ANATOMY SCENARIO – THE ELBOW AND THE HUMERUS

Station scenario:

You are the examiner for this station and the candidate has been presented with the
following scenario:

You are on call for the Orthopaedic Department and have been asked to see a child
with an obvious deformity at the right elbow after falling out of a tree. There is no
radial pulse. This station tests your anatomy of the elbow and the antecubital fossa.

Please ask the candidate the following questions and mark them against the ideal
answers given below. Ensure that you have carefully read through and understand
all content before addressing the candidate, so that you can listen and mark more
effectively.

Examiner marking instructions:

1 What are the boundaries of the antecubital fossa? 2

The antecubital fossa is a triangle. It is superiorly bordered by an imaginary marks
line between the two epicondyles of the humerus. Pronator teres is medial
and the brachioradialis lateral to it. The floor is the brachialis and the roof
the overlying skin and fascia.
2 What are the contents of the antecubital fossa from lateral to medial? 1 mark
The contents are the common biceps tendon, brachial artery and median
nerve.
3 What structures are at risk in supracondylar fractures of the elbow? 1 mark
The median nerve and brachial artery are at risk.
4 What is the importance of the greater tubercle, lesser tubercle and deltoid 2
tuberosity of the humerus? marks
• They are bony prominences on the humerus and insertion points for
various muscles.
• Supraspinatus, infraspinatus and teres minor insert on to the greater
tubercle.
• Subscapularis inserts on to the lesser tubercle.
• The deltoid muscle inserts on to the deltoid tuberosity.
5 What four muscles are involved with the bicipital groove of the humerus? 2
The tendon of the long head of biceps brachii runs through the groove. marks
Teres major inserts on to the medial lip of the groove, latissimus dorsi on to
the base of the groove and pectoralis major on to the lateral lip of the
groove .
6 What is unique about the tendon of the long head of biceps brachii? 1 mark
It is the only tendon that runs within the shoulder joint itself, with its origin
from the supraglenoid tubercle. It is therefore a shoulder flexor and supports
the shoulder joint.
7 What runs in the spiral groove of the humerus? 1 mark
The radial nerve and profunda brachii artery (branch of the brachial artery).
8 When does the axillary artery terminate? 1 mark
The axillary artery terminates when it becomes the brachial artery at the
inferior border of teres major.
9 How many parts does the axillary artery have and what are they? 3
• It has three parts which are divided by the pectoralis minor muscle. marks
• The first part is medial to pectoralis minor (gives off the superior
thoracic artery), the second is deep to pectoralis minor (gives
thoracoacromial and lateral thoracic arteries) and the third is lateral
to pectoralis minor (gives the subscapular artery, anterior and
posterior humeral circumflex arteries).
10 When are the circumflex humeral arteries at risk? 1 mark
These vessels wrap around the surgical neck of the humerus; fractures are
common in this region.
11 What is the importance of the epicondyles of the humerus? 2
The medial and lateral epicondyles of the humerus are the origin of many marks
muscles of the forearm: the common flexor and common extensor origins,
respectively.
12 What are the bony articulations of the elbow? 3
• Trochlea of humerus articulates with the trochlear notch of the ulna. marks
• The capitulum of the humerus articulates with the head of the radius.
• The head of the radius articulates with the radial notch of the ulna to
form the superior radioulnar joint.
Total marks for clinical knowledge domain (0–20):

Examiner overall assessment

Fail Borderline Pass