Evaluation, Recognition and Treatment of the Elbow and Forearm
SEATA-Student Symposium Competencies
Workshop
Dr. Ben Velasquez, D.A. ATC, LATAssociate Professor, Program DirectorAthletic Training Education Program
School Human Performance and Recreation
University of Southern MississippiHattiesburg, Mississippi
Introduction to this lecture Before beginning:
Ask yourself “what” does this topic have to do with “me” getting certified??????
Where does this “fit in?” The NATABOC Role Delineation Study 4th
ed. NATA Athletic Training Educational
Competencies
The Role Delineation Study- Under the domain of “Prevention”
“Educate the appropriate individual(s) about risks associated with participation using effective communication techniques to minimize risk of injury”
Knowledge of: Mechanisms of injury
The Role Delineation Study- Under the domain of “Prevention”
“Review preparticipation screening information by applying accepted guidelines to minimize the risk of
injury and illness.”
Skill in: Identifying conditions that may limit or compromise participation
The Role Delineation Study- Under the domain of “Immediate Care”
“Initiate and/or execute techniques to mitigate life-threatening and other emergency conditions through the use of standard emergency care procedures”
Knowledge of: Immobilization techniques and equipment
The Elbow & Forearm:
The elbow is a hinge joint, important to the kinetic chain by adjusting the length of the arm and allowing positioning of the forehand, wrist and hand for effectiveness during daily living and sport activities.
The Elbow & Forearm:
The elbow is vital for positioning the hand for all functional activities.
The elbow is also vital for providing a “link” between the powerful movements of the shoulder and the fine motor control of the hand and fingers.
Anatomy: Review
Bones: Humerus, Radius, Ulna Articulations: Humeroulnar, Radiohumeral,
and Radioulna articulations. Ligamentous:
Ulnar Collateral Ligament - (UCL)Anterior Oblique Ligament- (AOL)Lateral Collateral Ligament- (LCL)Radial Collateral Ligament- (RCL)Accessory Collateral Lig - (ACL)Lateral Ulnar Collateral Lig- (LUCL)
Elbow Anatomy:Review Muscles and Movements:
1. Flexion: Biceps, Brachialis, Brachioradialis
2. Extension: Triceps, Anconeus
3. Supination: Supinator, Biceps,
Brachioradialis
4. Pronation: Pronator Teres, Pronator
Quadratus
Forearm Anatomy-Review Muscles:
Extensors and Flexors of the wristSupinator and Pronator of the wrist
Elbow Review- Range of Motion Flexion: 135+ degrees Extension: 0/-5 degrees Supination: 90 degrees Pronation:90 degrees
(see Hoppenfeld-Physical Examination of the Elbow)
Prevention of Elbow Injuries
The keys to preventing injuries to the elbow are:
1. Strength of all muscles surrounding the joint.
2. Flexibility and proper Range of Motion
3. Use of proper throwing techniques and biomechanics.
Elbow Injury Evaluation Sequence
History: Acute injury:
-What, where, when, how
-Type of pain (radiating, sharp, referred, dull, aching, intermittent)
-Previous injury
-Sounds: (popping , crepitus)
-Sensations: (numbness or tingling)
Elbow Injury Evaluation Sequence
History: Chronic Injury
1. All the previous questions of an acute injury plus:
-conditioning program
-throwing mechanism
-biomechanics
-pain (type and source during activity)
Elbow Injury Evaluation Sequence
-swelling
-deformity
-discoloration
-signs of trauma
or injury
-skin color
-carrying angle
-muscle guarding/spasm
Observation and Inspection Bilaterally For Comparison of:
Elbow Injury Evaluation Sequence
Palpation:
Palpate underlying anatomy (bilaterally)
-swelling
-deformity
-skin temperature
-crepitation
-muscle spasms and sensations
Elbow Injury Evaluation Sequence
Range of Motion Evaluation:
Perform bilateral range of motion tests
(observe for pain and limitations of motion)
-passive ROM
-active and resistive ROM
-flexion and extension
-pronation and supination
Evaluation and Recognition of Elbow Injuries-Review: Check the Bony Anatomy Check the Joints that compose the elbow:
1. Humeroulnar (Trochlea & Trochlea Notch of the Ulna)
2. Humeroradial (Capitulum & Radial Head)
3. Superior Radioulna (Radial Head & Radial notch of the Ulna)
Evaluation and Recognition of Elbow Injuries Review: Check the Ligmentous Structures:
1. Ulnar Collateral (Medial) 3 sections:
Ant./Transverse/Posterior Obilque
2. Radial Collateral (Lateral)
3. Lateral Ulnar Collateral
4. Annular
5. Interosseous Membrane
Evaluation and Recognition of Elbow Injuries Review: Evaluate Muscle Structure, Range of Motion,
Strength and Power.1. Flexion: Biceps Brachii , Brachialis,
Brachioradialis2. Extension: Triceps Brachii, Anconeus3. Supination: Supinator, Biceps Brachii ,
Brachioradialis4. Pronation: Pronator Teres, Pronator
Quadratus
Emergency Care of an Acute Elbow Injury: Careful evaluation:
- Check the Distal Radial Pulse
- Check Fingernail Bed Compression
- Immobilize in the position in which the
body part is found using proper types of
splints
- Ice, Compression and Elevation as
indicated by the position of the injury.
