Anatomy Flashcards
What is the nerve supply of the Pec Major muscle and where does it insert on the arm?
C5-T1
Medial and lateral pectoral nerves
Anterior axillary fold on lateral humerus
What is nerve supply and insertion of Pec minor?
C8-T1
Medial and lateral pectoral nerves
From ribs 3-5 to coracoid process of scapula
Insertion, action and nerve supply of Trapezius muscle?
From Occipital protuberance and cervical and thoracic vertebrae
To spine of scapula and lateral 1/3rd of clavicle
Elevates, retracts and rotates scapula
Braces shoulder backwards
Accessory nerve (CN 11)
Insertion, action and nerve supply of Lat dorsi?
From T6-L5 spines and iliac crest (thoracolumbar fascia)
To intertubercle groove of humerus
Adduction and medial rotation of arm
C6 + C7 - Thoracodorsal nerve
Insertion, action and innervation of Serratus anterior?
From lateral border of ribs 1-8
To medial border of scapula
Holds scapula against thoracic wall
Protracts scapula and rotates (helps with abduction)
C6 + C7 - Long thoracic nerve
Insertion, action and innervation of Subscapularis muscle?
From subscapular fossa
To lesser tubercle of humerus
Adduction and medial rotation of arm
C5-7 - Subscapular nerves
Insertion, action and innervation of Teres Major muscle?
From lower angle of scapula
To intertubercular sulcus of humerus
Medial rotation and adduction of arm
C6-7 - Lower subscapular nerve
Tell me about Axillary artery and branches?
From subclavian artery at lateral border of 1st rib and becomes brachial artery at inferior border of Teres Major
More easily palpated in axilla when arm is adducted as suspensory ligaments are then relaxed.
6 branches (Save The Lions And Protect Species) - Superior thoracic, Thoracoacromial, Lateral thoracic, Anterior circumflex humeral, Posterior circumflex humeral, Subscapular
Split into 3 parts by Pectoralis Minor, giving off 1 branch above, 2 beneath, 3 below.
Branches of Thoracoacromial artery
It is branch of axillary artery
4 branches (Cadavers Are Dead People) - Clavicular, Acromial, Deltoid, Pectoral
Tell me about Erb’s palsy?
Superior brachial plexus injury (C5/6) - waiter’s tip deformity.
From fall forcing shoulder down and head to opposite side.
During difficult delivery in infants where shoulder is forced down in head first delivery (most common obstetric brachial plexopathy).
Arm is adducted and internally rotated at shoulder, pronated, extended at elbow.
Good prognosis.
Tell me about Klumpke palsy?
Lower brachial plexus injury (C8/T1) - claw hand
Caused by excessive abduction - eg grabbing something when falling from height.
Also cervical rib or lung mets.
A/w preganglion injury and Horner’s syndrome.
Deficit of all small muscles of hand (ulnar and median nerves)
Extended wrist, hyperextension of MCP, flexion of IP.
Poor prognosis.
Explain lymphatic drainage of the breast?
75-90% is to axillary nodes, typically collecting in a single sentinel lymph node at lateral border of pec major.
Superficial lymphatics of nipple and areola collect in Sappey subareolar plexus.
Some deep breast tissue on medial side may drain into internal mammary nodes.
Axillary chain divided into 6 groups: Apical/subclavicular Brachial/lateral/axillary vein Central Subscapular/posterior Interpectoral/Rotter's nodes Pectoral/anterior/external mammary
Infraclavicular - surrounding cephalic vein, drainage from forearm and hand.
Tell me about chest drain insertion site and safe triangle?
5th intercostal space MAL, just above the rib
Safe triangle:
Lateral border of pec major
Anterior border of lat dorsi
Above level of nipple
Supraspinatus muscle - action and nerve supply?
Initiates abduction of arm
Suprascapular nerve (C4-6)
Infraspinatus muscle - action and nerve supply?
External rotation of arm
Suprascapular nerve (C4-6)
Teres minor - action and nerve supply?
External rotation of arm
Axillary nerve (C5-6)
Deltoid muscle - action and nerve supply?
Ant - flexion and medial rotation of arm
Med - abduction
Pos - extension and lateral rotation of arm
Axillary nerve (C5-6)
List 4 rotator cuff muscles?
Supraspinatus
Infraspinatus
Subscapularis
Teres minor
List the 3 anterior arm muscles and nerve supplying them?
Coracobrachialis
Brachialis
Biceps brachii
Musculocutaneous nerve
Biceps brachii - action, insertion, innervation, blood supply?
Long head originates from supraglenoid tubercle of scapular.
Short head originates from coracoid process of scapular (with coracobrachialis).
Single tendon inserts into radial tuberosity of radius.
Musculocutaneous nerve (C5-6)
Brachial artery
Flexion and supination of forearm
Weak flexion of arm at shoulder
Coracobrachialis - action, insertion, innervation, blood supply?
From coracoid process of scapular to anterior surface of humerus.
Strong adductor of arm
Also weak flexion at shoulder
Musculocutaneous nerve (C5-6)
Muscular branches of brachial artery
Brachialis - action, insertion, innervation, blood supply?
From distal half of anterior surface of humerus to coronoid process and tuberosity of ulna.
Main flexor of forearm at elbow
Musculocutaneous (C5-6) and radial (C7) nerves
Brachial, radial recurrent arteries and branches of inferior ulnar collateral arteries
Where is median nerve found in upper arm?
Median nerve is medial to brachial pulse
Brachial pulse is medial to biceps tendon
Carpal bones
Scaphoid Lunate Triquetrum Pisiform Trapezium Trapezoid Capitate Hamate
Tell me about supracondylar fractures?
Mostly in children - fall onto outstretched hand with elbow bent.
Anterior interosseous nerve most common structure to be injured. 2nd commonest is brachial artery.
Malunion can result in gunstock deformity
Treatment usually manipulation under anaesthetic with X-ray control then immobilisation with collar and cuff for 6-8 weeks.
LOAF muscles?
Intrinsic hand muscles innervated by median nerve
Lateral two lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
Describe autonomic and sensory innervation to parotid glands?
Parasympathetic - carried by auriculotemporal nerve from otic ganglion
Sympathetic - from superior cervical ganglion
Sensory - auriculotemporal nerve which is branch of mandibular nerve
What are the 4 infrahyoid muscles?
Sternohyoid
Sternothyroid
Omohyoid
Thyrohyoid
What are the borders of the posterior triangle of the neck?
Anterior boundary – sternocleidomastoid muscle
Posterior boundary – trapezius muscle
Inferior boundary (base) – middle third of the clavicle
Superior boundary (apex) – point that sternocleidomastoid and trapezius meet on the superior nuchal line of the occipital bone
List structures in the posterior triangle of the neck?
The nerves contained within the posterior triangle of the neck are: The accessory nerve (CN XI) The phrenic nerve (C3,4,5) The suprascapular nerve Branches of the cervical plexus Roots and trunks of the brachial plexus
The vessels contained within the posterior triangle of the neck are: The 3rd part of the subclavian artery The transverse cervical artery The subscapular artery The occipital artery The terminal part of the external jugular vein The subclavian vein The brachiocephalic vein
The muscles contained within the posterior triangle of the neck are:
The inferior belly of omohyoid muscle
The anterior, middle, and posterior scalene muscles
Levator scapulae muscle
Splenius capitis muscle
What muscle divides the posterior triangle of the neck into 2 further triangles and what are they?
