MSK detailed Flashcards
progression of the brachial plexus
anterior rami – trunks – divisions – cords – terminal branches
brachial superior trunk roots
C5 and C8
brachial middle trunk root
C7
brachial inferior trunk
C8 and T1
lateral cord consists of
superior trunk and middle trunk
posterior cord consists of
middle trunk, superior trunk and inferior trunk
medial cord consists of
inferior trunk
ulnar artery pathway
inferior deep to superficial pronator teres , palmaris longus, flexor digitorum superficial to reach medial side of the arm and passes superficial to the flexor retinaculum.
radial artery pathway
inferior laterally under the brachioradialis, lies lateral to flexor carpi radialis, winds round lateral aspect of radius and cross floor of the anatomical snuff box to pierce the 1st dorsal interosseus muscle.
thumb dermatome
C6
basilic vein pathway
runs up the postaxial border of the upper limb, pierces the deep fascia halfway between the elbow and axilla to join the brachial veins in forming the axillary vein
cephalic vein pathway
; runs up from the anatomical snuffbox along the preaxial border of the upper limb. It runs in the upper arm lateral to the biceps in the deltopectoral groove and perforates the clavipectoral fascia to drain into the axillary
index finger dermatome
C7
little finger dermatome
C8
lymphatic drainage of the upper arm
cubital-> humeral axillary. Most however, apical axillary lymph nodes and some to the deltopectoral lymph nodes.
pectoralis major action
adducts and medially rotates shoulder
pectoralis minor action
stabilises scapula
pectoralis major innervation
lateral and medial pectoral nerves C6, C7, C8).
subclavius action
anchors and depresses clavicle
subclavius innervation
medial pectoral nerve C8, T1
pectoralis minor innervation
medial pectoral nerve C8, T1
serratus anterior action
protects scapula and holds it against thoracic wall
serratus anterior innervation
long thoracic nerve C6, C7
trapezius innervation
spinal accessory nerve
trapezius descending action
elevates scapula
trapezius ascending action
depresses scapula
trapezius middle action
retracts
trapezius ascending and descending action
rotate glenoid superiorly
latissimus dorsi action
extends, adducts and medially rotates
latissimus dorsi nerve
thoracodorsal nerve C6, C7
levator scapulae movements
elevates scapula and tilts glenoid inferiorly
rhomboid minor and major movement
retracts scapula and rotate it to depress glenoid cavity
rhomboid minor and major nerve innervation
dorsal scapular nerve C5).
supraspinatus action
abduction
supraspinatus innervation
suprascapular nerve C5
infraspinatus movement
laterally rotate shoulder joint
infraspinatus innervation
(suprascapular nerve C5
teres minor action
laterally rotate shoulder joint
teres minor innervation
suprascapular nerve C5
teres major action
adducts and medially rotates
teres major innervation
lower subscapular nerve C6
subscapularis action
: medially rotates and adducts shoulder joint:
subscapularis innervation
upper and lower subscapular nerves C6
subacromial bursa function
facilitates movement of supraspinatus tendon under the coraco-acromial arch and of the deltoid over the joint capsule and the greater tubercle of the humerus.
subscapular bursa function
between the tendon of the subscapularis and neck of the scapula. Protects the tendon where is passes inferior to the root of the coracoid process and over the neck of the scapula.
glenohumeral ligaments description
internal aspect, strengthens the anterior aspect
coracohumeral ligament description
strong band that passes from the base of the coracoid process to the anterior aspect of the greater tubercle. Strengthens capsule superiorly.
transverse humeral ligament description
broad fibrous band that runs from the greater to lesser tubercle
coraco-acromial ligament description
extrinsic protective, spans the coraco-acromial arch. Prevents superior displacement.
