ELBOW JOINT
&
ANASTOMOSIS AROUND ELBOW JOINT
OBJECTIVES
 TO STUDY THE MORPHOLOGY OF THE JOINT.
 MUSCLES ACTING ON THE ELBOW JOINT.
 THE NEUROVASCULAR SUPPLY OF THE JOINT.
 CARRYING ANGLE AND APPLIED ASPECT OF THE JOINT.
 TO KNOW ABOUT ANASTOMOSIS AND COLLATERAL CIRCULATION.
 TO DESCRIBE FORMATION OF ANASTOMOSIS AROUND ELBOW
JOINT.
Elbow Anatomy
 BONES:
 Humerus
 medial epicondyle
 lateral epicondyle
 Radius
 Ulna
 Olecranon
Elbow Joint Articulation
- Elbow consists of 3 articulations:
 Humeroulnar (elbow flexion/extension)
 Humeroradial (forearm pronation/supination)
 Radioulnar (forearm pronation/supination)
INTRODUCTION
Type:
hinge joint, compound synovial type
Articulation:
between lower end of humerus and upper end of radius and ulna
Flexion and Rotation:
biceps muscles in the arm. Ligaments located at the front, back, and sides
of the elbow help stabilize the joint.
CAPSULAR LIGAMENT
 Superiorly it is attached the lower end of the humerus in such a way that it
covers the capitulum, trochlea, radial fossa, coronoid fossa and the
olecranon fossa.
 Inferiomedially it is attached to the margin of the trochlear notch of ulna.
 Inferiolaterally it is attached to the annular ligament of the superior
radioulnar joint.
Medial Ligamentous Structures:
 Medial/Ulnar Collateral Ligament
 Anterior bundle – most discrete segment
 Posterior bundle – thickening of posterior capsule
 Transverse bundle – spans medial border of semilunar notch,
little/no contribution to elbow stability
lateral liagamentous structures:
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Lateral medial / ulnar collateral ligament:
– present in approximately 50% of population.
 Accessory lateral/radial collateral ligament:
- tight only during various stress maneuvers and assists annular ligament
when stress applied to elbow
synovium and bursa:
A synovial membrane envelops the elbow and superior radioulnar articulations
and lubricates the deeper structures of the two joints.
The two main bursae are the bicipital bursae which cushions the tendon when
the forearm is pronated and the olecranon bursae which forms a liquid
cushion.
 MUSCLES ACTING ON JOINT
 Flexion:biceps brachii, brachialis,
brachioradialis, pronator teres.
 Extension: triceps brachii and anconeus.
 Supination: biceps brachii, supinator,
brachioradialis.
 Pronation:pronator teres, pronator quadratus,
anconeus, brachioradialis.
Elbow Anatomy - muscles
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Flexors (3 B’s)
Bicepslong (bicipital groove) and short head (coracoid)
Brachioradialis
Brachialis
Extensors
Triceps
Anconeus
Elbow Flexors:
Biceps Brachii
Origin:
long head - supraglenoid tubercle
short head - coracoid process
Insertion:
radial tuberosity
Action:
elbow flexion
forearm supination
Elbow Flexors:
Brachialis
Origin:
Anterior surface of distal humerus
Insertion:
ulnar tuberosity
Action:
elbow flexion
Elbow Flexors
Brachioradialis
Origin:
lateral supracondylar ridge of humerus
Insertion:
radial styloid process
Action:
elbow flexion
Elbow Extenders
Triceps brachii
Origin:
long head - infraglenoid tubercle
lateral - posterior humerus(above spiral groove)
medial - posterior humerus(below spiral groove)
Insertion:
olecranon process
Action:
elbow extension
 NEUROVASCULAR SUPPLY AND BLOOD SUPPLY: brachial artery and
it’s branches.
 NERVE SUPPLY: musculocutaneous, radial, and median nerves.
Carrying Angle/Cubitus Valgus
 Formed by long axis of humerus and midline of forearm
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COMMON ELBOW PROBLEMS
Male norms – 11-14 degrees
Female norms – 13-16 degrees
Larger angles are considered abnormal
Arthritis:
Common forms of arthritis that can affect the elbow include osteoarthritis,
rheumatoid arthritis, infectious arthritis.
Bursitis:
Bursitis of the elbow, also called olecranon bursitis, occurs as a result of
injury or constant pressure on the elbow (for example, when leaning on a
hard surface).
Fractures:
Falling on an outstretched hand or directly on the tip of the elbow can
result in dislocation and/or several types of fractures, depending on the
fall.
Injury:
Repetitive strain on the elbow can cause inflammation
Elbow Pathology
Tendonitis (epicondylitis)
Medial (golfer’s elbow)
flexor mass
Lateral (tennis elbow)
extensor mass
Grip size
Pressure point
 Elbow Pathology:
 Sprains
 Capsular
 MCL/LCL
 Dislocations
 Rare due to stability
 Almost always posterior
 Bursitis
 Result of direct trauma
 Pad and protect
Anastomosis around elbow joint
The vessels engaged in this anastomosis divided into those situated in
front of and those behind the medial and lateral epicondyles of the humerus.
The branches anastomosing in front of the medial epicondyle are :
 The anterior branch of the inferior ulnar collateral, the anterior ulnar
recurrent (branch of ulnar artery), and the anterior branch of the superior
ulnar collateral
Those behind the medial epicondyle are :
 The inferior ulnar collateral, the posterior ulnar recurrent, and the posterior
branch of the superior ulnar collateral.
The branches anastomosing in front of the lateral epicondyle are :
 The radial recurrent (branch of radial artery) and the anterior descending
(radial collateral) branch of the profunda brachii.
Those behind the medial epicondyle are :
 The inferior ulnar collateral, the posterior ulnar recurrent, and the posterior
branch of the superior ulnar collateral.
The branches anastomosing in front of the lateral epicondyle are :
 The radial recurrent (branch of radial artery) and the anterior descending
(radial collateral) branch of the profunda brachii.
Those behind the lateral epicondyle are:
 The inferior ulnar collateral, the interosseous recurrent, and the radial
collateral branch of the profunda brachii