MSK Flashcards
upper limb bone divisions
1) shoulder: pectoral girdle
2) arm: humerus
3) forearm: radius, ulna
4) hand: carpals, metacarpals, phalanges
upper limb bone count
32 in total
pectoral girdle components
clavicle and scapula
pectoral girdle function
- connects upper limb to axial skeleton
- attachment site for muscles
sternoclavicular joint
- clavicle + manubrium (sternum)
- only articulation between upper limb and axial skeleton
clavicle function
- strut: allows range of movement
- protects upper limb
- transmits shock from upper limb to axial skeleton
clavicle surfaces
- smooth superior
- rough inferior: for ligamentous connections
clavicle structure
1) acromial end
2) shaft
3) sternal end
scapula bone type
flat bone
scapula anterior vs posterior surface
- posterior has spine and acromion
- anterior has coracoid process
scapula borders
1) superior
2) lateral
3) medial
scapula angles
1) superior
2) inferior
3) lateral
scapula fossae and cavities
anterior:
1) subscapular fossa
2) glenoid cavity
posterior:
3) supraspinous
4) infraspinous
5) suprascapular notch
humerus bone type
long bone
humerus articulations
- proximal glenohumeral joint: head (humerus) + glenoid cavity (scapula)
- distal elbow joint: articulates with radius and ulna
humerus anterior and posterior structures
1) head: 1/3 sphere, glenoid cavity = shallow = mobile joint
2) greater tubercle (lateral side)
3) anatomical neck
4) surgical neck: only bone with two necks, common breaking point
5) deltoid tuberosity (lateral): roughened area for deltoid attachment
humerus anterior only structures
1) intertubercular sulcus
2) lesser tubercle: more medial
3) radial fossa: head of radius during elbow flexion
4) coronoid fossa: coronoid process of ulna during elbow flexion
5) lateral epicondyle: forearm muscle attachment
6) medial epicondyle: funny bone (nerve) presses against this
7) capitulum (lateral)
8) trochlea (medial)
humerus posterior only structures
1) radial groove: radial nerve + artery
2) olecranon fossa: olecranon process of ulna during elbow extension
radius and ulna bone types
long bones
radius and ulna articulations
1) antebrachial interosseous membrane (DICT): holds bones together, separates anterior from posterior
2) proximal radioulnar joint: with humerus
3) distal radioulnar joint: with carpal bones
ulna features
1) olecranon: forms elbow in olecranon fossa
2) coronoid process
3) trochlear notch: grips humerus trochlea
4) radial notch: radial articulation
5) ulnar tuberosity: muscle attachment
6) head of ulna (distal end!): ball of wrist
7) ulnar styloid process
radius features
1) head of radius: articulates with radial notch of ulna
2) neck of radius
3) radial tuberosity: muscle attachment
4) radial styloid process
5) carpal articular surface: articulates with carpals
ulna and radius relative location
ulna medial to radius
carpal bone types
short bones (cube shaped)
carpal bone arrangement
proximal row (lateral to medial):
1) scaphoid: biggest, commonly broken
2) lunate
3) triquetrum
4) pisiform
distal row (lateral to medial):
5) trapezium: thumb bone
6) trapezoid
7) capitate
8) hamate: anterior side has hook of the hamate
SOME LOVERS TRY POSITIONS THAT THEY CAN’T HANDLE
carpal bone that can’t be seen posteriorly
pisiform because lies on top of triquetrum
metacarpal and phalange bone types
long bones
metacarpal structure
each has base (attached to carpals), body and head
metacarpal numbering
1-5 lateral to medial (thumb is one)
phalange naming
- proximal, middle and distal (except thumb does not have middle)
thumb anatomical name
pollex
upper limb joint classification
- most are diarthrotic synovial joints
- exceptions:
1) scapulothoracic joint: scapula + thoracic wall = not a true joint (no bone-bone articulation, no joint capsule)
2) antebrachial interosseous membrane: amphiarthrotic fibrous joint
synovial joint classification
1) plane = uniaxial
2) pivot = uniaxial
3) saddle = biaxial
4) hinge = uniaxial
5) condylar (condyloid) = biaxial
6) ball and socket = multiaxial
synovial joint structure
- double layered joint capsule: inner synovial, outer fibrous
- creates joint cavity with synovial fluid
- ligaments reinforce capsule (have unique names
- articular cartilage along bones
- some have bursae
synovial fluid function
- lubrication
- nourishes articular cartilage
- shock absorber
bursae function
- fibrous saclike structures filled with synovial fluid
- alleviate friction
carpometacarpal joint (CMC) classification
digit 1 = saddle, others = plane
metacarpophalangeal joint (MCP) classification
condyloid
proximal/distal interphalangeal joint (PIP) classification
hinge
thumb movements
1) abduction: perpendicular away from pal
2) adduction
3) extension: parallel away from palm
4) flexion
5) opposition: connect thumb to other digits in front of palm
CMC joint movement
- for digits 2-5: flex/ex
MCP joint movement
- flex/ex
- ab/adduction (middle finger considered midline)
PIP joint movement
- flex/ex
sternoclavicular joint type
- saddle synovial
- acts as ball and socket
sternoclavicular joint movements
- elevation/depression
- anterior/posterior
sternoclavicular joint features
1) articular disc: shock absorber from upper limb
sternoclavicular joint ligaments
1) anterior/posterior sternoclavicular ligaments: reinforce capsule
2) interclavicular ligament
3) costoclavicular ligament: underside of clavicle
acromioclavicular joint type
plane synovial, allows gliding
acromioclavicular joint articulation
acromial end of clavicle + acromion of scapula
acromioclavicular joint features
- articular disc
- muscle fibers of trapezius help support the joint
acromioclavicular joint ligaments
1) acromioclavicular ligament: intrinsic
2) coracoclavicular: extrinsic, attaches to underside of clavicle
intrinsic vs extrinsic ligament
- intrinsic: part of joint, formed by thickening of joint capsule
- extrinsic: not part of joint capsule
glenohumeral joint (shoulder joint) type
ball and socket
glenohumeral joint articulation
head of humerus (1/3) + glenoid cavity
glenohumeral joint features
1) standard joint capsule
2) glenoid labrum: wraps around glenoid cavity, deepening it for more stability (more of head can fit)
glenohumeral joint movements
1) flex/ex in sagittal plane
2) abd/add in frontal plane
3) horizonal abd/add in transverse plane
4) medial/lateral rotation in transverse plane
glenohumeral joint supporting structures
1) inferior aspect of acromion and coracoid process support joint superiorly
2) rotator cuff muscles/tendons (absent inferiorly! common dislocation = moves inferior, pulled ant/post)
glenohumeral joint ligaments
1) coracoacromial ligament: limits superior dislocation
2) intrinsic glenohumeral ligaments
3) coracohumeral ligament: inhibits excessive rotation
glenohumeral joint bursae
1) subacromial
2) subdeltoid
3) tendinous sheath
*all located in areas of friction
glenohumeral joint muscle support
1) rotator cuffs on anterior/posterior
2) tendon of long head of biceps brachii: helps stabilize head of humerus
shoulder separation
- acromioclavicular joint separated
shoulder dislocation
- glenohumeral joint separated
scapulothoracic joint type
- not a true joint!
