B2 MSK wk1

Radius and ulna are joined by the _____

Interosseous membrane

Function of Ulna? What muscle inserts on Ulnar tuberosity? What does the ulna NOT participate in?

1. Elbow flexion/extension 2. Brachialis 3. Wrist joint

What muscle inserts on the radial tuberosity? What is the function of the interossesous membrane?

Biceps Brachii Transmit force from radius to ulna to humerus

What is the most commonly fractured carpal bone?

Scaphoid

Proximal 1/3 ulna fracture and anterior radial head dislocation

Monteggia

Distal 1/3 radius fracture and ulnar head subluxation

Galeazzi

Distal fracture with dorsal displacement

Colles

Which fracture is often common with a fall on an outstretched hand (FOOSH)?

Colles and Scaphoid bone

Cole's fracture is this direction with ____ displacement

Outward, dorsal

Smith's fracture is this direction with _____ displacement?

Inward, volar

A fall on the back of the hand with a radiograph showing the distal fragment of the radius has shifted anteriorly, would result in what type of displacement of the carpus?

Volar displacement

A fall on an outstretched hand with a radiograph showing the distal fragment of the radius has shifted posteriorly, would result in what type of displacement of the carpus?

Dorsal displacement

What damage can occur from a scaphoid fracture? And how is it most often fractured.

Scaphoid Avascular Necrosis due to compression of radial artery in the anatomical snuffbox. Fall on an outstretched hand (FOOSH)

What tendons form the boundaries of the anatomical snuffbox?

Medially: Extensor pollicis longus (EPL) Laterally: Abductor pollicis longus (APL)

Hand fractures: Bennett's fracture is of the ______ Boxer's fracture is of the ______

Thumb Pinkie

What are the contents of the anterior compartment of the arm? What ligament is located here?

Flexors, Pronator, Ulnar+Median nerve, Palmar carpal ligament.

What are the contents of the Posterior compartment of the arm? What ligament is located here?

Extensors, supinators, Radial nerve, Extensor Retinaculum

What ligament forms the carpal tunnel? What is this a passage for?

Flexor retinaculum, flexor tendons+ median nerve.

The flexor retinaculum continues into the palmar fascia as the ____, which is continuous with the ______ if present. Bleeding of muscle in the Antebrachial fascia can cause _____.

palmar aponeurosis, palmaris longus, compartment syndrome.

What are the 4 muscles of the superficial layer of the arm? Where do they all originate?

Pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris Medial Epicondyle

What muscle makes up the middle layer of the arm?

Flexor digitorum superficialis

What 3 muscles make up the deep layer of the arm?

Flexor pollicis longus, flexor digitorum profundus, Pronator quadratus

Action of Pronator Teres

Pronates forearm, assists in elbow flexion

What passes through the two heads of the Pronator teres?

Median Nerve

if a patient gets a forearm fracture and has pain that is disproportionate to the injury with increased pain upon passive extension of the fingers, what is the diagnosis?

Acute Compartment syndrome

Action of Flexor Carpi radialis

Flexes/ABducts wrist

Action of Palmaris longus

Flexes wrist, tenses palmar aponeurosis

Action of Flexor Carpi Ulnaris

Flexes/ ADDucts wrist

action of flexor digitorum superficialis

Flexes PIP joints, assists with wrist/MCP flexion

action of flexor pollicis longus

flexes thumb at IP joint

action of flexor digitorum profundus

Flexes DIP joints

Action of Pronator quadratus

Pronates Forearm

What muscle is often harvested as a tendon graft because its absence causes little or no functional impairment?

Palmaris longus

What is Pronator syndrome, the cause, and clinical signs?

-Entrapment of the median nerve -cause: repetitive pronation/grasping (hammering, tennis, dishwashing) -Clinical Signs: numbness/tingling in lateral 3 1/2 digits

What makes up the thenar eminence?

Base of the thumb (larger)

What makes up the hypothenar eminence?

Base of 5th finger (smaller)

Where is the palmar fascia thin versus thick? What is it continuous with? What are the fibrous digital sheaths?

1. Thin over thenar/hypothenar areas. Thick centrally over palmar aponeurosis. 2. Continuous with flexor retinaculum and tendon of palmaris longus. 3. Ligamentous tunnels enclosing synovial sheaths/flexor tendons

What are the thenar muscles of the hand?

1. Abductor pollicis 2. Opponens pollicis 3. Flexor pollicis brevis 4. Adductor pollicis

What are the hypothenar muscles of the hand?

1. Abductor digiti minimi 2. Flexor digiti minimi 3. Opponens digiti minimi

What are the muscles of the hollow portion of hand? (Intermediate Midpalmar)

1. Lumbricals 2. Palmar Interossei 3. Dorsal Interossei

Action of abductor pollicis longus

ABDucts thumb at MCP

Action of Opponens pollicis

Moves thumb across palm to meet little finger (opposition)

Action of Flexor Pollicis brevis

Flexes thumb

Action of Adductor pollicis

ADDucts thumb

Action of Abductor digiti minimi

ABDducts and flexes little finger

Action of Flexor Digiti Minimi

Flexes little finger

Action of Opponens Digiti Minimi

Moves little finger across palm to meet thumb (opposition)

Action of Lumbricals

Flexes MCP joints while extending IP joints

Action of Palmar Interossei

ADDuction of thumb, index, ring, and little finger at MCP joints

Action of Dorsal Interossei

ABduction of the index, middle, and ring fingers at MCP joints

What is claw hand caused by?

Damage to ulnar nerve resulting in the "claw" of ring and pinkie finger.

What occurs in Guyon's canal syndrome? And a common cause?

