Kines Ch. 11 Elbow Joint

musculocutaneous, median, and radial

What nerves help in flexion?

soft

With flexion, the end feel is ____ because the muscle bulk of the arm and forearm compresses together and limits further motion.

proximal radioulnar joint; distal radioulnar joint

At the proximal end, the head of the radius pivots within the radial notch of the ulna, forming the superior or _____. Due to the shape of the radius, the distal end of the radius rotates around the distal end of the ulna, forming the inferior or _______.

radius

Because the radius moves and the ulna does not, a muscle must attach on the _____ to be able to pronate and supinate the forearm.

supracondylar fractures

____ are among the most common fractures in children and are caused by falling on the outstretched hand. This distal end of the humerus fractures just above the condyles.

lateral epicondylitis, aka tennis elbow

_____ is a very common overuse condition that affects the common extensor tendon where it inserts into the lateral epicondyle of the humerus. The extensor carpi radialis brevis is particularly affected.

medial epicondylitis, aka golfer's elbow

______ is an inflammation of the common flexor tendon that inserts into the medial epicondyle. It is an overuse condition that results in tenderness over the medial epicondyle and pain on resisted wrist flexion.

elbow dislocation

______ is caused when a great deal of force is applied to an elbow that is in a slightly flexed position. This causes the ulna to slide posterior to the distal end of the humerus.

145 degrees

Measured from the anatomical position, the elbow joint has approximately _____ degrees of flexion. Extension is the return to anatomical position from flexion.

90 degrees supination; 80 degrees pronation

Measured from the neutral or mid position, there are approximately ____ degrees of supination and _____ degrees of pronation.

humeroulnar and humeroradial articulations

On the humerus, the trochlea articulates with the trochlear notch of the ulna, and the capitulum articulates with the head of the radius. These articulations are sometimes referred to as the ______ and ______ articulations, respectively. However, they move together to produce the same joint motion; therefore, they are collectively called the elbow joint.

bony

Pronation has a ____ end feel due to the bony contact between the radius and the ulna. This end feel is more subtle than that felt during elbow extension.

triceps

elbow extension

biceps, brachialis, and brachioradialis

elbow flexion

radial tuberosity of radius

insertion of biceps brachii

coronoid process and ulnar tuberosity of the ulna

insertion of brachialis muscle

styloid process of the radius

insertion of brachioradialis

distal half of humerus, anterior surface

origin of brachialis muscle

lateral supracondylar ridge on the humerus

origin of brachioradialis muscle

True

T/F Functionally, the proximal and distal radioulnar joints are considered one joint as they move together to produce the same motions.

True

T/F The radius moves and the ulna does not.

False, the radius does move around the ulna, but the ulna does NOT rotate, as it is locked in place by its bony shape at the proximal end.

T/F When pronation and supination occur, the radius moves around the ulna as the ulna rotates.

coracoid process

The _____ is the projection on the anterior surface that provides attachment for the short head of the biceps muscle.

collateral ligaments

The _____ reinforce the joint capsule on the sides of the joint.

medial collateral ligament

The ______ is triangular and spans the medial side of the elbow. It attaches on the medial epicondyle of the humerus and runs obliquely to the medial sides of the coronoid process and olecranon process of the ulna.

lateral collateral ligament

The ______ is triangular. It attaches proximally on the lateral epicondyle of the humerus and distally on the annular ligament and the lateral side of ulna.

articulation of the humerus with the ulna and radius

The _______ is commonly called the elbow joint.

cork out of a bottle with a corkscrew ("corkscrew effect")

The action of the biceps as a forearm supinator and elbow flexor is used when pulling a _______.

median nerve with exception of the flexor carpi ulnaris

The anterior forearm is innervated by what nerve?

two

The biceps brachii muscle has one or two heads?

cubital fossa; brachial artery

The brachial pulse can be palpated in the _____, and during blood pressure measurement, the stethoscope is placed over the _____ in this location.

