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Year 1 Semester 2 > Anatomy > Flashcards

Anatomy Flashcards

1
Q

Upper limb overview as a result of evolution

A
  • Has almost no locomotor function
  • Has a great degree of freedom of movement
  • Used as a locomotor prop
  • Is an organ for grasping and manipulating
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2
Q

Overview of the lower limb

A
  • Supports the body weight
  • Involved mainly in locomotion
  • The bones are more robust
  • Joints are more stable
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3
Q

What happens during week 4 of development?

A

Specialised cells migrate from the somites and the lateral plate mesoderm. Limb buds form where the arms and legs will develop.

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4
Q

Name the 3 muscle types

A

Smooth, cardiac and skeletal

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5
Q

Define origin

A

The proximal end of the muscle, which remains fixed during muscular contraction

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6
Q

Define insertion

A

Distal end of the muscle, which is movable

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7
Q

Simple explanation of muscle contraction

A

When muscles contract and shorten, they usually shorten in the direction of insertion to origin however some muscles can shorten in both directions.

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8
Q

Isometric contraction

A

Muscle tone changes

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9
Q

Isotonic contraction

A

Muscle length changes

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10
Q

Concentric contraction

A

Muscle contracts according to the sliding filament mechanism and shortens

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11
Q

Eccentric contaction

A

the muscle elongates while under tension due to an opposing force greater than the muscle generates - protect from injury

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12
Q

Prime mover

A

Muscle(s) that play the primary role in movement

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13
Q

Agonist

A

Muscle(s) that acts directly to produce a desired movement

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14
Q

Synergist muscles

A

Muscle(s) which prevent unwanted movements associated with the action of the prime movers

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15
Q

Antagonistic muscles

A

Muscle(s) which directly oppose a movement

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16
Q

Fixating muscles

A

Muscle(s) that provide the necessary support to assist in holding the rest of the body in place while the movement occurs

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17
Q

What is fascia?

A

Connective tissue - two types: deep and superficial

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18
Q

Superficial fascia

A
  • Just beneath the skin
  • Contains adipose tissue
  • 2 layers
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19
Q

Deep (investing) fascia

A
  • Ensheath muscles but continuous
  • Facilitate contraction
  • Barrier between muscles
  • Compartments of muscles
  • Passages for nerves and vessels
  • Attachment for muscles
  • Hold tendons in place (by forming retinaculae)
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20
Q

Compartment syndrome

A

An injury to the muscle within a tough compartment may cause swelling and increased pressure that compresses the neurovascular bundles

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21
Q

Compartments of the arm

A

Anterior (flexor) and posterior (extensor)

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22
Q

Compartments of the forearm

A

Antebrachial fascia separates anterior (flexor) and posterior (extensor) compartments

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23
Q

Why is the deep fascia of the lower limb thicker

A

Because we need the muscles to compress the veins during contraction for the venous blood to return to the heart

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24
Q

Name for deep fascia of the thigh

A

Fascia lata

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25
Q

Compartments of the thigh

A

Anterior (extensor), medial (adductor) and posterior (flexor)

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26
Q

What does fascia lata become when it reaches the leg?

A

Crural fascia

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27
Q

What bone does the crural fascia fuse with

A

Tibia

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28
Q

Compartments of the leg

A

Anterior (extensor), 2 posterior (superficial and deep flexor) and lateral (peroneal)

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29
Q

Define dermatome

A

An area of skin supplied by 1 spinal nerve

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30
Q

Define myotome

A

the skeletal muscle or group of skeletal muscles supplied by 1 spinal nerve

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31
Q

What is the original position of the limbs

A

Both the thumb and hallux are on the cranial side of each limb and both the palm and sole face anteriorly

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32
Q

Rotation of the upper limb

A

Rotates laterally from its in-utero position.

  • Thumb moves from superior to lateral
  • flexor muscle groups move to an anterior position
  • extensors move to a posterior position
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33
Q

Rotation of the lower limb

A

Rotates medially

  • hallux moves from superior to medial
  • flexor muscle groups move from an anterior to a posterior position
  • extensors move to an anterior position
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34
Q

What plexus supplies the upper limb

A

Brachial plexus

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35
Q

What plexus supplies the lower limb?

A

Lumbo-sacral plexus

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36
Q

Main upper limb arterial supply

A

Subclavian artery

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37
Q

Main lower limb arterial supply

A

External iliac artery

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38
Q

Where are superficial veins found?

A

Superficial fascia

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39
Q

What are the two main superficial veins of the upper limb?

A

Cephalic and basilic

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40
Q

Direction of venous flow

A

Superficial to deep via perforators

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41
Q

What are the 2 main superficial veins of the lower limb?

A

Great saphenous vein and small saphenous vein

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42
Q

What features of the lower limb help venous return to the heart, against gravity?

A
  • Muscle pump
  • Arterial pulsation
  • Negative intrathoracic pressure
  • Valves in veins
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43
Q

Where does lymph drain to in the upper limb?

A

Axillary lymph nodes

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44
Q

Where does lymph drain to in the lower limb?

A

Inguinal lymph nodes

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45
Q

What roots are involved in lateral rotation of the upper limb?

A

C5

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46
Q

What roots are involved in medial rotation of the upper limb?

A

C6, C7 and C8

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47
Q

Which roots are involved in abduction of the upper limb?

A

C5

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48
Q

Which roots are involved in adduction of the upper limb?

A

C6, C7 and C8

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49
Q

Which roots are involved in extension of the arm at the shoulder joint?

A

C6, C7 and C8

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50
Q

Which roots are involved in flexion of the arm at the shoulder joint?

A

C5

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51
Q

Which roots are involved in flexion of the forearm at the elbow joint?

A

C5 and C6

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52
Q

Which roots are involved in extension of the forearm at the elbow joint?

A

C6 and C7

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53
Q

Which roots are involved in flexion of the wrist?

A

C6 and C7

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54
Q

Which roots are involved in extension of the wrist?

A

C6 and C7

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55
Q

Which roots are involved in pronation of the upper limb?

A

C7 and C8

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56
Q

Which roots are involved in supination of the upper limb?

A

C6

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57
Q

Which roots are involved in digital flexion in the upper limb?

A

C7 and C8

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58
Q

Which roots are involved in digital extension in the upper limb?

A

C7 abd C8

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59
Q

Which roots are involved in lateral and medial abduction of the 3rd digit of the upper limb?

A

T1

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60
Q

Which roots are involved in abduction and adduction of digits 2-5?

A

T1

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61
Q

Which roots are involved in lateral external rotation of the hip?

A

L5 and S1

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62
Q

Which roots are involved in medial internal rotation of the hip?

A

L1, L2 and L3

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63
Q

Which roots are involved in abduction of the hip?

A

L5 and S1

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64
Q

Which roots are involved in adduction of the hip?

A

L1, L2, L3 and L4

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65
Q

Which roots are involved in inversion?

A

L4 and L5

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66
Q

Which roots are involved in eversion?

A

L5 and S1

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67
Q

Which roots are involved in dorsiflexion of the digits?

A

L5 and S1

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68
Q

Which roots are involved in plantarflexion of the digits?

A

S1 and S2

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69
Q

Which roots are involved in extension of the hip?

A

L4 and L5

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70
Q

Which roots are involved in flexion of the hip?

A

L2 and L3

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71
Q

Which roots are involved in flexion of the knee?

A

L5 and S1

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72
Q

Which roots are involved in extension of the knee?

A

L3 and L4

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73
Q

Which roots are involved in ankle dorsiflexion?

A

L4 and L5

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74
Q

Which roots are involved in ankle plantarflexion?

A

S1 and S2

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75
Q

How many bones in the upper limb?

