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Block 3 > Anatomy > Flashcards

Anatomy Flashcards

1
Q

Anatomical planes

A

Median:
- midline plane that divides into L and R halves

Sagittal:
- divides into L and R parts
- infinite number of sagittal planes parallel to mid-sagittal plane

Coronal:
- divides into front and back
- aka frontal plane

Transverse:
- divides into top and bottom
- aka horizontal plane, aka axial plane

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2
Q

Levator scapula

A

spacular elevation

dorsal scapular n.

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3
Q

Rhomboid minor/major

A

scapular elevation, retraction

dorsal scapular n.

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4
Q

Latissumis dorsum

A

arm extension, adduction, medial rotation

thoracodorsal n.

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5
Q

Deltoids

A

arm abduction

axillary n.

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6
Q

Trapezius

A

upper fibers: scapular elevation, upward rotation

middle fibers: scapular retraction

lower fibers: scapular depression, upward rotation

accessory n.

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7
Q

Intermediate back muscles

A

serratus posterior superior, serratus posterior inferior

respiratory muscles

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8
Q

Deep/intrinsic intermediate muscles

A

erector spinae: spinalis, iliocostalis, longissimus

vertebral column and head movements

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9
Q

Shoulder ligaments, muscles

A

Ligaments:
- acromioclavicular ligament (weak)
- coracoacromial ligament (weak)
- coracoclavicular ligament (strong) <- if torn, you get a 3rd degree shoulder separation

Rotator cuff muscles:
- supraspinatus
- infraspinatus
- teres minor
- subscapularis

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10
Q

Supraspinatus

A

rotator cuff muscle; initial abduction (0˚-15˚)

suprascapular n.

empty can test
- supraspinatus travels deep to the coracoacromial arch; the proximity of the bones and ligaments of this arch makes the supraspinatus easily injured
- most commonly injured rotator cuff muscle

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11
Q

Infraspinatus

A

rotator cuff; lateral rotation of arm

suprascapular n.

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12
Q

Subscapularis

A

medial rotation of arm

upper and lower subscapular n.

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13
Q

Teres minor

A

lateral rotation

axillary n.

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14
Q

Teres major

A

medial rotation, extension

lower subscapular n.

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15
Q

Axillary n.

A

C6, C7 (posterior cord of brachial plexus)

innervates deltoid, teres minor
innervates skin of lateral upper arm

injured in humerus fracture of surgical neck

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16
Q

Axillary foramens

A

Suprascapular foramen - suprascapular n.

Quadrangular space - axillary n., posterior circumflex humeral a.

Triangular space - circumflex scapular a.

Triangular interval - radial n., profunda brachii a. (mid-shaft humeral fracture)

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17
Q

Pectoralis major

A

arm adduction, flexion, medial rotation

medial & lateral pectoral n.

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18
Q

Pectoralis minor

A

shoulder depression, scapular protraction, forced inspiration

medial pectoral n.

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19
Q

Subclavicus

A

clavicular depression

n. to sublavicus

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20
Q

Serratus anterior

A

spacular protraction and rotation, holds scapula to thoracic wall

long thoracic n.

winged scapula

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21
Q

Clavipectoral/Deltopectoral triangle

A

hole in clavipectoral fascia that allows cephalic vein to exit axilla

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22
Q

Veins down arm/forearm

A

medial cubital vein ==> cephalic v. (lateral) + basilic v. (medial)

basilic v. ==> axillary v. ==> subclavian v.

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23
Q

Axillary artery

A

starts at 1st rib and ends below teres major

3 parts:
1. 1st rib to superior aspect of pectoralis minor
2. superior aspect of pec minor to inferior aspect
3. inferior aspect of pec minor to teres major

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24
Q

1st part of axillary a.

A

superior thoracic a.

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25
Q

2nd part of axillary a.

A

thoraco-acromial a.
lateral thoracic a.

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26
Q

3rd part of axillary a.

A

subscapular a.
- circumflex scapular a.
- thoracodorsal a.

anterior circumflex humoral a.
posterior circumflex humoral a.

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27
Q

Subclavian artery

A

above axillary artery:
suprascapular a.
dorsal scapular a.

creates anastamoses with 3rd part of axillary a.

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28
Q

Axillary lymph nodes

A

[humeral (lateral) + pectoral (anterior) + subscapular (posterior) nodes] ==> central nodes ==> apical nodes

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29
Q

Coracobrachialis

A

arm flexion
- attaches to coracoid process and midshaft of humerus

musculocutaneous n.

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30
Q

Brachialis

A

forearm flexion

musculocutaneous n.

