Gross Anatomy Exam 1 - weeks 1-4 Flashcards
What are the muscles of the 2nd layer of the sole of the foot and what do they do?
Quadratus plantae - assists flexor digitorum longus in flexion of 2-5 digits Lumbricals - Flex proximal phalanges, extend middle and distal and phalanges of 2-5
What does the superficial layer of the extrinsic back muscles do?
It controls the upper limb. It also connects the axial skeleton with the superior appendicular skeleton.
What innervates the posterior arm muscles?
The radial nerve.
What is the blood supply of the latissimus dorsi?
The thoracodorsal artery.
What is the origin and insertion of the subscapularis?
O: subscapular fossa I: lesser tubercle
Where does the semitendinosus insert?
The medial tibia.
What does the ischiofemoral ligament do?
Stabilizes the hip joint posteriorly.
What’s more lateral, the extensor carpi radialis longus or brevis?
Longus is more lateral.
What are the palpable structures on the back?
Vertebra prominens (C7) Scapular spine (T4) Medial border of scapula Inferior angle (T7/T8) Iliac crest (L4) Posterior superior iliac spine Acromion Greater tuberosity Ribs 6-12 Anterior superior iliac spine Sacrum Greater trochanter Ischial tuberosity
What is Erb-Duchenne palsy and how is it caused?
“Waiter’s tip” deformity, shoulder medially rotated and extended and adducted, forearm pronated. Deltoid, brachialis, biceps brachii paralyzed. Caused by a separation of head and shoulder (labor dystocia) during birth. An upper brachial plexus (C5 and C6) injury.
What is the innervation of the infraspinatus?
The suprascapular nerve (C5).
What are the fascia of the breast/pectoral region?
Deltoid, Axillary, Pectoral, Clavipectoral.
What is the insertion of the latissimus dorsi?
The intertubercular sulcus of the humerus.
What are the nerve roots of the tibial nerve?
L4-S3.
What is the insertion of the obturator internus and the superior and inferior gemellus?
The trochanteric fossa.
What is the innervation of the supraspinatus?
the suprascapular nerve (C5).
What is the insertion of the trapezius?
The acromion and spine of the scapula.
What are some general symptoms of breast cancer?
Lymphedema, swelling, peau d’orange, can feel palpable nodes.
What is psoas major innervated by?
The anterior rami of L1-L3. An exception to the anterior thigh muscles.
What does the plantar reflex test?
The tibial nerve, roots L4-S2. The normal response is flexion - abnormal is Babinski’s sign.
Where does breast lymph go?
To the subareolar lymphatic plexus.
What can a humeral shaft fracture result in?
Tranverse - deltoid pulls proximal fracture laterally. Spiral - may cause shortening. Damage to the triangular interval (radial nerve and deep artery of the arm).
What is the name of the deep fascia of the leg?
Crural fascia.
What’s the only medial thigh muscle that only adducts, doesn’t flex the thigh.
Adductor longus - obturator externis doesn’t flex the thigh either, it laterally rotates the leg and steadies the head of femur in the acetabulum.
Where does the nervous innervation to the breast come from?
The anterior and lateral cutaneous branches of the 4-6th intercostal nerves.
What’s the name of the deep fascia of the foot?
The pedal fascia.
Describe the terminal branches of the brachial plexus.
Axillary - posterior cord (C5,C6) Radial - posterior cord (C5-T1) Musculocutaneous - lateral cord (C5-C7) Ulnar - medial cord (C8-T1) Median - lateral and medial cord (C6-T1)
Which anterior thigh muscle has its own innervating branch?
The vastus medialis - has a branch of the femoral nerve called nerve to vastus medialis.
How many vertebral bodies are there?
- 7 cervical, 12 thoracic, 5 lumbar, 5 sacral (fused), and 4 coccygeal (fused after age 30).
What do the carpals articulate proximally with?
The radius.
What is the cutaneous innervation of the radial nerve?
Basically the entire posterior compartment of the arm and the forearm.
