Elbow, forearm and wrist Flashcards by George Ratcliffe

Name the carpal bones.

1st row – scaphoid, lunate, triquetrum, pisiform

2nd row – hamate, capitate, trapezoid, trapezium

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What are the two articular surfaces of the distal humerus and what do they articulate with?

Capitulum – articulates with the head of the radius

Trochlea – articulates with the head of the ulna

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What is the importance of the epicondyles of the humerus?

They are important sites of attachment of forearm muscles

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Which fossae are present on the anterior side of the distal humerus?

Radial fossa
Coranoid fossa (the coranoid process of the ulna slots in here when the elbow is flexed)

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Which fossa is present on the posterior side of the distal humerus?

Olecranon fossa – the olecranon process of the ulna slots in here when the elbow is extended

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Where are tuberosities found near the elbow joint?

Radial tuberosity

Ulnar tuberosity

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What are the two ridges running down the anterior and posterior of the radius?

Anterior oblique line

Posterior oblique line

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What does the distal end of the ulna articulate with

An articular disc (not with carpal bones)

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What does the distal end of the radius articulate with?

Scaphoid and lunate

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What separates the anterior and posterior compartments of the forearm?

Interosseous membrane

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Which carpal bone is a sesamoid bone and which muscle tendon is it enclosed in?

Pisiform

It is within the flexor carpi ulnaris tendon

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What is the distal attachment of biceps brachii?

Radial tuberosity

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What is the distal attachment of brachialis?

Coronoid process of ulna

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What is the distal attachment of triceps?

Olecranon process

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Which compartment are the pronators and supinators in?

Pronators – anterior

Supinators – posterior

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Which muscles are in the superficial anterior compartment of the forearm?

Pronator teres 
Flexor carpi radialis 
Palmaris longus 
Flexor digitorum superficialis 
Flexor carpi ulnaris

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Which muscles are in the deep anterior compartment of the forearm?

Flexor digitorum profundus
Flexor pollicis longus
Pronator quadratus

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What is the common flexor origin?

Medial epicondyle of the humerus – this is where most of the anterior compartment muscles (particularly the superficial muscles) originate

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Which of the superficial anterior compartment muscles do not cross the wrist?

Pronator teres

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Describe the attachments of pronator quadratus.

It is attached between the distal ends of ulna and radius

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What forms the roof of the carpal tunnel?

Flexor retinaculum

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Which tendon is continuous with the palmar aponeurosis?

Palmaris longus tendon
NOTE: palmaris longus tendon isn’t present in everyone and before it spreads to form the palmar aponeurosis, it is attached to the flexor retinaculum

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Name all the muscles in the extensor compartment of the forearm.

Muscles that move the wrist:
Extensor carpi radialis longus 
Extensor carpi radialis brevis 
Extensor carpi ulnaris 
Muscles that move the fingers:
Extensor indicis 
Extensor digitorum
Extensor digiti minimi
Muscles that move the thumb:
Abductor pollicis longus 
Extensor pollicis longus 
Extensor pollicis brevis 
Others:
Brachioradialis 
Supinator

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Where is the common extensor origin?

Lateral epicondyle of the humerus

What can be palpated in the anatomical snuffbox?

Scaphoid (this is often fractured when trying to break a fall)

Which tendons mark the anatomical snuffbox?

Lateral – Extensor Pollicis Brevis + Abductor Pollicis Longus Medially – Extensor Pollicis Longus

Which blood vessel is present in the anatomical snuffbox?

Branch of the radial artery

What does the head of the radius articulate with?

Capitulum

What are the main ligaments found at the elbow joint?

Radial collateral ligament Ulnar collateral ligament Anular ligament

What are the three parts of the ulnar collateral ligament?

Anterior band Posterior band Oblique band

What is the role of the anular ligament?

It goes around just under the head of the radius and it helps hold the radius in place It allows the radius to rotate

Describe the difference in carrying angle between genders.

Men – 10-15 degrees | Women - > 15 degrees

Describe the articulation of the radius and ulna with the carpal bones.

