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Musculoskeletal System > Week 5 - The elbow and joints of the arm > Flashcards

Week 5 - The elbow and joints of the arm Flashcards

1
Q

What are the articulating surfaces in the elbow?

A

2 separate articulations:

  • Trochlear notch of the ulna and the trochlea of the humerus
  • Head of the radius and the capitulum of the humerus
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2
Q

What type of joint is the elbow joint?

A

A hinge type synovial joint

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3
Q

Which muscles produce the hinge movements in the elbow joint?

A 
Flexion:
- Biceps brachii
- Brachioradialis
- Brachialis
Extension:
- Triceps brachii
- Anconeus
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4
Q

What factors contribute to the stability of the elbow joint?

A
  • Capsule

- Elbow joint ligaments

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5
Q

Describe the 2 elbow joint ligaments

A 
Ulnar collateral ligaments:
- 3 bands: anterior (largest and strongest), posterior (fan-shape), oblique (deepens the socket for the trochlea)
- Originates from the medial epicondyle
- Attaches to the coronoid process and the olecranon of the ulna
Radial collateral ligaments:
- Fanlike
- Blends with annular ligament
- From the lateral epicondyle
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6
Q

What are the clinically important bursae in the elbow joint?

A
  • Subcutaneous olecranon bursa (just deep to the skin, overriding the olecranon)
  • Subtendinous olecranon bursa (found between the olecranon and the tendon of the triceps brachii, reducing friction between the 2 structures)
  • These bursae can become inflamed, causing “student’s elbow”
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7
Q

What nerves are found at the elbow?

A
  • Radial nerve passes anterior to the lateral epicondyle

- Ulnar nerve passes posterior to medial epicondyle

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8
Q

What is the vascular supply in the elbow?

A

Arterial anastomoses formed by collateral arteries and recurrent branches of ulnar, radial and interosseous arteries
- The recurrent branches travel in 1 direction then turns back and travels in opposite direction

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9
Q

What are the articulating surfaces in the proximal radioulnar joint?

A
  • The head of the radius

- The radial notch of the ulna

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10
Q

What are the articulating surfaces in the distal radioulnar joint?

A
  • The ulnar notch of the radius

- The ulnar head

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11
Q

Where are the radioulnar joints found?

A

In the forearm

  • Proximal: near the elbow
  • Distal: near the wrist
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12
Q

What are the radioulnar joints?

A
  • Pivot joints
  • They are responsible for pronation and supination of the forearm
  • Head of radius pivots on the capitulum of the radius
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13
Q

What ligament is found in the proximal radioulnar joints?

A

Anular radial ligament

  • Holds the radial head in place
  • It forms a ‘collar’ around the joint
  • Maintains contact with the radial notch on the ulna
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14
Q

What ligaments are found in the distal radioulnar joints?

A
  • Anterior and posterior ligaments that strengthen the joint
  • The articular disk (fibrocartilaginous ligament that binds the radius and ulna together, holding them together during movement at the joint, it separates the distal radioulnar joint from the wrist joint)
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15
Q

Describe the capsule that surrounds the elbow joint

A
  • Weak anteriorly and posteriorly
  • Strengthened by collateral ligaments medially
  • Capsule is shared by elbow and proximal radioulnar joint
  • The fibrous membrane is lined by synovial membrane
  • The humerus encloses the capsule
  • It is strong and fibrous itself
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16
Q

Which muscles are involved in the major movements at the radioulnar joint?

A 
Pronation:
- Pronator quadratus
- Pronator teres
Supination:
- Supinator
- Biceps brachii
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17
Q

What are the common fractures at the radioulnar joints?

A

Forearm usually breaks in 2 places (think of it as a ring)
Monteggia’s fracture:
- Usually caused by a force from behind the ulna
- The proximal shaft of the ulna is fractured
- The head of the radius dislocates anteriorly at the elbow
Galeazzi’s fracture:
- A fracture to the distal radius
- The ulna head dislocates at the distal radio-ulnar joint

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18
Q

What is subtendinous bursitis?

A
  • Caused by repeated flexion and extension of the forearm
  • Usually flexion is more painful as more pressure is put on the bursa
  • Commonly seen in assembly line workers
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19
Q

What is subcutaneous bursitis?

