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Block 4 > Anatomy: Bones and Muscles of the Lower limb > Flashcards

Anatomy: Bones and Muscles of the Lower limb Flashcards

(212 cards)

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1
Q

What are the 3 portions of a long bone called, from joining end to long end?

A

Epiphysis

Metaphysis

Diaphysis

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2
Q

Describe 3 things about a sesamoid bone

Give an example of a sesamoid bone

A

Patella

Found within tendons

Reduce wear

Improve muscle efficiency

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3
Q

Describe 3 things about a flat bone

Give an example of a flat bone

A

Scapula

Large surface area for muscle attachment

Weight/force transfer region

Protection (pelvic girdle and skull)

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4
Q

What is Wolff’s Law?

A

Bone is deposited and reabsorbed in accordance with the stresses placed upon it (it is able to remodel)

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5
Q

Name the 2 types of bone?

within a single bone

A

Cancellous/trabecular/spongy bone

Cortical bone

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6
Q

What 6 things make up the axial skeleton?

A 
Skull
Ribs
Sternum
Vertebrae 
Sacrum
Coccyx
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7
Q

What 3 things make up the appendicular skeleton

A

Hip bones (pelvic girdle)
Pectoral girdle
Limbs (upper and lower)

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8
Q

Define Amelia

A

No limb growth

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9
Q

Define Meromelia

A

Partial limb

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10
Q

Define Phocomelia

A

Seal-like limb/flipper

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11
Q

Define Polydactyly

A

Additional digits

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12
Q

Define Syndactyly

A

Webbing/joining of digits

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13
Q

Name the 2 large groups of bone to bone joint

A

Fibrous joints

Cartilaginous Joints

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14
Q

What are the 3 types of fibrous joints?

Give an example and characteristic of each type of joint

A

Suture

  • do not move
  • skull

Gomphosis

  • small degree of movement
  • teeth to jaw

Syndesmosis

  • fibrous sheet of tissue that keeps 2 long bones in proximity to each other
  • forearm
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15
Q

What are the 2 types of cartilaginous joints?

Give an example and characteristic of each type of joint

A

Epiphysis

  • mainly in children
  • growth plate of a bone

Symphysis

  • movable discs between joints
  • vertebral discs
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16
Q

Describe 3 things about hyaline cartilage

A

Found at the ends of 2 adjoining bones

Avascular, smooth and slippy

Sits withing a joint capsule

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17
Q

What lines a joint capsule and produces synovial fluid?

A

Synovium (serous membrane)

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18
Q

What is a bursae?

A

Pockets of synovium and synovial fluid found in regions of friction/wear

Inflammation of the bursae causes bursitis

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19
Q

Where are synovial sheaths found?

A

Around tendons at points of wear/friction/direction change

Inflammation of the synovium causes synovitis

Inflammation of the sheath and the tendon causes

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20
Q

What is a nerve plexus?

A

A region where the ventral rami of spinal nerves join and exchange neurons

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21
Q

What wraps the compartments in the forearms?

A

Connective tissue fascia

Wraps around the muscles and tissues to form anterior and posterior compartments

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22
Q

Anterior compartments are mainly responsible for….

A

Flexor function

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23
Q

Posterior compartments are mainly responsible for….

A

Extensor function

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24
Q

What does the anterior thigh compartment contain?

A

Hip flexor and knee extensor

Femoral nerve (L2, L3, L4)

