Elbow Joint

i s a synovial joint composed of three elbow joint articulations:

a. the trochlea and ulna
b. capitellum and the radial head
C.. proximal ulna and radius

elbow joint has prominent joint recesses located in the coronoid

and radial fossae anteriorly and within the olecranon fossa
posteriorly
Within each joint recess exists an intracapsular but extrasynovial
fat pad, which becomes displaced with joint distention
MEDIAL ELBOW joint
-is stabilizedby the ulnar collateral ligament,
which the anterior band extends anteriorly to the
sublime tubercle of the ulna- is the most important
Other components of the ulnar collateral ligament:
posterior and oblique bands.
 Td/ l d Sa
9.

Ulnar collateral Ligament

Medial epicondyle

Anular
ligament Anterior band
Sublime Tubercle

Middle band

L Oblique band
of ulnar
Posterior band
collateral
Anterior band ligament
Posterior band
Eiaure n Diaorammaticillustration ofthe suhlimatuhercda
Laterally Elbow
isstabilized by the radial collateral ligament complex
composed of the radial collateral ligament
annular ligament
smaller accessory radial collateral ligament
-
lateral ulnar collateral ligament
the lateral epicondyle to insert the crista
-extends from on

supinator of the proximal ulna

 Medial epicondyle

Anular
ligament Anterior band
Sublime Tubercle

Middle band

Oblique band
of ulnar
Posterior band
collateral
Anterior band ligament
Posterior band

Figure a Diacrammaticillustration blimetubercie

Radial Collateral Ligament-
- triangular

-
attached apex to the lateral epicondyle of the humerus
and by its base to the upper margin of the annular ligament
 Lateral Elbow Ligaments

Radial
collateral
ligament
Annular AccessorY
ligament Colateral
Ligament Tuberosity of Anular
radius ligament

Joint
capsule
Arbaular
capsule

Radial collateral
ligament
Lateral ulnar collateralligament
Right elbow: anterior view
Humerus

Joint capsule
Lateral epicondyle- -Medial epicondyle

-
Ulnar collateral ligament
Radial collateralligament
Anular ligament of radius
Quadrate ligament
Insertion of brachialis muscle
Biceps brachii tendon

Radius Ulna
Medial epicondyle

Synovlal membrane

Olecranon
Synovial membrane
Anular ligament
ANTERIOR ELBOW JOINT
-the brachialis inserts on the ulna
biceps brachii tendon inserts on the radial tuberosity
Biceps Brachi
dual insertion exists where the short head is superficial and
inserts more distal relative to the long head on the radial tuberosity
 Long head
of biceps
muscle

Short head
of bicep:
muscle

Long h e a d
distal tendon

Lacertus
fibrosus

Short head
distal tendon
MEDIAL ELBOW
Medial epicondyle
-
inserts the conmmon flexor tendon
-
flexor
carpi radialis
-palmaris longus
flexor carpi ulnaris
-

flexor digitorum superficialis

Common Flexor Tendon

Pronator teres
Flexor carpt
Biceps Pronalor teres
radialis
(humeral head)

Paimans
Common flexor tendon
LacerntusfbrosuS- ongus
Flexor carpi uinaris

Pronator teres Flexor dagitorum

humeral head)1 Superficialis

Pronator teres ** Palmaris longus

(uinar head) Flexor Flexor caroi
-

Flexor carp radialis digitorum uinans

Superticialis
LATERAL ELBOW
Lateral Epicondyle
-
Common Extensor Tendon is inserted
-extensor carpi radialis brevis -- MOST ANTERIOR

-extensor digitorum
-extensor digiti minimi
extensor carpi ulnaris
Common Extensor Tendon

Extensor carpi
radialis longus
Extensor carpi
radialis brevis

Common
extensor
tendon
Extensor Extensor Extensor
carpi ulnaris digiti minirni digitor um
comunis
POSTERIOR ELBOw
triceps brachii inserts on the olecranon process of the
-

proximal ulna over which is located the olecranon bursa

Long heads of the triceps brachii
-

represent the most superficial layer of the distal triceps

Medial Head - deep with a relatively shorter tendon

Anconeus
-located between the olecranon process and the lateral
epicondyle of the humerus
 Infraglenoid
tubercle.

Lateral heada
Long h e a d -

Triceps t e n d o n
D e e p medial
head
Medial h e a d

Olecranon Anconeus
mucle
 space between the olecranon process of the ulne and the medial
epicondyle is bridged by the cubital tunnel retinaculum ( Osborne
fascia)
-
contains the ulnar nerve
just distal to this, the ulnar nerve enters the true cubital
tunnel-between the dual origins of the flexor carpi ulnaris and
deep to the arcuate ligament.
 Cubital tunnel

Bicepsm
Brachial a.< Triceps m
Medal epteende & median n.

