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Anatomy of the limbs > Elbow, forearm and wrist > Flashcards

Elbow, forearm and wrist Flashcards

1
Q

What are the carpal bones?

A

proximal: scaphoid, lunate, triquetrium, pisiform
distal: trapezium, trapezoid, capitate, hamate

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2
Q

Which side is the capitulum and which side is the trochlea?

A

capitulum - lateral

trochlea - medial

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3
Q

What is the importance of the radial tuberosity?

A

Th biceps brachii attaches here

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4
Q

What is the structure of the capitulum and trochlea?

A

Capitulum - ball like

Trochlea - pulley shape

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5
Q

What is the name of the part of the ulna that articulates with the humerus and where does it fit in?

A

coronoid process into the coronoid fossa

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6
Q

Which fossa does the radius fit into in the ulna?

A

radial fossa

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7
Q

What fossa is found posteriorly on the humerus and what fits in there?

A

Olecranon fossa - olecranon process

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8
Q

What do both the ulna and radius have at their distal ends?

A

styloid prcoess

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9
Q

Which membrane connects the ulna and radius?

A

interosseous membrane

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10
Q

What is the importance of the interosseous membrane?

A

mechanical - forces are transmitted between the bones

structural - attachment site for muscles and seperates the anterior and posterior forearm compartments

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11
Q

What is the annular ligament?

A

Strong band of fibres that encircles the head of the radius and retains it in contact with the radial notch of the ulna

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12
Q

Which carpal bone (proximal row) doesn’t articulate with the radius or ulna?

A

pisiform

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13
Q

What type of bone is the pisiform?

A

sesamoid bone - a bone that forms within a tendon e.g. the patella

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14
Q

What forms from the biceps and attaches to the radial tuberosity?

A

bicipital tendon

biceps also forms a biceps aponeurosis

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15
Q

Describe the attachment of the brachialis muscle

A

It attaches to the mid-distal part of the shaft of the humerus and then crosses over the elbow joint and attaches to the coracoid process of the ulna

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16
Q

What is the role of brachialis?

A

flexor

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17
Q

What does the triceps form and what does it attach to?

A

Three heads converge to form a tendon that crosses the elbow and attaches to the olecranon process of the ulna

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18
Q

What is the attachment of anconeus?

A

Lateral epicondyle of the humerus and the lateral and upper part of the ulna shaft

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19
Q

What is the role of the anconeus?

A

A small muscle that is important in stabilisation during some movements

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20
Q

How is the forearm divided?

A

Anterior - divided into superficial and deep

Posterior

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21
Q

Where do the forearm muscles originate?

A

the distal humerus, radius and ulna

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22
Q

Where are the flexors , pronators and extensors, supinators found?

A

flexors and pronators - anterior

extensors and supinators - posterior

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23
Q

What is found in the superficial anterior compartment of the forearm?

A
  • pronator teres
  • flexor carpi radialis
  • palmaris longus
  • flexor digitorum superficialis (not everyone has this)
  • flexor carpi ulnaris
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24
Q

What is found in the deep anterior compartment of the forearm?

A
  • flexor pollicis longus
  • flexor digitorium profundus
  • pronator quadratus
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25
Q

Where do the superficial muscles originate?

A

distal humerus (medial epicondyle) - the common flexor tendon

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26
Q

Where is pronator teres and what does it do?

A

wraps around radius, pronates the arm

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27
Q

Where is flexor carpi radialis and what does it do?

A

Flexor on the radial side

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28
Q

Where is flexor carpi ulnaris and what does it do?

A

Flexor on the ulnar side

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29
Q

Where is flexor digitorium superficialis?

A

second layer beneath flexor carpi radialis/ulnaris and pronator teres

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30
Q

What is in the third layer (deep)?

A
  • flexor digitorium profundus

- flexor pollicis longus

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31
Q

What is found deep to the third layer?

A

pronator quadratus

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32
Q

What does pronator quadratus do?

A

Small quadratus muscle that attaches at the anterior surface of the distal parts of the ulnar and radial shaft

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33
Q

What forms the roof of the carpal tunnel?

