This document provides an overview of the anatomy and examination of the elbow and its clinical applications. It describes the elbow as a compound synovial hinge joint made up of three joints: the humeroulnar joint, humeroradial joint, and superior radioulnar joint. It outlines the ligaments, muscles, nerves, arteries, and range of motion involved in the elbow. The document provides guidance on inspecting, palpating, and evaluating the range of motion of the elbow during a physical examination. Key assessment points include observing deformities, muscle wasting, swelling, and tenderness and evaluating the three point bony relationship between the medial epicondyle, lateral epicondyle, and olecran

1. ANATOMY AND EXAMINATION
OF ELBOW AND ITS CLINICAL
APPLIED
CO GUIDE : DR S.PHULJHELE
(MS)
( HOD AND PROFFESOR
)
GUIDE : DR A .SAHU (MS)
DR PRANAY SHRIVASTAVA
(M.S)
AUTHOR : DR DEEPAK JANGRE
(2ND YEAR PG)

2. ANATOMICAL FEATURE
• Compound synovial Hinge Joint
• Made up of
• (1) Humeroulnar joint
• (2) Humeroradial joint
• (3) Superior Radio Ulnar Joint

4. JOINTS
3 JOINT ENVELOPED BY COMMON
CAPSULEjoint From To Description
Humeroulnar joint Trochlear notch of
the ulna
Trochlea of humerus - Simple hinge joint
- Allows movement
of flexion and
extension only
Humeroradial joint Head of the radius Capitulum of the
humerus
-synovial ball and
socket hinge type
joint
- Allow flexion ,
extension ,pronation
and supination
Proximal radioulnar
joint
Head of the radius Radial notch of the
ulna
- pivot joint
- Flexion or
extension

5. LIGAMENTS
•Ulnar Collateral Ligament
•Radial Collateral Ligament
•Anular Ligament

6. ULNAR COLLATERAL LIGAMENT
. Also known as medial
collateral ligament
. Triangular in shape -
Anterior bundle
Posterior bundle
Transverse ligament
•The UCl connect the humerus
to the ulna and prevents elbow
valgus and distraction

7. RADIAL COLLATERAL LIGAMENT
Triangular in shape
• Extends from lateral
Epicondyle humerus to
radius head .
• Prevent excessive
adduction (Varus) of
elbow joint

8. ANNULAR LIGAMENT
•Binds the Radial
Head to the Radial
notch of the Ulna
•Does Pronation &
Supination

9. FAT PADS
There are two fat pads of the elbow
• Anterior fat pad ( Radial and coronoid fossa )
• Posterior fat pad (olecranon fossa)
. Which sit between the two layers of the joint
capsule making them extra-synovial:
. An anterior fat pad is often normal.
. However a posterior fat pad seen on a lateral x-
ray of the elbow is always abnormal.

10. BURSAE
•superficial olecranon bursa: lies between the
olecranon and the subcutaneous tissue
•sub tendinous olecranon bursa: lies between
olecranon and triceps brachii tendon
•intratendinous olecranon bursa: variably lies
in the triceps brachii tendon
•bicipitoradial bursa: lies between biceps
brachii distal tendon and ant. radial tuberosity

11. FAT PADS AND BURSAE

12. Blood & Nerve supply
• Arterial supply is via
anastomotic (medial, lateral
and posterior) arcades
formed by branches of
the radial, ulnar and brachial
arteries.
• Articular branches of the
radial, ulnar, median and
musculocutaneous nerves.

13. Nerves
• Radial nerve: originates from posterior cord of brachial plexus
– Roots: C5-8, T1
– Motor innervation: triceps brachii and extensors of the hand & wrist
– Sensory innervation: most of the back of the hand
• Ulnar nerve: originates from medial cord of brachial plexus
– Roots: C8 – T1
– Motor innervation: muscles in the forearm that move the hand & wrist (mostly
flexors)
– Sensory innervation: 5th finger, medial half of 4th finger
• Median nerve: originates from lateral & medial cords of brachial plexus
– Roots: C5-8, T1
– Motor innervation: pronator teres, pronator quadratus, flexors of hand & wrist
– Sensory innervation: parts of palm, some fingertips
• Musculocutaneous nerve: originates from lateral cord of brachial plexus
– Roots: C5-7
– Motor innervation: biceps brachii, brachialis, coracobrachialis
– Sensory innervation: lateral forearm

