1.3 Flashcards
1
Q
List the components of the spinal canal
A
Epidural space (fat) Dura mater Arachnoid mater CSF Pia mater Spinal cord
2
Q
Where does the epidural space lie relative to the dura mater?
A
Further away from the spinal cord
3
Q
How many layers is the dura mater in the spinal cord?
A
1 layer (different from the dura mater in the CNS)
4
Q
From outside to in (spine to spinal cord) list the order of the meninges
A
Dura mater
Arachnoid mater
Subarachnoid space (where CSF sits + location of many blood vessels)
Pia mater
5
Q
In a lumbar puncture, where is the needle inserted into?
A
Between intervertebral space
through dura mater, arachnoid mater and into subarachnoid space to collect a sample of CSF
6
Q
Where is local anaesthetic administered during an epidural?
A
Into the epidural space usually between spinal segments L3-4 or L4-5 (because the spinal cord ends around L1)
7
Q
What happens if there is excessive local anaesthetic infusion into the subarachnoid space?
A
Total spinal block
Which results in hypotension, loss of consciousness and apnoea
8
Q
Which is the thinest layer of the meninges?
A
Pia mater
9
Q
Where do the spinal nerves exit?
A
Laterally via the combination of the dorsal and ventral roots
10
Q
Which direction does the spinous process protrude?
A
Posteriorly
11
Q
Bifid spinous processes are unique to which vertebrae?
A
Cervical
12
Q
How many cervical nerves does the spinal cord give off?
A
8
13
Q
How many cervical vertebrae are there?
A
7
14
Q
How many thoracic nerves does the spinal cord give off?
A
12
15
Q
How many lumbar nerves does the spinal cord give off?
A
5
16
Q
How many sacral nerves does the spinal cord give off?
A
5
17
Q
How many cocygeal nerves does the spinal cord give off?
A
1
18
Q
Where does the first cervical nerve arise from?
A
Above C1 vertebra
19
Q
Where does the 8th cervical nerve arise from?
A
Below C7 vertebrae
20
Q
What does the cervical enlargement supply?
A
Brachial plexus to the arm
21
Q
What does the lumbar enlargement supply?
A
Leg
22
Q
Which is longer, the spinal cord or spinal column?
A
Column is longer
Cord ends at L1
23
Q
How does the spinal nerves exit at the correct vertebral level if the cord is shorter than the spinal column?
A
Spinal nerves descend within canal before exiting at the corresponding vertebral level
24
Q
Where is the conus medullaris?
A
L1-2
25
What is the cauda equina?
Sacral spinal nerves within spinal canal (which descend to their appropriate vertebral level before exiting the spinal column)
26
Where does the filum terminale attache?
To posterior sacrum
27
Describe the blood supply of the spinal cord
1 anterior spinal artery and 2 posterior spinal arteries
28
What is the anterior spinal artery associated with?
Motor and spinothalamic
29
What is the posterior spinal arteries associated with?
Dorsal columns
30
What does enlargement at the ventral horn indicate?
Higher density of lower motor neurons in that area
31
What does infarction of the artery of Adamkiewicz (lower 2/3rd of anterior spinal) cause?
A lower limb motor paralysis w/ dissociated sensory loss due to sparing of dorsal colunns
32
What is the filum terminale?
Extension of the pia mater which attaches the spinal cord to the posterior sacrum
33
Where does the artery of Adamkiewicz come from?
Aorta
This artery is particularly important for supplying the lower 2/3rds of the anterior spinal artery
34
Which vessels supply the spinal arteries?
Vertebral, intercostal, aorta, lumbar
35
Which proportion of the spinal cord does the anterior and posterior arteries supply?
1 anterior artery - 2/3rd
2 posterior arteries - 1/3rd
36
Which arteries supply the dorsal horns (thus the sensory part of the cord)?
Posterior spinal arteries
37
List the ascending sensory spinal tracts.
Spinothalamic
| Spinocerebellar
38
What is a tract?
Group of axons travelling in similar direction w/ similar functoin
39
Where does the spinocerebellar tract carry information from and to?
From periphery to cerebellum
40
List the descending motor tracts
Corticospinal (lateral + ventral)
41
What is somatotopic mapping
There is an area within the CNS that corresponds to an area in the body
42
Give an example of how somatotopic mapping is demonstrated in the spinal cord
The medial neurons in the ventral horns supply postural extensor muscles
The lateral neurons in the ventral horn supply the distal flexors
43
What type of fibres does the dorsal root contain?
Afferent - carry sensory info
44
What lies in the dorsal root ganglion
Location of cell bodies for almost all primary sensory afferent neurons
45
Where do the ventral and dorsal root mix?
Spinal nerve
46
What do medial lower motor neurons control?
Proximal, postural, extensors
47
What do lateral lower motor neurons control?
Distal, fine control, flexors
48
Spinal nerves give off plexuses which give off what?
Peripheral nerves - which supply a group of muscles/skin
49
Define neurotome
Area of skin innervated by a peripheral nerve
50
Spinal nerves give off plexuses which give off what?
Peripheral nerves - which supply a group of muscles/area of skin skin
51
Define myotome
Group of muscles innervated by a spinal nerve
52
Name the 4 joints of the shoulder girdle
Sternoclavicular
Acromioclavicular
Glenohumeral
Scapulothoracic - not a true articulation
53
What is the upper limb broken down into?
Shoulder girdle
Arm - 2 compartments
Forearm - 2 compartments
Wrist + hand
54
Which is the most lateral process of the scapula?
Acromion
55
The scapulothoracic joint isn't a true articulation but there is movement of the scapula upon the rib cage in which movement in particular?
Last stages of the abduction of the upper limb
56
The scapulothoracic joint isn't a true articulation but there is movement of the scapula upon the rib cage in which movement in particular?
Last stages of the abduction of the upper limb particularly
57
The glenoid fossa isn't very deep so how is the head of the humerus held in position?
Supported by a number of ligaments
58
What is the glenoid labrum
Ring of fibrocartilage that sits on edge of glenoid fossa
Helps to deepen the fossa + improve articulation
59
How many muscles articulate with the scapula?
17
60
What is the acromion a part of?
Scapula
61
What is the coracoid process a part of?