Common Mechanisms of Injury
Falling on the outstretched arm Direct contact from blows Overuse syndromes
Common Mechanisms of Injury (young athletes) Falling on the
outstretched arm Direct contact from
blows Overuse syndromes strength imbalances
during periods of growth
Bone length imbalances during periods of growth.
Decreased flexibility Impaired coordination Biomechanical stress
on the epiphysis
Injuries to the Elbow
Osseous and Articular Ligamentous Soft Tissue/Joint Tendon Alterations Muscle Alterations Nerve Alterations
Elbow Injuries: Osseous and Articular Bony hypertrophy Traction spur
formation Osteochondral defects Loose bodies Joint degeneration
-Chondromalacia -Osteophyte formation
Problems of bone immaturity:
Epiphyseal -Apophyseal -Hypertrophy
-Fragments and avulsion
Effects of fracture and dislocation
Elbow Injuries: Soft Tissue/Joint /Tendon Injuries Synovitis Adhesive Capsulitis
(inflammation of the joint capsule)
Tendinosis Tendinitis Tenosynovitis
Elbow Injuries: Nerve Alteration
Ulnar nerve entrapment in the cubital tunnel Ulnar nerve stretching and dislocation Median nerve entrapment (Pronator
syndrome) Radial nerve entrapment Lateral antebrachial cutaneous nerve
entrapment
Injury Evaluation Key Points:
Deformity or crepitation may indicate fracture.
Suspect avulsion fracture with pre-adolescents and adolescents rather than ligamentous or muscular injury
Throwing mechanisms produce great force at the elbow joint.
Injury Evaluation Key Points:
Elbow injuries may refer pain into the forearm, wrist and fingers.
Nerves of the brachial plexus innervate the elbow and forearm.
Major blood supply to the elbow and forearm is the brachial artery which branches into the radial and ulna artery.
When To Refer The Athlete To A Physician: Joint instability, or suspected fracture. Gross deformity, or swelling around the
joint and loss of sensation below the elbow. Significant loss of ROM. Considerable PAIN (on finger extension). Audible “click” or “pop” a time of injury. If you have any doubt regarding severity.
Review of Special Tests for Elbow Evaluation: Valgus and Varus Stress Test Wrist Extension Test (Lateral Epicondylitis) Hand Shaking Test (Lateral Epicondylitis Medial Epicondylitis Test Ulnar, Median and Radial Nerve
Distribution Test
Management and Treatment of Elbow Injuries: Use of Cryotherapy / Thermotherapy/
Hydrotherapy that is appropriate to the healing process
Local compression Use of nonsteroidal anti- inflammatory
medications (NSAIDs) Rehabilitation protocols
Goals of Elbow Rehabilitation
Reduce pain and local inflammation Regain normal joint movement and artho-
kinematics Regain strength, power, and endurance of the
entire elbow region (forearm and upper arm) Elbow must perform functionally and handle
stresses from sports specific activities Minimize the risk of re injury.
Preventing Recurrence of Injuries to the Elbow Education of the athlete in maintaining
1. proper conditioning2. proper biomechanics3. functional strength
Hands On Practice:
Break up in to groups of eight or nine.
Use your practice sheets.
Evaluate your partner for an elbow injury.
HAVE FUN!!!!!!!