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Anatomy of the Individual > Surface Anatomy - Limbs > Flashcards

Surface Anatomy - Limbs Flashcards

1
Q

What is the shape of the clavicle?

A

Medial 1/3 = Convex

Lateral 1/3 = Concave

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2
Q

Where does the brachial plexus lie in relation to the clavicle?

A

The trunks of the brachial plexus are in the supraclavicular notch, posterior to the middle 1/3 of the clavicle

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3
Q

Where does the coracoid process lie in relation to the clavicle?

A

3cm below the junction of the middle and lateral 1/3s of clavicle

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4
Q

What attaches to the coracoid process?

A

Pectoralis minor
Short head biceps brachii
Coracobrachialis

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5
Q

Where does the lateral part of the clavicle end?

A

Acromioclavicular joint

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6
Q

What happens to the clavicle as the upper limb is raised?

A

Lateral end of clavicle elevates
As limb is raised fully:
- Clavicle rotates backwards
- Normal anterior surface now faces superiorly

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7
Q

Where does the medial border of the scapula lie?

A

5cm lateral to the spine of T2-T8 vertebrae

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8
Q

Why is the medial border somewhat difficult to palpate?

A

Attachments of muscles such as rhomboids

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9
Q

Why is the superior angle of the scapula difficult to palpate?

A

Muscle mass of superficial muscle layer of back

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10
Q

Where does the inferior angle of the scapula overlie?

A

Posterolateral parts of the 7th or 8th ribs

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11
Q

What happens to the inferior angle of the scapula as the upper limb is moved above shoulder height?

A

Scapula is protracted and inferior angle moves anteriorly and superiorly (upward rotation)

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12
Q

Why does the scapula move when the arm is raised?

A

Moves the acromion process superiorly so the head of the humerus does not get restricted by it

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13
Q

How can pectoralis major be palpated in the axilla?

A

Place hand at anterior border of axilla and flex the arm

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14
Q

How can the latissimus dorsi be palpated in the axilla?

A

Extend the arm and palpate posterior wall of axilla

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15
Q

What structures can be palpated moving laterally from the coracoid process of the scapula?

A

Anterior rim of glenoid cavity
Head of humerus
Lesser tubercle of humerus

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16
Q

What structure can be palpated in the intertubercular groove of the humerus? How does it feel?

A

Tendon of long head of biceps

Cord-like structure

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17
Q

Why is the greater tubercle of the humerus difficult to palpate?

A

Usually covered by deltoid

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18
Q

How does the greater tubercle contribute to the palpable shape of the shoulder?

A

Contributes to the rounded shape of the lateral side of the shoulder

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19
Q

How can the humeral head be more easily palpated?

A

Laterally rotating the arm

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20
Q

Where can the shaft of the humerus be palpated?

A

Halfway down the lateral side of the arm by following the attachment of deltoid

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21
Q

What muscle group originates from the lateral epicondyle of the humerus?

A

Extensors of wrist and digits (posterior forearm)

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22
Q

What cord-like structure can be palpated in the deep bony groove posterior to the medial epicondyle? What happens when pressure is applied here?

A

Ulnar nerve
Pressure:
- Tingling in medial 1.5 digits
- Tingling in medial palm and dorsum of hand

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23
Q

Where does the coronoid process lie in relation to the medial epicondyle of the humerus?

A

Anteromedial

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24
Q

What structure prevents further extension of the elbow joint?

A

Olecranon process of ulna

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25
Q

Where can the biceps tendon be palpated?

A

Cubital fossa

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26
Q

How can the triceps tendon be palpated?

A

Ask someone to extend their arm against gentle resistance

Palpate posterior arm

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27
Q

What bone lies immediately distal to the head of the ulna?

A

Triquetral carpal bone

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28
Q

What bone can be palpated on the triquetral bone’s anterior surface?

A

Pisiform

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29
Q

What type of joints are the intercarpal joints?

A

Plane synovial

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30
Q

Where can the hook of the hamate be palpated?

A

1cm distal and slightly lateral to the pisiform

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31
Q

Why must the hook of the hamate be palpated carefully?

