Anatomy Flashcards
What nerve is most damaged w Primary THA?
Peroneal division of sciatic, more lateral.
What vessel sits below quadratus femoris?
Medial femoral circumflex artery ascending branch (posterosuperior and posteroinferior retinacular) lateral epiphyseal branch most important This is most at risk with posterior approach to acetabulum
What is the only muscle supplied by peroneal division above fibular head?
Short head of biceps femoris
What is POPS IQ?
Lateral to medial nerves exiting below piriformis
Pudendal
Nerve to obturator internus
Posterior femoral cutaneous
Sciatic
Inferior gluteal nerve
Nerve to quadratus femoris
What nerve is at risk during percutaneous iliosacral screw placement?
L5 nerve root
Which two nerves leave the greater and return via the lesser sciatic notch?
Pudendal, nerve to obturator internus
Femoral triangle borders? Contents?
- Sartorius (lat)
- pectineus (med)
- inguinal ligament (sup)
- Floor is the iliacus, psoas, pectineus, adductor longus
- Contents: Fem nerve, art, vein, lymphatics
What spine condition manifests as hip pain? Why?
Potts disease - tuberculosis spondylitis
Illiopsoas comes off the lumbar spine
Obturator nerve splits into anterior and posterior divisions. What do they supply? When can they be injured by a retractor?
Ant - obturator externus, pectineus, adductor longus, brevis, gracilis, sensation to medial thigh Post - obturator externus, adductor brevis, upper part of adductor Magnus Retractor placed behind TAL
Aorta divides into common iliac arteries at what lumbar vertebrae?
L4
Internal Iliac branches? What one is at risk w anterior inferior acetabular screw insertion?
(I Love Going Places In My Very Own Underwear)
I: iliolumbar artery
L: lateral sacral artery
G: gluteal (superior and inferior) arteries
P: (internal) pudendal artery
I: inferior vesicle (uterine in females) artery
M: middle rectal artery
V: vaginal artery
O: obturator artery
U: umbilical artery
At risk in antero-inferior screw placement: Obturator nerve, artery, vein
What’s the corona mortis?
Anastomosis of inferior epigastric branch of external iliac and obturator vessels n obturator canal
External iliac continues as femoral artery. What quadrant of screws puts it at risk?
Anterior superior
Cruciate Anastomosis is made up of?
Ascending branch of first perforating, descending branch of inferior gluteal artery, transverse branch of the medial and lateral circumflex femoral Lies at inferior border of quadratus femoris
Quadrangular space borders?
Medial: long head of triceps Lateral: humeral shaft Superior: teres minor Inferior: teres major
Quadrangular space contents:
Axillary nerve Posterior humeral circumflex
Triangular space borders?
Inferior: teres major Lateral: long head of triceps Superior: lower border of teres minor
Triangular space content?
Scapular circumflex artery
Triangular interval borders?
Superior: teres major Lateral: lateral head of triceps or humerus Medial: long head of triceps
Triangular interval contents?
Profunda brachii artery, radial nerve
Posterior lateral corner of knee structures?
APPPLL Arcuate ligament, Popliteus, Posterolateral capsule, LCL, Popliteofibular ligament, Lateral head of gastrocnemius
Name the 3 primary and secondary stabilizers of the elbow.
Primary: 1. Ulnohumeral joint 2. MCL 3. LCL Secondary: 1. Radial head 2. Joint capsule 3. The common flexor and extensor origins
Median Nerve sites of compression?
Supracondylar process and ligament of struthers
Lacertus Fibrosis
Pronator teres: Pronator Syndrome
Subliminus Bridge
AIN sites of compression?
Pronator teres FDS ABerrrant vesels Accessory muscles: Gantzer’s accessory FPL muscle
What is the Martin-Gruber Anastomosis?
Axons leaving median nerve or ain to join ulnar nerve
Ulnar nerve compression sites? 10!
