ELBOW

By: John Paul Q. Galleros

ELBOW

 Structurally stable joint

 Hinge joint
 Carrying Angle
 i. Female: 10-15
 ii. Male: 5-10
 iii. < 5 = cubitus varus, aka gunstock deformity
 iv. >15 = cubitus valgus
Bones

 Distal humerus
 Trochlea
 Coronoid fossa
 Capitulum
 Radial fossa Medial
 lateral epicondyles
 Medial and lateral supracondylar ridge
 Olecranon fossa
 Radius
 Radial head
 Fovea of radius
 Radial neck
 Radial tuberosity
 Ulnar notch of radius Styloid process
 Ulna
 Olecranon process
 Coronoid process
 Trochlear notch
 Radial notch
 Tuberosity of the ulna
 Ulnar head
 Styloid proces
Joints
HUMEROULNAR JOINT (Trochlear joint)

 Is found between the trochlea of the humerus and the trochlear notch of the
ulna
 Uniaxial hinge joint
 Function: Keeping objects carried in the hand away from the body
 Mean value: 5-19 degrees
 Males: 5-10 degrees
 Females: 10-15 degrees
HUMERORADIAL JOINT

 Uniaxial hinge joint

 Between the capitulum of the humerus and the head of the radius
 permits the radius to rotate to any degree of flexion or extension of the
humeroulnar joint
PROXIMAL RADIOULNAR JOINT

 Uniaxial pivot joint

 head of the radius articulates with the radial notch of the ulna
 Permits pronation and supination
Elbow Ligaments
 Medial (Ulnar) Collateral Ligament
 Thicker, stronger & denser
 Limits
 excessive valgus stress that would force the forearm laterally
 Anterior fibers also limit extension, posterior fibers limit flexion
 Prevents subluxation at humeroulnar articulations
 Lateral (Radial) Collateral Ligament
 A cordlike structure that extends from the lateral epicondyle to the annular
ligament & neck of the radius
 Limits
 Excessive varus stress that would force the FA medially
 Prevents subluxation of humeroulnar articulation by securing humerus to ulna
 Stabilizes radial head and humeroradial articulation
Osteokinematics

UH joint RH
OPP 70o elbow flexion Full extension
10o supination Full supination
CPP Extension with supination Elbow flexed 90 5
supination
CP Flexion>extension Flexion>extension
Ligaments

 Annular ligament
 Maintains integrity of PRU articulation
 Prevents dislocation
 Prevents excessive radial distraction
 Oblique cord
 Fibers run perpendicular to interosseous membrane to offer major stabilization to
proximal RU joint
 Taut in full supination
 Quadrate ligament
 Limits spinning of radial head
 Maintains radial head up against ulnar radial notch
 Dorsal and palmar RU ligament
 Stabilizes distal RU connection
 Interosseous membrane
 Provides stability for both superior and inferior RU joints
 Taut when forearm is in neutral
 Slack when forearm is Supinated or pronated
 Serves as attachment for muscles
 Muscles
Elbow flexors
 Biceps brachii
 Origin
 Long head
 supraglenoid tubercle of scapula

 short head
 Coracoid

 Insertion
 tuberosity of radius and bicipital aponeurosis
 Innervation
 musculocutaneous nerve
 Action
 Supinator of forearm and flexor of elbow joint; weak flexor of shoulder joint
 Brachialis
 Origin
 from the front of lower half of humerus

 Insertion
 coronoid process of ulna

 Innervation
 musculocutaneous nerve

 Action
 Pure elbow flexor
 Brachioradialis
 Origin
 ridge on the humerus

 Insertion
 styloid process of the radius

 Innervation
 radial nerve

 Action
 Elbow flexion
 rotates forearm to the midprone position
 Elbow extensors
 Triceps brachii
 Origin
 Long head
 Infraglenoid tubercle of scapula

 Lateral head
 Upper half of posterior shaft of humerus

 Medial head
 Lower half of posterior shaft of humerus

 Insertion
 3 heads insert at the olecranon process of ulna

 Innervation
 radial nerve
 Action
 Elbow & shoulder extension
 Lateral head
 Strongest of the three

 Medial head
 Active in all forms of extension

 Long head
 Advantageous in combined elbow extension & shoulder flexion
 Anconeus
 Origin
 lateral epicondyle of the humerus

 Insertion
 ulna, partly into the olecranon process

 Innervated
 radial nerve

 Action
 Initiates elbow extension
Supinator muscle

 Supinator
 Origin
 lateral epicondyle of the humerus

 Insertion
 volar & lateral surfaces of the proximal radius

 Innervation
 radial nerve

 Action
 Radioulnar supination
Pronator muscle

 Pronator teres
 Origin
 medial epicondyle of the humerus
 smaller portion from the coronoid process of the ulna
 Insertion
 lateral side of the radius about halfway down the forearm
 Innervation
 median nerve
 Action
 poor leverage for elbow flexion
 Radioulnar pronation
 Pronator quadratus
 Origin:
 transversely over the ulna & the radius in the distal forearm

 Insertion
 anterior shaft of radius

 Innervation
 anterior interosseous branch of median nerve

 Action
 Pronates the forearm
 Unaffected by change in elbow position