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EM: > MSK Anatomy > Flashcards

MSK Anatomy Flashcards

1
Q

Three muscles in the anterior compartment of the lower leg

what is their innervation and blood supply

A
  • extensor digitorum longus
  • extensor hallucis longus (deepest)
  • tibialis anterior

all innervated by the deep fibular nerve (branch of common peroneal which is a branch of the sciatic)

all supplied by the anterior tibial artery which is a branch of the popliteal artery

drainage is by the anterior tibial vein

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2
Q

what might happen with paralysis of the common peroneal nerve

A

FOOT DROP

paralysis of the anterior and lateral compartment of the foot

these are dorsiflexors of the foot

there’s therefore unopposed pull of the plantarflexors

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3
Q

muscles of the lateral compartment of the lower leg and what they are innervated by and what their action is

what is their blood supply?

A

NB peroneal muscles are sometimes called fibularis muscles

  • NB2 these are muscles of eversion of the foot (turning the sole of the foot outwards
  • peroneal (fibularis) longus
  • peroneal (fibularis) brevis
  • both innervated by the superficial fibular nerve (s. peroneal nerve)
  • they attach to the lateral foot
    • NB brevis is longer in the foot but much shorter in the leg

They’re supplied by the fibular artery

(which is a branch of the tibioperoneal trunk - the other branch is the posterior tibial artery)

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4
Q

How many muscles are there in the posterior compartment of the leg and what is their collective action

A

7

these are organised into superficial and deep layers

their collective action is to plantar flex the foot

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5
Q

what are the muscles of the posterior compartment of the leg innervated by? what is their blood supply?

A

the tibial nerve (branch off the sciatic)

the posterior tibial artery (a branch of the popliteal)

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6
Q

Superficial muscles of the posterior compartment of the lower leg

do it in order of most superficial to least

A
  • all insert into the calcineus of the foot
  • gastrocnemius
    • medial head and a lateral head converge to form a single belly
  • plantaris
    • tiny one
    • absent in 10% of people
  • soleus
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7
Q

calcaneal tendon

A

attaches the soleus, plantaris and the gastrocnemius to the calcaneal tendon

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8
Q

Deep muscles of the posterior compartment of the leg

A
  • Popliteus
    • forms the base of the popliteal fossa
  • The next three extend into the foot
    • Tibialis posterior
    • Flexor digitorum longus
    • Flexor hallucis longus
  • Tom Dick And Very Nervous Harry when looking at the lateral side of the ankle
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9
Q

how many layers of muscle in the foot are there?

A

4

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10
Q

label this foot

A
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11
Q

label this foot

A
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12
Q

why might a fracture in the lower 3rd of the tibia take longer to heal?

A

bones recieve blood supply from the muscles attached to them

there is poor blood supply here because there are no muscle attachments

this is why fractures in this location are thought to take longer to heal

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13
Q

label these hip ligaments

A
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14
Q

Label this picture of proximal femur and say whether it is anterior or posterior view

A

this is the anterior view

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15
Q

Label this picture of proximal femur and say whether it is anterior or posterior view

A

this is posterior view

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16
Q

Arteries of the lower limb: can you draw the diagram?

A
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17
Q

nerves of the lower limb - can you draw the diagram?

A
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18
Q

what is the pectoral girdle?

A

It is the scapula, clavicle and all the muscles attached to these as well as the latissumus dorsi muscle

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19
Q

what is flexion and extension of the shoulder joint?

A
  • Moving the arm forward is flexion of the shoulder joint
  • Moving the arm backwards is extension of the shoulder joint
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20
Q

label this

A
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21
Q

What is the difference between extrinsic and intrinsic muscles of the shoulder?

A

Extrinsic originate from the torso and attach to the bones of the shoulder (clavicle, scapula and humerus)

Intrinsic originate from the scapula or the clavicle and attach to the humerus

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22
Q

label this

A
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23
Q

Label this

A

SITS

  • From top to bottom it’s
    • Supraspinatus
    • Infraspinatus
    • Teres minor
  • Then deep to the scapula is
    • Subscapularis
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24
Q

What are the innervations of the muscles of the rotator cuff?

A

All of them are the suprascapular nerve except for Teres minor which is the axillary nerve

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25
Q

what are the functions of the rotator-cuff muscles?

