MSK Midterm Flashcards
Where can you find embryonic connective tissue?
umbilical cord, pulp of teeth
embryonic CT is rich in undifferentiated mesenchymal stem cells, extracellular matrix, and sometimes collagen or reticular fiber. what is CT in the umbilical cord called?
wharton’s jelly
embryonic CT is rich in undifferentiated mesenchymal stem cells can differentiate into what kinds of tissue?
any CT (adipose, cartilage, endothelium, osteocyte)
where do we find loose (areolar) CT?
mucosa and submucosa, deep to epithelium (surround vessels in tunica adventitia and nerves)
what are the extracellular components of areolar CT?
collagen and elastic fibers, ground substance
what are the cellular components of areolar CT?
mast cells, fibroblasts, macrophages
where in the body do we find dense regular CT?
tendon, ligament, cornea, fascia
fascia is made of what type of CT?
dense regular
where do we find dense irregular CT?
dermis and GI submucosa
what is the most common extracellular component of dense irregular CT?
collagen
what are the 2 kinds of dense irregular CT?
reticular and elastic
what type of cell is responsible for producing collagen, elastin, and reticular fiber as well as proteoglycans and glycoproteins for CT?
fibroblast
where do we find reticular CT? (dense irregular)
lymphatic tissue
where do we find elastic CT) (dense irregular with discontinuous lamellae around the lumen)
walls of large vessels and ligaments
what type of cell makes elastic fiber? (its made of elastin + fibrillin)
smooth muscle, fibroblast, chondroblast
this type of tissue is used as energy reserve and is unilocular
white fat (adipocytes)
this type of tissue is used to dissipate energy and is multilocular
brown fat (adipocytes)
which type of fat is rich in mitochondria and has numerous lipid deposits
brown fat
adipocytes are a modified form of what cell type that has used vacuole for lipid storage pushing all other cellular contents to the periphery?
modified fibroblast
this CT cell is spindle shaped with an oval nucleus
fibroblast
this is a 3 chain fibrous protein wound into a triple helix that is coiled for tensile strength
collagen
Where do you find Type I collagen? What are characteristics of the fibrils?
bone, tendon, dentin
banded fiber for tensile strength
Where do you find Type II collagen? What are characteristics of the fibrils?
hyaline and elastic cartilage
thinner fibrils
Where do you find Type III collagen? What are characteristics of the fibrils?
reticular lamina of the basement membrane
reticular fibrils
Where do you find Type IV collagen? What are characteristics of the fibrils?
basal lamina
No bundles
Where do you find Type v collagen? What are characteristics of the fibrils?
fetal amnion/ chorion, muscle and tendon sheaths
no banded fibrils
what is the only kind of collagen that is NON-fibrillar
Type IV (found in basal lamina)
macrophages are abundant in what organelle?
lysosomes-help breakdown phagocytized material
what do you call a macrophage in the liver? bone? CNS?
liver- Kupffer cell
bone- osteoclast
CNS- microglial cell
this cell type is abundant in cytoplasmic granules containing histamine, heparin, and other chemoattractants and can form leukotrienes to be released from the cell
mast cell
these cells have a well developed rER, golgi, and nucleolus and their nucleus distributes heterochromatin to look like a “cartwheel”
plasma cell (they serve to produce a single class of Ig)
what makes up the ECM?
proteoglycans, glycosaminoglycans, hyaluronan
water
laminin, fibronectin, integrin
the paraxial mesoderm differentiates into head and somites. the somites further differentiate into what?
sclerotome (cartilage)
myotome (skeletal muscle)
dermatome (dermis)
sensory information is carried in which horn of the spinal cord
posterior horn
motor information is carried in which horn of the spinal cord
anterior horn
visceromotor information is carried in which horn of the spinal cord
lateral horn
the spinal nerve proper is made of what component parts that arise from the spinal cord
anterior root and posterior root
which part of the spinal nerve innervates epaxial (intrinsic) mm. in the back?
dorsal ramus (posterior ramus)
which part of the spinal nerve innervates hypaxial (extrinsic) mm. in the trunk and limbs?
ventral ramus (anterior ramus)
From the posterior ramus of the spinal n. What two components arise and what do they innervate?
Cutaneous n- dermatome
Motor n- myotome
Which nerve innervates the skin on the top of the head
CN 1
Which nerve innervates the skin on the anterior neck
C3
The skin overlaying the deltoid muscle is innervated by what nn.?
