Our clinical experience has demonstrated that the development of elbow injuries is often secondary to dysfunction of the shoulder andlor cervical regions. In response to this observation, we have developed a rehabilitation protocol for the entire upper quarter as the focus of our management of elbow injuries. Our approach addresses range of motion deficits in shoulder rotation, weakness of shoulder external rotation and abduction, cervical facet impingement, and other associated deficits, with the goal being restoration of the flexibility, strength, endurance, proprioception, and coordination needed for activity. Presented are specific elements of this approach, possible mechanisms of injury involved, and a case history.Evaluation and treatment of elbow injuries have traditionally focused on the biomechanics of the forearm itself (1 2,22) with secondary concern aimed at the overall condition of the upper extremity (1 1 , 14, 15). Our clinical experience has demonstrated a strong relationship between the development of elbow injuries and preexisting dysfunction of the shoulder and/or cervical regions. In the course of treating our patients with elbow injuries, we have developed an approach predicated on addressing the entire upper quarter, which has proven to be successful in returning most of our patients to demanding activity.Other investigators have noted the role played by the shoulder in injuries to the elbow (13-15, 19, 21, 23) but we feel more thorough attention to this relationship is warranted. In our elbow-injury patients, we have seen a pattern emerge involving shoulder deficits, cervical dysfunction, and previous history of shoulder and/or The purpose of this article is to give an overview of the type of rehabilitation approach we have found to be successful in treating elbow injuries, to discuss the possible mechanisms of injury involved, and to present a typical case exemplifying the relationship of dysfunction at the shoulder and neck to the development of elbow problems. HISTORY AND SYMPTOMSWhile most of our patients present with lateral and/or medial epicondylitis, we also see a number of postsurgical elbow patients. (The surgeries were usually performed on professional athletes and typically involved ulnar nerve transposition, tendon debridement, and/or the removal of loose bodies.) A common thread running through the evaluations of our patients is that previous history of shoulder or neck injury is often reported although symptoms directly related to the shoulder and/or neck have subsided. Most commonly specified are rotator cuff injuries, cervical sprains, and shoulder dislocations and/or subluxations. Physical examination of the upper quarter tends to reveal a pattern of dysfunction in the affected 402DILORENZO ET AL JOSPT