1. Elbow and Hand
PTA 106 Fall 2008
Chanel
Kyle
Sandra

2. Surface Anatomy Lateral Epicondyle Medial Epicondlye Olcranon
Ulnar Styloid Process
Cubital Fossa
Site of Median Nerve
Tendon of Palmaris Longus
Tendon of Flexor Carpi Radialis
Distal Wrist Crease

3. Anatomical Snuff Box
Thenar Eminance
Hypothenar Eminence

4. The Humerus Medial Epicondyle Lateral Epicondyle
Capitulum- on lateral edge of condyle
Trochlea- medial and mid section of condyle
Coronoid Fossa
Olecranon Fossa

5. Ulna Olecranon Process Trochlear Notch Coronoid Process Radial Notch
Ulnar Tuberosity
Styloid Process

6. Radius
Head
Neck
Radial Tuberosity
Ulnar Notch
Styloid Process

7. Wrist/Hand
Scaphoid, Lunate, Triquetrum, Pisiform, Trapezium, Hamate, Trapezoid, Capitate
Metacarpals: Numbered 1-5, starting at thumb
Phalangeal: Numbered 1-5
Distal, Middle, Proximal

8. LIGAMENTS OF THE ELBOW (HUMEROULNAR JT)
A. Ligaments
Elbow
Articular Capsule
Radial anular ligament
Interosseous membrane
Ulnar collateral ligament
Radial collateral ligament
Hand
Palmar aponeurosis
Common Flexor sheath
Flexor retinaculum
B. Bursae
Subcutaneous olecranon bursa
Subtendinous olecranon bursa
C. Cartilage, articular cartilage
D. Articular Capsule
Synovial membrane
Fibrous layer

9. LIGAMENTS OF THE ELBOW (HUMEROULNAR AND HUMERORADIAL JOINTS)
Articular Capsule
Radial Anular ligament
Interosseous membrane
Ulnar collateral ligament
Radial collateral ligament
All provide strength and support to the joint as do the surrounding muscles
Two ligaments found in the elbow joint are:
the ulnar collateral ligament and the radial collateral ligament.
They are strong, fan shaped condensations of the fibrous joint capsule

10. LIGAMENTS OF THE ELBOW (HUMEROULNAR JT)
Movements of the elbow joint
Flexion and extension occur at the elbow joint
The long axis of the fully extended ulna makes an angle of approximately 170° with the long axis of the humerus
Called the carrying angle for the way the forearm angles away from the body when something is carried
The obliquity of the angle is more pronounced in women than in men
Obliquity—how oblique an angle is

11. LIGAMENTS OF THE ELBOW (HUMEROULNAR AND PROXIMAL RADIOULNAR JT)
Articular capsule
A sac enclosing a joint, formed by an outer fibrous membrane and an inner synovial membrane. Also called joint capsule
The synovial fluid nourishes the fibrocartilage and lubricates the joint surface

12. LIGAMENTS OF THE ELBOW (HUMEROULNAR JT)
Weak anteriorly and posteriorly, the capsule strengthened on each side by the ulnar and radial collateral ligaments
The fibrous layer of the capsule is continuous with the fibrous layer of the elbow joint
It attaches to the humerus at the margins of the lateral and medial ends of the articular surfaces of the capitulum and trochlea
Fig 6.35

13. LIGAMENTS OF THE ELBOW (HUMEROULNAR JT)
Radial anular ligament
Encircles and holds the head of the radius in the radial notch of the ulna
Forms the proximal radioulnar joint
Allows pronation and supination of forearm
In pronation/supination it is the radius that rotates
Figure 6.33E, 6.36C

14. LIGAMENTS OF THE ELBOW (HUMEROULNAR JT)
Ulnar collateral ligament
Located on the medial side of the joint, it extends from the medial epicondyle of the humerus to the proximal portion of the ulna
Prevents excessive abduction of the elbow joint
Note the anular ligament, interosseous membrane, and bony landmarks

15. LIGAMENTS OF THE ELBOW (HUMEROULNAR JT)
Radial collateral ligament
Located on the lateral side of the joint, extending from the lateral epicondyle of the humerus to the head of the radius.
Prevents excessive adduction of the elbow joint.
Here too you can see the interosseous membrane, which is coming up

16. LIGAMENTS OF THE ELBOW (HUMEROULNAR JT)
Interosseous membrane
Connects the shafts of the ulna and the radius throughout most of their length
Classified as a fibrous joint, or syndesmosis
Note: The ulnar and radial collateral ligaments of the proximal humeroulnar joint are not to be confused with the ligaments of the same name at the distal radioulnar joint
Fig 6.20A,B

