The elbow region is a complex structure that includes Lateral supracondylar ridge

three individual joints that are surrounded by only one - Superior to the lateral epicondyle, a landmark that is
capsule. palpable between the lateral head of the triceps
● humeroulnar and humeroradial joints - these are the posteriorly and the brachioradialis muscle anteriorly.
articulations we typically think of as the “elbow”.
- act as one joint, creating a modified The distal humerus that forms the proximal portion
uniaxial hinge joint with one degree of of the elbow joint has two prominences:
freedom.This uniaxial joint’s motions ● the medial trochlea - articulates with the ulna
include elbow flexion and extension in the - Hourglass-shaped, large and comprised
sagittal plane around the medial-lateral of two portions that are separated by the
axis. trochlear groove
● Proximal radioulnar articulation - the third joint of ● the lateral capitulum - articulates with the radius.
the elbow complex. Even though this joint lies within - almost spheroid in shape.
the elbow capsule, it is technically not part of the
elbow joint; it is where forearm rotation occurs and Capitulotrochlear Groove
is not involved in movement at the elbow - between the lateral spheroid-shaped capitulum and
medial hourglass-shaped trochlea.
Humeroulnar - radial head slides within this groove when the
↳ where most of the contact and osteokinematic elbow elbow flexes.
motion comes.
Coronoid fossa
Uniaxial proximal radioulnar joint - superior to the trochlea on the anterior humerus,
- also offers only one degree of freedom. when the elbow fully flexes, the ulna’s coronoid
process moves into this fossa. Similarly, superior to
Proximal radioulnar joint also has the capitulum
- one degree of freedom, but its motion occurs in the
transverse plane around a vertical axis. Radial fossa
- houses the radial head at the end of elbow flexion.
Radioulnar joint
- provides forearm supination and pronation. Olecranon fossa
- the posterior aspect of the distal humerus, providing
The elbow and radioulnar joints are each uniaxial, but a deep and stable articulating surface for the
because they work together in different planes. superior ulna when the elbow is in full extension

Epicondyles Ulna
- most distinct palpable bony landmarks. - more integral articulating bony partner with the
- prominences immediately proximal to the distal humerus at the elbow, forming the humeroulnar
condyles of the humerus. joint.
- Most easily identifiable landmarks in this region. - Located on the medial forearm.

When the shoulder is laterally rotated, the medial Olecranon process

epicondyle lies closest to the trunk; the less prominent - the distinctive posterior prominence of the superior
lateral epicondyle lies on the lateral side of the humerus, ulna and is the most posterior portion of the elbow
farthest from the trunk. when the joint is flexed

Medial epicondyle Trochlear notch

- serves as the proximal attachment site for a primary - Concave ulnar, articulates with the more proximal
forearm pronator (pronator teres), for a major humeral trochlea to form the medial elbow joint.
stabilizing ligament (the ulnar collateral ligament),
and for most of the wrist and finger flexor muscles. Semilunar notch
- Shaped like a half-moon, ulnar articulatio.
Lateral epicondyle - This large articulating ulnar surface is divided in the
- less prominent, is easily located by positioning the center by a prominent trochlear or longitudinal
elbow at 90 ° of flexion with the forearm in ridge that articulates with the
midposition as if to shake someone’s hand; as the trochlear groove of its humeral companion.
body leans laterally towards an adjacent wall (on
the flexed elbow side), the knobby bony landmark The anterior surface of the ulna is marked by a distinctive,
that makes contact with the wall is the lateral sharp, medial superior process called the coronoid
epicondyle. process.
- serves as the attachment for many of the wrist and
finger/thumb extensors and the forearm supinator. When the elbow flexes, this ulnar process moves to fit snugly
into the coronoid fossa
Ulnar tuberosity Most activities of daily living occur within an arc of elbow
- Inferior to the coronoid process, an attachment site motion between 30° and 130°.
for a primary elbow flexor muscle, the brachialis.
Elbow extension - has a hard end feel with contact
On the lateral aspect of the proximal ulna, distal to the between the ulna’s olecranon process and the humeral
trochlear notch is the slightly concave radial notch. This olecranon fossa.
radial notch articulates with the radius to form the proximal - Average extension motion is 0°
radioulnar joint
Close-packed Position:
Humeroulnar Joint - full extension
Humeroradial Joint - 90 degree flexion, 5 degree supination
Radioulnar Joint - Full Supination or Full Pronation

