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Clinical anatomy of elbow

PMR PG Teaching

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Clinical anatomy of elbow

  1. 1. CLINICAL ANATOMY OF ELBOW JOINT DR. RAJESH ARORA PROFESSOR ANATOMY
  2. 2. ELBOW JOINT  Compound joint  Hindge joint  Cubital Articulation humero-ulnar humero-radial superior radio-ulnar joint
  3. 3. BONY STRUCTURE OF ELBOW
  4. 4. HUMERUS LOWER END
  5. 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. 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. 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. 8. RELATIONS
  9. 9. LIGAMENTS OF ELBOW JOINT  Capsular ligament  Ulnar collateral ligament or Medial ligament  Radial collateral ligament or Lateral ligament
  10. 10. FIBROUS CAPSULE  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.
  11. 11. 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.
  12. 12. ULNAR COLLATERAL LIGAMENT
  13. 13. RADIAL COLLATERAL LIGAMENT  RCL is triangular and extends from lateral epicondyle to annular ligament. It is related to supinator and ECRB
  14. 14. RADIAL COLLATERAL LIGAMENT
  15. 15. SYNOVIAL MEMBRANE
  16. 16. CARRYING 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
  17. 17.  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 when a load is carried in the hand  Carrying angle is generally greater in females than in males
  18. 18. 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
  19. 19. ANTERIOR RELATIONS
  20. 20. ARTERIAL SUPPLY  Peri-articular branches of anastomosis around elbow joint. NERVE SUPPLY Musculo-cutaneous nerve through branch to Brachialis Radial nerve through nerve to anconeous Ulnar nerve
  21. 21. MOVEMENTS  Flexion- (C5 and C6) range is about 150 degree when flexor surface of arm and forearm approximate  Chief flexor is brachialis, biceps when forearm is supinated act as spurt muscle, brachioradialis in midprone position act as shunt muscle.
  22. 22. MOVEMENTS AT ELBOW JOINT
  23. 23. EXTENSION  Extension-(C7 and C8) reached when arm and forearm assume straight line. It makes the joint close-packed  It is performed by triceps, anconeus and assisted by gravity
  24. 24. BURSAE AROUND ELBOW JOINT  Above the olecrenon, between the triceps tendon and capsule of the joint.  A subcutaneous bursa on the dorsal triangular surface of olecrenon process.  Between the biceps tendon and the smooth anterior part of radial tuberosity.
  25. 25. BURSAE AROUND ELBOW JOINT
  26. 26. OLECRANON BURSITIS  the olecranon bursa is the largest bursa in the elbow and sits just over the olecranon process  injury results due to a direct fall, constant irritation, or infection
  27. 27.  an acutely inflamed bursa will rapidly swell, show signs of redness and increased heat  often termed golf ball swelling  the bursa may become infected – it will be swollen and hot to touch along with a possible fever , pain , tenderness and restricted range of motion.
  28. 28. ELBOW DISLOCATION / SUBLUXATION  Ulnar dislocation-  It occurs in hyperextension ( Fall on hand elbow extended) with violent twisting action of the ulna .This needs a tremendous amount of force More common displacement is of radial head especially in children , swinging of children by their arms , may cause radial head to snap out of the annular ligament
  29. 29.  severe pain with loss of functions , cracking or snapping sensation , rapid swelling , obvious deformity and inability to move elbow  90 % posterior , management is important to avoid long term disabilities
  30. 30. ELBOW STRAIN  Elbow strains usually the result of attempting to overcome large force with muscles  inadequate warm-up , excessive training (past point of fatigue)  common with biceps brachii, brachiallis, triceps  pain and point tenderness over the injury site, reduced strength and ROM
  31. 31. ELBOW SPRAIN  usually the result of fall on extended arm, producing a hyperextension of elbow  or through a valgus/varus force  may be due to a repetitive force that irritate or tear the ligaments  pain , local tenderness . pain and or laxity with stressing of the ligament, decreased ROM
  32. 32. MEDIAL EPICONDYLITIS little league elbow or golfer’s elbow  repetitive motions with poor technique, muscular weakness or anatomical weakness  often seen in the acceleration phase of throwing
  33. 33.  valgus force is placed on the elbow, which strains the flexor muscle , the ulnar collateral ligament and possibly the ulnar nerve.  swelling at the medial epicondyle, point tenderness, pain on resisted wrist flexion and pronation  tingling and numbness may be felt if the ulnar nerve is involved
  34. 34. MEDIAL EPICONDYLITIS
  35. 35. LATERAL EPICONDYLITIS  tennis elbow  most common overuse injury in the elbow  this condition is typically due to eccentric overloading of the extensor muscles as seen in the deceleration phase of throwing or the tennis stroke  pain will be located on the lateral epicondyle , it may be swollen and the pain will increase with resisted wrist extension
  36. 36. Contributing factors to tennis elbow  lack of experience  poor technique on backhand  heavy stiff racquet ( 12 - 12.5 seem to be best)  grip size  racquet strings to tight( 2-3 lbs. best)  playing surface ( ball bounces more off cement)
  37. 37. CUBITAL TUNNEL SYNDROME  impingement of ulnar nerve in cubital tunnel of the elbow ( through ulnar groove and under the ulnar collateral ligament)  here the nerve is vulnerable to compression and tensile stress caused by trauma
  38. 38.  sharp pain along medial aspect forearm, tingling and numbness into ring and little finger of hand  signs and symptoms reproduced by tapping over ulnar groove
  39. 39. SUPRACONDYLAR FRACTURE OF HUMERUS
  40. 40. THANKS

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