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Year 2 Anatomy of the Limbs > Elbow, forearm and wrist > Flashcards

Elbow, forearm and wrist Flashcards

1
Q

What are the bones of the elbow, forearm and wrist? (x4 groupings)

A

 Humerus

 Radius – lateral.

 Ulna – medial.

 The carpal bones: there are two rows – the proximal row containing the scaphoid, lunate, triquetrum and pisiform; and the distal row containing the trapezium, trapezoid, capitate, hamate.

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2
Q

What is the anatomy of the bones of the elbow?

A

 CAPITULUM: lateral condyle of the humerus that is hemispherical that articulates with the head of the radius – largely anteriorly;

 TROCHLEA: medial condyle that is bobbing-shaped and articulates with the proximal head of the ulna – the condyle extends anteriorly and posteriorly.

 There are MEDIAL and LATERAL EPICONDYLES. The lateral is smaller and rough to allow for attachment with muscles in the POSTERIOR compartment of the arm. The medial is larger and roughened for attachment with muscles in the ANTERIOR compartment of the arm.

 SUPRACONDYLAR RIDGES: are proximal to their respective epicondyles.

 FOSSAE: RADIAL – immediately superior to the capitulum (anteriorly); CORONOID – superior to the trochlear (anteriorly); OLECTRANON – superior to the trochlea (posteriorly).

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3
Q

Relation of the ulnar nerve with the elbow?

A

Passes along posterior surface of the medial epicondyle of the humerus.

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4
Q

What is the anatomy of the bone of the proximal radius?

A

 RADIAL TUBEROSITY is a large and blunt projection on the medial surface to allow attachment of the biceps brachii.

 The OBLIQUE LINE continues diagonally distally from the inferior margin.

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5
Q

What is the anatomy of the bone in the proximal ulnar?

A

 OLECRANON and CORONOID PROCESS hook onto bone.

 Triceps brachii attaches to the olecranon, and the bone articulates with the humerus via the trochlear notch superiorly and the radius via the radial notch laterally.

 Brachialis attaches to the tuberosity of the ulna.

 Supinator crest attaches to the supinator muscles of the forearm.

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6
Q

What connects the radius and ulnar?

A

INTEROSSEOUS MEMBRANE: thin fibrous sheet that connect the medial and lateral borders of the radius and ulnar, passing inferiorly from the radius to the ulnar. It has a free upper margin next to the radial tuberosity and a circular aperture distally to allow vessels to pass.

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7
Q

What is the function of the interosseous membrane? (x4)

A

Connects bones without restricting movement, allows for muscle attachment, separates the anterior and posterior forearm compartment, and transfers force from the hand to the humerus.

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8
Q

What is the anatomy of the bones of the wrist?

A

 The PROXIMAL ROW containing the scaphoid, lunate, triquetrum and pisiform; and the DISTAL ROW containing the trapezium, trapezoid, capitate, hamate.

 The proximal row is involved in the articulation with the radius and ulnar, with exception to the pisiform row, which does not articulate with the forearm.

 The pisiform bone is a SESAMOID bone, meaning that it has no covering membrane of periosteum. Instead, the pisiform bone is embedded within a tendon.

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9
Q

What are the muscle compartments of the elbow, forearm and wrist? (x4)

A

 Anterior compartment of the arm.  Posterior compartment of the arm.  Anterior compartment of the forearm – superficial and deep compartment.  Posterior compartment of the forearm.

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10
Q

Which muscles of the anterior compartment of the arm are relevant to forearm anatomy?

A

Biceps brachii and brachialis, as they act across the elbow.

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11
Q

What muscles of the posterior compartment of the arm are relevant to forearm anatomy?

A

All of them – the Triceps brachii and anconeus.

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12
Q

How are the hands and wrists movements controlled?

A

By muscles in the forearm.

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13
Q

What directions do muscles of the forearm typically exert their movement? !!!

A

Flexor (and pronators) anteriorly; Extensors (and supinators) posteriorly.

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14
Q

What are the muscles of the superior anterior compartment of the forearm? (x5)

A

 Pronator teres (PT).  Flexor carpi radialis (FCR).  Palmaris longus (PL).  Flexor digitorum superficialis (FDS).  Flexor carpi ulnaris (FCI).