Scapula
62
Whatis the subscapular muscle a part of?
Rotator muscles
63
Relative to the acromion, where is the coracoid process?
Medial, anterior, inferior to acromion
64
The glenoid fossa is quite flat, how is the head of the humerus held in the fossa?
With support from the ligaments ligaments.
- Majority of which are thickenings of the joint capsule: glenohumeal, coracohumeral, transverse humer
- Unlike the othrs, corcacoacromial ligament isn not a thickening of the joint capsule
The glenoid labrum - fibrocartilage than helps deepen the fossa
65
Name the ligaments between the scapular and humerus
Glenohumeral ligaments (superior, middle, inferior)
Coracohumeral ligament
Transverse humeral ligament
Coracoacromial ligament
66
What is the function of the glenohumeral ligaments?
Stabilise the anterior aspect of the shoulder joint
67
Which ligament prevents superior displacement of the shoulder joint?
Corcacoacromial ligament
68
What is the role of the corcacohumeral ligament?
Attaches the base of the coracoid process of the greater tubercle of the humerus
Supports the superior part of the joint capsule
69
What is the role of the transverse humeral ligament?
Holds tendon of the long head of the biceps in the intertubercular groove
70
What is the span of the transverse humeral ligament?
Spans the distance between the 2 tubercles of the humerus
71
What is the joint capsule?
A fibrous sheeth which encloses the structures of the joint
72
Where does the shoulder joint capsule extend?
From the anatomical neck of the humerus to the border of the glenoid fossa
73
The joint capsule is lax, what does this permitted?
Greater mobility (particular abduction)
74
What structure produces synovial fluid?
Synovial membranes that lines the inner surface of the joint capsule
75
Purpose of synovial bursae
Reduce friction in the shoulder joint
76
What is a bursa?
A synovial fluid filled sac
Acts as a cushion between tendons + other joint structures
77
Name 2 important bursae
Subacromial - located inferiorly to deltoid + acromion, superiorly to supraspinatus tenson + joint capsule
Subscapular - between subscapularis tendon + scapula
78
What does the subacromial bursa support?
Deltoid + supraspinatus muscles
79
Which bursa reduces wear and tear on the subscapularis tendon during movement at the shoulder joint?
Subscapular
80
Arterial supply to the glenohumeral joint is via which arteries?
Anterior + posterior circumflex artereies
Supracular artery
81
The glenohumeral joint is supplied by which nerves?
Axillary, suprascapular, lateral pectoral nerves
82
What are the nerve roots of the axillary, suprascapular, lateral pectoral nerves?
C5 - C6 of the brachial plexus
83
What is adduction of the upper limb?
Upper limb towards midline in coronal plane
84
What movement does the posterior deltoid, latissmus dorsi an teres major muscles produce?
Extension - upper limb backwards in sagittal place
85
What movement does the biceps brachii (both heads), pectoralis major, anteriior deltoid and coracobrachialis produce?
Flexion
86
What muscle produces the first 0-15 degrees of abduction of UL?
Supraspinatus
87
Which muscle is responsible for the next 15-90 degrees of the abduction of UL?
Middle fibers of deltoid
88
Past 90 degrees of abduction of UL, what needs to rotate?
Which muscles do this rotation?
Scapula - carried out by the trapezius + serratus anteroir
89
What is abduction of the UL?
Upper limb away from midline in coronal plane
90
What is medial rotation of the UL?
Rotation towards the midline
So thumb is pointing medially
91
What is lateral rotation of the UL?
Rotation away from the midline
So that the thumb is pointing laterally
92
Which muscles are responsible for lateral rotation of UL?
Infraspinatus
Teres minor
93
Which muscles are responsible for medial rotation of UL?
Subscapularis, pectoralis majorm, latissimus dorsi, tersmajor, anterior deltoid
94
What type of joint is the shoulder joint?
Ball + socket joint
95
Name the 4 rotator cuff muscles
Subscapularis (upper and lower subscapular nerves, posterior cord of brachial plexus, C5-C7)
Supraspinatus (suprascapular nerve , superior trunk of brachial plexus, C5-C6)
Infraspinatus (innervation same as supraspinatus)
Teres minor (posterior branch of axillary nerve, C5-C6)
96
What forms the coraco-acromial arch?
Coracoacomial ligament
97
What is anterior dislocation usually caused by?
Excessive extension + lateral rotation of the humerus
98
Injury to what can cause paralysis of the deltoid?
Axillary nerve - can be damanged in dislocation
99
How is deltoid paralysis assessed?
Test sensation overregimental badge area (C5)
100
What is rotator cuff tendonitis?
Inflammation of the muscle tendons usually due to overuse
Overtime this causes degenerative changes in teh subacroial bursa + suipraspinatus tendon
101
How many ligaments connect that acromion, coracoid and clavicle
3
102
Innervation of supraspinatus muscle?
The axillary nerve (roots C5, C6) from the posterior cord of the brachial plexus
103
Innervation of teres minor muscle?
Suprascapular Nerve, C5, C6, superior trunk of the brachial plexus.
104
Innervation of infraspinatus muscle?
Suprascapular Nerve (C5, C6)
105
Innervation of subscapularis muscle?
Upper and lower subscapular nerves which come from the posterior cord of the brachial plexus.
Suprascapular Nerve (C5, C6)
106
Arterial supply of subscapular muscle
Subscapular artery
107
Arterial supply of infraspinatus muscle
Suprascapular and circumflex scapular arteries
108
Which rotator cuff muscle is the smallest?
Supraspinatus is the smallest of the 4 muscles which comprise the Rotator Cuff of the shoulder joint specifically in the supraspinatus fossa.[1]
It travels underneath the acromion
109
Action of subscapularis muscle
It abducts the arm from 0 to 15 degrees, when it is the main agonist, then assists deltoid to produce abduction beyond this range up to 90 degrees.
110
What 2 ligaments make up the coracoclavicular ligament?
Conoid + trapeziod
111
What are the 2 compartments of the arm?
Anterior and posterior
112
What does the axillary artery become once it leaves the axillary area?
Brachial artery
113
First branch of brachial artery?
Profunda artery
114
What is the source of the axillary artery?
Subclavian artery
115
What is the profunda brachii artery?
