Clinical Anatomy, Kinesiology and

Biomechanics of the Elbow and Forearm

Supplementary Handout
Prepared by: John Andre Perando, PTRP

Bones of the Elbow and Forearm

Joints

Elbow Joint

Articulation between the trochlea and capitulum of the humerus (humeroulnar joint) and the trochlear
notch of the ulna and the head of the radius (humeroradial joint)
Type of Synovial Joint Synovial diarthrodial hinge
Ligaments Lateral collateral ligament complex (lateral collateral ulnar, radial collateral)
Medial collateral ligament (anterior, posterior and transverse fibers)

Osteokinematics
Movements Flexion and Extension
Axis of Rotation X
Plane of Motion Sagittal
Degrees of Freedom 1

Arthrokinematics OKC CKC

Flexion The concave articulating surfaces of
radius and ulna roll and slide
anteriorly on the fixed convex
articular surface of the humerus
Extension The concave articular surfaces of
radius and ulna roll and slide
posteriorly on the fixed convex
articular surface of the humerus
The convex articular surface of the
humerus rolls anteriorly and glides
posteriorly on the fixed concave
articular surface of radius and ulna
The convex articular surface of the
humerus rolls posteriorly and glides
anteriorly on the fixed concave
articular surface of radius and ulna
 Joint Humeroulnar Humeroradial
Loose-packed/Resting Position 70° flexion & 10° supination Full extension and supination
Close-packed Position Full extension and supination 90° flexion & 5° supination
Capsular Pattern Loss of flexion > extension Loss of flexion > extension

Proximal Radioulnar Joint

Articulation Between the circumference of the head of the radius and the annular ligament and the radial
notch on the ulna
Type of Synovial Joint Synovial, diarthrodial, pivot
Ligaments Annular Ligament
Quadrate Ligament

Osteokinematics
Movements Forearm Supination and Pronation
Axis of Rotation Y
Plane of Motion Transverse
Degrees of Freedom 1

Arthrokinematics OKC CKC

Supination The convex surface of the radial head
spins posteriorly within the annular
ligament and the radial notch of the
ulna
Pronation The convex surface of the radial head
spins anteriorly within the annular
ligament and the radial notch of the
ulna
The annular ligament and radial
notch rotates around a fixed radial
head
The annular ligament and radial
notch rotates around a fixed radial
head

Distal Radioulnar Joint

Articulation Between the rounded head of the ulna and the ulnar notch on the radius
Type of Synovial Joint Synovial, diarthrodial, pivot
Ligaments Anterior radio-ulnar ligament
Posterior radio-ulnar ligament

Osteokinematics
Movements Forearm Supination and Pronation
Axis of Rotation Y
Plane of Motion Transverse
Degrees of Freedom 1
 Arthrokinematics OKC CKC
Supination The concave surface of the radius Opposite roll and slide
rolls and slides posteriorly against the
convex surface of the ulna
Pronation The concave surface of the radius Opposite roll and slide
rolls and slides anteriorly against the
convex surface of the ulna

Joint PRU DRU

Loose-packed/Resting Position 70° flexion & 35° supination 10° supination
Close-packed Position 5° supination & full extension 5° supination
Capsular Pattern Limitation: supination = pronation

Summary of stabilizers for the movements at the elbow and forearm

Elbow Flexion Elbow Valgus Varus Distraction External Rotation

Extension Of Radius
MCL (anterior & MCL (anterior MCL* LCL (ulnar Annular Ligament RCL
posterior fibers) fibers) Proximal fibers of collateral Oblique Cord LCL (ulnar
LCL (ulnar wrist flexors ligament)* Brachioradialis collateral
collateral (notably FCU) and RCL (dynamic stabilizer) ligament)
ligament) pronator teres Annular Ligament
(dynamic stabilizers)
Forearm Supination Forearm Pronation
TFCC (palmar capsular ligament) TFCC (dorsal capsular ligament)
Interosseous membrane Biceps brachii and supinator (dynamic stabilizer)
Pronators (dynamic stabilizer)

Muscles of the Arm

Anterior Compartment Posterior Compartment
Biceps Brachii Triceps brachii
Coracobrachialis - Long head
Brachialis - Lateral head
- Medial head

Muscles of the Forearm

Anterior Compartment
Superficial Group:
- Pronator Teres
- Flexor Carpi Radialis
- Palmaris Longus
- Flexor Carpi Ulnaris
Intermediate Group:
- Flexor Digitorum Superficialis
Deep Group:
- Flexor Pollicis Longus
- Flexor Digitorum Profundus
- Pronator Quadratus
Posterior Compartment Lateral Compartment
Superficial Group: Brachioradialis
- Extensor carpi radialis brevis Extensor Carpi Radialis Longus
- Extensor digitorum
- Extensor digiti minimi
- Extensor carpi ulnaris
- Anconeus
Deep Group:
- Supinator
- Abductor Pollicis Longus
- Extensor Pollicis Brevis
- Extensor Pollicus Longus
- Extensor Indicis
Summary of Muscle Actions

ELBOW FLEXORS ELBOW EXTENSORS FOREARM SUPINATORS FOREARM PRONATORS

Brachialis Triceps Brachii Biceps brachii Pronator teres
Biceps Brachii Anconeus Supinator Pronator quadratus
Brachioradialis
Pronator Teres

