Podcast
Questions and Answers
Which of the following is NOT a bone that forms part of the elbow joint complex?
Which of the following is NOT a bone that forms part of the elbow joint complex?
- Scapula (correct)
- Humerus
- Ulna
- Radius
Which joint in the elbow complex is classified as a uniaxial hinge joint?
Which joint in the elbow complex is classified as a uniaxial hinge joint?
- Humeroradial joint
- Humeroulnar joint (correct)
- Distal Radioulnar Joint
- Proximal radioulnar joint
Which ligament primarily resists valgus stress at the elbow?
Which ligament primarily resists valgus stress at the elbow?
- Interosseous membrane
- Annular ligament
- Medial (ulnar) collateral ligament (correct)
- Lateral (radial) collateral ligament
What is the primary motion occurring at the proximal radioulnar joint?
What is the primary motion occurring at the proximal radioulnar joint?
During elbow flexion, which arthrokinematic motion occurs at the humeroulnar joint?
During elbow flexion, which arthrokinematic motion occurs at the humeroulnar joint?
What type of end feel is typically present with full elbow extension?
What type of end feel is typically present with full elbow extension?
In which position is the humeroulnar joint typically in its open-packed position*
In which position is the humeroulnar joint typically in its open-packed position*
What is the normal carrying angle (cubitus valgus) range for females?
What is the normal carrying angle (cubitus valgus) range for females?
Which bony landmark on the humerus serves as a common attachment site for muscles of the forearm?
Which bony landmark on the humerus serves as a common attachment site for muscles of the forearm?
Which structure primarily strengthens the annular ligament?
Which structure primarily strengthens the annular ligament?
What is the primary function of the interosseous membrane between the radius and ulna?
What is the primary function of the interosseous membrane between the radius and ulna?
The elbow joint capsule is described as:
The elbow joint capsule is described as:
Which of the following muscles is considered a primary elbow flexor and inserts onto the coronoid process of the ulna?
Which of the following muscles is considered a primary elbow flexor and inserts onto the coronoid process of the ulna?
The biceps brachii generates peak force at what range of elbow flexion?
The biceps brachii generates peak force at what range of elbow flexion?
Which of the following best describes the action if the Brachioradialis?
Which of the following best describes the action if the Brachioradialis?
Which head of the triceps brachii originates from the infraglenoid tubercle of the scapula?
Which head of the triceps brachii originates from the infraglenoid tubercle of the scapula?
What is the primary action of the Anconeus muscle?
What is the primary action of the Anconeus muscle?
Which nerve innervates the pronator teres muscle?
Which nerve innervates the pronator teres muscle?
What is the primary action of the pronator quadratus?
What is the primary action of the pronator quadratus?
Which nerve innervates the supinator muscle?
Which nerve innervates the supinator muscle?
Which of the following muscles can perform 'reversal of muscle action' by performing a pull-up?
Which of the following muscles can perform 'reversal of muscle action' by performing a pull-up?
What type of relationship is seen with the Biceps Brachii and the Pronator Teres regarding elbow flexion.
What type of relationship is seen with the Biceps Brachii and the Pronator Teres regarding elbow flexion.
Which pair of muscles works together as a force couple to achieve forearm supination?
Which pair of muscles works together as a force couple to achieve forearm supination?
What motion is created from forearm pronators attaching to the radius?
What motion is created from forearm pronators attaching to the radius?
What pathology of the elbow is commonly seen in young children under the age of 5?
What pathology of the elbow is commonly seen in young children under the age of 5?
The normal end feel for elbow flexion is described as what?
The normal end feel for elbow flexion is described as what?
If a patient lacks flexibility of the anterior joint capsule and anterior annular ligament, what motion may be limited at Proximal RU joint?
If a patient lacks flexibility of the anterior joint capsule and anterior annular ligament, what motion may be limited at Proximal RU joint?
To create elbow flexion, how must the muscle cross the elbow joint?
To create elbow flexion, how must the muscle cross the elbow joint?
Identify the plane of motion and axis of rotation for completing elbow extension
Identify the plane of motion and axis of rotation for completing elbow extension
What osteokinematic motion occurs at the elbow complex during forearm pronation?
What osteokinematic motion occurs at the elbow complex during forearm pronation?
