Elbow Anatomy. Bones of the Elbow Humerus –Medial and Lateral Epicondyle Ulna –Olecranon Process Radius –Head.

Elbow Anatomy

Bones of the Elbow• Humerus

–Medial and Lateral Epicondyle

• Ulna–Olecranon

Process

• Radius–Head

Elbow Anatomy• Joint

– Humeroulnar• Actions

– Flexion and Extension

• Ligaments– Lateral Collateral

• Ulna and radius to humerus

– Medial Collateral• Ulna to humerus

– Keep elbow stable

Lateral and Medial Collateral Ligaments

Muscles of the Elbow

• 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 radius

A: Elbow flexion Assists in supination when forearm is pronatedAssists in pronation when forearmis 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 elbow is extended and the forearm is

supinated, the humerus, radius and ulna are not perfectly aligned. This is called Carrying Angle

• This angle allows the elbow to be tucked into the waist depression above the iliac crest; it increases when a heavy object is being lifted

• 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

– Medially or laterally rotating the shoulder• 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 elbow flexors

Triceps Brachii

O: 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

Triceps Brachii• The medial head (C) of the

triceps is the most active but the lateral head (B) is the strongest

• Both lateral and long heads (A) 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

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

A: Assists in extension of elbow Stabilizes elbow

Integrated Function: Assists in deceleration of elbow flexion

Golfer’s Elbow and Tennis Elbow

• Tennis Elbow–Lateral Epicondylitis

• Golfer’s Elbow–Medial Epicondylitis

Lateral Epicondylitis

• Tennis elbow

• Overuse injury on the lateral epicondyle of humerus –Tennis, raquetball, squash, painting

• Caused by overuse of the wrist extensors, primarily the extensor carpi radialis brevis which attaches to the lateral epicondyle of the humerus

Medial Epicondylitis

• Golfer's elbow• Overuse injury on the medial

epicondyle of humerus –Pitching, golfing, gardening, typing,

bricklaying

• Caused by overuse of the wrist flexors that attach onto the medial epicondyle of the humerus

Lateral and Medial Epicondylitis• Symptoms

– Pain and tenderness on the medial or lateral epicondyle of the humerus

• Pain during– Grasping, pushing, pulling or squeezing of

objects • Shaking hands • Carrying a briefcase • Writing • Lifting objects • Steering a car

Lateral and Medial Epicondylitis• Treatment

– Diagnosis by physician– RICE

• Rest : Avoid activities that aggravate the injury

• Absolute rest should be avoided as it encourages muscle atrophy 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

Lateral and Medial Epicondylitis

• Treatment–Stretch

• Wrist flexors and extensors•Strengthen:

–Rotator cuff muscles–Scapular muscles–Forearm pronators and supinator muscles

–Wrist extensors and flexor muscles–Finger flexor and extensor muscles

• Gentle stretching of wrist flexors and extensors

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

• Hold each stretch for 30 seconds

• Perform 5-10 reps, at least twice a day

• Vigorous stretching should be avoided - do not stretch to the point of pain

Strengthening Exercises

• Support forearm and wrist on table

• Perform wrist extension and wrist flexion with one pound weights

• Perform 3 sets of 10 reps with 60 sec rest intervals

Strengthening Exercises

• Support forearm on edge of table or thigh

• Use a wrench or hammer

• Perform forearm pronation and supination

• Perform 3 sets of 10 reps with 60 sec rest intervals

Strengthening Exercises Finger Extension • Place a rubber band around all

five finger tips• Abduct fingers for 3 sets of 20

reps with 60 sec rest intervals • For increased resistance, add a

second rubber band or use a rubber band of greater thickness

Ball Squeeze • Squeeze a tennis ball, piece of

foam or sponge for 3 sets of 20 reps with 60 sec rest intervals