EXAM III 2015 Flashcards
Define Extrinsic muscle, which CN innervates?
Hypaxial, Superficial back muscles; move shoulder and upper extremity
CN XI (Accessory) or branches of brachial plexus (ventral rami of spinal nerves)
Define Intrinsic muscles, purpose, what CN innervates?
Epaxial Deep back muscles
Support upright position and allow movements of the vertebral column
Proprioception
Dorsal rami of spinal nerves
Actions of the trapezius?
Elevates, depresses, and retracts scapula
Rotates glenoid fossa superiorly
What are the motor and sensory innervations of the trapezius?
Motor: Accessory Nerve
Sensory: Ventral rami of C3 & C4
Actions of the Latissimus dorsi and Innervation
Extends, adducts, & medially rotates humerus, raises torso towards arms during climbing
Innervation: thoracodorsal nerve
Action and Innervation of Rhomboid major and minor
Actions
Both retract, elevate, and rotate scapula downward and fix scapula to thoracic wall
Innervation
Both innervated by dorsal scapular nerve
Actions and Innervation of Levator Scapulae
Elevates scapula and tilts glenoid fossa inferiorly by rotating scapula (downward rotation)
Innervates: dorsal scapular nerve and ventral rami of cervical spinal nerves
Actions and Innervation of Serratus posterior superior
Elevates Ribs
Innervation: T2-T5 intercostal nerves (ventral rami)
Actions and Innervations of Serratus posterior inferior
Depresses ribs
Innervation: Intercostal nerves and subcostal nerve (ventral rami)
What are the major groups of epaxial back muscles?
Splenius (most superficial)
Splenius capitis, splenius cervicis
Erector Spinae Group
Iliocostalis, Longissimus, Spinalis
Transversospinalis Group
Rotatores, Multifidus, Semispinalis
Actions and Innervation of splenius cervicis and capitis
Bilaterally - extend head and neck
Unilaterally - laterally flex neck and rotate head to side of contracting muscle (epsilateral rotation)
Innervation: dorsal rami of spinal nerves
What are the muscles of the superficial layer of the erector spinae group?
Iliocostalis
Longissimus
Spinalis
What are the actions and innervations of the erector spinae group?
Bilaterally - extend vertebral column and head
Unilaterally - laterally flex vertebral column
Innervation - dorsal rami of spinal nerves
What are the 3 regional parts of the Spinalis? What is the origin of thoracis?
Thoracis: O - spinous processes & insert on spinous processes superior to them
Cervicis
Capitis
What are the deep layer intrinsic muscles of the back? What do they innervate?
Transversospinalis group
Semispinalis
Rotatores
Multifidus
Innveration: dorsal rami of spinal nerves
Cervicis, Capitis, Thoracis and Action
Action: extend head, thoracic & cervical regions; rotates them contralaterally (opposite side of muscle)
Cervicis: cervical transverse processes to spinous processes of 2nd cervical v.
Capitis: (deep to splenus capitis) superficial to cervicis, t.p. of T1-6 to nuchal line
Thoracis: transverse to spinous processes in thoracic region
Origin, Insertion, and Action of Multifidus
O: transverse processes from sacrum to 2nd cervical vertebra
I: spinous processes
Action: stabilizes vertebrae during localized movements of vertebral column
Rotatores brevis and longus and action
Action: extend head, thoracic & cervical regions; rotates them contralaterally
Brevis: t.p. of one vertebra to base of s.p. of next vertebra above (spans one intervertebral joint)
Longus: t.p. of one vertebra to s.p. of 2nd vertebra above (spans 2 intervertebral joints)
What are the intrinsic segmental muscles of the back and what do they innervate?
Interspinales - dorsal rami of spinal nerves
Intertransversari - dorsal & ventral rami of s.nerves
Levator Costarum - dorsal rami of C8-T11 s.nerves
What are the osteological structures of the suboccipital triangle?
