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Chapter 6 The Elbow and Radioulnar Joints

Manual of Structural Kinesiology

R.T. Floyd, E d D, A T C, C S C S

Manual of Structural Kinesiology

The Elbow and Radioulnar Joints

Most upper extremity movements involve the elbow and radioulnar joints

Usually grouped together owing to their close anatomical relationship

Elbow joint movements may be clearly distinguished from those of the radioulnar joints

Radioulnar joint movements may be distinguished from those of the wrist

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Bones, 1

Ulna is much larger proximally than in radius

Radius is much larger distally than the ulna

Scapula and humerus serve as proximal attachments for muscles that flex and extend the elbow

Jump to Bones, 1, Appendix

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Bones, 2

Ulna and radius serve as distal attachments for the same muscles

Scapula, humerus, and ulna serve as proximal attachments for muscles that pronate and supinate the radioulnar joints

Distal attachments of radioulnar joint muscles are located on the radius

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Bones, 3

Bony landmarks

Medial condyloid ridge

Olecranon process

Coranoid process

Radial tuberosity

Jump to Bones, 3, Appendix

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Bones, 4

Key bony landmarks for wrist and hand muscles

Medial epicondyle

Lateral epicondyle

Lateral supracondylar ridge

Jump to Bones, 4, Appendix 1

Jump to Bones, 4, Appendix 2

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Joints, 1

Elbow: Ginglymus or hinge-type joint

Allows only flexion and extension

Interrelated joints

Humeroulnar joint

Radiohumeral joint

Jump to Joints, 1, Appendix

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Joints, 2

Elbow motions

Primarily involve movement between articular surfaces of the humerus and ulna

Specifically the humeral trochlear fitting into the ulna trochlear notch

Radial head has a relatively small amount of contact with the capitulum of the humerus

As the elbow reaches full extension, the olecranon process is received by the olecranon fossa

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Joints, 3

Increased joint stability when fully extended

With the elbow in full flexion, the coranoid process fits into the coranoid fossa

As the elbow flexes 20 degrees or more, its bony stability is unlocked, allowing for more side-to-side laxity

Jump to Joints, 3, Appendix

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Joints, 4

Stability in flexion is more dependent on the lateral or radial collateral ligament and the medial or ulnar collateral ligament

Ulnar collateral ligament is critical in providing medial support to prevent the elbow from abducting when stressed during physical activity

Jump to Joints, 4, Appendix

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Joints, 5

Many contact sports and throwing activities place stress on medial aspects of the joint, resulting in injury

Ulnar collateral ligament or U C L

Particularly crucial to high-velocity sporting activities, such as baseball pitching, that require optimal medial elbow stability

Compromise of this structure often requires surgery

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Joints, 6

Tommy John procedure

UCL surgical reconstruction using a tendon graft such as the palmaris longus tendon

Radial collateral ligament provides lateral stability and is rarely injured

Annular ligament provides a sling effect around the radial head for stability

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Joints, 7

Elbow moves from 0 degrees of extension to 145 to 150 degrees of flexion

Flexion: zero to 150 degrees

Extension: 150 degrees to zero

Hyperextension: measured in degrees beyond the zero starting point

This motion is not present in all persons

When it is present, it may vary from 5 to 15 degrees

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Joints, 8

Carrying angle

In the anatomical position, it is common for the forearm to deviate laterally from the arm between 5 to 15 degrees

Slightly greater in a dominant limb than in a nondominant limb

Females commonly have a slightly greater carrying angle than men

Courtesy of R.T. Floyd

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Joints, 9

Radioulnar joint

Trochoid or pivot-type joint

Radial head rotates around at the proximal ulna

Distal radius rotates around the distal ulna

Annular ligament maintains the radial head in its joint

Jump to Joints, 9, Appendix 1

Jump to Joints, 9, Appendix 2

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Joints, 10

Jump to Joints, 10, Appendix

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Joints, 11

Radioulnar joint

Supinates 80 to 90 degrees from the neutral position

Pronates 70 to 90 degrees from the neutral position

Pronation: zero to 80 or 90 degrees

Supination: zero to 80 or 90 degrees

Total forearm motion: 160 to 180 degrees

Persons may vary in the range of supination and pronation

Some may reach the 90-degree arc, and others may have only 70 degrees plus

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Joints, 12

Called syndesmosis because the joint between shafts of the radius and ulna are held tightly together between the proximal and distal articulations by an interosseus membrane

