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MSK > Elbow And Forearm > Flashcards

Elbow And Forearm Flashcards

1
Q

Describe the articulations are in the elbow joint

A

Humeroulnar joint: Between Trochlea of humerus and Trochlear/ Sigmoid notch of Ulna

Humeroradial joint: Between Capitellum of humerus and Radius head

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2
Q

Describe the Proximal Radio-Ulnar joint

Where is it found?

Is it part of the elbow joint

A

Between side of Radial head and Radial Notch of Ulna

Found within joint capsule of elbow

Not part of elbow joint

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3
Q

What muscle groups attach to the Medial and Lateral Epicondyles of the Humerus

A

Medial Epicondyle: Flexor-Pronator muscle groups in anterior forearm

Lateral Epicondyle: Extensor muscle groups in posterior forearm

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4
Q

During elbow flexion, what do the Coronoid and Radial Fossae accommodate

During elbow extension, what does the Olecranon Fossa accommodate

A

Coronoid fossa accommodates the Coronoid Process of Ulna

Radial fossa accommodates the Radial head

Accommodates the tip of the Olecranon

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5
Q

Why is the radial neck susceptible to fracture

A

It’s thin

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6
Q

Describe the attachments of the Radial Collateral Ligament

What is its function

A

Attaches Lateral Epicondyle of humerus to Annular Ligament of Radius (with which it blends)

Keeps head of radius and capitellum close together during pronation/ supination

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7
Q

Describe the attachments of the Ulnar Collateral Ligament

What are the 3 bands
Which is strongest and weakest
Which one deepens the socket

A

Attaches Medial Epicondyle of Humerus to Coronoid process and Olecranon of Ulna

Anterior band: Strongest
Posterior band: Weakest
Inferior/ Oblique band: Deepens socket for trochlea of humerus

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8
Q

Which ligament stabilises the Proximal Radioulnar joint

How does it do this?

A

Annular ligament

Forms a collar around Radial Head, so that it can rotate whilst maintaining contact with radial notch of ulna

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9
Q

What is the Carrying Angle?

How much is it normally in men and women

A

The Valgus angle between between the Ulna and and long axis of Humerus (Made in full extension of ulna)

Women: 10-15 degrees
Men: 5-10 degrees

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10
Q

Compare Cubitus Valgus and Cubitus Varus

A

Cubitus Valgus: Excessive carrying angle

Cubitus Varus: Carrying angle that deviates towards body (e.g -5 degrees)

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11
Q

What are 3 major muscles that flex the elbow

A

Brachialis
Biceps brachii
Brachioradialis

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12
Q

At which 2 joints does Pronation and Supination occur

Which muscles do Supination;

  • In absence of resistance to movement
  • With resistance to movement
A

Proximal and distal Radio-Ulnar joints

In absence of resistance to movement: Supinator
With resistance: Biceps brachii

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13
Q

Describe the Olecranon Bursa and Subtendinous Bursa in elbow

A

Olecranon Bursa;
- Between olecranon and overlying subcutaneous tissue

Subtendinous Bursa;
- Between Triceps Brachii tendon and tip of olecranon

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14
Q

Describe how the Ulnar notch of the Radius rotates around Head of Ulna during Pro/ Supination

A

Ulnar notch of radius rotates anteriorly around Head of Ulna

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15
Q

What Fibrocartilaginous articular disc binds the radius and ulna together distally

A

The TFCC (Triangular fibrocartilage complex)

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16
Q

Other than Proximal and Distal Radio-Ulnar joints, describe a fibrous joint connecting the 2 bones together

What are 2 functions of this structure?

A

Interosseus membrane runs diagonally from radius proximally to ulna distally

  • Keeps bones together during Pronation/ Supination
  • Prevents proximal displacement of radius if a force is applied to outstretched hand
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17
Q

Name the 3 Posterior arm muscles that affect the elbow

Name all the muscles of Anterior compartments/ sub-compartments of forearm

Remember “4-1=3” for anterior compartment

A

Posterior;

  • Brachioradialis
  • Supinator
  • Anconeus

Anterior Superficial; (pass/fail/pass/fail)

  • Flexor carpi ulnaris
  • Palmaris longus
  • Flexor carpi radialis
  • Pronator teres

Anterior Intermediate;
- Flexor digitorum superficialis

Anterior Deep;

  • Flexor digitorum profundus
  • Flexor pollicis longus
  • Pronator quadratus
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18
Q

