Elbow joint

“ When the epiphysis is displaced upwards and unites in this position, it may interfere with complete extension of the elbow.
Treatment.—It would appear that too much stress has hitherto been laid on the necessity of bringing the fragments into perfect apposition, and too little attention paid to the importance of maintaining the functions of the triceps and the movements of the elbow-joint.
Massage and movements are carried out from the first, and the forearm is supported in a sling. Full flexion is the last movement to be attempted. ”

“ For disease of the elbow-joint which has resisted ordinary remedies, and is wearing down the patient's strength, including caries, ulceration of cartilages, and gelatinous synovial degeneration.
2. For wounds of the elbow penetrating the joint, the prognosis both as to the patient's life and the usefulness of his arm is much better after excision than after endeavours to save the joint without excision. ”

“ The elbow joint, unlike that of the shoulder, is a rigid hinge, permitting motion in only one plane, that of the wing itself, or nearly so. The same is true of the wrist joint, which holds the hand firmly, allowing no motion save that which opens and closes the wing. ”

“ The upper tendons, being fastened to the fixed shoulder-blade, cannot move; but the lower tendon is fixed to the radius; the radius, with the ulna to which it is fastened, readily moves up and down on the elbow-joint—the shape of bones in the joint and all the arrangements of the joint, as we have seen, readily permitting this. When the muscle, then, pulls on its lower tendon, its pulls on the radius at the point where the tendon is fastened on to the bone. The radius thus pulled on forms with the ulna a lever of the third order, working on the end of the humerus as a fulcrum ”

“ Of these, the knee-joint is most frequently affected, probably from the greater extent of cancellated and articulating surface. In young persons of unhealthy constitutions, the joints not unfrequently become affected one after another, and superficial abscesses form, terminating in open sores. I was obliged to amputate the upper extremity of a young lady a few days ago, in which a metacarpal bone and its articulation, the entire chain of carpal bones, the wrist and elbow joints, were all thoroughly involved in disease. ”

“ The fracture is exposed, the joint cavity opened up and cleared of clots, and silver-wire sutures passed through the fragments without encroaching upon the articular cartilage. The limb is fixed with the elbow-joint in the position of almost complete extension. Movement may be commenced at the end of a week, the angle at which the joint is fixed being changed morning and evening. During the day the flexed position should be maintained and the arm carried in a sling; during the night the limb is fixed to a pillow in the extended position. ”

“ The ankle- and elbow-joints suffer much less commonly than the knee. The effusion into the articulation takes place insidiously, although rapidly producing considerable enlargement of and fluctuation in the joint, without local heat, redness, or tenderness, and often with but little or no pain or pyrexia. ”

“ The splints and rollers should be removed on the fourth or fifth day, that the positions of the fragments may be examined and the roller again applied to draw them closer together. After ten or twelve days, passive motion of the wrist and fingers, with pronation and supination of the radius, should be adopted, but great care is to be taken that the patient does not inadvertently bend the elbow joint while free of the splint. The splint must be worn, with the frequent removals directed above, for five weeks, by which time gentle flexion of the elbow may be practised. ”

“ It often follows in old people upon long disuse and confinement of a limb to one position, as during the cure of fractures. A very valuable specimen was presented to me lately by my friend Mr. Busk, of the Dreadnought hospital ship. The elbow had been apparently subjected to great injury. The radius and ulna had been fractured: the former had united, whilst a false joint had been formed betwixt the portions of the ulna. There is profuse deposit of bone around the elbow-joint, which must have been quite stiff, or nearly so, as regarded flexion and extension ”

“ Figs. 136 and 137.—Amputation through the forearm above the upper third. The elbow joint does not flex beyond the right angle.
Fig. 138.—Limb for amputation through the upper third of the forearm. (For a description of the ratchet see page 135.)
The chief functional difficulty depends upon the fact that, with the elbow at a right angle, the anterior surface of the forearm stump is too short to support a weight; for example, a basket held by the handle. The stump escapes partly from the bucket when the forearm extends. ”

“ Any of the vessels of the lower limb may be controlled by compressing just behind the knee between the two prominent tendons that will be found there when the leg is doubled up. Arteries of the forearm and hand can be stopped by pressing with the thumb at the elbow joint just to the inner side of the tendon of the biceps which you may feel like a cord when the arm is extended. If the bleeding is from the upper arm stretch the whole arm by raising it above the head. ”

“ After all attempts at reduction, whether successful or not, it is necessary to moderate the inflammation that ensues, by local bleeding and fomentation, combined, if necessary, with nauseating laxatives: general depletion is seldom required.
Luxation of the Elbow-joint is an extremely common accident, particularly in young persons, before the bony processes have been fully formed. It is produced by wrenches, or by force applied to the farther end of the forearm, the bones neither breaking nor bending. ”

“ If a joint is left permanently stiff in an awkward and useless position, the limb may be greatly improved by excision of the joint. Thus, if the knee is left bent and the joint is excised a useful, straight limb may be obtained, somewhat shortened, and, of course, permanently stiff. If after disease of the hip-joint the thigh remains fixed in a faulty position, it may be brought down straight by dividing the bone near the upper end. A stiff shoulder or elbow may be converted into a useful, movable joint by excision of the articular ends of the bones. ”

