Joints of the Upper Limb

Elbow Joint

Dr. G.O. Omotoso

Department of Anatomy
 Elbow Joint

• Is a synovial joint
• Is a hinge joint
• Significance:
– A very stable joint
– helps shoulder in application of force and controls
placement of hand in space

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 Synovial Joint of the Elbow
Characteristics of
synovial joints:

•Synovial cavity

•Synovial membrane

•Articular cartilage

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 Bones of the Elbow Joint
humerus

ulna

radius

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• Bones
– Formed by the articulation of humerus with ulna and radius

• Trochlea of humerus (medial side) articulates with the

trochlear notch of ulna, while the capitulum of humerus
(lateral side) articulates with the proximal surface of the
head of radius

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• The humeroulnar and the humeroradial joints
are the joints that give the elbow its
characteristic hinge like properties.
• The rounded surfaces of the trochlea and
capitulum of the humerus rotate against the
concave surfaces of the trochlear notch of the
ulna and head of the radius.
• Articular surfaces are covered by hyaline
cartilage

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 Fibrous Capsule
• The fibrous capsule completely encloses the joint.
• Its anterior and posterior parts are thin and weak, but collateral ligaments
strengthen its sides.
• It is attached to the proximal margins of the coronoid and radial fossae
anteriorly, but not quite to the superior limit of the olecranon fossa
posteriorly.
• Distally the fibrous capsule is attached to the margins of the trochlear
notch, the anterior border of the coronoid process, and the annular
ligament.

Synovial membrane
• Lines the internal surface of the fibrous capsule

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 Ligaments of the Elbow Joint
• Ligaments connect bones forming the elbow
joint to each other
• they contribute to the stability of the joint
• 3
– Ulnar collateral lig
– Radial collateral lig
– Annular lig

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 Elbow Joint Ligaments
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 Ligaments of the Elbow Joint
Ulnar collateral ligament
• triangular in shape
• extends from the medial epicondyle of the humerus to the
coronoid process of the ulna
• is composed of three parts: an anterior, a posterior and an
inferior/oblique band

Ulnar
collateral
ligament

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 Ligaments of the Elbow Joint
Radial collateral ligament
• Extends from lateral epicondyle of the humerus to the
lateral and posterior part of annular ligament of radius

Radial collateral ligament

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 Ligaments of the Elbow Joint
Annular ligament
• reinforces the joint by holding the radius and
ulna together at their proximal articulation.

Annular ligament

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 Movement of the Elbow Joint
• mainly flexion and extension (hinge/uni-axial)
• In full extension, the ulna makes an angle of
165-170° with the long axis of humerus
(‘carrying angle’); more acute in females

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 Muscles acting on the Elbow Joint
• Flexion:
– mainly brachialis, biceps brachii and brachioradialis
– the first 2 are present in the anterior compartment of
the arm
– lesser extent: pronator teres and extensor carpi
radialis longus
• Extension:
– mainly triceps brachii
– lesser extent: anconeus

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 biceps brachii
Elbow Flexors
multi-articular muscle
whose effectiveness
is dependent on Flexors are almost
position of shoulder as
& radioulnar jts the extensors making
us better pullers than
pushers

brachialis

brachioradialis
(Used more in rapid mvmts or against resistance) Note: brachialis is the
MOST EFFECTIVE
elbow flexor!
biceps brachii not
effective when pronated

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 Elbow Extensors
triceps brachii

long head is bi-articular

so its force production
dependent on shoulder
position

lateral head is strongest

yet is relatively inactive
unless acting against
resistance

anconeus

medial head is the

‘workhorse’ of this group
active in all positions
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 Blood Supply
• The blood supply is derived from a number of periarticular
anastamoses formed by the collateral and recurrent branches of
the brachial, profunda brachii, radial and ulnar arteries.

Proximal to the elbow joint

• Brachial art, the largest in the arm, gives off two branches:
– superior and inferior ulnar collateral artery.
• Profunda brachii gives off :
– a radial collateral and a middle collateral artery.

Distal to the elbow joint

• Radial art gives off :
– radial recurrent artery
• Ulnar artery gives off:
– anterior and posterior ulnar recurrent arteries.
• These arteries ascend towards the elbow joint, anastamosing with
the branches from the brachial and profunda brachii arteries in the
arm.
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 Blood Supply

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 Innervation
• By adjacent nerves
– Ulnar
– Median
– Radial: brachioradialis, triceps
– Musculocutaneous: biceps brachii, brachialis

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 Bursae
• are fibrous sacs lined by synovial membrane, and
containing small quantity of synovial fluid
• 3 bursae:
• Subcutaneous olecranon bursa
– loc in the subcut connective tissue over the olecranon
• Subtendinous olecranon bursa
– loc between olecranon and triceps
• Intratendinous olecranon bursa
– loc in the triceps brachii

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 Clinical Correlates
• Bursitis
– Inflammation of the bursae, due to trauma or
infection
• Dislocation
– Cause: fall on the hand >> hyperextension on EJ
– Leading to:
• # head of radius, coronoid process, olecranon
• tearing of ulnar collateral ligament

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 Radio-Ulnar Joints

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 Introduction
• 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

