STRUCTURE: MS SYSTEM Flashcards
What nerve innervates the biceps?
C6
What nerve innervates the deltoid
C5
What nerve innervates the radial and ulnar extensors?
C6
What nerve innervates the long and short finger flexors?
C8
What nerve innervates the intrinsic muscles and pollicis brevis?
T1
Where is the glenoid labrum attached and what is its purpose?
Glenoid labrum is attached to the edge of the glenoid fossa. It deeps the socket and helps to stabilise the joint
what are the different ligaments of the GH joint?
Intrinsic + Anterior: - glenohumeral - transverse humeral Extrinsic + superior -coracoacromial -coracohumeral
what structures make up the coraco-acromial arch?
coracoid process
acromion
coraco-acromial ligament
PREVENTS SUPERIOR DISPLACEMENT OF HUMERUS
What is a bursae?
A sac-like cavity near joints containing synovial fluid which also helps facilitate movement
Which part of the humerus does the subscapularis attach to?
the lesser tuberosity hencing on contraction is causing medial rotation
What are the attachments, actions and nerves of teres major?
Attachments: from lateral margin of scapula to the medial lip of the bicipital groove of the humerus
nerve: lower subscapular nerve
action: adducts and medially rotates humerus
Deltoid: attachments, actions and nervous supply?
Attachments: clavicle, acromion and spine of scapula to the deltoid tuberosity of the humerus.
Actions: abductor of the arm BUT requires supraspinatus to initiate the first 15 degrees. Also flex, extend, medially/laterally rotates UL
Nerves: Axillary nerve
attachments of long head of biceps?
Supraglenoid tubercle of the scapula to the radial tuberosity
attachments of coracobrachialis?
coracoid process of scapula to middle 1/3 of humerus
What are the two gateways to the scapular region?
The subscapular notch, upper triangular space, lower triangular space and quadrangular space
What is the acetabulum? Fusion of which bones? Lined by?
The deep socket of the hip joint. Formed by fusion of ilium, pubis and ischium. Lined on the rim by the acetabular labrum.
What is the functional difference between the trochanters and the intertrochanteric line?
Trochanters: muscle attachment
Intertrochanteric line: hip joint capsule and ligament insertion
What are the 3 ligaments of the hip joint?
Iliofemoral
Pubofemoral
Ischiofemoral
Iliofemoral ligament: attachments and function?
Attachments: from anterior, inferior iliac spine to intertrochanteric line
Function: prevents hyperextension of hip joint during standing
Pubofemoral ligament: attachments and function?
Attachments: (blends with iliofemoral) attaches from obturator crest of pubic bone to merge with fibrous capsule
Function: prevents overabduction of hip joint, tightens during abduction and extension of hip
Ischiofemoral ligament: attachments?
Attachments: from acetabular rim to medial part of greater trochanter
Where are the retinacular arteries of the hip joint derived from?
Circumflex femoral and obturator arteries
Name the 3 flexors of the hip joint?
Pecitneus, iliopsoas and Sartorius
Name 5 adductors of the hip joint?
Adduction longus adductor brevis adductor magnus gracilis obturator externus
Extensors of the hip joint? (3)
Semitendinosus
Semimembranosus
Biceps femoris
Abductors/rotators of the hip joint? (6)
Glut maximus, medius and minimus Tensor fascia latae Piriformis Obturator internus Superior and inferior gemelli Quadratus femoris
Muscle supplied by the femoral nerve? (hint: flexors)
Pectineus
Iliopsoas
Sartorius
Attachments of pectineus?
From pubis to the femur
Attachments of iliopsoas?
Made up of psoas major and minor. They attach from vertebrae to the lesser trochanter (major) and pectineal line (minor)
Also made up of Iliacus which attaches from the iliac crest to the lesser trochanter
Attachments of Sartorius?
Attaches from the anterior superior spine to the superior medial tibia.
Attachments and nervous supply of adductor longus and brevis?
from pubis to femur
Obturator nerve
What are the attachments of the adductor part of the adductor magnus? Nervous supply?
from pubis and ischial ramus to the femur
Obturator nerve
What are the attachments of the hamstring part of the adductor magnus? nervous supply?
From ischial tuberosity to the femur
Sciatic Nerve
Attachments of the obturator externus? and nervous supply?
Obturator foramen and membrane to femur
Obturator nerve
Attachments and nervous supply of gracilis?
From pubis to superior/medial tibia.
Obturator nerve
Attachments of semitendinosus? and Nervous supply?