ROM

The brachialis is made for ______ not strength.

strength

The brachioradialis is made for _____ not ROM.

getting your hand to your mouth

The carrying angle is quite functional in ______.

active hyperextension

Unlike the shoulder joint, the elbow joint has no _____.

men= 5 degrees women= between 10 and 15 degrees

What is the normal carrying angle for men and women?

median nerve

pronator quadratus innervation

distal one-fourth of radius

pronator quadratus muscle insertion

distal one-fourth of ulna

pronator quadratus muscle origin

median nerve

pronator teres innervation

lateral aspect of radius at its midpoint

pronator teres insertion

medial epicondyle of humerus and coronoid process of ulna

pronator teres muscle origin

brachialis muscle

sometimes called the "workhorse of the elbow joint"

radial nerve

supinator innervation

anterior surface of the proximal radius

supinator insertion

lateral epicondyle of humerus and adjacent ulna

supinator muscle origin

long head: infraglenoid tubercle of scapula lateral head: inferior to greater tubercle on posterior humerus medial head: posterior surface of humerus

triceps brachii muscle origin

olecranon process of ulna

triceps insertion

elbow extension and neutralizer in flexion

triceps muscle action

radial nerve

triceps muscle innervation

women

Does the carrying angle tend to be greater in men or women?

radial

Every extensor from the elbow down to the hand is the ____ nerve.

olecranon process

Hyperextension of the elbow is blocked by the ______ of the ulna making bone-on-bone contact as it fits into the olecranon fossa of the humerus.

yes

If the musculocutaneous nerve is damaged can the patient still have flexion?

no

If the radial nerve is damaged can the patient still have extension?

interosseous membrane

In addition to the annular ligaments, the radioulnar articulations are held together by the ______. This broad, flat membrane is located between the radius and the ulna for most of their length.

firm

In supination, the end feel is ___ because of muscle and ligament tension.

carrying angle

In the anatomical position, the longitudinal axes of the humerus and forearm form an angle called the ____.

ulnar nerve compression

Pain from "hitting the funny bone" does not come from a bone, but from ________. It is very superficial where it crosses the medial elbow between the bony olecranon process and medial epicondyle. Any impact to the nerve can create pain, numbness, and tingling in the medial hand and fourth and fifth fingers innervated by this nerve.

1) medial collateral ligament 2) lateral collateral ligament 3) annular ligament

The 3 ligaments of the elbow:

supinator and biceps muscles

The ___ and ___ combine in a force couple action to move the radius around the ulna.

head

The ___ of the ulna is at the distal end, on the lateral surface; the ulnar notch of the radius pivots around it during pronation and supination.

joint capsule

The ____ attaches around the distal end of the humerus and encompasses the trochlea and capitulum and the fossas located above them. It attaches around the proximal end of the ulna, under the radial notch and coronoid process, and around the trochlear notch. It attaches around the radius, just under the head.

trochlear notch

The ____ is also called the semilunar notch; articulates with the trochlea of the humerus; makes up the anterior surface at the proximal end.

styloid process

The ____ is at the distal end of the ulna, on the posterior medial surface.

ulnar tuberosity

The ____ is located below the coronoid process; provides attachment for the brachialis muscle.

coronoid process

The ____ is located just below the trochlear notch; with the ulnar tuberosity, provides attachment for the brachialis muscle.

lateral epicondyle

The ____ is located on the lateral side of the distal end of the humerus, above the capitulum; provides attachment for the anconeus and supinator muscles.

trochlea

The ____ is located on the medial side of the distal end of the humerus; articulates with the ulna.

olecranon fossa

The ____ is located on the posterior surface between the medial and lateral epicondyles; articulates with the olecranon process of the ulna.

spiral groove

The ____ is the groove that the radial nerves runs through as it spirals around the midhumerus.

infraglenoid tubercle

The ____ is the raised portion of the inferior lip of the glenoid fossa that provides attachment of the long head of the triceps muscle.

supraglenoid tubercle

The ____ is the raised portion on the superior lip of the glenoid fossa that provides attachment for the long head of the biceps muscle.

interosseous membrane

The ____ keeps the radius and ulna from separating and provides most surface area for attachment of the forearm and wrist muscles.

