Chapter 6 The Elbow and Radioulnar Joints 6-1. The Elbow & Radioulnar Joints Most upper extremity...

Chapter 6 Chapter 6 The Elbow and Radioulnar The Elbow and Radioulnar

JointsJoints

6-6-11

The Elbow & Radioulnar JointsThe Elbow & Radioulnar Joints

• Most upper extremity movements Most upper extremity movements involve the elbow(humeroulnar joint) & involve the elbow(humeroulnar joint) & radioulnar jointsradioulnar joints

• Usually grouped together due to Usually grouped together due to close anatomical relationshipclose anatomical relationship

• Elbow joint movements may be Elbow joint movements may be clearly distinguished from those of clearly distinguished from those of the radioulnar jointsthe radioulnar joints

Manual of Manual of Structural Structural KinesiologyKinesiology The Elbow and Radioulnar JointsThe Elbow and Radioulnar Joints 6-6-22

BonesBones

• Ulna is much larger Ulna is much larger proximally than radiusproximally than radius

• Radius is much larger Radius is much larger distally than ulna distally than ulna

• Scapula & humerus serve Scapula & humerus serve as proximal attachments as proximal attachments for muscles that flex & for muscles that flex & extend the elbowextend the elbow

• Ulna & radius serve as Ulna & radius serve as distal attachments for distal attachments for these same musclesthese same muscles


BonesBones

• Scapula, humerus, & Scapula, humerus, & ulna serve as ulna serve as proximal attachments proximal attachments for muscles that for muscles that pronate & supinate pronate & supinate the radioulnar jointsthe radioulnar joints

• Distal attachments of Distal attachments of radioulnar joint radioulnar joint muscles are located muscles are located on radiuson radius

Manual of Manual of Structural Structural KinesiologyKinesiology 6-6-44

JointsJoints

• Ginglymus or hinge-type jointGinglymus or hinge-type joint• Allows only flexion & extensionAllows only flexion & extension• 2 interrelated joints2 interrelated joints

– humeroulnar jointhumeroulnar joint– radiohumeral jointsradiohumeral joints


JointsJoints

• Elbow motionsElbow motions– primarily involve movement between primarily involve movement between

articular surfaces of humerus & ulnaarticular surfaces of humerus & ulna– specifically humeral trochlear fitting into specifically humeral trochlear fitting into

ulna trochlear notchulna trochlear notch– radial head has a relatively small amount radial head has a relatively small amount

of contact with capitulum of humerusof contact with capitulum of humerus– As elbow reaches full extension, As elbow reaches full extension,

olecranon process is received by olecranon process is received by olecranon fossa olecranon fossa • increased joint stability when fully extendedincreased joint stability when fully extended


JointsJoints

• Ulnar collateral Ulnar collateral ligament is critical in ligament is critical in providing medial providing medial support to prevent support to prevent elbow from abducting elbow from abducting when stressed in when stressed in physical activityphysical activity– Many contact sports & Many contact sports &

throwing activities place throwing activities place stress on medial aspect stress on medial aspect of joint, resulting in of joint, resulting in injuryinjuryManual of Manual of

Structural Structural KinesiologyKinesiology The Elbow and Radioulnar JointsThe Elbow and Radioulnar Joints 6-6-77

JointsJoints

• Ulnar collateral ligament (UCL)Ulnar collateral ligament (UCL)– particularly crucial to high-velocity

sporting activities requiring optimal medial elbow stability like baseball pitching

– compromise of this structure often requires surgery

– “Tommy John procedure” • UCL surgical reconstruction using a tendon

graft such as palmaris longus tendon


JointsJoints

• Radial collateral Radial collateral ligament provides ligament provides lateral stability & is lateral stability & is rarely injuredrarely injured

• Annular ligament Annular ligament provides a sling provides a sling effect around radial effect around radial head for stabilityhead for stability


JointsJoints

• Elbow moves from 0 degrees of Elbow moves from 0 degrees of extension to 145 to 150 degrees of extension to 145 to 150 degrees of flexionflexion


