Anatomy🫀 Flashcards
(433 cards)
1
Q
what is the type of Acromioclavicular joint?
A
Synovial plane.
2
Q
articulating bones of Acromioclavicular joint
A
Acromion process of scapula with clavicle (lateral end).
3
Q
what are the ligaments of Acromioclavicular joint? and what is its function?
A
Coracoclavicular: Transmits weight of upper limb to clavicle and then to axial skeleton.
4
Q
what is the type of Sternoclavicular joint?
A
Synovial saddle
5
Q
what are the articulating bones of Sternoclavicular joint?
A
Sternal end of clavicle with manubrium sterni and 1st costal cartilage.
6
Q
what are the ligaments of Sternoclavicular joint?
A
Costoclavicular: From 1st costal cartilage to the inferior surface of medial end of clavicle.
7
Q
what are the muscles that act on shoulder girdle?
A
8
Q
what are the movements done by shoulder girdle?
A
Protraction, retraction, Elevation, depression. Upward and downward rotation
9
Q
what are the muscles that cause protraction of shoulder girdle?
A
- Serratus anterior.
- Pectoralis minor.
10
Q
what are the muscles that causes retraction of shoulder girdle?
A
- Middle trapezius.
- Rhomboids.
11
Q
what are the muscles that Cause elevation of shoulder girdle?
A
- Upper trapezius.
- Levator scapulae.
12
Q
what are the muscles that cause depression of shoulder girdle?
A
- Lower trapezius.
- Pectoralis minor.
13
Q
muscles involved in a upward rotation of shoulder Girdle
A
- Upper and lower trapezius.
- Serratus anterior (lower 5 digitations).
14
Q
muscles involved in downward rotation of shoulder girdle
A
- Levator scapulae
- Rhomboids
- Pectoralis minor.
15
Q
what is the type of shoulder joint?
A
Synovial ball and socket.
16
Q
what are the articular surfaces of shoulder joint?
A
✓ Head of humerus.
✓ Glenoid cavity of scapula.
17
Q
what are the ligaments of shoulder joint?
A
- Coracohumeral.
- Glenohumeral.
- Transverse humeral
18
Q
what is the function of transverse humoral ligament?
A
Bridges Bicepital groove between greater and lesser tuberosities and acting as a retinaculum for long head of biceps.
19
Q
what is labrum glenoidale?
A
fibrocartilaginous rim around the glenoid cavity deepens the glenoid cavity and so assist in stabilizing the humeral head on the fossa.
20
Q
what are the muscles that act on shoulder joint?
A
21
Q
what are the movements done by shoulder joint?
A
Flexion, Extension, Abduction, Adduction, Medial and Lateral rotation & Circumduction
22
Q
what are the muscles involved In flexion of shoulder joint?
A
- Pectoralis major (clavicular head).
- Deltoid (ant fibers).
- Coracobrachialis & Biceps (Assistant).
23
Q
what are the muscles involved in extension of shoulder joint?
A
- Latissimusdorsi.
- Teres major.
- Deltoid (post fibers).
- Triceps (Assistant).
24
Q
what are the muscles involved in abduction of shoulder joint?
A
- Supraspinatus(0-15°)
- Deltoid, Middle fiber (15-90°).
25
what are the muscles involved in adduction of shoulder joint?
1. Pectoralis major.
2. Latissimus dorsi.
3. Teres major.
26
what are the muscles involved in medial rotation of shoulder joint?
1. Pectoralis major.
2. Latissimus dorsi.
3. Teres major
4. Subscapularis
5. Deltoid (ant fibers).
27
what are the muscles involved in the lateral rotation of shoulder joint?
1. Infraspinatus
2. Teres minor.
3. Deltoid (post. fibers).
28
Circumduction
Association of flexion, abduction, extension and adduction in succession.
29
what are the type of elbow joint?
Synovial hinge.
30
what are the articulating bones of elbow joint?
- Capitulum articulates with radial head.
- Trochlea articulates with trochlear notch of ulna.
- Fossae immediately above trochlea and capitulum admit coronoid process of ulna and radial head, respectively, during full flexion.
- The olecranon fossa admits olecranon process during full extension.
31
what are the ligaments of elbow joint?
**1. Medial collateral ligament:** Attached to medial epicondyle of humerus.
**2. Lateral collateral ligament:** attached to lateral epicondyle of humerus.
32
what are the muscles Acting on elbow joint?
- Biceps
- Brachialis
- Brachioradialis
- Triceps
- Anconeus
33
what are the movements done by elbow joint?
Flexion & Extension
34
what are the muscles involved flexion of elbow joint?
1. Brachialis.
2. Biceps.
3. Brachioradialis (in mid-prone position).
4. Superficial group of the anterior compartment of the forearm
35
what are the muscles involved in extension of elbow joint?
1. Triceps.
2. Anconeus.
3. Superficial group of the posterior compartment of the forearm except brachioradialis
36
what is deltoid muscle?
Thick triangular muscle forming the round contour of the shoulder
37
what is the origin of deltoid muscle?
1. Anterior border of Lateral third of the clavicle.
2. Lateral border of acromion process.
3. Lower lip of the crest of the spine of scapula.
38
insertion of deltoid muscle
Deltoid tuberosity of the humerus.
39
nerve supply of deltoid muscle
Axillary nerve
40
action of Deltoid muscles
1. Anterior fibers: Flexion and medial rotation of the arm.
2. Posterior fibers: Extension and lateral rotation of the arm.
3. Middle fibers: Abduction of the arm from (15 – 90)
41
What are rotator cuff muscles?
- Supraspinatus
- Infraspinatus
- Teres Minor
- Subscapularis
42
Origin, insertion, nerve supply & action of rotator cuff muscles
43
Origin of teres major
Lower 1/3 of the lateral border of the scapula.
44
insertion of teres major
Medial lip of bicepital groove.
45
nerve supply of teres major
lower subscapular
46
action of teres major
Extension, adduction and medial rotation of the arm.
47
what are the clinical cases related to rotator cuff muscles?
1) Dislocation of the shoulder joint
2) Rupture of rotator cuff
48
in what direction does dislocation of shoulder joint usually occur?
anteroinferior direction
49
what causes dislocation of shoulder joint? and what does it damage?
- the lack of support by tendons of the rotator cuff, It may damage the axillary nerve and the posterior circumflex humeral vessels.
50
what causes rupture of rotator cuff?
By chronic wear and tear or an acute fall on the outstretched arm.
51
which tendon is most frequently affected in rupture of rotator cuff?
supraspinatus tendon.
52
what are the manifestations of rupture of rotator cuff?
Manifested by severe limitation of shoulder joint motion, chiefly abduction. And painful abduction of the arm or a painful shoulder.
53
what are the muscles of the anterior compartment of the arm?
1. Biceps Brachii
2. Coracobrachialis
3. Brachialis
54
Origin of Biceps brachii
**1. Long head:** supraglenoid tubercle of the scapula
**2. Short head:** tip of the coracoid process of scapula.
55
insertion of biceps brachii
**1) Biceps tendon:** Into the radial tuberosity.
**2) Bicepital aponeurosis:** Blends with deep fascia of forearm.
56
nerve supply of biceps brachii
Musculocutaneus nerve
57
action of biceps brachii
1. Powerful flexor of the elbow.
2. Powerful supinator of the flexed elbow.
3. Weak flexor of the shoulder joint.
58
Origin of coracobrachialis
Tip of coracoid process of scapula.
59
insertion of coracobrachialis
Middle of the medial border of humerus.
60
nerve supply of coracobrachialis
Musculocutaneus nerve.
61
Action of coracobrachialis
Flexion and weak adduction of the arm.
62
Origin of brachialis
Lower half of the front of the humerus.
63
insertion of brachialis
Ulnar tuberosity.
64
nerve supply of brachialis
- Musculocutaneus nerve
- Radial nerve
65
action of brachialis
Flexion of the elbow joint
66
what are the muscles of the posterior compartment of the arm?
Triceps Brachii
67
Origin of triceps brachii
**1. Long head:** Infraglenoid tubercle of the scapula.
**2. Lateral head:** Posterior surface of the humerus above spiral groove.
**3. Medial head:** Posterior surface of the humerus below spiral groove.
68
insertion of triceps brachii
Upper surface of olecranon process.
69
nerve supply of triceps brachii
Radial nerve
70
action of triceps brachii
1. Powerful extension of the elbow.
2. Weak extensor of the shoulder joint
71
what is the type of superior radioulnar joint?
Synovial, pivot
72
articulating bones of superior radioulnar joint
- Head of radius.
- osseofibrous ring formed by annular ligament (4/5) and radial notch of ulna (1/5).
73
what are the ligaments of the superior radioulnar joint?
**Annular ligament:** Encircles head of radius.
74
what is the type of middle radioulnar joint?
Syndesmosis
75
articulating bones of middle radioulnar joint
Shaft of radius and ulna are connected by an interosseous membrane.
76
what is the type of inferior radioulnar joint?
Synovial, pivot
77
articulating bones of inferior radioulnar joint
- Head of ulna.
- Ulnar notch of radius.
78
what are the muscles acting on radioulnar joint?
**Supination:**
1. Brachioradialis.
2. Supinator (extension).
3. Biceps (flexion).
**Pronation:**
1. Brachioradialis.
2. Pronator teres.
3. Pronator quadratus.
79
what is the type of wrist (Radiocarpal) Joint?