14. Arteries
• Brachial artery: continuation of subclavian artery
(à axillary artery à brachial artery)
– Supplies blood to nearly all structures of the arm, incl.
the humerus
– At the cubital fossa, divides to form the radial and
ulnar arteries
• Deep brachial artery (profunda brachii): arises
from brachial artery in upper arm
– Supplies posterior compartment of upper arm
• Radial artery: arises from brachial artery at
cubital fossa (smaller of the two branches)
• Ulnar artery: arises from brachial artery at cubital
fossa (larger branch)

15. Veins
• Dorsal venous arch: network of veins that drains the dorsal
surface of the fingers & hands. Veins come together to form
the basilic and cephalic veins.
• Basilic vein: travels up the medial side of the arm and joins
the brachial vein to become the axillary vein in the mid-arm
region
• Cephalic vein: travels up the lateral side of the arm and joins
the axillary vein in the pectoral region
• Median cubital vein: crosses cubital fossa between basilica &
cephalic veins
• Median antebrachial vein: drains the venous network of the
palmar side of the hand. Ascends the front of the ulnar side
of the forearm and ends in the median cubital vein.
• Brachial vein: begins at cubital fossa at the joining of the ulnar
& radial veins. Runs parallel to the brachial artery, but deeper.
Joins the basilic vein in the axillary region to become the
axillary vein.

17. MusclesMuscles
• FlexionFlexion
- brachialis- brachialis
- biceps brachii- biceps brachii
- brachioradialis- brachioradialis
- pronator teres (when flexion is- pronator teres (when flexion is
resisted)resisted)
• ExtensionExtension
- triceps brachii- triceps brachii
- anconeus (a minor contributor)- anconeus (a minor contributor)
• PronationPronation
- pronator teres- pronator teres
- pronator quadratus- pronator quadratus
• SupinationSupination
- biceps brachii- biceps brachii
- supinator- 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

19. EXAMINATION

20. COMPONENTS OF PHYSICAL
EXAMINATION
• History
• Chief complains
• General Examination
• Systemic examination
• Orthopedic exam - Inspection
• Palpation
• Movement
• Measurement
• Neurovascular status
• Special Tests
• Important line and angle
• Radiological image

21. HISTORY TAKING
•Patient details – name ,age ,sex,edu/occu,address, marital
status, contact no
•Chief complain- complain in chronological order in pt. word
•History of presenting illness- complain in brief
•Negative history – fever, cough
•Past history – DM,HTN,PTB,SCD, any surgical history
•Family history- similar problem in family
•Menstrual history - if patient is female
•Personal history – diet ,sleep ,appetite , bladder and bowel
•Any long time drug history - steroid

22. COMMON COMPLAINTS
• Pain- site , mode of onset, intensity, nature, progression, aggravating factor , relieving factor
• Stiffness - generalized ,localized ,
• Swelling – site, size, shape,marzin ,edge , 1st notice, progression, reducibility ,
• Deformity- site, time of onset ( congenital, developmental, acquired ) ,correctability(
complete,partial,incorrectable)
• Weakness – site. – generalized ,localized
Type. - pure motor, sensorimotor, muscular, mixed
duration - acute, chronic
onset - sudden ,gradual
progression – static, progressive
• Instability- time of onset, frequency, aggravating factor , reducibility ,
• Paresthesia – mode of onset, duration, site, progression, aggravating and relieving factors
• Loss of function – mode of onset , duration, involved region, progression

23. • General examination – Consciousness
- Vital –BP ,Pulse , Respiratory rate , temperature
- Pallor
- Built
– Height and weight
- Icterus
- Clubbing
- Cyanosis
- Lymphadenopathy
- Wasting
Syestemic Examination – Cardiovascular system
Central nervous system
Respiratory system
Abdomen
bowel sound

24. INSPECTION
• Attitude & deformity
• Carrying angle
• Swelling
• Skin -
Sinuses, scars, oedema, engorged veins
• Muscle wasting

25. INSPECTION
ATTITUDE OF THE LIMB
• How limb is placed?
• Right side: Shoulder abducted and
internal Rotation and elbow is
flexed:

