The Elbow

Sports MedicineSports Medicine

John Hardin, InstructorJohn Hardin, Instructor

Anatomy of Elbow and Forearm

HumerusHumerus UlnaUlna RadiusRadius

Humerus

Medial & lateral epicondylesMedial & lateral epicondyles Olecranon fossaOlecranon fossa TrochleaTrochlea CapitulumCapitulum

Ulna

Olecranon processOlecranon process Articulates with trochlea and olecranon Articulates with trochlea and olecranon

fossa of humerusfossa of humerus

Radius

Head of radiusHead of radius Articulates w/ the capitulum of the humerusArticulates w/ the capitulum of the humerus

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

Ligaments

Joint capsule surrounds jointJoint capsule surrounds joint Ulnar collateral Ulnar collateral Radial collateral Radial collateral Annular ligamentAnnular ligament Interroseus membraneInterroseus membrane

Muscles

Flexors of the elbowFlexors of the elbow Biceps brachiiBiceps brachii BrachialisBrachialis BrachioradialisBrachioradialis Forearm flexorsForearm flexors Forearm extensorsForearm extensors

Extensors of the elbow

Triceps brachiiTriceps brachii Long headLong head Lateral headLateral head Medial headMedial head

Pronators

Pronator teresPronator teres Pronator quadratusPronator quadratus

Supinators

Biceps brachiiBiceps brachii SupinatorSupinator

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

Other structures

NervesNerves Ulnar, radial, medianUlnar, radial, median

Landmarks

Cubital fossaCubital fossa Olecranon processOlecranon process Olecranon fossaOlecranon fossa Medial and lateral epicondylesMedial and lateral epicondyles Radial headRadial head

Olecranon Bursitis

Another view?

Mechanism

Direct blowDirect blow Falling on elbowFalling on elbow May appear spontaneously without heat and May appear spontaneously without heat and

painpain

Signs & symptoms

PainPain SwellingSwelling POTPOT HeatHeat

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

Elbow Sprains

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

Signs & Symptoms

PainPain Inability to throw or grasp an objectInability to throw or grasp an object POT (usually over UCL)POT (usually over UCL)

Treatment

IceIce CompressionCompression Sling for support @ 90 degreesSling for support @ 90 degrees Progress to full ROM and strengthProgress to full ROM and strength

Lateral Epicondylitis

Tennis elbowTennis elbow

Mechanism

Backhand stroke involving overextending Backhand stroke involving overextending of wristof wrist

Repetitive extension of the wristRepetitive extension of the wrist

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

Treatment

RICERICE NSAIDSNSAIDS AnalgesicsAnalgesics HeatHeat Deep friction massageDeep friction massage

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

Medial epicondylitis

Pitcher’s elbowPitcher’s elbow Racquetball elbowRacquetball elbow Golfer’s elbowGolfer’s elbow Javelin-thrower’s elbowJavelin-thrower’s elbow

Mechanism

Repeated forceful forearm flexionRepeated forceful forearm flexion Excessive throwingExcessive throwing

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

Treatment

RICERICE NSAIDSNSAIDS UltrasoundUltrasound AnalgesicsAnalgesics BraceBrace Exercises for ROM and strengtheningExercises for ROM and strengthening

Dislocation of Elbow

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

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

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

Fracture of elbow

Mechanism

Fall on outstretched armFall on outstretched arm Direct blow to elbowDirect blow to elbow

Signs & symptoms

Possible deformityPossible deformity Swelling/bleedingSwelling/bleeding Muscle spasmMuscle spasm PainPain POTPOT

Treatment

ImmobilizeImmobilize IceIce ERER

Injuries to forearm

ContusionsContusions Forearm strainForearm strain fracturesfractures

Contusion

Mechanism

Direct blow to forearmDirect blow to forearm Repeated blows to forearmRepeated blows to forearm

Signs & Symptoms

PainPain SwellingSwelling DiscolorationDiscoloration HematomaHematoma

Treatment

RICERICE Protective paddingProtective padding Modify activity if necessaryModify activity if necessary

Forearm strain

Mechanism

Hyperextension or hyperflexionHyperextension or hyperflexion Fall on outstretched handFall on outstretched hand

Signs & Symptoms

Pain along extensors or flexorsPain along extensors or flexors POTPOT Pain with motionPain with motion Inability to gripInability to grip swellingswelling

Treatment

RICERICE Modify activityModify activity Restore ROM and strengthRestore ROM and strength Tape for protectionTape for protection

Fractures

RadiusRadius UlnaUlna Both bonesBoth bones

Mechanism

Direct blowDirect blow Fall on outstretched armFall on outstretched arm

Signs & Symptoms

Possible deformityPossible deformity PainPain POTPOT SwellingSwelling Unable to use armUnable to use arm ““+” compression/percussion test+” compression/percussion test

Treatment

ImmobilizeImmobilize IceIce ER ER