5. MOB TCD
Elbow Joint
•
•
•
•
Synovial hinge joint
One degree of freedom
Uniaxial
The articular surfaces are the
trochlea and the capitulum of
the humerus
• The trochlear notch of the ulna
• The superior aspect of the
head of the radius
6. MOB TCD
Elbow Joint
• When the elbow is extended,
medial epicondyle,
olecranon and
lateral epicondyle
are in a straight line
• When flexed, they form a
triangle
7. MOB TCD
Capsule of Elbow Joint
Capsule surrounds the joint
• Anteriorly to the margins of the
coronoid and radial fossae of
the humerus
• Medially and laterally just
beyond the articular margin
• Excluding the medial and
lateral epicondyles to which
the common flexor and
extensor origins are attached
8. MOB TCD
Capsule of Elbow Joint
Capsule surrounds the joint
• Posteriorly to the margins of
the olecranon fossa
• Inferiolaterally it is inserted
into the annular ligament of
the superior radioulnar joint
9. MOB TCD
Synovial Membrane
• Lines the capsule and nonarticular structures inside the
capsule
• Continuous inferiorly with
synovial membrane of superior
radio-ulnar joints
• Annular ligament covered with
articular cartilage
10. MOB TCD
Synovial Membrane
• Between the capsule and
synovial membrane are three
other pads of fat
• The largest, at the olecranon
fossa, is pressed into it by
triceps during flexion
• Two, at the coronoid and
radial fossae, are pressed in
by brachialis during extension
• They are all slightly displaced
in contrary movements
11. MOB TCD
Synovial Membrane
• Smaller synovial-covered
tags of fat project into the
joint near constrictions
flanking the trochlear notch,
covering small non-articular
areas of bone
12. MOB TCD
Medial or Ulnar Collateral Ligament
• Thick triangular ligament
attached superiorly to the
medial epicondyle
• Its anterior band is attached
distally to the tubercle on
the upper medial margin of
the coronoid process
• The posterior band is
attached to the medial
margin of the olecranon
• A thinner portion, the
oblique band, unites both
bands
13. MOB TCD
Medial or Ulnar Collateral Ligament
• The ulnar nerve lies on the
medial ligament
• The anterior band may be
ruptured in throwing events
14. MOB TCD
Lateral or Radial Collateral Ligament
• The ligament is attached to
the lateral epicondyle
• Fans out to be attached to
the upper border of the
annular ligament
• The annular ligament is
attached to the margins of
the radial notch of the ulna
• It is part of the articulation of
the superior radioulnar joint
• Covered with articular
cartilage
22. MOB TCD
Movements of Elbow Joint
•
•
•
•
•
•
•
•
Flexion and extension
Semiflexion is least pack position
Flexion of the elbow is limited by:
Impact of the radial head in the
radial fossa
Coranoid process against the
coronoid fossa
Tension of posterior part of capsule
Tension of triceps
Apposition (contact) between soft
tissues of forearm and upper arm
23. MOB TCD
Flexion of Elbow
• Main flexors
• Brachialis, musculocutaneous
(C5,6)
• Biceps, musculocutaneous
(C5,6)
• Weak flexors
• Common flexor origin, median
(C6,7)
• Except flexor carpi ulnaris,
ulnar nerve (C6,7)
• Brachioradialis, radial (C5,6)
26. MOB TCD
Extension of Elbow
• Triceps is the main extensor
• Weak are extensors from
common extensor origin
• Nerve supply radial (C7,8)
• Extension of the elbow is
limited by:
• Impingement of the olecranon
of the ulna on the olecranon
fossa of the humerus
• Tension of the anterior arm
muscles and collateral
ligaments
27. MOB TCD
Biceps Brachii
• Crosses shoulder, elbow and
superior radioulnar
• A long head arising from the
supraglenoid tubercle
• The adjoining portion of the
labrum within the capsule of the
shoulder joint
• It passes above the head of the
humerus
