Anatomy Flashcards
Rotator cuff muscles and their origins, insertions and actions?
Supraspinatus- supraspinous fossa to Superior facet of GT
Abduction. Suprascapular nerve
Infraspinatus- infraspinous fossa to medial facet of GT
Ext rotation. Suprascapular nerve
Teres Minor- Lateral boarder of scapula to inferior facet of GT
Ext rotation. Axillary nerve
Subscpularis- subscapular fossa to LT, Internal rotation
Subscapular Nerve
What nerve innervates Teres Major?
Subscapular nerve- also innervates subscapularis
What muscles attach to the coracoid process?
Conjoint tendon- Short head of biceps, coracobrachialis
Pec Minor inserts
Attachments of Biceps brachii?
Supraglenoid tubercle + coranoid
To Bicipital tuberosity on radius
Axillary spaces and their contents?
Quadrangular Space- Axillary nerve and post circumflex humeral A
Triangular space- post circumflex scapular A
Triangular Interval- Radial Nerve and profunda Brachii
What are the muscular and ligamentous attachments to the clavicle and how does this affect the displacement of fractures such as this?
The muscular attachments include the sternocleidomastoid muscle, trapezius, deltoid, pectoralis major, sterno-hyoid and the subclavius muscle. The ligamentous attachments are the costoclavicular, sternoclavicular and interclavicular ligaments to the medial end of the clavicle and the acromioclavicular ligament and the two coracoclavicular ligaments laterally.
Middle third fractures of the clavicle tend to displace with the medial fragment pulled superiorly by the action of the sternocleidomastoid muscle and the lateral fragment pulled inferiorly by the weight of the arm and its attachments to the lateral clavicle.
Describe the origin, course and insertion of the flexor digitorum supericialis (FDS) and flexor digitorum profundus (FDP) muscles.
And their innervation?
Flexor digitorum superficialis:
From medial epicondyle runs in intermediate flexor compartment of forearm.
Inserts into the middle phalanges of each finger.
Median nerve
Flexor digitorum profundus:
From interosseous membrane in the proximal forearm
Inserts into the distal phalanges of each finger.
AIN and Ulna nerve
What muscles does AIN innervate?
FPL
Pronator Quadratus
Radial half of FDP
Boundaries and contents of antecubital fossa?
Superiorly- imaginary line between epicondyles
Medially by Pronator teres
Laterally by Brachioradialis (radial nerve underneath)
Floor is Brachialis and supinator
Roof is fascia and skin
Contents
Lateral to medial- TAN
Biceps tendon
Brachial Artery
Median Nerve
Describe the path of the radial nerve?
C5-T1- posterior cord
Exits axilla via triangular interval with profunda brachii
Runs in posterior compartment of arm
Spiral groove of humerus
Passes anteriorly to lateral epicondyle underneath brachioradialis
Divides into PIN and SPN
PIN pierces supinator + runs on posterior interosseous membrane
Supplies muscles of extension in forearm
SPN runs underneath brachioradialis lateral to radial artery to hand
Runs through base of anatomical snuff box suppling sensation to posterior aspect of forearm and radial half of dorsum hand
What muscles does the radial nerve supply before its division into PIN and SRN
Aconeus
Triceps
Brachioradialis
ECRL
Common causes of nerve injury- generic answer?
Trauma vs compression
What muscles attach to the medial epicondyle?
Superfiscial flexors of the forearm
FCU, PL, FCR, PT, FDS
What is the sensory nerve supply to the forearm?
Posterior aspect- posterior cutaneous nerve of forearm from radial N
Anteromedially- medial cutaneous nerve of the forearm from medial cord of brachial plexus
Anterolaterally- lateral cutaneous nerve of the forearm from musculocutaneous nerve
Course of the radial and ulna artery?
Divisions of brachial artery
Radial artery runs beneath and lateral to brachioradialis with SRN lateral to it.
Crosses into the hand in the floor of the anatomical snuffbox becomes deep palmar arch
Ulnar artery runs atop of FDP, between FDS and FCU running with Ulna nerve. Crosses into the hand via Guyon’s canal splitting into the deep and superfiscial palmar arch
Course of median nerve?
