overview Flashcards
what is te function of the upper limbs
move the hands
what is te function of the lower limbs
locomotion and support weigt
what is the axial skeleton
the axis of the head, neck and trunk
contains skull, spinal column and rib cage
what is the appendicular skeleton
limbs
what level of the spinal column is the upper and lower limbs associated with
c5-t1 - upper
l2-s3 - lower
where are the flexor and extensor muscles in the upper limb
flexor anterior - in anatomical position
extensers posterior
where are the flexor and extensor muscles in the lower limb *
lower limb rotates internally during development below the hip
so flexers are posterior and extensers are anterior
so moving leg forward is a flexion
where are the dermatomes in the lower limbs *
lower limb rotates internally during development below the hip - the limb picks up nerve supply before rotation occures = there is a twist in the dermatome fields so they are oblique
wat is the same within a limb compartment
hhave same distinct function eg all floexor or extensor
have same nerve supply
blood supply
what is the upper arm
between elbow and shoulder
what is the forearm
between elbow and wrist
what are the compartments of the upper limb
pectoral (chest) girdle muscles - pectoral girdle is the clavical and scapular
intrinsic soulder muscles
anterior (upper) arm muscles - flexers - boen is humorous
posterior (upper) arm muscles - extensers
anterior forearm muscles - flexers - bones are radius and ulnar
posterior forearm muscles - extensors
intrinsic hand muscles - bones are carpus, metacarples adn phalanges
what is an attachment for upper limb muscles
the pelvis
describe movements of the pectoral girdle
movements of teh arm relative to the scapular at the shoulder joint, and movements of scapula relative to the chest wall
describe te muscles of te pectoral girdle
have attachments in te neck, anterior chest, back and arm
detoid - intrinsic muscle of the shoulder
trapezius - supplied by cranial nerves (accessory) and acts on scapular and clavical
pectoralis major- has broad attachments on the sternum, clavical and humerous
scapular is hub for muscle attacment - rotator cuff muscles of shoulder - for movement of the shoulder and scapular in relation to trunk
descrieb cross sections of muscles in te arm
deltoid present then disappears becasue it attaches to the lateral side of the humerous
biceps small at top but thicker lower down where the bellies fuse
what are te comaprtments of te lower limb *
hip abducters - gluteal
hip extensers - gluteal
hip flexors
anterior thigh muscles - extensers
medial tigh muscles - adductors
posterior thigh muscle - flexor
anterior leg muscle - extensors - dorsiflexors
lateral leg muscle - foot evertprs
posterior leg muscle - flexors - plantarflexors
intrinsic foot muscles - variety of functions
what is the thigh
hip to knee
what is he leg
knee to ankle
what are the bones in lower limb
hip attach to trunk via sacroiliac joint
ten have femor
then tibia and fibia in lower limb
then tarsus, metarsals, phalanges
what part of teh body is the glutamus maximus part of
the lower limb
describe the muscles of te lower limb that attach in te abdo and pelvic cavities
iliacus and psoas muscles - form the iliopsoas muscle
psoas attaches to L1-5
psoas fibres comnverge wit iliacus that lines the inner surface of the iliac bone
they attach to the inferior tubercle
describe cross sectional view of muscles in the lower limbs
adducters are medial
soleus and gastrocnemiuss muscles are the thigh muscles
why is blood supply to the limbs important
DVT
arteries adn veins are used to access the heart
take pulse to assess teh blood supply in vascular disease
summarise the arterial supply to the upper limb
aorta becomes subclavian
becomes axillary when enter axillary area
changes name to be brachial - in arm
which becomes deep brachial artery which divides at tehh elbow joint
then radial and ulnar arteries
then hand palmer branches - cross wrist - deep and superficial
then metacarpel and digital arteries
have circumflex branches around neck of the humourus
what is teh cubital fossa and what is its relevance
it is the space in front of the elbow
where you access veins and arteries - access median cubital vein for venepuncture
where can you take pulses form the upper limb
brachial artery - medial side of arm
wrist 0 ulnar and radial arteries - better laterally which is the radial artery
