Anatomy Flashcards
1
Q
What parts make up the appendicular skeleton?
A
Hip bones (of pelvic girdle)
Pectoral girdle
Limbs (upper & lower)
2
Q
Describe the basic layout of the upper and lower limb bones
A
Girdle
Single long bone
Paired long bones
Short and long bones
3
Q
What functions is the upper limb specialised for?
A
Range of movement in preference to strength Carriage Fine manipulative tasks Feeding Minimal locomotion
4
Q
What functions is the lower limb specialised for?
A
Strength in preference to range of movement Support body weight Maintain upright posture Locomotion (gait) Accommodate shock loading
5
Q
What is the pectoral girdle?
A
Mobile structure, clavicle and scapula
Only one joint with axial skeleton - clavicle at sternum
Compressive forces transmitted via the clavicle
Tension transmitted via muscles
6
Q
What is the pelvic girdle?
A
Rigid ring of bone that is partly formed by the axial skeleton
Distributes weight of axial body to lower limbs
Enables locomotion & standing
Force transmission mostly via compression
7
Q
What are the major joint types?
A
Fibrous - skull sutures, gomphosis (teeth), syndesmosis
Primary cartilaginous - growth plate
Secondary cartilaginous - between vertebrae
Synovial
8
Q
Describe the structure of synovial joints
A
Hyaline cartilage at the end of bones
Surrounded by synovial cavity with fluid
Surrounded by synovium (serous membrane secretes fluid)
Surrounded by fibrous joint capsule
9
Q
What are bursae? And how can they be treated?
A
Pockets of synovium & synovial fluid found in regions of friction/wear
Some are isolated & some communicate with joint spaces
Bursa inflammation = bursitis
Bursitis causes localised pain & tenderness to palpation
Can be aspirated/injected with steroid
10
Q
What are tendons surrounded by at points of wear, friction or direction change?
A
Synovial sheath
11
Q
What is Tenosynovitis?
A
Inflammmation of both sheath & tendon
12
Q
Describe the anatomy of a long bone
A
Epiphysis - ends
Metaphysis
Diaphysis - shaft
13
Q
What are sesamoid bones?
A
Found within tendons eg patella
Reduce wear
Improve muscle efficiency
14
Q
What are flat bones?
A
Large surface areas for muscle attachment
Weight / force transfer region
Protection (pelvic girdle & skull)
15
Q
What is Wolff’s Law?
A
Bone is deposited and reabsorbed in accordance with the stresses placed upon it (it is able to remodel)
16
Q
When do limb buds grow out of embryo during development?
A
From week 4/5
Upper limbs buds appear 36h before the lower
Digits and limb shape present by week 8
17
Q
What is Amelia/Meromelia/phocomelia?
A
No limb formation
Abnormal limb formation
Seal like limb
18
Q
What is Polydactyly?
A
Extra digits
19
Q
What can be causes of limb defects?
A
Thalidomide (anti-nauseant, sleeping pill)
Retinoids (vitamin A derivatives)
Mechanical – amniotic bands ‘strangle’ tissue
20
Q
How does embryology help to explain dermatomes of the upper limb?
A
Limbs appear with ventral & dorsal surfaces - Initially look like flippers that later rotate
Upper limb rotates laterally, Lower limb rotates medially
Dermatomes wind around the limbs
Eg C5 outside of arm, T1 inside of arm
21
Q
What are nerve plexi?
A
Regions where the ventral rami of spinal nerves join and exchange neurons
Brachial plexus = upper limb, Lumbar and sacral plexi = lower limbs
Most named nerves of the limbs consequently contain neurons from multiple spinal nerves
22
Q
What advantage does having nerve plexi have?
A
Means damage to a spinal nerve won’t leave the entire limb paralysed
23
Q
What is a dermatome?
A
Area of skin innervated by a single spinal nerve
24
Q
What is a Cutaneous nerve area?
A
Area of skin innervated by a named cutaneous nerve eg sciatic nerve
25
What separates the limbs into compartments?
Thick deep fascia
26
What function does the anterior compartment of the upper limb have?
Flexor
27
What function does the posterior compartment of the upper limb have?
Mostly extensor function
28
How many compartments does the upper limb have?
2
| Anterior and posterior
29
How many compartments does the thigh have? And what do they do?
3
Anterior - Knee extensor
Posterior - Hip extensor, knee flexor
Medial - Hip adductor
30
How many compartments does the leg have? And what do they do?
3
Anterior - Foot dorsiflexor
Posterior - Foot plantarflexor
Lateral - Foot evertor
31
Which nerve and artery supply the anterior thigh compartment?
```
Femoral nerve (L2,L3 & L4)
Femoral artery
```
32
What are retinacula?
Thick bands of fascia
Prevent tendon bowstringing
Keep tendons in proximity of a joint enabling functioning through range of joint motion
33
Describe the artery supply to the upper limb
Subclavian Artery
Axillary Artery, gives off profunda branch
Brachial Artery (pulse)
Radial and ulnar artery (pulses at wrist)
Palmar arches
34
Describe the blood supply to the lower limb
Femoral Artery, gives off profunda branch
Popliteal artery (pulse)
Anterior and posterior tibial, gives off fibular
Dorsalis pedis (pulse anterior)
Posterior tibial (pulse)
Deep plantar arch and arcuate artery
35
What run close to superficial veins?
Cutaneous nerves
36
What are Venae comitantes? And why are they where they are?
Run with arteries & between muscles
Usually paired at sides of arteries
Muscle pump mechanisms help venous return
Valves direct blood flow
37
What is the cubital fossa?
Axillary nodes in the armpit
Humeral, subscapular, pectoral drain to Central
This drains to apical which in turn drains to supraclavicular
38
What is the popliteal fossa?
Inguinal nodes, superficial and deep
39
What are the root values of the sciatic nerve?
L4-S3
40
What root values supply the hamstrings?
L5-S2
41
What root values supply gastrocnemius and soleus?
S1-S2
42
What root values supply tibialis posterior and popliteus?
L4-L5
43
Which area of the skin is supplied by the obturator nerve?
Medial thigh
44
What type of joint is the pubic symphysis?
Secondary cartilaginous
45
What are the 3 bones of the hip?
Ilium
Ischium
Pubic
46
Why is the ischial tuberosity so large?
