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Anatomy of the limbs > Overview of the anatomy of the upper and lower limbs > Flashcards

Overview of the anatomy of the upper and lower limbs Flashcards

1
Q

Discuss the embryology of the limbs.

A

In the foetus the limb buds grow out from the trunk and take the nerves destined to supply those parts with them (arms, C5-T1; legs L2-S2).
In the upper limb, flexors are anterior and extensors are posterior. No significant rotation.
In the lower limb, the arrangement of muscle compartments is complicated by the fact that the limb undergoes extension and internal rotation. Extensor muscles lie anteriorly and flexor muscles posteriorly.
The limbs pick up their nerve supply at the start of development, before limb rotation occurs.

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2
Q

Where do the radial and ulnar arteries meet distally, and what do their branches then supply?

A

Via an anastomosis in the hand at the superficial palmar arch and the deep palmar arch. These arches give off metacarpal arteries and digital arteries to supply the fingers.

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3
Q

What does the radial artery supply?

A

Lateral (radial) aspect of forearm and hand.

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4
Q

What does the ulnar artery supply?

A

Medial (ulnar) aspect of forearm and hand.

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5
Q

What is the main branch of the ulnar artery?

A

Common interosseous artery.

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6
Q

What does the common interosseous artery divide into?

A

Anterior interosseous artery

Posterior interosseous artery

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7
Q

What does the brachial artery supply?

A

Upper arm

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8
Q

What does the subclavian artery become as it passes into the limb?

A

Axillary artery, mainly within the axilla.

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9
Q

Where does the brachial artery divide, and into what?

A

At the level of the elbow.

Ulnar artery and radial artery.

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10
Q

What does the axillary artery become as it leaves the axilla and enters the upper arm?

A

Brachial artery

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11
Q

What does the superficial system of venous drainage of the upper limb consist of?

A

Cephalic vein
Basilic vein
Arise from dorsal venous arch on the back of the hand.

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12
Q

Describe the path of the basilic vein.

A

Runs superficially on the medial (ulnar) aspect of the forearm.
Passes deep halfway up the arm to become the axillary vein.

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13
Q

Describe the path of the cephalic vein.

A

Runs superficially on the lateral (radial) aspect of the forearm and upper arm.
Passes deep at the level of the shoulder to drain into the axillary vein.

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14
Q

Describe the path of the deep forearm veins.

A

Pass from the forearm and drain into the basilic vein.

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15
Q

Describe the path of the venae comitantes.

A

Pass alongside the brachial artery in the upper arm and drain into the axillary vein.

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16
Q

Describe the path of the axillary vein.

A

Passes from the upper arm into the axilla- continuation of basilic vein.
Then passes into the root of the neck to continue as the subclavian vein.

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17
Q

What drains into the axillary vein?

A

Cephalic vein

Venae comitantes of the brachial artery

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18
Q

What does the aorta divide into in the abdomen?

A

Common iliac arteries.

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19
Q

Where do the common iliac arteries divide, and into what?

A

At the pelvic brim.

Each common iliac artery divides into the internal iliac artery and the external iliac artery.

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20
Q

What does the internal iliac artery supply?

A

The contents of the pelvis.

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21
Q

Describe the path of the external iliac artery.

A

Passes beneath the inguinal ligament in the groin to become the femoral artery, which provides the principal blood supply to the lower limb.

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22
Q

What does the profunda femoris artery supply, and what is it a branch of?

A

Large branch of the femoral artery given off in the thigh.

Supplies posterior compartment of thigh and continues as the superficial femoral artery.

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23
Q

Describe the path of the femoral artery and what it supplies.

A

Continues towards the knee on the medial/anterior aspect of the thigh, which it supplies.

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24
Q

Describe the path of the superficial femoral artery.

A

Passes through the hiatus of adductor magnus muscle to the back of the knee where it becomes the popliteal artery.

25
Q

Where does the popliteal artery divide, and into what?

A

Relatively short- divides variably just below the knee.

Posterior tibial artery, anterior tibial artery, and peroneal (fibular) artery.

26
Q

What does the posterior tibial artery supply?

A

Posterior compartment of the leg.

27
Q

Describe the path of the posterior tibial artery.

A

Passes behind the medial malleolus of the ankle, where its pulse can be taken.

28
Q

Where does the posterior tibial artery divide, and into what?

A

In the foot.

Medial and lateral plantar arteries.

29
Q

What does the anterior tibial artery supply?

A

Anterior compartment of the leg.

30
Q

Describe the path of the anterior tibial artery.

A

Passes on the dorsal of the foot as the dorsals pedis artery- pulse can be taken. Divides into a number of arteries to supply the foot.

31
Q

What does the peroneal artery supply?

A

Lateral compartment of the leg. Much smaller than the anterior and posterior tibial arteries and inconstantly anastomoses distally with the anterior tibial artery in the distal leg.