A

2 small branches of the ulnar nerve pass close to this bony landmark

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32
Q

What bones are located in the anatomical snuffbox?

A 
Radial styloid process
Trapezium
Scaphoid
1st metacarpal:
- Base marked by a small tubercle
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33
Q

How can the tubercle of the scaphoid bone be palpated?

A

Extend wrist

Pass fingers to proximal end of thenar eminence, 1cm medial to tip of radial styloid process

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34
Q

How can the trapezium be palpated?

A

Move fingers 1cm distal to where tubercle of scaphoid bone was palpated and press a little deeper

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35
Q

What joint can be palpated at the base of the thenar eminence?

A

1st CMC joint

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36
Q

Why is it difficult to locate other small landmarks in the hand?

A

Muscle and fascia of wrist and palm

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37
Q

What bony features of the ulna can be palpated at the posterior aspect of the wrist?

A

Head of ulna

Ulnar styloid process

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38
Q

What tendon lies near the ulnar styloid process and can be palpated at the posterior aspect of the wrist?

A

Tendon of extensor carpi ulnaris

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39
Q

During which movement does the ulna styloid process become more prominent?

A

Wrist abduction

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40
Q

Why must care be taken when palpating along the lateral aspect of the forearm the the distal radius?

A

You may accidentally compress the superficial branch of the radial nerve

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41
Q

What tendon runs across the medial side of the dorsal tubercle of the radius?

A

Extensor pollicis longus tendon

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42
Q

If the wrist is flexed and an imaginary line running transversely across the wrist just distal to the radial and ulnar styloid processes is drawn, what does this coincide with?

A

The posterior surfaces of:

  • Scaphoid
  • Lunate
  • Triquetral
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43
Q

Which metacarpals do the following carpal bones lie at the bases of:

  • Trapezoid
  • Capitate
  • Hamate
A 
Trapezoid = 2nd metacarpal
Capitate = 3rd metacarpal
Hamate = 4th and 5th metcarpals
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44
Q

How can the base, shaft and head of each metacarpal and phalanx be palpated?

A

From the dorsal surface of the hand, if fingers are flexed

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45
Q

Where can the tendon of flexor carpi radialis be palpated?

A

Medial to radial styloid process on anterior wrist

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46
Q

What muscle tendon will appear if you clench the fist and flex the wrist? Where?

A 
Palmaris longus (if present):
- Just medial to tendon of flexor carpi radialis
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47
Q

What tendon lies at the medial aspect of the anterior wrist?

A

Flexor carpi ulnaris

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48
Q

If the space between flexor carpi ulnaris tendon and palmaris longus tendon is observed, what tendons can be palpated during the following movements:

  • Flexion of MCPJs and PIPJs
  • Flexion of MCPJs, PIPJs AND DIPJs?
A 
Flexion of MCPJs and PIPJs:
- Tendons of flexor digitorum superficialis
Flexion of MCPJs, PIPJs AND DIPJs:
- Tendons of flexor digitorum profundus
- Medial forearm
- Deep to flexor carpi ulnaris tendon
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49
Q

What tendons can be identified on the posterior hand when the thumb is extended?

A

Abductor pollicis longus and extensor pollicis brevis (lateral border snuffbox)
Extensor pollicis longus (medial border snuffbox)

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50
Q

Why should a pulse never be palpated with the thumb?

A

You will feel the pulse of princeps pollicis

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51
Q

Why are only part of the courses of upper limb arteries palpable?

A

They usually lie deep within upper limb tissues

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52
Q

What arteries of the upper limb are too deep to palpate?

A

Brachiocephalic

Subclavian

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53
Q

Where can the subclavian artery be palpated? Why is this difficult to palpate?

A

Where it passes over the 1st rib posterior to the midpoint of the clavicle:
- Difficult to feel as deep pressure required and it is uncomfortable

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54
Q

How can the axillary artery be palpated?

A

Press upwards and laterally within the axilla:

- Compresses the artery against the lateral wall of the axilla

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55
Q

Why might palpation of the axillary artery be uncomfortable?