Atlas (C1)
Axis (C2)
What are the muscles of the suboccipital triangle? (4)
Rectus capitis posterior major
Rectus capitis posterior minor
Obliquus capitis superior (superior oblique capitis)
Obliquus capitis inferior (inferior oblique capitis)
Mainly postural muscles, aid in extension/rotation at atlantoaxial joint
**ALL innervated by suboccipital nerve (dorsal rami of C1)
What are the nerves & vessels of the suboccipital region? (4)
Vertebral artery
Suboccipital nerve - dorsal ramus of C1, b/w skull & atlas = motor to all triangle muscles
Greater occipital nerve - dorsal ramus of C2, b/w atlas & axis, only sensory fibers
Posterior atlanto-occipital membrane - continuous w/ ligamentum flava
List the ribs and types of them
12 Total
1-7 True ribs
8-10 “false ribs”
11-12 “floating ribs”
Ribs 1 and 2, 11 and 12 are “atypical”
What are the general features of typical ribs?
Vertebral End
Head, Neck, Tubercle, Angle
Middle
body/shaft
Sternal End
Articulates directly w/ sternum, costal cartilages, or sits on fascia
What does the breast rest on?
Pectorial fascia
Superficial to the pectoralis major
What is retromammary space?
Potential space between the breast and pectoral fascia
Cooper’s ligaments of the breast
Attaches the breast to the dermis of overlying skin via these ligaments = Suspensory ligaments
Mammary gland lobules converge at nipple surrounded by pigmented areola
What are the arteries that supply the breast?
Subclavian artery - branches off into internal thoracic and medial mammary branches
Axillary artery - branches off into lateral thoracic and lateral mammary branches
What is the venous drainage of breast tissue?
Mainly medial and lateral mammary branches to lateral thoracic to axillary vein
Some via internal thoracic vein via anterior intercostal veins
Explain Lymphatic drainage of breast tissue; what are the levels?
Level I (most lateral)
Nipple, areola, lactiferous lobules = Subareolar L.N.
Level II (medial)
>75% lymph via breast; Allixary L.N. (pectoral, central, apical)
Level III (internal)
Remaining lymph = parasternal & abdominal l.n.
Explain innervation of breast tissue
Mainly from anterior and lateral branches of 4th-6th intercostal nerves
Also some via supraclavicular nerve branches & branches from intercostal nerves
Define Polymastia & Polythelia
Supernumerary breasts or nipples
What are the superficial fascia of the pectoral region? (3)
Platysma
Supraclavicular nerves
Anterior & lateral branches of intercostal nerves
What are the fascias of the pectoral region? (2)
Superficial fascia
Clavipectoral fascia
What does the deltopectoral/clavipectoral triangle of the pectoral region consist of? What makes up the borders? vein? lymph nodes? arteries?
Bordered by: deltoid. pectoralis major, middle 1/3 of clavicle
Deltopectoral lymph nodes
Cephalic vein
Deltoid branch of thoracoacromial artery via axillary artery
What’s involved with the clavipectoral fascia? What does it attach to and what vessels are involved?
Subclavius & pectoralis minor
Attaches to clavical and anterior thoracic wall
Pierced by the cephalic vein, thoracoacromial artery, & lateral pectoral nerves
Becomes susepensory ligament of axilla
What rami innervate the pectoral muscles?
Ventral
What muscles are composed of the pectoral region? (4)
Pectoralis major and minor
Serratus anterior
Subclavius
What are the actions of the pectoralis major and blood supply and innervations?
Adduction & medial rotation of humerus
Draws scapular anteriorly & inferiorly via clavicle
Clavicular part flexes humerus in addition to extending humerus from sternal part
Blood supply: pectoral branches of thoracoacromial arterial trunk
Innervation: Lateral & medial pectoral nerve (medial & lateral cord of the brachial plexus)
What are the actions, blood supply, and innervations of pectoralis minor?
Actions: Stabilizes scapula; pulls it anteriorly and inferiorly against posterior thoracic wall
Blood Supply: pectoral branches of thoracoacromial arterial trunk
Innervation: Medial pectoral nerve (C8,T1)
What are the actions, blood supply, and innervations of the subclavius muscle?
