The Elbow Lecture 14

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The ElbowLecture 14
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The Elbow

• the elbow is second to the shoulder for
  dislocations ( first in children ) and second to
  the knee for overuse injuries.

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Bony Structure of Elbow

• 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

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• 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
• Most important ligament in the elbow for
  stability

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• Lateral Collateral
• a) anterior
• b) intermediate
• c) posterior
• all help to reinforce the strong annular ligament

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Elbow movements

• Flexion
• Extension
• Pronation
• Supination

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Common Injuries
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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
• 90 posterior , management is important not to
  cause long term disabilities

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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

• 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

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• 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

• 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

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Medial Epicondylitis

• aka little league elbow or golfers elbow
• repetitive motions with poor technique, muscular
  weakness or anatomical weakness
• often seen in the acceleration phase of throwing

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• 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

• 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

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• 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)

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Cubital Tunnel Syndrome

• 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

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• 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