Biomechanics of Elbow Complex

ELBOW COMPLEX Articulating Surfaces on the Humerus

 Provide mobility for the hand in space by 1. Trochlea
shortening and lengthening of the upper  Lies on the anterior medial aspect of the
extremity distal humerus
 Provide stability for skilled or forceful  Forms part of the humeroulnar articulation
movements of the hand that are necessary  Trochlear groove - divides the trochlea into
when performing activities using tools medial and lateral portion
 Composed of:  Set at an angle and slightly anterior to the
1. Elbow Joints shaft of the humerus
 associated with 2 major ligaments  Concave transversely and convex
and 5 muscles anteroposteriorly
a. Humeroulnar (Ulnotrochlear joint)  An indentation above the trochlea is called
b. Humeroradial (Radiocapitular joint) coronoid fossa
2. Superior and Inferior Radioulnar Joints
 associated with 6 ligaments and
4 muscles

2. Capitulum
 Located on the anterior lateral surface of
the distal humerus
 Part of the humeroradial articulation
 Capitulotrochlear groove – separates the
capitulum from the trochlea
 Radial fossa- indentation above capitulum
Humeroulnar and Humeroradial Joints  Olecranon fossa

Articulating Surfaces on the Humerus

 Biomechanics of Elbow Complex

Articulating Surfaces on the Radius and Ulna Joint Capsule

1. Trochlear Notch  Anteriorly: above the coronoid and radial
 Semicircular-shaped fossae (humerus) and margin of the coronoid
concave surface process (ulna)
 Ulnar articulating surface  Posteriorly: upper edge of olecranon fossa
of the humeroulnar joint  Capsule is fairly large, loose, and weak
 Divided into two unequal anteriorly and posteriorly
parts by trochlear ridge  Fat pads are located between the capsule
2. Head of the Radius
 Cup-shaped concave
surface surrounded by a
rim
 Radial articulating surface
of the humeroradial joint

Articulation: Humeroulnar Joint

Occurs primarily as sliding motion of the ulna on
the trochlea

Collateral Ligaments
 Located on the medial and lateral sides of
hinge joints to provide medial-lateral stability
to the joint and to keep joint surfaces in
apposition
 Two Main Ligaments of Elbow Joints:
1. Medial (Ulnar) Collateral Ligament
2. Lateral (Radial) Collateral Ligament

Articulation: Humeroradial Joint

Sliding of the concave radial head over the convex
surface of capitulum
 Biomechanics of Elbow Complex

2 Main Ligaments of Elbow Joints:

1. Medial (Ulnar) Collateral Ligament b. Posterior Fibers of MCL
 Triangular-shaped ligament consisting  Proximal attachment: posterior aspect
of: Anterior Fibers, Posterior Fibers and of medial epicondyle
Transverse/Oblique Fibers  Distal attachment: ulnar coronoid and
olecranon process
 Plays less significant role in valgus
stability of elbow

a. Anterior Fibers of MCL

 Proximal attachment: anterior aspect
of medial epicondyle c. Oblique Fibers of MCL
 Distal attachment: ulnar coronoid  Proximal attachment: olecranon process
process  Distal attachment: ulnar coronoid process
 Primary stabilizer of elbow to valgus  Assists in providing valgus stability and
stress in the range of elbow flexion helps to keep the joint surfaces in
from 20 to 120 degrees approximation
 Biomechanics of Elbow Complex

2. Lateral (Radial) Collateral Ligament Complex Axis of Motion: Elbow Joint

 Axis for flexion/extension: center of trochlea
a. Radial Collateral Ligament and capitulum
 Proximal attachment: lateral epicondyle
 Distal attachment: Annular ligament
 Provides reinforcement for the
humeroradial articulation
 Offers protection against varus stress in
some position of elbow
 Weaker than MCL

b. Lateral Ulnar Collateral Ligament Carrying Angle

 Proximal attachment: lateral epicondyle  long axis of the humerus + long axis of forearm
 Distal attachment: Supinator crest
 Average angle in men: 5°
 Primary contributor to varus stability,
 Average angle in women: 10-15°
particularly as elbow flexes
 Cubitus Valgus – increased carrying angle,
especially if it occurs unilaterally
 Biomechanics of Elbow Complex

 The configuration of the trochlear groove 3. Brachioradialis

determines the pathway of forearm during  Shunt muscle
passive flexion and extension  Muscle force goes toward compression
 The ulna is guided progressively medially of the joint surface and toward stability
from extension to flexion  Moderate activity if load is applied
 In full flexion, the forearm comes to rest midway between pronation and
in the same plane as humerus supination
 In extension, the forearm moves laterally
until it reaches a position slightly lateral Muscle Action: Extensors
to the axis of humerus 1. Triceps Brachii
 All three heads are active when heavy
resistance is given to extension or quick
extension during gravity assisted
position
 Active in extension and flexion of elbow
joint in CKC such as in push up
 Long head
Affected by changing shoulder position
Actively insufficient when shoulder is in
hyperextension (excessively shortened)
Factors that determine the amount of Elbow Joint  Medial head
Range of Motion Active in unresisted elbow extension
1. Type of motion (active or passive) against gravity or gravity eliminated
 Active ROM: 135-145°
 Passive ROM: 150-160°
2. Position of the forearm
3. Position of the shoulder
 Muscles that cross both the shoulder
and elbow may become passively
insufficient

