lower limb Flashcards
1
Q
No patellar tendon reflex?
A
hermiation of IV discs - L2 - L3 or L3 -L4 - reflex decreased on affected side
nerve - FEMORAL
2
Q
No Achilles tendon reflex?
A
L5 - S1
3
Q
epidural - go thru what layers
A
skin, fascia, lig. flavum, into EPIDURAL space
4
Q
lumbar puncture - go thru?
A
skin, fascia, flavum, epidural space, dura mater into sub arach space
5
Q
filum terminale?
A
cord in dural sac - extends out of sac - past S4
6
Q
dural sac ends where?
A
L2
7
Q
Where do herniated discs most happen?
A
L4-5, L5-S1
C5-6, C6-7
usually compresses nerve one below - L4-5 compresses L5
30 - 50 y0
8
Q
spondylolisthesis?
A
Disc slip - can cause Lordosis
Spondylolisthesis is a spinal condition that affects the lower vertebrae (spinal bones). This disease causes one of the lower vertebrae to slip forward onto the bone directly beneath it. It’s a painful condition but treatable in most cases.
9
Q
What causes scoliosis?
A
lateral deviation - pilionyelitis, leg length discrepency, hip dieases
10
Q
Kyphosis caused by?
A
elderly - osterporosiss or IV disk degeneration
Thoracic area
11
Q
Lordosis caused by?
A
caused by can occur re pregnant or potbelly or spondylolisthesis
12
Q
upper limb fracture - clavile risk?
A
subclavian vessels and trunks of brachial plexus at risk re lie behind only the thin subclavius muscle
2/3 break - patient holds arm with other and
medial 2/3, lateral 1/3
13
Q
humerus fratures
A
Follow the ARM
Axil nerve + posterior humeral circuflex at surgical neck
radial nerve and profunda brachaii artery (aka deep brachial artery - branch from brachial) at mishaft - affects Brachialia muscle
median nerve and brachial artery at suprecondylar
ulnar nerve at medial epicondyle (funny bone
14
Q
fracture distal radius -
A
most common after 50 - 2 cm on distal radius
smith’s fracture - dorsal fall on flexed wrist - flexion fracture
Distal frag is anteriorly displaced
Colles - dinner fork deformity, trying to ease fall - often ulnarstyoloid process is avulsed (broken)
extension fracture
distal fragment displaced dorsally
15
Q
scaphoid fracture - what part will necrose?
A
proximal fragment
radial artery and superficial branch of radial nerve greatest at risk in this fracture
16
Q
Boxer fractures?
A
unskilled 5th metacarpal
skilled 2 and 3
necks of metacarpals broken
17
Q
mallet - basevall finger
A
DIP beings jammed - extreme frlexion - hyperflexion - avulse extensor digitorum tendon to based of distal phalanx - can’t extend DIP joint
18
Q
shoulder dislocation
anterior most common
dislocation most likely inferiorly - re no muscles there
A
most freq dislocted large joint? glenohumeral
anterior most common - muscle traction can pull dislocated humeral head into subcoracoid position
dislocation most likely inferiorly - re no muscles there
Infraspinature - lateral rotation
subscap - medial - pronation
19
Q
abduction upper limb?
A
1 - 15 - supraspinnouse - suprascap n
15 - 110
deltoi - axil n
100 - 180 trapezium, access n and Serratus anterior - long thoracic
20
Q
student elbow
A
olecrnon busitis - tricept tendon attaches -
21
Q
pulled elbow
A
kids - annular lig
adults - annular lig is TORN to dislocate
22
Q
tennis elbow
A
lateral epicondylitis - strain of common extensor tendon
origins of five muscles may be affects - extensor - carpi radialis longus, brevis, dititorum, digit minimi, carpit ulnaris
23
Q
golfer’s elbow
A
medial epicondylitis - inflamed common flexor tendon of wrist - where originated on medial epicondyle - origins of 4 m may be affected
pronator teres
flexor carpi radialis
palmaris longus
flexor carpi ulnaris
24
Q
arteries around scapula?
anastamoses?
A
blockage of subclavian or axillary can be bipassed via
thyrocervical trunk superiorly - transverse cervical, suprascapular
and subscapular inferiorly -
subscapular
curcumflex scapular
25
Cubital fossa
venipunture - median cubital vein - why? because it overlies bicipital aponeurosis, so deep structure protected and NOT acommpanied by nerves -
Contents - lateral to medial -
Biceps brachii tedon
Brachial artery
Median nerve
Subcutaneous structures from lateral to medial
Cephalic vein
median cubital vein
basilic vein
muscles surrounding?
pronator teries
The cubital fossa contains four structures, which from lateral to medial are:
SOME DON"T LIST RADIAL
the radial nerve.
he tendon of biceps brachii (biceps brachii is a muscle of the anterior compartment of the arm)
the brachial artery.
the median nerve.
26
carpal tunnel?
median nerve
palm sensation not affected re superficial palmar cutaneous branch passes superfilcially to tunnel
dislocation of LUNATE-
apehand deformity - lateral three digits can't move like they want
pins and needles
27
Pip and DIP?
Dip are DISTAL - tests -
PIP hold three fingers flexed, see how one moves on own
DIP hold all but last piece - see if last piece can move
28
erb palsy
three things don't work -
adducted shoulder
medially rotated arm
extended elblo
loss of sensation in lateral upper limb
axil nerve - posterior cord
musculocut - lateral cord
suprascap - superior roots
C5, c6 upper brachial plexus
fall on neck,shoulder or birthing problem
29
lower brachial plexus problem?
Thoracic outlet syndrome
klumpke paralysis - arm pulled at birth - or catch self on limb -
injury to lower roots and trunk - c8 - T1 or inferior trunk
impacts ulnar and median nerve
Claw and ape hand
30
horner syndrome may be combined with klumpke paralysis
Horner syndrome is a combination of signs and symptoms caused by the disruption of a nerve pathway from the brain to the face and eye on one side of the body. Typically, Horner syndrome results in a decreased pupil size, a drooping eyelid and decreased sweating on the affected side of your face.
