Session 2 Flashcards
(49 cards)
List the contents of the cubital fossa (from lateral to medial)
Radial nerve - not strictly part of the cubital fossa but passes underneath the brachioradialis muscle, where it divides into its superficial and deep branches.
Biceps tendon
Brachial artery - it bifurcates at the apex of the fossa into the radial and ulnar arteries.
Median nerve
Where can the brachial pulse be palpated?
Immediately medial to the biceps tendon in the cubital fossa
What vein is a common site for venepuncture in the cubital fossa?
Median cubital vein - located superficially within the roof of the cubital fossa connecting the basilic and cephalic veins.
Describe the borders of the cubital fossa
Lateral - the medial border of the brachioradialis muscle
Medial - the lateral border of the pronator teres
Superior - an imaginary line between the epicondyles of the humerus
Floor - brachialis proximally and supinator distally
Roof - skin and fascia
What are the main cause and consequences of a supracondylar fracture?
Usually occurs by falling on a flexed elbow. The blood supply to the forearm from the brachial artery can be compromised. The resulting ischaemia can cause Volkmann’s ischaemic contracture - uncontrolled flexion of the hand as muscles become fibrotic and short.
The median or radial nerves can also be damaged.
What holds the long head of the biceps brachii in the Intertubercular groove?
The transverse humeral ligament
What is a test for the spinal cord segment C6?
A tap on the biceps brachii tendon
How would a person with a ruptured long head of the biceps brachii present?
A bulge where the muscle belly is on flexion at the elbow. Th patient would not notice any weakness of the upper limb.
What is the function of the bicipital aponeurosis?
Protects the brachial artery and the median nerve. Helps to lessen the pressure of the biceps brachii tendon on the radial tuberosity.
What is a test for the spinal segment C7?
A tap on the triceps brachii tendon
What can result in biceps tendinitis?
Repetitive microtrauma (eg in throwing and racquet sports) or a tight/rough intertrabecular groove.
The brachial artery descends down the arm immediately posterior to which nerve?
Median
What is the most superior and largest branch of the brachial artery and what path does it take?
Profunda brachii artery - deep artery of the arm. It travels along the posterior surface of the humerus, running in the radial groove. It supplies structures in the posterior aspect of the arm and terminates by contributing to a network of vessels at the elbow joint.
What are the major superficial veins in the upper limb? Outline their route.
Cephalic and basilic veins, both arising from the dorsal venous nerwork.
The cephalic vein ascends the antero-lateral aspect of the upper limb. At the shoulder, it travels along the deltopectoral groove before entering the axilla via the clavipectoral triangle. It then joins the axillary artery.
The basilic vein ascends the medial aspect of the upper limb. It moves deep into the arm at the border of the teres major to join with the brachial vein.
What connects the deep and superficial veins of the upper limb?
Perforating veins
How can x Ray’s of carpal bones in children be useful in forensic medicine?
Can be used to estimate the age of the child at the time of death. Endochondrial ossification of carpal bones occurs in a predictable sequence.
What is the anterior surface of the scapula called?
Costal (rib facing)
How can fractures of the scapula occur and how are they treated?
Severe chest trauma. Not much intervention needed because the tone of the surrounding muscles keeps the pieces in place.
What are the functions of the clavicle?
Attaches the upper limb to the trunk.
Protects underlying neurovascular structures.
Transmits force from the upper limb to the axial skeleton.
What are the bony landmarks of the sternal end of the clavicle?
Convex. A large facet for articulation with the manubrium of the sternum. There is a rough oval depression on the inferior surface for attachment of the costoclavicular ligament.
What are the bony landmarks of the acromial end of the clavicle?
Concave. Small facet for articulation with acromion. The conoid tubercule provides attachment for the conoid ligament (medial part of the coracoclavicular ligament). The trapezoid line provides attachment for the trapezoid ligament (lateral part of the coracoclavicular ligament).
How can the clavicle become fractured and where is the most common point of fracture?
Fall onto shoulder or outstretched hand. The junction between the lateral 1/3 and medial 2/3.
How are the parts of the clavicle displaced after fracture?
The lateral end is pulled inferiorly and medially by the weight of the arm and the pectoralis major muscle. The medial end is pulled superiority by the sternocleidomastoid muscle.
What nerve(s) can be damaged by a fractured clavicle and how would this present?
Suprascapular nerves by the upwards movement of the medial part of the fracture. The lateral rotators of the upper limb are paralysed so there is unopposed medial rotation of the upper limb - “waiters tip” position.
