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MBBS > 204 MSK - Anatomy > Flashcards

204 MSK - Anatomy Flashcards

1
Q

What does the superior gluteal nerve innervate?

A

Motor:
Gluteus medius
Gluteus minimus
Tensor fascia latae

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2
Q

Origin of superior gluteal nerve

A

Lumbo-sacro plexus - nerve roots L4-S1

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3
Q

Course of superior gluteal nerve

A

Leaves pelvis through the greater sciatic notch → runs over the piriformis between the gluteus medius & minimus
- branches to the gluteus minimus and medius muscles and terminates by innervating the tensor fasciae latae muscle.

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4
Q

What happens if superior gluteal nerve is injured?

A

Positive Trendelenburg test

  • gluteus medius & gluteus minimus keeps pelvis level when contralateral limb is elevated
  • When superior gluteal nerve injured – pelvis drops on unaffected side, bc contralateral muscles are paralyzed
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5
Q

Which anatomical landmark marks the transition from the femoral vein to the external iliac vein?

A

Inguinal ligament

  • The femoral vein leaves the thigh by running underneath the inguinal ligament, at which point it is known as the external iliac vein.
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6
Q

Which vessel do the superior and inferior gluteal veins empty into?

A

Internal iliac

  • The gluteal region is drained by inferior and superior gluteal veins. These empty into the internal iliac vein.
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7
Q

The small saphenous vein drains into the deep vasculature at which level?

A

Popliteal vein

  • The small saphenous vein moves between the two heads of the gastrocnemius muscle and empties into the popliteal vein in the popliteal fossa.
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8
Q

A vascular surgeon is preparing to harvest the longest vein in the body to use as a conduit for peripheral arterial bypass procedure. Where will she find and harvest this vein?

A

Medial side of the thigh

  • The great saphenous vein is the longest vein in the body and runs along the length of the leg. It can be found traveling up the medial side of the thigh.

The great saphenous vein originates at the medial aspect of the foot, courses anterior to the medial maleolus and travels up the medial side of the leg and thigh to just inferior to the pubic tubercle. There it joins with the femoral vein in the region of the femoral triangle.

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9
Q

Deep veins of lower limbs

A

Located underneath the deep fascia of the lower limb, accompanying the major arteries

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10
Q

Superficial veins of lower limbs

A

Found in the subcutaneous tissue. They eventually drain into the deep veins.

Great saphenous vein
Small saphenous vein

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11
Q

Deep vein course

A
  1. (foot) Deep perforating veins from dorsal venous arch form anterior tibial vein
  2. (plantar foot) Medial & lateral plantar veins arise → combine to form posterior tibial & fibular veins
  3. (posterior surface of the knee) Anterior tibial, posterior tibial & fibular veins → combine to form popliteal vein
  4. (enters thigh via adductor canal) Popliteal vein is now known as femoral vein
  5. (terminal section of femoral vein) Deep vein of thigh joins femoral vein
  6. (Leaves thigh by running underneath inguinal ligament) Femoral vein known as external iliac vein
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12
Q

Great saphenous vein (course)

A

Dorsal venous arch gives rise to great saphenous vein on medial side of foot → ascends up medial side of leg, passes anteriorly to medial malleolus at ankle & posteriorly to medial condyle at knee
→ drains into femoral vein distal to inguinal ligament

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13
Q

Course of small saphenous vein

A

Dorsal venous arch gives rise to small saphenous vein on lateral side of foot → ascends on posterior side of leg, passes posterior to lateral malleolus along lateral border of calcaneal tendon
→ moves between 2 heads of gastrocnemius muscle
→ drains into popliteal vein in politeal fossa

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14
Q

Varicose veins

A

Valves of superficial veins become incompetent, resulting in dilation of superficial veins

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15
Q

Origin of obturator nerve

A

Lumbar plexus - L2 - L4

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16
Q

Sensory innervation of the obturator nerve

A

Medial aspect of thigh

Articular branches to hip & knee joints

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17
Q

Motor innervation of the obturator nerve

A

Muscles of the medial compartment of the thigh:

Anterior:

  • Adductor longus
  • Adductor brevis
  • Gracilis

Posterior:

  • Obturator externus
  • Adductor magnus
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18
Q

Course of obturator nerve

A

Formed in lumbar plexus – L2-L4 → descends through psoas major → posterior to common iliac arteries → laterally along pelvic wall → enter obturator foramen of pelvis → enters medial thigh through obturator canal

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19
Q

A patient visits her GP with difficulty walking. After clinical examination, obturator nerve palsy is suspected. Which movement is most likely to be impaired?

