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Exam 2 Flashcards

0
Q

Type II AC separation

A

Torn AC capsule and ligament c slight elevation of lateral end of clavicle relative to acromion

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1
Q

Type I AC separation

A

STRAINED AC capsule and ligament (collagen microtears)

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2
Q

Type III AC separation

A

Torn AC capsule, ligament, coracoclavicular ligament c MARKED elevation of lateral clavicle

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3
Q

Ligaments of SC joint

A

Thin anterior SC
Thick posterior SC
interclavicular
costoclavicular

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4
Q

Bankart lesion

A

torn anterior glenoid labrum

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5
Q

Hill-Sachs deformity

A

flattened/defective humeral head; increases likelihood of anterior GH dislocation

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6
Q

Structures to go through in anterior surgical approach of GH joint (2 muscles, 3 tendons, 1 bursa, 1 other)

A

Deltoid, pec
corabrachialis, short head biceps
subscapular bursa
capsule

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7
Q

enlargement of what structures would reduce space between humeral head and coracoacromial arch? (1 bone, 2 lig, 2 tendons, 1 bursa)

A

acromion
coracoacromial L., coracohumeral L.
supraspinatus tendon, long head of bicep tendon
subacromial bursa

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8
Q

damage to suprascapular nerve would affect sensation in which joint(s)? what about to axillary nerve?

A

Both: GH and AC joints

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9
Q

scapular GH group (5 muscles)

A 
trapezius
rhomboid minor
rhomboid major
levator scapulae
serratus anterior
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10
Q

serratus anterior (nerve, action, attachments)

A

Long thoracic N. (C5-7)
Scap. protract., upward rotation, stabilize scapula against ribs
vertebral border (ant. scap.)//ribs 1-9

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11
Q

Muscles of anterior GH group (6)

A 
Pec major
Pec minor
Subclavius
Coracobrachialis
Long head Biceps
Short head Biceps
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12
Q

Pectoralis Major (nerve, attachment, action)

A

Lateral pectoral N. (C5-7):clavicular, upper sternal
Medial pectoral N. (C8,T1): lower sternal, costal

Medial clavicle, sternum, costal cartilage 1-6//crest of gr. tubercle

  • Ant. tendon (clavicular/upper sternal)
  • post tendon (lower sternal/costal)

GH adduction, IR,flexion (in ext. position), extension (in flexed position)

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13
Q

Pectoralis Minor (nerve, attachment, action)

A

Medial Pectoral N. (C8,T1)
medial coracoid//mid ribs 3-5
scapular depression, anterior tilt, downward rotation, stabilize against rib cage

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14
Q

Subclavius (nerve, attachment, action)

A

Nerve to subclavius (C5,6*)
subclavius groove//superior 1st rib-cartilage junction
clavicular depression, stabilize

*little if any contribution

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15
Q

3 muscles of posterior GH group

A

Teres Major
Latissimus Dorsi
Long Head Triceps

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16
Q

Teres Major (nerves, attach, action)

A

Lower Subscapular N (C5,6)
inferior dorsal scapula (lateral border)//crest of lesser tbrcle
GH adduction, IR, extension?

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17
Q

Muscles of sup. GH group (3)

A

Ant delt
Mid delt
Post delt

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18
Q

Deltoid (nerve,attach,action)

A 
Axillary N. (c5,6)
Ant delt:distal clavicle//delt tub
 Flex,and,IR of humerus
Mid delt: acromion//delt tub
 Abd
Post delt: distal scap spine//delt tub
 Ext,abd,ER
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19
Q

Infraspinatus(nerve,trunk)

A

Suprascapular(c5,6)

Superior trunk

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20
Q

Supraspinatus(nerve,trunk)

A

Suprascapular(c5,6)

Superior trunk

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21
Q

Teres minor(nerve)

A

Axillary(c5,6)

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22
Q

Subscapularis N.(nerve, cord)

A

Upper Subscapular N. (*lower Subscapular n)

Posterior cord

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23
Q

Scapulothoracic upward rotators

A

Upper/lower trap, serratus ant

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24
Q

Scapulathoracic downward rotators

A

Rhomboids, levator, pec minor

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25
Q

Boundaries of axillary region

A

A/P: Pec major, scapula

M/L: ribs (1-7),bicipital groove

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26
Q

Anterior/Posterior axillary fold

A 
Pec Major (ant)
Lats,teres major (post)
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27
Q

Axillary A. (Boundary, branch)

A

Lateral border 1st rib//superior border of pec minor

Supreme (highest) thoracic A. (1st/2nd intercostal space, upper serratus ant.)

