Anatomy Flashcards
What is the superior border of the femoral triangle?
the inguinal ligament
What is the lateral border of the femoral triangle?
the medial aspect of the sartorius muscle
what is the medial border of the femoral triangle?
the lateral aspect of the adductor longus muscle
what muscles make up the floor of the femoral triangle?
iliopsoas muscle laterally
pectineus muscle medially
What 4 structures does the femoral triangle contain?
lateral –> medial
- femoral nerve
- femoral artery
- femoral vein
- femoral canal
Where are the deep inguinal lymph nodes located?
femoral canal
What are the femoral artery and vein enveloped in?
femoral sheath
what fascia from the abdominal wall makes up the femoral sheath superiorly?
transversalis fascia and iliopsoas fascia
What does the femoral sheath blend inferiorly with?
the adventita of the femoral artery and vein
where is the femoral nerve in relation to the femoral sheath?
femoral nerve is lateral to the femoral sheath
from what spinal nerves does the femoral nerve arise from?
L2, L3, L4
formed in the lumbar plexus
what type of nerve is the saphenous nerve? (with regards to function)
sensory nerve
what nerve does the saphenous nerve branch off of?
the femoral nerve
When branching off the femoral nerve and leaving the adductor canal, what 2 muscles does the saphenous nerve pass between?
sartorius muscle
gracilis muscle
What compartment of the thigh is the gracilis muscle in?
medial compartment
What does the saphenous nerve supply?
- fascia and skin of the anteromedial aspects of the knee and leg
- fascia and skin of the medial aspect of the foot
when the saphenous nerve makes its way down to the foot from the knee, what vein does it accompany?
the great saphenous vein
What is a femoral hernia?
when peritoneum (with or without abdominal contents) herniates into the femoral canal through the femoral ring
what does a femoral hernia usually present as?
a painful lump in the groin
what does the femoral canal contain?
deep inguinal lymph nodes
adipose tissue
how are the deep inguinal lymph nodes positioned in the femoral canal?
in a chain
which artery do the medial and lateral circumflex femoral arteries emerge from?
profunda femoris artery
what part of the body do the medial and lateral circumflex femoral arteries supply?
the majority of the head of the femur
What is the inferior border of the external oblique aponeurosis?
inguinal ligament
what is an aponeurosis?
flattened tendon
From what 2 bony features does the inguinal ligament run between?
ASIS
pubic tubercle
What does the medial half of the inguinal ligament contain?
inguinal canal
What does the inguinal canal contain in males?
spermatic cord
What does the inguinal canal contain in females?
the round ligament
How do the femoral vessels, femoral nerve and the iliopsoas muscle/combined tendon enter or leave the lower limb?
by passing posterior to the inguinal ligament in the retroinguinal space then into the femoral triangle
What is the name of the deep fascia of the thigh?
fascia lata
Where is the origin of the iliopsoas? (ie attachment of the iliacus and attachment of the psoas major)
iliacus: iliac fossa
psoas major: lumbar transverse processes
Where is the insertion of the iliopsoas? (ie the attachment of the iliacus and the attachment of the psoas major)
lesser trochanter of the femur (for both)
what is the function of the iliopsoas muscle?
flexion at the hip
what is the origin of the sartorius muscle?
ASIS
what is the insertion of the sartorius muscle?
medial aspect of the proximal tibia
what is the function of the sartorius muscle?
flexion at hip and knee
also externally rotates the hip
what is the nerve supply to the sartorius muscle?
femoral nerve
how many proximal attachments does the quadriceps femoris have?
4
what is the origin of the quadriceps femoris- rectus femoris head?
ASIS
what is the origin of the quadriceps femoris- vastus lateralis?
shaft of the femur
what is the origin of the quadriceps femoris-vastus intermedius?
shaft of the femur
what is the origin of the quadriceps femoris-vastus medius?
shaft of the femur
what is the insertion of the quadriceps femoris?
patella then tibial tuberosity
what is the function of the quadriceps femoris?
extension of the knee
what nerve supplies the quadriceps femoris?
femoral nerve
What ligament is hit with a tendon hammer during a ‘knee jerk’ test?
patellar ligament
what does hitting the patellar ligament with a tendon hammer cause normally?
reflex contraction of the quadriceps and extension of the knee joint
Where are the adductor muscle group in thigh located?
medial compartment
what are the 5 adductor muscles in the thigh?
gracilis adductor brevis adductor longus adductor magnus obturator externus
what adductor muscle also has a hamstring part to it?
adductor magnus
what adductor muscle in the thigh is the most medial?
gracilis
what is the most posterior adductor muscle in the thigh?
adductor magnus
where is adductor brevis in relation to adductor longus?
adductor brevis is superior and posterior to the adductor longus
where are the origins of the adductor muscles in the thigh?
inferior pubic rami
ischial tuberosity for hamstring part of adductor magnus
where are the insertions of the adductor muscles in the thigh?
the linea aspera of the femur
or
adductor tubercle of the tibia
where is the linea aspera of the femur?
posterior surface
what nerves supply the muscles of the medial compartment of the thigh?
all innervated by the obturator nerve (L2,3,4) except the hamstring part of the adductor magnus which is innervated by the tibial nerve
through what foramen of the hip bone do the obturator nerve, artery and vein enter the medial compartment of the thigh?
obturator foramen
where does the obturator nerve divide into anterior and posterior branches?
upper border of the adductor brevis
what does the anterior cutaneous nerve of the thigh branch off of?
femoral nerve (L2,3,4)
what does the lateral cutaneous nerve of the thigh branch off of?
lumbosacral plexus (L2,3)
what supplies the medial cutaneous innervation of the thigh?
cutaneous branch of the obturator nerve (L2,3,4)
what lymph nodes does lymph following the great saphenous vein drain into?
superficial inguinal lymph nodes
where are superficial inguinal lymph nodes located?
in superficial fascia around the great saphenous vein
where are the 2 places lymph from superficial inguinal lymph nodes can drain?
external iliac lymph nodes
deep inguinal lymph nodes
what lymph nodes does lymph following the small saphenous vein drain into?
popliteal lymph nodes
where are popliteal lymph nodes located?
popliteal fossa
where does lymph from popliteal lymph nodes drain?
deep inguinal lymph nodes
where does lymph from deep inguinal lymph nodes drain?
external iliac lymph nodes
ultimately, where does all lymph from the lower limb drain?
external iliac nodes
which head of the quadriceps femoris is most superficial?
rectus femoris
what is the name of the opening in the distal tendon of the adductor magnus into the popliteal fossa?
adductor hiatus
what happens to the femoral vein and artery as they pass through the adductor hiatus into the popliteal fossa?
renamed popliteal artery and vein
What type of bone is the patella?
a sesamoid bone
embedded within the patella tendon
what is a sesamoid bone?
a bone embedded within a tendon or a muscle
what head of the quadriceps femoris is also involved in flexion at the hip- in addition to the usual function of extension at the knee?
rectus femoris
why has the rectus femoris got an additional function (flexion of the hip)?
because unlike the other quadriceps, it also spans over the hip joint- not just the knee joint
what combination of muscles makes up the iliopsoas muscle?
psoas major muscle
iliacus muscle
what muscle is the most powerful hip flexor?
iliopsoas mucle
What are the 6 regions of the lower limb?
gluteal femoral knee leg ankle foot
What region of the lower limb is the ‘odd-one out’ because it doesn’t have an anterior and posterior part?
gluteal
only found posteriorly, no anterior part
What are the 2 distinct muscle groups of the gluteal region?
superficial muscle group
deep muscle group
What are the 4 muscles in the superficial muscle group of the gluteal region?
gluteus maximus
gluteus medius
gluteus minimus
tensor fascia latae
describe the positions of the gluteus maximus, medius and minimus relative to each other?
gluteus maximus is the most superficial
gluteus medius is in the middle
gluteus minimus is the most deep
what are the functions of the superficial muscle group of the gluteal region?
extensors, abductors and medial rotators of the thigh
what innervates the gluteus maximus?
inferior gluteal nerve
what innervates the gluteus medius?
superior gluteal nerve
what innervates the gluteus minimus?
superior gluteal nerve
what innervates the tensor fascia latae?
superior gluteal nerve
what muscles don’t contract properly when there is a problem with the inferior gluteal nerve? and what is this known as?
gluteus medius
gluteus minimus
tensor fascia latae
Trendelenburg’s Gait
What are the 5 muscles of the deep muscle group of the gluteal region?
piriformis obturator internus superior gemelli inferior gemelli quadratus femoris
the superior and inferior gemelli lie on either side of what muscle?
obturator internus
when the skin and fascia has been removed, what are the 2 muscles which can be seen in the gluteal region?
(ie most superficial muscles of the gluteal region?)
tensor fascia latae
gluteus maximus
what is the position of the tensor fascia latae in relation to the gluteus maximus?
tensor fascia latae is lateral to the gluteus maximus
when the skin, fascia and the most superficial muscles of the gluteal region (tensor fascia latae and gluteus maximus) have been removed, what muscles can be seen in the gluteal region?
