Q1

X-ray Elbow TextX-ray Elbow

Identify the bony features on this X-ray.

  • Medial epicondyle
  • Lateral epicondyle
  • Capitulum
  • Olecranon
  • Radius
    • head
    • neck
  • Olecranon fossa
  • Coronoid fossa
  • Trochlea
  • Proximal radio-ulnar joint
  • Coronoid process of ulna

Pass Criteria:

  • 6 to pass

What factors determine the stability of the elbow joint?

PROMPT – What are the ligaments of the elbow?

  • Bony factors
    • shape of trochlea and olecranon fossa
  • Joint capsule – fibrous joint capsule weak
  • Ligamentous factors
    • Radial collateral ligament – lateral epicondyle and blends with the annular ligament of the radius (which holds the radial head in the radial notch of the ulna).
    • Medial ulnar collateral ligament from medial epicondyle to the coronoid process and olecranon of the ulnar – 3 bands
      1. Anterior – strongest
      2. Posterior – weakest
      3. Oblique – deepens trochlear notch
  • Muscular factors
    • biceps,
    • brachialis,
    • brachioradialis,
    • triceps

Pass Criteria:

  • Bone and ligaments
  • 3 of 4 bolded

Q2

You are inserting an IV into the cubital fossa. Please identify and name the superficial veins.

Q5 Elbow_Forearm

  • Medial cubital vein
  • Cephalic vein
  • Medial forearm vein

Pass Criteria

  • Bold to pass

Please identify the arteries and the nerves.

  • Median nerve
  • Radial artery in cubital fossa or wrist
  • Ulnar artery
  • Brachial artery

(see photo for answers below after answering the next question)

Pass Criteria

  • At one site to pass

Please identify and name the muscles of the forearm.

Q6_2_5 Elbow_Forearm

  • Pronator teres
  • Brachioradialis
  • Biceps tendon  and aponeurosis
  • Flexi carpi ulnaris
  • Flexi carpi radialis
  • Palmaris longus
  • Flexor digitorum superficialis

Pass Criteria

  • Name 4

Q3

Model – Upper limb

Demonstrate the boundaries of the cubital fossa.

  • Lateral: medial border of brachioradialis (20)
  • Medial: lateral border of pronator teres (12)
  • Floor: Brachialis (1)
  • Superior: line between 2 epicondyles of humerus
  • Roof: Skin, deep fascia reinforced by bicipital apon
  • 13 = FCR

Pass Criteria

  • Bold to pass

What are the contents of the cubital fossa?

  • Medial to lateral:
    • Median nerve (71)
    • Brachial artery (49)
    • Biceps tendon (9)
    • Radial nerve deep to brachioradialis (20)

Pass Criteria

  • Bold to pass

Identify the brachial artery and its branches in the forearm.

  • Brachial (49)
  • Radial (55)
  • Ulnar (59)
  • Common interosseous (60)
  • Posterior interosseous (61)
  • Median (62)

Pass Criteria

  • Bold to pass

Q4

Photo – Forearm

On the photo please identify the major veins that can be seen.

  • Proximal to distal:
    • 1 – basilic vein
    • 6 – cephalic vein
    • 13 – median cubital vein
    • 14 – median forearm vein

Pass Criteria

  • 2 required

What other vascular structures can you identify?

  • 4 – brachial artery
  • 21 – radial artery
  • 22 – ulnar artery

Pass Criteria

  • Brachial + 1 other required

Describe the venous drainage of the hand and forearm.

  • Superficial
    • Dorsal venous network, and superficial palmar venous arch drains to either the basilic vein ulnar side or cephalic vein radial side of the forearm (highly variable distribution).
  • Deep
    • Deep venous palmar arch drains to paired radial veins and paired ulnar veins which accompany the arteries of the same name. Interosseous veins unite with radial and ulnar veins. All terminate into the brachial veins as they leave the forearm.

Pass Criteria

  • Mention of superficial and deep systems
  • Mention of venae comitantes (or principle)

Q5

Describe the boundaries of the cubital fossa.

  • Lateral:
    • Brachioradialis 
    • Extensors from lateral epicondyle
  • Medial:
    • Pronator teres 
    • Flexors of forearm from CFO
  • Floor:
    • Brachialis
    • Supinator
  • Superior:
    • Line between 2 epicondyles of humerus
  • Roof:
    • Skin
    • Deep fascia reinforced by bicipital aponeurosis

 

Pass Criteria

  • Bold

Q5 Elbow_Forearm copy

Please identify the major veins that can be seen in the photo.

  • Basilic vein
  • Cephalic vein
  • Median cubital vein
  • Median forearm vein

Q5 Elbow_Forearm

Pass Criteria

  • 2 of 4 to pass

Q6_2_5 Elbow_Forearm copy

Identify the major arteries that can be seen in the photo. (Bonus: which is the larger terminal branch?)

