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MOB TCD
MOB TCD
Bones of Elbow
MOB TCD
Elbow Joint
Synovial hinge joint One degree of freedom Uniaxial The articular surfaces are the trochlea and the capitulum of the humerus The trochlear notch of the ulna The superior aspect of the head of the radius
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Elbow Joint
When the elbow is extended, medial epicondyle, olecranon and lateral epicondyle are in a straight line When flexed, they form a triangle
MOB TCD
MOB TCD
MOB TCD
Synovial Membrane
Lines the capsule and nonarticular structures inside the capsule Continuous inferiorly with synovial membrane of superior radio-ulnar joints Annular ligament covered with articular cartilage
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Synovial Membrane
Between the capsule and synovial membrane are three other pads of fat The largest, at the olecranon fossa, is pressed into it by triceps during flexion Two, at the coronoid and radial fossae, are pressed in by brachialis during extension They are all slightly displaced in contrary movements
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Synovial Membrane
Smaller synovial-covered tags of fat project into the joint near constrictions flanking the trochlear notch, covering small non-articular areas of bone
MOB TCD
MOB TCD
MOB TCD
MOB TCD
MOB TCD
Anterior Relations
Brachialis lies on capsule Medial to lateral Common flexor origin Median nerve Brachial artery covered by bicipital aponeurosis Biceps Radial nerve Superficial Deep branch is posterior interosseus nerve
MOB TCD
Posterior Relations
Triceps Anconeus Olecranon bursa Ulnar nerve posterior to medial epicondyle Common extensor origin
MOB TCD
Extensor Tendons
Brachioradialis Extensor carpi radialis longus Extensor carpi radialis brevis* Extensor digitorum communis Extensor digiti minimi Extensor carpi ulnaris
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Posterior Relations
medial
olecranon bursitis
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Posterolateral
Below lateral epicondyle Head of radius Behind the extensors of the forearm Posterior interosseous nerve
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Lateral Elbow
MOB TCD
MOB TCD
Flexion of Elbow
Main flexors Brachialis, musculocutaneous (C5,6) Biceps, musculocutaneous (C5,6) Weak flexors Common flexor origin, median (C6,7) Except flexor carpi ulnaris, ulnar nerve (C6,7) Brachioradialis, radial (C5,6)
MOB TCD
MOB TCD
Elbow
Biceps brachii Brachialis Pronator teres Supinator posterior Musculocutaneous C5,6 Musculocutaneous C5,6 Median C6,7 Interosseous C5,6
MOB TCD
Extension of Elbow
Triceps is the main extensor Weak are extensors from common extensor origin Nerve supply radial (C7,8) Extension of the elbow is limited by: Impingement of the olecranon of the ulna on the olecranon fossa of the humerus Tension of the anterior arm muscles and collateral ligaments
MOB TCD
Biceps Brachii
Crosses shoulder, elbow and superior radioulnar A long head arising from the supraglenoid tubercle The adjoining portion of the labrum within the capsule of the shoulder joint It passes above the head of the humerus Leaves the joint below the transverse ligament, which acts as a retinaculum
MOB TCD
Biceps Brachii
It is surrounded by synovial membrane, which extends inferiorly to the lower margin of the teres major, i.e. the posterior fold of the axilla Short head arises from the coracoid process with the coracobrachialis
MOB TCD
Biceps Brachii
The two heads unite to form a fleshy belly, which becomes a tendon, inserted into the posterior aspect of the radial tuberosity The bicipital aponeurosis extends from its medial margin, passing anterior to the brachial artery and the median nerve, fuses with deep fascia of the forearm and the medial margin of the ulna A bursa separates it from the radius Nerve supply is musculocutaneous nerve C5,6,7
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MOB TCD
Brachialis Muscle
Arises from the anterior aspect of the shaft of the humerus below the deltoid tuberosity It is inserted into the anterior aspect of the coranoid process of the ulna and the capsule of the elbow joint It lies directly anterior to the elbow joint and is only a flexor of the elbow The musculocutaneous nerve C5,6,7 supplies it
MOB TCD
Coracobrachialis Muscle
It arises from the coracoid process, together with the short head of the biceps brachii Inserts into the middle of the medial surface of the humerus Helps to flex and adduct the arm at the shoulder joint
MOB TCD
Coracobrachialis Muscle
The coracobrachialis muscle also helps to stabilise the shoulder joint A persistent lower head may remain as supra-trochlear spur or Ligament of Struthers, attached to the medial epicondyle of the humerus May compress the median nerve or the brachial artery Musculo-cutaneous nerve C5,6,7
MOB TCD
MOB TCD
MOB TCD
MOB TCD
Elbow Pain
Loose bodies Pain Locking
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MOB TCD
MOB TCD
MOB TCD
Lateral Epicondylitis
Extensor carpi radialis brevis in most cases Anterior edge of extensor digitorum communis 30% Less frequently Extensor carpi radialis longus Extensor carpi ulnaris
Nirschl, 1993
MOB TCD
MOB TCD
Lateral Epicondylitis
Racquet sports Backhand Throwing sports Golfers Musicians Labourers
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Elbow Effusion
Fullness in the triangular area bounded by The radial head The lateral epicondyle The tip of the olecranon
Behr & Altchek, 1997
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Elbow Dislocation
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