26. INSPECTION
• From the front- - Carrying angle
- Bicep bulge
- Depression of cubital fossa
- Upper forearm shape and bulge
- Any noticeable wasting
- Swelling
- Discharging sinus
- Scar mark
- Venous prominence
- Varus/valgus deformity
NOTE - always compare to the opposite side

27. INSPECTION
• From the lateral side –
- Fixed flexion deformity
- lateral epicondyle humerus
- Proximal brachioradialis bulge
- Tip of olecranon process
- Wasting
- Scar and sinus
- Hyperextension
- Swelling

28. INSPECTION
From the Posterior –
- Prominence of olecranon process
- Para olecranon depression
- Prominence of medial & lateral
epicondyles
-Swelling
-Scar ,sinus,

29. INSPECTION
• Carrying Angle -
Angle b/w longitudinal Axis of arm
and forearm
• When Patient standing w/ arm
close to the chest and elbow
fully extended & forearm
supinated
• Normal: Males 7-11o
• Females 15-20o
• In fixed flexion deformity of the
elbow, this angle cannot be
commented
• This angle allows your forearms
to clear your hips when you
swing your arms during walking
or carrying objects

31. • By Sushmitha Baskar, Saravana Kumar on journal of
pharmaceuticals science and research on 2013 in Saveetha Dental
College and Hospitals,Velapanchavadi, Chennai
• We have studied variations in carrying angle between males and
females. Females had greater carrying angle than males. Due to
secondary sexual characters, that is broader pelvis arms are more
laterally angulated and they have greater carrying angle2

32. • By Dr. Srushti Ruparelia, Dr. Shailesh Patel, Dr. Ankur Zalawadia, Dr. Shaival
Shah, Dr. S. V. Patel on GMERS, Medical College, Patan on journal of NJIRM on
july-septamber on 2010
• There is significant difference between male & female carrying angle, in female it is
11.8 degree and in male it is 6.9 degree. Greater carrying angle in female is considered
as secondary sex characteristic. From the present study it is clear that the height &
length of the forearm are directly related to each other. Length of the forearm in female
is22.7 cm on right side and 22.6 cm on left side where as in male this value is 24.9 cm
on both sides which is inversely related to the carrying angle. It may be considered as
secondary sex characteristics in female because according to the study of some

34. CUBITUS VARUS
GUNSTOCK DEFORMITY CUBITUS
VALGUS
( MALUNION OF # SUPRACONDYLAR HUMERUS) (# SUPRACONDYLAR
HUMERUS
# LATERAL CONDYLE
HUMERUS)

35. FIXED FLEXION DEFORMITY OLECRANON
BURSITIS

36. BICIPITORADIAL BURSITIS

37. • Muscle wasting(Rt) Any surgical scar, Sinus

38. TUBERCULOSIS 0F ELBOW
•Diffuse Swelling
•Flexion Deformity
• Muscle Wasting

39. HYPEREXTENSION

40. PALPATION
• Confirmation the inspectory finding by touch
(palpation)

41. PALPATION
• Local rise of temperature
• Tenderness
• Bony components
• Soft Tissue components
• Ulnar nerve thickening
• Supratrochlear lymph node

42. PALPATION
•Temperature –
• Palpate from dorsum of hand
• 1st palpate normal site than affected
side than again normal site
• Cause-
• Infective - Pyogenic Tubercular
• Inflammatory - Polyarthritis Acute
Myositis
• Traumatic - Fresh injury - haematoma
oedema ,arthritis ,bursitis .

