Sports Medicine Unit 16 Elbow I. Bones a. b. c. II. What movements does the elbow perform? a. Flexion b. c. Pronation d. III. Muscles in motion a. FLEXION (supinated) i Brachialis (pronated) ii (neutral) iv. Prime movers depends on position of the forearm b. EXTENSION a. Primary mover i Anconeus a. Secondary mover c. SUPINATION a. Primary mover i Biceps brachii a. Secondary mover ii Brachioradialis a. Secondary mover b. Also pronates forearm from a supinated position d. PRONATION i Pronator quadratus ii Primary movers IV. Tendons a. Biceps b. Triceps c. d. V. Joints a. Humeroulnar joint i Allows for flexion and extension b. Humeroradial joint
Humerus and radius i ii VI. Ligaments a. Medial resists stress (UCL) i three bands a. anterior oblique band a. medial epicondyle to coronoid process b. restrains against valgus stress b. transverse band a. medial epicondyle to coronoid process c. posterior oblique band a. medial epicondyle to olecranon process b. Lateral resists stress (LCL) i Main lateral stabilizer a. Middle of the lateral epicondyle to ulnar tuberacle c. collateral ligament Thickened capsule i Lateral epicondyle to annular ligament ii Maintain close relationship between humeral head and radial head d. ligament Encircles the radial head i Permits internal/external rotation of radius on ulna e. Interosseous membrane Dense band of fibrous connective tissue i Obliquely between radius to the ulna ii Transmits forces iv. Attachment point for muscles VII. Assessment of the elbow a. History Past history i ii When and where does it hurt? iv. Motions that increase or decrease pain v. v Sounds or feelings? vi How long were you disabled? vii Swelling? ix. Previous treatments? b. Deformities and swelling? i a. Cubitus valgus versus cubitus varus ii Flexion and extension
c. a. Cubitus recurvatum iv. Elbow hyperextension? Be sure to check sites of pain and deformity i Assess epicondyles, olecranon, distal aspect of humerus and proximal aspect of ulna ii muscles, tendons, joint capsules and ligaments surrounding joint d. Methods to assess elbow and forearm injuries include: a. ROM test for elbow flexion b. ROM test for elbow extension c. ROM test for elbow supination d. ROM test for elbow pronation e. Manual muscle tests a. Flexion strength test b. Extension strength test c. Supination strength test d. Pronation strength test VIII. of elbow/forearm injuries a. Vulnerable to a variety of acute and chronic injuries b. gear is always recommended to reduce severity of injury c. Chronic injury reduction (baseball, tennis) i Utilize proper mechanics ii Use that is appropriate for skill level iv. Maintain appropriate levels of strength, flexibility, and endurance for activity IX. Injuries a. Fractures b. Dislocations and subluxations c. Contusions d. Sprains Valgus stress test for the elbow i Varus stress test for the elbow e. Impingement Tinel s sign f. Synovitis and bursitis g. Biceps brachii rupture h. Epicondylitis Volkmann s contracture X. Common Injuries a.
a. Superficial location makes it extremely susceptible to injury (acute or chronic) --direct blow a. Pain, b. Swelling will appear and w/out usual pain and heat a. Contusion 1. Vulnerable area due to 2. Result of direct blow or repetitive blows 1. (rapidly after irritation of bursa or synovial membrane) 1. Treat w/ immediately for at least 24 hours 2. If severe, refer for X-ray to determine presence of fracture 3. In acute conditions, ice 4. Chronic cases require protective therapy 5. If swelling fails to resolve, aspiration may be necessary 6. Can be padded in order to return to competition b. Elbow Sprains 1. Elbow hyperextension or a force (often seen in the cocking phase of throwing 1. Pain along aspect of elbow 2. Inability to grasp objects 3. Point tenderness over the MCL 1. Conservative treatment begins w/ RICE elbow fixed at 90 degrees in a sling for at least 24 hours 2. Coach should be concerned with gradually regaining elbow full ROM 3. Athlete should 4. Gradual progression involving an increase in number of throws while range and strength return c. Lateral Epicondylitis ( ) 1. Repetitive to insertion of extensor muscles of lateral epicondyle 1. Aching pain in region of lateral epicondyle after activity 2. Pain worsens and and hand develop 3. Elbow has decreased ROM; pain w/ resistive wrist extension
1. RICE, NSAID s and analgesics 2. ROM exercises and PRE, deep friction massage, hand grasping while in supination, avoidance of pronation motions 3. Mobilization and stretching in pain free ranges 4. Use of a counter force or neoprene sleeve 5. Proper mechanics and equipment instruction is critically important d. Epicondylitis (Little league elbow) 1. Repeated forceful flexion of wrist and extreme valgus torque of elbow 1. Pain produced w/ forceful flexion or extension 2. and mild swelling 3. Passive movement of wrist seldom elicits pain, but active movement does 1. Sling, rest, cryotherapy or heat through ultrasound 2. 3. Curvilinear brace below elbow to reduce elbow stressing 4. Severe cases may require splinting and complete rest for 7-10 days e. Ulnar Nerve Injuries 1. Pronounced cubital valgus may cause deep friction problem 2. 3. Traction injury from valgus force, irregularities w/ tunnel, subluxation of ulnar nerve due to lax impingement, or progressive compression of ligament on the nerve 1. Generally respond with 1. Conservative management avoid aggravating condition 2. Surgery may be necessary if stress on nerve can not be avoided f. Dislocation of the Elbow 1. High incidence in sports caused by 1. Swelling, severe pain, 2. May be displaced backwards, forward, or laterally
3. Complications w/ median and radial nerves and blood vessels 4. Rupture and tearing of will usually accompany the injury 1. Immobilize and refer to physician for reduction 2. Following reduction, elbow should remain splinted in flexion for 3 weeks, then rehab g. Fractures of the Elbow 1. 2. Fracture can occur in any one or more of the bones 3. Fall on outstretched hand often fractures humerus above condyles or between condyles 1. May or may not result in visual deformity 2. Hemorrhaging, swelling, muscle spasm 1. Ice and sling for support h. Elbow Osteochondritis Dissecans 1. Impairment of blood supply to anterior surface resulting in degeneration of articular cartilage, and bone creating loose bodies within the joint 1. Sudden pain, locking; range usually returns in a few day 1. If repeated locking occurs, loose bodies may be removed surgically 2. Without removal, arthritis may develop Volkmann s Contracture 1. Associate w/ humeral supracondylar fractures, causing muscle spasm, swelling, or bone pressure on brachial artery, inhibiting circulation to forearm 2. Can become permanent muscle contraction/paralysis 1. Pain in forearm - increased w/ passive extension of fingers 1. Immediate referral is necessary 2. Time is of the essence