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28
Q

part II of Axillary A. (Boundary, branches)

A 
Deep to pec minor
1.thoracoacromial A. 
 A. acromial: acromion, AC joint
 B.pectoral: pec major
 C. deltoid: deltoid, pec major
D. clavicular: SC joint

2.Lateral thoracic A. (pec major/minor, serratus ant, breast)

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29
Q

Part III of Axillary A. (boundary, branches)

A

Inferior border of Pec minor//inferior border of teres major
Subscapular A.
A. circumflex scapular A: posterior scapular muscles
B.Thoracodorsal A: lats
Anterior humeral circumferential A. (delt, ant. GH jt)
Posterior humeral circumferential A. (delt, triceps,post/lat GH jt)
*communicates c ant circumferential A. at anterolateral surgical neck
*often branches off Subscapular A. rather than Axillary A.

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30
Q

Borders of Axillary v.

A

Inferior teres major//lateral border 1st rib

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31
Q

Boundaries of part I, II of Axillary A?

A

Part I: lateral first rib//sup pec minor

Part II: sup pec minor//inf pec minor

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32
Q

Blockage of part II of Axillary A will affect what branches of this artery?

A 
Thoracoacromial A: 
 A.acromial: acromion, AC joint
 B.clavicular: SC joint
 C.pectoral: pec major
 D.deltoid: deltoid, pec major

Lateral Thoracic A: pec major/minor, serratus anterior, breaststststs

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33
Q

Blockage of part III of Axillary A. will affect which branches of Axillary A?

A

1.Subscapular A:
A. Circumflex scapular A:posterior scapular muscles
B. Thoracodorsal A: lats
2. Anterior humeral circumflex A: anterior GH joint, deltoid

  1. Posterior humeral circumflex A: posterior/lateral GH joint, deltoid, triceps.
    * often arises from Subscapular A. versus Axillary A.
    * anastomoses w/ anterior humeral circumflex A. at posterolateral surgical neck
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34
Q

Axillary Vein location

A

Inferior Teres Major//lateral border first 1st rib

Basilic V. –>Axillary V. –>Subclavian V. –>Brachiocephalic V.

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35
Q

Basilic Vein

A

superficial medial arm, forearm, hand

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36
Q

Cephalic V.

A

lateral arm, forearm, hand

Runs through deltopectoral groove (ant delt//pec major)–>enters Axillary V. here at deep proximal end

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37
Q

Veins at cubital fossa

A

median cubital vein (runs medially upward from cephalic –> basilic)
median antebrachial vein: drains superficial ant. forearm; runs between basilic and cephalic on anterior forearm

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38
Q

Veins that enter Axillary V?

A
  1. Supreme Thoracic V.
  2. Lateral Thoracic V.
  3. Cephalic V. (instead of thoracoacromial)
  4. Subscapular V.
  5. Anterior Humeral Circumflex V.
  6. Posterior Humeral Circumflex V.
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39
Q

Musculocutaneous N (spinal segment, cord)

A

C5,6,7*
lateral cord
biceps, brachialis (5,6)
coracobrachialis (5,6,7)

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40
Q

Axillary N (segment, cord)

A

C5,6
posterior cord
deltoid
teres minor

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41
Q

Medial N (segment, cord)

A

C5*,6,7,8,T1

medial and lateral

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42
Q

Radial N (seg, cord)

A

C5,6,7,8,T1*

posterior

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43
Q

Ulnar N (seg, cord)

