Sports Medicine

Unit 18

Elbow

I.Bones

a.

  1. What movements does the elbow perform?
  2. Flexion
  3. Pronation
  4. Muscles in motion
  5. FLEXION
  6. (supinated)
  7. Brachialis (pronated)
  8. (neutral)
  9. Prime movers depends on position of the forearm
  10. EXTENSION
  11. Primary mover
  12. Anconeus
  13. Secondary mover
  14. SUPINATION
  15. Primary mover
  16. Biceps brachii
  17. Secondary mover
  18. Brachioradialis
  19. Secondary mover
  20. Also pronates forearm from a supinated position
  21. PRONATION
  22. Pronator quadratus
  23. Primary movers
  24. Tendons
  25. Biceps
  26. Triceps

V.Joints

  1. Humeroulnar joint
  2. Allows for flexion and extension
  3. Humeroradial joint
  4. Humerus and radius
  1. Ligaments
  2. Medial – resists ______stress
  3. (UCL)
  4. three bands
  5. anterior oblique band
  6. medial epicondyle to coronoid process
  7. restrains against valgus stress
  8. transverse band
  9. medial epicondyle to coronoid process
  10. posterior oblique band
  11. medial epicondyle to olecranon process
  12. Lateral – resists ______stress
  13. (LCL)
  14. Main lateral stabilizer
  15. Middle of the lateral epicondyle to ulnar tuberacle
  16. ______collateral ligament
  17. Thickened capsule
  18. Lateral epicondyle to annular ligament
  19. Maintain close relationship between humeral head and radial head
  20. ______ligament
  21. Encircles the radial head
  22. Permits internal/external rotation of radius on ulna
  23. Interosseous membrane
  24. Dense band of fibrous connective tissue
  25. Obliquely between radius to the ulna
  26. Transmits forces
  27. Attachment point for muscles