A

flexor retinaculum (transverse ligament)

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34
Q

What is the antebrachial fascia?

A

continuous with the brachial fascia - it is a deep fascia of the arm

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35
Q

Describe the antebrachial fascia

A

Dense, membrane which forms a sheath for the muscles in the region

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36
Q

What are the attachments of the antebrachial fascia?

A

olecranon and the dorsal border of the ulna

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37
Q

What merges with the antebrachial fascia?

A

bicipital aponeurosis

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38
Q

What is found at the wrist to hold down the tendons?

A

retinaculum

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39
Q

Where are the extensor muscles found?

A

posterior compartment

40
Q

What are the muscles that move the wrist joint?

A
  • Extensor carpi radialis longus
  • Extensor carpi radialis brevis
  • Extensor carpi ulnari
41
Q

What are the muscles that move the digits?

A
  • Extensor digitorum
  • Extensor indicis
  • Extensor digit minimi
42
Q

What are the muscles that move the thumb?

A
  • Abductor pollicis longus
  • Extensor pollicis brevis
  • Extensor pollicis longus
43
Q

What are the other extensor muscles?

A

brachioradialis and supinator

44
Q

What are the attachments for supinator?

A

Lateral epicondyle of the humerus and the supinator crest of the ulna
Attaches to lateral and posterior surface of radius

45
Q

Where is the attachment for some of the extensors?

A

common extensor tendon on the lateral epicondyle

46
Q

Where else may extensor muscles originate?

A

interosseous membrane, ulnar and radial shafts

47
Q

What is the role of supinator?

A

When forearm is pronated, it supinates it

48
Q

What does pollicis, indicis and digiti minimi mean?

A

pollicis (thumb)

indicis (index finger) digiti minimi (little finger)

49
Q

What is the anatomical snuff box and its importance?

What is found in it?

A

Tendons of extensor pollicis longus and extensor pollicis brevis - within the depression is the radial artery, the scaphoid can be palpated too

Important in determining if the scaphoid might be fractured: a common injury.

50
Q

Why is it important to determine a scaphoid injury?

A

Can fracture when putting hands out to break fall

  • Its blood supply comes from arteries that have entered the wrist, gone past scaphoid and then given branches back
  • So a scaphoid fracture can result in an interruption of blood supply to a more proximal part (e.g. part involved in the wrist joint) -> avascular necrosis of the bone (can be very debilitating)
51
Q

What are the joints of the forearm?

A

Elbow joint, proximal radio-ulnar joint, distal radio-ulnar joint, wrist joint

52
Q

What kind of a joint is the elbow joint?

What movements can it do?

A

hinge

flexion and extension

53
Q

What are the ligaments associated with the elbow and what are their roles?

A

collateral (ulnar and radial collateral ligaments) - prevents deviation

radial annular ligament - allows rotation for supination and pronation

54
Q

What is the difference in the sexes in the elbow carrying angle?

A

The carrying angle (the angle that the forearm deviates from vertical compared to the arm) is greater in women than in men. One obvious reason for this may be the difference in the relative width of the hips (the pelvis).

55
Q

Proximal radio-ulnar joint

A
  • Head of radius is held close to the proximal part of ulna
  • Head of radius articulates with the capitulum as part of the elbow joint
  • On the joint is a rim, allowing the head of radius to also articulate with the radial notch of ulna
  • When radius is pronated it is held in place at the proximal RUJ and crosses over ulna to bring about pronation
56
Q

Distal radio-ulnar joint

A
  • Ulna and radius articulates with the 3 bones of the proximal row of carpals (not pisiform)
  • On an x-ray, there is a bigger gap between the ulna and the bones because there is an intervening articular disc
  • The ulna actually articulates with this disc, that in turn articulates with the proximal carpal bones
57
Q

Does the distal ulna articulate with the triquetrium carpal bone directly?

A

No it attaches to the articular disc - this moves a bit during pronation and supination

58
Q

What causes flexion and extension at the elbow joint?

A

Flexion: brachialis, biceps, brachioradialis and pronator teres

Extension: triceps and anconeus

59
Q

What causes supination and pronation?

