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Y2 LCRS Anatomy of Limbs > introduction to the limbs > Flashcards

introduction to the limbs Flashcards

organisation of the limbs: describe the skeletal and regional organisation of the upper and lower limbs, and describe the organisation the neuromuscular compartments of the limbs, and their main innervation, blood supply and functions; describe the basic organisation of the nerve plexuses of the limbs and their importance in understanding the consequences of spinal and peripheral nerve damage

1
Q

2 components of skeleton

A

diagram; axial (head neck and trunk; skull, spinal column, thoracic cage) and appendicular (upper and lower limbs)

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2
Q

what are limbs divided into

A

compartments

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3
Q

3 features of compartments (function, nerve supply, blood supply)

A

have distinct function, and same nerve and blood supplies

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4
Q

7 compartments of upper limb from top down, and whether flexor, extensor or both

A

pectoral (chest) girdle muscles (anterior and posterior), intrinsic shoulder muscles, anterior (upper) arm muscles (flexors), posterior (upper) arm muscles (extensors), anterior forearm muscles (flexors), posterior forearm muscles (extensors), intrinsic hand muscles (palmar is anterior, dorsum is posterior)

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5
Q

compartments with relation to skeleton

A

pectoral girdle (clavicle and scapula, humerus, radius, ulna, carpus, metacarpals, phalanges

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6
Q

examples of anterior and posterior muscles attached to pectoral girdle

A

pectoralis major anterior; trapezius attached to sacupla for positioning of arm, latissimus dorsi attached to iliac crest and scapula posterior

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7
Q

what 2 movements does the movement of the shoulder involve

A

movement of arm relative to scapula at shoulder joint, movement of scapular relative to chest wall

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8
Q

where do muscles acting on shoulder joint have attachments in; blood supply of trapezius muscle

A

neck, anterior chest, back, arm; blood supply from cranial accessory nerve

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9
Q

anterior muscles of pectoral shoulder girdle

A

trapezius, deltoid, serratus anterior, pectoralis major

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10
Q

posterior muscles of pectoral shoulder girdle

A

trapezius, lattisimus dorsi, rotator cuff muscles of shoulder

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11
Q

compartments of upper arm in cross-section (CT, MRI etc.): top compartment

A

pectoralis major, triceps, deltoid (attaches to lateral side of humerus), biceps

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12
Q

compartments of upper arm in cross-section (CT, MRI etc.): middle compartment

A

biceps, triceps, bachialis

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13
Q

compartments of upper arm in cross-section (CT, MRI etc.): bottom compartment

A

biceps, triceps, bachialis

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14
Q

10 compartments of lower limb from top down, and whether flexor, extendor, abductor, adductor etc.

A

hip abductors (gluteal), hip extensors (gluteal), hip flexors, anterior thigh muscles (extensors), medial thigh muscles (adductors), posterior thigh muscles (flexors), anterior leg muscles (extensors/dorsiflexors), lateral leg muscles (foot evertors), posterior leg muscles (flexors/plantarflexors), intrinsic foot muscles (variety of functions)

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15
Q

lower limb bones and anterior compartments

A

attached to trunk via sacroiliac joint -> femur -> tibia and fibula -> tarsus -> metatarsals and phalanges; anterior thigh, anterior leg, dorsal surface of foot, medial (adductor) compartment of thigh, lateral (peroneal/fibular) compartment of leg

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16
Q

lower limb posterior compartments

A

gluteal, posterior thigh, posterior leg (superficial and deep), plantar (sole) surface of foot, medial (adductor) compartment of thigh, lateral (peroneal/fibular) compartment of leg

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17
Q

where do muscles and nerves of lower limb arise in

A

abdominal and pelvic cavities

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18
Q

what function do muscles with attachments in abdomen and pelvis have

A

flexors of hip; psoas (T12-L4), iliacus (iliac fossa)

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19
Q

what spinal cord level do nerves supplying lower limb arise from

A

lumbosacral plexus (L2-S3); femoral nerve, sciatic nerve

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20
Q

compartments of upper leg in cross-section (CT, MRI etc.): top compartment

A

adductors, quadriceps

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21
Q

compartments of upper leg in cross-section (CT, MRI etc.): middle compartment

A

quadriceps

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22
Q

compartments of upper leg in cross-section (CT, MRI etc.): bottom compartment

A

hamstrings

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23
Q

compartments of upper leg in cross-section (CT, MRI etc.): just above middle of leg

