Anatomy of elbow joint

Anatomy of elbow joint by Dr Bipul Borthakur

1. ANATOMY OF ELBOW JOINT Dr.Bipul Borthakur Professor & HOD, Department Of Orthopaedics, Smch

2. ELBOW JOINT Elbow joint is formed by three joints: Humeroulnar ( Ulnotrochlear ) joint Humeroradial ( Radiocapitellar ) joint Proximal Radio- Ulnar joint

3. Type of joint It is a Synovial joint Hinge type (Allowing movement only in one plane) & Compound joint (as there are two articulations in the joint)

4. Proximal Articular surfaces Trochlea : It is a pully like structure on medial aspect of distal end of the humerus . It form Ulno-Trochlear joint with Trochlear notch of ulna. Capitellum : It is present on lateral aspect of distal end of humerus . It form Radio- Capitellar joint with head of radius.

5. Distal articular surface Head of Radius Olecrenon process of Ulna The Ulno-Trochlear & Radio- Capitellar joints allow movement only in one plane & give Hinge type property of joint.

6. Proximal Radio- Ulnar joint It is the articulation between the circumferential head of the radius and a fibro-osseous ring formed by the radial groove of the ulna and the annular ligament that hold the head of radius in this groove . The proximal radioulnar joint is functionally a pivot joint , allowing a rotational movement of the radius on the ulna.

7. Ligaments The joint capsule of the elbow is strengthened by ligaments medially and laterally. Ulnar Collateral ligament : It has three bundle Anterior bundle Posterior bundle Oblique bundle Ulnar collateral ligament is critical in providing medial support to prevent elbow from abducting when stressed in physical activity.

8. Lateral Collateral ligament : It provides lateral stability and is rarely injured.

9. Annular Ligament It wraps around the radial head and provides a sling effect around radial head for stability.

10. Relations of Elbow joint Muscle Bursae Vessels and Nerves

11. Relation of Elbow joint :Muscle Anteriorly : Biceps brachi Brachialis Brachioradialis Pronator Teres Pronator Quadratus Posteriorly: Triceps brachi Anconeus Supinator

12. Bursae Subtendinous olecranon bursa : Lies between triceps tendon and upper surface of olecranon process Subcutaneous olecranon bursa : Lies on posterior surface of olecranon . Bicipitoradial bursa: A small bursa separating biceps tendon from radial tuberosity .

13. BLOOD SUPPLY OF ELBOW JOINT Arterial blood supply of elbow joint is by arterial anastomosis around the elbow formed by branches of brachial , radial and ulnar artery. Venous blood supply of elbow joint is by Cephalic vein , Basilic vein and median Cubital vein .

14. NERVE SUPPLY OF ELBOW All Elbow and Radioulnar joints muscles are innervated from Median , musculocutaneous and radial nerve.

15. MOVEMENT OF ELBOW JOINT Flexion : By Brachialis , Biceps brachii , Brachioradialis Extension : Triceps Brachii , Anconeus

16. Supination : External rotatory movement of radius on ulna . Pronation : Internal rotatory movement of radius on ulna .

17. Ossification Centres about Elbow Ossification centres Age(years) Capetellum 1 Radius 3 Medial Epicondyle 5 Trochlea 7 Olecranon 9 Lateral Epicondyle 11

18. CARRYING ANGLE Carrying angle is a small degree of cubitus valgus , formed between the axis of a radially deviated forearm and the axis of humerus . It helps the arm to swing without hitting the hips while walking.

19. Normally it is 5-15 degree away from the body (more in female). A decresed carrying angle can result in the forearm pointing towards the body , known as Gunstock deformity or cubitus varus

20. A increased carrying angle can result in the forearm away from the body , known as Cubitus Valgus .

21. Fracture around Elbow in adult Locations Incidence Radial head and Neck 50% Olecranon 20% Supracondylar 10% Fracture dislocation 15%

22. Fracture around elbow in children Location Incidence Supracondylar 60% Lateral Epicondyle 15% Medial Epicondyle 10%

23. SUPRACONDYLAR FRACTURE Extra-articular fracture Three bony point relationship normal It is most common fracture in children around elbow Most common mode of injury is fall on out stretch hand . It is two type : Extension type and Flexion type Most common displacement is posteromedial.

24. Most common complication is malunion ( cubitus varus ) Most common nerve injury is Anterio r interocious nerve injury.

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