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Yr 2 - Movement > Forearm and Wrist SDL > Flashcards

Forearm and Wrist SDL Flashcards

1
Q

The forearm bones are the radius and ulna. What do these bones articulate with?

A

Proximally with the humerus at the elbow joint

Proximally with each other at the proximal radioulnar joint

Distally with with each other at the distal radioulnar joint

Radius - distally with the carpal bones to form the radiocarpal/wrist joint

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2
Q

In life, a tough, fibrous membrane lies between the radius and ulna. What is this membrane called?

A

Interosseous membrane

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3
Q

Bony landmarks of radius and ulna

A
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4
Q

What muscles is supination of the arm achieved by?

A
  • Supinator (a deep posterior forearm muscle)
  • Biceps brachii (an anterior arm muscle) acts as powerful supinator especially when the elbow is flexed
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5
Q

What muscle is pronation of the forearm achieved by?

A

2 anterior forearm muscles:

  • Pronator teres (superficial)
  • Pronator quadratus (deep)
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6
Q

What type of joints are the joints within the hand?

A

Synovial

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7
Q

The human thumb is opposable. What benefit is this?

A

Allows us to manipulate all manner of objects with great dexterity, and form various grips, including a precision grip.

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8
Q

How are the 8 carpal bones arranged?

A

In 2 rows; proximal and distal

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9
Q

What bones makes up the proximal carpal row?

A
  • Scaphoid, lunate, triquetral, pisiform (from radial to ulnar side)
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10
Q

What bones make up the distal carpal row?

A
  • Hamate, capitate, trapezoid, trapezium (from ulnar to radial side)
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11
Q

Which carpal bones articulate with the radius to form the wrist (radiocarpal) joint?

A

Scaphoid and lunate

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12
Q

The scaphoid bone is the most commonly fractured carpal bone. What can happen as a result of a missing a scaphoid fracture?

A

Arthritis, wrist fusion, death of bone tissue, non union

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13
Q

What bones does the first carpometacarpal joint involve?

A

The first metacarpal and the trapezium

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14
Q

What movements is the thumb capable of?

A
  • Abduction
  • Adduction
  • Flexion
  • Extension
  • Opposition
  • Reposition
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15
Q

What movements is the wrist capable of?

A
  • Flexion
  • Extension
  • Abduction
  • Adduction

All 4: circumduction

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16
Q

What movements are the fingers capable of?

A
  • Abduction
  • Adduction
  • Flexion
  • Extension
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17
Q

Why is the (ante)cubital fossa important in clinical practice?

A
  • Contains several important neurovascular structures
  • Superficial veins that overlie the cubital fossa are routinely accessed for venepuncture and intravenous cannulation.
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18
Q

What is the superior boundary of the cubital fossa?

A

An imaginary line between the medial and lateral epicondyle of the humerus

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19
Q

What makes up the floor of the cubital fossa?

A

Brachialis

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20
Q

What makes up the medial and lateral borders of the cubital fossa?

A

2 forearm muscles: pronator teres and brachioradialis

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21
Q

If the skin that overlies the cubital fossa is removed, what do we see?

A

Fascia and superficial veins overlying the cubital fossa

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22
Q

When accessing the superficial veins in the cubital fossa, why must care be taken to keep the needle superficial?

A

The brachial artery and median nerve lie deeper in the cubital fossa

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23
Q

How many layers of muscles are there in the anterior forearm?

A

3; superficial, middle, deep

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24
Q

What muscles make up the superficial layer of the anterior forearm?

A
  • Flexor carpi radialis
  • Flexor carpi ulnaris
  • Palmaris longus
  • Pronator teres
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25
Q

What muscles make up the middle layer of the anterior forearm?

A

Flexor digitorum superficialis

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26
Q

What muscles make up the deep layer of the anterior forearm?

A
  • Flexor digitorum profundus
  • Flexor pollicis longus
  • Prontor quadratus
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27
Q

Where do the superficial flexors of the anterior forearm arise from?

A

The medial epicondyle - ‘common flexor origin’

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28
Q

Location of superficial flexors

A
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29
Q

Which superficial anterior forearm muscle is found most laterally? What is its action?

A

Pronator teres - pronator (and weak flexor) of the forearm

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30
Q

Where does palmaris longus lie?

