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Block 4 > Forearm and Elbow > Flashcards

Forearm and Elbow Flashcards

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1
Q

What can be damaged by a mid humeral shaft fracture?

A

Median nerve

Profunda brachii artery

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2
Q

Where does the ulnar nerve pass the medial epicondyle?

A

Posteriorly

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3
Q

What movements does the capitulum allow?

A

Pronation and supination

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4
Q

What movements does the trochlea allow?

A

Flexion and extension

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5
Q

What movement does the radial head allow and why?

A

The rounded head of the radius allows pronation and supination

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6
Q

Where is the radial styloid palpable?

A

Via the anatomical snuffbox on the lateral wrist

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7
Q

What does the olecranon bursa allow?

A

Free movement of the skin over the olecranon (point of elbow)

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8
Q

How might the olecranon be fractured?

A

Direct trauma, avulsion by strong triceps extension, e.g. in fall

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9
Q

What bones form the elbow joint?

A

Distal humerus, radial and ulnar heads

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10
Q

What movement does the lateral collateral ligament of the elbow prevent?

A

Valgus movement/ abduction

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11
Q

What movement does the medial collateral ligament of the elbow prevent?

A

Varus movement/ adduction

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12
Q

What 3 points make up the anconeus triangle? Why is this the safest place to inject/aspirate the elbow?

A

Radial head, olecranon and lateral epicondyl Safest place to inject into or aspirate from elbow as it contains the least structures.

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13
Q

What movements do the radio-ulnar joints permit?

A

Pronation (median nerve) and supination (radial and musculocutaneous nerve) of the forearm

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14
Q

What ligament supports the proximal radio-ulnar joint? What type of joint is this?

A

Annular ligament Synovial pivot joint

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15
Q

Interosseous membrane forms what type of joint between the radius and ulna? What is its role?

A

Fibrous joint Transmission of forces between radius and ulna

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16
Q

What is the role of the articular disc?

A

Separates the ulna from the proximal carpal bones of the hand

17
Q

What nerves supply the anterior compartment of the forearm?

A

Everything median nerve innervated except:

  • Flexor carpi ulnaris
  • Flexor digitorum profundus to digits 4 & 5
18
Q

How many layers does the anterior compartment of the forearm have?

A

3

19
Q

What muscles are found in layer 1 of the anterior compartment of the forearm?

What are their actions and nerve supplies?

Where do they originate from?

A

Pronator teres:

  • Forearm pronator (pulls radius over ulna)
  • Median nerve.
  • Originates from medial epicondyle and the coronoid process of the ulna.

Flexor carpi radialis:

  • Wrist flexor and abductor
  • Median nerve (sits medially at wrist)
  • Originates from medial epicondyle

Palmaris longus (absent in around 20%):

  • Wrist flexor
  • Median nerve
  • Attaches into aponeuroses on palm of hand.
  • Originates from medial epicondyle

Flexor carpi ulnaris:

  • Wrist flexion and adduction
  • Ulnar nerve
  • Originates from medial epicondyle
20
Q

What muscle is found in layer 2 of the anterior compartment of the forearm? What is its action and nerve supply?

A

Flexor digitorum superficialis:

  • Flexion of fingers 2-5 at PIP joint
  • Median nerve
  • (Attaches to both radius and ulna)
21
Q

What muscles are found in layer 3 of the anterior compartment of the forearm?

What are their actions and nerve supplies?

A

Flexor pollucis longus:

  • Thumb flexor to DIP joint
  • Median nerve

Flexor digitorum profundus:

  • Flexion of digits 2-5 at DIP joint
  • Median nerve digits 2-3, ulnar nerve digits 4-5.

Pronator quadratus:

  • Forearm pronator, median nerve
22
Q

How do you test flexor digitorum profundus and ulnar nerve?

A

Flexion of digits 4 & 5 at DIP

23
Q

How do you test Flexor Digitorum Profundus and median nerve?

