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Elbow joint
Add your text
T.Elisha
Mpt ortho
Features
The elbow joint is a hinge variety of synovial joint
between the lower end of humerus and the upper
ends of radius and ulna bones.
Elbow joint is the term used for humeroradial and
humeroulnar joints.
The term elbow complex also includes the superior
radioulnar joint also.
Articular Surfaces
Upper
The capitulum and trochlea of the
humerus.
The coronoid fossa lies just above
the trochlea and is designed in a
manner that the coronoid process
of ulna fits into it in extreme
flexion.
Similarly, the radial fossa just
above the capitulum allows for
radial head fitting in the radial
Lower
i. Upper surface of the head of the radius articulates
with the capitulum.
ii. Trochlear notch of the ulna articulates with the
trochlea of the humerus (Fig. 10.10).
The elbow joint is continuous with
the superior radioulnar joint. The
humeroradial, the humeroulnar and
the superior radioulnar joints are
together known as cubital
articulations.
Ligaments
1 Capsular ligament:
Superiorly, it is attached to the lower end of the
humerus in such a way that the capitulum the trochlea,
the radial fossa, the coronoid fossa and the olecranon
fossa are intracapsular.
Inferomedially it is attached to the margin of the
trochlear notch o the ulna except laterally;
inferolaterally, it is attached to the annular ligament of
the superior radioulnar joint.
The synovial membrane lines the capsule and the
fossae, named above.
2.The ulnar collateral ligament is triangular in shape .
Its apex is attached to the medial epicondyle of the
humerus, and its base to the ulna.
The ligament has thick anterior and posterior bands:
These are attached below to the coronoid process and
the olecranon process, respectively.
Their lower ends by are joined to each other by an
oblique band which gives attachment to the thinner
intermediate fibres of the ligament.
The ligament is crossed by the ulnar nerve and it gives
origin to the flexor digitorum superficialis
It is closely related to flexor carpi ulnaris and triceps
branchi
3 .The radial collateral or lateral
ligament:
It is a fan-shaped band extending
from the lateral epicondyle to the
annular ligament.
It gives origin to the supinator and
to the extensor carpi radialis brevis
Relations
Relations
• Anteriorly: Brachialis, median nerve, brachial artery
and tendon of biceps brachii.
• Posteriorly: Triceps brachii and anconeus.
• Medially: Ulnar nerve, flexor carpi ulnaris and
common flexors.
. Laterally: Supinator, extensor carpi radialis brevis
and
other common extensors.
Blood Supply
From anastomoses around the elbow joint (see Fig.
8.10).
Nerve Supply
The joint receives branches from the following nerves.
i. Ulnar nerve
ii. Median nerve
iii. Radial nerve
iv. Musculocutaneous nerve through its branch to the
brachialis
Movements
1 Flexion is brought about by:
i. Brachialis
ii. Biceps brachii
iii. Brachioradialis
2 Extension is produced by:
i. Triceps brachii
ii. Anconeus
Carrying Angle
The transverse axis of the elbow joint is directed
medially and downwards.
Because of this, the extended forearm is not in
straight line with the arm, but makes an angle of
about 13 deg with it.
This is known as the carrying angle.
The factors responsible for formation of the
carrying angle are as follows.
a. The medial flange of the trochlea is 6 mm
deeper than the lateral flange.
b. The superior articular surface of the coronoid
process of the ulna is placed oblique to the long
axis of the bone.
The carrying angle disappears in full flexion of the elbow,
and also during pronation of the forearm.
The forearm comes in line with the arm in the midprone
position, and this is the position in which the hand is Mostly
used
This arrangement of gradually increasing carrying angle
during extension of the elbow increases the precision with
which the hand ( 10 deg - 15 deg held in it) can be controlled.
The angle is in males and more than 15 deg in females
Clinical anatomy
• Distension of the elbow joint by an effusion
occurs posteriorly because here the capsule is
weak and the covering deep fascia is thin.
Aspiration is done posteriorly on any side of the
olecranon process
• Dislocation of the elbow is usually posterior, and is
often associated with fracture of the coronoid process.
The triangular relationship between the olecranon
process and the two humeral epicondyles is lost
• Subluxation of the head of f the radius (pulled
elbow) occurs in children when the forearm is
suddenly pulled in pronation.
The head of the radius slips out from the
annular ligament
• Tennis elbow occurs in tennis players. Abrupt pronation
with fully extended elbow may lead to pain and tenderness
over the lateral epicondyle which gives attachment to
common extensor
origin
This is possibly due to:
a. Sprain of radial collateral ligament.
b. Tearing of fibres of the extensor carpi radialis brevis.
c. Recent researches have pointed out that it is more of a
degenerative condition rather than inflammatory condition.
• Student's (miner's) elbow is
characterised by effusion into the
bursa over the subcutaneous
posterior surface of the olecranon
process.
Students during lectures support
their head (for sleeping) with their
hands with flexed elbows.
The bursa on the olecranon process
gets inflamed
• Golfer's elbow is the microtrauma of medial epicondyle of
humerus, occurs commonly in golf players. The common
flexor origin undergoes
repetitive strain and results in a painful
condition on the medial side of the elbow
• If carrying angle (normal is 13°) is more, the
condition is cubitus valgus, ulnar nerve may get
stretched leading to weakness of intrinsic
muscles of hand. If the angle is less, it is called
cubitus varus
• Under optimal position of the elbow:
Generally elbow flexion between 30° and 40 deg is
sufficient to perform common activities of daily living
such as eating, combing, dressing, etc.
Because of this reason even people who have lost
terminal flexion or extension after a fracture/trauma
are able to accomplish these personal tasks without
much problems.