Synovial ellipsoid joint.
80
articulating bones of wrist joint
**From above:** Distal radius and a triangular disc of fibrocartilage covering distal ulna.
**From below:** Scaphoid & Lunate bones and triquetral during adduction.
81
what are the muscles acting on wrist joint?
82
what are the joints of the hand?
83
what is flexor retinaculum?
thick band of deep fascia crossing the front of the carpal bones converting its concave anterior surface into the carpal tunnel.
84
Attachment of flexor retinaculum
**Medially:** Pisiform and Hamate.
**Laterally:** Scaphoid and Trapezium.
85
What are the structures that pass superficial to flexor retinaculum?
- from medial to lateral
1. Ulnar nerve.
2. Ulnar artery.
3. Palmar cutaneous branch of ulnar nerve.
4. Palmaris longus tendon.
5. Palmar cutaneous branch of median nerve.
86
what are the structures that pass deep to flexor Retinaculum (contents of carpal tunnel)?
1. Tendon of flexor carpi radialis (in a special tunnel)
2. Tendon of flexor digitorum superficialis.
3. Tendon of flexor digitorum profundus.
4. Median nerve.
5. Tendon of flexor pollicis Iongus.
6. Synovial sheathes around the above mentioned tendons.
87
what are synovial flexor sheaths?
**1. Common Synovial Flexor Sheath (Ulnar Bursa):** Envelops the tendons of both the flexor digitorum superficialis and profundus muscles.
**2. Synovial Sheath for Flexor Pollicis Longus (Radial Bursa):** Envelops the tendon of the flexor pollicis longus muscle.
88
what is extensor retinaculum?
Thickened band of deep fascia 2.5 cm wide extending obliquely across the back of the junction of forearm and wrist.
89
what is the function of extensor retinaculum?
keeps the extensor tendons in contact with the wrist joint during their contraction.
90
what are the structures that pass superficial to extensor retinaculum?
1. Basilic vein.
2. Cephalic vein.
91
what are the structures that pass deep to extensor retinaculum?
The tendons of the muscles of the posterior compartment of the forearm.
92
what is the anatomical snuffbox?
It is a depression on the lateral side of wrist identified when the thumb is abducted and extended.
93
what are the boundaries of the anatomical snuffbox?
**Anteriorly:**
- Tendons of abductor pollicis longus & extensor pollicis brevis.
**Posteriorly:**
- Tendon of extensor pollicis longus.
**Floor:**
- styloid process of radius
- scaphoid.
- trapezium.
94
what are the contents of the anatomical snuffbox?
Radial artery.
95
what is the definition of Palmar aponeurosis?
a triangular fibrous layer overlying the tendons in the palm and is continuous with the palmaris longus tendon, the thenar and hypothenar fasciae and the flexor retinaculum.
96
what is the function of palmar aponeurosis?
Protects the superficial palmar arterial arch, the palmar digital nerves, and the long flexor tendons
97
what are the fascial spaces of the palm?
Are fascial spaces deep to the palmar aponeurosis and divided by a midpalmar (oblique) septum into thenar space and midpalmar space.
98
what is the Thenar Space?
the lateral space that contains the flexor pollicis longus tendon and the other flexor tendons of the index finger
99
what is the mid-Palmer space?
the medial space that contains the flexor tendons of the medial three digits.
100
what are the muscles of the hand?
101
innervation of hand muscles
all the muscles of the hand are supplied by deep branch of ulnar nerve except the three muscle of the thenar eminence and the 1st & 2nd lumbricals which are supplied by median nerve
102
what is the action of lumbricals?
- They flex metacarpophalangeal joints and extend the interphalangeal joints of the medial four fingers (writing position), Assisted by the interossei.
103
what is the action of palmar interossei?
- They flex metacarpophalangeal joints and extend the interphalangeal joints of the medial four fingers (writing position).
- Adduction of fingers towards the axis of middle finger (PAD).
104
what is the action of dorsal interossei?
- They flex metacarpophalangeal joints and extend the interphalangeal joints of the medial four fingers (writing position).
- Abduction of fingers away from the axis of middle finger (DAP).
105
what are the stages of brachial plexus?
- Roots
- Trunks
- Divisions
- Cords
106
roots of brachial plexus
These are the anterior primary rami of C5, 6, 7, 8, T1.
107
Trunks of brachial plexus
3 trunks lie in the posterior triangle of the neck, pass laterally over the 1st rib to enter the axilla.
- Upper trunk: formed by C5, 6 roots.
- Middle trunk: formed by C7 root.
- Lower trunk: formed by C8, T1 roots.
108
Divisions of brachial plexus
Each trunk is divided into anterior & posterior divisions.
109
Cords of brachial plexus
3 cords lie in the axilla & are related to 2nd part of axillary artery.
- Lateral cord: formed by the anterior divisions of the upper
& middle trunks.
- Medial cord: formed by the anterior division of lower trunk.
- Posterior cord: formed by all the posterior divisions.
110
what is the position of stages of brachial plexus?
Roots & trunks lie in the neck, divisions lie behind the clavicle, cords& branches lie in the axilla.
111
what are the branches of the brachial plexus?
- From the Roots
- From the Trunks
- From the Cords
112
branches from the root of brachial plexus
1. Dorsal scapular nerve (C5): Nerve to rhomboid.
2. Long thoracic nerve (C5, 6, 7): Nerve to serratus anterior.
113
branches from the trunks of brachial plexus
(only from the upper trunk (C5 & 6))
- Suprascapular nerve: passes through the suprascapular notch to supply supraspinatus & infraspinatus muscles.
- Nerve to subclavius.
114
branches from the lateral cord of brachial plexus (C5,6&7)
1. Lateral pectoral nerve: supplies pectoralis major.
2. Lateral root of median nerve.
3. Musculocutaneous nerve (C5, 6, 7).
115
branches from the Medial cord of brachial plexus (C8&T1)
1. Medial pectoral nerve: supplies pectoralis major & minor.
2. Medial cutaneous nerves of the arm.
3. Medial cutaneous nerves of the forearm.
4. Medial root of median nerve.
5. Ulnar nerve.
116
Branched from the posterior cord of brachial plexus (C5,6,7,8&T1)
1. Upper subscapular nerve (C5 & 6): supplies subscapularis.
2. Lower subscapular nerve (C5 & 6): supplies subscapularis& teres major.
3. Nerve to latissimus dorsi (C6, 7 & 8): Thoraco-dorsal nerve.
4. Axillary nerve (C5, 6).
5. Radial nerve (C5, 6, 7, 8, T1).
117
118
what are the lesions of **brachial plexus**?
- lesion in the upper trunk of brachial plexus C5&6 (Erb's Paralysis)
- lesion in in the lower trunk of brachial plexus (Klumpk's Paralysis)
119
what causes lesion in the upper trunk of brachial plexus C5&6 (Erb's Paralysis)?
head traction during birth.
120
what deformity results from legion in upper trunk of brachial plexus?
waiter’s tip position (policeman's position):
- Adduction of the shoulder, extension & pronation of forearm.
121
what causes lesion in in the lower trunk of brachial plexus (Klumpk's Paralysis)?
- Stretch of the upper limb during climbing.
- Difficult breech delivery.
122
what is the deformity that results from lesion in in the lower trunk of brachial plexus (Klumpk's Paralysis)?
paralysis of the muscles of the hand and claw hand.
123
what is the origin of axillary nerve?
from the posterior cord of the brachial plexus (C5, 6).
124
course of axillary nerve
- Passes backward through the quadrangular space with the posterior circumflex humeral artery.
- It ends by dividing into anterior & posterior divisions.
125
branches of axillary nerve
1. Muscular branches to deltoid & teres minor.
2. Upper lateral cutaneous nerve of the arm.
126
what does a lesion in the axillary nerve cause?
paralysis of the deltoid muscle
127
what are the causes of lesions in axillary nerve?
1. Dislocation of shoulder.
2. Fracture of surgical neck of the humerus.
128
what are the results of a lesion in the axillary nerve?
Flat shoulder due to paralysis & atrophy of the deltoid muscle.
129
what is the origin of musculocutaneous nerve?
from the lateral cord of the brachial plexus.
130
course of musculocutaneous nerve
Pierces the coracobrachialis to descend between brachialis & biceps.
131
termination of musculocutaneous nerve
continues as lateral cutaneous nerve of the forearm.
## Footnote
- Medial cutenous nerves to the arm & forearm: From the medial cord
- Superior & Inferior Lateral cutenous nerve to the arm: From the axillary and radial respictively (Posterior cord)
- Lateral cutenous nerve to the forearm: From the musculocutenous nerve (lateral cord)
- Posterior cutenous to the arm & forearm: From the radial nerve (Posterior cord)
132
what are the branches of musculocutaneous nerve?
- **Muscular:** to biceps brachii, brachialis & coracobrachialis.
- **Cutaneous:** lateral aspect of the forearm till root of thumb.
133
what is the origin of radial nerve?
posterior cord of the brachial plexus (C5, 6, 7, 8, T1).
134
course of radial nerve
- Passes through the lower triangular space.
- Runs in the spiral groove with profunda brachii artery.
- Pierces the lateral intermuscular septum to enter the anterior compartment.