describe the venous drainage of teh upper limb
there are superficial and deep systems
deep veins run with the arteries
palmar venosu plexus and palmar digital form a network
have dorsal venous arch - superficial vein in hand
from network in hands have - cephalic (lateral) and basilic (medial) veins - superficial
median cubital connects the cephalic and basilic veins in the cubital fossa - blood taken from here - can use other superficial veins if not present
venae comitantes - pair the deep veins, they pass along the brachial artery and drain into the axillary vein
basilic merge with deep vessels = axillary vein is deep, cephalic joins the axillary (brachial goes deep but cephalic stays superficial)
axillary pass under clavical and become subclavian vein
superior vena cava
describe the arterial supply of the lower limb *
aorta spilts into the common iliac arteries - split into internal and external iliac arteries - both supply lower limb
internal iliac supplies the contents of the pelvis
most of the lower limb supply is from external iliac artery, internal supplies medial part of thigh
external iliac passes under thhe inguinal ligament - becomes teh femoral artery -just under inguinal ligament feel femoral pulse - access heart to put a stent in here
femoral artery gives off branch in thigh - profunda femoris artery which supplies the posterior compartment of thigh and continues as superficial femoral artery
deep femoral artery goes anterior and medially then posterior behind the knee
superficial femoral artery then passes through the hiatus of adductor magnus muscle to the back of the knee where it becomes the popliteal artery - area behind knee is the popliteal fossa
popliteal artery gives off local branches in the popiteal fossa
then gives off anterior and posterior tibeal arteries and perineal/fibular artery
anterior tibeal artery is artery of anterior compartment of the leg - passes over foot anteriorly as the dorsalis pedis - supply anterior of foot
posterior tibial artery - artery of the posterior component of leg - passes behind medial malleolus of ankle - pulse taken here- divides in foot to become medial and lateral plantar arteries
fibular goes behind teh lateral malleolus - inconsistantly anastomososes with the anterior tibial artery in distal leg
give plantar arches derived from anterior and psoterior tibial arteries (plantar surface is sole of foot) - supply foot
what are the pulses of the lower limb *
femoral
popliteal
anterior and posterior tibial artery
dorsalis pedis
why are there more pulses in lower than upper limbs
lower limbs affeected first when arteries go
describe the vwnous drainage of the lower limb *
mirrors the aretrial supply
deep - anterior and posterior tibeal venae comitantes, popliteal vein -> superficial femoral vein which is joined by venae comunicantes of profunda femoris artery ->femoral vein -> external iliac vein -> drain into the vena cava
superficial - venous arches in foot - on medial limb crosses anteriorly to medial malleolus up leg behind knee and drain into inguinal region this is long saphrenous vein,
superficial - behind lateral malleolus, posterior of calf - pierce fascia over popiteal fossa and drain into popiliteal vein - this is short saphrenous vein
venae comitantes - pair of veins that closely accompany arteries so the pulses of the arteries aid venous return also cool venous blood is warmed by the arteries - artery and vein joined by connective tissue
saphrenous veins arise from venous network of dorsum of foot - long saphrenous drains anterior to medial mallelous and continues up medial side of limb into femoral vein at groin, short into popliteal vein and popliteal fossa
perferating vessels connect deep and superficial veins
what is the femoral traingle
in inguinal region
both femoral artery and vein here
where femoral artery is accessed - through this access the cardiac vessels for angiograms and angioplasty
feel pulse here
why are lower limb veins important clinically
perforating veins connecting superficial and deep veins contain a valve - only allow flow from superficial to deep
if valve damaged - blood flows from deep to superficial - varicose veins (dilated veins)
how does movement help venous return from the lower limbs
deep vessels between muscles
contraction of muscles in movement squeeze veins, open valves and pump blood up this is the calf pump
