Clinical Anatomy Flashcards
What does a bump on a bone (i.e. the tibial tuberosity) signify?
It is a place for a muscle attachment
What parts of the pelvis often fracture in older patients with osteoporosis?
Pubic Ramus
Sacroiliac joints
Name the 3 compartments of the knee
1) Medial
2) Lateral
3) Patello-femoral
What is the ankle mortise and what does it hold in it?
Lateral malleolus (fibula)
Distal Tibia
Medial Malleolus
holds TALUS bone in it
Where is Chopart’s joint located?
Between hindfoot and midfoot
What joints in the foot are responsible for abduction/adduction?
joints between midfoot and forefoot
What is the acetabular labrum?
ring of cartilage that surrounds the acetabulum of the hip
What is the function of the acetabular labrum?
Increases contact with the femoral head in the joint socket
=> joint is more stable
What type of hip fracture is treated by replacement?
Intra-capsular
- due to risk of avascular necrosis
What type of hip fracture is treated by surgery and normal healing?
Extra-capsular
- since blood supply is still intact it should heal relatively well
What muscles are described as the Hip Flexors?
ILIACUS
PSOAS MAJOR
Where does the iliacus muscle attach to?
Origin: Iliac crest / inner aspect of ilium
Insertion: Lesser trochanter of femur
What is the origin and insertion of the psoas major muscle?
Origin: Transverse processes L1-L5
Insertion: Lesser trochanter
In what patients does a psoas abscess usually present?
Immunocompromised
IVDU
How do patients with a psoas abscess usually sit?
They dont like to extend their hip
=> they sit with it flexed
What muscles are thought of as secondary hip flexors?
RECTUS FEMORIS (1 of 4 heads of quadriceps)
SARTORIUS
Where does the rectus femoris attach to?
Origin: AIIS
Insertion: Tibia via patella tendon
Where does the sartorius attach to?
Origin: ASIS
Insertion: Tibia
What is an avulsion fracture?
- Injury to the bone in a location where a tendon or ligament attaches to the bone
- tendon or ligament pulls off a piece of the bone
Where do the hip adductors commonly originate, and where do they insert to?
Common origin: Inferior pubic rami
Insertion: Linea aspera
Pectineal line (P)
Tibia (G)
What muscles are classified as hip abductors?
GLUTEUS MINIMUS / MEDIUS
Where do the gluteus minimus and medius originate and insert?
Origin: Iliac wing
Insertion: Greater trochanter of femur
Where does the tensor fascia lata?
Origin: Iliac crest
Insertion: Lateral tibia via iliotibial tract (ITB)
What muscle is classified as a hip extensor
GLUTEUS MAXIMUS
Where does the gluteus maximus attach
Origin: Posterior aspect of ilium/ sacrum
Insertion: Iliotibial tract
What actions do the hamstring muscles do?
hip extension
knee flexion
What muscles make up the hamstrings?
BICEPS FEMORIS
SEMIMEMBRANOSUS
SEMITENDINOSUS
Where does the biceps femoris attach to?
Origin: Long head: Ischial tuberosity
Short head: Linea aspera
Insertion: Fibula head
Where does the semimembranosus attach to?
Origin: Ischial tuberosity
Insertion: Posterior tibia
Where does the semitendinosus attach to?
Origin: Ischial tuberosity
Insertion: Medial tibia
What clinical pathologies are the hamstrings involved in?
Avulsion
Tears
What pathology usually presents with lateral hip pain?
Trochanteric bursitis
What is the function of the collateral ligaments around the knee?
Resist varus / valgus stresses at the knee joint
VARUS stress = moving foot IN
=> stressing lateral collateral
VALGUS stress = moving foot OUT
=> stressing medial collateral
What is the purpose of the Anterior Cruciate Ligament (ACL)
Resists anterior translation and external rotation of the tibia on the femur
What is the purpose of the Posterior Cruciate Ligament (PCL)
Resists posterior translation of the tibia on the femur
What are the most important functions of the meniscus in the knee?
- Load transfer (“shock absorbers”)
- Increase femero-tibial conformity
- Stabilise the knee during movement
- Lubricate the knee
What injuries can present in the meniscus?
Bucket-handle tear
Radial transverse tear
What muscle group is responsible for knee extension?
QUADRICEPS MUSCLES
- Rectus femoris
- Vastus intermedius
- Vastus medialis
- Vastus lateralis
Where does the Rectus Femoris originate?
Origin: AIIS
Where do the vastus group of muscles originate?