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15
Q

What are the muscles of the deep anterior compartment of the forearm? (x3)

A

 Flexor digitorum profundus (FDP).  Flexor pollicuis longus (FPL).  Pronator quadratus (PQ).

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16
Q

What is the common proximal attachment for all superficial anterior forearm muscles?

A

All muscles have a common proximal attachment from the medial epicondyle of the humerus – the COMMON FLEXOR TENDON. For many of the muscles, they ALSO have proximal ulnar attachments.

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17
Q

What is the anatomy of the pronator teres muscle? Action? (x2)

A
  • PROXIMAL ATTACHMENT: medial epicondyle of the humerus via the common flexor tendon, and medial side of the coronoid process of the ulna.
  • DISTAL ATTACHMENT: middle of the lateral surface of the radius.
  • ACTION: pronation of the forearm; flexes elbow.
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18
Q

What is the anatomy of the Flexor carpi radialis muscle? Action?

A
  • PROXIMAL ATTACHMENT: medial epicondyle of the humerus via the common flexor tendon.
  • DISTAL ATTACHMENT: bases of the second and third metacarpal bones.
  • ACTION: flexes and abducts wrist joint.
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19
Q

What is the anatomy of the Palmaris longus muscle? Action? (x2)

A
  • PROXIMAL ATTACHMENT: medial epicondyle of the humerus via the common flexor tendon.
  • DISTAL ATTACHMENT: palmar aponeurosis and flexor retinaculum of the hand (fibrous band that covers the carpal bones on the palmar side of the hand near the wrist).
  • ACTION: wrist flexor; resists shearing forces when gripping.
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20
Q

What is the anatomy of the Flexor digitorum superficialis muscle? Action?

A
  • PROXIMAL ATTACHMENT: medial epicondyle of the humerus via the common flexor tendon, and oblique line of the radius – HAS TWO HEADS.
  • DISTAL ATTACHMENT: four tendon that attach to the palmar surfaces of the middle phalanges of the fingers.
  • ACTION: flexor of fingers.
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21
Q

What is the anatomy of the Flexor carpi ulnaris muscle? Action?

A
  • PROXIMAL ATTACHMENT: medial epicondyle of the humerus via the common flexor tendon, and medial margin on olecranon of the ulna.
  • DISTAL ATTACHMENT: pisiform, and FROM HERE to the hook of the hamate via the pisohamate ligament, and base of the fifth metacarpal bone via the pisometacarpal ligament.
  • ACTION: flexion and abduction of the wrist joint.
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22
Q

How can the superficial muscles (from their common flexor origin) be remembered?

A

See photo.

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23
Q

What is the palmar aponeurosis and what is it formed by?

A

Palmaris longus is relatively small muscle with a long tendon. Its tendon continues past the wrist and forms the PALMAR APONEUROSIS which fans out across the palmar surface to protect the underlying structures. This aponeurosis is a triangular fascia.

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24
Q

What is the flexor retinaculum? What space does it create?

A

Band of connective tissue (attached to tendons of the palmaris longus muscle) that holds down the tendons of the muscles that flex the hand and covers the median nerve. The tendons and median nerve passing beneath the flexor retinaculum, pass through what is called the CARPAL TUNNEL.

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25
Q

How do you test the presence of the flexor retinaculum?

A

Tested by cupping the hand without bending the digits. If the flexor retinaculum is present, the palmar longus muscle will be seen – see photo.

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26
Q

What is the anatomy of the Flexor digitorum profundus muscle? Action? (x2)

A
  • PROXIMAL ATTACHMENT: upper 3/4 of the anterior and medial surface of the ulna, and anterior medial half of the interosseous membrane.
  • DISTAL ATTACHMENT: four tendons, which attach to the palmar surfaces of the distal phalanges of the fingers
  • ACTION: flexes hand and both interphalangeal joints (shown by red arrows).
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27
Q

What is the anatomy of the Flexor pollicuis longus muscle? Action?

A
  • PROXIMAL ATTACHMENT: the middle half of the anterior surface of the radius, and the adjacent interosseous membrane.
  • DISTAL ATTACHMENT: the palmar surface of the base of the distal phalanx of the thumb.
  • ACTION: flexes thumb.
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28
Q

What is the anatomy of the Pronator quadratus muscle? Action? (x2)

A
  • PROXIMAL ATTACHMENT: medial, anterior surface of the ulna.
  • DISTAL ATTACHMENT: lateral, anterior surface of the radius.
  • ACTION: pronates the forearm.
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29
Q

How would you identify on the surface anatomy, the flexor carpi ulnaris tendon?