- no bone-bone articulation, instead separated by muscle
- no capsule/ligaments
scapulothoracic joint function
- enable free range of motion of the upper limb
scapulothoracic joint movements
1) elevation/depression
2) retraction (scapula closer together) / protraction (move away from vertebral column
3) upward rotation: glenoid cavity and inferior angle point up, contributes to abduction of UL
4) downward rotation: glenoid cavity and inferior angle down, contributes to adduction of UL
scapulothoracic joint supporting muscles
1) subscapularis: between thoracic wall and scapula
2) serratus anterior: wraps around thorax
elbow joint type
- compound: more than one articulation
- hinge synovial
elbow joint articulations
1) humeroulnar: trochlea of humerus + trochlear notch of ulna
2) humeroradial articulation: capitulum of humerus and head of radius
3) proximal radio-ulnar joint: within articular capsule
elbow joint movements
flex/ex
elbow joint ligaments
1) anular ligament: stabilizes radial head within radial notch of ulna (goes one side of ulna to other)
2) radial collateral ligament: stabilizes lateral aspect
3) ulnar collateral ligament: medial aspect
why is anular ligament important in elbow?
- shallow groove
- doesn’t completely ossify until older = needs more support
collateral ligaments
on sides of joints
elbow joint bursae
1) olecranon bursa
radioulnar joints characteristics
- connected by flat ligament: antebrachial interosseous membrane
- articulation of radius and ulna
radioulnar joint type
pivot synovial: radius rotates around stationary ulna
radioulnar joint movements
1) supination: palm up, radial tuberosity up
2) protonation: palm down, radial tuberosity down
radiocarpal (wrist) joint type
condyloid synovial
radiocarpal joint articulations
- proximal row of carpals (except pisiform) + distal radius + articular disc
radiocarpal joint ligaments
1) anterior/posterior
2) ulnar collateral: stretched during abduction
3) radial collateral: stretched during adduction
radiocarpal joint capsule contents
1) distal radioulnar joint
2) intercarpal joints
*ulna not included in wrist joint!
radiocarpal joint movements
1) flex/ex
2) abd/add
how do skeletal muscles produce movement?
work together to pull on bones (cross joint that they move)
agonist (prime mover)
muscle that provides major force for producing a movement
antagonist
muscle that opposes action of agonist, located on opposite side of joint
fixators
when agonists and antagonists contract simultaneously
synergists
help agonist by adding extra force to the same movement
concentric contraction
muscles shorten under tension
origin vs insertion
- origin: attachment point that often stays fixed during muscle contraction, usually proximal
- insertion: moves closer to origin during contraction, usually distal
muscles that move pectoral girdle location and function
- anterior and posterior thorax
- fix scapula to wall of thorax
- move pectoral girdle
pectoral girdle muscles
1) trapezius
2) levator scapulae
3) rhomboid major/minor
trapezius origin
occipital bone, nuchal ligament, spinous processes of C7-T12
trapezius insertion
spine of scapula, lateral clavicle, acromion
trapezius action
1) upper fibers: elevate scapula
2) middle fibers: retract scapula
3) lower fibers: depress scapula
4) upper and lower: upward rotation of scapula
trapezius nerve
accessory nerve (CN XI)
levator scapulae and rhomboid locations
deep to trapezius, levator scapulae is superior and lateral to rhomboids
levator scapulae and rhomboid origin
C1-T5 mnemonic: 4, 2, 2, 4
C1-C4 (transverse processes: levator scapulae
C5-6 skip
C7-T1 (spinous processes): rhomboid minor
T2-T5 (spinous processes): rhomboid major
levator scapulae and rhomboids insertion
- medial border of scapula
- levator scapulae above spine, rhomboids below
levator scapulae and rhomboid actions
- levator scapulae: elevate and downward rotation of scapula
- rhomboids: retract and downward rotation of scapula
levator scapulae and rhomboid nerve
dorsal scapular nerve
anterior thoracic muscles
1) subclavius
2) pectoralis minor
3) serratus anterior (“boxer’s muscle”)
subclavius origin
side of manubrium
subclavius insertion
underside of clavicle
subclavius action
stabilize and depress clavicle
subclavius nerve
nerve to subclavius
serratus anterior origin
ribs 1-8
serratus anterior insertion
medial border of scapula (wraps around)
serratus anterior action
protraction and upward rotation of scapula
serratus anterior nerve
long thoracic nerve
pectoralis minor origin
ribs 3-5
pectoralis minor insertion
coracoid process
pectoralis minor action
stabilize scapula by drawing it inferiorly and anteriorly
