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1. ANATOMI TERAPAN
REGIO ELBOW
Rakhmad Rosadi,SST.FT

2. What Is Palpation?
• Palpation is as much an act of the mind
as it is of the palpating fingers. Sensory
stimuli entering through the therapist's
• hands must be correlated with a
knowledge base of anatomy.

3. How to Palpate

4. Move Slowly
Moving too quickly or
frenetically jumping around the client's body does not allow
for effective and mindful palpation.

5. Use Appropriate Pressure
1. most new therapists use too little pressure, prob
ably because they are afraid of hurting the client
2. With a stronger knowledge base of the underlying anatomand
more hands-on experience, this fear usually recedes

6. How to Learn Palpation
A long-standing exercise to learn palpation is to take a hair
and place it under a page of a textbook without seeing where
you placed it. With your eyes closed, palpate for the hair until you
find it.

13. Functional Characteristics of Muscle Tissue
normal resting length
Irritability
Contractility
Extensibility
Elasticity

14. Length-Tension Relationship
in Muscle Tissue

15. Types of Muscle Contraction

16. Muscle types. Cardiac, smooth, and skeletal muscles
are the three types in the human body. Each has a unique
structure and location reflecting its function.

17. TYPES OF SYNOVIAL JOINTS

18. Ball and socket

19. Hinge

20. Pivot Number of
Planes/Axes
Movement
possible
examples
Uniaxial Rotation Atlantoaxial
joint
Radioulnar
joints

21. Ellipsoid/condyloid
Number of
Planes/Ax
es
Movement
possible
examples
Biaxial Flexion
Adduction
Atlantoocci
pital joint
Extension Metacarpo
phalangeal
joints
Abduction Radiocarp
al joints
(or lateral
flexion in
spine)

22. Saddle
Number of
Planes/Axes
Movement
possible
examples
Biaxial Flexion 1 st
Carpometacarp
al
joint (thumb)
extension
abbduction
adduction

23. Giding Number
of
Planes/A
xes
Moveme
nt
possible
example
s
Nonaxial N/A Acromioc
lavicular
joint
Intercarp
al joints

24. Movement Muscles Nerve Supply Nerve Root
Brachialis Musculocutaneous C5 C6 (C7)
Biceps brachii Musculocutaneous C5 C6
Elbow flexion Brachioradialis Radial C5 C6 (C7)
Pronator teres Median C6 C7
Flexor carpi ulnaris Ulnar C7 C8
Elbow Triceps Radial C6 C7 C8
extension Anconeus Radial C7 C8 (T1)
Forearm
supination
Supinator Posterior interosseous (radial) C5 C6
Biceps brachii Musculocutaneous C5 C6
Forearm Pronator quadratus Anterior interosseous (median) C8 T1
pronation Pronator teres Median C6 C7
Flexor carpi radialis Median C6 C7
Wrist flexion Flexor carpi radialis Median C6 C7
Flexor carpi ulnaris Ulnar C7 C8
Extensor carpi radialis longus Radial C6 C7
Wrist
extension
Extensor carpi radialis brevis Posterior interosseous (radial) C7 C8
Extensor carpi ulnaris Posterior interosseous (radial) C7 C8

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Muscles
• Anterior
• Primarily flexion &
pronation
• Biceps brachii
• Brachialis
• Brachioradialis
• Pronator teres
• Pronator quadratus

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Muscles
• Posterior
• Primarily extension
& supination
• Triceps brachii
• Anconeus
• Supinator

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Biceps Brachii Muscle
Flexion of elbow
Supination of
forearm
Weak flexion of
shoulder joint
Weak abduction of
shoulder joint when
externally rotated

37. Palpation of the
biceps brachii with the forearm fully supinated

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Brachialis Muscle
True
flexion
of elbow

39. Palpation of the brachialis with the forearm
fully
Palpation of the brachialis with the forearm
fully
pronated
Palpation of the brachialis with the forearm fully
pronated

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Brachioradialis Muscle
Flexion of elbow
Pronation from supinated
position to neutral
Supination from pronated
position to neutral

41. Palpation of the brachioradialis with
the forearm halfway between full supination and full
pronation.

42. All heads:
extension
of elbow
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Triceps Brachii Muscle
Long head:
extension of
shoulder joint;
adduction of
shoulder joint;
horizontal
abduction

43. Palpation of the belly of the right triceps brachii as
the client extends the forearm against resistance

44. Anconeus Muscle Extension of elbow
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Pronator Teres Muscle
Pronation of
forearm
Weak flexion of
elbow

46. Palpation of the right pronator teres as the client
pronates the forearm at the radioulnar joints against resistance.

