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Clinical Anatomy Block 2 > Upper limb (Muscle of forearm and hand) > Flashcards

Upper limb (Muscle of forearm and hand) Flashcards

1
Q

What is the First layer of the Anterior compartment of the Forearm?

A

Four muscles in the First layer: “Pass fail Pass fail”

  1. Pronator teres
    * Insertion: Radius (lateral surface)
  2. Flexor carpi radialis
    * Insertion: 2nd metacarpal
  3. Palmaris longus
    * Insertion: Palmar aponeurosis & Flexor retinaculum
  4. Flexor carpi ulnaris
    * Insertion: Pisiform, Hamate, and 5th metacarpal

*Origin: Medial Epicondyle

  • Clinical:
    • Golfer’s elbow (medial epicondititis)
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2
Q

What is the Second Layer of the Anterior compartment of the Forearm?

A
  1. Flexor digitorum superficialis (4 tendons)
  • Origin: Medial epicondyle
  • Insertion: Each tendon splits
    • Surrounds tendons of the Flexor digitorum profundus
    • Attaches to Middle phalanx
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3
Q

What is the Third layer of the Anterior compartment of the Forearm?

A
  1. Flexor Digitorum profundus
  • Origin:
    • Bones of forearm & Interosseous membrane
  • Insertion:
    • Each tendon: passes through Flexor digitorum superficialis
    • Attaches to Distal phalanx
  1. Flexor pollicis longus (pollicis refers to thumb)
  • Origin:
    • Bones of forearm & Interosseous membrane
  • Insertion:
    • Distal phalanx of thumb
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4
Q

What is the Fourth layer of the Anterior compartment of the Forearm?

A
  1. Pronator quadratus
  • Origin and Insertion:
    • Bones of the forearm & Interosseous membrane
  • Hold Radius and Ulna together
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5
Q

What muscles pass through the 6 tunnels formed by the extensor retinaculum?

A
  1. Tunnel One
  • Abductor pollicis longus tendon (Deep muscle)
  • Extensor pollicis brevis tendon (Deep muscle)
  1. Tunnel Two
  • Extensor carpi radialis longus (Superficial muscle)
  • Extensor carpi radialis brevis (Superficial muscle)
  1. Tunnel Three
    * Extensor pollicis longus (Deep muscle)
  2. Tunnel Four
  • Extensor digitorum (Superficial muscle)
  • Extensor Indicis (Deep muscle)
  1. Tunnel Five
    * Extensor digiti minimi (Superficial muscle)
  2. Tunnel Six
    * Extensor carpi ulnaris (Superficial muscle)
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6
Q

What is Brachioradialis?

A

Posterior compartment of Forearm

  1. Origin:
  • Intermuscular septum
  • Lateral supracondylar ridge
  1. Insertion:
    * Radius (lateral part of distal end)

*Clinical: Lateral epicondylitis (Tennis elbow)

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7
Q

What is the Extensor carpi radialis longus?

A

Posterior compartment of Forearm

  1. Origin:
  • Intermuscular septum
  • Lateral supracondylar ridge
  1. Insertion:
    * 2nd Metacarpal
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8
Q

What is the Extensor digitorum?

A

Posterior compartment of Forearm

  1. Origin:
    * Lateral epicondyle
  2. Insertion:
  • Four tendons (connected by Intertendinous connections)
    • Creates four extensor expansions
      • A central slip (middle phalanx)
      • Two lateral slips (Distal phalanx)
    • Expansions attach to the Lumbricals and Interossei
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9
Q

What is Mallet finger?

A
  1. Avulsion of a extensor digitorum from its attachment at the distal phalanx results in a flexion finger deformity
  2. Clinical:
  • Rupture of the tendon caused by traumatic impaction to the tip of the extended finger
  • Resulting in a sudden, forced flexion of the distal interphalangeal joint
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10
Q

What is the Anatomical snuff box?

A
  1. Lateral border:
    * Extensor pollicis brevis
  2. Medial border:
    * Extensor pollicis longus
  3. Roof:
  • Fascia
  • Superfical branch of radial nerve
  1. Floor
  • Scaphoid
  • Trapezium
  • Radial artery
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11
Q

What is the Cubital Fossa?

