Part 6 of 6 Anatomy Flashcards

Question 1

Q

The flexor retinaculum is one of the structures arising from the deep fascia.

Answer

A

Fibro-osseous channel allowing passage of soft tissue structures from forearm to hand
Attached mainly to: scaphoid, trapezium, pisiform, hamate
Forms the roof of the carpal tunnel

F486 - Flexor retinaculum

Question 2

Q

Know the anatomy of the carpal tunnel.

Answer

A

Anatomy of Carpal Tunnel

F487 - Anatomy of carpal tunnel

Question 3

Q

What is carpal tunnel syndrome?

List the clinical features and possible causes.

Answer

A

Carpal Tunnel Syndrome

Conditions which causes narrowing of the CT may lead to entrapment neuropathy of the median nerve –> Carpal Tunnel Syndrome

Example Conditions

Repetitive strain injuries
Tenosynovitis
Wrist # and dislocations
Arthritis
Pregnancy
Hypothyroidism

Clinical Features

Early:
- Intermittent Pain** and tingling in the distribution of the nerve
- Pain common at night.
Late:
- Nerve damage from early stages leads to weakness of hand, e.g. dropping objects

F488 - Carpal Tunnel Syndrome

Question 4

Q

Describe the anatomy and movement of the wrist-joint complex.

Answer

A

Wrist-joint Complex

Anatomy

The complex is composed of various joints:

Radiocarpal
Midcarpal
Carpo-metacarpal

Movements

Extension, flexion
Ulnar deviation (adduction)
Radial deviation (abduction)

F489 - Wrist-joint complex

Question 5

Q

Describe these 3 common fractures found in the wrist:

Colle’s fracture
Smith’s fracture
Scaphoid fracture

Answer

A

All 3 of these injuries are caused by FOOSH injuries.

Colle’s Fracture - Common in osteoporosis patients

Distal radius fracture, caused by FOOSH upon extension of wrist
Dorsal displacement of wrist and hand
‘Dinner fork’ appearance

Smith’s Fracture

Distal radius fracture, caused by FOOSH upon flexion of wrist
Ventral displacement of wrist and hand
‘Spoon’ appearance

Scaphoid Fracture

Commonly associated with distal radius fractures, e.g. Smith or Colle’s fractures
Important because avascular necrosis of proximal fragment of scaphoid may result
- Suspect if snuff box is very painful

F490 - Smith’s, Colle’s and scaphoid fractures of wrist.

Question 6

Q

Examine the sacrum and coccyx and identify these features:

Sacrum

auricular surface
promontory
anterior (concave) surface
anterior sacral foramina
posterior (convex) surface
posterior sacral foramina
sacral canal

Coccyx

Sacral articulation

Answer

A

See F532 -
Major anatomical features of the sacrum and coccyx.

Question 7

Q

Examine the hip and identify these major features.

iliac fossa
iliac crest
anterior superior iliac spine
anterior inferior iliac spine
posterior superior iliac spine
posterior inferior iliac spine
gluteal surface
gluteal lines
acetabulum
greater sciatic notch
ischial spine
lesser sciatic notch
ischial tuberosity
obturator foramen
body of pubis
ischiopubic ramus

Answer

A

F533 - Major anatomical features of pelvic girdle.

Question 8

Q

Examine the tibia and fibula and identify these major features:

Tibia

tuberosity
plateau
intercondylar eminence
body (shaft)
medial malleolus
anterior border
interosseous border
medial surface
soleal line

Fibula

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head
neck
lateral malleolus
interosseous border

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Answer

A

See F535 -
Major anatomical features of tibia and fibula.

Question 9

Q

Examine the femur and identify the major anatomical features.

head
neck
greater trochanter
lesser trochanter
intertrochanteric line
intertrochanteric crest
gluteal tuberosity
linea aspera
adductor tubercle <!–[if gte mso 9]><xml><w:WordDocument>
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* medial and lateral condyles
* medial and lateral epicondyles

Answer

A

F534 -
Major anatomical features of femur.

