Transcript The Elbow - Emily Gavlick

The Elbow
Ulnar Collateral Ligament Sprain
Elbow Dislocation
Ulnar Nerve Irritation
Emily Gavlick
Bone Anatomy of Elbow
 Involved
bones:
– Humerus
– Ulna
– Radius
 General
Joint Type: hinge
– Movement allowed in only one plane
Bone Anatomy of the Elbow

Joint Actually Comprised of 3 Areas
1. Humeroulnar Joint: flexion and extension
2. Proximal Radioulnar Joint: supination and
pronation of hand
3. Humeroradial Joint: arthrodial joint (only a slight
gliding motion)
Ligament Anatomy of Elbow
 Ulnar
Collateral Ligament (UCL): medial side
of the elbow
 Radial
Collateral Ligament (RCL): lateral side
of the elbow
 Annular
Ligament: wraps around the radial
head and holds it tight against the ulna
– annular means ring-shaped
Ligament Anatomy of Elbow
Muscle Anatomy of Elbow
 Anterior:
– Biceps
 Posterior:
– Triceps Brachii
 Lateral:
– Supinator
 Medial:
– Flexor Carpi Ulnaris
Tendon Anatomy of Elbow
 Anterior:
– biceps tendon
 Posterior:
– triceps tendon
 Lateral:
– common tendon of
origin of the Extensor
muscles
 Medial:
– common tendon of
origin of the Flexor
muscles
Muscle / Tendon Anatomy of
Elbow
Muscle / Tendon Anatomy of
Elbow
Elbow Injuries
Ulnar Collateral Ligament Sprain
What is it?

Stretch or tear of the UCL
Involved Structures:
The UCL
 The Humerus
 The Ulna

Location:

Medial side of elbow
Ulnar Collateral Ligament Sprain
Mechanism of Injury:
 Force
bends elbow inward toward midline
 most commonly occurs in throwing activities
Ulnar Collateral Ligament Sprain
General Signs and Symptoms: (specific
symptoms depend on severity of sprain)
 Pain
 Popping
/ tearing sensation
 Tenderness
 Swelling
 Bruising
Ulnar Collateral Ligament Sprain
Grades: (as with any sprain)
Grade I: partial tear of a ligament
– Mild tenderness and swelling
– Slight or no functional loss
– No mechanical instability
Ulnar Collateral Ligament Sprain
Grade II: incomplete tear of a ligament
with moderate functional impairment
– Moderate pain and swelling
– Mild to moderate bruising
– Tenderness over involved structures
– Some loss of motion and function
– Mild to moderate instability
Ulnar Collateral Ligament Sprain
Grade III: complete tear and loss of
integrity of a ligament
– Severe swelling
– Severe bruising
– Loss of function and motion
– Mechanical instability
Ulnar Collateral Ligament Sprain
Testing for Injury

Valgus stress testing:
– Pain
– Instability

Radiographs:
– loose bodies
– traction spurs (protrusion of bone / cartilage)

MRI:
– partial and complete tears
– not usually necessary
Ulnar Collateral Ligament Sprain
Treatment for Injury:
 Prevention
– Long-term strengthening and conditioning
appropriate for sport.
– Warm up before practice or competition.
– Tape vulnerable joints before practice or
competition
Ulnar Collateral Ligament Sprain
Treatment for Injury
 Grade
I Sprain:
– PRICE
– Possible application of a cast, tape, elastic bandage
or sling
– If no device is applied, icepacks, whirlpool
therapy, and massage may be used
– Recovery time: 2-6 weeks
Ulnar Collateral Ligament Sprain
Treatment for Injury
 Grade
–
–
–
–
II Sprain:
PRICE
Application of cast, tape, elastic bandage or sling
Possible physical therapy
Recovery time: 6-8 weeks
Ulnar Collateral Ligament Sprain
Treatment for Injury
 Grade
–
–
–
–
–
III Sprain:
PRICE
Application of cast, tape, elastic bandage or sling
Physical therapy
Surgery
Recovery time: 8-10 weeks, with potential for
prolonged disability
Ulnar Collateral Ligament Sprain
Ramon Ramirez: Colorado Rockies pitcher
missed 23 games with an elbow sprain in April 2007
Elbow Dislocation
What is it?

