The elbow joint, commonly known as the elbow, is the joint that connects the large arm (also called the upper arm) to the small arm (also called the forearm).
Anatomy of the elbow joint.
Anatomically, the elbow joint is a compound joint. It is composed of the humerus, radius, ulna, and the joint capsule of the elbow, as well as the surrounding ligaments.
We usually speak of the elbow joint as if it were one joint. In fact, the elbow joint includes three joints: the humeral ulnar joint, the humeral radial joint and the superior ulnar radial joint.
On the anterior and posterior surfaces of the elbow joint, there are ligaments that form the joint capsule. The sides of the elbow joint are reinforced by the ulnar collateral ligament and the radial collateral ligament, which serve to prevent excessive pronation and abduction of the elbow joint. Also wrapped around the neck of the radial tuberosity is the annular ligamentous tissue, which is important for maintaining the stability of the radial tuberosity.
The elbow joint is a joint with two axes of motion and two degrees of freedom. In other words, the elbow joint can flex and extend, that is, bend the arm and straighten it; it can also do forward and backward rotation of the small arm. This means that the small arm can be rotated so that the palm of the hand faces upward (posterior rotation) and so that the palm of the hand faces downward (anterior rotation).
These two movements are usually performed in concert with the rotational function of the shoulder joint in various movements of our daily life, so flexion and extension are easily noticed and the rotational function is often overlooked.
The normal angle of flexion and extension of the elbow joint is approximately 135-150°-0°. Many people (especially women) also have hyperextension of the elbow joint, about 10-15°. Both anterior and posterior rotation are roughly 80-90°. There is also a physiological valgus angle, called the carry angle or carry angle, which is approximately 15°.
Dysfunction of the joint.
Following an injury to the elbow joint itself, or a surrounding fracture, such as a humeral fracture or forearm fracture, a certain degree and duration of immobilization is necessary in the treatment. Commonly, this can be done by suspension with a “triangular scarf”, plaster cast, splinting or bracing, etc.
In either case, there is inflammation and braking of the soft tissues surrounding the elbow joint. This leads to morphological, structural, and biomechanical changes in the muscles, ligaments, and joint capsule surrounding the elbow joint, resulting in joint adhesions and atrophy of the muscles surrounding the elbow joint.
However, if the elbow joint is restricted in extension and flexion, it does not have a great impact on the function of the elbow joint, but the arm is not straight and does not look good. However, if the forearm rotation is limited at the same time, it will seriously affect the daily life.
For example, when washing the face, the forearm must be able to rotate backwards in order to wipe the face with the palm upwards; when eating, the bowl must be carried with the palm upwards; when writing with a pen or holding chopsticks, the forearm must be rotated forward in order to complete! If you can’t bend, the problem is even worse, even if you have food in your hand, you can’t bend your arm to get it into your mouth! Every time you eat something, you have to stretch your neck to find it, which is really a great pain and unsightly!
For these dysfunctions, the limited mobility of the elbow joint must be treated with rehabilitation and functional exercises in order to improve and restore the function!
Considerations for rehabilitation of elbow adhesions.
The elbow joint is very susceptible to ossifying myositis, which in layman’s terms means that calcium salts are deposited in the muscles and other soft tissues and grow into bone! This is a very scary complication, imagine, soft tissue into bone, how can the joint still move! As for why the elbow joint is prone to this serious problem, the mechanism is not very clear, but there is absolutely no doubt about the fact, so it should never be taken lightly! Don’t practice on your own, not to mention the use of violence, one exercise angle progress too much!
The following is a brief and concise introduction to arthrodesis for the treatment of elbow mobility disorders.
Arthrodesis of the elbow joint.
I. Isolated traction (acting on the brachioradialis joint) – for increasing the flexion and extension angle of the elbow joint
The patient is seated with the forearm flexed 90 degrees in a neutral position. The therapist sits on the affected arm with the upper hand in the elbow socket and the lower hand holding the distal forearm and wrist. The lower hand is immobilized and the upper hand pushes the radius laterally to separate the brachioradialis joint.
