Elbow Anatomy and Injuries Quiz

Elbow Anatomy

• The elbow is a complex joint allowing flexion, extension, pronation, and supination.
• It has a range of 145 degrees of flexion, and 90 degrees of supination and pronation.
• The elbow's bony structure, ligaments, and muscles provide stability and protection against overuse and trauma.
• The elbow has a carrying angle, a normal deviation, which is 10-15 degrees in females and 5 degrees in males.

Elbow Anatomy (Bones)

• The elbow joint is formed by the humerus, radius, and ulna.
• The humerus (upper arm bone) has the medial and lateral epicondyles.
• The radius and ulna (forearm bones) join at the proximal and distal ends.
• The olecranon and coronoid processes of the ulna articulate with the humerus trochlea and capitulum respectively

Elbow Anatomy (Ligaments)

• The elbow ligaments provide stability.
• Medial and lateral collateral ligaments stabilize the joint against valgus and varus forces.
• The annular ligament surrounds the radial head.

Elbow Anatomy (Muscles)

• Various muscles act on the elbow, including biceps brachii, brachialis, brachioradialis, triceps brachii, pronator teres, and supinator.

Elbow Assessment

• An assessment of the elbow involves history, observations, and palpation.
• History of previous injuries, pain, mechanism of injury, and disabling time are crucial.
• Observations include deformities, swelling, and carrying angle.
• Palpation checks bony (humerus, epicondyles, olecranon process, radial head, radius, ulna, collateral ligaments, and annular ligament) and soft tissue structures (biceps brachii, brachialis, brachioradialis, pronator teres, triceps, supinator, wrist flexors, and extensors).

Special Tests

• Evaluating circulatory and neurological function (pulse, sensation) is important for a complete examination.
• Tinel's sign detects nerve irritation.
• Valgus/Varus stress tests asses the collateral ligaments.
• Epicondylitis tests (different tests for medial and lateral epicondylitis), address pain at the epicondyles when resisted flexion or extension occurs.
• The Pinch Grip test determines anterior interosseous nerve issues.
• Pronator Teres Syndrome Test checks for nerve impingement during resisted forearm pronation

Functional Evaluation

• Pain and weakness are evaluated through AROM, PROM, and RROM (active, passive, and resisted range of motion).
• The range of motion of flexion, extension, pronation, and supination is noted.

Classification of Elbow Injuries

• Contusion: resulting from direct blows. Treatment includes RICE (rest, ice, compression, elevation) and a 24 hour minimum protocol; if severe, X-ray to rule out fracture.
• Olecranon Bursitis: superficial location makes it prone to injury. Treatment includes compression for an hour and therapy (compression); severe symptoms need aspiration.
• Strains: result from excessive resistive motion, commonly causing rupture of distal biceps. Treatment includes RICE, cryotherapy, exercises, and potential X-ray.
• Ulnar Collateral Ligament Injuries: valgus (stress) injury; symptoms include pain, tenderness on medial aspect, and possible nerve impingement; treatment includes RICE, NSAIDS, strength exercises, and if needed, surgical intervention (Tommy John).
• Lateral Epicondylitis (Tennis Elbow): Repetitive stress at the insertion of extensor muscles. Treatment includes RICE, NSAIDS and analgesics, and ROM/PRE exercises, avoiding pronation motions, avoiding forceful extension, and considering mechanical retraining.
• Medial Epicondylitis: Repeated forceful wrist flexion (e.g., overuse). Treatment includes rest, cryotherapy, ultrasound, analgesics, and bracing.
• Elbow Osteochondritis Dissecans: An impairment of blood supply to the anterior surface of the joint creating loose bodies and potential grating. Management includes activity restriction, NSAIDs, splinting if severe, surgical removal of loose bodies if repeated locking symptoms occur.
• Little League Elbow: This involves repetitive microtrauma to the muscles of the throwing mechanisms. Management includes RICE, NSAIDs, analgesics, no throwing until pain/ROM recovered, moderate strengthening and stretching.
• Cubital Tunnel Syndrome: This is damage to the ulnar nerve. Symptoms include pain, possible paresthesia, and intermittent nerve pain symptoms. Treatment includes rest, immobilization, NSAIDs, possible surgical decompression, and activity modifications to prevent hyperflexion.
• Elbow Dislocation: Resulting from falls, can be displaced backward, forward, or laterally; symptoms include significant swelling, severe pain, disability; treatment involves applying cold compresses, immobilization, referral for reduction, and possible surgery; followed by ROM and strength exercises.
• Fractures of the Elbow: This can result from direct blows or falling on a flexed elbow; can involve any or multiple bones; signs and symptoms include visual deformity, hemorrhaging, swelling, muscle spasms. Treatment involves monitoring neurovascular, use of splints/surgery based on severity, and ROM exercises.
• Volkmann's Contracture: a complication of supracondylar humerus fractures, which can cause muscle spasm and swelling which inhibit circulation in the forearm. Treatment involves removing restrictive elements, close monitoring, and possibly surgical intervention to correct the issues.

Elbow Rehabilitation

• General conditioning, flexibility, joint mobilization, strengthening, and functional progression are key components.
• Rehabilitation focuses on restoring range of motion (ROM), strength, and function, along with avoiding movements that increase pain symptoms.
• Progressive exercises are followed by functional progressions to return to activity (e.g., PNF).
• Protective taping and bracing may be useful during recovery.