Elbow Flashcards
Elbow Complex consists of?
- Elbow joint
- Superior (Proximal) Radio-Ulnar joint
(Inferior (Distal) Radio-Ulnar joint)
Functions? ADLs? Of elbow
Prime function is to position the hand
Can change the height and length of the arm
Rotation allows effective positioning
Key for functional tasks (e.g. eating, drinking)
Classification Elbow J, degrees freedom, movements, ART?
Synovial hinge joint
1 degree of freedom
Movements
Flexion
Extension
Articulation between distal end of humerus and proximal end of radius and ulna
[1. Capitulum and radial head
2. Trochlea and olecranon ??]
Radial Collateral Ligament
Ulnar Collateral Ligament
Joint capsule / synovial fluid / hyaline cartilage
Superficial olecranon bursa
Joint capsule Continuous with annular ligament and ulnar and radial collateral ligaments, stregthened posterially by triceps tendn
Superior radio ulnar J, ART? Define types of surfaces and what they allow?
Synovial pivot joint
- It is articulation between the head of the radius and the radial notch of the ulna
- Head of radius, radial notch of ulna - Annular ligament attaches to it
Congruent = stability
Joint line elbow j?
With elbow extended find lateral and medial epicondyles, which are on same level in this position, 1 cm below the lateral epicondyle and 2 cm below the medial epicondyle is the joint line of the elbow sloping downwards and medially.
Joint line Superior radio-ulnar joint (SRUJ)
https://www.youtube.com/watch?v=phfvhoa7pUc
Represented by a vertical line,approx. 1cm long, between the medial edge of the head of the radius; between radial head and the ulna. Palpable posteriorly
Key point: Medial part of radius articulates with lateral part of the ulnar
Find the HOR - ie inbetwen the lat condyle of humerus and the olecrenon .. then get pt to supineate / pronate - feel it moving
With the forearm in pronation the medial aspect of the radius will look like it is lateral.. however if refer back to the anatomical position it is actually medial
Carrying angle due to? Angle / relevance?
Due to the orientation of the trochlear notch
Average angle:
Men: 10-15°
Women: 20-25°
Relevance?
Arms need to clear pelvis in gait
Allows greater ROM in flexion
Mechanical advantage for carrying heavy objects
Anterior Capsule includes?
Weak where?
Elbow Joint
Superior Radio-Ulnar Joint
Continuous with annular ligament and ulnar and radial collateral ligaments
Weak anteriorly and posteriorly
Capsule weak where?
Relatively weak posterially
Strengthened by blending with distal insertion of triceps
Ligaments
=== Collateral ligaments (resist what force?)
Radial Collateral Ligament
Ulnar Collateral Ligament
==== Radial collateral (lateral) Resist varus stress
Ulnar Collateral (medial) Resist valgus stress
Bursa
Superficial olecranon bursa
Can be susceptible to bursitis (‘student’s elbow’) by pressure on elbow (leaning/trauma)
Muscles elbow j
Flexion Biceps brachii (A) Brachialis (B) Brachioradialis (B) Pronator teres (B)
Extension
Triceps (A)
(Anconeus)
Measure ROM elbow J, degrees? End feel?
Fulcrum on lateral epicondyle, fixed arm towards shoulder
Flexion: 140°-160°
Extension: 0° (up to 10° hyperextension)
End feel
Flexion: soft (soft tissue bulk)
Extension: hard (olecranon in olecranon fossa)
Biceps..
Morphology - Fusiform, 2 Heads (short head and long head)
O- Supraglenoid tubercle (Long Head) Corocoid Process (Short head)
I-Radial Tuberosity
[+bicipital aponeurosis into deep fascia on medial part of forearm]
Super man jumps off glencoe and catches corona virus so jumps in a radioactive tube to get rid of it
Action-
Flexion of elbow and shoulder
Supinator of forearm
Nerve - Musculocutaneous
Triceps..
Nerve?