A

Flex wrist against resistance.

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30
Q

How would you identify on the surface anatomy, the flexor carpi radialis tendon?

A

Flex wrist against resistance.

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31
Q

How do the names of muscles in the forearm help us identify its attachments and function? !!!

A

• Flexors (anterior) and Extensors (posterior) • Movers of the wrist (the “carpi” muscles) act on the radial (radialis) or ulnar (ulnaris) aspects of the forearm. • Movers of the digits: act on GROUPS of digits (digitorum muscles) or on INDIVIDUAL digits (pollicis (thumb), indicis (index finger) digiti minimi (little finger)) (THESE MUSCLES ALSO CONTRIBUTE TO WRIST MOVEMENTS). • Also note that if there’s a longus, there’s a brevis – meaning that if two muscles are named the same (because they have the same attachments), longus denotes that it’s the longest of the two, and brevis denotes it’s the shortest. • If two muscles have the same name again, they can also be differentiated because one may be called superficialis (meaning it’s a superficial muscle), and one is called a profundus (meaning it’s deep). • The main exceptions to this nomenclature are the muscles involved in pronation (anterior) and supination (posterior).

32
Q

What are the names of the muscles of the posterior compartment of the arm? (x12)

A

• MUSCLES THAT MOVE THE WRIST JOINT: • Extensor carpi radialis longus (ECRL) • Extensor carpi radialis brevis (ECRB) • Extensor carpi ulnaris (ECU) • MUSCLES THAT MOVE THE DIGITS: • Extensor digitorum (ED) • Extensor indicis (EI) • Extensor digit minimi (EDM) • MUSCLES THAT MOVE THE THUMB: • Abductor pollicis longus (APL) • Extensor pollicis brevis (EPB) • Extensor pollicis longus (EPL) • OTHER MUSCLES: • Brachioradialis • Supinator • ANCONEUS – don’t forget about this one, although I have excluded it from the rest of this flashcard set.

33
Q

What is the anatomy of the Brachioradialis muscle? Action?

A
  • Let the terminology help you.
  • PROXIMAL ATTACHMENT: Proximal part of the lateral supra-epicondylar ridge of the humerus and adjacent intermuscular septum.
  • DISTAL ATTACHMENT: lateral surface of distal end of radius.
  • ACTION: Accessory flexor of elbow.
34
Q

What is the anatomy of the Extensor carpi radialis longus muscle? Action?

A
  • Let the terminology help you.
  • PROXIMAL ATTACHMENT: distal part of the lateral (radial side) supraepicondylar ridge of humerus and adjacent intermuscular septum.
  • DISTAL ATTACHMENT: dorsal surface of base of metacarpal II.
  • ACTION: extends and abducts the wrist.
35
Q

What is the anatomy of the Extensor carpi radialis brevis muscle? Action?

A
  • Let the terminology help you.
  • PROXIMAL ATTACHMENT: lateral epicondyle of humerus and adjacent intermuscular septum.
  • DISTAL ATTACHMENT: dorsal surface of metacarpals II and III.
  • ACTION: extends and abducts the wrist.
36
Q

What is the anatomy of the Extensor carpi ulnaris muscle? Action?

A
  • Let the terminology help you.
  • PROXIMAL ATTACHMENT: lateral epicondyle of humerus and adjacent intermuscular septum.
  • DISTAL ATTACHMENT: tubercle on the base of the medial side of metacarpal V.
  • ACTION: extends and abducts the wrist.
37
Q

What is the anatomy of the Extensor digitorum muscle? Action?

A
  • Let the terminology help you.
  • PROXIMAL ATTACHMENT: lateral epicondyle of humerus and adjacent intermuscular septum and deep fascia.
  • DISTAL ATTACHMENT: four tendons, which insert via extensor hoods into the dorsal aspects of the bases of the middle and distal phalanges of the fingers.
  • ACTION: extends fingers and wrist.
38
Q

What is the anatomy of the Extensor indicis muscle? Action?