A
  • Student’s elbow
  • Repeated friction and pressure on the bursa can cause it to become inflamed
  • Because this bursa lies relatively superficially, it can also become infected, and this would also cause inflammation
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20
Q

How does dislocation occur at the elbow joint?

A
  • Usually occurs when a young child falls on a hand with the elbow flexed
  • The distal end of the humerus is driven through the weakest part of the joint capsule (anterior side)
  • The ulnar collateral ligament is usually torn
  • Most elbow dislocations are posterior
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21
Q

What is avulsion of the medial epicondyle?

A
  • Can occur after a fall which causes severe abduction of the fully extended forearm
  • Traction on the ulnar collateral ligament pulls the medial epicondyle medially
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22
Q

What is a supraepicondylar fracture?

A
  • Occurs by falling on a flexed elbow

- It is a transverse fracture, spanning between the 2 epicondyles

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23
Q

What is epicondylitis?

A
  • Most of the flexor and extensor muscles in the forearm have a common tendinous origin
  • Flexor muscles originate from the medial epicondyle
  • Extensor muscles originate from the lateral epicondyle
  • Sports persons can develop an overuse strain of the common tendon, which results in pain and inflammation around the area of the affected epicondyle
  • Typically tennis players experience pain in the lateral epicondyle
  • Golfers experience pain in the medial epicondyle
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24
Q

Describe the interosseous membrane

A
  • A sheet of connective tissue
  • Joins the radius and ulna together between the radioulnar joints
  • A fibrous joint
  • Spans the distance between the medial radial border and the lateral ulnar border
  • Has small holes in it, as a conduit for the forearm vasculature
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25
Q

What are the functions of the interosseous membrane?

A
  • Holds the radius and ulna together during pronation and supination of the forearm, providing additional stability
  • Acts as a site of attachment for muscles in the anterior and posterior compartments of the forearm
  • Transfers forces from the radius to the ulna
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26
Q

What are the articulating surfaces in the wrist joint?

A
  • The proximal row of the carpal bones (except the pisiform)

- The distal end of the radius and the articular disk

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27
Q

What factors contribute to the stability of the wrist joint?

A
  • Joint capsule

- Ligaments: ulnar collateral, radial collateral, palmar radiocarpal, dorsal radiocarpal

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28
Q

Describe the ulnar collateral ligaments

A
  • From the ulnar styloid process to the triquetrum and pisiform
  • Works in union with the other collateral joint to prevent excessive lateral joint displacement
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29
Q

Describe the radial collateral ligaments

A
  • From the radial styloid process to the scaphoid and trapezium
  • Works in union with the other collateral ligament to prevent excessive later joint displacement
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30
Q

Describe the palmar radiocarpal ligament

A
  • From the radius to both rows of carpal bones
  • Increases stability
  • Ensures that the hand follows the forearm during supination
  • Found on the palmar side of the hand
31
Q

Describe the dorsal radiocarpal ligament

A
  • From the radius to both rows of carpal bones
  • Increases stability of the wrist
  • Ensures that the hand follows the forearm during pronation
  • Found on the dorsum side of the hand
32
Q

Which muscles are involved in the major movements of the wrist joint?

A
  • Flexion: flexor carpi ulnaris, flexor carpi radialis, (assistance from flexor digitorum superficialis)
  • Extension: extensor carpi radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris (assistance from extensor digitorum)
  • Adduction: extensor carpi ulnaris, flexor carpi ulnaris
  • Abduction: abductor pollicis longus, flexor carpi radialis, extensor carpi radialis longus, extensor carpi radialis brevis
33
Q

What are the common injuries at the wrist joint?

A
  • Fracture of the scaphoid
  • Colles’ fracture
  • Anterior dislocation of the lunate
34
Q

Describe anterior dislocation of the lunate

A
  • Can occur by falling on a dorsiflexed wrist
  • The lunate is forced anteriorly
  • It compresses the carpal tunnel, causing symptoms of carpal tunnel syndrome
  • Manifests clinically as parasthesia in the sensory distribution of the median nerve and the weakness of the thenar muscles
  • Lunate can undergo avascular necrosis
35
Q

Describe fracture of the scaphoid

A
  • In the event of a blow to the wrist, the scaphoid takes most of the force
  • Scaphoid has a unique blood supply, which runs distal to proximal
  • A fracture to the scaphoid can disrupt the blood supply to the proximal portion; this is an emergency
  • Failure to revascularise the scaphoid can lead to avascular necrosis and future arthritis for the patient
  • Main clinical sign: tenderness in the anatomical snuffbox
36
Q

Describe the features of the vertebral column

A
  • Forms the main central axis of the skeleton
  • Accounts for 42% of height (70-75cm long)
  • Made from a series of many small bones, that are joined and close to each other
  • It is highly flexible
  • The bones are strapped together by ligaments to give it strength
  • It is very strong
37
Q

What are the movements of the vertebral column?

