The elbow joint

Introduction:
The elbow is a complex joint between the lower end of humerus and
upper end of radius ulna allowing flexion and extension of the arm
and rotating movement of the forearm
Type: Hinge type of synovial joint
Articulation of bones
3 distinct articulations occur (cubital articulation)
1. Humero ulanar Trochlea of the humerus True Hinge type joint.
joint + Olecranon process of Movement only in one
the ulna plane
2. Humero radial Capitulum of the hemerus Ball & socket type.
joint + head of the radius Movement in multiple
direction
3. Superior Ulnar side of the radius +
radioulnar joint radial notch of the ulna

Fig - Obliquity of humeroulnar joint in comparison with

Humero – radial joint

Ligaments:
1. Capsule
2. Ulnar collateral ligament
3. Radial collateral ligament
4. Annular ligament

1. Capsule:
a. Fibrous capsule covers the joint completely
b. It is thin posteriorly and anteriorly not to obstruct flexion and
extension
c. It is thick medially and laterally in the form of collateral
ligament to give stability of the joint
d. Excludes 2 epicondyle but includes 3 fossa – coronoid, radial,
olecranon
 e. Synovial membrane covers the inner membrane
2. Ulnar collateral ligament
a. Triangular in shape
b. Superior attachment - distal part of medial epicondyle
c. Inferior attachment – ligament consist of 3 band
i. Anterior band – coronoid process
ii. Posterior band – olecranon process
iii. Inferior band – extends obliquely between coronoid and
oblique process
d. Gives origin to some fibre of FDS
e. Importance – preventing lateral movement of elbow joint
Closely related with ulnar nerve
3. Radia collateral ligament
a. Fan shaped extension
b. Superior attachment – Distal part of the lateral epicondyle
c. Inferior attachment – Annular ligament of head of the radius
d. Intimately related to supinator and ECR Brevis
4. Annular ligament
a. Cup shaped
b. Surrounds the radial head to keep it located during rotating
movement
c. Attached at both ends of ulna

Bursa in relation
1. 2 in relation to the triceps insertion
a. upper one above olecranon between
triceps tendon and the capsule – little importance
b. Lower one between triceps expansion and
subcutaneous triangular area on dorsal surface of olecranon
– large & may become inflammed
2. 2 in relation to the biceps insertion
a. Between biceps tendon and anterior part
of bicipital tuberosity of the radius
b. Between Bicipital tendon and oblique cord
Bicipitoradial bursa

Blood supply
From numerous periarticular branches from brachial, radial, ulnar
artery (anastomosis around elbow joint)
Nerve supply
All the major nerves which cross the joint –
Musculocuteneous nerves – anterior part of capsule
Radial – posterior and lateral part of capsule
Ulnar – ulnar collateral ligament
Median
Movement of the joint:
Name of ROM Muscle Spinal segment
movemen cont - rolling
t movement
Flexion 0– Brachialis with– C6 mainly
135/140 (workhorse)
degree Biceps brachii – In
supinated arm (act as
spurt muscle)
Brachioradialis – In mid
prone (act as shunt
muscle)
Extension Triceps, Anconeus C7 mainly
assisted by gravity

Special feature of elbow

Carrying angle – Obtuse angle between arm and supinated
forearm
10-15 degree (in female more than male due to
wider pelvis)
Cause:
a. Medial edge of trochlea is 6mm below the lateral edge
b. Superior articular surface of the coronoid process is
placed obliquely

Applied anatomy:
BONES
Supracondylar fracture of humerus –
FractureDislocation of elbow
Ligaments
Subluxation of head of radius from annular ligament (pulled elbow)
Dislocation of elbow
Tendons
Tennis elbow
Golfer’s elbow
Bursa
Miner’s (student’s elbow)
Blood supply
VIC – due to supracondylar fracture
Malunited supracondylar fracture – cubitus
varus/valgus
Nerve – Nerve entrapment syndrome
Median nerve – Compressed by hypertrophid pronator muscle (it
pass through
pronator muscle) abnormally dense aponeurotic edge
of sublimes ridge( it dips under sublimes)
Ulner nerve – Tardy ulner nerve palsy from cubitus vulgus deformity
due to ot
compressed in the cubitul tunnel against the posterior
aspect of medial epicondyle
PIN – may compressed just distal to the elbow where it goes
beneath the
 aponeurotic bridge of extensor carpi radialis brevis or it
penetrates the supinator.[This is a motor nerve. Compression
– deep, poorly localized pain in the lateral part of the elbow
aggravated by rotation and extension of wrist]

What are the common injuries around the elbow in children?

Ans:

Boyd and Altenberg studied

Elbow Fractures in Children

% %
Supracondylar fractures 65 65.4
Condylar fractures 25 25.3
- Lateral condyle —
65 – 70
- Medial epicondyle —
20 
- Medial condyle —
12
Fractures of neck of radius 5 4.7
Monteggia fractures 2-3 2.2
Olecranon fractures 1-2 1.6
T-condylar fractures 1 0.8

Pulled elbow