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Elbow and Forearm PowerPoint PPT Presentation


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Elbow and Forearm. Anatomy Review. 3 bones Humerus, Ulna, and Radius 3 joints Humero-ulnar, Humero-radial, and Proximal radio-ulnar 3 ligaments Ulnar collateral, Radial Collateral, and Annular ligament. Musculature Biceps / Triceps Common Extensor Tendon / Common Flexor Tendon

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Elbow and Forearm

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Elbow and forearm l.jpg

Elbow and Forearm


Anatomy review l.jpg

Anatomy Review

  • 3 bones

    • Humerus, Ulna, and Radius

  • 3 joints

    • Humero-ulnar, Humero-radial, and Proximal radio-ulnar

  • 3 ligaments

    • Ulnar collateral, Radial Collateral, and Annular ligament


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  • Musculature

    • Biceps / Triceps

    • Common Extensor Tendon / Common Flexor Tendon

    • Brachialis / Brachioradialis

    • Supinator / Pronator teres


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General Considerations

  • Joint Stresses

    • Baseball 2300°/ sec

      • Acceleration – valgus stress

      • Deceleration – varus stress

    • Tennis serve 1000°/ sec

      • Backhand – varus stress

      • Forehand / Serve – valgus stress

    • Golf swing

      • Poor mechanical swing

        • Lead elbow – varus stress

        • Trail elbow – valgus stress


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  • Unique Structure

    • Congruency of bones makes it stable

    • Brachialis muscle crosses the joint and inserts into anterior-superior capsule

      • Immobilization > 2 weeks should be avoided

    • Anterior capsule is thin and easily damaged

      • Aggressive, high intensity elbow stretches should be avoided

    • Active stretches are preferred at the elbow, unless passive are required, but most be monitored closely


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ROM / Flexibility


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  • Active

  • Passive

  • PNF


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Strengthening


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  • Isometric

  • Isotonic

    • MRE

    • PRE

    • Rubber Tubing / Banding

    • Machines

  • Isokinetic


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Special Considerations


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Epicondylitis

  • Lateral Epicondylitis (Tennis Elbow)

    • Backhand shots in tennis

    • Strong lead arm in golf

    • Most commonly involves ECRB

  • Medial Epicondylitis (Golfer’s Elbow)

    • Tennis serve or leading with elbow

    • Strong trail arm in golf

    • Curveballs in baseball


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  • Key Signs / Symptoms

    • Gradual Onset

    • Tenderness at epicondyle

    • Pain w/ MMT

      • Lateral – wrist extensors

      • Medial – wrist flexors

    • Grasping objects / Shaking hands painful

    • Demonstrates tendinitis pattern


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  • Treatment Options

    • Must find the cause!!

    • Avoid aggravating activities

    • Anti-inflammatory modalities

      • + CFM, Ionto

    • Improve flexibility of affected musculature

    • Strengthen affected musculature

      • High rep / Low weight

    • Counterforce bracing

    • Gradual return to full activity


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Sprains

  • Hyperextension Injuries

    • Anterior Capsule sprain

    • Olecranon / Olecranon Fossa contusion

  • Valgus Stress

    • Medial Collateral sprain

    • Conservative vs. Surgical Treatment

  • Dislocations

    • Posterior dislocation most common

    • May involve MCL / LCL / Annular Lig / Fractures


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Ulnar Nerve Injury

  • Most common in repetitive overhand throwing sports

  • Stretched / Irritation / Subluxation

  • Key Signs / Symptoms

    • 4th & 5th finger numbness and tingling

    • Posteromedial elbow pain

  • Treatment Options

    • Conservative vs. Surgical


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Arthroscopy

  • Usually done for:

    • Synovitis debridement

    • Removal of loose bodies

  • More accelerated rehab than if an open procedure performed


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