Anatomy Flashcards
(379 cards)
1
Q
What are the functions of the lower limb?
A
Support body weight.
Locomotion.
Maintain balance.
2
Q
What are the 6 regions of the lower limb?
A
Gluteal.
Femoral (thigh).
Knee.
Leg.
Ankle.
Foot.
3
Q
What are the range of movements of the acetabulo-femoral joint?
A
Flexion-extension.
Abduction-adduction.
Medial-lateral rotation.
Circumduction.
4
Q
What type of joint is the acetabulo-femoral joint?
A
Synovial joint in which the joint is encased by a strong joint capsule and has an external fibrous layer (the spiral ligaments) and an internal membranous layer.
5
Q
Which ligaments make up the spiral ligaments of the acetabulo-femoral joint?
A
Iliofemoral.
Ischiofemoral.
Pubofemoral.
6
Q
What is the function of the ligaments of the acetabulo-femoral joint?
A
To stabilise the hip joint, but also to control movement and restrict the joint from going into extreme positions.
The iliofemoral ligament is Y shaped and resists external rotation (prevents the foot from falling out) and internal rotation.
7
Q
What are the attachments of the ligamentum teres of the femur (round ligament of femur)?
A
The ligamentum teres is a round ligament that connects the femoral head with the acetabulum.
8
Q
What is the primary blood supply of the femur?
A
Medial circumflex femoral artery.
9
Q
What arteries are damage in femoral neck fractures?
A
Intracapsular retinacular arteries.
10
Q
What type of joint is the knee complex?
A
Modified synovial hinge joint which contains 3 joints:
- 2x tibiofemoral (medial and lateral).
- 1x patellofemoral.
11
Q
What are the movements of the knee complex?
A
Main movement is flexion and extension.
Slight rotation.
12
Q
Which muscles cause flexion/extension of the knee complex?
A
Quadriceps - extension.
Hamstrings - flexion.
13
Q
The knee is mechanically weak. What helps stabilise the knee?
A
Quadriceps muscles.
The knee also has more extracapsular ligaments which stabilise the joint.
14
Q
What are the extracapsular ligaments of the knee complex?
A
Patellar ligament (AKA patellar tendon).
Lateral (fibular) collateral ligament.
Medial (tibial) collateral ligament.
15
Q
What are the intra-articular ligaments of the knee complex?
A
Anterior cruciate ligament (ACL).
Posterior cruciate ligament (PCL).
16
Q
What are the anatomical differences between the medial and lateral collateral ligaments?
A
Lateral collateral - cord-like.
Medial collateral - broad.
17
Q
What is the function of the menisci in the knee complex?
A
Medial and lateral menisci are fibrocartilage that aid joint stability and absorb forces.
18
Q
What movement does the anterior cruciate ligament prevent?
A
Anterior displacement of the tibia on the femur.
Hyperextension of the knee joint.
19
Q
What movement does the posterior cruciate ligament prevent?
A
Posterior displacement of the tibia on the femur.
Hyperflexion of the knee joint.
20
Q
Structures travelling to the gluteal region pass through which foramen?
A
Great sciatic foramen.
21
Q
What is the Q-angle?
A
The Q-angle is defined as the angle between a line drawn from the anterior superior iliac spine (ASIS) to the center of the patella and a line from the center of the patella to the tibial tubercle.
Genu varum - decreased Q-angle.
Genu valgum - increased Q-angle.
22
Q
Structures travelling to the perineum pass through which foramen?
A
Lesser sciatic foramen.
23
Q
The gluteal region is divided into quarters for injections. Which quarter is best to inject into and why?
A
The upper left quadrant of the left gluteal region (or upper right quadrant of the right gluteal region) as there are less dangerous structures to hit in that region.
24
Q
Which nerves enter/exit the pelvis via the gluteal region?
A
Sciatic (L4-S3).
Pudendal (S2-S4).
Posterior cutaneous nerve of thigh (S1-S3).
25
What does the sciatic nerve supply?
Posterior thigh (NOT anterior and medial compartments).
All leg and foot muscles and most and most of the skin via the tibial and common fibular branches.
26
What does the pudendal nerve supply?
Pelvic floor and perineum.
*S2,3,4 keep your guts off the floor.*
27
What does the posterior cutaneous nerve of the thigh supply?
Skin over posterior thigh, popliteal fossa, lateral perineum and upper medial thigh.
28
Which muscles are in the superficial muscle group (extensors, abductors and medial rotators of the thigh)?
Gluteus maximus.
Gluteus medius.
Gluteus minimus.
Tensor fascia latae.
29
Which muscles are innervated by the gluteal nerves?
Inferior gluteal nerve - gluteus maximus.
Superior gluteal nerve - gluteus medius, gluteus minimus, tensor fascia latae.
30
Which muscles are in the deep muscle group (lateral rotators of the thigh and hip stabilisers)?
Piriformis.
Obturator internus.
Gemeli (superior and inferior).
Quadratus femoris.
31
Which nerves supply the deep muscle group (lateral rotators of the thigh and hip stabilisers)?
Sacral plexus nerves.
32
What is the Trendelenburg gait?
Reduced function of the superior gluteal nerve causing the hip to drop on the contralateral side due to weak hip abduction by the gluteus medius.
33
Where does the sciatic nerve exit the greater sciatic foramen?
Usually inferior to the piriformis and is usually the most lateral exiting the greater sciatic foramen.
34
What are the 2 portions of the sciatic nerve?
Tibial nerve (larger, medial).
Common fibular (smaller, lateral).
35
What is compartment syndrome?
Fascia creates an enclosed space, so increased pressure caused by swelling or tissue or increased in fluid (bleeding) affects the functions of the muscles or nerves in the compartment.
Can be acute or chronic.
36
What are the 3 muscle compartments of the thigh?
37
What are the 3 muscle compartments of the leg?
38
What is the treatment of compartment syndrome?
Fasciotomy to relieve pressure in emergency.
39
What are the flexor muscles of the thigh and which compartment are they in?
**Anterior compartment** **of the thigh**.
Pectineus.
Iliopsoas (psoas major, psoas minor + iliacus).
Sartorius.
Rectus femoris.
40
What are the extensor muscles of the leg and which compartment are they in?
**Anterior compartment of the thigh**.
Rectus femoris.
Vastus lateralis.
Vastus medialis.
Vastus intermedius.
41
What is the nerve supply of the flexor and extensor muscles in the anterior compartment of the thigh?
The femoral nerve (L2-4) for all muscles, except psoas major which is L1-3.
42
What are the boundaries of the femoral triangle?
Superior - inguinal ligament.
Medial - lateral border of the adductor longus.
Lateral - medial border of the sartorius.
Floor - iliopsoas laterally and pectineus medially.
Roof - deep fascia (fascia lata).
43
What are the contents of the femoral triangle? From lateral to medial.
Femoral **n**erve.