pectoralis minor nerve
medial pectoral nerve
winged scapula
- impaired serratus anterior causes protrusion of scapula when arms raised
muscles that move the glenohumeral joint
anterior:
1) pectoralis major
posterior:
2) deltoid
3) teres major
4) latissimus dorsi
lateral:
5) rotator cuff muscles
rotator cuff muscles
1) supraspinatus
2) infraspinatus
3) teres minor
4) subscapularis
pectoralis major structure
large, fan-shaped muscle with two “heads”: clavicular and sternocostal
pectoralis major origin
medial clavicle, sternum, costal cartilages of ribs 1-6
pectoralis major insertion
intertubercular sulcus of humerus
pectoralis major actions
- clavicular head: flex GH joint
- sternocostal head: adduct and medial rotation of GH joint
- lower fibers of sternocostal head: extends GH joint from flexed position
pectoralis major nerve
medial and lateral pectoral nerves
deltoid origin
lateral clavicle, acromion, spine of scapula
deltoid insertion
deltoid tuberosity of humerus
deltoid actions
- all fibers: abduct GH joint
- anterior part: flex and medial rotation of GH joint
- posterior part: opposite of anterior = extend and lateral rotation of GH joint
deltoid nerve
axillary nerve
teres major origin
dorsal region of inferior scapula
teres major insertion
intertubercular sulcus of humerus
teres major action
adduct and medially rotate GH joint
teres major nerve
lower subscapular nerve
latissimus dorsi origin
very broad along spine
latissimus dorsi insertion
intertubercular sulcus (humerus)
latissimus dorsi action
extend, adduct, medially rotate GH joint
latissimus dorsi nerve
thoracodorsal nerve
intertubercular sulcus muscles (insertions)
P.L.T (lateral to medial)
pectoralis major, latissimus dorsi, teres major
teres major and latissimus dorsi relationship
teres major = synergist to latissimus dorsi
rotator cuff muscle function
- rotate humerus
- stabilize GH joint
rotator cuff muscles
1) supraspinatus
2) infraspinatus
3) teres minor
4) subscapularis
subscapularis origin and insertion
origin = subscapular fossa
insertion = lesser tubercle
subscapularis action
medial rotation
subscapularis innervation
upper/lower subscapular nerves
supraspinatus origin/insertion
supraspinous fossa, greater tubercle
supraspinatus action
abduction (NO rotation!)
supraspinatus innervation
suprascapular nerve
infraspinatus origin and insertion
infraspinous fossa, greater tubercle
infraspinatus action
lateral rotation
infraspinatus nerve
suprascapular nerve
teres minor origin and insertion
lateral border of scapula, greater tubercle
teres minor action
lateral rotation
teres minor nerve
axillary nerve
rotator cuff anterior/posterior muscles
anterior: supraspinatus, subscapularis
posterior: supraspinatus, infraspinatus, teres minor
axilla location
pyramidal space inferior to GH joint
axilla purpose
protective passageway for neurovascular structures
axilla apex
clavicle, 1st rib, superior border of scapula
axilla lateral wall
intertubercular sulcus
axilla medial wall
thoracic wall (some ribs), serratus anterior
axilla base
armpit skin + subcutaneous CT
axilla anterior wall
pectoralis major, pectoralis minor
axilla posterior wall
scapula, subscapularis, teres major, latissimus dorsi
axillary contents
1) axillary sheath: nerves and BVs
2) fat: protects sheath
3) lymph nodes: in fat
axillary artery
- branches from subclavian artery
- begins at lateral border of rib 1
- continues posterior to pectoralis minor
- ends at inferior border of teres major
axillary artery parts
1) before pec. minor:
a) superior thoracic branch
2) under pec. minor:
a) thoraco-acromial
b) lateral thoracic
3) after pec. minor:
a) posterior circumflex
b) anterior circumflex
c) subscapular: posterior scapula
upper arm veins
- deep veins accompany arteries (with same names)
posterior/anterior circumflex branch of axillary artery
- around surgical neck
- can anastomose with each other
brachial plexus parts
1) 5 roots (C5-T1)
2) 3 trunks: superior, middle, inferior
3) 2 divisions: anterior/posterior
4) 3 cords: lateral, posterior, medial
5) 5 terminal branches
Really Thirsty Drink Cold Beer
terminal branches of brachial plexus
1) musculocutaneous
2) axillary (C5/6 only!)
3) median
4) radial
5) ulnar
additional nerves of brachial plexus
1) C5: dorsal scapular
2) superior trunk: suprascapular
3) C5-7: long thoracic
4) lateral cord: lateral pectoral
5) medial cord: medial pectoral
6) posterior cord: upper/lower subscapular
7) posterior cord: thoracodorsal
brachial plexus cord naming
named based on relationship to axillary artery
brachial plexus drawing
:)
where do brachial plexus roots emerge from?