List the 4 muscles of Anterior Superficial Forearm Laterally to Medially

Describe their origin

A
  • Flexor carpi ulnaris
  • Palmaris longus
  • Flexor carpi radialis
  • Pronator teres

Originate from the COMMON FLEXOR ORIGIN (a single tendon) from the Medial Epicondyle of the Humerus

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19
Q

State the Origins and Insertions of Flexor carpi ulnaris (FCU)

A

Origins;
- Humeral head: Common Flexor Origin from Medial Epicondyle

-Ulnar head: Medial aspect of Olecranon

Insertion;
- Pisiform bone, Hook of hamate and Base of Metacarpal 5

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20
Q

State the Actions and Innervation of Flexor carpi ulnaris (FCU)

A

Actions: Flexion and Adduction of Wrist

Innervation: Ulnar nerve

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21
Q

State the Insertion of Palmaris Longus (PL)

Is this muscle present in everyone?

A

Insertion: Flexor retinaculum of wrist and Palmar aponeurosis

Not always present (Absent in 15% of population)

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22
Q

State the Actions and Innervation of Palmaris Longus (PL)

What is the surgical result of this?

A

Innervation: Median nerve

Actions: (Very weak) wrist flexor, can be harvested for use in tendon grafting

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23
Q

Describe how to check if you have Palmaris Longus (PL)

A

Flex wrist and oppose thumb and little finger

PL tendon will protrude in midline

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24
Q

State the Insertion, Innervation and Action of Flexor carpi radialis (FCR)

A

Insertion: Base of Metacarpals 2-3

Innervation: Median nerve

Action: Flexion and Adduction of wrist

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25
Q

State the Origins and Insertions of Pronator teres

A

Origins;

  • Humeral head: Common Flexor Origin from Medial Epicondyle
  • Ulnar head: Coronoid process of Ulna

Insertion: (Passes laterally to) Insert onto mid-shaft of Radius

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26
Q

State the Innervation and Action of Pronator teres

A

Innervation: Median nerve

Action: Pronation of forearm

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27
Q

State the Origins and Insertion of Flexor digitorum superficialis (FDS)

A

Origins;

  • Humeroulnar head: Common Flexor Origin, Ulnar Collateral Ligament, Coronoid Process
  • Radial head: Anterior surface of radius

Insertion: (Base of) Middle phalanges of fingers 2-5

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28
Q

State the Actions and Innervation of Flexor digitorum superficialis (FDS)

A

Actions;

  • Assists with flexion of wrist
  • Flexion of MCP Joints of fingers 2-5
  • Flexion of PIP joints of fingers 2-5

Innervation: Median nerve

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29
Q

State the Origin and Insertions Flexor digitorum profundus (FDP)

A

Origin: Proximal 2/3rds of Ulnar shaft, Interosseus membrane

Insertions: (Base of) Distal phalanages of fingers 2-5

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30
Q

State the Actions and Innervations of Flexor digitorum profundus (FDP)

A

Actions;

  • Flexion of DIP joints of fingers 2-5
  • Flexion of MCP joints of fingers 2-5
  • Assists in wrist flexion

Innervation;

  • Ulnar/ Medial half: Ulnar nerve
  • Radial/ Lateral half: Anterior interosseus branch of Median nerve
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31
Q

Which fingers are innervated by the;

  1. Ulnar half of Flexor digitorum profundus (FDP)
  2. Radial half of Flexor digitorum profundus (FDP)
A
  1. Ulnar half- Little and ring fingers

2. Radial half- Index and middle fingers

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32
Q

State the Origins and Insertions of Flexor pollicis longus (FPL)

A

Origin: Interosseus membrane, Anterior surface of middle of radial shaft

Insertion: (Base of) Distal phalanx of thumb

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33
Q

State the Actions and Innervation of Flexor pollicis longus (FPL)

A

Actions;

  • Flexion of IP Joint of thumb
  • Flexion of MCPJ joint of thumb

Innervation;
- Anterior interosseus branch of median nerve

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34
Q

State the Origin, Insertion, Action and Innervation of Pronator Quadratus

A

Origin: Anterior surface of distal ulna
Insertion: Anterior surface of distal radius

Action: Pronates forearm
Innervation: Anterior interosseus branch of median nerve

35
Q

State the Origin and Insertion of Brachioradialis

A

Origin: Proximal aspect of Lateral Supracondylar ridge of humerus

Insertion: Distal end of radius

36
Q

State the Innervation and Action of Brachioradialis

A

Innervation: Radial nerve

Action;

  • Elbow flexion (Most effective when forearm is mid-prone)
  • Assist flexion in supinated position
37
Q