A

May compress some cords of brachial plexus

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56
Q

How can the brachial artery be palpated?

A

Compress the artery against the humerus on the medial side of the biceps tendon
Also palpable just prior to bicipital aponeurosis in cubital fossa

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57
Q

What other structures may be palpated when feeling the brachial pulse in the arm?

A 
Ulnar nerve (superior to artery)
Median nerve (inferior to artery)
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58
Q

Where is the radial pulse palpated?

A

At the wrist:

  • Place fingertips on lower border of radius and radial styloid process
  • Move 0.5cm medially
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59
Q

Between what structures is the radial pulse felt?

A

Between anterior border of radius and tendon of flexor carpi radialis

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60
Q

Where else can the radial artery be palpated?

A

Against lateral side of scaphoid in anatomical snuffbox:

- Between tendons of extensor pollicis longus (medially) and tendons of EPB and APL (laterally)

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61
Q

Where can the ulnar artery be palpated?

A

At the wrist:

- Just lateral to pisiform bone

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62
Q

What small arteries in the hand may be palpable?

A

The metacarpal arteries on the dorsal surface near the metacarpal heads

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63
Q

Where can the princeps pollicis artery be palpated?

A

Cleft between thumb and index finger:

- On anteromedial side of thumb

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64
Q

How else can the princeps pollicis pulse be felt?

A

By pressing pad of thumb against a hard surface

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65
Q

Where can the princeps indicis (radialis indicis) pulse be felt?

A

Lateral side of the metacarpal of the index finger

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66
Q

Where do the superficial veins of the upper limb originate?

A

From dorsal venous arch on hand

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67
Q

How can the dorsal venous arch of the hand be made more prominent?

A

Hand arm by side and apply light pressure to the medial aspect of the arm

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68
Q

What is the course of the cephalic vein?

A

Runs from lateral side of dorsal venous arch
Runs through roof of anatomical snuffbox
Runs along lateral border of forearm
Passes anterior to head of radius at cubital fossa
Runs on lateral side of biceps brachii
Enters deltopectoral groove

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69
Q

What is the course of the basilic vein?

A

Runs from medial side of the dorsal venous arch
Along medial side of the forearm
Passes anterior to the medial condyle of the humerus and along the medial side of the arm
Pierces the deep fascia to join with the brachial veins to form the axillary vein

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70
Q

Where are the cephalic and basilic veins most easy to identify?

A

Close to hand and distal forearm

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71
Q

What communication may be visible between the cephalic and basilic veins and where?

A

Median cubital/median antebrachial vein

In skin covering cubital fossa

72
Q

How do nerves feel on palpation?

A

Cord-like structures

73
Q

Why must palpation of nerves be gentle?

A

Too deep a pressure will result in unpleasant tingling sensations or pain

74
Q

Why may the nerves of the upper limb only be palpated in specific areas?

A

Are deep within the tissues

75
Q

What nerves of the upper limb cannot be palpated?

A

Axillary nerve

Musculocutaneous nerve

76
Q

Where can the trunks of the brachial plexus be palpated?

A

Above medial part of clavicle

Close to lateral border of SCM

77
Q

What nerves can be palpated in the lateral wall of the axilla when compressing the axillary artery?

A

Median nerve

Ulnar nerve

78
Q

Where can the radial nerve be palpated?

A

Rolled against surface of humerus halfway down lateral side of arm:

  • Below insertion of deltoid
  • Anterior to lateral head of triceps brachii
79
Q

Where can the superficial branch of the radial nerve be palpated?

A

On the distal half of the lateral surface of the radius as it passes from under brachioradialis and onto the dorsum of the hand

80
Q

Where can the ulnar nerve be palpated at the elbow?

A

Behind medial epicondyle of humerus as it crosses over medial collateral ligament of the elbow

81
Q

Where does the ulnar nerve pass under in the forearm?

A

Fibrous arch of flexor carpi ulnaris

82
Q

Where does the ulnar nerve become superficial again in the forearm? Is it palpable here?

