BIOMCHANICS OI IBOW

COMPIX
BY: R.NITI KH\RANA(PT)
WTho joInfs nnd muscIos of
fho oIbow comIox nro
dosIgnod fo sorvo fho hnnd.
WThoy rovIdo mobIIIfy for
fho hnnd In snco by
nnronf shorfonIng nnd
IongfhonIng of fho uor
oxfromIfy.
W.
W Tho oIbow comIox sfrucfuros
nIso rovIdo sfnbIIIfy for skIIIod
or forcofuI movomonfs of fho
hnnd whon orformIng ncfIvIfIos
wIfh fooIs or ImIomonfs.
W Tho oIbow comIox IncIudos fho
oIbow joInf (humorouInnr nnd
humororndInI joInfs) nnd fho
roxImnI nnd dIsfnI rndIouInnr
joInfs
IBOW JOINT
H\MRO\INAR
AN
H\MRORAIAI
ARTIC\IATIONS
ARTIC\IATING S\RIACS ON TH
H\MR\S
Tho nrfIcuInfIng surfncos on fho nnforIor nsocf of fho dIsfnI
humorus nro :l.TROCHIA
2. CAPIT\I\M
Tho frochIon, whIch forms nrf of fho Lumevou!nuv
uvtIcu!utIon Is sof nf nn nngIo on fho modInI nsocf of fho
dIsfnI humorus nnd IIos sIIghfIy nnforIor fo fho humornI
shnff.
Tho IndonfnfIon In fho humorus Iocnfod jusf nbovo fho
frochIon Is cnIIod fho covonoId Iossu nnd Is dosIgnod fo
rocoIvo fho coronoId rocoss of fho uInn nf fho ond of oIbow
fIoxIon rnngo of mofIon (!OM).
Tho cnIfuIum, IIko fho frochIon, IIos nnforIor fo fho shnff of fho humorus. A
groovo cnIIod THI CAPIT\IOTROCHIAR GROOV sonrnfos fho
cnIfuIum from fho frochIon .
Tho IndonfnfIon Iocnfod on fho humorus jusf nbovo fho cnIfuIum Is cnIIod fho
RAIAI IOSSA nnd Is dosIgnod fo rocoIvo THI HIA OI THI !AI!S In
oIbow fIoxIon. IosforIorIy, fho dIsfnI humorus Is Indonfod by n doo fossn cnIIod
THI OICRANON IOSSA, whIch Is dosIgnod fo rocoIvo fho oIocrnnon rocoss
of fho uInn nf fho ond of oIbow oxfonsIon !OM
ARTIC\IATING S\RIACS ON TH
RAI\S AN \INA
Tho nrfIcuInfIng surfncos of fho uInn nnd rndIus
corrosond fo fho humornI nrfIcuInfIng surfncos .
THI !!A! A!TIC!!ATIC S!!IACI of fho
humorouInnr joInf T!OCH!IA! OTCH.
Tho roxImnI orfIon of fho nofch Is Info fwo unoqunI
nrfs by fho tvocL!euv vIdge, whIch corrosonds fo fho
frochIonr groovo on fho humorus .Tho uInnr CO!OOI
I!OCISS forms fho dIsfnI ond of fho nofch, whorons fho
O!IC!AO I!OCISS rojocfs ovor fho roxImnI ond .
THI !AIA! A!TIC!!ATIC S!!IACI of fho humororndInI joInf Is
comosod of fho roxImnI ond of fho rndIus, known ns fho HA OI TH
RAI\S(If hns n sIIghfIy cu-shnod concnvo surfnco cnIIod fho Ioveu
tLut Is suvvounded by u 72 Tho rndInI hond`s convox rIm fIfs Info fho
CAIIT!!OT!OCH!IA! groovo.
ARTIC\IATION
ArfIcuInfIon bofwoon fho uInn nnd humorus nf fho
humorouInnr joInf occurs rImnrIIy ns n sIIdIng
mofIon of fho uInnr frochIonr rIdgo on fho humornI
frochIonr groovo.
ArfIcuInfIon bofwoon fho rndInI hond nnd fho
cnIfuIum nf fho humororndInI joInf InvoIvos sIIdIng of
fho shnIIow concnvo rndInI hond ovor fho convox
surfnco of fho cnIfuIum. Tho humornI cnIfuIum Is
sIIghfIy smnIIor fhnn fho corrosondIng rndInI fovon,
nnd so fho joInf surfncos nro sIIghfIy Incongruonf
JOINT
CAPS\I
Tho humorouInnr nnd humororndInI
joInfs nnd fho suorIor rndIouInnr joInf
nro oncIosod In n SINGI JOINT
CAPS\I.
ATTACHMNT:
AnforIorIy, fho roxImnI nffnchmonf of fho cnsuIo Is jusf
nbovo fho coronoId nnd rndInI fossno, nnd dIsfnIIy If Is
Insorfod Info fho uInn on fho mnrgIn of fho coronoId
rocoss.
Tho cnsuIo bIonds wIfh fho roxImnI bordor of fho
nnnuInr IIgnmonf oxcof osforIorIy, whoro fho cnsuIo
nssos doo boIow fho nnnuInr IIgnmonf fo nffnch fo fho
osforIor nnd InforIor mnrgIns of fho nock of fho rndIus
!nfornIIy, fho cnsuIo`s nffnchmonf fo fho rndIus
bIonds wIfh fho fIbors of fho InfornI coIInfornI
IIgnmonf (!C!). ModInIIy, fho cnsuIo bIonds wIfh
fIbors of fho modInI coIInfornI IIgnmonf (MC!).
IosforIorIy, fho cnsuIo Is nffnchod fo fho
humorus nIong fho uor odgo of fho oIocrnnon
fossn.