Femoral **a**rtery.
Femoral **v**ein.
L**y**mphatics.
44
What are the adductor muscles of the thigh and which compartment are they in?
**Medial compartment of the thigh**.
Adductor longus.
Adductor brevis.
Adductor magnus.
Gracilis.
Obturator externus.
45
What nerve supplies the adductors of the thigh?
Obturator nerve (L2-4).
## Footnote
*Hamstring part of the adductor magnus is supplied by the tibial nerve.*
46
What are the extensor muscles of the leg and flexors of the leg and which compartment are they in?
**Posterior compartment of the thigh**.
Semitendinosus.
Semimembranosus.
Biceps femoris.
47
What is the nerve supply of the extensors of the thigh and flexors of the leg?
Tibial division of the sciatic nerve (L5, S1-2).
## Footnote
*Except the short head of the biceps femoris which is the common fibular division of the sciatic.*
48
What are the superficial group muscles of the leg (plantarflexors of ankle) and which compartment are they in?
**Posterior compartment of the leg**.
Gastrocnemius.
Soleus.
Plantaris.
49
What are the deep group muscles of the leg (plantarflexors of ankle and flexors of toes) and which compartment are they in?
**Posterior compartment of the leg**.
Popliteus.
Flexor hallucis longus.
Flexor digitorum longus.
Tibialis posterior.
50
Which nerve supplies the posterior compartment of the leg (superficial group - plantarflexors of ankle; deep group - flexors of toes and plantarflexors of ankle)?
Tibial nerve.
51
What are the dorsiflexor muscles of the ankle and extensors of toes and which compartment are they in?
**Anterior compartment of leg**.
Tibialis anterior.
Extensor digitorum longus.
Extensor hallucis longus.
Fibularis tertius.
52
What nerve supplies the dorsiflexor muscles of the ankle and extensors of toes?
Deep fibular nerve (L4-5).
53
What are the muscles that evert the foot and weakly plantarflex the ankle and which compartment are they in?
**Lateral compartment of leg**.
Fibularis longus.
Fibularis brevis.
54
What nerve supplies the muscles that evert the foot and weakly plantarflex the ankle?
Superficial fibular nerve (L5, S1-2).
55
What causes deep fibular nerve palsy/foot drop?
Loss of the muscle action in the anterior compartment of the leg causing reduced or absent dorsiflexion.
56
What are the boundaries of the popliteal fossa?
Superolaterally - biceps femoris.
Superomedially - semiteninosus/semimembranosus.
Inferiorly - medial and lateral heads of gastrocnemius.
Roof - popliteal fascia.
57
What are the contents of the popliteal fossa?
Lots of fat.
Terminal small saphenous vein.
Popliteal vessels.
Tibial and common fibular nerves.
58
What does the ankle jerk reflex examine?
The sensory and motor integrity of S1 and S2 nerve roots.
The normal result is plantarflexion.
59
The achilles (calcneal) tendon is the tendon of which muscle(s)?
Gastrocnemius and soleus together.
60
What does the achilles tendon attach to?
The calcaneal tuberosity of the calcaneus.
61
What is the course of the superficial lymphatics in the leg?
Follow saphenous veins (small saphenous drains into popliteal lymph nodes first).
Drain into superficial inguinal lymph nodes.
Then external iliac lymph nodes.
62
What is the course of the deep lymphatics in the leg?
Follow deep veins.
(Small saphenous vein drains into popliteal lymph nodes first).
Deep inguinal lymph nodes.
External iliac lymph nodes.
63
From superficial to deep, what can be found in the neurovascular bundle in the popliteal fossa?
Tibial nerve (from sciatic nerve).
Popliteal vein (continuation of posterior tibilar vein(s)).
Popliteal artery (continuation of femoral artery).
64
Where are the popliteal lymph nodes located in the popliteal fossa?
Along the popliteal vein in the popliteal fossa.
65
Where does the sciatic nerve divide into the tibial and common fibular nerve?
At the superior apex of the fossa (if that division has not already taken place within the gluteal region or posterior compartment of the thigh.
66
Where are the sural nerves located and what do they supply?
Found within the region of the popliteal fossa (mainly in superficial fascia).
Supply skin and fascia on the posterolateral aspect of the leg and foot.
67
Where does the medial sural cutaneous nerve arise from?
The tibial nerve.
68
Where does the lateral sural cutaneous nerve arise from?
Common fibular nerve.
69
What nerves combine together to give the sural nerve?
The medial sural cutaneous nerve and the fibres in the communicating branch between the medial and lateral sural cutaneous nerves.
70
What is the course of the sural nerve?
Leaves the fossa to descend alongside the small saphenous vein, in the superficial fascia of the median plane of the posterior aspect of the leg.
71
When is the common fibular nerve likely to get damaged?
Compression injury against the neck fo the fibula (e.g. a tight plaster cast).
Fractures of the fibular neck.
72
Name the structures from anterior to posterior that leave the posterior compartment of the leg to reach the sole of the foot?
**T**ibialis posterior tendon.
flexor **D**igitorum longus tendon.
posterior tibial **A**rtery.
tibial **N**erve.
flexro **H**allucis longus tendon.
***T**om **D**ick **AN**d **H**arry.*
73
What are the attachments of the gastrocnemius?
Gastrocnemius has two heads and two muscle bellies: medial and lateral.
Both attach distally to the calcaneus via the Achilles tendon and proximally to their respective femoral condyle.
74
What is the movement of the gastrocnemius muscle?
Weak knee flexor and powerful ankle plantar-flexor (push off phase in walking/running).
75
What are the attachments of the soleus muscle?
Attaches proximally to the neck of the fibula and the soleal line of the tibia.
Distally attaches to the calcaneus via the Achilles tendon.
76
What does a positive ankle jerk reflex confirm?
The function of the muscles, their peripheral nerve supply (tibial nerve: S1-S2) and the central connections at spinal cord level (reflex arc) and above (descending controls which normally act to prevent unwanted recurrent reflexes from occurring during normal functioning).
77
What are the branches of the popliteal artery?
Popliteal artery divides immediately distal to the popliteal fossa into the anterior and posterior tibial arteries.
The fibular artery is a branch of the posterior tibial artery.
78
What does the anterior tibial artery pierce to supply the anterior compartment of the leg?
Interosseous membrane.
79
What compartment does the posterior tibial artery supply?
Posterior compartment of the leg.
80
In the foot, what does the posterior tibial artery divide into?
The medial and lateral plantar arteries.
81
Where does the fibular artery branch from the posterior tibial artery?
In the proximal half of the posterior compartment of the leg.
82
What compartment does the fibular artery supply?
Lateral compartment of the leg.
83
Why is the sciatic nerve clinically important?
Because it supplies the muscles in the posterior compartment of the thigh and, via its divisions, also supplies the muscles in all the compartments of the leg and the intrinsic muscles of the foot.
