Anatomy of the Limbs Flashcards
(392 cards)
1
Q
What are the bones in the region of the shoulder?
A
- scapula
- clavicle
- humerus
2
Q
What are the muscular compartments of the shoulder and arm?
A
- anterior pectoral girdle muscles
- posterior pectoral girdle muscles
- intrinsic shoulder muscles
- anterior compartment of the upper arm
- posterior compartment of the upper arm
3
Q
What are the 4 muscles of the pectoral girlde?
A
- pectoralis major
- pectoralis minor
- subclavius
- serratus anterior -> runs between the anterior and posterior
4
Q
Where is the pec major attached?
A
o PROXIMAL ATTACHMENTS -> broad attachment at the medial third of the clavicle, the sternum ad the costal cartilages
o DISTAL ATTACHMENT -> branches to the lateral lip of the intertubercular sulcus
5
Q
What is the role of the pec major?
A
- adduction and medially rotation of the humerus -> punching muscle
6
Q
Where does the pec minor originate and attach to?
A
- originates -> coracoid process of the scapula
- attaches to ribs 2, 3, 4 and 5
7
Q
Where does the the subclavius attach?
A
- first rib
- under surface of the clavicle
8
Q
What is the role of the subclavius?
A
- stabilising the clavicle
9
Q
Where does the serratus anterior attach?
A
- ribs 1-9 coming posteriorly from the medial edge of the scapula
- runs around the side of the chest wall and divides into its different, finger-like parts
10
Q
What is the role of the serratus anterior?
A
- holding and stabilisng the scapula
11
Q
What muscles make up the anterior pectoral girdle?
A
- Trapezius
- Latissimus dorsi
- Levator scapulae
- Rhomboids
12
Q
Where does the trapezius attach?
A
- proximal attachment = spinous processes
- distal attachment = scapula and clavicle
13
Q
What is the motor supply of the trapezius?
A
- spinal accessory nerve -> cranial nerve XI
14
Q
What is the major action of the trapezius?
A
- stabilise, hold and movement of the scapula
15
Q
Where does the latissimus dorsi attach?
A
- attaches from T8, right down to the connective tissue in the posterior pelvic region
- fibres coming from the broad, distal attachment converge to form a strap, with an attachment to the floor of the intertubercular groove
16
Q
What is the role of the latissimus dorsi, naming some activities in which it is heavily involved?
A
- extends, adducts and rotates the humerus
- pulling yourself up, climbing, rowing
17
Q
What are the components of the rhomboids and where do they attach?
A
- two muscles -> minor and major -> combine to form a single strap muscle
- medial border of the scapula, the spinous processes at the lower end of the neck and the upper part of the thorax
18
Q
Where does the levator scapulae attach?
A
- originates from C1-4 and attaches to the scapula
19
Q
What is the role of the levator scapulae?
A
- elevates and rotates the scapula
20
Q
What muscles make up the intrinsic shoulder muscle compartment?
A
- deltoid
- teres major
- rotator cuff muscles
21
Q
Where does the deltoid muscle attach?
A
- posteriorly attaches to the scapular spine, acromial region and the clavicle
- fibres converge onto the deltoid tuberosity (of the humerus)
22
Q
What are the actions of the deltoid?
A
- muscle of adduction
- when different parts are working separately, it contributes to other movements of the shoulder joint
23
Q
What nerve supplies the deltoid?
A
- axillary nerve
24
Q
What are the muscles of the rotator cuff?
A
- supraspinatus
- infraspinatus
- teres minor
- subscapularis
25
Where are the rotator cuff muscles attached?
- come off of the scapula at various places and cross the shoulder joint to attach around the head of the scapula
26
What is the role of the rotator cuff?
- holding the head of humerus into the socket -\> the socket is very shallow, so a lot of muscular activity is required to stabilise this joint
27
Where is the teres minor attached?
- comes off the inferior angle of the scapula and into the floor and medial lip of the intertubercular sulcus of the humerus
28
What nerve supplies the teres major?
- lower subscapular nerve
29
What muscles make up the anterior compartment of the arm?
- biceps
- brachialis
- coracobrachialis
30
What muscles does the musculocutaneous nerve supply?
