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2nd Year Medicine > MSK anatomy > Flashcards

MSK anatomy Flashcards

1
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2
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3
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2 muscle groups gluteal region?

A

Superifcial muscle group

* Gluteus maximum, medius + minumus

* Tensor fascia late

Deep muscle group

* Piriformis

* Obturator internus

* Gemelli (superior + inferior - gemelli means twins)

* Quadratus femoris

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4
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Fucntion of superficial muscles of gluteal region? WHat are they innervated by?

A

Extensors, abductors and medial rotators of thigh

* Innervated by gluteal nerves

* Gluteus maximum = inferior gluteal

* All others = superior gluteal

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5
Q

Reduced function of superior gluteal nerve leads to?

A

Trendelenburg’s gait - hip will drop on contralateral side (weak hip abduction by gluteus medius)

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6
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7
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Function of deep muscle group of gluteal region? Innervated by?

A

Lateral rotators of thigh and hip stabilisers

* Innervated by sacral plexus

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8
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9
Q

Hip joint called? What kind of joint is it? (2)

A

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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10
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11
Q

Ligaments of the gluteal region?

A
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12
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13
Q

Primary blood supply to head of femur?

A

Medial circumflex femoral artery

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14
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15
Q

Arteries damaged in femoral neck fractures?

A

Retinacular arteries

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16
Q

Knee joint? Movement? (2)

A

Modified synovial hinge joint

* Main movement = flexion/extension

* Slight rotation

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17
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A

fibula is lateral

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18
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articulations of knee joint?

A

3 articulations

* 2 x tibiofemoral (medial + lateral)

* 1 x patellofemoral

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19
Q

Ligaments of knee joint? (2)

A

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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20
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21
Q

Menisci of the knee joint?

A

Crescent-shaped fibrocartilage (medial + lateral)

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22
Q

How to test joint integrity of the knee? (2)

A

* Aterior drawer test - ACL

* Posterior drawer test - PCL

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23
Q

Why is lateral collateral ligament much smaller than medial collateral ligament?

A

Has to withstand much more force

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24
Q
A

Women have larger Q angles so more prone to osteoarthritis

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25
Q

How do nerves enter/exit the gluteal region? The perineum?

A

* Gluteal region = greater sciatic foramen

* Perineum = lesser sciatic foramen

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26
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27
Q

What splits the gluteal region into greater and lesser sciatic foramen?

A

sacrospinous ligament

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28
Q

Nerves of the gluteal region? (3)

A

* Sciatic (L4-S3)

* Pudendal (S2-S4)

* Posterior cutaneous nerve of thigh (S1-S3)

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29
Q

Sciatic nerve supplies? Pudendal? POsterior cutaneous nerve of thigh?

A

* 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

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30
Q

Sciatic nerve exits gluteal region where?

A

Exits inferior to piriformis via greater sciatic foramen (usually most lateral structure exiting greater sciatic foramen)

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31
Q

Sciatic nerve artery?

A

Artery to the sciatic nerve

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32
Q

Sciatic nerve splits into? (2)

A

* Tibial nerve = larger, medial

* Common fibular = smaller, lateral

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33
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34
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35
Q

Compartment syndrome tx?

A

Fasciotomy

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36
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37
Q

Flexures of thigh? Extensors of leg?

What are they innervated by?

A

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)

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38
Q

Femoral triangle boundaries? Contents?

A

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

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39
Q

Where are flexures and extensors of thigh/leg found?

A

Anterior compartment of thigh

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40
Q

Where are adductors of thigh found? What are they? What are they innervated by?

A

Medial compartment of thigh

* Adductor longus

* Adductor brevis

* Adductor magnus

* Gracilis

* Obturator externus

All innervated by obturator nerve (L2, 3, 4)

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41
Q

Where are the exensors of the thigh and flexors of leg found? What are they? What are they innervated by?

A

Posterior compartment of the thigh

* Semitendinosus

* Semimembranosus

* Biceps femoris

All tibial division of sciatic nerve (L5, S1, S2)

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42
Q

Ischial tuberosity?

A

Bony part of bum you sit on

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43
Q

Muscle groups of posterior compartment of the leg? Innervated by?

A

Superifcial group

* Gastrocnemius

* Soleus

* Plantaris

Deep group

* Popliteus

* Flexor hallicus longus

* Flexor digitorum longus

* Tibialis posterior

All innervated by tibial nerve!!

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44
Q

Muscles of anterior compartment of leg? Innervated by?

Lateral compartment of leg? Innervated by?

A

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)

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45
Q

What causes “foot drop”?

A

Deep fibular nerve palsy leading to absent dorsiflexion

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46
Q

Boundaries of popliteal fossa? Contents?