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31
Q

Biceps brachii

A

short and long head (long head tendon more commonly ruptured <- popeye sign)

forearm flexion and supination; accessory muscle for arm flexion

musculocutaneous n.

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32
Q

Triceps brachii

A

forearm extension
long head also does arm extension and adduction

radial n.

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33
Q

Musculocutaneous n.

A

C5, C6, C7 (lateral cord of brachial plexus)

pierces coracobrachialis and goes between biceps and brachialis; ends as cutaneous nerve of lateral forearm

coracobrachialis, brachialis, biceps bracii

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34
Q

Radial n.

A

C5, C6, C7, C8, T1 (posterior cord of brachial plexus)

posterior cord of brachial plexus, travels through triangular interval and goes along radial groove on humerus

innervates triceps brachii, posterior forearm muscles (extensors)

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35
Q

Brachial a.

A

continuation of axillary artery, from bottom of teres major to cubital fossa (radius neck)

branches into profunda brachii a. (triceps), which passes through triangular interval

profunda brachii a. ==> radial & middle collateral a.

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36
Q

Afferent vs. efferent neurons

A

Afferent = sensory
- dorsal root ganglion (posterior)
- somatic: pain, touch, proprioception
- visceral: organs

Efferent = motor
- ventral root (anterior)
- somatic: skeletal muscle
- visceral: smooth muscle, cardiac muscle, glands

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37
Q

Spinal nerves & vertebrae

A

spinal nerves C1-C7 emerge superior to pedicle of corresponding vertebrae

spinal nerves C8, T1-T12, L1-L5, S1-S5, Co emerge inferior to pedicle of corresponding vertebrae

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38
Q

Cauda equina

A

nerve roots suspended in CSF, below L2

spinal cord ends around L1-L2 (lumbar cistern)
- lumbar punctures ideally between L3-L4 or L4-L5
- anatomical landmark for L4: iliac crest

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39
Q

Brachial plexus

A

Real Teachers Drink Cold Beer:
- Roots (C5-C8, T1)
- Trunks (superior, middle, inferior)
- Divisions (anterior, posterior)
- Cords (lateral, posterior, medial)
- Branches (musculocutaneous, median, radial, axillary, ulnar)

3 musketeers assassinated 5 rats, 5 mice, and 2 unicorns
- musculocutaneous: C5, C6, C7
- axillary: C5, C6
- radial: C5, C6, C7, C8, T1
- medial: C5, C6, C7, C8, T1
- ulnar: C8, T1

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40
Q

Brachial plexus: Lateral cord

A
  • lateral pectoral n.
  • musculocutaneous n.
  • lateral root of median n.
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41
Q

Brachial plexus: Medial cord

A
  • median n.
  • medial pectoral n.
  • ulnar n.
  • medial cutaneous n.
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42
Q

Brachial plexus: Posterior cord

A
  • superior subscapular n.
  • inferior subscapular n.
  • thoracodorsal n.
  • axillary n.
  • radial n.

Injury to posterior cord would present with:
- atrophy of posterior axillary muscles
- atrophy of shoulder muscles
- inability to extend arm/forearm
- wrist drop

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43
Q

Erb-Duchenne Paralysis

A
  • traction injury to upper trunk of brachial plexus (C5, C6)
  • axillary n. completely affected
  • adducted shoulder, extended elbow, internally rotated arm, waiter’s tip hand
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44
Q

Klumpke Paralysis

A
  • traction injury to lower trunk of brachial plexus (C8, T1)
  • caused by excessive abduction of arm (hanging injury)
  • ulnar n. completely affected
  • median n. and radial n. also affected
  • complete claw hand (4 digits affected) <- opposite actions of lumbricals
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45
Q

Radiculopathy vs. peripheral nerve injuries

A

Radiculopathy = damage to nerve roots where they leave the spine
- check dermatomes, myotomes, reflexes

Peripheral nerve injuries = damage in peripheries
- check specific nerve functions (motor & sensory)

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46
Q

Cubital fossa contains:

A

from medial to lateral:
1. ulnar n. (posterior to humerus)
2. median n. (middle of cubital fossa)
3. brachial a.
4. biceps tendon (attaches to radius)
5. radial n. (anterior to humerus)

superior: median cubital v.

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47
Q

Superficial anterior muscles of forearm

A
  • pronator teres
  • flexor carpi radialis
  • palmaris longus
  • flexor carpi ulnaris

median n. innervates all of them except flexor carpi ulnaris, which is innervated by the ulnar n.

