Anatomy Flashcards
What is the requirement for full abduction of the shoulder?
Scapular rotation via serratus anterior
Impingement of greater tuberosity by acromian process
List the extrinsic muscles of the toe
Extensor hallucis longus
Flexor hallucis longus
Fibularis longus
List the intrinsic muscles of the toe and give their action
Extensor hallucis brevis (toe extension)
Flexor hallucis brevis (toe flexion)
Adductor hallucis (toe adduction)
Abductor hallucis (toe abduction)
List the extrinsic muscles of the digits of the foot
Flexor digitorum longus Extensor digitorum longus Tibialis anterior Tibialis posterior Fibularis brevis Fibularis tertius
List the intrinsic muscles of the digits of the foot and give their action
Extensor digitorum brevis (digit extension)
Flexor digitorum brevis (digit flexion)
Abductor digiti minimi (little toe abduction)
Flexor digiti minimi (little toe flexion)
Quadratus plantae (flexion at DIPs)
Lumbricals
Interossei
How many lumbrical muscles are there in the foot?
4
How many interossei muscles are there in the foot?
7
List the five types of joints in the foot
Subtalar (talus - calcaneus) Midtarsal (calcaneus - cuboid - talus) Tarsometatarsal (cuneiforms, cuboid and MTs) MTP IP
What bones make up the hindfoot, midfoot and forefoot respectively?
Talus and calcaneus
Navicular, cuboid, cuneiforms
MTs and phalanges
List the posterior ankle tendons in the tarsal tunnel starting from closest posteriorly to MM to furthest away
TOM: Tibial posterior DICK: Flexor digitorium longus AND: Posterior tibial artery VERY: Posterior tibial vein NERVOUS: Tibial nerve HARRY: Flexor hallucis longus
What is the main blood supply to the foot, give it’s origin and branches?
Dorsalis pedis (from A tibial artery) ---> Arcuate arteries M + L plantar arteries (from P tibial artery) ---> MT arteries ---> Digit arteries
What is the main venous supply from the foot?
SUPERFICIAL: dorsal venous arch into great and small saphenous veins
DEEP: A + P tibial and fibular veins into popliteal vein
What is the motor nerve supply to the foot?
SOLE: Tibial nerve
DORSUM: Deep fibular nerve
What is the sensory nerve supply to the foot?
1ST CLEFT: Superficial fibular nerve
PROX. LATERAL: Sural nerve
PROX. MEDIAL: Saphenous nerve
List the anterior muscles of the leg
What is their main movement?
Tibialis anterior Extensor digitorum longus Extensor hallucis longus Fibularis tertius Dorsiflexors of ankle and toe extensors
What is the main nerve supply to the anterior leg muscles?
Deep fibular nerve (L4, 5)
List the lateral muscles of the leg
What is their main movement?
Fibularis longus
Fibularis brevis
Eversion of foot, ankle plantarflexion
What is the main nerve supply to the lateral leg muscles?
Superficial fibular nerve (L5, S1, S2)
List the posterior superficial muscles of the leg
What is their main movement?
Gastrocnemius
Soleus
Plantaris
Ankle plantarflexion, knee flexion
What is the main nerve supply to the posterior superficial leg muscles?
Tibial nerve
List the posterior deep muscles of the leg
What is their main movement?
Popliteus Flexor hallucis longus Flexor digitorum longus Tibialis posterior Toe flexion, ankle plantarflexion
What is the main nerve supply to the posterior deep leg muscles?
Tibial nerve
What type and class is the knee joint? What is it’s main movement?
Hinge
Synovial
FL-EX (some rotation)
What are the main articulations of the knee joint?
2 x femorotibial
1 x femoropatellar
What are the extra- and intracapsular ligaments of the knee joint?
Medial and lateral collateral ligaments
Anterior and posterior cruciate ligaments
Medial and lateral menisci
What material are menisci composed of?
Fibrocartilage
What are the boundaries of the popliteal fossa?
SL - biceps femoris
SM - semimembranous
I - gastrocnemius
Roof - popliteal fossa
What are the components of the popliteal NVB (superficial - deep)?
Tibial nerve
Popliteal vein
Popliteal artery
What are the branches of the popliteal artery, and what do they become?
