Common Elbow Injuries and What to Do About Them

1. Common Elbow Injuries and What to Do About Them Injury Management & Prevention www.mybreakthrough.com

2. Rehabilitating the Elbow • Taking care of and rehabilitating the elbow is all about strengthening the injured muscle. • Being a joint, it needs strengthening both above and below the joint. • For the sprained elbow, once inflammation is down and range of motion has been restored, strengthening can proceed. www.mybreakthrough.com

3. Elbow Anatomy • The elbow is a hinge joint that is formed by the union of three bones: • Humerus • Radius • Ulna. • Through the action of four muscle groups, including the well-known biceps and triceps, the elbow can bend upward or straighten out. • Stress on this joint can affect the surrounding ligaments and muscles and cause tissue damage. www.mybreakthrough.com

4. Ligaments of the Elbow Joint • Two ligaments are present in the elbow joint. • These ligaments provide strength and support to the joint, as do the surrounding muscles. • The ulnar collateral ligament is located on the inner side of the joint. It prevents excessive outward movement of the elbow joint. • The radial collateral ligament is located on the outer side of the joint. It prevents excessive inward movement of the elbow joint. www.mybreakthrough.com

5. Recovering From Elbow Injury • The elbow, although a fairly stable looking joint, can be susceptible to many injuries. • They can range from relatively minor to something major that requires surgery. • It is good for you to have a basic idea of injuries and how to handle them. • Always begin with RICE. • Move to range of motion exercises, regaining flexion and extension as needed. • Incorporate exercises that will help build strength and stability to the joint.  www.mybreakthrough.com

6. Form 602 Joint Evaluation of the Elbow www.mybreakthrough.com

7. Form 408 Special Tests Instructions • Provocative Tests for the Wrist: • Varus Stress • Valgus Stress • Mill’s • Cozen’s • Tinel’s www.mybreakthrough.com

8. Varus Stress Test • Procedure: The examiner holds the patient’s arm so that the examiner is supporting the elbow and wrist. An adduction or Varus force is applied to the distal forearm with the patient’s elbow held in 20 to 30 degrees of flexion. • Positive: Pain or altered mobility of the lateral collateral ligament of the elbow. www.mybreakthrough.com

9. Valgus Stress Test • Procedure: The examiner holds the patient’s arm so that the examiner is supporting the elbow and wrist. An abduction or Valgus force is applied to the distal forearm with the patient’s elbow held in 20 to 30 degrees of flexion. • Positive: Pain or altered mobility of the medial collateral ligament of the elbow. www.mybreakthrough.com

10. Mill’s Test • Procedure: With the elbow in full extension, the wrist and fingers are fully flexed, the forearm is then maximally pronated. • Positive: The test is positive for Tennis Elbow if this maneuver causes sharp tenderness and pain of the lateral elbow joint. www.mybreakthrough.com

11. Cozen’s Test • Procedure: The patient is directed to tightly clench the fist, dorsiflex it and maintain that position. The examiner grasps the lower forearm and applies a flexing counter force to oppose the patient’s dorsiflexion. • Positive: Acute pain in the region of the lateral epicondyle is positive for Tennis elbow. www.mybreakthrough.com

12. Tinel’s Test • Procedure: The examiner should locate the Ulnar nerve that is seated in the groove between the olecranon process and the medial epicondyle, the Ulnar nerve is then tapped on repeatedly by the index finger of the therapist.  • Positive: A positive sign is indicated by a tingling sensation in the ulnar distribution of the forearm and hand distal to the tapping point. www.mybreakthrough.com

13. Form 402 ROM Elbow • Flexion: 140 degrees • Extension: 0 degrees • Pronation: 80 degrees • Supination: 80 degrees  www.mybreakthrough.com

