The Elbow and Forearm Complex. Anatomy of the Elbow.
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Transcript of The Elbow and Forearm Complex. Anatomy of the Elbow.
The Elbow and Forearm Complex
Anatomy of the Elbow
Muscles of the Elbow
Nerves of the Upper Extremity
Joint Positions and Capsular Patterns
Loose Packed Position/resting position
Closed-Pack Position
Capsular Pattern
Ulnohumeral Joint (elbow)
70 degrees flexion, 10 degrees supination
Extension Flexion, Extension
Radiohumeral Joint
Full Extension, Full Supination
Elbow flexed 90 deg, forearm supinated 5 deg.
Flexion, Extension, Supination, Pronation
Proximal Radioulnar Joint
70 deg. flexion,
35 deg. supination
5 deg. supination Supination, Pronation
Distal Radioulnar Joint
10 deg. supination 5 deg. supination Full ROM, pain at extremes of rotation
Total Elbow Arthroplasty
• This picture depicts the prosthesis for a total elbow arthroplasty (TEA)
• This is the most common surgery when there is joint destruction (such as with RA)
• This procedure includes a humeral and ulnar implant and the head of the radius may be replaced as well.
• Cement is used for placement (don’t do US over a TEA)
Figure 18.5 Kisner & Colby page 568
Joint Surgery and Post-op Management
• Some specific motions of the joint may be limited after surgery to prevent stress on the capsule, ligaments, tendons, etc.
• Consult with the PT, KNOW THE LIMITATIONS!
Lateral Epicondylitis
• Lateral Epicondylitis (Tennis Elbow)
-pain in the common wrist extensor tendons along the lateral humeral epicondyle
-typically brought on by repetitive movements of the wrist or activities requiring stability of the wrist (tennis backhand)
http://www.hss.edu/conditions_tennis-elbowoverview.asp
Medial Epicondylitis
Medial Epicondylitis
(Golfer’s Elbow)
-pain at the common wrist flexor tendon along the medial humeral epicondyle
-due to repetitive movements into wrist flexion (golf swing, gripping, throwing a ball, etc.)
-ulnar neuropathy can also occur
http://www.aidmyelbow.com/common-elbow-strains.php
General Considerations for Overuse Syndromes
• PROTECTION PHASE
-Immobilize: rest the muscles, can use a splint
-Avoid provoking activities: repetitive wrist motions, gripping
-Cryotherapy: ice massage, cold pack
-Multi-angle muscle setting (low-intensity isometrics)
-Cross-fiber massage
-Maintain mobility / strength in unaffected joints (shoulder, etc)
General Considerations for Overuse Syndromes
• CONTROLLED MOTION AND RETURN TO FUNCTION PHASE
*Progress to this stage only when inflammation is controlled
-Manual stretching
-Self-stretching
-Cross-fiber (friction) massage
-Isometrics progressing to Theraband, free weights, etc.
-Isolated motions progressing to functional patterns
-General strengthening and conditioning
-Simulation of work or recreational activities
-Plyometrics (if returning to sports, etc)
-Activity Modification / Patient Education
Self Stretching to Increase Elbow Extension and Flexion
Self Stretching- Muscles of the Lateral and Medial Epicondyles
• This figure demonstrates stretching of the wrist extensors (from the lateral epicondyle)
• Stretching the wrist flexors involves extension at the wrist with the elbow in full extension
• See HEP handouts as well for more pictures• Figure 18.10 Kisner & Colby page 579
Resistance Exercises for the Elbow, Forearm, and Wrist
Functional Exercises for the UE
UE Theraband Exercises for Elbow Strengthening
Combined Pushing Motions
Case Study
• John is a 45 y/o painter who comes to your clinic with a diagnosis of left ‘elbow pain’. During the PT evaluation the therapist palpates tenderness and inflammation at the lateral epicondyle of the humerus and testing reveals tight wrist extensors with 4/5 MMT. Pain is a 4/10 in the morning and an 8/10 after working all day (painting). The patient is left hand dominant. His grip strength is weaker in his left hand by 30% when compared to the right.
1) What term (pathology) would best describe the patient’s condition?
2) What mechanics (actions) likely initiated his symptoms?
3) What patient education would you give John?
4) Create a home management program for this patient.
5) What are the key components to this patient’s treatment?