The deep artery of arm (also known as arteria profunda brachii and the deep brachial artery) is a large vessel which arises from the lateral and posterior part of the brachial artery, just below the lower border of the teres major.
116
Jut after the intercubital fossa what dos the brachial artery divided into>
Radial and ulnar arteries
117
Which movement is the supraspinatus muscle responsible for?
Abduction
118
Which movement is the infraspinus muscle responsible for?
External rotation
119
Which movements is the subscapularis muscle responsible for?
Internal rotation
120
Which movement is the teres minor muscle responsible for?
External rotation
121
Where does the cephalic vein run along?
Lateral aspect of arm
122
Where does the basilic vein run along?
Medial aspect of arm
123
What does the brachial plexus supply?
Upper limb
124
How is the brachial plexus formed?
Roots, trunks, divisions, cords, branches
125
Where does the long thoracic nerve come off?
This nerve characteristically arises from the anterior rami of three spinal nerve roots: (C5-C7) although the root from C7 may be absent
126
What does the long thoracic nerve supply?
Supplies the serratus anterior muscle.
Thoracodorsal nerve (C6 – C8)
127
What does the thoracodoesal nerve supply?
Latissimus dorsi
128
What does the names of the cords of the brachial plexus refer to?
Nerve position relative to the axillary artery
129
How is the posterior cord relate to the axillary artery?
It is posterior to the artery
130
How is the medial cord relate to the axillary artery?
Medial to the artery
131
Where does serratus anterior run along?
Runs from lateral aspect of ribs (1-8/9) to scapula
132
What is the relation between serratus anterior and subscapularis muscle?
The serratus anterior lies deep to the subscapularis, from which it is separated by the subscapularis (supraserratus) bursa
133
What does the intraserratus (scapulothoracic) bursa separate?
Ribs from serratus anterior muscle
134
Why is serratus anterior occasionally called the "big swing muscle" or "boxer's muscle"?
Because it is largely responsible for the protraction of the scapula — that is, the pulling of the scapula forward and around the rib cage that occurs when someone throws a punch.
135
Contration of latissmus dorsi does what?
Depression, adducts, extends and internally rotates the arm at the shoulder
136
3 muscles that contribute to arm abduction
Suprapintus - initiates
Deltoid - most of range (15-90)
Trapezius - elevation
137
Painful arc syndrome (30-90/110)
30-90
Occurs due to entrapment of structures underneath the corcoacromial arch
Supraspinatus tendinitus can cause this
138
What do all anterior compartment muscles of the arm have in common?
They are all flexors of the elbow
Many are also flexors o shoulder joint
All innervated by musculocutaneous nerve (except brachioradialis - innervated by radial nerve)
All arterially supplied by profunda brachii
139
What is painful arc syndrome?
Patient has pain on arm abduction particularly between 30-90 degrees
Occurs due to entrapment of structures below coracoacromial arch
140
What does the trapezius muscles do to the arm?
Elevation
141
Which nerve innervates the anterior compartment of the arm?
Musculocutaneous
142
Action of anterior compartment of arm muscles
Flexers of the elbow, many are also flexors at the shoulder joint
143
List anterior arm compartment muscles
Coracobrachialis
Biceps brachii
Brachialis
144
List posterior arm compartment muscles
Triceps brachii
Anconeus
Articularis cubiti
145
List muscles in the superficial anterior forearm compartment
```
Pronator teres
Palmaris longus
Flexor carpi radialis
Flexor carpi ulnaris
Flexor digitorum superficialis
```
146
List muscles in the deep anterior forearm compartment
Pronator quadratus flexor Digitorum profundus flexor Pollicis longus
147
List muscles in the superficial posterior forearm compartment
Brachioradialis
Extensor carpi
Radialis longus
Brevis extensor
Digitorum extensor
Digiti minimi
Extensor carpi ulnaris
148
List muscles in the deep posterior forearm compartment
```
Supinator
Abductor pollicis longus
Extensor pollicis brevis
Extensor pollicis longus
Extensor indicis
```
149
List hand muscles in the lateral volar
Thenar:
- opponens pollicis
- flexor pollicis brevis
- abductor pollicis brevis
Adductor pollicis
150
List hand muscles in the medial volar
Hypothenar:
- opponens digiti minimi
- flexor digiti minimi brevis
- abductor digiti minimi
Palmaris brevis
151
Hand muscles of the intermediate area
Lumbrical
| Interossei dorsal palmar
152
List the fascia of the anterior hand
Flexor retinaculum
| Palmar aponeurosis
153
List the fascia of the posterior hand
Extensor retinaculum
| Extensor expansion
154
Name the muscles in the anatomical snuffbox
Abductor pollicis longus
Extensor pollicis brevis
Extensor pollicis longus
155
Which nerve innervates the muscles of the posterior compartment of the arm?
Radial nerve
156
Which artery supplies the arm muscles?
Profunda brachii
Arm is from shoulder to elbow
157
What is the significance of the Annular ligament?
It runs from ulna and raps around head of radius
In young children, the radial head can split out from underneath the annular ligament (when you swing children by forearms)
Is painful but can be reduced easily
158
What is the innervation of the forearm anterior compartment muscles?
Median nerve mostly
| and ulnar nerve
159
What is the function of the forearm anterior compartment muscles?
Flexors of wrist + fingers
160
What is the vasculature of the forearm anterior compartment muscles?
Radial + ulnar arteries
161
What can the anterior forearm compartment be split into?
Superficial + deep layers
162
What is the function of the forearm posterior compartment muscles?
All extensors of wrist and fingers
163
Which nerve supplies the posterior forearm compartment muscles?
Radial nerve
164
Which arteries supply the posterior forearm compartment muscles?
Radial + ulnar arteries
165
Which bone contributes to the wrist joint the most, radius or ulna?
Radius
166
What movement occurs at the ulnar notch?
Supination + pronation
167
Which bones does the thumb connect via to the radius?
What does this mean when you fall and land with outstretched hand?
FOOSH injury - falling on outstretched hand
Thumb --> trapezium --> scaphoid --> radius
The force is transmitted to via all those bones to radius and continues up to axial skeleton and can end up with:
- Humeral, scaphoid, clavicular fractures
168
Which hand muscles abduct fingers?
