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Block 4 > Elbow & Forearm > Flashcards

Elbow & Forearm Flashcards

1
Q

What can be damaged if the mid-shaft of the humerus is fractured through the spiral groove posteriorly?

A

Radial n.

Profunda brachii artery

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2
Q

What can be damaged if the medial epicondyle (funny bone) is damaged?

A

Ulna n. (and in the cubital tunnel)

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3
Q

What can regional pain and tenderness of the epicondyles indicate?

A

Tendonitis:

  • Lateral epicondylitis i.e. Tennis elbow
  • Medial epicondylitis i.e. Golfer’s elbow
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4
Q

What are the structures of the distal humerus? What do they allow?

A

Capitulum (lateral): pronation and supination

Trochlea (medial): flexion/extension

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5
Q

Why is the head of radius circular? What surrounds it?

A

Permits supination and pronation - surrounded by annular ligament

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6
Q

What attaches to the radial tuberosity?

A

Biceps brachii

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7
Q

What attaches to the raised ridge of bone of the radius?

A

Interosseous membrane that attaches it to the ulna and transmits forces from the radius to the ulna

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8
Q

How can you palpate the radial styloid? How can it be damaged?

A

Via anatomical snuffbox

if fallen onto hand

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9
Q

What attaches to the olecranon posterior of the ulna? How can it become damaged?

A

Attachment point for triceps tendon and covered by a bursa to allow free movement of skin - can be # by direct trauma or avulsion by strong triceps contraction e.g. in fall

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10
Q

What attaches to the coronoid process of the ulna?

A

Brachialis

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11
Q

What distal features of the ulna can you palpate and where?

A

Ulnar head: dorsally

Ulnar styloid: medial wrist

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12
Q

What is the carrying angle?

A

The angle that the hands and forearm takes away from body in the anatomical position i.e. they are not straight next to the thigh as a result of the elbow joint - bigger in women due to allow room for bigger pelvises

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13
Q

What nerve can a fracture of the neck of the radius damage?

A

Posterior interosseous n. (branch of radial)

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14
Q

What is the cubital tunnel?

A

Space of dorsal medial elbow allowing passage of ulna n. around elbow bordered by:

  • Medially by medial epicondyle of humerus
  • Laterally by olecranon process of ulna and the tendinous arch joining the humeral and ulnar heads of the flexor carpi ulnaris
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15
Q

What is the anconeus triangle?

A

Region for elbow injection/aspiration bordered by:

  • Radial head
  • Lateral epicondyle
  • Olecranon (should align with epicondyles in elbow extension)
  • Covered by anconeus muscle
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16
Q

Why is the fibrous capsule of the elbow joint weak anteriorly and posteriorly?

A

To permit flexion and extension

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17
Q

What ligaments exist in the elbow joint?

A
  1. Lateral collateral: resists adduction and varus movement

2. Medial collateral: resists abduction and valgus movement

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18
Q

What is the radioulnar joint? What does it allow? How can it become damaged?

A

Proximal and distal synovial pivot joints that permits pronation (median n.) by pronator teres and pronator quadratus and supination (radial and musculocutaneous n.) by biceps brachii and supinator - proximal joint can be dislocated esp. in children when parents swing them by arm as traction travels up from radio-carpal wrist joint (Nursemaid’s elbow)

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19
Q

What are the 2 compartments of the forearm, their actions and innervation?

A
  1. Anterior: flexors and pronators - mostly median n. and some ulnar n.
  2. Posterior: extensors, supinator and thumb abduction - all radial n. (or posterior interosseous branch)
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20
Q

Where you identify tendons of forearm muscles? Why is this useful?

A

At the wrist as some are useful landmarks for major arteries and nerves

21
Q

How is the anterior forearm compartment divided?

A

Into layers with the ulnar and median n. and ulnar and radial artery between the layers:

  • Superficial muscles x 4: flexor carpi ulnaris (FCU), palmaris longus (PL), flexor carpi radialis (FCR) and pronator teres (PT)
  • Intermediate muscle x 1: flexor digitorum superficialis (FDS)
  • Deep muscles x 3: flexor digitorum profundus (FDP), flexor pollicis longus (FPL) and pronator quadratus (PQ)
22
Q

Where do the superficial and intermediate muscles of the anterior forearm originate?

A

Medial epicondyle

23
Q

What are the functions and innervation of the muscles of the superficial layer of the anterior forearm?

A

Median n.:

  1. PT: forearm pronator
  2. FCR: wrist flexor and abductor sitting laterally at wrist
  3. PL: wrist flexor (absent in ~20% of people)

Ulnar n.:
4. FCU: wrist flexor and adductor sitting medially at wrist

24
Q

What is the function and innervation of the anterior forearm muscle in the intermediate layer?

A

FDS: flexes fingers up to the PIP joint attaching to the radius and ulna - median n. (FDP tendon passes through those of FDS both of which are held down by a pulley system of bands of tissues)

25
Q

What is the function of the carpal tunnel? What borders it?

A

Prevents tendon bowstringing and bordered by:

  • Roof is the flexor retinaculum (transverse carpal ligament)
  • Laterally by scaphoid and trapezium tubercles
  • Medially by hook of hamate and pisiform
26
Q

What is the function and innervation of the anterior forearm muscles in the deep layer?

A

Median n.:

  1. FPL: thumb flexor to DIP
  2. PQ: forearm pronator

Median n. AND ulnar n.:
3. FDP: finger flexor to DIP joint

27
Q

How can you test the median and ulnar nerve in the hands?