84
What bone in the leg does not take part in the knee joint?
The fibula.
85
What are the main movements of the knee complex and which muscles are responsible for these movements? What is the nerve supply of these muscles?
Flexion (hamstrings and gastrocnemius/tibial and common fibular nerve).
Extension (mainly quadriceps/femoral nerve).
Medial rotation (hamstrings and gracilis/tibial and obturator nerve).
Lateral rotation (biceps femoris/tibial and common fibular nerves).
*When bent at 90 degrees can achieve slight medial and lateral rotation.*
86
What ligaments of the knee joint help stabilise the joint?
Iliotibial tract.
Tibial collateral ligament (medial).
Fibular collateral ligament (lateral).
Anterior and posterior cruciate ligaments.
87
Where are the menisci thickest?
Peripherally where they are attached to the fibrous capsule.
88
Why is the medial meniscus more vulnerable to being torn?
Because it is attached peripherally to the tibial (medial) collateral ligament.
89
What is the unhappy triad knee injury?
Injury to the anterior cruciate ligament, tibial (medial) collateral ligament and medial meniscus.
90
What is the function of the anterior and posterior cruciate ligaments?
Maintaining joint stability.
91
What does the anterior drawer test assess?
The integrity of the anterior cruciate ligament.
92
What does the posterior drawer test assess?
The integrity of the posterior cruciate ligament.
93
What is the suprapatellar bursa?
An extension of the synovial cavity.
94
What is the purpose of the suprapatellar bursa?
To reduce friction on the quadriceps tendon during knee movements.
95
What is the massage test?
A test to clinically detect whether there is abnormal fluid within the suprapatellar bursa (e.g. blood, inflammatory exudate or pus).
96
What does the common fibular nerve divide into and where?
Superficial and deep fibular nerves at the fibular neck.
97
What does the superficial fibular nerve supply?
The muscles of the lateral compartment of the leg and the skin and fascia of dorsum of the foot.
98
What does the deep fibular nerve supply?
The muscles of the anterior compartment of the leg and the skin of the first interdigital cleft.
99
What are the attachments of the muscles of the anterior compartment of the leg?
They all attach proximally to tibia, fibula or interosseous membrane and distally to the base of 1st metatarsal and medial cuneiform (Tibialis Anterior), distal phalanges of great toe (Extensor Hallucis Longus) and all digits (Extensor Digitorum Longus) and base of 5th metatarsal (Fibularis Tertius).
100
What are the main actions of the muscles of the anterior compartment of the leg?
Dorsiflexion of the ankle, great toe and digits and inversion (Tibialis Anterior – in combination with tibialis posterior) and eversion (Fibularis Tertius with fibularis longus and brevis) of the foot.
101
What separates the lateral and anterior compartments of the leg?
Anterior intermuscular septum.
102
What are the muscles found in the lateral compartment of the leg?
Fibularis longus.
Fibularis brevis.
103
What is the main action of the muscles within the lateral compartment of the leg?
Evert the foot.
104
What is the subtalar joint of the foot?
Between the talus and calaneus.
105
What are the midtarsal joints of the foot?
2 joints: calcaneocuboid and talocalcaneonavicular.
106
What are the main movements of the midtarsal joints?
Mainly inversion (tibialis anterior and tibialis posterior innervated by tibial and deep fibular nerves) and eversion (fibularis muscles innervated by both fibular nerves).
107
Where is the tarsometatarsal joint in the foot?
Between the cuneiforms/cuboid proximally and the metatarsal.
108
What movements are the metaphalangeal (MTP) joints involved in?
Flexion, extension, adduction, abduction and circumduction of the digits (toes).
109
What movements can the interphalangeal joints of the foot do?
Flexion and extension of the toes.
110
What are the joints of the foot?
Subtalar joint.
Midtarsal joint x2.
Tarsometatarsal joints.
Metatarsophalangeal joints.
Interphalangeal joints.
111
What are the functions of the arches of the foot?
Shock absorption.
Push-off spring function.
Increased weight-bearing capacity by weight redistribution across whole foot.
112
What structures support the arches of the foot?
Plantar aponeurosis - thickened central area of the plantar fascia which protects against puncture wounds.
Plantar ligaments.
113
What are the arches of the foot?
Medial longitudinal arch.
Lateral longitudinal arch.
Transverse arch.
114
The medial longitudinal arch of the foot consists of which bones?
Calcaneus.
Talus.
Navicular.
Cuneiforms x3.
Metatarsals x3.
115
What supports the medial longitudinal arch of the foot?
Flexor hallucis longus.
Attachments of the anterior tibialis.
Attachment of the fibularis longus.
116
What bones form the lateral longitudinal arch?
Calcaneus.
Cuboid.
Metatarsals 4 and 5.
117
What bones form the transverse arch of the foot?
Cuboid.
Cuneiforms.
Bases of all 5 metatarsals.
118
What structures support the transverse arch of the foot?
Fibularis longus.
Tibialis posterior.
119
Where do the intrinsic muscles of the foot attach?
Proximally and distally within the foot.
120
What movements do the sole/interosseous muscles of the foot produce?
Mainly flexion (sole).
Abduction/adduction (interossei).
121
What movements are produced by the 2 dorsal muscles of the foot?
Short extensors of the toes.
122
What are the main arteries of the foot?
Dorsalis pedis artery.
Medial and lateral plantar arteries.
123
What is the dorsalis pedis artery a branch of?
Anterior tibial artery.
124
Where is the dorsalis pedis pulse taken?
Lateral to the extensor hallucis longus tendon.
125
Where do branches of the dorsalis pedis artery go?
Arcuate artery on the dorsum of the foot.
126
What artery do the lateral and medial plantar arteries branch from?
Posterior tibial artery.
127
Which arteries contribute to the deep plantar arch?
Lateral and medial plantar arteries.
128
What branches from the deep plantar arch and the arcuate artery?
The metatarsal arteries which branch into digital arteries.
129
What are the superficial veins of the foot?
Dorsal venous arch giving rise to great (medially) and small (laterally) saphenous veins.
130
What is the course of the deep veins of the foot and where do they drain?
Accompany the arteries of the foot and drain into the anterior and posterior tibial and the fibular veins that join to form the popliteal vein.
131
What is the motor supply to the foot?
Tibial nerve to the muscles of the sole.
Deep fibular nerve to the muscles of the dorsum.
132
What is the sensory nerve supply of the dorsum of the foot?
Superficial fibular nerve mainly.
Deep fibular nerve supplies the first interdigital cleft.
Sural nerve supplies the proximal lateral border.
Saphenous nerve supplies the proximal medial border.
133
What is the sensory nerve supply of the plantar surface of the foot?
Mainly tibial nerve to the heel and majority of the sole (medial and lateral plantar nerves).
Sural nerve supplies the proximal lateral border.
