Elbow Anatomy And Examination

ELBOW: ANATOMY AND EXAMINATION Dr. Jose Rico-Pecero Orthopaedics Departmet Newham University Hospital

ANATOMY
Effective use of our hands requires stable, painless elbow joints.
Structures:
- bones and joints.
- ligaments and tendons.
- muscles.
- nerves.
- blood vessels.

Bones and joints
The elbow proper consists of three articulations that share one synovial cavity:
Humeroulnar articulation.
Humeroradial articulation.
Proximal radioulnar articulation.

Bones and joints

Muscles
Flexion - brachialis - biceps brachii - brachioradialis - pronator teres (when flexion is resisted)
Extension - triceps brachii - anconeus (a minor contributor)
Pronation - pronator teres - pronator quadratus
Supination - biceps brachii - supinator
Ant Comparment arm:
- Brachialis
- Bicep Brachialis
Post Compartment arm:
- Tricep Brachii
Ant Compartment forearm:
- Pronator teres
- Pronator cuadratus
Post Comparment forearm:
- Brachioradialis
- Supinator
- Anconeus

Ligaments and Tendons
The fibrous capsule is supported by three ligaments:
- Anular ligament.
- Radial collateral ligaments.
- Ulnar collateral ligaments.

Bursaes
Subcutaneous olecranon bursa
Deep to the skin, but superficial to the triceps brachii tendon and the olecranon, lies the subcutaneous olecranon bursa.
2. Subtendinous olecranon bursa .
The subtendinous olecranon bursa reduces friction between the olecranon and the triceps brachii muscle.

Surface landmarks of the elbow

Imaging the elbow
Anteroposterior (AP)
Lateral (L)

EXAMINATION
Inspection: Observe the whole patient, front and back, looking especially for deformity.
The physiological valgus (“carrying angle”) of the elbow is increased when a load is being carried. Normally, the angle is between 9 and 14° when the elbow is extended and the forearm is supinated.

EXAMINATION
2. Palpation: Feel for tenderness.
Palpation starts at the posterior aspect, with the patient standing with his or her shoulder braced backwards. The three palpation landmarks - the two epicondyles and the apex of the olecranon - form an equilateral triangle when the elbow is flexed 90°, and a straight line when the elbow is in extension

Flexing the elbow allows palpation of the olecranon fossa on either side of the triceps tendon. Anatomical landmarks on the lateral aspect of the elbow: The radial head is palpated with the thumb, while the examiner’s other hand is used to pronate and supinate the forearm.

Palpation and testing of brachioradialis, a forearm flexor . Palpation and testing of the wrist extensors

Palpation of the medial aspect of the elbow. Above the medial epicondyle is the ridge on which the intermuscular septum inserts. Two centimetres above the epicondyle is the site used for lymph node palpation. The ulnar nerve is palpated behind the intermuscular septum. It may sometimes sublux or roll on the epicondyle. Ulnar nerve instability is more readily demonstrated if the elbow is flexed 60° and the upper limb is abducted and externally rotated

Diagrammatic view of the pattern of the flexor-pronator group: The thumb represents pronator teres; the index, flexor carpi radialis; the middle finger, palmaris longus; and the ring finger, flexor carpi ulnaris Palpation of the medial biceps expansion (lacertus fibrosus), which courses over the brachial vessels and the median nerve

EXAMINATION
Accentuate the pain of tennis elbow.
4. Tennis elbow: point tenderness.
5. Tennis elbow: pain on resisted extension.
6. Tennis elbow: pain on passive stretch.

EXAMINATION
7. Examine extension.

EXAMINATION
8. Examine flexion.

EXAMINATION
9. Examine supination.
10. Examine pronation.

EXAMINATION
11. Pivot shift of elbow (instability).

EXAMINATION
12. Provocative test for Cubital Tunnel Syndrome (puts tension on ulnar nerve at elbow).

EXAMINATION
13. Palpate the ulnar nerve.

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Elbow Anatomy And Examination

by med027972 on Jan 10, 2009

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