Elbow Joint Biomechanics

ELBOW JOINT BIOMECHANICS
Dr. Sneha Kumbhani

M.P.T (Musculoskeletal)
ELBOW JOINT BIOMECHANICS 1

CONTENTS
Introduction
Anatomy
The elbow joint structures:
Articulating surfaces
Capsule
Synovial membrane
Ligaments – MCL & LCL
Kinematics
Kinetics:
Muscles – Flexors & Extensors

INTRODUCTION
The elbow complex structures also provide stability for
skilled or forceful movements of the hand when
performing activities with tools or implements.
Many of the muscles that cross the elbow complex

also act at either the wrist or shoulder and therefore
the wrist and shoulder are linked with the elbow in
enhancing function of the hand.

ANATOMY
The elbow complex includes:
1. the elbow joint (humeroulnar and humeroradial

joints)
2. the proximal and distal radioulnar joints
The elbow joint and the proximal radioulnar joint are

enclosed in a single joint capsule.

THE ELBOW JOINT
Type of joint: compound/ modified or loose hinged
joint
Degrees of Freedom of Motion: 1

Flexion and extension, which occur in the sagittal
plane around a coronal axis
2 major ligaments
5 muscles

ARTICULATING SURFACES ON THE
HUMERUS
OLECRANON
FOSSA

Articulating surfaces on the anterior aspect of the distal humerus are
the hourglass-shaped trochlea and spherical capitulum.
Trochlea forms part of the humeroulnar articulation, lies slightly ant.

to humerus shaft.
Medial portion of trochlea projects distally more than the lateral
portion of and results in a valgus angulation of the forearm.
Trochlear groove divides trochlea into medial and lateral portions.

Coronoid fossa receive the coronoid process of the ulna at the
end of the elbow flexion.
Capitulum part of humeroradial articulations,located at the
lateral surface of the distal humerus.
Capitulotrochlear groove
Radial fossa design to receive the head of the radius in elbow
flexion.
Olecranon fossa designed to receive the olecranon process of
ulna at the end of elbow extension.

ARTICULATING SURFACES
ON THE ULNA
OLECRANON
PROCESS
TROCHLEAR
TROCHLEA
CORONOID RIDGE
R NOTCH
PROCESS

Articulating Surfaces
on the Radius and Ulna
The articulating surfaces of the ulna and
radius correspond to the humeral
articulating surfaces.
The ulnar articulating surface of the
humeroulnar joint is a deep semicircular
concave surface called the trochlear notch.
The proximal portion of the notch is divided
into two unequal parts by the trochlear
ridge, which corresponds to the trochlear
groove on the humerus.

The ulnar coronoid process forms the distal
end of the notch, whereas the olecranon
process projects over the proximal end.
The radial articulating surface of the
humeroradial joint is composed of the
proximal end of the radius, known as the
head of the radius.
The radial head has a slightly cup-shaped
concave surface called the fovea that is
surrounded by a rim.

The radial head’s convex rim fits into the
capitulotrochlear groove.

ARTICULATING SURFACES
ON THE RADIUS
FOVEA
RADIAL HEAD
RADIAL NECK

HUMERO-ULNAR ARTICULATION

HUMERO-ULNAR ARTICULATION
Articulation at the humeroulnar joint occurs primarily
as a sliding motion of the ulnar trochlear ridge on the
humeral trochlear groove.
In extension, sliding continues until the olecranon

process enters the olecranon fossa.
In flexion, the trochlear ridge of the ulna slides along

the trochlear groove until the coronoid process
reaches the floor of the coronoid fossa in full flexion.

Opposing articulating surface of the trochlea and trochlear
notch appear to be completely congruent.
Articulating surface of the trochlea does not contact the
articulating surface at the bottom centre of the notch unless
the joint is heavily loaded.

HUMERO-RADIAL ARTICULATION

HUMERO-RADIAL ARTICULATION
Articulation at the humeroradial joint involves sliding
of the shallow concave radial head over the convex
surface of the capitulum.
In full extension, no contact occurs between the

articulating surfaces.
In flexion, the rim of the radial head slides in the

capitulotrochlear groove and enters the radial fossa as
the end of the flexion range is reached.