If the elbow and forearm create 9 degrees of freedom, what occurs distally or proximally to compensate from the loss of the elbow and forearm.
If the elbow and forearm create 9 degrees of freedom, what occurs distally or proximally to compensate from the loss of the elbow and forearm.
Which of the following is the capsular pattern of the humeroulnar joint?
Which of the following is the capsular pattern of the humeroulnar joint?
Which of the following is the capsular pattern of the radiohumeral joint?
Which of the following is the capsular pattern of the radiohumeral joint?
What arthrokinematic motion occurs when the elbow is shooting a foul shot in basketball?
What arthrokinematic motion occurs when the elbow is shooting a foul shot in basketball?
If someone is turning a door knob counter clockwise using their right hand, what arthrokinematic direction the Radius is moving?
If someone is turning a door knob counter clockwise using their right hand, what arthrokinematic direction the Radius is moving?
The Triceps are contracting eccentrically during what phase of the push up?
The Triceps are contracting eccentrically during what phase of the push up?
According to normal ROM Values, how many degrees should you expect someone to supinate?
According to normal ROM Values, how many degrees should you expect someone to supinate?
What two structures do the Annular Ligament connect?
What two structures do the Annular Ligament connect?
Where is the Biceps Brachii inserted at?
Where is the Biceps Brachii inserted at?
Which muscle is primarily responsible for extending the elbow?
Which muscle is primarily responsible for extending the elbow?
Flashcards
Elbow Joint Bones
Elbow Joint Bones
The elbow joint complex includes three bones: humerus, ulna, and radius.
Elbow Joint Joints
Elbow Joint Joints
The elbow joint complex includes the humeroulnar, humeroradial, and proximal radioulnar joints.
Elbow Joint Ligaments
Elbow Joint Ligaments
The elbow joint complex includes the medial (ulnar) collateral, lateral (radial) collateral, and annular ligaments.
Motions: Humeroulnar & Humeroradial
Motions: Humeroulnar & Humeroradial
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Motions: Proximal Radioulnar
Motions: Proximal Radioulnar
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Normal Elbow Flexion ROM
Normal Elbow Flexion ROM
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Normal Elbow Extension ROM
Normal Elbow Extension ROM
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Normal Forearm Pronation/Supination ROM
Normal Forearm Pronation/Supination ROM
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Humeroulnar Arthrokinematics
Humeroulnar Arthrokinematics
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End Feel: Elbow Flexion
End Feel: Elbow Flexion
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End Feel: Elbow Extension
End Feel: Elbow Extension
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End Feel: Forearm Pronation
End Feel: Forearm Pronation
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End Feel: Forearm Supination
End Feel: Forearm Supination
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Open Pack Humeroulnar Joint
Open Pack Humeroulnar Joint
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Closed Pack Humeroulnar Joint
Closed Pack Humeroulnar Joint
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Normal Carrying Angle
Normal Carrying Angle
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Medial Collateral Ligament Fibers
Medial Collateral Ligament Fibers
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Brachialis: Origin, Insertion, Nerve, Action
Brachialis: Origin, Insertion, Nerve, Action
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Biceps Brachii: Origin, Insertion, Nerve, Action
Biceps Brachii: Origin, Insertion, Nerve, Action
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Brachioradialis: Origin, Insertion, Nerve, Action
Brachioradialis: Origin, Insertion, Nerve, Action
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Triceps Brachii: Origin, Insertion, Nerve, Action
Triceps Brachii: Origin, Insertion, Nerve, Action
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Anconeus: Origin, Insertion, Nerve, Action
Anconeus: Origin, Insertion, Nerve, Action
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Pronator Teres: Origin, Insertion, Nerve, Action
Pronator Teres: Origin, Insertion, Nerve, Action
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Pronator Quadratus: Origin, Insertion, Nerve, Action
Pronator Quadratus: Origin, Insertion, Nerve, Action
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Supinator: Origin, Insertion, Nerve, Action
Supinator: Origin, Insertion, Nerve, Action
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Elbow and Forearm Muscle Actions
Elbow and Forearm Muscle Actions
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Elbow & Forearm Muscle Innervation
Elbow & Forearm Muscle Innervation
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Prime Mover Elbow Flexion
Prime Mover Elbow Flexion
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Prime Mover Elbow Extension
Prime Mover Elbow Extension
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Force Couple For Supination
Force Couple For Supination
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Study Notes
Elbow and Forearm Overview
- Chapter 14 focuses on the elbow and forearm, covering bones, joints, ligaments, and motions.
