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Year 2 - LCRS - Anatomy of the Limbs > Session 3: Anatomy of the Elbow, Forearm and Wrist (10.01.2020) > Flashcards

Session 3: Anatomy of the Elbow, Forearm and Wrist (10.01.2020) Flashcards

1
Q

What are the important bones in the area?

A
  • humerus (elbow joint)
  • radius
  • ulna
  • carpals
    • Proximal row: scaphoid, lunate, triquetrum, pisiform
    • distal row: trapezium, trapezoid, capitate, hamate
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2
Q

What are the carpals in the proximal row called?

A

scaphoid, lunate, triquetrum, pisiform

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3
Q

What are the carpals in the distal row called?

A

trapezium, trapezoid, capitate, hamate

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4
Q

Which joints make up the elbow joint?

A
  • humerus - radius (capitulum and head of radius)
  • humerus - ulna (trochlea and trochlear notch of ulna)
  • radius - ulna (via head of radius and radial notch of ulna)
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5
Q

Capitulum

A
  • rounded condyle on the distal end of the humerus

- articulation with radius (via head of radius) at the elbow joint

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6
Q

Trochlea of humerus

A
  • condyle on distal end of the humerus
  • forms articulation with the ulna (via trochlear notch of ulna)
  • trochlea fits in the ulnar articulation
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7
Q

What are the articulations at the wrist joint?

A
  • radius and ulna articulate with the proximal row of carpal bones apart from pisiform which is a sesamoid bone.
  • The distal ulna does not articulate directly with the triquetrum carpal bone. An articular disc intervenes.
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8
Q

Interosseous membrane

A
  • there is a membrane between the shafts of the radius and the ulna
  • The interosseous membrane separates the anterior and posterior compartments, and is a site of attachment for muscles in the forearm.
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9
Q

Coronoid vs Coracoid

A
  • coronoid is on the ulna

- coracoid is on the scapula

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10
Q

What are the features on the distal ends of the radius and ulna?

A
  • styloid process of ulna
  • styloid process of radius
  • grooves for tendons
  • distal radio-ulnar joint
  • dorsal tubercle of radius
  • for articular disc (to articulate)
  • for scaphoid (to articulate)
  • for lunate (to articulate)
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11
Q

Coronoid vs Coracoid

A
  • coronoid is on the ulna (brachial attaches there)

- coracoid is on the scapula (short head of biceps attaches there, to the apex of the coracoid)

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12
Q

What are the features on the distal ends of the radius and ulna?

A
  • styloid process of ulna
  • styloid process of radius
  • grooves for tendons
  • distal radio-ulnar joint
  • dorsal tubercle of radius
  • for articular disc (to articulate)
  • for scaphoid (to articulate)
  • for lunate (to articulate)
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13
Q

What are the groups of muscles in that region?

A
  • anterior compartment of the arm
  • posterior compartment of the arm
  • anterior compartment of the forearm
    • superficial compartment
    • deep compartment
  • posterior compartment of the forearm
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14
Q

Anterior Compartment of the Arm - which muscles are found there? What is their innervation?

A
  • Biceps -> tendon to radial tuberosity and aponeurosis which merges with the fascia
  • Brachialis -> also acts across the elbow joint, important flexor of the elbow, attaches to coronoid process
    (- Coracobrachialis -> does not act over the elbow)

Innervated by musculocutaenous nerve (C5,C6)

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15
Q

Posterior Compartment of the Arm - which muscles are there? What is their innervation?

A
  • Triceps -> triceps tendon attachment to the olecranon process of the ulna
  • Anconeus -> stabilisation

Innervated by Radial nerve (C7,8) -> greys anatomy say C6,7,8

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16
Q

The forearm muscles - general info

A
  • The hand and wrist are operated by ‘remote control’ by these muscles
  • The forearm muscles actually take origin from the distal humerus as well as the radius and ulna
  • Flexors (and pronators) anteriorly
  • Extensors (and supinators) posteriorly
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17
Q

Where are the flexors and extensors of the forearm found?

