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Anatomy of the limbs > Overview of the limbs > Flashcards

Overview of the limbs Flashcards

1
Q

What is the axial skeleton?

A

The central skeleton, consisting of the spinal column, skull and the thoracic cage

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2
Q

What is the appendicular skeleton?

A

The rest of the skeleton – all the limb skeletons are part of the appendicular skeleton

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3
Q

Which spinal segments are the upper limbs associated with?

A

C5-T1

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4
Q

Which spinal segments are the lower limbs associated with?

A

L1/2-S3

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5
Q

In the upper limbs are the flexors and extensors anterior or posterior?

A

flexors - anterior

extensors - posterior

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6
Q

In the lower limbs are the flexors and extensors anterior or posterior?

A

flexors - posterior

extensors - anterior

LIMB INTERNALLY ROTATES DURING DEVELOPMENT

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7
Q

Describe lower limb rotation during development

A

During development, as the limb buds grow out, they maintain the general arrangement of the segments

But, there is internal rotation below the hip region (in the upper to mid thigh)

Therefore, everything that should be at the front is at the back, and vice versa

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8
Q

What do limb compartments share?

A

nerve supply and blood supply

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9
Q

What does each compartment have?

A

A distinct function - e.g. extensor, flexor, both

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10
Q

What are the compartments of the upper limb?

A

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 muscles

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11
Q

What is the forearm made of (bones)?

A

ulna and radius

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12
Q

What are the writs bones called?

A

carpals

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13
Q

What is the clavicle attached to?

A

manubrium

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14
Q

What is the only joint of the upper limb with the trunk and what kind of joint is it?

A
  • The sternoclavicular joint is the only joint of the upper limb with the trunk (the pivot point)
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15
Q

What are the bones of the digit?

A

metacarpals and phalanges

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16
Q

What is the upper arm bone?

A

humerus

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17
Q

What are some muscles of the back?

A

trapezius
deltoid
latissimus dorsi

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18
Q

What does movement of the shoulder involve?

A

Movements of the shoulder involve both movements of the arm relative to the scapula at the shoulder joint, and 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.

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19
Q

What is the collective name of muscle attached to the shoulder blade?

A

rotator cuff muscles

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20
Q

What are the compartments of the lower limbs?

A

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

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21
Q

What is the main thigh bone?

A

femur - very large head

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22
Q

What does the head of the femur fit into?

A

acetabulum

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23
Q

What does the distal end of the femur articulate with?

A

tibia

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24
Q

What is the patella?

A

knee cap

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25
Q

What are the two bones of the lower leg?

A

tibia and fibula

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26
Q

What do the distal ends of the tibia and fibula form?

A

ankle joint

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27
Q

At the ankle in standing position what is the main weight bearing bone in the lower leg?

A

tibia

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28
Q

What are the main muscles of the thigh?

A

quadriceps (4 heads)

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29
Q

What do the quadriceps attach to and what do they do?

A

tibia via the patella - main knee extensor

30
Q

What is an anterior leg muscle?

A

tibialis anterior

31
Q

What is the biggest gluteal muscle (buttock region)?

A

gluteus maximus

32
Q

What are some posterior leg muscles?

A

hamstrings and calf muscles

33
Q

Where are some muscle of the upper and lower limb attached?

A
  • Some of the muscles of the upper limb have attachments that are low down in the back
  • There’s a similar phenomenon in the lower limbs – flexors of the hip joint have attachments higher up
  • The flexors of the hip joint have attachments up in the abdomen, almost to the thorax
  • These muscles are the psoas and iliacus
34
Q

What is the iliopsoas and where does it attach and what does it do?

A
  • Together the iliacus and psoas form the iliopsoas, which crosses the hip joint and attaches to the iliac tuberosity
  • When the muscles contract, they flex the hip
35
Q

What is the thick fibrous membrane joining the tibia and fibula?

A

interosseous membrane - seperates the anterior and posterior compartments

(other membranes seperate the lateral and posterior compartments)

36
Q

Which muscles give bulk and shape to the calf?

