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Newz Flashcards

1
Q

What are the major structures of the Axial Skeleton?

A
  • Skull
  • Vertebrae
  • Ribs
  • Sacrum
  • Coccyx
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2
Q

Skull Functions

1) - Protection
2) - Senspry input
3) Attachment of m,uscles

A

1)

  • Brain
  • Brainstem
  • Sensory organs

2)
- Sight
- Smell
- Hearing
- Taste
- Balance

3)
- Speech
- Chewing
- Eye movement
- Facial expression

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3
Q

Skull structure

Cranium

  • How many bones?
  • What other parts of the cranium?

face

  • How many bones?
  • How are they paired?

What does to skull equal?

A
  • 8 bones
  • Roof
  • Walls
  • Floor
  • Calvarium
  • 14 bones
  • Bilaterally paired
  • Skull = cranium = facial bones
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4
Q

Skull structure
- What are diploe?

Skull joints
- What sutures?

  • Temporomandibular joint
A
  • Cancellous regions b/w compact tables
  • Fibrous
  • Patent when young
  • Fuse in adolescence - adulthood
  • Fontanelles
  • Synovial
  • condylar
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5
Q

Skull Base
- What is apart of the vault floor?

Skull Fossae
- What is apart of the depressions?

A
  • Ethmoid
  • Sphenoid
  • Occipital
  • Temporal
  • Anterior
  • Middle
  • Posterior
  • Hypophyseal (pituitary)
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6
Q

Frontal bone

  • Where?
  • Joined to?
  • What type of joint?
  • What suture?
  • Articulates with how many other bones?

Features of the frontal bone

  • What type of notch/foramen?
  • What type of precess/ridge?
  • What is the junction of bones just above the nose & b/w eyes?
A
  • Anterior wall & roof of vault
  • Joined to parietal bones
  • Fibrous joint
  • Coronal suture
  • 12
  • Supraorbital
  • Supraorbital
  • Glabella
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7
Q

Parietal bones

  • Where?
  • Joined to?
  • What type of joint?
  • What suture?
  • Other sutures?
  • What bone does it articulate with?

Features

  • What is superior & inferior & has attachment of temporalis muscle?/w frontal, sphenoid, temporal & paietal bones?
  • What is the junction b
A
  • Lateral wall and roof of vault
  • Joined to several cranial bones
  • Fibrous joint
  • Joined together medially (sagittal suture)
  • Coronal suture anteriorly (frontal bone) , lamboid suture posteriorly (occipital bone), squamous suture inferiorly (temporal bone)
  • Sphenoid
  • Temporal lines
  • Pterion (weak point of skull)
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8
Q

Temporal bones

  • Where?
  • Joined to?
  • Contains?

Features
- What are the processes?

  • Where is the Foramina?openings?
A
  • Lateral wall & floor of vault
  • Joined to several cranial bones
  • Contains mandibular fossa for temporomandibular joint (TMJ)
  • Zygomatic process
  • Mastoid process
  • Styloid process
  • External & internal acoustic meatus
  • Stylomastoid foramen
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9
Q

Occipital bone?

  • Where?
  • Joined to? What suture?

Features
- What processes?

  • Where is the Foramina/openings?
  • What are the grooves?
A
  • Posterior wall & floor of vault
  • Joined to temporal & parietal bones (lamboid sutre)
  • Occipital protuberance
  • Internal occipital crest
  • Occipital condyles
  • Foramen magnum
  • Sinuses & blood vessels
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10
Q

Sphenoid bone

  • Where?
  • Joined?
  • Other link to?

Features
- What wings?

  • What does the fossa form?
  • Are there many Foramina? What is apart of it?
  • What are the processes?
A
  • Lateral wall & floor of vault
  • Joined to all other cranial bones
  • Other link to pterion
  • Greater wing
  • Lesser wing
  • forms the pituitary/hypophyseal fossa
  • Many! cranial nerves, blood vessels
  • Pterygoid processes
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11
Q

Ethmoid bone

  • Where?
  • How much is visible
  • What plate?

Features
- What is the Foramina?

  • Processes?
  • other?
A
  • Anterior floor of vault
  • Only a small portion visible
  • Cribiform plate
  • Cribiform plate
  • Crista galli
  • Ethmoidal sinuses/air cells
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12
Q

Skull Facial bones

M
N
Z
V
C
P
L
M
  • What varied features
A
  • Maxilla - 2
  • Nasal - 2
  • Zygomatic - 2
  • Vomer - 1
  • Conchae - 2
  • Palatine - 2
  • Lacrimal - 2
  • Mandible - 1
  • Articulation
  • Foramina
  • Processes
  • Modifications
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13
Q

Mandible
- Attached to?

  • Other features
  • What is the strong muscle attachment for?
A
  • Attached to temporal bone
    • TMJ
    • Synovial
    • Condylar
  • Ramus
  • Body
  • Coronoid procces
  • Mandibular notch
  • Alveolar processes
  • Mental foramen
  • Mental process
  • Chewing
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14
Q

Vertebral column Functions

  • What does it protect?
  • Hold torso upright & attachment of pelvic girdle
  • What is Muscle & ligament attachment for?
A
  • Spinal cord
  • Exit of spinal nerves
  • Bipedalism
  • Adaption to environment
  • Stability
  • Attachment of limbs to axis
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15
Q

Vertebral column
Composition
- How many mobile vertebrae?

  • What 7-10 fused vertebrae?
  • What disks?
A
  • 24 mobile vertebrae
    • 7 cervical
    • 12 thoracic
    • 5 lumbar
  • 5 sacral
  • 2-5 coccygeal
  • Intervertebral discs
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16
Q

Vertebral column
Curvature

  • Alternations of?
  • Initially?
  • When does the secondary curvatures develop?
A
  • Alternations of kyphosis (1* thoracic) & lordosis (2* cervical & lumbar)
  • Initially all one kyphosis (primary curvature)
  • When the child assumes upright position
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17
Q 
Cervical vertebra
Composition
- How many?
- Size?
- What process?
-Contain?
   - Transmits?
A
  • 7 in total
  • Small, delicate
  • Bi furocated spinous process
  • Contain transverse foramina bilaterally in transverse processes
    • Transmitts the vertebral arteries & veins
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18
Q 
Thoracic vertebra
composition
- How many?
- Size
- What process?
  • What Costal facets?
A
  • 12 in total
  • Progressively large
  • Single, inferiorly deviated spinous process
  • Superior
  • Inferior
  • Transverse
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19
Q 
Lumbar vertebra
Composition
- How many?
- Size?
Process?
- Are there costal facets?
  • What is load bearing?

Foramen forming verebral canal is wide

  • Where does the distal portions of the spinal cord end?
  • What does it become?
  • Clinically important for?
A
  • 5 in total
  • very large
  • Single, parallel spinous process
  • No costal facets
  • Transmits froce from above
  • Ends at L1-L2
  • Becomes cauda equina (spinal nerve roots)
  • Lumbar puncture
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20
Q

Joints of vertebral column

Zygaphyseal

  • Between?
  • Location
  • Is it synovial?
  • Creates?
    • Transmits?

Intervertebral

  • Separated by>
    • What joints?
  • What do discs contain? Inner & outer?
  • What is a “Slipped disc”
A
  • B/w articular processes
  • Superior & inferior
  • Yes
  • Creates intervertebal foramen
    • Transmits spinal nerve
  • Separated by intervertebral discs
    • Cartilaginous joints - fibrocartilage
  • Contain fibrous ring
    • Annulus fibrosis (outer)
    • Nucleus pulposis (inner)
  • A rupture of the disc contents
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21
Q

Sacrum

  • How many fused vertebrae?
  • Creates what to transmit spinal nerves?
  • What is the joint b/w sacrum & ilium?
  • What is inferior? What is inferior?
A
  • 5 fused vertebrae?
  • Create foramina to transmit spinal nerves
  • sacroiliac joint
  • Sacral canal (superior)
  • Sacral hiatus (inferior)
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22
Q

Coccyx

  • How many vertebrae?
  • What tail of humans?
  • Cornu forms?
  • Surrounded by?
  • Deteriorates with?
A

2-5 vertebrae

  • vestigal tail
  • Cornu forms posterior & lateral margins of sacrococcygeal symphysis
  • Surrounded by ligaments
  • Deteriorates with age
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23
Q

Key ligaments of the vertebral column

  • Ligamentum nuchae
    • what for?
  • Supraspinous ligament
    • Support?
  • Ligamentum flavum
    • WHat for?
  • Anterior longitudinal ligament
    • Limits?
  • Posterior longitudinal ligament
    • Limits?
A
  • Posterior neck support
  • Support of head & back
  • “yellow” ligament - posture
  • Limits extension of vertebral column
  • Limits flexion of vertebral column
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24
Q

Muscles of the vertebral column

  • Movements?
  • Posture?
  • Support?
A
  • Unilateral
  • Bilateral
  • Balance
  • Upright stance
  • Head
  • Neck
  • Vertebral column
  • Appendicular connections
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25
Q

Spinotransversales
splenius capitis

origin?

insertion?

Function?

A

Origin:

  • Ligament nuchae
  • Spinous processes of C7 to T4

Insertion:

  • Mastoid process
  • Lateral superior nuchal line

Function:

  • Bilaterally extend neck
  • Individually rotate head
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26
Q

Spenius cervicis

  • Origin?
  • Insertion?
  • Function?
A

Origin:
- Spinous processes of T3 to T6

Insertion:
- transverse processes of C1 to C3

Function:

  • Bilaterally extend neck
  • Individually rotate head
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27
Q

Erector spinae

illiocostalis (lateral column)

  • Three parts?
  • Origin?
  • Insertion?
  • Function?
A

Three parts:
- Cervicis, Thoracis, Lumborum

Origin:
- Sacrum, illiac cres, spinous processes of T10-L5, angles of ribs 3-12

Insertion:
- Transverse processes C4-C7, angles of ribs 1-12

Function

  • Bilaterally extend back, posture
  • Individually laterally flex vertebral column
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28
Q

Erector spinae

Longissimis (middle column)

  • Three parts?
  • Origin?
  • Insertion?
  • FUnction?
A

Three parts:
- Captitis, Cervicis, Thoracis

Origin:
- Mostly transverse processes of cervical & thoracic vertebrae, blends with iliocostalis muscle

Insertion:
- Mastoid process, mostly transverse processes of C2 - T12

Function:

  • Bilaterally extedd back, posture
  • Individually laterally flex vertebral column
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29
Q

Erector Spinae

Spinalis (medial column)

  • Three parts?
  • Origin?
  • Insertion?
  • Function?
A

Three parts:
- Captitis, cervicis, thoracis

Origin:
- Blends with semispinalis capitis ligamentum nuchae spinous processes of C7 and T10-L2

Insertion:
- With semispinalis capitis, spinous processes of C2 & T1 - T8

Funtion:

  • Bilaterally extend back, posture
  • Individually laterally flex vertebral column
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30
Q

Transversospinales

Semispinalis (superficial)

Three parts?

