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Orthopedic Surgery Ultimate > Elbow/Forearm Anatomy > Flashcards

Elbow/Forearm Anatomy Flashcards

1
Q
A

radial fossa

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2
Q
A

coronoid fossa

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3
Q
A

olecranon fossa

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4
Q
A

trochlea

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5
Q
A

trochlea

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6
Q
A

capitellum

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7
Q

at what angles do the medial and lateral columns of the elbow diverge from the humeral shaft?

A

medial 45°

lateral 20°

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8
Q

describe the humeral-ulnar joint

A

trochlea articulates with semilunar notch and is covered by 300° of cartilage

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9
Q

normal sagittal radius of the capitellum

A

10-12 mm

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10
Q

normal angles of elbow articulation

A

5° radial inclination

6° valgus

30° anteverted

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11
Q
A

radial tuberosity

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12
Q
A

interosseous border

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13
Q
A

ulnar notch

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14
Q
A

interosseous border

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15
Q

normal coronal bow of radius

A

10° apex lateral

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16
Q

normal sagittal bow of radius

A

only proximal, but 4.66° apex volar

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17
Q

where is it safe to put radial head screws?

A

in the 110° of arc that does not articulate in pronation and supination

you find this between lister’s tubercle and the radial styloid

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18
Q
A

radial notch

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19
Q
A

ulnar tuberosity

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20
Q
A

interosseous edge

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21
Q
A

crest for supinator

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22
Q
A

space for the meniscoids

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23
Q
A

space for the meniscoids

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24
Q
A

ulnar tuberosity

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25
radial notch
26
2 alignments to check on lateral elbow
radiocapitellar anterior humeral \*both should bisect the capitellum
27
what is normal proximal ulna dorsal angulation?
5.7° located 47 mm distal to tip of olecranon
28
normal distal humerus articular surface angle
82-84°
29
normal carrying angle
female 15-20° male 10-15°
30
what is baumann angle?
humeral shaft and a line along the lateral condyle normal ~72°
31
what are the orders and ages for ossification of the elbow?
Capitellum = 1 Radial head = 3 Internal (meaning medial epicondyle) = 5 Trochlea = 7 Olecranon = 9 External (meaning lateral epicondyle) = 11
32
what does the angle X show?
this is the anterior angulation of the articular surface of the distal humerus normal is ~30° (what you called anteversion in the last card)
33
where is the coronoid in relation to local structures?
6 mm from joint capsule 12 mm from brachialis 18 mm from MCL
34
anterior capsule
35
radial collateral ligament
36
annular ligament
37
lateral ulnar collateral ligament
38
posterior capsule
39
transverse ligament (part of medial ulnar collateral ligament)
40
anterior bundle (part of medial ulnar collateral ligament)
41
posterior bundle (part of medial ulnar collateral ligament)
42
what does the annular ligament do?
attaches to the anterior and posterior margins of the sigmoid notch of the proximal ulna to hold down the radial head
43
where does the radial collateral ligament insert?
annular ligament!
44
where does the lateral ulnar collateral ligament insert?
tubercle of supinator crest
45
where does the anterior bundle of the medial ulnar collateral ligament insert?
sublime tubercle the primary stabilizer to valgus stress from 20-120°
46
describe the anterior bundle of the MUCL
anterior (more susceptible at extension), central and posterior (more susceptible at flexion) bands
47
what is the role of the transverse band of the MUCL?
unknown - it doesn't span the joint
48
which ligament can be released without causing instability in a stiff elbow?
the posterior bundle of MUCL
49
what provides valgus stability at \<20° or \>120° if the MUCL does the range between?
osseous interaction between the olecranon and trochlea
50
list 3 primary stabilizers of the elbow
ulnohumeral articulation MUCL LUCL
51
list 3 secondary stablizers of the elbow
radial head joint capsule common flexor and exensor origins
52
what is the primary stabilizer of axial stability in the forearm?
intact radial head
53
2 secondary stablizers of the forearm
TFCC (responsible for 8% of the forearm stiffness) interosseous membrane
54
how is force transmitted through the wrist and elbow?
at the wrist the radiocarpal joint takes 80% of the brunt, however, the interosseous membrane redistributes this load so that by the elbow the split is only 60% radiocapitellar
55
what makes up the interosseous membrane of the forearm?
5 kinds of ligaments: central band accessory band distal oblique bundle proximal oblique cord dorsal oblique accessory cord
56
anterior superficial muscles of the forearm (5)
PT FCR PL FCU FDS
57
anterior deep muscles of the forearm (3)
FDP FPL PQ
58
mobile wad muscles (3)
BR ECRL ECRB
59
posterior superficial muscles of the forearm (4)
anconeus ED EDM ECU
60
posterior deep muscles of the forearm (5)
supinator APL EPB EPL EI
61
course of the radial artery
on pronator teres deep to brachioradialis enters the wrist between FCR and brachioradialis
62
course of ulnar artery
deep to pronator teres between FDS and FDP enters wrist between FDS and FCU