Femoral artery

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25
What is a retinacula?
Thick bands of fascia that connect tendons to bone and stop them lifting off when activated
26
Venous drainage runs from....
Superficial to deep
27
The origin site of a muscle is
Generally more fixed and proximal
28
The insertion site of a muscle is
Normally more mobile and distal
29
Give 5 roles of connective tissue
Structural support Metabolic support Cell adhesion Medium of exchange Defense, protection and repair
30
What 2 things is connective tissues made from?
Cells Extracellular matrix
31
What 2 things is extracellular matrix formed of? Give properties of each
Fibrous proteins - collagen - elastin Ground substances - transparent - colourless
32
What 3 things is ground substance formed from? Give properties of each
Proteoglycans - repeated disaccharides (GAG) around a protein core - GAG attracts water Glycoproteins -allow cells to adhere to the ECM Water -attracted by GAG
33
What provides the rigidity of bones?
Mineralised extracellular matrix (hydroxyapatite)
34
What provides the resilience of bones?
Type 1 collagen fibres | part of the fibrous proteins component of ECM, other component is ground substance remember
35
Name the 5 functions of bone
Movement Mineral homeostasis Support Protection Site of haematopoiesis
36
Describe the structure and function of the periosteum
Dense, irregular connective tissue layer covering the bones where tendons and ligaments insert Out fibrous layer Inner cellular layer -osteoprogenitor cells and osteoblasts Helps the bone grow in thickness, # repair nourishes bone tissue
37
Where is the endosteum?
Lines the inside of the bones
38
What are the 2 types of bone (mature/immature)
Woven bone Lamellar bone (mature)
39
Describe the structure of woven (immature) bone
First bone formed at any site Collagen fibres are arranged randomly Occurs at site of # healing
40
Describe the structure of lamellar (mature) bone
Collagen fibres remodel into orderly arrangement
41
What are the 2 types of mature (lamellar) bone?
Trabecular Cortical
42
Describe the characteristics of trabecular bone and how structure is related to function
Looks like beams and struts. Orientated along the lines of stress and redistributes stress along the bone. Spaces make the bone lighter and give space for bone marrow as well
43
Describe the characteristics of cortical bone and how structure is related to function
Dense and compacted bone Arranged into Haversian systems (osteons)
44
What is a lamellae?
A bony plate made up of collagen fibres arranged in parallel
45
Describe the composition of lamellar bone
And outer circumferential lamellae runs along the shape on the bone Concentric lamellae form around Haversian canals, which contain blood vessels, lymph vessels and nerves. Collagen fibres in the Haversian systems (osteons) form around the Haversian canals in parallel to each other Volkmann's canals run transversely and allow communications between the Haversian systems and between the periosteum and the osteons
46
What type of cell are osteoprogenitor cells derived from?
Mesenchymal stem cells
47
What do osteoprogenitor cells turn into?
Osteoblasts
48
What do osteoblasts mature into?
Osteocytes
49
What type of cell produces osteoid?
Osteoblasts
50
What is in osteoid?
Type 1 collagen Proteoglycans Glycoproteins
51
List 2 features of osteocytes
Mature bone cells Do not undergo cell division
52
Give 2 functions of osteocytes
Mechanotransduction (detecting stresses and triggering action of other bone cells) Calcium homeostasis
53
Name the space that an osteocyte sits in within the bone
Lacunae
54
What are the channels within bone called? What sits within these channels?
Canaliculi Dendritic processes of osteocytes
55
What role do osteoclasts have?
Remodeling, growth and repair of bones
56
What do osteoclasts derive from?
Monocyte-macrophage system
57
What do osteoclasts secrete?
Enzymes and acid
58
Name the space the osteoclasts sit in
Howship's lacunae
59
Which type of cell secretes RANKL?
Osteoblasts
60
When do osteoblasts secrete RANKL?
In response to calcitrol and PTH
61
Where is the RANK receptor located?
Osteoclasts
62
What 2 things do osteoblasts secrete?
RANKL OPG
63
Which hormone increases the amount of OPG?
Oestrogen
64
What does OPG do?
Mops up excess RANKL so that bone re-absorption does not get out of control
65