A

C8,T1

medial

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44
Q

Dorsal Scapular N

A

C5 ventral ramus

Rhomboid minor/major, levator scap

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45
Q

suprascapular N

A

C5,6
superior trunk
supraspinatus, infraspinatus

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46
Q

Nerve to Sublcavius

A

C5,6*
superior trunk
Subclavius

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47
Q

Long Thoracic N

A

ventral rami C5,6,7

serratus anterior

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48
Q

Musculocutaneous N

A 
C5,6,7*
lateral cord
Brachialis (C5,6)
Biceps (C5,6)
Coracobrachialis (C5,6,7)
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49
Q

Lateral Antebrachial Cutaneous N

A

C5,6,7
continuation of musculocutaneous N
lateral cord
sensory to lateral forearm

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50
Q

Lateral root of median N

A

C5 (sensory),6,7

muscles of forearm, hand, skin of hand

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51
Q

Lateral Pectoral N

A

C5,6,7
posterior cord
pec major

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52
Q

Medial Pectoral N

A

C8,T1
Medial cord
Pectoralis Major/Minor

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53
Q

Medial Brachial Cutaneous N

A

C8,T1
Medial Cord
sensory medial arm, upper forearm

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54
Q

Medial Antebrachial Cutaneous N

A

C8,T1
medial cord
sensory to medial forearm

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55
Q

Medial root of Median N

A

C8,T1
medial cord
muscles of hand

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56
Q

Ulnar N

A

C8,T1
medial cord
muscles of forearm/hand, skin of hand (digits 4,5)

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57
Q

upper subscapular N.

A

C5,6, 7*
posterior cord
subscapularis m.

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58
Q

thoracodorsal N.

A

C6,7,8
posterior cord
lats

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59
Q

lower subscapular N.

A

C5,6,7*
posterior cord
subscapularis, teres major

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60
Q

lateral brachial cutaneous N.

A

C5,6
off of musculocutaneous N.
sensory for skin of lateral upper arm

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61
Q

radial N.

A

c5,6,7,8
posterior cord
deep radial:triceps, anconeus, brachioradialis, extensors of hand, wrist
posterior antebrachial N: skin of posterior arm/forearm
superficial radial: sensory for skin of hand

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62
Q

lymphangitis

A

inflamed lymph vessel

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63
Q

lymphadenitis

A

inflamed lymph node

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64
Q

what is lymph composed of?

where does it drain from and to?

A
  1. plasma proteins and lymphocytes

2. drained from interstitial fluid, transported to lymph node (mass of lymphoid cells)

65
Q

Lateral (brachial) lymph node

A

Below pec minor at lateral border of axilla
Medial, posterior aspects of Axillary V.
Drain upper limb below shoulder

66
Q

Pectoral lymph nodes

A

Inferior border of pec minor
Along Lateral Thoracic A. & V. (part 2 of axillary A.)
Drain mammary glands, upper anterior thoracic wall

67
Q

Subscapular lymph nodes

A

Near costal surface of subscapularis muscle
Along Subscapular A. & V.
Drain scapular region, upper posterior thoracic wall

68
Q

Central lymph nodes

A

Lie behind pec minor along axillary V.

Drain lateral, pectoral, subscapular nodes

69
Q

Apical lymph nodes

A

above pec minor
runs along medial aspect of first part of axillary v.
Drains central nodes–>empties into venous circulation at junction of subclavian V.//internal jugular V.

70
Q

boundaries of posterior cervical triangle

A

SCM, superior nuchal line, trapezius, clavicle
Superficial region: between superficial/prevertebral fascia
Deep region: deep to prevertebral layer
-muscular floor: splen. capitis, lev scap, scalenes

71
Q

Nerves of superficial posterior cervical triangle

A
  1. lesser occipital N. (scalp behind & above ear)
  2. greater occipital N. (skin of posterior scalp)
  3. greater auricular N.(skin over parotid gland, angle of jaw, post ear)
  4. spinal accessory N. (trapezius, SCM)
  5. dorsal scapular N. (levator, rhomboid major/minor)
  6. supraclavicular N. (SC->Acromion, lat.neck,ant. upper thoracic wall)
    • lateral, intermediate, medial supraclavicular
  7. suprascapular N. (supraspinatus, infraspinatus)
72
Q

nerves of Deep Posterior Triangle

A
  1. spinal accessory N (SCM, Trapezius)
  2. Dorsal Scapular N (levator, rhomboids)
  3. long thoracic N (serratus ant)
  4. suprascapular N (infraspinatus, supraspinatus)
73
Q

