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MSK > Week 8 > Flashcards

Week 8 Flashcards

1
Q

The distal humerus has two epicondyles, the articulations surfaces of the consumes are called the trochlea and the capitellum. Which is medial?

A

Trochlea

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2
Q

What are the two joints of the elbow?

A

Humeroulnar and humeroradial

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3
Q

What joint exists at the radial botch of the ulnar?

A

The proximal radioulnar joint

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4
Q

Which group of muscles originate at the medial epicondylitis of the humerus and which at the lateral one?

A

Medial - flexor-pronator group in the anterior forearm

Lateral - extensor group in posterior forearm

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5
Q

Where does the olecranon of the ulnar articulate with the humerus?

A

In the olecranon fossa on the posterior humerus

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6
Q

Why is the radial neck vulnerable to fracture?

A

Because it is thin

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7
Q

Where is the site of insertion of the biceps brachii (both heads)?

A

The radial tuberosity

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8
Q

What inserts on to the olecranon of the ulna?

A

All three heads of the triceps brachii

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9
Q

As with every synovial joint the elbow joint is surrounded by a joint capsule, what ligaments strengthen these this capsule?

A

The radial (lateral) collateral ligament and ulnar (medial) collateral ligament

Note - the ulnar ligament also deepens the socket for the trochlea of the humerus to sit in

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10
Q

Which ligament stabilises the proximal radioulnar joint and allows the radial head to rotate whilst maintaining contact with the ulna?

A

The annular ligament (forms a collar around the radial head

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11
Q

The elbow joint is capable of flexion and extension. What is the position of the ulna in respect to the humerus in full extension?

A

It has a valgus (lateral) angels - also known as the carrying angle - this is 10-15 degrees in women and 5-10 in men

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12
Q

What is the purpose of the ‘carrying angle?’

A

Allows the forearm to clear the hips in swinging movements of the arm during walking

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13
Q

What are the following carrying angles called?

a) an excessive one where there is a larger than usual carrying angle
b) a smaller than usual carrying angle where the arm is deviated toward the body?

A

A) cubitus valgus

B) cubitus varus

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14
Q

Which muscles are the major flexors of the elbow?

A

Biceps brachii
Brachioradialis
Brachialis

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15
Q

Which muscles are also weak flexors of the elbow

A

Those that originate at the medial epicondylitis of the humerus

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16
Q

Which muscle is the major extensor of the elbow joint?

A

Triceps brachii

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17
Q

Which muscles are weak extensors of the elbow

A

Those that originate from the lateral humeral epicondylitis and the anconeus

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18
Q

Which muscles supinate the hand?

A 
Supinator (in absence of resistance to movement) 
Biceps brachii (in resistance to movement)
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19
Q

Which muscles pronate?

A

Pronator quadratus and pronator teres (medial epicondylitis origination)

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20
Q

Which two clinical relevant bursae act to reduce friction during movement of the elbow joint?

A 
Olecranon bursa (superficial, above olecranon)
Subtendinous bursa (between triceps tendon and tip of olecranon)
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21
Q

At which joint does the movements of supination and pronation take place?

A

Distal radio-ulnar joint, radius moves round ulnar at ulnar notch of radius

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22
Q

What does the triangular fibrocartilage complex do?

A

Bonds the radius and ulna together and separated the radioulnarjoint from the wrist joint

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23
Q

What is the function of the interosseous membrane in the forearm?

A

Binds the ulna and radius together and prevents proximal displacement of the radius if a force is applied to an outstretched hand

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24
Q

Where do the flexor muscles of the forearm originate from?

A

The common flexor origin on the medial epicondyle of the humerus

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25
Q

Following the rule, the humeral head of the flexor carpi ulnaris originates from the medial epicondyle of the humerus, where does the ulnar head originate and where does the muscle insert?

A

Ulnar head - olecranon

Inserts - pisiform, hamate and vase of fifth metacarpal

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26
Q

The ulnar nerve passes between the two heads of the flexor carpi ulnaris to enter the anterior compartment of the forearm, T/F?

A

T

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27
Q

What is the function of the flexor carpi ulnaris?

A

Flexion and adduction of the wrist

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28
Q

Where does the palmaris longus insert and what’s interesting about this muscle?

A

The flexor retinaculum of the wrist and the palmar aponeurosis

It is absent in 15% of the population, because it is a weak flexor of the wrist it can be harvested and used for tendon grafting without any weakness

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29
Q

What structure lies directly inferior to the palmaris longus?

A

The median nerve

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30
Q

Where does the flexor carpi radialis insert and what are it’s actions?

A

Flexed and ABducts the wrist (abduct is opposite of the ulnaris which adducts)

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31
Q

The pronator teres has two heads, where does the ulnar head originate and where does the muscle insert?
What is it’s action?

A

Ulnar head - coronoid process of ulna
Inserts - midshaft of radius

Only pronates the forearm

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32
Q

The flexor digitorum superificialis muscle is the only muscle of the intermediate layer in its anterior compartment, it has two blended heads that originate from the common flexor orgin at the medial epicondyle across to the anterior radius, it travels through the carpal tunnel and insets at the base of the middle phalanges of the four fingers. What are it’s actions?

