DaVinci medical academy

No 55/2, New Avadi Road, Alagappa Nagar, Kilpauk. Chennai

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ELBOW JOINT

  • Tennis elbow
    • Tennis Elbow, or lateral epicondylitis, is an orthopedic condition that occurs when the outside of the upper arm near the elbow becomes inflamed and sore due to muscle overuse, which causes the tendons to tear.
  • Golfers elbow
    • Golfer’s Elbow, or medial epicondylitis, is an orthopedic condition that occurs when the anterior tendons of the elbow become Inflamed and stressed due to generally injury or overuse.
  • Pulled elbow
    • Also known as subluxation of radial head/nursemaid’s elbow
    • caused by longitudinal traction applied to an extended arm
    • caused by subluxation of the radial head and interposition of the annular (orbicular) ligament into the radiocapitellar joint
    • pain and tenderness localized to the lateral aspect of the elbowon physical examination 
  • Radioulnar joint
    • superior-pivot joint & mobile
    • middle-immobile joint/syndesmosis
    • inferior-pivot joint joint & mobile
  • Valgus alignment
    • normal valgus carrying angle (this diminishes with flexion)
    • 7° for males
    • 13° for females
  • Axial loading
    • in extended elbow
      • loading of 40% of weight is through ulnohumeral joint
      • loading of 60% of weight is through radiohumeral joint

4 MAJOR NERVES OF THE ELBOW

  • Musculocutaneous nerve (lateral cord of the brachial plexus)
    • innervates elbow joint
    • it supplies the biceps and brachialis
      • the nerve runs between these muscles
      • it exits laterally, distal to the biceps tendon
      • it will terminate as the LABC (forearm), which is found deep to the cephalic vein
  • Radial nerve (posterior cord of the brachial plexus )
    • it leaves the triangular interval (teres major, long head of triceps and humeral shaft)
    • found in spiral groove 13 cm above the trochlea
    • pierces lateral intermuscular septum 7.5 cm above the trochlea
      • this is usually at the junction of the middle and distal third of the humerus
      • lies between the brachialis and the brachioradialis
    • distally it is located superficial to the joint capsule, at the level of the radiocapitellar joint.
  • Median nerve (medial/lateral cords of the brachial plexus)
    • it courses with brachial artery, running from lateral to medial
      • lies superficial to brachialis muscle at level of elbow joint
    • it gives branches to elbow joint
    • it has no branches in upper arm
  • Ulnar nerve (medial cord)
    • runs medial to brachial artery, pierces medial intermuscular septum (at the level of the arcade of Struthers) and enters posterior compartment
    • it traverses posterior to the medial epicondyle through the cubital tunnel
    • it gives branches to elbow joint
    • it has no branches in upper arm
      • first motor branch to FCU is found distal to the elbow joint

 BLOOD SUPPLY OF ELBOW

  • Brachial artery
    • is located medially in the upper arm
    • it enters cubital fossa laterally
      • contents– biceps tendon (lateral), brachial artery, median nerve (medial)
      • lateral border–brachoradialis
      • medial border–pronator teres
      • proximal border –distal humerus
    • at the level of elbow it splits into the radial and ulnar arteries
  • Principle branches
    • superior/inferior ulnar collateral
    • nutrient/muscular
    • supratrochlear