Origin: Anterolateral prox. femur
Origin: Medial edge linea aspera
Greater troachanter
Origin: Medial edge linea aspera
Lesser troachanter
Where do the quadricep muscles commonly insert?
Tibia via PATELLAR TENDON
Explain the progression of structures through which the knee is extended
Quadriceps muscle
Quadriceps tendon
Patella
Patella tendon
Tibial tubercle
What factors may predispose to patellar instability
Genu valgum
Femoral head anteversion
Weak quadriceps (vastus medialis)
Ligamentous laxity (more common in females)
What is the nerve supply to the anterior compartment of the leg?
Deep peroneal nerve
What is the nerve supply to the lateral compartment of the leg?
Superficial peroneal nerve
What is the nerve supply to the deep posterior compartment of the leg?
Tibial nerve
What is the nerve supply to the superficial posterior compartment of the leg?
Medial sural cutaneous
What are the 2 branches of the common peroneal nerve?
Common peroneal (fibular) nerve divides to:
- Superficial peroneal nerve
- Deep peroneal nerve
What part of the foot does the superficial peroneal nerve supply?
most of dorsal surface of foot
What part of the foot does the deep peroneal nerve supply?
1st web
in between first two toes
What nerve is at risk in femoral neck fractures?
common peroneal (fibular) nerve
What muscles are responsible for ankle plantar flexion?
GASTROCNEMIUS: MEDIAL & LATERAL HEADS
SOLEUS
PLANTARIS
Where does the gastrocnemius originate?
Origin: Femoral condyles
Where does the soleus originate?
Origin: Broad area on posterior tibia/fibula
Where does the plantaris originate?
Origin: Lateral femoral condyle
What is the common insertion point of the muscles which plantar flex the ankle?
Calcaneus via ACHILLES TENDON
What muscle is responsible for dorsiflexing the ankle?
Tibialis anterior
Where does the tibialis anterior attach?
Origin: Lateral surface proximal tibia
Insertion: Medial cuneiform Base 1st metatarsal
What ligaments are found medially and laterally at the ankle joint?
MEDIALLY: Deltoid ligament
- anterior
- medial
- posterior
LATERALLY: Lateral ligament complex
What structures support the medial arch?
TIBIALIS POSTERIOR TENDON
SPRING LIGAMENT (Calcaneonavicular)
Where does the tibialis posterior tendon attach to?
Origin: Posterior proximal tibia / fibula
Insertion: Navicular / plantar surface of medial cuneiform
Where does the plantar tendon attach to?
Origin: Tuberosity of calcaneus
Insertion: Heads of metatarsals
What clinical condition is most commonly associated with the plantar?
Plantar fasciitis
What is Pes Planus?
Flat foot
Describe what is meant by Pes Cavus?
“claw foot”
foot is abnormally arched (like a cave)
How does the arch of our foot make it more efficient?
Stores energy when weight is beared and foot flattens
Releases energy when foot comes off of floor
What bone is the only one to connect the upper limb to the axial skeleton?
Clavicle
What ligaments rupture during an acromioclavicular joint dislocation?
Acromioclavicular ligament (rupture of this alone does not displace clavicle)
Coracoclavicular ligaments
What is the origini and insertion of the Trapezius muscle?
Origin: Spinous processes (C1→ T12)
Insertions: Occiput and spine of scapula
What nerve innervates the trapezius muscle?
CN XI - Spinal accessory nerve
What is the function of the trapezius muscle?
Elevates and depresses scapula
Retracts scapula
What types of arthritis can be found in the glenohumeral joint?
Osteoarthritis
Rheumatoid arthritis
Why is the shoulder joint more likely to dislocate than the hip, even though both are ball and socket joints?
Glenohumeral joint = shallower
=> greater range of movement but more unstable
What is the clinical term for frozen shoulder?
adhesive capsulitis
What is the purpose of the labrum in the glenohumeral joint?
Increases capture of the humeral head
=> ↑ STABILITY
What type of labral tear occurs at the origin of the long head of biceps brachii?
SLAP tears
at supraglenoid tubercle
Where do BANKART labral tears usually occur?
Inferior anterior labrum
usually from anterior movement of humerus pulling on labrum
Name the 4 rotator cuff muscles
Suprpaspinatus
Infraspinatus
Teres Minor
Subscapularis
What is the origin and insertion of supraspinatus?
Origin: Supraspinous fossa
Insertion: Greater tuberosity of humerus
What nerve innervates supraspinatus?
Suprascapular nerve (C5 / C6)
What is the function of the supraspinatus muscle?
Abducts arm (first 15 degrees until deltoid takes over)
What is the origin and insertion of the infraspinatus muscle?
