Anatomy Booklet Questions Flashcards
How does contraction of pectoralis major assist in breathing?
The 2 pectoralis muscles form part of a ring of muscles which encircle the thoracic cage; the other muscles forming the ring are SCAPULA muscles. When the ring contracts the thoracic pressure rises to assist exhalation. (This only occurs in disease and during exercise, normal exhalation is a passive process)
Which bony structures lie subcutaneously in the anterior chest wall?
Clavicles
Sternum (manubrium, body, xiphi-sternum)
What are the articulations of the clavicle?
At the medial end to the manubrium of the sternum; the sternoclavicular joint and at the lateral end to the acromion of the scapula; the acromioclavicular joint.
What forms the anterior axillary fold?
The lower edge of the pectoralis major muscle
What lies deep to the pectoralis minor muscle?
The axilla
The majority of breast tissue is in the upper outer quadrant of the breast. Where does lymph from this part of the breast drain?
To the axillary lymph noes
Which costal cartilage connects to the sternum at the sternal angle? (angle of Louis)
2nd costal cartilage
Which nerves carry sensation from the parietal and visceral pleura?
The parietal pleura lines the inside of the thoracic wall and is supplied by the same nerves as the tissue of the thoracic wall; the spinal nerves, T1 and T2. The visceral pleura covers the surface of the lung and is supplied by the same nerves as the lung; the vagus and sympathetic nerves.
What is a bronchopulmonary segment?
A bronchopulmonary segment has a feeding artery and bronchus which run together through the centre of the segment and repeatedly branch to reach all parts of the segment. The veins which drain the segment run on the surface of the segment rather than through the centre. The ten segments on each side are separate dby layers of connective tissue and the fissures. Each segment is anatomically and functionally seperate and this influences how diseases may spread throughout the lungs.
What structures pass through the hilum of the lung?
Main bronchus Pulmonary artery Two pulmonary veins Bronchial artery Lymphatic vessels branches of the vagus and sympathetic nerves
How does contraction of the diaphragm assist in returning blood to the heart?
Contraction of the diaphragm decreases intra-thoracic pressure and increases intra-abdominal pressure. The net effect is for blood to flow from the abdomen into the chest.
What is the sensory and motor nerve supply to the diaphragm?
Sensory and motor supply are both from the phrenic nerve which arises from the spinal chord at C3, 4, 5 (C345 keeps the diaphrahm alive)
What is the surface markings of the lowest extent of the lungs?
At the midclavicular line to lowest part of the lung lies at the tip of the 6th rib, at the mid-axillary line the 8th rib and posteriorly the 10th rib.
What is intercostal recession?
When a patient is having difficulty taking a breath in and is having to create very negative pressure in the thorax the intercostal muscles get ‘sucked in’.
What is the developmental significance of the ligamentum arteriosum?
It is the remnant of a shunt between the pulmonary artery and aorta. The shunt carries all the blood from the pulmonary artery into the aorta before the lungs have developed and most of the blood after the lungs have developed. At birth it closes so that all the right ventricular blood passes to the lungs.
What are the main branches of the following arteries and what organs/tissues do these vessels supply:
1 - left common carotid artery
2 - left subclavian artery
Left common carotid artery
- Internal and external carotid arteries
External -> left side of the face and head
Internal -> most of the cerebral hemispheres
Left subclavian arteries
- Vertebral, thyro-cervical, axillary
Vertebral; cerebellum, brain stem, occipital lobe and the interior temporal lobe
Thyro-cervical; thyroid gland and neck
Axillary; upper limb
What are the nerve roots of the phrenic nerve? Why is this clinically important?
C3, 4, 5
Painful diseases affecting the diaphragm are felt by the patient in the side of the neck and onto the shoulder tip which is the dermatome supplied by C345.
What structures are supplied by the vagus nerve?
- Pharynx
- Larynx
- Heart
- Lungs
- Fore gut
- Mid gut
What are the vessels which connect the heart to other structures?
Aorta Pulmonary artery Four pulmonary veins Superior vena cava Inferior vena cava
What is the surface marking for the apex of the heart?