  • Origin?
  • Insertion?
  • Function?
A

Three parts:
- Captitis, Cervicis, Thoracis

Origin:
- transverse processes of C7 - T10

Insertion:
- Spinous processes of C2 - T4 + nuchal lines

Function:

  • Bilaterally extend back, posture
  • Individually rotate opposite side of vertebral column
  • Semispinalis capitis also individually rotates & lift the chin superiorly
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31
Q

Transversopinales

Multifidus (middle)

  • Origin?
  • Insertion?
  • Function?
A

Origin:
- C4- L5, sacrum, PSIS

Insertion:
- Spinous processes of C2 - L5

Function:

  • Bilaterally extend back, posture
  • Individually laterally flex vertebral column
  • Best seen in lumbar vertebral column
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32
Q

Transversospinales

Rotatores (deep)

  • Three parts?
  • Origin?
  • Insertion?
  • Function
A

Three parts:
- Cervics, Thoracis, Lumborum

Origin:
- Varied, but from all vertebrae C1 - L5

Insertion:

  • Spinous processes of C1 - L5
  • Broken into long (2 segments) & short (1 segment) rotators

Function:

  • Bilaterally extend back, posture
  • Individually laterally flex vertebral column
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33
Q

Intercostals

External intercostals (inspiration)
- Originate from?
Internal Intercostals (expiration)
- Originate from?
Inermost intercostals (expiration)
- Originate from?
A 
External intercostals (inspiration):
- Originate from inferior border of rib above; insert into superior border of rib below)
Internal intercostals (expiration):
- Originate from superior border of rib below; insert into inferior border of rib above (deep to associated external intercostals)
Innermost intercostals (expiration):
- Originates from costal groove of rib above; insert into inner superior surface of rib below
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34
Q

Diaphragm

  • Attaches to various anterior, lateral & posterior structures?
  • Projects to central tendon?
  • Function?
A

Attaches to various anterior, lateral & posterior structures:

  • Xiphisternum
  • Costal arch
  • Ribs 11 & 12
  • Posterior ligaments of abdomen
  • Lumbar vertebrae

Projects to central tendon:
- Oesophagus, major vessels & nerves pass through here

Function:

  • Relaxation = elevation (decrease volume)
  • Contraction = depression (increase volume)
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35
Q

Abdominal muscles

Rectus abdominis

Origin?

  • Insertion?
  • Function?
A

Origin:
- Pubic crest, tubercle & symphysis

Insertion:
- Xiphod process, costal arch

Function
- Compress abdominal contents, flex abdomen

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36
Q

Abdominal muscles

Transverse abdominis

  • Origin?
  • Insertion?
  • Function?
A

Origin:
- Thoracolumbar fascia, illiac crest, inguinal ligament

Insertion:
- Linea alba, pubic crest, pectineal line

Function:
- Compress abdominal contents

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37
Q

Abdominal muscles

External oblique

  • Origin?
  • Insertion?
  • Function?
A

Origin:
- Outer surfaces of ribs 5 - 12

Insertion:
- Lateral lip of iliac cres, linea alba

Function:
- Compress abdominal contents, bilaterally flex abdomen, individually bend abdomen & turn to opposite side

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38
Q

Abdominal muscles

Internal oblique

  • origin?
  • Insertion?
  • Function?
A

Origin:
- Thoracolumbar facia, illiac crest, inguinal-ligament

Insertion:
- Inferior border of ribs 3 or 4, linea alba, pubic crest, pectineal lin

Function:
Compress abdominal contants, bilaterally flex abdomen, individually bend abdomen & turn to same side

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39
Q

Pelvic girdle
Osteoligamentous ring

  • what bones contribute?
  • What ligaments contribute?
  • What does it articulate with?
A

Osteoligamentous ring:

What bones contribute?

  • Sacrum
  • Hip bones x 2

What ligaments contribute?
- Lots

What does it articulate with?

  • Laterally: femora x 2
  • Inferiorly: Coccyx
  • Superiorly: L5 (disc & vertebral body)
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40
Q
  • Function of the pelvic girdle?

- What are the pelvic organs?

A
  • Protects & supports pelvic organs

- Bladder, rectum, anal canal, reproductive tracts

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41
Q

Function of the pelvic girdle?
- Essential for?

  • Have a look at lecture 17 slide 23
A

Transmits body weight from trunk to lower extremities

- Essential for standing

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42
Q

Function of the pelvic girdle:

  • Bony prominences for?
A

Function of the pelvic girdle:

  • Bony prominences for attachment of muscles & ligaments
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43
Q

Function of the pelvic girdle:

what are the 3 functions?

A

Function of the pelvis girdle?

  • Protects & supports pelvic organs
  • Transmits body weight from trunk to lower extremities
  • Attachment of muscles & ligaments
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44
Q

Sacrum:

  • How many fused vertebrae? What do they contribute to?
  • What is superior? what is inferior?
  • Continuation of what?Contain sacro spinal nerves that end where?

Note: Have a look at the sacrum Lecture 17 slide 26

A

Sacrum:

  • 5 fused vertebrae, contributes to the sacroiliac joint
  • It has sacral CANAL (superior), sacral HIATUS (inferior)
  • COntinuation of vertebral canal, contain
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45
Q

Hip bone:

  • Pelvis consist of 3 fused bones?
  • What is the joint that forms at the acetabulum?
A

Pelvis consist of 3 fused bones:

  • Ilium
  • Ischium
  • Pubis

Forms a joint at the acetabulum
- Ball-and-socket joint

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46
Q

What muscles attach at the ischial tuberosity?

A

Hamstrings:

  • Long head of biceps femoris
  • Semitendinosus
  • Semimembranosus
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47
Q

What ligaments attach at the ischial spine & Ischial tuberosity?

A

Ligaments attached in the hip that make

1) Greater sciatic foramen:
2) Lesser sciatic foramen:

  • Sacrospinous ligament
  • Sacrotuberous ligament

Ligament attached in the hip that makes
1) Obturator canal

  • Obturator membrane
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48
Q

Sacrospinous & sacrotuberous ligaments:

Functions?

  • Resist?
  • Form boundaries of?
A

Sacrospinous & sacrotuberous functions:

  • Resist rotation of sacrum b/w hip bones
  • Form boundaries of greater & lesser sciatic foramina
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49
Q

greater sciatic foramen:

what structures exit through the greater sciatic foramen?

A

What structures exit through the greater sciatic foramen?

  • Piriformis muscle
  • Superior & inferior gluteal nerves
  • Sciatic nerve
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50
Q

Cheack out leacture 17 slide 33

A

watyu

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51
Q

Whats near the inguinal ligament?

  • Inguinal canal?
  • Femoral artery?
A

Whats near the inguinal ligament?

Inguinal canal:

  • Superior to the inguinal ligament
  • Relevance to inguinal hernia

Femoral artery:

  • Under the inguinal ligament
  • Location for catherization
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52
Q

What are the joints of the pelvic girdle?

A

What are the joints of the pelvic girdle?

  • Sacroiliac joint (SIJ) Left & right
  • Pubic symphysis
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53
Q

Sacroiliac ligaments

  • Sacroilliac ligaments help stabilize SIJs. They consis of:
A

Sacroilliac ligaments help stabilize SIJs. They consis of:

  • Anterior
  • Interosseous
  • Posterior sacroiliac ligaments
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54
Q

What muscle group attaches to the:

  • Greater trochanter?
  • Lesser trochanter?
A

What muscle group attaches to the:

Greater trochanter?

  • Gluteus medus
  • Guleus minimus

Lesser trochanter

  • Psoas major
  • iliacus
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55
Q

Hip joint

Synovial joint - Ball & socket, multiaxial
- Bony components?

Function:

A

Hip Joint

Synovial joint - Ball & socket, multiaxial
Bony components:
- Acetabulum
- Head of femur

Function:

  • Links lower limb to pelvis
  • Transmit upper body weight to lower limb
  • Designed for stability (most stable joint)
  • 2nd most movable joint in the body
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56
Q

Hip joint - capsule

  • Joint capsule 9two layers):
  • Attaches arround?
  • Reinforced by?
A

Hip joint - capsule

Joint capsule (two layers):

  • Outer, fibrous layer
  • Inner, synovial membrane

Attaches:
- Around margin of acetabulum and to femoral neck

Reinforced by:
- Ligaments

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57
Q

Hip joint - capsular ligaments

Functions:

A

Hip joint - capsular ligament functions:

  • Stabilizes & strengthens the joint
  • All ligaments are tight with hip extension
  • This position is energy efficient
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58
Q

Hip joint - capsular ligaments

Three ligaments?

A

Hip joint - capsular ligaments

Three ligaments:

  • Iliofemoral (Y-shaped, strongest)
  • Ischiofemoral
  • Pubofemoral
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59
Q

Acetabular labrum

  • What does labrum =?
  • What type of structure? Attached to what?
  • What does it increase?
A

Acetabular labrum:

  • Labrum = lips
  • Fibrocartilage structure,m attached to the rim of the acetabulum
  • It increases the articular area by `10%, help to fit the femoral head to acetabulum
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60
Q

Lower limb innervation

  • The lumbosacral plexus innervates?
  • Consist of?
A

Lower limb innervation

Lumboscacral plexus:

  • Innervates the lower limb
  • Consists of ventral rami of L1-S4)
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61
Q

All muscles need a nerve

Three main nerves for lower limb?

A

Three main nerves for lower limb:

1) Femoral
2) Obturator
3) Sciatic

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62
Q

Nerves supply the hip & thigh:

  • Anterior thigh
  • Medial thigh
  • Posterior thigh
A

Nerves supply the hip & thigh:

  • Anterior thigh = femoral nerve
  • Medial thigh = Obturator nerve
  • Posterior = Sciatic nerve
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63
Q

Femoral triangle

  • Boundaries?
  • Contents (from medial to lateral) - VAN?
A

Femoral Triangle

Boundaries:

  • Superior (base) = inguinal ligament
  • Medial = adductor longus
  • Lateral: sartorius

Contents (from medial to lateral) - VAN:

  • Femoral Vein
  • Femoral Artery
  • Femoral Nerve
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64
Q

Hip flexors - iliopsoas

Origin?

Functions?

Nerve?

