Elbow, forearm and wrist

THIS IS AN AXIAL IMAGE ABOVE THE LEVEL OF THE ELBOW JOINT, MEDIAL IS THE BOTTOM OF THE IMAGE, LATERAL IS THE TOP OF THE IMAGE, VENTAL (ANTERIOR) IS TO THE RIGHT AND DORSAL (POSTERIOR) IS TO THE LEFT

FIRST, LETS TRY AND IDENTIFY SOME OF THE MAJOR MUSCLE WE ARE LOOKING AT.

IF YOU FLEX YOU ARM WHAT MUSCLE DO YOU FEEL? HOW ABOUT WHEN YOU EXTEND IT? GO AHEAD GIVE YOUR ARM A GRAB

BICEPS ON FLEXION AND TRICEPS ON EXTENSION

T

B

IF YOU FEEL THE MEDIAL SIDE OF YOU BICEPS, DO YOU FEEL A PULSE? WHAT VESSEL IS THIS? AND FOR EXTRA CREDIT WHAT NERVE RUNS WITH IT?BRACHIAL ARTERY AND VEIN WITH THE MEDIAN NERVE

WE ARE JUST ABOVE THE ELBOW JOINT WHAT HAS HAPPENED TO THE BICEPS MUSCLE? AGAIN GIVE YOUR ARM A FEEL.

IT IS NOW TENDON, NOTE ITS RELATIONSHIP TO THE MEDIAN NERVE AND BRACHIAL NEUROVASCULAR BUNDLE

TENDON

NVB

WHAT OTHER MAJOR NERVES DO YOU EXPECT TO SEE IN THE ARE AT THIS LEVEL?

RADIAL AND ULNAR NERVES. CAN YOU FIND THEM?

RADIAL (WHITE ARROW)

ULNAR (BLACK ARROW)

FOR EXTRA CREDIT WHAT ARE THE 2 MUSCLES THE BORDER THE RADIAL NERVE?

BRACHIORADIALIS AND BRACHIALIS, CAN YOU FIND THEM?

NOW WE ARE JUST ABOVE THE LEVEL OF THE ELBOW JOINT, AGAIN IDENTIFY THE BICEPS TENDON, THE BRACHIAL ARTERY AND VEIN, MEDIAN NERVE AND THE BICEPS TENDON AND THE RADIAL ARTERY.

WHERE IS THE ULNAR NERVE AND WHAT DO WE CALL IT IN THIS AREA? HINT IT IS NOT FUNNY.

THIS IS THE ULNAR NERVE IN THE CUBITAL TUNNEL ALSO KNOWN AS YOUR “FUNNY BONE”. THE NERVE IS VERY SUPERFICIAL IN THIS AREA, TRY AND FEEL YOURS

WHY DOES IT LOOK LIKE THIS PATIENT HAS CRACKS IN HIS BONES?

THESE ARE GROWTH PLATES IN A SKELETALLY IMMATURE PERSON, THERE ARE A LOT AROUND THE ELBOW

HERE WE ARE AT THE LEVEL OF THE JOINT, AGAIN IDENTIFY ALL OF THE PREVIOUSLY IDENTIFIED STRUCTURES. BRACHIAL ARTERY AND VEINS, MEDIAN NERVE, BICEPS TENDON, RADIAL ARTERY AND ULNAR NERVE IN THE CUBITAL TUNNEL.

VENOUS ANATOMY IS EXTREMELY VARIABLE BUT SEE IF YOU CAN IDENTIFY THE CEPHALIC VEIN, MEDIAL CUBITAL VEIN AND THE BASILIC VEIN

C

MB

HERE WE ARE BELOW THE LEVEL OF THE ELBOW JOINT. WHAT IS HAPPENING TO THE BICEPS TENDON AND THE BRACHIAL ARTERY?

THE BICEPS TENDON IS INSERTING ON TO THE RADIAL TUBEROSITY

THE BRACHIAL ARTERY IS SPLITTING INTO THE RADIAL AND ULNAR ARTERIES

RADIAL ARTERY

ULNAR ARTERY

THIS IS AN IMAGE IN THE PROXIMAL FOREARM. TO ORIENT YOU THE RADIUS AND THE ULNA AS WELL AS THE FLEXOR (VOLAR) AND EXTENSOR (DORSAL) SURFACES ARE LABELED.

R

U

EXTENSOR

FLEXOR

CAN YOU FIND THE RADIAL ARTERY?

HOW ABOUT THE ULNAR ARTERY?

CAN YOU IDENTIFY SOME OF THE EXTENSOR MUSCLES

BRACHIORADIALIS

EXTENSOR CARPI RADIALIS LONGUS

EXTENSOR CARPI RADIALIS BREVIS

EXTENSOR DIGITORUM

EXTENSOR DIGITI MINIMI

EXTENSOR CARPI ULNARIS

ED

EDM

ECU

ECRLECRB

BRACHIO

NOW WE ARE AT THE LEVEL OF THE MID FOREARM. AGAIN IDENTIFY THE REGIONS OF THE ULNAR AND RADIAL ARTERIES. WHAT NERVES RUN WITH THESE VESSELS?