31
sciatic nerve injury?
foot drop (lack of dorsiflexion)
Falil foot (lack of both dorsiflexion and plantar)
weakened hip extension and knee flexion
cause of injury - poor placement of gluteal injection - OR posterior hip dislocation
shot goes up by iliac crest
Piriformis is the landmark of the area
32
nerves of lower limb
| femoral L2 -4
anterior thigh - loss knee extension
33
obturator L2 -4
medial thigh
| Loss thigh adduction
34
Tibia L4 - S3
posterior thigh (except 0.5), leg and plantar foot
LOSS - plantar flexion, everted foot
35
common fibular L4 - S2
0.5 - short head of biceps femoris
foot drop, inverted foot
36
superficial fibular
Lateral leg (evertors) skin dorsum foot
inverted foot,
37
deep fibular
anterior leg and dorsum of foot (first web)
foot drop
38
superior gluteal - injury in surgery, posterior disloc of hip, or polio
glut mediu and min
Trendelenburg sign (opposite side) if right injured - left falls down - CONTRALATERAL to nerve injury
39
INFERIOR gluteal
glut max - climb stair prob or standing from seated position
40
ankle bone with no tendon or muscle attachement?
talus - between fib and tib
navicular anterior, calcaneous inferior
dorsiflex common break - slamming on breaks
necrosis possible re poor blood supply
41
ankle jerk reflex tests what nerve?
tibial n
terminal branch of sciatic (posterior compartment of leg)
42
sprained ankle, most common?
anterior talofibular lig
ankle most injured main joint in body
inversion twist injuries
most common ATL lateral
Calcaneousfiburluar lig MORE serious injury - if can't keep playing the game...
Pose
43
McMurry test?
popping when knee bent and rotating foot -
LIME (Lateral intermal, medial external)
Medial - valvus, external - Tears when force from LATERAL side "valateral" COMMON
RARE - Lateral Menicule Tear - varus forces, internal forces - force from medial side (spread legs)
44
most common ankle sprain?
ATF = Always Tears First -
anterior TaloFibular lig = over invert
45
Drawer signs?
checking KNEE injuries -
PCL - Posterior Drawer
ACL - Anterior Drawer LACKMAN (30) test also (more sensitive)
LAMP - Lateral Acl, Medial pcl
lateral/medial re condyles
46
Can't extend leg, blunted patellar reflex?
femoral nerve
47
Test - abnormal passive induction - tests for what?
MCL, LCL tears - Meniscus tears -
with (val) lateral force - if medial opens - MCL
with vagus force (from medial area) if lateral opens - LCL
48
trauma to knee - what may be cause other than trauma?
baker's cyst, tarsal tunnel syndrome (distal)
49
What type of ankle sprain is the most common?
The most common type of ankle sprain is the inversion sprain. This is what most people refer to as "turning or twisting" the ankle. The eversion sprain is another type of sprain. It occurs when the ankle turns outward causing the inner ligaments to stretch or tear.
50
Talus break when seen?
high impact, foot in exagerated dorsiflex position - stepping on brakes
51
calcaneous bone?
heel bone - largest, strongest - holds us up on our feet
52
cuboid bone of ankle?
most lateral bone -
53
BASS ?
sciatic nerve supplies -
biceps femoris: supply to short head arises from the common peroneal part, supply to long head arises from the tibial part.
adductor magnus: arises from the tibial part.
semitendinosus: arises from the tibial part.
semimembranosus: arises from the tibial part.
These muscles extend thigh from hip, flex leg at knee
BSS = Hamstrings
54
BSS = Hamstrings
biceps femoris: supply to short head arises from the common peroneal part, supply to long head arises from the tibial part.
semitendinosus: arises from the tibial part.
semimembranosus: arises from the tibial part.
55
calcaneal tendon reflex?
achilles reflex - tibial n. S1-2
56
taping ankle and keep playing?
ATL - Anterior Talofibular Lig
others more severe _
calcaneo
posterior talofib (most severe)
57
small saphenous harvested -
sural n.
terminal of femoral
numbness post leg, 5th toe
58
to test L1-L2?
cremasterie reflex
59
unique foot evolution of humans - what muscle?
fibularis tertitius - near 5th meta - eversion of foot.
60
deltoid lig in ankle?
excessive eversion - covers medial side of ankle.strong - so may cause avulsion to medial malleolus
61
plantar calcaneo lig of ankle?
plantar aspect of foot (spring) - high density elastic fibers -
62
calcaneo lig?
lateral ankle - resists inversion - as does anterior and Posterior talofib and (Anterior most common)
63
fracture greater trochanter - which muscles affected?
medius and min gluteus
64
ilipsoas inserts where on femur
lesser trochanter
65
biceps femoris attaches?
ischael tubersity to lateral fibula
66
sartoris attaches?
iliac crest - tibia medially
67
sneaky 11 yo - pushes friend at hip from back, what ligament resists anterior dislocation of head of femur?
YYYY???
iliofemoral lig-
Y structure
resists hyperextension - largest lig
68
lig of head of femur?
early life - blood to epiphysis of head of femur. - not a strong lig - but fame listed above
aka ROUND lig of head
69
tearing of sacrotuberous lig?
gluteus max. - lig runs from sacrum, coccyx to ischael tuberosity - stabilizes sacroiliac, and partially defines lesser sciatic foraman (with sacrospinours lig)
70
push out of starting blocks - - quads avulse tibial tubersoity - fragmenting it - m affected? can't straighten leg -
rectus femoris - loss of ability to extend knee - shows detachment
71
What muscle unlocks knee?
poplitius
72
fall, lands on foot - what torn when fractures sustentaculum tali?
FHL - flexus hallucis longus -
73
where is small saphenous vein often harvested for grafting?
at ankle crossing posterior to lateral malleolus
74
soldier - foot pain marching - what structure likely strained? FLAT FOOT
Spring lig - plantar calcaneo
fallen arches strains lig - wear on medial side of soles of shoes
75
extensor retinaculum?
two part band deep fascia across anteroinferior leg and dorsum of foot - binds and stabilitex extensor tendons emerging from anterior compartment of leg to pass into dorsum of foot
76
tendon of the fibularis?
peroneus longus muscle - very long tendon across foot to base of first metatarsal and medial cuneifomr.
77
great saphenous harvested - loss of sensation medial knee to ankle
saphenous n affected
78
lesser trochanter avulsed, what m?
iliopsoas
79
tibial collateral lig? TCL?
supports medial side of knee - valgus test -
valgus test abducts leg at knee
tearing TCL may tear/detach medial meniscus
ACL, TCL, and medial meniscus often damaged together in sports - when foot is planted and knee flexed (unhappy triad)
80
unhappy triad of leg?
The unhappy triad, also known as a blown knee among other names, is an injury to the anterior cruciate ligament, medial collateral ligament, and meniscus. Analysis during the 1990s indicated that this 'classic' O'Donoghue triad is actually an unusual clinical entity among athletes with knee injuries.
81
painful m spasms in thigh after lateral abdominal lymph surgery?
gracilis m, obturator n - may be damaged during abdominal lateral wall surgery
82
cut on soul of foot - to "depth of layer of first plantar m" - what is damaged?
abductor hallucis m
4 layers - superficial to deep
first layer - hallucis, abductor digiti minimi, flexor digitorum brevis
83
junkyard, fall and deep cut immediately posterior to lateral malleolus - what injured?
tendon of fibularis (peroneus) longus
84
dr checking patient ask patient touch heel to butt while resisting what muscles ?
hamstrings
85
What are the 4 compartments of the lower leg?
