Unit 5 - Bones and Joints/ Proximal Upper + Lower limbs Flashcards
What are the 5 types of bones?
- Long bone
Tubular shape
Longer in length than in width - Short bone
Cuboidal shape
Provide stability
Only carpals and tarsal bones - Flat bone
Protective function - Irregular bone
Complex shapes - Sesamoid bone
Develop in tendons
Protect tendons from wear and tear
Describe the following bony features:
Tubercle
Tuberosity
Trochanter
Fossa
Epicondyle
Condyle
Malleolus
Label the bones of the body.
- What is hiltons law?
- The nerves supplying a joint also supply both the muscles that move the joint and the skin covering the articular insertion of those muscles.
Label the bony structures.
What is a nutrient foramina?
- Small openings in bones through which blood vessels and nerves enter and exit. They are important for the circulation of blood and the delivery of nutrients to the bone tissue.
- Especially important in long bones such as the femur and humerus > provide nourishment to the bone marrow and the hard outer layer of the bone called the cortex.
What is the difference between femur head/neck and humerus head/neck?
The acetabulofemoral joint has greater stability? Why is this significant ?
1- Humerus head 10x bigger than socket = more likely to dislocate
- Additional mobility (due to increased articular surface area) of the shoulder makes it relatively unstable and at increased risk of dislocation.
- Humerus has surgical neck.. fractures most likely to occur
2- The hip is a weight bearing joint unlike the shoulder, therefore requires much greater stability.
What are the differences between vertebrae?
C1 - Atlas (allows yes motion)
> No spinous process
> No vertebral body
C2- Axis (allows no motion)
> Bifid spinous process SPLITS INTO 2
> fused remnants of atlas become axis known as odontoid process/ Dens, acts as vertebral body of C1
Cervical vertebrae = Foramen transversarium in transverse process for vertebral artery to run.
Note *T1 has 1 demi facet… ribs can not articulate with cervical vertebrae
what is pectoral girdle and pelvic girdle?
- Pectoral girdle: Connects the upper limbs (appendicular skeleton) to the bones to the axial skeleton. (clavicle, scapula, acromion)
- Pelvic girdle: Connects the Lower limb (appendicular skeleton) to the bones of the axial skeleton
- Gluteal region
- Anterior thigh
- Posterior thigh
- Anterior knee
- Posterior knee (Popliteal fossa)
- Anterior leg
- Posterior leg
- Anterior ankle
- Posterior ankle
- Foot
- Anterior arm
- Posterior arm
- Anterior elbow (Cubital fossa)
- Anterior forearm
- Posterior forearm
- Hand
What components work together to move the body?
Describe the following terms of movement:
Flexion/ Extension
Adduction/ Abduction
Pronation/ Supination
Inversion/ Eversion
Plantar flexion/ Dorsi flexion
Protraction/ Retraction
Circumduction
Muscles, bones and joints work together to move the body:
1- Bones provide a solid framework - load (think of the weight)
2- Joints allow rotation around an axis - fulcrum
3- Muscle fibres contract to perform the action - force
> Plantar flexion/ Dorsi flexion - foot down foot up
Protraction/ Retraction - Forwards, backwards
Circumduction - movement in circular manner
* Flexion of ankle(downwards)
What is a fibrous joint?
What are the 3 types?
- Bones connected by dense connective tissue (ligaments) completely fixed
1: Gomphosis
2: Syndesmosis
3: Sutres
What is a cartilaginous joint?
What are the 2 types?
- Joined by cartilage to allow some movement
1: Synchondrosis (hyaline cartilage)
2: Symphysis (fibrocartilage between hyaline cartilage) , no ossification, less flexible , stretch little
What is a synovial joint?
What are the 6 characteristics?
Label the synovial joint.
- Cavity within a capsule, range of movement
- Bone ends are covered by hyaline articular cartilage
- Surrounded by a joint capsule
- Joint capsule is lined by a synovial membrane
- Encloses a joint cavity filled with synovial fluid
- Capsule reinforced externally/internally by ligaments
- Joints are capable of varying degrees of movement
What are the 6 synovial joints?
Give examples
What are Atypical synovial joints?