- biceps
- brachialis
- coracobrachialis
31
Describe the structure of the bicep and where it attaches?
o two-headed muscle of the arm
- the short head proximal attachments is the coracoid process
- the long head tendon also crosses over the shoulder joint (through the intertubercule groove) and it attaches to the supraglenoid tubercule of the scapula
- the two heads converge to form a single tendon, part of which attaches to a tuberosity on the radius while some of the tendon splays out into a fan-shaped tendinous structure called an aponeurosis
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32
Where are the attachments of the brachialis?
- middle and distal parts of the humeral shaft
- coronoid process of the ulna
33
What is the role of the brachialis?
- major contributor to the flexion of the elbow joint -\> along with the bicep
34
Where does the coracobrachialis attach?
- comes from the coracoid process and attaches to the shaft of the humerus
35
What is the role of the coracobrachialis?
- flexion of the shoulder joint
36
What muslces make up the posterior compartment of the arm?
- triceps
- anconeus
37
What nerve supplies the posterior compartment of the arm?
- radial nerve
38
Describe the structure of the tricep and where it attaches?
o have a long head, a lateral head and a medial head
- long head covers the other heads -\> crosses the shoulder group, towards the infraglenoid tubercle -\> other proximal attachments are posterior to the shaft of the humerus
- the heads converge to form the triceps tendon, which crosses over the elbow joint and attaches to the olecranon process of the ulna
39
Where does the anconeus attach?
- a small muscle that attaches from the lateral epicondyle of the humerus to the upper part of the posterior of the ulna bone
40
What are joints of the shoulder and arm?
- sternoclavicular joint
- acromioclavicular joint
- gleno-humeral joint (shoulder joint)
- scapulothoracic joint (“physiological” joint)
- elbow joint
41
What joints make up the pectoral girdle?
- sternoclavicular joint
- acromioclavicular joint
- gleno-humeral joint
- scapulothoracic joint
42
What makes up the sternoclavicular joint?
- medial end of the clavicle articulating with a disc at the manubrium
43
What forms the acromioclavicular joint?
- lateral end of the scapula articulating with the acromion process of the scapula
44
Which is the only joint to have direct bone attachment in the upper limb?
- sternoclavicular joint -\> pivot point of the upper limb to the trunk
45
What kind of joint is the gleno-humeral joint?
- ball and socket synovial joint
46
Describe reason for lots of muscle being required for the shoulder joint.
- the glenoid fossa of the scapula is very shallow -\> unstable, so you need lots of ligaments and muscles for stabilisation
- it is deepened slightly with a small rim of cartilage called the glenoid labrum or lip
47
What are bursae?
- are found around many joints where there are lots of movements going on
- act to lubricate joints and have a cushioning effect
- can become inflamed and this can be very problematic and painful
48
Which direction is dislocation of the shoulder most likely to be?
- downwards -\> up is prevented by bone and sideways by muscles of the rotator cuff
49
What are the arteries of the shoulder and arm?
- subclavian -\> axillary -\> brachial -\> ulnar and radial arteries
50
Describe the venous drainage of the shoulder and arm.
- in limbs, venous return is via superficial and deep vessels
- deep return essentially mirrors the arterial supply
- COMPLICATION: veins in the deep return are not single veins (often a pair, sometimes more) -\> are closely opposed to the artery, sometimes with communicating branches (venae communicantes)
- cephalic vein (superficial) runs up lateral border of arm
- basilic vein (superficial) runs up the medial border of arm
- axillary vein becomes the subclavian vein at the level of the first rib
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51
Which lympathic vessels are important in breast cancer?
- axillary lymph nodes
52
Which lympathic vessels are at risk of damage in surgery?
- long thoracic nerve and thoracodorsal nerve
53
What are the 5 largest nerves of the brachial plexus?
- axillary nerve
- musculocutaneous nerve
- ulnar nerve
- median nerve
- radial nerve
54
What nerve supplies the pectoral muscles?
- pectoral nerves
55
Which nerve do you hit when you bang your elbow?
- ulna nerve -\> wraps around the medial epicondyle of the humerus
56
Which nerve is at most risk of damage when the shoulder is dislocated?
- axillary
57
Name the bones in the elbow, forearm and wrist.
o Humerus
o Radius
o Ulna
o Carpal Bones
- proximal row: scaphoid, lunate, triquetrum, pisiform
- distal row: trapezium, trapezoid, capitate, hamate
58
Where does the radius join with the humerus?
- anterior border of the head of radius is received by the radial fossa in forearm flexion
59
Where does the ulna join with the humerus?
- coronoid process of the ulna fits into the coronoid fossa
- olecranon fossa – it receives the olecranon process of the ulna
60
Which area of the radius is linked with the bicep?