A

Hip flexors - iliopsoas

Origin:

  • Iliacus: iliac fossa & crest
  • Psoas: vertebrae

Functions:

  • Strong hip flexor
  • Flexes trunk if legs fixed

Nerve:
- Femoral

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65
Q

Hip flexors - Quadriceps

  • Part of the quadriceps femoris?
A

Hip flexors - Quadriceps

Part of the quadriceps femoris:

  • Rectus femoris
  • Vastus medialis
  • Vastus intermedius
  • Vastus lateralis
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66
Q

Hip flexors - rectus femoris

  • Origin?
  • Insertion?
A

Hip flexors - rectus femoris

Origin:
- Anterior inferior iliac spine

Insertion:
- Quadriceps femoris tendon → patella → patellar ligament → tibial tuberosity

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67
Q

Hip flexors - rectus femoris

Functions?

Nerve?

A

Hip flexors - rectus femoris

Functions

  • Hip: Flex
  • Knee: extension

Nerve:
- Femoral

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68
Q

Hip flexors - sartorius

  • Origin?
  • Insertion?
  • Functions?
  • Nerve?
A

Hip flexors - sartorius

Origin:
- Anterior superior iliac spine

Insertion:
- Medial side tibia (pes anserinus)

Functions:
- Known as the Tailors muscle (sitting cross-legged)

Nerve:
- Femoral

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69
Q

Pes anserinus

  • Insertion site for thee muscles (one from each compartment of the thigh)
A

Pes anserinus

Insertion site for thee muscle:

  • Sartorius
  • Gracilis
  • Semitendinosus
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70
Q

Hip extensors - gluteus maximus

  • Origin?
  • Insertion?
  • Function?

Nerve & blood?

A

Hip extensors - gluteus maximus

Origin:
- Posterior ilium, lateral sacrum & coccyx

Insertion:

  • Gluteal tuberosity
  • Iliotibial band

Functions
- Hip extension

Nerve & blood:
- Inferior gluteal

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71
Q

Hip extensors - gluteus maximus

Functions?

A
  • Hip extension
  • For climbing
  • For changing from sitting to standing position
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72
Q

Hip extensors - Hamstrings

  • Three muscles in this group, posterior thigh?
A

Hip extensors - Hamstrings

Three muscles in this group, posterior thigh:

1) Semitendinous
2) Semimembranosus
3) Biceps femoris

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73
Q

Hip extensors - Hamstrings

  • Origin?
A

Origin:

  • Ischial tuberosity
    • Long head of biceps femoris
    • Semitendinosus
    • Semimembranosus
  • Except biceps femoris short head: linea aspera
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74
Q

Hip extensors - Hamstrings

  • Insertion?
A

Hip extensors - Hamstrings

Insertion:

  • Tibia - semimembranosus & semitendinosus
  • Head of fibula - Bicep femoris
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75
Q

Function of the hamstring

  • Actions?
  • Nerve?
A

Function of the hamstrings

Actions:

  • Hip = extension
  • Knee = ?
  • Rotation at the knee

Nerve:
- All are supplied by tibial nerve, excepts for short head of bicep femoris

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76
Q

Hip abductors

Gluteus Medius & Minimus:

  • Origin?
  • Insertion?
A

Gluteus Medius & Minimus

Origin:
- Ilium

Insertion:
- Greater trochanter

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77
Q

Hip abductors

Tensor fascia lata:

  • Origin?
  • Insertion?
A

Tensor fascia lata

Origin:
- ASIS & Iliac crest

Insertion:
- Iliotibial band

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78
Q

Hip abductors

  • Function?
A

Function:

- Hip joint abduction & internal rotation

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79
Q

Hip abductors in standing

  • Maintain?
  • In case of muscle weakness or nerve injury: dropping of?
A

Hip abductors in standing:

  • Maintain pelvis horizontal during single-leg stance
  • In case of muscle weakness or nerve injury: dropping of contralateral pelvis
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80
Q

Hip abductors

Superior gluteal:

What are the nerves & arteries?

A

Superior gluteal:

  • Superior gluteal artery & nerve
  • Inferior gluteal artery & nerve
  • Piriformis m.
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81
Q

Hip adductors

Group of Muscles?

Origin?

Insertions?

A

Hip adductors

Group of Muscles

  • Three “adductors” (brevis, longus, magnus)
  • Pectineus
  • Gracilis

Origins
- Pubic bone

Insertions
- Femur

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82
Q

Adductor Magnus

Origins?

Insertions?

Passage of femoral artery into popliteal space?

A

Adductor Magnus

Origin:
- Pubic bone & ischium

Insertions:
- Femur & adductor tubercle

Adductor hiatus:
- Passage of femoral artery into popliteal space

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83
Q

Hip adductors

Functions?

When do we adduct?

Adductor magnus has a hamstring part for?

Swing phase gait?

A

Hip adductors

Functions:
- To adduct the thigh

When do we adduct?
- Stabilize one-leg stance, together with the abductors

Adductor magnus has a hamstring part for:
- hip extension

Swing phase gait:
- Adductor longus conrtibutes to hip flexion

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84
Q

Hip adductors

Innervated by?

Enters the thigh through?

A

Hip adductors

Innervated by:
- The obturator nerve

Enters the thigh through:
- The obturator canal

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85
Q

What is osteoporosis?

What is it associated with?

How is it diagnosed?

A

What is osteoporosis?

  • Bone reorption > bone formation
  • Reduction in bone mass
  • Bones become brittle & loses elasticity

Associated with:
- ageing & some medical conditions or treatments

Diagnosed:
- When bone density drops below a specific level

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86
Q

How can we measure bone mineral density?

A

How can we measure bone mineral density?
- Dual-energy X-ray absorptiometry
(DXA or DEXA)

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87
Q

Asteoporosis & sacropenia

  • Contribute to?
A

Contribute to:

- Fall-related fractures

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88
Q

Osteoprosis of the femoral neck

Why in post-menopausal women?

Why at these sites?

A

Osteoprosis of the femoral neck:

Why in post-menopausal women?

  • Decrease bone mineral density
  • Increased risk in those with a wider neck-shaft angle

Why at these sites?

  • Decreased bone density in femoral neck
  • Decreased force absorption due to sacropenia
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89
Q

Osteoporosis Prevention

A

Osteoporosis Prevention

  • Dietary intake of calcium & vitamin D
  • Prevent falls
  • Limit alcohol & smoking
  • Exercise (weigh-bearing/resistance exercise)
  • Maintain healthy weight
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90
Q

Bones of the leg & foot

  • Look @ lecture 19 slide 5
A

asdxfghbjkn

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91
Q

Joints of the leg?

Inferior strengthened by?

A

Joints of the leg

  • Superior tibiofibular joint: synovial joint
  • Inferior tibiofibular joint: Syndesmosis

Inferior tibiofibular joint is strengthened by:

  • Anterior tibiofibular joint
  • Posterior tibiofibular joint
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92
Q

Which ligaments stabilise the ankle?

A

Which ligaments stabilise the ankle?

  • Anterior tibiofibular ligament
  • Posterior tibiofibular ligament
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93
Q

Bones of the foot:

MNT P CC C(MIL)

A

Bones of the foot:

Metatarsals
Navicular
Talus

Phalanges

Calcaneus
Cuboid

Cuneiforms
(Medial, intermediate, Lateral)

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94
Q

Arches of the foot

  • Three arches?
  • Formed & supported by?
  • Dynamic structures?
A

Arches of the foot

Three arches

  • Medial longitudinal Arch
  • Lateral longitudinal Arch
  • Transverse Arch

Formed & supported by:
- Bones, ligaments, plantar fascia, muscles, tendons

Dynamic structures:

  • Stability
  • Absorb & distribute force
  • Aid propulsion
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95
Q

Ankle Joint Movements

  • Muscles passing over the dorsal surface?
  • Muscles passing over the plantar surface?
A

Ankle Joint Movements

Muscles passing over the dorsal surface:

  • Dorsiflex the ankle joint
  • Extend the toes

Muscles passing over the plantar surface:

  • Plantarflex the ankle joint
  • Flex the toes
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96
Q

Ankle Joint

  • Joint classification?
  • What bones form the socket?
  • Tibia & fibula articulate with the?
A

Ankle Joint

Joint classification:
- Hinge

What bones form the socket:

  • Medial malleolus (tibia)
  • Lateral malleolus (fibula)
  • Inferior surface of the distal end of tibia

Tibia and fibula articulate with the:
- Talus

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97
Q

Subtalar joint movements

The subtalar joint (b/w talus & calcaneus) allows?

A

Subtalar joint movements

The subtalar joint (b/w talus & calcaneus) allows:
- Inversion & eversion

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98
Q

Subtalar Joint Movements

Medial?

Lateral?

A

Subtalar Joint Movements

Medial:
- Muscles inserting from the medial side invert the foot

Lateral:
- Muscles inserting from the lateral side evert the foot

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99
Q

Which ligaments stabilise the ankle?

Lateral collateral ligamens:

Function?

A

Lateral collateral ligaments

Function:
- Restrict Inversion

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100
Q

Which ligaments stabilise the ankle?

Medial collateral (deltoid) ligament:

Function:

A

Medial collateral (deltoid) ligament

Function:
Restricts Eversion

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101
Q

Which ligaments stabilise the ankle?

Which is stronger b/w the ligaments that stabilise the ankle?

A

Which is stronger b/w the ligaments that stabilise the ankle?

  • Medial collateral (deltoid) ligament
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102
Q

Ankle sprain

Incidence comparison?

A

Ankle sprain

Incidence:

  • Female > Male
  • Children > Adolescents > Adults
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103
Q

Ankle sprain

  • Higher likelihood during?
A

Ankle sprain

Higher likelihood during:
- Plantarflexion & inversion

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104
Q

Muscle compartments - leg

Look at lecture 19, slide 21

A

xdrctfyvgubhi

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105
Q

Plantarflexors - gastrocnemius

Origin?

Insertion?

During gait?

Nerve?

A

Plantarflexors - gastrocnemius

Origin:
- Medial & lateral femoral condyles

Insertion:
- Calcaneus vis calcaneal (Achilles) tendon

During gait:
- Propulsion

Nerve:
- Tibial

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106
Q

Plantarflexors - soleus

  • Deep to the?
  • Doesnt cross?

Origin?

Insertion?

Nerve?

A

Plantarflexors - soleus

  • Deep to gastrocnemius
  • Does not cross the knee joint

Origin:

  • Tibia & fibula
  • Interosseous membrane

Insertion:
- Calcaneus via calcaneal (Achilles) tendon

Nerve:
- Tibial

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107
Q

Extrinsic Foot Muscles

Long tendons

  • Held in place by?
  • Have associated bursae to?
  • Bones & muscles create?
A

Extrinsic Foot Muscles

Long Tendons:

  • These tendons held in place by retinaculum
  • Have associated bursae to reduce friction
  • Bones & muscles create pulleys
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108
Q

Deep flexors

Deep posterior compartment of the leg:

What?
Insert (Plantart surface)?