Dorsal interossei
169
Which hand muscles adduct fingers?
Palmar interossei
170
Which nerve supplies the dorsal + palmar interossei muscles?
Ulnar nerve
171
Action of the lumbrical muscles of the hand
Flexors at the MCP joint
172
Innervation of lumbrical muscles of hand
Lateral 2 supplied by - median
Medial 2 supplied by - ulna
173
Function and innervation of the thenar eminence
Control thumb movements
Median nerve
174
Function and innervation of the thenar eminence
Control movement of little finger predominantly
Ulnar nerve
175
What is the anastomosis of the radial and ulnar arteries in the hand called?
What branches does this anastomosis give off?
Deep + superficial palmar arches
Give off digital palmar arteries
176
Name the 2 nerves that supply the dorsum of the hand
Radial (lateral 3.5 digits)
Ulnar (medial1.5 digits)
177
Name the 2 nerves that supply the palmar of the hand
Median (lateral 3.5 digits)
Ulnar (medial 1.5 digits)
178
Which nerve supplies the medial 1.5 digits on the palmar and dorsal aspects of the hand?
Ulnar nerve
179
Tenderness in the anatomical snuffbox tends to be a fracture of what?
Scaphoid bone
180
Which nerve and tendons runs under the flexor retinaculum?
Flexor tendons
Median nerve
181
What is compression of the median nerve under the flexor retinaculum called?
Carpal tunnel syndrome
182
What does the brachial plexus (C5-T1) supply?
Upper limb
183
What does the radial nerve supply?
Arm, forearm, hand EXTENSORS
184
Which nerve supplies the thenar eminence?
Median nerve
185
What is the hip joint an articulation between?
Femur + pelvis
Articulates at the acetabulum
Acetabulum is comprised of 3 bones that form the pelvis
186
Name the 3 bones that make up the acetabulum?
Ilium, ischium, pubis
187
Name the ligaments that keep the hip joint in place
Extrapsular
- Iliofemoral
- Pubofemoral
- Ischiofemoral
Intracapsular
- Ligament of head of femur
188
What does the external iliac artery become when it runs under the inguinal ligament?
Femoral artery
189
Name the first branch of the femoral artery.
Profunda femoris (deep femoral)
190
Name the arteries given off by profunda femoris
Medial circumflex
Lateral circumflex
191
Name the branches given off by the lateral circumflex artery
Ascending branch
Descending branch
192
Where does the descending branch of the lateral circumflex artery run along?
Along the capsular attachment line
Approximately the intratrochenteric line
193
Damage to the anterior spinal cord leads to what type of deficit?
Motor deficit to muscles supplied by nerves below the damage
194
How many anterior and posterior spinal arteries are there?
1 anterior (supplies anterior 2/3 of the cord)
2 posterior (supply the posterior 1/3 of the cord)
195
Lesion of the posterior spinal artery causes what type of deficit?
Sensory
196
Which tract is closer to the ventral horn within the spinal cord, spinocerebellar or spinothalamic?
Spinothalamic
197
What do the medial nerves within the ventral horn supply?
Postural extensors
198
What do the lateral nerves within the ventral horn supply?
Distal flexors
199
Afferent fibres are contained within which spinal root?
Dorsal root
200
Efferent fibres are contained within which spinal root?
Ventral root
201
Where do the dorsal and ventral root meet?
Spinal nerve
202
Name the anterior arm compartment muscles
Coracobrachialis
Biceps
Brachialis
203
Name the posterior arm compartment muscles
Triceps brachii
Anconeus
Articularis cubiti
204
Name the anterior forearm compartment muscles
Superficial
- Pronator teres
- Palmaris longus
- Flexor carpi radialis
- Flexor carpi ulnaris
- Flexor digitorum sperficialis
Deep
- Pronator quadratus
- Flexor digitorum profundus
- Flexor pollicis longus
205
Name the posterior forearm compartment muscles
Superficial
- Brachioradialis
- Extensor carpi radialis longus + brevis
- Extensor digitorum
- Extensor digiti minimi
- Extensor carpi ulnaris
Deep
- Supinator
- Extensor indicis
- anatomical snuff box (abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus)
206
Name the anterior thigh compartment muscles
- Sartorius
- Quadriceps (rectus femoris, vastus lateralis, vastus intermedius, vastus medialis)
- Articularis genus
207
Name the medial thigh compartment muscles
- Pectineus
- External obturator
- Gracilis
- Adductor (longus, brevis, magnus, minimus)
208
Name the posterior thigh compartment muscles
- Hamstring (biceps femoris, semitendinosus, semimembranosus)
209
Name the anterior leg compartment muscles
Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus
Peroneus tertius
210
Name the posterior leg compartment muscles
Deep
- Tibialis posterior
- Flexor hallucis longus
- Flexor digitorum longus
- Popliteus
Superficial
- Gastrocnemius
- Soleus
- Plantaris
211
Name the lateral leg compartment muscles
Fibularis (peroneus) longus
| Fibularis (peroneus) brevis
212
Of these two veins which runs medially up the arm and which runs laterally?
Basilic medially
Cephalic laterally
213
Which two veins are united at the antecubital fossa very the median cubital vein?
Cephalic and basilic veins
214
Which nerve innervates serratus anterior?
Long thoracic nerve
215
What is deltoid innervated by?
Axillary nerve
216
The 3 muscles involved in arm abduction.
Supraspinatus (initiation)
Deltoid (most of range)
Trapezius (elevation)
217
Function of the anterior compartment of arm muscles.
They are all flexors of the elbow and many are flexors of the shoulder joint
218
List all the intrinsic shoulder muscles.
Deltoid
Rotator cuff (supraspinatus, infraspinatus, teres minor, subscapularis)
Teres major
219
Which muscle lies superficial to the brachialis muscle?
Biceps brachii
220
Function of biceps brachii muscle
Flexors forearm at elbow joint
| Supinates forearm at radio-ulnar joint
221
Which compartment do supinators of the forearm belong to?
Posterior compartment of forearm
222
Which posterior forearm compartment muscle is a flexor of the elbow, and responsible for supination and pronation of the forearm?
Brachioradialis
223
Which artery and nerve supplies the brachioradialis muscle?