# Fill in the gaps: Many different hormones regulate bone remodelling. Osteoblasts secrete _____ in response to ______ and ___. RANKL binds to ____ receptors on ______ and stimulates bone reabsorption. _____ secrete OPG: this mops up excess ______ so that bone reabsorption does not get out of control.
Many different hormones regulate bone remodelling. Osteoblasts secrete RANKL in response to calcitriol and PTH. RANKL binds to RANK receptors on osteoclasts and stimulates bone reabsorption. Osteoblasts secrete OPG: this mops up excess RANKL so that bone reabsorption does not get out of control.
66
What are the 2 types of bone development?
Intramembronous ossification Endochondral ossification
67
Draw out the pathways for the 2 types of ossification
Intramembranous: mesenchyme --> bone Endochondral: mesenchyme --> cartilage --> bone
68
What is mesenchyme?
Undifferentiated embryonic connective tissue
69
Which bones undergo intramembronous ossification?
Flat bones of the skull, clavicle and mandible
70
How are the flat bones of the skull, clavicle and mandible formed?
Intramembranous ossification
71
Which enzyme leads to calcification of the ECM?
Hydroxyapatite
72
Where are primary ossification centres found?
Diaphysis of weight bearing bones
73
In endochondral ossification, what does the mesenchyme develop into?
Chondroblasts (cartilage building cells)
74
Where are secondary ossification centres found?
Epiphyses of weight bearing bone
75
What is the difference between primary and secondary ossification sites
Primary found at diaphysis and forms bony structure all around. Develop as a foetus. Secondary found and epiphysis and doesn't lay bone down on articular surfaces and epiphyseal growth plate. Develop after birth
76
What are the 6 stages of fracture healing?
Haematoma Granulation tissue Callus Woven bone Lamellar bone Remodelling
77
What are the 2 types of bone growth?
Longitudinal growth Appositional growth
78
Where does longitudinal growth occur?
At the epiphyseal growth plates of weight bearing long bones
79
Name the 5 zones in the epiphyseal growth plate
Resting zone Proliferation zone Hypertrophic zone Calcification zone Ossification zone
80
In which zone of the epiphyseal growth plate to chondrocytes undergo mitosis?
Proliferation zone
81
What are cartilage cells called?
Chondrocytes
82
In which zone of the epiphyseal growth plate are chondrocytes stacked like coins in columns?
Proliferation zone
83
In which zone in the epiphyseal growth plate do chondrocytes die?
Calcification zone
84
In which zone in the epiphyseal growth plate do osteoprogenitor cells invade?
Ossification zone
85
What is the name given to a fracture of the epiphyseal growth plate?
Salter-Harris fracture
86
What is a fracture?
A breach in the integrity of part or the whole of a bone
87
What 3 factors aid fracture healing?
Stability of the fracture Apposition of bone ends Adequate blood supply
88
What 4 factors delay fracture healing?
Excessive movement of bone ends Poor blood supply Infection Foreign bodies
89
What forms the ball and socket join of the hip?
Femoral head (ball) Acetabulum of pelvis (socket)
90
Name the 4 symptoms visible in a posterior hip dislocation
Limb shortened Limb flexed Limb adducted Internal rotation
91
Name the 2 symptoms visible in an anterior hip dislocation
Limb abduction External rotation
92
What makes up the bony pelvis?
Sacrum 2 hip bones
93
What joints connects the sacrum to the 2 hip joints? What type of joints are they?
Sacroiliac joints Synovial joints
94
What joints the anterior portions of the hip bones together? What type of joint is this? What are some common features of this type of joint?
Pubic symphysis Secondary cartilaginous type joint These joints are found typically in the midline and typically symphysis type joints e.g. IV discs
95
What is a ligament?
Fibrous tissue that connects bone to bone
96
What is a tendon?
Fibrous tissue that connects muscle to bone
97
Where is the sacrospinous muscle?
Connects sacrum to spine of ischium
98
Where is the sacrotuberous ligament?
Connects the sacrum to the ischial tuberosity
99
What 2 foramen are made by the sacrospinous and sacrotuberous ligaments?
Great and lesser sciatic foramen
100
Which muscle divides the greater sciatic foramen? What is the function of this muscle?
Piriformis muscle Lateral rotatory muscle of the hip
101
What does the greater sciatic foramen connect with?
Pelvic cavity Gluteal region
102
What does the lesser sciatic foramen connect with?
Perineal region Gluteal region
103
Which 3 bones fuse together at the acetabulum?
Ilium Ischium Pubis
104
Which muscles insert on the greater trochanter of the femur?
Gluteus medius Gluteus minimus
105
Which muscle has an attachment point at the lesser trochanter of the femur?
