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MRCSalah anatomy > Limb anatomy exam > Flashcards

Limb anatomy exam Flashcards

1
Q

Attachments of gluteus maximus

A

Originates from lateral sacrum, coccyx and gluteal surface of ilium at posterior gluteal line

INsertion: gluteal tuberosity

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2
Q

Attachments of gluteus medius

A

-Originates from gluteal surface of ilium, between posterior and anterior gluteal lines
-Inserts into lateral surface of greater trochanter

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3
Q

Attachments of gluteus minimus

A

Originates from gluteal surface of ilium between anterior and inferior gluteal lines
Inserts on anterior greater trochanter

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4
Q

Attachments of piriformis:

A

Anterior sacrum
INserts superior aspect greater trochanter

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5
Q

What is the attachment of the iliotibial tract/

A

-Origin; Tubercle of iliac crest
-Insertion: lateral tibial condyle

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6
Q

What muscles insert into iliotibial tract?

A

-Tensor fascia lata
-Gluteus maximus

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7
Q

What is the clinical significance of iliotibial tract?

A

-Stabilises knee in extension and in partial flexion. Is important in walking/running

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8
Q

Origin and insertion of quadriceps

A

-Vastus medialis: medial linea aspera–> Medial patella
-Vastus lateralis: lateral linea aspera –> lateral patella

-Vastus intermedius: proximal anterior femoral shaft –> patella

-Rectus femoris:
–> straight head: anterior inferior iliac spine
–> reflected head: acetabular rim
–> insertion: patella and tibial tubercle

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9
Q

Origins and insertions of the hamstrings

A

Origin:
–> All ischial tuberosity except for short head of biceps femoris (linea aspera_

Insertion:
–> biceps femoris: fibular head
–> others: Medial tibia/tibial condyle (membranosus

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10
Q

innervation of hamstring muscles

A

All tibial except for short head of biceps (peroneal)

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11
Q

What are the actions of the hamstring muscles?

A

-All 3 muscles: flexion of leg at knee, extension of thigh at hip

Biceps:
-Lateral rotation of hip and knee

Semitendinosus and semimembranous:
–> medially rotate thigh at hip joint and leg at knee joint

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12
Q

What structures are at risk in supracondylar fracture of the femur?

A

-femoral/popliteal artery
-femoral nerve
-hamstrings/quadriceps/their tendons
-tendons/ligaments of the knee joint

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13
Q

What runs in femoral canal?

A

Fat
lymphatics
Cloquet’s node
Femoral branch of genitofemoral nerve

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14
Q

Point out lateral cutaneous nerve of thigh

A

.

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15
Q

What happens with transection of femoral nerve

A

Loss of knee extension
Also supplies hip flexors (depending on level): pectineus, iliacus, sartorius

Sensation
–> anteromedial thigh (anterior cutaneous branches of femoral nerve)
–> medial leg and foot (saphenous nerve)

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16
Q

What does the saphenous nerve innervate?

A

Medial lower leg
Medial foot

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17
Q

What nerve innervate biceps femoris?

A

Short head: Peroneal nerve
Rest: tibial nerve

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18
Q

Sensation lower leg

A

Thigh
-Lateral: lateral femoral cutaneous nerve (lumbar plexus)
-Medial: medial femoral cutaneous nerve (femoral nerve)
-POsterior: posterior femoral cutaneous nerve

Lower leg

Superficial peroneal: anterolateral, dorsum of foot except first webspace

Deep peroneal: First webspace

Sural: lateral foot and lower leg

Saphenous: medial foot and lower leg

Sole: medial and lateral plantar nerves from tibia (lateral is in ulnar nerve distribution)

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19
Q

Action of nerve innervating biceps femoris

A

: Tibial nerve innervates posterior compartment of the leg and sole of the foot

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20
Q

What is the innervation of gluteus medius?

A

-Superior gluteal nerve (L4-S1)

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21
Q

Attachments of deltoid ligament

A

Superior:
–> medial malleolus

Inferior:
–> Tuberosity of navicular
–> neck and body of talus
–> sustetaculum tali on calcaneum/spring ligament

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22
Q

What are the parts of the deltoid ligament?