Compression of the ulnar nerve- pinkie and 1/2 of ring finger are affected. Cause-ganglion cyst

What is the cause of the hand of benediction?

Damage to the median nerve- 1st three fingers are afffected.

What structures do the median and ulnar nerve pass through?

Median- carpal tunnel Ulnar- Guyon's canal

What is the cause of trigger finger? (Stenosing tenosynovitis). In what region does this occur.

Nodule/tendon inflammation catches on the A1 pulley causing the finger to lock in flexion. At the MCP joints.

What is the cause of Bowstringing (pulley rupture)

Loss of pulley support b/c tendon lifts off bone. Weak grip and visible bowstring.

Explain how Digital synovial sheath infection can spread?

Usually occurs due to puncture and if left untreated spreads to from the ulnar bursa of pinkie or radial bursa of thumb to palm-carpal tunnel-Parona's space in forearm.

What occurs in Dupuytren Contracture?

Fibrosis/degeneration of palmar aponeurosis with progressive flexion of the 4th and 5th digits.

What part of the hand does the median nerve innervate?

Digits 1, 2, 3, and 1/2 ring finger

What part of the hand does the ulnar nerve innervate?

Pinkie and 1/2 of ring finger

What part of the hand does the radial nerve innervate?

Back or hand and base of thumb

What is the cause of carpal tunnel syndrome?

Compression of the median nerve in the carpal tunnel.

Location of the Cephalic vein- Location of the Basiilic vein- What does the Median Cubital Vein do?

1. Lateral 2, Medial 3. Connects Cephalic vein to Basilic vein over Cubital fossa

What arteries form elbow anastomoses?

Recurrent arteries

Branches of recurrent arteries (branch of ulnar artery)

1. Anterior ulnar recurrent 2. Posterior ulnar recurrent

Branches of Common interosseous artery (branch of ulnar artery)

1. Anterior interosseous artery 2. Posterior interosseous artery

These two branches of arteries form the palmar carpal arch

Palmar Carpal branch of Ulnar artery Palmar carpal branch of Radial artery

These two branches of arteries form the dorsal carpal arch

Doral carpal branch of Ulnar artery Dorsal carpal branch of radial artery

These two branches of arteries form the deep palmar arch

Deep branch of branch of the Ulnar artery and termination of the radial artery

What are the branches of the deep palmar arch?

1. 3 palmar metacarpal arteries 2. Princeps pollicis artery (supplies thumb) 3. Radial indicis artery

The termination of the ulnar artery forms this arch that has 3 branches.

Superifical Palmar arch That has 3 common palmar digital arteries that each divide into proper palmar digital arteries.

What is the cause of Raynaud Syndrome?

Ischemia of digits due to abnormality or underlying disease. Digital arteries are innervate by sympathetic fibers from brachial plexus. Excess sympathetic activity can trigger vasospasm leading to ischemic episodes.

What De Quervain syndrome? What positive test is it associated with?

Inflammation of snuffbox tendons after repetitive hand and wrist movements. Positive Finklestein test

What is PIN syndrome?

Entrapment of the Posterior Interossesous Nerve under the Arcade of Frohse. Difficulty extending fingers and weakness in wrist extension. Local pain due to nocireceptors from Group IV fibers.

Deep fascia of the thigh divides the thigh into what three components?

Anterior, medial, and posterior

Inervation of anterior compartment

Femoral nerve

Innervation of medial compartment

Obturator nerve

Innervation of Posterior compartment

Mainly tibial portion of sciatic nerve

Describe the superficial layer of thigh fascia and its contents.

Loose connective tissue containing the great saphenous vein

Describe the deep layer of thigh fascia.

Dense irregular connective tissue that thickens laterally.

In what direction does the Great (long) Saphenous vein run and where does it terminate.

Runs medially, terminates into the femoral vein.

What is the importance of the tunica intima of the Great Saphenous vein?

They facilitate unidirectional blood flow.

What procedure procedures can the Great Saphenous vein be used for?

Coronary Artery Bypass (CABG) or in Saphenous Cutdown for IV access.

In what direction does the Small (short) Saphenous vein run and where does it terminate? What nerve runs with it?

Runs Laterally and ends in the popliteal vein. Nerve- sural nerve

How do the Great Saphenous and Small Saphenous veins run in relation to the Malleolus.

Great Saphenous runs Anteriorly Small Saphenous runs Posteriorly

What ventral rami make up the Lumbar Plexus? And what two nerves are derived from it?

L1-L4. Obturator and Femoral nerve

What division of the ventral rami are the obturator and femoral nerve derived from?

Obturator: anterior division Femoral: posterior division

What makes up the sacral plexus and what nerve is derived from it?

Lumbosacral trunk + Ventral rami S1-L4. The sciatic nerve

During embryogenesis, how do the lower vs upper extremities rotate?

Lower- medially Upper- laterally

What structure does the Great Saphenous vein pass through to terminate into the femoral vein?

Saphenous opening of the fascia lata

When the fascia lata thickens laterally, what is it called? And what tubercle does it attach on?

Iliotibial tract, attaches on Gerdy's tubercle.

What is the purpose of the iliotibial tract?

To stabilize the hip and knee

What are the anterior muscles of the thigh?

Iliopsoas, Sartorius, Quadriceps Femoris

1. What two muscles make up the iliopsoas?

2. What structure does the iliopsoas insert on?

3. Nerve Innervation?

4. Action?

1. Psoas minor + Iliacus

2. Lesser trochanter of femur

3. Anterior rami of lumbar nerves

4. Flexion + Lateral rotation of hip joint (Chief flexor)