Occipital Triangle

A

superior part of post cerv triangle (above inferior omohyoid)

74
Q

supraclavicular triangle

A

inferior part of post cerv triangle (below inferior omohyoid)

75
Q

prevertebral layer

A

deepest layer
forms fascial floor of posterior cervical triangle
covers deep neck muscles in posterior cerv triangle
-splenius capitis, levator, scalenes

76
Q

superficial layer of posterior cervical triangle

A

cervical sp, ligamentum nuchae –> infrahyoid region ventral to trachea

77
Q

pretracheal layer of posterior cervical triangle

A

deep to superficial layer in anterior neck

covers trachea, esophagus, thyroid gland

78
Q

trauma to only the superficial part of post cervical triangle will affect which sensory nerves and impair sensation to which part of head and neck? will there be any motor nerve involvement with this trauma? if so, what nerves and muscles will be involved?

A

Sensory nerves affected:
1. lesser occipital N. (skin behind/above ear)
2. greater occipital N. (posterior skin of scalp)
3.greater auricular N. (parotid gland, angle of jaw)
4. supraclavicular N. (skin from acromion–>SC joint, lateral neck, ant
upper thoracic wall)

motor nerves:

  1. spinal accessory (SCM, traps)
  2. dorsal scapular (levator, rhomboids)
  3. suprascapular (supraspinatus, infraspinatus)
79
Q

Trauma to only deep part of posterior cervical triangle will affect which motor nerves? What effect will this have on the brachial plexus? Which nerves of the brachial plexus will be affected?

A
  1. spinal accessory N. (traps, scm)
  2. dorsal scapular N. (levator, rhomboids)
  3. long thoracic N. (serratus anterior)
  4. suprascapular N. (infraspinatus, supraspinatus)

Only C5,6 of brachial plexus affected

80
Q

Tightness of middle scalene will affect which nerves?

A

Long thoracic N. (serratus ant)
Dorsal Scapular N. (levator, rhomboids)
-passes through V-shaped opening in middle scalene

81
Q

What is the difference between supraclavicular nerves and supraclavicular part of brachial plexus?

A

Supraclavicular nerves: C3,4

  • sensory to acromion–>SC joint, lateral neck, ant upper thoracic wall
  • lateral,intermediate,medial

supraclavicular part of brachial plexus:
-involves ventral rami and trunks: superior to clavicle

82
Q

sensation of elbow joint comes from which nerves?

A
  • mainly by musculocutaneous, radial nerves

- to a lesser extent by median, ulnar nerves

83
Q

which 3 joints make up the elbow joint?

A
  1. humeroulnar
  2. humeroradial
  3. proximal radio-ulnar
84
Q

Which ligaments make up elbow joint?

A

radial collateral lig.
ulnar collateral lig.
annular lig.
oblique cord( annular lig –>below radial tuberosity, posterior radius)

85
Q

4 bursae of elbow

A

Olecranon (2)
A. subcutaneous:between skin/olecranon
B. subtendinous olecranon:between tricep tendon//superior aspect of olecranon

Bicipital Bursae: between biceps and radial tub.

radioulnar bursae: between extensor digitorum m. & underlying hum-rad jt, supinator

86
Q

posterior dislocation (elbow)

A
  • fall c extended elbow
  • humerus goes anteriorly
  • hyperextension
87
Q

Two common elbow injuries in children

A
  1. supracondylar fx (falls, hyperextension)
  2. nursemaid’s elbow
    - sublux radial head (tear distal annular lig)
    - prox annular lig trapped between capitulum and rad head–>blocks motion
88
Q

most common cause of nursemaid elbow (radial head dislocation)? second most? what are the localized physical signs?

A
  1. axial traction 2. fall
  2. ABSENT of erythema, warmth, edem, signs of trauma
    - Distal circulation, sensation, motor activity are normal
    - maybe tender at radial head
    - resist pro/sup, flex/ext
89
Q

what is a monteggia fracture? mechanism?

