Elbow(Humeroulnar) Joint

Presentation by Lindsey Bidleman and Linda McConnell

Components of the Elbow Joint Include…

Surface Anatomy Bones Articular Capsule Cartilage Bursae Ligaments Muscles Nerves Arteries Veins

Linda

Surface Anatomy of the Elbow

Cubital Fossa Medial Bicipital Groove Biceps Tendon Triceps Tendon Olecranon Lateral Epicondyle Medial Epicondyle Radial Styloid Process Ulnar Styloid Process

Linda

Surface Anatomy of the Elbow Joint

Lateral EpicondyleMedial EpicondyleCubital Fossa

Triceps TendonOlecranon

Medial Bicipital GrooveBiceps Tendon

Linda

Surface Anatomy of the Elbow Joint

Ulnar Styloid ProcessRadial Styloid Process

Linda

Surface Anatomy of the Elbow Joint

When arms are at your sides, palms facing forward, you hands and forearms should be about 5-15 degrees away from your body.

This angle allows your forearms to clear you hips when swinging your arms while walking. Also very important when carrying various objects.

The angle is more pronounced in women than men.

Carrying angle

Linda

Surface Anatomy of the Elbow JointCarrying Angle: Male vs Female

Linda

Bones of the Elbow Joint Include…

Humerus- Largest bone in the upper extremity. Articulates with the radius and ulna.

Ulna- The stabilizing bone of the forearm. The medial and longer bone of the two forearms. (Pinky side)

Radius- The lateral and shorter of the two forearm bones. (Thumb side)

Linda

Ulna

Olecranon Process- Big bony projection on proximal end.

Coronoid Process-Prominant elevation on anterior surface.

Trochlear Notch- Articulates with the trochlea of the humerus.

Ulnar Tuberosity- Inferior to the coronoid process.

Radial Notch- Smooth, rounded curve that articulates with the head of the radius.

Linda

Ulnar Tuberosity

Olecranon ProcessRadial Notch

Coronoid Process

Trochlear Notch

Anterior Right Posterior Right

Humerus

Capitulum- Articulates with the head of the radius.

Olecranon Fossa- Big depression on the posterior side of the humerus.

Medial Epicondyle- More prominent than the lateral epicondyle.

Trochlea- Articulates with the trochlear notch of the ulna.

Coronoid Fossa- Superior to the trochlea, the smaller depression in the anterior side of the humerus.

Lateral Epicondyle- Smaller than the medial epicondyle.

Linda

Coronoid Fossa

Olecranon FossaTrochlea

Capitulum

Medial Epicondyle

Lateral Epicondyle

Anterior Right Posterior Right

Radius

Head- Smooth, flat surface for articulation with the capitulum of the humerus.

Neck- Narrow part between the head and the radial tuberosity.

Radial Tuberosity- Directly under the head and neck, flat surface. The attachment for the biceps muscle.

Linda

HeadNeck

Radial Tuberosity

Anterior Right

Articular Capsule

Articular Capsule is “sleeve like” and surrounds a synovial joint, encloses the synovial cavity, and unites articulating bone. Composed of two layers…

Fibrous Membrane- usually consisting of dense irregular connective tissue that attaches to the periosteum of the articulating bones.

Synovial Membrane- Composed of areolar connective tissue with elastic fibers.

Linda

Cartilage

Cartilage is a solid, stretchable type of connective tissue that forms parts of the skeleton where more flexibility and protection are necessary.

Articular Cartilage provides a smooth, low friction gliding surface for free movement for the humerus, radius, and ulna.

Its shiny surface also makes it kind of pretty!

Linda

Bursae

Bursae are closed sacs containing fluid , they prevent friction and enable structures to move freely over one another.

Intratendinous Olecranon Bursa- Sometimes present in the tendon of the triceps

Subtendinous Olecranon Bursa- Located between the olecranon and the triceps tendon, just proximal to its attachment to the olecranon

Subcutaneous Olecranon Bursa- Located in the subcutaneous connective tissue over the olecranon

Linda

Clinical Awareness of Bursae

Injury can happen to the subcutaneous olecranon bursa by falls on the elbow, and from infraction from abrasions of the skin covering the olecranon, causing the bursa to become inflamed.

Repeated excessive pressure and friction produce a friction called Subcutaneous olecranon bursitis.

Pain is severe during flexion of the forearm

It is easy to treat if the patient follows the “P.R.I.C.E”. Protection, Rest, Ice, Compression, Elevation.