17. LIGAMENTS OF THE HAND
Fascia of the palm is continuous with the antebrachial fascia, and the fascia of the dorsum of the hand
Palmar aponeurosis
Common Flexor Sheath
Flexor retinaculum

18. LIGAMENTS OF THE HAND Fig 6.25C Palmar aponeurosis
Strong, well-defined, central part of the palmar fascia
Covers soft tissues and overlies long flexor tendons
Proximal end is continuous with the flexor retinaculum and palmaris longus tendon
Fig 6.25C
Palmar,of course, refers to the palm or ventral side of the hand

19. LIGAMENTS OF THE HAND Palmar aponeurosis
The end distal to apex forms four longitudinal bands that radiate from the apex
These attach distally to the bases of the proximal phalanges
Forming the fibrous digital sheaths of individual digits

20. LIGAMENTS OF THE HAND Flexor Retinaculum Or transverse carpal ligament
Continuous with the antebrachial fascia
Fibrous band that extends between the anterior prominences of the outer carpal bones

21. LIGAMENTS OF THE HAND Flexor retinaculum
and converts the anterior concavity of the carpus into the carpal tunnel
Through which the flexor tendons and median nerve pass
This is the area involved in carpal tunnel syndrome

22. LIGAMENTS OF THE HAND Common Flexor Sheath
Deep to the Flexor retinaculum
Together with the digital sheaths enables the tendons to slide freely past each other during movement

23. BURSAE OF THE HUMEROULNAR JT AND HAND
closed sacs containing fluid which prevent friction, and enable structures to move freely over one another
Subcutaneous olecranon bursa-Located in the subcutaneous connective tissue over the olecranon
Subtendinous olecranon bursa-Located between the olecranon and triceps tendons, just proximal to its attachment

24. CARTILAGE Articular cartilage
Caps the articulating surfaces of bones participating in a synovial joint
Provides a smooth, low-friction gliding surface
Avascular, nourished by diffusion (synovial fluid)

25. Biceps Brachii
O: Scapula: Long Head: Supraglenoid Tubercle; Short Head: Coracoid Process.
I: Radial Tuberosity of Raidus.
A: Elbow Flexion, Forearm Supination.
I: Musculocutaneous Nerve
Vascular: Brachial Artery

26. Triceps Brachii
O: Long Head- Infraglenoid Tubercle of Scapula, Lateral Head- Inferior to Great Tubercle on Posterior Humerus Medial Head- Posterior Surface of Humerus
I: Olecranon Process of Ulna
A: Elbow Extension
I: Radial Nerve
Vascular: Deep Brachial Artery

27. Coracobrachialis O: Apex of the Coracoid Process
I: Middle of the medial Surface and border of the Humerus.
A: Flexes and adducts the arm.
I: Musculocutaneous Nerve (C6 and C7)
Vascular: Brachial Artery

28. Brachialis O: Distal Half of Humerus, Anterior Surface
I: Coronoid Process and Ulnar Tuberosity of the Ulna
A: Elbow Flexion
I: Musculocutaneous Nerve
Vascular: Brachial Artery

29. Brachioradialis O: Lateral Supracondylar Ridge on the Humerus
I: Styloid Process of the Radius
A: Elbow Flexion
I: Radial Nerve
Vascular: Radial Artery

30. Supinator O: Later Epicondyle of Humerus and adjacent Ulna
I: Anterior Surface of the Proximal Radius
A: Forearm Supination
I: Radial Nerve
Vascular: Recurrent Interosseous Artery

31. 1) Pronator Teres 2) Pronator Quadratus
O: Medial Epicondyle of Humerus and Coranoid Process of Ulna
I: Lateral aspect of Radius at its midpoint
A: Forearm Pronation, Assistive in elbow flexion
I: Median Nerve
Vascular: Ulnar Artery
2) Pronator Quadratus
O: Distal Fourth of Ulna
I: Distal Forth of Radius
A: Forearm Pronation
I: Median Nerve
Vascular: Anterior Interosseous Artery

32. Flexor Carpi Radialis O: Medial Epicondyle of the Humerus
I: Base of Second and Third Metacarpals
A: Wrist Flexion, Radial Deviation
I: Median Nerve
Vascular: Radial and Ulnar Arteries

33. Flexor Carpi Ulnaris O: Medial Epicondyle of Humerus
I: Pisiform and base of Fifth Metacarpal
A: Wrist Flexion, Ulnar Deviation
I: Ulnar Nerve
Vascular: Ulnar Artery

34. Extensor Carpi Radialis Longus
O: Supracondylar Ridge of Humerus
I: Base of Second Metacarpal
A: Wrist extension, Radial Deviation
I: Radial Nerve
Vascular: Radial Artery