- tuberosity of the radius is an important attachment for biceps brachii
61
What connects the ulna to the radius?
- a fibrous membrane called the interosseous membrane
62
What is the function of the interosseous membrane?
o forces are transmitted between the ulna and radius so is mechanical support
o acts as a partial or complete attachment site for muscles
- seperates the anterior and posterior compartments of the forearm
63
What is the annular ligament?
- a strong band of fibres that encircles the head of the radius, and retains it in contact with the radial notch of the ulna
64
Which proximal bone does not articulate with the ulna and radius row?
- pisiform
65
What is the pisiform?
- a sesamoid bone -\> a bone that forms within a tendon -\> another example of a sesamoid bone is the patella
66
Which of the anterior arm muscles cross in the forearm?
- both the biceps and brachialis BUT NOT the coracobrachialis
- are powerful flexors of the forearm at the elbow joint
- biceps are an important supinator (acts on the radial tuberosity)
67
Which nerve supplies the anterior compartment of the arm?
- musculocutaneous nerve (C5, 6)
68
Which posterior arm muscles extend to the elbow?
- both the tricep and anconeus
- 3 heads of the tricep converge to form a triceps tendon, which crosses the elbow joint posteriorly and attach to the olecranon process of the ulna
- anconeus attaches to the lateral epicondyle of the humerus and the lateral and upper part of the ulna shaft -\> small muscle that is involved in stabilisation during certain movements
69
What nerve supplies the posterior compartment of the arm?
- radial nerve
70
What are the compartments of the forearm?
- anterior superficial -\> flexors
- anterior deep -\> flexors
- posterior -\> extensors
71
What is the purpose of the forearm muscles?
- remote control of the hand and wrist
- whole purpose of the upper limb revolves around hand movement control
72
What are the 5 muscles of superficial anterior compartment of the forearm?
- pronator teres (PT)
- flexor carpi radialis (FCR)
- palmaris longus (PL)
- flexor digitorum superficialis (FDS)
- flexor carpi ulnaris (FCU)
73
What muscles are in deep anterior compartment of the forearm?
- flexor digitorum profundus (FDP)
- flexor pollicis longus (FPL)
- pronator quadratus (PQ)
74
What is the medial epicondyle?
- a point on the distal humerus -\> the COMMON FLEXOR TENDON -\> many muscles, particularly the superficial region, these muscles fan out from the common flexor to attach to different points
75
What does the pronator teres do?
- wraps around the radius -\> when it contracts it pulls it to pronate (turn the limb so that the palm is facing downwards or inwards) the arm
76
What are the roles of the flexor carpi radialis and the flexor carpi ulnaris?
- flexor of the wrist on the radial and ulnar side respectively
77
What does the pronator quadratus do?
- a small quadrate muscle that attaches at the anterior surfaces of the distal part of the shafts of radius and ulna -\> contraction causes bones to close over on one another
78
What is the common way to emphasise the position of the common flexor origin?
79
What is the the deep fascia of the forearm?
- the antebrachial fascia -\> is continuous with the brachial fascia
- is a dense, membranous investment, which forms a general sheath for the muscles in this region
80
Where is the antebrachial fascia attached?
- to the olecranon and dorsal border of the ulna
81
What emerges with the antebrachial fascia?
- the bicipital aponeurosis merges with the antebrachial fascia
82
What is the retinaculum?
- tough band of connective tissue found close/at the joints -\> holds down lots of tendons
83
What muscles move the wrist joint?
- extensor carpi radialis longus (ECRL)
- extensor carpi radialis brevis (ECRB)
- extensor carpi ulnaris (ECU)
84
What are the mucles that move the digits?
- extensor digitorum (ED)
- extensor indicis (EI)
- extensor digit minimi (EDM)
85
What muscles move the thumb?
- abductor pollicis longus (APL)
- extensor pollicis brevis (EPB)
- extensor pollicis longus (EPL)
86
What are the muscles of the posterior/extensor compartment of the forearm?
- extensor carpi radialis longus (ECRL)
- extensor carpi radialis brevis (ECRB)
- extensor carpi ulnaris (ECU)
- extensor digitorum (ED)
- extensor indicis (EI)
- extensor digit minimi (EDM)
- abductor pollicis longus (APL)
- extensor pollicis brevis (EPB)
- extensor pollicis longus (EPL)
- brachioradialis
- supinator
87
Where is the most common sites of proximal attachments of posterior muscles?