A

Deep flexors

Deep posterior compartment of the leg:

  • Tibialis posterior (TP)
    • Insert to the tarsals & metatarsals
  • Flexor Digitorum longus (FDL)
    • FDL inserts to Distal phalanges, toes 2-5
  • Flexor Hallucis longus (FHL)
    • FHL inserts to the Distal phalanx big toe
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109
Q

Deep flexors - Deep posterior compartment of the leg

TP, FDL & FHL

  • Their tendons pass?
A

TP, FDL & FHL:

-Their tendons pass posterior to medial malleolus

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110
Q

Deep flexors - ankle & toes

  • Pass through?

Tom Dick ANd Harry

A

Deep flexors - ankle & toes

Pass through:
- Tarsal tunnel

TP
FDL
Artery (posterior tibial)
Nerve (tibial)
FHL
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111
Q

Deep flexors - ankle & toes

Function?

A

Deep flexors - ankle & toes

Function:

  • Stabilise medial longitudinal arch (especially TP)
  • Propulsion at toe-off (FHL)
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112
Q

Tibialis Posterior Tendon

Spring Ligament supports?

Spring Ligament =?

A

Tibialis Posterior Tendon

Spring Ligament supports:
- Head of talus

Spring Ligament = Plantar calcaneonavicular ligament

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113
Q

Flat foot deformity

  • If ruptured, the spring ligament cant support?
  • Flat foot deformity could be due to ruptured? As a result of?
A

Flat foot deformity

If ruptured, the spring ligament cant support:
- The head of the talus

Flat foot deformity could be due to ruptured TP tendon, as result of aging, trauma or denervation

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114
Q

Anterior Compartment Muscles

Three muscles:

Inserts?

Nerve

A

Anterior Compartment Muscles

Tibialis anterior (TA)
- Inserts to medial cuneiform, base of 1st metatarsal

Extensor hallucis Longus (EHL)
- Inserts to the distal phalanx big toe

Extensor digtorum longus (EDL)
- Inserts to the distal phalanges of toes 2-5

Nerve:
- Deep fibular

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115
Q

Anterior Compartment Muscles

  • The muscle tendons pass under?

Function?

A

The muscle tendons pass under:
- Extensor retinacula

Function:
- Stabilise medial longitudinal arch (TA)

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116
Q

Lateral Compartment Muscles

Two muscles

Origins

Insertions

A

Lateral Compartment Muscles

Fibularis (peroneus) longus
- insertion at base of 1st metatarsal

Fibularis (peroneus) brevis
- insertions at base of 5th metatarsal

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117
Q

Lateral Compartment Muscles

Function?

A

Lateral Compartment Muscles

Function:

  • Both stabilize lateral longitudinal arch
  • Fibularis longus stabilizes transverse arch
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118
Q

Which tendons stabilize the foot arches?

Medial longitudinal arch is supported by tendons that pass on medial aspect of foot:

A

Which tendons stabilize the foot arches?

Medial longitudinal arch is supported by:

  • Tibialis anterior
  • Tibialis posterior
  • Long toe flexor tendons
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119
Q

Which tendons stabilize the foot arches?

Lateral longitudinal arch is supported by tendons that pass on lateral aspect of foot:

A

Which tendons stabilize the foot arches?

Lateral longitudinal arch is supported by:

  • Fibularis longus
  • Fibularis brevis
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120
Q

Which tendons stabilize the foot arches?

longitudinal arch is supported by tendons that pass transversely:

A

Which tendons stabilize the foot arches?

longitudinal arch is supported by:

  • Fibularis longus
  • Small intrinsic muscles of foot
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121
Q
  • What innervates the lower limb?

- What are the three main nerves to the leg; all branch off the sciatic nerve

A 
Lumbosacral plexus (L1-S4)
   - Innervates the lower limb

Three main nerves to leg; all branch off the sciatic nerve

  • Tibial
  • Common fibular which divides into:
    • Deep fibular
    • Superficial fibular
122
Q

Innervation to the leg & foot

  • Posterior leg & foot?
  • Anterior leg?
  • Lateral leg?
A

Innervation to the leg & foot

Posterior leg & foot:
- Tibial nerve

Anterior leg:
- Deep fibular nerve

Lateral leg:
- Superficial fibular nerve

123
Q

Blood supply the leg & foot

  • Check lecture 19 slide 54
A

xdfcghvbjn

124
Q

Gait Cycle

Running

  • What is reduced?
A

Running

What is reduced?
- Time & frequency

125
Q

Standing

What muscle groups maintain standing?

What happens at lower limb joints?

A

Standing

What muscle groups maintain standing?
- Primarily extensor muscle of the back & plantarflexors

What happens at lower limb joints?

  • Hip & knee joints are extended
  • The knees are ‘locked’ (all ligaments are taut)
126
Q

Gait cycle

Gait cycle involves a repetitious sequence of:

From a standing position, the gait cycle is initiated by:

A

Gait cycle

Gait cycle involves a repetitious sequence of:

  • Propulsion
  • Support

From a standing position, the gait cycle is initiated by:

  • Relaxation of soleus
  • Dorsiflextion of the ankle joint
  • Then the limb enters into the swing phase
127
Q

Gait cycle

Phases?

A

Gait cycle

Phases:

1) Heel-strike
2) Support (stance)
3) Toe off (stance)
4) carry through (swing)

128
Q

Gait cycle - Stance phase

  • Stance begins with and ends with?
  • Limb needs to? PADS
A

Gait cycle - Stance phase

  • Stance begins with heel strike, ends with toe off

Limb needs to: PADS

  • Preserve foot arches
  • Accepts weigh
  • Decelerate mass
  • Stabilize pelvis
129
Q

Gait cycle - Swing Phase

  • Swing begins with, ends with?
A

Gait cycle - Swing Phase

  • Swing begins with toe off, ends with heel strike
130
Q

Gait - factor to consider

At each phase, consider?

A

At each phase, consider:

  • Position of each lower limb joint
  • Muscles that position the joints
131
Q

Heel Strike

During heel strike:

A

Heel strike

During heel strike:

  • Ankle joint is dorsiflexed
  • Knee joint is extended
  • Hip joint is flexed
132
Q

Gait - hip joint during stance

Heel strike:

Mid stance:

Late stance:

A

Gait - hip joint during stance

Heel strike:

  • Shock absorption
  • Flexed hip gets extended after heel strike

Mid-Stance:

  • Progress body over stationary foot
  • Maintain limb and trunk stability
  • Hip extension

Late stance:

  • Progress body beyond supporting foot
  • Accelerate body
  • Hips start to flex in preparation for swing
133
Q

Gait - hip joint during swing

Mid-swing:

Late-swing

A

Gait - hip joint during swing

Mid-swing:

  • Limb advancement
  • Foot clearance off the ground

Late-swing:

  • Complete limb advancement
  • Prepare for stance phase (deceleration)
  • Hip extensors contract to decelerate the forward movement
134
Q

High Heel shoes

  • Increase pressure on?
  • Prone to?
A

High Heel shoes

During stance:
Increase pressure on metatarso-phalangeal joints

Prone to:

  • hallux valgus (bunion)
  • Calluses
  • Metatarsalgia
135
Q

Foot binding

Impaired gait including effects on reduced range of:

A

Foot binding

Impaired gait including effects on reduced range of:

  • Ankle joint
  • Contact area
  • Increased pressure
136
Q

Gait - ankle joint during stance

Heel strike:

Mid Stance:

Late stance:

A

Gait - ankle joint during stance

Heel strike:

  • Initial impact deceleration
  • Shock absorption
  • Dorsiflexors also contract to lower foot to ground

Mid stance:

  • Foot has been lowered to the ground
  • Movement foward
  • Dorsiflexors contract to pull tibia fowards over the foot, then gravity & momentum take over

Late stance:

  • Prepare for swing phase
  • Accelerate body forward
  • Plantarflexors
  • Toe-off propulsion
  • Foot stabilisers active
137
Q

Gait - ankle joint during swing

Mid swing:

Late swing:

A

Gait - ankle joint during swing

Mid swing:

  • Limb advancement
  • Foot clearance off the ground
  • Dorsiflexors…..
  • Toe extensors…

Late swing:

  • Complete limb advancement
  • Prepare for stance phase (deceleration)
  • Dorsiflexors & toes extensors ensure foot is in optimal position for heel strike
138
Q

Gait changes

Gait changes with age:

A

Gait changes

Gait changes with age:

  • Muscles get weaker/atrophy
  • Flexed posture in lower limb during standing, flexed neck
  • Balanced compromised
  • Gait is slower
139
Q

Other causes of gait changes

Nerve damage:

Medical treatment:
- Look a L20, slide 36 & 37

A

Other causes of gait changes

Nerve damage:
- Superior gluteal nerve injury from hip replacement surgery

Medical treatment:
- androgen deprivation therapy causes muscle atrophy & increase fat in men with prostate cancer

140
Q

Gait changes - Example 1

Which muscles?
- Unable to maintain pelvis level during single leg stance:

Compensation:

A

Which muscles?

  • Unable to maintain pelvis level during single leg stance:
  • CONTRlateral drop

Compensation:
- Contralateral lateral trunk flexion

141
Q

Gait changes - Example 2

Which muscles?

Compensation?

A

Gait changes - Example 2

Which muscles?

  • Weak dorsiflexion
  • Toes dont clear during swing
  • Foot slap/ foot drop after heel strike

Compensation:
- Knee raised high during swing

142
Q

Gluteal arteries

  • exit through?
  • The superior gluteal artery exist?
  • The inferior gluteal artery exits?
A

Gluteal arteries

Gluteal arteries exit through:
- Greater sciatic foramen

The superior gluteal artery exits:
- Superior to piriformis

The inferior gluteal artery exits
- Inferior to piriformis

143
Q

Gluteal arteries

Functions for superior & Inferior?

A

Gluteal arteries

Functions:

  • The superior gluteal artery supplies the hip abductors
  • The inferior gluteal artery supplies the gluteaus maximus
144
Q

Blood supply to the hip joint

Blood supply to the hip joint include:

A

Blood supply to the hip joint

Blood supply to the hip joint include:

  • Medial & lateral circumflex femoral arteries
  • Obturator artery
145
Q

Blood supply to the hip joint

What is the consequence of disrupted blood supply after femoral neck fracture?

