Elbow -Wrist Flashcards
INTRODUCTION—ELBOW AND WRIST
Musculoskeletal injuries to the elbow, forearm, and wrist account for approximately one-third of all workday illnesses. These injuries are associated with greater loss of productivity and wages than those of other anatomic regions such as the low back. Common diagnoses include tendon-related disorders such as lateral epicondylitis, which occurs in up to 3% of the general population. The risk factors for these injuries are similar and include tasks that are repetitive, hand intensive, and forceful. These factors all increase the stress on the flexor and extensor tendons of the elbow. Therefore, injury prevention and treatment strategies aim to decrease sure to repetitive tasks and limit extremes of elbow and wrist motion.
Elbow and Wrist Functional
Anatomy
Bones and Joints
The elbow’s primary function is to transfer energy from the shoulder to the hand, allowing for precise and forceful movements simultaneously. The articulations between the humerus, radius, and ulna from the humeroulnar joint or “true” elbow, humeroradial joint between the capitulum and radial head, and the proximal radioulnar joint. arm pronation and supination.
The wrist is composed of the distal radioulnar joint and articulations between the proximal (scaphoid, lunate, triquetrum, pisiform) and distal (trapezium, trapezoid, capitate, hamate, or TFCC [triangular fibrocartilage complex]) carpal rows. The proximal wrist is the articulation between the radius, scaphoid, lunate, and TFCC. The distal wrist joint is considered the articulation between the proximal and distal carpal rows. The majority of wrist flexion and extension and radial and ulnar deviation range of motion derives from the proximal wrist joint
Elbow and Wrist Functional
Anatomy
Muscles
Muscles about the elbow, forearm, and wrist can be simply divided into elbow flexors and extensors and wrist flexors and extensors. The brachialis is the primary flexor of the elbow and is assisted by the biceps, which is also an important supinator in certain positions. The elbow extensors include the long and short head of the triceps and are an important stabilizer with the brachialis to allow the elbow to maintain a constant position during powerful pronation and supination and wrist motion.
Common Elbow and Wrist Injuries
An inflammation or tendinosis of the sheath or tunnel that surrounds two tendons that control the movement of the thumb.
SYSTEMATIC PROCESS TO DETERMINE ELBOW AND WRIST
IMPAIRMENTS
RANGE OF MOTION ASSESSMENT
Assessment of the elbow and wrist to determine the most appropriate corrective
exercise strategy can be simplified into two steps: range of motion or flexibility
assessment and strength assessment. If limitations in elbow flexion or extension
are observed, follow-up assessments of these movements with the shoulder
flexed and extended should be conducted to determine which muscles are
causing the deficit.
CORRECTIVE EXERCISE STRATEGIES FOR THE ELBOW AND
WRIST IMPAIRMENTS
Step 1: Inhibit Inhibitory techniques can be easily applied by having the individual provide self-applied pressure to regions of tightness and sensitivity on the upper arm and forearm. Maintain that pressure for 30 seconds.
Step 2: Lengthen A combination of movements that extend the shoulder and elbow is most effective for lengthening the long head of the biceps. Similarly, combined movements of elbow extension and wrist flexion or extension are most effective for lengthening forearm musculature. These techniques should follow lengthening guidelines for bouts of 2 to 3 repetitions for 30 seconds to facilitate a change in length over the course of a few weeks.
CORRECTIVE EXERCISE STRATEGIES FOR THE ELBOW AND
WRIST IMPAIRMENTS
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Step 3: Activate Activation exercises to isolate the elbow flexors and extensors as well as the wrist flexors and extensors should follow the selected inhibit or lengthen intervention(s). Effective exercises to isolate both the long and short triceps, as well as the long and short elbow flexors, are examples of how a traditional strengthening exercise applied in the appropriate progression can obtain optimal results. Similar isolation exercises should be performed for the wrist flexors and extensors.
Step 4: Integration Integration exercises for the wrist and elbow can include almost any exercise you may currently implement that requires gripping with the hand while performing combined movements of the kinetic chain. The most effective interventions will likely draw on neural principles that couple wrist and elbow flexion with shoulder flexion and wrist extension with elbow extension and shoulder extension. These movements can be incorporated into the full workout during exercise such as a standing latissimus dorsi pulldown
(flexor mechanism) or a prone ball triceps extension with cobra (extensor
mechanism).
Summary
Shoulder, elbow, and wrist injuries can significantly limit participation in recreational and competitive athletics. Common shoulder injuries such as impingement syndrome and instability are routinely correlated with movement dysfunction. Common elbow injuries include lateral and medial epicondylitis. As with the other regions of the body,
identify cation of movement dysfunction using a battery of simple clinical screens provides an efficient way to address muscle imbalances in many clients. Focused corrective exercise programs progressing from inhibition–lengthen–activate–integrate are likely to address these muscle imbalances of the shoulders, elbow, and wrist. Identification of clients with movement dysfunction that does not resolve or produces pain indicates the need for a more thorough clinical examination by a physical therapist or certified athletic trainer.
