MSK anatomy Flashcards
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2 muscle groups gluteal region?
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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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Fucntion of superficial muscles of gluteal region? WHat are they innervated by?
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Extensors, abductors and medial rotators of thigh
* Innervated by gluteal nerves
* Gluteus maximum = inferior gluteal
* All others = superior gluteal
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Reduced function of superior gluteal nerve leads to?
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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?
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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)
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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?
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Medial circumflex femoral artery
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Arteries damaged in femoral neck fractures?
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Retinacular arteries
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Knee joint? Movement? (2)
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Modified synovial hinge joint
* Main movement = flexion/extension
* Slight rotation
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fibula is lateral
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articulations of knee joint?
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3 articulations
* 2 x tibiofemoral (medial + lateral)
* 1 x patellofemoral
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Ligaments of knee joint? (2)
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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?
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Crescent-shaped fibrocartilage (medial + lateral)
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How to test joint integrity of the knee? (2)
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* Aterior drawer test - ACL
* Posterior drawer test - PCL
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Why is lateral collateral ligament much smaller than medial collateral ligament?
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Has to withstand much more force
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Women have larger Q angles so more prone to osteoarthritis
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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
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Nerves of the gluteal region? (3)
\* Sciatic (L4-S3)
\* Pudendal (S2-S4)
\* Posterior cutaneous nerve of thigh (S1-S3)
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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
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Sciatic nerve exits gluteal region where?
Exits inferior to piriformis via greater sciatic foramen (usually most lateral structure exiting greater sciatic foramen)
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Sciatic nerve artery?
Artery to the sciatic nerve
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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)
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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
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Where are flexures and extensors of thigh/leg found?
Anterior compartment of thigh
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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)**
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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)**
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Ischial tuberosity?
Bony part of bum you sit on
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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!!**
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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)**
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What causes "foot drop"?
Deep fibular nerve palsy leading to absent dorsiflexion
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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
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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
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What is teh degree of rotation of the thumb?
90 degrees
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Axioappendicular muscles? (6)
\* Trapezius
\* Rhomboid major + minor
\* Serratus anterior
\* Subclavius
\* Latissimus dorsi
\* Levator scapulae
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Trapezius attachment? Innervation? Function?
\* Attachments = spinoscapular, accromium, clavical
\* Innervation = CN XI (spinal accessory) - also innervate sternocleidomastoid
\* Function = moves shoulder blades back, up, down
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Innervation of serratus anterior? Thomboid major/minor? Levator scapulae?
Serratus = long thoracic nerve (winged scapula)
Rhomboid = dorsal scapula nerve
Levator scapulae = dorsal scapula nerve
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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
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Where are rotator cuffs attached?
\* Supraspinatus, infraspinatus, teres minor = greater tuberosity of humerus
\* Subscapularis = lesser tuberosity
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Compartments of arm?
Anterior and posterior
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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)
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Muscles of posterior compartment of arm?
Innervation?
Actions?
Triceps brachii
\* Radial nerve
\* Extension of arm + forearm
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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
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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
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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
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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!!!)**
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Attachment of lumbricals?
Function of interossei?
\* Lumbricals = attached to tendons of flexor digitorum profundus
\* Dorsal interossei = abduction of digits
\* Palmar interossei = adduction of digits
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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**
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Learn how to draw
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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
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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
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Greater trochanter ossification begins at what age?
4
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Hip flexors? (2)
Iliacus
\* Origin = iliac crest
\* Insertion = lesser trochanter
Psoas major
\* Origin = transverse processes L1-L5
\* Insertion = lesser trochanter
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Psoas abscess s/s? (3)
Risk factors? (2)
S/s
\* Hold hip flexed
\* Raised CRP
\* Sepsis symptoms
Risk factors: PWID, immunocompromised
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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!
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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
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Hip abductors? (3)
Origin and insertion?
Gluteus minimus + medius
\* Origin = iliac wing
\* Insertion = greater trochanter
Tensor fascia lata
\* Origin = iliac crest
\* Insertion = lateral tibia
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Hip extensor?
Origin and insertion?
Gluteus maximus
\* Origin = posterior ilium/sacrum
\* Insertion = iliotibial tract
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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
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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)
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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
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Factors which predispse to patellar instability? (4)
\* Genu valgum (large Q angle)
\* Femoral head anteversion
\* Weak quadriceps
\* lax ligaments
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Draw muscle compartment of leg
hint: smiley pirate
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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
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Ankle dorsiflexors?
Origin and insertion?
Tibialis anterior
\* Origin = lateral proximal tibia
\* Insertion = medial cuneiform
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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
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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)
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Plantar fascia origin and insertion?
\* Origin = tuberosity of calcaenous
\* Insertion = metatarsals
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Development of the acetabulum
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Describe x-ray findings
Normal - femoral epiphysis in medial inferior quadrant
(\<6 y/o as can't see greater trochanter yet)
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Developmental dysplasia of hip (left hip)
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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
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What are the 3 arches of the foot?
\* Medial longitudinal arch
\* Lateral longitudinal arch
\* Transverse arch
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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)
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Lateral longitudinal arch made up of?
Function?
Calcaneus, cuboid, metatarsals 4 + 5
Usually weight bearing
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Transverse arch made up of?
Supported by?
Cuboid, cuneforms, bases of all 5 metatarsals
\* Supported by fibularis longus
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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
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Where does eversion/inversion and dorsiflexion/plantarflexion occur in the foot?
At subtalar and midtarsal joints
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Where do the superficial and deep fibular nerves branch from?
Branch of common fibular nerve from sciatic nerve
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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
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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)
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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
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Lymphatic drainage of foot?
Accompany great and small saphenous veins to inguinal/iliac nodes
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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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