MSK Flashcards
1
Q
upper limb bone divisions
A
1) shoulder: pectoral girdle
2) arm: humerus
3) forearm: radius, ulna
4) hand: carpals, metacarpals, phalanges
2
Q
upper limb bone count
A
32 in total
3
Q
pectoral girdle components
A
clavicle and scapula
4
Q
pectoral girdle function
A
- connects upper limb to axial skeleton
- attachment site for muscles
5
Q
sternoclavicular joint
A
- clavicle + manubrium (sternum)
- only articulation between upper limb and axial skeleton
6
Q
clavicle function
A
- strut: allows range of movement
- protects upper limb
- transmits shock from upper limb to axial skeleton
7
Q
clavicle surfaces
A
- smooth superior
- rough inferior: for ligamentous connections
8
Q
clavicle structure
A
1) acromial end
2) shaft
3) sternal end
9
Q
scapula bone type
A
flat bone
10
Q
scapula anterior vs posterior surface
A
- posterior has spine and acromion
- anterior has coracoid process
11
Q
scapula borders
A
1) superior
2) lateral
3) medial
12
Q
scapula angles
A
1) superior
2) inferior
3) lateral
13
Q
scapula fossae and cavities
A
anterior:
1) subscapular fossa
2) glenoid cavity
posterior:
3) supraspinous
4) infraspinous
5) suprascapular notch
14
Q
humerus bone type
A
long bone
15
Q
humerus articulations
A
- proximal glenohumeral joint: head (humerus) + glenoid cavity (scapula)
- distal elbow joint: articulates with radius and ulna
16
Q
humerus anterior and posterior structures
A
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
17
Q
humerus anterior only structures
A
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)
18
Q
humerus posterior only structures
A
1) radial groove: radial nerve + artery
2) olecranon fossa: olecranon process of ulna during elbow extension
19
Q
radius and ulna bone types
A
long bones
20
Q
radius and ulna articulations
A
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
21
Q
ulna features
A
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
22
Q
radius features
A
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
23
Q
ulna and radius relative location
A
ulna medial to radius
24
Q
carpal bone types
A
short bones (cube shaped)
25
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
26
carpal bone that can't be seen posteriorly
pisiform because lies on top of triquetrum
27
metacarpal and phalange bone types
long bones
28
metacarpal structure
each has base (attached to carpals), body and head
29
metacarpal numbering
1-5 lateral to medial (thumb is one)
30
phalange naming
- proximal, middle and distal (except thumb does not have middle)
31
thumb anatomical name
pollex
32
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
33
synovial joint classification
1) plane = uniaxial
2) pivot = uniaxial
3) saddle = biaxial
4) hinge = uniaxial
5) condylar (condyloid) = biaxial
6) ball and socket = multiaxial
34
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
35
synovial fluid function
- lubrication
- nourishes articular cartilage
- shock absorber
36
bursae function
- fibrous saclike structures filled with synovial fluid
- alleviate friction
37
carpometacarpal joint (CMC) classification
digit 1 = saddle, others = plane
38
metacarpophalangeal joint (MCP) classification
condyloid
39
proximal/distal interphalangeal joint (PIP) classification
hinge
40
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
41
CMC joint movement
- for digits 2-5: flex/ex
42
MCP joint movement
- flex/ex
- ab/adduction (middle finger considered midline)
43
PIP joint movement
- flex/ex
44
sternoclavicular joint type
- saddle synovial
- acts as ball and socket
45
sternoclavicular joint movements
- elevation/depression
- anterior/posterior
46
sternoclavicular joint features
1) articular disc: shock absorber from upper limb
47
sternoclavicular joint ligaments
1) anterior/posterior sternoclavicular ligaments: reinforce capsule
2) interclavicular ligament
3) costoclavicular ligament: underside of clavicle
48
acromioclavicular joint type
plane synovial, allows gliding
49
acromioclavicular joint articulation
acromial end of clavicle + acromion of scapula
50
acromioclavicular joint features
- articular disc
- muscle fibers of trapezius help support the joint
51
acromioclavicular joint ligaments
1) acromioclavicular ligament: intrinsic
2) coracoclavicular: extrinsic, attaches to underside of clavicle
52
intrinsic vs extrinsic ligament
- intrinsic: part of joint, formed by thickening of joint capsule
- extrinsic: not part of joint capsule
53
glenohumeral joint (shoulder joint) type
ball and socket
54
glenohumeral joint articulation
head of humerus (1/3) + glenoid cavity
55
glenohumeral joint features
1) standard joint capsule
2) glenoid labrum: wraps around glenoid cavity, deepening it for more stability (more of head can fit)
56
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
57
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)
58
glenohumeral joint ligaments
1) coracoacromial ligament: limits superior dislocation
2) intrinsic glenohumeral ligaments
3) coracohumeral ligament: inhibits excessive rotation
59
glenohumeral joint bursae
1) subacromial
2) subdeltoid
3) tendinous sheath
*all located in areas of friction
60
glenohumeral joint muscle support
1) rotator cuffs on anterior/posterior
2) tendon of long head of biceps brachii: helps stabilize head of humerus
61
shoulder separation
- acromioclavicular joint separated
62
shoulder dislocation
- glenohumeral joint separated
63
scapulothoracic joint type
- not a true joint!