Resting Position:
Humeroulnar Joint - 70° elbow flexion with 10° forearm
supination
Humeroradial Joint - full elbow extension with full forearm
supination
Radius Radioulnar Joint - 70° elbow flexion with
- contributes to proximal forearm function 35° forearm supination
- it plays a more important role at the distal radioulnar
joint and at the wrist. This angulation creates the cubital angle, commonly called
the carrying angle. The biomechanical term for this
Head of the radius angulation is cubital valgus (L., turned outward). This angle
- Proximal end, located just distal to the humeral is approximately 15°.
lateral condyle. - Carrying angle, laterally in relation to the shaft of
the humerus in the anatomical position.
The superior surface of the radial head has a deep concave
fovea, which articulates with the round convex head of the Cubital varus, or a carrying angle, less than the normal 5° to
humeral capitulum to form the humeroradial joint. 15° of valgus is sometimes called a gun stock deformity.

Just distal to the radial head on the anterior radial neck is The carrying angle results from a combination of
the radial tuberosity. The radial tuberosity is the attachment glenohumeral lateral rotation, elbow extension, and forearm
site for the biceps brachii. supination.

The primary motions at the humeroulnar joint are flexion and

extension, the primary reinforcing ligaments are specialized
thickenings of the capsule— the medial (ulnar) and lateral
(radial) collateral ligaments. These two ligaments stabilize
the capsule medially and laterally, respectively, to offer
stability in the frontal plane.

These two ligaments stabilize the capsule medially and

laterally, respectively, to offer stability in the frontal plane.

The elbow joints include the humeroulnar and Medial (ulnar) collateral ligament (MCL)
humeroradial joints whereas the proximal forearm joint - quite large and comprised of three distinct parts:
is the proximal radioulnar joint. anterior, posterior, and transverse.
- extends from the medial epicondyle of the humerus
Primary articulating segments at the elbow joint: to the ulna’s coronoid process anteriorly and
- humerus olecranon process posteriorly.
- ulna - It stabilizes the elbow against excessive valgus
forces to restrict the forearm from excessive lateral
The axis for elbow flexion-extension is medial-lateral displacement on the arm.
(x-axis). - the primary stabilizer of the elbow; damage to it
may result in an unstable elbow joint.
The distal end of the humerus lies in 30° of anterior rotation
with respect to the humeral shaft, and the proximal ulna is Lateral (radial) collateral ligament (LCL)
rotated about 30° posteriorly in relation to the ulnar shaft. - on the lateral elbow is a fan-shaped structure. Like
This matching relationship provides the 145° range in flexion the MC.
as well as the stability of the joint in full extension. - has three parts; these segments extend from the
humeral lateral epicondyle to the annular ligament
Although the typical passive range of elbow flexion motion surrounding the radial head and to the ulna’s
averages 145°, normal variability ranges from 120° to 160°. olecranon process.
 - This ligament stabilizes the elbow against Annular ligament
excessive varus forces, prevents humeroulnar - has firm, fibrous connections to the ulna, attaching
subluxation, stabilizes the humeroradial joint, and to it on either side of the radial notch, anchoring
assists the annular ligament in stabilizing the radial firmly around the radial head and neck.
head against the ulna (Fig. 6.3). - this ring encircles the head of the radius forming a
circle within which the radial head can pivot, or
Olecranon bursa - vitally important in absorbing force and rotate
reducing shock occurring when the elbow extends forcefully,
compressing the olecranon process into the humeral Quadrate ligament
olecranon fossa. - quite short but strong, arising from the ulna just
inferior to the radial notch and attaching to the
Radioulnar Articulations medial surface of the radial neck.
- include a proximal, or superior, component that lies - Reinforces the joint capsule and maintains a close
within the elbow joint capsule and a distal, or relationship of the radial head against the ulnar
inferior, component that is just proximal to the wrist. radial notch, thereby limiting spinning of the radial
- Motions of these joints include forearm supination head.
and pronation.
Oblique cord
In supination, the ulna and radius lie parallel to each other, - flat band of fascia on the ventral forearm running
whereas in pronation the radius crosses over the ulna. from the inferior aspect of the ulna’s radial notch to
just below the ulna’s radial tuberosity. Its fibers run
The combined range of motion of both radioulnar joints - perpendicular to those of the interosseous
150° to 180° membrane and become taut in full supination,
providing additional stability to the radioulnar
When range of pronation-supination motion is examined, the connection
elbow should be flexed to 90° and in contact with the side of
the body. MUSCLES