“ Moderate extension for the most part sufficeth, extension being made at the leg, and counter-extension at the thigh.
38. Dislocations at the elbow are more troublesome than those at the knee, and, owing to the inflammation which comes on, and the configuration of the joint, are more difficult to reduce if the bones are not immediately replaced. For the bones at the elbow are less subject to dislocation than those of the knee, but are more difficult to reduce and keep in their position, and are more apt to become inflamed and ankylosed. ”

“ Thus, we observe, that two very different substances enter into the composition of a joint. The ligament, very unyielding, affords strength, while the cartilage, elastic and moist, gives ease and smoothness of motion. The amount of motion provided for varies greatly in different joints. In some there is none at all, as in the skull, where one bone is dove-tailed into another by what are termed sutures. Others have a hinge-like motion, such as those of the elbow, wrist, ankle, and knee ”

“ The upper arm, between the shoulder and elbow is short, and is buried in muscle so that one doesn’t notice it. So the first joint that shows, where the fore-leg joins the body, is not the shoulder but the elbow. ”

“ No better example of the maximum changes which the uses of support and prehension bring about can be found than in contrasting the elbow of the Sheep or other Ungulate with that of Man. Towards one or other of these types the elbows of all Mammals tend. It may be roughly stated that, when pronation and supination to the extent of a quarter of a circle are possible, an orbicular ligament appears.
The Wrist Joint, or radio-carpal articulation, lies between the radius and triangular fibro-cartilage above, and the scaphoid, semilunar, and cuneiform bones below. ”

“ The muscle that bends the elbow acts at disadvantage, and this is greatest when the arm is nearly or quite extended, as the angle of action is then least. This disadvantage is further increased by the attachment of the motive muscles near the joint. ”

“ The joints of the body always show some changes. The epiphyses are enlarged to a variable degree, resembling the epiphyses typical of human rickets. As in infants, this change is met with most commonly at the wrist joint, involving the ulna and the radius. The knee-joint is likewise often involved, especially the ends of the tibia; the elbow, ankle, and the shoulder may also show an articular swelling of the bones. About these joints hemorrhages in the subcutaneous tissues may be seen, or edema extending along the extremities. ”

“ If the subject turns out to be a good self nurse, and the nature of the fracture is such that practical apposition of the broken ends of bone may be maintained, recovery will occur in some cases.
Inflammation of the Elbow.
(Arthritis.)
Affections of this articulation other than those which are produced by traumatism are rare. This joint has wide articular surfaces, and securely joined as they are by the heavy medial and lateral ligaments (internal and external lateral ligaments) , luxation is practically impossible. When luxation does occur, irreparable injury is usually done. ”

“ Dislocation forward is much less common than the backward variety. It is produced by severe force acting from behind on the flexed elbow, the ulna being driven forward, tearing the ligaments of the joint and the muscles attached to the condyles. ”

“ In cases in which there has been recurrent attacks of locking, the ligaments become slack, the joint is wobbly, and the quadriceps is wasted. The patient himself, or the surgeon, may discover the loose body and feel it roll beneath his fingers, especially if it is lodged in the supra-patellar pouch in the knee, or on one or other side of the olecranon in the elbow. In most instances the patient has carefully observed his own symptoms, and is aware not only of the existence of the loose body, but of its erratic appearance at different parts of the joint. ”

“ Locking of joints is more often met with as a result of injuries, especially in fractures occurring in the region of the elbow. In certain injuries of the semilunar menisci of the knee, also, the joint is liable to a variety of locking, which differs, however, in many respects from that described above. ”

“ These joints can move backward and forward in one plane like a hinge, but they cannot move in a circle like the ball and socket joints. You cannot swing your forearm about on a pivot at the elbow as you can your whole arm, nor will the knee joint bend in every direction as does the joint at the hip. ”

“ Amputation, at any point between the wrist and elbow-joints, requires, in all, the same method of incision, but the nearer to the elbow the better is the stump; at the wrist the flaps are composed principally of integuments and tendons, and the cushion so formed for the bones is very inferior to one of muscle. ”

“ The tibial collateral ligament, and through it the coronary ligament, are thus gradually stretched, so that the cartilage becomes less securely anchored, and is rendered liable to be displaced towards the centre of the joint during some sudden movement which combines flexion of the knee with medial rotation of the femur upon the tibia, as, for example, in rising quickly from a squatting position, or turning rapidly and pushing off with the foot, in the course of some game such as football or tennis. ”

“ On looking at the arm-bone, which, being connected to the shoulder by a joint, has much to do with the act of climbing and striking, it will be noticed that it greatly resembles that of man in shape, but is longer, stouter, and clumsier. The joint is nearly in the shape of a rounded knob, and the corresponding depression or cup on the blade or shoulder-bone into which it fits, is an oval and concave surface, and they are kept close together by a kind of capsule which stretches from one bone to the other and encloses the joint. ”