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Ortho Anatomy Review. 2012. agenda. The exam Little points Commonly tested Questions – breeze through Jeopardy Lab. The Exam. A mix of: Short answer Long Answer Multiple Choice (aka guess) Diagrams with fill-in-the-blanks Photos/Imaging/Axial cuts. Why care?.

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agenda
agenda
  • The exam
  • Little points
  • Commonly tested
  • Questions – breeze through
  • Jeopardy
  • Lab
the exam
The Exam
  • A mix of:
    • Short answer
    • Long Answer
    • Multiple Choice (aka guess)
    • Diagrams with fill-in-the-blanks
    • Photos/Imaging/Axial cuts
why care
Why care?
  • Reviewed as part of ITER, WerierMtgs
  • Pride
  • The CUP
    • Recent winners:
        • Daneshvar PGY-4,5
        • Butterwick PGY-2!
        • Abdelbary PGY-5
        • Brown PGY-4

Brad & some other guy holding up the Anatomy Cup

easy points
Easy Points
  • Draw the Brachial Plexus
    • Seniors – LS Plexus
  • Nerve entrapment syndromes
  • Hand is high-yield
    • Know deformities (e.g. swan, bout,etc) and anatomic reasons
high yield
High Yield
  • Approaches
    • intervals
    • Risks
  • Common trivia
where to focus
Where to focus?
  • No Abdominal
      • (aside from Spine/Pelvis crossover)
  • No Thoracic
      • (aside from Spine, and UE attachments)
  • No Head/Face
      • (aside from Spine/HALO)
  • Therefore:
    • Just about everything else
        • (‘cept gonads)
slide8
CAQ
  • Contents and borders of:
    • Sartorial Canal
    • Rotator Interval
    • Carpal Tunnel/ Guyon’s
    • Triangular space/interval
    • Quadrangular space
slide9
CAQ
  • Common approaches and their neuromuscular intervals
  • Ilioinguinal Approach
    • 3 windows and their borders
  • Cruciateanastamosis & Corona Mortis
  • Blood supply to:
    • Humeral head, Femoral head
    • Talus
    • Scaphoid
slide10

Wrist extensor compartments

  • Muscles with dual innervation
  • Intracapsular tendons
    • LHB & Popliteus
  • 5 semimembranous insertions
    • Anterior tibia
    • Post capsule (& medial meniscus – post horn)
    • Oblique poplitial ligament
    • Posterior Oblique Ligament
    • Popliteusaponeurosis
  • Arcuatecomplex of knee: includes posterior 1/3 of lateral supporting structures
    • LCL
    • Arcuatelig
    • extension of popliteus
  • Arcuatere-inforced by biceps femoris, popliteus, & lateral head of gastroc
slide11

Posterior latero-corner of knee: (APPPLL)

    • Arcuatelig
    • Popliteus
    • Posterolateral capsule
    • LCL
    • Popliteofibularlig
    • Lat head of gastroc
  • Knot Henry - FDL/FHL
  • Plantar Layers
q a anatomy course 2012

Q & AAnatomy course 2012

Elbow and Forearm

William Desloges

question 1
Question # 1
  • What are the superficial landmarks to identify the safe zone to apply hardware in the radial head?
radial head fixation safe zone
Radial head fixation Safe Zone
  • Landmarks:
    • 90 degrees angle localized by palpation of the radial styloidand Lister's tubercle
question 2
Question # 2
  • Name the components of the medial collateral ligaments of the elbow?
    • Which Bundle is most important in valgus stability?
      • Which band from that bundle is most important?
anterior bundle
Anterior Bundle
  • Anterior Band:
    • more susceptible to valgus overload when the elbow was in extension or at a low flexion angle
  • Central band:
    • Aka: the isometric bundle
    • can maintain normal elbow kinematics and stability throughout the arc of flexion.
  • Posterior Band
    • more susceptible when the elbow was at higher flexion angles

(J Shoulder Elbow Surg 2002;11:65-71.)

