Chapter 6 Chapter 6 The Elbow and Radioulnar The Elbow and Radioulnar Joints Joints 6- 6-1
Jan 15, 2016
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
Manual of Manual of Structural Structural KinesiologyKinesiology The Elbow and Radioulnar JointsThe Elbow and Radioulnar Joints 6-6-33
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
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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
Manual of Manual of Structural Structural KinesiologyKinesiology The Elbow and Radioulnar JointsThe Elbow and Radioulnar Joints 6-6-55
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
Manual of Manual of Structural Structural KinesiologyKinesiology The Elbow and Radioulnar JointsThe Elbow and Radioulnar Joints 6-6-66
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
Manual of Manual of Structural Structural KinesiologyKinesiology The Elbow and Radioulnar JointsThe Elbow and Radioulnar Joints 6-6-88
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
Manual of Manual of Structural Structural KinesiologyKinesiology The Elbow and Radioulnar JointsThe Elbow and Radioulnar Joints 6-6-99
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
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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
Manual of Manual of Structural Structural KinesiologyKinesiology The Elbow and Radioulnar JointsThe Elbow and Radioulnar Joints 6-6-1111
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
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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
Manual of Manual of Structural Structural KinesiologyKinesiology The Elbow and Radioulnar JointsThe Elbow and Radioulnar Joints 6-6-1414
MusclesMuscles
• AnteriorAnterior– Primarily flexion Primarily flexion
& pronation& pronation• Biceps brachiiBiceps brachii• BrachialisBrachialis• BrachioradialisBrachioradialis• Pronator teresPronator teres• Pronator Pronator
quadratusquadratus
Manual of Manual of Structural Structural KinesiologyKinesiology The Elbow and Radioulnar JointsThe Elbow and Radioulnar Joints 6-6-1515
MusclesMuscles
• PosteriorPosterior– Primarily Primarily
extension & extension & supinationsupination• Triceps brachiiTriceps brachii• AnconeusAnconeus• SupinatorSupinator
Manual of Manual of Structural Structural KinesiologyKinesiology The Elbow and Radioulnar JointsThe Elbow and Radioulnar Joints 6-6-1616
Biceps Brachii Biceps Brachii MuscleMuscleFlexion of elbowFlexion of elbow
Manual of Manual of Structural Structural KinesiologyKinesiology The Elbow and Radioulnar JointsThe Elbow and Radioulnar Joints 6-6-1717
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
Manual of Manual of Structural Structural KinesiologyKinesiology The Elbow and Radioulnar JointsThe Elbow and Radioulnar Joints 6-6-1818
Brachioradialis MuscleBrachioradialis MuscleFlexion of elbowFlexion of elbow
Manual of Manual of Structural Structural KinesiologyKinesiology The Elbow and Radioulnar JointsThe Elbow and Radioulnar Joints 6-6-1919
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
Manual of Manual of Structural Structural KinesiologyKinesiology The Elbow and Radioulnar JointsThe Elbow and Radioulnar Joints 6-6-2020
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
Manual of Manual of Structural Structural KinesiologyKinesiology The Elbow and Radioulnar JointsThe Elbow and Radioulnar Joints 6-6-2121
Extension of elbowExtension of elbow
Pronator Teres MusclePronator Teres Muscle
Manual of Manual of Structural Structural KinesiologyKinesiology The Elbow and Radioulnar JointsThe Elbow and Radioulnar Joints 6-6-2222
Pronation of Pronation of forearm forearm
Weak flexion Weak flexion of elbow of elbow
Pronator Quadratus MusclePronator Quadratus Muscle
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Pronation Pronation of of forearm forearm
Supinator MuscleSupinator Muscle
Manual of Manual of Structural Structural KinesiologyKinesiology The Elbow and Radioulnar JointsThe Elbow and Radioulnar Joints 6-6-2424
Supination of Supination of forearmforearm
Elbow FlexionElbow Flexion• Ex. Biceps curlEx. Biceps curl• AgonistsAgonists
– Biceps brachiiBiceps brachii– BrachialisBrachialis– BrachioradialisBrachioradialis
Manual of Manual of Structural Structural KinesiologyKinesiology The Elbow and Radioulnar JointsThe Elbow and Radioulnar Joints 6-6-2525
Elbow ExtensionElbow Extension
• EX. Push-upEX. Push-up
• AgonistsAgonists– Triceps brachiiTriceps brachii
• AnconeusAnconeus
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Radioulnar PronationRadioulnar Pronation
• AgonistsAgonists– Pronator teresPronator teres– Pronator Pronator
quadratusquadratus– BrachioradialisBrachioradialis
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Radioulnar SupinationRadioulnar Supination
• Ex. Tightening a Ex. Tightening a screwscrew
• AgonistsAgonists– Biceps brachiiBiceps brachii– Supinator Supinator
musclemuscle– BrachioradialisBrachioradialis
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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.
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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.
Manual of Manual of Structural Structural KinesiologyKinesiology The Elbow and Radioulnar JointsThe Elbow and Radioulnar Joints 6-6-3131
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
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