A

Flexes metacarpophalangeal and proximal interphalangeal joints and is a weak flexor of the wrist

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33
Q

What are the three muscles of the deep layer of the anterior arm?

A

Flexor digitorum profundus, flexor pollicus longus and pronator quadratus

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34
Q

The flexor digitorum profundus (remember profundus = deep) is the only muscle which can flex the distal interphalangeal joonts of the fingers and it assists flexion of the wrist. What is interesting about it’s nervous interaction?

A

The medial half (little and ring fingers) is innervated by the ulnar nerve whilst the lateral half (middle and index) is innervated by the median nerve

35
Q

What contributes to the stability of the elbow joint?

A

collateral ligaments and the surrounding muscles

36
Q

Where does the flexor pollicus longus originate which inserts onto the base of the distal phalynx of the thumb?

A

Anterior surface of radial shaft

37
Q

Which nerve innervates the lateral half of the flexor digitorum profundus, flexor pollicus longus and pronator quadratus?

A

Median nerve

38
Q

Why is the brachioradialis a paradoxical flexor muscle?

A

Because it originates from the lateral shaft of the humerus, inserts onto the distal radius and is innervated by the radial nerve

39
Q

What is the action of the brachioradialis?

A

Flexion of the arm in neutral position, assists flexion when supinated

40
Q

The supinator forms part of the floor of the cubital fossa, it is one of the deep muscles of the posterior forearm. The supinator looks like it’s clinging to the proximal radius, it has an ulnar and a humeral head and insert onto the lateral radius, when does the supinator have the biggest role in supination?

A

In absence of resistance, so in the pronated position, in resistance the biceps brachii does it

41
Q

The anconeus originates at the common extensor origin and inserts onto the olecranon, what is it’s actions?

A

Weak extensor of elbow
Helps stabilise the elbow joint
Prevents joint capsule impingement during pronation

42
Q

The posterior forearm muscles are all innervated by the radial nerve but which is innervated by its deep branch?

A

The supinator

43
Q

In general (know the exceptions) which nerve supplies the following compartments?

a) anterior arm
b) anterior forearm
c) posterior forearm
d) flexor carpi ulnaris and medial (ulnar) half of flexor digitorum profundus

A

A) musculocutaneous
B) median nerve
C) radial nerve
D) ulnar nerve

44
Q

The superficial veins of the arm are an important site for venopuncture, there are two common arrangements (see paper) but which is the medial and which is the lateral vein in all arrangements at this site?

A

Medial - basilic

Lateral - cephalic

45
Q

The deep veins are easy to remember because there are two either side of their corresponding artery in the arm: brachial veins, radial veins, ulnar veins

A

T

46
Q

which vein is usually accessed for venopuncture?

A

The median cubical vein which runs between the basilic and cephalic veins in the cubical fossa

47
Q

What structures form the following in the cubical fossa:

1) lateral border
2) medial border
3) superior border
4) floor
5) roof

A

1) medial border of brachioradialis
2) lateral border of pronator teres
3) hypothetical line between humerus epicondyles
4) proximally by brachialis, distally by supinator
5) fascia and skin within which run the medial cubical vein and cutaneous nerves of the forearm

48
Q

The mnemonic Really Need Beer To Be At My Nicest describes the contents of the cubits fossa medically to laterally, from this definite the contents

A

Radial nerve
Biceps tendon
Brachial artery
Median nerve

49
Q

Although we can see the median nerve belly by reflections the palmaris longus tendon, where does the median nerve run deep to?

A

The flexor digitorum superficialis and above the flexor digitorum profundus (this is distally)

50
Q

Which cords of the brachial plexus is the median nerve made up of?

A

It is the union of the medial and lateral cords

51
Q

The ulnar nerve is a continuation of the medial cord at the brachial plexus it passes down the medial arm and posterior to the medial epicondyle of the humerus, it passes through the gap between the two heads of which muscle to enter the forearm?

A

Flexor carpi ulnaris

52
Q

The ulnar nerve gives off three branches, a muscular branch to supply its muscles in the forearm and two cutaneous branches, what are these and what do they innervated?

A

Palmar cutaneous branch - sensory innervation of the medial third of the palm including the first and half of the second medial fingers

Dorsal cutaneous branch - same but on dorsum

53
Q

How does the ulnar nerve enter the hand?

A

Superficial to the flexor retinaculum and medial to the ulnar artery via the ulnar canal

54
Q

Where does the brachial artery bifurcate to form the ulnar and radial arteries and what regions do these supply?

A

Cubital fossa

Radial - posterolateral forearm
Ulnar - anteromedial forearm

55
Q

What are the three main complications of a supracondylar fracture?

What is the most common mechanism of a supracondylar fracture?

A

Malunion
Damage to the median nerve
Volkmanns ischaemic contracture

Falling onto an outstretched hand with a hyperextended elbow

56
Q

What is the most common mechanism for elbow dislocation?

A

Falling onto an outstretched hand with a slightly flexed elbow - damage to ulnar nerve is common

57
Q

90% of elbow dislocations are anterior or posterior?

