[Music] [Music] okay now that we've discussed the bones the humerus the scapula the radius and the ulna let's talk about where those bones come together remember that's called a joint what's the technical name for a joint do you remember that you've had several lectures on muscles and joints right articulation where bones come together and move is called an articulation and we say the bones articulate on each other so what we call the elbow joint it's actually kind of misnamed there's three joints not one they're called the elbow joint because all three joints are contained within the same joint capsule there's actually three places where these bones come together so let's take a look at them here's the humerus here's the ulna they clearly come together so we have the humero ulnar joint humerus ulna humero aldner remember joints are pretty easy they usually name the two bones that come together or the parts of the bones here's the bones humerus and old now they come together here that's called the humeral ulnar joint it's one of your three elbow joints so the movements that can occur here are simply flexion and extension that's it because can you see by the shape here curves indentations inclinations you cannot because the ligaments and muscles holding this tight when this is in here you can't turn it they don't turn on each other they can't move this way they can't move that way this is all they can do this can stay still and the ulna can move or the only can stay still like when you're hanging from a bar and this can move it's the same it's the same movement that goes on between these bones whether it's this position this position or this position it's the same movement flexion remember is decreasing the angle in a joint extension is increasing this is flexion of the elbow that's the extension of the elbow that's the only thing the humeral holder joint can do what parts come together well just the trochlea of the humerus and the trochlear notch of the ulna pretty easy right so this is a hinge joint synovial hinge joint just as a quick review right we have three basic types of joints in the body we have joints that are freely movable somewhat movable or non-movable center arthritic anti-arthritic diarthritic diathritic or you're freely movable anti-arthritic somewhat movable and center arthritic like the sutures in your skull non-movable they're very little movement okay so the six synovial joints three of them are at the elbow so this is a synovial hinge joint hinge joint is one of your six types of synovial or diathritic joints only movement's possible okay now we also have the hemorrhoid radial joint humerus and radius now that also can do this and since the radius and the olden are firmly attached together when the ulna moves in flexion the radius goes with it so the head of the radius though does not form a hinge joint it's a rounded part here fitting against another rounded part so although this is one of the movements we also get this so that's not a hinge joint hinge joint only allows movement in one plane right in the sagittal plane this is a gliding joint so it allows flexion and extension and allows the radius to turn like this matter of fact when you move your arm to palm forward on backwards the only bone that's moving is your radius when you turn this hand from this position to that position you notice i'm holding the oldness still it doesn't move only the radius moves palm backwards palm forward it's the same if i do it out here you can hold the ultima perfectly still and still do pronation and supination remember pronate turning palm down supinate turning it up so the only bone that moves in the forearm when you do that is the radius when you're in anatomical position these bones are parallel to each other but when you do pronation and supination the radius crosses over and makes an x over the illness see the x when you come back to supination parallel when you pronate there's an x they cross now this is good for you to remember because if the radius is the only bone that moves in pronation and supination remember the difference in the terms origin and insertion origin is the fixed or more stable end of a bone or bone an insertion is the more movable bone so any muscle that does pronation means removing the radius to move the radius it has to attach to the radius so all muscles of pronate have an insertion somewhere on the radius same with supination supination is movement of the radius so any muscle that does supination has to insert on the radius that's a memory hint for your test and vice versa if you know it inserts on the radius there's a good likelihood it does pronation or supination it can also do flexion but if you know it inserts on the radius think oh how can the pronator supinate real simple just think here's the bones the radius is here all night here ultima doesn't move so if i want to do this movement which is pronation that means the radius has got it in this one remember muscles can only pull so if i want to pull the radius this way that means the other end's got to be somewhere over here so the origin is going to be over here the insertion is going to be out here to do that okay all right so that's the radio humeral radial joint again it's a gliding joint and it