A
  • Let the terminology help you.
  • PROXIMAL ATTACHMENT: posterior surface of ulna (distal to extensor pollicis longus) and adjacent interosseous membrane.
  • DISTAL ATTACHMENT: extensor hood of index finger.
  • ACTION: extends index finger.
39
Q

What is the anatomy of the Extensor digit minimi muscle? Action?

A
  • Let the terminology help you.
  • PROXIMAL ATTACHMENT: lateral epicondyle of humerus and adjacent intermuscular septum.
  • DISTAL ATTACHMENT: extensor hood of the little finger.
  • ACTION: extends the little finger.
40
Q

What is the anatomy of the Abductor pollicis longus muscle? Action? (x2)

A
  • Let the terminology help you.
  • PROXIMAL ATTACHMENT: posterior surfaces of ulna and radius (distal to the attachments of supinator and anconeus) and intervening interosseous membrane.
  • DISTAL ATTACHMENT: lateral side of base of metacarpal I.
  • ACTION: abducts CMC joint of thumb (joint at base of thumb); accessory extensor of the thumb.
41
Q

What is the anatomy of the Extensor pollicis brevis muscle? Action?

A
  • Let the terminology help you.
  • PROXIMAL ATTACHMENT: posterior surface of radius (distal to abductor pollicis longus) and the adjacent interosseous membrane.
  • DISTAL ATTACHMENT: dorsal surface of base of proximal phalanx of the thumb.
  • ACTION: extension of the thumb at metacarpophalangeal joint.
42
Q

What is the anatomy of the Extensor pollicis longus muscle? Action?

A
  • Let the terminology help you.
  • PROXIMAL ATTACHMENT: posterior surface of ulna (distal to the abductor pollicis longus; proximal to extensor indicis) and the adjacent interosseous membrane.
  • DISTAL ATTACHMENT: dorsal surface of base of distal phalanx of thumb.
  • ACTION: extension of the thumb (at the metacarpophalangeal and interphalangeal joints).
43
Q

What is the anatomy of the Supinator muscle? Action?

A
  • PROXIMAL ATTACHMENT: SUPERFICIAL LAYER – lateral epicondyle of the humerus, radial collateral and anular ligaments; DEEP LAYER – supinator crest of the ulnar.
  • DISTAL ATTACHMENT: lateral surface of radius superior to the anterior oblique line.
  • ACTION: supination.
44
Q

What is the anatomical snuffbox?

A

Medial border: tendon of the extensor pollicis longus; lateral border: a pair of parallel tendons – extensor pollicis brevis and the abductor pollicis longus. Proximal border is the styloid process of the radius.

45
Q

What is the clinical significance of the anatomical snuffbox? (x2)

A

The scaphoid bone can be palpated in this region and therefore tested for fracture. It also contains the radial artery.

46
Q

What are the joints of the elbow, forearm and wrist? (x4)

A

Elbow, proximal radio-ulnar, distal radio-ulnar and wrist joints.

47
Q

What is the bone anatomy of the elbow joint? Movement?

A
  • Complex joint involving two articulations:
  • (i) trochlea of the humerus articulated with the ulna – note the notches; (ii) capitulum with the head of the radius. Both these allow flexion and extension at the joint.
  • Both these articulations are held within a common synovial cavity.
48
Q

What is the carrying angle? Difference between males and females?

A

In the anatomical position, the bend in the elbow (the carrying angle), differs between men and women – see photo.

49
Q

What are fat pads in the elbow joint? [Don’t think we need to know this.]

A

Fat pads overlie fossae to accommodate bony processes during extension/flexion to separate the fibrous membrane from the synovial membrane.

50
Q

What are the ligaments of the elbow joint? Function?

A

Thickenings of fibrous membranes of the joint capsule form ligaments, which anchor the radius and ulnar to the humerus (stability of the joint), and support movement of flexion and extension. The ligaments are the medial (ulnar), lateral (radial) collateral ligaments and the annular ligament (part of the proximal radio-ulnar joint).

51
Q

What is the anatomy of the proximal radio-ulnar joint? Movement?

