Anatomy of the Elbow Joint and Surgical Approaches

  • Gregory I. Bain
  • Janak A. Mehta


A sound knowledge of the surgical anatomy and approaches to the elbow is critical for the safe and competent execution of elbow surgery. Just as we are sure others do, we prefer certain surgical approaches to others to treat specific elbow injuries or disorders (Table 1.3). We hope that this review of the pertinent surgical anatomy and approaches furthers the practice of the art of elbow surgery.


Ulnar Nerve Radial Head Medial Collateral Ligament Elbow Joint Medial Epicondyle 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Dowdy PA, Bain GI, King GJW, et al. The midline posterior elbow incision. An anatomical appraisal. J Bone Joint Surg 1995;77B:696–699.Google Scholar
  2. 2.
    Chang CW, Oh SJ. Posterior antebrachial cutaneous neuropathy: Case report. Electromyogr Clin Neurophysiol 1990;30:3–5.PubMedGoogle Scholar
  3. 3.
    Graham B, Adkins P, Scheker LR. Complications and morbidity of the donor and recipient sites in 123 lateral arm flaps. J Hand Surg 1992;17B:189–192.Google Scholar
  4. 4.
    Leffert RD. Anterior submuscular transposition of the ulnar nerves by the Learmonth technique. J Hand Surg 1982;7A:147–155.Google Scholar
  5. 5.
    Dellon AL. Techniques for successful management of ulnar nerve entrapment at the elbow. Neurosurg Clin N Am 1991; 2:57–73.PubMedGoogle Scholar
  6. 6.
    Dellon AL, MacKinnon SE. Injury to the medical antebrachial cutaneous nerve during cubital tunnel surgery. J Hand Surg 1985;10B:33–36.Google Scholar
  7. 7.
    Gray H, Williams PL, Bannister LH, eds. Gray’s anatomy of the human body, 38th ed. Edinburgh: Churchill Livingstone; 1995.Google Scholar
  8. 8.
    McMinn RMH. Last’s anatomy regional and applied, 8th ed. Edinburgh: Churchill Livingstone; 1991:13.Google Scholar
  9. 9.
    Romanes GJ. Cunningham’s manual of practical anatomy, Vol. 1, 14th ed. Oxford: Oxford University Press, 1976.Google Scholar
  10. 10.
    Tountas CP, Bergman RA. Anatomical variations of the upper extremity. New York: Churchill Livingstone, 1993.Google Scholar
  11. 11.
    Wadsworth TG. A modified posterolateral approach to the elbow and proximal radioulnar joints. Clin Orthop 1979;144:151–153.PubMedGoogle Scholar
  12. 12.
    Boyd HB. Surgical exposure of the ulna and proximal third of the radius through one incision. Surg Gyn Obst 1940;71:86–88.Google Scholar
  13. 13.
    Basmajian JV. Muscles alive, 2nd ed. Baltimore: Williams & Wilkins, 1967.Google Scholar
  14. 14.
    Spinner M. The arcade of Frohse and its relationship to posterior interosseous nerve paralysis. J Bone Joint Surg 1968;50B:809–812.Google Scholar
  15. 15.
    Strachan JC, Ellis BW. Vulnerability of the posterior interosseous nerve during radial head resection. J Bone Joint Surg 1971;53B:320–323.Google Scholar
  16. 16.
    Dellon AL, Mackinnon SE. Musculoaponeurotic variations along the course of the median nerve in the proximal forearm. J Hand Surg (Br) 1987;12:359–363.Google Scholar
  17. 17.
    Bateman JE. Denervation of the elbow joint for the relief of pain. A preliminary report. J Bone Joint Surg 1948;30B:635–641.PubMedGoogle Scholar
  18. 18.
    Osterman AL, Kitay GS. Compression neuropathies: Ulnar. In: Peimer CA, ed. Surgery of the hand and upper extremity, Vol. 2. New York: McGraw-Hill Book Co, 1995:1339–1362.Google Scholar
  19. 19.
    Lister GD, Belsole RB, Kleinert HE. The radial tunnel syndrome. J Hand Surg 1979;4A:52–59.Google Scholar
  20. 20.
    Polonskaja R. Zue frage der arterienanastomosen im gobiete der ellenbagenbeuge des menschen. Anat Anz 1932;74:303.Google Scholar
  21. 21.
    Fuss FK. The ulnar collateral ligament of the human elbow joint. Anatomy, function and biomechanics. J Anat 1991;175: 203–212.PubMedGoogle Scholar
  22. 22.
    O’Driscoll SW, Jaloszynski R, Morrey BF, et al. Origin of the medial ulnar collateral ligament. J Hand Surg 1992;17A:164–168.Google Scholar
  23. 23.