immobility = less efficient venous return from foot and leg - sluggish venous return cause DVT
how can you prevent DVT after surgery
socks that compress the superficial veisn so push blood into deep veins
mean you ahve more vigorous venous flow - prevents DVT
how many spinal nerves do we have in each section
8 - cervical
12 t
5 l
5 s
1 or 2 coccygeal
which spinal nerves are associated with which region
c1-4 neck
c5-t1 - upper limb - so upper limb has 5 spinal roots
t2-l1 trunk
l2-s3 lower limb - 7 spinal roots
s2-s4 - perineum
what does the brachial plexus supply
upper limb
describe plexuses
plexus is a network of nerves fromed from spinal nerves - merge and intermingle - make new peripheral nerve therefore fibres have >1 spinal root
descrive the path of the brachial plexus
start in neck - from anterior rami of c5 to t1 spinal nerves
goes under the clavical to axilla
describe the nerves to the lower limb
from the lumbosacral plexus - originated from teh lumbar and sacral rami
femoral nerve supplies the anterior compartment of the thigh - comes under the inguinal ligament
obturator nerve supplies medial (adductor) compartment of thigh, passes through obturator foramen
sciatic nerve (or its terminal branches - tibeal and common peroneal nerves) supply posterior thigh, anterior and posterior leg and foot
what are the 2 types of innervation
segmental and peripheral
describe segmental motor innervation of lower limbs
referring to myotomes
there are groups of motor cell bodies in spinal chord
there is a plexi for each limb
anterior and posterior divisions of anterior and posterior rami:
anterior divisions - flexor muscles
posterior divisions - extensor muscles
describe prinicples of the segmental nerve supply to muscles
muscles are generally supplied by 2 adjacent spinal segments
muscles wit te same action on a joint generallly ave te same nerve supply
opposing muscles ie flexors and extensers are usually 1 or 2 segments above or below
the more distal the muscle is in the limb, the more caudal te spinal segment is
what is the segmental motor supply to the shoulder
abduction - C5
adduction - C6, 7, 8
external rotation C 5
internal rotation C 6, 7, 8
what is the segmental motor supply to the elbow
flexion - C5 6
extension C 7 8
what is the segmental motor supply to the forearm
supination (turn to face palm upwards) C6
pronation C7 or 8
what is the segmental motor supply to the wrist
flexion C6 7
extension C6 7
what is the segmental motor supply to the long tendons to hand
flexion C7 8
extension C 7 8
what is the segmental motor supply to the intrinsic hand
T1
what is the segmental motor supply to the hip
flexion L2 3
extension L4 5
what is the segmental motor supply to the knee
extension L3 4
flex L5 S1
what is the segmental motor supply to the ankle
dorsiflex L4 5 (foot towards you)
plantarflex s1 s2 (foot away from you)
what is te difference between segmental and cutaneous nerve supply
segmental - all nerves in that dermatome get there from 1 spinal level
cutaneous - all nerves from that spinal level get to that dermatome throug differnt peripheral nerves eg C5 dermatome has cutaneous innervation from axillary and anterior cutaneous nerve
what is te segmental SENSORY supply to te infraclavicular region
c4
what is te segmental SENSORY supply to lateral arm
c5
what is te segmental SENSORY supply to lateral forearm adn thumb
c6
what is te segmental SENSORY supply to middle finger
c7
what is te segmental SENSORY supply to little finger and medial forearm
c8
what is te segmental SENSORY supply to medial arm
t1
what is te segmental SENSORY supply to axilla and trunk
t2
what is te segmental SENSORY supply to nipple
t4
what is te segmental SENSORY supply to umbilicus
t10
what is te segmental SENSORY supply tolower abdo
t12
what do you assess wen you assess nerve function
motor function
sensory function
reflex function
autonomic function
what would be te effect of a prolapsed intervertebral disk at L5/s1 (spinal root injury(
motor - loss of eversion - turn soul of foot out when walk on uneven ground
sensory - loss of sensation outer border of foot
reflex - loss of ankle jerk (this is s1 effect)
autonomic - minimal effects
what does the sciatic nerve divide into and where
teh common perineal and tibial nerve
just above the knee
what is the effect of damage to the common perineal nerve (peripheral nerve injury)
inability to raise foot = high step/swinging gait - nerve supply to teh anterior of leg tat raises foot