C4-5
Which nerve supplies a dermatome that extends across the anterior chest inferior to the clavicle and down the anterior medial aspect of the arm all the way to the wrist
T2
Which nerve supplies the dermatome that includes the middle finger
C7
Which nerve supplies the dermatome Overlaying the nipple
T4-5
Which nerve supplies the dermatome that covers the thumb and extends superiorly all the way to the triceps
C6
Which nerve supplies the dermatome overlaying the navel
T10
Which nerve supplies the dermatome overlaying the 5th phalange
C8
Which nerve supplies the dermatome of the medial foot?
L5
Which nerve supplies the dermatome of the lateral foot ?
S1
Which nerve supplies the dermatome of the heal (calcaneus region)
S1
Meralgia paresthetica is a nerve compression syndrome involving the dermatome overlaying the anterolateral thigh. Which nerve supplies this dermatome?
L2-L3 (lateral femoral cutaneous nerve) it gets pinched beneath the inguinal ligament
Which nerves are involved. In the brachial plexus
C5- T1
Which spinal nerves supply the cervical plexus
C1- C5
Which spinal nerves supply the lumbar plexus
L1- L4
Which spinal nerves supply the sacral plexus
L4- S4
What are the terminal branches of the brachial plexus
Musculocutaneous, median, ulnar, radial, axillary
What. Are the terminal branches of the lumbosacral plexus
Femoral, obturator, sciatic (tibial and common fibular), lateral femoral cutaneous, posterior femoral cutaneous
What are the 3. Types of fibrous joints
Gomphosis, suture, syndesmosis
Which structural classification of joints are made of bones Held together by dense regular CT?
Fibrous
Which structural classification of joints has no joint cavity and are made of bones joined by cartilage?
Cartilagenous
Which structural classification of joints are made of bones covered with articular cartilage capsule with a joint cavity
Synovial (synovial fluid in the joint cavity)
Which functional classification of joints are immovable
Synarthrosis
Which functional classification of joints are slightly movable
Amphiarthrosis
Which functional classification of joints are freely movable
Diarthrosis
Fibrous joints can have which functional classification(s)?
Synarthrosis, amphiarthrosis
What are the 3 sub-types of fibrous joints?
Gomphoses, sutures, syndesmoses
Carbilagenous joints can have which functional classification(s)?
Synarthroses or amphiarthroses
What are the two subtypes of cartilagenous joints
Synchondroses, symphyses
Synovial joints can have which functional classification(s)?
Diarthroses
What is the word for: fibrous, saclike structure that contains synovial fluid and is lined by synovial membrane
Bursae
What protective material fills the peripheral spaces as packing material in a joint cavity formed by bones moving?
Fat pads
What are the 6 types of synovial joints in order from least to most freely movable?
Planar, hinge, pivot, condyloid, saddle, ball and socket
Which muscular organizational pattern would a sphincter have? (Contraction= closure)
Circular
Which muscular organizational pattern involves widespread fascicles that come together at 1 common attachment (triangular in shape)
Convergent
Which muscle organization pattern has fascicles that run along the axis of a long bone
Parallel
Which muscle organization pattern have one or more tendons extending through their body and fascicles are arranged at an oblique angle to the tendon
Pennate
Describe first class lever
Fulcrum in middle (tilt head back)
Which structural classification of joints are made of bones Held together by dense regular CT?
Fibrous
Which structural classification of joints has no joint cavity and are made of bones joined by cartilage?
Cartilagenous
Which structural classification of joints are made of bones covered with articular cartilage capsule with a joint cavity
Synovial (synovial fluid in the joint cavity)
Which functional classification of joints are immovable
Synarthrosis
Which functional classification of joints are slightly movable
Amphiarthrosis
Which functional classification of joints are freely movable
Diarthrosis
Fibrous joints can have which functional classification(s)?
Synarthrosis, amphiarthrosis
What are the 3 sub-types of fibrous joints?
Gomphoses, sutures, syndesmoses
Carbilagenous joints can have which functional classification(s)?
Synarthroses or amphiarthroses
What are the two subtypes of cartilagenous joints
Synchondroses, symphyses
Synovial joints can have which functional classification(s)?
Diarthroses
What is the word for: fibrous, saclike structure that contains synovial fluid and is lined by synovial membrane
Bursae
What protective material fills the peripheral spaces as packing material in a joint cavity formed by bones moving?
Fat pads
What are the 6 types of synovial joints in order from least to most freely movable?