Substantial rotary motion between the bones

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Joints, 13

Synergy among the glenohumeral, elbow, and radioulnar joint muscles

As the radioulnar joint goes through its ROM, the glenohumeral and elbow muscles contract to stabilize or assist in the effectiveness of movement at the radioulnar joints

Example: When tightening a screw with a screwdriver that involves radioulnar supination, we tend to externally rotate and flex the glenohumeral and elbow joints, respectively

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Joints, 14

Conversely, when loosening a tight screw with pronation, we tend to internally rotate and extend the elbow and glenohumeral joints, respectively

We depend on both the agonists and antagonists in the surrounding joints to provide an appropriate amount of stabilization and assistance with the required task

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Movements, 1

Flexion

Movement of the forearm to the shoulder by bending the elbow to decrease its angle

Jump to Movements, 1, Appendix

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Movements, 2

Extension

Movement of the forearm away from the shoulder by straightening the elbow to increase its angle

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Movements, 3

Pronation

Internal rotary movement of the radius on the ulna that results in the hand moving from a palm-up to a palm-down position

Jump to Movements, 3, Appendix

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Movements, 4

Supination

External rotary movement of the radius on the ulna that results in the hand moving from a palm-down to a palm-up position

Jump to Movements, 4, Appendix

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Muscles, 1

Elbow flexors

Biceps brachii

Brachialis

Brachioradialis

pronator teres

Elbow extensors

Triceps brachii

Anconeus

Jump to Muscles, 1, Appendix

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Muscles, 2

Deltoid, pectoralis major, and pectoralis minor muscles removed to reveal deeper structures

Jump to Muscles, 2, Appendix 1

Jump to Muscles, 2, Appendix 2

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Muscles, 3

Radioulnar pronators

Pronator teres

Pronator quadratus

Brachioradialis

Radioulnar supinators

Biceps brachii

Supinator muscle

Brachioradialis

Jump to Muscles, 3, Appendix

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Muscles, 4

Tennis elbow: Common problem usually involving the extensor digitorum muscle near its origin on the lateral epicondyle

Known as the lateral epicondylitis or depending upon specific pathology may be termed lateral epicondylagia or lateral epicondylosis

Associated with gripping and lifting activities

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Muscles, 5

Medial epicondylitis

Somewhat less common and is known as golfer's elbow

Associated with the medial wrist flexor and the pronator group near their origin on the medial epicondyle

Both conditions involve muscles that cross the elbow but act primarily on the wrist and hand

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Muscles, 6

Primarily flexion and pronation

Biceps brachii

Brachialis

Brachioradialis

Pronator teres

Pronator quadratus

Jump to Muscles, 6, Appendix

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Muscles, 7

Posterior

Primarily extension and supination

Triceps brachii

Anconeus

Supinator

Jump to Muscles, 7, Appendix

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Nerves, 1

All elbow and radioulnar joints muscles are innervated from the median, musculotaneous, and radial nerves of the brachial plexus

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Nerves, 2

Radial nerve: Originates from C 5, C 6, C 7, and C 8

Triceps brachii

Brachioradialis

Supinator or posterior interosseous nerve

Anconeus

Provides sensation to the posterolateral arm, forearm, and hand

Jump to Nerves, 2, Appendix

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Nerves, 3

Median nerve: Originates from C 6 and C 7

Pronator teres

Pronator quadratus or anterior interosseus nerve

Provides sensation to the palmar aspect of the hand and first three phalanges, the palmar aspect of radial side of the fourth finger, and the dorsal aspect of index and the long fingers

