4/6/2014 Elbow Joint Anatomy

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Gross Anatomy
Bones and osteology
The elbow joint is composed of the distal end of the humerus and the proximal ends of the radius and the ulna
(see the images below).
Elbow joint, anterior view.
Elbow joint, posterior view.
The humerus contributes the humeral condyle, composed of the trochlea medially from anterior to posterior and
the capitulum laterally on the anterior aspect, to the articular surface of the elbow joint. The humeral condyle itself
is a rounded, almost tubelike structure that occupies most of the space of the distal end of the humerus and is
located centrally. The condyle is covered in articular cartilage and allows the hooking-on of the C-shaped trochlear
notch of the ulna and the concave superior aspect of the head of the radius.
The humerus has small indentations just superior to the condyle on the anterior aspect; the radial fossa (laterally)
and the coronoid fossa (medially) allow the humerus to accept the head of the radius and the coronoid process of
the ulna when in full flexion.
On the central aspect of the posterior humerus above the trochlea of the humeral condyle is the olecranon fossa,
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which allows the humerus to accept the olecranon of the ulna when in extension. The olecranon is the proximal
end of the ulna, from which the C-shaped trochlea notch is carved.
Lateral to the humeral condyle are the medial and lateral epicondyles, and superior to those on their respective
sides are the medial and lateral supracondylar ridges. The epicondyles and supracondylar ridges act as
attachment sites of for ligamentous supporting structures of the elbow, as well as for muscles that cross and act
on the elbow joint.
The ulna contributes the articular cartilagecovered trochlear notch to the hinge of the elbow joint, which is carved
out of the olecranon process at the proximal end of the ulna. The olecranon posteriorly acts as an insertion point
for muscles crossing the elbow joint. Anteriorly, the anteroinferior portion of the C shape created by the trochlear
notch culminates in a blunt central point called the coronoid process.
Inferior to the coronoid process on the anterior aspect of the ulna is the tuberosity of the ulna, after which, further
distally, is the shaft. Laterally on the proximal end, next to the coronoid process, is the radial notch, in which lies
the head of the radius. Below the radial notch lies the supinator crest, just anterior to which is the supinator fossa.
The supinator fossa is a longitudinal space along the proximal one quarter of the shaft of the ulna; its anterior
border is the interosseous border.
The radius contributes the superior aspect of the head of the radius proximally to the hinge portion of the elbow
joint and contributes the medial circumferential aspect of the head of the radius to the radioulnar articulation. Distal
to the head of the radius is a narrowing of the bone, referred to as the neck, and anteromedially is the radial
tuberosity, followed distally by the shaft of the bone. On the medial aspect of the radius lies the interosseous
border of the radius.
Joint capsule and ligamentous structures
The elbow joint has a synovial membranelined joint capsule that is contiguous between the hinge and radioulnar
aspects of the joint. The synovial lining covers the internal surface of the fibrous joint capsule and the nonarticular
surfaces of the joint that are located intracapsularly. The superior aspect of the joint capsule begins just superior
to the coronoid and olecranon fossae and continues inferiorly, covering just past the proximal radial-ulnar
articulation.
Medially, the joint capsule thickens to form the medial or ulnar collateral ligament, which extends from the medial
epicondyle of the humerus to the coronoid and olecranon of the ulna. The ulnar collateral ligament is a triangular
thickening with 3 main bands: the anterior or cordlike band, the posterior fanlike band, and the oblique band. The
oblique band also helps to deepen the trochlear notch.
Laterally, the lateral or radial collateral ligament extends from the lateral humeral epicondyle and distally blends
into the anular ligament of the radius. The anular ligament of the radius wraps around the head of the radius and
attaches to the ulna anteriorly and posteriorly. The surface of the anular ligament is lined with synovial membrane
and allows the head of the radius to rotate inward during supination and pronation, while maintaining stability of the
radial ulnar joint.
Three major bursae are located at the elbow joint. First is the subcutaneous olecranon bursa, found in the
connective tissue over the olecranon; second is the intratendinous olecranon bursa found in the triceps brachii
tendon; and third is the subtendinous olecranon bursa, which reduces friction between the triceps tendon and the
olecranon proximal to its insertion on the olecranon.
Musculature
Muscles with actions at the elbow joint
The humeroulnar articulation engages primarily in flexion and extension in the sagittal plane, with flexion to 150
and extension to 0 in the neutral position. The biceps brachii, brachialis, brachioradialis, and pronator teres all
flex the elbow. The triceps brachii and anconeus serve to extend the elbow.
The proximal radioulnar joint engages in pronation and supination, with the supinated position being anatomic
position. The proximal radioulnar joint requires concomitant movement at the distal radioulnar articulation to
Elbow Joint Anatomy
Author: Stephen Kishner, MD, MHA; Chief Editor: Thomas R Gest, PhD more...

