Anatomy 3 Flashcards
What are the 3 arches of the foot?
Medial and lateral longitudinal
Anterior transverse
Components of medial arch of foot?
Bones - calcaneum, talus, navicular, all 3 cuneiforms and medial 3 metatarsals
Ligments - interosseus and spring
Muscles - Flexor hallucis longus, digitorum longus and breiv
Tibilais anterior and posterior
Components of lateral arch of foot?
Bones - calcaneus, cuboid and lateral 2 metatarsals
Ligaments - long and short plantar
Muscles- peroneus longus, flexor digitorum longus nad brevis to 4/5 digits
What forms the fibrous tunnel for passage of the peroneus longus tendon?
Long plantar ligament and cuboid
Components of anterior transverse arch of foot?
Bases of all 5 metatarsals
Interosseus ligaments
Peroneus longus muscle
Muscle layers of the sole of the foot from deep to superficial?
Plantar and dorsal interossei, and tendons of peroneus longus/tibilalis posterior
Flexor hallucis brevis, adductor hallucis, flexor digiti minimi
Quadratus plantae and lumbricals, tendons of FDL and FHL
Abductor hallucis, abductor digiti minimi, flexor digitorum brevis
Where is the plantar fascia in relation to the layers of muscles in the foot?
Superficial
Where does the deep plantar arch sit between?
Deepest and second-deepest layers
Where do the medial and lateral plantar arteries and nerves run between?
Quadratus plantae/lumbricals layer and abductor hallucis/digiti minimi and FDB layers (superficial and second)
What arteries form the plantar arch?
Lateral plantar branch of posterior tibial artery, and deep plantar branch of dorsalis pedis
3 muscles that flex elbow?
Brachioradialis
Biceps brachii
Brachialis
Boundaries of the antecubital fossa?
Medial = pronator teres Lateral = brachioradialis Superior = line between epicondyles of humerus Floor = brachialis and supinator Roof = fascia and bicipital aponeurosis
Contents of the ACF from medial to lateral?
Median nerve
Brachial artery
Biceps tendon
Also median cubital vein
2 nerves at risk of damage in supracondylar humerus fractures?
Median nerve
Ulnar as it passes behind medial epicondyle
What are the muscular layers of the forearm?
Mobile Wad of Henry - brachioradialis, extensor carpi radialis longus and extensor carpi radialis brevis
Anterior - superficial and deep
Posterior - superficial and deep
Msucles of the mobile Wad of Henry in forearm?
Brachioradialis and ext carpi radialis long and brevis
Muscles of the anterior compartment of the forearm?
Superficial = pronator teres, palmaris longus, flexor carpi radialis / ulnaris and flexor digitorum superficialis Deep = flexor pollicis longus, flexor digitorum profundus and pronator quadratus
Muscles of the posterior compartment of the forearm?
Superficial = extensor digitorum communis, extensor carpi ulnaris and extensor digiti minimi Deep = abductor policis longus, extensor pollicis brevis, extensor pollicis longus, extensor indicis and supinator
Describe how to do fasciotomy of forearm?
Two-incision fasciotomy:
Volar e.g. along ulnar border
Dorsal e.g. from lateral epicondyle of humerus to mid-wrist
What is the path of the ulnar nerve in the forearm?
Emerges from ulnar tunnel just behind medial epicondyle of distal humerus
Passes between the 2 heads of flexor carpi ulnaris to enter anterior compartment of forearm and run alongside ulna
Joins ulnar artery to pass deep to FCU before travelling through canal of Guyon at wrist
What travels through the canal of Guyon?
Ulnar nerve
Ulnar artery
Tendon of FCU
What are the 3 forearm branches of the ulnar nerve?
Dorsal and palmar cutaneous, and muscular
What does the muscular branch of the ulnar nerve innervate?
Ulnar half of FDP and whole of FCU
Which compartment of the forearm does the ulnar nerve run in?
Anterior compartment
Nerve supply to the forearm?
Posterior compartment = radial nerve
Anterior (flexor) compartment = median nerve except flexor carpi ulnaris and ulnar half of FDP (ulnar)
Common sites for venepuncture in the arm?
