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Anatomy of the Elbow

Anterior View

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Posterior View

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Medial View

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Lateral View

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Physiologic (Osteokinematic) Motions of the Elbow

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Joint Normal ROM OPP CPP Normal End Feel(s) Abnormal End Feel(s)
Humeroulnar

Flex >135°

Ext = 5°

70° flex

10° sup

Full ext Full sup

Flex = soft tissue or bony approximation

Ext = bony approximation

Boggy = joint effusion

Capsular = flex > ext

Humeroradial Full ext Full sup

90° flex

5° sup

Superior radioulnar

Pronation = 80°–90°

Supination = 80°–90°

70° flex

35° sup

5° sup

Supination = ligamentous

Pronation = bony approximation or ligamentous

Capsular = pronation & supination equally limited

Accessory (Arthrokinematic) Motions of the Elbow

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Arthrology Arthrokinematics

Humeroulnar

Concave surface:

Trochlear notch of ulna

Convex surface:

Trochlea of humerus

To facilitate flex:

OKC = radius & ulna roll & glide anterior & medial on humerus

To facilitate ext:

OKC = radius & ulna roll & glide posterior & lateral on humerus

Humeroradial

Concave surface:

Radial head

Convex surface:

Capitulum of humerus

Proximal radioulnar

Concave surface:

Radial notch of ulna

Convex surface:

Radial head

To facilitate pronation:

Radius spins medially & glides anteriorly on ulna

To facilitate supination:

Radius spins laterally & glides posteriorly on ulna

Elbow Mobilization Techniques

Humeroulnar (H/U) Distraction

Indications:

  • To improve both elbow flex & ext

Patient:

  • Supine with upper arm resting on table or bolster & dorsal forearm resting on clinician's shoulder

  • Elbow in H/U open-packed position of 70° of flex & 10° of supination

  • May pre-position with arm at point of restriction

Clinician:

  • Sitting on ipsilateral side

  • Stabilizing contact: Holds upper arm in contact with bolster

  • Mobilizing contact: Grasps the most proximal aspect of anterior ulna (avoid contact with radius)

Accessory Motion Technique:

  • While stabilizing upper arm, force is exerted through ulnar contact in caudal direction

  • Progress this technique by moving elbow in direction of greatest restriction

Accessory With Physiologic Motion Technique:

  • Pt supine & clinician standing on ipsilateral side with mobilizing contact as above & stabilizing contact now moved to posterior aspect of distal forearm

  • Pt actively moves in direction of greatest restriction

  • During active mov't, clinician applies force perpendicular to olecranon against stabilizing force at distal forearm

  • Requires a change in clinician position t/o technique

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H/U Medial & Lateral Glides

Indications:

  • Medial glide is component motion of elbow flex

  • Lateral ...

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