A

32

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76
Q

Features of the clavicle

A
  • S-shaped
  • Smooth superior surface
  • Rough inferior surface
  • Round proximal end
  • Flat distal end
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77
Q

What bone does the clavicle articulate with?

A

The manubrium

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78
Q

What does the clavicle attach to at the distal end

A

Scapula

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79
Q

Joint between acromion and clavicle

A

acromioclavicular joint

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80
Q

Ligaments joining scapula and clavicle

A
  • Acromioclavicular ligament

- Coracoclavicular ligament (trapezoid ligament and conoid ligament)

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81
Q

Name the 3 angles of the scapula

A

Superior, inferior and lateral

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82
Q

Name the 3 fossae of the scapula

A

Supraspinous, infraspinous and subscapular

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83
Q

Name the 3 borders of the scapula

A

Medial, lateral and superior

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84
Q

How many glenohumeral ligaments are there

A

3 - superior, middle and inferior

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85
Q

Ligaments in glenohumeral joint

A

Coraco-acromial ligament, coraco-humeral ligament and transverse humeral ligament

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86
Q

Ligaments in glenohumeral joint

A

Coraco-acromial ligament, coraco-humeral ligament and transverse humeral ligament

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87
Q

What are the group of muscles at the glenohumeral joint?

A

Rotator Cuff muscles

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88
Q

Name the bursae in the glenohumeral joint

A
  • Subacromial (subdeltoid)
  • Subscapular
  • Subcoracoid
  • Coracobrachial
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89
Q

Which nerve is damaged during a surgical neck fracture?

A

Axillary nerve

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90
Q

Which nerve is damaged during a mid shaft fracture?

A

Radial nerve

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91
Q

Which nerve is damaged during a supracondylar fracture?

A

Median nerve

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92
Q

What is collies’ fracture?

A

Distal radius fracture with upwards displacement. Very common

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93
Q

What is collies’ fracture?

A

Distal radius fracture with upwards displacement. Very common

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94
Q

How many phalanges in the hand?

A

14

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95
Q

How many metacarpals?

A

5

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96
Q

How many carpals?

A

8

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97
Q

How many carpals?

A

8

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98
Q

Name the proximal carpal bones

A

Scaphoid, lunate, triquetrium, pisiform

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99
Q

Name the distal carpal bones

A

Trapezium, trapezoid, capitate, hamate

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100
Q

What forms the roof of the carpal tunnel?

A

Flexor retinaculum

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101
Q

What type of joint is the 1st carpal-metacarpal joint?

A

Saddle joint

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102
Q

What type of joint are the metacarpal-phalangeal joints?

A

Condylar joints

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103
Q

Define abduction of the digits

A

Moving away from the middle finger

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104
Q

Define adduction of the digits

A

Moving towards the middle finger

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105
Q

What does the sublclavian artery become when it passes the lateral border of the first rib?

A

Axillary artery

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106
Q

Name the two branches of the subclavian artery

A

Dorsal scapular and suprascapular

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107
Q

What does the axillary artery become at teres major

A

Brachial artery

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108
Q

Name the branch in the first part of the axillary artery

A

Superior thoracic artery

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109
Q

Name the branches in the second part of the axillary artery

A
  • Thoraco-acromial artery

- Lateral thoracic artery

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110
Q

Name the branches in the third part of the axillary artery

A
  • Subscapular artery
  • Anterior circumflex humeral artery
  • Posterior circumflex humeral artery
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111
Q

Explain the scapular anastamosis

A

Dorsal scapular artery and suprascapular artery form an anastamosis with the circumflex scapular branch of subscapular artery

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112
Q

Name the 3 branches of the brachial artery

A
  • Profunda brachii
  • Superior ulnar collateral
  • Inferior ulnar collateral
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113
Q

Radial and ulnar arteries - similarities and differences

A
  • variable bifurcation
  • ulnar is larger and deeper than radial
  • both have recurrent branches
  • radial, anterior in forearm, moves dorsally at the wrist, posterior in hand
  • ulnar remains anterior into the hand
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114
Q

Interosseous Arteries

A
  • Ulnar gives a branch called the common interosseous

- this then becomes anterior and posterior interosseous

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115
Q

Where do the radial and ulnar arteries pass the carpal tunnel?

A
  • Neither go through the carpal tunnel
  • Radial passes posteriorly to the carpal bones
  • Ulnar passes anterior (superficially) to the flexor retinaculum in a space called Guyon’s canal
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116
Q

Allen’s Test

A

Compress both main arteries limiting blood flow to the hand causing it to turn white. Then release one artery and see if colour returns to the hand showing that blood is flowing through that artery. Repeat the test but release the other artery to check for good blood flow from both arteries. Indicates good colateral flow in the hand.

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117
Q

Carpal branches

A
  • Radial and ulnar both have palmar and dorsal carpal branches
  • Both contribute to dorsal and palmar arches
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118
Q

Scaphoid Fractures

A
  • Blood supply of scaphoid is from distal end to proximal
  • Fractures can cut off this supply which can result in avascular necrosis
  • Scaphoid fractures are very common
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119
Q

Superficial Arteries of the Hand

A
  • Ulnar enters hand and gives off the deep branch
  • Continues as superficial branch creating the superficial palmar arch
  • Meets the superficial palmar branch of radial
  • The arch gives off 3 common palmar digital arteries
  • Each divides into two proper palmar digital arteries
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120
Q

Deep arteries of the hand

A
  • Radial artery passes posteriorly on the scaphoid and trapezium
  • It re-enters the palmar surface through the 1st dorsal interosseous muscles
  • Forms deep palmar arch - anastomosing with deep branch of ulnar
  • Deep palmar arch gives palmar metacarpal arteries that anastomose with common palmar arteries
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121
Q

How do most deep veins present?

A

Deep veins mainly follow arterial supply as venae comitantes.

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122
Q

What name is given to the network superficial of veins in the hand?

A

Dorsal venous network (arch)

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123
Q

What superficial vein runs along the medial aspect of the upper limb?

A

Basilic vein

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124
Q

What superficial vein runs along the lateral aspect of the upper limb?

A

Cephalic vein

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125
Q

Which muscles does the cephalic vein run between?

A

Deltoid and pectoralis major

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126
Q

What vein does the basilic vein join half way up the arm?

A

Brachial vein

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127
Q

Which vein does the cephalic vein join just below the clavicle?

A

Axillary vein

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128
Q

What other system follows veins superficially and both veins and arteries when deep?

A

Lymphatics

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129
Q

Which lymph nodes do lymphatics running along side the basilic vein drain into?

A

Lateral lymph nodes

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130
Q

Which lymph nodes to lymphatics running along side the cephalic vein drain into?

A

Apical lymph nodes

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131
Q

What lymph nodes do deep lymphatics of the upper limb drain into?

A

Lateral lymph nodes

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132
Q

What is the pattern through the brachial plexus?

A

Roots, trunks, division, cords, branches (nerves)

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133
Q

What bone does the brachial plexus run under?

A

Clavicle

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134
Q

What are the roots of the brachial plexus?

A

C5, C6, C7, C8, T1

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135
Q

Which roots form the superior trunk?

A

C5 and C6

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136
Q

Which roots form the middle trunk?

A

C7

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137
Q

Which roots form the inferior trunk?

A

C8 and T1

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138
Q

What type of divisions does each trunk have?

A

A posterior and anterior

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139
Q

Which divisions form the lateral cord?

A

Anterior division of superior trunk and anterior division of middle trunk

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140
Q

Which divisions form the posterior cord?

A

The posterior division of all 3 trunks

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141
Q

Which divisions form the medial cord?