Radial nerve + artery
224
Innervation and arteries supply of anterior arm compartment muscles (brachialis, coracobrachialis, biceps)?
```
Musculocutaneous nerve (C5-7)
Brachial artery
```
225
List all the extrinsic shoulder muscles.
```
Trapezius
Latissimus dorsi
Rhomboid major
Rhomboid minor
Levator scapulae
Serratus anterior
```
226
Which nerve innervates the trapezius muscle (extrinsic shoulder muscle)?
Accessory nerve (CN XI)
227
Which nerve and artery supplies posterior arm compartment muscles (triceps)?
```
Radial nerve (C6-8)
Brachial artery
```
228
Between which structures is the articulation that make up the elbow joint?
Trochlear notch of ulna
| Trochlea of humerus
229
What is the ulnar processes on the posterior surface of the elbow known as?
Olecranon (process of ulna)
230
In which compartment are almost all the flexors of the fingers and wrist?
Anterior (superficial and deep)
Median nerve
231
In which compartment are the extensors of the hand and fingers?
What nerve supplies them?
Posterior compartment
Radial nerve
232
Which nerve supplies almost all the flexors of the wrist and fingers?
Median nerve - supplies the anterior forearm compartment
233
Which arteries supply the anterior and posterior forearm compartment muscles?
Radial (lateral aspect)
Ulnar (medial aspect)
For both anterior and posterior compartment muscles
234
Which bone found in the forearm makes forms the wrist joint?
Radius predominately
235
List the 5 groups of hand muscles which lie which one of the 5 compartments of the hand.
```
Hypothenar muscles
Thenar muscles
Adductor pollicis
Lumbricals
Interossei
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236
What action do interosseous muscles have?
Dorsal interossei - abduction at MCP joints
Palmar interossei - adduction at MCP joints
BOTH - Flexion of the MCP joint (90 degrees), Extension at PIP and DIP joints (30 degrees of motion)
237
What is the action of lumbricals?
The lumbrical muscles, with the help of the interosseous muscles, simultaneously flex the MCP joints while extending both interphalangeal joints of the digit on which it inserts.
238
Action of the dorsal interossei of the hand.
Abduct the index, middle, and ring fingers away from hand's midline
239
Action of the palmar interossei muscle.
Adductor fingers towards hand's midline.
240
How many dorsal and palmar interossei muscles are there?
4 dorsal - bipennate
| 3 palmar - unipennate
241
Which are smaller, the dorsal or palmar interossei muscles?
Palmar interossei muscles are smaller than the dorsal interossei of the hand.
242
Which nerve innervates muscles of the hand?
Hypothenar muscles - ulnar n.
Thenar muscles - median n.
Adductor pollicis - ulnar n.
Lumbricals - lateral 2 supplied by median n., medial 2 supplied by ulnar n.
Interossei - ulnar n.
243
Name the 3 thenar muscles
Abductor pollicis brevis (note NOT ADDuctor)
Flexor pollicis brevis
Opponens pollicis
244
Name the 4 hypothenar muscles
Palmaris
Opponens digiti minimi of hand
Flexor digiti minimi of hand
Abductor digiti minimi of hand
245
Function of thenar and hypothenar muscles.
Thenar - movements of thumb (pollicis) mainly
Hypothenar - movements of little finger (digiti minimi) predominantly
246
Name the 2 arteries which are made up of an anastomosis between the radial and ulnar arteries.
Superficial and deep palmar arch's
247
Which nerve supplies the thenar eminence and can be compressed in carpal tunnel?
Median nerve
248
Which nerve supplies all the muscles of the posterior arm and forearm (extensors)?
Radial nerve
249
Which 2 cords come together to form the median nerve?
Lateral and medial
250
From which cord does the ulnar nerve come off?
Medial cord
251
Which nerve arises from the lateral cord?
Musculocutaneous nerve (supplies anterior arm compartment muscles (flexor muscles of arm))
252
What does the median nerve supply?
Flexor muscles of the forearm
253
What is the articulation of the ilium, ischium and pubic known as?
Acetabulum
254
What does the external iliac artery and its branches supply?
Lower limb, external genitalia and anterolateral abdominal wall
255
What is the femoral artery a distal continuation of?
Where does this divide occur?
The external iliac artery
Occurs after it passes deep to the midpoint of the inguinal ligament
256
Which artery gives of a medial and lateral circumflex femoral artery?
Deep femoral artery (aka profunda femoris)
257
Where do the retinacular arteries which supply the head of the femur arise from?
Trochanteric anastomosis
258
Which arteries form the trochanteric anastomosis (which supplies retinacular arteries)
Formed by the combination of the:
- ascending branch of medial circumflex femoral artery
- ascending branch of lateral circumflex fmemoral artery
- branches of the gluteal arteries
259
Which arteries supply the head of the femur?
Retinacular arteries which come from the medial and lateral circumflex arteries anastomoses
Acetabular artery
260
When can avascular necrosis of the femoral head occur?
Fracture of the neck of the femur (intracapsular) leadinging to damage to retinacular arteries and insufficient blood supply leading to death of the bone
261
How many compartments does the upper and lower limbs have in total?
UL - 4
| LL - 6
262
Name the compartments of the thigh
Anterior
Medial
Posterior
But also has lateral muscles
263
What are the borders of the femoral triangle?
Superiorly - inguinal ligament
Medially - adductor longus
Laterally - sartorius
264
Lateral to medial what are the structures that pass within the femoral triangle.
NAVEL acronym
Femoral:
- Nerve
- Artery
- Vein
- Empty space (allows veins and lymph vessels to distend when they cope with different evels of flow)
- Lymph canal
265
What does the femoral canal contain?
Deep lymph nodes and vessels
266
Which artery is located superficially within the femoral triangle?
FEmoral artery
267
What happens when part of the bowel pushes into the femoral canal, underneath the inguinal ligament?
Femoral hernia
This manifests clinically as a lump or bulge in the area of the femoral triangle
Treatment = surgical intervention usually
268
Where does the great saphenous vein drain into?
FEmoral vein
269
Which compartment does the femoral nerve innervate?
Anterior compartment of the thigh
270
What is the main artery of the LL?
