Exam #6: Anterior Arm & Forearm Flashcards by Jonathan Kallevang

Review the bony landmarks of the humerus.

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Review the bony landmarks of the radius & ulna.

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Which is lateral, the radius or the ulna?

Radius

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What does the radial head articulate with?

Capitulum of the humerus

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What is the name for the proximal part of the ulna?

Olecranon process

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What is the difference between the heads of the ulna and radius?

Radius= proximal
Ulna= distal

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What is the mechanism for a radius fracture?

Falling on an outstretched arm

*This can occur across the length of the shaft

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What is the mechanism for ulna fracture?

Falling on the forearm

- Defensive wounds

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What is a nightstick fracture?

Ulnar fracture

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What is an ulnar pseudoarthrosis?

Congenital or improperly set ulnar fracture that results in the formation of a “joint” midshaft in the ulna

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Radiographically, how can you tell the difference between an ulnar fracture and a pseudoarthrosis?

Acute fracture= subtle

Pseudoarthrosis= prominent

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What is the elbow joint proper? How many joints make the elbow? What types of joints are these?

Humeroradial & humeroulnar joints together

Humeroradial= ball & socket
Humeroulnar= hinge

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What is the radio-ulnar joint? What is the function?

Annular ligament connects the radius & ulnar, which limits the humeroradial joint to a hinge joint

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What are the ligaments of the elbow?

1) Annular ligament*****
2) Ulnar collateral ligaments
- Posterior
- Anterior
- Transverse
3) Radial collateral ligament

*****Most important ligament

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What are the three main parts of the ulnar collateral ligaments? What is the clinical significance?

1) Posterior
2) Anterior
3) Transverse

*Baseball players rupture this ligament & ALL 3x of the components have to be replaced

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Review the radiographic landmarks of the elbow.

N/A

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What typically happens when you get a posterior dislocation of the elbow?

Fracture of the coronoid process

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What is a nursemaid’s elbow?

Dislocated radial head i.e. rupture of the fibers of the annular ligament

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What nerve innervates the anterior compartment of the arm?

Musculocutaneous n.

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Which muscle of the anterior compartment has dual innervation? Why is this important?

Brachialis

*****Also innervated by the Radial N.; thus, if the musculocutaneous branch in damaged, you can still flex your arm at the elbow

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What is the function of all the muscles of the anterior compartment?

Flexors

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List the muscles of the anterior compartment or the arm.

1) Biceps brachii
2) Brachialis
3) Coracobrachialis

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What are the origins of the Biceps Brachii?

Coracoid process

Supraglenoid tubercle

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What are the insertions of the Biceps Brachii?

Radial tuberosity

- Bicipital aponeurosis that blends with the antebrachial fasica, indirectly connecting to the ulna

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What is the function of the Biceps Brachii?

Flexion of the shoulder Flexion of the elbow Supination

What is the origin of the Brachialis?

Anterior humerus

What is the insertion of the Brachialis?

Ulnar tuberosity

What muscle is the main flexor of the arm?

Brachialis

What is the function of the Brachialis?

Flexion of the elbow *****This is where most of the power of flexion comes from i.e. MAIN FLEXOR

What are the origins of the Coracobrachialis?

Coracoid process

What is the insertion of the Coracobrachialis?

Medial humerus

What are the function of the Corachobrachialis?

1) Prevention of dislocation of the humerus 2) Flexion of the shoulder 3) Adduction of the arm

Anterior compartment of the forearm are innervated by what nerve?

Predominantly the median nerve with a few exceptions: - Flexor carpi ulnaris (ulnar n.) - Medial 1/2 of the flexor digitorum profundus (ulnar n.)

What are the muscles in the superficial group of the anterior compartment of the forearm?

Pronator teres Palmaris longus Flexor carpi radialis Flexor carpi ulnaris

What is the origin of the Pronator teres?

Medial epicondyle of the humerus

What is the insertion of the Pronator teres?

Midshaft of the radius

What is the function of the Pronator teres?

Pronation

What is the origin of the Palmaris longus?

Medial epicondyle of the humerus

What is the insertion of the Palmaris Longus?

Palmar aponeurosis

What is the function of the Palmaris longus?

- Flex wrist | - Tense palmar aponeurosis

What is the origin of the flexor carpi radialis?

Medial epicondyle of the humerus

What is the insertion of the flexor carpi radialis?

Base of MC II

What is the function of the flexor carpi radialis?

Flex & abduct the wrist

What is the origin of the flexor carpi ulnaris?

Medial epicondyle of the humerus & olecranon process

What is the insertion of the flexor carpi ulnaris?

Hook of hamate Pisiform Base of MC B

What nerve innervates the flexor carpi ulnaris?

Ulnar nerve

What is the function of the flexor carpi ulnaris?

Flex & adduct wrist

What are the muscles of the intermediate group of of muscles in the anterior compartment of the forearm?

- Pronator teres (deep head) | - Flexor digitorum superficialis

What is the origin of the flexor digitorum superficialis?

Medial epicondyle | Proximal radius

What is the insertion of the flexor digitorum superficialis?

Middle phalanges (#2-5)

What nerve innervates the flexor digitorum superficialis?

Median n.

What is the function of the flexor digitorum superficialis?

Flex PIP, MCP, & wrist

What is the origin of the flexor digitorum profundus?