5th intercostal space
midclavicular line
How may the fibrous pericardium contribute to a reduction in ventricular filling?
Fibrous tissue is resistant to stretching, and so restricts the maximum end diastolic volume. Diseases which ‘take up volume’ in the pericardial sac (E.g. fluid, muscle, hypertrophy etc.) whill reduce diastolic filling and therefore reduce stroke volume. Cardiac output can then only increase by increasing the heart rate. Disease which progress very slowly (over years rather than days) can stretch the pericardium.
Describe the anatomy of the tricuspid and mitral valves. What happens if they are incompetent?
Both of these valves have a similar structure with the tricuspid having 3 cusps and the mitral having 2 cusps. The cusps are made of fibrous tissue covered with endothelium and are very flexible. The cusps are attached to a ring of fibrous tissue which forms the orifice between the atrium and ventricle, the myocardium is also attached to this fibrous ring. The free edge of the cusp has multiple tendinous cords attached, the cordi tendini; for each cusp these cords attach to a cylinder of myocardium, the papillary muscle, which contracts during systole to keep the cordi tendini taught.
Describe the anatomy of the aortic and pulmonary valves. What happens if they are incompetent?
Both of these valves have a similar structure with both having three cusps. The cusps are made of fibrous tissue covered with endothelium and are very flexibile. The cusps are attached to a ring of fibrous tissue which form the orifice between the ventricle and artery. The free edge of the cusps have a thickening, like a baton in a sail, which helps to shape the valve when it is closed.
At what phase of the cardiac cycle do the coronary arteries fill? Why?
Blood flows through the coronary arteries during ventricular dystole. Blood flows from high pressure to low pressure. During ventricular systole the highest pressure is in the ventricular lumen and in the myocardium surrounding the lumen. Pressure in the coronary arteries on the surface of the heart is initially lower so these fill with blood. However, most of the coronary arteries are inside the myocardium where the pressure is highest so these will be squeezed so that they are empty. Blood cannot flow from the surface arteries into the myocardium so there is no flow. During ventricular diastole, pressure in the aorta is high, pressure in the myocardium drops to zero; now the coronary arteries inside the muscle can fill and blood flow occurs.
Describe the conducting system of the heart and its function.
The 4 fibrous rings which support the four heart valves form a complete electrical isolation of the ventricles from the atria. In order for the ventricles to contract there has to be a system of carrying the electrical impulse across this barrier. Furthermore, the ventricles need to contrat from the apex towards the aortia and pulmonary valve for maximum efficiency.
As a result, the conducting system starts at the atrio-ventricular node, which is positioned in the atrial septum close to the fibrous rings. From the atrio-ventricular node modified myocardium (purkinje fibres) extends into the ventricular septum and travels down to the apex of the heart. In the ventricular septum it divides twice to provide a right bundle to the right ventricle and two bundles (an anterior and posterior) for the left ventricle. The right bundle crosses the lumen of the ventricle as the moderator band.
What is the blood supply of the sinoatrial node and the atrioventricular node?
The sino-atrial node is supplied by the right coronary artery in 60% of hearts and the left in 40%.
The atrioventricular node is supplied by the posterior intraventricular artery in all hearts. However, in 90% of hearts the posterior intraventricular artery arises from the right coronary artery and in 30% of hearts from the left coronary artery. In 20% of hearts there are 2 posterior intraventricular arteries, one from the left and one from the right.
What is the location of the sinoatrial node?
The sinoatrial node is located on the crista terminalis (a ridge of tissue on the inside between the right atrium and right atrial appendage) just where the superior vena cava enters the right atrium.
On a chest X-ray, which chambers and vessels form the right and left borders of the cardiac shadow?
Right heart border; right atrium
Left heart border; left auricular appendage superiorly and the left ventricle.
What is the thoracic duct and where does it join the vascular system?
The thoracic duct is the main lymphatic channel draining lymph from the lower half of the body and the bowel back to the bloodstream. The bowel component is important because fat is absorbed into the lymphatics so this is the only route for fat absorption.
It joins the vascular system at the confluence of the left subclavian and left internal jugular vein.
What structures are supplied by the three splanchnic nerves and where does a patient
appreciate pain felt by these nerves?