- no bone-bone articulation, instead separated by muscle
- no capsule/ligaments
64
scapulothoracic joint function
- enable free range of motion of the upper limb
65
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
66
scapulothoracic joint supporting muscles
1) subscapularis: between thoracic wall and scapula
2) serratus anterior: wraps around thorax
67
elbow joint type
- compound: more than one articulation
- hinge synovial
68
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
69
elbow joint movements
flex/ex
70
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
71
why is anular ligament important in elbow?
- shallow groove
- doesn't completely ossify until older = needs more support
72
collateral ligaments
on sides of joints
73
elbow joint bursae
1) olecranon bursa
74
radioulnar joints characteristics
- connected by flat ligament: antebrachial interosseous membrane
- articulation of radius and ulna
75
radioulnar joint type
pivot synovial: radius rotates around stationary ulna
76
radioulnar joint movements
1) supination: palm up, radial tuberosity up
2) protonation: palm down, radial tuberosity down
77
radiocarpal (wrist) joint type
condyloid synovial
78
radiocarpal joint articulations
- proximal row of carpals (except pisiform) + distal radius + articular disc
79
radiocarpal joint ligaments
1) anterior/posterior
2) ulnar collateral: stretched during abduction
3) radial collateral: stretched during adduction
80
radiocarpal joint capsule contents
1) distal radioulnar joint
2) intercarpal joints
*ulna not included in wrist joint!
81
radiocarpal joint movements
1) flex/ex
2) abd/add
82
how do skeletal muscles produce movement?
work together to pull on bones (cross joint that they move)
83
agonist (prime mover)
muscle that provides major force for producing a movement
84
antagonist
muscle that opposes action of agonist, located on opposite side of joint
85
fixators
when agonists and antagonists contract simultaneously
86
synergists
help agonist by adding extra force to the same movement
87
concentric contraction
muscles shorten under tension
88
origin vs insertion
- origin: attachment point that often stays fixed during muscle contraction, usually proximal
- insertion: moves closer to origin during contraction, usually distal
89
muscles that move pectoral girdle location and function
- anterior and posterior thorax
- fix scapula to wall of thorax
- move pectoral girdle
90
pectoral girdle muscles
1) trapezius
2) levator scapulae
3) rhomboid major/minor
91
trapezius origin
occipital bone, nuchal ligament, spinous processes of C7-T12
92
trapezius insertion
spine of scapula, lateral clavicle, acromion
93
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
94
trapezius nerve
accessory nerve (CN XI)
95
levator scapulae and rhomboid locations
deep to trapezius, levator scapulae is superior and lateral to rhomboids
96
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
97
levator scapulae and rhomboids insertion
- medial border of scapula
- levator scapulae above spine, rhomboids below
98
levator scapulae and rhomboid actions
- levator scapulae: elevate and downward rotation of scapula
- rhomboids: retract and downward rotation of scapula
99
levator scapulae and rhomboid nerve
dorsal scapular nerve
100
anterior thoracic muscles
1) subclavius
2) pectoralis minor
3) serratus anterior ("boxer's muscle")
101
subclavius origin
side of manubrium
102
subclavius insertion
underside of clavicle
103
subclavius action
stabilize and depress clavicle
104
subclavius nerve
nerve to subclavius
105
serratus anterior origin
ribs 1-8
106
serratus anterior insertion
medial border of scapula (wraps around)
107
serratus anterior action
protraction and upward rotation of scapula
108
serratus anterior nerve
long thoracic nerve
109
pectoralis minor origin
ribs 3-5
110
pectoralis minor insertion
coracoid process
111
pectoralis minor action
stabilize scapula by drawing it inferiorly and anteriorly