43. PALPATION
• Tenderness – Superficial
Deep
Maximum point of tenderness
Cubital fossae - Bicipitoradial bursitis
Lat. Epicondyle - Tennis elbow
Med. Epicondyle - Golfer’s elbow
Lower end of Humerus - S/C # Humerus
Radial head - # Radial head
Upper end of Ulna - Olecranon # , students elbow

44. MEDIAL SIDE POSTERIOR
SIDE

45. LATERAL SIDE PALPATION
•Lateral epicondyle
•Radial Head
•Lateral olecranon
•Soft spot

46. THREE BONY POINT RELATIONSHIP
COMPARE WITH OPPOSITE NORMAL ELBOW
•. MEDIAL EPICONDYLE
•. LATERAL EPICONDYLE
• OLECRANON
FLEXION (90’ FLEXION) EXTENSION

48. INTERPRETATION OF THREE POINT BONY RELATIONSHIP
• Decreased length of medial limb – posteromedial dislocation
medial rotation of fracture
fragment
• Decreased length of lateral limb - posterolateral dislocation
• - lateral rotation
• Increase length of medial limb. - fracture medial
condyle/epicondyle
• Increase length of lateral limb - fracture lateral condyle
• Increase base ( interepicondylar distance) – malunited fracture

49. • By Mandeep S Dhillon, Nirmal Raj Gopinathan, and Vishal Kumar from
Department of Orthopaedic Surgery, PGIMER in Indian J Orthop. 2014 Sep-
Oct;
• No two sides of the triangle in any elbow measured were equal (hence these
lines formed a scalene triangle, i.e., one with unequal sides)
• Even measurements on both limbs were not exactly the same in more than
half the elbows; this was not affected by dominance of hand. Its clinical
implication needs to be validated. Inter-observer variability is not the cause,
as two surgeons measured all the elbows and the mutually agreed points
were taken. However, parallax error cannot be ruled out.

50. PALPATION
•Soft tissue –
•Antecubital Fossa
•Mobile wad, biceps tendon,
•brachial pulse
•Medial
•Flexor-pronator mass
•Ulnar nerve
•UCL

51. PALPATION OF ULNAR NERVE
• 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
subluxate

52. THICKENED ULNAR NERVE IN LEPROSY

53. PALPATION OF SUPRATROCHLEAR NODE
.Flex the Elbow to right angle to
relax surrounding structures
• Palpated on anterior surface
of medial intermuscular
septum 1 cm above the medial
epicondyle
• Not Palpable: Normal elbow,
Palpable - Traumatic causes
Unilateral or Bil (systemic)

54. MOVEMENT

55. MOVEMENTS
•Normal ROM
• Flexion 0 - 140
• Extension 0-10
• Functional range 30-130
• Supination 0 - 90
• Pronation 0 – 90
• Functional range 50 each
direction

56. FLEXION & EXTENSION

57. • Examined with arm by the side of trunk and elbow in 90 deg. flexion
SupinationNeutral
rotation
Pronation

58. MEASUREMENTS

59. MEASUREMENTS
•Upper limb length –
•Segment from to
•Upper limb angle of acromion radial styloid
•Arm angle of acromion lateral epicondyle
•Forearm lateral epicondyle radial styloid
•Angle of acromion –palpate laterally along the spine of scapula .the point at which it
meets the acromion process is the angle of acromion
• Lateral epicondyle – palpate the lateral supracondylar ridge and run the finger down along the
ridge .the most prominent bony prominent felt at the end of the ridge is the lateral epicondyle.
• Radial styloid process –the forearm is pronated and wrist is slightly flexed. Feel the radial
and ulnar styloid process simultaneously with the index finger which are bent to 90’ at the pip joint
mark the 3rd point.

60. NEUROLOGICAL EXAMINTION
• Palpate – Radial artery
brachial artery
• Muscle Test –
Flexion – Extension
Pronation – supination
Sensation Test
• C5-C6-C7-C8-T1
• Reflex Test
• Biceps Reflex – C5-C6
• Brachioradial reflex – C5-C6
• Triceps Reflex – C7-C8

61. BICEPS REFLEX
•Place your thumb or finger firmly
on the biceps tendon.
•Strike with the reflex hammer so
that the blow is aimed through
your thumb toward the biceps
tendon
•Observe flexion at the elbow, and
watch for and feel the contraction
of the biceps muscle
•Test C5-C6

62. TRICEPS REFLEX
•Strike the triceps tendon
above the elbow
•Watch for contraction of the
triceps muscle and
extension at the elbow
•Test C7-C8

63. BRACHIORADIALIS REFLEX
•Strike forearm approximately 2-
3cm above radial styloid process
•Watch for flexion and supination
of the forearm
•Test C5-C6

