Anatomy Flashcards
(155 cards)
1
Q
What is the innervation and blood supply of the abductor digits minimi?
A
Deep branch of ulnar artery. deep branch of the ulnar nerve (C8&T1).
2
Q
What does the posterior interosseous artery supply?
A
superficial and deep extensor compartment of the forearm.
3
Q
What is the blood supply of the palmar interossei muscles?
A
Palmar metacarpal artery.
4
Q
What dorsal roots supply the lateral femoral cutaneous nerve?
A
L2-L3.
5
Q
What does the anterior interosseous artery supply?
A
The flexor compartment of the forearm.
6
Q
What is the main blood supply to the femoral head?
A
deep branch of the medial femoral circumflex artery.
7
Q
At birth what is the blood supply to the femoral head? What becomes the main blood supply?
A
MFCA, LFCA, and artery the ligament teres.
8
Q
What innervates the Gluteus maximus?
A
inferior gluteal nervel.
9
Q
What innervates the iliacus muscle?
A
femoral nerve.
10
Q
What nerve is formed by branches of L5, S1, and S2?
What muscles does in innervate?
A
Superior gluteal nerve
Gluteus medius and gluteus minimus
11
Q
What nerve roots supply the common peroneal nerve?
Superficial vs Deep Peroneal
A
L4-S2
L4-S1 superficial
L4-L5 Deep
12
Q
What nerve roots supply the saphenous nerve?
A
L3-L4
13
Q
What nerve roots supply the sural nerve?
A
S1-S2
14
Q
What are the layers of the quadriceps tendon?
A
3 layers
Superficial fromed rectus femoris
Middle fromed vastus medialis and lateralis
Deep formed by vastus intermedius
15
Q
What is the blood supply to the patella?
A
anastomotic ring from the geniculate arteries.
Most important blood supply is located at the inferior pole.
16
Q
Where does the AITFL specifically attatch?
A
anterior aspect of lateral distal tibial epiphysis (CHAPUT TUBERCLE) to the anterior aspect of distal fibula (WAGSTAFFE TUBERCLE).
17
Q
Where does the ulnar nerve run in the forearm?
A
Between the FDP and FCU.
18
Q
How far from the following locations does the radial nerve pass through the spiral groove?
Coracoid?
Distal aspect of lesser tubersoity?
Superior latissimus dorsi insertion?
Inferior latissimus dorsi insertion?
A
13cm
10cm
8cm
4cm
19
Q
Which pediatric joints have intra-articular metaphyseal cortex?
Which notable joint does not?
A
Hip, shoulder, elbow, and ankle
Knee does not.
20
Q
What structure can connect the psoas directly to the hip joint and lead to spread of infection?
A
Psoas bursa
direct passage between the iliofemoral and iliopubic ligaments.
21
Q
What muscles typically insert of the medial border of the scapula.
A
levator scapulae
rhomboids major and minor
teres major
latissimus dorsi
22
Q
Describe the Brachial Plexus in Detail?
A
23
Q
True of false? The proximal femoral physis and greater trochanteric aophysis develop from different cartilage physis
A
False, they develop from the same cartilage physis and then undergo apoptotic division in the child.
24
Q
What interval is used for a Ludloff approach to the hip?
A
medial approach between the pectineus and adductor longus and brevis.
25
What is a Weinstein approach?
anteromedial approach to the hip between the neurovascular bundle and pectineus.
26
What is a Ferguson approach?
posteromedial approach. Superficially between the adductor longus and gracilis.
Deep between the adductor brevis and adductor magnus.
27
What is the origin and insertion of the posterior tibial tendon?
**Origin**: posterior tibia, fibula, and interosseous membrane.
**Insertion**: Three parts. ANTERIOR- navicular tuberosity and plantar surgace of the 1st cuneiform.
The MIDDLE plantar portion inserts into the bases of the 2md-4th metatarsals, the 2nd and 3rd cuneiforms, the cuboid, and the flexor hallucis brevis muscle.
The POSTERIOR recurrent portion inserts into the sustentaculum tali.
28
What is the internervous and intermuscular planes for the smith-peterson approach?
SUPERFICIAL: Sartorius(femoral nerve) and TFL(Superior gluteal nerve)
DEEP: Rectus Femoris(femoral nerve and gluteus medius(superior gluteal nerve)
29
Where does the indirect head of the rectus femoris orginate?