Jump to Nerves, 3, Appendix

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Nerves, 4

Musculotaneous nerve: Branches from C 5 and C 6

Biceps brachii

Brachialis

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Biceps Brachii Muscle

Jump to Biceps Brachii Muscle, Appendix

Flexion of elbow

Supination of forearm

Weak flexion of shoulder joint

Weak abduction of shoulder joint when externally rotated

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Brachialis Muscle

Jump to Brachialis Muscle, Appendix

True flexion of elbow

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Brachioradialis Muscle

Jump to Brachioradialis Muscle, Appendix

Flexion of elbow

Pronation from supinated position to neutral

Supination from pronated position to neutral

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Triceps Brachii Muscle

Jump to Triceps Brachii Muscle, Appendix

All heads

Extension of elbow

Long head

Extension of shoulder joint

Adduction of shoulder joint

Horizontal abduction

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Anconeus Muscle

Jump to Anconeus Muscle, Appendix

Extension of elbow

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Pronator Teres Muscle

Jump to Pronator Teres Muscle, Appendix

Pronation of forearm

Weak flexion of elbow

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Pronator Quadratus Muscle

Jump to Pronator Quadratus Muscle, Appendix

Pronation of forearm

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Supinator Muscle

Jump to Supinator Muscle, Appendix

Supination of forearm

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Elbow Flexion

Example: Biceps curl

Agonists

Biceps brachii

Brachialis

Brachioradialis

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Elbow Extension

Example: Push-up

Agonists

Triceps brachii

Anconeus

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Radioulnar Pronation

Agonists

Pronator teres

Pronator quadratus

Brachioradialis

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Radioulnar Supination

Example: Tightening a screw

Agonists

Biceps brachii

Supinator muscle

Brachioradialis

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Websites, 1

American Sports Medicine Institute

Pitching Biomechanics Evaluation

University of Washington School of Medicine

Information on various upper extremity conditions

eOrthopod

A Patient’s Guide to Elbow Anatomy

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Websites, 2

Huei Ming Chai

Functions, stability and joint structure of elbow complex; kinematics, muscle action and common injuries of the elbow

American Family Physician

Evaluation of overuse elbow injuries

Wheeless’ Textbook of Orthopaedics

An extensive index of links to the fractures, joints, muscles, nerves, trauma, medications, medical topics, lab tests, and links to orthopaedic journals and other orthopaedic and medical news

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Appendices

Manual of Structural Kinesiology

Bones, 1, Appendix

The different parts of the elbow shown in the figure are as follows: lateral supracondylar ridge, lateral epicondyle, capitulum, head of radius, radial tuberosity, radius, ulna, ulnar tuberosity, coronoid process, trochlea, medial epicondyle, medial supracondylar ridge, and coronoid fossa.

Jump back to Bones, 1

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Bones, 3, Appendix

The different parts of the elbow shown in the figure are as follows: humerus, coronoid fossa, trochlea, radial tuberosity, radius, ulna, ulnar tuberosity, coronoid process, trochlear notch, olecranon process, medial epicondyle, and medial supracondylar ridge.

Jump back to Bones, 3

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Bones, 4, Appendix 1

Jump back to Bones, 4

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Bones, 4, Appendix 2

The different parts of the elbow shown in the figure are as follows: lateral supracondylar ridge, olecranon fossa, lateral epicondyle, olecranon process, radial notch, ulna, radius, radial tuberosity, radial head, capitulum, and humerus.

Jump back to Bones, 4

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Joints, 1, Appendix

The different parts of the elbow shown in the figure are as follows: joint capsule, lateral epicondyle of the humerus, annular ligament, insertion of the tendon of the biceps brachii muscle open parenthesis cut close parenthesis, radius, ulna, ulnar collateral ligament, medial epicondyle of humerus, and humerus.

Jump back to Joints, 1

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Joints, 3, Appendix

The different parts of the elbow shown in the figure are as follows: tendon of biceps brachii muscle open parenthesis cut close parenthesis, joint capsule, synovial membrane, radius, ulna, coronoid process, olecranon, olecranon bursa, synovial membrane, trochlea, and humerus.

