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BIOMECHANICS OF ELBOW COMPLEX

Elbow complex is designed to serve hand.
They provide MOBILITY for Hand in space by apparent shortening and Lengthening of upper extremity.
They provide Stability for skillful and forceful movements

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BIOMECHANICS OF ELBOW COMPLEX

  1. 1. BIOMECHANICS OF ELBOW COMPLEX
  2. 2. INTRODUCTION  Elbow complex is designed to serve hand.  They provide MOBILITY for Hand in space by apparent shortening and Lengthening of upper extremity.  They provide Stability for skillful and forceful movements
  3. 3. ELBOW JOINT
  4. 4. HUMERO ULNAR JOINT  ARTICULATIONS OF HUMEROULNAR JOINT  The articulating surface on the Humerus is Hour glass shaped TROCHLEA  The articulating surface on Ulna is a semicircular shaped concave surface called TROCHLEAR NOTCH
  5. 5. HUMERO RADIAL JOINT  ARTICULATION OF HUMERORADIAL JOINT  The articulating surface on the Humerus is spherical – shaped CAPITULUM  The articulating surface on the RADIUS is the cup shaped Radial head surrounded by a rim
  6. 6. ARTICULATIONS OF JOINT  IN EXTENSION  The OLECRANON PROCESS enter the olecranon fossa in Humeroulnar Joint  There is no contact between the articulating surfaces in Humeroradial Joint.
  7. 7. ARTICULATIONS OF JOINT  IN FLEXION  The Trochlear ridge of Ulna slides along the Trochlear groove until the Coronoid process reaches the Coronoid fossa in Humeroulnar joint  The radial head slides over capitulum and reaches Radial fossa in Full Flexion.
  8. 8. JOINT CAPSULE  The Humeroulnar , Humeroradial and Superior Radioulnar Joint are enclosed in a single Joint capsule.The capsule is fairly loose .  Anteriorly, it is attached above coronoid and radial fossa  Posteriorly ,it is attached above Olecranon fossa.
  9. 9. Joints © 2007 McGraw-Hill Higher Education. All rights reserved.6-9  Elbow moves from 0 degrees of extension to 145 to 150 degrees of flexion
  10. 10. Joints  Radioulnar joint  Trochoid or pivot-type joint  Radial head rotates around at proximal ulna  Distal radius rotates around distal ulna  Annular ligament maintains radial head in its joint © 2007 McGraw-Hill Higher Education. All rights reserved.6-10 From Seeley RR, Stephens TD, Tate P: Anatomy & physiology, ed 7, New York, 2006, McGraw-Hill; Shier D, Butler J, Lewis R: hole’s human anatomy & physiology, ed 9, New York, 2002, McGraw-Hill.
  11. 11. Joints © 2007 McGraw-Hill Higher Education. All rights reserved.6-11  Radioulnar joint  Supinate 80 to 90 degrees from neutral  Pronate 70 to 90 degrees from neutral
  12. 12. LIGAMENTS  MEDIAL COLLATERAL LIGAMENT Extends from Medial epicondyle of Humerus to Coronoid and Olecranon process of Ulna  LATERAL COLATERAL LIGAMENT Extends from Lateral Epicondyle of Humerus to Annular Ligament and Olecranon process.  ANNULAR LIGAMENT It encircles the head of Radius
  13. 13. LIGAMENTS OF ELBOW
  14. 14. Movements of Elbow Joint  FLEXION-EXTENSION ( 0-140 degree)  AXIS-------Medio Lateral Axis (Passess through Trochlea)  PLANE------Saggital plane  MUSCLES:  FLEXORS OF ELBOW  Biceps Brachi---Powerful flexor when elbow is in 90 degree Flexion.  Brachialis----Flexor of elbow in all position  Brachioradialis---Flexor of elbow in midprone position
  15. 15. BICEPS BRACHI
  16. 16. EXTENSORS OF ELBOW  TRICEPS is the powerful extensor of the Shoulder  Long head of Triceps depends on Shoulder Position  Medial head of Triceps is active in unresisted Elbow extension  All three Heads of Triceps are active when heavy resistance is given to Extension.
  17. 17. Movements © 2007 McGraw-Hill Higher Education. All rights reserved.6-17  Flexion  movement of forearm to shoulder by bending the elbow to decrease its angle  Extension  movement of forearm away from shoulder by straightening the elbow to increase its angle
