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Musculoskeletal MBCHB > Anatomy > Flashcards

Anatomy Flashcards

1
Q

What does the proximal aspect of the femur articulate with?

A

The acetabulum of the pelvis to form the hip joint.

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2
Q

What is the linea aspera?

A

Roughened edges of the bone on the posterior surface of the femoral shaft. It splits distally to form the medial and lateral supracondylar lines.

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3
Q

When does the linea aspera become the pectineal line?

A

Proximally the medial border of the linea aspera becomes the pectineal line

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4
Q

What does the lateral border of the linea aspera proximally become?

A

Gluteal tuberosity

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5
Q

What happens distally to the linea aspera?

A

Distally, the linea aspera widens and forms the floor of the popliteal fossa, the medial and lateral borders form the medial and lateral supracondylar lines

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6
Q

Where does the medial supracondylar line end?

A

The medial supracondylar line ends at the adductor tubercle, where the adductor magnus attaches

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7
Q

What are the characteristic features of the distal end of the femur?

A

Medial and lateral condyles

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8
Q

What do the medial and lateral condyles do?

A

They articulate with the tibia and patella to form the knee joint.

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9
Q

What is the function of the greater sciatic foramen?

A

allows structures into the pelvis

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10
Q

What is the function of the lesser sciatic foramen?

A

allows structures into the perineum

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11
Q

How are the foramina formed?

A

formed by the sacrotuberous and sacrospinous ligaments

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12
Q

What is the composition of the hip bone?

A

Ilium
Ischium
Pubis

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13
Q

What are the features of the apex of the patella?

A

connected to the tibial tuberosity by the patellar ligament

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14
Q

What are the features of the medial facet of the patella?

A

articulates with themedial condyleof thefemur

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15
Q

What are the features of the lateral facet of the patella?

A

articulateswiththelateral condyleof thefemur

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16
Q

What forms the tibial plateau?

A

Medial and lateral condyles

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17
Q

What is the function of the tibial plateau?

A

articulates with the femoral condyles in the knee joint

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18
Q

What is the intercondylar eminence?

A

main site of attachment for the ligaments and the menisci of the knee joint

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19
Q

What is the proximal aspect of the anterior border of the the tibial shaft?

A

Tibial tuberosity

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20
Q

What is on the posterior surface of the tibial shaft?

A

Soleal line (Origin of the soleus)

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21
Q

What does the lateral border of the tibial shaft give rise to?

A

gives attachment to the interosseous membrane that binds the tibia and the fibula together

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22
Q

What is the medial malleolus?

A

bony projection continuing inferiorly on the medial aspect of the tibia that articulates with the tarsal bones to form part of the ankle joint

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23
Q

Where does the tendon of the tibialis posterior pass?

A

On the posterior surface of the tibia, there is agroovethrough which the tendon of tibialis posterior passes

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24
Q

Where is the fibular notch?

A

Laterally is thefibular notch,where the fibula is bound to the tibia - forming the distal tibiofibular joint

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25
Q

What is the fibula?

A

Bone located within the lateral aspect of the leg; main function is to act as an attachment for muscles, and not as a weight-bearer

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26
Q

What are the features of the proximal fibula?

A

Head has a facet to articulate with the lateral condyle of the tibia
The common fibular nerve can be found on the posterior and lateral surface of the fibular neck

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27
Q

How many surfaces does the shaft of the fibula have?

A

Three surfaces for each compartment of the leg

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28
Q

What is the distal lateral border of the fibula called?

A

The lateral malleolus

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29
Q

What are the bones of the hindfoot?

A

Talus and calcaneus

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30
Q

What are the bones of the midfoot?

A

Navicular, cuboid and cuneiforms

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31
Q

What are the bones of the forefoot?

A

5 Metatarsals and 14 phalanges

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32
Q

What are the scapulas articulations?

A

Articulates with the humerus at the glenohumeral joint, and with the clavicle at the acromioclavicular joint

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33
Q

What surface of the scapula faces the ribcage?

A

The costal surface

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34
Q

What surface of the scapula faces the humerus?

A

The lateral surface

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35
Q

What is the glenoid fossa?

A

The scapula articulates with the head of the humerus to form the glenohumeral (shoulder) joint

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36
Q

What is the supraglenoid tubercle?

A

attachment for long head of biceps brachii

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37
Q

What is the infraglenoid tubercle?

A

attachment for long head of triceps brachii

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38
Q

What surface of the scapula faces outwards?

A

The posterior surface

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39
Q

What is the spine of the scapula?

A

divides the surface of the scapula in two

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40
Q

What is the acromion?

A

projection of the spine that arches over the glenohumeral joint and articulates with the clavicle at the acromioclavicular joint

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41
Q

What is the infraspinous fossa?

A

area below the spine of the scapula, origin of infraspinatus

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42
Q

What is the supraspinous fossa?

A

area above the spine of the scapula, origin of supraspinatus

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43
Q

Describe the sternal end of the clavicle?

A
  • Contains a large facet for articulation with the manubrium of the sternum at the sternoclavicular joint
  • Inferior surface is marked by a depression for the costoclavicular ligament
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44
Q

Describe the shaft of the clavicle?

A

Acts a point of origin and attachment for several muscles - deltoid, trapezius, subclavius, pectoralis major, sternocleidomastoid and sternohyoid

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45
Q

Describe the acromial end of the clavicle?

A
  • Contains a small facet for articulation with the acromion of the scapula at the acromioclavicular joint
  • Attachment for conoid tubercle and trapezoid line
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46
Q

What is the humerus?

A

The long bone of the upper limb

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47
Q

What are the articulations of the humerus?

A

Articulates proximally with the glenoid fossa of the scapula (glenohumeral joint) and distally with the head of radius and trochlear notch of the ulnar (elbow joint)

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48
Q

What is the greater tubercle of the humerus?

A

attachment for supraspinatus, infraspinatus and teres minor

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49
Q

What is the lesser tubercle of the humerus?

A

attachment for subscapularis

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50
Q

What are the key features of the proximal end of the humerus?

A

Head
Greater tubercle
Lesser tubercle
Intertubercular sulcus

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51
Q

What is the intertubercular sulcus?

A

deep groove between the tubercles, head of biceps runs along the sulcus, pectoralis major, teres major at latissimus dorsi insert onto the lips (edges) of the sulcus

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52
Q

What is the deltoid tuberosity?

A

roughened attachment point for deltoid muscle

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53
Q

What is the radial groove?

A

shallow depression that runs diagonally down the posterior surface of the humerus, the radial nerve and profunda brachii artery lie in this groove

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54
Q

What muscles attach anteriorly to the humeral shaft?

A

Coracobrachialis, deltoid, brachialis and brachioradialis

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55
Q

What muscles attach posteriorly to the humeral shaft?

A

Medial and lateral heads of the triceps

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56
Q

What is the lateral supraepicondylar ridge?

A

site of common origin of the forearm extensor muscles

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57
Q

Where does the ulnar nerve pass in relation to the humerus?

A

Ulnar nerve passes in a groove on the posterior aspect of the medial epicondyle where it is palpable

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58
Q

What are the key features of the distal end of the humerus?

A

Lateral supraepicondylar ridge
Lateral and medial epicondyles
Trochlea
Capitulum
Coronoid, radial and olecranon fossae

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59
Q

What is the capitulum?

A

articulates with radius

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60
Q

What is the function of the coronoid, radial and olecranon fossae?

A

accommodate the forearm bones during flexion or extension at the elbow

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61
Q

What are the articulations of the ulna?

A

Proximally articulates with the humerus (elbow joint), distally articulates with the radius (distal radio-ulnar joint)

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62
Q

What si the olecranon?

A

‘tip’ of the elbow, attachment for triceps brachii

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63
Q

What are the key features of the proximal ulna?

A

Olecranon
Coronoid process
Trochlear notch
Radial notch
Tuberosity of ulna

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64
Q

What is the trochlear notch?

A

formed by the olecranon and coronoid process, articulates with the trochlear of the humerus

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65
Q

What is the radial notch?

A

articulates with the head of the radius

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66
Q

What is the tuberosity of ulna?

A

attachment for brachialis

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67
Q

Where does the pronator quadratus attach to the ulna?

A

Anterior surface of ulna distally

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68
Q

What border of the shaft is palpable along the entire length of the forearm?

A

Posterior border

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69
Q

What is important about the interosseous border?

A

site of attachment for the interosseous membrane, which spans the distance between the two forearm bones

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70
Q

Describe the distal end of the ulna.

A

Rounded head with a distal projection, styloid process, that articulates with the ulnar notch of the radius to form the distal radio-ulnar joint

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71
Q

What are the articulations of the radius?

A

Pivots around the ulna to produce movement at the proximal and distal radio-ulnar joints

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72
Q

What are the areas of the proximal radius?

A

The head
The neck
The radial tuberosity

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73
Q

What muscles attach to the radial tuberosity?

A

Biceps brachii

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74
Q

Where does the pronator teres attach on the radius?

A

Middle lateral surface of the shaft of the radius.

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75
Q

What forms the radioulnar joint?

A

There is a concavity in the medial surface called theulnar notch, which articulates with the head of ulna, forming the distalradioulnar joint

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76
Q

Describe the wrist joint.

A

The distal surface of the radius has two facets, for articulation with thescaphoidandlunatecarpal bones

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77
Q

What forms the styloid process?

A

Lateral side of the radius projects distally

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78
Q

What are the carpal bones of the hand?

A

Scaphoid
Lunate
Triquetrum
Pisiform
Trapezium
Trapezoid
Capitate
Hamate

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79
Q

What carpals are present in the proximal row (from lateral to medial)?

A

Scaphoid
Lunate
Triquetrum
Pisiform

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80
Q

What carpals are present in the distal row (from lateral to medial)?

A

Trapezium
Trapezoid
Capitate
Hamate

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81
Q

What are the articulations of the metacarpals?

A

Articulate proximally with the carpals, and distally with the proximal phalanges

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82
Q

How are the metacarpals named?

A

Numbered e.g., Metacarpal 1 - thumb, Metacarpal 5 - little finger

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83
Q

What are the bones of the fingers?

A

Phalanges

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84
Q

All fingers have proximal, middle and distal phalanges. True or False?

A

False. The thumb has a proximal and distal phalanx, while the rest of the digits have proximal, middle and distal phalanges

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129
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130
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131
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132
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133
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134
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135
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136
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137
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138
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139
Q

Identify bone 1

A
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140
Q

Identify bone 2

A
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141
Q

Identify bone 3

A
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142
Q

Identify bone 4

A
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143
Q

Identify bones 5

A
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144
Q

Identify bone 6

A
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145
Q

Identify bone 7

A
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146
Q

Identify bone 8

A
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147
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A
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148
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149
Q
A
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150
Q

What forms the superior border of the femoral triangle?

A

Inguinal ligament

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151
Q

What forms the medial border of the femoral triangle?

A

Adductor longus

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152
Q

What forms the lateral border of the femoral triangle?

A

Sartorius

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153
Q

What forms the floor of the femoral triangle?

A

iliopsoas and pectineus

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154
Q

What forms the roof of the femoral triangle?

A

deep fascia (fascia lata)

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155
Q

What are the contents of the femoral triangle from lateral to medial?

A

Femoral nerve
Femoral artery
Femoral vein
Inguinal canal (deep inguinal lymph nodes)

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156
Q

What is in the femoral sheath?

A

The femoral artery and vein

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157
Q

What is the femoral sheath?

A

The sheath is a short tube of transversalis and iliopsoas fascia from the abdominal wall which surrounds the most proximal parts of the femoral artery and vein

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158
Q

How does a femoral hernia occur?

A
  • Increased abdominal pressure can result in peritoneum (with or without abdominal contents) herniating into the canal
  • This is called a femoral hernia and can present as a painful ‘lump in the groin’
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159
Q

What is the inguinal ligament?

A

The inguinal ligament is the inferior border of the external oblique aponeurosis, which is the flattened tendon of the most superficial of the anterolateral abdominal wall muscles

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160
Q

Where does the inguinal ligament lie?

A

The inguinal ligament runs between the anterior superior iliac spine (ASIS) and the pubic tubercle, and forms a gutter

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161
Q

What is contained in the inguinal canal?

A

contains the spermatic cord (males) or the round ligament (females)

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162
Q

Where can the femoral pulse be palpated?