> Articular surface covered with fibrocartilage
e.g.
Temporomandibular joint
Sternoclavicular joint
2nd-7th sternochondral joints
What factors influence stability of joints?
- Ligaments
- Muscles
- Articulation surface
- Size and shape
> Keep the joints in place
Label the bony landmarks of the upper proximal limb?
Label the bony features of the upper limb.
Label the acromioclavicular joint.
What type of joint is it? What is it supported by?
- plane/gliding synovial joint – supported by the coracoclavicular ligaments
Label the Elbow joint.
What does the radius have?
How do we test integrity of Ligaments?
How does the elbow joint differ from the proximal radioulnar joint?
- radius has a distinctive round head and large tuberosity for biceps brachii muscle/tendon to insert.
- Testing Integrity of Elbow Ligaments:
applying lateral and medial stress to the elbow joint, respectively, to assess the integrity of the collateral ligaments. - Elbow: flexion/extension
- Radioulnar: pronation/supination
Label the glenohumeral joint?
What does a wide range of movement require?
Key note on biceps brachi tendon?
- multiple ligaments and tendons to provide stability
Glenohumeral ligaments radiate laterally from the supraglenoid tubercle to reinforce the anterior part of the joint capsule.
Note that the tendon of the long head of biceps brachii travels within the joint capsule!
What is the arterial supply of the arm?
Subclavian Artery: Proximal to the first rib.
Axillary Artery: Between the lateral border of the first rib and the inferior border of teres major.
Brachial Artery: Distal to the inferior border of teres major, coursing through the arm.
BRACHIAL artery:
Continuation of the axillary a. once it passes teres major m.
Proximally, lies medial to the humerus
Travels inferolaterally and lies deep to biceps brachii but overlies brachialis m.
Accompanies the median nerve to the cubital fossa
Terminates in cubital fossa by dividing into the radial artery (which travels superficially in the proximal forearm) & the ulnar artery (which dives deep under pronator teres muscle).
Blood supply of arm/forearm.
What are the superficial veins of the arm?
Cephalic vein:
Originates from lateral (radial) side of dorsal venous arch and terminates into the axillary vein
In the forearm, runs with a cutaneous nerve called the lateral cutaneous nerve of the forearm.
Basilic vein:
Originates from medial (ulnar) side of dorsal venous arch and terminates halfway along the arm by draining into the brachial vein
In the forearm, runs with a cutaneous nerve called the medial cutaneous nerve of the forearm.
What is the lymphatic drainage of the arm?
Name the boundaries and contents of the axilla
Anterior > pectoralis major muscle as it inserts into the humerus
Posterior > Lattsiumus dorsi
Medial > Serratus anterior
Lateral > Intertubercular sulcus of the humerus.
Apex > meeting of the clavicle, the first rib, and the upper edge of the scapula.
What is the nerve supply for the arm?
> 3 branches can be found anterior to the axillary artery:
1. Musculocutaneous n. > (C5, C6, C7)
2. Median n.> C5/C6, C7, C8, T1)
3. Ulnar n. > C8, T1)
> 2 branches can be found behind the axillary artery:
1. Axillary n.> C5, C6)
2. Radial n.> C5, C6, C7, C8, T1)
- 3 (Mu)sketeers (thumb, index, and middle)
- (A)ssassinated (making a gun with thumb and index)
- 5 (M)ice
- 5 (R)ats (all five fingers),
- 2 Unicorns (ring finger and pinky)
Which nerve of the brachial plexus runs:
a) Posterior to the medial epicondyle:
b) Along the spiral groove:
c) Through coracobrachialis muscle:
d) Around the surgical neck of the humerus:
e) In the cubital fossa:
a- Ulna > Posterior to the medial epicondyle
b- Radial > Along the spiral groove
c- Musculocutaneous Nerve > Pierces Through coracobrachialis muscle
d- Axillary Nerve > Around the surgical neck of the humerus
e- Median > In the cubital fossa
Label the nerves of the arm.
Describe cutaneous distribution of brachial plexus?
Label the Scapular.
- Winged scapula presents as a result of damage to which nerve? What muscle is affected in this condition?