In the lower leg there are 4 compartments, the anterior (A), lateral (L), deep posterior (DP) and superficial posterior (SP). The bones of the lower leg (tibia and fibula), the interosseous membrane and the anterior intermuscular septum are the borders of the compartments.
86
number compartments in thigh?
```
three
Anterior compartment (pink) – Sartorius and quadriceps muscles (rectus femoris, vastus lateralis, vastus intermedius, vastus medialis).
```
87
posterior femoral compartment blood supply?
profunda femoris artery
gives off medial and lateral circumflex femoral art - then ~4 perforating arts. they pierce adductor magnus m to reach posterior compartment of thight
supply add magnus and hamstrings
88
nerves of posterior femoral compartment?
The hamstrings are innervated by the sciatic nerve, specifically by a main branch of it: the tibial nerve. (The short head of the biceps femoris is innervated by the common fibular nerve).
89
Thigh compartment syndrome ?
is uncommon and may go unrecognized. Signs and symptoms include a history of thigh swelling and/or hematoma and pain after minor injury in a patient who is anticoagulated.
90
gunshot in calf - severs posterior artery at origin - which vessels won't receive blood immediately?
fibular peroneal art.
91
how does popliteal art terminate?
divide to posterior/ anterior tibial arteries at lower border of popliteal m
92
dorsalis pedis artery comes from?
anterior tibial
93
inferior medial and lateral genicular arts are branches of?
popliteal art w/in popliteal fossa - proximal to terminal branch of popliteal art.
94
pulse of dorsalis pedis artery best taken where?
betw tendons of extensor hallucis longus and extensor digitorum longus
95
major nerves of lower limb?
femoral, L2 - 4 (extend knee, flex hip)
obturator L2 -4 thigh - adduct, rotate
Tibial L4 - S3 - flex knee, xtend thigh, TIPS
common fib L4 - s2
sup gluteal L4 - s1
inf gluteal L5 S2
96
nothing working below knee?
sciatic n
97
most freq damaged nerve of lower limb?
common fib where crosses lateral knee at neck of fib - foot drop, loss of eversion - sensory loss on lateral surf of leg and dosum of foot
98
what nerve can the piriformis muscle compress?
piriformis syndrome- when common fib nerve passes through piriformis insteada of inferior to muscle w/ tibila nerve
Piriformis syndrome is a condition in which the piriformis muscle, located in the buttock region, spasms and causes buttock pain. The piriformis muscle can also irritate the nearby sciatic nerve and cause pain, numbness and tingling along the back of the leg and into the foot (similar to sciatic pain).
99
sciatic damage during posterior hip dislocation?
yep -
100
Cardiac Catheterization route
Femoral artery - External iliac - common iliac, aorta, left ventricle
for left cardiac angiography
can visualize coronary arteries
101
What does a posterior hip dislocation mean?
ball forced out of joint, femoral head forced out of acetabulum - jt capsule ruptures (often in car accidents when knee strikes dashboard)
fracture of ishium, femoral head passes thru tear in capsule, tearing of ishiofemoral lig>
shortens and medial rotates limb
102
What will injury to sciatic nerve look like?
weakened hip extension and foot flesion
FOOTdrop
Flail foot
Why happen? injection in wrong place or posterior displaced hip
103
Fixing posterior hip dislocation may adversely affect what nerve?
superior Gluteal - Trendelenburg sign
contralateral to nerve injury
104
What's an avulsion fracture of hip and hamstring?
occurs where muscles attached to ischial tuberosity
Hamstrings muscles 3 - BSS
Biceps femoris
Semitendinosus
Semimembranosus
extension of hip join and flesion of knee jt
Nerve - Tibial - (short head of bicep femoris - Common Fibular)
105
What's an avulsion fracture? more common in certain places -
Hip, elbow and ankle most common locations for avulsion fractures in the young athlete.
An injury to the bone in a location where a tendon or ligament attaches to the bone. When an avulsion fracture occurs, the tendon or ligament pulls off a piece of the bone. Avulsion fractures can occur anywhere in the body, but they are more common in a few specific locations.
106
What is in the femoral ring?
The femoral ring is the base of the femoral canal. It is directed upward and is oval in form, its long diameter being directed transversely and measuring about 1.25 cm. Part of the intestine can sometimes pass through the femoral ring into the femoral canal causing a femoral hernia.
107
structures under inguinal ligament?
lateral to medial
```
iliopsoas m
femoral n
femoral art
femoral vein
femoral canal (ring)
```
followed by lacunar ligament
108
Where does a femoral hernia occur?
below inguinal lig through femoral ring into femoral canal - swell in upper thigh inferior and lateral to pubic tubercle
aberrant obturator artery at risk during repair
hernial sac may protrude through spahemous hiatus into superficial fascia -
more often in females - danger re strangulation of hernial sac
109
The saphenous nerve entrapment?
multiple locations along its long descending course from the thigh to the leg. Common sites of entrapment include the site where the nerve penetrates the roof of the adductor canal, or at the infrapatellar branch during knee surgery or varicose vein stripping surgery.
110
Superficial veins of Lower limb?
Great saphenous vein - medial - rises w/ saph n, to femoral vein
Small - lateral side - posterior leg w/ sural n - ends in popliteal vein - piercing popliteal fascia
111
Knee joint - unhappy triad?
lateral leg struck more - so tibial collateral lig is MOST freq torn lig in knee -
athletes -
1. tibial collateral lig MCL
2. medial meniscus
3. anterior cruciate lig ACL
The main difference between an ACL tear and an MCL tear is that an ACL tear will have a distinctive popping sound, while an MCL tear will not. MCL tears are typically easier to recover from than ACL tears. With an MCL tear, the recovery process may take up to eight weeks or more with rehabilitation.
112
Which is worse ACL or MCL tear?
There are 4 major ligaments in the knee. The ACL (Anterior Cruciate Ligament) is most likely to be considered the worst ligament in the knee to tear. ... Tearing the MCL (Medial Collateral Ligament) and the LCL (Lateral Collateral Ligament) is not as common as tearing the ACL.
113
acl vs pcl
The ACL, or anterior cruciate ligament, keeps the knee from sliding forward. The PCL, or posterior cruciate ligament, keeps the knee from sliding backward. An ACL or PCL injury occurs when the ligament has been torn. The tear may be partial or complete.