Hamstring muscles pull on it so it is remodelled and strengthened
47
What is the acetabulum?
Socket part of hip joint
| Union of the 3 bones of the pelvis
48
Describe the hip joint
Ball & socket joint (synovial)
Shares features with the shoulder joint
Combines mobility & transmission of weight
Wide range of movement sacrificed for stability
Supported by muscles, ligaments, bone shape & acetabular labrum
49
What is the acetabular labrum?
Fibrocartilage rim surrounding the acetabulum
Attaches to bony margin of acetabulum, Makes socket deeper
Aids joint stability
Can get impinged within joint causing pain on movement
50
What is special about the ligaments of the hip? And what are they?
Thickened joint capsule
Iliofemoral, ischiofemoral (posterior), pubofemoral
Hip joint less stable when flexed as ligaments are lax and not providing as much support
51
Why is blood supply to the hip joint vulnerable to interruption from injury?
Arteries to the femoral head pass through retinacular fibres of the joint capsule, Circumflex arteries surround femoral neck, Branches travel to femoral neck & head
Intra-capsular femoral neck fractures can disrupt blood supply
Avascular necrosis of femoral head can result from intra-capsular fracture
52
What is an intertrochanteric fracture?
Extracapsular hip fracture between greater and lesser trochanter
53
What is coxa valga? (Valgus)
Distal part of bone directed away from the midline
54
What is coxa vara? (Varus)
Distal part of bone directed toward the midline
55
What is the iliotibial tract?
Lateral thickening of fascia lata
Acts as a muscle attachment point
Assists in knee extension & stability as it crosses the knee joint so allows gluteous maximus to aid in control of the knee
56
What surrounds the compartments of the thigh and forms structural features?
Fascia lata
57
Where does the saphenous vein run?
Superficial to the fascia lata, medial thigh
58
What are the root values of the femoral nerve?
L2-L4
59
What are the root values of the the tibial part of the sciatic nerve?
L5 S1
60
What are the gluteal muscles and what is their job?
Gluteus maximus, medius and minimus
| Powerful hip/trunk extension (stair climbing, arising from chair) and pelvic stabilisation during walking
61
What nerve supplies gluteus maximus?
Inferior gluteal nerve (L5-S1)
62
Which nerve supplies gluteus minimus and medius?
Superior gluteal nerve (L4-L5)
63
What covers the ischial tuberosity?
Ischial bursa – bursitis causes pain on sitting & deep palpation
64
Where do gluteus minimus and medius attach?
Greater trochanter of the femur
65
What does damage or paralysis of gluteus medius and minimus lead to?
Trendelenburg sign & lurch when walking
66
What function do the gluteal muscles perform during walking?
Medius & minimus: prevents pelvis tilting toward unsupported side
Maximus: prevents trunk from tipping forwards
67
What does damage or paralysis of gluteus maximus lead to?
Lurching backward when the weaker limb is on the floor during walking; makes getting out of a chair difficult
68
What is the greater sciatic foramen?
Connects to pelvic cavity & gluteal region
| Above sacrospinous ligament
69
What is the lesser sciatic foramen?
Connects to perineal & gluteal regions
| Below sacrospinous ligament, posterior border sacrotuberous ligament
70
What are the lateral rotator muscles?
Support and laterally rotate the hip
Located deep to gluteus medius
Pass between the pelvic bones & ligaments & proximal femur
Innervated by L4-S2
Piriformis, Gemelli, Quadratus femoris, obturator internus
71
What does the piriformis muscle divide the greater sciatic foramen into?
Supra and infra piriform parts
Superior gluteal artery & nerve emerge above piriformis
Inferior gluteal artery & nerve and sciatic nerve emerge below piriformis
72
Where does the sciatic nerve run in relation to the hip joint?
Posterior
73
What are the 2 methods for finding the safe zone for intramuscular injection into the gluteal region?
Method 1: Vertical line through highest point of iliac crest, Horizontal line midway between ischial tuberosity and highest point of iliac crest
Method 2: Vertical line through highest point of crest, Line from PSIS to the greater trochanter
74
What is iliopsoas?
Powerful hip flexor L1-L2
Psoas major - attachment to lumbar vertebrae Hip flexion can exacerbate back pain
Iliacus - Inner surface of iliac bone
Attach to lesser trochanter which can be subject to avulsion fracture
75
What can mimic a femoral hernia?
Abscesses can track down the fibrous sheath covering psoas producing a femoral triangle swelling that can mimic a femoral hernia
76
What are the hip adductor muscles?
Occupy medial thigh (obturator n. L2,3) – Adduct the hip joint
Pectineus, Adductor Longus (superficial)
Adductor Brevis, Adductor Magnus (deep)
77
What passes through the adductor hiatus?
Femoral artery passes through adductor hiatus to go behind knee and continue as the popliteal artery
78
What are the quadriceps?
Quadriceps muscle group (Femoral n. L3,4) = knee extension & hip flexor
Rectus femoris
Vastus intermedius (deep to rectus femoris)
Vastus lateralis
Vastus medialis
79
What muscles other than the quads occupy the anterior compartment?
Sartorius
| Tensor fascia lata
80
What does loss of function of the quads lead to?
Weak or absent knee extension
| Difficulty getting out of a chair
81
What are the hamstrings?
Hamstring muscle group (tibial part of sciatic nerve L5, S1)– hip extension & knee flexion
Semimembranosus
Semitendinosus
Biceps femoris
82
Which muscles cross the knee joint and attach to the tibia and fibula?
Biceps femoris
| Semitendinosus
83
What muscle does the lumbar plexus sit around?
Psoas major
84
What does the lumbar plexus innervate?
Anterior and medial thigh muscles
85
What nerve branches come off the lumbar plexus?
```
Lumbosacral trunk (L4,5)
Obturator n. (L2, L3, L4)
Genitofemoral n. (L1,L2)
Femoral n. (L2, L3, L4)
Subcostal n. (T12)
Iliohypogastric n. (L1)
Ilioinguinal n. (L1)
Lateral cutaneous nerve of thigh (L2,L3)
```
86
What forms the borders of the femoral triangle?
```
Inguinal ligament (between ASIS and PT)
Adductor longus
Sartorius
```
87
Where does the femoral artery enter the femoral triangle?
Midinguinal point +/- 1.5cm
88
What do Inguinal lymph nodes drain?