Concavity above the acetabulum.
30
What forms the quadrilateral space?
Confluence of the:
teres minor superiorly
teres major inferiorly
long head of triceps medially
surgical neck of the humerus laterally
Can compress the axillary nerve and posterior humeral circumflex artery leading to quadrilateral space syndrome.
31
What is normal femoral anteversion at birth?
What is a normal acult femoral anteversion?
30-40 degrees
15 degrees
Not much change occurs after 8 years of age.
32
What is the first bone to ossify?
Medial clavicle.
33
What is the last physis to close?
medial clavicle Age 20-25.
34
What is the structure most important for anterior-posterior stability of the sternoclavicular joint?
posterior capsular ligament.
35
What is the treatment for a traumatic sternoclavicular dislocation?
Closed reduction under general surger with thoracic surgery on standby.
Needs to be acute \< 3 weeks.
Stable Reduction: Velpeaus bandage for 6 weeks. Elbow exercises at 3. Return to sport at 3 months
Unstable Reduction: Accept deformity of medial clavicle excision.
36
What ligaments make up the coracoclavicular ligaments?
Where do they insert?
Which is the strongest?
Trapezoid (3 cm from end of clavicle)
Conoid ligament (4.5cm from end of clavicle along posterior border)
Conoid is strongest.
37
What is thought to be the main blood supply to the humeral head?
Posterior humeral circumflex artery.
38
How far is the axillary nerve usually found from the distal tip of the acromion?
7cm
39
Which of the CC ligaments are closer to the AC joint?
What are the distances of each from the AC joint typically?
Trapezoid ligament 2cm
Conoid ligament 4cm
40
The medial epicondyle is the origin for?
UCL
Flexor pronator mass.
41
What is the blood supply to the medial epicondyle?
Anterior: branches of inferior ulnar collateral artery
Posterior: branches of the superior and inferior ulnar collateral artery
42
What makes up the TFCC?
ECU tendon sheath, articular disc, dorsal and volar radioulnar ligaments, the meniscus homologue, and the ulnar collateral ligament.
43
Name all of the structures.
44
What are the components of the extensor hood and what are their functions?
Central slip- helps to extend PIP. Inserts onto the base of the middle phalanx.
Lateral band- Fuctions to extend DIP interts into distal phalanx.
Lumbricals, extensor indicis, dorsal and palmar interossei insert on lateral band.
45
Which ligament is dorsal to the digital nerves. Cleland's or Grayson's ligament?
Cleland for "C'eiling so dorsal to digital nerves.
Grayson's for "G"round volar to digital nerves
46
What components make up MCP joint collateral ligaments?
Accessory Ligament- volar. Tight in extension. Test wtih adduction/abuction stress in extension.
Proper Ligament- Dorsal. Tight in 30 degrees of flexion. Test in 3- degrees of flexion.
47
What is usually the predominant blood supply the superfical arch of the hand?
Ulnar artery
Minor supply from superficial branch of radial artery.
48
What is different about the digital arteries in the palm compared to digital arteries in the digits?
Digital arteries are volar to digital nerves in the palm and then dorsal to digital nerves in the digits.
49
Which arterial arch is more distal, the superfical or deep?
Superficial arch is more distal and the deep arch is more proximal.
superficial arch is at the level of the fully abducted thumb.
Deep arch is one fingerbreadth proximal.
50
What is the predominant blood supply to the deep arch of the hand?
Deep branch of the radial artery.
Minor supply from the deep branch of the ulnar artery.
51
True or false dominant digital arteries are found on the median side of the digit (closer to midline)
True
Index finger is ulnar
Little finger is radial.
52
What is the blood supply dorsal metacarpal artery flaps?
Posterior interosseous artery and or dorsal perforation branch of anterior interosseous artery.
53
What is the course of the AIN?
Branches from the median nerve within the forearm 5-8CM distal to the lateral condyle.
Passes between the two heads of the pronator teres.
Runs along the volar FDP.
Ends in pronator quadratus at wrist.
54
What is the course of the PIN?
Branches from the radial nerve at the level of the radiocapitellar joint.
Dives through the supinator at the Arcade of Frohse.
Courses around the radial neck
Emerges within the deep compartment of the forearm
Ends in the dorsal wrist capsule
55
What is the course of the superficial branch of the radial nerve?
