Arm & Cubital Fossa Flashcards
Osteology of Scapula & Humerus
Osteology of Elbow Joint
Elbow Joint Capsule
Flexion-Extension of Forearm: caused by ____ notch of ulna moves against _____ of humerus
Flexion-Extension of Forearm: caused by trochlear notch of ulna moves against trochlea of humerus
Supination-Pronation of Forearm: head of ____ swivels inside _____ ligament against capitulum and _____ notch of ulna
Supination-Pronation of Forearm: head of radius swivels inside annular ligament against capitulum and radial notch of ulna
Humeral shaft fracture:
- Transverse fracture: Proximal fragment is pulled _____ by (deltoid)
Humeral shaft fracture:
- Transverse fracture: Proximal fragment is pulled laterally by (deltoid)
Humeral shaft fracture:
- Spiral fracture: may result in _______ (overriding end)
Humeral shaft fracture:
- Spiral fracture: may result in shortening (overriding ends of bones)
Humeral shaft fracture: results in _____ nerve injury (in radial groove)
Humeral shaft fracture: results in radial nerve injury (in radial groove)
Surgical neck fracture: common in ______ and causes ____ nerve injury
Surgical neck fracture: common in elderly and causes axillary nerve injury
Distal humerus fracture can cause ____ nerve injury (intercondylar or supercondylar fracture)
Distal humerus fracture can cause median nerve injury (intercondylar or supercondylar fracture)
Elbow dislocation: can result in the “terrible triad” injury
1. _____ dislocation
2. ____ head fracture
3. ______ process fracture
Elbow dislocation: can result in the “terrible triad” injury
1. elbow dislocation
2. radial head fracture
3. coronoid process fracture
Characteristic of elbow dislocation in 80-90% is the radius and ulna dislocated (anteriorly/posteriorly) to humerus
Characteristic of elbow dislocation in 80-90% is the radius and ulna dislocated posteriorly to humerus
Risk of _____ nerve injury (most common) and ____ nerve injury in elbow dislocation
Risk of ulnar nerve injury (most common) and median nerve injury in elbow dislocation
Nursemaid’s elbow is also known as ____ and _____ of the ____
Nursemaid’s elbow is also known as subluxation and dislocation of the radius
Characteristic of subluxation and dislocation of radius: muscle pulls radial head (inferiorly or superiorly); tenderness due to pinched ______ ligament by radial head against ______
Characteristic of subluxation and dislocation of radius: muscle pulls radial head superiorly; tenderness due to pinched annular ligament by radial head against capitulum
Anterior compartment of upper limb fascia contains mostly (flexors/extensors) innervated by ______ nerve
Anterior compartment of upper limb fascia contains mostly flexors innervated by musculocutaneous nerve
Posterior compartment of upper limb fascia contains mostly (flexors/extensors) innervated by ______ nerve
Posterior compartment of upper limb fascia contains mostly extensors innervated by radial nerve
Compartment syndrome: increased _____ in the muscle ______
Compartment syndrome: increased pressure in the muscle compartment
Upper arm muscles (5)
- Biceps brachii
- Coracobrachialis
- Brachialis
- Triceps brachii
- Anconeus
Identify this muscle
biceps brachii
Biceps brachii
Origin:
Insertion:
Action:
Innervation:
Biceps brachii
Origin: Short head - coracoid process
Long head - supraglenoid tubercle
Insertion: Radial tuberosity
Action: Flexion + supination of the forearm (from a prone position)
Innervation: Musculocutaneous nerve (C5-C7)
Identify this muscle
Coracobrachialis
Identify this muscle
brachialis
Coracobrachialis
Origin:
Insertion:
Action:
Innervation:
Origin: Coracoid process
Insertion: Middle 1/3 of medial humerus
Action: Flex and adduct arm at shoulder joint
Innervation: Musculocutaneous nerve (C5-C7)
Brachialis
Origin:
Insertion:
Action:
Innervation:
Origin: Distal ½ of anterior surface of humerus
Insertion: Coronoid process of ulna
Action: Flexion of the forearm at the elbow joint
Innervation: Musculocutaneous nerve (C5-C7)
Identify this muscle
triceps brachii
Triceps brachii
Origin:
Insertion:
Action:
Innervation:
Origin: Lateral + long head originates superior to radial groove; medial head is inferior to the radial groove
Insertion: Olecranon process
Action: Primarily extend forearm at elbow joint; long head resists inferior dislocation of humerus during adduction;
Innervation: Radial nerve (C5-T1)
Identify this muscle
Anconeus
Anconeus
Origin:
Insertion:
Action:
Innervation:
Origin: Lateral epicondyle of humerus
Insertion: Lateral surface of olecranon process + superior part of posterior ulna
Action: Forearm extension, stabilizes elbow
Innervation: Radial nerve (C5-T1)
What is the injury?