A

The femoral pulse can easily be palpated 2-3 cm inferior to the midpoint of the inguinal ligament

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163
Q

What is contained in the retroinguinal space?

A

The femoral vessels, femoral nerve, and the iliopsoas muscle/combined tendon enter/leave the lower limb by passing deep (posterior) to the inguinal ligament in the retro inguinal space

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164
Q

What is the femoral canal?

A

Anatomical compartment located in the anterior thigh; the smallest and most medial part of the femoral sheath

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165
Q

What forms the medial border of the femoral canal?

A

Lacunar ligament

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166
Q

What forms the lateral border of the femoral canal?

A

femoral vein

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167
Q

What forms the anterior border of the femoral canal?

A

Inguinal ligament

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168
Q

What forms the posterior border of the femoral canal?

A

pectineal ligament, superior ramus of the pubic bone, and the pectineus muscle

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169
Q

What is the femoral ring?

A

The opening to the femoral canal is located at its superior border, known as the femoral ring

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170
Q

What is contained in the femoral canal?

A
  • Deep inguinal lymph nodes
    • The deep inguinal lymph nodes run in a chain in the femoral canal medial to the femoral vein
  • Adipose tissue
  • Forms the most medial part of the femoral sheath
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171
Q

What forms the superomedially popliteal fossa?

A

Semitendinosus/semimembranosus

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172
Q

What forms the superolaterally popliteal fossa?

A

biceps femoris

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173
Q

What forms the inferiorly popliteal fossa?

A

Medial and lateral heads of gastrocnemius

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174
Q

What forms the roof popliteal fossa?

A

popliteal fascia

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175
Q

What is contained in the popliteal fossa?

A
  • Lots of fat
  • Terminal small saphenous vein
  • Popliteal vessels
    • Contains a major neurovascular bundle - in the median plane of the fossa, from superficial to deep, lie the tibial nerve, the popliteal vein, and popliteal artery
  • Common fibular nerve
  • Popliteal lymph nodes are located along the popliteal vein in the fossa
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176
Q

Where does the genicular anastomoses provide blood to?

A

Provides collateral blood supply to the structures of the knee joint, leg, and foot

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177
Q

When is the genicular anastomoses important?

A

Important during periods when the knee is maximally flexed, which can lead to partial occlusion of the popliteal artery

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178
Q

How can you palpate the popliteal pulse?

A

Flexion of the knee to approximately 30° and relaxation of the hamstring muscles will aid examination

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179
Q

What is the purpose of the arches of the foot?

A

Provide shock absorption, ‘push-off’ spring in function and increase weight-bearing capacity by weight redistribution across the whole foot

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180
Q

How are the arches of the foot supported?

A

The arches are supported by the plantar aponeurosis (thickened central area of the plantar fascia, also protects against puncture wounds), plantar ligaments and the tendons of the muscle of the leg

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181
Q

What makes up the medial longitudinal arch?

A

Composed of the bones of the medial aspect of the foot - calcaneus, talus, navicular, 3 cuneiforms and metatarsals 1-3

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182
Q

What supports the medial longitudinal arch?

A
  • Flexor hallucis longus
  • Attachments of tibialis anterior
  • Attachment of fibularis longus
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183
Q

What forms the lateral longitudinal arch?

A

formed by the calcaneus, cuboid and metatarsals 4 and 5

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184
Q

What forms the transverse arch?

A

Consists of the cuboid, cuneiforms and the bases of all 5 metatarsals

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185
Q

What supports the transverse arch?

A

Also supported by the fibularis longus, as well as tibialis posterior

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186
Q

What is the plantar fascia?

A

The plantar fascia is the deep fascia found on the plantar aspect of the foot, deep to the skin and superficial fascia

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187
Q

What is the plantar aponeurosis?

A
  • Central part of the plantar fascia
  • Similar to the palmar aponeurosis of the hand
  • Gives rise to five digital longitudinal bands
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188
Q

What is the function of the plantar aponeurosis?

A
  • Helps to support the arches of the foot
  • Protects against deep spread of infection from puncture wounds to the sole of the foot
  • Clinical relevance: becomes inflamed and painful in plantar fasciitis
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189
Q

What is the axilla?

A

The axilla is the pyramidal space inferior to the shoulder joint and just superior to the hollow that patients will refer to as the ‘armpit’

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190
Q

What forms the anterior wall of the axilla?

A

Pectoralis major

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191
Q

What forms the posterior wall of the axilla?

A

Teres major

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192
Q

What is contained in the axilla?

A

Axillary vein
Axillary artery
Brachial plexus
Axillary lymph nodes

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193
Q

Where does the axillary vein arise from?

A

The brachial vein becomes the axillary vein at the lower border of teres major

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194
Q

Where does the axillary artery arise from?

A

The subclavian artery becomes the axillary artery at the lateral border of the first rib

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195
Q

What is the brachial plexus?

A

collection of spinal nerves that form the peripheral nerves of the upper limb

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196
Q

What are the axillary lymph nodes?

A

filter lymphatic fluid that has drained from the upper limb and pectoral region

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197
Q

What creates the pectoral girdle?

A

Scapula
Clavicle

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198
Q

What are the functions of the pectoral girdle?

A
  • Permits articulation of the upper limb with the appendicular skeleton via three bilateral joints (glenohumeral, acromioclavicular and sternoclavicular) to offer an increased range of movement for hand function
  • Maintains the relatively lateral position of the upper limb
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199
Q

Describe the rotation of the scapula.

A
  • In order for full adduction/abduction of the upper limb to occur, the scapula must rotate so that the glenoid fossa faces more inferiorly/superiorly respectively
  • Superior rotation of the glenoid is required to prevent the greater tubercle of the humerus from impinging on the acromion of the
    scapula i.e. without superior rotation of the scapula we would be unable to fully abduct our upper limb
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200
Q

How is the pectoral girdle stabilised?

A
  • The pectoral girdle is stabilised by providing attachment points for ligaments and muscles
    • Deltoid, trapezius, levator scapulae, rhomboid major, rhomboid minor, rotator cuff muscles, teres major, pectoralis major, pectoralis minor, serratus anterior
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201
Q

What is the carpal tunnel?

A

Narrow passageway found on the anterior portion of the wrist that serves as the entrance to the palm for several tendons and the median nerve

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202
Q

Describe the structure of the carpal tunnel.

A

The carpal tunnel is formed by the flexor retinaculum (anteriorly) and the carpal bones (posteriorly)

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203
Q

What is contained in the carpal tunnel?

A
  • The long tendons of the forearm flexor muscles - flexor digitorum superficialis (x4), flexor digitorum profundus (x4), flexor pollicis longus (x1)
  • The median nerve
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204
Q

What is contained in the cubital tunnel?

A

The cubital fossa is a triangular space between the skin and the anterior aspect of the capsule of the elbow joint

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205
Q

What forms the superior border of the cubital fossa?

A

Transverse line between the epicondyles of the humerus

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206
Q

What forms the medial border of the cubital fossa?

A

Pronator teres

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207
Q

What forms the lateral border of the cubital fossa?

A

Brachioradialis

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208
Q

What are the superficial contents of the cubital fossa?

A

Medial cubital vein, cephalic vein and basilic vein
The distal tendon and aponeurosis of biceps brachii are palpable in the fossa

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209
Q

What are the deep contents of the cubital fossa?

A
  • Medial nerve (medially) which continues into the anterior compartment of the forearm
  • Brachial artery which bifurcates into radial and ulnar arteries at the apex of the triangle
  • Radial nerve (laterally) which divides deep into its superficial and deep branches deep to brachialis
    • The deep branch pierces supinator to enter the posterior compartment of the forearm
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210
Q

What is the innervation for the skin and fascia of the fossa?

A

supplied by cutaneous nerves of arm and forearm

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211
Q

What is the anatomical snuffbox?

A

Triangular depression found on the lateral aspect of the dorsum of the hand

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212
Q

What is contained in the anatomical snuffbox?

A
  • Radial artery
  • Superficial branch of radial nerve
  • Cephalic vein
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213
Q

What comprises the wrist?

A

Comprises of the carpal bones and the gliding synovial joints between them

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214
Q

What is the midcarpal joint?

A

joint between the proximal and distal row of carpal bones

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215
Q

What is the proximal deep fascia of the hand?

A

Palmar carpal ligament and flexor retinaculum

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216
Q

What is the central deep fascia of the hand?

A

Palmar aponeurosis

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217
Q

What is the lateral deep fascia of the hand?

A

Deep fascia of the thenar eminence

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218
Q

What is the medial deep fascia of the hand?

A

Deep fascia of the hypothenar eminence

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219
Q

What is the distal deep fascia of the hand?

A

fibrous digital sheaths continuous with the longitudinal digital bands of the palmar aponeurosis

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220
Q

Describe the hip joint.

A

Ball and socket joint synovial joint formed by an articulation between the pelvic acetabulum and the head of the femur

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221
Q

What ligaments are involved in the hip joint?

A

Extracapsular ligaments: iliofemoral, pubofemoral, ischiofemoral
Intracapsular ligament: ligament to head of femur (ligamentum teres)

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222
Q

Which ligament can be ruptured in a hip dislocation?

A

(ligamentum teres)

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223
Q

Describe the acetabular labrum.

A
  • increases the depth of the acetabulum
    • Horseshoe shaped fibrocartilaginous ring around the acetabulum
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224
Q

What is the function of the acetabular labrum?

A

Provides a larger articular surface, increasing stability of the joint

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225
Q

What is the blood supply to the hip joint?

A
  • Medial and lateral circumflex arteries - usually from deep femoral arteries
  • Artery to head of femur
    • Branch of obturator
    • Travels in ligament to head of femur
    • More important in children <4 years - usually becomes obliterated in the adult
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226
Q

What muscles are involved in flexion of the hip joint?

A

Iliopsoas, rectus femoris, sartorius, pectineus

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227
Q

What muscles are involved in extension of the hip joint?

A

gluteus maximus, semimembranosus, semitendinosus and biceps femoris (the hamstrings)

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228
Q

What muscles are involved in abduction of the hip joint?

A

gluteus medius, gluteus minimus, piriformis and tensor fascia latae

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229
Q

What muscles are involved in adduction of the hip joint?

A

adductors longus, brevis and magnus, pectineus and gracilis

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230
Q

What muscles are involved in lateral rotation of the hip joint?

A

biceps femoris, gluteus maximus, piriformis, assisted by the obturators, gemilli and quadratus femoris

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231
Q

What muscles are involved in medial rotation of the hip joint?

A

anterior fibres of gluteus medius and minimus, tensor fascia latae

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232
Q

Why may hip pain radiate as knee pain?

A

This is due to the obturator nerve supplying the hip and the knee

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233
Q

Describe the knee joint.

A

Hinge type synovial joint which mainly allows for flexion and extension (and a small degree of medial and lateral rotation); consists of the medial and lateral compartments of the tibiofemoral joint and the patellofemoral joint

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234
Q

What are the articulating surfaces of the knee joint?

A

Consists of 3 articulations in total: 2 between the femur and the tibia (femorotibial), 1 between the femur and the patella (femoropatellar)

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235
Q

What are the articulating surfaces of the knee joint covered by?

A

The surfaces are covered with hyaline cartilage with the retropatellar surface having the thickest hyaline cartilage in the body

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236
Q

What are the main movements of the knee joint?

A

Flexion
Extension

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237
Q

What muscles and nerves are involved in knee flexion?

A

mainly hamstrings and gastrocnemius/tibial and common fibular nerve

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238
Q

What muscles and nerves are involved in knee extension?

A

mainly quadriceps femoris/femoral nerve

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239
Q

What muscles and nerves are involved in lateral rotation of the knee?

A

biceps femoris/tibial and common fibular nerve

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240
Q

What muscles and nerves are involved in medial rotation of the knee?

A

hamstrings and gracilis/tibial and obturator nerves

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241
Q

What are the extracapsular ligaments of the knee?

A

Patellar ligament
Lateral collateral ligament
Medial collateral ligament

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242
Q

What are the intracapsular ligaments of the knee?

A

Anterior cruciate ligament
Posterior cruciate ligament

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243
Q

What are the attachments of the patella tendon?

A

continuation of the quadriceps femoris tendon distal to the patella that attaches to the tibial tuberosity

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244
Q

What are the attachments of the lateral collateral ligament?

A

attaches proximally to the lateral epicondyle of the femur, distally it attaches to a depression on the lateral surface of the fibular head

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245
Q

What are the attachments of the medial collateral ligament?

