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CHAPTER OBJECTIVES
At the completion of this chapter, the reader will be able to:
Describe the anatomy of the elbow complex’s joints, ligaments, muscles, blood, and nerve supply.
Describe the biomechanics of the elbow complex, including open- and close-packed positions, normal and abnormal joint barriers, force couples, and stabilizers.
Describe the purpose and components of the tests and measures for the elbow complex.
Examine the elbow complex, including palpation of the articular and soft-tissue structures, specific strength testing, passive articular mobility tests, and stability tests.
Evaluate the total examination data to establish a prognosis.
Describe the relationship between muscle imbalance and the functional performance of the elbow.
Outline the significance of the key findings from the tests and measures and establish a diagnosis or working hypothesis.
Summarize the various causes of elbow dysfunction.
Develop self-reliant intervention strategies based on clinical findings and established goals.
Describe and demonstrate intervention strategies and techniques based on clinical findings and established goals.
Evaluate the intervention’s effectiveness to progress or modify an intervention.
Plan an effective home program and instruct the patient in the same.
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OVERVIEW
The elbow is a complex (trochoginglymoid) joint with several traversing neurovascular structures serving 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 few 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. For example, the shapes of the articulating surfaces are important to remember when assessing joint mobility and applying joint mobilizations.
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The elbow complex, enclosed within the shared capsule of the cubital articulation, comprises 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
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CLINICAL PEARL
Ligaments reinforce the joint capsule of the elbow complex medially and laterally, making it thin but strong.
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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 ...