A

supination: supinator, biceps (EPL, ECRL)
pronation: pronator teres, pronator quadratus (FCR, PL and brachioradialis)

60
Q

What happens in the supine and prone positions and to which muscles?

A
  • In the supine position the pronator teres is stretched around the bone
  • It is attached to the lateral side of the shaft of the humerus
  • Pronator quadratus is stretched into its approximately quadrate shape
  • Supinator has contracted here, and has pulled the radius round so that the bones are parallel again
  • In the prone position, the pronator teres has contracted and has rotated the radius round, as has pronator quadratus
61
Q

What are the muscles causing flexion, extension, abduction and adduction at the wrist?

A

Flexion –FCR, FCU, PL, APL

Extension –ECU, ECRL, ECRB

Abduction –FCR, ECRL, ECRB, APL

Adduction –FCU, ECU

62
Q

Describe wrist movement

A
  • There is a combination of muscles involved in the various movements of the wrist joints
  • If the flexor muscles work together, you’ll get straightforward flexion
  • If just one of them works, you’ll get slight deviation one way or the other
  • In order to get abduction or adduction, there is a flexor and an extensor working
63
Q

GO OVER WRIST ABDUCTION, ADDUCTION, FLEXION AND EXTENSION

A

learn what they look like

64
Q

What are the arteries in the forearm and what do they come from?

A
  • At the elbow, the brachial artery divides into the ulnar and radial arteries
  • Ulnar passes anteriorly then down the ulnar side and is medial to wrist joint
  • Radial descends down lateral arm
  • The ulnar artery branches almost immediately to give a common interosseous branch
  • Common interosseous branch immediately branches to give anterior & posterior interosseous arteries
65
Q

What is the cubital fossa?

A

Space anterior to the elbow joint

66
Q

What type of joints are the proximal and distal radio-ulnar joints?

A

pivot type synovial

67
Q

How is the biceps tested for?

A

flex arm against resistance

68
Q

How is the triceps tested for?

A

extend forearm against reisistance

69
Q

How is the brachioradialis tested for?

A

elbow flexed against resistance with forearm in midprone position

70
Q

How is flexor carpi radialis, flexor carpi ulnaris and palmaris longus tested for?

A

wrist flexed against resistance

71
Q

What are the wrist joint movements?

A
  • flexion, extension

- radial deviation and ulnar deviation (abduction and adduction)

72
Q

What kind of joint is the wrist joint?

A

ellipsoid synovial joint

73
Q

Which ligaments stabilise the wrist?

A
  • The ulnar collateral ligament
  • The radial collateral ligament
  • The palmar radio-carpal ligament
  • The palmar ulnocarpal ligament
  • The dorsal radio-carpal ligament
  • The inter-carpal ligaments
74
Q

What does the ulnaar artery supply?

A

medial muscles of forearm

75
Q

Where does the ulnar artery end?

A

In the hand to form the palmar arches with the radial artery

76
Q

Describe the lymphatic drainage of the forearm

A
  • Superficial and deep systems, running with veins
  • Cubital lymph nodes drain the forearm (usually 3 or 4 lymph nodes, often on the medial side)
  • Axillary nodes are also draining nodes for the distal parts of the upper limb
77
Q

Why may cubital lymph nodes be enlarged?

A

If they are enlarged, this may indicate HIV status or syphilis

78
Q

What are the main nerves of forearm?

A
  • median
  • ulnar
  • radial
79
Q

Describe the venous drainage of the forearm

A
  • Major superficial veins: cephalic vein and the basilic vein
  • The cephalic vein ascends the upper limb on its lateral side, whilst the basilic vein runs medially
  • Arise from the lateral and medial sides, respectively, of the dorsal venous arch on the posterior surface of the hand
  • Median cubital vein connects the cephalic and basilic veins at the level of the elbow
  • Deep veins (venae comitantes) accompany the radial and ulnar arteries
  • They eventually flow to the brachial vein in the arm
80
Q

What is the importance of the median cubital vein?

