elbow
The elbow:
review of anatomy and common collateral ligament complex pathology using MRI. Posterolateral rotatory instability, stage 3B. Consecutive coronal T1-weighted MRI (a–c), and consecutive coronal FS PD-weighted MRI (d–f) showing an acute proximal full-thickness tear of the lateral ulnar collateral ligament and radial collateral ligament (white arrows) and anterior bundle of the medial collateral ligament complex sprain (white arrowheads)
The elbow:
review of anatomy and common collateral ligament complex pathology using MRI. Posterolateral rotatory instability, stage 2. Coronal FS PD-weighted MRI showing a complete detachment of the proximal lateral ulnar collateral ligament, the proximal radial collateral ligament proper, and the common extensor tendon (white short arrow), with retraction of the lateral ulnar collateral ligament (white arrowhead) and common extensor tendon (long white arrow). Note the extravasation of the joint fluid through the tear (black asterisk)
The elbow:
review of anatomy and common collateral ligament complex pathology using MRI. Posterolateral rotatory instability, stage 3B. Consecutive coronal FS T1-weighted direct MR arthrographic images (a–f) showing a proximal partial-thickness tear of the anterior bundle of the medial collateral ligament complex (short arrows), proximal complete tear of the lateral ulnar collateral (long white arrows), and partial-thickness tear of the radial collateral ligament proper (white arrowhead)
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Normal radiographic anatomy of the elbow - Ganzer Fall bei Radiopaedia
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Lateral elbow ligaments (Gray's illustration) - Ganzer Fall bei Radiopaedia
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Medial elbow ligaments (Gray's illustration) - Ganzer Fall bei Radiopaedia
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Elbow joint capsule (Gray's illustration) - Ganzer Fall bei Radiopaedia
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Elbow anatomy (illustration) - Ganzer Fall bei Radiopaedia
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Normal elbow (AP acute flexion view) - Ganzer Fall bei Radiopaedia
The elbow:
review of anatomy and common collateral ligament complex pathology using MRI. Axial FS PD-weighted MRI (a) showing the measurement of normal ulnohumeral incongruity: the distance between the trochlear joint surface and olecranon joint surface (D1, D2, D3, and D4). Sagittal FS PD-weighted MRI (b) showing the measurement of normal radiocapitellar incongruity (RCI): the distance between CAP and R. Axial FS PD-weighted MRI showing an ulnohumeral incongruity of more 1 mm (c). Sagittal FS PD-weight MRI showing a radiocapitellar incongruity of more 2 mm (d)
The elbow:
review of anatomy and common collateral ligament complex pathology using MRI. Posterolateral rotatory instability, stage 3C. Consecutive coronal FS T1-weighted direct MR arthrographic images (a–c), and consecutive axial FS T1-weighted direct MR arthrographic images (d–f) demonstrating a full-thickness tear of the anterior bundle of the medial collateral ligament complex (yellow arrow), proximal full-thickness tear of the common flexor tendon (short white arrows), proximal full-thickness tear of the common extensor tendon (white arrowheads), proximal complete tear of the lateral ulnar collateral ligament and radial collateral ligament proper (long white arrows), and a complete tear of the posterior bundle of the medial collateral ligament complex (yellow arrowheads)
The elbow:
review of anatomy and common collateral ligament complex pathology using MRI. Posterolateral rotatory instability, stage 1. Coronal FS PD-weighted MRI (a, b) and coronal T1-weighted MRI (c, d) showing an avulsion of the proximal lateral ulnar collateral ligament and retraction of the osseous fragment (white arrows). Bone marrow edema is seen in the capitellum (white arrowheads) and radial head (white asterisks)
The elbow:
review of anatomy and common collateral ligament complex pathology using MRI. Posterolateral rotatory instability, stage 3B. Consecutive coronal FS T1-weighted direct MR arthrographic images (a, b), sagittal FS T1-weighted direct MR arthrographic image (c), and consecutive axial FS T1-weighted direct MR arthrographic images (d, e) showing a proximal complete tear of the lateral ulnar collateral ligament and radial collateral ligament proper (white short arrows), diffuse partial-thickness tear of the anterior bundle of the medial collateral ligament complex (white arrowheads), and a non-displaced fracture of the coronoid process (long white arrows)