(name from superior to inferior)
gluteal medius piriformis superior gemelli obturator inturnus internal gemelli quadratus femoris
what is the function of the deep muscle group of the gluteal region?
lateral rotators of thigh
hip stabilisers
what innervates all of the deep muscle group of the gluteal region?
sacral plexus
what do nerves enter/exit the pelvis an perineum via?
greater and lesser sciatic foramen
What 2 ligaments split the greater and lesser sciatic notches into greater and lesser sciatic foramen?
sacrotuberous ligament
sacrospinous ligament
what does the sacrotuberous ligament run between?
sacrum and ischial tuberosity
what does the sacrospinous ligament run between?
sacrum and ischial spine
the gluteal region is divided into quadrants for injections, what region should be used for injections?
superolateral quadrant
From what spinal nerves is the sciatic nerve made of?
L4-S3
From what spinal nerves in the pudendal nerve made of?
S2,3,4
What areas of the body does the pudendal nerve supply?
pernieum
what muscles separate the pelvis from the perineum?
pelvic floor muscles
From what spinal nerves in the posterior cutaneous nerve of the thigh made of?
S1,2,3
What areas of the body does the posterior cutaneous nerve of the thigh supply?
skin of the: posterior thigh, popliteal upper medial thigh lateral perineum
Where does the sciatic nerve exit the pelvis?
greater sciatic foramen
what is the usually most lateral nerve to exit the greater sciatic foramen?
sciatic nerve
The sciatic nerve exits the pelvis just inferior to what muscle?
piriformis
what is the name of the artery which supplies blood to the sciatic nerve?
artery to the sciatic nerve
What areas of the gluteal region does the sciatic nerve supply?
none
The sciatic nerve bifurcates into what 2 nerves?
tibial nerve (greater section of divied) common fibular
Where usually does the sciatic nerve bifurcate into the tibial nerve and the common fibular nerve?
distal 1/3 thigh
but can occur anywhere from gluteals to popliteal fossa
compare the tibial nerve to common fibular nerve in terms of size and relative position?
tibial nerve: larger and medial
common fibular: smaller and lateral
what is the roof of the femoral triangle made of?
deep fasica
What is the name of the condition where increased pressure in a body compartment affects the function of the muscles of nerves?
compartment syndrome
What is the cause of the increased pressure in compartment syndrome?
swelling of tissue
increase in fluid (bleeding or oedema)
what is used to relieve the pressure in emergency compartment syndrome?
fasciotomy
What are the 3 muscle compartments in the lower limb?
anterior
posterior
lateral
What are the 3 muscle compartments in the thigh?
anterior
posterior
medial
What are the 4 muscles of the anterior compartment of the thigh?
pectineus
iliopsoas
sartorius
quadriceps femoris (rectus femoris; vastus lateralis, intermedius, medialis)
what muscles of the anterior compartment of the thigh are flexors of the thigh? (hip flexors)
iliopsoas
pectineus
sartorius
what muscles of the anterior compartment of the thigh are extensors of the leg?
quadriceps femoris
what is the innervation of the iliopsoas muscle?
iliacus muscle- femoral nerve (L2,3,4)
psoas major- (L1,2,3)
what is the innervation of the pectineus muscle?
femoral nerve (L2,3,4)
what is the innervation of the sartorius muscle?
femoral nerve (L2,3,4)
what is the innervation of the quadriceps femoris muscle?
femoral nerve (L2,3,4)
what innervates the adductor longus?
obturator nerve (L2,3,4)
what innervates the adductor magnus?
obturator nerve (L2,3,4) hamstring part = tibial nerve
what innervates te gracilis?
obturator nerve (L2,3,4)
what innervates the adductor brevis?
obturator nerve (L2,3,4)
what innervates the obrurator externus?
obturator nerve (L2,3,4)
the obturator externus is an adductor muscle found in the medial compartment of the thigh, but unlike the other adductor muscles what is its main function?
lateral rotation of the thigh
What are the 4 muscles in the posterior compartment of the thigh?
semimembranosus
semitendinous
biceps femoris (long head)
biceps femoris (short head)
which muscle in the posterior compartment of the thigh is the most lateral?
biceps femoris (short head)
what innervataes the semitendinosus?
tibial division of the sciatic nerve (L5, S1,2)
what innervates the semimembranosus?
tibial division of the sciatic nerve (L5, S1,2)
what innervates the biceps femoris?
tibial division of the scaitic nerve (L5, S1,2)
short head = common fibular division of hte sciatic nerve
what are the muscles in the anterior compartment of the leg?
tibialis anterior
extensor hallicus longus
extensor digitorum longus
fibularis tertius
what is the function of the muscles in the anterior compartment of the leg?
dorsiflexion of the ankle
extension of the toes
what innervates the tibial anterior?
deep fibular nerve (L4,5)
what innervates the extensor digitorum longus?
deep fibular nerve (L4,5)
what innervates the extensor hallicus longus?
deep fibular nerve (L4,5)
what innervates the fibularis tertius?
deep fibular nerve (L4,5)
what are the muscles of the lateral compartment of the leg?
fibularis longus
fibularis brevis
what is the function of the muscles in the lateral compartment of the leg?
eversion of the foot
weak plantarflex of the ankle
what innervates the fibularis longus?
superficial fibular nerve (L5, S1,2)
what innervates the fibularis brevis?
superficial fibular nerve (L5, S1,2)
what does the common fibular nerve bifurcate into?
superficial fibular nerve
deep fibular nerve
what are the 2 groups of muscles in the posterior compartment of the leg?
superficial group
deep group
what is the function of the superficial group of the posterior compartment of the leg?
plantarflexion of the ankle
what is the function of the deep group of the posterior compartment of the leg?
plantarflexion of the ankle
flexion of the toes
what are the 4 muscles of the superficial group of the posterior compartment of the leg?
gastrocnemius
soleus
plantaris
popliteus
what are the 3 muscles of the deep group of the posterior compartment of the leg?
tibialis posterior
flexor hallicus longus
flexoror digitorum longus
what is the innervation of the soleus?
tibial division of the sciatic nerve (L5, S1,2)
what is the innervation of the gastrocnemius?
tibial division of the sciatic nerve (L5, S1,2)
what is the innervation of the plantaris?
tibial division of the sciatic nerve (L5, S1,2)
what is the innervation of the popliteus?
tibial division of the sciatic nerve (L5, S1,2)
what is the innervation of the flexor hallicus longus?
tibial division of the sciatic nerve (L5, S1,2)
what is the innervation of the flexor digitorum longus?
tibial division of the sciatic nerve (L5, S1,2)
what is the innervatio of the tibialis posterior?
tibial division of the sciatic nerve (L5, S1,2)
what is the superolateral border of the popliteal fossa?
biceps femoris tendon
what is the superomedial border of the popliteal fossa?
semimembranosus tendon
what are the inferior borders of the popliteal fossa?
gastrocnemius
2 heads to form a diamond shape
what are the contents of the popliteal fossa?
- fat
- terminal small saphenous vein
- popliteal vessels
- tibial and common fibular nerves
what are the articulations of the hip joint?
head of femur and acetabulum of hip
What are the 3 ligaments which spiral from the pelvis to the femur?
iliofemoral ligament
pubofemoral ligament
ischiofemoral ligament
out of the 3 ligaments which spiral from the pelvis to the femur, which 2 are anterior?
iliofemoral ligament and pubofemoral ligament are anterior
ischiofemoral ligament is posterior
What is the first main branch off of the femoral artery?
profunda femoris
deep femoral artery
what are the first 2 branches off the profunda femoris?
medial circumflex artery
lateral circumflex artery
what artery does the artery to the head of the femur branch off of?
obturator artery
what do the medial and lateral circumflex arteries supply?
the hip joint
in what ligament does the artery to the head of femur run?
in the ligamentum teres to the head of the femur
what are the 3 articulations in the knee joint?
2 x femerotibial
1 x femeropatellar
what muscle from the anterior compartment of the thigh stabilises the knee?
quadriceps femoris
What are the main 2 extracapsular ligaments of the knee joint?
lateral (fibular) collateral ligament
medial (tibial) collateral ligament
What are the 2 intra-articular ligaments of the knee joint?
anterior cruciate (ACL) posterior cruciate (PCL)
what are menisci of the knee joint made of?
crescent shaped fibrocartilage
what sign do you get if the anterior cruciate (ACL) of the knee is damaged?
positive lachmans test
anterior sliding of the tibia under the femur
what sign do you get if the posterior cruciate (PCL) of the knee is damaged?
posterior drawer sign
posteiror sliding of the tibia under the femur
what is the calcaneal tendon more commonly known as?
achilles tendon
what is the strongest ligament in the body?
iliofemoral ligament
what is the strongest tendon in the body?
calcaneal tendon
what 3 muscles tendon make up the calcaneal tendon?
gastrocnemius, soleus and plantaris
from superficial group of posterior leg compartment
what is the normal result of an ankle jerk reflex test?
plantar flexion
what spinal nerves roots does an ankle jerk reflex test?