question 3
Question 3
  • Name the primary stabilizers and secondary stabilizers to the elbow?
elbow stability
Elbow Stability
  • Primary Stabilizers:
    • Ulnohumeral articulation
    • MCL
    • LCL
  • Secondary Stabilizers:
    • Radial head
    • Joint capsule
    • The Common flexor and extensor origins
question 4
Question 4
  • Name the potential sites of compression of the Median n.
median n site of compression
Median n. site of Compression
  • Median n.
    • Supracondylar process of humerus and ligament of Struthers
    • Lacertus Fibrosis (Bicipital aponeurosis)
    • Pronator teres: Pronator Syndrome
    • Subliminus bridge:
      • fibrotendinousarcade that represents the origin of the FDS muscle
  • AIN
    • Pronator teres
    • FDS
    • Aberrant vessels
    • Accessory muscles: Gantzer’s accessory FPL muscle
  • Pronator syndrome and AIN syndrome are the 2 most frequently referenced compression neuropathies of the median nerve in the forearm
question 5
Question 5
  • If you ask a patient to hold a piece of paper between their index and thumb and they do this, what is your diagnosis?
answer
Answer
  • AIN palsy
question 6
Question 6
  • Name the potential sites of compression of the ulnar n.
ulnar n compression
Ulnar n. Compression
  • Ligament of struthers
  • Medial intermuscular septum
  • Arcade of Struthers
  • Hypertrophied medial triceps muscle.
  • Cubital tunnel
  • Arcuateligament of Osborne
  • Two heads of FCU
  • Anconeusepitrochlearis
  • Ligament of Spinner:
    • distinct aponeurosis between the FDS of the ring finger and the humeral head of the FCU
  • Deep flexor pronator aponeurosis
question 7
Question 7
  • A 28yo M at the Basic Science course in Montreal was partying at “Chez Paré”, when a stripper accidently slipped on stage and stabs him in the arm with her stellato. He sustains a complete laceration of his median n. at the level of his elbow. Suprisingly, he is unable to adduct his thumb after the injury.
  • Why?
martin gruber anastomosis
Martin-Gruber Anastomosis
  • Prevalence of 15-32 %
  • This anastomosis involves axons leaving either the main trunk of median nerve or the anterior interosseousnerve, crossing through the forearm to join the main trunk of the ulnar nerve and ultimately innervating the intrinsic hand muscles
  • Intrinsic muscles often affected:
    • First dorsal interosseous
    • Adductor pollicis
    • Abductor digitiquinti
    • Less commonly: 2nd and 3rd dorsal interosseous
  • High ulnar n. laceration:
    • Preservation of intrinsic muscle function, along with loss of function of the FCU and FDP to the ulnar two fingers
  • High median n. laceration:
    • Loss of some of the intrinsic muscles usually innervated by the ulnar n.
question 8
Question 8
  • What is the internervous plane of the volar Henry approach?
anterior henry approach
Anterior (Henry) Approach
  • Position:
    • supine, armboard
  • Landmarks & Incision:
    • Biceps, mobile wad, styloid process
  • Interval:
    • Superficial
      • Prox- BR (radial), PT (median)
      • Distal - BR (radial), FCR (median)
    • Deep:
      • Supinator
      • FDS
      • FDP
      • Pronator quadratus
  • Dangers:
    • PIN - radial neck under supinator
    • Sup Rad N – under BR
    • Radial A – under BR - recurrent leash back to elbow
question 9
Question 9
  • What is the internervous plane of the Thompson approach?
posterior thompson approach
Posterior (Thompson) Approach
  • Distal extension of Kaplan approach to elbow
  • Internervous plane
    • ECRB (radial n.)
    • EDC (PIN)
slide34
FOOT
  • Plantaris tendon insertion –
  • Blood supply to talus –
  • Name 5 Ligamentous components of the syndesmosis

  AITFL – anterior/inferior tib-fib lig•     

PITFL – posterior/inferior tib-fib lig•    

IOL – Interosseouslig -      Thickened distal IOM•    

IOM - Interosseous membrane•    

ITL – inferior transverse ligament•    

Fibrocartilaginous•     

Really the distal part of PITFL

match the eponym
Match the eponym
  • Anterolateral tubercle tibia
  • Anterior tubercle of fibular
  • Posterolateraltubercle of tibia
  • (Volkmans Fragment)
  • (Chaput Fragment)·
  • (Wagstaff Fragment)·  
slide36

Describe the 3 components of the Lisfranc ligaments and their insertions and origins-         

  • Also - which is the strongest?
slide37

Which accessory bone is located posterior to the talus?

  • Which tubercle of the posterior process of the talus is this associated with
slide38

What is the knot of Henry –

  • How many compartments are in the foot?
  • Which tendon passes immediately deep to the sustentaculumtali –
slide39

From which nerve does baxter’s nerve originate?-    

  • Name the interval for the posterolateral approach to the ankle –
  • Which structures does the sural nerve runs with? and on which side of it
slide40

  Which two structures combine to form the sural nerve – 

  • How many cm above the tip of the distal fibula does the superficial Peroneal nerve pierce the fascia and become subcutaneous –
spine
Spine
  • Smallest diameter pedicle overall:
  • Artery of Adamkiewicz, side and levels most commonly
  • Main motor pathway
  • Which facet is anterior (superior or inferior articulating)
slide42

Level of bifurcation of Iliac Vessels

Level of bifurcation of Aorta

  • Between what and what does recurrent laryngeal lie?
  • 8. Occiput is thickest in what location?
  • 9. 3 fascial layers (in order) of smith robinson approach
  • 10. Cutoff for Jefferson Fracture
  • 11. Cutoff for PADI
thigh knee
Thigh/Knee
  • Q contents of Adductor/Hunter's Canal?
  • Q. CruciateAnastomosis?
  • Q. Number of facets of patella?
  • Q. What bands of ACL and PCL are tight in flexion?
slide44

Q. Where does the MPFL insert on the patella?

  • Q. In an isolated posterolateral corner injury the most accurate test is _____ and the major finding is _____
shoulder elbow
Shoulder/Elbow
  • 1Q. Interval posterior approach shoulder?1A.  Infraspinatus (suprascapular) / Teres Minor (Axillary
  • )2Q.  Contents quadrangular space?2A. Axillary nerve, posterior circumflex humeral artery
  • 3Q. 4 preclavicular branches of brachial plexus?
  • 3A.  Dorsal scapular, long thoracic, suprascapular, nerve to subclavius4Q. Innervation brachialis?4A. Dual- musculocutaneous, radial
slide46

InnervationTrapezius?.

  • Describe the rotator interval.
  • List 5 attachments to coracoid
  • What is the primary static restraint against anteroinferior dislocation of GH joint in 90 degrees abduction and external rotation?
  • What are the boundaries of the posterior triangle of the neck?
  • Injury to what nerve might cause medial scapular winging?