Moving arm: Bony landmarks for goniometer alignment (lateral aspect of acromion process, lateral midline of thorax, lateral humeral epicondyle) indicated by red line and dots. Documentation: Normal range of motion in the lower extremity joints is not static but changes across the life span, from birth until the later decades of life (Table 16-3). If elbow flexion is more restricted than elbow extension, then a capsular pattern is present, and involvement of the capsule should be suspected.4,9, Grays Anatomy2 describes three articulations that interconnect the bones of the forearm: the proximal and distal radioulnar joints and the middle radioulnar union. Elbow extension ROM is limited by contact of the olecranon process of the ulna with the olecranon fossa of the humerus. At the extremes of flexion and extension, rolling motions of the ulna and radius replace the gliding motion.13,28. 16-6 End of shoulder lateral rotation ROM, showing proper hand placement for stabilizing and laterally rotating shoulder. Fig. Its not as accurate as using a goniometer but it can still give useful feedback. The ability to turn your wrist over so your hand faces up is called supination, and this motion occurs at both your elbow and at your wrist joint. Lower extremity range of motion then is discussed, followed by techniques associated with the lower extremity. This means that every degree of flexion lost is roughly equivalent to 2 degrees further extension loss in terms of functional impact. 16-11 Goniometer alignment for measurement of elbow extension. There are a few different things that can restrict forearm and elbow range of motion including: If you want help working out what is causing your elbow pain or restricting your movement, visit the elbow pain diagnosis section. During pronation and supination of the forearm, motion occurs at the proximal and distal radioulnar joints simultaneously. Remember that the muscles of your injured arm must remain relaxed, while your "good" hand does all the work to rotate . Hyperextension injuries occur when the elbow is forced backwards and bends back to far - you can find out all about the common causes, symptoms, diagnosis and treatment in the hyperextended elbow section. Physiopedia articles are best used to find the original sources of information (see the references list at the bottom of the article). Tags: Joint Range of Motion and Muscle Length Testing When the forearm is fully supinated, the radius and the ulna lie parallel to each other. Use as much assistance from the uninvolved side as needed. Fig. Fig. Keep your hand relaxed. Distally, the concave ulnar notch of the radius rolls and slides anteriorly on the ulnar head during pronation and posteriorly during supination. Normal Range of Motion Reference Values. We cover the anatomy, rehab prescription, ACL, meniscal injuries knee replacements and patellofemoral issues. End of shoulder lateral rotation ROM, demonstrating proper alignment of goniometer at end of range. and thanks so much, great site! Proximal to humeral head and distal to elbow (Fig. Supination of the forearm is limited by tension in ligamentous structures (anterior radioulnar ligament and oblique cord).25 Limitation of forearm pronation occurs as the result of contact between the bones of the forearm (radius crossing over ulna) and tension in the medial collateral ligament of the elbow and the dorsal radioulnar ligament of the distal radioulnar joint.7,21 Information regarding normal ranges of motion for forearm supination and pronation is located in Appendix B. Bony landmarks for goniometer alignment (lateral aspect of acromion process, lateral midline of thorax, lateral humeral epicondyle) indicated by red line and dots. What to Expect from Physical Therapy for Tennis Elbow. TECHNIQUES OF MEASUREMENT Ulnar border of forearm toward ulnar styloid process. Therapeutic Exercise Program for Epicondylitis. During pronation and supination of the forearm, motion occurs at the proximal and distal radioulnar joints simultaneously. Thoracic and cervical spine including kyphosis and forward head. 0 I am currently working with a patient that rests with her elbow flexed at 90 degrees, when working on PROM I am able to extend to 40-50 degrees flexion. 6 16-8 End of shoulder lateral rotation ROM, demonstrating proper alignment of goniometer at end of range. 4-1 Bony anatomy of the joints of the elbowanterior view. Patient position: Perform passive lateral rotation of the shoulder, stopping at the point of elevation of the scapula off the table. 16-1 Lateral view of passive hyperextension of the elbow demonstrated by a 3-year-old female. Shoulder Flexion General posture of the upper quarter: Proximal factors should be considered which could predispose the patient to elbow symptoms. Performing passive movement provides an estimate of ROM (see Fig. End of shoulder flexion ROM, demonstrating proper alignment of goniometer at end of range. Flex patients wrist through available ROM (see Note). 