112
pectoralis minor nerve
medial pectoral nerve
113
winged scapula
- impaired serratus anterior causes protrusion of scapula when arms raised
114
muscles that move the glenohumeral joint
anterior:
1) pectoralis major
posterior:
2) deltoid
3) teres major
4) latissimus dorsi
lateral:
5) rotator cuff muscles
115
rotator cuff muscles
1) supraspinatus
2) infraspinatus
3) teres minor
4) subscapularis
116
pectoralis major structure
large, fan-shaped muscle with two "heads": clavicular and sternocostal
117
pectoralis major origin
medial clavicle, sternum, costal cartilages of ribs 1-6
118
pectoralis major insertion
intertubercular sulcus of humerus
119
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
120
pectoralis major nerve
medial and lateral pectoral nerves
121
deltoid origin
lateral clavicle, acromion, spine of scapula
122
deltoid insertion
deltoid tuberosity of humerus
123
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
124
deltoid nerve
axillary nerve
125
teres major origin
dorsal region of inferior scapula
126
teres major insertion
intertubercular sulcus of humerus
127
teres major action
adduct and medially rotate GH joint
128
teres major nerve
lower subscapular nerve
129
latissimus dorsi origin
very broad along spine
130
latissimus dorsi insertion
intertubercular sulcus (humerus)
131
latissimus dorsi action
extend, adduct, medially rotate GH joint
132
latissimus dorsi nerve
thoracodorsal nerve
133
intertubercular sulcus muscles (insertions)
P.L.T (lateral to medial)
pectoralis major, latissimus dorsi, teres major
134
teres major and latissimus dorsi relationship
teres major = synergist to latissimus dorsi
135
rotator cuff muscle function
- rotate humerus
- stabilize GH joint
136
rotator cuff muscles
1) supraspinatus
2) infraspinatus
3) teres minor
4) subscapularis
137
subscapularis origin and insertion
origin = subscapular fossa
insertion = lesser tubercle
138
subscapularis action
medial rotation
139
subscapularis innervation
upper/lower subscapular nerves
140
supraspinatus origin/insertion
supraspinous fossa, greater tubercle
141
supraspinatus action
abduction (NO rotation!)
142
supraspinatus innervation
suprascapular nerve
143
infraspinatus origin and insertion
infraspinous fossa, greater tubercle
144
infraspinatus action
lateral rotation
145
infraspinatus nerve
suprascapular nerve
146
teres minor origin and insertion
lateral border of scapula, greater tubercle
147
teres minor action
lateral rotation
148
teres minor nerve
axillary nerve
149
rotator cuff anterior/posterior muscles
anterior: supraspinatus, subscapularis
posterior: supraspinatus, infraspinatus, teres minor
150
axilla location
pyramidal space inferior to GH joint
151
axilla purpose
protective passageway for neurovascular structures
152
axilla apex
clavicle, 1st rib, superior border of scapula
153
axilla lateral wall
intertubercular sulcus
154
axilla medial wall
thoracic wall (some ribs), serratus anterior
155
axilla base
armpit skin + subcutaneous CT
156
axilla anterior wall
pectoralis major, pectoralis minor
157
axilla posterior wall
scapula, subscapularis, teres major, latissimus dorsi
158
axillary contents
1) axillary sheath: nerves and BVs
2) fat: protects sheath
3) lymph nodes: in fat
159
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
160
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
161
upper arm veins
- deep veins accompany arteries (with same names)
162
posterior/anterior circumflex branch of axillary artery
- around surgical neck
- can anastomose with each other
163
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
164
terminal branches of brachial plexus
1) musculocutaneous
2) axillary (C5/6 only!)
3) median
4) radial
5) ulnar
165
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
166
brachial plexus cord naming
named based on relationship to axillary artery
167
brachial plexus drawing
:)
168
where do brachial plexus roots emerge from?
