Elbow

 joint    
By  
Hossein  Khorrami,  DOMP,  PhD.  
khorrami4@yahoo.com    
h?p://www.scribd.com/khorrami4    
 
Elbow,  synovial  joint  
Olecranon  process    
Elbow  lateral  ligaments  
Elbow,  medial  ligaments  
 Biceps  Brachii  
•  InnervaGon  

•  Musculocutaneous    

•  Elbow  flexor    
•  Forearm  supinaGon  
 Brachialis    
•  Musculocutaneous  N.  
•  Radial  N.  

•  Strongest  elbow  flexor  

 Triceps  Brachii  
•  Radial  N.  
•  Axillary  N.  
 Anconeus    
•  ConGnuaGon  of  triceps  
•  Connects  lat.  Epicondyle  of  
humerus  to  olecranon  

•  Assists  forearm  extension  

 Brachioradialis    
•  Origin:  humerus    

•  InserGon:  styloid  process    

of  radius  
•  FuncGon:  elbow  flexion    
 Brachioradialis  muscle  
•  Radial  nerve  
•  Elbow  flexion  

h?ps://www.youtube.com/watch?v=Duuf2a2MWiI  
 Pronator    Teres  
•  Connects  med.  Epicondyle  
of  humerus  to  radius  

•  Median  Nerve  
•  PronaGon    
 Supinator  muscle  
•  Connects  lateral  
epicondyle  of  humerus  
to  the  proximal  Ulna  

•  Forearm  supinaGon  
Nerves  in  cubital  area    
 Elbow  movements  
mvmt  
Flexion   Brachialis,  biceps  
Extension     Triceps  
PronaGon   Pronator  teres,  pronator  qudratus  
SupinaGon     Supinator    
 Elbow  muscles  
•  Brachialis:  palm  up  flexion  
•  Brachioradialis:  mid.  flexion  
•  Biceps  brachii:  supinated  flexion+  supinaGon  
•  Pronator  teres:  pronaGon  
•  Pronator  quadratous:  pronaGon  
 Elbow  problems  
•  Cubital  tunnel  syndrome(ulnar  neuropathy)    
•  Tennis  elbow(lateral  epicondiliGs)  
•  Radial  tunnel  syndrome(tenderness),  RTS    
 Cubital  tunnel  syndrome    
•  Ulnar  nerve    
 Cubital  tunnel  syndrome,  risk  factors  
•  Repeatedly  lean  on  elbow(funny  bone),  
especially  on  a  hard  surface  
•  Bend  elbow  for  sustained  periods,  such  as  
while  talking  on  a  cell  phone  or  sleeping  with  
hand  crooked  under  pillow  
•  Intense  physical  acGvity  
 Cubital  tunnel  syndrome,  Symptoms  
•  Pain  and  numbness  in  the  elbow  
•  Tingling,  especially  in  the  ring  and  li?le  fingers  
•  Weakness  affecGng  the  ring  and  li?le  fingers  
•  Decreased  ability  to  pinch  the  thumb  and  li?le  
finger  
•  Decreased  overall  hand  grip  
•  Muscle  wasGng  in  the  hand  
•  Claw-­‐like  deformity  of  the  hand  
 Treatment    
•  Avoidance  of  undue  pressure  on  the  elbow  
during  daily  acGviGes  
•  Wearing  a  protecGve  elbow  pad  over  the  "funny  
bone"  during  daily  acGviGes  (compression  strap)  
•  Wearing  a  splint  during  sleep  to  prevent  over-­‐
bending  of  the  elbow  
•  Ergonomic  educaGon  to  reduce  the  effects  of  
repeGGve  stress,  nerve-­‐gliding  exercises,    
•  Stretching/strengthening  exercises    
•  Heat,  cold    
•  Ultrasound    
 Radial  Tunnel  Syndrome  
•  Also  named  Radial  Pronator  Syndrome  
•  Radial  tunnel  syndrome  causes  dull  aching  pain  at  the  top  of  
the  forearm,  to  the  outside  of  the  elbow,  or  the  back  of  the  
hand.  PaGents  less  o`en  describe  the  pain  as  cuang,  
piercing,  or  stabbing.  It  happens  most  o`en  when  the  person  
straightens  his  or  her  wrist  or  fingers  
•  Radial  tunnel  syndrome  can  cause  faGgue  and  weakness  in  
the  forearm  muscles  and  weakness  in  the  wrist  