Branches from the radial nerve at the level of the radiocapitellar joint.
Runs deep to the brachioradialsi and latera to the radial artery.
Pierves the fascia of the forearm 7-9cm proximal to the wrist where it courses to supply sensation over the snuffbox and dorso-radial hand.
56
What is the course of the median nerve?
runs with brachial artery where it enters the forearm between the pronator teres and biceps tendon.
Travels between the flexor digitorum superficialis and profundus until
emerging between flexor digitorum superficialis and flexor pollicis longus distally and entering the carpal tunnel.
57
What is the dual innervation of the FDP?
index and long are innervated by the AIN of the median nerve.
Ring and small fingers are innervated by the ulnar nerve.
58
FCU inserts where in the extremity?
pisiform
hook of hamate
base of the 5th metacarpal
59
What is and where is camper chiasm?
Where FDP and FDS split.
Located at the level of the proximal phalanx.
60
What is the major blood supply to the scaphoid?
What supplies the distal 20% of the scaphoid?
Dorsal carpal brach of the radial artery- enters the scaphoid in a non-articular ridge on the dorsal surface and supplies proximal 80% of scaphoid via retrograde flow
Superficial palmar arch branch of the volar radial artery.
61
What structure lies under the hook of the hamate?
Deep branch of the ulnar nerve
62
What structures form Guyon's Canal?
**Roof-** Superficial palmar carpal ligament
**Floor-** Deep flexor retinaculum, hypothenar muscles
**Ulnar border-** pisiform and pisohamate ligament
**Radial border-** hook of hamate
63
Where is the pisiform bone found?
It is the most ulnar and plamar carpal bone in the proximal row.
## Footnote
**Is a sesmoid bone and is located within the FCU tendon.**
64
Identify the structures in the photo.
65
Where does the radialis longus insert?
Where does the radialis brevis insert?
Base of Metacarpal II
Base of Metacarpal III
66
Where are the sesmoids of the hand?
Pisiform
sesamoid attached to flexor pollicis brevis and abductor pollicis brevis in thumb.
67
What is the primary stabilizer of the MCP joint?
Proper collateral ligaments.
Originate from the dorsal aspect of metacarpal head
Insert on the volar aspect of base of proximal phalanx
68
What structures stabilize the DIP joint?
Collateral ligaments. Both primary and accessory
Terminal Extensor tendon
FDP
Volar plate
69
What structures stabilize the PIP Joint?
Collateral ligaments. Both Proper and Accessory
Central Slip
FDS
Volar Plate
70
What muscles create deforming forces in base of the thumb fractures?
Abductor pollicis longus (PIN)- Poximal, dorsal, and radial force on the shaft fragment.
Extensor pollicis longus (PIN)- Proximal, dorsal, and radial force on the shaft fragment.
Adductor pollicis (Ulnar N.)- Supination and adduction force on the shaft fragment.
71
What are the ligaments of the thumb CMC joint?
72
Where is the radial nerve proximal to the lateral epicondyle and the medial epicondyle?
14cm proximal to lateral epicondyle
20cm proximal to medial epicondyle
73
What are the brnaches of the median nerve at the level of the wrist?
**palmar cutaneous branch**- lies between PL and FCR at level of the wrist flexion crease
**Recurrent motor branch-** 50% are extraligamentous, 30% are subligamentous, and 20% are transligamentous.
**Because they can be transligamentous this is why we cut the transverse ligament far ulnarly.**
74
What three muscles are innervated by the AIN?
FDP to index and long.
FPL
Pronator Quadratus
75
Describe the branching point and course of the AIN?
branches from the median nerve 4-6cm distal to the medial epicondyle.
Travles between the FDS and FDP initiially, then between FPL and FDP, then it lies on the naterior surface of the interosseous membrane where it travels with the anterior interoseous artery to pronator quadratus.
Terminal branch innervates the joint capsule and the intercarpal, radiocarpal, and distal radioulnar joints.
76
What attaches to the coronoid?
No avulsion injuries of the tip as nothing attaches there.
Anterior bundle of the medial UCL attaches to the sublime tubercle 18mm distal to tip.
Anterior capsule attaches 6mm distal to the tip of the coronoid
77
Describe the kocher approach?
