Anatomy Flashcards
1
Q
The lower limb extends from where?
A
The pelvis
2
Q
Describe functions of the lower limb
A
- support body weight
- locomotion
- maintain balance
3
Q
Name the largest and heaviest muscle in the body
A
Gluteus maximus
4
Q
Name the muscles of the superficial muscle group of the gluteal region
A
- gluteus maximus
- gluteus medius
- gluteus minimus
- tensor fascia latae
5
Q
What is the role of the muscles of the superficial muscle group of the gluteal region?
A
They are extensors, adductors and medial rotators of the thigh
6
Q
Gluteus maximus has what role in movement?
A
Lateral rotation of the thigh
7
Q
The superficial muscles of the gluteal region are innervated by what?
A
Gluteal nerves
- gluteus maximus = inferior gluteal
- all others = superior gluteal
8
Q
Name the muscles of the deep muscle group of the gluteal region
A
- piriformis
- orbturator internus
- gemelli and quadratus femoris
9
Q
The deep muscle group of the gluteal region has what role in movement?
A
Lateral rotators of thigh and hip stabilisers
10
Q
What innervated the deep muscle group of the gluteal region?
A
Nerves from the sacral plexus
11
Q
What is the tensor fascia latae?
A
Tenses the fascia latae (name given to the deep fascia of the thigh)
Specifically tenses the iliotibial tract
12
Q
What is trendelburgs gait?
A
- some type of pathology involved with the superior gluteal nerve
- they stand on on leg then the pelvis on the unsupported side (ie the leg that is lifted) will tilt towards that side as it is not supported
- usually medius and minimus help to keep the pelvis straight
- the limb on the affected side is longer so the swing phase of walking is scraping along the ground
- then they try to compensate by leaning to the opposite side to try and pull the pelvis up
13
Q
When is gluteus maximus involved in walking?
A
- not really involved in walking
- only really contracts with extensive force ie walking up a hill or running
14
Q
Where do the nerves enter / exit the pelvis and perineum?
A
Via the greater and lesser sciatic foramen
15
Q
The greater sciatic foramen is a passageway for what structures?
A
- pelvic structures
- most things go through here
16
Q
The lesser sciatic foramen is a passageway for what structures?
A
- perineum
17
Q
The greater and lesser sciatic foramen are formed by what?
A
The sacrotuberous and sacrospinous ligaments
18
Q
The gluteal region is divided into what for injections?
A
Four quadrants
19
Q
Name the four quadrants of the gluteal region
A
- upper outer
- upper inner
- lower outer
- lower inner
20
Q
What are creates the ‘lines’ of the four quadrants?
A
- between the superior aspects of the greater trochanter of the femur (horizontal line)
- midpoint of the iliac crest (vertical line)
21
Q
Where would you inject into the gluteal region?
A
Into the upper outer region to avoid nerves
22
Q
Name the three major nerves the enter / exit the pelvis via the gluteal region
A
- sciatic (L4-S3)
- pudendal (S2-S4)
- posterior cutaneous nerve of thigh (S1-S3)
23
Q
Describe the sciatic neve
A
- L4-S3
- largest in body
- supplies posterior thigh, all leg and foot muscles and most of the skin via tibial and common fibular branches
- supplies nothing in the gluteal region
24
Q
Describe the pudendal nerve
A
- S2-S4
- principal nerve to the perineum
25
Describe the posterior cutaneous nerve of the thigh
- S1-S3
| - skin over posterior thigh, popliteal fossa, lateral perineum and upper medial thigh
26
The sciatic nerve branches where and into what?
- separates in the distal 1/4 of the thigh
- tibial nerve
- common fibular
27
The sciatic nerve usually exits where?
Inferior to the piriformis
28
What is usually the most lateral structure of the greater sciatic foramen?
The sciatic nerve
29
Which artery has its own blood supply as its so large?