- shaft of the ulnar or radius and interosseous membrane
88
What is the supinator muscle?
- wraps around the radius -\> when the forearm is pronated its action supinates it
89
What bone is most commonly broken in a fall?
- the scaphoid
90
How can the scaphoid be located/assessed?
- in the anatomical snuff box
- tendons of extensor pollicis longus and extensor pollicis brevis -\> if you extend the thumb, there is a small depression
91
Describe the elbow joint.
- the joint between the capitulum and trochlea of the distal humerus, and the head of radius and proximal part of ulna -\> the radius articulates with the capitulum (lateral) and the ulna with the trochlea
- a synovial joint
92
What ligaments are assocaited with the elbow joint?
- collateral ligaments (both ulnar and radial) -\> prevent deviation (adduction and abduction)
- radial annular ligament wraps around the neck of radius -\> allows for rotation
93
What movements are possible with the elbow joint?
- flexion
- extension
94
What is the difference between the carrying angle at the elbow when comparing the sexes?
- women = \>15 degrees
- men = 10-15 degrees
- obvious reason being the relative width of the pelvis
95
Describe the proximal radio-ulnar joint.
- the head of radius is held close to the proximal part of ulna -\> it has an articular surface that articulates with the capitulum as part of the elbow joint (head of radius)
- the JOINT also has a trochlear articulating surface (proximal part of ulna)
- on the joint is a rim, allowing the head of radius to also articulate with the radial notch of ulna
96
Why is there a bigger gap between the ulna and the carpal bones than the radius?
- there is an intervening articular disc -\> it articulates with the disc which articulates with the carpal bones
97
What muscles are involved in flexion of the elbow?
- brachialis
- biceps
- (brachioradialis)
- (pronator teres)
98
What muscles are involved in extension of the elbow?
- tricep
- (anconeus)
99
What muscles are involved in supination of the radio-ulnar joint?
- supinator
- bicep
- (EPL)
- (ECRL)
100
What muscles are involved in pronation of the radio-ulnar joint?
- pronator quadratus
- pronator teres
- (FCR)
- (PL)
- (brachioradialis)
101
Describe the position of the pronator teres and the supinator in the supine/anatomical and prone position?
- in the supine position: the pronator teres is stretched around the bone, pronator quadratus is stretched into its approximately quadrate shape and the supinator has contracted here, and has pulled the radius round so that the bones are parallel
- in the prone position, the pronator teres has contracted and has rotated the radius round, as has pronator quadratus
102
Where is the pronator teres attached?
- lateral side of the shaft of the radius and the medial head of the humerus
103
What muscles are important in the flexion of the wrist?
- flexor carpi radialis
- flexor carpi ulnaris
104
What muscles are important in the extension of the wrist?
- extensor carpi radialis longus
- extensor carpi radialis brevis
- extensor carpi ulnaris
105
What muscles are important in the radial deviation (abduction) of the wrist?
- abductor pollicis longus
- flexor carpi radialis
- extensor carpi radialis longus
- extensor carpi radialis brevis
106
What muscles are important in the ulnar deviation (adduction) of the wrist?
- extensor carpi ulnaris
- flexor carpi ulnaris
107
What are the arteries of the forearm?
- at the elbow, the brachial artery divides into the ulnar and radial arteries
- ulnar artery branches almost immediately to give a common interosseous branch -\> common interosseous branch immediately branches to give anterior (supplies deep structures) & posterior (posterior compartment) interosseous arteries
108
Where does the cephalic vein run?
- a superficial vein which runs up the lateral border of the arm
109
What forms the subclavian vein?
- basilic veins joins venae comitantes to form the axillary vein in the arm -\> cephalic vein joins axillary vein in the axilla -\> axillary vein becomes the subclavian vein at the level of the first rib
110
Where does the basilic vein run?
- superficially along the medial border of the arm
111
Where does the cephalic and basilic veins arise from?
- the dorsal venous arch of the hand
112
What commonly joins the cephalic and basilic veins?
- connected at the cubital fossa by the median cubital vein -\> not always present or prominent
113
What is the clinical significance of the median cubital vein?
- commonly used in phlebotomy -\> if it is absent the cephalic or basilic vein is used instead
114
How similar are veins and arteries paths in the arm?
- deep drainage by veins follows that of arteries -\> especially in the distal regions
115
Describe the lympathic drainage of the forearm?