What are the pros and cons of this approach over a Kaplan approach if used for a radial head replacement?
Between ECU (PIN) and anconeus (radial n.)
PRO: less risk of PIN injury because it is more posterior
CON: risk of destabilizing elbow if capsule incision is too posterior and LUCL is violated. **Stay anterior crista supinatoris.**
78
What is Kaplans interval?
EDC (PIN) and ECRB (radial n.)
PRO: less risk of LUCL injury with this approach
CON: greater risk of PIN and radial nerve injury.
79
Where does the ulnar nerve pass from the anterior compartment of the arm to the posterior compartment?
At the arcade of Struthers which is 8cm proximal to the medial epicondyle.
80
What forms the roof, floor, and walls of the cubital tunnel?
ROOF: FCU fascia and Osborne's ligament (travels from the medial epicondyle to the olecranon)
FLOOR: formed by posterior and transverse bands of MCL and elbow joint capsule
WALLS: formed by medial epicondyle and olecranon.
81
What are the zones of Guyons Canal?
82
What is innervated by the deep branch of the ulnar nerve?
all of the interosseous muscles
3rd and 4th lumbricals
Innervates the hypothenar muscles, the adductor pollicis, medial head (deep) of the flexor pollicis brevis (FPB).
83
What is the course of the PIN?
Passes between the two heads of origin of the supinator muscle
Direct contact with the radial neck osteology
Passes over abductor pollicis longus muscle origing to reach interosseous membrane
Transverses along the posterior interosseous membrane
84
Where is the radial tunnel and what are the boundaries?
Extends from the level of the radiocapitellar joint, extending distally past the proximal edge of the supinator. 5cm in length.
**Lateral-** Brachioradialis, ECRL, and ECRB
**Medial-** biceps tendon and brachialis
**Floor-** capsule of the radiocapitellar joint
85
What is the course of the superficial radial sensory nerve?
Arises form the bifurcation of the radial nerve in the proximal forearm
Travels deep to the brachioradialis in the forearm.
Emerges from between brachioradialis and ECRL 9cm proximal to radial styloid
Bifurcates proximal to the wrist:
Dorsal branch lies 1-3cm radial to Lister's tubercles supplies 1st and 2nd web space.
Palmar branch passes within 2cm of 1st dorsal compartment directly over EPL supplies dorsolateral thumb.
86
What is the origin and insertion of the lumbrical?
Originate from the FDP
Insert on the lateral bands.
87
What is the purpose of the triangular ligament?
spans the two lateral bands preventing them from subluxating volarly
88
What is the purpose of the transverse retinacular ligament?
Prevents dorsal subluxation of the lateral bands.
89
What forms the lateral bands?
The deep head of the dorsal interossi combining with the volar interossi.
The lateral bands insert onto the base of the distal phalanx to extend the DIP joint.
90
What 5 ligaments comprise the interosseous membrane in the forearm?
What ligament is key when considering reconstruction after injuries?
Central band, accessory band, distal oblique bundle, proximal oblique cord, and dorsal oblique accessory cord.
## Footnote
**central band**
91
What adult forearm fracture can be treated non-operatively.
Nightstick fracture.
isolated, nondisplaced, and distal 2/3 of ulna.
\<50% displacement and \< 10 degrees of angulation.
**Even isolated non-displaced radial shaft fractures cannot be treated with non-operative management.**
92
How should open both bone forearm fractures with segmental bone loss be treated?
Need bone graft even in small defects.
This is really the only considertion for acute bone grafting.
Should be delayed grafting in open injures.
In Gustillo IIIb and IIIC should consider external fixation.
93
What is the primary advantage of fixing both bone forearm fractures through two incisions instead on one.
Lower risk of synostosis.
94
What are the extensor compartments of the hand?
95
Describe the common iliac vascular system?
Common iliac system begins near L4 at bifurcation of abdominal aorta
External iliac artery courses anteriorl along pelvic brim and emerges as the common femoral artery distal to the inguinal ligament.
Internal iliac artery dives posterior near SI joint and divides into the posterio division (giving off superior gluteal artery) and the anterior division (becoming obturator artery)
96
Corona mortis is a connection between wich two vessels?
obturator artery and external iliac artery.
Mean distance is 6.2cm from the pubic symphysis.
97
What structures exit the pelvis through the greater sciatic foramen?