Anterior tibial artery —> Dorsalis pedis
Posterior tibial artery —> Fibular artery
M + L plantar arteries
The calcaneal tendon is a combination of what two tendons?
Gastrocnemus
Soleus
List the superficial gluteal muscles
Gluteus maximus
Gluteus medius
Gluteus minimus
Tensor fasciae latae
Which movements does gluteus maximus enable?
Hip: mostly extension (also external rotation, abduction)
Which movements does gluteus medius enable?
Hip: abduction
Thigh: medial rotation
Which movements does gluteus minimus enable?
Hip: abduction
Thigh: medial rotation
Which movements does tensor fasciae latae enable?
Hip: flexion, medial rotation, abduction
Knee: lateral rotation
What is the main nerve supply to the superficial gluteal muscles?
Superior gluteal nerve (L4, L5, S1)
except gluteus maximus, which has inferior gluteal nerve
List the deep gluteal muscles
What is the main movement of these muscles?
Piriformis Superior gemellus Inferior gemellus Obturator internus Quadratus femoris Lateral rotation of the thigh
What is the nerve supply to piriformis?
Nerve to piriformis
What is the nerve supply to superior gemellus?
Nerve to obturator internus
What is the nerve supply to inferior gemellus?
Nerve to quadratus femoris
What is the nerve to obturator internus?
Nerve to obturator internus
What is the nerve supply to quadratus femoris?
Nerve to quadratus femoris
The sciatic nerve is found inferior to what muscle? What areas does it innervate anatomically? What are the nerve roots?
Piriformis
Posterior thigh, leg, foot
L4 - S3
Where does the pudenal nerve supply anatomically? What are it’s nerve roots?
Perineum
S2 - S4
Where does the posterior cutaneous nerve of the thigh supply? What are it’s nerve roots?
Skin over posterior thigh, popliteal fossa, lateral perineum, upper medial thigh
S1 - S3
What is the arterial supply to the sciatic nerve?
Artery to sciatic nerve
Where does the sciatic nerve branch? List these branches
Tibial and common fibular branches form at inferior third of the thigh
The thickening of the fascia lata, on the lateral surface of the thigh is known as…
The iliotibial tract
List the superior, lateral, medial, floor and roof borders of the femoral triangle respectively?
SAIL Inguinal ligament Adductor longus (lateral border) Sartorius (medial border) Iliopsoas and pectinus Fascia lata
List, from lateral to medial, the components of the femoral triangle?
Nerve
Artery
Vein
Lympatics
What is contained within the femoral sheath?
Femoral artery and vein
What is the only palpable vessel within the femoral triangle? It is a continuation of…
Femoral artery
External iliac artery
The inguinal ligament is located between which two bony landmarks?
ASIS
Pubic tubercle
A weakness in what muscles can cause a Trendelberg’s gait? What nerve lesion is this associated with?
Abductor muscles of lower limb - gluteus medius and gluteus minimus
Superior gluteal nerve
List the anterior muscles of the thigh
What is their main movement?
Sartorius Iliopsoas Pectineus Quadriceps femoris Hip flexion, knee extension
Which 2 muscles make up the iliopsoas muscle?
Iliacus
Psoas major
Which 4 muscles make up the quadriceps femoris muscle?
Rectus femoris
Vastus intermedius
Vastus medius
Vastus lateralis
What is the main nerve supply to the anterior thigh muscles?
Femoral nerve (L2-L4)
List the medial muscles of the thigh
What is their main movement?
Adductor longus Adductor brevis Adductor magnus Obturator externus Gracilis Hip adduction
What is the main nerve supply to the medial thigh muscles? What is the exception to this?
Obturator nerve (L2-L4) Tibial nerve (hamstring part of adductor magnus)
List the posterior muscles of the thigh
What is their main movement?
Semimembranosus
Semitendinosus
Biceps femoris
Hip extension,knee flexion
What is the main nerve supply to the posterior thigh muscles? What is the exception to this?
Sciatic nerve (tibial portion) (L5, S1, S2) Common fibular nerve [short head of biceps femoris]
What nerve is the continuation of the femoral nerve?
Saphenous nerve
The femoral nerve passes between what two muscles?
Sartorius
Gracillus
Radiation of pain from the hip to the knee can be atrributed to what nerve?