A
  • Flexors (and pronators) anteriorly

- Extensors (and supinators) posteriorly

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18
Q

What is the anterior compartment of the forearm subdivided into?

A
  • superficial compartment

- deep compartment

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19
Q

Superficial Anterior Compartment of the Forearm - what muscles are found there?

A
  • Pronator teres (PT)
  • Flexor carpi radialis (FCR)
  • Palmaris longus (PL)
  • Flexor digitorum superficialis (FDS)
  • Flexor carpi ulnaris (FCU)

=> generally these muscles are involved with

  • movements of the wrist joint
  • flexion of the fingers including the thumb
  • pronation
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20
Q

Pronator Teres (PT)

A

Attachments:

  • humeral head (medial epicondyle and adjacent supra-epicondylar ridge); ulnar head - medial side of the coronoid process
  • roughening on lateral surface, mid shaft, of radius

Innervation: Median neve (C6,7)

Function: Pronation

wraps around the lateral side of the radius

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21
Q

Flexor carpi radialis (FCR)

A

Attachments:

  • medial epicondyle of humerus
  • base of metacarpals I and II

Innervation: median nerve (C6,7)

Function: flexes and abducts the wirst

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22
Q

Palmaris longus

A

Attachments:

  • medial epicondyle of humerus
  • palmat aponeurosis of hand

Innervation: Median nerve (C7,8)

Functions:

  • flexes wrist joint
  • because the palmar aponeurosis anchors skin of the hand, contraction of the muscle resists shearing forces when gripping

This muscle is relatively small and it is not present in everyone. Palmaris longus is better developed in primates that climb so some people don’t have it.

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23
Q

Flexor digitorium superficialis

A

Attachments:

  • humeri-ulnar head - medial epicondyle of humerus and adjacent margin of coronoid process; radial head - oblique line of radius
  • four tendons which arch to the palmar surfaces of the middles phalanges of the index, middle, ring and little fingers.

Innervation: median nerve (C8,T1)

Function:
- flexes proximal interphalangeal joints of the index, middle, ring and little fingers; can also flex metacarpophalangeal joints of the same fingers and the wrist joint.

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24
Q

Flexor carpi ulnaris

A

Attachments:

  • humeral head: medial epicondyle of humerus; ulnar head: olecranon and posterior border of ulna
  • pisiform bone, and then via pisohamate and pisometacarpal ligaments into the hamate and base of metacarpal V

Innervation: Ulnar nerve: C7,8,T1

Function:
- flexes and adducts the wrist joint

The muscles is quite straight in appearance.

25
Q

Flexion vs Extension

A

Flexion:

26
Q

Flexion vs Extension

A

Flexion: decreases the angle between 2 body parts
Extension: increases the angle between 2 body parts

27
Q

Flexion vs Extension

A

Flexion: decreases the angle between 2 body parts
Extension: increases the angle between 2 body parts

28
Q

Flexor retinaculum

A

The flexor retinaculum forms the roof of the carpal tunnel and is an important structure that will be considered next time.

29
Q

Flexor retinaculum

A
  • The flexor retinaculum forms the roof of the carpal tunnel and is an important structure that will be considered next time.
  • Thick band of connective tissue that connects bony features in the wrist
  • Protects all of the stuff going from anterior regions to palmar region
  • Number of tendons
  • Median nerve
30
Q

Pronator quadratus (PQ)

A

Attachments:

31
Q

Flexor digitorum profundus (FDP)

A

Attachments:

  • anterior and medial surfaces of ulna and anterior medial half of interosseous membrane
  • four tendons, which attach to the palmar surfaces of the distal phalanges of the index, middle, ring and little fingers

Innervation:

  • lateral half by median nerve (anterior interosseous nerve)
  • medial half by ulnar nerve
  • C8,T1

Function:

  • flexes distal interphalangeal joints of the index, middle, ring, and little dingers
  • can also flex metacarpophalangeal joints of the same fingers and the wrist joint
32
Q