VII.Assessment of the elbow

  1. History
  2. Past history
  3. When and where does it hurt?
  4. Motions that increase or decrease pain
  5. Sounds or feelings?
  6. How long were you disabled?
  7. Swelling?
  8. Previous treatments?
  9. Deformities and swelling?
  10. Cubitus valgus versus cubitus varus
  11. Flexion and extension
  12. Cubitus recurvatum
  13. Elbow hyperextension?
  14. Be sure to check sites of pain and deformity
  15. Assess epicondyles, olecranon, distal aspect of humerus and proximal aspect of ulna
  16. ______– muscles, tendons, joint capsules and ligaments surrounding joint
  17. Methods to assess elbow and forearm injuries include:
  18. ROM test for elbow flexion
  19. ROM test for elbow extension
  20. ROM test for elbow supination
  21. ROM test for elbow pronation
  22. Manual muscle tests
  23. Flexion strength test
  24. Extension strength test
  25. Supination strength test
  26. Pronation strength test
  1. ______of elbow/forearm injuries
  2. Vulnerable to a variety of acute and chronic injuries
  3. ______gear is always recommended to reduce severity of injury
  4. Chronic injury reduction
  5. ______(baseball, tennis)
  6. Utilize proper mechanics
  7. Use ______that is appropriate for skill level
  8. Maintain appropriate levels of strength, flexibility, and endurance for activity
  9. Injuries
  10. Fractures
  11. Dislocations and subluxations
  12. Contusions
  13. Sprains
  14. Valgus stress test for the elbow
  15. Varus stress test for the elbow
  16. Impingement
  17. Tinel’s sign
  18. Synovitis and bursitis
  19. Biceps brachii rupture
  20. Epicondylitis
  21. Volkmann’s contracture
  22. Common Injuries
  23. Cause of Injury
  24. Superficial location makes it extremely susceptible to injury (acute or chronic) --direct blow
  25. Signs of Injury
  26. Pain,
  27. Swelling will appear and w/out usual pain and heat
  28. Contusion
  29. Cause of Injury
  30. Vulnerable area due to ______
  31. Result of direct blow or repetitive blows
  32. Signs of Injury
  33. ______(rapidly after irritation of bursa or synovial membrane)
  34. Care
  35. Treat w/______immediately for at least 24 hours
  36. If severe, refer for X-ray to determine presence of fracture
  37. In acute conditions, ice
  38. Chronic cases require protective therapy
  39. If swelling fails to resolve, aspiration may be necessary
  40. Can be padded in order to return to competition
  41. Elbow Sprains
  42. Cause of Injury
  43. Elbow hyperextension or a ______force (often seen in the cocking phase of throwing
  44. Signs of Injury
  45. Pain along ______aspect of elbow
  46. Inability to grasp objects
  47. Point tenderness over the MCL
  48. Care
  49. Conservative treatment begins w/ RICE elbow fixed at 90 degrees in a sling for at least 24 hours
  50. Coach should be concerned with gradually regaining elbow full ROM
  51. Athlete should ______
  52. Gradual progression involving an increase in number of throws while range and strength return
  53. Lateral Epicondylitis (______)
  54. Cause of Injury
  55. Repetitive ______to insertion of extensor muscles of lateral epicondyle
  56. Signs of Injury
  57. Aching pain in region of lateral epicondyle after activity
  58. Pain worsens and ______and hand develop
  59. Elbow has decreased ROM; pain w/ resistive wrist extension
  60. Care
  61. RICE, NSAID’s and analgesics
  62. ROM exercises and PRE, deep friction massage, hand grasping while in supination, avoidance of pronation motions
  63. Mobilization and stretching in pain free ranges
  64. Use of a counter force or neoprene sleeve
  65. Proper mechanics and equipment instruction is critically important
  66. ______Epicondylitis (Little league elbow)
  67. Cause of Injury
  68. Repeated forceful flexion of wrist and extreme valgus torque of elbow
  69. Signs of Injury
  70. Pain produced w/ forceful flexion or extension
  71. ______and mild swelling
  72. Passive movement of wrist seldom elicits pain, but active movement does
  73. Care
  74. Sling, rest, cryotherapy or heat through ultrasound
  75. Curvilinear brace below elbow to reduce elbow stressing
  76. Severe cases may require splinting and complete rest for 7-10 days
  77. Ulnar Nerve Injuries
  78. Cause of Injury
  79. Pronounced cubital valgus may cause deep friction problem
  80. Traction injury from valgus force, irregularities w/ tunnel, subluxation of ulnar nerve due to lax impingement, or progressive compression of ligament on the nerve
  81. Signs of Injury
  82. Generally respond with ______
  83. Care
  84. Conservative management – avoid aggravating condition
  85. Surgery may be necessary if stress on nerve can not be avoided
  86. Dislocation of the Elbow
  87. Cause of Injury
  88. High incidence in sports caused by ______
  89. Signs of Injury
  90. Swelling, severe pain, ______
  91. May be displaced backwards, forward, or laterally
  92. Complications w/ median and radial nerves and blood vessels
  93. Rupture and tearing of ______will usually accompany the injury
  94. Care
  95. Immobilize and refer to physician for reduction
  96. Following reduction, elbow should remain splinted in flexion for 3 weeks, then rehab
  97. Fractures of the Elbow
  98. Cause of Injury
  99. Fracture can occur in any one or more of the bones
  100. Fall on outstretched hand often fractures humerus above condyles or between condyles
  101. Signs of Injury
  102. May or may not result in visual deformity
  103. Hemorrhaging, swelling, muscle spasm
  104. Care
  105. Ice and sling for support – ______
  106. Elbow Osteochondritis Dissecans
  107. Cause of Injury
  108. Impairment of blood supply to anterior surface resulting in degeneration of articular cartilage, and bone creating loose bodies within the joint
  109. Signs of Injury
  110. Sudden pain, locking; range usually returns in a few days
  111. Swelling, pain and crepitation may also occur
  112. Care
  113. If repeated locking occurs, loose bodies may be removed surgically
  114. Without removal, arthritis may develop
  115. Volkmann’s Contracture
  116. Cause of Injury
  117. Associate w/ humeral supracondylar fractures, causing muscle spasm, swelling, or bone pressure on brachial artery, inhibiting circulation to forearm
  118. Can become permanent – muscle contraction/paralysis
  119. Signs of Injury
  120. Pain in forearm - increased w/ passive extension of fingers
  121. Care
  122. Immediate referral is necessary
  123. Time is of the essence