II. Long axis traction (acting on the brachioradialis joint) – for increasing the flexion and extension angle of the elbow joint
The patient is positioned supine with the shoulder joint abducted and the elbow joint at the point of limited elbow extension activity, with the forearm rotated back. The therapist sits between the abducted upper extremity and the trunk with the medial hand holding the distal humerus and the lateral hand holding the radial aspect of the distal forearm. The medial hand is held in place and the lateral hand is pulled distally along the long axis of the radius.
Third, flexion and swing of the elbow (acting on the humeral ulnar joint)-increasing the flexion angle of the elbow joint
The patient is placed in a supine position with the forearm rotated forward and the elbow flexed. The therapist sits on the affected side with the upper hand in the elbow socket and the lower hand holding the distal forearm. The upper hand is held in place while the lower hand slightly tracts the forearm in the long axis before flexing the elbow joint.
IV. Elbow extension swing (acting on the humeral ulnar joint)-increasing the elbow joint extension angle
The patient is in supine position with the forearm rotated back. The therapist sits on the affected side with the upper hand on the elbow fossa and the lower hand holding the distal ulnar aspect of the forearm. The upper hand is fixed and the lower hand is swung at the end of the restricted elbow extension movement.
V. Anterior-posterior sliding (acting on the proximal radial-ulnar joint) – Increasing the anterior angle of forearm rotation
The patient is seated with the forearm rotated posteriorly to extend the elbow. The therapist sits facing the patient and holds the radius and proximal ulna in each hand, with the thumb on top and the four fingers on the bottom. One hand fixes the ulna and the other hand pushes the radius dorsally.
VI. Posterior-anterior sliding (acting on the proximal radial-ulnar joint)-increasing the angle of forearm rotation posteriorly
The patient is placed in a supine position with the forearm in a neutral position with the elbow slightly flexed. The therapist sits facing the patient with the thumb of the upper hand on the radial tuberosity and the four fingers on the elbow fossa, while the lower hand holds the distal forearm and wrist. The upper hand pushes the radial tuberosity to the palmar side.
VII. Forearm rotation-Increasing forearm rotation angle
The patient is placed in a supine or sitting position with the forearm in a neutral position with the elbow flexed at 90 degrees. The therapist sits on the affected side with the upper hand on the distal humerus and the lower hand holding the palmar side of the distal forearm. The upper hand is held in place while the lower hand swings the forearm forward or backward in rotation.
To improve the mobility of the elbow joint, it is not only necessary to perform arthrodesis, but also to stretch the muscles around the elbow joint to improve the elasticity and extension of the soft tissues around the joint in order to better and more safely restore the mobility of the joint, as well as to improve the flexibility of the active movement of the joint.
Like arthroplasty, there is a specific technique for stretching the muscles around the joint, the muscle stretching technique.
Techniques for distraction of the muscles surrounding the elbow joint.
I. Distraction of the elbow extensor muscle group – increase the angle and flexibility of elbow flexion
The patient is placed in a supine position with the upper extremity slightly abducted. The therapist faces the patient on the affected side of the arm, holding the palmar side of the distal forearm with one hand and holding the elbow with the other. The elbow is passively flexed to its maximum range, and the elbow extensor muscle group is pulled.
2. Stretching the elbow flexor group – increase the angle and flexibility of elbow joint extension
The patient is placed supine with the upper extremity slightly abducted. The therapist stands facing the patient’s head on the pulling side with the medial hand on the proximal humerus and the lateral hand holding the palmar side of the distal forearm. The elbow joint is passively extended to its maximum extent, and the flexor elbow muscles are retracted.
C. Extension of the anterior and posterior rotators – increase the angle and flexibility of the anterior and posterior forearm rotation
The patient is placed in a supine position with the upper extremity slightly abducted and the elbow flexed at 90 degrees. The therapist stands facing the patient on the pulling side, with the upper hand holding the palmar side of the distal forearm and the lower hand holding the elbow joint to fix the humerus. The pull is rotated anteriorly or posteriorly to its maximum extent, the radius is pulled to rotate around the ulna, and the corresponding muscle groups are stretched.
