Anatomy Flashcards
What innervates the flexor muscles of the forearm?
The median nerve
The deepest muscles of the forearm perform what motion?
Rotation (pronation/supination)
The brachial artery bifurcates into what two arteries?
Ulnar and radial arteries
Which artery provides most of the blow flow to the hand?
Ulnar
Which muscle allows the “hitch hiker” thumb?
Extensor pollicus longus
The extra tendons on the small and index fingers are always found where?
The ulnar side of their redundant tendons
What innervates the extensors of the forearm?
The radial nerve
Which carpals articulate with the radius?
Scaphoid and the lunate
Which carpals articulate with the thumb?
Trapezium
Which carpals articulate with the ulna?
None
What are you concerned about with a fall on an outstretched hand?
Scaphoid fracture
Which metacarpals are fixed?
first and second digits (index and middle finger)
Why are fingers mobile in extension and tight on flexion?
Collateral ligaments
- only true for joint between metacarpal and 1st phalynx
- ligament tension is equal in flexion and extension for proximal interphalangeal joint
What are the prime flexor of the hand (make a fist)
Interosseous muscles
What is the purpose of the palmar aponeurosis?
for non-slip power grip
What are the thenar muscles? (3)
Abductor pollicis brevis
Flexor pollicis brevis
Opponens pollicis
What are the hypothenar muscles? (3)
Abductor Digiti Minimi
Flexor Digiti Minimi Brevis
Opponents Digiti Minimi
Which muscle is key for pinching?
Adductor Pollicis (along with 1st dorsal interosseus muscle); both controlled by ulnar nerve
Which is the last muscle innervated by the median nerve?
Opponens pollicis
Which is the last muscle innervated by the ulnar nerve?
Middle finger (wiggle side to side)
Ulnar nerve palsy
- can’t pinch thumb and forefinger together (atrophy of interosseus muscles)
- last two digits are clawed (not first 2 because median nerve are still intact)
Carpal Tunnel
median nerve is compressed
- atrophy of thenar muscles over time
- nighttime splinting is classic treatment
What is a dermatome?
the area of skin supplied by a cutaneous branches from a single spinal nerve
What is a myotome?
all muscles derived from one somite and innervated by one segmental spinal nerve
From superficial to deep, what muscles cover the occipital triangle? (3)
- trapezius
- splenius (capitus)
- semispinalis
What are the boundaries of the quadrangular space? (4)
- long head of triceps brachii (medial border)
- teres major (inferior border)
- teres minor (superior border)
- surgical neck of humerus (lateral border)
What comes through the quadrangular space? (2)
- the axillary nerve
- posterior circumflex humeral artery
What are some gross distinguishing features between arteries and nerves? (3)
- arteries always branch at right angles; nerves branch at acute angles
- if cut, arteries will have a lumen; nerves will not
- nerves will appear to have fibers running along their longitudinal surface; arteries will not
What are the boundaries of the triangular space? (4)
- teres minor (superior border)
- long head of triceps brachii (lateral border)
- teres major (inferior border)
What comes through the triangular space? (1)
circumflex scapular artery
What are the boundaries of the triangular interval? (3)
- teres major (superior border)
- lateral head of triceps brachii (lateral border)
- long head of triceps brachii (medial border)
What comes through the triangular interval? (2)
- radial nerve
- profunda(deep) brachii artery
What structures may also be injured with a fracture near the surgical neck? (2)
- axillary nerve
- posterior humoral circumflex artery
What structures may also be injured with a mid-shaft fracture of the humerus? (2)
- radial nerve
- deep brachial artery
What structure may also be injured with a supracondylar fracture of the humerus?
- median nerve
What structure may also be injured with medial epicondyle fracture?
- ulnar nerve
What are the boundaries of the triangle of auscultation? (3)
- rhomboid major
- trapezius
- latissimus dorsi
What are the boundaries of the lumbar triangle and what is the significance of the location?
- external abdominal oblique
- latissimus dorsi
- iliac crest
- location where hernias will present
What attaches to the lateral epicondyle?
the extensors and suppinators
What attaches to the medial epicondyle?
the flexors and pronators
What are the four branches of the thoracoacromial trunk?
- acromial
- pectoral
- clavicular
- deltoid
What muscles attach to the coracoid process? (3)
- short head of the biceps
- coracobrachialis
- pectoralis minor
What are the components of the femoral sheath, from lateral to medial? (4)
- femoral Nerve (actually outside)
- femoral Artery (lateral compartment)
- femoral Vein (middle compartment)
- Lymphatics (in femoral canal)
What are the boundaries of the femoral triangle?
