ELBOW JOINT

ELBOW COMPLEX
INCLUDES:
-elbow joint
-proximal &
distal radio
ulnar
joint
ELBOW JOINT
CONSIST OF
- Humeroulnar
- humeroradial
ARTICULATING SURFACES ON HUMERUS
- Trochlea
- capitulum
ARTICULATING SURFACES ON ULNA& RADIUS
- trochlear notch trochlear groove
- head of radius capitulotrochlear groove
ELBOW JOINT
ELBOW JOINT
CONGRUENT- HUMEROULNAR
INCONGRUENT-HUMERORADIAL
NORMAL VALGUS ANGULATION

TYPE-MODIFIED/LOOSE HINGE JOINT(?)

1DEGREE OF FREADM
CONTACT DURING FLE.-EXT.
JOINT CAPSULE
Attachment:-
Anteriorly-just above coronoid & radial fossa
& distally on the Coronoid process of ulna
Medially & Laterally-it is blends with the fiber of
the M.C.L & L.C.L
Posteriorly-on the olecranon fossa
It is weak anteriorly & posteriorly

JOINT CAPSULE
Synovial fold attaches to the proximal RU joint
near the junction of annular ligament & joint
capsule.
Practical application-hypertrophied synovial
fold is a source of pain in case of lateral
epicondylalgia
Resting position(CAPSULE RELAXED)
HU JT-70* FLEXION,10* SUPINATION
HR JT- NEAR EXT. SOME SUP.
Closed position-
HU JT-EXTENSION & SUPINATION
HR JT-90*FLEXION,5* SUPINATION



JOINT CAPSULE
LIGAMENTS
MEDIAL COLLATERAL
LIGAMENT-
ANTERIOR MCL-PRIMARY RESTRAINT OF
VALGUS STRESS FROM 20*-120* OF
FLEXTION
POSTERIOR MCL-LESS SIGNIFICANT
ROLE IN PROVIDING VALGUS STABILITY
OBLIQUE MCL-ASSIST IN PROVIDING
VALGUS STABILITY AND KEEP THE JOINT
SURFACES IN APPROXIMATION
LATERAL COLLATERAL
LIGAMENT COMPLEX
LCL-PROVIDES REINFORCEMENT FOR THE
HR ARTICULATION AND PROTECTION AGAINST
VARUS STRESS IN SOME POSITION
LCL as a key structure that is always disrupted in
elbow position.
LUCL-IS A SECONDARY RESTRAINT TO THE
VARUS STRESS
LUCL provides posterolateral stability by securing the
ulna to the humerus
Practical application..


MUSCLES
THREE MAIN FLEXORS-
-biceps
-brachialis
-brachioradialis
TWO MAIN EXTENSOR
-triceps
-anconeus
Common extensor
Practical application







AXIS OF MOTION
Passes through the center of the trochlea and
capitulum.
Axis is not fixed
Instantaneous axis
during flexion-
extension
Valgus-varus laxity
Max.(0*-40*)


LONG AXIS OF HUMERUS AND
FOREARM
Lateral deviation of
ulna in relation
to the humerus
(valgus
angulation)
Cubitus valgus (normal)
angle-15*in full ext
Cubitus varus(abnomal)
RANGE OF MOTION
FLEXION RANGE-0*-135*/145*
SHOULDER AND FOREARM POSITION
AFFECT AHE R.O.M

MUSCLE ACTION
FLEXORS
BRACHIALIS
-Is a mobility muscle
(insertion close to jt)
-M.A is greatest
at >100*of flexion
-Not affected by position
-active in all type of contra-
ction.


MUSCLE ACTION
BICEPS
-Is also mobility muscle
-M.A is largest in 80*-100*
-small in extension
-It is active during unresisted elbow
flexion & supinated forearm
BRACHIORADIALIS
-Inserted distally hence its provide stability
-largest component muscle force goes
towards
compression
-M.A is largest in 100*-120*
-inactive in eccentric flexor
activity
-B.R shows no activity in
slow,Unresisted Concentric
elbow flexion
-It shows higher level of
activity in rapid alternating
supination-pronation

MUSCLE ACTION
EXTESORS
-Largest M.A.at 90*
-elbow extension is done by
-lateral &medial head of triceps70-
90 persent
-anconeus-15 persent
-triceps contribute less
C.N.S SELECTIVELY RECRUITS
UNIARTICULAR MUSCLE

