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Musculoskeletal Anatomy Flashcards

1
Q

What makes up the axial skeleton?

A

The skull, vertebral column, ribs, and sternum (the CENTRAL parts).

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2
Q

What makes up the appendicular skeleton?

A

The bones of the limbs, including the scapulae, clavicles and the hip bones.

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3
Q

What happens to the skeleton from babies -> adults?

A

The cartilage (which babies’ skeletons are mostly made up of) ossifies as they grow. Some cartilage remains in adulthood.

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4
Q

What is a joint?

A

Where two bones meet and articulate with each other.

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5
Q

What is the most common type of joint? Give examples of this type of joint.

A

Synovial joint. Shoulder, knee and wrist joints.

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6
Q

What is the structure of a synovial joint? Describe the available movement.

A

Narrow synovial cavity containing lubricating synovial fluid, enclosed in a joint capsule.
Joint capsule has two layers.
Articular surfaces covered with articular hyaline cartilage.
Allow a great deal of movement.

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7
Q

What is the structure of a fibrous joint? Describe the available movement and give an example of this type of joint.

A

Strong fibrous tissue connects two bones, no cavity and no fluid.
Usually very little (if any) movement.
Individual bones of the skull (sutures).

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8
Q

What is the structure of a primary cartilaginous joint? Describe the available movement and give an example of this type of joint.

A

Like fibrous joints, but connected by hyaline cartilage instead.
Some flexibility.
Where the ribs meet the sternum (sternocostal joints).

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9
Q

What is the structure of a secondary cartilaginous joint? Describe the available movement and give an example of this type of joint.

A

Joints connected by fibrocartilage, plus a layer of hyaline cartilage covers the articular surfaces of the bones.
Flexible, but strong and able to support a lot of weight.
The intervertebral discs between vertebrae in the spine.

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10
Q

What are the six types of synovial joint?

A

Ball and socket, hinge, pivot, saddle, condyloid, and plane joint.

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11
Q

What is a ball and socket joint? Give examples and discuss mobility.

A

The end of one bone is shaped like a ball, fitting in a bowl-shaped socket on another bone.
Shoulder joint and hip joint.
Allow significant range of movement in all directions -> better fit = more stable but less mobile, and vice versa.

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12
Q

What is a hinge joint? Give examples and discuss mobility.

A

Just like a hinge on a door.
Elbow joint and knee joint.
Allow significant range of movement, but only in one plane.

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13
Q

What is a pivot joint? Give examples and discuss mobility.

A

Allows rotational movement only.
C1 pivots around the peg of C2, allowing us to turn our head.

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14
Q

What is a saddle joint? Give examples and discuss mobility.

A

Shaped like a rider sat in a saddle.
Joint at the base of the thumb.
Permit movement in two planes.

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15
Q

What is a condyloid joint? Give examples and discuss mobility.

A

Like ball and socket, but oval-shaped.
Wrist joint and the metacarpophalangeal joints (knuckles).
Good range of movement, but only in two planes.

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16
Q

What is a plane joint? Give examples and discuss mobility.

A

The articular surfaces are flat, almost gliding against each other.
Joints between small carpal bones of the wrist.
Movement is usually limited and dictated y neighbouring bones and ligaments.

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17
Q

What is a ligament?

A

A band of fibrous connective tissue that attaches bone to bone.

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18
Q

What is the function of ligaments?

A

Stabilising joints and limiting their movement. Can stretch over time to allow greater joint movility.

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19
Q

What is a sprain?

A

Occurs when a ligament is overstretched and injured. They may not return to their original shape.

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20
Q

What are the three types of muscle?

A

Skeletal, smooth, and cardiac.

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21
Q

Which types of muscle are under voluntary or involuntary control?

A

Voluntary - skeletal.
Involuntary - smooth and cardiac.

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22
Q

Which types of muscle are striated?

A

Skeletal and cardiac, not smooth.

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23
Q

Where can skeletal, smooth, and cardiac muscle be found?

A

Skeletal - throughout the body.
Smooth - walls of blood vessels and internal organs such as the intestine.
Cardiac - in the heart.

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24
Q

What connects skeletal muscles to bone or soft tissue?

A

Tendons, composed of strong connective tissue.