64. SPECIAL TEST

65. LIGAMENTOUS STABILITY
valgus Stress Test
With the patient seated or standing, stand on the right side of patient
and firmly grasp the lower arm just above the elbow with your left hand
and hold the proximal forearm with your right hand with thumb on tip
of middle finger below medial epicondyle keep the elbow in 30 degree
flexion and forearm supinated
Now forcefully abducted for valgus stress
• Positive Test - increased laxity compared with the opposite side, pain, or
both
• Implications – sprain / tear of the ulnar collateral ligament

66. VALGUS STRESS TEST

68. • By O'Driscoll SW , Lawton RL, Smith AM from on Feb. 2005 in NCBI publication
• The moving valgus stress test is an accurate physical examination technique that,
when performed and interpreted correctly, is highly sensitive for medial elbow pain
arising from the medial collateral ligament.

69. (2) VARUS STRESS TEST
With the patient seated or standing, stand on the right side of patient and
firmly grasp the lower arm just above the elbow with your left hand and hold
the proximal forearm with your right hand with thumb on tip of middle finger
below medial epicondyle keep the elbow in 30 degree flexion and forearm
supinated
Now forcefully adducted for Varus stress
• Positive Test - increased laxity compared with the opposite side, pain, or
both
• Implications - moderate laxity sprain to radial collateral ligament
gross laxity sprain to the annular or accessory lateral collateral
ligament

70. VARUS STRESS TEST

72. TEST FOR TENNIS ELBOW
•

73. COZENS TEST
• Patient seated ,elbow extended forearm
pronated slightly radial deviated The
clinician stabilizes the patient's elbow
with one hand, and thumb is on lateral
epicondyle the patient should make a
fist and extend it against resistance
• pain in the area of the lateral
epicondyle indicates a positive test
• Also called Tennis elbow

75. MILL'S TEST
• The clinician palpates the patient's
lateral epicondyle with thumb by
holding elbow , while pronating the
patient's forearm, radial deviated
fully flexing the wrist, and
extending the elbow.
• A positive test is reproduction of
pain in the area of the lateral
epicondyle

77. MAUDSKY’S TEST
•The examiner resists extension
of the 3 rd. digit of the hand
while other hand thumb is on
lateral epicondyle Stressing the
extensor digitorum muscle and
tendon .
• A positive test is indicated by
pain over the lateral epicondyle
of the Humerus.

79. CHAIR TEST
•The Chair Test : Ask the patient
to attempt to lift a chair with elbow
straight and shoulders flexed to 60°
• Difficulty to perform and complain of
pain over lateral epicondyle is a
positive sign

80. • Thomson’s test :
• Ask the patient to clench the
fist, dorsiflex the wrist and
extend the elbow. A forceful
palmar flexion against
patient’s resistance
• Pain over the area is a
positive sign

81. • By G Saroja ,Antony Leo Aseer P ,Venkata Sai P M on international journal of
physiotherpay and research on november 2014 at Sri Ramachandra University,
Chennai, Tamil Nadu, India.
• CONCLUSION
• The validation study on finding the diagnostic accuracy of provocative tests in lateral
epicondylitis highlighted that Cozen’s test and Maudsley test are better tests for ruling
out lateral epicondylitis whereas Mills test is an excellent diagnostic test for ruling in
lateral epicondylitis.

82. • By Naveen ,*, Chaitanya , Shiva Kumar Dept. of Orthopedics, SIMS, Shivamogga
publish on Indian Journal of Orthopedics Surgery on October 2017
Injection of autologous blood significantly reduced the pain and improved the pain scores
clinical function when compared to corticosteroid injection at six months follow up, even
though there was initial drastic improvement in pain scores after corticosteroid injection at
four weeks but many patients had recurrence. So autologous blood injection is efficient
treatment modality for lateral epicondylitis, which is simple, cheap, with less side-effect
and minimum recurrence rate.

