MSK anatomy Flashcards
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2 muscle groups gluteal region?
Superifcial muscle group
* Gluteus maximum, medius + minumus
* Tensor fascia late
Deep muscle group
* Piriformis
* Obturator internus
* Gemelli (superior + inferior - gemelli means twins)
* Quadratus femoris
Fucntion of superficial muscles of gluteal region? WHat are they innervated by?
Extensors, abductors and medial rotators of thigh
* Innervated by gluteal nerves
* Gluteus maximum = inferior gluteal
* All others = superior gluteal
Reduced function of superior gluteal nerve leads to?
Trendelenburg’s gait - hip will drop on contralateral side (weak hip abduction by gluteus medius)
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Function of deep muscle group of gluteal region? Innervated by?
Lateral rotators of thigh and hip stabilisers
* Innervated by sacral plexus
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Hip joint called? What kind of joint is it? (2)
Acetabulo-femoral joint
* Ball + socket = flexion/extension, abduction/adduction, medial-lateral rotation, circumduction
* Synovial joint = external fibruous layer (spiral ligaments) + internal membranous layer
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Ligaments of the gluteal region?
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Primary blood supply to head of femur?
Medial circumflex femoral artery
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Arteries damaged in femoral neck fractures?
Retinacular arteries
Knee joint? Movement? (2)
Modified synovial hinge joint
* Main movement = flexion/extension
* Slight rotation
fibula is lateral
articulations of knee joint?
3 articulations
* 2 x tibiofemoral (medial + lateral)
* 1 x patellofemoral
Ligaments of knee joint? (2)
Extracapsular (outside joint capsule)
* Patellar ligament
* Lateral (fibular) collateral ligament
* Medial (tibial) collateral ligament
Intra-articular (in joint capsule)
* Anterior cruciate ligament (ACL)
* Posterior cruciate (PCL)
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Menisci of the knee joint?
Crescent-shaped fibrocartilage (medial + lateral)
How to test joint integrity of the knee? (2)
* Aterior drawer test - ACL
* Posterior drawer test - PCL
Why is lateral collateral ligament much smaller than medial collateral ligament?
Has to withstand much more force
Women have larger Q angles so more prone to osteoarthritis
How do nerves enter/exit the gluteal region? The perineum?
* Gluteal region = greater sciatic foramen
* Perineum = lesser sciatic foramen
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What splits the gluteal region into greater and lesser sciatic foramen?
sacrospinous ligament
Nerves of the gluteal region? (3)
* Sciatic (L4-S3)
* Pudendal (S2-S4)
* Posterior cutaneous nerve of thigh (S1-S3)
Sciatic nerve supplies? Pudendal? POsterior cutaneous nerve of thigh?
* Sciatic nerve (L4-S3) is largest nerve in body - supplies posterior thigh, leg + foot
* Pudendal (S2-S4) - perineum
* Posterior cutaneous nerve of thigh (S1-S3) - posterior thigh, popliteal fossa, lateral perineum, upper medial thigh
Sciatic nerve exits gluteal region where?
Exits inferior to piriformis via greater sciatic foramen (usually most lateral structure exiting greater sciatic foramen)
Sciatic nerve artery?
Artery to the sciatic nerve
Sciatic nerve splits into? (2)
* Tibial nerve = larger, medial
* Common fibular = smaller, lateral
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Compartment syndrome tx?
Fasciotomy
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Flexures of thigh? Extensors of leg?
What are they innervated by?
Flexures
* Pectineus
* Iliopsoas (psoas major, minor + iliacus)
* Sartorius
* Rectus femoris
Extensors
* Rectus femoris
* Vastus lateralis
* Vastus medialis
* Vastus intermedius
Anterior thigh innervated by femoral nerve (L2, L3, L4)
(except psoas major - L1, L2, L3)
Femoral triangle boundaries? Contents?