Saphenous nerve supplies the proximal medial border.
134
What is the lymphatic drainage of the foot?
Lymphatic vessels accompany the great and small saphenous veins.
135
What are the joints of the upper limb?
136
What are the movements of the radioulnar joint?
Supination and pronation.
## Footnote
*Radius moves over the ulnar during pronation.*
137
What are the joints of the hand?
Proximal interphalangeal (PIP).
Distal interphalangeal (DIP).
Metacarpal-phalangeal (MCP).
Carpal-metacarpal (CMC).
138
What type of joint is the 5th MCP joint of the hand?
Condyloid type.
139
What type of joint is the 1st CMC joint?
Saddle type.
140
What are the axio-appendicular muscles of the upper limb?
Trapezius (CN XI).
Serratus anterior (long thoracic nerve).
Rhomboid minor and major (dorsal scapula nerve).
*Subclavius, latissimus dorsi and levator scapulae.*
141
What muscles are in the scapula region of the upper limb?
Levator scapulae (dorsal scapula nerve).
Rotator cuff muscles.
142
What are the 4 rotator cuff muscles?
Supraspinatus.
Infraspinatus.
Teres minor.
Subscapularis.
143
What is the function of the rotator cuff muscles?
Hold the head of the humerus in the glenoid fossa.
1/3 of the humeral head is in contact with the glenoid fossa at any time.
144
Which rotator cuff muscles attach to the greater tuberosity of the humeral head?
Supraspinatus.
Infraspinatus.
Teres minor.
145
Which rotator cuff muscles attach to the lesser tuberosity of the humeral head?
Subscapularis.
146
What are the compartments of the upper limb?
Anterior.
Posterior.
147
What muscles are found in the anterior compartment of the arm?
Biceps brachii.
Brachialis.
Coracobrachialis.
148
What is the innervation of the anterior compartment of the arm?
Musculocutaneous nerve.
149
What are the movements of the muscles of the anterior compartment of the arm?
Flexion of the arm and forearm.
## Footnote
*Biceps brachii also supinates the forearm.*
150
What muscles are in the posterior compartment of the arm?
Triceps brachii.
151
What is the innervation of the posterior compartment of the arm?
Radial nerve.
152
What are the movements of the muscles of the posterior compartment of the arm?
Extension of the arm and forearm.
153
What are the muscles in the superficial layer of the anterior compartment of the forearm?
Pronator teres.
Flexor carpi radialis.
Flexor carpi ulnaris.
Palmaris longus.
154
What are the muscles in the intermediate layer of the anterior compartment of the forearm?
Flexor digitorum superficialis.
155
What are the muscles in the deep layer of the anterior compartment of the forearm?
Flexor pollicis longus.
Flexor digitorum profundus.
Pronator quadratus.
156
What is the innervation of the anterior compartment of the forearm?
Median nerve.
Except flexor carpi ulnaris and the medial half of the flexor digitorum superficialis which is the ulnar nerve.
157
What are the actions of the muscles of the anterior compartment of the forearm?
Flexion of the wrist and digits.
Pronation, abduction and adduction of the wrist.
158
What are the muscles of the superficial layer of the posterior compartment of the forearm?
Brachioradialis.
Extensor carpi radialis longus.
Extensor carpi radialis brevis.
Anconeus.
Extensor digitorum.
Extensor carpi ulnaris.
Extensor digiti minimi.
159
What are the muscles of the deep layer of the posterior compartment of the forearm?
Supinator.
Extensor pollicis brevis.
Extensor indicis.
Extensor pollicis longus.
Abductor pollicis longus.
160
What is the innervation of the posterior compartment of the forearm?
Radial nerve.
161
What are the actions of the muscles of the posterior compartment of the forearm?
Extension of the wrist and digits.
Supination, abduction and adduction of the wrist.
162
What are the muscles of the thenar eminence?
Abductor pollicis brevis.
Flexor pollicis brevis.
Opponens pollicis.
163
What is the innervation of the thenar eminence?
Recurrent branch of the median nerve.
164
What part of the hand is affected by carpal tunnel syndrome?
The thenar eminence.
165
What are the muscles of the hypothenar eminence?
Abductor digiti minimi.
Flexor digiti minimi brevis.
Opponens digiti minimi.
166
What is the innervation of the thenar eminence?
Deep branch of the ulnar nerve.
167
What muscles are found in the hand itself?
Lumbricals.
Dorsal interossei (abduction of digits).
Palmar interossei (adduction of digits).
168
What nerve innervates the interossei muscles of the hand?
Ulnar nerve.
169
What nerves innervate the lumbricals of the hand?
Median nerve (lateral 2 lumbricals).
Ulnar nerve (medial 3 lumbricals).
170
Where does the brachial plexus originate from?
The anterior rami of C5-T1.
171
What is the course of the brachial plexus?
Passes through the axilla to the medial arm.
Cords travel around the brachial artery.
172
What is the pneumonic for remembering the different parts of the brachial plexus?
**R**eally **T**ired **D**rink **C**offee **N**ow (proximal to distal).
**R**oots.
**T**runks.
**D**ivisions.
**C**ords.
**N**erves.
173
What is the carpal tunnel formed by?
Flexor retinaculum.
Carpals.
174
What are the contents of the carpal tunnel?
Flexor digitorum superficialis x4.
Flexor digitorum profundus x4.
Flexor pollicis longus x1.
Median nerve.
175
What is carpal tunnel syndrome?
Compression of the median nerve leading to weakness of the thenar muscles.
Experience numbness in digits 1-2 and the lateral half of digit 4.
176
What is the arterial vasculature of the upper limb?
Subclavian -\> brachial divides into radial and ulnar which anastomose into superficial (ulnar a. dominant) and deep palmar (radial a. dominant) arch.
177
What are the common spine conditions?
Mechanical back pain & spondylosis.
Facet joint arthritis.
Multi-level degenerate back pain (osteoarthritis).
Discogenic back pain.
Disc prolapse, sciatic and radiculopathy.
Spinal stenosis & bony root entrapment.
Trauma and osteoporotic fracture.
178
What are the less common spine conditions?
Scoliosis.
Spondylolisthesis.
Ankylosing spondylitis.
Benign tumours - osteoid osteoma.
Malignant tumours - metastatic disease, multiple myeloma.
Discitis & osteomyelitis.
Cauda equina syndrome.
179
What is the organisation of the 33 vertebrae?
7 cervical.
12 thoracic.
5 lumbar.
5 sacral (fused).
4 coccygeal (fused).
180
Why does the spin have 4 curves normally?
To help maintain posture and balance.
181
Which are the atypical vertebra and why?
Atlas (C1) and axis (C2) - allow head rotation.
Vertebra prominens (C7) - small foramina transversaria, long spinous process.
182
What are the movements of the facet joints of the spine?
Flexion, extension and lateral flexion - give a cumulative effect.