From ischial tuberosity to superior medial tibia
Sciatic nerve
Attachments of semimembranosus? and Nervous supply?
From ischial tuberosity to posterior medial condyle of tibia
Sciatic nerve
attachments of the biceps femoris? nervous supply?
Attaches from ishial tuberosity (Long head) or femur (short head) to the tibula
Sciatic nerve
What is the function fo the anular ligament?
holds the radial head in place, but allows its rotatory movement for supination and pronation
Radial Collateral Ligament, where does it attach?
from just inf. to Lat. Epicondyle, fanning to Anular Ligament (not radius)
Ulnar Collateral Ligament, where does it attach?
2 strong bands and a weaker, posterior fan, from just inf. to Med. Epicondyle, to Olecranon and Coronoid Process of Ulna
Anteriorly, the fibrous capsule is replaced by…
the quadriceps tendon (patellar ligament) and the patella (sesamoid bone), but also augmented by the iliotibial tract and by patellar retinacula from quadriceps
What are the two collateral ligaments of the LL and what are their attachments?
Lateral (Fibular): strong cord from Lat. Epicondyle to Head of Fibula
Medial (Tibial): broad, flat band from Med. Epicondyle to Tibia -condyle and superior, medial surface
What are menisci?
Medial and Lateral crescents of fibrocartilage – give congruence for femur on tibia, shock absorption and proprioception
What is the difference between the medial and lateral menisci?
Medial is attached to the tibial collateral ligament
Lateral is not attached to a ligament and is smaller
Brachioradialis: attachments and innervation?
(Radial Nerve, C6)
Attaches to the lateral supracondylar ridge of the humerus and the distal radius
Brachialis: attachments and innervation?
Attaches to the distal anterior aspect of the humerus and to the coronoid process of the ulna Musculocutaneous Nerve (and radial)
Biceps Brachii: attachments and innervation?
attaches to scapula (long head to supraglenoid tubercle, short head to coracoid process), and to the bicipital tuberosity of the radius, as well as the ulna via the bicipital aponeurosis and deep fascia
Musculocutaneous Nerve
Triceps: attachments and innervation?
Long head: infraglenoid tubercle of the scapula
Lateral head: lateral/superior to spiral groove
Medial head: medial/inferior to spiral groove
–>
All 2 heads attach to the olecranon
What are the muscle involved in supination?
Biceps
Supinator: from ulna to lateral aspect of radius. Radial Nerve
What are the tarsal bones of the foot?
Cuboid, cuneiforms (1-3), talus, calcaneus (heel), navicular
What are the ligaments of the wrist?
Collateral ligaments (radial and ulnar) Radiocarpal ligaments (palmar and dorsal)
Where does the fibrous capsule attach to?
Tibia, both malleoli and talus
Where do all the ligaments of the ankle originate from?
at the malleoli
Flexor carpi ulnaris: attachments and innervation?
Attachments: med epicondyle of humerus to pisiform/hamate
Ulnar nerve
Flexor carpi radialis: attachments and innervation?
Med epicondyle of humerus to base of 2nd metatarsal
Median Nerve
What plantar flexor muscles attach to the posterior surface of the calcaneus? Innervation? Origins?
Gastrocnemius: From lateral and medial condyles of femur
Soleus: From posterior/superior surface of fibula and medial border of tibia
Plantaris: from lateral/distal femur and oblique popliteal ligament
SUPPLIED BY TIBIAL NERVE
Which muscles attach to the digits of the foot?
Flexor digitorum longus: from tibia to distal phalanges of digits 2-5
Flexor halluces longus- from fibula to distal phalanx of digit 1
Where does tibialis posterior attach?
To posterior surface of fibula, tibia and interosseous membrane
Name the deep and superficial venous system of the lower limbs
Deep: Popliteal vein --> femoral vein --> external iliac --> common iliac --> IVC Superficial: Great saphenous (long) Small saphenous (small)
Where does the lymph from the UL drain to?
Axillary lymph nodes which then drain to the subclavian lymph trunk
Where does the lymph from the LL drain to?
Popliteal nodes then Iliac nodes
What muscles does the dorsal scapular nerve innervate?
Levator scapulae and rhomboids
What muscles does suprascapular innervate?
Infraspinatus and supraspinatus
What muscles does the lateral pectoral nerve innervate? Also which part of the brachial plexus does it branch from?
Pec min and major
The lateral cord
What muscle does the upper subscapular nerve innervate?Also which part of the brachial plexus does it branch from?
Subscapularis
Posterior cord
What muscle does the thoracodorsal nerve innervate? Also which part of the brachial plexus does it branch from?
