Elbow(Humeroulnar) Joint Presentation by Lindsey Bidleman and Linda McConnell

Components of the Elbow Joint Include… Surface Anatomy Bones Articular Capsule Cartilage Bursae Ligaments Muscles Nerves Arteries Veins Linda

Surface Anatomy of the Elbow Cubital Fossa Medial Bicipital Groove Biceps Tendon Triceps Tendon Olecranon Lateral Epicondyle Medial Epicondyle Radial Styloid Process Ulnar Styloid Process Linda

Surface Anatomy of the Elbow Joint Medial Bicipital Groove Biceps Tendon Cubital Fossa Lateral Epicondyle Medial Epicondyle Olecranon Triceps Tendon Linda

Surface Anatomy of the Elbow Joint Radial Styloid Process Ulnar Styloid Process Linda

Surface Anatomy of the Elbow Joint Carrying angle When arms are at your sides, palms facing forward, you hands and forearms should be about 5-15 degrees away from your body. This angle allows your forearms to clear you hips when swinging your arms while walking. Also very important when carrying various objects. The angle is more pronounced in women than men. Linda

Surface Anatomy of the Elbow Joint Carrying Angle: Male vs Female Linda

Bones of the Elbow Joint Include… Humerus- Largest bone in the upper extremity. Articulates with the radius and ulna. Ulna- The stabilizing bone of the forearm. The medial and longer bone of the two forearms. (Pinky side) Radius- The lateral and shorter of the two forearm bones. (Thumb side) Linda

Ulna Trochlear Notch Olecranon Process Coronoid Process Radial Notch Olecranon Process- Big bony projection on proximal end. Coronoid Process-Prominant elevation on anterior surface. Trochlear Notch- Articulates with the trochlea of the humerus. Ulnar Tuberosity- Inferior to the coronoid process. Radial Notch- Smooth, rounded curve that articulates with the head of the radius. Ulnar Tuberosity Anterior Right Linda Posterior Right

Humerus Anterior Right Posterior Right Coronoid Fossa Capitulum- Articulates with the head of the radius. Olecranon Fossa- Big depression on the posterior side of the humerus. Medial Epicondyle- More prominent than the lateral epicondyle. Trochlea- Articulates with the trochlear notch of the ulna. Coronoid Fossa- Superior to the trochlea, the smaller depression in the anterior side of the humerus. Lateral Epicondyle- Smaller than the medial epicondyle. Coronoid Fossa Medial Epicondyle Lateral Epicondyle Capitulum Olecranon Fossa Trochlea Linda

Radius Head Neck Radial Tuberosity Head- Smooth, flat surface for articulation with the capitulum of the humerus. Neck- Narrow part between the head and the radial tuberosity. Radial Tuberosity- Directly under the head and neck, flat surface. The attachment for the biceps muscle. Linda Anterior Right

Articular Capsule Articular Capsule is “sleeve like” and surrounds a synovial joint, encloses the synovial cavity, and unites articulating bone. Composed of two layers… Fibrous Membrane- usually consisting of dense irregular connective tissue that attaches to the periosteum of the articulating bones. Synovial Membrane- Composed of areolar connective tissue with elastic fibers. Linda

Cartilage Cartilage is a solid, stretchable type of connective tissue that forms parts of the skeleton where more flexibility and protection are necessary. Articular Cartilage provides a smooth, low friction gliding surface for free movement for the humerus, radius, and ulna. Its shiny surface also makes it kind of pretty! Linda

Bursae Bursae are closed sacs containing fluid , they prevent friction and enable structures to move freely over one another. Intratendinous Olecranon Bursa- Sometimes present in the tendon of the triceps Subtendinous Olecranon Bursa- Located between the olecranon and the triceps tendon, just proximal to its attachment to the olecranon Subcutaneous Olecranon Bursa- Located in the subcutaneous connective tissue over the olecranon Linda

Clinical Awareness of Bursae Injury can happen to the subcutaneous olecranon bursa by falls on the elbow, and from infraction from abrasions of the skin covering the olecranon, causing the bursa to become inflamed. Repeated excessive pressure and friction produce a friction called Subcutaneous olecranon bursitis. Pain is severe during flexion of the forearm It is easy to treat if the patient follows the “P.R.I.C.E”. Protection, Rest, Ice, Compression, Elevation. Linda