Origin: Infraspinous fossa
Insertion: Greater tuberosity of humerus
What nerve innervates the infraspinatus muscle?
Suprascapular nerve (C5 / C6)
What is the main function of the infraspinatus muscle?
Externally rotates the arm
What is the origin and insertion of Teres Minor?
Origin: Dorsal surface of lateral border of scapula
Insertion: Greater tuberosity of humerus
What nerve innervates the Teres Minor?
Axillary nerve (C5 / C6)
What is the main function of Teres Minor?
Externally rotates the arm
What is the origin and insertion of subscapularis?
Origin: Anterior surface of scapula (Subscapular fossa)
Insertion: Lesser tuberosity of humerus / shoulder capsule
What nerve innervates Subscapularis?
Upper & Lower subscapular nerve (C5 / C6)
What is the function of the subscapularis?
Internally rotates the arm
What area of the rotator cuff muscles is most susceptible to tears and impingement?
common insertion of the first three muscles:
=> greater tuberosity of the humerus
Where do the three sections of the deltoid muscle originate from?
Clavicle
Acromion
Spine of scapula
What is the insertion of the deltoid muscle?
Deltoid tuberosity on lateral aspect of humerus
What nerve innervates the deltoid muscle?
Axillary nerve (C5 / C6)
What is the main function of the deltoid muscle?
Abducts the arm
Takes over after the first 15 degrees from supraspinatus
Where do the long and short heads of the biceps brachii originate from?
SHORT head: Coracoid process
LONG head: Supraglenoid tubercle
Where does the tendon of biceps brachii insert?
Radial tuberosity
What nerve innervates the biceps brachii?
Musculocutaneous nerve (C5 / C6)
What are the main functions of the biceps brachii?
Supination of forearm Flexes elbow (most of this is done by Brachialis)
Where anatomically does tendonitis usually occur in the biceps tendon?
As it passes through bicipital groove and over the head of the humerus
What arthritis most commonly occurs in the elbow?
Osteoarthritis
Rheumatoid arthritis
Where in the elbow joint is commonly fractured?
Olecranon
What type of fracture at the elbow joint is more common in children?
supracondylar fractures
“students elbow” is the inflammation of what structure?
Olecranon bursa
What are the main ligaments which surround the elbow joint?
Medial (anterior and posterior parts)
Lateral
Annular (over radius)
Where do all of the forearm extensor muscles originate?
Lateral epicondyle
What is the common origin of all the forearm flexor muscles?
Medial epicondyle
The Radial head is found at the wrist joint. TRUE/FALSE
FALSE
it is found at the elbow joint
the radial styloid is found at the wrist joint
What shape do distal radius fractures usually make?
Dinner fork appearance
Where can a scaphoid fracture be palpated?
Anatomical snuff box
Where are the intrinsic muscles of the hand located and what is their function?
located within the hand
responsible for the fine motor functions of the hand
Where are the extrinsic muscles of the hand located and what is their function?
located in the anterior and posterior compartments of the forearm
control finger flexion and extension and movements of the wrist
Name the 3 thenar muscles and their innervation
1) OPPONENS POLLICIS
2) FLEXOR POLLICIS BREVIS
3) ABDUCTOR POLLICIS BREVIS
Median nerve
What is the main hypothenar muscle and its innervation?
ABDUCTOR DIGITI MINIMI
moves little finger
Ulnar nerve
What movement is carried out by the dorsal interossei muscles compared to the palmar interossei muscles?
Dorsal - ABduct (DAB)
Palmar - ADduct (PAD)
How may lumbrical muscles do you have and what are they innervated by?
4 muscles
Lateral 2 = Median nerve
Medial 2 = Ulnar nerve
What is the function of the flexor digitorum superficialis
Flexes fingers at PIP joints
What muscle is responsible for flexing the fingers at the DIP joints
Flexor digitorum profundus
What is the function of pulleys in the digits?
anchors tendon to fingers for more efficient movement
What condition can result from hypertrophy and fibrosis of the palmar fascia?
Dupuytrens contracture
Why is the ulnar artery more important than the radial artery?
It can supply both palmar arches
Where on the hand should you test for median nerve sensation/ function?
Tip of index finger and base of thenar muscles
Where on the hand should you test for radial nerve sensation/ function?
Dorsum of 1st webspace
Where on the hand should you test for ulnar nerve sensation/ function?
Dorsum and volar aspects of little finger
What nerve is affected in cubital tunnel syndrome?
ulnar nerve
at elbow joint
What is compression of the median nerve more commonly known as?
Carpal Tunnel syndrome
