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The Elbow

The Elbow. Denisha Fergusson, ATC, LAT Primary Lab Instructor Florida International University Acute Care and Injury Prevention. Ligaments of the elbow. Elbow Injuries. Subject to injury due to… Broad range of motion Weak lateral bone structure Exposure of soft tissue

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The Elbow

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  1. The Elbow Denisha Fergusson, ATC, LAT Primary Lab Instructor Florida International University Acute Care and Injury Prevention

  2. Ligaments of the elbow

  3. Elbow Injuries • Subject to injury due to… • Broad range of motion • Weak lateral bone structure • Exposure of soft tissue • Many sports place excessive stress on joint • Locking motion of some activities • Throwing motion

  4. Elbow Injuries: Contusion • MOI = direct blow or repetitive blows • Vulnerable area due to lack of padding • Signs and Symptoms • Rapid swelling due to irritation of bursa or synovial membrane • Management • RICE immediately, for at least 24 hours • If severe, refer for X-ray to rule out fracture

  5. Elbow Injuries: Olecranon Bursitis • MOI = direct blow • Superficial location: extremely susceptible to injury • Signs and Symptoms • Pain, swelling, and point tenderness • Swelling will appear almost spontaneously without the pain and heat

  6. Elbow Injuries:Olecranon Bursitis • Management • Acute: compression for at least 1 hour • Chronic: requires superficial therapy primarily involving compression • If swelling fails to resolve, aspiration may be necessary • May be padded to return to competition

  7. Elbow Injuries: Muscle Strains • MOI = overstretching or too forceful a contraction • Falling on outstretched arm • Repeated microtears may cause chronic injury • Rupture of distal biceps is most common

  8. Elbow Injuries: Muscle Strains • Signs and Symptoms • Pain with AROM and RROM • Point tenderness in muscle, tendon, or lower part of muscle belly • Management • PRICE • Sling in severe cases • Follow-up treatment • Modalities, ROM and PRE exercises • If severe loss of function, refer for X-ray to rule out avulsion or epiphyseal fracture

  9. Elbow Injuries: Ulnar Collateral Ligament Injuries • MOI = valgus force from repetitive trauma • Secondary injuries may include… • Ulnar nerve inflammation • Wrist flexor tendonitis • Joint instability

  10. Elbow Injuries: UCL Injuries • Signs and Symptoms • Pain along medial aspect of elbow • Point tenderness over UCL • Associated paresthesia (Reason:?)

  11. Elbow Injuries: UCL Injuries • Management • Conservative treatment • PRICE and NSAID’s • ROM and PRE exercises as pain decreases • Analysis of the throwing motion (if applicable) • Surgical intervention may be necessary • Tommy John Procedure • Throwing athlete may be able to return to activity approximately 22-26 weeks post surgery

  12. Elbow Injuries: Lateral Epicondylitis (Tennis Elbow) • MOI = repetitive microtrauma to insertion of wrist extensor muscles

  13. Elbow Injuries: Lateral Epicondylitis (Tennis Elbow) • Signs and Symptoms • Aching pain at lateral epicondyle after activity • Decreased elbow ROM • Pain with AROM and RROM wrist extension • Pain and weakness in wrist and hand develop

  14. Elbow Injuries: Lateral Epicondylitis (Tennis Elbow) • Management • PRICE • NSAID’s and analgesics • Mobilization and stretching in pain free ranges • Deep friction massage • Hand grasping while in supination • Avoid pronation motions • Use of neoprene sleeve • Mechanics and skills training in order to avoid recurrence of injury

  15. Elbow Injuries: Medial Epicondylitis • MOI = repeated forceful wrist flexion and extreme valgus torque on the elbow • May involve common flexor tendons • Can be associated with ulnar nerve neuropathy

  16. Elbow Injuries: Medial Epicondylitis • Signs and Symptoms • Pain with AROM and RROM wrist flexion • Point tenderness and mild swelling at medial epicondyle

  17. Elbow Injuries: Medial Epicondylitis • Management • PRICE • NSAID's and analgesics • Sling in severe cases • Severe cases may require splinting and complete rest for 7-10 days • Cryotherapy, Ultrasound • Curvilinear brace • Below elbow to reduce stress at the elbow joint

  18. Elbow Injuries: Little League Elbow • MOI = repetitive microtraumas that occur from throwing motion (Not due to the type of pitch)