Planar, hinge, pivot, condyloid, saddle, ball and socket
Which muscular organizational pattern would a sphincter have? (Contraction= closure)
Circular
Which muscular organizational pattern involves widespread fascicles that come together at 1 common attachment (triangular in shape)
Convergent
Which muscle organization pattern has fascicles that run along the axis of a long bone
Parallel
Which muscle organization pattern have one or more tendons extending through their body and fascicles are arranged at an oblique angle to the tendon
Pennate
Describe first class lever
Fulcrum in middle (tilt head back)
Describe a. Second class lever. System
Resistance in middle (standing on tiptoes)
Describe a third class lever system
Force in middle (biceps)
What is the most common lever system in the body?
THIRD CLASS **
what radiological technique uses photons from a tungsten target passing through the body to be exposed on a recorded plate? (bone appears white and soft tissues are dark)
X ray
which contrast agents are typically used with x rays / fluoroscopy / CT / MRI scans and in what circumstances?
barium sulfate- GI study
iodine compounds- arteriogram (2-3 frames per second for peripheral vasculature, 15-30 for coronary aa.)
which radiological technique uses x rays from below the patient to view movement of structure in real time?
fluoroscopy
in what case can fluoroscopy be used to go e 3D information
with a C arm the apparatus can rotate
which radiological technique uses images generated via x ray passing through the body in a helical fashion as the patient moves through a gantry that contains the x ray tube
CT scan
how are images created in a CT scan?
math algorithms used to reconstruct transverse plane images of the body and these are put together to view 3D renderings
what is the scale that measures density numbers in a CT scan? (water is zero, air is -1000, bone is +3095)
hounsfield scale
the number on the hound field scale is set to middle gray referred to as “window level” and range of grey scale is mapped. All CT numbers below the window display as __ whereas those above the window appear ___
black, white
the number on the hound field scale is set to middle gray referred to as “window level” and range of grey scale is mapped. a wide window range is great for imaging what body tissue?
bone
the number on the hound field scale is set to middle gray referred to as “window level” and range of grey scale is mapped. a narrow window range is great for imaging what body tissue?
soft tissue
which radiological technique uses no ionizing radiation but rather image is creating using radio frequent energy emitted by H’s when strong magnetic fields around the body are manipulated
MRI
nuclear spin is altered in the magnetic field manipulation and as a tissue returns to normal (relaxation time) energy is emitted and can be measured by current in which radiological technique
MRI
tissues with greater relaxation times (measured in MRI) depending on what two factors
water content, molecular composition
radioactive molecules attach to other compounds that can be administer orally or intravenously in which radiologic technique measures physiological rather than anatomical activity?
nuclear medicine
in nuclear medicine, pathology can be detected by identifying areas of what?
increased physiological activity- hot spot
decreased activity- cold spot
which radiological technique is based on pulse echo using sound waves
ultrasound
neck vessels, thyroid glands, breast, and testes are great candidates for ultrasound visualization because they are what
near the skin surface
what are advantages to ultrasound
cheap, portable, no radiation, good for capturing motion
what type of ultrasound is best to use for visualizing and measuring blood flow
doppler
peripheral angiography is invasive and uses what fluoroscopic form of radiologic technique
digital subtraction angiography (real time x rays taken and then digitally we subtract bones and tissue to see contrast in vessels)
when performing angiography, what advantage do volume rendering algorithms (like those in CT scans) provide that can only be achieved by rotating the view in MIP (such as in MR) studies?
depth perpective
a fracture of what vertebral structure gives us the “scotty dog” x ray
lumbar vertebrae fracture of pars interarticularis
Hiltons law states that a joint is innervated by what nerves?
the same ones that supply muscles moving that joint and the skin over it
the synovium of a joint contains thinly myelinated and unmyelinated nerve fibers. what are the two types of synovial fibers?
postganglionic sympathetic andrenergic (around vessels controlling blood flow)
unmyelinated C fibers (nocireceptors: pain transmission)
what mediator associated with inflammation can induce signaling in nocireceptive fibers of joints causing pain in the normal ROM after trauma to that joint?
prostaglandin E2
what type of joint is the hip and what bony articulation does it include?
diarthrotic ball and socket joint (synovial)
femoral head + acetabulum
which ligament bridges the incomplete inferior part of the acetabulum (called the ace tabular notch)
transverse acetabular ligament
what articulates with the acetabular fossa
NOTHING (just a space for fat pad covered by synovial membrane)
whats the name of the cartilaginous rim that increases the depth of the “socket” for the femoral head
acetabular labrum
This type of hip injury can be repaired arthroscopically and presents as:
diffuse pain
no swelling (although effusion may increase volume)
possibly feel pinching during flexion
pain reproduced while weight bearing and twisting
labrum tear
what structure is most important in resisting hyperextension of the hip joint?
