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Movement 1 > The Arm and Elbow > Flashcards

The Arm and Elbow Flashcards

1
Q

Who is at most risk of surgical neck of humerus injury?

A

most common in elderly - may be associated with osteoporosis.

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2
Q

What nerve is at risk of humeral shaft fracture?

A

Radial nerve (runs posterolaterally to humerus in radial groove)

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3
Q

Who is most likely to get a supracondylar fracture and which nerve and artery is most at risk?

A
  • Most common in children

- median nerve and brachial artery most at risk.

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4
Q

What are the three bones of the elbow?

A

humerus, ulna, radius

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5
Q

What are the two articulations of the elbow?

A

Humero-ulnar: between trochlea of humerus and trochlear notch of ulna
Humero-radial: between capitulum and radial head.

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6
Q

How is the joint capsule reinforced?

A
  • medially via ulnar collateral ligament
  • laterally via radial collateral ligament
    BUT capsule is thin and loose anteriorly & posteriorly which allows for flexion and extension.
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7
Q

What are the movements of the elbow and which muscles are involved?

A

(via humero-ulnar and humero-radial joints)

flexion: biceps contracts, triceps relaxes
extension: triceps contract, biceps relaxes

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8
Q

What are the three elbow flexors?

A 
Brachialis (underneath biceps brachi)
Biceps brachi (long head more lateral and smaller than short head)
Brachioradialis (accessory flexor of the elbow joint when forearm is mid-pronated).
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9
Q

Origins/Function/Innervation/Insertion of Triceps Brachii?

A

Origin:

  • Long head= infraglenoid tubercle (scapula)
  • Lateral head - Posterolateral humerus above spiral groove
  • Medial head - posteriomedial humerus below spiral groove

Insertion : Olecranon process (Ulna)
Function: Elbow extensor
Innervation: Radial nerve (C5-T1)

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10
Q

Why is dislocation of elbow joint rare and how would it occur?

A
  • very stable due to congruity between trochlear notch of ulnar and trochlea of humerus
  • considerable force required for dislocation
  • sports activities majority of dislocations- most common in YA
  • posterior dislocation by far most common type
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11
Q

What is posterior dislocation of the elbow?

A
  • distal end of humerus driven through weak anterior part joint capsule
    cause by: fall onto hands with elbows flexes or hypertension (force that drives ulna posteriorly or posterolateral)
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12
Q

What may associated findings be of posterior dislocation of elbow?

A
  • ulnar collateral ligament torn
  • fractures of head of radius, coronoid process, olecranon process
  • ulnar nerve injury
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13
Q

What are symptoms of posterior dislocation of elbow?

A
  • Severe pain in elbow region
  • elbow area appears wider
  • prominent olecranon process
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14
Q

What signs would you expect from injury to ulnar nerve (likely in posterior dislocation)?

A
  • numbness of medial part of palm and medial 1.5 fingers

- weakness of flexion & adduction of wrist

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15
Q

What is the Fat Pad sign on X-Ray?

A
  • indicative of occult ‘hidden’ fracture
  • in children- of condyles of humerus
  • in adults - of radial head

= fat pads visible posteriorly (abnormal) and ventrally fat pad bowed (normally can see but not bowed).

  • flexion will be impossible
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16
Q

What is olecranon bursitis of the elbow?

A

= swelling of olecranon buses which may be visible and is painful on palpation

  • > caused by excessive & repeated pressure & friction over olecranon which may inflame bursa
  • AKA ‘Student’s elbow’
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17
Q

What is epicondylitis?

A

inflammation of the wrist flexor/extensor tendons attaching to the medial/lateral epicondyles known as golfers/tennis elbow

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18
Q

What is golfer’s elbow?

A

Inflammation of the insertions of wrist flexor tendons on the medial epicondyle (FM*)

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19
Q

What is tennis elbow?

A

Inflammation of insertions of wrist extensor tendons on lateral epicondyle (EL)

  • local tenderness, pain radiating into forearm along affected muscles.
    treatment: rest or injection of corticosteroids if pain severe.
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20
Q

What is the proximal radioulnar ligament?

A

articulation of radial head and radial notch of ulna.

  • in elbow capsule.
  • stabilised by angular ligament
21
Q

What is the Anular ligament?

A

Anular ligament wraps around radial head.

  • maintains stability of radius
  • allows rotation of radius during pronation and supination of forearm.
22
Q

What are the movements of the proximal radioulnar joint?

A
  1. Supination (hand holding out for something)
  2. pronation (hand on table)
    - > radius crosses over ulna
23
Q

When is the annular ligament relatively weak?