```
Lower limb
Perineal region
Penis
Lower anal canal
Lower vagina
Anterior labia majora / scrotal skin
```
89
What is a saphena varix?
Great saphenous vein running in superficial location to meet femoral vein, Can dilate here forming a saphena varix
90
What supplies the main arterial supply to the lower limb?
Common iliac artery
91
What are the 4 phases of walking?
Heel strike - stance
Support - stance
Toe-off - swing
Swing / Carry through - swing
92
What is the fibrous joint between tibia and fibula & muscle attachment point?
Interosseous membrane
93
Where does long saphenous vein pass in ankle?
Anterior to medial malleolus
94
Where does short saphenous vein run in the ankle?
Posterior to lateral malleolus
95
What parts of the ankle can be avulsed following excess inversion?
Lateral malleolus and tuberosity of the 5th metatarsal
96
What is the axis of abduction adduction in the foot?
2nd digit
97
How many phalanges are there in the toes?
Big toe has 2: proximal and distal
| Other digits have 3: proximal, middle and distal
98
What is the bony mass of the heel?
Calcaneous
99
What are the tarsals of the foot?
Cuneiform bones nearest to metatarsals
Cuboid near tuberosity of 5th metatarsal
Navicular between cuneiform and talus
Talus part of ankle joint and calcaneus is heel
100
Describe the anterior compartment of the leg including neurovascular supply
Foot & digit dorsiflexion & inversion
Deep fibular nerve L4, L5
Anterior tibial artery
101
Describe the lateral compartment of the leg including neurovascular supply
Foot eversion
Superficial fibular nerve L5,S1
Fibular artery
102
Which nerve runs in close proximity to the short saphenous vein?
Sural nerve
103
Which nerve runs in close proximity to the great saphenous vein?
Saphenous nerve
104
Describe the posterior compartment of the leg including neurovascular supply
Foot & digit plantarflexion & inversion
Tibial nerve S1, S2
Posterior tibial artery
105
What movements are available at the knee joint?
Flexion-extension
Rotation (medial & lateral)
Translocation (Sliding)
106
Where is the knee joint line?
Palpable anteriorly, sits ~2cm distal to the skin crease behind the joint
107
What type of joint is the knee?
Modified synovial hinge joint
108
What are the articulations at the knee joint?
3 Articulations: 2 femero-tibial, 1 femero-patellar
109
What is the piece of bone between the tibial condyles called?
Intercondylar eminence
110
What supports the knee joint?
Muscles
Ligaments
Menisci
111
What are menisci?
Crescent shaped pieces of fibrocartilage sat on the tibial condyles
112
What are the functions of the menisci?
Increase contact area
Weight-bearing
Act as shock absorbers
Participate in locking mechanism
113
What can damage menisci?
Compression and medial collateral ligament tears
114
What is the patella?
Sesamoid bone that articulates with the femoral condyles
115
What is the function of the patella?
```
Reduces ligament & tendon wear
Spreads forces passing to femoral condyles
Increases moment (mechanical bending force) of quadriceps muscles
```
116
Where does the patella ligament insert into?
Tibial tuberosity
117
What do the cruciate ligaments do?
Resist anterior-posterior translocation & rotation of the knee
118
What does the anterior cruciate do?
Prevents anterior tibial movement on femur
119
What does the posterior cruciate ligament do?
Prevents posterior tibial movement on femur
120
When is the ACL at risk of injury?
Force/kick to back of flexed knee
121
When is the PCL at risk of injury?
Force/kick to front of load-bearing knee
122
What test can be used to examine cruciate ligament integrity or laxity?
Drawer or Lachman test
123
What do the collateral ligaments in the knee do?
Medial & lateral collateral ligaments resist valgus and varus forces at the knee
124
What does the medial collateral ligament do?
Prevents tibial abduction (valgus)
125
What does the lateral collateral ligament do?
Prevents tibial adduction (varus)
126
How can medial collateral ligaments be damaged?
Injured by lateral blow
| Attached to medial meniscus so both can be damaged together
127
How can the lateral collateral ligament be damaged?
By a medial blow
128
What does valgus and varus deformity describe?
Appearance of the part of the bone distal to the joint in question
129
Describe the blood supply to the knee
Extensive and anastomotic genicular vessels
| Tibial or femoral fractures do not normally result in avascular bone necrosis
130
What is Housemaids knee?
Prepatella bursitis
131
What is clergymans knee?
Infrapatella bursitis
132
Where can knee joint inflammation/effusion extend to? And how can this be tested?
Suprapatellar bursa
| Patella tap: Milk suprapatellar bursa inferiorly then press patella posteriorly
133
What is close-packing of the knee joint? And which muscle can release it?
Femur rotates medially on tibia & locks
Passive movement
Ligaments under tension
Position of stability
Popliteus laterally rotates knee to unlock it
134
Where is the common fibular nerve at risk of compression?
Subcutaneous at head of fibula
135
Loss of which nerve and muscle can result in foot drop?
Tibialis anterior muscle, L4
136
What do the anterior leg muscles do? And what might cause pain here?
Guides foot placement during gait
Supports arches of foot
Regional pain from compartment syndrome, tibial stress # or chronic exertional stress on fascia
137
What are the anterior compartment leg muscles?
Tibialis anterior - L4
Extensor digitorum longus - L5
Extensor hallucis longus - L5
138
Which nerve supplies the anterior compartment of the leg?
Deep fibular nerve
139
What are the superior and inferior extensor retinaculum and what do they do?
Fibrous thickening of fascia
| Prevent bowstringing of the anterior leg compartment muscle tendons
140
Which tendon does the dorsalis pedis pulse sit laterally to?
Extensor hallucis longus tendon
141
What are the lateral leg compartment muscles?
Fibularis longus
| Fibularis brevis
142
What do the lateral leg muscles do?
Primary foot eversion & weak plantarflexion
Help prevent excess foot inversion
Protect lateral collateral ligament from excess inversion stress
Help balance body on foot & foot placement
143
Which nerve supplies the lateral leg muscles?
Superficial fibular nerve L5, S1
144
What are the posterior compartment muscles?
Gastrocnemius and soleus - superficial
| Tibialis posterior, flexor digitorum, flexor hallucis - deep
145
What nerve roots does the calcaneal reflex test?
S1-S2
146
What do the posterior leg compartment muscles do?