Boundaries
* Superior - inguinal ligament
* Medially - lateral border of abductus longus
* Laterally - medial border of sartorius
* Floor - iliopsoas + pectineus
* Roof - fascia lata
Contents = NAVY (lateral to medial)
* Femoral nerve, femoral artery, femoral vein, lymphatics
Where are flexures and extensors of thigh/leg found?
Anterior compartment of thigh
Where are adductors of thigh found? What are they? What are they innervated by?
Medial compartment of thigh
* Adductor longus
* Adductor brevis
* Adductor magnus
* Gracilis
* Obturator externus
All innervated by obturator nerve (L2, 3, 4)
Where are the exensors of the thigh and flexors of leg found? What are they? What are they innervated by?
Posterior compartment of the thigh
* Semitendinosus
* Semimembranosus
* Biceps femoris
All tibial division of sciatic nerve (L5, S1, S2)
Ischial tuberosity?
Bony part of bum you sit on
Muscle groups of posterior compartment of the leg? Innervated by?
Superifcial group
* Gastrocnemius
* Soleus
* Plantaris
Deep group
* Popliteus
* Flexor hallicus longus
* Flexor digitorum longus
* Tibialis posterior
All innervated by tibial nerve!!
Muscles of anterior compartment of leg? Innervated by?
Lateral compartment of leg? Innervated by?
Anterior
* Tibialis anterior
* Extensor digitorum longus
* Extensor hallicus longus
* Fibularis tertius
Innervation = deep fibular nerve (L4, L5)
Lateral
* Fibularis longus
* Fibularis brevis
Innervation = superficial fibular nerve (L5, S1, S2)
What causes “foot drop”?
Deep fibular nerve palsy leading to absent dorsiflexion
Boundaries of popliteal fossa? Contents?
Boundaries
* Superlateral = biceps femoris
* Supermedial = semimembranosus
* Inferior = gastrocnemius
* Roof = popliteal fascia
Contents
* Fat
* Small saphenous vein
* Popliteal vessels
* Tibial and common fibular nerves
Calcaneal tendon? How long? What is it composed of? Where is its attachment point?
Achilles tendon = thickest and strongest in body
* 15 cm long
* gastrocnemius and soleus muscle aponeurosis together
* Attachment point is calcaneal tuberosity of calcaneus (heel bone)
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Ankle jerk reflex?
Normal result is plantarflexion - tests S1, S1 nerve roots
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Which movement is required in the forearm during PRONATION?
Radius moved over ulna during pronation
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Whate type of joint is metacarpophalangeal joint? carpometacarpal joint?
MCP = condyloid joint
CMC = saddle type
What is teh degree of rotation of the thumb?
90 degrees
Axioappendicular muscles? (6)
* Trapezius
* Rhomboid major + minor
* Serratus anterior
* Subclavius
* Latissimus dorsi
* Levator scapulae
Trapezius attachment? Innervation? Function?
* Attachments = spinoscapular, accromium, clavical
* Innervation = CN XI (spinal accessory) - also innervate sternocleidomastoid
* Function = moves shoulder blades back, up, down
Innervation of serratus anterior? Thomboid major/minor? Levator scapulae?
Serratus = long thoracic nerve (winged scapula)
Rhomboid = dorsal scapula nerve
Levator scapulae = dorsal scapula nerve
4 rotator cuff muscles?
Function of rotator cuff?
Individual functions??
* SITS = supraspinatus, infraspinatus, teres minor, subscapularis
* The hold head of humerus in glenoid fossa (only 1/3rd of humeral head in contact with fossa at any time)
* Supraspinatus = 1st 15* of abduction is supraspinatus then deltoid abducts the rest
* Infraspinatus and teres minor = lateral rotators
Subscapularis = medial rotator
Where are rotator cuffs attached?
* Supraspinatus, infraspinatus, teres minor = greater tuberosity of humerus
* Subscapularis = lesser tuberosity
Compartments of arm?
Anterior and posterior
Muscles of anterior compartment? (3)
Innervation?
Action?
Anterior compartment run by BBC!
