ELBOW JOINT

SURFACE ANATOMY OF ELBOW JOINT

 https://www.youtube.com/watch?v=QLFKWpqyYyk
Surface Anatomy: Elbow - Medial and Posterior aspect
 INTRODUCTION
THE ELBOW JOINT is a synovial joint found in the
upper limb between the arm and the forearm.
• It is the point of articulation of 03 bones: the humerus of
the arm and the radius and the ulna of the forearm
 The elbow joint is classified structurally as a HINGE-
TYPE SYNOVIAL JOINT. It is also classified structurally
as a compound joint, as there are two articulations in the
joint. Synovial joints, also called diarthroses, are free
movable joints.
• A fibrous capsule encloses the joint, and is lined
internally by a synovial membrane.
• Synovial joints can be further categorized based on
function. The elbow joint is functionally a hinge
joint, allowing movement in only one plane
(uniaxial).
COMPOUND
JOINT
HING E
JOIN T
UNIAXIAL
SYNOVIAL JOINT
DIARTHROSES
Osteology
There are three bones that comprise
the elbow joint:

1. The humerus
2.The radius
3. The ulna.
These bones give rise to two joints:

HUMEROULNAR JOINT is the joint between the pulley like trochlea

on the medial aspect of the distal of the humerus and the trochlear notch
on the ulna.
Humeroradial joint is the joint between the capitulum on the lateral
aspect of the distal end of the humerus with the head of the radius.

The humeroulnar and the humeroradial joints are the joints that give the
elbow its characteristic hinge like properties.
• The PROXIMAL RADIOULNAR JOINT is the
articulation between the circumferential head of the
radius and a fibro- osseous ring formed by the radial
groove of the ulna and the annular ligament that hold
the head of the radius in this groove.

• The proximal radioulnar joint is functionally a PIVOT

JOINT, allowing a rotational movement of the radius on
the ulna.
Ligaments
The joint capsule of the elbow is strengthened by ligaments medially and
laterally.
The RADIAL COLLATERAL LIGAMENT is found on the lateral side of
the joint, extending from the lateral epicondyle, and blending with the
annular ligament of the radius (a ligament from the proximal radioulnar
primary restraint to varus and external stress during full arc of elbow motion
Ligaments
• The joint capsule of the elbow is strengthened by ligaments medially and
laterally.

• The ULNAR COLLATERAL LIGAMENT originates from the medial

epicondyle, and attaches to the coronoid process and olecranon of the
ulna. MCL provides resistance to valgus and distractive stresses
BURSAE RELATED TO THE ELBOW JOINT
• Subtendinous olecranon bursa lies between triceps tendon
and upper surface of the olecranon process.

• Subcutaneous olecranon bursa is comparatively a larger

bursa that lies between skin and subcutaneous triangular area on
the posterior surface of the olecranon.

• Bicipitoradial bursa is a small bursa separating biceps tendon

from smooth anterior part of the radial tuberosity.

• A small bursa separating the biceps tendon from the oblique

cord.
Movements of the Joint
The orientation of the bones forming the elbow joint produces
a hinge type synovial joint, which allows for extension and
flexion of the forearm:

• Extension – triceps brachii and anconeus

• Flexion – brachialis, biceps brachii, brachioradialis
Movements at this joint are called pronation and
supination.
• These are rotational movements that occur when the distal
end of the radius moves over the distal end of the ulna by
rotating the radius in the pivot joint formed by the circular
head of the radius, the radial groove of the ulna and the
ligament.
BLOOD SUPPLY OF THE ELBOW JOINT
• The blood supply of elbow joints is by arterial anastomosis
around the elbow formed by the branches of brachial, radial
and ulnar arteries.
Nerves
All of the nerves that travel
down the arm pass across the
elbow
Three main nerves begin
together at the shoulder: the
radial nerve, the ulnar nerve,
and the median nerve.
These nerves carry signals
from the brain to the muscles
that move the arm. The
nerves also carry signals back
to the brain about sensations
such as touch, pain, and
temperature.
The approximate ages of appearance of the secondary
ossification centers around the elbow joint are:
 capitulum-1 year;
 head (of radius)-5 years;
 medial epicondyle-5 years;
 trochlea-11 years;
 olecranon-12 years;
 lateral epicondyle-13 years.
The Carrying Angle
• The extended ulna makes with the humerus an angle of
about 170 degrees
• This is called the carrying angle
• The carrying angle fits the elbow into the waist when
the arm is at the side
• The carrying angle is more pronounced in women
because the obliquity of the ulna in relation to the
humerus is more marked in women
• The normal elbow is always in a valgus position more
marked in women
Carrying angle of the Elbow joint
Elbow Joint and the carrying angle
A very stable joint that assists shoulder
in application of force and controlling
placement of hand in space
humeroulnar joint

humeroradial
joint
Asymmetrical structu
of trochlea creates
proximal
angulation of ulna
radioulnar when extended know
joint as the carrying ang
Clinical correlates

Bursitis
Dislocation
Epicondylitis
Supracondylar Fracture
 Volkmann’s Ischaemic Contracture
• In 1861, Richard von Volkmann described the contracture and
paralysis caused by tissue damage that occurs as a sequale of
compartment syndrome in the forearm

• This is due to ischaemic muscle damage in the forearm

• Muscles closest to the forearm bones get damaged first-e.g flexor

digitorum profundus, flexor pollicis longus and the pronator teres

• In this condition, fingers and thumb are fixed in flexion

Volkmann’s Ischaemic Contracture
• It is the contractures of the muscles of the forearm that
follows fractures of the distal end of the humerus or
fractures of the radius and ulna.
• Spasm of a localized segment of the brachial artery
reduces the blood flow to the flexors and extensor
muscles so that they under go ischemic necrosis.
• The flexor muscles are mostly affected
• The muscles are replaced by fibrous tissue, which
contract and result in the deformity
3 types of deformity exists:
 The long flexors of the carpals and
fingers are more contracted than
extensors. The wrist joint is flexed and
the fingers are extended.
 The long extensors of the fingers are
greatly contracting The wrist and
metacarpo-phalngeal joints are
extended. The interphalngeal joints are
flexed.
 Both the flexor and extensor are
contracted:
 The wrist joint and the interphalangeal
joints are flexed. The metacarpo-
phalangeal joints are extended.
 Proximal radioulnar joint
Articulation
The radial head articulates with the radial notch of the ulna.
The head of the radius is held in position by the strong annular (annular)
ligament,

Fibrous Capsule
The fibrous capsule enclosing the joint is continuous with the fibrous capsule of
the elbow joint

Synovial membrane
The deep surface of the annular ligament is lined with synovial membrane.
Continues above with elbow joint

Ligaments
The annular ligament is attached to anterior and posterior margins of radial
notch. It is continuous with the capsule of the elbow joint. It is not attached to
radius
Distal radioulnar joint
Type
Pivot type of synovial joint
Articulation
Head of the ulna & ulnar notch of radius
Capsule
The capsule encloses the joint but deficient superiorly
Ligaments
Weak anterior & posterior ligaments strengthen the joint
Articular disc
Triangular fibrocartilaginous, separates the cavity of the distal radioulnar joint from
the cavity of the wrist joint. Unites the radius & ulna
Synovial membrane
Lines the capsule
Nerve supply
Anterior interosseous & deep branch of radial nerves
Movement
Supination and pronation
GOOD DAY