PowerPoint Presentation

Elbow and Forearm Injuries Lewis Young, ATC, LAT

Image 1: Flexion of forearm muscles

OverviewAnatomy of upper extremity and surrounding structuresAcute elbow injuriesNon-acute elbow injuriesTreatment and rehab methods injuriesCurrent upper extremity cases

Image 2: Elbow dislocation

Anatomy

Image 3: AnatomyOf the upper extremity

Acute Elbow InjuriesElbow DislocationOlecranon Process Fracture

Image 4: Lateral and Anterior X-ray imaging of acute elbow dislocation

Elbow DislocationDislocation: Can dislocate in various directions.Tx: Reduce dislocation (doctor), surgery, cryotherapy, immobilization, exercises

Elbow FractureType I: A "nondisplaced" fracture, where the bone has a break, but is still in its normal position.Type II: A fracture where a fragment of bone is shifted from its normal position.Type III: The most serious type of fracture, with multiple breaks of the bone.

Image 6: Classifications of elbowfracture

Non-Acute Elbow InjuriesOsteochondritis Dissecans Cubital Tunnel SyndromeUCL SprainTennis Elbow Golfers Elbow

Image 7: A health care professional provides infrared laser for tennis elbow

Osteochondritis DissecansLocalized lesion of the capitelumAffects mostly throwing athletes and gymnasts.Late part of cocking and early acceleration phases of throwing create a valgus stress across elbow. Causes shear and compressive forces.Patients present with elbow pain and stiffnessMay feel a locking or catching sensationTx: Rest will relieve pain, surgery may be needed if severe.

Image 8: An OCD Lesion on the capitelum of the elbow

Cubital Tunnel SyndromeElbow in full flexion causes retinaculum to be taut, cubital tunnel becomes tight and compresses nerve. Max strain on the ulnar nerve occurs in the acceleration phase of a throw.Tx: reduce nerve irritation and increase dynamic joint stability, NSAID, night splint to limit flexion, strengthen if stability is a concern.

Image 9: The ulnar nerve (elbow)is blocked and has caused a loss of sensation in the highlightedportion of the hand

UCL PathologyOverhead throwing athletes place repetitive valgus stress on Anterior Oblique Ligament (AOL) of the UCL ComplexPain and soreness in the medial elbow with throwingPoint tenderness at insertion of ulnaAssess valgus laxity through moving valgus stress testTx: Rest from throwing sport, anti-inflammatory meds, strength and stability exercises. Surgery if pathology is worse or doesnt see improvement.http://www.theplayerstribune.com/adam-ottavino-rockies-tommy-john-rehab-video/

Image 10: The ulnar collateral Ligament (AOL complex) is torn

Tennis & Golfers ElbowTennis Lateral EpicondylitisGolfers Medial EpicondylitisFeeling of a dead armTx: Active Release, IASTM, cold compression therapy, strengthening and grip exercises, NSAIDS, extensor flexibility

Image 11: A tennis player is massaging the Lateral epicondyle to relieve histennis elbow symptoms

Active Release TechniqueNew method of soft tissue mobilization for breaking scar tissue adhesionsOver time micro tears form on muscle fibers and tendon fibers, scar tissue formsMuscle will become tight and therefore weakened due to inadequate length/tension relationshipActive release involves moving muscle actively and passively while placing pressure on muscle/tendonResult is autogenic inhibition with scar tissue alignment.

Image 12: An athletic trainerPerforms active release (activerange of motion) on an athlete.

Current Tennis Elbow CasesMale tennis player* with lateral epicondylitisSymptoms described as gripping a racquet with a dead arm.Upper body lifts and long practices caused onset of symptoms in season. Tx: Active Release technique/IASTM, Game ready full arm, extensor strengthening and stretching, accupuncture once weekly*For confidentiality purposes names and pictures of the athlete are not shown

Image CitationFound images, licensing, and citationCadogan, M. (n.d.). Elbow Dislocation X-Ray [Elbow Dislcoation]. Retrieved April 25, 2016, from http://lifeinthefastlane.com/elbow-dislocation/Anatomy of Upper Extremity: Copyright Elsevier inc, photo ID 4541 from https://netterimages.com/arteries-and-nerves-of-upper-limb-labeled-multiple-publications-neurology-neurosciences-frank-h-netter-4541.htmlClassification of elbow dislocations; Reproduced with permission from Bruce, D., Browner, Jupiter, J. B., Levine, A. m. & Trafton, P. G. Skeletal Trauma. Fractures, dislocations and Ligamentous Injuries, Vol 2. Philadelphia: Saunders, 1992. From dutchemergencymedicinecases.comAvruskin, A. (2016, February 19). Elbow Fractures [Elbow Fracture Types]. Retrieved April 26, 2016, from http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=6a70b18b-ccb7-43f1-b36c-05615be668dfOCD: Little league elbow youtube photo creative commons license, from https://www.youtube.com/watch?v=sfAxCsv_HesCubital Tunnel Syndrome: Image created by me using ebscos health library.UCL Pathology: Copyright MMG 2008, from http://www.houstonmethodist.org/orthopedics/where-does-it-hurt/elbow/ulnar-collateral-ligament-injuries/ART: Photo from Dr. Tracey Reeb, accessed from http://www.studiocitychiropractor.com/styled-2/styled-9Tennis Elbow: Photo from Bill Gray, accessed at http://www.tennis.com/gear/2010/07/mailbag-advice-for-tennis-elbow-sufferers/38767/#.Vx99LqgrLIUForearm image: photo from Scott Eaton, on http://www.scott-eaton.com/courses/anatomy-courses-and-workshops/anatomy-for-artists-online-course/upper-arms-and-forearms

Information CitationGliedt, J. A., & Daniels, C. J. (n.d.). Chiropractic Treatment of Lateral Epicondylitis: A Case Report Utilizing Active Release Techniques. Retrieved May 02, 2016, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4322013/Goforth, Mike. (n.d.). Upper extremity pathology in sports medicine. Lecture. February 12, 2016.