Cubital Fossa and Forearm

Question 1

Boundaries of the Cubital Fossa

Answer 1

1. Superior (base)- imaginary line between medial and lateral epicondyles of humerus
2. Medially- pronator teres
3. Laterally- brachioradialis
4. Inferiorly (apex)- meeting of brachioradialis and pronator teres
5. Posteriorly (floor)- brachialis superiorly and supinator muscle inferiorly
6. Anteriorly (roof)- skin, superficial and deep fasciae and bicipital aponeurosis

Question 2

List the superficial content of the cubital fossa

Answer 2

o Median cubital vein
o Medial cutaneous nerve of forearm
o Upper lateral cutaneous nerve of forearm

Question 3

list the deep content of the cubital fossa

Answer 3

o Median nerve
o Biceps brachii tendon
o Radial nerve deep to brachialis
o Terminal end of brachial artery
o Radial and ulnar arteries
o Radial recurrent artery

Question 4

one function of the bicipital aponeurosis

Answer 4

Bicipital aponeurosis separates
superficial and deep structures
of the cubital fossa

Question 5

Vein associated with IV and venipuncture injections

Answer 5

median cubital vein

Question 6

Vein that runs diagonally from cephalic vein of forearm to basilic vein of arm

Answer 6

medial cubital vein

Question 7

which vein is fixed by a communicating perforating vein (pierces the bicipital aponeurosis as it becomes
superficial)

Answer 7

median cubital vein

Question 8

bone that articulates with 2 carpal bones of the wrist: lunate medially and scaphoid laterally

Answer 8

radius

Question 9

bone that articulates proximally with the humerus at the capitulum and medially with the ulna on both proximal
and distal ends

Answer 9

radius

Question 10

List the 9 landmarks of the radius

Answer 10

radial head, radial neck, radial tuberosity, shaft, interosseus border, anterior oblique line, ulnar notch, styloid process, suprastyloid crest

Question 11

Describe the radial head landmark of the radius

Answer 11

1. Radial head
   * Round articular structure on the proximal end of the radius
   * Cupped proximal surface (articular fovea or facet) articulates with the capitulum of the humerus
   * The articular circumference articulates with the ulna

Question 12

describe the radial neck landmark of the radius

Answer 12

2. Radial neck
   * Slender segment of the radius between the head and the radial tuberosity

Question 13

describe the radial tuberosity landmark of the radius

Answer 13

3. Radial (bicipital) tuberosity
   * Blunt variably shaped structure on the anteromedial side of the proximal radius
   * Marks the insertion of the biceps brachii

Question 14

Describe the landmark of the radius: shaft

Answer 14

Long, thin section between the radial tuberosity and the expanded distal end
* Divided into 3 surfaces- anterior, posterior and lateral

Question 15

Describe the landmark of the radius: interosseus border

Answer 15

• Sharp medial edge of the radial shaft
• Serves as attachment site for interosseus membrane which divides forearm into anterior and
  posterior compartments

Question 16

Describe the landmark of the radius: anterior oblique line

Answer 16

Gives origin to the extrinsic muscles of the hand

Question 17

Describe the landmark of the radius: ulnar notch

Answer 17

Concave articular hollow surface on the medial corner of the distal radius, articulating with distal
ulna

Question 18

Describe the landmark of the radius: styloid process

Answer 18

Sharp projection on the lateral side of the distal radius

Question 19

Describe the landmark of the radius: Suprastyloid crest

Answer 19

Runs obliquely over the styloid process on the anterior surface
* Serves as attachment for brachioradialis

Question 20

Describe the landmark of the ulna: olecranon

Answer 20

1. Olecranon
   * Most proximal part of the bone
   * Massive blunt process
   * Triceps brachii inserts onto the tuberosity of this process

Question 21

Describe the landmark of the ulna: trochlear notch

Answer 21

2. Trochlear notch
   * Articulates with the trochlea of the distal humerus
   * Rotary motion is restricted at the ulnar part of the elbow which limits its ability to rotate along its long
   axis