Omohyoid muscle
Occipital triangle
Subclavian triangle
What is the venous drainage of the cerebellum?
Via superior and inferior cerebellar veins, which in turn drain into dural venous sinuses
What are the 6 main nerves that innervate the scalp?
Some Special Zoos Allow Giant Lions
The branches of the trigeminal nerve that innervate the scalp are:
The supratrochlear nerve is a branch of the ophthalmic division of the trigeminal nerve and it supplies the anteromedial forehead.
The supraorbital nerve is also a branch of the ophthalmic division of the trigeminal nerve and it supplies the scalp region between the anterolateral forehead and the vertex.
The zygomaticotemporal nerve is a branch of the maxillary division of the trigeminal nerve and supplies the region of the temple.
The auriculotemporal nerve is a branch of the mandibular division of the trigeminal nerve and supplies the skin supero-anteriorly to the auricle.
The branches of the cervical nerves that innervate the scalp are:
The greater occipital nerve is a branch of the anterior rami of cervical nerves C2 and C3. It supplies the posterior aspect of the scalp up to the vertex.
The lesser occipital nerve is also a branch of the anterior rami of cervical nerves C2 and C3. It supplies the area posterior to the auricle.
List the 6 main nerves that innervate the scalp?
Some Special Zoos Allow Giant Lions
Trigeminal branches: Supratrochlear Supraorbital Zygomaticotemporal Auriculotemporal
Cervical branches:
Greater occipital
Lesser occipital
At what level does the trachea arise?
C6 vertebral level
Lower border of cricoid cartilage
At what level does trachea bifurcate?
T5 vertebral level
Level of sternal angle
Describe the lining of the trachea and bronchi?
The trachea and bronchi are lined by ciliated pseudostratified columnar epithelium, interspersed by goblet cells, which produce mucous.
List the 7 branches of the facial artery and how it terminates?
The cervical branches of the facial artery are:
The ascending palatine artery
The tonsillar branch of the facial artery
The submental artery
The glandular artery
The facial branches of the facial artery are:
The inferior labial artery
The superior labial artery
The lateral nasal branch of the facial artery
Terminates as the angular artery on the anterior face, medially at the corner of the eye.
Describe blood supply to the scalp?
The branches of the internal carotid artery supplying the scalp are:
The supratrochlear artery accompanies the supratrochlear nerve and is a branch of the ophthalmic branch of the internal carotid artery. It supplies part of the forehead above the eye, and anastamoses with the supraorbital artery and with the supratrochlear artery on the other side.
The supraorbital artery is also a branch of the ophthalmic branch of the internal carotid artery. It accompanies the supraorbital nerve and supplies the lateral forehead and scalp.
The branches of the external carotid artery supplying the scalp are:
The superficial temporal artery supplies a large part of the scalp via its frontal and parietal branches. These are mainly located in the frontal and temporal areas. It anastamoses with the supraorbital artery.
The posterior auricular artery supplies the area of the scalp superior to and posterior to the auricle.
The occipital artery lies posteriorly on the scalp and supplies much of this area.
Approximately how much CSF is present at any one time?
Where is CSF produced?
How much CSF is produced per day?
Where is CSF absorbed?
150 ml
Produced in choroid plexuses, located in lining of ventricles, from arterial blood
Produces about 500 ml per day
Absorbed across arachnoid granulations into venous circulation
Also small amount of CSF drainage via cribriform plate
Where do all the lymphatic vessels of the head and neck ultimately drain into?
Deep cervical lymph nodes which run alongside the internal jugular vein
Where does lymphatic drainage of lateral face and eyelids drain to?
Parotid lymph nodes
Where does lymphatic drainage of the upper lip and lateral lower lip drain to?
Submental lymph nodes
What is the light reflex on otoscopy?
When light shone on tympanic membrane, a cone shaped reflection of light appears in anterior inferior quadrant, just below the umbo.
List the 4 suprahyoid muscles?
The digastric muscle
The stylohyoid muscle
The geniohyoid muscle
The mylohyoid muscle
List the foramina of the ventricular system of the brain?
The interventricular foramina (foramina of Monro) connects the lateral ventricles with the third ventricle at the midline of the brain
The cerebral aqueduct (aqueduct of Sylvius) connects the third ventricle with the fourth ventricle
The median aperture (foramen of Magendie) connects the fourth ventricle with the subarachnoid space via the cisterna magna
The right and left lateral apertures (apertures of Luschka) connect the fourth ventricle with the subarachnoid space via the cistern of the great cerebral vein
Which structures pass through the Cavernous sinus?
Oculomotor nerve Trochlear nerve Abducens nerve Ophthalmic nerve Maxillary nerve
Internal carotid artery
Describe the course of the facial nerve up to its division into 5 terminal branches?
The facial nerve exits the cranium through the stylomastoid foramen, just posterior to the styloid process of the temporal bone.
As the nerve exits the stylomastoid foramen it gives of the posterior auricular nerve, which controls movements of some of the scalp muscles around the ear.
After exiting the cranium, it runs anteriorly to the outer ear before passing between the posterior belly of the digastric muscle and the stylohyoid muscle, giving off branches to each of these muscles in the process.
It then enters the parotid gland, which it does not innervate. Lying between the deep and superficial lobes of the gland the nerve divides into its five terminal motor branches, which innervate the muscles of facial expression: Temporal branch Zygomatic branch Buccal branch Marginal mandibular branch Cervical branch
What are the 5 parts of the brachial plexus?
Real Teenagers Drink Cold Beer
Roots Trunks Divisions Cords Branches
What are the 3 trunks of the brachial plexus?
The C5 and C6 roots combine to form the superior trunk
The C7 root continues to form the middle trunk
The C8 and T1 roots combine to form the inferior trunk
Which 3 muscles make up the hypothenar eminence?
Abductor digiti minimi
Flexor digiti minimi brevis
Opponens digiti minimi
What is the nerve and blood supply to the dorsal interossei?
Deep branch of ulnar nerve
Dorsal and palmar metacarpal arteries
What are the 4 main sensory branches of the radial nerve?
Inferior lateral cutaneous nerve of the arm – supplies the lateral aspect of the anterior upper arm between the deltoid and the elbow
Posterior cutaneous nerve of the arm – supplies part of the posterior aspect of the upper arm
The posterior cutaneous nerve of the forearm – supplies a tapered strip of the middle portion of the posterior forearm
The superficial branch of the radial nerve – supplies the posterior surface of the lateral 3 ½ digits and the associated areas of the palm
Which bones form the borders of the carpal arch?
Laterally - scaphoid and trapezium tubercles
Medially - hook of hamate and pisiform
What are the 8 carpal bones from starting on lateral side?
Scaphoid Lunate Triquetrum Pisiform Trapezium Trapezoid Capitate Hamate
What are the contents of the carpal tunnel?
9 tendons and median nerve
Flexor digitorum profundus (4 tendons)
Flexor digitorum superficialis (4 tendons)
Flexor pollicis longus (in its own synovial sheath)
Which tendon lies within the flexor retinaculum itself?
Flexor carpi radialis tendon
What 4 muscles are innervated by the median nerve?
LOAF
Lateral 2 lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
What are the 3 sensory branches of the ulnar nerve and where do they arise?
