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The Elbow

 

 

The Elbow

General Anatomy
The elbow is composed of three separate joints: the humeroulnar joint which allows for elbow flexion and extension, the humeroradial joint which also allows for flexion and extension but also allows forearm supination and pronation (palm facing up or down), and the proximal radioulnar joint . The stabilizing soft tissues of the elbow consist of the medial collateral ligament (MCL), the lateral collateral ligament (LCL), the annular ligament, muscles and joint capsule.

 

Caution

 

Disclaimer:

This website is an information and education resource for health professionals and individuals with injuries. It is not intended to be a service for patients and should not be regarded as a source of medical or diagnostic information, or used as a substitute for professional medical instruction or advice. Not all conditions and treatment modalities are described on this website. Any liability (in negligence or otherwise) arising from any third party acting, or refraining from acting, on any information contained on this website is hereby excluded.

Lateral Epicondylitis

Commonly referred to as “tennis elbow”, it is typically due to overuse of the elbow and forearm muscles resulting in lateral elbow pain. Pain will worsen with activities such as gripping, lifting, shaking hands and repetitive movements. Tennis elbow affects men more than women. It most often affects people between the ages of 30 and 50, although people of any age can be affected. Similar symptoms will be noted with medial epicondylitis or “golfers elbow”.


Possible Physical Therapy Treatment
Conservative treatment typically consists of physical therapy. This will include the use of modalities such as ultrasound, electrical stimulation and ice. Manual intervention such as cross friction massage combined with an exercise program will often produce positive results. If further intervention is needed your physician may consider a corticosteroid injection or possible surgery.

 

References:
Orthopaedic Physical Therapy Secrets: Your Physical Therapy Questions Answered by ExpertsYou Trust, 2nd Edition. Jeffrey D. Placzek, MD, PT, David A. Boyce, PT, EdD, OCS, 2006.

www.webmd.com

www.orthopedics.about.com

Lateral Epicondylitis

 

Lateral Epiconydlitis

 

Lateral Epicondylitis

 

 

Bicep

Bicep

 

Bicep Tendon Ruptures

The distal biceps tendon is injured around the elbow joint. This is usually an injury that occurs with heavy lifting or sports in middle-aged men. Most patients with a distal biceps rupture will have surgery to repair the torn tendon.

 

Possible Physical Therapy Treatment

Physical therapy is often prescribed by your physician post surgery at the appropriate time. This typically includes manual therapy to increase ROM and decrease soft tissue restrictions such as scarring. In addition to ROM activities, strengthening exercises are prescribed to gradually increase strength as appropriate. Modalities such as ice and electrical stimulation for pain and swelling control are often used.

 

References:

Orthopaedic Physical Therapy Secrets: Your Physical Therapy Questions Answered by ExpertsYou Trust, 2nd Edition. Jeffrey D. Placzek, MD, PT, David A. Boyce, PT, EdD, OCS, 2006. www.webmd.com www.orthopedics.about.com

 

Radial Head Fracture

 

 

 

Radial Head Fractures

A radial head fracture is the most common broken elbow bone seen in adults. This type of injury is most commonly caused by a fall onto an outstretched hand. Radial head fractures cause pain and swelling around the elbow.

 

Possible Physical Therapy Treatment
Treatment typically will result in splinting of the joint or in more serious cases may result in surgery. Typically your doctor will order physical therapy after the fracture has healed to regain ROM and strength which is lost after a period of immobilization.

 

References:
Orthopaedic Physical Therapy Secrets: Your Physical Therapy Questions Answered by ExpertsYou Trust, 2nd Edition. Jeffrey D. Placzek, MD, PT, David A. Boyce, PT, EdD, OCS, 2006.

www.webmd.com

www.orthopedics.about.com



Laura Maruhashi

 

Open Crimp

 

Handgrips

 

Laura Maruhashi

 

Laura Maruhashi

 

Laura Maruhashi

 

 

