The document provides an overview of elbow joint anatomy, including bones, ligaments, muscles, and range of motion. It describes the compound synovial joint formed by the distal humerus, proximal radius, and proximal ulna. Common fractures are also classified, such as supracondylar fractures in children and radial head fractures in adults. X-ray projections of the elbow joint are outlined to properly evaluate fractures and dislocations.
2. Introduction
Anatomy of the ELBOW joint.
Ossification of Bones.
X ray Projections.
Major Lines in X ray joint.
Fracture Classification.
Common fractures and Dislocations.
Conclusion.
4. īļ Compound Synovial Joint
īļ Distal end of humerus and Proximal
end of Radius & Ulna
īļ Formed by three joints
ī Humeroulnar joint (ulna trochlear)
ī Humeroradial joint (radio
capitellar)
ī Proximal radio ulnar joint
īļ Most upper extremity movements
involve the elbow & radioulnar joints
īļ These two joints are usually grouped
together due to close anatomical
relationship
5. The long mid center of the humerus is the
body (shaft), and the humeral condyle is its
expanded distal end.
īļArticular part of the humeral condyle is
made up of trochlear and the capitulum.
īļTrochlear is more medial and articulates
with the ulna.
īļCapitulum is more lateral and will
articulate with head of radius.
īļLateral epicondyle is a small projection on
lateral aspect of distal humerus.
īļ Medial epicondyle (larger and more
prominent) is located on medial edge of
distal humerus.
6. īļ Anterior depressions:
Coronoid fossa and radial
fossa.
īļPosterior depression: is the
olecranon fossa.
īļLateral view of elbow shows
proximal radius and ulna with
radial head and neck and
radial tuberosity.
7. ī Radioulnar joint
ī Trochoid or pivot-type
joint
ī Radial head rotates
around at proximal
ulna
ī Distal radius rotates
around distal ulna
ī Annular ligament
maintains radial head
in its joint
8. īRadioulnar joint
ī Supinate 80 to 90 degrees from neutral
ī Pronate 70 to 90 degrees from neutral
9. īRadioulnar joint
īJoint between shafts of
radius & ulna held tightly
together between
proximal & distal
articulations by an
interosseus membrane
(syndesmosis)
11. ī Bony landmarks
ī Medial condyloid ridge
ī Olecranon process
ī Coronoid process
ī Radial tuberosity
12. âĸ Elbow motions
âĸ primarily involve movement between articular surfaces
of humerus & ulna
âĸ specifically humeral trochlear fitting into ulna trochlear
notch
âĸ radial head has a relatively small amount of contact
with capitulum of humerus
âĸ As elbow reaches full extension, olecranon process is
received by olecranon fossa
âĸ increased joint stability when fully extended
13. ī As elbow flexes 20 degrees
or more, its bony stability is
unlocked, allowing for more
side-to-side laxity
ī Stability in flexion is more
dependent on the lateral
(radial collateral ligament) &
the medial or (ulnar collateral
ligament)
14. LIGAMENTS OF THE JOINT
īļ Stability of joints maintained by ligaments.
1. Radial collateral ligament
2. Ulnar collateral ligament :
Anterior bundle
Posterior bundle
Oblique bundle
3. Annular ligament: that wraps around the
radial head and holds it tight against the ulna.
15. Ulnar Collateral Ligament
ī Ulnar collateral ligament is
critical in providing medial
support to prevent elbow
from abducting when
stressed in physical
activity
ī Many contact sports &
throwing activities place
stress on medial aspect
of joint, resulting in injury
18. ī Flexion
ī Movement of forearm to
shoulder by bending the elbow
to decrease its angle
ī Extension
ī Movement of forearm away from
shoulder by straightening the
elbow to increase its angle
19. ī Pronation
ī Internal rotary movement of
radius on ulna that results in
hand moving from palm-up
to palm-down position
ī Supination
ī External rotary movement
of radius on ulna that results
in hand moving from palm-down
to palm-up position
26. ī Biceps tendon anteriorly (allows elbow to flex with
force)
ī Triceps tendon posteriorly (allows elbow to extend
with force)
27. ī The articular surfaces are connected together by a
capsule
ī Anterior part â from radial and coronoid fossa of
humerus to coronoid process of ulna and annular
ligament of radius
ī Posterior part â from capitulum, olecranon fossa, and
lateral epicondyle of humerus to annular ligament of
radius, olecranon of ulna, and posterior to radial
notch.