Learning Objectives for Elbow and Forearm Study
- Identify key bones and bony landmarks in each region.
- Recognize joint structures and functions.
- Identify force couples.
- Describe osteokinematic and arthrokinematic joint motions.
- Understand plane of movement, axes of rotation, and normal ROM values.
- Characterize normal and abnormal end feels.
- Describe muscle origins, insertions, nerve supply, and actions.
- Recognize muscle action reversal and specific movement relationships (scapulohumeral rhythm, carrying angle, etc.)
- Understand how motion in one joint segment affects others.
- Determine agonist muscle groups and contraction types during functional movements.
- Identify anatomical roles and relationships between muscles.
- Identify joint pathologies and open/closed pack positions.
- Identify active/passive insufficiency and muscle line of pull in relation to a joint's axis of rotation.
Elbow Joint Complex
- Includes three bones: humerus, ulna, and radius.
- Three joints: humeroulnar, humeroradial, and proximal radioulnar.
- Three Ligaments: medial collateral, lateral collateral, and annular ligament.
Joint Motion
- Humeroulnar: flexion and extension in the sagittal plane.
- Humeroradial: flexion and extension in the sagittal plane, pronation, and supination in the transverse plane.
- Proximal Radioulnar: pronation and supination in the transverse plane.
Normal Range of Motion
- Elbow flexion: 0-150 degrees.
- Elbow extension: 150-0 degrees.
- Forearm pronation: 0-80 degrees.
- Forearm supination: 0-80 degrees.
Arthrokinematics of the Humeroulnar Joint
- Trochlea is convex shaped, found at the medial aspect of the distal humerus.
- Trochlear notch of the ulna is concave shaped.
- Anterior glide occurs with flexion, posterior glide with extension.
Arthrokinematics
- HU flexion: Ulna moves anteriorly with concave on concave.
- HU extension: Ulna moves posteriorly with concave on concave.
- HR flexion: Radius moves anteriorly with concave on concave.
- HR extension: Radius moves posteriorly with concave on concave.
- HR pronation: Radius moves medially with concave on concave and medial spin.
- HR supination: Radius moves laterally with concave on concave and lateral spin.
- Prox. RU pro: Radius moves anteriorly with convex on convex.
- Prox. RU sup: Radius moves posteriorly with convex on convex.
- Distal RU pro: Radius moves anteriorly with concave on concave.
- Distal RU sup: Radius moves posteriorly with concave on concave.
End Feels
- Elbow flexion: Soft tissue approximation or soft.
- Elbow extension: Bony or hard.
- Forearm pronation: Capsular or firm. Some consider it bony or hard.
- Forearm supination: Capsular or firm.
Open/Close Pack Positions & Capsular Patterns
- Humeroulnar joint: Open packed at 70° elbow flexion, 10° supination. Close packed is full extension with full supination and a capsular pattern of flexion>extension.
- Radiohumeral joint: Open packed at full extension and supination and close packed in 90° elbow flexion, 5° supination, and a capsular pattern of Flex > Ext > Sup > Pro.
- Proximal Radioulnar joint: Open packed position is 70° elbow flexion, 35° supination, closed packed 5º supination, and a capsular pattern of supination=pronation.
Carrying Angle
- The angle is formed between the longitudinal axes of the humerus and forearm.
- The trochlea is more distal than the capitulum, creating an oblique joint line.
- Normal carrying angle: approximately 5 degrees in males, 10-15 degrees in females.
- Benefits: Hand to mouth, arm swing avoids the pelvis during walking/running.
Bones and Bony Landmarks
- Scapula: coracoid process, supraglenoid tubercle, infraglenoid tubercle.
- Humerus: medial/lateral epicondyle, olecranon fossa, capitulum, trochlea.
- Ulna: trochlear notch, coronoid process, ulnar tuberosity. Trochlea convex, articulating concave trochlear notch.
- Radius: head, radial tuberosity.
Ligaments and Structures of the Elbow
- Medial (Ulnar) Collateral Ligament: triangular, has anterior/posterior/transverse bundles, strongest anterior fibers.