A

proximally attaches to the medial epicondyle of the femur, distally it attaches to the medial condyle of the tibia

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246
Q

How does the iliotibial tract stabilise the knee joint?

A

the bottom of the band attaches to the top of the tibia

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247
Q

What are the attachments of the anterior cruciate ligaments?

A

attaches at the anterior intercondylar region of the tibia where it blends with the medial meniscus, ascends laterally and posteriorly to attach to the lateral femoral condyle

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248
Q

What are the attachments of the posterior cruciate ligament?

A

lies medial to the ACL, attaches at the posterior intercondylar region of the tibia and ascends anteriorly to attach to the medial femoral condyle

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249
Q

What are the functions of the knee ligaments?

A
  • MCL resists valgus stress
  • LCL resists varus stress and abnormal external rotation of the ligaments
  • ACL resists internal rotation of the tibia in extension and anterior subluxation of the tibia onto the femur
    • Integreity of this ligament is tested by the anterior drawer test
  • PCL resists posterior subluxation of the tibia onto the femur and hyperextension of the knee
    • Integreity of this ligament is tested by the posterior drawer test
  • The posterolateral corner (PCL, LCL, popliteus and other smaller ligaments) resist external rotation of the tibia in flexion
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250
Q

What are the functions of the menisci?

A

The menisci are important ‘shock absorbers’ and act to distribute load evenly

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251
Q

Describe the menisci.

A

They are C shaped and attached at both ends to the intercondylar area of the tibia
- The menisci are thicker peripherally where they are attached to the fibrous capsule
- The inner (deep) edges of the menisci are unattached to bone and very thin

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252
Q

What is genu varum?

A

Bow legs

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253
Q

What is genu valgum?

A

Knock knees

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254
Q

What is the suprapatellar bursa?

A

Extension of the synovial cavity of the knee, located between the quadriceps femoris and the femur

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255
Q

What are the functions of the suprapatellar bursa?

A

Reduces friction on the quadriceps tendon during knee movements

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256
Q

What is the subtalar joint?

A

Between the talus and calcaneus

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257
Q

Describe the subtalar joint and its function.

A

Synovial joint with the movements of inversion (produced by tibialis anterior and tibialis posterior/tibial and deep fibular nerves) and eversion (produced by the fibularis muscles/both fibular nerves)

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258
Q

What muscles and nerves are involved in inversion of the foot?

A

produced by tibialis anterior and tibialis posterior/tibial and deep fibular nerves

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259
Q

What muscles and nerves are involved in the eversion of the foot?

A

produced by the fibularis muscles/both fibular nerves

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260
Q

What are the midtarsal joints?

A

2 joints - calcaenocubiod and talocalcaneonavicular

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261
Q

Describe the midtarsal joints and their function

A

Synovial joints with the movements of inversion (produced by tibialis anterior and tibialis posterior/tibial and deep fibular nerves) and eversion (produced by the fibularis muscles/both fibular nerves)

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262
Q

What is the tarsometatarsal joint?

A

between the cuneiforms/cubiod proximally at the metatarsals

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263
Q

What are the metatarsophalangeal joints?

A

synovial joints which allow flexion, extension, abduction, adductoin and circumduction of the digits

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264
Q

What are the interphalangeal joints?

A

synovial hinge joints which allow flexion and extension of the toes

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265
Q

Describe the shoulder joint.

A

Ball and socket synovial joint formed by the humeral head and the scapular glenoid

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266
Q

What is the shoulder girdle?

A

the scapula, the clavicle, the proximal humerus and the supporting muscles including the deltoid and the muscles of the rotator cuff

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267
Q

How is the shoulder joint stabilised?

A
  • Joints are generally stabilised by 3 main factors:
    • Shape of the articulating bones (congruency)
    • Ligaments (and capsule)
    • Muscle tone
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268
Q

What is a subluxation?

A

partial dislocation, where the articular surfaces are displaced, but still overlap

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269
Q

What is a dislocation?

A

articular surfaces no longer overlap at all

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270
Q

What are the articulating surfaces of the shoulder joint?

A

The shoulder joint is a synovial joint formed by the articulation of the head of the humerus with the glenoid cavity (or fossa) of the scapula

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271
Q

What is the glenoid labrum?

A

The glenoid labrum is a fibrocartilage rim which deepens the glenoid fossa to reduce the disproportion in surfaces

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272
Q

What is the shoulder joint capsule?

A
  • The joint capsule is a fibrous sheath which encloses the structures of the joint
  • It extends from the anatomical neck of the humerus to the border of the glenoid labrum
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273
Q

Where is the subacromial bursa?

A

located deep to the deltoid and acromion, and superficial to the supraspinatus tendon and joint capsule

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274
Q

What is the function of the subacromial bursa?

A

Reduces friction beneath the deltoid, promoting free motion of the rotator cuff tendons

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275
Q

Where is the subscapular bursa?

A

located between the subscapularis tendon and the scapula

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276
Q

What is the function of the subscapular bursa?

A

Reduces wear and tear on the tendon during movement at the shoulder joint

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277
Q

What is the glenohumeral ligament?

A

form the joint capsule, connect the humerus to the glenoid fossa, are the main stabilises of the joint and prevent anterior dislocation

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278
Q

What is the coracohumeral ligament?

A

attaches the base of the coracoid process to the greater tubercle of humerus, supports the superior part of the joint capsule

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279
Q

What is the coracoacromial ligament?

A

runs between the acromion and coracoid process of the scapula, prevents superior dislocation of the femoral head

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280
Q

What is the transverse humeral ligament?

A

spans between the two tubercles of the humerus, holds the tendon of the long head of biceps in the intertubercular groove

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281
Q

What muscles are involved in the extension of the shoulder joint?

A

posterior deltoid, latissimus dorsi and teres major

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282
Q

What muscles are involved in the flexion of the shoulder joint?

A

pectoralis major, anterior deltoid and coracobrachialis, biceps brachii weakly assists

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283
Q

What muscles are involved in the abduction of the shoulder joint?

A
  • The first 0-15 degrees of abduction is produced by the supraspinatus
  • The middle fibres of the deltoid are responsible for the next 15-90 degrees
  • Past 90 degrees, the scapula needs to be rotated to achieve abduction - carried out by the trapezius and serratus anterior
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284
Q

What muscles are involved in the adduction of the shoulder joint?

A

pectoralis major, latissimus dorsi and teres major

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285
Q

What muscles are involved in the internal rotation of the shoulder joint?

A

subscapularis, pectoralis major, latissimus dorsi, teres major and anterior deltoid

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286
Q

What muscles are involved in the external rotation of the shoulder joint?

A

infraspinatus and teres minor

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287
Q

What is the elbow joint?

A

Hinge type synovial joint between the humerus and the bones of the distal forearm

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288
Q

What are the articulations of the elbow joint?

A
  • Consists of two separate articulations:
    • Trochlear notch of the ulnar and the trochlea of the humerus (humero-ulnar)
    • Head of the radius and capitulum of the humerus (radio-capitallar)
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289
Q

Where is the intratendinous bursa?

A

located within the tendon of the triceps brachii

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290
Q

Where is the subtendinous bursa?

A

between the olecranon and the tendon of the triceps brachii, reducing friction between the two structures during extension and flexion of the arm

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291
Q

Where is the subcutaneous bursa?

A

between the olecranon and the overlying connective tissue (implicated in olecranon bursitis)

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292
Q

What are the ligaments of the elbow joint?

A

Lateral collateral ligament
Annular ligament
Medial ligament

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293
Q

What is the lateral collateral ligament?

A

originates from the lateral epicondyle of the humerus, blends with the annular ligament of the radius

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294
Q

What is the annular ligament?

A

stabilizes proximal radioulnar joint by holding radius against radial notch of ulna

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295
Q

What is the medial ligament?

A

originates from the medial epicondyle and attaches to the coronoid process and olecranon of the ulna

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296
Q

What joint is responsible for extension of the elbow joint?

A

Humero-ulnar joint via the triceps brachii and anconeus

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297
Q

What joint is responsible for flexion of the elbow joint?

A

Humero-ulnar joint via brachialis, biceps brachii and brachioradialis

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298
Q

What joint is responsible for supination of the elbow joint?

A

Radio-capitallar joint via biceps brachii and supinator

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299
Q

What joint is responsible for pronation of the elbow joint?

A

Radio-capitallar joint via pronator teres and pronator quadratus

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300
Q

Describe the proximal radioulnar joint.

A

located near the elbow, articulation between the head of the radius and the radial notch of the ulna

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301
Q

Describe the distal radioulnar joint

A

located near the wrist, articulation between the ulnar notch of the radius, and the ulnar head

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302
Q

What are the movements permitted by the wrist joint?

A

Permits flexion-extension, adduction-abduction and circumduction between the distal radius and articular disc proximally, and the scaphoid, lunate and triquetrum distally

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303
Q

What is the midcarpal joint?

A

joint between the proximal and distal row of carpal bones (wrist)

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304
Q

What is the carpometacarpal joint?

A

permit slight flexion between the distal carpals and the 2nd to 5th metacarpals

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305
Q

Describe the metacarpal joint of the thumb.

A
  • permits a full range of movement between the trapezium and 1st metacarpal including opposition
    • The thumb is rotated 90° - pad faces medially (rather than anteriorly) which affects terms of movement
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306
Q

What is the metacarpophalangeal joint?

A

permit all movements except opposition between the metacarpals and proximal phalanges

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307
Q

What movements do the proximal and distal interphalangeal joints permit?

A

permit flexion/extension between the phalanges

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308
Q
A
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309
Q
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310
Q
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311
Q
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312
Q
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313
Q
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314
Q
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315
Q
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316
Q
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317
Q
A
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318
Q

What is the fascia lata?

A

Deep fascial investment of the musculature of the thigh

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319
Q

Where is the fascia lata located?

A

Begins proximally around the iliac crest and inguinal ligament and ends distal to the bony prominences of the tibia

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320
Q

What is the iliotibial tract?

A

Deep thickening of the fascia lata

321
Q

What are the attachments of the iliotibial tract?

A

runs from the ASIS to the lateral aspect of the lateral tibial condyle at the Gerdy tubercle

322
Q

What is the function of the iliotibial tract?

A

supports the knee joint

323
Q

What is the tensor fascia lata?

A
  • Muscular part of the fascia lata
  • Enclosed within the proximal portion of the tract
324
Q

What are the attachments of the tensor fascia lata?

A
  • Proximal: ASIS
  • Distal: inserts into ITT
325
Q

What are the actions of the tensor fascia lata?

A

assists the gluteus medius and minimus in abduction and medial rotation of the lower limb

326
Q

What is the innervation of the tensor fascia lata?

A

superior gluteal nerve (L4-S1)

327
Q

Describe the anatomical location of the gluteal region.

A
  • The gluteal region lies between the back and the posterior thigh and is posterior to the pelvis
  • It is bounded superiorly by the iliac crests and inferiorly by the gluteal fold/sulcus
  • The intergluteal cleft lies between the buttocks
  • The greater trochanter of the femur marks its lateral extent
328
Q

What is the function of the superficial gluteal muscles?

A
  • Abduct and extend the lower limb at the hip joint
  • Helps to define the gluteal fold
329
Q

What muscles are in the superficial gluteal muscle?

A

Gluteus maximus
Gluteus medius
Gluteus Minimus

330
Q

What are the attachments of the gluteus maximus?

A
  • Proximal: iliac crest, sacrum, sacrotuberous ligament and coccyx
  • Distal: iliotibial tract
331
Q

What is the function of the gluteus maximus?

A

most powerful extensor of the hip

332
Q

What is the innervation of the gluteus maximus?

A

inferior gluteal nerve (L5-S2)

333
Q

What are the attachments of the gluteus medius?

A
  • Proximal: external ileum between anterior and posterior gluteal lines
  • Distal: lateral surface of greater trochanter of femur
334
Q

What is the function of the gluteus medius?

A

abduct and medially rotate the thigh at the hip joint

335
Q

What is the innervation of the gluteus medius?

A

superior gluteal nerve (L4-S1)

336
Q

What are the attachments of gluteus minimus?

A
  • Proximal: external ileum between anterior and inferior gluteal lines
  • Distal: superior surface of greater trochanter of femur
337
Q

What is the function of gluteus minimus?

A

abduct and medially rotate the thigh at the hip joint

338
Q

What is the innervation of gluteus minimus?