Overuse Injuries in Rock Climbers

Rock climbing is an increasingly common sport and more and more indoor rock climbing gyms are appearing throughout the US. Rock climbers are subject to both acute traumatic injuries as well as chronic overuse injuries. Chronic overuse injuries are becoming increasingly common, as rock climbers have improved access to indoor gym training. It has been found that approximately 60% of climbing injuries involve the wrist or hand, and 40% involve the shoulder or elbow.1 Fifty-two percent of hand and wrist injuries involve finger tendon injury.1 Climbing injuries are often specific to the type of hand grip used.1,2
Hand grips can be categorized into 4 different types
“open-crimp” or “open-cling grip,” where the climber holds onto the rock with the distal interphalangeal joint extended and the proximal and metacarpal phalangeal joints flexed. The thumb may make direct contact with the rock.
“closed-crimp” or “closed-cling grip,” is similar to the “open-crimp” hold except that the thumb is locked over the index finger.
“open-hand” or “sloper grip,” the climber’s fingers are flexed at the distal interphalangeal joints and relatively extended at the proximal and metacarpal phalangeal joints.
“pocket grip,” involves one or two fingers jammed into a small pocket of rock.1
Hand & Wrist
In the hand and wrist, the most common injuries include flexor tendon injury, ligament sprain/rupture of the A2 and A4 pulley’s, medial nerve entrapment at the carpal tunnel, ganglion cysts in the A1 and A2 pulley areas. The “open-hand grip” predisposes the climber to A4 pulley injury, whereas the “crimp” grips predispose the climber to A2 pulley injuries.1,2 “Crimp” grips can also predispose young climbers to epiphyseal fractures of the proximal interphalangeal joint.3 Dupytren contractures are rare but possible climbing related injuries.3
Elbow
In the elbow, the most common climbing injuries include medial epicondylitis, and brachialis muscle strains.1 Brachialis muscle strains will present as pain in the cubital fossa (climber’s elbow).3 Biceps strains are less common.3 Climbers with natural joint laxity may be predisposed to development of medial epicondylitis because instability of the elbow joint may place greater strain on the common flexor origin.3 Though less common, excessive “undercling” training, where the climber holds onto the rock in a supinated position, may cause the supinator muscle to become inflamed and compress the posterior interosseous nerve, another cause of diffuse elbow pain.3
Shoulder
In the shoulder, the most common injuries include SLAP labral tears, external shoulder impingement, anterior dislocation, biceps tendon tears, and supraspinatus tendinopathy.1 Roseborrough & Lebec found that rock climbers tended to have a smaller ratio of scapular upward rotation to glenohumeral motion with shoulder elevation.4 This was theorized to be due to inadequate strength of the lower trapezius and serratus anterior and inadequate muscle length of the pectoralis minor from prolonged isometric holds in a protracted shoulder position, which may predispose the climber to impingement symptoms.4 Possible Physical Therapy Treatment Surgical management is often limited to multiple pulley rupture, dislocated epiphyseal fractures, and severe Dupytren contractures.3 Muscular, tendon, and ligamentous injury can often be managed conservatively for incomplete ruptures.1,2,3,4

 

Physical therapy management may include:
1. Manual joint mobilizations – to restore normal joint movement, and to enhance joint nutrition and healing.
2. Soft tissue mobilization – to decrease swelling, promote tissue healing, and improve muscle extensibility.
3. Strengthening – to restore muscle imbalances, and promote ideal biomechanics.
4. Neuromuscular re-education – to normalize scapular motion and decrease impingement symptoms.
5. Modalities – for pain management and promote tissue healing.

 

Authors:
ProOrtho:
Camille Clinton, MD
Lake Washington Physical Therapy
Laura Maruhashi, SPT
Benjamin Wobker, PT, MSPT, CSCS, SFMA

 

References
1. Chang C, Torriani M, Huang A. Rock Climbing Injuries: Acute and Chronic Repetitive Trauma. Current Problems In Diagnostic Radiology. July 13, 2015.
2. Holtzhausen L, Noakes T. Elbow, forearm, wrist, and hand injuries among sport rock climbers. Clinical Journal Of Sport Medicine: Official Journal Of The Canadian Academy Of Sport Medicine. July 1996;6(3):196-203.
3. Schöffl V, Schöffl I. Finger pain in rock climbers: reaching the right differential diagnosis and therapy. The Journal Of Sports Medicine And Physical Fitness. March 2007;47(1):70-78.
4. Roseborrough A, Lebec M. Differences in static scapular position between rock climbers and a non-rock climber population. North American Journal Of Sports Physical Therapy: NAJSPT. February 2007;2(1):44-50.
5. Climbing Project & Lecture: courtesy of Mitch Owens, PT : Union Physical Therapy Wallingford

 

 

 



 

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