- between anterior and middle scalene muscles
axillary nerve location
around surgical neck of humerus
arm muscle division
- divided into two compartments by septa
upper arm transverse section
1) skin
2) superficial fascia with superficial veins
3) brachial fascia
4) lateral and medial intermuscular septa
5) muscles
6) humerus
anterior compartment arm muscles
1) biceps brachii
2) coracobrachialis
3) brachialis
anterior compartment arm muscles nerve
musculocutaneous nerve
posterior compartment arm muscles
1) triceps brachii
2) anconeus
posterior compartment arm muscles nerve
radial nerve
biceps brachii origin
- long head: supraglenoid tubercle
- short head: coracoid process
biceps brachii heads
lateral long head, medial short head
biceps brachii insertion
- radial tuberosity and forearm fascia
- via bicipital aponeurosis
biceps brachii action
- elbow flexion
- radioulnar supination (when elbow flexed)
- GH flexion (synergist)
coracobrachialis origin and insertion
coracoid process, middle 1/3 of humerus
coracobrachialis action
GH joint flexion
brachialis origin and insertion
distal anterior surface of humerus, ulnar tuberosity
brachialis location
deep to biceps brachii
brachialis action
elbow flexion
musculocutaneous nerve location
- pierces coracobrachialis
- continues distally between biceps brachii and brachialis
proximal biceps brachii rupture
tendon comes off radial tuberosity leading to the popeye sign
triceps head orientation
long and lateral heads superior to medial
triceps brachii origin
- long: infraglenoid tubercle
- lateral: posterior surface of humerus ABOVE radial groove
- medial: posterior surface of humerus BELOW radial groove
triceps brachii insertion
olecranon process
triceps action
- extension of elbow
- long head = extension at GH joint
anconeus action
synergist to triceps brachii elbow movement and stabilizer
radial nerve location
- in radial groove
- pierces lateral intermuscular septum
- continues distally in anterior compartment of arm
upper arm blood supply
1) brachial artery branches from axillary, runs along anterior surface of arm
2) deep brachial artery branches from brachial, runs in radial groove going posterior
3) collateral branches: from brachial artery
4) recurrent arteries: form arterial anastomoses around elbow
3/4: collateral flow ensures blood flow in different joint positions
cubital fossa borders
1) superior: imaginary line between lateral and medial epicondyles
2) lateral: medial border or brachioradialis
3) medial: lateral border of pronator teres
cubital fossa contents
lateral to medial: biceps brachii tendon, brachial artery, median nerve
forearm muscles function
move hand at wrist and/or joints of fingers
forearm muscle transverse section
1) skin
2) superficial fascia with superficial veins
3) antebrachial fascia: creates anterior/posterior compartment
4) radius + ulna: connected by interosseous membrane
anterior forearm muscle layers
1) superficial
2) intermediate
3) deep
anterior forearm common origin
superficial and intermediate muscles share common flexor tendon at medial epicondyle
anterior forearm nerve
mostly median, with some exceptions
anterior forearm superficial layer muscles and actions
1) pronator teres: protonation
2) flexor carpi radialis: major wrist flexor, abduction
3) palmaris longus: weak wrist flexor
4) flexor carpi ulnaris: major wrist flexor, adduction
flexor retinaculum
- anchors tendons of FCR/FCU
- palmaris longus tendon lies overtop
what is unique about palmaris longus?
- vestigial
- not every wrist has one
anterior forearm intermediate layer muscles and actions
1) flexor digitorum superficialis: flexes metacarpophalangeal joint and proximal interphalangeal joints of 2-5, some wrist flexion
flexor digitorum superficialis tendons
- spilt at MCP to leave room for flexor digitorum profundus tendon
anterior forearm deep layer muscles and actions
1) flexor digitorum profundus: flex MCP/PIP/DIP of 2-5
2) pronator quadratus: protonation
3) flexor pollicis longus: flex MCP/IP of thumb
anterior forearm innervation exceptions
ulnar nerve = flexor carpi ulnaris and medial (vs lateral) half of FDP
median nerve location
- descends between FDS and FDP
- continues into hand to innervate thenar muscles
ulnar nerve location
- posterior to medial epicondyle
- descends between FCU and FDP
- continues into hand to innervate intrinsic hand msucles
carpal tunnel location
- between carpal bones (CT and synovial membrane) and flexor retinaculum
carpal tunnel contents
- long flexor tendons of FDS (4), FDP (4) and FPL (1)
- median nerve
carpal tunnel syndrome
- compression of median nerve
- ex. build up of synovial fluid due to inflammation
- chronic = muscle atrophy
posterior forearm muscle layers
1) superficial
2) deep
posterior forearm common origin
many attach on common extensor tendon on lateral epicondyle
posterior forearm common nerve
radial nerve and deep branch of radial nerve
extensor retinaculum
- covers tendons of posterior forearm muscles
posterior forearm superficial layer muscles and actions
1) brachioradialis: elbow flexion
2) extensor carpi radialis longus: main wrist extension, abduction
3) extensor carpi radialis brevis: main wrist extension, abduction
4) extensor digitorum: digits extension (primarily MCP, secondarily IP of 2-5)
5) extensor digiti minimi: extends fifth digit
6) extensor carpi ulnaris: main wrist extension, adduction
what is special about brachioradialis?
- can be seen from both anterior and posterior
- transition between compartments
ECRlongus vs ECRbrevis?
longus starts above lateral epicondyle
extensor digitorum tendons pass under…
- pass under extensor retinaculum
extensor digitorum origin and insertion
common extension origin, extensor expansions of medial 4 digits
extensor digitorum intertendinous connections
- variable in people
- restrict independent extension of digits
posterior forearm deep layer function
- act on pollex and index finger
- except supinator
posterior forearm deep layer common nerve
deep branch of radial nerve
posterior forearm deep layer muscles
1) abductor pollicis longus: I = lateral aspect of thumb
2) extensor pollicis brevis
3) extensor pollicis longus
4) extensor indicis
5) supinator: supinate proximal radioulnar joint (works with biceps brachii)
*only supinator attaches to lat. epicondyle
radial nerve location entire arm
- perforates lateral intermuscular septum of arm: runs with radial groove with deep brachial artery