Median cubital vein - in ACF
Cephalic vein origin - at wrist
Boundaries of the inguinal canal?
Floor = inguinal ligament - lacunar ligament medial third, iliopubic tract lateral third
Ant wall = external oblique aponeurosis
Roof = int oblique and transversus abdominis
Post wall = transversalis fascia - conjoint ligament medial
What is the conjoint tendon? Where is it?
Lower part of transversus abdominis and internal oblique aponeurosis as they insert at pectineal line and pubic crest
Posteromedially in inguinal canal
Nerve supply to external oblique muscles?
Lower 6 intercostal nerves and subcostal nerve on each side
What are the 3 coverings of the spermatic cord?
External spermatic fascia - from external oblique
Cremasteric muscle and fascia from internal oblique/transversus abdominis
Internal spermatic fascia - transversalis fascia
Contents of spermatic cord?
3 arteries - to vas, cremasteric, testicular
3 nerves - gen branch genfem, ilioinguinal (next to), autonomic nerves
3 others - vas, lymphatics and pampiniform plexus
Nerve supply to testes? Clinical relevance?
T10 sympathetic nerve
So ball pain can refer to umbilicus, or ureteric colic can refer to balls
Lymph drainage of the testes and scrotum?
Testes themselves = para-aortic
Scrotum = inguinal LNs
This is why you don’t biopsy possible Ca
Boundaries of Hasselbach’s triangle? Clinical relevance?
Lateral aspect of rectus sheath medially
Inguinal ligament inferiorly
Inferior epigastric vessels superolaterally
Site of weakness in abdominal wall which can be a site for direct inguinal hernias
Distinguishing between direct and indirect inguinal hernia?
Press over deep ring - should stop indirect from coming out
In reality related to position of hernia sac - lateral to inferior epigastrics = indirect, medial to sac = direct
Which nerves can be damaged in an inguinal hernia repair? How may this present?
Ilioinguinal nerve - upper and medial thigh, anterior scrotum and base of penis
Iliohypogastric nerve - skin above pubis
Genital branch of genitofemoral nerve - cremaster and sensory innervation to scrotum
Where do femoral herniae emerge?
From femoral ring and slide into femoral canal
What is the femoral canal?
Contains space for femoral vein expansion and lymphatics (Cloquet node)
What does Cloquet’s node drain and where is it?
In femoral canal - drains anterior abdominal wall below umbilicus, perineum and lower limb
Boundaries of the femoral ring?
Anteriorly = inguinal ligament Posteriorly = pectineal ligament Medially = lacunar ligament Laterally = fibrous septum on medial side of femoral vein
Most common hernia in elderly females?
Still inguinal, although femoral more comon in females than males
Why are femoral hernias usually repaired?
High incidence of strangulation - due to tight sharp edged lacunar ligament medially in femoral ring
Boundaries of the femoral triangle?
Superiorly = inguinal ligaemnt Medially = adductor longus Laterally = sartorius Floor = pectineus and adductor longus medially, iliopsoas laterally Roof = fascia lata
What does the femoral sheath enclose?
Femoral artery, vein and canal - not nerve
Muscle attaching to ASIS?
Sartorius
What is Hunter’s canal?
The subsartorial/adductor canal
Runs from base of femoral triangle to popliteal fossa
Boundaries of Hunter’s canal?
Vastus medialis anterolaterally
Roof = sartorius
Posteriorly = adductor longus and magnus
What does Hunter’s canal contain?
Femoral artery and vein
Saphenous nerve
Nerve to vastus medialis
Surface marking for adductor hiatus? What is it and what goes through it?
Gap in adductor magnus muscle where it inserts onto femur - end of Hunter’s canal
2/3 along line beween ASIS and adductor tubercle of femur
Allows passage of femoral artery and vein from anterior to posterior thigh
What is the difference between the mid-inguinal point and the midpoint of the inguinal ligament?
Mid-inguinal point is a marker for femoral artery palpation - between ASIS and pubic symphysis
Mid point of inguinal lig is between ASIS and tubercle and is the surface marker for the deep inguinal ring
Where may bruits be auscultated in SFA disease?
Adductor hiatus
What are the carpal bones?