• Leaves the joint below the
transverse ligament, which acts
as a retinaculum
28. MOB TCD
Biceps Brachii
• It is surrounded by
synovial membrane,
which extends
inferiorly to the lower
margin of the teres
major, i.e. the
posterior fold of the
axilla
• Short head arises from the coracoid
process with the coracobrachialis
29. MOB TCD
Biceps Brachii
• The two heads unite to form a
fleshy belly, which becomes a
tendon, inserted into the posterior
aspect of the radial tuberosity
• The bicipital aponeurosis extends
from its medial margin, passing
anterior to the brachial artery and
the median nerve, fuses with deep
fascia of the forearm and the medial
margin of the ulna
• A bursa separates it from the radius
Nerve supply is musculocutaneous
nerve C5,6,7
30. MOB TCD
Action of Biceps Muscle
• Helps to stabilise and flex the
shoulder
• Its role as a dynamic
stabiliser of the glenohumeral joint is particularly
important in the late cocking
phase of throwing
• Flexes the elbow
• The most powerful supinator
of the forearm when the
elbow is flexed
• The action of the biceps is
weak at the shoulder and
powerful at the elbow
31. MOB TCD
Brachialis Muscle
• Arises from the anterior aspect
of the shaft of the humerus
below the deltoid tuberosity
• It is inserted into the anterior
aspect of the coranoid process
of the ulna and the capsule of
the elbow joint
• It lies directly anterior to the
elbow joint and is only a flexor
of the elbow
• The musculocutaneous nerve
C5,6,7 supplies it
32. MOB TCD
Coracobrachialis Muscle
• It arises from the coracoid
process, together with the
short head of the biceps
brachii
• Inserts into the middle of the
medial surface of the
humerus
• Helps to flex and adduct the
arm at the shoulder joint
33. MOB TCD
Coracobrachialis Muscle
• The coracobrachialis muscle also
helps to stabilise the shoulder
joint
• A persistent lower head may
remain as supra-trochlear spur or
• Ligament of Struthers, attached
to the medial epicondyle of the
humerus
• May compress the median nerve
or the brachial artery
• Musculo-cutaneous nerve C5,6,7
34. MOB TCD
Pain in Elbow and Wrist
• Must rule out referred pain
from cervical spine
• Upper thoracic spines
• Increased neural tension
35. MOB TCD
Test for Stability of Elbow
• Varus and valgus stresses
• 0 and 30 degrees of flexion
Behr & Altchek, 1997
44. MOB TCD
Test for Lateral Epicondylitis
•
•
•
•
Stabilise flexed elbow
Resisted extension and radial deviation of wrist
Passive stretching of wrist extensors
Resisted extension of extensor digitorum communis
of middle finger with wrist extended
Anderson & Hall, 1995
46. MOB TCD
Test for Ulnar Neuritis
• Tap ulnar nerve on posteromedial aspect of medial
epicondyle
• Completely flex elbow and hold for five minutes
• Positive = tingling along nerve
Anderson & Hall ,995
47. MOB TCD
Elbow Effusion
• Fullness in the triangular area
bounded by
• The radial head
• The lateral epicondyle
• The tip of the olecranon
Behr & Altchek, 1997
48. MOB TCD
Pediatric Elbow Injuries
• Fractures lateral condyle
and olecranon
• Physeal fractures of
radial head
• Supracondylar fracture
and fracture of radial
neck
• ‘Little League elbow’
• Osteochondritis
dissecans of capitellum
Behr & Altchek, 1997
49. MOB TCD
Pediatric Elbow Injuries
• Traction apophysitis ‘Little
League elbow’
• Due to repeated stress on
medial epicondyle
by contraction of the flexor
pronator group
• Valgus loads during late
cocking and acceleration
stages of throwing
Behr & Altchek, 1997
51. Osteochondritis Dissecans
of Capitellum
• Avascular necrosis of subchondral bone
• Repetitive trauma to blood supply in dominant arm in
athletic children >8 years
• Female gymnasts
• Male baseball
Pappas, 1982
MOB TCD