- the sciatic nerve
| - the artery to the sciatic nerve
30
What is special about what the sciatic nerve supplies?
- it doesn't directly supply anything
| - it supplies structures via its branches (tibial or fibular)
31
Describe the position of the common fibular nerve
- more lateral
- smaller division
- lateral aspect of knee joint so can be easily damaged
32
Describe the position of the tibial nerve
- large division
| - lies more medially, almost midline
33
Describe the boundaries of the femoral triangle
- superior; inguinal ligament
- medially; adductor longus
- laterally; sartorius
- floor; ilipsoas and pectineus
- roof; deep fascia (fascia lata)
34
Describe the contents of the femoral triangle
- femoral nerve
- femoral artery
- femoral vein
- lymphatics
35
Where is the femoral triangle found?
Anterior aspect of the thigh
36
The artery, vein and lymphatics of the femoral triangle run in a what?
A sheath (femoral sheath)
37
Describe compartment syndrome
- fascia creates enclosed space
- increased pressure caused by swelling of tissue or increase in fluid
- affects functions of the muscles or nerve in the compartment
- can be acute or chronic
- fasciotomy to relieve pressure in emergency
38
The thigh has how many compartments and what are their names?
- 3
| - anterior, medial and posterior compartments
39
The leg has how many compartments and what are their names?
- 3
| - anterior, posterior and lateral compartments
40
Describe the muscles of the anterior compartment of the thigh
- flexors of the thigh; pectineus, iliopsoas and sartorius
| - extensors of the leg; quadriceps femoris
41
What innervates the muscles of the anterior compartment of the thigh?
All innervated by the femoral nerve (L2,L3, L4)
Except the psoas major (L1, L2, L3)
42
Describe the muscles of the medial compartment of the thigh
- adductors of the thigh; adductor longus, adductor brevis, adducor mahnus, gracilis and obturator externus
43
What innervates the muscles of the medial compartment of the thigh?
All obturator nerve (L2,L3,L4)
Except hamstring part of adductor magnus (tibial nerve)
44
Describe the muscles of the posterior compartment of the thigh
- extensors of thigh and flexors of the leg; semitendinosus, semimembranosus and biceps femoris
45
What innervates the muscles of the posterior compartment of the thigh?
All the tibial division of sciatic nerve (L5,S1,S2)
Except short head biceps femoris (common fibular division of sciatic)
46
Semitendinosus has a very long what?
Tendon
47
Semimembranosus has a very large what?
Membrane
48
Describe the biceps femoris muscle
- more laterally
- two headed femoris muscle
- has a long head and a short head
- long head is classed as a true hamstring
- short head is not a true hamstring
49
All hamstrings attach to where?
The ischial tuberosity
50
Describe the features of the short head biceps femoris
- it has slightly different attachment points as it attaches directly to the femur
- cannot extend the thigh as it is not crossing the hip joint
- it does however cross the knee joint so can still flex
- innervated by the common fibular division of sciatic nerve
51
Describe the muscles of the anterior compartment of the leg
- dorsiflexors of ankle and extensors of toes; tibialis anterior, extensor digitorum longus, extensor hallucis longus and fibularis tertius
52
What innervates the muscles of the anterior compartment of the leg?
All the deep fibular nerve (L4,L5)
53
Hallucis means what?
Big toe
54
What is the action of the extensor hallucis?
Extends big toe
55
Describe the muscles of the lateral compartment of the leg
- evert foot and weakly plantarflex ankle; fibularis longus, fibularis brevis
56
What innervates the muscle of the lateral compartment of the leg?
All superficial fibular nerve (L5,S1,S2)
57
Describe the muscles of the posterior compartment of the leg
- superficial group - plantarflexors of the ankle. gastrocnemius, soleus, plantaris
- deep group - flexors of toes and plantarflexors of ankle; popliteus, flexor hallucis longus, flexor digitorum longus, tibialis posterior
58
What innervates the muscles of the posterior compartment of the leg?