A

Between the flexor carpi ulnaris and radialis

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31
Q

Where does palmaris longus arise from? Where does it insert?

A

Arises from ‘common flexor origin’ and inserts into palmar aponeuorsis

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32
Q

What is palmar aponeurosis?

A

A thick band of connective tissue in the palm

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33
Q

Action of palmaris longus?

A

Flexes the wrist

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34
Q

Distal insertion of pronator teres?

A

Lateral surface of radial midshaft

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35
Q

Distal insertion of flexor carpi radialis?

A

Metacarpals of 2nd and 3rd digits

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36
Q

Distal insertion of flexor carpi ulnaris?

A

Base of metacarpal 5

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37
Q

Distal insertion of palmaris longus?

A

Palmar aponeurosis

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38
Q

Insertions of superficial anterior forearm muscles

A
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39
Q

Other than flexion, what actions do FCR and FCU have at the wrist?

A
  • Flexor carpi ulnaris adducts
  • Flexor carpi radialis abducts
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40
Q

Which nerves innervate the superficial flexors of the wrist?

A

Median nerve - innervates flexor carpi radialis, palmaris longus and pronator teres

Ulnar nerve - innervates flexor carpi ulnaris

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41
Q

How many tendons does flexor digitorum superficialis give rise to? Where do these travel?

A

4 - these travel under the flexor retinaculum to digits 2-5

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42
Q

Onto which phalanges of digits 2-5 do the FDS tendons insert?

A

Each tendon of FDS then splits into 2, inserting either side of the middle phalanx of digitis 2-5

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43
Q

What happens to the FDS tendons just before they insert upon these bones?

A

They split into 2

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44
Q

What is the action of FDS and what is its innervation?

A

Actions:

  • Flexor of digits at PIPJ, MCPJ and wrist

Innervation:

  • Median nerve
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45
Q

Diagram of origin and insertion of FDS

A
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46
Q

Where do the ulnar and radial neurovascular bundles lie in relation to FDS?

A

Ulnar neurovascular bundle - lies medial

Radial neurovascular bundle - lies lateral

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47
Q

Where does the median nerve lie in relation to FDS?

A

Deep to FDS

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48
Q

Where do the deep flexors of the anterior forearm arise from?

A

The shaft of the radius and ulna and the interosseous membrane

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49
Q

What are the deep flexors of the anterior forearm?

A
  • Flexor digitorum profundus
  • Flexor pollicis longus
  • Pronator quadratus
50
Q

What are the deep muscles of the forearm innervated by?

A

A branch of the median nerve called the anterior interosseous nerve

51
Q

Describe the innervation of FDP?

A

Dual innervation:

  • Lateral part (which sends tendons to the index and middle fingers) is innervated by the anterior interosseous nerve
  • Medial part (part (which sends tendons to the ring and little fingers) is innervated by the ulnar nerve
52
Q

How many tendons does FDP give rise to?

A

4

53
Q

Where do the tendons of flexor digitorum profundus insert? How are they related to the tendons of FDS?

A
  • Insert on the distal phalanges of digits 2-5
  • Run deep to FDS
    • The 4 tendons of FDS then split into 2 and FDP tendons travel between this split
54
Q

What is the action of FDP?

A

Flexes digits 2-5: at the DIPJ, PIPJ, MCPJ

55
Q

Where does FPL insert, and what action does it have?

A

Flexor pollicis longus inserts on the distal phalanx of the thumb

Action: flexes the thumb

56
Q

What is the action of pronator quadratus?

A

Pronates the forearm at the distal radioulnar joint

57
Q

What is the carpal tunnel?

A

A space or ‘channel’ on the anterior aspect of the wrist through which some of the long flexor tendons of the forearm and the median nerve travel to reach the hand.

58
Q

What forms the roof of the carpal tunnel?

A

The transverse carpal ligament

59
Q

What forms the floor and sides of the carpal tunnel?

A

The carpal bones

60
Q

Diagram of carpal tunnel

A
61
Q

What structures run through the carpal tunnel?

A
  • Median nerve
  • Long flexor tendons of the forearm (4 tendons of FDS + FDP, tendon of FPL)
62
Q

What causes carpal tunnel syndrome?

A

Compression of the median nerve in the carpal tunnel

63
Q

What specific areas of skin are affected in carpal tunnel syndrome?

