Dr Bronwen Ackermann · 2012. 4. 4. · ELBOW SURFACE ANATOMY & MOVEMENT REVIEW ELBOW SURFACE...

3/20/11

Copyright 2011 Dr Bronwen Ackermann University of Sydney 1

MUSCLES OF THE ELBOW REGION Dr Bronwen Ackermann

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All figures are from the Palastanga textbook unless otherwise noted

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ELBOW SURFACE ANATOMY & MOVEMENT REVIEW

ELBOW SURFACE ANATOMY

nicolebuckland

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Many muscles have a shoulder and elbow role

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When fibres go in two directions it means it has two roles… look at the muscle fibres to determine what way the muscle is going to work.

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Biceps

Deltoid (post)

Long head of triceps Lateral head of triceps

Biceps tendon

Biceps brachii

Anterior deltoid

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Most prominent head of the triceps in this position

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Triceps all attach onto triceps tendon that attaches to the ulnar tuberosity

nicolebuckland

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Will be asked to find the biceps tendon.- very thin so it's commonly ruptured

nicolebuckland

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Under the biceps is the brachialis

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POSTERIOR FOREARM

FOREARM SURFACE ANATOMY (POST)

Lateral head of triceps

Extensor carpi radialis brevis

Extensor digitorum

Abductor pollicis longus

Extensor carpi ulnaris

Anconeus

Extensor carpi radialis longus

nicolebuckland

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Brachilradialis is an elbow muscle Stabilises elbowComes from the lateral epicondyle

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Anconeus stabilises ulna at the elbow. Important for elbow stability.Comes from the lateral epicondyle

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FOREARM SURFACE ANATOMY (ANT)

Pronator teres

Flexor carpi radialis

Flexor carpi ulnaris Flexor digitorum superficialis

Palmaris longus

ANTERIOR FOREARM

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Woven in with the forearm

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CUBITAL FOSSA - BOUNDARIES

 Triangular hollow located on the anterior elbow

 Medial boundary: flexor/pronator muscle group (pronator teres)

 Lateral boundary: extensor-supinator muscle group (brachioradialis)

 Superior boundary: imaginary line from lateral epicondyle to medial epicondyle

CUBITAL FOSSA - CONTENTS

 Biceps tendon  Brachial artery  Median nerve  Superficial layer (roof):

  Skin   fascia   median cubital vein   lateral and medial

cutaneous nerve of forearm   bicipital aponeurosis

 Deep boundary(floor):   Brachialis   supinator

Gray’s anatomy

nicolebuckland

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Where most of the blood vessels go through -- this is where you get blood drawn from.

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Median nerve (yellow)

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ELBOW FLEXORS AND EXTENSORS

Elbow flexors  Biceps  Brachialis  Brachioradialis

Elbow extensors  Triceps brachii  Anconeus

BICEPS BRACHII  Actions & functions:

supinator, elbow flexor (in supination), shoulder flexion

 Surface anatomy – tendon at cubital fossa (supination and flexion at 90 degrees)

 Origin:   Long head: suprageloid

tubercle and adjacent glenoid labrum

  Short head: corocoid process  Insertion:

  Radial tuberosity  Nerve supply:

  Musculocutaneous (C5/6)

http://www.davedraper.com

Grays anatomy

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BRACHIALIS

 Actions & functions:   Elbow flexion

 Surface anatomy   Either side biceps tendon

 Origin:   Distal 2/3 shaft of humerus

 Insertion:   Coronid process and tuberosity of

ulna  Nerve supply:

  Musculocutaneous nerve (C5/6)

Figure 2.26 from Palastanga

BRACHIORADIALIS

"   Actions & functions: – Elbow flexion neutral forearm,

elbow joint stabiliser (shunt) "   Surface anatomy

–  lateral supracondylar ridge "   Origin:

– Upper 2/3 supracondylar ridge "   Insertion:

– Distal lateral radius near styloid process

"   Nerve supply: radial nerve (C5/6) Picture modified from Gray’s anatomy

nicolebuckland

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Very strong insertion, would be very difficult to detach

