The forearm and cubital fossa Flashcards
Articulations between the ulna and radius? (2)
Proximal radioulnar joint- radius articulates with radial notch of ulna=pivot join. Allows pronation and supination (radius crossover ulna in pronation)
Distal radioulnar joint: Near wrist between ulnar head and ulnar notch of radius
What membrane lies between the radius and ulna?
Features of membrane (2)
Interosseous membrane- thick and fibrous
Supination- what is it how is this achieved?
Palm up. Supinator(post forearm m) and biceps brachii (ant forearm m) contact and the elbow is flexed
Pronation- what is it how is this achieved?
Palm Down- Pronator teres and pronator quadrates contract (ant arm muscles)
Cubital fossa- what is it
triangular depression anterior to elbow joint contains superficial veins used for IV connotations and blood samples
Superior border of cubital fossa
imaginary border between lateral and medial epicondyles
Floor of cubital fossa
Brachialis
lateral border of cubital fossa
Brachioradialis
Medial border of cubital fossa
Pronator teres
Superficial muscles of anterior arm
Pronator teres, flexor carpi radialis, palmaris longus and flexor carpi ulnaris
Intermediate muscles of anterior arm
Flexor Digitorum Superficialis
Deep muscles of anterior arm
Flexor digitorum profundus, flexor pollicus longus, Pronator quadratus
Action of most of the muscles in the anterior forearm
Flexors of the wrist, fingers and thumb
Origin of the superficial flexors
Medial epicondyle of humerus
PT, FCU,FCR,PL which order are they in from the most lateral
PT, FCR, PL, FCU
Pronator teres- attachment, action and innervation
Laterally to mid shaft of radius, pronates forearm, Median N
Flexor carpi radialis- attachment, action and innervation
Base of metacarpal 2&3. Flexion and abduction at wrist, Median N
Palmaris longus - attachment, action and innervation
Absent in 15% population, inserts onto the flexor retinaculum (palmar aponeurosis(which band of CT in wrist)) Flexion of wrist. Median N
Flexor carpi ulnaris - attachment, action and innervation
Attaches onto the pisiform carpal bone. Flexion and abduction at wrist. Ulnar N
what muscles are vulnerable when the palmar spect of the hand is injured
Muscles of the anterior arm
Flexor digitorum superficialis- origin, attachment, action and innervation
from medial epicondyle and radius. Gives rise to 4 tendons that travel under flexor retinaculum through carpal tunnel and attach to middle phalanges of the 4 fingers.
Flexes metacarpopharengeal joints and proximal interpharengeal joints of 4 fingers and flexes the wrist.
Innervation: Median N (by 2nd finger
Ulnar NV bundle lies medial to FDS and radial NV bundle lies lateral
Flexor digitorum profundus- origin, attachment, action and innervation
From ulna and Interosseous membrane. Gives rise to 4 tendons that travel under flexor retinaculum through carpal tunnel and attach to distal phalanges of the 4 fingers.
Only m that flexes distal interpharengeal joints of 4 fingers. Also flexes the wrist.
Medial 1.5 (4th and 5th finger)- Ulnar N the rest by anterior interosseous N (deep branch of median N)
Flexor pollicus longus- origin, attachment, action and innervation
Lateral to FDP. Originates from ant radius and Interosseous membrane. Inserts onto distal phalanx of thumb. Flexes thumb
anterior interosseous N (deep branch of median N)
Pronator quadratus- origin, attachment, action and innervation
From ant radius and inserts onto ant ulna.
Pronates the forearm
Anterior interosseous N (deep branch of median N)
Superficial muscles of posterior forearm
Brachioradialis Extensor carpi radialis longus (ECRL) Extensor carpi radialis brevis (ECRB) Extensor digitorum (ED) Extensor digiti minimi (EDM) Extensor carpi ulnaris (ECU)
Innervation of the posterior forearm muscles
Radial Nerve
Origin of the posterior forearm muscles
lateral epicondyle of the humerus - the common extensor origin.