Tho cnsuIo Is fnIrIy !A!CI, !OOSI, nnd WIAK
untevIov!y und postevIov!y, nnd If confnIns
foIds fhnf nro nbIo fo unfoId fo nIIow for n fuII
rnngo of oIbow mofIon.
!nfornIIy nnd modInIIy, fho cnsuIo Is
roInforcod by fho coIInfornI IIgnmonfs. Inf
nds nro Iocnfod bofwoon fho cnsuIo nnd fho
synovInI mombrnno ndjnconf fo fho oIocrnnon,
coronoId, nnd rndInI fossno.
Tho cnsuIo`s synovInI mombrnno IInos fho
coronoId, rndInI, nnd oIocrnnon fossno. If nIso
IInos fho fInf modInI frochIonr surfnco nnd fho
Iowor nrf of fho nnnuInr IIgnmonf.
A frInnguInr synovInI foId Insorfod bofwoon
fho roxImnI rndIus nnd uInn nrfIy dIvIdos
fho oIbow joInf Info fwo joInfs.
IIGAMNTS
Mosf hIngo joInfs In fho body hnvo
coIInfornI IIgnmonfs.
CoIInfornI IIgnmonfs nro Iocnfod on
fho modInI nnd InfornI sIdos of hIngo
joInfs fo rovIdo modInI/InfornI
sfnbIIIfy fo fho joInf nnd fo koo joInf
surfncos In nosIfIon.
Tho fwo mnIn IIgnmonfs nssocInfod
wIfh fho oIbow joInfs nro fho
MIAI (\INAR) AN IATRAI
(RAIAI) COIIATRAI
IIGAMNTS.
MIAI (\INAR) COIIATRAI IIGAMNT
Is consIdorod fo bo fho mnjor soff fIssuo rosfrnInf of
vnIgus sfross nf fho modInI nsocf of fho oIbow.
Tho oIbow joInf`s normnI vnIgus confIgurnfIon subjocfs
fho modInI nsocf of fho joInf fo n hIgh dogroo of vnIgus
sfross, osocInIIy durIng fhrowIng nnd goIfIng .
Tho MC! Is doscrIbod ns consIsfIng of fwo nrfs
(nnforIor nnd osforIor) or fhroo nrfs (nnforIor,obIIquo
or frnnsvorso, nnd osforIor)
THI ATI!IO! IA!T OI THI MC! :
oxfonds from fho nnforIor nsocf, fI, nnd modInI odgo
of fho modInI oIcondyIo of fho humorus fo nffnch on
fho uInnr coronoId rocoss.
Throo nrfs of fho modInI (uInnr)
coIInfornI IIgnmonf nro shown on fho
modInI nsocf of fho rIghf oIbow.
Mochnnorocofors (CoIgI orgnns, !uffInI formInnIs, IncInI
coruscIos, nnd froo norvo ondIngs)nro donsoIy dIsfrIbufod nonr
fho IIgnmonf`s humornI nnd uInnr nffnchmonfs .
Is consIdorod fo bo fho rImnry rosfrnInf of vnIgus sfross from
20 fo l20 of oIbow fIoxIon .
MC! ns hnvIng nn nnforIor bnnd nnd n osforIor bnnd fhnf
fIghfon In n rocIrocnI mnnnor ns fho oIbow fIoxos nnd oxfonds.
THI IOSTI!IO! IO!TIO OI THI MC! :
Ixfonds from fho osforIor nsocf of fho modInI oIcondyIo of
fho humorus fo nffnch fo fho uInnr coronoId nnd oIocrnnon
rocossos.
Tho osforIor MC! IImIfs oIbow oxfonsIon buf Inys n Ioss
sIgnIfIcnnf roIo fhnn fho nnforIor MC! In rovIdIng vnIgus
sfnbIIIfy for fho oIbow .
THI OI!IQ!I (T!ASVI!SI) IIII!S OI THI MC!
Ixfond bofwoon fho oIocrnnon nnd uInnr coronoId rocossos.
ThIs orfIon of fho IIgnmonf nssIsfs In rovIdIng vnIgus
sfnbIIIfy nnd hoIs fo koo fho joInf surfncos In nroxImnfIon
I!CTIO OI MC!
l.SfnbIIIzos fho oIbow ngnInsf vnIgus
forquos
2. !ImIfs oxfonsIon nf fho ond of fho oIbow
oxfonsIon !OM
3. CuIdos joInf mofIon fhroughouf fIoxIon
!OM
4. IrovIdos somo rosIsfnnco fo IongIfudInnI
dIsfrncfIon of joInf surfncos.
IATRAI (RAIAI) COIIATRAI IIGAMNTO\S
COMPIX
IncIudos fho
!C! .
THI !ATI!A! !!A! CO!!ATI!A!
!ICAMIT .
THI A!!A! !ICAMIT.
TH ICI
Is n fnn-shnod sfrucfuro
Ixfonds from fho InforIor nsocf of fho InfornI
oIcondyIo of fho humorus fo nffnch fo fho
nnnuInr IIgnmonf (fho IIgnmonf oncIrcIIng fho
hond of fho rndIus) nnd fo fho oIocrnnon rocoss.
!!C!
!Ignmonfous fIssuo oxfondIng from fho InfornI oIcondyIo fo fho InfornI
nsocf of fho uInnr nnd fho nnnuInr IIgnmonf Is roforrod fo ns fho
!!C! .
ndhoros cIosoIy fo fho suInnfor, oxfonsor, nnd nnconous muscIos nnd
IIos jusf osforIor fo fho !C! .
!!C! Is nof n mnjor rosfrnInf buf confrIbufos fo osforoInfornI
sfnbIIIfy by socurIng fho uInn fo fho humorus. AIso, If mny rovIdo
suorf fo fho nnnuInr
!Ignmonf .