SUPERIOR RADIOULNAR
JOINT
ARTICULATING
SURFACE:
-ulnar radial notch
-head of radius
-annular ligament
-capitulam
UNIAXIAL PIVOT
TYPE
INFERIOR RADIOULNAR JOINT
ARTICULATING
SURFACES:
-ulnar notch of
radius
-articular disk
-head of ulna

ARTICULAR DISK
Also referred as a
triangular
fibrocartilage
BASE:attached to the
distal edge of the
ulnar notch of radius
APEX:atteched to the
ulnar styloid process
& ulnar head
MEDIALLY: continues
with UCL

ARTICULAR DISK
The margin is formed
by dorsal and palmar
radioulnar ligament
AVASCULAR:
-80 percent of central
portion
A.D has a free nerve
ending in periphery,
disk may be a source
of pain


RADIO-ULNAR ARTICULATION
Mechanically linked
Pronation of the
forearm occurs as a
result of the radiuss
crossing over the ulna
at S.R.U JOINT
At D.R.U JOINT the
ulnar notch of the
radius slides around
the ulnar head & the
disk follows the radius


LIGAMENTS
THREE MAIN LIGAMENTS:
o ANNULAR LIGAMENT- is a strong band that
forms 4/5
th
of a ring that encircles the radial head
o QUADRATE LIGAMENT- it reinforces the inferior
aspect of the joint capsule & maintain the radial head
in apposition.Also limits spin of the radial head in
supination &pronation
o OBLIQUE CORD- is a flat band on ventral
forearm.its fiber is right angle to Introsseus
membrane.it may assist in preventing separation of
the radius & ulna
LIGAMENTS continue
o DORSAL AND PALMAR RADIOULNAR LIGAMENT-
originate from the ulnar notch of the radius to
insert on the ulnar fovea &base of the ulnar styloid
process.Both reinforce the D.R.U JT.
o INTEROSSEUS MEMBRANE-
-central portion
-membranous portion
-dorsal oblique cord

LIGAMENTS cont.
CENTRAL BAND-strong,thick,ligamentous
structure that consist of high collagen content
surrounded by elastin.it is taut throughout the
forearm rotation
MEMBRANOUS PORTION- soft & thin
structure.that max. taut in supination
DORSAL OBLIQUE CORD-extend from the
proximal quarter of ulna to middle of radius.that
max. taut in pronation


IOM maintain the space
between radius ulna
Force in the IOM that
depends on:
- elbow flexion angle &
forearm rotation
-maximum 43N at
30*flexion & forearm
supinated
The IOM transfers load
from the wrist to the
forearm via oblique
fiber




MUSCLES
PRIMARY MUSCLES-
-pronator teres
-pronator quadratus
-biceps
-supinator
OTHER MUSCLES THAT ACTIVE
DURING SUPINATION AND PRONATION,
ESPECIALLY WHEN GRIPPING IS INVOLVED
-FCU & ECU
-ECRB
-anconeus
-brachioradialis



AXIS OF MOTION
EXTENDING FROM
CENTER OF RAIUS
HEAD TO THE
CENTER OF ULNAR
HEAD.
In pronation...
There is a little motion
of ulna
Ulnar head moves
distally & dorsally in
pronation
Motion of the proximal
ulna is negligible
RANGE OF MOTION
TOTAL ROM IS 150* AT RADIOULNAR JOINT
ASSESSED WITH ELBOW IN 90* FLEXION
SUPINATION IS LIMITED BY PASSIVE
TENSION IN THE PALMAR RADIO-ULNAR
LIGAMENT AND THE OBLIQUE CORD
MUSCLE ACTION
Pronator teres produce pronation & stabilize
the RU JT.
Pronator quadratus is active in resisted &
unresisted pronation & in slow/fast
pronation.The deep head is active in both
resisted supination & pronation
ACT AS A DYNAMIC STABILIZER
Supinator act during unresisted slow
supination in all position.
Biceps act during supination perform against
resistance and during fast supination


Elbow in varus position,
force was transmitted
From distal radius
through the IOM to
the proximal ulna


Elbow in valgus position,
The force is transmitted
Through the radius




EFFECT OF AGE AND INJURY
INJURY-
o COMPRESSION INJURY-falling on hand with
elbow in closed pack.
o DISTRACTION INJURY-tensile force may pulled
radius inferiorly out of the annular ligament.lifting
a child(nursemaids elbow)

INJURY
o VALGUS/VARUS INJURY-in valgus stress
MCL is subjected to undergoing repetitive
stress,ligament may become lax & lead to medial
instability increase carrying angle.


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