A

peroneal compartment, soleus, glastrocnemius; interosseous membrane

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24
Q

arterial supply to upper limb: heart to hand

A

aorta -> subclavian -> axillary -> brachial (deep brachial) -> ulnar (medial) and radial (lateral) -> hand palmar arches (deep and superficial) -> metacarpal and digital

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25
Q

which 3 arteries can a pulse be felt for in upper limb

A

brachial, ulnar and radial (assess blood supply to extremities)

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26
Q

diagram of arterial supply to upper limb

A

diagram

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27
Q

venous drainage of upper limb: hand to heart and whether superficial or deep

A

dorsal venous arch (superficial) -> cephalic (lateral) and basilic (medial) (both superficial) -> median cubital vein connects both at cubital fossa (in front of elbow; where venipuncture common) -> axillary (deep) -> subclavian -> superior vena cava; venae comitantes (pair of veins, occasionaly more, that closely accompany an artery in such a manner that the pulsations of the artery aid venous return; deep; run more distal from limb)

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28
Q

diagram of venous drainage of upper limb

A

diagram

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29
Q

arterial supply to lower limb: heart to hand

A

aorta -> common iliac (internal and external) -> external iliac (small from internal to medial compartment of thigh) -> femoral (external passes under inguinal ligmanent to become deep femoral) -> popliteal (posterior tibial, anterior tibial, peroneal (fibula; -> plantar arteries), dorsalis pedis (anterior)))

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30
Q

which 5 arteries can a pulse be felt for

A

femoral artery, popliteal (posterior tibial, anterior tibial, dorsalis pedis)

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31
Q

diagram of arterial supply to lower limb

A

diagram

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32
Q

venous drainage of lower limb: deep system

A

anterior and posterior venae comitantes, popliteal, femoral, external iliac

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33
Q

venous drainage of lower limb: superficial system

A

venous arches, long saphenous, short saphenous

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34
Q

what are venae comitantes

A

pair of veins (occasionally more), that closely accompany an artery in such manner that pulsations of artery aid venous return

35
Q

diagram of venous drainage of lower limb

A

diagram

36
Q

superficial veins of lower limb: where do great and small saphenous veins arise from

A

venous network of dorsum of foot

37
Q

superficial veins of lower limb: where does the great (long) saphenous vein drain into and where

A

femoral vein at groin

38
Q

superficial veins of lower limb: where does the small (short) saphenous vein drain into and where

A

popliteal vein at popliteal fossa (posterior at knee)

39
Q

superficial veins of lower limb: consistency of veins

A

numerous perforating veins linking superficial and deep vessels, but only saphenous veins are consistent (other superficial veins more variable)

40
Q

organisation of spinal nerves: spinal cord levels for neck, upper limb, trunk, lower limb, perineum

A

neck C1-C4, upper limb C5-T1, trunk T2-L1, lower limb L2-S3, perineum S2-C2

41
Q

define plexus

A

network of nerves formed from group of spinal nerves which mingle then separate out to form new nerves containing fibres from more than one spinal root

42
Q

diagram of brachial plexus supplying upper limb

A

diagram

43
Q

what does femoral nerve supply from lumbosacral plexus for lower limb

A

anterior compartment of thigh

44
Q

what does obturator nerve supply from lumbosacral plexus for lower limb

A

medial (adductor) compartment of thigh

45
Q

what nerve supplies remaining lower limb compartments from lumbosacral plexus for lower limb

A

sciatic nerve (or its terminal branches tibial and common peroneal nerves)

46
Q

2 types of nerve innervation

A

segmental, peripheral

47
Q

describe segmental motor supply to limbs: location of motor nerve cell bodies, plexi and what divisions innervate what types of muscles

A

groups of motor nerve cell bodies in spinal cord (upper limb: C5-T1, lower limb: L2-S3); plexi for each limb, with anterior divisions innervating flexor muscles and posterior divisions innervating extensor muscles

48
Q

4 principles of segmental nerve supplies

A

muscles supplied by two adjacent segments; same action on joint = same nerve supply; opposing muscles 1-2 segments above or below; more distal in limb = more caudal in spine

