EXAM2 G12_Flexor_UE Flashcards
What styloid process extends further?
What is the ulnar slant?
Distal radius has a normal volar tilt of ?
Radial styloid process extends 9-12mm further than ulnar sP.
distal radius slant angle of 15-25degrees AP view
volar tilt of 10-25 degrees Lateral view
important for evaluating fracture of radius and ulna
SO LONG TO PINKY HERE COMES THE THUMB
Scaphoid, Lunate, Triquetrium, Pisiform, Hamate, Capitate, Trapezoid, Trapezium
PIP, DIP, MCP
What are the bones of the thumb and what is the joint of the thumb?
Proximal interphalangeal joints (middle knucks) Distal interphalangeal joints (tip joints) Metacarpophalangeal joints (knucks) THUMB only has proximal and distal phalanx and a single IP joint
What types of HUMERUS fractures? What risk with each type of fracture?
Surgical neck (axillary nerve PCHA)
MID shaft (Radial nerve and Profunda brachii artery)
Distal fracture (Ulnar nerve at medial epicondyle) (Median nerve and Brachial artery at distal humerus)
COLLES FRACTURE how common? How broken? What broken? What is deformity seen? What lost? what is also broken? What is at risk?
Most common wrist fracture in adults
fall on outstretched hand- complete transverse fracture of the radial metaphysis
Posterior displacement of wrist and hand results in dinner fork deformity and loss of volar tilt of distal radius
60-70% fracture Styloid process of ULNA too
MEDIAN NERVE AT RISK
SMITHS FRACTURE
Forced flexion (reverse colles fracture)
complete transverse fracture of distal metaphysis of Radius
Anterior displacement= garden spade deformity
- Syloid process of ULNA (arrowhead) commonly fractured too
- MORE RISK OF MEDIAN NERVE than colles
Transverse Humeral Ligament
converts intertubercular sulcus into a canal where long biceps tendon passe through
Distal biceps brachii forms what tendon sheet ?
Bicipital aponeurosis covering cubital fossa
What is the division in the inner arm seen and can be palpated for brachial pulse called?
Medial bicipital groove
Medial intermuscular septum
What deformity if long head of biceps tendon ruptures?
Popeye deformity
Chronic degenerative tendinitis >35yo; muscle belly balls up inside distal arm
Tapping the biceps tendon at cubital fossa. what is this test?
What does it test?
Bicipital myotatic Reflex
reflex contraction testing C5,C6 spinal cord segments
Which muscle mostly resists dislocation in the arm?
What spinal nerve contributors?
Coracobrachialis (C5,6,7)
What nerve pierces the coracobrachialis?
Musculocutaneous nerve and runs inbetween the plane of the biceps and the brachialis
What muscle flexes the arm regardless of position
SN contributors?
Brachialis (c5,C6)
Superficial forearm group where do these muscles originate? what joints do they cross? What do they act on ? What innervations?
Originates at medial epicondyle
Crosses elbow joint
Mainly acts on wrist
Innervation is Medain except for 1 muscle
Deep forearm group Where is attachments and actions relative to superficial forearm group? Do they cross the elbow joint? What do they act on? What is innervation?
Attachments and actions more distal
Dont cross elbow joint
Act on digits
INNERVATION IS ANTERIOR INTEROSSEOUS N. except 1/2 muscle
What nerve passes between the two heads of the pronator teres?
MEDIAN
What is the landmark for the median nerve and radial artery in the forearm?
Flexor Carpi Radialis
median nerve medial to tendon of FCR
Radial artery lateral to tendon of FCR
Flexor carpi ulnaris is the landmark for what ?
Origin insertion?
Ulnar nerve and artery (lies deep to the FCU)
originates CFO inserts on 5th metacarpal
FDS
origin
insertion
Action
origin Medial epicondyle and coronoid process (humeroulnar head) Proximal radius (radial head)
inserts (middle phalanx shaft of digits 2-5)
Flexes at proximal interphalangeal joints
can also flex metacarpophalangeal joint
What is the cause of Golfers elbow or medial epicondylitis?
Median nerve being compressed as it passes under tendinous arch of flexor digitorum superficialis
Flexor digitorum profundus Origin insertion
Origin proximal ulna and interosseous membrane
inserts distal phalanx base of digits 2-5
Ulnar head innervated by ULNAR NERVE
Radial lateral head innervated by Anterior interosseous N.
Where does the FDP tendon pass to get to the distal phalanx of 2-5?
