NASM CES Chapter 15: Corrective Strategies for the Wrist and Elbow 5

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Chapter Goals:

  • Know the basic functional anatomy of the wrist and the elbow.
  • Find the mechanisms that are common for wrist and elbow injuries.
  • Be able to discuss the influence of alterations in elbow and wrist movement in the kinetic chain. 
  • Find the strategies for appropriate systematic assessment in the wrist and elbow. 
  • Find the right corrective exercise strategies for the wrist and elbow. 

Introduction

The elbow joint is the link between the shoulder and the wrist, giving great stability and motion.

The elbow joint is not simply a hinge joint, as it also works to give pronation and supination.

Force transmission in the forearm is a complex interaction between the radius, ulna, and interosseus membrane.

The wrist affects the force transmission to the elbow. 

The wrist is one of the most complex joints that we have in the body. It has many bones, ligaments, connective tissues, nerves, and muscles.

It allows us to have many movements and fine motor skills.

We have a total of 37 bones in the wrist and hand. 

Review of Elbow and Wrist Functional Anatomy

The elbow and wrist, like the shoulder, allow us to do limitless amounts of movement in the upper body.

The elbow is similar to the knee in the lower extremities, except it is not as robust due to less force traveling through it. 

Bones and Joints

The elbow is seen as simple and only really made up of three bones. These are the humerus, ulna, and radius.

The humerus and ulna will form the humeroulnar joint.

This joint is mainly for flexion and extension.

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It is considered to be the pure elbow joint.

The radius and the humerus together work to make up the humeroradial joint. 

In the wrist, we have the radius and ulna making the distal radioulnar joint, and it works to interact with the carpal bones.

It is important to look at the diagram and know the bones of the hand. 

Muscles

The muscles in the elbow, forearm, and wrist may be divided into the following 6 categories: 

  • Forearm flexor- the pronator group
  • Forearm extensor – the supinator group
  • Wrist flexors
  • Wrist extensors
  • Wrist ulnar deviation
  • Wrist radial deviation

Some of the other key muscles to know that have involvement with the elbow and wrist are the following:            

  • Biceps brachii, brachialis, brachioradialis, pronator teres, triceps brachii, and then the ones that make up those previous six categories. 

Altered Wrist and Elbow Movement

Musculoskeletal injuries in the elbow, forearm, and wrist comprise a third of workday illnesses.

Elbow pain has been found to affect 1 – 3 percent of the population and 25% of athletic sports related injuries are in the wrist and hand. 

Static Malalignments

Common malalignments of the elbow cause constant elbow flexion, which results from overactivity in the biceps brachii and the brachialis and under activity of the triceps.

This may or may not be affected by the instability of the shoulder.

Excessive flexion of the elbow has restricted the wrist’s range of motion.

These static malalignments in the wrist usually show up as chronic wrist extension and flexion. 

Abnormal Muscle Activation Patterns

It has been shown that many people with elbow and wrist impairments have less than optimal stability and range of motion, along with alterations in muscle activation patterns at the shoulder joint.

Repeated use of the wrist and elbow motion may lead to overusing the extensors of the wrist or to injuries to tendons. 

Dynamic Malalignments

A lack of wrist and elbow movement can lead to alterations in the shoulder girdle activation patterns since more movement may be needed to compensate for reduced distal mobility.

These changes may lead to increased strain on the elbow muscles, tendons, and rotator cuff. 

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Wrist and Elbow Dysfunction and the Regional Interdependence Model

The proper function of the elbow and wrist depends on the proper structures of the upper extremities.

Proper mobility of the thoracic spine, stability of the scapula, and shoulder position can play a large part in dysfunctions and wrist and elbow injuries.

The length tension relationships of the upper body may be compromised due to poor posture, repetitive activities, or immobilization in some form of brace or cast. 

Influence on the Wrist

Considering that the upper extremity joints are linked functionally in a chain and one joint impacts the function of the others, the shoulder and the elbow influence the wrist.