Lrar a

Arcade of
Struthers
Medial
intermuscular
septum

ULNAR NERVE
Flexor-pronator Med.
ep
mass
Articular branch

f r cara srurs Arcuate ugaTd of nborne

1 Flexor carpit
unarism Olec
Cubital tunnel retinaculum
(Osborne 's ligament)

Fioure1:listrationshnwino.cuhitaltunnelwathadistalenit Reorintedwith
Motor branch
Osborne's fascia to FCU
 Proximal Radioulnar Joint

Between the circumference of the

head of the radius and the annular Trochlaar notch
ligament and the radial notch of Radial notch of ulna Coroncid process
the ulna Radal nctch ol una
Pivot joint Head Uinar tubercsily
Neck
Ligament: annular ligament
attached to the anterior and
posterior margin of the radial Radial tuberosity
notch on the ülna
forms a collar around the
-

head of the radius

-

Continuous above with the

capsule of the elbow joint
not attached to the radius
-

Interosseous -Ulina
Movement: pronation, Supination idgos
 Proximal Radioulnar Joint

Type: Uniaxial pivot joint. Anular ligament

Articulating surfaces
Circumference of the radial head Oblique cord

Fibro-osseous ring formed by

ulnar radial notch & annular Una

ligament
Interosseous
membrane
 Supinatioon Pronation

Head of Olecranon
process of
the radius ulna

Proximal
radioulnar
joint

Movement:

Supination Pronation
pronation

Supination

A Supine position B Prone position

Source: Outton Mi Dutton's Orthopaedic Examination, Evauation, and intervention. 3rd Edition:
ww.accessphysiotherapy.com
Copyught The McGra Hil Companies Inc Allvights reserved.
Cubital Fossa

a depression on the anterior aspect of the elbow

i t is a space filled with a variable amount of fat anterior to the
most distal part of the humerus and the elbow join
Three boundaries of the triangular cubital fossa:
imaginary line connecting the medial and lateral
a.
Superiorly -
an
epicondyles
b. Medially- mass of flexor from
muscles of the forearm arisingmost
thecommon flexor attach ment on the medial epicondyle;
specifically, the pronator teres.
 C. Laterally the mass of extensor muscles of the forearm arising
from the lateral epicondyle and supraepicondylar ridge;
specifically, the brachioradialis
most

Floor ofthe cubital fossa formed by the brachialis and

supinator muscles of the arm and forearm
Roof ofthe cubital fossa- formed by the continuity of brachial and
antebrachial (deep) fascia reinforced by the bicipital apo- neurosis,
subcutaneous tissue, and skin
Contents of the Cubital Fossa

Terminal part of the brachial artery and the commencement of its

terminal branches, the radial and ulnar arteries
The brachial artery lies between the biceps tendon and the
median nerve.
(Deep) accompanying veins of the arteries
Biceps brachii tendon
Median nerve
Radial nerve, deep between the muscles forming lateral
boundary of the fossa (the brachioradialis)
Superficially i n the subcutaneous tissue overlying the cubital
fossa are the
1. median cubital vein -

lying anterior to the brachial artery

2. medial and lateral cutaneous nerves of the forearm, related
to the basilic and cephalic veins
 Skin and subcutaneous
tissue
Cephalic vein Brachial fascia- Medial cutaneous
of am
covering biceps nerve of farearm
brachii Basilic vein
Basilic vein of am
of arm
-Median
Cephalic vein Cubital lymph
of am node
Cubital fossa cubital vein
Median
Lateral cutaneous cubital vein
nerve of foream
Medial Basilic veun of
Cephalic vein-
of foream epicondyle forearm
Median Pertoratng vein
Median antebrachial
antebrachial BicIpitai
vein aponeuroSIs
vein (median Basilic vein
ven of Anteorachiai
of torearm
forearm) ascia
Cephalic vein
of torearm

(A) (B)
Anterior views

FIGURE 6.55. Suface anatomy of cubutal fossa

 Cubital Fossa

Superior border CUBITAL FOSSA

Transverse ine between
Medial border the medial and lteral
Superior bordeer
(Epicondylar line)
Pronator teres epcondyles of the rumenus
Radial narve Brachial artery

Biceps tendon Brachial vein

Mecian nerve
Medial border
Superficial radialnerve (Pronator teres)