A

Hip adduction

  • The obturator nerve innervates the muscles of the medial thigh. Their collective action is hip adduction.
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20
Q

Which muscle is the exception in the medial compartment of the thigh (not innervated by obturator nerve)?

A

The hamstring part of the adductor magnus (innervated by the tibial nerve).

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21
Q

What are the spinal roots of the deep fibular nerve?

A

L4-S1

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22
Q

Which artery does the deep fibular nerve follow as it descends inferomedially along the leg?

A

Anterior tibial

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23
Q

Which structure does the deep fibular nerve pass under at the ankle joint?

A

Extensor Retinaculum

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24
Q

Motor innervation of deep peroneal nerve

A

Muscles on anterior compartment of the leg

  • tibialis anterior
  • extensor digitorum longus
  • peroneus tertius
  • extensor hallucis longus

Intrinsic muscles of the foot.
- extensor digitorum brevis - extensor hallucis brevis

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25
Q

Sensory innervation of deep peroneal nerve

A

The triangular region of skin between the 1st and 2nd toes.

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26
Q

Footdrop

A

Paralysis of the muscles in the anterior compartment of the leg - due to deep peroneal nerve injury
- so a patient loses the ability to dorsiflex the foot.

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27
Q

Course of deep peroneal nerve

A

Bifurcation of the common peroneal nerve → interosseous membrane → crosses anterior tibial artery → anterior tarsal tunnel → lateral & medial terminal branches

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28
Q

Action of flexor digitorum profundus

A

Flexion of the fingers at the MCP and IP joints.

Assists with flexion of the hand

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29
Q

Innervation of flexor digitorum profundus

A

Digits 2-3: Median nerve (anterior interosseous nerve);

Digits 4-5: Ulnar nerve (C8, T1)

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30
Q

Action of supraspinatus

A

Initiates and assists deltoid in abduction of arm and acts with other rotator cuff muscles

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31
Q

Innervation of supraspinatus

A

Suprascapular nerve (C5, C6)

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32
Q

What does the long thoracic nerve innervate?

A

Serratus anterior

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33
Q

Origin of the long thoracic nerve

A

Arises from ventral rami of C5, C6, C7 roots of brachial plexus

34
Q

2 types of winging of scapula

A

Medial winging of scapula - serratus anterior problem

Lateral winging of scapula - trapezius problem

35
Q

Medial winging of scapula

A

Dysfunction of the serratus anterior (long thoracic nerve)

36
Q

Lateral winging of scapula

A

Dysfunction of the trapezius (cranial nerve XI - spinal accessory nerve)

37
Q

Sign of axillary nerve injury

A

Flattened deltoid

38
Q

Sign of radial nerve injury

A

Wrist drop

39
Q

Sign of median nerve injury

  • distal
  • proximal
A

Distal - median claw hand (when asked to extend figers) - bc loss of lateral lumbricals

Proximal - ulnar claw hand (when asked to flex fingers) - bc loss of long forearm flexors

40
Q

Sign of ulnar nerve injury

  • distal
  • proximal
A

Distal - ulnar claw hand (when asked to flex fingers) - bc loss of long forearm flexors

Proximal - median claw hand (when asked to extend figers) - bc loss of lateral lumbricals

41
Q

What are the 4 rotator cuff muscles & their functions ?

A

Supraspinatus - initial abduction
Infraspinatus - lateral rotation of arm
Teres minor - adduction & lateral rotation of arm
Subscapularis - adduction & medial rotation of arm

42
Q

Rotator Cuff Tendonitis

A

Inflammation of the tendons of the rotator cuff muscles – most commonly supraspinatus

43
Q

What are the 3 thenar muscles & their innervation?

A

Opponens Pollicis
Abductor Pollicis Brevis
Flexor Pollicis Brevis

Innervated by median nerve

44
Q

What are the 3 hypothenar muscles & their innervation?

A

Opponens Digiti Minimi
Abductor Digiti Minimi
Flexor Digiti Minimi Brevis

Innervated by ulnar nerve

45
Q

What are the actions of the 3 thenar muscles?

A

Opponens Pollicis - opposes thumb
Abductor Pollicis Brevis - abducts thumb
Flexor Pollicis Brevis - Flexes thumb at MCP

46
Q

What are the actions of the 3 hypothenar muscles?

A

Opponens Digiti Minimi - opposes little finger
Abductor Digiti Minimi - abducts little finger
Flexor Digiti Minimi Brevis - Flex MCP of little finger

47
Q

What are the lumbricals?