Foot & digit plantarflexion & foot inversion
Support arches of foot
Loss of function = weak/absent push-off
147
What nerve supplies the posterior leg muscles?
Tibial nerve
148
What muscles are responsible for ankle dorsiflexion?
Tibialis anterior, extensor hallucis longus & extensor digitorum longus
149
Which muscles are responsible for ankle plantarflexion?
Gastrocnemius, Soleus
FLexor digitorum & flexor hallucis
FIbularis longus & fibularis brevis
150
Which muscles cause ankle inversion?
Tibialis anterior
| Tibialis posterior
151
Which muscles cause ankle eversion?
Fibularis longus
| Fibularis brevis
152
What is the popliteal fossa? And what are its borders?
```
Diamond-shaped fat-filled region sat behind the knee
Semimembranosus/Semitendinosus
Biceps femoris
Gastrocnemius medial head
Gastrocnemius lateral head
```
153
Which structures sit in the popliteal fossa?
```
Popliteal Artery (deep)
Popliteal Vein
Tibial Nerve (superficial)
```
154
What swellings can occur within the popliteal fossa?
Neuroma
Pulsatile swelling - popliteal artery aneurysm
Popliteal cyst above knee joint line
Baker cyst – synovial cyst below knee joint line
155
How can the popliteal fossa be accessed for sciatic nerve block?
From lateral perspective
| In triangle between iliotibial band, vastus lateralis and biceps femoris
156
Describe the branching of the vascular supply to the leg
Femoral artery passes through adductor hiatus to become popliteal artery which runs through popliteal fossa
Anterior tibial artery branches off and passes anterior to interosseous membrane onto dorsal foot as dorsalis pedis
Posterior tibial artery branches off and continues to supply the foot, passes posterior to medial malleolus to continue as plantar arteries on sole of foot, fibular artery branches from posterior tibial
157
Describe the contents of the tarsal tunnel
```
Tom, Dick, And, Very, Naughty, Harry
T - Tibialis posterior
D – Flexor Digitorum
A – Posterior Tibial Artery
V - Vein
N – Tibial Nerve
H – Flexor Hallucis longus
Covered by the flexor retinaculum
```
158
Where can the posterior tibial artery pulsation be examined?
1/3rd of the way back between the medial malleolus & calcaneus
159
Which nerve runs close to anterior tibial artery in anterior leg?
Deep fibular nerve
160
Which artery becomes the dorsalis pedis in foot?
Anterior tibial artery
161
What forms the superficial venous drainage of the lower limb?
Saphenous veins
162
Where does the great saphenous vein drain?
Passes up medial leg & thigh
| Drains deep at femoral triangle
163
Where does the short saphenous vein drain?
Passes up posterior leg
| Drains deep at popliteal fossa
164
Where does deep venous drainage of lower limb pass?
```
Passes from posterior leg toward groin
Gastrocnemius muscle (Third Heart) large venous plexus site for thrombus formation
```
165
What can be causes of DVT?
```
Clotting disorder
Oral contraceptive pill
Travel
Cancer
Post surgical
```
166
What type of joint is the ankle?
Synovial hinge joint between the talus, tibia and fibula
167
When is the ankle least stable?
During plantarflexion
168
At what joint do eversion and inversion take place?
Subtalar joint
169
Describe the medial ligaments of the ankle
```
Medial Collateral (Deltoid) Ligament x4
Prevent excess foot eversion
Damaged by excess eversion
Named tibio-x (e.g. tibio-calcaneal)
x4 ligaments known collectively as the deltoid
```
170
Describe the lateral ligaments of the ankle
Lateral Collateral Ligament (x3)
Anterior talofibular most commonly injured by excess inversion
Prevent excess foot inversion
Damaged by excess inversion
Named x-Fibular (eg calcaneo-fibular), anterior and posterior talofibular
Injured more than the medial collateral
171
What can excess tension in ankle ligaments lead to?
Sprains or malleolar avulsion
172
What would a malleolar avulsion fracture present like?
Pain, swelling, inability to weight-bear and pain on direct palpation
173
What are the foot arches? And what do they do?
Medial, lateral and transverse
| Absorb shock, distribute weight and store forces for release during walking
174
What soft tissues support the foot arches?
Intrinsic foot muscles
Tendons of leg muscles
Long & short plantar ligaments
175
What is the medical name for flat feet?
Pes planus
176
What can lead to flat feet?
Soft tissue support damaged/weakened
177
What arteries and nerves supply the plantar foot?
Posterior tibial artery enters plantar foot, branches into plantar vessels and forms an arch
Medial and lateral plantar arteries and nerves
Digital arteries pass along sides of digits on plantar and dorsal foot with the digital sensory nerves
178
How can digits be anaesthetised?
Web space/ring block as neurovascular bundles located here
179
What is Plantar fasciitis?
Overuse/trauma
Tenderness over calcaneus
Exacerbated by passive digitdorsiflexion or pressure over median calcaneal tubercle
180
Describe the intrinsic muscles of the foot
Arranged in 4 layers
Medial & lateral plantar nerves S1,2 from tibial nerve
Support the foot arches & act as dynamic ligaments
Support digits & great toe at push-off
Balance activities of long flexor/extensor muscles
Weakness/paralysis can lead to arch collapse
181
What does having a plexus mean?
Damage to a spinal nerve won’t leave the entire limb paralysed
182
What are the axillary folds formed by?
Muscle covered in skin
183
What forms the posterior axillary fold?
Lattisimus dorsi and teres major
184
What forms the anterior axillary fold?
Pectoralis major and minor
185
What is the axilla?
Region superior to armpit connecting the neck to the upper limb
186
What borders the axilla?
Pectoral girdle muscles and thoracic cage
187
What sits in the axilla?
Neurovascular supply to upper limb
Filled with fat
Tail of breast
Lymph node groups
188
Where do the axillary artery and plexus sit?
In axillary sheath
189
What do axillary lymph nodes drain?
Anterior thoracic wall & breast
Posterior thoracic wall
Upper limb
190
What are the axillary lymph node groups?
```
Humeral
Subscapular
Pectoral
Central
Apical
```
191
What can removal of axillary lymph nodes lead to?
Lymphoedema of the limb
192
Where does the axillary artery come from?
