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Y1 TP2 Musculoskeletal System > 8. Elbow And Forearm > Flashcards

8. Elbow And Forearm Flashcards

1
Q

3 JOINTS OF FOREARM:

A
  • Elbow
    • Proximal radio-ulnar
    • Distal radio-ulnar
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2
Q

Bones of forearm

A
  • Distal Humerus
    • Radius
    • Ulna
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3
Q

Elbow joint

3 articulations

A
  • Humero- radial articualtion = radius and humerus
    • Proximal radio – ulnar joint = Radial head and inside ulna
    • Humero –ulnar artciulation
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4
Q

Capitulum – smaller lateral surface

A

• Radial heads fits into this
• Radial fossa above
On distal end of humerus

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5
Q

Trochlear

A

• Articualr surface around ulna
• Coronaoid fossa above
On distal end of humerus

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6
Q

Fossa

A

Fossas – small depression allowing bony protrusions to slot into them

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7
Q

Olecranon

A

Proximal ulna - olecranon process fits into eoecronon fossa

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8
Q

Coronoid process

A

• Anterior part of ulna

Occupies coronoid fossa

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9
Q

Proximal radius

A
  • Head = cup like shape articulating with capitulum

* Inner side of radial head articulates iwht ulna on radial notch = proximal radio ulna joint

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10
Q

Hummer ulnar articulatiuon

A
  • Trochlear notch ulna

* Trochlea of humerus

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11
Q

Humero radial articualtiuon

A
  • Head radius

* Capitulum humerus

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12
Q

Proximal radio ulnar articualtion

A
  • Head radius

* Radial notch ulna

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13
Q

Flexion of the elbow

A
  • humerus coronoid fossa + ulna coronoid process

* humerus radial fossa + radius head

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14
Q
A

• humerus olecranon fossa +ulna olecranon

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15
Q

Joint capsule of elbow joint lines the

A
  • radial fossa
  • coronoid fossa
  • olecranon fossa
  • medialsurface trochlea
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16
Q

Joint capsule of elbow joint - structure

A

• Outer = fibrous
• Inner = synovial
Envelopes top of the radius

Fibrous
• Strongest around the sign
• Weakest in the middle

Fat pads
• Where fossa are that receive radial head and corocid process of ulna

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17
Q

Joint capsule of elbow joint purpose

A

Purpose = provide protective seal around the joint and structure to joint and synovial fluid

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18
Q

3 ligaments of elbow joint

A

—> Strengthen the capsule medially and laterally

  • Ulnar collateral ligament
  • Radial collateral ligament
  • Annular ligament = wraps around radial head – jolds radius in psotion but allows movement in supination and pronation
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19
Q

Flexors at elbow joint

A

• Brachialis
• Biceps brachii
Brachioradialis

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20
Q

Extensors At elbow joint

A

• Triceps brachii

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21
Q

2 bones of forearm

A

Radius

ulna

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22
Q

Radius

A
  • Thin at top
    • Widens further down
    • Only distal end or radius articulates with the wrist
    • Styloid process at end or radius – near where you feel pulse
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23
Q

Ulna

A
  • Longer than radius
    • Wide at top
    • Thin further down
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24
Q

Proximal radio-ulnar joint

A
  • head radius + radial notch ulna
  • anular ligament holds it in place
  • articular cavity continuous with that of the elbow joint
    • Articular disc off the end of radius so ulna articulates with it
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25
Q

Distal radio-ulnarjoint

A
  • head ulna + ulnar notch radius

* articular disc

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26
Q

Supination

A

• Radius rotates laterally around its longitudinal axis Dorsum of the hand faces posteriorly Palm faces anteriorly

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27
Q

Pronation

A

• Radius rotates medially around its longitudinal axis Dorsum of the hand faces anteriorly Palm faces posteriorly

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28
Q

2 movements of radial ulnar joint

A

Supination

Pronation

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29
Q

Supination

2 muscles

A
  • Supinator (when resistance is absent)

* Biceps brachii

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30
Q

Pronation

2 muscles

A
  • Pronator quadratus (primarily) - base of forearm

* Pronator teres (secondarily)