Scaphoid, lunate, triquetrum, pisiform, trapezium, trapezius, capitate, hamate
What are the boundaries of the carpal tunnel? Attachments?
Floor = carpal bones
Roof = flexor retinaculum
Proximal surface marking = distal skin crease of wrist
Attachments are tubercle of scaphoid and piriform proximally, and trapezium/hook of hamate distally
What are the contents of the carpal tunnel?
Median nerve
Flexor digitorum superficialis and profundus tendons
Flexor pollicis longus tendon
What runs through the canal of Guyon?
Ulnar artery
Ulnar nerve
Which muscle runs within its own compartment from forearm to wrist? Where abouts?
Flexor carpi radialis - runs between superficial and deep flexor retinaculum
What are the boundaries of the anatomical snuffbox?
Abductor pollicis longus and extensor polilcis brevis laterally
Extensor pollicis longus medially
Proximally = styloid process of radius
Base = bones - base of 1st metacarpal, trapezium, scaphoid
Roof = fascia and skin
Contents of anatomical snuffbox?
Radial artery and terminal branches of radial nerve Cephalic vein (origin)
Where does the cephalic vein originate from?
Anatomical snuffbox
Nerve supply to intrinsic muscles of hand? How to test?
1/2 LOAF = median (lateral 2 lumbricals, opponens policis, abductor policis brevis, flexor policis brevis - test by thumb abduction
Rest are ulnar - test by abducting fingers (dorsal interossei)
What is the first muscle to waste in ulnar nerve injury?
1st dorsal interosseus
What do the interossei muscles do?
Palmar adduct fingers
Dorsal abduct fingers
What do the lumbrical muscles do?
Aid in flexion of MCPJs with extension of IPJs
What are the insertions and actions of flexor digitorum profundus/superficialis?
FDP - inserts onto distal phalanx and flexes DIPJ
FDS - inserts onto middle phalanx and flexes PIPJ
What mechanisms prevent bow-stringing of the flexor tendons?
Pulleys consisting of fascial thickening - proximally the flexor retinaculum, distally 5 annular pulleys and 3 cruciate pulleys
How many compartments of the extensor retinaculum are there?
6: EPB and APL ECRL and ECRB EPL Extensor indicis proprius and extensor digitorum communis EDM ECU
Surface markings of the heart?
Superior border = third rib right sternal edge to second rib left sternal edge
Inferior border = apex horizontally across to right sternal edge at 6th rib
What forms the right heart border on CXR?
Right atrium
What forms the left heart border on CXR?
Left ventricle and part of left auricle
What chambers make up the anterior surface of the heart?
Right atrium and right ventricle
What chambers make up the posterior surface of the heart?
Left atrium mostly
What forms the inferior surface of the heart?
Right and left ventricles
How many layers of pericardium are there?
Fibrous, and serous (parietal and visceral)
Which layer of pericardium attaches to the central tendon of the diaphragm and roots of great vessels?
Fibrous outer layer
What runs in the anterior interventricular sulcus of the heart?
Great cardiac vein and Left anterior descending artery
Describe blood supply on surface of heart?
Left and right coronary arteries filled from aortic sinuses
Left runs in AV sulcus and gives off LAD to ant IV sulcus before continuing as circumflex artery
Right gives off posterior interventricular artery which runs in PIV sulcus
Marginal branches from each which cross corresponding ventricle
How many aortic sinuses are there and what comes from them?
3 - anterior, lelft posterior and right posterior
Left from left posterior
Right from anterior
None from right posterior
Which aortic sinus doesn’t yield a vessel?
Right posterior
Where is the sinoatrial node found and what is it supplied by?
Sits in crista terminalis of right atrium
Supplied by RCA in 60% and LCA in 40%
Where does the coronary sinus open into?
Inferior part of right atrium between IVC and tricuspid valve
Which 5 veins drain into the coronary sinus?
Great, middle and small cardiac veins
Oblique vein
Posterior vein
Describe the venous drainage of the heart?
2/3 via coronary sinus into right atrium
1/3 into each chamber via venae cordis minimae, also 3-4 anterior cardiac veins directly into the right atrium
Where is the coronary sinus found?
Along posterior surface of heart between left ventricle and left atrium