State the Origins and Insertion of Supinator

A

Origins;
- Humeral head: Common Extensor Origin on lateral epicondyle of humerus

  • Ulnar head: Supinator crest on lateral border of proximal shaft of ulna

Insertion: Proximal lateral surface of radius

38
Q

State the Innervation and Action of Supinator

A

Action: Supinates forearm (Mainly when resistance is absent)

Innervation: Deep branch of radial nerve

39
Q

State the Origins and Insertion of Anconeus

A

Origin: Common Extensor Origin
Insertion: Lateral side of Olecranon, Posterior surface of proximal ulna

40
Q

State the Innervation and 3 Actions of Anconeus

A

Innervation: Radial nerve

Actions;

  • Weak extensor of elbow, assists triceps
  • Stabilises elbow joint
  • During Pronation, abducts ulna and prevents joint capsule from impingement within olecranon fossa
41
Q

Outline the motor and sensory functions of the Median nerve

A

Motor function: Innervates Flexor, Pronator muscle in Anterior forearm (except FCU and ulnar half of FDP)

Sensory function: Radial aspect of palm, radial 3.5 fingers on palmar surface and Dorsum of their respective distal phalanges

42
Q

Which Median nerve branches supply the;

  • radial aspect of palm
  • radial 3.5 fingers+ dorsum of distal phalanges
A

Palm: Palmar cutaneous branch of median nerve

Fingers: Digital cutaneous branch of median nerve

43
Q

The median nerve is initially lateral to brachial artery.

Describe its path into the anterior forearm

A
  • Halfway down arm, crosses over becoming medial to brachial artery
  • Enters anterior forearm via cubital fossa
44
Q

Outline the path of Median nerve from Cubital fossa into hands

A
  • Exits cubital fossa by travelling between Pronator Teres heads, deep to tendinous arch of FDS
  • Passes distally between FDS and FDP
  • Gives off Anterior Interosseus and Palmar Cutaneous Branch
  • Enters hand via carpal tunnel, gives off 2 branches (Recurrent, Palmar Digital)
45
Q

FDS is a useful anatomical landmark. What 2 structures pass through its 2 heads

A

Median nerve

Ulnar artery

46
Q

Outline the motor and sensory functions of the Ulnar nerve

A

Motor: Innervates intrinsic muscles of hand, FCU and ulnar half of FDP

Sensory: Innervates Palmar+Dorsal surfaces of Ulnar 1.5 fingers, and Ulnar aspect of Pam+Dorsum

47
Q

Outline the path of the Ulnar nerve from elbow into anterior forearm

A
  • At elbow, passes posterior to medial humeral epicondyle in the cubital tunnel
  • Passes between 2 heads of FCU to enter forearm, travels deep to FCU
48
Q

What 3 branches does the Ulnar nerve give off in the forearm

A

Muscular branch: (FCU and Ulnar half FDP)

Palmar cutaneous branch: (Ulnar 3rd of palm)

Dorsal cutaneous branch: (Dorsal surface of ulnar 1.5 fingers +dorsum)

49
Q

Outline the pathway of Ulnar nerve from wrist into hand

A
  • At wrist, travels medially to ulnar artery
  • Enters hand via Ulnar/ Guyon’s canal
  • In hand, terminates into superficial and deep branches
50
Q

what is Froment’s sign

Describe it

A

A test for ulnar nerve palsy (Specifically paralysis of adductor pollicis)

  • Patient asked to grab paper between thumb and index finger, as paper pulled away
  • If normal, thumb Adduction should hold paper in place
  • If positive test, can’t adduct thumb. Instead, they flex the thumb at IPJ to hold paper in place
51
Q

Where does the Superficial branch of ulnar nerve arise?

What does it Innervate

A

Arises in palm

Innervates Ulnar 1.5 fingers (Via palmar digital nerves)

52
Q

Outline the motor and sensory functions of the Musculocutaenous nerve

A

Motor: Anterior arm muscles (BBC)

Sensory: Lateral forearm (Now called the Lateral Cutaneous Nerve)

53
Q

Describe the path of the MSC Nerve from the Plexus to the Elbow

A
  • Emerges from brachial plexus at inferior border of Pec Minor
  • Pierces Coracobrachialis near its insertion (Giving a branch to it)
  • Passes down anterior arm, between Biceps and Brachialis (Giving them each a branch)
  • Perces deep fascia lateral to Biceps, emerging laterally to Biceps and Brachialis
54
Q

Describe the path of the MSC Nerve from the Elbow to forearm

Which vein can it be found close to in this region?