A

Hold the middle phalanx and get patient to flex end of finger at the DIP:

  • Digits 2 and 3 tests FDP and median n.
  • Digits 4 and 5 tests FDP and ulnar n.
28
Q

What must you bare in mind when thinking about the movement of the thumb?

A

The thumb is a finger rotated through 90 degrees so it carries out the same movements as the finger but through 90 degrees

29
Q

What is the golden rule of anterior forearm innervation?

A

EVERYTHING is median n. supplied EXCEPT:

  • FCU
  • FDP to fingers 4 and 5
30
Q

What sensory loss would be associated with median nerve damage?

A
  1. Lateral aspect of palm (spared in carpal tunnel syndrome as does not pass through carpal tunnel)
  2. Palmar surface and fingertips of lateral 3.5 digits
31
Q

What are the 7 muscles of the superficial layer of the posterior forearm?

A
  1. Anconeus: elbow extensor
  2. Extensor digitorum (ED): finger extensor to DIP joint
  3. Extensor digiti minimi (EDM): 5th digit extensor to DIP
  4. Extensor carpi ulnaris (ECU): wrist extensor and adductor
  5. Extensor carpi radialis brevis (ECRB): wrist extensor and abductor
  6. Exensor carpi radialis longus (ECRL): wrist extensor and abductor
  7. Brachioradiialis: flexes elbow and moves forearm to mid supination/pronation
32
Q

What is a common origin for some of the tendons in the superficial layer of the posterior forearm?

A

Lateral epicondyle is a common origin for tendons ED, ECRB, EDM and ECU

33
Q

What are the 5 muscles of the deep layer of the posterior forearm?

A
  1. Supinator: forearm supination
  2. Extensor pollicis longus (EPL): thumb extensor of all joints
  3. Extensor pollicis brevis (EPB): thumb extension to MCP joint
  4. Extensor indicis (EI): extension of 2nd digit to PIP
    joint
  5. Abductor pollicis longus (APL): thumb abduction
34
Q

What is the golden rule of the posterior forearm innervation?

A

Everything is POSTERIOR INTEROSSEOUS NERVE (branch of radial n.) innervated

35
Q

What sensory loss would be associated with radial nerve damage?

A
  1. Lower lateral aspect of arm inferior to deltoid insertion
  2. Posterior surface of arm
  3. Posterior middle strip down forearm
  4. Dorsal surface of lateral 3.5 digits and associated areas on back of hand
36
Q

There are 6 extensor compartments of the wrist. Describe how 3 of them can become inflamed.

A
  1. Affected by painful De-Quervains tenosynovitis
  2. EPL can wear on dorsal radial tubercle and rupture
  3. ECU can wear on the ulnar styloid process and rupture
37
Q

What is contained within the 6 extensor compartments of the wrist?

A 
Posterior forearm muscles covered in common synovial sheaths:
1. EPB and APL
2. ECRB and ECRL 
Dorsal radial tubercle
3. EPL
4. ED and EI
5. EDM
6. ECU
38
Q

What are the borders of the cubital fossa?

A
  1. Lateral: medial border of the brachioradialis muscle
  2. Medial: lateral border of the pronator teres muscle
  3. Superior: inter-epicondylarl line between the medial and lateral epicondyles of the humerus
  4. Roof: aponeurosis of biceps (protects median n. and brachial a. from clinicians as will feel too tough to put a needle through - dont push harder!)
39
Q

How can you test the brachioradialis muscle? What happens if you hit it too hard?

A

C5-6 tendon reflex around lateral wrist area - if hit too hard you will hit the superficial radial cutaneous n.

40
Q

What can the biceps tendon be used to landmark?

A

When it passes centrally through the cubital fossa, the median n. and brachial a. sit medially to it

41
Q

What superficial veins pass over the cubital fossa? What one is best used for phlebotomy or cannulation and why?

A

Cephalic and basilic joined by the median cubital vein - try and insert needle into median cubital vein as cephalic and basilic sit close to cutaneous nerves

42
Q

What other structures sit near the cubital fossa?

A

Cubital lymph nodes - can enlarge with hand/forearm infection

43
Q

What is the route of the forearm nerves?

A
  1. Radial: passes anterior to elbow and lateral to biceps tendon -> deep interosseous branch then passes close to radial neck
  2. Median: passes medial to biceps tendon down forearm to sit under or just lateral to PL at wrist
  3. Ulnar: passes through cubital tunnel then behind medial epicondyle entering anterior forearm running under cover of FCU and sitting lateral to pisiform in hand
44
Q

What are the 2 points of compression of the ulnar nerve?

A
  1. Behind medial epicondyle (funny bone)

2. Lateral to pisiform in hand

45
Q

What is the blood supply to the forearm?

A
  1. Brachial artery branches into radial and ulnar artery
  2. Ulnar artery branches into interosseous arteries inc. posterior and anterior
  3. Ulnar and radial rejoin at the deep and superficial plantar arch of the hand
46
Q

What would happen to the hand if the radial artery was blocked just proximal to the wrist?

A

If the superficial and deep palmar arches meet as they are supposed to, the blood supply to the hand will mostly be fine as the ulnar a. is supplying all of it too

47
Q

Where does the ulnar artery sit? Why is it not just straight?

A

Under/lateral to FCL at anterior wrist with a bendy bit in it so you can move wrist w/o excess traction being placed on the vessel

48
Q

Where does the radial artery sit? What can this be used for?

A

Lateral to FCR at anterior wrist where it can be used for:

  • Cannulation for ABG
  • Harvested
  • Anastomosed to cephalic vein for dialysis port

Block 4 (33 decks)

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