Two of these arise in the forearm and travel into the hand:
Palmar cutaenous branch, which innervates the skin of the medial half of the palm
Dorsal cutaneous branch, which innervates the dorsal skin of the medial one and half fingers and associated dorsal hand
The third branch arises in the hand:
Superficial branch, which innervates the palmar surface of the medial one and a half fingers
How does the location of damage to ulnar nerve affect the pattern of injury?
Ulnar nerve innervates 2 muscles in the forearm - flexor carpi ulnaris and medial 1/2 of flexor digitorum profundus.
With injury at the elbow these 2 forearm muscles are spared.
Flexion of hand at the wrist still occurs due to intact median nerve but hand will be abducted as flexor carpi ulnaris also adducts the hand. Wrist flexion is unaffected with ulnar nerve lesion at the wrist.
Damage to the ulnar nerve at either the elbow or wrist results in a characteristic ‘claw hand’ appearance with hyperextension of the metacarpophalangeal joints and flexion of the distal and proximal interphalangeal joint of the little and ring fingers. When the ulnar nerve has been damaged at the elbow there will be less clawing of the little and ring fingers as there will also be loss of flexor digitorum profundus to these fingers.
Sensory function also differs depending upon the site of damage. When damaged at the elbow all three cutaneous branches will be affected and there will be complete sensory loss in the areas that are innervated by the ulnar nerve. When damaged at the wrist the two branches that arise in the forearm can be spared.
What is Froment’s sign in testing for an ulnar nerve lesion?
This is tested for by placing a piece of paper between the patient’s thumb and index finger. The tester then attempts to pull the paper out of the patient’s pinched grip. In the case of an ulnar nerve palsy the patient will have difficulty maintaining the grip and will compensate by flexing flexor pollicis longus of the thumb to maintain grip pressure. The patient’s interphalangeal joint of the thumb will flex.
Which muscles are supplied by the median nerve and its branches?
Median nerve: Pronator teres Flexor carpi radialis Palmaris longus Flexor digitorum superficialis
Anterior interosseous nerve:
Flexor digitorum profundus (lateral 1/2)
Flexor pollicis longus
Pronator quadratus
Recurrent branch:
Thenar muscles - opponens pollicis, abductor pollicis brevis, flexor pollicis brevis
Palmar digital branch:
1st and 2nd lumbricals
Which nerve innervates the supinator muscle?
Deep branch of radial nerve
What are the 3 attachments of the biceps brachii muscle?
Short head arises from tip of coracoid process of scapula
Long head arises from supraglenoid tubercle of scapula
Inserts into radial tuberosity and deep fascia of forearm via bicipital aponeurosis
Describe the empty can test?
To perform the test the patient is placed in a standing or sitting position, and the arms are raised parallel to the ground in the scapular plane.
The arm is then rotated to full internal rotation (thumb down) and the clinician pushes down on either the wrists or the elbow, and the patient is instructed to resist the downward pressure.
The test is considered positive if weakness, pain or both are present during resistance.
A positive test result suggests a tear to the supraspinatus tendon or muscle, or neuropathy of the suprascapular nerve.
List the muscles supplied by the ulnar nerve and its 2 main motor branches?
In forearm:
Flexor carpi ulnaris
Flexor digitorum profundus (medial 1/2)
Depp branch (in hand): Hypothenar muscles 3rd and 4th lumbricals Palmar interossei Dorsal interossei Adductor pollicis Flexor pollicis brevis
Superficial branch (in hand): Palmaris brevis
What is the piano key sign?
Sign of triangular fibrocartilage complex injury.
Dorsal distal radioulnar joint instability can cause a protruding ulna head, which can be pressed down. When you release the pressure, it will spring back in position again, just like a piano key.
The best place to palpate the TFCC is between extensor carpi ulnaris and flexor carpi ulnaris.
What causes winged scapula?
Damage to long thoracic nerve which innervates serratus anterior muscle.
Can be seen more clearly by asking them to push against a wall.
Describe blood supply to the hand?
The radial artery primarily supplies the thumb and the lateral side of the index finger.
The ulnar artery primarily supplies the medial side of the index finger and the rest of the fingers.
The ulnar artery lies lateral to flexor carpi ulnaris before passing superficial to the flexor retinaculum.
Deep palmar arch - predominantly from radial artery, also from deep palmar branch of ulnar artery, gives rise to palmar metacarpal arteries.
Superficial palmar arch - predominantly from ulnar artery, also from superficial palmar branch of radial artery, gives rise to the common palmar digital arteries and four digital branches.
Where can the median nerve be located?
Between the tendons of palmaris longus and flexor carpi radialis.
It should be noted that palmaris longus is absent in around 15% of the population and if this is the case the median nerve can be located 5-10 mm medial to flexor carpi radialis.
What are the main actions of the 4 rotator cuff muscles?
Supraspinatus - abduction (first 15 degrees)
Subscapularis - internal rotation, adduction
Infraspinatus - main external rotator
Teres minor - assists with external rotation
What are the 3 main sensory branches of the ulnar nerve?
Palmar cutaneous branch – supplies the medial half of the palm (arises in forearm and travels into the hand)
Dorsal cutaneous branch – supplies the dorsal aspect of the medial 1 ½ digits and associated dorsal hand area (arises in forearm and travels into the hand)
Superficial terminal branch – supplies the palmar aspect of the medial 1 ½ fingers (arises in the hand)
What are the 4 main passageways that connect the abdomen/pelvis to the lower limb?
Obturator canal
Greater sciatic foramen
Lesser sciatic foramen
Gap between inguinal ligament and anterosuperior margin of pelvis
Where is the obturator canal located within the obturator foramen?
Anterosuperior edge of obturator foramen
Obturator membrane fills most of obturator foramen.
Obturator internus and externus connect to obturator membrane and surrounding bone.
What structures pass through the obturator canal?
Obturator nerve and vessels
What are the borders of the greater sciatic foramen?
What muscle divides it into 2?
Major route for structures to pass between pelvis and gluteal region
Margins are:
Greater sciatic notch
Part of upper borders of sacrospinous and sacrotuberous ligaments
Lateral border of sacrum
Divided into 2 by piriformis muscle, 1 part below and 1 part above
What structures pass through the greater sciatic foramen above the piriformis muscle?
Superior gluteal nerve, artery and vein
What structures pass through the greater sciatic foramen below the piriformis muscle?
Inferior gluteal nerve, artery and vein
Sciatic nerve
Pudendal nerve
Internal pudendal artery and vein
Posterior femoral cutaneous nerve
Nerve to obturator internus and gemellus superior muscles
Nerve to quadratus femoris and gemellus inferior muscles
What regions does the lesser sciatic foramen connect?
Connects gluteal region to perineum
It is inferior to the lateral attachment of the pelvic floor (levator ani and coccygeus muscles)
What structures pass through the lesser sciatic foramen?
Obturator internus muscle tendon
Pudendal nerve and internal pudendal vessels, which first pass through the greater sciatic foramen below the piriformis muscle, enter perineum below pelvic floor by passing medially through lesser sciatic foramen.
What 3 muscles pass below the inguinal ligament to enter the thigh?
Psoas major
Iliacus
Pectineus
List structures which pass through the gap below the inguinal ligament to enter the thigh?
Psoas major, iliacus, pectineus muscles
Femoral artery and vein
Lymphatics of lower limb
Femoral nerve
Which nerve routes form the lumbar plexus?
