Elbow Joint Anatomy and Injuries

Elbow Joint Anatomy

• The elbow joint has anterior (front) and posterior (back) structures.
• Anterior structures include the capitulum and trochlea.
• The head of the radius is also an anterior structure.
• Posterior structures include the olecranon and the trochlear notch.

Elbow Joint Stability

• The ulnar/medial collateral ligament prevents valgus instability.
• The radial/lateral collateral ligament prevents varus instability.
• The ulnohumeral articulation provides structure.
• The annular ligament helps position the radius.

Lateral Epicondylitis (Tennis Elbow)

• It is a common overuse injury.
• Repetitive activities like grasping, pulling, and hammering can cause it.
• It affects the wrist extensors.
• 35-50% of tennis players experience this.
• It is more common in patients over 35 years old.

Lateral Epicondylitis (Tennis Elbow) - Pathophysiology

• The primary structure affected is the extensor carpi radialis brevis tendon.
• Tendinitis is an acute inflammatory response increasing tissue healing.
• Tendinosis is a chronic, degenerative condition.
• Tendinopathy encompasses both acute and chronic issues.

Lateral Epicondylitis (Tennis Elbow) - Symptoms

• Pain gradually begins, typically lateral to the elbow.
• Pain worsens with activity.
• Daily activities like holding a coffee cup or gallon of milk can cause pain.
• The pain might radiate into the forearm, hand, and the lateral side of the arm.
• Pain may be present during the night.

Lateral Epicondylitis (Tennis Elbow) - Diagnosis

• Physicians look for localized tenderness.
• Muscle strength assessment, specifically resisted wrist extension, is common.
• Range of motion (ROM) assessment is typically normal.
• The Cozen's test helps evaluate tenderness by applying pressure.

Lateral Epicondylitis (Tennis Elbow) - Chronic Cases

• Shoulder stability and scapular integrity need assessment.
• Scapular stabilizer weakness might lead to the condition.
• Referred pain may originate from the cervical spine (C5-C6).
• Other conditions like glenohumeral joint problems, elbow osteoarthritis, lateral epicondyle avulsion, and lateral ligament sprains can coexist, warranting investigation.

Lateral Epicondylitis (Tennis Elbow) - Treatment (Acute Stage)

• Protect the injured tendon from further stress, avoiding activities that exacerbate pain.
• Reduce pain and inflammation (e.g., ice, ultrasound, iontophoresis, topical NSAIDs).
• Maintain or improve range of motion.
• Use splints during activities to maintain extensor muscle rest.
• Proper positioning will aid in reducing maximum muscular contraction.

Lateral Epicondylitis (Tennis Elbow) - Treatment (Continued)

• Counterforce bracing (tennis elbow strap) is used to unload the area of origin at the elbow.
• Further muscle atrophy and negative effects should be avoided with proper bracing and exercises.
• Transverse friction massages are beneficial for releasing underlying adhesions.
• Exercises like range of motion to improve circulation and collagen orientation are helpful.
• Include gentle stretches along with progressive exercises for complete recovery.

Lateral Epicondylitis (Tennis Elbow) - Treatment (Continued)

• Focus on progressive eccentric exercises to improve forearm muscles, particularly wrist extensors.
• Proper positioning of the elbow (ext), forearm (pronated), and wrist (ext) position are important for these exercises.

Scapular Stabilization Exercises

• These are crucial for overall shoulder health (related to previous subheadings).

Rotator Cuff Strengthening Exercises

• These are crucial for rotator cuff health (related to previous subheadings).

Chronic Stage Treatment

• Includes ultrasound, deep friction massage, and stretching/strengthening.
• Scapular stabilization and sports-specific training are vital here.

Return to Play

• Athletes can return to play once full strength, and complete ROM are reached.
• A brace may be needed for temporary support.
• Athletes should continue with therapy during recovery.

Medial Epicondylitis (Golfer's Elbow)

• Often involves the common flexor tendons (e.g., flexor carpi radialis).
• Results in repetitive microtrauma due to valgus stress.
• Less frequent than lateral epicondylitis (<10%).

Medial Epicondylitis (Golfer's Elbow) - Risk Factors

• Training errors.
• Repeated wrist flexion and forearm pronation.
• Biomechanical abnormalities (e.g., poor strength, flexibility imbalance).

Medial Epicondylitis (Golfer's Elbow) - Special Test

• Golfer's elbow test (reverse Cozen's test).

Medial Epicondylitis (Golfer's Elbow) - Treatment

• Treatment mirrors lateral epicondylitis, but focuses on stretching and strengthening wrist flexor muscles.

Cubital Tunnel Syndrome

• Ulnar nerve entrapment in the cubital tunnel.
• Symptoms include numbness, tingling, in the elbow.
• Commonly involves the fifth digit.
• Symptoms worsen with elbow flexion activities.
• Night symptoms of numbness and tingling are frequent.
• Loss of grip strength, claw deformity, and weak hand are possible.

Cubital Tunnel Syndrome - Special Tests

• Tinel's sign.
• Elbow flexion test.

Cubital Tunnel Syndrome - Conservative Treatment

• Patient instruction, behavior modification, anti-inflammatory medications, night splints, elbow supports.
• Avoiding aggravating activities, rest, physical therapy, ultrasound, and corticosteroid injections can aid in recovery.

Return to Play (Cubital Tunnel Syndrome)

• Play resumption depends on therapy and recovery time.
• Athletes should have pain-free complete ROM.
• Any continued therapy needs to be focused on safe movements to prevent recurrence.

This quiz covers key aspects of the elbow joint, including its anatomy, stability, and common injuries such as lateral epicondylitis. Test your knowledge on the structures involved and the implications of overuse injuries. Ideal for students studying anatomy or sports medicine.