BIOMECHANICS OF
ELBOW COMPLEX
Dr. Simranjeet Kaur (PT)
Assistant Professor
MMIPR, MMDU, MULLANA,
HARYANA
INTRODUCTION
• THE JOINTS AND MUSCLES OF THE
ELBOW COMPLEX ARE DESIGNED TO
SERVE THE HAND.
• THEY PROVIDE MOBILITY FOR THE
HAND IN SPACE BY SHORTENING AND
LENGTHENING OF UPPER EXTREMITY.
ELBOW JOINT
• IT IS A COMPOUND JOINT THAT
FUNCTIONS AS A MODIFIED OR
LOOSE HINGE JOINT.
• ONE DEGREE OF FREEDOM IS
POSSIBLE i.e FLX. AND EXT. IN
SAGITTAL PLANE AND CORONAL AXIS.
COMPOSITION OF
ELBOW COMPLEX
1. IT INCLUDES
• ELBOW JOINT
(HUMEROULNAR
(H.U)AND
HUMERORADIAL (H.R)
JOINTS)
• PROXIMAL
RADIOULNAR JOINT
• DISTAL RADIOULNAR
JOINT.
STRUCTURE:ELBOW JT.
HUMEROULNAR & RADIOULNAR
ART
1. ARTICULATING SURFACES ON
HUMERUS
– ANTERIORLY,TROCHLEA AND CAPITULUM.
– POSTERIORLY,DISTAL HUMERUS
INDENTED BY A DEEP FOSSSA CALLED
OLECRANON FOSSA.
2 ARTICULATING SURFACES ON
RADIUS & ULNA
– ULNAR ARTICULATING SURFACE
ON H.U JT. IS TROCHLEAR NOTCH.
– DISTAL END BY ULNAR CORONOID
PROCESS.
– THE RADIAL ARTICULATING
SURFACE IS HEAD OF RADIUS.
– RADIAL HEAD’S CONVEX RIM FITS
INTO CAPITULOTRCHLEAR NOTCH
MUSCLES
MSCLS OF ANT. ASPECT
• PRIMARY MUSCLES
– BRACHIALIS
– BICEPS BRACHII
– BRACHIORADIALIS
• SUPINATOR TERES& PRONATOR Teres FUNCTION AT
RADIOULNAR JTS
• ADDITIONAL MSCLS
– FLEXOR CARPI RADIALIS
– FLEXOR CARPI ULNARIS
– FLEXOR DIGITORUM SUPERFICIALIS
– PALMARIS LONGUS
Flexors of the elbow
• BRACHIALIS
• BICEPS
BRACHII
• BRACHIORADI
ALIS
Extensors of the elbow
– Triceps
– Anconeus
RANGE OFMOTION
• THE ACTIVE ROM OF ELBOW FLX. IS
WITH FOREARM SUPINATED IS 135’ TO
145’ WHERE AS PASSIVE ROM IS 150’
TO 160’
LIGAMENTS
• MEDIAL OR
ULNAR
COLLATERAL LIG.
• LATERAL OR
RADIAL
COLLATERAL LIG.
Factors affecting elbow
mscl activity
• NO. OF JOINTS CROSSED BY MSCLES
• PHYSIOLOGIC CROSS-SECTIONAL
AREA(PCSA)
• LOCATION IN RELATION TO JT.
• POSITION OF FOREARM
• MAGNITUDE OF APPLIED LOAD
• TYPE OF MSCLE ACTION
• SPEED OF MOTION(SLOW OR FAST)
• MOMENT ARM AT DIFF. JT POSITION
• FIBER TYPE
SUP. RADIOULNAR
JOINT
• ULNAR RADIAL
NOTCH
• ANNULAR
LIGAMENT
INF. RADIOULNAR JOINT
• ULNAR NOTCH
OF RADIUS
• ARTICULAR
DISK(TFC OR
TFCC)
-TRIANGULAR
FIBROCARTILAG
E-
• HEAD OF ULNA
LIGAMENTS
• ANNULAR LIGAMENT
• QUADRATE LIGAMENT
• DORSAL AND PALMAR
RADIOULNAR LIGAMENT
• INTEROSSEOUS MEMBRANE
CARRYING ANGLE
• THE FOREARM LIES SLIGHTLY LATERAL TO
THE HUMERUS WHEN THE ELBOW IS FULLY
EXTENDED IN ANATOMIC POSITION.