The radius and ulna move out of place compared with the
humerus
Involved Structures:




The Radius
The Humerus
The Ulna
Surrounding tissues
Location:

Elbow joint
Elbow Dislocation
General Signs and Symptoms: (specific
symptoms depend on severity of dislocation)
 Tenderness
 Swelling
 Deformity
 Bruising
 Poor
blood flow to the lower arm and hand
Elbow Dislocation
Nursemaid’s / Babysitter’s Elbow
•Partial or radial dislocation (subluxation)
•Common in children
•Caused when child is lifted by arm
 Signs
/ Symptoms:
– pain
– Refuse to use injured arm
– Holding elbow slightly bent
Elbow Dislocation
Simple

radius and ulna become dissociated from the
humerus without associated fracture
Complex

simple dislocation combined with fracture of the
humerus, radius, ulna or a combination of all three
bones
Elbow Dislocation
Mechanism of Injury:
 Force
sent through ulna/radius to elbow
 Often accompanied by a twisting force
 Usually occurs when a person attempts to
break a fall or cushion an impact
Elbow Dislocation
Signs / Symptoms:
 Severe
pain
 Deformity
 Swelling
 Inability to bend arm
 In some cases:
– Numbness
– Lack of pulse
Elbow Dislocation
Testing for Injury:
 Evaluation
of tenderness, swelling, deformity,
sensation, and circulation
 X-ray
 CT scan may help evaluate fractures
 Angiogram may be done if arterial injury is
suspected
Elbow Dislocation
Treatment for Injury:
 Nursemaid’s
/ Babysitter’s Elbow
– Closed Reduction: manipulating arm; the annular
ligament and radial head return to their normal
anatomic positions
 immobilize
elbow and palpate region of radial head
 apply axial compression at wrist while supinating
forearm and flexing elbow
 a click or snap can be felt at the radial head
Elbow Dislocation
Treatment for Injury
 Simple
Dislocation:
– Closed Reduction
– Splinting
– 24-hour hospital
observation if nerve /
artery injury is
suspected
– Possible physical
therapy
Elbow Dislocation
Treatment for Injury
 Complex
Dislocation:
– Reconstructive Surgery (open reduction)
Elbow Dislocation
Partial
Simple
Radial
Complex
Ulnar Nerve Irritation
What is it?
The ulnar nerve, one of the 3
main nerves that innervate the
hand, is affected
 The Funny Bone

Location:
 runs from the shoulder to the
hand
Ulnar Nerve Irritation
Two ways to irritate the ulnar nerve:
1.
Impingement (pinching)
–
Cubital Tunnel Syndrome
2.
Entrapment (stuck to surrounding tissue)

Location: Posterior elbow joint
Ulnar Nerve Irritation
 Mechanism
of Injury:
– Genetic, natural build
– Frequent bending of elbow joint
– Fracture of nearby bone
– Blow to cubital tunnel
Cubital
tunnel: tunnel of muscle, ligament, and
bone on the inside of the elbow allows the Ulnar
nerve to travel over the elbow
Ulnar Nerve Irritation
 Signs
/ Symptoms:
– Numbness on the inside of the hand and in
the ring and little fingers
– Pain
– Weak Grip
– Muscle Wasting
Ulnar Nerve Irritation
 Testing
for Injury:
– Physical examination to confirm location
– MRI / CT scan to check for bone spurs or arthritis
– Nerve Conduction Velocity (NCV) test: measures
speed of impulses traveling along the nerve
– Electromyogram (EMG). sometimes used; tests
whether the muscles are working properly.
Ulnar Nerve Irritation
 Treatment
for Injury:
– Conservative: discontinue irritating action, antiinflammatory medications, nighttime splint / elbow
pad, and/or physical therapy
– Surgical: ulnar nerve transposition, or removing
medial epicondyle on medial elbow
Ulnar Nerve Irritation
Ulnar Nerve Transposition