- superficial and deep systems, running with veins
- cubital lymph nodes drain the forearm (usually 3 or 4 lymph nodes, often on the medial side) -\> enlargements may indicate HIV status or syphilis
- axillary nodes are also draining nodes for the distal parts of the upper limb
116
Describe the musculocutaneous nerve.
- C5, 6, 7
- supplies all the anterior compartment of the upper arm
- sensory to the lateral forearm as the lateral cutaneous nerve of the forearm -\> terminal branch
117
Describe the median nerve.
- C6, C7, C8, T1
- courses through the anterior compartment of the arm (no significant branches) -\> lies anterior to the elbow, with the brachial artery (easily damaged) – found in cubital fossa
- main nerve to the muscles of the forearm -\> supplies LOADS of the flexors, but only HALF of the flexor digitorum profundus -\> ulnar supplies the other half of the flexor digitorum profundus
118
Describe the ulnar nerve.
- C8, T1
- courses via the posterior compartment of the upper arm (no significant branches in the upper arm) -\> lies behind the medial epicondyle at the elbow (easily damaged)
- main nerve of the hand
119
Describe the radial nerve.
- C5, 6, 7, 8, T1
- supplies all the muscles of the posterior compartments of the upper arm and forearm
- passes around the body of the humerus at its mid-shaft in the radial groove -\> easily damaged
- divides just above the level of the elbow -\> deep branch supplying the posterior interosseous nerve and the superficial branch supplying the superficial radial nerve (sensory)
120
Summarise the motor supply in the forearm.
- Radial Nerve supplies all posterior muscles
- Ulnar Nerve supplies only FCU and the Ulnar half of FDP
- Median Nerve supplies all of the remaining anterior muscles
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What are the names of the thumb and digits?
- thumb
- index finger
- middle finger
- ring finger
- little finger
215
What are the bones of the wrist and hand?
- radius
- ulna
carpal bones -\> proximal row = scaphoid, lunate, triquetrum, pisiform and distal row = trapezium, trapezoid, capitate, hamate
- metacarpal bones
- phalanges
216
What are the fascia of the palm?
- palmar fascia
- palmar aponeurosis
- fibrous digital sheaths
217
Describe the palmar aponeurosis.
- overlies the long flexor tendons of the hand
- proximally continuous with the flexor retinaculum (at the wrist)
- distally continuous with the fibrous digital sheaths
218
What is contained within the fibrous digital sheath?
- flexor tendons
- synovial sheaths
219
What are the muscle compartments of the hand?
- hypothenar compartment (elongated prominence associated with the little finger)
- central compartment (contains lots of tendons)
- thenar compartment (muscle compartment at the base of the thumb)
- adductor compartment (small compartment – essentially just a single muscle)
220
What muscles are the thenar muscle compartment?
- abductor pollicis brevis
- flexor pollicis brevis
- opponens pollicis
221
What muscles are in the adductor muscle compartment?
- adductor pollicis
222
What muscles are in the hypothenar muscle compartment?
- abductor digiti minimi
- flexor digiti minimi
- opponens digiti minimi
223
What muscles are in the interossei and lumricals muscle compartment?
- lumbricals
- palmar interossei
- dorsal interossei
224
What are the movements of the thumb?
225
What muscles abduct the thumb?
- abductor pollicis longus
- abductor pollicis brevis
226
What muscles are involved in adducting the thumb?
- adductor pollicis
- first dorsal interosseous
227
What muscles are involved in extension of the thumb?
- extensor pollicis longus
- extensor pollicis brevis
- abductor pollicis longus
228
What muscles are involved in flexion of the thumb?
- flexor pollicis longus
- flexor pollicis brevis
229
What muscles are involved in opposition of the thumb?
- opponens pollicis
230
Where does the adductor pollicis attach?
- broad attachment to the middle metacarpal
- fibres combine to the proximal end of the first phalanx of the thumb
231
What nerves supplies the thenar muscles?
- ulnar supplies the adductor pollicis
- rest is supplied by the median nerve
232
What muscles allow for extension of the fingers?
- lumbricals are muscles that are coming off the long tendons from flexor digitorum profundus
- arise from these (proximal attachment), and converge at a little tendon more distally -\> this tendon on the anterior surface of the palm goes round posteriorly, and attaches to the tendinous structures posteriorly -\> aows these muscles to flex the metacarpal phalangeal joint, and extend the fingers
233
Describe the anterior tendinous anatomy of the hand.
