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ELBOW JOINT

SUBMITTED TO:
DR.SUPREET
BINDRA
SUBMITTED BY:
RAMANDEEP
KAUR

ARTICULATING SURFACES ON
THE HUMERUS

Trochlea
Trochlear
groove
Capitulum
Coronoid
fossa
Radial fossa
Olecronon
fossa

Capitulotrochlear
groove

Trochlear
groove

ARTICULATING SURFACES
ON RADIUS , ULNA

Trochlear notch
Trochlear ridge
Head of radius
Fovea

Rim
Fovea

ARTICULATION

BETWEEN HUMERUS AND ULNA


Primarily as sliding motion of ulnar trochlear ridge
on humeral trochlear groove
IN EXTENSION: Sliding continuous until olecranon
process enters olecranon fossa
IN FLEXION: Trochlear ridge of ulna slides along
trochlear groove until coronoid processs reaches
coronoid fossa

ARTICULATION

BETWEEN HUMERUS AND RADIUS


Between radial head and capitulum of humerus
IN EXTENSION:No contact occurs between
articulating surfaces
IN FLEXION:Rim of radial head slides in
capitulotrochlear groove

CAPSULE

PROXIMALLY HUMERAL ATTACHMENT


Of capsule is just above the coronoid and radial
fossa
DISTALLY : attaches into ulna along the margin of
coronoid process and blend with annular ligament
MEDIALLY AND LATERALLY
Capsule is continuous with collateral ligaments

CAPSULE
Medial
epicondyle

Radius
Ulna

POSTERIORLY: attached to humerus along the


upper edge of olecranon and to the back of
medial epicondyle.
Capsule is fairly large, loose and weak anteriorly
ad posteriorly
Fat pads are located between capsule and
synovial membrane
Laterally and medially capsules are reinforced
by collateral ligaments

MEDIAL [ULNAR]COLLATERAL
LIGAMENT

Either two or three


parts : anterior,
posterior or transvers
Proximal enthesis
fused with common
flexor tendon and
part of humeral
articular cartilage
Distal enthesis on
coronoid process of
ulna

Distal enthesis is broad proximally and tapers


distally with fibers of ligament crossing
coronoid process and insert further distally
on proximal and medial ulna.
Anterior bundle is primary restrain to
ligamentous restrain of valgus stress.
Anterior bundle consists of anterior and
posterior band that tighten in reciprocal
manner as elbow flex and extend.
Posterior bundle is not not distinct as
anterior sometimes fibers blend with the
fibers from the medial portion of capsule.

Posterior bundle extends from the posterior


aspect of medial epicondyle of humerus to
attach to thne ulnar coronoid and olecranon
process.
It limits elbow extension but plays a less
significant role in than anterior bundle in
providing valgus stability for elbow.
Transverse fibers of ligament extends
between the olecranon and ulnar coronoid
process.

LATERAL COLLATERAL
LIGAMENT

Lateral
ligamentous
complex includes
lateral [radial]
collateral
ligament,lateral
ulnar collateral
ligament and
annular ligament.

Lateral radial collateral ligament is fan


shaped structure extends from the inferior
aspect of lateral epicondyle of humerus to
merge with annular ligament.
Ligamentous tissue extends from the the
lateral humeral epicondyle to the lateral
aspect of the ulna and annular ligament is
referred as lateral ulnar collateral ligament.
Lateral ulnar collateral ligament assists
lateral radial collateral ligament in resisting
varus stress at elbow.