Muscle Action: Flexors

1. Brachialis
 Spurt or mobility muscle
 Moment arm (MA) is greatest at slightly
more 100° of elbow flexion
 Unaffected by changes in FA position
2. Biceps brachii
 Spurt or mobility muscle
 Moment arm (MA) is largest between
80 and 100° of elbow flexion
 Active during unresisted elbow flexion
with the FA supinated or midway
between pronation and supination
 Biomechanics of Elbow Complex

Superior and Inferior Radioulnar Joints Inferior (Distal) Radioulnar Joint

Articulating Surfaces include:
1. Ulnar Notch of the Radius
2. Articular disk
o Base: Radial Ulnar Notch
o Apex: Ulnar Styloid Process
o Proximal surface articulates with ulnar
head
o Distal surface – part of radiocarpal joint
3. Head of Ulna

Superior Radioulnar Joint

Articulating Surfaces include:
1. Ulnar Radial Notch
2. Annular Ligament Articulation
3. Capitulum of Humerus  Superior and inferior radioulnar joints are
4. Head of Radius mechanically linked
 Distal radioulnar joint is considered to be
functionally linked to the wrist
 Radius carries approximately 80% of the
load
 Ulna carries 20% of the load
 Pronation of the FA occurs as a result of the
radius crossing over the ulna at the superior
radioulnar joint
 Biomechanics of Elbow Complex

Arthrokinematics: Pronation/Supination 2. Quadrate Ligament

• Proximal attachment: inferior edge of
1. Superior Radioulnar Joint
ulnar radial notch (ulna)
 Rim of the head of the radius spins
• Distal attachment: neck of the radius
within the osteoligamentous enclosure
• Reinforces the inferior part of the
formed by the radial notch and the
elbow joint capsule
annular ligament
• Helps maintain the radial head in
 Surface of the head spins on the
apposition to the radial notch
capitulum of humerus
• Limits the spin of the radial head in
2. Inferior Radioulnar Joint supination and pronation
 Concave surface of the ulnar notch of
the radius slides over the ulnar head 3. Oblique Cord
 Articular disk follows the radius by  Proximal attachment: inferior of ulnar
twisting at its apex and sweeping along radial notch (ulna)
the ulnar head  Distal attachment: below bicipital
tuberosity of radius
 Limits supination of the FA

3 Ligaments: Superior Radioulnar Joint

1. Annular Ligament
 Strong band that forms 4/5 of a ring
that encircles the radial head; other 1/5
is radial notch of ulna
 Proximal attachment: anterior margin
of radial notch of ulna
 Distal attachment: posterior margin of
radial notch of ulna
 Holds radial head against ulna and cups
it distal to the head to provide restraint
against distal dislocation of radius
3 Ligaments: Inferior Radioulnar Joint
1. Anterior Radioulnar Ligament
 Biomechanics of Elbow Complex

 Short ligament that attaches just above • Very little motion of the ulna during
the ulnar head and extends to just pronation and supination
above the ulnar notch • Motion of the distal ulna is of less
 Provides volar stability to distal magnitude and opposite in direction of the
radioulnar joint radius
2. Posterior Radioulnar Ligament  Pronation: ulnar head moves distally
and dorsally
 Short ligament that crosses from the
 Supination: ulnar head moves
posterior aspect of the head of ulna to
proximally and medially
attach on the posterior aspect of the
ulnar notch
 Provides dorsal stability to distal
radioulnar joint

3. Interosseous Membrane
 Broad collagenous sheet that runs
between radius and ulna Range of Motion: Radioulnar Joint
 Fibers run distally and medially from
 A total ROM of 150° has been ascribed to
radius to the ulna
the radioulnar joints
 Under tension when the FA is in neutral
 ROM is assessed with the elbow in 90
position
degrees of flexion(Stabilizes the humerus
 Provides for the transmission of
 Cause of limitations in pronation:
forces from the hand and distal
1. Passive tension in the biceps brachii
end of radius to ulna
2. Bony approximations of radius and ulna
 Fibers are relaxed in both supinated
3. Tension in posterior radioulnar
and pronated positions
ligament and posterior fibers of MCL
 Cause of limitations in supination:
1. Passive tension in the anterior
radioulnar ligament and oblique cord
 Quadrate ligament limits spin of radial
head in both pronation and supination

Axis of Motion: Radioulnar Joint Functional Activities

 Axis of motion: longitudinal axis from the
radial head to the ulnar head
 Biomechanics of Elbow Complex

A total of 100° of elbow flexion and 100° of

supination/pronation is sufficient to accomplish
simple tasks

2 Muscles: Pronation
1. Pronator Teres
 Produce pronation by exerting a pull on
the radius, which causes its shaft to
turn over ulna
 Contributes some of its force toward
stabilization of superior radioulnar joint
 Helps to maintain contact of radial
head with the capitulum
2. Pronator Quadratus
 Active in resisted and unresisted
pronation and in slow or fast pronation
 Maintain compression of the distal
radioulnar joint

3 Muscles: Supination
1. Supinators
 Pulling the shaft and distal end of
radius over ulna
 Produces unresisted slow supination in
all positions of the elbow and FA
 Provides unresisted fast supination
when the elbow is extended
2. Biceps Brachii
 Evident when supination is performed
against resistance and during fast
supination when elbow is flexed to 90°
3. Anconeus
 Active in supination and pronation
 Stabilization role