Obturator nerve
What class and type of joint is the hip joint? What movements can occur here?
Ball and socket
Synovial
FL-EX, M-L rotation, circumduction
What ligaments can be found at the hip joint?
Iliofemoral
Pubofemoral
Ischiofemoral
Ligament to femur head
What is the arterial supply to the hip joint?
Retinacular arteries from medial and lateral circumflex arteries (branch of deep femoral artery)
Artery to head of femur
The femoral artery branches into…
Popliteal artery
Deep femoral artery
What are the superficial veins of the lower limb and what do they each drain into?
Great saphenous vein (posteromedial) —> Femoral vein
Short saphenous vein (posterior) —> Popliteal vein
What is Trendelenburg test? What does it indicate?
Pelvis drops on the contralateral side during a single leg stand on the affected side
Superior gluteal nerve lesion
What nerve is commonly affected in a humeral midshaft fracture?
Radial nerve
What nerve is commonly affected in a surgical neck of humerus fracture?
Axillary nerve
What nerve and what artery is commonly affected in a supracondylar fracture?
Median nerve
Brachial artery
What ligament is injured in an inversion injury of the ankle on running vs in stationary?
Anterior talofibular ligament (running) Calcaenofibular ligament (in stationary)
What ligament is injured in an eversion injury of the ankle?
Deltoid ligament
Guyon’s tunnel compression is common in…
Cyclists
Ulnar nerve compression would affect which muscles?
Hypothenar eminence
Intrinsic hand muscles (interossei)
Median nerve compression would affect which muscles?
LOAF Lumbricals (1-2) (Thenar eminence) Opponens pollicis Abductor pollicus brevis Flexor pollicus brevis
Cubital tunnel syndrome affects which nerve?
Ulnar nerve
Carpal tunnel syndrome affects which nerve?
Median nerve
What supplies the muscles in the anterior forearm? What is the exception to this?
Median nerve
Medial half of flexor digitorium profundus, flexor carpi ulnaris are supplied by ulnar nerve
Which clinical sign is most likely in severe sciatica?
Decreased power of plantar-flexion
Which muscle is the main flexor of the hip joint?
Iliopsoas
A thrombosis originating in the posterior tibial vein has extended to the level of the inguinal ligament. Further proximal progression will extend the thrombus into which vein next?
External iliac vein
List the ligaments of the back and give their position
Ligamentum flavum (connect lamina) Anterior longitudinal ligament (front of vertebral body) Posterior longitudinal ligament (back of vertebral body) Supraspinous ligament (connects tips of spinous processes) Interspinous ligament (connect spinous processes)
Which ligament of the back is most commonly transected in a laminectomy?
Ligamentum flavum
List the main reflexes of the upper and lower limbs
Biceps reflex (C5/C6) Triceps reflex (C7/C8) Supinator reflex (C6) Knee jerk (L3/L4) Ankle jerk (S1,S2)
Which cutaneous nerve most commonly causes left foot drop?
Deep fibular nerve
A patient presents with anaesthesia in the first web space only. Which cutaneous nerve is likely to be affected?
Deep fibular nerve
Superficial fibular is dorsum of foot
A lesion of the anterior roots would affect which side of the body anatomically
Ipsilateral side
A 45yo man presents with an uncomfortable swelling visible and palpable in relation to the posteromedial aspect of the knee. What is the most likely pathology?
Great saphenous vein (phlebitis)
A patient in a RTA is diagnosed with compartment syndrome. On examination, pain is elicited on stretching the function of the muscles supplied by the tibial nerve. What compartment of the lower limb is affected?
Anterior compartment of the leg
On lower limb examination when the patient is asked to stand on their right leg, their pelvis tips inferiorly towards their left side. Which of the options would give this sign?
Congenital hip dislocation
Spinal stenosis is diagnosed on an MRI scan. Which movement of the spine would exacerbate the pain the most?
Extension
Shopping trolley sign
The clinician flexes and extends the patients hip. The patient feels pain in the anterior aspect of their thigh. Which neural structure is involved in transmitting action potentials that carry pain?
Lumbosacral plexus Femoral nerve (L2-L4)
What is meant an UMN?
Located within brainstem and send axons down the spinal cord to LMNs
What is meant by a LMN?