- Damage to the long thoracic nerve (C5-7)
The serratus anterior needed for stabilisation of scapula. when it weakens, and the scapula loses its normal stability, leading to the winged appearance.
SIDE NOTE:
Coracobrachialis
Pectoralis Minor
Biceps Brachii (Short Head)
= attach to coracoid process
Label.
What are the superficial back muscles?
What is their function?
What is their innervation?
- Trapezius
Stabilize and move the scapula
-spinal accessory n. (CN XI) - Latissimus dorsi
EXTENDS the arm
Medially ROTATES and ADDUCTS the arm
-thoracodorsal n - Teres major
Medially ROTATES and ADDUCTS the arm
-lower subscapular n.
*does not attach to the capsule of the glenohumeral joint = not rotator cuff
Label.
What muscles in the upper limb are found in the axillary region?
What is their function?
What is their innervation?
- Deltoid m.
Powerful ABDUCTOR of the arm
- axillary nerve - Trapezius m.
-spinal accessory nerve (cranial nerve XI) - Pectoralis major m.
Clavicular head:
ADDUCTS and flexes arm
Sternocostal head:
ADDUCTS and medially rotates arm
- medial and lateral pectoral n - Serratus anterior muscle
PROTRACTION of the scapula
-long thoracic n
Label.
What are the rotator cuff muscles?
What is their function?
What is their innervation?
- Supraspinatus m.
- Innervated by suprascapular nerve
Initiates the first 15° of abduction of the arm > before deltoid muscle then takes over - Infraspinatus m.
- Innervated by suprascapular nerve
Laterally rotates arm - Teres minor m.
- Innervated by axillary nerve
Laterally rotates arm
(above 3 attach to greater tuberosity of humerus) - Subscapularis m.
- Innervated by upper and lower subscapular nerves
Medially rotates arm
(attaches to lesser tuberosity of humerus)
>They all stabilise the glen-numeral joint by compressing humeral head against the glenoid.
How do the rotator cuff muscles rotate the glenohumeral joint?
What do they attach to on the humerus?
> If the tendon of the muscle passes anteriorly to the joint, then the muscle confers medial (internal) rotation
If the tendon of the muscle passes posteriorly to the joint, then the muscle confers lateral (external) rotation
- Supraspinatus m. – Greater tubercle…first 15° of abduction
- Infraspinatus m. – Greater tubercle…lateral rotation
- Teres minor m. – Greater tubercle…lateral rotation
- Subscapularis m. – Lesser tubercle…medial rotation
What is the anterior and posterior compartment of the arm innervated by?
What is the main function of these two compartments?
> Anterior compartment
Innervated by musculocutaneous nerve (C5-C7)
- Main muscle actions:
Flexion of arm
Flexion of forearm
> Posterior compartment
Innervated by > radial nerve (C5-T1)
- Main muscle actions:
Extension of arm
Extension of forearm
What is the anterior and posterior compartment of the forearm innervated by?
What is the main function of these two compartments?
> Anterior compartment
Innervated by both median nerve (C6-T1) and ulnar nerve (C8-T1)
- Main muscle actions:
Pronation of forearm
Flexion of hand
Flexion of digits
> Posterior compartment
Innervated by radial nerve (C5-T1)
- Main muscle actions:
Supination of forearm
Extension of hand
Extension of digits
Label.
1. What is the muscle of the posterior arm? Where does its heads originate from?
2. How would you test the integrity of the radial nerve?
1 - large EXTENSOR muscle : Triceps Brachii
> 3 heads
1- Long head
Originates from the infraglenoid tubercle of scapula
Only head to cross both shoulder and elbow joint…hence LONG tendon!
2- Lateral head
Originates above radial/spiral groove on the humeral shaft
3- Medial head
Originates below radial/spiral groove on the humeral shaft
> All three heads of triceps come together and insert on the OLECRANON process of the ulna
2- Triceps brachii reflex (test C7-C8 nerve roots)
Label.
What are the 3 anterior muscles of the arm?
What is their function.
What is the biceps brachii reflex test?
- Biceps Brachii a supinator???
