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Medicine Sem 3 > Case 8 anatomy > Flashcards

Case 8 anatomy Flashcards

1
Q

where is the quadrate tubercle? what attaches to it?

A

below greater trochanter, before the intertrochanteric crest, posterior side of femur

quadratus femoris inserts onto it

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2
Q

where is the gluteal tuberosity? what attaches onto it?

A

lateral ridge of the linea aspera, posterior femur

gluteus maximus inserts onto it

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3
Q

what are the different lines of the femur?

A
  • pectineal/spiral line - coming from lesser trochanter
  • linear aspera - main line
  • medial and lateral supracondylar lines - continuing on from the linear aspera
  • all posterior femur
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4
Q

where is the soleal line?

A

top half of the tibia

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5
Q

what’s at the end of the fibula?

A
  • malleolar fossa

- groove for peroneus longus tendon (lateral)

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6
Q

how is the patella orientated? what type of bone?

A
  • its triangular and the apex is directed inferiorly

- sesamoid bone

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7
Q

what does the medial longitudinal arch include?

A

calcaneus, talus, navicular, cuneiforms, first to third metatarsals

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8
Q

what does the lateral longitudinal arch include?

A

calcaneus, cuboid, fourth and fifth metatarsals

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9
Q

what does the transverse arch include?

A

cuboid, cuneiforms, bases of metatarsals

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10
Q

which muscles help to strengthen the medial arch and how?

A
  • peroneus longus and tibialis anterior

- they insert into the base of the first metatarsal and the medial cuneiform (both insert onto both)

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11
Q

what is the femoral artery a continuation of?

A

external iliac artery

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12
Q

where does the femoral artery lie in relation to the femoral vein in the femoral triangle?

A

lateral

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13
Q

what branches does the femoral artery give off?

A
  • Gives off the superficial epigastric, superficial circumflex iliac and the superficial & deep external pudendal arteries (all these go up into pelvis)
  • Gives off the profunda femoris artery
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14
Q

what does the femoral artery descend through? under cover of what?

A
  • adductor canal

- under cover of the sartorius muscle

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15
Q

what is the most important branch of the femoral artery? what does the vessel give rise to? how does it end?

A
  • profunda femoris
  • gives rise to the medial and lateral circumflex arteries, three perforating branches and the descending genicular
  • ends by becoming the fourth perforating artery
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16
Q

what do the circumflex arteries supply?

A

the proximal femur and hip joint and assist the perforating vessels in supplying the muscles of the thigh

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17
Q

what does the descending genicular artery supply?

A

contributes to the vascular anastomoses around the knee joint

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18
Q

what happens to do femoral artery?

A
  • As the femoral artery enters the popliteal fossa it becomes the popliteal artery
  • This vessel lies deep to the tibial nerve and popliteal vein (when looking posteriorly)
  • At the lower border of the popliteus muscle it bifurcates into its two terminal branches – anterior and posterior tibial arteries (posterior)
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19
Q

what happens to the anterior tibial artery?

A
  • The anterior tibial artery arises at the lower border of the popliteus muscle
  • Passes through the opening at the proximal end of the interosseous membrane
  • Enters the anterior compartment of the leg
  • Passes under the extensor retinaculum
  • Lies between extensor hallucis longus and the deep peroneal nerve
  • Becomes the dorsalis pedis in front of the ankle
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20
Q

what happens to the dorsalis pedis?

A

passes between the two heads of the first dorsal interossei to join the lateral plantar artery and complete the plantar arch

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21
Q

what happens to the posterior tibial artery?

A
  • Arises at the lower border of the popliteus muscle
  • Passes deep to the gastrocnemius and soleus muscles (gives off the fibular artery)
  • Lies first on the posterior tibial muscle and then on the tibia
  • Passes behind medial malleolus deep to the flexor retinaculum
  • Divides into medial and lateral plantar arteries
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22
Q

are the saphenous veins superficial or deep?

A

superficial

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23
Q

great saphenous vein

  • how is it formed
  • what is its course
A
  • The great saphenous vein is formed by the union of the dorsal vein of the great toe and the dorsal venous arch
  • Passes into the leg anterior to the medial malleolus
  • Ascends on the medial side of the leg
  • Passes into the thigh posterior to the medial condyle of femur
  • Traverses the saphenous opening of the fascia lata (deep fascia of the thigh, it encloses the thigh muscles and forms the outer limit of the fascial compartment of thigh, which are internally separated by intermuscular septa)
  • Empties into the femoral vein
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24
Q

where is the saphenous opening?

A

just below the inguinal ligament

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25
Q

small saphenous vein

  • how is it formed
  • what is its course
A
  • The short saphenous vein is formed by the union of the dorsal vein of the fifth toe and the dorsal venous arch
  • Passes into the leg posterior to the lateral malleolus
  • Ascends along the lateral border of the calcaneus tendon (Achilles tendon)
  • Inclines to the midline of the fibula and pierces the deep fascia
  • Ascends between the heads of the gastrocnemius
  • Empties into the popliteal vein (becomes the femoral vein)
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26
Q

what are the deep veins of the leg?

