Clinical Anatomy of the Elbow & Forearm Flashcards


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1

Humero-radial joint

Flexion and extension

2

Humero-ulnar joint

Flexion and extension

3

Radio-ulnar joint

Pronation and supination

4

Proximal radio-ulnar joint

-Radial head with radial notch of ulna

-Held in place by the anular ligament

5

Middle radio-ulnar joint

-Interosseous membrane

-Sheet of dense CT that run obliquely between radius and ulna

-Transfers forces from radius to the ulna and then the humerus

6

Distal radio-ulnar joint

Articular head of ulna with ulnar notch of radius

7

What does the proximal radio-ulnar joint do during pronation and supination?

Radial head rotates on the capitulum in the radial notch of the ulnar

8

What does the distal radio-ulnar joint do during pronation and supiation?

Radius slides anteriorly around the head of ulna

9

What are the ulna and radius held together by?

-Anular ligament

-Interosseous membrane

-Articular disc

10

Radiocapitellar line

A line drawn down the neck of the radius should intersect the capitulum

11

Anterior humeral line

A line drawn down the anterior surface of the humerus should intersect the middle third of the capitulum

12

Nursemaid's elbow/pulled elbow

Subluxation of the radial head where radial head slips out of the annular ligament. Commonly occurs in young children (1-4 y/o).

13

How to fix Nursemaid's elbow/pulled elbow

Easily reduced by popping the radial head back under the ligament

14

Which neurovascular structures are at most risk in displaced supracondylar fractures?

Median nerve and brachial artery

15

Volkmann’s Ischemic Contracture

• Consequence of supracondylar fracture if not recognized and quickly repaired

• Injury to brachial artery lead to ischemic flexor contracture of the muscles of the anterior compartment

16

What neurovascular structures can be damaged in a posterior dislocation of the elbow joint?

Ulnar and median nerves, brachial artery

17

What are anterior and posterior compartments separated by?

Intermuscular septum and interosseous membrane

18

Anterior/flexor compartment

-Ulnar nerve (medial one and half)

-Median nerve: anterior interosseous nerve

19

Posterior/extensor nerve

Radial nerve: deep radial nerve, posterior interosseous nerve

20

Pronator teres

-Pronation

-Median nerve

21

Flexor carpi radialis

-Flexes and abducts the wrist

-Median nerve

22

Palmaris longus

-Flexes the wrist

-Resist shearing forcing when gripping

-Median nerve

23

Flexor carpi ulnaris

-Flexes and adducts the wrist

-Ulnar nerve

24

What are the muscles on the superficial layer of the anterior compartment of the arm?

Flexor carpi radialis, flexor carpi ulnaris, palmaris longus, pronator teres

25

What are the muscles found in the middle layer of the anterior compartment of the forearm?

Flexor digitorum superficialis

26

Flexor digitorum superficialis

-Flexes the wrist, flexes the metacarophalangeal (MCP) and proximal interphalangeal (PIP) joints of digits 2-5

-Innervated by the median nerve

27

What are all the muscles found in the deep layer of the anterior compartment of the forearm?

Flexor pollicus longus, flexor digitorum profundus, pronator quadratus

28

Flexor pollicus longus

-Flexes metacarpophalangeal (MCP) joint and interphalangeal (IP) joint of the thumb

-Innervated by the anterior interosseous nerve

29

Flexor digitorum profundus

-Flexes wrist, flexes MCP joint, proximal and distal interphalangeal joints of digits 2-5

-Innervated by the anterior interosseous nerve (lateral 2 tendons)

-Innervated by the ulnar nerve (medial 2 tendons)

30

Pronation quadratus

-Pronation of the forearm

-Innervated by the anterior interosseous nerve

31

Borders of the cubital fossa

-Line btw the epicondyles

-Pronator teres (medially)

-Brachioradialis (laterally)

32

Contents of the cubital fossa

Median nerve, brachial artery, biceps tendon

33

Floor of cubital fossa

Brachialis muscle

34

Roof of cubital fossa

Skin, fascia, median cubital vein, bicipital aponeurosis

35

What are the muscles found in the superficial layer of the posterior compartment of the forearm?

Extensor carpi ulnaris, extensor digiti minimi, extensor carpi radials brevis, extensor digitorum, extensor carpi radialis longus, brachioradialis

36

Extensor carpi ulnaris

-Extends and adducts the wrist

-Posterior interosseous nerve

37

Extensor digiti minimi

-Extends the MCP joints, PIP, and DIP joints of the little finger

-Innervated by the posterior interosseous nerve

38

Brachioradialis

-Accessory flexor when the hand is midprone position

-Radial nerve

39

Extensor carpi radialis longus

-Extends and abducts the wrist

-Innervated by the radial nerve

40

Extensor carpi radialis brevis

-Extends and abducts the wrist

-Innervated by the deep branch of the radial nerve

41

Extensor digitorum

-Extends wrist, extends (MCP) joints, PIP and DIP joints of digits 2-5

-Innervated by the posterior interosseous nerve

42

What are all of the muscles found in the deep layer of the posterior compartment of the forearm?