A

superior gluteal nerve (L4-S1)

339
Q

What are the deep gluteal muscles?

A

Piriformis
Gemelli
Obturator internus
Quadratus femoris

340
Q

What are the attachments of the piriformis?

A
  • Proximal: anterior surface of sacrum
  • Distal: superior surface of greater trochanter of femur
341
Q

What is the function of the piriformis?

A
  • laterally rotates the extended thigh and abducts the flexed thigh
    • Also divides the greater sciatic foramen into suprapiriform and infrapiriform foramina
342
Q

What is the innervation of the piriformis?

A

anterior ramus of S1, S2

343
Q

What are the attachments of the gemelli?

A

proximally ischial spine, distally ischial tuberosity

344
Q

What is the function of the gemelli?

A

laterally rotates the extended thigh and abducts the flexed thigh

345
Q

What is the innervation of the gemelli?

A
  • Superior: nerve to obturator internus
  • Inferior: nerve to quadratus femoris
346
Q

What is the attachment for the obturator internus?

A

proximally internal surface of obturator membrane, distally trochanteric fossa

347
Q

What is the function of the obturator internus?

A

laterally rotates the extended thigh and abducts the flexed thigh

348
Q

What is contained in the inferior neurovascular bundle? and where is it located?

A

Contains the inferior gluteal artery, vein and nerve (L5, S1, S2)
Located deep to gluteus maximus

349
Q

What is contained in the superior gluteal neurovascular bundle? and where is it located?

A

Contains the superior gluteal artery, vein and nerve (L4, L5, S1)
Located deep to gluteus medius

350
Q

When does Trendelenburg sign occur?

A

Damage to the gluteus medius/gluteus minimus or their nerve supply (superior gluteal nerve) can result in the clinical sign identified in the ‘Trendelenburg Test’
A positive Trendelenburg sign indicates gluteal muscle weakness e.g. if the left gluteal muscles are weak, the right side of the pelvis will drop when the patient stands on their left leg (and the right leg is unsupported)

351
Q

What muscles are contained in the anterior thigh?

A

Iliopsoas
Sartorius
Quadriceps femoris

352
Q

What are the attachments of iliopsoas?

A
  • Proximal: iliacus - iliac fossa, psoas major - lumbar vertebrae
  • Distal: lesser trochanter of the femur
353
Q

What are the functions of iliopsoas?

A

flexes the thigh at the hip joint

354
Q

What is the innervation of iliopsoas?

A
  • Iliacus: femoral nerve (L2-L4)
  • Psoas major: anterior rami of L1-L3
355
Q

What are the attachments of sartorius?

A
  • Proximal: ASIS
  • Distal: superior, medial surface of the femur (via pes anserinus)
356
Q

What is the function of sartorius?

A

flexor, abductor and lateral rotation of the hip joint, flexor of the knee joint

357
Q

What is the innervation of sartorius?

A

femoral nerve

358
Q

What are the attachments of quadriceps femoris?

A
  • Proximal:
    • Rectus femoris - ASIS
    • Vastus lateralis, vastus intermedius, vastus medius - shaft of femur
  • Distal: patella (via quadriceps tendon) then tibial tuberosity (via patellar tendon/ligament)
359
Q

What is the function of quadriceps femoris?

A

extension of the knee, weak flexion of the hip for rectus femoris

360
Q

What is the innervation of quadriceps femoris?

A

femoral nerve

361
Q

How is the knee jerk reflex elicited?

A
  • The knee jerk is a deep tendon reflex elicited by striking the patellar ligament with a tendon hammer to suggest a sudden stretch of the quadriceps muscle
  • This normally produces a reflex contraction of the quadriceps and a slight extension at the knee joint
  • A positive test confirms the function of this muscle, its nerve supply (femoral nerve L2-L4), the spinal cord connections (reflex arc) and descending controls from the brain which normally act to prevent unwanted recurrent reflexes from occurring during normal functioning
362
Q

What are the muscles in the medial thigh?

A

Adductor magnus
Adductor longus
Adductor brevis
Obturator externus
Gracialis

363
Q

What are the attachments of the adductor magnus?

A
  • Adductor part: proximally inferior rami of pubis, distally linea aspera of the femur (posterior surface)
  • Hamstring part: proximally ischial tuberosity, distally adductor tubercle of the femur (posterior surface)
364
Q

What is the function of the adductor magnus?

A

both parts adduct the thigh, adductor component also flexes the thigh, hamstring component also extends the thigh

365
Q

What is the innervation of the adductor magnus?

A
  • Adductor part: tibial component of the sciatic nerve (L4-S3)
  • Hamstring part: obturator nerve (L2-L4)
366
Q

What are the attachments of the adductor longus?

A
  • Proximal: pubis
  • Distal: linear aspera of the femur
367
Q

What is the function of the adductor longus?

A

adduct the thigh

368
Q

What innervates the adductor longus?

A

obturator nerve (L2-L4)

369
Q

What are the attachments of the adductor brevis?

A
  • Proximal: body of pubis and inferior pubic rami
  • Distal: linear aspera of the femur
370
Q

What are the actions of adductor brevis?

A

adduct the thigh

371
Q

What is the innervation of adductor brevis?

A

obturator nerve (L2-L4)

372
Q

What are the attachments of obturator externus?

A
  • Proximal: membrane of the obturator foramen
  • Distal: posterior aspect of the greater trochanter
373
Q

What is the action of obturator externus?

A

adduction and lateral rotation of the thigh

374
Q

What is the innervation of the obturator externus?

A

obturator nerve (L2-L4)

375
Q

What are the attachments for gracialis?

A
  • Proximal: inferior rami and body of pubis
  • Distal: medial surface of the tibia
376
Q

What is the action of gracialis?

A

adduction of the thigh at the hip, weak flexion of leg at knee (only muscle of this group to cross the knee joint as well as the hip joint)

377
Q

What is the innervation of gracialis?

A

obturator nerve (L2-L4)

378
Q

What are the muscles of the posterior thigh?

A

semitendinosus, semimembranosus and biceps femoris

379
Q

What is the innervation of the posterior muscles of the thigh?

A

All innervated by the tibial division of sciatic nerve (L5, S1, S2) except short head of biceps femoris which is supplied by the common fibular division of the sciatic n

380
Q

What are the attachments of biceps femoris?

A
  • Proximally: long head - ischial tuberosity, short head - linea aspera and lateral supracondylar line of femur
  • Distally: both parts insert into the lateral side of head of fibula - tendon split at this site by the fibular collateral ligament of the knee
381
Q

What is the function of biceps femoris?

A

flexes leg and rotates it laterally when knee is flexed, extends thigh

382
Q

Why is the short head of biceps femoris not a true hamstring muscle?

A
  • Attaches proximally to linea aspera of the femur, not to the ischial tuberosity
  • Does not cross the hip joint - does not contribute to movement
  • Supplied by the common fibular branch of the sciatic nerve rather than the tibial branch
383
Q

What are the attachments of semimembranosus?

A
  • Proximally: ischial tuberosity
  • Distally: posterior part of medial condyle of tibia; reflected attachment forms oblique popliteal ligament
384
Q

What are the actions of semimembranosus?

A

extend thigh, flex leg and rotate it medially when knee is flexed, can extend trunk when thigh and leg are flexed

385
Q

What are the attachments of semitendinosus?

A
  • Proximally: ischial tuberosity
  • Distally: medial surface of superior part of tibia
386
Q

What are the actions of semitendinosus?

A

extend thigh, flex leg and rotate it medially when knee is flexed, can extend trunk when thigh and leg are flexed

387
Q

What are the superficial muscles of the posterior leg?

A

Gastrocnemius
Soleus
Plantaris

388
Q

What are the attachments of gastrocnemius?

A
  • Proximal: lateral head - lateral aspect of lateral condyle of femur, medial head - popliteal surface of femur superior to medial condyle
  • Distal: posterior surface of calcaneus via calcaneal tendon (both heads)
389
Q

What is the function of gastrocnemius?

A

plantarflexes ankle when knee is extended, raises heel during walking, flexes leg at knee joint

390
Q

What innervates the superficial muscles of the posterior leg?

A

tibial nerve (S1, S2)

391
Q

What are the attachments of soleus?

A
  • Proximal: posterior aspect of head and superior quarter of posterior surface of fibula, soleal line and middle third of medial border of tibia, tendinous arch extending between the bony ligaments
  • Distal: posterior surface of calcaneus via calcaneal tendon
392
Q

What are the actions of soleus?

A

plantarflexes ankle (independent the of the position of knee), steadies leg on foot

393
Q

What are the attachments for plantaris?

A
  • Proximal: inferior end of lateral supracondylar line of femur, oblique popliteal ligament
  • Distal: posterior surface of calcaneus via calcaneal tendon
394
Q

What are the actions of plantaris?

A

weakly assists gastrocnemius in plantarflexing ankle

395
Q

What are the deep muscles of the posterior leg?

A

Popliteus
Flexor hallucis longus
Flexor digitorum longus
Tibialis posterior
Calcaneal tendon

396
Q

What are the attachments of the popliteus muscle?

A
  • Proximal: lateral surface of lateral condyle of femur and lateral meniscus
  • Distal: posterior surface of tibia, superior to soleal line
397
Q

What are the actions of politeus?

A

laterally rotates the femur on the tibia - ‘unlocking’ the knee joint so that flexion can occur

398
Q

What nerve innervates the deep muscles of the posterior leg?

A

tibial nerve (L4, L5, S1, S2, S3)

399
Q

What are the attachments of flexor hallucis longus?

A
  • Proximal: inferior 2/3 of posterior surface of fibula, inferior part of interosseous membrane
  • Distal: base of distal phalanx of great toe (hallux)
400
Q

What is the action of flexor hallucis longus?

A

flexes great toe at all joints, weakly plantarflexes angle, supports medial longitudinal arch of foot

401
Q

What is the action of flexor digitorum longus?

A

flexes lateral 4 digits, plantarflexes ankle, supports longitudinal arches of foot

402
Q

What are the attachments of flexor digitorum longus?

A
  • Proximal: medial part of posterior surface of tibia inferior to soleal line
  • Distal: bases of distal phalanges of lateral 4 digits
403
Q

What are the attachments of tibialis posterior?

A
  • Proximal: interosseous membrane, posterior surface of tibia inferior to soleal line, posterior surface of fibula
  • Distal: tuberosity of navicular cuneiform, cuboid, and sustentaculum tali of calcaneus, bases of 2nd, 3rd and 4th metatasals
404
Q

What is the action of tibialis posterior?

A

plantarflexes ankle, inverts foot

405
Q

What is the calcaneal tendon?

A

Tendons of gastrocnemius and soleus together

406
Q

Where does the calcaneal tendon attach?

A

Attaches to calcaneal tuberosity of the calcaneous

407
Q

What does a positive ankle jerk reflex indicate?

A

A positive test confirms the function of the muscles, their peripheral nerve supply (tibial nerve: S1-S2) and the central connections at spinal cord level (reflex arc) and above (descending controls - prevent unwanted reflex actions occurring during normal functioning)

408
Q

What muscles are in the anterior compartment of the leg?

A

tibialis anterior, extensor digitorum longus, extensor hallucis longus, fibularis tertius

409
Q

What muscles are in the anterior compartment of the leg?

A

tibialis anterior, extensor digitorum longus, extensor hallucis longus, fibularis tertius

410
Q

What are the attachments of tibialis anterior?

A
  • Proximal: lateral condyle and superior half of lateral surface of tibia and interosseous membrane
  • Distal: medial and inferior surfaces of medial cuneiform and base of 1st metatarsal
411
Q

What is the action of tibialis anterior?

A

dorsiflexes ankle and inverts foot

412
Q

What nerve innervates the anterior muscles of the leg?

A

deep fibular nerve (L4, L5)

413
Q

Where does the extensor digitorum longus attach?

A
  • Proximal: lateral condyle of tibia and superior 3/4 of medial surface of fibula and intersseous membrane
  • Distal: middle and distal phalanges of lateral 4 digits
414
Q

What is the action of the extensor digitorum longus?

A

extends lateral 4 digits and dorsiflexes ankle

415
Q

What is the action of extensor hallucis longus?

A

extends great toe and dorsiflexes ankle

416
Q

What are the attachments of the extensor hallucis longus?