Question 22

Describe the landmark of the ulna: coronoid process

Answer 22

• Anterior beak-shaped projection at the base of the trochlear notch

Question 23

Describe the landmark of the ulna: ulnar tuberosity

Answer 23

• Roughened depression immediately inferior to the coronoid process
• Marks the insertion of the brachialis muscle

Question 24

Describe the landmark of the ulna: radial notch

Answer 24

• Small articular surface for the radius
• Located along the lateral margin of the coronoid process

Question 25

Describe the landmark of the ulna: shaft

Answer 25

* Long segment between the brachial tuberosity and the distal end of the ulna * Divided into 3 surfaces by the 3 borders- interosseus, anterior (medial), posterior

Question 26

Describe the landmark of the ulna: interosseus border

Answer 26

* Sharpest border of the ulna * Lies opposite to radius * Between the anterior and posterior surfaces

Question 27

Describe the landmark of the ulna: ulnar head

Answer 27

* Enlarged distal end of the bone

Question 28

Describe the landmark of the ulna: ulnar styloid process:

Answer 28

* Sharp distalmost projection of the ulna * On the posteromedial aspect of the bone * Provides attachment to the ulnar collateral ligament of the wrist * Separated from the remainder of the head by a deep groove, the fovea

Question 29

Describe the landmark of the ulna: articular circumference

Answer 29

* Distal, lateral, round articulation that conforms to the ulnar notch of the radius (in the same way that the radial head conforms to the radial notch of the proximal ulna)

Question 30

Type of joint in the elbow joint

Answer 30

hinge type synovial joint

Question 31

What movements does the elbow joint allow

Answer 31

o Flexion by brachialis and biceps brachii o Extension by triceps brachii assisted by anconeus

Question 32

The elbow joint has 2 articulations. Describe the articulations?

Answer 32

* Articulation: 1. Humeroulnar o Trochlear of humerus and trochlear notch of ulna 2. Humeroradial o Capitulum of humerus and head of radius

Question 33

Describe the radial collateral ligament

Answer 33

o Fan-like o Extends from lateral epicondyle of humerus and blends distally with the anular ligament of the radius

Question 34

Describe the anular ligament

Answer 34

o Encircles and holds the head of the radius in the radial notch of the ulna o Forms the proximal radio-ulnar joint which allows the pronation and supination of the forearm

Question 35

describe the ulnar collateral ligament

Answer 35

Ulnar collateral ligament o Triangular o Extends from the medial epicondyle of the humerus to the coronoid process and olecranon of the ulna o Consists of 3 bands: 1. The strongest anterior cord-like band 2. The weakest posterior fan-like band 3. The slender oblique band deepens the socket for the trochlear of the humerus

Question 36

What is the blood supply of the elbow joint

Answer 36

Anastomosis around elbow joint: * Inferior ulnar collateral artery anastomoses with anterior ulnar recurrent artery * Superior ulnar collateral artery anastomoses with posterior ulnar recurrent artery * Middle collateral branch of profunda brachii a. anastomoses with recurrent interosseus a. * Radial collateral branch of profunda brachii artery anastomoses with radial recurrent artery

Question 37

innervation of the elbow joints

Answer 37

Musculocutaneous, radial and ulnar nerves

Question 38

Describe the bursae in the elbow joint

Answer 38

o Bursae: 1. Intratendinous olecranon bursa- in the tendon of triceps brachii 2. Subtendinous olecranon bursa- between olecranon and triceps tendon 3. Subcutaneous olecranon bursa- in subcutaneous tissue over olecranon 4. Bicipitoradial bursa- separates biceps tendon from the anterior part of the radial tuberosity and reduces abrasion