**Above the piriformis:** superior gluteal vessles and superior gluteal nerve
**Below the piriformis:** Inferior fluteal vessles, inferior gluteal nerve, internal pudendal vessels, pudendal nerve, sciatic nerve, posterior femoral cutaneous nerve, nerve to obturator internus and nerve to quadratus femoris.
**Greater sciatic foramen boundaries:** ANTEROLATERALLY- greater sciatic notch of ilium. POSTEROMEDIALLY- by the sacrotuberous ligament. INFERIORLY- sacrospinous ligament and ischial spine. SUPERIORLY- anterior sacroiliac ligament.
98
What is the lateral inclination and anteversion of the native acetabulum?
40-48 degrees inclination
18-21 degrees anteversion.
99
What comprises the posterior column of the inominate bone?
Anterior column?
Quadrilateral surface, Posterior wall and dome, ischial tuberosity, and greater/lesser sciatic notches.
Anterior ilium (border ar gluteus medius tubercle), anterior wall and dome, ilipectineal eminence, and lateral superior pubic ramus
100
What are the three working windows and their borders for the ilioinguinal approach?
What is the space of Retzius, lacuna vasorum, and lacuna musculorum?
MEDIAL WINDOW: medial to external iliac artery & ven.
MIDDLE WINDOW: between external iliac vessels and the iliopsoas
LATERAL WINDOW: lateral to iliopsoas(iliopectinial fascia)
SPACE OF RETZIUS: plane between symphysis pubis and the bladder
LACUNA VASORUM: femoral vessles and surrounding lymphatics
LACUNA MUSCULORUM: iliopsoas, femoral nerve, and LFCN.
101
During the ilioinguinal approach when unroofing the inguinal canal what structrues are exposed that should be isolated and protected?
ilioinguinal nerve. travels with round ligament through the superficial inguinal ring.
**Does not pass through the deep inguinal ring.**
Should also isolate spermatic cord/round ligament and place a penrose around structures to retract.
102
What is the difference between the Southern/Moore and the Kocher-Langenbeck approach?
Not much, they both use the same interval/
Southern/Moore is a more limited hip arthroplasty approach. localized more posterior to the greater trochanter.
Kocher-Langenbeck is more extensile and can be used to expose the acetabulum.
103
What is the internervous plane for the Kocher-Langenbeck approach?
No true internervous plane.
Split gluteus maximus in avascular plane until first nerve branch to upper part of muscle is encountered. (Gmax is innervated by inferior gluteal nerve)
Upper 1/3 of muscle -\> superior gluteal artery
Lower 2/3 of muscles -\> inferior gluteal artery
104
The obturator internus followed to its origin will lead to what?
Lesser siatic notch
Contents: Tendon of obturator internus, nerve to obturator internus, pudendal nerve, and internal pudendal artery.
105
The pirifromis is a landmark leading to what during a kocher-langenbeck approach?
Greater sciatic notch
Contents: piriformis, superior/inferior gluteal vessels and nerves, sciatic and posterior femoral cutaneous nerves, internal pudendal vessels, nerve to the obturator internus muscle and quadratus femoris.
106
Which branch of the sciatic nerve has the best prognosis for recovery?
Tbial division has better prognosis despite intitial injury.
Peroneal division recovery is dependant on severity of initial injury.
107
What should you do if inferior fluteal artery is cut during a posterio approach to the hip?
Tie it off, if it retracts into the pelvis need to place patient supine, open abdomen, and tie off internal iliac artery or get them to IR if available.
Call vascular.
108
Excessive retraction of the quadratus femoris can lead to injury to what structure?
Medial circumflex artery.
109
What is the relation of the superior and inferior gluteal arteries to the piriformis?
Inferior leaves pelvis beneath piriformis
Superior leaves pelvis above the piriformis
110
What are the three compartments of the thigh?
What muscles are in each compartment?
**Anterior:** Sartorius, quadriceps
**Posterior:** biceps femoris, semitendinosus, semimembranosus
**Adductor:** Gracilis, adductor longus, adductor brevis, adductor magnus
111
Describe the course of the anterior tibial artery?
First branch of the popliteal artery
Passes between 2 heads of tibialis posterior and interosseous membrane (IOM)
Lies anterior to IOM between tibialis anterior and EHL
terminates as dorsalis pedis artery
112
Describe the course of the posterior tibial artery?