All the tibial nerve (S1,S2)
59
Gastrocnemius has two what?
Heads
60
Describe the features of the plantaris muscle
- absent in 5-10% of people
- very variable in shape and size in people who have it
- almost fingerlike projection of muscle, can be harvested
- has a slim tendon and can be used for hand reconstruction etc
- it crosses both the knee and ankle so can technically be classed as a plantar and knee flexor
- very small so is a very weak muscle and has lots of proprioceptor fibres
61
What type of joint is the hip joint?
Ball and socket (synovial)
62
The hip joint is multiaxial which means it can do what movements ?
- flexion extension
- abduction / adduction
- medial lateral rotation
- circumduction
63
The synovial joint of the hip has two layers, name these
- external fibrous layer
| - internal membranous layer
64
Describe neck of femur fractures
- age and sex related (old and female)
- secondary to osteoperosis
- head is the narrowest point of the femur and lies at a direct angle against weight bearing
- females are more likely due to their higher risk to suffer from osteoperosis
65
Describe the hip joint blood supply
- medial and lateral circumflex femoral arteries; usually from deep femoral artery
- artery to head of femur; branches in obturator, travels in ligament to heaf of femur
66
The artery to the head of the femur is important when?
- up to the age of 4 it supplies a lot of blood
- afterwards blood is mainly from other arteries
- in adults not very important
67
In a hip fracture, what can be easily comprimised?
- the blood supply
| - the artery to the head of the femur may be the only supply so necrosis occurs easily
68
The knee joint is which type of joint?
Hinge joint (synovial)
69
What is the main movement of the knee joint?
Flexion-extension (a little bit of medial and lateral rotation when flexed)
70
How many articulations does the knee have and what are these?
- 3
- 2 x femerotibial
- 1 x femeropatellar
71
Describe the features of the knee synovial joint
- external fibrous layer (not as strong as hip)
| - internal membranous layer, extensions as bursae
72
Name the knee joint ligaments
- extracapsular; patellar ligament, lateral (fibular) collateral ligament, medial (tibial) collateral ligament
- intra-articular; anterior cruciate (ACL), posterior cruciate (PCL)
- menisci; fibrocartilage, medial and lateral
- joint integrity; anterior / posterior drawer signs
73
Where is the popliteal fossa found?
Posterior to the knee
74
Describe the boundaries of the popliteal fossa
- superolaterally; biceps femoris
- superomedially; semimembranosus
- inferiorly; gastrocnemius
- roof; popliteal fascia
75
Describe the contents of the popliteal fossa
- lots of fat
- terminal small saphenous vein
- popliteal vessels
- tibial and common fibular nerves
76
Describe the calcaneal tendon
- achilles tendon
- thickest and strongest in body
- around 15cm long
- tendons of gastrocnemius and soleus together
- attached to calcaneal tuberosity of the calcaneus
77
Describe the ankle jerk reflex
- normal result is plantarflexion
| - tests S1,S2 nerve roots
78
Describe the superficial lymphatics of the lower limbs
- follow saphenous veins
- drain to superficial inguinal lymph nodes
- then to external iliac lymph nodes
79
Describe the deep lymphatics of the lower limb
- follow deep veins
- popliteal lymph nodes
- then deep inguinal lymph nodes
- then external iliac lymph nodes
80
What lymphatics run from external to common iliac?
Lumbar lymphatics
81
Name the true hamstrings
- semimembranosus
- semitendinosus
- long head of biceps femoris
82
Skeletal muscle is innervated by what?
- by fast conducting alpha-motor neurones (aka alpha motorneurones) with myelinated axons and cell bodies in the spinal cord or brain stem
83
Near the muscle, the axon divides into what?
Unmyelinated branches that innervate an individual muscle fibre. The neurone and the number of fibres that it innervates is the motor unit
84
What is a terminal bouton?