The greater splanchnic nerve supplies the foregut and pain is felt in the epigastrium.
The lesser splanchnic nerve supplies the midgut and pain is felt round the umbilicus.
The least splanchnic nerve supplies the hindgut and pain is felt in the suprapubic area.
What structure lies immediately behind the trachea in the upper thorax and the left atria in the lower thorax?
Oesophagus
What structures drain blood into the azygous system?
The lateral and posterior chest wall and the lateral and posterior abdominal wall
Why is the left recurrent laryngeal nerve at risk from thoracic disease, but not the right?
The LRL passes into the thorax, round the aortic arch and back into the neck. The RRL does not pass through the thorax.
Where do the sympathetic nerves attach to the CNS?
T1 - T12
L1
L2
What happens if the sympathetic nerves to the head and neck are damaged?
There will be no sweating on the face (anhidrosis)
The eye lid will droop (ptosis)
The pupil will be constricted (miosis)
Slightly withdrawn eye ball (enopthalmos)
Horner’s syndrome
What is the function of the extrinsic laryngeal muscles? (sternothyroid, thyrohyoid?)
They move the larynx up and down the neck and support its central position, this is particularly important for swallowing.
Where may you create an emergency airway?
Between the thyroid and cricoid cartilage, through the cricothyroid membrane.
Why does the thyroid gland have such a good blood supply?
Iodine is present in very low conc. in the blood so the gland needs a high blood flow to ensure adequate delivery of iodine.
Which structure may be compressed by an enlarged thyroid gland?
trachea
What is the location of the parathyroid glands and how many are there?
They are positioned on the posterior surface of the thyroid gland.
There are four.
What is the only complete cartilage ring around the airway?
The cricoid cartilage.
A patient may develop hypocalcaemia after thyroid surgery, why?
The parathyroid glands may be accidentally or deliberately removed during thyroid surgery which will cause acute hypoparathyroidism.
What forms the ganglia on the sympathetic chains and vagus nerves?
A collection of neuron cell bodies.
What is the name of the fused first thoracic and lower cervical sympathetic ganglia?
The stellate ganglion
What structures are supplied by the superior laryngeal nerve?
Sensation to the inside of the larynx down to the vocal cords and the cricothyroid muscle.
Which special sensation is carried in the glossopharyngeal nerve
Taste from the posterior 1/3rd of the tongue
What is the location of the carotid sinus and what sensation does it detect?
The origin of the internal carotid artery; blood pressure.
Which structures lie immediately behind the pharyngeal wall?
A thin layer of loose areolar tissue and then the cervical vertebral bodies.
Which parts of the pharynx lie below the lower border of the mandible?
The hypopharynx
Which structure stops liquid refluxing into the back of the nose during swallowing?
the soft palate
Which nerve carries sensation from the larynx below the vocal cords?
The recurrent laryngeal nerves
Describe the histology of the mucosa of the trachea
Simple ciliated pseudostratified columnar
+ goblet cells
Which nerve travels through the parotid gland?
Facial nerve C7
Where do the parotid and submandibular ducts enter the mouth?
Parotid; from the cheek adjacent to the second upper premolar
Submandibular; under the tongue
Which nerve supplies the muscles of the tongue?
Hypoglossal nerve
C12
What is the upper extent of the abdominal cavity?
Anteriorly the undersurface of the diaphragm reaches the 5th intercostal space.
Describe the 9 regions of the abdominal wall
Two vertical lines down from the midclavicular line.
A horizontal line across the lowest point on the thoracic cage.
A horizontal line across the tubercules of the iliac crest.
Three areas down the midline are; epigastrium, umbilical and suprapubic from top down.
The three lateral areas are hypochondrium, flank and iliac fossa from top down.
Describe the nerve supply to the skin of the abdominal wall
The dermatomes of the abdominal wall start at T5 in the upper epigastrium, with T10 being at the umbilicus and T12 being just above the hair bearing area in the lower suprapubic area. Each dermatome starts at the back at the level of the name vertebra; the dermatomes run towards as they pass round the trunk to the front.
How is the rectus sheath formed?