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Pronator Quadratus Muscle
Pronation of
forearm

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Supinator Muscle
Supination of
forearm

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Elbow Flexion
• Ex. Biceps curl
• Agonists
• Biceps brachii
• Brachialis
• Brachioradialis

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Elbow Extension
• EX. Push-up
• Agonists
• Triceps brachii
• Anconeus

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Radioulnar Pronation
• Agonists
• Pronator teres
• Pronator
quadratus
• Brachioradialis

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Radioulnar Supination
• Ex. Tightening a screw
• Agonists
• Biceps brachii
• Supinator muscle
• Brachioradialis

53. Epicondylitis
• Overuse condition caused by repeated overload of the
musculotendinous units attaching to one of the epicondyles
• Also due to: faulty techniques/mechanics, weak muscle groups,
inappropriate equipment
• Lateral
• Tennis elbow
• Medial
• Golfer’s elbow
• Thrower’s elbow
• Pitcher’s elbow

54. Lateral Epicondylitis

55. Medial Epicondylitis

56. Epicondylitis—Signs & Symptoms
• Local tenderness over involved epicondyle
• Pain on use of involved muscles
• Swelling
• Resisted wrist motion often reproduces
pain

57. Epicondylitis—Treatment
• Preventative measures:
• Proper technique
• Use of appropriate equipment
• Limited stress
• Proper/adequate warm-up
• Stretch to maintain flexibility
• RICE
• Modify activities that aggravate condition
• Decrease amount, frequency, or intensity of
activity

58. Sprains of the Elbow
• Result from:
• Hyperextension
• Valgus/varus force
• Signs/Symptoms
• “click” or “pop”
• Sharp pain at time of injury
• Point tenderness
• Localized swelling
• Paint with attempt to
reproduce MOI
• Extension may be limited
• Treatment
• Special tests
• Progressive rehab
• Bracing
• Depends on degree of injury

59. Elbow Dislocations
• Second most frequently dislocated major joint
• Posterior displacement of ulna and radius in relationship to humerus
most common
• Result of FOOSH with elbow in extension
• Collateral ligament will be severely stretched or ruptured

61. Elbow Dislocation
Signs & Symptoms
• Obvious deformity
• Loss of elbow function
• PAIN
• Check for:
• Circulation
• Nerve function
• Properly immobilized
• Refer immediately
Treatment
• Prompt reduction important
• Rehab based on injury

62. Fractures of the
Elbow and Forearm
• Result of:
• Direct trauma
• Indirect stresses transmitted through UE (FOOSH)
• Excessive forces associate with throwing and swinging activities
• Most frequent in children and skeletally immature athletes

63. Volkmann’s Contracture
• Occurs in absence of blood flow (ischemia) to forearm
• Caused by increased pressure due to:
• Swelling
• Trauma
• fracture
• Blood vessels compress, decreasing blood flow to arm
• ® injury to muscles, causing it to shorten
• Pulls on joint at end of muscle just as it would if it were normally
contracted

64. Volkmann’s Contracture
• Wrist remains flexed and cannot be straightened
• Causes fingers to form fist and flex the wrist
• Muscles involved are on palm side of forearm
• Three levels of severity:
• Mild—two/three fingers only; no or limited loss of sensation
• Moderate—all fingers flexed; thumb stuck in palm; wrist stuck in
flexion; usually loss of some sensation
• Severe—all muscles in forearm involved; completely disabling

65. Volkmann’s Contracture
Signs & Symptoms
• Severe pain with passive movement
• Forearm tensely swollen and shiny
• Pain when forearm squeezed
• Pain not improve with rest
• Continue to get worse over time
• If condition not corrected:
• Decreased sensation
• Weakness
• Paleness of skin

66. Injury to the Ulnar Nerve
• Passes through cubital tunnel in the
posterior aspect of medial epicondyle
• Vulnerable to compression forces and
tension stresses due to:
• Repetitive movement in cubital tunnel
• Relative lack of bony protection
• Repetitive throwing and/or swinging can
irritate, compress or entrap the nerve
• aka cubital tunnel syndrome

67. Injury to the Ulnar Nerve

68. Injury to the Radial Nerve
• Passes anteriorly to the lateral epicondyle and lies in a tunnel formed
by several muscles and tendons
• Repetitive pronation/supination can cause entrapment
• aka radial tunnel syndrome
• Differentiate from lateral epicondylitis

69. Injury to the Radial Nerve
• Pain over lateral aspect of elbow
• Tenderness present over anterior radial head
• Symptoms reproduced by:
• Resisting supination with elbow at 90
• Resisting extension of middle finger with elbow extended
• Failed treatment of lateral epicondylitis may be radial nerve

70. Injury to the Median Nerve
• Crosses anterior elbow and passes between the
heads of the pronator teres muscle just distal to
the joint
• Entrapment caused by:
• Hypertrophy of the pronator teres
• Activities that involve repetitive pronation
• aka pronator teres syndrome

71. Injury to the Median Nerve
• Pain radiating down the anterior forearm
• Numbness & tingling in
thumb, index, and
middle fingers
• Increases pain with
resistive pronation