Anatomy Flashcards
1
Q
What two groups are the gluteal muscles divided into?
Which muscles are in each group?
A
Superficial - Gluteus maximus - Gluteus medius - Gluteus minimus - Tensor fascia latae Deep - Piriformis - Obturator internus - Gemelli - Quadratus femoris
2
Q
Superficial gluteal muscles
Functions?
Nerve supply?
A
Extensors, abductors, medial rotators
Innervated by gluteal nerves
- Gluteus maximus: inferior gluteal nerve
- Other three: superior gluteal nerve
3
Q
Inferior gluteal muscles
Functions?
Nerve supply?
A
Lateral rotators of the thigh and hip stabilisers
Nerves from sacral plexus
4
Q
Where do structures which pass through the greater sciatic foramen go into?
A
Pelvis
5
Q
Where do structures which pass through the lesser sciatic foramen go into?
A
Perineum
6
Q
From what levels of the spine does the sciatic nerve arise from?
Where does it tend to leave the pelvis?
A
L4-S3
Inferior to the piriformis, through the greater sciatic foramen
7
Q
What nerve supplies the perineum?
Which levels of the spine?
Pneumonic?
A
Pudendal
S2-4
S2,3,4 keeps the guts off the floor
8
Q
Posterior cutaneous nerve of the thigh
What spinal roots?
What does it supply?
Where is it located?
A
S1-3
Skin over posterior thigh, popliteal fossa, lateral perineum and upper medial thigh
Runs parallel to the sciatic nerve out of the pelvis
9
Q
What does the piriform muscle split the greater sciatic foramen into?
A
Suprapiriform hiatus and infrapiriform hiatus
10
Q
Does the sciatic nerve supply anything in the gluteal region?
When does it split and into what?
A
No
Around 10cm above the knee it splits into the tibial nerve and common fibular (perineal) nerve
Common fibular branch is smaller (like the fibula)
11
Q
What are the boundaries of the femoral triangle?
A
Superior – inguinal ligament Medially – lateral border of adductor longus Laterally – medial border of sartorius Floor – iliopsoas and pectineus Roof – deep fascia (fascia lata)
12
Q
What are the contents of the femoral triangle and how are they organised?
A
From lateral to medial: - femoral Nerve - femoral Artery - femoral Vein - lYmphatics Remember this as NAVY
13
Q
What are the two main functions of the anterior compartment of the thigh?
Which muscles contribute to these functions?
Which nerve supplies this compartment?
A
Flexors of the thigh - Pectineus - Iliopsoas - Sartorius - Rectus femoris Extensors of the leg - Quadriceps femoris, made up of vastus lateralis, vastus medialis, vastus intermedius, rectus femoris All are supplied by the femoral nerve (L2, L3, L4)
14
Q
Which muscles converge to form the patellar ligament?
A
Quadriceps femoris
- Vastus lateralis
- Vastus medialis
- Vastus intermedius
- Rectus femoris
15
Q
Medial compartment of thigh
Function?
Muscles?
Innervation?
A
Adduction of the thigh - Adductor longus - Adductor brevis - Adductor magnus - Gracilis - Obturator externus All are supplied but the obturator nerve (L2,3,4), except the hamstring part of the adductor magnus which is supplied by the tibial nerve
16
Q
What is the adductor hiatus?
A
The adductor hiatus is a gap in the distal attachment of the adductor magnus to the femur, which permits the femoral artery + femoral vein to pass from the adductor canal downward into the popliteal space
17
Q
What are the two parts of the adductor magnus?
A
Adductor muscle
Hamstring
18
Q
Posterior compartment of thigh
Functions?
Which muscles?
Nerve supply?
A
Extensors of thigh + flexors of leg Semitendinous Semimembranous Biceps femoris All are supplied by the tibial division of the sciatic nerve, except the short head of the biceps femoris, which is common fibular division of sciatic
19
Q
Anterior compartment of leg
Functions?
Muscles?
Nerve supply?
A
Dorsiflexors of ankle (brings toes closer to the knee) and extensors of the toes
- Tibialis anterior
- Extensor digitorum longus
- Extensor hallucis longus
- Fibularis tertius
All are supplied by the deep fibular nerve (L4,5)
20
Q
Lateral compartment of leg
Functions?
Muscles?
Nerve supply?
A
Evert foot + weakly plantarflex ankle
- Fibularis longus
- Fibularis brevis
Both are supplied by superficial fibular nerve (L5, S1,2)
21
Q
Common fibular nerve
Where does it split?
Into what?
Functions of each?
A
Around head of fibula
Superficial and deep fibular nerves
Deep supplies anterior compartment of the leg; superficial supplies lateral
22
Q
Posterior compartment of leg
What two groups are muscles divided into and what is the funcion of each?
