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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
Q
A

radial notch

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26
Q

2 alignments to check on lateral elbow

A

radiocapitellar

anterior humeral

*both should bisect the capitellum

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27
Q

what is normal proximal ulna dorsal angulation?

A

5.7° located 47 mm distal to tip of olecranon

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28
Q

normal distal humerus articular surface angle

A

82-84°

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29
Q

normal carrying angle

A

female 15-20°

male 10-15°

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30
Q

what is baumann angle?

A

humeral shaft and a line along the lateral condyle

normal ~72°

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31
Q

what are the orders and ages for ossification of the elbow?

A

Capitellum = 1

Radial head = 3

Internal (meaning medial epicondyle) = 5

Trochlea = 7

Olecranon = 9

External (meaning lateral epicondyle) = 11

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32
Q

what does the angle X show?

A

this is the anterior angulation of the articular surface of the distal humerus

normal is ~30° (what you called anteversion in the last card)

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33
Q

where is the coronoid in relation to local structures?

A

6 mm from joint capsule

12 mm from brachialis

18 mm from MCL

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34
Q
A

anterior capsule

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35
Q
A

radial collateral ligament

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36
Q
A

annular ligament

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37
Q
A

lateral ulnar collateral ligament

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38
Q
A

posterior capsule

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39
Q
A

transverse ligament (part of medial ulnar collateral ligament)

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40
Q
A

anterior bundle (part of medial ulnar collateral ligament)

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41
Q
A

posterior bundle (part of medial ulnar collateral ligament)

42
Q

what does the annular ligament do?

A

attaches to the anterior and posterior margins of the sigmoid notch of the proximal ulna to hold down the radial head

43
Q

where does the radial collateral ligament insert?

A

annular ligament!

44
Q

where does the lateral ulnar collateral ligament insert?

A

tubercle of supinator crest

45
Q

where does the anterior bundle of the medial ulnar collateral ligament insert?

A

sublime tubercle

the primary stabilizer to valgus stress from 20-120°

46
Q

describe the anterior bundle of the MUCL

A

anterior (more susceptible at extension), central and posterior (more susceptible at flexion) bands

47
Q

what is the role of the transverse band of the MUCL?

A

unknown - it doesn’t span the joint

48
Q

which ligament can be released without causing instability in a stiff elbow?

A

the posterior bundle of MUCL

49
Q

what provides valgus stability at <20° or >120° if the MUCL does the range between?

A

osseous interaction between the olecranon and trochlea

50
Q

list 3 primary stabilizers of the elbow

A

ulnohumeral articulation

MUCL

LUCL

51
Q

list 3 secondary stablizers of the elbow

A

radial head

joint capsule

common flexor and exensor origins

52
Q

what is the primary stabilizer of axial stability in the forearm?

A

intact radial head

53
Q

2 secondary stablizers of the forearm

A

TFCC (responsible for 8% of the forearm stiffness)

interosseous membrane

54
Q

how is force transmitted through the wrist and elbow?

A

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
Q

what makes up the interosseous membrane of the forearm?

A

5 kinds of ligaments:

central band

accessory band

distal oblique bundle

proximal oblique cord

dorsal oblique accessory cord

56
Q

anterior superficial muscles of the forearm (5)

A

PT

FCR

PL

FCU

FDS

57
Q

anterior deep muscles of the forearm (3)

A

FDP

FPL

PQ

58
Q

mobile wad muscles (3)

A

BR

ECRL

ECRB

59
Q

posterior superficial muscles of the forearm (4)

A

anconeus

ED

EDM

ECU

60
Q

posterior deep muscles of the forearm (5)

A

supinator

APL

EPB

EPL

EI

61
Q

course of the radial artery

A

on pronator teres deep to brachioradialis

enters the wrist between FCR and brachioradialis

62
Q

course of ulnar artery

A

deep to pronator teres

between FDS and FDP

enters wrist between FDS and FCU

63
Q

where does the common interosseous artery come from?

A

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
Q

list the 4 recurrent arteries of the forearm

A

radial recurrent

anterior ulnar recurrent

posterior ulnar recurrent

recurrent interosseous

65
Q

course of median nerve in forearm

A

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
Q

muscles AIN supplies

A

FPL

lateral half of FDP

PQ

67
Q

order of supply of median nerve

A

PT

FCR

PL

FDS

*gives off AIN

APB

FPB

OP

lumbricals 1/2

68
Q

4 sites of potential compression of the median nerve

A

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
Q

where could AIN be impinged?

A

PT

FDS

aberrant vessels

accessory muscles like Gantzer’s FPL

70
Q

so how do you tell the difference between pronator (median nerve) and AIN syndrome?

A

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
Q

what is the ligament of struthers?

A

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
Q

what is the sublimis bridge?

A

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
Q

what is Gantzer’s accessory FPL

A

an extra FPL that originates on the medial epicondyle and coronoid process and can entrap the median nerve

74
Q

course of the ulnar nerve

A

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
Q

order of supply for ulnar nerve

A

FCU

FDP 3/4

abductor DM

opponens DM

flexor DM

lumbricals 3/4

FPB (deep head only)

adductor P

interossei

76
Q

7 potential sites of ulnar nerve compression

A

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
Q

what is the arcade of struthers?

A

~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
Q

what is the cubital tunnel?

A

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
Q

what is the anconeus epitrochlearis?

A

an anomalous muscle found in ~10%

arises from medial olecranon to medial epicondyle

can be muscular or fibrous

80
Q

3 signs of low ulnar nerve palsy

A

froment (pinch paper)

clawing (lumbricals not working)

wartenberg (unopposed EDM)

81
Q

what is a Martin-Gruber anastomosis?

A

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
Q

course of the radial nerve

A

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
Q

order of supply radial nerve

A

triceps

lateral 1/3 brachialis

anconeus

brachioradialis

ECRL

*then PIN*

ECRB

supinator

ECU

ED

EDM

APL

EPL

EPB

EI

84
Q

which muscle is last to regain function after a PIN palsy?

A

EI

85
Q

5 sites of compression of PIN

A

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
Q

what is the chief complaint in PIN syndrome?

A

motor loss of wrist and digit/thumb extension

87
Q

what is the chief complaint in radial tunnel syndrome?

A

proximal lateral forearm pain

88
Q

how do you tell the difference between lateral epicondylitis and radial tunnel syndrome?

A

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
Q

where is the SRN most vulnerable to compression?

A

as it exits the deep tissue at the posterior border of brachioradialis

90
Q

patient presents with pain and dysesthesia on the dorsal radial forearm radiating to the thumb and index finger

A

this is wartenberg syndrome - entrapment of the superficial radial nerve

91
Q

contents of the cubital fossa from medial to lateral

A

median nerve

brachial artery

biceps tendon

radial nerve/PIN

92
Q
A

PT

93
Q
A

brachioradialis

94
Q
A

ECRL

95
Q
A

anconeus

96
Q
A

FDS

97
Q
A

PT

98
Q
A

brachioradialis

99
Q
A

supinator

100
Q
A

ECRL

101
Q
A

anconeus

102
Q
A

FCU

Orthopedic Surgery Ultimate (88 decks)

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