The elbow joint is the connection between the humerus and the bones of the forearm . The elbow joint is formed by three joints: 1) shoulder-ulnar, in which there is flexion and extension; 2) shoulder-beam, in which the bending, extension and rotation of the beam are possible; 3) proximal radial-elbow, in which the beam rotates, pronation and supination. In general, the elbow joint functions as a helical joint: it can move around the front axis - flexion and extension. All three joints forming the elbow joint are enclosed in one joint joint bag (Figures 1 and 2). The joint cavity has an anterior and posterior chamber, which are interconnected by narrow slits. In places of contact of the tendons of the muscles of the shoulder with the elbow joint are mucous bags.
Fig. 1. Elbow joint : 1 - humerus; 2 - articular bag; 3 - lateral ulnar ligament; 4 - ulnar bone; 5 - radius bone; 6 - annular ligament of the radius; 7 - lateral radial ligament.
Fig. 2. The elbow joint (opened); 1 - humerus; 2 - articular bag; 3-block of humerus; 4 - articular cavity; 5 - ulnar bone; 6 - Radial bone; 7 - annular ligament of the radius; 8 - head of the radius; 9 - head of humerus.
The blood supply of the elbow joint is due to eight anastomosing arteries separating from the brachial, radial and ulnar arteries. The lymph that flows from the elbow joint region is concentrated in the reservoirs that run along the brachial artery to the lymph nodes of the axillary cavity. The elbow joint is innervated by the branches of the median, radial, ulnar and musculocutaneous nerves. The area of the elbow joint is divided into anterior (flexor) and posterior (extensor) surface. In the subcutaneous layer, the subcutaneous veins, the lateral and medial cutaneous nerves of the forearm and the medial vein of the elbow are located on the front surface. In the inner part of the ulnar fossa near the biceps tendon muscle under the aponeurosis are the brachial artery, vein and median nerve.
Malformation of the elbow joint is rare. These include a pronounced congenital elbow curvature, characterized by a deviation of the forearm relative to the shoulder to the outside, an extra bone of the elbow joint, which can be accepted with trauma behind the bone fragment. Very rarely occur congenital ankylosis and elbow joint contractures.
Congenital curvature of the elbow (cubitus valgus) is characterized by a deviation of the forearm relative to the shoulder outside. A small (7-10 °) deviation of the forearm from the outside is physiological. More pronounced curvatures are already pathological. The extra bone of the elbow joint (patella cubiti, s. Sesamum cubiti) is rare (it has a certain value in examination after trauma). This is an independently developed apophysis of the elbow process, which can be taken as a bone fragment.
Damage . Contusions of the elbow joint are often observed, can be accompanied by a hemorrhage into the surrounding soft tissues, mucous bags and less often into the joint cavity, complicated by inflammatory processes that can lead to arthritis, ankylosis, contracture. With a contusion of the ulnar nerve, sharp pain occurs, radiating to the IV and V fingers. Elongations in the elbow joint occur with excessive extension (during a game of tennis, with exercises with weights, etc.), can be accompanied by a rupture of the capsule, hemarthrosis (see Arthritis). Treatment of bruises and sprains: fixing soft bandage, peace, cold, sometimes immobilization with gypsum lint in the average physiological position of the elbow joint for 3-5 days; then - thermal procedures and medical gymnastics . When large hemarthrosis - puncture the joint with suction of blood.The
Open injuries of the elbow joint in peacetime are observed most often in the workplace, and gunshot wounds - in wartime (according to the frequency they occupy the third place among the injuries of other joints).
Wounds can be various: blind, through, non-penetrating (with damage to soft tissues), penetrating (with damage to the joint bag), with minor bone damage or extensive damage to soft tissues and bone crushing. In the latter case, the wound has the shape of a funnel filled with crushed muscles, bone fragments, blood clots, sometimes foreign bodies and scraps of clothing.
First aid in case of injury: extensive lubrication of iodine wound circumference, aseptic dressing with wound tamponade in order to stop bleeding, weakened tourniquet on the shoulder , immobilization by the tire, administration of serums and morphine.
At the advanced stages of evacuation, surgical treatment of the wound with excision of nonviable tissues, stopping of bleeding, removal of bone fragments, devoid of periosteum, blood clots , foreign bodies, scraps of clothing is performed. Blood transfusion , local and intramuscular use of antibiotics. Gypsum dressing with a window to observe the wound.
Complications of injuries of the elbow joint include: shock (see), blood loss (see), osteomyelitis, fistulas , contracture (see), ankylosis (see). Treatment - operative and therapeutic gymnastics.
Dislocations in the elbow joint occur when falling on an elongated outgrowth in the elbow joint arm. In the overwhelming majority of cases, posterior dislocations of both bones of the forearm are observed (see Dislocations ).
Dislocation of the head of the radial bone can be combined with a fracture of the ulnar bone at the border of the upper and middle third - the Montejean fracture. Symptoms: local soreness, swelling, lack of pronation and supination of the forearm. The radiograph confirms the diagnosis. First aid is the immobilization of the joint by a kerchief bandage. Treatment: the reposition of fragments of the ulna and the direction of the head of the radius are usually performed by the doctor. If this can not be done in a bloodless way, an operation of osteosynthesis of the ulna and a repositioning of the head of the radius are performed.