Lat Dorsi
Posterior Cord
What muscles does the lower subscapular nerve innervate? Also which part of the brachial plexus does it branch from?
Subscapularis and teres major
Posterior cord
What muscles does the medial pectoral nerve innervate? Also which part of the brachial plexus does it branch from?
Pec major and minor
Medial cord
What muscles does the Medial cutaneous nerve of the arm innervate? Also which part of the brachial plexus does it branch from?
All sensory supply of the skin in the arm
Medial cord
What muscles does the medial cutaneous nerve of the forearm innervate? Also which part of the brachial plexus does it branch from?
Sensory supply to skin of forearm
Medial cord
Muscles supplied by: Radial terminal branch?
All extensory muscles of arm and forearm
Muscles supplied by: axillary terminal branch?
deltoid, teres minor
Muscles supplied by: musculocutaneous terminal branch?
Flexor compartment of the arm (BBC)
Muscles supplied by: Median terminal branch
All flexors of the forearm (except flexor digitorum ulnaris), thenar muscles and lateral 2 lumbiricals
Muscles supplied by: ulnar terminal branch?
Flexor digitum ulnaris of the forearm, intrinsic muscles of the hand
Which nerves from the lumbar plexus supply the lower limb? (5)
Ilioinguinal Lateral cutaneous of thigh Genitofemoral Femoral Obturator
What nerves from the sacral plexus supply the lower limb? (4)
Super gluteal
Inferior gluteal
Sciatic
Posterior femoral cutaneous
What does the median nerve supply in the hard?
LOAF Lateral 2 lumbricals Opponens pollicis Abductor pollicis Flexor pollicis
What 3 arteries branch from the subclavian artery? and where do they supply?
Internal thoracic: sternal end of clavivle and 1st CC before descending into thorax
Thyrocervical trunk: gives of suprascapular and others for neck
Suprascapular: Crosses under clavicle to supraspinous fossa then infraspinous fossa
The axillary artery is split into parts based on which muscle?
Pec minor (1st part = proximal, 2nd part= behind, 3rd part= distal)
How many branches are there in the 1st part of the axillary artery and what is it?
1 branch:
Superior thoracic. Supplies anterior wall of the thorax
How many branches are there in the 2nd part of the axillary artery and what is it?
2 branches:
Thoraco-acromial- anterior wall of axilla and thorax.
Lateral thoracic- breast and anterior wall of the thorax
How many branches are there in the 3rd part of the axillary artery and what is it?
3 branches: All supply the posterior wall of the axilla
Anterior circumflex humeral, posterior circumflex humeral, Subscapular (when then branches into Thoracodorsal and circumflex scapular)
Terminal branches of the brachial artery?
Radial and ulnar
Main branches of the brachial artery?
Profunda brachii Collateral branches (Superior and inferior)
From medial to lateral what are the structures you would meet in the cubital fossa?
Pronator teres Median nerve Brachial artery (as brachial artery ends at cubital fossa) Tendon of biceps Brachioradialis
What are the three branches of the ulnar artery in the forearm?
Common, anterior and posterior interosseous arteries
What is the terminal branch of the ulnar artery?
Superficial palmar arch
Which is a larger branch of the brachial artery, ulnar or radial?
Ulnar
The deep palmar arch is branch of the …..
radial artery
Where does the ulnar artery enter the hand?
anterior to the flexor retinaculum between pisiform and hamate
What does the superficial palmar arch supply?
the common digital arteries which branch into the proper palmar digital arteries (2-4 digits) and anastomose with palmar metacarpal arteries.
Where does the radial artery enter the hand?
Curving posteriorly around scaphoid and trapezium cross the anatomical snuff box
What does the deep palmar arch supply?
Palmar metacarpal arteries
Princeps pollicus artery
Radial indices artery
Name the 5 main veins of the UL and roughly where the travel
Cephalic: along lateral border of the wrist and anterolateral surface of the forearm and arm. Joins with axillary vein
Basilic: medial forearm and inferior arm. Merges with deep veins to FORM the axillary vein
Median cubital: branch of cephalic that communicate with the basilica at cubital fossa
Median vein of the arm
Axillary vein
Where can pulses be felt in the UL?
Midshaft of humerus
Cubital fossa
Wrist (radial pulse)
What does the external iliac branch into and where do these vessels supply?
The femoral and profunda femoris artery.
These supply the hip joint, thighs, legs and feet
What does the internal iliac branch into and where do these vessels supply?
