Elbow and forearm Flashcards
Which structure does the proximal humerus articulate with?
Glenoid fossa
Which 2 structures wrap around the surgical neck of the humerus?
Axillary nerve
Posterior humeral circumflex artery
Which 2 structures run through the posterior spiral groove (shaft) of the humerus?
Radial nerve
Deep brachial artery
What do the radial nerve and deep brachial artery pass through before wrapping round the posterior spiral groove of the humerus?
Triangular interval
Which condyle is next to the medial epicondyle?
Trochlea
Which condyle is next to the lateral epicondyle?
Capitulum
A fracture of the medial supracondylar ridge could injure which nerve?
Median nerve
Which nerve passes anterior to the medial epicondyle?
Median nerve
Which nerve passes posterior to the medial epicondyle?
Ulnar nerve
What shape is the head of the radius?
Circular
Which muscle attaches to the radial tuberosity?
Biceps brachii
Which muscle attaches to the olecranon process?
Triceps brachii
Which muscle attaches to the coronoid process of the ulna?
Brachialis
Which structure stretches between the radius and ulna?
Interosseous membrane
The elbow joint is formed by what 3 things?
Humerus
Proximal medial ulna
Proximal lateral radius
The head of the radius articulates with what?
Capitulum of the humerus
What causes the hands to be slightly lateral to the upper arm?
Carrying angle
The carrying angle helps to prevent what?
Hands hitting the body when swinging arms
As the ulnar nerve passes posterior to the medial epicondyle, what structure does it travel through?
Cubital tunnel
Which nerve passes through the cubital tunnel?
Ulnar nerve
The posterior interosseous nerve is a branch of which nerve?
Radial nerve
Damage to which nerve causes wrist drop?
Radial nerve
What is the function of the medial collateral ligament of the elbow?
Resists abduction / valgus
What is the function of the lateral collateral ligament of the elbow?
Resists adduction / varus
Which structure circles the head of the radius?
Annular ligament
What is Nursemaid’s Elbow?
When the annular ligament which wraps around the radial head slips off, causing subluxation or dislocation of the radial head
What is the term for the safe access point on the posterior elbow?
Anconeus triangle
The Anconeus triangle is formed by what 3 things?
Olecranon
Lateral epicondyle
Radial head
Describe which 2 muscles permit supination and the nerves which innervate each muscle.
Biceps - musculocutaneous nerve
Supinator - radial nerve
Describe which 2 muscles permit pronation and the nerve that innervates them.
Pronator teres + pronator quadratus
Median nerve
What are the 2 functions of the anterior forearm muscles?
Flexion
Pronation
What is the golden rule of innervation of the anterior forearm?
All anterior forearm muscles are innervated by the median nerve, except for 1.5 muscles (ulnar nerve)
What are the 3 functions of the posterior forearm muscles?
Extension
Supination
Thumb abduction
What is the golden rule of innervation of the posterior forearm?
All posterior forearm muscles are innervated by the radial nerve or its posterior interosseous branch
Which joints allow for pronation + supination of the forearm?
Proximal and distal radioulnar joints
How many muscles are in each of the 3 layers of the anterior compartment of the forearm?
Layer 1 (superficial) - 4 muscles
Layer 2 - 1 muscle
Layer 3 - 3 muscles
What are the 4 muscles in the superficial layer of the anterior compartment of the forearm?
Pronator teres
Flexor carpi radialis
Palmaris longus
Flexor carpi ulnaris
Where do all of the muscles of the superficial layer of the anterior compartment of the forearm originate?
Medial epicondyle of humerus
Which pathology is golfer’s elbow?
Medial epicondylitis
Describe the innervation of the 4 muscles of the superficial layer of the anterior compartment of the forearm.
Pronator teres - median nerve
Flexor carpi radialis - median nerve
Palmaris longus - median nerve
Flexor carpi ulnaris - ulnar nerve
Which muscle of the superficial layer of the anterior compartment of the forearm is absent in about 20% of people?
Palmaris longus
What is the only muscle in the middle layer of the anterior compartment of the forearm?
What is its innervation?
Flexor digitorum superficialis - median nerve
Which joints does the FDS flex and which does it not?
Carpometacarpal joints
MCP joints
PIP joints
NOT DIP joints
Tendons of the FDS travel underneath what?
Transverse carpal ligament (flexor retinaculum)
What forms the roof of the carpal tunnel?
Transverse carpal ligament (flexor retinaculum)
What are the 3 muscles of the bottom layer of the anterior compartment of the forearm and their innervation?
