upper and lower limb Flashcards
what type of joint is the wrist?
an ellipsoid type biaxial synovial joint
movement allowed; flexion extension, adduction, abduction
no active rotation takes place
what bones are involved in the wrist joint?
Distally; proximal row of carpal bones except pisiform
Proximaly; distal end of radius, articular disc (fibrocartilginous ligament which lies between the ulna and the wrist joint
where does the dorsal scapular nerve come off
C5
what is serratus anterior supplied by
C5 C6 C7 long thoracic nerve
What does the median nerve supply?
Pronator teres, Felxor carpi radialia, palmaris longus
Flexor digitorum superficialis
Flexor digitorum profundus (lateral), Flexor pollicis longus, Pronator quadratus
1st and 2nd lumbricals, Opponens pollicis, Abductor pollicis brevis, Flexor pollicis brevis
Describe the annular ligament
attached to the margins of the radial notch
clasps the head and neck of the radius
is intracapsular
radius have no attachment to the annular
Contents of the Quadrangular space
Axillary nerve
Posterior circumflec artery and vein
Contents of triangular space
Circumflex scapular artery
Contents of triangular interval
radial nerve, profundi brachii artery
boundaries of the adductor canal (Hunters canal)
Anteriorly - sartorius
Postermedially - adductor longus and adductor magnus
laterally - vastus medialis
Describe the long head of biceps
is intracapsular, arise from the supraglenoid tubercle
the tendon of the long head passes through the shoulder joint and intertubecular groove of the humerus to meet the short head
At the level of the humeral shaft, the two heads combine to form the muscle belly
Boundaries of the anatomical snuff box
Medial/ulnar side = extensor pollicis longus
lateral/radial side = extensor pollicis brevis, abductor pollicis longus
proximal = styloid process of the radius
floor = trapezium and scaphoid
Describe the injury to the medial cord of the brachial plexus
Nerves involved; ulnar, medial root of median
Muscles paralysed; ulnar nerve supplied muscles, 5 muscles of the hand supplied by the median nerve
Claw hand
sensory loss to the ulnar side of the forearm and hand
In abduction of the arm what happens to the clavicle and the scapula?
medial end of the clavicle moves downwards
scapula moves laterally on the chest wall
Scapula movement at first slower than the humerus
what is the proximal row of the carpals of the wrist?
scaphoid lunate triquetrium pisiform
what carpal bones articulate with the radius
scaphoid and lunate
Extensor part of the wrist has 6 compartments; compartment 1 contains
Extensor pollicis brevis
Abductor pollicis longus
Extensor part of the wrist has 6 compartments; compartment 2 contains
Extensor carpi radialis brevis
Extensor carpir radialis longus
Extensor part of the wrist has 6 compartments; compartment 3 contains
Extensor pollicis longus
Extensor part of the wrist has 6 compartments; compartment 4 contains
Extensor digitorum
Extensor indicis
Extensor part of the wrist has 6 compartments; compartment 5 contains
Extensor digiti minimi
Extensor part of the wrist has 6 compartments; compartment 6 contains
extensor carpi ulnaris
origin, insertion, artery, nerve and action of palmaris longus
O; medial epicondyle of humerus
I; palmer aponeurosis
A; ulnar artery
N; median nerve
action; wrist flexor
Origin, insertion, artery, nerve and action of Extensor Pollicis Longus
O; middle third of posterior urface of ulna, interosseus membrane
I; thumb distal phalanx
A; posterior interoseus artery
N; Posterior interosseous nerve, branching from the radial nerve
Action; Extension of the thumb MCP and IP
Origin, insertion, artery, nerve and action of Flexor carpi radialis
O; medial epicondyle of humerus, common flexor tendon
I; bases of second and third metacarpal bones through the flexor retinaculum
A; radial artery
N; Median nerve
Action; flexion and abduction at the wrist
Describe the sternoclavicular joint
a saddle type of synovial joint but functions as a ball and socket
divided into two compartments by an articular disc
the disc is attached to the anterior and posterior sternoclavicular ligaments and interclavicular ligament
Ligaments of the sternoclavicular joint
Anterior and posterior sternoclavicular ligaments reinforce the joint capsule
Interclavicular ligament strengthens the capsule superiorly
the costoclavicular ligament anchors the inferior surface of the sternal end of the clavicle to the 1st rib
Origin, insertion, action, innervation of Abductor Pollicis Brevis
O; flexor retinaculum and tubercles of scaphoid and trapezium
I; lateral side of base of the proximal phalanx of the thumb
A; palmer abduction
N; recurrent branch of median nerve
Origin, Insertion, Action, Innervation of Opponens Pollicis
O; flexor retinaculum and tubercle of trapezium
I; lateral side of first metacarpal bone
A; rotates thumb, pinch with index finger
N; recurrent branch of median nerve
Origin, insertion, action and innervation of Flexor Pollicis Brevis
O; flexor retinaculum and tubercle of trapezium
I; medial side of base proximal phalanx of the thumb
Action; flexes and stabilizes the MPJ
N; recurrent branch of median nerve
Describe the course of the ulnar nerve
located in the grooved surface of middle band of the medial collateral ligament
lies in contact with the sublime tubercle
enters the forearm between 2 heads of FCU
runs between FCU and FDP
passes below the ulnar head of pronator teres
Describe the course of the Cephalic vein
Arises from the lateral side of the dorsal venous network
Communicates with the basilic vein via the median cubital vein at the elbow
located in the superficial fascia along the anterolateral surface of the biceps brachii muscle
Passes between the deltoid and pectoralis major muscles
Through the deltopectoral triangle
empties into the axillary vein
what is the largest branch of the brachial plexes
Radial nerve
how much larger is the humeral head compared to the glenoid fossa
4x larger
loss of the greater tuberosity leads to loss of what direction of movement?