A

-Anterior tibiotalar (deep)
-Tibionavicular
-Tibiocalcaneal
-posterior tibiotalar

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23
Q

What are the parts of the lateral collateral ligament?

A

-Anterior talofibular
-POsterior taloribular
-Calcaneofibular

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24
Q

What are the parts of the syndesmosis?

A

-Anterior inferior tibiofibular ligament
-Posterior inferior tibiofibular ligament
-Interosseous membrane
-Inferior transverse tibiofibular (deep fibres of posterior tibiofibular)

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25
Q

What is the midtarsal joint of chopart?What type of joint is it?

A

-Articulation of calcaneus with the cuboid (calcaneocuboid joint) (saddle)
-Articulation of the talus with the navicular (talocalcaneonavicular joint (ball and socket)

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26
Q

What movements occur at the subtalar (talocalcaneal) joint?

A

-Inversion and eversion of the foot

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27
Q

Which muscles perform inversion and eversion?

A

-Inversion: tibialis anterior and posterior (with some help from the extensor and flexor hallucis longus muscles)
-Eversion: peroneus longus and brevis

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28
Q

What is the type of the subtalar (talocalcaneal) joint?

A

Synovial plane joint

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29
Q

What is the type of the ankle (talocrural) joint?

A

Synovial hinge joint

30
Q

What are the bones forming the ankle joint

A

Trochlear surface of the talus, lower end of tibia and fibula

31
Q

Movements at the ankle joint and muscles?

A

Plantar flexion:
-all muscles except popliteus

Dorsiflexion:
-All muscles naterior compartment

32
Q

Why is the ankle joint most stable in dorsiflexion?

A

-Wider anterior side of trochlea is immobilised by tibial articulation
-In plantarflexion, the narrow posterior side is articulating more and so more movement is possible

33
Q

What is the type of inferior tibiofibular joint?

A

-A syndesmosis joint

34
Q

What is the associated injury in syndesmotic fracture?

A

Fractures of the lateral malleolus

35
Q

What makes up the achilles tendon?

A

-Soleus
-Gastrocnemius
-Plantaris

36
Q

Structures passing behind medial malleolus

A

as previous

37
Q

Structures deep to extensor retinaculum

A

Tibialis anterior
Extensor hallucis longus
Anterior tibial vessels
Anterior tibial nerve
Extensor digitorum longus
Peroneus tertius

Tom has very nice dogs and pigs

38
Q

What are the arteries of the foot?

A

Dorsalis pedis:
-continuation of anterior tibial and begins as anterior tibial crosses ankle joint
-Crosses tarsal bones and then passes inferiorly as deep plantar artery

Medial and lateral plantar arteries
-Supply the sole of the foot
-Branches of the posterior tibial artery
-lateral plantar artery forms plantar arch with dorsalis pedis

39
Q

Where would you palpate dorsalis pedis and posterior tibial?

A

-DP: lateral to EHL tendon
-PT: halfway betwween posterior border of medial malleolus and achilles tendon

40
Q

Demonstrate the foot pulses on this actor?

A

-DP found between first two metatarsals
-PT: 2-3cm below and behind medial mal

41
Q

What movements does EHL perform?

A

-Extension of big toe
-Dorsiflexion of foot
-Assists with inversion of foot

42
Q

What vessels would you find deep to EHL

A

Anterior tibial artery and vein

43
Q

What nerve lies deep to EHL?

A

Deep peroneal nerve

44
Q

Where would you test sensation of S1?

A

`Lateral aspect of foot

45
Q

Where would you test L4?

A

Medial malleolus

46
Q

Where would you test deep peroneal nerve/superfiical/sural?

A

-1st webspace
-Superfiical : dorsum of foot
-Sural: lateral malleolus

47
Q

At what joint does dorsiflexion occur?

A

-Ankle joint between tibia/fibula and talus

48
Q

What muscles are involved in dorsiflexion?

A

-Tibialis anterior
-EHL
-Extensor digitorum longus
-Peroneus tertius

49
Q

What muscles are involved in plantarflexion?

A

-Posterior compartment except for popliteus (superficial and deep)

50
Q

What action occurs when tibialis anterior and posterior contract together?

A

=Inversion

51
Q

At which joint does inversion occur?

A

-Subtalar joint

52
Q

What muscles are responsible for ankle eversion?