I\NCTIONS :
l. Tho !C! rovIdos roInforcomonf for fho humororndInI nrfIcuInfIon,
offors somo rofocfIon ngnInsf vnrus sfross fo fho oIbow.
2. !C! nssIsfs In rovIdIng rosIsfnnco fo IongIfudInnI dIsfrncfIon of fho
joInf surfncos .
OIson nnd coIIonguos concIudod fhnf fho !C! wns fho rImnry soff
fIssuo rosfrnInf nnd fho !!C! nnd fho nnnuInr IIgnmonf woro
socondnry rosfrnInfs fo combInod forcod vnrus nnd suInnfIon sfrossos
nnd forcod vnIgus sfross.
I\NCTIONS IOR IATRAI COIIATRAI IIGAMNTO\S COMPIX
l.SfnbIIIzos oIbow ngnInsf vnrus forquo.
2. SfnbIIIzos ngnInsf combInod vnrus nnd suInnfIon
forquos.
3. !oInforcos humororndInI joInf nnd nssIsfs In rovIdIng
somo rosIsfnnco fo IongIfudInnI dIsfrncfIon of fho
nrfIcuInfIng surfncos.
4. SfnbIIIzos rndInI hond, fhus rovIdIng n sfnbIo bnso for
rofnfIon.
5. MnInfnIns osforoInfornI rofnfory sfnbIIIfy
6. Irovonfs subIuxnfIon of humorouInnr joInf by socurIng
uInn fo humorus.
?. Irovonfs foronrm from rofnfIng off of fho humorus In
vnIgus nnd suInnfIon durIng fIoxIon from fuIIy oxfondod
osIfIon .
M\SCIS
Tho mnjor fIoxors of fho oIbow
nro :
WTH BRACHIAIIS.
WTH BICPS BRACHII.
WTH BRACHIORAIAIIS.
I!ACHIA!IS:
Tho brnchInIIs Is consIdorod fo bo n mobI!Ity musc!e
bocnuso Ifs InsorfIon Is cIoso fo fho oIbow joInf nxIs.
Ifs MA Is gronfosf nf sIIghfIy moro fhnn l00 of oIbow
fIoxIon, nf whIch Ifs nbIIIfy fo roduco forquo Is gronfosf .
Tho brnchInIIs Is Insorfod on fho uInn, If Is unnffocfod by
chnngos In fho foronrm osIfIon broughf nbouf by rofnfIon of
fho rndIus.
IoIng n ono-joInf muscIo,If Is nof nffocfod by fho osIfIon of
fho shouIdor .
IMC sfudIos, fho brnchInIIs muscIo works In fIoxIon of
fho oIbow In nII osIfIons of fho foronrm, wIfh nnd wIfhouf
rosIsfnnco. If nIso Is ncfIvo In nII fyos of confrncfIons
(IsomofrIc, conconfrIc, nnd occonfrIc) durIng sIow nnd fnsf
mofIons.
THI IICIIS I!ACHI
MobIIIfy muscIo bocnuso of Ifs InsorfIon cIoso fo fho oIbow
joInf nxIs.
Tho Iong hond of fho bIcos brnchII hns fho Inrgosf voIumo
nmong fho fIoxors,
buf fho muscIo hns n roInfIvoIy smnII ICSA .
MA of fho bIcos Is Inrgosf bofwoon 80 nnd l00 of oIbow
fIoxIon nnd, fhoroforo, fho bIcos Is cnnbIo of roducIng Ifs
gronfosf forquo In fhIs rnngo .
Tho MA of fho bIcos Is rnfhor smnII whon fho oIbow Is In
fuII oxfonsIon, nnd mosf of fho muscIo forco Is frnnsInfory
nnd fownrd joInf comrossIon .
Whon fho oIbow Is fuIIy oxfondod, fho bIcos Is Ioss
offocfIvo ns nn oIbow fIoxor fhnn whon fho oIbow Is fIoxod fo
90. Whon fho oIbow Is fIoxod boyond l00, fho frnnsInfory
comononf of fho muscIo forco Is dIrocfod nwny from fho
oIbow joInf nnd, fhoroforo,ncfs ns n dIsfrncfIng or dIsIocnfIng
forco.
Tho funcfIonIng of fho bIcos Is nffocfod by fho
osIfIon of fho shouIdor
Tho bIcos brnchII Is ncfIvo durIng unrosIsfod
oIbow fIoxIon wIfh fho foronrm suInnfod nnd
whon fho foronrm Is mIdwny bofwoon suInnfIon
nnd ronnfIon In bofh conconfrIc nnd occonfrIc
confrncfIons, buf If fonds 349 94 -0 ,.9;0 03 90
1470,72 8 5743,90/.
Whon fho mngnIfudo of fho rosIsfnnco Incronsos
much boyond IImb woIghf, fho bIcos Is ncfIvo In
nII osIfIons of fho foronrm.
THI I!ACHIO!AIA!IS
Tho brnchIorndInIIs Is Insorfod nf n dIsfnnco from fho joInf
nxIs, nnd fhoroforo fho Inrgosf comononf of muscIo forco
goos fownrd comrossIon of fho joInf surfncos nnd honco
fownrd sfnbIIIfy.
Tho brnchIorndInIIs hns n roInfIvoIy smnII monn ICSA (l.2
cm) buf n roInfIvoIy
Inrgo nvorngo onk MA (?.? cm) In comnrIson wIfh ofhor
oIbow fIoxors
Tho onk MA for fho brnchIorndInIIs occurs bofwoon l00
nnd l20 of oIbow fIoxIon. Is unnffocfod by fho osIfIon of fho
shouIdor.