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31
Q

Anterior compartment of forearm

A
  • Contains all of the flexors
    • Flex the wrist and digits
    • Pronate the hand
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32
Q

posterior compartment of forearm posterior

A
  • Extend the wrist and digits

* Supinate the hand

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33
Q

Anterior compartment contents

A

• Deep to the skin is

(1) subcutaneoustissue (superficial fascia) containing fat 
(2) deep fascia compartmentalizing muscles

Deep fascia of the forearm: antebrachial fascia
• extensor retinaculum
• flexor retinaculum

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34
Q

The flexor–pronator muscles are arranged in three layers:

A

Superficial
Intermediate
Deep

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35
Q

Superificial layer

A

Lateral (radial head) to medial

  • pronator teres
  • flexor carpi radialis
  • palmaris longus
  • flexor carpi ulnaris – supplied by ulna nerve

From lateral to medial – more input for ulna nerve
Other 3 All supply mainly from median nerve

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36
Q

Intermediate layer

A 
• Flexor digitorum superficialis 
2 heads 
	• Radial head
	• Humero ulnar head
Supplied by median nerve 
Controls all of the fingers but not the thumb
37
Q

Deep layer

A

Superficial to deep
• Flexor digitorum profundus – dual innervation, laterally controlled by median nerve and medial side is innervated by ulna nerve)
• Flexor pollici longus – controls the thumb
• Pronator quadratis

38
Q

Cubital fossa boundaries

A
  • Pronator teres – medial
    • Brachio radialis – lateral
    • Between lateral and medial epicondyle = base
39
Q

Contents of the cubital fossa

A 
Lateral to medial 
	• Tendon of biceps brachii
	• Brachial artery 
	• Median nerve 
Radial nerve is also passing through but hidden under brachoradialis

Ulna nerve – passes behind medial epichondyle

Superior surface of cbital fossa
• Bicepital aponeurosis

40
Q

Venipuncture in Cubital Fossa

A 
The cubital fossa is the common site for 
• Blood sampling 
• Blood transfusion 
• Intravenousinjections
• Introduction of cardiac catheters

because of the prominence and accessibility of veins

41
Q

Arteries of the forearm

A

Apex of antecubital fossa
• Brachial artery splits into ulna and radial artery at antecubital fossa
• Ulna artery splits into interosseous artery and deep penetrating arteries
• Ulnar and radial arteries form deep and suoerficial palmar arch

42
Q

Superifical veins

A
  • Cephaoilic – outside of upper arm
    • Basilic vein = inside of upper arm
    • Join by medial cubital veins
43
Q

2 Deep veins of fore curl

A
  • Radial veins
    • ulnar veins
    • Connect to a deep palmar arch from distal part of hand up into forearm and upper limb
44
Q

Superficial lymphatic vessels

A
  • From lymphatic plexuses in the skin of the fingers, palm, and dorsum of the hand
    • Ascend mostly with the superficial veins, such as the cephalic and basilic veins.
    • Some vessels accompanying the basilic vein enter the cubital lymph nodes, located proximal to the medial epicondyle and medial to the basilic vein. Efferent vessels from these lymph nodes terminate in the humeral (lateral) axillary lymph nodes
    • Most superficial lymphatic vessels accompanying the cephalic vein enter the apical axillary lymph nodes and deltopectoral lymph nodes.
45
Q

Deep lymphatic vessels

A
  • Less numerous than superficial vessels
    • Accompany the major deep veins in the upper limb (radial, ulnar, and brachial)
    • Terminate in the humeral axillary lymph nodes.
    • Drain lymph from the joint capsules, periosteum, tendons, nerves, and muscles
46
Q

Ulnar nerve

A

Supplies only one and a half muscles:
• the Flexor Carpi Ulnaris (FCU)
• the ulnar part of the Flexor digitorum profundus (FDP)

47
Q

Median nerve

A

Principal nerve of the anterior compartment of the forearm

Supplies muscular branches directly to the muscles of the
• superficial and intermediate layers of forearm flexors (except the FCU)
• deep muscles (except for the medial [ulnar] half of the FDP)
via its branch, the anterior interosseous nerve.