In the upper 2/3 of the abdomen, the aponeurosis of the external oblique muscle passes in front of the rectus abdominus and the aponeurosis of the transversus abdominus passes behind. The aponeurosis of internal oblique sends fibres both in front and behind rectus abdominus. In the lower 1/3 of the abdomen all three aponeuroses pass in front of the rectus abdominus.
What is the surface marking of the aortic bifurbication?
The level of the umbilicus
In which regions of the abdomen is pain from the 3 parts of the bowel felt?
Foregut - epigastrium
Midgut - umbilicus
Hindgut - suprapubic
Describe the anatomy of a ‘six pack’?
The rectus abdominus muscle runs vertically from the pubis up to the costal margin. Along its length there are 3 places where is becomes a tendon. When exercised the muscle hypertrophies (becomes bigger) but the tendinous part stays the same. The result is three bulges of muscle between the tendons. This occurs on either side of the midline; six bulges in all.
With the patient in a supine position, where might fluid collect in the abdomen?
Posterior to the liver
What embryological structure forms the ligamentum teres?
The umbilical vein, returning blood from the placenta to the liver.
Where does the base of the appendix lie? (surface marking and internally)
2/3 of the way from the umbilicus to the anterior superior iliac spine, McBurnie’s point.
Which parts of the bowel have a mesentery?
The first 1cm of the duodenum, all of the jejunum and ileum, the transverse and sigmoid colon and the appendix.
What structures form the portal triad?
Hepatic portal vein
Bile duct
Hepatic artery
What is the (greater and lesser) omentum?
They are sheets of tissue covered on both surfaces with peritoneum and containing fat, blood vessels, lymphatics and nerves. The greater omentum attaches to the greater curve of the stomach and the posterior abdominal wall. The lesser omentum connects to the lesser curve of the stomach and the liver. The lesser omentum also contains the portal triad entering the porta hepatis.
At what vertebral level does the oesophagus pass through the diaphragm?
T10
Which structures pass through the diaphragm alongisde the oesophagus?
The vagal trunks, inferior oesophageal artery and vein.
Name the parts of the stomach
Fundus cardia body pylorus pyloric sphincter duodenum greater curvature (bottom curve) lesser curvature (top curve)
From where does the stomach receive its nerve supply?
Parasympathetic from the vagus nerves, C10
Sympathetic from the greater splanchnic nerves, T5-T9
What structure attaches the stomach to the liver?
The lesser omentum
Which structures lie in front ofthe stomach?
Left lobe of the liver
Anterior abdominal wall
Which structures lie behind the stomach?
The lesser sac, behind the lesser sac is the pancreas and diaphragm
What is portosystemic anastomosis?
It is a vein which joins to the hepatic portal system (so can carry blood to the liver) to the systemic system. It can take blood from the bowel and bypass the liver to return the blood to the heart.
Which bein drains blood from the colon and where does it flow to?
Inferior mesenteric vein drains into the splenic vein.
Where does lymph from the small bowel drain?
Into the cisterna chyli and to the thoracic duct.
Which foodstuffs are absorbed through the lymphatic system?
Lipids
What 4 anatomical features ensure the small bowel has a high surface area for absorption of nutrients?
Length
Mucosal folds (plicae circularis)
Villi
Microvilli
Where is the junction between the midgut and the hindgut
2/3 of the way along the transverse colon
How do you distinguish a loop of large intestine from that of small intestine?
Large intestine has appendices epiploicae and tenia coli. The small bowel is centrally located and the colon is round the sides.
Which part of the bowel is supplied by sacral nerves 2, 3 and 4.
The hind gut.
Which artery is the cystic artery a branch of?
Usually the right hepatic artery but it can be the left hepatic artery or the hepatic artery.
Which structure degenerates to form the ligamentum venosum?
The ductus arteriosis; an embryological bypass for the liver which exists before the liver has fully formed.
Where is the bare area of the liver?
Under the central tendom of the right side of the diaphragm.
What is the surface marking of the fundus of the gall bladder?
The tip of the ninth costal cartilage. Where the midclavicular line crosses the costal margin. The most lateral attachment of the rectus abdominus onto the costal margin.