FLEXORS OF ELBOW JOINT

BICEPS BRACHII
BRACHIALIS
BRACHIORADIALIS

MUSCLE

ORIGIN

INSERTION NERVE
SUPPLY

BICEPS
BRACHII

Short head:
coracoid
process of
scapula
Long head:
supraglenoid
tubercle of
scapula
Anterior
surface of
lower portion
of humeral
shaft
Lateral
supracondyla

Tuberosity of
radius

BRACHIA
L-IS
BRACHIO
-

Musculocut
a-neous
nerve

Ulnar tuberosity Musculocut


and and
a-neous
coronoid
nerve
process
Proximal to
radial styloid

Musculocut

EXTENSORS OF ELBOW

Triceps brachii
anconeus

MUSCLE INSERTION

INSERTION NERVE
SUPPL
Y

TRICEPS
BRACHII
[two joint
muscle]

Long head :
infraglenoid
tubercle of scapula
Medial head: covers
the extensive area
as originate from
post. Humerus
Lateral head: covers
only narrow ridge on
posterior of
humerus

Via a
common
tendon into
olecranon
process

Anconeus

Posterior surface of Lateral


lateral epicondyle of aspect of

Radial
nerve

Radial
nerve

AXIS OF MOTION

A relative fixed
axis that passes
horizontally
through center of
trochlea and
capitulum and
bisects the
longitudinal axis of
shaft of humerus

CARRYING ANGLE

The medial portion of the


trochlea projects distally
more than lateral portion
and result in valgus
angulation of forearm is
called carrying angle.
Normal carrying angle is
15
and varies between 8 to
15

Functional use of
carrying angle in
shoulder lateral
rotation ,elbow
extension and forearm
supination which
enable person to carry
out bucket in one hand
such a way that avoid
contact between
carried load and lower
limb on same side.

FEMALES HAVE LARGER


CARRYING ANGLE THAN MALES

Proximal end of ulna angulates more and


medial flange of trochlea grows longer in
shorter person than in taller.
Because average height of women is less
than in men .

MOBILITY AND STABILITY


Amount of motion at elbow depends upon:
Type of motion [active or passive]
Position of forearm[pronation and supination]
Body mass index
Position of shoulder

TWO JOINT MUSCLE EFFECT ON


ELBOW ROM
Two or multiple joint muscles do not have sufficient
length to allow simultaneous full ROM at all joints
For e.g ,in passive motion passive tension in triceps
limit the full elbow flexion when shoulder
simultaneously into flexion
In active motion,torque produced by long head of
biceps brachii muscle excessively shortened over
both joints in full active shoulder and elbow
flexion

ACTION OF TRICEPS IN PUSHUPS

Triceps work
eccentrically in
reverse action to
control elbow flexion
during lower phase of
push up
Triceps work
concentrically in
reverse action to
produce elbow
extension that raises
body in push-up

ARTICULATING SURFACES ON
PROXIMAL RADIOULNAR JOINT

Ulnar radial notch


Annular ligament
Head of radius
Humerus capitulum

ARTICULATING SURFACES ON
DISTAL RADIOULNAR JOINT

Ulnar notch of
radius
The articular disc
Head of ulna

ARTICULAR DISC

Also called triangular


fibrocartilage because
of its triangular shape
or TFFC Because of
extensive fibrocartilage
connections.
Disc is like a shelf
whose medial border is
embeded in wedge of
vascular connective
tissue join disc to ulna
and articular tissue.

ATTACHMENTS OF DISC

Base is attached to distal


edge of ulnar notch of
radius
Apex has two attachments:
to fovea on ulnar head and
other to base of ulnar
styloid process
Medially :continuous with
fibers of ulnar collateral
ligament
Disc has two articulating
surfaces: Proximal
Distal

SURFACES OF DISC

Proximal surface:
articulates with ulnar
head at distal
radioulnar joint
Distal surface:
articulates with carpal
bones
Margins of disc are
thick formed by or are
integeral part of dorsal
or palmer radioulnar
ligaments.

ARTICULATIONS

Proximal and distal radioulnar


joints are linked therefore motion
at one joint is always accompanied
by motion at other joint
Pronation occurs as a result of
radius crossing over ulna at
superior radioulnar joint
During pronation and supnation
Rim of head of radius spins within
osteoligamentous formed by radial
notch and annular ligament

LIGAMENTS
Ligaments associated with proximal radioulnar
joint are:
Annular ligaments
Qudrate ligaments
The oblique cord
Interosseous membrane provide stabilization
at both proximal and distal radioulnar joint

