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ELBOW Elbow Joint Biomechanics
JOINT Joint Structure and Motions
Bones and Landmarks
Ligaments and Other
Structures
BY. Muscles of the Elbow and
Forearm
PROF. Dr. HIMANSHU SHARMA(PT)
B.P.T, M.P.T, M.I.A.P
PRINCIPAL,
MCPRC, SATARA Common Elbow Pathologies
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Scapula
The bony landmarks of the scapula,
those are important to elbow function
are as follows:-
◦ Infraglenoid tubercle:- providing
attachment of the long head of the triceps
muscle
◦ Supraglenoid tubercle:-providing
attachment for the long head of the biceps
muscle
◦ Coracoid process:- providing attachment
for the short head of the biceps muscle
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Humerus
Trochlea:- Located on the medial side of
the distal end; articulates with the ulna
Capitulum:- On the lateral side next to
the trochlea; articulates with head of
radius
Medial epicondyle:- Located on the
medial side of the distal end above the
trochlea; larger and more prominent than
the lateral epicondyle. It provides
attachment for the pronator teres muscle
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Ulna
Lateral epicondyle:- Located on the The medial bone of the forearm lying parallel
lateral sides of the distal end above the to the radius.
capitulum; provides attachment for the Olecranon process:- Located at the
anconeus and supinator muscles proximal end of the ulna, on posterior
Lateral supracondylar ridge:- Located surface; forms the prominent point of the
above the lateral epicondyle; provides elbow and provides attachment for the
attachment for the brachioradialis muscle triceps muscle
Olecranon fossa:- Located on the Trochlear notch:- Also called the semilunar
posterior surface between the medial and notch; articulates with the trochlea of the
lateral epicondyles; articulates with the humerus; makes up the anterior surface at
olecranon process of the ulna the proximal end
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Coronoid process:- Located just below
the trochlear notch; with the ulnar
tuberosity, provides attachment for the
brachialis muscle
Radial notch:- Located at the proximal end
on the lateral side just distal to the trochlear
notch; articulation point for the head of the
radius
Ulnar tuberosity:- Located below the
coronoid process; provides an attachment
for the brachialis muscle
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The elbow complex is made of three
Radius bones, three ligaments, two joints, and
Head:- Proximal end; has a cylinder one capsule.
shape with a depression in the superior The articulation of the humerus with the
surface where it articulates with the ulna and radius is commonly called the
capitulum of the humerus elbow joint
Radial tuberosity:- Located on the On the humerus, the trochlea articulates
medial side near the proximal end; with the trochlear notch of the ulna.
provides attachment for the biceps The capitulum articulates with the head
muscle of the radius.
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The elbow joint is
continuous with
◦ The Superior
radioulnar joint.
◦ The humeroradial,
◦ The humeroulnar
and these all three
joints are together
known as cubital
articulations.
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Humeroulnar joint Humeroradial joint
Articulation between the ulna and humerus Articulation between the radial head and the
at the humeroulnar joint occurs primarily as capitulum at the humeroradial joint involves
a sliding motion of the ulnar trochlear ridge sliding of the shallow concave radial head over
on the humeral trochlear groove. the convex surface of the capitulum.
The humeral capitulum is slightly smaller than the
In extension, sliding continues until the
corresponding radial fovea, and so the joint
olecranon process enters the olcranon fossa. surfaces are slightly incongruent.
In flexion, the trochlear ridge of the ulna In full extension, no contact occurs between the
slides along the trochlear groove until the articulating surfaces.
coronoid process reaches the floor of the In flexion, the rim of the radial head slides in the
coronoid fossa in full flexion. capitulotrochlear groove and enters the radial
fossa as the end of the flexion range is reached.
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• Type:- Hinge type of Synovial joint.
• Degree of freedom:- 0ne Movements
• Close pack position:- Extension The elbow is a uniaxial hinge joint that
• Loose pack position:- 70 of flexion & 10 of allows only flexion and extension.
supination There are approximately 145 degrees of
• Capsular pattern:- flexion>extension flexion measured from the 0-degree position
• End feels:- Flexion: Soft, Extension:Hard of extension.
• Pronation: Hard, Supination: Firm There is no active hyperextension at the
• Restrictions:- elbow as there is at the shoulder joint. This
• Flexion: approximation of biceps, Tightness of motion is blocked by the olecranon process
Triceps & Posterior capsule. of the ulna fitting into the olecranon fossa of
• Extension:- bony block of ulna, collateral the humerus.
ligaments, tightness of elbow flexors & anterior
capsule.
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Radioulnar joint
The articulation between the radius and ulna is They are considered together as one
known as the radioulnar joint. joint.
They articulate with each other at both ends.
The radioulnar joint is a uniaxial pivot
At the proximal end, the head of the radius pivots
within the radial notch of the ulna, forming the joint, allowing only pronation and
superior or proximal radioulnar joint. supination of the forearm.
At the distal end, the ulnar notch of the
Measured from the neutral or
radius rotating around the head of the ulna forms
the inferior or distal radioulnar joint. midposition, there are approximately 90
degrees of supination and 80 degrees of
pronation.
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• Type:- Pivot type of Synovial joint.
• Degree of freedom:- 0ne
• Close pack position:- 5 Supination
• Loose pack position:- 70 of elbow flexion
& 35 of forearm supination
• Capsular pattern:- Supination>Pronation
• End feels:- Pronation: Hard, Supination:
Firm
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The three ligaments of the elbow are:
◦ The Medial (Ulnar) collateral ligaments:-
Triangular shaped and spans the medial side of the
elbow. It attaches on the medial epicondyle of the
humerus and runs obliquely to the medial sides of the
coronoid process and olecranon process of the ulna.