does pronation supination flexion and extension okay now if you're looking at the elbow can you notice that this medial side here where the trochlea is it goes a little further down it's kind of tilted like that so it's this side is longer than this side another way to phrase that the trochlea extends more distally on the humerus than the capitulum therefore when you extend your elbow and supinate your forearm your forearm is going to deviate laterally look at my arm my forearm doesn't go my humerus is going straight down isn't it straight down however because of that this going further down you notice uh the wrist is further away from the body than the elbow is check it yourself get in front of a mirror your elbow's pretty close to your body i can barely get a hand in between it but look how far away my wrist is that's because this is further down this way than that is so when this fits on there this goes out at a slight angle doesn't go straight down like this this would be straight down it doesn't fit like that it fits like that that's called the carrying angle of the elbow it allows you to carry stuff without hitting your thigh every time you walk so the carrying angle this angulation called the carrying angle sometimes it's called the cubital angle elbow angle carrying angle or elbow angle cubital angle okay is due to that trochlea coming further down okay so do you remember that prefixes and suffixes in regions cubital angle cubital means elbow what's this forearm what's it called anti-brachial what's arm brachial what's front of the elbow anti-cubital what's back olecranon all right so we have one more joint to look at you notice the head of the radius here fits in to this radial notch of the ulna so when we did pronation and supination this radius is rotating it's turning like this that's rotation so we discussed the definition of flexion and extension flexion decreasing the angle of the joint extension increase and angle of the joint these are terms you need to know before your final exam in your license exam rotation is described as movement turning around the longitudinal axis so again here's the longitudinal axis so the radius turns like this just like both turning around the longitudinal axis that's rotation movement around a longitudinal axis so the radius turns not only against the capitulum but also here in that radial notch of the ulna by the way there is a ligament that completely goes around the head of the radius here to hold it into that notch so the bones stay together that's one of the things that holds it and allows it to do that and it's a ring like obviously this is a ring right a circle so the ligament starting over here and going all the way around to here holding this in is called the annular ligament angular means ring-like annulus fibrosis remember the ring-like part of the intervertebral disc so the angular ligament helps hold the head of the radius against the ulna in children we sometimes when we grab their hand and lift them up we can actually pull this out of there it's called nursemaid's elbow it's a dislocation of the head of the radius here because children remember they're not fully developed yet they're not mature so both the muscles joints they're not quite strong as an adult you wouldn't be able to do this to an adult just by pulling on their hand but you couldn't the children if you grab their hands and swing them in a circle when they're real little you could but their shoulder most likely you're gonna hurt right here so again this is called the radio aldener joint so is this radioaldener remember this is the proximal radial ulnar joint so that's the part of the elbow so rotation is the only movement available there because that ring-like ligament holds it in place the ligament wasn't there this might act like a ball and socket joint but then that would look what happened to we can't have that okay so this is a pivot joint so your elbow has three of the six types of synovial joints it has a pivot joint here a gliding joint here and a hinge joint here so your humeral ulna is hinge radial is gliding and radial ulna is pivot those are the movements of your elbow joints okay so remember anatomic position your hand is supinated when you turn it around or your palm is facing backwards that's pronated if i flex my elbow decrease the angle in the elbow right pronation is palm down supination is palm up remember that's mid position handshake position semi-pronated semi-supinated bunch of terms so those are the main things of the joint now sometimes our forearm extends further out so we have terms to describe that all over the body valgus and varus valgus is where the distal end of the bone moves away moves more lateral embarrass it moves inward so sometimes that's the dysfunction we'll talk about later remember that's the carrying angle sometimes it's way out like that that's an extreme valgus or it's him like this varus that's called the gunstock deformity usually that's caused by fractures up in here so that's not something you're going to fix as a massage therapist that's going to require surgery okay so cubitus valgus is an excessive angulation of your forearm and cubitus varus is the opposite okay it goes in we've discussed that humororadial joint being part