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Clinical anatomy > Upper Limb II > Flashcards

Upper Limb II Flashcards

1
Q

Label this image

A
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2
Q

What is the spiral groove on the humerus for?

A
  • radial nerve
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3
Q

What does the capitulum of the humerus articulate with?

A
  • radius
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4
Q

Label this image

A
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5
Q

What are the ulnar medial collateral ligaments in order of strongest to weakest?

A
  • anterior (strongest)
  • posterior (weakest)
  • oblique (deepens socket)
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6
Q

What is the function of the annular ligament?

A
  • holds the head of the radius in the radial notch of the ulna
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7
Q

What movement does the olecranon fossa limit?

A
  • over extension of the joint
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8
Q

What movement does the coronoid fossa limit?

A
  • full flexion
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9
Q

Label this diagram

A
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10
Q

Which nerve is at risk of injury with an olecranon fracture?

A
  • ulnar nerve
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11
Q

Identify the distal radioulnar joint. Which aspects of the radius and ulna form this joint?

A
  • between the ulnar notch of the radius and the ulnar head.
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12
Q

What attaches to the Radial styloid process?

A
  • tendon of the brachioradialis attaches at its base,
  • radial collateral ligament of the wrist attaches at its apex.
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13
Q

What is the most common fracture in adults over 50 and in what gender?

A
  • Fracture of the distal end of the radius
  • occurs more frequently in women because their bones are often weakened by osteoporosis
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14
Q

What is Colles’ fracture?

A
  • A complete transverse fracture within the distal 2cm of the radius
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15
Q

What is seen in Colles’ fracture?

A
  • The distal fragment is displaced dorsally and is often comminuted (broken into pieces).
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16
Q

Why does Colles’ fracture occur?

A
  • forced dorsiflexion of the hand, usually as the result of trying to ease a fall by outstretching the upper limb.
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17
Q

Label these bones

A
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18
Q

What are the 2 rows of the carpal bones separated by?

A
  • midcarpal joint
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19
Q

Why are falls on an outstretched hand transmitted through the radius?

A
  • wrist joint (radio-carpal joint) involves only the articulation of the distal end of the radius with the Scaphoid and Lunate bones
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20
Q

Why is a fracture of the scaphoid commonly associated with avascular necrosis of the proximal fragment?

A
  • Since the scaphoid blood supply comes from two different vascular branches of the radial artery, fractures can limit access to blood supply
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21
Q

What are the 4 carpal bones in the proximal row?

A
  • Scaphoid
  • Lunate
  • Triquetrum (triquetral)
  • Pisiform
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22
Q

What are the 4 carpal bones in the distal row?

A
  • Trapezium
  • Trapezoid
  • Capitate
  • Hamate
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23
Q

What is a sesamoid bone?

A
  • a bone located within a tendon (i.e. the patella)
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24
Q

Which one of the carpals is a sesamoid bone?

