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T4 MSK > Mid-term OP > Flashcards

Mid-term OP Flashcards

1
Q

What mm are in the superficial layer of back muscles?

A
  • trapezius (upper, mid, lower)
  • latissimus dorsi
  • levator scapula
  • rhomboid major & minor
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2
Q

What mm are in the intermediate layer of back muscles?

A
  • serratus posterior superior
  • serratus posterior inferior
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3
Q

What mm are in the deep layer of back muscles?

A

Superficial layer (of deep mm)

  • splenius capitis
  • splenius cervicis

Intermediate layer (of deep mm) from medial to lateral:

  • spinalis
  • longissimus
  • iliocostalis

Deep layer (of deep mm) from superficial to deep:

  • semispinalis (capitis cervicis, thoracis)
  • multifidus
  • rotatores
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4
Q

What are the attachments of Quadratus Lumborum?

A
  • S: medial ½ of rib 12, TVPs of lumbar vertebrae
  • I: iliac crest, iliolumbar ligament
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5
Q

What are the actions of Quadratus Lumborum?

A

bilateral contraction:

  • extends lumbar spine
  • fixes 12th rib during forced expiration
  • stabilizes lumbar spine

unilateral contraction:

  • Ipsilateral lateral flexion (hip fixed)
  • Hip hike (12th rib fixed)
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6
Q

What are the attachments of Psoas Major?

A
  • S/P: sides of T12-L5 vertebrae and the associated intervertebral discs
  • I/D: lesser trochanter of the femur
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7
Q

What are the actions of Psoas Major?

A
  • works with iliacus to flex the hip joint
  • flexes the lumbar spine when you’re already somewhat forward flexed
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8
Q

What are the attachments of Iliacus?

A
  • S/P: iliac fossa
  • I/D: lesser trochanter of femur
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9
Q

What are the actions of Iliacus?

A
  • works with psoas major to flex hip joint
  • pulls hip bone anteriorly (anterior tilt)
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10
Q

What are the divisions of iliocostalis and generally where do they attach?

A
  • Cervicis: (TVPs of C3-6)
  • Thoracis: (angle of ribs 1-7)
  • Lumborum: (angle of ribs 8-12)
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11
Q

What are the actions of erector spinae (aka paraspinals)?

A
  • unilateral: lateral flexion of the vertebral column
  • bilateral: extension of the vertebral column
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12
Q

What are the divisions of spinalis, generally where are they located and generally where to they attach?

A

(very thin)

  • sit in the laminar groove
  • thoracis, cervicis, capitis
  • attach to the SPs
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13
Q

What are the divisions of longissimus and generally where to they attach?

A
  • all attach to TVPs
  • thoracis, cervicis, capitis (also attaches to mastoid process superiorly)
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14
Q

Generally where are semispinalis muscles, what are their divisions, and generally where do they attach?

A
  • superior 1/2 of spinal column
  • thoracis, cervicis, capitis (capitis attaches superiorly between the superior and inferior nuchal lines; it’s the largest mass in the posterior neck)
  • attaches to a TVP laterally then SP of a superior vertebrae (skips 3-6 vertebrae)
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15
Q

What are the actions of Semispinalis?

A
  • bilateral: extension of the head and neck
  • unilateral: contralateral rotation of the neck
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16
Q

Generally where do multifidus muscles attach?

A
  • S4-C2 (skipping 1-3 vertebrae)
  • (only “intrinsic” back muscle to cross the sacrum)
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17
Q

What are the actions of Multifidus?

A
  • bilateral: extension of the spine, stabilization
  • unilateral: lateral flexion, contralateral rotation
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18
Q

Generally where do rotatores muscles attach?

A

attaches to a TVP laterally then SP of a superior vertebrae

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19
Q

What are the actions of Rotatores?

A
  • bilateral: stabilization
  • unilateral: contralateral rotation
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20
Q

What are the deep lateral rotators of the hip?

A

From superior to inferior:

  • Piriformis
  • Gemellus Superior
  • Obturator Internus
  • Gemellus Inferior
  • Obturator Externus
  • Quadratus Femoris (overlies Ob Ex posteriorly)
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21
Q

What are the attachments of Piriformis?

A
  • Origin: Anterior Sacrum through the greater sciatic notch
  • Insertion: posteromedial aspect of the greater trochanter
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22
Q

What are the actions of Piriformis?

A

external rotation, abduction at 60 degrees, medial rotation at >60 degrees

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23
Q

What are the attachments of Gemellus Superior?