  18. 18. Movements © 2007 McGraw-Hill Higher Education. All rights reserved.6-18  Pronation  internal rotary movement of radius on ulna that results in hand moving from palm-up to palm-down position  Supination  external rotary movement of radius on ulna that results in hand moving from palm- down to palm-up position
  19. 19. CARRYING ANGLE  The angle formed between the axis of Humerus and the Longitudinal axis of Forearm  Normal angle: In MEN=5 degree , In WOMEN=10 degree  The angle is more in Women due to Wider Pelvis  CUBITUS VALGUS: Increase in Carrying Angle  CUBITUS VARUS: Decrease in Carrying Angle
  20. 20. CARRYING ANGLE
  21. 21. SUPERIOR RADIOULNAR JOINT  ARTICULATION  The Radial notch on Ulna articulate with Head of Radius along with Annular Ligament & Capitulum.  LIGAMENTS  Annular Ligament-----circle the head of Radius and keeps the Ulna together.  Quadrate Ligament----extends from the Inferior edge of radial notch to Neck of Radius  Oblique cord------attached to inferior part of Radial notch on Ulna to just below Radial Tuberosity
  22. 22. INFERIOR RADIOULNAR JOINT  ARTICULATION  The Ulnar notch of Radius articulates with head of Ulna along with Articular Disc.  LIGAMENTS  Anterior Radio Ulnar Ligament----attached to anterior aspect just above the Ulnar head to above Ulnar notch.  Posterior Radio Ulnar Ligament---attached to posterior part of Ulnar head to above Ulnar notch.  Interosseous Membrane---binds the shaft of Radius and Ulna together.
  23. 23. MUSCLES  PRONATOR TERES----- helps in Pronation,it acts in all position of Elbow, helps in Stabilization of Superio Radio Ulnar Joint. Active during rapid and resisted Pronation.  PRONATOR QUADRATUS---- helps in Pronation in all position of Elbow  SUPINATOR---------helps in Supination in all position of Elbow  BICEPS BRACHI-------- helps in Supination when Elbow is flexed to 90 degree
  24. 24. MOVEMENTS  Pronation & Supination  Axis of movement extends from radial head to Ulnar head  Pronation and Supination movement is good when Elbow is Flexed to 90 degree  In Elbow extended position Pronation is limited due to passive tension in Biceps Brachi. Supination is limited due to passive tension in Interosseous Membrane.
  25. 25. Nerves © 2007 McGraw-Hill Higher Education. All rights reserved.6-25  All elbow & radioulnar joints muscles are innervated from median, musculotaneous, & radial nerves of brachial plexus
  26. 26. Nerves © 2007 McGraw-Hill Higher Education. All rights reserved.6-26  Radial nerve - originates from C5, C6, C7, & C8  Triceps brachii  Brachioradialis  Supinator (posterior interosseous nerve)  Anconeus  Sensation to posterolateral arm, forearm, & hand
  27. 27. Nerves © 2007 McGraw-Hill Higher Education. All rights reserved.6-27  Median nerve - derived from C6 & C7  Pronator teres  Pronator quadratus (anterior interosseus nerve)  Sensation to palmar aspect of hand & first three phalanges, palmar aspect of radial side of fourth finger, dorsal aspect of index & long fingers
  28. 28. Nerves © 2007 McGraw-Hill Higher Education. All rights reserved.6-28  Musculotaneous nerve - branches from C5 & C6  Biceps brachii  Brachialis
  29. 29. PROBLEMS OF ELBOW  TENNIS ELBOW or LATERAL EPICONDYLITIS:  Inflammation at origin of Extensors of Wrist at Lateral Epicondyle.  It is caused due to repeated forceful contraction of Wrist Extensors.  Extensor carpi radialis brevis is affected  GOLFER’S ELBOW or MEDIAL EPICONDYLITIS:  Inflammation at origin of Flexors of Wrist at Medial Epicondyle.  Repetitive contractions of Pronator Teres,Flexor Carpi Ulnaris
  30. 30. PROBLEMS OF ELBOW  NURSEMAID’S ELBOW or PULLED ELBOW  In small children the radial head is not fully developed ,lifting small child up in to by one hand may cause the RADIAL HEAD to slip out of Annular Ligament.  CUBITAL TUNNEL SYNDROME  Repetitive forceful contractions of Flexor carpi Ulnaris may compress Ulnar Nerve as it passess through the cubital tunnel between Medial Epicondyle of Humerus and Olecranon process of Ulna.

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