49
Q

segmental motor supply to upper limb: 6 movements and spinal roots

A

shoulder, elbow, pronation/supination, wrist, hand, fingers

50
Q

segmental motor supply to lower limb: 5 movements

A

hip, knee, ankle, inversion and eversion, big toe

51
Q

segmental motor supply to upper limb - spinal cord levels: shoulder abduction, adduction, external rotation, internal rotation

A

abduction C5, adduction C6,7,8; external rotation C5, internal rotation C6,7,8

52
Q

segmental motor supply to upper limb - spinal cord levels: elbow flexion and extension

A

flexion C5,6; extension C7,8

53
Q

segmental motor supply to upper limb - spinal cord levels: forearm supination and pronation

A

supination C6, pronation C7,8

54
Q

segmental motor supply to upper limb - spinal cord levels: wrist flexion and extension

A

flexion C6,7; extension C7,8

55
Q

segmental motor supply to upper limb - spinal cord levels: long tendons to hand flexion and extension

A

flexion C7,8; extension C7.8

56
Q

segmental motor supply to upper limb - spinal cord levels: intrinsic hand

A

T1

57
Q

segmental motor supply to lower limb - spinal cord levels: hip flex and extend

A

flex L2,3; extend L4,5

58
Q

segmental motor supply to lower limb - spinal cord levels: knee extend and flex

A

extend L3,4; flex L5,S1

59
Q

segmental motor supply to lower limb - spinal cord levels: ankle dorsiflex and plantarflex

A

dorsiflex L4,5; plantarflex S1,2

60
Q

pattern of segmental sensory nerve supply dermatomes in trunk, upper and lower limbs

A

orderly in trunk and upper limb, but twists in lower limb

61
Q

segmental vs cutaneous sensory innervation

A

nerves through brachial plexus, so get to dermatome via different peripheral nerves

62
Q

segmental sensory nerve supply to upper limb: dermatomes

A

diagram

63
Q

segmental sensory nerve supply to lower limb: dermatomes

A

diagram

64
Q

sensory segmental supply to upper limb: C4

A

infraclavicular region

65
Q

sensory segmental supply to upper limb: C5

A

lateral arm

66
Q

sensory segmental supply to upper limb: C6

A

lateral forearm and thumb

67
Q

sensory segmental supply to upper limb: C7

A

middle finger

68
Q

sensory segmental supply to upper limb: C8

A

little finger and medial forearm

69
Q

sensory segmental supply to upper limb: T1

A

medial arm

70
Q

sensory segmental supply to upper limb: T2

A

axilla and trunk

71
Q

sensory segmental supply to upper limb: T4

A

nipple

72
Q

sensory segmental supply to upper limb: T10

A

umbilicus

73
Q

sensory segmental supply to upper limb: T12

A

lower abdomen

74
Q

4 aspects of assessment of nerve function

A

motor function, sensory function, reflex function, autonomic function

75
Q

example of assessment of nerve function: root injury with prolapsed intervertebral disc at L5/S1

A

motor function - loss of eversion, sensory function - loss of sensation outer border of foot, reflex function - loss of ankle jerk (S1), autonomic function - minimal

76
Q

example of assessment of nerve function: lesion of common peroneal nerve at fibular neck (peripheral nerve)

A

motor function - foot drop (nerve supplies anterior muscles of leg), sensory function - dorsum of foot at least, reflex function - none, autonomic function - minimal

77
Q

summary of compartments

A

muscles, segmental supply, peripheral nerve supply, blood supply, function and movement

78
Q

in confined compartments, what are muscle groups separated by

A

fibrous septa

79
Q

what is compartment syndrome

A

ischaemia caused by trauma-induced increased pressure in confined leg compartment

80
Q

where is compartment syndrome common

A

anterior, posterior and lateral compartments of leg

81
Q

is pulse still present in compartment syndrome

A

yes

82
Q

what is associated with acute compartment syndrome

A

trauma

83
Q

what induces chronic compartment syndrome

A

exercise

84
Q

treatment of acute compartment syndrome, and why

A

emergency fasciotomy required to prevent death of muscles, and other tissues, in affected compartment (relieve pressure)

Y2 LCRS Anatomy of Limbs (25 decks)

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