- between anterior and middle scalene muscles
169
axillary nerve location
around surgical neck of humerus
170
arm muscle division
- divided into two compartments by septa
171
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
172
anterior compartment arm muscles
1) biceps brachii
2) coracobrachialis
3) brachialis
173
anterior compartment arm muscles nerve
musculocutaneous nerve
174
posterior compartment arm muscles
1) triceps brachii
2) anconeus
175
posterior compartment arm muscles nerve
radial nerve
176
biceps brachii origin
- long head: supraglenoid tubercle
- short head: coracoid process
177
biceps brachii heads
lateral long head, medial short head
178
biceps brachii insertion
- radial tuberosity and forearm fascia
- via bicipital aponeurosis
179
biceps brachii action
- elbow flexion
- radioulnar supination (when elbow flexed)
- GH flexion (synergist)
180
coracobrachialis origin and insertion
coracoid process, middle 1/3 of humerus
181
coracobrachialis action
GH joint flexion
182
brachialis origin and insertion
distal anterior surface of humerus, ulnar tuberosity
183
brachialis location
deep to biceps brachii
184
brachialis action
elbow flexion
185
musculocutaneous nerve location
- pierces coracobrachialis
- continues distally between biceps brachii and brachialis
186
proximal biceps brachii rupture
tendon comes off radial tuberosity leading to the popeye sign
187
triceps head orientation
long and lateral heads superior to medial
188
triceps brachii origin
- long: infraglenoid tubercle
- lateral: posterior surface of humerus ABOVE radial groove
- medial: posterior surface of humerus BELOW radial groove
189
triceps brachii insertion
olecranon process
190
triceps action
- extension of elbow
- long head = extension at GH joint
191
anconeus action
synergist to triceps brachii elbow movement and stabilizer
192
radial nerve location
- in radial groove
- pierces lateral intermuscular septum
- continues distally in anterior compartment of arm
193
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
194
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
195
cubital fossa contents
lateral to medial: biceps brachii tendon, brachial artery, median nerve
196
forearm muscles function
move hand at wrist and/or joints of fingers
197
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
198
anterior forearm muscle layers
1) superficial
2) intermediate
3) deep
199
anterior forearm common origin
superficial and intermediate muscles share common flexor tendon at medial epicondyle
200
anterior forearm nerve
mostly median, with some exceptions
201
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
202
flexor retinaculum
- anchors tendons of FCR/FCU
- palmaris longus tendon lies overtop
203
what is unique about palmaris longus?
- vestigial
- not every wrist has one
204
anterior forearm intermediate layer muscles and actions
1) flexor digitorum superficialis: flexes metacarpophalangeal joint and proximal interphalangeal joints of 2-5, some wrist flexion
205
flexor digitorum superficialis tendons
- spilt at MCP to leave room for flexor digitorum profundus tendon
206
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
207
anterior forearm innervation exceptions
ulnar nerve = flexor carpi ulnaris and medial (vs lateral) half of FDP
208
median nerve location
- descends between FDS and FDP
- continues into hand to innervate thenar muscles
209
ulnar nerve location
- posterior to medial epicondyle
- descends between FCU and FDP
- continues into hand to innervate intrinsic hand msucles
210
carpal tunnel location
- between carpal bones (CT and synovial membrane) and flexor retinaculum
211
carpal tunnel contents
- long flexor tendons of FDS (4), FDP (4) and FPL (1)
- median nerve
212
carpal tunnel syndrome
- compression of median nerve
- ex. build up of synovial fluid due to inflammation
- chronic = muscle atrophy
213
posterior forearm muscle layers
1) superficial
2) deep
214
posterior forearm common origin
many attach on common extensor tendon on lateral epicondyle
215
posterior forearm common nerve
radial nerve and deep branch of radial nerve
216
extensor retinaculum
- covers tendons of posterior forearm muscles
217
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
218
what is special about brachioradialis?
- can be seen from both anterior and posterior
- transition between compartments
219
ECRlongus vs ECRbrevis?
longus starts above lateral epicondyle
220
extensor digitorum tendons pass under…
- pass under extensor retinaculum
221
extensor digitorum origin and insertion
common extension origin, extensor expansions of medial 4 digits
222
extensor digitorum intertendinous connections
- variable in people
- restrict independent extension of digits
223
posterior forearm deep layer function
- act on pollex and index finger
- except supinator
224
posterior forearm deep layer common nerve
deep branch of radial nerve
225
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
226
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
227
radial nerve branches
1) deep branch: pierces supinator, continues along interosseous membrane
2) superficial branch: cutaneous nerves, descends deep to brachioradialis
228
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
229
radial artery location forearm
- descends deep to brachioradialis
- winds around lateral wrist (goes posterior) in anatomical snuff box
230
ulnar artery location
- descends deep to pronator teres
231
forearm veins
deep veins accompany arteries, have same names
232
superficial veins location
run subcutaneously in superficial fascia
233
superficial veins function
venous return, temperature regulation
234
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
235
cannulation
inserting a cannula, a small tube, into a vein, artery, or other body cavity to provide access for fluids, medications, or blood sampling
236
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
237
anatomical snuff box contents
- branch of radial nerve
- radial artery
- cephalic vein
238
lower limb bone functional division
1) pelvic girdle
2) bones of free lower limb
239
lower limb bone articulations
primarily diarthroses and synovial joints
240
lower limb bones structural division
1) thigh: hip to knee
2) leg: knee to ankle
3) foot: below ankle
241
pelvic girdle
- consists of left and right hip bones
242
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
243
acetabulum features
1) lunate surface: smooth, where head of femur articulates
2) acetabular fossa: bony depression filled with fat
3) acetabular notch
244
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
245
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
246
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
247
sacrospinous ligament
- attaches from sacrum to ischial spine
- creates foramina: greater/lesser sciatic foramen
248
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
249
largest bone in the body?