A
  • Proximal: middle part of anterior surface of fibula and interosseous membrane
  • Distal: dorsal aspect of base of distal phalanx of great toe (hallux)
417
Q

What are the attachments of fibularis tertius?

A
  • Proximal: inferior third of anterior surface of fibula and interosseous membrane
  • Distal: dorsum of base of 5th metatarsal
418
Q

What is the action of fibularis tertius?

A

dorsiflexes ankle and aids in eversion of foot

419
Q

What is foot drop and when does it occur?

A
  • It typically occurs as a consequence of damage to the common fibular (peroneal) nerve - from which the deep fibular nerve arises
  • The muscles in the anterior compartment are paralysed
  • The unopposed pull of the muscles in the posterior leg produces permanent plantarflexion, which can interfere with walking
  • Patient flicks their foot outward during walking - ‘eversion flick’
420
Q

What muscles are in the lateral leg?

A

fibularis longus, fibularis brevis

421
Q

What nerve innervates the lateral leg muscles?

A

superficial fibular nerve (L5, S1, S2)

422
Q

What are the attachments of fibularis longus?

A
  • Proximal: head and superior 2/3 of lateral surface of fibula
  • Distal: base of 1st metatarsal and medial cuneiform
423
Q

What are the actions of fibularis longus?

A

everts foot and weakly plantarflexes ankle

424
Q

What are the attachments of fibularis brevis?

A
  • Proximal: inferior 2/3 of lateral surface of fibula
  • Distal: dorsal surface of tuberosity on lateral side of base of 5th metatarsal
425
Q

What are the actions of fibularis brevis?

A

everts foot and weakly plantarflexes ankle

426
Q

Where are the extrinsic muscles of the foot?

A

arise from the anterior, posterior and lateral compartments of the leg - responsible for eversion, inversion, plantarflexion and dorsiflexion of the foot

427
Q

Where are the intrinsic muscles of the foot?

A

The intrinsic muscles are located within the foot and are responsible for the fine motor actions of the foot, for example movement of individual digits

428
Q

How many sole muscles are there?

A

11 sole muscles - in compartments within the sole, where they are arranged in 3 layers and produce flexion of the toes

429
Q

How many muscles are between the metatarsals?

A

7 interosseous muscles

430
Q

How many muscles are on the dorsum of the foot?

A

2 dorsal muscles

431
Q

What are the actions of the intrinsic muscles of the foot?

A
  • Sole muscles - flexion of the toes
  • Interosseous muscles - adduction/abduction of the toes
  • Dorsal muscles - short extensors of the toes
  • The muscles work as a group to assist with maintenance of the arches of the foot and stabilise the foot in preparation for the ‘push off’ phase of locomotion
  • The individual movements produced by the intrinsic muscles are less important than in the hand since fine control of the toes is less important to most people than fine control of the thumb and fingers
432
Q

What is the innervation of the intrinsic foot muscles?

A

All of the intrinsic muscles are supplied by the tibial nerve (via medial and lateral plantar nerves) or deep fibular nerve (2 dorsal muscles)

433
Q

What are the superficial extrinsic muscles of the shoulder?

A

Trapezius
Latissimus dorsi

434
Q

What is the attachment of the trapezius?

A
  • Proximal: the skull, nuchal ligament and the spinous processes of C7-T12
  • Distal: the clavicle, acromion, and the scapula spine
435
Q

What is the action of the trapezius?

A
  • Upper fibres: elevate the scapula and rotates it during abduction of the arm
  • Middle fibres: retract the scapula
  • Lower fibres: pull scapula inferiorly
436
Q

What is the innervation of the trapezius?

A

CN XI (accessory nerve)

437
Q

What are the attachments of the latissimus dorsi?

A
  • Proximal: spinous processes of T7-T12, iliac crest, thoracolumbar fascia and the inferior 3 ribs
  • Distal: fibres converge into a tendon that attaches to the intertubular sulcus of the humerus
438
Q

What is the action of the latissimus dorsi?

A

extends, adducts, and medially rotates the upper limb

439
Q

What is the innervation of the latissimus dorsi?

A

thoracodorsal nerve

440
Q

What are the deep extrinsic muscles of the shoulder?

A

Levator scapulae
Rhomboid major
Rhomboid minor

441
Q

What are the attachments of levator scapulae?

A
  • Proximal: transverse processes of the C1-C4 vertebrae
  • Distal: medial border of the scapula
442
Q

What are the actions of levator scapulae?

A

elevation of the scapula and inferior rotation of gleniod fossa

443
Q

What is the attachment of the rhomboid major?

A
  • Proximal: spinous processes of T2-T5 vertebrae
  • Distal: medial border of the scapula
444
Q

What is the action of rhomboid major?

A

retraction of the scapula and inferior rotation of glenoid fossa

445
Q

What is the attachment of rhomboid minor?

A
  • Proximal: spinous processes of C7-T1 vertebrae
  • Distal: medial border of the scapula
446
Q

What is the action of rhomboid minor?

A

retraction of the scapula and inferior rotation of glenoid fossa

447
Q

What are the deep extrinsic muscles of the shoulder innervated by?

A

Dorsal scapular nerve

448
Q

What are the intrinsic muscles of the shoulder?

A

Deltoid
Teres Major
Supraspinatus
Infraspinatus
Teres Minor
Subscapularis

449
Q

What are the attachments of the deltoid?

A
  • Proximal: lateral 1/3 of the clavicle, the acromion, and the spine of the scapula
  • Distal: deltoid tuberosity of the humerus
450
Q

What is the action of the deltoid?

A
  • Anterior fibres: flexion and medial rotation at shoulder
  • Posterior fibres: extension and lateral rotation at shoulder
  • Middle fibres: major abductor of the arm (taking over from supraspinatus beyond 15°)
451
Q

What is the innervation of the deltoid?

A

axillary nerve

452
Q

What is the attachment of teres major?

A
  • Proximal: inferior angle of the scapula
  • Distal: medial lip of the intertubecular groove of the humerus
453
Q

What is the action of teres major?

A

adducts and extends the shoulder, and medially rotates the arm

454
Q

What nerve innervates teres major?

A

lower subscapular nerve

455
Q

What are the attachments of the supraspinatus?

A
  • Proximal: supraspinatus fossa of the scapula
  • Distal: greater tubercle of the humerus
456
Q

What is the action of supraspinatus?

A

stabilises head of humerus in glenoid, abducts arm 0-15°

457
Q

What nerve innervates supraspinatus?

A

suprascapular nerve

458
Q

What are the attachments of infraspinatus?

A
  • Proximal: infraspinatus fossa of the scapula
  • Distal: greater tubercle of the humerus
459
Q

What are the actions of infraspinatus?

A

stabilises head of humerus in glenoid, laterally rotates the arm

460
Q

What nerve innervates infraspinatus?

A

suprascapular nerve

461
Q

What are the attachments of teres minor?

A
  • Proximal: posterior surface of the scapula, adjacent to its lateral border
  • Distal: greater tubercle of the humerus
462
Q

What are the actions of teres minor?

A

stabilises head of humerus in glenoid, laterally rotates the arm

463
Q

What innervates teres minor?

A

axillary nerve

464
Q

What are the attachments of subscapularis?

A
  • Proximal: subscapular fossa on the costal surface of the scapula
  • Distal: lesser tubercle of the humerus
465
Q

What are the actions of subscapularis?

A

stabilises head of humerus in glenoid, medially rotates the arm (principle internal rotator)

466
Q

What innervates subscapularis?

A

upper and lower subscapular nerves

467
Q

What is the arterial supply to the anterior compartment of the upper arm?

A

Brachial artery

468
Q

What is the venous drainage of the anterior compartment of the upper arm?

A

Brachial vein

469
Q

What muscle is in the anterior compartment of the upper arm?

A

Biceps brachii
Coracobrachialis
Brachialis

470
Q

What are the attachments of biceps brachii?

A
  • Long head: originates from the supraglenoid tubercle of the scapula
  • Short head: originates from the coracoid process of the scapula
  • Both heads insert distally into the radial tuberosity via the biceps tendon, and the fascia of the forearm via the bicipital aponeurosis
471
Q

What are the actions of biceps brachii?

A

supination of the forearm, flexion of the arm at the elbow and at the shoulder

472
Q

What is the innervation of biceps brachii?

A

musculocutaneous nerve

473
Q

What are the attachment of coracobrachialis?

A
  • Proximal: coracoid process of the scapula
  • Distal: medial side of the humeral shaft
474
Q

What are the actions of coracobrachialis?

A

flexion of the arm at the shoulder, weak adduction

475
Q

What is the innervation of coracobrachialis?

A

musculocutaneous nerve

476
Q

What are the attachments of brachialis?

A
  • Proximal: medial and lateral surfaces of the humeral shaft
  • Distal: ulnar tuberosity
477
Q

What is the innervation of brachialis?

A

musculocutaneous nerve

478
Q

What is the action of brachialis?

A

flexion at the elbow

479
Q

What is the blood supply to the posterior upper arm?

A

profunda brachii artery and ulnar collateral artery

480
Q

What is the venous drainage of posterior upper arm?

A

profunda brachii vein

481
Q

What muscles are in the posterior upper arm?

A

Triceps brachii

482
Q

What are the attachments of the triceps brachii?

A
  • Long head: originates from the infraglenoid tubercle of the scapula
  • Lateral head: originates from the humerus, superior to radial groove
  • Medial head: originates from the humerus, inferior to radial groove
  • Distally, the heads converge to form the triceps tendon and insert into the olecranon process of the ulna
483
Q

What are the actions of triceps brachii?

A

weak extension of the arm at the shoulder joint, and extension of the forearm at the elbow, resists dislocation of the humerus, especially during adduction

484
Q

What is the innervation of triceps brachii?

A

radial nerve

485
Q

What muscles are in the superficial anterior compartment of the forearm?

A

Palmaris Longus
Pronator Teres
Flexor carpi radialis
Flexor carpi ulnaris

486
Q

What muscles are in the intermediate anterior compartment of the forearm?

A

Flexor digitorum superficialis

487
Q

What muscles are in the deep anterior compartment of the forearm?

A

Flexor digitorum profundus
Flexor pollicis longus
Pronator quadratus
Flexor retinaculum

488
Q

What are the attachments of palmaris longus?

A
  • Proximal: medial epicondyle
  • Distal: palmar aponeurosis
489
Q

What is the action of palmaris longus?

A

flexion at the wrist

490
Q

What is the innervation of palmaris longus?

A

median nerve

491
Q

What are the attachments of pronator teres?

A
  • Proximal: two origins, one from the medial epicondyle, and the other from the coronoid process of the ulna
  • Distal: mid-shaft of theradius
492
Q

What are the actions of pronator teres?

A

pronation of the forearm

493
Q

What is the innervation of pronator teres?

A

median nerve

494
Q

What are the attachments of flexor carpi radialis?

A
  • Proximal: medial epicondyle
  • Distal: base of metacarpals II and III (metacarpals on the radial side)
495
Q

What are the actions of flexor carpi radialis?

A

flexion and abduction at the wrist

496
Q

What is the innervation of flexor carpi radialis?

A

median nerve

497
Q

What are the attachment of the flexor carpi ulnaris?

A
  • Proximal: medial epicondyle with the other superficial flexors, also has a long origin from the ulna
  • Distal: pisiform carpal bone (metacarpals on ulnar side)
498
Q

What is the action of flexor carpi ulnaris?

A

flexion and adduction at the wrist

499
Q

What is the innervation of flexor carpi ulnaris?

A

ulnar nerve

500
Q

What are the attachments of flexor digitorum superficialis?

A
  • Proximal: medial epicondyle of humerus, coronoid process of ulna and radial head
  • Distal: splits into four tendons at the wrist, which travel through the carpal tunnel, and attaches to the middle phalanges of the four fingers
501
Q

What is the action and innervation of flexor digitorum superficialis?

A
  • Actions:flexes the metacarpophalangeal joints and proximal interphalangeal joints at the 4 fingers, and flexes at the wrist
  • Innervation:median nerve
502
Q

What are the attachments of flexor digitorum profundus?

A
  • Proximal: originates from the ulna and associated interosseous membrane
  • Distal: splits into four tendons at the wrist that pass through thecarpal tunnel and attach to the distal phalanges of the four fingers
503
Q

What is the action of flexor digitorum profundus?

A

the only muscle that can flex the distal interphalangeal joints of the fingers, also flexes at metacarpophalangeal joints and at the wrist

504
Q

What is the innervation of flexor digitorum profundus?