Linda

Ligaments: Connect bone to bone

Collateral ligaments of the elbow joint are strong triangular bands that are medial and lateral thickenings of the fibrous layer of the joint capsule

Ulnar Collateral Ligament- Medial and triangular ligament that extends from the medial epicondyle of the humerus to the coronoid process and olecranon of the ulna consisting of three bands…

1. Anterior cord-like band is the strongest 2. Posterior fan-like band is the weakest 3. Slender oblique band that deepens the socket for the trochlea of the humerus

Linda

Ligaments Cont…

Radial Annular Ligament- This ligament encircles and holds the head of the radius in the radial notch of the ulna, and permits pronation and supination of the forearm

Radial Collateral Ligament- Lateral fan-like ligament that extends from the lateral epicondyle of the humerus to the annular ligament of the radius and the radial notch of the ulna.

Radial Annular Ligament

Radial Collateral Ligament

Linda

Ligaments Continued

Interosseous Membrane- Fibrous connective tissue that joins the shafts of the radius and ulna.

Interosseous Membrane

Linda

Biceps Brachii

#9 on classroom model

Origin Long Head Supraglenoid tubercleShort Head Coracoid process

Insertion Radial Tuberosity of Radius

Innervation Musculocutaneous Nerve

Vascular Supply

Brachial Artery

Action Elbow Flexion, Forearm Supination

Myology of the Elbow and Forearm

Myology of the Elbow and Forearm

Triceps #11 on classroom model

Origin Long Head: infraglenoid tubercle of scapula

Lateral Head: Inferior to greater tubercle on posterior humerus

Medial Head: Posterior surface of humerus

Insertion Olecranon Process of Ulna

Innervation Radial Nerve

Vascular Supply

Deep Brachial artery

Action Elbow Extension

Myology of the Elbow and Forearm

Supinator #25 on classroom model

Origin Lateral epicondyle of humerus and adjacent ulna

Insertion Anterior Surface of the proximal radius

Innervation Radial Nerve

Vascular Supply Recurrent interosseous artery

Action Forearm supination

Myology of the Elbow and Forearm

Pronator Teres

#12 on classroom model

Origin Medial epicondyle of humerus and coranoid process of ulna

Insertion Lateral aspect of radius at its midpoint

Innervation Median Nerve

Vascular Supply

Ulnar artery

Action Forearm pronation, assistive in elbow flexion

Myology of the Elbow and ForearmPronator Quadratus

Origin Distal ¼ of Ulna

Insertion Distal ¼ of Radius

Innervation Median Nerve

Vascular Supply Anterior interosseous artery

Action Forearm pronation

Myology of the Elbow and Forearm

Brachioradialis #20 on classroom model

Origin Lateral supracondylar ridge on the humerus

Insertion Styloid process of the radius

Innervation Radial Nerve

Vascular Supply Radial artery

Action Elbow flexion

Myology of the Elbow and Forearm

Brachialis #10 on classroom model

Origin Distal ½ of humerus, anterior surface

Insertion Coronoid process and ulnar tuberosity of the ulna

Innervation Musculotaneous Nerve

Vascular Supply Brachial Artery

Action Elbow Flexion

Summary of Muscle Innervation

Prime Movers of the Elbow

Tis’ the Season

http://consumingcostarica.files.wordpress.com/2011/11/turkey.jpg

http://www.ebaumsworld.com/pictures/view/82927666/

http://www.andpop.com/2012/10/02/10-funny-turkey-day-photos/http://sharelike.me/time-and-events/funny-thanksgiving-turkey-cartoon/

Actions of Thanksgiving

http://www.google.com/search?q=thanksgiving+praying&client=safari&rls=en&source=lnms&tbm=isch&sa=X&ei=kBWJUpvfNoPj2AXRwYFg&ved=0CAkQ_AUoAQ&biw=980&bih=648#facrc=_&imgdii=_&imgrc=jGWndG_tXGgZlM%3A%3BDXJM2b8TbPyTRM%3Bhttp%253A%252F%252Fcache2.asset-cache.net%252Fxc%252F87834607-family-praying-at-thanksgiving-table-photos-com.jpg%253Fv%253D1%2526c%253DIWSAsset%2526k%253D2%2526d%253D910C62E22B9F47AAC26E85847CFC85B782FF195C3D97418B98B265C480BC42FEE30A760B0D811297%3Bhttp%253A%252F%252Fwww.photos.com%252Froyalty-free-images%252Ffamily-praying-at-thanksgiving-table%252F87834607%3B506%3B336

