Anatomy of the limbs Flashcards
Which muscles are responsible for abduction of the shoulder?
Initiation is supraspinatus and then it is assisted by deltoid. Rotation of the scapula is by trapezius.
What muscles are involved in abduction of the shoulder?
Supraspinatus initiates abduction, and after 10-15 degrees it is assisted by deltoid
Which nerve supplies trapezius?
CN XI (spinal accessory nerve)
Which nerve is damaged by a posterior dislocation of the shoulder and what sensory/motor loss is experienced?
Axially nerve; sensory loss in skin over the insertion of deltoid muscle & paralysis of deltoid
What structures stabilise the shoulder joint?
Rotator cuff muscles (supraspinatus, infraspiantus, 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 acromium
What is frozen shoulder?
- The tendon of supraspinatus passes through a tight gap between humerus/acromion.
- If the tendon becomes inflamed it will cause pain as the swollen part passes through the gap.
- Typically, patient can lift arm a short distance pain free but then, as swollen area passes through the gap, it will be very painful to raise the arm.
- Once the swollen area has passed through the gap, further raising of the arm is pain free; patient describes a painful arc, termed the ‘frozen shoulder’
What is axillary nerve palsy?
Axillary nerve runs against humerus neck and can be damaged with posterior dislocation of shoulder (and fracture of humerus neck)
What is radial nerve palsy? (and what is it commonly known as)?
Saturday night palsy
- Radial nerve runs in spiral groove (mid shaft) against humerus and can easily be damaged by fracture of humerus or direct pressure
When you hit your funny bone, what nerve does it impact?
Ulnar nerve
Bang it as it passes behind medial epicondyle of humerus. Leads to severe pain and pins/needles in skin supplied by nerve
Will Saturday night palsy/radial palsy result in weakness of triceps?
Saturday night palsy = loss of function of radial nerve as it runs against mid-shaft of the humerus in the spiral groove.
Although the posterior compartment of the arm (formed by triceps) I supplied by the radial nerve, the branches leave the nerve before the spiral groove
What are the 5 groups of axillary lymph nodes?
Anterior (pectoral) Lateral Posterior (sub scapular) Central (intermediate) Apical (subclavicular/medial)
Which body area drains lymph directly to the axillary lymph nodes?
Ipsilateral upper limb and body wall above umbilicus
What is Horner’s syndrome?
The T1 nerve root forms the lower root of the brachial plexus; carries fibres of SNS which are destined to supply the face.
Damage to these SNS fibres will result in; drooping of the eyelid, lack of facial sweating and a constricted pupil.
How does blood travel from the left ventricle to the right axillary artery?
Aorta –> brachiocephalic artery –> subclavian artery –> axillary artery
How do the cords of the brachial plexus lie in relation to the axillary artery?
Cords lie laterally, medially and posterior to the axillary artery (immediately behind pectorals minor muscle)
Where do the muscles of the rotator cuff insert?
Supraspinatus, infraspinatus and theres minor - greater tuberosity of humerus (superior, middle and inferior facet respectively)
Subscapularis - lesser tuberosity of humerus
What structures lie along the medial border of the biceps in the middle of the arm?
Median nerve, ulnar nerve, medial cutaneous nerve of forearm, brachial artery and basilar vein
What is the carpal tunnel?
A tunnel formed by flexor retinaculum and carpal bones of the wrist.
The tunnel transmits 8 flexor tendons for fingers and median nerve
What is carpal tunnel syndrome?
Swelling of tendons/arthiritis affecting carpal bone joints can increase pressure –> compresses median nerve.
What happens when you have carpal tunnel syndrome?
Manifests as pain and diminished sensation on skin along median nerve distribution
Is the ulnar nerve affected by carpal tunnel syndrome?
No, ulnar nerve lies superficial to the retinaculum.
Median nerve travels through carpal tunnel so is impacted
What is repetitive strain injury?
De Quervain’s synovitis: common in ppl who carry out some movements repeatedly eg using keyboard.
Synovial sheath of tendons of wrist becomes inflamed and painful.
What are the 3 superficial veins of the forearm?
- Cephalic
- Basilic
- Median cubital
Where does the cephalic vein run?
