elbow joint kinematics

loss of ______ is more important at the elbow jiont

flexion

working range of motion elbow extension to flexion

30-130 degrees

working range of motion pronation to supination

50-50 degrees

how much does the center of rotation move at the elbow for flexion/extension

very little

elbow joint capsule is ______, ______, and ______

large; loose; weak

50% of stability comes from _________ and the other 50% comes from _______

capsule and ligaments; boney architecture

carrying angle of the elbow joint

cubitus valgus (slightly abducted when in anatomical position)

how does the ulna move with extension to flexion

ulna moves closer to the humerus making that angle smaller, but it also moves into more cubitus varus

in pronation the radius is ______ the ulna

crossed over

in supination the radius is _______ the ulna

parallel to

general open packed position of the elbow

60-70 degrees of flexion

closed packed position of the general elbow

full extension with supination

capsular pattern of the elbow

flexion > extension

norm value for elbow flexion ROM

145 degrees

norm values for elbow extension ROM

5 degrees hyperextension

norm values for elbow supination

85-90 degrees

norm values for elbow pronation

75-85 degrees

humero-ulnar joint open packed position

70 degrees flexion, 10 degrees supination

humero-ulnar close packed position

full extension and supination

what process on the ulna limits flexion and helps with stability during movement

coronoid process

coronoid process on the ulna limits what

elbow flexion

humero-ulnar joint, what is concave and what is cvonex

concave trochlear notch on ulna articulates with convex trochlea on humerus

describe the arthrokinematics of humeroulnar flexion in open chain

ulna trochlear notch (concave) rolls and glides anterior/superior on the trochlea of the humerus (convex)

describe the osteokinematics of humeroulnar flexion in open chain

ulna is moving anterior/superior and medial (via adduction) as the coronoid process goes into the coronoid fossa

describe the arthrokinematics of open chain humeroulnar extension

ulna trochlear notch (concave) rolls and glides posterior on the trochlea of the humerus (convex)

describe the osteokinematics of open chain humeroulnar extension

ulna is moving posterior and lateral (via abduction) as the olecranon goes into the olecranon fossa

what type of joint is the humeroradial joint

gliding

what are the articulations for the humeroradial joint

fovea on the radial head articulates with the capitulum of the humerus

in extension how much is the radius in contact with the huemrus

very little contact, in fact this joint is only engaged with flexion

what does this joint contribute to elbow stability

very little, but it does have a boney block to valgus force

open packed position of humeroradial joint

full extension and supination

close packed position of the humeroradial joint

90 degrees flexion, 5 degrees supination

arthrokinematics of humeroradial joint with elbow flexion in open chain (only need to know open chain)

fovea of radius (concave) rolls and glides anterior/superior on the capitulum of the humerus (convex)

arthrokinematics of humeroradial elbow extension

fovea of radius (concave) rolls and glides posterior/inferior on capitulum of humerus (convex)

what increases compression of the humeroradial joint

elbow flexion

what type of joint is the proximal radioulnar joint

plane joint

open packed position of proximal radioulnar joint

35 degrees supination, 70 degrees flexion

close packed position of proximal radioulnar joint

5 degrees supination

capsular pattern of radioular joint

equal limitations of pronation/supination

stability of proximal radioulnar joint is from what 3 things

annular ligament, quadrate ligament, oblique cord

during pronation and flexion the radial head moves where (hint think about where the distal end goes)

posterior and lateral

during supination and extension the radial head moves where (hint think about where the distal end goes)

anterior and medial

in closed chain arthrokinematics for the radioulnar joint, you have to move the shoulder (GH joint) in order to move the radioulnar joint. in order to cause forearm pronation what must the GH joint do

GH (and ulna) need to externally rotate (you can do this yourself and see: when the radius is crossed over the ulna that is pronation,,, so when to ER your shoulder with your hand on the table and you see a bone sort of pop up a little,,, that’s the radius crossing over the ulna,,, that’s the pronation)

in closed chain arthrokinematics for the radioulnar joint, you have to move the shoulder (GH joint) in order to move the radioulnar joint. in order to cause forearm supination what must the GH joint do

the GH (and ulna) need to internally rotate (you can do this yourself and see: when the radius is crossed over the ulna that is pronation and when the bones are parallel that is supination,,, so when to ER your shoulder with your hand on the table and you see a bone sort of pop up a little,,, that’s the radius crossing over the ulna,,, that’s the pronation… then when you IR you see it go away because the bones are parallel,,, well the bones need to be parallel in supination,,, so this is supination)

open packed position of distal radioulna rjoint

10 degrees supination

close packed position of distal radioulnar joint

5 degrees supination

know what muscles cause elbow flexion, extension, pronation, supination

know muscle cards

what wrist muscles cause forceful wrist flexion

flexor carpi radialis, flexor carpi ulnaris, flexor digitorum superficialis

what does forceful wrist flexion cause at the elbow

varus force

what does forceful wrist extension cause at the elbow

valgus force

what wrist muscles cause forceful wrist extension

extensor carpi ulnaris, extensor digitorum, extensor carpi radialis

T/F: the wrist flexors and extensors cause dynamic stability at the elbow

true

UE normal values in gait

shoulder goes through how many degrees of arc?

