51 Elbow joint structure 52 Elbow joint biomechanics

The Elbow Joint

This is a hinge type of synovial joint that is formed where the distal end of the humerus articulates with the proximal ends of the radius and ulna. The elbow is a uniaxial joint; its movements consist of flexion and extension.

The Articular Surfaces of the Elbow Joint The trochlea and capitulum of the humerus articulates with the trochlear notch of the ulna and the head of the radius, respectively.

The articular surfaces, covered with hyaline cartilage, are most fully in contact when the forearm is in the position midway between pronation and supination and is flexed to a right angle.

The elbow joint includes three articulations: 1. The humeroulnar articulation is between the trochlea of the humerus and the trochlear notch of the ulna. They form a uniaxial hinge joint, permitting movement in one axis: flexion and extension. 2. The humeroradial articulation is between the capitulum of the humerus and the head of the radius. The capitulum fits into the slightly cupped surface of the head. 3. The proximal radioulnar joint is between the head of the radius and radial notch of the ulna. This is a pivot joint, permitting rotation of the radius about the ulna.

The Articular Capsule of the Elbow Joint The fibrous capsule completely encloses the joint. Its anterior and posterior parts are thin and weak, but collateral ligaments strengthen its sides.

The fibrous capsule is attached to the proximal margins of the coronoid and radial fossae anteriorly, but not quite to the superior limit of the olecranon fossa posteriorly. Distally the fibrous capsule is attached to the margins of the trochlear notch, the anterior border of the coronoid process, and the anular ligament.

The Collateral Ligaments of the Elbow Joint These are strong triangular bands are medial and lateral thickenings of the fibrous capsule; hence, they are intrinsic ligaments.

The Radial Collateral Ligament Its apex is attached proximally to the lateral epicondyle of the humerus and its base blends with the anular ligament of the radius.

The Ulnar Collateral Ligament It is composed of anterior and posterior bands (parts), which are connected by a thinner, relatively weak oblique band.

Its apex is attached to the medial epicondyle of the humerus. The strong cord-like anterior part is attached to the tubercle on the coronoid process of the ulna and the weaker fan-like posterior part is attached to the medial edge of the olecranon. The ulnar nerve passes posterior to the medial epicondyle and is closely applied to the ulnar collateral ligament.

The Synovial Membrane of the Elbow Joint This lines the fibrous capsule and is reflected onto the humerus, lining the coronoid and radial fossae anteriorly and the olecranon fossa posteriorly. The synovial capsule is continued into the proximal radioulnar joint.

A redundant fold of the synovial capsule, called the sacciform recess, emerges distal to the anular ligament and facilitates rotation of the head of the radius, e.g., during supination and pronation.

Movements of the Elbow Joint This joint can be flexed or extended.

Flexion is produced by the brachialis and brachioradialis muscles, but the main flexor is the brachialis. When the forearm is supinated, the biceps brachii muscle also flexes this joint; when it is pronated, the pronator teres does. Flexion is limited by apposition of the anterior surfaces of the forearm and arm, by tension of the posterior arm muscles, and by the radial and ulnar collateral ligaments. The flexion of the forearm, or twitch of the biceps brachii that occurs following tapping of the bicipital aponeurosis without movement, is known as the biceps jerk. The reflex centre is in C5 and C6 segments of the spinal cord. The main extensor of the elbow joint is the triceps brachii muscle. Gravity and the anconeus muscle assist with this movement. Extension is limited by impingement of the olecranon of the ulna on the olecranon fossa of the humerus and by tension of the anterior arm muscles and collateral ligaments. The anconeus muscle stabilises the elbow joint and may assist in its extension. The extension of the forearm, or twitch of the triceps without movement that occurs following tapping of the triceps tendon, is known as the triceps jerk. The reflex centre is in C6, C7, and C8 segments of the spinal cord.

When the forearm is fully extended and supinated in the anatomical position, the arm and forearm are not in the same line. This is as the articular surfaces of the distal end of the humerus are not set at a right angle to the body (shaft). Normally the forearm is directed laterally, forming a carrying angle of about 165 degrees. This angle permits the extended forearm to clear the side of the hip in swinging movements during walking, which is important when carrying heavy loads. The angle is diminished when the forearm is pronated or flexed.

Stability of the Elbow Joint In adults this joint is quite stable because of the hinge-like arrangement formed by the jaw-like trochlear notch of the ulna into which the spool-shaped trochlear of the humerus fits.

In addition, very strong ulnar and radial collateral ligaments strengthen the joint.

Blood Supply of the Elbow Joint

The articular arteries are derived from the anastomosis around the elbow, which are formed by collateral branches of the brachial and recurrent branches of the ulnar and radial arteries.

Nerve Supply of the Elbow Joint The articular nerves are derived mainly from the musculocutaneous and radial nerves, but the ulnar, median, and anterior interosseous nerves may also supply articular branches.