A

Just the anterior division of the inferior trunk

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142
Q

What artery passes through the brachial plexus at the cords?

A

Axillary artery

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143
Q

What are the 5 main branches of the brachial plexus?

A

Musculocutaneous, Axillary, Median, Radial, Ulnar

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144
Q

Motor and sensory actions of musculocutaneous nerve

A
  • Arm: anterior compartment muscles

- Lateral cutaneous nerve of the forearm

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145
Q

Motor and sensory actions of the axillary nerve

A
  • Deltoid and teres minor

- Skin of supra-lateral arm

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146
Q

Motor and sensory actions of the median nerve

A
  • Forearm: anterior compartment muscles, hand: thenar muscles
  • 1/2 skin of palm
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147
Q

Motor and sensory actions of the radial nerve

A
  • Arm and forearm: posterior compartment muscles

- Forearm: posterolateral skin, hand: dorsal skin

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148
Q

Motor and sensory actions of the ulnar nerve

A
  • Forearm: 1 1/2 muscles, hand: small muscles

- 1/2 skin of hand

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149
Q

Motor and sensory actions of the ulnar nerve

A
  • Forearm: 1 1/2 muscles, hand: small muscles

- 1/2 skin of hand

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150
Q

Explain Erb’s palsy

A
  • upper brachial plexus injury
  • Damages roots C5 and C6
  • Results in waiters tip
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151
Q

Explain Klumpkey’s palsy

A
  • Lower brachial plexus injury
  • Damages roots C8 and T1
  • Results in Claw hand
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152
Q

What is the pectoral girdle?

A

An incomplete ring of bone comprising of the scapula and clavicle

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153
Q

What are the 4 muscles in the anterior chest region?

A
  • Subclavius: moves clavicle, nerve to subclavius
  • Pectoralis major: moves humerus, medial and lateral pectoral nerves
  • Pectoralis minor: moves scapula, medial pectoral nerve
  • Serratus anterior: moves scapula, long thoracic nerve
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154
Q

Features of pectoralis major

A
  • 2 heads, 1 attaches to medial 1/3 of clavicle, the other attaches to upper 6 ribs
  • inserts onto lateral lip of intertubercular sulcus
  • Adducts and medially rotates the glenohumeral joint
  • Clavicular head can aid in shoulder flexion
  • In flexed position, the sternocostal head can aid in extension
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155
Q

Features of pectoralis minor

A
  • Stabilises/depresses the scapula
  • Origin: Usually 3 of ribs 2 to 5
  • Insertion: coracoid process
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156
Q

Features of subclavius

A
  • Stabilises/depresses clavicle
  • Origin: 1st rib/1st costal cartilage
  • Insertion: lower border of the clavicle
157
Q

Features of serratus anterior

A
  • Origin: upper 9 ribs
  • Insertion: medial border of scapula
  • Protraction of scapula
  • Prevents scapula winging
158
Q

Name the 4 extrinsic back muscles

A
  • Latissimus dorsi: moves humerus, thoracodorsal nerve
  • Trapezius: moves scapula, spinal accessory
  • Rhomboids (major and minor): move scapula, dorsal scapular nerve
  • Levator scapula: moves scapula, cervical nerves and dorsal scapular
159
Q

Features of trapezius

A
  • Origin: base of the skull
  • Insertion: spine of scapula and wrapping around onto the clavicle
  • Medial attachment: nuchal ligament and spinous processes of C7-T12
160
Q

Features of rhomboids

A
  • Both attach to medial border of scapula

- Minor closer to spine of scapula with major inferior to minor

161
Q

Features of latissimus dorsi

A
  • Origin: spinous processes of T8-T12 and lumbar vertebra via the thoracolumbar fascia
  • Insertion: Floor of intertubercular groove of humerus
  • Twists and wraps around teres major
  • Adductor of humerus
  • Extends
  • Medially rotates
162
Q

Muscles involved in scapular elevation

A
  • Upper Trapezius (prime mover)
  • Levator scapula (synergist)
  • Rhomboids (synergist)
163
Q

Muscles involved in scapular depression

A
  • Gravity is prime mover
  • Pectoralis major (inferior fibres)
  • Latissimus dorsi
  • Lower trapezius
  • Serratus anterior (inferior part)
  • Pectoralis minor
164
Q

Muscles involved in scapular protraction

A
  • Serratus anterior (prime mover)
  • Pectoralis major
  • Pectoralis minor
165
Q

Muscles involved in scapular retraction

A
  • Middle trapezius (prime mover)
  • Rhomboids
  • Latissimus dorsi
166
Q

Muscles involved in scapular lateral/upward rotation

A
  • Upper trapezius (prime mover)
  • Serratus anterior - inferior part (prime mover)
  • Lower trapezius
167
Q

Muscles involved in scapular medial/downward rotation

A
  • Latissimus dorsi (prime mover)
  • Levator scapula
  • Rhomboids
  • Pectoralis major (inferior fibres)
  • Pectoralis minor
  • Gravity
168
Q

Name the intrinsic shoulder muscles

A
  • Deltoid: axillary nerve
  • Teres major: lower subscapular nerve
  • Rotator cuff (SITS)
169
Q

Features of deltoid

A
  • Origin: U-shaped attachment attaching to clavicle, acromion and spine of scapula
  • Insertion: deltoid tuberosity on humerus
  • 3 functional parts
  • Anterior(clavicular): flexion and medial rotation
  • Middle(acromial): abduction
  • Posterior(spinal): extension and lateral rotation
170
Q

Features of teres major

A
  • Origin: Bottom of scapula
  • Insertion: Medial lip of intertubercular sulcus
  • Adductor
  • Medial rotator
171
Q

Name the 4 rotator cuff muscles

A
  • Supraspinatus: suprascapular nerve
  • Infraspinatus: suprascapular nerve
  • Teres minor: axillary nerve
  • Subspacularis: upper and lower subscapular nerves
172
Q

What is the function of the rotator cuff?

A

Hold the humeral head in the glenoid fossa i.e glenohumeral joint stability

173
Q

Where to find rotator cuff muscles

A
  • Supraspinatus: above spine of scapula inserting onto the greater tuberosity
  • Infraspinatus: below spine of scapula inserting onto greater tuberosity
  • Teres minor: between infraspinatus and teres major (looks like major but smaller) inserting onto greater tuberosity
  • Subscapularis: anterior aspect of scapula inserting onto lesser tuberosity
174
Q

Explain abduction of the GH joint

A
  • Supraspinatus initiates abduction (first 15 degrees)

- After that, deltoid takes over

175
Q

Additional movements of the rotator cuff muscles

A
  • Supraspinatus: initiate abduction (first 15 degrees)
  • Infraspinatus: external rotation
  • Teres minor: external rotation
  • Subscapularis: internal rotation
176
Q

Explain the fascias of the upper limb

A
  • Deep fascia for each muscle
  • Clavipectoral fascia from clavicle and around pec. minor
  • Pectoral fascia around pec. major
  • Both join making axillary fascia which attaches to floor of axilla
  • Brachial fascia acts like a sock for the rest of the upper limb
  • Infra- and supra- spinatus fascia: very thick and dense and is the origin of the muscles
177
Q

Explain the 4 walls of the axilla

A
  • Anterior: pec. major, minor and fascia
  • Posterior: scapula, subscapularis, teres major, lat. dorsi
  • Medial: ribs 1-4, serratus anterior
  • Lateral: humerus (intertubercular groove)
178
Q

What shape is the axilla?

A

Pyramidal shape

179
Q

What forms the floor of the axilla?

A

Skin and axillary fascia

180
Q

What is the contents of the axilla?

