Anatomy, surgical approaches and biomechanics of the elbow

The elbow is a complex, trochoginglymoid joint consisting of three articulations with close relationships to the surrounding soft tissue envelope. It facilitates positioning of the hand in space, acts as a fulcrum for the forearm lever and as a load-carrying joint. In this article, we consider the anatomy of the elbow including the osteology, the surrounding muscles and the neurovascular structures. Surgery around the elbow may be required in the management of degenerative, inflammatory and traumatic conditions – the choice of surgical approach depends on the pathology. We aim to familiarize the reader with a number of surgical approaches to the elbow including posterior, medial, lateral and anterior approaches. We consider the indications for each and the possible pitfalls. This article provides an introduction to the biomechanics of the elbow, in particular an understanding how both the mobility and the stability required for recreational and professional activities is achieved. Elbow biomechanics can be considered in terms of motion, stability and force transmission. An understanding of the anatomy and biomechanics of the elbow has guided the design and development of both replacement prostheses and other surgical implants.