A

fracture of proximal 1/3 ulna
ant dislocation of radial head

direct blow, hyperpronation, hyperextension

90
Q

galeazzi fx

A

fx radial shaft

ulnar head dislocat @ distal rad-uln jt

91
Q

compartments of hand

A

thenar (thumb side)
hypothenar (opposite side)
central (superficial and deep)

92
Q

nerves, artery, muscles of anterior brachial compartment

A

nerves:

  • musculocut.
  • median
  • ulnar
  • radial

brachial artery
flexor muscles of GH and elbow jts

93
Q

which elbow jts permit flexion/extension?

supination/pronation?

A

flex/ext: humeroradial, humeroulnar jts

sup/pro: proximal radioulnar jt, humeroradial jt.

94
Q

what movements would be most affected by tearing of the following lig?

a. medial collateral
b. lateral collateral
c. annular
d. annular and lateral

A

a. flexion/extension
b. flexion/extension
c. pro/sup
d. pro/sup, flex/ext

95
Q

Nerves of anterior and posterior compartment

A

Radial

  • motor: triceps (C6,7,8), anconeus(C7,C8), brachioradialis (C5,6,7*), posterior compartment of forearm (extensors)
  • sensory (cutaneous): posterior arm (post brach cutaneous), posterior forearm, posterior radial half of hand (superficial rad N)
96
Q

Nerve injuries of anterior brachial compartment

A
  1. Musculocutaneous N.
    - entrapped by tight/hypertrophied coracobrachialis
    - tingling/numbness/weakness from GH abd, ER, ext
  2. Ulnar N. (in the cubital tunnel)
    - compression against med epicondyle
    - repetitive press
    - stretch
    - trauma
97
Q

muscles innervated by ULNAR N in anterior forearm compartment

A

FCU (C8,T1)

FDP III, IV (digits 4,5)–>C8,T1

98
Q

muscles innervated by median N at anterior forearm compartment

A

Pronator Teres (C6,7)
Flexor Carpi Radialis (C6,7)
Palmaris Longus (C7)
Flexor Digitorum Superficialis (C7,C8,T1*)

99
Q

muscles innervated by Anterior Interosseous Branch (Med. N) in the anterior forearm compartment
*oklahoma butthole sign

A
  1. Flexor Digit Profund I,II (digits 2,3)–>(C7),C8,T1
  2. flexor pollicis longus–>(C7),C8,T1
  3. pronator quadratus–>C8,T1
100
Q

muscles innervated by Radial N in posterior forearm compartment

A
  1. Brachioradialis:C5,6, (7)
  2. Extensor Carpi Radialis Longus:C6,7
    - lateral supracondylar ridge//base of 1st MC

Radial/Post Interosseous

  1. Extensor Carpi Radialis Brevis: (C6),7,(C8)
  2. Supinator: C5,6
101
Q

muscles innervated by Posterior Interosseous N (deep Rad N) in posterior forearm compartment

A
  1. extensor digitorum: C7,8
  2. extensor digiti minimi: C7,8
  3. extensor carpi ulnaris: C7,8
  4. abductor pollicis longus: C7,8
  5. extensor pollicis longus: C7,8
  6. extensor pollicis brevis: C7,8
  7. extensor indicis: C7,8
102
Q

Branches of Brachial A.

A
  1. Profunda Brachii A:
    - radial groove w/ Radial N.
    - supplies triceps
    - arises distal to teres major
    - ant & post collateral branch (relative to lat epi)
    - ant branch–>radial recurrent A.–>radial A. (cubital fossa)
  2. Superior ulnar collateral A:
    - emerges from brachial A (middle,medial humerus)
    - runs posterior to med epicondyle
  3. Inferior ulnar collateral A:
    - emerges from distal brachial A (lower than sup uln collat A)
    - runs anterior to med epicondyle
  4. Radial A–>superficial (sensory) & deep (extensor m.) near lat epi
  5. Ulnar A: gives rise to common interosseous A–>ant/post interosseous A.
103
Q

superficial veins of arm

A

cephalic
basilic
median cubital (connects cephalic to basilic at cubital fossa)

104
Q

deep veins of arm

A

brachial: inferior to teres major
axillary: between inferior teres major and lateral border 1st rib
subclavian: above lateral border 1st rib

105
Q

supreme thoracic A.