sensory - decrease of sensation at the dorsum of foot and maybe elsewhere
reflex- none
autonomic - minimal
describe te anterior compartment of the arm *
muscles: brachialis, biceps and coraco-brachialis
c5 6 7 nerve supply get there by te musculocutaenous nerve
deep brachial artery
flexes elbow
biceps strong supinator to forearm throughh attachment to radius bone
describe compartment syndrome
muscle groups confined in their compartments and are separated by fibrous septa
therefore can get ischemia due to trauma/inflammation induced increase in pressure in 1 compartment - commonly anterior, posterior, lateral compartment of leg
normal tissue bp (out of bv) is 20mmHg - only need 50-60mmHg to collapse small vessels so muscles not getting supplied - tis is above what you need to collapse big bv so still have pulse (ie tissue bp still lower than inside the vessels)
acute compartment syndrome is trauma associated
chronic is exercise induced
impairs venous drainage and arterial output - muscles and nerves die
how do you treat acute compartment syndrome
emergancy fasciotomy (open up compartment to relieve pressure) - to prevent deat of muscles in affected compartment
muscles in the anterior compartment of the arm *
biceps
brachalis
coracobrachialis
innervation of teh anterior compartment of the arm
*
the musculocutaneous nerve
what does the brachial artery supply *
the upper arm
what is a major branch of the brachial artery *
the profunda brachial artery
what is a branch of the ulnar artery and what are divisions of this *
common interosseous
this divides into anterior interosseous artery and posterior interosseous artery
what is venous graft harvesting 8
where a vein is taken and used to bypass a block in a coronary artery
list 3 muscoskeletal patologies
*
fractures
tendon/ligament sprains
arthritis and other joint problems
describe how the dermatomes are formed in the upper limb *
the skin has been ‘borrowed’ from te trunk and from c5 to t1
teh segmental nerves get to the upper limb by te bracial plexus
describe how te dermatomes are formed in the lower limb *
skin is borrowed from t12 to s3
describe teh autonomic nerve supply to the limbs *
no pns supply to limbs
sns for upper limbs t2-t6
lower limbs t11-l2
what are axial lines
*
where dermatomes do not follow axial outflow
eg s2 and l2 are next to each other in posterior thigh
describe the sensory innervation of the thumb *
The sensory nerves fibres pass from the skin in both the median and radial nerves, via the brachial plexus to the C6 spinal segment.
segmental supply is c6
peripheral supply is median nerve anteriorly and radial nerve posteriorly
what regions is the upper arm split into and what divides it into these regions *
shoulder, arm, forearm, hand
shoulder is upper limb attachment to trunk
arm - between shoulder (axilla) elbow joints (cubital fossa)
forearm - between elbow and wrist joints (flexor retinaculum)
hand is distal to the wrist joints
summarise the anterior compartment of the arm *
Brachialis, biceps and coraco-brachialis
C5,6,7 segmental supply
Musculocutaneous nerve
Deep brachial artery
Flexes the elbow
Biceps is also a strong supinator of the forearm through its attachment to the radius bone
summarise the posterior compartment of the arm *
triceps brachii
c6 7 8
radial nerve
extensor of elbow
profunda brachii artery
summarise the anterior compartment of the forearm *
FCU PL FCR PT FDS FDP PQ FPL
median nerve mainly and some ulnar nerve
c6 7 8
flex wrist and pronation
ulnar and radial arteries
summarise the posterior compartment of the forearm *
brachioradialis ECRL ECRB extensor digitorum, extensor digiti minimi, ECU anconeus, supinator, ABL, EPB, EPL, extenor indicis
radial nerve
c6 7 8
extensor of the wrist and digits
radial, posterior interosseous, anterior interosseous artery
describe the facia that separates the compartments in the arm & forearm *
arm - anterior and posterior are separated by medial and lateral intermuscular septa which are continuous with the deep facia enclsoing the arm and attach to the sides of the humerus. brachial fascia encloses posterior adn anterior compartments of the arms
forearm - anterior and posterior compartments are separated by lateral intermuscular septum and the interosseous membrane
symptoms of an ischemic limb from compartment syndrome *
pain more than expected
pallor of limb, patchy
limb is cool
pulses absent
passive extension is painful