A
  • Flexion (bowing)
  • Extension (arching back)
  • Abduction
  • Rotation
38
Q

What are the functions of the vertebral column?

A
  • Protection (encloses spinal cord)
  • Support (carries the weight of the body above the pelvis)
  • Axis (forms the central axis of the body)
  • Movement (has roles in both posture and movement)
  • Attachment for bones and trunk muscles
39
Q

What is the arrangement of the vertebral column?

A
  • 7 cervical
  • 12 thoracic
  • 5 lumbar
  • 5 fused sacral
  • 3-5 coccygeal
40
Q

Describe the curvatures of the vertebral column in a young adult

A

Has 4 distinct curvatures

  • These bends give the column great resilience
  • Has a sinusoidal profile
  • There are 2 anterior flexions (thoracic and sacral)
  • There are 2 posterior flexions (cervical and lumbar)
41
Q

What does a typical vertebra consist of?

A
  • A vertebral body

- A vertebral/neural arch

42
Q

What are some features of the vertebral body?

A
  • Usually the largest part of the vertebra
  • Usually the main weight bearing part of the vertebra
  • Main site of contact between adjacent vertebrae
  • Lined with hyaline cartilage
  • Linked to adjacent vertebral bodies by intervertebral disks
  • Size increases as the vertebral column descends
43
Q

What are the features of the vertebral/neural arch?

A
  • Spinous process (in midline, posterior)
  • 2 transverse processes (found laterally, 1 on each side of midline)
  • Pedicle (the part of the vertebral arch between the body and the transverse process)
  • Lamina (the part of the vertebral arch between the transverse process and the spinous process)
  • Articular processes
  • Vertebral notches (each pedicle has 2 to reduce its height)
44
Q

How is the intervertebral foramen formed?

A

By the superior and inferior vertebral notches of adjacent vertebrae

45
Q

Describe the articular processes

A
  • Found at the junction of the lamina and pedicle
  • 1 above and 1 below on each side
  • Cartilage-lined
  • Allow synovial joints to be formed between neural arches of adjacent vertebrae
  • Strengthened by ligaments flavour
  • Prevent anterior displacements of the vertebrae
46
Q

Describe the cervical vertebrae

A
  • The smallest of the discrete vertebrae
  • Form the skeleton of the neck
  • Have 2 distinguishing features: bifid spinous process, oval transverse foramen in the transverse process
  • Large triangular vertebral foramen
  • The C7 vertebrae has a much longer spinous process, which does not bifurcate
  • C1 and C2 are specialised to allow for movement of the head
47
Q

Describe the thoracic vertebrae

A
  • Intermediate in size
  • Increase in size as they move down the back
  • Have facets on the sides pf the body (articulate with the head of its respective rib and the rib inferior to it)
  • Have facets on the transverse processes (costal facets for articulation with respective rib)
  • Small, circular vertebral foramen
48
Q

Describe the lumbar vertebrae

A
  • Largest of the vertebrae
  • Act to support the weight of the body
  • Large, kidney-shaped vertebral bodies
  • Small, triangular vertebral foramen
49
Q

What is the sacrum?

A

A collection of 5 fused vertebrae

  • Upside-down triangle, with the apex pointing inferiorly
  • Facets on the lateral wall for articulation with the pelvis at the sacro-iliac joint
50
Q

What is the coccyx?

A
  • Small bone
  • Articulates with the apex of the sacrum
  • Has a lack of vertebral arches, hence no vertebral canal and so it doesn’t transmit spinal cord
51
Q

What are the vertebral body joints?

A

Cartilaginous joints

  • Covered by hyaline cartilage
  • Connected by a fibrocartilage intervertebral disk
  • Designed for weight-bearing
52
Q

How are the vertebral body joints strengthened?

