Regional anatomy Flashcards
What are the walls of the compartments of the thigh?
Fascia lata septa attached to the line aspera of the femur.
What is the saphenous opening?
An opening in the fascia lata inferior to the medial inguinal ligament and inferolateral to the pubic tubercle. Allows the passage of the efferent lymph vessels and great saphenous vein and tributaries.
What are the attachments of the fascia lata?
Superiorly it attaches to the inguinal ligament, pubic arch, body of pubis, pubic tubercle, scrap fascia, iliac crest, sacrum and coccyx, inferiorly to the exposed parts of the bones of the knee and the deep fascia of the leg.
What does the fascia lata form laterally?
Iliotibial tract
What is the superficial venous drainage of the lower limb?
Great and small saphenous veins, found in the subcutaneous tissue.
What are the tributaries of the great saphenous vein?
Dorsal vein of the great toe and the dorsal venous arch of the foot
Where does the great saphenous vein run?
Ascends anterior to the medial malleolus, posterior to the medial condyle of femur, anastomoses with small saphenous vein, into the saphenous opening and to the femoral vein.
What other superficial veins are there?
Lateral cutaneous vein
What is the course of the small saphenous vein?
Ascends posterior to medial malleolus, lateral border of calcanea tendon, midline of the fibula and penetrates deep fascia, empties into the popliteal vein in the popliteal fossa.
What are the deep veins of the lower limb?
Anterior tibial vein, medial and lateral plantar veins, posterior tibial and fibular veins, join popliteal vein in popliteal fossa.
Where does the femoral vein pass?
Deep to the inguinal ligament to become the external iliac.
What is the lymph drainage of the lower limb?
The superficial lymph follows the saphenous veins and drains to the superficial inguinal lymph nodes and popliteal lymph nodes. The deep lymph follows the deep veins and drains to the deep lymph nodes and the lumbar lymphatic trunks.
What are the nerve roots of the cutaneous nerves innervating the skin of the lower limb?
T12 or L1
Which never roots supply lateral external rotation of the hip?
L1 and L5
Which never roots supply medial internal rotation of the hip?
L1, L2, L3
Which never roots supply adduction of the hip?
L1, L2, L3, L4
Which never roots supply abduction of the hip?
L5, S1
Which never roots supply inversion of the ankle?
L4, L5
Which never roots supply eversion of the ankle?
L5, S1
Which never roots supply dorsiflexion of the phalanges?
L5, S1
Which never roots supply plantar flexion of the phalanges?
S1, S2
Which never roots supply hip extension?
L4, L5
Which never roots supply hip flexion?
L2, L3
Which never roots supply knee extension?
L3, L4
Which never roots supply keep flexion?
L5, S1
Which never roots supply ankle dorsiflexion?
L4, L5
Which never roots supply ankle plantarflexion?
S1, S2
What causes compartment syndrome?
Trauma to muscles or vessels such as burns, blunt trauma, or intense use may cause haemorrhage or oedema. Because the boundaries of the compartments by the fascia lata are strong the intracompartmental pressure will build causing compression of nerves and vessels in that compartment. Structures distal to this may become ischaemic and numb.
How do varicose veins arise?
Valves in the great saphenous vein are incompetent due t dilation and rotation, causing blood to flow inferiorly.
What are the roots of the femoral nerve?
L2-L4
What are the phases of the gait cycle?
Stance phase- heel strike and push off, loading response as foot is flattened and mid stance. Heel off, pressing, toe off.
Swing phase- initial and midswing, terminal swing.
What are the functions of the anterior thigh muscles?
Flexors of the hip and extensors of the knee
What is the action of the pectineus?
Superior rams of pubis to femur, femoral nerve and part of obturator, medial rotation and adduction of the thigh.
What is the action of the iliopsoas?
Flexor at the hip, attached T12 to L5 and innervated from L1, L2 and L3
What is the action of sartorius?