of the capitulum right and we've just actually we've discussed all of the joints haven't we and we've discussed pronation and supination so i guess let's go ahead and move on to the muscles oh there's one other thing i should probably talk about ligaments so let's talk about things that hold these together i already mentioned really important ligament right here i mean what is called the ring-like ligament angular ligament we also have ligaments that go on the side here that keeps your forearm from doing that too much the shape of this bone the ulna is very good at preventing this however this there's nothing the shape of these bones doesn't prevent so we have to have other structures called ligaments so annular ligament around the head here now we have ligaments that go on the outside here if you've studied several other areas of the body you know those are called ligaments that connect long bones lengthwise remember what they're called collateral collateral ligaments or ligaments that connect bones lengthwise they prevent so in the forearm here they prevent this and that going too much so on this side this is the lateral side it'd be called the lateral collateral ligament of the elbow or since it connects to the radius here it's sometimes called the radial collateral ligament it's the same as lateral on this side we have a medial collateral ligament connecting the humerus and the ulna it's also called the aldmar collateral ligament okay all in our collateral ligament is the medial collateral ligament radiocollateral ligament is the lateral collateral ligament and their job is to prevent the elbow from trying to go that way this way too much okay now we also have two main ligaments in here one running mostly the length almost the whole length of your forearm connecting these two bones remember we had an interosseous border on each of them so we have a ligament connecting those two borders called the interosseous ligament pretty simple intraosseous ligament keeps those bones from trying to come too far apart we have another shorter one up here called the oblique cord or the oblique ligament it extends downward lateral from the lateral side of the ulna so down and out that way from here going down this way and then the rest of the way is that interosseous border those are the critical ligaments remember collateral ligaments occur in a lot of different places on the body they connect bones here here here most people are familiar with the ones at the knee those are the ones that are injured in most contact sports like soccer and football medial collateral ligament sprains and lateral collateral ligament strains although the medial or the more common okay let's go ahead and now get a little detail on our muscles okay let's review what muscles do first remember muscles have one job one main job and that's the cause movement and or support the body when a muscle is stimulated to contract it always responds the same way always when a muscle let's say this is my between my hands is a muscle when it stimulates to contract both ends try to move toward the middle 100 of the time that's how a muscle reacts they try to pull toward the middle but sometimes one moves more than the other sometimes one is still and the other one moves or sometimes this one still but both ends are trying to move now sometimes neither end moves why is that well what if something's resistant the muscle can only develop so much force so it's trying to shorten that's all they try that's all muscles can do when they contract the short on their own they can't push the other part they can only pull toward the middle but what if something else is creating an equal force in the opposite direction well that means there's not going to be any length change in the muscle it's not going to shorten it's not going to lengthen but what if the outside force opposing this muscle is stronger than the force the muscle can develop then the muscle is going to get longer the muscle can't get longer on its own but something can pull it apart so you can try this experiment on yourself right you all know how to flex your elbow so start here right ask somebody to bring their hand toward your shoulder flex the elbow like this obviously the muscle if you measured the length between here that's your insertion of your biceps brachii and up here it picked it you measure this length and now measure it again when you do this that muscle just got shorter didn't it you could tell by using the tape measure so let's start here i can still get shorter can i again from here to here that got shorter from here to here it got shorter so now what if somebody who's stronger than i am puts their hand here and pushes down while i try and push up try to yourself get a friend and have have somebody try and bring their hand up and have somebody else put all their weight pushing down that muscle is going to do this no matter how hard they try and contract the muscles they're trying to shorten the muscle it's trying to come this but if someone is putting more force here then that muscle can resist that muscle is going to get longer you remember the name of this when a muscle shortens it's said to be doing an isotonic contraction isotonic means the length changes the tension stays the