ELBOW JOINT & CUBITAL FOSSA

OKOKO, I. E.

Elbow Anatomy

• Elbow joint- a compound joint where the radius and ulna articulate with the humerus.
• Humero- ulnar part
• Humero- radial part

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Bones involved are

REVIEW

• Bones of the Elbow

REVIEW

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Name the structures labelled 1-12:

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2.

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12.

Bones of Elbow

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12.

1. Lateral Supracondylar Ridge
2. Lateral Epicondyle
3. Capitulum
4. Head of Radius
5. Radial Tuberosity
6. Radius
7. Coronoid Fossa
8. Medial Epicondyle
9. Trochlea
10. Coronoid Process
11. Ulnar Tuberosity
12. Ulna

• Type/Classification: Synovial hinge joint.
• Allows only flexion & extension

around a

transverse

axis

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Articulations:

• Humeral capitulum articulate with Radial head
• Humeral trochlea articulate with Trochlear notch of ulna
• Articular surfaces are covered in hyaline cartilage.

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• Fossae above the trochlea & capitulum admit the coronoid process of the ulna & the radial head, respectively, during full flexion
• Olecranon fossa admits the olecranon process during full elbow extension.

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• Ligaments : capsule is strengthened Medially & Laterally by collateral lig

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• Capsule: being a hinge joint, the articular capsule is lax in front & behind to permit full elbow flexion & extension
• The non-articular medial & lateral epicondyles are extracapsular

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• Lateral collateral ligament
• Extends from the lat epicondyle (humerus) to the annular ligament (AL)
• AL is attached medially to the radial notch of the ULNA and clasps, but DOES NOT attach to, the radial head& neck thus free to rotate within the lig.

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• Medial collateral lig:
• Is triangular
• Comprise anterior, posterior & middle bands
• It extends from the medial epicondyle of the humerus and the olecranon to the coronoid process of the ulna

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Anteriorly: Brachialis, tendon of biceps, median nerve & brachial artery (structures in the cubital fossa)

Posteriorly: insertion of the triceps brachii

Medially: Ulnar nerve

Laterally: Common extensor tendon & supinator

Relations of the elbow joint

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Blood Supply of the Elbow Joint

• Derived from the anastomosis around the elbow joint

Nerve Supply of the Elbow Joint

• Musculocutaneous, radial, & ulnar nerves

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Movements at the elbow

• Flexion/Extension occur at the elbow joint
• Supination/Pronation occur mostly at the superior/Inferior radio-ulnar joints

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• Flexion (140°): Biceps, Brachialis, brachioradialis & forearm flexor muscles
• Extension (0°): Triceps + anconeus(lesser extent)
• Pronation (90°): pronator teres & pronator quadratus.
• Supination (90°): biceps is the most powerful supinator. Weaker supinators (Supinator, extensor pollicis longus and brevis)

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Elbow dislocation

• The classical injury is a posterior dislocation caused by a fall on the outstretched hand
• It is commonest in children whilst ossification is Incomplete

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Nerve injury

• Ulnar nerve is adjacent to the medial collateral ligament as it passes forwards below the medial epicondyle
• The nerve is at risk in many types of injury, e.g. fracture dislocations, compression and even during surgical explorations

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��������������������GROSS ANATOMY OF THE CUBITAL FOSSA �

Department of Anatomy

Faculty of Basic Medical Sciences

College of Medicine of the University of Lagos

OKOKO, I. E..

CUBITAL FOSSA

• LOCATION
• SHAPE
• BOUNDARIES
• CONTENTS
• APPLIED ANATOMY

INTRODUCTION

• DEFINITION: A triangular intermuscular space seen as a shallow surface depression in front of the elbow

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LOCATION

• Anterior to the elbow joint.

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SHAPE

• Triangular depression on the anterior view of the elbow.

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BOUNDARIES

• SUPERIOR WALL( base)
• MEDIAL WALL
• LATERAL WALL

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• APEX

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• FLOOR

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• ROOF

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BOUNDARIES

• SUPERIOR (base)

Formed by an imaginary horizontal line connecting medial and lateral epicondyles

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BOUNDARIES

• Medial (Ulnar)

Lateral border of pronator teres muscle

Lateral (radial)

Medial border of brachioradialis muscle.

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• Apex: Directed inferiorly, formed by the meeting point of lateral & medial boundaries.

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Floor: Formed by brachialis & supinator muscles

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ROOF

1. Skin
2. Superficial fascia containing: cephalic vein, lateral cutaneous nerve of forearm, basilic vein, medial cutaneous nerve of forearm & medial cubital vein
3. Deep fascia
4. Bicipital aponeurosis

CONTENTS

• Major contents from medial to lateral are;
• The median nerve
• The brachial artery.

The brachial artery bifurcates into the radial and ulnar arteries Deep accompanying veins of the arteries.

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iii.The tendon of the biceps brachii muscle.

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CONTENT CONTINUES

• Radial nerve
• Posterior interosseous nerve

OTHER CONTENTS

• ROOF-
• Median cubital vein
• Medial and lateral cutaneous nerves of forearm related to the basilic and cephalic veins

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VARIATION OF VEINS IN THE CUBITAL FOSSA

• There exists a fair amount of variation of the median cubital vein.
• More commonly, the vein forms an H-pattern with the cephalic and basilic veins making up the sides.
• Other forms include an M-pattern, where the vein branches to the cephalic and basilic veins.

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APPLIED ANATOMY

• BP measurement
• Venipuncture----Intravenous infusion, Blood transfusion
• Volkmann’s Ischaemia contracture
• Ligament of Struther’s

APPLIED ANATOMY

• During blood pressure measurements, the stethoscope is placed over the brachial artery in the cubital fossa.
• The brachial pulse may be palpated in the cubital fossa also just medial to the tendon.

Applied anatomy:

• Venipuncture: The Cubital Fossa is the common site for sampling & transfusion of blood & intravenous injections becos of the prominence & accessibility of veins. Usually, the median cubital vein or basilic vein is selected.

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Venipuncture�

• The median cubital vein is located superficially within the roof of the cubital fossa. It connects the basilic and cephalic veins, and can be accessed easily – this makes it a common site for venipuncture

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• Historically, when (venous) blood-letting was practiced, the bicipital aponeurosis (the ceiling of the cubital fossa) was known as the “Grace of God" tendon because it protected the more important contents of the fossa (i.e. the brachial artery and the median nerve).

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Supracondylar Fractures�

• A supracondylar fracture usually occurs by falling on a flexed elbow. It is a transverse fracture, spanning between the two epicondyles.
• The displaced fracture fragments may impinge and damage the contents of the cubital fossa.

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• Direct damage, or post-fracture swelling can cause interference to the blood supply of the forearm from the brachial artery.
• The resulting ischaemia can cause Volkmann’s ischaemic contracture – uncontrolled flexion of the hand, as flexors muscles become fibrotic and short.
• There also can be damage to the median or radial nerves

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CUBITAL FOSSA

• DEFINITION: A triangular intermuscular space seen as a shallow surface depression in front of the elbow
• BOUNDARIES:
• Base: an imaginary line between the 2 epicondyles of humerus
• Laterally: medial border of brachioradialis
• Medially: Lateral border of pronator teres
• Apex: brachioradialis overlaps pronator teres