A
  • pisiform
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25
Identify the metacarpals (I-V) and phalanges (I-V) (proximal, middle\* and distal)
26
What 2 carpals are part of the wrist joint complex (radiocarpal joint)?
* scaphoid and lunate
27
How do the phalanges of the first digit differ from those of the other digits?
* only proximal and distal
28
Label this image with 1) radiocarpal 2) carpometacarpal 3) metacarpophalangeal 4) interphalangeal joints
29
What type of joint is the first carpometacarpal joint?
* saddle
30
What do the carpal bones have on their surface and why?
* concavity on their anterior surface which allows for attachment of the flexor retinaculum
31
What does the concavity and flexor retinaculum form?
* carpal tunnel
32
What passes through the carpal tunnel?
* flexor tendons and the median nerve
33
What is the radiocarpal joint?
* synovial articulation of the concave distal end of the radius with the scaphoid and lunate bones
34
What actions occur at the wrist?
* flexion * extension * abduction * adduction * circumduction
35
Label the palmar aponeurosis
36
Label these 3 structures
37
38
What is the structure in blue?
* flexor retinaculum
39
Label the structure in blue
* extensor retinaculum
40
What are the flexor and extensor retinaculums?
* Flexor retinaculum (transverse carpal ligament) * Extensor retinaculum (thickening of posterior antebrachial fascia)
41
Label this image
42
Label the 1) Distal tendon of biceps brachii, 2) Median cubital vein 3) Median antebrachial vein, 4) Median nerve -at this level no branches are given off 5) Brachial artery 6) Bicipital aponeurosis 7) brachioradialis 8) pronator teres 9) ulnar nerve 10) ulnar artery 11) brachioradialis 12) radial nerve
43
What is the anatomical relationship between the bicipital aponeurosis and the neurovascular structures listed above?
* it passes above them
44
What divides the forearm into compartments?
* fascial sheath with the interosseous membrane
45
What is the function of the interosseous membrane?
* strong membrane that attaches the shafts of the radius and ulna to each other
46
In what direction do the fibers of the interosseous membrane run and why?
* run obliquely so that a force that is applied to the lower end of the radius is transmitted through the radius to the ulna to the humerus and scapula
47
Label these structures
48
What is the function of the anterior/flexor compartment of the forearm?
* move the wrist joint * flex fingers and thumb * pronate the hand
49
What is the function of the posterior/extensor compartment of the forearm?
* move the wrist joint * extend fingers and thumb * supinate the hand
50
What are the 4 muscles in the superficial layer of the forearm (flexor/pronator)?
* Pronator teres * Flexor carpi radialis * Palmaris longus * Flexor carpi ulnaris
51
Where do the superficial muscles attach?
* medial epicondyle
52
What is the intermediate muscle in the forearm?
* flexor digitorum superficialis
53
What are the 3 deep muscles in the forearm (flexor/pronator)?
* Flexor pollicis longus * Flexor digitorum profundus * Pronator quadratus
54
What is the difference between the superficial muscles and the deep muscles?
* muscles of the superficial layer cross the elbow joint and the deeper layer muscles do not cross the elbow joint
55
Label this image
56
Label this image, and the layer
* deep layer
57
Label this image with the superior,deep and intermediate layers of the flexor compartment
58
Label this image
59
What are the 7 superficial muscles of the extensor compartment?
* Brachioradialis * Extensor carpi radialis longus * Extensor carpi radialis brevis * Extensor digitorum * Extensor digiti minimi * Extensor carpi ulnaris * Anconeus
60
What are the 5 deep muscles of the extensor compartment?
* Supinator * Abductor pollicis longus * Extensor pollicis brevis * Extensor pollicis longus * Extensor indicis
61
What is the function of the brachioradialis?
* flexes the forearm at the elbow joint
62
Label this image
63
Where do the superficial extensor muscles attach?
* onto the lateral epicondyle of the humerus
64
What is the principal movement of the muscles in the posterior compartment?
* extension/supination
65
What is the innervation of the posterior/extensor compartment of the arm and what are the spinal segments?
* Spinal segments : C5, C6, C7, C8 , T1 * radial nerve
66
What does the radial nerve innervate?
* all muscles in the posterior/extensor compartment of the arm and forearm * Sensory innervation to skin on the posterior aspect of the arm and forearm and dorsal lateral surface of the hand
67
How would you test flexor digitorum superficialis and flexor digitorum profundus function independently of each other?
* patient is asked to flex PIP joint of one of the digits from 2nd to 5th while other remaining three digits held in extension so as to inactivate Flexor Digitorum Profundus
68
Label the 1) median nerve 2) radial nerve 3) ulnar nerve
69
Through which muscle does the median nerve enter the forearm?
* passes between the two heads of the pronator teres
70
Through which muscles does the ulnar nerve enter the forearm?
* between the two heads of flexor carpi ulnaris
71
Through which muscles does the radial nerve enter the forearm?
* pierces the posterior extensor muscles
72
Label the 1) brachial artery 2) superficial palmar branch of radial artery 3) deep palmar arch 4) superficial palmar arch 5) radial artery 6) ulnar artery 7) common interosseus artery 8) anterior and posterior interosseus arteries
73
What branches does the ulnar artery divide into in the forearm?
* anterior and posterior interosseous branches
74
What branch does the median nerve give off anteriorly?
* anterior interosseus branch
75
What branch does the radial nerve give off posteriorly?
* posterior interosseous branch
76
When the PIP joint is fully flexed what cannot be flexed?
* DIP joint
77
What structures form the boundaries of the anatomical snuffbox?
* Ulnar (medial) border: Tendon of the extensor pollicis longus. * Radial (lateral) border: Tendons of the extensor pollicis brevis and abductor pollicis longus. * Proximal border: Styloid process of the radius.
78
Label this diagram
79
Which superficial vein and cutaneous nerve lie within it?
* cephalic vein * cutaneous branch of radial nerve
80
What is the anatomical relationship between the scaphoid and the anatomical snuffbox?