Where do the hepatic veins drain?
Directly into the inferior vena cava
Can the spleen be palpated during abdominal examination?
No, it needs to be considerably enlarged or displaced by a large mass to be palpable.
What structures might a tumour of the head of the pancreas involve?
The hepatic portal vein, bile duct or pancreatic duct
What structures join to form the common bile duct and what is its course?
The common hepatic and cystic duct. The common bile duct runs in the free edge of the lesser omentum and behind the first part of the duodenum, onto the posterior or the pancreas where it enters the pancreas to run alongside the pancreatic duct before opening into the duodenum.
What structures join to form the common bile duct and what is its course?
The common hepatic and cystic duct. The common bile duct runs in the free edge of the lesser omentum and behind the first part of the duodenum, onto the posterior or the pancreas where it enters the pancreas to run alongside the pancreatic duct before opening into the duodenum.
Where is the sphincter of Oddi located?
On the medial wall of the duodenum between the 2nd and 3rd parts
Which artery lies behind the first part of the duodenum?
Gastroduodenal artery
What lies between the pancreas and the stomach?
The lesser sac
How many pancreatic ducts are there? What is the embryological significance?
Two
One from the ventral pancreatic bud and one from the dorsal pancreatic bud
What is the function of the eustachian tube?
To equalize the air pressure either side of the tympanic membrane
Why is the maxillary sinus more prone to infection?
The opening into the nasal cavity is at the top of the sinus so it does not drain easily.
What is the nerve supply to the anterior 2/3 of the tongue?
General sensation: mandibular branch of the trigeminal nerve
Taste sensation: facial nerve (C7)
Muscles: hypoglossal nerve (C12)
Where do the ducts for the submandibular salivary glands open into the mouth?
Below the tongue
Why may disease in the maxillary sinus cause numbness of the cheek?
The nerve which gives sensation to the cheek passes in the roof of the maxillary sinus
What are the attachments of the muscles of the tongue?
The hyoid bone
What structure stops reflux of liquid into the nose during swallowing?
The soft palate
Which muscles are responsible for abduction of the shoulder?
Initiation = supraspinatus and then it is assisted by deltoid
Rotation of the scapula is by the trapezius
Describe the movements of the scapula and humerus during abduction of the shoulder
Supraspinatus initiates abduction and after 10-15 degrees it is assisted by deltoid. As the arm rises the humerus externally rotates to keep the articular surfaces in contact. At full abduction the humerus has externally rotated 90 degree (Arm vertical above head).
Which nerve supplies trapezius?
spinal accessory nerve (CN XI)
Which nerve is damaged by posterior dislocation of the shoulder and what sensory and motor loss is experienced?
Axillary nerve; sensory loss in skin over the insertion of deltoid muscle and paralysis of deltoid.
What structures stabilise the shoulder joint?
The rotator cuff muscles; supraspinatus, infraspinatus, teres minor and subscapularis
Which bony parts of the shoulder girdle lie subcutaneously and can be palpated easily?
Manubrium sternum, clavicle, spine of the scapula and acronium
Will ‘Saturday night palsy’ result in weakness of triceps, explain your answer?
No. Saturday night palsy is loss of function of the radial nerve as it runs against the mid-shaft of the humerus in the spiral groove. Although the posterior compartment of the arm, which is formed by triceps, is supplied by the radial nerve the branches leave the nerve before the spiral groove.
How does blood reach the right axillary artery from the left ventricle?
It passes through aorta, then brachiocephalic artery, subclavian artery, axillary artery
Outline the arrangement of cords of the brachial plexus around the second part of the axillary artery.
The chords of the brachial plexus lie lateral, medial and posterior to the axillary artery (immediately behind pectoralis minor muscle)
Which muscles for the rotator cuff, where are they inserted?
Supraspinatus; superior facet on the greater tuberosity of the humerus
Infraspinatus; middle facet on the greater tuberosity of the humerus
Teres minor; inferior facet on the greater tuberosity of the humerus
Subscapularis; lesser tuberosity of the humerus
What parts of the body drain lymph directly to the axillary lymph nodes?