A

Blood supply to the hip joint

What is the consequence of disrupted blood supply after femoral neck fracture?
- Avascular necrosis of the femoral head

146
Q

Blood vessels supply to the thigh

  • What supplies most thigh muscles?
A

Blood vessels supply to the thigh

What supplies most thigh muscles?
- The deep femoral artery

147
Q

Blood vessels supply to the thigh

  • femoral artery passes through the? & becomes?
A

Blood vessels supply to the thigh

  • Femoral artery passes through the adductor hiatus (in adductor magnus), & becomes the popliteal artery
148
Q

Behind the knee

Popliteal artery is in the popliteal fossa

Boundaries:

Content:

Popliteal artery supplies

What maintains knee circulation during flexion

A

Behind the knee

Popliteal artery is in the popliteal fossa

Boundaries:

  • Semimembranosus
  • Semitendinosus
  • Biceps femoris
  • Gastrocnemius

Content:

  • Popliteal vein (V)
  • Popliteal artery (A)
  • Tibial nerve (N)
  • Common fibular nerve

Popliteal artery supplies:
- Genicular branches to the knee joint

Maintains knee circulation during flexion:
- The genicular anastomosis

149
Q

In the leg

  • Popliteal artery splits into?
  • Posterior tibial artery gives off to?
  • Blood supply to the compartments of the leg
A

In the leg

Popliteal artery splits into:
- Anterior & Posterior tibial arteries

Posterior tibial artery gives off to:
- Fibular artery

Blood supply to the compartments of the leg

  • Anterior ….
  • Posterior …
  • Lateral ….
150
Q

Blood supply of the leg

Anterior - supplied by?

Lateral - supplied by?

Posterior - supplied by?

A

Blood supply in leg

Anterior - supplied by:
- Anterior tibial artery

Lateral - supplied by:
- Fibular artery

Posterior - supplied by:
- Posterior tibial artery

151
Q

Peripheral arterial disease

  • Build up of?
  • Risk factors?
A

Peripheral arterial disease

Build up of:
- Plaque inside major arteries of body

Risk factors

  • Smoking
  • Diabetes
  • Obesity
  • High cholesterol levels
152
Q

Peripheral arterial disease

Symptoms?

A

Peripheral arterial disease

Symptoms:

  • Claudication
    • Painful cramping in buttock, thigh or calf after exercise
153
Q

Veins

Two mechanisms help venous blood movements:

A

Veins

Two mechanisms help venous blood movements:

  • Arteriovenous pump
  • Musculovenous pump
154
Q

Veins

The lower limb has two venous systems:

A

Veins

The lower limb has two venous systems:

  • Superficial (outside to the deep fascia)
  • Deep (inside the muscle compartment) venous system
155
Q

Veins

  • Deep veins follow their arteries as?
  • Two major superficial veins in the lower limb are:
A

Veins

Deep veins follow their arteries as?
- Venae comitantes

Two major superficial veins in the lower limb are:

  • Great saphenous vein (empties into the femoral vein)
  • Small saphenous vein (empties into the popliteal vein)
156
Q

When the valves fail

  • Valve failure in the superficial veins can lead to?
A

When the valves fail

Valve failure in the superficial veins can lead to?
- Varicose vein

157
Q

Deep venous thrombosis

  • What can cause thrombus (blood clot) formation?
  • Can be fatal if thrombus travels & blocks?
A

Deep venous thrombosis

What can cause thrombus (blood clot) formation:
- Venous stasis

Can be fatal if thrombus travels & blocks:
- The pulmonary artery

158
Q

Plexus

  • What forms the plexuses?
A

Plexus

What forms the plexuses?
- Ventral/anterior rami of spinal nerves

159
Q

What is a plexus?

Three plexuses in the body:

Lumbosacral plexus is formed by?

A

What is a plexus?

Three plexuses in the body:

1) Cervical - supplying the neck
2) Brachial - supplying upper limb
3) Lumbosacral - supplying lower limb

Lumbosacral plexus is formed by?
- Ventral rami of L1-S4

160
Q

What nerves supply the lower limb?

Forms three main peripheral nerves:

A

What nerves supply the lower limb?

Forms three main peripheral nerves:

  • Sciatic
  • Femoral
  • Obturator
  • Gluteal nerves
161
Q

Inferior gluteal nerve

Inferior gluteal nerve innervates:

What is the consequence of inferior gluteal nerve injury?

A

Inferior gluteal nerve

Inferior gluteal nerve innervates:
- gluteaus maximus

What is the consequence of inferior gluteal nerve injury?
- Difficulty in getting up from a chair or climbing stairs

162
Q

Superior gluteal nerve

Superior nerve innervates the:

Main functions:

What is the consequence of superior gluteal nerve injury?

A

Superior gluteal nerve

Superior nerve innervates the:
- Hip abductors

Main functions:

  • To maintain a level pelvis during single leg stance
  • Hip abduction & internal rotation

What is the consequence of superior gluteal nerve injury?
- Dropping of contralateral pelvis

163
Q

Femoral Nerve Course

  • Emerge b/w?
  • Passes from?
  • Runs through?
A

Femoral Nerve Course

Emerge b/w:
- Psoas major & iliacus

Passes from:
- Pelvis into anterior thigh under the ….

Runs through:
- Femoral triangle with…

164
Q

Femoral Nerve

Innervates:

What is the consequence of femoral nerve injury?

A

Femoral Nerve

Innervates:

  • Muscles in the anterior thigh
  • Skin in anterior thigh & medial leg

What is the consequence of femoral nerve injury?
- Weakness/difficulty in hip flexion and/or knee extension

165
Q

Obturator nerve

Exits?

Innervates?

A

Obturator nerve

Exits:
- The pelvis into the medial thigh through the ….

Innervates?
- Innervates muscles in the medial compartment of the thigh

166
Q

Sciatic nerve

Enters?

What is piriformis syndrome?

A

Sciatic nerve

Enters:
- The posterior thigh through the …

What is piriformis syndrome:
- If sciatic nerve pierces through the piriformis muscle

167
Q

Sciatic nerve

Composed of?

A

Sciatic nerve

Composed of?

  • Tibial nerve
  • Common fibular/peroneal nerve
  • Superficial fibular nerve
  • Deep fibular nerve
168
Q

Tibial nerve

What is the consequence of tibial nerve injury?

A

Tibial nerve

What is the consequence of tibial nerve injury?
- Paralysis of plantarflexors & intrinsic foot muscles

169
Q

Common fibular nerve

Divides into? near?

Innervates?

A

Common fibular nerve

Divides into? near?
- Superficial & deep branches, near the head of fibula

Innervates:

  • Short head of biceps femoris
  • Lateral leg muscles
  • Anterior leg muscles
170
Q

Common fibular nerve

What is the consequence of common fibular nerve injury?

A

Common fibular nerve

What is the consequence of common fibular nerve injury?

  • Loss of function from anterior & lateral leg muscles
  • May include the loss of ankle dorsiflexion (foot drop)
171
Q

Deep fibular nerve

Descends:

Innervates:

A

Deep fibular nerve

Descends:
- In the leg along with the anterior tibial artery & vein

Innervates anterior leg muscles:

  • Tibialis anterior
  • Extensor digitorum longus
  • Extensor hallucis longus
172
Q

Superficial fibular nerve

Innervates lateral compartment muscles:

A

Superficial fibular nerve

Innervates lateral compartment muscles:

  • Fibularis longus
  • Fibularis brevis
173
Q

Skin innervation

Femoral supplies:

Obturator supplies:

Deep fibular supplies:

Superficial fibular supplies:

A

Skin innervation

Femoral supplies:
- Anterior thigh & medial leg skin

Obturator supplies:
- Medial thigh

Deep fibular supplies:
- Area b/w the first 2 toes

Superficial fibular supplies:
- Anterolateral leg & dorsum of the foot

174
Q

What is the Upper Limb?

Functions:

Proximal (larger) muscles?

Distal (smaller) muscles?

A

What is the Upper Limb?

  • Shoulder
  • Arm
  • Forearm
  • Hand

Functions:

Proximal (larger) muscles?
- Position hand

Distal (smaller) muscles?
- For fine motor movements

175
Q

Pectoral girdle

Made of?

Function?

Ligaments limit & provide?

Protect deep structures:

A

Pectoral girdle

Made of?
- Scapula + clavicle

Function?
- Attach the upper limb to axial skeleton

Ligaments limit & provide?

  • Limit movement
  • Provide stability

Protect deep structures:

  • Veins
  • Arteries
  • Nerves
176
Q

Clavicle

draw and name

Lecture 22 slide 9

A

sezrxdctfvygb

177
Q

Clavicle Feature

Easily fractures:

A

Clavicle Feature

Easily fractures:

  • Medial fragment is pulled by sternocleidomastoid
  • Lateral fragment drops because of gravity
178
Q

Scapula

Draw & name

Lecture 22, slide 12 & 13

A

aszdxfcgvh

179
Q

Scapula Movements: PUDDER

Also look at L22, slide 14 & 15

A

Scapula Movement

  • Protraction
  • Upward rotation
  • Depretion
  • Downward rotation
  • Elevation
  • Retraction
180
Q

Joints of the pectoral girdle

Sternoclavicular joint:

A

Joints of the pectoral girdle

Sternoclavicular joint:

  • Saddle synovial joint, allowing biaxial movement
  • Has an articular disc
181
Q

Joints of the pectoral girdle

Acromioclavicular Joint:

A

Joints of the pectoral girdle

Acromioclavicular Joint:

  • Synovial plane joint, allowing sliding movement
  • Has an incomplete articular disc
  • Extrinsic ligaments help stabilize the joint
182
Q

Ligaments of the pectoral girdle

Key ligaments:

A

Ligaments of the pectoral girdle

Key ligaments:

1) Coracoclavicular
2) Acromioclavicular
3) Coracoacromial

183
Q

Dislocation of the acromioclavicular joint

Common in?

A

Dislocation of the acromioclavicular joint

Common in?

  • Contact sports
  • Or fall on shoulders
184
Q

Glenohumeral joint:

A

Glenohumeral joint

Synovial ball & socket joint:

  • Head of the humerus
  • Glenoid fossa of the scapula
185
Q

Glenohumeral joint movements?

A

Glenohumeral joint movements?

  • Adduction/ Abduction
  • Flexion/ Extension
  • Circumduction
  • Medial & lateral rotation
186
Q

Glenohumeral joint

Relatively unstable & requires external stabilization from:

A

Glenohumeral joint

Relatively unstable & requires external stabilization from:

  • Ligaments & muscles
  • Glenoid labrum (increase concavity)
  • Capsule (taut superiorly)
187
Q

Glenohumeral joint

Lecture 22, slide 24

A

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188
Q

Shoulder Muscles

Connect?

Move?