Question 39

Type of joint of the proximal radio-ulnar joint

Answer 39

Pivot type synovial joint

Question 40

Articulation of the proximal radio-ulnar joint

Answer 40

Articulation: head of radius and radial notch of ulna

Question 41

Describe the ligament of the proximal radio-ulnar joint

Answer 41

1. Anular ligament: o Attached to ulna anterior and posterior to radial notch o Creates a ring that completely encircles the head of the radius o Synovial membrane continues distally as sacciform recess of proximal radio-ulnar joint on the neck of the radius (Anular ligament allows the radius to rotate within the anular ligament without binding, stretching or tearing the synovial membrane)

Question 42

Blood supply of the proximal radio-ulnar joint

Answer 42

Blood supply: o Radial portion of the peri-articular arterial anastomosis of elbow joint o Radial and middle collateral arteries anastomose with the radial and recurrent interosseus arteries

Question 43

List the movements of the proximal radio-ulnar joint

Answer 43

1. Supination 2. Pronation

Question 44

Muscles involved with supination at the proximal radio-ulnar joint

Answer 44

o When there is no resistance, supinator acts o With resistance, biceps brachii acts with assistance from extensor pollicis longus and extensor carpi radialis longus

Question 45

Muscles involved with pronation at the proximal radio-ulnar joint

Answer 45

o Primarily pronator quadratus o Secondarily pronator teres o When forearm is in mid-pronated position (palm facing thigh), flexor carpi radialis, palmaris longus and brachioradialis act

Question 46

nerves that allow for supination at the proximal radio-ulnar joint

Answer 46

musculocutaneous and radial nn.

Question 47

nerves that allow for pronation at the proximal radio-ulnar joint

Answer 47

median nerve

Question 48

type of joint of the distal radio-ulnar joint

Answer 48

Pivot type synovial joint

Question 49

Describe the movement that can occur at the distal radio-ulnar joint

Answer 49

1. Pronation o Distal end of the radius rotates anteromedially crossing over the ulnar anteriorly 2. Supination o Radius uncrosses from ulna- its distal end rotates posterolaterally to make the bones parallel

Question 50

Blood supply and innervation of the distal radio-ulnar joint

Answer 50

o Anterior and posterior interosseus arteries o Anterior and posterior interosseus nerves

Question 51

type of joint at the wrist joint

Answer 51

Condyloid type synovial joint

Question 52

what are the 4 ligaments of the wrist joint

Answer 52

palmer radiocarpal ligaments, dorsal radiocarpal ligaments, ulnar collateral ligament, radial collateral ligament

Question 53

the ligament that : o Attached to radial styloid process and scaphoid o Strengthens the joint laterally

Answer 53

radial collateral ligament

Question 54

ligament that: o Attached to ulnar styloid process and triquetrum o Strengthens the joint medially

Answer 54

ulnar collateral ligament

Question 55

the ligament that: o Pass from radius to the 2 rows of carpals o Strong and directed so that the hand follows the radius during supination of the forearm

Answer 55

palmar radiocarpal ligament

Question 56

the ligament that: o Take the same direction as palmar radiocarpal ligaments so that the hand follows the radius during pronation of the forearm

Answer 56

dorsal radiocarpal ligament

Question 57

blood supply to the wrist joint

Answer 57

Branches of the dorsal and palmar carpal arches

Question 58

innervation of the wrist joint

Answer 58

From anterior interosseus branch of median n., posterior interosseus branch of radial n. and the dorsal and deep branches of the ulnar n.

Question 59

do superficial muscles cross the elbow joint

Answer 59

true

Question 60

list the superficial muscles of the anterior flexor-pronator compartment

Answer 60

1. Pronator teres 2. Flexor carpi radialis 3. Palmaris longus 4. Flexor carpi ulnaris

Question 61

what is the intermediate muscle

Answer 61

Flexor digitorum superficialis

Question 62

list the deep muscles of the anterior flexor-pronator compartment

Answer 62

1. Flexor digitorum profundus 2. Flexor pollicis longus 3. Pronator quadratus

Question 63

innervation of the pronator teres

Answer 63

median nerve

Question 64

innervation of the Flexor carpi radialis

Answer 64

median nerve

Question 65

innervation of the Palmaris longus

Answer 65

median nerve

Question 66

innervation of the Palmaris longus

Answer 66

ulnar nerve

Question 67

innervation of the Flexor digitorum superficialis

Answer 67

median nerve

Question 68

innervation of the Flexor digitorum profundus

Answer 68

lateral half - median nerve

Question 69

innervation of the Flexor pollicis longus

Answer 69

anterior interosseous n. from median n.