Stretches across the hip and knee joint from ASIS to medial tibia and flexes at the knee, flexes hip, abducts and medially rotates. Femoral nerve, L2, L3.
Which muscles make up the quadriceps femurs and what is the innervation?
Vastus medialis, vastus lateralis, vastus intermedius and rectus femoris. Innervated by the femoral nerve, L2, L3, L4.
What is the action of quadriceps femoris?
Flexion of the thigh at the hip joint and extension of the leg at the knee joint.
Where does the quadriceps femurs attach distally?
Quadriceps femoris tendon which becomes the patellar ligament.
Which part of the quadriceps femurs elicits flexion at the hip joint?
Rectus femoris
Which nerve supplies the medial compartment of the thigh?
Obturator nerve
What are the general attachments of the adductor muscles?
Anteroinferior external surface of the pelvis to the line aspera of the femur.
Which muscles make up the medial compartment?
Adductor longus, adductor brevis, adductor magnus, gracilis, obturator externus.
What are the actions of the adductor muscle group?
Adduct the thigh, stabilise stance when standing and contribute to extension of flexed thigh and flexion of extended thigh in running.
What is the adductor hiatus?
Opening between the adductor magnus and hamstring part of the same muscle transmitting the femoral artery and vein from the adductor canal in the thigh to the popliteal fossa.
What are the borders of the femoral triangle?
Superior- inguinal ligament
Medially- lateral border of adductor longus
Laterally- medial border of sartorius
Floor- iliopsoas laterally and pectineus medially
Roof- fascia lata, cribriform fascia and subcutaneous fat and skin.
What are the contents of the lateral triangle?
Lateral to medial- femoral nerve, femoral artery, femoral vein, deep inguinal lymph nodes.
What is the adductor canal?
Deep to sartorius, it transmits the neuromuscular bundle.
What is the terminal cutaneous branch the femoral nerve?
The saphenous nerve.
What does the saphenous nerve supply?
The skin over the knee, leg and foot
What are the boundaries of the adductor canal?
Anteriorly and laterally- vastus medialis
Posteriorly- adductors longus and magnus
Medially- sartorius
How can the femoral artery be visualised?
Cannulated just inferior to the mid inguinal ligament and arteriography imaged.
What are the superficial muscles of the gluteal region, their attachments, actions and innervations?
Gluteus maximus, ala of ilium to iliotibial tract. Power extensor and lateral rotation, inferior gluteal nerve, L5, S1, S2.
Gluteus medius, ala of ilium to lateral greater trochanter. Abduct and medially rotate thigh, support ipsilateral side in swing stage of gait. Superior gluteal nerve, L5, S1.
Gluteus minimus, ala of ilium to anterior greater trochanter. Abduct and medially rotate thigh, support ipsilateral side in swing stage of gait. Superior gluteal nerve, L5, S1.
What are the deep muscles of the gluteal region?
Piriformis- S1, S2
Obturator internus- L5, S1
Superior and inferior gemelli- L5, S1
Laterally rotate extended thigh and abduct flexed thigh, stabilise femur in acetabulum.
Which muscles make up the hamstring?
Semitendinosus- ischial tuberosity to tibia.
Semimembranosus- ischial tuberosity to tibia.
Tibial branch of sciatic, L5, S1, S2. Extend thigh, flex leg, medial rotation.
Biceps femoris- ischial tuberosity and linea aspera to lateral head of fibula. Long head- tibial sciatic, L5, S1, S2 and short head fibular sciatic, L5, S1, S2.
What are the boundaries of the popliteal fossa?
Superolaterally- biceps femoris
Superomedially- semimembranosus and semitedinosus
Inferolaterally and inferomedially- lateral and medial gastrocnemius.
Posteriorly- skin and popliteal fascia
What are the contents of the popliteal fossa?
Termination of the small saphenous vein, popliteal vein, popliteal artery, tibial and common fibular nerve.
Where does the common fibular nerve run?