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25
What are the four main orientations of skeletal muscle fibres?
Parallel, convergent, circular, and pennate.
26
Describe parallel skeletal muscles.
Muscle fibres are aligned parallel to each other. Two subtypes: - Fusiform: long tendon at each end, muscle belly bulges in the middle. - Strap: belt-shaped and relatively uniform in width.
27
Describe convergent skeletal muscles.
Fan-shaped with a very broad attachment at one end, and a very small attachment at the other.
28
Describe circular skeletal muscles.
Muscle fibres arranged in concentric rings around a structure, often called sphincters.
29
Describe pennate skeletal muscles.
Muscles fibres arranged at an angle to the direction in which the muscle acts. Three subtypes: - Unipennate: fibres arranged diagonally, inserting onto one side of the tendon only (like a one sided feather). - Bipennate: fibres arranged in a v-shape, inserting onto both sides of the tendon (like a feather). - Multipennate: look like multiple bipennate muscles side-by-side, all converging onto one tendon (like multiple fathers).
30
What is a motor unit?
Composed of a single motor neuron, its axon, and the muscle fibres it supplies. Can massively vary in size dependent on the size of the muscle it supplies. In an eyeball, may supply only a few muscle fibres. In the thigh, may supply thousands.
31
Describe the gross anatomy of the upper and lower limbs.
- Ball and socket joint where limbs meet torso - Large bone in proximal part - Hinge joint - Two bones in middle part - Collection of small bones at the distal part - Five digits, one significantly larger - Most of the muscle mass concentrated proximally
32
For what purposes have upper and lower limbs evolved differently to one another?
Upper - for dexterity and mobility. Lower - for bipedal locomotion and to support body weight.
33
How have the upper limbs evolved for dexterity and mobility?
Shoulder joint has a shallow socket and lax ligaments - allows for a range of movement. The fingers are also long and capable of complex movements.
34
How have the lower limbs evolved for bipedal locomotion and to support body weight?
Hip joint has a deep socket and strong ligaments - very stable. Foot and toes adapted to weight-bearing rather than dexterity.
35
How many vertebrae are in the vertebral column, and how many 'sections' are these divided into? What are these 'sections' called?
33 vertebrae 5 sections Cervical, thoracic, lumbar, sacral, and coccygeal.
36
How many cervical vertebrae are there and where are they in the vertebral column?
7 In the neck C1 - C7
37
How many thoracic vertebrae are there and where are they in the vertebral column?
12 In the thorax T1 - T12
38
How many lumbar vertebrae are there and where are they in the vertebral column?
5 In the abdomen L1 - L5
39
How many sacral vertebrae are there and where are they in the vertebral column?
5 In the pelvis, fused into the sacrum S1 - S5
40
How many coccygeal vertebrae are there and where are they in the vertebral column?
4 In the pelvis, fused into the coccyx Co1 - Co4
41
Which segment/s of the vertebral column curve anteriorly? What does this form?
Cervical segment -> cervival lordosis Lumbar segment -> lumbar lordosis
42
Which segment/s of the vertebral column curve posteriorly? What does this form?
Thoracic segment -> thoracic kyphosis Sacral segment -> sacral kyphosis
43
What connects the vertebrae to one another?
Small synovial joints. Intervertebral discs. Several groups of ligaments.
44
What are the distinguishing features of cervical vertebrae?
Bifid (two-pronged) spinous processes. Holes in the transverse processes (transverse foramen). Oval-shaped bodies. Triangular vertebral foramen.
45
What are the distinguishing features of thoracic vertebrae?
Long, sharp, downward-sloping spinous processes. Additional articular facets. Heart-shaped bodies. Round vertebral foramen.
46
What are the distinguishing features of lumbar vertebrae?
Short, blunt spinous processes. Extra-large oval-shaped bodies. Triangular vertebral foramen.
47
What are the distinguishing features of sacral vertebrae?
Fused into the sacrum. Triangular bone sitting in posterior midline. Articulates with hip bones.
48
What are the distinguishing features of coccygeal vertebrae?
Fused to form the coccyx.
49
What is the most commonly fractured bone?
The clavicle.
50
Describe the shape of the clavicle. Is it palpable?
- Slender, S-shaped bone. - Easily palpable in most individuals.
51
What does the clavicle articulate with and where?
- The manubrium of the sternum at its proximal end. - The acromion of the scapula at its distal end.
52
What type of joints are the sternoclavicular joint and acromioclavicular joint?
Synovial joints.
53
Describe the shape, location and palpability of the scapula.
- Mostly flat but with some bony projections. - Located on the posterior thorax. - Some parts can be easily palpated through the skin.
54
What is the ridge of bone on the posterior surface of the scapula? What does the lateral end of this expand to form?
- The spine. - Expands to form the acromion (articulates with lateral end of the clavicle).
55
What is the projection of bone just inferior to the acromion on the anterior surface of the scapula? What does this do?
The coracoid process - site of attachment for several muscles.
56
What comprises the pectoral girdle?
The clavicle, scapula and the attached muscles.
57
What is the name of the shallow fossa on the lateral aspect of the scapula? What does this articulate with?
The glenoid fossa - articulates with the proximal humerus (a poor fit).
58
Describe the humerus.
The long bone of the arm, has a shaft and an expanded proximal and distal end.
59
Describe the shoulder/glenohumeral joint.
A poor fit which increases the range of movement possible at the shoulder but compromises the stability of the joint.
60
What does the head of the humerus articulate with?
The glenoid fossa of the scapula.
61
What is the name of the bony projection on the proximal humerus? What does it do?
The greater tubercle - an important site for muscle attachments.
62
What is immediately distal to the smooth head of the humerus?
A groove which is the position of the anatomical neck of the humerus.
63
What is the name of the smaller bony projection on the anterior humerus? What does it do?
The lesser tubercle - also a site of muscle attachment.
64
What happens to the humerus just distal to the tubercles? What is this region then called?
- The bone narrows and becomes continuous with the shaft. - Called the surgical neck.
65
Why is the surgical neck clinically important?
Commonly fractured, especially in the elderly.
66
What nerve runs close to the surgical neck region of the humerus?
The axillary nerve.
67
What is the name of the slight protuberance on the upper lateral aspect of the humeral shaft? What does it do?
- The deltoid tuberosity. - Site of attachment for the deltoid muscle.
68
What is the radial (spiral) groove?
Marks the path of the radial nerve over the posterior aspect of the humeral shaft. Radial nerve runs along a spiral route.
69
What are the 5 movements of the scapula?
- Protraction. - Retraction. - Elevation. - Depression. - Rotation.
70
What is the key muscle involved in protraction of the scapula?
The serratus anterior.
71
What are the 2 large and superficial muscles of the posterior pectoral girdle (connect the scapula to the vertebral column)?
The trapezius and latissimus dorsi.
72
What does the latissimus dorsi attach to?
The anterior aspect of the proximal humerus, not the scapula.
73
What are the 3 smaller and deeper muscles of the posterior pectoral girdle (connect the scapula to the vertebral column)? What are they attached to?
- Levator scapulae, rhomboid major and rhomboid minor. - Attach to the medial border of the scapula and to the vertebral column.
74
How does the trapezius move the scapula?
Rotation, and individually: the upper part elevates, middle part retracts, and the lower part depresses the scapula.
75
How does the latissimus dorsi move the humerus?
Extends, adducts, and medially rotates the humerus.
76
How does the levator scapulae move the scapula?
Elevates.
77
How does the rhomboid major move the scapula?
Retracts.
78
How does the rhomboid minor move the scapula?
Retracts,
79
What is the origin of a muscle?
The more 'fixed' or stable bone.
80
What is the insertion point of a muscle?
The bone that moves when the muscle contracts.
81
What is the origin of the trapezius?
Skull, cervical and thoracic vertebrae.
82
What is the insertion of the trapezius?
Clavicle and scapula (spine and acromion).
83
What is the origin of the latissimus dorsi?
Lower thoracic vertebrae.
84
What is the insertion of the latissimus dorsi?
Humerus - proximal and anterior.
85
What is the origin of the levator scapulae?
Upper cervical vertebrae.
86
What is the insertion of the levator scapulae?
Scapula - medial border.
87
What is the origin of the rhomboid minor?
C7 and T1 vertebrae.
88
What is the insertion of the rhomboid minor?
Scapula - medial border.
89
What is the origin of the rhomboid major?
Thoracic vertebrae.
90
What is the insertion of the rhomboid major?
Scapula - medial border.
91
What nerves supply most of the muscles of the posterior pectoral girdle?
Branches that arise from the brachial plexus - a complex network of nerves that innervate the upper limb.
92
What innervates the trapezius?
The accessory nerve (CN XI).
93
What innervates the latissimus dorsi?
A branch of the brachial plexus called the thoracodorsal nerve.
94
What type of joint is the shoulder (glenohumeral) joint?
Synovial ball and socket joint.
95
What are the 7 possible movements at the shoulder joint?
- Flexion. - Extension. - Abduction. - Adduction. - Internal (medial) rotation. - External (lateral) rotation. - Circumduction.
96
What is the most commonly dislocated joint in the body?
The shoulder joint.
97
How many muscles attach the scapula to the humerus? What are they called?
6 - Deltoid. - Supraspinatus. - Infraspinatus. - Subscapularis. - Teres minor. - Teres major.
98
Which 4 muscles work together to provide stability to the shoulder joint? What are they referred to as?
- Supraspinatus. - Infraspinatus. - Subscapularis. - Teres minor. - Known as the rotator cuff.
99
Describe the deltoid muscle.
- Large muscle over the lateral aspect of the shoulder. - Attaches humerus to lateral part of the clavicle and to the spine of the scapula. - Gives the shoulder its rounded contour. - Inserts onto humerus at the deltoid tuberosity.
100
What does the deltoid act as?
- A powerful abductor of the shoulder joint, though it cannot initiate abduction - take s over at 15 degrees. - Also contributes to flexion and extension of the shoulder.
101
What innervates the deltoid?
The axillary nerve.
102
Describe the teres major.
- Arises from posterior aspect of the scapula. - Tendon slots underneath the humerus and inserts onto the anterior aspect of the humerus.
103
What does the teres major act as?
An internal rotator and adductor of the shoulder joint.
104
What do the supraspinatus, infraspinatus, teres minor and subscapularis muscles attach?
The scapula to the tubercles of the humerus.
105
What does the supraspinatus act as?
Abductor of the shoulder joint - first 15 degrees.
106
What does the infraspinatus act as?
External rotator of the shoulder joint.
107
What does the teres minor act as?
External rotator of the shoulder joint.
108
What does the subscapularis act as?
Internal rotator of the shoulder joint.
109
The tendons of which 3 muscles fuse with the fibrous capsule that surrounds the shoulder joint?
The supraspinatus, infraspinatus, and teres minor.
110
What is the origin of the deltoid?
Spine and acromion of the scapula, and the clavicle.
111
What is the insertion of the deltoid?
Deltoid tuberosity of the humerus.
112
What is the origin of the teres major?
Posterior surface of the scapula, inferior part of the lateral border.
113
What is the insertion of the teres major?
Anterior humerus.
114
What is the origin of the supraspinatus?
Supraspinous fossa of the scapula.
115
What is the insertion of the supraspinatus?
Greater tubercle of humerus - superior facet.
116
What is the origin of the infraspinatus?
Infraspinous fossa of the scapula.
117
What is the insertion of the infraspinatus?
Greater tubercle of humerus - middle facet.
118
What is the origin of the teres minor?
Lateral border of the scapula.
119
What is the insertion of the teres minor?
Greater tubercle of humerus - inferior facet.