S1, S2 nerve roots
what is the most powerful extensor of the hip?
gluteus maximus
what gluteal muscle, along with the superficial fascia overlying it, helps to define the gluteal fold?
gluteus maximus
Where is the inferior gluteal neurovascular bundle located?
deep to the gluteal maximus
where is the superior gluteal neurovascular bundle located?
deep to the gluteus medius
what is the distal attachment of the deep muscles of the gluteal region?
greater trochanter of the femur
What is the iliotibial tract?
a thickening of the deep fascia of the thigh
thickening of the fascia lata
Where does the iliotibial tract run?
from the ASIS to the lateral aspect of the laterl tibial condyle- at the Gerdy tubercle
what is the function of the iliotibial tract?
supports the knee joint
What compartment of the thigh does the sciatic nerve enter?
posterior compartment
What type of fibres does the posterior cutaneous nerve of the thigh contain?
sensory and sympathetic fibres
at what level of the spine is a lumbar puncture taken?
L3,4
the plane between the iliac crests
at what level does the spinal cord end?
L1/2
during a lumbar puncture, samples of CSF are taken from what area surrounding the spinal cord?
subarachnoid space
What is the conus medullaris?
the terminal part of the spinal cord
What is the order of the muscles in the posterior thigh? (medially to laterally)
semimembranosus
semitendinosus
biceps femoris (long head)
biceps femoris (short head)
which is more superficial- semimembranous or semitendinous?
semitendinosus
What is the function of the muscles of the posterior thigh?
extend the hip
flex the knee
What are the 3 reasons the biceps femoris (short head) is diffferent to the rest of the muscles of the posterior thigh?
- attaches to the linea aspera of the femur and not the ischial tuberosity
- it doesn’t cross the hip joint so doesn’t contribute to extension of the hip joint
- supplied by common fibular branch instead of tibial branch
what increases the depth of the acetabulum?
the acetabular labrum
what ligament attaches the femur to the depth of the acetabulum and also contains the artery to the head of the femur?
the ligament of the head of the femur
what happens to the artery to the head of the femur in adulthood?
becomes obliterated
still remains within the ligament of the head of the femur
what happens to the ligament of the head of the femur during hip dislocation?
ligament ruptures
what type of joint is the hip joint?
synovial, ball and socket joint
which is more stable- hip joint or shoulder joint?
hip joint
what is the function of the ligaments around the hip joint?
reinforce stability of the joint
Where is the intertrochanteric line of the femur?
a line in between the greater trochanter and the lesser trochanter of the femur
(anterior aspect)
where does the fibrous capsure of the hip joint attach to the femur anteriorly?
intertrochanteric line of the femur
What branches are given off the medial and lateral circumflex femoral branches and pass deep to the fibrous capsule into the head of the femur?
retinacular arteries
What type of hip joint fracture will affect the retinacular arteries?
intercapsular hip fracture
occurs proximal to the intertrochanteric line
what is the serious problem which can accompany intercapsular hip fracture?
damaged blood supply to the head of th femur causing avascular necrosis
what fascia must the small saphenous vein pass through to end up in the popliteal fossa?
popliteal fascia
deep fascia
from superficial to deep, names the components of the major neurovascular bundle that lies in the popliteal fossa?
tibial nerve
popliteal vein
popliteal artery
what nerve gives rise to the medial sural cutaneous nerve?
tibial nerve
what nerve gives rise to the lateral sural cutaneous nerve?
fibular nerve
what nerve enables communication between the medial and lateral sural cuteneous nerves?
sural communicating branch
what 2 nerves combine to form the sural nerve?
medial cutaneous sural nerve and branches from the sural communicating nerve
what blood vessel does the sural nerve follow in the superficial fascia of the posterior aspect of the leg?
small saphenous vein
what nerve gives branches to both the heads of gastrocnemius which in the popliteal fossa?
tibial nerve
what muscle is deep to the lateral head of the gastocnemius?
plantaris muscle
what muscle is deep to the plantaris muscle?
popliteus muscle
what is the insertion of the plantaris
the calcaneus via the achilles tendon
the tibial nerve courses through the posterior compartment of the leg deep to what muscle of the superficial compartment?
soleus
what blood vessel does the tibial nerve follow through the posterior compartment of the leg?
posterior tibial artery
From anterior to posterior, name the tendons of the muscles of the deep posterior compartment of the leg along with the tibial nerve and the posterior tibial artery?
tendon of Posterior Tibialis tendon of Flexor Digitorum Longus Posterior Tibial Artery Tibial Nerve tendon of Flexor Hallicus Longus [Tom, Dick ANd, Harry]
what is the insertion of the gastrocnemius
to the calcaneus via the Achilles tendon
where does the medial head of the gastrocnemius attach proximally?
medial femoral condyle
where does the lateral head of the gastrocnemius attach proximally?
lateral femoral condyle
why does the gastrocnemius have a weak knee flexor function in addition to it’s powerful ankle plantar-flexor role?
it crosses the knee joint as well as the ankle joint
where is the origin of the soleus?
to the neck of the fibula and the soleus line of the tibia
slopes inferiorly from lateral to medial
where is the insertion of the soleus?
to the calcaneus via the achilles tendon?
where does the popliteal artery divide into the anterior and posterior tibial arteries?
divides immediately distal to the popliteal fossa
what artery is the fibular artery a branch of?
the posterior tibial artery
What does the anterior tibial artery pierce in order to get to the anterior compartment of the leg?
interosseous membrane
The posterior tibial artery leaves the posterior compartment by passing anterior or posterior to the medial malleolus?
posterior to the medial malleolus
in the foot, the posteiror tibial artery terminates by dividing into what 2 arteries?
medial plantar artery
lateral plantar artery
What are the 3 articulations of the knee joint?
2 between femur and tibia
1 between femur and patella
What are the main movements of the knee?
flexion
extension
(at 90 degrees flexion also medial and lateral rotation)
what muscles are involved in flexion of the knee?
mainly hamstrings and gastrocnemius
what muscles are involved in extension of the knee?
mainly quadriceps
what muscles are involved in the medial rotation of the knee?
hamstrings and gracilis
what muscles are involved in the lateral rotation of the knee?
biceps femoris
what are the main ligaments that help with stabilisation of the knee?
iliotibial tract medial collateral ligament (MCL) lateral collateral ligament (LCL) anterior cruciate ligament (ACL) posterior cruciate ligament (PCL)
what are the medial and lateral menisci of the knee made of?
fibrocartilage
what is the function of the medial and lateral menisci?
shock absorbers
assist with stabilisation of curved femoral condyles upon flatter tibial condyles
what menisci is compromised in genu varum? and what occurs?
medial menisci
bowed legs
what menisci is compromised in genu valgas? and what occurs?
lateral menisci
knock knees
what 3 structures are torn in ‘unhappy triad’ knee injury?
medial collateral ligament
median menisci
anterior cruciate ligament
what is the function of the anterior cruciate ligament?
prevents anterior displacement and excessive internal rotation of the tibia on the femur
what femoral condyle does the anterior cruciate ligament attach to?
the lateral femoral condyle
what is the function of the posterior cruciate ligament?
prevents posterior displacement of the tibia on the femur
what femoral condyle does the posterior cruciate ligament attach to?
medial femoral condyle
what test assesses the integrity of the ACL?
anterior drawer test
what test assesses the intergrity of the PCL?
posterior drawer test
what reduces friction on the quadriceps tendon during knee movements?
suprapatellar bursa
where does the common fibular nerve bifurcate into the deep fibular nerve and the superficial nerve?
at the fibular neck
what muscle compartment of the leg does the deep fibular nerve supply?
anterior compartment
what muscle compartment of the leg does the superficial fibular nerve supply?
lateral compartment
what muscles are involved in inversion of the foot?
tibialis anterior and tibialis posterior
what muscles are involved in the eversion of the foot?
fibularis tertius
fibularis longus
fibularis brevs
What separates the anterior and lateral compartment of the leg?
anterior intermuscular septum
what nerve supplies the anterior compartment of the arm?
musculocutaneous nerve
what nerve supplies the posterior compartment of the arm?
radial nerve
what nerve supplies the anterior compartment of the forearm?
mainly median nerve (ulnar supplies flexor carpi ulnaris and the medial part of flexor digitorum profundis)
what nerve supplies the posterior compartment of the forearm?
radial nerve
what nerve supplies the hand?
ulnar nerve (except LOAF = median)
what nerve is damage in wrist drop? (ie can’t extend wrist)
radial nerve
what are the 5 spinal nerve roots involves in the brahcial plexus?
anterior rami of C5 C6 C7 C8 T1
what spinal nerve roots form the upper trunk of the brachial plexus?