After anterior tibial artery branches off popliteal artery continues as posterior tibial artery in the deep posterior compartment of the leg
Takes an oblique course from there to pass behind the medial malleolus
Terminates by dividing into medial and lateral plantar arteries
113
Describe the couse of the peroneal artery?
branches off 2.5cm distal to popliteal fossa
continues in deep posterior compartment between tibialis posterior and FHL
terminates as clacaneal branches
114
What nerve roots are responsible for the tibial nerve and what is its course in the leg?
L4-S3
Crosses over popliteus from the popliteal fossa and splits the 2 heads of gastrocnemius
passes deep to soleus coursing to the posterior aspect of the medial malleolus
terminates as medial and lateral plantar nerves
muscular branches supply posterior leg (superficial and deep posterior compartments)
115
What nerve roots supply the common peroneal nerve?
What is its course in the leg?
L4-S2
Winds around neck of fibula and runs deep to peroneus longus
divides into superficial and deep peroneal nerves
116
What is the course of the superficial peroneal nerve in the leg?
courses along border between lateral and anterior compartments of leg
supplies muscular branches to peroneus longus and brevis (lateral compartment)
terminates as medial dorsal and intermediate dorsal cutaneous nerves
117
What is the course of the deep peroneal nerve?
courses along anterior surface of IOM
supplies musculature of anterior compartment and sensation to first web space
118
What is the course of the saphenous nerve in the leg?
L3-L4
continuation of femoral nerve of the thigh
becomes subcutaneous on medial aspect of knee between sartorius and gracilis
supples sensation to medial aspect of leg and foot
119
What nerve roots supply the sural nerve?
What is its course in the leg?
S1-S2
formed by cutaneous branches of tibial (medial sural cutaneous) and common peroneal (lateral sural cutaneous) nerves
lies on lateral aspect of leg and foot.
120
Name the following labeled structures?
Popliteus tendon and the popliteofibular ligament are the lateral knee structures that provie the most rotational stability in knee flexion.
The LCL provides rotational stability in knee extension.
121
What is a stener-type lesion of the MCL
torn MCL flipped over the inseriton of the pes anserinus where it is unable to heal normally.
122
Name the marked muscles on the MRI.
123
What is the most common anatomical pattern of the siciatic nerve as it exits the pelvis?
A single nerve anterior to the piriformis muscle.
So will be passing under the piriformis on a posterior approach. Dont get it confused.
Also can be two branches where both are anterior, posterior or split.
124
What are the ligaments of the knee and their primary and secondary fuction.
125
What are the three layers and lateral structures of the Knee?
126
What are the three layers and medial structures of the knee?
127
What are the posteromedial corner of the knee structures?
128
What is the origin of the PCL in detail?
129
What is the insertion of the PCL in detail?
Posterior tibial sulcus below the articular surface.
Between the meniscofemoral ligaments. Ligament of Humphrey anteriorly and ligament of Wrisberg posteriorly.
130
What is the approximate size of the native PCL?
How many bundles and what are they?
38x13mm
**Anterolateral:** shorter, thicker, and stronger.
**Posteromedial:** longer thiner, weaker.
131
What meniscofemoral ligaments originate from the posterior horn of the lateral meniscus?
where do they insert?
They insert into the substance of the PCL?
Anterior meniscofemoral ligament. The ligament of Humphrey.
Posterior meniscofemoral ligament. The ligament of Wrisberg.
132
What are the two components of the MCL?
133
What is the origin and insertion of the MPFL?
**Origin:** Patella. Fan-like structure inserting at junction between proximal-middle thirds of superomedial border of patella.
**Insertion:** Femur. medial femoral condyle. Distal to adductor tubercle and proximal to MCL attachment. isometric between 0-90 degrees.
Known as **Schottle's point**. 1.3mm anterior to posterior femoral diaphyseal cortex. 2.5mm distal to posterior origin of medial femorla condyle. Proximal to the level of the posterior point of Blumensaat's line.
134
What is the relationship of the popliteal artery to anatomic structures in the knee?
Lies posterior to the psoterior horn of the lateral horn of the lateral meniscus.
Lies directly behind the posterior capsule.
Branches into anterior and posterior tibial arteries at distal popliteus muscles.
