ELBOW ANATOMY

Functions: the elbow, along with the shoulder, helps to position the hand. It is relatively immobile compared to the
hand and shoulder so it provides stability for precise hand movements. The ranges of movement of the elbow are: flexion, extension, pronation, supination. These movements are divided between the joints of the elbow; this means that the effects of injury are more limited and there is rarely global loss of function. The elbow also plays a part in redirecting/transmitting forces from thorax to UEX and vice-versa. When faced with UEX injuries, consider how the different joints work together. E.g. what happens to the elbow if the shoulders are turned in? Or what happens to the arm if pronation is reduced?

Joints (3)
Normal ranges of movement Flexion Extension Supination Pronation 130 0-5 90 85 N.B. Pro/supination are increased by elbow extension as it brings the elbow into line with shoulder movements. The three joints share a common synovial cavity. Fat pads lie between the joint capsule and the synovial membrane in the olecranon, radial and coronoid fossae. Attachments of brachialis and triceps pull them out of the way when the adjacent bony bits need to move into these fossae. Superior radio-ulnar joint: movements = supination and pronation. Radio-humeral joint: between the capitulum (malteser) and the radius. Humero-ulnar joint: between the ulna and the trochlea (bobbin).

Ligaments
Ulnar collateral ligament: thick, triangular ligament attaching to olecranon, coranoid process and medial epicondyle. Radial collateral ligament: from lateral epicondyle to annular ligament. Lateral ulnar collateral ligament: some sources say that this is indistinguishable from the RCL, but theoretically it goes from the lateral epicondyle to the supinator crest (ulna). Annular ligament: blended with the joint capsule, this ligament cuffs the radial head. It also blends with the radial collateral ligament. It allows the radial head to slide against the ulna and turn on the capitulum. There is a little pocket of synovial membrane that protrudes from the margin of the joint capsule and aids radial head rotation during pro/supination. Quadrate ligament: attaches from radial notch to the radius, securing the radial head and resisting pro/supination. It looks a lot like a bit of the annular ligament.

Muscles
Brachialis
Biceps brachii

Attachment Anterior aspect of humerus

Long head: supraglenoid tubercle. Short head: coracoid process. Long head: infraglenoid tubercle. Medial head: post humerus, inf to radial groove. Lat. Head: post humerus, sup. To radial groove. Medial epicondyle, medial side of coronoid process of the ulnar. Supinator crest of the ulna, radial coll. ligament, annular lig.

Attachment Ulna tuberosity

Radial tuberosity via bicipital aponeurosis.

Nerve supply Musculocut. N. (C5, C6)

Musculocut. N. (C5, C6).

Function Flexes forearm

Supination, flexes elbow.

Triceps brachii

Olecranon

Radial n., (C6, C7, C8)

Extension of forearm. Can also extend and abduct arm.

Pronator teres

Lateral mid-shaft of radius Lateral proximal shaft of the radius (wraps around the back).

Median n., C6/7 Radial n. (C6, C7, C8).

Pronation

Supinator

Ersupinates.

Cubital fossa
This is the elbow pit the triangular depression on the anterior elbow formed between brachioradialis and pronator teres. The base of the triangle is an imaginary line between the epicondyles. It is a significant area of transition between arm and forearm and the main contents are: - brachial artery -median nerve - tendon of biceps The brachial artery usually bifurcates (into ulnar and radial arteries_ near the top of the fossa.