135
termination of radial nerve
divides into superficial & deep (posterior interosseous) branches.
136
what are the branches of radial nerve?
**Muscular:**
- Triceps.
- Anconeus.
- Brachialis.
- Brachioradialis.
- Extensor carpi radialis longus.
**Cutaneous branch:**
- Inferior lateral cutaneous nerve of arm.
- Posterior cutaneous nerve of arm.
- Posterior cutaneous nerve of forearm.
- Superficial branch of radial nerve:
137
what does the superficial branch of radial nerve supply?
- Skin of the lateral 2/3 of the dorsum of the hand.
- Skin of the dorsal surface of the lateral 3.5 fingers except their distal part.
138
what does a lesion of radial nerve cause?
wrist drop.
139
what are the branches of posterior interosseous nerve?
Muscular to
- All extensor group of the forearm except brachioradialis,
extensor carpi radialis longus & anconeus.
140
what is the origin of median nerve?
arises by 2 roots:
- Lateral root: from the lateral cord (C5, 6, 7).
- Medial root: from the medial cord (C8, T1).
141
what is the course of median nerve?
**In the arm:**
- Passes lateral to the upper part of the brachial artery.
- Then crosses in front of the middle part of the artery.
- Then passes medial to the artery.
**In the cubital fossa:**
- lies medial to the brachial artery.
**In the forearm:**
- Enters the forearm between 2 heads of pronator teres muscle.
- Descends between flexor digitorum superficialis & profundus.
- Passes deep to the flexor retinaculum (in carpal tunnel) to enter the palm of the hand.
142
what are the branches of median nerve?
143
what does a lesion in the medial nerve (carpal tunnel syndrome) cause?
ape hand deformity
144
what does median nerve supply?
**Muscles**
- All muscles of the front of the forearm except: Flexor carpi ulnaris & Medial 1⁄2 of flexor digitorum profundus.
- 3 muscles of thenar eminence.
- 1st lumbrical& 2nd lumbrical.
**Skin**
- Skin of lateral 2/3 of the palm of the hand.
- Skin of lateral 31⁄2 fingers.
145
what is the origin of Ulnar nerve?
from the medial cord (C8, T1).
146
what is the course ulnar nerve?
- Passes behind the medial epicondyle of the humerus.
- Enters the palm of the hand superficial to the flexor retinaculum, lateral to the pisiform bone.
147
what are the branches of ulnar nerve?
148
what does a lesion in the ulnar nerve cause?
partial claw hand.
149
what does the ulnar nerve supply?
**Muscles**
- Flexor carpi ulnaris & Medial 1⁄2 of flexor
- All muscles of the hand except: 3 muscles of thenar eminence, 1st lumbrical& 2nd lumbrical.
**Skin**
- Skin of medial 1/3 of the hand.
- Skin of medial 1.5 fingers.
150
what are dermatomes of the upper limb?
- It is an area of skin that is mainly supplied by a single spinal nerve.
- Each of these spinal nerves send sensations from a particular region of the skin to the brain.
151
what are important dermatomes of the upper limb?
Important dermatomes of the upper limb:
C4: shoulder
C6: thumb.
C8: little finger
152
what are the manifestations of nerve lesion?
1. Sensory loss in the area of the skin supplied by this nerve.
2. Paralysis of muscles supplied by this nerve.
3. Deformity.
153
what causes Lesion in long thoracic nerve?
Occurs during breast surgery
154
what deformity results from injury of long thoracic nerve?
winging of scapula due to paralysis of serratus anterior muscle.
155
Beginning of axillary artery
Continuation of subclavian artery at outer border of 1st rib
156
course of axillary artery
Divided by pectoralis minor into 3 parts
157
what are the branches of axillary artery?
**1st Part**
- Superior thoracic
**2nd part**
- Lateral thoracic
- Acromio-thoracic: (Pierce clavi-pectoral fascia to give):
1. Acromial branch
2. Pectoral branch
3. Clavicular branch
4. Deltoid branch
**3rd part**
- Sub-scapular gives:
1. Circumflex scapular
2. Thoraco-dorsal
- Anterior circumflex humeral artery
- Posterior circumflex humeral artery
158
what are the veins of the upper limb?
**Superficial veins:**
- Cephalic vein
- Basilic vein
**Deep veins:**
- Axillary vein
159
Origin of cephalic vein
Lateral end of dorsal venous arch + dorsal digital vein of Thumb
160
course of cephalic vein
- Pass superficial to extensor retinaculum
- Wind around forearm to reach its anterior surface
- Run along lateral side of Forearm then cubital fossa then arm
- Pass in delto-pectoral groove
- Pierce clavipectoral fascia
161
termination of cephalic vein
In axillary vein
162
origin of basilic vein
Medial end of dorsal venous arch + dorsal digital vein of little finger
163
course of basilic vein
- Pass superficial to extensor retinaculum
- Wind around forearm to reach its anterior surface
- Run along medial side of Forearm then cubital fossa then arm
164
termination of basilic vein
Form axillary vein at lower border of teres major
165
Origin of axillary vein
Continuation of basilic vein at lower border of teres major
166
Course of axillary vein
Pass upward, backward on medial side of axillary artery
167
termination of axillary vein
form subclavian vein at outer border of 1st rib
168
anastomosis around scapula
- Suprascapular & Deep branch of transverse cervical from Thyrocervical of 1 part of subclavian
- Posterior intercostal braches of descending thoracic aorta
- Subscapular artery of 3rd part of axillary
169
anastomosis around surgical Neck
- Suprascapular from Thyrocervical of 1st part of subclavian
- ACHA & PCHA: from 3rd part of axillary
- Ascending branch of profunda brachii: from brachial artery
170
Origin of brachial artery
Continuation of axillary artery at lower border of teres major
171
termination of brachial artery
Gives 2 terminal branches (ulnar & radial) at level of neck of radius
172
what are the branches of brachial artery?
- Terminal branches: ulnar & radial
- Superior ulnar collateral : Pass behind medial epicondyle
- Inferior ulnar collateral Divide at medial epicondyle giving anterior & posterior divisions
- Profunda brachii
Pass in lower triangular space then in spiral groove with radial nerve and Gives:
1. Ascending branch
2. Posterior descending branch: Pass behind lat. epicondyle
3. Anterior descending branch: pass anterior to lat. epicondy
173
Origin of ulnar artery
One of 2 terminal branches of brachial artery at level of neck of radius
174
what is the course of ulnar artery?
Enter the hand superficial to flexor retinaculum
175
termination of ulnar artery
Divides into deep & superficial branches:
- The deep branch joins radial artery → deep palmar arch.
- The superficial branch joins superficial palmar branch of radial artery → superficial palmar arch
176
what are the branches of ulnar artery?
**In forearm:**
- Anterior ulnar recurrent: return to elbow
- Posterior ulnar collateral: return to elbow
- Common interosseous: gives
1. Anterior interosseous: gives median branch
2. Posterior interosseous: gives recurrent IOA
- Palmar carpal: join that for radial to form palmar carpal arch
- Dorsal carpal: join that for radial to form dorsal carpal arch
**In hand:**
- Deep palmar
- Superficial palmar
177
Median cubital vein
From cephalic to basilic vein
178
what is the origin of the radial artery?
One of 2 terminal branches (smaller) of brachial artery at level of neck of radius
179
what is the course of the radial artery?
**In the forearm:**
- Cross lower end of the radius
**In the hand:**
- Enters dorsum of hand → anatomical snuff box→ pierce
1st interosseous space → passes to the palm
180
what is termination of the radial artery?
Join deep branch of ulnar artery forming deep palmar arch
181
what are the branches of the Radial artery?
**(In forearm)**
- **Radial recurrent:** return to elbow
- **Palmar carpal:** join palmar carpal of ulnar to form palmar carpal arch
- **Superficial palmar:** join superficial Palmar of ulnar forming superficial palmar arch
**(In Hand)**
***In the dorsum:***
- **Dorsal digital:** to lateral side of thumb
- **1st dorsal metacarpal:** to adjacent sides of thumb & index
- **Dorsal carpal:** join dorsal carpal of ulnar to form dorsal carpal arch
***In the palm:***
- **Princips pollicis:** supply the thumb
- **Radialis indicis:** to lateral side of index
182
anastomosis around the elbow
**Front of medial epicondyle:**
- Anterior division of Inferior ulnar collateral of brachial
- Anterior ulnar recurrent of ulnar
**Back of medial epicondyle:**
- Posterior division of Inferior ulnar collateral of brachial
- Superior ulnar collateral of brachial
- Posterior ulnar recurrent of ulnar
**Front of Lateral epicondyle:**
- Anterior descending of profunda brachii
- Radial recurrent of radial
**Back of Lateral epicondyle:**
- Posterior descending of profunda brachii
- Interosseous recurrent of posterior IOA
183
what are the arches of the hand?