Flexor pollicis longus (FPL)

A

Attachments:

  • anterior surface of radius and radial half o interosseous membrane
  • palmar surface of base of distal phalanx of thumb

Innervation:
- median nerve (anterior interosseous nerve) (C7,8)

Function:

  • flexes interphalangeal joint of the thumb
  • can also flex metacarpophalangeal joint of the thumb
33
Q

Pronator quadratus (PQ)

A

Attachments:

  • linear ridge in distal anterior surface of the ulna
  • distal anterior surface of the radius

Innervation:
- median nerve (anterior interosseous nerve (C7,8))

Function:
- Pronation

34
Q

Extensor (posterior) Compartment of the Forearm

A

Muscles that move the wrist joint

  • Extensor carpi radialis longus (ECRL)
  • Extensor carpi radialis brevis (ECRB)
  • Extensor carpi ulnaris (ECU)

Muscles that move the digits

  • Extensor digitorum (ED)
  • Extensor indicis (EI)
  • Extensor digit minimi (EDM)

Muscles that move the thumb

  • Abductor pollicis longus (APL)
  • Extensor pollicis brevis (EPB)
  • Extensor pollicis longus (EPL)

Other muscles

  • Brachioradialis
  • Supinator
35
Q

Posterior/extensot compartment: which muscles move the wrist joint?

A
  • Extensor carpi radialis longus (ECRL)
  • Extensor carpi radialis brevis (ECRB)
  • Extensor carpi ulnaris (ECU)
36
Q

Posterior/extensot compartment: which muscles move the digits?

A
  • Extensor digitorum (ED)
  • Extensor indicis (EI)
  • Extensor digit minimi (EDM)
37
Q

Posterior/extensot compartment: which muscles move the thumb?

A
  • Abductor pollicis longus (APL)
  • Extensor pollicis brevis (EPB)
  • Extensor pollicis longus (EPL)
38
Q

Helpful anatomical terminology

A

Flexors (anterior) and Extensors (posterior)

Movers of the wrist (the “carpi” muscles) act on the radial (radialis) or ulnar (ulnaris) aspects of the forearm.

Movers of the digits:- act on groups of digits (digitorum muscles) or on individual digits (pollicis (thumb), indicis (index finger) digiti minimi (little finger)) (these muscles also contribute to wrist movements).

Also note that if there’s a longus, there’s a brevis; if there’s a superficialis, there’s a profundus.

The main complications are the muscles involved in pronation (anterior) and supination (posterior).

39
Q

What is the anatomical snuff box?

A

Formed by EPL (extensor policies longus) and EPB tendon
Importance:

  • There is a branch of the radial artery in the area
  • Also you can palpte that scaphoid in that area
  • Important in determining if the scaphoid might be fractured: a common injury (the scaphoid has recurrent BS)
40
Q

What are the joints of that region?

A

Elbow joint
Proximal radio-ulnar joint
Distal radio-ulnar joint
Wrist joint

41
Q

Ligaments at the elbow joint - what is their function?

A

Ligaments at the elbow joint are arranged to stabilise the joint, but allow pronation/supination movements.

42
Q

Carrying angle

A
  • difference between sexes, in women it is >15 dg in men it is between 10 and 15 dg
  • associated with wider hips in women
43
Q

Movements of the elbow joint

A

Flexion

  • Brachialis
  • Biceps
  • (Brachioradialis)
  • (Pronator teres)

Extension

  • Triceps
  • (Anconeus)
44
Q

Movements of the radio-ulnar joints

A

Supination

  • Supinator
  • Biceps (is an important supinator (attaches to the radial tuberosity)
  • (EPL, ECRL)

Pronation

  • Pronator quadratus
  • Pronator teres
  • (FCR, PL, brachioradialis)
45
Q

Movements of the wrist joint

A

Flexion

  • FCR and FCU – important
  • Long flexors of thumb and fingers
  • (PL, APL)