A 
In children (under age 4)
- makes the radius more prone to incomplete dislocation (subluxation) or complete
24
Q

What is this type of dislocation called (When radial head slips out from weak annular ligament’?

A
  • ‘Pulled elbow’ or ‘Nursemaid elbow’
  • caused by adult swinging a child by their arms.
  • radial head moves superiorly
25
Q

What is the cubital fossa?

A

Triangular depression at front of elbow

26
Q

What are the boundaries of the cubital fossa?

A

Lateral border = brachioradialis
Medial border = pronator teres
Superior border = imaginary line between epicondyles.
Floor = proximally brachioradialis, distally supinator
Roof = skin & fascia (reinforced by bicipital aponeurosis and median cubital vein runs through)

27
Q

What are the contents of the cubital fossa (lateral to medial)?

A

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  1. Radial Nerve (not strictly in CF - passes underneath brachioradialis- divides into superficial and deep branches
  2. Biceps Tendon - runs through and attaches to radial tuberosity, distal to neck
  3. Brachial Artery - supplies oxygenated blood to muscles of forearm.
  4. Medial Nerve - supplies flexors of forearm. Leaves CF between two heads of pronator teres.
28
Q

What happens to the brachial artery in the cubital fossa?

A

Bifurcates into radial and ulnar arteries at apex (radial lateral, ulnar medial)

29
Q

Where do the veins lie relative to the cubital fossa?

A

Not in fossa as superior to roof of CF.

30
Q

(Aside from the medial cubital vein in the middle of CF- what are the other two superficial veins lateral to medial)

A

Lateral superficial vein = cephalic vein

Medial superficial vein = basilic vein

31
Q

Where does radial nerve lie?

A

Just deep to brachioradialis at lateral boundary- bifurcates into superficial and deep branches here.

32
Q

What effect would damage to median nerve have to movements of upper limb?

A

Reduced flexion.

33
Q

How are the muscles of the forearm divided?

A

By deep fascia :
Anterior compartment = flexors
Posterior compartment = extensors

34
Q

How are the flexor muscles divided?

A

Superficial - pronator teres, flexor carpi ulnaris & radialis, palmaris longus
Intermediate - flexor digitorum superficialis
Deep - flexor digitorum profundus, flexor pollicis longus, pronator quadratus

35
Q

Which flexors are the main flexors of the wrist?

A

SUPERFICIAL Pronator teres, flexor capri ulnaris & radialis and palmaris longus

36
Q

Where do the superficial flexors arise from/

A

The medial epicondyle of humerus known as the common flexor origin.

37
Q

What is the first superficial flexor muscle you encounter?

A

Pronator teres (pronator and weak flexor of forearm)

38
Q

What are the pair of muscles with similar functions medial to pronator teres?

A

Flexor carpi radialis and flexor carpi ulnaris.

39
Q

Where does flexor carpi radialis insert distally and what specific action does it do?

A

base of 2nd and 3rd metacarpals (flexes and abducts hand)

40
Q

Where does flexor carpi ulnaris insert distally and what specific function does it do?

A

Pisiform, hook of hamate and base of fifth metacarpal (flexes and adducts)

41
Q

What is the fourth superficial flexor which intervenes between flexor carpi radialis & ulnaris?

A

Palmaris longus (in 85% of individuals)

*press thumb and little finger together, look for visible tendon at wrist.

42
Q

What are attachments of palmaris longus?

A

From common extensor origin to palmar aponeurosis.

43
Q

What is the innervation to superficial flexors

A

ALl median nerve except for flexor carpi ulanris which is ulnar nerve.

44
Q

What is the muscle most lateral to the superficial flexors and what is unique about it?

A

Brachioradialis - comes from the common extensor origin (supercondylar ridge of humerus) but is a flexor!

45
Q

What is brachioradialis’ insertion and innervation?

A

Radial styloid process and radial nerve.

46
Q

What trick can you use to locate four superficial flexor tendons?

A

Four fingers from medial epicondyle of right arm

47
Q

What is the intermediate flexor of the forearm?

A

FDS Flexor digitorum superficialis

48
Q

Where does flexor digitorum superficial insert?

A

Middle phalanges of digits 2-5.

49
Q

Where do the ulnar, radial and media NVB’s lie in relation to FDS?

A 
Ulnar = medial
Radial = lateral 
Median = in between FDS (innervates) and FDP (innervates lateral half via interosseous branch)

Movement 1 (4 decks)

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