Ligaments: Connect bone to bone Collateral ligaments of the elbow joint are strong triangular bands that are medial and lateral thickenings of the fibrous layer of the joint capsule Ulnar Collateral Ligament- Medial and triangular ligament that extends from the medial epicondyle of the humerus to the coronoid process and olecranon of the ulna consisting of three bands… 1. Anterior cord-like band is the strongest 2. Posterior fan-like band is the weakest 3. Slender oblique band that deepens the socket for the trochlea of the humerus Linda

Ligaments Cont… Radial Annular Ligament Radial Annular Ligament- This ligament encircles and holds the head of the radius in the radial notch of the ulna, and permits pronation and supination of the forearm Radial Collateral Ligament- Lateral fan-like ligament that extends from the lateral epicondyle of the humerus to the annular ligament of the radius and the radial notch of the ulna. Radial Collateral Ligament Linda

Ligaments Continued Interosseous Membrane- Fibrous connective tissue that joins the shafts of the radius and ulna. Interosseous Membrane Linda

Myology of the Elbow and Forearm Biceps Brachii #9 on classroom model Origin Long Head Supraglenoid tubercle Short Head Coracoid process Insertion Radial Tuberosity of Radius Innervation Musculocutaneous Nerve Vascular Supply Brachial Artery Action Elbow Flexion, Forearm Supination

Myology of the Elbow and Forearm Triceps #11 on classroom model Origin Long Head: infraglenoid tubercle of scapula Lateral Head: Inferior to greater tubercle on posterior humerus Medial Head: Posterior surface of humerus Insertion Olecranon Process of Ulna Innervation Radial Nerve Vascular Supply Deep Brachial artery Action Elbow Extension

Myology of the Elbow and Forearm Supinator #25 on classroom model Origin Lateral epicondyle of humerus and adjacent ulna Insertion Anterior Surface of the proximal radius Innervation Radial Nerve Vascular Supply Recurrent interosseous artery Action Forearm supination

Myology of the Elbow and Forearm Pronator Teres #12 on classroom model Origin Medial epicondyle of humerus and coranoid process of ulna Insertion Lateral aspect of radius at its midpoint Innervation Median Nerve Vascular Supply Ulnar artery Action Forearm pronation, assistive in elbow flexion

Myology of the Elbow and Forearm Pronator Quadratus Origin Distal ¼ of Ulna Insertion Distal ¼ of Radius Innervation Median Nerve Vascular Supply Anterior interosseous artery Action Forearm pronation

Myology of the Elbow and Forearm Brachioradialis #20 on classroom model Origin Lateral supracondylar ridge on the humerus Insertion Styloid process of the radius Innervation Radial Nerve Vascular Supply Radial artery Action Elbow flexion

Myology of the Elbow and Forearm Brachialis #10 on classroom model Origin Distal ½ of humerus, anterior surface Insertion Coronoid process and ulnar tuberosity of the ulna Innervation Musculotaneous Nerve Vascular Supply Brachial Artery Action Elbow Flexion

Summary of Muscle Innervation

Prime Movers of the Elbow

Tis’ the Season http://consumingcostarica.files.wordpress.com/2011/11/turkey.jpg http://www.ebaumsworld.com/pictures/view/82927666/ http://sharelike.me/time-and-events/funny-thanksgiving-turkey-cartoon/ http://www.andpop.com/2012/10/02/10-funny-turkey-day-photos/

Actions of Thanksgiving http://www.google.com/search?q=thanksgiving+praying&client=safari&rls=en&source=lnms&tbm=isch&sa=X&ei=kBWJUpvfNoPj2AXRwYFg&ved=0CAkQ_AUoAQ&biw=980&bih=648#facrc=_&imgdii=_&imgrc=jGWndG_tXGgZlM%3A%3BDXJM2b8TbPyTRM%3Bhttp%253A%252F%252Fcache2.asset-cache.net%252Fxc%252F87834607-family-praying-at-thanksgiving-table-photos-com.jpg%253Fv%253D1%2526c%253DIWSAsset%2526k%253D2%2526d%253D910C62E22B9F47AAC26E85847CFC85B782FF195C3D97418B98B265C480BC42FEE30A760B0D811297%3Bhttp%253A%252F%252Fwww.photos.com%252Froyalty-free-images%252Ffamily-praying-at-thanksgiving-table%252F87834607%3B506%3B336