- Flexion of arm
-Biceps brachii reflex (C5-C6): - tests the integrity of musculocutaneous nerve
-> Biceps join and attach to radial tuberosity
-> Coracobrachialis attach to humerus
-> Brachialis attach to ulna tuberosity
*Biceps brachii is a strong supinator when flexed as when flexed attaches to radial tuberosity.
What is the superficial,lateral and medial boarder of cubital fossa, as well as the floor?
What is its contents?
- Superior border
Imaginary line between the two epicondyles of the humerus - Lateral border
Brachioradialis m. - Medial border
Pronator teres m. - Floor
Brachialis m.
Supinator m.
> TAN (lateral to medial)
1. Biceps brachii Tendon
2. Brachial Artery divides:
- Radial a.
- Ulnar a.
3. Median Nerve
How does the bicipital aponeurosis differ from the biceps brachii tendon and why might it be useful in venepuncture?
- Bicipital aponeurosis is a flat, sheet-like structure that arises from the distal part of the biceps brachii muscle.
The primary function of the bicipital aponeurosis is to provide a connection between the biceps brachii muscle and the forearm, helping to reinforce the cubital fossa and providing a protective covering for structures beneath it. - Biceps brachii tendon is a strong, cord-like structure that attaches the biceps muscle to the radius bone in the forearm.
> Helps to define the boundaries of the cubital fossa, where major veins like the median cubital vein are commonly accessed for blood draws.
The bicipital aponeurosis forms a “roof” over the cubital fossa, protecting the neurovascular structures beneath it. e.g. median nerve
What are the shoulder Medial rotators?
What are the shoulder Lateral rotators?
What is a myotome?
What are the 3 myotomes of the arm?
> Collection of spinal nerve roots that collectively innervate a group of muscles
- C5…sun rise = Abduction of arm at shoulder tests nerve innervating DELTOID muscle
- C5, C6…pick up sticks = Flexion of forearm at elbow tests nerve innervating ANTERIOR compartment of arm (e.g. action of biceps brachii)
- C7, C8…shut the gate = Extension of forearm at elbow tests nerve innervating POSTERIOR compartment of arm (e.g. action of triceps brachii)
What is a dermatome?
What are the dermatomes of the arm/forearm?
A dermatome is a single spinal nerve roots that innervates an area of skin.
Label the femur.
What structures attach to A,B and C?
A-
Gluteus medius+ minimus
Piriformis
Obturator externus + internus
B-
Psoas major
Iliacus
C-
ligamentum teres
Label the bony landmarks of the lower proximal limb.
Label the bony features of the lower limb.
-How do the 2 hip bones articulate?
- anteriorly at the pubic symphysis
> also firmly attached to sacrum (vertebral column) via the sacro-iliac joint
» allows transmission of body weight AND propulsive force
What is the arterial supply for the thigh?
- Femoral artery:
> Continuation of the external iliac a. once it passes under the inguinal ligament.
> Changes name as soon as it passes through the adductor hiatus (gap in the adductor magnus muscle) to emerge in the popliteal fossa. - Femoral head mainly > deep femoral artery via the ‘medial circumflex femoral artery’
- BUT very small contribution from the obturator artery via ‘artery to the head of the femur’
What is the blood supply of thigh/leg/foot?
What are the superficial veins of the thigh/leg?
Great saphenous vein:
Originates from medial side of dorsal venous arch and terminates into the femoral vein
In the leg, runs medially with a cutaneous nerve called the saphenous nerve.
Small saphenous vein:
Originates from lateral side of dorsal venous arch and terminates into the popliteal vein
In the leg, runs posteriorly with a cutaneous nerve called the sural nerve.
Explain musculovenous pump?
-Deep veins in leg
> their valves can be assisted through the contraction of muscles.
What is the lymphatic drainage of leg and thigh?
-Lymphatic drainage of the limbs typically follows the same pattern as the superficial veins.
Label the nerves of the thigh/leg.
What is the nerve supply for the thigh?
What part of the thigh do they innervate?
Describe cutaneous distribution of leg.
What 3 bones fuse to make the hip?
Label the Acetabulofemoral joint.
What is a hip fracture?