Attachment: medial epicondyle of humerus
- golfer’s elbow

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48
Q

Pronator teres

A

forearm flexion and pronation

median n.

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49
Q

Flexor carpi radialis

A

wrist abduction and flexion

median n.

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50
Q

Palmaris longus

A

wrist flexion

median n.

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51
Q

Flexor carpi ulnaris

A

wrist adduction and flexion

ulnar n.

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52
Q

Intermediate & deep anterior muscles of forearm

A

Intermediate:
- flexor digitorum superficialis

Deep:
- flexor digitorum profundus
- flexor pollicis longus
- pronator quadratus

all innervated by median n. (or anterior interosseous branch of median n.), except for digits 4-5 of flexor digitorum profundus (ulnar n.)

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53
Q

Flexor digitorum superficialis

A

flexion of digits 2-5 at PIP

median n.

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54
Q

Flexor digitorum profundus

A

flexion of digits 2-5 at DIP (attach to lumbricals)
- the only muscle that flexes the DIP joints

digits 2-3: anterior interosseous n.
digits 4-5: ulnar n.

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55
Q

Flexor pollicis longus

A

thumb IP flexion

anterior interosseous n.

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56
Q

Pronator quadratus

A

forearm pronation

anterior interosseous n.

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57
Q

Median n.

A

C5, C6, C7, C8, T1 (from lateral and medial cords of brachial plexus)

passes under flexor retinaculum (carpal tunnel)
- palmar branch passes superior to flexor retinaculum <- not affected in carpal tunnel syndrome

sensory: lateral palm + lateral 3.5 digits

motor: anterior forearm flexors (except flexor carpi ulnaris and digits 4-5 of flexor digitorum profundus)

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58
Q

Dupuytren’s disease

A

abnormal thickening of palmar aponeurosis, causing flexion of MCP joints (4th and 5th digits most commonly affected)

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59
Q

Thenar muscles

A
  • abductor pollicis brevis
  • flexor pollicis brevis
  • opponens pollicis

all innervated by median n.

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60
Q

Hypothenar muscles

A
  • abductor digiti minimi
  • flexor digiti minimi
  • opponens digiti minimi
  • palmaris brevis (wrinkles skin of medial palm)

all innervated by ulnar n.

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61
Q

Lumbricals

A

connect from flexor digitorum profundus; do MCP flexion and PIP/DIP extension
- claw hand if nerve lesion affects lumbricals

lateral digits 1-2: median n.
medial digis 3-4: ulnar n.

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62
Q

Deep palm muscles

A
  • abductor pollicis
  • palmar interossei
  • dorsal interossei

all innervated by ulnar n.

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63
Q

Abductor pollicis

A

abduction of thumb

ulnar n.

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64
Q

Palmar interossei

A

adduction of digits 2, 4, 5

ulnar n.

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65
Q

Dorsal interossei

A

Abduction of digits 2, 4, 5

ulnar n.

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66
Q

Tenosynovitis (Trigger finger)

A

inflammation of synovial sheaths; fingers stuck in flexion

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67
Q

Carpal tunnel

A

median n. affected

intermediate/deep flexor tendons travel beneath flexor retinaculum:
- flexor pollicis longus
- flexor digitorum superficialis
- flexor digitorum profundus

Tinel’s sign (tapping), Phalen maneuver (wrist flexion for 60s)

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68
Q

Anterior interosseous n. syndrome (AINS)

A

median n. lesion affecting lateral flexor digitorum profundus and flexor pollicis longus

OK sign is flattened

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69
Q

Pope’s hand

A

flexor digitorum profundus (lateral) and flexor digitorum superficialis affected

digits 1-2 don’t flex when trying to make a fist

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70
Q

Supracondylar fracture of humerus

A

most common pediatric elbow fracture
- FOOH

compression of medial n. and brachial a. ==> weak forearm flexors and pronators

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71
Q

Nursemaid’s elbow

A

radial head subluxation (partial dislocation) at proximal radio-ulnar joint

annular ligament slips over head of radius

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72
Q

Ulnar n.