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Line

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Anular ligament -- brachialis rotates around it

nicolebuckland

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strap muscleshunts the joint together to give us elbow stability

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GRAYS ANATOMY ANT VIEW

brachialis

brachioradialis

Common extensor origin

Pronator teres

Common flexor origin

TRICEPS BRACHII

 Action & function:   extends elbow, long head can adduct arm

and extend shoulder from a flexed position

 Surface anatomy   Back of upper arm

 Origin:   Long head: infraglenoid tubercle and

adjacent labrum   Lateral head: post humerus above and

lateral to spiral groove   Medial head: post humerus below and

medial to spiral groove  Insertion:

  Olecranon of ulna  Nerve supply:

  Radial nerve (C6/7/8)

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All the extensor muscles attach here

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All the flexor muscles attach here

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Where the radial nerve runs through

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ANCONEUS

 Action & function:   Elbow extension, stabilise ulna

during rotary movements

 Origin:   Posterior lateral epicondyle

  Insertion:   Lateral surface olecranon and

proximal ¼ of lateral ulna

 Nerve supply:   Radial nerve (C7/8)

Grays anatomy- post view

Medial head of triceps

Anconeus

Lateral head of triceps

nicolebuckland

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Holds ulna into the joint Helps make sure the ulna isn't moving at the elbow end when it is translating at the the wrist end. engages when rotating and extending… screwing something into a wallEasy to get mixed up with supinatorSupinator and pronator teres land on radius, anconeus lands on ulna

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RADIUS AND ULNA ANTERIOR VIEW

Supinator attachment

Brachialis attachment

Biceps attachment

Grays anatomy

RADIUS AND ULNA POSTERIOR VIEW

Olecranon bursa

Anconeus attachment

Triceps attachment

Supinator attachment

Grays anatomy

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FOREARM PRONATORS AND SUPINATORS

Pronators  Pronator teres  Pronator quadratus

Supinators  Biceps  Supinator

PRONATOR TERES

 Actions & functions:   Forearm pronation

 Origin:   Medial supracondylar ridge and

medial epicondyle and pronator ridge on ulna

  Insertion:   Middle of lateral surface of radius

 Nerve supply:   Median nerve (C6/7)

nicolebuckland

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Two heads for extra stability

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PRONATOR QUADRATUS

 Actions & functions:   Initiates pronation, stabilises

DRUJ  Origin:

  Lower quarter anterior surface of ulna

  Insertion:   Lower quarter anterior radius

 Nerve supply:   Anterior interosseous branch

median nerve (C8/T1)

SUPINATOR

 Actions & functions:   Supinates forearm (ext)

 Origin:   Lat epicondyle, RCL ligament,

supinator crest and fossa of ulna

  Insertion:   Post, lat ant aspects of radius

 Nerve supply:   posterior interosseous nerve of

radial nerve (C5/6)

nicolebuckland

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named for the membrane

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Don't get this muscle confused with Anconeus! Both are deep and small and arise from lateral epicondyle -- Remember that the radius rotates

nicolebuckland

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assists in supination when flexing shoulder because biceps is already busy

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SUMMARY

ACTION MUSCLES

ELBOW FLEXION

ELBOW EXTENSION

FOREARM SUPINATION

FOREARM PRONATION

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Brachialis C5/6 (musculocutaneous) Biceps Brachii C5/6(musculocutaneous) Brachioradialis C5/6 (radial)

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Triceps C6/7/8 (radial) Anconeus C7/8 (radial)

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Biceps Brachii c5/6 Supinator c5/6 post int branch radial

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Pronator teres C8/T1 (ant. inf branch Pronator Quad Median

Dr Bronwen Ackermann · 2012. 4. 4. · ELBOW SURFACE ANATOMY & MOVEMENT REVIEW ELBOW SURFACE...

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Transcript of Dr Bronwen Ackermann · 2012. 4. 4. · ELBOW SURFACE ANATOMY & MOVEMENT REVIEW ELBOW SURFACE...