Biomechanics of Elbow joint &

Wrist joint
 Stability defining factors
Rotator cuff and other soft tissues integrity
Shape of articulating surfaces
Static stabilizer
Dynamic stabilizers
Mobility defining factor
Type ,nature and variety of joint
Stability at joint
Cartilage type?
Soft tissues extensibility and elasticity?
Integrity of soft tissues
bone and its articular surfaces
ligaments
Tight/lax
 Muscle (elasticity, contractility, fiber no's)
 Skin fascia(tight/relaxed)
Elbow Articulations
 Humeroulnar Joint
 True elbow joint
 Strong bony configuration
 Hinge joint
 Humeroradial Joint
 Slides along capitulum
 Modified ball and socket joint
 Provides no ABD or ADD
 Proximal Radioulnar Joint
 Annular ligament
 Movements
 Interosseous membrane
 Joint Capsule
Anterior
Posterior
Medial
Lateral
Large, loose and weak
Reinforced by other
ligaments
Medial (Ulnar) Collateral Ligament
Anterior Band
 Primary stabilizer
against valgus force
 Three bands
Anterior to medial
epicondyle
Below tip of medial
epicondyle
Inferior edge of medial
epicondyle
Posterior Band
Limits elbow extension
Transverse band
Lateral (Radial) Collateral Ligament

Fan shaped
Resists varus force
Ligaments of the Elbow
Annular Ligament
Retains head of radius
in contact with the
radial notch of the
ulna.
 Angles of elbow
Carrying angle
Cubitus valgus and cubitus varus
 Segments at the Elbow

Flexion and Extension

 Muscles crossing anterior side of elbow are the flexors:

Brachialis, biceps brachii, brachioradialis

 Muscles crossing posterior side of elbow are the extensors:

Triceps, anconeus muscle

 Segments at the Elbow
Pronation and Supination

 Involves rotation of radius around ulna

 Articulations:

Proximal and distal radioulnar joints (both pivot joints)

Middle radioulnar joint (syndesmosis)

Pronator quadratus

Supinator
 Loads on the Elbow
 Large loads generate by muscles that cross

elbow during forceful pitching/throwing

 Also in weight lifting, gymnastics

 Extensor moment arm shorter than flexor

moment arm
 Tricep attachment to ulna closer to elbow

joint center than those of the brachialis

on ulna and biceps on radius
 Moment arm also varies with position of

elbow
Common Injuries to Elbow
 Sprains and Dislocations (MOA= fall on outstretched
hand ,forceful twisting blow)

 Overuse Injuries
 Lateral Epicondylitis = “tennis elbow” (e.g in
tennis,,swimming ,fencing etc)
 Medial Epicondylitis = “Little Leaguer’s Elbow”(e.g in
pitching or throwing )

Valgus instability
Damage of ulnar colllateral ligament (e.g. in throwing)
“nursemaid’s elbow” or “pulled elbow” (ulnar collateral ligament sprain)
 Wrist and Hand Bones

Wrist
 Scaphoid
 Lunate
 Triquetrium
 Pisiform
 Trapezium
 Trapezoid
 Capitate
 Hamate
 Wrist and Hand Bones

Hand
 Metacarpals
 Phalanges 2-5
Proximal
Middle
Distal
 Phalange 1 (Thumb)
Proximal
Distal
 Wrist And Hand Joints
Radio-carpal joint
Inter carpal joints
Carpo-metacarpal joints
Metacarpophalangeal joints MCP Joints
Interphalangeal joints IPJ = PIP AND DIP Joints
 Wrist Musculature
Primary Wrist Flexors
 Flexor Carpi Radialis
 Flaxor Carpi Ulnaris
Secondary Wrist Flexors
 Palmaris Longus
 Flexor Digitorum
superfialis
 Flexor Digitorum Profundus
 Flexor Pollicus Longus
 Wrist Musculature
Primary Wrist Extensors
 Extensor Carpi Radialis
Longus/Brevis
 Extensor Carpi Ulnaris
Secondary Wrist Extensors
 Extensor Digitorum
 Extensor Indicis
 Extensor Digit Minimi
Arches of hand
 Hand Musculature
Hand Flexors

 Flexor Digitorum Profundus

 Flexor Digitorum Superficialis

 Flexor Pollicis Longus/Brevis

 Flexor Digit Minimi Brevis

 Lumbricales
Closer Look at the Carpal Tunnel
Structures within
Tunnel
 FDS
 FDP
 FPL
 Median Nerve
 Carpal Tunnel Syndrome

Carpal tunnel
syndrome is a common
condition that causes pain,
numbness, and tingling in
the hand and arm. The
condition occurs when one
of the major nerves to the
hand — the median nerve
— is squeezed or
compressed as it travels
through the wrist.
 Structure of the Wrist
Radiocarpal joint
 Reinforced by: volar radiocarpal, dorsal radiocarpal,
radial collateral and ulnar collateral ligaments
Retinacula
 Form protective passageways for tendons, nerves and
blood vessel to pass through
1. Flexor retinaculum (contents)
2. Extensor retinaculum (contents)
 Movements of the Wrist
Sagittal and frontal plane movements
Rotary motion = transverse plane
Flexion
Extension and Hyperextension
Radial Deviation
Ulnar Deviation
 Joint Structure of the Hand
Carpometacarpal (CM)

Metacarpophalangeal (MP)

Interphalangeal (IP)
 Movements of the Hand
 CM Joints allow large ROM because similar to ball and

socket joint
 Digits 2-4 constrained by ligaments

 MP joints allow flexion, extension, abduction, adduction

and circumduction for digits 2-5

 IP joints allow flexion and extension

 Extrinsic Muscles

 Intrinsic Muscles
Common Injuries of the Wrist and Hand

Sprains and strains fairly common, due to breaking a

fall on hyperextended wrist

Certain injuries characteristic of sport type

 Metacarpal fractures and football

 Ulnar collateral ligament and hockey

 Wrist fracture and skate/snowboarding

 Wrist in non-dominant hand for golfers

 If localized pain is reported in the

anatomical snuffbox = a fracture of the scaphoid

It has been shown that falls from heights greater than
0.6 m can readily result in wrist fracture
 Fracture of the distal radius is the most common type
of fracture in the population under 75 years of age
 Examples are metacarpal (boxer’s) fractures and
mallet or drop finger deformity resulting from injury at
the distal interphalangeal joints among football
receivers and baseball catchers
. Forced abduction of the thumb leading to ulnar
collateral ligament injury often results from wrestling,
football, hockey, and skiing
In sport rock climbing, 62% of all injuries are to the
elbow, forearm, wrist, and hand
De Quervains disease
Workers at tasks requiring large handgrip forces,
repetitive movements, or use of vibrating tools are
particularly susceptible to carpal tunnel syndrome
The anatomical snuff box or snuffbox is a
triangular deepening on the radial, dorsal aspect of
the hand—at the level of the carpal bones,
specifically, the scaphoid and trapezium bones
forming the floor.
Swan neck deformity= mallet finger (extensor
tendon damage)
Boutonniere deformity =PIP flexion with DIP
hyperextension).