A

Shoulder Muscles

Connect:

  • Scapula
  • Clavicle
  • Body wall to the humerus

Move:
- The shoulder joints

189
Q

Shoulder Muscles

Deltoid

Origin:

Insertion:

Inervated by:

Function on arm:

A

Shoulder Muscles

Deltoid

Origin:
- Scapula, Clavicle

Insertion:
- Humerus

Innervated by:
- The axillary nerve

Function on arm:

  • Anterior fibres = flex
  • Middle fibres = abduct
  • Posterior fibres = exdend
190
Q

Shoulder Muscles

Pectoralis major

Origin:

Insertion:

Function:

A

Shoulder Muscles

Pectoralis major

Origin:

  • Clavicle
  • Sternum
  • Costal cartilages

Insertion:
- Humerus

Function:

  • Flexion
  • Adduction
  • Medial rotation of arm
191
Q

Shoulder muscles

Latissimus dorsi

Origin:

Insertion:

Function:

A

Shoulder muscles

Latissimus dorsi

Origin:

  • Spinous processes of the vertebrae
  • Iliac crest
  • Inferior ribs

Insertion:
- Humerus

Function:

  • Extend
  • Adduct
  • Medially rotate are
192
Q

Shoulder Muscles

Teres Major

Origin:

Insertion:

Function:

A

Shoulder Muscles

Teres Major

Origin:
- Inferior angle of scapula

Insertion:
- Humerus

Function:

  • Extend
  • Adduct
  • Medially rotate are
193
Q

Shoulder Muscles

In close proximity?

A

Shoulder Muscles

In close proximity:

  • Pectoralis Major
  • Long tendon of Biceps
  • Latissimus dorsi
  • Teres Major
194
Q

Pectoral Girdle Muscle

Connects:

General function:

A

Pectoral Girdle Muscle

Connects:
- Scapula & clavicle to the trunk

General function:
- To move the scapula

195
Q

Pectoral Girdle Muscles

Trapezius

Origin:

Insertion:

Function on scapula:

A

Pectoral Girdle Muscles

Trapezius

Origin:
- Occipital bone

Insertion:

  • Clavicle
  • Scapula (spine & acromion)

Function on scapula:

  • Superior fibres = Elevate
  • Horizontal fibres = Retract
  • Inferior fibres = Depress
  • Rotation
196
Q

Pectoral Girdle Muscles

Levator scapulae

Origin:

Insertion:

Function:

A

Pectoral Girdle Muscles

Levator scapulae

Origin:
- Transverse processes of cervical vertebrae

Insertion:
- Superior angle of scapula

Function:
- Elevate scapula

197
Q

Pectoral Girdle Muscles

Rhomboids

Origin:

Insertion:

Function:

A

Pectoral Girdle Muscles

Rhomboids

Origin:
- Spinous processes of the vertebrae

Insertion:
- Medial border of scapula

Function:
- Retract scapula

198
Q

Rotator Cuff Muscles

Connect:

General function:

A

Rotator Cuff Muscles

Connect:
- Scapula & clavicle to humerus

General function:

  • To support glenohumeral joint
  • All rotate humerus, excepts for supraspinatus
199
Q

Rotator Cuff Muscles

All attach:

Look at L22, Slide 40

A

Rotator Cuff Muscles

All attach:

  • To the greater tubercle
  • Except for subscapularis
200
Q

Rotator Cuff Muscles

Function:

Supraspinatus

Infraspinatus & Teres minor

Subscapularis

A

Rotator Cuff Muscles

Function:

Supraspinatus
- Initiates abduction

Infraspinatus & Teres minor
- laterally rotate humerus

Subscapularis
- medially rotates humerus

201
Q

Clinical conditions

Rotator cuff impingement Implications:

A

Clinical conditions

Rotator cuff impingement Implications:

  • Inflammation (Tendinitis, bursitis)
  • Swelling & pain
  • Impairs movement
  • Possible rupture of tendons
  • Capsular weakness
202
Q

Elbow

Elbow joint is a?

Function?

Made of?

A

Elbow

Elbow joint is a:
- Synovial hinge joint

Function:
- Forearm flexion & extension

Made of:

  • Humerus
  • Ulna
  • Radius
203
Q

Elbow

Proximal radio-ulnar joint is a?

For?

A

Elbow

Proximal radio-ulnar joint is a:
- Synovial pivot joint

For:
- Pronation & supination

204
Q

Proximal radioilnar joint

Ligaments aid stability

Angular ligament:

A

Proximal radioilnar joint

Ligaments aid stability

Angular ligament:

  • Laxity in childhood
  • Yanking movements can dislocate the radius
  • Potential damage to ligament
  • aka Nursemaids elbow
205
Q

Distal radio-ulnar joint

Distal radio-ulnar joint is a?

For?

A

Distal radio-ulnar joint

Distal radio-ulnar joint is a:
- Synovial pivot joint

For:
- Pronation & supination

206
Q

Distal radio-ulnar joint

Ligaments and stability

Anteriorly & Posteriorly:

Articular disc:

A

Distal radio-ulnar joint

Ligaments and stability

Anteriorly & Posteriorly:

  • Dorsal radioulnar
  • Palmar radioulnar

Articular disc:
- Allows twisting of joint capsule during pronation

207
Q

Wrist (radio-carpal joint)

Wrist joint is an?

B/w?

Movements of wrist?

A

Wrist (radio-carpal joint)

Wrist joint is an:
- ellipsoid (condyloid) synovial joint

B/w:
- Radius & proximal carpals

Movements of wrist:

  • Flexion
  • Extension
  • Abduction
  • Adduction
  • Circumduction
208
Q

Carpal Bones

Intercarpal joints:

Proximal row (lat - med):

Distal row (lat - med):

A

Carpal Bones

Intercarpal joints:
- Synovial plane joints

Proximal row (lat - med):

  • Scaphoid
  • Lunate
  • Triquetral
  • Pisiform

Distal row (lat - med):

  • Trapezium
  • Trapezoid
  • Capitate
  • Hamate
209
Q

Hand

Bony features:

Functions:

A

Hand

Bony features:

  • Metacarpas
  • Phalanges

Functions:

  • Manipulation
  • Sensation
  • Interaction w/ environment
  • Joints w/in hands are synovial joints
210
Q

Hand

  • Inter-phalangeal joints:
  • Metacarpo-phalangeal joints:
  • Carpo-metacarpal joint 1:
  • Carpo-metacarpal joints 2-5:
A

Hand

Inter-phalangeal joints:
- Flexion & extension

Metacarpo-phalangeal joints:

  • Flexion, extension
  • Abduction, adduction
  • circumduction

Carpo-metacarpal joint 1:

  • Joint at thumb
  • Important for opposition

Carpo-metacarpal joints 2-5:
- Minimal movement

211
Q

Arm Muscles

Anterior Compartment:

Posterior Compartment:

A

Arm Muscles

Anterior Compartment:

  • Flexors
  • Muscle: Biceps brachii, Brachialis, Coracobrachialis
  • Nerve: MusculoCutaneous nerve

Posterior Compartment:

  • Extensors
  • Muscle: Triceps brachii
  • Nerve: radial nerve
212
Q

Arm Muscles

Biceps brachii

Origin?

Insertion?

Function?

A

Arm Muscles

Biceps brachii

Origin:

  • Long head: supraglenoid tubercle of scapula
  • Short head: coracoid process

Insertion:
- Radial tuberosity

Function:

  • Flex arm & forearm
  • Supinate forearm
213
Q

Arm Muscles

Triceps brachii

Origin?

Insertion?

Function?

A

Arm Muscles

Triceps brachii

Origin:

  • Long head: infraglenoid tubercle of scapula
  • Medial head: humerus
  • Lateral head: humerus

Insertion:
- olecranon of ulna

Function:
- Extend arm & forearm

214
Q

Arm Muscles

Coracobrachialis

Origin?

Insertion?

Function?

A

Arm Muscles

Coracobrachialis

Origin:
- Coracoid process

Insertion:
- Humerus

Function:

  • Flex arm
  • Adduct arm
215
Q

Arm Muscles

Brachialis

Origin?

Insertion?

Function?

A

Arm Muscles

Brachialis

Origin:
- Humerus

Insertion:
- Coronoid process of ulna

Function:
- Flex forearm

216
Q

Arm Muscles

Innervation of Anterior Muscles?

MC supplies BBC

Inervation of Posterior Muscles?

A

Arm Muscles

Innervation of Anterior Muscles:
- Musculocutaneous nerve

MC supplies BBC
- MusculoCutaneous supplies Biceps, Brachialis, Coracobrachialis

Inervation of Posterior Muscles:
- Radial Nerve

217
Q

Forearm Muscles

Pronators - for pronation:

Supinators - for supination:

A

Forearm Muscles

Pronators - for pronation:

  • Pronator teres
  • Pronator quadratus

Supinators - for supination:

  • Biceps brachii
  • Supinator
218
Q

Forearm Muscles

  • Flexors in the?
  • Extensors in the?
A

Forearm Muscles

Flexors in the:
- anterior compartment

Extensors in the:
- posterior compartment

219
Q

Forearm Muscles

Innervation anterior muscles:

Innervation of Posterior muscles:

A

Forearm Muscles

Innervation anterior muscles:

  • Median nerve - supplies most forearm muscles
  • Ulnar nerve - Supplies some forearm muscles

Innervation of Posterior muscles:
- Radial Nerve

220
Q

Carpal Tunnel

  • Name parts of the carpal arch:
A

Carpal Tunnel

Name parts of the carpal arch:

  • Tubercle
  • Trapezium
  • Trapezoid
  • Capitate
  • Hamate
  • Triquetrum
  • Pisiform
221
Q

Carpal Tunnel

  • What passes through the carpal tunnel?
  • What causes Carpal Tunnel Syndrome?
A

Carpal Tunnel

What passes through the carpal tunnel:
- Median nerve & tendons

What causes Carpal Tunnel Syndrome:
- Entrapment of the nerve

222
Q

Intrinsic Hand Muscles

Functions:

Thenar & hypothenar muscles are for?

Interossei muscles or for?

Lumbricals:

A

Intrinsic Hand Muscles

Functions:
- For fine motor movements

Thenar & hypothenar muscles are for:

  • Thumb and digit 5 movements
    • Used in grips, precise movements & control of the digits

Interossei muscles or for:
- Digits abduction & adduction

Lumbricals:
- Flex the metacarpo-phalangeal joint & extend the interphalangeal joints (through the extensor expansion)

223
Q

Innervation of the Upper Limb

What innervates the upper limb? Formed by?

A

Innervation of the Upper Limb

What innervates the upper limb:

  • Brachial Plexus
  • Formed from the anterior rami of C5-T1 spinal nerves
224
Q

Innervation of the Upper Limb

Main branches of the brachial plexus:

A

Innervation of the Upper Limb

Main branches of the brachial plexus:

  • Axillary
  • Radial
  • Musculocutaneous
  • Median
  • Ulnar
225
Q

Innervation of the upper limb

Main branches of the brachial plexus:

Axillary:

Radial:

Musculocutaneous:

Median:

Ulnar:

A

Innervation of the upper limb

Main branches of the brachial plexus:

Axillary:
- Deltoid & teres minor

Radial:
- Posterior arm & forearm

Musculocutaneous:
- BBC

Median:
- Anterior forearm + hand

Ulnar:
- Anterior forearm + hand

226
Q

Arteries of the Upper Limb?

A

Arteries of the Upper Limb?

