other Flashcards
Muller maneuver
the opposite of the valsava –> breath against close month and nose –> collapsion o fupper airway
beside external auditory foramen, XII is also pass through
Stylomastroid foramen
Rigor mortirs - mechanism
not release of actin from myosin (lack of ATP)
full anterior fontanelle in infants
in infants, cranial bone are not fully formed –> if meningitis —> increased intracranial pressure –> full anterior fontanelle
ankle - bones
Talus, tibia. fibula
calcaneus (under fibula, the heel)
Ankle ligaments - groups
- lateral ligament complex
- Medial ligament complex (deltoid ligament) (strong
- -> not commonly injured) - ligament that connect distal fibula + tibia
ankle - lateral ligament complex (by frequency of damage)
- anerior talofibular
- calcaneofibular
- posterior talofibular
ankle - medial ligament complex
- anterior tibiotalar
- posterior tibiotalar
- tibiocalcaneal
- tibionavicular
ankle - ligaments that connect distal fibula + tibia
ankle syndesomosis:
- anterior inf tibiofibular
- posterior inf tibiofibular
- Tranverse ligament
- interrossi ligament (from bone to ankle)
Achilles tendon is formed by … which …. (location)
soleus + gastrocnemius muscles combine to form to Achileles tendon which insert on the posterior calcaneus and acts on ankle flexion
ligament that connect distal fibula + tibia at the knee - causes of injury
dorsiflexion and/or eversion of the ankle –> unstable ankle with tenderness but not significant swelling)
Boxer’s fracture
metacarpal fracture
femoral nerve mononeuropathy can occur due to
- trauma (pelvic fructure)
- compression from hematoma or abscess
- stretch injury
- ischemia
femoral nerve - sensation
- anterior + medial thight
- medial leg
muscles used when sitting up from supine position
- external abdominal obliques
- rectus abdominis
- hip flexors
major muscles responsible for hip motion
- flexion: ilipsoas, rectus femoris, tensor fascia lata
- extension: gluteus maximus, semitendinosus, semimembranosus, long head of biceps
- abduction medius/minimus
- adduction: adductor brevis/longus/magnus
trapezius is frequently injured by
rear-end (whiplash) motor vehicle accidents
psoas muscle - origin / action
origin: anterior surface of the transverse processes + lateranl surface of vertebral T12 + L5
action: flex the tight, also contributes to lateral rotation + abduction of the tight
platella fracture signs
- swollen knee
- focal patella tenderness
- inability to extend the knee against resistance
platella fracture - how
- direct blow to anterio aspect
2. indirect: extension force transmitted through quadicipet tendon (landing on feet after falling from height)
patellar ligaemnt attaches
patella to tibial tuberosity and is the continuation of the quadricepts femoris tendon
valsva is due to
rectus abdominis (most importatnt)
vaslava action on paroxysmal suprventricular tachycardia
dmininish (due to increased vagus action
iliac muscle - action + location
flexion of the hip in the iliac fossa
anterior dislocation of the arm is follow
a blow to an extended abducted arm
latissimus dorsi - location / innervation / function
from iliac crest + lumbar fascia to spinous processes of T7-T12 and lower ribs. It inserts at the bicipital groove of the humerus
innervates by thoracodorsal nerve
functions: extension, adduction, internal rotation of humerus
erector spinae muscle - location / action
location: large muscle group of the back (longitudinally along the spinous processes
action: bilateral contraction –> spine extension
carpal tunnel contains
- tendons of the flexor digitorum profadus, superficialis, + flexor pollicis longus (flex the thumb)
- median nerve
transverse ligament (aka?) of carpal tunnel attachments
- hamate + pisiform on the ulnar side
- trapezium + scaphoid on the radial side
aka: flexor retinaculum
Dupuytren contracture?
