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MSK Exam 1 Flashcards

1
Q

What nerves make up the lumbar plexus?

A

L1-L4

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2
Q

What nerve root(s) innervate(s) the ilioinguinal nerve?

A

L1

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3
Q

What nerve root(s) innervate(s) the genitofemoral nerve?

A

L1 and L2

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4
Q

What nerve root(s) innervate(s) the lateral femoral cutaneous nerve?

A

L2 and L3

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5
Q

What nerve root(s) innervate(s) the femoral nerve?

A

L2, 3 and 4

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6
Q

What nerve root(s) innervate(s) the obturator nerve?

A

L2, 3, and 4

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7
Q

What nerve root(s) innervate(s) the lumbosacral trunk?

A

L4, L5.

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8
Q

What is the nerve distribution of the lateral cutaneous branch of the iliohypograstric nerve?

A

Lateral gluteal region

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9
Q

What is the nerve distribution of the ilioinguinal nerve?

A

Upper medial thigh

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10
Q

What is the nerve distribution of the genital branch of the genitofemoral nerve?

A

Upper medial thigh

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11
Q

What is the nerve distribution of the femoral branch of the genitofemoral nerve?

A

Upper anterior thigh

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12
Q

What is the nerve distribution of the lateral femoral cutaneous nerve?

A

Lateral and anterolateral thigh

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13
Q

What is the nerve distribution of the obturator nerve?

A

Medial thigh, just above the knee

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14
Q

What is the nerve distribution of the anterior cutaneous branches of the femoral nerve?

A

Anterior and anteromedial thigh

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15
Q

What is the nerve distribution of the saphenous branch of the femoral nerve?

A

Medial side of knee, leg, ankle

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16
Q

What nerve root(s) innervate(s) the sciatic nerve?

A

L4,L5,S1-3

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17
Q

What nerve root(s) innervate(s) the superior gluteal nerve?

A

L4,L5,S1

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18
Q

What nerve root(s) innervate(s) the nerve to the quadratus femoris?

A

L4,5,S1

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19
Q

What nerve root(s) innervate(s) the inferior gluteal nerve?

A

L5,S1,S2

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20
Q

What nerve root(s) innervate(s) the nerve to the obturator internus?

A

L5,S1,2

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21
Q

What nerve root(s) innervate(s) the nerve to piriformis?

A

S1, S2

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22
Q

What nerve root(s) innervate(s) the posterior cutaneous nerve of the thigh?

A

S1, S2, S3

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23
Q

What is the nerve distribution of the inferior cluneal nerves?

A

Lower buttock

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24
Q

What is the nerve distribution of the perineal branch of the posterior femoral cutaneous nerve?

A

Upper medial thigh

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25
Q

What is the nerve distribution of the posterior femoral cutaneous nerve?

A

Lower buttock, posterior thigh

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26
Q

What is the nerve distribution of the sural nerve?

A

Posterior leg, lateral side and the dorsum of the foot

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27
Q

What is the nerve distribution of the lateral sural cutaneous nerve?

A

Lateral side of the leg

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28
Q

What is the nerve distribution of the of the superficial fibular nerve?

A

Anterior lower leg & ankle, dorsum of the foot, adjacent sides toes 1-4

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29
Q

What dermatomes does the sacral plexus innervate?

A

Lower buttocks, posterior thigh and leg, lower anterior leg and foot.

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30
Q

What dermatomes does the lumbar plexus innervate?

A

The anterior and medial thigh, upper anterior leg, and medial leg

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31
Q

What innervates the upper buttocks?

A

Dorsal rami of lumbar and sacral nerves

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32
Q

Which dermatomes innervate the anterior region of the leg?

A

L1-L5

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33
Q

Which dermatomes innervate the posterior region of the leg?

A

S1-S2

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34
Q

Which dermatomes innervate the coccygeal region?

A

S3-S5

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35
Q

Where does the small saphenous vein originate?

A

Lateral side of the dorsal venous arch of the foot

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36
Q

Where does the small saphenous vein terminate?

A

In the popliteal vein between the heads of the gastrocnemius muscle

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37
Q

Where does the great saphenous vein originate?

A

From the dorsal venous arch of the foot

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38
Q

Where does the great saphenous vein terminate?