83. • By A Sundeep Kund, J Satyanarayana, Thakur Rajani from Department of
Orthopedics, Osmania General Hospital, Hyderabad, Telangana on November 2015 on
International Journal of Scientific Study
• Treatment with PRP holds promising results with minimal risk for the treatment of
Tennis elbow. More scientific evidence studies need to done before we can determine
whether PRP therapy is effective in other conditions. PRP therapy as a viable
procedure that may decrease the progression of more injuries may decrease the
overall time for healing, and therefore may setback the overall need for surgical
intervention

84. GOLFER'S ELBOW (MEDIAL
EPICONDYLITIS)
• Also called swimmers elbow
• The clinician palpates the
medial epicondyle with one
hand while supinating the
forearm, and extending the wrist
and elbow with the other hand.
• A reproduction of pain in the
area of the medial epicondyle
indicates a positive test

85. TINEL'S SIGN (AT THE ELBOW)
• its name from French neurologist
Jules Tinel (1879–1952)
• The clinician locates the groove
between the olecranon process and
the medial epicondyle through which
the ulnar nerve passes.
• This groove is tapped many time by
the index finger of the clinician.
• A positive sign is indicated by a
tingling sensation in the ulnar
distribution of the forearm and hand
distal to the tapping point

87. PHALEN TEST
• Phalen's manoeuvre is a diagnostic test
for carpal tunnel syndrome[1] discovered by an
American orthopedist named George S. Phalen
• Placing the wrists in maximum flexion, both
hands in one time with the elbow extended (the
normal hand acts as a control).
• Onset of numbness - tingling in the median
nerve distribution in less than 60 seconds is
considered diagnostic for carpal syndrome or
median nerve impingement .
• Reversed Phalen’s test: Placing the palms of
the hands together, raising the elbow as high as
possible. Occasionally positive when the
Phalen’s test is negative.

89. ELBOW FLEXION TEST
• Fully flex the elbow, wrist
extended, Hold this position for 3-
5 minutes.
• (+) sign: Tingling or paraesthesia
in the ulnar nerve distribution of
the forearm and
• Significance: Cubital Tunnel
Syndrome

91. MILKING MANOEUVRE
• Px: sitting; elbow flexed 700, adduction
forearm supinated external rotated
which hold by pt hand and Grasp the
px’s thumb and pull it importing a
valgus stress to the elbow
• (+) sign: pain laxity over medial
epicondyle
• Significance: Partial tear to the ulnar
collateral ligament

93. LATERAL PIVOT SHIFT TEST
• Pivot-shift test for posterolateral rotatory
instability.
• (A) the patient in the supine position and
with the shoulder and elbow flexed 90 ‘
.the patient forearm is fully supinated and
with the examiner holding the patients
wrist and forearm a valgus and axial
compression force is applied to the elbow
whilst the elbow is slowly extended
• a positive test result demonstrates a clunk
with greater than 40 of flexion or
apprehension when awake.
• (B) Subluxated radio capitellar joint.
• (C) Reduction of radio capitellar joint
under fluoroscopy view

95. STAND UP TEST FOR POSTEROLATERAL
ROTATORY INSTABILITY
The stand-up test for
posterolateral rotatory
instability.
• The patient attempts to stand up
from a seated chair by pushing
against the chair with forearms
maximally supinated.
• A positive test result will
reproduce the patient’s symptoms
or apprehension just before full
extension

96. BICEPS SQUEEZE TEST
• For the bicep tendon,
• You will ask the patient to flex their elbow
to 80 degrees and keep the forearm in
some pronation, then you will squeeze the
biceps with one hand or with two hands.
• Supination of the forearm will occur if the
biceps is intact.
• NO supination of the forearm will occur if
the biceps is torn

97. HOOK TEST FOR BICEP TENDON
• The hook test is performed to diagnose
rupture or tear of the distal biceps tendon.
• The examiner will use the index finger to
hook the biceps tendon from the lateral side
of the elbow.
• the patient will need to flex the elbow at a 90
degree angle and fully supinate the forearm.
Then, the physician will use their index finger
to hook the lateral edge of the biceps tendon

98. IMPORTANT LINE AND
ANGLE

99. LINES
• A radiocapitellar line can be drawn on
each image: it runs through the central
radius and passes the central
capitellum on a normal image.
• The anterior humeral line is drawn
along the front of the humerus and
passes the antero-medial 1/3 of the
capitellum.
• When one of the above lines is
abnormal, a fracture should be
suspected.

