Human Movement Week 5

Bony landmarks of radius: proximal

Radial head Radial tuberosity

The joint where supination occurs

Radioulnar

At what joint(s) does pronation and supination occur?

Radioulnar joints

coronoid fossa

Receives coronoid process in flexion

Radial Fossa

Receives radial head in flexion

Bony Landmarks of the distal Humerus

Trochlea, Capitulum, Medial Epicondyle, Lateral Epicondyle, Lateral epicondyle, radial fossa, coronoid fossa, olecrenaon fossa, funny bone

Muscles of the Elbow and Forearm: Flexors

(when supinated or neutral, when pronated biceps brachii is not active) Biceps Brachii Brachialis Brachioradialis

Synergies at the elbow and forearm: Pronator teres (humeral head)

-Pronates the radioulnar joint -Flexes the elbow For pronator teres to pronate the radioulnar joint w/out flexing the elbow it must act in synergy with an elbow extensor

Anatomy of elbow complex: joints

1. humeroulnar 2. humeroradial

Anatomy of elbow complex: bones

1. humerus 2. ulna 3. raidus

What does the elbow complex allow?

1. positioning of the hand in space (near or far) in relation to the body which creates optimal position for fine motor function 2. forearm pronation/supination is vital to the functioning of the UE 3. Stabilizes the hand for skilled and forceful movements

Brachialis: PM Elbow Flexion

Attaches to anterior surface of humeral shaft and coronoid process of ulna Not influenced by rotation of radius WHY? Not attached to the radius, only the ulna Active in elbow flexion with or without resistance

Ligament that binds radius and ulnar together so that they move together

Annular ligament

Which ligament binds the radial head to the ulna so they move together?

Annular ligament

Humeroulnar Joint

Articulation between the trochlea (humerus) and the trochlear notch and groove (ulna)

Humeroradial Joint

Articulation of the capitulum (humerus) and radial head

Brachioradialis: Flexion

Attached at lateral supracondylar ridge of humerus and distal end of radius Much of the force is direction to compress the joint in early flexion Most active as flexor in 120 degrees of flexion, why? This is where the brachioradialis line of pull is 90 degrees to the bony segment Partially functions as both a pronator and supinator

What muscle flexes the elbow joint and supinates the forearm?

Biceps brachii

Which of the following muscles is a pm for flexion but less when pronated

Biceps brachii

Which of the following muscles is considered a prime mover for elbow flexion, but is less active during elbow flexion when the forearm is pronated?

Biceps brachii

Which muscle(s) are prime movers for the following action from Position A to Position B?

Biceps brachii, brachialis, brachioradialis

Synergies at the elbow and forearm: Biceps Brachii

Biceps brachiii -Flexes the elbow -Supinates the radioulnar joint For biceps to supinate the radioulnar joint w/out flexing the elbow, it must act in synergy with an elbow extensor For biceps to flex the elbow w/out supinating the radioulnar joint it must act in synergy with a r-u pronator

Elbow flexion and forearm movement

Biceps flexes and supinates -When elbow flexes with forearm in pronation, biceps are nearly inactive Brachialis flexes in all forearm positions, all types of contractions (concentric) Clinical implications: pronating forearm will inhibit biceps therefore, inactivate it

Clinical problems elbow: 7. How much extension do you need to tie shoes?

Full extension Limitation: can bring your foot to your arms

Clinical problems elbow: 5. Your patients has a grade 2 forearm supination, what functions will be affected? What substitutions might be used?

Grade 2 forearm supination Lack of supination functions: -Can't hold arm to receive change at store -Carrying things would need compensation Compensation: abduct shoulder and externally rotate

Clinical problems elbow: 4. Which patients is more likely to be able to use their arms too lower themselves into a chair with arms?: one who has a grade 3 strength in biceps and grade 4 in triceps or vice versa?

Grade 4 triceps and grade 3 biceps Triceps are the one doing more of the work Eccentric triceps

Trochlea

Hourglass shaped located on medial side of distal end, articulates with ulna (trochlear groove on humerus articulates with trochlear notch on ulna)

What makes up the joint capsule?

Humeroradial, humeroulnar, and proximal radicular joints are all enclosed in a single joint capsule

What is the carrying angle?

In anatomical position it is the angle that is created by the longitudinal axis of the humerus and forearm -10 to 15 degrees -axis of movement at elbow joint is not horizontal -allows objects to be carried away from the body 2 end feels: In flexion: soft In extension: hard

Distal Radioulnar

Inferior articulation of the radius with the ulna

Funny bone

Is the ulnar nerve that runs medial to the olecranon fossa

Muscles of the Elbow and Forearm: Pronators

Pronator Quadratus Pronator Teres

Clinical problems elbow: 6. List 5 activities that a patient with only 10 degrees of forearm pronation will have difficulty with? How might you compensate?