Updated: Jun 5, 2013
4/6/2014 Elbow Joint Anatomy
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engage fully in its actions. Proximally, the supinator and biceps brachii function to supinate the forearm at the
elbow and the pronator teres and pronator quadratus pronate the forearm.
Muscles that cross the elbow joint
Anteriorly, the humeral head of the pronator teres is attached to the medial epicondyle of the humerus along with
the flexor carpi radialis, the palmaris longus (if present), the humeroulnar head of the flexor digitorum superficialis,
and the humeral head of the flexor carpi ulnaris at the common flexor origin. The ulnar head of the pronator teres
attaches at the coronoid process, and the ulnar head of the flexor carpi ulnaris attaches at the olecranon. The
humeroulnar head of the flexor digitorum superficialis does extend over to the coronoid process.
Posteriorly, the extensor carpi radialis longus has its proximal attachment at the lateral supraepicondylar ridge.
The extensor carpi radialis brevis, extensor digitorum, and extensor digiti minimi all have their proximal attachment
at the lateral epicondyle of the humerus at the common extensor origin and cross the joint.
[4]
Nerve supply
The humeroulnar and humeroradial articulations of the elbow joint are served by the musculocutaneous, radial, and
ulnar nerves. Anteriorly, the lateral aspect of the elbow joint is covered by the C6 dermatome; the more medial
area is covered by the C5 and T1 dermatomes; and, finally, the medial aspect is covered by the C8 dermatome.
Posteriorly, the C6 dermatome laterally and the C8 dermatome medially are split down the middle by the C7
dermatome.
The inferior lateral cutaneous nerve of the arm and the posterior cutaneous nerve of the forearm are the sensory
nerves of the lateral elbow. The medial cutaneous nerve of the forearm, via its ulnar (posterior) and anterior
branches, supplies sensation to the medial aspect of the elbow. Across the anterior aspect of the elbow, in the
cubital fossa, the sensory branch of the musculocutaneous nerve (the lateral cutaneous nerve of the forearm)
supplies sensation.
Crossing the elbow joint anteriorly is the median nerve. Just proximal to the joint, it gives off a branch to the
pronator teres, where the muscle originates at the medial epicondyle; just distal to the joint, it gives off branches
to the palmaris longus (if present), to the flexor carpi radialis, and again to the pronator teres before continuing
down the forearm.
Posteriorly, the ulnar nerve travels medially down the arm to pass posterior to the elbow joint in a groove at the
posterior aspect of the medial epicondyle, known as the cubital tunnel; it then gives off branches to the flexor carpi
ulnaris and the medial half of the flexor digitorum profundus just distal to the joint before continuing down the
forearm.
The radial nerve is an interesting case. Passing from the posterior as it leaves the radial groove laterally in the arm,
it gives off branches to the brachioradialis and the extensor carpi radialis longus before splitting into the superficial
and deep branches proximal to the elbow joint and then traveling anterior to the elbow joint.
The superficial branch of the radial nerve continues primarily as a sensory branch. The deep branch gives off
innervation to the extensor carpi radialis brevis and then crosses the elbow joint anterior to the lateral epicondyle of
the humerus. It continues down the forearm as the posterior interosseous nerve after piercing the supinator
muscle, which it innervates, and moves posteriorly again to pass down the posterior of the forearm.
[5]
Vasculature
The blood supply to all the articulations of the elbow joint comes via local branches from the periarticular arterial
anastomoses of the elbow region.
[6]
The brachial artery gives off the superior and inferior ulnar collateral arteries
(which generally anastomose with each other as well), and the deep artery of the arm continues and splits into the
radial collateral and middle collateral arteries.
After crossing the elbow joint in the cubital fossa, the brachial artery splits into the ulnar and radial arteries. The
ulnar artery gives rise to both the anterior ulnar recurrent artery, which joins the inferior ulnar collateral anterior to
the medial epicondyle of the humerus, and the posterior ulnar recurrent artery, which joins the superior ulnar
collateral artery posterior to the medial humeral epicondyle.
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The radial artery gives off the radial recurrent artery, which joins with the radial recurrent branch of the deep artery
of the arm anterior to the lateral epicondyle. The middle collateral branch of the deep artery of the arm splits
posterior to the elbow joint. One branch of this artery passes inferiorly across the elbow to join with the recurrent
interosseous artery off the ulnar artery; the other crosses the elbow horizontally just proximal to the joint and joins
the superior ulnar and posterior ulnar arterial anastomoses.
[7]


Medscape Reference 2011 WebMD, LLC
Contributor Information and Disclosures
Author
Stephen Kishner, MD, MHA Professor of Clinical Medicine, Physical Medicine and Rehabilitation Residency
Program Director, Louisiana State University School of Medicine in New Orleans
Stephen Kishner, MD, MHA is a member of the following medical societies: American Academy of Physical
Medicine and Rehabilitation and American Association of Neuromuscular and Electrodiagnostic Medicine
Disclosure: Nothing to disclose.
Coauthor(s)
Patrick Mahaney, MD, MS Resident Physician, Section of Physical Medicine and Rehabilitation, Louisiana
State University School of Medicine in New Orleans
Disclosure: Nothing to disclose.
Chief Editor
Thomas R Gest, PhD Professor of Anatomy, Department of Radiology, University of South Florida Morsani
College of Medicine
Disclosure: Lippincott Williams & Wilkins Royalty Other
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