Iliopsoas muscle | a hip flexor muscle
106
Along which bony prominence do all 3 thigh compartments attach?
Linea Aspera of the thigh (posterior)
107
What 3 ligaments help stabalise and reinforce the external hip joint? Can they be viewed anteriorly or posteriorly?
Iliofemoral Pubofemoral (anterior) Isciofemoral (posterior)
108
Name the 3 layers of joints/connections around the hip joint from deep to superficial
Synovial membrane Fibrous membrane 3 ligaments
109
What would a valgus hip do to the knee?
Knee would move away from midline (bow legs)
110
What would a varus hip do to the knee?
Move the knee towards the midline
111
Name the 3 compartments of the thight
Anterior Posterior Medial
112
What fascia covers all 3 compartments of the thigh?
Fascia lata
113
What is the iliotibial tract?
Lateral thickening of fascia lata
114
Which vein runs superficial to the fascia lata?
Saphenous vein
115
Which large muscle inserts into the iliotibial tract?
Gluteus maximus
116
What nerve innervates the gluteus maximus?
Inferior gluteal nerve | L5-S2
117
What are the proximal attachments of the gluteus maximus?
Ilium Sacrum Sacral ligaments
118
What are the distal attachments of the gluteus maximus?
Femur Iliotibial tract (ITT)
119
What nerve supplies gluteus medius?
Superior gluteal nerve | L4-S1
120
What nerve supplies gluteus minimus?
Superior gluteal nerve | L4-S1
121
Which muscles insert on the greater trochanter?
Gluteus medius Gluteus minimus
122
What sign is illicited when gluteus medius and minimus are damaged? What nerve could be responsible?
Trendelenburg sign -when patient lifts right leg, left hip droops as loss of stabilising muscles Superior gluteal nerve
123
Which nerves innervate the lateral rotators of the hip?
L4 - S2
124
Which 4 muscles laterally rotate the hip?
Piriformis Gemelli (superior + inferior) Quadratus femoris Obturator internus
125
Which 3 muscles are in the posterior compartment of the thigh?
Semimembranous Semitendinous Biceps femoris
126
What is the common point of origin for the hamstring muscles (posterior thigh compartment)?
Ischial tuberosity
127
Where is the safe zone for IM injections in the gluteal region and how would you identify it?
Sits superolaterally 1. Vertical line through highest point of iliac crest 2. Line from PSIS to greater trochanter
128
Which 4 muscles are found in the medial thigh compartment?
Pectineus Adductor longus Adductor magnus Adductor brevis
129
What are the 3 types of muscle?
Skeletal Cardiac Smooth
130
Give 6 features of skeletal muscle
Cylindrical cells Striated Multinucleated cm in length Limited regeneration Voluntary control
131
Give 6 features of cardiac muscle
Branched cells with intercalated discs Striated Mono/binucleate Length: 100 μm No regeneration Spontaneous contraction
132
Give 6 features of smooth muscle
Spindle shaped Central nucleus Length: 20-200 μm Regenerate Vessels, hollow organs, glands Regulated by ANS & endocrine system
133
By what process do muscles get bigger?
Cell hypertrophy
134
What is the epimysium?
A tough dense connective tissue that surrounds a muscle
135
What smaller structures make up a muscle?
Muscle fascicles
136
What covers the muscle fascicles?
Perimysium
137
What is the perimysium?
Slightly lose connective tissue surrounding muscle fascicles
138
What is contained within the perimysium?
Muscle fascicle Blood vessels Lymphatics Nerves
139
What smaller structures make up a muscle fascicle?
Muscle fibres
140
What surrounds the muscle fibres?
Endomysium thin lose connective tissue
141
Why are muscle fibres sometimes called muscle cells?
Because they are individual muscles cells that have their membranes fused together to form multinucleated cells
142
What is found in the endomysium?
Muscle fibres Capillaries Nerve fibres
143
What makes up muscle fibres?
Myofibrils
144
How are myofibrils arranged?
Arrangements of myofilaments (actin and myosin)
145
What is a motor unit?
A motor neuron and the muscle fibres it innervates
146
What is myasthenia gravis?
An autoimmune disease that effect the nicotinic acetylcholine receptors on post-synaptic membranes of muscle fibres Affects extraocular muscles, facial muscles, bulbar muscles
147
How would you test for myasthenia gravis?
Raise your finger up and see if the extraocular muscles start to droop and cause ptosis
148
How is myasthenia gravis treated?
Acetylcholinesterase inhibitors NEOSTIGMINE
149
What is neostigmine and what is it used to treat?