* Biceps brachii, brachialis, coracobrachialis
* Innervation = musculocutaneous nerve
* Actions = flexion of arm and forearm (biceps brachii also SUPPINATES forearm)
Muscles of posterior compartment of arm?
Innervation?
Actions?
Triceps brachii
* Radial nerve
* Extension of arm + forearm
Muscles of anterior compartment of forearm?
Innervation?
Actions?
Superficial = pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris
Intermediate = flexor digitorum superficialis
Deep = flexor pollicus longus, flexor digitorum profundus, pronator quadratus
* Innervation = ALL median nerve except from flexor carpi ulnaris and medial half of flexor digitorum superficialis (ulnar nerve)
* Action = flexion of wrist + digits, pronation, abduction and adduction of wrist
Muscles of posterior compartment of forearm?
Innervations?
Actions?
All come from lateral epicondyle of humerus!!!
Superficial = brachioradialis, anconeus, extensor carpi radialis longus, extensor digitorum, extensor carpi ulnaris, extensor carpi radialis brevis, extensor digiti minimi
* Deep = suppinator, abductor pollicus longus, extensor pollicus longus, extensor pollicus brevis, extensor indicis
Innervations = ALL radial nerve!
Actions = extension of wrist + digits, supination, abduction and adduction of wrist
Compartments of hand?
Contents?
* Thenar eminence (thumb) = abductor pollicus brevis, flexor pollicis brevis, opponens pollicus
* Hypothenar eminence (pinky) = abductor digiti minimi, flexor digiti minimi brevis, opponens digiti minimi
* Intermediate compartment = lumbricals + interossei
Innervation of compartments of hand?
Significance of thenar eminence?
* Thenar eminence = recurrent branch of median nerve
CARPAL TUNNEL SYNDROME!!
* Hypothenar eminence = unlar nerve
* Lateral 2 lumbicals = median nerve
* Medial 2 lumbricals = ulnar nerve
* Interossei = ALL ulnar nerve
(Most of hand is ulnar nerve - ONLY lumbricals and thenar eminence supplied by median!!!)
Attachment of lumbricals?
Function of interossei?
* Lumbricals = attached to tendons of flexor digitorum profundus
* Dorsal interossei = abduction of digits
* Palmar interossei = adduction of digits
Origins of brachial plexus?
Route?
Brachial plexus originates from anterior rami of C5 - T1
* Passes thru axilla to medial arm, cords travel around brachial artery
It is situated in medial arm for protection i.e. when arms are by side
Learn how to draw
learn how to draw
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Distal nerve injury = cutaneous innervation pattern
Proximal nerve injury – more dermatomal image
Carpal tunnel – thumb, index, middle and half of ring finger
What is the carpal tunnel formed by?
Contents? (4)
Carpal tunnel syndrome?
* Flexor retinaculum + carpals
* Contents = flexor digitorum superficialis (x4), flexor digitorum profundus (x4), flexor pollicis longus (x1), median nerve
Capal tunnel syndrome = compression of median nerve, weakness in thenar muscles, numbness in digits 1-3 and half of digit 4
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Ankle mortise?
Tibia + lateral + medial malleoli
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Labrum is important stabiliser of hip joint
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Red is what u see on x-ray
Note: intra-articular physis in children
Greater trochanter ossification begins at what age?
4
Hip flexors? (2)
Iliacus
* Origin = iliac crest
* Insertion = lesser trochanter
Psoas major
* Origin = transverse processes L1-L5
* Insertion = lesser trochanter
Psoas abscess s/s? (3)
Risk factors? (2)
S/s
* Hold hip flexed
* Raised CRP
* Sepsis symptoms
Risk factors: PWID, immunocompromised
Secondary hip flexors? (2)
What is their main function?
RECTUS FEMORIS:
* One of 4 heads of quadriceps
* Origin: AIIS
* Insertion: Tibia via patella tendon
SARTORIUS:
* Origin: ASIS
* Insertion: Tibia
* Also externally rotates hip
EXTENSORS OF THE KNEE!
Hip adductors? (5)
Origin and insertion?
