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Elbow

Elbow. Sports Medicine. Movements. Carrying angle Females 10-15 degrees, Males 5 degrees Flexion 145 degrees Extension Pronation 90 degrees Supination 90 degrees. Articulations. Consists of 3 separate joints Humeroulnar Humeroradial Proximal radioulnar. Ligaments and Bursae.

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Elbow

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  1. Elbow Sports Medicine

  2. Movements • Carrying angle • Females 10-15 degrees, Males 5 degrees • Flexion • 145 degrees • Extension • Pronation • 90 degrees • Supination • 90 degrees

  3. Articulations • Consists of 3 separate joints • Humeroulnar • Humeroradial • Proximal radioulnar

  4. Ligaments and Bursae • Ulnar collateral ligament • Prevents valgus forces • Radial collateral ligament • Prevents varus forces (uncommon) • Annular ligament • Stabilizes head and neck of radius (strong) • Olecranon bursa • Between olecranon process and skin

  5. Musculature • Biceps Brachii, Brachialis, brachioradialis • Elbow flexion • Triceps brachii, anconeus • Elbow extension • Pronatorteres, supinator • Pronation and supination

  6. Nerve/Blood Supply • Median Nerve • Radial Nerve • Ulnar Nerve • Funny bone • Radial Artery • Ulnar Artery

  7. Assessment • History • Land on tip of bent elbow? (most common MOI) • Overuse from throwing? • Over extension? • Location and duration of pain? • Positions that increase or decrease pain? • Previous elbow injuries? • Locking or crepitation w/movement?

  8. Assessment • Observations • Deformities, swelling • Carrying angle • Too great or little could = epiphysealfx • Decreased flexion or extension • 45 degree angle, posterior observation of epicondyles and olecranon process to make isosceles triangle

  9. Assessment • Bony Palpations • Medial epicondyle • Lateral epicondyle • Olecranon process • Radial head • Radius • ulna • Soft tissue palpations • Anterior • Biceps brachii • Brachialis • Brachioradialis • Pronaterteres • Posterior • Triceps • supinator • Medial • Ulnar collateral ligament • Lateral • Radial collateral ligament • Annular ligament

  10. Strains • MOI • FOOSHA = hyperextension • S/S • AROM or RROM= pain • Point tender • TX • RICE possibly a sling • Cryotherapy, US, rehab • X-ray if severe

  11. Elbow Dislocation • MOI • FOOSHA, or severe twist with flexion • Ulna and radius are pushed posterior (most common) • S/S • Severe pain, swelling and disability • Deformity • Probable radial head fx • TX • Ice, sling, check circulation • Refer for x-ray and reduction

  12. Elbow Fractures • MOI • FOOSHA, or direct blow • S/S • Possible visible deformity • Hemorrhage, muscle spasm, and swelling • TX • Stabilize, monitor distal pulse • Refer for x-ray, splint 6-8 weeks

  13. Elbow MMTs • Flexion • Extension • Pronation • Supination http://youtu.be/pN_x3X3PNrs http://youtu.be/3NGbZ2lUdDI

  14. UCL sprain • MOI • Valgus force from repetitive trauma • Tennis, golfing, throwing • S/S • Pn. On medial aspect of elbow • Parasthesia, and laxity • TX • Rest, NSAIDs, strengthening, correct form

  15. Valgus Test • Procedure • Athlete sits with elbow flexed at 20 degrees. Evaluator grasps athletes wrist and lateral elbow applying a valgus force. • Positive Test • Pn at the medial aspect of elbow, laxity • Ulnar (medial) collateral ligament sprain

  16. Varus Test • Procedure • Athlete sits with elbow flexed at 20 degrees. Evaluator grasps athletes wrist and medial elbow applying a varus force. • Positive test • Lateral elbow pn, and laxity • Radial (lateral) collateral ligament sprain

  17. Volkmann’s Contracture • MOI • Complication of serious elbow injury • Muscle spasm, swelling, or bone pressure on the brachial artery • S/S • Pn. In the forearm that is worse when fingers are passively extended • Decreased or absent brachial and radial pulses • TX • Removal of constricting casts, wraps or braces, elevation • Can become permanent

  18. Tinel’s sign • Procedure • Patient is seated, elbow in flexion • Evaluator grasps wrist and taps the ulnar notch with reflex hammer • Positive Test • Athlete complains of tingling sensation along forearm, hand and fingers • Indicates ulnar nerve compromise http://www.medvideo.us/watch_video.php?v=A2YU3N52O8ON

  19. Epicondylitis • MOI • Lateral (tennis elbow) • Tennis, baseball, swimming, golfing • Repeated forearm flexion and extension • Medial (pitchers or golfers elbow) • Repetitive wrist flexion, valgus stress on elbow • S/S • Aching pn. During and after activity • decreased ROM • hand weakness • TX • RICE, NSAIDS • ROM, PRE, Deep friction massage • Elbow sleeve or band just below the bend of the elbow

  20. Epicondylitis Tests • Procedure • Elbow is flexed to 45 degrees • Wrist extension is resisted, increases pn at lateral epicondyle • Wrist flexion is resisted, increases pn at medial epicondyle • Positive Test • Pn at either epicondyle

  21. Olecranon Bursitis • MOI • Direct blow • S/S • Pain, severe swelling, point tenderness • TX • Acute= ice, compression • Chronic = compression, modalities, aspiration • Padding for play

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