A

4 lumbricals each associated with a finger

Act to flex the fingers at MCP & extend at IP

48
Q

Innervation of lumbricals

A 
Lateral 2 (index & middle) – median nerve
Medial 2 (little & ring) – ulnar nerve
49
Q

PAd Dab

A

P: palmar interossei
Ad: adduction

D: dorsal interossei
Ab: abduction

50
Q

Which nerve innervates the opponens digiti minimi muscle of the hand?

A

Ulnar nerve

  • The ulnar nerve innervates the muscles of the hypothenar eminence, including the opponens digiti minimi.
51
Q

What is the action of the lumbricals on the interphalangeal joints?

A

Extension

  • The lumbricals extend at the IP joints and flex at the MCP joints.
52
Q

Hand muscles supplied by ulnar nerve

A

All except 3 thenar muscles & 2 lateral lumbricals

3 hypothenar muscles

  • opponens digiti minimi
  • abductor digiti minimi brevis
  • flexor digiti minimi brevis

2 medial lumbricals
- little & ring

Interosseous
- Dorsal & Palmar

Palmaris Brevis
Adductor Pollicis

53
Q

Hand muscles supplied by median nerve

A

3 thenar muscles

  • opponens pollicis
  • abductor pollicis brevis
  • flexor pollicis brevis

2 lateral lumbricals
- index & middle

54
Q

Which nerve innervates the interosseous?

A

Ulnar nerve

55
Q

How many dorsal & palmar interosseous?

A

Dorsal: 4
Palmar: 3

56
Q

Action of palmaris brevis

A

Wrinkles skin of hypothenar eminence & deepens curvature of hand, improving grip

57
Q

Action of adductor pollicis

A

Adductor of thumb

58
Q

Ulnar paradox

A

Higher the lesion, less the deformity

59
Q

4 normal curves of the vertebral column

A

Cervical lordosis
Thoracic kyphosis
Lumbar lordosis
Sacral kyphosis

60
Q

Regions of vertebral column and their number of vertebrae

A 
Cervical - 7
Thoracic - 12
Lumbar - 5
Sacrum - 5
Coccyx - 4
61
Q

3 types of prolapsed intervertebral disc (PID)

A

Central - compress on spinal cord
Posterolateral - compress nerve on its way to next intervertebral level
Far lateral - compress spinal nerve leaving the level

62
Q

Femoral nerve palsy

A

Loss of knee extension & weak hip flexion

63
Q

Tibial nerve palsy

A

Loss of plantar flexion, weak inversion

64
Q

Common peroneal nerve palsy

A

Loss of ankle dorsiflexion (foot drop) & foot eversion

Numbness on dorsum of foot & lateral leg

65
Q

Superficial peroneal nerve palsy

A

No foot drop, loss of foot eversion, numbness on foot dorsum (except 1st web)

66
Q

Deep peroneal nerve palsy

A

Loss of dorsiflexion (foot drop), numbness in 1st web

67
Q

Valgus stress test for elbow

A

Test medial collateral ligament

Distal part push to lateral side

68
Q

Varus stress test for elbow

A

Test lateral collateral ligament

Distal part push to medial side

69
Q

Test for anterior cruciate ligament (ACL)

A

Anterior drawer test

70
Q

Test for posterior cruciate ligament (PCL)

A

Posterior drawer test

Posterior sag test

71
Q

ACL enters the ______ anteriorly

knee

A

tibia

72
Q

PCL enters the tibia ______

knee

A

posteriorly

73
Q 
ACL function
(knee)
A

Prevents knee from sliding forward

74
Q 
PCL function
(knee)
A

Prevents knee from sliding backward

75
Q

McMurray’s test

A

For meniscal tear

76
Q

Apley’s test

A

For meniscal tear

77
Q

Varus stress test for knee

A

Test lateral cruciate ligament

Distal part push to medial side

78
Q

Valgus stess test for knee

A

Test medial cruciate ligament

Distal part push to lateral side

79
Q

Varus stress test for elbow/knee tests ______;

Valgus stress test for elbow/knee tests ______

A

lateral; medial

80
Q

Carpal tunnel syndrome

A

Compression of the median nerve as it runs deep to the transverse carpal ligament (TCL) causes:

  • atrophy of the thenar eminence
  • weakness of the flexor pollicis brevis, opponens pollicis, abductor pollicis brevis
  • sensory loss in the digits supplied by the median nerve.

MBBS (28 decks)

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