iliofemoral ligament
the articular capsule of the hip joint includes ligaments that attach where?
from acetabulum to femoral neck
circularly around the neck
while the obturator artery supplies blood to the head of the femur early in life, which vessel is responsible for taking over this area and always supplies the neck of this large bone?
medial circumflex femoral (via retinacular branches)
what are the two ligamentous bands that help to keep the femoral head in the acetabulum?
orbicular zone (circle the neck) retinacula (deep longitudinal fibers, where reticular aa. run)
thickened parts of the articular capsule in the hip joint are called intrinsic ligaments. what are the 3 intrinsic ligaments?
iliofemoral, pubofemoral, ischiofemoral
which intrinsic hip ligament is Y shaped, covers anterior aspect of the hip, runs from AIIS and ace tabular rim to the intertrochanteric line to help PREVENT OVEREXTENSION
iliofemoral ligament
which intrinsic hip ligament strengthens anterior and inferior aspect of the fibrous hip capsule, runs from obturator crest of pubic bone and laterally joins iliofemoral ligament to help prevent BOTH overabduction and overextension?
pubofemoral ligament
which intrinsic hip ligament strengthens the hip capsule posteriorly, runs from ace tabular rim to femoral neck to help prevent overextension
ischiofemoral ligament
what is the name of a weak intracapsular ligament of the hip that attaches to acetabular notch and fovea of the femoral head (contains an obturator vessel and may help spread synovial fluid)
round femoral head ligament // ligamentum teres
which type of hip dislocation is less common (10-15%) and can occur with dashboard strike if thigh is abducted or from a blow to the back while in a squatted position? (femoral neck/ gr. trochanter may impinge ace tabular rim freeing the femoral head from acetabulum)
anterior hip dislocation
other than the fact that it is less common, what danger ensues from a patient with an anterior hip dislocation?
may be impinging components of the femoral triangle
how does a posterior hip dislocation present
thigh adducted, MEDIALLY rotated, and flexed (sensory change in skin over posterolateral leg and foot)
why is posterior hip dislocation particularly problematic
sciatic damage can cause paralysis to hamstrings and distal to knee
femoral neck fracture presents how
LATERAL rotation, adduction, and flexion at the thigh (posterior hip dislocation is the same except medially rotated)
describe the prosthetics used in the replacement of an osteoarthritic hip
metal head and neck cemented to femur
plastic “socket” cemented to replace acetabulum
who has a longer load arm for the hip joint and thus a more prominent inward angle of the femur?
females
which small lateral rotator of the hip is least effect at abduction when the thigh is flexed
quadratus femoris
which glut muscles are responsible for medial rotation of the hip joint during walking
glut medius, glut minimus, and tensor fasciae latae
during knee extension, which muscle pulls supra patellar bursa superiorly to keep it from getting sqished
articularis genu
what muscles attach to the pea anserinus and what innervates these muscles
SGT FOT
sartorius- femoral n.
Gracillus- obturator n.
semitendinosis- tibial division of the sciatic n.
genicular branches of the popliteal artery form a genicular anastemosis which provides circulation to bypass popliteal artery in what states?
provides blood to articular capsule and ligaments of knee after long periods of flexion and when popliteal vessel narrowed
what type of joint is the knee
diarthrotic, synovial, hinge
what are the bony articulations at the knee joint
femur slants laterally at the knee, tibia is nearly vertical.
