Upper limb (Muscle of forearm and hand) Flashcards
What is the First layer of the Anterior compartment of the Forearm?
Four muscles in the First layer: “Pass fail Pass fail”
- Pronator teres
* Insertion: Radius (lateral surface) - Flexor carpi radialis
* Insertion: 2nd metacarpal - Palmaris longus
* Insertion: Palmar aponeurosis & Flexor retinaculum - Flexor carpi ulnaris
* Insertion: Pisiform, Hamate, and 5th metacarpal
*Origin: Medial Epicondyle
- Clinical:
- Golfer’s elbow (medial epicondititis)
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What is the Second Layer of the Anterior compartment of the Forearm?
- 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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What is the Third layer of the Anterior compartment of the Forearm?
- Flexor Digitorum profundus
- Origin:
- Bones of forearm & Interosseous membrane
- Insertion:
- Each tendon: passes through Flexor digitorum superficialis
- Attaches to Distal phalanx
- Flexor pollicis longus (pollicis refers to thumb)
- Origin:
- Bones of forearm & Interosseous membrane
- Insertion:
- Distal phalanx of thumb
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What is the Fourth layer of the Anterior compartment of the Forearm?
- Pronator quadratus
- Origin and Insertion:
- Bones of the forearm & Interosseous membrane
- Hold Radius and Ulna together
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What muscles pass through the 6 tunnels formed by the extensor retinaculum?
- Tunnel One
- Abductor pollicis longus tendon (Deep muscle)
- Extensor pollicis brevis tendon (Deep muscle)
- Tunnel Two
- Extensor carpi radialis longus (Superficial muscle)
- Extensor carpi radialis brevis (Superficial muscle)
- Tunnel Three
* Extensor pollicis longus (Deep muscle) - Tunnel Four
- Extensor digitorum (Superficial muscle)
- Extensor Indicis (Deep muscle)
- Tunnel Five
* Extensor digiti minimi (Superficial muscle) - Tunnel Six
* Extensor carpi ulnaris (Superficial muscle)
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What is Brachioradialis?
Posterior compartment of Forearm
- Origin:
- Intermuscular septum
- Lateral supracondylar ridge
- Insertion:
* Radius (lateral part of distal end)
*Clinical: Lateral epicondylitis (Tennis elbow)
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What is the Extensor carpi radialis longus?
Posterior compartment of Forearm
- Origin:
- Intermuscular septum
- Lateral supracondylar ridge
- Insertion:
* 2nd Metacarpal
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What is the Extensor digitorum?
Posterior compartment of Forearm
- Origin:
* Lateral epicondyle - 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
- Creates four extensor expansions
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What is Mallet finger?
- Avulsion of a extensor digitorum from its attachment at the distal phalanx results in a flexion finger deformity
- 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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What is the Anatomical snuff box?
- Lateral border:
* Extensor pollicis brevis - Medial border:
* Extensor pollicis longus - Roof:
- Fascia
- Superfical branch of radial nerve
- Floor
- Scaphoid
- Trapezium
- Radial artery
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What is the Cubital Fossa?
- 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
- 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
- Contents (lateral to medial)
- Radial nerve
- Biceps brachii tendon
- Brachial artery
- Radial and ulnar arteries near the apex
- Median nerve
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What is Volkmann’s contracture or Volkmann’s ischemic contracture?
- Swelling or bleeding within the cubital fossa causing compartment syndrome
- 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
- Other causes
- Major vascular injury
- Bleeding disorders
- Increased capillary permeability due
- Sternuous exercise
- Burns
- Hypoalbuminemia
- Intra-arterial drugs
- Surgery
- Iatrogenic infiltrated infusions
- Signs and Symptoms (five P’s)
- Pain (earlies sign)
- Pallor (pale appearance)
- Pulselessness
- Paresthesias (burning sensation)
- Paralysis
- 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
What is the Fibrous Digital Sheath?
- Enclose
- Synovial digital sheath
- Tendons of Flexor digitorum superficialis/profundus
- Synovial digital sheath of 5th digit
* Continous with Ulnar bursa - 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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What is Palmar aponeurosis?
- Attachment of palmaris longus tendon
- Four digital bands
- Continous with fibrous digital sheaths
- Fibrous dengeration: DUPUYTEN’ CONTRACTURE (trigger finger)
- Medial septum
- Hypothenar compartment
- Hypothenar muscles (except palmaris brevis)
- Lateral septum
- Thenar compartment
- Thenar muscles (except adductor pollicis)
- Central compartment
- Lumbricals
- Tendons of flexor digitorum superficialis/profundus in the ulnar bulsa
What is the Thenar muscles?
- Abductor pollicis brevis
- O: Flexor retinaculum, Scaphoid, and Trapezium
- I: Thumb (proximal phalanx)
- Flexor pollicis brevis
- O: Flexor retinaculum, Scaphoid, and Trapezium
- I: Thumb (proximal phalanx)
- Opponens pollicis
- O: Flexor retinaculum, Scaphoid, and Trapezium
- I: 1st metacarpal
- Adductor pollicis (excluded from Thenar muscles)
- O: 3rd metacarpal
- I: Thumb (proximal phalanx)
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