- individual branches further divide into multiple fine branches that end in a terminal bouton
- this forms a chemical synapse with the muscle membrane at the neuromuscular junction
85
Action potentials arising in the cell body are conducted via what?
- the axon to the boutons causing the release of the transmitter acetylcholine (ACh)
86
What are the key features of the skeletal neuromuscular junction?
- the terminal bouton (and surrounding schwann cell)
- synaptic vesicles
- the synaptic cleft
- the end plate region of the muscle cell membrane (sacrolemma) thrown into a series of junctional folds
87
Where do synaptic vesicles (containing ACh) awaiting release cluster?
At active zones
88
Nicotinic ACh receptors are located where?
At regions of the junctional folds that face the active zones
89
Describe the key steps in neuromuscular transmission
- synthesis of ACh in cytoplasm of bouton
- uptake of ACh into synaptic vesicles for concentration and storage
- Ca2+ dependent release of ACh into synaptic cleft by exocytosis
- brief activation of nicotinic ACh receptors (nAChRs) by reversible binding of ACh
- rapid termination of transmitter action by AChE) within the synaptic cleft
90
Describe the presynaptic processes of neuromuscular transmission
- choline is transported into the terminal by the choline transporter (symport with Na+)
- ACh is synthesised in the cytosol from choline and acetyl coenzyme A (acetyl CoA) by the enzyme choline acetyltransferase (ChAT, or CAT)
- ACh is concentrated in vesicles by the vesicular ACh transporter
- arrival of the action potential at the terminal causes; depolarisation, opening of voltage-activated Ca2+ channels, Ca2+ entry to the terminal
- CA2+ causes vesicles 'docked' at active zones to undergo exocytosis
- ACh diffuses into the synaptic cleft to activate post-synaptic nicotinic ACh receptors in the endplate region
91
Describe the post synaptic processes of neuromuscular transmission
- two ACh molecules activate each nicotinic ACh receptor (nAChR)
- nAChRs are pentamers of glycoprotein subunits surrounding a central cation selective pore (formed by five M2 helices)
- the pore contains a gate that is closed in the absence of ACh but open when ACh binds to the exterior of the receptor at subunit interfaces
- the open channel is roughly equally permeable to Na+ and K+ but does not conduct anions
- when the gate is open Na+ enters the muscle cell (influx) whilst K+ exits (efflux) simultaneously through nAChRs
- because the driving force for Na+ is greater than for K+ at resting membrane potential influx of Na+ is greater than efflux of K+; a depolarising end plate potential is generated by the simultaneous opening of many nAChRs
92
Each vesicle of ACh contains a quantum of what?
Neurotransmitters
93
What is a miniature endplate potential?
The electrical response to one quantum of transmitter, due to activation of nAChRs at the endplate
94
Many miniature endplate potential summate to produce what?
The end plate potential - a graded eletrotonic response
95
An end plate potential that exceeds thresholds triggers what?
An all or none propagated action potential that initiates contraction. This always occurs normally
96
The end plate potential arises from activation of what?
nAChRs at the endplate and is a graded response determined by the number of vesicles released
97
The muscle action potential cause contraction by what?
Release of Ca2+ from intracellular stores
98
The action potential propagates where?
- over the surface membrane (sarcolemma) of skeletal muscle fibre and enters transverse (T) tubules
- t tubules are in close apposition to the sarcoplasmic reticulum
99
The action potential arriving at the T tubule triggers release of what?
