Week 3 SDL: The arm and the elbow Flashcards
What are some types of arthritis?
- SLE
- psoriatic arthritis
- rheumatoid arthritis
- reactive arthritis
- gout/pseudogout
What is the most common type of arthritis?
osteoarthritis
What is osteoarthritis?
- inflammation
- cartilage loss
- joint swelling
What is synovitis?
synovial lining becomes inflammed and irritable
What are the features of inflammatory arthritis?
- morning stiffness more than 30 minutes
- raised inflammatory markers (CRP)
- definite joint swelling
- inflammatory back pain
- not just elderly people
What are the features of rheumatoid arthritis?
- autoimmune inflammatory arthritis
- F >M, 40-50s
- joint swelling, heat, pain, morning stiff ness
- mostly affects small joints of hands and feet
- rheumatoid nodules
What is psoriatic arthritis?
- swollen toes and fingers
- funny discolouration around the nail
What is axial spondyloarthritis?
- inflammatory back pain
- worsens with rest
- affects spine and sacroiliac joints
What is gout?
- too much uric acid
- uric acid accumulates in joints in uric acid crystals
What is pseudogout due to?
calcium pyrophosphate
What is the axilla?
a pyramidal space with four walls and an inferiorly facing base made up by the skin and fascia of the armpit
What forms the lateral wall of the axilla?
intertubercular sulcus of the humerus
What forms the posterior wall of the axilla?
- teres major
- latissimus dorsi
- subscapularis
- scapula
What forms the medial wall of the axilla?
serratus anterior and 4th rib
What forms the anterior wall of the axilla?
pec major and minor
What important structure enters through the apex of the axilla?
neurovascular bundle
What is contained within the neurovascular bundle of the axilla?
axillary artery/vein, cords of the brachial plexus
When does the axillary artery become the brachial artery?
at the point that it crosses teres major
Which branches does the axillary artery give rise to in the axilla
anterior and posterior circumflex humeral arteries
Where do the anterior and posterior circumflex humeral arteries anastomose?
around the surgical neck of the humerus
What is the main supplier of blood to the upper arm?
profunda brachii (branch of the brachial)
Where do we find the profunda brachii?
- 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.
Where does the axillary vein become the subclavian vein?
at the lateral border of the first rib
what are the two major superificial veins in the arm?
cephalic and basilic
What is the medial cubital vein?
the vein that connects the cephalic and basilic veins in the region anterior to the elbow joint (the antecubital fossa)
What are the roots of the brachial plexus?
the ventral rami of spinal nerves C5 to T1
The roots of the plexus come together to form what?
3 trunks: superior, middle and inferior
What does each trunk of the brachial plexus split into?
an anterior and posterior division
The anterior and posterior divisions from different drunks come together to form what?
3 cords (medial, lateral and posterior) - named relative to their position around the 2nd part of the axillary artery
What is a brachial plexus block?
- 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
How many nodes does the axilla have?
4
How is the arm divided into 2 functional compartments by the deep fascia of the arm?
- Flexor compartment - this lies anterior to the humerus. It contains muscles that flex the shoulder and elbow
- Extensor compartment - this lies posterior to the humerus. It contains a muscle that extends the shoulder and elbow
Explain how bicep reflex is carried out
- 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.
- 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
What would you expect to see with a normal biceps reflex?
there should be a reflex contraction of the biceps brachii muscle (elbow flexion)
In a bicep reflex, which peripheral nerves and which spinal nerves are being tested?
spinal nerves - C5-C6
What is seen in a normal triceps reflex?
A sudden contraction of the triceps muscle causes extension, and indicates a normal reflex
For the tricep reflex, which spinal nerves are being tested?
a tap on the triceps tendon tests spinal segment C7
What are the: 1. Superior 2. Inferior 3. Medial 4. Lateral borders of the quadrilateral space
Superior - teres minor
Inferior - teres major
Medial - long head of tricep brachii
Lateral - surgical neck of the humerus
Which artery and nerve travel through the quadrilateral space?
the axillary nerve and posterior circumflex humerus artery and vein
Where is the proximal radioulnar joint and which movements does it allow?
- 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
What ligament holds the head of the radius in place?
radial collateral ligament