A

1st part of axillary A.

106
Q

2nd part of axillary A.

A

thoracoacromial A.

lateral thoracic A.

107
Q

3rd part of Axillary A.

A
  1. Subscapular A.
    - circumflex scapular A.(curves under and behind lateral border of scapula): posterior scapular muscles
    - thoracdorsal A: lats
  2. Anterior humeral circumflex A: ant GH jt, deltoid
  3. Posterior humeral circumflex A: deltoid, tricep, post,lat GH joint
108
Q

Quadrangular space

A
  • Boundaries: Teres Major/Minor & humerus/long head triceps
  • Axillary N
  • posterior humeral circumflex A
109
Q

Triangular Space

A
  • Boundaries: Teres Major/Minor/long head Tricep

- scapular circumflex A.

110
Q

Triangular Interval

A
  • Boundaries: Medial Tricep/Lateral Tricep/Teres Major
  • Radial N
  • Profunda Brachial A
111
Q

suprascapular notch

A
  • transverse scap lig
  • suprascapular N (under lig): infraspinatus,supraspinatus
  • suprascapular A (over lig): infraspinatus,supraspinatus, scapula
112
Q

muscles of common flexor tendon (superficial muscles that attach to medial epicondyle)

A
  1. pronator teres: C6,7 (median N)
  2. flexor carpi radialis: C6,7 (median N)
  3. palmaris longus: C7 (median N)
  4. flexor digitorum superficialis (median N): C7,8
  5. flexor carpi ulnaris: C8,T1 (ulnar N)
113
Q

deep muscles of anteromedial forearm

A
  1. flexor digitorum profundus (Median N: 1,2//Ulnar N:3,4)
    - C8,T1
  2. flexor pollicis longus
    - ant interosseous N: C8,T1
  3. pronator quadratus
    - ant interosseous N: C8,T1
114
Q

Muscles of superficial lateral forearm

A
  1. brachioradialis: radial N (C5,6)
  2. extensor carpi radialis longus: radial N (C6,7)
  3. extensor carpi radialis brevis: Deep Radial N (C7)
115
Q

Muscles of superficial posterior forearm

A
  1. extensor digitorum: deep radial N (C7,8)
  2. extensor digiti minimi: deep radial N (C7,8)
  3. extensor carpi ulnaris: deep radial N (C7,8)
116
Q

Muscles of Deep posterolateral forearm

A
  1. supinator: deep radial N. (C5,6)
  2. abductor pollicis longus: deep radial N. (C7,8)
  3. extensor pollicis brevis: deep radial N. (C7,8)
  4. extensor pollicis longus: deep radial N. (C7,8)
  5. extensor indicis: deep radial N. (C7,8)
117
Q

flexor retinaculum boundaries

A
  • bridges distal/prox rows

- trapezium/scaphoid–>pisiform/hook of hamate

118
Q

Nerves/tendons in carpal tunnel (10 structures)

A
  1. median N
  2. tendons of FDS/FDP (8 total)
  3. tendon of FPL
  4. synovial sheaths surrounding tendons of FDS, FDP
    - 2nd sheath for tendon of FPL
119
Q

what lies in Guyon’s Tunnel?