Which nerve routes form the sacral plexus?
Lumbar plexus - anterior rami of L1-L3 and part of L4.
The rest of L4 and anterior ramus of L5 form lumbosacral trunk which joins with anterior rami of S1-S3 and part of S4 to form sacral plexus.
What is the sensory and motor innervation of the femoral nerve?
What are its spinal roots?
All muscles in anterior compartment of thigh.
In abdomen branches innervate iliacus and pectineus.
Skin over anterior thigh, anteromedial knee, medial side of lower leg and medial side of foot.
L2-L4
What is the sensory and motor innervation of the obturator nerve?
What are its spinal roots?
All muscles in medial compartment of thigh except: part of adductor magnus that originates from the ischium (sciatic nerve) pectineus muscle (femoral nerve)
Obturator externus muscle
Skin on medial side of upper thigh
What are the spinal roots of the sciatic nerve?
Through what gap does it leave the pelvis?
What are its 2 major branches?
What does it innervate?
L4-S3
Through greater sciatic foramen below piriformis muscle
In posterior compartment of thigh it divides into 2 major branches:
Common fibular nerve - posterior divisions of L4-S2
Tibial nerve - anterior divisions of L4-S3
All muscles in posterior compartment of thigh
The part of adductor magnus originating from ischium
All muscles in leg and foot
Skin on lateral side of leg and lateral side and sole of foot
What are the 2 gluteal nerves?
Where do they leave the pelvis?
What muscles do they innervate?
Superior and inferior gluteal nerves
Superior:
Leaves pelvis through greater sciatic foramen above piriformis muscle
Gluteus medius and minimus muscles
Tensor fasciae latae muscle
Inferior:
Leaves pelvis through greater sciatic foramen below piriformis muscle
Gluteus maximus
Where does the ilio-inguinal nerve leave the abdominal wall?
What are its spinal roots?
Where does it supply sensory innervation to?
What motor function does it have?
Through the inguinal canal and out of superficial inguinal ring
L1
Innervates skin on medial side of upper thigh and adjacent parts of perineum
Innervates muscles of abdominal wall
Where does the genitofemoral nerve leave the abdomen?
Where does it supply sensory innervation to?
What motor function does it have?
Passes anteroinferiorly through psoas major muscle then descends on its anterior surface.
Its femoral branch passes under inguinal ligament lateral to femoral artery.
Femoral branch innervates skin over upper central part of anterior thigh.
Genital branch innervates cremaster muscle in wall of spermatic cord in men
Which 2 nerves are involved in the cremasteric reflex?
When the inner thigh is stroked, sensory fibers of the ilioinguinal nerve are stimulated.
These activate the motor fibers of the genital branch of the genitofemoral nerve which causes the cremaster muscle to contract and elevate the testis.
What are the spinal roots of the lateral cutaneous nerve of the thigh?
Where does it leave the abdomen?
Where does it give sensory innervation to?
L2/L3
Leaves abdomen either:
Below inguinal ligament just medial to ASIS
Or by passing through inguinal ligament
Sensory innervation to lateral side of thigh
What are the spinal roots of the posterior cutaneous nerve of the thigh?
Where does it leave the pelvic cavity?
Where does it supply sensory innervation to?
S1-S3
Through greater sciatic foramen below piriformis muscle
Passes deep to gluteus maximus
Innervates longitudinal band over posterior thigh that continues into upper leg, skin over gluteal fold, upper medial part of thigh and adjacent regions of perineum.
Where does the perforating cutaneous nerve innervate?
Overlaps with posterior cutaneous nerve of the thigh in innervating skin over the medial aspect of the gluteal fold.
The superior and inferior gluteal arteries are branches of what artery?
Through which foramen do they leave the pelvis?
Branches of internal iliac artery
Both through greater sciatic foramen
Superior is above piriformis muscle
Inferior is below piriformis muscle
They supply gluteal region
The obturator artery is a branch of which artery?
Where does it leave the pelvis?
Where does it supply?
Branch of internal iliac artery
Through obturator canal
Supplies medial compartment of thigh
Which 3 veins drain into the popliteal vein around the level of the knee?
Small saphenous vein
Anterior and posterior tibial veins
What 3 factors make up Virchow’s triad wich precipitate thrombosis?
Venous stasis
Injury to vessel wall
Hypercoagulable state
Where are the superficial inguinal nodes located?
Where do they receive lymph from?
Where do they drain to?
In the superficial fascia and run parallel to the inguinal ligament, medially they run inferiorly along terminal part of great saphenous vein.
Receive lymph from gluteal region, lower abdominal wall, perineum, superficial regions of lower limb.
Drain to external iliac nodes.
Where are the deep inguinal nodes found?
Where do they receive lymph from?
Where do they drain to?
Medial to femoral vein. Up to 3 per side.
Receive lymph from deep lymphatics associated with femoral vessels and from glans penis (or clitoris) in perineum.
Interconnect with superficial inguinal nodes to drain to external iliac nodes.
What is the iliotibial tract?
What 2 muscles are associated with it?
Thickening of the fascia lata laterally into a longitudinal band. Descends from tuberculum of iliac crest to a bony attachment just below knee.
Tensor fascia lata muscle inserts into superior and anterior aspects of iliotibial tract.
Most of gluteus maximus muscle inserts into posterior aspect of iliotibial tract.
What are the borders of the femoral triangle?
Base - inguinal ligament
Medial border - medial margin of adductor longus
Lateral border - medial margin of sartorius
Floor - medially by pectineus and adductor longus muscles, laterally by iliopsoas muscle descending from abdomen
Apex - continuous with adductor canal which descends down thigh then posteriorly through aperture in lower end of adductor magnus to open into popliteal fossa.
List the 5 muscles that make up the deep muscular group of the gluteal region?
Piriformis Obturator internus Gemellus superior Gemellus inferior Quadratus femoris
These are mainly lateral rotators of the hip.
List the 4 muscles that make up the superficial muscular group of the gluteal region?
Gluteus minimus
Gluteus medius
Gluteus maximus
Tensor fasciae latae - stabilises the knee in extension by acting on iliotibial tract.
These mainly abduct and extend the hip.
Which 3 muscles of the superficial muscular group of the gluteal region are supplied by the superior gluteal nerve?
What are the 3 nerve roots associated?
Gluteus minimus
Gluteus medius
Tensor fasciae latae
L4, L5, S1
Which 2 muscles of the deep muscular group of the gluteal region are supplied by the nerve to the obturator internus?
What are the associated nerve roots?
Obturator internus
Gemellus superior
L5, S1
Which 2 muscles of the deep muscular group of the gluteal region are supplied by the nerve to the quadratus femoris?
What are the associated nerve roots?
Quadratus femoris
Gemellus inferior
L5, S1
What are the 2 actions of the piriformis muscle based on the position of the femur?
Laterally rotates extended femur at hip joint
Abducts flexed femur at hip joint
The gemellus superior and inferior muscles are associated with the tendon of which other muscle?
Where do the 3 muscles insert on the femur?
Obturator internus tendon
Insert into greater trochanter of femur to abduct and laterally rotate.
What is the origin and insertion of the quadratus femoris muscle?
What is its action?
From lateral aspect of ischium
To quadrate tubercle on intertrochanteric crest of proximal femur
Lateral rotation
Trendelenburg’s test is for which 2 muscles?
