Arm & Cubital Fossa

Question 1

Osteology of Scapula & Humerus

Answer 1

Question 2

Osteology of Elbow Joint

Answer 2

Question 3

Elbow Joint Capsule

Answer 3

Question 4

Flexion-Extension of Forearm: caused by ____ notch of ulna moves against _____ of humerus

Answer 4

Flexion-Extension of Forearm: caused by trochlear notch of ulna moves against trochlea of humerus

Question 5

Supination-Pronation of Forearm: head of ____ swivels inside _____ ligament against capitulum and _____ notch of ulna

Answer 5

Supination-Pronation of Forearm: head of radius swivels inside annular ligament against capitulum and radial notch of ulna

Question 6

Humeral shaft fracture:
- Transverse fracture: Proximal fragment is pulled _____ by (deltoid)

Answer 6

Humeral shaft fracture:
- Transverse fracture: Proximal fragment is pulled laterally by (deltoid)

Question 7

Humeral shaft fracture:
- Spiral fracture: may result in _______ (overriding end)

Answer 7

Humeral shaft fracture:
- Spiral fracture: may result in shortening (overriding ends of bones)

Question 8

Humeral shaft fracture: results in _____ nerve injury (in radial groove)

Answer 8

Humeral shaft fracture: results in radial nerve injury (in radial groove)

Question 9

Surgical neck fracture: common in ______ and causes ____ nerve injury

Answer 9

Surgical neck fracture: common in elderly and causes axillary nerve injury

Question 10

Distal humerus fracture can cause ____ nerve injury (intercondylar or supercondylar fracture)

Answer 10

Distal humerus fracture can cause median nerve injury (intercondylar or supercondylar fracture)

Question 11

Elbow dislocation: can result in the “terrible triad” injury
1. _____ dislocation
2. ____ head fracture
3. ______ process fracture

Answer 11

Elbow dislocation: can result in the “terrible triad” injury
1. elbow dislocation
2. radial head fracture
3. coronoid process fracture

Question 12

Characteristic of elbow dislocation in 80-90% is the radius and ulna dislocated (anteriorly/posteriorly) to humerus

Answer 12

Characteristic of elbow dislocation in 80-90% is the radius and ulna dislocated posteriorly to humerus

Question 13

Risk of _____ nerve injury (most common) and ____ nerve injury in elbow dislocation

Answer 13

Risk of ulnar nerve injury (most common) and median nerve injury in elbow dislocation

Question 14

Nursemaid’s elbow is also known as ____ and _____ of the ____

Answer 14

Nursemaid’s elbow is also known as subluxation and dislocation of the radius

Question 15

Characteristic of subluxation and dislocation of radius: muscle pulls radial head (inferiorly or superiorly); tenderness due to pinched ______ ligament by radial head against ______

Answer 15

Characteristic of subluxation and dislocation of radius: muscle pulls radial head superiorly; tenderness due to pinched annular ligament by radial head against capitulum

Question 16

Anterior compartment of upper limb fascia contains mostly (flexors/extensors) innervated by ______ nerve

Answer 16

Anterior compartment of upper limb fascia contains mostly flexors innervated by musculocutaneous nerve

Question 17

Posterior compartment of upper limb fascia contains mostly (flexors/extensors) innervated by ______ nerve

Answer 17

Posterior compartment of upper limb fascia contains mostly extensors innervated by radial nerve

Question 18

Compartment syndrome: increased _____ in the muscle ______

Answer 18

Compartment syndrome: increased pressure in the muscle compartment

Question 19

Upper arm muscles (5)

Answer 19

1. Biceps brachii
2. Coracobrachialis
3. Brachialis
4. Triceps brachii
5. Anconeus

Question 20

Identify this muscle

Answer 20

biceps brachii

Question 21

Biceps brachii

Origin:
Insertion:
Action:
Innervation:

Answer 21

Biceps brachii

Origin: Short head - coracoid process
Long head - supraglenoid tubercle

Insertion: Radial tuberosity

Action: Flexion + supination of the forearm (from a prone position)

Innervation: Musculocutaneous nerve (C5-C7)

Question 22

Identify this muscle

Answer 22

Coracobrachialis

Question 23

Identify this muscle

Answer 23

brachialis

Question 23

Coracobrachialis

Origin:
Insertion:
Action:
Innervation:

Answer 23

Origin: Coracoid process

Insertion: Middle 1/3 of medial humerus

Action: Flex and adduct arm at shoulder joint

Innervation: Musculocutaneous nerve (C5-C7)

Question 24

Brachialis Origin: Insertion: Action: Innervation:

Answer 24

Origin: Distal ½ of anterior surface of humerus Insertion: **Coronoid process of ulna** Action: **Flexion of the forearm at the elbow joint** Innervation: Musculocutaneous nerve (C5-C7)

Question 25

Identify this muscle

Answer 25

triceps brachii

Question 26

Triceps brachii Origin: Insertion: Action: Innervation:

Answer 26

Origin: Lateral + long head originates superior to radial groove; medial head is inferior to the radial groove Insertion: **Olecranon process** Action: Primarily extend forearm at elbow joint; long head resists inferior dislocation of humerus during adduction; Innervation: **Radial nerve (C5-T1)**

Question 27

Identify this muscle

Answer 27

Anconeus

Question 28

Anconeus Origin: Insertion: Action: Innervation:

Answer 28

Origin: Lateral epicondyle of humerus Insertion: Lateral surface of **olecranon process + superior part of posterior ulna** Action: Forearm extension, stabilizes elbow Innervation: Radial nerve (C5-T1)

Question 29

What is the injury? Location of injury: “wear and tear” over the intertubercular sulcus; “popeye deformity”

Answer 29

Rupture of tendon of Long Head of Biceps Brachii:

Question 29

What is the injury? Symptoms: audible snap/pop, bulge in center of distal anterior arm pain and tenderness at shoulder Common in males 40-60yo

Answer 29

Rupture of tendon of Long Head of Biceps Brachii:

Question 30

How is the muscle displaced in rupture of tendon of long head of biceps brachii injury?