- Superficial vein of the forearm
Runs from back of hand - more/less over radius - groove between bi/triceps - deltoid - clavicle - axillary vein
Where does the basilic vein run?
- Superficial vein of the forearm
Back of hand - more/less over ulna - half way up the arm it becomes brachial vein
Where does the median cubital vein run?
- Superficial vein of the forearm
Connects basilic and cephalic, often used for venipuncture
What are the 3 major nerves entering the forearm?
- Radial
- Median
- Ulnar
What does the radial nerve supply?
- Motor to the posterior compartment
- Skin on the thumb/forefingerish on the back of the hand
What does the median nerve supply?
- Motor to all muscles in flexor forearm including lateral part of flexor digitorum profundus (EXCEPT flexor carpi ulnaris/ulnar half of flexor digitorum profundus)
- Motor to the LLOAF muscles of hand
- Skin on thumb, forefinger and middle fingerish on palm of hand, first 3ish fingertips on back of hand
What does the ulnar nerve supply?
- Motor to flexor carpi ulnari and medial/ulnar flexor digitorum profundus
- Motor to all muscles in hand EXCEPT LLOAF
- Skin to the pinky and hagfish of ring finger on both sides (simple one)
What is LLOAF?
Lateral lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
(muscles in the hand supplied by the median nerve)
Where is the common flexor origin?
Medial epicondyle of humerus
How do you test muscles supplied by median nerve?
Flexion of thumb, forefinger and middle finger
Movement of thenar muscles
Which 3 muscles are in the thenar eminence?
- Abductor pollicis brevis
- Flexor pollicis brevis
- Opponens pollicis
Where can you palpate the brachial artery?
Medial to the biceps aponeurosis
Where can you palpate the radial artery?
Lateral to the most lateral tendon at the wrist (this is the easiest because it is superficial and has bone directly behind it)
Where can you palpate the ulnar artery?
Lateral to the pisiform or just proximal to this
What is pronation?
Positioning the radius and ulna crossing each other; hand faces backwards
Which muscles perform pronation?
Pronator teres Pronator quadratus (both in any position of the elbow)
What is supination?
Positionng both the radius and ulna parallel to each other; hand faces forward
Which muscles perform supination?
Supinator (in any position of the elbow)
Biceps (with elbow flexed)
Which 3 muscles are in the hypothenar eminence?
- Abductor digiti minimi
- Flexor digiti minimi
- Opponens digiti minimi
What is PAD DAB?
Palmar interossei Adduct = PAD
Dorsal interossei ABduct = DAB
When the scaphoid is fractured, where is there often tenderness?
Anatomical snuff box
What can scaphoid fracture lead to?
Avascular necrosis (death of tissue due to no blood vessel)
Which carpal bone is most prone to injury and why?
Scaphoid because it is in direct contact with radius so putting your hand out to stop yourself falling ver will put all force directly through this
Where are the thenar muscles?
At the base of the thumb on the palmar side of the hand
How do you test the interossei muscles?
Abdution and adduction of fingers
How does division of the median nerve at the elbow differ from 1 at the wrist?
Sensory loss = same
Motor @ wrist (paralyse LLOAF)
Motor @ elbow (paralyses flexrors & LLOAF)
What is the anatomical snuff box?
A space proximal to the thumb bounded medially by extensor pollicis longus and laterally by the tendons of the abductor pollicis longus and extensor pollicis brevis
Which bone forms the floor of the anatomical snuff box?
Scaphoid
Where do the radial artery and cephalic vein lie in relation to the anatomical snuff box?
Radial artery lies IN it
Cephalic vein CROSSES it superficially
What is the difference between golfer’s and tennis elbow?
Golfer’s elbow - damage to common flexor origin (medial epicondyle)
Tennis elbow - damage to common extensor origin (lateral epicondyle)
What is the nerve supply of the extensor compartment of the forearm?
Radial nerve
If T1 nerve root is damaged, which group of muscles will be paralysed and which area of skin will be anaesthetic?
All hand muscles will be paralysed
Skin over medial arm is anaesthetic
Which muscle is the most powerful supinator?
Biceps
Which position does the elbow need to be in to maximise the biceps’ force in supination?