4-5). Having a range of 30o-130o of flexion allows for around 80% of normal forearm and hand function but outside this range, losing more flexion has a greater impact than losing more extension, at a ratio of around 2:1. Atencin a Clientes: 614 241-0154 | clientes@kape.mx. Fig. If you haveelbow painor an injury to your elbow, wrist, or shoulder, you may benefit from physicaltherapy (PT)to help improve your ability to use your arm normally without pain. During pronation and supination of the forearm, motion occurs at the proximal and distal radioulnar joints simultaneously. Bony landmarks for goniometer alignment (olecranon process of ulna, triquetrum, lateral midline of fifth metacarpal) indicated by red dots. The annular ligament is attached to the anterior and posterior margins of the radial notch of the ulna and encircles the radial head, holding it firmly against the radial notch (see Figs. Read scale of goniometer (see Fig. Stabilization: ROM - Evaluation of the Wrist and Elbow Range of motion (rom) Range of motion is traditionally performed three different ways: Active Range of Motion (AROM) where the athlete performs the movement under their own power Passive Range of Motion (PROM) where the examiner takes athlete through the full ROM or up until the point of pain *Anatomical position of forearm defined as 0 pronation. Elbow ROM using a goniometer; ERROR ALERT elbow extension end feel is HARD (not firm) MCCCPTAP 5.46K subscribers Subscribe 51K views 8 years ago Please note that the normal end feel for. Feedback can be delivered many ways. are doing a lot of good in the world with this helpful site, thanks again." Only gold members can continue reading. Fig. Studies of large groups of children in China, England, and Scotland revealed hyperextension of the knee in young children that disappeared at some point between the ages of 6 and 10 years.15,21 Karen, The material on this website is intended for educational information purposes only. If a person has a 10 degree contracture and loss of full knee extension with 130 degrees of knee flexion, it would be documented as -10-130. 116 Walker et al.18 Turn your hand and wrist over as far as possible, then reach your other hand over the top of your forearm. Read scale of goniometer (see Fig. **Forero et al8 (neonates). Elbow flexion range of motion (ROM) is limited by soft tissue approximation between the structures of the anterior arm and the forearm, particularly during active flexion of the joint when contact between contracting flexors of the arm and forearm stops the motion. In most cases Physiopedia articles are a secondary source and so should not be used as references. Supine with upper extremity in anatomical position (see Note), with elbow extended as far as possible, folded towel under distal humerus, proximal to humeral condyles (optional) (Fig. Patients forearm should be completely supinated at beginning of ROM, or beginning reading of goniometer. Fig. 16-13). Stationary arm: Goniometer alignment: Repeat the pronation ROM stretch 10 times. Landmarks for goniometer alignment (olecranon and styloid processes of ulna) indicated by red dots. With regards to knowledge of performance the therapist can provide descriptive information regarding the past movement (e. you moved your hand too soon) or prescriptive information offering a possible solution to be used for the next attempt (e. next time move your hand as you extend your elbow). You should feel a slight stretch as you perform each of the elbow ROM exercises; if any exercise causes an increase in pain, though, you must consult your healthcare provider. During the movements of elbow flexion and extension, the concave surface of the trochlear notch of the ulna glides along the convex trochlea of the humerus. Lateral epicondyle of humerus. Axis: Lateral view of passive hyperextension of the elbow demonstrated by a 3-year-old female. Clearly written and matches the guidance from my orthopedic surgeon. 16-3 End of shoulder flexion ROM, showing proper hand placement for stabilizing and flexing shoulder. Changes in Lower Extremity Range of Motion: Birth to 84 Years of Age Range of motion measures from the dominant and nondominant sides were compared. https://www.physio-pedia.com/index.php?title=Goniometry:_Elbow_Extension&oldid=205924. 16-5), and align goniometer accordingly (Fig. 4-2 Bony anatomy of the joints of the elbowposterior view. 1 year (n = 64) 116. Hold the bent position of your elbow for five to 10 seconds, and then release the stretch by straightening your elbow. Source: Watanabe et al. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. If someone can only extend to 40 you know they aren't getting all the way to 0 or full extension. These ligaments resist valgus and varus stresses to the joint throughout the full range of elbow motion.18,26,21 Additional stability of the elbow joint is provided by the high degree of bony congruency between the articular surfaces that make up the joint. I give my consent to Physiopedia to be in touch with me via email using the information I have provided in this form for the purpose of news, updates and marketing. 16-2 Starting position for measurement of shoulder flexion. Capsular restrictions of forearm ROM result in relatively equal deficits of forearm pronation and supination.4,9 "Posterior Elbow Dislocation" Protocol Sequence Phase I: Days 3-5 Sling immobilization progressing to extension blocking (custom splint or articulated brace) locked at 30 degrees of extension. To improve your elbow flexion ROM: To improve your ability to fully straighten your elbow, you must work on elbow extension ROM exercises. Line the moveable arm of the goniometer up with that point. To improve your ability to supinate your hand, perform the forearm supination ROM exercise. When we talk about elbow range of motion, we are looking at the amount of movement there is at the elbow joint. Record patients ROM. The distal radioulnar joint is located anatomically at the wrist, although inside a separate joint capsule. 16-5). Goniometer alignment: 16-14 Starting position for measurement of wrist flexion, demonstrating proper initial alignment of goniometer. Palpate following bony landmarks (see Fig. Stationary arm: Owing to decreased ability to stabilize trunk in these positions, great care must be taken to ensure that stationary arm of goniometer remains aligned with lateral midline of thorax, and that extension of spine does not occur. Fig. Big help. 10 Information regarding normal ROM for the elbow is located in Appendix B. END-FEEL The normal end-feel for elbow flexion is soft, because of the fact that soft tissue approximation normally limits motion. The chapter is organized so that upper extremity range of motion is discussed, followed by techniques associated with the upper extremity. Neck 4. 1. Conditions that may require you to performelbowrange of motion exercises may include: Here is a step-by-step exercise program that your physical therapist may prescribe for you to improve your elbow range of motion. You may need a pillow under the upper arm in cases of hyperextension (>0), Expected range of motion is 0 degrees in males and 10-15 degrees in females (hyperextension)[1], Get Top Tips Tuesday and The Latest Physiopedia updates, The content on or accessible through Physiopedia is for informational purposes only. Bony landmarks for goniometer alignment (olecranon process of ulna, triquetrum, lateral midline of fifth metacarpal) indicated by red dots. Because bony contact limits pronation, the normal end-feel for that motion is hard. 16-15). Out of this comes two arms, a stationary arm that extends out of the circle and a moveable arm. 16-6). Effects of an Exercise Protocol for Improving Handgrip Strength and Walking Speed on Cognitive Function in Patients with Chronic Stroke. Caution should be used in extrapolating these data to the general population because sample sizes for all studies were small. Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. Elbow Flexion: 150 degrees Pronation (rotation inward): 80 degrees Supination (rotation outward): 80 degrees Wrist Flexion: 60 degrees Extension: 60 degrees Abduction: 20 degrees Adduction: 30 degrees Metacarpophalangeal (MCP) These joints are where your finger bones meet your hand bones. Repeat elbow supination ROM for 10 repetitions. At infants elbow to maintain alignment (Fig. LIMITATIONS OF MOTION Elbow flexion and extension may be measured with the patient in the upright (standing or sitting), supine, or side-lying position. Changes in Upper Extremity Range of Motion: Birth to 19 Years of Age 16-14 Starting position for measurement of wrist flexion, demonstrating proper initial alignment of goniometer. As in the adult, follow standard procedures for measuring range of motion that have been outlined in Chapter 1. WordPress theme by UFO themes. Repalpate landmarks and confirm proper goniometric alignment at end of ROM, correcting alignment as necessary (see Note). When a stretch is felt, hold the position for five to 10 seconds. 