A

C8, T1 (from medial cord of brachial plexus)

passes over flexor retinaculum, under Guyon’s canal (ulnar tunnel)
- deep branch goes to palm
- superficial branch goes to digits

sensory: medial palm/dorsum + medial 1.5 digits

motor: flexor carpi ulnaris and digits 4-5 of flexor digitorum profundus

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73
Q

Ulnar claw

A

loss of medial lumbricals (4-5)

MCP extension + IP flexion

Ulnar paradox: ulnar claw is less severe in proximal lesions (elbow) than distal lesions (wrist) because the IP joints are left intact in proximal lesions

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74
Q

Guyon’s canal syndrome

A

caused by direct pressure on ulnar n. near wrist (bicyclists)

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75
Q

Anterior forearm/palm arteries

A

Brachial a. ==> radial a. (lateral) + ulnar a. (medial)
- Radial a. passes by flexor carpi radialis tendon and goes to supply deep palmar arch + lateral 1.5 digits
- Common interosseous a. branches off of ulnar a.
- Ulnar a. goes to supply superficial palmar arch + medial 3.5 digits

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76
Q

Posterior forearm/hand blood supply

A

Common interosseous a. (from ulnar a.) ==> anterior interosseous a. + posterior interosseous a.
- posterior interosseous a. ==> dorsal arch
- radial a. comes from anterior forearm and passes through anatomical snuffbox

Basilic v. + cephalic v. ==> dorsal venous arch
- cephalic venipuncture

77
Q

Superficial posterior forearm muscles

A
  • brachioradialis
  • extensor carpi radialis longus
  • extensor carpi radialis brevis
  • extensor digitorum
  • extensor digiti minimi
  • extensor carpi ulnaris

all innervated by branches of radial n.

Attachment: lateral epicondyle
- tennis elbow

78
Q

Brachioradialis

A

forearm flexion in midpronated position

radial n.

79
Q

Extensor carpi radialis longus & brevis

A

wrist extension and abduction

extensor carpi radialis longus: radial n.
extensor carpi radialis brevis: deep branch of radial n.

80
Q

Extensor digitorum

A

extension of digits 2-5

posterior interosseous n. (from deep branch of radial n.)

81
Q

Extensor digiti minimi

A

extension of 5th digit

posterior interosseous n.

82
Q

Extensor carpi ulnaris

A

wrist extension and adduction

posterior interosseous n.

83
Q

Deep posterior forearm muscles

A
  • supinator
  • adductor pollicis longus
  • extensor pollicis brevis
  • extensor pollicis longus
  • extensor indicis

all innervated by branches of radial n.

84
Q

Supinator

A

forearm supination

deep branch of radial n.

85
Q

Adductor pollicis longus

A

thumb base extension and abduction

posterior interosseous n.

86
Q

Extensor pollicis brevis

A

thumb MCP extension

posterior interosseous n.

87
Q

Extensor pollicis longus

A

thumb MCP and IP extension

posterior interosseous n.

88
Q

Extensor indicis

A

digit 2 extension

posterior interosseous n.

89
Q

Anatomical snuffbox

A

FOOH: scaphoid fracture leads to swelling and pain in anatomical snuffbox
- most common fractured carpal bone
- radial a. injury ==> avascular necrosis of proximal scaphoid

cephalic v. passes superficial to snuffbox
radial a. passes through snuffbox

90
Q

Lunate dislocation

A

rare; lunate is displaced and rotated volarly (90˚)

carpal tunnel compression ==> median n. compression

91
Q

DeQuervain tenosynovitis

A

overuse of abductor pollicis longus and extensor pollicis brevis (forceful gripping)
- inflammation of compartment 1 (most lateral), inferior to extensor retinaculum

Finkelstein’s test (ulnar adduction + thumb flexion)

92
Q

Radial n.

A

passes through triangular interval to radial groove (posterior arm), then lateral forearm (along radius)

Radial n. ==> deep branch + posterior interosseous n. + superficial branch (sensory to dorsum of lateral hand)

93
Q

Saturday night palsy

A

compression of radial n. at triangular interval

triceps brachii affected (elbow extension)

94
Q

Midshaft humerus fracture

A

wrist drop, lateral dorsal hand sensory loss

triceps/elbow extension not affected, posterior arm/forearm sensation intact

95
Q

Radial head fracture / Compression between supinator heads

A

deep branch of radial n. compressed

no wrist drop:
- extensor carpi radialis longus stays intact
- extensor carpi radialis brevis affected

96
Q

UE dermatomes & myotomes

A

Dermatomes:
C4 - skin over shoulder tip
C5 - upper lateral arm
C6 - thumb
C7 - index finger
C8 - pinky finger
T1 - medial elbow
T2 - skin of axilla

Myotomes:
C5 - shoulder abduction
C6 - elbow flexion
C7 - elbow extension
C8 - finger flexion
T1 - finger abduction/adduction

97
Q

C4 dermatome

A

skin over shoulder tip

98
Q

C5 dermatome/myotome

A

Derm: upper lateral arm

Myotome: shoulder abduction

99
Q

C6 dermatome/myotome

A

Derm: thumb

Myotome: elbow flexion

100
Q

C7 dermatome/myotome

A

Derm: index finger

Myotome: elbow extension

101
Q

C8 dermatome/myotome

A

Derm: pinky finger

Myotome: finger flexion

102
Q

T1 dermatome/myotome

A

Derm: medial elbow

Myotome: finger abduction/adduction

103
Q

T2 dermatome

A

skin of axilla

104
Q

UE tendon reflexes

A

C5-6 roots - biceps reflex

C6 roots - brachioradialis reflex

C7 - triceps reflex

105
Q

Lumbar plexus innervates

A

anterior compartment of thigh (femoral n.)

medial compartment of thigh (obturator n.)