femur
250
patella bone type
sesamoid: within tendons
251
patella location
within quadriceps femoris tendon: convergence of quadriceps muscles
252
patella in babies
not fully ossified
253
patella function
- protect knee joint
- allow quadriceps femoris tendon to glide smoothly over joint: maximises movement
254
patella structure
- rough anterior: tendon attachment
- smooth posterior: articular cartilage with femur
- base
- anterior apex
- posterior facets
255
why is tibia bigger than fibula?
tibia bears all the weight when standing
256
fibula purpose?
muscle attachment and forms part of ankle joint
257
tibia superior view
1) flat articular surfaces of condyles
2) intercondylar eminences
3) can see tibial tuberosity on anterior side
258
tibia and fibula inferior view
1) lateral/medial malleolus
2) fibular notch
3) inferior articular surface
259
tibia features
1) lateral tibial condyle
2) medial tibial condyle
3) tibial tuberosity: large, rough, for quadriceps femoris muscles
4) medial malleolus
260
fibula features
1) head
2) neck
3) lateral malleolus
261
tibia and fibula relative anatomy
- tibia medial side
- connected by interosseous membrane
262
foot purpose
- support body weight
- act as lever to propel body forward in walking and running
263
foot bone divisions
7 tarsals, 5 metatarsals, 14 phalanges
264
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
265
calcaneus features
1) calcaneal tuberosity: connects to calcaneal (Achilles) tendon
2) sustentaculum tali: holds up talus
266
talus features
1) trochlea: articulates with mallei
2) head: articulates with navicular
267
foot metatarsals
numbered big to small toe
268
foot phalanges
- only two for big toe
- others have proximal, middle and distal
- all long bones
269
foot arches
1) medial and lateral longitudinal arches
2) transverse arch
270
foot medial longitudinal arch
in most people
1) metatarsals 1-3
2) cuneiforms
3) navicular
4) talus
5) calcaneus
271
foot lateral longitudinal arch
typically not as prominent as medial
1) calcaneus
2) cuboid
3) metatarsals 4-5
272
foot transverse arch
1) bases of metatarsals 1-5
2) cuboid
3) cuneiforms
4) muscle tendons
273
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
274
pes planus
- flat feet
- medial longitudinal arch affected
- causes: bone development, ligament/muscle injury, excess weight
275
ankle (talocrural) joint type
hinge synovial: thin joint capsule reinforced by collateral ligaments
276
ankle joint articulation
- malleoli of tibia and fibula form mortise (deep socket): articulates with trochlea of talus
277
ankle joint movements
1) dorsiflexion: flex foot
2) plantarflexion: point foot
278
why is dorsiflexion more stable?
- trochlea widest anteriorly
- fits between trochlea and mortise tightest and with more articulation
279
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
280
subtalar tarsal joint
plane synovial joint between talus and calcaneus
281
transverse tarsal joint
plane synovial joint between talus and navicular
282
subtalar and transverse tarsal joint movements
1) eversion: sole away from body
2) inversion: sole towards body
283
sacroiliac joints type
compound joint:
1) synovial plane: auricular surfaces of ilium and sacrum
2) syndesmosis: connected by fibrous CT
284
sacroiliac joint characteristics
- connects axial skeleton and inferior appendicular skeleton
- strong, weight-bearing
- limited mobility
285
sacroiliac joint intrinsic ligaments
1) anterior sacroiliac
2) posterior sacroiliac
3) interosseous sacroiliac (many)
286
sacroiliac joint extrinsic ligaments
1) sacrospinous: sacrum to ischial spine
2) sacrotuberous: sacrum to ischial tuberosity
287
sacroiliac joint extrinsic ligament function
- prevent excess anterior rotation of pelvis
- weight of body passes anterior to axis of rotation of sacroiliac joint
288
hip joint type
ball and socket synovial
289
hip joint articulation
head of femur + lunate surface of acetabulum
290
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
291
hip joint movements
1) flex/ex
2) abd/ad
3) medial/lateral rotation
292
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
293
knee joint type
modified hinge synovial joint
294
knee joint articulations
1) femorotibial: condyles of femur + tibia
2) femoropatellar: facets of patella + condyles of femur
295
lateral and medial meniscii
- between femorotibial articulations
- stabilize, increase articulation and absorb shock
296
knee joint actions
flex/ex and slight rotation (two axes)
297
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)
298
fibular collateral ligament
- stability during extension
- separate from meniscus
299
tibial collateral ligament
- stability during extension