Jump back to Joints, 3

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Joints, 4, Appendix

The different parts of the elbow shown in the figure are as follows: tendon of biceps brachii muscle open parenthesis cut close parenthesis, coronoid process of ulna, ulnar collateral ligament, medial epicondyle of humerus, joint capsule, and annular ligament.

Jump back to Joints, 4

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Joints, 9, Appendix 1

The different parts of the radioulnar joint shown in the figure are as follows: radial notch of ulna, head of radius, coronoid process, trochlear or semilunar notch, and olecranon process.

Jump back to Joints, 9

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Joints, 9, Appendix 2

The different parts of the radioulnar joint shown in the figure are as follows: posterior, anterior, radial notch, coronoid process, trochlear notch, and olecranon process.

Jump back to Joints, 9

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Joints, 10, Appendix

The different parts of the radioulnar joint shown in both the anterior and the posterior views of the figure are as follows: radius, ulna, interosseous margins, interosseous membrane, ulnar notch of radius, head of ulna, and styloid process. The anterior view also shows the olecranon, radial notch of ulna, head of radius, neck of radius, tuberosity of radius, styloid process, articular facets, tuberosity of ulna, coronoid process, and trochlear notch. The posterior view also shows the olecranon, head of radius, neck of radius, and styloid process.

Jump back to Joints, 10

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Movements, 1, Appendix

It shows a girl with her right hand lying horizontal in the sagittal plane, bending her elbow such that the tip of her right hand touches the back of her right shoulder. The movement is flexion.

Jump back to Movements, 1

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Movements, 3, Appendix

It shows a girl with her right forearm at right angles to her biceps. The palm is in a vertical position and it moves anti-clockwise till it reaches a horizontal position.

Jump back to Movements, 3

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Movements, 4, Appendix

It shows a girl with her right forearm at right angles to her biceps. The palm is in a vertical position and it moves clockwise till it reaches a horizontal position.

Jump back to Movements, 4

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Muscles, 1, Appendix

The different parts of the elbow shown in the figure are as follows: origins on both the right and the left sides; scapula; humerus; bellies; insertion on both the right and the left sides; radius; ulna; extensors, which include the triceps brachii, long head, and lateral head; and flexors, which include the biceps brachii and the brachialis.

Jump back to Muscles, 1

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Muscles, 2, Appendix 1

The different muscles in the right shoulder and arm shown in the lateral view of the figure are as follows: spine of scapula; acromion process; clavicle; deltoid; pectoralis major; biceps brachii, which includes the long head; brachialis; brachioradialis; anconeus; and the triceps brachii, which includes the long head and the lateral head.

Jump back to Muscles, 2

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Muscles, 2, Appendix 2

The different muscles in the right shoulder and arm shown in the anterior view of the figure are as follows: serratus anterior open parenthesis cut close parenthesis; coracobrachialis; teres major; tendon of latissimus dorsi; triceps brachii, which includes the long head and medial head; medial epicondyle of humerus; brachialis; aponeurosis of biceps brachii; ulna; radius; pronator teres; biceps brachii tendon; and biceps brachii, which includes the short head and long head.

Jump back to Muscles, 2

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Muscles, 3, Appendix

The arm in the positions of supination and pronation includes the lateral epicondyle, the medial epicondyle, the supinator, the pronator teres, the ulna, the radius, and the pronator quadratus. The cross section of muscle actions includes the biceps brachii, the radius, the bursa, the ulna, and the supinator.

Jump back to Muscles, 3

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Muscles, 6, Appendix

The different anterior upper extremity muscles shown in the figure are as follows: the trapezius muscle, the clavicle, the deltoid muscle, the triceps brachii muscle, the brachioradialis muscle, the pectoralis major muscle, the biceps brachii open parenthesis short head close parenthesis, the biceps brachii open parenthesis long head close parenthesis, the brachialis muscle, the pronator teres muscle, the bicipital aponeurosis, the flexor carpi radialis muscle, the palmaris longus muscle, the flexor carpi ulnaris muscle, the flexor digitorum superficialis muscle, the flexor retinaculum, and the palmar aponeurosis.