Which muscles are in each?
Nerve supply?
A
Superficial group (plantarflexors of ankle) - Gastrocnemius - Soleus - Plantaris Deep group (flexors of toes & plantarflexors of ankle) - Popliteus, - Flexor hallucis longus, - Flexor digitorum longus, - Tibialis posterior ALL TIBIAL NERVE
23
Q
What is the function of the popliteus muscle?
A
Unlocks the knee joint
24
Q
What are the boundaries of the popliteal fossa?
A
Superolaterally - biceps femoris
Superomedially - semimembranosus
Inferiorly - gastrocnemius
Roof - popliteal fascia
25
What does the popliteal fossa contain?
Lots of fat
Terminal small saphenous vein
Popliteal vessels
Tibial and common fibular nerves
26
Which three muscles come together to form the achilles tendon?
Which compartment do these muscles lie in?
Gastrocnemius
Soleus
Plantaris
posterior compartment of leg (superficial group)
27
What does the femoral artery split into to supply the hip joint?
Femoral artery --> deep femoral artery, which gives off lateral and medial circumflex arteries, which wrap around the top of the shaft of the femur and anastomose posteriorly
28
Which artery generally supplies the head and neck of femur?
Medial circumflex artery - important in trauma
29
What artery supplies the most medial part of the head of the femur?
Where does it arise from?
"Artery to head of femur", branches off of the obturator and travels in ligament to head of femur
30
What are the three articulations of the knee joint?
2 x tibiofemoral
| 1 x patellofemoral
31
What are the three groups of ligaments in the knee?
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Extracapsular
- Patellar ligament
- Lateral collateral ligament
- Medial collateral ligament
Intra-articular
- Anterior cruciate (ACL)
- Posterior cruciate (PCL)
Menisci
- Medial menisci
- Lateral menisci
```
32
How are ACL and PCL named?
According to where they attach to the tibia
33
Calcaneal tendon
Aka?
Formed from the tendons of which muscles?
Attaches where?
Achilles tenson
Tendons of gastrocnemius and soleus together
Attaches to calcaneal tuberosity of the calcaneus
34
What type of fascia surrounds muscle compartments?
Deep fascia
35
What compartments lie in the arm?
Anterior + posterior
36
What compartments lie in the forearm?
Anterior
posterior
Some texts say lateral, but not alway
37
Artery, vein and nerve for anterior compartment of arm?
Brachial artery
Brachial vein
Musculocutaneous nerve
38
Artery, vein and nerve for posterior compartment of arm?
Profunda brachii artery
Profunda brachii vein
Radial nerve
39
Artery, vein and nerve for anterior compartment of forearm?
Radial, ulnar arteries
Venae comitantes (accompanying veins)
Median (+ ulnar)
40
Artery, vein and nerve for posterior compartment of forearm?
Interosseous artery
Venae comitantes
Radial nerve
41
Arteries and nerve that supply the hand?
Deep and superficial palmar arches arteries
| Ulnar (+ median = LOAF) nerves
42
What are the spinal roots of the brachial plexus?
C5, C6, C7, C8, T1
43
Which roots form which trunks at the brachial plexus?
C5 + C6 - superior trunk
C7 - middle trunk
C8 + T1 - inferior trunk
44
What does each trunk divide into?
An anterior and posterior division
45
What do the three posterior divisions come together to form?
Posterior cord
46
How are the cords named?
lateral, posterior and medial - according to their relation to the brachial artery
47
What does the lateral cord form?
Lateral cord continues and divides into musculocutaneous and contributes to the median nerve
48
What does the medial cord form?
The medial cord forms the ulnar nerve and a contribution to the median nerve
49
What does the posterior cord form into?
Splits into the axillary and radial nerves
50
What does the ulnar artery mostly form into?
Superficial palmar arch
51
What does the radial artery mosty form into?
The deep palmar arch
52
What are the two main superficial veins of the arm?
| What vein connects them?
```
Cephalic vein (lateral)
basilic vein (medial)
Median cubital vein
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53
What are the deep veins of the arm called?
What do they accompany?
what do they form into?
Deep veins are just given the name venae comitantes
They accompany the brachial arteries and eventually come together to form a brachial or axillary vein, depending on the location
54
What are the three main factors contributing to joint stability?
Ligaments (inc capsule)
Muscle tone
Shape of the articular surfaces
55
What are the three most important pelvic ligaments to know?
Sacrospinous
Posterior sacroiliac
Sacrotuberous
56
Which nerves than run through the pelvis are important for bowel and bladder control?
Pudendal
| Pelvic splanchnic
57
Which nerve supplies every muscle below the knee?
