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The Elbow Complex

Osteology
• Consist of
– Humerus
– Ulna
– Radius

Anterior aspect
Osteology

Posterior aspect
Bony Anatomy: Humerus
Osteology

Radius Ulna
Joints of Elbow

• Humeroulnar joint

• Humeroradial joint

• Radioulnar joint
– Proximal radioulnar joint

– Distal radioulnar joint


Joints of Elbow
• Humeroradial joint
– gliding joint in which the capitellum of
the humerus articulates with the
proximal end of the radius
Joints of Elbow
• Humeroulnar joint
– hinge joint in which the humeral
trochlea articulates with the trochlear
fossa of the ulna
Joints of Elbow
• Radioulnar joint
– the proximal and distal radioulnar joints
are pivot joints
Ligaments of the Elbow
Lateral Ligamentous Structures
• Lateral/radial collateral ligament – origin is near
axis of elbow flexion/extension, so fibers uniformly
tight throughout ROM
• Annular ligament – inserts on anterior/posterior
margins of lesser (radial) semilunar notch, maintains
radial head in contact with ulna (forms 4/5 of fibro-
osseous ring)
Ligaments of the Elbow
Medial Ligamentous Structures
• Medial/Ulnar Collateral
Ligament
– Anterior bundle – most
discrete segment
– Posterior bundle –
thickening of posterior
capsule
– Transverse bundle –
spans medial border of
semilunar notch,
little/no contribution to
elbow stability
Vascular
Vascular
Nervous Innervation

Median nerve

Ulnar nerve

Radial nerve
Median Nerve
Ulnar Nerve
Range of Motion
• Flexion/extension –
ginglymus joint
(ulnohumeral articulation)
• Flexion typically 0-150
degrees, stops due to soft
tissue approximation
• Extension typically 0-10
degrees (hyperextension,
especially in females), stops
due to bony opposition
Range of Motion
• Forearm pronation and
supination – trochoid joint
(radiohumeral and proximal
radioulnar articulations)
• Pronation/supination typical
0-85/90 degrees each from
neutral point (thumb up),
stops due to tissue
tensions/stretch from
opposing tissue
Movements of the Elbow
Movements of the Elbow

• Flexion
– Brachialis
– Biceps Brachii
– Brachioradialis
Brachialis Biceps brachii
Brachioradialis
Movements of the Elbow

• Extension
– Triceps Brachii
– Assisted By:
• Anconeus
Anconeus

Triceps brachii
Movements of the Elbow

• Pronation
– Pronator teres
– Pronator quadratus
Pronator quadratus
Pronator teres
Movements of the Elbow
• Pronation
– Flexor group
• Pronator teres
• Flexor carpi radialis
• Flexor digitorum
superficialis
• Flexor digitorum
profundus
• Palmaris longus
• Flexor carpi ulnaris
Flexor Digitorum
Flexor Carpi Radialis
Superficialis

Flexor Carpi Ulnaris


Palmaris Longus

Flexor Digitorum
Profundus
Movements of the Elbow

• Supination
– Supinator
– Biceps brachii
Biceps brachii
Supinator
Movements of the Elbow
• Supination
– Extensor group
• Supinator
• Extensor carpi
radialis longus
• Extensor carpi
radialis brevis
• Extensor carpi
ulnaris
• Extensor digitorum
Extensor Carpi
Radialis Longus Extensor Carpi Ulnaris

Extensor Carpi
Radialis Brevis Extensor
Digitorum
Supination and Pronation
Elbow Kinematics
• One of the most congruous and stable
joints
• In extension, anterior capsule provides
most restraint, while MCL becomes
primary stabilizer at 90 degrees flexion
• Annular ligament encircles the head of
the radius, stabilizing it in the radial
notch
Elbow Kinematics
• Varus stress
– In extension resisted by bone structure, LCL
and lateral joint capsule
– In flexion, resisted primarily by bone structure
• Valgus stress
– In flexion, resisted primarily by MCL
– In extension equally resisted by bone
structure, MCL and medial joint capsule
Load on the Elbow
Load on the Elbow
Load on the Elbow
Biomechanics of Elbow Flexors

• Dominant side produces higher flexion


torque, work, and power
• Flexion torques are 70% higher than
extension
• Flexion torques are 20-25% higher in
supinated versus pronated positions due
to increased flexor moment arm of biceps
and brachioradialis
• Max torque at 90°
Biomechanics of Elbow Extensors

• Generate large and dynamic extensor


torques through high-velocity concentric
and eccentric activities (throw, push)
• Shoulder flexion with pushing activity,
counteracts the tendency of elbow
extensors to extend the shoulder