JOINT CAPSULE

JOINT CAPSULE

JOINT CAPSULE

JOINT CAPSULE
Anteriorly:
Proximally- above the coronoid and radial fossa
Distally- on the margins of coronoid process
Posteriorly:
Proximally- along the upper edge of olecranon fossa
Distally- posterior and inferior margins of radial neck

JOINT CAPSULE
Laterally: Blends with the fibers of LCL
Medially: Blends with the fibers of MCL
Capsule is large, loose and weak anteriorly and

posteriorly.
Contains folds that are able to unfold to allow full
elbow ROM.
Presence of fat pads.

A triangular synovial fold inserted between
the proximal radius and ulna partly divides
the elbow joint into two joints.
The synovial folds varied from 1 to 4 mm in
thickness, from 9 to 51 mm in length, and
from 110 mm in width and contained fat
pads and nerve fibers.

SYNOVIAL MEMBRANE

LIGAMENTS
Located on the medial and lateral sides of hinge joints
to provide medial-lateral stability and to keep the joint
surfaces in apposition.
2 main ligaments:
The medial (ulnar) collateral ligament
The lateral (radial) collateral ligament

MEDIAL COLLATERAL LIGAMENT
Major restraint of valgus stress
Consists of 3 parts:
The anterior portion
The posterior portion
The oblique or transverse portion


The anterior portion:
Extends from the anterior aspect, tip, and medial edge

of the medial epicondyle of the humerus to attach on
the ulnar coronoid process.
Primary restraint of valgus stress from 20 to 120

degrees of elbow flexion.

The posterior portion:
Extends from the posterior aspect of the medial

epicondyle of the humerus to attach to the ulnar
coronoid and olecranon processes.
Limits elbow extension.
Plays less role than anterior MCL in providing valgus

stability.

The oblique/ transverse portion:
Extends between the olecranon and ulnar coronoid

processes.
Assists in providing valgus stability.
Helps to keep the joint surfaces in approximation

Functions of MCL:
Stabilizes against valgus torques at the medial elbow.

Limits extension at the end of the elbow extension ROM.
Guides joint motion throughout flexion ROM
Provide some resistance to longitudinal distraction of joint
surfaces.

LATERAL COLLATERAL LIGAMENTOUS
COMPLEX
The lateral collateral ligamentous complex includes:
the LCL
the lateral ulnar collateral ligament (LUCL)
the annular ligament

LATERAL COLLATERAL LIGAMENTOUS
COMPLEX
LCL

LATERAL COLLATERAL
LIGAMENTOUS COMPLEX
The LCL:
The LCL is a fan-shaped structure
Extends from the inferior aspect of the lateral

epicondyle of the humerus to attach to the annular
ligament and to the olecranon process.

LATERAL COLLATERAL
LIGAMENTOUS COMPLEX
Provides reinforcement for the humeroradial
articulation
Offers some protection against varus stress in some

positions of the elbow
Assists in providing resistance to longitudinal

distraction of the joint surfaces

LATERAL COLLATERAL
LIGAMENTOUS COMPLEX
O’Driscoll described the LCL as a key structure that is
always disrupted in elbow dislocations.

LATERAL COLLATERAL
LIGAMENTOUS COMPLEX
The LUCL:
Ligamentous tissue extending from the lateral

epicondyle to the supinator crest of the ulna is
referred to as the LUCL.
LCL
Lies just posterior to the LCL.

LATERAL COLLATERAL
LIGAMENTOUS COMPLEX
Assists the LCL in resisting varus stress at the elbow
Assists in providing lateral support to the elbow joint
Provides support to the annular ligament.
Imatani and colleagues suggested that the LUCL is not

a major restraint but contributes to posterolateral
stability by securing the ulna to the humerus.

LATERAL COLLATERAL
LIGAMENTOUS COMPLEX
The Annular ligament:
Is a strong fibrous band that forms four fifths of a ring that
encircles the radial head attaching to the radial notch on
ulna.
Inner surface of the ligament is covered with cartilage and

serves as a joint surface.
Stabilizes radial head, thus providing a stable base for

rotation.
Maintains posterolateral rotatory stability.