A

soleus and gastrocnemius

37
Q

What is an issue regarding blood supply to the limbs?

A

they are far from the heart so the distance blood has to travel is long

38
Q

What is the arterial supply to the upper limb?

A
  • Aorta
  • Subclavian artery (supply to both right and left upper limbs) – pulse
  • When the subclavian artery enters the axilla, it becomes the axillary artery – pulse
  • Continues as the brachial artery (pulse), and crosses the anterior of the elbow joint
  • The brachial artery divides to form the ulnar (medial) and radial (lateral) arteries (pulses)
  • Radial and ulnar arteries anastamose to form the hand arches – superficial and deep arches
  • This becomes the metacarpal and digital arteries
39
Q

Describe the venous drainage for the upper limb

A

Superficial and deep systems
- deep is same as arterial supply
- in distal parts of limbs there are not single veins usually pairs called venae comitantes
- venae comitantes -> axillary vein -> subclavian vein ->
superior vena cava

  • superficially there are dorsal venous arches which give rise to the cephalic vein (radial side) and basilic vein (ulnar side)
40
Q

Describe the drainage of the cephalic and basilic vein

A

cephalic
- into axilla region

basilic
- merges with venae comitants to from axillary vein -> subclavian -> SVC

41
Q

Which veins are commonly used for insertion of a venous line?

A

Superficial veins in the region of the Cubital Fossa - when present the medial cubital vein (links the basilic and cephalic vein)

42
Q

Describe the arterial supply to the lower limb

A
  • The aorta bifurcates to form the common iliac arteries (right and left) – main supply to the lower limbs
  • Common iliac arteries -> Internal and external iliac arteries
  • The external iliac artery provides most of the supply for the lower limb
  • The external iliac crosses beneath the inguinal ligament to become the femoral artery (pulse). Deep femoral artery is a branch
  • The femoral artery continues down the thigh, behind the knee to form the popliteal artery (pulse)pulse)
43
Q

What are the branches of the popliteal artery?

A
  • Posterior tibial artery (pulse)
  • Anterior tibial artery (pulse)
  • Peroneal artery
  • The anterior tibial artery rise rise to the dorsalis pedis
44
Q

What is the use of pulse in the foot?

A

efficiency of blood supply to the distal parts of the limb

45
Q

Describe venous drainage of the lower limb

A

Deep System of Venous Drainage – venous return follows arterial supply

  • Anterior & Posterior tibial venae Comitantes
  • Popliteal Vein -> femoral Vein -> external iliac vein

Superficial system of Venous Drainage

  • Venous arches
  • The venous arches give rise to the long saphenous vein
  • Short saphenous vein
46
Q

Where do the great and small saphenous veins arise from?

A

venous network of dorsum of foot

47
Q

Where does the long and short saphenous veins drain?

A

long - blood drains into the femoral vein in groin

short - blood drains into the popliteal vein behind the knee -> femoral vein

48
Q

What is the importance of the femoral triangle?

A

Is the region of the groin where the femoral artery is accessed e.g. access to the cardiac vessels to carry out angiograms and angioplasty. A pulse can be felt in this area. Catheters can be put into the big vessels of the femoral triangle, to access the heart chambers.

49
Q

What can cause varicose veins?

A

Perforating veins connecting superficial and deep veins contain a valve that will allow flow only from superficial to deep. If such a valve is compromised, blood is pushed from deep to superficial veins leading to varicose veins.

50
Q

Why do patients on surgical wards wear special socks?

A

Prevent DVT

Compression stockings compress the superficial veins, and push venous return deeply to produce vigorous venous return.

51
Q

What is the calf pump?

A

In the leg, the deep vessels are sandwiched between layers of calf muscles. During walking and running, contractions of these muscles squeeze the thin-walled veins and push blood up the veins: the calf pump. Immobility (e.g. a long plane journey) means less efficient venous return from the foot and leg.