A

7cm above the wrist, lateral to flexor carpi ulnaris

Not easily

83
Q

What can the distal branches of the ulnar nerve be compressed agains?

A

Hook of hamate bone:

- Distal to pisiform

84
Q

Where can the median nerve be palpated?

A

Between tendons of flexor carpi radialis and flexor digitorum superficialis on the anterolateral aspect of the wrist

85
Q

What may cause difficulty in palpation of the median nerve in some people?

A

May be covered by palmaris longus tendon

86
Q

What structures are vulnerable during dislocation of the shoulder joint?

A

Axillary nerve

Glenoid labrum

87
Q

What structures are vulnerable in a mid-shaft fracture of the humerus?

A

Radial nerve (in radial groove)

88
Q

What structures are vulnerable in a fracture of the humeral condyles?

A 
Ulnar nerve (medial condyle)
Brachial artery and median nerve (supracondylar)
89
Q

What structures are vulnerable in a fracture of the distal radius and ulna?

A

Median nerve

Radial and ulnar arteries

90
Q

What structures are vulnerable in incisions/lacerations to the thenar eminence?

A

Median nerve

91
Q

What structures are vulnerable in incisions/lacerations to the hypothenar eminence?

A

Ulnar nerve

92
Q

What structures are vulnerable in mid-palm incisions/lacerations?

A

Palmar arches

93
Q

Why are only some of the bony features palpable in the hip region?

A

Large amount of muscle and other soft tissues in hip region

94
Q

What bony feature if palpable by placing hands on your waist and sliding them down until a large bony ridge is felt?

A

Iliac crests

95
Q

What bony feature is palpable at the anterior ends of the iliac crests?

A

ASIS

96
Q

What structures attach to the ASIS?

A

Sartorius
Inguinal ligament
Tensor fascia latae

97
Q

What can be palpated 5-7cm posterior to the ASIS?

A

The tubercle of the crest that gives attachment to the iliotibial tract

98
Q

Where is the AIIS located?

A

2cm above the rim of the acetabulum

Located by finding the ASIS and following the border of the ilium down

99
Q

How is the greater trochanter of the femur located?

A

Locate the most lateral point of the iliac crest

Pass fingers down 10cm onto surface of thigh

100
Q

Why can the greater trochanter of the femur be palpated?

A

It is the most lateral bony prominence of the hip joint

101
Q

How can the ischial tuberosities be palpated?

A

Sit down in a chair and place your hands under your gluteal regions
You will feel the large bony tuberosities press against your hands

102
Q

What structures attach to the ischial tuberosities?

A 
Posterior thigh (hamstrings):
- Except short head biceps femoris
AND
Hamstring part of adductor magnus
AND
Sacrotuberous ligament
103
Q

What is the easiest structure to palpate at the knee?

A

Patella

104
Q

What lies at the superior and inferior borders of the patella?

A 
Superior = Quadriceps tendon
Inferior = Patellar tendon
105
Q

How does the patella move when the knee is flexed?

A

Posteroinferiorly

106
Q

When is the patella quite mobile?

A

When the knee is extended

107
Q

What lies at the inferior end of the patellar tendon and can be palpated?

A

Tibial tuberosity

108
Q

What can be palpated on either side of the patella when the knee is flexed?

A

Medial and lateral condyles of the femur

109
Q

What small tubercles can be palpated on the medial and lateral condyles of the femur?

A

Medial and lateral epicondyles

110
Q

What other tubercle is present on the medial side of the femur?

A

Adductor tubercle

111
Q

What structures are palpated by first palpating the medial and lateral femoral condyles then moving your fingers inferiorly?

A

Medial and lateral tibial condyles

112
Q

Where can the head of the fibula be palpated?

A

1cm posterolateral to the lateral condyle of the tibia

113
Q

Why must care be taken when palpating the head of the fibula?

A

Common fibular nerve passes down the posterior surface of the head of fibula

114
Q

Why is the anterior border of the tibia so easily palpable?

A

Is subcutaneous as far as the medial malleolus

115
Q

How can the tendon of biceps femoris be located?

