Transcript Elbow Anatomy and Injuries

Elbow Flexors and Extensors
Elbow Anatomy - Bones
• Humerus
–Medial
Epicondyle
–Lateral
Epicondyle
• Radius
• Ulna
–Olecranon
Process
The Ulna
Radial
notch
Olecranon Process
Trochlear Notch
Coronoid
Process
Ulnar
Tuberosity
Head
Styloid
Process
The Radius
Head
Neck
Radial Tuberosity
Styloid
Process
Ulnar Notch on
medial surface
Humerus Lateral View
Humeroulnar Joint
Ulna, lateral view
Elbow Anatomy - Ligaments
• Lateral Collateral Ligament
–Ulna and radius to humerus
• Medial Collateral Ligament
–Ulna to humerus
• Keep the elbow stable
Lateral Collateral Ligament
Medial Collateral Ligament
Radioulnar joint
Radius, lateral view
Ulna, lateral view
Nerves
• Three primary nerves of the humerus, radius, ulna,
and wrist:
– Radial Nerve
• Innervates the triceps brachii and provides
sensation to dorsal side of thumb, index,
middle, and half of ring finger
– Ulnar Nerve
• Palmar side of the little finger and half of the
ring finger
– Median Nerve
• Palmar side of thumb, index , and half of ring
finger
Arteries
• Brachial artery
travels across
the crease of the
elbow and splits
into two
branches below
the elbow
–Ulnar and
Radial Artery
Elbow Anatomy Muscles
• Elbow Flexors (3 B’s)
–Biceps Brachii
• Long and Short head
–Brachioradialis
–Brachialis
• Elbow Extensors
–Triceps Brachii
–Anconeus
Biceps Brachii
O: Short head: Coracoid
process of scapula
Long head: Supraglenoid
tubercle of scapula
I:
Radial tuberosity
A: Elbow Flexion
Forearm Supination
Assists in Shoulder
Flexion
Integrated Function of Biceps Brachii
• Assists in deceleration of elbow extension
• Assists in deceleration of forearm
pronation
• Assists in deceleration of shoulder
extension
• Assists in dynamic stabilization of the
humeral head during head during
functional movements
Brachialis
O: Anterior surface of
distal humerus
I: Ulnar tuberosity
A: Elbow flexion
Integrated Function:
Assists in deceleration of
elbow extension
Assists in dynamic
stabilization of elbow
Brachioradialis
O: Lateral supracondylar ridge
of humerus
I: Styloid process of radius
A: Elbow flexion
Assists in supination when forearm
is pronated
Assists in pronation when forearm
is supinated
Integrated Function: Assists in
deceleration of elbow extension
Assists in dynamic stabilization of
elbow
Elbow Flexors
• The biceps brachii is most powerful when
elbow supination is maintained throughout
the exercise (it pulls on the radius to rotate
it). Both heads work together-very hard to
isolate long or short head separately
• The brachialis is a strong elbow flexor
regardless of whether the forearm is
pronated or supinated (it cannot rotate the
ulna)
• The brachioradialis is strongest in a neutral
position (between pronation and supination)
Carrying Angle
• When the forearm is supinated the humerus,
radius, and ulna are not perfectly aligned
• The typical carrying angle is 5 to 15 degrees
which allows the forearm to clear the hips
during ambulation
• In females a wider carrying angle is due to a
wider pelvic girdle
• Carrying angle influences how people hold
objects
• Individuals with extreme carrying angles tend to
pronate
Preacher Curls-Ouch!
• Common Mistake Made: External/Internal rotation the
shoulder joint.
• Possible Negative Effect: When you sit at the machine
or bench you place your shoulders in an unnatural
position which puts strain on your biceps tendon. Also,
the bench or machine does not allow natural shoulder
flexion that is created by the biceps brachii during a
curl.
• Avoid preacher curls! There are more effective ways
to train your forearm flexors.
Triceps Brachii
O:
Long head Infraglenoid tubercle of
scapula
Lateral - Posterior
humerus
Medial - Posterior
humerus
I: Olecranon process of
ulna
A: Elbow extension
Assists in shoulder
extension (long head)
Integrated Function of Triceps Brachii
• Assists in deceleration of elbow
flexion
• Assists in deceleration of shoulder
flexion
• Assists in dynamic stabilization of the
glenohumeral joint
Anconeus
O: Lateral epicondyle of
humerus
I: Olecranon process &
upper posterior ulna
A: Assists in extension
of elbow
Stabilizes elbow
Integrated Function: Assists
in deceleration of elbow
flexion
Triceps Brachii
• The medial head (deep) of the triceps is the most
active but the lateral head is the strongest
• Both lateral and long heads have 60% Type II Fast
Twitch Muscle Fibers
• Medial head has 60% Type I Slow Twitch Muscle
Fibers
• The triceps are not affected by grip position
Golfer’s Elbow and Tennis Elbow
• Golfer’s Elbow:
–Medial
Epicondylitis
• Tennis Elbow:
–Lateral
Epicondylitis
Medial Epicondylitis
• Golfer's elbow
• Most common overuse injury on the
medial epicondyle of humerus
• It is the inflammation of the wrist and
finger flexor tendons that attach onto the
medial epicondyle of the humerus
• This causes micro tearing of tendons,
hemorrhage, inflammation, scarring,
degeneration and shortening of the
tendons
Symptoms of Medial Epicondylitis
• There is pain and tenderness on the medial
(middle) aspect of the elbow on the medial
epicondyle.
