Transcript Lecture 14 the elbow

The Elbow
Lecture 14
The Elbow
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the elbow is second to the shoulder for
dislocations ( first in children ) and second
to the knee for overuse injuries.
Bony Structure of Elbow
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humeroulnar is the
hinge joint , where the
trochlea of the
humerous articulates
with the trochlera fossa
of the ulna
the humeroradial joint is
a gliding joint , here the
capitulum of the
humerous articulates
with the radius
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the annular ligament binds the head of the
radius to the radial notch of the ulna
forming the proximal radioulnar joint – this
is a pivot joint allowing for pronation and
supination
Carry Angle of the Elbow
 The angle between the long axes of the
humerus and the ulna when the arm is in
an anatomical position
 This is called this because it allows the
forearm to angle away from the body when
a load is carried in the hand
 Carrying angle is generally greater in
females than in males
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Elbow Stability
Medial Collateral
a) anterior - strong &
reinforces annual lig.
b) transverse - weaker
c) posterior fibres
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Most important ligament
in the elbow for
stability
Lateral Collateral
a) anterior
b) intermediate
c) posterior
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all help to reinforce the strong annular
ligament
Elbow movements
Flexion
 Extension
 Pronation
 Supination
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Common Injuries
Elbow Dislocation /
Subluxation
ulnar dislocations
 hyperextension ( Fall on hand elbow
extended) with violent twisting action of
the ulna , needs a tremendous amount
of force
 more common displacement of radial
head especially in children , swinging of
children by their arms , may cause
radial head to snap out of the annular
ligament
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severe pain with loss of function , cracking
or snapping sensation , rapid swelling and
obvious deformity , inability to move elbow
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90 % posterior , management is important
not to cause long term disabilities
First Aid
In case of dislocations a primary concern
is not to cause complications to the
neurovascular tissue
 Apply ice and compression
 Splint on both sides of the injury and
stabilize as best as possible
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Olecranon Bursitis
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the olecranon bursa is
the largest bursa in
the elbow and sits just
over the olecranon
process
injury results due to a
direct fall, constant
irritation, or infection
an acutely inflamed bursa will rapidly
swell, show signs of redness and
increased heat
 often termed golf ball swelling
 the bursa may become infected – again it
will be swollen and hot to touch along with
a possible fever , pain , tenderness and
restricted range of motion, refer to Dr
immediately if infected
 Rx – PIER – protection, aspiration may be
necessary
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Elbow strain
usually the result if someone attempting
to overcome large force with muscle
 inadequate warm-up , excessive
training (past point of fatigue)
 common with biceps brachii, brachiallis,
triceps
 pain and point tenderness over the
injury site, reduced strength and ROM
 Rx – PIER , NSAIDS .. strengthening
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Elbow Sprain
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usually the result of fall on extended arm,
producing a hyperextension of elbow
or through a valgus/varus force
may be due to a repetitive force that irritate
or tear the ligaments
pain , local tenderness . pain and or laxity
with stressing of the ligament, decreased
ROM
Rx – PIER , NSAIDS .. strengthening
Medial Epicondylitis
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aka : little league elbow
or golfer’s elbow
repetitive motions with
poor technique,
muscular weakness or
anatomical weakness
often seen in the
acceleration phase of
throwing
valgus force is placed on the elbow,
which strains the flexor muscle , the
ulnar collateral ligament and possibly
the ulnar nerve.
 swelling at the medial epicondyle, point
tenderness, pain on resisted wrist
flexion and pronation
 tingling and numbness may be felt if the
ulnar nerve is involved
 Rx- PIER , NSAIDS, bracing modalities
retraining
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Lateral Epicondylitis
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aka : tennis elbow
most common overuse injury in the elbow
this condition is typically due to eccentric
overloading of the extensor muscles as seen
in the deceleration phase of throwing or the
tennis stroke
pain will be located on the lateral epicondyle ,
it may be swollen and the pain will increase
with resisted wrist extension
Rx- PIER , NSAIDS, bracing , retraining
Contributing factors to tennis elbow
 lack of experience
 missing "sweet spot" poor technique on
backhand
 heavy stiff racquet ( 12 - 12.5 seem to be
best)
 grip size
 racquet strings to tight( 2-3 lbs. best)
 playing surface ( ball bounces more off
cement)
Cubital Tunnel Syndrome
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impingement of ulnar
nerve in cubital tunnel of
the elbow ( through
ulnar groove and under
the ulnar ligament)
here the nerve is
vulnerable to
compression and tensile
stress caused by
trauma
sharp pain along medial aspect forearm,
tingling and numbness into ring and little
finger of hand
 signs and symptoms reproduced by
tapping over ulnar groove
 Rx- depending on severity should be
referred to doctor –watch icing of a nerve
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