Elbow flexed to 90 degrees
Which fingers have 2 extensor muscles and tendons?
Index and little fingers
How does the radius move during pronation and supination?
Distal radius rotates around the ulna
Proximal radius rotates about its own axis
What is the motor supply of the anterior thigh?
Femoral nerve
What is the posterior thigh supplied by?
Sciatic nerve
What is the medial thigh supplied by?
Obturator nerve
Where do the femoral vessels and nerve pass from the back of the abdomen into the thigh?
The gap between the inguinal ligament and superior pubic ramus
In the femoral triangle, is the femoral vein medial or lateral to the femoral artery?
Medial
In the femoral triangle, is the femoral nerve medial or lateral to the femoral artery/vein?
Lateral
In the femoral triangle, what is in the centre: the femoral nerve, artery or vein
Femoral artery
What is the surface marking of the femoral artery?
Point half way between the pubic tubercle and ASIS
Which vein becomes the superficial femoral vein?
Popliteal vein as it passes through the adductor canal
What supplies the anterior thigh skin, hip and knee joint?
Femoral nerve
What are the attachments of the adductor muscles?
All 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 adductor canal?
A narrow tunnel located in the thigh - acts as a passageway from structures moving between the anterior thigh and posterior leg
Where does the adductor canal run to and from?
Extends from the apex of the femoral triangle to the adductor hiatus of the adductor magnus
Which nerve is responsible for paralysis of the quadriceps?
Femoral nerve
Which direction do the lowermost fibres of vastus medalis run and why?
Oblique - to resist lateral displacement of the patella (shaft of femur meets shaft of tibia at an angle, so quads tend to pull patella laterally leading to dislocation hence fibres of vastus medals run like this [and depth of the patella grove])
Which nerve roots dos the sciatic nerve arise from?
L5 and S1-4
What is the area of skin where sensation is transmitted by the sciatic nerve?
Lateral thigh and leg into the foot
Which area of the buttock may damage the sciatic nerve when injected into?
Lower medial quadrant: injection in the upper outer quadrant is safe
Which is the most powerful hip extensor?
Gluteus maximus (used for climbing uphill)
Which muscles abduct the hip and when is abduction vital to norma function?
Gluteus minimus and medius.
They hold the pelvis horizontal during walking when 1 leg is off the ground
What structures pass through the greater sciatic foramen?
- Sciatic nerve
- Piriformes muscle
- Superior/inferior gluteal vessels
- Pudendal nerves
Where can the ischial spine be palpated?
Through the vagina or rectum
If the sciatic nerve is completely cut, which parts of the lower limb will still have nerve supply?
Anterior and medial muscle compartments of the thigh and sensation.
Which major vessels supply the buttock with blood?
Superior and inferior gluteal arteries
Where do the sup/inf gluteal arteries branch from?
Posterior branch of the internal iliac artery
What is significant about a fractured tibia?
Lower 1/3 of tibia has no muscle attachments thus a limited blood supply
Where can the dorsal pedis pulse be felt?
Between 1st and 2nd metatarsal, on the dorsal of the foot
Where can the posterior tibial pulse be felt?
Behind the medial malleolus
When _____ swells, knee bending becomes restricted and kneeling becomes painful
bursa (over the infra-patellar tendon)
Where does the leg run from?
Knee to ankle! NOT thigh
Which nerves supply the anterior compartment of the leg?
Deep branch of the common peroneal nerve
Which nerves supply the lateral compartment of the leg?
Superficial branch of the common peroneal nerve
Which artery supplies the anterior compartment of the leg?
Anterior tibial artery
How many extensor tendons are there to each of the toes?
2 tendons to each:
- Longus tendon (from a muscle in anterior leg)
- Brevis tendon (from a muscle in the foot)
The brevis tendon to which toe is often absent?
Little
Where are the palpable pulses in the leg?
- Popliteal: behind the knee between the heads of gastrocnemius
- Posterior tibial: posterior to the medial malleolus
Describe the movements at the ankle joint
Ankle joint: between tibia/fibula and talus
Only movement: doors flexion and plantar flexion (extension and flexion)
What is the peroneal nerve also known as?
Fibular
What would be the effect of damage to the common peroneal nerve?
