Elbow joint anatomy and examination

orthopedic, anatomy
examination of elbow

1. ELBOW JOINT ANATOMY AND EXAMINATION Dr.Raman Ghimire

2. Osteoarticular Anatomy ( Trochlear notch) (Radial notch)

3. Humero -ulnar articulation : Hinge Humero -radial articulation : Ball and socket Proximal radio-ulnar articulation : pivot

4. Capsuloligamentous anatomy Capsular ligament Ulnar collateral ligament or Medial ligament Anterior Posterior Inferior Radial collateral ligament or Lateral ligament Anular ligament

5. LATERAL VIEW MEDIAL VIEW

6. Muscles 2 groups of muscle crosses elbow joint Having action on elbow Having action on wrist and fingers

7. A) Group of muscle have action on elbow (8) Ant Compartment arm : - Brachialis - Bicep Brachialis • Post Compartment arm: - Tricep Brachii • Ant Compartment forearm: - Pronator teres - Pronator quadratus • Post Comparment forearm: - Brachioradialis - Supinator - Anconeus Flexion - brachialis - biceps brachii (in supine position ) - brachioradialis (in midprone position) - pronator teres ( when flexion is resisted) • Extension - triceps brachii - anconeus (a minor contributor) • Pronation - pronator teres - pronator quadratus • Supination - biceps brachii - supinator

8. B) Have action on wrist and fingers (8) The flexor group :  flexor carpi radialis  flexor carpi ulnaris   palmaris longus flexor digitorum superficialis     The extensor group : extensor carpi radialis longus  extensor carpi radialis brevis extensor digitorum   extensor digiti minimi

9. Stability of the elbow A. STATIC STABILIZERS a) 3 primary static constraints  Ulnohumeral articulation,  the anterior bundle of the MCL  the lateral collateral ligament (LCL) complex b) 4 Secondary constraints  Radiocapitellar articulation,  the common flexor tendon,  the common extensor tendon,  the capsule. B. DYNAMIC STABILIZERS - Muscles that cross the elbow joint

10. ARTERIAL SUPPLY Cubital anastomosis

11. Venous drainage Lymphatic drainage D eep and superficial cubital nodes( epitrochlear nodes); lies just above the medial epicondyle Drains to axillary nodes.

12. NERVE SUPPLY median,  musculocutaneous  and  radial  nerves anteriorly ,   ulnar  nerve posteriorly .

13. BURSAE AROUND ELBOW JOINT

14. RELATIONS OF ELBOW JOINT Anterior -Brachialis , tendon of biceps, median nerve and brachial artery . Posterior - Triceps and anconeus . Medial -common origin of superficial flexors , Flexor carpi ulnaris and ulnar nerve. Lateral - common origin of superficial extensors , supinator, extensor carpi radialis brevis , radial nerve with its superficial and deep branches

15. CUBITAL FOSSA / antecubital fossa  

16. EXAMINATION OF ELBOW

17. COMMON COMPLAINTS Pain • Swelling • Stiffness • Deformity • Instability • Paraesthaesias

18. REMEMBER ! Consent Examine with clean hands Exposure: whole upper limb on both side Compare both sides Examination of shoulder and C-spine

19. PHYSICAL EXAMINATION Inspection Palpation Movements Measurements Distal Neurovascular Status Regional Lymph nodes Thickening of Ulnar nerve Special Tests

20. A. Inspection Attitude Alignment ( Carrying angle) D eformity • Swelling olecranon bursitis,effusion,tumor,myositis ossificans,sub cutaneous nodules(in RA) • Skin : Sinuses , scars, oedema , engorged veins , erythema,bruise • Muscle wasting

21. Malunited s/c # Non united lateral condylar #

22. B. Palpation Temperature Tenderness: diffuse-arthritis localised -tennis elbow,golfers elbow, olecranon bursitis,bicipital tendinitis

23. C.Movements Any restrictions on passive and active movements Flexion – Extension Supination–Pronation

24. D.Measurements Carrying angle 3 bony relationships Arm length & girth Forearm length & girth Range of motion

25. Maintained: s/c # R eversed: posterior dislocation of elbow Base of triangle broadened: intercondylar #

26. Arm and Forearm length GIRTH : measured in the mid point of those bony prominences and compared on both sides

27. ROM measurement Flexion -140 * Extension - 0 Supination - 90 * Pronation – 90*

28. E.Distal Neurovascular Status Biceps( C5 ,C6), triceps(C6, C7 ) & supinator jerks(C5, C6 ) Ulnar , median & radial nerves Radial & ulnar pulse

29. MOTOR

30. SENSORY

31. F.Regional Lymph nodes Axillary E pitrochlear

32. G. Ulnar Nerve 1. Thickening : Hansen’s disease 2 . Subluxation : Gently palpate the nerve between medial epicondyle and Olecranon. Now flex and extend. On flexion, there is subluxation of the nerve anteriorly with a palpable snap. 15 % of population ulnar nerve subluxates . 3 . Ulnarstretch test : Elbow flexion; forearm supinationand wrist in dorsiflexion Provocative test for ulnar entrapment at the elbow joint

33. H. Special Tests Cozen’s test Mill’s test Maudsley's test TESTS FOR TENNIS ELBOW

34. TEST FOR GOLFER’S ELBOW CHAIR TEST FOR TENNIS ELBOW

35. YERGASON’S TEST FOR BICIPITAL TENDINITIS Supination of the forearm against resistance with elbow at 90 deg. produces pain at the biceps tendon

36. REFERENCES Apley’s system of Orthopaedics and Fractures-9 th edition Essential of orthopaedics ( J.Maheshwari )- 4 th edition BD Chaurasia's Human Anatomy: Vol. 1 Gray's Anatomy Medscape

37. THANK YOU