  • Sublavian
  • Axillary
  • Brachial
  • Subscapular
  • Radial
  • Ulnar
227
Q

Superficial Veins of the Upper Limb?

A

Superficial Veins of the Upper Limb?

  • Axillary vein
  • Cephalic
  • Basilic
  • Dorsal venous arch
228
Q

Osteoarthritis

Tissues affected include:

Symptoms:

A

Osteoarthritis

Tissues affected include:

  • Articular cartillage
  • Subchondral bone
  • Capsule
  • Muscles
  • Tendons/ ligaments

Symptoms:

  • Pain
  • Stiffness
  • Tenderness
  • Joint locking
  • Effusion (fluid build up)
229
Q

Osteoarthritis (cont):

Pathology:

A

Osteoarthritis (cont):

Pathology:

  • Significant worldwide health issue
  • Genetic factors
  • Aging not necessarily a cause
  • Changes to protein content in cartilage
  • Collagen is degenerated
  • Absorbed into the synovial fluid
  • Remodelled (calcified) into bone spurs
230
Q

Osteoarthritis

Pathology (cont):

A

Osteoarthritis

Pathology (cont):

  • Aging = loss in cartilage water content due to reduction in proteoglycan levels
  • Reduces resiliency of cartilage
  • Normal cartilage has water balance from compressive force & pressure
  • Collagen exerts the pressure, whereas proteoglycans raw water in
  • OA causes a reduction in protective proteoglycans = collagen disruption
231
Q

Osteoarthritis

Treatment:

A

Osteoarthritis

Treatment:

  • Diet, lifestyle
  • NSAIDs
  • Analgesics
  • Injection of corticosteroids
  • Other injections (harmful)
  • Surgical intervention
232
Q

Knee replacement

Full or partial

Invasive:

A

Knee replacement

Full or partial

Invasive:

  • Full replacement of some structures
  • Other structures may not be replaced
  • Postoperative movement encouraged
  • Functionality vs pain tradeoff important to consider
233
Q

Sarcopaenia

Normal age-related muscle wasting:

Muscle loses?

Symptoms:

A

Sarcopaenia

Normal age-related muscle wasting:

  • Different to wasting with illness cancer
  • Cachexia

Muscle loses?
- Cytoplasmic & protein content

Symptoms:

  • Loss of cross sectional area
  • Weakness
  • Joint instability
  • Prone to falls
  • Exacerbates other clinical risks
234
Q

Sarcopaenia

Pathology:

A

Sarcopaenia

Pathology:

  • Adipogenesis
  • Fibrosis
  • Breakdown of neuromuscular junctions
  • Sarcomeric disruption
  • Impairment of satelite cell numbers (repair)
  • Hormonal changes (decreased sex steroids)
  • Ongoing cycle of degeneration
  • Compounded by reduced activity
  • Satellite cell impairment leads to less muscle repair when exertion is applied
  • Progressive wasting
235
Q

Sarcopaenia

Treatment:

A

Sarcopaenia

Treatment:
- Exercise
- Diet
- Hormone treatment ineffective
    \+ harmful side-effects
     - GH, testosterone
- Gene therapy investigated
   - Myostatin
236
Q

Regional anatomy of the bifurcation of the trachea

Cardiovascular system:

Respiratory system:

Gastrointestinal system:

Musculoskeletal system:

Look at lecture 25, slide 8

A

Regional anatomy

Cardiovascular system:
- Superior vena cava; Ascending aorta; Pulmonary trunk

Respiratory system:
- Lung; Primary bronchi

Gastrointestinal system:
- Eosophagus

Musculoskeletal system:
- Vertebra

237
Q

Regional anatomy

Look at lecture 25, slide, 9

A

hfgjbkn

238
Q

Lymph nodes have rich blood supply (FG.a L5, slide 10);

however:

Normally there may be two groups of vessels in the area:

A

Lymph nodes have rich blood supply (FG.a L5, slide 10);

however:

1) the vessels are very small;
2) The density of enhancing appearance is not even

Normally there may be two groups of vessels in the area:

1) one supplying the great vessels, such as aorta (Fig.b)
2) Bronchial arteries

239
Q

Left bronchial artery in front of:

A

Left bronchial artery in front of:

- Bronchus

240
Q

Variation of the right bronchial artery (2/19 cadavers):

A

Variation of the right bronchial artery (2/19 cadavers):

1) Arising from the arch of aorta
2) Running anterior to the bifurcation of the trachea and main bronchi

241
Q

The Thorax: Conceptual Overview

The thorax is the superior part of the trunk b/w the neck & abdomen. It consist of:

Look at lecture 25, slide 15

A

The Thorax: Conceptual Overview

The thorax is the superior part of the trunk b/w the neck & abdomen. It consist of:

  • A wall
  • A cavity which contains
    • Two pleural cavities
      - The lung
    • The mediastinum
242
Q

The Thorax

The thoracic cavity is enclosed by the thoracic wall and diaphragm and can be divided into THREE MAJOR COMPARTMENTS:

A

The Thorax

The thoracic cavity is enclosed by the thoracic wall and diaphragm and can be divided into THREE MAJOR COMPARTMENTS:

  • A left and a right pleural cavity, each surrounding a lung
  • Mediastinum
243
Q

Relationship b/w the lung and pleura:

A

Relationship b/w the lung and pleura:

  • Parietal pleura
    • Pleural cavity
      Visceral pleura (or external membrane of the lung)
  • Lung
244
Q

The Thorax (cont):

The pleural cavity:

A

The Thorax (cont):

The pleural cavity:

  • Has a negative intrapleural pressure which hold the parietal and visceral pleurae together
  • Is a potential (rather than real) space in the normal living subject
245
Q

The Thorax (cont):

The pleura is “hooked” by:

A

The Thorax (cont):

The pleura is “hooked” by:
- Connective tissue (the endothoracic fascia) onto the chest wall

246
Q

The Thorax (cont):

Damage of the “pleura-endothoracic fascia” complex may result in:

A

The Thorax (cont):

Damage of the “pleura-endothoracic fascia” complex may result in:
- “pneumothorax” (air in the pleural cavity): LUNG COLLAPSE

247
Q

The Thorax (cont):

The functions of the thorax are:

A

The Thorax (cont):

The functions of the thorax are:

  • Breathing
    • The thorax not only contains the lungs but also provides the machinery necessary (the diaphragm and thoracic wall) for effectively moving air into and out of the lungs
248
Q

The Thorax (cont)

Inspiration:

Expiration:

A

The Thorax (cont)

Inspiration:

  • Air inhaled
  • Rib cage expands as rib muscles contract
  • Diaphragm contracts (moves down)

Expiration:

  • Air exhaled
  • Rib cage gets smaller as rib muscles relax
  • Diaphragm relaxes (moves up)
249
Q

The Thorax (cont):

The functions of the thorax are:

Main organs in the mediastinum:

A

The Thorax (cont):

The functions of the thorax are:

  • Protection of vital thoracic organs
    • Also some abdominal organs

Main organs in the mediastinum:

  • Trachea
  • Bronchus
  • Eosophagus
  • Aorta
250
Q

The Thorax (cont):

Important concepts:

A

The Thorax (cont):

Important concepts:

  • Not all the thoracic organs are protected by the thoracic wall as the apex of the lungs is above the 1st rib
  • The thoracic wall also protects the abdominal organs, eg liver, stomach.
251
Q

The Thorax (cont.)

Relationships to other regions:

A

The Thorax (cont.)

Relationships to other regions:

  • Abdomen (via the diaphragm)
  • Neck (the root of the neck)
  • Upper limb (axillary region)
252
Q

Structures Superficial to the Thorax:

The pectoral region consist of:

A

Structures Superficial to the Thorax:

The pectoral region consist of:

  • Skin and subcutaneous tissue (superficial fascia_
    • Includes breast tissue
  • Deep fascia and muscle
    • Pectoralis major
    • Pectoralis minor
  • Bones
    • Clavicle
    • Scapula
253
Q

Structures Superficial to the Thorax (cont):

The upper portion is covered by:

The lower portion is covered by:

The lateral portion is covered by:

A

Structures Superficial to the Thorax (cont):

The upper portion is covered by:
- Pectoralis major & Pectoralis minor

The lower portion is covered by:
- The abdominal muscles - external oblique and rectus abdominus

The lateral portion is covered by:

  • The serratus anterior
  • This muscle functions to rotate the inferior angle of the scapula laterally
254
Q

The Thorax

The thoracic wall consists of a combination of musculoskeletal components:

A

The Thorax

The thoracic wall consists of a combination of musculoskeletal components:

  • Posteriorly it is formed by 12 thoracic vertebrae and corresponding invertebral discs
  • Laterally it is formed by the 12 ribs and intercostal muscles
  • Anteriorly it is formed by the sternum
255
Q

The Thorax (cont.):

The thorax contains major apertures (openings):

A

The Thorax (cont.):

The thorax contains major apertures (openings):

  • The superior aperture is bordered by T1; rib1; and the upper margin of the sternum (jugular notch)
  • The inferior aperture is bordered by T12; rib 12; and the . end of rib 11; the costal margin (arch); the xiphoid process; closed by diaphragm
256
Q

The Thorax (cont):

Joints b/w skeletal elements:

A

The Thorax (cont):

Joints b/w skeletal elements:

  • Costovertebral joints
  • Intervertebral joints
  • Sternocostal joints
257
Q

The intercostal space:

A

The intercostal space:

  • External intercostal
  • Internal intercostal
  • Innermost intercostal
  • Vasculature
  • Innervation
258
Q

The intercostal Space (cont):

The intercostal arteries:

A

The intercostal Space (cont):

The intercostal arteries:

  • Anterior and Posterior arteries
  • Arise from internal thoracic artery and thoracic aorta, respectively
  • Anastomose (join) with eachother laterally
259
Q

The Intercostal Space (cont.):

The internal thoracic artery arises from the:

A

The Intercostal Space (cont.):

The internal thoracic artery arises from the:
- Bilateral subclavian arteries

260
Q

The intercostal space (cont.):

The intercostal veins:

A

The intercostal space (cont.):

The intercostal veins:

  • Anterior and posterior veins
  • Drain into the azygous system (post) and internal thoracic vein (ant)
  • Anastomose (join) with each other laterally
261
Q

The intercostal Space (cont):

The azygous system:

A

The intercostal Space (cont):

The azygous system:

  • Azygos vein
  • Hemiazygos vein
  • Accessory hemiazygos vein
262
Q

The intercostal space (cont):

The intercostal nerves (single nerves, no anterior/posterior):

A

The intercostal space (cont):

The intercostal nerves (single nerves, no anterior/posterior):

  • Accompanies the arteries and veins
  • Arise from ventral ramus of the spinal nerves
  • Supplies intercostal muscles, skin & parietal pleura
263
Q

The intercostal space (cont.)

