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Elbow and Forearm

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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  1. Elbow and Forearm

  2. 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

  3. Musculature • Biceps / Triceps • Common Extensor Tendon / Common Flexor Tendon • Brachialis / Brachioradialis • Supinator / Pronator teres

  4. 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

  5. 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

  6. ROM / Flexibility

  7. Active • Passive • PNF

  8. Strengthening

  9. Isometric • Isotonic • MRE • PRE • Rubber Tubing / Banding • Machines • Isokinetic

  10. Special Considerations

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. Arthroscopy • Usually done for: • Synovitis debridement • Removal of loose bodies • More accelerated rehab than if an open procedure performed

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