Femoral artery which is a continuation of the external iliac artery (which is the terminal branch of the abdominal aorta)
271
Name the 3 main branches of the profunda femoris artery.
Perforating branches that perforate the adductor magnus, contributing to supply of medial and posterior thigh muscles
Lateral femoral circumflex
Medial femoral circumflex
272
Which artery wraps round the anterior, lateral side of the femur?
Lateral femoral circumflex artery
273
Which artery supplies some of the muscles on the lateral aspect of the thigh and is a branch of the profunda femoris artery?
Lateral femoral circumflex artery
274
Which artery wraps around the posterior side of the femur and supplies the femoral neck and head?
MEDIAL demoral circumflex artery
275
What does the adductor canal contain?
It's a tunnel where the femoral artery continues down the anterior surface of the thigh via,after exiting the femoral triangle.
276
Name given to where the adductor canal ends.
Adductor hiatus
277
Once the femoral artery moves through the adductor hiatus opening, where does it go?
What is it known as after this passage?
Enters the posterior compartment of the thigh, proximal to the knee
And becomes known as the popliteal artery
278
Where does the obturator artery arise from?
Internal iliac artery in the pelvic region
279
Where does the obturator artery descend to via the obturator canal?
Medial thigh where it bifurcates into an anterior and posterior branch.
280
The gluteal region is largely supplied by which arteries?
Superior and inferior gluteal arteries
281
Where do the superior and inferior gluteal arteries arise from?
Where do they enter the gluteal region?
Internal iliac artery
Enter gluteal region via greater sciatic foramen
282
The deep and superficial veins of the lower limb mirrors what?
Deep = mirrors arteries of the lower limb
Superficial = comprised of sapneous vessels that do not mirror arteries
283
Where do the short saphenous veins run along?
Posterior aspect of calf
284
Where do the short saphenous veins run along?
Starts anterior to medial malleolus and runs up medial aspect of limb up until saphenofemoral junction (medial aspect of upper thigh)
285
Which vessels allow communication between the superficial saphenous veins and the deep veins of the lower limb?
Perforating vessels
286
What are the nerve roots supplying the lumbosacral plexus?
L1-S4
287
Name the hip abductors
Gluteus medius
Gluteus minimus
Tensor fascia latae
288
Neurovasculature of hip abductors
Superior gluteal nerve and artery
Except
289
Action of gluteus maximus
Hip extensor
290
Which nerve supplies the gluteus maximus?
Inferior gluteal nerve
291
Which thigh compartment contains hip adductors?
Medial compartment
292
Name the hip adductors (medial compartment muscles).
What is their innervation and vascular supply?
Adductor longus
Adductor magnus
Adductor brevis
Gracilis
Obturator nerve
Profunda femoris
293
Which of the following medial thigh compartment muscles is the most medial?
Adductor longus
Adductor magnus
Adductor brevis
Gracilis
Gracilis
294
Name the muscles in the anterior compartment of the thigh and their innervation and arterial supply.
Vastus medialis
Vastus lateralis
Vastus intermedius (deep)
Rectus femoris
Sartorius * - external hip rotation mainly, hip and knee extension also
- Femoral nerve
- Profunda femoris artery (same as medial compartment)
295
Action of the anterior thigh compartment muscles
Quadriceps (Vastus medialis, Vastus lateralis, Vastus intermedius, Rectus femoris) extensors of knee
296
Longest muscle of the body?
Sartorius which lies in the anterior compartment
297
What is the innervation and vascular supply of the posterior compartment muscles?
Sciatic nerve
| Profunda femoris
298
Which muscles make up the posterior compartment of the thigh?
Semimembranosus
Semitendinosus
Biceps femoris
299
The knee joint is formed by an articulation between the _ and _?
Femur
TIbial plateau
Fibia doesn't play a significant role in the knee joint but it's where the lateral collateral ligament inserts
300
Name the ligaments of the knee
Lateral collateral ligament
Medial collateral ligament
Anterior cruciate ligament
Posterior cruciate ligament
301
Which ligaments sit inside the capsule of the knee?
Anterior cruciate ligament
| Posterior cruciate ligament
302
Where does the anterior and posterior cruciate ligaments insert on the tibial plateau?
Anterior cruciate ligament - inserts anterior on tibial plateau
Posterior cruciate ligament - inserts posterior upon tibial plateau
303
Which movement does the anterior and posterior cruciate ligaments prevent?
Anterior cruciate ligament - prevents anterior movement of the tibial upon the femur
Posterior cruciate ligament - prevents posterior movement of the tibial upon the femur
304
Name the bursae of the knee.
Pre-patellar
Suprapatellar
Infrapatellar
Popliteal
305
A lateral blow to the knee, particularly with foot fixed on ground can cause the unhappy triad of injury to what?
Anterior cruciate ligament
Medial collateral ligament
Medial meniscus
306
Generally which thigh compartment muscles are: knee extensors, knee flexors, hip adductors?
Knee extensors - anterior
Knee flexors - posterior
Hip adductors - medial
307
Where are short saphenous veins found?
Below knee only
308
Where are long saphenous veins found?
Above knee, medially
309
What does the popliteal artery become distally?
Anterior tibial --> dorsalis pedis
| Posterior tibial
310
Which artery gives off the popliteal artery?
Superficial femoral which is a branch of the femoral artery
311
What does the sciatic nerve divide into in the popliteal fossa?
- Common peroneal nerve (anterior and lateral compartments, foot extensors)
- Tibial nerve (posterior leg compartment, foot flexors)
312
Which nerve supplies the posterior leg compartment and foot flexor muscles?
Tibial nerve
313
Which nerve supplies the anterior leg compartment and foot extensor muscles?
Deep peroneal nerve (from common peroneal nerve)
314
Which nerve supplies the lateral le compartment?
Superficial peroneal (from common peroneal nerve, which is from sciatic nerve)
315
Which leg compartment muscles is responsible for eversion?
Lateral compartment
316
Which nerve supplies foot dorsiflexors?
Deep peroneal nerve (which supplies anterior leg compartment)
317
Muscles in the anterior leg compartment
Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus
318
Muscles in the lateral leg compartment
Peroneus longus
| Peroneus brevis
319
Muscles in the posterior leg compartment
Deep (toe flexion)
- Tibialis posterior
- Flexor hallucis longus
- Flexor digitorum longus
Superficial (ankle flexion)
- Gastrocnemius
- Soleus
320
Which arteries supply the leg?