A

In the femoral vein in the saphenous opening

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39
Q

What causes varicose veins?

Which vein is often the culprit?

A

When the valves of superficial veins become incompetent.

The great saphenous vein and its tributaries often become varicose.

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40
Q

What does the primitively VENTRAL surface correspond to?

A

the FLEXOR side.

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41
Q

What does the primitively DORSAL surface correspond to?

A

the EXTENSOR side.

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42
Q

What causes compartment syndrome?

A

Swelling or bleeding into a compartment. The fascia will not stretch, and the increased pressure causes blood flow to the muscles/nerve cells to be disrupted. In acute compartment syndrome, a fasciotomy must be performed.

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43
Q

Which compartment of the thigh is the extensor compartment?

A

The ANTERIOR compartment.

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44
Q

Which compartment of the thigh is the flexor compartment?

A

The POSTERIOR compartment.

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45
Q

Which compartment of the thigh is the adductor compartment?

A

The MEDIAL compartment.

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46
Q

What supplies blood to a joint?

A

Arteries derived from the PERIARTICULAR ARTERIES of blood vessels.

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47
Q

How are joints innervated?

A

Joints are supplied by the nerves which innervate the muscles producing movement at that joint. (Hilton’s Law)

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48
Q

What are the movements allowed by synovial joints?

A

Gliding movements, angular motion, circumduction, and rotation.

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49
Q

What is the role of the acetabular labrum ligament of the hip joint?

A

Deepens the acetabulum

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50
Q

What is the role of the transverse acetabular ligament?

A

It crosses the notch to complete the rim of the acetabulum.

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51
Q

What is the role of the round ligament?

A

The round ligament is INTRACAPSULAR. It extends from the acetabular notch and transverse acetabular ligament to the FOVEA of the femur.

AKA the ligamentum capitus femoris

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52
Q

What is the role of the Iliofemoral ligament?

A

AKA the Y ligament of Bigelow.

Extends from the AIIS to the intertrochanteric line; prevents OVEREXTENSION.

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53
Q

What is the role of the pubofemoral ligament?

A

From the superior pubic ramus, joins the iliofemoral ligament, checks ABDUCTION.

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54
Q

What is the role of the ischiofemoral ligament?

A

Extends from the ischium behind the acetabulum to blend with the capsule, checks medial rotation

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55
Q

Which arteries serve as the PRINCIPAL blood supply to the head of the femur?

A

The medial and lateral circumflex arteries (both branches of the profunda femoris)

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56
Q

Which arteries contribute to the blood supply to the head of the femur that arise mainly from the medial circumflex artery?

A

Retinacular arteries (nutrient arteries), which pass along the femoral neck beneath the capsule.

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57
Q

Which artery provides VARIABLE (0-20%) blood supply to the head of the femur?

A

Artery of the ligament of the head of the femur; a branch of the obturator artery

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58
Q

Why is a fracture of the femoral neck a problem, and what condition does it often cause as a result?

A

The retinacular arteries originating from the medial circumflex artery are TORN leaving only the ligament of the femoral head as the sole source of blood supply, which is insufficient. Thus, ASEPTIC VASCULAR NECROSIS commonly results.

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59
Q

What is the action of the muscles of the anterior compartment of the thigh?

A

flexors of the hip joint and extensors of the knee joint

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60
Q

What innervates the muscles of the anterior compartment of the thigh?

A

The femoral nerve

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61
Q

What is the blood supply of the anterior compartment of the thigh?

A

The femoral artery

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62
Q

What is the proximal attachment of the pectineus muscle?

A

The superior ramus of the pubis

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63
Q

What is the distal attachment of the pectineus muscle?

A

Penctineal line of the femur (a ridge of the posterior surface of the shaft of the femur from the lesser trochanter)

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64
Q

What is the innervation of the pectineus?

A

Femoral nerve (L2, L3), sometimes obturator nerve

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65
Q

What is the action of the pectineus?

A

Adducts and flexes thigh; assists in medial rotation of the thigh

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66
Q

What 2 muscles make up the Iliopsoas?

A

The iliacus and the psoas major

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67
Q

What is the proximal attachment of the iliopsoas muscle?

A

Iliacus–> the iliac fossa

psoas major -> transverse processes and bodies of lumbar vertebrae

68
Q

What is the distal attachment of the iliopsoas muslces?