The superior and inferior gluteal arteries and internal pudendal artery
What structure outline the femoral triangle?
the inguinal ligament (base)
the Sartorius muscle (lateral border)
Adductor (medial border)
From medial to laterial name the structures present inside the femoral triangle?
Femoral vein
Femoral artery
Femoral nerve
The femoral sheath encloses the which structures?
The femoral artery and vein
NOT THE NERVE
What other vessels arise from the femoral artery apart from profunda femoris?
Superficial epigastric
Superficial circumflex iliac
Deep and superficial external pudendals
What does the obturator artery supply?
Head of acetabulum, hip adductors, knee and skin of medial thigh
What vessels provide the main arterial supply to the femoral head?
circumflex femorals and obturator arteries
What structures are before and after the popliteal artery? And as which point does it become the popliteal artery?
Femoral artery –> (at adductor hiatus) popliteal artery –>branches into posterior and anterior tibial arteries
How many genicular branches are there from the popliteal artery? And what muscles do they supply?
There are 5 genicular branches which supply hamstring, gastrocnemius, soleus and plantaris muscles
The anterior tibial artery supplies which group of muscles? And what does it become?
the dorsiflexors in the anterior compartment of the leg
Becomes the dorsalis pedis artery
The posterior tibial artery supplies which group of muscles? And which arteries does it give of? and what does it become?
Plantar flexors in the posterior compartments of the legs
Gives of: fibular, circumflex fibular and nutrient arteries Becomes the medial and lateral plantar arteries
What does dorsalis pedis supply, what are its branches and what vessels does it give rise to?
Supplies the dorsum of the foot
Branches: lateral tarsal, deep plantar, arcuate, 1st dorsal metatarsal
Gives rise to dorsal digital arteries of the phalanges
What does the medial and lateral plantar arteries supply, what are their branches and what vessels do they give rise to?
Supplies the sole of the foot
Branches: superficial and deep plantar arches
Gives rise to plantar digital arteries of the phalanges
Where does venous drainage of the LL originate from?
the dorsal venous arch of the foot and dorsal veins of the foot
What are the main two veins in the LL?
Great saphenous (joins femoral vein) and small saphenous (merges with deep veins to form popliteal vein)
What are lymph nodes?
Small nodules that filter and phagocytoise particulate matter with the help of macrophages and lymphocytes. All drainage goes back to the venous system
What are the three superficial and palpable lymph nodes?
Cervical, axillary (all lymph from thoracic wall)and inguinal
The lymph vessels accompanying the basilica vein drain to a series of nodes around the elbow, what are these nodes called?
Superficial and deep cubital lymph nodes.
What are the 5 groups present in the axillary lymph nodes? And where do the receive their lymph?
Lateral (humeral) nodes (from upper limb)
Anterior (pectoral) nodes (receives from anterior thoracic wall and breast)
Posterior (subscapular) (from posterior thoracic wall and scapula)
Central (receives from previous 3)
Apical (receives from central)
Where does lymph from the apicial axillary nodes drain to?
Supraclavicular nodes and then to the subclavian lymph trunk. Then then drains into the venous system at the junction between internal jugular and subclavian veins
Where do the lymph vessels accompanying the great saphenous vein along the leg and thigh drain to?
superficial inguinal lymph nodes then deep injunial nodes then the extental iliac nodes
Where do the lymph vessels accompanying the small saphenous vein along the leg drain to?
popliteal lymph nodes to the deep inguinal nodes
Note: deep channels also follow this route
Then to the external iliac nodes
Are the superficial inguinal nodes inside or outside of the femoral triangle? and the deep inguinal nodes?
Outside- superficial
Inside- Deep
Where do the superficial nodes receive from?
Anterior abdominal
Perineum
Gluteal region
Superficial lower limb
Where do the deep inguinal nodes drain?
Lower limb
Most of the drainage from the superficial inguinal nodes
External genitalia
Deep and Sup. inguinal nodes –>……. —> venous system
External iliac nodes–> Common iliac nodes –>lateral lumbar lymph nodes –> thoracic duct/cisterna chyli
What is the femoral ring?
an opening of the femoral canal at the abdominal side
What does a positive Trendelenburg test show?
When glut medium and minimus are injuryed results in a waddling gait. This is seen as raiding of the pelvis to allow clearance of the foot moving forward
What muscles does the sciatic nerve and its branches supply?
Hamstrings and all muscles of the leg and foot
What muscles does the superficial fibular nerve innervate?
Fibularis longus and brevis
What muscles does the deep fibular innervate?