femur condyles contact tibial condyles (no involvement of fibula)
what are the 5 extra capsular ligaments of the knee
patellar ligament
fibular collateral ligament (aka lateral collateral)
tibial collateral ligament (intrinsic= thick)
oblique popliteal ligament (intrinsic= thick)
arcuate popliteal ligament
the patellar ligament is an anterior knee joint ligament that is a continuation of what muscle
quadricepts (patellar tendon)
name for aponeurotic expansion of vast us medial is and laterals which supports articular capsule laterally and medially
patellar retinacula
extra capsular ligament of knee extends from lateral femoral epicondyle inferiorly to fibular head
fibular collateral ligament
which tendon passes deep to fibular collateral ligament separating it from lateral meniscus
popliteus tendon
the tendon of which muscle is split in two before its distal attachment because of the position of fibular collateral ligament
biceps femoris
this ligament extends from medial femoral epicondyle to medial tibial condyle to prevent medial disruption and deep fibers attach to medial meniscus
tibial collateral ligament (taut when leg is extended preventing rotation)
which knee ligament is an expansion of semimembranosis tendon that strengthens capsule posteriorly
oblique popliteal ligament
which knee ligament is y shaped and arches over popliteus muscle to strengthen capsule posteriorly discouraging hyperextension
arcuate popliteal
what are the intracapsular ligaments of the knee
anterior and posterior cruciate ligaments
this intracapsular knee ligament runs from anterior intercondylar area of tibia (moves superior, posterior, and laterally) before attaching to lateral condyle of femur
ACL- anterior cruciate ligament
this ligament prevents posterior displacement of femur and anterior displacement of tibia (and taut while extending leg)
ACL
this intracapsular knee ligament runs from intercondylar area of tibia superior, anterior and medial to attach at lateral surface of medial femoral condyle
PCL- posterior cruciate ligament
this ligament in the knee is taut when leg is flexed, prevents anterior displacement of femur and posterior tibial displacement
PCL
the ACL contains two bundles with separate functions. what are they?
anteromedial bundle (AMB) resists anterior tibial translation during flexion
posterolateral bundle (PLB) resist anterior tibial translation and tibial rotation in extension
what is the clinical test performed to determine if ACL is torn
anterior drawer sign
what is the clinical test performed to determine if PCL is torn
posterior drawer sign
menisci can move together during femur and tibial movement because they are joined by which ligament of the knee
transverse ligament
which meniscus of the knee is broader posteriorly and adheres to deep surface of TCL and can attach to both the ACL and PCL and tears more often
medial meniscus
which knee meniscus is smaller, nearly circular, joined to posterior cruciate ligament via meniscofemoral ligament, does not tear very often, and is the site where popliteus tendon passes by fibular collateral ligament
lateral meniscus
what is the unhappy triad of Odonahue knee injuries often occurring together?
ACL tear, TCL tear, medial meniscus torn
if a boards question does NOT say Odonahue then lateral rather than medial meniscus is torn
the function of foot arches is to absorb shock and adapt to surface and weight changes. what are the two foot arches
longitudinal arch (with a medial and lateral part) transverse arch
the medial longitudinal arch of the foot is made up of which bones?
medial 3 metatarsals, cuneiforms, navicular, talus, calcaneus
the lateral longitudinal arch of the foot is made up of which bones?
lateral 2 metatarsals, cuboid, calcaneous
which bones make up the transverse arch of the foot?
cuboid, 3 cuneiforms, and metatarsal bones
tibialis anterior and posterior along with flexor hallucis lingua and intrinsic plantar muscles make up which component of the arches of the foot
dynamic
plantar aponeurosis, short and long plantar ligaments, plantar calcaneonavicular ligaments make up which component of the arches of the foot
passive
a passive fallen arch is primarily due to a laxity in which ligament
the spring ligament
flat feet (pea planus) normally develops as a result of fallen arches which causes stretching of plantar aponeurosis and plantar ligaments. which arches most commonly display this abnormality?
medial parts of longitudinal arch
flat feet (pea planus) normally develops as a result of fallen arches which causes stretching of plantar aponeurosis and plantar ligaments. specifically the calcaneonavicular ligament cannot support talus head causing what to happen
talar head displaces inferomedially becoming prominent
foot deformity characterized by lateral deviation of the great toe causing swelling of surrounding tissue
hallux valgus
what toe deformity causes rubbing of the medial aspect of the foot on the shoe causing an inflamed bursa (bunion) as well as thickened skin over proximal interphalangeal joints (corns)
hallux valgus
toe deformity where there is excess flexion in distal IP joint of toes 2-4
mallet toe
from proximal to distal toe joints: normal, normal, flex
toe deformity where there is excess extension at MP joint and flexion in proximal IP joint of toes 2-4 but usually 2 (distal IP joint is extended)
hammer toe
from proximal to distal toe joints: extend, flex, extend
toe deformity where in the BIG TOE there is excess extension at MP joint and flexion in proximal IP joint
trigger toe
from proximal to distal toe joints: extend, flex, normal
all toe deformities appear as a consequence of shortening of which muscles?
