Elbow Joint Anatomy www.vompti.com Joint articulations Humeroulnar - PDF document

Property of VOMPTI, LLC Elbow Joint Anatomy www.vompti.com – Joint articulations • Humeroulnar E LBOW A NATOMY , B IOMECHANICS • Radiohumeral AND P ATHOLOGY • Radioulnar (proximal and Kristin Kelley, DPT, OCS, FAAOMPT distal) Orthopaedic Manual Physical Therapy Series Charlottesville 2017-2018 Orthopaedic Manual Physical Therapy Series 2017-2018 Orthopaedic Manual Physical Therapy Series 2017-2018 www.vompti.com Bone Anatomy Bone Anatomy • Mid-Distal • Proximal Radius Humerus • Head • Fovea • Trochlea • Radial tuberosity • Medial epicondyle • Coronoid fossa • Proximal Ulna • Capitulum • Olecranon process • Radial Fossa • Coronoid process • Lateral epicondyle • Trochlear notch • Olecranon Fossa • Radial notch Orthopaedic Manual Physical Therapy Series 2017-2018 www.vompti.com Orthopaedic Manual Physical Therapy Series 2017-2018 www.vompti.com For Use of Participants Only. No Use or Reproduction Without Consent 1

Property of VOMPTI, LLC Elbow Resting Position (open packed) Elbow ROM Flexion & Extension Humero-Ulnar/Humero-Radial • UH: 70 ° flexion, slight supination joints • RH: full extension, supination – Normal (maximal): +5°-145 ° • Proximal RU: 70 ° flexion, 35° supination – Functional: 30 °-130 ° • Distal RU: 10 ° supination Pronation/Supination Radioulnar joints – Normal Pronation 75° - Normal Supination 85° – Functional: 50 ° for both Orthopaedic Manual Physical Therapy Series 2017-2018 www.vompti.com Orthopaedic Manual Physical Therapy Series 2017-2018 www.vompti.com Elbow Closed Packed Position Arthrokinematics: Humero-ulnarJt • Humero-ulnar Joint: • UH: full extension Concave trochlear notch rolls • RH 90 flexion, 5 ° supination and glides on the convex • Proximal RU: 5 ° supination, full elbow trochlea extension • Humero-radial Joint: • Distal RU: 5 ° supination Concave radial fovea rolls and glides on the convex capitulum -flexion: proximal radial glide -extension: posterior and distal radial glide Orthopaedic Manual Physical Therapy Series 2017-2018 www.vompti.com Orthopaedic Manual Physical Therapy Series 2017-2018 www.vompti.com For Use of Participants Only. No Use or Reproduction Without Consent 2

Property of VOMPTI, LLC Arthrokinematics: Radio-ulnar Joint Carrying Angle Pronation Carrying angle: average – Ulna and radius cross 13 ° – Ulna moves posterior/lateral --conjunct rotation of – Limited by bone on bone the ulna producing Supination slight pronation in ext, – Radius and ulna are parallel slight supination in – Ulna moves medial and anterior – Limited by tightening of flexion interosseus membrane, quadrate ligament and anterior ligament of distal RU joint Orthopaedic Manual Physical Therapy Series 2017-2018 www.vompti.com Orthopaedic Manual Physical Therapy Series 2017-2018 www.vompti.com Joints of the Forearm Ligament Stabilizing Structures Radio-ulnarJoint • Anterior/Medial — UCL, Anterior Capsule, • Proximal radio-ulnar jt Annular Ligament – lateral surface: radial head • Lateral — RCL – medial surface: radial notch and annular ligament • Distal radio-ulnar jt – Btw concave ulnar notch of radius and convex lower end of ulna – Joint surface enclosed by articular capsule and disc (TFCC) • Radio-ulnar syndesmosis Orthopaedic Manual Physical Therapy Series 2017-2018 www.vompti.com Orthopaedic Manual Physical Therapy Series 2017-2018 www.vompti.com For Use of Participants Only. No Use or Reproduction Without Consent 3

