8 Elbow Anatomy:Pathologies.pptx

ICI I ISTITUTO CLINICO HUMANITAS ICI I ISTITUTO CLINICO HUMANITAS Shoulder and Elbow Unit Humanitas Rozzano ICI I ISTITUTO CLINICO HUMANITAS Elbow Anatomy ICI I ISTITUTO CLINICO HUMANITAS TOPOGRAPHIC ANATOMY Definition: Articular Segment Between Arm And Forearm. 1 Limits: Two Axia...

ICI I ISTITUTO CLINICO HUMANITAS ICI I ISTITUTO CLINICO HUMANITAS Shoulder and Elbow Unit Humanitas Rozzano ICI I ISTITUTO CLINICO HUMANITAS Elbow Anatomy ICI I ISTITUTO CLINICO HUMANITAS TOPOGRAPHIC ANATOMY Definition: Articular Segment Between Arm And Forearm. 1 Limits: Two Axial Planes Passing Two Fingers Above And Under The Elbow Cutaneous Plication 2 ICI I ISTITUTO CLINICO HUMANITAS Elbow Joint ICI I ISTITUTO CLINICO HUMANITAS Elbow Anatomy Elbow Joint Is Made Of • • • • • 3 Bones 2 Joints One Capsule Hinge Joint Flexion(145) And Extension ICI I ISTITUTO CLINICO HUMANITAS Elbow Anatomy • Elbow Joint- Where The Radius And Ulna Articulate With The Humerus. • Flexion And Extension: Hinge Joint ICI I ISTITUTO CLINICO HUMANITAS Elbow Anatomy • Radialulnar joint: • where the radius and ulna articulate. – How many of this joint are there??? ICI I ISTITUTO CLINICO HUMANITAS Elbow Anatomy • Radioulnar Joint Is A Pivot Joint • It Allows Supination And Pronation. ICI I ISTITUTO CLINICO HUMANITAS Elbow Anatomy • The Ulna Does Not Move. • The Radius Moves Around The Ulna. • The Ulna Is Locked In Place By The Proximal End At The Olecranon Process. ICI I ISTITUTO CLINICO HUMANITAS Elbow Anatomy Infraglenoid Tubercle: Inferior Lip Of The Glenoid Fossa, Where The Long Head Of Triceps Attaches. ICI I ISTITUTO CLINICO HUMANITAS Elbow Anatomy Supraglenoid Tubercle: Superior Portion Of The Glenoid Fossa. Where The Long Head Of Biceps Attaches. ICI I ISTITUTO CLINICO HUMANITAS Elbow Anatomy Capitulum Humeri: Lateral Side Of Joint, It Articulates With The Radius. ICI I ISTITUTO CLINICO HUMANITAS Elbow Anatomy Medial Epicondyle: Medial Side Of Humerus At Distal End Just Above Trochlea. Pronator Teres Attachment. ICI I ISTITUTO CLINICO HUMANITAS Elbow Anatomy Lateral Epicondyle: Located On Lateral Side Of Distal End Above Capitulum. Anconeus And Supinator Insertion. ICI I ISTITUTO CLINICO HUMANITAS Elbow Anatomy Olecranon Fossa: Posterior Surface Of The Humerus Between The Medial And Lateral Epicondyles. ICI I ISTITUTO CLINICO HUMANITAS Elbow Anatomy Olecranon Process: Proximal End Of Ulna, On Posterior Surface. The Point Of Elbow Where Distal Triceps Attaches. ICI I ISTITUTO CLINICO HUMANITAS Elbow Anatomy Trochlea: Located On The Medial Side Of The Distal End Of The Humerus. Articulates With Ulna. ICI I ISTITUTO CLINICO HUMANITAS Elbow Anatomy Coronoid Process: Just Below The Trochlear Notch And Next To The Radial Notch. Attachment For Brachialis. ICI I ISTITUTO CLINICO HUMANITAS Elbow Anatomy Styloid Process: Distal End Of The Lateral/Medial Surface At The Ulna Or Radius. ICI I ISTITUTO CLINICO HUMANITAS Elbow Anatomy Ulnar Head: Distal End On The Lateral Surface, Radial Head Pronates Around It. ICI I ISTITUTO CLINICO HUMANITAS Elbow Anatomy Radial Head: Proximal End, Where It Articulates With The Capitulum. ICI I ISTITUTO CLINICO HUMANITAS Elbow Anatomy Radial Tuberosity: Attachment For The Biceps Muscle.On Medial Side of Radius Just Distal to The Radial Head. ICI I ISTITUTO CLINICO HUMANITAS Elbow Ligaments Medial Collateral Ligament (MCL): Runs from Medial Epicondyle of Humerus to The Medial Side of Coranoid Process and Olecranon Process. ICI I ISTITUTO CLINICO HUMANITAS Elbow Ligaments