- fibrous digital sheath
- osseo-fibrous tunnels -\> long flexor tendons and their synovial sheaths run them
- annular and cruciform pulleys
234
Describe the tendinous anatomy of the digits.
o A = annular parts (ring)
o C = cruciate parts (crossing)
- important structures to protect the joint region.
235
What makes up the posterior tendinous antomy of the hand?
- extensor retinaculum
- synovial tendon sheaths
- inter-tendinous bands
- extensor expansions
- lumbricals and interossei attach to the expansions
- extensor digitorum, EI, EDM
236
Nae the 6 joint in the hand region.
- distal radio-ulnar joint
- wrist joint
- intercarpal joints
- carpo-metacarpal and inter-metacarpal joints
- metacarpo-phalangeal joints
- interphalangeal joints
237
What movements are possible with the carpometacarpel and interphalangeal joints?
- flexion
- extension
- radial deviation
- ulnar deviation
- circumduction
238
What movement is possible in the metacarpophalangeal joints?
- flexion and extension
- abduction and adduction
239
What movement is possible in the interphalangeal joints?
- flexion and extension
240
What prevents over-extension of the interphalangeal joints?
- volar plates
241
What is the main role of the lumbricals?
- straightening of the fingers
242
What arteries supply the hand?
o ulnar Artery
- interosseous arteries in the forearm
- superficial palmar arch – palmar digital arteries
- deep palmar branch
o radial Artery
- deep palmar arch
- palmar metacarpal arteries
243
Describe the venous drainage of the hand.
- superficial and deep
- superficial = cephalic and basilic
- deep = runs with arteries
244
What nerves supply the hand?
- ulnar -\> main nerve to the hand
- median -\> some supply to intrinsic muscle
- radial -\> some sensory component ot the hand
245
What are the digital nerves?
- purely sensory nerves which are often damaged
246
What hand muscles are supplied by whihc nerve?
- median supplies thenar muscles and the lateral 2 lumbricals
- ulnar supplies all of the other intrinsic hand muscles
247
Describe the cutaneous innervation of the hand.
- anteriorly = ulnar nerve is supplying the medial part of the palm and the medial one and a half digits -\> median nerve is supplying the rest of the palm, and the rest of the digits -\> small contribution on the palmar surface from radial at the wrist
- posteriorly = ulnar nerve supplies the medial part of the dorsal of the hand and the digits there -\> radial nerve supplies the bulk of the dorsal, and dorsal of the thumb.
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What are the bony attachments of the carpal tunnel?
- scaphoid
- trapezoid
- hamate
- pisiform
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What forms the roof of the carpal tunnel?
- flexor retinaculum (transcarpal ligament)
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What is contained within the carpal tunnel?
- median nerve
- FPL tendon
- 4 tendons of FDP
- 4 tendons of FDS
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What are the 3 types of grip?
o Power Grip -\> long flexors of the fingers and thumb, intrinsic muscles of the palm, extensors of the wrist joint
o Precision Grip -\> wrist and fingers are held rigidly by the long flexors and extensors, intrinsic muscles of the hand carry out the fine movements needed
o Hook Grip -\> consumes little energy, mainly involves long flexors of digits; e.g. carrying shopping bag or briefcase
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Describe the movement of the lower limb during development.
- during development, the limb twists -\> can be seen from the segmentation of the embryo, and later in foetal development
- structures below the hips are rotated -\> everything that is anterior should have been posterior, and vice versa -\> the movements associated with lower limbs, and nerve supply, are the wrong way around
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What are the movements of the lower limb?
254
What three bones make up the pelvis?
- ilium
- pubis
- ischium
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What is the fascia lata?
- deep, thick fascia of the thigh
- extends like a stocking beneath the skin
- binds the anterior, posterior and medial thigh muscle groups
- lateral thickened area of the fascia lata is called the ilio-tibial tract -\> runs down to the knee to bind the lateral muscles
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Name the gluteal muscles.
o gluteus maximus
o gluteus medius
o gluteus minimus
o (tensor fasciae latae) -\> has more flexion activity
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Name the short external (lateral) rotators of the hip.
o piriformis
o obturator internus
o gemelli (sup. and inf.)
o quadratus femoris
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What is the role of the gluteus maximus?
- extending the hip (backwards) and sitting down
- assists flexion of the kness during running, jumping etc
- big, coarse fibres -\> NO SUBTLE ACTIVITY
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Where is the gluteus maximus attached?