- Palmar carpal arch (cruciate anastomosis)
- Deep palmar arch
- Superficial palmar arch
- Dorsal carpal arch
184
Formation of Palmar carpal arch
**Formation**
- Palmar carpal of ulnar a
- Palmar carpal of radial a
- Recurrent of deep palmar arch
- Descending branch of ant. IOA
185
Formation & Branches of deep palmar arch
**Formation**
- Radial artery
- Deep branch of ulnar
**Branches**
- 3 palmar metacarpal
- 3 perforators (join dorsal metacarpal)
- Recurrent arteries (join palmar carpal arch)
186
Formation & Branches of superficial palmar arch
**Formation**
- Superficial branch of radial
- Superficial branch of ulnar
**Branches**
- Palmar digital (to medial side of little finger)
- 3 common palmar digital (to adjacent sides of fingers)
187
Formation & Branches of dorsal carpal arch
**Formation**
- Dorsal carpal of ulnar a
- Dorsal carpal of radial a
- Anterior IOA
**Branches**
- 2nd,3rd, 4th dorsal metacarpal arteries to supply medial 3.5 fingers (dorsal surface)
188
what divides the muscles of the thigh?
The thigh is divided by Three intermuscular septa (Medial, lateral and posterior intermuscular septa) into three compartments.
189
what are the compartments of the thigh?
Anterior, Posterior & Medial
190
contents and nerve supply of the anterior compartment of the thigh
**Contents:**
1. quadriceps femoris muscle
2. Sartorius muscle
3. Articularis genu muscle
4. Iliopsoas muscle
**Nerve Supply:**
- Femoral nerve except psoas major
191
contents and nerve supply of the medial compartment of the thigh
**Contents:**
- The anterior layer: pectineus (laterally) and adductor longus medially.
- The middle layer: adductor brevis.
- The posterior layer: adductor magnus, Obturator externs lies deep to adductor muscles.
- The gracilis muscle: lies medial to these layers of muscle.
**Nerve Supply:**
- Obturator Nerve except pectinius muscle & Ischial part of adductor magnus
192
contents and nerve supply of the posterior compartment of the thigh
**Contents:**
the hamstring muscles:
1. biceps femoris
2. semitendinosus
3. semimembranosus
**Nerve Supply:**
- Sciatic nerve
193
Origin, Insertion, Nerve Supply & Action of Quadriceps femoris
194
Origin, Insertion, Nerve Supply & Action of sartorius
**Origin:**
- Anterior superior iliac spine.
**Insertion:**
- Upper part of the medial surface of the tibia in front of gracilis and semitendinosis (SGS).
**Nerve Supply:**
- femoral nerve
**Action:**
1. Flexion, Abduction and lateral rotation of the hip joint (tailors position).
2. Flexion and medial rotation at knee joint.
195
Origin, Insertion, Nerve Supply & Action of articularis genu
**Origin:**
- lower fourth of the anterior surface of the shaft of the femur
**Insertion:**
- upper part of the synovial membrane of the knee joint
**Nerve Supply:**
- Femoral Nerve
**Action:**
- Elevates the synovial membrane of the knee joint during extension of the knee to prevent it from being trapped between the tibial and femoral condyles.
196
Origin, Insertion, Nerve Supply & Action of iliacus
**Origin:**
- Iliac fossa
**Insertion:**
- lesser trochanter of the femur
**Nerve Supply:**
- femoral nerve (in the abdomen)
**Action:**
- Main flexor of the hip joint
197
Origin, Insertion, Nerve Supply & Action of Psoas major
**Origin:**
- Lumbar Vertebrae
**Insertion:**
- lesser trochanter of the femur
**Nerve Supply:**
- Lumber plexus (L1,2,3)
**Action:**
- Main flexor of the hip joint
198
Origin, Insertion, Nerve Supply & Action of gracilis muscle
**Origin:**
- The margin of pubic arch (inferior pubic ramus and ischial ramus)
**Insertion:**
- upper part of the medial surface of the tibia, posterior to Sartorius (SGS).
**Nerve Supply:**
- Anterior division of obturator nerve
**Action:**
1. Adduction, flexion and lateral rotation of hip joint.
2. Flexion and medial rotation of the knee joint.
199
Origin, Insertion, Nerve Supply & Action of pectinius muscle
**Origin:**
- pectineal surface of superior pubic ramus
**Insertion:**
- upper 2/3 of pectineal line of femur
**Nerve Supply:**
- femoral nerve
**Action:**
- adduction - flexion - lateral rotation of the hip joint.
200
Origin, Insertion, Nerve Supply & Action of adductor longus
**Origin:**
- the front of the body of the pubis just below the pubic crest
**Insertion:**
- linea aspera of the femur
**Nerve Supply:**
- Anterior division of obturator nerve
**Action:**
- adduction - flexion - lateral rotation of the hip joint.
201
Origin, Insertion, Nerve Supply & Action of adductor brevis
**Origin:**
- Body of pubis.
- Inferior pubic ramus.
**Insertion:**
- lower 1/3 of pectineal line of femur
- linea aspera of the femur
**Nerve Supply:**
- Anterior division of obturator nerve
**Action:**
- adduction - flexion - lateral rotation of the hip joint.
202
Origin, Insertion, Nerve Supply & Action of adductor magnus
**Origin:**
- Pubic part: from the pubic arch
- Ischial part: from the ischial tuberosity
**Insertion:**
- Pubic Part: medial edge of gluteal tuberosity, medial lip of the linea aspera, upper 1/2 of the medial supracondylar line.
- Ischial Part: Adductor tubercle.
**Nerve Supply:**
- Pubic part: Posterior division of obturator nerve.
- Ischeal Part: Sciatic nerve.
**Action:**
- Pubic Part: Adduction and lateral rotation of the hip joint.
- Ischeal Part: Extension the hip joint.
203
Origin, Insertion, Nerve Supply & Action of obturator externus
[](http://)**Origin:**
- outer surface of obturator membrane.
- margins of the obturator foramen.
**Insertion:**
- the trochanteric fossa of greater trochanter.
**Nerve Supply:**
- Posterior division of obturator nerve.
**Action:**
- Flexion and lateral rotation of the hip joint.
204
Origin of Gluteus maximus
1. gluteal surface of the ilium behind the posterior gluteal line.
2. sacrum & coccyx.
3. sacrotuberous ligament.
205
Insertion of Gluteus maximus
**superficial3/4:** into the iliotibial tract.
**deep 1/4:** into the gluteal tuberosity of the femur.
206
Nerve supply of Gluteus maximus
Inferior gluteal nerve.
207
Action of Gluteus maximus
1. Main extensor of the hip joint
2. Powerful lateral rotator of the hip
3. helps in extension of the knee joint
4. Steadies the femur on the tibia during standing
208
Origin of Gluteus medius
gluteal surface of the ilium between the anterior and posterior gluteal line.
209
Insertion of Gluteus medius
lateral surface of the greater trochanter.
210
Nerve supply of Gluteus medius
Superior gluteal nerve
211
Action of Gluteus medius
1. Abduction and medial rotation of the hip.
2. Stabilize the pelvis during walking (prevent tilting of the pelvis when the opposite limb is raised off the ground).
212
Origin of Gluteus minimus
gluteal surface of the ilium between the anterior and inferior gluteal lines.
213
Insertion of Gluteus minimus
anterior surface of the greater trochanter
214
Nerve supply of Gluteus minimus
Superior gluteal nerve
215
Action of Gluteus minimus
1. Abduction and medial rotation of the hip.
2. Stabilize the pelvis during walking (prevent tilting of the pelvis when the opposite limb is raised off the ground).
216
Origin of Tensor fasciae lata
anterior part of the outer lip of iliac crest
217
Insertion of Tensor fasciae lata
iliotibial tract
218
Nerve supply of Tensor fasciae lata
Superior gluteal nerve
219
Action of Tensor fasciae lata
1. Abduction and medial rotation of the hip.
2. helps in extension of the knee joint
3. Steadies the femur on the tibia during standing
220
Small lateral rotators of the thigh
221
what is the definition of iliotibial tract?
it is thickened Lateral part of deep fascia of the thigh
222
extension of iliotibial tract
from tubercle of iliac crest to the lateral tibial condyle.
223
what is the function of iliotibial tract?
- It receives insertion of two muscles (tensor fascia lata and gluteus maximus)
- Help in extension of the knee joint.
- maintains the erect posture by:
1. Steadies the pelvis on the femur.
2. Steadies the femur on the tibia.
224
Origin of Biceps femoris
**long head:** arises from the ischial tuberosity.
**short head:** Arises from the lateral lip of the linea aspera and lateral supracondylar line.
225
Insertion of Biceps femoris
Styloid process of the fibula.
226
Nerve supply of Biceps femoris
**long head:** sciatic nerve (tibial part).
**short head:** sciatic nerve (common peroneal part).
227
Action of Biceps femoris
- Flexion and lateral rotation of the knee (locking after fully extension).
- Extension of the hip joint.
228
Origin of Semi-tendinosus
from the ischial tuberosity
229
Insertion of Semi-tendinosus
upper part of the medial surface of the tibia behind the sartorius and gracilis muscles (SGS)
230
Nerve supply of Semi-tendinosus
sciatic nerve (tibial part).
231
Action of Semi-tendinosus
- Flexion and medial rotation of the knee.
- Extension of the hip joint.
232
Origin of Semi-membranosus
from the ischial tuberosity
233
Insertion of Semi-membranosus
groove on the back of the medial tibial condyle.
234
Nerve supply of Semi-membranosus
sciatic nerve (tibial part).
235
Action of Semi-membranosus
- Flexion and medial rotation of the knee.
- Extension of the hip joint.