Surrounding structures:

A

The intercostal space (cont.)

Surrounding structures:

  • Superficial: thoracic muscles; deep fascia; subcutaneous tissue (superficial fascia); skin
  • Deep; endothoracic fascia (loose CT); parietal pleura; pleural cavity; visceral pleura
264
Q

Surgical Approach to the Thoracic cavity

Three main access methods:

A

Surgical Approach to the Thoracic cavity

Three main access methods:

1) Intercostal space (intercostal muscle) Thoracotomy
2) Rib bed (requires rib transection) Costal resection
3) Sternum (requires sternal transection) Sternotomy

265
Q

Intercostal space summary

Lecture 26, slide 21

A

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266
Q

The inferior thoracic wall - Diaphragm:

A

The inferior thoracic wall - Diaphragm:

  • Fills the inferior thoracic aperture
  • Separates thoracic cavity from the abdominopelvic cavity
  • Comprised of muscle fibres that insert into a central tendon
  • Innervated by the phrenic nerve
  • Mainly perfused by the internal thoracic arteries
267
Q

Diaphragm (cont.)

Two major portions:

Three major apertures (openings):

A

Diaphragm (cont.)

Two major portions:

  • Skeletal muscle fibres
    • Sternal
    • Costal
    • Lumbar
  • Central tendon

Three major apertures (openings):

  • Aortic hiatus
  • Vena caval foramen
  • Oesophageal hiatus
268
Q

Diaphragm (cont.)

Vena caval foramen:

Oesophageal hiatus:

Aortic hiatus:

A

Diaphragm (cont.)

Vena caval foramen:

  • T8
  • Inferior vena cava

Oesophageal hiatus:

  • T10
  • Oesophagus
  • Vagus nerves

Aortic hiatus:

  • T12
  • Descending aorta
  • Thoracic duct
  • Azygous vein
269
Q

Diaphragm (cont.):

Lecture 26, slide 25

A

qeawrstdyftugy

270
Q

Summary:

Lecture 26, slide 26

A

szdxfcgvjhbkjnlk

271
Q

The mediastinum

Is the space b/w the pleura:

A

The mediastinum

Is the space b/w the pleura:
- Contains all the structures w/in the thoracic cavity (except the lungs & the pleura itself)

272
Q

Boundaries of the mediastinum:

Boundaries:

A

Boundaries of the mediastinum:

Boundaries:

  • Upper border (superior thoracic aperture)
  • Inferior border (diaphragm)
  • Lateral borders (mediastinal pleurae)
273
Q

Subdivision of the mediastinum:

4 Subdivisions:

A transverse plane (T4 and T5) extends from:

The inferior mediastinum is subdivided by the:

A

Subdivision of the mediastinum:

4 Subdivisions:

  • Superior
  • Inferior
    - Anterior
    - Middle
  • Posterior

A transverse plane (T4 and T5) extends from:
- The sternal angle to the intervertebral disc b/w vertebrae T4 and T5

The inferior mediastinum is subdivided by the:
- Pericardium which occupies the middle mediastinum

274
Q

Subdivisions of the mediastinum:

The sternal angle is the junction b/w:

The sternal angle is a useful landmark that indicates the level at which the:

A

Subdivisions of the mediastinum:

The sternal angle is the junction b/w:
- The manubrium and the body of the sternum

The sternal angle is a useful landmark that indicates the level at which the:
- 2nd rib articulates anteriorly. This ultimately allows you to identify the other ribs and landmarks

275
Q

Right lateral view of the mediastinum:

Lecture 27, slide 8 & 9

A

szdxfcghvbj

276
Q

Left lateral view of the mediastinum:

Lecture 27, slide 10 & 11

A

ertyfugihoj

277
Q

Anterior and middle mediastinum:

Lecture 27, slide 13

A

fcgvhjbkn

278
Q

Anterior mediastinum:

Contains:

A

Anterior mediastinum:

Contains:

  • Parasternal lymph nodes
  • Internal thoracic arteries & veins
    • Pericardiacophrenic a.
    • Anterior intercostal a.
    • Musculophrenic a.
    • Superior epigastric a.
279
Q

Anterior mediastinum (cont):

The internal thoracic artery is a branch of the:

A

Anterior mediastinum (cont):

The internal thoracic artery is a branch of the:
- Subclavian artery

280
Q

Middle mediastinum

Contains:

A

Middle mediastinum

Contains:

  • Pericardium
  • Heart
281
Q

Middle mediastinum (cont):

Pericardium:

Draw diagram on lecture 27, slide 18

A

Middle mediastinum (cont):

Pericardium:

  • Fibrous
  • Parietal serous
  • Cavity
  • Visceral serous
282
Q

Middle mediastinum (cont):

Nerve supply to pericardium:

A

Middle mediastinum (cont):

Nerve supply to pericardium:

  • Heart and visceral pericardium by the cardiac plexus (vagus and other sympathetic fibres)
  • Parietal and fibrous pericardium by the phrenic nerve
283
Q

The Superior mediastinum

Subdivided into 3 layers:

A

The Superior mediastinum

Subdivided into 3 layers:

  • Superficial layer
  • Middle layer
  • Deep layer
284
Q

The superior mediastinum (cont):

Superficial layer:

A

The superior mediastinum (cont):

Superficial layer:

  • Thymus
  • Internal thoracic a/v
  • SVC and its tributaries
285
Q

Thymus

The thymus is large in:

The thymus extends:

A

Thymus

The thymus is large in:
- Child (barely seen in adult)

The thymus extends:

  • Superiorly into the root of the neck
  • Inferiorly into the anterior mediastinum
286
Q

The superior mediastinum (cont.)

The left brachiocephalic vein:

The right brachiocephalic vein:

A

The superior mediastinum (cont.)

The left brachiocephalic vein:
- Crosses the midline to the right and joins with the right brachiocephalic vein to form the SVC

287
Q

The superior mediastinum (cont):

Three main tributaries of the superior vena cava (SVC):

A

The superior mediastinum (cont):

Three main tributaries of the superior vena cava (SVC):

  • Left brachiocephalic vein
  • Right brachiocephalic vein
  • Azygos vein
288
Q

The superior mediastinum (cont)

Middle layer:

A

The superior mediastinum (cont)

Middle layer:

  • Aortic arch and branches
  • Pulmonary trunk and arteries
  • Ligamentum arteriosum
  • Vagus n.
  • Phrenic n.
289
Q

Ligamentum arteriosum

In the embryo, it connects:

It closes soon after birth and forms:

A

Ligamentum arteriosum

In the embryo, it connects:e
- The pulmonary trunk with the aortic arch and allows blood to bypass the lungs

It closes soon after birth and forms:
- A “ligamentous” connection

290
Q

The superior Mediastinum (cont)

The vagas nerve:

A

The superior Mediastinum (cont)

The vagas nerve:

  • Is the 10th cranial nerve
  • Provides parasympathetic fibres for the majority of the thoracic and abdominal organs
  • Gives off the recurrent laryngeal nerve
291
Q

The superior mediastinum (cont)

The phrenic nerve:

A

The superior mediastinum (cont)

The phrenic nerve:

  • Is a branch of the cervical plexus
  • Passes on the surface of the scalenus anterior in the neck and anterior to the root of the lung in the thorax
  • Innervates the diaphragm and parietal pericardium
292
Q

The superior mediastinum (cont)

Deep layer:

A

The superior mediastinum (cont)

Deep layer:

  • Trachea
  • Oesophagus
  • Recurrent Laryngeal n.
  • Thoracic duct
  • Azygous vein system
  • Sympathetic trunks
293
Q

The superior mediastinum (cont):

The Trachea:

A

The superior mediastinum (cont):

The Trachea:

  • Is a midline structure
  • Has a cervical and a thoracic segment
  • Divides into the right & left main bronchi at the T4/T5 level
294
Q

The superior mediastinum (cont)

The recurrent laryngeal nerve:

A

The superior mediastinum (cont)

The recurrent laryngeal nerve:

  • Is a branch of the vagus nerve
  • ‘hooks’ around the subclavian artery on the right or the aortic arch (just lateral to the ligamentum arteriosum) on the left
  • Ascends in a groove b/w the trachea and esophagus
  • Supplies the vocal cords
295
Q

The superior mediastinum (cont)

The thoracic duct:

A

The superior mediastinum (cont)

The thoracic duct:

  • Passes b/w the esophagus and vertebral column
  • Is the major lymphatic vessel in the body
  • Empties into the junction of the left subclavian and internal jugular veins
  • Drains 3/4 of the body (a lower 1/2 and uper left 1/4)
296
Q

The superior mediastinum (cont):

Name and draw all 9 lymphatic trunks:

A

The superior mediastinum (cont):

Name and draw all 9 lymphatic trunks

Thoracic duct (Pairs):

  • Left jugular trunk
  • Left subclavian trunk
  • Left bronchomediastinal trunk
  • right & left lumbar trunks
Thoracic duct (single):
- Intestinal trunk

Right lymphatic duct (Pairs)

  • Right jugular trunk
  • Right subclavian trunk
  • Right bronchomediastinal trunk
297
Q

The superior mediastinum (cont)

The azygos vein system:

A

The superior mediastinum (cont)

The azygos vein system:

  • Passes along the vertebral column
  • Empties into the SVC
  • Drains blood from the thoracic wall
298
Q

The superior mediastinum (cont)

The sympathetic trunk:

A

The superior mediastinum (cont)

The sympathetic trunk:
- Provides sympathetic nerve fibres for the thoracic and abdominal organs

299
Q

The posterior mediastinum:

Location:

Contents:

A

The posterior mediastinum:

Location:
- The posterior mediastinum is posterior to the pericardium (middle mediastinum)

Contents:
- Major structures in the posterior mediastinum are continuous with that of the deep layer of the superior mediastinum (except trachea) and the abdominal cavity

300
Q

The Posterior mediastinum:

A

The Posterior mediastinum:

  • Oesophagus
  • Vagus nerves
    - Oesophageal plexus
  • Thoracic aorta and its branches
    • Parietal
      - Posterior intercostal
    • Visceral
      - Bronchial and oesophageal
301
Q

The Posterior mediastinum

The oesophagus:

A

The Posterior mediastinum

The oesophagus:

  • Is located b/w the vertebral column and the pericardium or trachea in the posterior or superior mediastinum, respectively
  • Passes through the esophageal hiatus of the diaphragm, together with the right/left vagus nerve
302
Q

The posterior mediastinum (cont)

The thoracic aorta:

A

The posterior mediastinum (cont)

The thoracic aorta:

  • Is the upper portion of the descending aorta
  • Begins at the T4/5 level
  • Is continuous w/ the abdominal aorta at the aortic hiatus of the diaphragm
  • Is located anterior and left of the vertebral column

ANAT (2 decks)

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