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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
What structures attach to the glenoid labrum?
long head of biceps tendon (superior) glenohumeral ligaments
26
What structures penetrate the capsule of the shoulder joint?
subscapular bursa long head of biceps
27
What muscles stabilize the glenohumeral capsule?
**Rotator cuff:** Supraspinatus (top) Infraspinatus (back) Teres minor (back) Subscapularis (front)
28
Infraspinatus and teres minor (function)
externally rotate shoulder
29
Supraspinatus (function)
abduction of shoulder (w/deltoid)
30
Subscapularis (function)
internal rotation of shoulder
31
How does supraspinatus impingement occur?
weak RC muscles cannot oppose strength of deltoid supraspinatus tendon gets pinched between head of humerus and the superior labrum
32
How does subacromial bursitis occur?
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
The most common type of shoulder dislocation is
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
What structures are endangered by shoulder dislocation?
axillary nerve supplies deltoid, teres minor & overlying skin (dermatome C5 insertion of deltoid, military badge area)
35
What are the types of synovial joints?
* ball & socket * hinge * plane * pivot * condylar * saddle
36
The collateral ligaments of the elbow attach to
medial & lateral epicondyles
37
Collateral ligaments of the elbow resist
abduction and adduction (relative to the arm)
38
The medial/ulnar collateral ligament runs
from medial epicondyle to the coronoid & olecranon processes of the ulna
39
The lateral/radial collateral ligament runs from
lateral epicondyle to the annular ligament
40
The annular ligament
encloses the head of the radius on the proximal radioulnar joint attachment of LCL permits pronation and supination of the forearm
41
The elbow joint is most secure in
extension (ligaments taut)
42
What is valgus angulation?
in extension, the forearm points laterally by 165 degrees
43
What is cubitus valgus?
increased valgus angulation of the elbow (increased lateral displacement of forearm) that stretches the MCL and ulnar nerve
44
Movements of the radioulnar joints
rotational: pronation & supination
45
Radioulnar joints (structure)
synovial pivot joints | (inferior includes disc)
46
What is the function of the IOM?
* 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
Dislocation of the elbow is most commonly
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
What is tennis elbow?
lateral epicondylitis of extensor carpi radialis brevis tendon (extension, pronation, and wrist flexion)
49
Epicondyles are susceptible to
traction injuries because they are traction epiphyses (muscles/tendons can pull off the epiphyses)
50
Fracture of the medial epicondyle endangers
ulnar nerve
51
Which carpal bones articulate with the radius at the wrist?
scaphoid & lunate (1 & 2) triquetral (3) in ulnar deviation
52
What are the names of the proximal carpal bones?
1. scaphoid 2. lunate 3. triquetral 4. pisiform (sesamoid in tendon of flexor carpi ulnaris)
53
What are the names of the distal carpal bones?
1. trapezium 2. trapezoid 3. capitate 4. hamate
54
What bones form the anatomical snuffbox?
proximal boundary: styloid process of radius floor: scaphoid bone
55
What are the bony attachments of the flexor retinaculum?
lateral/radial: scaphoid tubercle and trapezium tubercle medial/ulnar: pisiform, hook of hamate
56
What movements occur at the radiocarpal joint?
* 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
Which movements are greater at the radiocarpal joint?
flexion \> extension ulnar deviation \> radial deviation
58
What type of joint is the radiocarpal joint?
synovial ellipsoid
59
Which is the largest bone of the hand?
capitate
60
What is the clinical significance of the capitate bone?
largest tf receives and transmits forces in a fall
61
Which movements are greater at the midcarpal joints?
extension \> flexion radial deviation \> ulnar *cannot actually be distinguished*
62
What is the function of the palmar radiocarpal ligaments?
anchored to the radius, prevent carpal bones from sliding medially to space between proximal carpals and ulna
63
What is the function of the radio-scapho-lunate ligament?
* 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
Which carpal bone is most commonly dislocated?
lunate; may involve damage to radio-scapho-lunate ligament
65
Vessels are transmitted to carpal bones via
ligaments because there are no tendons to carpal bones
66
What is a Colles fracture and how does it present?
* 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
What is the most commonly fractured carpal bone?
scaphoid; along waist (where vascula foramina lie)
68
What is endangered in scaphoid fractures?
* 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
What are the movements of the metacarpophalangeal joints?
flexion/extension abduction/adduction
70
What are the movements of the interphalangeal joints?
flexion/extension **only**
71
What type of joint are the carpometacarpal joints?
synovial
72
What is unique about the articular surface of the trapezium?
two concave survaces in opposite directions; forms the saddle joint of the thumb and allows opposition
73
What is the function of the deep transverse metacarpal ligament?
links & stabilizes carpometacarpal joints II-V (ROM increases radial to ulnar)
74
What type of joint are the metacarpalphalangeal joints?
condyloid synovial joints
75
What is the function of the dorsal and volar/palmar plates?
fibrocartilage that expands the articular surface on the proximal end/base of the phalanges with the distal metacarpal condyles, & at the interphalangeal joints
76
Collateral ligaments of the MCP joints tighten in
flexion; harder to abduct in flexion than extension
77
What is a 'swan neck' deformity of the finger?
* 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
What is a Boutonniere deformity of the finger?
* 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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