114
tight clothing problem what nerve?
lateral cutaneous nerve
115
to deaden femoral n - need to go thru what structure?
fascia iliaca
116
deep inguinal lymph
in this area of anterior thigh - what drains to it?
117
femoral canal - why there
to allow expansion of artery and vein during exercise - but can herniate here
118
femoral canal - why there
to allow expansion of artery and vein during exercise - but can herniate here
especially women
neck of hernia - will be the ring - need to push it back thru ring - may be irreducible - may need to cut boundary - LACUNAR LIGAMENT is only thing that can be cut
can strangulate - emergency
119
near lacunar ligamnet, if cutting... problem may be
obdurator art - the abnormal obdurator art
120
Gimbernat's ligament?
lacunar lig - another name - medial boundary of femoral ring
121
near lacunar ligamnet, if cutting... problem may be
obdurator art - the abnormal obturator art - if passes behind gimbernat's lig - it's a problem
if passes laterally to femoral canal - it is out of harm's way
122
inguinal vs. femoral hernia?
below inguinal lig - femoral
123
Triangle of doom?
can bleed to death
124
to push femoral hernia back in?
often need to push in a weird direction
125
where is femoral sheath?
funnel shaped, opening in fascia iliace - nerve behind ?
sruround femoral vessels 0 infront of vessels -
126
somettimes things lymph or other things sweeling there - is a hernia - but it isn't
lymph or saphenous?
127
femoral triangle?
floor - longus something -
roof - deep fascia of thigh (fascia lata)
posterior?
sartorius at the bottom, long part of the triangle
Contents:
sheath, nerve, artery, vein, (and their branches) canal, deep inguinal lymph nodes, fatty tissue
including Great saphenous vein - longest in body
128
femoral artery?
main artery of thigh, DEEP femoral artery or profunda femoris
external artery terminates at inguinal lig
femoral starts at Iguanal lig -
gives off big branch to deep femoral art, and continues on as femoral art
runs through abductor canal (medial, above knee)
pierces abductor hiatus
becomes popliteal artery
129
How long is femoral nerve?
1 inch - divides 1 inche after inguinal lig - divides into terminal branches - anterior and posterior
130
Branches of profunda femoris?
medial circumflex femoral, lateral circumflex femoral,
perforating arteries,
superficial inguinal tributaries 3)
DRAIN to Great Saphenous
131
"deeP in thigh"
deep to deep fascia - or fascia lata
132
obturator artery is a branch of ?
internal iliac artery
133
peripheral vascular disease PPPPP
pain after walking - blockage of arteries, pain only occurs when walking a certain distance
```
classic signs
Pulselessness
paralysis
paraesthesia
pain
pallor
```
134
femoral popliteal disease
exacerbated by walking
most common calf claudication
135
peripheral vascular disease PPPPP
pain after walking - blockage of arteries, pain only occurs when walking a certain distance
```
classic signs
Pulselessness
paralysis
paraesthesia
pain
pallor
```
Signs -
1.Ankel brachial index is less than 1
normally more than 1
2. blood flow using dopler ultrasongongraphy
136
PVD signs?
can cause ulcers - skin can be cool - PVD - shiny skin, decreased hair -
137
claudication distance -?
pain when walking a certain distance
treatment - stop smoking, eat better, ltd exercise, finally surgery - angioplasty
various types of bypass depending upon where the blockage is - often near knee
138
femoral vein -
begins at adductor hiatus - terminates when becomes external iliac vein
several valves -
tributaries - Great saphenous vein,
139
deep inguinal lymph nodes - where are they?
near iguanal lig - first one runs from glans penis
140
femoral nerve -
posterior, anterior
141
Saphenous nerve?
from femoral to skin over head of Great Toe (fist metatarsal) - travels with Great saphenous vein
supplies great toe
runs with femoral artery
in adductor canal
142
Adductor canal? middle third of thigh - beneath the sartorius
saphenous nerve, femoral artery, fem. vein, lymphatic vessel, Loos CT
from apex of femoral triangle to adductor tendinous opening
143
3 compartments in thight
anterior, posterior, medial
144
medial compartment?
obturator Art, obturator n, muscles?
obturator n divides post, anterior
adducts hip jt
145
anterior compartment
Femoral n -
extend knee
Muscles?
adductor brevis, longus
146
post comparment
sciatic n (tibial portion)
flexor compartment - extend thigh at hip and flex the leg at knee
"Flexor" compartment
147
anterior compartment
Femoral n -
extend knee
Muscles?
adductor brevis, longus
flex the hip with sartorius and rectus femoris (two two joint muscles - on knee and hip)
Artery - deep femoral artery
148
adductor canal is in which compartment?
anterior
149
3 compartments in thigh?
anterior, posterior, medial
150
Psoas major
Lumbar plexus within this muscle - ventral rami L1 - L3 innervate -
inserts lesser trochanter of femur
origina T12 - L5
151
Iliacus inserts to what of femur?
lesser trochanter with Psoas major
152
Iliopsoas Tendonitis?
can cause pain - over use or trauma - repetitive hip flexion
Pain in groin
starts after certain exercise
rested - pain became less
may radiate down anterior thigh toward knee (referred pain if pain in knee)
may hear click in groin
153
pectinius m
femoral n, may receive a branch from obturator too (hybrid m if two nerve supplies)
adducts / flexes hip
154
sartorius - tailor muscle - squats on ground -
long and thin, in front of thigh
femoral n, come from lateral hip to medial tibia -
flexes thigh
Sartor means tailor
155
sartorius - tailor muscle - squats on ground - this muscle - hip jt flexed when squating, laterally rotated
long and thin, in front of thigh
femoral n, come from lateral hip to medial tibia -
flexes thigh
Sartor means tailor
156
bursa where three m insert at tibia SGT at knee
Pes Anserine Bursitis
SGT - sartorius, gracilis, semitendinosus - three mus meet from 3 diffenent comparments -
PES Anserine bursa = can get inflamed - jogging, breast stroking,
157
rectus femoris - foot baller's action - two joint m
iliac spine to base of patella and patellar ligament to tibial tuberosity
femoral n
extends leg at knee -
foot baller's m - extends knee, flexes hip joint
158
vastus lateralis
greater trochanter and lateral lip of linea aspera of femur to base of patella and by patellar lig
femoral n
extends leg at knee joint
159
vastus intermedius
extends knee, femoral n, insert base of patella
160
vastus medialis
base of patella , etc
161
Quad dysfunction - L3 - L4
if no patellar reflex, may have L3-l4 disc herniation
knee jerk reflex - quads pull up, hamstrings relax
if can't walk up stairs - peripheral lesion
162
medial compartment - 5 m, obturator n, adduct hip joint?
adductor longus,
163
medial compartment - 5 m, obturator n, adduct thigh at hip?
adductor longus, boundary of femoral triangle - and forms border of adductor canal
adductor brevis
from pubis to femur
adductor magnus -
opening adductor hiatus -
innervate - obturator n and tibial part of sciatic n - hybrid m
164
adductor hiatus?
space near knee in adductor magnus m
connetion betwe adductor canal and popliteal fascia
165
Gracilis
slender, obturator N
adducts thigh at hip, flexes knee, help medial rotation
two joint m - attaches to tibia
166
adductor Muscle Tears
groin strain - lots of athletic injuries -
initial intense pain, then dull ache - better after warm up
distinguish from
iliopsoas strain (hip flexsion against resistanec)
Osteitis of pubis -
lesions of conjoined tendor - tenderness near inguinal canal - "sportsman hernia" - coug causes pain
167
obturator neuropathy
howship sign?