It leaves the popliteal fossa and passes superficial to the lateral head of the gastrocnemius and winds around the head of the fibula and divides into its terminal branches.
What is the innervation of the anterior compartment of the leg?
Deep fibular L4, L5
What is the innervation of the lateral compartment of the leg?
Superficial fibular, L5, S1, S2
What is the innervation of the posterior compartment of the leg?
Tibial nerve, S1, S2
What is the innervation of the medial compartment of the thigh?
Obturator nerve L2, L3, L4
What is the innervation of the anterior compartment of the thigh?
Femoral nerve L2, L3, L4
What is the innervation of the posterior compartment of the thigh?
Sciatic nerve, L5, S1, S2
Which muscles make up the anterior compartment of the leg?
Extensor digitorum longus, extensor hallucis longus, tibialis anterior, fibularis tertius. Dorsiflexion.
Which muscles make up the lateral compartment of the leg?
Fibularis brevis and fibularis longus, they evert and weakly plantar flex.
Which muscles make up the superficial posterior compartment of the leg?
Gastrocnemius, soleus and plantaris. Plantarflexion
Which muscles make up the deep posterior compartment of the leg?
Flexor digitorum longus- flexes lateral 4 digits, plantarflexes ankle, flexor hallucis longus- flexes great toe and pf ankle, popliteus- unlocks the knee, tibialis posterior- plantar flexes the ankle
What happens with an injury to the tibial nerve?
Uncommon because it is deep in the popliteal fossa but could be injured by deep laceration or posterior dislocation of the knee joint. Paralysis of flexor muscles in the leg and intrinsic muscles in the sole of the foot. Unable to plantar flex the ankle and flex the toes. Loss of sensation to the sole of the foot.
What symptoms and signs are there of an injury to the common fibular nerve?
Vulnerable to direct trauma around the head of the fibula. Severed during fractured fibular neck. Common fibular nerve damage results in paralysis of all muscles in the anterior and lateral compartments. Loss of dorsiflexion- foot drop.
What are the means of compensating for a limb too long? eg. by foot drop or pelvic tilt
1) Waddling gait, leans onto opposite side
2) Swing out gait, long limb swung laterally so toes clear the ground
3) Steppage gait- high stepping with extra flexion at hip and knee to raise the foot and toes off the ground.
What are the implications of deep fibular nerve entrapment?
Pain in the anterior compartment and the dorm of the foot.
What are the implications of superficial fibular nerve entrapment?
Lateral leg and dorm of foot pain. Numbness.
What happens in a clavicular fracture?
SCM pulls the medial bone up and the trapezius is unable to support the weight so the shoulder drops.
What are the possible humeral fractures and possible nerve damage for each?
Surgical neck, axillary
Supracondylar, median
Midshaft/radial groove, radial
Medial epicondyle, ulnar
What is a Colles fracture?
Transverse fracture of the radius creating a dinner fork deformity
What is the clinical significance of a scaphoid fracture?
Has a circumflex blood supply so the proximal scaphoid may suffer avascular necrosis.
What is the clinical significance of a fractured hamate?
Ulnar nerve runs near the hook so could be damaged.
What are the extrinsic muscles of the shoulder, their actions and innervations?
Trapezius- retracts scapula, CNXI
Latissimus dorsi- extends, adducts, medially rotates humerus and raises body towards arms, thoracodorsal nerve.
Levator scapulae- elevates scapula, dorsal scapular nerve
Rhomboid minor and major- retract scapulae, dorsal scapular nerve
What are the intrinsic muscles of the shoulder, their actions and innervations?
Deltoid- flex and medially rotate arm, abducts arm and extends and laterally rotates arm, axillary nerve
Supraspinatus- initially assists deltoid in abduction, rotator cuff, suprascapular nerve
Infraspinatus- laterally rotates, rotator cuff, suprascapular nerve
Teres minor- laterally rotates, rotator cuff, axillary nerve
Teres major- adducts and medially rotates, lower sub scapular nerve
Subscapularis- medially rotates, rotator cuff, holds head of humerus in gleaned cavity, upper and lower sub scapular nerves
What occurs with paralysis of the serrates anterior?