A

Anterior and posterior longitudinal ligaments

  • Anterior = thick, prevents hyperextension of the vertebral column (atlas to sacrum)
  • Posterior = weaker, prevents hyperflexion (C2 to sacrum)
53
Q

What are the atlas and axis?

A

C1 and C2 vertebrae respectively

54
Q

What are the facet joints?

A

Joints between the articular facets

55
Q

What do the facet joints do?

A
  • Allow for some gliding motions between the vertebrae

- Permit varying degrees of flexion, extension, lateral flexion and rotation

56
Q

How are the facet joints strengthened?

A

By various ligaments:

  • Ligamentum flava (extends from lamina to lamina)
  • Infraspinous and supraspinous (joins spinous processes together; supraspinous is known as the nuchal ligament in the cervical region)
  • Intertransverse (extends between transverse processes)
57
Q

What is the intervertebral disk?

A

A fibrocartilage cylinder that lies between the vertebrae, joining them together

58
Q

What does the intervertebral disk do?

A
  • Acts as a shock absorber

- Permits the flexibility of the spine

59
Q

What is the structure of the intervertebral disk?

A
  • Has a high water content that keeps it turgid and forms its bulk
  • Wedge-shaped in the lumbar and thoracic regions, supporting the curvature of the spine
  • Has 2 regions: nucleus pulposus and the annulus fibrosus
  • It may shrink in size with age (so may account for reduction in height with age)
60
Q

Describe the nucleus pulposus

A
  • Central region
  • Jelly like
  • Located posteriorly
  • Acts as a water reservoir for the disk
61
Q

Describe the annulus fibrosus

A
  • Tough and collagenous
  • The real shock absorber
  • Made from a series of annular bands with varying orientations
62
Q

What is the atlanto-occipital joint?

A

A joint formed by the condyles of the occiput and the superior articular facets of the axis
- Permits flexion and extension of the head

63
Q

What is herniation of the intervertebral disk?

A
  • Nucleus pulposus ruptures, breaking through the outer layer
  • Occurs in a posterior and lateral direction
  • Puts pressure on the spinal cord
  • Results in a variety of neurological and muscular symptoms
64
Q

What are some abnormal spine curvatures?

A
  • Kyphosis
  • Lordosis
  • Scoliosis
65
Q

What is kyphosis?

A

Exaggeration of the posterior thoracic curvature

66
Q

What is lordosis?

A

Exaggeration of the anterior lumbar curvature

- Sometimes developed in pregnancy to compensate for the additional weight of the foetus

67
Q

What is scoliosis?

A

Lateral deviation of the vertebral column

- Side-to-side curvatures

68
Q

What is cervical spondylosis?

A

A decrease in the size of the intervertebral foramina

  • Usually due to the degeneration of the joint of the spine
  • The smaller size of the intervertebral foramina puts pressure on the exiting nerves, causing pain
69
Q

What superficial muscles are found in the posterior forearm? (from thumb to little finger)

A
  • Brachioradialis
  • Extensor carpi radialis longus
  • Extensor carpi radialis brevis
  • Extensor digitorum
  • Extensor digiti minimi
  • Extensor carpi ulnaris
70
Q

What deep muscles are found in the posterior forearm? (from thumb to little finger)

A
  • Anconeus
  • Supinator
  • Abductor pollicis longus
  • Extensor pollicis brevis
  • Extensor pollicis longus
  • Extensor indices
71
Q

What innervates all the muscles in the posterior forearm?

A

Radial nerve

72
Q

What are the borders of the anatomical snuffbox?

A
  • Lateral: tendon of the abductor pollicis longus, tendon of the extensor pollicis brevis
  • Ulnar/medial: tendon of the extensor pollicis longus
  • Floor: carpal bones; scaphoid and trapezium
  • Roof: skin
  • Proximal: styloid process of the radius
73
Q

What are the contents of the anatomical snuffbox?

A
  • Radial artery (on the floor of it)
  • A branch of the radial nerve (superficial)
  • Cephalic vein
74
Q

What is the anatomical snuffbox?

A

A triangular depression found on the lateral aspect of the dorsum of the hand

  • Located at the level of the carpal bones
  • Best seen when the thumb is abducted

Musculoskeletal System (12 decks)

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