Tibialis anterior
EDL, EDB
EHL, EHB
Fibularis tertius
What does muscles does the femoral nerve innervate?
Hip flexors: Pectineus, iliacus, Sartorius
Knee extensors: Quadriceps femoris
When is intramembranous ossification?
The formation of bone in fibrous connective tissue (which is formed from condensed mesenchyme cells)
What is mesenchyme?
Generalised embryonic connective tissue derived from mesoderm
At week 7 gestation, what happens to the limbs of the foetus?
The forelimbs rotate 90 degrees laterally
The hind limbs rotate 90 degrees medially
What is the UL equivalent to the hallux?
Pollux
What do HOX genes code for?
Transcription factors which then regulates the expression of other genes.
During embryonic development HOX genes determine the body axis and the positions of the limbs
What are the three axis which limb growth is regulated along?
- Proximo-distal
- Antero-posterior
- Dorso-ventral
What controls proximo-distal development?
AER (Apical Ectodermal Ridge)
What structures make up the limb bud?
Core of mesenchyme
Ectoderm which forms the outer covering of the limb
Ectoderm is thickened at the ‘apex’ of the developing limb to form the Apical Ectodermal Ridge (AER)
What does the AER do?
Induces the underlying tissue to remain as a population of undifferentiated, rapidly proliferating cells known as the progress zone
What happens to cells as they move away from the AER?
They begin to differentiate into cartilage and muscle
What is the mechanism of proximo-distal development?
- HOX-8 genes control the position of the long axis of the body
- Initiation of outgrowth of the fore limb is controlled by transcriptor factors and growth factors
- AER secretes growth factors (FGF4 and FGF8) to maintain the progress zone
- As growth progresses, mesenchymal cells are left behind and differentiate.
What structure controls the antero-posterior axis?
ZPA- Zone of polarizing Activity
How is development of the antero-posterior axis controlled?
Clusters of cells near the posterior border of the limb form the ZPA which regulates the AP axis. It ensures that the thumb grows on the anterior side of the lib bud.
ZPA expresses the preotin Sonic Hedgehog
What substance initially stimulates endoderm to be ventral?
Presence of BMPs (Bone morphogenetic protein)
Dorsal surface doesn’t contain BMP
BMP in ventral endoderm —> —> —> Cells specifies not to be dorsal
BMP in ventral endoderm—> EN1 production —>decrease in WNT7 —>Cells specifies not to be dorsal
Expression of HOX genes is dependent on: (3, one for each axis)
Sonic Hedgehog: Antero-posterior
FGFs: Proximo-distal
WNT7a: Dorso-ventral
What is: Amelia? Meromelia? Phocomelia? Micromelia?
Amelia: Complete absence of the limbs
Meromelia: Partial absence of the limbs
Phocomelia: Absence of long bones
Micromelia: Segments of abnormally short bones
What does thalidomide consumption cause to the feotus of pregnant women?
Blocks the signal of the progress zone, at the AER, hence prevent the moving out and creating of the upper limb bud
What is Hold Oram Syndrome?
TBX5 (transcription factor) mutation leads to failuare of the limb bud development
Adductor canal: contents?
The adductor canal serves as a passageway from structures moving between the anterior thigh and posterior leg. It contains the femoral artery, femoral vein, nerve to the vastus medialis and the saphenous nerve (the largest cutaneous branch of the femoral nerve).
As the femoral artery and vein exit the canal, they become the popliteal artery and vein respectively.
Adductor canal: path?
From the apex of the femoral triangle to the adductor hiatus of the adductor magnus
Adductor canal: Borders?
The adductor canal is bordered by muscular structures:
•Anterior: Sartorius.
•Lateral: Vastus medialis.
•Posterior: Adductor longus and adductor magnus.
What are the borders of the femoral triangle: Superior? Lateral? Medial? Anterior? Posterior?
- Superior border – Formed by the inguinal ligament, a ligament that runs from the anterior superior iliac spine to the pubis tubercle.
- Lateral border – Formed by the medial border of the sartorius muscle.
- Medial border – Formed by the medial border of the adductor longus muscle. The rest of this muscle forms part of the floor of the triangle.
- Anteriorly, the roof of the femoral triangle is formed by the fascia lata.
- Posteriorly, the base of the femoral triangle is formed by the pectineus, iliopsoas and adductor longus muscles.
What is the role of the inguinal ligament in the femoral canal?
The inguinal ligament acts as a flexor retinaculum, supporting the contents of the femoral triangle during flexion at the hip.
