Manual of Structural KinesiologyThe Elbow and Radioulnar Joints6-1 Chapter 6 The Elbow and...

Manual of Manual of Structural Structural KinesiologyKinesiology The Elbow and Radioulnar JointsThe Elbow and Radioulnar Joints 6-6-11

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

JointsJointsManual of Structural KinesiologyManual of Structural Kinesiology

R.T. Floyd, Ed.D, ATC, CSCSR.T. Floyd, Ed.D, ATC, CSCS

Copyright © The McGraw-Hill Companies, Inc. Reprinted by permission.


The Elbow & Radioulnar JointsThe Elbow & Radioulnar Joints

• Most upper extremity movements Most upper extremity movements involve the elbow & radioulnar jointsinvolve the elbow & radioulnar 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

• Radioulnar joint movements may be Radioulnar joint movements may be distinguished from those of the wrist distinguished from those of the wrist


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, & ulna serve as Scapula, humerus, & ulna serve as

proximal attachments for muscles proximal attachments for muscles that pronate & supinate the that pronate & supinate the radioulnar jointsradioulnar joints

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

• Bony landmarksBony landmarks– medial condyloid ridgemedial condyloid ridge– olecranon processolecranon process– coranoid processcoranoid process– radial tuberosityradial tuberosity


BonesBones

• Key bony landmarks Key bony landmarks for wrist & hand for wrist & hand musclesmuscles– medial epicondylemedial epicondyle– lateral epicondylelateral epicondyle– lateral supracondylar lateral supracondylar

ridgeridge


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

• As elbow flexes 20 As elbow flexes 20 degrees or more, its bony degrees or more, its bony stability is unlocked, stability is unlocked, allowing for more side-to-allowing for more side-to-side laxityside laxity

• Stability in flexion is more Stability in flexion is more dependent on the lateral dependent on the lateral (radial collateral (radial collateral ligament) & the medial or ligament) & the medial or (ulnar collateral ligament)(ulnar collateral ligament)


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 injuryinjury


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 jointTrochoid or pivot-type joint– Radial head rotates around at Radial head rotates around at

proximal ulnaproximal ulna– Distal radius rotates around distal Distal radius rotates around distal

ulnaulna– Annular ligament maintains radial Annular ligament maintains radial

head in its jointhead in its 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 Pronate 70 to 90 degrees from

neutralneutral


JointsJoints

• Radioulnar joint Radioulnar joint – Joint between shafts of radius & ulna Joint between shafts of radius & ulna

held tightly together between held tightly together between proximal & distal articulations by an proximal & distal articulations by an interosseus membrane (syndesmosis)interosseus membrane (syndesmosis)•substantial rotary motion between substantial rotary motion between

the bonesthe bones


MovementsMovements

• FlexionFlexion– movement of forearm to movement of forearm to

shoulder by bending the shoulder by bending the elbow to decrease its angleelbow to decrease its angle

• ExtensionExtension– movement of forearm away movement of forearm away

from shoulder by from shoulder by straightening the elbow to straightening the elbow to increase its angleincrease its angle


MovementsMovements

• PronationPronation– internal rotary movement internal rotary movement

of radius on ulna that of radius on ulna that results in hand moving results in hand moving from palm-up to palm-from palm-up to palm-down positiondown position

• SupinationSupination– external rotary movement external rotary movement

of radius on ulna that of radius on ulna that results in hand moving results in hand moving from palm-down to palm-from palm-down to palm-up positionup position


MusclesMuscles

• Elbow flexorsElbow flexors– Biceps brachiiBiceps brachii– BrachialisBrachialis– BrachioradialisBrachioradialis– Weak assistance from Pronator teresWeak assistance from Pronator teres

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


MusclesMuscles

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

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


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


NervesNerves• All elbow & radioulnar joints muscles are innervated All elbow & radioulnar joints muscles are innervated

from median, musculotaneous, & radial nerves of from median, musculotaneous, & radial nerves of brachial plexusbrachial plexus


NervesNerves• Radial nerve - originates Radial nerve - originates

from C5, C6, C7, & C8from C5, C6, C7, & C8– Triceps brachiiTriceps brachii– BrachioradialisBrachioradialis– Supinator (posterior Supinator (posterior

interosseous nerve)interosseous nerve)– Anconeus Anconeus – Sensation to posterolateral Sensation to posterolateral

arm, forearm, & handarm, forearm, & hand


NervesNerves

• Median nerve - derived from Median nerve - derived from C6 & C7C6 & C7– Pronator teresPronator teres– Pronator quadratus (anterior Pronator quadratus (anterior

interosseus nerve) interosseus nerve) – Sensation to palmar aspect of Sensation to palmar aspect of

hand & first three phalanges, hand & first three phalanges, palmar aspect of radial side of palmar aspect of radial side of fourth finger, dorsal aspect of fourth finger, dorsal aspect of index & long fingersindex & long fingers


NervesNerves

• Musculotaneous nerve - Musculotaneous nerve - branches from C5 & C6 branches from C5 & C6 – Biceps brachiiBiceps brachii– BrachialisBrachialis


Biceps Brachii Biceps Brachii MuscleMuscleFlexion of elbowFlexion of elbow

Supination of Supination of forearmforearm

Weak flexion of Weak flexion of shoulder joint shoulder joint


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 . Supination from pronated position to pronated position to neutralneutral


Triceps BrachiiTriceps Brachii MuscleMuscle

Long head:Long head:extension extension of shoulder of shoulder joint joint adduction adduction of shoulder of shoulder jointjoint

All heads: All heads: extension extension of elbowof elbow


AnconeusAnconeus Muscle Muscle

Extension of elbowExtension of elbow


Supinator MuscleSupinator Muscle

Supination of Supination of forearmforearm


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


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


Web SitesWeb SitesAnatomy & Physiology Tutorials

www.gwc.maricopa.edu/class/bio201/index.htmRadiologic Anatomy Browser

http://radlinux1.usuf1.usuhs.mil/rad/iong/index.html– This site has numerous radiological views of the

musculoskeletal system.University of Arkansas Medical School Gross Anatomy for

Medical Students http://anatomy.uams.edu/htmlpages/anatomyhtml/gross.html– Dissections, anatomy tables, atlas images, links, etc.

Loyola University Medical Center: Structure of the Human Body www.meddean.luc.edu/lumen/MedEd/GrossAnatomy/GA.html– An excellent site with many slides, dissections, tutorials, etc.

for study of human anatomy.

http://www.gwc.maricopa.edu/class/bio201/index.htm

http://radlinux1.usuf1.usuhs.mil/rad/iong/index.html

http://anatomy.uams.edu/htmlpages/anatomyhtml/gross.html









http://www.meddean.luc.edu/lumen/MedEd/GrossAnatomy/GA.html


Web SitesWeb SitesWheeless' Textbook of Orthopaedics

www.ortho-u.net/– This site has an extensive index of links to the fractures,

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

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

the upper and lower extremity.Premiere Medical Search Engine

www.medsite.com– This site allows the reader to enter any medical condition and

it will search the net to find relevant articles.

http://www.ortho-u.net/

http://www.arthroscopy.com/sports.htm

http://www.arthroscopy.com/sports.htm

http://www.medsite.com/


Web SitesWeb SitesVirtual Hospital

www.vh.org– Numerous slides, patient information, etc.

http://www.vh.org/

Manual of Structural KinesiologyThe Elbow and Radioulnar Joints6-1 Chapter 6 The Elbow and...

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