Actions: Anchors & depresses clavicle
Blood Supply: clavicular branches of thoracoacromial arterial trunk
Innervation: “nervce to subclavius” (C5, C6)
What are the actions, blood supply, and innervation of the serratus anterior muscle?
Actions: Protracts and rotates scapula and holds scapular against thorax
Blood supply: Lateral thoracic artery
Innervation: Long thoracic nerve (C5,C6,C7)
What are the 3 divisions of the subclavian artery that are in relation to the anterior scalene muscle?
Part 1 = medial to anterior scalene muscle
Part 2 = posterior to anterior scalene muscle
Part 3 = lateral to anterior scalene muscle
Subclavian artery arises posterior to sternoclavicular joint
What 2 large named arteries have tributaries that provide blood to the pectoral shoulder and axillary regions?
Subclavian artery - runs underneath clavicle where it becomes axillary
Axillary artery - starts underneath clavicle & runs underneath pectoralis minor
What are the branches of the medial portion of the subclavian artery? In respect to the anterior scalene muscle
1. Vertebral artery
2. Internal thoracic artery (internal mammary)
3. Thyrocervical arterial trunk
What anterior arteries branch off the thryocervical arterial trunk? (4)
Suprascapular artery
Transverse cervical –> deep branch, superficial branch
Ascending cervical artery
Inferior thyroid artery
What posterior branches arise from the subclavian artery? (2)
Supreme intercostal artery
Deep cervical artery
via the costocervical arterial trunk
What could potentially arise on the lateral portion of the subclavian artery, what can potentially arise?
Potentially: dorsal scapular artery (can also arise from the transverse cervical artery)
Always Laterally: Axillary artery
What’s involved in the apex of the axilla boundaries? (3)
Clavicle - anteriorly
Scapula - medially
1st rib - posteriorly
What contributes to the base of the boundaries of the axilla? (4)
Skin & Superficial fascia
Anterior axillary fold; pectoralis major
Posterior axillary fold; latissimus dorsi, tere major
Chest wall; serratus anterior
What are the components of the anterior wall of the bondaries of the axilla? (4)
Clavicle
Subclavius
Pectoralis major
Pectoralis minor
What are the components of the posterior wall of the boundaries of the axilla? (4)
Scapula
Subcapularis
Latissimus dorsi
Teres major
What are the lateral components of the boundaries of the axilla? (3)
Bicipital groove (interrubercular sulcus)
Tendon of long head of biceps
Coracobrachialis tendon
All humerus
Where do the nerves of the brachial plexus originate from?
Ventral rami of cervical and thoracic spinal nerves C5-T1
What is a result of injury to the superior trunk (C5 & C6 spinal nerve roots), sensory and motor deficits?
“Erb’s” Palsy; via excessive, forceful increase in angle b/w neck and shoulder
Sensory deficits: Lateral aspect of upper limb
Motor deficits: Loss of arm abductionm, elbow flexion & forearm supination, weakness of wrist extension
“Waiter’s tip” position
What is a result of injury to the inferior trunk (C8 & T1 spinal nerve roots), sensory and motor deficits?
“Klumpke’s” Palsy
Sensory: Medial aspect of upper limb (except axilla)
Motor: Loss of precision finger movements, weakness in forearm pronation, wrist & finger extension, and wrist & finger flexion
“claw-hand”, attempted extension but 4th & 5th digits stay flexed
What is a result of injury to the radial nerve (C5-T1 spinal nerve roots)?
Mid-shaft fractures of humerus or axilla compression (crutches)
“wrist drop” “Saturday night palsy”
Extensors compartments affected
What is a result of injury to the axillary nerve (C5 & C6 spinal nerve roots)?
Via fractures to surgical neck of humerus or glenohumeral joint dislocation; improper use of backpack (Quadrangular space syndrome); impaired or lost function of deltoid & teres minor
Paresthesia and/or pain w/ along course of nerve
Patient cannot fully abduct arm, possible inability to laterally rotate arm
What is a result of injury to the long thoracic nerve (C5,C6,C7 spinal nerve roots), sensory and motor deficits?