same in the muscle but the length changes well if it's changing that means it's getting shorter than normal or longer than normal those are the only two possibilities but they're both isotonic contractions if they get shorter it's called a concentric contraction or a concentric isotonic if they get longer it's called an eccentric or eccentric contraction a lengthening so a shortening contraction is concentric a lengthening contraction is eccentric muscles cannot do an eccentric contraction on their own something has to pull them apart can be an outside force it could be other muscles so let's talk about the muscles here when the biceps brachii muscle which is the most superficial muscle on the front it's one of the most well-known elbow flexors we have it originates i mentioned earlier on the scapula way up here on the top of that glenoid fossa on the supraglenoid tubercle that's where the long head originates then the muscle comes out and goes between these two tubercles here at the bicipital groove comes all the way down to this radial tuberosity the short head comes from here the coracoid process of the scapula so both origins of your bicep are on the scapula not on the humerus coracoid process is the short head supraglonoid tubercle is a long head short head comes straight down long head has to go out like this remember long head goes in that bicepital groove and they both insert down here in that radial tuberosity so that means it can flex the elbow it also means it can do this can't do that okay so the biceps when it shortens can pull this to the scapula that's flexion of the elbow right it's not our strongest elbow flexor it's pretty strong when the hand is supinated but when i turn my hand like this remember that turns this tuberosity to the back and now it's not a very strong elbow it can still flex the elbow it's just not as strong but can it do this yes remember it attaches here so if your hand is pronated like this and you imagine having a string something hooked into there and now i pull that string up that's going to rotate that radius just like that so the biceps does this supination it's your strongest supinator it's a big strong muscle and it's the strongest muscle for supination so it flexes the elbow and if your hand is pronated it supinates since two ends also come from the scapula it's a shoulder muscle so it flexes the shoulder brings the humerus forward so it's a shoulder flexor and an elbow flexor and a supinator does all of those okay so since it works the shoulder it's a shoulder flexor and it works the elbow it's an elbow flexor and supinator it's a two-joint muscle or a biarticular muscle remember bi means two seps means head so biceps means two heads and brachii means arm so biceps brachii tells you it's in the arm and it's got two heads now if you took the biceps off the next muscle you would see underneath it is called brachialis again breaking means arm the brachialis actually originates a lot of this is faded on here can you see all the red down here on the front almost the whole bottom half that's the origin of your brachialis muscle so it originates all down here now it crosses the elbow and it goes to the ulnar tuberosity whereas biceps went to the radial tuberosity brachialis goes to the ulnar tuberosity so it originates here and attaches down here so it doesn't cross the shoulder joint but it certainly crosses the elbow joint so it's very strong it flexes the elbow now remember ulna doesn't rotate when you do this here's a good way to remind yourself by the way you can find your olecranon process right here that's your ulna hold it turn your hand you don't feel this moving at all do you your ulna doesn't move when you pronate and supinate so muscles that attach to the ultimate can't do this okay so your brachialis attaches to the ulna so it can't pronate or supinate that way no it doesn't matter if you're pronated or supinated the brachialis has the same strength that's why it's called the strongest elbow flexor okay common test question strongest elbow flexor brachialis the next muscle we're going to look at is called brachioradialis brachioradialis originates from up here the lateral supracondylar ridge continues from this lateral superconductor ridge all the way down to the styloid process of the radius this is a very interesting muscle it does cross the elbow because one end is up here right one end is up here that lateral supracondylar ridge and the other end is down here in the styloid process of the radius so if i move the radius in toward this it can flex the elbow however it can also partly pronate and partly supinate so if i start this way i want you to think of the muscle is going to originate right up here lateral supracondy ridge of the humerus and it's going to insert right here so when this end is pulled up if i start this way in addition to flexing my elbow it's going to turn my hand like this that's as far as it can turn it halfway you can turn it to neutral position mid position handshake position semi-pronated but what if i start this way remember it's going to attach right here the other end is here so if i start this way in addition to flexion on my elbow it turns my hand back to the same position mid position handshake position so it does