- enters cubital fossa between brachioradialis and brachialis
radial nerve branches
1) deep branch: pierces supinator, continues along interosseous membrane
2) superficial branch: cutaneous nerves, descends deep to brachioradialis
blood supply of entire arm
1) subclavian
2) axillary
a) brachial artery: anterior compartment, divides in cubital region into radial/ulnar
b) deep brachial artery: runs posterior
4) collateral branching/anastomoses
5) radial artery
6) ulnar artery: three branches
a) common interosseous divides into:
b) anterior interosseous
c) posterior interosseous
7) deep and superficial palmar arches in hand: anastomoses
radial artery location forearm
- descends deep to brachioradialis
- winds around lateral wrist (goes posterior) in anatomical snuff box
ulnar artery location
- descends deep to pronator teres
forearm veins
deep veins accompany arteries, have same names
superficial veins location
run subcutaneously in superficial fascia
superficial veins function
venous return, temperature regulation
superficial veins in arm
1) axillary vein
2) cephalic vein: from back of hand to axillary
3) basilic vein: medial side, from palm to axillary
4) median cubital vein: joins 2/3, common site for cannulation
cannulation
inserting a cannula, a small tube, into a vein, artery, or other body cavity to provide access for fluids, medications, or blood sampling
anatomical snuff box borders
1) floor: scaphoid and trapezium
2) lateral: tendons of extensor pollicis brevis and abductor pollicis longus
3) medial: tendon of extensor pollicis longus
anatomical snuff box contents
- branch of radial nerve
- radial artery
- cephalic vein
lower limb bone functional division
1) pelvic girdle
2) bones of free lower limb
lower limb bone articulations
primarily diarthroses and synovial joints
lower limb bones structural division
1) thigh: hip to knee
2) leg: knee to ankle
3) foot: below ankle
pelvic girdle
- consists of left and right hip bones
hip bone structure
- three separate bones:
1) ilium (most superior)
2) ischium
3) pubis/pubic bone (anterior to ischium) - acetabulum: where bones fuse together around mid 20s, before separated by hyaline cartilage
- obturator foramen: formed by 2/3, covered with fascia and muscle
acetabulum features
1) lunate surface: smooth, where head of femur articulates
2) acetabular fossa: bony depression filled with fat
3) acetabular notch
ilium features
lateral surface:
1) iliac crest
2) ala
medial surface:
3) iliac fossa
4) arcuate line
for muscle attachment:
5) anterior superior iliac spine
6) anterior inferior iliac spine
7) posterior superior iliac spine
8) posterior inferior iliac spine
other:
9) greater sciatic notch: sciatic (largest nerve) passes through
ischium features
1) ischial tuberosity: “big bump” that are “sit” bones, hamstrings attach here –> lateral view
2) ischial spine: muscle attachment
3) lesser sciatic notch
4) ischial ramus
pubis features
1) pectineal line: medial view, continuous with arcuate line
2) superior pubic ramus
3) pubic tubercle: ligament attachment
4) body of pubis: between rami, forms pubic symphysis
5) inferior pubic ramus
sacrospinous ligament
- attaches from sacrum to ischial spine
- creates foramina: greater/lesser sciatic foramen
femur structures
1) head
2) neck
3) greater trochanter: lateral
4) lesser trochanter: medial
5) lateral/medial epicondyle
6) lateral/medial condyle
7) adductor tubercle
anterior only:
1) intertrochanteric line
posterior only:
1) intertrochanteric crest: more prominent than line
2) gluteal tuberosity
3) linea aspera
4) intercondylar fossa
largest bone in the body?
femur
patella bone type
sesamoid: within tendons
patella location
within quadriceps femoris tendon: convergence of quadriceps muscles
patella in babies
not fully ossified
patella function
- protect knee joint
- allow quadriceps femoris tendon to glide smoothly over joint: maximises movement
patella structure
- rough anterior: tendon attachment
- smooth posterior: articular cartilage with femur
- base
- anterior apex
- posterior facets
why is tibia bigger than fibula?
tibia bears all the weight when standing
fibula purpose?
muscle attachment and forms part of ankle joint
tibia superior view
1) flat articular surfaces of condyles
2) intercondylar eminences
3) can see tibial tuberosity on anterior side
tibia and fibula inferior view
1) lateral/medial malleolus
2) fibular notch
3) inferior articular surface
tibia features
1) lateral tibial condyle
2) medial tibial condyle
3) tibial tuberosity: large, rough, for quadriceps femoris muscles
4) medial malleolus
fibula features
1) head
2) neck
3) lateral malleolus
tibia and fibula relative anatomy
- tibia medial side
- connected by interosseous membrane
foot purpose
- support body weight
- act as lever to propel body forward in walking and running
foot bone divisions
7 tarsals, 5 metatarsals, 14 phalanges
foot tarsals
medial to lateral, proximal to distal
1) talus: on top of…
2) calcaneus: heel bone
3) navicular
4) cuboid
5) medial, intermediate and lateral cuneiform
calcaneus features
1) calcaneal tuberosity: connects to calcaneal (Achilles) tendon
2) sustentaculum tali: holds up talus
talus features
1) trochlea: articulates with mallei
2) head: articulates with navicular
foot metatarsals
numbered big to small toe
foot phalanges
- only two for big toe
- others have proximal, middle and distal
- all long bones
foot arches
1) medial and lateral longitudinal arches
2) transverse arch
foot medial longitudinal arch
in most people
1) metatarsals 1-3
2) cuneiforms
3) navicular
4) talus
5) calcaneus
foot lateral longitudinal arch
typically not as prominent as medial
1) calcaneus
2) cuboid
3) metatarsals 4-5
foot transverse arch
1) bases of metatarsals 1-5
2) cuboid
3) cuneiforms
4) muscle tendons
support of foot arches
1) shape of bones
2) ligaments: spring, long/short plantar ligaments
3) intrinsic foot muscles and muscle tendons
4) plantar aponeurosis
pes planus
- flat feet
- medial longitudinal arch affected
- causes: bone development, ligament/muscle injury, excess weight
ankle (talocrural) joint type
hinge synovial: thin joint capsule reinforced by collateral ligaments
ankle joint articulation
- malleoli of tibia and fibula form mortise (deep socket): articulates with trochlea of talus
ankle joint movements
1) dorsiflexion: flex foot
2) plantarflexion: point foot
why is dorsiflexion more stable?