- direct attachment to meniscus
300
posterior cruciate ligament
- from posterior tibia
- prevents anterior sliding of femur on tibia, especially during flexion
301
anterior cruciate ligament
- from anterior tibia
-prevents posterior sliding (hyperextension)
302
testing for cruciate ligament tears
1) anterior drawer sign: pull anteriorly for ACL
2) posterior drawer sign: push posteriorly for PCL
303
muscle groups that move hip joint
1) gluteal
2) lateral rotators
3) iliopsoas
4) adductors
304
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
305
gluteus maximus origin and insertion
O: iliac crest, sacrum, coccyx
I: gluteal tuberosity and posterior iliotibial tract
306
gluteus maximus nerve
inferior gluteal nerve
307
gluteus maximus action
extension and lateral rotation of hip joint
308
gluteus medius/minimis nerve
superior gluteal
309
gluteus medius/minimis action
abduction, medial rotation of hip joint
310
gluteus medius/minims origin and insertion
O: external ilium
I: greater trochanter
311
tensor fasciae latae action
- tense iliotibial tract (anterior)
- assist with flexion, abduction and medial rotation of hip joint
312
tensor fasciae nerve
superior gluteal
313
muscles during single leg stance
- abductors on opposite side of lifted leg contract
- keeps pelvis level by counteracting force of gravity
314
trendelenburg gait
- compromised abductors
- pelvis drops to contralateral side during single leg stance
315
lateral rotator muscles
1) piriformis
2) superior gemellus
3) obturator internus
4) inferior gemellus
5) obturator externus
6) quadratus femoris
P-GO-GO-Q
316
lateral rotators general origin and insertion
pelvis to greater trochanter
317
lateral rotators action
- lateral rotation of extended hip joint
- abduct flexed hip joint
- stabilize hip by pulling head of femur into acetabulum
318
lateral rotators location
- run horizontally posterior to hip joint
- under gluteus maximus
- inferior to gluteus medius and minimis
319
lateral rotators nerve
branches from lumbosacral plexus
320
lateral rotators along sciatic notches
- greater: piriformis
- lesser: obturator internus
321
obturator internus vs externus
- both cover obturator foramen
- externus = external aspect, internus = internal
322
sciatic nerve location
emerges below piriformis
323
iliopsoas parts
- composite muscle: psoas major and iliacus
- merge beneath inguinal ligament
324
psoas major origin
lumbar vertebrae
325
iliacus origin
iliac fossa
326
iliopsoas common insertion
lesser trochanter
327
psoas major nerve
branches of lumbar plexus
328
iliacus nerve
femoral
329
iliopsoas action
hip flexors
330
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
331
adductor muscles common origin
external pubis
332
adductor muscles common insertion
linea aspera, except gracilis = anterior tibia
333
adductor muscles common nerve
obturator nerve, except hamstring of adductor magnus by tibial division of sciatic nerve
334
adductor muscles common action
hip adduction, except gracilis also does knee flexion
335
adductor hiatus
gap in adductor magnus where BVs pass through
336
parts of adductor magnus
- anterior adductor part
- posterior hamstring part, connected to sacrotuberous ligament
337
lumbar plexus rami
anterior rami of L1-L4
338
lumbar plexus location
formed within psoas major and innervates it
339
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
340
obturator nerve location
- enters medial compartment of thigh via obturator canal: gap of obturator foramen
- accompanied by obturator vessels
341
femoral nerve location
- passes deep to inguinal ligament into anterior thigh
- accompanied by femoral vessels
342
sacral plexus rami
- anterior rami of L4-S4
343
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
344
superior gluteal nerve location
- passes through greater sciatic foramen SUPERIOR to piriformis
- accompanied by superior gluteal vessels
345
inferior gluteal nerve location
- passes through greater sciatic foramen INFERIOR to piriformis
- accompanied by inferior gluteal vessels
346
sciatic nerve location
- passes through greater sciatic foramen INFERIOR to piriformis
- goes to posterior thigh
- consists of tibial and common fibular divisions
347
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
348
thigh cross section
1) skin
2) superficial fascia with veins
3) fascia lata
4) anterior, medial and posterior compartments
5) femur
349
anterior thigh muscles
1) sartorius
2) quadriceps femoris:
a) rectus femoris
b) vastus lateralis
c) vastus medialis
d) vastus intermedius
350
anterior thigh common action
knee extension (except sartorius)
351
anterior thigh common nerve
femoral
352
iliotibial tract formed by...