flex the elbow but no matter how and if i start this way if i started in neutral and this was the only muscle contracting it would flex my elbow and keep my hand that way so no matter where you start here here which is pronated or here which is supinated no matter how you start if this was the only muscle it would turn you to this position that's why it's said to be able to do pronation and supination it can't do it it can't turn your hand to full supination or full pronated it can go halfway though so the brachioradialis pronates and supinates so therefore you end up in that handshake position so that's its nickname it's called the handshake muscle okay now we have two muscles who specifically do pronation and they start with the word pronator that should be easy pronation remember is turning the hand down which means the radius has to be pulled that way now one crosses the elbow it starts up here on that medial epicondyle of your humerus and also attaches to the coronoid process here it continues to go to the lateral part of your radius out here so since it starts here and crosses over an angle like this it does cross the elbow so it is an elbow flexor from the other teres that teres means round it's more like a shape round shape pronator means it pronates okay so it flexes the elbow but it can also pronate from literatures so we've studied biceps brachii brachialis brachioradialis and now pronator teres four muscles that flex the elbow now pronator teres also pronates now at the wrist there's another muscle down here that's the deepest muscle at your wrist called pronator quadratus quad means four right pronator means pronate so why do we call it quad well if you divided the forearm in half right this would be the proximal half this would be the distal half right proximal half distal half now what if i took this half and cut it in half again now this would be said to be the distal fourth wouldn't it that's where this muscle is this muscle is in the distal fourth of your forearm so it's down here see if you can figure this out it's called pronator so it doesn't supinate it pronate switches what's the only bone that moves in pronation or supination radius correct can you see this i'm holding the oldness still brown nation so if this is where the muscle is located there's only two bones here one's radius one zolta only one can move in pronation or supination that means it's always going to be the insertion the radius is going to be the insertion of any movement that's called pronation or supination so that means the distal fourth of the ultimate is going to be the origin of pronator quadratus just a fourth of the radius is going to be the insertion okay now we also have a muscle that just just does supination called supinator probably the easiest muscle on the test the name of the muscle is supinator it tells you what motion it does it does supination and it also originates on this area called the supinator crest of your ulna so most of the test questions dealing with supinator have the word supinate in their name so if you say what muscle originates from supinator crest supinator what's the action of supinator supination soon man pretty easy what's the insertion of supinator only one bone moves when you pronate or supinate so the insertion would have to be radius origin would have to be the other bone so there's our elbow flexors our pronators and our supinators only two muscles left to go remember all muscles have a primary action that they perform muscles can only shorten that means something else has to return that muscle to its normal length so here we talked about four muscles biceps brachii brachialis brachioradialis and pronator teres they all do that now none of them can make me straighten my elbow out again that would be elbow extension all of these muscles do elbow flexion so how do i how do i do that these muscles can't do it that would be the muscles don't have the ability to lengthen that means there must be muscles back here on the other side because these muscles were all on the front weren't they which is where flexors are on the front of the body remember extensors are on the back so we have two muscles that extend the elbow one that's a tiny little helper it's not even mostly up here it's just down here but a big muscle up here it's got three parts called triceps that's its first name triceps brachii right triceps means three heads brachii means arm so we have a three-headed muscle called triceps brachii on the back of the arm common test question what's the only muscle on the back of the arm tricep brachii so it has three origins because it's got three heads now when we talked about the scapula i mentioned right here below the glenoid fossa was a infraglenoid tubercle part that's the origin of the long head of triceps then we had something called the spiral groove of the humerus one of the heads is above the spiral groove one of the heads is below the spiral groove those are your three heads of the triceps they all insert on this electron all of them so can you see if it doesn't matter if it was coming from here or anywhere up here when i flex my elbow this is going to move away let's just put my finger here can you see the electron process moving further away from my finger