OTA Elbow Student Presentation

Elbow (humeroulnar)
Olecranon Fossa
Medial Epicondyle
Lateral Epicondyle
Coronoid Fossa
Olecranon Process
Coronoid Process
Ulnar Tuberosity
Trochlear Notch
Radial Notch
Styloid Process
Radial Tuberosity
Ulnar Notch
Styloid Process
Articular capsule
Ulnar collateral ligament
Radial anular ligament
Radial collateral ligament
Interosseous membrane
Subcutaneous Olecranon Bursae
Subtendinous Olecranon Bursae
Intratendinous Olecranon Bursae
Articular Cartilage: is the smooth, white tissue that
covers the ends of bones where they come
together to form joints. Healthy cartilage in our
joints makes it easier to move. It allows the bones
to glide over each other with very little friction.
Articular Capsule
An articular capsule is an envelope
surrounding a synovial joint. Each Joint capsule
has two parts.
◦ Fibrous layer: the outer fibrous part of the
capsule of a synovial joint.
◦ Synovial membrane: Is the soft tissues found
between the articular capsule and the joint
Mickey Mouse University
Musculocutaneous Nerve: arises from the lateral
cord of the brachial plexus, pierces the
coracobrachialis, and then continues distally
between the brachialis and the biceps.
Supplies muscles of the anterior upper arm.
◦ Biceps Brachii
◦ Brachialis
Median Nerve: is formed in the axilla by the
union of the medial and lateral roots from the
medial and lateral cords of the brachial plexus.
Supplies most of the muscles of the anterior
◦ Pronator teres
◦ Flexor Carpi Radialis
◦ Palmaris Longus
Ulnar Nerve: arises from the medial cord of the
brachial plexus.
◦ Flexor Carpi Ulnaris
Radial Nerve: enters the arm posterior to the brachial
artery, medial to the humerus, and anterior to the long
head of the triceps. Supplies muscles in the posterior
compartments of the arm.
Triceps Brachii
Extensor Carpi Radialis Longus
Extensor Carpi Radialis Brevis
The medial and ulnar supply articular branches to the
elbow joint.
Vascular Supply :
Deep brachial
Recurrent interosseous-Supinator
Anterior interosseous
Posterior interosseous
Median antebrachial
Median cubital
◦ Provides the main arterial supply to the arm and
is the continuation of the axillary artery. It
divides into the ulnar artery and the radial
artery. Used for measuring BP.
Deep Brachial
◦ Branch off of the brachial artery which travels
along the humerus. It supplies blood to most
brachial arm muscles.
◦ Descends through the anterior compartment of
the forearm, deep to the pronator teres muscles.
◦ The radial artery supplies the posterior
aspect of the forearm and the ulnar
artery supplies the anterior aspect.
Convenient for taking pulse
Recurrent interosseous:
◦ supplies the deep layer of the anterior compartment of
the forearm toward the pinky on the ulnar side, including
the flexor digitorum profundus, flexor pollicis longus,
supinator and pronator quadratus muscles.
Anterior interosseous:
◦ The anterior interosseous artery supplies the deep layer of
the anterior compartment of the forearm, including the
flexor digitorum profundus, flexor pollicis longus, and
pronator quadratus muscles.
Posterior interosseous:
◦ passes backward between the oblique cord and the upper
border of the interosseous membrane. It appears between
the contiguous borders of the supinator and the abductor
pollicis longus, and runs down the back of the forearm
between the superficial and deep layers of muscles, to
both of which it distributes branches.
◦ proceeds along the lateral border of the wrist
and the anterolateral surface of the forearm and
◦ Medial side of the forearm and inferior part of
the arm.
Median antebrachial:
◦ ascends in the middle of the anterior aspect of
the forearm
Median cubital:
◦ passes obliquely across the anterior aspect of
the elbow and joins the basilic vein.
