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March 27 - ch 19 elbow, forearm, wrist and hand.doc

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Physical Education and Sport
Brad Kern

April 3 – Ch 19: Elbow, Forearm, wrist and hand Anatomy of the elbow Pronation and supination occur in the elbow between the joints of the radius and ulna Remember arm is supinated when holding a bowl of soup When supinated the radius and ulna are parallel Ulna has an L so remember its lateral UCL stops valgus forces This ligament gets hurts in throwing. RCL is on the lateral side of the elbow and inserts onto the annular ligament and originates off the lateral epicondyle Muscles of the elbow • Flexion and extension occur in the elbow • Muscles involved in flexion are biceps brachii, brachilais, and brachioradialis • In a supinated position the biceps brachii is isolated • In the beer drinking pose, the brachioradialis is isolated • A pronated position will isolate the brachialis • Pronator muscles are prontator teres and quadrates • Biceps brachii is a 2 joint muscle • Triceps is involved in elbow and shoulder extension Assessment of the Elbow History • Past history • MOI • When and where does it hurt? If palpation doesn’t produce pain, we may be able to assume injury is due to internal organs being in dysfunction • Sharp and point specific may mean a fracture • Motions that increase or decrease pain? • Type, quality, duration of pain? • Sounds or feelings? • How long were you disabled? • Swelling? • Previous treatments? • If there is something wrong in internal organs, the pain could be referred to the elbow or shoulder Observations • Deformities and swelling? • Carrying angle (cubitus valgus (increased angle) vs. Cubitus varus (decreased angle)) greater than 15 degree is cubital valgus. Less than 5 degrees is cubital varus. Normal is 5-15 degrees. • Flexion and extension – cubitus recurvatum • Elbow hyperextension • Epicondyles are non articulating surfaces • Condyles are where common wrist extensors and flexors originate • Tennis elbow and pitchers elbow is really medial or lateral epicondylitis and inflammation where those muscles insert. Palpation • Epicondyles, olecranon, distal aspect of humerus and proximal aspect of ulna • Soft tissue – muscles, tendons, joint capsules and ligaments surrounding joint Prevention of Elbow, Forearm, and Wrist Injuries • Vulnerable to a variety of acute and chronic injuries • Protective gear is always recommended to reduce severity of injury Chronic injury reduction • Limit reps (baseball, tennis) • Use proper mechanics • Use equipment that is appropriate for skill level • Maintain appropriate levels of strength, flexibility, and endurance for activity Recognition and Management of Injuries to the Elbow Olecranon Bursitis • Superficial location makes it extremely susceptible to injury (acute or chronic) Cause of Olecranon Bursitis • Direct Blow Signs of Olecranon Bursitis • Pain, swelling, and point tenderness • Swelling will appear almost spontaneously and without usual pain and heat Caring for Olecranon Bursitis • in acute conditions, ice • chronic conditions require protective therapy • if swelling fails to resolve, aspiration may be necessary • can be padded in order to return to competition Elbow Sprains Causes of Elbow Sprains
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