- Lateral (Radial) Collateral Ligament: triangular, strengthens annular ligament.
- Annular Ligament: ring-shaped, maintains head of radius against ulna.
Interosseous Membrane
- Broad, flat membrane binding radius/ulna.
- Buffers loads through the hand.
- Fibers run distally from ulna to proximal radius at an oblique angle.
Joint Capsule of the Elbow
- Surrounds the elbow complex.
- Encompasses the distal humerus, proximal radius, and ulna.
- Capsule is fairly large and loose, weak anteriorly and posteriorly.
Muscles of the Elbow and Forearm
- Brachialis, biceps brachii, brachioradialis, triceps brachii, anconeus, pronator teres, pronator quadratus, supinator.
Brachialis Details
- Origin: distal half of humerus (anterior surface).
- Insertion: coronoid process and ulnar tuberosity.
- Nerve: musculocutaneous (C5, C6).
- Action: elbow flexion.
Biceps Brachii Details
- Greatest strength at 80-100 degrees of elbow flexion.
- Origin: Long head from supraglenoid tubercle. Short head from coracoid process of scapula.
- Insertion: radial tuberosity.
- Nerve: musculocutaneous nerve (C5, C6).
- Action: shoulder flexion (long head), elbow flexion, and forearm supination (both heads).
Brachioradialis Details
- Origin is the lateral supracondylar ridge of humerus.
- Insertion is the styloid process of the radius.
- Radial nerve supply (C5 and C6).
- Key actions are elbow flexion, forearm pronation to neutral, and forearm supination to neutral.
Triceps Brachii Details
- Origin: Long head from infraglenoid tubercle of the scapula, lateral head from the posterior humerus, medial head from the posterior humerus.
- Insertion: Olecranon process of the Ulna.
- Nerve Supply is the Radial Nerve (C6, C7, C8, T1).
- Action: long head: shoulder extension. The whole triceps is elbow extension.
Anconeus Details
- Lateral epicondyle of the humerus origin.
- Lateral and inferior to the olecranon process of the ulna insertion.
- Radial nerve supply (C6*, C7, C8).
- Elbow extension action and is weak.
Pronator Teres Details
- Origin: medial epicondyle of the humerus & coronoid process of the ulna.
- Insertion: lateral aspect of radius (midpoint).
- Nerve: median nerve (C6, C7).
- Action: forearm pronation, assists in elbow flexion.
Pronator Quadratus Details
- Origin: Distal ¼ of the ulna.
- Insertion: Distal ¼ of the radius.
- Nerve Supply: Median Nerve (C8, T1).
- Action: Forearm pronation.
Supinator Details
- Origin: lateral epicondyle of the humerus and adjacent ulna.
- Insertion: anterior surface of proximal radius.
- Supply Radial Nerve (C6).
- Action: forearm supination.
Anatomical Relationships
- Muscles crossing the elbow affect it to varying degrees.
- Prime elbow flexors: biceps, brachialis, brachioradialis, assisting wrist joint movers.
- Prime elbow extensors: triceps, anconeus, assisting wrist joint movers.
- Forearm pronators: attach to cause radius to move anteriorly/medially.
- Supinators: attach on posterior radius for posterior/lateral movement.
Summary Of Muscle Action
- Flexion: Biceps brachii, Brachialis, Brachioradialis.
- Extension: Triceps, Anconeus.
- Pronation: Pronator Teres, Pronator quadratus, Brachioradialis (to neutral).
- Supination: Biceps, Supinator, Brachioradialis (to neutral).
Summary of Muscle Innervation
- Brachialis: Musculocutaneous nerve (C5, C6)
- Biceps brachii: Musculocutaneous nerve (C5, C6)
- Brachioradialis: Radial nerve (C5, C6)
- Triceps: Radial nerve (C6, C7, C8, T1).
- Anconeus: Radial nerve (C6, C7, C8)
- Pronator teres: Median nerve (C6, C7)
- Pronator quadratus: Median nerve (C8, T1)
- Supinator: Radial nerve (C6)
Common Elbow Pathologies
- Lateral epicondylitis ("tennis elbow").
- Medial epicondylitis ("golfer's elbow").
- Little Leaguer's Elbow.
- Elbow dislocation and nursemaid's elbow.
- Supracondylar fractures.
- Ulnar nerve compression.
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