The fractures of the bones of the elbow joint include: 1) fractures of the lower end of the shoulder, both condyles, supracondylar, T-shaped and Y-shaped fractures of the metaphysis of the shoulder, fractures of the cephalic elevation and external epicondyle; 2) fractures of the epiphysis of the bones of the forearm, the elbow process, the coronoid process, the head and neck of the radius. According to the mechanism of occurrence, these fractures are divided into extensor and flexion. Symptoms: rapidly increasing swelling of the elbow joint, local soreness, impaired mobility in the joint, hemorrhage into the joint cavity (hemarthrosis). The diagnosis of the fracture and its appearance are determined on the basis of the data of the X-ray study. Treatment, as a rule, is conservative. When the reposition of fragments is successful (the doctor makes), a plaster bandage is applied for a different period depending on the type of fracture. If it is impossible to compare bone fragments, surgical treatment is performed. With fracture of the elbow process with a divergence of fragments, treatment is always prompt. To restore the functions of the limbs after fracture, the fracture is carried out active and passive gymnastics, physiotherapeutic treatment ( mud treatment , etc.).
Diseases . Inflammation of the elbow joint, specific and nonspecific, - see Arthritis, Tuberculosis of bones and joints .
Bursitis of the elbow joint (inflammation of the mucous bags) usually arise due to traumatization during labor processes. They flow sharply and chronically (see Bursitis). Treatment : with acute bursitis - immobilization of the joint, pressing dressing, antibiotics intramuscularly; with suppuration - incision . With chronic bursitis, often recurrent, - the operation of removing the mucous bag.
Acroosteopathy ("tennis elbow") - a traumatic and professional epicondylitis (inflammation of the epicondyle of the shoulder), occurs as a result of reloading the elbow joint during work and sports activities. It is characterized by the appearance of sharp pains in the region of the epicondyle of the shoulder during movements in the joint. Treatment: rest, immobilization with gypsum lunget, novocain blockade, thermal procedures, massage .
The elbow joint (articulatio cubiti) is the connection between the bones of the shoulder and forearm. The topographic area of the elbow joint is called the elbow (cubitus). The elbow joint is a complex joint, formed by three bones, consists of three joints: 1) the humerus (between the block of the shoulder and the block cutting of the ulna), in which the flexion and extension occur; 2) the humerus (between the pit of the radial head and the head of the shoulder), in which the bending, extension and rotation of the ray are possible; 3) proximal ray-ray (between the articular circumference of the ray head and radial cutting of the ulna). In this joint, rotation of the ray, pronation and supination occurs. The joint is cylindrical. In general, the elbow joint functions as a screw-like (art. Cochlearis). It can move around the frontal pox: flexion and extension. On the sides of the elbow joint capsule there are collateral ligaments (ligg. Collateralia ulnare et radiale). The deep bundles of the latter pass into the circular bundle of the ray (lig. Anulare radii), encircling the ray head (Figure 1-3). All three joints are enclosed in one joint capsule - a capsule. In the cavity of the joint, there are anterior and posterior chambers, which communicate with narrow slits. With the development of purulent arthritis, these slits are closed due to swelling of the synovial membrane, which must be taken into account when the joint is opened, and both sections must be drained. Mucous bags of the elbow joint are located under the tendon of the triceps muscle at the elbow and over the tendon and two bags - on the sides of the biceps tendon.
Nutrition of the elbow joint occurs due to the arterial network, which is formed from eight anastomosing with each other arteries. Collateral circulation in the ligation of the humerus, ulnar or radial arteries is easily restored through the arterial network.
The lymph drainage from all segments of the elbow joint is concentrated in the reservoirs running along the brachial artery and is interrupted in the lymph nodes of the axilla. The innervation of the elbow joint is performed by the branches of the median, radial, ulnar and musculocutaneous nerves.
Fig. 3. Distal end of humerus, posterior surface (with contours of upper attachment of the elbow joint bag); the lines of epiphyseal cartilages are visible: 1 - fossa olecrani; 2 - the line of attachment of the joint bag.
Topographically, the region of the elbow joint splits into the anterior flexion and posterior extensor surfaces. In the subcutaneous layer, the head subcutaneous vein and the lateral cutaneous nerve of the forearm (v. Cephalica, n. Antebracliii lateralis), on the inner side - the main vein and the medial cutaneous nerve of the forearm (v. Basilica, n. Cutaneus antebracliii medialis) and between they are the median vein of the elbow (v. mediana cubiti). In the inner part of the ulnar fossa near the tendon of the biceps muscle under the aponeurosis of the latter (aponeurosis musculi bicipitis brachii) lies the brachial artery, and 0.5-1 cm medially from it - the median nerve. The groove between the inner epicondyle of the humerus and the elbow is used as a bed for the ulnar nerve.