Tho osIfIon of fho oIbow joInf wns found fo nffocf
brnchIorndInIIs muscIo ncfIvIfy onIy durIng voIunfnry
mnxImum occonfrIc confrncfIons. IIbow joInf nngIo hnd no
offocf on conconfrIc, IsomofrIc, or IsokInofIc mnxImum
voIunfnry confrncfIons
Tho ronnfor foros, ns woII ns
fho nImnrIs Iongus, fIoxor
dIgIforum suorfIcInIIs, fIoxor
cnrI rndInIIs, nnd fIoxor cnrI
uInnrIs, Is n wonk oIbow fIoxor
wIfh rImnry ncfIons nf fho
rndIouInnr nnd wrIsf joInfs
Tho fwo oxfonsors of
fho oIbow nro
TH TRICPS
TH ANCON\S
Tho offocfIvonoss of fho frIcos ns n whoIo Is nffocfod by
chnngos In fho osIfIon of fho oIbow buf nof by chnngos In
osIfIon of fho foronrm, bocnuso fho frIcos nffnchos fo fho
uInn nnd nof fho rndIus.
Tho Iong hond`s nbIIIfy fo roduco forquo mny dImInIsh
whon fuII oIbow oxfonsIon Is nffomfod wIfh fho shouIdor
In hyoroxfonsIon.
Tho modInI nnd InfornI honds of fho frIcos, boIng ono-
joInf muscIos, nro nof nffocfod by fho osIfIon of fho
shouIdor.
AII fhroo honds nro ncfIvo whon honvy rosIsfnnco Is
gIvon fo oxfonsIon or whon quIck oxfonsIon of fho oIbow Is
nffomfod In fho grnvIfynssIsfod osIfIon.
MnxImum IsomofrIc forquo gonornfIon Is nf n osIfIon of 90 of oIbow
fIoxIon.
Tho fofnI nmounf of oxfonsor forquo gonornfod nf 90 vnrIos wIfh
fho osIfIon of fho shouIdor.
Tho frIcos Is ncfIvo occonfrIcnIIy fo confroI oIbow fIoxIon ns fho
body Is Ioworod fo fho ground In n .Tho frIcos Is ncfIvo
conconfrIcnIIy fo oxfond fho oIbow whon fho frIcos ncfs In n cIosod
kInomnfIc chnIn, such ns In n ush-u.
Tho ofhor oxfonsor of fho
oIbow, fho nnconous, nssIsfs In
oIbow oxfonsIon nnd
nnronfIy nIso ncfs ns n
sfnbIIIzor durIng suInnfIon
nnd ronnfIon.
SynorgIsfIc ncfIons of oIbow fIoxor nnd oxfonsor
muscIos hnvo boon InvosfIgnfod durIng IsomofrIc
confrncfIons In rosonso fo n vnrIofy of sfrossos,
IncIudIng vnrus sfross, vnIgus sfross, fIoxIon, nnd
oxfonsIon
SynorgIos nro nffocfod by fho dIrocfIon nnd
vnrIofy of sfross, synorgIsfIc ncfIvIfy nIso nonrs
fo bo nffocfod by fho fyo of muscIo confrncfIon
boIng usod (IsomofrIc, conconfrIc, occonfrIc)
MuscIos of fho oIbow woro rosonsIbIo for
movomonf of fho onfIro IInkngo, nnd fho wrIsf
muscIos woro rosonsIbIo for mnkIng fho
corrocfIons fo fho movomonf fhnf woro nocossnry
fo comIofo fho fnsk
I\NCTION: IBOW
JOINT
(H\MRO\INAR AN
H\MRORAIAI
ARTIC\IATIONS)
AXIS OI MOTION
WAxIs for fIoxIon nnd oxfonsIon hns
boon doscrIbod ns boIng n roInfIvoIy
fIxod nxIs fhnf nssos horIzonfnIIy
fhrough fho confor of fho frochIon nnd
cnIfuIum nnd bIsocfs fho IongIfudInnI
nxIs of fho shnff of fho humorus.
WAn oxncf doformInnfIon of fho nxIs of
mofIon nf fho oIbow Is Imorfnnf
bocnuso of fho nood fo osIfIon oIbow
rosfhosos In such n wny fhnf fhoy
corrocfIy mImIc oIbow joInf mofIon.
IONG AXS OI TH H\MR\S AN IORARM
WWhon fho uor oxfromIfy Is In fho
nnnfomIc osIfIon ,fho Iong nxIs of fho
humorus nnd fho Iong nxIs of fho foronrm
form nn ncufo nngIo modInIIy whon fhoy
moof nf fho oIbow .
W Tho nnguInfIon In fho fronfnI Inno Is
cnusod by fho confIgurnfIon of fho
nrfIcuInfIng surfncos nf fho humorouInnr
joInf.
ThIs normnI vnIgus nnguInfIon Is cnIIod fho CARRYING ANGI OR
C\BIT\S VAIG\S .
Tho nvorngo nngIo In fuII oIbow oxfonsIon Is nbouf l5 .
A vnrus nnguInfIon nf fho oIbow Is roforrod fo ns cubItus vuvus und Is
usuu!!y ubnovmu!.
RANG OI MOTION :
Incfors fhnf doformIno fho nmounf of mofIon
fhnf Is nvnIInbIo nf fho oIbow joInf:
WTyo of mofIon
W Tho osIfIon of fho foronrm (roInfIvo
ronnfIon-suInnfIon)
W Tho osIfIon of fho shouIdor.
WTwo-JoInf MuscIo Iffocfs on IIbow !OM
AcfIvo !OM for oIbow fIoxIon 0 l35
Tho rnngo for nssIvo fIoxIon Is bofwoon l50
nnd l60
Ofhor fncfors fhnf IImIf fho !OM buf hoI
rovIdo sfnbIIIfy for fho oIbow nro fho
confIgurnfIon of fho joInf surfncos, fho IIgnmonfs,
nnd joInf cnsuIo .
