PTY108 Lecture 6 Elbow PDF

PTY108 Kinesiology in Physiotherapy I: Lecture 0 ELBOW AND RADIO-ULNAR JOINT BAHMAN BIN JAMALUDDIN Senior Lecturer Physiotherapy Program UiTM Cawangan Pulau Pinang Kampus Bertam CONTENT TOPIC SLIDE PAGE 1. Course Learning Outcomes 4 2. Learning Objectives...

PTY108 Kinesiology in Physiotherapy I: Lecture 0 ELBOW AND RADIO-ULNAR JOINT BAHMAN BIN JAMALUDDIN Senior Lecturer Physiotherapy Program UiTM Cawangan Pulau Pinang Kampus Bertam CONTENT TOPIC SLIDE PAGE 1. Course Learning Outcomes 4 2. Learning Objectives 6 3. Introduction 7 4. Key Bony Landmarks 12 14 5. Joints 19 6. Movements 29 7. Muscles 51 8. Function of Rotator Cuffs 54 9. References 3 1 COURSE LEARNING OUTCOMES At the end of the course, students should be able to: CLO1 Explain the musculoskeletal and neuromuscular concepts in relation to functions of muscles and the principles of kinesiological and biomechanical analysis in human motion. (C2) CLO2 Show the palpation skills in identifying bony features, joints and muscles on upper and lower extremities and the ability to analyze joint movements and muscles actions in upper and lower extremities (P2) 4  CLO3. Analyze joint movements and muscles actions in upper and lower extremities in activity performance. (C3) 5 2 LEARNING OBJECTIVES At the end of the session, the students should be able to: Identify the surface anatomy Describe the physiological movement Perform the palpation of bony prominences, joints and muscles 6 3 INTRODUCTION Elbow joint movements may be clearly distinguished from those of the Radio-Ulnar joints Usually grouped together due to their close anatomical proximity relationship 3.1 The Elbow joint connecting the upper arm to the forearm hinge-type synovial joint 7 3.1.1 Structures of the Elbow Joint Articulating Surfaces It consists of two separate articulations: Trochlear notch of the ulna and the trochlea of the humerus Head of the radius (extracapsular) and the capitulum of the humerus (intracapsular) Joint Capsule and Bursae (simpan dan menghasilkan synovial fluid) is strong and fibrous, strengthening the joint The capsule is thickened medially and laterally to form collateral ligaments, which stabilise the flexing and extending motion of the arm.  (lateral supracondylar ridge) (Attachment of muscle) (ANTERIOR VIEW) (MEDIAL VIEW) (LATERAL VIEW)  A bursa is a membranous sac filled with synovial fluid (acts as a cushion to reduce friction between the moving parts of a joint) Intratendinous bursa – located within the tendon of the tricep brachii. Subtendinous bursa – between the olecranon and the tendon of the triceps brachii, reducing friction during extension and flexion Subcutaneous (olecranon) bursa – between the olecranon and the overlying connective tissue (implicated in olecranon bursitis).  Ligaments The joint capsule of the elbow is strengthened by ligaments medially and laterally. The radial collateral ligament is found on the lateral side of the joint, extending from the lateral epicondyle, and blending with the annular ligament of the radius (a ligament from the proximal radioulnar joint). The ulnar collateral ligament originates from the medial epicondyle, and attaches to the coronoid process and olecranon of the ulna.  (ulna) (radius) (radius and ulna) (coronoid process)  Neurovasculature The arterial supply to the elbow joint is from the cubital anastomosis, which includes recurrent and collateral branches from the brachial and deep brachial arteries. Its nerve supply is provided by anteriorly Median nerve Musculocutaneous nerve Radial nerves posteriorly - the Ulnar nerve.  Movements the orientation of the bones forming the elbow joint produces a hinge type synovial joint, which allows for extension and flexion of the forearm: Extension – triceps brachii and anconeus Flexion – brachialis, biceps brachii, brachioradialis 3.2 The Radio-Ulnar joints There are two locations in which the radius and ulna articulate in the forearm: Proximal Radio-ulnar joint Distal Radio-ulnar joint Both are pivot joints, responsible for pronation and supination of the forearm.  