Location of injury: “wear and tear” over the intertubercular sulcus; “popeye deformity”
Rupture of tendon of Long Head of Biceps Brachii:
What is the injury?
Symptoms: audible snap/pop, bulge in center of distal anterior arm pain and tenderness at shoulder
Common in males 40-60yo
Rupture of tendon of Long Head of Biceps Brachii:
How is the muscle displaced in rupture of tendon of long head of biceps brachii injury?
distally displaced
What is the injury: audible snap/pop, bulge in center of proximal anterior arm, pain at elbow; palpable soft mass proximally displaced
Rupture of distal biceps brachii tendon: rare 3% of ruptures
What is the injury?
Location of injury: torn from radial tuberosity, can be an avulsion fracture
Rupture of distal biceps brachii tendon: rare 3% of ruptures
How is the muscle displaced in rupture of tendon of distal biceps brachii tendon injury?
Proximally displaced
Ischemia of Elbow and Forearm “Volkmann’s Contracture”:
sudden ______ artery occlusion/laceration; collateral pathways only help in gradual and ______ occlusion
Ischemia of Elbow and Forearm “Volkmann’s Contracture”:
sudden brachial artery occlusion/laceration; collateral pathways only help in gradual and partial occlusion
Muscles can tolerate up to ___ hours of ischemia; fibrous tissue replaces necrotic tissue,
Muscles can tolerate up to 6 hours of ischemia; fibrous tissue replaces necrotic tissue,
Result of ischemia to brachial artery: ____ of fingers + wrist; loss of hand _____
Result of ischemia to brachial artery: contraction of fingers + wrist; loss of hand power
Musculocutaneous nerve pathway:
- Pierces ________
- Travels distally between _____ brachii + _______
- Emerges _____ to biceps as the lateral ______ nerve of the forearm
Musculocutaneous nerve pathway:
- Pierces coracobrachialis
- Travels distally between biceps brachii + brachialis
- Emerges lateral to biceps as the lateral cutaneous nerve of the forearm
Radial nerve is located in the ______ interval
Radial nerve is located in the TRIANGULAR INTERVAL
Injury to musclulocutaneous nerve results in:
- _____ flexion at _______ joint
- _____ flexion and ______ at ______ joint
- Loss of sensation in the _____ aspect of the forearm
Injury to musclulocutaneous nerve results in:
- Weak flexion at glenohumeral joint
- Weak flexion and supination at elbow joint
- Loss of sensation in the lateral aspect of the forearm
Radial nerve pathway:
- lies _____ to brachial artery, and ____ to humerus.
- Descends inferolaterally with ____ artery of the arm in the _____ groove of the humerus
- Moves into the forearm _____ to the ____ epicondyle
Radial nerve pathway:
- lies posterior to brachial artery, and medially to humerus.
- Descends inferolaterally with deep artery of the arm in the radial groove of the humerus
- Moves into the forearm anterior to the lateral epicondyle
Injury to the radial nerve superior to the origin of the triceps results in:
______ of all muscles of supplied by the radial nerve
Injury to the radial nerve superior to the origin of the triceps results in:
Paralysis of all muscles of supplied by the radial nerve
What are the muscles supplied by radial nerve?
- triceps
- brachioradialis
- supinator
- wrist + fingers extensors
Injury in the radial groove results in:
paralysis of ____ head of triceps and all ______ muscles of forearm _____to the site of nerve lesion;
- elbow extension _____ but not lost (lateral +long heads not affected)
Injury in the radial groove results in:
paralysis of medial head of triceps and all posterior muscles of forearm distal to the site of nerve lesion;
- elbow extension weakened but not lost (lateral +long heads not affected)
Median nerve pathway:
Runs ____ to the ____ artery; in the middle of the arm is runs medial to brachial artery
Median nerve pathway:
Runs laterally to the brachial artery; in the middle of the arm it runs medial to brachial artery
Ulnar nerve pathway:
Proximally runs medial to brachial artery; Passes _____ to _____epicondyle into the forearm.
Ulnar nerve pathway:
Proximally runs medial to brachial artery; Passes posterior to medial epicondyle into the forearm.
Brachial artery
Elbow Anastomosis
Superficial Cubital Fossa:
Deep View of Cubital Fossa:
Tendon of Biceps brachii
Brachial Artery
Median Nerve
What protects the brachial artery and median nerve during venipuncture?
Bicipital aponeurosis