Jump back to Muscles, 6

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Muscles, 7, Appendix

The different posterior upper extremity muscles shown in the figure are as follows: trapezius muscle, the ulnar nerve, the anconeus, the flexor carpi ulnaris muscle, the extensor carpi ulnaris muscle, the extensor retinaculum, the acromion process of scapula, the deltoid muscle, the triceps brachii muscle, the brachioradialis muscle, the extensor carpi radialis longus muscle, the extensor carpi radialis brevis muscle, the extensor digitorum muscle, and the extensor digiti minimi muscle

Jump back to Muscles, 7

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Nerves, 2, Appendix

The distribution of the radial nerve shown in the figure is as follows: medial cord of brachial plexus, posterior cord of brachial plexus, lateral cord of brachial plexus, radial nerve, lateral head of triceps brachii muscle, brachioradialis muscle, extensor carpi radialis longus muscle, extensor carpi radialis brevis muscle, abductor pollicis longus muscle, extensor pollicis longus and brevis m muscle, extensor indicis muscle, extensor retinaculum, extensor digitorum muscle, extensor digiti minimi muscle, extensor carpi ulnaris muscle, supinator muscle, anconeus muscle, medial head of triceps brachii muscle, and long head of triceps brachii muscle. The parts of the arm covered by these nerves are also highlighted.

Jump back to Nerves, 2

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Nerves, 3, Appendix

The distribution of the median nerve shown in the figure is as follows: posterior cord of brachial plexus, the lateral cord of brachial plexus, the medial cord of brachial plexus, the median nerve, the pronator teres muscle, the flexor carpi radialis muscle, the palmaris longus muscle, the superficial digital flexor muscle, the deep digital flexor muscle, the flexor retinaculum, the lateral lumbricales m muscle, the thenar m muscle, the pronator quadratus muscle, and the flexor pollicis longus muscle

The parts of the arm covered by these nerves are also indicated.

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Biceps Brachii Muscle, Appendix

O represents origin, and I represents insertion.

The first image depicts the long and short heads of biceps brachii and the I, bicipital aponeurosis, and the second image depicts the O, coracoid process; the O, supraglenoid tubercle; and the I, radial tuberosity.

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Brachialis Muscle, Appendix

O represents origin, and I represents insertion. The first image depicts the brachialis muscle, and the second image illustrates I, coronoid process of ulna and O, distal half of anterior portion of humerus.

Jump back to Brachialis Muscle

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Brachioradialis Muscle, Appendix

O represents origin, and I represents insertion. The first image depicts brachioradialis muscle, and the second image depicts the O, distal two-thirds of the lateral condyloid or supracondylar ridge of the humerus and the I, lateral surface distal end of radius at styloid process.

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Triceps Brachii Muscle, Appendix

O represents origin, and I represents insertion.

The first image depicts the lateral head, the long head, and the medial head of the triceps brachii muscle in extension.

The second image depicts the I, olecranon process of the ulna, the O, infraglenoid tubercle of the scapula, the O, distal two-thirds of posterior surface of humerus, and the O, upper half of posterior surface of the humerus.

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Anconeus Muscle, Appendix

O represents origin, and I represents insertion.

The first image depicts the anconeus muscle in extension.

The second image depicts I, posterior surface of the upper ulna and olecranon and the O, posterior surface of the lateral condyle of humerus.

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Pronator Teres Muscle, Appendix

O represents origin, and I represents insertion.

The first image depicts pronator teres muscle.

The second image depicts O, distal part of medial condyloid ridge of humerus, medial side of proximal ulna and I, middle third of the lateral surface of the radius.

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Pronator Quadratus Muscle, Appendix

O represents origin, and I represents insertion.

The first image depicts pronator quadratus muscle.

The second image depicts O, distal fourth of anterior side of ulna, and I, distal fourth of anterior side of radius.

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Supinator Muscle, Appendix

O represents origin, and I represents insertion.

The first image depicts posterior view of supinator muscle.

The second image depicts the posterior and anterior views of supinator muscle. These views include O, neighboring posterior part of ulna and I, lateral surface of proximal radius just below head. The posterior view also shows the O, lateral epicondyle of the humerus.

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