annular ligament

The _____ attaches anteriorly and posteriorly to the radial notch of the ulna, encompassing the head of the radius and holding it against the ulna.

lateral supracondylar ridge

The _____ is located above the lateral epicondyle; provides attachment for the brachioradialis muscle.

olecranon process

The _____ is located at the proximal end of the ulna, on the posterior surface; forms the prominent point of the elbow and provides attachment for the triceps muscle.

radial notch

The _____ is located at the proximal end on the lateral side of the ulna, just distal to the trochlear notch; articulation point for the head of the radius.

medial epicondyle

The _____ is located on the medial side of the distal end of the humerus, above the trochlea; larger and more prominent than the lateral one. It provides attachment for the pronator teres muscle.

capitulum

The _____ is on the lateral side of the humerus, next to the trochlea; articulates with the head of the radius.

the distal end of the humerus is not level (The medial side [the trochlea] is lower than the lateral side [the capitulum] therefore, as the ulna and radius move around the trochlea and capitulum of the humerus, they do not move in a straight line like a typical hinge joint. Usually, the long axis of the lower segment is in line with the long axis of the upper segment.)

The carrying angle occurs because ________.

ulna; radius

The concave trochlear notch is at the proximal end of the _____, and the concave radial head is at the proximal end of the _____.

1) the trochlea articulating with the ulna 2) the capitulum articulating with the radius

The distal end of the humerus has two convex areas:

3 bones, 3 ligaments, two joints, one capsule

The elbow complex consists of:

flexion and extension

The elbow is a uniaxial joint that allows only ____ and _____, which occurs in a sagittal plane around the frontal axis.

bony end feel

The end feel for extension is the opposite as the end feel for flexion. It is described as hard due to bone-on-bone contact as the olecranon process of the ulna moves into the olecranon fossa of the humerus, limiting further joint motion. This is called ______.

brachial artery; Volkmann's ischemic contracture

The great danger of both elbow dislocation and supracondylar fracture is the potential damage to the ____ because of its close proximity. This can lead to ______, a rare but potentially devastating ischemic necrosis of the forearm muscles.

ulnar nerve

The hand is mostly innervated by what nerve?

capitulum of the humerus

The head of the radius articulates with the _______.

annular

The joint capsule is strengthened anteriorly and somewhat posteriorly by the ____ ligament.

stability

The medial and lateral collateral ligaments provide a great deal of ____ to the elbow.

radial nerve

The posterior forearm is innervated by what nerve?

biceps muscle

The radial tuberosity of the radius provides attachment for the _____.

pronation and supination

The radioulnar joint is a uniaxial pivot joint, allowing only ____ and _____ of the forearm. These motions occur in the transverse plane around the vertical axis.

radius and ulna; radioulnar joint

The second joint of the elbow complex involves articulations between the _____ and _____. This is known as the _____ joint and involves each bone articulating with the other at both ends of the forearm.

brachioradialis muscle

The styloid process of the radius provides attachment for the _______.

anteriorly during flexion; posteriorly during extension

The trochlear notch and the radial head glide anteriorly during _____ and posteriorly during _____.

pulled elbow, or nursemaid's elbow

______ is seen in young children under the age of 5 years who have experienced a sudden strong traction force on the arm. This often occurs when an adult suddenly pulls on the child's arm, or the child falls away from an adult while being held by the arm. This force causes the radial head to sublux out from under the annular ligament.

elbow flexion, forearm supination

action of biceps brachii

elbow flexion

action of brachialis

elbow flexion

action of brachioradialis

forearm pronation

action of pronator quadratus

forearm pronation, assistive in elbow flexion

action of pronator teres

forearm supination

action of supinator

musculocutaneous nerve

biceps brachii innervation

long head: supraglenoid tubercle of scapula short head: coracoid process of scapula

biceps brachii muscle (aka biceps muscle) origin

musculocutaneous nerve

brachialis muscle innervation

radial nerve

brachioradialis innervation

pronator teres, pronator quadratus

forearm pronation

biceps and supinator

forearm supination