AC ligaments are
coracoclavicular ligament, conoid ligament, nearly horizontal trapezoid ligament
coracoclavicular ligaments description
anchors the clavicle to the coracoid process of the scapula. Enables scapula and free limb passively suspended
conoid ligament description
attached to the root of the coracoid process
nearly horizontal trapezoid ligament description
superior surface of the coracoid process and extends laterally and posteriorly to the trapezoid line on the inferior surface of the clavicle
elbow collateral ligament description
strong triangular bands that are medial and lateral thickenings.
elbow lateral collateral ligament description
fan like radial from the epicondyle of the humorous and blends distally with the annular ligament of the radius
the medial triangular ulnar collateral ligament description elbow
extends from the medial epicondyle of the humerus to the coronoid process and olecranon of the ulna.
biceps brachii action
supinates forearm, flexes elbow joint, flexes shoulder joint.
biceps brachii nerve innervation
musculocutaneous nerve C5, C6).
brachialis action
flexes elbow joint
brachialis nerve innervation
musculocutaneous nerve C5, C6).
coracobrachialis action
helps flex and adduct shoulder
coracobrachialis innervation
musculocutaneous nerve (C6))
triceps brachii action
chief extensor of the elbow
triceps brachii innervation
(radial nerve C7, C8)
anconaeus action
assists in extending the elbow, abducts the ulnar during pronation
anconaeus innervation
radial nerve
median nerve journey
distally in the arm initially on the lateral side of the brachial artery on the lateral side of the brachial artery until the middle of the arm where it crosses over to the medial side an contacts the brachialis. It then descends into the cubital fossa
ulnar nerve journey
passes distally anterior to the insertion of the teres major to the long head of the triceps on the medial side of the brachial artery around the middle of the arm. It pierces the medial intermuscular septum with the superior ulnar collateral artery and descends between the septum and medial head of triceps. Passes posterior to the medial epicondyle of the humerus to enter the forearm.
musculocutaneous nerve journey
arises from lateral cord and pierces the coracobrachialis continuing distally between the brachialis and the biceps. Nerve emerges lateral to the biceps brachii
radial nerve journey
enters the arm posterior to the brachial artery, medial to the humerus and anterior to the long head of triceps. Descends inferolaterally with the profunda brachii, pierces the lateral intermuscular septum and continues inferiorly in the anterior compartment between the brachialis and the brachioradialis in the cubital fossa. Divides into deep and superficial branches.
pronator teres function and innervation
: pronates and flexes forearm (median nerve C7)
flexor carpi radialis function and innervation
flexes and abducts hand at wrist (median nerve C7)
palmaris longus innervation and function
flexes hand at wrist and tenses palmar aponeurosis (median nerve)
flexor carpi ulnaris innervation and function
: flexes and adducts hand at wrist (ulnar C8)
flexor pollicis longus function and innervation
flexes wrist, flexes metacarpophalangeal and interphalangeal joints of the thumb. Supplied by anterior interosseous nerve from median nerve
pronator quadratus innervation and action
pronates forearm. Supplied by anterior interosseous nerve from median nerve
where can the pisiform be palpated?
on the anterior aspect of the medial border of the wrist
the hook of the hamate can be palpated
deep pressure over the medial side of the palm lateral to the pisiform
tubercles of the scaphoid and trapezium can be palpated at
the base and medial aspect of the thenar eminence
cephalic vein course
runs superiorly in the lateral bicipital groove and the basilic ascends in the medial bicipital groove.
lilium composition of the hip
S. acetabulum, body and wing with super iliac crest
ischium composition of the hip
posterior inferior part Acetabulum , ramus, ischiopubis ramus
pubis composition of the hip
anterior acetabulum, rami superior and inferior
key features of the femur
double ridged linea aspera on the posterior aspect. head contains depression for the fovea for the ligament of the head. Greater and lesser trochanter joined posteriorly by the intertrochanteric crest, anteriorly by the intertrochanteric line.
