ELBOW

 Repetitive valgus stress commonly

seen in the throwing motion, especially
late cocking-acceleration phase
Functional position: 90° FLEX, midway and the back and downward motion of
between PRON and SUP a golf swing prior to impact of the ball
Range of Motion  S/sx: tenderness over medial
Conditions
Flexion: 0-135° epicondyle, weakness in grip strength,
Lateral Epicondylitis (Tennis Elbow)
Extension: 0° pain reproduced when making a fist
 Affects the Extensor Carpi Radialis
Supination & Pronation: 0-80° and with wrist FLEX and PRON
Brevis, involved Extensor Digitorum
Applied Anatomy  Occurs 3 to 7 times less frequently
Communis in 30% of cases
Humeroulnar Jt than lateral epicondylitis, degenerative
 Backhand swing, gripping, wrist EXT w/
Resting position: 70° elbow FLEX, 10° SUP changes most frequent at Pronator
PRON and SUP. Activities that place
Closed pack position: Full EXT Teres and Flexor Carpi Radialis
repetitive stress on the lateral forearm
Capsular pattern: FLEX, EXT origins. Can occur as result of acute
musculature, overuse, poor mechanics,
Humeroradial Jt rupture of UCL
and improper technique in racquet
Resting position: Full EXT and SUP  Tx: Rest, modalities, bracing (med.
sports including improper backhand
Close packed position: Elbow FLEX 90°, sup counter-force bracing), analgesics and
and inappropriate string tension and
5° corticosteroids, modification of poor
grip size
Capsular pattern: FLEX, EXT, SUP, PRON throwing mechanics
 Reported to occur in 50% of tennis
Proximal Radioulnar Jt Olecranon Bursitis (Draftsman’s, Student’s-
players, more common in people
Resting position: 70° elbow FLEX, 35° SUP acute) (Miner’s-chronic)
above 35 years of age and peaks
Closed pack position: Full SUP/PRON  Inflammation of the subcutaneous
between 40 to 50 y/o
Capsular pattern: Equal limitation of PRON bursa over the olecranon process
 Oblique view of lat. epicondyle can
and SUP caused by repetitive trauma or
show punctuate calcifications in
Ulnar Collateral Ligament inflammatory disorders
extensor origin
 Primary restraint to valgus instability  Aseptic bursitis is either acute
 S/sx: point tenderness at lat.
 Has three parts (anterior, posterior, hemorrhagic bursitis from
epicondyle, pain distal to lateral
oblique) and c the FCU forms the macrotraumatic insult or chronic
epicondyle at extensor origin, pain and
cubital tunnel bursitis caused by repetitive
weakness in grip strength
Radial Collateral Ligament microtrauma, frequently seen in
 (+) Cozen’s test
 Primary restraint to posterolateral players of football and hockey
 Tx: discontinuation of provocative
instability (m/c instability)  Septic bursitis can occur as a result of
activities, oral analgesics, modalities,
Annular Ligament localized or systemic infection,
bracing (lat. counter-force brace), and
 Holds the radial head in position. associated with edema, erythema, and
eccentric strengthening of the wrist
Carrying Angle hyperthermia in area of affected bursa
extensors (most effective)
 Anatomic valgus angulation between  S/sx: Swelling, pain, decreased ROM
Medial Epicondylitis (Golfer’s Elbow)
the upper arm and forearm when the (FLEX), ↑ white blood cell count and
 Inflammation of the common flexor
arm is fully extended erythema if infection is present
tendon causing hypertrophy of medial
 Males: 5-10°  Tx:
epicondyle. Little leaguer’s is
 Females: 10-15° o Aseptic: Septic aspiration of bursa
hypertrophy of medial epicondyle
 Cubitus Valgus: > 20° followed by compressive dressing,
leading to fragmentation of medial
 Cubitus Varus: < -5° begin NSAID medication and apply
epicondylar apophysis
 Gunstock deformity: < -15° ice frequently. Intrabursal injection
 and sclerotherapy (tetracycline) is
advocated, together with surgical
incision as last resort.
o Septic: aspirate bursa for relief and
taking of sample for lab analysis
(Gram stain, culture and sensitivity,
crystal analysis), compression and
elevation. IV antibiotics for
systemic symptoms, oral antibiotics
for those with localized symptoms,
refer for incision and drainage if no
improvement.
Ulnar Collateral Ligament Sprain
(Thrower’s, Major Leaguer’s, Little
Leaguer’s)
 Inflammation of the anterior band of
the ulnar collateral ligament as a result
of valgus stress to the elbow
 Frequently seen with repetitive
microtrauma associated with throwing
during late cocking (64 N-m valgus
stress) and acceleration phases.
 S/sx: Significant medial elbow pain
after throwing, pop or click
precipitating pain, ulnar nerve
traction, UCL tenderness, and pain
with or without laxity during instability
testing, ↓ in throwing velocity and
accuracy
 5° elbow flexion contracture and (+)
valgus stress test
 Tx: Rest (3-6 wks), ice, NSAIDs,
rehabilitation for strengthening and
stretching, establish return-to-play
criteria, strengthening of med.
forearm musculature, hinged elbow
brace and taping. Ligament
reconstruction for non-improvement
and full-thickness injuries.