106
Q

Sacral plexus innervates

A

gluteal muscles (superior/inferior gluteal n.)

anterior/lateral leg and foot (common fibular n.)

posterior leg and foot (tibial n.)

107
Q

Lateral cutaneous n. of thigh

A

branch of lumbar plexus, passes under inguinal ligament

supplies skin of lateral thigh

Meralgia paresthetica:
- compression of lateral cutaneous n. (low-waisted jeans)

108
Q

Lymphatics of LE

A

Superficial inguinal nodes:
- along inguinal ligament and great saphenous v.
- drain into external iliac nodes (higher up in hip region)

Deep inguinal nodes:
- associated with femoral vessels (within femoral triangle)
- drain into external iliac nodes

Popliteal nodes:
- along popliteal a., receives lymph along small saphenous v.
- drain into inguinal lymph nodes

109
Q

Anterior thigh muscles

A
  • iliopsoas: iliacus, psoas major
  • sartorius
  • tensor fascia lata (attaches to iliotibial tract)
  • quadriceps femoris: rectus femoris, vastus lateralis, vastus medialis, vastus intermedius

all innervated by femoral n.

110
Q

Iliopsoas

A

primary hip flexor:
- iliacus (attaches to iliac crest)
- psoas major (attaches to vertebrae T12-L5)

iliacus innervated by femoral n.
psoas major innervated by lumbar plexus

111
Q

Sartorius

A

tailor’s muscle; flexion and lateral rotation of thigh and leg (criss cross apple sauce)
- attaches to anterior superior iliac spine (lateral)
- crosses thigh diagonally and goes all the way down to superficial pes anserinus (goose’s foot), on medial side of knee

femoral n.

112
Q

Tensor fascia lata

A

thigh abduction, medial rotation, flexion

femoral n.

113
Q

Quadriceps femoris

A

thigh flexion and leg extension:
- rectus femoris

leg extension:
- vastus lateralis
- vastus medialis
- vastus intermedius

femoral n.

114
Q

Femoral triangle contains:

A

VAN (medial to lateral):
1. femoral ring
2. femoral v.
2. femoral a.
3. femoral n.

Femoral ring contains lymphatics, is a potential site for femoral hernia

Femoral canal opens up to saphenous opening, through which great saphenous v. enters femoral triangle and becomes femoral v.

Femoral sheath becomes adductor canal, which connects femoral triangle with popliteal fossa

115
Q

Femoral n.

A

largest branch of lumbar plexus
- passes between iliacus and psoas major muscles

innervates all anterior thigh muscles except psoas major

branches into anterior cutaneous n. and saphenous n. (skin of medial leg and foot)

116
Q

Femoral a.

A

From femoral triangle, continues through adductor canal and becomes popliteal a.

Branch: Deep femoral a. (posterior)
- lateral and medial circumflex femoral a. (loop around proximal femur, supplying hip)
- perforating branches (supply posterior thigh)

117
Q

Medial thigh muscles

A
  • obturator externus
  • gracilis
  • pectineus
  • adductor longus
  • adductor brevis
  • adductor magnus
  • adductor minimus

all innervated by obturator n. except for pectineus (femoral n.) and hamstring portion of adductor magnus (sciatic n.)

118
Q

Obturator externus

A

thigh lateral rotation (attaches to obturator foramen)

obturator n.

119
Q

Gracilis

A

thigh adduction, leg flexion and internal rotation
- attaches to pubis
- goes all the way down to superficial pes anserinus (goose’s foot), on medial side of knee

obturator n.

120
Q

Pectineus

A

thigh adduction
- attaches to superior pubic ramus

obturator n. and femoral n.

121
Q

Adductors

A

thigh adduction:
- adductor longus
- adductor brevis

thigh adduction and extension:
- adductor magnus

all innervated by obturator n.

hamstring part of adductor magnus: tibial n. (sciatic n. branch)

122
Q

Obturator n.