A

As someone to flex their knee against gentle resistance
Tendon of biceps femoris will be on posterolateral side of knee:
- Passes down to insert onto head of fibula

116
Q

How can the tendon of semitendinosus be palpated?

A

Ask someone to flex their knee against gentle resistance

Tendon of semitendinosus at posteromedial side of knee

117
Q

Where can semimembranosus be palpated? How?

A

Either side of semitendinosus tendon:

  • Place fingers on semitendinosus tendon
  • Ask them so flex and extend knee
  • Feel semimembranosus moving under fingers
118
Q

Starting at the lateral malleolus, how far up the leg can the fibula be traced?

A

15cm (before it disappears into the muscle mass of the leg)

119
Q

How can the sustentaculum tali be palpated?

A

Palpate tip of medial malleolus

Pass fingers inferiorly by 1cm

120
Q

What structure is palpated by passing fingers from the anterior end of the sustentaculum tali?

A

Tubercle of the navicular bone

121
Q

How can the head of the talus be palpated?

A

Place right hand on left ankle:

  • Index finger on lateral malleolus
  • Thumb on medial malleolus
  • Bring finger and thumb together (and slightly forward)
122
Q

What bone is palpable immediately distal to the head of the talus?

A

Navicular bone

123
Q

What bone is palpable immediately distal to the navicular bone?

A

Medial cuneiform

124
Q

What bone can be palpated from the distal aspect of the medial cuneiform?

A

1st metatarsal

125
Q

Which 2 tendons attach to the medial cuneiform and the base of the 1st metatarsal?

A

Fibularis longus

Tibialis anterior

126
Q

What bone is encountered by following the 5th metatarsal proximally?

A

Cuboid

127
Q

What is palpated by starting at the lateral malleolus and moving fingers forward and dowards by 1cm?

A

Fibular tubercle of the lateral side of the calcaneous

128
Q

If the foot is everted, what structures may be palpable either side of the fibular tubercle of the calcaneus?

A 
Fibularis brevis (superiorly)
Fibularis longus (inferiorly)
129
Q

Where can the calcaneofibular ligament be palpated?

A

Just inferior and posterior to the tip of the lateral malleolus

130
Q

What nerve roots does the achilles tendon reflex test?

A

S1 and S2

131
Q

Where can the long extensor tendons of the foot be palpated?

A

Dorsal surface of ankle

132
Q

What is the most medial tendon on the dorsal ankle?

A

Tibialis anterior

133
Q

What tendon lies lateral to the tibialis anterior tendon?

A

Extensor hallucis longus

134
Q

How can the tendon of EHL be followed to its insertion? Where is this insertion?

A

By extending the big toe

Inserts on base of distal phalanx of 1st digit (great toe)

135
Q

What tendon can be palpated lateral to EHL tendon on the dorsal ankle?

A

Extensor digitorum longus

136
Q

Where might a visible swelling indicating the small extensors of the digits of the foot be seen?

A

2cm anterior to lateral malleolus on dorsum of foot

137
Q

Where is the femoral artery palpable?

A

In the groin area just below the midpoint of the inguinal ligament

138
Q

What is the course of the femoral artery?

A

Lies relatively superficial in the femoral triangle
Then runs under sartorius
Runs through adductor hiatus
Become popliteal artery in the popliteal fossa

139
Q

How can the popliteal artery be palpated?

A

Bend knee to 45 degrees to release tendon of surrounding tendons
Palpate in popliteal fossa

140
Q

Where is the anterior tibial artery palpable?

A

On anteromedial aspect of ankle joint
Between tendons of:
- EHL
- EDL

141
Q

Where is the dorsalis pedis artery palpable?

A

In the space between the 1st and 2nd metatarsals

142
Q

What is the dorsalis pedis a branch of?

A

Anterior tibial artery

143
Q

Where does the posterior tibial artery lie?

A

Deep in the posterior compartment under gastrocnemius and soleus

144
Q

Where is the posterior tibial artery palpable?