Lateral Medial

Cubital fossa Lateral border Lateral border Utnar vein

Brachioradiels (Brachioradialis) Ulinar artery

Deep radial nerve

Radial artery

Radal voin

Radiopaodia org

K F
 -Humerus

Lateral adiograph

Humenus

-Olecranon fosa
Medial epcondye -

Olecranon
Lateral epicondyle
-Captulum
Trocheaohumernus- -Captulum
Head of radius
Coonoid proces of uir
Head of tadus Radius- -Laterai epicondyle

eck of radus -Trochiear notch

Coronoid proces of uina-

Uina- -Olecranon
Racia. tuberosty

Ute Rad us
ELBOW DISLOCATIONS - Humerus

-
common ; usually Radius
posterior
- posterior dislocations
common in children parts of
the bones that stabilize the
joints are incompletely SEIF &ASSOCATES, INNC.

developed Ulna
Fig. 49.33 A type 1 Monteggia fracture with anterior dislocation of the
Distal forearm

BT
A
BR PT

B
Biceps Brachii

B
FIGURE 4-5 Biceps brachii: mnedial approach.A, Coronal-
bliguuebiceps
distal imaging over the medial
brachii tendon
elbow shows (B) the
(arrowheads) and radial
t baresitv R)
Ulnar Collateral Ligament /Ulnar Nerve

IGURE 4-5 Ulnar collateral ligament and common

flexor tendon evaluation. A, Coronal imaging over
the medial elbow shows (B) the anterior band of the
ulnar collateral ligament (arrowheads), the common B
flexor tendon (arrows) and musculature (M), the
medial epicondyle (E), trochlea (T), and uina (U).
FASCIA OF THE FOREARM

ANTEBRACHIAL FASCIA
Deep fascia surrounding the compartments of the forearm
Sends intermuscular septa into the forearm to divide the forearm
muscles into an anterior fascial compartment and aposterior
fascial compartment
Each fascial compartment will have its own set of muscles,
which has similar functions and innervations.
Fascia of Arm and Forearm

Doltoid f a s c i a

Pectoni tancia

Bracial fada

antebrachia1 Bicipital
fascia aponourosis

Patnar
carpal
igament
endon off
pamars iongus

Superfical Paimar
transversse
aponeurosis
motacarpal
gament
MUSCLES OF THE FOREARM

ANTERIOR MUSCLES OF THE FOREARM

The anterior muscles of the forearm are known as the flexor
pronator muscles.
o These muscles are further grouped into three -

SUPERFICIAL
INTERMEDIATE
DEEP
A. SUPERFICIAL LAYER

1. PRONATOR TERES
During dissection, thisnot
muscle mayand
not itbesometimes
that easy blends
t0 with
identifybecause it is
themuscles beside it.
very big,
Most lateral of the superficial forearm flexors [Moore]
o Its lateral border forms the medial boundary of cubital fossa

Actions: pronates and flexes the forearm (at elbow)

At the proximal part of the forearm, the median nerve will pass
between the two (2) heads of pronator teres site is susceptible
2. FLEXOR CARPI RADIALIS
Long fusiform muscle located medial to the pronator teres
Actions: flexes the hand at wrist (when acting with the flexor
carpi ulnaris) and abducts the hand at wrist (when acting with the
extensors carpi radialis
longus and brevis)
o When acting alone, the FCR simultaneously flexes and abducts
the hand.
3. PALMARIS LONGUS
In some individuals, this muscle may be absent; however, its
absence does not compromise the function of the flexor pronator
muscles.
o lf present, has a short belly and a long tendon.
o Attached to the palmar aponeurosis and is responsible for
tensing the fascia, which helps in gripping
Actions: flexes hand at wrist and tenses palmar aponeurosis
3. PALMARIS LONGUS
In some individuals, this muscle may be absent; however, its
absence does not compromise the function of the flexor pronator
muscles.
o lf present, has a short belly and a long tendon.
o Attached to the palmar aponeurosis and is responsible for
tensing the fascia, which helps in gripping
Actions: flexes hand at wrist and tenses palmar aponeurosis
3. FLEXOR CARPI ULNARIS
Most medial of the superficial forearm flexors
Actions: flexes the hand at wrist (with the FCR) and adducts hand
at wrist (with extensorcarpi ulnaris)
o When acting alone, the FCU simultaneously flexes and
adducts the hand.
Note: FCU is the only muscle in the anterior compartment of the
forearm that is fully innervated by the ulnar nerve. The rest
is innervated by the median nerve
 Thenar eminence Site of commat
Site of median nerve Cubital fossa
frommedial eploand

Pronat
onato r te r
Fllexor carpi radialis erese
arpi radial
Palmaris longus
Palmaris longus tendon Flexor capi uinaris
Distal wrist crease
Hypothenar eminence
 Uina nene
B a h a l artery and median nenve.