C5 and C6
what spinal nerve roots form the middle trunk of the brachial plexus?
C7
what spinal nerve roots form the lower trunk of the brachial plexus?
C8 and T1
what divisions do each trunk of the brachial plexus divide into?
anterior division and posterior division
what divisions of which trunks form the lateral cord of the brachial plexus?
anterior divisions of upper and middle trunks of the brachial plexus
what divisions of which trunks form the posterior cord of the brachial plexus?
posterior divisions of the upper, middle and lower trunks of the brachial plexus
what divisions of which trunks form the medial cord of the brachial plexus?
anterior division of lower trunk form of the brachial plexus
what cords of the brachial plexus form the muscutaneous nerve?
lateral cord
what cords of the brachial plexus form the median nerve?
lateral cord + medial cord
what cords of the brachial plexus form the axillary nerve?
posterior cord
what cords of the brachial plexus form the radial nerve?
posterior cord
what cords of the brachial plexus form the ulnar nerve?
medial cord
what are the cords of the brachial plexus named in relation to?
the axillary artery
where are the trunks of the brachial plexus found?
neck region
what 3 nerves of the brachial plexus form the letter M shape?
musculocutaneous
median
ulnar
what spinal nerve roots are tested in the ankle reflex?
S1, S2
what spinal nerve roots are tested in the knee reflex?
L3, L4
what spinal nerve roots are tested in the biceps brachii tendon reflex?
C5, C6
what spinal nerve roots are tested in the triceps brachii tendon reflex?
C7, C8
what vein drains the lateral aspect of the forearm/arm?
cephalic vein
what vein drains the medial aspect of the forearm/arm?
basilic vein
what vein joins the cephalic vein to the basilic vein? (and where does it lie?
median cubital vein
in the cubital fossa
what is the name of the 2 veins that accompany the brachial artery?
venae comitantes
what are teh 3 types of joint?
fibrous
cartilaginous
synovial
what type of joint is the interosseous membrane?
fibrous joint
what are the 6 types of synovial joint?
- synovial ball and socket joint
- synovial hinge joint
- synovial pivot joint
- synovial plane joint
- synovial ellipsoid joint
- synovial saddle joint
what type of joint is the shoulder joint?
synovial ball and socket joint
what type of joint is the elbow joint?
hinge joint
what type of joints are the interphalangeal joints of the hands?
hinge joints
what type of movement to pivot joints allow?
rotational movement only
what type of joints are the proximal radio-ulnar joints?
pivot joints
what type of joints are the acromioclavicular joints?
plane joints
what type of joints are the wrist joints?
ellipsoid joints
what type of joints are the metacarple pharyngeal joints? (MCP)
ellipsoid joints
what type of joints are the 1st carple metacarple joints?
saddle joints
what is the main part of a synovial joint affected by trauma?
ligaments or capsule
what is the main part of a synovial joint affected by osteoarthritis?
hyaline articular cartilage
what is the main part of a synovial joint affected by rheumatoid arthritis?
synovial membrane
what movement does a synovial plane joint allow?
movement in one plane - gliding
where is the adductor canal?
anterior compartment of the thigh
posterior to the sartorius muscle
what does the adductor canal contain?
femoral vein
femoral artery
branches of femoral nerve (eg saphenous nerve)
what are the 5 joints of the foot?
- subtalar joint
- midtarsal joints
- tarsometatarsal joints
- metatarsophalangeal joints
- interphalangeal joints
what bones of the foot are involved in the subtalar joint?
talus and calcaneous
how many midtarsal joints are there? and what are they?
2
calcaneocuboid joint
talocalcaneonavicular joint
what bones of the foot are involved in the calcaneovuboid (midtarsal) joint?
calcaneous and cuboid
what bones of the foot are involved in the talocalcaneonavicular (midtarsal) joint?
talus, calcaneous and navicular
what type of joints are the midtarsal joints of the foot?
synovial joints
what range of movement do the midtarsal joints of the foot have?
inversion and eversion
what bones are involved in the tarsometatarsal joints?
cuneiforms/cuboid with the metatarsals
what bones are involved in the metatarsophalangeal (MTP) joints?
metatarsals and phalanges
what type of joints are the metatarsophalangeal joints?
synovial joints
what range of movement do the metatartsophalangeal joints have?
flexion extension abduction adduction circumduction
what joints are involved in the interphalangeal joints of the foot?
proximal to middle phalanges
middle to distal phalanges
proximal to distal 1st phalanx
what type of joints are the interphalangeal joints of the foot?
synovial hinge joints
what range of movement do the interphalngeal joints of the foot have?
flexion and extension
what are the 3 arches of the foot?
medial longitudinal arch
lateral longitudinal arch
transverse arch
what are the 3 main functions of the arches of the foot?
- shock absorption
- spring function
- weight redistrubution to increased weight-bearing capacity
what is the name of the thickened central area of the plantar fascia?
plantar aponeurosis
what is the plantar fascia?
the deep fascia of the sole of the foot
what supports the arches of the foot?
plantar aponeurosis and plantar ligaments
what bones of the foot compose the medial longitudinal arch?
calcaneus, talus, navicular, 3 cuneiforms and metatarsals 1-3
what muscles support the medial longitudinal arch of the foot?
flexor hallicus longus
attachments of the tibialis anterior
attachments of the fibularis longus
where does the tibialis anterior attach to the foot?
to the junction between the medial cuneiform and the base of 1st metatarsal
where does the fibularis longus attach to the foot?
tendon passes across the plantar aspect of the foot from lateral to medial to attach to the junction between the medial cuneiform and the base of the 1st metatarsal
what bones of the foot compose the lateral longitudinal arch?
calcaneus, cuboid and metatarsals 4/5
what bones of the foot compose the transverse arch?
cuboid, cuneiforms and metatarsals 1-5
what muscles support the transverse arch of the foot?
fibularis longus
tibialis posterior
what are the muscle compartments of the intrinsic muscles of the foot?
3 layers within the sole +
additional muscles between the metatarsals (interosseous muscles
2 on dorsum
what movement do the intrinsic sole muscles of the foot perform?
flexion of the toes
what movement do the interosseous muscles of the foot perform?
abduction/adducion of the toes
what artery does the dorsalis pedis artery branch off of?
anterior tibial artery
where is the pulse of the dorsalis pedis taken?
lateral to the extensor hallicus longus tendon
what artery does the arcuate artery branch off of?
dorsalis pedis artery
what arteries supply the dorsum of the foot?
dorsalis pedis
+ arcuate artery
what artery do both the medial and lateral plantar arteries branch off of?
posterior tibial artery
what arteries form the deep plantar arch?
medial and lateral plantar arteries
what arteries do the metatarsal arteries arise from?
deep plantar arch and the arcuate artery
what arteries do the digital arteries of the foot arise from?
metatarsal arteries
how many digital arteries does each toe have?
4
where do the great and small saphenous veins arise from?
dorsal venous arch
what do the deep veins of the foot drain into?
anterior tibial vein, posterior tibial vein and fibular vein
all join to form popliteal vein
how many dorsal foot muscles are there?
2
what is the function of the dorsal foot muscle?
extension of the toes
what is the motor nerve supply to the intrinsic muscles of the sole of the foot?
tibial nerve
what is the motor nerve supply to the intrinsic muscles of the dorsum of the foot?
deep fibular nerve
what is the sensory supply of the dorsum of the foot?
mainly superficial fibular nerve
deep fibular nerve supplies first interdigital cleft
sural nerve supplies proximal lateral border
saphenous nerve supplies proximal medial border
what is the sensory supply of the plantar surface of the foot?
mainly tibial nerve to heel and majority of sole
sural nerve supplies proximal lateral border
saphenous nerve supplies proximal medial border
what vessels do the lymphatic vessels of the foot follow?
the great and small saphenous veins
[in limbs, lymphatics follow veins]
what forms the anterior wall of the axilla?
pectoralis major
what are the main muscles of climbing?
pectoralis major and latissimus dorsi
what vein is the axillary vein a continuation of?
brachial vein (a deep vein of the arm)
when does the brachial vein become the axillary vein?
at the lower border of the teres major muscle
where is the teres major in relation to the axilla?
the teres major contributes to the posterior wall of the axilla
(inferior border of teres major is the inferior extent of the axilla)
where can pulsations of the subclavian artery be palpated?
where the artery crosses the first rib
when does the subclavian artery become the axillary artery?
at the lateral border of the first rib
what muscles do the roots and trunks of the brachial plexus lie between?
between anterior and middle scalene muscles
where do the divisions of the brachial plexus lie?
immediately posterior to the subclavian vessels
deep to the clavicle
where do the cords of the brachial plexus lie?
around the axillary artery, distal to the first rib
what 3 muscles does the musculocutaneous nerve supply?
anterior compartment of the arm:
coracobrachialis
biceps brachii
brachialis
which nerves of the brachial plexus pass into the posterior compartment of the arm?