Elbow Flexion – Passing Dishes

Forearm Pronation- Pouring Wine

Elbow Flexion – Forearm Pronation http://admissions.vanderbilt.edu/insidedores/2011/11/thanksgiving-break-so-far/img_0358/

Elbow Extension – Forearm Supination

Nerve Supply to the Elbow Brachial Plexus RootsRandy TrunksTravis DivisionsDrinks ChordsCold BranchesBeer B. Branches of Brachial Plexus (Lateral to Medial) MusculocutaneousMoms AxillaryAre RadialReally MedianMad UlnarUsually

Innervations of Elbow The Musculocutaneous Nerve Supplies the elbow flexors EXCEPT the brachioradialis The Radial Nerve Supplies the elbow extensors The Median Nerve Supplies all the pronators of the forearm The Ulnar Nerve Runs posterior to the medial epicondyle

The Ulnar Nerve Known as the “Funny Bone” Largest nerve that is unprotected by deep tissues, ligaments, muscles, or bones. The severity of the numbness or pain varies from person to person Can cause spontaneous paralysis of pinky and lateral ½ of ring finger. http://youtu.be/ZEcNgyIOO_E

Arteries of the Elbow Brachial Radial Anterior interosseous Ulnar Superficial palmar arch Radial Recurent interosseous Posterior interosseous

Organization of Arteries

Upper Extremity vascular site significance http://www.papercards.com/sp/CD4934.asp http://www.nowpublic.com/culture/pulse-rate

Location of Brachial Artery To control hemorrhage Site where cuff compresses artery against humerus to obtain blood pressure

Veins of the Elbow Cepthalic Basilic Brachial Median antebrachial Median cubital Dorsal venous arch

Upper extremity veins provide best source to obtain blood Venipuncture Upper extremity veins provide best source to obtain blood It is readily assessable Veins can be visualized Quickly cleaned Does not impede with life activities http://www.oneplaceforspecialneeds.com/main/library_blood_test.html

Tennis Elbow Elbow tendinitis(tennis elbow) is inflammation of the lateral epicondyle. Occurs most commonly in the extensor carpi radialis brevis, where there is an increase in pain receptors in the area making the region very tender! Causes of tennis elbow… The most common cause is the overuse or repetitive strain caused by repeated extension of the wrist against resistance. Gripping heavy objects Tennis is also a cause, although the above causes are more common. Linda

Treatment for Tennis Elbow Goals of treatment Identify the cause of injury Reduce pain and inflammation Gradually return the patient to activity Treatment It may take several different types of exercise to completely relieve pain caused by tennis elbow… Icing to reduce inflammation and pain. Plenty of rest, but also with a few low grade exercises such as… Stretching Exercises Strengthening Exercises The Real Life Dangers of Tennis Elbow - YouTube Linda

References You Tube Zach Thurow( April 4th, 2012) Retrieved on November 15th, 2013. The Real Life Dangers of Tennis Elbow - YouTube Sportsinjuryclinic.net (2013). Tennis Elbow/ Lateral Epicondylitis. Retrieved November 15th, 2013 from http://www.sportsinjuryclinic.net/sport- injuries/elbow-pain/tennis-elbow A.D.A.M. quality (1997-2013). Carrying Angle of the Elbow- excessive. Retrieved November 15th, 2013. Carrying angle of the elbow - excessive: MedlinePlus Medical Encyclopedia Wikimedia Commons (April 23, 2013). File: Slide2xzxzxz.JPG. Retrieved on November 16th, 2013. File:Slide2xzxzxz.JPG - Wikipedia, the free encyclopedia Tortora, G. & Derrickson, B. (2012). Principles of Anatomy & Physiology. (13th ed.). Hoboken, NJ: John Wiley & Sons, Inc. Retrieved November 2013.

References Moore, L., Agur, A., & Dalley, A. (2011). Essential Clinical Anatomy (4th ed.). Baltimore, MD: Lippincott Williams & Wilkins. Retrieved November 2013. Figures: SA6.3, SA6.4, 6.55, 6.56, 6.57, B6.21 Clemente, C. (2011). Anatomy A Regional Atlas of The Human Body (6th ed.). Baltimore, MD: Lippincott Williams & Wilkins. Retrieved November 2013. Figures: 88-1l, 88-3l Linda

Quiz on Thursday 1.Biceps Brachii 2.Brachialis 3.Supinator 4.Brachioradialis 5.Pronator Quadratus