MOB TCD Professor Emeritus Moira O’Brien FRCPI, FFSEM, FFSEM (UK), FTCD Trinity

MOB TCD Professor Emeritus Moira O’Brien FRCPI, FFSEM, FFSEM (UK), FTCD Trinity www.phwiki.com

MOB TCD Professor Emeritus Moira O’Brien FRCPI, FFSEM, FFSEM (UK), FTCD Trinity

Santmaria, Alex, Morning Drive-Time Personality has reference to this Academic Journal, PHwiki organized this Journal MOB TCD Professor Emeritus Moira O’Brien FRCPI, FFSEM, FFSEM (UK), FTCD Trinity College Dublin Clinical Anatomy of Elbow Injuries to Elbow in addition to Wrist Skin Bones Muscles, tendons Nerves Blood vessels

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Bones of Elbow Elbow Joint Synovial hinge joint One degree of freedom Uniaxial The articular surfaces are the trochlea in addition to the capitulum of the humerus The trochlear notch of the ulna The superior aspect of the head of the radius When the elbow is extended, medial epicondyle, olecranon in addition to lateral epicondyle are in a straight line When flexed, they as long as m a triangle Elbow Joint

Capsule of Elbow Joint Capsule surrounds the joint Anteriorly to the margins of the coronoid in addition to radial fossae of the humerus Medially in addition to laterally just beyond the articular margin Excluding the medial in addition to lateral epicondyles to which the common flexor in addition to extensor origins are attached Capsule of Elbow Joint Capsule surrounds the joint Posteriorly to the margins of the olecranon fossa Inferiolaterally it is inserted into the annular ligament of the superior radioulnar joint Synovial Membrane Lines the capsule in addition to non- articular structures inside the capsule Continuous inferiorly with synovial membrane of superior radio-ulnar joints Annular ligament covered with articular cartilage

Between the capsule in addition to synovial membrane are three other pads of fat The largest, at the olecranon fossa, is pressed into it by triceps during flexion Two, at the coronoid in addition to radial fossae, are pressed in by brachialis during extension They are all slightly displaced in contrary movements Synovial Membrane Synovial Membrane Smaller synovial-covered tags of fat project into the joint near constrictions flanking the trochlear notch, covering small non-articular areas of bone Medial or Ulnar Collateral Ligament Thick triangular ligament attached superiorly to the medial epicondyle Its anterior b in addition to is attached distally to the tubercle on the upper medial margin of the coronoid process The posterior b in addition to is attached to the medial margin of the olecranon A thinner portion, the oblique b in addition to , unites both b in addition to s

Medial or Ulnar Collateral Ligament The ulnar nerve lies on the medial ligament The anterior b in addition to may be ruptured in throwing events Lateral or Radial Collateral Ligament The ligament is attached to the lateral epicondyle Fans out to be attached to the upper border of the annular ligament The annular ligament is attached to the margins of the radial notch of the ulna It is part of the articulation of the superior radioulnar joint Covered with articular cartilage Medial Structures of Elbow Common flexor origin, ulnar nerve

Anterior Relations Brachialis lies on capsule Medial to lateral Common flexor origin Median nerve Brachial artery covered by bicipital aponeurosis Biceps Radial nerve Superficial Deep branch is posterior interosseus nerve Posterior Relations Triceps Anconeus Olecranon bursa Ulnar nerve posterior to medial epicondyle Common extensor origin Extensor Tendons Brachioradialis Extensor carpi radialis longus Extensor carpi radialis brevis Extensor digitorum communis Extensor digiti minimi Extensor carpi ulnaris

Posterior Relations olecranon bursitis medial Posterolateral Below lateral epicondyle Head of radius Behind the extensors of the as long as earm Posterior interosseous nerve Lateral Elbow

Movements of Elbow Joint Flexion in addition to extension Semiflexion is least pack position Flexion of the elbow is limited by: Impact of the radial head in the radial fossa Coranoid process against the coronoid fossa Tension of posterior part of capsule Tension of triceps Apposition (contact) between soft tissues of as long as earm in addition to upper arm Flexion of Elbow Main flexors Brachialis, musculocutaneous (C5,6) Biceps, musculocutaneous (C5,6) Weak flexors Common flexor origin, median (C6,7) Except flexor carpi ulnaris, ulnar nerve (C6,7) Brachioradialis, radial (C5,6) Common Flexor Origin Pronator teres Flexor carpi radialis Flexor digitorum superficialis Palmaris longus Median nerve (C6,7) Flexor carpi ulnaris Ulnar nerve (C6,7)

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Elbow Biceps brachii Musculocutaneous C5,6 Brachialis Musculocutaneous C5,6 Pronator teres Median C6,7 Supinator posterior Interosseous C5,6 Anderson & Hall, 1995 Extension of Elbow Triceps is the main extensor Weak are extensors from common extensor origin Nerve supply radial (C7,8) Extension of the elbow is limited by: Impingement of the olecranon of the ulna on the olecranon fossa of the humerus Tension of the anterior arm muscles in addition to collateral ligaments Biceps Brachii Crosses shoulder, elbow in addition to superior radioulnar A long head arising from the supraglenoid tubercle The adjoining portion of the labrum within the capsule of the shoulder joint It passes above the head of the humerus Leaves the joint below the transverse ligament, which acts as a retinaculum

Biceps Brachii It is surrounded by synovial membrane, which extends inferiorly to the lower margin of the teres major, i.e. the posterior fold of the axilla Short head arises from the coracoid process with the coracobrachialis The two heads unite to as long as m a fleshy belly, which becomes a tendon, inserted into the posterior aspect of the radial tuberosity The bicipital aponeurosis extends from its medial margin, passing anterior to the brachial artery in addition to the median nerve, fuses with deep fascia of the as long as earm in addition to the medial margin of the ulna A bursa separates it from the radius Nerve supply is musculocutaneous nerve C5,6,7 Biceps Brachii Action of Biceps Muscle Helps to stabilise in addition to flex the shoulder Its role as a dynamic stabiliser of the gleno-humeral joint is particularly important in the late cocking phase of throwing Flexes the elbow The most powerful supinator of the as long as earm when the elbow is flexed The action of the biceps is weak at the shoulder in addition to powerful at the elbow

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