What are static and dynamic stabilisers of hip joint?
-Acetabulum ( surface of hip bone that articulates with head of femur)
> Cracks or breaks in the top of the femur close to the hip joint.
> > Static stabilisers include the capsule, ligaments and labrum
Dynamic stabilisers consist of the muscles acting across the joint
What is the popliteal fossa?
Label the muscles of the popliteal fossa.
What is the neurovasculature?
- Diamond-shaped depression located posterior to the knee joint. Important nerves and vessels pass from the thigh to the leg by traversing through this fossa.
> Popliteal muscle = floor
- Plantaris muscle is NOT included
AVN (deep > superficial)
What does the Popliteus muscle do?
- Popliteal muscle is deep and does not contribute to form the calcaneal tendon
− Pops to unlock the knee by rotating the femur 5°
− Important relationship as separates lateral meniscus and lateral collateral ligaments
Label the connective tissue structures present in the knee?
What 3 bones make up the knee?
What are the dynamic and static stabilisers?
What do ACL and PCL attach to?
- Complex synovial hinge joint formed from the articulation between the femur, patella and tibia. Knee joint passively “locks” when knee fully extended while standing – popliteus m. ‘pops’ to unlock
– Due to medial rotation of femoral condyles on tibial plateau.
– Makes lower limb solid and adapted for weight-bearing.
-The static stabilisers are the joint capsule, menisci, cruciate and collateral ligaments
>The dynamic stabilisers are the quadriceps and hamstring muscles
-Anterior cruciate ligament:
Attaches to tibia anteriorly
- Posterior cruciate ligament:
Attaches to tibia posteriorly.
How would you test the integrity of a patient’s cruciate ligaments?
- What is the difference between medial and lateral menisci?
- How is damage to medial menisci and medial (tibial) collateral ligament linked?
- How does popliteas muscle protect lateral menisci?
- The function of each meniscus is to deepen the articular surface and absorb impactful forces
> Lateral: tighter C - Medial collateral is partly attached to the medial meniscus, therefore more commonly damaged compared to the lateral
- Retracts the lateral meniscus posteriorly to avoid being entrapped between the femur and tibia.
- Why are the following important landmarks?
1- Greater sciatic foramen
2- Lesser sciatic foramen
3- Subinguinal space
4- Obturator foramen - What ligaments/membranes create these spaces?
- What are the ligament attachment points?
What does :
1- Greater sciatic foramen
2- Lesser sciatic foramen
3- Subinguinal space
4- Obturator foramen
Allow to transmit through?
1- Greater sciatic foramen:
Superior gluteal nerve
Superior gluteal a. & v.
Piriformis muscle travels through!
Inferior gluteal nerve
Inferior gluteal a. & v.
SCIATIC NERVE
2- Lesser sciatic foramen
Pudendal nerve
Internal pudendal a. & v.
Nerve to obturator internus
Tendon of obturator internus muscle travels through!
3- Subinguinal space
FEMORAL NERVE
Femoral a. & v.
Lymphatics
Iliopsoas muscle/tendon
4- Obturator foramen
OBTURATOR NERVE
Obturator a. & v.
Label.
What muscles are found in the gluteal region?
What is their function?
What is their innervation/ blood supply?
- Where would an intramuscular injection in the gluteal region be delivered and why?
-Gluteus maximus m.
Innervated by INFERIOR GLUTEAL nerve
Main action is EXTENSION of the thigh
*Inferior + superior gluteal artery…
-Gluteus medius m.
-Gluteus minimus m.
-Tensor fascia lata m.
Innervated by SUPERIOR GLUTEAL nerve
Main action is ABDUCTION of the thigh
*Superior gluteal artery + vein
> Gluteal arteries are branches of internal Iliac artery
- Upper outer quadrant > avoid nerves and vessels
Label.
What are the lateral rotator muscles?
How is lateral/medial rotation caused by them?
What is their function?
What is significant about Piriformis muscle?
> Tendon of the muscle passes posteriorly to the joint, then the muscle confers lateral (external) rotation
e.g. muscles
Tendon of the muscle passes anteriorly to the joint, then the muscle confers medial (internal) rotation
e.g. tensor fascia lata m.