1 year (n = 64) Technique Muscle lag is an inability to actively move a joint to its passive limit. Fig. Patient/Examiner action: 4-5). TECHNIQUES OF MEASUREMENT: UPPER EXTREMITY. The focus of this chapter is to examine differences in range of motion values and techniques for the pediatric patient compared with the adult. You may also needRELIABILITY and VALIDITY of MEASUREMENTS of RANGE of MOTION and MUSCLE LENGTH TESTING of the UPPER EXTREMITYRELIABILITY and VALIDITY of MEASUREMENT of RANGE of MOTION for the SPINE and TEMPOROMANDIBULAR JOINTRELIABILITY and VALIDITY of MEASUREMENTS of RANGE of MOTION and MUSCLE LENGTH TESTING of the LOWER EXTREMITYMEASUREMENT of RANGE of MOTION and MUSCLE LENGTH: CLINICAL RELEVANCEMUSCLE LENGTH TESTING of the UPPER EXTREMITYMUSCLE LENGTH TESTING of the LOWER EXTREMITYMEASUREMENT of RANGE of MOTION of the CERVICAL SPINE and TEMPOROMANDIBULAR JOINTMEASUREMENT of RANGE of MOTION of the THORACIC and LUMBAR SPINE Ulnar border of forearm toward ulnar styloid process. 16-9), and align goniometer accordingly (Fig. Fig. Both radial and ulnar articular surfaces glide anteriorly as the elbow flexes and posteriorly as it extends. How far you can move or stretch your elbow (range of motion) can be limited by medical conditions such as burned skin tightening up, muscle shortness, tight tendons or ligaments, bone fractures, spine and nerve disorders, arthritis, or neuromuscular diseases such as cerebral palsy. Sayed, "Hi Forearm pronation refers to your ability to turn your hand over so your palm faces the floor. Most of the studies from which data were derived were performed in healthy adults, although some data were obtained from elderly and pediatric subjects. Shoulder and elbow range of motion for the performance of activities of daily living: A systematic review. When you reach a dip, you have reached the edge of the acromion process and dropped down onto the humeral head. By accepting all cookies, you agree to our use of cookies to deliver and maintain our services and site, improve the quality of Reddit, personalize Reddit content and advertising, and measure the effectiveness of advertising. Stabilization: Elbow flexion and extension may be measured with the patient in the upright (standing or sitting), supine, or side-lying position. Using your "good" hand, grasp the wrist of your of your. See our T&C'sShoulder-Pain-Explained.com is a trading name of Wilson Health Ltd.All rights reserved. As the forearm pronates, the radius crosses anteriorly over the surface of the ulna. Although the elbow joint traditionally has been classified as a hinge joint, the hinge component occurs at the humeroulnar articulation, and the humeroradial joint is classified as a plane joint.2 Motions available at the elbow are flexion and extension, which occur in a plane oriented slightly oblique to the sagittal plane, owing to the angulation of the trochlea of the humerus.10 The axis of rotation for flexion and extension of the elbow is centered on the trochlea, except at the extremes of flexion and extension, where the axis moves anteriorly and posteriorly, respectively.13 Mouton LJ. most activities require a 100 degree arc of motion at the elbow to be functional a 30 degree loss of extension is well tolerated by most patients 50 - 50 (pronation/supination) Elbow ligaments and biomechanics primary ligaments of elbow include medial ulnar collateral ligament anterior bundle 2018 Jun; 2018(6): CD013042. 16-14). 16-6). Essentials of the study populations and the instrumentation used are included in the table. 16-10 End of elbow extension ROM, showing proper hand placement for stabilizing humerus and extending elbow. 4-4 Ligamentous reinforcement of the elbow and proximal radioulnar jointlateral view. 16-1) and then gradually resolves to adult levels. At the proximal joint, the convex radial head spins within the ring formed by the radial notch of the ulna and the annular ligament. Moving arm: Depending on your injury, you should continue the exercises for six to 12 weeks. When using a goniometer to measure elbow motion, it is much easier to get someone else to do the measuring for you its hard to try and line everything up and get an accurate yourself. Elbow extension ROM is limited by contact of the olecranon process of the ulna with the olecranon fossa of the humerus. Starting position for measurement of wrist flexion using lateral alignment technique. OSTEOKINEMATICS Cookie Notice Norkin CC, White DJ. ANATOMY Record patients ROM. Elbow pain can limit your ability to perform basic functional tasks. ARTHROKINEMATICS You 16-5), and align goniometer accordingly (Fig. Goniometer alignment: Patient/Examiner action: 4-4 Ligamentous reinforcement of the elbow and proximal radioulnar jointlateral view. Olecranon process of ulna. hb``b``g`e`X8f0>P ]` A4@:"A&^oB`l>+"-p33p.0uR!x 3#K c)WH[287;lbfaG81 RggHLdefrr\Y. WorkplaceTesting Explains Extension of the Elbow. Very informative" Marilyn, "I benefited a lot Fig. The American Academy of Orthopaedic Surgeons5 recommends that the patient be in the upright position with the shoulder flexed to 90 degrees when measurements of elbow flexion and extension are taken. Chapter 4 At the elbow joint, most functional activities require around 100 degrees of flexion/extension and rotation: This means you can still perform most daily activities even if you have lost 20o-30o of motion in any direction. 