Long thoracic nerve injury, medial border of scapula moves laterally and posteriorly, becomes a winged scapula. Also may not be able to abduct above horizontal because serrates anterior unable to rotate the gleaned cavity superiorly.
What happens with an injury of CNXI?
Ipsilateral weakness in shoulder elevation
Injured thoracodorsal nerve consequences?
Supplies the latissimus dorsi, unable to raise the trunk with upper limbs in climbing
Injured dorsal scapular nerve consequences?
Nerve to rhomboids, scapula further from the midline.
Axillary (C5, C6) nerve injury consequences?
Regimental badge sign, deltoid atrophies, flattened shoulder appearance, loss of theres minor.
What are the boundaries of the axilla?
Apex- 1st rib, clavicle, superior edge of the scapula
Base- concave skin, subcutaneous and axillary fascia
Anterior- Pectorals major and minor and pectoral and clavipectoral fascia
Posterior- Scapula and subscapularis, theres major and latissimus dorsi
Medial- thoracic wall and serratus anterior
Lateral- intertubercular sulcus in humerus
What are the contents of the axilla?
Axillary artery and vein, lymph vessels and axillary lymph nodes, cords and branches of brachial plexus.
What are the muscles of the arm, actions and innervations?
Biceps brachii- flexes and suppinates forearm, musculocutaneous
Coracobrachialis- flex and adduct the arm, resist dislocation of the shoulder, musculocutaneous
Brachialis- flexes forearm, musculocutaneous and radial laterally.
ANTERIOR
Triceps brachii- extends forearm, resists dislocation of the humerus, radial nerve
Anconeus- Extends forearm, stabilises elbow joint, abduct ulna in pronation, radial nerve
POSTERIOR
What happens in a radial nerve injury?
Paralysis of triceps, brachioradialis, supinator, extensor of muscles of wrist and fingers. If injured in the radial groove the triceps isn’t fully paralysed because only medial head affected, wrist drop.
What are the superficial muscles in the anterior compartment of the forearm?
Pronator teres, flexor carpi radialis, palmaris longus- median nerve, flexor carpi ulnaris- ulnar nerve
What are the intermediate muscles in the anterior compartment of the forearm?
Flexor digitorum superficialis- median nerve
What are the deep muscles in the anterior compartment of the forearm?
Flexor digitorum profundus, ulnar and median nerves, flexor pollicis longus and pronator quadratus- median nerve
What are the superficial muscles in the posterior compartment of the forearm?
Brachioradialis, extensor carpi radialis, extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi, extensor carpi ulnaris, RADIAL NERVE
What are the deep muscles in the posterior compartment of the forearm?
Supinator, extensor indicis, abductor pollicis longus, extensor pollicis longus, extensor pollicis brevis, RADIAL NERVE
What are the compartments of the intrinsic muscles of the hand?
Thenar compartment, adductor compartment, hypothenar compartment, central compartment, interosseous compartment
What are the thenar muscles of the hand?
Opponens pollicis- median nerve-oppose thumb
Abductor pollicis brevis- median nerve- abducts thumb
Flexor pollicis brevis- superficial head median, deep head ulnar- flexes thumb
Adductor pollicis- ulnar nerve- adducts thumb
What are the hypothenar muscles of the hand?
Abductor digiti minimi- ulnar- abducts 5th digit
Flexor digiti minimi- ulnar- flexes proximal phalanx of 5th digit
Opponens digiti- ulnar- opposition with thumb
What are the short muscles of the hand?
Lumbricals- 1st and 2nd- median, 3rd and 4th- ulnar,- flex MCP, extend IP
Dorsal interossei- abduct digits 2-4, ulnar nerve
Palmar interossei- aduct digits 2,4,5