Paralysis of all muscles in anterior/lateral compartments of the leg
Loss of sensation down the lateral leg from the knee to the ankle and onto the
Which muscles attach to the Achilles tendon?
Gastrocnemius
Soleus
Plantaris
What is the nerve supply of the posterior compartment?
Tibial nerve
What is the tibial nerve a branch of?
Sciatic nerve
Where does the long saphenous vein start?
It starts at the medial end of the dorsal venous arch on the dorsal of the foot
Where does the long saphenous vein join the femoral vein?
About 3cm below inguinal ligament
How many flexor tendons does each toe have?
1 tendon to the hallux (big toe), 2 tendons to each of the other toes;
- longus (muscle attached to tibia)
- brevis (muscle attached to calcaneum)
How many layers is there at the sole of the foot?
4 (cba to learn each 1, Dr Rennie said it wasn’t that important lol)
What is the importance of deep veins and their valves?
Deep veins transmit blood back to the heart and work using muscle pumps.
Valves only allow blood to flow up vein and from outside of leg to inside.
When muscle is relaxed, deep veins fill w/ blood & when muscle contracts, blood is pumped further up the vein
At which joints does flexion and extension of the ankle take place?
Joint between tibia/fibula and talus
At which joints does inversion and eversion take place?
Joint between talus and calcaneum which lies below talus
List some anatomical features that maintain arches of the foot
- Shape of bones (wedge)
- Tendons (coming from leg, pulling arch up)
- Strong ligaments (running btwn bones on plantar surface)
- Plantar ligament/fascia (hold front and back of foot closer)
What is the rule for nerve supply to a joint?
The nerve supplying a joint with sensation is the same as the nerve supplying the muscles which move the joint
eg hip = femoral (eg rectus femurs), obturator (adductors) and tibial component of sciatic (hamstrings)
What do the ACL and PCL do?
ACL stops tibia moving forwards relative to femur and PCL is backwards
what does the pectoral girdle consist of?
scapula
clavicle
all muscles attached to these
latissimus dorsi muscle
what’s the elevator scapulae’s main function
to lift the scapula
what is the function of the latissimus dorsi
adducts, extends and internally rotates the arm
discuss the deltoid’s fibres arising from the acromion
multi-pennate arrangement making it a powerful muscle
what would be the sensory/motor loss from the axillary nerve
sensory: loss of sensation of lateral side of proximal arm
motor: paralysis of deltoid/teres minor muscles & impaired abduction of shoulder
which veins form the axillary vein
basilic and brachial
which nerve supplies the flexors of arm (BBC)
musculocutaneous
which nerve supplies the extensors of arm
radial
which nerve supplies the deltoid
axillary
which nerve supplies the trapezius muscle
CN XI (accessory)
what does the axilla vein
fat/lymph nodes, axillary artery/vein, brachial plexus
briefly describe the 4 walls of the axilla
ant border: pec major/minor
lat border: intertubecular sulcus
med border: serrates anterior/thoracic wall
post border: scapularis, teres major, lattisimus dorsi
which parts of the brachial plexus lie close to the axillary artery deep to pec minor
cords
is the medial epicondyle a common flexor or extensor origin
flexor
what is the common extensor origin
lateral epicondyle
list the 6 superficial posterior forearm muscles (extensors)
- brachioradialis
- extensor carpi radialis longus/brevis
- extensor digitorum
- extensor digiti minimi
- extensor carpi ulnaris
- anconeus
list the 4 deep post forearm muscles (extensors)
- supinator
- abductor pollicis longus
- extensor pollicus longus/brevis
- extensor indices
list the 4 superficial ant forearm muscles (flexors)
- pronator teres
- flexor carpi radilis
- palmaris longus
- flexor carpi ulnaris
name the intermediate ant forearm muscle (flexor)
flexor digitorum superficialis
list the 3 deep ant forearm muscles (flexors)
- flexor digitorum profundus
- flexor pollicis longus
- pronator quadratus
what are the borders of the femoral triangle
superior/base = inguinal ligament medially = medial border of adductor longus laterally = medial border of sartorial
what is l2-4
femoral nerve
why are iliacus and psoas major commonly referred to as iliopsoas despite originating in diff areas
they come together to form a tendon
what does iliopsoas do
- flexes the lower limb at the hip joint
- assists in lateral rotation at the hip joint
what do the quads consist of
3 vastus muscles
rectus femoris
what do the vests muscles do
extend knee joint
stabilise patella
what are the actions of the sartorial at the hip and knee
hip: flexor, abductor, lateral rotator
knee: flexor
what are the actions of the pectineus
adduction and flexion @ hip
what are the muscles in the medial compartment of the thigh collectively known as
hip adductors
what are the 5 muscles in the medial compartment of thigh
gracilis
obturator externus
adductor brevis, longus and magnus
where does the obturator nerve arise from
lumbar plexus
what is the arterial supply of medial thigh
obturator artery
what is the largest muscle of the medial thigh and where does it lie in relation to others
adductor magnus - posterior
what are the 2 functional parts of the adductor magnus (and nerve supply)
- adductor part (obturator nerve)
2. hamstring part (sciatrc nerve)
what are the actions of the 2 parts of adductor magnus?