A

venae comitantes - (external iliac ->) femoral, popliteal, anterior and posterior tibial, fibular veins

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27
Q

describe the lymphatic drainage of the lower limb

A
  • Lymph from the lower limb drains by either superficial or deep lymph vessels
  • The superficial lymph vessels ascend with the superficial veins
  • The vessels that accompany the great saphenous vein drain into superficial inguinal nodes
  • The superficial inguinal nodes drain directly into the external iliac nodes or the deep inguinal nodes
  • The vessels that accompany the short saphenous vein drain into the popliteal nodes
  • The efferent vessels from the popliteal nodes drain into the deep inguinal nodes
  • Some superficial vessels drain directly into the deep inguinal nodes
  • Lymph from the vessels that surround the deep veins of the lower limb drain into the popliteal nodes or directly into the deep inguinal nodes
  • Efferent vessels from the deep inguinal nodes empty into the external iliac nodes
  • Efferent vessels from the external iliac nodes empty into the common iliac nodes
  • The lumbar trunk returns lymph from the lower limb into the thoracic duct
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28
Q

what does the sciatic nerve give rise to?

A

tibial and common peroneal nerves

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29
Q

what does the common peroneal nerve bifurcate into?

A

superficial and deep peroneal nerves

30
Q

where does the femoral nerve arise from?

A

L2-L4

31
Q

where does the obturator nerve arise from?

A

L2-L4

32
Q

what are the muscles you always forget in the leg?

A
  • plantaris
  • peroneus tertius
  • popliteus
33
Q

what is the order in the anterior compartment of the leg?

A

medial to lateral in terms of tendons

  • tibialis anterior
  • extensor hallucis longus
  • extensor digitorum longus
  • peroneus tertius

but EHL and PT most posterior, with tibialis anterior most anterior

34
Q

where is plantaris situated?

A

between gastrocnemius and soleus

35
Q

what is the order in the deep posterior compartment?

A

medial to lateral

  • flexor digitorum longus
  • tibialis posterior
  • flexor hallucis longus
  • popliteus = lateral to medial
36
Q

what is the course and insertion of peroneus longus?

A

tendon of peroneus longus enters the foot behind the lateral malleolus, runs obliquely along the sole of the foot and attaches to the base of the first metatarsal and medial cuneiform

37
Q

where does extensor hallucis longus insert?

A

onto the base of the distal phalanx of the great toe

38
Q

where does flexor digitorum longus insert?

A

onto the base of the distal phalanges of the lateral four digits

39
Q

where does flexor hallucis longus arise?

A

from the inferior two thirds of the posterior surface of the fibula and the interosseous membrane

40
Q

where does tibialis posterior insert?

A

into the navicular, cuneiforms, cuboid, calcaneus and bases of the second to fourth metatarsals

41
Q

which structures pass into the foot posterior to the medial malleolus?

A 
•	Tendon of tibialis posterior 
•	Tendon of flexor digitorum longus
•	Posterior tibial artery 
•	Posterior tibial vein 
•	Tibial nerve 
•	Tendon of flexor hallucis longus 
(Tom, Dick & A Very Nervous Harry)
42
Q

what covers the sole of the foot? what i continuous with it?

A
  • plantar fascia
  • deep fascia is thin over the dorsum, lateral and posterior aspects of the foot - it is continuous with the plantar fascia
43
Q

what does the plantar fascia thicken to form?

A

it’s thickened in its central part to form the plantar aponeurosis

44
Q

where does the plantar aponeurosis arise from and go to?

A

the calcaneus posteriorly and is continuous anteriorly with the fibrous digital sheaths that cover the flexor tendons

45
Q

what are extensor expansions?

A

special connective attachments by which the extensor tendons insert into the phalanges

46
Q

what is the intrinsic muscle on the dorsum of the foot? describe it

A

extensor digitorum brevis

  • arises from the upper surface of the calcaneum and the inferior extensor retinaculum
  • the fleshy muscle belly gives rise to four tendons which insert into the medial four toes
  • the most medial tendon inserts into the proximal phalanx of the big toe and is termed the extensor hallucis brevis
  • the remaining tendons insert into the long extensor tendons of the 2nd, 3rd and 4th toes
47
Q

what’s in the first layer of the sole of the foot?

A
  • Abductor digiti minimi
  • Flexor digitorum brevis
  • Abductor hallucis

(all arise from the calcaneus)
(no tendons in first layer)
(all toes)

48
Q

flexor digitorum brevis

  • origin
  • describe it
  • insertion
  • what other tendons do
  • action
A
  • It arises from the medial tubercle (?) of the calcaneum and from the plantar aponeurosis
  • The muscle belly gives rise to four tendons which pass to the lateral four toes, each tendon divides to from slips that insert into the sides of the middle phalanx
  • The tendons of the flexor digitorum longus pass between the slips on route to the distal phalanx
  • It flexes the lateral four toes
49
Q

which nerve supplies the flexor digitorum brevis?

A

medial plantar

50
Q

abductor hallucis

  • origin
  • insertion
  • action
A
  • The abductor hallucis extends from the medial tubercle of the calcaneum and the flexor retinaculum to the base of the proximal phalanx of the big toe
  • The muscle abducts and flexes the big toe
51
Q

what nerve supplies the abductor hallucis?

