Elbow Flexors and Extensors

Elbow Anatomy - Bones• Humerus

–Medial Epicondyle

–Lateral Epicondyle

• Radius

• Ulna

–Olecranon Process

The Ulna Olecranon Process

Trochlear Notch

Coronoid Process

Radial notch

Ulnar Tuberosity

HeadStyloid Process

The Radius

Head

Neck

Radial Tuberosity

Styloid Process

Ulnar Notch on medial surface

Ulna, lateral view

Humeroulnar Joint

Humerus Lateral View

Elbow Anatomy - Ligaments

• Lateral Collateral Ligament–Ulna and radius to humerus

• Medial Collateral Ligament–Ulna to humerus

• Keep the elbow stable

Lateral Collateral Ligament

Medial Collateral Ligament

Ulna, lateral view

Radius, lateral view

Radioulnar joint

Nerves • Three primary nerves of the humerus, radius, ulna,

and wrist:

– Radial Nerve

• Innervates the triceps brachii and provides sensation to dorsal side of thumb, index, middle, and half of ring finger

– Ulnar Nerve

• Palmar side of the little finger and half of the ring finger

– Median Nerve

• Palmar side of thumb, index , and half of ring finger

Arteries• Brachial artery

travels across the crease of the elbow and splits into two branches below the elbow

–Ulnar and Radial Artery

Elbow Anatomy Muscles• Elbow Flexors (3 B’s)

–Biceps Brachii

• Long and Short head

–Brachioradialis

–Brachialis

• Elbow Extensors

–Triceps Brachii

–Anconeus

Biceps BrachiiO: Short head: Coracoid process of scapulaLong head: Supraglenoid tubercle of scapula

I: Radial tuberosity

A: Elbow Flexion Forearm Supination Assists in Shoulder Flexion

Integrated Function of Biceps Brachii

• Assists in deceleration of elbow extension

• Assists in deceleration of forearm pronation

• Assists in deceleration of shoulder extension

• Assists in dynamic stabilization of the humeral head during head during functional movements

BrachialisO: Anterior surface of distal humerusI: Ulnar tuberosityA: Elbow flexion

Integrated Function: Assists in deceleration of elbow extensionAssists in dynamic stabilization of elbow

BrachioradialisO: Lateral supracondylar ridge of humerusI: Styloid process of radiusA: Elbow flexion Assists in supination when forearm is pronated Assists in pronation when forearm is supinatedIntegrated Function: Assists in deceleration of elbow extensionAssists in dynamic stabilization of elbow

Elbow Flexors• The biceps brachii is most powerful when

elbow supination is maintained throughout the exercise (it pulls on the radius to rotate it). Both heads work together-very hard to isolate long or short head separately

• The brachialis is a strong elbow flexor regardless of whether the forearm is pronated or supinated (it cannot rotate the ulna)

• The brachioradialis is strongest in a neutral position (between pronation and supination)

Carrying Angle• When the forearm is supinated the humerus,

radius, and ulna are not perfectly aligned

• The typical carrying angle is 5 to 15 degrees which allows the forearm to clear the hips during ambulation

• In females a wider carrying angle is due to a wider pelvic girdle

• Carrying angle influences how people hold objects

• Individuals with extreme carrying angles tend to pronate

Preacher Curls-Ouch!• Common Mistake Made: External/Internal rotation the

shoulder joint.• Possible Negative Effect: When you sit at the machine

or bench you place your shoulders in an unnatural position which puts strain on your biceps tendon. Also, the bench or machine does not allow natural shoulder flexion that is created by the biceps brachii during a curl.

• Avoid preacher curls! There are more effective ways to train your forearm flexors.

Triceps BrachiiO: Long head - Infraglenoid tubercle of scapula Lateral - Posterior humerusMedial - Posterior humerusI: Olecranon process of ulnaA: Elbow extensionAssists in shoulder extension (long head)

Integrated Function of Triceps Brachii

• Assists in deceleration of elbow flexion

• Assists in deceleration of shoulder flexion

• Assists in dynamic stabilization of the glenohumeral joint

AnconeusO: Lateral epicondyle of humerusI: Olecranon process & upper posterior ulna

A: Assists in extension of elbow Stabilizes elbowIntegrated Function: Assists in deceleration of elbow flexion

Triceps Brachii• The medial head (deep) of the triceps is the most

active but the lateral head is the strongest

• Both lateral and long heads have 60% Type II Fast Twitch Muscle Fibers

• Medial head has 60% Type I Slow Twitch Muscle Fibers

• The triceps are not affected by grip position

Golfer’s Elbow and Tennis Elbow

• Golfer’s Elbow:–Medial

Epicondylitis

• Tennis Elbow:–Lateral

Epicondylitis

Medial Epicondylitis• Golfer's elbow• Most common overuse injury on the

medial epicondyle of humerus • It is the inflammation of the wrist and

finger flexor tendons that attach onto the medial epicondyle of the humerus

• This causes micro tearing of tendons, hemorrhage, inflammation, scarring, degeneration and shortening of the tendons

Symptoms of Medial Epicondylitis• There is pain and tenderness on the medial

(middle) aspect of the elbow on the medial epicondyle.

