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CHAPTER OBJECTIVES

CHAPTER OBJECTIVES

At the completion of this chapter, the reader will be able to:

  1. Describe the anatomy of the joints, ligaments, muscles, blood, and nerve supply comprising the elbow complex.

  2. Describe the biomechanics of the elbow complex, including open- and close-packed positions, normal and abnormal joint barriers, force couples, and stabilizers.

  3. Describe the purpose and components of the tests and measures for the elbow complex.

  4. Perform a comprehensive examination of the elbow complex, including palpation of the articular and soft-tissue structures, specific passive mobility, and passive articular mobility tests, and stability tests.

  5. Evaluate the total examination data to establish a prognosis.

  6. Describe the relationship between muscle imbalance and functional performance of the elbow.

  7. Outline the significance of the key findings from the tests and measures and establish a diagnosis or working hypothesis.

  8. Summarize the various causes of elbow dysfunction.

  9. Develop self-reliant intervention strategies based on clinical findings and established goals.

  10. Describe and demonstrate intervention strategies and techniques based on clinical findings and established goals.

  11. Evaluate the intervention effectiveness in order to progress or modify an intervention.

  12. Plan an effective home program and instruct the patient in same.

OVERVIEW

OVERVIEW

The elbow is a complex joint with several traversing neurovascular structures that serves an important linkage function that enables proper positioning of the hand and the transmission of power from the shoulder to the hand, thus augmenting the versatility and agility of the upper extremity. Unlike the shoulder, the elbow complex is an inherently strong and stable joint, because of the interrelationship of its articular surfaces and ligamentous constraints. However, the stability of the elbow complex allows little in the way of compensatory adjustments, making it particularly vulnerable to overuse injury from repetitious muscle activity and sudden movements of acceleration and deceleration. Appropriate diagnosis and treatment require a detailed understanding of the normal anatomy of the elbow.

ANATOMY

The elbow complex, enclosed within the capsule of the cubital articulation, is composed of three distinct articulations: the humeroulnar joint, the humeroradial joint, and the proximal radioulnar joint. The anterior joint capsule of the elbow originates from the distal humerus proximal to the radial and coronoid fossa, from where it then inserts distally into the rim of the coronoid and the annular ligament (AL).1 Posteriorly, the capsule incorporates the area proximal to the olecranon process; it attaches distally along the articular margin of the sigmoid notch and the proximal aspect of the olecranon fossa.2

CLINICAL PEARL

The joint capsule of the elbow complex is thin but strong and is reinforced medially and laterally by ligaments.

HUMEROULNAR JOINT

The humeroulnar (trochlear) joint is a uniaxial hinge joint formed between the incongruent saddle-shaped joint surfaces of the spool-shaped trochlea of the humerus and the trochlear notch of the proximal ulna (Fig. 17-1). Anteriorly, the humeral trochlear groove is ...

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