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 Proximal RU Joint

Distal RU Joint

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 Proximal Radio-Ulnar Joint
Articulation
• Formed by the radial notch of the ulna and the head of
radius
• Supported by annular ligament
• A pivot joint; Uni-axial
Fibrous Capsule
• The fibrous capsule enclosing the joint is continuous
with the fibrous capsule of the elbow joint
Synovial Membrane
• The deep surface of the annular ligament is lined with
synovial membrane.
• Continues above with elbow joint
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 Ligaments
• 2 ligaments
• A weak quadrate
ligament
– joins the neck of radius
and lower margin of
radial notch
• A strong annular
ligament
– attached to the anterior
and posterior margins of
radial notch

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 Types of Movement
biceps brachii
supinator Pronation and supination
active in rapid
of the forearm
always active mvmts or Supination Pronation
against
large loads

pronator teres
active in rapid mvmts
or against large loads
pronator quadratus
always active

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Muscles acting on the Proximal Radio-
Ulnar Joint
• Supination
– Biceps (during resistance)
– Supinator
– Extensor carpi radialis longus
• Pronation
– Pronator quadratus
– Pronator teres
– Flexor carpi radialis
– Palmaris longus
– brachioradialis
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Blood Supply
As elbow joint

Nerve supply
The joint is supplied by the branches of median, ulnar,
musculocutaneous & radial nerves

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 Distal Radio-Ulnar Joint
• Articulation
• formed by articulation of the head of ulna with the
ulnar notch of radius
• They are bound together by a fibrocartilaginous disc
(articular disc) called triangular ligament
• The disc separates the cavity of the distal RUJ from that
of the wrist joint
• The interosseous membrane and the weak fibrous
capsule also participate in keeping the bones in
position
• A pivot joint

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 Distal radioulnar joint

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 Fibrous Capsule
• Lined by synovial membrane
• Passes between the anterior and posterior
borders of the articular disc and the adjacent
surfaces of the radius and ulna (anterior and
posterior ligaments)
• the capsule is deficient superiorly
Ligaments
• Weak anterior & posterior ligaments strengthen
the joint

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 Types of Movement
Pronation and supination:
biceps brachii
supinator active in rapid
always active
The distal end of the radius mvmts or
against
moves anteriorly and medially,
large loads
crossing the ulna anteriorly

pronator teres
active in rapid mvmts
or against large loads
pronator quadratus
always active

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 Muscles acting on Distal Radio-Ulnar Joint
• As for Proximal Radio-Ulnar Joint

Innervation
• Anterior interosseous nerves
• Deep branch of radial nerves

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 Wrist Joint

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 Wrist joint (radiocarpal)
Type
is a condyloid type of synovial joint
Articulation
distal end of the radius and the articular disc above & scaphoid, lunate & triquetral bones
below
Capsule
The capsule encloses the joint & is attached above to the distal ends of radius &
ulna below to the proximal row of carpal bones
Ligaments
Anterior & posterior ligaments strengthen the capsule the medial is attached to
the styloid process of ulna & to the triquetral bone. The lateral ligament is
attached to the styloid process of radius & to the scaphoid bone

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 Wrist Joint
Synovial membrane
• Lines the capsule & attached to the margins of the articular surfaces.
•The joint cavity does not communicate with that of distal radioulnar joint or
with the joint cavities of intercarpal joints

Nerve supply
•Anterior interosseous & deep branch of radial nerves

Movement
• The movements of adduction, abduction, flexion and extension.
• Rotation of the wrist joint is impossible because the articular surfaces are ellipsoid in
shape; however, pronation and supination of the hand compensate for the absence of
this movement

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 Muscles acting on the Wrist Joint
Flexion Flexion and Abduction
• Flexor digitorum • Flexor carpi radialis
profundus
• Flexor digitorum Flexion and Adduction
superficialis • Flexor carpi ulnaris
• Flexor policis longus
Extension and Abduction
Extension • Extensor carpi radialis longus
• Extensor digitorum • Extensor carpi radialis brevis
• Extensor digiti minimi
• Extensor policis longus Extension and Adduction
• Extensor indicis • Extensor carpi ulnaris

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 Blood Supply

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 Clinical correlates
• Fractures
• Dislocations
• Subluxation- partial dislocation

• Fractures of the wrist (e.g. Colles' fracture)

involving the distal end of the radius are the
most common type of fracture in persons over
50 years of age

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 • Wrist Dislocations
– Radius or Ulna
– Lunate is very common

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• Wrist Fractures
– Distal Radius/Ulna
• Colles’ Fracture
– fall on outstretched
– “silver fork deformity” - radius & ulna posteriorly
• Smith’s Fracture (Reverse Colles)
– “garden spade deformity” - radius
& ulna anteriorly

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• Drop Wrist Syndrome or Wrist Drop
– Radial nerve compression at elbow
– Inability to extend wrist and fingers
• Carpal Tunnel Syndrome
– Compression of median nerve
• Sprain
– tear of ligament: slight, moderate or complete
– Due to poor blood ss, ligament injury does not heal well
– Severe injury requires surgical intervention
• Strain
– Excessive stretch of tissue (i.e. tendon or muscle) with no
serious damage
• Wrist Ganglion
– Herniation of the joint capsule or synovial sheath of a tendon.

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