- trochlea widest anteriorly
- fits between trochlea and mortise tightest and with more articulation
ankle joint ligaments
1) anterior and posterior tibiofibular ligaments: reinforce mortise
2) lateral ligament of ankle: three bands that stabilize ankle during inversion
a) anterior talofibular ligament
b) calcaneofibular ligament
c) posterior talofibular ligament
3) medial (deltoid) ligament: stabilizes ankle during eversion
subtalar tarsal joint
plane synovial joint between talus and calcaneus
transverse tarsal joint
plane synovial joint between talus and navicular
subtalar and transverse tarsal joint movements
1) eversion: sole away from body
2) inversion: sole towards body
sacroiliac joints type
compound joint:
1) synovial plane: auricular surfaces of ilium and sacrum
2) syndesmosis: connected by fibrous CT
sacroiliac joint characteristics
- connects axial skeleton and inferior appendicular skeleton
- strong, weight-bearing
- limited mobility
sacroiliac joint intrinsic ligaments
1) anterior sacroiliac
2) posterior sacroiliac
3) interosseous sacroiliac (many)
sacroiliac joint extrinsic ligaments
1) sacrospinous: sacrum to ischial spine
2) sacrotuberous: sacrum to ischial tuberosity
sacroiliac joint extrinsic ligament function
- prevent excess anterior rotation of pelvis
- weight of body passes anterior to axis of rotation of sacroiliac joint
hip joint type
ball and socket synovial
hip joint articulation
head of femur + lunate surface of acetabulum
hip joint supporting structures
1) fat pad
2) transverse acetabular ligament: spans acetabular notch, merges with…
3) acetabular labrum: around acetabulum, extend depth of articulation (2/3 sphere)
4) joint capsule
5) ligament of femoral head: not as important for stability, but makes path for BV
hip joint movements
1) flex/ex
2) abd/ad
3) medial/lateral rotation
hip joint intrinsic ligaments
- all spiral anteriorly and become taut during extension
1) iliofemoral: ilium to femur (intertrochanteric line), strongest ligament in the body
2) pubofemoral: limits overabduction
3) ischiofemoral
knee joint type
modified hinge synovial joint
knee joint articulations
1) femorotibial: condyles of femur + tibia
2) femoropatellar: facets of patella + condyles of femur
lateral and medial meniscii
- between femorotibial articulations
- stabilize, increase articulation and absorb shock
knee joint actions
flex/ex and slight rotation (two axes)
knee joint ligaments
1) fibular (lateral) collateral
2) tibial (medial) collateral
3) posterior cruciate ligament
4) anterior cruciate ligament
5) patellar ligament and tendon (quadriceps)
fibular collateral ligament
- stability during extension
- separate from meniscus
tibial collateral ligament
- stability during extension
- direct attachment to meniscus
posterior cruciate ligament
- from posterior tibia
- prevents anterior sliding of femur on tibia, especially during flexion
anterior cruciate ligament
- from anterior tibia
-prevents posterior sliding (hyperextension)
testing for cruciate ligament tears
1) anterior drawer sign: pull anteriorly for ACL
2) posterior drawer sign: push posteriorly for PCL
muscle groups that move hip joint
1) gluteal
2) lateral rotators
3) iliopsoas
4) adductors
gluteal muscles
1) gluteus maximus, partially layered over…
2) gluteus medius: slightly lateral
3) gluteus minimis: deep to all, slightly lateral
4) tensor fasciae latae (TFL): lateral
gluteus maximus origin and insertion
O: iliac crest, sacrum, coccyx
I: gluteal tuberosity and posterior iliotibial tract
gluteus maximus nerve
inferior gluteal nerve
gluteus maximus action
extension and lateral rotation of hip joint
gluteus medius/minimis nerve
superior gluteal
gluteus medius/minimis action
abduction, medial rotation of hip joint
gluteus medius/minims origin and insertion
O: external ilium
I: greater trochanter
tensor fasciae latae action
- tense iliotibial tract (anterior)
- assist with flexion, abduction and medial rotation of hip joint
tensor fasciae nerve
superior gluteal
muscles during single leg stance
- abductors on opposite side of lifted leg contract
- keeps pelvis level by counteracting force of gravity
trendelenburg gait
- compromised abductors
- pelvis drops to contralateral side during single leg stance
lateral rotator muscles
1) piriformis
2) superior gemellus
3) obturator internus
4) inferior gemellus
5) obturator externus
6) quadratus femoris
P-GO-GO-Q
lateral rotators general origin and insertion
pelvis to greater trochanter
lateral rotators action
- lateral rotation of extended hip joint
- abduct flexed hip joint
- stabilize hip by pulling head of femur into acetabulum
lateral rotators location
- run horizontally posterior to hip joint
- under gluteus maximus
- inferior to gluteus medius and minimis
lateral rotators nerve
branches from lumbosacral plexus
lateral rotators along sciatic notches
- greater: piriformis
- lesser: obturator internus
obturator internus vs externus
- both cover obturator foramen
- externus = external aspect, internus = internal
sciatic nerve location
emerges below piriformis
iliopsoas parts
- composite muscle: psoas major and iliacus
- merge beneath inguinal ligament
psoas major origin
lumbar vertebrae
iliacus origin
iliac fossa
iliopsoas common insertion
lesser trochanter
psoas major nerve
branches of lumbar plexus
iliacus nerve
femoral
iliopsoas action
hip flexors
adductor muscles
1) pectineus: same plane as…
2) adductor longus
3) adductor brevis: deep to 1)
4) adductor magnus: adductor and hamstring, deep to 1-3
5) gracilis: also crosses posterior knee
adductor muscles common origin
external pubis
adductor muscles common insertion
linea aspera, except gracilis = anterior tibia
adductor muscles common nerve
obturator nerve, except hamstring of adductor magnus by tibial division of sciatic nerve
adductor muscles common action
hip adduction, except gracilis also does knee flexion
adductor hiatus
gap in adductor magnus where BVs pass through
parts of adductor magnus
- anterior adductor part
- posterior hamstring part, connected to sacrotuberous ligament
lumbar plexus rami
anterior rami of L1-L4
lumbar plexus location