flexor muscles shorten and override lumbrical function
toe deformity characterized by hyperextension of MP joints and flexion of distal and proximal IP joint
claw toe
from proximal to distal toe joints: extend, flex, flex
at the ankle (talocrural) joint, the malleoli grip onto trochlea the strongest during which foot motion
dorsiflexion
what type of joint is the ankle
hinge, synovial
which medial ankle ligament stabilizes during eversion (very strong)
deltoid ligament (and to some degree plantar calcaneonavicular ligament)
what are the 4 component parts of the deltoid ligament in the ankle?
anterior tibiotalar, tibionavicular, tibiocalcaneal, and posterior tibiotalar part
the lateral ligaments of the ankle consist of 3 parts that attach the lateral malleolus to talus and calcareous. what are the 3 parts?
anterior talofibular, anterior tibiofibular ligament, and posterior tibiofibular ligament
when the foot is surgically amputated, it is commonly transected across the transverse tarsal joint which is made of which two tarsal joints
talonavicular
calcaneocuboid
the subtler (talocalcanean) joint is where the talus rests on calcaneus, its fibrous capsule is supported by the interosseous talocalcaneal ligament) and its main movements are what?
eversion, inversion
what is the most frequently injured joint in the body
ankle (usually inversion)
the leg is separated into anterior, lateral, and posterior divisions by what thick septa
crural fascia
the crural fascia thickens distally to form what
extensor retinaculum
which muscles are contained within the anterior leg compartment
FEET
fibularis tertius, extensor digitorum longus, extensor hallucis longus, tibialis anterior
what are the primary functions of the anterior leg compartment
dorsiflex, toe extension
which muscle of the anterior leg originates on the lateral tibial condyle and inserts on the medial surface of the medial cuneiform to dorsiflex and invert the foot?
tibialis anterior
which muscle of the anterior leg originates on the lateral tibial condyle and anterior fibular surface and inserts on each of the lateral 4 tendons of the digits at the extensor retinaculum
extensor digitorum longus
function of tibialis anterior
dorsiflex, invert
function of extensor digitorum longus
extend lateral 4 toes, dorsiflex
which anterior leg muscle originates on the anteroinferior fibula and inserts at the dorsum of the 5th metatarsal to produce dorsiflexion and eversion in some prople
fibularis tertius
which anterior leg muscle is lateral to the tibialis anterior and runs form anteromedial fibula and extensor digitorum longs to the base of distal phalanx of hallux
extensor hallucis longus
what are the functions of extensor hallucis longus
extend big toe, dorsiflex
what supplies innervation to the anterior leg compartment
deep fibular nerve ( a branch of the common fibular )
what does the deep fibular nerve supply ?
anterior leg compartment muscles, ankle joint, MP joints of foot, dorsal intrinsic foot muscles, “flip flop skin”
what vessel supplies blood to the anterior leg compartment
anterior tibial artery
what path do anterior tibial artery and del fibular nerve take to get from knee to inferior leg (hint: anterior)
they pass anteriorly to interosseus membrane between the EHL m. and Tibialis anterior m.
once the anterior tibial artery crosses the ankle joint what do we call it?
dorsalis pedis a.
what mm. are contained within the lateral compartment of the leg
fibularis brevis, fibularis longus
what nerve runs in the lateral compartment of the leg supplying the two muscles which lie here
superficial fibular n.
which muscle of the lateral leg compartment extends superficially from fibular head, posterior to lateral malleolus, to plantar surface of first metatarsal and medial cuneiform?
fibularis longus m
what is the function of fibularis longus
eversion, plantar flex
which tarsal bones have grooves or attachment sites for fibularis longs?
groove- 5th metatarsal, cuboid
insertion- 1st metatarsal, medial cuneiform
which lateral leg muscle runs from inferolateral tibia, descends posterior to lateral malleolus, and inserts on dorsal tuberosity of the 5th metatarsal
fibularis brevis m
what cutaneous innervation is the superficial fibular nerve responsible for?
anteroinferior leg, most of dorsal surface of foot and digits
what is the most commonly injured lower extremity nerve
common fibular nerve (b/c it wraps around fibular head)
what is the clinical manifestation of common fibular nerve functional deficit
foot drop (lose dorsiflexion and eversion)
heel strike difficult, high stepping gait, loss of sensation along anterolateral leg and dorsum of foot
which leg compartment is the only one without a distinct arterial branch running in it/ supplying it? what supplies blood to the muscles in this compartment?
lateral compartment
supplied by branches that pass anteriorly from the fibular a.