A
  • Articulation between the head of the radius and ulna – involved in pronation and supination.
  • Contained within the same synovial capsule as the articulations of the elbow joint.
  • ANULAR LIGAMENT OF THE RADIUS: laterally reinforces the synovial capsule of this joint and therefore found at the head of the radius. It allows the radial head to slide against the radial notch of the ulnar and pivot on the capitulum during pronation/supination.
52
Q

What is the olecranon bursa?

A

A sac overlying the olecranon process of the elbow beneath the skin. It has a synovial lining but is not an articulation – instead, it reduces friction on movement between the skin, tendons, ligaments, and bone, and allows them to glide smoothly over one another. It frequently becomes inflamed.

53
Q

What is the anatomy of the distal ends of the radius and ulna?

A
  • ULNAR: ulnar head, styloid process (medially – important for muscles attachment).
  • RADIUS: ulnar notch (concave, and articulates with the head of the ulnar forming the distal radio-ulnar joint), styloid process (laterally) and dorsal tubercle (on the ulnar side – called the Lister’s tubercle. It serves as a point of attachment to the extensor pollicis longus and is palpable).
54
Q

What is the anatomy of the distal radio-ulnar joint? Movement?

A
  • Head of the ulnar articulates with the ulnar notch on the end of the radius, with a fibrous articular disc that separates it from the wrist joint.
  • The articular disc is triangular and attached at the apex to the roughened depression of the ulnar between the styloid process and articular surface of the head, and by its base to the angular margin of the radius.
  • This joint allows for the distal end of the radius to move ANTEROMEDIALLY in pronation.
55
Q

What happens to the radial and ulnar bones in pronation?

A

See photo.

56
Q

What is the anatomy of the wrist joint?

A
  • An ‘ELLIPSOID SYNOVIAL JOINT’ between the distal end of the radius, articular disc of the ulna, scaphoid, lunate and triquetrum.
  • Scaphoid and lunate articulates with the radius head; triquetrum with the ulnar articular disc.
  • Note that the carpals don’t directly articulate with the ulna. They instead articulate with the articular disc of the ulna.
  • Articular surface of the carpals forms an oval shape with a convex contour to articulate with the radius and ulnar articular disc.
57
Q

What are the movements of the wrist joint? (x3)

A

Moves on two axes - flexion/extension and ad/abduction. The radial styloid process is larger (i.e. comes out more distally) than the ulnar styloid process, so the hand can be adducted more that it can be abducted. AND circumduction (rotating i.e. pronation and supination of the forearm).

58
Q

What are the ligaments of the wrist? (x6) Function?

A

There are a number of strong ligaments stabilising the wrist joint: the ulnar and radial collateral ligaments, the palmar radio-carpal and palmar ulnocarpal ligaments, the dorsal radio-carpal ligaments, and inter-carpal ligaments.

59
Q

What happens at the wrist joint during pronation of the forearm?

A

The wrist orientates around the ulnar styloid disc, with the ulnar articular disc – see photo.

60
Q

What are alternative names for abduction and adduction in the wrist?

A

Radial deviation and ulnar deviation respectively.

61
Q

What muscles in the arm and forearm are responsible for pronation and supination? (x4 and x5) !!!

A

• SUPINATION: Supinator, Biceps, (Extensor carpi radialis longus, Extensor pollicis longus).  PRONATION: Pronator quadratus, Pronator teres, (Flexor carpi radialis, Palmaris longus and brachioradialis).

62
Q

What is the arterial blood supply of the forearm?

A

 Brachial artery divides at the level of the elbow into ULNAR and RADIAL arteries. The ulnar artery has a common interosseous branch which immediately branches to give the anterior and posterior interosseous arteries.

 The posterior branch pierces the interosseous membrane proximally where it becomes the recurrent interosseus artery to supply the elbow joint and posterior forearm. The anterior interosseous artery also has numerous branches, some of which pass through the distal aperture to supply posterior muscles too.

 In the hand, radial and ulnar arteries anastomose to form the deep and superficial palmar arches.

63
Q

What is the cubital fossa?

A

Space anterior to the elbow joint.

64
Q

What are the boundaries of the cubital fossa?

A

Brachioradialis muscle laterally, pronator teres muscle medially and the line between the humeral epicondyles superiorly.

65
Q

What is the venous drainage of the forearm?

A

 Superficial and deep drainage systems with deep systems following the arteries.

 SUPERFICIALLY drained by cephalic and basilic veins, which arise from dorsal venous arch of the hand.