A
  • Origin: ischial spine
  • Insertion: posteromedial aspect of the greater trochanter (via tendon of obturator internus)
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24
Q

What are the actions of Gemellus Superior?

A

external rotation

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25
Q

What are the attachments of Obturator Internus?

A
  • Origin: inner margin of obturator foramen
  • Insertion: posteromedial aspect of greater trochante
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26
Q

What are the actions of Obturator Internus?

A

external rotation

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27
Q

What are the attachments of Gemellus Inferior?

A
  • Origin: ischial tuberosity
  • Insertion: posteromedial aspect of greater trochanter
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28
Q

What are the actions of Gemellus Inferior?

A

External Rotation

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29
Q

What are the attachments of Obturator Externus?

A
  • Origin: outer margin of the obturator foramen
  • Insertion: posteromedial aspect of the greater trochanter
30
Q

What are the actions of Obturator Externus?

A

External rotation

31
Q

What are the attachments of Quadratus Femoris?

A
  • Origin: lateral ischial tuberosity
  • Insertion: intertrochanteric crest
32
Q

What are the actions of Quadratus Femoris?

A

External rotation

33
Q

What are the attachments of External Obliques?

A

S/L:

  • ribs 5-12
  • upper fibres interdigitate with serratus anterior
  • lower fibres interdigitate with latissimus dorsi

I/M:

  • linea alba (via abdominal aponeurosis)
  • pubic tubercle
  • anterior 1/2 of iliac crest
34
Q

What are the actions of External Obliques?

A
  • (unilateral contraction): rotates column to contralateral side
  • (unilateral contraction): ipsilateral lateral flexion
  • (bilateral contraction): trunk flexion
  • (bilateral contraction): stabilizes the pelvis during leg-lowering
  • (bilateral contraction): compress and support viscera
35
Q

What are the attachments of Internal Obliques?

A

I/L:

  • anterior 1/2 of the iliac crest

S/M:

  • linea alba (via abdominal aponeurosis)
  • ribs 10-12 (inferior borders)
36
Q

What are the actions of Internal Obliques?

A
  • (unilateral contraction): rotates column to ipsilateral side
  • (unilateral contraction): ipsilateral lateral flexion
  • (bilateral contraction): trunk flexion
  • (bilateral contraction): compress and support viscera
37
Q

What are the attachments of Rectus Abdominis?

A
  • S: costal cartilages of ribs 5-7, xiphoid process
  • I: pubic symphysis and pubic crest
38
Q

What are the actions of Rectus Abdominis?

A
  • flexes the vertebral column (trunk)
  • stabilizes the pelvis during leg-lowering
  • compresses viscera
39
Q

What are the attachments of Pectineus?

A

(floor of the femoral triangle)

  • S/P: anterior pubic bone
  • I/D: just inferior to the lesser trochanter on the pectineal line
40
Q

What are the actions of Pectineus?

A
  • hip adduction
  • hip flexion (weak)
41
Q

What are the attachments of Tensor Fascia Lata?

A
  • S/P: outer ASIS
  • I/D: iliotibial band (approximately 1/3rd down the thigh)
42
Q

What are the actions of Tensor Fascia Lata?

A
  • hip joint flexion
  • hip joint abduction
  • hip joint medial rotation
43
Q

What are the attachments of Masseter?

A

note: superficial and deep fibres

  • S: inferior border of the zygomatic arch
  • I: angle of the mandible
44
Q

What are the actions of Masseter?

A
  • elevation of the mandible (prime mover)
  • protraction of the mandible (superficial fibres)
  • retraction of the mandible (from a protracted position)
45
Q

What are the attachments of Lateral Pterygoid?

A

note: superior and inferior heads

  • A:
    • greater wing of the sphenoid (superior head)
    • lateral surface of the lateral pterygoid plate of the sphenoid (inferior head)
  • P:
    • neck of the mandible (inferior head)
    • articular disc (superior head)
46
Q

What are the actions of Lateral Pterygoid?

A
  • protraction of the mandible
  • translational (anterior/posterior) control of the articular disc (superior head)
  • depression of the mandible (inferior head) (once translation occurs)
  • contralateral deviation of the mandible
47
Q

What are the attachments of Medial Pterygoid?

A
  • A: medial surface of the lateral pterygoid plate
  • I: pterygoid tuberosity (inner surface of the angle of the mandible)
48
Q

What are the actions of Medial Pterygoid?