168
obturator externus
hidden muscle - one of 6 short lateral rotators - obturator N
169
gluteal region - superior boundary?
iliac crest - very important to know - re injections - lots of nerves here 11 I count in picture
170
pain may be referred betwen pelvis (autoS2,3) and posterior femoral cutaneous
S2 - S3
171
Where do sympathetic n end?
L3 - T1 - L3
in limbs - there are NO parasympathetics ???
Sympathetic innervation of the lower limbs originates in the lumbar plexus which supplies the femoral and deep saphenous nerves to the femur, and the tibial, medial, and popliteal nerves to the tibia and fibula.
172
How does gluteaus m abduct hip joint? HY!
raises pelvis of opposite side - by pressing down on original side
173
Strongest muscle ?
iliofemoral as strong as interosseous sacroiliac joint
174
gluteus medius - where should injection happen?
gluteus medius
175
inntervation of gluteus maximus?
interior luteal nerve L5 - S2 -
| m extends hip joint when climbing stairs or standing from sitting
176
gluteus medius - does it help in walking?
yes - very important
superior gluteal n - L4 - S1
177
HOchstetter technique?
injection in gluteus medius mucles in upper outer quadrant of buttock
178
ways to give an injection - different angles
intramusular - 90 degree, three other kinds
179
HOchstetter technique?
injection in gluteus medius mucles in upper outer quadrant of buttock
or Ventrogluteal site - hand on greater trochanter - coming from the side - space between two fingers
180
ways to give an injection - different angles
intramusular - 90 degree, three other kinds
181
Trendelenburg's sign
loss of superior gluteal nerve may lead to loss of walking function - waddling gait - on opposite side
182
Trendelenburg's sign
loss of superior gluteal nerve may lead to loss of walking function - waddling gait - on opposite side
Duchenne gait
to lift foot off ground on other side - person needs to lurch to side so foot comes off ground.
183
Tensor fasciae latae?
IT band - bursa near knee -
184
Trochanteric Bursitis - c
pain on lateral side of hip -
| lateral femoral cutaneous n
185
piriformis
insert greater trochanter - nerve directly from rami S1 - S2
186
piriformis syndrome?
m spasm
often overlooked syndrome - hip and buttock pain - presents similarly to other problems -
compresses sciatic nerve
187
piriformis syndrome?
m spasm
often overlooked syndrome - hip and buttock pain - presents similarly to other problems -
compresses sciatic nerve
two spaces - one above, one below
KEY to region
superior is everything above it
inferior is below
infraspiriform and supraprirform foramens
188
sacrospinous lig - what nerve winds around?
pudendal
189
suprapiriform foramen, what passes through?
superior gluteal n, art, vein
190
infrapiriform foramen?
```
structure - sciatic nerve, posterior femoral cutaneous nerve
inferior gluteal nerve
inferioro gluteal artery and vein
internal pudendal art and vein
pudendal n
```
191
what nerve is affected during episiotomy?
Pudendeal off of sacrospinoic ligament
192
sciatic nerve - comes from sacral plexus
through infrapiriform foramne, deep to gluteus max, down back of thigh - divides into two terminal branches tibial and common peroneal
supplies posterior compartment of thight
BSS muscles - biceps femoris
semi tendinosus and semimembranosus
innervates hip and knee joint
some variations exist as it comes out - sometimes comes out above and below or pierces piriformis
epinuerium - binds two parts of sciatic n but can divide out
193
spasm of piriformis ?
can bother sciatic n - creating piriformis syndrome
pain in buttocks, bowel movements, many pains -
treatment - physio therapey
194
obturator internus -
inserts greater trochanter - n supply? obturator internus L5 - S1
195
quadratus femoris
one of six short rotators - n to quadratus femoris L4, L5, S1
196
anastamosis around hip - variety
cruciate anastomoses
```
medial circumflex
lateral circumflex
superior gluteal
inferior gluteal
fist perforating
```
197
posterior compartment of thigh - Adductors
m - hamstrings
n - tibial division of sciatic exc short head of biceps - innervated by common fib
femoral artery - both femoral and deep femoral
198
sciatica L4 - S2
low back pain? 5 to 10% have sciatica -
age 35 - 64yo
height increases risk
smoking
menal stress
occupational hard workers, lifting weights, bending, twisting, driving
199
sciatica L4 - S2
low back pain? 5 to 10% have sciatica -
age 35 - 64yo
height increases risk
smoking
stress
occupational hard workers, lifting weights, bending, twisting, driving
200
n winding around neck of fibula?
common fibula nerve - one branch of sciatic
201
lateral compartment?
supraficial?? n
202
winding around neck of fibula?
common fibula nerve - one branch of sciatic
203
no feeling on dorsal part of foot (except web)?
Superficial fib nerve
204
Piriformis syndrome?
Common fib?
205
Foot drop?
deep fib nerve (also sciatica) - common peroneal nerve PED - foot dropPED - Peroneal everts dorsiflexus
206
can climb stairs?
inferior gluteal
207
pelvis drop on other side?
superior gluteal
208
loss of sensory medial thigh?
obturator
209
can't extend knee? loss of anterior thigh?
femoral
210
can't stand on tiptoes?
Tibial n
211
longest nerve in body?
great saphenous - starts 1" below inguinal lig (from femoral??) to big toe
212
longest nerve in body?
great saphenous - starts 1" below inguinal lig (from femoral??) to big toe
The saphenous nerve is a sensory branch of the femoral nerve (lumbar plexus L3, L4), and supplies sensation to the anteromedial, medial and posteromedial surface of the leg. ... The nerve passes through the adductor canal, and gives off an infrapatellar branch.
The great saphenous vein is a large venous blood vessel running near the inside surface of the leg from the ankle to the groin. It arises from the dorsal venous arch at the top (dorsum) of the foot and drains into the femoral vein, the main deep vein for the leg.