A

branch of lumbar plexus, passes through obturator canal

innervates all muscles of medial thigh except pectineus and hamstring part of adductor magnus

innervates skin of upper medial thigh

123
Q

Hip joint ligaments & blood supply

A

Hip & femoral ligaments: limit hip extension
- pubofemoral ligament
- iliofemoral ligament
- ischiofemoral ligament (deep)

Femoral head:
- transverse acetabular ligament
- ligament of the head of the femur (contains artery of ligament of head)

Lateral and medial circumflex femoral a.
- from deep branch of femoral a.

124
Q

Femoral head fracture

A

Posterior dislocation is most common (eg, a dashboard injury):
- adduction and internal rotation of extremity

If accompanied by anterior dislocation:
- abduction and external rotation of extremity

125
Q

Trochanteric femoral fracture

A

Not typically associated with dislocations

Greater trochanteric fracture:
- pain, especially with abduction and extension
- no deformity may be apparent, but pressure through greater trochanters will result in pain

Lesser trochanteric fracture:
- pain occurs during flexion and internal rotation

126
Q

Gluteus muscles

A
  • gluteus maximus
  • gluteus medius
  • gluteus minimus
  • tensor of fascia lata

all innervated by superior gluteal n. except for gluteus maximus (inferior gluteal n.)

127
Q

Gluteus maximus

A

hip extension (standing up from seated position), lateral rotation
- attaches to ilium
- attaches to iliotibial tract (along with tensor fascia lata) and gluteal tuberosity

inferior gluteal n.

128
Q

Gluteus medius/minimus

A

hip abduction, medial rotation
- attach to ilium
- attach to lateral surface of greater trochanter of femur

superior gluteal n.

129
Q

Trendelenburg sign

A

hip drop on contralateral side due to superior gluteal n. lesion (gluteus medius/minimus)

130
Q

Tensor of fascia lata

A

thigh abduction, flexion, lateral rotation

superior gluteal n.

131
Q

Superior/inferior gluteal n.

A

branch of sacral plexus

Superior gluteal n.:
- gluteus medius
- gluteus minimus

Inferior gluteal n.:
- gluteus maximus

passes through greater sciatic foramen:
- superior gluteal n. passes above piriformis
- inferior gluteal n. passes below piriformis

132
Q

Hip external rotator muscles

A
  • piriformis
  • obturator internus
  • superior/inferior gemellus (stabilize obturator internus tendon)
  • quadratus femoris
133
Q

Piriformis syndrome

A

Piriformis comes through greater sciatic foramen, potentially entrapping sciatic n.
- sciatic-like symptoms: pain in buttock, wallet sign

Causes:
- trauma to region
- muscle strain ==> fibrosis/scarring around nerve
- variation in sciatic n.

134
Q

Posterior thigh muscles (hamstrings)

A
  • biceps femoris (long/short heads)
  • semitendinosus
  • semimembranosus
  • hamstring part of adductor magnus

innervated by sciatic n. (tibial n. and common fibular n. branches)

proximal attachment: ischial tuberosity

135
Q

Biceps femoris

A

Long head of biceps femoris: medial
- thigh extension, leg flexion
- tibial n.

Short head of biceps femoris: lateral
- leg flexion
- common fibular n.

136
Q

Semitendinosus

A

thigh extension, leg flexion and medial rotation

tibial n.

137
Q

Semimembranosus

A

thigh extension, leg flexion and medial rotation

tibial n.

138
Q

Sciatic n.

A

passes through greater sciatic formamen, below piriformis

innervates posterior thigh, leg, foot
innervates skin of lateral leg, dorsum, sole of foot

branches into common fibular n. (lateral) and tibial n. (medial, through popliteal fossa)

139
Q

Popliteal fossa contains:

A

From medial to lateral:
1. popliteal a. (from femoral a.)
2. popliteal v. (branches into small saphenous v., superficial to popliteal fascia)
3. tibial n. (from sciatic n.)
4. common fibular n. (from sciatic n.)

140
Q

Common fibular n.

A

comes from sciatic n., branches into deep fibular n. and superficial fibular n.
- deep fibular n.: anterior leg
- superficial fibular n.: lateral leg

Common fibular n. lesion:
- fibular neck fracture
- paralysis of all anterior and lateral leg compartments ==> foot drop (inability to dorsiflex + inversion of foot)
- sensory loss to dorsum and lateral leg

141
Q

Popliteal a.

