Download Elbow Joint - By Dr Nand Lal Dhomeja ( Anatomy Department )

ELBOW JOINT & ANASTOMOSIS AROUND ELBOW JOINT
AT THE END OF LECTURE, STUDENT SHOULD BE ABLE TO:
 Identify the morphology of the joint.
 Muscles acting on the elbow joint
 The neurovascular supply of the joint.
 Describe the carrying angle and applied aspect of the joint.
 Know about anastomosis and collateral circulation.
 Describe formation of anastomosis around elbow joint.
JOINT.
Elbow Anatomy
 BONES:
 Humerus
 medial epicondyle
 lateral epicondyle
 Radius
 Ulna
 Olecranon
Elbow Joint Articulation
- Elbow consists of 3 articulations:
 Humeroulnar (elbow flexion/extension)
 Humeroradial (forearm pronation/supination)
 Radioulnar (forearm pronation/supination)
INTRODUCTION
Type:
hinge joint, compound synovial type
Articulation:
between lower end of humerus and upper end of radius and
ulna
Flexion and Rotation:
biceps muscles in the arm. Ligaments located at the front, back,
and sides of the elbow help stabilize the joint.
CAPSULAR LIGAMENT
 Superiorly it is attached the lower end of the humerus in such a
way that it covers the capitulum, trochlea, radial fossa, coronoid
fossa and the olecranon fossa.
 Inferiomedially it is attached to the margin of the trochlear notch
of ulna.
 Inferiolaterally it is attached to the annular ligament of the
superior radioulnar joint.
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
lateral liagamentous structures:
 Lateral medial / ulnar collateral ligament:
– present in approximately 50% of population.
 Accessory lateral/radial collateral ligament:
- tight only during various stress maneuvers and assists annular
ligament when stress applied to elbow
synovium and bursa:
A synovial membrane envelops the elbow and superior radioulnar
articulations and lubricates the deeper structures of the two joints.
The two main bursae are the bicipital bursae which cushions the
tendon when the forearm is pronated and the olecranon bursae which
forms a liquid cushion.
 MUSCLES ACTING ON JOINT
 Flexion:biceps brachii, brachialis,
brachioradialis, pronator teres.
 Extension: triceps brachii and anconeus.
 Supination: biceps brachii, supinator,
brachioradialis.
 Pronation:pronator teres, pronator quadratus,
anconeus, brachioradialis.
Elbow Anatomy - muscles
 Flexors (3 B’s)
 Bicepslong (bicipital groove) and short head (coracoid)
 Brachioradialis
 Brachialis
 Extensors
 Triceps
 Anconeus
Elbow Flexors:
Biceps Brachii
Origin:
long head - supraglenoid tubercle
short head - coracoid process
Insertion:
radial tuberosity
Action:
elbow flexion forearm supination
Elbow Flexors:
Brachialis
Origin:
Anterior surface of distal humerus
Insertion:
ulnar tuberosity
Action:
elbow flexion
Elbow Flexors
Brachioradialis
Origin:
lateral supracondylar ridge of humerus
Insertion:
radial styloid process
Action:
elbow flexion
Elbow Extenders
Triceps brachii
Origin:
long head - infraglenoid tubercle
lateral - posterior humerus(above spiral groove)
medial - posterior humerus(below spiral groove)
Insertion:
olecranon process
Action:
elbow extension
 BLOOD SUPPLY: brachial artery and it’s branches.
 NERVE SUPPLY: musculocutaneous, radial, and median
nerves.
Carrying Angle/Cubitus Valgus
 Formed by long axis of humerus and midline of forearm
 COMMON ELBOW PROBLEMS
 Male norms – 11-14 degrees
 Female norms – 13-16 degrees
 Larger angles are considered abnormal
 Arthritis:
Common forms of arthritis that can affect the elbow include
osteoarthritis, rheumatoid arthritis, infectious arthritis.
 Bursitis:
Bursitis of the elbow, also called olecranon bursitis, occurs as a
result of injury or constant pressure on the elbow (for example,
when leaning on a hard surface).
 Fractures:
Falling on an outstretched hand or directly on the tip of the
elbow can result in dislocation and/or several types of fractures,
depending on the fall.
 Injury:
Repetitive strain on the elbow can cause inflammation
 Elbow Pathology
 Tendonitis (epicondylitis)
 Medial (golfer’s elbow)
 flexor mass
 Lateral (tennis elbow)
 extensor mass
 Grip size

Pressure point

Elbow Pathology:
 Sprains
 Capsular
 MCL/LCL
 Dislocations
 Rare due to stability
 Almost always posterior
 Bursitis
 Result of direct trauma
 Pad and protect
Anastomosis around elbow joint
The vessels engaged in this anastomosis divided into those
situated in front of and those behind the medial and lateral
epicondyles of the humerus.
The branches anastomosing in front of the medial
epicondyle are :
 The anterior branch of the inferior ulnar collateral, the anterior
ulnar recurrent (branch of ulnar artery), and the anterior branch
of the superior ulnar collateral
Those behind the medial epicondyle are :
 The inferior ulnar collateral, the posterior ulnar recurrent, and
the posterior branch of the superior ulnar collateral.
The branches anastomosing in front of the lateral epicondyle
are :
 The radial recurrent (branch of radial artery) and the anterior
descending (radial collateral) branch of the profunda brachii.
Those behind the medial epicondyle are :
 The inferior ulnar collateral, the posterior ulnar recurrent, and
the posterior branch of the superior ulnar collateral.
The branches anastomosing in front of the lateral epicondyle are :
 The radial recurrent (branch of radial artery) and the anterior
descending (radial collateral) branch of the profunda brachii.
Those behind the lateral epicondyle are:
 The inferior ulnar collateral, the interosseous recurrent, and the
radial collateral branch of the profunda brachii