Interactions of the muscles of the elbow and forearm

Elbow Flexors

Brachialis Biceps Brachii Brachioradialis Pronator Teres

Always recruited in elbow
flexion regardless of
forearm position due to
ulnar attachment
Known as the “workhorse”
of the elbow due to it
having the largest cross-
sectional area among the
elbow flexors and being
single-jointed
Innsertion is closer to the
axis, giving efficient
mobility
Selectively recruited when
task requires elbow flexion
with the forearm supinated
Beyond 100° of flexion or
when the elbow is close to
full extension, the
contractile force becomes
more translatory. This
translatory force provides
joint compression to add
stability to the elbow.
Always recruited against
heavy resistance regardless
of forearm position
Mainly an elbow flexors Weak elbow flexors when
but has limited role in forearm is pronated
forearm pronantion and
supination
Since it inserts far distally
from the humeroulnar joint
axis, some of its force
compresses the joint to
provide additional stability
to the joint

Elbow Extensors

Triceps Brachii Anconeus

Extends the elbow regardless of forearm position
because of ulnar attachment
The triceps acts concentrically to extend the elbow,
eccentrically as a major elbow stabilizer during elbow
flexion, and as a powerful stabilizer of the upper
extremity during any functional closed-chain activity
5x the cross-sectional size of the anconeus and has 2x the
shortening range
Contracts during elbow extension to tighten the loose
posterior elbow capsule, perhaps helping to prevent
pinching of the capsule folds as the olecranon locks into
the olecranon fossa.
Initiates low-load extension
Only 10-15% of extensor force

Medial head is recruited first and usually sufficient for

low loads. If load increases, the lateral then the long head
are recruited
Forearm Supinators

Biceps Brachii Supinator Brachioradialis

A powerful supinator when Sole action is forearm supination Weak supinator when bringing
supination is done: forearm into neutral position from a
With the elbow flexed Always recruited regardless of speed pronated position
Against heavy resistance or load

4 times as effective as Supinator Supplies adequate force when

muscle when flexed at 90 degrees supination is done:
Only 2 times as effective as Supinator 1. Slowly
muscle when the elbow is extended 2. With light resistance
(against resistance). 3. When the elbow is extended

- acts alone during slow supination or

when the elbow is extended.

Forearm Pronators

Pronator Teres Pronator Quadratus Brachioradialis

Main function is forearm pronation Single jointed muscle thus performs Will pronate the forearm from a
but can be recruited in elbow flexion pronation regardless of position supinated position to midposition
when facing heavy load when faced with heavy resistance and
Also acts as a dynamic stabilizer of the when the elbow is flexed
Strongest pronator distal radioulnar joint.

The pronator teres exerts some of its
force to stabilize the proximal
radioulnar joint and works
synergistically with the pronator
quadratus to rotate or pivot the radius
around the ulna during pronation
2/3 the size of the pronator teres
Shortening distance is small
Pronates forearm unaided during
slow and unresisted pronation

OINA

Muscle Origin Insertion Action Innervation

Biceps Brachii
Supraglenoid
- Long Radial Supinator of
tubercle of scapula
Head tuberosity and forearm and
bicipital flexor of Musculocutaneous
aponeurosis elbow joint; nerve
- Short Coracoid process into deep weak flexor of
Head of scapula fascia of shoulder joint
forearm
 Front of lower half Coronoid Flexor of Musculocutaneous
Brachialis
of humerus process of ulna elbow joint nerve

Flexes
forearm at
Lateral Base of styloid elbow joint;
Radial nerve
Brachioradialis supracondylar process of rotates
ridge of humerus radius forearm to
the midprone
position

Triceps Brachii
Infraglenoid
- Long
tubercle of scapula
Head
Upper half of
- Lateral
posterior surface Olecranon Extensor of
Head Radial nerve
of shaft of process of ulna elbow joint
humerus
Lower half of
- Medial posterior surface
Head of shaft of
humerus
Lateral surface
Lateral epicondyle Extends
Anconeus of olecranon Radial nerve
of humerus elbow joint
process of ulna

Lateral epicondyle Neck and shaft Supination of Deep branch of

Supinator
of humerus of radius forearm radial nerve

Pronator Teres
Medial epicondyle
- Humeral Pronation of
of humerus Lateral aspect
Head forearm
of the shaft of Median nerve
Medial border of Flexion of
- Ulnar radius
coronoid process elbow
Head
of ulna

Anterior Anterior
Pronator Anterior surface of Pronates
surface of interosseus branch
Quadratus shaft of ulna forearm
shaft or radius of median nerve
Cubital Fossa

Boundaries Lateral: Brachioradialis

Medial: Pronator Teres
Base: Imaginary line drawn between the 2 epicondyles
Floor: supinator laterally and brachialis medially
Roof: skin and fascia
Contents From medial to lateral: median nerve, bifurcation of the brachial artery into ulnar and radial arteries,
the tendon of biceps muscle, and radial nerve and its deep branch

Mnemonics

Be Right There Always My PT

Lateral to Medial:

Brachioradialis

Radial Nerve

Tendon of Biceps

Artery (Bifurcation of Brachial into Radial and Ulnar)

Median Nerve

Pronator Teres

Label these as practice and for your quick reference