• THE LONG AXIS OF HUMERUS AND LONG
AXIS OF FOREARM FORM THE CARRING
ANGLE
• NORMAL IN MEN = 5’ , WOMEN = 10’ TO 15’
• INCREASE IN CARRYING ANGLE IS
CONSIDERED TO BE ABNORMAL ,ESPECIALLY
IF IT OCCURS UNILATERALLY.
• WHEN THE ANGLE INCREASED BEYOND THE
AVERAGE , IT IS CALLED CUBITUS VALGUS
• THE CONFIGURATION OF THE TROCHLEAR
GROOVE DETERMINES THE PATHWAY DURING
FLEXION AND EXTENSION.
Effects of age& injury
• AGE- DUE TO ADVANCING AGE,THE
DEC. IN MSCLE STRENGTH AND LESS
PHYSICAL ACTIVITY TENDS TO DEC IN
ROM
• INJURY-IJURIES ARE FREQUENT. IT
IS ONE OF THE MOST COMMON SITES
FOR APOPHYSITIS (STRAIN AT
APOPHYSIS)
Compression injuries
• EXCESSIVE COMPRESSION OFTEN RESULT
IN BONY FAILURE.
• FALLING ON HANDS WHEN ELBOW IS IN A
CLOSE –PACKED POSITION RESULT IN
TRANSMISSION OF FORCES
IF FORCES R TRANSMITTED TROUGH
RADIUS,DUE TO CONCOMITANT VALGUS
STRESS,A FRACTURE OF RADIAL HEAD ON
CAPITULUM
Compression injuries
IF FORCE IS TRANSMITTED TO
ULNA,FRACTURE OF CORONOID OR
OLECRANON PROCESSES MAY OCCUR FROM
IMPACT OF ULNA ON HUMERUS
IF NEITHER RADIUS NOR ULNA ,THE
FORCE MAY B TRANSMITTED TO HUMERUS&
RESULTS IN SUPRACONDYLAR FRACTURE.
Distraction injuries
• A TENSILE FORCE OF SUFFICIENT
MAGNITUDE EXERTED ON A PRONATED OR
EXTENTED FOREARM MAY CAUSE RADIUS TO
BE PULLED INFERIORLY OUT OF THE
ANNULAR LIGAMENT
• COMMON IN YOUNG CHILDREN & RARE IN
ADULTS.
• LIFTING A SMALL CHILD UP IN AIR OR
YANKING A CHILD BY ONE HAND IS THE
USUAL CAUSATIVE MECHANISMAND
THEREFORE THE INJURYIS REFFERED TO AS
EITHER NURSEMAID’S ELBOW OR ’’PULLED
ELBOW’
Varus or Valgus Injuries
• DISTRACTION & COMPRESSION FORCES R
CREATED IF EITHER ONE OF COLLATERAL
LIG. IS OVERSTRETCHED OR TORN.
• OTHER CONDITIONS THAT MAY OCCUR IN
THROWING ELBOW INCLUDE ULNAR
NEUTRITIS, FLEXOR PRONATOR MSCL
STRAINS& MED. EPICONDYLITIS, LAT.
EPICONDYLITIS(TENNIS ELBOW)
TENNIS ELBOW
• THE CLASSIC TENNIS
ELBOW (EPICONDYLITIS
OF LAT.
EPICONDYLE)APPEARS TO B
CAUSED BY REPEATED
FORCEFUL CONTRACTION
OF WRIST EXTENSORS.
• SOME TREATMENT
INCLUDE
SPLINTING,FOREARM
SUPPORT BANDS &
TAPING,ULTRASOUND,
MANIPULATION,EXERCISE,
MOBILIZATION TECH.s
• STEROID INJECTIONS R
EFFECTIVE IN RELIEVING
PAIN.