Damaged nerve during surgical removal of lymph nodes or other tissues in axillary region; penetrating trauma to axillary region
serratus anterior affected
“winged scapula”; inability to raise arms past 90 degrees
What is a result of injury to the ulnar nerve (C8, T1, often C7 spinal nerve roots), sensory and motor deficits?
Via fracture of medial epicondyle of humerus; fracture of proximal ulna; slashed wrist
Damage can involved wrist and digit flexors, intrinsic hand muscles
Radial deviation at wrist join, loss of ab- adduction of fingers, weak wrist flexion, some loss of digit flexion
What is a result of injury to the median nerve (C6-T1 spinal nerve roots), sensory and motor deficits?
Via fracture of humerus above condyles; slashing of wrist, inflammation or irritation in carpal tunnel; Carpal Tunnel Syndrome
Flexors of wrist and digits affected, & intrinsic hand muscles (usually thumb; digit 1)
“Pope’s Blessing”; attempted flexion where 2nd & 3rd digits are left extended;“Ape Hand”
Which muscle extend the head?
Longissimus
Splenius capitis & cervicis
Spinalis capitis & cervicis
Semispinalis
Rotatores
Muscles of the Suboccipital Triangle
What muscles elevate the scapulae?
Trapezius
Rhomboids major & minor
Levator scapulae
What muscles retract the scapulae?
Trapezius
Rhomboid major & minor
What muscles rotate the scapulae?
Trapezius
Rhomboids major & minor
What muscles medially rotate the body of the humerus/shaft?
Latissimus Dorsi
What muscles retract the scapulae?
Rhomboid major & minor
What muscles extend the neck?
Iliocostalis Cervicis
Splenius capitis & cervicis
Longissimus Cervicis
What muscles extend the spine?
Iliocostalis Thoracis & Lumborum
Longissimus Thoracis
Spinalis Thoracis
What muscles laterally bend the neck?
Iliocostalis Cervicis
Longissimus Cervicis
Semispinalus Cervicis
What muscles laterally bend the spine?
Iliocostalis Thoracis & Lumborum
Longissimus Thoracis
Semispinalis Thoracis
Multifidus
What muscles are involved in the dynamic support of the arch of the foot?
APHLI
Anal Play Has Long Interactions
Tibialis Anterior
Tibialis Posterior
Flexor Hallicus Longus
Fibularis Longus
Intrinsic plantar muscles
What structures are involved in Passive Support of the Dynamic Arch of the foot?
PSLP
P.S. Let’s Play
Plantar aponeurosis
Short plantar ligament
Long plantar ligament
Plantar calcaneonavicular ligament
What is a unique characteristic of the gastrocnemius?
Lateral head may contain a sesamoid bone close to its proximal attachment
Fabella (3-5% people)
May possibly assit as a leverage; during knee replacement, can become cracked and cause pain in individuals
What is the function of the gastrocnemius?
Plantar flexion
Flexes leg at knee joint
Most superficial posterior compartment muscle of the lower leg
What is the function of the soleus muscle? Characteristics?
Plantarflexion
Broad, flat multipennate muscle
Lies deep to gastrocnemius
Forms a tripartite muscle w/ gastrocnemius = “triceps surae” = forms calf prominence
What does the “triceps surae” of the lower leg consists of and what does it form?
Forms the calf prominence
Soleus muscle joining with the gastrocnemius = tripartite muscle
What is the function of the plantaris muscle?
Weak plantarflexion and leg flexion
What is the function of the popliteus muscle? Characteristics?
Unlocks extended leg by laterally rotating femus on a stationary tibia
Weakly extends the leg
Thin, flat triangular muscle
Forms the inferior border of popliteal fossa
Deep to plantaris
What is the function and characteristics of the flexor hallicus longus muscle?
Flexes great toe
Plantarflexes foot at ankle joint
Lies deep to soleus; largest deep posterior muscle
Passes inferiorly deep to flexor retinaculum
What is the largest deep posterior muscle? What is its function?
