AthleticTherapy：体育疗法.ppt

The Elbow Lecture 14 The Elbow nthe elbow is second to the shoulder for dislocations ( first in children ) and second to the knee for overuse injuries. Bony Structure of Elbow nhumeroulnar is the hinge joint , where the trochlea of the humerous articulates with the trochlera fossa of the ulna nthe humeroradial joint is a gliding joint , here the capitulum of the humerous articulates with the radius nthe annular ligament binds the head of the radius to the radial notch of the ulna forming the proximal radioulnar joint this is a pivot joint allowing for pronation and supination nCarry Angle of the Elbow nThe angle between the long axes of the humerus and the ulna when the arm is in an anatomical position nThis is called this because it allows the forearm to angle away from the body when a load is carried in the hand nCarrying angle is generally greater in females than in males Elbow Stability nMedial Collateral a) anterior - strong & reinforces annual lig. b) transverse - weaker c) posterior fibres Most important ligament in the elbow for stability nLateral Collateral a) anterior b) intermediate c) posterior nall help to reinforce the strong annular ligament Elbow movements nFlexion nExtension nPronation nSupination Common Injuries Elbow Dislocation / Subluxation nulnar dislocations nhyperextension ( Fall on hand elbow extended) with violent twisting action of the ulna , needs a tremendous amount of force nmore common displacement of radial head especially in children , swinging of children by their arms , may cause radial head to snap out of the annular ligament nsevere pain with loss of function , cracking or snapping sensation , rapid swelling and obvious deformity , inability to move elbow n90 % posterior , management is important not to cause long term disabilities First Aid nIn case of dislocations a primary concern is not to cause complications to the neurovascular tissue nApply ice and compression nSplint on both sides of the injury and stabilize as best as possible Olecranon Bursitis nthe olecranon bursa is the largest bursa in the elbow and sits just over the olecranon process ninjury results due to a direct fall, constant irritation, or infection nan acutely inflamed bursa will rapidly swell, show signs of redness and increased heat noften termed golf ball swelling nthe bursa may become infected again it will be swollen and hot to touch along with a possible fever , pain , tenderness and restricted range of motion, refer to Dr immediately if infected nRx PIER protection, aspiration may be necessary Elbow strain nusually the result if someone attempting to overcome large force with muscle ninadequate warm-up , excessive training (past point of fatigue) ncommon with biceps brachii, brachiallis, triceps npain and point tenderness over the injury site, reduced strength and ROM nRx PIER , NSAIDS strengthening Elbow Sprain nusually the result of fall on extended arm, producing a hyperextension of elbow nor through a valgus/varus force nmay be due to a repetitive force that irritate or tear the ligaments npain , local tenderness . pain and or laxity with stressing of the ligament, decreased ROM nRx PIER , NSAIDS strengthening Medial Epicondylitis naka : little league elbow or golfers elbow nrepetitive motions with poor technique, muscular weakness or anatomical weakness noften seen in the acceleration phase of throwing nvalgus force is placed on the elbow, which strains the flexor muscle , the ulnar collateral ligament and possibly the ulnar nerve. nswelling at the medial epicondyle, point tenderness, pain on resisted wrist flexion and pronation ntingling and numbness may be felt if the ulnar nerve is involved nRx- PIER , NSAIDS, bracing modalities retraining Lateral Epicondylitis naka : tennis elbow nmost common overuse injury in the elbow nthis condition is typically due to eccentric overloading of the extensor muscles as seen in the deceleration phase of throwing or the tennis stroke npain will be located on the lateral epicondyle , it may be swollen and the pain will increase with resisted wrist extension nRx- PIER , NSAIDS, bracing , retraining Contributing factors to tennis elbow nlack of experience nmissing “sweet spot“ poor technique on backhand nheavy stiff racquet ( 12 - 12.5 seem to be best) ngrip size nracquet strings to tight( 2-3 lbs. best) nplaying surface ( ball bounces more off cement) Cubital Tunnel Syndrome nimpingement of ulnar nerve in cubital tunnel of the elbow ( through ulnar groove and under the ulnar ligament) nhere the nerve is vulnerable to compression and tensile stress caused by tr