Proximal Radioulnar Joint (Pivot Joint) The primary muscles that flex the elbow include the:
- The articular surfaces of this joint include the brachialis, biceps brachii, and brachioradialis.
convex radial head and the slightly concave radial
notch of the ulna. The annular ligament surrounds Pronator teres - assists to a limited degree; since its
the radial head. primary responsibility is in forearm pronation, it is presented
with that group of muscles. Of the primary elbow flexors,
Annular ligament – forms most of the articulating ring both the biceps brachii and brachioradialis also influence
around the head of the radius, and the smaller radial notch of forearm motion.
the ulna completes the articular ring formation.
Brachialis - located deep to the prominent biceps
In contrast to the humeroulnar joint which derives most brachii, attaches only to the ulna acting across the
of its stability from its bony structure, the radioulnar humeroulnar joint and, therefore, will always be
joints are dependent on soft tissue for stability.
recruited in elbow flexion regardless of forearm
position.
Soft tissue stability at the proximal radioulnar joint is provided
- only one-joint elbow flexor muscle, unaffected by
by the:
shoulder or forearm position.
- annular ligament
- known as the “workhorse” of the elbow because it
- reinforced by the LCL
has a large work capacity due to a large cross
- Oblique cord
section area, is the largest of all of the elbow
- Quadrate ligament.
flexors, and it crosses only the humeroulnar joint.
- It is recruited in all tasks requiring elbow flexion.
The distal radioulnar joint stability is derived from the
This muscle is also very efficient forachieving
articular disc and the dorsal and palmar radioulnar ligaments.
mobility at the humeroulnar joint because its
insertion is close to the joint axis, exerting its
A close anatomic relationship between the radius and ulna is
greatest moment arm of force at around 90° to 100°
enhanced by the presence of an interosseous membrane
of elbow flexion.
located between the two bones.
- This thick membrane reinforces both radioulnar
Biceps Brachii
joints without restricting pronation or supination
- fusiform-shaped muscle with two heads located on
motions.
the anterior arm. The biceps brachii originates from
- absorbs shock and transmits force along the kinetic
the scapula and attaches below the elbow joint so it
chain to protect the forearm bones from injury
has no direct connection with the humerus and can
during times of excessive force
be passively moved about easily.
- Primarily engaged in activities when elbow is flexed
with forearm pronated.
Brachioradialis
- the longest of the elbow flexors and is the only
primary elbow flexor whose belly lies in the forearm.
- strong contributor to elbow flexion and has a limited
role in forearm pronation and supination.
- Because of its attachment site on the radius, it may
contribute to pronation or supination. Although it
has a relatively small cross section, it exerts peak
force at 100° to 120° of elbow flexion

Pronator teres - weak elbow flexor, predominantly

contributing to flexion when the forearm is pronated. Since its
main action is forearm pronation, this muscle will be
described in detail with the forearm muscles.

The principal extensor of the elbow is the triceps

brachii. The small anconeus adds only minimally to the
total strength of elbow extension.

Triceps brachii
- named because it has three heads, makes up the
entire muscle mass on the posterior aspect of the
arm.
- Its greatest extension force is exerted in midrange
at 70° to 90° of elbow flexion.
- acts concentrically to extend the elbow,
eccentrically as a major elbow stabilizer during
elbow flexion, and as a powerful stabilizer of the
upper extremity during any functional closed-chain
activity

Anconeus
- small muscle located deep, adjacent to the joint,
blending close to the fibers of the humeroulnar joint
capsule.
- It contracts during elbow extension to tighten the
loose posterior elbow capsule, perhaps helping to
prevent pinching of the capsule folds as the
olecranon locks into the olecranon fossa. It is an
accessory muscle for elbow extension.
- It provides only 10% to 15% of required extensor
force.

Forearm supinators include primarily the biceps

brachii and supinator. The brachioradialis may assist to a
limited degree.

supinator
- the only muscle whose sole action is forearm
supination. As such, it is always recruited for
forearm supination, regardless of the speed or load.
- deep muscle located on the dorsal interosseous
membrane between the two bones of the forearm. It
is covered by the anconeus, the extensor carpi
radialis longus, and the brachioradialis.

The muscles that are primarily responsible for pronating the

forearm are named by their prime action and include the
pronator teres and pronator quadratus.