* Adductor brevis
* Adductor longus
* Adductor magnus
* Pectineus
* Gracilis
Common origin = inferior pubic rami
Insertion = linea aspera, pectineal line, tibia
Hip abductors? (3)
Origin and insertion?
Gluteus minimus + medius
* Origin = iliac wing
* Insertion = greater trochanter
Tensor fascia lata
* Origin = iliac crest
* Insertion = lateral tibia
Hip extensor?
Origin and insertion?
Gluteus maximus
* Origin = posterior ilium/sacrum
* Insertion = iliotibial tract
Hip extensors + knee flexors? (3)
Origin and insertion?
Biceps femoris
* Origin = long head: ishial tuberosity, short head: linea aspera
* Insertion = fibula head
Semimembranosus
* Origin = ishial tuberosity
* Insertion = posterior tibia
Semitendinosus
* Origin = ischial tuberosity
* Insertion = medial tibia
Difference between true hip pain and pain caused by trochanteric bursitis?
True hip pain = groin
Trochanteric bursitis = lateral hip pain
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Functions of knee menisci? (4)
Differences in shape of menisci?
* shock absorbers
* Increase femero-tibial conformity
* Stabilise knee during movement
* Lubricate knee
Medial meniscus is bigger C than lateral meniscus (due to tibia)
Knee extensors? (4)
Origin and instertions?
QUADRICEPS MUSCLE (4)
rectus femoris
* origin = AIIS
Vastus intermedius
* Origin = anterolateral proximal femur
Vastus medialis
* Origin = Greater trochanter
Vastus lateralis
* Origin = lesser trochanter
COMMON INSTERION = tibia via PATELLAR TENDON
Factors which predispse to patellar instability? (4)
* Genu valgum (large Q angle)
* Femoral head anteversion
* Weak quadriceps
* lax ligaments
Draw muscle compartment of leg
hint: smiley pirate
Ankle plantar flexors (i.e. tip toes)? (3)
Origin and insertion?
Gastrocnemius
*Origin = femoral condyles
Soleus
* Origin = broad area of posterior tibia/fibula
Plantaris
* Origin = lateral femoral condyle
COMMON INSERTION = calcaneus via ACHILLES TENDON
Ankle dorsiflexors?
Origin and insertion?
Tibialis anterior
* Origin = lateral proximal tibia
* Insertion = medial cuneiform
Ankle ligaments? (2)
Medially = deltoid ligament
* Made up of: tibiospring ligament, superficial posterior tibiotalar ligament, tibiocalcaneal ligament, spring ligament
Laterally = lateral ligament complex
* Made up of: posterior talofibular ligament, calcaneofibular ligament, anterior talofibular ligament, posterior inferior tibiofibularligament, anterior inferior tibiofibular ligament
Supporting structures of the medial arch? (2)
Origin and insertion?
Tibialis posterior tendon
* Origin = posterior proximal tibia/fibula
* Insertion = navicular + medial cuneiform
Spring ligament (calcaneonavicular ligament)
Plantar fascia origin and insertion?
* Origin = tuberosity of calcaenous
* Insertion = metatarsals
Development of the acetabulum
Describe x-ray findings
Normal - femoral epiphysis in medial inferior quadrant
(<6 y/o as can’t see greater trochanter yet)
Developmental dysplasia of hip (left hip)
Late presenting DDH
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Which 2 tarsal bones are located in hindfoot?
Which five tarsal bones are located in midfoot?
Which 19 bones are located in forefoot?
Hindfoot = talus + calcaneus
Midfoot = cuboid, navicular, medial, intermediate + lateral cuneforms
Forefoot = metatarsals + phalanges
What are the 3 arches of the foot?
* Medial longitudinal arch
* Lateral longitudinal arch
* Transverse arch
Medial longitudinal arch made up of?
Medial longitudinal arch supported by?
Bones of medial aspect of foot (calcaneus, talus, navicular, cuneforms and metatarsals 1-3)
Supported by:
* Flexor hallicus longus
* Tibialis anterior (medial cuneform)
* Fibularis longus (across plantar aspect to attach to medial cuneform)
* Tibialis posterior (attaches to navicular + medial cuneform)
Lateral longitudinal arch made up of?