33. ī§Demonstrates: Distal humerus,
proximal ulna, proximal radius,
and elbow joint.
ī§Measure: AP through the elbow
at the epicondyles.
ī§kVp: 55 (50 to 60).
ī§Film Size: 10 Ã 12 inches (24 Ã 30
cm)
34. īPatient Position: Seated, with body
rotated away from the table. Apply a lead
half apron for gonad protection.
īPart Position: Arm fully extended, and
the hand supinated. If the elbow cannot be
extended, two APs are done, one with the
forearm on the film and the second with the
humerus on the film.
īCR: To the elbow, between and 1 inch
below the level of the epicondyles.
īBreathing Instructions: Suspended
expiration.
36. īļDemonstrates: Distal
humerus, proximal ulna,
proximal radius, and elbow
joint.
īļMeasure: At the CR.
īļkVp: 55 (50 to 60).
īļFilm Size: 10 Ã 12 inches
(24 Ã 30 cm),
37. īPatient Position: Seated, with the body rotated
away from the table. Apply a lead half apron for
gonad protection.
īPart Position: Elbow flexed to 90°, with the ulnar
surface of the forearm flat on the film. The hand is
in the true lateral position. The humerus must also
be parallel to the film plane, with the shoulder
abducted to 90°.
īCR: Mid-elbow joint, just anterior to the lateral
epicondyle.
īBreathing Instructions: Suspended expiration
39. ī POSITIONING OF PATIENT
ī Extend the limb as in AP view
ī Center the mid point of cassette to
the elbow joint
ī Rotate the hand laterally to place the
posterior surface of elbow at an angle
of 40 degree.
īCentral ray perpendicular to elbow
joint.
ī Demonstrates FRACTURE of
lateral epicondyle & radial head.
40. STRUCTURE SHOWN
ī Oblique image of the elbow with radial head free of
superimposition of ulna
EVALUATION CRITERIA
ī Radial head, Neck and tuberosity projected free of ulna
ī Elbow joint should be open.
41. īSynonyms: AP Internal Oblique.
īDemonstrates: Distal humerus,
proximal ulna, proximal radius, and
elbow joint.
īMeasure: At the CR.
īkVp: 55 (50 to 60).
īFilm Size: 10 Ã 12 inches (24 Ã 30
cm)
42. īPatient Position: Seated, with body
rotated away from the table. Apply a lead
half apron for gonad protection.
īPart Position: Arm fully extended and
the forearm pronated.
īCR: 1 inch below the epicondyles.
īBreathing Instructions: Suspended
expiration.
45. CARRYING ANGLE
īļ It is the angle at which the
humerus and forearmarticulate,
with the elbow in full extension,
and the palms facing forward.
īļ The carrying angle permits the arm
to be swung without contacting the
hips.
Normal values.
Males=15 deg
Female=20 deg
46. ī§ A line in the longitudinal axis
of proximal end of radius
passes to the centre of
capitulum.
ī§ A line in the Anterior cortex of
distal end of humerus passes
to the centre of capitulum
ī§ Distruption from this
indicates Fracture or
Dislocation.
48. īļApproximately 6% of all fractures and dislocations involve the elbow.
īļ The frequency of injury at various sites around the elbow differ between
adults and children
LOCATION INCIDENCE LOCATION INCIDENC
E
RADIAL HEAD
& NECK
50% SUPRACONDYLA
R
60%
OLECRANON 20% LATERAL
EPICONDYLE
15%
SUPRACONDY
LAR
10% MEDIAL
EPICONDYLE
10%
FRACTURES -
DISLOCATION
15%
49. ī§ X-ray :
ī§ AP view & Lateral View
ī§ gentle traction x-ray help in: -
ī§ - accurate Diagnosis
ī§ -classification
ī§ - pre-operative planning
51. īļDISTAL HUMERUS:
FRACTURES:
īļSUPRACONDYLAR
īļINTERCONDYLAR
īļCONDYLAR
īļEPICONDYLAR
īļFRACTURES OF
PROXIMAL ULNA:
īļOLECRANON
FRACTURE
īļCORONOID PROCESS
FRACTURE
īļFRACTURES
OF RADIUS:
īļRADIAL HEAD
īļRADIAL NECK
53. īļThis is the most
common fracture to
occur around the elbow
in children (60%).