Flexor Hallucis Longus
Flexes great toe; Plantarflex foot at ankle joint
What is the function of the flexor digitorum longus muscle?
Flexes lateral four digits
Plantarflex foot at ankle joint
What is the function of the tibialis posterior?
Inversion
Plantarflexion
List the 5 components that run past the ankle laterally
Tom, Dick, a.n. Harry
Tibialis posterior
Flexor digitorum longus
Posterior tibial artery
Tibial nerve
Flexor Hallucis longus
What nerve innervates the posterior leg muscles?
Tibial Nerve branch of sciatic nerve
Deep to soleus
Explain how the posterior tibial artery is related to clinical anatomy
Can be palpated if patient has cold feet or is losing sensation
Palpated between posterior surface of medial malleolus and medial border of calcaneal tendon
Deep to flexor retinaculum
What are the crural/leg fascias? (3)
Fascia lata
Crural fascia
Extensor retinaculum
What is the function of the tibialis anterior muscle?
Dorsiflexion
Inversion of foot
What is the function of the extensor digitorum longus muscle?
Extends lateral four digits
Dorsiflexion
What is the function of the fibularis tertius muscle?
Dorsiflexion
Eversion of the foot
What is the function of the extensor hallucis longus?
Extends hallux
Dorsiflex ankle
What nerve(s) supplies the anterior compartment muscles?
Deep fibular nerve
One of the two terminal branches of the common fibular nerve (begins b/w fibula and fibularis longus muscle)
Runs inferomedially w/ anterior tibial vessels b/w tibialis anterior and extensor hallucis longus
What does the deep fibular nerve innervate other than the anterior compartment muscles?
Ankle joint and metacarpel phalangeal joints
Dorsal intrinsic foot muscles
Skin b/w 1st and 2nd digits
(only cutaneous innervation of foot)
What artery supplies the anterior compartment of the leg?
Anterior tibial artery via popliteal artery
What is the function of the fibularis longus muscle?
Eversion
Plantarflexion
What is the function of the fibularis brevis muscle?
Eversion
Plantarflexion
Runs deep to fibularis longus muscle
What nerve supplies the lateral leg compartments?
Superficial Fibular Nerve
What occurs with damage to the common fibular nerve?
Paralysis of all anterior and lateral crural muscles
Footdrop = loss of dorsiflexion and eversion
What causes shin splints?
Repetitive microtrauma to tibialis anterior
inducing small tears to periosteum over tibia
What muscles are involved with layer 1 of the plantar aspect of the foot? (3)
Abductor digiti minimi
Flexor digitorum brevis
Abductor Hallucis
List the 3 fascia of the foot on the dorsum, sole, and plantar
Dorsum = continuous w/ extensor retinaculum
Sole = Plantar fascia thickens to become plantar aponeurosis = Plantar
What are the roles of the foot muscles located on the sole?
Help maintain foot arches
Standing on uneven ground
What muscles are involved in the 2 layer of the foot? (2) What are their functions?
Quadratus plantae
Assists flexor digitorum longus in flexing lateral four digits, if absent, toes will be pulled laterally; keeps toes straight when flexed; corrects the line of pull of the flexor
Lumbricals
Flex mp joint
Extend pip and dip joints
What nerves supply the sole of the foot?
Medial and Lateral Plantar Nerve
Supplies Plantar skin
Appears in second foot layer
What muscles of the foot do the medial plantar nerve innervate?
Larger of the two terminal branches of the tibial nerve
Abductor Hallucis
Flexor digitorum brevis
Medial 1 lumbrical
Flexor hallucis brevis
All others are innervated by lateral plantar nerve
What nerve is derived to form the blood supply of the sole of the foot?
Posterior tibial artery
Divides deep to abductor hallucis to form medial and lateral plantar arteries
What bones form the foot arch? What is the function and what are the two foot arches?
Tarsal and Metatarsal bones
Absorbs shock during weightbearing
Makes foot adaptable to surface and weight changes
Longitudinal (medial & lateral parts) and Transverse Arch (runs b/w medial & lateral longitudinal arches)