- comes off the a small part of the ilium, sacrum and fascia of the region
- majority of gluteus maximus inserts and attaches into the ilio-tibial tract (thickened lateral band)
- part of the gluteus maximus attaches to the gluteal tuberosity on the posterior proximal shaft of femur
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What is the role of the short external rotators?
- muscles of the gluteal region which are involved in stabilising the hip joint and pulling the femur head into the acetabulum
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What is the tensor fascia lata, also explain its function?
- related with the gluteus maximus in function and structure
- muscle assists in keeping the balance of the pelvis while standing, walking, or running
- due to its position it is likely to have a flexor function on the trunk as well as abduction
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Where is the tensor fascia lata attached?
- comes off part of the anterior iliac crest and inserts into the ilio-tibial tract (continuous)
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What is the piriformis?
- a lateral/external rotator that runs form the sacrum to the greater trochanter
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What are the attchments of the obturator internus?
- the rim of the obturator foramen through 90 degrees to the greater trochanter of the proximal femur
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What muscles are in the anterior compartment of the thigh?
o pectineus
o ilio-psoas
o (tensor fasciae latae)
o sartorius
o quadriceps femoris
- rectus femoris
- vastus medialis
- vastus intermedius
- vastus lateralis
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What is the role of the muscles within the anterior thigh?
- hip flexors and knee extensors
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What is the pectineus?
- a small muscles that comes off the superior pubic ramus, and attaches to the superior-anterior shaft of femur
- flexes and adducts the hip
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What is the sartorius?
- long strap muscle coming off ASIS and crossing inferiorly and medially -\> sartorius crosses the knee joint and attaches below the knee joint
- also crosses the hip joint -\> involved in flexing the hip and knee
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What are the 4 heads of the quadriceps?
- rectus femoris
- vastus lateralis
- vastus medialis
- vastus intermedius
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Where do the four heads of the quadricep converge too?
- on to a tendinous structure on the patella or directly on to the patella
- patella forms within the ligement of the quadricep
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Where does the patellar ligament run?
- is a continuation of the quadriceps tendon which continues to the tibial tuberosity
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What muscles make up the medial compartment of the thigh?
- adductor longus (long)
- adductor brevis (short)
- adductor magnus (big)
- gracilis
- obturator externus
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Where do the adductor longus, adductor brevis and adductor magnus attach?
- medial compartment thigh muscles on both the superior and inferior pubic rami, and on the central body of pubis.
- distal attachments on the posterior of the femoral shaft -\> in particular, a ridge that runs down the femur -\> the linea aspera
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What is the role of the adductor longus, adductor brevis and adductor?
- adduct the thigh
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What is a groin strain?
- any of the adductor muscles of the thigh, on the inner side of the thigh
- an acute groin strain is usually caused by sudden movements -\> kicking, twisting to change direction while running, or jumping
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Describe the path of the gracilis muscle.
- attaches from the inferior pubic ramus -\> crosses the knee joint and inserts into the proximal medial surface of the body of tibia
- is a long strap muscle, that stays medial
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What is the general role of the medial compartment of the thigh?
- hip adduction
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What is obturator externus?
- is contained within the external rim of the obturator foramen
- acts as the lateral rotator of the hip joint as well as stabilising the hip joint as a postural muscle
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What is the adductor hiatus?
- a gap between the adductor magnus muscle and the femur that allows the passage of the femoral vessels from the anterior thigh to the posterior thigh and then the popliteal fossa
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What muscles make up the posterior compartment of the thigh?
- semimembranosus
- semitendinosus
- biceps femoris
* - the hamstrings*
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Where is the common attachment for all posterior thigh muscles?
- the ischial tuberosity
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Where are the attachments for the biceps femoris?
- long head travels laterally to insert into the head of the fibula
- short head comes off the posterior surface of the femoral shaft.
- long head crosses the hip joint but the short one doesn’t -\> the two heads form a tendon, which attaches to the head of the fibula, and so obviously crosses the knee joint
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Where does the semitendinosus attach?
- the ischial tuberosity and forms the pes anserinus
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What is the pes anserinus?
- the conjoined tendons of three muscles that insert onto the anteromedial surface of the proximal extremity of the tibia
- muscles are the sartorius, gracilis and semitendinosus.
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What are the borders of the femoral triangle?
- superiorly -\> the inguinal ligament
- medially -\> adductor longus
- laterally -\> sartorius
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What is contained within the femoral triangle?