LATERAL COLLATERAL
LIGAMENTOUS COMPLEX

KINEMATICS

KINEMATICS
Degrees of Freedom of Motion: 1
Flexion and extension, which occur in the sagittal
plane around a coronal axis
Axis of Motion:
Passes horizontally through the center of the trochlea

and capitulum and bisects the longitudinal axis of the
shaft of the humerus

KINEMATICS

KINEMATICS
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 medially when they meet at the elbow.
This normal valgus angulation is called the carrying angle

or cubitus valgus.
The average angle in full elbow extension is about 15

degrees.

KINEMATICS

KINEMATICS
A varus angulation at the elbow is referred to as
cubitus varus and is usually abnormal.
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.

KINEMATICS
Range of Motion:
Active flexion ROM: 135o-145o
Passive flexion ROM: 150o – 160o
Factors which determine the amount of motion that is

available at the elbow joint include:
The type of motion (active or passive)

The position of the forearm (relative pronation-supination)
The position of the shoulder

ARTHROKINEMATICS AT THE HUMERO-
ULNAR JOINT
Articulation between the concave trochlea notch of the ulna

and the convex trochlea of the humerus.
During FLEXION:
The concave surface of the trochlear notch rolls and slides on
the convex trochlea.

• Full flexion of coronoid process of the ulna fits into the
coronoid fossa of humerus.
• The medial and lateral axis of rotation is shown through the
center of the trochlea.
• Taut structures are shown as thin elongated arrows and
slackened structures as wavy arrows.
• Elongation- Full elbow flexion requires elongation of the
posterior capsule, extensor muscles, ulnar nerve and post.
fibers of collateral ligament.

During EXTENSION, required that the prominent tip of the
olecranon process become wedged into the olecranon fossa.
Extensibility- dermis ant. to elbow, flexor muscles, ant.

capsule, ant. fibers of the medial collateral ligament.

ARTHROKINEMATICS AT THE
HUMERORADIAL JOINT
Articulation between the cuplike fovea of the radial head and

reciprocally shaped rounded capitulum.
The arthrokinematics of flexion and extension consists of the

fovea of the radius rolling and sliding across the convexity of the
capitulum.
The medial-lateral axis of rotation in the center of capitulum.

During elbow flexion,
The radial fovea is pulled firmly against the capitulum by
contracting muscles.
The stretched structures as thin elongated arrows which are

posterior capsule, LUCL, extensors muscle.
Slackened structures as wavy arrows which are ant. capsule,
flexors.

KINEMATICS
Stability
Limits to extension:
Joint surfaces, the ligaments, and joint capsule
Bony contact of the olecranon process in the
olecranon fossa
The bony components, MCL and anterior joint capsule
contribute equally to resist valgus stress in full
extension
Anterior portion of the joint capsule provides the
majority of the resistance to anterior displacement of
the distal humerus out of the olecranon fossa

KINEMATICS
Limits to flexion:
Approximation of the coronoid process with the
coronoid fossa and of the rim of the radial head in the
radial fossa.
In 90o of flexion, the anterior part of the MCL provides

the primary resistance to both distraction and valgus
stress.

KINEMATICS
The majority of the resistance to varus stress when
the elbow is flexed to 90o, is provided by the osseous
structures of the joint.
The anterior joint capsule contributes only slightly to

varus/valgus stability and provides little resistance to
distraction when the elbow is flexed.

KINETICS

KINETICS
Muscle action determined by a number of factors including:
number of joints crossed by the muscle (one joint or two joint
muscles)
physiologic cross-sectional area (PCSA)
location in relation to joint
position of the elbow and adjacent joints
position of the forearm

KINETICS
magnitude of the applied load
type of muscle action (concentric, eccentric, isometric,

isokinetic)
speed of motion (slow or fast)
moment arm (MA) at different joint positions
fiber types

FLEXORS
Brachialis:
ORIGIN INSERTION
Anterior lower Ulnar tuberosity and
humeral shaft coronoid process
Considered to be a mobility muscle because its insertion is
close to the elbow joint axis.
Has a large strength potential in that it has a large PCSA

and a large work capacity (volume).