Question 10

Q

Examine the patella and identify these major features:

Apex
Articular surfaces (3)
- Facet for lateral condyle of femur
- Facet for medial condyle of femur
- Surface for patellar ligament

Answer

A

See F534 - Major anatomical features of femur.

Question 11

Q

Explain what the pelvic ring is.

What is a serious clinical complication often related to pelvic fractures?

Answer

A

Pelvic Ring

Pelvic ring is the ‘ring’ made by the sacral bone and the innominate (hip) bone.

Clinical Complication

Massive internal haemorrhage (mainly due to damage to thin walled internal iliac veins).

Question 12

Q

For the femoral nerve, state the:

Motor innervation
Senstory innervation
Spinal segments
Briefly describe basic course

Answer

A

Motor Innervation

Muscles of anterior compartment of thigh, most of which are knee extensors, for example:
- Quadriceps femoris:
  - Rectus femoris
  - Vastus lateralis
  - Vastus medialis
  - Vastus intermedius
Exceptions: psoas major (musc branch lumbar plex.), tensor fasciae latae (sup. glut n.) and pectineus (obt. n.).

Sensory Innervation

Branches:
- Lateral cutaneous nerve (lateral femoral cutaneous n.) –> lateral thigh
- Anterior cutaneous branches –> anterior thigh
- Saphenous nerve –> medial knee, leg and ankle

Spinal Segments

Ventral rami of L2-L4, specifically the posterior divisions of the lumbar plexus

Basic Course

Largest branch of lumbar plexus, has a short course and quickly gives off branches.
Travels posterior to the inguinal ligament within the muscular lacuna, which also contains the iliopsoas (i.e. the joining point of the psoas major and iliacus m.)

See F553 - Femoral nerve course, innervation and branches.

Question 13

Q

For the obturator nerve, state the:

Motor innervation
Sensory innervation
Spinal Segments
Basic course

Answer

A

Motor Innervation

Group: Medial compartment of thigh, i.e. mostly hip adductors. Injury usually occurs inside pelvis and leads to weakened adduction of thigh.
- Anterior branch - pectineus (usually), adductor longus, gracilis, adductor brevis, and skin on the medial side of the thigh
- Posterior branch - obturator externus, adductor magnus (and sometimes brevis)
- Accessory branch (if present) - joins to the anterior branch and supplies pectineus

Sensory Innervation

Small region on inner (medial) thigh

Spinal Segments

L2-4

Basic Course

Originates from lumbar plexus, near the psoas major muscle
Comes out from medial side of psoas major muscle
Divides into deep (posterior) and superficial (anterior) branches around the obturator externus muscle and adductor brevis muscle

F555 - Dermatomes of the lower limb.

Question 14

Q

Be able to draw a line diagram of the dermatomes of the lower limb.

Answer

A

See F555 - Dermatomes of the lower limb.

Question 15

Q

Identify the myotomes in these movements:

Lower limb myotomes:
- Hip flexion
- Hip extension
- Knee flexion
- Knee extension
- Ankle dorsiflexion
- Ankle plantarflexion
- 1st metatarsal (big toe) extension
Reflexes:
- Ankle jerk
- Knee jerk

Answer

A

(See F556 - Myotomes of the lower limb.)

Question 16

Q

Explain the innervation, actions and attachments of these muscles which are found in the anterior compartment of the thigh.

Vastus lateralis
Vastus medialis
Vastus intermedius
Sartorius
Iliopsoas

Answer

A

(See F557 -Muscles of anterior compartment of thigh.)

Question 17

Q

Explain the innervation, actions and attachments of these muscles which are found in the posterior compartment of the thigh.

Semitendinosus
Semimembranosus
Biceps femoris

Answer

A

See F558 - Muscles of posterior compartment of thigh.

Question 18

Q

Explain the innervation, actions and attachments of these muscles which are found in the medial compartment of the thigh.