Describe the ankle joint. What’s another name for it?
aka the talocrural joint. Uniaxial, hinge-type joint. Made up of tibia, fibula, and trochlea of talus.
What is the insertion of the triceps brachii?
The olecranon process.
What are the dorsum intrinsic muscles and what innervates them?
Extensor digitorum brevis and extensor hallucis brevis. The deep fibular nerve.
What is polythelia?
Extra nipples.
What and where is the lumbar cistern?
An enlargement of subarachnoid space between the conus medullaris and the end of the dural sac around S2. Around L4 through this is where you do spinal anaesthesia or a lumbar puncture.
What are the important portions of the ulna?
Olecranon process, coronoid process, trochlear notch.
What are the muscles of the anterior compartment of the arm? What are they innervated by? What is their blood supply?
Biceps brachii, coracobrachialis, brachialis. Musculocutaneous nerve Brachial artery
What innervates the popliteus? What is its action?
The tibial nerve. Weak knee flexion / unlocks knee joint by rotating femur 5 degrees laterally on fixed tibia (or tibia 5 degrees medially on fixed femur).
Where are the capitulum and trochlea relative to each other?
Capitulum is lateral, trochlea is medial.
Tell me about the sciatic nerve.
It is the largest nerve in the body. It has L4-S3 nerve roots. divides into the tibial and common fibular nerve in the greater sciatic foramen, under the piriformis, and travels in its divisions posterior to the knee. 12% of people have nerve variations where it branches earlier or one branch travels above/through the piriformis. Damage can be be fround medial buttock injury/surgery, trauma to posterior thigh, posterior dislocation of the femural head) It also gives rise to the superior and inferior gluteal nerves.
What is the dorsal venous arch made of?
The small and great saphenous veins.
What muscles do contralateral head rotation?
Sternocleidomastoid Semispinalis capitis
Besides wrist flexion, what are the actions of flexor carpi radialis and flexor carpi ulnaris?
Flexor carpi radialis abducts the hand, flexor carpi ulnaris adducts the hand.
What is the name of the arterial arch on the dorsum of the foot? What’s it made of?
The arcuate arch. The lateral tarsal artery and the dorsalis pedis artery, both of which come from the anterior tibial artery. It anastomoses with the deep plantar arch.
What makes up the cutaneous innervation of the posterior thigh and knee?
The posterior cutaneous nerve of the thigh (S1-S3).
What is the blood supply of the levator scapulae?
The dorsal scapular artery.
List the intrinsic back muscles.
The paraspinous muscles and the erector spinae group.
What are the thenar muscles and what innervates them?
Abductor pollicis brevis Flexor pollicis brevis Opponens pollicis The recurrent branch of tte medial nerve.
What do the 4 dorsal interossei do? What innervates them?
Abduct digits 2-4 and flex the metacarpophalangeal joints. The deep branch of the ulnar nerve.
What is the medial collateral ankle ligament made of?
AKA the deltoid ligament. The posterior and alterior tibiotalar, the tibiocalcaneal, and the tibiovanicular ligaments.
What is the action of the lateral leg muscles? What is the blood supply/innervation?
Eversion and weak plantarflexion. The perforating branches of the fibial and posterior tibial arteries and veins. The superficial fiibular nerve.
Where is a clavicular fracture most common?
At the junction of the middle and lateral 1/3 of the clavicle. The subclavian vein is just deep to the clavicle, can be affected.
What is special about the adductor magnus?
It has two heads and dual innervation. The hamstring division is innervated by the tibial division of the sciatic nerve. It also has an opening in its tendon called the adductor hiatus. The hamstring part originates at the ischial tuberosity and inserts on the adductor tubercle.
What is the innervation of the subclavius?
Nerve to subclavius (C5-6).
Where does the axillary artery become the brachial artery?
At the inferior border of teres minor.
What is genu varum?
Bowlegged
What is the action of serratus anterior?
Abduction of the arm and protraction of the scapular.
What is the facet/zygophasial joint?
Joint between two one vertebra’s superior articular facet (on articular process) and another’s inferior one.
