling
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Treatment
RICERICE Modify activityModify activity Restore ROM and strengthRestore ROM and strength Tape for protectionTape for protection
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Fractures
RadiusRadius UlnaUlna Both bonesBoth bones
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Mechanism
Direct blowDirect blow Fall on outstretched armFall on outstretched arm
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Signs & Symptoms
Possible deformityPossible deformity PainPain POTPOT SwellingSwelling Unable to use armUnable to use arm ““+” compression/percussion test+” compression/percussion test
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Treatment
ImmobilizeImmobilize IceIce ER ER