14. Form 506 Patient-Rated Tennis Elbow Evaluation (PRTEE) www.mybreakthrough.com

15. Form 560 FOTO Elbow, Wrist, Hand Functional Status Short Form www.mybreakthrough.com

16. Common Elbow Injuries www.mybreakthrough.com

17. UCL Injury • Snap! Pop! That is a common sound heard and felt within the elbow of a professional baseball pitcher.  • The cause is a torn ulnar collateral ligament. • With varying degrees of injury to the ligament, an individual may be out for a few days to over a year if there is a complete rupture to the UCL. • The most minor of these sprains means a person could return relatively quickly to activity, usually within a few days. www.mybreakthrough.com

18. Bursitis • If you have ever hit your elbow hard enough, especially on the edge, then you may have noticed major swelling, also known as bursitis.  • This can be rather painful. • Use ice and compression on the area. • In more extreme cases, it may require draining. www.mybreakthrough.com

19. Tennis Elbow • You don’t have to be a tennis player to be affected by tennis elbow. • Anyone who participates in activities that require repetitive arm, elbow, and wrist movement, such as baseball players, bowlers, gardeners or assembly line workers, may be at risk.  • Tennis elbow (lateral epicondylitis) is also an inflammatory disorder. • Tennis elbow results when the muscles that extend the wrist are overused. • This overuse results in swelling or inflammation of the muscle tendons. • This inflammation causes pain and discomfort at the outer aspect of the elbow. • 10X more common than Golfer’s Elbow. www.mybreakthrough.com

20. Golfer’s Elbow • Golfer's elbow (medial epicondylitis) is an inflammatory disorder. • Golfer's elbow results when the muscles that flex the wrist are overused. • This overuse results in swelling or inflammation of the muscle tendons. • Golfer's elbow is named as such due to its common occurrence in people who play the sport. • Repetitive flexing of the wrist contributes to this disorder. www.mybreakthrough.com

21. Muscle Strains • Around the elbow, the biceps, triceps, forearm flexors, and extensors are the most commonly injured. • The worst of these can be a torn biceps. When this happens the muscle “balls” up in the upper arm. • From here there are two options: let it heal as it is or have surgery to have it reattached. • A less severe biceps injury means the muscle was strained without a complete tear. • These can be slow healing because of the amount the arm is used and the fact this muscle serves two purposes: elbow flexion and assisting with shoulder flexion. • The best and worst case scenario is a few days to a few months for recovery. www.mybreakthrough.com

22. Elbow Injury Prevention • Dehydration: Healthy muscles are comprised of at least 70% water. Dehydration causes muscle fatigue, strain, tendonitis, and other disorders of the movement system. Soda pop is not water, it’s liquid junk. • Poor Nutrition: Eating too many “empty” calories that don’t contain the nutrients our body needs is a primary cause of injuries and disorders of the movement system. Tobacco contains toxins that increase inflammation. • Inflammation: Inflammation causes many lifestyle-related disorders, including heart disease and movement system disorders. Too much sugar and fat within our diet can contribute to inflammation. • Fatigue: Adequate amounts of rest and sleep are very important ingredients for our health. • Poor Fitness: Poor levels of physical fitness increases the risk of disease and injury. www.mybreakthrough.com

23. Elbow Exercises www.mybreakthrough.com

24. Thera-Band Elbow & Forearm Exercises • Perform these exercises with a resistance level that allows you to complete 8-12 repetitions to fatigue. • Start with one set and progress to 2-3 sets of 20. • Increase to the next color resistance level when these exercises become easy. • All exercises should be performed pain free. • CPT Code: 97110 or 97530 www.mybreakthrough.com

25. Thera-Band Elbow Flexion (Standing Unilateral) • Begin with one end of the band stabilized under your foot. • Grasp the band with your elbow by your side and tension on the band. • Lift the band upward, keeping your wrist straight and elbow by your side. • Hold and slowly return. www.mybreakthrough.com

26. Thera-Band Elbow Extension in Standing • Securely attach one end of the band with a Door Anchor or Assist. • Grasp the end of the band and take up the slack. • Keep your elbow by your side as you extend your elbow. • Hold and slowly return. • Keep your back straight. www.mybreakthrough.com