213
NAVeL - femoral triangle
nerve, artery, vein, e (empty) L - lacunar lig and lymph
sartorius (lateral)
adductor longus - sometimes considered as "floor" sometimes not - if on the floor - triangle gets bigger
inguinal lig
214
adductor canal?
The canal contains the femoral artery, femoral vein, and branches of the femoral nerve (specifically, the saphenous nerve, and the nerve to the vastus medialis). It consists of three foramina: superior, anterior and inferior.
215
adductor hiatus?
is a hiatus (gap) between the adductor magnus muscle and the femur that allows the passage of the femoral vessels from the anterior thigh to the posterior thigh and then the popliteal fossa.
216
linea aspera
the linea aspera is a roughed longitudinal line on the posterior surface of the shaft of the femur which gives attachment to several muscles) medial epicondyle. the enlargement of bone on the medial side of the femur just superior to the medial condyle.
217
The popliteal fossa ?
(sometimes referred to colloquially as the knee pit, or poplit) is a shallow depression located at the back of the knee joint.
Contents - The popliteal fossa contains the popliteal vessels, the tibial and the common peroneal nerves, the termination of the small saphenous vein, the lower part of the posterior femoral cutaneous nerve, the articular branch from the obturator nerve, a few small lymph glands, and a considerable quantity of fat.
218
A Baker's cyst
forms when excess synovial fluid bulges into the hollow at the back of the knee joint. ... Baker's cysts aren't dangerous and they may go away on their own. But occasionally they burst, and if that happens, synovial fluid can leak into the calf below, causing pain, swelling, and reddening.
usually the result of a problem with your knee joint, such as arthritis or a cartilage tear. Both conditions can cause your knee to produce too much fluid, which can lead to a Baker's cyst.
219
Decreased sensation to anterio/lateral thig ?
clothing too tight - lateral femoral cutaneous nerve. See also in pregnancy, pelvic procedures
220
torus fracture?
buckle fractures, are incomplete fractures of the shaft of a long bone that is characterized by bulging of the cortex. They result from trabecular compression due to an axial loading force along the long axis of the bone.
vs greenstick fracture - a fracture of the bone, occurring typically in children, in which one side of the bone is broken and the other only bent.
There is a difference between buckle fracture and greenstick fractures. Buckle fractures (also called torus) are defined as a compression of the bony cortex on one side with the opposite cortex remains intact. In contrast, a greenstick fracture the opposite cortex is not intact.
221
most frequently fractures foot bone?
calcaneous of tarsal bones (heel bone)
222
carpal tunnel - what muscles?
opponens pollicis, flexor pollicis brevis, and abductor pollicis brevis
The muscles supplied by the recurrent branch of the median nerve (opponens pollicis, flexor pollicis brevis, and abductor pollicis brevis) are most commonly weakened in patients with carpal tunnel syndrome.
223
A 25-year-old white female bodybuilder sees you at your office because she had problems doing push-ups lately. Whenever she is doing 30 repetitions or more she gets anterior shoulder pain on the right. She has tried to use machines but experienced the same pain with every pushing movement. The area around the coracoid process is very sore.
pectoralis minor
224
The tendon of which muscle is deep to the flexor digitorum superficialis, yet passes through the tendon to insert on the distal phalanges?
Flexor digitorum profundus
225
You diagnose your patient with a tibial fracture and place a BK cast on for 8 weeks. He understands that his leg muscles will decrease in size and strength. You suggest some exercises to be done each day at home. One of the exercises is to "scrunch up" a towel on the floor with his toes. In this exercise, he is using his digital flexor muscles. Which muscle is the major flexor of the DIPJ and is innervated by the tibial nerve?
Flexor digitorum longus
226
A branch from the posterior cord of the brachial plexus innervates which of the following muscles
lats
The latissimus dorsi is innervated by the thoracodorsal nerve which is a branch of the posterior cord of the brachial plexus. Also arising from the posterior cord is the upper subscapular nerve which innervates the subscapularis, the lower subscapular nerve which supplies the subscapularis and the teres major, and the axillary nerve which furnishes the deltoid and teres minor muscles. The radial nerve is a continuation of the posterior cord. The pectoralis major is innervated by the lateral and medial pectoral nerves which are branches of the lateral and medial cords respectively. The coracobrachialis, biceps brachii, and the brachialis are innervated by the musculocutaneous nerve, a branch of the lateral cord.
227
Rotator cuff muscles stabilize the humerus in the glenoid cavity while allowing extreme range of motion. Which of the following muscles is an internal rotator muscle?
subscapularis
228
To which sites is the anterior cruciate ligament of the knee attached?
Anterior intercondylar area of tibia; medial surface of lateral femoral condyle
229
Which forearm muscle originates on the medial epicondyle of the humerus?
The distal end of the humerus flares out to form two rounded protuberances (one on each side of the elbow) called epicondyles. The medial and lateral epicondyles serve as attachments for muscles of the forearm.
The pronators of the forearm and flexors of the wrist and fingers (with two exceptions) originate on the medial epicondyle. They include pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris, and flexor digitorum superficialis. (The two exceptions are flexor digitorum profundus and pronator quadratus, which originate on the proximal and distal shaft of the ulna, respectively.) All of these muscles are located in the anterior compartment of the forearm.
The supinators of the forearm and extensors of the wrist and fingers originate on the lateral epicondyle. They include extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi, extensor carpi ulnaris, and supinator (all located in the posterior compartment of the forearm). The anconeus muscle, an extensor of the elbow, also originates on the lateral epicondyle. (Anconeus is sometimes considered part of the triceps brachii, and does not belong to the posterior compartment of the forearm.)
230
A 38-year-old construction worker sees his health care provider because of shoulder pain. Physical examination reveals a dislocated glenohumeral joint. Radiographic imaging reveals a tear in the muscles that stabilize the glenohumeral joint. Identify the muscle most likely injured in this patient.
Infraspinatus muscle
The rotator cuff muscle group stabilizes the glenohumeral joint. The tendons of these muscles reinforce the ligaments of the glenohumeral joint capsule. The tendons of the long head of the biceps and triceps brachii muscles attach to the supraglenoid and infraglenoid tubercles, but do not significantly contribute to stability of the glenohumeral joint.
231
The serratus anterior acts to pull the scapula forward around the thorax.
long thoracic nerve
The contraction of the entire serratus anterior leads to a anterolateral movement of the scapula along the ribs. Due to the pull of the inferior part at the lower scapula, the shoulder joint is shifted superiorly. This shifting now enables to lift the arm above 90° (elevation).
232
A 29-year-old man is diagnosed with paralysis of the left piriformis muscle. Which of the following actions is the most likely difference between the left and right foot during gait?