The degree to these ranges of movements varies across the different regions of the spine:
* Cervical spine – greatest movement due to more horizontal facet joints.
* Thoracic spine – less flexion/extension due to constraint of ribs.
* Lumbar spin – less than thoracic due to more vertically orientated facet joints.
183
How are overloaded facet joints and secondary osteoarthritis caused?
Intervertebral disc loses water content with ageing.
Pain is worse on extension of the spine.
184
What is the treatment for osteoarthritis of the facet joints?
Facet joint injections under fluoroscopy but not for non-specific multi-level osteoarthritis.
185
What is the intervertebral disc made of?
Outer annulus fibrosis.
Inner gelatinous nucleus pulposus.
186
Which vertebral discs are the most common to degenerate with age?
L4/5.
L5/S1.
187
When would surgery be considered for an intervertebral disc prolapse?
If the symptoms do not settle \>3 months post injury or with physio.
188
Which part of the intervertebral disc normally tears in an acute disc prolapse?
Annulus fibrosus.
189
Where do the mixed spinal nerves exit the spinal column?
Intervertebral foramen.
190
Which level does the spinal cord end at?
Conus medullaris - T12-L2 (commonly L1).
191
What are the symptoms of nerve injury in the cauda equina for an upper motor neuron?
Weakness, spasticity, increased tone and hyperreflexia.
192
What are the symptoms of nerve injury in the cauda equina for a lower motor neuron?
Weakness, flaccidity and loss of reflexes.
193
If there is a lesion of the lateral part of the cauda equina, what nerve root would be affected?
Traversing nerve root.
194
If there is a lesion of the central part of the cauda equina, what nerve root would be affected?
Exiting nerve root.
195
What is the exiting nerve root of the cauda equina?
Nerve root outside the thecal sac passes under the pedicle of the corresponding vertebra (ie L4 root passes under L4 pedicle).
196
What is the traversing nerve root of the cauda equina?
Remains in the thecal sac and is positioned anteriorly (in an area known as the lateral recess) in preparation to penetrate the thecal sac whilst becoming the next exiting nerve root more distally.
197
Which nerve root is commonly compressed in a disc prolapse?
The traversing nerve root.
## Footnote
*The exiting nerve root can be compressed in a far lateral disc prolapse.*
198
What does nerve root compression cause?
A radiculopathy resulting in pain down the sensory distribution of the nerve root (dermatome), which in the lower leg is known as sciatica.
Also weakness in any muscle supplied (myotome) and reduced or absent reflexes (lower motor neuron signs).
199
What is a myotome?
Muscle group supplied by a specific nerve root.
200
Compression of which nerve roots lead to sciatica?
L4-S1 nerve roots.
Radiation of nerve pain along the sensory distribution of the sciatic nerve = sciatica.
201
What is spinal stenosis?
Nerve roots become compressed by osteophytes and hypertrophied ligaments in osteoarthritis causing a radiculopathy or burning leg pain on walking (neurogenic claudication).
202
What is cauda equina syndrome?
Pressure (usually prolapsed disc) on all lumbosacral nerve roots at the level of lesion including sacral nerve roots for bladder and bowel control.
203
What are the symptoms of cauda equina syndrome?
Bilateral lower motor neuron signs.
Bladder and bowel dysfunction.
Saddle anaesthesia.
Loss of anal tone.
204
Which 3 muscles make up the erector spinae?
Iliocostalis.
Longissimus thoracis.
Spinalis thoracis.
205
What is the main function of the spinal ligaments?
206
What imaging modality is best to check loss of spinal stability?
MRI, xrays are not adequate for this.
207
What is a chance fracture?
Fractures vertebral body with disruption of the posterior ligaments with/without fracture of the posterior elements.
Very unstable fracture that may need surgical stabilisation.
208
Where in the spine would you perform a lumbar puncture or spinal anaesthesia and why?
Posterior iliac crest L4 or PSIS S2.
Any higher and you could injure the spinal cord. By doing it here you are putting a needle into the cauda equina.
209
What are the bone-related causes of back pain?
Fracture - trauma, osteoporosis (spondylolisthesis).
Tumour.
Infection.
210
What are the joint-related causes of back pain?
Spondylosis and osteoarthritis.
Spinal stenosis.
211
What are the muscle- and ligament-related causes of back pain?
Sprains and strains.
212
What are the disc-related causes of back pain?
Discogenic back pain.
Sciatica.
Cauda equina syndrome.
213
What is the inferior border of the axilla?
Armpit.
214
What is the superior border of the axilla?
Shoulder joint.
215
What is the medial wall of the axilla?
Superolateral spect of the chest
216
What is the anterior wall of the axilla?
Pectoralis major.
217
What are the functions of pectoralis major?
Climbing.
Accessory muscle of inspiration.
218
Where does the brachial vein become the axillary vein?
At the lower border of the teres major muscle.
219
What is the posterior wall of the axilla?
Teres major.
220
Where can pulsations of the subclavian artery be palpated?
Where the artery crosses the first rib.
221
Where does the subclavian artery become the axillary artery?
At the lateral border of the first rib.
222
What are the roots of the brachial plexus?
Anterior rami of C5-T1 spinal nerves.
223
What are the trunks of the brachial plexus?
**Superior** = combined anterior rami of C5-6 spinal nerves.
**Middle** = anterior ramus of C7 spinal nerve.
**Inferior** = combined anterior rami of C8 & T1 spinal nerves.
224
What are the divisions of the brachial plexus?
Each trunk divides to give an anterior and posterior division which combine to give cords.
225
What are the cords of the brachial plexus?
Medial.
Lateral.
Posterior.
226
Which cord of the brachial plexus is a direct continuation of the anterior division of the inferior trunk?
Medial cord.
227
Which cord of the brachial plexus is formed from the anterior divisions of the superior and middle trunks?
Lateral cord.
228
Which cord of the brachial plexus is formed from the posterior divisions of all three trunks?
Posterior.
229
What are the named nerves of the brachial plexus?
Ulnar nerve.
Musculocutaneous nerve.
Axillary nerve.
Radial nerve.
Median nerve.
230
Which nerve of the brachial plexus continues directly from the medial cord?
Ulnar nerve.
231
Which nerve of the brachial plexus continues directly from the lateral cord?
Musculocutaneous nerve.
232
Which nerves of the brachial plexus are branches of the posterior cord?
Axillary and radial nerves.
233
Which nerve of the brachial plexus is formed from the medial and lateral cords?
Median nerve.
234
Where are the roots and trunks of the brachial plexus found?
Between the anterior and middle scalene muscles in the root of the neck.
235
Where are the divisions of the brachial plexus found?
Immediately posterior to the subclavian vessels in the root of the neck (deep to the clavicle).
236
Where are the cords of the brachial plexus found?
Around the axillary artery, which is distal to the first rib.
237
What muscles does the musculocutaneous nerve supply?