Lara cuaneous neveofforearmn LEnar n e y

t e n n a musuocutaneous n e r e -

M e d i epiconchye ofhumem
Badialismsde
-Common fleror e ndon
Biceps brachä tendon
- Pronator ten

Rada arery

BecipaB poneurosa
h e ts nei
dense connec Fadialis muscle

Bachoradais musa Panarn

ongn usde O ervuc le

FBe xor cap.

uinars muscle

TDercr dagtorm
INTERMEDIATE LAYER

1. FLEXOR DIGITORUM SUPERFICIALIS

Big/wide muscle
When it nears the wrist joint, it gives rise to four tendons, which
insert into the medial four digits.
O The tendon of the FDS splits into two to allow the tendon of
the flexor digitorum profundus to pass and insert to the
distal phalanx of the 4th digit
Actions:

flexes the middle phalanges of the medial four fingers (at the
proximal interphalangeal joints) and flexes the proximal phalanges
at the metacarpophalangeal joints and wrist joints

-Flexes the medial four fingers at the proximal

interphalangealjoints
DEEP LAYER

.Note:
All muscles at this layer (except for the ulnar half of the FDP) is
supplied by the branch of the median nerve called the
anteriorinterosseus nerve (AIN), which branches out of the median
nerve and goes deeper after passing the two heads of pronator
teres.
1. FLEXOR DIGITORUM PROFUNDUS
Profundus = deep
When it nears the wrist joint, it also gives rise to four tendons, which
also insert into the medial four digits.
Action: flexes the distal phalanges
distal interphalangeal joints)
of the medial four fingers (atthe

o Helps the FDS in making a fist [Roxas, 2019]

.Innervation:
o Ulnar/medial half = ulnar nerve
o Radial/lateral half= median nerve (AIN)
2.FLEXOR POLLICIS LONGUS
Located lateral to the FDP
Action: flexes the 1st digit (thumb)

Note: Quick assessment to know if AIN is injured is to ask the

patient to perform an "ok" sign to test flexion of the distal
phalanx of the 2nd digit (action of FDP) and the flexion of the
distal phalanx of the 1st digit (action OF FPL)
3. PRONATOR QUADRATUS
Deepest muscle in the anterior aspect of the forearm
o Difficult to demonstrate in dissection because of its location
This is the only muscle that attaches only to the ulna at one end
and only to the radius at the other end.
Action: primarily pronates the forearmH workhorse" of
pronation
o Assisted by the pronator teres when more speed and power are
needed
 Flexor pollicls Pronator
langus quadratus Let Forearm

Flexordigitorum
protundus
POSTERIOR MUSCLES OF THE ARM
MUSCLES THAT EXTEND AND ABDUCT/ADDUCT
THE ARM

1. EXTENSOR CARPI RADIALIS LONGUS (ECRL)

Extends and abducts the hand at the wrist joint
Active during fist clenching [Moore]
2. EXTENSOR CARPI RADIALIS BREVIS (ECRB)
Extends and abducts the hand at the wrist joint
Note: ERCL, ECRB, and brachioradialis, together, called the
are
mobile wad of three - the surgical term used to describe the radial
muscles of the posterior forearm
3. EXTENSOR CARPI ULNARIS
Extends and adducts the hand at the wrist joint
Active during fist clenching
Muscles that Extend the Medial 4 Digits

1. EXTENSOR DIGITORUM
Superficial muscle
.Gives rise to four tendons as it approaches the wrist joint,
similar to its counterparts in the anterior compartment,
which then insert into the medial four digits
Action: extends the medial four fingers (principal extensor)
2. EXTENSOR DIGITI MINIMI
Superficial muscle
Partially separates from the extensor digitorum, inserting intothe
5th digit (little finger)
Action: extends the 5th digit, aiding in the extension of the
medial four fingers
3. EXTENSOR INDICIS

Deep muscle
More deeply located than the extensor
o digitorum
Inserts into the 2nd digit (index finger)
Action: extends the 2nd digit
Allows the
o
index finger to extend independently from other
digits
o Most useful muscle when pointing at something
Supricr ulnar collateral aneny Triceps brachä tendon
anastomoses distay with
pos terior ulnar r e a m e n t
artery
adalisimscle
Ulnar nene
EtsM wadialiskongusmus
Medi epic ondhle ofhumerus

Comm>n e x t e s a tendon
Olcranon of ulra

Extenser carpi radials brevs muse

A n c o n a s mns d e

- E n s o r ditorum muscle
Fievor c a p i uinars n u s d e

Exensr dstiminimi musde

E t e s o carpi uinaris u s d e

cuck polics longus u s d e

Esensr pellica brevis s c

Etemsc t g i l e rs i n g u tencbuo