A
  • Supraspinatus = abduction
  • Infraspinatus and teres minor = lateral rotation
  • Subscapularis = medial rotation
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26
Q

label this

A
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27
Q

which nerve are you likely to damage with a posterior dislocation of the shoulder

A
  • The axillary because it runs against the back of the humerous
  • Damage can cause paralysis of the deltoid and a patch of numb skin on the arm
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28
Q

what are the bounderies of the axilla?

A
  • Anterior wall
    • Pec muscles
  • Posterior wall
    • Subscapularis, teres major and latissimus dorsi
  • Lateral wall
    • Upper end of humerus
  • Medial wall
    • Serratus anterior
  • Apex
    • Formed by first rib, clavicle and scapula
    • This is the canal through which the posterior triangle of the neck communicates with the axilla
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29
Q

Structures found in the axilla

A

Fat

Lymph nodes

Axillary artery - major artery supplying the upper limb

Axillary vein - major venous drainage of the arm

Brachial plexus

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30
Q

What are the 4 ligaments of the shounder joint and where do they attach?

A
  • Glenohumoral ligaments (sup middle and inf)
    • the main ones
    • stabilise anterior aspect of the joint
  • Coracohumeral ligament
    • from coracoid process to greater tubercle of the humerus
  • Transverse humeral ligament
    • spans distance of the two tubercles of the humerus
    • holds tendon of biceps longhead in place
  • Coraco-clavicular ligament and coraco-acromial ligament
    • between where they sound like they’re between
    • they work to keep the scapula attached to the clavicle
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31
Q

what drains into the axillary lymph nodes

A
  • Lymph from:
    • the upper limb
    • the chest wall (front and back)
    • the abdominal wall all the way down to the umbilicus
    • breast lateral to the nipple
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32
Q

How does blood from the arch of the aorta get into the arms

A
  • Subclavian (on right this is from the brachiocephalic trunk)
  • When subclavian crosses lateral edge of first rib it becomes the axillary artery
  • Axillary arteries go under pec minor
  • At the humeral neck, anterior and posterior circumflex arteries come off and supply the shoulder
  • Subscapular artery also comes off
  • The axillary artery becomes the brachial at the level of teres major
  • As it passes the cubital fossa, the brachial artery bifurcates into radial and ulnar
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33
Q

What passes through the carpal tunnel?

A
  • 10 things
    • 4 flexor digitorum profundis tendons
    • 4 flexor digitorum superficialis tendons
    • one flexor pollicus longus tendon
    • the medial nerve

swelling of the tendons may compress the medial nerve and cause carpal tunnel syndrome

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34
Q

what happens with the flexor tendons in the hand?

A
  • The superficialis tendon splits and attaches to each side of the middle phalanx
  • profundus passes through the gapa and inserts onto the distal phalanx
  • Pollicus longus inserts at the base of the terminal phalanx of the thumb
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35
Q

label this

A
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36
Q

what are the muscles in the superficial compartment of the posterior forearm?

A
  • brachioradialis
  • extensor carpi radialis longus
  • extensor carpi radialis brevis
  • extensor digitorum
  • extensor carpi ulnaris
  • extensor digiti minimi
  • anconeus

common extensor origin is the back of the lateral epicondyle

37
Q

muscles within the thenar group

what nerve supplies them

A

abductor pollicus brevis

flexor pollicus brevis

opponens pollicus

all supplied by the median nerve

38
Q

label this diagram of the muscles of the hand

A
39
Q

what are the muscles in the hypothenar group?

A

abductor digiti minimi

flexor digiti minimi

opponens digiti minimi (deeper)

40
Q

what muscles lie beteween the metacarpal bones and what do they do? What nerve are they supplied by?

A
  • palmar and dorsal interossei
  • Dorsal abduct (DAB)
  • Palmar adduct (PAD)

All are supplied by the ulnar nerve

remember adduction and abduction is moving towards or away from the middle finger

41
Q

Muscular innervation of the hand

A

LLOAF muscles are supplied by the median nerve

Lateral Lumbricals, Opponens pollicis, Abductor pollicis, Flexor pollicus brevis

All the others are supplied by the ulnar

Remember it’s abductor not adductor that’s part of lloaf because if you were going to be abducted it would be by an oaf

42
Q

Sensation to the hand

A
43
Q

what are these muscles and where are they found. What are they innervated by?