S\PRIOR
RAIO\INAR
JOINT
Tho nrfIcuInfIng surfncos of fho roxImnI rndIouInnr joInf
IncIudo fho
\!nuv vudIu! notcL
TLe unnu!uv !Igument
TLe cupItu!um oI tLe Lumevus
TLe Leud oI tLe vudIus.
Tho surfnco of fho rndInI nofch Is concnvo nnd covorod
wIfh nrfIcuInr cnrfIIngo. A cIrcuInr IIgnmonf cnIIod fho
nnnuInr IIgnmonf Is nffnchod fo fho nnforIor nnd osforIor
odgos of fho nofch. Tho IIgnmonf Is IInod wIfh nrfIcuInr
cnrfIIngo, whIch Is confInuous wIfh fho cnrfIIngo IInIng of
fho rndInI nofch.
Tho nnnuInr IIgnmonf oncIrcIos fho rIm of fho rndInI
hond, whIch Is nIso covorod wIfh nrfIcuInr cnrfIIngo .
INIRIOR
RAIO\INAR
JOINT
Tho nrfIcuInfIng surfncos of
fho dIsfnI rndIouInnr joInf
IncIudo fho
\!nuv notcL oI tLe vudIus
TLe uvtIcu!uv dIsk
TLe Leud oI tLe u!nu
Tho uInnr nofch of fho rndIus Is Iocnfod nf fho dIsfnI ond of fho rndIus
nIong fho Inforossoous bordor.
TH ARTIC\IAR ISK
Is somofImos roforrod fo ns oIfhor fho tvIungu!uv IIbvocuvtI!uge (TIC)
bocnuso of Ifs frInnguInr shno or ns n nrf of tLe tvIungu!uv
IIbvocuvtI!uge comp!ex (TICC) becuuse oI Its
oxfonsIvo fIbrous connocfIons.
!osomboIs n shoIf whoso modInI bordor Is omboddod In n wodgo of vnscuInr
connocfIvo fIssuo confnInIng fIno IIgnmonfous bnnds fhnf joIn fho dIsk fo fho
uInn nnd nrfIcuInr cnsuIo .
ATTACHMITS:
Tho bnso of fho nrfIcuInr dIsk Is nffnchod fo fho dIsfnI odgo of fho uInnr
nofch of fho rndIus.
Tho nox of fho nrfIcuInr dIsk hns fwo nffnchmonfs. Ono nffnchmonf Is
fo fho fovon on fho uInnr hond. Tho ofhor nffnchmonf Is fo fho bnso of fho
uInnr sfyIoId rocoss.
ModInIIy, fho nrfIcuInr dIsk Is confInuous wIfh fho fIbors of fho uInnr
coIInfornI IIgnmonf, whIch nrIsos from fho sIdos of fho sfyIoId rocoss .
Tho mnrgIns of fho nrfIcuInr dIsk nro fhIckonod nnd nro oIfhor formod by or
nro InfogrnI nrfs of fho dorsnI nnd nImnr cnsuInr rndIouInnr
!Ignmonfs .Tho IIgnmonfs nro fIrmIy nffnchod fo fho rndIus; fho uInnr
nffnchmonfs nro somo whnf Ioss fIrmIy nffnchod.
Tho confrnI nron of fho nrfIcuInr dIsk, whIch Is offon so
fhIn fhnf If Is frnnsnronf.AIso, fho confrnI nron mny bo
orfornfod, nnd fho numbor
of orfornfIons Incronsos wIfh ngo . Is 80nvnscuInr.
Tho nrfIcuInr dIsk hns fwo nrfIcuInfIng surfncos:
W Tho roxImnI (suorIor) surfnco nrfIcuInfos wIfh fho
uInnr hond nf fho dIsfnI rndIouInnr joInf .
Tho dIsfnI (InforIor) surfnco nrfIcuInfos wIfh fho cnrnI
bonos ns nrf of fho rndIocnrnI joInf.
Iofh surfncos of fho nrfIcuInr dIsk nro concnvo.
Tho suorIor surfnco of fho nrfIcuInr dIsk Is dooonod fo
nccommodnfo fho convoxIfy of fho uInnr hond .
fho dIsfnI surfnco Is ndnfod fo nccommodnfo fho cnrnI
bonos .
Tho orIhornI nrfs of bofh fho uInnr nnd cnrnI dIsk
surfncos nro covorod by synovIum comIng from fhoIr
rosocfIvo joInf cnsuIos
IIGAMNTS
Tho fhroo IIgnmonfs nssocInfod wIfh fho roxImnI
rndIouInnr joInf nro
Tho nnnuInr
Qundrnfo IIgnmonfs
Tho obIIquo cord
Tho unnu!uv !Igument Is n sfrong bnnd fhnf forms
four fIffhs of n rIng fhnf oncIrcIos fho rndInI hond
TH Q\ARAT IIGAMNT
Extends Irom the inIerior edge oI the
ulna`s radial notch to insert in the neck oI
the radius.
The quadrate ligament reinIorces the
inIerior aspect oI the joint capsule helps
maintain the radial head in apposition to
the radial notch.
The quadrate ligament also limits the
spin oI the radial head in supination and
pronation.
TH OBIIQ\ COR
WIs n fInf fnscInI bnnd on fho vonfrnI
foronrm fhnf oxfonds from nn
nffnchmonf jusf InforIor fo fho rndInI
nofch on fho uInn fo Insorf jusf boIow fho
bIcIIfnI fuborosIfy on fho rndIus.
