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Anatomy (Karen) > Bones & Joints of the Upper Limb > Flashcards

Bones & Joints of the Upper Limb Flashcards

1
Q

What are the features of a synovial joint?

A
  • articular cartilage (avascular & aneural)
  • fibrous capsule (collagen, elastin, fibroblasts)
    • may be reinforced by stabilizer muscles
    • strengthened by intrinsic ligaments
    • extrinsic/accessory ligaments may be primary stabilizers
  • synovial membrane lining non-articular surfaces
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2
Q

What is haemarthrosis?

A

blood in a joint; caused by rupture of synovium which is highly vascularized

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3
Q

Effusion of a synovial joint refers to

A

overproduction of synovial fluid

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4
Q

Why do ligaments repair slowly?

A

Poor blood supply

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5
Q

What is the function of intracapsular fat pads?

A

spreading of synovial fluid with joint movement

fat pads are extrasynovial

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6
Q

What are discs/menisci?

A
  • act as schock absorbers and weight-bearers
  • have nerve & blood supply to the outer 3rd
  • typically found in knee (menisci)
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7
Q

What are bursae?

A
  • sacs containing synovial fluid
  • common wherever there is friction (eg patella, olecranon)
  • **may or may not communicate with the joint cavity **
  • can become inflamed
    • eg olecranon bursitis
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8
Q

What are the joints of the shoulder complex?

A
  • sternoclavicular & acromioclavicular
  • glenohumeral
  • scapulothoracic (physiological/functional joint of scapula on posterior chest wall via fatty tissue)
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9
Q

Long bones commence ossification

A

in utero @ 8 weeks (embryo –> foetus)

epiphyses generally appear after birth but can appear in utero in longer bones

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10
Q

Fracture of the surgical neck of the humerus endangers

A

axillary nerve

common in elderly

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11
Q

Fracture of the mid-shaft of the humerus endangers

A

radial nerve

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12
Q

Fracture of the supracondylar region of the humerus endangers

A

median nerve, brachial artery

common in children

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13
Q

The anatomical neck of the humerus serves as

A

attachment site of the shoulder capsule

except medially where it drops down further (+ROM)

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14
Q

What lies between the tuberosities of the humerus?

A

bicipital/intertubercular groove lies between greater and lesser tuberosities of the humerus

this is hte groove for the long head of the biceps tendon

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15
Q

Where is the most common site of clavicular fracture?

A

Where the lateral concave 1/3rd changes to the medial convex 2/3rds

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16
Q

Injury to the clavicle limits

A

ROM of upper limb; can’t abduct arms above the head

acts as ‘hinge’ at acromioclavicular joint for scapula to slide on the posterior thoracic wall

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17
Q

On CXR, clavicular fractures present

A

depressed lateral 1/3rd pulled down by upper limb

elevated medial 2/3rds pulled up by sternomastoid

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18
Q

The sternoclavicular joint is (type)

A

synovial

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19
Q

What is the function of the disc of the sternoclavicular joint?

A

divides the capsule:

lateral - elevation and depression

medial - rotation

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20
Q

What is the extrinsic ligament of the sternoclavicular joint?

A

costoclavicular ligament

forms a tight, strong joint capsule; stabilizes joint

attaches clavicle to underside of 1st rib

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21
Q

What structures are endangered by sternoclavicular dislocation/subluxation?

A

rare; more likely fractured via blunt trauma

subclavian vein & artery

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22
Q

What type of joint is the acromioclavicular joint?

A

plane (sagittal) synovial

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23
Q

Dislocation or subluxation of the acromioclavicular joint usually occurs

A

anterioposteriorly

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24
Q

The main stabilizer of the acromioclavicular joint is

A

coracoclavicular ligament

prevents upward rotation of the clavicle at the AC joint

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25
Q

What structures attach to the glenoid labrum?

A

long head of biceps tendon (superior)

glenohumeral ligaments

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26
Q

What structures penetrate the capsule of the shoulder joint?