A
  • elevation of the maindible
  • protraction of the mandible
  • contralateral deviation of the mandible
49
Q

What are the attachments of Temporalis?

A
  • S: temporal bone (fossa)
  • I: coronoid process and anterior ramus of mandible
50
Q

What are the actions of Temporalis?

A
  • elevation of the mandible
  • retraction of the mandible (more horizontal/posterior fibres)
51
Q

What’s Active Inhibition?

A

Inhibition of a muscle by either its own activity or that of its antagonist

52
Q

When a muscle contraction exceeds a certain critical value, there is a relaxation of the muscle via the GTO influence. This is known as the ___ aka ___. This falls under what subtype of active inhibition?

A
  • inverse stretch reflex aka antimyotatic reflex
  • autogenic inhibition (type of active inhibition)
53
Q

What are the two types of active inhibition?

A
  • reciporacal inhibition
  • autogenic inhibition
54
Q

What are sites of compression for the ulnar nerve?

A
  • tunnel of guyon
  • between the heads of FCU and FDP
  • cubital tunnel
  • arcade of struthers (thick fascia from medial head of triceps to the intermuscular septum [int. sep. is deep fascia separating triceps and biceps compartments])
  • TOS
  • GH joint/axillary compression (e.g. crutch use)
  • C-Spine
55
Q

What’s the nerve pathway for the ulnar nerve?

A
  • roots C8, T1
  • medial cord brachial plexus
  • exits in the lowest position from brachial plexus
  • descends, relatively superficially, with brachial artery in groove along medial head of triceps
  • pierces intermuscular septum between humeral and ulnar heads of FCU as it dives into the cubital tunnel
  • descends deeps to FCU under the Palmar Carpal Ligament and into the hand
56
Q

What’s the nerve pathway of the radial nerve?

A
  • roots C5-T1
  • posterior cord of brachial plexus (largest branch of BP)
  • supplies triceps before wrapping around radial/spiral groove
  • divides into motor and sensory branches proximal to elbow
    • posterior interosseous branch (deep radial [motor] nerve) travels down posterolateral arm and forearm
    • superficial radial nerve runs over dorsal surface of forearm and terminates at dorsal web space of hand
57
Q

What are sites of compression for the radial nerve?

A
  • wrise: compression of superficial radial nerve by tight bracelets/handcuffs/watch bands (superficial radial nerve syndrome aka handcuff/watch strap neuropathy)
  • Brachioradialis: radial sensory nerve can be entrapped as it passes btwn brachioradialis and ECRL
  • Arcade of frohse/radial tunnel (most frequent site of compression) -located at prox tendinous edge of supinator m, an arch btwn superficial and deep layers of supinator, where deep motor branch diveds and can be compressed (supinator syndrome aka posterior interosseous nerve syndrome aka radial tunnel syndrome)
  • Entrapment within triceps/lateral intermuscular septum
  • GH/axilla (Saturday night palsy/crutches)
  • TOS
  • C-Spine
58
Q

What’s the nerve pathways for the median nerve?

A
  • roots C6-T1
  • crosses brachial artery from lateral to medial in upper arm
  • passes over brachialis towards cubital fossa
  • deep to FDS in forearm
59
Q

What are sites of compression for the median nerve?

A
  • carpal tunnel: deep to FCR and palmaris longus into tunel along with tendons of FPL, FDS, FDP (carpal tunnel is fibro-osseous tunnel formed by tubercles of scaphoid and trapeqium laterally, pisiform and hook of hamate medially, carpal bones dorsally, flexor retincaculum volarly)
  • pronator teres syndrome: space between superficial and deep heads of pronator teres (at the origin of FDS where a fibrous arch exists, or at bicipital aponeurosis)
  • GH joint/axilla (crutches)
  • TOS
  • C-Spine
60
Q

What’s the pathway for the sciatic nerve?

A
  • roots L4-S2
  • through buttock encased in common sheath forming sciatic nerve
  • exits pelvis through greater sciatic foramen
  • deep to piriformis
  • proximal to kneee, splits into its tibial and common peroneal divisions to supply lower leg mm
61
Q

What are sites of compression for sciatic nerve?

A
  • quadratus femoris compression
  • pelvis/buttocks: piriformis syndrome: entrapment (related to hypertrophy, inflammation, spasticity, irritability of piriformis); hypertrophy of piriformis m can reduce space within greater sciatic foramen (seen in hyperlordosis hip flexion deformities or overstretching)
  • lumbar spine
62
Q

What are sites of compression for the tibial nerve?