  19. Elbow Injuries: Little League Elbow • Linked to: • Accelerated apophyseal growth and delayed medial epicondyle epiphysis growth • Traction apophysitis with possible fragmentation of medial epicondylar apophysis • Avulsion fracture at medial epicondyle or radial head • Osteochondrosis of humeral capitellum • Non-union stress fracture of olecranon epiphysis

  20. Elbow Injuries: Little League Elbow • Signs and Symptoms • Onset is slow • Slight flexion contracture • Tight anterior joint capsule • Weakness in triceps • “Locking” or “Catching” sensation • Decreased ROM • Especially forearm pronation and supination

  21. Elbow Injuries: Little League Elbow • Management • PRICE • NSAID’s and analgesics • Stop throwing until… • Pain resolved • Full ROM is regained • Gentle ROM exercises • Gentle triceps strengthening exercises • Analysis of throwing motion

  22. Elbow Injuries: Osteochondritis Dissecans • MOI = Repetitive microtrauma • Injurious movements include elbow rotation and extension • Excessive valgus stresses causes compression of the radial head, which adds shearing forces at the radiocapitular joint • Impairment of blood supply may result, which causes degeneration of articular cartilage creating loose bodies

  23. Elbow Injuries: Osteochondritis Dissecans • Panner’s disease • Occurs in children (age <10) • Osteochondrosis of capitellum due to localized avascular necrosis

  24. Elbow Injuries: Osteochondritis Dissecans • Signs and Symptoms • Sudden pain at radiohumeral joint • Swelling, creptitus • Decreased ROM (full extension) • ROM usually returns in a few days • Grating with pronation and supination • Locking of the joint • X-ray • May show loose bodies in joint

  25. Elbow Injuries: Osteochondritis Dissecans • Management • Activity restriction for 6-12 weeks • NSAID’s • Splint and cast applied in severe cases of deterioration • If repeated locking of the elbow joint occurs, loose bodies are removed surgically

  26. Elbow Injuries: Cubital Tunnel Syndrome • MOI = narrowing of cubital canal or irregularity of cubital tunnel • Pronounced cubital valgus may cause deep friction contributing to injury • Ulnar nerve injury may result

  27. Elbow Injuries: Cubital Tunnel Syndrome • Signs and Symptoms • Pain on medial aspect of elbow • Pain may be referred proximally or distally • Point tenderness in cubital tunnel • Pain with hyperflexion • Intermittent paresthesia in 4th and 5th fingers

  28. Elbow Injuries: Cubital Tunnel Syndrome • Management • Rest, immobilization for 2 weeks • NSAID’s • Splinting, surgical decompression or transposition of subluxating nerve may be necessary • Avoid hyperflexion and valgus stresses

  29. Elbow Injuries: Dislocation • MOI = fall on outstretched hand with elbow extended or severe twist while elbow flexed • High incidence in sports • Dislocation may be posterior, anterior, or lateral

  30. Elbow Dislocation

  31. Elbow Injuries: Dislocation • Signs and Symptoms • Swelling, severe pain, disability • Median and radial nerves may be compromised • Blood vessels may be compromised • Often a radial head fracture is involved

  32. Elbow Injuries: Dislocation • Management • Immobilize and ice immediately • Refer for reduction immediately • Rehabilitation includes • Heat and PROM exercises to regain full ROM • ROM and PRE exercises should be initiated by athlete

  33. Elbow Injuries: Fractures • MOI = fall on flexed elbow or direct blow • May occur in one or more of bones in elbow joint • Signs and Symptoms • May not result in visual deformity • Hemorrhaging, swelling, muscle spasm

  34. Elbow Injuries: Fractures • Management • Monitor neurovascular status • Non-surgical treatment • Appropriate for stable fractures • Immobilize with cast or removable splint for 6-8 weeks • Surgical treatment • Used to stabilize unstable fractures in adults • ROM exercises initiated early to prevent frozen elbow

  35. Elbow Injuries: Volkmann’s Contracture • MOI = impaired circulation or ischemia • Associate with humeral supracondylar fractures • Compromises the brachial artery and inhibits circulation to forearm • May be loss of motor and sensory function • Classic case involves median nerve

  36. Elbow Injuries: Volkmann’s Contracture • Signs and Symptoms • Pain in forearm which increases with PROM finger extension • Cessation of brachial and radial pulses • Coldness in arm • Decreased ROM • Management • Monitor neurovascular integrity

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