Anterior and posterior tibial arteries which as branches of the popliteal artery
321
What happens at the sapheno-popliteal junction?
The short saphenous vein joints with the popliteal vein (which continues to become the femoral vein)
322
What is another name for common peroneal nerve?
Common fibular nerve
323
Posterior thigh muscles are known as what?
Hamstrings (knee flexor)
324
Posterior thigh muscles are known as what?
Hamstrings (knee flexor)
325
Which nerves innervate the anterior, medial and posterior thigh compartments?
Anterior (quadriceps) - femoral
Medial (hip adductors) - obturator
Posterior (hamstrings) - sciatic
326
Which muscles make up hamstrings?
From medial to lateral:
- Semimembranosus
- Semitendinosus
- Biceps femoris
327
When the trunk is fixed and when knee is bent what action does the hamstring muscles have?
Semitendinosus and semimembranosus - extend the hip when the trunk is fixed
Semitendinosus and semimembranosus - also flex the knee and medially (inwardly) rotate the lower leg when the knee is bent
Biceps femoris - flex knee and laterally rotate the leg when the knee is bent
328
From superficial to deep list the components of the anterior abdominal wall.
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Skin
Adipose
Superficial fascia
Abdominal wall muscles
- External oblique
- Internal oblique
- Transversus abdominis
Deep fascia
Extraperitoneal fat
Parietal peritoneum
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329
Which direction does external oblique muscle fibres run in?
Hands in pockets direction
inferiorly and medially
330
Where is the arcuate line?
Halfway between umbilicus and pubic symphisis
331
Which muscles are at 90 degrees to external oblique muscles
Internal oblique
From iliac crest --> midline and ribs
superiorly and medially
332
What divides the rectus abdominis muscle into 8 sections?
Aponeuroses (flat, thin tendons)
- Central vertical band
- 3 horizontal bands
333
Where do abdominal wall muscles insert?
Linea alba
334
What is the anterior triangle of the neck bordered by?
Midline
Sternocleidomastoid
Mandible
335
What is the posterior triangle of the neck bordered by?
Trapezius
Sternocleidomastoid
Clavicle
336
List the types of neurons.
Multipolar (interneuron)
Bipolar (retina has bipolar cells, which have a cell body with 2 axon like processes - technically the bipolar cells in the retina are not neurons)
Pseudounipolar (1st sensory afferent)
Unipolar (UMN)
337
Schwann cells lie within what?
Endoneurium
338
What are schwann cells and what are they responsible for?
Peripheral glial cells responsible for myelination
339
Each schwann cell myelinates how many neurones?
1
340
How many schwann cells myelinate/associate one myelinated and unmyelinated neuron?
Many schwann cells myelinate each myelinated neuron
One schwann cell is associated with many unmyelinated neurones
341
What are the types of peripheral nerves?
A-alpha
A-beta
A-delta
C
342
What is the largest and thicken peripheral nerve type?
A-alpha
They tend to be LMNs
343
What are the functions of the following types of peripheral nerves:
- A-alpha
- A-beta
- A-gamma
- A-delta
- C
A-alpha (proprioception + motor)
A-beta (proprioception + form muscle spindles)
A-delta (sensory only normally, pain and other sensation)
C (pain)
344
What is the resting membrane potential in a neurone?
What is it determined by?
-65mV
Determined by passive movements of ions (leak channels)
345
What is absolute refractory periods?
Insufficient channels
| - Fast sodium ion channels in refractive state therefore no AP regardless of stimulus intensity
346
What is relative refractory periods?
Some fast sodium ion channels available therefore AP possible with large stimulus
347
What does increasing neuron diameter do to speed of conduction?
Reduces resistance nad incerases speed
348
What does myelination do to speed of nerve impulse conduction?
Myelination allows conduction jumps between myelin (saltatory conduction) at nodes of Ranvier
Unmyelinated neurons are much smaller
349
What is depolarisation due to?
Opening of fast voltage-gated Na+ channels
350
What is repolarisation due to?
K+ exit
351
What does the refractory period ensure?
Unidirectional propagation
352
How many connexin proteins form 1 connexon?
6
353
Gap junctions (electrical synapses) are formed by what?
Connexons (hydrophilic channels)
Which allow small (charged) molecules to be transferred between 2 cells
354
Where are gap junctions found?
Cardiac muscles and smooth muscle where contractions spread throughout the muscle so they contract synchronously
355
Where are chemical synapses found?
Between 1 neuron and another neurone or a tissue (e.g. motor end plate of a muscle)
356
When an AP arrives at the presynaptic neuron, the membrane depolarises. What happens lead to a change in the post-synaptic neurone?
Activates voltage-gated channel (e.g. calcium channel)
Calcium enters the pre-synaptic neuron and causes fusion of the neurosecretory vesicles containing neurotransmitter with the membrane and release of the neurotransmitter
NT diffuses across the synaptic cleft passively
This causes some change in the post synaptic neurone (excitatory, inhibitory) - post synaptic potential
The neurotransmitter is taken up into post or pre-synaptic receptor or broken down via enzymes in the cleft --> action of the chemical synapse is terminated
357
What is summation?
Cumulative action or effect.
The process by which a sequence of stimuli that are individually inadequate to produce a response are cumulatively able to induce a nerve impulse
358
What does excitatory refer to in a chemical synapse?
Causes depolarisation in post-synaptic neuron
359
What does inhibitory refer to in a chemical synapse?
Causes hyperpolarisation in post-synaptic neuron
360
What are local anaesthetics?
Drugs that can cause reversible block a nerve conduction without loss of consciousness by intracellular inhibition of. voltage-gated sodium channels
361
Which nerves do local anaesthetics favour?
Small neurones better blocked that larger neurones
Therefore affect A-delta and C fibres preferentially (pain sensation carriers)
362
Why are local anaesthetics given with adrenaline sometimes?
Because adrenaline causes vasoconstriction which increases duration of local anaesthetic action
363
Difference between peripheral muscle reflex and polysynaptic reflex?
Peripheral muscle reflexes (patellar reflex, achilles reflex) = brief stimulation to the muscle spindle results in contraction of the agonist or effector muscle.