• Painful activities include:– Grasping or squeezing a handle,  a golf club

or a tennis racquet. – Shaking hands. – Carrying a briefcase – Writing – Lifting objects – Steering a car

Common Causes of Medial Epicondylits• Occupational overuse • Weak grip strength • Poor fitting equipment– grip size or weight of 

club or racquet • Cervical spine nerve pinching• Elbow hyperextension, "double jointed". • Overuse in a sporting or daily activity • Improper technique • Direct trauma • Untreated past injury of the upper extremity 

or fracture

Lateral Epicondylitis• Tennis elbow

• Most common overuse injury on the lateral epicondyle of humerus

• It is the inflammation of the wrist and finger extensor tendons that attach onto the lateral epicondyle of the humerus

• This causes micro tearing of tendons, hemorrhage, inflammation, scarring, degeneration and shortening of the tendons

Symptoms of Lateral Epicondylitis• Pain or tenderness on the outer side of

the elbow • Pain when you straighten or raise your

wrist and hand • Pain made worse by lifting a heavy object • Pain when you make a fist, grip an object,

shake hands, or turn door handles • Pain that shoots from the elbow down into

the forearm or up into the upper arm.

Common Causes of Lateral Epicondylitis

• Repetitive movement• Strain or the overuse of forearm and wrist

extensor muscles• Incorrect grips, poor hitting positions,

using a metal framed tennis racquet, improperly carrying a briefcase or other heavy object, or spending too much time using isolated muscle groups in the elbow area.

• Golfers, computer users, machinists, carpenters, mechanics, painters…

Factors of Lateral Epicondylitis• Poor Posture:

– In an EMG study of computer operating office workers, they found that in a slumped posture with foreword head,the tension in the wrist extensors rose approximately 25%. 

– If gently tapping on a keyboard with faulty posture had such a dramatic effect, can you imagine what lifting weights would do?

• Shoulder Flexibility:– Flexibility deficits in shoulder rotation may lead

to elbow problems    

Factors of Lateral Epicondylitis

Rotator Cuff Strength• Strengthening of the rotator cuff and scapular

stabilizing muscles - in addition to the wrist extensors - is very important. 

• Any weakness in this kinetic chain can cause Lateral Epicondylitis. 

• If there is no scapular stability, posture will suffer • If the rotator cuff fatigues, the wrist extensors will

often compensate • Both of these situations result in increased forces

at the elbow joint and can eventually lead to Lateral Epicondylitis or a reoccurrence of it 

Treatment for Epicondylitis• Diagnosis by Doctor• RICE:

– Rest : Avoid activities that aggravate the injury. – Absolute rest should be avoided as it encourages

muscle atrophy, deconditions tissue, and decreases blood supply to the area

– Ice- Place an ice bag or a bag of frozen veggies on your elbow 3 times a day for 20 to 30 minutes and for 15 min after active use of your arm. You may also run an ice cup directly on the elbow for 5- 10 minutes.

– Compress and Elevate if appropriate to assist venous return and minimize swelling.

Treatment for Epicondylitis• Stretching:

–Will help prevent stiffness by breaking down any scar tissue that may result from the inflammation

• Strengthening• Brace• Physical Therapy/Occupational

Therapy

• Gentle stretching exercises including wrist flexion, extension and rotation.

• The elbow should be extended and not flexed to increase the amount of stretch as required

• These stretches should be held for 20-30 seconds and repeated 5-10 times, at least twice a day.

• Vigorous stretching should be avoided - do not stretch to the point of pain that reproduces your symptoms.

Strengthening Exercises• With the elbow bent and

the wrist supported perform the following exercises:

• Wrist Extension-Place 1 lb. weight in hand with forearm pronated; support forearm at the edge of a table

• Extend wrist slowly (concentric contraction), and flex slowly (eccentric contraction).

Strengthening Exercises

• Wrist Flexion:–Place 1 lb. weight in

hand with forearm supinated support forearm at the edge of a table

–Flex wrist up slowly (concentric), then extend slowly (eccentric).

Strengthening Exercises• Combined Flexion/Extension:

– Attach one end of a string to a cut broom stick or similar device, attach the other end to a weight.

– In standing, extend your arms and elbows straight out in front of you.

– Roll the weight up from the ground by turning the wrists.

– Flexors are worked with the palms facing upward. Extensors are worked with the palms facing downward.

Strengthening ExercisesForearm

Pronation/Supination Grasp hammer (wrench, or some similar device) in hand with forearm supported. Rotate hand to palm down position, return to start position (hammer perpendicular to floor), rotate to palm up position, repeat. To increase or decrease resistance, by move hand farther away or closer towards the head of the hammer

Strengthening Exercises Finger Extension • Place a rubber band around all five

finger tips. • Spread fingers 25 times, repeat 3

times. • If resistance is not enough, add a

second rubber band or use a rubber band of greater thickness which will provide more resistance.

Ball Squeeze • Place rubber ball or tennis ball in

palm of hand, squeeze 25 times, repeat 3 times.

• If pain is reproduced squeeze a folded sponge or piece of foam