Left foot points more medially
The action of the piriformis muscle is lateral rotation of the hip. Therefore, during gait, the left piriformis muscle would laterally rotate the left hip so that the toe points anteriorly. However, in a patient with a paralyzed left piriformis muscle, the toe points more medially because there is a weaker counter contraction from the piriformis muscle.
233
Which of the following muscles flexes the glenohumeral and elbow joints and supinates the radioulnar joints?
two joint muscle??
Biceps brachii muscle , two head, two joint, two words starting w B
NOT the brachialis
The biceps brachii muscle flexes the glenohumeral and elbow joints because of its anterior position. Its attachment to the radial tuberosity also allows it to supinate the radioulnar joints.
The brachialis (brachialis anticus) is a muscle in the upper arm that flexes the elbow joint. It lies deeper than the biceps brachii, and makes up part of the floor of the region known as the cubital fossa. The brachialis is the prime mover of elbow flexion.
234
Which of the following arteries courses through the anatomical snuffbox?
radial artery
235
During a physical examination, a 24-year-old woman is instructed to lie supine on the examination table. During the procedure, she is instructed to resist allowing the health care provider to pull her feet downward into plantarflexion. The patient presents with right-sided weakness in this task. Which of the following nerves is most likely responsible for this muscle weakness in this patient?
deep fibular
When the feet are pulled downward, the dorsiflexion muscles in the anterior compartment of the leg are being tested. If the patient exhibits weakness in this task, the most likely explanation then is lack of innervation from the deep fibular (peroneal) nerve.
Foot drop is a gait abnormality in which the dropping of the forefoot happens due to weakness, irritation or damage to the common fibular nerve including the sciatic nerve, or paralysis of the muscles in the anterior portion of the lower leg. It is usually a symptom of a greater problem, not a disease in itself.
236
The suprascapular and dorsal scapular arteries form a collateral circuit on the posterior side of the scapula with which of the following branches of the axillary artery?
The circumflex scapular artery courses through the triangular space to form a collateral circuit with the suprascapular and dorsal scapular arteries.
237
What does the posterior humeral circumflex artery supply?
It winds around the surgical neck of the humerus and is distributed to the deltoid muscle and shoulder-joint, anastomosing with the anterior humeral circumflex and deep artery of the arm. It supplies the teres major, teres minor, deltoid, and (long head only) triceps muscles.
The anterior circumflex humeral artery provides part of the blood supply to the glenohumeral joint, teres major and minor, and deltoid muscles. The ascending branch provides supply to the head of the humerus 1
238
The boundaries of the three parts of the axillary artery are determined by its relationship to which muscle?
Pectoralis minor muscle
239
A 49-year-old woman is diagnosed with carpal tunnel syndrome. Which tendon of the following muscles would most likely be associated with carpal tunnel syndrome?
Flexor pollicis longus muscle
The tendon of the flexor pollicis longus muscle courses through the carpal tunnel with the tendons of the flexor digitorum superficialis and the flexor digitorum profundus muscles and the median nerve.
240
A 17-year-old boy is admitted to the emergency department with a leg fracture. He fell off his motorcycle and tore the interosseous membrane and fractured the proximal fibula. On examination, the patient is found to have decreased cutaneous sensation over the distal lateral aspect of his right leg and over the dorsal aspect of his right foot, with sparing of the space between his first and second digits. The primary motor abnormality you are most likely to observe would be decreased
Eversion of the foot
The decreased cutaneous sensation of this patient is in the field of the superficial fibular (peroneal) nerve with sparing of the deep fibular (peroneal) nerve (space between digits 1 and 2). Therefore, with injuries involving the superficial fibular (peroneal) nerve, the muscles of the lateral compartment of the leg would be affected, and therefore, eversion of the foot would be weakened.
241
Which of the following nerves courses between the brachialis and brachioradialis muscles?
radial
The radial nerve courses between the brachialis and brachioradialis muscles on the lateral side of the brachium after piercing the intermuscular septum.
242
The biceps femoris muscle receives its name because it has two origins. One attachment is to the linea aspera of the femur. The other attachment is to the
Ischial tuberosity
243
Inflammation in Guyon's canal will most likely result in weakness in which of the following movements?
Adduction of digits 2 to 5
The ulnar nerve courses through Guyon's canal. Compression of the nerve will cause weakness in the muscles it innervates, including the palmer interosseous muscles, which are responsible for adduction of digits 2 to 5.
244
A 20-year-old woman stepped on a nail and it penetrated the plantar surface of her bare foot, injuring the lateral plantar nerve. Which of the following muscles would most likely be rendered nonfunctional?
Dorsal interossei muscles
The dorsal interossei are muscles innervated by the lateral plantar nerve. The other muscles listed as choices (i.e., first lumbrical, abductor hallucis, flexor digitorum brevis, and flexor hallucis brevis muscles) are all innervated by the medial plantar nerve.
245
A paralabral cyst arising from a detached inferior glenoid labrum tear compresses neurovascular structures coursing through the quadrangular space. If this condition were to become chronic, which of the following findings would most likely be revealed on an MRI?
deltoid atrophy
The axillary nerve courses through the quadrangular space with the posterior humeral circumflex artery. Therefore, compression of the axillary nerve would weaken the deltoid muscle and thus weaken shoulder abduction.
246
Which of the following actions would you most likely expect to be the weakest if your patient has a lesion of the tibial nerve in the popliteal fossa?
Flexion of the digits
The tibial nerve innervates the posterior compartment of the leg and intrinsic muscles of the feet. Therefore, if there is a nerve lesion within the popliteal fossa, the nerves innervating the posterior muscles of the leg would then be affected. These muscles include the flexor digitorum muscles.
247
The upper subscapular, lower subscapular, and thoracodorsal nerves branch from which cord of the brachial plexus?
Posterior cord
The upper subscapular, lower subscapular, and thoracodorsal nerves branch off of the posterior cord in the axilla, just anterior to the subscapularis muscle.
248
The posterior compartment of the thigh primarily receives its blood supply from branches of which of the following arteries?
The deep femoral artery gives rise to perforating arteries, which pierce through openings in the adductor magnus muscle insertion and provide the primary vascular supply to the posterior thigh compartment. The inferior gluteal artery provides some vascular supply but not as much as the deep femoral artery.
249
A 46-year-old woman sees her health care provider with a complaint of pain over the anterolateral forearm. Clinical examination reveals no muscle weakness in the patient's upper limb, but notes problems with the right lateral cutaneous nerve of the forearm. Which of the following is the most likely activity resulting in this patient's injury?