Lateral Collateral Ligament (LCL): Attaches Proximally to the Lateral Epicondyle and Distally to the Lateral Ulna and Annular Ligament. ICI I ISTITUTO CLINICO HUMANITAS Elbow Ligaments Annular Ligament: Encompasses Radial Head at the Radial Notch and Hold It Against the Ulna. (Red) ICI I ISTITUTO CLINICO HUMANITAS Elbow/Forearm Muscles Brachialis: Attaches Distal Half Of The Humerus To The Coronoid Process And Ulnar Tuberosity Of Ulna. ICI I ISTITUTO CLINICO HUMANITAS Elbow/Forearm Muscles Biceps Brachii – Long Head-supraglenoid Tubercle, Through Bicipital Groove, Joins With The – Short Head- Comes From The Coracoid Process – Both Combine To Inset Onto The Radial Tuberosity. ICI I ISTITUTO CLINICO HUMANITAS ICI I ISTITUTO CLINICO HUMANITAS Elbow/Forearm Muscles Brachioradialis: Attached To Humerus Just Slightly Above The Lateral Epicondyle, Crosses The Elbow Anterior And Lateral To Attach On The Styloid Process Of The Radius. ICI I ISTITUTO CLINICO HUMANITAS Brachialis, Biceps, Brachioradialis Primary Function Of These Three Muscles Is What ??? ICI I ISTITUTO CLINICO HUMANITAS Elbow/Forearm Muscles Triceps Brachi: Entire Muscle Mass of Posterior Arm. It Attaches to the Olecranon Process When All 3 Heads of The Muscle Combine. Function Is Extension. Radial Nerve. ICI I ISTITUTO CLINICO HUMANITAS Elbow/Forearm Muscles Anconeus: Helps the Triceps With Extension And Keeps The Annular Ligament Out of the Olecranon Fossa. ICI I ISTITUTO CLINICO HUMANITAS Elbow/Forearm Muscles Pronator Teres: Cordlike Shape Is Teres, And Pronation Is Its Pimary Action. Mostly Superficial Muscle. ICI I ISTITUTO CLINICO HUMANITAS Elbow/Forearm Muscles Pronator Quadratus: Small Flat Quadrilateral Muscle That Pronates The Wrist. Deep Muscle At Distal End Of Forearm. ICI I ISTITUTO CLINICO HUMANITAS Elbow/Forearm Muscles Supinator: Deep Muscle That Wraps Around The Elbow Joint Laterally From Posterior To Anterior Surfaces. ICI I ISTITUTO CLINICO HUMANITAS ICI I ISTITUTO CLINICO HUMANITAS Elbow Interosseous Membrane: Broad Flat Membrane Located Between the Radius and Ulna for Most of Their Length. ICI I TOPOGRAPHIC ANATOMY ISTITUTO CLINICO Axial view HUMANITAS Anterior Region of The Elbow Or ANTECUBITAL Posterior Region or OLECRANIC Antecubital Region ICI I ISTITUTO CLINICO HUMANITAS Muscle Layers 3 Prominences: Lateral Prominence: 4 Epycondylar Muscles (1) Intermediate Or Bicipital Prominence (2) Medial Prominence: 4 Epitrochlear Muscles (3) ICI I ISTITUTO CLINICO Antecubital Region HUMANITAS Lateral Prominence: 4 Epicondilar Muscles Extensor And Supinator Of The Wrist • Brachio-Radialis • Extensor Carpi Radialis Longus • Extensor Carpi Radialis Brevis Supinator ICI I ISTITUTO CLINICO HUMANITAS Deep Dissection ICI I ISTITUTO CLINICO Antecubital Region HUMANITAS Medial Prominence: 4 Epitroclear Muscles Flexor And Pronator Of The Wrist 4 • Pronator Teres (1) • Flexor Carpi Radialis (2) • Palmaris Longus (3) • Flexor Carpi Ulnaris (4) • Superficial Flexor Of The Fingers 1 3 2 ICI I Antecubital Region ISTITUTO CLINICO HUMANITAS Deep Vessels And Nerves The Humeral Artery Is On The Medial Side Of The Bicipital Sulcus. It Ends Into Two Branches 2-3 Cm Under The Elbow Plication ICI I Antecubital Region ISTITUTO CLINICO HUMANITAS Humeral Artery And Its Forking Recurrent Branches Anterior Radial Collateral Artery, Term. Branch Of The Deep Humeral Artery Anastomotic Branches Between Radial Collateral Artery And Ulnar Collateral One ICI I ISTITUTO CLINICO ANTECUBITAL REGION HUMANITAS DEEP NERVES • Median nerve: It is along