A
  • continuation from femoral a., comes through adductor hiatus into popliteal fossa
  • superior genicular a. branch wraps around knee joint
  • after passing through popliteal fossa, branches into anterior tibial a. (goes down anterior leg) and posterior tibial a. (goes down posterior leg and to tarsal tunnel)

At risk in knee dislocation or distal fracture of femur

142
Q

Knee joint

A
  • patellar tendon: continuation of quadriceps tendon (rectus femoris), attaches to tibial tuberosity
  • lateral/medial menisci

Ligaments:
- fibular/lateral collateral ligament (LCL)
- tibial/medial collateral ligament (MCL)
- anterior cruciate ligament (ACL) <- Lachman (anterior drawer) test
- posterior cruciate ligament (PCL)

Varus force = away from midline
- LCL and lateral meniscus damaged
Valgus force = towards midline
- MCL and medial meniscus damaged

Terrible triad = ACL + MCL + medial meniscus

143
Q

Anterior leg muscles

A
  • tibialis anterior
  • extensor hallucis longus
  • extensor digitorum longus
  • fibularis tertius (not everyone has)

innervated by deep fibular n.

tendons pass under superior/inferior extensor retinaculum to reach dorsal foot

144
Q

Tibialis anterior

A

dorsiflexion, inversion of foot
- attaches to base of first metatarsal and cuneiform

deep fibular n.

145
Q

Extensor hallucis longus

A

great toe extension, foot dorsiflexion

deep fibular n.

146
Q

Extensor digitorum longus

A

extension of lateral 4 digits, foot dorsiflexion

deep fibular n.

147
Q

Fibularis tertius

A

dorsiflexion and eversion
- distal part of extensor digitorum longus

deep fibular n.

148
Q

Deep fibular n.

A

comes from common fibular n. (sciatic n.)

innervates anterior leg muscles
innervates skin between great/2nd toe

Deep fibular n. lesion: ski boot syndrome
- anterior leg muscles affected ==> foot drop, steppage gait
- sensory loss between great/2nd toes

149
Q

Dorsal arteries

A

anterior tibial a. (from popliteal a.) ==> dorsalis pedis a. ==> deep plantar a. (deep plantar arch)

150
Q

Dorsal veins

A

great saphenous v. (branch that goes into femoral n.) is anterior to medial malleolus

small saphenous v. is posterior to lateral malleolus

151
Q

Lateral leg muscles

A
  • fibularis longus
  • fibularis brevis

innervated by superficial fibular n.

pass under fibular retinaculum (on lateral side of foot)

152
Q

Fibularis longus

A

eversion and plantarflexion
- after passing through fibular retinaculum, tendon crosses underneath foot ==> attaches at base of first metatarsal and medial cuneiform

superficial fibular n.

153
Q

Fibularis brevis

A

eversion and plantarflexion
- after passing under fibular retinaculum, tendon attaches to tuberosity of fifth metatarsal

superficial fibular n.

154
Q

Superficial fibular n.

A

branch of common fibular n. (sciatic n.)

innervates lateral leg muscles
innervates skin of dorsum and toes (except between great/2nd toes)

Superficial fibular n. lesion:
- lateral leg muscles affected ==> no foot drop, but plantarflexion/eversion affected
- sensory loss to dorsum of foot

155
Q

Superficial posterior leg muscles

A
  • gastrocnemius (medial/lateral heads)
  • soleus
  • plantaris

innervated by tibial n.

156
Q

Gastrocnemius

A

plantarflexion, knee flexion
- superior attachment is at femur
- attaches to calcaneal tendon (Achilles tendon)

tibial n.

157
Q

Soleus

A

plantarflexion
- attaches to calcaneal tendon

tibial n.

158
Q

Plantaris

A

plantarflexion, knee flexion
- superior to soleus muscle
- attaches to calcaneal tendon

tibial n.

159
Q

Deep posterior leg muscles

A
  • popliteus
  • tibialis posterior
  • flexor digitorum longus
  • flexor hallucis longus

innervated by tibial n.

160
Q

Popliteal

A

unlocks knee by laterally rotating femur on tibia, weakly flexes knee

tibial n.

161
Q

Tibialis posterior

A

inversion, plantarflexion

tibial n.

162
Q

Flexor digitorum longus

A

plantarflexion, flexion of toes 2-5

tibial n.

163
Q

Flexor hallucis longus

A

plantarflexion, flexion of great toe

tibial n.

164
Q

Tibial n.

