The Elbow and Forearm Complex

Anatomy of the Elbow

Muscles of the Elbow

Nerves of the Upper Extremity

Joint Positions and Capsular Patterns

Loose Packed Position/resting position

Closed-Pack Position

Capsular Pattern

Ulnohumeral Joint (elbow)

70 degrees flexion, 10 degrees supination

Extension Flexion, Extension

Radiohumeral Joint

Full Extension, Full Supination

Elbow flexed 90 deg, forearm supinated 5 deg.

Flexion, Extension, Supination, Pronation

Proximal Radioulnar Joint

70 deg. flexion,

35 deg. supination

5 deg. supination Supination, Pronation

Distal Radioulnar Joint

10 deg. supination 5 deg. supination Full ROM, pain at extremes of rotation

Total Elbow Arthroplasty

• This picture depicts the prosthesis for a total elbow arthroplasty (TEA)

• This is the most common surgery when there is joint destruction (such as with RA)

• This procedure includes a humeral and ulnar implant and the head of the radius may be replaced as well.

• Cement is used for placement (don’t do US over a TEA)

Figure 18.5 Kisner & Colby page 568

Joint Surgery and Post-op Management

• Some specific motions of the joint may be limited after surgery to prevent stress on the capsule, ligaments, tendons, etc.

• Consult with the PT, KNOW THE LIMITATIONS!

Lateral Epicondylitis

• Lateral Epicondylitis (Tennis Elbow)

-pain in the common wrist extensor tendons along the lateral humeral epicondyle

-typically brought on by repetitive movements of the wrist or activities requiring stability of the wrist (tennis backhand)

http://www.hss.edu/conditions_tennis-elbowoverview.asp

Medial Epicondylitis

Medial Epicondylitis

(Golfer’s Elbow)

-pain at the common wrist flexor tendon along the medial humeral epicondyle

-due to repetitive movements into wrist flexion (golf swing, gripping, throwing a ball, etc.)

-ulnar neuropathy can also occur

http://www.aidmyelbow.com/common-elbow-strains.php

General Considerations for Overuse Syndromes

• PROTECTION PHASE

-Immobilize: rest the muscles, can use a splint

-Avoid provoking activities: repetitive wrist motions, gripping

-Cryotherapy: ice massage, cold pack

-Multi-angle muscle setting (low-intensity isometrics)

-Cross-fiber massage

-Maintain mobility / strength in unaffected joints (shoulder, etc)

General Considerations for Overuse Syndromes

• CONTROLLED MOTION AND RETURN TO FUNCTION PHASE

*Progress to this stage only when inflammation is controlled

-Manual stretching

-Self-stretching

-Cross-fiber (friction) massage

-Isometrics progressing to Theraband, free weights, etc.

-Isolated motions progressing to functional patterns

-General strengthening and conditioning

-Simulation of work or recreational activities

-Plyometrics (if returning to sports, etc)

-Activity Modification / Patient Education

Self Stretching to Increase Elbow Extension and Flexion

Self Stretching- Muscles of the Lateral and Medial Epicondyles

• This figure demonstrates stretching of the wrist extensors (from the lateral epicondyle)

• Stretching the wrist flexors involves extension at the wrist with the elbow in full extension

• See HEP handouts as well for more pictures• Figure 18.10 Kisner & Colby page 579

Resistance Exercises for the Elbow, Forearm, and Wrist

Functional Exercises for the UE

UE Theraband Exercises for Elbow Strengthening

Combined Pushing Motions

Case Study

• John is a 45 y/o painter who comes to your clinic with a diagnosis of left ‘elbow pain’. During the PT evaluation the therapist palpates tenderness and inflammation at the lateral epicondyle of the humerus and testing reveals tight wrist extensors with 4/5 MMT. Pain is a 4/10 in the morning and an 8/10 after working all day (painting). The patient is left hand dominant. His grip strength is weaker in his left hand by 30% when compared to the right.

1) What term (pathology) would best describe the patient’s condition?

2) What mechanics (actions) likely initiated his symptoms?

3) What patient education would you give John?

4) Create a home management program for this patient.

5) What are the key components to this patient’s treatment?