A

ulnar A

  • superficial
  • deep

ulnar N

  • superficial: skin of D4,5; exception: palmaris brevis
  • Deep: muscles of hand
120
Q

contents of carpal tunnel from bottom to top (in terms of digits)

A

top: median N
FDS 4 3
5 2 FPL
FDP 5 4 3 2

121
Q

boundaries of guyon’s canal/tunnel

A
  • volar carpal lig (superficial/roof)

- flexor retinaculum (deep/floor)

122
Q

1st extensor tunnel

A

abductor pollicis longus
extensor pollicis brevis

lateral/radial margin of distal radius
“bottom of snuff box”

123
Q

2nd extensor tunnel

A

extensor carpi radialis L & B
posterolateral surface of distal radius (medial to 1st tunnel)
“floor of snuff box”
radial to lister’s tubercle

124
Q

3rd extensor tunnel

A

Extensor Pollicis Longus
Middle posterior surface of distal radius
top/roof of snuff box
ulnar to lister’s tubercle

125
Q

4th extensor tunnel

A

ED & EI

ulnar side of distal radius

126
Q

5th extensor tunnel

A

Extensor Digiti Minimi

between distal radius and head of ulna

127
Q

6th extensor tunnel

A

extensor carpi ulnaris

radial side of ulnar styloid process (almost in the middle of ulnar head)

128
Q

lateral epicondylitis

A
  • repeated forceful supination, wrist ext, rad dev
  • ECRB and Ext Dig usually involved
  • tightness–>compress deep radial nerve
  • could have tenderness at lateral epicondyle or radial tunnel (belly of ED)
129
Q

medial epicondylitis

A
  • repeated forceful pronation, finger flexion

- pronator teres & FCR

130
Q

DeQuervains Tenosynovitis

A
  • tendons slide between radius and ext retinaculum
  • APL,EPB in 1st tunnel
  • ECR L&B in 2nd tunnel
131
Q

Intersection syndrome

A
  • APL and EPB cross over ECR L&B

- pain, swelling, redness, squeaking

132
Q

cubital tunnel syndrome

A

Area of pain/numbness:

  • palmar cutaneous ulnar distal wrist
  • 4th/5th hand/digits
133
Q

5 annular ligaments of hand

A
  • A1 head of MC
  • A2 base of prox phalanx
  • A3 head of prox phalanx
  • A4 middle of mid phalanx
  • A5 base of distal phalanx
134
Q

3 cruciate pulley-like ligaments of hand

A
  • C1 between A2&A3 (distal half of prox phalanx)
  • C2 between A3&A4 (prox end of mid phalanx)
  • C3 between A4&A5 (distal end of mid phalanx)
135
Q

common flexor tendon sheath of digits (5 annular, 3 cruciate lig)

A
  • guides tendons of FDS,FDP

- within flexor tendon sheath, tendon wrapped with synovial memb

136
Q

Trigger finger

A
  • inflamed tendon (at MCP) caught on proximal end of A1 pulley
  • prevents smooth passage through A1
  • locks finger in flexion when attempting to extend finger
137
Q

Extensor Assembly

  • function
  • joints
  • what it consists of
A

Strengthens dorsal surface of MCP, proximal/distal IP joints
Extend PIP, DIP jts
tension from ext digitorum, lumbricals, interossei

  1. extensor expansion
  2. median band (central)
  3. two lateral bands
  4. terminal tendon
138
Q

Extensor expansion (fibrous hood)

A
  • flat tendinous expansion of ext dig

- lumbricals, interossei insert into expansion

139
Q

Median band (central slip)

A
  • arises centrally from extensor expansion
  • inserts at base of middle phalanx
  • extends PIP
140
Q

Lateral bands (two of them) of extensor assembly

A
  • arise from sides of extensor expansion
  • lie on each side of median band (PIP)
  • tighten terminal tendon–>extend DIP
141
Q

Terminal tendon of extensor assembly

A
  • formed by union of two lateral bands at distal end of proximal phalanx
  • inserts at base of distal phalanx
142
Q

deformities of phalangies

A
  1. PIP dysfunction
    - Swan neck deformity: lateral bands dorsal to PIP–>hyperextension
    - Boutonniere deformity: lateral bands palmar to PIP–>flexion
  2. Mallet finger: flexion of DIP (ruptured terminal tendon)–>unable to extend DIP
143
Q