4-1 and 4-2). 2-4 weeks (n = 57) Privacy Policy. Because of greater stability provided to the humerus, the supine position is preferred for measurement of ROM. Very limited, if any, movement occurs at the middle radioulnar union. Hold the position with overpressure for five to 10 seconds, and then release the stretch. Although the elbow joint traditionally has been classified as a hinge joint, the hinge component occurs at the humeroulnar articulation, and the humeroradial joint is classified as a plane joint.2 Motions available at the elbow are flexion and extension, which occur in a plane oriented slightly oblique to the sagittal plane, owing to the angulation of the trochlea of the humerus.10 The axis of rotation for flexion and extension of the elbow is centered on the trochlea, except at the extremes of flexion and extension, where the axis moves anteriorly and posteriorly, respectively.13, During the movements of elbow flexion and extension, the concave surface of the trochlear notch of the ulna glides along the convex trochlea of the humerus. Alternative patient position: Repalpate landmarks and confirm proper goniometric alignment at end of ROM, correcting alignment as necessary (see Note). Viktoria, "This is a great site. Med Sci Monit. Observation. 16-12 Starting position for measurement of wrist flexion using lateral alignment technique. Gently straighten your arm fully until you feel a stretch in the elbow. Althoughtherapeutic modalitieslike electrical stimulation and ultrasound may be used during your elbow rehab, exercise should be the mainstay of your physical therapy program. Grab your wrist, and turn your arm further into a pronated position. Functional range of motion refers to the amount of movement needed to do normal activities of daily life such as eating, drinking and brushing your hair. Landmarks for goniometer alignment (olecranon and styloid processes of ulna) indicated by red dots. Component of supination. By rejecting non-essential cookies, Reddit may still use certain cookies to ensure the proper functionality of our platform. Moving arm: Table 16-2 Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy. AGE Anatomical Movement Elbow extension Testing position Patient is supine with the hand supinated. 16-3 End of shoulder flexion ROM, showing proper hand placement for stabilizing and flexing shoulder. We have not included techniques for every joint of the upper extremity, because the focus of the chapter is to examine changes in the pediatric population compared with the adult. Izabela, "I am a massage The focus of this chapter is to examine differences in range of motion values and techniques for the pediatric patient compared with the adult. Return limb to starting position. Rehabilitation of the overhead athlete's elbow. Drews et al7 (neonates). Ligamentous reinforcement of the elbow and proximal radioulnar jointlateral view. 3. Record patients ROM. Most functional activities require a fairly large amount of elbow flexion ROM (Figs. 16-11 Goniometer alignment for measurement of elbow extension. Im overthinking it because its both flexion/extension at the same time. Determine whether elbow is extended as far as possible, providing pressure across the elbow in the direction of extension (Fig. 120 Switch sides for your left elbow. END-FEEL The chapter concludes with special tests that are specific to the pediatric population with focus on alignment changes through development. 229 0 obj <>stream 4-5 Anatomy of the proximal radioulnar joint. Bony landmarks for goniometer alignment (lateral aspect of acromion process, lateral midline of thorax, lateral humeral epicondyle) indicated by red line and dots. Because bony contact limits pronation, the normal end-feel for that motion is hard. End of elbow extension ROM, showing proper hand placement for stabilizing humerus and extending elbow. Palpate following bony landmarks (shown in Fig. 16-11). Fig. If you want to learn more about how I treat ACL's or the knee in general, then you can check out our all online knee seminar at www.onlinekneeseminar.com and let me know what you think. FOREARM JOINTS See Chapter 5. If elbow ROM is not full, the restrictions should be assessed for the presence of a capsular pattern. 16-2). End of shoulder flexion ROM, showing proper hand placement for stabilizing and flexing shoulder. Range of motion of many upper extremity joints appears to differ in infants and young children compared with adults (Table 16-1). 