formed within psoas major and innervates it
lumbar plexus end nerves
abdominal wall:
1) iliohypogastric nerve: L1
2) ilioinguinal nerve: L1
lumbar region:
3) obturator nerve: L2-L4
4) femoral nerve: L2-L4
obturator nerve location
- enters medial compartment of thigh via obturator canal: gap of obturator foramen
- accompanied by obturator vessels
femoral nerve location
- passes deep to inguinal ligament into anterior thigh
- accompanied by femoral vessels
sacral plexus rami
- anterior rami of L4-S4
sacral plexus nerves
1) lumbosacral trunk: L4-S5
sacral part:
2) superior gluteal nerve: L4-S1
3) inferior gluteal nerve: L5-S2
4) sciatic nerve: L4-S3
superior gluteal nerve location
- passes through greater sciatic foramen SUPERIOR to piriformis
- accompanied by superior gluteal vessels
inferior gluteal nerve location
- passes through greater sciatic foramen INFERIOR to piriformis
- accompanied by inferior gluteal vessels
sciatic nerve location
- passes through greater sciatic foramen INFERIOR to piriformis
- goes to posterior thigh
- consists of tibial and common fibular divisions
thigh blood supply
1) aorta
2) common iliac arteries:
a) internal iliac artery: gives rise to superior/inferior gluteal arteries and obturator artery
b) external iliac artery: becomes 3) below inguinal ligament
3) femoral artery: becomes
4) deep femoral artery: chief artery, gives rise to medial and lateral femoral circumflex and perforating branches
*deep veins accompany arteries
thigh cross section
1) skin
2) superficial fascia with veins
3) fascia lata
4) anterior, medial and posterior compartments
5) femur
anterior thigh muscles
1) sartorius
2) quadriceps femoris:
a) rectus femoris
b) vastus lateralis
c) vastus medialis
d) vastus intermedius
anterior thigh common action
knee extension (except sartorius)
anterior thigh common nerve
femoral
iliotibial tract formed by…
thickening of fascia lata + muscles (gluteus maximus)
sartorius origin and insertion
anterior superior iliac spine, medial tibia
sartorius actions
1) hip flexion, abduction and lateral rotation
2) knee flexion
quadriceps muscle origins
1) rectus femoris: anterior inferior iliac spine
2) vastus lateralis: greater trochanter
3) medialis: femur
4) intermedius: femur
quadriceps muscles common insertion
- over patella –> patellar ligament –> tibial tuberosity
quadriceps muscles arrangment
- rectus femoris most superficial
- intermedius deep to RF
- lateralis = lateral, medialis = medial, goes a little more distal
quadriceps muscles actions
- all extend knee joint
- rectus femoris can also flex hip
which quadriceps muscles stabilize knee joint?
all, but especially inferior fibers of vastus medialis and lateralis
femoral triangle location
- subfascial space in anterosuperior 1/3 of thigh
femoral triangle boundaries
1) floor (deep): iliopsoas and pectineus
2) roof (more superficial): fascia lata, subcutaneous tissue, skin
3) superior: inguinal ligament
4) medial: adductor longus
5) lateral: sartorius
femoral triangle contents
NAVL lateral to medial:
Nerve
femoral Artery
femoral Vein
Lymphatics
femoral canal
- in femoral triangle
- formed by femoral sheath
- contain artery, vein and lymphatics
groin injuries
- strain, stretch or tear of proximal attachments of anteromedial thigh muscles
- often occur in sports with quick starts, ex. sprints
posterior thigh muscles (hamstring muscles)
1) biceps femoris
2) semimembranosus
3) semitendinosus
posterior thigh common origin
ischial tuberosity, except short head of biceps femoris = linea aspera
posterior thigh common action
1) hip extension (except short head)
2) knee flexion
posterior thigh common nerve
tibial division of sciatic, except short head = common fibular division
biceps femoris insertion
fibula
semimembranosus characteristics
deep to semitendinosus, ligament broadens distally
biceps femoris heads
medial long, lateral short (under iliotibial tract)
semimembranosus insertion
medial condyle of tibia
semitendinosus characteristics
- ends in long, thin tendon
- more superficial than semimembranosus
semitendinosus insertion
medial tibia
pes anserinus components
conjoined tendon of:
1) sartorius
2) gracillis
3) semitendinous
pes anserinus location
anteromedial side of proximal tibia
pes anserinus function
reinforce medial aspect of knee joint
femoral artery location
- passes through femoral triangle and adductor canal
- supplies anterior thigh compartment
deep femoral artery location
- passes deep between pectineus and adductor longus
- supplies posterior thigh compartment
adductor hiatus close arteries
- femoral artery passes posterior here to become popliteal artery
- part of abductor magnus
popliteal artery location
- ends at inferior border of popliteus
- branches around knee
popliteal fossa location
- fat-filled, diamond shaped space posterior to knee joint
popliteal fossa boundaries
1) roof (superficial: skin, popliteal fascia
2) floor: femur, knee joint capsule, fascia of popliteus
3) medial: semimembranosus superior to medial head of gastrocnemius
4) lateral: biceps femoris, lateral head of gastrocnemius
leg transverse section
1) skin
2) superficial fascia with veins
3) crural fascia: forms anterior, posterior and transverse intermuscular septae
4) 3 compartments
a) anterior: interosseus membrane and anterior septum
b) medial: anterior/posterior septa
c) posterior: interosseus membrane and posterior septum, transverse separates deep from superficial)
leg retinaculae
- thickening of fascia at distal leg
- hold muscle tendons in place as they cross ankle joint
- ex. inferior extensor retinaculum
common action of leg tendons
tendons passing:
1) posterior to ankle = plantarflexion
2) anterior to ankle = dorsiflexion
3) dorsal toes: extension
4) plantar toes: flexion
tendons attaching to:
1) medial foot: inversion
2) lateral foot: eversion
anterior leg muscles
1) tibialis anterior
2) extensor digitorum longus
3) extensor hallucis longus
4) fibularis tertius
1-3 superficial to deep
tibialis anterior origin and insertion
lateral condyle of tibia, medial side of foot (medial cuneiform + metatarsal 1 base)
tibialis anterior actions
inversion + dorsiflexion of foot
