ANATOMY OF THE ELBOW AND

PROXIMAL RADIOULNAR JOINTS

BY CHUKWU, V.O
20/10/23 1
 INTRODUCTION
• The elbow is a synovial
hinge joint between the
distal end of the
humerus and the
proximal ends of the
radius and ulna.

• It is located 2–3cm
inferior to the
epicondyles of the
humerus

2
 INTRODUCTION
Bones involved
• Humerus
• Radius
• Ulna

Joints formed
• Humeroulnar
• Humeroradial
• Radioulnar

3
 ARTICULATION OF ELBOW JOINT
• Laterally, the capitulum of
the humerus articulates
with the slightly concave
upper surface of the head
of the radius.

• Medially, the trochlea of

the humerus articulates
with the deep trochlear
notch of the ulna.

• The spheroidal capitulum

of the humerus articulate
with the slightly concave
superior aspect of the
head of the radius. 4
 JOINT CAPSULE OF ELBOW JOINT
• A fibrous layer of the joint
capsule surrounds the
elbow joint.

• It is attached to the
humerus at the margins of
the lateral and medial ends
of the articular surfaces of
the capitulum and trochlea.

• Anteriorly and posteriorly it

is carried superiorly,
proximal to the coronoid
and olecranon fossae.
5
•
JOINT CAPSULE OF
Synovial membrane lines the capsule and
ELBOW JOINT
clothes the underlying pads of fat that
project into the radial, coronoid and
olecranon fossae of the humerus.

• The cavity of the elbow joint is continuous

with that of the proximal radio-ulnar joint

• Like all synovial joints, the elbow joint has

a capsule enclosing the joint. This in itself
is strong and fibrous, strengthening the
joint.

• The joint capsule is thickened medially and

laterally to form collateral ligaments,
which stabilise the flexing and extending
motions of the arm. 6
 JOINT CAPSULE AND BURSAE
 A bursa is a membranous sac filled with synovial fluid. It acts as a
cushion to reduce friction between the moving parts of a joint, limiting
degenerative damage.
There are many bursae in the elbow, but only a few have clinical
importance:
• Intratendinous olecranon – located within the tendon of the triceps
brachii.

• Subtendinous olecranon – between the olecranon and the tendon of

the triceps brachii, reducing friction between the two structures during
extension and flexion of the arm.

• Subcutaneous olecranon bursa – between the olecranon and the

overlying connective tissue (implicated in olecranon bursitis).

• The bicipitoradial bursa (biceps bursa) separates the biceps tendon

from, and reduces abrasion against the anterior part of the radial
7
tuberosity.
 LIGAMENTS OF ELBOW JOINT
The joint capsule of
• The collateral
the elbow is
ligaments of the
strengthened by
elbow joint are
ligaments
strong
medially and
triangular bands
laterally.
that are medial
and lateral
• Medial(ulnar) thickenings of
Collateral the fibrous layer
Ligament. of the joint
• Lateral capsule.
(radial)Collateral
Ligament.

• Annular Ligament.
8
 LIGAMENTS OF ELBOW JOINT
• The radial (lateral) fan-like
collateral ligament passes
between the lateral
epicondyle and the anular
ligament.

• It encircles and holds the

head of the radius in the
radial notch of the ulna,
forming the proximal radio-
ulnar joint and permitting
pronation and supination
of the forearm.
9
 LIGAMENTS OF ELBOW JOINT
• The ulnar (medial) collateral
ligament also triangular, attaches
proximally to the medial
epicondyle, while distally its fibres
diverge and attach to the medial
aspects of the coronoid and
olecranon processes of the ulna.

It consists of three bands:

• the anterior cord-like band is the
strongest.
• the posterior fan-like band is the
weakest, and
• the slender oblique band deepens
the socket for the trochlea of the
humerus. 10
 ANNULAR LIGAMENTS
• The annular ligament also
reinforces the joint by holding
the radius and ulna together at
their proximal articulation.

• It wraps around the radial head

within the radial notch and
attaches it to the ulna.

• This allows for the rotation of

the two bones during the
supination and pronation of the
forearm.

• This simply means the annular

ligament supports the rotation 11
motion of the hand.
 LIGAMENTS OF ELBOW JOINT
• Stability of the joint depends
on the integrity of these
collateral ligaments, which
hold the trochlea of the
humerus firmly in the trochlear
notch.

• Rotation of the ulna is

prevented by the shape of the
articular surfaces of the
trochlea.