FLEXORS
Its MA is greatest at slightly more than 100 degrees of
elbow flexion, at which its ability to produce torque is
the greatest.
Because the brachialis is inserted on the ulna,
it is unaffected by changes in the forearm
position brought about by rotation of the
radius.
Being a one-joint muscle, it is not affected by
the position of the shoulder.

FLEXORS
Biceps Brachii:
ORIGIN INSERTION
Short head: coracoid Rough posterior area
process of the scapula of the radial tuberosity
Long head: supra-
glenoid tubercle of
the scapula
Also considered to be a mobility muscle because of its

insertion close to the joint axis.

FLEXORS
The long head of the biceps brachii has the largest
volume among the flexors, but the muscle has a
relatively small PCSA.
The MA of the biceps is largest between 80 and 100

degrees of elbow flexion and, therefore, the biceps is
capable of producing its greatest torque in this range.
The MA of the biceps is rather small when the elbow

is in full extension.

FLEXORS
When the elbow is flexed beyond 100 degrees, the
translatory component of the muscle force is directed
away from the elbow joint and, therefore, acts as a
distracting or dislocating force.
The functioning of the biceps is affected by the position of

the shoulder.
???????
If full flexion of the elbow is attempted with the shoulder
in full flexion, especially when the forearm is supinated,
the muscle’s ability to generate torque is diminished.

FLEXORS
The biceps brachii is active during unresisted elbow
flexion with the forearm supinated and when the
forearm is midway between supination and pronation
in both concentric and eccentric contractions, but it
tends not to be active when the forearm is pronated.
However, when the magnitude of the resistance

increases much beyond limb weight, the biceps is
active in all positions of the forearm.

FLEXORS
Brachioradialis:
ORIGIN INSERTION
Lateral supra- Distal radius,
condylar ridge of proximal to the
the humerus radial styloid process
Inserted at a distance from the joint axis, and

therefore the largest component of muscle force goes
toward compression of the joint surfaces and hence
toward stability.

FLEXORS
The brachioradialis has a relatively small mean PCSA
but a relatively large average peak MA in comparison
with other elbow flexors.
The maximum MA for the brachioradialis occurs

between 100 and 120 0 of elbow flexion.

FLEXORS
Brachioradialis does not cross the shoulder and
therefore is unaffected by the position of the shoulder.
The position of the elbow joint affects brachioradialis

muscle activity only during voluntary maximum
eccentric contractions.
When the speed of the motion is increased, the

brachioradialis shows moderate activity if a load is
applied and the forearm is either in a position midway
between supination and pronation or in full pronation.

EXTENSORS
Triceps:
ORIGIN INSERTION
Long head: Infra-glenoid Olecranon process
tubercle of the scapula
Medial head: entire
posterior surface of the
humerus
Lateral head: narrow
ridge on the posterior
humeral surface

EXTENSORS
The effectiveness of the triceps as a whole is affected by
changes in the position of the elbow but not by changes in
position of the forearm. ???????
Activity of the long head of the triceps is affected by

changing shoulder joint positions.
The long head’s ability to produce torque may diminish

when full elbow extension is attempted with the shoulder
in hyperextension.
In this instance, the muscle is shortened over both the
elbow and shoulder simultaneously.

EXTENSORS
The medial and lateral heads of the triceps are not
affected by the position of the shoulder.
The medial head is active in unresisted active elbow

extension, but all three heads are active when heavy
resistance is given to extension or when quick
extension of the elbow is attempted in the gravity-
assisted position.

EXTENSORS
Maximum isometric torque generation is at a position
of 90 degrees of elbow flexion.
However, the total amount of extensor torque

generated at 90 degrees varies with the position of
the shoulder and the body.

EXTENSORS
The triceps is active eccentrically to control elbow flexion as
the body is lowered to the ground in a push-up.
The triceps is active concentrically to extend the elbow when

the triceps acts in a closed kinematic chain, such as in a push-
up.