A
  • politeal fossa: due to excessive kneeling (passes over politeus m and under tendinous arch of soleus) or compression by Baker’s cyst, neuromas, hematomas
  • tarsal tunnel syndrome: compression as it passes under flexor retinaculum at level of ankle or distally (tarsal tunnel is fibro-osseous space that extends from posteriomedial aspect of the ankle to plantar aspect of foot)
    • upper tarsal tunnel: covered by deep aponeurosis and has an osseous floor that is formed by the posterior aspect of the tibia and talus. The tendon of tib post and FDL, the tendon and m of the FHL, and the post tib neurovascular bundle pass through this space
    • lower tarsal tunnel: covered by the flexor retinaculum and AB.H m with its fascia. Its osseous floor is formed by the posteriomedial aspect of the talus, inferomedial aspect of navicular bone, medial aspects of sustentaculum tali and calcaneus (tarsal tunnel syndrome can be caused by external compression [from shoes/casts], compression from bony impingement, ganglion cysts, tumours, tenosynovitis, accessory or hypertrophic muscles, thick fibrous septa, variscosity)
  • abdctor hallucis: baxter’s neuritis: compression of inferior calcaneal nerve (branch of lateral plantar nerve, which is a branch of post tib nerve) by hypertrophied abductor hallucis m, heel spur, quadratus plantae, distance running, hypermobile pronated foot, plantar fasciitis
  • morton’s neuroma: compression of plantar interdigital nerves (terminal branches of medial and lateral plantar nerves) between adjacent MT heads - usually between 2nd and 3rd MT/stretch of interdigital nerves across deep MT lig leading to neuroma
  • Jogger’s foot: entrapment of medial plantar nerve in narrow space between AB.H m and anatomic crossover between FDL and FHL tendons (knot of Henry)
63
Q

What are sites of compression for the common peroneal nerve?

A
  • fibular head: nerve crosses over fibular head deep to peroneus longus tendon and enters peroneal tunnel where entrapment can occur and enters anterior compartment of leg. Compression from crossing legs, high boots ending at knee, ski boots, prolonged squatting – strawberry picking palsy
  • anterior ankle joint: ant tarsal tunnel syndrome: entrapment of deep peroneal nerve deep to extensor retinaculum/talonavicular joint/where EHL tendon crosses over it or compressed in dorsum of foot (tight tunnel beneath EHB tendon and deep fascia at 1st and 2nd tarsoMT joints)
64
Q

What are the motor functions of the superficial and deep peroneal nerves respectively?

A
  • superficial peroneal nerve: foot eversion
  • deep peroneal nerve: foot dorsiflexion, toe extension
65
Q

What actions are governed by the median nerve?

A
  • thumb flexion and opposition
  • flexion of digits 2 and 3
  • wrist flexion and abduction
  • forearm pronation
66
Q

What’s the sensory area of the median nerve?

A

Skin over anerolateral surface of hand

67
Q

What muscles are motor innervated by the Median nerve?

A
  • pronator teres
  • palmaris longus
  • flexor carpi radialis
  • flexor digitorum profundus (radial 1/2)
  • flexor pollicis longus
  • pronator quadratus
  • abductor pollicis brevis
  • opponens pollicis
  • flexor pollicis brevis (superficial 1/2)
  • lumbricals 1 and 2 (MCP flexion at digist 2 and 3)
  • flexor digitorum superficialis
68
Q

What’s the area of isolated (sole) supply for the median nerve? What’s the primary zone?

A

Isolated: anterior and posterior aspects of distal tips of fingers 2 and 3

Primary:

  • anterior: lateral 2/3 of palm, boundaries include midline of finger 4 to wrist line
  • posterior: distal 2/3 fingers 2 and 3, lateral 1/2 finger 4 (excluding tips of fingers 2 and 3)
69
Q

What muscles are motor innervated by the Ulnar nerve?

A
  • flexor carpi ulnaris
  • flexor digitorum profundus (medial half)
  • (palmaris brevis)
  • adductor digiti minimi
  • opponens digiti minimi
  • flexor digiti minimi brevis
  • interossei muscles: PADs and DABs
  • lumbricals to fingers 4 and 5
  • adductor pollicis
  • flexor pollicis brevis (deep half)
70
Q

What are the areas of isolated supply and primary zone for the ulnar nerve?

A
71
Q

What are the spasm techniques?

A
  • mm approx
  • GTO
  • R.I.

T4 MSK (2 decks)

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