    O’Driscoll SW, Morrey BF, Korinek SL, et al. The patho-anatomy and kinematics of posterolateral rotatory instability (pivot-shift) of the elbow. Orthop Trans 1990;14:306.Google Scholar
  24. 24.
    Osborne G, Cotterill P. Recurrent dislocation of the elbow. J Bone Joint Surg 1966;48B:340–346.Google Scholar
  25. 25.
    Olsen BS, Vaesel MT, Sojbjerg TO, et al. Lateral collateral ligament of the elbow joint: Anatomy and kinematics. J Shoulder Elbow Surg 1996;5:103–112.PubMedCrossRefGoogle Scholar
  26. 26.
    Bert JM, Linscheid RL, McElfresh EC. Rotatory contracture of the forearm. J Bone Joint Surg 1980;62A:1163–1168.Google Scholar
  27. 27.
    Gray DJ, Gardner E. Prenatal development of the human elbow joint. Am J Anat 1951;88:429–469.PubMedCrossRefGoogle Scholar
  28. 28.
    Wood VE, Campbell GS. The supratrochleare dorsale accessory ossicle in the elbow. J Shoulder Elbow Surg 1994;3:395–398.CrossRefGoogle Scholar
  29. 29.
    Haraldsson S. On osteochondritis deformans juvenilis capituli humeri including investigations of intra osseous vasculature in distal humerus. Acta Orthop Scand 1959;38(Suppl).Google Scholar
  30. 30.
    Toniolo RM, Wilkins KE. Avascular necrosis of the trochlea. In: Rockwood CA Jr, Wilkins DE, Beaty JH, eds. Fractures in children, 4th ed. Philadelphia: Lippincott-Raven, 1996:822–830.Google Scholar
  31. 31.
    Aebi H. Der ellbowgenwinkel, seine beizehungen zu geschlect. Korperbay und huftbreite. Acta Anat 1947;3:228.CrossRefPubMedGoogle Scholar
  32. 32.
    Beals RK. The normal carrying angle of the elbow. A radiographic study of 422 patients. Clin Orthop 1976;119:194–196.PubMedGoogle Scholar
  33. 33.
    Wilkins KE, Beaty JH, Chambers HG, et al. Fractures and dislocations of the elbow region. In: Rockwood CA Jr, Wilkins KE, Beaty JH, eds. Fractures in children, 4th ed. Philadelphia: Lippincott-Raven, 1996:653–904.Google Scholar
  34. 34.
    Conwell HE, Reynolds FC. Key and Conwell’s management of fractures, dislocations and sprains, 7th edition. St. Louis, MO: CV Mosby, 1961.Google Scholar
  35. 35.
    Regan W, Morrey B. Fractures of the coronoid process of the ulna. J Bone Joint Surg 1978;71A:1348–1354.Google Scholar
  36. 36.
    Cabanela ME. Fractures of the proximal ulna and olecranon. In: Morrey BF, ed. The elbow and its disorders, 2nd ed. Philadelphia: WB Saunders, 1993:382–399.Google Scholar
  37. 37.
    Kocher T. Textbook of operative surgery, 3rd ed. London: Adam and Charles Black, 1911:314–319.Google Scholar
  38. 38.
    Campbell WC. Incision for exposure of the elbow joint. Am J Surg 1932;15:65–67.CrossRefGoogle Scholar
  39. 39.
    Van Gorder GW. Surgical approach in supracondylar “T” fractures of the humerus requiring open reduction. J Bone Joint Surg 1940;22:278–292.Google Scholar
  40. 40.
    Molesworth HWL. An operation for the complete exposure of the elbow-joint. Brit J Surg 1930;18:303–307.Google Scholar
  41. 41.
    Henry AK. Extensile exposure, 3rd ed. Edinburgh: Churchill Livingstone, 1995:95–107.Google Scholar
  42. 42.
    MacAusland WR. Ankylosis of the elbow: with report of four cases treated by arthroplasty. JAMA 1915;64:312–318.Google Scholar
  43. 43.
    Bryan RS, Morrey BF. Extensive posterior exposure of the elbow. A triceps-sparing approach. Clin Orthop 1982;166:188–192.PubMedGoogle Scholar
  44. 44.
    Morrey BF, Bryan RS, Dobyns JH, et al. Total elbow arthroplasty. A five-year experience at the Mayo Clinic. J Bone Joint Surg 1981;63A:1050–1063.Google Scholar
  45. 45.
    Morrey BF, Adams RA. Semiconstrained arthroplasty for the treatment of rheumatoid arthritis of the elbow. J Bone Joint Surg 1992;74A:479–490.Google Scholar
  46. 46.
    Morrey BF: Complications of elbow replacement surgery. In: Morrey BF, ed. The elbow and its disorders, 3rd ed. Philadelphia: WB Saunders, 2000:667–677.Google Scholar
  47. 47.
    Morrey BF. Surgical exposures of the elbow. In: Morrey BF, ed. The elbow and its disorders, 3rd ed. Philadelphia: WB Saunders, 2000:109–134.Google Scholar
  48. 48.