Function?
Calcaneus, cuboid, metatarsals 4 + 5
Usually weight bearing
Transverse arch made up of?
Supported by?
Cuboid, cuneforms, bases of all 5 metatarsals
* Supported by fibularis longus
Functions of arches of the foot? (3)
What is the plantar aponeurosis?
* Shock absorption
* Push-off spring
* Weight-bearing
Plantar aponeurosis supports arches of foot - it is thickened central area of planta fascia (deep fascia of the sole of the foot)
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What does plantar aponeurosis give rise to?
What is it called when it becomes inflamamed?
Gives rise to digital longitudinal bands
* Plantar fasciitis
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How are the INTRINSIC muscles of the foot organised? (3)
Function?
Nerve supply?
* 11 sole muscles - arranged in 3 layers + produce flexion of the toes
* 7 interossei muscles - adduction/abduction of the toes
* 2 dorsal muscles - short extensors of the toes
Function: maintenance of arches of foot + stabilisation
ALL of intrinsic muscles of foot supplied by TIBIAL NERVE (via medial and lateral plantar nerves)
* EXCEPT 2 dorsal muscles - DEEP FIBULAR NERVE
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Extrinsic muscles of the foot? (9)
* Anterior compartment of leg = tibialis anterior, extensor digitorium longus, extensor hallicus longus, fibularis tertius (dorsiflexion + inversion)
* Posterior: tibialis posterior, flecor hallicus longus, flexor digitorium longus (plantarflexion + inversion)
* Lateral: fibularis longus and brevis (eversion)
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Nerve supply to compartments of leg? (3)
Anterior = deep fibular nerve (“foot drop”)
Posterior = tibial nerve
Lateral = superficial fibular nerve
Where does eversion/inversion and dorsiflexion/plantarflexion occur in the foot?
At subtalar and midtarsal joints
Where do the superficial and deep fibular nerves branch from?
Branch of common fibular nerve from sciatic nerve
What is calcaneal tendon formed from?
Flexor retinaculum? What other structures pass through here? (3)
Significance?
Achilles = gastrocnemius, plantaris + soleus
Flexor retinaculum = Tom, Dick and Harry (Tibialis posterior, flexor digiorium longus, flexor hallicus longus)
* Tom Dick and Very Nervous Harry: V (vein = posterior tibial vein), N (nerve = tibial nerve), A (artery = posterior tibial artery)
TARSAL TUNNEL SYNDROME
Blood supply to foot? (3)
* Dorsalis pedis artery (branch of anterior tibial artery) - pulse taken lateral to extensor hallicus longus tendon - BRACNHES TO GIVE ARCUATE ARTERY ON DORSUM
* Medial and lateral plantar arteries - branches of posterior tibial artery - GIVE DEEP PLANTAR ARCH
* Metatarsal arteries - arise from deep plantar arc and arcuate arery - branch into 4 digital arteries (end arteries)
Venous drainage of foot? (2)
Superficial = dorsal venous arch gives rise to great saphenous vein (medial) and small saphenous vein (lateral)
Deep = drain into anterior/posterior tibial veins + fibular veins to form popliteal vein
Lymphatic drainage of foot?
Accompany great and small saphenous veins to inguinal/iliac nodes
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(should be 3 images)
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Motor supply to foot? (2)
* The tibial nerve to the muscles of the sole
* The deep fibular nerve to the muscles of the dorsum
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Sensory supply to foot? (2)
Dorsum = mainly superficial fibular nerve
* Deep fibular nerve - first interdigital cleft (i.e. between big toe and 2nd toe)
* Sural nerve - proximal lateral border
* Saphenous nerve - proximal median border incl. malleolus
Plantar = mainly tibial nerve (via medial + lateral plantar nerves)
* Sural nerve - proximal lateral border
* Saphenous nerve = proximal medial border
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