ANNULAR LIGAMENT

Strong ligament
Forms 4/5th of ring that
encircles radial head
Inner surface is covered
with cartilage
Proximal border blend
with joint capsule
Lateral aspect is
reinforced by fibers
from lateral collateral
ligament

QUADRATE LIGAMENT

Extend from inferior


edge of ulnas radial
notch to insert neck of
radius
Reinforces the inferior
aspect of joint capsule
Helps to maintain radial
head in apposition to
radial notch
Limit the spin of radial
head during supination
and pronation

OBLIQUE CORD

Flat fascial band on


ventral forearm
Extend from
attachment just inferior
to radial notch on ulna
to insert below bicipital
tuberosity on radius
Fibers are right angle to
the fibers of
interosseous membrane
Prevent separation of
radius and ulna

DORSAL AND PALMAR


LIGAMENTS

With interossseous membrane reinforce


distal radioulnar joint
Dorsal and palmer ligaments are formed by
the longitudinally oriented collagen fiber
bundles originating from distal and palmar
aspect of ulnar notch of radius
Two ligaments extend along margins of
articular disc to insert on ulnar fovea and
base of ulnar styloid process

INTEROSSEOUS MEMBRANE
Complex structure
located bw radius
and ulna
consisting of 3
components:
Central band
A thin membranous
portion
Dorsal oblique cord

CENTRAL BAND

Strong, thick ligamentous or


tendinous structure
Consisting of bundles of
fibers run obliquely from
radius to ulna
High collagen content
arranged in fibrillar
structures surrounded by
elastin
Collagen is more abundant
in proximal bundles than in
distal
More tensile strength than
patellar tendon

MEMBRANOUS PORTION

Soft and thin structures that lies adjacent


proximally and distally to central band

DORSAL OBLIQUE CORD


Extends from proximal quarter of ulna to
middle region of radius
Interosseous membrane maintains the space
between radius and ulna during forearm
rotation

MUSCLES
PRIMARY MUSCLES ASSOCIATED WITH
RADIOULNAR JOINTS ARE:
Pronator teres
Pronator quadratus
Biceps brachii
Supinator

MUSCLE

ORIGIN

INSERTION ACTIO
N

Pronator
teres

Humeral head:
common flexor
tendon on medial
epicondyle
Ulnar head:from
medial aspect of
coronoid process

Insert on lateral
side of radius

pronatoion

Pronator
quadratus

Superficial and
deep heads: both
aarises from ulna
and cross
interosseous
membrane
anteriorly

Insert on radius

pronation

supinator

Lateral epicondyle
of humurus,radial
collateral
ligament and

Crosses post.
Aspect of
interosseous
membrane insert

supination

OTHER MUSCLES
MUSCLE

ORIGIN

INSERTION

ACTION

FLEXOR
CARPI
ULNARIS

Medial
epicondyle of
humurus
Medial aspect
of olecranon
process

Pisiform bone
to hook of
hamate and
base of 5th
metacarpal

Flex and
adduct hand at
wrist joint

EXTENSOR
CARPI
ULNARIS

Lateral
epicondyle of
humurus

Base of 5th
metacarpal
bone

Extends and
adducts hand
at wrist joint

FLEXOR
CARPI
RADIALIS

Medial
epicondyle of
humurus

Base of 2nd and Flexes and


3rd metacarpal abducts hand
bone
at wrist joint

AXIS OF MOTION

Axis of motion for


pronation and
supination is
longitudinal axis
extending from center
of radial head to
center of ulnar head
In supination , radius
and ulna lies parallel
to each other
In pronation , radius
crosses over ulna

ROM

Total 150 occur at radioulnar


joint
In clinic, ROM of Pronation
and supination is assessed with
elbow against trunk in 90 of
flexion
When elbow is in extension
movements occur in conjuction
with shoulder rotation.

NURSEMAIDS ELBOW

A tensile force of sufficient


magnitude exerted on a
pronated and extended forearm
may cause radius to be pulled
inferiorly out of annular ligament
Common in younger children
than 5 years
Lifting a small child up into air
by one or both hands or yanking
a child by one hand is usual
cause and therefore injury
caller nursmaid s elbow or
pulled elbow