Unit 5 & 6 Flashcards
Muscle test for L4
Tibialis Anterior (Dorsi-flexed, inversion)
Reflex test for L4
Patellar tendon (Quads)
Sensory test for L4
Medial foot
Muscle test for L5
Ext. Hallicus Longus (Dorsi-flexion of big toe)
Reflex test for L5
Medial Hamstring (Hard to elicit)
Sensory test for L5
Dorsal foot
Muscle test for S1
Fibularis longus and brevis (Dorsi-flexion and eversion)
Gastroc/soleus (toe walking)
Reflex test for S1
Achilles tendon
Sensory test for S1
Lateral foot
Segments of the lumbar plexus
L1-4
What two nerves from the lumbar plexus only come from L1?
Iliohypogastric
Ilioinguinal
Anterior division nerves of the lumbar plexus
Iliohypogastric
Ilioinguinal
Genitofemoral
Obturator
Posterior division nerves of the lumbar plexus
Lateral femoral cutaneous
Nerve to psoas and iliacus
Femoral
Segments of the genitofemoral nerve?
L1, 2
Segments of the lateral femoral cutaneous nerve?
L2, 3
Segments of the nerves to psoas and iliacus?
L2-4
Segments of the femoral nerve?
L2-4
Segments of the obturator nerve?
L2-4
Muscles innervated by the iliohypogastric nerve (L1)
Transversus abdominus
Internal oblique
Cutaneous innervations of the ilioinguinal nerve
Upper and medial part of the thigh
Skin over root of penis, upper part of scrotum (male)
Skin over mons pubis, labia majora (female)
Cutaneous innervations of the iliohypogastric nerve
Lateral gluteal region
Above the pubis
Hypogastric area (above the inguinal ligament)
List the three nerves in order of most likely to be entrapped in the inguinal ring area to least likely
- Ilioinguinal
- Genitofemoral
- Iliohypogastric
The genital branch of the genitofemoral nerve supplies what muscle? (In males)
Cremaster
The genital branch of the genitofemoral nerve supplies what cutaneous areas?
Anterior scrotum (male) Skin of mons pubis and labia majora (females - same as ilioinguinal)
The femoral branch of the genitofemoral nerve supplies what cutaneous area?
Upper anterior thigh
Clinical significance of the lateral femoral cutaneous nerve?
Meralgia Paresthetica (tingling, burning, pain in lateral thigh)
Borders of the femoral triangle
Lateral: medial border of sartorius m
Medial: medial border of adductor longus m
Upper: inguinal ligament
Innervation of quadratus lumborum muscle
Ventral primary rami of T12-L4
Cutaneous branches of the femoral nerve
Anterior femoral cutaneous
Saphenous nerve
The saphenous nerve distribution resembles what segmental dermatome?
L4
___ may present as “foot drop”, while ____ does not
L4 radiculopathy, femoral neuropathy
The obturator nerve exits the pelvic cavity via the obturator foramen and must pierce what muscle as it descends to innervate the medial thigh?
Obturator externus
What is a cause of exercise-related groin pain?
Obturator neuropathy
Spinal segments of tibial nerve
L4-S3
Spinal segments of the common fibular nerve
L4-S2
The common fibular portion of the sciatic nerve will innervate what muscle?
Biceps femoris (short head)
Biceps femoris-long head is innervated by what nerve?
Sciatic (tibial portion)
The superficial fibular nerve will innervate what two muscles?
Fibularis longus, brevis
Spinal segments of the nerves to quadratus femoris and inferior gemellus
L4-5
Spinal segments of the nerves to obturator internus and superior gemellus
L5-S2
Spinal segments of the pudendal nerve
S2-4
Nerves arising from the posterior division of sacral plexus (3)
Superior gluteal
Inferior gluteal
Nerve to the piriformis
The most common entrapment of the sciatic nerve
Piriformis syndrome
What can be found in the tarsal tunnel?
- Posterior tibial nerve
- Artery and Vein
- Tendons of:
Tibialis posterior
Flexor digitorum longus
Flexor hallucis longus
(Tom, Dick and Harry)
Cutaneous branch formed by the tibial and common fibular nerves? Covering posterolateral leg and lateral foot
Sural nerve
Terminal branches of the tibial nerve
Medial and lateral plantar nerves
Muscular branches of the medial plantar nerve (4)
Abductor hallucis
Flexor hallucis brevis
Flexor digitorum brevis
First lumbrical
Muscular branches of lateral plantar nerve (7)
- Lateral three lumbricals
- Quadratus plantae
- Flexor digiti minimi brevis
- Abductor digiti minimi
- Adductor hallucis
- Plantar interossei (PADs)
- Dorsal interossei (DABs)
When thinking of the medial and lateral plantar nerves, think of _____ nerves in the hand
Median (medial plantar)
Ulnar (lateral plantar)
Deep fibular nerve entrapment would present as:
Paresthesia in the dorsal web between 1st and 2nd toes, and foot drop.