EXTENSORS

EXTENSORS
Anconeus:
ORIGIN INSERTION
Posterior surface of Lateral aspect of the
the lateral olecranon porcess
epicondyle of and adjacent
humerus posterior surface of
the ulna
Assists in elbow extension.

Also acts as a stabilizer during supination and pronation.

Superior and Inferior
Articulations

Superior Radioulnar Joint
The articulating surfaces of the proximal
radioulnar joint include the ulnar radial
notch, the annular ligament, the
capitulum of the humerus, and the head of
the radius.
The annular ligament encircles the rim of the
radial head, which is also covered with
articular cartilage.
Mechanoreceptors are evenly distributed
throughout the ligament

Distal radioulnar joint
The articulating surfaces of the distal radioulnar
joint include the ulnar notch of the radius, the
articular disk, and the head of the ulna.
The radius of curvature of the concave ulnar
notch is 4 to 7 mm larger than that of the ulnar
head.
The articular disk is sometimes referred to as
either the triangular fibrocartilage (TFC)
because of its triangular shape or as a part of
the triangular fibrocartilage complex (TFCC)
because of its extensive fibrous connections.

TFCC
The disk has been described as resembling a
shelf whose medial border is embedded in a
wedge of vascular connective tissue containing
fine ligamentous bands that join the disk to the
ulna and articular capsule.
The base of the articular disk is attached to the
distal edge of the ulnar notch of the radius.
The apex of the articular disk has two
attachments.
One attachment is to the fovea on the ulnar head.
The other attachment is to the base of the ulnar

styloid process.
Radioulnar Articulation
The proximal and distal radioulnar joints are
mechanically linked; therefore, motion at one
joint is always accompanied by motion at the
other joint.
The distal radioulnar joint is also considered
to be functionally linked to the wrist in that
compressive loads are transmitted through
the distal radioulnar joint from the hand to
the radius and ulna.

Pronation of the forearm occurs as a result
of the radius’s crossing over the ulna at the
superior radioulnar joint.
During pronation and supination, the rim of
the head of the radius spins within the
osteoligamentous enclosure formed by the
radial notch and the annular ligament.
At the same time, the surface of the head
spins on the capitulum of the humerus.

At the distal radioulnar joint, the concave
surface of the ulnar notch of the radius
slides around the ulnar head, and the disk
follows the radius by twisting at its apex and
sweeping along beneath the ulnar head.
Joint surface contact is optimal only with the
forearm in a neutral position between
supination and pronation.
In maximal pronation and supination, the
articulating surfaces have only minimal
contact.

SUPERIOR RADIOULNAR
JOINT
❑ LIGAMENTS
Annular Ligament-----circle the head of
Radius and keeps the Ulna together.
Quadrate Ligament----extends from the
Inferior edge of radial notch to Neck of
Radius
Oblique cord------attached to inferior part of
Radial notch on Ulna to just below Radial
Tuberosity
INFERIOR RADIOULNAR JOINT
❑ LIGAMENTS
Anterior Radio Ulnar Ligament----attached to
anterior aspect just above the Ulnar head to
above Ulnar notch.
Posterior Radio Ulnar Ligament---attached to
posterior part of Ulnar head to above Ulnar
notch.
Interosseous Membrane---binds the shaft of
Radius and Ulna together.
The IOM maintains space between the radius
and ulna during forearm rotation,

MUSCLES
PRONATOR TERES- helps in Pronation, it acts
in all position of Elbow, helps in Stabilization of
Superio Radio Ulnar Joint. Active during rapid
and resisted Pronation.
PRONATOR QUADRATUS-helps in Pronation

in all position of Elbow
SUPINATOR-helps in Supination in all position

of Elbow
BICEPS BRACHI-helps in Supination when
Elbow is flexed to 90 degree
Functions of radioulnar
joint
❑ Axis of motion:
The axis of motion for pronation and
supination is a longitudinal axis extending
from the center of the radial head to the
center of the ulnar head.
In supination, the radius and ulna lie parallel
to one another, whereas in pronation, the
radius crosses over the ulna.
There is very little motion of the ulna during
pronation and supination

Motion of the proximal ulna is negligible.
Motion of the distal ulna is of less magnitude
than that of the radius and opposite in
direction to motion of the radius.