Passes through the TENDINOUS CHIASM of the FDS to reach distal phalanx
What is the ONLY MUSCLE THAT CAN FLEX THE DIP JOINTS
Flexor digitorum profundus
Flexor pollicis longus origin insertion action
Origin at radius and interosseous membrane
Inserts distal phalanx base of thumb
Flexes IP joint of thumb (only has proximal & distal phalanx)
ANTERIOR INTEROSSEOUS NERVE
Primary pronator oina
Pronator Quadratus origin on ulna inserts radius inn: ant interosseous nerve
Describe path of Musculocutaneous
Terminal branch of lateral cord pierces coracobrachialis and emerges lateral to biceps as the lateral cutaneous nerve of forearm
ONLY SENSORY AT THAT POINT ON
Median Nerve What does it travel with in arm? Where does it enter in the forearm? What is it deep to? What does it pass between? What does it pass behind?
travels w/ brachial artery in arm
Enters cubital fossa and lies deep to bicipital aponeurosis and median cubital vein
In forearm passes between heads of pronator teres
passes behind tendinous arch of flexor digitorum superficialis and becomes superficial at the wrist
Innervation of forearm except for FCU
What does it branch into/form?
What does it innervate at that point? any sensation?
Median Nerve
- Branches to form Anterior interosseous nerve
inn deep forearm flexors
- Palmar cutaneous branch- sensation of central palm
What causes central sensation of palm?
Palmar cutaneous branch of Median nerve
Paresthesias
Numbness tingling; LESION OF CUTANEOUS NERVE
PARESIS
Muscle weakness: LESION OF MOTOR N OR MUSCULAR BR.
2 entrapment sites for medain nerve in forarm
What does it cause?
between pronator teres and as it descends posterior to tendinous arch of radial head of flexor digitorum superficialis- causes pronator teres syndrome
Where does the anterior interosseous nerve run?
sensory or motor or both?
lateral and deep to flexor digitorum profundus and flexor pollicis longus
NO SENSORY JUST MOTOR
Anterior interosseous nerve palsy
What other muscles affected/actions?
entraped between flexor digitorum profundus and flexor pollicis longus
- Cant make OK sign w/ hand (more like a q in sign language)
Flexion of dIP (FDP), IP joint of thumb (FPL), pronation (PQ)
ULNAR NERVE LANDMARKS
Ulnar groove (funny bone)
Cubital Tunnel formed by tendinous arch between humeral and ulnar heads of flexor carpi ulnaris
Courses deep to flexor carpi ulnaris w/ ulnar vessels
NO BRANCHES IN ARM
Sensory in palm of Ulnar nerve
Dorsal branch (test tip of pinky) Palmar cutaneous branch (lateral palm)
Entrapment of ulnar nerve occurs at two locations and causes what syndrome? What is difficult about Ulnar diagnosis?
Ulnar groove (vulnerable to trauma-distal fracture etc) Deep to tendinous arch connecting two heads of FCU at humeral and ulnar attachments
CUBITAL TUNNEL SYNDROME
CANT DISTINGUISH WHERE ENTRAPMENT OF ULNAR NERVE IS
Brachial artery- origin
Inferior border of teres major
Palpable in medial bicipital groove
accompanies median nerve in arm
Ends in cubital fossa and divides into radial and ulnar a’s
Profunda brachii
What does it travel with?where
deep artery of arm
supplies posterior arm
Travels w radial nerve in Spiral groove
contributes shoulder and elbow arterial anastomoses
Superior/inferior ulnar collateral arteries
Contribute periarticular anastomoses of elbow
Clinical: can clamp of distal to profundus brachii and still be okay b/c so many anastomoses
RADIAL artery
Branches to radial recurrent artery
Palmar carpal branch
Ulnar artery- ap two branches
Anterior ulnar recurrent artery
Posterior ulnar recurrent artery
Ulnar forms a common interosseous artery then
anterior interosseous artery and posterior dives through interosseous membrane
What runs deep to the FCU
Ulnar artery and nerve then come superficial at wrist. can get a ulnar pulse lateral to tendon of FCU at wrist
Contents of Cubital fossa
Brachioradialis and pronator teres and bicipital aponeurosis from biceps protects underlying nv structures
3 features occur at the cubital fossa
brachial artery branches to radial and ulnar arteries
(median nerve is medial to brachial artery)
Radial nerve divides into deep and superficial branches
What vein used to draw blood?
Median cubital
What provides Superior lateral cutaneous nerves of the ARM ? (around lateral inferior deltoid region)
Branch of axillary nerve
What provides Inferior lateral cutaneous nerves of the ARM?
Branch of RADIAL nerve
what provides lateral cutaneous nerves of the forearm?
Continuation of musculocutaneous nerve