ULNAR ARTERY => ULNAR NERVE

RADIAL ARTERY => SUPERFICIAL BRANCH OF THE RADIAL NERVE

WHAT ARE THESE OTHER 2 NEUROVASCULAR BUNDLES?

GREEN =>ANTERIOR INTEROSSEOUS ARTERY AND NERVE FROM MEDIAN NERVE

YELLOW => POSTERIOR INTEROSSEOUS ARTERY AND NERVE FROM DEEP BRANCH OF THE

NOW WE ARE IN THE DISTAL FOREARM, AGAIN NOTE THE POSITIONS OF THE ULNAR AND RADIAL ARTERIES. LET’S TAKE A LOOK AT SOME OF THE MUSCLES OF THE FLEXOR COMPARTMENT AT THIS LEVEL. FIND THE FLEXOR POLLICIS LONGUS AND THE FLEXOR CARPI RADIALIS

FPL FCR

FLEXOR DIGITORUM SUPERFICIALIS AND PROFUNDUS

FDPFDSFLEXOR CARPI ULNARIS

FCU

NOW WE ARE A FEW CMS PROXIMAL TO THE WRIST JOINT, AGAIN THE RADIUS AND ULNA ARE LABELED FOR YOU. CAN YOU DETERMINE WHICH IS THE FLEXOR AND EXTENSOR SURFACES BY THE SIZE OF THE MUSCLES. HINT, FEEL YOUR WRIST

R

U

EXTENSOR

FLEXOR

NOW TRY AND FIND BOTH THE RADIAL AND ULNAR ARTERIES. FEEL YOUR OWN RADIAL AND ULNAR PULSES AS A GUIDE

R

U

NOW THAT YOU HAVE YOUR BEARINGS, WHAT IS THIS ROUND TUBULAR STRUCTURE BETWEEN THE FLEXOR POLLICIS LONGUS, FLEXOR CARPI RADIALIS TENDON AND THE FLEXOR DIGITORUM SUPERFICIAILIS

FCR

FPL

FDSHINT, IT CAUSES PROBLEMS WITH CARPAL TUNNEL SYNDROME

MEDIAN NERVE

NOW WE ARE JUST PROXIMAL TO THE LEVEL OF THE WRIST JOINT. THE EXTENSOR TENDON ARE DIVIDED INTO 6 COMPARTMENTS #1 BEING ON THE RADIAL SIDE AND #6 BEING ON THE ULNAR SIDE. THERE IS A BONY RIDGE IN THE DORSAL ASPECT OF THE RADIUS THAT HELPS US DIVIDE THESE COMPARTMENTS CALLED LISTER’S TUBERCLE DO YOU SEE IT? NOW TRY AND DIVIDE THE EXTENSOR COMPARTMENTS.

LT

COMPARTMENT 1

COMPARTMENT 2

COMPARTMENT 3

COMPARTMENT 4

COMPARTMENT 5

COMPARTMENT 6

TO REVIEW YOUR ANATOMY LOOK UP THE COMPONENTS OF THESE EXTENSOR COMPARTMENTS

NOW WE ARE JUST DISTAL TO THE WRIST JOINT. TRY AND LOCATE THE RADIAL ARTERY, ULNAR ARTERY, ULNAR NERVE AND MEDIAN NERVE

Ulnar artery and nerveMedian nerve

Radial artery

CAN YOU FIND THE FLEXOR RETINACULUM? HINT IT IS JUST SUPERFICIAL TO THE MEDIAN NERVE

THIS THIN BLACK LINE IS THE FLEXOR RETINACULUM AND THIS IS WHAT IS CUT WITH A CARPAL TUNNEL RELEASE

NOW WE ARE MORE DISTAL IN THE CARPUS AT THE LEVEL OF THE HOOK OF THE HAMATE. DO YOU SEE THE HOOK?

NOTE THE POSITIONS OF THE RADIAL AND ULNAR ARTERIES AT THIS LEVEL AND APPRICIATE HOW THEY CONTRIBUTE TO THE PALMAR ARCHES IN THE HAND

RADIAL ARTERY

HERE ARE THE SUPERFICIAL AND DEEP ULNAR ARTERIES AND NERVES

HERE IS AN INJECTION OF A RADIAL ARTERY FROM AN ANGIOGRAM. NOW THAT YOU HAVE SEEN ITS APPEARANCE ON AXIAL IMAGES, TRY AND APPRECIATE ITS RELATIONS SHIPS ON THIS ANGIOGRAPHIC IMAGE

HERE IS AN INJECTION OF A ULNAR ARTERY FROM AN ANGIOGRAM. NOW THAT YOU HAVE SEEN ITS APPEARANCE ON AXIAL IMAGES, TRY AND APPRECIATE ITS RELATIONS SHIPS ON THIS ANGIOGRAPHIC IMAGE