A

medial half (acts on the little and ring fingers) is innervated by the ulnar nerve, lateral half (acts on the middle and index fingers) is innervated by the anterior interosseous branch of the median nerve

505
Q

What are the attachments of flexor pollicis longus?

A
  • Proximal: anterior surface of the radius and surrounding interosseous membrane
  • Distal: base of the distal phalanx of the thumb
506
Q

What are the actions and innervation of flexor pollicus longus?

A
  • Actions: flexes the interphalangeal joint and metacarpophalangeal joint of the thumb
  • Innervation: median nerve (anterior interosseous branch)
507
Q

What are the attachments of pronator quadratus?

A
  • Proximal: anterior surface of the ulna
  • Distal: anterior surface of the radius
508
Q

What is the action and innervation of pronator quadratus?

A
  • Actions:pronates the forearm
  • Innervation:median nerve (anterior interosseous branch)
509
Q

What is the flexor retinaculum and where is it?

A
  • The antebrachial (deep) fascia of the anterior forearm thickens distally, firstly as the palmar carpal ligament at the aspect of the wrist joint then, distally and deeper, as the flexor retinaculum (transverse carpal ligament)
  • The flexor retinaculum attaches to the scaphoid/trapezoid laterally and the pisiform and hamate medially - arches over the carpal bones, covering them and forming the carpal tunnel
510
Q

What are the superficial posterior muscles of the forearm?

A

Brachioradialis
Extensor carpi radialis longus
Extensor carpi radialis brevis
Extensor digitorum
Extensor digiti minimi
Extensor carpi ulnaris

511
Q

What is the innervation of the posterior forearm muscles?

A

Radial nerve

512
Q

What is the attachments for brachioradialis?

A
  • Proximal: 2/3rds of supracondylar ridge of humerus
  • Distal: lateral surface of distal end of the radius, just before the radial styloid process
513
Q

What is the action of brachioradialis?

A

flexion of the semi-pronated forearm (e.g. when drinking from a cup)

514
Q

What are the attachments of extensor carpi radialis longus?

A
  • Proximal: lateral supracondylar ridge of humerus
  • Distal: dorsal aspect of base of 2nd metacarpal
515
Q

What are the actions of extensor carpi radialis longus?

A

extends and abducts the hand at the wrist joint; active during clenching

516
Q

What are the attachments of extensor carpi radialis brevis?

A
  • Proximal: lateral epicondyle of humerus (common extensor origin)
  • Distal: dorsal aspect of base of 3rd metacarpal
517
Q

What is the action of extensor carpi radialis brevis?

A

extends and abducts the hand at the wrist joint

518
Q

What are the attachments of extensor digitorum?

A
  • Proximal: lateral epicondyle of humerus (common extensor origin)
  • Distal: extensor expansions of medial 4 digits
519
Q

What are the actions of extensor digitorum?

A

extends medial four fingers at the MCP and IP joints

520
Q

What are the attachments of extensor digiti minimi?

A
  • Proximal: lateral epicondyle of humerus (common extensor origin)
  • Distal: extensor expansions of 5th digit
521
Q

What is the action of extensor digiti minimi?

A

extends the little finger and MCP and IP joints

522
Q

What are the attachments of extensor carpi ulnaris?

A
  • Proximal: lateral epicondyle of humerus (common extensor origin)
  • Distal: dorsal aspect of base of 5th metacarpal
523
Q

What is the action of extensor carpi ulnaris?

A

extension and adduction of hand at wrist joint (also active during fist clenching)

524
Q

What are the deep muscles of the posterior forearm?

A

Supinator
Extensor indicis
Abductor pollicis longus
Extensor pollicis brevis
Extensor retinaculum

525
Q

What are the attachments of supinator?

A
  • Proximal: lateral epicondyle of humerus, radial collateral and annular ligaments, supinator fossa, crest of ulna
  • Distal: lateral, posterior, and anterior surfaces of proximal third of radius
526
Q

What are the actions of supinator?

A

supinates the forearm, rotates radius to turn palm anteriorly or superiorly (if elbow is flexed)

527
Q

What are the attachments of extensor indicis?

A
  • Proximal: posterior surface of distal 1/3 of ulna and interosseous membrane
  • Distal: extensor expansion of 2nd digit
528
Q

What is the action of extensor indicis?

A

extends the index finger, helps extend hand at wrist

529
Q

What are the attachments of abductor pollicis longus?

A
  • Proximal: posterior surface of proximal halves of ulna, radius and interosseous membrane
  • Distal: dorsal aspect of base of 1st metacarpal
530
Q

What are the actions of abductor pollicis longus?

A

abducts the thumb and extends it at CMC joint

531
Q

What are the attachments of extensor pollicis brevis?

A
  • Proximal: posterior surface of distal 1/3 of radius and interosseous membrane
  • Distal: dorsal aspect of base of distal phalynx of thumb
532
Q

What are the actions of extensor pollicis brevis?

A

extends at the MCP and CMC joints of the thumb

533
Q

What are the attachments of extensor pollicis longus?

A
  • Proximal: posterior surface of middle 1/3 of ulna and interosseous membrane
  • Distal: dorsal aspect of base of distal phalynx of thumb
534
Q

What are the actions of extensor pollicis longus?

A

extends all joints of the thumb - CMC, MCP, IPJ

535
Q

What is the innervation of the thenar eminence?

A

Median nerve

536
Q

What are the muscles of the thenar eminence?

A

Abductor pollicis brevis
Flexor pollicis brevis
Opponens pollicis

537
Q

What are the attachments for the abductor pollicis brevis?

A
  • Proximal: flexor retinaculum and tubercles of scaphoid and trapezium
  • Distal: lateral side of base of proximal phalynx of thumb
538
Q

What are the actions of abductor pollicis brevis?

A

abducts the thumb, helps opposition of the thumb

539
Q

What are the attachments of flexor pollicis brevis?

A
  • Proximal: flexor retinaculum and tubercles of scaphoid and trapezium
  • Distal: lateral side of base of proximal phalynx of thumb
540
Q

What is the actions of flexor pollicis brevis?

A

flexes the first MCP joint of the thumb

541
Q

What are the attachments of opponens pollicis?

A
  • Proximal: flexor retinaculum and tubercles of scaphoid and trapezium
  • Distal: lateral side of 1st metacarpal
542
Q

What are the actions of opponens pollicis?

A

opposes the thumb, by medially rotating and flexing the metacarpal on the trapezium

543
Q

What are the muscles of the hypothenar eminence?

A

Abductor digiti minimi
Flexor digiti minimi
Opponens digiti minimi

544
Q

What are the attachments of abductor digiti minimi?

A
  • Proximal: pisiform
  • Distal: medial side of base of proximal phalanx of 5th digit
545
Q

What are the actions of abductor digiti minimi?

A

abducts the 5th digit; assists in flexion of its proximal phalanx

546
Q

What nerve innervates the hypothenar muscles?

A

Ulnar

547
Q

What are the attachments of flexor digiti minimi?

A
  • Proximal: hook of hamate and flexor retinaculum
  • Distal: medial side of base of proximal phalanx of 5th digit
548
Q

What are the actions of flexor digiti minimi?

A

flexes proximal phalanx of 5th digit

549
Q

What are the attachments of opponens digiti minimi?

A
  • Proximal: hook of hamate and flexor retinaculum
  • Distal: medial border of 5th metacarpal
550
Q

What are the actions of opponens digiti minimi?

A

draws 5th metacarpal anterior and rotates it, bringing 5th digit into opposition with thumb

551
Q

What are the attachments for the lumbricals?

A
  • Proximal: tendons of flexor digitorum profundus
    • 1st and 2nd - lateral 2 tendons
    • 3rd and 4th - medial 3 tendons
  • Distal: extensor expansion of the same digit
552
Q

What are the actions of the lumbricals?

A
  • flex the MCP and extend the PIP joints
    • Span the anterior aspect of the 2nd to 5th MCP joints and then the posterior aspect of the 2nd to 5th PIP joints
553
Q

What is the innervation of the lumbricals?

A

medial nerve (lateral 2), deep branch of ulnar nerve (medial 2)

554
Q

What are the attachments of the dorsal interrossei?

A
  • Proximal: lateral and medial surfaces of metacarpals
  • Distal: extensor expansions and proximal phalanx of each finger
555
Q

What are the actions of the dorsal interossei?

A

abducts the fingers at the MCP joint (DAB)

556
Q

What is the innervation of the dorsal interossei?

A

deep branch of ulnar nerve

557
Q

What is the attachment of the palmar interossei?

A
  • Proximal: medial or lateral surface of a metacarpal
  • Distal: bases of proximal phalanges, extensor expansion and proximal phalanx of same finger
558
Q

What is the action of the palmar interossei?

A

adducts the fingers at the MCP joint (PAD)

559
Q

What is the innervation of palmar interossei?

A

deep branch of ulnar nerve

560
Q

What is the main artery of the lower limb?

A

Femoral artery

561
Q

Where does the femoral artery arise from?

A
  • Continuation of the external iliac artery
    • External iliac becomes the femoral artery when it crosses under the inguinal ligament and enters the femoral triangle
562
Q

Where does the profunda femoris artery arise from?

A

In the femoral triangle, the profunda femoris artery arises from the posterolateral aspect of the femoral artery, travelling posteriorly and distally

563
Q

What are the 3 main branches of the profunda femoris artery? and what do they supply?

A
  • Perforating branches: 3/4 arteries that perforate the adductor magnus, contributing to the supply of the muscles in the medial and posterior thigh
  • Lateral femoral circumflex artery and medial femoral circumflex artery: supply the majority of blood to the head of the femur through their retinacular branches, which pass superiorly to the femoral neck and capsule of hip joint
564
Q

What artery can be damaged in a neck of femur fracture and what are the complications?

A

Fractures occurring at the neck of the femur are in danger of severing the medial circumflex artery - if not corrected can lead to avascular necrosis of the femoral head

565
Q

Where can the femoral pulse be felt?

A

The femoral pulse can easily be palpated in the femoral triangle, 2-3 cm inferior to the midpoint of the inguinal ligament

566
Q

Where does the popliteal artery arise from?

A

Continuation of the femoral artery

567
Q

What does the popliteal artery give rise to?

A

The popliteal artery divides immediately distal to the popliteal fossa into the anterior and posterior tibial arteries; the fibular artery is a branch of the posterior tibial artery

568
Q

What does the anterior tibial artery supply?

A

Pierces the interosseous membrane to supply the anterior compartment of the leg

569
Q

What does the posterior tibial artery supply?

A

The posteriro compartment of the leg

570
Q

Where is the posterior tibial artery located?

A
  • Runs with the tibial nerve, mainly between the superficial and deep muscles
  • Leaves the posterior compartment by passing posterior to the medial malleolus (where the posterior tibial pulse is taken) and deep to the flexor retinaculum
571
Q

What does the posterior tibial artery give rise to?

A

In the foot, the posterior tibial artery terminates by dividing into the medial and lateral planter arteries

572
Q

Where does the fibular artery arise from?

A

The fibular artery branches from the posterior tibial artery in the proximal half of the compartment

573
Q

What does the fibular artery give rise and supply to?

A

It descends in the compartment on the posterior intermuscular septum and sends perforating branches through the septum to supply the lateral compartment of the leg

574
Q

Where does the dorsalis pedis artery arise from? and what does it give rise to?

A

Branch of anterior tibial artery
Branches to give the arcuate artery of the dorsum of the foot

575
Q

Where can the dorsalis pedis pulse be felt?

A

Pulse taken lateral to extensor hallucis longus tendon

576
Q

Where do the medial and lateral plantar arteries arise from? and what do they give rise to?

A

Branches of posterior tibial artery
- Both contribute to the deep plantar arch
- From the deep plantar arch and the arcuate artery arise metatarsal arteries which branch into digital arteries (as in the hand, 4 digital arteries per toe)

577
Q

Where do the metatarsal arteries arise from?

A

Arise from the deep plantar arch and the arcuate artery

578
Q

Where do the digital arteries arise from and what is important clinically about them?

A
  • The metatarsal arteries branch into 4 digital arteries per toe
  • These are end arteries - no adrenaline-containing local anaesthetic should be used
579
Q

What is the main venous drainage in the foot?

A

dorsal venous arch, which mostly drains into the superficial veins

580
Q

How is the anterior tibial vein formed?