Continuation of subclavian artery, continues as branchial artery in arm
Rich anastomoses between subclavian & axillary artery via arteries surrounding the scapula
193
What nerve runs with the circumflex humeral artery?
Axillary nerve
194
Which artery runs with radial nerve?
Profunda brachi artery
195
What are the branches of the brachial plexus in the upper limb?
```
Musculocutaneous
Median
Radial
Axillary
Ulnar
```
196
What spinal roots contribute to the brachial plexus?
C5-T1
197
From the upper limb to the neck describe the branches of the brachial plexus
```
Branches
Cords
Divisions
Trunks
Roots
```
198
What does damage to the Musculocutaneous nerve of the brachial plexus result in?
Loss of anterior arm compartment muscles
| C5-7
199
What does damage to the axillary nerve of the brachial plexus result in? And how can this nerve be damaged?
Loss of deltoid & teres minor
Dislocation of shoulder or fracture of surgical neck humerus)
C5-6
200
What does damage to the median nerve of the brachial plexus result in? And how can it be damaged?
Loss of most anterior compartment forearm muscles, thenar muscles and lumbricals 1 & 2
Stab to medial arm or anterior wrist
C5-T1
201
What does damage to the ulnar nerve of the brachial plexus result in? And how can it be damaged?
Loss of most small muscles of hand
Fracture of medial humeral epicondyle or injury to anterior wrist
C8-T1
202
What does damage to the radial nerve of the brachial plexus result in? And how can it be damaged?
Loss of posterior arm & posterior forearm compartment muscles
Fracture of humeral shaft through spiral groove
Dislocated/fractured head of radius affects posterior interosseous nerve
C5-T1
203
Why can a pancoast tumour result in wasting of small muscles of the hand?
T1 root damage to brachial plexus
204
What 3 nerves branch off from C5-6 roots of the brachial plexus?
Dorsal scapula nerve
Supra scapular nerve
Lateral pectoral nerve
205
What are close relations of the brachial plexus?
Passes behind clavicle
Wraps around axillary artery
Axillary vein sits close by, which can be cannulated in this region
Runs toward humerus
206
What does the radial nerve (C5-T1) supply?
```
Posterior compartments
Triceps C7 & C8
Brachioradialis (C5 & 6) (elbow flexor)
Radial wrist extensor (C5 & 6)
Posterolateral dermatomes (C5 & 6)
Digit extensors (C7 & C8)
```
207
What do plexus injuries result in?
Paralysis & sensory loss
| Remaining functional muscle groups pull limb into a different resting position
208
What is Erb's palsy?
C5 & C6 Upper Root/Trunk Damage
Results in waiters tip appearance of upper limb
Limb = Medially rotated, pronated, hangs limp
209
What can cause Erb's palsy?
Forced separation of neck from shoulder
| Stab wound to neck
210
What is Klumpke’s Palsy? And what can cause it?
C8 & T1 Lower Root Damage/Compression
Upward traction of upper limb
Cancer at lung apex
Compression via cervical rib
211
What runs in the bicipital (inter tubercular) groove of the humerus?
Biceps tendon
212
Where is the coracoid process palpable?
Below lateral clavicle
213
What muscles attach to the tubercles of the humerus?
Rotator cuff muscles
214
What do the superior and inferior angles of the scapula mark?
Mark the ~T2-T7 spinous processes
215
What does the medial spine of the scapula mark?
T3 spinous process
216
Where does the auscultation triangle sit in relation to the inferior angle of the scapula?
Medially
217
What does the medial scapula border of an abducted upper limb mark?
Oblique lung fissure
218
What is the Acromioclavicular joint supported by? And what can damage it?
```
Coracoclavicular ligaments (trapezoid & conoid)
Can be torn by AC joint dislocation
```
219
What does the Coracoacromial ligament do? And what can damage it?
Supports the shoulder joint superiorly
Can be ruptured by superiorly directed forces
Can impinge supraspinatus/subacromial bursa
220
What is special about the Sternoclavicular joint and what supports it?
Only joint between the upper limb and axial skeleton
| Supported by the costoclavicular ligament
221
What direction is the joint line of the acromioclavicular joint?
Anterior - posterior
222
What can damage Coracoclavicular ligament?
AC joint dislocation
223
What is the function of the clavicle?
Strut supporting upper limb & transmitting forces to axial skeleton
224
When is the clavicle at risk of fracture?
Fall onto an outstretched limb or onto lateral shoulder
225
What type of joint is the acromioclavicular joint?
Synovial plane joint
226
What type of joint is the sternoclavicular joint?
Synovial ball and socket joint
227
Why must joint aspiration of the sternoclavicular joint be done under ultrasound guidance?
Risk of damaging apex of lung
228
Which part of the clavicle is most easily fractured?
Middle 1/3 > lateral 1/3 > medial 1/3
| Weakest point - junction between middle & lateral 1/3rds
229
What happens to the separated parts of the clavicle after fracture?
Move in opposite directions
Lateral part pulled down due to gravity
Medial part pulled up by sternocleidomastoid
230
Which dislocation can be mistaken for clavicle fracture?
AC joint dislocation
231
What is at risk of damage with a surgical neck of humerus fracture?
Axillary nerve
232
Which structure is at risk of damage with a mid shaft fracture of the humerus?
Through spiral groove (sits posteriorly) can damage radial nerve & profunda brachii artery
233
Which nerve passes posterior to the medial epicondlye (funny-bone)?
Ulnar nerve
234
What type of joint is the shoulder and what is it formed by?
Mobile ball and socket joint formed by humeral head & glenoid fossa of the scapula
235
What forms the Coracoacromial arch? And what does it do?
Acromion
Coracoid process
Coracoacromial ligament
Prevents superior dislocation
236
What is the glenoid labrum? And what can damage it?
Fibrocartilage rim deepening socket & stabilising joint
Tear injury can result from trauma or overuse & can produce a snapping sensation or pain on abduction or lateral rotation
237
How can the shoulder joint be accessed with a needle?
Point 2cm inferior to coracoid. Needle directed supero-laterally
238
What properties does the shoulder joint possess? And what risk does that increase?
Joint support is lax so allowing a wide range of motion which increases risk of dislocation
239
Where are the glenohumeral ligaments and what do they do?
3 of them
| Pass from margins of the glenoid to the humerus & support the shoulder anteriorly
240
Which part of the shoulder joint capsule is most susceptible to damage?
