Week 3 SDL: The arm and the elbow

Question 1

What are some types of arthritis?

Answer 1

• SLE
• psoriatic arthritis
• rheumatoid arthritis
• reactive arthritis
• gout/pseudogout

Question 2

What is the most common type of arthritis?

Answer 2

osteoarthritis

Question 3

What is osteoarthritis?

Answer 3

• inflammation
• cartilage loss
• joint swelling

Question 4

What is synovitis?

Answer 4

synovial lining becomes inflammed and irritable

Question 5

What are the features of inflammatory arthritis?

Answer 5

• morning stiffness more than 30 minutes
• raised inflammatory markers (CRP)
• definite joint swelling
• inflammatory back pain
• not just elderly people

Question 6

What are the features of rheumatoid arthritis?

Answer 6

• autoimmune inflammatory arthritis
• F >M, 40-50s
• joint swelling, heat, pain, morning stiff ness
• mostly affects small joints of hands and feet
• rheumatoid nodules

Question 7

What is psoriatic arthritis?

Answer 7

• swollen toes and fingers

- funny discolouration around the nail

Question 8

What is axial spondyloarthritis?

Answer 8

• inflammatory back pain
• worsens with rest
• affects spine and sacroiliac joints

Question 9

What is gout?

Answer 9

• too much uric acid

- uric acid accumulates in joints in uric acid crystals

Question 10

What is pseudogout due to?

Answer 10

calcium pyrophosphate

Question 11

What is the axilla?

Answer 11

a pyramidal space with four walls and an inferiorly facing base made up by the skin and fascia of the armpit

Question 12

What forms the lateral wall of the axilla?

Answer 12

intertubercular sulcus of the humerus

Question 13

What forms the posterior wall of the axilla?

Answer 13

• teres major
• latissimus dorsi
• subscapularis
• scapula

Question 14

What forms the medial wall of the axilla?

Answer 14

serratus anterior and 4th rib

Question 15

What forms the anterior wall of the axilla?

Answer 15

pec major and minor

Question 16

What important structure enters through the apex of the axilla?

Answer 16

neurovascular bundle

Question 17

What is contained within the neurovascular bundle of the axilla?

Answer 17

axillary artery/vein, cords of the brachial plexus

Question 18

When does the axillary artery become the brachial artery?

Answer 18

at the point that it crosses teres major

Question 19

Which branches does the axillary artery give rise to in the axilla

Answer 19

anterior and posterior circumflex humeral arteries

Question 20

Where do the anterior and posterior circumflex humeral arteries anastomose?

Answer 20

around the surgical neck of the humerus

Question 21

What is the main supplier of blood to the upper arm?

Answer 21

profunda brachii (branch of the brachial)

Question 22

Where do we find the profunda brachii?

Answer 22

• This artery travels around the back of the humerus and runs down the posterior aspect of the humerus in the radial groove
• The profunda brachii runs alongside the radial nerve, which also travels in the radial groove.

Question 23

Where does the axillary vein become the subclavian vein?

Answer 23

at the lateral border of the first rib

Question 24

what are the two major superificial veins in the arm?

Answer 24

cephalic and basilic

Question 25

What is the medial cubital vein?

Answer 25

the vein that connects the cephalic and basilic veins in the region anterior to the elbow joint (the antecubital fossa)

Question 26

What are the roots of the brachial plexus?

Answer 26

the ventral rami of spinal nerves C5 to T1

Question 27

The roots of the plexus come together to form what?

Answer 27

3 trunks: superior, middle and inferior

Question 28

What does each trunk of the brachial plexus split into?

Answer 28

an anterior and posterior division

Question 29

The anterior and posterior divisions from different drunks come together to form what?

Answer 29

3 cords (medial, lateral and posterior) - named relative to their position around the 2nd part of the axillary artery

Question 30

What is a brachial plexus block?

Answer 30

- BP is visualised using an ultrasound then a local anaesthetic is injected around the nerves - surgery can then be performed on the anaesthetised upper limb

Question 31

How many nodes does the axilla have?

Answer 31

4

Question 32

How is the arm divided into 2 functional compartments by the deep fascia of the arm?

Answer 32

1. Flexor compartment - this lies anterior to the humerus. It contains muscles that flex the shoulder and elbow 2. Extensor compartment - this lies posterior to the humerus. It contains a muscle that extends the shoulder and elbow

Question 33

Explain how bicep reflex is carried out

Answer 33

1. The tendon of the muscle is tapped with a tendon hammer. The muscle fibres stretch, and this is detected by stretch receptors within the muscle spindles. This information is carried to the spinal cord by afferent fibres which synapse with efferent (motor) fibres, which then stimulate contraction of the muscle, producing movement. 2. The examiner palpates the biceps tendon in the cubital fossa and places the thumb or forefinger over the tendon, and then allows the head of the hammer to swing down onto their thumb / finger

Question 34

What would you expect to see with a normal biceps reflex?

Answer 34

there should be a reflex contraction of the biceps brachii muscle (elbow flexion)

Question 35

In a bicep reflex, which peripheral nerves and which spinal nerves are being tested?

Answer 35

spinal nerves - C5-C6

Question 36

What is seen in a normal triceps reflex?

Answer 36

A sudden contraction of the triceps muscle causes extension, and indicates a normal reflex

Question 37

For the tricep reflex, which spinal nerves are being tested?

Answer 37

a tap on the triceps tendon tests spinal segment C7

Question 38

``` What are the: 1. Superior 2. Inferior 3. Medial 4. Lateral borders of the quadrilateral space ```

Answer 38

Superior - teres minor Inferior - teres major Medial - long head of tricep brachii Lateral - surgical neck of the humerus

Question 39

Which artery and nerve travel through the quadrilateral space?

Answer 39

the axillary nerve and posterior circumflex humerus artery and vein

Question 40

Where is the proximal radioulnar joint and which movements does it allow?

Answer 40

- the head of the radius articulates with the radial notch of the ulna to form a pivot joint - this allows pronation and supination of the forearm and hand

Question 41

What ligament holds the head of the radius in place?

Answer 41

radial collateral ligament