A

subscapular bursa

long head of biceps

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27
Q

What muscles stabilize the glenohumeral capsule?

A

Rotator cuff:

Supraspinatus (top)

Infraspinatus (back)

Teres minor (back)

Subscapularis (front)

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28
Q

Infraspinatus and teres minor (function)

A

externally rotate shoulder

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29
Q

Supraspinatus (function)

A

abduction of shoulder (w/deltoid)

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30
Q

Subscapularis (function)

A

internal rotation of shoulder

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31
Q

How does supraspinatus impingement occur?

A

weak RC muscles cannot oppose strength of deltoid

supraspinatus tendon gets pinched between head of humerus and the superior labrum

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32
Q

How does subacromial bursitis occur?

A

inflammation of bursa w/overproduction of synovial fluid

w/weak RC bursa can be impinged between head of humerus and acromion process/coracoacromial ligament) in abduction

difficult to differentiate from supraspinatus tears or calcification

33
Q

The most common type of shoulder dislocation is

A

anterior & inferior; force applied to abducted and externally rotated arm

(posterior is less common; grand mal epileptic attack, electric shock - sudden force transmitted through upper limb)

34
Q

What structures are endangered by shoulder dislocation?

A

axillary nerve

supplies deltoid, teres minor & overlying skin (dermatome C5 insertion of deltoid, military badge area)

35
Q

What are the types of synovial joints?

A
  • ball & socket
  • hinge
  • plane
  • pivot
  • condylar
  • saddle
36
Q

The collateral ligaments of the elbow attach to

A

medial & lateral epicondyles

37
Q

Collateral ligaments of the elbow resist

A

abduction and adduction (relative to the arm)

38
Q

The medial/ulnar collateral ligament runs

A

from medial epicondyle to the coronoid & olecranon processes of the ulna

39
Q

The lateral/radial collateral ligament runs from

A

lateral epicondyle to the annular ligament

40
Q

The annular ligament

A

encloses the head of the radius on the proximal radioulnar joint

attachment of LCL

permits pronation and supination of the forearm

41
Q

The elbow joint is most secure in

A

extension (ligaments taut)

42
Q

What is valgus angulation?

A

in extension, the forearm points laterally by 165 degrees

43
Q

What is cubitus valgus?

A

increased valgus angulation of the elbow (increased lateral displacement of forearm) that stretches the MCL and ulnar nerve

44
Q

Movements of the radioulnar joints

A

rotational: pronation & supination

45
Q

Radioulnar joints (structure)

A

synovial pivot joints

(inferior includes disc)

46
Q

What is the function of the IOM?

A
  • joins radioulnar joints to produce pronation & supination
  • transmits forces
    • wrist - from radius to ulna (elbow) up arm
    • fracture of one bone can cause fracture in the other (ring principle)
  • attachment for deep muscles of the forearm
47
Q

Dislocation of the elbow is most commonly

A

posterior

can result in fracture of the coronoid process & Volkmann’s ischaemia (vascular necrosis of forearm due to spasm/stretch of brachial artery or its branches)

48
Q

What is tennis elbow?

A

lateral epicondylitis of extensor carpi radialis brevis tendon (extension, pronation, and wrist flexion)

49
Q

Epicondyles are susceptible to

A

traction injuries because they are traction epiphyses

(muscles/tendons can pull off the epiphyses)

50
Q

Fracture of the medial epicondyle endangers

A

ulnar nerve

51
Q

Which carpal bones articulate with the radius at the wrist?

A

scaphoid & lunate (1 & 2)

triquetral (3) in ulnar deviation

52
Q

What are the names of the proximal carpal bones?

A
  1. scaphoid
  2. lunate
  3. triquetral
  4. pisiform (sesamoid in tendon of flexor carpi ulnaris)
53
Q

What are the names of the distal carpal bones?

A
  1. trapezium
  2. trapezoid
  3. capitate
  4. hamate
54
Q

What bones form the anatomical snuffbox?