abduction and lateral rotation
Branches of the axillary artery
First part - Superior thoracic artery
Second part - thoraco-acrominal artery, lateral thoracic artery
Third part - subscapular artery, anterior and posterior humeral circumflex arteries
what nerve supplies the shoulder joint
axillary, suprascapular, lateral pectoral nerves C5, C6
injury will cause upper brachial plexus injury, erbs palsy
Origin, Insertion, atery, nerve, action of Subscapularis
O; subscapular fossa
I; Lesser tubercle of humerus
Artery; Subscapular artery
N; upper subscapular nerve, lower subscapular nerve
actions; internally (medially) rotates humerus stabilizes shoulder
covered by dense fascia
origin, insertion, artery, nerve and action of palmer interossei
O; sides of metacarpals facing midline
I; bases of proximal phalanges, extensor expansions
artery; palmar metacarapal artery of deep palmer arch
N; deep branch of ulnar nerve
Action; adduction, flexion and extension of fingers
Origin, Insertion, Artery, Nerve and action of Dorsal interossei
O; metacarpals
I; proximal phalanges and extensor expansions
Artery; dorsal and palmer metacarpal artery
N; deep branch of ulnar nerve
Action; abduct fingers
In the palmer aspect of the wrist where does the median nerve lie?
Between FDS and FPL
at the wrist where does the ulnar nerve lie
the Guyon canal, which is above the flexor retinaculum
where does the brachial artery divide
at the level of the radial neck
origin, insertion, artery, nerve and action of Flexor Pollicis longus
O: the middle 2/4 of the volar surface of the radius and the adjacent interosseus membrane
I; base of the distal phalanx of the thumb
Artery; anterior interosseus artery
N; anterior interosseous nerve, branch of median nerve
Action; Flexion of the thumb
When static the Glenohumeral Joint is stabilised by ?
the firmness of the superior capsule and suprahumeral ligament
the adhesive and cohesive forces of synovial fluid and negative joint pressure
the deepening of the fossa by the Glenoid labrum via the rotator cuff
whilst dynamic the Glenohumeral joint is stabilised by?
the Rotator Cuff
the Deltoid
the long head of biceps
what artery mostly supplies the humerus shaft
brachial artery
Origin, insertion, artery, nerve and action of Opponens pollicis
O; trapezium and transverse carpal ligament
I; radial side of metacarpal bone of thumb
Artery; superficial palmer arch
N; recurrent branch of median nerve
Action; flexion of thumb at CMCJ/trapezoimoetacarpal joint
what is the groove of the first rib related to?
subclavian artery
what are the 3 branches of the 3rd part of the axillary artery
subscapular artery
anterior humeral circumflex artery
posterior humeral circumflex artery
how does the brachial plexus relate to the axillary artery
the brachial plexus cords surround 2nd part of the artery
cords named in relation to the artery
branches surround the 3rd part
when does the axillary artery become the brachial artery?