236
what is the type of hip joint?
Synovial polyaxial joint of ball and socket variety.
237
what are the articular surfaces of hip joint?
1. Lunate surface of the acetabulum with its labrum acetabulare.
2. Head of the femur.
238
what are the ligaments of hip joint?
**Capsular ligaments:**
- iliofemoral ligament
- pubofemoral ligament
- ischiofemoral ligament
**Non capsular ligaments:**
- ligament of head of the femur
- transverse acetabular ligament
- Labrum acetabulare
239
what is the site and shape of iliofemoral ligament?
- Lies on the front of the joint.
- inverted Y- shaped
240
attachment of iliofemoral ligament
**Apex:** is attached to the anterior inferior iliac spine.
**Base:** is attached to the intertrochanteric line of the femur.
241
what are the functions of iliofemoral ligament?
- It is one of the strongest ligaments in the body
- It resists the hyperextension of the hip joint.
- It resists the tendency of body to fall backwards during the erect posture.
242
what is the site and shape pubofemoral ligament?
- Lies on the inferomedial part of the fibrous capsule
- Triangular in shape
243
attachment of pubofemoral ligament
**Apex:** is attached to the iliopectineal eminence.
**Base:** blends with the anterior and inferior parts of the capsule.
244
what are the functions of pubofemoral ligament?
It checks the hip abduction.
245
what is the site and shape of ischiofemoral ligament?
- Lies on the posterior part of the capsule.
- Spiral in shape
246
attachment of ischiofemoral ligament
**Above:** The posterior and superior parts of the capsule.
**Below:** ischium below acetabulum.
247
what are the functions of ischiofemoral ligament?
It checks the medial rotation.
248
attachment of ligament of head of the femur
**Apex:** is attached to the fovea of the head of the femur.
**Base:** is attached to the transverse acetabular ligament and edges of the acetabular notch.
249
functions of ligament of head of the femur
1. The ligament is too weak to play any mechanical part in the hip joint, but it becomes tense when the thigh is flexed and adducted.
2. It may help to spread synovial fluid on the head of the femur.
3. Sometimes, it transmits a small blood vessel to the head of the femur.
250
attachment of transverse acetabular ligament
**Attachment:** to the margin of the acetabular notch.
251
what are the functions of transverse acetabular ligament?
converts the notch into the acetabular foramen through which vessels and nerves enter the joint.
252
what is the definition of Labrum acetabulare?
it is a ring of Fibrocartilage.
253
attachment of Labrum acetabulare
to the margin of the acetabulum.
254
what are the characters of Labrum acetabulare?
Lies completely intracapsular.
255
what is the function of Labrum acetabulare?
deepens the acetabulum to hold the head of femur.
256
what are the movements done by hip joint?
Flexion, Extension, Adduction, Abduction, Medial Rotation, Lateral Rotation & Circumduction
257
which muscles cause flexion of hip joint?
**Mainly By:**
- iliopsoas muscle
**Assisted By:**
- Adductors
- rectus femoris
- Sartorius
**Limited By:**
- Opposition with Ant. Abd Wall
258
which muscles cause extension of hip joint?
**Mainly By:**
- gluteus maximus
**Assisted By:**
- hamstring muscles
**Limited By:**
- iliofemoral ligament
259
which muscles cause Adduction of hip joint?
**Mainly By:**
- adductor longus, brevis and magnus muscles
**Assisted By:**
- pectineus and gracilis
**Limited By:**
- lateral portion of the iliofemoral ligament
- upper part of fibrous capsule
260
which muscles cause abduction of hip joint?
**Mainly By:**
- gluteus medius and minimus
**Assisted By:**
- tensor fasciae lata
**Limited By:**
- pubofemoral ligament
261
which muscles cause lateral rotation of hip joint?
**Mainly By:**
- The 6 small lateral rotators
**Assisted By:**
- Sartorius muscle.
- Adductors muscles.
- Gluteus maximus
**Limited By:**
- pubofemoral ligament.
262
which muscles cause medial rotation of hip joint?
**Mainly By:**
- gluteus medius and minimus
**Assisted By:**
- tensor fasciae lata
**Limited By:**
- ischiofemoral ligament
263
what is the most stable joint of the body?
hip joint
264
what causes stability of hip joint?
**Shape of the bone:**
- The depth of the acetabulum which accommodates the head of the femur.
- The length and obliquity of the neck of the femur: allows the lower limb to move easily clear of the pelvis.
**Ligaments:**
- The labrum acetabulare: which deepens the acetabulum and slightly narrows its margin.
- Fibrous capsule: strong and tense.
- Strong ligaments outside the capsule: especially the iliofemoral.
**Muscles:**
- strong muscles: and their intimate relation with the joint capsule.
**The atmospheric pressure:**
- resists separation of the head of the femur from the acetabulum.
265
what divides the leg into compartments?
The leg is subdivided into three compartments by means of the anterior and the posterior intermuscular septa and the interosseous membrane between the interosseous borders of the tibia and fibula
266
what are the compartments of the leg?
**Anterior compartment:** contains the extensor group of muscles.
**Lateral compartment:** contains the peroneal group of muscles.
**Posterior compartment:** contains the flexor group of muscles.
267
what are the contents of the anterior compartment Of the leg?
1. Tibialis anterior muscle.
2. Extensor digitorum longus muscle.
3. Extensor hallucis longus muscle.
4. Peroneus tertius muscle.
5. Anterior tibial vessels.
6. Anterior tibial (deep peroneal) nerve.
268
what are the contents of the lateral compartment of the leg?
1. Peroneus longus muscle.
2. Peroneus brevis muscle.
3. Superficial peroneal nerve (Musculocutaneous nerve).
269
Origin, Insertion, Nerve Supply & Action of Tibialis anterior
**Origin:**
- The upper half of the lateral surface of the tibia.
**Insertion:**
- Medial cuneiform bone.
- 1st metatarsal bone
**Nerve Supply:**
- Deep peroneal nerve
- Recurrent genicular nerve
**Action:**
- Dorsiflexion of the ankle joint
- inversion of the foot at subtalar joints
270
Origin, Insertion, Nerve Supply & Action of Extensor digitorum longus
**Origin:**
- The upper 3/4 of the anterior surface of the fibula.
**Insertion:**
- Middle and distal phalanges of the lateral 4 toes through the extensor expansions.
**Nerve Supply:**
- Deep peroneal nerve
**Action:**
- Dorsiflexion of the ankle joint
- inversion of the foot at subtalar joints
- extension of all joints of the lateral four toes
271
Origin, Insertion, Nerve Supply & Action of Extensor Hallucis longus
**Origin:**
- The middle 2/4 of the anterior surface of the fibula.
**Insertion:**
- distal phalanx of big toe
**Nerve Supply:**
- deep peroneal nerve
**Action:**
- Dorsiflexion of the ankle joint
- inversion of the foot at subtalar joints
- extension of all joints of the big toe
272
Origin, Insertion, Nerve Supply & Action of Peroneus tertius
**Origin:**
- The lower 1/4 of the anterior surface of the fibula
**Insertion:**
- 5th metatarsal bone.
**Nerve Supply:**
- Deep peroneal nerve
**Action:**
- Dorsiflexion of the ankle joint
- Eversion of the foot at the subtalar joints
273
Origin, Insertion, Nerve Supply & Action of Peroneus longus
**Origin:**
- The lateral surface of the head of the fibula.
- The upper 2/3 of the lateral surface of the shaft of the fibula.
**Insertion:**
- Medial cuneiform bone.
- 1st metatarsal bone
**Nerve Supply:**
- superficial peroneal nerve
**Action:**
- Eversion of the foot at the subtalar joints
- Planter flexion of the ankle joint.
- Maintains the transverse arch of the foot
274
Origin, Insertion, Nerve Supply & Action of Peroneus brevis
**Origin:**
- The lower 2/3 of the lateral surface of the shaft of the fibula
**Insertion:**
- 5th metatarsal bone.
**Nerve Supply:**
- superficial peroneal nerve
**Action:**
- Eversion of the foot at the subtalar joins
- Planter flexion of the ankle joint.
- Maintains the transverse arch of the foot
275
what are the parts of the posterior compartment of the leg?
It is divided into three layers of muscle by two layers of fasciae:
**The superficial layer:** consists of the powerful plantar flexors of the ankle; gastrocnemius, soleus with plantaris muscle.
**The middle layer:** consists of the long flexors of the toes, flexor hallucis longus and flexor digitorum longus muscle.
**The deep layer:** is formed by tibialis posterior muscle. It lies on the interosseous membrane between the tibia and fibula.
276
Origin, Insertion, Nerve Supply & Action of Gastrocnemius
**Origin:**
- Lateral head: lateral surface of the lateral femoral condyle above the lateral epicondyle.
- Medial head: popliteal surface of femur above the medial condyle.
**Insertion:**
- The tendons of the 3 muscles join each other to form tendocalcaneus
- The tendocalcaneus is inserted into the middle 1/3 of the posterior surface of the calcaneus.
**Nerve Supply:**
- Tibial nerve
**Action:**
1. The main and powerful plantar flexor of the ankle joint.
2. Provide the propelling force in walking.
3. They are important elements in the muscle pump, returning venous blood from the lower limbs toward the heart.
4. Gastrocnemius muscle assists in flexion of the knee joint.
277
Origin, Insertion, Nerve Supply & Action of soleus
**Origin:**
- The posterior surface of the upper part of fibula.