Some exercises that you can perform on your own.
I. Flexion of the elbow joint (bending the arm).
Sitting, bend the elbow with the fist facing you and the muscles completely relaxed, hold the wrist on the affected side with the healthy hand and pull it hard towards yourself. Alternatively, the hand is fixed against the wall or table, the muscles are completely relaxed, and the body is gradually leaned forward so that the distance between the fist and the shoulder is close, increasing the angle of flexion of the elbow. To the painful place should stop, wait for the tissue to adapt to the pain to disappear and then increase the angle, usually 10-15 minutes / time, 1-2 times / day. The angle of elbow flexion can be measured indirectly by measuring the distance from the wrist to the shoulder, the shorter the distance, the greater the angle of flexion.
II. Elbow extension (straightening the arm).
In a seated position, extend the elbow with the fist up, fix the elbow support on the table, and hang the small arm and hand outside the table. Muscles completely relaxed, so that the elbow in the role of self-weight or weight slowly down to straighten (if necessary, add a light weight at the wrist as a load to increase the practice). Stop at the place of pain and increase the angle after the tissue has adapted to the disappearance of the pain, generally 10-15 minutes / time, 1-2 times / day. The angle of elbow extension can be measured indirectly by measuring the distance from the wrist to the level of the arm, the shorter the distance, the greater the extension angle and the smaller the gap with the healthy side.
3. Forearm rotation: Sitting, bending the elbow, forearm extension.
Sitting position, bending the elbow, forearm horizontal on the table, the affected limb hand holding a gymnastic stick or any other small hard stick, the healthy side hand holding another gymnastic stick, the healthy side active for rotation forward action through the gymnastic stick so that the affected side do passive rotation forward. The force should be even and slow, without violence. To the pain should stop, to adapt to the tissue pain disappeared and then increase the angle, generally 10-15 minutes / time, 1-2 times / day.
Four, forearm rotation back:
Sitting, elbow flexion, forearm level on the table, the affected limb hand holding one end of the gymnastic stick, the healthy side of the hand holding another gymnastic stick (any other hard stick) head, the healthy side of the active spin back action, through the gymnastic stick so that the affected side of the passive spin back. The force should be even and slow, no violence. The pain should be stopped and the angle should be increased after the tissue adapts to the pain, usually 10-15 minutes/time, 1-2 times/day.
The above basically covers all aspects of elbow joint mobility exercises. They include both what can be done in the hospital by a rehabilitation therapist and functional exercises that you can perform on your own. It is important to note that joint release and muscle stretching techniques are very technical and professional operations, and should never be done by yourself with the help of others, but must be done by professionals in a hospital, otherwise very serious adverse consequences may occur! Exercises that you can do on your own should only be started after professional guidance, otherwise they may increase inflammation and disrupt the therapist’s treatment plan, and should never be attempted lightly!
In addition, while undergoing rehabilitation, care should be taken to avoid localized movements that irritate the joint and to avoid excessive movement of the elbow joint in order to control inflammation at a relatively low level. It is also important to recognize that there is often “repetition” in the recovery of the angle, so it is important to overcome both the fear of pain and impatience, and to progress gradually.
To clarify the function of the elbow joint, do not just rush to restore the elbow joint straightening angle. Because the function of the upper limb is mainly accomplished only in the position of elbow flexion, try to practice the angle of elbow flexion under the premise of ensuring that the angle of extension does not regress.
In addition to rehabilitation and practice, it is also important to pay attention to the training of the elbow joint’s daily living ability in daily life. Don’t just move when practicing, but usually still in a self-protective position afraid to move.
The functional exercises for the elbow joint are not only the ones described above, but also muscle strength exercises, functional movement exercises, joint stability and flexibility exercises, and many other aspects. In addition to the above-mentioned manipulation, the treatment also involves the selection of appropriate physical therapy depending on the condition of the tissue. In addition to the above mentioned manipulation and relaxation exercises, physical therapy is also used to improve the effectiveness of the treatment depending on the condition of the tissue. The physiotherapy is used to improve the effectiveness of the treatment.