THANK
YOU

ELBOW COMPLEX.ppt

  • 1.
    BIOMECHANICS OF ELBOW COMPLEX Dr.Simranjeet Kaur (PT) Assistant Professor MMIPR, MMDU, MULLANA, HARYANA
  • 2.
    INTRODUCTION • THE JOINTSAND MUSCLES OF THE ELBOW COMPLEX ARE DESIGNED TO SERVE THE HAND. • THEY PROVIDE MOBILITY FOR THE HAND IN SPACE BY SHORTENING AND LENGTHENING OF UPPER EXTREMITY.
  • 3.
    ELBOW JOINT • ITIS A COMPOUND JOINT THAT FUNCTIONS AS A MODIFIED OR LOOSE HINGE JOINT. • ONE DEGREE OF FREEDOM IS POSSIBLE i.e FLX. AND EXT. IN SAGITTAL PLANE AND CORONAL AXIS.
  • 4.
    COMPOSITION OF ELBOW COMPLEX 1.IT INCLUDES • ELBOW JOINT (HUMEROULNAR (H.U)AND HUMERORADIAL (H.R) JOINTS) • PROXIMAL RADIOULNAR JOINT • DISTAL RADIOULNAR JOINT.
  • 5.
    STRUCTURE:ELBOW JT. HUMEROULNAR &RADIOULNAR ART 1. ARTICULATING SURFACES ON HUMERUS – ANTERIORLY,TROCHLEA AND CAPITULUM. – POSTERIORLY,DISTAL HUMERUS INDENTED BY A DEEP FOSSSA CALLED OLECRANON FOSSA.
  • 6.
    2 ARTICULATING SURFACESON RADIUS & ULNA – ULNAR ARTICULATING SURFACE ON H.U JT. IS TROCHLEAR NOTCH. – DISTAL END BY ULNAR CORONOID PROCESS. – THE RADIAL ARTICULATING SURFACE IS HEAD OF RADIUS. – RADIAL HEAD’S CONVEX RIM FITS INTO CAPITULOTRCHLEAR NOTCH
  • 7.
    MUSCLES MSCLS OF ANT.ASPECT • PRIMARY MUSCLES – BRACHIALIS – BICEPS BRACHII – BRACHIORADIALIS • SUPINATOR TERES& PRONATOR Teres FUNCTION AT RADIOULNAR JTS • ADDITIONAL MSCLS – FLEXOR CARPI RADIALIS – FLEXOR CARPI ULNARIS – FLEXOR DIGITORUM SUPERFICIALIS – PALMARIS LONGUS
  • 9.
    Flexors of theelbow • BRACHIALIS • BICEPS BRACHII • BRACHIORADI ALIS
  • 10.
    Extensors of theelbow – Triceps – Anconeus
  • 11.
    RANGE OFMOTION • THEACTIVE ROM OF ELBOW FLX. IS WITH FOREARM SUPINATED IS 135’ TO 145’ WHERE AS PASSIVE ROM IS 150’ TO 160’
  • 12.
    LIGAMENTS • MEDIAL OR ULNAR COLLATERALLIG. • LATERAL OR RADIAL COLLATERAL LIG.
  • 13.
    Factors affecting elbow msclactivity • NO. OF JOINTS CROSSED BY MSCLES • PHYSIOLOGIC CROSS-SECTIONAL AREA(PCSA) • LOCATION IN RELATION TO JT. • POSITION OF FOREARM • MAGNITUDE OF APPLIED LOAD • TYPE OF MSCLE ACTION • SPEED OF MOTION(SLOW OR FAST) • MOMENT ARM AT DIFF. JT POSITION • FIBER TYPE
  • 14.
    SUP. RADIOULNAR JOINT • ULNARRADIAL NOTCH • ANNULAR LIGAMENT
  • 15.
    INF. RADIOULNAR JOINT •ULNAR NOTCH OF RADIUS • ARTICULAR DISK(TFC OR TFCC) -TRIANGULAR FIBROCARTILAG E- • HEAD OF ULNA
  • 16.