that means that muscle's being stretched doesn't it it's lengthened when i flex my elbow so now can you imagine when the triceps contracts it's going to pull this back to here so triceps is your elbow extensor very very powerful muscle okay it's actually the antagonist to all of your elbow flexors remember those terms agonist antagonist synergist you should let's review them agonist is another name for prime mover it's a muscle that's primarily responsible for a given movement like flexion so if i was saying what muscles flex the elbow those would be agonists of the elbow muscles the primary job is to flex the elbow biceps brachii brachialis brachioradialis pronator teres and actually some of these wrists and finger flexors those all flex the elbow so would they be synergist to each other or antagonist i haven't discussed those terms have i a synergist is a muscle that helps it does the same action as another muscle so for test questions that's what you're going to need to know if two muscles if an action is named and those two muscles do that same action they're synergist if they don't do the same action they can't be synergist what if they do opposite actions what if one flexes and one extends then they're said to be what antagonistic so antagonist muscles do the opposite action of an agonist muscle now you can't name the muscle as an agonist or an antagonist unless you name the action first so if i named elbow flexion any muscles that flex the elbow would be said to be synergist to each other so your biceps brachii brachialis brachioradialis pronator teres and your wrists and finger flexors which those are all synergists during elbow flexion so what muscles are opposite triceps and we haven't named the other one called anconius because they straighten the elbow out they do extension so flexion and extension are opposite actions so muscles that flex are called antagonistic two muscles that extend if you're talking about flexion and extension so triceps which has three heads is your main extensor so it's an antagonist to all of your elbow flexors now then we have the little anconeus called the little helper to triceps it originates on that lateral epicondyle of your humerus again remember this is medial epicondyle this is your lateral epicondyle out here and it inserts down on this electron process so it actually forms a little triangle here just right here it's really not it's not in the arm up here is it it's just down here right here so it's not even said to be in the arm but it is at the elbow so it can help extend it some people say it's mainly a stabilizer of the elbow people that injure their elbow what they call tennis elbow lateral epicondylitis this muscle anconeus is almost always involved so anconeus is an elbow extension test wise okay it's the helper to triceps which is a really really big muscle so now we've discussed antagonist agonist center just hopefully you remember that we've discussed muscle movements isotonic means muscle shortens or lengthens if it shortens it's a concentric or shortening contraction if it lengthens it's an eccentric contraction well what if it doesn't lengthen offshore and what if it stays the same but it's contracting what was that called isometric and isometric contraction is where the tension is there but the length doesn't change the tension does again if you stood in the doorway and tried to push the frame apart you could strain all you wanted to you know you were working your muscles were working but nothing's moving right same thing if you tried to lift the barbell that was twice the weight you can do just to if you're just holding it here and you can't flex your elbows obviously there's no movement there's no length change right those are all considered to be isometric contractions so that's going to pretty much conclude our lecture on the muscles bones joints movements carrying angle of the elbow cubital valgus cubital varus a gunstock deformity the next thing will be pathology let's talk about things that can go wrong at the elbow pathology remember pathology path means disease algae logic means the study of so pathology are things that can go wrong at the elbow obviously bones can move out of place that's called either a dislocation or a subluxation in a dislocation the bones completely come out of the normal contact area in a subluxation that's a partial dislocation it only comes out partly your elbow is typically really really stable so it's a stable joint again it does flexion and extension and it does pronation and supination so you don't commonly dislocate sublux or sprain that elbow it happens but it's not common when it does happen it's usually the radial head you remember that the radius is held against the ulna by that angular ligament okay so we can frequently move this away from that ulna so if you were to take somebody's hand and grab it i'm not tall enough if this was a child and you they were stepping off a curb and you pulled up you can actually pull this bone out of place here you can dislocate or sublux the head of the radius that's called nursemaid's elbow or just dislocation or subluxation got a lot of names dislocated elbow in a child a pulled elbow radiohead dislocation uh elbow subluxation those are all common names for that