Coracobrachialis.
Biceps brachii.
Brachialis muscles.
238
What muscles do the radial and axillary nerve supply?
Posterior compartment of the arm.
239
Which nerve is vulnerable to injury in a shoulder dislocation or fracture neck of humerus?
Axillary nerve.
240
Which nerve is vulnerable to injury in a mid-shaft humeral fracture?
Radial nerve.
241
What is the femoral sheath?
A short tube of transversalis and iliopsoas fascia from the abdominal wall which surrounds the proximal parts of the femoral artery and vein.
Inferiorly, sheath blends with adventitia of these vessels.
242
What does the saphenous nerve supply?
Fascia and skin of the anteromedial aspects of the knee, leg and the medial aspect of the foot.
243
What is a femoral hernia?
Increased abdominal pressure resulting in peritoneum herniating into the femoral canal.
*Can present as a painful lump in the groin.*
244
What is found in the femoral canal?
Deep inguinal lymph nodes and adipose tissue.
245
What arteries supply the head of the femur and how?
Medial and lateral circumflex femoral arteries.
Pass superiorly in relation to the femoral neck and capsule of the hip joint.
246
Why is the femoral artery an important access route clinically?
Useful in angiograms, coronary artery stenting, aortic and mitral valve replacements, aortic aneurysm repair, contralateral femoral artery stenting, contralateral uterine artery embolisation.
247
Why is the femoral cannulation an important access route clinically?
Cannulation and nerve block procedures.
248
What is the inferior border of the external oblique aponeurosis?
Inguinal ligament.
249
Where does the inguinal ligament run between?
Between the anterior superior iliac spine (ASIS) and pubic tubercle forming a 'gutter'.
250
Where is the inguinal canal found?
The medial half of the inguinal ligament 'gutter'.
251
What is found in the inguinal canal?
Spermatic cord (males).
Round ligament (females).
252
What is the action of the iliopsoas and what nerve supplies it?
Flexion at the hip.
Anterior rami of the lumbar spinal nerves.
253
What is the action of the sartorius and what nerve supplies it?
Flexion at the hip and knee.
Femoral nerve.
254
What is the action of the quadriceps femoris and what nerve supplies it?
Extension of the knee (and weak flexion of the hip by rectus femoris).
Femoral nerve.
255
What muscles make up the quadriceps femoris?
Rectus femoris.
Vastus lateralis.
Vastus intermedius.
Vastus medius.
256
What does a positive 'knee jerk' confirm?
Function of the quadriceps muscle.
Function of the femoral nerve (spinal roots L2-L4).
Spinal cord connections (reflex arc).
Descending controls form the brain.
257
Which nerves give sensory innervation of the thigh?
Anterior cutaneous nerve of the thigh (branch of femoral nerve [L2-L4]).
Lateral cutaneous nerve of the thigh (branch of lumbosacral plexus [L2-L3]).
Cutaneous branch of the obturator nerve (L2-L4).
258
Where does lymph from the superficial structures of the lower limb drain to?
If following the great saphenous vein it drains into the superficial inguinal lymph nodes (-\> deep inguinal nodes) -\> external iliac nodes.
If following small saphenous vein it drains into the deep inguinal nodes -\> external iliac nodes.
259
What are the borders of the gluteal region?
Superior - iliac crests.
Inferior - gluteal gold/sulcus.
Lateral - greater trochanter of the femur.
260
What muscles can be found in the superficial layer of the gluteal region?
Gluteus maximus.
Gluteus medius.
Gluteus minimus.
261
What is the most powerful extensor muscle of the hip?
Gluteus maximus.
262
What are the actions of the gluteus medius and minimus?
Abduct and medially rotate the thigh at the hip joint.
263
What nerve supplies gluteus medius and minimus?
Superior gluteal nerve.
264
What is found in the inferior gluteal neurovascular bundle?
Inferior gluteal artery, vein and nerve (L5, S1, S2).
## Footnote
*Supplies gluteus maximus.*
265
What is found in the superior gluteal neurovascular bundle?
Superior gluteal artery, vein and nerve (L5, S1, S2).
## Footnote
*Supplies gluteus medius and minimus.*
266
What is the action of the deep muscle layer of the gluteal region?
External (lateral) rotation of the lower limb at the hip joint.
Stabilise (hold) the head of the femur in the acetabulum.
267
What is the iliotibial tract?
Thickening of the deep fascia of the thigh -\> fascia lata.
268
What is the function of the iliotibial tract?
Support the knee.
269
What is the tensor fasciae latae?
The muscular part of the fascia lata which is enclosed in the proximal portion of the iliotibial tract.
270
Which parts of the lower limb does the sciatic nerve supply?
Posterior compartment of the thigh.
Posterior and lateral compartments of the leg.
271
What does the pudendal nerve supply?
Muscles, fascia and skin of the perineum.
272
What does the posterior cutaneous nerve of the thigh supply?
Skin over the posterior aspect of the thigh.
273
What is the method of a lumbar puncture?
Patient should lie on their left side fully flexed (knees to chin).
Iliac crests should be IDed and plane between them visualised (L3/4 level).
Spinal pack should be used to withdraw cerebrospinal fluid at this level.
274
Why do you insert a lumbar puncture at the L3/L4 level?
The spinal cord ends around the L1/2 intervertebral disc, so insertion at the L3/4 level avoids injury to the terminal part of the spinal cord (conus medullaris).
275
Where does the sciatic nerve divide and into what?
Anywhere between the gluteal region and the popliteal fossa (most commonly inferior 1/3rd of thigh).
Tibial and common fibular nerves.
276
What muscles make up the hamstrings?
Semimembranosus.
Semitendinosus (medially).
Biceps femoris (laterally).
277
What are the actions of the hamstring muscles?
Extend and flex the hip and knee joints.
278
Where are the tendons of the hamstrings bound?
Superomedially and superolaterally to the popliteal fossa.
279
Why is the short head of the biceps femoris not considered a 'true' hamstring muscle?
Attaches to the linea aspea of the femur, not the ischeal tuberosity.
Doesn't cross the hip joints -\> doesn't contribute to movement of the hip joint.
Supplied by the common fibular branch of the sciatic nerve, not the tibial branch.
280
Where does the ligament of the head of the femur attach to?
Depth of the acetabulum.
281
Which muscles are involved in movement at the shoulder joint?
Deltoid.
Trapezius.
Levator scapulae.
Rhomboids.
Rotator cuff (SITS) muscles.
Teres major.
282
Which part of the deltoid is responsible for extension at the shoulder?
Posterior (spinal) part of deltoid.
283
Which part of the deltoid is responsible for abduction at the shoulder (taking over from supraspinatus beyond 15 degrees)?
Middle (acromial) part of deltoid.
284
Which part of the deltoid is responsible for mainly flexion at the shoulder?
Anterior (clavicular) part of deltoid.