due to the “toughness” of crural fascia, trauma which causes hemorrhage, edema, and inflammation can result in the need for what procedure?
fasciotomy to relieve pressure (avoid ischemia)
repetitive trauma to which leg muscle causes “shin splints” (small tears in tibial periosteum)
tibialis anterior
shin splints are a mild form of what condition? Hint tibialis anterior swells with repetitive trauma
compartmental syndrome
which bones make up the hind foot
talus, calcaneus
which bones make up the mid foot
navicular, cuboid, cuneiforms
which bones make up the forefoot
metatarsals, phalanges
the extensor retinaculums of the foot assist in which movements
dorsiflexion, toe extension
what are the two surfaces of your foot called?
top- dorsum
bottom- plantar
laxity of the spring ligament is associated with fallen arch: which bones are connected by the spring ligament
also called plantar calcaneo-navicular ligament
the sustentaculum talk serves as an insertion site for which ankle ligament that also attach to the tibia?
tibiocalcaneal part of the medial (deltoid) ligament of the ankle
which tendon in the ankle joint is supported by a bursa?
calcaneal tendon
which muscles insert onto the calcaneal tendon
gastrocnemeus, soleus, plantaris
which side of the ankle joint is made up of “weaker” tendons and thus is more susceptible to sprain/ tearing
lateral (this is also why we cannot evert our foot as far as we can invert it)
when patient comes in with inversion sprain of the ankle which ligament is most likely stretched the furthest?
anterior talofibular ligament
nicknamed: always tears first
which lateral ankle ligaments are responsible for keeping the fibula in place?
calcaneofibular
anterior talofibular
posterior talofibular
when a patient has an inversion ankle sprain what is the order of tearing of the lateral ligaments?
ATFL
calcaneofibular
PTFL
which foot arch is mainly utilized for weight bearing
medial arch
which foot arch is mainly utilized for providing balance
lateral arch
which bone is part of both foot arches
calcaneous
the central fascia on the bottom surface of the foot is called what
plantar aponeurosis
overuse of running or high imp ace aerobics can often cause inflammation of plantar fascia (plantar fascists) and sometimes it gets so bad that it causes pain on the medial side of the foot when walking. What happens that causes this secondary tenderness?
heel spur- abnormal bony process often accompanied by a bursa that is inflamed and tender
which muscle of the foot originates on the calcaneus and causes abduction and flexion of the first digit
abductor hallucis
which muscle of the foot originates on the calcaneus and causes flexion of lateral 4 digits
flexor digitorum brevis
which muscle of the foot originates on the calcaneus and causes abduction and flexion of the little toe
abductor digiti minimi
which muscle of the foot originates on the calcaneus and assists FDL in flexing lateral 4 digits
quadratus plantae
which muscle of the foot originates on the tendon of FDL and flexes proximal phalanges, extends MP and DP of lateral 4 digits
lumbricals
which muscle of the foot originates on the plantar cuboid and cuneiforms and causes flexion of 1st digit
flexor hallucis brevis
which muscle of the foot originates on the base of metatarsals and plantar ligaments and functions to adduct 1st digit as well as assist in transverse arch medially
adductor hallucis
which muscle of the foot originates on the 5th metatarsal and flexes the proximal phalanx of 5th digit
flexor digit minimi brevis
which muscle of the foot originates on the plantar metatarsals and adducts digits 3-5 and flexes metatarsophalangeal joints
plantar interossei (3 of them we call them PAD’s because they ADduct)
which muscle of the foot originates on the metatarsals 1-5 and abducts digits 2-4and flexes metatarsophalangeal joints
dorsal interossei (4 of them we call DAB’s because they ABduct)
which muscle of the foot originates on the calcaneus and aids extensor digitorum longs in extending 4 medial toes and metatarsophalangeal and interphalangeal joints
extensor digitorum brevis
which muscle of the foot originates with extensor digitorum previs and aids in extending hallucis longs at MP joint
extensor hallucis brevis
which muscles of the foot are innervated by medial plantar nerve (S2-S3)?