A

The lesser trochanter of the femur

69
Q

What is the innervation of the iliopsoas muscles?

A

Ventral rami of lumbar nerves (L1, 2, 3)

70
Q

What is the action of the iliopsoas group?

A

Flexes thigh at hip joint

71
Q

What is the proximal attachment of the sartorius muscle?

72
Q

What is the distal attachment of the sartorius?

A

Medial surface of the proximal tibia

73
Q

What innervates the sartorius?

A

The femoral nerve (L2,L3)

74
Q

What are the main actions of the sartorius muscle?

A

Flexes, abducts and laterally rotates the thigh; flexes the leg at the knee joint

75
Q

What muscle group extends the knee?

A

The quadriceps femoris group

76
Q

What 4 muscles make up the quadriceps femoris group?

A

Rectus femoris
Vastus lateralis
Vastus medialis
Vastus intermedius

77
Q

What is the proximal attachment of the rectus femoris?

78
Q

What is the distal attachment of all of the muscles of the quadriceps femoris group?

A

Base of the patella via the quadriceps tendon

79
Q

What is the innervation of all of the muscles of the quadriceps femoris group?

A

Femoral nerve (L2, L3, L4)

80
Q

Aside from extension of the leg at the knee joint, what additional actions does the rectus femoris muscle provide?

A

Steadies hip joint and helps the iliopsoas flex the thigh

81
Q

What is the proximal attachment of the vastus lateralis?

A

Lateral lip of the linea aspera

82
Q

What is the proximal attachment of the vastus medialis?

A

Medial lip of the linea aspera

83
Q

What is the proximal attachment of the vastus intermedius?

A

Anterior and lateral surfaces of the shaft of the femur

84
Q

What are the muscles of the adductor group of the thigh?

A

Adductor longus, adductor brevis, adductor magnus, gracilis, and obturator externus

85
Q

What is the proximal attachment of the adductor longus?

A

The pubic bone

86
Q

What is the distal attachment of the adductor longus?

A

Linea aspera of the femur

87
Q

What is the innervation of the adductor longus?

A

The obturator nerve (anterior division)

88
Q

What is the action of the adductor longus AND adductor brevis?

A

Adducts the thigh (the name basically tells you so duh)

89
Q

What is proximal attachment of the adductor magnus?

A

Adductor part –> ischiopubic ramus

Hamstring part –> ischial tuberosicity

90
Q

What is the only muscle in the adductor compartment NOT innervated by the obturator nerve?

A

The hamstring part of the adductor magnus, which is innervated by the tibial part of the sciatic nerve (L4)

91
Q

What is the distal attachment of the adductor magnus?

A

Adductor part: linea aspera

Hamstring part: adductor tubercle of the femur

92
Q

What is the innervation of the adductor magnus?

A

Adductor part: obturator nerve (L2,3,4) [branches of the posterior division]

Hamstring part: tibial part of the sciatic nerve (L4)

93
Q

What are the main actions of the adductor magnus?

A

Whole muscle: adducts thigh

Adductor part: flexes thigh

Hamstring part: Extends thigh

94
Q

What is the proximal attachment of the gracilis?

A

Pubic bone

95
Q

What is the distal attachment of the gracilis?

A

Medial condyle of the tibia

96
Q

What is the innervation of the gracilis?

A

Obturator nerve (L2,3)

97
Q

What is the main action(s) of the gracilis?

A

Adducts thigh, flexes leg and helps rotate thigh medially

98
Q

What is the proximal attachment of the obturator externus?

A

Margins of the obturator foramen and obturator membrane

99
Q

What is the distal attachment of the obturator externus?

A

Posterior side of the femur; on/around the greater trochanter

100
Q

What is the innervation of the obturator externus?

A

Obturator nerve (L3, L4)

101
Q

What is the main action(s) of the obturator externus?

A

Laterally rotates the thigh, steadies the head of the femur in the acetabulum.

102
Q

What causes a groin pull?

A

A pulling, stretching or tearing of the anteromedial thigh muscles (usually the flexor/adductor muscles). Usually seen in individuals who participate in sports such as ice hockey or soccer

103
Q

What are the borders of the femoral triangle?