285
What are the parts of the trapezius and what are their actions?
Ascending - scapular depression.
Middle - scapular retraction.
Descending - elevation of the scapula.
Ascending and descending parts together produce superior rotation of the glenoid fossa.
286
What is the action of the levator scapulae?
Elevation of scapula and inferior rotation of the glenoid fossa.
287
Which rhomboid causes retraction of the scapular and inferior rotation of the glenoid fossa?
Both rhomboid major and minor.
288
What are the rotator cuff muscles?
**SITS.**
**S**upraspinatus.
**I**nfraspinatus.
**T**eres minor.
**S**ubscapularis.
289
Which rotator cuff muscle is responsible for the first 15 degrees of abduction at the shoulder?
Supraspinatus.
290
Which rotator cuff muscle is responsible for stabilising the head of the humerus in the glenoid and lateral rotation at the shoulder?
The infraspinatus and teres minor.
291
Which rotator cuff muscle is responsible for stabilising the head of the humerus in the glenoid and medial rotation at the shoulder?
Subscapularis.
292
What is the action of the teres major muscle?
Adduction/medial rotation at the shoulder.
293
Why is superior rotation of the glenoid is required?
To prevent the greater tubercle of the humerus from impinging on the acromion of the scapular i.e. without this movement we would be unable to fully abduct our upper limb.
294
Which rotator cuff muscles insert onto the greater tubercle of the humerus?
Supraspinatus.
Infraspinatus.
Teres minor.
295
Which rotator cuff muscle inserts onto the less tubercle of the humerus?
Subscapularis.
296
What can lead to 'painful arc syndrome'?
Impingement of the supraspinatus tendon between the humerus and the acromion process.
## Footnote
*Patients complain of pain during 50-130 degrees of abduction.*
297
What nerve supplies the deltoid muscle?
Axillary nerve.
298
What are the proximal attachments of the deltoid?
Lateral third of the clavicle.
Inferior aspects of the scapular spine and acromion.
299
What is the distal attachment of the deltoid?
Deltoid tuberosity of the humerus.
300
What is the function of the rotator cuff muscle tendons?
Strengthen the fibrous capsule of the shoulder joint superiorly (supraspinatus) and posteriorly (infraspinatus and teres minor).
301
Where is the subacromial bursa?
Between the supraspinatus tendon and acromion process of the scapula.
302
What is the sensory innervation medially to the posterior aspect of the arm?
Anterior rami of spinal nerves C8, T1 and T2.
303
What is the sensory innervation laterally to the posterior aspect of the arm?
Anterior rami of spinal nerves C5 and C6 via the axillary nerve.
304
What is the only muscle found in the posterior compartment of the arm?
Triceps brachii.
305
What is the innervation of the triceps brachii?
Radial nerve (nerve of the posterior compartment of the arm).
306
What are the proximal attachments of the triceps brachii?
Infraglenoid tubercle of the scapula (long head), superior (lateral head) and inferior (medial head) to the radial groove of the humerus.
307
What are the distal attachments of the triceps brachii?
All three heads combine to form the triceps tendon, which attaches to the olecranon process of the ulna.
308
What are the actions of the triceps brachii?
Weak extension of the arm at the shoulder joint.
Extension of the forearm at the elbow joint.
309
Where is the axillary nerve found?
Quadrangular space.
310
What are the borders of the quadrangular space?
Superior - teres minor.
Inferior - teres major.
Medial - long head of the triceps.
Lateral - humerus.
311
What muscles does the axillary nerve supply?
Deltoid.
Teres minor.
312
What is the area of skin innervated by the axillary nerve called?
Badge patch (lateral aspect of the arm).
313
Where would you find the radial nerve in the posterior compartment of the arm?
In the radial groove of the humerus.
314
What nerve is likely to be damaged in a (spiral) mid-shaft fracture of the humerus?
Radial nerve.
315
What are the actions of the superficial layer of muscles in the posterior compartment of the forearm?
Extension, adduction and abduction of the wrist (carpus).
Extension of the fingers (digitorum).
316
What are the actions of the deep layer of muscles in the posterior compartment of the forearm?
Extension and abduction of the thumb (pollicis).
Supination of the forearm at the proximal and distal radioulnar joints.
317
What are the proximal attachments of the superficial layer of muscles in the posterior compartment of the forearm?
Common extensor tendon on the lateral epicondyle of the humerus.
318
What are the proximal attachments of the deep layer of muscles in the posterior compartment of the forearm?
Shafts of the radius and ulna and the interosseous membrane.
319
What is the nerve supply to the muscles in the posterior compartment of the forearm?
Radial nerve.
320
Which muscle is located at the boundary between the anterior and posterior compartments of the forearm and what's its action and innervation?
Brachioradialis.
Flexion of the semi-pronated forearm (as when drinking from a cup).
Radial nerve.
321
Where does the radial nerve branch into its superficial and deep branches?
Anterior to the lateral epicondyle.
322
What does the deep branch of the radial nerve supply?
Supinator muscle of the posterior compartment of the forearm.
323
What nerve does the deep branch of the radial nerve become once it has passed through the supinator muscle?
Posterior interosseous nerve.
324
What does the posterior interosseous nerve supply?
Muscles of the posterior compartment of the forearm.
325
What are the muscles of the anterior compartment of the arm and what is their innervation?
Biceps brachii.
Coracobrachialis.
Brachialis.
Musculocutaneous nerve.
326
What are the two distal tendons of the biceps brachialis?
Biceps tendon and bicipital aponeurosis.
327
What are the proximal attachments of the biceps brachii?
Supraglenoid tubercle of the scapula (via the long head) and to the coracoid process of the scapula (via the short head).
328
Which head of the biceps brachii passes superiorly in the intertubercular groove/sulcus of the humerus and becomes enclosed within the fibrous layer of the shoulder joint capsule to reach the supraglenoid tubercle of the scapula?
Long head.
329
What are the distal attachments of the biceps brachii?
Biceps tendon - radial tuberosity.
Biceps aponeurosis - blends with the deep (antebrachial) fascia on the medial side of the proximal forearm.
330
What are the attachments of the coracobrachialis?
From the coracoid process of the scapula to the humerus.
331
What separates the coracobrachialis from the triceps?
Medial intermuscular septae.
332
What are the attachments of the brachialis?
From the humerus to the coronoid process of the ulna.
333
What separates the brachialis from the triceps?
Lateral intermuscular septae.
334
Which muscle is the most powerful supinator of the forearm?
Biceps brachii.
335
What is the innervation of the anterior compartment of the forearm?
Median nerve, except the flexor ulnaris carpi and the medial part (digits 4 & 5) of the flexor digitorum profundus which are supplied by the ulnar nerve.
336
What are the actions of the muscles of the anterior compartment of the forearm?
Flexion, abduction and adduction of the wrist (carpus).