Adductor longus
Adductor brevis
Adductor magnus

Adductor longus

Adductor brevis
Adductor magnus

Answer

A

See F559 - Muscles of medial compartment of thigh

Question 19

Q

Explain the innervation, actions and attachments of these muscles which are found in the gluteal compartment of the thigh.

Gluteus maximus.
Gluteus medius.
Gluteus minimus.
Tensor fascia latae.
Piriformis.
Obturator internus.

Answer

A

See F560 -
Muscles of gluteal compartment of thigh.

Question 20

Q

Explain the role of the gluteus medius during walking and relate this to the Trendelenburg sign.

Answer

A

Gluteus medius and minimus work together to move the gait cycle from heel strike to toe off. (At leisure, see p292 Netter’s)

They abduct on the weight-bearing limb to minimise pelvic tilting.

Evidence of pelvic tilty (aka ‘gluteal lurch’) = positive Trendelenburg sign, i.e. weak/paralysed abductor muscles.

Question 21

Q

For the sciatic nerve, describe it, then state the:

Motor innervation
Sensory innervation
Spinal Segments
Basic course

Describe what an injury to the sciatic nerve would present as clinically.

Answer

A

Description

Thickest and biggest nerve in the body
Comprised of 2 nerves surrounded by common epineurium:
- Tibial n.
- Common fibular n.

Motor Innervation

Group:
- Posterior compartment of thigh (tibial component), aka mostly hip extensors and knee flexors.
- All muscles of lower leg (below knee) and foot
- Hamstring portion of adductor magnus

Sensory Innervation

Antero- and postero- lateral aspect of leg and almost all the foot

Spinal Segments

L4-S3

Basic Course

Travels through pelvis, then exits, usually inferior to the piriformis muscle
The point of exit is called the greater sciatic foramen
It then travels along the posterior wall of the acetabulum before making its way down the thigh, at which point it runs along the midpoint between the greater trochanter and the ischial tuberosity

Clinical Presentation of Sciatic Nerve Injury

Complete motor loss of the muscles of the posterior thigh, leg and foot; sensory loss over the territories described above.

Question 22

Q

What are the terminal branches of the sciatic nerve and what muscles do they innervate?

Answer

A

Tibial nerve: the muscles of the posterior leg (calf muscles), and some of the intrinsic muscles of the foot
Common fibular nerve: the muscles of the anterior leg, lateral leg, and the remaining intrinsic foot muscles.

Question 23

Q

What precautions must you take when doing intramuscular injections into the buttocks in order to avoid the sciatic nerve?

Answer

A

Injection Volume

Ideal volume is 1-3mL and less than 5mL

Patient Suitability

Not for
Not for emaciated patients

Injection Site

See F561 - Intragluteal injection, sciatic nerve precautions.

Position client in side-lying or supine position, with knee flexed on injection side, or prone with toes pointed inward to rotate femur.
Locate site by palpating the posterior iliac spine where the spine and pelvis meet. Imagine a line from the posterior iliac spine to the greater trochanter.
Administer medication above imaginary line at midpoint.

Question 24

Q

Describe the muscles involved in these common hip movements:

Flexion
Extension
Abduction
Adduction
Medial rotation
Lateral rotation

Also briefly describe the general nerve supply to each of these implicated compartments.

Answer

A

See F562 -

Actions of muscles at hip joint.

Question 25

Q

Explain the spinal roots, main nerves and their root values of the lumbar region of lumbo-sacral plexus.

Also briefly explain the relations of the nerves of the lumbar plexus.

Answer

A

Lumbo-sacral Plexus(Lumbar Region)

Spinal Roots: The lumbar plexus is formed from the anterior rami of L1-L4, T12

6 Branches of Lumbar Plexus

Ian –> iliohypogastric
is –> ilioinguinal
grumbling –> genitofemoral
less –> lat. femoral cutaneous
on –> obturator
Friday –> femoral

Root Values of the Branches

2 from 1
- Iliohypogastric and ilioinguinal both come from L1, I-H is located superiorly to I-I
2 from 2
- Genitofemoral L1-L2
- Lateral fem. cutaneous L2-L3
2 from 3
- Obturator L2-L4 –> medial cmpt of thigh
- Femoral L2-L 4 –> ant. cmpt of thigh

Also note: L4-L5 = lumbosacral trunk

Relations of the Lumbar Plexus Nerves

All the nerves except G & O emerge laterally of psoas major muscle
- G emerges anteriorly from psoas major
- O runs down the medial border of the psoas major

See F563 - Lumbar region of lumbo-sacral plexus.

