The Elbow Joint

1
The Elbow Joint

• Muscles and Movement
• Joints and Ligaments
• Blood Supply and Innervations
• Injuries
• Demonstration of Dissected Elbow

2
Muscles

• There are 24 muscles associated with the elbow
  joint that can be broken down into four
  categories based on their movement
• 1. Flexors
• 2. Extensors
• 3. Pronation
• 4. Supination

3
Flexors

• Brachialis- strongest flexor, workhorse, only
  pure flexor maximum output is 120
• Biceps brachii- dependent upon position of arm
  and forearm
• Brachioradials- used mainly with rapid elbow
  flexion and against resistance
• Pronator Teres- flexes forearm at the elbow
• Extensor Carpi Radialis- assists in flexion

4
Extensors

• Triceps Brachii- strongest arm muscle due to
  volume the medial head is considered the
  workhorse of extension the lateral head is for
  resistance

5
Pronation

• Pronator Quadratus- pronates the forearm
• Pronator Teres- rotates the radius on the ulna

6
Supination

• Supinator- contributes to a slow unresisted
  action in all position of forearm
• Biceps Brachii- only under special circumstances
  such as rapid or rested movements when the elbow
  is flexed this action is neutralized by the
  actions of the triceps brachii

7
Surrounding Muscles

• The surrounding muscles are positioned to create
  forces in the mediolateral direction
• Lateral
• anconeus, brachioradialis, extensor carpi
  radialis, extensor digitorum communis, and
  extensor carpi ulnaris
• Medial
• pronator teres, flexor carpi radialis, flexor
  digitorum superficialis, and flexor carpi ulnaris

8
Joints of the Elbow

• The elbow is considered a stable joint. There are
  three joints which allow motion between the three
  bones of the arm and forearm (Humerus, Radius,
  and Ulna).
• The three joints are
• 1. Ulnar- Humeral Joint
• 2. Radiohumeral Joint
• 3. Radioulnar Joint

9
Ulnar- Humeral Joint

• Major contributing joint to flexion and
  extension of the forearm
• Union between the trochlea on the distal end of
  humerus and the trochlear notch of the ulna
• Movements
• Hinge-like flexion and extension of the forearm
  and arm are together the principal articulations
  of the elbow joint
• Trochlear notch of the ulna offers good
  structural stability

10
Radiohumeral Joint

• Movements
• Capitulum of humerus makes contact with the
  radius allowing for radial movement during
  flexion and extension
• Capitulum contributes to lateral compression and
  other rotational forces absorbed during throwing
  and other rapid forearm movements

11
Radioulnar Joint

• Movements
• Establishes movement between radius and ulna in
  pronation and supination
• Interosseus membrane runs the length between the
  radius and ulna increasing attachment and
  ensuring the maintenance of a specific
  relationship between them

12
Ligaments

• Annular Ligament of Radius- attaches the radial
  head to the radial notch of ulna it allows the
  radial head to slide against the radial notch of
  ulna and pivot on the capitulum during pronation
  and supination
• Radial Collateral Ligament- attaches the lateral
  epicondyle of humerus to the radial notch of ulna
• Ulnar Collateral Ligament- attaches coronoid
  process of the ulna to the medial epicondyle of
  humerus and the medial epicondyle to olecranon of
  the ulna

13
Collateral Arteries

• Radial Collateral Artery
• Middle Collateral Artery
• Superior Ulnar Collateral Artery
• Inferior Ulnar Collateral Artery

14
Recurrent Arteries

• Radial Recurrent Artery
• Recurrent Interosseous Artery
• Anterior Ulnar Recurrent Artery
• Posterior Ulnar Recurrent Artery

15
Blood Supply

• Anatomic Networks Of Vessels Derived From
  Collateral and Recurrent Branches Of The
  Brachial, Profunda Brachii, Radial and Ulnar
  Arteries.