Damage to which nerve is the cause?
List some causes?
Gluteus medius and gluteus minimus
Superior gluteal nerve
Pelvic fractures, space occupying lesion, hip surgery
What are the 2 insertions of the gluteus maximus muscle?
Iliotibial tract
Elongate gluteal tuberosity of proximal femur
Of the 7 nerves that enter the gluteal region from the pelvis via the greater sciatic foramen, which is the only nerve to pass above the piriformis muscle?
Superior gluteal nerve
At what margin does the sciatic nerve enter the posterior thigh?
Lower margin of quadratus femoris
Where does the posterior cutaneous nerve of the thigh exit the pelvis?
Where does it provide sensory innervation to?
Greater sciatic foramen below piriformis muscle
Gluteal branches supply skin over gluteal fold.
A small perineal branch contributes to supply to scrotum or labia majora.
Main trunk gives rise to branches innervating skin on posterior thigh and leg.
What is the course of the pudendal nerve?
Where does it provide somatic innervation to?
Enters gluteal region through greater sciatic foramen inferior to piriformis muscle and medial to sciatic nerve.
Passes over sacrospinous ligament then immediately through lesser sciatic foramen to enter perineum.
Major somatic nerve of perineum.
Has no branches in gluteal region.
What is the only nerve of the gluteal region that does not enter through the greater sciatic foramen?
Where does it enter?
Where does it supply?
The perforating cutaneous nerve
Pierces sacrotuberous ligament, then loops around lower border of gluteus maximus
Supplies skin over medial aspect of gluteus maximus
Where is a safe site for intramuscular injection into the gluteal region?
How are the quadrants defined?
Which muscle will be injected?
Upper outer quadrant anterior corner
Vertical line down from highest point of iliac crest.
Horizontal line between highest point of iliac crest and level of ischial tuberosity.
Needle placed here enters gluteus medius
What is the origin of the inferior gluteal artery?
Where does it enter the gluteal region from the pelvic cavity?
Originates from anterior trunk of internal iliac artery
Through greater sciatic foramen below piriformis muscle, with inferior gluteal nerve
What is the origin of the superior gluteal artery?
Where does it enter the gluteal region from the pelvic cavity?
What are its 2 branches in the gluteal region?
Originates from posterior trunk of internal iliac artery
Through greater sciatic foramen above piriformis muscle, along with superior gluteal nerve
Superficial and deep branch
Also contributes to supply of hip joint. Branches anastomose with lateral and medial femoral circumflex arteries from deep femoral artery.
How many compartments does the thigh have and what are they?
3
Anterior - femoral nerve
Posterior - sciatic nerve
Medial - mostly obturator nerve
What is a sesamoid bone?
What is the largest sesamoid bone in the body and what tendon does it lie within?
A bone formed within a tendon
Patella bone within tendon of quadriceps femoris muscle
What are the 7 muscles of the anterior compartment of the thigh?
What nerve innervates them?
Sartorius
4 large quadriceps femoris muscles (rectus femoris, vastus lateralis, vastus medialis, vastus intermedius).
These 5 are innervated by femoral nerve.
Psoas major - branches of anterior rami of L1-L3
Iliacus - femoral nerve
What are the 6 muscles of the medial compartment of the thigh?
What is their innervation?
Gracilis Pectineus Adductor longus Adductor brevis Adductor magnus Obturator externus
All innervated by obturator nerve except:
Pectineus by femoral nerve
Part of adductor magnus by sciatic nerve
What are the 3 muscles of the posterior thigh?
What nerve innervates them?
Hamstrings:
Biceps femoris
Semitendinosus
Semimembranosus
Sciatic nerve
Which 2 muscles in the anterior compartment of the thigh act on both the hip and knee joint?
Rectus femoris and Sartorius
Where does the iliopsoas muscle insert into the femur and what are its actions?
Lesser trochanter
Flexion and lateral rotation of hip
What spinal root levels are tested for by patella tendon reflex and why?
Patella is contained within tendon of quadriceps femoris which is innervated by femoral nerve with contributions from L3 and L4.
Therefore tests L3 L4
What is the origin of the muscles that make up the quadriceps femoris?
Vastus muscles originate from femur
Rectus femoris originates from pelvic bone with 2 tendinous heads:
One from ASIS (straight head)
One from roughened area of ileum immediately superior to acetabulum (reflected head)
Which tiny muscle, often part of the vastus intermedius, pulls the suprapatellar bursa away from the knee joint during extension?
Articularis genus
What is the most superficial muscle in the anterior compartment of the thigh?
What is its origin and insertion?
What are its actions?
Sartorius
From ASIS
To medial surface of proximal shaft of tibia
Flexion of hip and knee
Abducts thigh and laterally rotates it - as if sitting with foot resting on opposite knee.
What is the pes anserinus?
Sartorius, Gracilis and Semitendinosus muscles attach to tibia in a 3-pronged pattern.
Their combined tendons of insertion are often called the pes anserinus (Latin for “goose foot”)
Where can the dorsalis pedis pulse be located?
What artery is the dorsalis pedis artery a continuation of?
The pulse of the dorsalis pedis artery can be easily palpated lateral to extensor hallucis longus tendon and medial to the extensor digitorum longus tendon, on the dorsal surface of the foot. The pulse is situated distal to the dorsal most prominence of the navicular bone, which serves as a reliable landmark for palpation.
Continuation of anterior tibial artery
It then anastomoses with the lateral plantar artery to form the deep plantar arch.
Of the 6 muscles of the medial compartment of the thigh, which muscle is different in that it laterally rotates at the hip?
Obturator externus laterally rotates at the hip
The other muscles adduct and medially rotate
Of the 6 muscles of the medial compartment of the thigh, which muscle is different in that it also flexes the knee joint?
Gracilis
Which muscle in the medial compartment of the thigh is innervated by the anterior division of the obturator nerve?
Adductor longus
Describe innervation to the adductor magnus muscle?
The muscle has 2 parts:
Adductor part - obturator nerve
Hamstring part - tibial division of sciatic nerve
What nerve innervates the obturator externus muscle?
Posterior branch of obturator nerve
What are the 3 hamstring muscle that make up the posterior compartment of the thigh and what are their actions?
Biceps femoris
Semitendinosus
Semimembranosus
All except short head of biceps femoris cross both hip and knee joints
Flex at the knee
Extend at the hip
The long and short heads of the biceps femoris muscle are innervated by which branches of the sciatic nerve?
Which branch of the sciatic nerve innervates both the semitendinosus and semimembranosus?
Long head - tibial division of sciatic nerve
Short head - common fibular division of sciatic nerve
Tibial division of sciatic nerve
What are the 4 small branches of the femoral artery that arise in the femoral triangle which supply cutaneous regions of the upper thigh, lower abdomen and perineum?
Superficial epigastric artery
Superficial circumflex iliac artery
Superficial external pudendal artery
Deep external pudendal artery
What are the 5 branches of the deep artery of the thigh (profunda femoris)?
Lateral and medial circumflex femoral branches
3 perforating branches - as the deep artery of the thigh travels down anterior to adductor brevis, one branch comes off above the muscle, one branch anterior to the muscle, the third branch below the muscle.
Which arterial branch enters the hip joint through the acetabular notch and contributes to the supply of the head of the femur?