120
What is the origin of the subscapularis?
Subscapular fossa of the scapula.
121
What is the insertion of the subscapularis?
Lesser tubercle of humerus.
122
What is impingement?
When the supraspinatus tendon can become inflamed and pinched between the acromion and humerus during movement of the shoulder.
123
Describe the quadrilateral space.
Square-shaped space bound by: teres minor above, teres major below, long head of the triceps medially, and surgical neck of the humerus laterally.
124
What travels through the quadrilateral space?
The axillary nerve.
125
What provides stability to the shoulder joint?
- The rotator cuff. - The glenoid labrum - Ligaments reinforcing the capsule. - The tendon of biceps brachii.
126
How many boundaries does the axilla have? Describe them.
6 - Anterior wall: pectoralis major and minor. - Posterior wall: subscapularis, teres major and latissimus dorsi. - Lateral wall: proximal humerus. - Medial wall: serratus anterior and thoracic wall. - Apex: first rib, clavicle and scapula. - Base: skin and fascia between thoracic wall and arm.
127
What are 5 important structures in the axilla?
- Fat. - Lymph nodes. - Axillary artery. - Axillary vein. - Brachial plexus.
128
When does the subclavian artery become the axillary artery?
After it passes over the lateral border of the first rib.
129
When does the axillary artery become the brachial artery?
As it crosses over the inferior border of the teres major.
130
When does the axillary vein become the subclavian vein?
At the lateral border of the first rib.
131
What forms the axillary vein?
The union of the brachial veins with the basilic vein, cephalic vein also joins the axillary vein in the axilla.
132
Which type of shoulder dislocation is more common?
Anterior dislocation (humeral head ends up anterior to the glenoid fossa).
133
What can shoulder dislocation cause?
Injury to the axillary nerve.
134
What can cause shoulder dislocation?
Blunt force trauma, such as a fall.
135
What can cause a rotator cuff injury?
Acute trauma or repetitive use.
136
When are tears of the rotator cuff usually painful?
At rest and on movement.
137
What 2 nerves are at risk when removing axillary lymph nodes?
- The long thoracic nerve. - The thoracodorsal nerve.
138
What does the long thoracic nerve innervate?
The serratus anterior.
139
What does the thoracodorsal nerve innervate?
The latissimus dorsi.
140
What 2 prominences form from the shaft of the humerus distally?
The medial and lateral epicondyles.
141
What are the 2 further prominences of the distal humerus? What do these articulate with?
- The trochlea (articulates with the trochlear notch of the ulna at the elbow joint). - The capitellum (articulates with the head of the radius at the elbow joint).
142
What separates the arm into anterior and posterior compartments?
The intermuscular septa
143
How many muscles does the anterior compartment of the arm contain? What are these called? What do they act as? What are they innervated by?
- 3. - Biceps brachii, brachialis and coracobrachialis. - Act as flexors. - Innervated by the musculocutaneous nerve.
144
Describe the structure of the biceps brachii.
- Lies most superficially. - Two heads: long head and short head. - Proximally, both heads attach to scapula (long -> supraglenoid tubercle, short -> coracoid process). - Long head pierces capsule and helps stabilise the joint. - 2 muscle bellies converge to their insertion via a common tendon onto the radial tuberosity of the radius.
145
What does the biceps brachii act as?
- A flexor of the elbow joint, and also contributes to flexion of the shoulder joint as it crosses the joint. - A powerful supinator of the forearm when the elbow if flexed
146
Describe the structure of the brachialis.
- Lies deep to biceps. - Proximally, attached to anterior aspect of distal half of the shaft of the humerus. - Crosses the elbow joint to insert distally upon the ulna tuberosity.
147
What does the brachialis act as?
A powerful flexor of the elbow joint, but does not act upon the shoulder joint as it does not cross the joint.
148
Describe the structure of the coracobrachialis.
- Deep and much smaller muscle. - Attaches proximally to the coracoid process of the scapula and distally to the medial aspect of the middle part of the humerus.
149
What does the coracobrachialis act as?
A weak flexor of the shoulder joint as it crosses the joint.
150
How many muscles does the posterior compartment of the arm contain? What are these called?
- 1. - The triceps brachii.
151
Describe the triceps brachii.
- Has 3 muscle bellies/heads, all of which converge via a common tendon onto a single insertion point - the olecranon of the ulna.
152
What does the triceps brachii act as?
Extender of the elbow when it contracts, as it crosses the posterior aspect of the elbow joint.
153
What are the 3 heads of triceps called, and where do they originate?
- Long head: infraglenoid tubercle of the scapula. - Lateral head: posterior humerus, proximal to the radial groove. - Medial head: posterior humerus, distal to the radial groove.
154
What is the long head of the triceps brachii able to act as?
Contributes to extension of the shoulder joint in addition to extension of the elbow joint, as it is attached to the scapula.
155
What innervates the 3 parts of the triceps?
The radial nerve.
156
Which spinal nerves form the brachial plexus? Which type of fibres do these carry?
- C5, C6, C7, C8, and T1. - Sensory and motor fibres.
157
Describe the roots of the brachial plexus.
C5 -> T1 spinal nerves exit the spinal cord and become the brachial plexus (they are found in the neck).
158
Describe the trunks of the brachial plexus.
Also located in the neck, formed from the roots: - C5 and C6 = superior trunk. - C7 = middle trunk. - C8 and T1 = inferior trunk.
159
Describe the divisions of the brachial plexus.
Each trunk divides into an anterior and a posterior division under the clavicle.
160
Describe the cords of the brachial plexus.
Named relative to their position around the second part of the axillary artery. - Anterior division of superior and middle trunks combine = lateral cord. - Anterior division of inferior trunk continues = medial cord. - Posterior divisions of all trunks combine = posterior cord.
161
Describe the branches of the brachial plexus.
Located in the axilla, formed by cords. - Axillary: branch from posterior cord. - Radial: continuation of posterior cord. - Musculocutaneous: branch from lateral cord. - Ulnar: branch from the medial cord. - Median: formed by branches from lateral and medial cords. - Gives rise to other nerves, but do not need to know their origins, only the 5 terminal nerves above.
162
What does the axillary nerve innervate?
- Deltoid and teres minor, and a small region of skin over the upper lateral arm.
163
What cord is the axillary nerve a branch of? Which spinal nerves does it contain fibres from?
- Branch of the posterior cord. - Fibres from C5 and C6.
164
Where does the axillary nerve run? When is it vulnerable?
- Runs close to the surgical neck of the humerus. - Vulnerable to injury in fractures of the surgical neck of the humerus, or dislocations of the humeral head.
165
What does the radial nerve innervate?
- Triceps in the posterior arm, muscles in the posterior component of the forearm. Also innervates the regions of the skin over the arm, forearm and hand.
166
What cord is the radial nerve a continuation of? Which spinal nerves does it contain fibres from?
- Continuation of the posterior cord. - Fibres from C5 -> T1.
167
Where does the radial nerve run? When is it vulnerable?
- Along the radial (spiral) groove on the posterior surface of the humerus. - Vulnerable in mid-shaft fractures of the humerus.
168
What does the musculocutaneous nerve innervate?
- The 3 muscles of the anterior compartment of the arm: biceps brachii, brachialis and coracobrachialis.
169
What cord is the musculocutaneous nerve a branch of? Which spinal nerves does it contain fibres from?
- Arises from the lateral cord. - Fibres from C5 -> C7.
170
Where does the musculocutaneous nerve run? When is it vulnerable?
- Continues as a sensory nerve that innervates a region of skin over the lateral forearm, after supplying the 3 muscles. - Rarely injured in isolation.
171
What does the median nerve innervate?
- Most of the muscles of the anterior forearm, and small muscles of the thumb. Also provides sensory innervation to the skin over the lateral aspect of the palm of the hand and over the lateral digits.
172
What cord is the median nerve a branch of? Which spinal nerves does it contain fibres from?
- Formed from both the lateral and medial cords. - Normally, fibres from C6 -> T1, but in some individuals, fibres from C5 -> T1.
173
Where does the median nerve run? When is it vulnerable?
- Crosses the anterior aspect of the elbow, in a region called the cubital fossa. - Most vulnerable in the arm.
174
What does the ulnar nerve innervate?
- Most of the small muscles in the hand, also innervates skin over the medial aspect of the hand and medial digits.
175
What cord is the ulnar nerve a continuation of? Which spinal nerves does it contain fibres from?
- Continuation of the medial cord. - Fibres from C8 -> T1.
176
Where does the ulnar nerve run? When is it vulnerable?
- Lies in a superficial position behind the medial epicondyle. - Vulnerable to injury behind the medial epicondyle.
177
What can injury of the axillary nerve result in?
- Weakness or paralysis of deltoid (presents functionally as difficulty abducting the shoulder). - Altered sensation or numbness over the upper lateral arm.
178
What can injury of the radial nerve result in?
- Weakness and paralysis of muscles that are innervated downstream of the point of injury. - Usually affects movement of the wrist.
179
What can injury of the ulnar nerve result in?
- Motor impairments of the hand and sensory impairments in the hand. - Tingling and pain in the same regions of the hand are possible if the elbow is knocked.
180
How does Erb's Palsy (upper brachial plexus injury) typically present?
- Paralysis of the lateral rotators of the shoulder, and extensors of the wrist. - Affected limb appears medially rotated with the wrist flexed.
181
What typically causes Erb's Palsy?
- Trauma e.g. being thrown off a motorbike or horse, or in new-borns if the shoulder becomes stuck during delivery. - Involves C5 -> C6/7.
182
How does Klumpke's Palsy (lower brachial plexus injury) typically present?
- Paralysis of the small muscles of the hand.
183
What typically causes Klumpke's Palsy?
- Trauma e.g. if a baby's arm is pulled forcefully superiorly to aid delivery. - Involved C8 -> T1.
184
How does Horner's syndrome present?
- Triad of ptosis, miosis and anhidrosis on one side of the face.
185
What typically causes Horner's syndrome?
- When the sympathetic nerve supply to the face is interrupted. - A brachial plexus injury affecting the T1 nerve root may result in Horner's syndrome, as T1 carries sympathetic fibres to the face.
186
What is brachial plexus block?
- A form of regional anaesthesia, can be used as an alternative to general anaesthesia for surgery of the upper limb. - Local anaesthetic is infiltrated around the nerves of the plexus, which anaesthetises the upper limb, under ultrasound guidance.
187
What are the 2 bones of the forearm? How are they connected?
- Radius and ulna. - Interosseous membrane.
188
How do the radius and ulna articulate with the humerus?
- Trochlea notch of ulna articulates with trochlea of humerus. - Radial head articulates with capitellum of humerus.
189
What movement can occur at the elbow joint?
Flexion and extension.
190
Where do the radius and ulna articulate with each other?
Proximal and distal radioulnar joints.
191
What movement do the proximal and distal radioulnar joints allow? How? Which muscles are involved?
- Pronation and supination of the forearm and hand. - Radius pivots around the ulna. - Muscles in the anterior arm, and the anterior and posterior forearm.
192
What does the radius articulate with distally?
Two carpal bones of the wrist (scaphoid and lunate), forming the radiocarpal joint.
193
What movement is possible at the radiocarpal joint? Which muscles are involved?
- Flexion, extension, abduction and adduction. - Muscles in the anterior and posterior foraerm.
194
What is the name of the bulky process on the posterior proximal ulna? What does this fit into? What does this allow?
- The olecranon. - Fits in the olecranon fossa of the posterior distal humerus. - Allows full extension.