• Dislocation of the joint is

usually associated with
ligamentous or bony injury.
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MOVEMENTS OF ELBOW JOINT

13
 MOVEMENTS OF ELBOW JOINT
• Only flexion and extension
occur at the elbow joint.

• Flexion (about 150°) is

produced mainly by biceps
and brachialis with a
contribution from
brachioradialis when the
elbow is partially flexed.

• Flexion is limited by contact

between the anterior
surfaces of the arm and the
forearm. 14
 MOVEMENTS OF ELBOW JOINT
• Extension is often assisted
by gravity.

• Active extension is
produced by triceps s
eu
assisted by anconeus. on
c
An
• In full extension the
olecranon engages in the
olecranon fossa of the
humerus, limiting the
movement and increasing
joint stability. 15
 MUSCLES MOVING ELBOW JOINT
• A total of 17 muscles cross the elbow and extend to the
forearm and hand, most of which have some potential to
affect elbow movement.

• In turn, their function and efficiency in the other movements

they produce are affected by elbow position.

• The chief flexors of the elbow joint are the brachialis and
biceps brachii .

• The brachioradialis can produce rapid flexion in the absence

of resistance (even when the chief flexors are paralyzed).

• Normally, in the presence of resistance, the brachioradialis

and pronator teres assist the chief flexors in producing 16
slower flexion.
 MUSCLES MOVING ELBOW JOINT
• The chief extensor (Active extensors of the
elbow joint is the triceps brachii, especially the
medial head, weakly assisted by the anconeus.

• Behind the elbow joint lies the tendon of

triceps. Immediately anterior to the capsule
are brachialis and the tendon of biceps in the
cubital fossa.

• The brachial artery and median nerve are

separated from the capsule by brachialis. The
ulnar nerve lies behind the medial epicondyle
in contact with the ulnar collateral ligament.

• The vessels and nerves are vulnerable to injury

in traumatic dislocation of the joint. 17
 BLOOD SUPPLY OF ELBOW JOINT
• The arteries
supplying the elbow
joint are derived
from the
anastomosis around
the elbow joint.

• That is from the

anastomosis around
the joint formed by
branches of the
brachial, radial and
ulnar arteries.
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 NERVE SUPPLY OF ELBOW JOINT
The elbow joint is supplied
by:

• Musculocutaneous
• Radial, and
• Ulnar nerves
• Sometimes Median
nerves

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 PROXIMAL RADIO-ULNAR JOINT
• The proximal (superior) radio-
ulnar joint is a pivot type of
synovial joint that allows
movement of the head of the
radius on the ulna.

• The head of the radius articulates

with the radial notch of the ulna.

• The head and neck are encircled

by the anular ligament, which
attaches to the anterior and
posterior margins of the notch on
the ulna and blends with the
capsule and radial collateral
ligament of the elbow. 20
 JOINT CAPSULE OF PROXIMAL RADIO-
ULNAR JOINT
• The fibrous layer of the joint
capsule encloses the joint and is
continuous with that of the
elbow joint.

• The synovial membrane lines

the deep surface of the fibrous
layer and nonarticulating
aspects of the bones.

• The synovial membrane is an

inferior prolongation of the
synovial membrane of the
elbow joint.
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 LIGAMENTS OF PROXIMAL RADIO-ULNAR
JOINT
• The strong anular ligament, attached to the
ulna anterior and posterior to its radial notch,
surrounds the articulating bony surfaces and
forms a collar that, with the radial notch,
creates a ring that completely encircles the
head of the radius.

• The deep surface of the anular ligament is

lined with synovial membrane, which
continues distally as a sacciform recess of the
proximal radio-ulnar joint on the neck of the
radius.

• This arrangement allows the radius to rotate

within the anular ligament without binding,
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stretching, or tearing the synovial membrane
 MOVEMENTS OF PROXIMAL RADIO-ULNAR
JOINT
• During pronation and supination of the
forearm, the head of the radius rotates
within the collar formed by the anular
ligament and the radial notch of the ulna.

• Supination turns the palm anteriorly, or

superiorly when the forearm is flexed.

• Pronation turns the palm posteriorly, or

inferiorly when the forearm is flexed.

• The axis for these movements passes

proximally through the center of the head
of the radius and distally through the site of
attachment of the apex of the articular disc
to the head (styloid process) of the ulna. 23
 MOVEMENTS OF PROXIMAL RADIO-ULNAR
JOINT
• During pronation and supination, it is
the radius that rotates; its head
rotates within the cup-shaped collar
formed by the anular ligament and
the radial notch on the ulna.

• Distally, the end of the radius rotates

around the head of the ulna.

