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Before beginning:
Ask yourself what does this topic have to do with me getting certified??????
The NATABOC Role Delineation Study 4th ed. NATA Athletic Training Educational Competencies
Under the domain of Prevention Educate the appropriate individual(s) about risks associated with participation using effective communication techniques to minimize risk of injury Knowledge of: Mechanisms of injury
Under the domain of Prevention Review preparticipation screening information by applying accepted guidelines to minimize the risk of injury and illness. Skill in: Identifying conditions that may limit or compromise participation
Under the domain of Immediate Care Initiate and/or execute techniques to mitigate life-threatening and other emergency conditions through the use of standard emergency care procedures
The elbow is a hinge joint, important to the kinetic chain by adjusting the length of the arm and allowing positioning of the forehand, wrist and hand for effectiveness during daily living and sport activities.
The elbow is vital for positioning the hand for all functional activities. The elbow is also vital for providing a link between the powerful movements of the shoulder and the fine motor control of the hand and fingers.
Anatomy: Review
Bones: Humerus, Radius, Ulna Articulations: Humeroulnar, Radiohumeral, and Radioulna articulations. Ligamentous: Ulnar Collateral Ligament - (UCL) Anterior Oblique Ligament- (AOL) Lateral Collateral Ligament- (LCL) Radial Collateral Ligament- (RCL) Accessory Collateral Lig - (ACL) Lateral Ulnar Collateral Lig- (LUCL)
Anatomy:Review
Nerves:
Nerve
Elbow Anatomy:Review
Forearm Anatomy-Review
Muscles:
Extensors and Flexors of the wrist Supinator and Pronator of the wrist
The keys to preventing injuries to the elbow are: 1. Strength of all muscles surrounding the joint. 2. Flexibility and proper Range of Motion 3. Use of proper throwing techniques and biomechanics.
History: Acute injury: -What, where, when, how -Type of pain (radiating, sharp, referred, dull, aching, intermittent) -Previous injury -Sounds: (popping , crepitus) -Sensations: (numbness or tingling)
History: Chronic Injury 1. All the previous questions of an acute injury plus: -conditioning program -throwing mechanism -biomechanics -pain (type and source during activity)
Palpation: Palpate underlying anatomy (bilaterally) -swelling -deformity -skin temperature -crepitation -muscle spasms and sensations
Range of Motion Evaluation: Perform bilateral range of motion tests (observe for pain and limitations of motion) -passive ROM -active and resistive ROM -flexion and extension -pronation and supination
Check the Bony Anatomy Check the Joints that compose the elbow: 1. Humeroulnar (Trochlea & Trochlea Notch of the Ulna) 2. Humeroradial (Capitulum & Radial Head) 3. Superior Radioulna (Radial Head & Radial notch of the Ulna)
Check the Ligmentous Structures: 1. Ulnar Collateral (Medial) 3 sections: Ant./Transverse/Posterior Obilque 2. Radial Collateral (Lateral) 3. Lateral Ulnar Collateral 4. Annular 5. Interosseous Membrane
Evaluate Muscle Structure, Range of Motion, Strength and Power. 1. Flexion: Biceps Brachii , Brachialis, Brachioradialis 2. Extension: Triceps Brachii, Anconeus 3. Supination: Supinator, Biceps Brachii , Brachioradialis 4. Pronation: Pronator Teres, Pronator Quadratus
Careful evaluation: - Check the Distal Radial Pulse - Check Fingernail Bed Compression - Immobilize in the position in which the body part is found using proper types of splints - Ice, Compression and Elevation as indicated by the position of the injury.
Falling on the outstretched arm Direct contact from blows Overuse syndromes
Falling on the outstretched arm Direct contact from blows Overuse syndromes strength imbalances during periods of growth
Bone length imbalances during periods of growth. Decreased flexibility Impaired coordination Biomechanical stress on the epiphysis
Osseous and Articular Ligamentous Soft Tissue/Joint Tendon Alterations Muscle Alterations Nerve Alterations
Bony hypertrophy Traction spur formation Osteochondral defects Loose bodies Joint degeneration -Chondromalacia -Osteophyte formation
Problems of bone immaturity: Epiphyseal -Apophyseal -Hypertrophy -Fragments and avulsion Effects of fracture and dislocation
Synovitis Adhesive Capsulitis (inflammation of the joint capsule) Tendinosis Tendinitis Tenosynovitis
Ulnar nerve entrapment in the cubital tunnel Ulnar nerve stretching and dislocation Median nerve entrapment (Pronator syndrome) Radial nerve entrapment Lateral antebrachial cutaneous nerve entrapment
Deformity or crepitation may indicate fracture. Suspect avulsion fracture with preadolescents and adolescents rather than ligamentous or muscular injury Throwing mechanisms produce great force at the elbow joint.
Elbow injuries may refer pain into the forearm, wrist and fingers. Nerves of the brachial plexus innervate the elbow and forearm. Major blood supply to the elbow and forearm is the brachial artery which branches into the radial and ulna artery.
Joint instability, or suspected fracture. Gross deformity, or swelling around the joint and loss of sensation below the elbow. Significant loss of ROM. Considerable PAIN (on finger extension). Audible click or pop a time of injury. If you have any doubt regarding severity.
Valgus and Varus Stress Test Wrist Extension Test (Lateral Epicondylitis) Hand Shaking Test (Lateral Epicondylitis Medial Epicondylitis Test Ulnar, Median and Radial Nerve Distribution Test
Use of Cryotherapy / Thermotherapy/ Hydrotherapy that is appropriate to the healing process Local compression Use of nonsteroidal anti- inflammatory medications (NSAIDs) Rehabilitation protocols
Reduce pain and local inflammation Regain normal joint movement and arthokinematics Regain strength, power, and endurance of the entire elbow region (forearm and upper arm) Elbow must perform functionally and handle stresses from sports specific activities
Minimize the risk of re injury.
Education of the athlete in maintaining 1. proper conditioning 2. proper biomechanics 3. functional strength
Hands On Practice:
Break up in to groups of eight or nine. Use your practice sheets. Evaluate your partner for an elbow injury. HAVE FUN!!!!!!!