◦ begins at the elbow and ends by merging with
the basilic vein to form the axillary vein
Biceps Brachii (Musculocutaneous Nerve)
O: Short head: Coracoid process Long head:
Supraglenoid tubercle of scapula
I: Radial Tuberosity and Bicipital Aponeurosis
A: Supinates forearm, with forearm supinated
flexes forearm, long head flexes arm
Brachialis (Musculocutaneous Nerve)
O: Distal ½ of anterior surface of humerus
I: Coronoid process and ulnar tuberosity
A: Flexes forearm
Triceps Brachii (Radial nerve)
O: Long head: Infraglenoid tubercle
Lateral head: Posterior surface of
humerus superior to radial groove
Medial head: Posterior surface of
humerus inferior to radial groove
I: Proximal end of Olecranon process
A: Extension of the forearm, Long head
extends arm, resists dislocation
Supinator (Radial nerve)
O: Lateral epicondyle, radial collateral nerve and anular ligaments
I: Lateral, posterior and proximal 1/3 of radius
A: Supinates forearm
Pronator teres (Median nerve)
O: Ulnar head: Coronoid process of ulna
Humeral head: Medial epicondyle of humerus
I: Middle of lateral surface of radius
A: Forearm pronation and flexion
Pronator quadratus (Anterior interosseous nerve)
O: Distal ¼ of anterior surface of ulna
I: Distal ¼ of anterior surface of radius
A: Pronates forearm
Flexor Carpi Radialis (Median nerve)
O: Medial epicondyle of the humerus
I: Base of 2nd and 3rd metacarpal
A: Flexes and abducts hand at wrist (radial deviation)
Palmaris Longus ( Median nerve)
O: Medial epicondyle of humerus
I: Flexor retinaculum and palmar aponeurosis
A: Flexes wrist, tenses palmar aponeurosis
Flexor Carpi Ulnaris (Ulnar nerve)
O: Humeral head: medial epicondyle of humerus
Ulnar head: olecranon process and posterior border of ulna
I: Pisiform, hamulus of hamate, base of 5th metacarpal
A: Flexes and adducts hand at wrist (ulnar deviation)
Brachioradialis (Radial nerve)
O: Proximal 1/3 of lateral supra-epicondylar
ridge of humerus
I: lateral surface of distal end of radius
A: Weak flexion of forearm
Extensor Carpi Radialis Longus (Radial nerve)
O: Lateral supra-epicondylar ridge of humerus
I: Dorsal aspect of base of 2nd metacarpal
A: extends and abducts wrist
Extensor Carpi Radialis Brevis (Radial nerve)
O: Lateral supra-epicondylar ridge of humerus
I: Dorsal aspect of base of 3rd metacarpal
A: Extends and abducts wrist
Extensor Digitorum (Posterior Interosseous nerve)
O: Lateral epicondyle
I: Extensor tendons of medial 4 fingers at distal digits
A: Extends fingers (digits 2-5) at MCP, PIP, DIP
Surface Anatomy
Lateral Epicondyle
Medial Epicondyle
Radial Styloid Process
Ulnar Styloid Process
Cubital Fossa
Carrying Angle
Clinical concerns
Tennis Elbow (Lateral Epicondylitis)
oResults from trauma or overuse of the common extensor tendon of the posterior forearm
muscles. Pain arises from lateral epicondyle of humerus. Most often results from repeated
forceful contraction of forearm extensors such as a backhand shot in tennis.
oRest, Ice, painkiller(ibuprofen), stopping activities, or learning new techniques, surgery is a last
Carpal tunnel syndrome
Tendons and median nerve are in the tunnel
formed by the flexor retinaculum. When the
tendons or the median nerve get compressed
in the tunnel, it results in Carpal tunnel
syndrome. Common cause is overuse,
common in people that use the computer. Also
common in females in the last trimester due to
increased water retention resulting in
compression within the carpal tunnel.
Characterized by pain and sometimes sensory
and motor loss of the hand. Treatment
includes splinting, anti-inflammatory drugs
and in severe cases, surgery in which the flexor
retinaculum is incised, opening the carpal
tunnel and relieving pressure.
Things to remember
oThe Elbow is a hinge joint, which means its movement is confined to a single axis, like the hinge
on a door
oThe elbow is an extremely stable joint because:
o The articular capsule is very thick
o The bony surfaces of the humerus and ulna interlock very well, providing a solid bony support
o Multiple strong supporting ligaments help reinforce the articular capsule
oBecause the elbow is extremely stable the tradeoff is that it is not as mobile as other joints,
such as the glenohumeral joint
oMickey Mouse University, PFPF