slow progressive fibroproliferative disease of palmar fascia (nodules form on fascia)
radial head subluxation (aka?) results from
aka: nursemaid’s elbow (MC elbow injury in children 1-4 –> by age 5 the ligament becomes stronger)
from sudden traction on the outstretched + pronated arm of a child –> torsion and displacement of annular ligament
interosseous membrane of forearm
thick connective tissue between radius + ulna –> disruption can lead to instability
common peronial nerve is divided to … /action + location of every division
- superficial (lateral) –> foot eversion, sensation of lateral shin + dorsal foot
- deep (anterior) –> foot dorsiflexion, sensation between 1st + 2nd toes
vein traum during supracondylar fructure
rare due to their superficial coruse
anatomic snufbox location
- between extensor policis longus tendon (medially)
- tendons of the abductor pollicis longus and extensor pollicis brevis tendons (laterally)
ulnar collateral ligament - injuries occur MC in / treatment
throwers (eg. baseball) due to intesne valgus stress at elbow)
treatment: ligament reconstruction (Tommy John surgery)
deep branchial artery passes inferior to … muscle
teres major
deltoin origin
clavicle, acromion, spine of scapule
characteristic finding in bicep tenonditis
tenderness of the bicipital groove (spearates lesser + greater tubercles)
De Quervain tenosynovitis
overuse of abductor pollicis longus –> thumb + wrist pain
tha largest carpal bone
capitate
main muscle for foot inversion
tibialis posterior
- prepatellar bursa - location
2. suprapatellar bursa - location
- between patella + the overlying skin
2. anteriorly between distal femur + quadriceps
ACL is most common injured during
noncontact injuries –> in sudden deceleration + pivot on the extended knee
ACL - artery
ACL is supplied by middle geniculate artery –> ACL injuery –> rapid onset hemarthroses
movent of knee in bursitis
active is decreased or painful
passive is normall
fracture of coracoid process of scapula
rare / in gun shoots
the abnormal curvatures if an adult vertebral column
- kyphosis –> increase of posterior curvatuire
- lordosis –> increase of anterior curvatire
- scoliosi –> lateral curvature
the curvatures of an adult vertebral column
- cervical 2. thoracic
3. lumbar 4. sacral
tendon of biceps femoris attach to (at the knee)
styloid process of the head to fibula
supraspinatus muscle is vulneable to injury due to
impingement between the acromion + the head of the humerus
supraspinatus tendinopathy is the MC cause of rotator cuff syndrome
clavicular fracture - due to / mc location / nerves + vessels
- due to direct trauma
- MC in middle 1/3
- neurovascular damage is rare
- medial part goes up (due to sternocl.), lateral goes down due to weight + pectoralis major (in oppose to trapezius force)
clavicle is the point of origin or insertion of numerous muscles including
- deltoin (inf lateral)
- pect major (inferomedial)
- subclavius (inf lateral)
- trapezius (superolateral)
- sternocleid (supromedial)
- sternohyoid (inf medial)
superior gluteteal location - IM injection / trauma
superior lateral: safe
superior medial: superior gluteteal + sciatic nerve
inferior medial: sciatic nerve
inferior lateral: sciatic nerve
but THE MOST SAFE is anterolateral gluteal –> at von Hochstetter triangle
rotator cuff muscles - origin on scapule + attachement on humerus
supraspinatus - supraspinous fossa to greater tuberosity
infraspinatous - infraspinous fossa to greater tuberosity
teres minor - lateral border of scapula to greater tuberosity
subscapularis - subscapular fossa to lesser tuberosity
quatdricepts muscle is connected to the tibia by
repetitive contraction can lead to
- patella to tibial tuberosity and is the continuation of the quadricepts femoris tendon
- Osgood - Schlatter disease (focal pain + swelling at the tibial tuberosity)
Biceps tendon ruptures present as / due to
visible or palpable mass in the mid-upper arm (Popeye deformity)
due to sudden extendion of flexed elbow while contraction of the biceptos (eg. lifting of a heavy object)
foramen of vertebra
- vertebral foramen
- tranverse foramen
- intravertebral foramina
lateral epicondylitis (tennis elbow) - overuse of
extensor carpi radialis brevis (wrist extension)
medial epicondylitis (golfer’s elbow) - overuse of
wrist flexors
piriformis location / action / clinical significance
passes through the greater sciatic foramen + is involved with external rotation –> muscle injury or hypertrophy –> compress sciatic nerve in the foramen –> PIRIFORMIS SYNDROME –> tender muscle in deep palpation or on adduction + internal location
structure passing above piriformis: superior gluteal vessels + nerves
structure passing below piriformis: inferior gluteal vessels, internal pupendal vessels, multiple nerves (esp sciatic)
Acromioclavicular joint subluxation
from downward blow of the tip of the shoulder –> swelling and upward displacement of clavicle –> not associated with nerves
sciatic foramen is divided to … by
greater + lesser foramen by sacrospinous ligament
greater sciatic foramen borders
anterolaterally by greater sciatic notch of the ilium, inferiorly by the ischial spine and sacrospinous ligament, superiorly by the anterior sacroiliac ligaent, posteromedially by the sacrotuberous ligament
calcaneovalgus foot
dorsiflexed + everted
oblique popliteal ligament
wide fibrous band that connect posterior distal femur to the posterior proximal tibial
seminomembranous muscle attach to (at the knee) / action
medial condyle of tibia
knee flexion + hip extension
longest muscle of the body / origin / attachment / injury commonly occurs in … and cause …
sartorius muscle
origin: anterior iliac spine –> inserts into the pes anserinus of anteromedial tibia (near the tibial tuberosity)
pes anserinus bursitis occurs in renners –> anteromedial knee pain
LATERAL BORDER OF FEMORAL TRIANGLE
MCC of spinal stenosis
degenerative arthritis –> lead to formation of facet joint osteophytes + hypertrophy of ligamentum flavum (a strong elastic liga,ent supporting the posterior aspect of the spinal canal) + disc herniation –> spinal narrowing (stenosis)
synovial sheath of flexor digitorum superficialis + profandus tendons
from palm through carpal tunnel to a point 1 cm proximal to transverse carpal ligament –> median nerve lies outside
obturator artery on children
gives the artery of the ligamentum teres –> supplies a minor portion of femoral head –> important in children because it supplies the region of femoral head proximal to the epiphyseal growth plate (minimal significance in adults)
LP - lugament that will traverse
off the midline –> ligamentum flavum
in midline –> supraspinous + interspinous ligament
Anserine bursitis
pain along the medial knee and well defined tenderness approximately 4 cm distal to the anteromedial joint margin of the knee
sural nerve in greek / function
γαστροκίμιο
pure sensory nerve –> postolateral leg + lateral foot
musculocutaneous nerve in arm
penetrates the coracobranchialis –> between bicep + coracobranchialis –> goes to elbow between biceps branchi + branchialis
ulnar nerve course in forearm
between olecranon + medial epicondyle of humerus –> between flexor carpi ulnaris + flexor digitorum profundus
Radial nerve course in forearm
through the supinator muscle near the head of the radius
median nerve course in forearm
between the humeral + ulnar heads of the pronator teres muscles –> between flexor digitorum superficialis + flexor digitorum profundus –> carpal tunel
hamstrings?