    Morrey BF. Limited and extensile triceps reflecting exposures of the elbow. In: Morrey BF, ed. The elbow: Master techniques in orthopaedic surgery. New York: Raven Press, 1994:3–19.Google Scholar
  49. 49.
    Patterson, SD, Bain, GI, Mehta, JA. Surgical approaches to the elbow. Clin Orthop 2000;370:19–33.PubMedCrossRefGoogle Scholar
  50. 50.
    Alonso-Llames M. Bilaterotricipital approach to the elbow. Its application in the osteosynthesis of supracondylar fractures of the humerus in children. Acta Orthop Scand 1972;43:479–490.PubMedCrossRefGoogle Scholar
  51. 51.
    Müller ME, Allgower M, Willenegger H. Manual of internal fixation: Technique recommended by the AO group, 2nd ed. New York: Springer-Verlag, 1979.Google Scholar
  52. 52.
    Pankovich AM. Anconeus approach to the elbow joint and the proximal part of the radius and ulna. J Bone Joint Surg 1977; 59A:124–126.Google Scholar
  53. 53.
    Heim U, Pfieffer KM. Small fragment set manual: Technique recommended by AO group, 2nd ed. New York: Springer-Verlag, 1982.Google Scholar
  54. 54.
    Cadenat FM. Les voies de penetration des membres. Membre Superieur, p146, Paris Gastoon doin and Cie, 1932.Google Scholar
  55. 55.
    Kaplan EB. Surgical approach to the proximal end of the radius and its use in fractures of the head and neck of the radius. J Bone Joint Surg 1941;23:86–92.Google Scholar
  56. 56.
    Key JA, Conwell HE. The management of fractures dislocations and sprains, 2nd ed. St. Louis, MO: CV Mosby, 1937.Google Scholar
  57. 57.
    Pearl RM, Johnson D. The vascular supply to the skin: An anatomical and physiological reappraisal-Part I. Ann Plast Surg 1983;11:99–105.PubMedGoogle Scholar
  58. 58.
    Pearl RM, Johnson D. The vascular supply to the skin: An anatomical and physiological reappraisal-Part II. Ann Plast Surg 1983;11:196–205.PubMedCrossRefGoogle Scholar
  59. 59.
    Bain GI, Mehta JA, Heptinstall RJ. The dynamic elbow suspension splint. J Shoulder Elbow Surg. 1998;7:419–421.PubMedCrossRefGoogle Scholar
  60. 60.
    Figgie MP. Elbow arthroplasty. In: Peimer CA, ed. Surgery of the hand and upper extremity, Vol. 1. New York: McGraw-Hill Book Co, 1996:535–571.Google Scholar
  61. 61.
    Wolfe SW, Ranawat CS. The osteo-anconeus flap. An approach for total elbow arthroplasty. J Bone Joint Surg 1990; 72A:684–688.Google Scholar
  62. 62.
    Failla JM, Amadio PC, Morrey BF, et al. Proximal radioulnar synostosis after repair of distal biceps brachii rupture by the two-incision technique. Report of four cases. Clin Orthop 1990;253:133–136.PubMedGoogle Scholar
  63. 63.
    Gordon ML. Monteggia fracture. A combined surgical approach employing a single lateral incision. Clin Orthop 1967; 50:87–93.PubMedGoogle Scholar
  64. 64.
    Jupiter JB. The surgical management of intraarticular fractures of the distal humerus. In: Morrey BF, ed. The elbow: Master techniques in orthopaedic surgery. New York: Raven Press, 1994:53–70.Google Scholar
  65. 65.
    Husband JB, Hastings H II. The lateral approach for operative release of posttraumatic contracture of the elbow. J Bone Joint Surg 1990;72A:1353–1358.Google Scholar
  66. 66.
    Gschwend N, Simmen BR, Matejovsky Z. Late complications in elbow arthroplasty. J Shoulder Elbow Surg 1996;5:86–96.PubMedCrossRefGoogle Scholar
  67. 67.
    Hotchkiss RN. Compass elbow hinge: Surgical technique. In: Product manual. Memphis, TN: Smith & Nephew Richards.Google Scholar
  68. 68.
    Smith GR, Altchek DW, Pagnani MJ, et al. A muscle-splitting approach to the ulnar collateral ligament of the elbow. Neuroanatomy and operative technique. Am J Sports Med 1996;24: 575–580.PubMedGoogle Scholar
  69. 69.
    Jobe FW. Surgical anatomy of the elbow. In: Jobe FW, ed. Operative techniques in upper extremity sports injuries. St. Louis, MO: CV Mosby, 1996:405.Google Scholar

Copyright information

© Springer-Verlag New York, Inc. 2002

Authors and Affiliations

  • Gregory I. Bain
  • Janak A. Mehta

There are no affiliations available

Personalised recommendations