okay uh shoulder dislocations are the most common type of dislocations we have but for children that's pretty common as well okay the typically when you dislocate your elbow it's result of a fall or direct blow okay and it's frequently associated with a fracture of the humerus or the radius of the old nuts if it's an elbow problem it's got to be one of those three bones right humerus radius and old and those are no other choices and frequently involves a twisting motion okay and typically it's what we call a posterior dislocation about 90 of all elbow dislocations which means the radius or ultimate goes posterior it goes this way on the humerus okay all right the other thing that can go wrong in almost every joint two common things you can have inflammation of a tendon which is going to be called tendinitis let's break that term down prefix and suffix this again itis itis and what it means inflammation so tendinitis is inflammation of a tendon that used to be a real common diagnosis and it can still exist but most things that used to be called tendonitis we're now called tendinosis because there's no actual inflammation it's a repetitive injury type strain but it can in other words the the tendon is injured it was just wasn't due to inflammation okay so bicipital tendinitis is it the biceps tendon there's a distal end here that's the most common one so the distal biceps tendonitis is a fairly common or tendinosis okay it could be to have a lifting uh repetitive hyperextension of the elbow with with pronation or repetitive pronation and supination can remember your biceps is your most powerful supinator okay so the distal part of the belly and the muscular tenderness area down here is the most common areas involved now you can also strain the muscle itself the biceps doesn't have that often the brachialis has it commonly let's review the difference in a sprain and a strain for a minute remember strain s-t-r-a-i-n and sprain s-p-r-a-i-n they both start with an s they both end with rain r-a-i-n the difference is one has the t it's the second letter one has a p so think of the t for tendon remember muscles and tendons are units you can't separate them so if an energy to a tendon or a muscle it's called a strain if an injury to a ligament or a joint capsule is called a sprain so with biceps it's usually the tendon that's injured with brachialis it's usually the muscle okay so the biceps is a tendon injury usually the brachialis is typically the muscle belly itself okay those are the two big areas on strains and sprains biceps and brachialis triceps can also be injured triceps can have a strain right it can't be a sprain because there's no ligaments involved with the triceps or it'd be a tendonitis okay when people have pain at their elbow and you're going to have people come in all the time talking about first they'll tell you they have elbow pain then you know you find out is it in the front of the elbow is it the back of the elbows on the inside is on the outside they mean different things so the three most common causes of pain at the back of the elbow are going to be something that we call posterior impingement or it's going to be called student's elbow which is also called olecranon bursitis remember this is the olecranon process back here a burst exactly two bursts of cover in this a superficial and a deep bursa and either one can be inflamed bursitis inflammation of a bursa or you can have a triceps strain or inflammation of the tendon those are the three common things that cause pain at the back of the elbow on the inside we end up golfer's elbow medial epicondylitis on the outside we can have tennis elbow lateral epicondylitis but if it's on the back it's triceps inflammation or strain olecranon bursitis or posterior impingement okay so remember um bursa or fluid-filled sacs that can be found anywhere on the body where there's a strain usually found between a tendon and bone or between tendon and skin so back here we have a superficial and a deep bursa you can feel the bursa if you relax your elbow you can pick up skin squeeze it see how easy that moves that's a superficial bursa it's right under the skin when that's injured and it's called student's elbow because students frequently put their elbows on a desk like this when they're studying reading trying to ignore the teacher and doing this the elbows on and that that's what usually gets inflamed so that superficial olecranon bursa okay is a pretty common now you can also hyperextend the elbow now if you worked with me in your basic three weeks of training i try and make that a focus when your clients face down so this parts on the table i tell you don't work down here because you have a tendency to want to lift the arm that way you can hurt your shoulder and you can do that you can hyper the elbows are not made to bend this way the elbow's made to bend this way right elbow's made to bend this way it's not made to bend that way so anytime you take a customer and they're face down and you grab their hand or their forearm and you lift it up you're putting a potential strain on the elbow area and you risk causing a hyperextension injury now it's real common in contact sports like rugby martial arts that's really common to hyperextend that elbow