A
  • Axillary vessels
  • Brachial plexus (cords and branches)
  • Axillary sheath (from prevertebral fascia)
181
Q

Explain the lymphatics of the axilla

A
  • Drain upper limb and thoracic wall
  • Axillary tail of breast
  • 5 groups of lymph nodes: anterior, lateral, posterior, central and apical
  • Goes to subclavian trunk and on to respective lymph trunks
182
Q

Name the three gateways to the posterior upper limb

A
  • Upper triangular
  • Lower triangular
  • Quadrangular
183
Q

Name the borders of the quadrangular space

A
  • Teres minor
  • Teres major
  • Humerus
  • Long head of triceps
184
Q

What is the contents of the quadrangular space?

A
  • Posterior circumflex humeral artery

- Axillary nerve

185
Q

Name the borders of the upper triangular space

A
  • Teres minor
  • Teres major
  • Long head of triceps
186
Q

What is the contents of the upper triangular space?

A
  • Circumflex scapular artery

- Leads to scapular anastomosis

187
Q

Name the borders of the lower triangular space (triangular interval)

A
  • Lateral head of triceps
  • Long head of triceps
  • Teres major
188
Q

What is the contents of the lower triangular space (triangular interval)?

A
  • Radial nerve
  • Profunda Brachii artery
  • Leads to spiral groove
189
Q

Name the 4 muscles of the arm

A
  • Triceps brachii
  • Biceps brachii
  • Coracobrachialis
  • Brachialis
190
Q

What are some features of biceps brachii?

A
  • Origin: long head - supraglenoid tubercle of scapula, short head - coracoid process
  • Insertion: tendinous - radial tuberosity, also has bicipital aponeurosis that inserts into soft tissues
191
Q

What are the attachments of coracobrachialis?

A
  • Coracoid process

- Anteromedial surface of the humeral shaft

192
Q

What are the attachments of the brachialis?

A
  • Distal half of anterior surface of humerus

- Coronoid process

193
Q

Innervation and movements of the anterior arm

A
  • All innervated by musculocutaneous nerve
  • Brachialis - C5,C6 - prime mover in elbow flexion
  • Biceps brachii - C5,C6,C7 - supination, then flexion (also short head - stability)
  • Coracobrachialis - C5,C6,C7 - flexion adduction at GH joint (also stability)
194
Q

What spinal segments are tested when doing a biceps reflex test?

A

C5 and C6

195
Q

Attachments of triceps brachii

A
  • Long head: infraglenoid tubercle
  • Lateral head: humerus
  • Medial head: humerus
  • All converge and insert onto olecranon of ulna
196
Q

Movement of triceps brachii

A
  • Extension at the elbow

- Could help in extension at glenohumeral joint as well

197
Q

What is anconeous?

A
  • A muscle that assists triceps in extension of elbow by tensing the joint capsule of the elbow to prevent it getting pinched in extension
  • Attachments: posterior of humerus, ulna
198
Q

Innervation and movements of posterior arm

A
  • Innervated by radial nerve (muscular branches before spiral groove)
  • Triceps brachii - C6,C7,C8 - extension (also long head - stability)
  • Anconeus - C7,C8,T1 - elbow stability, tenses joint capsule (abduct ulna during pronation)
199
Q

What spinal segments are tested during a triceps reflex test?

A

C6 and C7

200
Q

What are the borders of the cubital fossa?

A
  • Line between lateral and medial epicondyles
  • Pronator teres (medial)
  • Brachioradialis (lateral)
201
Q

What is the roof of the cubital fossa?

A

Bicipital aponeurosis

202
Q

What are the contents of the cubital fossa from medial to lateral?

A
  • Median nerve
  • Brachial artery
  • Biceps tendon
  • Radial nerve
203
Q

What makes up the floor of the cubital fossa?

A
  • Supinator

- Brachialis

204
Q

How are the anterior forearm muscles innervated?

A
  • 1 1/2 muscles by the ulnar nerve

- The rest by the median nerve

205
Q

Describe the superficial layer of the anterior forearm

A
  • Pronator teres - C6,C7 - pronates the forearm
  • Flexor carpi radialis - C6, C7 - flexes wrist at radial side
  • Palmaris longus - C7, C8 - has little purpose in humans
  • Flexor carpi ulnaris - C7, C8 - innervated by ulnar nerve - flexes wrist at ulnar side
206
Q

Describe the muscle in the anterior intermediate layer of the forearm

A
  • Flexor digitorum superficialis
  • C7,C8,T1
  • Middle phalanges insertion
207
Q

Describe the anterior deep layer of the forearm

A
  • Flexor digitorum profundus - medial 1/2-ulnar nerve - lateral half-anterior interosseous nerve (C8,T1) - distal phalanges insertion
  • Flexor policis longus - anterior inteosseous nerve (C8,T1)
  • Pronator quadratus - anterior interosseous nerve (C8,T1)
208
Q

What is the carpal tunnel?

A

Carpal arch closed over by flexor retinaculum

209
Q

What is the contents of the carpal tunnel?

A
  • Flexor digitorum superficialis (4 tendons that bunch up)
  • Flexor digitorum profundus
  • Flexor policis longus
  • Median nerve
210
Q

What nerve innervates the dorsal forearm?

A

Radial nerve

211
Q

Describe the brachioradialis

A
  • In the superficial group
  • Elbow flexor
  • 1/2 pronator
  • 1/2supinator
  • Innervated by radial nerve - C5,C6,C7
212
Q

What spinal segments are tested in a supinator reflex test?

A

C5 and C6

213
Q

Name the muscles of the superficial layer of the dorsal forearm

A
  • Extensor carpi radialis longus - C6,C7 - radial
  • Extensor carpi radialis brevis - C7,C8 - deep radial
  • Extensor digitorum - C7,C8 - deep radial
  • Extensor digiti mini - C7,C8 - deep radial
  • Extensor carpi ulnaris - C7,C8 - deep radial
214
Q

What are the outcropping muscles of the dorsal forearm?

A
  • Abductor policis longus - post. interosseous - C7,C8
  • Extensor policis brevis - post. interosseous - C7,C8
  • Extensor policis longus - post. interosseous - C7,C8
215
Q

What are the deep muscles of the dorsal forearm?

A
  • Supinator - deep radial - C7,C8

- Extensor indicis - post. inetrosseous - C7,C8

216
Q

What is found in the superficial palm?

A
  • Flexor retinaculum
  • Palmar aponeurosis - deep attachments, 3rd and 5th metacarpals - palmaris longus +brevis
  • Fibrous digital sheaths
  • Thenar eminence
  • Hypothenar eminence
  • Dupuytren’s contracture
217
Q

What are the palmar spaces and what creates them?

A
  • Mid palmar space
  • Thenar space
  • Created by deep attachments
218
Q

What happens to the long flexor tendons in the hand?

A
  • Common flexor synovial sheath from wrist to mid palm
  • Flexor policis longus; separate sheath that goes to distal phalanx
  • Synovial sheaths for each digit
  • Digiti minimi sheath; continuous to palm
219
Q

What are the thenar muscles?

A
  • Abductor pollicis brevis - recurrent branch of median nerve (C8,T1)
  • Opponens pollicis - recurrent branch of median nerve (C8,T1)
  • Flexor pollicis brevis - 2 heads: superficial (recurrent median) and deep (deep ulnar nerve (C8,T1))
  • Adductor pollicis - deep branch of ulnar (C8,T1) - transverse and oblique
220
Q

What are the hypothenar muscles?

A
  • Abductor digiti minimi
  • Opponens digiti minimi
  • Flexor digiti minimi brevis
221
Q

What innervates the hypothenar muscles?