A
  • Enters forearm as the Lateral Cutaneous Nerve

Cephalic vein

55
Q

MSC nerve damage is protected in Axilla, so is uncommon

What are 3 mechanisms of injury

A
  • Post shoulder dislocation
  • Injury during shoulder surgery
  • Penetrating trauma to axilla (Stabbing)
56
Q

Outline the effects of MSC Nerve damage on Motor and Sensory function

A

Motor;

  • Paralysis of BBC muscles
  • Weakened elbow+shoulder flexion (Pec major and Brachialis allow function)
  • Weakened supination (Supinator allows function)

Sensory: Loss of sensation over lateral forearm

57
Q

What is the small branch of the Brachial Plexus?
What nerve root fibres does it have

What does it innervate

A

Medial cutaneous nerve of the arm, T1 fibres

Skin of distal anterior surface of medial arm, extending as far as the elbow

58
Q

What nerves fibres are in Medial Cutaenous Nerve of Forearm?

What does it Innervate?

A

C8 and T1

Skin on distal anterior surface of arm and medial forearm, extending as far as wrist

59
Q

How are the Radial and Ulnar arteries formed? Where?

Which parts of the forearm are supplied by each?

Which arteries branch off of the Ulnar artery

A

Bifurcation of brachial artery, in cubital fossa

Radial artery: Posterolateral forearm
Ulnar artery: Anteromedial forearm

Ulnar artery gives rise to Common Interosseus artery-> Ant and Post Interosseus arteries

60
Q

Where can you measure the;

  • Brachial pulse
  • Radial pulse
  • Ulnar pulse
A

Brachial pulse: In cubital fossa, medial to Biceps tendon

Radial pulse: At wrist, lateral to FCR tendon

Ulnar pulse: At wrist, lateral to FCU tendon and proximal to pisiform bone

61
Q

Compare the 2 common variants of the Superficial veins in the upper limb

A
  1. Cephalic and Basilic vein connected by Median Cubital Vein
    • Basilic vein branches-> Median Basilic vein
    • Cephalic vein branches-> Median Cephalic vein
    • Median Basilic and Median Cephalic veins connected by Median Vein of Forearm
62
Q

What veins form the deep venous system of upper limb?

How are the Deep and Superficial venous systems connected?

A

Venue comitantes (Paired veins that lie on either side of an artery)

Deep and superficial veins connected by Perforating veins

63
Q

What is the Cubital Fossa?

What are its 3 borders?

A

A triangular depression anterior to elbow joint

Lateral border: Brachioradialis
Medial border: Pronator teres
Superior border: Imaginary line between Humeral Epicondyles

64
Q

What makes up the Floor and Roof of Cubital Fossa?

What reinforces the Cubital Fossa roof?
What 3 things run within the roof?

A

Floor;

  • Proximal floor: Brachialis
  • Distal floor: Supinator

Roof;
- Skin and fascia, reinforced by Bicipital Aponeurosis

Median cubital vein, Medial cutaenous nerve, Lateral cutaneous nerve run within the roof

65
Q

State the content of the Cubital Fossa, Laterally to Medially

A

Really Need Beer To Be At My Nicest

Really Need: Radial nerve
Beer To: Biceps tendon
Be At: Brachial Artery
My Nicest: Median nerve

66
Q

Identify the muscles in the (5) Deep and (7) Superficial Posterior Forearm (laterally to Medially)

A

Superficial;

  • Brachioradialis
  • Extensor carpi radialis longus (ECRL)
  • Extensor carpi radialis brevis (ECRB)
  • Extensor Digitorum (ED)
  • Extensor digiti minimi (EDM)
  • Extensor carpi ulnaris (ECU)
  • Anconeus

Deep;

  • Supinator
  • Abductor pollicis longus (APL)
  • Extensor pollicis brevis (EPB)
  • Extensor pollicis longus (EPL)
  • Extensor indicis (EI)
67
Q

Which 4 Posterior Superficial muscles of forearm share a common origin?

What is the origin called? Where is it?

A
  • Extensor carpi radialis brevis (ECRB)
  • Extensor Digitorum (ED)
  • Extensor digiti minimi (EDM)
  • Extensor carpi ulnaris (ECU)

Common Extensor Origin, at Lateral Humeral Epicondyle

68
Q

Which 2 fingers do the Deep Posterior Forearm muscles act on?