What is the action of the coracobrachialis?
Adduct humerus, flex arm.
What is a hangman’s fracture?
Abrupt hyperextension of the neck breaks the pedicles of C2 posterior to the superior articular facets.
Describe the calcaneal tendon reflex. What if it ruptures?
Normal response plantarflexion - tests S1/S2 roots of tibial nerve. Rupture - cannot rise to tiptoes, bulge in posterior leg, palpable gap where it ruptured.
Where is the angle of Louis?
Around the 2nd rib - at T4/T5.
What is the origin and insertion of the infraspinatus?
O: Infraspinous fossa I: greater tubercle
What does the basilic vein travel with?
The medial antebrachial cutaneous nerve.
What is a back sprain?
Only ligamentous tissue is involved; no dislocation or fracture. It comes from strong contractions related to movement of the vertebral column.
What is the path of the spinal nerves?
They emerge laterally from the intervertebral foramina and divides into anterior and posterior branches.
What is the action of the supraspinatus?
It abducts the arm 0-15 degrees. It also stabilizes the glenohumeral joint.
What does superior gluteal nerve injury result in?
Weakness of hip/thigh adduction, inability to stabilize pelvis. A positive Trendelenburg’s sign is when you stand on one leg and the unsupported side pelvis drops.
What is special about the fibularis tertius?
Not every person has one, its belly blends in with the extensor digitorum longus, and it does weak eversion of the foot.
What is the axial skeleton?
The cranium, vertebral column, manubrium, sternum, and ribs. Everything else is the appendicular skeleton.
What nerve can a hamate fracture compress?
The ulnar nerve - runs underneath it in the Guyon’s canal.
What is a chance fracture?
It is an anterior crush fracture and also fractures along the transverse processes of the vertebra.
What is the name of the anastomosis of arteries around the knee joint?
The genicular anastomosis (genicular branches of popliteal artery)
What is a sentinel lymph node?
The first node to drain an affected area. Radioactive particles injected at least 3-4 hours prior to surgery. If tumour is in the medial breast, the SLN may be in the sternal/internal mammary chain.
What are the spaces of the scapulary/arm muscles?
Triangular - circumflex scapular artery. Quadrangular - axillary nerve and posterior circumflex humeral artery. Triangular interval - radial nerve and deep artery of the arm.
What is the innervation of pec major?
The lateral + medial pectoral nerve (C5-7).
What is a Volkmann’s contracture?
Sudden occlusion or laceration of the brachial artery resulting in a permanent contraction/flexion.
What innervates the gluteus maximus?
The inferior gluteal nerve.
What muscles are affected by ulnar nerve damage at the elbow?
The medial 1/2 of the flexor digitorum profundus. Cannot flex the DIPs of 4-5. Claw becomes less prominent “ulnar paradox”.
Where does the rectus femoris originate?
Anterior inferior ilia spine, and ilium superior to the acetabulum.
What are the symptoms of breast cancer that has invaded the subareolar space?
Retraction and deviation of nipples caused by shortening of ducts.
What provides cutaneous innervation to the lateral bit of the foot?
The sural nerve.
Where does the popliteus originate and insert?
Origin: lateral condyle of femur Insertion: Proximal posterior tibia
What does the cephalic vein travel with?
The lateral antebrachial cutaneous nerve.
What are the nerve roots of the sciatic nerve?
L4-S3.
What is the innervation of the pec minor?
The medial pectoral nerve (C8-T1).
What does the nerve to obturator internus innervate?
The obturator internus and the superior gemellus.
What do the 3 palmar interossei do? What innervates them?
Adduct digits 2, 4, 5 and flex the metacarpophalangeal joints. The deep branch of the ulnar nerve.
What is the action of the paraspinous muscles?
They act on the vertebral column to control movements and maintain posture.
Describe the route of the radial nerve.
Enters the arm posterior to the brachial artery medial to the humerus, anterior to the long head of the triceps. Descends inferolaterally *with the deep artery* in the radial groove, between the lateral and medial heads of the triceps. When lateral to the humerus it pierces lateral intermuscular septum as it moves to the forearm anterior to the lateral epicondyle, between the brachialis and brachioradialis.