Question 70

innervation of the pronator quadratus

Answer 70

anterior interosseous n. from median n.

Question 71

innervation of the brachioradialis

Answer 71

radial nerve

Question 72

innervation of the extensor carpi radialis longus

Answer 72

radial nerve

Question 73

innervation of the Extensor carpi radialis brevis

Answer 73

Deep branch of radial n.

Question 74

innervation of the extensor digitorum

Answer 74

Deep branch of radial n.

Question 75

innervation of the Extensor digiti minimi

Answer 75

Deep branch of radial n.

Question 76

innervation of the Extensor carpi ulnaris

Answer 76

Deep branch of radial n.

Question 77

innervation of the Supinator

Answer 77

Deep branch of radial n.

Question 78

innervation of the extensor indicis

Answer 78

Posterior interosseus n. from deep branch of radial n.

Question 79

innervation of the Abductor pollicis longus

Answer 79

Posterior interosseus n.

Question 80

innervation of the extensor pollicis longus

Answer 80

Posterior interosseus n.

Question 81

innervation of the extensor pollicis brevis

Answer 81

Posterior interosseus n.

Question 82

Pronators of the forearm:

Answer 82

* Pronator teres * Pronator quadratus

Question 83

flexors of the wrist:

Answer 83

* Flexor carpi radialis (also abducts wrist) * Flexor carpi ulnaris (also adducts wrist) * Palmaris longus

Question 84

Flexors of the fingers:

Answer 84

* Flexor digitorum superficialis (middle phalanges) * Flexor digitorum profundus (distal phalanges)

Question 85

Flexor of the thumb:

Answer 85

* Flexor pollicis longus

Question 86

supinator of forearm:

Answer 86

Supinator

Question 87

extensors of wrist:

Answer 87

* Extensor carpi radialis longus * Extensor carpi radialis brevis * Extensor carpi ulnaris

Question 88

extensors of the fingers:

Answer 88

* Extensor digitorum (4 fingers) * Extensor indicis (index finger) * Extensor digiti minimi (little finger)

Question 89

Extensors of the thumb

Answer 89

* Extensor pollicis longus * Extensor pollicis brevis

Question 90

abductor of the thumb:

Answer 90

* Abductor pollicis longus

Question 91

distal articulation of the ulna?

Answer 91

Articulates distally with the ulnar notch of the radius and with the articular disc that separates it from the carpal bones

Question 92

Proximal articulation of the ulnar

Answer 92

Articulates proximally with the trochlea of the humerus and with the head of the radius

Question 93

Longest, thinnest bone in the forearm?

Answer 93

ulna

Question 94

muscles that flex the wrist joint

Answer 94

Flexion- Flexor carpi radialis and flexor carpi ulnaris, with assistance from flexors of the fingers and thumb, palmaris longus and abductor pollicis longus

Question 95

muscles that extend the wrist joint

Answer 95

Extension- extensor carpi radialis longus AND brevis, extensor carpi ulnaris, with assistance from extensors of the fingers and thumb

Question 96

muscles that abduct the wrist joint

Answer 96

Abduction- abductor pollicis longus, flexor carpi radialis, extensor carpi radialis longus AND BREVIS (limited to 15° by radial styloid process)

Question 97

muscles that adduct the wrist joint

Answer 97

Adduction- simultaneous contraction of extensor carpi ulnaris and flexor carpi ulnaris