Which muscle in this group is an exception

A

Thumb and index finger

Supinator

69
Q

State the Origin, Insertion, Innervation and Actions of Extensor carpi radialis longus (ECRL)

A

Origin: Lateral Supracondylar Ridge of humerus
Insertion: Dorsal surface of base of Metacarpal 2

Innervation: Radial nerve

Actions: Abduction and Extension of Wrist

70
Q

State the Origin, Insertion, Innervation and Actions of Extensor carpi radialis brevis (ECRB)

A

Origin: Common Extensor Origin
Insertion: Dorsal surface of Base of Metacarpal 3

Innervation: Deep branch of radial nerve (radial nerve already divided before perforating the muscle)

Actions: Extension and Abduction of Wrist

71
Q

State the Origin, Insertion, of Extensor Digitorum (Communis)

How are the 4 tendons of this muscle connected?
What is the significance of this?

A

Origin: Common Extensor Origin
Insertion: Extensor hood of fingers 2-5

Juncturae tendinum (Fibrous bands on the dorsum)

This connection prevents full extension of middle/ ring finger, if other fingers are flexed

72
Q

State the Innervation and Action of Extensor Digitorum (Communis)

A

Innervation: Posterior interosseus branch of radial nerve

Action: Extension of fingers at MCP and IP joints

73
Q

How do you test the function of Action of Extensor Digitorum (Communis)

A

When forearm is pronated, extend fingers against resistance

74
Q

State the Origin, Insertion, Innervation and Actions of Extensor Digiti Minimi (quinti proprius)

A

Origin: Common Extensor Origin

Insertion: Extensor hood of little finger

Innervation: Posterior interosseus branch of radial nerve

Action: Extension of little finger, assists wrist extension

75
Q

State the Origins and Insertion of Extensor carpi ulnaris (ECU)

A

Origins;

  • Humeral head: Common Extensor Origin
  • Ulnar head: Olecranon, Posterior Proximal Ulna and Deep fascia

Insertion: Base of metacarpal 5

76
Q

State the Innervation and Actions of Extensor carpi ulnaris (ECU)

A

Innervation: Posterior interosseus branch of radial nerve

Actions: Adduction and extension of wrist

77
Q

State the Origins, Insertion, Innervation and Actions of Abductor pollicis longus (APL)

(APL is immediately distal to Supinator)

A

Origin: Interosseus membrane, Posterior radius and ulna

Insertion: (Lateral side of base of) Metacarpal 1

Innervation: Posterior interosseus branch of radial nerve

Action: Thumb abduction, assists in Carpometacarpal joint extension

78
Q

State the Origins, Insertion, Innervation and Action of Extensor pollicis longus (EPL)

A

Origin: Interosseus membrane, Middle 1/3 of posterior ulna

Insertion: Distal phalanx of thumb

Innervation: Posterior interosseus branch of radial nerve

Action: Thumb extension

79
Q

State the Origins, Insertion, Innervation and Action of Extensor pollicis brevis (EPB)

A

Origin: Interosseus membrane, posterior radius

Insertion: (Base of) Proximal phalanx of thumb

Innervation: Posterior interosseus branch of radial nerve

Action: Thumb extension

80
Q

State the Origins, Insertion, Innervation and Action of Extensor indicis (EI)

A

Origin: Interosseus membrane, posterior ulna (Distal to EPL)

Insertion: Extensor hood of index finger

Innervation: Posterior interosseus branch of radial nerve

Action: Index finger extension

81
Q

Outline the Motor and Sensory functions of the Radial Nerve

A

Motor: Triceps and Extensor muscles in forearm

Sensory;

  • Posterior arm
  • Lower lateral arm
  • Posterior forearm
  • Dorsal surface of radial side of hand
  • Dorsal surface of radial 3.5 digits (Except distal phalanges)
82
Q

Outline the pathway of the radial nerve from posterior upper arm to lower arm

A
  1. In posterior arm, gives off branches to;
    - Long+Lateral Triceps heads
    - Posterior Cutaneous nerve of the arm
  2. Goes down radial groove of humerus, gives off branches to; - Medial Triceps head
    - Lower Lateral Cutaneous Nerve of Arm
    - Posterior Cutaneous Nerve of Forearm
83
Q

Outline the path of the Radial Nerve as it runs through and exits the Cubital Fossa

What is it now called?

A
  • Through the cubital fossa, runs anteriorly to lateral epicondyle
  • In cubital fossa, branches into Superficial and Deep branches
  • Exits cubital fossa by passing posteriorly between heads of supinator (Which it innervates).

It is now called the Posterior Interosseus Nerve

MSK (21 decks)

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