27. Thera-Band Wrist/Forearm Radial Deviation • Sit and secure the ends of the band under your feet, creating a loop in the middle. • With your elbow stabilized on your thigh, grasp the middle loop of the band with thumb pointing upward. • Keeping your elbow steady, move your wrist upward, hold and slowly return. • TIP: Keep your elbow in one position during the exercise; don’t use your elbow to complete the exercise. www.mybreakthrough.com

28. Thera-Band Wrist/Forearm Ulnar Deviation • Sit and secure the ends of the band under your feet, creating a loop in the middle. • With your elbow by your side, grasp the middle loop of the band with thumb pointing forward. • Keeping your elbow steady, move your wrist backward, hold and slowly return. • TIP: Keep your elbow in one position during the exercise; don’t use your elbow to complete the exercise. www.mybreakthrough.com

29. Thera-Band Wrist/Forearm Pronation • Sit and secure the ends of the band under your feet, creating a loop in the middle. • With your elbows bent, stabilize your forearms on your thighs. • Grasp the middle loop of the band with palm up. • Turn your wrist downward, hold and slowly return. • TIP: Keep your elbow in one position during the exercise; don’t use your elbow to complete the exercise. www.mybreakthrough.com

30. Thera-Band Wrist/Forearm Supination • Sit and secure the ends of the band under your feet, creating a loop in the middle. • With your elbows bent, stabilize your forearms on your thighs. • Grasp the middle loop of the band with palm down. • Turn your wrist upward, hold and slowly return. • TIP: Keep your elbow in one position during the exercise; don’t use your elbow to complete the exercise. www.mybreakthrough.com

31. Thera-Band Wrist Extension • Sit and secure the ends of the band under your feet, creating a loop in the middle. • With your elbows bent, stabilize your forearm on your thigh. • Grasp the middle loop of the band with palm down. • Bend your wrist upward, hold at the top and slowly return. • TIP: Keep your elbow in one position during the exercise; don’t use your elbow to complete the exercise. www.mybreakthrough.com

32. Thera-Band Wrist Flexion • Sit and secure the ends of the band under your feet, creating a loop in the middle. • With your elbows bent, stabilize your forearm on your thigh. • Grasp the middle loop of the band with palm up. • Bend your wrist upward, hold at the top and slowly return. • TIP: Keep your elbow in one position during the exercise; don’t use your elbow to complete the exercise. www.mybreakthrough.com

33. Thera-Band Elbow Extension Kick Back • Begin with one leg slightly in front of the other. • Stand on the end of the band with the front foot. • Bend forward at the hips, keeping your back straight. • Grasp end of band with shoulder extended and elbow bent. • Pull band backward by extending elbow, keeping your shoulder extended as well. • Hold and slowly return. www.mybreakthrough.com

34. FlexBar® Tyler Twist for Tennis Elbow • Grasp FlexBar® exerciser in front of you with the injured side and extend your wrist.  • Grasp the upper end of the bar with your other hand facing away from you • Twist the bar with the top hand as you stabilize with the bottom hand • Hold both wrists steady as you extend both elbows in front of you. The wrist on your injured side should be extended and the other wrist flexed. • Slowly release the bar with your injured side while maintaining tension with the uninjured side. www.mybreakthrough.com

35. FlexBar® Reverse Twist for Golfers Elbow • Grasp FlexBar® exerciser with the injured side, bending your elbow and holding the bar parallel to the ground. • Lift the elbow of your un-injured side upward and rotate your forearm so your palm faces away from you. • Grasp the other end of the FlexBar ® with the un-injured hand facing away from you and pointing downward. • Twist the FlexBar ® with the hand on the un-injured side as you stabilize with the injured-side hand. • Hold both wrists steady as you extend both elbows in front of you. The wrist on your injured side should be flexed toward you and the other wrist extended. • Slowly release the FlexBar ® with your injured side while maintaining tension with the uninjured side. www.mybreakthrough.com

36. Common Elbow Injuries and What to Do About Them Injury Management & Prevention www.mybreakthrough.com