Chapter 19 elbow - class copy
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Transcript of Chapter 19 elbow - class copy
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Elbow AnatomyMedial EpicondyleLateral EpicondyleTrochlea and CapitulumOlecranon ProcessUlna and RadiusRadial Head Interosseus Membranehttp://www.courses.vcu.edu/DANC291-
003/elbow_jt.jpg - Pic of Bony Anatomy
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© 2007 McGraw-Hill Higher Education. All rights reserved.
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Elbow Anatomy http://images.main.uab.edu/healthsys/ei_0153.jpg
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Elbow Anatomy (2) Humeroulnar joint
______________ Trochlea of humerus _______________
Flexion (0 – 150) Extension (0)-some hyperextension(-5 to -15) Ligaments:
_________________________ _________________________
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Elbow Anatomy (3)Radioulnar joint
Not part of elbow but associated with __________________________
Supported by the annular ligament which binds the head of the radius to the radial notch of the ulna forming the joint
___________________________
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Muscular Anatomy______________________Brachioradialis (flexion with arm neutral)Brachialis (flexion w/ pronation)______________________Pronator Group (pronation)______________________http://images.main.uab.edu/healthsys/ei
_0153.jpg - biceps attachment
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Bursa, Blood and Nerve Supply
Bursa- _____________________Blood supply
Brachial artery ___________ ___________
Nerve supply Brachial plexus extends into the radial and
ulna nerve***
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Prevention of InjuriesGeneral muscular conditionRestrict pitching/ teach proper formMake sure equipment is proper (ie:
racquet)- grip size, racquet weightTeach shoulder roll method of falling-
example volleyball players rolling after a dig
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Contusions MOI: Direct contact HOPS
__________________________________ Limited range of motion
TX Rule out fracture first Ice, wrap and pad area Avoid aggressive stretching and strengthening Watch for ectopic bone formation
________________________________
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Olecranon BursitisOlecranon bursa is largest in elbowMOI: fall on bent arm, leaning on elbow
for long periods, infectionHOPS
____________________________Tx: ice, compression, pad area
If associated with fever: refer_____________________________
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http://www.physsportsmed.com/issues/2000/03_00/mcfarland4.gif
http://www.aafp.org/afp/971101ap/salzfig3.jpg
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Elbow Sprains (1 – UCL) MOI: valgus force, repetitive stress HOPS:
Pain over medial joint especially in cocking phase or acceleration phase of throwing
Point tenderness over joint line ____________________________________
____________________________ Tx: rest, general strengthening of flexors/
pronators; _________________________ ________________________________
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Elbow DislocationsMOI: ____________________________
______________________________, falling on outstretched hand
HOPS Obvious deformity Snapping or cracking sensation Severe pain Forearm in flexion and appears shortened
Tx: immobilize and refer MED EMERGENCY Check neurovascular status
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-http://www.worldortho.com/database/intro-trauma/pics/img0123.jpg http://www.angelfire.com/sc2/seahawksportsmed/injpix.html
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Medial Epicondylitis ______________________________ MOI: repetitive tension or valgus forces on
the arm HOPS-
Swelling, ecchymosis over medial epicondyle Pain aggravated by pronation and resisted flexion
of wrist _________________________________
Tx: RICE, Strengthening/Stretching, look at technique
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http://www.esportmed.com/smrn/figures/GolferElbowInjury.gif
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Lateral Epicondylitis__________________Most common overuse injury in the
adult elbowMOI: _______________________
______________________Precursor: too large tennis racquet,
gripping racket too tightly, excessive string tension, faulty mechanics
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Lateral Epicondylitis (2) HOPS
Pain over lateral epicondyle Pain with resisted wrist extension + tennis elbow test
Tx RICE __________________________________
_________________________ Counter force brace
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Impingement of Ulnar nerve Ulnar nerve passes behind humerus in ulnar
groove _______________ HOPS
_________________ Can be caused from a medial elbow injury “crazy bone” or “funny bone” Tingling and numbness in ring and little finger __________________
Refer if chronic
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Strength Testing
Elbow flexion Elbow extension Wrist flexion and extension Pronation Supination
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Stress TestsValgus (UCL)/Varus (RCL) stress test –
Positive Sign is laxityTennis Elbow test-(Lateral Epicondylitis)
- Positive Sign is increased painTinel’s sign (Ulnar nerve) – Numbness,
Tinkling into Ulnar nerve region.