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