at the inferior border of teres major
route of the radial artery at the wrist
disappears beneath the tendons of APL and EPB at the wrist
branches of the radial artery in the forearm
radial recurrent artery
palmer carpal branch of radial artery
superficial palmer branch of radial artery
branches of the radial artery at the wrist
dorsal carpal branch of radial artery
first dorsal metacarpal artery
branches of the radial artery in the hand
princeps pollicis artery
radial indicis
deep palmer arch
attachment of the flexor retinaculum
scaphoid trapezium hamate pisiform
what nerve is unaffected in compression of the median nerve in carpal tunnel syndrome
Palmer branch of the median nerve
how do the tendons of FDP and FDS travel in the flexor sheath
invested by a single synovial sheath
what happens when the palmer and dorsal interossei contract together
flexion of the MCPJ
regarding the cubital fossa where does the posterior interosseous nerve exit
between the 2 heads of supinator
Injury to the lateral cord causes damage to what
Nerves; musculocutaneous, lateral root of the median nerve
Muscles; biceps, coracobrachialis, all muscles supplied by the median nerve
loss of flexion of the forearm and wrist, sensory loss on the radial side of the forearm
number of ossification centres in the scapula
7
Describe digital nerves
are only sensory
lie anterior to digital artery
innervation of radial nerve proximally to distally
triceps
brachioradialis
extensor carpi radialis longus
supinator
extensor carpi radialis brevis
extensor digitorum
extensor carpi ulnaris
extensor digiti minimi
abductor pollicis longus
extensor pollicis longus
extensor pollicis brevis
extensor indicis
what is the largest branch of the brachial plexus
radial nerve
where do lumbricals arise from ?
flexor digitorum profundus tendons
where does the dorsal scapula nerve come from
C5
origin, insertion, artery, nerve and action of flexor carpi radialis
O; medial epicondyle of humerus
I; bases of second and third metacarpal bones
A; radial artery
N; median nerve
action; flexion and abduction at wrist
deep peroneal nerve travels with which artery in the leg
anterior tibial
Injury to L5 will cause what clinical signs
inability to;
extend hip
flex knee
foot eversion
dorsiflex big toe
loss of sensation to ;
lateral part of the leg, dorsum of the foot and medial sole
where does the plantar aponeurosis arise
from the medial process of calcaneous and fans out over the sole
what does the ACL do for the knee?
limits posterior rolling of the femoral condyles on the tibial plateau during flexion
prevents hyperextension of the knee
prevents posterior displacement of the femur on the tibia
what does the PCL do for the knee?
limits anterior rolling of the femur on the tibial plateau during extension
helps prevents hyperflexion of the knee
prevents anterior displacement of the femur on the tibia
what are the extracapsular ligaments of the knee? (5)
patellar ligament
fibular collateral ligament
tibial collateral ligament
oblique popliteal
arcuate popliteal
of the extra-capsular ligaments which is stronger out of the tibial collateral or fibular collateral
Fibular collateral ligament
Describe the position of the Arcuate popliteal ligament
arises from the posterior aspect of the fibular head
passes superomedially over the tendon of popliteus
spreads over the posterior surface of the knee joint
blood supply of the sciatic nerve
sciatic artery
branch of inferior gluteal artery
what muscles form the hamstrings
semitendinosus
semimembranosus
long head of biceps femoral
hamstring part of adductor magnus
what nerve supplies the long head and the short head of biceps femoris
tibial division of sciatic nerve = long head
fibular division of sciatic nerve = short head
Course of the sciatic nerve
most lateral nerve entering the greater sciatic foramen inferior to piriformis
runs inferolaterally under gluteus maximus, midway between the greater trochanter and ischial tuberosity
rests on the ischium
passes posterior to obturator internus, quadratis femoris and adductor muscles
descends in the posterior thigh deep to biceps femoris
bifurcates into tibial and common fibular nerve at apex of popliteal artery
what is the main nerve of the lateral compartment of the leg
superficial fibular nerve
what is the function of the lumbricals in the foot
flex proximal phalanges
extend middle and distal phalanges of the lateral four toes
Describe the course of the deep veins of the leg
the three deep veins into the popliteal vein, into the femoral vein in thigh, passes deep to inguinal ligament to become external iliac vein
what does the DP artery come from
anterior tibial artery
how does DP travel into the foot
begins midway between the malleoli
runs anteriomedially
deep to inferior extensor retinaculum
between extensor hallucis longus and extensor digitorum longus