  • Brachial artery
  • Ulnar artery
  • Ulnar artery is the larger terminal branch

Q6_2_5 Elbow_Forearm

Pass Criteria

  • Bold to pass

Q6

Describe the boundaries of the cubital fossa.
Prompt: Look at your own cubital fossa

  • Superiorly
    • Imaginary line connecting the epicondyles
  • Medially
    • Flexor muscles of forearm arising from common flexor attachment and medial epicondyle (pronator teres)
  • Laterally
    • Extensor muscles of forearm arising from the lateral epicondyle & supraepicondylar ridge (brachioradialis)
  • Floor
    • Brachialis and supinator muscles of the arm & forearm
  • Roof
    • Deep fascia reinforced by bicipital aponeurosis, subcutaneous tissue and skin

Pass Criteria:

  • 4 of 5 to pass

Describe the contents of the cubital fossa.

  • Brachial artery dividing into terminal branches; radial and ulnar arteries lie between
  • Biceps brachii tendon
  • Median nerve
  • Radial nerve – deep between brachioradialis and brachialis, dividing into deep and superficial branches
  • Veins accompanying arteries
  • Venepuncture veins (median cubital and medial/lateral antebrachial)

Pass Criteria:

  • First 4 to pass (and order correct)

Q7

PHOTO: Arteries of the arm

Identify on this specimen the median nerve.

  • Median nerve (16)

Pass Criteria:

  • Correct to pass

What are the structures supplied by the median nerve.
Prompt: What muscles are supplied by the median nerve? Identify the numbered branches – what do they supply?

  • No branches in the arm
  • Articular branches to elbow joint
  • Muscular branches to PT; FCR: PL: FDS
  • Anterior interosseus nerve to PQ; FPL; ½ FDP; articular branches to wrist joinPalmar cutaneous branch to skin of lateral part of palm and adjacent thenar eminence
  • Recurrent branch to thumb (APB; OP; FPB)
  • Palmar digital branches to lumbricals 1,2, and cutaneous supply

Pass Criteria:

  • 8 structures to pass

Q8

X-ray Elbow TextX-ray Elbow

Demonstrate the bony features on these xrays.

  • Elbow joint
  • Distal humerus:
    • Medial & lateral epicondyles
    • Trochlea & capitulum
    • Olecranon fossa
  • Proximal radius:
    • Radial head and neck
    • Proximal radio-ulnar joint
    • Biceps tuberosity
  • Proximal ulna:
    • Coronoid process
    • Trochlear notch
    • Olecranon

Pass Criteria:

  • At lead 5 to pass

Indicate the common extensor origin and name the muscles that arise from it.

  • Lateral epicondyle
  • Extensor carpi radialis brevis
  • Extensor digitorum
  • Extensor digiti minimi
  • Extensor carpi ulnaris
  • Others that arise from lateral epicondyle
    • Aconeus
    • Superficial head of supinator

Pass Criteria:

  • Bold + 2 of 4 muscles to pass

Q9

Media: Radius and ulna model.

Identify this bone and describe its anatomical features.

Identify radius. Candidates can mention side and why.

  • Head – articulates with the capitellum of the humerus.
  • Neck
  • Radial tuberosity – demarcates the head/neck from the shaft and is the attachment site for the biceps brachii.
  • Shaft – triangular in cross-section, anterior and posterior oblique lines
  • Distal end – styloid process, ulnar notch and dorsal tubercle of the radius.

Pass Criteria:

  • Radius and 5/7 bold to pass

Which carpal bones articulate with its distal end?

The distal end articulates with the lunate and scaphoid.

Pass Criteria:

  • Bold to pass.

Describe the normal relative relationship between the radial and ulnar styloid process.
Prompt: Which is normally more distal?

The radial styloid projects further (ie. more distal) that the ulnar styloid.

Pass Criteria:

  • Bold to pass.

Demonstrate the movement of the radius during supination.

The axis of supination passes through the centre of the head of the radius proximally and the ulnar styloid distally. The head of the radius rotates within the collar formed by the annular ligament and the ulnar radial notch. Supination rotates the radial head laterally around its axis (pronation rotates it medially).

Pass Criteria:

  • Ability to describe concept to pass.

Q10

Media: Photo of cubital fossa (from McMinn’s).

Identify the superficial veins.

  • Basilic vein (1)
  • Cephalic vein (6)
  • Median cubital vein (13)
  • Median forearm vein (14)

Pass Criteria:

  • Bold plus 1 vein

Identify other neurovascular structures in the cubital fossa.

  • Median nerve (15)
  • Brachial artery (4)
  • Ulnar artery (22)
  • Radial artery (21)

Pass Criteria:

  • Bold plus 1 other

Identify the tendons at the wrist.

  • Flexor carpi ulnaris (9)
  • Flexor digitorum superficialis (10)
  • Palmaris longis (18)
  • Flexor carpi radialis (8)
  • Flexor pollicus longus (11)
  • Brachioradialis (5)

Pass Criteria:

  • 4 out of 6

Which structures lie deep to flexor retinaculum at the wrist?

  • Flexor digitorum superficialis
  • Flexor digitorum profundus
  • Flexor pollicus longus
  • Median nerve
  • +/- Flexor carpi radialis

Pass Criteria:

  • 3 out of 4

Shoulder & Arm  Wrist & Hand