Ipsilateral upper limb and body wall above the umbilicus
What structures lie along the medial border of the biceps in the middle of the arm?
Median nerve, ulna nerve, medial cutaneous nerve of the forearm, brachial artery and basilar vein
What are the 3 superficial veins of the forearm and where do they run?
The cephalic vein arises from the lateral end of the dorsal venous arch on the back of the hand. It runs more or less over the radius up to antecubital fossa where it gives the antecubital vein. It continues in the groove between triceps and biceps on the lateral side of the arm until it reaches deltoid where it passes up in the delto-pectoral groove to just below the clavicle. Just below the clavicle it passes deep into the axillary vein.
The basilic vein arises from the medial end of the dorsal venous arch on the back of the hand. It passes up the forearm over the ulna to pass medial to the elbow joint where it is joined by the antecubital vein. It passes halfway up the medial side of the arm in the groove below triceps and biceps. Half way up the arm it passes deep to become the brachial vein.
What are the 3 major nerves entering the forearm and what do they supply?
Radial; motor to the posterior compartment and skin on the lateral part of the back of the hand
Median; motor to all muscles in flexor forearm except flexor carpi ulnaris and ulna half of flexor digitorum profundus (both ulna nerve). Motor to the LLOAF muscles of the hand; lateral lumbricles, opponese pollicis, abductor pollicis brevis, flexor pollicis brevis, skin on lateral 3.5 digits of hand
Ulna nerve ; motor flexor carpi ulnaris and ulna half of flexor digitorum profundus. Motor all muscles EXCEPT LLOAF.
Skin - medial 1.5 digits on palm of hand
What is the common flexor origin?
Medial epicondyle of the humerus
How do you test the muscles supplied by the median nerve?
Flexion of the thumb and lateral two fingers. Movement of the thenar muscles
Where does the brachial artery and median nerve pass into the forearm?
Medial to the biceps aponeurosis
What is pronation and supination; which muscles perform these movements/
Supination is position both the radius and ulna parallel to each other; the hand faces forwards in the anatomical position or upwards with the elbow flexed. Supinator (in any position of the elbow) and biceps (with the elbow flexed) produce supination.
Pronation is positioning the radius and ulna crossing each other; the hand faces backwards in the anatomical position or downwards with the elbow flexed. Pronator teres and prontator quadratus (in any position of the elbow) produces pronation.
Which carpal bone is most prone to injury?
Scaphoid; it is in direct contact with the radius so putting your hand out to stop yourself falling over will put all the force directly through the scaphoid.
What is the cutaneous distribution of the median and ulnar nerves in the hand?
Median; palmar lateral 3.5 digits and extending over the finger tips up to the nail bed
Ulna; palmar medial 1.5 digits and extending over the finger tips up to the nail bed
What are the thenar muscles? What is their nerve supply?
The thenar muscles are at the base of the thumb on the palmar side of the hand (opponens pollicis, abductor pollicis brevis, flexor pollicis brevis).
They are supplied by the MEDIAN nerve
If infection occurs in the synovial flexor tendon sheath how far will it spread in the:
middle finger?
thumb?
little finger?
middle finger = to the distal skin crease on the palm of the hand
thumb = into the forearm
little finger = into the forearm
How do you test the interrossei muscles?
Test abduction and adduction of the fingers
How does division of the median nerve at the elbow differ from one at the wrist?
Sensory loss will be the SAME.
Motor at the wrist will paralyse the LLOAF muscles (lateral lumbricles, opponens pollicis, abductor pollicis brevis, flexor pollicis brevis)
Motor at the elbow will paralyse the long flexor to the thumb, both flexors to the index and middle fingers and the superficial flexors to the ring and little finger. (and LLOAF)
What is the nerve supply of the extensor compartment of the forearm and what area of skin does this nerve also supply?
Radial nerve; skin on the dorsal aspect of the the lateral 3.5 digits up to the distal interphalangeal joint.
Which bone lies in the base of the anatomical snuff box?
Scaphoid
Which nerve and vein cross the anatomical snuff box superficially?
Radial nerve
cephalic vein
If the T1 nerve root is damaged which group of muscles will be paralysed and which area of skin will be anaesthetic?