- inguinal ligament
- sartorius (medial border)
- adductor longus (lateral border)
What are the short lateral rotators of the pelvis?
PGOGOQ
- piriformis
- geminal superior
- obturator externus
- geminal inferior
- obturator internus
What muscles make up the “true” hamstrings, from medial to lateral? (3)
Semimembranousus
Semitendinosus
Long head of the biceps femoris
What muscles insert at the Pes Anserinus, from anterior to posterior? (3)
- Sartorius
- Gracilis
- Semitendinosus
What does the sciatic nerve bifurcate into, and where does the split occur?
tibial nerve and fibular nerves, above the popliteal fossa
What is the innervation of the gluteus minimis, gluteus medius, and tensor fascia lata, and what function do they perform?
Superior Gluteal Nerve
Keep the pelvis level when the opposite foot is off the ground
What muscles are active when climbing stairs or rising from a sitting position?
Gluteus maximus (esp for sitting to rising), quadriceps femoris (esp for stairs)
What is the angle of inclination, and how does it change with age?
angle formed by the imaginary line from the head of the femur down the neck, and the shaft
- decreases with age (more acute): from 120 to 90 degrees
What makes up the Triceps Surae?
The two gastrocnemius muscles and the soleus, which all coalesce into the Achilles tendon
What are the P’s of compartment syndrome?
- persistent pain (earliest impt finding), esp with passive stretching of the muscle group
- paresthesia/anasthesia
- paresis/paralysis
- pressure
foot ambulation: what muscles “grip the surface”
intrinsics
foot ambulation: what muscle everts the foot
fibularis longus
foot ambulation: what muscle does “push off”
gastrocnemius and soleus
foot movement: wedge shape of talus allows (2)
easy dorsiflexion and tightens the ankle
common fibular nerve branches into (2)
circumscribes neck of fibula–>Deep and superficial fibular branches
all dorsum of foot innervated by
deep fibular nerve
what is “Intermittent claudication”
Block arteries (superficial femoral and popiteal arteries) and blood flow= lactic acid build up; restricts movement (limps)
locate: pedial pulse
dorsalis pedis artery:
lateral to EHL (extensor hallucis longus)
locate: “tarsal tunnel”
medial ankle: posterior to the medial malleolus.
holds posterior tibial artery, tibial nerve, and tendons of the tibialis posterior, flexor digitorum longus, and flexor hallucis longus muscle
TDVNH
what innervates the Anterior compartment of the leg
Deep fibular nerve
what innervates the lateral compartment of the leg
Superficial fibular nerve
what innervates the posterior compartment of the leg
tibial nerve
What attaches at the supraglenoid tubercle?
Long head of biceps brachii
What attaches at the infraglenoid tubercle?
Long head of triceps brachii
Which ligament is injured with nursemaid’s elbow?
Annular ligament of radius
What is shin splints?
Very mild compartment syndrome of the anterior compartment
What is the “spring ligament”?
Plantar calcaneonavicular ligament
What is a bunion?
Bony deformity of the metatarsal/ phalangeal joint
The medial plantar nerve innervates?
Flexor hallucis brevis and abductor hallucis ________
Flexor Digitorum Brevis
Lumbrical of 2nd toe
Calcaneal (Achilles) tendon rupture
commonly distal
cannot plantar flex
Cast in plantar flex (toe point)
bleeding
Calcaneal tendonitis
inflammatory changes at heel
Painful walking
Gastrocnemius strain
overload, partial muscle rupture, hematoma, can lead to compartment syndrome
The fourth layer on the sole of the foot contains what muscles? (2)
- Dorsal Interossei
2. Plantar Interosseus Muscles
Where do the major nerves and blood vessels run on the sole of the foot?
Between the first and second layers of muscle.
What are the names of the major nerves and arteries in the plantar region of the foot? (4)
Medial and Lateral Plantar Nerves
Medial and Lateral Plantar Arteries
ankle joint for eversion/inversion
subtalar joint
The first layer on the sole of the foot contains what muscles? (3)
- Flexor Digitorum Brevis
- Abductor Digiti Minimi
- Abductor Hallucis
The second layer on the sole of the foot contains what muscles? (4)
- Quadratus Plantae
- Lumbricals
- Flexor Hallucis Longus (Tendon)
- Flexor Digitorum Longus
The third layer on the sole of the foot contains what muscles? (4)
- Adductor Hallucis – Oblique Head
- Adductor Hallucis – Transverse Head
- Flexor Hallucis Brevis
- Flexor Digiti Minimi Brevis
The fourth layer on the sole of the foot contains what muscles? (2)
- Dorsal Interossei
2. Plantar Interosseus Muscles
What are the names of the major nerves and arteries in the plantar region of the foot? (4)
Medial and Lateral Plantar Nerves
Medial and Lateral Plantar Arteries
define: antalgic gait
limping due to pain
ligament sprained when ankle rolls in FLAT foot
CFL: calcaneo-fibular ligament
ligament sprained when ankle rolls in plantar flexion
ATFL: anterior talo-fibular ligament
pes planus
flat arch
pes cavus
high arch
lis Franc injury
tarsometatarsal injury, or midfoot injury
plantar fascitis
pain at medial tubercle of calcaneus
degeneration of attachment
tarsal tunnel syndrome
compression on the posterior tibial nerve
spondylolysis
pars defect/ stress fracture
spondylolisthesis
forward displacement of a vertebra, especially the fifth lumbar vertebra, most commonly occurring after a break or fracture
cauda equina syndrome
serious neurologic condition in which damage/compression to the cauda equina causes acute loss of function of the lumbar plexus
radiculopathy
nerves are affected and do not work properly
cervical nerve root can cause pain and other symptoms through the arms and hands
Fibrous Joints
The bones of these joints are connected by fibrous ligaments only
ex) Suture Joints, Syndesmoses
Cartilaginous Joints
The bones involved in cartilaginous joints are joined by some type of cartilage
joined by either hyaline cartilage or fibrocartilage
ex) Symphyses, between vertebral segments
Synovial Joints
- A joint cavity between the bones
- A synovial membrane lining
- Articular cartilage
- diarthroses (freely moveable)
ligament
connects bone to bone
tendons
connect muscles to bones
synostosis
A joint that has ossified over time
Syndesmoses
fibrous joint- apposed bones are joined by a fibrous membrane (interosseous membrane) or a ligament.
amphiarthroses (slightly moveable)
borders of the radius and ulna
what nerve and artery innervate trapezius
spinal accessory nerve
transverse cervical artery
what nerve innervates latissimus dorsi
thoracodorsal nerve
erector spinae muscles (3)
lateral to medial:
iliocostalis, longissimus, spinalis
“i like spag”
maintain posture
deep/intrinsic muscles of back
where are transverse foramen? what do they transmit?
cervical vertebrae
vertebral arteries
lordotic: define and where is it found
curve in C/L vertebrae
sway back
concave posterior
kyphotic: define and where is it found
curve in T/S
hunch back
concave anteriorly
define scoliosis
lateral curve
what muscles flex/extend head and rotate neck
splenius capitus/cervicis (superficial layer)
what is a sesamoid bone? where common?
bone embedded within a tendon or a muscle
patella, on hands/feet
smooth and nontender
act like pulleys, increase muscular forces
what innervates the levator scapulae m., rhomboideus major m., rhomboideus minor m.
dorsal scapular artery
muscles help to retract and elevate the scapula
Spina prominens
the seventh cervical vertebra. It has a long, non-bifid spinous process which is prominent at the nape of the neck
what seperates the greater/lesser sciatic foramen
sacrospinous ligament and the sacrotuberous ligament.
innervation/action of thoracodorsal nerve?
thoracodorsal nerve innervates latissimus dorsi, which is an important muscle for adducting, medially rotating, and extending the arm.
area of the posterior axillary fold
Ligamentum flavum
ligaments of the spine.
connect the laminae of adjacent vertebrae, axis to sacrum.
interior of the vertebral canal
what does denticulate ligament seperate
ventral (motor) roots and dorsal (sensory) roots
where to perform a spinal tap
L4-L5 in subarchnoid space
where spinal cord terminates in adult
L1-L2
lumbar cistern
where LP is done:
enlargement of the subarachnoid space
holds conus medullaris
cervical nerves are named for vertebra____ them
below
T/L nerves are named for vertebra____ them
above
*except L4/L5
list path for LP (8 layers)
skin--> fascia ligamentum flavum epidural space dura mater subdural space arachnoid matter subarachnoid space
where spinal cord terminates in BABY
AT BIRTH, THE END OF THE CORD is located at the IV disk at (L3)
conus medullaris ends at (L4/L5)
2 spinal cord enlargements: where and why
THE SPINAL CORD WIDENS in 2 regions to form the cervical and lumbar enlargements which are located at the level of origin of nerves that give rise to the brachial plexus for the upper extremity and the lumbosacral plexus for the lower extremity
boundaries of subopcipital triangle
rectus capitus posterior major rectus capitus posterior minor obliquus capitus superior obliquus capitus inferior at C1/C2
contained in suboccipital triangle
suboccipital nerve and vertebral artery
scapular notch: how are things stacked?
“air force over navy”
(superficial) suprascapular artery –> transverse scapular ligament –> suprascapular nerve
phases of abduction of arm (3 muscles act)
1 supraspinatus
2 deltoid
3 trapezius
What structure runs in the deltopectoral groove?
Cephalic vein
What structure maybe injured during a mastectomy? What injury would this cause?
Long thoracic nerve
Winged scapula
Where are lactiferous ducts found and what function do they perform?
Surround the nipple; carry milk from the glands to the nipple
Where do most breast cancers originate?
Lactiferous ducts
In what quadrant do most breast cancers why?
Upper outer quadrant; has more area because of the tail of Spence (extra piece of tissue extending into the axilla)
What are the two heads of the pec major?
- Sternocostal head
- Clavicular head
What blood vessel runs under the pec major?
Thoracoacromial artery
Describe the origin, location, and destination of the lateral and medial pectoral nerves.
- Origin: lateral comes from lateral cord; medial from medial cord
- Location: lateral goes around pec minor; medial runs through pec minor
- Destination: medial innervates both pec minor and major; lateral only innervates pec major
What runs under the sternocleidomastoid?
Internal jugular vein and carotid artery
Name the 3 parts of the sternum, from superior to inferior.
- manubrium
- gladeolus
- xiphoid process
How many true ribs we have?
1-7 (attach to the sternum)
How many false ribs do we have?
8-10 (attach to cartilage of the upper rib)
How many floating ribs do we have?
11-12 (don’t attach to anything)
Pectus excavatum
sterum is pushed inward like a bowl
due to an overgrowth of ribs
Pectus carinatum
sternum protrudes outward
Gynecomastia
Gynecomastia is the growth of abnormally large breasts in males. It is due to the excess growth of breast tissue, not excess fat tissue.
What muscle separates the subclavian artery and vein?
Anterior scalene
- vein is anterior; artery is posterior (same place where brachial plexus runs)
Where does the brachial plexus emerge from the neck?
Between anterior scalene and middle scalene, along with the subclavian vein and phrenic nerve
What are the branches in the 3 sections of the axillary artery?
1: Superior thoracic artery
2: Thoracoacromial trunk, Lateral thoracic artery
3: Subscapular artery, Anterior humoral circumflex artery, Posterior humoral circumflex artery
What are the boundaries of the posterior triangle?
- sternocleidomastoid (anterior)
- clavicle (inferior)
- trapezius (posterior)
What is the largest branch of the axillary artery?
Subscapular artery
What is associated with an ape hand deformity?
Medial nerve injury
muscles/nerves in anterior compartment of upper arm
Anterior compartment= flexors ○ Coracobrachialis ○ Biceps brachii ○ Brachialis ○ Muscocutaneous nerve
muscles/nerves in posterior compartment of upper arm
Posterior compartment= extensors
○ Triceps
○ olecranon process
○ Radial nerve
Brachial plexus: branches of posterior cord
STAR: Subscapular [upper and lower] Thoracodorsal Axillary Radial
medial to lateral: name structures in order in the cubital space
Elbow: (MAT) medial to lateral: ○ Median nerve ○ Brachial artery ○ Biceps tendon
3 groups of axillary lymph nodes
1) lateral to pectoralis minor muscle
2) behind pect. minor
3) medial to pect. minor
bad nodes for breast cancer to spread to
parasternal/ internal mammary nodes= cancer has penetrated chest cavity and will spread quickly
after piercing the supinator muscle, the deep branch of the radial nerve is renamed…..and provides what muscle action
this deep branch of the radial nerve becomes the posterior interosseus nerve
on dorsal hand: extends central digits of hand
what is lister’s tubercle
bone in forearm on dorsal radius
acts as a post for pulley action by the EPL tendon
used to elevate the thumb
predisposes the tendon for rupture (friction or Fx)
most common area of radius to fracture
distal radius
what lies between the flexor and extensor compartment of the forearm
interosseus membrane, radial artery, sharp medial edge of ulna (no nerves)
can do longitudinal surgery incisions here
boundaries and contents of snuffbox
radial artery and scaphoid bone
only flexor muscle in posterior compartment of arm, and its innervation
brachioradialis
flexor of elbow
innervated by radial nerve (like other extensors)
spread of “synergistic (flesh-eating) infections” in forearm
spreads to hand first; posterior and anterior compartments in arm do not communicate
rapid spread if necrosis= surgical emergency
most vulnerable position arm can be in for dislocation injury
abduction and external rotation
baseball pitcher
7 processes of vertebrae
(4) articular processes
(2) transverse
(1) spinous
prime flexors of MPJs in hand
interossei muscles
helped my lumbricals
ulnar nerve enters hand through… (? canal)
guyon’s canal
all interosseous muscles innervated by
ulnar nerve
what muscles give the hand “pinch function”
adductor pollicis and 1st dorsal interosseus muscle
what muscles give the hand “power grip”
hypothenar muscles on ulnar side of hand
what tendons support the transverse arch of the foot
fibularis longus and tibialis posterior tendons act as a stirrup uner transverse arch
What is the action of the quadriceps?
Knee extension
What is the course of the pudendal nerve?
Out the greater sciatic foramen, then into the lesser sciatic foramen to enter and innervate the perineum
How do you place a pudendal nerve block
palpate for the internal pudendal artery then inject jsut anterior to th epulsation to block the pudendal nerve block
What 3 muscles act together in ambulation, and how are they innervated?
gluteus medius, gluteus minimis, tensor fascia lata
- superior gluteal nerve
What 3 muscles internally rotate the femur?
gluteus medius, gluteus minimis, tensor fascia lata
What 3 muscles keep the pelvis level?
gluteus medius, gluteus minimis, tensor fascia lata
What is the gross evidence of a posterior hip dislocation? When is this seen?
the affected leg will appear shortened, and the knee will be kept locked because the hamstrings are pulled
- trocanter sits laterally
- common in car accidents if the knee his the dashboard
What is the gross evidence of an anterior hip dislocation?
Affected extremity is laterally located but not shortened (may even appear longer than normal)
What are 3 fractures that can result in aseptic (sterile) necrosis of bone?
carpal scaphoid
femoral head (intracapular fracture)
calcaneus
What supplies the blood flow to the femoral head?
upper 2/3:
What are the main muscles used when ascending teh stairs or rising form the sitting position?
gluteus max
quadracepts femoris
Whar are the 3 “antigravity muscles”?
gluteus maximum (mainly) quadracepts femoris (mainly) soleus
What is contained in the posterior compartment of the thigh?
Sciatic nerve
the hamstring muscles
What innervates the two heads of the biceps femoris?
Long head: sciatic nerve
Short hand: common fibular nerve
What is at risk with a knee dislocation?
Popliteal artery, and all the tissues distal to it
An injury that causes an “unhappy triad” disrupts what structures?
MCL, ACL, medial meniscus
What runs with the deep branch of the fibular nerve?
anterior tibial artery
- lacerations to these areas (anterior compartment) would cause hemorrhage and nerve damage (foot drop: can’t extend the toes)
What everts the foot?
fibularis longus and fibularis brevis in the lateral compartment of the foot
What is the only sensory space of the deep fibular nerve?
The webspace between the great and 2nd toes
What muscles invert the mood
Tibilalis anterior and tibilalis posterior
Where does inversion/everson occur?
subtalar joint
Where does flexion/extension occur?
ankle joint
What is the “spring ligament”?
palantar calcaneonavicular ligament
What are the boundaries of the popliteal fossa?
- lateral head of gastrocnemius
- medial head of gastrocnemius
- semimembranosis
- biceps femoris
What is contained in the popliteal fossa?
- tibial nerve
- common fibulae nerve
- political artery
- popliteal vein
- sural nerve
What runs through the Hunter’s canal?
Femoral artery and vein
What ligament divides the anal triangle and urge it’ll triangle?
Superficial transverse perineal ligament
What are the boundaries of the urogenital and anal triangles?
Urogenital (upper): superficial transverse perineal muscle, ischial tuberosity, Ramos of ischium, public symphysis
Anal triangle (lower): superficial transverse perineal muscle, ischial tuberosity, sacrotuberous ligament, coccyx
What is Alcock’s canal?
Where the pudendal nerve fiver the sacrotuberous ligament
What is the main action and innervation of the anterior compartment of the thigh?
Extension of the knee
Femoral nerve
What is the main action and innervation of the posterior compartment of the thigh?
Flexors of the knee
Sciatic nerve
What is the main action and innervation of the medial compartment of the thigh?
Adductor of the leg
Obturator nerve
What are the boundaries of the femoral triangle?
- Inguinal ligament
- adductor longus
- sartorius
