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MSK > Session 2 > Flashcards

Session 2 Flashcards

1
Q

List the contents of the cubital fossa (from lateral to medial)

A

Radial nerve - not strictly part of the cubital fossa but passes underneath the brachioradialis muscle, where it divides into its superficial and deep branches.
Biceps tendon
Brachial artery - it bifurcates at the apex of the fossa into the radial and ulnar arteries.
Median nerve

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2
Q

Where can the brachial pulse be palpated?

A

Immediately medial to the biceps tendon in the cubital fossa

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3
Q

What vein is a common site for venepuncture in the cubital fossa?

A

Median cubital vein - located superficially within the roof of the cubital fossa connecting the basilic and cephalic veins.

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4
Q

Describe the borders of the cubital fossa

A

Lateral - the medial border of the brachioradialis muscle
Medial - the lateral border of the pronator teres
Superior - an imaginary line between the epicondyles of the humerus
Floor - brachialis proximally and supinator distally
Roof - skin and fascia

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5
Q

What are the main cause and consequences of a supracondylar fracture?

A

Usually occurs by falling on a flexed elbow. The blood supply to the forearm from the brachial artery can be compromised. The resulting ischaemia can cause Volkmann’s ischaemic contracture - uncontrolled flexion of the hand as muscles become fibrotic and short.
The median or radial nerves can also be damaged.

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6
Q

What holds the long head of the biceps brachii in the Intertubercular groove?

A

The transverse humeral ligament

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7
Q

What is a test for the spinal cord segment C6?

A

A tap on the biceps brachii tendon

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8
Q

How would a person with a ruptured long head of the biceps brachii present?

A

A bulge where the muscle belly is on flexion at the elbow. Th patient would not notice any weakness of the upper limb.

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9
Q

What is the function of the bicipital aponeurosis?

A

Protects the brachial artery and the median nerve. Helps to lessen the pressure of the biceps brachii tendon on the radial tuberosity.

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10
Q

What is a test for the spinal segment C7?

A

A tap on the triceps brachii tendon

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11
Q

What can result in biceps tendinitis?

A

Repetitive microtrauma (eg in throwing and racquet sports) or a tight/rough intertrabecular groove.

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12
Q

The brachial artery descends down the arm immediately posterior to which nerve?

A

Median

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13
Q

What is the most superior and largest branch of the brachial artery and what path does it take?

A

Profunda brachii artery - deep artery of the arm. It travels along the posterior surface of the humerus, running in the radial groove. It supplies structures in the posterior aspect of the arm and terminates by contributing to a network of vessels at the elbow joint.

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14
Q

What are the major superficial veins in the upper limb? Outline their route.

A

Cephalic and basilic veins, both arising from the dorsal venous nerwork.
The cephalic vein ascends the antero-lateral aspect of the upper limb. At the shoulder, it travels along the deltopectoral groove before entering the axilla via the clavipectoral triangle. It then joins the axillary artery.
The basilic vein ascends the medial aspect of the upper limb. It moves deep into the arm at the border of the teres major to join with the brachial vein.

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15
Q

What connects the deep and superficial veins of the upper limb?

A

Perforating veins

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16
Q

How can x Ray’s of carpal bones in children be useful in forensic medicine?

A

Can be used to estimate the age of the child at the time of death. Endochondrial ossification of carpal bones occurs in a predictable sequence.

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17
Q

What is the anterior surface of the scapula called?

A

Costal (rib facing)

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18
Q

How can fractures of the scapula occur and how are they treated?

A

Severe chest trauma. Not much intervention needed because the tone of the surrounding muscles keeps the pieces in place.

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19
Q

What are the functions of the clavicle?

A

Attaches the upper limb to the trunk.
Protects underlying neurovascular structures.
Transmits force from the upper limb to the axial skeleton.

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20
Q

What are the bony landmarks of the sternal end of the clavicle?

A

Convex. A large facet for articulation with the manubrium of the sternum. There is a rough oval depression on the inferior surface for attachment of the costoclavicular ligament.

21
Q

What are the bony landmarks of the acromial end of the clavicle?

A

Concave. Small facet for articulation with acromion. The conoid tubercule provides attachment for the conoid ligament (medial part of the coracoclavicular ligament). The trapezoid line provides attachment for the trapezoid ligament (lateral part of the coracoclavicular ligament).

22
Q

How can the clavicle become fractured and where is the most common point of fracture?

A

Fall onto shoulder or outstretched hand. The junction between the lateral 1/3 and medial 2/3.

23
Q

How are the parts of the clavicle displaced after fracture?

A

The lateral end is pulled inferiorly and medially by the weight of the arm and the pectoralis major muscle. The medial end is pulled superiority by the sternocleidomastoid muscle.

24
Q

What nerve(s) can be damaged by a fractured clavicle and how would this present?