It has three parts ; Anterior, Posterior & Transverse/
oblique. Primary function is to resist Valgus stress
◦ The Lateral (Radial) Collateral Ligaments:-
Triangular shaped. It attaches proximally on the lateral
epicondyle of the humerus and distally on the annular
ligament and the lateral side of the ulna. Primary
function is to resist Varus stress.
◦ The Annular Ligament:- attaches anteriorly and
posteriorly to the radial notch of the ulna,
encompassing the head of the radius and holding it
against the ulna.
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Joint Capsule
The humeroulnar and Laterally, the capsule’s
humeroradial joints and the attachment to the radius blends
superior radioulnar joint are with the fibers of the lateral
enclosed in a single joint capsule. collateral ligament (LCL).
Anteriorly, the proximal Medially, the capsule blends with
attachment of the capsule is just fibers of the medial collateral
above the coronoid and radial ligament (MCL).
fossae. Posteriorly, the capsule is
Distally it is inserted into the attached to the humerus along
ulna on the margin of the the upper edge of the olecranon
coronoid process. fossa.
The capsule blends with the The capsule is fairly large, loose,
proximal border of the annular and weak anteriorly and
ligament except posteriorly, posteriorly, and it contains folds
where the capsule passes deep that are able to unfold to allow
below the annular ligament to for a full range of elbow motion.
attach to the posterior and Laterally and medially, the capsule
inferior margins of the neck of is reinforced by the collateral
the radius. ligaments.
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Summary of Muscle Action
Flexion:- Biceps, Brachialis, and
Brachioradialis
Extension:- Triceps
Pronation:- Pronator teres and Pronator
Quadratus
Supination:- Biceps and Supinator
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Kinematics
Osteokinematics:- for Flexion & Extension Arthrokinematics :- for Flexion &
Happens in Sagittal Plane & Frontal Axes Extension
Axis passes through the centre of Trochlea & Predominantly Gliding & very less Rolling
Capitulum. as Convex-Concave Rule.
Functional range is 30-130 Osteokinematic Arthrokinematic Direction of
Movement Movement Arthrokinematic
Close kinematic motion is Push ups & Pull Movement
ups.
Open kinematic motion is Biceps curls with FLEXION GLIDING ANTERIOR
dumbbell. EXTENSION GLIDING POSTERIOR
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Elbow Flexion
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Elbow Extension
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Kinematics
Osteokinematics:- for Pronation &
Supination
Happens in Transverse Plane & Vertical
Axes
Axis passes through the centre of Radial
head & Distal ulnar head.
Functional range is Mid Prone position.
Open kinematic motion is Screwing –
Unscrewing using a screw driver.
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Pronation
Arthrokinematics :- for Pronation &
Supination
Predominantly Gliding & very less Rolling
as Convex-Concave Rule.
Osteokinematic Arthrokinematic Direction of
Movement Movement Arthrokinematic
Movement
PRONATION GLIDING POSTERIOR
SUPINATION GLIDING ANTERIOR
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Supination
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Summary of Muscle Innervation
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Lateral epicondylitis Medial epicondylitis
Lateral epicondylitis, also know as Medial epicondylitis, also know as
tennis elbow, is a very common overuse golfer’s elbow, is an inflammation of the
condition of the common extensor common flexor tendon that inserts into
tendon where it inserts into the lateral the medial epicondyle.
epicondyle of the humerus. It is an overuse condition that results in
The extensor carpi radialis brevis is tenderness over the medial epicondyle
particularly affected. It is common in and pain on resisted wrist flexion.
racquet sports and other repetitive wrist
extension activities.
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Pulled elbow or nursemaid’s
Little league elbow
elbow
Little league elbow is an overuse injury Pulled elbow or nursemaid’s elbow is
of the medial epicondyle usually caused by seen in young children under the age of 5
a repetitive throwing motion. years when there is a sudden strong
traction force on the child’s arm.
It is seen in young baseball players who
This often occurs when an adult suddenly
have not reached skeletal maturity. pulls on the child’s arm, or the child falls
The throwing motion places a valgus away from an adult while being held by
stress on the elbow causing lateral the arm.
compression and medial distraction. This results in the radial head subluxing
out from under the annular ligament.
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Elbow dislocation a slightly flexed
position. This causes the ulna to slide Reference
posterior to the distal end of the Clinical Kinesiology and Anatomy 4th Edition By
humerus. Lynn S. Lippert
Textbook of Biomechanics & Kinesiology 1st
Supracondylar fractures are one of Edition by Ilona Gracie De Souza
the most common fractures in children Physiology of the joints (A. Kapandji)
and are caused by a fall on the Joint Structure and Function: A Comprehensive
Analysis Fourth Edition by Cynthia C. Norkin, PT,
outstretched hand. EdD
Volkmann’s ischemic contracture is BD Chaurasia’s Human Anatomy, Volume 1
Regional and Applied Dissection and Clinical
the result of ischemic necrosis of the Upper Limb and Thorax by B.D. Chaurasia
forearm muscles caused by trauma to the Pocket Atlas Of Human Anatomy by Heinz Feneis,
brachial artery. Wolfgang, M.D. Dauber
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THANK YOU
BY.
PROF. Dr. HIMANSHU SHARMA(PT)
B.P.T, M.P.T, M.I.A.P
PRINCIPAL,
MCPRC, SATARA
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