crystal clinic orthopaedic center summit hand

Elbow

Elbow Anatomy

The elbow is a complex joint formed by the articulation of three bones –the humerus, radius and ulna. The elbow joint helps in bending or straightening of the arm to 180 degrees and assists in lifting or moving objects.

The bones of the elbow are supported by

  • Ligaments and tendons
  • Muscles
  • Nerves
  • Blood vessels

Bones and Joints of the elbow joint:

The elbow joint is formed at the junction of three bones:

  • The Humerus (upper arm bone) forms the upper portion of the joint. The lower end of the humerus divides in to two bony protrusions known as the medial and lateral epicondyles which can be felt on either side of the elbow joint.
  • The Ulna is the larger bone of the forearm located on the inner surface of the joint. The curved shape of the ulna articulates with the humerus.
  • The Radius is the smaller bone of the forearm situated on the outer surface of the joint. The head of the radius is circular and hollow which allows movement with the humerus. The connection between the ulna and radius helps the forearm to rotate.

The elbow consists of three joints from articulation of the three bones namely:

  • Humero-ulnar joint is formed between the humerus and ulna and allows flexion and extension of the arm.
  • Humero-radial joint is formed between the radius and humerus, and allows movements like flexion, extension, supination and pronation.
  • Radio-ulnar joint is formed between ulna and radius bones, and allows rotation of the lower arm.

Articular cartilage lines the articulating regions of the humerus, radius and ulna. It is a thin, tough, flexible, and slippery surface that acts as a shock absorber and cushion to reduce friction between the bones. The cartilage is lubricated by synovial fluid, which further enables the smooth movement of the bones.

Muscles of the Elbow Joint

There are several muscles extending across the elbow joint that help in various movements. These include the following:

  • Biceps brachii: upper arm muscle enabling flexion of the arm
  • Triceps brachii: muscle in the back of the upper arm that extends the arm and fixes the elbow during fine movements
  • Brachialis: upper arm muscle beneath the biceps which flexes the elbow towards the body
  • Brachioradialis: forearm muscle that flexes, straightens and pulls the arm at the elbow
  • Pronator teres: this muscle extends from the humeral head, across the elbow, and towards the ulna, and helps to turn the palm facing backward
  • Extensor carpi radialis brevis: forearm muscle that helps in movement of the hand
  • Extensor digitorum: forearm muscle that helps in movement of the fingers

Elbow joint ligaments and tendons:

The elbow joint is supported by ligaments and tendons, which provide stability to the joint.

Ligaments are a group of firm tissues that connect bones to other bones. The most important ligaments of the elbow joint are the:

  • Medial or ulnar collateral ligament: comprised of triangular bands of tissue on the inner side of the elbow joint.
  • Lateral or radial collateral ligament: a thin band of tissue on the outer side of the elbow joint.

Together, the medial and lateral ligaments are the main source of stability and hold the humerus and ulna tightly in place during movement of the arm.

  • Annular ligament: These are a group of fibers that surrounds the radial head, and holds the ulna and radius tightly in place during movement of the arm.

The ligaments around a joint combine to form a joint capsule that contains synovial fluid.

Any injury to these ligaments can lead to instability of the elbow joint.

Tendons are bands of connective tissue fibers that connect muscle to bone. The various tendons which surround the elbow joint include:

  • Biceps tendon: attaches the biceps muscle to the radius, allowing the elbow to bend
  • Triceps tendon: attaches the triceps muscle to the ulna, allowing the elbow to straighten

Nerves of the elbow joint:

The main nerves of the elbow joint are the ulnar, radial and median nerves. These nerves transfer signals from the brain to the muscles that aid in elbow movements. They also carry the sensory signals like touch, pain, and temperature back to the brain.

Any injury or damage to these nerves causes pain, weakness or joint instability.

Blood vessels:

Arteries are blood vessels that carry oxygen-pure blood from the heart to the hand. The main artery of the elbow is the brachial artery that travels across the inside of the elbow and divides into two small branches below the elbow to form the ulnar and the radial artery.

Conditions

  • Arthritis of The Elbow

    Although the elbows are not weight-bearing joints, they are most important for the functioning of the upper limbs.

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  • Elbow Fracture (Olecranon Fractures)

    Three bones, the humerus, radius and ulna, make up the elbow joint. Elbow fractures may occur from trauma, resulting from various reasons...