135
What anchors the popliteal artery just proximal to the knee joint?
Just distal to the knee joint?
Insertion of adductor magnus.
Anchored by soleus tendon which originates from medial aspect of tibial plateau as the artery exits the knee.
136
What are the branches of the popliteal artery above the knee joint?
At the level of the knee joint?
Medial and lateral sural arteries, cutaneous branch, middle genicular artery.
Medial genicular artery and lateral genicular artery.
137
What are risk factors for peroneal nerve palsty in TKA?
What is the prognosis when they do occur?
Preoperative valgus and/or flexion deformity. Tourniquet time \> 120 min. Postoperative use of epidural analgesia. Aberrant retractor placement. Preoperative diagnosis of neuropathy
50% or more improve with time and no additional treatment.
Obtain EMG if no improvement after 3 months.
138
What treatment is recommended for peroneal palsy that occurs after TKA?
remove dressing and place knee in flexed position
AFO for complete foot drops
Late nerve decompression or muscle transfer if no recovery after 3 months.
139
What are the primary medial ligaments of the ankle?
Deltoid Ligament
Calcaneonavicular ligament
140
What are the primary lateral ligaments of the ankle?
Syndesmosis (Includes AITFL, PITFL, TTFL, IOL, ITL)
ATFL
PTFL
Calcaneal fibular ligament
Lateral talocalcaneal ligament
141
Does the peroneal division of the sciatic nerve innervate anything in the thigh?
Yes
Short head of the biceps.
142
Whithin Guyon's canal what is the relationship of the nerve and the artery?
Ulnar nerve is dorsal and ulnar to the artery.
143
What is the origin and insertion of the ECRB and ECRL?
ECRB- Lateral epidcondyle and inserts on 3rd metacarpal
ECRL- Lateral supracondylar ridge and inserts on the 2nd metacarpal.
144
What are the contents of the Quadrangular space?
Triangular space?
Triangular internal?
Axillary nerve and posterior circumflex humeral artery.
Circumflex scapular artery.
Radial nerve and profunda brachii artery.
145
What internal is the extended iliofemoral approach perfromed through?
What neurovascular structures are at risk?
Tensor fascia Lata (TFL) and sartorius
Neurovascular structures: superior gluteal artery and vein, sciatic nerve, lateral femoral cutaneous nerve, and perforation branches of the femoral artery.
Performed in the lateral decubitus position.
Abductor weakness is an expected and permanent complication.
146
Describe the anatomy of the Posterior Lateral Corner of the Knee?
The biceps femoris inserts posterior to the LCL.
147
Describe the zones of articular cartilage?
**1 superficial (tangential) zone**: collagen fibers oriented parallel with joint surface to resist compressive and sheer forces. Thinnest zone. Sometimes referred to as gliding zone.
**2 middle (transitional) zone**
**3 deep (radial) zone**
**4 calcified zone**
The surface layer is known as the lamina splendens, is cell free and composed mainly of randomly oriented, flat bundles of fine collagen fibrils.
148
149
Describe the course of the PIN nerve. What muscles does it innervate?
150
How far does the synovial capsule of the knee extend from the subchondral line of the proximal tibia?
Maximum distal extent is 14mm and occurs in the posterolateral region.
May be clinically relevant when palcing external fixator pins to avoid intra-articular placement.
151
What are the ligaments of the interosseous membrane of the forearm?
5 types: central band, accessory band, distal oblique bundle, proximal oblique cord, and dorsal oblique accessory cord.
152
Order of innervation from proximal to distal for the radial nerve?
Brachioradialis, extensor carpi radialis longus, supinator, extensor carpi radialis brevis, extensor digitorum communis, extensor carpi ulnaris, extensor digiti quinti, abductor pollicis longus, extensor pollicis longus, extrensor pollicis brevis, and extensor indicis proprius.
153
Where is the inferior gluteal artery found during a posterior hip approach?
IGA is the terminal branch of the internal iliac artery.
It can be found along the piriformis tendon and exits the pelvis out of the greater sciatic notch between the piriformis and coccygeus.
154
What is the distance from the proximal aspect of the pectoralis major tendon to the top of the humeral head?
5.6cm.
This is useful in settings of proximal humerus fracture where it is difficult to tell where the top of the proximal humeral prosthesis should sit.
155
