Elbow-joint

Elbow redirects here. For other uses of that word, see Elbow (disambiguation).

The elbow-joint (Articulatio Cubiti) 1,2 is a ginglymus or hinge-joint. Three bones form the elbow joint: the humerus of the upper arm, and the paired radius and ulna of the forearm.

Two main movements are possible at the elbow. The hinge-like bending and straightening of the elbow (flexion and extension) happens at the articulation ("joint") between the humerus and the ulna. The complex action of turning the forearm over (pronation or supination) happens at the articulation between the radius and the ulna (this movement also occurs at the wrist joint).

In the anatomical position (with the forearm supine), the radius and ulna lie parallel to each other. During pronation, the ulna remains fixed, and the radius rolls around it at both the wrist and the elbow joints. In the prone position, the radius and ulna appear crossed.

Most of the force through the elbow joint is transferred between the humerus and the ulna. Very little force is transmitted between the humerus and the radius. (By contrast, at the wrist joint, most of the force is transferred between the radius and the carpus, with the ulna taking very little part in the wrist joint).

In the anatomical position, the forearm and upper arm do not lie in a straight line: the forearm is deviated laterally (valgus) with respect to the upper arm by 5-10°. This angle is known as the carrying angle. In females the carrying angle is greater than in males. This may explain why females often carry an object with the forearm in the supine position (classical textbooks depict a milkmaid carrying two pails of milk), and males often carry an object with the forearm in the prone or semiprone position.

Ligaments

The trochlea of the humerus is received into the semilunar notch of the ulna, and the capitulum of the humerus articulates with the fovea on the head of the radius. The articular surfaces are connected together by a capsule, which is thickened medially and laterally, and, to a less extent, in front and behind. These thickened portions are usually described as distinct ligaments:

Synovial membrane

The synovial membrane is very extensive. It extends from the margin of the articular surface of the humerus, and lines the coronoid, radial and olecranon fossæ on that bone; it is reflected over the deep surface of the capsule and forms a pouch between the radial notch, the deep surface of the annular ligament, and the circumference of the head of the radius. Projecting between the radius and ulna into the cavity is a crescentic fold of synovial membrane, suggesting the division of the joint into two; one the humeroradial, the other the humeroulnar.

Between the capsule and the synovial membrane are three masses of fat:

the largest, over the olecranon fossa, is pressed into the fossa by the Triceps brachii during the flexion;
the second, over the coronoid fossa,
and the third, over the radial fossa, are pressed by the Brachialis into their respective fossæ during extension.

Muscles, arteries, and nerves

The muscles in relation with the joint are, in front, the Brachialis; behind, the Triceps brachii and Anconæus; laterally, the Supinator, and the common tendon of origin of the Extensor muscles; medially, the common tendon of origin of the Flexor muscles, and the Flexor carpi ulnaris.

The arteries supplying the joint are derived from the anastomosis between the profunda and the superior and inferior ulnar collateral branches of the brachial, with the anterior, posterior, and interosseous recurrent branches of the ulnar, and the recurrent branch of the radial. These vessels form a complete anastomotic network around the joint.

The nerves of the joint are a twig from the ulnar, as it passes between the medial condyle and the olecranon; a filament from the musculocutaneous, and two from the median.

Movements

The elbow-joint comprises three different portions - viz., the joint between the ulna and humerus, that between the head of the radius and the humerus, and the proximal radioulnar articulation. All these articular surfaces are enveloped by a common synovial membrane, and the movements of the whole joint should be studied together. The combination of the movements of flexion and extension of the forearm with those of pronation and supination of the hand, which is ensured by the two being performed at the same joint, is essential to the accuracy of the various minute movements of the hand.

Between the ulna and humerus

The portion of the joint between the ulna and humerus is a simple hinge-joint, and allows of movements of flexion and extension only.

Owing to the obliquity of the trochlea of the humerus, this movement does not take place in the antero-posterior plane of the body of the humerus.

When the forearm is extended and supinated, the axes of the arm and forearm are not in the same line; the arm forms an obtuse angle with the forearm (the carrying angle). During flexion, however, the forearm and the hand tend to approach the middle line of the body, and thus enable the hand to be easily carried to the face.

The accurate adaptation of the trochlea of the humerus, with its prominences and depressions, to the semilunar notch of the ulna, prevents any lateral movement.

Flexion is produced by the action of the Biceps brachii and Brachialis, assisted by the Brachioradialis and the muscles arising from the medial condyle of the humerus; extension, by the Triceps brachii and Anconæus, assisted by the Extensors of the wrist, the Extensor digitorum communis, and the Extensor digiti quinti proprius.

Between the head of the radius and the capitulum of the humerus

The joint between the head of the radius and the capitulum of the humerus is an arthrodial joint.

The bony surfaces would of themselves constitute an enarthrosis and allow of movement in all directions, were it not for the annular ligament, by which the head of the radius is bound to the radial notch of the ulna, and which prevents any separation of the two bones laterally.

It is to the same ligament that the head of the radius owes its security from dislocation, which would otherwise tend to occur, from the shallowness of the cup-like surface on the head of the radius.

In fact, but for this ligament, the tendon of the Biceps brachii would be liable to pull the head of the radius out of the joint.

The head of the radius is not in complete contact with the capitulum of the humerus in all positions of the joint.

The capitulum occupies only the anterior and inferior surfaces of the lower end of the humerus, so that in complete extension a part of the radial head can be plainly felt projecting at the back of the articulation.

In full flexion the movement of the radial head is hampered by the compression of the surrounding soft parts, so that the freest rotatory movement of the radius on the humerus (pronation and supination) takes place in semiflexion, in which position the two articular surfaces are in most intimate contact.

Flexion and extension of the elbow-joint are limited by the tension of the structures on the front and back of the joint; the limitation of flexion is also aided by the soft structures of the arm and forearm coming into contact.

Proximal radioulnar joint

In any position of flexion or extension, the radius, carrying the hand with it, can be rotated in the proximal radioulnar joint. This movement includes pronation and supination.

The hand is only directly articulated to the distal surface of the radius, and the ulnar notch on the lower end of the radius travels around the lower end of the ulna. The ulna is excluded from the wrist-joint by the articular disk.

Thus, rotation of the head of the radius around an axis passing through the center of the radial head of the humerus imparts circular movement to the hand through a very considerable arc.

External links

TheWorld - the weblog entry and photo of a man who can lick his own elbow.

Upper limb anatomy

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