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  • Distal Humerus Fractures

    The elbow is a region between the upper arm and the fore arm. The elbow joint is made up of 3 bones.

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  • Tennis Elbow

    Tennis elbow is the common name used for the elbow condition called lateral epicondylitis. It is an overuse injury that causes inflammation of the tendons that attach to the bony prominence on the outside of the elbow (lateral epicondyle).

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  • Distal Biceps Tears

    The biceps muscle is in front of your upper arm. It helps in bending your elbow, rotational movements of your forearm and in maintaining stability in the shoulder joint.

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  • Ulnar Nerve Entrapments (Cubital Tunnel Syndrome)

    Cubital Tunnel Syndrome is a condition characterized by compression of the ulnar nerve in an area of the elbow called the cubital tunnel.

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  • Distal Triceps Tears

    The triceps is a three-headed muscle at the back of the upper arm that attaches to the elbow and helps extend the arm. Distal triceps tears are rare injuries that can occur with falling on an outstretched arm or weightlifting.

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  • Elbow Dislocations

    The elbow is a hinge joint made up of 3 bones – humerus, radius and ulna. The bones are held together by ligaments to provide stability to the joint.

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  • Elbow Fractures in Children

    The elbow is a joint that consists of three bones – the humerus (upper arm bone), radius (forearm bone) and ulna (forearm bone).

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  • Forearm Fractures in Children

    The radius (bone on the thumb side) and ulna (bone on the little-finger side) are the two bones of the forearm.

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  • Elbow Bursitis

    The elbow contains a large, curved, pointy bone at the back called the olecranon, which is covered by the olecranon bursa, a small fluid-filled sac that allows smooth movement between the bone and overlying skin.

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  • Osteochondritis Dissecans

    Osteochondritis dissecans is a joint condition in which a piece of cartilage, along with a thin layer of the bone separates from the end of the bone because of inadequate blood supply.

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  • Elbow Sprain

    Elbow sprain is an injury to the soft tissues of the elbow. It is caused due to stretching or tearing (partial or full) of the ligaments which support the elbow joint.

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  • Medial Epicondylitis (Golfer's Elbow)

    Golfer’s elbow, also called Medial Epicondylitis, is a painful condition occurring from repeated muscle contractions in the forearm that leads to inflammation and microtears...

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  • Elbow Injuries

    Elbow Fractures: Fracture is a common injury to the elbow. Elbow fractures may result from a fall onto an outstretched wrist, a direct impact to the elbow or a twisting injury.

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  • Little League Elbow

    Little league elbow also called as medial apophysitis, is an overuse condition that occurs when there is overstress or injury to the inside portion of the elbow.

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  • Elbow Pain

    The elbow is a hinge joint made up of 3 bones – humerus, radius and ulna. The bones are held together by ligaments to provide stability to the joint.

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  • Elbow Contracture

    Elbow contracture refers to a stiff elbow with limited range of motion. It is a common complication following elbow surgery, fractures, dislocations, and burns.

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  • Elbow Instability

    The elbow is formed by the junction of the humerus (upper arm bone), and radius and ulna (forearm bones).

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  • Elbow Loose Bodies

    Loose bodies are small loose fragments of cartilage or a bone that float around the joint. The loose bodies can cause pain, swelling, locking and catching of the joint.

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  • Plica Syndrome

    A plica is fold in the lining of the elbow joint which can become irritated and inflamed causing pain and snapping with extension of the elbow. It can occur with sports such as basketball, tennis and golf.

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  • Forearm Fractures

    The forearm is made up of 2 bones, namely, the radius and ulna. The primary function of your forearm is rotation i.e., the ability to turn your palm up and down.

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  • Longitudinal Forearm Instability (Essex-Lopresti Injury)

    The Essex-Lopresti injury is a complex injury causing longitudinal forearm instability. It includes a fracture to the radial head at the elbow, dislocation of the radioulnar joint near the wrist and disruption of the interosseous membrane between the radius and ulna.

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  • Thrower's Elbow

    An athlete uses an overhand throw to achieve greater speed and distance. Repeated throwing in sports such as baseball and basketball ...