Connects the spinal cord (UMNs) and muscles
What is the role of the dorsal column/ medial lemniscus system?
SENSORY: Fine touch, vibration and conscious proprioception (mostly upper limb)
What is the role of the spinothalamic tract?
SENSORY: Carries pain, temperature and deep pressure
What is the role of the corticospinal/pyramidal tract?
MOTOR: fine, precise movement especially of distal limb muscles, for example digits
Which short ligament connects the adjacent lamina posteriorly to the spinal cord?
Ligamentum flavum
What is the function of the posterior longitudinal ligament?
Narrow and weak
Prevents overflexion
What is the function of the anterior longitudinal ligament?
Broad and strong
Prevents overextension
List the ligaments of the vertebral column
Ligamentum flavum Posterior longitudinal ligament Anterior longitudinal ligament Supraspinous ligaments Interspinous ligaments
Identify the sensory PERIPHERAL nerves of the lumbosacral plexus that form the named nerve cutaneous innervation of the ANTERIOR lower limb
1ST LAYER: lateral to medial Subcostal nerve (T12) - corner Genitofemoral nerve (L1, L2) - 1 or 2 balls Ilioinguinal nerve (L1) - 1lioinguinaL
2ND LAYER: lateral to medial
Lateral cutaneous nerve of the thigh (L3, L4)
Femoral nerve (L2, L3, L4) - FRONT
Obturator nerve (L2, L3, L4) - OPEN YOUR LEGS
3RD LAYER: lateral to medial
Deep fibular nerve (L2, L3) - TELLING A FIB - HIDING SOMETHING
Superficial fibular nerve
Saphenous nerve (L3, L4) - from femoral - SECRET
4TH LAYER: lateral to medial
Sural nerve (S1, S2) - ‘sweet’ little toe
Superficial fibular nerve (L4, L5, S1) - shoe (most of foot)
Deep fibular nerve (L5) - ‘fin’ - toe web
Identify the sensory PERIPHERAL nerves of the lumbosacral plexus that form the named nerve cutaneous innervation of the POSTERIOR lower limb
1ST LAYER: lateral to medial
Iliohypogastric nerve (L1) - ‘1Lio’
Posterior ramii (cluneal nerves) (S1, S2, S3) - ‘No clue = hiding at back)
Ilioinguinal nerve
2ND LAYER: lateral to medial
Lateral cutaneous nerve of thigh
Posterior cutaneous nerve of thigh (S1, S2, S3)
Obturator and femoral nerves
3RD LAYER: lateral to medial
Common fibular nerve
Sural nerve (from tibial and common fibular: S1, S2 - SECRET (in middle)
Saphenous nerve
4TH LAYER: lateral to medial
Tibial nerve (L4, L5, S1, S2, S3)
Calcaneal nerve (HEEL)
Medial and lateral plantar nerves (SOLE)
What is the difference between a spinal nerve and a named nerve?
Spinal nerves are axons originating from one spinal cord level e.g. L5 spinal nerve, whereas named nerve are axons originating from 1 or more spinal cord levels supplying an area e.g. musculocutaneous nerve (C5, 6, 7)
A patient presents with difficulty lifting his right leg out of bed. He is able to weight bear pain-free but his leg feels weak. On examination, he is unable to straight leg raise. Which injury is the most likely?
Ruptured quadriceps tendon
Extensor mechanism rupture
Where do visceral afferents enter the spinal cord for pelvic organs that touch the peritoneum? Where is pain perceived? List these organs
T11-L2 via sympathetic fibres
Suprapubic region
Uterine tubes, uterus, ovaries
Where do visceral afferents enter the spinal cord for pelvic organs that are not touching the peritoneum? Where is pain perceived? List these organs
S2-S4 via parasympathetic fibres
S2,3,4 dermatome (perineum and posterior thigh)
Cervix and superior vagina
Where does the pudenal nerve enter the spinal cord for structures in the perineum? Where is pain perceived? List these organs
S2-S4 via somatic sensory fibres
Localised pain in perineum
Inferior vagina, perineal muscles, glands, skin
What organs refer to the epigastric region?
Foregut organs
What organs refer to umbilical region?
Midgut organs
What organs refer to the suprapubic region?
Hindgut organs (inc. uterus, tubes, ovaries)