* radius and scaphoid articulate deep to the snuffbox to form the basis of the wrist joint * this is the area through which the brunt of the force will focus in a fall on an outstretched hand * This results in these two bones being the most often fractured of the wrist
81
To which bones/bony prominences is the flexor retinaculum attached (radial and ulnar side)?
* On the ulnar side, the flexor retinaculum attaches to the pisiform bone and the hook of the hamate bone * On the radial side, it attaches to the tubercle of the scaphoid bone, and the ridge of the trapezium bone.
82
Which structures pass superficial and deep to the flexor retinaculum?
* superficial : ulnar artery, ulnar nerve, palmaris longus tendon * deep : flexor digitorum superficialis tendons, median nerve, flexor carpi radialis tendon, flexor pollicis longus tendon
83
What is the relationship of the median nerve to the flexor retinaculum of the carpal tunnel? Why is this relationship significant?
* median nerve passes deep to it * entrapment of the median nerve in carpal tunnel syndrome
84
What is the pattern of sensory and motor deficit in “carpal tunnel syndrome”?
* tingling sensations and muscle weakness in the palm and lateral side of the hand and palm. * may extend and radiate up the nerve causing pain to the arm and shoulder
85
Label this image
86
How does Guyon's canal syndrome occur?
* Compression of the ulnar nerve may occur at the wrist where it passes between the pisiform and the hook of the hamate
87
What can Guyon's canal syndrome present with?
* Compression of the ulnar nerve in this tunnel may result in hypoesthesia in the medial 1.5 digits and weakness of the intrinsic muscles of the hand.
88
What is the function of the palmar aponeurosis?
* barrier between the palmar skin and the important underlying neurovascular and tendon structures
89
What fingers does the radial artery supply?
* thumb and 1/2 index
90
What fingers does the ulnar artery supply?
* 1/2 the index, middle, ring, pinky
91
Which artery makes the major contribution to the superficial palmar arch?
* ulnar artery
92
How is the superficial palmar arch related to the deep palmar arch?
* superficial is more distal than the deep palmar arch
93
What is the anatomical basis for Allen’s test?
* The hand is normally supplied by blood from both the ulnar and radial arteries. * The arteries join in the hand, if the blood supply from one of the arteries is cut off, the other artery can supply adequate blood to the hand
94
Where does venous drainage of the hand occur?
* the dorsal aspect
95
What are the 5 compartments of the intrinsic muscles?
* hypothenar * thenar * central * adductor * interosseous
96
Label this diagram
97
What are the 3 muscles of the thenar eminence?
* Abductor pollicis brevis * flexor pollicis brevis * opponens pollicis
98
What are the 3 muscles of the hypothenar eminence?
* Abductor digiti minimi * flexor digiti minimi brevis * opponens digiti minimi
99
Label this image
100
What is hypothenar atrophy associated with?
* lesion of the ulnar nerve
101
102
What can affect the muscles of the thenar compartment?
* median nerve compression at carpal's tunnel
103
What compartment are the lumbricals a part of and how many are there?
* central compartment * 4
104
How are lumbricals damaged and what happens as a result of this?
* The lumbricals are sometimes damages in crush injuries to the hand * Following these injuries, adhesions may occur between the lumbrical muscle and the interosseous muscles * This adhesion causes the patient to have inter-metacarpal pain when making a fist
105
What is the function of the lumbricals?
* Flex metacarpophalangeal joints and extend interphalangeal joints digits 2-5
106
Where are the interossei muscles located?
* between the metacarpals
107
What can the interosseous muscles be divided into?
* 2 groups : the dorsal and palmar interossei
108
What is the function of the dorsal and palmar interossei?
* DAB (dorsal ABduct) * PAD (palmar ADDuct) * Also assists lumbricals in flexion at MCP and extension at IP joints
109
What are these muscles and what compartment do they belong to?
110
What are these muscles called?
* Lumbricals
111
Where does the radial artery enter the palm?
* between heads of 1st dorsal interosseous muscle
112
What are the articulations of the wrist joint?
* Articulation between distal end of the radius and the articular disc overlying the distal end of the ulna and the proximal row of carpal bones
113
What type of articulation is the wrist joint and what movement does this allow?
* The articulation is an ellipsoid concave * Ellipsoid is also known as a condyloid joint * Ellipsoid joints allow back and forth and side to side movement
114
What are the movements of the thumb?
* opposition * reposition * abduction * adduction * flexion * extension
115
What are the joints between the carpal bones?
* synovial plane joints
116
What are the carpometacarpal and intermetacarpal joints?
* synovial plane joints
117
Why is there no rotation at the wrist joint?
* ellipsoid shape of articular surfaces
118
What does the median nerve innervate?
* Innervates most of the muscles in the anterior/flexor compartment of the forearm
119
What are the spinal segements of the median nerve?
* C5, C6, C7, C8, T1
120
What are the spinal segments of the ulnar nerve?
* C7, C8, T1
121
What does the ulnar nerve innervate?
*
122
How are the terminal parts of the tendons to flexor digitorum superficialis and flexor digitorum profundus related to each other and to the phalanges?
* they are enclosed by a common flexor sheath * have a split (Camper's Chiasm) at the end of them through which the tendons of flexor digitorum profundus pass. * tendons attach to the anterior margins on the bases of the intermediate phalanges of the four fingers
123
Label the nerves responsible for innervation of these locations
124
What views are gold standard for any skeletal X-ray?
* lateral * anteroposterior
125
What are the views for looking at a scaphoid fracture?
* oblique * scaphoid
126
Label this image
A) DIP B) PIP C) carpometacarpal D) 1st metacarpal E) Scaphoid F) Radial G) Ulna H) metacarpal I) proximal phalanx J) distal phalanx
127
What types of fracture is this and how is it displaced?
* distal radius fracture * backwards
128
What is the classic appearance of Colles' fracture?
* posterior displacement * dinner fork appearance
129

Clinical anatomy (10 decks)

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