Biomechanical analysis

of Elbow Joint.

Prepared by:
Dr. Tumaini Matandala
 Contents:

 Introduction
 Anatomy
 Kinematics
 Carrying Angle
 Elbow Stability
 Kinetics
 Elbow Joint Forces
 Articular Surface Forces
 Calculation of Joint Reaction Forces at the Elbow
Introduction
 Introduction.
• The elbow is a complex joint that functions as a
fulcrum for the forearm lever system that is responsible
for positioning the hand in space.

• A detailed understanding of the biomechanics of elbow

function is essential for the clinician to treat effectively
pathologic conditions affecting the elbow joint and for
biomedical Engineers in designing and developing
assistive devices such as braces(orthoses),artificial
upperlimbs(prosthesis) , fixators and traction
mechanism used in orthopedic management of upper
limbs.
 Anatomy of the Elbow Joint.
• Elbow is formed by Three Bones: Humerus, Radius and
Ulnar.
• It allows two types of motion: flex ion-extension and
pronation-supination:
(a) flexion-extension (b) pronation-supination

• It is formed with two articulation: (a) The humeroulnar and

humeroradial articulations (b) The proximal radioulnar
articulation.
• Is therefore a trochleoginglymoid joint.
Anatomy of the Elbow Joint
Anatomy of the Elbow joint
 Anatomy of the Elbow Joint.

Angular orientation of the proximal ulna in the AP (A) and lateral

(B) planes.
 Anatomy of the Elbow Joint.

Angular orientation of the distal humerus in the anteroposterior (A), lateral (B), and
axial (C) projections.
 Kinematics
• Elbow flexion and extension occur at the humeroulnar and
humeroradial articulations.
• Normal range of flexion-extension: 0° to 146°, with a
functional range of 30° to 130°.
• Normal range of forearm pronation-supination: 71° of
pronation to 81° of supination.
• Maximum angle of supination increases, while maximum
angle of pronation decreases as the elbow is flexed.
• Most activities occur within the functional range of 50°
pronation to 50° supination.
• Patients can tolerate flexion contractures up to 30°, beyond
which significant loss of motion occurs.
Kinematics
 Kinematics of the Elbow Joint.
• Axis of rotation for flexion-extension is at the center of the
trochlea, indicating a uniaxial hinge, but may change with
extreme flexion or extension.
• Surface joint motion during flexion-extension is primarily
gliding, changing to rolling at extremes.
• Elbow cannot be purely represented as a hinge joint due to
internal and external axial rotation of the ulna.
• Variation in findings among investigators exists, but
ulnohumeral joint movement is generally uniaxial except at
extremes.
• Axis of rotation for flexion-extension occurs about a tight
locus.
Kinematics of the Elbow Joint.
• Elbow joint replacement procedures and hinged external
fixators require consideration of specific anatomical
points.
• Pronation and supination primarily occur at the
humeroradial and proximal radioulnar joints, with the
forearm rotating about a longitudinal axis.
• During pronation-supination, the radial head rotates
within the annular ligament, while the distal radius
rotates around the distal ulna, forming a cone shape.
• Studies on instant centers of rotation at the proximal and
distal radioulnar joints show variations among
individuals, influenced by the curvature of the radial
head.
 Kinematics of the Elbow Joint.
• Pronation-supination leads to internal axial rotation of the
ulna during pronation and external axial rotation during
supination.
• The pronation-supination axis of the forearm remains
constant, unaffected by annular ligament transection.
• Some varus-valgus movement of the distal ulna is observed
with rotation.
• Proximal radial migration occurs with forearm pronation,
with proximal translation minimized in supination.
• The ovoid shape of the radial head causes lateral
displacement in pronation to accommodate medial rotation
of the radial tuberosity.
 Kinematics of the Elbow Joint.

Dimensions of the locus of the instant center of rotation. As depicted, the axis of
rotation runs through the center of the trochlea and capitellum.
 Carrying Angle

The carrying angle of the elbow, formed by the interception of the long axes of the
humerus and the ulna with the elbow fully extended and the forearm supinated. Valgus
angulation normally ranges from 10° to 15°
 Carrying Angle.
• The valgus position of the elbow in full extension is
commonly referred to as the carrying angle.
• The carrying angle is defined as the angle between the
anatomic axis of the ulna and the humerus measured in
the anteroposterior (AP) plane in extension.
• It's also described as the orientation of the ulna with
respect to the humerus, or vice versa, in full extension.
• The angle is less in children compared to adults and
greater in females compared to males, averaging 10° and
13° of valgus, respectively.
 Carrying Angle.
• When defined as the angle formed between the long axis of
the humerus and ulna on a plane containing the humerus or
vice versa, the carrying angle changes minimally with
flexion.

