dr.manal radwan salim lecturer of physical therapy biomeii fall 2013-2014 tuesday 3-12-2014
TRANSCRIPT
Pathomechanics of elbow)
Dr .Manal Radwan SalimLecturer of Physical Therapy
BiomeIIFall 2013-2014
Tuesday 3-12-2014
Elbow/ Forearm AnatomyArthrology and Movements
Humeroulnar Humeroradial Proximal & Distal Radioulnar
Ligaments and Capsule:Joint CapsuleUlnar Collateral (UCL)
3 bundlesLateral Ulnar Collateral (LUCL)Radial Collateral (RCL)Annular Interosseus Membrane
Common elbow abnormalities
the normal value of carrying angle is
10-5 degrees valgum
a) Cubitum Varum: abnormal decrease in carrying angle.
b) Cubitum Valgum: abnormal
increase in the angle.
1- Changes in Carrying Angle
2- Changes in bony alignment following fractures:Fracture of distal humerus or proximal ulna can alter the normal orientation of the articular surfaces of humeroulnar articulation.
a)From frontal view: Any change in the relative
alignment olecranon between the two humeral epicondyles affects both flexion and extension ranges
2- Cubitum Recurvatum: hyperextension of elbow joint.
ii. a hypothetical increase in the superior orientation of the trochlear notch increases extension ROM and decreases flexion ROM.
3-Humeroulnar Disolcation
a) Posterior dislocation:b) As there is little bony limitation
to the trochlear notch being pushed off trochlea.
b) Posterolateral dislocation:More frequent, occur in a combination of lateral and posterior movement of the forearm resulting from a force directed laterally on the distal forearm.
4- Superior radioulnar dislocation “pulled elbow injuries”
Occur at preschool children due to weakness of the annular ligament that allow the radial head to slip away from its ring by the tensile force applied to fore arm
5-Joint swelling and elbow flexion
Position of comfort in case of swelling is significant elbow flexi which is due to minimized tension on joint capsule at 80 degree flexion thus reducing stress on ligaments and minimize pain. But if condition persists this leads to flexion contractures.
6-BursitisSuperficial location
makes it extremely
susceptible to injury (acute or
chronic) --
direct blow
7-Musculature/Tendinitisa) Medial Epicondylitis –
chronic “Pitcher’s, Golfer Elbow” :
Caused by repeated flexion (common flexor tendon), valgus stresses, faulty biomechanics
b) Lateral Epicondylitis – chronic “Tennis Elbow”Caused by -overuse of extensor /supinator muscles, faulty biomechanics (common extensor tendon).-faulty backhand, too much topspin, too small or large grip.
9- PATHOMECHANICS OF MUSCLES AROUND ELBOW
a) Flexor groups:
Biceps Brachii
Brachioradialis
Pronator Teres
Brachialis
i. Biceps brachii Effect of weakness:Loss of flexion and radioulnar
supination strength that is compensated by other muscles.
Also may cause slight weakness in shoulder flexion
Supinated pronated
Effect of tightness:Limited extension range in elbow and
shoulder with tightness degree changes by alteration in other joint positions
if Shoulder in extension position lead to limit extension range at elbow and vice versa
- Forearm pronation lead to limit extension range at elbow and vice vera
ii. Brachiallis Effect of weakness:
Decreased elbow flexion in all forearm ranges.
Effect of tightness: Limited extension range regardless of shoulder and forearm position.
Brachialis
n.b. differentiate between brachialis tightness and anterior capsular tightnessTight muscular tissue feel rubbery or springy at end range. Capsular tightness end feel is harder and less spring
iii. brachioradialis Effect of
weakness:Decreased elbow flexion
strength in addition to decreased resisted pronation and supination as forearm moves toward neutral position
Effect of tightness:Limited extension range
in elbow and supination and pronation range
During rapid elbow flexion it acts as stabilizing to elbow joint against radial aaceleration
iv. Supinator Effect of weakness:Decreased forearm forceful
supination strength in case of intact biceps.
No supination with elbow extended.
Effect of tightness:A two joint muscle thus max
tightness appear when performing elbow extension and pronation
i. Pronator teris Effect of weakness:Decreased elbow flexion and forearm pronation strength In loading situations as loosening a screw
Effect of tightness:Limited extension range in elbow and
supination. A two joint muscle thus max tightness appear when performing elbow extension and supination
Pronator Teres
ii.Triceps brachii Effect of weakness:A profound decrease in elbow extension.In tetraplegia with zero triceps push up could
be done with elbow mechanically locked in hyperextension.
Effect of tightness:Limited flexion range in elbow and may
contribute to diminished shoulder elevation ROM that could interferes with functional daily activities as most daily activities can be performed with a total elbow flexion excursion of about 100°. Ex personal care activities as feeding and hygeine.
Other j positions
Effect of tightness (range)
Effect of weakness (strength)
Muscle
-Shoulder radioulnar
Elbow ext. range pron. Range
- Elbow flex. strength- flex. strength at shoulder - Sup. strength
Biceps brachii
Non elbow ext
elbow flex. strength in all forearm positions
brachialis
Non elbow ext
elbow flex strength resisted pron. and sup. force output as forearm moves toward neutral position
brachioradialis
Non pron forceful sup and pron with extended elbow
supinator
Radioulnar
elbow ext sup
resisted elbow flex resisted in pron
Pronator teres
elbow flex elbow flexion strngth Triceps brachii