52
Q

Describe the distribution of spinal nerves to the neck, upper limbs, trunk, lower limb and perineum

A 
C1-4: neck
C5-T1: upper limb
T2-L1: trunk
L2-S3: lower limb
S2-C2: perineum
53
Q

What is a plexus?

A

A plexus is a region where spinal nerves merge, swap fibres and form new branches. The nerves from different spinal roots merge.

54
Q

Which plexus supplies the upper limb?

A

brachial

55
Q

Which nerve supplies the anterior compartment of the thigh and what plexus does it come from?

A
  • femoral nerve
  • from the lumbosacral plexus
  • comes under the inguinal ligament
56
Q

Which nerve supplies the medial compartment of the thigh?

A

the obturator nerve (enters through obturator of pelvis)

57
Q

What are the two kinds of innervation?

A

segmental of peripheral

58
Q

Describe the segmental motor supply to the limbs

A

Groups of motor nerve cell bodies in the spinal cord supply particular muscles

C5-T1 = upper limb, L2-S3 = lower limb

There are plexi for each limb

  • Anterior divisions of spinal nerves give rise to the flexor muscles
  • Posterior divisions of spinal nerves give rise to the extensor muscles
59
Q

Describe the principles of segmental motor supply to the limbs

A
  • Muscles are often supplied by two adjacent segments
  • Muscles with the same action on joint will have the same nerve supply
  • Opposing muscles are usually 1-2 segments above or below
  • The more distal in limb (the further away from the trunk) = the more caudal in spine the nerve is
60
Q

List the segmental motor supply to the upper limb - shoulder, elbow, forearm, wrist, long tendons to hand and intrinsic hand

A

Shoulder:

  • Abduction C5, adduction C6-C8
  • External rotation C5, internal rotation C6-C8

Elbow:

  • Flexion C5 and C6
  • Extension C7 and C8

Forearm:

  • Supination (outward rotation) C6
  • Pronation C7 and C8

Wrist:

  • Flexion C6 and C7
  • Extension C6 and C7

Long tendons to hand: - Flexion C7 and C8
- Extension C7 and C8

Intrinsic hand: T1

61
Q

List the segmental motor supply to the lower limb - hip,knee and ankle

A

Hip: Flexion L2 and L3, extension L4 and L5

Knee: Extension L3 and L4, flexion L5 and S1

Ankle: Dorsiflex L4 and L5, plantarflex S1 and S2

62
Q

Describe the dermatomes of the upper and lower limbs

A

In the upper limb, dermatomes are relatively well organised in relation to the spinal origins

In the lower limbs, there are oblique fields (due to twisting during development)

63
Q

What is cutaneous sensory innervation?

A

Refers to the nerves that take fibres from the spinal root to the skin. Due to swapping over at plexi, they may have fibres from other roots as well

64
Q

Where is segmental innervation from?

A

a single spinal root

65
Q

List the sensory segmental supply to the upper limb (dermatomes)

A

C4: infraclavicular region

C5: lateral arm

C6: lateral forearm and thumb

C7: middle finger

C8: little finger and medial forearm

T1: medial arm

T2: axilla and trunk

T4: nipple

T10: umbilicus

T12: lower abdomen

66
Q

What is compartment syndrome?

A

Muscle groups in confined compartments are separated by thick, fibrous septa. If you got swelling in one of these compartments, you would get compression -> COMPARTMENT SYNDROM

67
Q

Where does compartment syndrome commonly occur?

A

anterior, posterior and lateral compartments of the leg

68
Q

What pressure is needed to collapse vessels?

A

50-60 mmHg

69
Q

What can cause compartment syndrome?

A

Acute compartment syndrome (trauma associated)

Chronic compartment syndrome (exercise-induced)

70
Q

What does acute compartment syndrome require and why?

A

emergency fasciotomy to prevent death of muscles and other tissues - skin opened and muscle compartment to relieve pressure

Anatomy of the limbs (5 decks)

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