C5-T1 from lateral and medial cords of Brachial Plexus
Runs lateral to brachial artery, then crosses to medial as it enters forearm at the medial aspect of the antecubital fossa
Divides as it passes through the 2 heads of PT
AIN runs along anterior aspect of interosseous membrane- supplies 1.5 FDP, FPL and PQ
Median nerve travels beneath FDS to the wrist. Giving off palmar cutaneous branch to thenar eminence 5cm before wrist crease. Then recurrent motor branch within or distal to carpal tunnel.
Boundaries and contents of the carpal tunnel?
Roof is the transverse carpal ligament
Floor are the carpal bones
Radial aspect by Scaphoid and trapezium
Ulna via hook of hamate and pisiform
Contents- FDP, FDS, FPL, Median nerve
Boundaries of the anatomical snuffbox?
Radially- EPB and APL
Ulnarly- EPL
Floor- scaphoid, radial styloid
Roof- fascia
Contents- radial artery, SRN, cephalic vein
Blood supply of scaphoid?
Retrograde from dorsal carpal branch of radial A
What is the function of the flexor sheaths?
Nutrition and lubrication to tendons
Prevents bow stringing
Fulcrum to facilitate flexion
Characteristics of a vertebra?
Body and neural arch
Neural arch with two TPs and a Spinous Process
Lamina connecting TPs and SP
Pedicle connects TPs to body
What are spinal facet joints?
Synovial joints formed by superior and inferior processes of adjacent vertebra
What are the characteristics of a cervical, thoracic and lumbar vertebra?
Cervical- small body, narrow lamina, bifid spinous process, foramen transversarium
Thoracic- facet joints for ribs, heart shaped body, inferiorly angled SP
Lumbar- large body, broad lamina, horizontal spinous process
Which muscle contributes most to the displacement of a supracondylar fracture?
Brachialis
Describe the course of the ulna nerve?
C8-T1
Medial cord of the brachial plexus
Runs medial to brachial artery
Pierces medial intermuscular septum and enters post compartment of the arm- 8cm proximal to medial epicondule.
Runs behind medial epicondyle through cubital tunnel.
Enters forearm between 2 heads of FCU
Runs laterally to FCU
Between FDS and FDP
Enters hand through guyon’s canal giving off superfiscial and deep branches
What is the ulna paradox?
An ulna nerve injury at the elbow will remove FDP flexion therefore lessening the clawed apperance
Clawing happens due to loss of interossi function and unopposed FDS function
Sciatic nerve course?
L4-S3 from lumbosacral plexus
Greater sciatic foramen below piriformis 90% of the time
Travels beneath gleut max and then travels in posterior compartment of thigh beneath adductor magnus
Divide in the upper region of politeal fossa
Boundaries of popliteal fossa? + contents
Superolaterally Biceps fem
Superomedially Semimembranosus and semitendinosus
Inferiorly gastrocnemius
Roof fascia lata
Floor is joint capsule and popliteus
Contents deep to superfiscial
Popliteal A
Popliteal V
CPN and Tibial N
Fat and LNs
Origin and insertion of ACL and PCL?
LAMP
ACL anterior intercondylar eminence of tibia to medial aspect of lateral femoral condyle
PCL posterior intercondylar eminence to lateral aspect of medial femoral condyle
What is the blood supply to the femoral head?
Retrograde blood supply from medial and lateral circumflex arteries off Profunda femoris
Ligamentus teres- obturator
Nutrient artery and periosteal blood supply
What stabilises the hip joint?
Bone- ball and socket
Labrum
Ligaments- iliofemoral is strongest- prevents hyperextension of hip
Muscles
What is the diameter of the lag screw?
12.5mm
What are the short external rotators of the hip?
Piriformis
Sup G
Obt Int
Inf G
Obt Externus
Quadratus Femoris
What are the hip flexors and abductors of the hip?
Flexors- Iliopsoas, pectineus, sartorisu, rectus femoris
Abductors- Gleut medius, minimus, TFL
What structures pass behind the medial malleolus?
Tibialis Post
FDL
Post tibial A
Vein
Tibial N
FHL
Deforming forces in clavicle fracture?
SCM superiorly displaces medial fragment
Weight of arm + Pec Major pulls inferiorly and medially
What may block your reduction?