16
Nerve Innervations

• Radial Nerve
• Musculocutaneous Nerve
• Some Innervation by branches of
• Ulnar Nerve
• Median Nerve

17
Injuries of the Elbow

• Epicondylitis (Tennis Elbow)
• Elbow Bursitis
• Pulled Elbow
• Elbow Arthritis

18
Tennis Elbow(Epicondylitis)

• Painful musculoskeletal condition that may follow
  pronation and supination of the forearm.
• Develops after overusing the affected arm or a
  single blow to the arm
• Symptoms
• Pain over the outside of the elbow
• Pain when lifting objects
• Pain radiating down the forearm

19
Tennis Elbow Cont.
Treatments Immobilization Anti-inflammatory
Drugs Surgery
20
Elbow Bursitis

• may follow a traumatic accident, such as a fall
  onto the back of the elbow, or it may seemingly
  pop up out of nowhere
• Symptoms
• Pain around the back of the elbow
• Swelling directly over the bony prominence of the
  tip of the elbow
• Slightly limited motion of the elbow

21
Elbow Bursitis Cont.

• Also called olecranon bursitis
• It causes fluid to collect in a sac that lies
  behind the elbow, called the olecranon bursa,
  which causes pain and swelling
• a bursa is a slippery, sac-like tissue that
  normally allows smooth movement around bony
  prominences, such as the point behind the elbow.

22
Pulled Elbow

• Children under 5 years of age
• Commonly caused by a sharp pull of the childs
  hand
• Head of radius is not yet developed, the slack of
  the anular ligament allows the head to come out
  of this cuff of tissue

23
Pulled Elbow Cont.

• Extremely painful but easily treatable
• Treatment
• Simple supination and compression of the elbow
  joint by a clinician
• Once the radius head is relocated, pain subsides
  immediately, and normal activity can be resumed

24
Elbow Arthritis

• Osteoarthritis commonly in dominant limb
• Small bone fragments may appear in the articular
  cavity
• Since the joint space is so small these fragments
  can result in a reduction of inflexion and
  extension
• Can also lodge within the olecranon and coronoid
  fossae

25
Dissection

• First, we removed the Brachialis muscle from
  where it inserts on the ulnar tuberosity and the
  anterior surface of the joint capsule
• Second, we detached the triceps brachii tendon
  from the olecranon process and the posterior
  surface of the joint capsule. The triceps brachii
  muscles extend the elbow.

26

• Next we removed the superficial flexor muscles of
  the forearm from their attachment to the medial
  epicondyle. (These muscles were detached at the
  common flexor tendon). These muscles included
• Pronator teres muscle
• flexor carpi radialis muscle
• palmaris longus muscle
• flexor carpi ulnaris muscle
• flexor digitorum superficialis muscle

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• After the superficial flexors were detached from
  the medial epicondyle we were able to view the
  ulnar collateral ligament.
• Consists of a strong anterior cord and a fan-like
  posterior portion

28

• Next we removed the superficial extensor muscles
  of the forearm from their attachment to the
  lateral epicondyle. (These muscles were detached
  at the common extensor tendon). These muscles
  included
• Extensor carpi radialis brevis
• Extensor digitorum muscle (4)
• Extensor digiti minimi muscle
• Extensor carpi ulnaris muscle
• Anconeus muscle
• Then we removed the supinator muscle from the
  medial surface of the radius.

29

• After the superficial extensors were detached
  from the lateral epicondyle and the supinator
  muscle was removed, we were able to view the
  radial collateral ligament.

• Fans out from the lateral epicondyle to the
  radius and anular ligament

30

• Identify the Proximal radioulnar joint and the
  annular ligament.
• Proximal radioulnar joint where the radial head
  inserts into the radial notch of the ulna.
• Annular ligament completely surrounds the head
  of the radius. The anular ligament holds the
  radius in place while it rotates. Notice the
  movement of the radius as it goes through
  pronation and supination.
• We detached the biceps brachii muscles, they
  insert on the radial tuberosity and aid in
  flexion of the elbow.

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• Presentation by Erin Adles, Aggie Brockie,
  Krystal Gantner, Nicole Harre, Crystal Hillyard,
  Laura Marchwinski, Tracy Mueller, Sarah Ruff