The elbow:
review of anatomy and common collateral ligament complex pathology using MRI. Anterior view of the elbow demonstrating the progression of the structures injured in a posterior dislocation, from lateral to medial. a Normal. b Proximal disruption of the lateral ulnar collateral ligament (white asterisk). c Proximal disruption of the lateral ulnar collateral ligament and the radial collateral ligament (black asterisk). d Anterior capsule tear (white arrow). Lateral ulnar collateral ligament (LUCL). Radial collateral ligament (RCL). Annular ligament (AL). Anterior bundle of the medial collateral ligament complex (A-MCL)
The elbow:
review of anatomy and common collateral ligament complex pathology using MRI. Axial illustrations with superior view demonstrating the progression of the structures injured in the posterolateral rotatory instability
The elbow:
review of anatomy and common collateral ligament complex pathology using MRI. Two different patients with chronic elbow pain and medial instability. Coronal FS PD-weighted MRI (a) showing a chronically thickened anterior bundle of the medial collateral ligament (white arrowhead). Coronal FS PD-weighted MRI (b) showing a chronically thickened anterior bundle of the medial collateral ligament (white arrow), and a deformity of the sublime tubercle due to malunion of an old fracture (white asterisk)
The elbow:
review of anatomy and common collateral ligament complex pathology using MRI. Axial FS PD-weighted MRI (a–d) and sagittal FS PD-weighted MRI (e) showing the intact annular ligament (white asterisks). Anterior attachment of the annular ligament (white arrow). The posterior attachment of the annular ligament can be fenestrated (white arrowheads). The annular ligament encircles the periphery of the radial head (white asterisks in b-d)
The elbow:
review of anatomy and common collateral ligament complex pathology using MRI. Consecutive coronal FS PD-weighted MRI (a–d) showing the intact lateral ulnar collateral ligament (white asterisks) and radial collateral ligament (short arrows). The lateral ulnar collateral ligament wraps around the posterior aspect of the radial neck. Annular ligament (long arrow). Common extensor tendon (white arrowheads). Lateral epicondyle (LE). Supinator crest of the ulna (SC)
The elbow:
review of anatomy and common collateral ligament complex pathology using MRI. Axial T1-weighted MRI (a) and axial FS PD-weighted MRI (b) in two different healthy volunteers showing the intact posterior bundle of the medial collateral ligament complex (white arrows). It extends from the posterior aspect of the medial epicondyle (ME) to the medial aspect of the olecranon process (OP). Cubital tunnel retinaculum (white arrowhead). Ulnar nerve (yellow asterisks). Anconeus epitrochlearis muscle (white asterisk)
The elbow:
review of anatomy and common collateral ligament complex pathology using MRI. Consecutive coronal FS PD-weighted MRI (a–c) showing the intact anterior bundle of the medial collateral ligament (A-MCL) complex (white asterisks). It extends from the inferior aspect of the medial epicondyle (ME) to the sublime tubercle of the ulna (white arrowheads). Note the typical striated appearance of the normal proximal A-MCL (white arrows)
The elbow:
review of anatomy and common collateral ligament complex pathology using MRI. Elbow illustration. Medial view (a) demonstrating the medial collateral ligament complex: anterior bundle of the medial collateral ligament (A-MCL), posterior bundle of the medial collateral ligament (P-MCL), and transverse ligament (T-MCL). Lateral view (b) demonstrating the lateral collateral ligament complex: lateral ulnar collateral ligament (LUCL), radial collateral ligament (RCL), and annular ligament (AL)
Overuse-related
instability of the elbow: the role of CT-arthrography. Elbow 3D reformatting with ligament illustrations. Medial view (a). The medial collateral ligament (MCL) complex and its components: the anterior bundle of the medial collateral ligament (A-MCL), the posterior bundle of the medial collateral ligament (P-MCL), and the transverse ligament (T-MCL). Lateral view (b). The lateral collateral ligament (LCL) complex and its components: the radial collateral ligament (RCL), the lateral ulnar collateral ligament (LUCL), and the annular ligament (AL)
The elbow is a complex synovial joint formed by the articulations of the humerus, the radius, and the ulna.