A

Deep branch of ulnar nerve (C8,T1)

222
Q

Features of the lumbricals

A
  • Origin - radial side of flexor digitorum profundus
  • Insertion - externsor expansion/hood distal to the metacarpophalangeal joint
  • Action - flex metacarpophalangeal joint and extend interphalangeal joint
  • Innervation - Medial 2: deep ulnar (C8,T1) - Lateral 2: median nerve (C8,T1)
223
Q

Describe the interossei

A
  • 4 dorsal - abduct digits - bipennate
  • 3 palmar - adduct digits - unipennate
  • All innervated by deep ulnar nerve (C8,T1)
  • Can act together with each other, and lumbricals
224
Q

What does PAD and DAB stand for in relation to hand muscles?

A
  • PAD - Palmar ADducts

- DAB - Dorsal ABducts

225
Q

Features of dorsal interossei

A
  • 1st and 5th digits have their own intrinsic abductors
  • Origin: metacarpals
  • Insertion: proximal phalanx and extensor hood
226
Q

Features of palmar interossei

A
  • No adduction of middle finger
  • Origin: adductor side of metacarpal
  • Insertion: proximal phalanx and extensor hood
227
Q

What happens to the hand in an ulnar nerve injury?

A
  • Muscles affected: medial 2 lumbricals, all interossei and 1/2 flexor digitorum profundus
  • Results in claw hand
228
Q

What is carpal tunnel syndrome?

A
  • Compression in the carpal tunnel
  • Affects median nerve
  • Pain or paraesthesia - not at the palm
  • More severe - weakness of thenar muscles
  • Phalen’s test used
229
Q

What happens in median nerve damage?

A
  • Muscles affected: lateral 2 lumbricals, flexor digitorum superficialis, 1/2 flexor digitorum profundus and thenar muscles
  • Hand of benediction - on forming a fist
  • Ape hand - loss of opposition
230
Q

What is hand of benediction?

A

When asked to make a fist, a patient will only flex medial two digits due to a median nerve injury

231
Q

What does wrist drop indicate?

A

Radial nerve damage

232
Q

What nerve is damaged by pronator teres syndrome?

A

Median nerve

233
Q

What are the functions of the pelvic girdle?

A
  • Transfer of weight
  • Helps with movement
  • Contains and protects viscera
234
Q

What is the structure of the pelvic girdle?

A
  • 2 hip bones

- Sacrum

235
Q

Where does the axial skeleton become the appendicular skeleton in terms of the lower limb?

A

Sacro-iliac joint

236
Q

What are the three main areas of the hip bone?

A
  • Ilium
  • Ischium
  • Pubis
237
Q

What is the acetabulum?

A

The socket part of the ball and socket joint of the hip

238
Q

What are the ligaments of the hip?

A
  • Iliofemoral
  • Pubofemoral
  • Ischiofemoral
239
Q

What are some features of the knee joint?

A
  • Largest joint
  • Synovial
  • Primarily hinge
  • Three articulations
  • Stability depends on ligaments/muscles
240
Q

Describe the lateral (fibular) collateral ligament

A
  • Strong cord from lateral femoral epicondyle to head of fibula
  • Prevents adduction of leg
  • Tendon of popliteus is between this ligament and capsule
241
Q

Describe the medial (tibial) collateral ligament

A
  • Broad, flat band from medial femoral epicondyle to tibial condyle
  • Fused to joint capsule and medial meniscus
  • Prevents abduction of leg
242
Q

Describe the menisci of the knee

A
  • Crescent shaped fibrocartilage
  • Lateral and medial

Purpose:

  • Increase congruence of articular surfaces
  • Dissipate force/stress on articular cartilage
  • Absorb shock
  • Decrease friction
  • Proprioception
243
Q

What type of joint is the ankle joint?

A
  • Hinge

- Synovial

244
Q

What bones are involved in the ankle joint?

A
  • Tibia
  • Fibula
  • Talus
245
Q

What are the ligaments of the ankle joint?

A
  • Collateral ligaments - originate at malleoli and fan out to tarsal bones
  • Medial deltoid ligament - resists over-eversion
  • Lateral ligament - resists over-inversion
246
Q

What movements can take place at the ankle joint?

A
  • Dorsiflexion

- Plantarflexion

247
Q

What are the basic bones of the foot?

A
  • Tarsals - 7 irregular bones
  • Metatarsals - 5
  • Phalanges
248
Q

What are the three arches of the foot?

A
  • Medial longitudinal arch
  • Lateral longitudinal arch
  • Transverse arch
249
Q

Describe the superior gluteal artery

A

-Passes from the pelvic cavity to the gluteal region via the greater sciatic foramen, above piriformis muscle

250
Q

Describe the inferior gluteal artery

A

-Enters the gluteal region via the greater sciatic foramen, below piriformis muscle

251
Q

What are the branches of the internal iliac artery?

A
  • Superior gluteal artery
  • Inferior gluteal artery
  • Internal pudendal artery
  • Obturator artery
252
Q

Describe the obturator artery

A

-Lies on lateral wall of pelvis and passes through obturator canal

253
Q

When does the external iliac artery become the femoral artery?

A

When it passes under the inguinal ligament

254
Q

Where can the pulse of the femoral artery be detected?

A

Inferior to mid-inguinal point

255
Q

What are some branches of the femoral artery?

A
  • Superficial epigastric artery
  • Superficial circumflex iliac artery
  • External pudendal arteries
  • Profunda femoris artery (deep artery of thigh)
256
Q

What does the femoral artery enter to pass into the popliteal fossa?

A

Adductor canal

257
Q

What branches does profunda femoris give off?

A
  • Medial circumflex femoral artery
  • Lateral circumflex femoral artery
  • 3-4 perforators
258
Q

What does the profunda femoris supply?

A

Posterior compartment of the thigh

259
Q

What arteries are involved in the trochanteric anastomosis?

A
  • Medial circumflex femoral artery
  • Lateral circumflex artery
  • Superior gluteal artery
  • Inferior gluteal artery
260
Q

Where is the trochanteric anastomosis located?

A

Around the greater trochanter

261
Q

What arteries are involved in the cruciate anastomosis?

A
  • First perforator
  • Inferior gluteal artery
  • Lateral circumflex femoral artery
  • Medial circumflex femoral artery
262
Q

Describe the popliteal artery

A
  • Between hiatus tendineus and lower border of popliteus muscle
  • Deepest structure in the popliteal fossa - difficult to get the pulse
  • Gives rise to 5 genicular branches
  • Exit the popliteal fossa by passing through tendinous arch of soleus
  • Ends as the posterior and anterior tibial arteries
  • Supplies the knee joint
263
Q

How is blood supplied to the knee joint?

A
  • 5 genicular branches of popliteal artery
  • Branches of the femoral artery
  • Branch of the profunda femoris
  • A branch from the anterior tibial artery
  • All join and form genicular anastomosis
264
Q

Which artery supplies the anterior compartment of the leg?

A

Anterior tibial artery

265
Q

When does the anterior tibial artery become the dorsalis pedis arterty?

A

When it passes inferior to extensor retinaculum

266
Q

Where is dorsalis pedis pulse felt?