 Cephalic vein run up the lateral border; Basilic vein runs up the medial border.

 They are commonly connected at the cubital fossa by the median cubital vein.

 Basilic vein joins venea comitantes in the arm to form the axillary vein. Cephalic vein joins the axillary vein in the axilla, and the axillary vein eventually becomes the subclavian vein at the level of the first rib.

 DEEP DRAINAGE follows the arteries – see right photo.

66
Q

What are the antecubital veins? Palpation?

A

Veins found in the cubital fossa – see photo for surface anatomy.

67
Q

What veins in the arm are used for phlebotomy?

A

Median cubital vein – commonly used in phlebotomy. When this is not prominent, the cephalic or basilic can be used to take blood and also found in the region.

68
Q

What are the lymphatics of the forearm and wrist?

A

Run with the superficial and deep veins. Lymph nodes include the CUBITAL LYMPH NODES. There are lymphatic plexuses in the hand. Axillary lymph nodes also drain the elbow.

69
Q

What are the main nerves of the upper limb, and what are their functions? (x4) !!!

A
  • MUSCULOCUTANEOUS (C5-7): supplies anterior compartment of upper arm and is sensory to lateral forearm.
  • ULNAR (C8-T1): courses through the posterior compartment of the upper arm without significant branches. It lies behind the medial epicondyle of the elbow (susceptible to damage), before innervating the hand.
  • MEDIAN (C6-T1): courses through anterior compartment of the arm with no significant branches and lies anteromedially to the elbow with the brachial artery (means it is easily damaged). It descends into the forearm between the HEADS OF THE PRONATOR TERES, before innervating most of the anterior muscles of the forearm
  • RADIAL: (C5-T1): supplies the posterior compartments of the upper and forearm, passing around the body of the humerus at the midshaft along the radial groove. It supplies the triceps, then courses through the anterior compartment of the upper arm more distally before dividing at elbow into a DEEP BRANCH: the posterior interosseous nerve (motor); and a SUPERFICIAL BRANCH: the superficial radial nerve (sensory). Radial supplies the posterior muscles of the forearm.
70
Q

How are the muscles of the anterior compartment of the forearm innervated? (!!!)

A

 Flexor carpi radialis: Median Nerve (C6-7).  Pronator teres: Median Nerve (C6-7).  Palmaris longus: Median Nerve (C7-8).  Flexor pollicis longus: Median Nerve (C7-8).  Pronator quadratus: Median Nerve (C7-8).  Flexor digitorum superficialis: Median Nerve (C8-T1).  Flexor carpi ulnaris: Ulnar Nerve (C7-T1).  Flexor digitorum profundus: lateral half of the muscle is innervated by the Median Nerve (C7-8); medial (ulnar) half of the nerve is innervated by the Ulnar Nerve (C8-T1).

71
Q

How are the muscles of the posterior compartment of the forearm innervated? (!!!)

A

• Extensor carpi radialis longus, Extensor carpi radialis brevis and Brachioradialis: Radial nerve before its division (C5-7). • Extensor carpi ulnaris, Extensor digitorum, Extensor indicis, Extensor digit minimi, Abductor pollicis longus, Extensor pollicis brevis, Extensor pollicis longus, Supinator: Posterior interosseous nerve (radial nerve – C7-8).

72
Q

What is the best way to study a muscle in surface anatomy?

A

Ask the subject to bring about movement of the muscle (muscle action) whilst the examiner opposes the movement, makes the muscle belly prominent and readily palpable; e.g. to identify the biceps muscle, the subject is instructed to flex the elbow whilst the examiner applies an opposing force against the flexion.)

73
Q

The wrist joint is not the only joint that allows flexion and extension at the wrist region: What else can bring about this movement? (x2)

A

The midcarpal joint and the carpo-metacarpal joints also allow these movements.

74
Q

How can the brachial artery pulse be palpated?

A

Extend the elbow and palpate medial to biceps tendon in the cubital fossa.

75
Q

What is the bicipital aponeurosis? Function? (x2) Palpation?

A

Broad aponeurosis of the biceps brachii which is located in the cubital fossa of the elbow and separates superficial from deep structures in much of the fossa. It overlies the medial nerve and brachial artery.

Year 2 Anatomy of the Limbs (8 decks)

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