-Lateral rotation of the thigh - Attach to greater trochanter of the femur.
*Piriformis - Innervated by nerve to piriformis
- Passes through greater sciatic foramen and separates superior and inferior gluteal nerve/vein/artery
What are the Neurovascular Structures
of the gluteal area?
What are the 3 muscular compartments of the thigh?
What is their innervation?
What is their function?
What name is given to the deep fascia of the thigh?
Fascia Lata
What are the 3 muscular compartments of the leg?
What is their innervation?
What is their function?
Label.
What is the function of muscles in the posterior thigh?
What is their innervation?
> All muscles in the posterior compartment are innervated by the sciatic nerve
> ‘True’ hamstring muscles:
- Originate at the ischial tuberosity
- Insert to the bones of the leg
- Span and act across two joints
1- Semitendinosus m.
2- Semimembranosus m.
3- Long head of biceps femoris m.
Hip EXTENSORS
Knee FLEXORS
- Innervated by the tibial division of sciatic nerve
4- Short head of biceps femoris not considered a ‘true’ hamstring
-Innervated by common fibular division of sciatic nerve
- Originates from femoral shaft
- Only acts at the knee joint
What is Pes Anserinus?
What muscles are involved?
- A useful anatomical landmark to help orientate and correctly identify the thigh muscles is to locate 3 tendons that attach on the medial aspect of the tibia
(one from each compartment of the thigh)
> which collectively appear to resemble a “goose’s foot”
Label.
What are the muscles of the anterior thigh?
What is their function?
What is their innervation?
What is patella tendon reflex?
- Sartorius (ASIS > Medial side of proximal tibia)
- Quadriceps femoris:
Rectus femoris m. (AISIS > Tibial tuberosity via Quadriceps tendon)
Vastus lateralis m. (Greater trochanter of femur > Tibial tuberosity via Quadricep tendon)
Vastus intermedius m. (Anterior femoral shaft > Tibial tuberosity via Quadricep tendon)
Vastus medialis m. (Intertrochantial line > Tibial tuberosity via Quadricep tendon)
- Rectus femoris also crosses both the hip and knee joints so is a Hip flexor aswell
- Patellar tendon reflex tests L2-L4 nerve roots
What is the superior, lateral, medial and floor boarders of the femoral triangle?
What is its contents?
- Superior border
Inguinal ligament - Lateral border
Sartorius m. - Medial border
Adductor longus m. - Floor
Iliopsoas (laterally)
Pectineus m. (medially) – sometimes a little of adductor brevis m. sneaks into view as it lies deep to adductor longus m.
> Lateral to medial
NAVEL
Femoral Nerve
Femoral Artery
Femoral Vein
Empty space/Lymph nodes
Label.
What are the muscles of medial thigh?
What is their inneration?
What is their function?
“3 ducks pecking grass”
- Adductor muscles =Adduction
(PUBIS > Linea aspera of femur) - Gracilis = hip adduction, knee flexion, and knee internal rotation
(PUBIS > medial tibia) - Pectineus = flex and adduct the thigh at the hip joint when it contracts.
(PUBIS > Linea aspera of femur)
Where is the adductor hiatus?
What happens here?
- Femoral artery changes name to POPLITEAL as soon as emerges through the gap in adductor magnus muscle
What are the hip Lateral rotators?
What are the hip Medial rotators?
What muscles flex the hip?
- Sartorius
- Rectus femoris
- Iliacus
- Psoas Major
What are the 4 myotomes of the lower limb?
1) L2, 3…lift my knee = Flexion of thigh at hip tests nerve innervating ILIOPSOAS
2) L4, 5…extend my thigh = Extension of thigh at hip tests nerve innervating GLUTEUS MAXIMUS
3) L3, 4…kick the door = Extension of leg at knee tests nerve innervating ANTERIOR compartment of thigh (e.g. action of vastus medialis)
4) L5, S1…kick my bum = Flexion of leg at knee tests nerve innervating POSTERIOR compartment of thigh (e.g. action of semitendinosus)
What are the dermatomes of the lower limb?