A

medial plantar

52
Q

abductor digiti minimi

  • origin
  • inserts
  • action
A
  • It arises from the medial and lateral tubercle of the calcaneum and inserts into the base of the proximal phalanx of the little toe and the tubercle of the 5th metatarsal
  • It abducts and flexes the little toe
53
Q

what nerve supplies the abductor digiti minimi?

A

lateral plantar

54
Q

what’s in the second layer of the sole of the foot?

A
  • Tendons of flexor hallucis longus
  • Tendons of flexor digitorum longus
  • Quadratus plantae muscle
  • Lumbricals

(2 tendons in this layer)
(middle toes – none specific to little or big)

55
Q

quadratus plantae

  • origin
  • inserts
  • action
A
  • The quadratus plantae arises by two heads, one from the medial tubercle and the other from the lateral tubercle of the calcaneus
  • The two heads unite and the muscle belly inserts into the tendon of the flexor digitorum longus
  • The muscles assist flexor digitorum longus in flexing the toes
56
Q

what nerve supplies the quadratus plantae?

A

lateral plantar

57
Q

lumbricals

  • origin
  • insertion
  • action
A
  • The lumbricals arise from the tendons of the flexor digitorum longus and they pass on the medial side of the lateral four toes to insert into the dorsal extensor expansors and the bases of the proximal phalanges of the lateral four toes
  • The lumbricals flex the proximal phalanx whilst extending the middle and distal phalanges
58
Q

what nerve supplies the lumbricals?

A
  • The first lumbrical is innervated by the medial plantar nerve
  • The other three are supplied by the lateral plantar nerve
59
Q

what’s in the third layer of the sole of the foot?

A
  • Flexor hallucis brevis
  • Adductor hallucis (transverse, oblique)
  • Flexor digiti minimi brevis

(no tendons in this layer)
(just big and little toes)

60
Q

flexor hallucis brevis

  • origin
  • insertion
  • action
A
  • The flexor hallucis brevis arises from the cuboid, lateral cuneiform and tendon of the tibialis posterior
  • The muscle belly splits into 2 tendons, one inserts into the medial and the other into the lateral side of the proximal of the big toe
  • It flexes the proximal phalanx of the big toe
61
Q

what nerve supplies the flexor hallucis brevis?

A

medial plantar

62
Q

adductor hallucis

  • origin
  • insertion
  • action
A
  • The adductor hallucis has two heads
  • The oblique head arises from the bases of the 3rd, 4th and 5th metatarsal bones and the transverse head arises from the plantar ligaments
  • A short tendon from the united heads inserts into the lateral side of the base of the proximal phalanx of the big toe
  • It adducts the big toe
63
Q

what nerve supplies the adductor hallucis?

A

lateral plantar nerve (unexpected)

64
Q

flexor digiti minimi

  • origin
  • insertion
  • action
A
  • The flexor digiti minimi brevis arises from the base of the 5th metatarsal and inserts into the proximal phalanx of the little toe
  • It flexes the proximal phalanx of the little toe
65
Q

what nerve supplies the flexor digiti minimi?

A

lateral plantar

66
Q

what’s in the fourth layer of the sole?

A
  • Tendon of tibialis posterior
  • Tendon of peroneus longus
  • Interossei

(2 tendons in this layer)
(none specific to big or little toe)

67
Q

what’s the insertion of tibialis posterior?

A

the tendon of the tibialis posterior inserts into the navicular, sustentaculum tali (horizontal shelf that arises from the anteromedial portion of calcaneus), cuboid, cuneiforms and the bases of the 2nd, 3rd and 4th metatarsals

68
Q

what’s the insertion of peroneus longus?

A

tendon passes underneath the cuboid and inserts into the medial cuneiform and the base of the 1st metatarsal

69
Q

where are the interossei located? what is action? innervation?

A
  • The interossei are located within the spaces between the metatarsals
  • Adduction of toes is brought about by the plantar interossei
  • Abduction of toes is brought about by the dorsal interossei
  • laterl plantar for both plantar and dorsal interossei
70
Q

where do the interossei arise and insert? why?

A
  • There are three plantar interossei which arise from the inferior surfaces of the 3rd, 4th and 5th metatarsals and insert into the medial sides of the proximal phalanges of the 3rd, 4th and 5th toes
  • Note that the big toe has its own adductor and therefore does not require a plantar interossei
  • There are four dorsal interossei which abduct the toes away from the second toe
  • They all arise from the adjacent (both?) sides of the metatarsals
  • The first dorsal interossei inserts into the medial side of the proximal phalanx of the 2nd toe
  • The 2nd, 3rd and 4th dorsal interossei insert into the lateral sides of the proximal phalanxes of the 2nd to 4th toes
  • Both the big and little toes have their own abductors
71
Q

what is the action of the interossei muscles?

A
  • The main role of the interossei is to assist the lumbricals in extending the interphalangeal joints during flexion of the metatarsal phalangeal joints in walking and running ??

Medicine Sem 3 (23 decks)

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