Polysynaptic reflex pathways - one or more interneurons connect afferent (sensory) and efferent (motor) signals.
364
Difference between monosynaptic and polysynaptic reflex?
Monosynaptic reflexes involve only one central synapse in the spinal cord grey matter, between the afferent and the efferent neurons. E.g. muscle spindle --> muscle contraction
Polysynaptic reflexes involve two to several synapses involving one or more interneurons. E.g. golgi tendon --> muscle relaxation
365
Which reflexes does the following describe?
Stimulus --> receptor --> afferent neurone --> efferent neurone --> effector
Neuronal reflex - an involuntary response of the CNS that is stereotyped, has a specific input and rapid output
366
The muscle spindle detects what?
Unexpected stretch of muscle which leads to muscle contraction
367
When the non-contractile part of a muscle fibre is stretched (unexpected stretch), what does this cause?
Activation of the 1a sensory neurone which runs via monosynaptic reflex through spinal cord to activate lower motor neurone (effector) leading to muscle contraction
E.g. tendon jerk reflex
368
What is the golgi tendon organ formed of?
Nerve fibres that sit within tendons
369
When a muscle contracts the force of it's tendon increases and is detected by the golgi tendon organs.
What does activation of the golgi tendon organ lead to?
Which leads to activation of the afferent neurone which passes to inhibitory interneuron which passes down lower motor neurone and causes muscle relaxation
370
Which channels to local anaesthetics inhibit?
Inhibit fast voltage-gated sodium channels intracellularly
371
What is fast, involuntary and has a specific afferent and efferent limb?
A reflex
372
What are muscle spindles responsible for?
Tendon jerk reflex
373
Are pre-ganglionic neurones of the autonomic nervous system myelinated or unmyelinated?
myelinated
374
Are post-ganglionic neurones of the autonomic nervous system myelinated or unmyelinated?
unmyelinated
375
The synapse between a pre and post ganglionic neurone in the autonomic nervous system is mediated by what type of receptor?
In both parasympathetic and sympathetic nervous systems
Nicotinic-ACh-receptor
376
Where does the cell body of the pre-synaptic ganglion lie?
Lateral horn of T1-L2
377
Where does the cell body of the post-synaptic ganglion lie?
Sympathetic chain or peripheal ganglion
378
What is the sympathetic chian?
Multiple interconected ganglia on posterior wall of thorax and abdomen
379
What are splanchnic nerves?
The splanchnic nerves are paired visceral nerves (nerves that contribute to the innervation of the internal organs), carrying fibers of the autonomic nervous system (visceral efferent fibers) as well as sensory fibers from the organs (visceral afferent fibers).
380
What does the coeliac ganglion supply?
Foregut
381
What does the superior mesenteric ganglion supply?
Midgut
382
What does the inferior mesenteric ganglion supply?
Hindgut
383
What does the renal plexus and aorticorenal ganglion supply?
Kidneys, adrenals, joints with aortic plexus
384
Name the sympathetic splanchnic nerves and their spinal cord levels.
Cardiopulmonary splanchnic nerves
Thoracic splanchnic nerves (Greater splanchnic, Lesser splanchnic, Least splanchnic)
Lumbar splanchnic nerve
Sacral splanchnic nerves
385
Name the sympathetic splanchnic nerves.
Cardiopulmonary splanchnic nerves
Thoracic splanchnic nerves (Greater splanchnic, Lesser splanchnic, Least splanchnic)
Lumbar splanchnic nerve
Sacral splanchnic nerves
386
Where does the greater splanchnic nerve originate?
T5-T9
387
Where does the lesser splanchnic nerve originate?
T10-11
388
Where does the least splanchnic nerve originate?
T12
389
Which nerve targets the renal plexus?
Least splanchnic nerve (T12)
390
Both NA and A can bind to either adrenoreceptor. Which type of adrenoceptor is A and NA better at binding to?
A - No preference
| NA - Higher affinity for alpha-adrenoceptors
391
What is the only example where a post-ganglionic sympathetic neurone does not release NA or A?
Sweat glands which release ACh which bind to muscarininc receptors to increase sweat production
392
What structure has many myofibres acting together?
Muscle fasciculus
393
What is a myofibre also known as?
Muscle cell
394
How many fibrils are in one myofibre?
Many
395
Contractile proteins are also called what?
Myofilaments
396
Many filaments make what?
A myofibril
397
What is the borders of one sarcomere?
Distance between 2 z lines
398
Which filaments are found at the M-line and Z-line?
Myosin only on M-line
| Actin (thin filaments) on Z line
399
Contraction of a sarcomere shortens which bands?
Only the I-band
| A-band stays same
400
Actin, tropomyosin and troponin are all examples what what?
Thin filaments
| Myosin is the only thick filament in muscles
401
What sits in actin grooves and have myosin binding sites?
Tropomyosin
402
What are type I skeletal muscles usually used for?
Long periods of activity of low intensity
E.g. postural muscles have high amounts of type I fibres
403
What are type II skeletal muscles usually used for?
Fast, high intensity, short duration of time before fatigued
404
Which type of skeletal muscle type has high myoglobin and is aerobic?
Type I
| Type II has anaerobic, and low myoglobin
405
What determines the type of skeletal muscle fibres?
The LMN innervating them (they are either type I or type II)
The activity of the LMN affects the ATPase of the muscle which determines the speed and rate t which the muscle can contract and use energy
406
In a muscle filament, the loss of P causes what action?
Power stroke
407
ATP binding in a muscle filament causes what?
Breaking of the cross bridges
408
What do osteoblasts secrete?
Osteoid which are mineralised with hydroxyapatite
409
Which cells resorb bones?
Osteoclasts - large multinulcleate cells
410
What does the endosteum cover?
Surface of bone
411
What is the shaft of a. long bone also known as?
DIaphysis
412
What is the end of a long bone also known as?
Epiphysis
413
What is. the physis region of the long bone also known as?
Growth plate
414
What is a condyle?
Articular surface
415
What is an epicondye
Projection adjacent to a condyle
416
What are trochanters?
Large tuberosities
417
What is lamellar bone formed of?
Outer compact bone with innr cancellous bone
