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Questions Answered: 238

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200
38

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Anatomy

Upper Limb

Question 120 of 239

A 26 year old builder presents to ED with an injury to his left upper limb whilst at work. He is unable to supinate his forearm. Which of the following nerves are most likely injured:

Answer:

Supination of the forearm is primarily produced by the biceps brachii in the anterior arm innervated by the musculocutaneous nerve and the supinator in the posterior forearm innervated by the radial nerve.

Radioulnar Joints

Anatomy / Upper Limb / Anterior Forearm

Last Updated: 10th April 2019

By OpenStax College [CC BY 3.0 , via Wikimedia Commons

Radioulnar Joints. (Image by OpenStax College [CC BY 3.0 , via Wikimedia Commons)

Proximal Radioulnar Joint

Table: Anatomical Overview of the Proximal Radioulnar Joint

Joint Proximal Radioulnar
Type Synovial pivot
Articulations Head of radius with radial notch of ulna
Stabilising factors Annular ligament
Movements Pronation and supination

The proximal radioulnar joint is a pivot type synovial joint occurring between the head of the radius and the radial notch of the ulnar. The radial head is held in position by the annular ligament of the radius.

Distal Radioulnar Joint

Table: Anatomical Overview of the Distal Radioulnar Joint

Joint Distal Radioulnar
Type Synovial pivot
Articulations Head of ulna with ulnar notch of radius
Movements Pronation and supination

The distal radioulnar joint is a pivot type synovial joint occurring between the head of the ulnar and the ulnar notch on the radius.

Movements

The radioulnar joints allow pronation and supination of the forearm.

Table: Movements of the Radioulnar Joints

Movement Main Muscles Involved Main Nerves Involved
Pronation Pronator quadratus, pronator teres Median nerve
Supination Biceps brachii, supinator Musculocutaneous nerve, radial nerve

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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