32
Q

What is the plantar arch in the foot formed from?

A

Arteries derived from the anterior and posterior tibial arteries, to supply the foot and toes.

33
Q

What does the short saphenous vein arise from?

A

Lateral aspect of dorsal venous arch.

34
Q

Describe the path of the short saphenous vein.

A

Ascends the posterior compartment of the leg to join the popliteal vein of deep system at the back of the knee.

35
Q

What does the long saphenous vein arise from?

A

Medial aspect of dorsal venous arch.

36
Q

Describe the path of the long saphenous vein.

A

Ascends very constantly just anterior to the medial malleolus of the ankle and continues up the medial side of the limb to join the femoral vein (passing to the deep system) in the groin.

37
Q

What do deep veins in the calf form at the back of the knee?

A

Deep veins in the calf (very important as a “muscle pump”) form the popliteal vein at the back of the knee. These deep calf veins correspond to the branches of the anterior and posterior tibial arteries.

38
Q

What does the popliteal vein become?

A

Superficial femoral vein, which runs alongside the superficial femoral artery in the thigh.

39
Q

What forms the femoral vein?

A

Superficial femoral vein is joined by venae comitantes of the profunda femoris artery in the thigh.

40
Q

Describe the path of the femoral vein.

A

The femoral vein passes with the femoral artery beneath the inguinal ligament to form the external iliac vein.

41
Q

What does the external iliac vein drain into?

A

Inferior vena cava in the abdomen- different pattern of drainage on each side.

42
Q

What is the segmental spinal innervation of the shoulder?

A

C5: abduction and external rotation
C678: adduction and internal rotation

43
Q

What is the segmental spinal innervation of the elbow?

A

C56: flexion
C78: extension

44
Q

What is the segmental spinal innervation of the forearm?

A

C6: supination
C78: pronation

45
Q

What is the segmental spinal innervation of the wrist?

A

C67: flexion and extension

46
Q

What is the segmental spinal innervation of the long tendons to the hand?

A

C78: flexion and extension

47
Q

What is the segmental spinal innervation of the intrinsic hand?

A

T1

48
Q

What is the segmental spinal innervation of the hip?

A

L23: flexion
L45: extension

49
Q

What is the segmental spinal innervation of the knee?

A

L34: extension
L5S1: flexion

50
Q

What is the segmental spinal innervation of the ankle?

A

L45: dorsiflexion
S12: plantarflexion

51
Q

What is a dermatome?

A

A segment of skin supplied by a single spinal nerve.

52
Q

What is the sequence of events in eliciting the knee jerk reflex?

A

Tap
Stretch the patellar tendon
Stimulation of afferent (1a) fibres in quadriceps
Passes to spinal cord via posterior nerve root
Synapse with alpha-motor neurone in anterior horn of spinal cord
Efferent signal to quadriceps
Quadriceps extends the knee joint

53
Q

What are the 2 main reflex arcs of the upper limbs?

A 
Biceps jerk (C6)
Triceps jerk (C7)
54
Q

What are the 2 reflex arcs of the lower limbs?

A 
Knee jerk (L3)
Ankle jerk (S1)
55
Q

What is the peripheral innervation of the upper limb derived from?

A

Brachial plexus, which is derived from the anterior rami of the C5-T1 spinal nerves.

56
Q

What is the peripheral innervation of the lower limb derived from?

A

Lumbosacral plexus, which is derived from the anterior rami of the lumbar and sacral spinal nerves.

57
Q

What modalities may nerve function be assessed via?

A 
Motor function
Sensory function
Reflex function
Autonomic function
Trophic function
58
Q

What segmental loss would occur in the right lower limb following a prolapsed intervertebral disc at L5/S1, causing pressure on the right S1 nerve root?

A

Motor – loss of eversion of the foot (and weakness elsewhere)
Sensory – loss of sensation along the lateral border of the ankle and foot
Loss of the ankle jerk (S1)
Abnormalities of sweating in the S1 cutaneous nerve distribution (not normally noticed by the patient in the lower limb, but quite a feature in the upper limb)
Trophic – in long-standing lesions, there may be trophic changes on the lateral aspect of the foot.

59
Q

What peripheral loss would occur if there was damage to the common peroneal nerve (L45, S12) at the level of the fibular neck (e.g. due to pressure of the leg against an operating table)?

A

Motor – foot drop, i.e. paralysis of the anterior and lateral compartments of the leg
Sensory – loss of sensation in the distribution of the common peroneal nerve i.e. the dorsum of the foot at least
Reflex – no loss of reflexes as the ankle jerk is provided mainly by the tibial nerve
Autonomic – abnormalities of sweating in the cutaneous distribution of the common peroneal nerve
Trophic – in chronic cases there may be damage to the sole of the foot due to the pressure effects of the foot drop.

Anatomy of the limbs (9 decks)

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