extensor digitorum longus origin/insertion
lateral condyle of tibia, dorsal aspect of digits 2-5
extensor digitorum longus action
dorsiflexion, extension of toes 2-5
extensor hallucis longus origin and insertion
medial fibula to dorsal digit 1
big toe anatomical name
hallux
extensor hallucis longus action
hallux extension, dorsiflexion
fibularis tertius origin and insertion
inferior/anterior fibula, dorsal digit 5
fibularis tertius action
dorsiflexion, eversion of foot
anterior leg muscles common nerve
deep fibular
lateral leg muscles
1) fibularis longus
2) fibularis brevis (deep)
fibularis longus origin and insertion
head of fibula, plantar surface of foot (crosses from lateral to medial side)
fibularis brevis origin and insertion
lateral fibula, base of 5th metatarsal
fibularis longus/brevis action
eversion, plantarflexion of foot
fibularis longus/brevis nerve
superficial fibular
foot drop
- foot drags instead of anterior part lifting
- compromised deep fibular nerve
posterior leg compartments
1) superficial
2) deep
superficial posterior leg muscles
1) gastrocnemius
2) soleus
3) plantaris
superficial to deep: 1, 3, 2
gastrocnemius origin
medial and lateral femoral condyles (2 heads)
soleus origin
posterior, proximal tibia and fibular head
plantaris origin
above lateral femoral condyle
superficial posterior leg muscles common insertion
calcaneus via calcaneal tendon (Achilles)
superficial posterior leg muscles common action
plantar flexion
superficial posterior leg muscles additional actions
gastrocnemius flexes knee, plantaris weakly assists
superficial posterior leg muscles common nerve
tibial nerve
flexor retinaculum of foot
- supports tendons of deep posterior leg muscles
- medial malleolus to calcaneus
- reinforced by transverse intermuscular septum
posterior leg deep compartment
1) flexor digitorum longus
2) flexor hallucis longus
3) tibialis posterior
4) popliteus
deep posterior leg muscles tendons organization
superior/medial
1) tibialis posterior
2) flexor digitorum longus
3) flexor hallucis longus
inferior/lateral
Tom, Dick, Harry
flexor digitorum longus origin/insertion
posterior tibia, bases of distal phalanges 2-5
flexor digitorum longus action
flexes digits 2-5
flexor hallucis longus origin/insertion
inferior/posterior fibula, base of distal phalanx 1
flexor hallucis longus action
flexes hallux
tibialis posterior origin/insertion
origin = interosseous membrane, posterior tibia and fibula
insertion = navicular, cuneiforms, cuboid, calcaneus (sustentaculum tali), bases of metatarsals 2-4
tibialis posterior action
inversion, plantarflexion, support medial longitudinal arch
popliteus characteristics
triangle-shaped, forms floor of popliteal fossa
popliteus origin and insertion
origin = lateral condyle of femur, lateral meniscus
insertion = posterior proximal tibia
popliteus action
unlocks knee by rotating femur slightly to enable knee flexion
posterior deep leg muscles common action
plantarflexion, except popliteus
posterior deep leg muscles common nerve
tibial
lower leg innervation
1) sciatic nerve branches into:
2a) common fibular nerve: branches into
3a) superficial fibular nerve: lateral compartment
3b) deep fibular nerve: anterior compartment
2b) tibial nerve: posterior compartment with tibialis posterior, branches into
3c) medial and lateral plantar nerves
leg arteries
1) (superficial) femoral artery
2) popliteal artery branches into
3a) anterior tibial artery: anterior compartment, also supplies lateral
4a) dorsalis pedis artery after extensor retinaculum
3b) posterior tibial artery: posterior compartment, also lateral, branches:
4b) fibular artery: posterior leg, near posterior septum
4c) medial and lateral plantar arteries after flexor retinaculum
leg deep veins
accompany arteries with same name
leg superficial veins
1) femoral vein
medial side:
2) dorsal venous arch empties into…
3) great saphenous vein, empties into 1)
posterior side:
4) small saphenous vein empties into popliteal vein
intrinsic back muscles location
- deepest muscles
- enclosed in deep fascia
intrinsic back muscles general purpose
movement and maintain posture of vertebral column
intrinsic back muscles common origin
- tendinous connection from posterior iliac crest, sacrum and spinous processes of lumbar vertebrae
- insert above
intrinsic back muscles common nerve
posterior rami of spinal nerves
nuchal ligament
from external occipital protuberance to C7 (spinous processes)
supraspinous ligament
thoracic vertebrae and below until median sacral crest
intrinsic back muscles layers
1) superficial: splenius
2) intermediate: 3x erector spinae
3) deep: transversospinalis muscle group
intrinsic back muscles bilateral contraction
extension of head and vertebral column
intrinsic back muscles division
divided into parts: capitis, cervicis, thoracis, lumborum
splenius parts
1) capitis
2) cervicis
splenius location
- deep to trapezius
- fibers run superolaterally to cervical vertebrae and cranium (V shape)
splenius origin
nucheal ligament
splenius unilateral contraction
ipsilateral head rotation and neck lateral flexion
erector spinae location
- column of muscles from sacrum to skull
- between spinous processes and angle of ribs
erector spinae origin
- tendinous connection from posterior iliac crest, sacrum and spinous processes of lumbar vertebrae
erector spinae muscles
lateral (longer)
1) iliocostalis
2) longissimus
3) spinalis
medial (shorter)
I Like Standing
erector spinae unilateral contraction
ipsilateral:
1) lateral flexion of VC
2) head rotation
3) spine rotation
iliocostalis insertion
transverse processes of cervical vertebrae
longissimus insertion
- ribs
- transverse processes of thoracic/cervical vertebrae
- temporal bone mastoid process
spinalis insertion
spinous processes of upper thoracic vertebrae + skull
transversospinalis group location
deep to erector spinae, fibers run superomedially (A shape)
transversospinalis muscle groups
1) semispinalis: capitis, cervitis, lumborum
2) short muscles that extend from 1 vertebrae to the next
transversospinalis group unilateral contraction
contralateral head and VC rotation