63
where does the common interosseous artery come from?
a branch of the ulnar artery, gives off the: - posterior interosseous artery which runs down the posteior compartment between superficial and deep layers - anterior interosseous artery which runs on the volar aspect of the interosseous membrane deep to FDP with AIN
64
list the 4 recurrent arteries of the forearm
radial recurrent anterior ulnar recurrent posterior ulnar recurrent recurrent interosseous
65
course of median nerve in forearm
medial to brachial artery at elbow passes between 2 heads of pronator teres runs between FDS and FDP gives off AIN as it passes 2 heads of PT, then runs on the volar surface of the interosseous membrane
66
muscles AIN supplies
FPL lateral half of FDP PQ
67
order of supply of median nerve
PT FCR PL FDS \*gives off AIN APB FPB OP lumbricals 1/2
68
4 sites of potential compression of the median nerve
1) supracondylar process of humerus and ligament of struthers 2) lacertus fibrosis (thick bicipital aponeurosis) 3) PT 4) sublimis bridge - the fibrotendinous arch that represents the origin of FDS
69
where could AIN be impinged?
PT FDS aberrant vessels accessory muscles like Gantzer's FPL
70
so how do you tell the difference between pronator (median nerve) and AIN syndrome?
no paresthesia in AIN syndrome tinel at anterior elbow in pronator syndrome pain is more proximal in pronator syndrome exacerbated by resisted pronation (AIN should still be strong in pronation)
71
what is the ligament of struthers?
a vestige in ~2% of the population on the distal medil humerus that has a fibrous connection to the medial epicondyle. this can entrap the median nerve causing a palsy. you can tell the difference between this and other median nerve entrapments if there is weakness in pronation
72
what is the sublimis bridge?
an abberant arch of FDS that originates on the medial epicondyle and inserts proximal to pronator teres on the proximal radius which can entrap the median nerve
73
what is Gantzer's accessory FPL
an extra FPL that originates on the medial epicondyle and coronoid process and can entrap the median nerve
74
course of the ulnar nerve
descends anterior to the medial intermuscular septum passes posteriorly through the intermuscular septum passes through arcade of struthers travels posterior to medial epicondyle in cubital tunnel passes into forearm between humeral and ulnar heads of FCU penetrates deep flexor/pronator aponeurosis travels with ulnar artery deep to FDS and FCU on FDP
75
order of supply for ulnar nerve
FCU FDP 3/4 abductor DM opponens DM flexor DM lumbricals 3/4 FPB (deep head only) adductor P interossei
76
7 potential sites of ulnar nerve compression
1) medial intermuscular septum 2) arcade of struthers 3) hypertrophied medial triceps muscle 4) cubital tunnel (arcuate ligament of osborne) 5) anconeus epitrochlearis 6) 2 heads of FCU 7) deep flexor pronator aponeurosis (\>5 cm distal to medial epicondyle)
77
what is the arcade of struthers?
~70% of population thickening of the deep investing fascia of distal arm from medial head of triceps to the intermuscular septum 1.5 - 2 cm width 8 cm proximal to medial epicondyle
78
what is the cubital tunnel?
the space through which the ulnar nerve passes at the elbow bounded by the MCL, joint capsule and olecranon and the arcuate ligament of osborne (an aponeurosis really, from the humeral and ulnar heads of the FCU
79
what is the anconeus epitrochlearis?
an anomalous muscle found in ~10% arises from medial olecranon to medial epicondyle can be muscular or fibrous
80
3 signs of low ulnar nerve palsy
froment (pinch paper) clawing (lumbricals not working) wartenberg (unopposed EDM)
81
what is a Martin-Gruber anastomosis?
15-32% of population essentially, fibres normally in the ulnar nerve travel all the way to mid forearm before joining the ulnar nerve from the median nerve. usually these are the nerves for: 1st DI adductor pollicis abductor DM
82
course of the radial nerve
through triangular interval into spiral groove between lateral head and medial head of triceps penetrates lateral intermuscular septum 10-12 cm proximal to elbow between brachioradialis and brachialis bifurcates into PIN and superficial radial nerve 3-4 cm proximal to leading edge of supinator superficial radial travels under brachioradialis then subcutaneously in distal 1/3 of forearm PIN courses deep to supinator
83
order of supply radial nerve
triceps lateral 1/3 brachialis anconeus brachioradialis ECRL \*then PIN\* ECRB supinator ECU ED EDM APL EPL EPB EI
84
which muscle is last to regain function after a PIN palsy?
EI
85
5 sites of compression of PIN
1) fibrous bands of tissue anterior to radiocapitellar joint between brachialis and brachioradialis 2) Lease of Henry (recurrent radial vessels near neck of radius) 3) leading edge of ECRB 4) arcade of Frohse (the proximal edge of the superficial portion of supinator 5) distal edge of supinator muscle as PIN exits
86
what is the chief complaint in PIN syndrome?
motor loss of wrist and digit/thumb extension
87
what is the chief complaint in radial tunnel syndrome?
proximal lateral forearm pain
88
how do you tell the difference between lateral epicondylitis and radial tunnel syndrome?
the location of pain is on the lateral epicondyle versus 3-4 cm distal in the radial tunnel \*you can also test radial nerve stretch by extending elbow, pronating and flexing wrist
89
where is the SRN most vulnerable to compression?
as it exits the deep tissue at the posterior border of brachioradialis
90
patient presents with pain and dysesthesia on the dorsal radial forearm radiating to the thumb and index finger
this is wartenberg syndrome - entrapment of the superficial radial nerve
91
contents of the cubital fossa from medial to lateral
median nerve brachial artery biceps tendon radial nerve/PIN
92
PT
93
brachioradialis
94
ECRL
95
anconeus
96
FDS
97
PT
98
brachioradialis
99
supinator
100
ECRL
101
anconeus
102
FCU

Orthopedic Surgery Ultimate (88 decks)

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