īļUsually, the distal
fracture fragment
displaces posteriorly.
54. īļThe fracture
line extends
transversely or
obliquely through
the distal
humerus above
the condyles.
55. Intercondylar Fracture.
īThe fracture line extends
between the medial and lateral
condyles and communicates with
the supracondylar region.
īThe resultant fracture line may
take on a T or Y configuration.
īThis type of fracture in adults
accounts for at least 50% of distal
humerus fractures.
56. īThe transverse fracture line
that passes through both
humeral condyles is called
a transcondylar fracture.
īA comminuted fracture of the
distal humerus, usually with
associated ulnar and radial
fractures, may occur if an object
is struck with the elbow
protruding from a car window
57. Condylar Fracture.
īA single condyle may be sheared off
owing to an angular force through the
elbow.
ī Fractures may occur along the
articular surfaces of the capitellum and
trochlea.
īThe convex surface of the capitellum
is particularly susceptible to
compression and breakage .
īThe radial head and capitellum are
occasionally fractured simultaneously.
58. Epicondylar Fracture.
īSeparation of the medial epicondyle is a
common injury in sports in which strong
throwing actions are performed, such as
baseball.
īEpicondylar fractures are usually avulsive
injuries from traction of the respective
common flexor or extensor tendons and
collateral ligaments on the medial or lateral
epicondyles.
60. Classification:
īļ Type I: large fragment of
bone and articular surface
(involves trochlea) are
fractured.
īļ Type II: small shell of
bone and articular surface
(not involves trochlea).
īļ Type III: comminuted
fracture.
63. īļ Mechanism Of injury :
īļ Direct: fall on the flexed elbow, and
this frequently produces comminution
and marked displacement of the major
fragments
īļ Indirect: fall on the outstretched arm,
produces an oblique or transverse
fracture with minimal displacement
īļ Imaging: Well demonstrated on a
lateral projection of the elbow.
66. It indicates severe
trauma to elbow.
Mechanism of injury:
- Striking of trochlea
in coronoid.
- avulsion (less
common).
67. Classification:
īļ Type I: simple
avulsion of tip.
īļ Type II: involve <50%.
īļ Type III :involve
>50%.
69. ī It is common in adults.
īMechanism of
Injury:
īļF.O.S.Hwhile arm is
pronated, head
impacted in capitulum.
70. ī Mason Classification
of radial head:
īļ Type I: undisplaced.
īļ Type II: displaced.
īļ Type III:Comminuted.
īļ Type IV: # associated
with posterior
elbow dislocation &
coroniod fracture.
72. Radial Neck Fracture
īļThe most common radial neck fracture is
an impaction at the junction of the head and
neck.
īļThe only sign may be a sharpened angle on
the anterior surface, best depicted on the
lateral projection.
īļComplete fractures will be readily seen as a
transverse lucent line with varying degrees
of displacement.
74. Fat-pad sign
īIt is the clear depiction of
displaced humeral capsular fat
pads.
īIn the normal elbow a layer of
fat (fat pad) lies between the
synovial and fibrous layers of
both the anterior and posterior
joint capsule.
īIn the lateral projection of
the normal elbow, the anterior
fat pad is seen as an obliquely
oriented radiolucency.
75. īWhen acute intracapsular
swelling is present from any
origin , the anterior fat pad is
elevated to be oriented
horizontally, and the posterior fat
pad becomes visible (fat-pad
sign)
īthe posterior fat pad, when
visible, is the most reliable sign
of intra-articular effusion.
76. Dislocation of elbow joint.
ī Form 20% of joint dislocation (after shoulder& finger)
ī classification: posterior [most common 80%]
-ant. - med. - lat. - divergent. [rare].
posterior or post.lat. dislocation :
mech of injury. :FOSH while elbow extended.
Diagnosis: -Clinically it may be associated with
neurovascular injury
(median & ulnar n. &brachial artery.)
79. Tennis Elbow
ī âTennis elbow" - common problem usually
involving extensor digitorum muscle near
its origin on lateral epicondyle
ī known lateral epicondylitis
ī associated with gripping & lifting
activities
80. Medial Epicondylitis
īSomewhat less common
ī Also known as golfer's elbow
īAssociated with medial wrist flexor & pronator group
near their origin on medial epicondyle.
ī Involves muscles which cross elbow but act
primarily on wrist & hand