A

Posterior

58
Q

What is the most common way subluxation of the radial head can occur

A

Child being swung by parents with outstretched arm in pronated position (annular ligament is relaxed in pronation)

59
Q

What is the most common elbow fracture in the adult?

A

Radial head and neck fracture due to falling on outstretched hand, radius is driven into capitellum of humerus

60
Q

Briefly describe the mechanism of rheumatoid arthritis

A

Autoantibodies attack the synovial membrane, the inflamed synovial cells penetrate the cartilage and erode the bone

61
Q

Name some symptoms of osteoarthritis at the elbow

A

Crepitus
Locking of the elbow
swelling

62
Q

Give some radiological features of RA

A

Joint space narrowing
Periarticular osteopenia
Erosions of bone
Subluxation (partial discloation) and gross deformity

63
Q

What causes lateral elbow tendinopathy (tennis elbow)?

A

This is iinflammation of the common extensor tendon, specifically the extensor carpi radialis brevis muscle (stabilises the wrist when the elbow is straight) is weakened and inflamed due to microscopic tears in overuse. The patient will present with pain over the lateral epicondyle during extension of the wrist

64
Q

Where would a patient feel pain with medial elbow tendinipathy (golfers elbow)?

A

Aching over the medial elbow. Pain on resisted flexion or pronation of the wrist (flexor carpi ulnaris and pronator teres most affected - same mechanism as tennis elbow)

65
Q

What are the three most common causes of swelling at the elbow?

A

Olecranon bursitis
Rheumatoid nodules
Gouty tophi

66
Q

What population group most commonly get olecranon bursitis and why?

A

Students, due to leaning on elbows for prolonged time. Treated with compression bandaging and potentially a hydrocortisone injection

67
Q

What patients are rheumatoid modules found in?

A

RA patients

68
Q

What is gouty tophi?

A

Urate crystals forming in the tendons and surrounding tissues

69
Q

What is the treatment for gouty tophi?

A

Anti-inflammatories initially and then after the acute inflammation caused by the crystals purine analogues can be prescribed to reduce uric acid production

70
Q

Which nerve is being compressed in cubital tunnel syndrome and what is the resulting symptoms?

A

Ulnar nerve

Patients will say it felt like they hit their funny bone, resulting in parasthesia to cutaneous ulnar nerve territories

71
Q

Which vein is lateral in the cubital fossa ceiling?

A

Cephalic

Note - basilic is medial

72
Q

Describe the sensory innervation of the hand

A

ulnar - medial one and a half fingers front and back
median - thumb and lateral two and a half fingers and, lateral palm. Also fingertips of those fingers on the dorsum
radial - dorsal surface of lateral two and a half fingers anf thumb and also a tiny portion of the palmar surface just below the thumb

73
Q

Give the motor supply of the median nerve

A

Flexor and pronator muscles of the anterior forearm (except flexor carpi ulnaris and ulnar half of profundus) Also the thenar muscles and lateral two lumbricals of the hand

74
Q

Give the motor supply of the ulnar nerve

A

Innervates the intrinsic muscles of the hand (apart from the thenar muscles and the lateral two lumbricals), innervates the flexor carpi ulnaris and ulnar half of FDP in the forearm

75
Q

The ulnar nerve runs down the ulnar side of the arm the whole way down , it exits the cubital fossa via the cubital tunnel. What structure does this lie just posterior to?

A

The medial epidondyle of the humerus making it vulnerable to injury here.

76
Q

The ulnar nerve enters the hand via the ulnar canal medial to the ulnar artery. Is this in the flexor retinaculum?

A

No it runs superficial to the retinaculum

77
Q

Froment’s sign is a test for ulnar nerve palsy, specifically paralysis of what muscle?
Explain the test

A

Adductor pollicis
Patient is asked to grasp a piece of paper between their thumb and index finger and the paper is pulled away, they should be able to hold the paper by adducting the thumb. A positive test is them being UNABLE to do this, they instead flex the thumb and the IPJ to try and hold it

78
Q

The lateral cutaneous nerve of the forearm is a continuation of the musculocutaenous nerve, look at peripheral territories picture

A

T

79
Q

The ulnar and radial arteries are formed by the bifurcation of the brachial artery within the cubital fosssa, what areas do they supply?

A

Radial - posterolateral forearm
Ulnar - anteromedial forearm
Both anastamose in the hand to give the superficial and deep arches

80
Q

What nerve can be impinged upon by osteophytes in OA of the elbow?

A

The ulnar nerve

81
Q

Explain what happens in RA

A

Autoantibodies attack the synovial membrane on the joint and break down cartilage and adjacent bone

82
Q

What is gout?

What is gouty tophi specifically

A

(a form of inflammatory arthritis) An inflammatory condition resulting from defective purine metabolism causing an increased production of uric acid and the formation of urate crystals in tendons and surrounding tissues

Tophi are nodular masses of urate crystal deposits

83
Q

What are the contents of the carpal tunnel?

A

Median nerve, tendons of FDS, FDP and flexor pollicis longus

MSK (11 decks)

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