A

these are superficial muscles of the posterior forearm.

They are all innervated by the radial nerve

44
Q

what are the deep muscles of the posterior forearm? what are they innervated by?

A
  • Supinator
  • Abductor pollicis longus
  • Extensor pollicis longus
  • Extensor indicis

all are innervated by the radial nerve

45
Q

what are these muscles? and what are they innervated by?

A

they are innervated by the radial nerve

all the posterior forearm is innervated by the radial nerve

46
Q

why might you get wrist drop?

A

all the extesors of the wrist are in the posterior compartment and are innervated by the radial nerve. If you get a radial nerve palsy you will have wrist drop as a result of the unaposed flexionof the anterior compartment.

47
Q

Tendons from which muscles make the anatomical snuff box?

A
48
Q

label this elbow

A
49
Q

label this

A
50
Q

label this pelvis

A
51
Q

label this leggy

A
52
Q

where does the fascia lata go between?

A

runs from iliac crest and is inserted onto the tibia

53
Q

what are the borders of the femoral triangle?

A
54
Q

what are the contents of the femoral triangle?

A

from lateral to medial:

  • femoral nerve
  • femoral artery
  • femoral vein
    • the great saphenous vein drains into the femoral vein in the femoral canal
  • femoral canal
    • structure that contains deep lymph nodes and vessels

NB canal, artery and vein contained within femoral sheath

55
Q

Describe the course of the great saphenous vein

A
  • formed by dorsal venous arch of foot and dorsal vein of big toe
  • ascends medially, passing anteriorly to the medial malleolus
  • passes posteriorly to the medial condyle at the knee
  • terminates by draining into the femoral vein just inferiorly to the inguinal ligament in the femoral triangle
56
Q

where does illiopsoas insert?

A

lesser trochanter

57
Q

which nerve innervates the muscles of the medial compartment of the thigh?

A

the obturator nerve

58
Q

muscles of the medial compartment of the thight, what they are innervated by and where their blood supply comes from

A
  • Adductor magnus
  • Adductor longus
  • Adductor brevis
  • Gracilis

they are all innervated by the obturator nerve which comes off the lumbar artery L2-L4

blood supply is via the obturator artery

59
Q

what is there in adductor magnus

A

there’s a small hole just superior to the knee where the femoral vessels can pass into the popliteal fossa

this is called the adductor hiatus

60
Q

where do the femoral vessels and nerve pass from the bakc of the abdomen into the thigh? why is this clinically relevant?

A

they pass through the space between the inguinal ligament and the superior ramus of the pubis. If bowel also passes through here it is known as a femoral hernia

61
Q

which structures pass underneith the inguinal ligament and above the superior pubic ramus?

A
  • Illiacus
  • Psoas major
  • Pectineus
  • the femoral artery, vein and nerve and canal
62
Q

which nerve supplies the muscles of the anterior compartment of the thigh? What plexus does it come off and what nerve roots is it derived from?

A

the femoral nerve

it is the largest branch of the lumbar plexus

it comes off nerve roots L2-L4

63
Q

why might the patella be laterally displaced and what two structures help to oppose the displacement?

A
  • the femur is at a slight angle due to the width of the hips
  • therefore the pull of the quadriceps tends to pull the patella laterally
  • sometimes it dislocates
  • the almost horizontal fibres of vastus medialis help to oppose this lateral displacement
  • so does the depth of the patellar groove
    • the lateral femoral condyle projects a little more than the medial
64
Q

what nerve supplies the medial thigh? what nerve roots does it come off and what plexus? where does it leave the pelvis?

A

Obturator nerve

Comes off lumbar plexus L2-L4

Sensory and motor to medial thigh

Leaves the pelvis through the obturator foramen with the obturator artery and vein

65
Q

label this x ray

A
66
Q

which are the bones that you sit on?

A

the ischial tuberosity

67
Q

what is the innervation of gluteus maximus and what is its action?

A
  • it is the main extensor of the thigh
  • innervation of the inferior gluteal nerve
68
Q

actions and innervations of gluteus medius and gluteus minimus

A

they are the same!

  • they both:
    • are innervated by the superior gluteal nervew
    • and they both abduct and medially rotate the limb
      • prevents pelvic drop on the opposite side during locomotion
69
Q

what is the action and innervation of tensor fascia lata

A

this is innervated by the superior gluteal nerve

TFL assists the medius and minimus in abducton and medial rotation of the lower limb

70
Q

what is the largest nerve in the body?