Acetylcholinesterase inhibitor Prevents the breakdown of acetylcholine so has more effect on the nicotinic acetylcholine receptors of muscles Used to treat myasthenia gravis
150
What is botulinum toxin and what can it cause?
Produced by C. botulinum Degrades the protein complex that binds ACh vesicles to the presynaptic cell membrane Results in total blockade of ACh release, causing flaccid paralysis
151
What is the cell membrane of the muscle fibre called?
Sarcolemma
152
What are invaginations in the sarcolemma (cell membrane) of the muscle fibres called?
T-tubules
153
What are T-tubules closely aligned with? What do these store?
Sarcoplasmic reticulum Store calcium
154
What is the name for the region in the middle of the sarcomere where thin and thick filaments overlop?
A band
155
What is the name for a thick filament within a sarcomere?
Myosin
156
What is the name for a thin filament within a sarcomere?
Actin
157
What is found in the I band of a sarcomere? How many per sarcomere?
Think actin filaments only 2 per sarcomere wither side of the A band
158
What is the M line in a sarcomere?
The point at which thick myosin filaments connect with a cell membrane
159
Which 3 proteins make up the thin filaments of muscle?
Actin Tropomyosin Troponin
160
Which of the 3 proteins on a thin filament attaches to myosin?
Actin
161
What protein surrounds actin? What does it cover?
Tropomyosin The myosin binding sites
162
What protein is attached to tropomyosin? What are its 3 parts?
Troponin I C T
163
What are the 3 parts of troponin responsible for?
Troponin I - helps tropomyosin block the myosin binding site on actin INHIBITION Troponin C - binds CALCIUM Troponin T - aTTaches troponin to tropomyosin
164
What protein is absent in Duchenne Muscular dystrophy?
Absence of dystrophin
165
Name the most dorsal vein in the foot
Doral venous arch
166
What 2 branches does the dorsal venous arch give off?
Small saphenous vein Great saphenous vein
167
Where does the small saphenous vein run near to?
Runs laterally from the dorsal venous arch of the foot Goes behind the lateral malleolus
168
Where does the great saphenous vein run near to? Why is the great saphenous important to remember?
Runs medially from the dorsal venous arch of the foot Goes in front of the medial malleolus Can be used for grafting Venous cut-down cannulation access if no other access available e.g. burns to rest of the body
169
Describe the course of the great saphenous vein from distal to proximal What nerve does it ascend near?
Dorsal venous arch of the foot Ascends medially at the ankle Anterior to the medial malleolus Along the posterior region of the medial tibial border alongside saphenous nerve Passes 7-10cm posterior to the patella Passes through the saphenous opening lateral and inferior to the pubic tubercle Joins the femoral vein in the femoral triangle Ascends near the SAPHENOUS NERVE
170
Describe the course of the short saphenous vein from distal to proximal What nerve does it ascend near?
Dorsal venous arch of the foot Ascends laterally at the ankle Runs posterior to the lateral malleolus Ascends midline posterior leg alongside sural cutaneous nerve Travels deep into popliteal fossa via crural fascia and into popliteal vein Ascends near the SURAL CUTANEOUS NERVE
171
Where do the greater and small saphenous veins join deep veins, and what veins do they join?
Greater saphenous vein - saphenous opening in the femoral triangle - joins the femoral vein Small saphenous vein - popliteal fossa - joins popliteal vein
172
What 4 muscles form the border of the popliteal fossa?
Lateral above the knee - biceps femoris Medial above the knee - semimembranous - semitendonous Below the knee - lateral and medial heads of the gastrocnemius
173
What nerve descends through the popliteal fossa?
Sciatic nerve
174
Which muscle sits on the anterior border of the popliteal fossa?
Plantaris
175
What 2 nerves does the sciatic nerve split into? How do they descend in relation to the sciatic?
Common fibular nerve - superficial and laterally Tibial nerve - medially and deep
176
Which 2 muscles insert into the greater trochanter of the femur? What do they do?
Gluteus medius and minimus Stable the lower limb during walking
177
What muscle inserts into the lesser trochanter of the femur?
Iliopsoas Hip flexion
178
What attaches at the linea aspera (femur)? Where is it?
3 intermuscular septa (compartments of the thigh) Attachment point for many thigh muscles
179
What is Wolff's Law?
Bone is deposited and reabsorbed in accordance with the stresses placed upon it
180
What is the acetabular labrum?