A

passes through popliteal fossa ==> posterior leg ==> tarsal tunnel (medial) ==> foot

innervates posterior leg muscles

branches into sural n. and medial calcaneal n., which innervate the skin of:
- sural n.: posterolateral leg, lateral foot, little toe
- medial calcaneal n.: medial/sole of heel

165
Q

Tarsal tunnel

A

Tom, Dick, and A Very Nervous Harry: anterior to posterior
1. Tibialis posterior
2. flexor Digitorum longus
3. posterior tibial Artery (palpate posterior to medial malleolus for pulse point)
4. posterior tibial Vein
5. tibial Nerve
6. flexor Hallucis longus

Tarsal tunnel syndrome: compression of tibial n.
- caused by flat feet, ankle sprain swelling, synovial sheath inflammation

166
Q

Plantar aponeurosis

A

protects internal structure of foot, supports arch of foot
- attached to calcaneal tuberosity
- can stretch and fall ==> flat foot

plantar fascitis ==> formation of calcaneal spur

167
Q

Medial & lateral plantar n.

A

tibial n. enters foot posterior to the medial malleolus
- innervates skin of heel

tibial n. branches into medial plantar n. and lateral plantar n.
- medial plantar n.: more sensory (skin of 3.5 medial toes)
- lateral plantar n.: more motor (skin of 1.5 lateral toes)

168
Q

First (most superficial) layer of foot

A

Medial plantar n.:
- abductor hallucis
- flexor digitorum brevis

Lateral plantar n.:
- abductor digiti minimi

169
Q

Second layer of foot

A

Medial plantar n.:
- 1st lumbrical (flexion of MTPs, extension of IPs)

Lateral plantar n.:
- 2nd-4th lumbricals
- quadratus plantae (flexion of toes 2-5)

170
Q

Third layer of foot

A

Medial plantar n.:
- flexor hallucis brevis

Lateral plantar n.:
- flexor digiti minimi
- adductor hallucis (transverse & oblique heads)

171
Q

Fourth (deepest) layer of foot

A

Lateral plantar n.:
- dorsal interosseous (abduction)
- plantar interosseous (adduction)

172
Q

Medial & lateral plantar a.

A

branches from posterior tibial a.
- lateral plantar a. forms deep plantar arch

173
Q

Foot arches

A

pes cavus = high arches
pes planus = flat footed

174
Q

Talus fracture

A

talus = ankle joint bone that articulates with tibia and fibula

fractures at neck of talus often interrupt blood supply ==> osteonecrosis

175
Q

Ankle sprains

A

In plantarflexion, the gap between the fibula and talus widens ==> higher risk of sprain on lateral side of ankle (inversion)

Anterior talofibular ligament
- most common lateral ligament sprain
- attaches to fibula and neck of talus

Deltoid ligament
- strong eversion sprain

176
Q

Potts fracture

A

Forced eversion ==> bimalleolar/trimalleolar fracture
- bimalleolar: deltoid malleolus, medial malleolus
- trimalleolar: deltoid malleolus, medial malleolus, distal tibial fracture

177
Q

Herniated discs

A

herniated discs affect the lower numbered vertebrae:
- Herniated disc between L4 and L5 ⇒ spinal nerve L5 would be affected
- Herniated disc between C5 and C6 ⇒ spinal nerve C6 would be affected

178
Q

LE dermatomes & myotomes

A

Dermatomes:
L1 - over inguinal ligament
L2 - lateral thigh
L3 - lower medial thigh
L4 - medial great toe
L5 - medial digit 2
S1 - little toe
S2 - back of thigh
S3 - lower butt cheek (gluteal fold)
S4/S5 - perineum

Myotomes:
L1/L2 - hip flexion
L3/L4 - knee extension
L4/L5 - foot and toe dorsiflexion
S1/S2 - foot and toe plantarflexion

179
Q

L1 dermatome/myotome

A

Derm: skin over inguinal ligament

Myotome: hip flexion

180
Q

L2 dermatome/myotome

A

Derm: lateral thigh

Myotome: hip flexion

181
Q

L3 dermatome/myotome

A

Derm: lower medial thigh

Myotome: knee extension

182
Q

L4 dermatome/myotome

A

Derm: great toe

Myotome: foot dorsiflexion

183
Q

L5 dermatome/myotome

A

Derm: 2nd toe

Myotome: toe dorsiflexion

184
Q

S1 dermatome/myotome

A

Derm: pinky toe

Myotome: plantarflexion

185
Q

S2 dermatome/myotome

A

Derm: back of thigh

Myotome: plantarflexion

186
Q

S3 dermatome

A

skin over gluteal fold (butt cheek)

187
Q

S4/S5 dermatome

A

perineum

188
Q

LE tendon reflexes

A

L3, L4 - patellar/knee reflex

S1, S2 - Achilles reflex

Block 3 (5 decks)

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