What is Dupuytren’s Contracture?
The palmar fascia of the medial hand thickens, pulling the fourth digit in flexed.
How does the affected limb in an acquired hip joint dislocation present?
Shorter and medially rotated.
What is the path of the spinal accessory nerve / CN XI?
It goes from the cranium down the neck and back deep to the trapezius. It is relatively superficial and can be easily injured with a blunt or penetrating injury.
What is the insertion of pec minor?
The coracoid process?
What is claw hand and how is it caused?
It is weak finger abduction and adduction, medial hand numbness, clawing of digits 4-5. It is caused by medial elbow and wrist trauma - specifically trauma to the ulnar nerve.
What makes up the deep cubital fossa?
From medial to lateral, the biceps brachii tendon, brachial artery, and medial nerve.
What is ankylosing spondylitis?
It is an inflammatory form of spinal arthritis where >1 vertebral and/or sacroiliac joints fuse. It causes a hunched forward appearance and is more common in males than females.
What is the unhappy triad?
Torn anterior cruciate ligament, tibial collateral ligament, medial meniscus. Caused by a lateral hit to the extended knee or excessive lateral twisting of the flexed knee.
What makes up the sacral plexus?
The ventral rami of L4-S4. The lumbosacral trunk (L4, L5) also contributes to it.
What muscles are affected by ulnar nerve damage at the wrist?
Hypothenars, interossei, 3rd and 4th lumbricals. Cannot flex the metacarpophalangeal joints of 4-5, extend the IPs, or move digit 5.
What are the general mechanisms of the serine proteases?
Chymotrypsin: cleaves peptide after aromatic residues, small side chain that lets large hydrophobic residues bind. Trypsin: cleaves after Lys and Arg, has a negative side chain that binds with a positive side chain of the substrate. Elastase: cleaves Gly, Val, Ala, has small hydrophobic side chains that interact with also phobic residues in the substrate.
Which anterior arm muscles originate at the medial epicondyle?
Pronator teres Flexor carpi radialis Palmaris longus Flexor digitorum superficialis Flexor carpi ulnaris
What is winged scapula and how is it caused?
Serratus anterior paralysis, medial scapula protrudes if patient pushes against a wall. Caused by a lesion to the thoracic nerve - often by a surgery (mastectomy) and trauma to the lateral chest.
What is the difference between a dermatome and cutaneous nerve areas?
The cutaneous nerve supplies an area of sin related to a peripheral nerve and can contain fibers from several individual spinal nerves. Its areas overlap with dermatomes and are generally broader and wider than a single dermatome.
What are important portions of the radius?
Radial head + tuberosity.
Where does the fibularis longus insert?
In the medial cuneiform and the base of the 5th metatarsal.
What muscles make up the suboccipital triangle? What margins do they make up?
Rectus capitis posterior major - superomedial. Obliquus capitis inferior - inferolateral. Obliquus capitis superior - superolateral. The greater occipital nerve (C2) is inside the triangle.
What happens in the case of a posterolateral disc herniation?
It may spare the nerve at the level of injury but affect the one inferior.
What does through the adductor hiatus?
The femoral artery and vein move through it from anterior thigh to posterior knee (popliteal fossa), and change their names to the popliteal artery and vein.
How does supination of the arm occur?
The head of the radius swivels inside the annular ligament, against the capitulum and radial notch of ulna.
What are the symptoms of breast cancer that has invaded retromammary space, pectoral fascia, or interpectoral lymph nodes.
Pectoral fascia - rock-hard, fixed nodule. The breast elevates when the pec contracts.
What are the types of mastectomies?
Simple/total - breast tissue. Modified radical - breast tissue + lymph nodes. Radical - breast tissue + lymph nodes + muscle.
Differentiate between mallet hand, swan neck, and boutonniere deformity.