Question 26

Q

Explain the spinal roots, main nerves and their root values of the sacral region of lumbo-sacral plexus.

Also briefly explain the relations of the nerves of the lumbar plexus.

Answer

A

Lumbo-sacral Plexus (Sacral Region)

Spinal Roots: L4-S4

Main Nerves:

(L4-S2) = Medial portion - common peroneal (fibular) nerve:
- Superior gluteal
- Inferior gluteal
- Piriformis
(L4-S3) Lateral portion - tibial nerve:
- Q = quadratus femoris
- O = obturator internus
- P = posterior femoral cutaneous
- P = pudendal
- C = Coccygeus

‘QOPPC’ = Quit operating post pot consumption

See F564 - Sacral region of lumbo-sacral plexus.

Question 27

Q

Memorise this diagram and the location of the structures labelled, so that you will, by looking at the nerve origins of the nerves, be able to tell which nerves are which in the lumbo-sacral plexus.

Answer

A

See F565 - Important relations of lumbosacral plexus.

Question 28

Q

Know the key anatomical structures and their locations around the sacral plexus, namely:

Lumbosacral trunk
Sciatic nerve
Obturator nerve
Piriformis
Obturator internus
Pelvic diaphragm

Answer

A

See F566 - Important relations of sacral plexus.

Question 29

Q

Summarise the innervation of the muscle compartments of the lower limb.

Thigh: Anterior, medial, posterior
Leg: Anterior, lateral, tibial
Gluteal
Foot

Answer

A

See F567 - Lower limb muscle compartment innervation.

Question 30

Q

Know the myotomes of the lower limb.

Answer

A

See F568 - Myotomes of lower limb.

Question 31

Q

What is the fascia lata, iliotibial tract and tensor fascia lata?

Answer

A

These are anatomical features found on the lower limb.

Fascia Lata

Deep fascia of the thigh

Tensor Fascia Lata

Thigh muscle, which is a tensor fo the fascia lata, allowing stabilisation of hip joint during hip extension

Iliotibial tract

Longitudinal fibrous reinforcement of fascia lata
Withs its associated muscles, the ITBT extends, abducts, and laterally rotates the hip
Stabilizes knee both in extension and in partial flexion, and is therefore used constantly during walking and running. –> Iliotibial Band Syndrome, common thigh injury due to sudden increase in runner mileage

See F569 -
Tensor fascia lata, iliotibial tract and fascia lata.

Question 32

Q

Be able to identify these deep muscles and features of the deep gluteal region:

Gluteus minimus, piriformis, gemellus superior, gemellus inferior, quadratus femoris, obturator internus, greater sciatic foramen below piriformis.

What is the main function of these features?

Answer

A

See F570 - Muscles and features of deep gluteal region.

Deep gluteal muscles are lateral rotators of the hip and they are also very important stabilisers of the hip, e.g. remember rotator cuff muscles.

Question 33

Q

Identify the superior and inferior gluteal nerves found in the gluteal region.

Answer

A

See F571 - Superior and inferior gluteal nerves.

Question 34

Q

Explain the meaning of a positive Trendelenburg test.

Answer

A

In weight-bearing phase of gait cycle (stance phase), pelvis of unsupported side tends to sag.

In a normal human, the gluteus medius contracts to bring the unsupported side (stance leg) back up.

Weakness of the gluteus medius would mean that the 2 sides of the pelvis would not be level. i.e. positive Trendelenburg sign.

Positive Trendelenburg = weak hip adductors

F572 - Trendelenburg sign.

Question 35

Q

Describe the borders and contents of the femoral triangle.