Ca2+ from the SR which in turn causes contraction by interacting with troponin associated with the myofibrils
100
Describe the termination of the action of ACh by acetylcholinesterase (AChE)
- rapid termination of neuromuscular transmission is the result of hydrolysis of ACh by AChE, an enzyme associated with the end plate enzyme
- AChE hydrolyses ACh to choline and acetate, the former is taken up by the choline transporter, the latter diffuses from the synaptic cleft
- AChE is extremely efficient; hydrolysis of some ACh molecules occurs even prior to the transmitter binding to nAChRs, once unbinding occurs virtually all ACh molecules are hydrolysed, limiting rebinding and terminating the e.p.p within a few milliseconds
- AChE is an important target of some therapeutic agents (anti-cholinesterases) that reversibly block the action of AChE and also some insecticides and nerve gases used in warfare, or terrorism (nerve gases acting irreversibly)
101
Name some common spinal conditions
- mechanical back pain and spondylosis
- facet joint arthritis
- multi level degenerate back pain / OA
- discogenic back pain
- disc prolapse, sciatic and radiculopathy
- spinal stenosis and bony root entrapment
- trauma and osteoporotic fracture
102
Name some less common spine conditions
- scoliosis
- spondylolisthesis
- ankylosing spondylitis
- benign tumours; osteoid osteoma
- malignant tumours
- discitis and osteomyelitis
- cauda equina syndrome
103
Name the five sections of the vertebral column
- 7 cervical
- 12 thoracic
- 5 lumbar
- 5 sacral (fused)
- 4 coccygeal (fused)
104
Name the vertebral column curvatures
- cervical; convex anteriorly
- thoracic; concave anteriorly
- lumbar; convex anteriorly
- sacral; concave anteriorly
105
Name some abnormal curvatures of the vertebral column
- thoracic kyphosis
- ankylosing spondylitis
- lumbar lordosis
- scoliosis
106
Name the typical features of vertebra
- vertebral body
- transverse process
- pedicle
- vertebral arch
- spinous process
- foramen
- lamina (between transverse and spinous process)
- superior vertebral notch (becomes intervertebral foramen when articulating with vertebra above)
- inferior vertebral notch
- inferior articular process (facet for articulation with superior articular facet of vertebra below)
- superior articular process
107
Describe the atlas
- C1
- no body
- no spinous process
108
Describe the axis
- C2
| - dens (odontoid process)
109
What is the atypical features of C7?
Long, prominent spinous process
110
Describe the typical cervical vertebrae
- vertebral body; small, kidney shaped with processes
- transverse process; foramina transversaria, anterior and posterior tubercles
- triangular vertebral foramen
- short bifid spinous process
111
Describe typical thoracic vertebrae
- vertebral body; costal facets, heart shaped, increasing in size as more inferior
- transverse processes; costal facets, broad, horizontal
- circular vertebral foramen
- long, downward sloping spinous process
112
Describe a typical lumbar vertebrae
- vertebral body; large, kidney shaped
- transverse process; slender, horizontal
- small, triangular vertebral foramen
- large horizontal spinous process
113
Name the layers of muscles of the back
- three layers; superficial (extrinsic), deep (intrinsic)
114
Name the deep intrinsic muscles of the back
- splenius
- erector spinae; iliocostalis, longissimus, spinalis
- transversopsinalis
- in 'gutter' between transverse and spinous process; semispinalis, multifidus and others
115
Describe the muscle of the back extrinsic
- move the upper limb
- trapezius
- levator scapulae
- rhomboid major
- rhomboid minor
- latissimus dorsi
116
Name the types of joints of the back
- facet (zyaphohyseal) joint)
| - intervertebral joint
117
Describe the orientation of the articular facets in the cervical region
- superior; face posterosuperior
| - inferior; face anteroinferior
118
Describe the orientation of articular facets in the thoracic region
- superior; face posterolateral
| - inferior; face anteromedial
119
Describe the orientation of articular facets in the lumbar region
- superior; face medially
| - inferior; face laterally
120
Describe spondylosis
- spinal osteoarthritis
- intervertebral disc loses water content with aging
- leads to overload facet joint and secondary OA
- pain worse with extension spine
- facet joint injections under fluoroscopy can help
121
What is the composition of the intervertebral disc?