195
What is the name of the process on the anterior proximal ulna? What does this fit into and when does this fit?
- Coronoid process. - Fits in the coronoid fossa of the anterior distal humerus when we flex our elbow fully.
196
Where can the radial tuberosity be found? What is it's relevance?
- Roughened lump near the proximal end of the radius, distal to the head and neck. - Where the biceps brachii tendon inserts onto the radius.
197
What are the distal protrusions on both the radius and ulna called which are often implicated in fractures?
Styloid processes.
198
What type of joint is the elbow joint?
Synovial hinge joint.
199
Give 2 factors that increase the stability of the elbow joint.
- Trochlea notch of the ulna forms a deep recess which the trochlea of the humerus fits into very well. - Coronoid process and olecranon of the ulna 'pinch' the trochlea of the humerus to increase stability.
200
What reinforces the joint capsule of the elbow joint?
Medial (ulnar) and lateral (radial) collateral ligaments.
201
What type of joint are the proximal and distal radioulnar joints?
Synovial, pivot-type joints.
202
Which ligament wraps around the radial neck and holds the radial head in place whilst attaching to the ulna to allow radial rotation around the ulna?
The annular ligament.
203
How many bones is the carpus comprised of? How are these arranged?
- 8. - 2 rows of 4 bones.
204
Give the proximal row of carpal bones, from lateral to medial.
Scaphoid, lunate, triquetrum and the pisiform.
205
Which is not a true carpal bone and why?
- The pisiform. - Small bone that develops in the tendon of flexor carpi ulnaris.
206
Give the distal row of carpal bones, from lateral to medial.
Trapezium, trapezoid, capitate and the hamate.
207
Which is the largest carpal bone?
Capitate.
208
What is the name of the anterior bony process on the hamate?
The hook.
209
What type of joint is the radiocarpal joint?
A condyloid synovial joint.
210
What type of joints are the intercarpal joints?
Synovial joints.
211
Which bones are located distal to the carpus?
The metacarpals.
212
What are the bones of the digits called? How many are there in each digit?
- Phalanges - 3 in each finger, 2 in the thumb.
213
Where can the cubital fossa be found?
Anterior to the elbow joint.
214
What else may the cubital fossa be referred as?
The antecubital fossa / ACF.
215
What forms the lateral border of the cubital fossa?
The brachioradialis (posterior forearm muscle).
216
What forms the medial border of the cubital fossa?
The pronator teres (anterior forearm muscle).
217
What forms the superior border of the cubital fossa?
An imaginary line between the medial and lateral epicondyles of the humerus.
218
Is the apex of the cubital fossa distal or proximal? Which direction is it pointing?
Distal, pointing towards the hand.
219
Give 5 contents of the cubital fossa.
- The tendon of the biceps brachii. - The bicipital aponeurosis. - The brachial artery. - The median nerve. - The radial nerve.
220
What happens to the brachial artery deep in the cubital fossa?
Bifurcates into its terminal branches - the radial and ulnar arteries.
221
Give 3 superficial veins located in the subcutaneous tissue over the cubital fossa.
- Cephalic cubital vein. - Basilic cubital vein. - Median cubital vein.
222
Give 3 clinical relevancies of the bones/joints of the forearm and the cubital fossa.
- Radial head subluxation. - Scaphoid fracture. - Fracture of the distal radius.
223
What is radial head sublaxation? Which group is it most common in?
- Annular ligament is partially torn, and the radial head moves distally out of the ligament. - Most common in young children, by being pulled up by their arm.
224
What is the risk of a scaphoid fracture?
Proximal part of the bone may be disconnected from the blood supply and death of this segment results - avascular necrosis.
225
Why is avascular necrosis a serious problem?
As the proximal scaphoid articulates with the distal radius at the wrist joint.
226
Who are distal radius fractures most common in? Why?
- Older people, particularly females. - Osteoporosis is more common in these groups.
227
What usually causes a distal radius fracture?
FOOSH: - Fall Onto OutStretched Hand.
228
How many muscles can be found in the anterior compartment of the forearm? How many layers can these be split into?
- 8 muscles. - 3 layers: superficial, middle and deep.
229
What do most of the muscles in the anterior compartment act as?
Flexors of the wrist, fingers or thumb.
230
What nerve innervates most of the muscles of the anterior compartment?
Median nerve.
231
How many muscles are in the superficial layer of the anterior compartment? What are these called?
4: - Pronator teres. - Flexor carpi radialis. - Palmaris longus. - Flexor carpi ulnaris.
232
What are the superficial muscles of the anterior compartment attached to proximally?
The medial epicondyle of the humerus AKA the common flexor origin.
233
What is the action of the pronator teres?
Pronator of the proximal radioulnar joint.
234
What is the action of the flexor carpi radialis?
Flexes and abducts the wrist.
235
Describe the palmaris longus.
Small muscle belly but long, thin, easily recognisable tendon when present (approx 15% don't have one).
236
Where does the tendon of the palmaris longus insert into?
The fascia of the palm of the hand.
237
What is the action of the flexor carpi ulnaris?
Flexes and adducts the wrist.
238
How many muscles can be found in the middle layer of the anterior compartment? What is it called?
1: - Flexor digitorum superficialis.
239
How many tendons does the flexor digitorum superficialis give rise to?
Four.
240
Where do the tendons of the flexor digitorum superficialis travel to?
Beyond the wrist, into the hand and to the fingers (digits 2-5).
241
What is the action of the flexor digitorum superficialis?
Flexor of the digits.
242
Which muscles of the anterior compartment does the media nerve travel between?
The flexor digitorum superficialis and the flexor digitorum profundus.
243
How many muscles can be found in the deep layer of the anterior compartment? What are they called?
3: - Flexor digitorum profundus. - Flexor pollicis longus. - Pronator quadratus.
244
How many tendons does the flexor digitorum profundus give rise to?
Four.
245
Where do the tendons of the flexor digitorum profundus travel to?
Into the hand and to the fingers (digits 2-5).
246
What is the action of the flexor digitorum profundus?
Flexor of the digits.
247
Describe the innervation of the flexor digitorum profundus.
- Lateral half of the muscle (which gives rise to the tendons that travel to the index and middle fingers) is innervated by the median nerve. - Medial half of the muscle (which gives rise to the tendons that travel to the ring and little fingers) is innervated by the ulnar nerve.
248
What is the action of the flexor pollicis longus?
Flexor of the thumb.
249
What is the action of the pronator quadratus?
Pronates the distal radioulnar joint.
250
Which anterior forearm muscles are NOT flexors?
- Pronator teres. - Pronator quadratus.
251
Which anterior forearm muscles are NOT innervated by the median nerve?
- Flexor carpi ulnaris. - Flexor digitorum profundus.
252
How many muscles can be found in the posterior compartment of the forearm? How many layers can these be split into?
- 12. - 2 layers: superficial and deep.
253
What is the action of most of the muscles of the posterior compartment?
Extensors of the wrist, digits or thumb.
254
What nerve innervates all of the muscles of the posterior compartment?
Radial nerve.
255
How many muscles are in the superficial layer of the posterior compartment of the forearm? What are these called?
7: - Brachioradialis. - Extensor carpi radialis longus. - Extensor carpi radialis brevis. - Extensor digitorum. - Extensor digiti minimi. - Extensor carpi ulnaris. - Anconeus.
256
What are the superficial muscles of the posterior compartment attached to proximally (generally)?
The lateral epidcondyle of the humerus AKA the common extensor origin.
257
Describe the brachioradialis.
- Located on the boundary of the anterior and posterior compartments of the forearm. - Originates from humerus, proximal to lateral epicondyle, inserts on the distal radius.
258
What is the action of the brachioradialis?
Weak flexor of the elbow joint (hence functions as an anterior compartment muscle).
259
Where are the extensor carpi radialis longus and brevis located in the posterior compartment?
On the radial side.
260
What is the action of the extensor carpi radialis longus and brevis?
Extend and abduct the wrist.
261
Where does the extensor carpi radialis longus insert onto?
The 2nd metacarpal.
262
Where does the extensor carpi radialis brevis insert onto?
The 3rd metacarpal.
263
What is the action of the extensor digitorum?
Extends the digits.
264
How many tendons does the extensor digitorum give rise to?
Four.
265
Where do the tendons on the extensor digitorum insert onto?
Dorsal aspects of the fingers (digits 2-5).
266
How are the tendons of the extensor digitorum connected? What does this cause difficulty doing?
- Connected by fibrous bands. - Difficult to fully extend the middle or ring fingers independently.
267
What is the action of the extensor digiti minimi?
Extends the little finger.
268
What is the insertion of the extensor digiti minimi?
Dorsum of the little finger.
269
What sis the action of the extensor carpi ulnaris?
Extends and adducts the wrist.
270
What is the insertion of the extensor carpi ulnaris?
The 5th metacarpal.
271
What is the name of the band of tissue the tendons of the superficial muscles of the posterior compartment travel under?
The extensor retinaculum.
272
What does the extensor retinaculum prevent?
The tendons bowing when the wrist is extended.
273
Describe the anconeus.
- Small muscle in superficial posterior compartment of the forearm. - Found near the olecranon (sometimes considered as arm not forearm). - Spans from lateral epicondyle to olecranon.
274
What is the action of the anconeus?
Very weak extensor of the elbow.
275
How many muscles are there in the deep layer of the posterior compartment of the forearm? What are these called?
5: - Supinator. - Abductor pollicis longus. - Extensor pollicis brevis. - Extensor pollicis longus. - Extensor indicis.
276
Which muscle of the deep layer of the posterior compartment does not attach proximally to the forearm bones and the interosseous membrane?
Supinator; attaches to the humerus then wraps around the proximal part of the radius.
277
What is the action of the supinator?
Supinates the forearm.
278
What is the action of the abductor pollicis longus?
Adbucts the thumb.
279
What does the abductor pollicis longus insert onto?
The 1st metacarpal.
280
What is the action of the extensor pollicis longus and brevis?
Extend the thumb.
281
What is the insertion of the extensor pollicis longus, and which joint does it therefore extend?
- The proximal phalanx. - The metacarpophalangeal joint.
282
What is the insertion of the extensor pollicis brevis, and which joint does it therefore extend?
- The distal phalanx. - The interphalangeal joint.
283
Where do the tendons of the extensor pollicis longus and brevis lie?
Superficially at the wrist, as they wrap around the distal radius.
284
What is the action of the extensor indicis?
Independent extension of the index finger.
285
What does the extensor indicis insert onto?
The dorsum of the index finger.
286
Which posterior forearm muscles are NOT extensors?
- Brachioradialis. - Supinator. - Adbuctor pollicis longus.
287
Describe the path of the arteries present in the forearm.
Brachial artery -> bifurcates at cubital fossa into radial and ulnar artery -> anastomose in the palm of the hand to form the palmar arteries.
288
What are 2 important superficial veins of the upper limb?
Cephalic vein and the basilic vein.
289
How are the cephalic and basilic veins connected and where?
By the median cubital vein in the region of the cubital fossa.
290
Which vein does all venous blood from the upper limb ultimately drain into?
Axillary vein.
291
Describe the venous pathway to the axillary vein.
- Basilic vein receives deep veins of the arm to from the axillary vein. - Cephalic vein drains into the axillary vein after passing through the deltopectoral groove.
292
What is the carpal tunnel?
- Narrow passageway at the wrist/. - Floor and sides are formed by carpal bones. - Fibrous band called the flexor retinaculum forms the roof.
293
What is the flexor retinaculum attached to laterally and medially?