Extension

  • ECRL, ECRB, ECU – important
  • Long extensors of the thumb and fingers
Radial deviation (abduction)
- APL, FCR, ECRL, ECRB
Ulnar deviation (adduction)
- ECU, FCU

=> look at slide 37

46
Q

Arteries of the region

A

(- Brachial artery

  • Gives off a large branch in the arm – Profunda brachii
  • Divides as the level of the elbow into…)
  • Ulnar and Radial arteries
  • Ulnar art. Has common interosseous branch which imediately branches to give the anterior and posterior interosseous atreries
  • Arches of the hand – anastomosis of the radial and ulnar arteries
47
Q

Cubital fossa

A

the space anterior to the elbow joint

- contains tendons, muscles, fascia, nerves, veins, arteries, lymph nodes

48
Q

Veins of the region

A
  • Superficial and deep systems
  • Cephalic vein (superficial) runs up lateral border of
    arm
  • Basilic vein (superficial) runs up the medial border
    of arm
  • Basilic veins joins venae comitantes to form the
    axillary vein in the arm
  • Cephalic vein joins axillary vein in the axilla
  • Axillary vein becomes the subclavian vein at the
    level of the first rib

Cephalic and Basilic veins arise from the dorsal venous arch of the hand.

Commonly connected at the cubital fossa by the median cubital vein (not always present or prominent).

Median cubital vein is commonly used in phlebotomy.

When median cubital vein is absent, cephalic or basilic in the region are used to take blood.

49
Q

Median cubital vein

A
  • one of the most commonly used veins for taking blood

- connection between cephalic and basilica vein

50
Q

Deep venous drainage

A
  • follows the arteries

- Venae comitantes -> more than 1 vein running with the arteries (usually paired)

51
Q

Lymphatic drainage of the region

A
  • Superficial and deep systems, run with veins
  • Cubital lymph nodes
  • Axillary nodes are also draining nodes for the distal parts of the upper limb
52
Q

Main nerves of the upper limb

A
  • Musculocutaneous nerve (C5,6,7) -> does not supply the muscles of the forearm
  • Ulnar nerve (C8,T1)
  • Median nerve (C6,7,8,T1)
  • Radial nerve (C5,6,7,8,T1)
53
Q

Musculocutaneous nerve

A
  • (C5,6,7)
  • Supplies all the anterior compartment of the upper arm
  • Sensory to the lateral forearm (as the lateral cutaneous nerve of the forearm)
54
Q

Median Nerve

A
  • (C6,7,8,T1)
  • Courses through the anterior compartment of the arm (no significant branches) and lies anterior to the elbow, with the brachial artery (easily damaged!)
  • Main nerve to the muscles of the forearm
  • Starts to supply forearm muscels in elbow region
  • commonly damaged at the wrist in particular
  • commonly damaged in fractures
55
Q

Ulnar Nerve

A
  • (C8,T1)
  • Courses via the posterior compartment of the upper arm
  • No significant branches in the upper arm
  • Lies behind the medial epicondyle at the elbow (easily damaged)
  • The main nerve of the hand
56
Q

What is the main nerve of the hand?

A

Ulnar nerve

57
Q

Radial Nerve

A
  • (C5,6,7,8,T1)
  • Supplies all the muscles of the posterior compartments of the upper arm and forearm
  • Passes around the body of the humerus at its mid-shaft in the radial groove (easily damaged!)
  • Supplies triceps in the arm
  • Courses via the anterior compartment of the upper arm more distally
  • Divides just above the level of the elbow into;
  • Deep branch – the posterior interosseous nerve (motor)
  • Superficial branch – the superficial radial nerve (sensory)
58
Q

Nerves: motor supply in the forearm

A
  • The Radial Nerve supplies all posterior muscles.
  • The Ulnar Nerve supplies only FCU and the Ulnar half of FDP .
  • The Median Nerve supplies all of the remaining anterior muscles.

Year 2 - LCRS - Anatomy of the Limbs (9 decks)

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