Chapter 5 The elbow joint

ANATOMY 125

The elbow joint 125

The superior radioulnar joint 125

The inferior radioulnar joint 126

Bony landmarks to be palpated 126

Ligaments 126

Muscles 127

Flexors 127

Extensors 128

Supinators 129

Pronators 130

MEASUREMENT 131

Range of movement 131

Flexion 131

Extension 132

Supination 133

Pronation 134

Observational/reflective checklist 136

Joint girth 137

Elbow 137

Muscle strength: Oxford muscle grading 139

Extensors 139

Flexors 141

Supinators 144

Pronators 146

Anatomy

The elbow joint

1. The elbow joint is a synovial hinge joint.

2. The trochlear surface of the humerus articulates with the trochlear notch of the ulna and the capitulum of the humerus articulates with the head of the radius.

3. A fibrous capsule completely encloses the elbow joint, including the superior radioulnar joint.

4. The elbow joint has strong collateral ligaments – the radial and ulnar collateral ligaments.

5. The movements that take place at the elbow joint are flexion and extension.

The superior radioulnar joint

1. This is a synovial pivot joint.

2. It is an articulation between the head of the radius, rotating within the fibro-osseous ring formed by the radial notch of the ulna and the annular ligament.

3. The movements that take place are pronation and supination.

The inferior radioulnar joint

1. This is a synovial pivot joint.

2. It is an articulation between the head of the ulna and the ulnar notch on the lower end of the radius.

3. The joint is closed inferiorly by an articular disc, which passes between the radius and the ulna.

4. The movements that take place are pronation and supination.

Bony Landmarks to be Palpated

The humerus – medial epicondyle, medial supracondylar ridge, lateral epicondyle and lateral supracondylar ridge.

The radius – the head.

The ulna – the olecranon process.

Ligaments

Table 5.1The ligaments

Muscles

Flexors

Table 5.2The flexors of the elbow

Extensors

Table 5.3The extensors of the elbow

Supinators

Table 5.4The supinators of the forearm

Pronators

Table 5.5The pronators of the forearm

Measurement

Range of Movement

Flexion

Figure 5.1 Goniometric measurement of elbow flexion.

Starting position:

The patient is positioned in supine lying on the plinth. Their arm is in the anatomical position, with the elbow in 0° of extension.

Stabilization:

The clinician stabilizes the humerus.

Goniometer axis:

The axis of the goniometer is placed over the lateral epicondyle of the humerus.

Stationary arm:

This is parallel to the longitudinal axis of the humerus, pointing towards the tip of the acromion process.

Moveable arm:

This is parallel to the longitudinal axis of the radius, pointing towards the styloid process of the radius.

End position:

The forearm is moved in an anterior direction so the hand approximates to the shoulder.

NB: It may be necessary to reposition the stationary and moveable arms of the goniometer prior to taking the reading, as they may have moved when the patient flexed their elbow.

Extension

Figure 5.2 Goniometric measurement of elbow extension.

Starting position:

The patient is positioned in supine lying on the plinth. Their arm is in the anatomical position, with the elbow in 0° of extension.

Stabilization:

The clinician stabilizes the humerus.

Goniometer axis:

The axis of the goniometer is placed over the lateral epicondyle of the humerus.

Stationary arm:

This is parallel to the longitudinal axis of the humerus, pointing towards the tip of the acromion process.

Moveable arm:

This is parallel to the longitudinal axis of the radius, pointing towards the styloid process of the radius.

End position:

The clinician encourages the patient to straighten their elbow as much as possible.

Supination

Figure 5.3 Goniometric measurement of elbow supination.

Starting position:

The patient is sitting, their shoulder is adducted, with the elbow flexed to 90°, the forearm in the mid-position and the wrist in neutral. A pencil is held in the tightly closed fist, with the pencil protruding from the radial (thumb) aspect of the hand.

Stabilization:

The clinician stabilizes the humerus.

Goniometer axis:

The axis of the goniometer is placed over the middle of the shaft of the third metacarpal.

Stationary arm:

This is perpendicular to the floor.

Moveable arm:

This is parallel to the pencil.

End position:

The patient is asked to rotate their forearm laterally (externally) from the mid-position so the palm is facing upwards (supination).

Trick movements:

Altered grip/wrist grip, shoulder movements.

Clinical tip

Ensure the arm remains adducted while performing the movement.

Pronation

Figure 5.4 Goniometric measurement of elbow pronation.

Starting position:

The patient is sitting, their shoulder is adducted, with the elbow flexed to 90°, the forearm in the mid-position and the wrist in neutral. A pencil is held in the tightly closed fist, with the pencil protruding from the radial (thumb) aspect of the hand.

Stabilization:

The clinician stabilizes the humerus.

Goniometer axis:

The axis of the goniometer is placed over the middle of the shaft of the third metacarpal.

Stationary arm:

This is perpendicular to the floor.

Moveable arm:

This is parallel to the pencil.

End position:

The patient is asked to rotate their forearm medially (internally), from the mid-position, so the palm is facing downwards (pronation).

Trick movements:

Altered grip/wrist grip, shoulder movements.

Clinical tip

Ensure the arm remains adducted while performing the movement.

Notes

Treatment record

Observational/reflective checklist

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