ELBOW COMPLEX

Joint Structure and Motions

 Theelbow complex includes three
bones,
 three ligaments,
 two joints,
 and one capsule.
 Thearticulation of the humerus with
the ulna and radius is commonly called
the elbow joint
BONES AND LANDMARKS
The ulna is the medial bone of the
forearm lying parallel to the radius.
The bony landmarks important to
elbow function
The radius, located lateral to the ulna, provides
many important bony landmarks for elbow function
 LIGAMENTS
AND
OTHER STRUCTURES
MUSCLES OF THE
ELBOW AND
FOREARM
The muscles of the elbow and forearm
 Brachialis
 Brachioradialis
 Biceps
 Supinator
 Triceps
 Anconeus
 Pronator teres
 Pronator quadratus
ANATOMICAL RELATIONSHIPS
 The muscle bellies of the biceps, brachialis, and triceps are
proximal to the elbow joint,
 The muscle bellies of the brachioradialis, pronator teres,
pronator quadratus, and supinator are at or distal to the elbow.
 You can feel the biceps if you put your hand on the anterior
surface of your arm.
 Lying directly underneath the biceps is the brachialis.
 The dotted lines in Figure indicate that the brachialis lies
beneath the biceps except at the distal humerus, where it can be
palpated on either side of the biceps tendon.
 The brachioradialis is the most superficial muscle on the lateral
side of the forearm.
 The pronator teres is also superficial, but it has its proximal
attachment on the medial side, along with the wrist flexors and
palmaris longus.
 The pronator quadratus is located deep to several wrist and hand
tendons at the distal end of the anterior forearm.
 COMMON
ELBOW
PATHOLOGIES
LATERAL EPICONDYLITIS,
 Also known as tennis elbow, is a very common overuse
condition that affects the common extensor tendon where
it inserts into the lateral epicondyle of the humerus. The
extensor carpi radialis brevis is particularly affected. It is
common in racquet sports and other repetitive wrist
extension activities.
MEDIAL EPICONDYLITIS,
 also know as golfer’s elbow, is an inflammation of the
common flexor tendon that inserts into the medial
epicondyle. It is an overuse condition that results in
tenderness over the medial epicondyle and pain on
resisted wrist flexion.
LITTLE LEAGUE ELBOW
 overuse injury of the medial epicondyle, usually caused by
a repetitive throwing motion. It is seen in young baseball
players who have not reached skeletal maturity. The
throwing motion places a valgus stress on the elbow,
causing lateral compression and medial distraction on the
joint.
PULLED ELBOW, OR NURSEMAID’S ELBOW
 is seen in young children under the age of 5 years who
have experienced a sudden strong traction force on the
arm. This often occurs when an adult suddenly pulls on
the child’s arm, or the child falls away from an adult
while being held by the arm. This force causes the radial
head to sublux out from under the annular ligament.
ELBOW DISLOCATION
 Caused when a great deal of force is applied to an elbow
that is in a slightly flexed position. This causes the ulna to
slide posterior to the distal end of the humerus.
SUPRACONDYLAR FRACTURES
 are among the most common fractures in children and are
caused by falling on the outstretched hand. The distal end
of the humerus fractures just above the condyles. The
great danger of this fracture as well as the elbow
dislocation is the potential damage to the brachial artery
because of the close proximity. This can lead to
Volkmann’s ischemic contracture, a rare but potentially
devastating ischemic necrosis of the forearm muscles.
 1. In a sitting position, place your
right forearm on the table palm
down with your elbow flexed as
necessary (Fig). Using your left
hand, push against the radial side
of the right forearm just proximal
to the wrist until the right palm is
facing up (Fig.B). The right
forearm remains relaxed.
 a. What joint motion is occurring
in the right forearm?
 b. What muscles are being
stretched?
2. Sit in a chair that has armrests and place your
hands on them. Do a chair push-up, lifting your
buttocks off the seat.
a. What joint motion is occurring in the right
elbow?
b. What type of contraction is occurring?
c. What muscles are being strengthened?
d. Is this an open- or closed-kinetic-chain activity?
3. Stand with your right arm extended
straight up toward the ceiling. Using your
left hand, push your right hand down behind
your head (Fig.). Allow your elbow to bend.

a. What joint motion is occurring in the

right elbow?
b. What muscles are being stretched?
 .Stand with your right hand next to your right
shoulder, and hold a small weight. Move your
hand to anatomical position.
 a. What joint motion is occurring in the right
elbow?
 b. What type of contraction (isometric,
concentric, or eccentric) is occurring?
 c. What muscles are being strengthened?
 d. Is this an open- or closed-kinetic-chain activity?
ELBOW
PAIN
Use of the upper limb in sport demands a well·functioning elbow. In
addition, injuries in this region may interfere with the patient's
everyday activities. It is impossible to think of "elbow pain" without
imagining a tennis player or a golfer with tendinopathy. But other
important conditions can also cause elbow and arm symptoms.
We outline the clinical approach to elbow pain under the following
headings:
lateral elbow pain, with a particular focus on extensor tendinopathy
medial elbow pain
posterior elbow pain
acute elbow injuries
forearm pain
upper arm pain,