101. • By Hsuan-Kai Kao, Wei-Chun Lee, Wen-E. Yang, Chia-Hsieh Chang from china on
october 2016 in ScienceDirect
• These findings demonstrate that children with AHL crossing the middle and posterior
thirds of
• the capitulum appear to have slightly better early elbow flexion and total range of elbow
• motion. AHL crossing the anterior third of the capitulum can be an under reduction that
has
• similar elbow motion as AHL anterior to the capitellum. AHL posterior to the capitellum
is a

102. FAT PAD SIGN
• Also known as sail sign
• When there is joint effusion
(fluid/blood/pus) or synovitis, the capsule
will become distended. Fat pads are
located at the anterior and posterior side of
the distal humerus.
• When the effusion becomes large enough,
the fat tissue can be displaced away from
the humerus. This is termed a so-called
‘positive fat pad

104. CORONOID LINE
• line directed proximally along the
anterior border of the coronoid
process of ulna should barely
touch the anterior portion of the
lateral condyle of humerus
• It indicate Posterior displacement
of the lateral condyle

105. FISH-TAIL SIGN
• FISH-TAIL SIGN:
• Due to rotation of the distal
fragment, the anterior border of
the proximal fragment look like
sharp spike

106. BAUMANN’S ANGLE
• Bauman’s angle is formed by a line
perpendicular to the axis of the humerus,
and a line that goes through the physis of
the capitulum.
• Normal range: 64 -81degrees
• Decreased angle is a sign of Varus
angulation
• It is not obscured by elbow flexion or
pronation.
• The Baumann angle is not equal to the
carrying angle of the elbow .
• Change in 5 deg will result in 2 deg
change of clinical carrying angle

108. CRESCENT SIGN
• Normal radiolucent gap of
elbow joint is missing.
• A crescent shaped shadow
due to overlap of capitulum
and olecranon
• Indicates Varus or valgus tilt
of distal fragment

109. TEAR DROP SIGN
• TEAR DROP SIGN : Disturbed in
Supracondylar fracture
• • Normally , there is an angulation of
40 degrees b/n long axis of humerus
& long axis of lat. Epicondyle

110. •The capitellum is angulated
anteriorly about 40 degrees.
•The appearance of the distal
humerus is similar to a
hockey stick. 40

111. ANCONEUS TRIANGLE
•Anconeus triangle
boundaries are the radial
head, lateral epicondyle,
and tip of the olecranon.
•Anconeus triangle is the site
for elbow joint aspiration,
injection and direct lateral
portal for elbow arthroscopy

112. TERRIBLE TRIAD
•Posterior
dislocation
•Radial head
fracture
•Coronoid fracture

113. RADIOLOGY

114. AP VEIW
• The arm is in exorotation (palm of
the hand pointing upward) and in
full extension. The back of the arm
should be in contact with the plate
(fig. 1).
The joint is then imaged from
above.
A good image shows the elbow
joint, plus 1/3 of the distal humerus
and 1/3 of the radius/ulna.

115. LATERAL VEIW
• the shoulder should be at the same
level as the elbow. Importantly, the
medial side of the entire arm should be
in contact with the table.
•
The hand is turned vertically, the hand
palm pointing toward the patient
•
The X-rays will pass through the joint
parallel to the humeral epicondyles.
A good image will show the elbow joint
with about 1/3 of the distal humerus
and 1/3 of the proximal radius/ulna

116. RADIAL HEAD - CAPITELLUM IMAGE
• For improved visualization of the
radial head, a separate radial
head image can be made, e.g. in
dubious/subtle fractures.
• The elbow is positioned as in the
lateral image. It is then imaged
under a 45-degree angle, rather
than cranial as in a purely lateral
image

117. DEVELOPMENT
•The sequence of development of the
ossification centers is fixed (CRITOE)
• capitellum (1-2 year)
• radial head (2-4 years)
• medial (= internal) epicondyle (4-6 years)
• trochlea (6-8 years)
• olecranon (8-10 years)
• lateral (= external) epicondyle (10-12 years)

120. • By Dr. S.S. Bhise, Dr. S. D. Nanandkar on Journal of Forensic Medicine, Science
and Law on jun-jan 2011 at Grant medical college Mumbai.
• It is therefore possible to determine the approximate age of an individual by
radiological examination of bones till ossification is complete

121. THANKING YOU