• Painful activities include:
– Grasping or squeezing a handle, a golf club
or a tennis racquet.
– Shaking hands.
– Carrying a briefcase
– Writing
– Lifting objects
– Steering a car
Common Causes of Medial Epicondylits
• Occupational overuse
• Weak grip strength
• Poor fitting equipment– grip size or weight of
club or racquet
• Cervical spine nerve pinching
• Elbow hyperextension, "double jointed".
• Overuse in a sporting or daily activity
• Improper technique
• Direct trauma
• Untreated past injury of the upper extremity
or fracture
Lateral Epicondylitis
• Tennis elbow
• Most common overuse injury on the lateral
epicondyle of humerus
• It is the inflammation of the wrist and finger
extensor tendons that attach onto the lateral
epicondyle of the humerus
• This causes micro tearing of tendons,
hemorrhage, inflammation, scarring,
degeneration and shortening of the tendons
Symptoms of Lateral Epicondylitis
• Pain or tenderness on the outer side of
the elbow
• Pain when you straighten or raise your
wrist and hand
• Pain made worse by lifting a heavy object
• Pain when you make a fist, grip an object,
shake hands, or turn door handles
• Pain that shoots from the elbow down into
the forearm or up into the upper arm.
Common Causes of Lateral Epicondylitis
• Repetitive movement
• Strain or the overuse of forearm and wrist
extensor muscles
• Incorrect grips, poor hitting positions,
using a metal framed tennis racquet,
improperly carrying a briefcase or other
heavy object, or spending too much time
using isolated muscle groups in the elbow
area.
• Golfers, computer users, machinists,
carpenters, mechanics, painters…
Factors of Lateral Epicondylitis
• Poor Posture:
– In an EMG study of computer operating office
workers, they found that in a slumped posture
with foreword head,the tension in the wrist
extensors rose approximately 25%.
– If gently tapping on a keyboard with faulty
posture had such a dramatic effect, can you
imagine what lifting weights would do?
• Shoulder Flexibility:
– Flexibility deficits in shoulder rotation may lead
to elbow problems
Factors of Lateral Epicondylitis
Rotator Cuff Strength
• Strengthening of the rotator cuff and scapular
stabilizing muscles - in addition to the wrist
extensors - is very important.
• Any weakness in this kinetic chain can cause
Lateral Epicondylitis.
• If there is no scapular stability, posture will suffer
• If the rotator cuff fatigues, the wrist extensors will
often compensate
• Both of these situations result in increased forces
at the elbow joint and can eventually lead to
Lateral Epicondylitis or a reoccurrence of it
Treatment for Epicondylitis
• Diagnosis by Doctor
• RICE:
– Rest : Avoid activities that aggravate the injury.
– Absolute rest should be avoided as it encourages
muscle atrophy, deconditions tissue, and
decreases blood supply to the area
– Ice- Place an ice bag or a bag of frozen veggies
on your elbow 3 times a day for 20 to 30 minutes
and for 15 min after active use of your arm. You
may also run an ice cup directly on the elbow for
5- 10 minutes.
– Compress and Elevate if appropriate to assist
venous return and minimize swelling.
Treatment for Epicondylitis
• Stretching:
–Will help prevent stiffness by
breaking down any scar tissue that
may result from the inflammation
• Strengthening
• Brace
• Physical Therapy/Occupational
Therapy
• Gentle stretching
exercises including
wrist flexion, extension
and rotation.
• The elbow should be
extended and not flexed
to increase the amount
of stretch as required
• These stretches should
be held for 20-30
seconds and repeated
5-10 times, at least
twice a day.
• Vigorous stretching
should be avoided - do
not stretch to the point
of pain that reproduces
your symptoms.
Strengthening Exercises
•
•
•
With the elbow bent and
the wrist supported
perform the following
exercises:
Wrist Extension-Place
1 lb. weight in hand with
forearm pronated;
support forearm at the
edge of a table
Extend wrist slowly
(concentric contraction),
and flex slowly
(eccentric contraction).
Strengthening Exercises
• Wrist Flexion:
–Place 1 lb. weight in
hand with forearm
supinated support
forearm at the edge of a
table
–Flex wrist up slowly
(concentric), then
extend slowly
(eccentric).
Strengthening Exercises
• Combined Flexion/Extension:
– Attach one end of a string to a
cut broom stick or similar device,
attach the other end to a weight.
– In standing, extend your arms
and elbows straight out in front of
you.
– Roll the weight up from the
ground by turning the wrists.
– Flexors are worked with the
palms facing upward. Extensors
are worked with the palms facing
downward.
Strengthening Exercises
Forearm Pronation/Supination
Grasp hammer (wrench, or
some similar device) in hand
with forearm supported.
Rotate hand to palm down
position, return to start
position (hammer
perpendicular to floor), rotate
to palm up position, repeat.
To increase or decrease
resistance, by move hand
farther away or closer towards
the head of the hammer
Strengthening Exercises
Finger Extension
• Place a rubber band around all five
finger tips.
• Spread fingers 25 times, repeat 3
times.
• If resistance is not enough, add a
second rubber band or use a rubber
band of greater thickness which will
provide more resistance.
Ball Squeeze
• Place rubber ball or tennis ball in
palm of hand, squeeze 25 times,
repeat 3 times.
• If pain is reproduced squeeze a
folded sponge or piece of foam