PMR PG Teaching

1. CLINICAL ANATOMY OF ELBOW
JOINT
DR. RAJESH ARORA
PROFESSOR ANATOMY

2. ELBOW JOINT
 Compound joint
 Hindge joint
 Cubital Articulation
humero-ulnar
humero-radial
superior radio-ulnar joint

3. BONY STRUCTURE OF ELBOW

4. HUMERUS LOWER END

5. HUMERO-ULNAR PART
 It is articulation between trochlea of humerus and
trochlear notch of ulna
 The medial edge of trochlea is 6mm beyond the
lateral edge
 Plane of the joint is 2cms distal to intercondylar line
slopes downwards and medially
 Two nonarticular depressions coronoid fossa and
olecrenon fossa are present in relation to this
articulation
 Trochlear notch of ulna is reciprocally saddle shape
and formed by the articular surfaces of olecrenon and
coronoid processes

6. HUMERO-RADIAL PART
 Structurally it is a ball and socket type of
joint.
 The ball is represented by capitulum of
humerus and socket is by articular surface
of disc like head of the radius
 In full flexion head of the radius lodges radial
fossa above the capitulum.

7.  the annular ligament binds the head of the
radius to the radial notch of the ulna
forming the proximal radioulnar joint – this
is a pivot joint allowing for pronation and
supination

8. RELATIONS

9. LIGAMENTS OF ELBOW JOINT
 Capsular ligament
 Ulnar collateral ligament or Medial
ligament
 Radial collateral ligament or Lateral
ligament

10. FIBROUS CAPSULE
 Fibrous capsule completely envelop the joint.
 It is attached to the lower end of humerus in
a continuous line, which excludes the two
epicondyles but include three fossae.
 Cushions of extra-synovial fat fill up the three
fossae.

11. ULNAR COLLATERAL LIGAMENT
 UCL is triangular in shape and extends from
medial epicondyle to medial margin of
trochlear notch. The ligament consists of
three bands, Anterior Posterior and Inferior
 UCL is overlapped by Triceps ,FCU , FDS
and Ulnar nerve.

12. ULNAR COLLATERAL LIGAMENT

13. RADIAL COLLATERAL LIGAMENT
 RCL is triangular and extends from lateral
epicondyle to annular ligament. It is related
to supinator and ECRB

14. RADIAL COLLATERAL LIGAMENT

15. SYNOVIAL MEMBRANE

16. CARRYING ANGLE
 The angle between the long axes of the
humerus and the long axes of ulna
when the forearm is supinated
 This is called carrying angle because it
allows the forearm to angle away from
the body when a load is carried in the
hand
 Carrying angle is generally greater in
females than in males

17.  Carry Angle of the Elbow
 The angle between the long axes of the
humerus and the ulna when the arm is in
an anatomical position
 This is called this because it allows the
forearm to angle away from the body when
a load is carried in the hand
 Carrying angle is generally greater in
females than in males

18. RELATIONS OF ELBOW JOINT
 In front-Brachialis, tendon of biceps, median
nerve and brachial artery.
 Behind- Triceps and anconeus.
 Medially-common origin of superficial flexors,
Flexor carpi ulnaris and ulnar nerve.
 Laterally- common origin of superficial
extensors, supinator, extensor carpi radialis
brevis, radial nerve with its superficial and
deep branches

19. ANTERIOR RELATIONS

20. ARTERIAL SUPPLY
 Peri-articular branches of anastomosis
around elbow joint.
NERVE SUPPLY
Musculo-cutaneous nerve through branch to
Brachialis
Radial nerve through nerve to anconeous
Ulnar nerve

21. MOVEMENTS
 Flexion- (C5 and C6) range is about 150
degree when flexor surface of arm and
forearm approximate
 Chief flexor is brachialis,
biceps when forearm is supinated act as
spurt muscle,
brachioradialis in midprone position act as
shunt muscle.

22. MOVEMENTS AT ELBOW JOINT

23. EXTENSION
 Extension-(C7 and C8) reached when arm
and forearm assume straight line. It makes
the joint close-packed
 It is performed by triceps, anconeus and
assisted by gravity

24. BURSAE AROUND ELBOW JOINT
 Above the olecrenon, between the triceps
tendon and capsule of the joint.
 A subcutaneous bursa on the dorsal
triangular surface of olecrenon process.
 Between the biceps tendon and the smooth
anterior part of radial tuberosity.

25. BURSAE AROUND ELBOW JOINT

26. OLECRANON BURSITIS
 the olecranon bursa is
the largest bursa in the
elbow and sits just
over the olecranon
process
 injury results due to a
direct fall, constant
irritation, or infection

27.  an acutely inflamed bursa will rapidly
swell, show signs of redness and
increased heat
 often termed golf ball swelling
 the bursa may become infected – it will be
swollen and hot to touch along with a
possible fever , pain , tenderness and
restricted range of motion.

29. ELBOW DISLOCATION / SUBLUXATION
 Ulnar dislocation-
 It occurs in hyperextension ( Fall on
hand elbow extended) with violent
twisting action of the ulna .This needs a
tremendous amount of force
More common displacement is of radial
head especially in children , swinging of
children by their arms , may cause
radial head to snap out of the annular
ligament

30.  severe pain with loss of functions ,
cracking or snapping sensation , rapid
swelling , obvious deformity and inability to
move elbow
 90 % posterior , management is important
to avoid long term disabilities

32. ELBOW STRAIN
 Elbow strains usually the result of
attempting to overcome large force with
muscles
 inadequate warm-up , excessive
training (past point of fatigue)
 common with biceps brachii, brachiallis,
triceps
 pain and point tenderness over the
injury site, reduced strength and ROM

33. ELBOW SPRAIN
 usually the result of fall on extended arm,
producing a hyperextension of elbow
 or through a valgus/varus force
 may be due to a repetitive force that irritate
or tear the ligaments
 pain , local tenderness . pain and or laxity
with stressing of the ligament, decreased
ROM

34. MEDIAL EPICONDYLITIS
little league elbow or
golfer’s elbow
 repetitive motions with
poor technique,
muscular weakness or
anatomical weakness
 often seen in the
acceleration phase of
throwing

35.  valgus force is placed on the elbow,
which strains the flexor muscle , the
ulnar collateral ligament and possibly
the ulnar nerve.
 swelling at the medial epicondyle, point
tenderness, pain on resisted wrist
flexion and pronation
 tingling and numbness may be felt if the
ulnar nerve is involved

36. MEDIAL EPICONDYLITIS

37. LATERAL EPICONDYLITIS
 tennis elbow
 most common overuse injury in the elbow
 this condition is typically due to eccentric
overloading of the extensor muscles as seen
in the deceleration phase of throwing or the
tennis stroke
 pain will be located on the lateral epicondyle ,
it may be swollen and the pain will increase
with resisted wrist extension

38. Contributing factors to tennis elbow
 lack of experience
 poor technique on backhand
 heavy stiff racquet ( 12 - 12.5 seem to be
best)
 grip size
 racquet strings to tight( 2-3 lbs. best)
 playing surface ( ball bounces more off
cement)

39. CUBITAL TUNNEL SYNDROME
 impingement of ulnar
nerve in cubital tunnel of
the elbow ( through
ulnar groove and under
the ulnar collateral
ligament)
 here the nerve is
vulnerable to
compression and tensile
stress caused by
trauma

40.  sharp pain along medial aspect forearm,
tingling and numbness into ring and little
finger of hand
 signs and symptoms reproduced by
tapping over ulnar groove

41. SUPRACONDYLAR FRACTURE OF HUMERUS

42. THANKS