axillary and radial nerve
why is the axillary nerve vulnerable to injury in shoulder dislocation or fractured neck of humerus?
it wraps around the posterior aspect of the surgical neck of the humerus
why is the radial nerve vulnerable to injury in a mid-shaft humeral fracture?
it wraps around the posterior aspect of the med-shaft of the humerus
which is the most medial of the nerves of the brachial plexus?
ulnar nerve
where is the ‘M-shaped’ configuration of the named nerves of the brachial plexus?
within the axilla
what is the main muscle of the posterior wall of the axilla?
latissimus dorsi
where does the subclavian vein drain into the internal jugular vein in relation to the sternoclavicular joint?
posterior to the sternoclavicular joint
where is the subclavian artery in relation to the subclavian vein?
subclavian artery is immediately posterior to the subclavian vein
where are the axillary lymph nodes located?
within the fascia of the axilla
what cranial nerve supplies the trapezium?
the accessory nerve
what type of nerves are the 5 named nerves of the brachial plexus?
somatomotor
somatosensory
sympathetic
what is the path of the median nerve?
goes down the medial aspect of the arm and crosses the anterior aspect of the elbow (cubital fossa) and crosses the forearm through the wrist and into the hand through the carpal tunnel
what is the path of the ulnar nerve
goes down the medial aspect of the arm and passes posteriorly to the medial epicondyle of the humerus, then into the anterior compartment of the forearm and into the hand
what is the path of the axillary nerve?
emerges anteriorly and passes into the posterior compartment of the arm. It wraps around the surgical neck of the humerous and supplies the deltoid muscle
what is the path of the radial nerve?
passes into the posterior compartment, passes anteriorly to the lateral epicondyle of the humerus and then into the posterior compartment of the forearm
which nerve of the brachial plexus carries somatosensory nerve fibres to the medial 1.5 fingers of the hand? (anterior)
ulnar nerve
which nerve of the brachial plexus carries somatosensory fibres to the lateral 3.5 fingers of the hand? (anterior)
median nerve
which nerve of the brachial plexus carries somatosensory fibres to the lateral aspect of the dorsum of the hand?
radial nerve
which nerve of the brachial plexus carries somatosensory fibres to the badge patche
of the lateral arm?
axillary nerve
describe the 33 vertebrae organised in the sections of the spine?
7 cervical 12 thoracic 5 lumbar 5 sacral (fused) 4 coccgeal (fused)
why do the cervical vertebrae have a really large central foramen?
large spinal cord
this thins as it gives out nerves roots
why do the vertebral bodies get larger from the cervical vertebrae to the lumbar vertebrae?
because as you go down, you have to carry more weight
where do the ribs attach to the vertebrae of the thoracic spine?
at the costal facets
2 superior costal facets, 2 inferior costal facets
what are the posterior elements of the vertebrae?
the bony features of the vertebral arch
ie everything but the vertebral body
compare the thoracic vertebra to the lumbar vertebra in terms of pedicles?
thoracic vertebra- small peedicles
lumbar vertebra- longer, wider pedicles
compare the thoracic vertebra to the lumbar vertebra in terms of articular facet joints?
thoracic vertebra- more vertical facet joints
lumbar vertebra- more horizontal facet joints
what type of joints are the superior and inferior articular facet joints of the vertebrae?
synovial joints
in which joints does osteoarthritis of the spine occur?
in the facet joints
what is the main peculiarity of the atlas vertebra?
it has no vertebral body
what extra process does the axis have?
dens process (odontoid peg)
what is the function of the dens process of the axis vertebra?
articulates with the atlas and allows rotation of the head and atlas around the dens
the atlas vertebra has big wide articular facets, where do these articulate superiorly?
to the occiput of the skull
what is the function of the transverse foramen of the cervical vertebrae?
allow transmission of the vertebral artery, vein and nerve fibres
compare the vertebral body of the cervical vertebrae to the ones of the thoracic vertebrae?
cervical vertebral body is smaller
compare the lamina of the cervical vertebrae to the lamina of the thoracic vertebrae?
cervical lamina is much wider
compare the transverse process of the cervical vertebrae to the transverse process of the thoracic vertebra?
cervical transverse process is much shorter
what are the movements of the atlanto-occipital joint?
flexion
extension
lateral flexions
what are the movements of the atlanto-dens joint?
rotation (with dens acting as pivot)
what is the vertebra prominens?
the most prominent vertebra- C7
why is there the greatest risk of spinal injury at cervico-thoracic or thoraco-lumbar junctions?
because there is greatest risk of injury at the junctions between mobile and fixed parts
what are the 2 main parts of the intervertebral discs?
annular fibrosis
nucleus pulposus
what is the annular fibrosis of the intervertebral disc?
ther peripheral tough fibrous structure, arranged in rings
what is the nucleus polposus of the intervertebral disc?
the central gelatinous, semi-fluid substance
where are the intervertebral discs most likely to rupture? and why?
posteriorly
annulus fibrosus is thinnest posteriorly
why in old age does the spine lose height and return to the C shape of the newborn?
intervertebral discs lose fluidity and size causing shrinking
what are the 5 main ligaments of the spine?
anterior longitudinal ligament posterior longitudinal ligament ligamentum flavum supraspinous ligament intraspinous ligament
where is the anterior longitudinal ligament of the spine?
runs along the anterior surface of the vertebral body and discs
where is the posterior longitudinal ligament of the spine?
runs along the posterior surface of the vertebral body and discs
what does the ligamentum flavum of the spine link?
links vertebral laminae
where is the supraspinous ligament of the spine?
runs along the peaks of the spinous processes
what does the intraspinous ligament of the spine link?
links the spinous processes of the vertebrae
compare the ligamentum flavum, supraspinous ligament and the intraspinous ligament in terms of strength?
ligamentum flavum and supraspinous ligament - tough
intraspinous ligament - relatively weak
what are the 3 columns of Denis? (of the spine)
anterior column- anterior 2/3 of the vertebral body
middle column- posterior 1/3 of vertebral body
posterior column- posterior elements
what happens to the stability of the spine when 1 column is injured?
spine is stable
what happens to the stability of the spine when 2 columns are injured?
spine might be unstable
what happens to the stability of the spine when 3 columns are injured?
spine is unstable
what are the 3 classifications of muscles of the spine?
- superficial (extrinsics)
- intermediate
- deep (intrinsics)
what is the main function of the intermediate muscles of the spine?
respiratory function
where is the origin of the intermediate muscles of the spine?
spinous processes
where is the insertion of the intermediate muscles of the spine?
ribs
what are the 3 intermediate muscles of the spine?
serratus posterior (x2) serratus superior (x2) serratus inferior (x2)
what are the 4 main superficial (extrinsic) muscles of the spine?
trapezius (x2)
latissimus dorsi (x2)
rhomboid minor and major (x2)
levatus scapularis (x2)
what is the function of the superficial (extrinsic) muscles of the spine?
movement of the shoulder and upper limb
not much to do with spinal movement
where is the origin of the trapezius?
C1-T12 spinous processes
where are the insertions of the trapezius?
occiput
spine of the scapula
what is the function of the trapezius?
elevates + depresses scapula (ie shrugging shoulders)
retracts scapula
where is the origin of the latissimus dorsi?
spinous processes and pelvis (brim of ilium)
where is the insertion of the latissimus dorsi?
humerus
what is the function of the latissimus dorsi?
adducts humerus
extends humerus
internally rotates humerus
what is the innervation of the latissimus dorsi?
C6/7/8
where are the rhomboid major and minor and the levatus scapularis in relation to the trapezium?
rhomboid major and minor and the levatus scapularis are just deep to the trapezium
where are the origins of the rhomboid major and minor?
minor- spinous processes of C7/T1
major- spinous processes of T2-T5
what are the insertions of the rhomboid major and minor?
medial border of the scapula
what is the innervation of the rhomboid major and minor?
dorsal scapula nerve (C3/4)
what is the function of the rhomboid major and minor?
keeps scapula against thoracic wall
retracts scapula
where is the origin of levatus scapularis?
transverse processes of C1
where are the insertions of levatus scapularis?
superior angle of scapula
what is the innervation of the levatus scapularis?
branches of C4/5
what is the function of the levatus scapularis?
elevates the scapula
what are the 3 deep muscles of the spine? (intrinsics)
erector spinae muscles:
iliocostalis (x2)
longisimus thoracis (x2)
spinalis thoracis (x2)
what happens to the lumbar lordosis in spinal trauma?
lordosis becomes flat
due to swelling
describe the positions oft eh erector spinae muscles?
all parallel to the spine
iliocostalis (laterally)
longisimus thoracis (in between)
spinalis thoracis (medially)
where is the origin of the erector spinae muscles?
occiput of the skull
where is the insertion of the erector spinae muscles?
pelvis
multiple attachments alon thoracic wall
what is the innervation of the erector spinae muscles?
posterior rami of the spinal nerves
what is the spinal cord a continuation of?
the medulla oblongata
where does the spinal cord exit the skull?
via the foramen magnum
where does the spinal cord terminate?
in the cauda equina at L2
what area of the body do nerves in the cervical spine govern?
arms
what area of the body do nerves in the thoracic spine govern?
middle of the body
what area of the body do nerves in the lumbar spine govern?
legs
what area of the body do nerves in the sacral spine govern?
posterior aspects of legs
pelvis
what are myotomes?
muscles controlled by the motor element of the nerve root from a specific level
what are dermatomes?
skin sensation supplied by the sensory element of the nerve root from a specific level
what type of mattern makes up the posterior and anterior horns in the spinal cord?
grey matter
what lives in the white matter of the spinal cord?
ascending sensory tracts
descending motor tracts
what are the 2 types of descending motor tracts?