WTho fIbors of fho obIIquo cord nro nf
rIghf nngIos fo fho fIbors of fho
Inforossoous mombrnno (Iom)
WTho funcfIonnI sIgnIfIcnnco of fho
obIIquo cord Is nof cIonr, buf If mny
nssIsf In rovonfIng sonrnfIon of fho
!ndIus nnd !Inn.
WThe dorsal and palmar radioulnar ligaments, as
well as the IOM, which stabilizes both proximal
and distal joints, reinIorce the distal radioulnar
joint.
W The dorsal and palmar ligaments are Iormed by
longitudinally oriented collagen Iiber bundles
originating Irom the dorsal and palmar aspects oI
the ulnar notch oI the radius.
W The two ligaments extend along the margins oI
the articular disk to insert on the ulnar Iovea and
base oI ulnar styloid process
The interosseous membrane (IOM)
Located between the radius and the ulna, is a complex structure
consisting oI the Iollowing three components:
W entral band
W A thin membranous portion
W Dorsal oblique cord
THE CENTRAL BAND
described as being a strong, thick, ligamentous or tendinous
structure consisting oI bundles oI Iibers that run obliquely Irom the
radius to the ulna. The central band has a very high collagen content
arranged in Iibrillar structures surrounded by elastin.
The collagen content is more abundant in proximal bundles than it is
in distal bundles.
TH MMBRANO\S PORTION Is
descvIbed us u soIt und tLIn sfrucfuro fhnf
IIos ndjnconf roxImnIIy nnd dIsfnIIy fo fho
confrnI bnnd.
TH ORSAI OBIIQ\ COR Is
consIdeved to bo nrf of fho IOM nnd shouId
nof bo confusod wIfh fho obIIquo cord Iocnfod
on fho vonfrnI nsocf of fho foronrm, whIch Is
nof consIdorod fo bo nrf of fho IOM. Tho
dorsnI obIIquo cord oxfonds from fho roxImnI
qunrfor of fho uInn fo fho mIddIo rogIon of fho
rndIus. Ifs fIbors run counfor fo fho confrnI
bnnd.
I!CTIO OI IOM :
Tho IOM mnInfnIns snco bofwoon fho rndIus
nnd uInn durIng foronrm rofnfIon .
nccordIng fo nn M!I sfudy by nknmurn nnd
nssocInfos, fho confrnI bnnd romnIns fnuf
fhroughouf foronrm rofnfIon, nnronfIy fo koo
fho rndIus nnd uInn from sInyIng nnrf . In
confrnsf, fho mombrnnous orfIon of fho IOM
ovIdoncod wnvy doformnfIons nf mnxImum
suInnfIon & In noufrnI osIfIon,doformnfIons
nIso occurrod nround fho obIIquo cord nf
mnxImum ronnfIon.
WIOM protects the proximal radioulnar joint by transIerring some
oI the compressive loads at the distal radius to the proximal ulna.
WThe IOM maintains transverse stability oI Iorearm during
compressive load transIer Irom the hand to the elbow .
W Maximum strain in the Iibers oI the central band was Iound to
occur when the Iorearm was in a neutral position (midway
between supination and pronation).
WThe IOM transIers loads Irom the wrist to the proximal Iorearm
via Iibers that run Irom the proximal radius to the distal ulna.The
Iibers in the central band are relaxed in both Iull supination and
Iull pronation.
WThe IOM provides stability Ior both the superior and inIerior
radioulnar joints.
A tract extends Irom the interosseus membrane and
inserts in the distal radioulnar joint capsule between the
tendon sheaths oI the EDM and the E& muscles.
The tract`s deep Iibers insert directly into the articular
disk (triangular Iibrocartilage).
The tract oI the interosseus membrane is taut in pronation
and loose in supination.
The articular disk also provides stability Ior the inIerior
radioulnar joint by binding the distal radius and ulna
together.
The distal radioulnar joint capsule, which is a separate
entity Irom the triangular Iibrocartilage,can be a source oI
limitation oI motion when it is
invaded by scar tissue aIter wrist injuries.
M!SC!IS
Tho rImnry muscIos nssocInfod wIfh fho
rndIouInnr joInfs nro :
TLe pvonutov teves,
Pvonutov quudvutus
BIceps bvucLII
SupInutov.
Another group oI muscles that are active during
supination and pronation, especially when
gripping is involved and during resisted motion,
include
WThe Ilexor carpi ulnaris
WE&
WThe brachioradialis,
WThe Ilexor carpi radialis
W E#.
WThe anconeus muscle may also play a role in
supination and pronation .
&NCTION:
RADIO&LNAR
1OINTS
AXIS OI MOTION
Tho nxIs of mofIon for ronnfIon nnd suInnfIon
Is n IongIfudInnI nxIs oxfondIng from fho confor
of fho rndInI hond fo fho confor of fho uInnr hond
In suInnfIon, fho rndIus nnd uInn IIo nrnIIoI fo
ono nnofhor, whorons In ronnfIon, fho rndIus
crossos ovor fho uInn .
Thoro Is vory IIffIo mofIon of fho uInn durIng
ronnfIon nnd suInnfIon.
The ulnar head moves distally and
dorsally in pronation and proximally
and medially in supination. ThereIore,
at the distal radioulnar joint, the ulnar
head glides in the ulnar notch oI the
radius Irom the dorsal lip oI the ulnar
notch in pronation to a position on the
palmar aspect oI the ulnar notch in Iull
supination .
RANG OI MOTION
Tho !OM of ronnfIon nnd suInnfIon Is nssossod
wIfh fho oIbow In 90 of fIoxIon.
ThIs osIfIon of fho oIbow sfnbIIIzos fho humorus
so fhnf rndIouInnr joInf rofnfIon mny bo
dIsfInguIshod from rofnfIon fhnf Is occurrIng nf
fho shouIdor joInf.