Horseshoe shaped fibrocartilage rim of tissue that surrounds the acetabulum (Pelvic portion of hip joint)
181
What 3 ligaments reinforce the hip joint? What do they sit on top of? When are the ligaments the tightest?
Iliofemoral Pubofemoral Ischiofemoral Sit on top of synovial membrane and fibrous membrane Tightest when standing
182
Describe the blood supply to the femoral head
Deep femoral artery gives off medial and lateral femoral circumflex arteries Anastomose to form circumflex femoral arteries that flow back up towards the femoral head
183
What divides the greater sciatic foramen?
Piriformis muscle
184
What structures pass through the greater sciatic foramen above the piriformis?
Superior gluteal nerve
185
What structures pass through the greater sciatic foramen below the piriformis?
Sciatic nerve Inferior gluteal nerve Posterior femoral cutaneous nerve Quadratus femoris nerve
186
Give the root values of the superior gluteal nerve
L4 - S1
187
Give the root values of the superior gluteal nerve What does it supply?
L4 - S1 Gluteus medius Gluteus minimus
188
Give the root values of the interior gluteal nerve
L5 - S2 Gluteus maximus
189
Which ligament separates the greater and lesser sciatic foramen?
Sacrospinous ligament
190
When the distal part of a limb points laterally, what is this type of deformity called?
Valgus l - laterally
191
When the distal part of a limb points medially, what is this type of deformity called?
Varus | thrust towards
192
Which vein runs superficial to the iliotibial tract? | lateral aspect of the thigh
Saphenous veins
193
Which large muscle inserts into the ITT?
Gluteus maximus
194
Which nerves arise from the sacral plexus? What are their root values?
Superior gluteal nerve (L4 - S1) Inferior gluteal nerve (L5 - S2) Posterior cutaneous nerve of thigh (S1 - S3) Pudendal nerve (S2 - S4) Sciatic nerve (L4 - S3)
195
Which 4 muscles laterally rotate the hip?
Obturator internus Quadratus femorus (S + I) Gemilli Piriformis
196
How do you find the safe zone for IM injections in the gluteal region?
Vertical line through highest point of iliac crest Line from PSIS to greater trochanter Superiorlaterally to the 2 lines
197
What are the borders of the adductor canal? In which compartment is the adductor canal found? What are the contents of the adductor canal?
Sartorius Vastus medialis Adductor longus/magnus Anterior compartment of the thigh Saphenous nerve Superficial femoral artery Superficial femoral vein
198
Which muscle is a powerful flexor of the hip that inserts onto the lesser trochanter?
Iliopsoas
199
Which 3 muscles form the pes anserinus tendon? Where does it insert?
Sartorius Gracilis Semitendonous Medial aspect of the tibia
200
The subclavian nerve passes ______ to the middle scalene
Anterior
201
The subclavian vein passes _______ to the anterior scalene
Anterior
202
What structures passes through the quadrangular space? | Humerus
Axillary nerve Posterior circumflex artery
203
What is the anatomical order in which a needle must pass in order to reach CSF during a spinal anaesthetic?
Skin Supraspinous ligament Interspinous ligament Ligamentum flavum Epidural space Subdural space Subarachnoid space
204
Which rotator cuff muscle causes internal rotation?
Subscapularis
205
Where do the movements of inversion and eversion of the foot take place?
At the talonavicular joint
206
Which nerve supplies the pectoralis major? What does this muscle do?
Medical and lateral pectoral nerve Adducts and medially rotates the shoulder
207
Which nerve supplies the pectoralis minor? What does this muscle do? Where do the 3 heads of pec minor insert into?
Medial pectoral nerve Depresses and protracts the scapula Ribs 3, 4, 5
208
Which nerve supplies the deltoid muscle? How can this nerve be damaged?
Axillary nerve Shoulder dislocation Surgical neck of humerus # IM injection
209
What are the 4 borders of the axilla?
Anterior - anterior axillary fold and pectoral muscles Posterior - posterior axillary fold, subscapulaaris and scapula Medial - serratus anterior and lateral thoracic wall Lateral - intertubercular groove
210
Which nerve supplies sorratus anterior? Where does this muscle go to/from? How would damage in a patient show/what test would you do?
Long thoracic nerve Medial scapula border - ribs 1-8 If broken, scapula will 'wing' - get patent to put hands on wall and lean in
211
Which nerve supplies the anterior compartment of the arm?
Musculocutaneous (radial/brachialis)
212
Which nerve supplies the posterior compartment of the arm?
Radial nerve

Block 4 (11 decks)

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