BIOMECHANICS OF

ELBOW JOINT
PRESENTED BY:PRATIBHA MOHANTY
MPO 1ST YEAR
NIOH,KOLKATA
INTRODUCTION
• The elbow complex includes the elbow joint
( Humeroulnar & Humeroradial joints) and the
Proximal & Distal radioulnar joint.
• The elbow joint is considered to be a complexed
joint that functions as a modified or loose hinge
joint.
• One degree of freedom is possible at the elbow
permitting the motion is flexion & Extension
which occurs in the sagittal plane around coronal
axis.
• A slight bit of axial rotation & side - to – side
motion of the ulna occurs during flexion &
extension and that is why the elbow is
considered to be a modified or loose hinge joint.
• Two major ligaments & five muscles are directly
associated with the elbow joint.
• Three of the muscles are flexors that cross the
anterior aspect of the joint .The other two
muscles are extensors that cross the posterior
aspect of the joint.
• The proximal & distal radioulnar joints are linked
& function as one joint . The two joints acting
together produce rotation of the forearm & have
one degree of freedom of motion.
• The radioulnar joints are diarthrodial uniaxial
joints of the pivot type & permit rotation
( Supination & Pronation ) which occurs in
transverse plane around a vertical axis.
• Six ligaments & four muscles are associates with
these joints . Two muscles are for supination &
two for pronation.
 Structure Of Elbow Joint( HU &
HR Articulation)
• Articulation between the ulna & humerus
at the humeroulnar joint occurs primarily
as a sliding motion of the ulnar trochlear
ridge on the humeral trochlear groove.
• Articulation between the radial head & the
capitulum at the humeroradial joint
involves sliding of the shallow concave
radial head over the convex surface of the
capitulum.
• JOINT CAPSULE : The HU & HR & The
superior radioulnar joint are enclosed in a
single joint capsule.
• The capsule is fairly large ,loose & weak
anteriorly & posteriorly and it contains
folds that are able to unfold to allow for a
full range of elbow motion.The capsule is
reinforced by the collateral ligaments.
• LIGAMENTS
• Collateral ligaments
: - Medial collateral ligament
:- Lateral collateral ligament
• Annular ligament
• Transverse ligament
 Function of MCL
• It is also called ulnar collateral ligament.
• Stabilize the elbow against valgus torque.
• Limit extension at the end of the elbow
extension ROM.
• Guides joint motion throughout flexion
ROM.
• Provides some resistance to longitudinal
distraction of joint surfaces.
 Function of LCL
• It is also called radial collateral ligament.
• Stabilize elbow against varus torque.
• Stabilize against combined varus &
supination torque.
• Reinforce HR joint & assists in providing
some resistance to longitudinal distraction
of the articulating surfaces.
• Prevents subluxation of humeroulnar joint
.
• MUSCLES :
• The major flexors of the elbow are the
brachialis,the biceps brachii, & the
brachioradialis.
• The brachialis muscle arises from the
anterior surface of the lower portion of the
humeral shaft & attaches by a thick
,broad tendon to the ulnar tuberosity &
coronoid process.
• The biceps brachii arises from two heads
one short & the other long.
• The short head arises as a thick ,flat
tendon from the coracoid process of the
scapula & the long head arises a narrow
tendon from scapula supraglenoid tubercle
& both head insert by way of the strong
flattened tendon on the on the rough
posterior area of the tuberosity of the
radius & other insert into the bicipital
aponeurosis
• The brachioradialis muscles arises from
the lateral supracondylar ridge of the
humerus & insert in to the distal end of the
radius just proximal to the radial styloid
process.
• The to extensors of the elbow are the
triceps & the anconeus.
• The triceps has three heads long,medial &
lateral.
• The long head arises from the infraglenoid
tubercle of the scapula by flattened tendon
that blends with the glenohumeral joint
capsule.
• The medial & lateral head cross the elbow
joint.
• Medial head arises from the entire
posterior surface of the humerus.
• Lateral head arises from only a narrow
ridge on the posterior humeral surface.
• Three heads insert via a common tendon
in the olecranon process.