Laterally - scaphoid and trapezium. Medially - hook of the hamate and pisiform.
294
What travels through the carpal tunnel?
- The 4 tendons of the flexor digitorum superficialis. - The 4 tendons of the flexor digitorum profundus. - The 1 tendon of the flexor pollicis longus. - The median nerve.
295
What causes carpal tunnel syndrome?
Compression of the median nerve e.g. swelling of the tendons in the carpal tunnel or arthritis between the joints of the carpal bones.
296
What does a patient with carpal tunnel syndrome typically present with?
- Impaired/altered sensation over the skin of the hand supplied by the median nerve. May experience tingling, numbness or pain in the hand. - Weakness of the hand muscles supplied by the median nerve, particularly the small muscles of the thumb.
297
What may happen if carpal tunnel syndrome is left untreated?
Small muscles of the thumb may atrophy and weakness may be permanent.
298
What can be done to alleviate the compression of the median nerve in carpal tunnel syndrome?
The flexor retinaculum is divided.
299
Give 4 clinical relevancies of the muscles of the forearm and the carpal tunnel.
- Injury to the flexor tendons. - Wrist drop. - Lateral and medial epicondylitis. - Arterial blood gas sampling.
300
What can failure to recognise tendon injuries cause?
Patients to have a permanent impairment.
301
What is a wrist drop?
- Inability to extend the wrist and fingers due to weakness/paralysis of the posterior forearm muscles. - Sensation also impaired over the lateral aspect of the dorsum of the hand (regions supplied by the radial nerve).
302
What can cause a wrist drop?
Injury to the radial nerve proximal to the forearm e.g. a mid-shaft humeral fracture.
303
What is lateral/medial epicondylitis.
Inflammation of the tendinous insertions of the superficial extensor muscles in the forearm at the lateral epicondyle, or the superficial flexor muscles in the forearm at the medial epicondyle.
304
What tends to cause lateral/medial epicondylitis?
Repetitive use and strain of the muscles e.g. during a tennis serve for lateral epicondylitis (tennis elbow), or a golf swing for medial epicondylitis (golfer's elbow).
305
Where is pain felt in lateral/medial epicondylitis?
At the affected epicondyle and may radiate down the forearm.
306
Where is arterial blood usually taken from for an ABG?
The radial artery.
307
Why is arterial blood gas needed for an ABG?
To accurately assess a patient's blood-oxygen and blood-carbon dioxide level.
308
What names are given to the phalanges of the digits?
Thumb: distal and proximal phalanx. 2-5: distal, middle and proximal phalanx.
309
Where can carpometacarpal joints (CMCJs) be found?
Between the distal row of carpal bones and the proximal parts of the metacarpals.
310
Describe the first CMCJ.
- Between trapezium and the 1st metacarpal (thumb). - Saddle joint, key to the range of movement possible at the thumb.
311
Where can metacarpophalangeal joints (MCPJs) be found?
Between the distal parts of the metacarpal and proximal phalanges. (AKA 'knuckles')
312
What type of joint are the MCPJs?
Condyloid synovial joints.
313
Where can interphalangeal joints (IPJs) be found?
- Between the phalanges. - Thumb only has one. - Digits 2-5 have two; proximal interphalangeal (PIP) joints between proximal and middle phalanges, and distal interphalangeal (DIP) joints between middle and distal phalanges.
314
What type of joint are IPJs?
Hinge synovial joints.
315
Give 3 types of grip the human hand can perform, and an example of each.
- Power grip: hold or squeeze objects tightly. - Hook grip: carrying objects with handles. - Precision grip: hold objects between pads of our thumb and fingers such as a pen.
316
In what ways can the fingers (digits 2-5) move?
- Flexion and extension. - Abduction and adduction.
317
In what ways can the thumb (digit 1) move?
- Flexion and extension. - Abduction and adduction. - Opposition (mixture of flexion, adduction, and internal rotation).
318
What affect does the tendon of the flexor digitorum superficialis (FDS) have on the digits?
- Splits in 2, inserting on either side of the middle phalanx of digits 2-5. - Flexes the MCP joints and PIP joints of these.
319
What affect does the tendon of the flexor digitorum profundus (FDP) have on the digits?
- Passes through gap in the FDS tendon to insert onto palmar aspect of the distal phalanx of digits 2-5. - Only muscle capable of flexing the DIP joints. - Also flexes the MCP joints and PIP joints of these.
320
What affect does the tendon of the flexor pollicis longus (FPL) have on the thumb?
- Inserts onto distal phalanx of the thumb. - Only muscle that can flex the IP joint of the thumb.
321
What encloses the long flexor tendons?
Fibrous sheaths, within which are synovial sheaths to reduce friction and allow tendons to slide freely during flexion and extension within the sheaths.
322
What protects the long flexor tendons, tendon sheaths and vessels as they pass through the palm of the hand?
The thick palmar aponeurosis.
323
What is the name for inflammation of the tendon and synovial sheath?
Tenosynovitis.
324
What can cause tenosynovitis?
Penetrating injury of the hand/digits piercing the tendon sheaths and them becoming infected.
325
How are the intrinsic muscles of the hand grouped? Name these groups, how many are in each, and where they can be found.
Four groups: - Thenar eminence: 3 muscles, proximal to the thumb. - Hypothenar eminence: 3 muscles, proximal to the little finger. - Lumbricals: 4 muscles, between the metacarpals. - Interossei: 7 muscles, also between the metacarpals. One remaining muscle of the thumb called the adductor pollicis.
326
What innervates the intrinsic muscles of the hand?
The median and ulnar nerves.
327
Which 3 muscles does the thenar eminence contain?
- Flexor pollicis brevis (FPB). - Abductor pollicis brevis (APB). - Opponens pollicis (OP).
328
Where is the opponens pollicis in relation to the flexor and abductor pollicis brevis'?
Deep.
329
What is the insertion of the FPB?
Proximal phalanx.
330
What is the insertion of the APB?
Proximal phalanx, lateral aspect.
331
What is the insertion of the OP?
1st metacarpal.
332
What innervates the muscles of the thenar eminence?
Recurrent branch of the median nerve.
333
Will the thenar eminence muscles be affected in carpal tunnel syndrome? Why?
Yes, as the recurrent branch of the median nerve leaves after it has passed through the carpal tunnel.
334
How does the adductor pollicis differ from the thenar eminence muscles?
- Located deep in the palm. - Innervated by ulnar nerve.
335
What are the attachments of the adductor pollicis?
3rd metacarpal (middle), and the proximal phalanx of the thumb.
336
Which 3 muscles does the hypothenar eminence contain?
- Flexor digiti minimi (FDM). - Abductor digiti minimi (ADM). - Opponens digiti minimi (ODM).
337
What is the insertion of FDM?
Proximal phalanx.
338
What is the insertion of ADM?
Proximal phalanx.
339
What is the insertion of ODM?
5th metacarpal.
340
What innervates the muscles of the hypothenar eminence?
Deep branch of the ulnar nerve.
341
Describe the location and paths of the lumbrical muscles.
- One for each finger (digits 2-5). - Originate from tendons of FDP. - Travel along lateral aspects of digits 2-5, to insert onto the dorsal aspects of them.
342
What is the action of the lumbricals?
Flex the MCP joints and simultaenously extend the IP joints.
343
What innervates the lumbricals?
The lateral two (digits 2 and 3) = median nerve. The medial two (digits 4 and 5) = ulnar nerve.
344
Where can the interosseous muscles be found?
- Attached to, and located between, the metacarpals; insert onto the dorsal aspects of digits 2-5. - 2 groups: palmar and dorsal.
345
How many palmar interosseous muscles are there?
3.
346
How many dorsal interosseuous muscles are there?
4.
347
What is the action of the palmar interossei?
Adduction when they contract.
348
What is the action of the dorsal interossei?
Abduction when they contract.
349
What is the name for the superficial veins of the dorsum of the hand?
Dorsal venous network.
350
Describe the drainage of the dorsal venous network.
Dorsal venous network -> cephalic vein laterally, and basilic vein medially.
351
What is the extensor expansion?
- Fibrous structure located on dorsal aspects of the digits. - Attached to the base of the proximal phalanx and gives rise to a central slip and 2 marginal slips. - Central slip inserts on the middle phalanx. - Marginal slips converge on distal phalanx.
352
Which tendons insert onto the extensor expansion? Where? Why?
- ED, EI and EDM. - Dorsal aspect. - Keeps the tendons fixed in the midline of the digits.
353
Which muscles insert onto the sides of the proximal parts of the extensor expansion? Why?
- The lumbricals and interossei. - Contribute to extension of the interphalangeal (IP) joints of the fingers.
354
What is the anatomical snuffbox (ASB)?
Triagnular-shaped depression on the lateral aspect of the wrist, at the base of the thumb (best seen when the thumb is fully extended.
355
What are the boundaries of the anatomical snuffbox?
- Tendon of the EPL medially. - Tendons of the EPB and APL laterally.
356
Why is the anatomical snuffbox a clinically important region?
- Scaphoid bone located in the floor, therefore ASB tenderness on palpation may indicate a scaphoid fracture. - Radial artery travels through it. - Cephalic vein travels across it. - Superficial branch of the radial nerve travels over the ASB to supply the skin of the lateral aspect of the dorsal of the hand.
357
Which 2 arteries supply the hand? Which artery are these terminal branches of?
Radial and ulnar arteries (terminal branches of the brachial artery).
358
Where do the radial and ulnar arteries anastomose?
Deep in the palm.
359
What does the anastomosis of the radial and ulnar arteries form?
Two palmar arches: - Superficial palmar arch (largely formed by ulnar artery, small contribution from radial). - Deep palmar arch (largely formed by radial artery, small contribution from ulnar).
360
What do the palmar arches give rise to?
Metacarpal and digital arteries that supply the palm and digits.
361
What are digital arteries accompanied by?
Digital nerves.
362
Describe the median nerve's territory.
- Palmar surface of lateral side of hand. - Palmar surface of lateral 3.5 digits. - Skin over the dorsum of the distal phalanges of the lateral 3.5 digits.
363
Describe the ulnar nerve's territory.
- Palmar and dorsal surfaces of the medial side of the hand and the medial 1.5 digits.
364
Describe the radial nerve's territory.
- Dorsal surface of the lateral side of the hand. - Skin over the dorsum of the lateral 3.5 digits as far as the DIP joint.
365
Where is the median nerve tested?
Central palm, just proximal to middle finger.
366
Where is the ulnar nerve tested?
Medial border of the hand.
367
Where is the radial nerve tested?
Dorsum of the hand in the thumb and index webspace.
368
What is a dermatome?
A region of skin innervated by a single spinal nerve.
369
What innervates the skin of the upper limb?
Brachial plexus and spinal nerves C5-T1.
370
What region does C4 innervate?
Superior aspect of the shoulder.
371
What region does C5 innervate?
- Lateral shoulder over the deltoid. - Anterior and posterior aspects of the arm.
372
What region does C6 innervate?
- Lateral sides of the anterior and posterior surfaces of the forearm. - Lateral sides of the anterior and posterior surfaces of the palm. - Anterior and posterior surfaces of the thumb and index finger.
373
What region does C7 innervate?
Anterior and posterior surfaces of the middle finger and middle of the palm (over the 3rd metacarpal).
374
What region does C8 innervate?
- Medial side of the anterior and posterior surfaces of the forearm. - Medial side of the anterior and posterior surfaces of the palm. - Anterior and posterior surfaces of the ring and little fingers.
375
What region does T1 innervate?
Medial side of anterior and posterior surfaces of the arm.
376
Where would you test the C5 dermatome?
Upper lateral arm, over the deltoid muscle.
377
Where would you test the C6 dermatome?
Thumb.
378
Where would you test the C7 dermatome?
Middle finger.
379
Where would you test the C8 dermatome?
Little finger.
380
Where would you test the T1 dermatome?
Medial border of the arm, just proximal to the elbow.
381
How do you test the FDP tendon in the case of a palmar injury?
Hold the PIP joint immobile and ask the patient to flex the finger - if the FDP tendon is intact, flexion is seen at the DIP joint. (Only FDP can move DIP joint).
