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Pathomechanics of elbow)

Pathomechanics of elbow). Dr . Manal Radwan Salim Lecturer of Physical Therapy BiomeII Fall 2013-2014 Tuesday 3-12-2014. Arthrology and Movements Humeroulnar Humeroradial Proximal & Distal Radioulnar. Elbow/ Forearm Anatomy. Ligaments and Capsule: Joint Capsule

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Pathomechanics of elbow)

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  1. Pathomechanics of elbow) Dr .ManalRadwanSalim Lecturer of Physical Therapy BiomeII Fall 2013-2014 Tuesday 3-12-2014

  2. Arthrologyand Movements HumeroulnarHumeroradial Proximal & Distal Radioulnar Elbow/ Forearm Anatomy • Ligaments and Capsule: • Joint Capsule • Ulnar Collateral (UCL) • 3 bundles • Lateral Ulnar Collateral (LUCL) • Radial Collateral (RCL) • Annular Interosseus Membrane

  3. Common elbow abnormalities 1- Changes in Carrying Angle the normal value of carrying angle is 10-5 degrees valgum a) CubitumVarum: abnormal decrease in carrying angle. b) CubitumValgum: abnormal increase in the angle.

  4. 2- Changes in bony alignment following fractures: Fracture of distal humerus or proximal ulna can alter the normal orientation of the articular surfaces of humeroulnar articulation.

  5. a)From frontal view: Any change in the relative alignment olecranon between the two humeral epicondyles affects both flexion and extension ranges

  6. ii. a hypothetical increase in the superior orientation of the trochlear notch increases extension ROM and decreases flexion ROM. 2- CubitumRecurvatum: hyperextension of elbow joint.

  7. 3-HumeroulnarDisolcation • Posterior dislocation: • As there is little bony limitation to the trochlear notch being pushed off trochlea. b) Posterolateral dislocation: More frequent, occur in a combination of lateral and posterior movement of the forearm resulting from a force directed laterally on the distal forearm.

  8. 4- Superior radioulnar dislocation “pulled elbow injuries” Occur at preschool children due to weakness of the annular ligament that allow the radial head to slip away from its ring by the tensile force applied to fore arm

  9. 5-Joint swelling and elbow flexion Position of comfort in case of swelling is significant elbow flexi which is due to minimized tension on joint capsule at 80 degree flexion thus reducing stress on ligaments and minimize pain. But if condition persists this leads to flexion contractures.

  10. 6-Bursitis Superficial location makes it extremely susceptible to injury (acute or chronic) --direct blow

  11. 7-Musculature/Tendinitis a) Medial Epicondylitis – chronic “Pitcher’s, Golfer Elbow” : Caused by repeated flexion (common flexor tendon), valgus stresses, faulty biomechanics b) Lateral Epicondylitis – chronic “Tennis Elbow” Caused by -overuse of extensor /supinator muscles, faulty biomechanics (common extensor tendon). -faulty backhand, too much topspin, too small or large grip.

  12. Brachialis 9- pathomechanics of Muscles around elbow Biceps Brachii a) Flexor groups: Brachioradialis PronatorTeres

  13. i. Biceps brachii • Effect of weakness: Loss of flexion and radioulnarsupination strength that is compensated by other muscles. Also may cause slight weakness in shoulder flexion Supinatedpronated

  14. Effect of tightness: Limited extension range in elbow and shoulder with tightness degree changes by alteration in other joint positions if Shoulder in extension position lead to limit extension range at elbow and vice versa • Forearm pronation lead to limit extension range at elbow and vice vera

  15. ii. Brachiallis Brachialis • Effect of weakness: Decreased elbow flexion in all forearm ranges. • Effect of tightness: Limited extension range regardless of shoulder and forearm position. n.b. differentiate between brachialis tightness and anterior capsular tightness Tight muscular tissue feel rubbery or springy at end range. Capsular tightness end feel is harder and less spring

  16. iii. brachioradialis • Effect of weakness: Decreased elbow flexion strength in addition to decreased resisted pronation and supination as forearm moves toward neutral position Effect of tightness: Limited extension range in elbow and supination and pronation range During rapid elbow flexion it acts as stabilizing to elbow joint against radial aaceleration

  17. iv. Supinator • Effect of weakness: Decreased forearm forcefulsupination strength in case of intact biceps. No supination with elbow extended. Effect of tightness: A two joint muscle thus max tightness appear when performing elbow extension and pronation

  18. i. Pronatorteris • Effect of weakness: Decreased elbow flexion and forearm pronation strength In loading situations as loosening a screw Effect of tightness: Limited extension range in elbow and supination. A two joint muscle thus max tightness appear when performing elbow extension and supination PronatorTeres

  19. ii.Tricepsbrachii • Effect of weakness: A profound decrease in elbow extension. In tetraplegia with zero triceps push up could be done with elbow mechanically locked in hyperextension. Effect of tightness: Limited flexion range in elbow and may contribute to diminished shoulder elevation ROM that could interferes with functional daily activities as most daily activities can be performed with a total elbow flexion excursion of about 100°. Ex personal care activities as feeding and hygeine.

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