Radial Collateral Ligament Sprain
 Elbow dislocation from a traumatic
event
 S/sx: recurrent locking or clicking of
the elbow with extension and
supination, lateral pain/instability with
elbow flexed 20-30° if RCL is torn
 (+) varus stress test
 Tx: Rest, ice, NSAIDs, rehabilitation
for strengthening and stretching,
establish return-to-play criteria
Elbow Dislocation (Nursemaid’s)
 M/c type of dislocation in children (3-5
y/o), second to shoulder dislocation in
adults, young adults between ages
25-30
 FOOSH or traction towards distal
direction
 Dislocation can be anterior or
posterior, but posterior accounts for
98% of cases
 Associated injuries include radial head
fracture and damage to brachial
artery and median nerve
 S/sx: evaluate radial artery and radial,
ulnar, and median nerves, inability to
bend elbow, pain in shoulder and
wrist, limits both PRON and SUP
 Tx: reduce dislocation as soon as
possible, splint for 10 days, initial
ROM exercises, NSAIDs
 Can lead to loss of elbow ROM,
ectopic bone formation, neurovascular
injury, and arthritis of the elbow
Distal Biceps Tendonitis
 Microtearing of distal biceps tendon
caused by overloading d/t repetitive
elbow flexion and supination or
resisted elbow extension
 Pain on antecubital fossa usually
following eccentric overload, audible
snap with obvious deformity, swelling,
and ecchymosis
 Tx: Rest, ice, NSAIDs, physical
modalities, correct improper
technique, surgical reattachment
Triceps Tendonitis/Avulsion
 Overuse syndrome/decelerating
counterforce during elbow extension
 Post. elbow pain tenderness at
insertion of triceps, pain with resisted
elbow extension, sudden loss of
extension with palpable defect in
triceps tendon
 Tx: Rest, ice, NSAIDs, physical
modalities, correct improper
technique, surgical reattachment
Valgus Extension Overload Syndrome of the
Elbow (Boxer’s)
 Osteophyte and loose body formation
secondary to repetitive abutment of
olecranon against fossa
 Overuse disorder caused by repetitive
and uncontrolled valgus forces during
throwing and punching
 S/sx: post. elbow pain with lack of full
extension, catching or locking during
extension, ↑ valgus laxity
Pronator Syndrome
 Median nerve compression at the
elbow by: Ligament of Struthers or
supracondylar spur, lacertus fibrosis,
pronator teres, between two heads of
flexor digitorum superficialis
 Is rare, often misdiagnosed as CTS
 S/sx: Dull aching pain in proximal
forearm distal to elbow, inflammation
of pronator teres, numbness in
median nerve distribution of hand,
exacerbated by pronation
 Tx: modification of activities, avoid
aggravation, stretching and
strengthening, surgical release of
median nerve compression
Cubital Tunnel Syndrome
 Hyperirritability/entrapment of the
ulnar nerve d/t hypermobility,
excessive valgus force, loose
body/osteophyte formation
  S/sx: Static Papal Benediction, aching
pain with paresthesia, weakness in
ulnar innervations
 (+) Tinel’s and Froment’s signs
Anterior Interosseous Nerve Syndrome
(Kiloh-Nevin Syndrome)
 Impingement of the ant. interosseous
nerve
 S/sx: weak FPL & FDP to index finger
(O sign), weak pronator quadratus
Radial Tunnel Syndrome
 Entrapment of the post. interosseous
branch of the radial nerve in the
Arcade of Frohse beneath the
Supinator muscle
 S/sx: Tenderness in EXT muscle mass
at the Arcade of Frohse 3-4 cm distal
to lat. epicondyle, weakness of finger
& thumb extensors and ext carpi
ulnaris
 (+) Long finger extension test
Osteochondrosis Dissecans of Elbow
(Panner’s disease)
 Dislocation of the epiphyseal plate.
(With epiphyseal aseptic necrosis of
capitulum in Panner’s)
 Usually occurs in young boys
 S/sx: tenderness and swelling on
lateral aspect of elbow, limited
extension
 Tx: Immobilization, gradual ROM
Fracture of Humeral Shaft
 Usually caused by direct trauma or
FOOSH
 Fairly common, constitutes 5% of all
fractures
 S/s: severe arm pain, swelling, and
deformity, radial nerve palsy if radial
nerve is affected
 Tx: splinting for two weeks
Fracture of Distal Humerus
 Can be displaced, involving one or  Nocturnal pain along the dorsum of
both condyles together with jt surface the wrist, thumb, and web space
involvement, or non-displaced,  Direct pressure at the junction of ECRL
 S/sx: swelling, ecchymosis, and pain and brachioradialis may reproduce sensory
at elbow, inability to flex elbow symptoms
 Complications: neurovascular injury, Observation
nonunion, malunion, elbow  Have pt assume anatomical position
contracture, poor ROM and observe carrying angle
 Tx: Displaced fractures require open  Hyperextension of up to 10° in lateral
reduction, non-displaced fractures can view is normal.
be treated by splinting and early  If swelling occurs, all 3 jts are affected
motion. because they have a common
Radial Head Fracture capsule, most evident in triangular
 Commonly associated with space between the radial head, tip of
dislocations of the elbow olecranon, and lateral epicondyle.
TYPE DESCRIPTIO TX  Observe if pt can assume normal
N functional position of the elbow: 90°
1 Non- Approx. 3-5 FLEX, midway between SUP and PRON
displaced days
 Observe alignment of olecranon and
immobilization
medial and lateral epicondyles for
, early ROM
triangle sign
2 Marginal Surgical
radial head fixation: > 2
fracture, mm
minimal displacement
displacement or 30% radial
head
involvement
3 Comminuted Surgical
Fracture of the Olecranon
 Direct blow to the elbow, fall on elbow
with elbow flexed
 Can be displaced or non-displaced
 S/s: Swelling and ecchymosis with
obvious deformity, pain on gentle
ROM, numbness and paresthesia with
ulnar nerve involvement
Cheiralgia Paresthetica (Wartenberg
Disease)
 Compression of the superficial branch
of the radial nerve as it passes under
the tendon of brachioradialis