Thank you

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Elbow joint - Anatomy of the Elbow joint

  • 1. Elbow joint Add your text T.Elisha Mpt ortho
  • 2. Features The elbow joint is a hinge variety of synovial joint between the lower end of humerus and the upper ends of radius and ulna bones. Elbow joint is the term used for humeroradial and humeroulnar joints. The term elbow complex also includes the superior radioulnar joint also.
  • 3. Articular Surfaces Upper The capitulum and trochlea of the humerus. The coronoid fossa lies just above the trochlea and is designed in a manner that the coronoid process of ulna fits into it in extreme flexion. Similarly, the radial fossa just above the capitulum allows for radial head fitting in the radial
  • 4. Lower i. Upper surface of the head of the radius articulates with the capitulum. ii. Trochlear notch of the ulna articulates with the trochlea of the humerus (Fig. 10.10).
  • 5. The elbow joint is continuous with the superior radioulnar joint. The humeroradial, the humeroulnar and the superior radioulnar joints are together known as cubital articulations.
  • 6. Ligaments 1 Capsular ligament: Superiorly, it is attached to the lower end of the humerus in such a way that the capitulum the trochlea, the radial fossa, the coronoid fossa and the olecranon fossa are intracapsular. Inferomedially it is attached to the margin of the trochlear notch o the ulna except laterally; inferolaterally, it is attached to the annular ligament of the superior radioulnar joint. The synovial membrane lines the capsule and the fossae, named above.
  • 7. 2.The ulnar collateral ligament is triangular in shape . Its apex is attached to the medial epicondyle of the humerus, and its base to the ulna. The ligament has thick anterior and posterior bands: These are attached below to the coronoid process and the olecranon process, respectively. Their lower ends by are joined to each other by an oblique band which gives attachment to the thinner intermediate fibres of the ligament. The ligament is crossed by the ulnar nerve and it gives origin to the flexor digitorum superficialis It is closely related to flexor carpi ulnaris and triceps branchi
  • 8.
  • 9. 3 .The radial collateral or lateral ligament: It is a fan-shaped band extending from the lateral epicondyle to the annular ligament. It gives origin to the supinator and to the extensor carpi radialis brevis
  • 10. Relations Relations • Anteriorly: Brachialis, median nerve, brachial artery and tendon of biceps brachii. • Posteriorly: Triceps brachii and anconeus. • Medially: Ulnar nerve, flexor carpi ulnaris and common flexors. . Laterally: Supinator, extensor carpi radialis brevis and other common extensors.
  • 11.
  • 12. Blood Supply From anastomoses around the elbow joint (see Fig. 8.10). Nerve Supply The joint receives branches from the following nerves. i. Ulnar nerve ii. Median nerve iii. Radial nerve iv. Musculocutaneous nerve through its branch to the brachialis
  • 13. Movements 1 Flexion is brought about by: i. Brachialis ii. Biceps brachii iii. Brachioradialis
  • 14. 2 Extension is produced by: i. Triceps brachii ii. Anconeus
  • 15. Carrying Angle The transverse axis of the elbow joint is directed medially and downwards. Because of this, the extended forearm is not in straight line with the arm, but makes an angle of about 13 deg with it. This is known as the carrying angle.
  • 16. The factors responsible for formation of the carrying angle are as follows. a. The medial flange of the trochlea is 6 mm deeper than the lateral flange. b. The superior articular surface of the coronoid process of the ulna is placed oblique to the long axis of the bone.
  • 17. The carrying angle disappears in full flexion of the elbow, and also during pronation of the forearm. The forearm comes in line with the arm in the midprone position, and this is the position in which the hand is Mostly used This arrangement of gradually increasing carrying angle during extension of the elbow increases the precision with which the hand ( 10 deg - 15 deg held in it) can be controlled. The angle is in males and more than 15 deg in females
  • 18.
  • 19. Clinical anatomy • Distension of the elbow joint by an effusion occurs posteriorly because here the capsule is weak and the covering deep fascia is thin. Aspiration is done posteriorly on any side of the olecranon process
  • 20. • Dislocation of the elbow is usually posterior, and is often associated with fracture of the coronoid process. The triangular relationship between the olecranon process and the two humeral epicondyles is lost
  • 21. • Subluxation of the head of f the radius (pulled elbow) occurs in children when the forearm is suddenly pulled in pronation. The head of the radius slips out from the annular ligament
  • 22. • Tennis elbow occurs in tennis players. Abrupt pronation with fully extended elbow may lead to pain and tenderness over the lateral epicondyle which gives attachment to common extensor origin This is possibly due to: a. Sprain of radial collateral ligament. b. Tearing of fibres of the extensor carpi radialis brevis. c. Recent researches have pointed out that it is more of a degenerative condition rather than inflammatory condition.
  • 23.
  • 24. • Student's (miner's) elbow is characterised by effusion into the bursa over the subcutaneous posterior surface of the olecranon process. Students during lectures support their head (for sleeping) with their hands with flexed elbows. The bursa on the olecranon process gets inflamed
  • 25. • Golfer's elbow is the microtrauma of medial epicondyle of humerus, occurs commonly in golf players. The common flexor origin undergoes repetitive strain and results in a painful condition on the medial side of the elbow
  • 26. • If carrying angle (normal is 13°) is more, the condition is cubitus valgus, ulnar nerve may get stretched leading to weakness of intrinsic muscles of hand. If the angle is less, it is called cubitus varus
  • 27. • Under optimal position of the elbow: Generally elbow flexion between 30° and 40 deg is sufficient to perform common activities of daily living such as eating, combing, dressing, etc. Because of this reason even people who have lost terminal flexion or extension after a fracture/trauma are able to accomplish these personal tasks without much problems.