Tendons, ligaments, periosteum, joint capsule, soft tissues in the joint
Blood supply of talus?
Artery of tarsal canal- dominant supply off PT
AT
Perforators from peroneal A
Describe the ligaments of the ankle?
Deltoid ligament- 4- superfiscial- anterior tibiotalar, tibionavicular, tibiocalcaneal
Deep-post tibiotalar
Lateral
Ant talofibular
Calcaneofibular
Post talofibular
Boundaries and contents of the adductor canal?
Connects femoral triangle with popliteal fossa
Sub sartorial canal
Boundaries:
Medial- Sartorius
Lateral- Vastus medialis
Posteriorly- Adductor longus and magnus
Contents
Superfiscial femoral artery and vein
Saphenous nerve
Nerve to vastus medialis
What is the adductor hiatus?And where?
Gap between the adductor muscle and the femur
Allows passage of SFA from adductor canal to popliteal fossa
2/3rds from ASIS to adductor tubercle on femur
What are the fascial layers of the neck?
Investing layer
Carotid Sheath
Pretracheal
Prevertebral
What are the infrahyoid muscles + innervation?
Sternohyoid (most medial)
Sternothryoid
Omohyoid (Lateral)
Thyrohyoid
Ansa Cervicalis- C1-C3
Course of recurrent Laryngeal nerve?
Division of Vagus nerve which is the 10th Cranial Nerve
Right recurrent laryngeal nerve - hooks around right subclavian artery and ascends in neck in tracheoesophageal groove- more variable than left so more liable to injury
Left recurrent laryngeal nerve – hooks under the arch of the aorta running in the tracheoseophageal groove.
Structures at risk during ACDF?
Recurrent Laryngeal Nerve
Sympathetic plexus- causing Horner’s syndrome
Carotid Sheath and contents (CCA, IJV, Vagus nerve)
Trachea/oesophageus
Sup/inf thyroid arteries
Structures at risk during posterior approach to lumbar spine?
Segmental vessels to the paraspinal muscles (erector spinae)
Divisions of the Subclavian A and Axillary A?
Subclavian- 3 parts divided by scalene anterior
1st- Vertebral A, internal thoracic and Thoracodorsal
2nd- Costocervical trunk
3rd- Dorsal scapular A
Axillary Artery-
3 parts divided by Pec Minor- screw the layer, save the patient
Superior thoracic
Thoraco-acromial
Lateral thoracic
Subscapular
Ant humeral circumflex
Post humeral circumflex
Recurrent laryngeal nerve supply and injury?
All intrinsic muscles of larynx except cricothryoid:
Arytenoid
Thyroarytenoid
Post/lat Cricoarytenoid
Some sensory supply to larynx below vocal cords
Injury leads to Hoarseness, loss of voice, changes in pitch, airway compromise, noisy breathing
Floor of Femoral triangle?
Iliopsoas, pectineus, adductor longus
Nerves targeted by FIB?
LC femoral nerve
Femoral nerve
Obturator nerve
What contributes to the Iliotibial tract?
TFL and Gleut max
What muscles form the mobile wad, superfiscial and deep extensor compartments?
MW- BR, ECRL, ECRB
Superfiscial- Aconeus, EDC, EDM, ECU
Deep- Supinator, EI, EPL, APL, EPB
Divisions of internal iliac artery?
Anterior dicision
Obturator
Inf Gluteal
Visceral branches (int pudendal, vesical, prostatic, uterine, middle rectal)
Post
Sup gluteal
Iliolumbar
Lateral sacral
Most likely neurovascular structures damaged in acute knee dislocations?
Popliteal A- tethered at adductor hiatus and soleus arch
CPN- tethered behind Fibula head
What muscle is sometimes seen superfiscial to the transverse carpal ligament?
Palmaris Brevis
Blood supply of the lower limb?
External iliac passes underneath IL
Common femoral A
Gives of profunda femoris
Continues as SFA- crosses into Popliteal fossa via adductor hiatus
Popliteal A gives off AT
Becomes TP trunk
Divides into Peroneal A and PT
PT and AT cross into foot as PT and DP
Forming medial and lateral plantar arteries
Why is Kaplan’s line the distal aspect of your incision in carpal tunnel decompression?
Superfiscial palmar arch