Sciatic
58
Which other structures can be injured in pelvic trauma?
| What should you do on examination related to this?
Note that the urethra, rectum and bladder can all be injured with pelvis trauma. It is therefore important to do a PR exam, examine the urethra etc in any pelvic trauma.
59
Briefly describe the blood supply to the head of the femur
From deep femoral artery, splits into
- Medial circumflex artery (posterior)
- Lateral circumflex artery (anterior) - splits into ascending, transverse and descending
These all anastomose around the neck of the femur
Eventually branch into retinacular arteries which supply the head of the femur
Artery of ligamentum teres also supplies the head of the femur
60
What does AVN of the head of femur show on x-ray?
Patchy sclerosis
| If very progressed, then femoral head collapse
61
What are the abductors of the hip?
What is the main one?
What special test may be positive if this
Gluteus maximus, gluteus medius and gluteus minimus.
| The main one is the gluteus medius, which if damaged during surgery can lead to a possible positive Trendelenburg test.
62
The abductors tilt the pelvis when standing on one leg. Which part of the gait is this important for?
Will a normal pelvis tilt towards the stance leg or the moving leg?
What about an abnormal pelvis?
Important in the single stance phase of gait.
| A normal pelvis will tilt towards the stance leg; an abnormal pelvis tilts away from the stance leg.
63
Aside from abduction, what other functions of movement does the gluteus maximus have?
The gluteus maximus also has functions of extension and external rotation.
64
Anterior compartment of thigh
Which muscles does this include?
Nerve supply?
Clinical relevance?
This includes – rectus femoris, vastus lateralis, vastus intermedius, vastus medialis (collectively known as the quads) and sartorius muscles.
All are supplied by the femoral nerve.
Clinical relevance – can get tears, quads or patellar tendon rupture.
65
Posterior compartment of thigh
Which nerve?
Which muscles are included?
Where do they originate from and insert to?
Functions?
Clinical relevance?
Which can be used for tendon graft and why?
Aka the hamstrings. These muscles are supplied by the sciatic nerve.
Includes – biceps femoris (long and short heads), semitendinosus and semimembranosus.
They originate from the ischial tuberosity and insert onto the proximal tibia.
Funciton – they are powerful flexors of the knee and secondary extensors of the hip joint.
Clinical relevance – can gave muscle tears, common hamstrong origin avulsion (more serious).
The semitendinosus can be used as a tendon graft e.g. for ACL reconstruciton. This is because functionall the most important muscles are the semimembranosus and the biceps femorus.
66
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Medial compartment of thigh
Which muscles does this include?
Which nerve?
Clinical relevance?
What must you make sure and examine?
Function?
```
Includes – adductor longus, adductor brevis gracilis and adductor magnus.
These muscles are supplied by the obturator nerve. This is important clinically as it is the obturator nerve that can refer hip pain to the knee.
Remember that some patients with hip pathology may present with knee pain, so you must examine the hip, especially internal rotation – as this is done by the adductor muscles.
Function – adduct the thigh at the hip joint.
67
What is the role of the adductor hiatus?
The adductor hiatus transmits the femoral artery and vein from Hunter’s (subsartorial) canal into the popliteal fossa. It also transmmits the saphenous nerve which supplies sensation to the medial calf and shin.
68
What are the two types of cartilage found in the knee?
1. Hyaline cartilage – covers surfaces
| 2. Disks of fibrocartilage – act as shock absorbers -> menisci
69
What is the function of the menisci?
| Which is most commonly torn and why?
Menisci act as shock absorbers between convex femoral condyles & the relatively flat tibial plateau.
The medial meniscus is fixed, lateral meniscus mobile, pivot through medial compartment -> MM tears more common 9:1.
70
Give the functions of the following ligaments
MCL resists valgus stress
ACL resists internal rotation and anterior translation tibia
PCL resists posterior translation tibia or anterior translation tibia e.g. descending stairs
LCL resists varus stress and helps to resist external rotation (with PCL and posterolateral corner)
71
On average, what angle does our tibiofemoral angle sit at?
6 degrees valgus
72
What are bursae?
| Clinical relevance?
Bursae are small films of fibrous tissue containing fluid which reduce friction between surfaces, e.g. between bone and skin; muscles and bone etc.
You can’t feel these but they can become inflamed and thickened in chronic inflammation; can also become infected. Knee bursitis is common in people who kneel a lot.
73
Anterior compartment of leg
Which muscles?
Function?
Nerve?
Includes – tibilis anterior, extensor digitorum longus, extensor hallucis longus, fibularis tertius.
Function – dorsiflexors of ankle and extensors of toes.
These muscles are supplied by the deep fibular nerve.
74
Lateral compartment of leg
Which muscles?