Lower part of joint capsule is lax & folded to permit free movement
Downward force applied to an abducted arm can dislocate the shoulder
241
In which direction is the shoulder most likely to dislocate?
Anterior
242
What does dislocation causing axillary nerve damage result in?
Paralysis of deltoid & teres minor
Limb to hang limp by side
Loss of shoulder contour
Sensory loss over lateral shoulder (regimental badge region)
243
Where does injection of the subacromial bursa take place?
Via the acromio-deltoid groove
244
Which nerve can be damaged by neck of radius fracture?
Posterior interosseus nerve
245
What can traction of the radius result in?
Dislocate head of radius from joint with ulnar
246
Which muscle attaches to the olecranon?
Triceps
247
Where is the elbow joint weakest?
Weaker anterior and posterior as collateral ligaments protect medial and lateral sides
248
What prominences normally align normally align in elbow extension?
Epicondyles and olecranon
249
What is Anconeus triangle?
Region for elbow injection/aspiration
Radial head
Lateral epicondyle
Olecranon
250
What does trapezius muscle do and which nerve supplies it?
Elevates, retracts and depresses the scapula
| Accessory n. (CN XI)
251
What does latissimus dorsi do and which nerve supplies it?
Extends, adducts and medially rotates humerus
Can raise the trunk to the arm e.g.dips/climbing
Thoracodorsal nerve
252
What does levator scapulae do and which nerve supplies it?
Elevates & rotates scapula
| Dorsal scapula nerve & C3-4
253
What do rhomboid major and minor do and what is their nerve supply?
Retract & fix position of scapula
| Dorsal scapula nerve
254
What does teres major do and what's its nerve supply?
Adduction & medial rotation of humerus
| Lower Subscapular nerve
255
What is the Triangle of auscultation?
Medial to the inferior angleof scapula. Borders:
Trapezius
Rhomboid major
Latissimus dorsi
256
What does pectoralis major do and what is its nerve supply?
Adducts & medially rotates shoulder, accessory breathing muscle
Attaches to clavicle, sternum & adjacent costal cartilages and lateral lip of the intertubercular groove
Medial & lateral pectoral nerve
257
What does pectoralis minor do and what is its nerve supply?
Depresses & protracts the scapula divides axillary artery into 3 parts Medial pectoral nerve
Attaches to ribs 3-5 and the coracoid process
258
What does the deltoid do and what is its nerve supply?
Deltoid: all shoulder movements except adduction
Attaches to lateral clavicle, acromion, scapula spine and humerus
Axillary nerve
259
What injuries can damage the axillary nerve?
Shoulder dislocation
Surgical neck of humerus fracture
Intramuscular injection
260
Where is the axially nerve and what does damage result in?
Passes around surgical neck of humerus ~5cm below acromion
| Damage affects shoulder functioning, produces shoulder contour flattening and regimental-badge sensory loss
261
What do the rotator cuff muscles do? And what can injury of them do?
Move & stabilise the shoulder
| Injury causes pain on movement and shoulder instability
262
What is supraspinatus and what is its nerve supply? And what does damage to it result in?
Assists with initial part of arm abduction to around 20º
Suprascapular nerve
Can become impinged under coracoacromial arch resulting in a painful arc (50-130°) of abduction which can radiate toward the hand
263
What does infraspinatus do and what is its nerve supply?
Lateral shoulder rotation
| Suprascapular nerve
264
What is teres minor and what is its nerve supply?
Lateral shoulder rotation
| Axillary nerve
265
What is subscapularis and what is its nerve supply?
Medial shoulder rotation
| Upper & lower subscapular nerve
266
What are the rotator cuff muscles?
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
267
Which muscle protracts scapula & holds it close to the thoracic wall?
Serratus anterior
Attaches to ribs 1-8 and medial scapula border
Long thoracic nerve
268
When is the long thoracic nerve at risk of damage?
Axillary or breast surgery with node clearance
269
What is the axilla and what are its borders?
Fat-filled region located superior to the armpit skin
Ant = Anterior axillary fold & pectoral muscles
Post = Posterior axillary fold, subscapularis & scapula
Med = Serratus anterior and lateral thoracic wall
Lat = Intertubercular groove
270
What are the contents of the axilla?
Axillary artery
Distal parts of the brachial plexus
Fat
Lymph nodes
271
What forms the anterior axillary fold?
Pectoralis major & minor
272
What forms the posterior axillary fold?
Latissimus dorsi & teres major
273
What do axillary lymph nodes drain?
Anterior thoracic wall & breast
Posterior thoracic wall
Upper limb
274
What does biceps brachii do and what is its nerve supply?
Flexes the shoulder & elbow & supinates the forearm
| Musculocutaneous nerve
275
Where do the long and short heads of biceps attach?
Long head: From supraglenoid tubercle. Tendon passes through intertubecular groove where inflammation/tendinitis can cause localised pain
Short head: From coracoid process
276
What are the distal insertions of biceps brachii?
Tendon attaches to radial tuberosity, Can avulse from tuberosity
Median nerve & brachial artery sit medially
Bicipital aponeurosis, Passes infero-medially and joins biceps with deep forearm fascia. Covers & protects median nerve & brachial artery
277
What does brachialis do and what is its nerve supply?
Flexes the elbow
| Musculocutaneous nerve & radial nerve
278
What does coracobrachialis do and what is its nerve supply?
Adducts arm
| Musculocutaneous nerve
279
Which tendon reflex tests C5-6?
Biceps reflex
280
What does triceps brachii do and what is its nerve supply?
Shoulder & elbow extension
| Radial nerve
281
What are the heads of triceps?
Long
Lateral
Medial
282
What is the quadrangular space? And what comes through it?
Triceps, humerus, teres minor, teres major form border
| Axillary nerve & posterior circumflex arteries travel through here and around the surgical neck of humerus
283
What is the triangular interval and what travels through it?
Long head of triceps, humerus and teres major form border
| Radial nerve & profunda artery travel through space and groove
284
What is the triangular space and what forms its border?
Teres minor, teres major and long head of triceps
| Circumflex scapular artery
285
Which reflex texts C7-8?
Triceps tendon reflex
286
What veins carry superficial drainage from arm?
Cephalic (lateral) & basilic (medial) veins
287
What are the main veins of the arm?