Bursae in palmar hand

A

deep to flexor retinaculum

Radial: flexor pollicis longus
Ulnar: FDS & FDP

144
Q

purpose of tendon sheaths in palmar hand

A
  • prevents friction on annular pulleys

- prevents friction of FDP passing through FDS

145
Q

5 palmar compartments

A
  1. thenar (thumb side)
  2. hypothenar
  3. mid-palmar (central)
  4. adductor
  5. intermetacarpal
146
Q

thenar compartment: muscles, nerves, arteries

A
  • abductor pollicis brevisa:recurrent branch of median N
  • opponens pollicis:recurrent branch of median N
  • flexor pollicis brevis
    - deep head: deep ulnar N
    - superficial head: recurrent branch of median N
  • tendon of FPL
  • proper digital nerves to skin of thumb
  • princeps pollicis A.
  • proper digital arteriole to palmar surface of thumb
147
Q

Innervation of hypothenar compartment

A

Deep Ulnar Branch

  • abductor digiti minimi
  • flexor digiti minimi
  • opponens digiti minimi

Superficial ulnar branch
-palmaris brevis

148
Q

Central compartment: arteries and nerves

A

Superficial

  • Median N and 3 common digital nerves
  • superficial Ulnar N and its common digital nerves to ring/little fingers
  • superficial palmar branch and 3 common digital A (superficial Ulnar A)

Deep

  • tendons/synovial sheaths of FDS and FDP
  • 4 lumbricals
  • deep palmar arch (deep radial/ulnar A)
149
Q

deep central compartment of hand

A

Lumbricals

  • flex MCP, extend PIP/DIP of digits 2-5
  • Median N to index/middle
  • Deep Ulnar N little/ring
  • prox attachment: FDP tendons
  • distal attachment: extensor assembly 2-5
150
Q

Ulnar A in hand

A

Superficial Palmar Arch
-common and proper digital A

Deep Palmar Arch

151
Q

Radial A in hand

A
  • Deep Palmar Arch
  • Palmar Metacarpal A
  • Princeps Pollicis A
  • Radialis Indicis A
152
Q

Radial A course in hand

A

Branch from brachial A in cubital fossa

  • wrist:between brachioradialis and FCR
  • snuff box

Through 1st dorsal interosseous

  • princeps pollicis A
  • deep palmar arch
153
Q

Ulnar A course in hand

A 
Branch from brachial A in cubital fosssa
wrist:lateral to FCU
Guyon's tunnel:
  -superficial palmar arch
  -deep palmar arch
154
Q

Adductor compartment

A

Deep to central and thenar compartments
-Transverse head (3rd mid MC//base of prox thumb)
-oblique head (capitate//base of prox thumb)
Innervated by deep Ulnar N

155
Q

Innervation of adductor compartment

A

Deep Ulnar N

  • lumbricals 3,4
  • palmar/dorsal interossei
  • adductor pollicis
156
Q

Intermetacarpal compartment

A

3 palmar interossei (all flex MCP and extend PIP/DIP)

  • bring digits (index, ring, little) towards middle finger
  • 1st: ulnar add; 2nd:radial add; 3rd: rad add

4 dorsal interossei (all flex MCP, and extend PIP/DIP)

  • 1st/2nd:radial abd
  • 3rd/4th: ulnar abd
157
Q

Lumbricals: strength in MCP position

A

Flexed MCP:

  • weak MCP flexor (due to small CSA despite mech advantage)
  • strong IP extensor (more active in IP extension when MCP=extended)

Extended MCP:

  • weak MCP flexor (due to small CSA despite mech advantage
  • strong IP extensor
158
Q

Interossei: strength at MCP joint position

abduction always stronger than adduction

A

Flexed MCP:

  • strong MCP flex
  • strong IP ext
  • weak MCP add/abd

Extended MCP:

  • weak MCP flex
  • weak IP ext
  • strong MCP add/abd
159
Q

cutaneous innervation of hand

A

Median N

  • palmar branch= palm (radial half)
  • digital branch= D1,2,3, half of 4

Ulnar N

  • dorsal branch=dorsal medial
  • superficial branch = palmar medial; D5, half of 4

Superficial Radial Branch=posterolateral hand

160
Q

Arches of hand

A
  • dynamic
  • supported by intrinsic musculature
  • 3 Arches:
    • prox transverse (CMC)
    • distal transverse (MCP)
    • longitudinal: wrist–>fingers

Anatomy (10 decks)

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