The distal end of the radius articulates with scaphoid and lunate The distal end of the ulna does not directly articulate with the carpal bones, it articulates with an articular disc

What is the name given to the joint between the first and second rows of carpal bones?

Midcarpal joint

``` Which nerves are responsible for: Elbow flexion Elbow extension Wrist flexion Wrist extension ```

``` Elbow flexion C56 Elbow extension C78 Write flexion C67 Wrist extension C67 ```

Which muscles are involved in supination?

Supinator Biceps brachii (EPL, ECRL)

Which muscles are involved in pronation?

Pronator teres Pronator quadratus (FCR, PL, brachioradialis)

Describe how the biceps contribute to supination.

The biceps tendon inserts into the radial tuberosity When prone, the radial tuberosity is turned posteriorly So then when the biceps contract, it will pull the tuberosity back around

``` Which muscles are important for: Flexion of the wrist Extension of the wrist Radial deviation (abduction) Ulnar deviation (adduction) ```

``` Flexion of the wrist FCU, FCR (APL, PL) Extension of the wrist ECRL, ECRB, ECU Radial deviation (abduction) ECRL, ECRB, FCR, APL Ulnar deviation (adduction) ECU, FCU ```

What is an important branch of the ulnar artery?

Common interosseous branch | This splits into the anterior and posterior interosseous arteries

What are the arterial arches of the hand made up of?

Anastomosis of the radial and ulnar arteries

What is the name given to the space anterior to the elbow and what are its boundaries?

Cubital fossa Superior border – line between the medial and lateral epicondyles of the humerus Medial border – lateral border of pronator teres Lateral border – medial border of brachioradialis

What happens to the biceps aponeurosis in this area?

It merges with the fascia of the region

What important vessels and nerves pass through the cubital fossa?

Brachial artery and veins | Median nerve

Describe the arrangement of superficial veins in the upper limb.

The cephalic vein (runs laterally) and the basilic vein (runs medially) originate from the dorsal venous arch of the hand The basilica vein joins venae commitantes to form the axillary vein in the arm The cephalic vein joins the axillary vein at the axilla The axillary vein becomes the subclavian vein at the level of the 1st rib NOTE: there is normally a median cubital vein joining the cephalic and basilic at the cubital fossa

Describe the deep venous drainage of the upper limb.

The deep venous drainage of the upper limb runs in reverse to the arterial supply

What are the two venous arches present on the palmar side of the hand?

Superficial venous palmar arch | Deep venous palmar arch

Where lymph nodes are found in the upper limb?

Cubital lymph nodes | Axillary lymph nodes

Name the difference subsets of axillary lymph nodes.

``` Pectoral Central Apical Subscapular Humeral ```

``` State which spinal nerves roots make up: Musculocutaneous nerve Radial nerve Median nerve Ulnar nerve ```

``` Musculocutaneous nerve C567 Radial nerve C5678 T1 Median nerve C678 T1 Ulnar nerve C8 T1 ```

What is the role of the musculocutaneous nerve in the forearm?

It has a lateral cutaneous branch, which provides sensory innervation to the lateral part of the forearm

Describe the passage of the median nerve through the arm.

Courses through the anterior compartment and lies anterior to the elbow, with the brachial artery It is the main nerve to the muscles of the anterior compartment of the forearm

Where can the median nerve be damaged easily?

Elbow and wrist

Where is the ulnar nerve easily damaged?

It lies behind the medial epicondyle of the humerus where it can easily be damaged It can also be damaged at the wrist

Where is the radial nerve easily damaged?

It lies close to the humerus in the radial groove so fractures of the humerus could damage the radial nerve It can also be damaged in the axillary region

What two branches does the radial nerve divide into?

Posterior interosseous nerve (motor) | Superficial radial nerve (sensory)

Which muscles of the forearm does the ulnar nerve supply?

FCU | Ulnar half of FDP

What is the role of the flexor retinaculum?

It holds down the long tendons and prevents them from bowing