Large veins of the proximal upper limb follow the main axillary and subclavian arteries
Basilic vein: Travels deep to join the brachial vein
Axillary vein: Sits anterior to the artery &is joined by the cephalic vein
Subclavian vein: Continuation of the axillary vein from 1st rib medially.
Accessed below the clavicle for central line
288
Which artery perfuses the upper limb?
Subclavian artery
289
Where does the subclavian artery change to become the axillary?
Passes behind middle 1/3 of the clavicle – becomes axillary artery after crossing rib 1
290
Which structures pass along the spiral groove?
Profunda brachii artery and radial nerve
291
Where does the axillary artery become the brachial?
Passes behind mid-clavicle, becomes brachial artery below teres major
292
Where does the brachial artery pass?
Passes down medial arm (pulse palpable) with median & ulnar nerves
293
What is the significance of the rich anastamotic supply between subclavian and axillary artery via scapula?
Parts of the axillary artery can be clamped/removed without affecting limb perfusion
294
Where does the femoral artery sit in the leg?
Relatively subcutaneous within the femoral triangle
| Runs under sartorius through adductor hiatus & into popliteal fossa
295
Where does the profunda femoris artery sit in the leg?
Runs close to femoral neck and alongside femoral shaft
| Branches pass through adductor magnus
296
Where does the popliteal artery run in the leg?
Runs in popliteal fossa close to supracondylar part of femur (think femoral # and bleeds)
Aneurysms present as a pulsatile fossa swelling
297
Where does the posterior tibial artery run into the foot?
Runs posterior to medial malleolus in tarsal tunnel where pulsation is
palpable
298
Where does the anterior tibial artery run into the foot?
Passes onto dorsal foot as dorsal pedis artery, lateral to EHL tendon
299
Where does the long saphenous vein run in the leg?
```
Medially located
Passes anterior to medial malleolus
Accompanies saphenous nerve (sensory) in leg
4 finger-breadth posterior to patella
Ascends medial thigh to femoral triangle
```
300
Where does the short saphenous run in the leg?
Laterally located
Passes posterior to lateral malleolus
Accompanies sural nerve (sensory) in leg
Ascends posterior leg to popliteal fossa
301
Where does brachialis attach on the ulna?
Coronoid process
302
What can cause fracture of the olecranon?
Direct trauma
| Avulsion by triceps
303
What joints allow pronation and supination?
Superior and inferior radioulnar joints
304
Which nerve controls pronation?
Median nerve
305
Which nerve controls supination?
Radial and Musculocutaneous
306
What does the annular ligament do?
Encircles radial head forming a synovial pivot joint permitting pronation & supination
307
What does the articular disc of the wrist do?
Separates ulna from carpals
308
Which is more powerful pronation or supination?
Supination due to involvement of biceps
309
What type of joint is the distal radioulnar joint?
Synovial pivot
310
What are the small bones of the hand?
```
Scared lovers try positions that they can't handle
Scaphoid
Lunate
Triguetral
Pisiform
Trapezium
Trapezoid
Capitate
Hamate
```
311
What type of bone is the pisiform?
Sesamoid
312
Which bones are involved in the wrist joint?
Articulation of the radius with the scaphoid, lunate & triquetrum
313
What type of joint is the wrist?
Condyloid synovial joint
314
What movements are possible at the wrist?
2 planes of movement: flex-extend, adduct-abduct
315
What are the ligaments at the wrist?
Medial Collateral ligament: Ulnar styloid – Triquetrum
| Lateral Collateral ligament: Radial styloid – Scaphoid
316
Which small bone can be fractured from a fall onto the hand? And what is the risk with this?
Scaphoid
| Anatomical Snuffbox tenderness & possible avascular necrosis (AVN)
317
Why is their risk of AVN with scaphoid fracture?
Scaphoid blood supply runs distal to proximal
| Proximal section of scaphoid can become necrotic following fracture
318
What is a Bennetts fracture? And what can cause it?
Proximal metacarpal 1 fracture dislocation
| Ski poles push thumb back
319
What is a Smiths fracture? And what can cause it?
Fracture to the distal radius with ventral displacement of the hand
Falling on back of wrist
320
What is a Colles fracture? And what can cause it?
Fracture to the distal radius with a dorsal displacement of the hand
Falling on outstretched hand
321
What're the compartments of the forearm and what nerves supply them?
Anterior: Flexors and pronatorsbMostly Median n. Some Ulnar n.
Posterior: Extensors, supinator & thumb abductor, All Radial n. or its posterior interosseous branch
322
What muscles of the anterior compartment have common origin at the medial epicondyle? And what nerves innervate them?
```
Layer 1 and 2 of anterior flexors
Pronator teres - median
Flexor carpi radialis - median
Palmaris longus - median
Flexor carpi ulnaris - ulna
Flexor digitorum superficialis - median
```
323
What is Golfers elbow?
Medial epicondylitis
324
What are the muscles of layer 3 of the anterior forearm?
Flexor pollucis longus
Flexor digitorum profundus
Pronator quadratus
325
What is the golden rule of anterior forearm innervation?
Everything is median nerve supplied except:
Flexor carpi ulnaris
Flexor digitorum profundus to digits 4 & 5 (muscle on the ulnar side) which are supplied by the ulnar nerve
326
How can you test ulnar nerve function?
Testing DIP flexion of digits 4&5 which tests the FDP
327
Which muscles attach to the lateral epicondyle?
Extensor digitorum
Extensor Carpi Radialis Brevis
Extensor Digiti Minimi
Exensor Carpi Ulnaris
328
What is tennis elbow?
Lateral epicondylitis
329
What is anconeus?
Elbow Extensor
330
What are the muscles of the posterior compartment which do not have their origin at the lateral epicondyle?
```
Extensor carpi radialis longus
Supinator
Abductor pollucis longus
Extensor pollucis longus
Extensor pollucis brevis
Extensor indicis
```
331
What is the golden room for posterior forearm innervation?
Radial nerve, or its branch from posterior interosseus nerve
332
What are the contents of the 6 compartments of the wrist?
1 extensor pollucis brevis & abductor pollucis longus
2 extensor carpi radialis brevis & longus
3 extensor pollucis longus
4 extensor digitorum, extensor indici
5 extensor digitorum Minimi
6 extensor carpi ulnaris
333
What sits between compartment 2 and 3 of the wrist?