muscles at posterior thigh
Myotome of upper extremity
C4: shoulder/scapula elevation C5: shoulder abduction C5/6: elbow flexion, wrist extension C7: elbow extension, finger extension C8: wrist flexion, finger flexion T1: finger abduction
lumpoosacral plexopathy duting fetal descent
foot drop + numbness in the lateral aspect of the leg + dorsal foot –> resolition within a year
pudendal nerve - course
S2-4 –> passes between piriformis + coccygeus muscle as it exis the pelvis through greater schiatic foramen –> reenters pelvis near the ischial spine through lesser sciatic foreamen –> divided to its terminal branches
muscle that attach to anterior iliac crest
sartorius muscle
anatomical mark of LP
LP at L3/4 or L4/5 –> L4 vertebral body lies on a line drawn between the highest points of the iliac crests
femoral nerve course
L2-L4 (the largest branch of plexus) –> between psoas and iliacus –> under iguinal ligament (lateral to artery)
–> branching into anterior + posterior
femoral nerve block for anesthesia - location
inguinal crease (not ring)
bladder cancer - nerve compression
it compresses the obturator nerve which is extis the pelvis through obturator foramen
pelvic innervation
- pudendal (S2-4) –> sensory: perineum, motor: urethral+anal sphincter
- Lateral femoral cutaneous (L2-3) –> sensroy: anter + lateral tight (injury during hyperflexion of the thighs for pelvic surgery or vaginal delivery
- inferior gluteal
- Genitofemoral (L1-2) –> sensory: scrotum/labia majora, medial thigh (anterior to psoas, injury during laparotomy), motor to parts of genitalia (eg. cremasteric reflex)
- Obturator
- Iliohypogastric (T12-L1) –> sensory hypogastric (injury due to Pfnannestiel skin incisions, like cesarean, appendidectomy), motor to anterolateral abdom walls
- ilioinguinal (L1) –> sensory from skin of the upper + medial thigh, the root of penis + upper scrotal, labia major
lumbosacral radiculopathy - nerves?
L2 –> upper antromedial tight sensor , hip flexion (iliopsoas)
L3 –> lower antromedial tight sensor, hip flexion (iliopsoas), hip adduction, knee extension (quadricepts)
L4 –> lower anterolateral thight knee, medial calf+ foot sensor, hip adduction, knee extension (quadriceps), patellar reflex)
L5 –> Buttocks, posterolateral tight, anterolateral leg, dorsal foot sensor, foot dorsiflexion + inversion, foot eversion, toe extension
s1 –> Buttocks, posterior tight + calf, lateral foot sensor, hip extension, knee flexion (hamstrings), foot plantarflexion, achilles reflex
conus medularis vs cauda equina syndrome - location / symptoms
conus medularis: L1-L2 –> flaccid paralysis of bladder + rectum, impotence + saddle anshesia, leg wekness
cauda equina syndrome: S2-S4 –> back pan radiates to legs, saddle anesthesia, bowel + bladder dysfuntion (LATE), loss of ankle reflex
radial nerve enter forearm anterior to lateral epicondyle - after?
divides into
superficial–> somatic sensory innervation to the radial half of the dorsal hand
deep –> innervates the extensor muscles of forerm
radial nerve trauma in the supinator trauma
due to repetitive pronation/sunipation of forearm (screwdriver), dirct, dislocation of radius –> finger drop, not wrist drop, and not sensory symptoms
(between superficial + deep parts of supinator muscle