both adduct thihh
- adductor part flexes thigh
- hamstring part extends thigh
what is the action of adductor longus and brevis
adducts thigh
what is the action of obturator externus
adduction and lateral rotation of the thigh
what is the action of the gracilis
- adduction of thigh at hip
- flexion of leg at knee
what are the 3 muscles in the posterior thigh
- biceps femors
- semitendinosus
- semimembranosus
what is the action of biceps femoris
- flexion at knee
- extends thigh at hip
- laterally rotates hip/knee
where is semimembranosus in relation to semitendinosus
underneath
what is the action of semimembranosus
- flexion of leg at knee
- extension of thigh at hip
- medially rotates thigh/leg
what are the cruciate ligaments named by
their attachments to the tibia
what is the subtalar joint aka
talo-calcaneal joint
what is eversion of a fixed foot accompanied by
medial rotation of the leg
which 3 muscles are in the anterior leg
- tibilaris anterior
- extensor digitorum longus
- extensor hallucis longus
- fibulas tertius
what do the anterior leg muscles act to do
dorsiflex and invert foot at ankle joint (fibulas tertius everts)
what do the extensor muscles of anterior leg do
also extend toes
which nerve are the muscles in anterior leg innervated by
deep peroneal nerve (l4-5)
what is the strongest dorsiflexor of the foot
tibialis anterior
what is the largest compartment of leg
posterior
collectively, what do the muscles of the posterior leg do
plantar flex and invert the foot
what is the posterior leg innervate by
tibial nerve
what is the tibial nerve a terminal branch of
sciatic nerve
what is the most superficial muscle of posterior leg
gastrocnemius
what is the action of gastrocnemius at the knee
flexor (plantar flexes ankle joint)
how many deep muscles are in the posterior leg
- popliteus
- tibialis posterior
- flexor hallucis longus
- flexor digitorum longus
what do the deep muscles of the posterior leg act on
popliteus - only on knee joint
tibialis posterior, flexor hallucis longus and flexor digitorum longus - on ankle/foot
which muscle forms the base of the popliteal fossa
popliteus
what does the popliteus do
laterally rotates femur on tibia
what nerve innervates posterior leg
tibial nerve
what does tibialis posterior do
inverts n plantar flexes foot, maintains medial arch of foot
what are the 2 muscles in the lateral leg
fibularis longus/brevis
is fibulas longus deeper or superficial to brevis
superficial
what is the action of fibularislongus
eversion and plantar flexion of foot
what is action of fibularis brevis
eversion of foot
what do the superficial gluteal muscles do
abduct and extend lower limb at hip joint
what is the largest and superficial muscle of gluteal region
gluteus maximus
what muscle in gluteal region is fan-shaped
gluteus medius
where does gluteus medium lie
between gluteus Maximus and minibus
which muscles prevents pelvic drop of opposite limb (and also abduct and medially rotate)
gluteus medius and minimus
what is the main extensor of the thigh
gluteus maximus (only used when force is required eg running)
what is gluteus Maximus innervated by
inferior glutea nerve
what are gluteus medius/minimus innervated by
superior gluteal nerve