A

Some veins from the arch penetrate deep into the leg, forming the anterior tibial vein

581
Q

Where are the medial and lateral plantar veins and what do they form?

A

On the plantar aspect of the foot,medialandlateralplantarveins arise and they combine toform theposterior tibialandfibularveins

582
Q

Where is the posterior tibial vein?

A

The posterior tibial vein accompanies the posterior tibial artery, entering the leg posteriorly to themedial malleolus

583
Q

How is the popliteal vein formed?

A

On the posterior surface of the knee, the anterior tibial, posterior tibial and fibular veins unite to form thepopliteal vein

584
Q

Where does the femoral vein occur?

A

Once the popliteal vein has entered the thigh, it is known as the femoral vein; it accompanies the femoral artery

585
Q

When does the femoral vein become the external iliac vein?

A

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

586
Q

What is the venous drainage of the gluteal region?

A

Drained by inferior and superior gluteal veins, which empty into the internal iliac vein

587
Q

What is the great saphenous vein and where does it arise from?

A
  • Arises from medial aspect of the dorsal venous arch of the foot
  • Ascends up the medial side of the leg, passing anteriorly to the medial malleolus of the tibia, and approximately 1 hands breadth medial to the medial aspect of the patella
    • In the leg runs with the saphenous nerve
  • Pierces the deep fascia of the thigh in the region of the femoral triangle and drains into femoral vein in the anterior proximal thigh, just distal to the approx. midpoint of the inguinal ligament
  • The great saphenous vein enlarges as it travels proximally through the acquisition of tributaries
588
Q

Where is the small saphenous vein and what is its function?

A
  • Arises from the lateral aspect of the dorsal venous arch of the foot
  • Travels up the posterior midline of the leg
  • Drains deep within the popliteal fossa into the popliteal vein - becomes the femoral vein proximally
589
Q

Where does the lymph following the great saphenous vein drain into?

A
  • Lymph following the great saphenous vein drains into the superficial inguinal lymph nodes located in the superficial fascia around the vein
    • Lymph from the superficial inguinal nodes then drains mostly into the external iliac nodes and some to the deep inguinal nodes
590
Q

Where does the lymph following the small saphenous vein drain into?

A
  • Lymph following the small saphenous vein drains into popliteal lymph nodes, located in the popliteal fossa
    • Lymph from the popliteal nodes then drains into the deep inguinal nodes
591
Q

Where are the deep inguinal lymph nodes and where do they drain?

A
  • The deep inguinal lymph nodes are found deep to the deep fascia of the thigh (fascia lata) medial to the femoral vein
  • The deep inguinal lymph nodes drain into the external iliac nodes - therefore all lymph from the lower limb ultimately drains to external iliac nodes
    • The external iliac lymph nodes drain to the common iliac nodes and enter lumbar lymphatics
592
Q

What is the anterior cutaneous nerve of the thigh and what does it supply?

A
  • Branch of the femoral nerve (L2-L4)
  • Supplies skin on anterior and medial aspects of the thigh
593
Q

What is the lateral cutaneous nerve of the thigh and what does it supply?

A
  • Branch of the lumbar plexus (L2-3)
  • Supplies skin on anterior and lateral aspects of the thigh
594
Q

What does the cutaneous branch of the obturator nerve supply?

A

Supplies skin on middle part of medial thigh

595
Q

What is the posterior cutaneous nerve of the thigh and what does it supply?

A
  • Branch of the sacral plexus (S1-S3)
  • Enters gluteal region through the intra-piriform foramen (part of greater sciatic foramen), can be found running medial to the sciatic nerve
  • Supplies the skin of the inferior half of the buttock, the skin of the posterior thigh and the skin of the popliteal fossa
  • Somatic nerve that contains sympathetic and sensory fibres
596
Q

What supplies the dorsum of the foot?

A

Mainly superficial fibular nerve with deep fibular nerve supplying the first interdigital cleft, sural nerve supplying the proximal lateral border and the saphenous nerve supplying the proximal medial border

597
Q

What supplies the plantar surface of the foot?

A

Mainly tibial nerve to the heel and majority of the sole (medial and lateral plantar nerves) with sural nerve supplying the proximal lateral border and the saphenous nerve supplying the proximal medial border

598
Q

Where is the pudendal nerve and what are it’s functions?

A
  • Principle nerve of the perineum
  • Formed in the sacral plexus within the pelvis
  • Enters gluteal region through the infra-piriform foramen, posterior to the sacrospinous ligament, to enter the pelvis through the lesser sciatic foramen
  • Emerges in the middle of the gluteal region
  • Motor functions: innervates various pelvic muscles, the external urethral sphincter and external anal sphincter
  • Sensory functions: innervates the external genitalia of both sexes and the skin around the anus, anal canal and perineum
599
Q

Where is the superior gluteal nerve and what are it’s functions?

A
  • Enters gluteal region through the suprapiriform foramen
  • Motor functions: supplies gluetus medius and minumus
  • Sensory functions: none
600
Q

Where is the inferior gluteal nerve and what are it’s functions?

A
  • Enters gluteal region through the infrapiriform formen, then divides into many branches before piercing the glueus maximus
  • Motor functions: supplies gluetus maximus
  • Sensory functions: none
601
Q

Where is the nerve to quadratus femoris and what are it’s functions?

A
  • Enters gluteal region through the infrapiriform formen, deep to the sciatic nerve
  • Motor functions: supplies hip joint, inferior gemellus and quadratus femoris
  • Sensory functions: none
602
Q

Where is the nerve to obturator internus and what are it’s functions?

A
  • Enters gluteal region through the infrapiriform foramen, posterior to sacrospinous ligament to enter the pelvis through lesser sciatic foramen
  • Motor functions: supplies superior gemellus and obturator internus
  • Sensory functions: none
603
Q

What nerves are in the sacral plexus?

A

Pudendal nerve
Superior gluteal nerve
Inferior gluteal nerve
Nerve to quadratus femoris
Nerve to obturator internus
Sciatic nerve
Posterior femoral cutaneous nerve
Nerve to piriformis

604
Q

What nerves are in the lumbar plexus?

A

Lateral cutaneous nerve of the thigh
Obturator nerve
Femoral nerve
Iliohypogastric
Ilioinguinal
Genitofemoral

605
Q

What does the lateral cutaneous nerve of the thigh supply?

A
  • Motor functions:none
  • Sensory functions: innervates the anterior and lateral thigh down to the level of the knee
606
Q

Where is the obturator nerve located and where does it split?

A
  • Obturator nerve, artery and vein enter the medial compartment of the thigh via the obturator foramen of the hip bone
  • Nerve divides into anterior and posterior branches at the upper border of adductor brevis
    • Anterior branch can be located between adductors longus (anteriorly) and brevis (posteriorly) in the superior part of the medial compartment
607
Q

What is the function of the obturator nerve?

A
  • Motor functions: innervates the muscles of the medial thigh - the obturator externus, adductor longus, adductor brevis, adductor magnus and gracilis
  • Sensory functions: innervates the skin over the medial thigh
608
Q

What is the function of the femoral nerve?

A
  • Motor functions: innervates the muscles of the anterior thigh - the illiacus, pectineus, sartorius and quadriceps femoris
  • Sensory functions: innervates the skin on the anterior thigh and the medial leg
609
Q

What are the nerve roots of the sciatic nerve and where does its branches arise?

A
  • Nerve roots: L4-S3
    • Divides into the tibial nerve and common fibular nerve; this can occur anywhere between the gluteal region and the popliteal fossa (most commonly inferior 1/3 of thigh)
610
Q

What are the functions of the sciatic nerve?

A
  • Motor functions:
    • Muscles of the posterior thigh and the hamstring portion of the adductor magnus
    • Indirectly innervates (via terminal branches) all the muscles of the leg and foot
  • Sensory functions:
    • No direct sensory functions
    • Indirectly innervates (via terminal branches) the skin of the lateral leg, heel, and both the dorsal and plantar surfaces of the foot
611
Q

What is the journey of the sciatic nerve?

A
  • The sciatic nerve is derived from the lumbosacral plexus
  • After formation, it usually exits the greater sciatic foramen inferior to periformis leaves the pelvis and enters the middle of the gluteal region via the greater sciatic foramen inferior to periformis
  • Supplies nothing in gluteal region
  • The sciatic nerve most commonly divides into the tibial and common fibular nerve at the superior apex of the popliteal fossa
  • Tibial and common fibular branches supply posterior thigh, all leg and foot, muscles and most of the skin via tibial and common fibular branches
612
Q

What are the tibial nerve branches and what do they supply?

A
  • Tibial nerve descends vertically through the popliteal fossa
  • While in the popliteal fossa the tibial nerve gives branches to both heads of gastrocnemius as well as the 2 small deeper muscles of the fossa
  • Supplies all the muscles in the posterior compartment of the leg
613
Q

Where is the common fibular nerve and where does it go?

A
  • Skirts the lateral border of the popliteal fossa, deep to biceps femoris tendon
  • Leaves the politeal fossa between that biceps femoris tendon and the lateral head of gastrocnemius to reach the fibular neck
  • Common fibula nerve winds the fibular neck and then divides the deep and superficial fibular nerves
    • Superficial fibular nerve supplies the muscle of the lateral compartment of the leg and skin/fascia of the dorsum of the foot
    • Deep fibular nerve supplies the muscles of the anterior compartment of the leg and the skin of the first interdigital cleft
614
Q

Where is the common fibular nerve vulnerable?

A
  • The common fibular nerve is vulnerable to compression injury against the neck of the fibula (e.g. in a tight plaster cast)
    • Can cause dysfunction of the nerve and the muscles it supplies, and can lead to abnormal sensation in the area of skin supplied by the nerve
  • Common fibular nerve can also be damaged in fractures of the fibular neck
615
Q

What are the 5 main vessels (from proximal to distal) that supply blood to the upper limb?

A
  • Subclavian artery
  • Axillary artery
  • Brachial artery
  • Radial artery
  • Ulnar artery
616
Q

Where can the subclavian artery be palpated?

A

Pulsations of the subclavian artery can be palpated where the artery crosses the first rib

617
Q

Where is the axillary artery?

A

At the lateral border of the first rib, the subclavian artery enters the axilla, and is renamed the axillary artery

618
Q

Where is the brachial artery? and what does it give rise to?

A
  • At the lower border of the teres major muscle, the axillary artery is renamed the brachial artery
  • Immediately distal to the teres major, the brachial artery gives rise to the profunda brachii (deep artery), which travels with the radial nerve in the radial groove of the humerus and supplies structures in the posterior aspect of the upper arm (e.g. triceps brachii)
  • As the brachial artery moves through the cubital fossa, it terminates by bifurcating into the radial and ulnar arteries
619
Q

What does the radial artery supply?

A

supplies the posterolateral aspect of the forearm

620
Q

What does the ulnar artery supply?

A

supplies the anteromedial aspect of the forearm, gives rise to the anterior and posterior interosseous arteries

621
Q

How are the superficial palmar arch and the deep palmar arch formed?

A

These two arteries anastomose in the hand by forming two arches - the superficial palmar arch, and the deep palmar arch

622
Q

What is the neurovascular supply of the fingers?

A

Each finger has 4 neurovascular bundles supplying it: medial palmar, lateral palmar, medial dorsal and lateral dorsal

623
Q

What is the houseman’s vein?

A

the section of the cephalic vein on the lateral aspect of the distal forearm, often used for siting a cannula

624
Q

Where is the cephalic vein?

A
  • Arises from dorsal venous network
  • Runs proximally on the lateral side of the anterior forearm and arm
    Runs anteriorly on the midline of the biceps brachii
    • As it courses proximally it runs through the deltopectoral groove
  • Pierces the deep fascia in the deltopectoral triangle to drain into axillary vein
    • Axillary vein becomes the subclavian vein at the lateral border of rib 1
625
Q

Where is the basilic vein located?

A
  • Arises from dorsal venous network
  • Runs proximally on the medial aspect of the anterior forearm
  • At the border of teres major, the vein pierces the deep fascia and combines with the brachial veins from the deep venous system to form the axillary vein
626
Q

What is the median cubital vein?

A

Connection between the cephalic and basilic veins within the cubital fossa

627
Q

Where does the brachial vein become the axillary vein?

A

The brachial vein becomes the axillary vein at the lower border of teres major

628
Q

Where do the superficial lymphatic vessels arise from and where do they go?

