elbow/forearm (brian) Flashcards

Question

describe the path of the ulnar artery form start to finish

Answer 1

brachial a branches in antecubital fossa into ulnar a lies deep to pronator teres ulnar a gives off common interosseous artery which branches into the anterior and posterior IO artery - these pass on either side of the IOM. the posterior IO artery passes through a hole at proximal end of IOM to get to dorsal side. anterior IO artery travels with AIN. posterior IO artery goes down to the wrist between superficial and deep extensors, where it runs with the PIN under the 4th compartment. ulnar a then continues between FDP and FDS. proximally it runs alongside median n (but median n dives between heads of pronator teres) distally at wrist, travels with ulnar n between FDS and FCU tendons (along with ulnar n) enters guyons canal - artery stays medial to n becomes superficial palmar arch

Answer 2

lies medial to brachial artery in arm, enters antecubital fossa and passes between heads of pronator teres runs between FDP and FDS (same plane as ulnar n, ulnar a) then emerges between FDS and FPL, gives off palmar cutaneous branch then enters the carpal tunnel, then divides to the fingers AIN branches from median n at variable point as it passes between pronator teres heads. Lies on IOM between FDP and FPL. travels with Anterior IO artery. terminates at PQ

Answer 3

AIN compression neuropathy or neuritis presents with weakness of things supplied by AIN: FPL, FDP2 and FDP3, normal sensory function.

Answer 4

rare residiual supracondylar process on ulnar side of distal humerus vistigial fibrous band connects it to medial epicondyle=ligament of struthers median n passes deep to it. it can cause median n compression distinguish from pronator and AIN syndrome by also having pronator weakness

Answer 5

Median n: supracondylar process/ligament of structers lacertus fibrosis pronator teres sublimus bridge AIN: pronator teres FDS aberrant vessels gantzer's accessory FPL

Answer 6

travels along anterior aspect of medial IM septum in upper arm, piercing it to the posterior side via arcade of struthers (8-10cm prox to medial epicondyle), then travels up against medial triceps head. goes behind medial epicondyle, enters cubital tunnel exits tunnel, passing into forearm between heads of FCU penetrates deep flexor-pronator aponeurosis travesl between FDS and FDP along with ulnar a (ulnar to it) emerges between FDS and FCU tendons at wrist, enters guyon's canal bifurcates in the hand in guyon's canal into 3 zones: zone 1: proximal to bifurcation - affects both sensory/motor zone 2: deep motor branch only (supplying intrinsics) zone 3: sensory branch - supplies ulnar side of hand

Answer 7

median n compression neuropathy in the forearm, usually from between pronator heads but can also be from sublimis bridge, lacertus. presents like CTS but also involves thenar/palm - i.e. palmar cutaneous n is also involved

Answer 8

floor: MCL capsule olecranon roof: osborne's ligament

Answer 9

medial IM septum arcade of struthers hmedial epicondyle (osteophytes) cubital tunnel/Osborne's ligament/anconeus epitrochlearis arcuate ligament - aponeurosis of FCU heads ligament of spinner (aponeurosis between FDS of D3 and humeral head of FCU) deep flexor/pronator aponeurosis guyon's canal (the 3 zones)

Answer 10

anomalous muscle from medial olecranon to medial epicondyle - i.e. like a medial sided anconeus roughly where osborne's ligament would be

Answer 11

thumb cannot adduct but compensates by IPJ flexion: ulnar n palsy

Answer 12

small finger abduction due to unopposed EDM (it inserts more ulnarly) from loss of palmar interosseous to counteract it from ulnar n palsy

Answer 13

ulnar 2 digits will claw, sometimes long finger involved a bit MCPJ hyperextension: from unopposed long extensors (loss of lumbricals) IPJs flexed - unopposed long flexors (loss of lumbricals) only occurs with LOW ulnar n palsy - high palsy would also involve FDP which would eliminate clawing

Answer 14

Martin-Gruber anastomosis. 15-32% prevalence. motor fibres from median n proper (proximal to bifurcation) or AIN cross over to ulnar n (remember they are in the same plane, between FDS and FDP). i.e. median n supplies intrinsics normally supplied by ulnar n. with high ulnar n palsy - can still have intrinsic function but lose FDP (D4,5) and FCU with high median n palsy - loss of intrinsics!

Answer 15

emerges at elbow between BR and brachialis branches into superficial branch - travels under BR and pierces deep fascia to become subcutaneous on dorsoradial wrist - about 9cm proximal to radial styloid travels to first dorsal webspace, branches. PIN dives under supinator (proximal edge=arcade of Frohse) and travels within the muscle substance, wraps around radial neck to dorsal side and supplies all extrnsic wrist extensors except ECRL (radial n) terminates as sensory branch to wrist capsule on dorsum, deep to 4th comp

Answer 16

compression neuroapthy of PIN: benign tumours, most often lipoma/ganglia, synovitis from RA, trauma, vasculitis

Answer 17

compression neuropathy of the PIN that only causes pain; no motor/sensory loss often confused with tennis elbow pain usually 3-cm distal to lateral epicondyle cf. tennis elbow occurs with compression at any of PIN syndrome sites

Answer 18

FREAS: Fibrous bands anterior to radiocapitellar joint - between barchialis and BR Recurrent radial vessels AKA leash of Henry ECRB leading edge Arcade of Frohse AKA proximal edge of supinator Supinator, distal edge

Answer 19

compression neuropathy of superficial radial n usually copreseed at posterior border of BR as nerve pierces fascia to become superficial causes: trauma e.g. traction during wrist reduction, or outside pressure AKA cheiralgia paresthetica

elbow/forearm (brian) Flashcards

(43 cards)