- The soleal line and middle 1/3 of the medial border of tibia.
- The tendinous arch between the tibia and fibula.
**Insertion:**
- The tendons of the 3 muscles join each other to form tendocalcaneus
- The tendocalcaneus is inserted into the middle 1/3 of the posterior surface of the calcaneus.
**Nerve Supply:**
- Tibial Nerve
**Action:**
1. The main and powerful plantar flexor of the ankle joint.
2. Provide the propelling force in walking.
3. They are important elements in the muscle pump, returning venous blood from the lower limbs toward the heart.
278
Origin, Insertion, Nerve Supply & Action of Plantaris
**Origin:**
- Popliteal surface of the femur above lateral condyle of femur.
**Insertion:**
- Medial to achillis tendon?
**Nerve Supply:**
- Tibial Nerve
**Action:**
1. Plantar flexion of the ankle joint.
2. Assists in knee flexion
279
Origin, Insertion, Neve Supply & Action of Tibialis posterior
**Origin:**
1. Posterior surface of the tibia.
2. Posterior surface of the interosseous membrane.
3. Posterior surface of the fibula.
**Insertion:**
- Navicular bone (main insertion).
- All the tarsal bones except the talus.
- Middle three (second, third and fourth) metatarsal bones.
**Nerve Supply:**
- Tibial nerve
**Action:**
- Plantar Flexion of the ankle joint
- Inversion of the foot
- Maintains the longitudinal arch of the foot
280
Origin, Insertion, Neve Supply & Action of Flexor digitorum longus
**Origin:**
- Posterior surface of the tibia
**Insertion:**
- Terminal phalanx of the lateral four toes.
**Nerve Supply:**
- Tibial Nerve
**Action:**
- Plantar Flexion of the ankle joint
- Inversion of the foot
- Maintains the longitudinal arch of the foot
- Flexion of all joints of the lateral four toes.
281
Origin, Insertion, Neve Supply & Action of flexor hallucis longus
**Origin:**
- posterior surface of the fibula
**Insertion:**
- terminal phalanx of the big toe.
**Nerve Supply:**
- Tibial nerve
**Action:**
- Plantar Flexion of the ankle joint
- Inversion of the foot
- Maintains the longitudinal arch of the foot
- Flexion of all joints of the big toe.
282
Origin, Insertion, Neve Supply & Action of Popliteus
**Origin:**
- Groove on the lateral surface of the lateral femoral condyle just below the lateral epicondyle.
**Insertion:**
- Upper part of the posterior surface of tibia above soleal line.
- Into the strong fascia which covering the muscle.
**Nerve Supply:**
- Tibial Nerve
**Action:**
- Flexes the knee
- Rotates the leg medially at the beginning of flexion of the fully extended leg (unlocks the knee joint).
283
Origin, Insertion, Neve Supply & Action of Extensor digitorum brevis muscle **(Muscle of the dorsum of the foot)**
**Origin:**
- From the calcaneus and the inferior extensor retinaculum
**Insertion:**
- it forms four tendons:
❖ The most medial: the extensor hallucis brevis is inserted into the proximal phalanx of the big toe.
❖The remaining three tendons join the long extensor tendons of the second to fourth toes to form extensor expansion.
**Nerve Supply:**
- lateral branch of deep peroneal nerve.
**Action:**
- Extension of the medial four toes
284
what are the muscles of the sole of the foot?
285
innervation of the muscles of the sole of the foot
All the muscles of the sole are supplied by the lateral plantar nerve except:
1. Abductor halluces
2. Flexor digitorum brevis
3. First lumbrical
4. Flexor halluces brevis
Are supplied by medial plantar
286
what is the action of lumbricals in the foot?
Flexion of the metatarsophalangeal joints and Extension of the interphalangeal joints of the lateral four toes.
287
what is the action of planter interossei side of the foot?
adduction of the lateral three toes towards the middle line of the second toe (PAD) + flexion of the metatarsophalangeal joints and extension the interphalangeal joints of the lateral three toes.
288
what is the action of dorsal interossei of the foot?
abduction of 2nd, 3rd & 4th toes away from the middle line of the second toe (DAP) + flexion of the metatarsophalangeal joints and extension the interphalangeal joints of the lateral three toes.
289
what is the type of Knee joint?
Synovial, biaxial condylar (or modified hinge) (it allows some rotatory movements beside flexion and extension).
290
what are the articular surfaces of knee joint?
**Articular surface of the femur:** An inverted V-shaped articular surface of femoral condyles.
**Articular surface of the patella:** Large lateral and small medial facets.
**Articular surfaces of the tibia:** The upper articular surface of the two condyles of the tibia.
291
articular capsule of knee joint
the capsule is deficient anteriorly and replaced by quadriceps tendon, patella and ligamentum patella.
292
what are the ligaments of the knee joint?
**Extra-capsular:**
- Ligamentum patellae
- Fibular collateral (lateral ligament)
- Tibial collateral (medial ligament)
- Posterior oblique ligament
**Intra-capsular:**
- Menisci (Semilunar cartilages)
- Cruciate ligaments
- Transverse ligament
293
attachment of Ligamentum patellae
**Above:** to the apex of the patella.
**Below:** to the tibial tuberosity.
294
characters of Ligamentum patellae
continuation of the quadriceps tendon below the patella.
295
attachment of Fibular collateral (lateral ligament)
**Above:** lateral epicondyle.
**Below:** to the head of the fibula. it pierces the tendon of insertion of biceps femoris.
296
characters of Fibular collateral (lateral ligament)
It is separated from lateral meniscus by the fibrous capsule and the tendon of popliteus.
297
attachment of Tibial collateral (medial ligament)
**Above:** medial epicondyle.
**Below:** The upper part of the medial surface of the tibia behind (S.G.S.).
298
characters of Tibial collateral (medial ligament)
It is firmly attached to the medial meniscus.
299
attachment of Posterior oblique ligament
- From the medial condyle of the tibia to the lateral condyle of the femur.
300
characters of Posterior oblique ligament
- It is an expansion of the tendon of semimembranosus.
301
what are **Menisci**?
two C-shaped plates of fibrocartilage on upper surface of tibial condyles
302
compare between lateral meniscus and medial meniscus according to:
- Shape
- Relation to capsule
- Fixation
- Liability to damage
- Function
303
what are cruciate ligaments?
two strong fibrous bands, which connect the tibia with the femur forming an X-shaped figure.
304
compare between anterior cruciate ligament and posterior cruciate ligament in terms of:-
- Tibial attachment
- Femoral attachment
- Direction
- Function
305
what does the transverse ligament of the knee joined connect?
Connects the anterior horns of both menisci together.
306
what are the muscles responsible for flexion of the knee joint?
**mainly by:** biceps femoris, semitendinosus muscles.
**Assisted by:** sartorius, gracilis and popliteus muscles.
307
what are the muscles responsible for extension of Knee joint?
**mainly by:** quadriceps femoris muscle.
**Assisted by:** tensor fascia lata muscle.
308
what are the muscles responsible for medial rotation (unlocking) of the knee joint?
**mainly by:** popliteus muscle.
**Assisted by:** semitendinosus, semimembranosus, sartorius and gracilis muscles.
309
what are the muscles Responsible for lateral rotation (locking) of the knee joint?
only done by the biceps femoris muscle
310
what is the type of Ankle joint?
Synovial uniaxial, of the hinge variety.
311
what are the articular surfaces of ankle joint?
**Below:** talus (superior surface - medial surface - lateral surface)
**Above:** tibia (inferior surface of the lower end and medial malleolus) – fibula (lateral malleolus)
312
what are the ligaments of the ankle joint?
1. The medial (deltoid) ligament
2. The lateral ligament
313
what is the shape of The medial (deltoid) ligament of the ankle?
it is triangular in shape.
314
attachment of The medial (deltoid) ligament of the ankle
**Above (apex):** distal border of the medial malleolus.
**Below (base):** is attached to the following structures
from before backwards:
i. The neck of the talus.
ii. The navicular bone.
iii. The medial edge of the spring ligament.
iv. The sustentaculum tali.
v. The medial side of the body of the talus.
315
What is the site of The lateral ligament Of the ankle?
on the lateral aspect of the ankle joint.
316
what is the shape of The lateral ligament Of the ankle?
**Is formed of three bands:**
1. The anterior talofibular ligament
2. The posterior talofibular ligament
3. The calcaneofibular ligament
317
What causes dorsiflexion at the ankle joint?
a. Tibialis anterior muscle.
b. Extensor hallucis longus muscle.
c. Extensor digitorum longus muscle.
d. Peroneus tertius muscle.
318
what causes plantar flexion at the ankle joint?
a. Gastrocnemius muscle (main).
b. Soleus muscle (main).
c. Plantaris.
d. Tibialis posterior muscle.
e. Flexor digitorum longus muscle.
f. Flexor hallucis longus muscle.
g. Peroneus longus.
h. Peroneus brevis.
319
what is the type of Talocalcanean joint?
Synovial plane.
320
what are the articular surfaces of the Talocalcanean joint?
a. The lower surface of the body of the talus.
b. The upper surface of the middle of the calcaneus.