Extensor policis longus, extensor indicis, supinator, abductor policis longus, extensor policis brevis

43

Extensor policis longus

-Extends the carpometacarpal (CMC) joint, metacarpophalangeal (MCP) joint, and interphalangeal joint (IPJ) of thumb

-Posterior interosseous nerve

44

Extensor indicis

-Extends the index finger

-Posterior interosseous nerve

45

Supinator

-Supination of forearm

-Posterior interosseous nerve

46

Abductor policis longus

-Abducts carpometacarpal (CMC) joint of the thumb

-Posterior interosseous nerve

47

Extensor policis brevis

-Extends the carpometacarpal (CMC) joint and metacarpophalangeal (MCP) joint of thumb

-Posterior interosseous nerve

48

Tennis elbow

Lateral epicondylitis common extensor origin

49

Golfer's elbow

Medial epicondylitis common flexor origin

50

Colle's fracture

-Fracture of the distal radius

-“Dinner fork” deformity of the distal forearm because the distal fracture fragment of fracture is displaced posteriorly

-May have injury to median and/ulnar nerves or acute carpal tunnel syndrome

-Can compromise the radial or ulnar arteries and impair vascular supply to the hand

51

Smith's fracture

-Fracture of the distal radius

-Also called reverse Colle’s

-“Garden spade” deformity of distal forearm because of anterior displacement of the distal fragment

-May have injury to median and/ulnar nerves or acute carpal tunnel syndrome

52

Intercarpal joints

-Synovial joints shared a single capsule

-Limited movements, but contributes to the positioning of the hand in flexion, extension, abduction and flexion

53

2nd to 5th carpometacarpal (CMC)joints

Only permits limited gliding movements

54

1st carpometacarpal (CMC) joint

Between trapezium and base of thumb - saddle joint which permits flexion, extension, abduction, adduction and opposition of thumb

55

MCP joints

Permits flexion, extension, abduction and adduction of digits

56

Boxer's Fracture

-Impaction fracture of the neck fifth metacarpal (sometimes can involve the fourth metacarpal)

-Usually comminuted

-Usually because of a direct blow with a clenched fist against a solid surface.

57

Scaphoid Fracture

Usually around the neck. May lead to avascular necrosis of the proximal fragment

58

Carpal Tunnel innervated by

Median nerve

59

Guyon's canal contains

ulnar nerve, artery, and vein

60

Roof of Guyon's canal

palmar carpal ligament

61

Floor of Guyon's canal

flexor retinaculum and hypothenar muscles

62

Dupuytren’s Contracture

-Flexion contracture of the hand

-Thickening and contraction of the palmar aponeurosis

-Nodule formation

-Unable to extend fingers

63

Trigger finger/Stenosing Tenosynovitis

-Fibrosis and tightening of the fibrous digital sheath of the flexor tendons at the level of the metacarpophalangeal (MCP) joint

-Inflammation and nodule formation of the flexor tendons.

-Triggering of the affected finger is due to tendons requiring excessive force to fully extend or flex

64

Fibrous digital tendon sheaths

-Dense connective tissue surrounding tendons of FDP, FDS, and FPL muscles.

-Hold tendons to the phalanges and prevent bowing

65

Radial Bursa

Synovial sheath surrounding the tendon of FPL continuing through to carpal tunnel

66

Ulnar Bursa- common flexor sheath

Synovial sheath surrounding the tendons of FDP and FDS of the fifth digit continuing through the midpalmar space and into the carpal tunnel

67

Synovial sheaths

Within the fibrous sheath the tendon has this directly surrounding it

68

Lumbricals

-1st-2nd palmar digital branches of median nerve

-3rd-4th Deep branch of ulnar nerve

-Flex metacarpophalangeal (MCP) joints and extend interphalangeal joints of digits 2-5

69

Superficial palmar arch

Mainly from ulnar artery

70

Deep palmar arch

Mainly from radial artery

71

Superficial lymphatic drainage: veins within the skin and superficial fascia

-Medial hand, forearm and arm

Lymphatic fluid will go to lateral (humeral) axillary nodes, then to central axillary nodes, then finally to apical axillary nodes

72

Superficial lymphatic drainage: veins within the skin and superficial fascia

-Lateral hand, forearm and arm

Lymphatic fluid will go directly to the apical axillary nodes

73

Lymphatic fluids from the compartments of the hand, forearm, and arm

will go to lateral (humeral) nodes, then to central then finally to apical

74

All lymph pass from ______ to _______________ to lymphatic/thoracic duct

Apical; subclavian trunk