Acetabular branch of posterior branch of obturator artery
Describe the origin and course of the saphenous nerve?
Where does it supply sensory innervation to?
Originates from femoral nerve
Accompanies femoral artery through adductor canal but does not pass through adductor hiatus.
Instead it penetrates directly through connective tissues to appear on medial side of knee.
Continues down medial side of leg.
Supplies sensory innervation to medial side of knee/leg/foot.
What is the sensory distribution of the femoral nerve?
Anterior and medial thigh, medial leg and foot
What are the 2 divisions of the obturator nerve and what do they supply?
Divides into anterior and posterior branches as it enters the thigh, these are separated by adductor brevis muscle.
Posterior branch - obturator externus, adductor brevis, part of adductor magnus.
Anterior branch - adductor longus, gracilis, adductor brevis, often contributes to pectineus, cutaneous branches innervate skin over medial thigh
What are the 2 terminal branches of the sciatic nerve?
Tibial nerve
Common fibular nerve (common peroneal nerve)
Both travel vertically down thigh and enter popliteal fossa
The muscles of the posterior thigh are innervated by which branches of the sciatic nerve?
Tibial nerve - long head of biceps femoris, semitendinosus, semimembranosus
Common fibular nerve - short head of biceps femoris
Summarise the innervation of the tibial nerve?
All muscles of posterior thigh except short head of biceps femoris
All muscles in posterior compartment of leg
All intrinsic muscles in sole of foot including first 2 dorsal interossei (may also receive innervation from deep fibular nerve)
Skin on posterolateral side of lower half of leg and lateral side of ankle, foot and little toe, and skin on sole of foot and toes.
Summarise the innervation of the fibular nerve?
All muscles in anterior and lateral compartments of leg
1 muscle (extensor digitorum brevis) on dorsal aspect of foot
First 2 dorsal interossei muscles in sole of foot
Skin over lateral aspect of leg, ankle, dorsal aspect of foot and toes
The oblique popliteal ligament which reinforces the fibrous membrane of the knee joint posteromedially is an extension of the tendon of which muscle?
Semimembranosus
List 3 parts of the locking mechanism of the knee?
The femoral surfaces become flatter and larger in extension
Medial rotation of the femur in extension tightens the ligaments
The bodies centre of gravity in extension is down a vertical line anterior to the knee joint, therefore maintaining extension
What is the name of the branch that leaves the femoral artery just before it enters the adductor hiatus?
Descending genicular artery
What are the borders of the popliteal fossa?
Upper part:
Medially by distal ends of semitendinosus and semimembranosus muscles.
Laterally by distal end of biceps femoris muscle.
Lower part:
Medially by medial head of gastrocnemius.
Laterally by lateral head of gastrocnemius and plantaris muscle.
Roof:
Deep fascia continuous above with fascia lata of thigh and below with deep fascia of leg.
What are the main structures of the popliteal fossa from medial to lateral?
Popliteal artery
Popliteal vein
Tibial nerve
Common fibular nerves
What is the origin and course of the tibial and common fibular nerves?
They are the 2 major branches of sciatic nerve, both enter popliteal fossa below margin of biceps femoris.
Tibial nerve descends vertically through popliteal fossa and exits deep to margin of plantaris muscle to enter posterior compartment of leg.
Common fibular nerve exits by following biceps femoris tendon over lateral margin of popliteal fossa, continues laterally where it swings round neck of fibular and enters lateral compartment of leg.
What are the branches of the popliteal artery?
Gives rise to geniculate arteries in popliteal fossa which contribute to vascular anastomoses around the knee.
Enters posterior compartment of leg where it divides into anterior and posterior tibial arteries.
What is the course of the small saphenous vein?
From lateral side of dorsal venous arch in foot
Ascends vertically in superficial fascia on back of leg
Penetrates deep fascia in back of knee to join with popliteal vein
Which 2 structures penetrate the roof of the popliteal fossa?
Small saphenous vein to drain into popliteal vein
Posterior cutaneous nerve of thigh - descends through thigh superficial to hamstring muscles, passes through roof of popliteal fossa, continues inferiorly with small saphenous vein to innervate skin on upper half of back of leg
What are the 4 compartments of the leg?
Anterior
Lateral
Superficial posterior
Deep posterior
What are the actions of the posterior compartments of the leg?
What nerve innervates them?
Generally they plantarflex and invert the foot and flex the toes
All are innervated by tibial nerve
What are the 3 muscles in the superficial posterior compartment of the leg?
Where do they all insert and what is their action?
Which 2 originate on the distal femur and can also flex the knee?
“GPS”
Gastrocnemius
Plantaris
Soleus
All 3 insert into calcaneus and act to plantarflex foot
Gastrocnemius and plantaris originate on the distal femur and can also flex the knee?
Which muscle in the superficial posterior compartment of the leg has 2 heads and what are they?
Which fossa do these two heads form the lower margin of?
Gastrocnemius
Medial head
Lateral head
Popliteal fossa
Where does the Plantaris muscle originate from?
Lower part of lateral supracondylar ridge of distal femur and from oblique popliteal ligament
Which antibiotic group can predispose to achilles tendon rupture and tendonitis?
Quinolone group such as Ciprofloxacin and Levofloxacin
What are the 4 muscles in the deep posterior compartment of the leg?
Which of these muscles acts on the knee?
Which nerve innervates all 4 of them?
Popliteus
Flexor hallucis longus
Flexor digitorum longus
Tibialis posterior
Popliteus muscle acts on the knee
Tibial nerve
What is the action of the popliteus muscle?
Where does it originate from?
Unlocks extended knee
Stabilises knee by resisting lateral rotation of tibia on the femur
Ascends laterally around knee and originates from a tendon which penetrates fibrous membrane of joint capsule.
What is the origin and insertion of the flexor hallucis longus muscle?
Originates from lower 2/3rds of posterior surface of fibula and interosseous membrane.
Inserts into palmar surface of great toe
This means it crosses from the lateral leg to the medial foot
What is the origin and insertion of the flexor digitorum longus muscles?
Arises mainly from medial side of posterior surface of tibia, inferior to soleal line
4 tendons insert into plantar surfaces of bases of distal phalanges of digits 2 to 5.
Crosses inferior to tendon of flexor hallucis longus
The tendons of which 2 muscles in the deep posterior compartment of the leg lie posterior to the medial malleolus of the ankle?
Tibialis posterior tendon lies medial to flexor digitorum longus tendon behind medial malleolus
Where does the tibialis posterior tendon insert into?
Tuberosity of navicular and to medial cuneiform
What are the actions of the tibialis posterior muscle?
Inverts and plantarflexes foot
Describe arterial supply to the leg from the popliteal artery?
What are the 2 major branches of the posterior tibial artery?
2 large sural arteries branch from popliteal artery to supply gastrocnemius, soleus and plantaris muscles.
Popliteal artery passes inferiorly into deep posterior compartment, then divides into anterior and posterior tibial arteries.
Anterior tibial artery passes through aperture in upper part of interosseous membrane and supplies anterior compartment of leg. Continues inferiorly onto dorsal aspect of foot.
Posterior tibial artery supplies posterior and lateral compartment and continues to sole of foot. Has 2 major branches in leg:
Circumflex fibular artery - passes laterally through soleus muscle and around neck of fibular to connect to anastomotic network of vessels around knee.
