BY: TAY LO R , J O R E Y A N D V I C T O R I A

ELBOW HUMEROULNAR JOINT

SURFACE ANATOMY

• Lateral epicondyle • Medial epicondyle• Radial styloid process• Ulnar styloid process• Olecranon• Cubital fossa• Carrying angle • Medial bicipital groove• Triceps tendon• Biceps tendon

LATERAL & MEDIAL EPICONDYLE

• Lateral Epicondyle = A rough projection on the lateral side of the distal end of the humerus

• Medial epicondyle =A rough projection on the medial side of the distal end of the humerus

LATERAL & MEDIAL EPICONDYLE

RADIAL & ULNARSTYLOID PROCESS

• Radial Styloid Process = The shaft of the radius widens distally to form this process on the lateral side, which can be felt proximal to the thumb

• Ulnar Styloid Process = Is located on the posterior side of the ulna’s distal end.

RADIAL & ULNARSTYLOID PROCESS

OLECRANON

• Located at the proximal end of the ulna. It forms the prominence of the elbow

CUBITAL FOSSA

• The fossa in front of the elbow, bounded laterally and medially by the humeral origins of the extensors and flexors of the forearm

CARRYING ANGLE

• When your arms are held out at the sides and your palms are in supination, your forearm and hands should normally be about 5 to 15 degrees away from the body • This is the normal carrying angle of the elbow • It allows your forearms to clear the hips when

swinging your arms, such as during walking • Because the carrying angle varies from person to

person it is important to compare one elbow with the other when evaluating a patient

CARRYING ANGLE

MEDIAL BICIPITAL GROOVE

• The groove along the medial surface of the arm separating the Biceps Brachii from Tricep Brachii

TRICEPS & BICEPS TENDON

• Triceps tendon = My be felt as it descends along the posterior aspect of the arm to the olecranon

• Biceps tendon = Can be palpated in the cubital fossa, immediately lateral to the midline.

BICEPS & TRICEPS TENDON

BONES OF THE HUMEROULNAR JOINT

HumerusThe Humerus is the bone that is most proximal to the Upper extremityContains-

• Capitulum, • Trochlea• Coronoid Fossa• Medial Epicondyle• Lateral epicondyle• Olecranon Fossa

BONES OF THE HUMEROULNAR JOINT CONT.

• Radius and UlnaThe Radius and Ulna are more distal of the Humeroulnar Joint and attach to Humerus

Radius Contains-

• Head• Neck • Radial Tuberosity

BONES OF THE HUMEROULNAR JOINT

Ulna contains-• Olecranon Process• Coronoid Process• Trochlear Notch• Radial Notch • Ulnar Tuberosity

BICEPS BRACHII

• O:Short head: Coracoid process; • Long process: Supraglenoid

tubercle of scapula• I: Radial Tuberosity and

Bicipital aponeurosis• A: Supinates forearm, with

forearm supinated flexes foreman, long head flexes arm• N: Musculocutaneous nerve• R: C5 and C6

SYNERGIST AND ANTAGONIST OF BICEPS BRACHII

• S: Supination: Supinator Forearm Flexion: Brachialis, Brachioradialis Arm flexion: Coracobrachialis, Anterior Deltoid• A: Pronation: Pronator teres and quadratus Forearm extension: Triceps Brachii Arm Extension: Long head of Triceps, Posterior

Deltoid, Latissimus Dorsi

TRICEPS BRACHII

• O: Long head: Infraglenoid tubercle of scapula,

Lateral head: Posterior surface of humerus superior to radial groove

Medial head: Posterior surface of humerus inferior to radial groove

• I: Proximal end of Olecranon process of ulna

• A: Extension of the forearm. Long head extends arm, resists dislocation

• N:Radial nerve R: C6-C8

SYNERGIST AND ANTAGONIST OF TRICEPS BRACHII

• S: Forearm extension: Anconeus

Arm extension: Posterior Deltoid• A: Flexion of forearm:

Brachialis, Brachioradialis, Biceps brachii

Arm flexion: Biceps brachii, Anterior Deltoid

BRACHIALIS

• O:Distal half of humerus, anterior surface

• I: Coronoid process and ulnar tuberosity

• A: Flexes forearm• N:Musculocutaneous

nerve• R:C5 and C6• S: Forearm flexion: Biceps

Brachii, Brachioradialis• A: Forearm extension:

Triceps brachii

BRACHIORADIALIS

• O:Proximal 1/3 of lateral supra-epicondylar ridge of humerus• I: Lateral surface of distal

end of radius• A: Weak flexion of forearm• N: Radial nerve• R:C5-C7• S: Biceps brachii,