A

Skin over lateral 3 1/2 digits (palm side)

Skin over lateral 3 digits (dorsal side)

64
Q

Which muscles in the hand are affected by carpal tunnel syndrome? What happens to these muscles over time if surgery is not performed?

A
  • Thenar muscles:
    • Opponens pollicis
    • Abductor pollicis brevis
    • Flexor pollicis brevis
  • Lateral two lumbricals

Lose control of the thumb

65
Q

How many layers of muscle are there in posterior forearm?

A

2 - deep and superficial

66
Q

What muscles make up the superficial layer of the posterior forearm?

A
  • Extensor carpi radialis brevis
  • Extensor carpi radialis longus
  • Extensor carpi ulnaris
  • Extensor digitorum
  • Extensor digiti minimi
  • Brachioradilais
67
Q

What muscles make up the deep layer of the posterior forearm?

A
  • Extensor pollicis longus
  • Abductor pollicis longus
  • Extensor pollicis brevis
  • Supinator
  • Extensor indicis
68
Q

What are all the muscles in the posterior forearm innervated by?

A

The radial nerve

69
Q

Where do the superficial extensors of the posterior forearm originate from?

A

Lateral epicondyle of the humerus - ‘common extensor origin’

70
Q

What are the superficial extensors of the posterior forearm?

A
  • Extensor radialis longus
  • Extensor radialis brevis
  • Extensor radialis ulnaris
  • Extensor digitorum
  • Extensor digiti minimi
71
Q

What muscles are the principal wrist extensors?

A

Extensor carpi radialis (longus and brevis) and extensor carpi ulnaris

72
Q

Where do ECRL, ECRB and ECU insert distally?

A

ECRL - inserts on 3rd metacarpal

ECRB - inserts on 2nd metacarpal

ECU - inserts on 5th metacarpal

73
Q

Diagram of origin and insertion of superficial flexors

A
74
Q

Where does ED lie in the forearm? How many tendons does it give rise to?

A

Lies centrally in the posterior forearm and gives rise to 4 tendons that travel to digits 2-5

75
Q

What is EDM? How many tendons does it have?

A

Part of ED and its tendon travels to the 5th digit.

76
Q

Where do the tendons of ED and EDM pass in relation to extensor retinaculum?

A

These tendons pass beneath the extensor retinaculum

77
Q

Where do ED and EDM tendons insert?

A

On the extensor expansion or ‘hood’

78
Q

What is extensor expansion?

A

A fibrous band of tissue that overlies the dorsum of the digits

79
Q

What is purpose of extensor expansion?

A

Helps to keep the extensor tendons in the midline of the digits and also serves as an insertion point for the tendons of some of the small muscles in the hand, thus allowing those muscles to move the fingers too

80
Q

Where does brachioradialis lie?

A

It lies over the most lateral part of the posterior compartment, on the boundary with the anterior compartment

81
Q

What is the action of brachioradialis? How is this unusual?

A

Contributes to flexion at the elbow joint and is also important for returning the forearm to the mid-prone position (i.e. like a racquet grip) from either full supination or pronation.

Unusual as is a posterior forearm muscle

82
Q

Where does brachioradialis originate from? Where does it insert?

A

The supracondylar ridge of the humerus (not the common extensor origin) and extends to the distal radius

83
Q

What is anconeus?

A

A small muscle situated on the posterior aspect of the elbow. Some consider it part of the posterior compartment of the arm, others as part of the posterior compartment of the forearm.

84
Q

What are the deep extensor muscles of the posterior forearm?

A
  • Extensor pollicis longus
  • Extensor pollicis brevis
  • Abductor pollicis longus
  • Extensor indicis
85
Q

Where do the deep extensor muscles of the posterior forearm arise? What movements are they involved in?

A
  • From the shaft of the radius and ulna and the interosseous membrane
  • Involved in abduction and extension of the thumb and extension of the index finger
86
Q

What are the deep extensor muscles of the posterior forarm innervated by?

A

A branch of the radial nerve called the posterior interosseous nerve

87
Q

Distal insertion of:

  1. EI
  2. EPL
  3. EPB
  4. APL
A
  1. EI - inserts on extensor expansion of index finger
  2. EPL - inserts on distal phalanx of thumb
  3. EPB - inserts on proximal phalanx of thumb
  4. APL - inserts on lateral aspect of 1st metacarpal
88
Q

Action of:

  1. EI
  2. EPL
  3. EPB
  4. APL
A

EI - extends index finger

EPL - extends thumb

EPB - extends thumb

APL - abducts thumb and accessory extensor of thumb

89
Q

What tendons are involved in forming the ASB?