A

Suprascapular nerves by the upwards movement of the medial part of the fracture. The lateral rotators of the upper limb are paralysed so there is unopposed medial rotation of the upper limb - “waiters tip” position.

25
Q

How can a surgical neck fracture of the humerus result and what structures are vulnerable?

A

Direct blow or by falling on an outstretched hand. Axillary nerve and posterior circumflex artery are vulnerable.

26
Q

What structures are vulnerable during a mid-shaft fracture of the humerus?

A

Profunda brachii artery and radial nerve.

27
Q

What part of the humerus articulates with the ulna and radius?

A

Ulna - trochlea, located medially and extends Posteriorly.

Radius - capitulum, lateral to the trochlea

28
Q

What are the 3 fossa found on the distal humerus?

A

Coronoid, radial and olecranon fossa.

29
Q

What are the bony landmarks of the proximal ulna?

A

Olecranon, coronoid process, trochlear notch (formed by the olecranon and the coronoid process), radial notch (located on the lateral surface of the trochlear notch) and ulnar tuberosity (brachialis muscle).

30
Q

What are the 3 borders and 3 surfaces of the shaft of the ulna?

A

Surfaces - anterior, posterior and medial

Borders - anterior, interosseous and posterior

31
Q

What are the bony landmarks of the distal ulna?

A

Terminates with a smaller rounded head with a distal projection - the styloid process.

32
Q

What is the most common cause and site of a fracture of the ulna alone? How is the ulna normally displaced?

A

Being hit by an object - the shaft is the most likely site. The normal tome pulls the proximal part Posteriorly.

33
Q

How can the olecranon process be fractured?

A

By falling on a flexed elbow. The triceps brachii displaces the fragment proximally.

34
Q

Why is fracture of both forearm bones not uncommon?

A

The force of trauma to one bone can be transmitted to the other via the interosseous membrane.

35
Q

What are the two classical fractures of both of the forearm bones?

A

Monteggia’s fracture - usually from a force behind the ulna. The proximal shaft of the ulna is fractured and the head of the radius dislocates anteriorly at the elbow.

Galeazzi’s fracture - a fracture to the distal radius with the ulna head dislocating at the distal radio-ulnar joint.

36
Q

What are the 4 articulations with the radius?

A

Elbow - head of the radius and the capitulum
Proximal radioulnar joint - radial head and radial notch of ulna
Wrist - distal end of radius and carpal bones
Distal radioulnar joint - ulnar notch and head of ulnar

37
Q

What are the bony landmarks in the proximal region of the radius?

A

Head (thicker medially to take part in the proximal radioulnar joint), neck and radial tuberosity (attachment for biceps brachii).

38
Q

What is the shape of the shaft of the radius?

A

Triangular in shape, expanding in diameter.

39
Q

What are the bony landmarks in the distal region of the radius?

A

The lateral side projects distally as the styloid process. The ulnar notch is in the medial surface (distal radioulnar joint). The distal surface has two facets for articulation with the scaphoid and lunate (wrist joint).

40
Q

What is a Colles’ fracture?

A

The most common type of radial fracture. A fall onto the outstretched hand causing s fracture of the distal radius. The wrist and hand are displaced Posteriorly (dinner fork deformity).

41
Q

What is a Smith’s fracture?

A

A fracture of the radius caused by falling onto the back of the hand. The distal fragment is placed anteriorly.

42
Q

How does a fracture of the radial head occur?

A

Falling on an outstretched hand - the radial head is forced into the capitulum of humerus.

43
Q

What are the 3 categories of the bones in the hand?

A

8 Carpal, 5 metacarpals and 14 phalanges (thumb only has proximal and distal)

44
Q

Name the proximal and distal carpal bones, lateral to medial.

A

Proximal - scaphoid, lunate, triquetrium, pisiform (sesamoid bone)
Distal - trapezium, trapezoid, capitate, hamate

45
Q

How can the scaphoid and lunate bones become fractured?

A

Falling of outstretched hand (lunate - hyperextension of wrist)

46
Q

How does a scaphoid fracture present and what are possible complications?

A

Pain and tenderness in anatomical snuffbox. Needs to be reduced quickly to prevent avascular necrosis (blood supply to proximal part can be cut off). If missed can lead to wrist arthritis later in life.

47
Q

What can be associated with a fractured lunate?

A

Damage to median nerve

48
Q

Why are the medial and lateral surfaces of the metacarpals concave?

A

To allow attachment for the interossei muscles.

49
Q

What are the two most common fractures of the metacarpals?

A

Boxers fracture - fracture at the 5th metacarpal neck usually by a fist clenching a hard object. Distal part is displaced posteriorly, shortening the finger.
Bennett’s fracture - fracture of the 1st metacarpal base caused by hyperabduction of the thumb.

MSK (16 decks)

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