Elbow Complex & Stability

The role of the elbow is to position

the hand for optimal function

restrictions in the elbow lead to

compensations in shoulder/wrist

Medial Collateral Ligament or Ulnar Collateral Ligament is comprised of 3 bands

anterior, posterior, & transverse bundles

The Medial Collateral Ligament or Ulnar Collateral Ligament connects the medial epicondyle to the

medial margin of trochlear notch of ulna

Medial Collateral Ligament or Ulnar Collateral Ligament exists to restrict

valgus stress

Lateral Collateral Ligament (Radial Collateral Ligament) connects the Lateral epicondyle to the

annular ligament

Lateral Collateral Ligament (Radial Collateral Ligament) connects to the

medial angulation of ulna on humerus (Varus Stress)

LCL Complex of the elbow comprises of

RCL

Annular ligament

Lateral Ulnar collateral ligament/Ulnar-Radial Collateral ligament: PLRI (provides rotary stability to radius)

Elbow boney Stability comes from

RH & UH

Coracoid: Buttress against posterior displacement of forearm

Elbow Stability from anterior jt capsule provides restraint against

varus & valgus force w/ elbow in full extension

elbow stability from MCL provides Valgus Restraint & medial posterior rotatory stability. When position is the MCL taut in?

Pronation

The Flexor pronator group is on medial side of elbow therefore the

extensor supinator group on lateral side

muscular extensors on lateral side provides compressive stability to the elbow & protect against

varus stress

Annular Ligament maintains Radial Head in position by its form of 4/5ths of a ring. It is lined w/ hyaline cartilage & blends w/ the

med & lat collateral ligaments

Dislocation of Radial Head: Nursemaid's Elbow occurs due to radial head being

not well formed w/in annular ligament

Younger 1-4 years old

Olecranon Bursa is found superficial to the olecranon process of the ulna, located between the skin & bone. Usually a result of

direct trauma or mirco-trauma; Studier’s Elbow

Septic related to infection

tx: Compression

Avoidance of provocative activities

Analgesics if necessary

Musculoskeletal Injuries of the elbow account for a small overall proportion of MSK conditions, can lead to High levels of disability. Common conditions are:

Fractures/Dislocations

Instability/Ligamentous injuries

Tendinopathies: Overuse

Neural Injuries/Entrapments

A pt w/ elbow pain may present w/ red flag conditions that are not MSK related. These red flags may be referred pain to the elbow stemming from

acute MI, Pancoasts syndrome, esophageal motor disorders

a pt w/ elbow pain may present w/ red flags including non- MSK acute painful swelling which may be

gout, septic arthritis, osteosarcoma, hemarthrosis, soft tissue abscess, cellulitis

during elbow pt eval, screen the

c-spine: radicular pain

shoulder: referred pain

neurologic exam: Brachial Plexus, TOS, Proximal or Distal Neural Entrapments

Clinical Tests and Measures during eval of the elbow

UQS

Observation, palpation

Active & Passive Elbow ROM

Elbow/Grip/Pinch Strength

Elbow Special Tests

In eval, observation of the elbow must look out for posture & carrying angle. What are the normal ranges & what to look out for?

Normal valgus (Males 5-10°; Females 10-15°)

Asymmetry, Deformity

Signs of inflammation: Edema, Erythema, Warmth

elbow Extension/Flexion AROM

0-145°/150°

elbow flexion/extension strength is strongest at

90°

elbow pronation/supination strength is strongest in

neutral

DASH pt reported outcome measures

30 questions

5 point scale

Higher score is higher disability

Quick DASH pt reported outcome measures

11 questions

MCID 5.91-20

Reliability and validity = good

RCL/LCL provides elbow stability from Varus stress & Posterolateral rotatory restraint. What position is it taut in?

Supination

if the RCL/LCL is injured brace in

pronation or neutral

If the elbow MCL is injured, brace in

supination or neutral

muscular flexors on medial side provides compressive stability to the elbow & protects against

valgus stress

elbow Supination/Pronation AROM

0-80°/90°