elbow flexion ROM?

shoulder: 20-30 degrees

elbow: 30-40 degrees

what position puts tension on the median nerve

shoulder abduction, wrist extension, elbow extension, slight supination

what puts tension on the radial nerve

shoulder extension, supination, elbow extension, wrist flexoin

what puts tension on the ulnar nerve

shoulder abduction, elbow flexion, wrist extenison, slight supination

path of the median nerve

medial brachium → anterior elbow and forearm → palm of hand on thumb side

path of radial nerve

posterior axilla → posterior brachium → lateral elbow/supinator → posterior forearm

path of ulnar nerve

medial brachium → behind medial epicondyle → medial forearm → pink side of hand

explain the steps for elbow flexion ROM

1. pt position: supine, knee flexed to flatten L/S, pad under distal humerus, forearm in full supination

2. pt perform AROM of elbow flexion (do a bicep curl)

3. perform PROM while stabilizing humerus

4. place goni (stationary: midline of humerus to acromion, axis: lateral epicondyle, moving arm: radial styloid process)

5. perform PROM and measure, do the other side, document

explain the steps for elbow extension ROM

1. pt position: supine, knee flexed to flatten L/S, pad under distal humerus, forearm in full supination

2. pt perform AROM of elbow extension

3. perform PROM while stabilizing humerus

4. place goni (stationary: midline of humerus to acromion, axis: lateral epicondyle, moving arm: radial styloid process)

5. perform PROM and measure, do the other side, document

explain the steps for pronation/supination ROM

1. pt position: seated, feet on floor, elbow flexed to 90 degrees and supported, shoulder neutral

2. pt perform AROM of pronation/supination

3. perform PROM while stabilizing humerus

4. place goni (stationary: parallel to midline of humerus, axis: proximal to side of ulnar styloid process, moving arm: proximal to both styloid processes aka parallel to the wrist)

5. perform PROM and measure, do the other side, document

explain the steps for elbow flexion (biceps) MMT

1. pt position: seated, feet on floor, forearm supinated (GE: seated with arm in 90 but fully supported by table)

2. perform AROM and observe

3. perform AROM and stabilize anterior humerus/shoulder and palpate biceps

4. perform AROM while applying perpendicular resistance just proximal to the wrist (pushing/pulling the forearm down)

5. repeat on other side, grade, document

explain the steps for elbow flexion (brachialis) MMT

1. pt position: seated, feet on floor, forearm pronated

2. perform AROM and observe

3. perform AROM and stabilize anterior humerus/shoulder, palpate brachialis

4. perform AROM with stabilization and apply resistance just proximal to wrist (pushing/pulling the forearm down)

5. repeat on other side, grade, document

explain the steps for elbow extension MMT

1. pt position: supine, 90 degrees shoulder flexion, full elbow flexion, arm supinated

2. perform AROM and observe

3. perform AROM and stabilize anterior humerus/shoulder, palpate tricep

4. perform AROM with stabilization and apply resistance just proximal to wrist

5. repeat on other side, grade, document

explain the steps for forearm supination MMT

1. pt position: seated, feet on floor, 0 degrees shoulder abduction, 90 degrees elbow flexion, full pronation

2. perform AROM and observe

3. perform AROM and stabilize inferior lateral humerus, palpate supinator and biceps

4. perform AROM with stabilization and apply resistance to distal forearm pushing hand into pronation (may tell pt “I want you to try and turn to a palm up position”)

5. repeat on other side, grade, document (ex: right forearm supination MMT -3/5 no pain)

explain the steps for forearm pronation MMT

1. pt position: seated, feet on floor, 0 degrees abduction, 90 degrees elbow flexion, full supination

2. perform AROM and observe

3. perform AROM and stabilize inferior lateral humerus, palpate pronator teres

4. perform AROM with stabilization and apply resistance to distal forearm pushing hand into supination (may tell pt “I want you to try and turn to a palm down position)

5. repeat on other side, grade, document