Lacking pronation functions: -Typing -Holding a knife -Piano -Writing -Weight bearing through hands -Sports Compensation: Internally rotate shoulder

medial epicondyle

Larger more prominent, provides attachment for pronator teres

Clinical problems elbow: 1. What is the min amount of elbow flexion ROM you need to put something in your mouth with your hand? What adaptations could you make if you only had 90 degrees of flexion?

More than 90 degrees around 100 Limited elbow flexion adaptations: neck and trunk flexion (head to hand), radial deviation, some wrist flexion

Biomechanics of flexion

Movement arm and angular force are greatest at 90 degrees As joint moves towards 0 degrees, movement arm decreases and stabilizing force increases As joint moves beyond 90 degrees and toward 180 degrees, movement arm decreases and dislocation force increases

Clinical problems elbow: 2. What is the min amount of elbow extension ROM you need to push yourself from sit to stand in a. chair with your arms? In a chair without arms? From a chair pulled up to a table, pushing from the table top?

Need 30 degrees of extension If the chair has no arms then they need full extension Chair pulled up to table (do not need much extension)

Bony Landmarks of ulna: proximal

Olecranon Trochlear notch Coronoid process Radial notch

olecranon fossa

Posterior humerus, articulates with olecranon process of ulna

Pronators: pronator teres

Primarily pronates forearm but assists with elbow flexion

Supinator

Prime mover for supination along with biceps Functions best and solely when elbow is extended Active in supination under all conditions

Pronators: Pronator Quadratus

Pronates forearm by pulling radius over the ulna which serves to turn palm downward

Lateral Epicondyle

Smaller, provides attachment for anconeus and supinator

Normal end feel for elbow flexion is _____ and for elbow extension is _____.

Soft; hard

Capititulum

Spherical located on later side of distal end, articulates with the radius

Bony landmarks of radius: distal

Styloid process Articular surface

proximal radioulnar

Superior articulation of the radius with the ulna

Muscles of the Elbow and Forearm: Supinators

Supinator Biceps Brachii

Considering this is a slow and controlled movement against gravity, which muscle(s) are prime movers for the following action from Position A (bent) to Position B (extended) ?

Triceps and anconeus

Considering this is a slow and controlled movement into gravity, when moving from Position A to Position B what are the prime movers involved at the elbow joint?

Triceps and anconeus

Weight extension over head (kinetic chain: open)

Triceps and anconeus

Triceps and Anconeus: Extension

Triceps 3 muscle heads and covers entire posterior surface of UE Attaches to olecranon process of ulna Prime mover in elbow extension Long head crossed over shoulder joint assisting with shoulder extension and Add Anconeus Initiation of elbow extension and maintaining a position of extension

Muscles of the Elbow and Forearm: Extensors

Triceps Anconeus

Clinical problems elbow: 3. What muscles are active when you use your arms to push from sit to stand: what type of contraction is this?

Triceps (concentric)

Considering this is a slow and controlled movement into gravity, which muscle(s) are prime movers for the following action from Position B to Position A?

Triceps and anconeus

Biceps Brachii: Flexion/supination

Two heads, two joint muscle Simultaneously flexes elbow and supinates forearm Active in all flexion activities with supination Assists in shoulder flexion (weakly)

Bony landmarks of ulna: distal

Ulnar head Styloid process

Funny bone is

Ulnar joint

Joe just bumped his "funny bone" against the edge of a table. What bodily structure is the "funny bone?"

Ulnar nerve

What are the joints of the elbow complex?

humeroulnar, humeroradial, proximal radioulnar, distal radioulnar

Motions of elbow joint

humerus articulates with the raidus and ulna (uniaxial, hinge, 1 degree of freedom) 1. flexion/extension (0-145) 2. AROM and PROM differences

Ligaments: Proximal Radioulnar Joint Annular Ligament

important for supination and pronation

Soft tissues

joint capsule

Elbow joint posterior landmarks

olecranon fossa, medial epicondyle, olecranon process

Ligaments: Proximal Radioulnar Joint Oblique cord

prevents separation, assists in pronation and supination

Ligaments: Distal Radioulnar Joint Interosseous Membrane

prevents separation, runs between radius and ulna

Ligaments: Humeroulnar and Humeroradial Joints Medial (ulnar) collateral ligament

primary stabilizer

Ligaments: Humeroulnar and Humeroradial Joints Lateral (radial) collateral ligament

protects against distraction of the humeral radial articulation Collateral= two ligaments on lateral sides

Additional elbow complex components

proximal radioulnar joint elbow ligaments elbow capsule

Motions of Radioulnar joints

radius moves around the ulna 1. pronation (0-90) 2. Supination (0-90)

Ligaments: Distal Radioulnar Joint Volar/Dorsal Radioulnar Ligaments

reinforces distal radioulnar joint