thickening of fascia lata + muscles (gluteus maximus)
353
sartorius origin and insertion
anterior superior iliac spine, medial tibia
354
sartorius actions
1) hip flexion, abduction and lateral rotation
2) knee flexion
355
quadriceps muscle origins
1) rectus femoris: anterior inferior iliac spine
2) vastus lateralis: greater trochanter
3) medialis: femur
4) intermedius: femur
356
quadriceps muscles common insertion
- over patella --> patellar ligament --> tibial tuberosity
357
quadriceps muscles arrangment
- rectus femoris most superficial
- intermedius deep to RF
- lateralis = lateral, medialis = medial, goes a little more distal
358
quadriceps muscles actions
- all extend knee joint
- rectus femoris can also flex hip
359
which quadriceps muscles stabilize knee joint?
all, but especially inferior fibers of vastus medialis and lateralis
360
femoral triangle location
- subfascial space in anterosuperior 1/3 of thigh
361
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
362
femoral triangle contents
NAVL lateral to medial:
Nerve
femoral Artery
femoral Vein
Lymphatics
363
femoral canal
- in femoral triangle
- formed by femoral sheath
- contain artery, vein and lymphatics
364
groin injuries
- strain, stretch or tear of proximal attachments of anteromedial thigh muscles
- often occur in sports with quick starts, ex. sprints
365
posterior thigh muscles (hamstring muscles)
1) biceps femoris
2) semimembranosus
3) semitendinosus
366
posterior thigh common origin
ischial tuberosity, except short head of biceps femoris = linea aspera
367
posterior thigh common action
1) hip extension (except short head)
2) knee flexion
368
posterior thigh common nerve
tibial division of sciatic, except short head = common fibular division
369
biceps femoris insertion
fibula
370
semimembranosus characteristics
deep to semitendinosus, ligament broadens distally
371
biceps femoris heads
medial long, lateral short (under iliotibial tract)
372
semimembranosus insertion
medial condyle of tibia
373
semitendinosus characteristics
- ends in long, thin tendon
- more superficial than semimembranosus
374
semitendinosus insertion
medial tibia
375
pes anserinus components
conjoined tendon of:
1) sartorius
2) gracillis
3) semitendinous
376
pes anserinus location
anteromedial side of proximal tibia
377
pes anserinus function
reinforce medial aspect of knee joint
378
femoral artery location
- passes through femoral triangle and adductor canal
- supplies anterior thigh compartment
379
deep femoral artery location
- passes deep between pectineus and adductor longus
- supplies posterior thigh compartment
380
adductor hiatus close arteries
- femoral artery passes posterior here to become popliteal artery
- part of abductor magnus
381
popliteal artery location
- ends at inferior border of popliteus
- branches around knee
382
popliteal fossa location
- fat-filled, diamond shaped space posterior to knee joint
383
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
384
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)
385
leg retinaculae
- thickening of fascia at distal leg
- hold muscle tendons in place as they cross ankle joint
- ex. inferior extensor retinaculum
386
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
387
anterior leg muscles
1) tibialis anterior
2) extensor digitorum longus
3) extensor hallucis longus
4) fibularis tertius
1-3 superficial to deep
388
tibialis anterior origin and insertion
lateral condyle of tibia, medial side of foot (medial cuneiform + metatarsal 1 base)
389
tibialis anterior actions
inversion + dorsiflexion of foot
390
extensor digitorum longus origin/insertion
lateral condyle of tibia, dorsal aspect of digits 2-5
391
extensor digitorum longus action
dorsiflexion, extension of toes 2-5
392
extensor hallucis longus origin and insertion
medial fibula to dorsal digit 1
393
big toe anatomical name
hallux
394
extensor hallucis longus action
hallux extension, dorsiflexion
395
fibularis tertius origin and insertion
inferior/anterior fibula, dorsal digit 5
396
fibularis tertius action
dorsiflexion, eversion of foot
397
anterior leg muscles common nerve
deep fibular
398
lateral leg muscles
1) fibularis longus
2) fibularis brevis (deep)
399
fibularis longus origin and insertion
head of fibula, plantar surface of foot (crosses from lateral to medial side)
400
fibularis brevis origin and insertion
lateral fibula, base of 5th metatarsal
401
fibularis longus/brevis action
eversion, plantarflexion of foot
402
fibularis longus/brevis nerve
superficial fibular
403
foot drop
- foot drags instead of anterior part lifting
- compromised deep fibular nerve