It is important to consider this when we are relating everything found throughout our assessments in this chapter and the one on the shoulder and thoracic spine. 

Assessment Results for the Elbow and Wrist

The elbow and the wrist need to be looked at as an extension of the shoulder and the rest of the upper body.

Essentially, any time there is dysfunction of the shoulder, some form of dysfunction will likely be found in the elbow or the wrist.

One specific common one is overactivity of the biceps that lead to rounding of the shoulders in the static posture or the arms falling forward as a movement compensation like in the overhead squat.

Pay attention to the various results of the different forms of assessments. 

Static Posture

Fitness professionals will see that there is no mention of elbow and wrist problems in the syndromes and spinal postures that we initially started to look at in the book.

But, due to the regional interdependence model, we can relate some of these dysfunctions to our syndromes.

Rounded shoulders can appear in various ways in the elbow and wrist, which usually evolves around the overactive biceps brachii.

Transitional Movement Assessments

The overhead squat and the overhead press movements will shine spotlights on the imbalances that may be present in the arms. 

Overhead Squat Assessment

Because doing the overhead squat means we need full mobility in the upper body, shoulders, and elbows, many of these common compensations can be found with the overhead squat pattern.

This is another reason the overhead squat is such a valued assessment. 

Loaded Movement Assessment

The overhead squat assessment gives a strong estimation of possible dysfunctions of the arms; predictions for limitations in the range of motion in the wrist can be made by looking at the client when they are doing pushing, pulling, and overhead press exercises. 

Mobility Assessments

The elbow and the wrist are functional extensions of the shoulder. When movement impairments are found in the shoulder and thoracic spine, there is likely to be some muscle overactive in the arm.

There should be tests done for elbow and wrist flexion and extension. 

Corrective Strategies for the Elbow and Wrist

The Sample Corrective Exercise Program for the Elbow and Wrist Impairments includes these phases:

We start by inhibiting the brachialis, biceps brachii, wrist flexors, or extensors through the use of SMR. Make sure to look at the acute training variables for this phase of corrective exercise in the appropriate chapter. 

Next is the lengthening phase, where static stretching is implemented on the biceps brachii and the wrist extensors or flexors. Make sure to look at the acute training variables for this phase of corrective exercise in the appropriate chapter. 

Activation is the third phase and it has us using isolated strengthening in the form of elbow extension, wrist flexion or extension, and wrist supination and pronation. Make sure to look at the acute training variables for this phase of corrective exercise in the appropriate chapter. 

Integrated dynamic movements are implemented in the final integration stage in the exercises of standing latissimus dorsi pulldowns, standing cable press, and prone ball triceps extension with a cobra. Make sure to look at the acute training variables for this phase of corrective exercise in the appropriate chapter. 

Make sure to go through the steps and pictures so you cannot see how everything should look for these four steps mentioned.  And look into the specific for elbow flexion and non-neutral wrist. 

Common Issues Associated with the Elbow, Wrist, and Hand

Wrist and elbow injuries have a significant impact on the daily life activities of everyone.

Pain will limit the simple tasks that we do. 

Lateral Epicondylitis

We also call this tennis elbow. This is a common issue related to overuse injuries of the forearm extensors.

It is more specifically from repeated wrist and elbow motions and can also lead to wrist extensors and tendons injuries. 

Medial Epicondylitis

This is also known as a golfer’s elbow. It is a very common overuse injury to the flexors of the forearms.

It is just like tennis elbow, where certain sports and occupations are more at risk due to chronic movements. 

De Quervain’s Tenosynovitis

This is inflammation of the sheath, or the synovium, surrounding the two tendons running between the wrist and the thumb.

There is no specific cause, but any activity relying on constant hand or wrist motions. 

Carpel Tunnel Syndrome

This neural entrapment condition affects around 3 – 6 percent of all adults in the US. It causes numbness, tingling, weakness, and other symptoms in hand. 

Tyler Read - Certified Personal Trainer with PTPioneer

Tyler Read


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