All the muscles in the hand are paralysed and the skin over the medial arm is anaesthetic
Which muscle is the most powerful supinator and what position does the elbow need to be in to maximise its force?
Biceps, with the elbow flexed to 90 degrees
Which fingers have two extensor muscles?
Index
little finger
Describe how the radius moves during pronation and supination
The proximal radius roatates about its own axis, the distal radius rotates round the ulna
What is the surface marking of the femoral artery and saphenous opening?
Femoral artery (within 1.5cm of) the point half way between the pubic tubercle and the anterior superior iliac spine.
Saphenous opening, 3cm below and lateral to the pubic tubercle. Medial to the femoral artery 3cm below the inguinal ligament.
What is the order of the femoral artery, vein and nerve in the groin?
Nerve lateral and vein medial (artery between them)
Which vein becomes the superficial femoral vein?
Popliteal vein as it passes through the adductor canal
What is the motor and sensory supply of the femoral nerve?
Motor, anterior compartment of the thigh
Sensory, anterior thigh skin, hip and knee joint
What are the attachments of the adductor muscles?
All have an origin on the pubis, all insert onto the femur
Which nerve supplies the adductor muscles?
Obturator nerve
What passes through the adductor canal?
Superficial femoral artery, popliteal vein
What is the function of the hip extensors, and which is the most powerful?
Gluteus maximus is the most powerful hip extensor, and it is used for climbing up hill/stairs.
Which muscles abduct the hip and when is abduction vital to normal function?
Gluteus minimus and medius. They hold the pelvis horizontal during walking when one leg is off the ground.
What structures pass through the greater sciatic foramen?
Sciatic nerve
Piriformes muscle
Superior and inferior gluteal vessels
Pudendal nerves
Is the ischial spine palpable in the living? If so, how do you palpate it?
Yes
through the vagina or rectum
Where is the surface marking of the sciatic nerve and why is it important?
Lower inner quadrant of the buttock.
Drug injection into muscle is common, injection into the nerve can completely destroy it.
If the sciatic nerve is completely cut, which parts of the lower limb will still have a nerve supply?
Anterior and medial muscle compartments of the thigh.
Sensation from the medial dorsum of the foot up the anteromedial calf (saphenous vein, branch of femoral). Sensation from anterior and medial thigh (femoral and obturator nerves).
Which major vessels supply the buttock with blood?
The superior and inferior gluteal arteries, both branches from the posterior branch of the internal iliac artery.
Which nerves supply the anterior and lateral compartments of the leg? (knee to ankle)
Anterior compartment = deep branch of the common peroneal and lateral = superficial branch
Where are the deep and superficial branch of the common peroneal at risk of damage?
Where they run against the neck of the fibula just under the skin
Which artery supplies the anterior compartment of the leg?
Anterior tibial artery
How many extensor tendons are there to each of the toes? Where do they originate?
Two tendons to each of the toes, a longus tendon from a muscle in the anterior leg (Which is attached to the fibula and interrouseous membrane) and a brevis tendon from a muscle in the foot (Attached to the dorsum of the calcanium and surrounding ligaments in the lateral foot). The brevis tendon to the little toe is often absent.
Why is the tibia prone to poor fracture healing?
Bones have nutrient arteries to supply the marrow but also receive a significant amount of blood from blood vessels which run fro mthe muscles which are attached to the bone. The tibia is relatively devoid of muscle attachment (none on subcutaneous surface) which means it has a poor blood supply and poor healing.
Describe the movements at the ankle joint?
The ankle joint is between the tibia/fibula mortice and the talus. The only movement possible at this joint = dorsi flexion and plantar flexion.
What would be the effect of damage to the common peroneal nerve?
Paralysis of all muscles in the anterior and lateral compartments of the leg. Loss of sensation down the lateral leg from the knee to the ankle and onto the dorsum of the foot including the dorsum of the medial four toes.
Which muscles attach to the Achilles tendon?
Gastrocnemius
soleus
plantaris
What is the nerve supply of the posterior compartment?
Tibial nerve; a branch of the sciatic nerve