A

Laterally: the medial side of the sartorius
Medially: the medial side of the adductor longus
Superiorly: in inguinal ligament

(SAIL)

104
Q

What are the contents of the femoral triangle, from lateral to medial?

A
  1. Femoral nerve and its branches
  2. Femoral sheath and its contents
    a. femoral artery
    b. femoral vein and its proximal tributaries
    c. deep inguinal lymph nodes/associated lymph vessels in the femoral canal
105
Q

What pathology associated with the femoral triangle is more common in women?

A

Femoral hernias, where a portion of the abdominal viscera protrudes through the femoral ring into the femoral canal.

106
Q

What lymphatic vessels drain the leg?

A

Superficial and deep groups

107
Q

What lymph nodes are located in the leg?

A

Popliteal, Superficial inguinal and deep inguinal

108
Q

When the femoral artery passes through the the adductor hiatus and emerges on the posterior side of the leg, what is its name?

A

The popliteal artery

109
Q

What is the IT band?

A

a longitudinal fibrous reinforcement of the fascia lata

110
Q

What is the proximal attachment of the IT band?

A

The iliac tubercle

111
Q

What is the distal attachment of the IT band?

A

Lateral condyle of the tibia

112
Q

What muscles insert into the iliotibial tract?

A

Gluteus maximus and tesnor fasciae latae

113
Q

What is the action of the IT band?

A

Extend, adduct and laterally rotate the hip

114
Q

What causes IT band syndrome?

A

Excessive friction between the IT band and the lateral femoral epicondyle. Common in runners/causes lateral knee pain.

115
Q

What are the 4 superficial gluteal muscles?

A

Gluteus maximus, gluteus medius, gluteus minimus and tensor fasciae latae

116
Q

What is the proximal attachment of the gluteus maximus?

A

Sacrum and sacrotuberous ligament

117
Q

What is the distal attachment of the gluteus maximus?

A

IT band and gluteal tuberosity

118
Q

What is the innervation of the gluteus maximus?

A

Inferior gluteal nerve (L5, S1, S2)

119
Q

What is the main action of the gluteus maximus?

A

Extends thigh and assists in lateral rotation; assists in rising from a seated position

120
Q

What is the proximal attachment of the gluteus medius?

A

Lateral surface of ileum

121
Q

What is the distal attachment of the gluteus medius?

A

Lateral surface of greater trochanter

122
Q

What is the innervation of the gluteus medius?

A

Superior gluteal nerve (L5, S1)

123
Q

What is the action of gluteus medius?

A

Abduct and medially rotate thigh; keep pelvis level

124
Q

What is the proximal attachment of the gluteus minimus?

A

Lateral surface of the ileum

125
Q

What is the distal attachment of the gluteus minimus?

A

Anterior surface of the greater trochanter of the femur

126
Q

What is the innervation of the gluteus minimus?

A

Superior gluteal nerve (L5, S1)

127
Q

What is the action of the gluteus minimus?

A

Abduct and medially rotate thigh; keep pelvis level

128
Q

What is the proximal attachment of the tensor fasciae latae?

129
Q

What is the distal attachment of the tensor fasciae latae?

130
Q

What is the innervation of the tensor fasciae latae?

A

Superior gluteal nerve (L5, S1)

131
Q

What is the action of the tensor fasciae latae?

A

Abduct and medially rotate thigh

132
Q

Where does the superior gluteal artery enter the gluteal region and what muscles does it supply?

A

Enters through the greater sciatic foramen superior to the piriformis muscle; divides into branches that supply the

  1. gluteus maximus
  2. gluteus medius
  3. gluteus minimus
  4. tensor fasciae latae
133
Q

Where does the inferior gluteal artery enter the gluteal region and what muscles does it supply?

A

Enters through the greater sciatic foramen inferior to the piriformis and descends medial to sciatic nerve.

Supplies:

  1. gluteus maximus
  2. obturator internus
  3. quadratus femoris
  4. superior part of the hamstrings
134
Q

Where does the superior gluteal nerve enter the gluteal region?

A

Passes through the greater sciatic foramen immediately superior to the piriformis muscle. Passes between gluteus medius and minimus and supplies both of those muscles as well as the tensor fasciae latae.

135
Q

Where does the inferior gluteal nerve enter the gluteal region?