A

It is a common site for venepuncture and is variable in its anatomy. If it isn’t found cephalic or basilic can be used instead

81
Q

What is important about venous connections between superficial and deep veins?

A

Valves allowing one-way flow from the superficial to the deep system

82
Q

At which place does the axillary vein become the subclavian?

A

at level of the first rib

83
Q

What is the pathway of the ulnar nerve?

Which spinal nerves is it made of ?

A

C8, T1

  • It has no branches in the arm and initially descends in its anterior compartment, but distally passes into the posterior compartment to lie superficially, posterior to the medial epicondyle of the elbow (risk of damage)
  • It enters the forearm passing between the heads of flexor carpi ulnaris, and then descends on the medial side of the forearm,
  • At the wrist, the ulnar nerve lies between the FCU (medially) and the ulnar artery (laterally) and then passes into the hand
84
Q

What does the ulnar nerve do?

A
  • Supplies the more medial muscles in the anterior compartment
  • Supplies: flexor carpi ulnaris (FCU), medial portion of flexor digitorum profundus (FDP) i.e. to the ring and little finger
  • Gives sensory supply to the medial aspect of the ventral forearm
  • It supplies most of the intrinsic muscles of the hand
85
Q

Which nerves make up the median nerve?

Describe its pathway

A

C6,7,8, T1

  • It descends in the anterior compartment of the arm, within which it does not give any branches
  • Anterior to the elbow, it lies medial to the brachial artery, where it is at risk of damage by supracondylar fractures of the humerus
  • The median nerve then descends into the forearm between the heads of pronator teres
  • At the anterior wrist, the median nerve lies quite superficially between the tendons of FDS and FDP and deep to palmaris longus, prior to entering the hand through the carpal tunnel
86
Q

What does the median nerve do?

A
  • Principal motor nerve of the anterior compartment
  • In the forearm it supplies: pronator teres, FDS, lateral portion of FDP (to the index and middle fingers), FCR, pronator quadratus and palmaris longus
  • Supplies half of flexor digitoruium profundus
87
Q

Which nerves make up the radial nerve?

Describe its pathway

A

C5,6,7,8 and T1

  • It lies on the humerus in the radial (spiral) groove where it is at risk in humeral shaft fractures
  • Just superior to the elbow it divides into the superficial radial nerve (cutaneous sensory) and the deep branch of the radial nerve (motor), which descends into the forearm between the heads of supinator, to become the posterior interosseous nerve
  • It ends as a pseudoganglion below the extensor retinaculum
88
Q

What does the radial nerve do?

A
  • Supplies the posterior (extensor) compartment of the arm
  • Supplies triceps
  • Divides above elbow to deep branch (mposterior interosseous nerve -motor to mainly extensors) and superficial (superficial radial nerve - sensory)
89
Q

What are the boundaries of the cubital fossa?

A
  • Brachioradialis muscle (lateral)
  • Pronator teres muscle (medial)
  • The line between the humeral epicondyles (superior)
90
Q

What do the radial, ulnar and median nerve supply briefly?

A

Radial Nerve supplies all posterior compartment muscles.

Ulnar Nerve supplies only FCU and the Ulnar half of FDP.

Median Nerve supplies all of the remaining anterior compartment muscles.

91
Q

What are the anterior compartment superficial flexors?

A

Pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris, flexor digitorum superficialis

92
Q

What are the anterior compartment deep flexors?

A

Flexor policis longus, flexor digitorum profundus, pronator quadratus.

93
Q

What are the posterior compartment superficial muscles?

A

Brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi, extensor carpi ulnaris, anconeus

94
Q

What are the posterior compartment deep muscles?

A

Supinator, abductor pollicus longus, extensor pollicis brevis, extensor pollicis longus, extensor indicis

95
Q

What is found in the cubital fossa?

A
  • radial nerve
  • biceps tendon
  • brachial artery
  • median nerve
    (lateral to medial)
96
Q

What muscles cause flexion and extension at the elbow?

A

Brachialis, Brachioradialis & Biceps Brachii

Triceps

Anatomy of the limbs (5 decks)

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