Fibular artery - descends along lateral side of posterior compartment, supplies posterior compartment and has branches that pass laterally through intermuscular septum to supply fibularis muscles in lateral compartment. A perforating branch passes through inferior aperture of interosseous membrane to anastomose with branch of anterior tibial artery.
Which artery passess behind medial malleolus?
Posterior tibial artery
What are the 2 major branches of the tibial nerve?
Sural nerve
Medial calcaneal nerve
Where does the sural nerve supply innervation to?
Which malleolus does it pass around?
Skin on lower posterolateral surface of leg and lateral side of foot and little toe
Descends superficially to gastrocnemius, penetrates superficially through deep fascia roughly in middle of leg, joined by sural communicating branch from common fibular nerve, passes down leg and around lateral malleolus and into foot.
Where does the medial calcaneal nerve supply innervation to?
Where does it originate from?
From tibial nerve low in leg, descends onto medial side of heel
Innervates skin on medial surface and sole of heel
What are the 2 muscles in the lateral compartment of the leg?
What is their action?
What nerve innervates them?
Fibularis longus
Fibularis brevis
Evert the foot
Fibularis longus also plantarflexes
Superficial fibular nerve (branch of common fibular nerve)
Where does fibularis longus tendon attach to?
Where does fibularis brevis tendon attach to?
Swings under foot to cross the sole and attach to inferior surfaces of bones on medial side of foot (lateral sides of base of metatarsal 1 and distal end of medial cuneiform).
Tubercle on lateral surface of base of metatarsal 5
Describe the arterial supply to the lateral compartment of the leg?
No major artery passes vertically through lateral compartment of leg.
Supplied by branches mainly from fibular artery in posterior compartment.
Describe the branches of the fibular nerve?
2 cutaneous branches from around proximal fibular:
Sural communicating nerve - joins sural branch of tibial nerve and contributes to supply over lower posterolateral side of leg.
Lateral sural cutaneous nerve - skin over upper lateral leg.
Common fibular nerve continues around neck of femur to enter lateral compartment between attachments of fibularis longus to head and shaft of fibula. Here divides into 2 terminal branches:
Superficial fibular nerve - innervates fibularis muscles, enters foot and divides into medial and lateral branches which supply dorsal areas of foot and toes except for:
- web space between great toe and 2nd toe which is supplied by deep fibular nerve
- lateral side of little toe which is supplied by sural branch of tibial nerve
Deep fibular nerve - supplies anterior compartment of leg after passing through intermuscular septum
Which nerve innervates skin over 1st dorsal webspace on foot?
What muscular compartment does this nerve also innervate?
Deep fibular nerve
Also supplies anterior compartment of leg
What are the 4 muscles in the anterior compartment of the leg?
What nerve innervates them?
What are their actions?
Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus
Fibularis tertius
Deep fibular nerve, a branch of common fibular nerve
Dorsiflex foot, extend toes, invert foot
Where does the tendon of the tibialis anterior muscle insert?
Inferior surface of medial cuneiform and metatarsal I
Which muscle is the fibularis tertius normally considered a part of?
Where does it insert?
Normally considered part of extensor digitorum longus
Inserts into dorsomedial surface of base of metatarsal 5
Which artery supplies the anterior compartment of the leg?
Where does it originate and how does it enter the anterior compartment of the leg?
Which 2 tendons does it lie between in the distal leg?
What artery does it become in the foot?
Anterior tibial artery
Arises from popliteal artery and enters compartment via aperture in interosseous membrane
Lies between tendons of tibialis anterior and extensor hallucis longus in distal leg
Gives rise to anterior medial malleolar artery and anterior lateral malleolar artery
Becomes dorsalis pedis artery palpable between tendons of extensor hallucis longus and extensor digitorum longus to metatarsal 2.
Which artery joins the anterior tibial artery in the distal leg?
Joined by perforating branch of fibular artery through aperture of interosseous membrane.
Damage to which nerve commonly causes foot drop?
Common fibular nerve
The femoral nerve is formed within which muscle?
Psoas major
The saphenous nerve is a branch of which nerve?
Where does it innervate?
Branch of posterior division of femoral nerve
Innervates skin on anterior and medial surfaces of leg
Which nerve innervates iliacus muscle?
Femoral nerve
Which muscles are innervated by the anterior and posterior divisions of the femoral nerve?
Femoral nerve - iliacus
Anterior division - pectineus, sartorius
Posterior - 4 quadriceps
What are the 3 branches of the tibial nerve in the foot?
Medial calcaneal branches - innervate skin over the heel
Medial plantar nerve - supplies the abductor hallucis, flexor digitorum brevis, flexor hallucis brevis, and the first lumbrical. It also innervates the skin on the medial sole and the medial three and a half toes.
Lateral plantar nerve - supplies the quadratus plantae, flexor digiti minimi, adductor hallucis, the interossei, the second to fourth lumbricals, and abductor digiti minimi. It also innervates the skin of the lateral sole and the lateral one and a half toes.
What are the borders of the adductor canal?
What structures are contained within it?
Anterior border – Sartorius
Lateral border – Vastus medialis
Posterior border – Adductor longus and adductor magnus
Femoral artery
Femoral vein
Nerve to vastus medialis
Saphenous nerve
What is the name of the only intracapsular ligament?
What artery does it carry?
Ligamentum teres
Carries foveal artery, a branch of obturator artery
What are the 3 extracapsular ligaments?
The iliofemoral ligament is a Y-shaped ligament that originates from the ilium, immediately below the anterior inferior iliac spine, and inserts to the intertrochanteric line of the femur. It is situated on the anterior aspect of the hip joint and prevents hyperextension of the hip joint.
The pubofemoral ligament originates from the obturator crest and superior ramus of the pubis and inserts into the joint capsule. It is situated on the anteroinferior aspect of the hip joint and prevents excessive abduction and extension of the hip joint.
The ischiofemoral ligament is a triangular band of strong fibres that originates from the ischium of the pelvis and inserts into the medial surface of the greater trochanter of the femur. It is situated on the posterior of the hip join and prevents excessive extension of the femur at the hip joint.
Describe the course of the great saphenous vein?
From dorsal arch of foot and dorsal vein of great toe.
Anterior to medial malleolus
Posterior border of medial epicondyle of femur
What are the points of attachment of the cruciate ligaments of the knee?
ACL - from anterior part of intercondylar region of tibia, goes superiorly, posteriorly and laterally, attaches to posterior part of lateral condyle of femur.
PCL - from posterior part of intercondylar area of tibia, passes medial to ACL, attaches to anterior part of lateral surface of medial condyle of femur.
ACL is weaker than PCL
What artery is responsible for most of the supply to the hip joint?
Medial circumflex artery
Others are lateral circumflex artery and foveal artery.
Medial and lateral circumflex are branches of profunda femoris artery
Foveal artery is a branch of obturator artery
The lateral circumflex artery has to penetrate through which ligament to reach the hip joint?
Iliofemoral ligament
What are the 2 vascular anastomoses of the hip joint?
Trochanteric anastomosis - superior gluteal artery and medial and lateral circumflex arteries.
Cruciate anastomosis - inferior gluteal artery, first perforating artery of profunda femoris, medial and lateral circumflex arteries
Which nerves innervate the 2 parts of the adductor magnus?
