Chapter 21: Rehabilitation of the Elbow

INTRODUCTION

Treatment of elbow injuries in active individuals requires an understanding of the mechanism of injury and the anatomy and biomechanics of the human elbow and upper-extremity kinetic chain, as well as a structured and detailed clinical examination to identify the structure or structures involved. Treatment of the injured elbow of both a younger adolescent patient and an older active patient requires this same approach. This approach consists of understanding the specific anatomical vulnerabilities present in the young athletes’ elbow, as well as the effects of years of repetitive stress and the clinical ramifications these stresses produce in the aging elbow joint. An overview of the most common elbow injuries, as well as a review of the musculoskeletal adaptations of the elbow, will provide a platform for the discussion of examination and most specifically treatment concepts for patients with an elbow injury. The important interplay between the elbow and shoulder joints in the upper-extremity kinetic chain is highlighted throughout this chapter in order to support comprehensive examination and intervention strategies, as well as the total-arm strength treatment concept.

FUNCTIONAL ANATOMY AND BIOMECHANICS

Anatomically, the elbow joint comprises three joints. The humeroulnar joint, humeroradial joint, and the proximal radioulnar joint are the articulations that make up the elbow complex (Figure 21-1). The elbow allows for flexion, extension, pronation, and supination movement patterns about the joint complex. The bony limitations, ligamentous support, and muscular stability help to protect it from vulnerability of overuse and resultant injury.

The elbow complex comprises three bones: the distal humerus, proximal ulna, and proximal radius. The articulations among these three bones dictate elbow movement patterns.¹ It is also important to mention that the appropriate strength and function of the upper quarter (defined as the cervical spine to the hand, including the scapulothoracic joint) need to be addressed when evaluating the elbow specifically. The elbow complex has an intricate mechanical articulation between the three separate joints of the upper quarter in order to allow for function.

In the elbow, the joint capsule plays an important role. The capsule is continuous (Figure 21-2A) among the three articulations and highly innervated.^2,3 This is important not ...