Property of VOMPTI, LLC Joint Stabilizing Structures Joint Stabilizing Structures • Distal Radio-ulnar Joint Interosseous Membrane Triangular Fibrocartilage • Stabilize the radius & Complex (TFCC) ulna • Articular Disc Functions: • Transmit forces -Connection of Radius and Ulna proximally through the -Separation of RU joint from ulna (20%) and radius RC joint (80%) -Provides a dual articular 80 % 20% surface to ulna during • Site of muscle pronation and to triquetrum during wrist ROM attachments Orthopaedic Manual Physical Therapy Series 2017-2018 www.vompti.com Orthopaedic Manual Physical Therapy Series 2017-2018 www.vompti.com Function Elbow-Forearm Muscles Function Elbow-Forearm Muscles Elbow Flexors — strength •Elbow Extensors max 90-110 deg – Triceps brachii – Biceps brachii- fast resisted – Anconeus – Brachialis- primary – Brachioradialis Orthopaedic Manual Physical Therapy Series 2017-2018 www.vompti.com Orthopaedic Manual Physical Therapy Series 2017-2018 www.vompti.com For Use of Participants Only. No Use or Reproduction Without Consent 4

Property of VOMPTI, LLC Function Elbow-Forearm Muscles Function Elbow-Forearm Muscles • Forearm Supinators • Forearm Pronators – Supinator — slow – Pronator teres – Biceps — fast/resisted, – Pronator quadratus strongest at 90 deg Orthopaedic Manual Physical Therapy Series 2017-2018 www.vompti.com Orthopaedic Manual Physical Therapy Series 2017-2018 www.vompti.com Medical Orthopedics-Elbow Elbow Instability • Arterial Injury • Subluxation/Dislocation – Pain out of proportion to injury and associated with stretch of muscle – MOI-fall on outstretched hand or traumatic event – Decreased or absent pulses, changes in skin color and decreased – Presentation-deformity/asymetry skin temperature • Compartment Syndrome (Volkmann’s Ischemia) – Need to rule out vascular and neural involvement – Pain out of proportion to injury and not relieved by immobilization • Ulnar and median common w/simple dislocations, – Swelling, numbness, weakness, tense tissues, but intact pulses and no changes in skin color radial with complex ones involving radial head • Olecranon Bursitis – Inflammation of bursal sac – Acute onset of unexplained swelling – Septic (aspiration) vs. aseptic (quick resolution) Orthopaedic Manual Physical Therapy Series 2017-2018 www.vompti.com Orthopaedic Manual Physical Therapy Series 2017-2018 www.vompti.com For Use of Participants Only. No Use or Reproduction Without Consent 5

Property of VOMPTI, LLC Elbow Instability Elbow Instability • Fractures Little Leager’s Elbow • – Capitulum – Children/adolescent overhead throwers – Olecranon • Uncommon • common in elderly – Apophysitis/fragmentation due to insufficient ossification centers • Young makes with high • Need to know fracture site – Risk factors: # of pitches and/or surgical procedure force trauma or elderly • < 25 pitches increased risk of elbow injury to 21% for PT decision making females, low trauma • 75-99 pitches = 35% risk – Radial head – Treatment: REST, gradual return to sport, limit # pitches – Coronoid • Fracture MOI: axial load on Distal Biceps Rupture pronated forearm, direct • • Typically part of terrible blow to elbow or – Males 40-60 yrs or younger athletes (weight lifters) hyperflexion triad: posterior – MOI: rapid, eccentric contraction of biceps with “pop” • Excision: used when UCL dislocation of elbow intact – Eccymosis at antecubital fossa, deformity of biceps insertion when w/fracture of radial • Replacement: may be acute performed if surrounding head, olecranon or – Surgery within 10 days stabilizing structures are medial epicondyle compromised Orthopaedic Manual Physical Therapy Series 2017-2018 www.vompti.com Orthopaedic Manual Physical Therapy Series 2017-2018 www.vompti.com Complications of Elbow Trauma, Instability and Injury • Elbow stiffness – Presentation — loss of extension, mild/mod pain, possible ulnar neuritis – Non-operative management • NSAIDs • Gentle mobilization – Operative management — failure of non-operative management, contracture for 12 months, lack of functional AROM • Dictated by structures involved Complex Regional Pain Syndrome • – Pain disproportionate to injury – Intractable pain in a nonperipheral nerve distribution – Edema, sensory, motor changes – Hyperalgesia, hyperpathia, allodynia, skin changes, integumentary changes Orthopaedic Manual Physical Therapy Series 2017-2018 www.vompti.com For Use of Participants Only. No Use or Reproduction Without Consent 6