Ligament of struthers (edit: I don’t think this is one - median nerve?) Medial intermuscular septum Arcade of struthers Hypertrophied medial triceps muscle Cubital tunnel Arcuate ligament of Osborne Two heads of FCU Anconeus epitrochlearis Ligament of Spinner (aponeurosis between FDS and FCU) Deep flexor pronator aponeurosis
What is the interval deep and superficial for the Volar henry approach?
Superficial - BR (radial) and PT (median) - Proximally - BR (radial) and FCR (median) - Distally Deep - Supinator, FDS, FDP, Pronator Quadratus Danges - PIN, Superficial radial nerve, Radial A
What is the internervous plane of the Thomson approach?
Extension of Kaplan - posterior approach Between ECRB (radial nerve) and EDC (PIN)
Name 5 ligamentous components of the ankle syndesmosis.
AIFTL, PITFL, IOL, IOM, Inferior transverse ligament - distal part of PITFL
Which accessory bone is located posterior to the talus? Which tubercle of the posterior process of the talus is this associated with?
Os trigonum - lateral tubercle
What is the knot of henry?
FDL and FHL cross
How many compartments are in the foot?
9
Which tendon passes immediately deep to sustentaculum tali?
FHL
From which nerve does Baxter’s nerve originate?
First branch of the lateral plantar nerve
Name the interval for the posterolateral approach to the ankle?
Peroneal and FHL
Which structure does the sural nerve run with? Which side?
Short saphenous is lateral
Which two structures combine to form the sural nerve?
Medial and lateral sural nerve
Which spine pedicle has the smallest pedicle?
T4
Artery of Adamkiewicz: what side, what levels?
Left T8-10
Which facet is anterior in the spine?
Superior facet of the caudal vertebrae
What is the main motor pathway in the spine?
Lateral corticospinal
Occiput is thickest in what location?
At level of nuchal line, approximately 2cm in either direction
Three fascial levels of the Smith Robinson approach?
1) Deep cervical fascia 2) Pretracheal fascia 3) Prevertebral fascia
Cutoff for Jefferson fracture?
6.9mm
Cutoff for PADI? (what does it stand for)
Posterior atlanto-dens interval and space available for cord describe the same thing.
What are the contents of Adductors/Hunter canal?
Femoral artery and vein, branches of femoral nerve (saphenous and nerve to vastus medialis)
What is the cruciate anastomosis?
Inferior gluteal artery, lateral and medial circumflex artery and first perforating branch of profunda femoris
What bands of ACL and PCL are tight in flexion?
Anterior bands (PCL - AL, ACL - AM)
Where does the MPFL insert on the patella?
Superior medial
In an isolated posterolateral corner injury the most accurate test is _____ and the major finding is _____.
Dial Test, greater than 15 degrees increase of external rotation at 30 degrees flexion
What is the interval for the posterior approach of the shoulder?
Infraspinatus (suprascapular) and Teres Minor (axillary)
What are the 4 preclavicular branches of the brachial plexus?
Dorsal scapular, long thoracic, suprascapular, nerve to subclavius
What is the innervation of brachialis?
Musculocutaneous, Radial
What is the innervation of Trapezius?
Accessory Nerve (XI)
Describe the rotator interval
Triangular portion of capsule between supraspinatus and subscapularis tendons, reinforced by SGHL and CHL
5 attaches to the coracoid?
Conoid, trapezoid, coracobrachilis, short head of biceps, pectoralis minor
What is the primary static restraint against anteroinferior dislocation of GH join in 90 degrees abduction and external rotation?
AIGHL
What are the boundaries of the posterior triangle of the neck?
SCM, Trapezius, Clavicle
Medial winging of the scapula?
Long thoracic nerve (serratus anterior)
Snuff box: borders, contents?
Palmar APL, and EPB. Dorsal EPL. Contains fat, radial artery, wrist capsule, sensory branch of radial nerve)
What dorsal compartment does the the articular branch of PIN lie within?