Adductor part - posterior branch of obturator nerve
Hamstring part - tibial nerve
What are the 2 main motor branches of the tibial nerve?
Medial and lateral plantar nerves
What is Cloquet’s node?
The most superior of the deep inguinal lymph nodes
What are the borders of the femoral canal?
Anteriorly: the inguinal ligament
Posteriorly: the pectineal ligament
Medially: the lacunar ligament
Laterally: the femoral vein
What divides the tongue into posterior 1/3 and anterior 2/3?
Divided into 2 parts (posterior 1/3 and anterior 2/3’s) by the sulcus terminalis (or terminal sulcus). This is a muscular groove just behind the circumvallate papillae
Describe innervation to the tongue?
Sensory innervation of the tongue is derived primarily from lingual & glossopharyngeal nerves
The lingual nerve supplies sensory innervation to the anterior 2/3 of the tongue whilst the chorda tympani supply taste sensation to the anterior 2/3 of the tongue
The glossopharyngeal nerve supplies general sensory and taste sensation to the posterior 1/3 of the tongue
Motor supply is to all of the muscles of the tongue is via the hypoglossal nerve (except palatoglossus)
Which lymph node is strongly associated with lymph drainage of the tongue?
The jugulo-omohyoid lymph node
A deep cervical lymph node
Where is McBurney’s point?
Point over the right side of the abdomen that is one-third of the distance from the anterior superior iliac spine to the umbilicus
What are the 4 main structures of the lung root?
bronchus, pulmonary artery and 2 pulmonary veins - superior and inferior
This means that the superior pulmonary vein is anterior, the pulmonary artery is in the middle, and the bronchus and bronchial vessels are behind. The second of the pulmonary veins is inferior to the bronchus.
Which 2 nerves pass anterior and posterior to the lung root?
Phrenic nerve passes anterior to lung root
Vagus nerve passes posterior to nerve root
What 4 structures are found within the adductor canal?
Superficial femoral artery
Femoral vein
Saphenous nerve
Nerve to the vastus medialis
Umbilical varices are the result of which veins meeting?
The portal veins of ligamentum teres meeting the systemic superior and inferior epigastric veins
What are the 5 sites of portosystemic anastomosis?
Oesophageal Rectal Intrahepatic Retroperitoneal Paraumbilical
What are the 3 locations where the ureters constrict?
- Pelviureteric junction (PUJ): the joining of the renal pelvis to the abdominal part of the ureter
- Where the ureters enter the pelvis in front of the sacro-iliac joint (at the bifurcation of the common iliacs, they pass anterior to vessels)
- Vesicoureteric junction (VUJ): where the ureters pierce the urinary bladder
Name the unpaired terminal branch of the abdominal aorta which comes off immediately superior to the bifurcation into common iliac arteries?
Median sacral artery
What are the 3 paired lateral visceral branches of the abdominal aorta?
Suprarenal
Renal
Gonadal
At what level does the IVC penetrate the diaphragm?
T8
At what level does the oesophagus penetrate the diaphragm?
T10
What are the attachments of the extensor retinaculum?
Laterally to radius
Medially to triquetrum and pisiform
When performing a lumbar puncture, piercing of what structures causes the first and second give?
FIrst give - ligamentum flavum
Second give - dura
What is Wartenberg’s sign in ulnar nerve injury?
Patient asked to place hand on table. Clinician passively abducts the fingers. Patient then asked to adduct the fingers back to the starting position
Positive test if little finger remains abducted away from hand.
This is due unopposed action of extensor digiti minimi (innervated by radial nerve)
What is the surface marking of the right lung horizontal fissure?
extends laterally in horizontal line from 4th costal cartilage to meet oblique fissure in midaxillary line
Which extrinsic eye muscle is innervated by the trochlear nerve?
Superior oblique
Which extrinsic eye muscle is innervated by the abducens nerve?
Lateral rectus
Which structure separates the quadrate and caudate lobes of the liver?
Porta hepatis
Caudate lobe sits above quadrate lobe
Which artery is occluded in locked in syndrome?
Basilar artery
How does Weber’s syndrome present?
What arteries are involved?
Ipsilateral CN III palsy
Contralateral weakness of upper and lower extremity
branches of the posterior cerebral artery that supply the midbrain
How does Posterior inferior cerebellar artery stroke present?
What is it otherwise known as?
Ipsilateral: facial pain and temperature loss
Contralateral: limb/torso pain and temperature loss
Ataxia, nystagmus
Lateral medullary syndrome
Wallenberg syndrome
The recurrent laryngeal nerves are branches of which nerves?
Vagus nerves
Left RLN passes under arch of aorta
Right RLN passes under right subclavian artery
Which parts of the duodenum are retroperitoneal?
2nd, 3rd, 4th
1st part of duodenum, jejunum and ileum are intraperitoneal
Which parts of the colon are retroperitoneal?
Ascending and descending parts are retroperitoneal
Sigmoid and transverse colon are intraperitoneal
Which 3 nerves give cutaneous sensation to nose?
Bridge of nose - infratrochlear nerve, branch of nasociliary branch of V1
Tip of nose - External nasal branches of anterior ethmoidal nerve, continuation of nasociliary branch of V1
Lateral lower half of nose including ala - infraorbital nerve, branch of V2
Which 3 nerves pass through the inguinal canal?
Genital branch of genitofemoral, ilioinguinal, autonomic fibres
Note ilioinguinal passes through superficial ring rather than truly through canal
Which 3 arteries pass through the inguinal canal?
Artery to Vas Deferens, Cremasteric artery, testicular artery
What male and female structures pass through the inguinal canal?
Male: spermatic cord
Female: Round ligament of Uterus
WHat are the boundaries of the inguinal canal?
Anterior wall:
Aponeurosis of external oblique reinforced by internal oblique
Posterior wall:
Transversalis fascia
Conjoint tendon
Deep inguinal ring
Floor:
Inguinal ligament
Lacunar ligament
Roof:
Transversalis fascia
Internal oblique
Transversus abdominis
Where is the superficial inguinal ring?
The exit to the inguinal canal is located 1cm above and medial to the pubic tubercle
What is Argyll-Robertson pupil?
Bilateral small pupils that don’t react to light but do constrict during accommodation.
Pathophysiology is believed to be the result of bilateral damage to the pretectal nuclei in the midbrain.
The sign is strongly associated with neurosyphilis.
What nerves innervate the rotator cuff muscles?
Supraspinatus and Infraspinatus - Suprascapular nerve
Teres minor - Axillary nerve
Subscapularis - Upper and Lower Subscapular nerves
What are the 3 ossicles of the middle ear?
Which of these connects to the tympanic membrane and which to the oval window?
malleus, incus and stapes
The malleus is connected to the tympanic membrane and the stapes is connected to the oval window of the inner ear.
Which 2 areas does the Eustachian tube connect?
Connects nasopharynx to middle ear
Which part of the temporal bone is the middle ear located within?
Petrous part of temporal bone
What are the 5 sensory branches of V1 supplying the face?
Supraorbital nerve Supratrochlear nerve Infratrochlear nerve External nasal nerve Lacrimal nerve
What are the 3 sensory branches of V2 supplying the face?
Zygomaticotemporal nerve
Zygomaticofacial nerve
Infraorbital nerve
What are the 3 sensory branches of V3 supplying the face?
Auriculotemporal nerve
Buccal nerve
Mental nerve