Whon fho oIbow Is fuIIy oxfondod, ncfIvo
suInnfIon nnd ronnfIon occur In conjuncfIon
wIfh shouIdor rofnfIon.
WLimitation oI pronation when the
elbow is extended may be caused by
passive tension in the biceps brachii.
WPronation in all elbow positions is
limited by bony approximation oI the
radius and ulna and by tension in the
dorsal radioulnar ligament and the
posterior Iibers oI the ML oI the
elbow.
W$upination is limited by passive tension in
the palmar radioulnar ligament and the
oblique cord.
W The quadrate ligament limits spin oI the
radial head in both pronation and
supination, and the annular ligament helps
to maintain stability oI the proximal
radioulnar joint by holding the radius in
close approximation to the radial notch.
M\SCI ACTION
WThe pronators produce pronation by exerting a
pull on the radius, which causes its shaIt and
distal end to turn over the ulna .
WThe pronator teres has its major action at the
radioulnar joints, but the long head, as a two-joint
muscle, plays a slight role in elbow Ilexion.
WThe pronator teres contributes some oI its Iorce
toward stabilization oI the proximal radioulnar
joint, inasmuch as the muscle`s translatory
component helps maintain contact oI the radial
head with the capitulum.
WThe pronator quadratus, a one-joint muscle, is
unaIIected by changing positions at the elbow.
WThe pronator quadratus is active in unresisted
and resisted pronation and in slow or Iast
pronation.
W The deep head oI the pronator quadratus is
active during both resisted supination and
resisted pronation and is thought to act as a
dynamic stabilizer to maintain compression oI
the distal radioulnar joint
WThe supinators, act by pulling the shaIt and distal end oI the
radius over the ulna.
W The supinator muscle may act alone during unresisted slow
supination in all positions oI the elbow or Iorearm.
WThe supinator also can act alone during unresisted Iast supination
when the elbow is extended.
WActivity oI the biceps is always evident when supination is
perIormed against resistance and during Iast supination when the
elbow is Ilexed to 90.
W As the Iorearm moves into pronation, its supination torque
increases and reaches a maximum at about 20 oI pronation.
W The biceps has been Iound to exert Iour times as much supination
torque with the Iorearm in the pronated position than in other
Iorearm positions.
STABIIITY
MuscuInr suorf of fho dIsfnI rndIouInnr joInf Is
nffrIbufod fo fho ronnfor qundrnfus nnd fho IC!
fondon .
AccordIng fo !InschoId, fho uInnr hond of fho ronnfor
foros mny hoI by bIndIng fho uInn fo fho rndIus whIIo
fho humornI hond dorossos fho uInn durIng
ronnfIon.
Tho doo hond of fho ronnfor qundrnfus Is ncfIvo
fhroughouf suInnfIon nnd ronnfIon nnd fhoroforo Is
fhoughf fo rovIdo dynnmIc sfnbIIIznfIon for fho dIsfnI
rndIouInnr joInf.
The E& muscle exerts a depressive Iorce on the dorsal
aspect oI the ulnar head as the tendon is stretched over
the head during supination.
Tension in the tendon helps to maintain the position oI
the ulnar head during both supination and pronation .
The E# also provides support Ior the Iorearm, as
evidenced by the maximum voluntary eIIort (MVE) in
the E# that occurs in both supination (26 to 43
MVE) and pronation torques (27 to 55 MVE).
The E# appears to act both as a stabilizer to the
Iorearm Ior gripping during pronation torques
(depending on Iorearm angle) and as a prime mover Ior
wrist extension Ior supination torques .
Ligamentous support oI the distal radioulnar joint is
provided by the dorsal and palmar radioulnar ligaments
and the IOM and its tract, and the articular disk provide
ligamentous support oI the distal radioulnar joint.
The dorsal radioulnar ligament becomes taut in
pronation, whereas the palmar radioulnar ligament
becomes taut in supination .
According to $chiend,70 the radioulnar ligaments have
limited cross-sectional areas and low structural stiIIness,
but they are able to prevent separation oI the radius
Irom the ulna during loading and also allow Ior Iorce
transmission Irom the radius to the ulna through the
WThoso IIgnmonfs do nof nugmonf IongIfudInnI
sfnbIIIfy.
WThoy nIIow nroxImnfoIy 5 mm of Iny bofwoon
fho rndIus nnd uInn boforo rovIdIng rosIsfnnco fo
furfhor dIsfrncfIon.
W Tho rndIouInnr IIgnmonfs, fho nrfIcuInr dIsk,
nnd fho ronnfor qundrnfus mnInfnIn fho uInn
wIfhIn fho uInnr nofch nnd rovonf fho uInn from
subIuxnfIng or dIsIocnfIng.
WThoso IIgnmonfs nIIow n hIgh dogroo of mobIIIfy.
WTho IOM rovIdos sfnbIIIfy for fho dIsfnI joInf by
bIndIng fho rndIus nnd uInn fogofhor.
$kahen and coworkers, the IOM in combination with the
triangular Iibrocartilaginous complex provide important
longitudinal stabilization. MarkolI and associates studied
radioulnar load sharing at the wrist and elbow with the
elbow in varus, valgus, and neutral positions.
When the elbow was in the varus position (no contact
between the radial head and capitulum), Iorce was
transmitted Irom the distal radius through the IOM to the
proximal ulna .
When the elbow was in the valgus position (contact
between the radial head and the capitulum), the Iorce
was transmitted through the radius.
WThe articular disk acts as a cushion
in allowing compression Iorce
transmission Irom the carpals to the
ulna and acts as a stabilizer oI the
ulnar side oI the carpals.