Extensor carpi radialis longus- attachment and action
metacarpal 2&3. Extension and adduction or wrist
Principle wrist extensor
Extensor carpi radialis brevis- attachment and action
metacarpal 2&3. Extension and adduction or wrist
Principle wrist extensor
Extensor carpi ulnaris- attachment and action
Base of metacarpal 5. Extension and adduction or wrist
Extensor digitorum- attachment and action
lies centrally in post forearm gives rise to 4 tendons that travel under flexor retinaculum through carpal tunnel and attach to extensor hood of the 4 fingers.
Main extensor of fingers. Also extends wrist
Extensor digiti minimi- attachment and action
Part of ED. Tendon attaches to extensor hood of the 5th digit. Extends finger and wrist
Brachioradialis- origin, attachment and action
most lateral post m. on border of ant compartment. originates from supracondylar ridge of the humerus and extends to the distal radius, and is therefore a flexor of the elbow joint. It does not flex the wrist as it does not cross the wrist joint. It is important in returning the forearm to the mid-prone position from either full supination or pronation
what muscles are vulnerable when the dorsal spect of the hand is injured
Muscles of the posterior arm
What is the extensor hood
Fibrous tissue band overlying the dorm of the digits - helps to keep extensor tendons on midline of the digits and serves as insertion point for some hand muscles
Anconeus
small muscle situated on the posterior aspect of the elbow.
Deep muscles of posterior forearm
Extensor indicis (EI) Extensor pollicis longus (EPL) Extensor pollicis brevis (EPB) Abductor pollicis longus (APL)
Origin of Deep muscles of posterior forearm
The shaft of the radius and ulna and the interosseous membrane
Action of Deep muscles of posterior forearm
abduction and extension of the thumb and extension of the index finger.
Injury to the Extensor indicis would affect movement of?
index finger
Injury to the Extensor pollicis longus/ Extensor pollicis brevis/ Abductor pollicis longus would affect movement of?
thumb
Innervation of the deep posterior muscles
Posterior interosseous N (deep branch of Radial N)
Extensor indicis-attachment and action
Extensor hood of index finger
extends index finger
Extensor pollicis longus-attachment and action
Distal phalanx of thumb
Extends carpometacarpal, interpharengeal and metacarpopharangeal joints of the thumb
Extensor pollicis brevis-attachment and action
Attaches to base of proximal phalanx of thumb.
Extends carpometacarpal and metacarpopharangeal joints of the thumb
Abductor pollicis longus-attachment and action
Attaches to lateral base of thumb
Abducts thumb
Supinator muscle- where is it, origin, insertion and action
Lies in floor of cubital fossa. 2 heads one from lateral epicondyle one from posterior ulna.
Inserts on posterior radius
Supinates forearm
Where is the anatomical snuffbox ?
Area between the tendons of abductor pollicis longus, extensor pollicis longus and extensor pollicis brevis form a distinctive depression at the wrist
When is the the anatomical snuffbox best seen
Best seen with the thumb in full extension
what lies in the floor of the anatomical snuffbox ?
The scaphoid bone
Which artery can be palpated in the snuffbox?
Radial Artery
Which vein can be accessed in the snuffbox?
Cephalic Veinb
Medial border of the anatomical snuffbox
Extensor pollicis longus
Lateral border of the anatomical snuffbox
Extensor pollicis brevis (EPB)
Abductor pollicis longus (APL)
What is Colles fracture
Fracture of the distal radius. most common in elderly and Middle Ages women and those with osteoporosis.
Usually result of falling onto outstretched forearm
Ulnar styloid may also be avulsed
Rich blood supple so usually heals well.
What is Guyons canal? What does it contain?
allows passage of ulnar A and N (AKA ulnar canal)
What are indications for carpal tunnel surgery?
Weakness of thumb, atrophy in thenar region, inability to oppose thumb due to thenar m paralysis due to a trapped of median N that cannot provide innervation
Dinner fork abnormality
What is the aim of carpal tunnel surgery?
Cut flexor retinaculum to release median N so it can provide innervation to thenar muscles.
What is circumduction?
Flexion and extension
What type of joint in the radoiocarpal joint?
Synovial ellipsoid joint. Radius articulates with carpal bones. Radoiocarpal ligaments strengthen the joint anteriorly and posteriorly.