- outer annulus fibrosis
| - inner gelatinous nucleus pulposus
122
Describe the root of the exiting nerve root
- outside the thecal sac passes under the pedicle of the corresponding vertebra
- ie L4 root passes under L4 pedicle
123
Describe the root of the transversing nerve root
- pair whilst remaining in the thecal sac is positioned anteriorly ( in an area known as the lateral recess) in preparation to penetrate the thecal sac and become the next exiting nerve root more distally
124
Describe spinal stenosis
- nerve roots can also be compressed by osteophytes and hypertrophied ligaments in OA known as spinal stenosis
125
What is neurogenic claudication?
Burning leg pain on walking
126
Name examples of the different types of joints in the upper limb
- acromioclavicular joint; synovial plane
- glenohumeral joint; synovial ball and socket
- elbow joint; synovial hinge
- proximal and distal radioulnar joints; synovial pivot
- radiocarpal joint; synovial ellipsoid
- sternoclavicular joint; synovial plane
127
The radius moves over what during pronation?
Ulna
128
Joints are generally stabilised by what three main factors ?
- shape of the articulating bone
- ligaments (and capsule)
- muscle tone
129
Failure of stabilising mechanism of a joint when it is subjected to forces ma lead to what?
- subluxation (partial dislocation, where the articular surfaces are displaced, but still overlap)
- dislocation (although not always used in this context, the true definition of a dislocation is where the articular surfaces no longer overlap at all)
130
Describe the annular ligament
- stabilised proximal radioulnar joint by holding radius against radial notch of ulna
131
Describe the lateral (radial) collateral ligament
- attaches to lateral epicondyle of humerus and annular ligament
132
Name the joints of the hand
- distal interphalangeal joint
- metacarpophalangeal joint (synovial condyloid)
- first carpometacarpal joint (synovial saddle)
- proximal interphalangeal joint (both synovial hinge)
133
Name the muscles of the shoulder girdle
- trapezius; innervation CN XI
- latissimus dorsi; innervation, thoracodrosal nerve
- rhomboid major
- rhomboid minor; innervation, dorsal scapular nerve
- serratus anterior; innervation, long thoracic nerve
- pectoralis minor; innervation, medial pectoral nerve
- pectoralis major; innervation, medial and lateral pectoral nerves
- levator scapulae; innervation dorsal scapular nerve
- rotator cuff muscles
- deltoid; innervation axillary nerve
- teres major; innervation lower subscapular nerve
134
Describe the rotator cuff
- the rotator cuff muscles are an important group of muscles found anterior, superior and posterior to the shoulder joint
- since the shoulder joint has poor congruency of articular surfaces and its ligaments are lax in order to allow its wide range of movements, the rotator cuff muscles are important stabilisers of the joint, resisting displacement of the humeral head
- their muscle fibres are oriented horizontally or obliquely and therefore hold the head of the humerus in the glenoid fossa of the scapula in all positions of the joint
135
Name the four rotator cuff muscles
- supraspinatus
- infraspinatus
- teres minor
- subscapularis
136
Supraspinous, infraspinous and teres minor all attach where?
The greater tuberosity
137
The subscapularis attaches where?
Lesser tuberosity
138
What is included in the anterior compartment of the arm?
- brachial artery
- brachial vein
- musculocutaneous nerve
139
What is included in the posterior compartment of the arm?
- profunda brachii, ulnar collateral
- profunda brachii vein
- radial nerve
140
What is included in the anterior compartment of the forearm?
- radial and ulnar artery
- venae comitantes
- median and ulnar nerve
141
What is included in the posterior compartment of the forearm?
- interosseous artery
- venae comitantes
- radial nerve
142
What is included in the compartment of the hand?
- deep and superficial palmar arches
| - ulnae and median nerve
143
Describe the brachial plexus
- brachial plexus originates from anterior rami of C5-T1
- branches pass through the axilla to the medial arm - cords are named according to their relationship with the axillary artery