382
How do you test the FPL tendon in the case of a palmar injury?
Movement of the IP joint of the thumb is assessed.
383
Describe Dupuytren's contracture.
- The fingers (usually little and ring) are pulled into flexion by progressive fibrosis of the palmar fascia and the palmar aponeurosis. - Palmar fascia is attached to flexor tendon sheaths of the fingers, fascia shortens -> pulls the fingers into flexion.
384
How can Dupuytren's contracture be treated?
Fascia can be released surgically.
385
What is rheumatoid athritis?
Autoimmune condition that affects various synovial joints - small joints of the hands are typically involved.
386
Which 2 types of joints in the hand are predominantly affected by rheumatoid athritis?
MCP and PIP joints, can cause significant deformities, which can lead to significant functional impairment.
387
What is a fracture of the 5th metacarpal otherwise known as? Why?
A boxer's fracture. Typically sustained by punching something hard.
388
What is the pelvis?
Bony ring formed by articulation of left and right innominate (hip) bones and the sacrum.
389
What does the pelvis do?
Take the weight of the body and transmits it to the lower limbs.
390
How are the hip bones formed?
Each from 3 separate bones: - Pubic bone. - Ileum. - Ischium. - Fuse at the acetabulum.
391
Where do the hip bones articulate with one another and with the sacrum?
Anteriorly: with each other at pubic symphysis. Posteriorly: with the sacrum at the sacroiliac joints.
392
Which structures surround the obturator foramen?
The superior and inferior pubic rami.
393
Describe the obturator foramen.
- In life, almost completely closed by obturator membrane and muscles. - Small gap = obturator canal. Vessels and nerves allowed to pass between pelvis and thigh.
394
Name 3 anterior bony landmarks of the pelvis.
- Iliac crests. - ASIS. - AIIS.
395
Name 2 posterior bony landmarks of the pelvis.
- Ischial spine. - Ischial tuberosity.
396
Which ligament attaches to the ischial spine?
Sacrospinous ligament.
397
Which ligament attaches to ischial tuberosity?
Sacrotuberous ligament.
398
What are the notches above and below the ischial spines called?
The greater and lesser sciatic notches.
399
What do the sciatic notches form, and how?
- Greater and lesser sciatic foramina. - Sacrospinous and sacrotuberous ligaments close the notches.
400
What do the sciatic foramina allow?
Structures to pass between the pelvis and the gluteal region and perineum.
401
What is the name of the long bone of the thigh?
Femur.
402
Describe the basic structure of the femur.
- Has a head, neck and shaft. - Distal end is expanded to form two condyles.
403
What does the head of the femur articulate with? What does this form?
- Acetabulum. - The hip joint.
404
What structures are located distally to the neck of the femur?
The greater and lesser trochanters.
405
What are the greater and lesser trochanters?
Sites of muscle attachment (similar to humerus' tubercles).
406
Where is the intertrochanteric line located?
Between the greater and lesser trochanters on the anterior surface of the femur.
407
Where is the linea aspera located? What is it?
- Posterior shaft of the femur. - Bony vertical ridge, a site of muscle attachnement.
408
Where is the gluteal tuberosity located? What is it?
- Posterior aspect of the femur, just inferior to the trochanters. - Site of muscle attachment.
409
The distal end of the femur is expanded to form what?
The medial and lateral femoral condyles.
410
What do the medial and lateral femoral condyles articulate with? Where?
The proximal tibia, at the knee joint.
411
What can be found just superior to the medial femoral condyle?
The small adductor tubercle.
412
What is located anterior to the knee joint?
The patella.
413
What type of joint is the hip joint?
Synovial ball and socket between the acetabulum and the femoral head.
414
Why is the hip joint a stable joint?
- Acetabulum is deep. - Good fit. - Acetabular labrum (rim of fibrocartilage) deepens the acetabulum. - Ligament of femoral head = weak, but joint capsule reinforced by other strong ligaments.
415
Which arteries go to the hip joint? What do these arise from? What do they give rise to?
- The medial and lateral circumflex femoral arteries. - From profunda femoris. - Give rise to retinacular arteries that supply the femoral head.
416
Which movements are possible at the hip joint?
Flexion, extension, abduction, adduction, internal and external rotation, and circumduction.
417
Which muscles flex the thigh at the hip joint?
Muscles in the anterior thigh.
418
Which muscles adduct the thigh at the hip joint?
Muscles in the medial thigh.
419
Which muscles extend the thigh at the hip joint?
Muscles in the posterior thigh.
420
Which muscles extend, abduct and rotate the thigh at the hip joint?
Muscles of the gluteal region.
421
What are the 3 ligaments which stabilise the hip joint? Are these anterior or posterior?
- Iliofemoral (anterior). - Pubofemoral (anterior). - Ischiofemoral (posterior).
422
What type of joint is the knee joint?
Synovial hinge joint between femoral condyles and tibial condyles.
423
Do the tibial condyles provide a good fit for the femoral condyles?
No, the most superior aspect forms a pair of tibial plateaus. As they are flat, they are not a good fit.
424
When do the femur and tibia achieve their best fit?
When the knee is extended.
425
How does the femur help us stand for long periods?
Rotates a very small amount so that the knee can reach full extension - 'locking' the knee, so it becomes very stable.
426
What is the name of the muscle which 'unlocks' the knee by rotating the flexor back again to permit flexion?
The popliteus.
427
What movements are possible at the knee joint?
Flexion and extension.
428
Which muscles extend the leg at the knee joint?
Muscles in the anterior thigh.
429
Which muscles flex the leg at the knee joint?
Muscles in the posterior thigh.
430
What are the menisci?
C-shaped cartilages that sit on the tibial plateaus.
431
What is the purpose of the menisci?
To deepen the tibial condyles for articulation with the femoral condyles, to improve their fit.
432
Which meniscus is more prone to injury? Why?
- Medial meniscus. - Attached to the joint capsule along it's peripheral margin, and to the medial (tibial) collateral ligament. - Prone to injury if knee is twisted. - Lateral meniscus not attached to lateral (femoral) collateral ligament, therefore less prone.
433
What do the medial and lateral collateral ligaments do?
Support the knee, and resist sideways movement of the tibia on the femur.
434
What does the medial collateral ligament connect?
Femur to tibia.
435
What does the lateral collateral ligament connect?
Femur to fibula.
436
What do the anterior and posterior cruciate ligaments connect?
Tibia to femur.
437
What does the anterior cruciate ligament (ACL) attach to?
- Anterior part of intercondylar area of the tibia. - Medial aspect of lateral condyle of the femur.
438
What does the ACL prevent?
The tibia moving anteriorly relative to the femur.
439
What does the posterior cruciate ligament (PCL) attach to?
- Posterior part of intercondylar area of the tibia. - Lateral aspect of medial condyle of the femur.
440
What does the PCL prevent?
The tibia moving posteriorly relative to the femur.
441
When is the ACL taut?
Knee extension.
442
When is the PCL taut?
Knee flexion.
443
What does a fractured hip refer to?
Fracture of the femoral neck.
444
Which group are NOF fractures most common in?
Elderly population.
445
What may a NOF fracture lead to?
Avascular necrosis of the femoral head, as the fracture may tear vessels supplying the femoral head and neck.
446
What is typically found on NOF fracture examinations?
Shortening and external rotation of the affect limb compared to the uninjured limb.
447
Which direction is patella dislocation most likely in?
Lateral.
448
When may posterior dislocation of the hip occur?
In car accidents when the knee forcibly impacts the dashboard.
449
What does a posterior dislocation of the hip risk injury to?
The sciatic nerve.
450
What is known as the 'unhappy triad of the knee'?
Damage to the medial (tibial) collateral ligament, medial meniscus, and anterior cruciate ligament; in a single injury.
451
How many groups of muscles does the gluteal region contain? What are these groups called? How many muscles are in each?
2 groups, superficial and deep. 4 muscles in each.
452
Name the 4 superficial gluteal muscles?
- Gluteus maximus. - Gluteus medius. - Gluteal minimus. - Tensor fascia latae.
453
Which is the most superficial gluteal muscles?
Gluteus maximus.
454
Describe the attachments of the gluteus maximus.
Proximally, most posterior parts of: - Posterior surface of the ileum. - Sacrotuberous ligament. - Sacrum. Distally: - Most insert onto iliotibial band. - Some onto the gluteal tuberosity.
455
What movements does the gluteus maximus allow?
- Extensor of the hip, important for standing from a seated position. - External rotator of the hip.
456
How does the gluteus maximus stabilise the knee joint?
As it inserts onto the iliotibial tract.
457
Where can the gluteus medius and minimus be found?
Medius = deep the maximus. Minimus = deep to medius.
458
What are the attachments of the gluteus medius and minimus?
- Similar points of attachment to the posterior ileum. - Also both attach to the greater trochanter.
459
What movements do the gluteus medius and minimus allow?
Abduction and internal rotation of the hip.
460
What particular movement do the gluteal medius and minimus play a key role in?
Normal gait! - When we stand on one leg, they are responsible for contracting that limb and holding the pelvis level, so it does not tilt to the unsupported side, preventing a limp.
461
What are the attachments of the tensor fascia latae?
- ASIS. - Inserts onto iliotibial band (which itself inserts onto lateral part of proximal tibia).
462
What does the tensor fascia latae do?
Tenses the fascia lata and iliotibial band upon contraction.
463
What is the fascia lata?
Thick fascia that envelops the muscles of the thigh from the iliac crest to the tibia.
464
What is the iliotibial band?
Thickening of the fascia lata laterally.
465
Which nerve supplies the gluteus maximus?
Inferior gluteal nerve.
466
Which nerve supplies the gluteus medius and minimus, and the TFL?
Superior gluteal nerve.
467
Where do the gluteal nerves leave from and travel via?
Leave the sacral plexus, and come via the greater sciatic foramen.
468
Name the 4 deep gluteal muscles.
- Piriformis. - Superior and inferior gemelli. - Obturator internus. - Quadratus femoris.
469
Where do all the deep gluteal muscles insert onto/near to?
The greater trochanter.
470
Describe the piriformis' attachments/path.
- Attached to anterior surface of the sacrum. - Passes through greater sciatic foramen. - Inserts onto the greater trochanter.
471
Which nerves are related to the piriformis in terms of location?
- Sacral plexus located on its surface in the pelvis. - Sciatic nerve emerges below its inferior border in the gluteal region.
472
Where do the superior and inferior gemelli, and the quadratus femoris arise from?
The ischium.
473
Where does the obturator internus arise from? Where does its tendon pass through?
- Obturator membrane. - Through the lesser sciatic foramen.
474
What is the role of the deep gluteal muscles?
Primarily, stabilisation and lateral rotation of the hip joint.
475
How many muscles does the anterior compartment of the thigh contain? What are these called?
- Quadriceps femoris (group of 4 large muscles: rectus femoris, vastus lateralis, vastus medialis, vasrus intermedius). - Sartorius. - Iliopsoas. - Pectineus.
476
As a group, how do the muscles of the anterior compartment primarily act?
As extensors of the knee, and some act upon the hip joint.
477
Which nerve innervates the muscles of the anterior compartment of the thigh?
The femoral nerve (spinal nerves L2-L4).
478
What are the muscles of the quadriceps femoris?
- Rectus femoralis. - Vastus lateralis. - Vastus medialis. - Vastus intermedius.
479
What is the role of the quadriceps femoris group of mucsles?
Primary extensor of the knee.
480
Where do the quadriceps femoris muscles converge and insert onto?
- Converge onto quadriceps tendon (runs over patella). - Inserts on tibial tuberosity via patellar ligament.
481
Where does the rectus femoris lie/attach?
- Lies in midline of anterior thigh. - Attaches to AIIS proximally.
482
What other movement can the rectus femoris contribute to? Why?