A

Boundaries

* Superlateral = biceps femoris

* Supermedial = semimembranosus

* Inferior = gastrocnemius

* Roof = popliteal fascia

Contents

* Fat

* Small saphenous vein

* Popliteal vessels

* Tibial and common fibular nerves

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47
Q

Calcaneal tendon? How long? What is it composed of? Where is its attachment point?

A

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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48
Q

Ankle jerk reflex?

A

Normal result is plantarflexion - tests S1, S1 nerve roots

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49
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50
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52
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53
Q

Which movement is required in the forearm during PRONATION?

A

Radius moved over ulna during pronation

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54
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A

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55
Q

Whate type of joint is metacarpophalangeal joint? carpometacarpal joint?

A

MCP = condyloid joint

CMC = saddle type

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56
Q

What is teh degree of rotation of the thumb?

A

90 degrees

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57
Q

Axioappendicular muscles? (6)

A

* Trapezius

* Rhomboid major + minor

* Serratus anterior

* Subclavius

* Latissimus dorsi

* Levator scapulae

58
Q

Trapezius attachment? Innervation? Function?

A

* Attachments = spinoscapular, accromium, clavical

* Innervation = CN XI (spinal accessory) - also innervate sternocleidomastoid

* Function = moves shoulder blades back, up, down

59
Q

Innervation of serratus anterior? Thomboid major/minor? Levator scapulae?

A

Serratus = long thoracic nerve (winged scapula)

Rhomboid = dorsal scapula nerve

Levator scapulae = dorsal scapula nerve

60
Q

4 rotator cuff muscles?

Function of rotator cuff?

Individual functions??

A

* 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

61
Q

Where are rotator cuffs attached?

A

* Supraspinatus, infraspinatus, teres minor = greater tuberosity of humerus

* Subscapularis = lesser tuberosity

62
Q

Compartments of arm?

A

Anterior and posterior

63
Q

Muscles of anterior compartment? (3)

Innervation?

Action?

A

Anterior compartment run by BBC!

* Biceps brachii, brachialis, coracobrachialis

* Innervation = musculocutaneous nerve

* Actions = flexion of arm and forearm (biceps brachii also SUPPINATES forearm)

64
Q

Muscles of posterior compartment of arm?

Innervation?

Actions?

A

Triceps brachii

* Radial nerve

* Extension of arm + forearm

65
Q

Muscles of anterior compartment of forearm?

Innervation?

Actions?

A

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

66
Q

Muscles of posterior compartment of forearm?

Innervations?

Actions?

A

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

67
Q

Compartments of hand?

Contents?

A

* 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

68
Q

Innervation of compartments of hand?

Significance of thenar eminence?

A

* 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!!!)

69
Q

Attachment of lumbricals?

Function of interossei?

A

* Lumbricals = attached to tendons of flexor digitorum profundus

* Dorsal interossei = abduction of digits

* Palmar interossei = adduction of digits

70
Q

Origins of brachial plexus?

Route?

A

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

71
Q
A

Learn how to draw

72
Q
A

learn how to draw

73
Q
A

…

74
Q
A

Distal nerve injury = cutaneous innervation pattern

Proximal nerve injury – more dermatomal image

Carpal tunnel – thumb, index, middle and half of ring finger

75
Q

What is the carpal tunnel formed by?

Contents? (4)

Carpal tunnel syndrome?

A

* 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

76
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A

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77
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78
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A

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79
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A

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80
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A

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81
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A

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82
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A

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83
Q

Ankle mortise?

A

Tibia + lateral + medial malleoli

84
Q
A

…

85
Q
A

Labrum is important stabiliser of hip joint

86
Q
A

…

87
Q
A

Red is what u see on x-ray

Note: intra-articular physis in children

88
Q

Greater trochanter ossification begins at what age?

A

4

89
Q

Hip flexors? (2)

A

Iliacus

* Origin = iliac crest

* Insertion = lesser trochanter

Psoas major

* Origin = transverse processes L1-L5

* Insertion = lesser trochanter

90
Q

Psoas abscess s/s? (3)

Risk factors? (2)

A

S/s

* Hold hip flexed

* Raised CRP

* Sepsis symptoms

Risk factors: PWID, immunocompromised

91
Q

Secondary hip flexors? (2)

What is their main function?

A

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!

92
Q

Hip adductors? (5)

Origin and insertion?

A

* Adductor brevis

* Adductor longus

* Adductor magnus

* Pectineus

* Gracilis

Common origin = inferior pubic rami

Insertion = linea aspera, pectineal line, tibia

93
Q

Hip abductors? (3)

Origin and insertion?

A

Gluteus minimus + medius

* Origin = iliac wing

* Insertion = greater trochanter

Tensor fascia lata

* Origin = iliac crest

* Insertion = lateral tibia

94
Q

Hip extensor?