A
  1. Roof:
  • Skin
  • Superficial fascia
    • Median cubital vein
    • Lateral cutaneous nerve of the forearm
    • Medial cutaneous nerve of the forearm
    • Cubital or supratrochlear lymph nodes
  • Deep fascia:
    • Reinforced by Bicipital aponeurosis
  1. Boundaries
  • Superior Boundary
    • Imaginary horizontal line connecting the medial and lateral epicondyle of humerus
  • Medial Boundary
    • Lateral border of Pronator teres muscle
  • Lateral Boundary
    • Medial border of Brachioradialis muscle
  • Apex
    • Formed by point of intersection of lateral and medial boundaries
  • Floor
    • Brachialis and supinator muscles
  1. Contents (lateral to medial)
  • Radial nerve
  • Biceps brachii tendon
  • Brachial artery
  • Radial and ulnar arteries near the apex
  • Median nerve
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12
Q

What is Volkmann’s contracture or Volkmann’s ischemic contracture?

A
  1. Swelling or bleeding within the cubital fossa causing compartment syndrome
  2. Clinical
  • Permanent shortening (contracture) of forearm muscles
  • Gives rise to claw like deformity of the hand, fingers, and wrist
  • Rare, serious complication of elbow fractures, especially supracondylar humeral fractures, in children 6 to 7 years old
  • Increase pressure from swelling that presses on blood vessels that can decrease blood flow to the forearm
  • 4 Hours will result in nerve and muscle ischemia causing stiffness and shortening
  1. Other causes
  • Major vascular injury
  • Bleeding disorders
  • Increased capillary permeability due
    • Sternuous exercise
    • Burns
    • Hypoalbuminemia
    • Intra-arterial drugs
    • Surgery
    • Iatrogenic infiltrated infusions
  1. Signs and Symptoms (five P’s)
  • Pain (earlies sign)
  • Pallor (pale appearance)
  • Pulselessness
  • Paresthesias (burning sensation)
  • Paralysis
  1. Medical Emergency
  • Pallor and Pulselessness
    • Injury to brachial artery from supracondylar fracture
  • Paresthesias and Paralysis
    • Injury to median, radial, and anterior interosseous nerve by displaced supracondylar fracture
    • Median nerve the most common injured nerve by Anterior displacement of distal fragment
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13
Q

What is the Fibrous Digital Sheath?

A
  1. Enclose
  • Synovial digital sheath
  • Tendons of Flexor digitorum superficialis/profundus
  1. Synovial digital sheath of 5th digit
    * Continous with Ulnar bursa
  2. Ulnar bursa (Deep to palmar aponeurosis)
  • Contents
    • Tendos of Flexor digitorum superficials/profundus
  • Entends into distal third of the anterior compartment of forearm
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14
Q

What is Palmar aponeurosis?

A
  1. Attachment of palmaris longus tendon
  2. Four digital bands
  • Continous with fibrous digital sheaths
  • Fibrous dengeration: DUPUYTEN’ CONTRACTURE (trigger finger)
  1. Medial septum
  • Hypothenar compartment
  • Hypothenar muscles (except palmaris brevis)
  1. Lateral septum
  • Thenar compartment
  • Thenar muscles (except adductor pollicis)
  1. Central compartment
  • Lumbricals
  • Tendons of flexor digitorum superficialis/profundus in the ulnar bulsa
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15
Q

What is the Thenar muscles?

A
  1. Abductor pollicis brevis
  • O: Flexor retinaculum, Scaphoid, and Trapezium
  • I: Thumb (proximal phalanx)
  1. Flexor pollicis brevis
  • O: Flexor retinaculum, Scaphoid, and Trapezium
  • I: Thumb (proximal phalanx)
  1. Opponens pollicis
  • O: Flexor retinaculum, Scaphoid, and Trapezium
  • I: 1st metacarpal
  1. Adductor pollicis (excluded from Thenar muscles)
  • O: 3rd metacarpal
  • I: Thumb (proximal phalanx)
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16
Q

What is the Hypothenar muscles?

A
  1. Abductor digiti minimi
  • O: Flexor retinaculum, pisiform, and hamate
  • I: 5th digit (proximal phalanx)
  1. Flexor digiti minimi brevis
  • O: Flexor retinaculum, pisiform, and hamate
  • I: 5th digit (proximal phalanx)
  1. Opponens digiti minimi
  • O: Flexor retinaculum, pisiform, and hamate
  • I: 5th metacarpal
  1. Palmaris brevis (excluded from hypothenar muscles)
  • Attach to Skin of hypothenar region
  • Ulnar artery and nerve are covered by the palmaris brevis

Clinical Anatomy Block 2 (7 decks)

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