Flexion of the fingers (digits 2-5).
Flexion of the thumb (digit 1 - muscles named pollicis).
Pronation of the forearm at the proximal and distal radioulnar joints.
337
Which muscles are found in the superficial layer of the anterior compartment of the forearm?
**Pronator teres**.
**Palmaris longus** (distally attaches to the palmar aponeurosis).
**Flexor carpi radialis** (distally attaches to the metacarpals on the radial side).
**Flexor carpi ulnaris** (distally attaches to the metacarpals on the ulnar side).
338
What are the proximal attachments of the muscles of the superficial layer of the anterior compartment of the forearm?
Common flexor tendon to the medial epicondyle of the humerus.
339
Which muscles are found in the intermediate layer of the anterior compartment of the forearm?
**Flexor digitorum superficialis** (four muscle bellies/tendons for the medial four digits).
340
What are the proximal attachments of the muscles of the intermediate layer of the anterior compartment of the forearm?
Distal humerus, coronoid process of ulna and radial head.
341
Which muscles are found in the deep layer of the anterior compartment of the forearm?
**Flexor digitorum profundus** (four bellies/tendons).
**Flexor** **pollicis** **longus** (attaches proximally to the shaft of the radius, ulna and interosseous membrane).
**Pronator quadratus** (attaches between distal anterior surfaces of radius and ulna.
342
What are the proximal attachments of the muscles of the deep layer of the anterior compartment of the forearm?
Distal to the intermediate muscles of the anterior compartment of the forearm.
343
What is 'golfers elbow'?
AKA medial epicondylitis.
Tendonitis of the common flexor tendon (proximally attaches tot he medial epicondyle of the humerus).
344
What are the boundaries of the cubital fossa?
Superior - a transverse line between the epicondyles of the humerus.
Medial - pronator teres.
Lateral - brachioradialis.
345
What are the superficial contents of the cubital fossa?
Median cubital vein.
Cephalic vein.
Basilic vein.
346
What structures are palpable in the cubital fossa?
Distal tendon (deep and lateral) and aponeurosis (medial) of the biceps brachii.
347
What are the deep contents of the cubital fossa?
Median nerve (medially).
Brachial artery.
Radial nerve (laterally).
348
What does the brachial artery bifurcate into and where?
Radial and ulnar arteries.
Apex of the triangle.
349
What is the cubital fossa?
Triangular space between skin and the anterior aspect of the capsule of the elbow joint.
350
What is the innervation of the skin and fascia of the cubital fossa?
Cutaneous nerves of the arm and forearm.
351
Where can the ulnar nerve be palpated and readily injured?
It crosses the posterior surface of the medial epicondyle of the humerus.
352
What is the flexor retinaculum?
Thickening of the antebrachial (deep) fascia of the distal anterior forearm.
353
What are the attachments of the flexor retinaculum?
Scaphoid/trapezoid laterally and pisiform/hamate medially.
354
What is the function of the flexor retinaculum?
Prevents 'bowstringing' of the tendons during flexion, which would reduce muscle efficiency.
355
What is the carpal tunnel structure formed of?
Carpal bones (posteriorly).
Flexor retinaculum (anteriorly).
356
What are the contents of the carpal tunnel?
Long tendons of the forearm flexor muscles and the median nerve.
357
What is carpal tunnel syndrome?
Compression of the median nerve due to swelling in the carpal tunnel.
358
Which nerve is spared in carpal tunnel syndrome?
Palmar cutaneous branch of the median nerve as it branches off proximal to the tunnel and travels superficially to reach the skin of the palm.
359
What does the superficial branch of the radial artery anastomose with to form the superficial palmar arch?
**Superficial palmar branch of the ulnar artery.**
This happens deep to the palmar aponeurosis.
360
Where is the deep palmar arch found?
Runs across the anterior aspects of the bases of the metacarpals.
361
What arteries anastomose to form the deep palmar arch?
Deep branch of the ulnar artery.
Deep branch of the radial artery.
362
What is Dupuytren's contracture?
Pathology affecting the palmar fascia that causes thickening and shortening (contracture) leading to fixed flexion deformities of the ring and little fingers, particularly.
363
What is the neurovascular supply of the fingers?
Each finger has four neurovascular bundles supplying it:
* Medial palmar.
* Lateral palmar.
* Medial dorsal.
* Lateral dorsal.
364
What is a 'ring block'
Technique to anaesthetise a finger.
Local anaesthetic is injected in a 'ring' around the base of the finger to anaesthetise all four proper digital nerves.
365
Why should you never use adrenaline along with local anaesthetic in a ring block?
The proper digital arteries are end arteries thus adrenaline will cause ischaemia in the digits as there is no other blood supply.
366
What part of the palmar aspect of the hand does the ulnar nerve provide sensory innervation to?
Medial part of the palm.
Little finger.
Medial half of the ring finger.
367
What part of the palmar aspect of the hand does the median nerve provide sensory innervation to?
Central/lateral palm.
Medial half of the ring finger.
Middle & index finger.
Thumb (excluding skin over the base).
368
What part of the palmar aspect of the hand does the radial nerve provide sensory innervation to?
Skin over the base of the thumb.
369
What part of the dorsal aspect of the hand does the ulnar nerve provide sensory innervation to?
Medial part of the dorsum of the hand.
Little finger.
Medial half of the ring finger.
370
What part of the dorsal aspect of the hand does the median nerve provide sensory innervation to?
Skin over the distal phalanges/nail beds of the thumb, index finger and middle finger.
371
What part of the dorsal aspect of the hand does the radial nerve provide sensory innervation to?
Skin over the anatomical snuffbox.
Lateral part of the dorsum of the hand.
Proximal index and middle fingers.
372
What are the attachments of the fibrous digital sheaths?
Both sides of the phalanges and form a secure tunnel through which the FDS, FDP and FPL tendons and their synovial sheaths travel distally.
373
What is the anatomical snuffbox?
Triangular depression on the radial, dorsal aspect of the hand that was used to place and sniff (snuff) powdered tobacco.
374
What does tenderness int he floor of the anatomical snuffbox following trauma suggest?
Scaphoid fracture.
375
What are the attachments of the lumbricals of the digits?
Attach between the FDP tendon and the extensor expansion of the same digit.
They span the anterior aspect of the 2nd to 5th MCP joints and then the posterior aspect of the 2nd to 5th PIP joints.
376
What is the action of the lumbricals of the hand?
Flex the MCP and extend the PIP joints.
377
Which nerves supply the lumbricals of the hand?
Ulnar nerve - medial 2 lumbricals.
Lateral nerve - lateral 2 lumbricals.
378
What are the actions of the interossei of the hand?
**P**almar interossei **ad**duct the digits (**PAD**).
**D**orsal interossei **ab**duct the digits (**DAB**).
379
Which nerve supplies the interossei muscles of the hand?
Ulnar nerve.