A

Flexion of digits 2 & 3 at DIP

24
Q

What nerve supplies the entire posterior compartment of the forearm?

A

Posterior interosseous nerve (branch of radial nerve)

25
Q

What muscles are found in layer 1 of the posterior compartment of the forearm? What are their actions?

A

Anconeous:

  • Elbow extensor

Extensor Carpi Ulnaris:

  • Wrist extensor and adductor

Extensor Digiti Minimi:

  • 5th digit extensor to DIP

Extensor Digitorum:

  • All finger extensor to DIP joint

Extensor Carpi Radialis Brevis and Longus:

  • Extensors and adductors of the wrist

Brachioradialis

  • Sits anteriorly but is in the posterior compartment
  • Elbow flexor
  • Moves arm to mid pronation/supination
26
Q

What muscles are found in layer 2 of the posterior compartment of the forearm?

What are their actions?

A

Extensor indices:

  • Extensor of 2nd digit to PIP joint

​Extensor pollicus longus:

  • Extension of thumb at all joints

Extensor pollicus brevis:

  • Thumb extension to MCP joint

Abductor pollicis longus:

  • Thumb adduction

ALL INNERVATED BY POSTERIOR INTEROSSEOUS NERVE (branch of radial nerve)

27
Q

What are the extensor compartments of the wrist? Which tendons do each contain?

A

1:

  • Extensor pollicus brevis
  • Adductor pollicus longus

2:

  • Extensor carpi radialis brevis
  • Extensor carpi radialis longus

3: Extensor pollicus longus

4:

  • Extensor digititorum
  • Extensor indices

5: Extensor digiti minimi
6: Extensor carpi ulnaris

28
Q

What form the borders of the cubital fossa?

A

Superior border: inter-epicondylar line

Lateral border: brachioradialis

Medial border: pronator teres

29
Q

What does the cubital fossa contain?

A

Aponeuroses of biceps (protects the median nerve and brachial artery)

Biceps tendon (brachial artery and medial nerve sit medially)

Brachial artery and its bifurcation into the ulnar and radial arteries, sits medial to the biceps tendon.

Median nerve, sits medially to brachial artery

30
Q

Where is the brachioradialis muscle located? What are its actions? How is it tested?

A

Sits anteriorly in the forearm but is part of the posterior compartment.

Flexes the elbow and moves arm to mid pronation/supination postition

Forms lateral border of cubital fossa

Tapping BR in the medial side of the forearm tests C5 & 6 reflex

31
Q

What are the superficial veins of the forearm? Where are they located?

A

Cephalic vein: lateral side of forearm

Basilic: medial side of forearm

Linked by median cubital vein

32
Q

Where are the main nerves of the forearm located?

A

Radial nerve: passes anterior to elbow and lateral to biceps tendon, gives off deep posterior interosseous branches which pass close to radial neck.

Ulnar nerve: passes through cubital tunnel behind medial epicondyl before entering anterior forearm. Runs under cover of FCU and sits lateral to pisiform in the hand- potential compression point.

Median nerve: passes medial to biceps tendon down the forearm.

33
Q

Can the radial nerve be lost?

A

The radial nerve can be harvested as long as the palmar arches of the hand join together.

Test anastomoses by occluded both radial and ulnar arteries then releasing ulnar to see if it supplies the whole hand alone.

34
Q

Describe the arterial supply to the forearm

A

The radial and ulnar arteries are formed by the bifurcation of the brachial artery within the cubital fossa:

Radial artery –

  • Supplies the posterolateral aspect of the forearm.
  • It contributes to anastomotic networks surrounding the elbow joint and carpal bones.

Ulnar artery –

  • Supplies the anteromedial aspect of the forearm.
  • It contributes to an anastomotic network surrounding the elbow joint.
  • Also gives rise to the anterior and posterior interosseous arteries, which supply deeper structures in the forearm.

These two arteries anastomose in the hand by forming two arches – the superficial palmar arch, and the deep palmar arch.

Block 4 (20 decks)

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