48
Q

Radial nerve

A
  • Deep branch: motor –> Muscles post. compartment forearm

* Superficial branch:sensory —> Skin dorsum of the hand and fingers

49
Q

3 examples of Traumatic injuries of elbow

A
  • Supracondylar
  • Elbow dislocation
  • Pulled elbow
50
Q

4 examples of Inflammatory disease in elbow

A
  • Osteoarthritis
  • Rheumatoid arthritis
  • Tendinopathy
  • Bursitis
51
Q

Fractures of the elbow:

A
  • Distal humerus
    • Supracondylar
    • Intercondylar
    • Medial or lateral (epi)condyle
      • Proximal radius
        • Radial head
        • Radial neck
    • Proximal shaft
      • Proximal ulna
        • Olecranon
    • Processus coronoideus
    • Proximal ulna shaft
52
Q

Supracondylar fracture of distal humerus - cause

A

• Supracondylar = most common due to fall with oustretched hands

53
Q

Supracondylar humerus fractures

A
  • Most common traumatic injury of the elbow
  • Typical age 5-7 years, fall on outstretched arm

• Risk of neurovascular injury(especially type 3)
• Gartland classification –degree of displacement
Type 1: undisplaced = fracture is place
Type 2: posterior cortex intact = one part intact
Type 3: displaced, no contact = 2 bones seperated

54
Q

Extension fall

A

• Extension = falling on outstretched hand

55
Q

Flexion fall

A

• Flexion = falling on point of elbow

56
Q

Assessing Supracondylar humerus fractures

A

Asses for neurovascular injury:

  • Median nerve > radial nerve > ulnar nerve (pin fixation) – neuropraxia AIN
  • Brachial artery spasm/thrombus/tear: Pulseless warm or cold hand
  • Volkmann’s (ischemic) contracture

Vascularity
• Pulse
• Capillary return filling time
• Neurology – ulnar, median (most commonly affected), radial

57
Q

Pulseless warm hand

A
  • Can’t feel pulse but hand is warm

* Reduce fracture and pulse should return

58
Q

Cold hand

A
  • Can’t feel pulse after reducing fracture
    • Open it
    • Hand is cold and white
59
Q
  • Volkmann’s (ischemic) contracture
A

• Soft tissue injury = increased pressure in forarm = compartment syndrome

60
Q

Supracondylar humerus fracture Treatment

A

Type 1 = simple fracture with cast
Type 2 = cast
Type 3 fix gap using wires

61
Q

Supracondylar humerus fracture Complications

A

acute
• Depedning on what injury is
long term
• Malunion = growth disturbance: varus or valgus deformity
• If not treated properly deformity round elbow

62
Q

Pulled elbow (‘nursemaid’s elbow”)

A

= subluxation of radial head due to longitudinal traction in very young child with ligament laxity. (common 2-4 years)
• Common in very young childtren
• Slipping of radial head
• Annular ligament = attatches radial head to ulna
• Rotation used to put radial head in place

63
Q

Elbow dislocation

Mechanism of injury:

A
  • axial loading
  • supination/externalrotation of the forearm
  • valgus posterolateral force
64
Q

“terrible triad injury”

A
  • Elbow dislocation
  • LUCL tear
  • Radial head fracture and coronoid tip fracture
65
Q

Elbow dislocation Treatment

Nonoperative

A

• closed reduction and splinting at least 90° for 5-10 days, early physiotherapy
indications
• acute simple stable dislocations
• recurrent instability after simple dislocations is rare (<1-2% of dislocations)

66
Q

Elbow dislocation Treatment

Operative

A

• ORIF (coronoid, radial head, olecranon), LCL repair, +/- MCL repair
indications
• acute complex elbow dislocations
• persistent instability after reduction = elbow requires >50-60° to maintain reduction
• reduction cannot be performed closed( often due to entrapped soft tissue or osteochondral fragments)