Mallet hand - hyperflexed DIP. Swan neck - hyperxetended PIP, flexed DIP. Boutonniere - flexed PIP, hyperextended DIP.
Describe the trunks of the brachial plexus.
Superior (C5 and C6) Middle (C7) and Inferior (C8 and T1)
What is a prefixed and a postfixed brachial plexus?
C4-C8 and C6-T2 respectively.
What is the action and origin of the gastrocnemius?
Plantarflexion when knee is extended, flexes leg at knee. Origin: the lateral and medial condyles of the femur.
What innervates adductor pollicis?
The deep branch of the ulnar nerve.
Describe elbow dislocation.
The most common is posterior dislocation, where the person falls on an extended, abducted arm. It hyperextends and the radius and the ulna are dislocated posteriorly relative to the humerus.
How any pairs of spinal nerves are there and where do they course.
- 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, one coccygeal. The cervical ones course superior to their vertebra (C8 above T1 vertebra), and the others course inferiorly.
What is the blood supply of the trapezius?
The transverse cervical artery.
Describe the drainage into the subclavian vein.
The basilic and brachial veins join into the cephalic vein, which joins with the axillary vein and goes into the subclavian.
Describe the venous drainage of the spinal cord.
3 anterior and 3 posterior spinal veins that communicate with each other and drain into the anterior and posterior medullary veins. They join the internal vertebral/epidural plexus (valveless) and communicate with the dural sinuses and then the vertebral veins. They also communicate with the external vertebral plexii on the external aspect of the vertebrae.
What is the adductor canal?
A fascial compartment posterior to sartorius thorugh which travel the femoral artery/vein, nerve to vastus medialis, saphenous nerve.
How can you identify the medial view of the foot?
The sustenaculum tali with the groove for the tendon of flexor hallucis longus. Also, the medial longitudinal arch is higher than the lateral one.
Quadriceps femoris is the anterior thigh. Quadratus femoris is the gluteal region.
Just a reminder!
What is a burst/Jefferson fracture?
4 breaks in C1 in the anterior and posterior arches. It comes from strong compression on the top of the head which drives the occipital condyles into the lateral masses of C1.
Where do the medial quadrants of the breast drain their lymph to?
The parasternal lymph nodes (they can also travel to the contralateral breast).
What are the muscles of the quadriceps femoris? Where do they insert?
Rectus femoris, vastus medialis, vastus intermedialis, vastus lateralis. They insert on the patella via the quadriceps femoris tendon, and the tibial tuberosity via the patellar ligament.
What are the spinal cord meninges and spaces?
The epidural space is filled with fat and is between the dura mater and vertebral column. The subdural space is only a potential (pathological) space and is between the dura mater and the arachnoid mater. The subarachnoid space is filled with CSF and is between the arachnoid mater and the pia mater.
Where do breast carcinomas usually come from?
Adenocarcinomas arising from the epithelial cells of the lactiferous ducts in the lobules.
What is Patellofemoral pain syndrome?
“Runner’s Knee”. It is pain/inflammation deep to the patella due to abnormal gliding over the femur surface. Causes: excessive downhill running, direct trauma to patella, weak vastus medialis, osteoarthritis.
What makes up the superficial cubital fossa?
The medial and lateral epicondyles on the top, the brachioradialis laterally, pronator teres medially.
What is the action of the piriformis?
It laterally rotates an extended thigh, abducts a flexed thigh. It exits through the greater sciatic foramen and so do the superior and inferior gluteal artery.
What is radial nerve palsy and how it caused?
Wrist drop, inability to extend wrist, loss of sensation from dorsum of thumb. Caused by trauma to the lateral albow or fracture to the midhumerus at the radial groove.
What is the innervation of teres minor?
The axillary nerve (C5-6) terminal branch.
What is a denticulate ligament?
It anchors the spinal cord to the dura mater at the midpoint between two spinal nerves.
What causes the hand of benediction?
Damage to the median nerve via supracondylar fracture.
Where do the flexor/extensor ulnaris and radialis originate?
At the base of the 5th and 2nd metacarpals respectively.