Origin and insertion?

A

Gluteus maximus

* Origin = posterior ilium/sacrum

* Insertion = iliotibial tract

95
Q

Hip extensors + knee flexors? (3)

Origin and insertion?

A

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

96
Q

Difference between true hip pain and pain caused by trochanteric bursitis?

A

True hip pain = groin

Trochanteric bursitis = lateral hip pain

97
Q
A

…

98
Q

Functions of knee menisci? (4)

Differences in shape of menisci?

A

* shock absorbers

* Increase femero-tibial conformity

* Stabilise knee during movement

* Lubricate knee

Medial meniscus is bigger C than lateral meniscus (due to tibia)

99
Q

Knee extensors? (4)

Origin and instertions?

A

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

100
Q

Factors which predispse to patellar instability? (4)

A

* Genu valgum (large Q angle)

* Femoral head anteversion

* Weak quadriceps

* lax ligaments

101
Q

Draw muscle compartment of leg

hint: smiley pirate

A
102
Q

Ankle plantar flexors (i.e. tip toes)? (3)

Origin and insertion?

A

Gastrocnemius

*Origin = femoral condyles

Soleus

* Origin = broad area of posterior tibia/fibula

Plantaris

* Origin = lateral femoral condyle

COMMON INSERTION = calcaneus via ACHILLES TENDON

103
Q

Ankle dorsiflexors?

Origin and insertion?

A

Tibialis anterior

* Origin = lateral proximal tibia

* Insertion = medial cuneiform

104
Q

Ankle ligaments? (2)

A

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

105
Q

Supporting structures of the medial arch? (2)

Origin and insertion?

A

Tibialis posterior tendon

* Origin = posterior proximal tibia/fibula

* Insertion = navicular + medial cuneiform

Spring ligament (calcaneonavicular ligament)

106
Q

Plantar fascia origin and insertion?

A

* Origin = tuberosity of calcaenous

* Insertion = metatarsals

107
Q

Development of the acetabulum

A
108
Q

Describe x-ray findings

A

Normal - femoral epiphysis in medial inferior quadrant

(<6 y/o as can’t see greater trochanter yet)

109
Q
A

Developmental dysplasia of hip (left hip)

110
Q
A

Late presenting DDH

111
Q
A

…

112
Q
A

…

113
Q

Which 2 tarsal bones are located in hindfoot?

Which five tarsal bones are located in midfoot?

Which 19 bones are located in forefoot?

A

Hindfoot = talus + calcaneus

Midfoot = cuboid, navicular, medial, intermediate + lateral cuneforms

Forefoot = metatarsals + phalanges

114
Q

What are the 3 arches of the foot?

A

* Medial longitudinal arch

* Lateral longitudinal arch

* Transverse arch

115
Q

Medial longitudinal arch made up of?

Medial longitudinal arch supported by?

A

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)

116
Q

Lateral longitudinal arch made up of?

Function?

A

Calcaneus, cuboid, metatarsals 4 + 5

Usually weight bearing

117
Q

Transverse arch made up of?

Supported by?

A

Cuboid, cuneforms, bases of all 5 metatarsals

* Supported by fibularis longus

118
Q

Functions of arches of the foot? (3)

What is the plantar aponeurosis?

A

* 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)

119
Q
A

…

120
Q
A

…

121
Q

What does plantar aponeurosis give rise to?

What is it called when it becomes inflamamed?

A

Gives rise to digital longitudinal bands

* Plantar fasciitis

122
Q
A

…

123
Q

How are the INTRINSIC muscles of the foot organised? (3)

Function?

Nerve supply?

A

* 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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125
Q

Extrinsic muscles of the foot? (9)

A

* 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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127
Q

Nerve supply to compartments of leg? (3)

A

Anterior = deep fibular nerve (“foot drop”)

Posterior = tibial nerve

Lateral = superficial fibular nerve

128
Q

Where does eversion/inversion and dorsiflexion/plantarflexion occur in the foot?

A

At subtalar and midtarsal joints

129
Q

Where do the superficial and deep fibular nerves branch from?

A

Branch of common fibular nerve from sciatic nerve

130
Q

What is calcaneal tendon formed from?

Flexor retinaculum? What other structures pass through here? (3)

Significance?

A

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

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Q

Blood supply to foot? (3)

A

* 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)

132
Q

Venous drainage of foot? (2)

A

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

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Q

Lymphatic drainage of foot?

A

Accompany great and small saphenous veins to inguinal/iliac nodes

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(should be 3 images)

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138
Q

Motor supply to foot? (2)

A

* The tibial nerve to the muscles of the sole

* The deep fibular nerve to the muscles of the dorsum

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A

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A

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141
Q

Sensory supply to foot? (2)

A

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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2nd Year Medicine (24 decks)

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