    LIGAMENTS • ANNULAR LIGAMENT •QUADRATE LIGAMENT • DORSAL AND PALMAR RADIOULNAR LIGAMENT • INTEROSSEOUS MEMBRANE
  • 18.
    CARRYING ANGLE • THEFOREARM LIES SLIGHTLY LATERAL TO THE HUMERUS WHEN THE ELBOW IS FULLY EXTENDED IN ANATOMIC POSITION. • THE LONG AXIS OF HUMERUS AND LONG AXIS OF FOREARM FORM THE CARRING ANGLE • NORMAL IN MEN = 5’ , WOMEN = 10’ TO 15’
  • 19.
    • INCREASE INCARRYING ANGLE IS CONSIDERED TO BE ABNORMAL ,ESPECIALLY IF IT OCCURS UNILATERALLY. • WHEN THE ANGLE INCREASED BEYOND THE AVERAGE , IT IS CALLED CUBITUS VALGUS • THE CONFIGURATION OF THE TROCHLEAR GROOVE DETERMINES THE PATHWAY DURING FLEXION AND EXTENSION.
  • 20.
    Effects of age&injury • AGE- DUE TO ADVANCING AGE,THE DEC. IN MSCLE STRENGTH AND LESS PHYSICAL ACTIVITY TENDS TO DEC IN ROM • INJURY-IJURIES ARE FREQUENT. IT IS ONE OF THE MOST COMMON SITES FOR APOPHYSITIS (STRAIN AT APOPHYSIS)
  • 21.
    Compression injuries • EXCESSIVECOMPRESSION OFTEN RESULT IN BONY FAILURE. • FALLING ON HANDS WHEN ELBOW IS IN A CLOSE –PACKED POSITION RESULT IN TRANSMISSION OF FORCES IF FORCES R TRANSMITTED TROUGH RADIUS,DUE TO CONCOMITANT VALGUS STRESS,A FRACTURE OF RADIAL HEAD ON CAPITULUM
  • 23.
    Compression injuries IF FORCEIS TRANSMITTED TO ULNA,FRACTURE OF CORONOID OR OLECRANON PROCESSES MAY OCCUR FROM IMPACT OF ULNA ON HUMERUS IF NEITHER RADIUS NOR ULNA ,THE FORCE MAY B TRANSMITTED TO HUMERUS& RESULTS IN SUPRACONDYLAR FRACTURE.
  • 24.
    Distraction injuries • ATENSILE FORCE OF SUFFICIENT MAGNITUDE EXERTED ON A PRONATED OR EXTENTED FOREARM MAY CAUSE RADIUS TO BE PULLED INFERIORLY OUT OF THE ANNULAR LIGAMENT • COMMON IN YOUNG CHILDREN & RARE IN ADULTS. • LIFTING A SMALL CHILD UP IN AIR OR YANKING A CHILD BY ONE HAND IS THE USUAL CAUSATIVE MECHANISMAND THEREFORE THE INJURYIS REFFERED TO AS EITHER NURSEMAID’S ELBOW OR ’’PULLED ELBOW’
  • 25.
    Varus or ValgusInjuries • DISTRACTION & COMPRESSION FORCES R CREATED IF EITHER ONE OF COLLATERAL LIG. IS OVERSTRETCHED OR TORN. • OTHER CONDITIONS THAT MAY OCCUR IN THROWING ELBOW INCLUDE ULNAR NEUTRITIS, FLEXOR PRONATOR MSCL STRAINS& MED. EPICONDYLITIS, LAT. EPICONDYLITIS(TENNIS ELBOW)
  • 26.
    TENNIS ELBOW • THECLASSIC TENNIS ELBOW (EPICONDYLITIS OF LAT. EPICONDYLE)APPEARS TO B CAUSED BY REPEATED FORCEFUL CONTRACTION OF WRIST EXTENSORS. • SOME TREATMENT INCLUDE SPLINTING,FOREARM SUPPORT BANDS & TAPING,ULTRASOUND, MANIPULATION,EXERCISE, MOBILIZATION TECH.s • STEROID INJECTIONS R EFFECTIVE IN RELIEVING PAIN.
  • 27.