321
what is the type of Talo-calcaneo-navicular joint?
synovial ball and socket.
322
what are the articular surfaces of Talo-calcaneo-navicular joint?
a. The ball: the head of the talus.
b. The socket: is formed by:
✓ The navicular bone.
✓ The calcaneus.
✓ The spring ligament (plantar calcaneonavicular ligament).
| §
323
what are the movements at subtalar (talo-calcaneo-navicular & talocalcanean) Joints?
eversion and inversion
324
what causes eversion at subtalar joints?
a) Peroneus longus
b) peroneus brevis
c) peroneus tertius.
325
what causes inversion at the subtalar joints?
a) Tibialis anterior and posterior.
b) Extensor and flexor hallucis longus.
c) Extensor and flexor digitorum longus.
326
what does **arches of the foot** mean?
The skeleton of the foot is built in the form of an arch.
327
what is the function of the arches of the foot?
a. Supporting the body weight.
b. Transmission of the body weight to the ground.
c. Important in the process of walking.
d. Protection of soft tissue of the sole of the foot.
328
what are the types of the Arches of the foot?
a. Longitudinal arch:medial and lateral
b. Transverse arch.
329
what are the bones that form medial longitudinal arch?
i. The key-stone: talus.
ii. The posterior pillar:calcaneus.
iii. The anterior pillar: navicular, three cuneiform and the medial three metatarsal bones.
330
what are the characters of medial longitudinal arch?
has a greater height
331
what is the function of medial longitudinal arch?
Important in the process of walking and running
332
what are the bones forming the Lateral longitudinal arch?
i. The calcaneus.
ii. Thecuboid.
iii. The 4th and 5th metatarsal bones.
333
what are the characters of the Lateral longitudinal arch?
nearly flat.
334
what is the function of the Lateral longitudinal arch?
important in support the body weight
335
what are the bones forming the Transverse arch?
1. cuboid and the three cuneiform.
2. The bases of the 5 metatarsal bones.
336
what are the characters of the Transverse arch?
Its medial end is high while its lateral end reaches the ground.
337
what is the function of the Transverse arch?
Protection of soft tissue of the sole of foot from the effect of pressure during standing or walking
338
what are the factors of maintaining the arches of the foot?
**Shape of the bones**
**Long tendons of the foot:**
1. Tendon of peroneus longus: maintains both the longitudinal and transverse arch.
2. Tendon of tibialis posterior, flexor hallucis longus and flexor digitorum longus: maintains the longitudinal
arch of the foot.
3. Tendon of tibialis anterior: pull the medial cuneiform upwards and hence it helps the medial longitudinal arch.
4. Short muscles of the foot: their contraction binds the bones of the foot together.
**Ligaments of the joints of the foot:**
plantar ligaments: They include:
1. Long plantar ligament.
2. Short plantar ligament.
3. Plantar calcaneonavicular ligament (spring ligament).
4. Deltoid ligament.
**Planter aponeurosis:** is the thickened central part of the deep fascia.
**Superficial fascia:** distribution of fat in the sole of the foot helps to preserve shape of the arches.
339
what is the definition of flat foot?
loss of the arches of the foot.
340
what are the causes of Flat foot?
**Congenital:**
- Weakness of the muscles of the sole
- Abnormal form of articulated bones.
**Acquired:**
- Rapid increase in the body weight
- Weakness or paralysis of the muscles of the sole
- Wearing improper arched shoes.
341
Nerves Of The lower limb
342
The Origin of Femoral nerve
ventral primary rami of (L 2, 3, 4) (dorsal division).
343
what is the course of Femoral nerve?
It enters the femoral triangle by passing behind the inguinal
ligament, outside the femoral sheath.
344
termination of Femoral nerve
it ends 1 inch below the inguinal ligament by dividing into muscular & cutaneous branches.
345
what are the the branches of Femoral nerve?
**Muscular**
1. Iliacus.
2. Quadriceps.
3. Sartorius.
4. Articularis genu.
5. Pectineus.
**Cutenous**
1. Medial cutaneous nerve of the thigh.
2. Intermediate cutaneous nerve of the thigh.
3. Saphenous nerve, It supplies the skin of:
- Medial side of the knee.
- Medial side of the leg.
- Medial side of the foot till the big toe.
**Articular**
- Hip & knee joints.
346
what is the origin of obturator nerve?
ventral primary rami of (L 2, 3, 4) (ventral division).
347
course of obturator nerve
In the obturator canal it divides into: anterior & posterior branches:
- Anterior division pass in front of the adductor brevis.
- Posterior division pass behind the adductor brevis.
348
what are the branches of obturator nerve?
349
what are the nerves of the gluteal region?
- superior gluteal nerve
- Inferior gluteal nerve
- Pudendal nerve
- Nerve to obturator internus
- Posterior cutaneous nerve of the thigh
- Nerve to quadratus femoris
350
what does superior gluteal nerve supply?
a. Gluteus medius.
b. Gluteus minimus
c. Tensor fasciae lata.
351
what do lesions in the superior gluteal nerve cause?
- Unilateral lesion: lead to (Lurching gait).
- Bilateral lesion: lead to (waddling gait).
352
what does of the inferior gluteal nerve supply?
gluteus maximus.
353
what is the course of the pudendal nerve?
- It leaves the pelvis through the greater sciatic foreman below the piriformis.
- Then, it enters the lesser sciatic foramen to the perineum.
354
what does the nerve to obturator internus supply?
Obturator internus & superior gemellus.
355
what are the branches of the posterior cutaneous nerve of the thigh?
Cutaneous branches to:
- Skin of the back of the thigh & roof of popliteal fossa.
- Skin of the upper half of the calf.
356
what does nerves to quadratus femoris supply?
quadratus femoris & inferior gemellus.
357
Origin of Sciatic nerve
from the sacral plexus (L. 4, 5, S. 1, 2, 3).
358
course of Sciatic nerve
- It leaves the pelvis through the greater sciatic foramen below the piriformis.
- Leaves gluteal region midway between the greater trochanter & ischial tuberosity.
- It enters the back of the thigh.
359
termination of Sciatic nerve
- At the middle of the back of the thigh it divides into:
1. Tibial (medial popliteal) nerve.
2. Common peroneal (Lateral popliteal) nerve.
360
branches of Sciatic nerve
**Muscular:**
- By tibial part
1. Ischial part of adductor magnus.
2. Semimembranosus.
3. Semitendinosus.
4. Biceps femoris (long head)
- By Common Peroneal Part
5. Biceps femoris (short head)
**Articular:**
- Hip & knee joints.
**Terminal:**
1. Tibial (medial popliteal) nerve.
2. Common peroneal (Lateral popliteal) nerve.
361
what is sciatica?
neuritis of sciatic nerve characterized by pain at the back of thigh.
362
what does a lesion in sciatic nerve Cause?
leads to paralysis of all muscle below the knee & loss of sensation on the leg & the foot except area supplied by saphenous nerve.
363
how to avoid sciatic nerve injury?
To avoid sciatic nerve injury, an intramuscular injection in the gluteal region is given in the upper outer quadrant.
364
Origin of Tibial nerve
one of the 2 terminal branches of the sciatic nerve.
365
Termination of tibial nerve
Enters the back of the leg between the 2 heads of gastrocnemius.
366
branches of Tibial nerve
**Muscular**
1. Gastrocnemius muscle.
2. Plantaris muscle.
3. Popliteus muscle.
4. Soleus muscle.
**Cutenous:**
- Sural nerve
**Articular:**
- Superior medial genicular nerve
- Inferior medial genicular nerve
- Middle genicular nerve.
367
Origen of common peroneal nerve
One of the 2 terminal branches of the sciatic nerve.
368
termination of common peroneal nerve
Terminates at the lateral side of the neck of the fibula by dividing into:
1. Superficial peroneal nerve.
2. Deep peroneal nerve.
369
branches of common peroneal nerve
**Cutaneous:**
- Sural communicating nerve: join the sural nerve.
- Lateral cutaneous nerve of the calf.
**Articular:**
- Superior lateral genicular nerve.
- Inferior lateral genicular nerve.
- Recurrent genicular nerve.
370
what is the cause of common peroneal nerve injury?
fracture of the neck of the fibula
371
what is the effect of a lesion in common peroneal nerve?
foot drop.
372
Distribution of sural nerve
It supplies the skin of the following parts:
- Lower parts of the lateral surface of the leg.
- Lateral side of the foot.
- Lateral side of the little toe.
373
Origin of tibial nerve of the leg
Continuation of the tibial nerve at the lower border of the popliteus muscle.
374
termination of tibial nerve of the leg
- Midway between medial malleolus & calcaneus deep to flexor retinaculum it divides into:
Medial & lateral plantar nerves.
375
what are the branches of tibial nerve of the leg?
376
Origin of Deep peroneal nerve
One of the 2 terminal branches of common peroneal nerve on the lateral side of the neck of the fibula.
377
termination of Deep peroneal nerve
Divides into medial & lateral divisions at the ankle joint.
378
what are the branches of Deep peroneal nerve?
**Muscular**
1. Tibialis anterior.
2. Extensor hallucis longus.
3. Extensor digitorum longus.
4. Peroneus tertius.
5. Extensor digitorum brevis.
**Articular**
- to ankle joint & joints of the foot.