abductor hallucis
flexor digitorum brevis
lumbricals (medial 1)
flexor hallucis brevis
which muscles of the foot are innervated by the lateral plantar nerve (S2-S3)
abductor digiti minimi quadratus plantae lumbricals (lateral 3) adductor hallucis (deep branch of LPN) flexor digit minimi brevis (superficial branch of LPN) all interossei
which muscles of the foot are innervated by deep fibular nerve (L5 or S1)
extensor digitorum brevis and extensor hallucis brevis
layer one of the foot muscles includes
abductor digiti minimi
abductor hallucis
flexor digitorum brevis
layer two of the foot muscles includes
lumbricals and quadrates plantae
the lumbrical muscles of the foot lie within which tendon
flexor digitorum longus tendon
layer three of the foot muscles includes
adductor hallucis (both oblique and transverse head)
flexor halucis brevis
flexor digiti minimi
layer four of the foot muscles includes
plantar interossei (PAD) dorsal interossei (DAB) and tendons of fibularis longs and tibialis posterior mm.
the second digit of the foot only has which kind of interosseous muscles attached to it?
dorsal interossei (DAB's) ... since this toe is the "midline" of the foot moving either direction is considered abduction
what does cutaneous innervation in the “flip flop” region
deep fibular nerve
what supplies cutaneous innervation to the medial ankle
saphenous nerve
the tibial nerve leaves the posterior compartment and passes deep to the flexor retinaculum and then splits into what two nerves
medial and lateral plantar nerves
the tibial nerve leaves the posterior compartment and passes deep to the flexor retinaculum between the medial malleous and calcaneus which can pinch together causing what
tibial nerve entrapment (tarsal tunnel syndrome)
which of the two plantar nerves supplies more of the foot? which artery supplies more?
medial plantar n.
lateral plantar a.
the anterior tibial artery becomes what artery distally while also giving off lateral malleolar and lateral tarsal aa.?
dorsalis pedis a.
the dorsalis pedis a. gives rise to which two branches in the foot?
arcuate a (anastemoses with lateral tarsal) deep plantar a (anastemoses with lateral plantar a. to form plantar arch)
what region of the foot receives blood supply from posterior tibial a
plantar surface
the deep fibular nerve runs through the foot adjacent to which artery
dorsalis pedis a.
what is the purpose of gastrulation
formation of 3 germ layers
when does neurulation happen in the developing embryo
week 3
at which somite in the developing embryo do we see a division between the brain and the spinal cord
between somite 4 and 5 (1-4 is brain)
where do autonomic pathways run in the spinal cord
lateral horn
from which spinal nerves do sympathetics arise
T1-L2
from which spinal nerves do parasympathetics arise
brainstem and S2-S4
the sulcus limitans divides the developing somites into what two plates?
alar and basal
what are the 3 zones in the developing spinal cord and in which zone do we find neural development
- ventricular zone
- intermediate zone (NEURONS DEVELOP HERE)
- marginal zone
what is the only CNS cell that does not derive from neural tube formation?
microglial cells (derived from monocytes)
high levels of what signal activate PAX3 and 7 allowing SENSORY neurons to develop in the alar plate
BMP
BMP activates PAX3 which causes what to happen
tells alar plate to develop sensory neurons
high levels of what signal activate NKX allowing MOTOR neurons to develop in the basal plate
SHH
SHH activates NKX causing what to happen
tells basal plate to develop motor neurons
what are examples of cells derived from neural crest
dorsal root ganglia
sensory ganglia of spinal nerves
schwann cells
sympathetic ganglia
what do general somatic efferent neurons supply innervation to
somatic muscle
what do general visceral efferent neurons supply innervation to
smooth and cardiac autonomics
what do special visceral efferent neurons supply innervation to
muscle derived from pharyngeal arches
what do general somatic afferent neurons supply innervation to
sensory in skin, joint capsule, tendon, muscle
what do general visceral afferent neurons supply innervation to
sensory of visceral structures
what do special somatic afferent neurons supply innervation to
CN8 to hearing and CN2 to balance and height
what do special visceral afferent neurons supply innervation to
taste (CN7,9,10) and smell (CN1)
which segment of the nervous system has short and myelinated preganglionic neuron and a long unmyelinated postganglionic neuron
sympathetic autonomics
which segment of the nervous system has long and myelinated preganglionic neuron, synapses in wall of viscera, and a short unmyelinated postganglionic neuron
parasympathetic
what causes myelination in the CNS
oligodendrocytes
what causes myelination in the PNS
schwann
which tissues show up dark in T1 MRI
water, edema, inflammation, tumor, infection, hemmorage
which tissues appear bright on T1 MRI
fat, melanin, subacute hemmorage, protein rich fluid, slowly flowing blood
which tissues appear dark on T2 MRI
calcification, fibrous tissue, protein rich fluid
which tissues appear bright on T2 MRI
water, edema, inflammation, tumor, infection, subdural collection