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  • Brachial Plexus Injury

    The brachial plexus is a system of nerves supplying the arm and hand with sensory and motor functions. Injury to these nerves can occur with forceful pulling or stretching of the arm.

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  • Monteggia Fractures

    The radius and ulna are the long bones in your forearm. These bones articulate with each other near the elbow and wrist, forming the proximal and distal radioulnar joints respectively.

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  • Radial Head Fractures

    The elbow is a junction between the forearm and the upper arm. The elbow joint is made up of 3 bones namely the humerus bone in the upper arm which joins...

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  • Radial Tunnel Syndrome

    The radial nerve runs from the neck, along the upper arm and forearm, providing sensation and motor function to the hand. At the elbow, it passes through a tunnel comprised of bone, muscle and tendons.

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  • Pronator Syndrome

    Pronator syndrome occurs due to compression of the median nerve at the elbow. It is characterized by abnormal sensations in the thumb and adjacent fingers and pain in the forearm.

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  • Terrible Triad

    Terrible triad is a complex injury to the elbow which includes dislocation of the elbow, fracture to the head of the radius, and fracture of the coronoid process of the ulna. Symptoms include pain and locking of the elbow in extension.

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  • Valgus Extension Overload

    This is an injury to the tissues on the inside and back of the elbow often seen in baseball pitcher’s due to repetitive throwing. It is characterized by pain with throwing and extension of the elbow.

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  • Elbow Masses

    An elbow mass is an abnormal growth of tissue at the elbow. It is a rare finding and may be benign or malignant.

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  • Golf/Baseball Injuries to Hand, Wrist and Elbow

    The hand and wrist may get injured while playing golf or baseball due to overuse or poor technique. Injuries can occur to the ligaments, tendons, bone or blood vessels.

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  • Gout and Pseudogout

    Gout is a very common, painful form of arthritis which causes swelling, redness and stiffness of the joints. Gout is caused by increased levels of uric acid in the tissues and blood from abnormal metabolism.

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  • Osteoarthritis

    Arthritis or joint inflammation can affect the bones and joints in the hand. Osteoarthritis is a type of arthritis where inflammation is produced as cartilage at the joint surface wears away or is injured.

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  • Rheumatoid Arthritis

    Rheumatoid arthritis is an autoimmune condition which means that the body’s immune system attacks its own tissues. It affects the lining of joints resulting in pain, swelling, bone loss and deformity and can affect other tissues as well.

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  • Psoriatic Arthritis

    Psoriatic arthritis (PsA) is an autoimmune disease that includes both psoriasis and a related form of arthritis. It is a form of inflammatory arthritis that causes pain, swelling and sometimes damage to any joint in the body.

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  • Acute Compartment Syndrome Hand and Forearm

    Compartment syndrome is a condition in which pressure develops within muscle tissue obstructing the flow of blood which carries oxygen and nutrients. A severe injury to the hand and forearm may cause an acute form of this condition which can result in permanent muscle damage if not treated emergently.

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  • Monteggia Fracture

    The radius and ulna are the long bones in your forearm. These bones articulate with each other near the elbow and wrist, forming the proximal and distal radioulnar joints respectively.

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  • Galeazzi Fracture

    The ulna and radius are long bones of the forearm. The radius is on the thumb side and the ulna is on the side of the little finger.

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  • Terrible Triad Injury of The Elbow

    Terrible triad is a complex injury to the elbow which includes dislocation of the elbow, fracture to the head of the radius, and fracture of the coronoid process of the ulna. Symptoms include pain and locking of the elbow in extension.

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  • PIN Compression Syndrome

    The posterior interosseous nerve supplies the muscles at the back of the forearm that extend the wrist and fingers. Compression of this nerve can occur with trauma or overuse injuries causing pain in the elbow and weakness of the wrist and fingers.

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  • Elbow Masses

    An elbow mass is an abnormal growth of tissue at the elbow. It is a rare finding and may be benign or malignant.

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  • Arthroscopic Elbow Arthritis Treatment

    Elbow Arthroscopy
    Total Elbow Replacement

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Procedures

  • The American Board of  Orthopaedic Surgery
  • Allegheny General Hospital
  • University of Pittsburgh  Medical Center
  • University of Cincinnati College of Medicine
  • American Society for Surgery of the Hand
  • American Association for Hand Surgery: AAHS
  • Alpha Omega Alpha