A

APL, EPL, EPB

90
Q

What carpal bone lies in the floor of the ASB?

A

Scaphoid bone

91
Q

Which artery can be palpated in the snuffbox?

A

Radial artery

92
Q

Which vein can be accessed in the snuffbox?

A

Cephalic vein

93
Q

What is E?

A

Styloid process of the ulna

94
Q

What forms the medial, lateral, superior, floor and roof of the cubital fossa?

A

Medial - pronator teres

Lateral - brachioradialis

Superior - An imaginary line between the humeral epicondyles

Floor - Brachialis

Roof - Antebrachial fascia, reinforced by the bicipital aponeurosis

95
Q

What is C?

A

Flexor carpi radialis

96
Q

What is B?

A

Brachioradialis

97
Q

Name B-F

A

B - extensor carpi ulnaris

C - extensor digitorum

D - Abductor pollicis longus

E - Extensor pollicis brevis

F - Extensor digiti minimi

98
Q

what is C?

A

Extensor pollicis longus

99
Q

Which carpal bone articulates with the distal radius at region C

A

Lunate

100
Q

Muscle B is innervated by which nerve?

A

Radial

101
Q

What is E?

A

Flexor digitorum superficialis

102
Q

Which bony landmark lies under region A?

A

Medial epicondyle - We can see the posterior forearm muscles and the dorsum of the hand, hence this is the posterior aspect of a right forearm. A is the medial epicondyle. The posterior forearm muscles can be seen origination form the region directly opposite region A - the lateral epicondyle.

103
Q

Muscle B is capable of producing which of the the following actions?

A

Extension of the interphalangeal joints of the fingers

Extension of the metacarpophalangeal joints of the hand

Extension of the radiocarpal joint

104
Q

Identify A and B.

A

A - Flexor pollicis longus

B - Flexor digitorum profundus

105
Q

Muscle A inserts on the:

A

distal phalanx of the thumb

106
Q

Nerve E innervates which muscles in the anterior forearm?

A

Pronator teres

Flexor carpi radialis

Flexor digitorum superficialis

Lateral half of flexor digitorum profundus

107
Q

Muscle B is innervated by which nerve?

A

Posterior interosseous nerve

108
Q

The red arrow indicates the:

A

Lateral epicondyle

109
Q

What is B?

A

Flexor digitorum profundus

110
Q

This image shows branches of which nerve innervating the skin of the region circled?

A

Superficial radial

111
Q

What is artery A?

A

Radial artery

112
Q

The tendons of which muscles travel through the carpal tunnel in the region circled B?

A

Flexor digitorum profundus

Flexor digitorum superficialis

Flexor pollicis longus

113
Q

What is A-E?

A

A - ulnar nerve

B - ulnar artery

C - median nerve

D - tendon of flexor pollicis longus

E - radial arery

114
Q

Muscle A is innervated by which nerve?

A

Anterior interosseous

115
Q

Identify the tendon indicated by the letter C.

A

Extensor pollicis longus

116
Q

Nerve G innervates which muscles in the forearm?

A

G is the ulnar nerve:

  • Flexor carpi ulnaris
  • Medial half of flexor digitorum profundus
117
Q

Letter C indicates the common flexor origin. Is this true or false?

A

True

118
Q

Identify the vein indicated by letter C.

A

Basilic

119
Q

What is the anterior interosseous nerve a branch of? What does it innervate?

A

Branch of the median nerve - innervates the deep muscles of the anterior forearm

120
Q

What is the posterior interosseous nerve a branch of? What does it innervate?

A

Branch of the radial nerve

Innervates:

  • Extensor carpi radialis brevis
  • Extensor carpi ulnaris
  • Extensor digitorum
  • Extensor digiti minimi
  • Supinator
  • Extensor pollicis brevis
  • Extensor indicis
  • Extensor pollicis longus
  • Abductor pollicis longus

Only exceptions are: extensor carpi radialis longus, brachioradiali which are innervated by the radial nerve itself

Yr 2 - Movement (39 decks)

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