3.2.1 Proximal Radio-ulnar Joint is located immediately distal to the elbow joint, and is enclosed with in the same articular capsule It is formed by an articulation between the head of the radius and the radial notch of the ulna. The radial head is held in place by the annular radial ligament, which forms a ‘collar’ around the joint The annular radial ligament is lined with a synovial membrane, reducing friction during movement. Movement is produced by the head of the radius rotating within the annular ligament.  There are two movements possible at this joint Pronation - produced by the pronator quadratus and pronator teres. Supination - Produced by the supinator and biceps brachii.  3.2.2 Distal Radio-ulnar Joint Located just proximally to the wrist joint It is an articulation between the ulnar notch of the radius, and the ulnar head. In addition to anterior and posterior ligaments strengthening the joint, there is also a fibrocartilaginous ligament present, called the articular disk. It serves two functions: Binds the radius and ulna together, and holds them together during movement at the joint. Separates the distal radioulnar joint from the wrist joint.  This is a pivot joint, allowing for Pronation - produced by the pronator quadratus and pronator teres Supination - produced by the supinator and biceps brachii The ulnar notch of the radius slides anteriorly over the head of the ulnar during such movements.  Interosseous Membrane A sheet of connective tissue that joins the radius and ulna together and spans the distance between the medial radial border, and the lateral ulnar border This connective tissue sheet has three major functions: Holds the radius and ulna together during pronation and supination of the forearm, providing addition stability. Acts as a site of attachment for muscles in the anterior and posterior compartments of the forearm. Transfers forces from the radius to the ulna. From Seeley RR, Stephens TD, Tate P: Anatomy & physiology, ed 7, New York, 2006, McGraw-Hill; Shier D, Butler J, Lewis R: hole’s human anatomy & physiology, ed 9, New York, 2002, McGraw-Hill. 4 RANGE OF MOTION  4 MUSCLES 4.1 Biceps Brachii (forearm supination & elbow flexion) (short bicep) (long bicep) 4.2 Brachialis(more to medial) (elbow flexion)  4.3 Brachioradialis (more to lateral- lateral supraepicondylar ridge) (elbow flexion) (lateral cubital fossa) (Distal end lateral radius) 4.4 Triceps Brachii (elbow extension)  4.5 Anconeus (fix pull extension sebab otot pendek dan kecil) (elbow extension) Pronator Teres (pronation) (medial cubital fossa) (superficial muscle)  Pronator Quadratus (distal muscle of forearm) (pronation but deep muscle) O – distal surface radius I – distal surface ulna Supinator Objectives Bones, bony landmarks and joint Muscles Movements  Movements Flexion: Movement of forearm to shoulder by bending the elbow to decrease its angle Extension Extension: Movement of forearm away from shoulder by straightening the elbow to increase its angle Movements Pronation Internal rotary movement of radius on ulna that results in hand moving from palm-up to palm- down position Supination External rotary movement of radius on ulna that results in hand moving from palm-down to palm- up position FLEXION Superior movement of the forearm in the sagittal plane FLEXION FLEXION MUSCLE Biceps brachii Brachialis Brachioradialis Pronator teres EXTENSION Inferior movement of the foremarm in the sagittal plane EXTENSION EXTENSION MUSCLE Triceps Long head also extends the shoulder Anconeus PRONATION Internal rotary movement of the palm to the down position Pronator Quadratus PRONATION Supinated position PRONATION Brachioradialis Pronator teres Pronator quadratus SUPINATION External rotary movement of the palm to the up position Supinator SUPINATION Supinated position SUPINATION Pronated position SUPINATION Biceps brachii Brachioradialis Supinator 9 REFERENCES Floyd RT and Thompson C, Manual of Structural Kinesiology, 20, New York: McGraw Hill, 2017, ISBN: n/a Kathryn Luttgens,Nancy Hamilton,Wendi Weimar, Kinesiology: Scientific Basis of Human Motion, McGraw- Hill Education, 2011, ISBN: 0078022541 Donald A. Neumann, Kinesiology of the Musculoskeletal System, Mosby, 2016, ISBN: 0323287530 Joseph Hamill,Kathleen Knutzen,Timothy Derrick, Biomechanical Basis of Human Movement, Lww, 2014, ISBN: 1451177305 57