Elbow Flexion – Passing Dishes

Forearm Pronation- Pouring Wine

http://admissions.vanderbilt.edu/insidedores/2011/11/thanksgiving-break-so-far/img_0358/

Elbow Flexion – Forearm Pronation

Elbow Extension – Forearm Supination

Nerve Supply to the Elbow

A. Brachial Plexus RootsRandyTrunksTravisDivisionsDrinksChordsColdBranchesBeer

B. Branches of Brachial Plexus(Lateral to Medial)

MusculocutaneousMomsAxillaryAreRadialReallyMedianMadUlnarUsually

Innervations of Elbow

The Musculocutaneous Nerve Supplies the elbow flexors EXCEPT the

brachioradialis

The Radial Nerve Supplies the elbow extensors

The Median Nerve Supplies all the pronators of the forearm

The Ulnar Nerve Runs posterior to the medial

epicondyle

The Ulnar Nerve

• Known as the “Funny Bone”• Largest nerve that is unprotected by deep tissues,

ligaments, muscles, or bones. • The severity of the numbness or pain varies from person

to person• Can cause spontaneous paralysis of pinky and lateral ½

of ring finger.

• http://youtu.be/ZEcNgyIOO_E

Arteries of the Elbow

• Radial

• Recurent interosseous

• Posterior interosseous

• Brachial

• Anterior interosseous

• Ulnar

• Superficial palmar arch

Organization of Arteries

Upper Extremity vascular site significance

http://www.papercards.com/sp/CD4934.asp http://www.nowpublic.com/culture/pulse-rate

Location of Brachial Artery To control hemorrhage

Site where cuff compresses artery against humerus to obtain blood pressure

Veins of the Elbow

• Cepthalic

• Basilic

• Brachial

• Median antebrachial

• Median cubital

• Dorsal venous arch

VenipunctureUpper extremity veins provide best source to obtain

blood

It is readily assessable Veins can be visualized Quickly cleaned Does not impede with life activities

http://www.oneplaceforspecialneeds.com/main/library_blood_test.html

Tennis Elbow

Elbow tendinitis(tennis elbow) is inflammation of the lateral epicondyle.

Occurs most commonly in the extensor carpi radialis brevis, where there is an increase in pain receptors in the area making the region very tender!

Causes of tennis elbow… The most common cause is the

overuse or repetitive strain caused by repeated extension of the wrist against resistance.

Gripping heavy objects Tennis is also a cause, although

the above causes are more common.

Linda

Treatment for Tennis Elbow

Goals of treatment Identify the cause of injury Reduce pain and inflammation Gradually return the patient to activity Treatment It may take several different types of

exercise to completely relieve pain caused by tennis elbow…

Icing to reduce inflammation and pain. Plenty of rest, but also with a few low

grade exercises such as… Stretching Exercises Strengthening Exercises

The Real Life Dangers of Tennis Elbow - YouTube

Linda

References

You Tube Zach Thurow( April 4th, 2012) Retrieved on November 15th, 2013. The Real Life Dangers of Tennis Elbow - YouTube

Sportsinjuryclinic.net (2013). Tennis Elbow/ Lateral Epicondylitis. Retrieved November 15th, 2013 from http://www.sportsinjuryclinic.net/sport-injuries/elbow-pain/tennis-elbow

A.D.A.M. quality (1997-2013). Carrying Angle of the Elbow- excessive. Retrieved November 15th, 2013. Carrying angle of the elbow - excessive: MedlinePlus Medical Encyclopedia

Wikimedia Commons (April 23, 2013). File: Slide2xzxzxz.JPG. Retrieved on November 16th, 2013. File:Slide2xzxzxz.JPG - Wikipedia, the free encyclopedia

Tortora, G. & Derrickson, B. (2012). Principles of Anatomy & Physiology. (13th ed.). Hoboken, NJ: John Wiley & Sons, Inc. Retrieved November 2013.

Linda

References

Moore, L., Agur, A., & Dalley, A. (2011). Essential Clinical Anatomy (4th ed.). Baltimore, MD: Lippincott Williams & Wilkins. Retrieved November 2013. Figures: SA6.3, SA6.4, 6.55, 6.56, 6.57, B6.21

Clemente, C. (2011). Anatomy A Regional Atlas of The Human Body (6th ed.). Baltimore, MD: Lippincott Williams & Wilkins. Retrieved November 2013. Figures: 88-1l, 88-3l

Quiz on Thursday

1.Biceps Brachii

2.Brachialis

3.Supinator

4.Brachioradialis

5.Pronator Quadratus