• Almost always, supination and

pronation are accompanied by
synergistic movements of the
glenohumeral and elbow joints that
produce simultaneous movement of
the ulna, except when the elbow is
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flexed.
 MUSCLES MOVING PROXIMAL RADIO-ULNAR
• Supination is produced by the JOINT
supinator (when resistance is
absent) and biceps brachii
(when power is required
because of resistance), with
some assistance from the EPL
and ECRL.

• Pronation is produced by the

pronator quadratus
(primarily) and pronator teres
(secondarily) with some
assistance from the FCR,
palmaris longus, and
brachioradialis (when the
forearm is in the midpronated 25
position).
 BLOOD SUPPLY OF PROXIMAL RADIO-ULNAR
JOINT
• The proximal radio-ulnar
joint is supplied by the
radial portion of the
periarticular arterial
anastomosis of the
elbow joint (radial and
middle collateral arteries
anastomosing with the
radial and recurrent
interosseous arteries,
respectively).

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 INNERVATION OF PROXIMAL RADIO-
ULNAR JOINT
• The proximal radio-ulnar
joint is supplied mainly by
the musculocutaneous,
median, and radial nerves.

• Pronation is essentialy a
function of the median
nerve, whereas supination
is a function of the
musculocutaneous and
radial nerves.
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Bursitis of Elbow
CLINICALS
• The subcutaneous olecranon bursa is exposed to injury during falls on the
elbow and to infection from abrasions of the skin covering the olecranon.
• Repeated excessive pressure and friction, as occurs in wrestling, may cause
this bursa to become inflamed, producing a friction subcutaneous olecranon
bursitis (e.g. “student’s elbow”).
• This type of bursitis is also known as “dart thrower’s elbow” and “miner’s
elbow.” Occasionally, the bursa becomes infected and the area over the bursa
becomes inflamed.

• Subtendinous olecranon bursitis is much less common. It results from

excessive friction between the triceps tendon and olecranon, resulting from
repeated flexion–extension of the forearm as occurs during certain assembly-
line jobs.
• The pain is most severe during flexion of the forearm because of pressure
exerted on the inflamed subtendinous olecranon bursa by the triceps tendon.

• Bicipitoradial bursitis (biceps bursitis) results in pain when the forearm is

pronated because this action compresses the bicipitoradial bursa against the
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anterior half of the tuberosity of the radius.
 CLINICALS
• Ulnar Collateral Ligament Reconstruction: Rupture, tearing, or
stretching of the ulnar collateral ligament (UCL) are increasingly
common injuries related to athletic throwing—primarily baseball
pitching (Fig. B6-37A) but also football passing, javelin throwing,
and playing water polo.

• Reconstruction of the UCL, commonly known as a “Tommy John

procedure” (for the first pitcher to undergo the surgery), involves
an autologous transplant of a long tendon from the contralateral
forearm or leg (e.g., the palmaris longus or plantaris tendon; Fig.
B6-37B).
• A 10- to 15-cm length of tendon is passed through holes drilled
through the medial epicondyle of the humerus and the lateral
aspect of the coronoid process of the ulna (Fig. B6-37C–E).
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 CLINICALS
Avulsion of Medial Epicondyle
• Avulsion of the medial epicondyle in children can result from a fall that causes
severe abduction of the extended elbow, an abnormal movement of this
articulation.

• The resulting traction on the ulnar collateral ligament pulls the medial
epicondyle distally.

• The anatomical basis of avulsion of the epicondyle is that the epiphysis for the
medial epicondyle may not fuse with the distal end of humerus until up to age
20.

• Usually fusion is complete radiographically at age 14 in females and age 16 in

males.

• Traction injury of the ulnar nerve is a frequent complication of the abduction

type of avulsion of the medial epicondyle.

• The anatomical basis for this stretching of the ulnar nerve is that it passes 30
 CLINICALS
Dislocation of Elbow Joint
• Posterior dislocation of the elbow joint may occur when children
fall on their hands with their elbows flexed. Dislocations of the
elbow may result from hyperextension or a blow that drives the
ulna posterior or posterolateral.

• The distal end of the humerus is driven through the weak anterior
part of the fibrous layer of the joint capsule as the radius and ulna
dislocate posteriorly.

• The ulnar collateral ligament is often torn, and an associated

fracture of the head of the radius, coronoid process, or olecranon
process of the ulna may occur.

• Injury to the ulnar nerve may occur, resulting in numbness of the

little finger and weakness of flexion and adduction of the wrist. 31
 ASSIGNMENT
• Study the cubital fossa

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 N G
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