A

In the first intermetatarsal space

267
Q

Describe the posterior tibial artery

A
  • Accompanies the tibial nerve as it descends deep to the soleus muscle
  • Gives off the fibular, circumflex fibular and nutrient arteries
  • Supplies the muscles of the posterior compartment of the leg (plantar flexors)
  • Becomes medial and lateral plantar arteries after running posterior to the medial malleolus
  • Pulse of posterior tibial artery can be felt behind the medial malleolus
268
Q

Describe the medial and lateral plantar arteries

A
  • The medial and lateral plantar arteries supply the sole of the foot along with their branches: superficial and deep plantar arches, respectively
  • The deep arch gives rise to plantar digital arteries of the phalanges
269
Q

Describe the great (long) saphenous vein

A
  • Ascends 2.5cm anterior to the medial malleolus, posterior to medial condyle of femur
  • Pierces fascia lata to join the femoral vein
270
Q

Describe the small (short) saphenous vein

A
  • Ascends posterior to lateral malleolus and penetrates the deep fascia lata of the leg in the popliteal fossa
  • Merges with deep veins to form the popliteal vein
271
Q

Describe the deep veins of the lower limb

A
  • They ascend internal to the deep fascia of the lower limb
  • Vena comitantes generally occur as paired veins travelling with the arteries of the same name, within vascular sheaths with the artery
  • Femoral vein ascends in the adductor canal from the popliteal vein, it enters the femoral sheath and ends as the external iliac vein
  • It recieves drainage from profunda femoris, great saphenous and other small branches
272
Q

Describe lymph drainage of the lower limbs

A
  • Superficial lymph vessels accompany the superficial veins
  • The lymph vessels accompanying the great saphenous vein drain to the superficial inguinal lymph nodes leading to the deep inguinal lymph nodes then the external iliac nodes
  • The lymph vessels accompanying the small saphenous vein enter the popliteal lymph nodes
  • Deep lymph vessels accompany deep veins and enter the popliteal lymph nodes, accompany femoral vein to the deep inguinal lymph nodes
273
Q

What do the superficial inguinal lymph nodes receive lymph from?

A
  • Anterior abdominal wall (under umbilicus)
  • Skin of back below iliac crest
  • Gluteal region
  • Perineum
  • Superficial lower limb
274
Q

What do the deep inguinal lymph nodes receive lymph from?

A
  • Lower limb (deep lymph vessels accompanying the femoral vessels including from popliteal nodes)
  • Superficial inguinal nodes
  • External genitalia
275
Q

Describe the lumbar plexus

A
  • Formed within the psoas major muscle and anterior to the transverse processes of the lumbar vertebrae
  • Has motor and sensory branches
276
Q

Describe the femoral nerve

A
  • L2-L4
  • Descends behind the inguinal ligament
  • Passes through the femoral triangle in the thigh
  • Gives off muscular, anterior cutaneous femoral and saphenous branches
276
Q

Describe the femoral nerve

A
  • L2-L4
  • Descends behind the inguinal ligament
  • Passes through the femoral triangle in the thigh
  • Gives off muscular, anterior cutaneous femoral and saphenous branches
277
Q

Describe the saphenous nerve

A
  • L3-L4
  • The terminal cutaneous branch
  • Enters the adductor canal with femoral vessels
  • Pierces the medial wall of the adductor canal and becomes superficial
  • Accompanies the greater saphenous vein in the leg
278
Q

Describe the obturator nerve

A
  • L2-L4
  • Travels anteriorly on lateral pelvic wall towards obturator canal
  • Passes through obturator canal and enters the medial aspect of the thigh
279
Q

Describe the sacral plexus

A
  • Formed by anterior rami of L4 and L5 + S1-4

- Located on the surface of the posterior pelvic wall, deep to the piriformis muscle

280
Q

Describe the superior gluteal nerve

A
  • L4-S1
  • Exits pelvis through suprapiriform space
  • Runs laterally between the gluteus medius and minimus
  • Supplies gluteus medius, gluteus minimus and tensor fascia lata
281
Q

Describe the inferior gluteal nerve

A
  • Exits pelvis through infrapiriform space

- Innervates gluteus maximus

282
Q

Describe the sciatic nerve

A
  • L4-S3
  • Enters the gluteal region through the infrapiriform space
  • Descends deep to gluteus maximus, midway between the ischial tuberosity and the greater trochanter, behind the hip joint
283
Q

What are the four pelvic gateways?

A
  • Greater sciatic foramen
  • Lesser sciatic foramen
  • Obturator canal
  • Muscular canal
284
Q

What goes through the greater sciatic foramen?

A

Piriformis muscle, sciatic nerve and superior and inferior gluteal neurovascular bundles

285
Q

What goes through the lesser sciatic foramen?

A

Tendon of obturator internus, internal pudendal neurovascular bundle

286
Q

What goes through the obturator canal?

A

Obturator neurovascular bundle

287
Q

What goes through the muscular canal?

A

Iliopsoas muscle, femoral artery and vein

288
Q

Give some further detail on the greater sciatic foramen

A
  • Further subdivided by piriformis
  • Superior gluteal neurovascular bundle is above piriformis
  • Inferior gluteal neurovascular bundle and sciatic nerve are below piriformis
289
Q

What binds the gluteal region?

A
  • Superiorly - iliac crest
  • Inferiorly - gluteal fold
  • Medially - intergluteal cleft
290
Q

What muscles occupy the gluteal region?

A
  • Gluteus maximus
  • Gluteus medius
  • Gluteus minimus
291
Q

Describe gluteus maximus

A
  • Largest and most superficial muscle in the gluteal region
  • Wide and bulky
  • Different fibres with different attachments
  • Superficial fibres (70%) insert into iliotibial tract
  • Extensor of hip/thigh
  • External/lateral rotator of hip/thigh
  • Abductor of hip/thigh
  • Slightly adducts hip/thigh
  • Extends and lock knee
292
Q

Describe gluteus medius and minimus

A

Gluteus medius:

  • Partly covered by maximus
  • Most powerful abductor of hip/thigh

Gluteus minimus:

  • Cannot be seen without dissecting
  • Abductor of hip/thigh

Attach to posterolateral surface/gluteal hip bone: posterior gluteal line, anterior gluteal line, inferior gluteal line

293
Q

What innervates the gluteus maximus?

A

Inferior gluteal nerve (L5-S2)

294
Q

What innervates gluteus medius and minimus?

A

Superior gluteal nerve (L4-S1)

295
Q

Describe tensor fasciae latae

A
  • Tenses fascia lata
  • Abduction, flexion and internal rotation of hip/thigh
  • Supplied by superior gluteal nerve
296
Q

Why are abductor thigh muscles important?

A

Keep pelvis level when walking (alongside contralateral adductors)

297
Q

What are the external/lateral rotators of the hip/thigh

A
  • Piriformis
  • Superior gemellus
  • Obturator internus
  • Inferior gemellus
  • Quatratus femoris
  • Obturator externus
297
Q

What are the external/lateral rotators of the hip/thigh

A
  • Piriformis
  • Superior gemellus
  • Obturator internus
  • Inferior gemellus
  • Quatratus femoris
  • Obturator externus
298
Q

What are some features of the lateral/external rotators of the hip/thigh?

A
  • These muscles pass from pelvis to femur, lie close and posterior to hip
  • Attach to femur
  • Stabilise hip joint, especially during walking
299
Q

What innervates piriformis?

A

Nerve to piriformis (S1-S2)

300
Q

What innervates superior gemellus and obturator internus?

A

Nerve to obturator internus (L5,S1,S2)

301
Q

What innervates inferior gemellus and quadratus femoris?

A

Nerve to quadratus femoris (L2,L3,L4)

302
Q

What innervates obturator externus?

A

Obturator nerve (L2,L3,L4)

302
Q

What innervates obturator externus?