Function?
Nerve?
Includes – fibularis longus, fibularis brevis.
Function – evert foot & weakly plantarflex the ankle.
These muscles are supplied by the superficial fibular nerve.
75
```
Lateral compartment of leg
Divided into what?
Which muscles are in each?
Function?
Nerve?
```
This is divided into superficial and deep.
Superfical muscles include – gastrocnemius, soleus, plantaris. Function – plantarlexors of the ankle.
Deep muscles include – popliteus, flexor hallucis longus, flexor digitorum longus, tibialis posteror. Function – flexors of toes + plantarflexors of the ankle.
Both superficial and deep layers are supplied by the tibial nerve.
76
What are the three lateral ligaments of the ankle?
| How many need to be sprained in order for instability to occur?
Posterior tibiofibular ligament, calcaneifibular ligament, anterior talofibular ligament. You need two out of three of these to be sprained in order for instability to occur.
77
Which two things contribute to the formation of the medial arch?
What can degeration of these lead to?
The tibiais posterior tendon and the plantar fascia contribute towards the medial arch. These can both degenerate, leading to microtears and pain.
78
What two things can degeneration of the tibialis posterior tendon lead to?
Flat foot (pes planus) and hindfoot valgus.
79
What are the two joints at the shoulder girdle?
| What type joint are these?
Glenohumeral - synovial
| Acromioclavicular -fibrous
80
Where does the labrum lie and what is its function?
| What is the term used for when it detaches in anterior dislocation?
The labrum lies anteriorly and stops external rotation of the humerus. If it’s too baggy then it can externally rotate too much. The labrum can commonly detach in anterior dislocation, known as a Bankart lesion.
81
Which nerve is most associated with nervous injury in anterior dislocation of the humerus?
Why?
How can you check its function?
Axillary nerve
It is stretched at the quadrangular space
Axillary nerve supplies the deltoid muscle - look for sensation
82
Pnemonic for remembering the regions of the brachial plexus?
```
Read The Damn Cadaver Books
Roots
Trunks
Divisions
Cords
Branches
```
83
Which movement is especially compromised in frozen shoulder?
External rotation
84
Which nerve supplies the anterior compartment of arm?
What is the most powerful flexor of the elbow?
What is the most powerful supinator of the wrist?
Musculocutaneous nerve
Brachialis
Biceps brachii
85
What does the radial nerve supply
| Which type of fracture is the radial nerve compromised in?
Posterior compartments of arm and forearm
I.e. all extensors of the upper limb
Humeral shaft fractures
86
What function does the radio-capitellar joint serve?
Supination and pronation
87
Tennis ekbow vs Golfers elbow
| Which is flexor origin and which is extensor origin?
Extensor origin = lateral epicondyle -> Tennis elbow.
| Flexor origin = medial epicondyle -> Golfers elbow.
88
Supracondylar fracture
Which two structures can be affected?
Who is this common in?
Brachial artery + median nerve
| Common in children
89
What is a monteggia fracture dislocation?
Monteggia fracture dislocation – if you get bone injury on one side, then you will get ligamentous injury on the other side – there is fracture of the proximal 1/3 of the ulna, with dislocation of the radial head, as shown opposite.
90
What is a Galeazzi fracture dislocation?
Galeazzi fracture dislocation – distal radial shaft fracture with associated dislocation of the distal radio-ulnar joint, as shown opposite.
91
Anterior compartment of forearm
Nerve?
Function?
Median nerve, except the flexr carpi ulnaris (FCU) and the ulnar half of the flexor digitorum profundus (these two are supplied by the ulnar nerve).
Their main function is flexion at the elbow.
92
Where is the trapezium located?
By the thumb
93
Where will a patient with scaphoid fracture have tenderness?
Anatomical snuff box
94
Which nerves are the muscles of the hand supplied by?
Most of the muscles in the hand are supplies by the ulnar nerve.
The exceptions are the Thenar muscles and the lateral two lubricals, which are supplied by the median nerve.
95
Give the functions of:
Flexor digitorum superficialis?
Flexor digitorum profundus?
Flexion at PIPJ > MCPJ
| Flexion at DIPJ
96
Median nerve motor function testing
Abductor pollicis brevis?
FPL + FDP?
Abductior pollicis brevis – ask the patient to move their thumb to the ceiling and test the resistance
FPL + FDP – okay sign – people with median nerve deficit can’t make the sign; they make a collapsed circle
97
How can you test the Ulnar nerve function?
Test finger abduction at the 1st dorsal interosseous
| Adductor pollicis – Froment’s test - try and get the patient to grab a piece of paper from your hands
98
How can you test radial nerve function?
High – triceps
Above elbow
Below elbow