**Cutaneous**
- Skin of the sides of the big & 2nd toes.
379
Origin of Superficial peroneal nerve
One of the two terminal branches of the common peroneal nerve at the lateral side of the neck of the fibula.
380
termination of Superficial peroneal nerve
In the distal third of the leg: it pierces the deep fascia & divides into medial and lateral branches.
381
what are the branches of Superficial peroneal nerve?
**Muscular**
1. Peroneus longus.
2. Peroneus brevis.
**Cutaneous**
- Front & lateral side of the lower part of the leg.
- Intermediate area of dorsum of foot.
- Dorsum of medial 3& 1⁄2 toes.
382
what is the origin of Medial plantar nerve?
One of the 2 terminal branches of the tibial nerve.
383
what are the branches of Medial plantar nerve?
384
what is the origin of lateral plantar nerve?
One of the 2 terminal branches of the tibial nerve.
385
what Are the branches of lateral plantar nerve?
**Origin**
- all muscles of the sole except 4
**Cutaneous**
- Lateral 1/3 of skin of sole of foot.
- Lateral 1&1/2 toes
**Articular**
- to joints of the foot.
386
cutaneous nerve supply of the dorsum of the foot
**Most of the dorsal surface of the foot is supplied by superficial peroneal nerve except:**
- The medial side of the foot: by saphenous nerve.
- The lateral side of the foot & lateral side of the little
toe: by sural nerve.
- Side between the big& 2nd toes: by deep peroneal nerve.
- Terminal phalanges of medial 31⁄2 toes: by medial
planter nerve.
- Terminal phalanges of the lateral 11⁄2 toes: by lateral
planter nerve.
387
cutaneous nerve supply of the sole of the foot
- Calcanean branch of the tibial nerve supply the skin of the heel.
- Medial planter nerve: supply:
a. Medial2/3 of the skin of the sole.
b. Medial 3&1⁄2 toes.
- Lateral planter nerve: supply:
a. Lateral 1/3 of skin of sole of foot.
b. Lateral 1&1⁄2 toes.
388
Origin of Femoral Artery
Direct continuation of the external iliac artery at the mid-inguinal point.
389
Termination of Femoral Artery
continues as popliteal artery at the adductor hiatus.
390
Branches of Femoral Artery
**Superficial:**
1. Superficial external pudendal
2. Superficial Epigastric
3. Superficial Circumflex iliac
**Deep:**
1. Deep External pudenda
2. Descending genicular
3. Profunda Femoris Artery (Deep Femoral Artery)
391
Origin of Profunda Femoris Artery (Deep Femoral Artery)
Largest branch of femoral artery, 1.5 inches below inguinal ligament
392
branches of Profunda Femoris Artery (Deep Femoral Artery)
A. Lateral circumflex femoral artery
B. Medial circumflex femoral artery
C. upper 3 perforator arteries
393
termination of Profunda Femoris Artery (Deep Femoral Artery)
Pierces adductor magnus as 4th perforator artery.
394
Origin of Popliteal Artery
Begins at the opening in the adductor magnus as the continuation of the femoral artery.
395
Termination of Popliteal Artery
At the distal border of the popliteus by dividing into anterior and posterior tibial arteries.
396
Branches of Popliteal Artery
**Genicular (5 branches to knee joint)**
1. Superior medial genicular.
2. Inferior medial genicular.
3. Superior lateral genicular.
4. Inferior lateral genicular.
5. Middle genicular.
**Terminal branches:**
1. Anterior tibial artery.
2. Posterior tibial artery.
397
Origin of Anterior Tibial Artery
One of the two terminal branches of the popliteal artery at the distal border of the popliteus muscle.
398
Termination of Anterior Tibial Artery
It ends in front of the ankle joint midway between the two malleoli and continuous as Dorsalis Pedis artery.
399
Origin of Dorsalis Pedis Artery
The continuation of the anterior tibial artery on the front of the ankle joint at a point midway between the medial and lateral malleoli.
400
Termination of Dorsalis Pedis Artery
At proximal end of 1st inter-metatarsal space, it pierces 1st dorsal inter-osseous muscle forming deep planter artery that anastomose with medial end of planter arch
401
Branches of Dorsalis Pedis Artery
1- Medial tarsal: arise just distal to ankle joint
2- Lateral tarsal: arise just distal to ankle joint
3- 1st dorsal metatarsal: supply dorsum of medial 1.5 toes
4- Arcuate: supply dorsum of lateral 3.5 toes
5- 1st planter metatarsal: arises from dorsalis pedis in sole to
supply the planter surface of 1st inter-digital cleft
402
Origin of Posterior Tibial Artery
One of the two terminal branches of the popliteal artery at the distal border of the popliteus muscle.
403
Termination of Posterior Tibial Artery
passes deep to flexor retinaculum to divide into medial & lateral planter arteries.
404
Branches of Posterior Tibial Artery
- **Circumflex Fibular artery:** share in anastomosis around knee joint.
- **Peroneal artery**
- **Communicating branch:** joins communicating branch of peroneal.
- **Medial malleolar:** passes on the medial malleolus
- **Medial calcenian:** share in anastomosis around ankle
- **Terminal branches:**
1. The medial plantar artery.
2. The lateral plantar artery.
405
Origin of Peroneal artery
one inch below lower border of popliteus.
406
Termination of Peroneal artery
behind inf tibio-fibular joint by giving lateral calcanean branches
407
Branches of Peroneal artery
- **Communicating:** joins communicating branch of posterior tibial a
- **Perforating:** pierces lower part of inter-osseous membrane
- **Lateral malleolar:** passes on the lateral malleolus
- **Lateral calcanian:** continuation of a at lateral side of calcaneus
408
Termination of Medial plantar artery
anastomose with 1st planter metatarsal
409
wjat does the Medial plantar artery supply?
medial side of big toe
410
what are the parts of the lateral plantar artery?
**1st part:** pass forward & laterally on base of 5th metatarsal bone
**2nd part:** pass medially to form planter arch that gives:
▪ perforating branches: anastomose with dorsal metatarsal arteries
▪ 2,3,4 planter metatarsal & planter digital to supply planter surface of lateral 3.5 toes
411
Anastomoses around knee joint
412
Anastomoses around ankle joint
413
Branches of Anterior Tibial artery
1. Posterior tibial recurrent artery: Arises while artery in back of leg.
2. Anterior tibial recurrent artery: Arises as artery reaches anterior compartment.
3. Anterior medial malleolar artery: Runs anterior to medial malleolus
4. Anterior lateral malleolar artery: Runs anterior to lateral malleolus.
414
what is the site of Dorsal Venous arch?
- dorsum of foot opposite head of metatarsal bones
415
Input of Dorsal Venous arch
- dorsal metatarsal veins formed by union of dorsal digital veins
416
Output of Dorsal Venous arch
- share in formation of great & short saphenous veins
417
beginning of Short (Small) Saphenous vein
- (lateral end) of dorsal venous arch + dorsal digital vein of lat. side of little toe
418
course of Short (Small) Saphenous vein
- Passes below lat malleolus.
- Ascends on back of lat malleolus
- then in midline on gastrocnemius
419
end of Short (Small) Saphenous vein
- pierces deep fascia at lower border of popliteal fossa to end at popliteal v.
420
what are the tributaries of Short (Small) Saphenous vein?
- lateral side of foot & back of leg
421
Beginning of Great (Long) saphenous vein
dorsal venous arch (medial end) + dorsal digital v. of med side of big toe
422
end of Great (Long) saphenous vein
- It passes on med side of dorsum of foot.
- Ascends in front of med malleolus to reach med border of tibia.
- Passes along posteromed. side of knee.
- Passes upwards in superf. fascia of thigh
423
what are the tributaries of Great (Long) saphenous vein?
1. Communicating veins with deep veins.
2. Superficial circumflex iliac v.
3. Superficial epigastric v.
4. Superficial external pudendal v.
424
Beginning of popliteal vein
At distal border of popliteus by union of venae commitants of ant & post tibial a
425
what is the course of popliteal vein?
- In lower part of fossa: Popliteal v is med to popliteal a
- In middle of fossa: Popliteal v crosses superf. to a
- In upper part of fossa: Popliteal v lies lat to popliteal a.
426
end of popliteal vein
Continue as femoral v at opening of adductor magnus.
427
tributaries of popliteal vein
- superior medial genicular
- inferior medial genicular
- superior lateral genicular
- middle genicular
- Short saphenous v
428
beginning of Femoral vein
At opening of adductor magnus as continuation of popliteal v
429
what is the course of Femoral vein?
✓ In lower part of subsartorial canal: Femoral v is posterolat. to femoral a.
✓ At apex of femoral ∆: Femoral v is post to femoral a.
✓ At base of femoral ∆ Femoral v is med to femoral a
430
what is the end of Femoral vein?
Continue as ex iliac v behind inguinal ligament
431
what are the tributaries of Femoral vein?
- Deep ex pudendal v.
- Profunda femoris v.
- MCF vein.
- LCF vein.
- Great saphenous
432
Valves of great saphenous vein
- divide it into segment to reduce venous pressure on venous wall during erect posture.
- Incompetence of valves causes venous dilatation (varicose veins)
433
end of great (Long) Saphenous vein
- pierces cribriform fascia at saphenous opening to end at femoral v.