67
Q

Radial head and neck fractures

A
  • Fall on outstretched hand(ext+pron)
  • Pain, swelling and limited ROM
  • Mason classification
    • Type 1 = in place
    • Type 2 = partially displace
    • Type 3 = injur
68
Q

Radial head and neck fractures Associated injuries

A

—> 35% have associated soft tissue or skeletal injuries including ligamentous injury
• lateral collateral ligament (LCL) injury
• medial collateral ligament (MCL) injury
• combined LCL/MCL

69
Q

Radial head and neck fractures treatment

Non-operative(undisplaced)

A
  • Short immobilization followed with Physiotherapy

* Good outcome

70
Q

Radial head and neck fractures treatment

Operative (displaced/associated injuries)

A

• ORIF – Radial head replacement

71
Q

2 types of Arthritis of the elbow

A
  • Osteoarthritis

* Rheumatoid arthritis

72
Q

Oa

A
  • Uncommon primary OA, mostly secondary/ associated with traumatic degeneration or inflammatory disease such as Rheumatoid arthritis
  • Clinical findings: crepitations, swelling, pain, locking (loose body)
73
Q

Rheumatoid arthritis

A 
– 1%of the population 
– Peak age onset 40-50y 
– Female > male
 – Autoimmune disease 
– Pannus formation (inflamed synovial cell proliferation)
74
Q

Arthritis of the elbow - Rheumatoid arthritis

A
  • MCP joints of the hands / PIP joints of the fingers Feet – metacarpal joint
    • Cervical spine
    • Large joint
    • Associated organ infiltration: eyes, skin, lungs, heart, kidneys
75
Q

Arthritis of the elbow - Rheumatoid arthritis

On scans

A

– Loss of jointspace
– Osteopenia
– Bone erosion
– Subluxation/deformity

76
Q

Arthritis of the elbow - Rheumatoid arthritis

Treatment

A

medical/ corticoinjections /joint replacement

77
Q

Tendinopathy

A

Inflaamtion of tendons around elbow

78
Q

Tennis elbow

A

• “tennis elbow” = lateral epicondylitis
• Extensor tendonipathy ECRB- extensor carpus radialis braevis : stabilizes wrist with elbow extension  overuse/inflammation
Self-limiting < 1y Activity modification

79
Q

Golfers elbow

A
  • = medial epicondylitis
  • Flexor tendinopathy
  • Repetitive valgus stress : FCR + pronator teres overuse/inflammation
  • Self-limiting < 1y Activity modification
80
Q

Bursitis causes

A
  • Trauma
  • Prolonged pressure
  • Infection
  • Medical conditions
81
Q

Bursitis treatment

A
  • NSAID
  • Aspiration/corticoinjection
  • Surgical removal
  • Elbow pads
  • Surgical drainage /AB (infectious)
82
Q

Neurologica disorders of the elbow

A

Cubital tunnel syndrome
= ulnar nerve entrapment

Entrapment between two heads of FCU = tendinous arch  enter cubital tunnel

83
Q

Neurologica disorders of the elbow

Causes

A
  • Prolonged bent position
  • Complication of fracture/dislocation (malunion)
  • Bone spurs/osteophytes
  • Swelling/cyst/tumour
84
Q

Neurologica disorders of the elbow

Symptoms

A
  • Paraesthesia
  • Muscles weakness

Clinical examination/diagnosis:
• Tinel’s test – tapping aorund nerve cause tingling
• Nerve conduction study

85
Q

Neurologica disorders of the elbow

Treatment

A
  • NSAID
  • Bracing in extension at night
  • Nerve sliding exercises
  • Surgical release/transposition
86
Q

Cubital tunnel

A

Epicondyleovecranon ligament / Osborne bone
Lateral - olecranon process of ulna
medial - medial epicondyce of humerus:

87
Q

Coles fracture

A

Wrist and hand displaced posteriorly to fracture

Dinner forK deformity

88
Q

Median nerve palsy

A

Unable to abduct or oppose thumb

Paralysis of thenar muscles

Y1 TP2 Musculoskeletal System (10 decks)

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