JointsJoints

• Radioulnar joint Radioulnar joint – Trochoid or pivot-type Trochoid or pivot-type

jointjoint– Radial head rotates Radial head rotates

around at proximal ulnaaround at proximal ulna– Distal radius rotates Distal radius rotates

around distal ulnaaround distal ulna– Annular ligament Annular ligament

maintains radial head in maintains radial head in its jointits joint


JointsJoints

• Radioulnar joint Radioulnar joint – Supinate 80 to 90 degrees from Supinate 80 to 90 degrees from

neutralneutral– Pronate 70 to 90 degrees from neutralPronate 70 to 90 degrees from neutral


MusclesMuscles

• Elbow flexorsElbow flexors– Biceps brachiiBiceps brachii– BrachialisBrachialis– BrachioradialisBrachioradialis– Weak assistance Weak assistance

from Pronator teresfrom Pronator teres

• Elbow extensorElbow extensor– Triceps brachiiTriceps brachii– Anconeus provides Anconeus provides

assistanceassistanceManual of Manual of Structural Structural KinesiologyKinesiology The Elbow and Radioulnar JointsThe Elbow and Radioulnar Joints 6-6-1313

MusclesMuscles

• Radioulnar pronators Radioulnar pronators – Pronator teresPronator teres– Pronator quadratusPronator quadratus– BrachioradialisBrachioradialis

• Radioulnar supinatorsRadioulnar supinators– Biceps brachiiBiceps brachii– Supinator muscleSupinator muscle– BrachioradialisBrachioradialis


MusclesMuscles

• AnteriorAnterior– Primarily flexion Primarily flexion

& pronation& pronation• Biceps brachiiBiceps brachii• BrachialisBrachialis• BrachioradialisBrachioradialis• Pronator teresPronator teres• Pronator Pronator

quadratusquadratus


MusclesMuscles

• PosteriorPosterior– Primarily Primarily

extension & extension & supinationsupination• Triceps brachiiTriceps brachii• AnconeusAnconeus• SupinatorSupinator


Biceps Brachii Biceps Brachii MuscleMuscleFlexion of elbowFlexion of elbow


Supination of Supination of forearmforearm

Weak flexion of Weak flexion of shoulder joint shoulder joint

Weak adduction of Weak adduction of shoulder joint shoulder joint when abductedwhen abducted

Brachialis MuscleBrachialis Muscle

True True flexion flexion of elbow of elbow


Brachioradialis MuscleBrachioradialis MuscleFlexion of elbowFlexion of elbow


Pronation from supinated Pronation from supinated position to neutralposition to neutral

Supination from pronated Supination from pronated position to neutralposition to neutral

Triceps BrachiiTriceps Brachii MuscleMuscle

All heads: All heads: extension extension of elbowof elbow


Long head:Long head:extension extension of shoulder of shoulder joint; joint; adduction adduction of shoulder of shoulder joint;joint;horizontal horizontal abductionabduction

AnconeusAnconeus Muscle Muscle


Extension of elbowExtension of elbow

Pronator Teres MusclePronator Teres Muscle


Pronation of Pronation of forearm forearm

Weak flexion Weak flexion of elbow of elbow

Pronator Quadratus MusclePronator Quadratus Muscle


Pronation Pronation of of forearm forearm

Supinator MuscleSupinator Muscle


Supination of Supination of forearmforearm

Elbow FlexionElbow Flexion• Ex. Biceps curlEx. Biceps curl• AgonistsAgonists

– Biceps brachiiBiceps brachii– BrachialisBrachialis– BrachioradialisBrachioradialis


