Overview of the anatomy of the upper and lower limbs Flashcards
What are some key clinical points relating to limbs? ( vascular, NM, Musculoskeletal)§
Vascular:
- pulses
- varicose veins
- DVT
- superficial veins for injections, veins, harvesting, etc.
- arteries for access to cardiac vessles
- compartment syndrome
Neuromuscular:
- spinal root injury
- peripheral nerve injury
- muscular deficits after nerve injuries
Musculoskeletal:
- fractures
- tendon/ligament sprains and tears
- arthritis and other joint problems
Which roots innervate the upper and lower limb?
upper: C5-T1
lower: L2-S3
Location of flexors and extensors in the upper and lower limb
U: flexors are anterior, extensors are posterior
L: extensors are anterior, flexors are posterior (the limb rotates internally) -> in addition the dermatomes have twisted
Compartments in Limb Anatomy
- The limbs are divided into compartments
- tend to have a distinct function
- tend to have the same nerve supply
- tend to have the same blood supply
List the compartments of the upper limb (7)
Pectoral (= chest) girdle muscles Intrinsic shoulder muscles Anterior (upper) arm muscles - flexors Posterior (upper) arm muscles - extensors Anterior forearm muscles - flexors Posterior forearm muscles - extensors Intrinsic hand muscle
What do movements of the shoulder involve?
- movements of the arm relative to the scapula
- movements of the scapula relative to the chest wall
Muscles acting on the shoulder joint have attachments in the neck, anterior chest, back and arm.
Where do muscles acting on the shoulder joint have attachments?
Muscles acting on the shoulder joint have attachments in the neck, anterior chest, back and arm.
List the compartments of the lower lomb (10)
Hip abductors (Gluteal)
Hip extensors (Gluteal)
Hip Flexors
Anterior thigh muscles – extensors
Medial thigh muscles – adductors
Posterior thigh muscles – flexors
Anterior leg muscles – extensors (dorsiflexors)
Lateral leg muscles – foot evertors
Posterior leg muscles – flexors (plantarflexors)
Intrinsic foot muscles – variety of functions
What are the different names fo the lateral compartment of the leg?
- lateral
- peroneal (UK)
- fibular (USA)
Where do the nerves supplying the lower limb arise from?
the lumbosacral plexus (L2-S3)
Which muscles act as flexors of the hip?
Muscles with attachments in the abdomen and pelvis are flexors of the hip
- iliacus, psoas
Arterial Supply to the Upper Limb
- Aorta
- Subclavian artery
- Axillary artery
- Brachial artery (pulse)
- Deep brachial artery - Ulnar and radial arteries (pulses)
- Hand palmar arches
- Metacarpal and digital arteries
Venous drainage of the upper limb
Superficial and deep systems:
- Dorsal venous arch (sup.); Cephalic vein and basilic vein (sup.);
Venae comitantes (deep -> radials and ulnaris); Axillary vein (deep);
-> Subclavian vein; Superior vena cava
Is the median cubital vein always present? (the vein linking the basilica and cephalic veins in the cubital fossa)
No
Arterial supply of the lower limb
- Aorta
- Common iliac arteries
- Internal iliac artery
- External iliac artery
- External iliac artery
- Femoral artery (pulse)
- Deep femoral artery
- Popliteal artery (pulse)
- Posterior tibial artery (pulse)
- Anterior tibial artery (pulse)
- Peroneal artery
- Dorsalis pedis (pulse)
What is dorsi and plantar flexion of the foot?
plantar flexion = pointed toes like a ballerina
dorsiflexion -> do mnie -> towards face
What is flexion and extension at the knee?
Flexion: moving the foot up and behind (like you are preparing to kick)
Extension: straightening the leg, i.e. kicking forwards and down.
When does the femoral artery become the popliteal A?
When it passes posteriorly through the adductor hiatus
Venous drainage of the lower limb
-> mirrors the arterial supply
Deep System
- Ant & Post Tibial Venae Comitantes
- Popliteal Vein
- Femoral Vein
- External iliac vein
Superficial system
- Venous arches
- Long saphenous vein
- Short saphenous vein
What are the branches of the popliteal A?
- anterior tibial A
- posterior tibial A -> continues as PTA and also gives off the fibular/peroneal A
- dorsalis pedis comes from the anterior tibial A
Which pulses do you check in the lower limb?
- femoral
- popliteal
- posterior tibial
- anterior tibial
- dorsalis pedis
Where is the posterior tibial artery in when it comes to the foot?
runs by the medial malleolus between the tendon of flexor hallucis longus and tendon flexor digitorum longus
next to tibial nerve and its venae comitantes.
What runs by the medial malleoulus?
- tibial N
- posterior tibial A
- its venae comitantes
- tendon of flexor hallucis longus
- tendon of flexor digitorum longus
- tendon of tibialis posterior
Summarise the superficial veins of the lower limb?
- Both the great and small saphenous veins arise from the venous network of the dorsum of the foot.
- The great (long) saphenous vein drains into the femoral vein at the groin.
- The small (short) saphenous vein drains into the popliteal vein at the popliteal fossa
- Saphenous veins are consistent; other superficial veins are more variable
- there are numerous perforating veins linking the superficial and deep vessles