The medial sural cutaneous nerve is a branch from _____, while the lateral sural cutaneous nerve is a branch from ____
Tibial nerve, common fibular
The superficial fibular nerve’s cutaneous distribution is comparable to what dermatome?
L5 (dorsal foot)
The deep fibular nerve has a very unique cutaneous distribution. Describe it
The dorsal web between 1st and 2nd toes
Entrapment of the superficial fibular nerve would cause:
Loss of fibularis longus and brevis muscles
The cutaneous branches of the superficial fibular nerve are: (2)
Medial and intermediate dorsal cutaneous nerves
Spinal segments of the deep fibular nerve
L4-S2 (same as common fibular)
Cutaneous nerves over gluteal region (buttocks)
Superior cluneal (main)
Medial cluneal
Inferior cluneal
The superior cluneal nerve is the D1R of what spinal segments?
L1-3
The only nerve below the knee NOT derived from the sciatic nerve?
Saphenous nerve
What are the four attributes of stimulus?
- Quality or Modality
- Intensity
- Duration
- Location
The 3 broad types of sensory receptors:
- Exteroceptors
- Proprioceptors
- Interoceptors
Meissner’s corpuscles, Pacinian corpuscles, merkel cells, and ruffini endings are all examples of ____receptors
Mechanoreceptors
What functional axon(s) would Meissner’s and Pacinian corpuscles be associated with?
GSA
Pacinian can also be GVA
Meissner’s and Pacinian corpuscles are ____ adapting receptors
Rapidly
Merkel cells and Ruffini endings are _____ adapting receptors
Slowly
Cold thermoreceptors respond to temps between ___ and ___ C, and greater than ___ C (paradoxical cold)
5 and 35 degrees,
45 degrees
Warm thermoreceptors respond to temps between ___ and ___ C
30 and 45 degrees
Baroreceptors and Chemoreceptors are examples of ____ (Exter, proprio, inter)
Interoceptors
The two major types of nociceptors
- High threshold mechanical nociceptors
- High threshold polymodal nociceptors
All nociceptors are _____ of A-Beta and C fibers
Free nerve endings
Are nociceptors rapidly adapting or slowly adapting?
Slowly adapting
The most effective stimulus of this type of nociceptor is sharp objects, and is associated with free nerve endings of A-delta axons
High threshold mechanical nociceptors
This type of nociceptor is activated by all types of tissue damaging stimulus, and is associated with free nerve endings of C-fiber axons
High threshold polymodal nociceptors
The two types of special sensory chemoreceptors are:
Taste buds
Olfactory receptors in the superior nasal concha mucosa
Taste buds and olfactory receptors (special sensory type) are associated with what functional axon(s)?
SVA
Muscle spindles and GTOs are proprioceptors associated with what functional axons?
GSA
Muscle spindles and GTOs are _____ proprioceptors, whereas joint receptors are _____ proprioceptors
Unconscious, conscious
Muscle spindles are myelinated fibers classified as what two numerical nomenclatures?
1a
II
Golgi Tendon Organs (GTOs) are myelinated fibers associated with what numerical nomenclature?
1b
Name the two conscious sensory tracts
- Dorsal white column/medial lemniscal pathway
2. Spinothalamic tract
Pain, temperature, and light touch would use what conscious sensory tract?
The spinothalamic tract
Two-point discriminating touch/conscious proprioception would use what conscious sensory tract?
Dorsal white column/medial lemniscal pathway
Samatotopism in the dorsal white columns is what?
The order in which the afferent fibers line themselves up to ascend in the column. C1-T6 laterally in the fasciculus cuneatus, and T6-S5 medially in the fasciculus gracilis
List order of afferent fibers as they receive stimuli and make their way to cortex (touch/proprioception)
Primary enters dorsal column, could go up or down a few segments, and ascends to medulla. Synapses and crosses the midline as the medial lemniscus and ascends to thalamus. Synapses in the internal capsule and ascends to cortex