•  Radial  tunnel  syndrome  affects  the  muscles,  not  the  nerves,  

so  it  does  not  cause  Gngling  or  numbness  in  the  arm,  wrist,  or  
fingers  
 Treatment    
•  over-­‐the-­‐counter  
medicaGons  to  reduce  
swelling  
•  steroid  injecGons  to  relieve  
inflammaGon  and  pressure  
on  the  radial  nerve  
•  wrist  and/or  elbow  splints  
to  reduce  irritaGon  of  the  
radial  nerve  
•  exercise,  techniques  to  
reduce  the  effects  of  
repeGGve  moGon  stress,  
ultrasound,  heat  and  cold  
 EpicondyliGs    
•  Much  more  common  on  the  lateral  side  of  the  
elbow,  rather  than  the  medial  side    
•  In  most  cases,  its  onset  is  gradual  and  
symptoms  o`en  persist  for  weeks  before  
paGents  seek  care  
•  In  golfer's  elbow,  pain  at  the  medial  
epicondyle  is  aggravated  by  resisted  wrist  
flexion  and  pronaGon,  which  is  used  to  aid  
diagnosis    
 Tennis  elbow    
•  Indicated  by  the  presence  of  lateral  
epicondylar  pain  precipitated  by  resisted  wrist  
extension    
•  Apoptosis  and  autophagic  cell  death  as  causes  
of  chronic  lateral  epicondyliGs    
 Apoptosis    
•  Decrease  the  muscle  density  and  cause  a  
snowball  effect  in  muscle  weakness  
•  Compromise  a  muscle's  ability  to  maintain  its  
integrity  
•  So  athletes,  like  pitchers,  must  work  on  
prevenGng  this  cell  death  via  flexibility  
training  and  other  preventaGve  measures  
 Tennis  elbow  (S  &  S)  
•  Lat.  epicondyle  pain  
•  Lat.  Epicondyle  point  tenderness  
•  Pain  with  wrist  extension  
•  Weakness  of  forearm  
–  Unable  to  hold  heavy  items  
–  Difficulty  in  turning  doorknob      
•  Morning  sGffness    
 Why  happened    
•  OverexerGon    
•  Trauma  
•  Sudden  forceful  pull  
•  Forceful  extension  
•  Tear  between  common  extensor  &  
periosteum  
•  Redial  nerve  involved  
 Treatment    
•  Ice  
•  Special  Brace    
•  Stretching  exercises  (pain  free)  
•  Strengthening  exercises  
 Elbow  Stretch    
•  With  the  opposite  hand,  hold  the  fingers  of  
the  affected  arm  up    
•  Stretch  for  5sec  rest  for  several  seconds  
•  10  repeGGons    
•  Perform  a  similar  stretch  
•  Wrist  of  the  affected  arm  down    
•  Hold  and  stretch  for  5sec    
•  Rest  for  several  seconds    
•  10  repeGGon  
 Golfer’s  elbow(medial  epicondyliGs)  
•  Medial  epicondyle    
•  Pain  in  griping  
•  Pain  in  hand  flexion  
 Treatment    
•  Ice  
•  Special  Brace    
•  Stretching  exercises(pain  free)  
•  Strengthening  exercises    
 Elbow  Flexion  
•  Hold  a  3-­‐5LB  wt  in  the    affected  hand  
•  Fully  bend  the  elbow  
•  3  sets  of  10  repeGGons    
•  Increase  the  weight  as  comfort  permits  
 Wrist  Curl  
•   In  the  hand  of  the  affected  arm  and  with  the  
forearm  facing  you  
•  Hold  a  2  pound  weight  and  bend  the  wrist  
slowly  up  
•  Hold  for  5  seconds,  then  rest  
•  Repeat  for  three  sets  of  10  repeGGons  
•  Increase  weight  as  comfort  permits  
 Wrist  Extension    
•  In  the  hand  of  the  affected  arm,  hold  a  2LB  
weight  with  the  forearm  and  hand  facing  
downwards  
•  Slowly  bend  the  wrist  up  and  hold  for  5  
seconds  then  rest  
•  Repeat  for  three  sets  of  10  repeGGons  
•  Increase  weight  as  comfort  permits  
 
 Towel  twist  
•  Hold  a  towel  with  two  hands    
•  Twist  the  towel  to  the  max  posiGon  with  the  
hand  in  the  opposite  direcGon  
•  Hold  for  5sec  then  relaxed  
•  Repeat  for  10  repeGGons  
 
Resist  wrist  support  with  weight  
 Forearm  RotaGon    
•  Hold  a  weight  in  affected  arm  and  slowly  
rotate  forearm    
•  Palm  up,  then  palm  down  
•   3  sets  of  10  repeGGons  and  then  increase  
weight  as  comfort  permits  
Thank you for your attention