Flexion of the hip, as it crosses the hip.
483
Where does the vastus lateralis lie/attach?
- Lies lateral to rectus femoris. - Attaches to linea aspera on posterior aspect of the femoral shaft.
484
Where does the vastus medialis lie/attach?
- Lies medial to rectus femoris. - Also attaches to linea aspera.
485
Where does the vastus intermedius lie/attach?
- Lies deep to rectus femoris. - Attaches to anterior aspect of the femoral shaft.
486
Where is the sartorius located? Where does it attach/insert?
- Superficially in the anterior thigh. - Attaches to ASIS, twists across the thigh, inserts on medial aspect of proximal tibia.
487
What movements can the sartorius allow?
- Flexion and external rotation of the hip joint. - Flexion of the knee joint.
488
Where is the iliopsoas located?
Proximally in the anterior thigh.
489
What names are merged together to form iliopsoas?
Psoas major and iliacus.
490
Where do the psoas major and iliacus converge?
Onto the lesser trochanter of the femur.
491
What movement does the iliopsoas allow?
Primary flexor of the hip joint.
492
Describe the innervation of psoas major and iliacus.
Psoas major = branches of L1-L3 spinal nerves. Iliacus = femoral nerve.
493
Where is the pectineus located? Where does it attach/insert?
- Proximal anterior thigh, medial to iliopsoas. - Attaches to superior pubic ramus proximally, and femur distally (just inferior to lesser trochanter).
494
What movement does the pectineus allow?
Flexion and adduction of the hip joint.
495
How many muscles are in the medial thigh? What are they called?
5: - Adductor brevis. - Adductor longus. - Adductor magnus. - Gracilis. - Obturator externus.
496
As a group, what movement do the muscles of medial thigh allow?
Primarily act as adductors of the hip.
497
What innervates the muscles of the medial thigh?
The obturator nerve (spinal nerves L2-L4).
498
Where can the adductor brevis and longus be found? What do they attach to?
- Brevis = deep to longus. - Attached to pubic bone and linea aspera.
499
What lies between the adductor brevis and longus?
The obturator nerve.
500
What 2 parts make up the adductor magnus?
- Adductor part. - Hamstring part.
501
Where does the adductor part of the adductor magnus attach? What movement does it allow? What innervates it?
- Attached to inferior pubic ramus and linea aspera. - Adduction of the hip. - Innervated by obturator nerve.
502
Where does the hamstring part of the adductor magnus attach? What movement does it allow? What innervates it?
- Attached to ischial tuberosity and adductor tubercle. - Extension of the hip. - Innervated by tibial part of sciatic nerve.
503
What is the adductor hiatus?
Gap between the distal attachments of the two parts of the adductor magnus.
504
What passes through the adductor hiatus to enter the posterior thigh?
The femoral artery and vein.
505
Where is the gracilis located? Where does it attach? What movement does it allow?
- Most medial. - Attached to pubic bone and medial aspect of tibia. - Weak adduction and flexion of the hip, and weak flexion of the knee.
506
Where does the obturator externus attach/insert? What movement does it allow?
- Attached to external surface of obturator membrane, and inserts onto femur near the greater trochanter. - Stabilisation and lateral rotation of the hip joint.
507
How many muscles are found in the posterior thigh? What are they called?
4: - Semimembranosus. - Semitendinosus. - Biceps femoris (long and short head). - Hamstring part of adductor magnus.
508
Which 3 muscles are referred to as the 'hamstrings'?
- Semimembranosus. - Semitendinosus. - Long head of biceps femoris.
509
Where do the 'hamstrings' attach? What movement do they allow? What are they innervated by?
- Proximally to the ischial tuberosity. - Extend the hip and flex the knee. - Innervated by tibial part of sciatic nerve.
510
Where do the semimembranosus and semitendinosus insert?
On the medial aspect of the proximal tibia.
511
Where do the long head and short head of the biceps femoris insert?
Form a common tendon and insert onto head of the fibula.
512
Where does the short head of the biceps femoris arise from? What movement does it allow? What innervates it?
- Arises from linea aspera. - Flexes the knee. - Innervated by common fibular part of sciatic nerve.
513
Where does the hamstring part of the adductor magnus arise from and insert onto? What movement does it allow? What innervates it?
- Arises from ischial tuberosity. - Inserts onto adductor tubercle of femur. - Extends the hip. - Innervated by tibial part of sciatic nerve.
514
Describe the borders of the femoral triangle.
Lateral = medial border of sartorius. Medial = lateral border of adductor longus. Superior = inguinal ligament. Apex = distal, where sartorius and adductor longus meet. Floor = iliopsoas laterally and pectineus medially.
515
Describe the contents of the femoral triangle.
- Femoral artery. - Femoral vein: located medial to femoral artery, receives great saphenous vein in the triangle. - Femoral nerve: located lateral to femoral artery, travels deep to inguinal ligament to enter the anterior thigh. - Lymphatics - medially to all of the above.
516
What mnemonic can be used to remember the order of the contents of the femoral triangle from lateral to medial?
NAVaL (nerve, artery, vein, lymphatics).
517
What are the superior and inferior gluteal arteries branches of?
The internal iliac artery.
518
What is the continuation of the external iliac artery?
The femoral artery.
519
What large branch does the femoral artery give off?
Profunda femoris.
520
What does the femoral artery become after passing through the adductor hiatus into the distal part of the posterior thigh?
Popliteal artery.
521
Which artery is the obturator artery a branch of?
Internal iliac artery.
522
Which arteries supply the hamstring muscles in the upper posterior thigh?
3/4 perforating arteries that arise from profunda femoris.
523
How do the perforating arteries travel to the posterior compartment?
Through small apertures in the adductor magnus.
524
Which vein do the superior and inferior gluteal arteries drain into?
Internal iliac vein.
525
Where is the femoral vein located in comparison to the femoral artery?
Medially.
526
What is the continuation of the popliteal vein?
Femoral vein.
527
What does the femoral vein receive? What does it then become?
- Receives great saphenous vein. - Becomes external iliac vein.
528
Which spinal nerves form the femoral nerve?
L2-L4.
529
What do branches of the femoral nerve supply?
Anterior thigh muscles.
530
What is the name of a sensory branch of the femoral nerve which innervates the skin over the leg?
The saphenous nerve.
531
Which spinal nerves form the obturator nerve?
L2-L4.
532
What do branches of the obturator nerve supply?
The medial compartment muscles, and skin over the medial thigh.
533
Which spinal nerves form the sciatic nerve?
L4-S3.
534
Which 2 nerves bound together form the sciatic nerve?
- Tibial nerve. - Common fibular nerve.
535
What does the tibial nerve supply?
Muscles of the posterior thigh and leg.
536
What does the common fibular nerve supply?
Muscles of the anterior and lateral leg.
537
When may the femoral artery need to be accessed?
For angiography.
538
When may the femoral vein need to be accessed?
For blood samples in an emergency, if blood cannot be obtained from other peripheral veins.
539
What is a fascia iliaca compartment block used for?
To provide analgesia to patients who have sustained a neck of femur fracture, as many nerves that carry pain sensation from the neck of the femur are within this comparment.
540
How much local anaesthetic is usually injected in a FICB?
30-40ml.
541
Which group of individuals are more likely to suffer from a femoral hernia?
Women.
542
What may irritate the obturator nerve?
Ovarian pathology e.g. a cyst, as it runs so close to the ovary.
543
What sensation can irritation of the obturator nerve cause?
Tingling, itching or pain in the medial thigh.
544
Where is the only safe place to give a gluteal intramuscular injection? Why?
- Upper outer quadrant. - Avoid sciatic nerve.
545
What is sciatica?
Pain felt in the posterior thigh and leg due to compression of nerve roots contributing to the sciatic nerve (L4-S3).
546
What is the most common cause of sciatica?
A prolapsed ('slipped') intervertebral disc between L5 and S1.
547
Describe the tibia.
Thick and strong bone.
548
What does the tibia articulate with?
Proximally - femur. Distally - talus and fibula.
549
Which structures articulate with the femoral condyles to form the knee joint?
The medial and lateral tibial plateaus (of the medial and lateral condyles).
550
What are the prominent ridges between the tibial plateaus called?
The intercondylar tubercles.
551
Where is the tibial tuberosity found?
Upper anterior surface of the tibia.
552
What inserts onto the tibial tuberosity?
The patellar ligament.
553
Where is the soleal line found? Describe it.
- Posterior surface of the tibia. - Oblique.
554
Which structure projects medially from the distal end of the tibia to form part of the 'socket' for the talus?
The medial malleolus.
555
Describe the fibula.
Slender bone.
556
What does the fibular articulate/attach with/to?
Proximally - not part of knee joint. Shaft - attachment site for muscles. Distally - lateral malleolus projects and forms part of the 'socket' for the talus.
557
What raises the part of the sole of the foot which does not make contact with the ground when we stand?
The longitudinal and transverse arches of the foot, formed by the arrangement of bones of the foot (supported by ligaments and tendons).
558
What do the small joints of the foot allow?
The foot to deform and absorb shock when walking over uneven ground.
559
How many tarsal bones are there? What are they called?
7: - Talus. - Calcaneus. - Navicular. - Cuboid. - Medial cuneiform. - Intermediate cuneiform. - Lateral cuneiform.
560
Which tarsal bones are referred to as the hindfoot?
Talus and calcaneus.
561
Which tarsal bones are referred to as the midfoot?
Navicular, cuboid, and the 3 cuneiforms.
562
What comprises the forefoot?
The metatarsals and phalanges.
563
Describe the metatarsals and phalanges.
- Numbered 1-5 just like metacarpals. - Great toe has 2 phalanges (proximal and distal). - Toes 2-5 have 3 phalanges (proximal, medial and distal).
564
What are the joints between the metatarsals and the proximal phalanges called?
Metatarsophalangeal joints (MTPJs).
565
What are the joints between the phalanges called?
Interphalangeal joints (IPJs). - Great toe only has 1 = IPJ of the great toe. - Toes 2-5 have 2 = proximal IPJs, and distal IPJs.
566
In what ways can the toes move?
- Flexion. - Extension. - Abduction. - Adduction.
567
Flexion of which joints of the toes is important for pushing the foot off the ground during walking and running?
MTP joints, especially MTPJ of the great toe.
568
What type of joint is the ankle joint? Which articulations form this joint?
- Synovial hinge joint. - Articulation between distal tibia, distal fibula, and the talus.
569
What is the name of the socket formed for the talus by the tibia and fibula?
The ankle mortise.
570
Is the ankle joint stable? Why?
Yes - good fit, and supported by strong medial and lateral ligaments.
571
What movements can occur at the ankle joint?
- Dorsiflexion (toes closer to shin). - Plantarflexion (pointing the toes).
572
What is the medial ligament of the ankle sometimes called?
The deltoid ligament.
573
Which articulations form the subtalar joint?
Articulation of the talus with the calcaneus and navicular.
574
What movements can occur at the subtalar joint?
- Inversion (sole of foot medially). - Eversion (sole of foot laterally).
575
What is the name of a fracture which results in broken skin or bone penetrating through the skin?
Open/compound fracture.
576
Why is the tibia likely to result in an open fracture?
As there is little subcutaneous tissue between the anterior surface of the tibia and skin.
577
Which part of the tibia is a common site for intra-osseous (IO) vascular access?
The flat, antero-medial part of the proximal tibia.
578
What is the most common cause of ankle sprains?
Forced inversion of the foot, stretching and tearing the lateral ligaments of the ankle.
579
What does an ankle fracture refer to?
A fracture of the lateral and/or medial malleolus.
580
Which type of ankle fracture may be able to be treated conservatively, as opposed to surgically?
Small lateral malleolus fractures.
581