5. Performing passive movement provides an estimate of ROM (see Fig. Failure to exercise such care will result in errors in measurement. Fig. Fig. Cochrane Database Syst Rev. Anatomy of the proximal radioulnar joint. 16-6). Normal elbow range of motion refers to how much the elbow bends, straightens and twists. Return limb to starting position. Confirmation of alignment: Perform passive lateral rotation of the shoulder, stopping at the point of elevation of the scapula off the table. The range of elbow flexion tends to be greater when the joint is moved passively because there is less interference by contracting muscle bulk. Palpate following bony landmarks (shown in Fig. The radial head spins anteriorly during pronation and posteriorly during supination. doi:10.1002/14651858.CD013042, Javed M, Mustafa S, Boyle S, Scott F. Elbow pain: a guide to assessment and management in primary care. Supportive sitting for lateral alignment. Using a goniometer is the most accurate way to measure elbow range of motion in all directions. Forearm (Pronation - Supination) Left Left It takes times for elbow range of motion to improve so stick with it, and only measure your range once or twice a week theres no need to do it more often. 4-4) collateral ligaments, respectively. Axis: To perform the forearm pronation ROM stretch: Once you improve your elbow ROM with these exercises, your physical therapist may then prescribe strengthening exercises. Documentation: 1173185. endstream endobj startxref Elbow range of motion exercises may be one component of your PT program. Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window)Click to share on Google+ (Opens in new window) Return wrist to neutral position. 16-6 End of shoulder lateral rotation ROM, showing proper hand placement for stabilizing and laterally rotating shoulder. Therefore, motions of the elbow joint should be measured with the shoulder maintained in the anatomical position. Ligamentous reinforcement of the elbow and proximal radioulnar jointmedial view. 16-7 Starting position for measurement of shoulder lateral rotation, demonstrating proper initial alignment of goniometer. )cz+}+7TRExDwGneyI\y9iv~ 6> Very useful. Bony landmarks for goniometer alignment (olecranon process of ulna, triquetrum, lateral midline of fifth metacarpal) indicated by red dots. You may want to rest your upper arm on a pillow or folded towel for comfort. There are established ranges that doctors consider normal for various joints in the body. %%EOF Flex patients shoulder through available range of motion (ROM), avoiding extension of spine. At the proximal joint, the convex radial head spins within the ring formed by the radial notch of the ulna and the annular ligament. A typical PT exercise program for an elbow injury includesgaining ROM first and then building strength in that new ROM. Elbow extension ROM is limited by contact of the olecranon process of the ulna with the olecranon fossa of the humerus.10 Information regarding normal ROM for the elbow is located in Appendix B. 4-3 Ligamentous reinforcement of the elbow and proximal radioulnar jointmedial view. Supine with shoulder abducted to 90 degrees, elbow flexed to 90 degrees, forearm pronated (Fig. If elbow flexion is more restricted than elbow extension, then a capsular pattern is present, and involvement of the capsule should be suspected.4,9 Landmarks for goniometer alignment (olecranon and styloid processes of ulna) indicated by red dots. 16-8). Perpendicular to floor. Capsular restrictions of forearm ROM result in relatively equal deficits of forearm pronation and supination.4,9. How to do this motion: You'll stand or sit with your elbow bent at 90 degrees, tucked in at your side. Starting position for measurement of shoulder lateral rotation. Bony landmarks for goniometer alignment (lateral aspect of acromion process, lateral humeral epicondyle, radial styloid process) indicated by red dots. Elbow flexion range of motion (ROM) is limited by soft tissue approximation between the structures of the anterior arm and the forearm, particularly during active flexion of the joint when contact between contracting flexors of the arm and forearm stops the motion. How do you describe range of motion in nursing? Seated or side-lying; towel not needed; goniometer alignment remains the same. FA Davis; 2016 Nov 18. Grays Anatomy2 describes three articulations that interconnect the bones of the forearm: the proximal and distal radioulnar joints and the middle radioulnar union. The humeroradial joint consists of the articulation between the convex capitulum of the distal humerus and the slightly concave proximal surface of the radial head. Roach and Miles.14 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles.