Elbow joint with applied anatomy

Human Anatomy

1. ELBOW JOINT Dr. Heta Patel(PT) Assistant Professor ARIP CHARUSAT

2. Hinge variety of Synovial Joint Distal end of humerus and Proximal end of Radius & Ulna Formed by three joints Humeroulnar joint (ulna trochlear) Humeroradial joint (radio capitellar) Proximal radio ulnar joint Most upper extremity movements involve the elbow & radioulnar joints These two joints are usually grouped together due to close anatomical relationship

3. The long mid center of the humerus is the body (shaft), and the humeral condyle is its expanded distal end. Articular part of the humeral condyle is made up of trochlear and the capitulum . Trochlear is more medial and articulates with the ulna. Capitulum is more lateral and will articulate with head of radius. Lateral epicondyle is a small projection on lateral aspect of distal humerus. Medial epicondyle (larger and more prominent) is located on medial edge of distal humerus.

4. Anterior depressions: Corono i d fossa and radial fossa . Posterior depression: is the olecranon fossa . Lateral view of elbow shows proximal radius and ulna with radial head and neck and radial tuberosity.

5. HUMERO-ULNAR PART  It is articulation between trochlea of humerus and trochlear notch of ulna  The medial edge of trochlea is 6mm beyond the lateral edge  Plane of the joint is 2cms distal to intercondylar line slopes downwards and medially  Two nonarticular depressions coronoid fossa and olecrenon fossa are present in relation to this articulation  Trochlear notch of ulna is reciprocally saddle shape and formed by the articular surfaces of olecrenon and coronoid processes

6. HUMERO-RADIAL PART  Structurally it is a ball and socket type of joint.  The ball is represented by capitulum of humerus and socket is by articular surface of disc like head of the radius  In full flexion head of the radius lodges radial fossa above the capitulum.

7.  the annular ligament binds the head of the radius to the radial notch of the ulna forming the proximal radioulnar joint – this is a pivot joint allowing for pronation and supination

8. LIGAMENTS OF ELBOW JOINT  Capsular ligament  Ulnar collateral ligament or Medial ligament  Radial collateral ligament or Lateral ligament

9. FIB R OUS CAPS U LE  Fibrous capsule completely envelop the joint.  It is attached to the lower end of humerus in a continuous line, which excludes the two epicondyles but include three fossae.  Cushions of extra-synovial fat fill up the three fossae.

10. ULNAR COLLATERAL LIGAMENT  UCL is triangular in shape and extends from medial epicondyle to medial margin of trochlear notch. The ligament consists of three bands, Anterior Posterior and Inferior  UCL is overlapped by Triceps ,FCU , FDS and Ulnar nerve.

11. ULNAR COLLATERAL LIGAMENT

12. RADIAL COLLATERAL LIGAMENT  RCL is triangular and extends from lateral epicondyle to annular ligament. It is related to supinator and ECRB

13. RADIAL COLLATERAL LIGAMENT

14. S YN O VIAL MEMBRANE

15. REL A TIONS

16. RELATIONS OF ELBOW JOINT  In front-Brachialis, tendon of biceps, median nerve and brachial artery.  Behind- Triceps and anconeus.  Medially-common origin of superficial flexors, Flexor carpi ulnaris and ulnar nerve.  Laterally- common origin of superficial extensors, supinator, extensor carpi radialis brevis, radial nerve with its superficial and deep branches

17. ANTERIO R REL A TIONS

18. Flexion Movement of forearm to shoulder by bending the elbow to decrease its angle Extension Movement of forearm away from shoulder by straightening the elbow to increase its angle

19. Pronation Internal rotary movement of radius on ulna that results in hand moving from palm-up to palm-down position Supination External rotary movement of radius on ulna that results in hand moving from palm- down to palm-up position

20. Elbow flexors Biceps brachii Brachialis Brachioradialis Weak assistance from Pronator teres Elbow extensor Triceps brachii Anconeus provides assistance Radioulnar pronators Pronator teres Pronator quadratus Brachioradialis Radioulnar supinators Biceps brachii Supinator muscle Brachioradialis

21. Anterior Primarily flexion & pronation Biceps brachii Brachialis Brachioradialis Pronator teres Pronator quadratus

22. Posterior Primarily extension & supination Triceps brachii Anconeus Supinator

23. All elbow joint and muscles are innervated from median, musculotaneous, ulnar & radial nerves of brachial plexus

24. Biceps tendon anteriorly (allows elbow to flex with force) Triceps tendon posteriorly (allows elbow to extend with force)

25. The articular surfaces are connected together by a capsule Anterior part – from radial and coronoid fossa of humerus to coronoid process of ulna and annular ligament of radius Posterior part – from capitulum, olecranon fossa, and lateral epicondyle of humerus to annular ligament of radius, olecranon of ulna, and posterior to radial notch.

26. CAR R YIN G ANGLE  The angle between the long axes of the humerus and the long axes of ulna when the forearm is supinated  This is called carrying angle because it allows the forearm to angle away from the body when a load is carried in the hand  Carrying angle is generally greater in females than in males

27. n  Carry Angle of the Elbow  The angle between the long axes of the humerus and the ulna when the arm is in an anatomical position  This is called this because it allows the forearm to angle away from the body whe a load is carried in the hand  Carrying angle is generally greater in females than in males

28. Ossification of Bones.

29. Capitelum - (1-2yrs) Medial epicondyle - 4yrs Trochlea - 8 yrs Lateral epicondyle - 10 yrs

30. Fracture Classification.

31. DISTAL HUMERUS: FRACTURES: SUPRACONDYLAR INTERCONDYLAR CONDYLAR EPICONDYLAR FRACTURES OF PROXIMAL ULNA : O L E CR AN ON FRACTURE CORONOID PROCESS FRACTURE F R A CTURES OF RADIUS: RADIAL HEAD RADIAL NECK

32. “Tennis elbow" - common problem usually involving extensor digitorum muscle near its origin on lateral epicondyle known lateral epicondylitis associated with gripping & lifting activities Tennis Elbow

33. Somewhat less common Also known as golfer's elbow Associated with medial wrist flexor & pronator group near their origin on medial epicondyle. Involves muscles which cross elbow but act primarily on wrist & hand Medial Epicondylitis