- crossed pyramidal tract (lateral cerebrospinal tract)
- uncrossed pyramidal tract (anterior cerebrospinal tract)
compare the crossed pyramidal tract (lateral cerbrospinal) to the uncrossed pyramidal tract (anterior cerebrospinal)?
crossed- motor neurones crosse at medullary level and descend spine on the contralateral side of the cord
uncrossed- motor neurones descend spine on the ipsilateral side of the cord and crosse at the same level it will exit from
what are the 6 types of ascending sensory tracts?
- anterior spinothalmic tract
- anterior spinocerebellar tract
- lateral spinothalmic tract
- posterior spinocerebellar tract
- posterior column of Goli
- posterior column of Burdach
what is the pathway of the anterior spinocerebellar tract?
sensory neurones enter and ascend on ipsilateral side of cord
then enter cerebellum
what is the pathway of the posterior spinocerebellar tract?
sensory neurones enter and ascend on the ipsilateral side of cord
then enter cerebellum
what information do the anterior spinocerebellar tract and the posterior spinocerebellar tract carry?
proprioception
what is the pathway of the anterior spinothalmic tract?
sensory neurones enter and ascend the spine on the ipsilateral side for a couple of levels. Then cross and ascend on the contralateral side.
Then enter thalmus
what is the pathway of the lateral spinothalmic tract?
sensory neurones enter and ascend the spine on the ipsilateral side for a couple of levels. Then cross and ascend on the contralateral side.
Then enter thalmus
what is the pathway of the posterior column of Goli?
sensory neurones enter and ascend the spine on the ipsilateral side of the cord
what is the pathway of the posterior column of Burdach?
sensory neurones enter and ascend the spine on the ipsilateral side of the cord
what information do the lateral spinothalmic tract and the anterior spinothalmic tract carry?
pain and temperature
what information do the posterior columns of Goli and Burdach carry?
fine touch and proprioception
what horn of the grey matter of the spinal cord do the descending motor tracts enter?
anterior horn
what root are the descending motor tracts transmitted via from the anterior horn to the nerve root?
ventral root
what root are the ascending sensory tracts transmitted via from the nerve root to the posterior horn?
dorsal root
what horn of the grey matter of the spinal cord do the ascending sensory tracts enter?
posterior horn
the dorsal root is for which type of nerve pathway?
sensory nerve function
the ventral root is for which type of nerve pathway?
motor nerve function
the anterior horn is for which type of nerve function?
motor nerve function
the posterior horn is for which type of nerve function?
sensory nerve function
what do the ventral and dorsal roots join to become?
nerve root
what does the nerve root divide to become?
anterior and posterior rami
what do the posterior rami form the nerve supply of?
the intrinsic muscles of the back
the strip of skin sensation in the centre of the back
what do the anterior rami form the nerve supply of?
everything in the body/limbs apart from the intrinsic muscles of the back and the strip of skin sensation in the centre of the back
where do the spinal nerve roots exit the spinal column? (ie what part of the spine)
the intervertebral foramina
what are the 3 main risks to the nerve root leavng the intervertebral foramina
prolapsed disc
facet joint osteophytes
foraminal stenosis
what nerve roots is the cauda equina made of?
L2-S5 and coocygeal nerve
what do the nerves of the cauda equina supply?
pelvic organs and lower limbs
at what level does the spinal cord terminate at?
L2
what type of joints are sacroiliac joints?
synovial plane joints
what is the treatment of sacroilitis?
non-surgical
NSAIDs, physiotherapy
does sacroilitis radiate?
no- localised pain
where do the anterior and posterior spinal arteries come from?
descend from the pia mater (innermost layer of the meninges)
reinforced by the cervical, intercostal and lumbar arteries at each level
what is Batson’s venous plexus?
a network of valveless veins that connect the deep pelvic veins and the thoracic veins to the internal vertebral venous plexus
why is the spine a common place for neoplastic metastases?
because of batson’s venous plexus linking deep pelvic veins (draining bladder and prostate) and the thoracic veins (draining breast) to the internal vertebral venous plexus
what are the intrinsice muscles of the dorsal foot?
extensor hallicus brevis
extensor digitorum brevis
what is the sensory nerve supply to the medial leg?
saphenous nerve
what is the sensory nerve supply to the medial foot?
saphenous nerve
what is the sensory nerve supply to the lateral leg?
superficial fibular nerve
what is the sensory nerve supply to the majority dorsal foot?
superficial fibular nerve
what is the sensory nerve supply to the sole of the foot and heel?
tibial nerve
what is the sensory supply to the section of the dorsal foot between 1st/2nd toes?
deep fibular nerve
what is the function of the MTP joints?
flexion, extension, abduction, adduction and circumduction of the toes
what is the function of the subtalar and metatarsal joints?
eversion and inversion of the foot
what is the function of the interphalangeal joints?
flexion and extension of the toes
where does the hip capsule insert into the femur?
inter-trochanteric line
what is the largest sesamoid bone in the body?
patella
what mechanism is the patella encapsulated by?
extensor mechanism
are people generally genu varum or genu valgum?
genu valgum
what is the ankle joint proper?
the articulation between the talus and the tibia
what movements are involved in the ankle joint proper?
flexion and extension
what joints within the foot is involved in the inversion and eversion of the foot?
midtarsal (calcaneocuboid, talocalcaneonavicular)
what is the ring-like cartilaginous structure which is an extension of the acetabulum?
acetabulum labrum
what is the function of the acetabulum labrum?
to increase the stability of the femoral head
what is a retrograde blood supply?
blood vessels journey past the area they supply then loop back
what is the main supplier of blood to the femoral head?
mainly- lateral and medial circumflex arteries
also- intermedullary artery of shaft of femur
retrograde
what ligament does the antegrade blood supply of the femoral head go through?
ligamentum teres
which type of blood supply is more at risk of avascular necrosis after trauma? (antegrade or retrograde)
retrograde
what bone in the hand has a retrograde blood supply so has a larger risk of avascular necrosis after trauma?
scaphoid
what bone in the foot has a retrograde blood supply so has a larger risk of avascular necrosis after trauma?
talus
what are the 2 main hip flexors?
iliacus and the psoas major (iliopsoas together)
what are the 2 secondary hip flexors?
rectus femoris
sartorius
what are the 3 main hip abductors?
gluteus medius
gluteus minimus
tensor fascia late
what is the origin of the gluteus minimus/medius?
iliac wing
what is the insertion of the gluteus minimus/medius
greater trochanter of femur
what is the origin of the tensor fascia lata?
iliac crest
what is the insertion of the tensor fascia lata?
lateral tibial via the iliotibial tract
what are the muscles which stabilise you when you stand onone leg?
hip abductors
what is the main function of the gluteus maximus?
hip extensor
what is the origin of the gluteus maximus?
posterior aspect of the ilium/sacrum
what is the insertion of the gluteus maximus?
iliotibial tract
what is the origin of both short head and long head of the biceps femoris?
long head- ischial tuberosity
short head- linea aspera
what is the insertion of the short and long head of the biceps femoris?
fibula head
what is the origin of the semimembranosus?
ischial tuberosity
what is the insertion of the semimembranosus?
posterior tibia
what is the origin of the semitendinosus?
ischial tuberosity
what is the insertion of the semitendinosus?
medial tibia
what is the likely diagnosis of a middle-aged/old patient presenting with lateral hip pain and no tenderness of the groin?
trochanteric bursitis
why is there always tenderness of the groin in a true inter-articular injury of the hip?
because the groin is right over the joint
what are the 3 compartments of the knee?
lateral compartment
medial compartment
patellofemoral compartment
what is the main function of the medial collateral ligaments of the knee?
resist valgus stresses
what is the main function of the lateral collateral ligaments of the knee?
resist varum stresses
what are the origins of the collateral ligaments of the knee?
lateral and medial condyles of the femur
what direction does the anterior cruciate ligament of the knee go in?
inferomedially
what direction does the posterior cruciate ligament of the knee go in?
inferolaterally
what are the 2 main types of acute meniscal tears?
bucket handle tear
radial tear
what are the 5 parts of the extensor mechanism?
quadriceps muscle quadriceps tendon patella patella tendon tibial tuberosity
what nerve should you worry about in a fracture of the proximal fibula?
common fibular nerve
what is the origin of the plantaris?
lateral femoral condyle
where is the origin of the tibialis anterior?
lateral surface of the proximal tibia
where is the insertion of the tibialis anterior?
medial cuneiform /base of the 1st metatarsal
what is the medial ankle ligament?
deltoid ligament
what is the lateral ankle ligament?
lateral ligament complex
what forces does the deltoid ligament of the ankle resist?
eversion /valgising forces of the ankle
what forces does the lateral ligament complex of the ankle resist?
inversion/ varising forces of the ankle
what is the origin of the plantar fascia?
tuberosity of calcaneus
what is the insertion of the plantar fascia?
heads of the metatarsals
what are the 3 muscles in the anterior compartment of the arm?
biceps brachii
coracobrachialis
brachialis
which is the most anterior muscle in the anterior compartment of the arm?
biceps brachii
where do the short head and the long head of the biceps brachii attach?
short head- coracoid process of the scapula
long head- supraglenoid tubercle of the scapula
what are the 3 muscles that attach to the coracoid process of the scapula?