Range of motion
A total ROM of 150 has been ascribed to the
radioulnar joints.
The ROM of pronation and supination is
assessed with the elbow in 90 of flexion.
This position of the elbow stabilizes the
humerus so that radioulnar joint rotation
may be distinguished from rotation that is
occurring at the shoulder joint.
When the elbow is fully extended, active
supination and pronation occur in
conjunction with shoulder rotation.

Limitation of pronation when the elbow is
extended may be caused by passive tension
in the biceps brachii.
Supination is limited by passive tension in
the palmar radioulnar ligament and the
oblique cord.
10
Muscle action
10
10
IOM force transmission
10
injury
10
Compression injury
10
10
Distraction injury (pulled
elbow)
10
Valgus and varus injury
10
THANK
YOU
10

Elbow Joint Biomechanics

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Elbow Joint Biomechanics

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ELBOW JOINT BIOMECHANICS

Dr. Sneha Kumbhani

ELBOW JOINT BIOMECHANICS 1

ELBOW JOINT BIOMECHANICS 2

Many of the muscles that cross the elbow complex

ELBOW JOINT BIOMECHANICS 3

1. the elbow joint (humeroulnar and humeroradial

2. the proximal and distal radioulnar joints

The elbow joint and the proximal radioulnar joint are

ELBOW JOINT BIOMECHANICS 4

Degrees of Freedom of Motion: 1

ELBOW JOINT BIOMECHANICS 5

ELBOW JOINT BIOMECHANICS 6

Trochlea forms part of the humeroulnar articulation, lies slightly ant.

ELBOW JOINT BIOMECHANICS 7

ELBOW JOINT BIOMECHANICS 8

ELBOW JOINT BIOMECHANICS 9

ELBOW JOINT BIOMECHANICS 10

ELBOW JOINT BIOMECHANICS 11

ELBOW JOINT BIOMECHANICS 12

ELBOW JOINT BIOMECHANICS 13

ELBOW JOINT BIOMECHANICS 14

In extension, sliding continues until the olecranon

In flexion, the trochlear ridge of the ulna slides along

ELBOW JOINT BIOMECHANICS 15

ELBOW JOINT BIOMECHANICS 16

ELBOW JOINT BIOMECHANICS 17

In full extension, no contact occurs between the

In flexion, the rim of the radial head slides in the

ELBOW JOINT BIOMECHANICS 18

ELBOW JOINT BIOMECHANICS 19

ELBOW JOINT BIOMECHANICS 20

ELBOW JOINT BIOMECHANICS 21

ELBOW JOINT BIOMECHANICS 22

Medially: Blends with the fibers of MCL

Capsule is large, loose and weak anteriorly and

ELBOW JOINT BIOMECHANICS 23

ELBOW JOINT BIOMECHANICS 24

ELBOW JOINT BIOMECHANICS 25

ELBOW JOINT BIOMECHANICS 26

ELBOW JOINT BIOMECHANICS 27

ELBOW JOINT BIOMECHANICS 28

Extends from the anterior aspect, tip, and medial edge

Primary restraint of valgus stress from 20 to 120

ELBOW JOINT BIOMECHANICS 29

Extends from the posterior aspect of the medial

Limits elbow extension.

Plays less role than anterior MCL in providing valgus

ELBOW JOINT BIOMECHANICS 30

Extends between the olecranon and ulnar coronoid

Assists in providing valgus stability.

Helps to keep the joint surfaces in approximation

ELBOW JOINT BIOMECHANICS 31

Stabilizes against valgus torques at the medial elbow.

ELBOW JOINT BIOMECHANICS 32

ELBOW JOINT BIOMECHANICS 33

ELBOW JOINT BIOMECHANICS 34

The LCL is a fan-shaped structure

Extends from the inferior aspect of the lateral

ELBOW JOINT BIOMECHANICS 35

Offers some protection against varus stress in some

Assists in providing resistance to longitudinal

ELBOW JOINT BIOMECHANICS 36