A

Traverses the greater sciatic foramen just inferior to the piriformis muscle and supplies the gluteus maximus.

136
Q

What is the action of all of the deep gluteal group of muscles? (Piriformis, obturator internus, superior/inferior gamelli, and quadratus femoris)

A

Laterally rotate the thigh

137
Q

What is the proximal attachment of the piriformis?

A

Anterior surface of the sacrum

138
Q

What is the distal attachment of the piriformis?

A

Greater trochanter

139
Q

What is the innervation of the piriformis?

A

Branches of anterior rami of S1, S2

140
Q

What is the proximal attachment of the obturator internus?

A

Pelvic margin of the obturator foramen and inner surface of the obturator membrane

141
Q

What is the distal attachment of the obturator internus?

A

Posterior aspect of the greater trochanter

142
Q

What is the innervation of the obturator internus?

A

Nerve to the obturator internus (L5, S1)

143
Q

What is the proximal attachment of the superior and inferior gemelli?

A

Superior: ischial spine

Inferior: Ischial tuberosity

144
Q

What is the distal attachment of the superior and inferior gemelli?

A

Greater trochanter

145
Q

What is the innervation of the superior and inferior gemelli?

A

Superior: nerve to obturator internus (L5, S1)

Inferior: nerve to quadratus femoris (L5, S1)

146
Q

What causes pressure sores and who is commonly affected?

A

According to the pressure ischemia theory, pressure sores result from constant pressure sufficient to impair local blood flow to soft tissue for extended time. Most common in patients hospitalized in acute care and chronic care facilities.

147
Q

From what spinal levels does the sciatic nerve emerge?

A

L4-5, S1-3 segments of the sacral plexus

148
Q

What 2 divisions are ensheathed in the sciatic nerve?

A
  1. Tibial nerve –> nerve of the posterior compartment of the leg and plantar foot)
  2. Common fibular (perineal) nerve –> nerve of the anterior and lateral compartments of the leg
149
Q

What is sciatica?

A

Pain in the distribution of the sciatic nerve; usually caused by pressure on the nerve from a herniated disc

150
Q

How do you avoid the sciatic nerve when giving an intramuscular injection in the gluteus maximus?

A

Divide the buttock into 4 quadrants and give the injection in the UPPER OUTER QUADRANT.

151
Q

What muscles balance the pelvis when the opposite leg is lifted?

A

The abductors of the hip

152
Q

What is Trendelenburg’s sign?

A

When the hip abductors are weak or paralyzed, then the pelvis will sink downward on the opposite, unsupported side.

153
Q

What 3 muscles make up the hamstrings (muscles of the posterior thigh), and what is their action?

A

Semimembranosus, semitendonosus and biceps femoris.

Action: extend thigh, flex leg

154
Q

What is the proximal attachment of the semitendonosus?

A

Ischial tuberosity

155
Q

What is the distal attachment of the semitendonosus?

A

Medial surface of superior part of the tibia

156
Q

What is the innervation of the semitendonosus?

A

Tibial division of the sciatic nerve (L5, S1-2)

157
Q

What is the proximal attachment of the semimembranosus?

A

Ischial tuberosity

158
Q

What is the distal attachment of the semimembranosus?

A

Posterior part of the medial condyle of the tibia

159
Q

What is the innervation of the semimembranosus?

A

Tibial division of the sciatic nerve (L5, S1-2)

160
Q

What is the proximal attachment of the biceps femoris?

A

Long head: ischial tuberosity

Short head: Linea aspera

161
Q

What is the distal attachment of the biceps femoris?

A

Lateral side of the head of the fibula

162
Q

What is the innervation of the biceps femoris?

A

Long head: tibial division of the sciatic nerve

Short head: common fibular division of the sciatic nerve

163
Q

What is the blood supply to the hamstrings?

A

Perforating arteries of the profunda femoris

164
Q

The tendons of which 3 muscles join to form the pes anserinus on the medial aspect of the knee?

A

Sartorius, Gracilis and semitendonosis

165
Q

What is the clinical relevance of the pes anserinus?

A

The pes anserinus bursa, which lies between the sartorius/gracilis/semitendonosus tendons and the more deeply located semimembranosus tendon can become inflamed and symptomatic in cases of per anserinus bursitis

MSK (3 decks)

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