- pectoralis minor
- coracobrachialis
- short head of biceps brachii
what groove does the tendon of the long head of the biceps brachii pass through?
intertubecular groove of the humeus
what are the 2 distal attachments of the biceps brachii?
- bicipital tuberosity of the radius via the biceps tendon
- medial side of proximal forearm via the bicipital aponeurosis
describe the location of the corachobrachialis relative to the biceps brachii and brachialis?
- deep to the biceps brachii
- medial to the brachialis
what separates the coracobrachialis from the triceps?
medial intermuscular septae
where is the distal attachment of the coracobrachialis?
humerus
where is the distal attachment of the brachialis?
coranoid process of ulna
where is the proximal attachment of the brachialis?
humerus
what separates brachialis fromt he triceps?
lateral intermuscular septae
what is the most powerful supinator of the forearm?
biceps brachii
why can biceps brachii supinate the forearm?
because it spans the radioulnar joint
what are the functions of the muscles of the anterior compartment of the forearm?
- flexion, abduction + adduction of wrist
- flexion of fingers + thumb
- pronation of forearm
what is the arrangement of the muscles of the anterior forearm?
layer 1, layer 2 and layer 3
suprficial to deep
what are the 4 muscles of layer 1 of the anterior compartment of the forearm?
- pronator teres
- palmaris longus
- flexor carpi radialis
- flexor carpi ulnaris
where do the muscles of layer 1 of the anterior compartment of the forearm attach proximally?
to the medial epicondyle of the humerus via the common flexor tendon
where does the palmaris longus (layer 1) attach distally?
palmar aponeurosis
where does the flexor carpi radialis attach distally?
to the metacarpals on the radial side (lateral)
where does the flexor carpi ulnaris attach distally?
to the metacarpals on the ulnar side (medial)
what muscles makes up layer 2 of the anterior forearm?
flexor digitorum superficialis
how many muscle bellies/tendons are there in the flexor digitorum superficialis and what are these for?
4 muscle bellies/tendons for the medial four digits
what are the 3 muscles of layer 3 of the anterior forearm?
- flexor digitorum profundus
- flexor pollicis longus
- pronator quadratus
how many muscle bellies/tendons are there in the flexor digitorum profunda and what are these for?
4 muscle bellies/tendons for the medial four digits
what are the long tendons of the muscles of the anterior compartment held in place by as they pass into the wrist and hand?
palmar carpal ligament
flexor retinaculum
what is golfers elbow?
medial epicondylitis (tendonitis of the common flexor tendon)
what makes the superior boundary of the cubital fossa?
transverse line between the epicondyles of the humerus
what makes the inferomedial boundary of the cubital fossa?
pronator teres
what makes the inferolateral boundary of the cubital fossa?
brachioradialis
what are the 3 veins and the 2 tendons which form the superficial contents of the cubital fossa?
median cubital vein cephalic vein basilic vein biceps tendon bicipital aponeurosis
what are the 2 nerves and the artery which form the deep contents of the cubital fossa?
median nerve (medially) radial nerve (laterally) brachial artery
where does the brachial artery bifurcate into the radial and ulnar arteries?
at the apex of the cubital fossa triangle
when does the radial nerve divide into its superficial and deep branches?
deep to the brachialis
just anterior to the lateral epicondyle
what muscle does the radial nerve pierce in order to enter the posterior compartment of the forearm?
supinator muscle
does the ulnar nerve cross the anterior or posterior surface of the medial epicondyle of the humerus?
posterior surface
which nerve is involved in the ‘funny bone’ site?
ulnar nerve
what muscle does the ulnar nerve pass through to reach the anterior compartment of the forearm? (and what tunnel does it do this in?)
through flexor carpi ulnaris (in the cibutal tunnel)
what nerve supplying the hand is spared in carpal tunnel syndrome and why?
palmar cutenous branch of the median nerve
because it passes into the hand superficially to the flexor retinaculum
what is the function of the brachialis?
flexion of the elbow
what is the function of the coracobrachialis?
flexion of the shoulder
what is the function of the biceps brachii?
(flexion of the shoulder)
flexion of the elbow
supination of the forearm
what are the 3 parts of the deltoid muscle?
- posterior (spinal) part
- middle (acromion) part
- anterior (clavicular) part
what is the function of the posterior (spinal) part of the deltoid muscle?
extension of the shoulder
what is the function of the middle (acromial) part of the deltoid muscle?
abduction of the shoulder
supraspinatus initiates and deltoid takes over at about 30 degrees
what is the function of the anterior (clavicular) part of the deltoid muscle?
flexion at the shoulder
what are the 3 parts of the trapezius?
ascending, middle and descending parts
what is the function of the ascending part of the trapezius?
scapular depression
what is the function of the middle part of the trapezius?
retraction of the scapulae
what is the function of the descending part of the trapezius?
scapular elevation
what do the ascending and descending trapezius parts contract together to produce?
superior rotation of glenoid fossa
what is the function of the levator scapulae?
elevation of scapula and inferior rotation of glenoid fossa
what is the function of the rhomboid major?
retraction of scapula and inferior rotation of glenoid fossa
what is the function of rhomboid minor?
retraction of scapula and inferior rotation of glenoid fossa
what are the 4 rotator cuff muscles?
- supraspinatus
- infraspinatus
- teres minor
- subscapularis
what is the function of supraspinatus?
first 15 degrees of abduction
what is the function of infraspinatus?
stabilises head of humerus in glenoid
external rotation of shoulder
what is the function of teres minor?
stabilises head of humerus in glenoid
external rotation of shoulder
what is the function of subscapularis?
stabilises head of humerus in glenoid
internal rotation of shoulder
what is the function of tere major?
adduction and medial rotation of the shoulder
what is the distal attachment of the supraspinatus?
greater tubercle of the humerus
what is the distal attachment of the infraspinatus?
greater tubercle of the humerus
what is the distal attachment of the subscapularis?
lesser tubercle of the humerus
what is the distal attachment of the teres minor?
greater tubercle of the humerus
what nerves innervate the rotator cuff muscles?
brachial plexus
what nerve supplies the deltoid muscle?
axillary nerve
what nerve supplies the teres minor?
axillary nerve
where does the deltoid attach proximally?
lateral 1/3 of the calvicle and the inferior aspect of the scapular spine and acromion
where does the deltoid attach distally?
to the deltoid tuberosity of the humerus
where does the subacromion bursa lie?
between supraspinatus tendon and acromion process of scapula
subacromial bursitis may give rise to shoulder pain, especially on what movement?
abduction
because inflamed bursa will irritate the supraspinatus tendon
what spinal nerves supply sensory innervation to the posterior aspect of the arm?
medially: anterior rami of spinal nerves C8, T1 + T2
laterally: anterior rami of spinal nerves C5 + C6 (via axillary nerve)
what is the only muscle of the posterior compartment of the arm?
triceps brachii
what are the proximal attachments of the triceps brachi?
long head- infraglenoid tubercle of the scapula
lateral head- superior to the radial groove of the humerus
medial head- inferior to the radial groove of the humerus
where is the distal attachment of the triceps brachii?
olecranon process of ulna (via the triceps tendon)
what is the action of the triceps brachii?
extension of the forearm
weak extension of the arm
what nerve supplies the triceps brachii?
radial nerve
define the borders of the quadrangular space where the axillary nerve is found?
superiorly- teres minor
inferiorly- teres major
laterally- humerus
medially- long head of triceps
what is the name of the area of skin on the lateral aspect of the arm that is supplied by the axillary nerve?
badge patch
when patients have sustained an inferior dislocation of the shoulder, why is the badge patch tested?
to test for function of the axillary nerve
what nerve does abduction of the shoulder beyond 15 degrees test?
axillary nerve
what spinal nerves make up the axillay nerve?
C5 and C6
what spinal nerves make up the radial nerve?