A

proximal boundary: styloid process of radius

floor: scaphoid bone

55
Q

What are the bony attachments of the flexor retinaculum?

A

lateral/radial: scaphoid tubercle and trapezium tubercle

medial/ulnar: pisiform, hook of hamate

56
Q

What movements occur at the radiocarpal joint?

A
  • flexion/extension
  • abduction (radial deviation)/adduction (ulnar deviation)
  • rotational movements are inhibited by the right-angle orientation of the articular surfaces for scaphoid and lunate on the distal radius
  • these movements also occur at the midcarpal joint (between proximal and distal carpal bones)
57
Q

Which movements are greater at the radiocarpal joint?

A

flexion > extension

ulnar deviation > radial deviation

58
Q

What type of joint is the radiocarpal joint?

A

synovial ellipsoid

59
Q

Which is the largest bone of the hand?

A

capitate

60
Q

What is the clinical significance of the capitate bone?

A

largest tf receives and transmits forces in a fall

61
Q

Which movements are greater at the midcarpal joints?

A

extension > flexion

radial deviation > ulnar

cannot actually be distinguished

62
Q

What is the function of the palmar radiocarpal ligaments?

A

anchored to the radius, prevent carpal bones from sliding medially to space between proximal carpals and ulna

63
Q

What is the function of the radio-scapho-lunate ligament?

A
  • goes from radius over scaphoid, attaches to scaphoid and encircles lunate
  • provides an archway over scaphoid and lunate that anchors them
  • damage to this ligament results in dislocation of the lunate bone
64
Q

Which carpal bone is most commonly dislocated?

A

lunate; may involve damage to radio-scapho-lunate ligament

65
Q

Vessels are transmitted to carpal bones via

A

ligaments because there are no tendons to carpal bones

66
Q

What is a Colles fracture and how does it present?

A
  • fracture of the distal radius
    • most common fracture of upper limb (w/clavicle)
      • especially in elderly, osteoporosis
  • ‘dinner fork’ on X-ray
    • distal portion remains articular w/scaphoid
    • proximal to fracture the radius pops upwards
67
Q

What is the most commonly fractured carpal bone?

A

scaphoid; along waist (where vascula foramina lie)

68
Q

What is endangered in scaphoid fractures?

A
  • radial artery branches passing through the vascular foramina
  • can result in avascular necrosis of the proximal pole of the scaphoid if undetected
  • tf several X-rays taken over a period of days in case scaphoid fracture is obscured by swelling (will be present in anatomical snuffbox)
69
Q

What are the movements of the metacarpophalangeal joints?

A

flexion/extension

abduction/adduction

70
Q

What are the movements of the interphalangeal joints?

A

flexion/extension only

71
Q

What type of joint are the carpometacarpal joints?

A

synovial

72
Q

What is unique about the articular surface of the trapezium?

A

two concave survaces in opposite directions; forms the saddle joint of the thumb and allows opposition

73
Q

What is the function of the deep transverse metacarpal ligament?

A

links & stabilizes carpometacarpal joints II-V

(ROM increases radial to ulnar)

74
Q

What type of joint are the metacarpalphalangeal joints?

A

condyloid synovial joints

75
Q

What is the function of the dorsal and volar/palmar plates?

A

fibrocartilage that expands the articular surface on the proximal end/base of the phalanges with the distal metacarpal condyles, & at the interphalangeal joints

76
Q

Collateral ligaments of the MCP joints tighten in

A

flexion; harder to abduct in flexion than extension

77
Q

What is a ‘swan neck’ deformity of the finger?

A
  • force applied to volar aspect of the MCP or IP joint results in hyperextension of the joint an compensatory flexion of the terminal joint
  • distal metacarpal can break through the volar plate
78
Q

What is a Boutonniere deformity of the finger?

A
  • force to the dorsal aspect of the MCP or IP joint causes flexion of the joint and compensatory hyperextension of the distal joint
  • bone can break through the dorsal plate into the capsule or extensor tendons

Anatomy (Karen) (16 decks)

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