• The anconeus is a small triangular muscle
that arises from the posterior surface of
the lateral epicondyle of the humerus &
extends medially to attach to the lateral
aspect of the olecranon process &
proximal of the posterior surface of the
ulna.
Long Axes of the Humerus and
Forearm
• When the upper extremity is in the
anatomic position ,the long axis of the
humerus and the long axis of the forearm
form an acute angle when the meet at the
elbow. The angulation in the frontal plane
is caused by the configuration of the
articulating surfaces at the humeroulnar
joint.
• The medial aspect of the trochlea extends
more distally than does the lateral aspect,
which shifts the medial aspect of the ulna
trochlear notch more distally and results in
a lateral deviation (or valgus angulation) of
the ulna in relation to the humerus. This
normal valgus angulation is called the
carrying angle or cubitus valgus.
• The average angle in full elbow extension
is about 15.
• An increase in the carrying angle beyond
the average is considered to be abnormal,
especially if it occurs unilaterally. A varus
angulation at the elbow is referred to as
cubitus varus and is usually abnormal.
• Normally, the carrying angle disappears
when the forearm is pronated and the
elbow is in full extension and when the
supinated forearm is flexed against the
humerus in full elbow flexion.`
 Range Of Motion
• The range of movement in the elbow is
from 0 degrees of elbow extension to 135
-145 degree of elbow flexion.
• Stability for the elbow joint depends upon
the configuration of the joint surfaces, the
ligaments, and joint capsule. The elbow
has inherent articular stability at the
extremes of extension and flexion.In full
extension, the humeroulnar joint is in a
close-packed position.
• In this position,bony contact of the
olecranon process in the olecranon fossa
limits the end of the extension range, and
the configuration of the joint structures
helps provide valgus and varus stability.
The bony components, MCL,and anterior
joint capsule contribute equally to resist
valgus stress in full extension.
 Radioulnar Joint
• The radius and ulna articulate with each
other at their proximal and distal ends at
synovial joints, called the proximal and
distal radioulnar joints. These articulations
are the pivot type of synovial joint that
produces pronation and supination.
Proximal radioulnar joint
• The radial head articulates with the
radial notch of the ulna.
• The head of the radius is held in
position by the strong annular (annular)
ligament.
• Distal radioulnar joint
• Head of the ulna articulates with the
ulnar notch of radius.
• The proximal and distal radioulnar joints
are mechanically linked; therefore, motion
at one joint is always accompanied by
motion at the other joint.
• Ligaments:-
• Annular ligament
• Quadrate ligament
• Oblique cord
 Muscles:-
• pronator teres, pronator quadratus,
• biceps brachii,and supinator.
 Range Of Motion
• In supination, the radius and ulna lie
parallel to one another,whereas in
pronation, the radius crosses over the
ulna.
• The normal range of forearm pronation –
supination averages from 71 degree of
pronation to 81 degree of supination.
• Most activities are accomplished within the
functional range of 50 degree pronation to
50 degree supination.
 Injury Around Elbow Joint
• Compression Injuries
• Distraction Injuries
• Varus/Valgus Injuries
 Compression Injury
• Falling on the hand when the elbow is in
extended position may involve
transmission of forces through the bones
of the forearm to the elbow.
• Transmission of forces from the hand to
the elbow may occur through either the
radius or ulna or through both.
Distraction Injury
• Nursemaid Elbow
• This injury is common in young children
younger than 5 years & rare in adults.
• Lifting a small child hand up into the air by
one or both hands.
• A pull on the hand creates tensile forces at
the elbow & radial head is being pulled out
of the annular ligament
• The application of a valgus stress to the
forearm produces a compression on the
lateral aspect of the elbow joint & tensile
stress on the medial joint aspect.
• The application of a varus stress to the
forearm produces a tensile stress on the
lateral aspect of the elbow joint &
compression on the medial joint aspect.
 References
• Joint Structure and Function :A
Comprehensive Analysis by Pmela K.
Levangie , Cynthia C. Norkin, Fourth
Edition, Pg No-273-299.
• Basic Biomechanics of the
Musculoskeletal System by Margareta
Nordin , Victor H.Frankel,Pg No-342