C5- T1
what groove in the humerus is the radial nerve found in?
radial groove
what nerve is particularly vulnerable to a spiral mid-shaft fracture of the humerus?
radial nerve
what are the 4 main functions of groups of muscles in the posterior compartment of the wrist?
1- extension, abduction and adduction of wrist
2- extension of fingers
3- extension and abduction of thumb
4- supination of the forearm
what 5 muscles of the posterior compartment of the wrist are known as the ‘superficial layer’?
brachioradialis extensor carpi ulnaris extensor carpi radialis extensor digitorum extensor digiti minim
what 5 muscles of the posterior compartment are known as the ‘deep layer’?
supinator extensor pollicis longus extensor pollicis brevis abductor pollicis longus extensor indicis
where do the muscles of the superficial layer of the posterior arm attach proximally?
to lateral epicondyle of humerus via the common extensor tendon
with the exception of the muscle group which supinate the forearm, where are the muscle bellies/tendons of the muscles of the posterior compartment of the arm?
muscle bellies within the posterior compartment
tendons pass to the wrist and fingers
what holds the tendons of the muscles of the posterior compartment of the wrist in place as they cross the wrist?
extensor retinaculum
what is the main action of brachioradialis? (a muscle of the posterior compartment of the forearm)
flexion of the semi-
pronated forearm
what happens to the radial nerve as it passes through the supinator muscle back into the posterior compartment of the forearm?
becomes renamed the posterior interosseous nrve
where is the medial head of the tricpes brachii in relation to the long head?
medial head is more deep and inferior to long head
what artery is found in the radial groove?
profunda brachii artery
what is tennis elbow?
lateral epicondylitis (tendonitis of the common extensor tendon)
what is the function of the extensor carpi radialis?
extends wrist on radial side
what is the function of the extensor carpi ulnaris?
extends wrist on ulnar side
what is the function of the extensor digitorum?
extends fingers
what is the funcion of the extensor pollicis longus?
extends thumb
what is the function of the abductor pollicis longus?
abducts thumb
what is the function of the extensor pollicis brevis?
extends thumb
what is the function of the extensor indicis?
extends index finger
what are the 2 parts of the elbow joint?
humero-ulnar joint
radiocapitellar joint
what is the function of the humero-ulnar joint?
flexion/extension
what is the function of the radio-capitellar joint?
supination/pronation
what muscles supinate the forearm?
biceps brachi and supinator muscles
what muscles pronate the forearm?
pronator teres
pronator quadratus
what 9 tendons pass through the carpal tunnel?
4 flexor digitorum profundus
4 flexor digitorum superficialis
flexor pollicis longus
what is the shoulder joint proper?
glenohumeral joint
what part of the ulna articulates with the humerus?
olecranon process
what is the origin of the supraspinatus?
supraspinous fossa
what is the innervation of the supraspinatus?
suprascapular nerve
what is the origin of the infraspinatus?
the infraspinous fossa
what is the innervation of the infraspinatus?
suprascapular nerve
what is the origin of the teres minor?
dorsal aspect of the lateral border of the scapula
what is the origin of the subscapularis?
subscapular fossa
anterior wall of the scapula
what is the insertion of the deltoid?
deltoid tuberosity on lateral aspect of the humerus
what bone feature of the humerus articulates with the ulna?
trochlea
what bony feature of the humerus articulates with the radial head?
capitulum
why are supracondylar humeral fractures common inchildren?
because the supracondylar region of bone is very thin
what 2 structures are susceptible to damage during supracondylar humeral fractures?
brachial artery
median nerve
compare skin that is innervated to skin that is denervated when running under water for a long time?
innervated skin wrinkles
denervated skin doesn’t wrinkle
what are the 3 main ligaments in the elbow?
the medial collateral ligament
the lateral collateral ligament
the annular ligament
which ligament is much thinner- the medial or lateral collateral ligament of the elbow?
lateral collateral ligament is much thinner than the medial collateral ligament
what is the function of the annular ligament of the elbow?
keeps the radial head in place
what is the site of insertion for all the extensor muscles of the forearm? (posterior compartment)
common extensor origin on the lateral epiconyle of the humerus
what is the site of insertion for all the flexor muscles of the forearm? (anterior compartment)
common flexor origin on the medial epicondyle of the humerus
during supination/pronation of the forearm, which is the bone that actually does the movement?
radius
ulna remains in the same place
what is the fracture which can present as a dinner fork deformity?
distal radius fracture
what are the 2 groups of muscles of the hand?
extrinsic
intrinsic
compare the intrinsic and extrinsic muscles of the hand in terms of where the muscle bellies are?
extrinsic- located in the anterior/posterior compartment of the forearm
intrinsic- located in the hand itself
what is the thenar eminence?
the muscular part at the base of the thumb
what are the 3 thenar muscles?
opponens pollicis
flexor pollicis brevis
abductor pollicis brevis
what is the function of the thenar muscles?
move the thub
what is the innervation of the thenar muscles?
median nerve
are the thenar muscles intrinsic or extrinsic muscles of the hand?
intrinsic
what is the function of the hypothenar muscles?
move the little finger
what are the 2 hypothenar muscles?
flexor digiti minimi brevis
abductor digiti minimi
what is the innervation of the hypothenar muscles?
ulnar nerve
are the hypothenar muscles part of the intrinsic of extrinsic muscles of the hand?
intrinsic
what is the function of the lumbricals muscles?
flex at the MCP joints
extend at the IP joints
compare the dorsal interossei and palmar interossei muscles in terms of which abduct and which adduct the fingers?
dorsal interossei abduct the fingers
palmar interossei adduct the fingers
are the interossei muscles intrinsic or extrinsic muscles of the hand?
intrinsic muscles
how many lumbrical muscles of the hands are there?
4
what is the innervation of the lumbrical muscles of the hand?
lateral 2 = median nerve
medial 2 = ulnar nerve
are the lumbrical muscles intrinsic or extrinsic muscles of the hand?
intrinsic muscles
what is the function of the flexor digitorum superficialis muscles of the hand?
flex fingers at PIP joints
what nerve innervates the flexor digitorum superficialis muscles of the hand?
median nerve
are the flexor digitorum superficialis muscles intrinsic or extrinsic muscles of the hand?
extrinsic
what is the function of the flexor digitorum profundus muscles of the hand?
flex fingers at the DIP joints
what nerve innervates the flexor digitorum profundus muscles of the hand?
lateral 2 = median nerve
medial 2 = ulnar nerve
what are the functions of the annular and cruciate pulleys in the hands?
keep the flexor tendons down to the bones
what are the 3 peripheral nerves of the hand?
median
ulnar radial
compare the ulnar and median nerve muscular supply of the hand?
median nerve - LOAF
(lateral lumbrical + opponens pollicis + abductor pollicis brevis + flexor pollicis brevis)
ulnar nerve - all other intrinsic hand muscles
compare cutaneous sensation nerve supply of the hand by the median, ulnar and radial nerves?
median nerve- radial 3.5 fingers
ulnar nerve- ulnar 1.5 fingers
radial enerve- variable portion of dorsum, particuarly 1st webspace dorsum
how do you test the median nerve muscular supply within the hand?
test abductor pollicis brevis
how do you test the median nerve cutaneous sensation within the hand?
touch tip of index finger and thenar eminsnce
how do you test the ulnar nerve muscular supply within the hand?
test abductor indicis and adductor digiti minimi
how do you test the ulnar nerve cutaneous sensation within the hand?
touch dorsum and volar aspects of little finger
how do you test the radial cutaneous sensation within the hand?
touch dorsum of 1st webspace
is the brachial plexus made of anterior or posterior rami?
anterior rami
where does the ulnar nerve pass in relation to the medial epicondyle?
posterior to the medial epicondyle
the superficial palmar arch is immediately deep to what tendon?
palmar aponeurosis
the deep palmar arch runs across the anterior aspects of what?
the bases of the metacarpals
each finger has 4 neurovascular bundles supplying it, what are these?
medial palmar
lateral palmar
medial dorsal
lateral dorsal
what is ring block technique?
depositing local anaesthetic in a ring around the base of the finger to anaesthetise all 4 proper digital nerves
what fascia is affected by dupuytren’s contractures?
palmar fascia
what structure forms a secure tunnel through which the tendons of the FDS/FDP/FPL and their synovial sheaths can travel distally?
fibrous digital sheaths
what does tenderness of the floor of the anatomical snuff box following trauma suggest?
scaphoid fracture
which nerve supplies the lateral dorsum of the hand and proximal index and middle fingers?
radial nerve
which nerve supplies the dorsal skin over the distal phalanges of the thumb, index finger, middle finger and lateral side of ring finger?
median nerve
which nerve suplies the medial part of the dorsum of the hand and the dorsum of the little finger and the medial hald of the ring finger?
ulnar nerve
what joints do the lumbricals of the hand span?
anterior MCPJs
posterior PIPs
of digits 2-5