Answer

A

See F573 - Femoral triangle borders and contents.

Question 36

Q

Describe the borders and contents fo the adductor canal.

Answer

A

F574 - Adductor canal borders and contents.

Question 37

Q

Identify the major articular surfaces of the hip joint.

Answer

A

See F575 - Articular surfaces of hip joint.

Question 38

Q

How stable is the hip joint? Explain what features are in place to help stabilise the joint.

Answer

A

Hip Joint Stability

High stability, large force required for dislocation

Factors Contributing to Stability

Bony factors
- Femoral head and acetabulum- close fit, specially in extension. Note that hip extends less than it flexes.
Acetabular labrum
- Fibrocartilage structure around rim of acetabulum, allows deepening of acetabulum - keeps femoral head in place
Muscles
- All muscles of hip joint, but especially the short stabilisers of the gluteal region
Ligaments
- Capsule and capsular thickenings - important for stability
- NB: Ligament on head of femur has no mechanical support, it is just a synovial fold for holding blood vessels

Question 39

Q

What is the capsule of the hip joint? Describe its structure.

Explain the role of the capsule in hip extension.

Answer

A

What is it?

Very strong capsule that surrounds the neck of the femur - covers articulation between femur and hip bone

Structure

Attachments

Hip bone - around acetabulum
Femur
- Anteriorly - Proximally it is attached around the acetabulum and distally to the intertrochanteric line
- Posteriorly - middle of the neck

Composition

Circular and longitudinal fibres
Longitudinal fibres have 3 distinct ligaments
- Iliofemoral ligament
- Pubofemoral ligament
- Ischiofemoral ligament
Internal fibres also present, give rise to retinacular fibres (carry blood vessels and run along femur neck)

Hip Extension

The hip joint is stabilised by the actions of the iliofemoral, ischiofemoral and pubofemoral ligaments. These wind around the neck of the femur in such a way that they tighten in extension. This drives the head of the femur firmly into the acetabulum preventing dislocation and also limits hip extension.

Also, although the joint is very stable, a long femur neck means that a large range of motion is still possible.

Question 40

Q

Study the image shown of the structures found in the posterior hip.

Answer

A

See F577 - Posterior relations of the hip and sciatic n.

Question 41

Q

Describe the blood supply to the femoral head.

Answer

A

F578 -Blood supply of femoral head.

Question 42

Q

What is the cruciate anastomosis?

Briefly explain its clinical significance.

Answer

A

See F579 - Cruciate anastomosis and clinical significance

Question 43

Q

Describe the different types of fractures of the femoral neck.

Answer

A

See F580 - Fractures of the femoral neck.

Question 44

Q

Displaced intra-capsular fracture (hip) is considered as an orthopaedic emergency. Why?

Answer

A

They run the risk of causing avascular necrosis of femoral head.

Involvement of the retinacula fibrescarrying blood vessels to the head of femur -either avulsion or compression due to haematoma inside the joint.
Femoral head blood supply may also be affected due to kinking or avulsion of blood vessels due to fractures and dislocation.

Hence, early reduction of fractures and dislocation is important to prevent avascular necrosis.

Question 45

Q

Describe the mechanism of hip dislocation and reduction.

What would be the clinical priorities and complications in this scenario?

Answer

A

See F581 - Hip dislocation and reduction mechanism

Clinical Priorities

Always exclude vascular injuries first, and monitor the patient for avascular necrosis for 2 yrs.
Neurological damage to sciatic nerve.
- Sensory loss in posterior leg and foot
- Loss of ankle plantar and dorsi flexion
- Loss of ankle reflex
Other fracture complications, e.g. acetabulum fracture if hip abducted, osteoarthritis
General complications - deep vein thrombosis.

See F581 -
Hip dislocation and reduction mechanism.

Question 46

Q

What radiological signs would you look for to differentiate between anterior and posterior dislocation of hip joint?

Answer

A

F582 - Radiological signs in different types of hip dislocation

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Part 6 of 6 Anatomy Flashcards

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