Answer 30

distally displaced

Question 31

What is the injury: audible snap/pop, bulge in center of proximal anterior arm, pain at elbow; palpable soft mass proximally displaced

Answer 31

Rupture of distal biceps brachii tendon: rare 3% of ruptures

Question 32

What is the injury? Location of injury: torn from radial tuberosity, can be an avulsion fracture

Answer 32

Rupture of distal biceps brachii tendon: rare 3% of ruptures

Question 33

How is the muscle displaced in rupture of tendon of distal biceps brachii tendon injury?

Answer 33

Proximally displaced

Question 34

Ischemia of Elbow and Forearm “Volkmann’s Contracture”: sudden ______ artery occlusion/laceration; collateral pathways only help in gradual and ______ occlusion

Answer 34

Ischemia of Elbow and Forearm “Volkmann’s Contracture”: sudden **brachial** artery occlusion/laceration; collateral pathways only help in gradual and **partial** occlusion

Question 35

Muscles can tolerate up to ___ hours of ischemia; fibrous tissue replaces necrotic tissue,

Answer 35

Muscles can tolerate up to **6** hours of ischemia; fibrous tissue replaces necrotic tissue,

Question 36

Result of ischemia to brachial artery: ____ of fingers + wrist; loss of hand _____

Answer 36

Result of ischemia to brachial artery: contraction of fingers + wrist; loss of hand power

Question 37

Musculocutaneous nerve pathway: 1. Pierces ________ 2. Travels distally between _____ brachii + _______ 3. Emerges _____ to biceps as the lateral ______ nerve of the forearm

Answer 37

Musculocutaneous nerve pathway: 1. Pierces **coracobrachialis** 2. Travels distally between **biceps brachii + brachialis** 3. Emerges lateral to biceps as the **lateral cutaneous nerve of the forearm**

Question 38

Radial nerve is located in the ______ interval

Answer 38

Radial nerve is located in the **TRIANGULAR INTERVAL**

Question 39

Injury to musclulocutaneous nerve results in: 1. _____ flexion at _______ joint 2. _____ flexion and ______ at ______ joint 3. Loss of sensation in the _____ aspect of the forearm

Answer 39

Injury to musclulocutaneous nerve results in: 1. Weak flexion at glenohumeral joint 2. **Weak flexion and supination at elbow joint** 3. **Loss of sensation in the lateral aspect** of the forearm

Question 40

Radial nerve pathway: 1. lies _____ to brachial artery, and ____ to humerus. 2. Descends inferolaterally with ____ artery of the arm in the _____ groove of the humerus 3. Moves into the forearm _____ to the ____ epicondyle

Answer 40

Radial nerve pathway: 1. lies **posterior** to brachial artery, and **medially** to humerus. 2. Descends inferolaterally with **deep** artery of the arm in the **radial** groove of the humerus 3. Moves into the forearm **anterior** to the **lateral** epicondyle

Question 41

Injury to the radial nerve superior to the origin of the triceps results in: ______ of all muscles of supplied by the radial nerve

Answer 41

Injury to the radial nerve superior to the origin of the triceps results in: **Paralysis** of all muscles of supplied by the radial nerve

Question 42

What are the muscles supplied by radial nerve?

Answer 42

1. triceps 2. brachioradialis 3. supinator 4. wrist + fingers extensors

Question 43

Injury in the radial groove results in: paralysis of ____ head of triceps and all ______ muscles of forearm _____to the site of nerve lesion; 2. elbow extension _____ but not lost (lateral +long heads not affected)

Answer 43

Injury in the radial groove results in: paralysis of **medial head of triceps** and all **posterior** muscles of forearm **distal** to the site of nerve lesion; 2. elbow extension **weakened** but not lost (lateral +long heads not affected)

Question 44

Median nerve pathway: Runs ____ to the ____ artery; in the middle of the arm is runs medial to brachial artery

Answer 44

Median nerve pathway: Runs **laterally** to the **brachial artery**; in the middle of the arm it runs medial to brachial artery

Question 45

Ulnar nerve pathway: Proximally runs medial to brachial artery; Passes _____ to _____epicondyle into the forearm.

Answer 45

Ulnar nerve pathway: Proximally runs medial to brachial artery; Passes posterior to medial epicondyle into the forearm.

Question 46

Brachial artery

Answer 46

Question 47

Elbow Anastomosis

Answer 47

Question 48

Superficial Cubital Fossa:

Answer 48

Question 49

Deep View of Cubital Fossa:

Answer 49

Tendon of Biceps brachii Brachial Artery Median Nerve

Question 50

What protects the brachial artery and median nerve during venipuncture?

Answer 50

Bicipital aponeurosis