ilio-femoral ligament description
anteriorly and superiorly Y
pubofemoral ligament description
inferiorly and anteriorly
ischiofemoral ligament
posteriorly
pectineus action and innervation
adducts and flexes hip joint, assists in medial rotation. Femoral nerve.
sartorius innervation and action
flexes and abducts, laterally rotates hip, flexes knee joint. Femoral nerve
ilipsoas innervation and action
flexing hip joint, controls deviation of trunk. Lumbar nerves anterior rami
quadriceps femoris innervation and action
extends knee joint, stabilises hip, aids iliopsoas. Femoral.
adductor longus innervation and action
adducts hip joint. Obturator nerve.
adductor brevis action
adduct hip joint and to some extent flexes it.
adductor magnus action and innervation
– adducts hip joint. Hamstring part extends it. flexor: obturator, extensor: sciatic nerve.
gracilis innervation and action
adduct hip joint , flexes knee joint, rotates medially. Obturator nerve.
obturator externus innervation and action
laterally rotates hip, pulls head of femur into acetabulum. Obturator nerve.
gluteus maximus action and innervation
extends hip joint, assists in lateral rotation. Inferior gluteal nerve
gluteus medius and minimus action and innervation
abducts and anteriorly medially rotates hip joint. Superior gluteal nerve.
tensor fascia latae action and innervation
flexes hip joint, stabilize the extended knee. Superior gluteal nerve.
piriformis innervation and action
: laterally rotate extended hip joint. Anterior rami of S1, S2.
obturator internus action and innervation
: laterally rotates extended hip join. Nerve to obturator internus S1
gemelli S action and innervation
laterally rotates extended hip join. L5 S1
gemelli inferior action and innervation
: laterally rotates hip joint. L5, S1
quadratus femoris action and innervation
: laterally rotates hip. L5, S1.
semitendinosus and semimembranosus action and innvervation
extends hip joint, flexes knee joint and rotate the leg medially when the knee is flex, when hip and knee flexed, extends trunk.
semitendinosus and semimembranosus innvervation
Tibial division of the sciatic nerve.
biceps femoris action
, long and short heads: flexes knee joint and rotates it laterally when the knee is flexed, extends hip joint
long head of the biceps femoris innervation
tibial division of the sciatic nerve
short head of the biceps femoris innervation
sort head common fibular division of sciatic nerve.
small toe dermatome is
S1
Big Toe dermatome
L5
medial ankle dermatome is
L4
knee dermatome is
L3
femoral nerve course
Originates in the abdomen from the lumber plexus within the psoas major, descends posterolateral through the pelvis to the midpoint of the inguinal ligament, passes deep, enters the femoral triangle lateral to its vessels. Divides with the terminal branch being the saphenous nerve via the adductor canal to supply the anteromedial aspects of the knee, leg and foot.
obturator nerve course
descends along the medial border of the psoas major, enters thigh through the obturator foramen with the obturator artery and vein. Divides into anterior and posterior branches. Anteriorly supplies the adductor longus, adductor brevis, gracilis, and pectineus. Posteriorly supplies obturator externus and adductor magnus.
lymphatic drainage flow from the superficial inguinal nodes
superficial inguinal nodes supplied by the superficial lymphatic vessels supply the external iliac nodes. Some may pass deep inguinal lymph nodes
deep inguinal lymph nodes flow
deep inguinal lymph nodes located medially however mostly supplied by deep lymphatic vessels and popliteal lymph nodes to the deep.
nerve outflow of the sacral plexus exit the pelvis through
sacral plexus exit through the greater sciatic foramen, all superior to the piriformis except the superior gluteal nerve. The only nerve that doesn’t is the pudendal nerve that exits via the lesser sciatic foramen.
tibial nerve supplies
Tibial nerve more superficial of the structures to supply the soleus, gastrocnemius, plantaris and popliteus muscle, via the sural nerve the lateral aspects of leg and foot sensation
common fibular nerve supplies
Common fibular nerve divides into the deep and superficial nerve, most inferior branches of the posterior cutaneous nerve of the thigh supply the skin that overlies the popliteal fossa.