Where can the popliteal fossa be found? Describe it's shape.
Diamond-shaped depression behind the knee joint.
582
Describe the borders of the popliteal fossa.
2 superior borders: - Formed by the semimembranosus and semitendinosus medially. - Formed by the biceps femoris laterally. 2 inferior borders: - Formed by the 2 heads of the gastrocnemius.
583
What are the 4 important contents of the popliteal fossa?
- Popliteal artery. - Popliteal vein. - Tibial nerve. - Common fibular (peroneal) nerve.
584
Describe the popliteal artery's path.
- Continuation of the femoral artery. - Traverses adductor hiatus -> popliteal fossa. - Bifurcates into anterior and posterior tibial arteries.
585
Describe the popliteal vein's path.
- Formed by deep veins of the leg. - Traverses adductor hiatus and continues proximally as the femoral vein.
586
What does the tibial nerve innervate?
Muscles of the posterior leg.
587
Describe the common fibular nerve's path.
- Travels along superolateral border of popliteal fossa, alongside the biceps femoris' tendon. - Wraps around neck of the fibula, then splits into a superficial and a deep branch.
588
What does the superficial fibular nerve innervate?
Muscles of the lateral leg.
589
What does the deep fibular nerve innervate?
Muscles of the anterior leg.
590
How many muscles does the anterior compartment of the leg contain? What are they called?
3: - Tibialis anterior. - Extensor hallucis longus (EHL). - Extensor digitorum longus (EDL).
591
What innervates the muscles of the anterior compartment of the leg?
The deep fibular nerve.
592
What are the primary actions of the muscles of the anterior compartment of the leg?
- Dorsiflexors of the foot at the ankle joint. - Extensors of the toes.
593
What does the tibialis anterior insert onto? What action does it perform?
- Crosses anterior aspect of ankle and inserts onto medial cuneiform. - Dorsiflexes and inverts the foot.
594
What does the extensus hallucis longus insert onto? What action does it perform?
- It's tendon crosses anterior aspect of the ankle and inserts onto distal phalanx of the great toe. - Extends the great toe. - Also dorsiflexes the foot.
595
What does the extensor digitorum longus insert onto? What action does it perform?
- It's 4 tendons cross the anterior aspect of the ankle and insert onto distal phalanges of toes 2-5. - Extends toes 2-5. - Also dorsiflexes the foot.
596
What fourth muscle may be found in the anterior compartment of the leg in some patients? What actions can it perform?
- The fibularis tertius. - Weak dorsiflexion and eversion of the foot.
597
How many muscles does the lateral compartment of the leg contain? What are they called?
2: - Fibularis longus. - FIbularis brevis.
598
What innervates the muscles of the lateral compartment of the leg?
The superficial fibular nerve.
599
What is the action of the muscles of the lateral compartment of the leg?
Evert the foot at the subtalar joint.
600
Where can the fibularis longus be found? Where does it insert onto?
- More superficial of the two. - Travels posterior to the lateral malleolus to reach it's insertion. - Inserts onto the plantar surface of the medial cuneiform bone.
601
Where can the fibularis brevis be found? Where does it insert onto?
- Deeper muscle of the two. - Travels posterior to the lateral malleolus to reach it's insertion. - Inserts onto the base of the 5th metatarsal.
602
How are the muscles of the posterior compartment of the leg divided?
Into a superficial and deep group of muscles.
603
What innervates the muscles of the posterior compartment of the leg?
The tibial nerve.
604
What are the primary actions of the muscles of the posterior compartment of the leg?
- Plantarflexors of the foot at the ankle joint. - Flexors of the toes.
605
How many superficial muscles are there in the posterior compartment of the leg? What are they called?
3: - Gastrocnemius. - Soleus. - Plantaris.
606
Where do the tendons of all 3 superficial muscles of the posterior compartment of the leg insert onto?
The calcaneus via the calcaneal (Achilles) tendon.
607
Describe the structure and location of the gastrocnemius.
- Most superficial. - Two heads which attach to the distal femur.
608
What movement can the gastrocnemius also allow other than plantarflexion of ankle?
Flexion of the knee.
609
Describe the structure and location of the soleus.
- Deep to gastrocnemius. - Large, flat muscle. - Attached to soleal line of tibia.
610
Why is the soleus important in relation to the venous system?
Contraction compresses the deep veins of the leg, therefore important for venous return.
611
Describe the structure and location of the plantaris.
- Very small muscle. - Located near the popliteal fossa. - Gives rise to a very long, thin tendon which merges with the calcaneal tendon.
612
Why is the plantaris a non-essential muscle? What can the plantaris be used for because of this?
- As it's primary function can be carried out by other, stronger muscles. - It's tendon an be harvested and used to repair or replace damaged ligaments or tendons as a graft.
613
How many deep muscles are there of the posterior compartment of the leg? What are they called?
4: - Popliteus. - Tibialis posterior. - Flexor hallicus longus (FHL). - Flexor digitorum longus (FDL).
614
Where do the tendons of the tibialis posterior, flexor hallicus longus, and flexor digitorum longus travel and insert?
- Travel posterior to medial malleolus. - Insert onto plantar surface of bones of the foot.
615
Where is the popliteus located? What is it attached to?
- Deep in the popliteal fossa. - Attached to tibia and femur.
616
What actions does the popliteus allow?
- Slight rotation of the knee. - Unlocking the knee by rotating the femur back, to permit flexion.
617
What actions does the tibialis posterior allow? Where does it insert?
- Plantarflexes and inverts the foot. - It's tendon attaches to multiple bones in the foot.
618
What actions does the flexor hallicus longus allow? Where does it insert?
- Flexes the great toe. - Also plantarflexes the foot. - Inserts onto the distal phalanx of the great toe.
619
What actions does the flexor digitorum longus allow? Where does it insert?
- Flexion of the toes. - Also plantarflexes the foot. - It's 4 tendons insert onto the distal phalanges of toes 2-5.
620
What is the name of the small muscle located in the dorsum of the foot? Where is it located? Where does it insert? What innervates it?
- Extensor digitorum brevis. - Located laterally. - Inserts onto tendons of the extensor digitorum longus. - Innervated by deep fibular nerve.
621
How many layers of intrinsic muscles are found in the plantar aspect of the foot?
4 layers, mirroring those of the palm.
622
What innervates the instrinsic muscles of the plantar aspect of the foot?
Medial and lateral plantar nerves (the terminal branches of the tibial nerve).
623
What does the plantar aponeurosis do?
Located superficially to the muscles to support the foot and provide a layer of protection.
624
What sensory innervation does the common fibular nerve and it's branches provide?
Sensory innervation to the skin over the anterolateral leg and dorsum of the foot.
625
What else does the tibial nerve innervate other than muscles of the posterior leg?
Muscles of the plantar surface of the foot and most of the skin on the plantar surface of the foot.
626
How does the tibial nerve travel past the ankle?
Posterior to the medial malleolus.
627
Describe the branching of the tibial nerve in the foot.
Tibial nerve -> medial and lateral plantar nerves -> digital nerves.
628
Describe the path and branches of the anterior tibial artery.
- Anterior tibial artery pierces the interosseous membrane to enter the anterior compartment of the leg. - Distally, crosses anterior aspect of the ankle joint and enters dorsum of the foot = dorsalis pedis artery. - Dorsalis pedis artery gives rise to branches that travel between metatarsals and anastamose with arteries in plantar aspect of the foot.
629
Describe the path and branches of the posterior tibial artery.
- Posterior tibial artery supplies the posterior compartment of the leg. - Gives rise to fibular artery, which supplies lateral compartment. - Travels posterior to medial malleolus to enter the plantar surface of the foot. - Bifurcates into medial and lateral plantar arteries which supply the sole.
630
What is the name of the important vessel formed by the lateral plantar artery and a branch of the dorsalis pedis anastamosing?
The deep plantar arch.
631
Which veins unite to form the popliteal vein?
The posterior tibial, anterior tibial, and fibular veins.
632
What are the 2 major superficial veins of the leg called? What do these drain?
- Great saphenous vein. - Small saphenous vein. - Drain most of the blood from the foot.
633
How does the dorsal venous network drain into the great saphenous vein? Where does the great saphenous drain then travel and terminate?
- Drains medially. - Travels anterior to medial malleolus, and all the way up the medial aspect of the lower limb. - Terminates at femoral vein in the femoral triangle.
634
How does the dorsal venous network drain into the small saphenous vein? Where does the small saphenous drain then travel and terminate?
- Drains laterally. - Travels posterior to the lateral malleolus and up the posterior aspect of the leg. - Terminates at popliteal vein in the popliteal fossa.
635
What does the flexor retinaculum of the tarsal tunnel connect?
The medial malleolus to the calcaneus.
636
What are the contents of the tarsal tunnel?
- Tibialis posterior tendon. - Flexor digitorum longus tendon. - Posterior tibial artery. - Posterior tibial vein. - Tibial nerve. - Flexor hallicus longus tendon.
637
The tendons of which compartment of the leg travel through the tarsal tunnel?
Tendons of the deep compartment of the leg.
638
Describe the femoral nerve's territory.
Anterior thigh and anteromedial leg (via saphenous nerve).
639
Describe the obturator nerve's territory.
Medial thigh.
640
Describe the common fibular nerve's territory.
Anterolateral leg and dorsum of the foot.
641
Describe the superficial fibular nerve's territory.
Lower anterolateral leg and most of the dorsum of the foot.
642
Describe the deep fibular nerve's territory.
1st interdigital webspace.
643
Describe the tibial nerve's territory.
Sole of the foot.
644
What region does L1 innervate?
Over the inguinal ligament.
645
What region does L2 innervate?
Proximal half of the anterior thigh.
646
What region does L3 innervate?
Distal anterior thigh and medial aspect of knee.
647
What region does L4 innervate?
Lateral thigh, anterior knee, anteromedial leg, medial malleolus, medial foot, and great toe.
648
What region does L5 innervate?
Lateral leg, distal anterior leg, dorsal and plantar strip down the middle of the foot, and dorsal and plantar surfaces of toes 2-4.
649
What region does S1 innervate?
Vertical strip of skin in the middle of the posterior thigh and leg, distal lateral leg, lateral malleolus, and little toe.
650
What region does S2 innervate?
Vertical strip of skin over the posterior aspect of the thigh and leg, plantar strip of skin on the foot and heel.
651
Where would you test the L1 dermatome?
Region over inguinal ligament.
652
Where would you test the L2 dermatome?
Upper anterior thigh.
653
Where would you test the L3 dermatome?
Medial aspect of knee.
654
Where would you test the L4 dermatome?
Anteromedial leg.
655
Where would you test the L5 dermatome?
Anterolateral leg.
656
Where would you test the S1 dermatome?
Little toe/lateral side of foot.
657
What is the name of the condition in whcih the common fibular nerve is injured and the foot cannot be dorsiflexed, so drags on the ground when walking?
Foot drop.
658
What type of thrombus or clot can occur in the leg?
Deep vein thrombosis (DVT).
659
Give 4 symptoms of DVT.
Affected leg: - Swelling. - Pain. - Redness. - Warmth.
660
Describe compartment syndrome.
Pressure in a compartment increases. Muscles, nerves and blood vessels are compressed. When pressure exceeds capillary perfusion pressure, ischaemia and infraction of the tissues occurs if not treated.
661
What procedure is used to release pressure in compartment syndrome?
Fasciotomy.
662
What typically causes Achilles tendon rupture?
Sudden, forceful plantarextension of the ankle; or sudden, forceful dorsiflexion of the ankle.
663
Which 2 pulses around the ankle should be palpable?
- Pulsation of the dorsalis pedis artery. Pulsation of the posterior tibial artery.

Anatomy JD (6 decks)

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