A

Posterior to medial malleolus between tendons of:
- Flexor digitorum longus
- Flexor hallucis longus
(Medial to tibial nerve)

145
Q

What does the posterior tibial artery branch into?

A

Medial and lateral plantar arteries in sole of foot

146
Q

What do the deep veins of the lower limb accompany?

A

The arteries of the lower limb

147
Q

Can the deep veins of the lower limb be palpated?

A

No

148
Q

Where do the superficial veins of the lower limb originate?

A

Dorsum of the foot from the dorsal venous arch

149
Q

When is the dorsal venous arch of the foot more prominent and more visible?

A

If you are standing

150
Q

Where does the great saphenous vein originate?

A

Medial side of the dorsal venous arch

151
Q

What is the course of the great saphenous vein?

A

Passes over anterior surface of medial malleolus
Runs over medial aspect of leg
Crosses knee posterior to medial condyles of tibia and femur (3-4 fingerbreadths from patella)
Ascends medial surface of thigh
Drains into femoral vein

152
Q

Where is the great saphenous vein most easily located?

A

At or near medial malleolus (even in people who are overweight)

153
Q

Where does the small saphenous vein originate?

A

From the lateral side of the dorsal venous arch

154
Q

What is the course of the small saphenous vein?

A

Passes posterior to lateral malleolus
Passes along lateral side of tendocalcaneus
Passes onto posterior aspect of calf
Drains into popliteal vin at popliteal fossa

155
Q

Why are the nerves of the lower limb difficult to palpate?

A

Run deep within the lower limb

156
Q

Where does the femoral nerve lie?

A

Most laterally in the femoral triangle

157
Q

Where does the obturator nerve lie?

A

Deep in medial compartment

158
Q

Where does the sciatic nerve lie?

A

Deep in the posterior comaprtment of the thigh

159
Q

Where does the tibial nerve lie and run?

A

Lies within popliteal fossa

Passes deep to gastrocnemius and soleus

160
Q

Where does the tibial nerve become palpable?

A

At posterior surface of the medial malleolus

161
Q

What does the tibial nerve form in the foot?

A

Medial and lateral plantar nerves

162
Q

What is the course of the common fibular nerve?

A

Formed from sciatic nerve in thigh

Passes down medial side of tendon of biceps femoris

163
Q

Where does the common fibular nerve become palpable?

A

As it passes around head of fibula:

- Easier to palpate on the posterior surface

164
Q

Where does the deep fibular nerve lie?

A

Deep in anterior compartment of leg until it crosses anterior surface of ankle

165
Q

Where can the deep fibular nerve be palpated?

A

Lateral to dorsalis pedis artery
Between tendons of:
- EHL
- EDL

166
Q

Where does the superficial fibular nerve become palpable?

A

Medial to the anterior border of the lateral malleolus

After it emerges between fibularis longus and brevis

167
Q

What structures are vulnerable if there is damage to the area inferior to the inguinal ligament?

A

Femoral nerve
Femoral artery
Femoral vein

168
Q

What structures are vulnerable if there is damage to the area at the head of the fibula?

A

Common fibular nerve

169
Q

What structures are vulnerable if there is damage to the area at the medial malleolus?

A 
Posterior tibial artery
Saphenous nerve
Great saphenous vein
Tibial nerve
TP, FDL and FHL tendons
170
Q

What structures are vulnerable if there is damage to the area of the gluteal region?

A

Superior gluteal nerve

Sciatic nerve

171
Q

What structures are vulnerable if there is damage to the posterior compartment of the thigh?

A

Hamstrings

Sciatic nerve

172
Q

What structures are vulnerable if there is damage to the popliteal fossa?

A

Tibial nerve

Popliteal artery

173
Q

What structures are vulnerable if there is damage to the lateral malleolus?

A

Small saphenous vein

Superficial fibular nerve

174
Q

What structures are vulnerable if there is damage to the dorsum of the foot?

A

Dorsalis pedis artery

175
Q

What structures are vulnerable if there is damage to the cleft between the 1st and 2nd digits?

A

Deep fibular nerve

Anatomy of the Individual (10 decks)

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