Flexor pollicis longus - median nerve
Flexor digitorum profundus - 1/2 median + 1/2 ulnar nerve
Pronator quadratus - median nerve
Which is the only muscle that can flex the distal phalanges?
Flexor digitorum profundus (FDP)
Describe which parts of the FDP muscle are innervated by the median and ulnar nerves.
Median nerve - lateral half of the muscle (digits 2 + 3)
Ulnar nerve - medial half of the muscle (digits 4 + 5)
Describe the anatomical relationship between the tendons of the FDS and FDP.
The tendons of the FDS sit on top of the tendons of the FDP. The FDP tendons pass through a split in the FDS tendons to reach the distal phalanx
Where do the tendons of the FDS reach up to / end?
Middle phalanx
Where do the tendons of the FDP reach up to / end?
Distal phalanx
Which nerve would a fracture in the surgical neck of the humerus damage and what symptoms would this cause?
Axillary nerve - deltoid muscle weakness and loss of sensation over lateral shoulder
Fractures in the shaft of the humerus would damage which nerve and cause which main symptom?
Radial nerve - causing wrist drop
Lateral epicondylitis is otherwise known as what?
Tennis elbow
Medial epicondylitis is otherwise known as what?
Golfer’s elbow
A fracture of the neck of the radius can damage which nerve?
Posterior interosseous nerve (branch of radial nerve)
What would be the symptoms of cubital tunnel syndrome?
Numbness and/or tingling in the ring and little fingers
Where do all of the muscles of the posterior compartment of the forearm originate?
Lateral epicondyle
A FOOSH injury can cause a fracture where?
Lateral epicondyle
What are the 6 muscles of the superficial layer of the posterior forearm?
Anconeus muscle
Extensor digitorum
Extensor digiti minimi
Extensor carpi ulnaris
Extensor carpi radialis brevis
Extensor carpi radialis longus
What is the primary muscle responsible for extending the fingers and wrist?
Extensor digitorum
Which muscle is responsible for extending the 5th digit?
Extensor digiti minimi
Which structure holds tendons in place on the posterior wrist?
Extensor retinaculum
What are the 5 muscles of the deep layer of the posterior forearm?
Supinator muscle
Extensor indicis
Extensor pollicis longus
Extensor pollicis brevis
Abductor pollicis longus
Which muscle specifically extends the index finger?
Extensor indicis
Which 3 extensor synovial compartments of the wrists are most susceptible to wear & tear and rupture?
1, 3, and 6
Which bony structure makes the 3rd extensor compartment susceptible to wear & tear and which particular tendon is at risk?
Dorsal radial tubercle
EPL
Which bony structure makes the 6th extensor compartment susceptible to wear & tear and which particular tendon is at risk?
Ulnar styloid process
ECU
An issue with the 1st extensor compartment can cause which pathology? What is this condition otherwise known as?
When will pain present?
De-Quervain’s tenosynovitis
Mommy’s thumb
Pain on extension + abduction of thumb
Which muscle is a forearm flexor but is in the posterior compartment?
Brachioradialis
How can the brachioradialis reflex be tested and which spinal cord levels does this test?
Tapping its distal insertion near the wrist - assesses C5 and C6
What forms the medial, lateral, superior borders and roof of the cubital fossa?
Medial - pronator teres
Lateral - brachioradialis
Superior - inter-epicondylar line
Roof - aponeurosis of biceps brachii
What are the 3 structures in the cubital fossa, from lateral to medial?
Biceps brachii tendon
Brachial artery
Median nerve
What are the 3 main veins in the cubital fossa?
Cephalic vein
Median cubital vein
Basilic vein
Which vein is most commonly used for cannulation?
Which vein is considered the safest to use?
Median cubital vein most often used
Cephalic vein is considered safest
What are the spinal cord levels of the radial nerve?
C5 - T1
What are the spinal cord levels of the median nerve?
C5 - T1
What are the spinal cord levels of the ulnar nerve?
C8 - T1
What does the radial nerve split into?
Deep branch - becomes posterior interosseous nerve
Superficial branch
What does the superficial branch of the radial nerve innervate?
Cutaneous innervation to the anatomical snuffbox and hand
What does the ulnar nerve pass through as it enters the hand?
Guyon’s canal
What passes through Guyon’s canal?
Ulnar nerve + ulnar artery
The brachial artery is a continuation of which artery?
Axillary artery
The brachial artery splits into which 2 arteries?
Radial artery
Ulnar artery
Which artery gives off the common interosseous artery?
Ulnar artery
Which artery primarily contributes to the deep palmar arch?
Radial artery
Which artery primarily contributes to the superficial palmar arch?
Ulnar artery