the anterior humeral brachialis. • Radial nerve: it is along the torsion humeral sulcus and in the distal part there is a superficial branch (to the brachio-radialis) and a deeper one (in the posterior region in the supinator muscle) • Ulnar nerve: posterior to the epitroclea, in the flexor ulnar carpi. Distally it is between the flexor ulnar carpi and the deep flexor of the fingers to the 4° e 5° ones. ICI I Olecranic Region ISTITUTO CLINICO HUMANITAS Limits: The Same Of The Anterior Region External Shape: 1.Median Prominence Of The Epitroclea 2.Posterior Prominence Of The Olecranon 3.Lateral Prominence Of The Epicondyle Huter Triangle ICI I ISTITUTO CLINICO Olecranic Region HUMANITAS Muscle Layer: Intermediate Group: • Triceps Lateral Group: • Anconeous Muscle • Ulnaris Carpi Extensor • Common Extensor Of Fingers Medial Group: • Flexor Ulnaris Carpi ICI I ISTITUTO CLINICO Olecranic Region HUMANITAS Deep Nerves: Ulnar N. (5): In The Epitrocleo-olecranic Sulcus, Under The Ulnar Flexor Carpi, - Anconeous N.(6) ICI I ISTITUTO CLINICO HUMANITAS ICI I ISTITUTO CLINICO HUMANITAS Elbow Function ICI I ISTITUTO CLINICO HUMANITAS Elbow Function ICI I ISTITUTO CLINICO HUMANITAS Elbow Function ICI I ISTITUTO CLINICO HUMANITAS Elbow Function ICI I ISTITUTO CLINICO HUMANITAS Elbow Function ICI I ISTITUTO CLINICO HUMANITAS Elbow Function ICI I ISTITUTO CLINICO HUMANITAS Elbow Function ICI I ISTITUTO CLINICO HUMANITAS Elbow Function ICI I ISTITUTO CLINICO HUMANITAS Elbow Function ICI I ISTITUTO CLINICO HUMANITAS FUNCTIONAL ANATOMY Flexion-extension (150°): It is very important the anterior inclination of 45° of the distal part of the humerus towards the diaphysis Extension to 0° : limited by the olecranon against the olecranic fossa Humeral-ulnar joint (angular ginglimo) The articular surfaces are the humeral troclea and the articular facet of the ulna ICI I ISTITUTO CLINICO FUNCTIONAL ANATOMY HUMANITAS Prono-supination (175°): Supination 90° Pronation 85° Radio-ulnar joint (lateral ginglimo) The articular surfaces are the radial facet of the ulna and the articular circumference of the radius ICI I ISTITUTO CLINICO FUNCTIONAL ANATOMY HUMANITAS FLEXORS BRACHIALIS BICEPS Proximal insertion: SHB: coracoid process of the scapula LHB: supraglenoid tubercle of the scapula Distal insertion: Radial bicipital tuberosity Action: It flexes the elbow, and supinates the forearm Functional Movement To take items, to get food to the mouth ICI I ISTITUTO CLINICO HUMANITAS FUNCTIONAL ANATOMY FLEXORS Anterior Brachialis Proximal Insertion: Distal Half Of The Volar Side Of The Humerus Distal Insertion: Coronoid Process And Ulnar Tuberosity Action: Flexes The Elbow Functional Movements: To Catch Items, To Bring Food To The Mouth ICI I ISTITUTO CLINICO HUMANITAS FUNCTIONAL ANATOMY BRACHIORADIALIS (radial n.) FLEXORS Proximal insertion : Proximal 2/3 of the supracondilic humeral edge Distal insertion : Lateral surface of the distal end of the radius Action: Flexes the elbow, pronates and supinates the forearm against resistence Functional movement: To twist a screw ICI I ISTITUTO CLINICO HUMANITAS FUNCTIONAL ANATOMY FLEXORS PRONATOR TERES (median n.) Proximal insertion: Medial Epicondyle of the humerus and coronoid process of the ulna Distal insertion At the half of the lateral side of the radius Action: It pronates the forearm and helps the flexion of the elbow Functional Movement : To put some liquid in a glass, to open the door, etc. ICI I ISTITUTO CLINICO HUMANITAS FUNCTIONAL ANATOMY EXTENSORS BRACHIALIS TRICEPS (radial n.)only posterior muscle of the arm Proximal insertion : LH: infraglenoid tubercle of the scapula Lat. H: posterior surface of the humerus cranially to the radial sulcus Med. H: posterior surface of the humerus distally to the radial sulcus Distal insertion: Proximal end of the olecranon Action: Extends the elbow, adduces and stabilyzes the shoulder Functional movement : To throw items, to pull a door ICI I ISTITUTO CLINICO HUMANITAS FUNCTIONAL ANATOMY PRONATORS PRONATOR TERES PRONATOR QUADRATUS (anterior interosseous nerve) Proximal insertion : Distal end of the volar side of the ulna Distal insertion Distal end of the volar side of the radius Action : It pronates the forearm, it flexes the elbow Functional Movement : To put some liquids into a glass, to twist the handle of a door ICI I ISTITUTO CLINICO HUMANITAS FUNCTIONAL ANATOMY SUPINATORS BRACHIALIS BICEPS BREVIS SUPINATOR Proximal insertion Lateral Epicondyle of the humerus, radial and annular collateral ligaments, supinator fossa and ulnar edge Distal insertion: Lateral and posterior side of the proximal end of the radius Action : Supinates the forearm Functional movement: To turn the handle of a door. ICI I ISTITUTO CLINICO HUMANITAS Elbow Pathologies ICI I ISTITUTO CLINICO HUMANITAS Epicondylitis • Overuse of the Tendon Attached to The Epicondyle of The Humerus. • Faulty Technique/Mechanics, Weak Muscles or Improper Equipment. • Can Be on Lateral Side: “Tennis Or Golfers Elbow” • Can Be on the Medial Side: “Pitcher’s Elbow” ICI I ISTITUTO CLINICO HUMANITAS Elbow pathology related to sport Tennis Lateral epicondilytis (backhand) Golf Medial epicondilytis swing (non D.A.) Lateral epicondilytis (D.A) Basket Posterior compartment (shot) Water sky Posterior compartment Bowling Flexors/pronators Tendonitis Baseball Valgus stress, medial traction, lateral compression, posterior impingement ICI I ISTITUTO CLINICO Epicondylitis HUMANITAS Signs and Sx – Pain over epicondyle – Increase pain with wrist flexion or extension – Elbow contracture Treatment – Proper technique – Proper equipment – Good warm up with slow increase in intensity – Stretching – RICE ICI I ISTITUTO CLINICO HUMANITAS Epicondylitis • Lateral epicondylitis is much more frequent than the medial one (9:1). • Etiology: • Backhand overload in tennis. • Indirect trauma at the epicondyle • Assumption of fluoroquinolones • It is not an inflammatory but degenerative disease ICI I Lateral elbow lesions ISTITUTO CLINICO HUMANITAS Epicondylitis • Clinical presentation: • Chronic: • Full ROM • lateral pain • Cozen’s test positive • Acute: • complete estension very difficult • Inflammation of the posterior branch of the radial nerve ICI I Lateral elbow lesions ISTITUTO CLINICO HUMANITAS Epicondylitis • Treatment: • Conservative: • Manipulations • Braces • ESWT • Topics (corticosteroids) • Injections • PRP • kinesiotaping ICI I ISTITUTO CLINICO HUMANITAS Dislocations • Elbow Is The Second Most Commonly Dislocated Major Joint. • Most Often The Ulna/Radius Dislocate Posterior To The Humerus. MoI: Fall of Outstretched Arm With Elbow Locked in Extension ICI I Dislocations ISTITUTO CLINICO HUMANITAS Signs and Sx – Obvious deformity – Check circulation and nerve function Treatment – Immobilization – Wrist strengthening and then progress to elbow – RICE ICI I ISTITUTO CLINICO HUMANITAS Monteggia’s fracture • Ulna fracture • Dislocation of the radial head ICI I ISTITUTO CLINICO HUMANITAS Galeazzi’s fracture • Fracture of the radius • Dislocation of the distal ulna Open fracture Grazie