The Elbow and Forearm Complex

1. The Elbow and Forearm Complex Chapter 18

2. Structure and Function of the Elbow and forearm

3. Elbow Joint Characteristics and Arthrokinematics • Humeroulnar Articulation • Humeroradial Articulation • Ligaments of the Elbow • Medial (ulnar) collateral ligament • Lateral (radial) collateral ligament

4. Forearm Joint Characteristics and Arthrokinematics • Proximal (superior) Radioulnar Articulation • Distal (inferior) Radioulnar Articulation

5. Muscle Function at the Elbow and Forearm • Primary Actions at the Elbow • Elbow flexion • Brachialis • Biceps brachii • Brachioradialis • Elbow extension • Triceps brachii • Anconeus

6. Muscle Function at the Elbow and Forearm (cont'd) • Primary Actions at the Forearm • Forearm supination • Supinator • Biceps brachii • Brachioradialis • Forearm pronation • Pronator teres • Pronator quadratus

7. Muscle Function at the Elbow and Forearm (cont'd) • Relationship of Wrist and Hand Muscles to the Elbow • Wrist flexor muscles • Wrist extensor muscles

8. Referred Pain and Nerve Injury in the Elbow Region • Common Sources of Referred Pain into the Elbow Region • Nerve Disorders in the Elbow Region • Ulnar nerve • Radial nerve • Median nerve

9. management of Elbow and forearm disorders and surgeries

10. Joint Hypomobility:Nonoperative Management • Related Pathologies and Etiology of Symptoms • Common Structural and Functional Impairments • Acute stage • Subacute and chronic stages • Common Activity Limitations and Participation Restrictions

11. Joint Hypomobility: Nonoperative Management (cont'd) • Management: Protection Phase • Educate the patient • Reduce effects of inflammation or synovial effusion and protect the area • Maintain soft tissue and joint mobility • Maintain integrity and function of related areas

12. Joint Hypomobility: Nonoperative Management (cont'd) • Management: Controlled Motion Phase • Increase soft tissue and joint mobility • Improve joint tracking of the elbow • Improve muscle performance and functional abilities

13. Joint Hypomobility: Nonoperative Management (cont'd) • Management: Return to Function Phase • Improve muscle performance • Restore functional mobility of joints and soft tissues • Promote joint protection

14. Radial Head Excision or Arthroplasty • Indications for Surgery • Contraindications to surgery • Procedure • Background • Selection of procedure • Implant designs, materials, and fixation • Overview of operative procedure

15. Radial Head Excision or Arthroplasty (cont'd) • Complications • Postoperative Management • Immobilization • Exercise: maximum protection phase • Exercise: moderate and minimum protection phases • Outcomes

16. Total Elbow Arthroplasty (TEA) • Indications for Surgery • Procedure • Background • Implant design and selection considerations • Materials and fixation • Operative overview • Complications

17. Total Elbow Arthroplasty (TEA) (cont'd) • Postoperative Management • Immobilization • Exercise: maximum protection phase • Exercise: moderate and minimum protection phases • Outcomes • Pain relief and patient satisfaction • ROM and functional use of the upper extremity

18. Myositis Ossificans • Definition: Formation of bone in atypical locations in the body • Synonymous with heterotopic bone formation • Etiology of Symptoms • Management

19. Overuse Syndromes: Repetitive Trauma Syndromes • Related Pathologies • Lateral elbow tendinopathy (tennis elbow) • Medial elbow tendinopathy (golfer’s elbow) • Etiology of Symptoms • Common Structural and Functional Impairments • Common Activity Limitations and Participation Restrictions

20. Nonoperative Management of Overuse Syndromes: Protection Phase • Decrease Pain, Edema, or Spasm • Develop Soft Tissue and Joint Mobility • Maintain Upper Extremity Function

21. Nonoperative Management: Controlled Motion and Return to Function Phases • Increase Muscle Flexibility and Scar Mobility • Restore Joint Tracking of the RU Joint • Improve Muscle Performance and Function • Patient Education

22. Exercise interventions for the Elbow and forearm

23. Exercise Techniques to Increase Flexibility and Range of Motion (ROM) • Manual, Mechanical, and Self-Stretching Techniques • To increase elbow extension • To increase elbow flexion • To increase forearm pronation and supination

24. Exercise Techniques to Increase Flexibility and ROM (cont'd) • Self-Stretching Techniques: Muscles of the Medial and Lateral Epicondyles • To stretch the wrist extensor muscles (from the lateral epicondyle) • To stretch the wrist flexor muscles (from the medial epicondyle)

25. Exercises to Develop and Improve Muscle Performance and Functional Control • Isometric Exercises • Multiple-angle isometric exercises • Angle-specific training • Alternating isometrics and rhythmic stabilization

26. Exercises to Develop and Improve Muscle Performance and Functional Control (cont'd) • Dynamic Strengthening and Endurance Exercises • Elbow flexion • Elbow extension • Long head of the triceps with elbow extension • Pronation and supination • Wrist flexion and extension

27. Exercises to Develop and Improve Muscle Performance and Functional Control (cont'd) • Functional Progression for the Elbow and Forearm • Diagonal patterns • Combined pulling motions • Combined pushing motions • Plyometric training (stretch-shortening drills) • Simulated tasks and activities

28. Independent Learning Activities • Critical Thinking and Discussion • Laboratory Practice • Case Studies