404
posterior leg compartments
1) superficial
2) deep
405
superficial posterior leg muscles
1) gastrocnemius
2) soleus
3) plantaris
superficial to deep: 1, 3, 2
406
gastrocnemius origin
medial and lateral femoral condyles (2 heads)
407
soleus origin
posterior, proximal tibia and fibular head
408
plantaris origin
above lateral femoral condyle
409
superficial posterior leg muscles common insertion
calcaneus via calcaneal tendon (Achilles)
410
superficial posterior leg muscles common action
plantar flexion
411
superficial posterior leg muscles additional actions
gastrocnemius flexes knee, plantaris weakly assists
412
superficial posterior leg muscles common nerve
tibial nerve
413
flexor retinaculum of foot
- supports tendons of deep posterior leg muscles
- medial malleolus to calcaneus
- reinforced by transverse intermuscular septum
414
posterior leg deep compartment
1) flexor digitorum longus
2) flexor hallucis longus
3) tibialis posterior
4) popliteus
415
deep posterior leg muscles tendons organization
superior/medial
1) tibialis posterior
2) flexor digitorum longus
3) flexor hallucis longus
inferior/lateral
Tom, Dick, Harry
416
flexor digitorum longus origin/insertion
posterior tibia, bases of distal phalanges 2-5
417
flexor digitorum longus action
flexes digits 2-5
418
flexor hallucis longus origin/insertion
inferior/posterior fibula, base of distal phalanx 1
419
flexor hallucis longus action
flexes hallux
420
tibialis posterior origin/insertion
origin = interosseous membrane, posterior tibia and fibula
insertion = navicular, cuneiforms, cuboid, calcaneus (sustentaculum tali), bases of metatarsals 2-4
421
tibialis posterior action
inversion, plantarflexion, support medial longitudinal arch
422
popliteus characteristics
triangle-shaped, forms floor of popliteal fossa
423
popliteus origin and insertion
origin = lateral condyle of femur, lateral meniscus
insertion = posterior proximal tibia
424
popliteus action
unlocks knee by rotating femur slightly to enable knee flexion
425
posterior deep leg muscles common action
plantarflexion, except popliteus
426
posterior deep leg muscles common nerve
tibial
427
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
428
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
429
leg deep veins
accompany arteries with same name
430
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
431
intrinsic back muscles location
- deepest muscles
- enclosed in deep fascia
432
intrinsic back muscles general purpose
movement and maintain posture of vertebral column
433
intrinsic back muscles common origin
- tendinous connection from posterior iliac crest, sacrum and spinous processes of lumbar vertebrae
- insert above
434
intrinsic back muscles common nerve
posterior rami of spinal nerves
435
nuchal ligament
from external occipital protuberance to C7 (spinous processes)
436
supraspinous ligament
thoracic vertebrae and below until median sacral crest
437
intrinsic back muscles layers
1) superficial: splenius
2) intermediate: 3x erector spinae
3) deep: transversospinalis muscle group
438
intrinsic back muscles bilateral contraction
extension of head and vertebral column
439
intrinsic back muscles division
divided into parts: capitis, cervicis, thoracis, lumborum
440
splenius parts
1) capitis
2) cervicis
441
splenius location
- deep to trapezius
- fibers run superolaterally to cervical vertebrae and cranium (V shape)
442
splenius origin
nucheal ligament
443
splenius unilateral contraction
ipsilateral head rotation and neck lateral flexion
444
erector spinae location
- column of muscles from sacrum to skull
- between spinous processes and angle of ribs
445
erector spinae origin
- tendinous connection from posterior iliac crest, sacrum and spinous processes of lumbar vertebrae
446
erector spinae muscles
lateral (longer)
1) iliocostalis
2) longissimus
3) spinalis
medial (shorter)
I Like Standing
447
erector spinae unilateral contraction
ipsilateral:
1) lateral flexion of VC
2) head rotation
3) spine rotation
448
iliocostalis insertion
transverse processes of cervical vertebrae
449
longissimus insertion
- ribs
- transverse processes of thoracic/cervical vertebrae
- temporal bone mastoid process
450
spinalis insertion
spinous processes of upper thoracic vertebrae + skull
451
transversospinalis group location
deep to erector spinae, fibers run superomedially (A shape)
452
transversospinalis muscle groups
1) semispinalis: capitis, cervitis, lumborum
2) short muscles that extend from 1 vertebrae to the next
453
transversospinalis group unilateral contraction
contralateral head and VC rotation