Morphology - Fusiform, 3 Heads (long head, medial head & lateral head)
O- Infraglenoid tubercle (Long Head)
Lateral side (lateral head), of posterior surface of humerus medial side (medial head) of posterior surface of humerus
I-Olecranon process
An infared beam of light shines on glencoe which prevents lattitude from happening in a medevil castle so ole has to cancel his ticket
Action-
Extension of elbow and shoulder
Nerve - Radial
Additional actions of Elbow Flexors
Biceps - Flex elbow and Supinate
Brachioradialis - Mid-prone flexion - hammer head [Lateral supracondylar ridge of the humerus -> Distal radius (radial styloid process)]
(ignore) Brachialis - [anterior surface of the distal half of humerus -> coronoid process and the tuberosity of the ulna]
Superior (Proximal) Radio-Ulnar joint
Synovial pivot joint
Medial aspect of head of radius with ulna
Annular ligament - where? purpose?
- Encirciles the head and neck of radius
2. Provides fexibile support during pro/supination
Joint line of the superior radioulnar joint
(pivot) Key point medial part of radial head articulates with the lateral part of ulnar.. find the groove where you palpate the head of the radius and then draw a line vertically downwards 1cm,
NB: with the forearm in pronation the ‘medial part’ will look lateral
Joint line of elbow joint
(esentially the elbow crease) mention:
- elbow extended
- find lateral / medial epicondyles
- 1cm below lateral epicondyle
- 2cm below medial epicondyle
- NB: it is an oblique line sloping downwards and mediailly
ROM at the elbow + positioning + limiting factor / end feel
Flexion: 140 - 160, supine lying, - tissues / muscle tension / posterior ligaments - soft end feel
Extension: 0 - 10 supine lying, bone olecrenon on olecrenon fossa, hard end feel
PILLOW!!!!!!!!!!
Superior radioulnar joint - movements ROM - positioning - limiting factors / end feel
Pronation: 0 -75, sitting neural (karate)- Firm - soft tissues / ligamentes
Supination: 0 - 85 - sitting neural (karate) - soft tissues / ligamentes
PILLOW!!!!!!!!!!
Muscles used pronation / supination
Pronation.. prone…?
Poronation:
- Pronator teres B
- Pronator quadratus
- Brachioradialis
Terry orders a quad vod and ends up prone..
Supination:
- Supinator B
- Biceps brachii A
- Brachioradialis
Brachioradialis does what re: sup / prone?
Can do either, in the extremes of sup / prone - will act to bring the forearm back into mid range
PAMs at elbow joint - how many? and how? positioning?
PA - arm in extension, stabilise infront of humerous, pt supine, bed at good height, pillow under shoulder,
AP - arm in extension, stablise behind humerous, pillow under shoulder, pt supine, bed at good height
Longitudinal caudad - fix humerous and yank, arm at 90 degrees of flexion
https://www.youtube.com/watch?v=Aa23pcpjYYM
PAM superior radion ulnar joint how many? and how? positioning?
PA - pt supine, arm on pts chest, push on medial aspect where you can palpate movement
AP - pt supine, arm on pts chest, push on lateral aspect, (otherside of radial head to PA)
How to put the biceps on stretch?
Elbow extension, shoulder extension, pronation
How to put the tricpes on stretch?
Shoulder flexion, elbow flextion
Medial epicondyle of humerus Positioning? Where? How? Attachments?
model in sitting (squish.. same as femur)
Slide fingers down medial aspect humerus, obvious bony prominence medial aspect above elbow joint
Provides attachment for; Common flexor tendon
Lateral epicodyle of humerus Positioning? Where? How? Attachments?
model in sitting (squish.. same as femur)
Slide fingers down lateral border of humerus, obvious bony prominence lateral aspect just above elbow joint.
Provides attachment for; Common extensor tendon, Anconeus
Lats extend the shoulder (extensor tendon)
Medial you have to flex to drink mead (flexor tendon)
Olecranon Positioning? Where? How? Attachments?
model in sitting
Posterior aspect of elbow joint, bony prominence, palpate lateral, medial and superior borders with elbow flexed.
Provides attachment for; Triceps
Posterior border of ulna Positioning? Where? How? Attachments?
model in sitting Palpate from the olecranon slide down to head of ulna.
Provides attachment for; ECU, FCU via common aponeurosis
Head of radius Positioning? Where? How? Attachments?
model in sitting
Find lateral epicondyle of humerus and point of olecranon. Palpate in dip midway between these two points, slightly distally. Check by pronating and supinating forearm can feel head rolling under fingers.
Surrounded by annular ligt