Elbow ExtensionElbow Extension

• EX. Push-upEX. Push-up

• AgonistsAgonists– Triceps brachiiTriceps brachii

• AnconeusAnconeus


Radioulnar PronationRadioulnar Pronation

• AgonistsAgonists– Pronator teresPronator teres– Pronator Pronator

quadratusquadratus– BrachioradialisBrachioradialis


Radioulnar SupinationRadioulnar Supination

• Ex. Tightening a Ex. Tightening a screwscrew

• AgonistsAgonists– Biceps brachiiBiceps brachii– Supinator Supinator

musclemuscle– BrachioradialisBrachioradialis


MusclesMuscles

• ““Tennis elbow" - common problem usually Tennis elbow" - common problem usually involving extensor digitorum muscle near involving extensor digitorum muscle near its origin on lateral epicondyleits origin on lateral epicondyle– known lateral epicondylitisknown lateral epicondylitis– associated with gripping & lifting activitiesassociated with gripping & lifting activities

• Medial epicondylitisMedial epicondylitis– somewhat less commonsomewhat less common– known as golfer's elbowknown as golfer's elbow– associated with medial wrist flexor & pronator associated with medial wrist flexor & pronator

group near their origin on medial epicondylegroup near their origin on medial epicondyle– Both conditions involve muscles which cross Both conditions involve muscles which cross

elbow but act primarily on wrist & hand elbow but act primarily on wrist & hand Manual of Manual of Structural Structural KinesiologyKinesiology The Elbow and Radioulnar JointsThe Elbow and Radioulnar Joints 6-6-2929

Web SitesWeb SitesAmerican Sports Medicine Institute

www.asmi.org/asmiweb/mpresentations/mmp.htm– Biomechanics of the Elbow during Throwing

University of Washington School of Medicinewww.orthop.washington.edu/PatientCare/OurServices/ShoulderElbow.aspx– Information on various upper extremity conditions

Medical Multimedia Groupwww.eorthopod.com/adult-elbow-patient-guides – Elbow Patient Guides

Huei Ming Chaiwww.pt.ntu.edu.tw/hmchai/Kines04/KINupper/Elbow.htm– Functions, stability and joint structure of elbow complex; kinematics,

muscle action and common injuries of the elbowSouthern California Orthopedic Institute

www.scoi.com/teniselb.htm– Tennis elbow information.


http://www.asmi.org/asmiweb/mpresentations/mmp.htm

http://www.orthop.washington.edu/PatientCare/OurServices/ShoulderElbow.aspx

http://www.orthop.washington.edu/PatientCare/OurServices/ShoulderElbow.aspx

http://www.eorthopod.com/adult-elbow-patient-guides

http://www.pt.ntu.edu.tw/hmchai/Kines04/KINupper/Elbow.htm

http://www.scoi.com/teniselb.htm

Web SitesWeb SitesThe Physician and Sportsmedicine

www.physsportsmed.com/index.php?article=886 – Elbow injuries in young baseball players.

American Family Physicianwww.aafp.org/afp/20000201/691.html – Evaluation of overuse elbow injuries.

Loyola University Medical Center: Structure of the Human Bodywww.meddean.luc.edu/lumen/meded/grossanatomy/index.html www.meddean.luc.edu/lumen/meded/grossanatomy/index.html – An excellent site with many slides, dissections, tutorials, etc.,

for the study of human anatomy.Wheeless’ Textbook of Orthopaedics

www.wheelessonline.com – An extensive index of links to the fractures, joints, muscles,

nerves, trauma, medications, medical topics, lab tests, and links to orthopaedic journals and other orthopaedic and medical news.


http://www.physsportsmed.com/index.php?article=886

http://www.aafp.org/afp/20000201/691.html

Web SitesWeb Sites

Arthroscopy.comwww.arthroscopy.com/sports.htm – Patient information on various musculoskeletal problems of

the upper and lower extremities.The Physician and Sportsmedicine

www.physsportsmed.com/index.php?article=1340 www.physsportsmed.com/index.php?article=1340 – Assessment and treatment guidelines for elbow injuries.

National Aeronautics and Space Administrationhttp://ihamedical.com/mesc/rehabworks/basicwristelbow.htmlhttp://ihamedical.com/mesc/rehabworks/basicwristelbow.html– Basic Wrist and Elbow Rehabilitation


Chapter 6 The Elbow and Radioulnar Joints 6-1. The Elbow & Radioulnar Joints Most upper extremity...

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