Gross anatomy
Articulations
The elbow joint is made up of three articulations :
- radiohumeral: capitellum of the humerus with the radial head
- ulnohumeral: trochlea of the humerus with the trochlear notch (with separate olecranon and coronoid process articular facets) of the ulna
- radioulnar: radial head with the radial notch of the ulna (proximal radioulnar joint)
In full flexion, the coronoid process is received by the coronoid fossa and the radial head is received by the radial fossa on the anterior surface of the humerus. In full extension, the olecranon process is received by the olecranon fossa on the posterior aspect of the humerus .
Movements
The elbow is a trochoginglymoid (combination hinge and pivot) joint :
- the hinge component (allowing flexion-extension) is formed by the ulnohumeral articulation
- forearm flexors at elbow:
- primary: biceps brachii, brachialis, brachioradialis
- secondary: pronator teres, palmaris longus, flexor digitorum superficialis, extensor carpi radialis longus and brevis
- forearm extensors at elbow:
- primary: triceps brachii
- secondary: none
- forearm flexors at elbow:
- the pivot component (allowing pronation-supination) is formed by the radiohumeral articulation and the proximal radioulnar joint
- forearm pronators at elbow:
- primary: pronator teres, pronator quadratus
- secondary: brachioradialis
- forearm supinators at elbow:
- primary: supinator, biceps brachii
- secondary: none
- forearm pronators at elbow:
Ligaments
- medial (ulnar) collateral ligament complex
- lateral (radial) collateral ligament complex
- oblique cord
- inconstant thickening of supinator muscle fascia and functionally insignificant
- runs from tuberosity of the ulna to just distal to radial tuberosity
- quadrate ligament (of Denuce)
- thickening of the inferior aspect of the joint capsule
- runs from just inferior to the radial notch of the ulna to insert to the medial surface of the radial neck
Joint capsule
The joint capsule has two layers, deep and superficial, and attaches proximally to the radial, coronoid and olecranon fossae. Distally, it attaches to the annular ligament of the radius and coronoid process of the ulna . The volume of the joint capsule is 24-30 mL .
Fat pads
There are three fat pads of the elbow, which sit between the two layers of the joint capsule, making them extrasynovial :
- coronoid fossa fat pad (anterior)
- radial fossa fat pad (anterior)
- olecranon fossa fat pad (posterior)
Bursae
- superficial olecranon bursa: lies between the olecranon and the subcutaneous tissue
- subtendinous olecranon bursa: lies between olecranon and triceps brachii tendon
- intratendinous olecranon bursa: variably lies in the triceps brachii tendon
- bicipitoradial bursa
Relations
- anteriorly: biceps brachii tendon, brachialis muscle, median nerve, brachial artery
- posteriorly: olecranon bursae, triceps brachii tendon
- laterally: common extensor tendon, supinator muscle
- medially: ulnar nerve
Arterial supply
Arterial supply is via anastomotic (medial, lateral and posterior) arcades formed by branches of the radial, ulnar and brachial arteries which contribute to the arterial anastomosis of the elbow.
Innervation
- articular branches of the radial, ulnar, median and musculocutaneous nerves
Variant anatomy
- synovial folds
- thin projections of synovial membrane (inner layer of joint capsule)
- may be confused with intra-articular loose bodies on MRI
- capitellar and olecranon pseudodefects
- normal areas devoid of articular cartilage
- can be mistaken on MRI for impaction injuries or osteochondral defects
- accessory ossicles
- os supratrochlear dorsale
- patella cubiti (very rare)
Ossification
Siehe auch:
- Radiusköpfchenfraktur
- Ossifikationszentren Ellenbogen
- Ellenbogenluxation
- Processus supracondylaris
- Sulcus-ulnaris-Syndrom
- Radiusköpfchenluxation
- suprakondyläre Humerusfrakturen
- Abrissfraktur Epikondylus ulnaris
- Olekranonfraktur
- Epicondylus radialis Fraktur
- Osteochondrose
- Fraktur Processus coronoideus ulnae
- Epicondylitis ulnaris humeri
- Radiusköpfchen-Subluxation
- CRITOE
- laterales ulnares Kollateralband des Ellenbogens
- Tennisellenbogen
- distale Bizepssehne
- Bursitis bicipitoradialis
und weiter:
Assoziationen und Differentialdiagnosen zu Ellenbogen:
