Anatomy Flashcards
Where does the hip fibrous capsule attach inferiorly?
The intertrochanteric line
Where does eversion and inversion of the foot occur?
At the subtalar and midtarsal joints
Where do the quadriceps insert?
The tibial tuberosity
Which nerve supplies the anterior compartment of the thigh?
The femoral nerve (L2, L3, L4)
Iliopsoas?
Iliacus and psoas major
The muscles in which compartment of the thigh are responsible for adduction of the hip?
Muscles in the medial compartment of the thigh
Which nerve supplies the muscles in the medial compartment of the thigh?
The obturator nerve
Which nerves make up the femoral nerve?
L2, L3, L4
Which nerves make up the obturator nerve?
L2, L3, L4
Which nerves make up the sciatic nerve?
L4-S3
Which nerve supplies the lateral compartment of the leg?
The superficial fibular (branch of sciatic
Which nerve supplies the anterior compartment of the leg?
The deep fibular
Which nerve supplies the posterior compartment of the leg?
The tibial nerve
What doe the gluteus maximus do?
Extension of the hip
What do the gluteus medias and gluteus minimus do?
External rotators of the hip
Pudendal nerve
Main nerve of the perineum
Nerve responsible for sensory over the back of the thigh?
Posterior cutaneous nerve (next to sciatic nerve)
Nerve supply to the intrinsic muscles of the foot?
Tibial nerve
L1/L2 myotome
hip flexion
L3/4 myotome
knee extension
L5
foot dorsiflexion and EHL
S1/S2
ankle plantarfelxion
Blood supply to the femoral head
- Intramedullary artery of shaft of femur
- Medial & lateral circumflex branches of profunda femoris
- Artery of ligamentum teres
Purpose of the facet joints
Provide stability whilst allowing movement
Which bone has the dens process?
C2
Name the vertebrae with no body?
C1
Name the ligaments you would find in the spine
- Anterior longitudinal ligament
- Posterior longitudinal ligament
- Ligamentum flavum
- Supraspinatus ligament
- Infraspinatous ligament
Origin of the trapezius?
Spinous processes (–> T12)
Insertion of the trapezius?
Occiput and spine of scapula
Nerve supply of the trapezius?
Accessory nerve (CNXI)
Function of the trapezius?
Elevates and depresses scapula
Retracts scapula
Origin of latissiumus dorsi?
Spinous processes and pelvis
Insertion of latissiumus dorsi?
Humerus
Function of latissimus dorsi?
Adducts
Extends
Internal rotation of humerus
Nerve supply to latissimus dorsi?
C6/C7/C8
Origin of the Rhomboid minor?
Spinous processes C7/T1
Origin of the Rhomboid major?
Spinous processes T2-T5
Insertion of the rhomboid major and minor?
Scapula
Innervation of the rhomboid major and minor?
Dorsal scapula nerve (C3/C4)
Function of rhomboid major and minor?
Keeps scapula against thoracic wall
Retracts scapula
Origin of levatus scapularis?
Transverse process of C1
Insertion of levator scapularis?
Superior angle of scpaula
Innervation of levator scapularis?
Branches of C4/C5
Function of levator scapularis?
Elevates scapularis
Where does the spinal cord exit the skull?
Foramen magnum
Nerves in the cervical spine
Arms
Nerves in the thoracic region
Middle of the body
Nerves in the lumbar spine
Legs
Sacral nerves
control the posterior aspects of the legs and organ functions of the pelvis
Descending motor tracts
Crossed pyramidal or lateral cerebrospinal tract
Uncrossed pyramidal or anterior cerebrospinal
What level do pyramidal/ lateral cerebrospinal tracts cross?
Cross at medullary level and then descend the spine on the contralateral side of the cord
What side do uncrossed pyramidal/anterior cerebrospinal tracts descend?
Uncrossed pyramidal/anterior cerebrospinal tracts descend on the ipsilateral side of the cord and then cross at the same level that they exit = exits on the contralateral side
What do the ventral and dorsal roots form?
They join to become the nerve root
What do the posterior rami serve?
The posterior rami serve the intrinsic muscle of the back and the strip of skin sensation in the centre of the back
What do the anterior rami serve?
They form the nerve supply to the rest of the body/limbs
Where do the spinocerebellar tracts ascend and what do they carry information relate to?
The spinocerebellar tracts ascend on the ipsilateral side and enter the cerebellu,,. They carry information relating to proprioception
Where do the lateral and anterior spinothalamic tracts ascend and what information do they carry?
The ascend on the ipsilateral side before crossing to the contralateral side and enter the thalamus. They carry information relating to pain and temperature
Where do the posterior columns (fascicula gracilis of Goll and fasiculus cuneatus of Burdoch) ascend and what do they carry?
They ascend on the ipsilateral side and carry information relating to fine touch and proprioception
Nerves you’ll find in the cauda equina
L2-L5
S1-S5
Coccygeal nerve
Where do the nerves from the cauda equina innervate?
They innervate the pelvic organs and lower limbs
Motor function of the cauda equina?
Hips, knees, ankles, feet, internal anal sphincter and external anal sphincter
Sensory function of the cauda equina?
Hips, knees, ankles, feet, Perineum and, partially, parasympathetic innervation of the bladder
Batsons venous complex
A network of valveless veins.
Connects the deep pelvic veins and the thoracic veins (draining the inferior end of the urinary bladder, breast and prostate) to the internal vertebral plexus. This has serious complications r.e haematological spread of carcinomas of the prostate
Garden Classification of Femur Fractures?
Garden 1: incomplete fracture, undisplaced
Garden 2: complete, undisplaced
Garden 3: complete, incompletely displaced
Garden 4: complete, completely displaced
What passes through the transverse foraminae?
The vertebral artery, vein and nerve fibres
Movements of the atlanto-occipital joint?
Flexion/extension
Lateral extensions
Movements of atlanto-dens joint?
Rotations
Which part of the annulus fibrosis is thin?
The posterior part especially
Where does the posterior tibialis insert?
The navicular tuberosity and the medial and middle cuneiforms
Which tendon is the primary stabiliser of the medial longitudinal arch?
The posterior tibialis
Movements produced by the posterior tibialis tendon?
Inversion and plantar flexion
Risk factors for posterior tibialis dysfunction?
Obese, middle aged female Diabetes, hypertension Steroid injection Flat foot Seronegative arthropathies Flat foot Due to a tendinosis of unknown aetiology
Clinical signs of tibialis posterior dysfunction
Flat foot Swelling posterior to medial malleolus - very specific Change in foot shape Diminshed walking ability/balance Dislike of uneven surfaces More noticeable hallux valgus Lateral wall "impingement" pain
Flat foot and diminshed walking ability/balance
Posterior tibialis dysfunction
Type I TPD
No deformity, swelling
Type II TPD:
Deformity, too many toes, cannot single heel raise
Type III and IV TPD:
Deformity, fixed forefoot abduction, rigid hindfoot valgus, deltoid ligament compromise, mortise signs, ankle pain
Surgery used to fix pes cavus?
Soft tissue release
Tendon transfer
Calcaneal osteotomy
Arthrodesis
ATFL and CFL
Anterior talofibular ligament and calcaneofibular ligament : lateral ligaments, usually involved in ankle sprains
Grading of ankle sprains
Gd1-3, grade 3 is complete rupture
Distal fibula fracture with no medial malleolus fractue or deltoid ligament rupture treatment?
This is stable
Treatment is boot or cast
Distal fibula fracture with medial malleolus fracture or deltoid ligament rupture treatment?
This is not stable
Treatment is pin/nails etc
5th metatarsal injury
Very common, inversion injury
1) Avulsion fracture by PERONEUS BREVIS (moon boot)
2) Jones fracture (POOR BLOOD SUPPLY, 25% risk non-union)
3) Proximal shaft (common site for stress fracture)
How could you fracture talus?
Forced dorsiflexion/rapid deceleration
How could you fracture calcaneus?
Falling from a height
Tinel’s test positive for Baxter’s nerve
Plantar fasciitis
Start-up pain after rest
Can be worse after exercise
Fullness or swelling, pain of plantarmedial aspect of heel
Plantar fasciits
“Heel spurs”
“Heel pad pain syndrome”
Plantar fasciitis
Causes of plantar fasciitis
Physical overload:excessive exercise, excessive weight
Seronegative arthropathy
Diabetes
Abnormal foot shape-planovalgus or cavovarus
Imrpoper footwear
Treatment for plantar fasciitis?
NSAIDS Night splints Taping Heel cups or medial arch support Physiotherapy - eccentric exercise programme Steroid injection Surgery - 50% success, better if acute onset Usually self-limiting over 18-24 months -Self managment
Operative management for Hallux valgus and indications
Indications – failure of non-op, pain, lesser toe deformities, lifestyle limitation, overlapping, ulceration, functional limitation
Many osteotomies (not core)
Aim to realign the hallux and decrease the HV angle
Correct any lesser toe deformities at same time (soft tissue releases, osteotomies, fusions)
-Break the bone and move the head laterally
Osteoarthritis of the first MTPJ
Hallux rigidus
Operative management of Hallux Rigidus
Joint replacement
Fusion
Hindfoot in rheumatoid arthritis
Talocalcaneal interosseous ligament
Unstable subtalar joint, calcaneus drifts into valgus
Medial arch collapses, flat feet
Often require multiple joint fusions
Morton’s Neuroma
Degenerative fibrosis of common digital nerve near its bifurcation
-Get forefoot pain (metatarsalgia)
Tendon-Achilles teninosis
Talocalcaneal interosseous ligament
Unstable subtalar joint, calcaneus drifts into valgus
Medial arch collapses, flat feet
Often require multiple joint fusions
Surgery for claw, hammer and mallet toes?
Tenotomies, tendon transfer, fusions (PIP) or amputation
