Elbow and Forearm Flashcards
Which of these is the ulna? Identify the landmarks
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Which of these is the radius? Identify the landmarks
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Which joints form the elbow joint?
Collection of 3 joints
- Ulno humeral - hinge joint
- Radio humeral - ball and socket
- Upper radioulnar - trochoid (pivot joint)
What type of joint is the elbow?
Synovial hinge joint
What is cubitus varus?
Elbow joint points towards the midline
Carrying angle is less than normal
What is cubitus valgus?
Carrying angle is greater than normal
Elbow points away from midline
Are cubitus valgus and cubitus varus both functional problems?
Cubitus varus is simply cosmetic. Valgus may lead to impingment of the ulna nerve posterially = tardy ulna nerve palsy.
What things are responsible for the stability of the elbow?
- Capsule that lines the joints
- Ligaments (reinforce joint)
- Muscles passing over joint
What are the ligaments of the elbow?
Medial collateral ligament
Lateral collateral ligament
Annular ligament
Medial collateral ligament
The ulnar collateral ligament originates from the medial epicondyle, and attaches to the coronoid process and olecranon of the ulna.
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Lateral collateral ligament
The radial collateral ligament is found on the lateral side of the joint, extending from the lateral epicondyle, and blending with the annular ligament of the radius (a ligament from the proximal radioulnar joint).
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Annular ligament
Holds radial head in position
Superior radioulnar nerve stabilised
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Why is the fat pad of the elbow clinically important?
Fracture = Effusion in joint (fluid or blood)
Confined within joint
Fat pad is lifted away from bone = fat pad sign
What are the movements that take place in the elbow joint?
- Ulna humeral (flexion and extension = -5 - 140)
- Radio humeral (flexion and extension = -5 - 140)
- Upper radioulnar joint (pronation and supination = 90 - 90)
What is the most important movement performed by the elbow joint?
Flexion and extension
Pronation and supination can be compensated for by shoulder joint. Many people have fused ulna and radius. Goes unoticed.
What are the flexor muscles of the elbow?
Brachialis (main flexor)
Brachioradialis
Brachial biceps
What are the extensors of the elbow?
Triceps
Anconeus
What muslces are responsible for supinating the elbow?
Supinator brevis
Brachial biceps
Which muscles are responsible for pronation at the elbow?
Pronator teres
Pronator quadratus
Which nerve is most likely to be damaged in a humeral fracture?
Radial nerve as it wraps around it.
What are the common flexor pronator muscles?
- Pronator teres
- Flexor carpi radialis
- Palmaris longus
- Flexor digitoram superficialis
- Flexor carpi ulnaris
What are the deep flexor muscles?
- Flexor digitorum profundus
- Flexor pollicis longus
- Pronator quadratus
Which two digits have independant extensor muscles?
Index finger
Little finger
What are the extensor muscles of the wrist and fingers?
Extensor carpi radialis longus
Extensor carpi radialis brevis
Extensor carpi ulnaris
Extendor digitoram communis
What are the flexor muscles of the wrist and fingers?
Flexor carpi radialis
Flexor carpi ulnaris
Palmaris longus
Superficial flexor digitorum
Flexor pollicis longus
Anconeus (location, origin, insertion, innervation and action)
Origin: Lateral epicondyle of the humerus
Insertion: Lateral side of the olecranon and superior part of the posterior ulna distally
Action: Extension of forearm
Innervation: Radial nerve
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Brachioradialis (location, origin, insertion, innervation and action)
Origin: Distal lateral supracondylar ridge of the humerus and the lateral intermuscular septum
Insertion: Lateral part of the styloid process of the radius
Action: Flexion of the elbow; supination and pronation fo the forearm
Innervation: Radial nerve (C5 - 6)
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Pronator teres (location, origin, insertion, innervation and action)
Origin: Medial epicondyle of the humerus; the coronoid process of the ulna; the common flexor tendon.
Insertion: Lateral radius distal to the insertion of the spinator muscle
Action: Weak flexion of the elbow joint; pronation of the forearm
Innervation: Median nerve (C6-C7)
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Median cubital vein
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Flexor carpi radialis (origin, inerstion, innervation and action)
Origin: Medial epicondyle of humerus
Insertion: Base of the 2nd and 3rd metacarpal
Action: Flexion of the wrist and abduction of the hand
Innervation: Median nerve (C6-7)
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Palmaris longus (origin, inerstion, innervation and action)
Origin: Medial epicondyle of humerus
Insertion: Palmar aponeurosis
Action: Tightens the palmer aponeurosis, flexion at wrist, weak flexion of the elbow joint
Innervation: median nerve (C7-C8)
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Flexor carpi ulnaris (origin, inerstion, innervation and action)
Origin: Medial epicondyle of humerus
Insertion: Pisiform
Action: Flexion of the wrist and adduction of the hand
Innervation: Ulnar nerve (C7-T1)
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Flexor digitorum superficialis (origin, inerstion, innervation and action)
Origin: Humeroulnar head: the medial epicondyle of the humerus, radial head: the middle third of the radius
Insertion: Shafts of the middle phalanges of the 2nd and 5th digits
Action: Weak flexion of the elbow; flexion of the wrist; flexion of the metocarpophalangeal and proximal interphalangeal joints of the 2nd and 5th digits.
Innervation: Median nerve (C8-T1)
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Flexor difitorum profundus (origin, inerstion, innervation and action)
Origin: Posterior and medial borders of the ulna
Insertion: Base and palmar surface of the distal phalanges of the 2nd and 5th digits
Action: Flexion of the wrist and flexion of the metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints of the 2nd and 5th digits.