what structure of the foot does the DP artery form part of
deep plantar arch
what is most important in stabilising the patella
the lowest fibres of the vastus medialis
which knee bursa is likely to cause septic arthritis
suprapatellar
what nerve supplies sensation to the dorsum of the foot between 1st and 2nd toes
deep fibular nerve
what sensation does the saphenous nerve supply
medial aspect of the foot and lower leg
what myotome is responsible for plantar flexion of ankle
S1 - S2
Damage to what nerve can cause a Trendelenburg gait
superior gluteal nerve
what structures attach to AIIS
rectus femoris
iliofemoral ligament
where are femoral hernias in relation to pubic tubercle
inferior and lateral
what are the lateral and medial boundaries of a femoral hernia
femoral vein laterally
lacunar ligament medially
injury to what artery in NOF can cause avascular necrosis
Medial circumflex artery
what movement occurs at the subtalar joint
inversion and eversion
what are the 3 divisions of the internal iliac artery
Iliolumbar
lateral sacral (superior and inferior)
superior gluteal
what does the iliolumbar artery supply
psoas major
iliacus
quadratus lumborum
cauda equina in vertebral canal
damage to what muscle causes shin splints
tibialis anterior
action of tibialis anterior
dorsiflexion of ankle
inversion of foot
maintains medial longitudinal arch
bony components of the medial longitudinal arch of the foot
calcaneus
Navicular
Talus
3 cuneiforms
heads of 3 metatarsal bones
what runs in the adductor canal
Femoral artery
Femoral vein
sapenous nerve
nerve to vastus medialis
Posterior branch of obturator
Descending genicular artery and vein
what is the origin of the femoral nerve
posterior division of the anterior rami of lumbar nerves 2,3,4
how does the femoral nerve enter the thigh
deep to the inguinal ligament
lateral to the artery
OUTSIDE the femoral sheath
origin of tibialis posterior
interosseus membrane and adjoining surfaces of tibia and fibula
action of tibialis posterior
plantarflex ankle
invert and adduct forefoot
contributes to maintaining the longitudinal arch of the foot
what forms the transverse arch of the foot
cuboid
cuneiforms
bases of metatarsals
what tendons help maintain the curvature of the transverse arch
fibularis longus
tibialis posterior
first layer of the foot
flexor digitorum brevis
abductor hallucis
abductor digiti minimi
second layer of the foot
tendon of flexor hallucis longus
tendon of flexor digitorum longus
quadratus plantae
lumbricals
third layer of the foot
flexor hallucis brevis
adductor hallucis
flexor digiti minimi brevis
4th layer of the foot
interosseous muscles
tendon of peroneus longus
tendon of tibialis posterior
where does gluteus maximus insert
deep lower 1/4 in gluteal tuberosity of femur
3/4 in iliotibial tract
At all levels of the thigh where does the femoral artery lie
between saphenous nerve and femoral vein
contents of the adductor canal
femoral artery
femoral vein
saphenous nerve
nerve to vastus medialis
bones of the medial longitudinal arch
calcaneus
talus
navicular
3 cuneiforms
3 metatarsals
what passes through the lesser sciatic foramen
tendon to obturator internus
internal pudendal artery and veins
pudendal nerve
nerve to obturator internus
structures in the femoral triangle lateral to medial
femoral nerve
femoral sheath
femoral artery
femoral vein (it receives from great saphenous and deep femoral vein)
femoral canal containing deep inguinal lymph nodes and associated lymph
what makes up the longitudinal arch of the foot
calcaneus
cuboid
lateral two metatarsals
what nerve supplies the skin over the femoral triangle
genito-femoral
what ligaments of the knee are extra capsular
Patellar ligament
Oblique popliteal ligament
Tibial collateral ligament
fibular collateral ligament
arcuate popliteal ligament
what structures pass deep to the superior extensor retinaculum
Tibialis anterior
extensor Hallucis longus
tibial anterior Artery
tibial anterior Vein
deep fibular Nerve
extensor Digitorium longus
peroneus Tertius
Tim Has A Very Nasty Diseased Toe
what nerve supplies the lateral leg
superficial peroneal nerve L5 S1 S2
origin of popliteus
lateral surface of lateral condyle of femur and lateral meniscus
Innervation and action of popliteus
Tibial nerve L4 L5 S1
unlocks the knee
how is the femoral artery separated from the hip joint
psoas major
action of gluteas maximus
laterally rotates and extends the hip
what landmark is the femoral artery at
mid inguinal point
what is the nerve supply of gluteus maximus
L5 S1 S2
what is the weakest ligament in the hip
ischiofemoral ligament
what limits the hip in full extension
iliofemoral ligament
what is the infero medial border of popliteal fossa
gastrocnemius
what is the sural nerve a branch of
tibial nerve
common peroneal nerve
where does tibialis anterior insert
inserts into the medial cuneiform and adjacent first metatrsal
