Radial Fossa

The articular surfaces of the elbow are contained within the joint capsule, which also encloses non-articular surfaces, including the coronoid, radial fossa and olecranon fossae. It attaches just distal to the coronoid and olecranon processes. The whole of the radial head is within the capsule. 

The joint capsule invests the entire elbow. Anteriorly, it is attached to the humeral shaft just above the coronoid and radial fossae, to the anterior aspect of the coronoid process and to the annular ligament... 

The bony structures of the elbow are the distal end of the humerus and the proximal ends of the radius and ulna. The elbow joint complex allows two degrees of freedom in motion flexion/extension and pronation/supination. The elbow joint complex is three separate synovial articulations. The humeral-ulnar joint is the articulation between the trochlea of the distal radius and the trochlear fossa of the proximal ulna. The humero-radial joint is formed by the articulation between the capitulum of the distal humerus and the head of the radius. The proximal radioulnar joint is formed by the head of the radius and the radial notch of the proximal ulna. 

Metaphyseal fractures can be classified according to mechanism of injury. The majority of injuries occur with the elbow in extension, the olecranon locked in the olecranon fossa and the maximum stress developed in the proximal metaphyseal region leading to fracture. When a valgus stress is applied, there may be asso ciated compression fractures of the radial neck and avulsion of the medial epicondyle. Varus stress is associated with radial head subluxation. 

In the subcutaneous tissues lie some of the superficial blood vessels. Palpate veins over the back of the hand or in the arrtecnbital fossa. Occlusion with a tourniquet makes the veins mote prominent. Note the springy feel. Palpate the radial and carotid arteries. Note that they are much firmer than unoccluded veins. Palpate the back for any abnormal tensions in the subcutaneous tissues. This may indicate contiactuie or fibrous changes of the fascia. 

Fig. 8.13a,b. Median nerve and brachial artery. Longitudinal gray-scale (a) and color Doppler (b) 12-5 MHz US images over the antecubital fossa demonstrate the normal appearance of the median nerve (white arrows in a) and the brachial artery (open arrows in b). Both lie superficial to the brachialis muscle (hr). Note the humeral capitellum (HC) and the radial head (RH). The inserts at the upper left side of the figures indicate probe positioning... 

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