Innervation: Median nerve and the ulnar nerve
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Flexor pollicis longus (origin, inerstion, innervation and action)
Origin: Interosseous membrane and anterior surface of the radius
Insertion: Palmar side of the sital phalanx of the 1st digit
Action: Abduction of the wrist, flexion of the carpometacarpal, metacatpopharalangeal and interphalangeal joint of the 1st digit.
Innervation: Median nerve
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Extensor carpi radialis brevis (origin, inerstion, innervation and action)
Origin: Lateral epicondyle of the humerus
Insertion: Dorsal base of the 3rd metacarpal bone
Action: Weak flexion of the elbow and extension and abduction of the wrsit
Innervation: Deep branch of radial nerve (C7-8)
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Supinator (origin, inerstion, innervation and action)
Origin: Supinator crest of the ulna and lateral epicondyle of humerus
Insertion: Lateral one-third of proximal radius
Action: Supination of the forearm at the radioulnar joints
Innervation: Deep branch of the radial nerve (C6-7)
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Flexor carpi radialis brevis (origin, inerstion, innervation and action)
Origin: Lateral epicondyle of the humerus
Insertion: Dorsal base of the 3rd metacarpal bone
Action: Weak flexion of the elbow and extension and abduction of the wrist
Innervation: Deep branch of the radial nerve (C7-8)
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Extensor pollicus brevis (origin, inerstion, innervation and action)
Origin: Posterior surface of the distal radius; interosseaous membrane
Insertion: Base of the proximal phalanx of the 1st digit
Action: Abduction of the radiocarpal joint; extension of the carpometacarpal and metacarpophalangeal joints
Innervation: Posterior interosseus nerve
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Extensor carpi radialis longus (origin, inerstion, innervation and action)
Origin: Lateral supracondylar ridge of distal humerus and the lateral intermuscular septum
Insertion: Dorsal base of the 3nd metacarpal bone
Action: Weak flexion of the elbow and extension and abduction of the wrsit
Innervation: Radial nerve (C6-7)
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Abductor pollicis longus (origin, inerstion, innervation and action)
Origin: Middle one-third of the posterior surface of the radius and ulna
Insertion: Base of the 1st metacarpal bone at the radial side
Action: Abduction of the radiocarpal joint and carpometacarpal joint of the 1st digit
Innervation: Deep branch of the radial nerve
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Extensor pollicis longus (origin, inerstion, innervation and action)
Origin: Posterolateral surface of the ulna
Insertion: Base of the distal phalanx of the 1st digit
Action: Extension and radial abduction of the wrist; adduction of the carpometacarpal joint of the 1st digit; extension of the metacarpophalangeal and interphalangeal joints of the 1st digit.
Innervation: Posterior interosseous nerve
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Extensor indicis (origin, inerstion, innervation and action)
Origin: Posterolateral surface of the ulna and the interosseous membrane
Insertion: Tendons join the extensor digitorum tendon to the 2nd digit
Action: Extension of the wrist; extension of the metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints of the 2nd digit.
Innervation: Posterior interosseous nerve
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Extensor carpi ulnaris (origin, inerstion, innervation and action)
Origin: Lateral epicondyle of humerus
Insertion: Base of the medial side of the 5th metacarpal bone
Action: Extension and adduction of the wrist
Innervation: Deep branch of the radial nerve (C7-C8)
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Extensor digiti minimi (origin, inerstion, innervation and action)
Origin: Lateral epicondyle of humerus
Inserton: Extensor digitorum tendon to the 5th digit
Action: Extension and ulnar abduction of the wrist; abduction and extension of the metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints of the fifth digit.
Innervation: Posterior interosseous nerve
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Extensor carpi radialis longus (origin, inerstion, innervation and action)
Origin: Lateral supracondylar ridge of the distal humerus
Insertion: Dorsal base of the 2nd metacarpal bone
Action: Weak flexion of the elbow and extension and abduction of the wrist
Innervation: Radial nerve (C6-7)
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Extensor digitorum of hand (origin, inerstion, innervation and action)
Origin: Lateral epicondyle of the humerus
Insertion: Dorsal digital expansion of the 2nd-5th digits
Action: Extension of the wrist; extension of the metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints of the 2nd and 5th fingers, abduction of the fingers
Innervation: Deep branch of radial nerve
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What are the borders of the cubital fossa?
Lateral border – The medial border of the brachioradialis muscle.
Medial border– The lateral border of the pronator teres muscle.
Superior border – An imaginary line between the epicondyles of the humerus.
Floor - Proximally by the brachialis, and distally by the supinator muscle.
Roof - Skin and fascia, and is reinforced by the bicipital aponeurosis.
What are the contents of the cubital fossa?
Lateral to medial
Radial nerve – This is not always strictly considered part of the cubital fossa, but is in the vicinity, passing underneath the brachioradialis muscle. As is does so, the radial nerve divides into its deep and superficial branches.
Biceps tendon – It runs through the cubital fossa, attaching to the radial tuberosity, just distal to the neck of the radius.
Brachial artery – The brachial artery supplies oxygenated blood the forearm. It bifurcates into the radial and ulnar arteries at the apex of the cubital fossa.
Median nerve – Leaves the cubital between the two heads of the pronator teres. It supplies the majority of the flexor muscles in the forearm.
Mnemonic for contents of the cubital fossa – Really Need Beer To Be At My Nicest.