Venipuncture of the right cephalic vein in the antebrachial fossa
The musculocutaneous nerve innervates the anterior compartment of the arm. The cephalic vein courses in the antebrachial fossa adjacent to the lateral cutaneous nerve of the forearm. Therefore, a venipuncture of the cephalic vein may injure the adjacent cutaneous branch of the musculocutaneous nerve. Avulsion of the medial epicondyle would affect forearm flexors, and a midhumeral fracture would affect the radial nerve. Hypertrophy of the coracobrachialis muscle would affect the entire musculocutaneous nerve and result in the cutaneous presentation, but would also negatively affect motor activity. Lateral epicondyle inflammation would affect forearm extensors.
250
A 42-year-old man is admitted to the emergency department in shock and requires a saphenous cut down to receive an infusion. To isolate the great saphenous vein in the ankle region, you would most likely determine its location in which of the following areas?
Anterior to the medial malleolus
The great saphenous vein is formed from the dorsal venous arch on the dorsum of the foot. The great saphenous vein then courses anterior to the medial malleolus of the tibia, up the medial aspect of the leg.
251
The superior ulnar collateral artery forms a collateral circuit with which of the following arteries?
The superior ulnar collateral artery anastomoses with the posterior ulnar recurrent artery from the ulnar artery that is posterior to the medial epicondyle.
252
A 38-year-old man is admitted to the emergency department after being involved in an automobile accident. He is unable to abduct or adduct his toes. If this patient has a deficit from a spinal cord lesion, which of the following spinal cord levels is most likely affected by this injury?
S2–S3
The intrinsic muscles of the feet are innervated by the lateral plantar nerves. The lateral plantar nerve primarily carries motor innervation from the S2–S3 spinal cord levels. L1–L2 would result in weak hip flexion. L3–L4 would result in weak knee extension. L5–S2 would result in weak hip extension and knee flexion, and S1–S2 would result in weak dorsiflexion and plantar flexion
253
Which of the following muscles can flex, extend, and abduct the glenohumeral joint?
deltoid
254
Most of the muscles of the medial thigh compartment are innervated by the obturator nerve. The exception is the vertical division of the adductor magnus muscle, which is innervated by which of the following nerves?
The vertical division of the adductor magnus muscle is also known as the hamstring division because it receives the same innervation of the hamstring muscles via the tibial nerve.
255
A 34-year-old man is diagnosed with a left internal iliac artery aneurism. As a result, he presents with a left superior gluteal nerve lesion and an accompanying gait disorder. While walking, this patient would most likely compensate by flexing his trunk to the
Left, to lift his right lower limb so that his right foot can be lifted off the ground
The left superior gluteal nerve innervates the gluteus medius and minimus muscles. While walking, the left gluteal muscles will stabilize the pelvis so that the right limb does not droop when swinging. However, if there is a lesion on the superior gluteal nerve, the left gluteal muscles are not functioning, and therefore, the right hip drops. To compensate, the patient will laterally flex the spine to the left so that the right foot will be higher off the ground when walking.
256
Extensor pollicis longus? tendon where?
in thumb you can see it - if severed it may retract into wrist.
Meanwhile, the abductor pollicis longus (APL) is one of the extrinsic muscles of the hand. As the name implies, its major function is to abduct the thumb at the wrist. Its tendon forms the anterior border of the anatomical snuffbox.
257
Foot muscles - all of them< 4 layers
Explanation The superficial layer or the first layer consists of the flexor digitorum brevis, abductor hallucis, and the abductor digiti minimi muscles.
The second layer consists of the quadratus plantae and the lumbrical muscles.
The third layer includes the flexor hallucis brevis, adductor hallucis, and the flexor digiti minimi brevis.
The fourth layer, the deepest layer, contains the interossei muscles.
258
list how to remember foot muslce
3,2,3,2
3 flexor digi, abductor hall, abd digit minim
2, lumbricals, quad
3 flexor hall brevis, add hall, flexor digi minim
2 ossio
259
carpal tunnel - muscles in it? 3 flexors and median n
flexor digit superficial, flexor digit profundis, flexor pollicus longus
260
The biceps femoris muscle receives its name because it has two origins. One attachment is to the linea aspera of the femur. The other attachment is to the
The biceps femoris muscle is a part of the hamstring group. Each hamstring muscle originates on the ischial tuberosity, which includes the long head of the biceps femoris muscle.
261
The upper subscapular, lower subscapular, and thoracodorsal nerves branch from which cord of the brachial plexus?
POSTERIOR CORD
The upper subscapular, lower subscapular, and thoracodorsal nerves branch off of the posterior cord in the axilla, just anterior to the subscapularis muscle.
262
CORDS OF Brachial Plexus
LATERAL LLM - Lucy Loves Me
POSTERIOR STAR
MEDIAL MMMUM
LLM - lateral pectoral, lateral root of the median nerve, musculocutaneous
STAR - subscapular (upper and lower), thoracodorsal, axillary, radial
- medial pectoral, medial cutaneous nerve of arm, medial cutaneous nerve of forearm, ulnar, medial root of the median nerve
263
A 44-year-old woman is suspected of having meningitis. To confirm the diagnosis, a lumbar puncture is ordered to collect a sample of the cerebrospinal fluid (CSF). Identify the last layer of tissue the needle will traverse in this procedure before reaching CSF.
A lumbar puncture collects cerebrospinal fluid and, therefore, the needle has to enter the subarachnoid space, which is located between the arachnoid and pia mater. Therefore, the last layer of tissue the needle would traverse to enter the subarachnoid space is the arachnoid mater.
264
lumbar puncture layers
The Lumbar Puncture needle pierces in order: skin, subcutaneous tissue, supraspinous ligament, interspinous ligament, ligamentum flavum, epidural space containing the internal vertebral venous plexus, dura, arachnoid, and finally the subarachnoid space.
265
what kind of joint is the inferior tibiofibular joint ?
The inferior tibiofibular joint is NOT a synovial joint, but is a fibrous joint.
266
Which severed nerve in the forearm will prevent flexion of the interphalangeal joint of the thumb?
The anterior interosseous nerve arises from the median nerve 5 to 8 cm. distal to the level of the lateral epicondyle. During its passage through the forearm this nerve innervates the flexor pollicis longus (flexes the interphalangeal joint of the thumb), the radial half of the flexor digitorum profundus (flexes the distal interphalangeal joints of the index and middle fingers), and the pronator quadratus (pronates the forearm). The patient in the photograph who has paralysis of the right interosseous nerve was asked to demonstrate the letter "o" with the thumb and index finger of both hands. The left hand is normal and the right hand illustrates her inability to flex the interphalangeal joint of the thumb and the distal phalangeal joint of the index finger.
267
Key test in fingers
ulnar - adduction
268
OK sign
anterio interosseous - median