• If defined as the abduction-adduction angle of the ulna

relative to the humerus using Eulerian angles to describe
arm motion, the carrying angle decreases with joint flexion,
changing to varus in extreme flexion.
Elbow Stability
Elbow Stability
Kinetics
Flexors of the Elbow:
• Brachialis is the primary flexor.
• Biceps and brachioradialis are also major flexors.
• Brachialis has the greatest work capacity.
• Biceps may be preferentially recruited during fast
exercises.
Extensors of the Elbow:
• Triceps is the primary extensor.
• Triceps has the largest work capacity among extensors.
• Anconeus assists in extension.
Kinetics
Muscles involved in Supination:
• Biceps brachii is the primary muscle.
• Supinator is also involved.
• Biceps generates more torque with forearm in pronated
position.

Muscles involved in Pronation:

• Pronator quadratus is primary pronator.
• Pronator teres assists in rapid pronation.
Kinetics
Strength Disparities:
• Supination strength is 20% to 30% greater than pronation
strength.
• Flexion strength is 30% greater than extension strength.
• Males are consistently 40% stronger than females in
elbow strength testing
Elbow Joint Forces
• Force Distribution:
• Halls and Travill (1964) found that 43% of longitudinal
forces are transmitted through the ulnotrochlear joint,
and 57% through the radiocapitellar joint.
• The coronoid process bears 60% of the total
compressive stress when the elbow joint is extended
(Chantelot et al., 2008).
• Force transmission through the radial head is greatest
between 0 and 30° of flexion and is greater in pronation
than supination (Morrey et al., 1988).
Elbow Joint Forces
Impact of Motion on Load Distribution:
• Radial head load decreases from 23% in neutral rotation
to 6% in full supination due to the "screw-home"
mechanism of the radius (Chantelot et al., 2008).
• Elbow force is greatest at initiation of flexion; decreased
forces are seen at 90° flexion due to improved
mechanical advantage (Pearson et al., 1963).
Elbow Joint Forces
Clinical Implications:
• Change in resultant force vector during flexion-extension
is crucial for internal fixation of distal humerus fractures
and total joint replacement (Morrey, 1994; Pearson et al.,
1963).
• During elbow flexion, the ulna is posteriorly translated as
contact occurs at the coronoid.
• In overhead athletes, impaction of the olecranon against
the olecranon fossa during forced extension may lead to
osteophyte formation (Tullos et al., 1972).
Elbow Joint Forces
Force Magnitudes:

• Elbow forces can be up to three times body weight

during certain activities (An et al., 1981).
• Joint reaction forces vary with activities: e.g., dressing
and eating activities result in 300 N, rising from a chair
1,700 N, and pulling a table 1,900 N, nearly three times
body weight (Nicol et al., 1977).
Articular Surface Forces
Contact Areas of the Elbow:
• There are four primary contact areas: two on the
olecranon and two on the coronoid.
• The contact area between the humerus and ulna
increases as the elbow moves from extension to flexion.
• The contact area between the radial head and capitellum
also increases during this motion.
Articular Surface Forces
Varus/Valgus Loads:
• Morrey et al. (1988) identified the pivot point
for varus/valgus loads at the midpoint of the
lateral aspect of the trochlea.
Calculation of Joint Reaction Forces at the Elbow
Summary of the Topic
1. Anatomy and Articulations: The elbow joint complex comprises three articulations:
humeroulnar, humeroradial, and proximal radioulnar. It facilitates flexion-extension
and pronation-supination motions.
2. Functional Range of Motion: The typical range for elbow motion is 30° to 130° for
flexion-extension and 50° to 50° for pronation-supination. Loss of range can
significantly impact daily activities.
3. Axis of Rotation: Flexion-extension occurs about a small locus of points, primarily
at the trochlea and capitellum, suggesting it's not a simple hinge joint.
4. Carrying Angle: Defined as the angle between the ulna and humerus in full
extension, typically 10° to 15° of valgus.
5. Stabilizers and Ligaments: Medial collateral ligament and radial head stabilize
against valgus stress, while the elbow articulation resists varus stress. Lateral ulnar
collateral ligament stabilizes against posterolateral rotatory instability.
6. Muscle Function: Brachialis is the primary flexor, triceps is the primary extensor,
biceps brachii is the main supinator, and pronator quadratus is the primary pronator.
7. Force Generation: Elbow can generate forces up to three times body weight during
daily activities.