35. Extensor Carpi Radialis Brevis
O: Lateral Epicondyle of Humerus
I: Base of Third Metacarpal
A: Wrist Extension
I: Radial Nerve
Vascular: Radial Artery

36. Extensor Digitorum O: Lateral Epicondyle of Humerus
I: Base of distal Phalanx of the Second-Fifth Fingers
A: Extends all three joints of the Fingers
I: Radial Nerve
Vascular: Recurrent Interosseous Artery

37. Extensor Carpi Ulnaris
O: Lateral Epicondyle of Humerus
I: Medial Side of Base of 5th Metacarpal
A: Extends and Adducts Wrist
I: Deep Radial Nerve
Vascular: Ulnar Artery

38. Flexor Digitorum Superficialis
O: Common Flexor tendon, Coronoid Process and Radius
I: Sides of the Middle Phalanx of the Four Fingers
A: Flexes MP and PIP joints of the Fingers
I: Median Nerve
Vascular: Ulnar Artery

39. Flexor Digitorum Profundus
O: Upper three-fourths of Ulna
I: Distal Phalanx of the Four Fingers digits (2-5)
A: Flexes all three joints of the Fingers
I: Median and Ulnar Nerves
Vascular: Ulnar Artery

40. Flexor Pollicis Longus
O: Radius, Anterior Surface
I: Distal Phalanx of Pollex
A: Flexes all joints of the Pollex or Thumb
I: Median Nerve
Vascular: Radial Artery

41. Abductor Pollicis Longus
O: Posterior radius, Interosseous Membrane, Middle Ulna
I: Base of the First Metacarpal
A: Abducts Pollex
I: Radial Nerve
Vascular: Posterior Interosseous Artery

42. Extensor Digiti Minimi
O: Lateral Epicondyle of Humerus
I: Base of Distal Phalanx of Fifth Finger
A: Extends all joints of Fifth Finger
I: Radial Nerve
Vascular: Recurrent Interosseous Artery

43. Extensor Pollicis Brevis
O: Posterior Distal Radius
I: Base of the Proximal Phalanx of Pollex
A: Extends MP joint of Thumb
I: Radial Nerve
Vascular: Posterior Interosseous Artery

44. Extensor Pollicis Longus
O: Middle Posterior Ulna and Interosseous Membrane
I: Base of Distal Phalanx of Pollex
A: Extends MP and IP joints of the Thumb
I: Radial Nerve
Vascular: Posterior Intercosseous Artery

45. Palmaris Longus O: Medial Epicondyle of Humerus I: Palmar Fascia
A: Assistinve in Wrist Flexion
I: Median Nerve
Vascular: Ulnar Artery

46. Carpal Tunnel What Is It? How Is It Caused? Predisposition
Happens when the median nerve becomes squeezed or pressed at the wrist
Sometimes caused by thickening of irritated tendons that go through the tunnel.
The result being pain that goes it to the hand and can even radiate up in to the forearm.
Most common of the entrapment neuropathies where the peripheral nerves are traumatized or compressed.
How Is It Caused?
Predisposition
Trauma, Injury, Swelling, Spain, Fracture.
Hormones
Overactivity of pituitary, Hypothyroidism
Mechanical Problems
Work stress, vibrating hand tools
Development of Cyst or Tumor in Canal
Some times there is no origin

47. Treatment Symptoms Surgical Non-Surgical
Frequent burning, tingling, itching, numbness in palm of hand and fingers.
Fingers feel worthless and swollen.
Decreased grip strength; difficult to form a fist, grasp small objects,
Can differentiate between hot and cold.
Treatment
Surgical
Open Release
Endoscopic
Non-Surgical
Drugs:NSAID, Corticosteroids, and Vitamin B6
Exercise: Stretching and strenthening
Alternative: acupuncture, yoga and chiropractic services

49. Tennis Elbow “Lateral Epicondylitis”
What is Tennis Elbow?
Is inflammation around the lateral epicondyle
It occurs when the muscle attachment, tendons, become irritated.
Causes
Tennis or any racket sport
Anything that involves extending your wrist or rotating his forearm, such as twisting a screwdriver or lifting a heavy object with your palm down.
With age irritation becomes inflamed more easily.

50. Symptoms
Pain that radiates from epicondyle in to forearm and wrist.
Pain with extension of wrist.
Forearm weakness.
Painful grip with activities such as shaking hands and turning door knobs.
Inability to hold objects such as coffee cups.
Treatment
Use of a brace to let muscles rest.
Corticosteroid injections.
PT: Stretching and ROM exercises.
Surgery is Rare

51. Is There Any Questions?