WAlso, the disk assists in the
transmission oI compressive Iorces
Irom the radius to the ulna.
MOBIIITY AN STABIIITY:
IBOW COMPIX
unctional Activities :
The joints and muscles oI the
elbow complex are used in almost
all activities oI daily living such
as dressing, eating, carrying, and
liIting .
RIATIONSHIP TO TH HAN AN
WRIST
Tho dosIgn of fho rndIouInnr joInfs onhnncos fho mobIIIfy of
fho hnnd.
Tho comIofo sonrnfIon of fho uInnfrom fho cnrnIs by fho
nrfIcuInr dIsk nnd fho formnfIon of n fruo dInrfhrodInI joInf
IInod wIfh nrfIcuInr cnrfIIngo nro fonfuros fhnf ormIf
ronnfIon nnd suInnfIon fo occur In ovory osIfIon of fho
hnnd fo fho foronrm.
IronnfIon nnd suInnfIon of fho foronrm, whon fho oIbow Is
fIoxod nf 90, rofnfos fho hnnds so fhnf fho nIm fncos oIfhor
suorIorIy or InforIorIy.
Tho mobIIIfy nffordod fho hnnd Is nchIovod nf fho oxonso
of sfnbIIIfy bocnuso fho movnbIo foronrm Is unnbIo fo
rovIdo n sfnbIo bnso for nffnchmonf of fho wrIsf nnd hnnd
muscIos.
Thoroforo, mnny of fho muscIos fhnf ncf on fho wrIsf nnd
hnnd nro nffnchod on fho dIsfnI ond of fho humorus rnfhor
fhnn on fho foronrm
IICTS OI AG AN INJ\RY
Age :
Tho docronso In muscIo sfrongfh fhnf
nccomnnIos IncronsIng ngo nonrs fo bo
nffocfod by fho fyo of muscIo ncfIon InvoIvod
InJuvy :
InjurIos fo fho oIbow nro fnIrIy froquonf, nnd In
onrIy ndoIosconco fho oIbow Is ono of fho mosf
common sIfos for nohysIfIs or sfrnIns nf fho
nohysIs .
COMPRSSION INJ\RIS
!osIsfnnco fo IongIfudInnI comrossIon forcos nf
fho oIbow Is rovIdod for mnInIy by fho confncf of
bony comononfs; fhoroforo, oxcossIvo
comrossIon forcos nf fho oIbow offon rosuIf In
bony fnIIuro. InIIIng on fho hnnd whon fho oIbow
Is In n cIoso-nckod (oxfondod osIfIon mny rosuIf
In fho frnnsmIssIon of forcos fhrough fho bonos of
fho foronrm fo fho oIbow).
If fho forcos nro frnnsmIffod fhrough fho rndIus,
ns mny hnon wIfh n concomIfnnf vnIgus sfross,
n frncfuro of fho rndInI hond mny rosuIf from
Imncf of fho rndInI hond on fho cnIfuIum .
Muscle contractions also may cause high
compressionIorces at the elbow. For example, during
the acceleration and deceleration phases oI baseball
pitching,the compression Iorces at the elbow can
attain 90 oI body weight.
Nerve compression, bony Iracture, or dislocation
may also result Irom muscle contractions.
#epetitive IorceIul contractions oI the Ilexor carpi
ulnaris muscle may compress the ulnar nerve as it
passes through the cubital tunnel between the medial
epicondyle oI the humerus and olecranon process oI
the ulna
ISTRACTION INJ\RIS
!Ignmonfs nnd muscIos rovIdo for rosIsfnnco of
fho joInfs of fho oIbow comIox fo IongIfudInnI
frncfIon. A fonsIIo forco of suffIcIonf mngnIfudo
oxorfod on n ronnfod nnd oxfondod foronrm mny
cnuso fho rndIus fo bo uIIod InforIorIy ouf of fho
nnnuInr IIgnmonf. ThIs Injury Is common In
young chIIdron youngor fhnn 5 yonrs nnd rnro In
nduIfs .
Tho Injury Is roforrod fo ns oIfhor nuvsemuId's
e!bow ov "pu!!ed e!bow .
VAR\S/VAIG\S INJ\RIS
Distraction and compression
Iorces are created iI either one oI
the collateral ligaments is
overstretched or torn. II one side
oI the joint is subjected to
abnormal tensile stresses, the
other side is subjected to
abnormal compressive Iorces .
For example, the ML is subjected to tensile stress
during the backswing or 'cock-up portion oI throwing a
ball . II the stress on the ML is repetitive,
such as in baseball pitching, the ligament may become
lax and unable to reinIorce the medial aspect oI the joint.
The resulting medial instability may cause an increase
in the normal carrying angle and excessive compression
on the lateral aspect oI the joint so that the radial head
impacts on the capitulum.
II the abnormal compression Iorces on the articular
cartilage are prolonged, these Iorces may interIere with
the blood supply oI the cartilage and result in avascular
necrosis oI the capitulum
Other conditions that may occur in the throwing elbow include
ulnar neuritis, Ilexor-pronator muscle strain or tendinitis, and
medial epicondylitis .
MEDIAL TENDINITIS OR MEDIAL EPICONDYLITIS
may be caused by IorceIul repetitive contractions oI the
pronator teres, the Ilexor carpi radialis, and, occasionally, the
Ilexor carpi ulnaris.
The classic TENNIS ELBOW (EPICONDYLITIS O THE
LATERAL EPICONDYLE) appears to be caused by repeated
IorceIul
contractions oI the wrist extensors, primarily the
E#, although Fairbank and orelett suggested
that the ED muscles may also be involved. The tensile
stress created at the origin oI the E# may cause
microscopic tears that lead to inIlammation oI the lateral
Epicondyle.