A
  • The superficial lymphatic vessels of the upper limb initially arise fromlymphatic plexusesin the skin of the hand
  • These vessels then travel up the arm in close proximity to the major superficial veins
  • The vessels shadowing thebasilic veingo on to enter the cubital lymph nodes
    • These are found medially to the vein, and proximally to the medial epicondyle of thehumerus
    • Vessels carrying on from these nodes then continue up the arm, terminating in the lateral axillary lymph nodes
  • The vessels shadowing thecephalic veingenerally cross the proximal part of the arm and shoulder to enter the apical axillary lymph nodes, though some exceptions instead enter the more superficial deltopectoral lymph nodes
629
Q

Where are the deep lymphatic vessels and where do they go?

A

The deep lymphatic vessels of the upper limb follow the major deep veins (i.e. radial, ulnar and brachial veins), terminating in the humeral axillary lymph nodes

630
Q

What are the basal lymph nodes and where are they/where do they drain?

A
  • Drain to central nodesPectoral (anterior)
    • Located along the lateral border of pectoralis minor and receive much lymph from the breast
    Subscapular (posterior)
    • Receive lymph from the scapular region
    Humeral (lateral)
    • Receive most of the lymph drained from the upper limb
631
Q

Where do the central lymph nodes drain?

A

Drain to apical nodes

632
Q

Where are the apical lymph nodes located and where do they drain?

A
  • Located in the apex of the axilla, close to the axillary vein and 1st part of the axillary artery
  • Drain towards the right lymphatic duct/thoracic duct
633
Q

What is the cutaneous supply to the medially posterior upper arm?

A
  • Anterior rami of spinal nerves C8, T1 and T2
  • This is therefore a common site for cardiac referred pain, especially to the left upper limb, via the intercostobrachial nerve and posterior cutaneous nerves of the arm (branch of radial nerve) and medial cutaneous nerve of forearm
634
Q

What is the cutaneous supply to the laterally posterior upper arm?

A
  • Anterior rami of spinal nerves C5 and C6 via the axillary nerve
    • The axillary nerve gives off the superior lateral cutaneous nerve of arm, which innervates the inferior region of the deltoid
    • The area of skin innervated by the axillary nerve is called the ‘badge patch’ (lateral aspect of arm)
635
Q

What is the cutaneous supply to the lateral aspect of the upper arm?

A

Radial nerve via lower lateral cutaneous nerve of arm inferior to insertion of deltoid

636
Q

What is the cutaneous supply to the forearm?

A
  • The musculocutanous nerve gives rise to the lateral cutaneous nerve of the forearm, which innervates the skin of the anterolateral aspect of the forearm
  • Posterior cutaneous nerve of forearm - branch of radial nerve that innervates a strip of skin down the middle of the posterior forearm
637
Q

What is the cutaneous supply to the palmar aspect of the hand?

A
  • Ulnar nerve: medial part of palm, little finger, medial half of ring finger
  • Median nerve: central/lateral palm, lateral half of ring finger, middle and index finger, thumb (excluding skin over base)
  • Radial nerve: skin over the base of the thumb
638
Q

What is the cutaneous supply to the dorsal aspect of the hand?

A
  • Ulnar nerve: medial part of dorsum of the hand, little finger, medial half of ring finger
  • Medial nerve: skin over distal phalanges/nail beds of thumb, index finger, middle and ring fingers
  • Radial nerve: skin over anatomical snuffbox, lateral part of dorsum of hand, proximal thumb, index, middle and ring fingers
639
Q

What is the pathway of the brachial plexus?

A
  • Brachial plexus originates from the anterior rami of spinal nerves C5-T1
  • Branches pass through the axilla to the medial arm
640
Q

What are the trunks of the brachial plexus?

A
  • C5 and C6 form the superior (upper) trunk
  • C7 continues as the middle trunk
  • C8 and T1 form the inferior (lower) trunk
641
Q

What are the divisions of the brachial plexus?

A

Each trunk divides into an anterior and posterior division

642
Q

What are the cords of the brachial plexus?

A
  • Cords are named according to their relationship with the axillary artery
  • Lateral cord: formed by the anterior division of the superior trunk and the anterior division of the middle trunk
  • Posterior cord: formed by the posterior division of all 3 trunks
  • Medial cord: formed by the anterior division of the inferior trunk
643
Q

Where is the brachial plexus?

A
  • The roots and trunks lie mainly between the anterior and middle scalene muscles in the root of the neck
  • The divisions lie immediately posterior to the subclavian vessels in the root of the neck (deep to the clavicle)
  • The cords lie around the axillary artery, which is distal to the first rib
644
Q

What are the major branches of the brachial plexus?

A

In the axilla and proximal aspect of the upper limb the cords give rise to 5 branches which are the main motor and sensory nerves of the upper limb: musculocutaneous nerve, median nerve, ulnar nerve, axillary nerve, radial nerve

645
Q

What are the nerve roots of musculocutaneous nerve?

A

C5-C7

646
Q

What is the anatomical course of the musculocutaneous nerve?

A

Continues directly from the lateral cord of the brachial plexus

647
Q

What are the motor and sensory functions of the musculocutaneous nerve?

A

Motor functions

  • Innervates the brachialis, biceps brachii and coracobrachialis muscles

Sensory functions

  • Gives off the lateral cutaneous branch of the forearm, which innervates the lateral half of the anterior forearm, and a small lateral portion of the posterior forearm
648
Q

What are the nerve roots of the median nerve?

A

C6-T1

649
Q

What is the anatomical course of the median nerve?

A
  • Formed from contributions from the medial and lateral cord of the brachial plexus
  • Forms the middle of the ‘M-shaped’ configuration of the named nerves within the axilla
  • In the forearm, the medial nerve gives off two major branches: anterior interosseous nerve and palmar cutaneous nerve
  • After giving off the anterior interosseous and palmar cutaneous branches, the median nerve enters the hand via the carpal tunnel - where it terminates by dividing into the recurrent branch and the palmar digital branch
650
Q

What are the functions of the median nerve?

A

Motor functions

  • Anterior interosseous nerve supplies all muscles of the anterior forearm except for the flexor carpi ulnaris and the medial part of flexor digitorum profundus
  • Recurrent branch innervates the thenar muscles
  • Palmar digital branch innervates the lateral 2 lumbricals

Sensory functions

  • Palmar cutaneous branch innervates the lateral part of the palm
  • Digital cutaneous branch innervates the lateral three and a half fingers on the anterior (palmar) surface of the hand
651
Q

What are the nerve roots of the ulnar nerve?

A

C8-T1

652
Q

What is the anatomical course of ulnar nerve?

A
  • Continues directly from the medial cord of the brachial plexus
  • It is the most medial of the named nerves of the brachial plexus - it passes posteriorly into the medial aspect of the arm
  • It crosses the posterior surface of the medial epicondyle of the humerus where it can be palpated and readily injured (‘funny bone’ site)
  • It passes through flexor carpi ulnaris to reach the anterior compartment of the forearm
653
Q

What are the functions of the ulnar nerve?

A

Motor functions

  • Innervates the muscles of the hand (apart from the thenar muscles and two lateral lumbricals), flexor carpi ulnaris and medial half of flexor digitorum profundus

Sensory functions

  • Innervates the anterior and posterior surfaces of the medial one and half fingers, and associated palm area
654
Q

What are the nerve roots of the axillary nerve?

A

C5-C6

655
Q

What is the anatomical course of axillary nerve?

A
  • Branch of posterior cord of the brachial plexus
  • Passes into the posterior compartment of the arm
  • Found in the quadrangular space between teres minor superiorly, teres major inferiorly, the long head of triceps medially and the humerus laterally
  • Lies superior to the radial nerve
  • Wraps around the posterior aspect of the surgical neck of the humerus
656
Q

When is the axillary nerve vulnerable?

A

As the nerve wraps around the posterior neck of the humerus, it is vulnerable to injury in shoulder dislocation or fractured neck of humerus

657
Q

What are the functions of the axillary nerve?

A

Motor functions

  • Innervates the teres minor and deltoid muscles

Sensory functions

  • Gives off the superior lateral cutaneous nerve of arm, which innervates the inferior region of the deltoid
  • The area of skin innervated by the axillary nerve is called the ‘badge patch’ (lateral aspect of arm)
658
Q

What is the importance of the badge patch?

A

Patients who have sustained an inferior dislocation of the shoulder joint should undergo specific assessment of sensation in the region of the badge patch to test the function of the axillary nerve

659
Q

What are the nerve roots of the radial nerve?

A

C5-T1

660
Q

What is the anatomical course of the radial nerve?

A
  • Branch of posterior cord of the brachial plexus
  • Passes from the axilla into the posterior compartment of the arm where it is round in the radial groove of the humerus (in the mid-shaft of the humerus)
  • After supplying the triceps brachii, the radial nerve leaves the posterior compartment of the arm to enter the lateral aspect of the cubital fossa
  • Just anterior to the lateral epicondyle, the radial nerve divides into a superficial and a deep branch
  • The deep branch passes into the posterior compartment of the forearm by winding around the neck of the radius and passing through supinator muscle (which it supplies)
    • After passing through supinator the deep branch is renamed the posterior interosseous nerve, which supplies the muscles of the posterior compartment of the forearm
    • The deep branch of the radial nerve lies with the posterior interosseous artery
  • The superficial branch contributes to the cutaneous innervation of the dorsal hand and fingers
661
Q

What are the functions of the radial nerve?

A

Motor functions

  • Innervates the triceps brachii
  • Deep branch innervates the muscles in the posterior compartment of the forearm

Sensory functions

  • Innervates the posterior aspect of the arm and forearm
  • Superficial branch innervates the posterolateral aspect of the hand
662
Q

When is the radial nerve vulnerable?

A

Due to its position in the radial groove, the radial nerve and its accompanying vessels are vulnerable to damage in a (spiral) mid-shaft fracture of the humerus

663
Q

What is wrist drop?

A

The characteristic clinical sign of radial nerve injury is wrist drop - inability to extend the wrist and fingers due to paralysis of the posterior forearm muscles

664
Q
A
665
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A
666
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A
667
Q
A
668
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A
669
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A
670
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A
671
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672
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673
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674
Q
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675
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A
676
Q
A
677
Q
A
678
Q
A
679
Q
A
680
Q

Identify the yellow

A
681
Q

Identify the green

A
682
Q

Identify the blue

A
683
Q

Identify the red

A
684
Q
A
685
Q
A
686
Q
A
687
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A
688
Q
A
689
Q
A
690
Q
A
691
Q
A
692
Q
A
693
Q
A
694
Q
A
695
Q

Identify the coloured bones

A
696
Q

Identify the bones

A
697
Q
A
698
Q
A
699
Q
A
700
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701
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702
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703
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704
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705
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706
Q
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707
Q
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708
Q
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709
Q
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710
Q
A
711
Q

Identify the coloured parts

A
712
Q
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713
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A
714
Q
A
715
Q
A
716
Q
A
717
Q
A
718
Q
A
719
Q
A
720
Q

Identify the arches

A
721
Q
A
722
Q
A
723
Q
A
724
Q
A
725
Q
A
726
Q
A
727
Q
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728
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729
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730
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731
Q
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732
Q
A
733
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734
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735
Q
A
736
Q
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737
Q
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738
Q
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739
Q
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740
Q
A
741
Q
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742
Q
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743
Q
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744
Q
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745
Q
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746
Q
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747
Q
A
748
Q
A
749
Q
A
750
Q
A
751
Q
A
752
Q
A
753
Q
A
754
Q

What is this area?

A

Cubital fossa

755
Q
A
756
Q
A
757
Q
A
758
Q
A
759
Q
A
760
Q
A
761
Q
A
762
Q
A
763
Q
A
764
Q
A
765
Q
A
766
Q
A
767
Q
A
768
Q

What is this area?

A

The anatomical snuffbox

769
Q
A
770
Q
A
771
Q
A
772
Q
A
773
Q
A
774
Q
A
775
Q
A
776
Q
A
777
Q
A
778
Q
A
779
Q
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780
Q
A
781
Q
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782
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783
Q
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784
Q
A
785
Q
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786
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787
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788
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A
789
Q
A
790
Q
A
791
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792
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793
Q
A
794
Q
A
795
Q
A
796
Q
A
797
Q
A
798
Q
A
799
Q
A

Musculoskeletal MBCHB (21 decks)

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