okay and when that elbow is made to go straight it's a lot of pain okay that's usually usually felt at the front of the elbow and if it's hyper extended there's usually going to be some swelling right muscles frequently go into spasm to protect an area around the joint so commonly your biceps break the eye will go into a spasm when you hyper extend the elbow so please be careful when you're moving your client's arm around and don't lift them up that way you can injure the shoulder like some of you have a little bit more mobility than i do but i've been to my shoulder many times that's as far as my shoulder goes you lift my arm further than that you're probably going to hurt something here okay that's pretty much it on the elbow again i just briefly touched on on the elbow you can have anything that originates on the medial side over here i mean that's the big bump here is the medial epicondyle a lot of muscles that attach here so particularly one called extensor carpi radialis brevis frequently involved in what we call golfer's elbow out here's tennis elbow or lateral epicondylitis and that's going to do it for our lecture i guess i could go into a little more detail if you wanted to right yeah let's do that so on your medial and lateral epicondylitis it's usually due to what we call an eccentric contraction remember muscles try and shorten but if there's something that has a stronger force pulling them apart the muscle's trying to shorten and something's trying to pull it apart that's going to typically injure your muscle most strains are actually due to an eccentric contraction eccentric muscle overload right so let's say when you're playing tennis we said that's one of the things that could happen here right you have extensor carpi radialis brevis out here is one of the main muscles attached out here when you go to do a tennis stroke you're trying to not only extend your elbow but if you're not really trained like myself you're trying to extend your wrist to hit that ball with the racket okay now that ball might be coming across the net very very fast so you're trying to do that so this muscle here extensor of the wrist is trying to shorten that ball hits the racket and it makes your wrist do that that stretches up muscle tears it that's it the muscles trying to shorten but the ball hitting the racket is more forceful than the muscle the force the muscle can develop so the muscle gets torn and it's usually torn right in there now tennis elbow can be caused by anything else that causes that all right most professional tennis players don't suffer from that injury because they know the proper arm mechanics and have the proper uh racket whereas some of us who aren't so skilled and knowledgeable we just play tennis occasionally we do that very very common okay so the other thing that can happen is you can do the same thing here on the medial epicondyle so anything that attaches remember this is medial and there's a whole lot of muscles remember all those red marks those are muscles that flex your fingers and we have the same thing back here on the lateral side so those red marks those are muscles that extend the wrist and fingers so we can have injuries to either side so here it's going to be called medial epicondylitis it's not really the epicondyle being inflamed usually although when you tear something there is an inflammation and lateral epicondylitis so it's usually the tendons that attach there that are the problem right so on the golf swing or the swimmers get that lateral i'm sorry medial epicondyles a lot when you're pulling phase of the stroke when you pull down they get that medial epicondylitis issue okay so pronator teres is frequently involved and so is your flexor carpi radialis okay now on tennis elbow it's extensor carpi radialis and golfer's double flexor carpi radialis i also mentioned earlier that we could have a superficial or a deep bursa covering the electron remember bursts are simply fluid-filled sacs that prevent friction usually between bone and tendon or some of the soft tissue they can swell they can get inflamed you can have bleeding inside them and the deep bursa over the electrolyte isn't usually involved but the superficial one is frequently involved either one can be so the superficial one is sometimes called the subcutaneous olecranon bursa so inflammation of that the student elbow is subcutaneous electron bursitis that's the most common bursitis at the elbow and again it's repeated excessive friction on a hard surface like bring your elbow down on something okay the other ten the other burst is called the subtendinous electron bursa means remember prefixes sub underneath so subcutaneous means under the skin cutane means skin so subcutaneous bursa is a burst under the skin subtendiness bursa is a little deeper subtending the electron bursa right it's under the tendon right over the bone so it's not common uh it can be inflamed this is not common it's friction between your triceps tendon and the electron process okay that's all the detail i'm going to go into today bursitis strains we don't usually have a lot of sprains here you could injure those collateral ligaments just not very common okay that's going to do it for today's lecture on the elbow [Music] [Music] you