A

Obturator nerve (L2,L3,L4)

303
Q

Name the flexors of the hip/thigh

A
  • Iliopsoas (iliacus and psoas major)
  • Sartorius
  • Rectus femoris
  • Pectineus
  • Tensor fascia latae
303
Q

Name the flexors of the hip/thigh

A

-Iliopsoas (iliacus and psoas major)
-Sartorius
-Rectus femoris
-Pectineus
Tensor fascia latae

304
Q

Describe the innervation of the flexors of the hip/thigh

A

All supplied by the femoral nerve (L2,L3,L4) except psoas major (lumbar plexus, ventral rami of L1-L3)and tensor fascialata (superior gluteal nerve , L4-S1)

305
Q

Describe iliopsoas

A
  • Most powerful flexor of the hip
  • Iliacus: originates from iliac fossa and iliac crest
  • Psoas major: originates from lumbar vertebrae and their intervertebral discs
  • Attaches to lesser trochanter
  • Lesser trochanter medial to sagittal axis of femur therefore a bit of adduction and medial rotation
306
Q

What are the two compartments of the muscular canal?

A
  • Muscular compartment: lateral side, contains muscles (psoas major and iliacus) and femoral nerve
  • Vascular compartment: medial side, contains femoral artery and vein
307
Q

What are the 3 compartments of the thigh?

A
  • Posterior
  • Medial
  • Anterior
308
Q

Describe the posterior compartment of the thigh

A
  • Muscles pass from pelvis to lower limb, they are posterior to transverse axis of hip
  • Hamstrings/ischio-cural muscles: Biceps femoris (long+short head), Semitendinosus, Semimembranosus
  • Extensors of hip/thigh
309
Q

What innervates the hamstrings?

A

All hamstrings are innervated by the sciatic nerve (L4-S3) except the short head of biceps femoris which is innervated by a tibial nerve component

310
Q

Where do the hamstrings originate from?

A

All hamstrings originate at ischial tuberosity, except short head of biceps femoris, which originates from lateral lip of linea aspera

311
Q

What are all the muscles in the medial compartment of the thigh?

A
  • Adductors of the thigh
  • Adductor magnus
  • Adductor longus
  • Adductor brevis
  • Gracilis
311
Q

What are all the muscles in the medial compartment of the thigh?

A
  • Adductors of the thigh
  • Adductor magnus
  • Adductor longus
  • Adductor brevis
  • Gracilis
312
Q

What innervates the adductors of the hip/thigh?

A

All suplied by obturator nerve (L2-L4) except pectineus (femoral nerve, L2-L4) and adductor magnus (obturator nerve, L2-L4 and tibial nerve, L4-L5)

313
Q

Describe the anterior compartment of the thigh

A
  • These muscles either flex the hip/thigh or extend the knee
  • Quadriceps femoris (4 muscles) - extend knee
  • Sartorius - flex hip/thigh, flexes knee
  • Ilipsoas - flex hip/thigh
  • Pectineus - flex hip/thigh (week)
314
Q

What innervates the anterior compartment of the thigh?

A

Innervated by femoral nerve (L2-L4) except for iliopsoas (psoas major: lumbar plexus, ventral rami of L1-L3, iliacus: femoral nerve)

315
Q

What is the role of quadriceps femoris?

A

Main extensor of the knee and knee stability

316
Q

Name the 4 quadriceps femoris muscles

A
  • Rectus femoris
  • Vastus medialis
  • Vastus lateralis
  • Vastus intermedius (deep to rectus femoris)
317
Q

Describe pes anserinus

A
  • Common attachment of sartorius, gracilis and semitendinosus on tibia
  • Attaches posterior to the transverse axis of roation of the knee - flexes the knee
  • Adds significant dynamic stability to the medial side of the knee
318
Q

Describe the adductor canal

A

-At inferior corner of femoral triangle, the proximal opening of the adductor canal is found
-A true, spiral canal
-Terminates as adductor hiatus - an opening in adductor magnus
-Femoral vessels and saphenous nerve enter
Saphenous nerve pierces antero-medial wall and becomes superficial

319
Q

What are the boundaries of the adductor canal?

A
  • Vastus medialis (antero-laterally)
  • Adductor longus and adductor magnus (posteriorly)
  • Sartorius (medially)
320
Q

What are the boundaries of the popliteal fossa?

A
  • Biceps femoris
  • Semitendinosus & semimembranosus
  • Medial & lateral heads of gastrocnemius
321
Q

What makes up the floor of the popliteal fossa?

A

Knee joint capsule, femur, tibia & popliteus

322
Q

What makes up the roof of the popliteal fossa?

A

Deep fascia

323
Q

What is the contents of the popliteal fossa?

A
  • Tibial nerve
  • Common fibular/peroneal nerve
  • Popliteal artery and vein - genicular branches, small saphenous vein
  • Lymph nodes
  • Fat
324
Q

Describe the posterior tibial artery

A
  • Larger branch
  • Posterior compartment
  • Palpable pulse posterior to the medial malleolus
  • Gives the peroneal/fibular artery
325
Q

Describe the anterior tibial artery

A
  • Smaller branch
  • Anterior compartment
  • Terminates at the dorsalis pedis - palpable on dorsum of foot
326
Q

Describe the deep veins of the leg

A
  • Venae comitantes

- Paired, interconnecting veins that flank the artery they accompany

327
Q

Describe the great saphenous vein

A
  • Medial side of dorsal venous arch
  • Medial side of leg, knee & thigh
  • Drains into femoral vein at the saphenous opening
328
Q

Describe the small saphenous vein

A
  • Lateral side of dorsal venous arch
  • Posterior aspect of leg
  • Drains into popliteal vein at the popliteal fossa
329
Q

Name the nerves of the leg

A
  • Sciatic nerve
  • Tibial nerve
  • Common peroneal/fibular -> superficial/deep
  • Sural nerve
  • Saphenous nerve
  • Posterior cutaneous nerve of the thigh
330
Q

Describe the locking/unlocking mechanism of the knee

A

Knee joint is locked into position to reduce the amount of muscle work needed to maintain a standing position

  • Vastus medialis contraction aided by gluteus maximus & tensor fascia lata
  • Medial rotation of the femoral condyles on the tibial plateau
  • Last 30 degrees of extension
  • Ligaments tighten
  • Joint surface broader and flatter

Unlock via lateral rotation of the femur on the tibia

  • Popliteus muscle contraction
  • Flexion can now occur
331
Q

What are the four compartments of the leg?

A
  • Anterior
  • Lateral
  • Superficial posterior
  • Deep posterior
332
Q

What muscles are in the anterior compartment of the leg?

A
  • Tibialis anterior
  • Extensor digitorum longus
  • Extensor hallucis longus
333
Q

What supply’s the anterior compartment of the leg?

A
  • Anterior tibial artery

- Deep peroneal/fibular nerve

334
Q

What are the muscles of the superficial posterior compartment of the leg?

A
  • Gastrocnemius
  • Soleus
  • Plantaris
335
Q

What are the muscles of the deep posterior compartment of the leg?

A
  • Tibialis posterior
  • Flexor digitorum longus
  • Flexor hallucis longus
  • Popliteus
336
Q

What supply’s the posterior compartments of the leg?

A
  • Posterior tibial & peroneal/fibular arteries

- Tibial nerve

337
Q

What muscles are in the lateral compartment of the leg?

A
  • Peroneus/fibularis longus

- Peroneus/fibularis brevis

338
Q

What supply’s the lateral compartment of the leg?

A
  • Superficial peroneal/fibular nerve

- Perforating branches from anterior tibial & peroneal/fibular arteries

339
Q

What are the 5 P’s of diagnosis of compartment syndrome?