A

the sciatic nerve

71
Q

what is the nerve root of the sciatic nerve, what does it innervate and what is its anatomical course through the body?

A
  • is from nerve roots L4-S3
  • does motor to the posterior thigh
  • it does sensation itno skin of lateral thigh, leg and into foot
    • sciatica
  • comes off the lumbosacral plexus
  • leaves pelvis via greater sciatic foramen
  • emerges inferior to piriformis and descends
  • goes behind long head of biceps femoris
  • bifurcates into common peroneal and tibial
    • this usually happens at the popliteal fossa
    • but because sciatic is two distinct bundles held together, in the cadaver it can look much further up if it has aged
  • NB to avoid sciatic, intramuscular injections should be upper lateral quadrant
72
Q

where is the greater sciatic foramen?

A
73
Q

label these muscles of the posterior thigh

what are they all innervated by?

A
  • semi-tendinosus spends half its time being a tendon
  • then the one that inserts on the same side as semi-tendinosus is semi-membranosus
  • then it’s biceps femoris long and short heads on the other side
  • THEY ARE ALL INNERVATED BY SCIATIC
    • all of them are innervated by the tibial portion except for the shoret head which is innervated by the common peroneal
  • NOTE: semo-tendinosus and long head of biceps have the same origin on the ischial tuberosity
74
Q

what is the action of the muscles of the posterior thigh.

A

all of them do flexion of the knee and extension of the thigh at the hip

75
Q

label this leggy

A
76
Q

what are the nerve roots of the sciatic nerve and why might this be clinically relevant?

A

L4-S3

  • IV disc between L5 and S1 commonly prolapses
  • this can compress the nerve in the IV foramina
  • the referred pain can be felt down the skin of the lateral thigh, leg and foot
    • the area of skin & sensation that is transmitted by sciatic nerve
77
Q

what is it called when you ask someone to stand on one leg to see if one of their hips drops? what are you testing?

A

You are testing the ability of the gluteus minimus and medius to abduct the hip and therefore support the opposite hip against dropping

This is called trendelenburg’s test

78
Q

what happens to the femoral artery once it goes through the adductor hiatus

A
  • it becomes the popliteal artery which splits into:
    • the anterior tibial artery
      • supplies anterior compartment
    • the tibioperoneal trunk
  • The tibioperoneal trunk then splits into:
    • the posterior tibial artery
      • supplies posterior compartment
    • the fibular artery
      • supplies the lateral compartment
79
Q

pulses in the feet - which arteries are they from?

A
  • Between 1st and 2nd metatarsal is the dorsalis pedis pulse
    • derived from anterior tibial artery
  • Behind medial malleolus is the posterior tibial pulse
80
Q

the cruciate ligaments are either posterior or anterior depending on their attachments to what ?

A

the tibia

81
Q

label this hip

A
82
Q

what attaches to the patella at the top and the botom

A
  • Quadriceps femoris tendon at the top
  • Patellar ligament at the bottom
83
Q

why is a fracture of the neck of the femur particularly dangerous

A
  • in the adult, the blood vessels of the head of the femur are those that travel along the neck
  • a fracture of the neck will interrupt this blood supply
  • this can cause avascular necrosis
  • the head of the femur will have to be surgically removed and replaced
84
Q

at what degree of flexion are the ligaments of the knee taught and when are they loose

A

both loose at 90 degrees

at 30 degrees the ACL is taught - this is when it is injured in sports

the PCL just prevents hyperextension

85
Q

what is a sprained ankle

A

the ankle is held together with a complex of ligaments - with forced inversion or eversion these can tear

this is a sprained ankle

86
Q

what connects the tibia and the fibula?

A

superior and inferior tibiofibular joints as well as the interosseus membrane

87
Q

what is the ankle joint? what are the movements of this joint? what stabilises this joint?

A

the synovial joint between the lower ends of the tibia and the fibula and the talus

the movements are plantar flexion and dorsiflexion

the medial and lateral malleoli stabilise this joint by gripping the sides of the talus. so do the various surrounding ligaments

88
Q

what bones is the subtalar joint between and what type of joint is it?

A

it is a synovial plane joint and it is between the talus and the calcaneus

EM: (14 decks)

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