oblique popliteal ligament function and description
strengthens capsule posteriorly, arises posterior to medial tibial condyle and passes to attach to the central aspect of the posterior capsule, arises from the semimembranosus.
arcuate ligament function and description
arises posterior aspect of the fibular head, passes superomedially over the tendon of the popliteus and spread over the posterior surface of the knee joint
tibialis anterior function and innervation
dorsiflexes ankle, inverts foot, supports medial longitudinal arch of foot. Deep fibular nerve.
extensor hallucis longus function and innervation
deep fibular nerve. Extends great toe, dorsiflexes ankle
extensor digitorum longus action and innervation
extends lateral four digits. Dorsiflexes ankle. Deep fibular nerve
fibularis tertius action and innervation
– dorsiflexes ankle, aids in eversion of foot. Deep fibular nerve.
fibularis longus and fibularis brevis action and innervation
evert foot, weakly plantarflex ankle. Supports transverse arch of foot. Superficial fibular nerve
lateral ligament of the ankle consists of
lateral ligament consists of:
anterior talofibular ligament
posterior talofibular
calcaneofibular ligament
foot blood supply
dorsal pedis -> lateral tarsal -> arcuate -> deep plantar artery + lateral plantar artery to form the deep plantar arch.
gastrocnemius lateral and medial head action and innervation
plantarflexes when knee is extended, raises heel during walking and flexes knee joint. Tibial nerve
soleus action and innervation
plantarflexes ankle. Tibial nerve
plantaris action and innervation
weakly assists gastrocnemius in plantarflexing ankle. Tibial nerve
superficial posterior compartment muscles
gastrocnemius, soleus, plantaris
deep posterior compartment muscles
popliteus, flexor hallucis longus, flexor digitorum longus, tibialis posterior
popliteus function and innervation
weakly flexes knee and unlocks it by laterally rotating femur on fixed tibia. Tibial nerve
flexor hallucis function and innervation
flexes great toe at all joints, weakly plantarflexes ankle, supports medial longitudinal arch. Tibial nerve
flexor digitorum longus function and innervation
flexes lateral four digits, plantarflexes ankle, supports medial longitudinal arch. Tibial nerve.
tibilais posterior innervation and function
plantarflexes ankle, inverts foot and supports medial longitudinal arch. Tibial nerve.
lateral nerve of the lateral leg
the superficial fibular nerve, the nerve in the lateral compartment, it is the terminal branch of the common fibular nerve.
any arteries in the lateral leg?
no
lateral muscles supplied by
fibular artery
describe the longitudinal arch of the foot
- medial and lateral parts, with the transverse arch spreading the weight in all directions.
medial longitudinal arch of the foot description
- important arch composed of calcaneus, talus and navicular, three cuneiforms and three metatarsals.
transverse arch of the foot description
medial and lateral parts of the longitudinal arch serves s pillars for the transverse arch.
muscles responsible for heel strike
ankle dorsiflexors, hip extensors, intrinsic muscles of foot, long tendons
muscles responsible for loading response
knee extensors, ankle plantarflexes, hip abductors, intrinsic muscles of the foot, long tendons of foot
muscle responsible for midstance
knee extensors, ankle plantarflexes, hip abductors, intrinsic muscles of the foot
preswing toe off muscles in action
long flexors of digits, intrinsic muscles of foot, long tendons of foot, flexor of hip
initial swing of leg muscles in action
flexor of hip, ankle dorsiflexors
midswing of the leg muscles
hip extensors
terminal swing of the leg muscles
hip extensors, knee flexors, ankle dorsiflexors, knee extensors
highest point of the Iliac crest is between which vertebrae?
L4/L5
gluteal fold marks the
inferior border of the gluteus maximus muscle
tuberosity of the navicular can be easily seen and palpated on what side of the foot?
medial aspect