A

-Peroneus brevis and longus

53
Q

Which nerve innervates peroneus brevis and longus?

A

-Superfiical peroneal nerve

54
Q

What motor and sensory function is lost with damage to superficial peroneal nerve?

A

-Inability to evert the foot and loss of sensation over the dorsum of the foot, apart from the first web space which is innervated by the deep peroneal nerve

55
Q

Identify the lower limb dermatomes

A

L1: groin crease
L2: lateral thigh
L3: medial lower thigh
L4: medial malleolus (medial lower leg)
L5: second toe
S1: little toe
S2: posterior thigh

SOle:
–> medial sole; L4
–> mid sole: L5
–> lateral: S1

56
Q

What are the myotomes of the lower limb?

A

-L2 hip flexion
-L3 knee extension
-L4: dorsiflexion
-L5: toe extensors
-S1: plantarflexion

57
Q

Origins of peroneus longus, brevis and tertius

A

Peroneus longus

Origin: superolateral fibula, lateral tibial condyle

Insertion: crosses under foot and attaches to bones on the medial side–> medial cuneiform and the base of the 1st metatarsal

Peroneus brevis
-originates from inferolateral surface of fibular sharft
–> Attaches to tubercle on 5th metatarsal

Peroneus tertius
–> O: medial fibula
–> I: 5th metatarsal

58
Q

Tibialis anterior and posterior origin and insertion

A

Anterior:
–> O: lateral surface of the tibia
—> I: medial cuneiform bone and the base of metatarsal I.

Posterior
-O: posterior surface and interosseous membrane of the tibia and fibula.

-I: medial tarsal bones.

59
Q

Extensor hallucis longus and extensor digitorum attachments

A

EHL
Attachments:
O: fibular shaft.
I: base of the distal phalanx of the great toe.

Extensor digitorum

Originates from the lateral condyle of the tibia and the medial surface of the fibula.
The fibres converge into a tendon, which travels onto the dorsal surface of the foot.
The tendon splits into four and each tendon inserts onto a toe(middle and distal phalanges)

60
Q

What arches are there of the foot?

A

Medial longitudinal
Lateral longitudinal
Transverse

61
Q

What forms the medial longitudinal arch?

A

Calcaneus, talus, navicular
3 cuneiform
3 medial metatarsal

62
Q

What is the function of the medial longitudinal arch?

A

High arch concerned with the elastic propulsion of the foot during walking

63
Q

What are the factors maintaining the medial longitudinal arch?

A

Ligaments
–> interosseous ligaments
–> plantar aponeurosis
–> long plantar ligament
–> Deltoid and spring ligaments (plantar calcaneonavicular ligament)

Muscles
–> Tibialis anterior and posterior
–> short muscles of the big toe
–> FHL

64
Q

What forms the lateral longitudinal arch?

A

Calcaneus
Cuboid
2 lateral metatarsal

65
Q

What is the function of the lateral longitudinal arch?

A

Low arch concerned mainly with body weight transmission

66
Q

What supports the lateral longitudinal arch?

A

Ligaments
–> interosseous ligaments
–> plantar aponeurosis
–> short planter ligament

Muscles
–> 3 peronei muscles
–> short muscles of little toe

67
Q

What are the components of the transverse arch?

A

-Cuboid, 3 cuneiform
-Bases of metatarsals

68
Q

What is the function of the transverse arch?

A

Elastic propulsion of foot and body weight transmission

69
Q

What are the factors maintaning the the transverse arch?

A

Ligaments
–> interosseous ligaments

Muscles
–> peroneus longus
–> Transverse head of adductor hallucis

70
Q

Identify ligaments on medial and lateral aspects of the ankle?

A

Deltoid
–> anterior tibiotalar (deep)
–> tibionavicular
–> tibiocalcaneal
–> posterior tibiotalar

LCL:
–>Anteiror talofibular
–> posterior talofibular
–> calcaneofibular

71
Q

Origin and insertion of deltoid

A
72
Q

Name structures that run on extensor aspect (dorsum) of foot

A

TEA DEPt
Tibialis anterior
EHL
Anterior tibial artery
Deep peroneal nerve
EDL
Peroneus tertius

MRCSalah anatomy (15 decks)

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