Brachialis• A: Triceps brachii

SUPINATOR

• O: Lateral epicondyle of humerus, radial collateral and anular ligaments • I: Lateral, posterior, and

proximal 1/3 of radius• A: Forearm supination• N: Radial nerve• R: C7 and C8• S: Supination: Biceps

brachii• A: Pronation: Pronator teres,

Pronator Quadratus

PRONATOR TERES

• O: Ulnar head: Coronoid process of Ulna

Humeral head: Medial epicondyle of humerus

• I: Middle of lateral surface of radius

• A: Forearm pronation, assistive in elbow flexion

• N: Median nerve• R:C6&C7

SYNERGIST AND ANTAGONIST OF PRONATOR TERES

• S: Pronation: Pronator quadratus• Flexion: Biceps brachii, Brachialis,

Brachioradialis• A: Supination: Supinator, Biceps brachii• Extension: Triceps brachii

PRONATOR QUADRATUS

• O:Distal fourth of anterior surface of ulna• I: Distal fourth of anterior

surface radius• A: Forearm pronation,

binds ulna and radius together• N: Median nerve, Anterior

interosseous nerve• R:C8,T1• S: Pronator teres• A: Supinstor, Biceps

Brachii

NERVES

• Ulnar nerve • Radial nerve• Median nerve • Musculocutaneous nerve

NERVES

1. Musculocutanous nerve (C5-C7)2. Radial nerve (C5-8, T1)3. Median nerve (C5-8, T1)4. Ulnar nerve (C7-8, T1)

ULNAR NERVE

RADIAL NERVE

MEDIAN NERVE

MUSCULOCUTANEOUS NERVE

LIGAMENTS

• Ligament = Connects bones to form a joint

• Articular Capsule • Radial anular ligament • Ulnar collateral ligament • Radial collateral ligament • Interosseous membrane

ARTICULAR CAPSULE

• A sac enclosing a joint, formed by an outer fibrous membrane and an inner synovial membrane. Also call joint capsule

RADIAL ANULAR LIGAMENT

• This ligament encircles and holds the head of the radius in the radial notch of the ulna, forming the proximal radio-ulnar joint and permitting pronation and supination of the forearm

INTEROSSEOUS MEMBRANE

• A thin strong sheet of fibrous tissue between and connecting the shafts of the radius and ulna

RADIAL COLLATERAL LIGAMENT

• Extends from the lateral epicondyle of the humerus and blends distally with the anular ligament of the radius

BURSAE

• Subcutaneous Olecranon bursa • Subtendinous olecranon bursa • Intratnedinous olecranon bursa

Bursitis:

SUBCUTANEOUS OLECRANON BURSA

• Is located in the subcutaneous connective tissue over the olecranon

SUBTENDINOUS OLECRANON BURSA

• Is located between the olecranon and the triceps tendon, just proximal to its attachment to the olecranon

INTRATNEDINOUS OLECRANON BURSA

• Is sometimes present in the tendon of triceps brachii.

CARTILAGE

• Articular cartilage = The cartilage covering the articular surfaces of the bones forming a synovial joint.

ARTICULAR CAPSULE

• Synovial membrane • Fibrous layer

SYNOVIAL MEMBRANE

• Lines the internal surface of the fibrous layer of the joint capsule and the intracapsular non-articular parts of the humerus. • It continuous inferiorly with the synovial

membrane of the proximal radio-ulnar joint • The joint capsule is weak anteriorly and

posteriorly but is strengthened on each side by ligaments

FIBROUS LAYER

• The outer fibrous part of the capsule of a synovial joint

ARTERIES OF THE HUMEROULNAR JOINT

• Arteries of the Humeroulnar Joint receive oxygenated blood from the heart

Arteries here include• Brachial• Ulnar• Radial• Deep Brachial • Superficial Palmar arch

ARTERIES CONT.

Other Arteries involved-• Posterior

Interosseous

• Recurrent Interosseous

• Anterior Interosseous

VEINS OF THE HUMEROULNAR JOINT

• Veins of the Humeroulnar joint deliver deoxygenated blood back to the heart

Veins here include• Cephalic • Brachial• Basilic• Median Antebrachial• Median Cubital• Dorsal Venous Arch

(Network)

CLINICAL CONCERNS OF HUMEROULNAR JOINT

• Lateral Epicondylitis- Tennis elbow is an inflammation of the tendons that join the forearm muscles on the outside of the elbow. The forearm muscles and tendons become damaged from overuse — repeating the same motions again and again. This leads to pain and tenderness on the outside of the elbow.

Causes of Tennis Elbow-Overuse of the elbow joint in the use of sports not limited to…Playing Tennis

TREATMENT OPTIONS FOR TENNIS

ELBOWNon Surgical options-• Physical Therapy• Braces• Non-Steroidal anti-inflammatory

medicines• Rest• Steroid Injections• Shock Wave Therapy

TREATMENT OPTIONS FOR TENNIS ELBOW

• Surgical options-• Open Surgery- The most common approach• Arthroscopic Surgery

RESOURCES

• Principles of Anatomy and Physiology Gerard J. Tortora and Bryan Derrickson 13th Edition • Essential Clinical Anatomy Keith L. Moore, Anne

M. R. Agur, Arthur F. Dalley. • Gary Blevins Muscle List 2014 • Trail Guide To The Body Andrew Biel 4th Edition