Ulnar shaft | Interosseous membrane

What is the insertion of the flexor digitorum profundus?

Distal phalanges (2-5)

What nerve innervates the flexor digitorum profundus?

Medial 1/2= ulnar n | Lateral 1/2= Median n., specifically anterior interosseous nerve

What is the function of the flexor digitorum profundus?

Flex DIP, PIP, MCP, wrist

What is the origin of the flexor pollicis longus?

Radial shaft | Interosseous membrane

What is the insertion of the flexor pollicis longus?

Base of distal phalanx of digit 1

What is the innervation of the flexor pollicis longus?

Median n., specifically anterior interosseous nerve

What is the function of the flexor pollicis longus?

Flex CMC, MCP, IP of digit 1 | Flex wrist

What is the origin of the pronator quadratus?

Distal ulnar shaft

What is the insertion of the pronator quadratus?

Distal radial shaft

What is the innervation of the pronator quadratus?

Anterior interosseous n.

What is the function of the pronator quadratus?

Pronation

What are the major branches of the brachial artery?

``` Profunda barchii Superior ulnar collateral Inferior ulnar collateral Radial a. Ulnar a. ```

What are the branches of the Profunda Brachii a?

Middle collateral a. | Radial collateral a.

What are the branches of the Superior Ulnar Collateral?

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What are the branches of the Inferior Ulnar Collateral?

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What are the two terminal branches of the brachial artery?

1) Radial artery | 2) Ulnar artery

What are the branches of the radial artery?

1) Radial recurrent artery

What artery does the radial recurrent artery anatamose with?

Radial collateral a.

What are the branches of the ulnar arteries?

1) Anterior ulnar recurrent 2) Posterior ulnar recurrent 3) Common interosseous

What does the Anterior Ulnar Recurrent anastamose with?

Inferior ulnar recurrent

What does the Posterior Ulnar Recurrent anastamse with?

Superior ulnar collateral

What are the branches of the common interosseous artery?

Anterior interosseous a. | Posterior interosseous a.

What is the branch of the posterior interosseous a? What does this artery anastamose with?

Recurrent interosseous a. that anastamoses with the middle collateral a.

What are the borders of the cubital fossa?

``` Superior= line connecting the medial & lateral epicondyles Lateral= brachioradialis Medial= Pronator teres ```

What are the contents of the cubital fossa?

- Superficial veins - Brachial a. - Ulnar a. - Radial a. - Median n. - Radial n. - Biceps brachii tendon - Bicipital aponeurosis

What covers the brachial a. & median nerve?

Bicpitial aponeurosis

What injury can damage the cubital fossa? What are the consequences of this injury?

Supra-epicondylar fracture - Brachial a. damage leads to: 1) Ischemia of the forearm 2) Tightness of the muscles 3) "Volkman's ischemic contracture" i.e. a tightly curled fist

What is the clinical sign for a median nerve injury in the cubital fossa, or more proximal?

"Hand of the Benediction"

What is pronator syndrome?

Pronator teres compression of the median nerve

What is anterior interosseous syndrome?

"Kiloh -Nevin Syndrome"

What is the "Hand of the Benediction?"

Median nerve injury proximal to cubital fossa; ask patient to make a fist & digits 1, 2, & 3 remain extended

Explain the underlying nerve pathology underlying Hand of the Benediction.

- Median nerve innervates all flexors EXCEPT the medial 2x digits of the flexor digitorum profundus; thus, digit # 4 & 5 can still flex - All thenar muscles are out via recurrent branch of median nerve

What is Pronator Syndrome?

Pain in the forearm with pronation

Explain the underlying nerve pathology underlying Pronator Syndrome.

- Compression of the median nerve between the superficial & deep heads of the pronator teres * Can lead to weakness & paresthesias

What is Anterior Interosseous Syndrome?

Damage to the anterior interosseous nerve by trauma-->patient cannot make the "OK sign" *****NO sensory deficits, but patient will have problems with fine motor movement of the first two digits of the affected hand

What are the three muscles innervates by the anterior interosseous nerve?

1) Pronator quadratus 2) Flexor pollicics longus 3) Lateral half of the flexor digitorum profundus

Explain the underlying nerve pathology of Anterior Interosseous Syndrome.

1) Flexor pollicis longus cannot flex thumb | 2) Cannot flex the DIP of the index finger b/c of flexor digitorum profundus injury

What is the clinical sign associated with ulnar nerve injury proximal to the elbow?

"Ulnar Claw"

What is ulnar claw? How is it different from "Hand of the Benedicition?"

*****Passive***** vs. active Hand of the Benediction 1) Extension of MCP in digits #4 & 5 2) Flexion at PIP joints 3) Wasting of the first dorsal interosseous

Explain the underlying nerve pathology associated with ulnar claw.

- Ulnar nerve damage= 1) No Flexor Carpi Ulnaris, cannot flex wrist 2) No medial flexor digitorum profundus, cannot flex DIP of #4 & 5 3) Numbness in digits 4 & 5 4) Loss of intrinsic hand muscles= wasting of first dorsal interosseous Superficialis is still functioning= not FULL loss of flexion

What is cubital tunnel syndrome?

Compression of the ulnar nerve as it passes through the cubital tunnel leads to paresthesias in digits #4 & 5