Dorsal radial tubercle
334
What injury can affect compartment 1 of the wrist?
Painful De-Quervains tenosynovitis
335
What injury can affect compartment 3 of the wrist?
EPL can wear on the dorsal radial tubercle and rupture
336
What injury can affect compartment 6 of the wrist?
ECU can wear on the ulnar styloid process and rupture
337
What is the flexor situated in the posterior compartment?
Brachioradialis
338
What does Brachioradialis do?
Moves forearm to mid-pronation-supination position & flexes elbow
339
What are the borders of the cubital fossa?
Brachioradialis - lateral
Interepicondylar line - superior
Pronator teres - medial
Aponeurosis of biceps forms roof
340
What structures pass through the centre of the cubital fossa?
Biceps tendon
| Brachial artery & median nerve sit medially
341
Where do superficial veins pass in relation to the cubital fossa?
Pass over cubital fossa and often used for phlebotomy or cannulation
342
Where do the Basilic and Cephalic veins run?
Cephalic - lateral elbow
Basilic - medial elbow
Median cubital between the 2
343
Where does the radial nerve run in the forearm?
Passes anterior to elbow and lateral to biceps tendon
| Deep posterior interosseous branch then passes close to radial neck
344
Where does the ulnar nerve run in the elbow?
Passes through cubital tunnel & behind medial epicondyle then enters anterior forearm
345
Where does the median nerve run in the forearm?
Passes medial to biceps tendon down forearm to sit under palmaris longus at wrist
346
Where does the ulnar nerve run in the forearm?
Runs under cover of flexor carpi ulnaris
| Sits lateral to pisiform in the hand
347
What forms the borders of the anatomical snuffbox?
Extensor pollucis longus
Extensor pollucis brevis
Abductor pollucis
348
What can be palpated in the anatomical snuffbox?
```
Radial artery (palpable pulse)
Radial styloid process
Scaphoid
Trapezium
Base of 1st metacarpal
```
349
What does tenderness in the anatomical snuffbox suggest?
Scaphoid fracture
350
What passes over the anatomical snuffbox?
Cephalic (houseman’s) vein, Commonly cannulated
| Runs alongside the superficial branch of the radial nerve and superficial to the radial artery
351
What is the tough fibrous layer limiting movement of the palmar skin?
Palmar aponeurosis
352
What is Dupuytren's contracture?
Aponeurotic thickening causing passive flexion of medial digits
353
What is the golden rule about hand muscle innervation?
```
Everything is ulnar nerve supplied except:
Thenar muscles
Lumbricals to digits 2 & 3
Which are median nerve
Everything is C8 & T1 supplied
```
354
What do the thenar and hypothenar eminences contain?
Flexor
Abductor
Opposer
355
What and where are the interosseus muscles?
Between metacarpal bones, ulnar nerve innervated
Palmar adduct - PAD
Dorsal abduct - DAB
356
What and where are the lumbricals?
Flex MCP joints & extend PIP & DIP joints
Attach to deep flexor tendons and extensor expansion
Digits 4+5 - ulnar nerve
Digits 2+3 - median nerve
357
What is Froment sign?
Adductor pollicis loss (e.g. Ulnar nerve lesion) excess thumb flexion whilst pinching
358
What is important about synovial sheaths?
Can be involved in infection spread, ganglion formation or tenosynovitis
Common sheath extends distally along 5th digit and through carpal tunnel into proximal forearm
359
Where are the palmar spaces?
Located deep to the flexor tendons in palm
| Thenar space, Midpalmar space
360
What passes through the carpal tunnel?
Nine tendons and median nerve
Flexor digitorum superficialis (x4)
Flexor digitorum profundus (x4)
Flexor pollicis longus
361
Which part of the median nerve is spared in carpal tunnel syndrome?
Palmar branch runs superficial to tunnel so median nerve cutaneous innervation to the palm is not affected in carpal tunnel syndrome
362
What forms the carpal tunnel?
Carpal bones & flexor retinaculum
363
What does the the flexor retinaculum attach to?
Pisiform, hook of hamate, scaphoid tubercle & trapezium tubercle
364
What is the surface marking for the carpal tunnel?
Passes ~2cm distal to distal wrist crease
365
What are the symptoms of carpal tunnel syndrome?
Sensory loss/paraestehsia, nocturnal pain in lateral 3.5 digits & thenar wasting
366
Where does the ulnar nerve run in relation to the carpal tunnel?
Runs above carpal tunnel in Guyon’s canal
367
What is carpal tunnel syndrome?
Compression of median nerve in carpal tunnel
368
What can cause carpal tunnel syndrome?
```
Anything that occupies excess space in the carpal tunnel
Ganglion cyst
Giant cell tumour
Neuroma
Lipoma
Soft tissue thickening
Fluid retention
```
369
What is done to relieve carpal tunnel syndrome?
Decompression/release
370
What is the cutaneous innervation of the hand?
Palmar hand & digits is split
Medial 1.5 ulnar
Lateral 3.5 Median
371
What is Tinels test?
Tap median nerve near palmaris longus proximal to carpal tunnel
Elicits tingling in carpal tunnel syndrome
372
What is phalens test?
Push back of hands together and hold
| Will induce pain in carpal tunnel syndrome
373
Where are Digital cutaneous nerves and what can they be used for?
Pass along the sides of the digits
| Can be locally blocked via dorsal web space
374
Where can sensory areas be tested in the hand?
Radial - base of thumb, posterior side
Median - 1st digit anterior side
Ulnar - medial side of palm
375
Where does the ulnar artery sit at the wrist?
Under or lateral to FCU at anterior wrist
376
Where does the radial artery sit at the wrist?
Lateral to FCR at anterior wrist
377
What can the radial artery at the wrist be used for?
Cannulated for ABG
Harvested
Anastomosed to cephalic vein for dialysis port
378
What is the blood supply to the hand?
Ulnar and radial arteries supply hand via 2 anastomotic palmar arches
Deep and superficial
Digital cutaneous branches pass along sides of the digits alongside cutaneous nerves
379
What needs to be done before vascular procedures at the wrist?
Ulnar artery patency and vascular anomalies
| Allens test
380
What parts make up the axial skeleton?
```
Skull
Ribs
Sternum
Vertebrae
Sacrum
Coccyx
```