4th dorsal compartment
Extensor Compartments, Contents and Pathology.
- APL, EPB - DeQuervain’s Tenosynovitis 2. ECRL, ECRB - Intersection Syndrome 3. EPL - Drummer’s wrist, Traumatic rupture with distal radius fracture 4. EIP, EDC (PIN) Extensor Tenosynovitis 5. EDM - Vaughn - Jackson Syndrome 6. ECU - Snapping ECU
Superficial branch of radial nerve - what inflammatory condition affects this nerve?
Radial neuritis (Wartenberg’s syndrome) - tight watch - compression between BR and ECRL
What is the TFCC complex made of?
Articular disc Dorsal and Volar radioulnar liagements (both sup. and deep) Meniscus homolog (Disc-carpal ligaments) Ulnar collateral ligament Sheath of ECU
DRUJ Stabilizers 4 extrinsic, 4 intrinsic
Extrinsic 1. ECU Tendon 2. ECU subsheath 3. Pronator Quadratus 4. IOM Intrinsic 1. Bony Contact 2. Superficial radioulnar ligament 3. Deep Radioulnar ligaments - AKA Ligamentum subcruentum - Most important for providing rotation/translation guidance
Scapholunate ligament - has 3 components and what is the ligament of testut?
Dorsal (strongest), Palmar, Proximal Ligament of Testut - Radioscapholunate ligament - is actually a NV bundle, no contribution to carpal stability
Volar Palmar Ligaments of the carpus. Extrinsic?
Extrinsic 1. RSC 2. Long radiolunate 3. Short Radiolunate 4. RSL 5. UL 6. UT
Carpus ligaments dorsal extrinsic?
DRC, DIC Doral radiotriquetral Scapholunate interosseous liagment (Resists DISI) Lunotriquetral interosseous ligament (Resists VISI)
Radial artery - which arch? Therefore Ulnar is?
Deep palmar arch Superficial palmar arch
What makes up the extensor hood?
EDC tendons DI and PI tendon Lumbricals Central Tendon Oblique Retinacular ligaments Sagittal bands
Swan neck?
Hyper extension at PIP Mallet finger can cause this Stretching of transverse retinacular ligament Dorsal subluxation of lateral bands, increase force through PIP
Boutonniere Deformity
Hyperflexion at PIP -Central slip rupture, hyper extension of DIP -Volar subluxation of lateral band - PIP hyper flexion - Triangular ligament rupture subluxation of lateral bands - hyperflexion of PIP and increased force through DIP
What is the last muscle innervated by the median nerve?
APB is last muscle innervated
Ulnar nerve what is last muscle innervated?
2nd MCP abduction, 1st dorsal interosseous is last muscle innervated
Wartenberg’s sign
D5 abduction upon extension Both ADM and EDQ insert on abductor tubercle on prox phalanx. Usually their function is counterreacted by 3rd palmer interosseous muscle
Froment’s Sign
Unable to work adductor policis so use AIN to assist in holding the object between 1st and 2nd digits
Parona’s space?
in forearm Between FDL/FPL and PQ
3 potential spaces in the hand
Midpalmer space Thenar space Hypothenar space
3 nerves emerge lateral to psoas:
- Illiohypogastric nerve 2. Ilioinguinal nerve 3. LFCN
2 nerves emerge medial to psoas
- Obturator nerve 2. Lumbosacral trunk
Nerve emerging between psoas and iliacus?
Femoral nerve
Nerve piercing and then lying anterior to psoas:
Genitofemoral nerve
list all the muscles with dual innervation and name the two nerves for each
brachialis (radial, MSC)
flexor pollicis brevis (ulnar, median)
pec major (lateral and medial pectoral)
adductor magnus (obturator, sciatric)
lumbricals of the hand (median, ulnar)
flexor digitorum profundus (AIN, ulnar)
pectineus (femoral, rarely also obturator)