A
  • Pain (disproportionate to the injury)
  • Pallor (or mottled)
  • Perishingly cold
  • Paralysis
  • Pulselessness
340
Q

Describe the foot

A
  • The region of the lower limb distal to the ankle joint
  • It is subdivided into the tarsus (ankle), the metatarsus and the digits (toes)
  • Hindfoot, midfoot and forefoot
  • The foot has a dorsum (superior surface of foot) and a sole (inferior surface)
341
Q

Describe the skin of the sole of the foot

A

The sole has thick, highly sensitive skin, very firmly attached to the plantar aponeurosis

342
Q

Describe the plantar aponeurosis

A
  • For grip and weight bearing
  • Thickens as 5 longitudinal bands that continue with the fibrous flexor sheaths
  • Sends septae to the metatarsals to create compartments and potential spaces
343
Q

Describe the plantar muscles

A
  • Plantar muscles are arranged in layers
  • Their actions are implied by the names but they also play important roles in arch support, adjustment of balance and gait (especially on uneven surfaces)
  • They are supplied by the lateral or medial plantar nerves
344
Q

Name the muscles in layer 1 of the sole of the foot

A
  • Abductor digiti minimi - lateral
  • Flexor digitorum brevis - medial
  • Abductor hallucis - medial
345
Q

Name the muscles in layer 2 of the sole of the foot

A
  • Lumbricals 1-4 - 1 (medial) 2-4 (lateral)

- Quadratus plantae (lateral)

346
Q

Name the muscles in layer 3 of the sole of the foot

A

-Flexor digiti minimi brevis - lateral
-Adductor hallucis - lateral
Flexor hallucis brevis - medial

347
Q

Name the muscles in layer 4 of the sole of the foot

A
  • Plantar interossei - lateral

- Dorsal interossei - lateral

348
Q

Describe the plantar arteries

A
  • Posterior tibial artery becomes the medial and lateral plantar arteries after running posterior to the medial malleolus
  • Pulse of posterior tibial artery can be felt behind the medial malleolus
349
Q

Describe the plantar nerves

A
  • Tibial nerve passes into the sole behind medial malleolus deep to the flexor retinaculum
  • Divides into the medial and lateral plantar nerves
350
Q

What are the boundaries of the tarsal tunnel?

A
  • Medial malleolus
  • Talus
  • Calcaneus
  • Flexor retinaculum
  • Inferior surface of the sustentaculum tali
351
Q

What does the mnemonic ‘Tom, Dick and A Very Nervous Harry’ stand for in relation to the contents of the tarsal tunnel?

A
  • Tom - tibialis posterior
  • Dick - digitorum longus
  • A - artery
  • Very - vein
  • Nervous - nerve (posterior tibial)
  • Harry - hallucis longus
352
Q

What forms the medial longitudinal arch of the foot?

A
  • Calcaneus
  • Talus
  • Navicular
  • 3 cuneiform bones
  • 3 metatarsals
353
Q

What forms the lateral longitudinal arch of the foot?

A
  • Calcaneus
  • Cuboid
  • 4th and 5th metatarsals
354
Q

What forms the transverse arch of the foot?

A

-Cuneiforms and cuboid

355
Q

What are the passive supporters of the plantar arches?

A
  • Shape of bones

- Strong ligaments - calcaneonavicular plantar ligament, long plantar ligament, plantar ligament, deltoid ligament

356
Q

What are the active supporters of the plantar arches?

A

Muscles (effective when contracting)

357
Q

Describe the supply to the dorsum of the foot

A
  • Deep fibular nerve enters the dorsum of the foot passing under the extensor retinaculum
  • Gives rise to dorsal digital nerve to toes 1-2
  • Anterior tibial artery passes under the inferior extensor retinaculum and becomes dorsalis pedis
  • Pulse of dorsalis pedis is felt in the first intermetatarsal space, between the tendons of extensor digitorum longus and extensor hallucis longus
358
Q

What is the lisfranc joint?

A

The joint between the final tarsals and the metatarsals

359
Q

Describe gait

A
  • 8 phases
  • Each limb alternates dynamically through stance to swing, to stance
  • Muscle activity is essential but momentum and gravity are equally important
360
Q

Describe the heel strike in gait

A

The right thigh decelerates and drops the right lower limb and heel to the ground, the foot remains dorsiflexed

361
Q

What muscles are involved in inversion of the foot?

A

Tibialis anterior and tibialis posterior

362
Q

Which joints are involved when walking on uneven ground?

A

Subtalar and transverse tarsal

363
Q

Which nerves are involved in inversion of the foot?

A

Deep fibular and tibial nerve

364
Q

Which muscle are involved in eversion of the foot?

A

Fibularis longus and fibularis brevis

365
Q

Which nerve is involved in eversion of the foot?

A

Superficial fibular nerve

366
Q

What happens at midstance in gait?

A

One limb carries the entire body weight while the other limb is lifted

367
Q

What happens at terminal stance in gait?

A
  • Start to push off
  • Heel is off the ground
  • Momentum must be created by drawing the body forwards over the ankle
368
Q

Which muscles are involved in plantar flexion of the foot?

A
  • Gastrocnemius
  • Soleus
  • Triceps surae (collective name for first 2)
369
Q

Which muscles help to stabilise the pelvis?

A
  • Gluteus medius

- Gluteus minimus

370
Q

Which muscles actively support the medial longitudinal arch?

A
  • Flexor digitorum longus
  • Tibialis anterior
  • Tibialis posterior
  • Fibularis longus
  • Intrinsic muscles of the foot
371
Q

What happens in preswing?

A

Lower limb is about to enter the swing phase

372
Q

If the right lower limb was in preswing, what would be the action of the right ankle?

A

Plantarflexion and powerful push off

373
Q

If the right lower limb was in preswing, what muscles and nerves would be involved in the right ankle’s actions?

A
  • Gastrocnemius
  • Soleus

-Tibial nerve

374
Q

If the right lower limb was in preswing, what would be the actions of the right toes?

A

Plantarflexion and powerful push off

375
Q

If the right lower limb was in preswing, what muscles and nerves would be involved in the right toes’ actions?

A
  • Flexor hallucis longus
  • Flexor digitorum longus
  • Flexor hallucis brevis
  • Flexor digitorum brevis
  • Quadratus plantae
  • Tibial nerve
  • Medial plantar branch of tibial
376
Q

If the right lower limb was in preswing, what actions would be taking place in the hip joint?

A

Extends slightly to help forward momentum

377
Q

If the right lower limb was in preswing, what muscles and nerves would be involved in the right hip’s actions?

A
  • Both heads of biceps femoris
  • Semitendinosus
  • Semimembranosus

-Sciatic nerve

378
Q

What is the action of the right hip if the right lower limb is in initial/midswing?

A

Flexion

379
Q

What muscles and nerves are involved in the right hip’s actions when the right lower limb is in initial/midswing phase of gait?

A
  • Iliopsoas
  • Rectus femoris
  • Femoral nerve
  • L1-L3
380
Q

What is the action of the right knee when right lower limb is in initial/midswing phase of gait?

A

Flexion

381
Q

What muscles and nerves are involved in the actions of the right knee when right lower limb is in initial/midswing phase of gait?

A
  • Hamstrings
  • Popliteus
  • Gastrocnemius
  • Sartorius
  • Sciatic nerve
  • Tibial nerve
382
Q

What happens during terminal swing of right lower limb?

A
  • Right lower limb is thrown further forward

- The right side of the pelvis moves anteriorly, using momentum to internally rotate at the left hip

383
Q

What are the actions of the right hip if the right lower limb is in terminal swing?

A
  • Further flexion

- Lateral rotation to keep the foot pointing forwards

384
Q

What muscles and nerves are involved in the actions of the right hip if the right lower limb is in terminal swing?

A
  • Lateral rotators of the hip

- L5-S2

Year 1 Semester 2 (26 decks)

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