- femoral nerve -\> branches into lots of fibres within the triangle
- femoral artery
- femoral vein
- lymph nodes -\> including the deep inguinal lymph nodes
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What is the saphenous opening?
- an opening in the fasica lata within the femoral triangle -\> where the great (long) saphenous vein enters to join the femoral vein
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What forms the adductor canal?
- anterior = vastus medialis
- posterior = adductor longus and magnus
- medial = sartorius
- extends along the medial aspect of the thigh
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What is contianed within the adductor canal?
- femoral artery
- femoral vein
- saphenous nerve
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Describe the path of the sciatic nerve.
- passes from pelvis to buttock via greater sciatic notch/foramen
- in the buttock, it lies in the inferior and medial quadrant -\> passes along posterior aspect of the thigh
- however there is lots of variation in different people -\> normally enters the gluteal region inferiorly to piriformis muscle, but can be superior or pierce the muscle
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What 2 nerves are contained with the sciatic nerve?
- tibial
- common peroneal
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What is the safe area for intramuscular injections into the buttocks?
- a triangle between the tubercle of the iliac crest and ASIS
- overlies gluteus medius -\> want to avoid gluteus maximus as well as the sciatic nerve in a buttock intramuscular injection
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What is the Trendelenberg test?
- tests the function of the hip abductors -\> glteus medius and minimus
- the subject is asked to stand on both legs, both right and left side of the pelvis should remain at same level without any tilt -\> the subject is asked to raise one leg off the ground -\> pelvis should remain horizontal on one leg if it tilts it is positive -\> indicates a loss or weakness of the motor function of the abductor muscles in the leg the subject is standing on
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Describe the hip joint.
- synovial ball and socket joint formed by the head of the femur and the acetabulum -\> is deepened in life with an acetabular labrum
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What are the 4 ligaments of the hip joint?
- ilio-femoral ligament
- pubo-femoral ligament
- ischio-femoral ligament
- ligament of the head of the femur
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Describe the blood supply to the head of the femur.
- blood supply to the head of femur is important because of breaks -\> damaged in intracapsular fractures of the femoral neck
- there is an acetabular branch in the ligament of head of femur – can supply part of the head but MOST of the supply comes distally from the circumflex arteries -\> fracture at the neck can lead to avascular necrosis of the femoral head -\> why hip replacement is so common -\> not worth risking fracture healing
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What arteries are in the buttock, hip and thigh?
- external iliac artery passes under the inguinal ligament and becomes the femoral artery and after the adductor hiatus it becomes the popliteal artery
- profunda femoris -\> a large branch of the femoral artery in the thigh
- circumflex arteries -\> supply the head of the femur
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What are the superficial veins of the buttock, hip and thigh?
- great (long) saphenous vein -\> joins the femoral vein at the sapheno-femoral junction
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What are the deep veins of the buttock, hip and thigh?
- popliteal vein
- femoral vein
- external iliac vein
- sapheno-femoral junction
- venae comitantes of the profunda femoris artery
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Describe the lympathic drainage of the buttock, hip and thigh.
- lymph flows with the superficial and deep veins
- superfiacl and deep inguinal lymph nodes as weel as the external iliac lymph nodes are present
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What nerve supplies the anterior thigh?
- femoral nerve
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What nerve supplies the medial (adductor) thigh?
- obturator nerve
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What supplies the posterior thigh, anterior and posterior leg and foot?
- sciatic nerve -\> or its terminal branches the tibial or common peroneal nerves
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Which leg bone articulates with the femur?
- the tibia -\> the fibula articulates with the tibia proximally but doesnt form the knee joint
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Which muscles are knee extensors?
- tensor fasciae latae
- sartorius
- quadriceps femoris
- all cross the knee joint
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Which medial compartment of the thigh muscle acts across the knee joint?
- gracilis
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What muscles are knee flexors?
- semimembranosus
- semitendinosus
- bicep femoris
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What muscles are found in the anterior compartment of the leg?
o ankle dosriflexors (true extensors) which are:
- ribialis anterior
- extensor digitorum longus
- extensor hallucis longus
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What is the blood supply to the anterior compartment of the leg?
- anterior tibial artery
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What nerve supplis the muscles of the anterior compartment of the leg?
- deep peroneal nerve -\> a branch of the common peroneal nerve
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What are the attachments of the tibialis anterior?
- the shaft, and also on the interosseous membrane between tibia and fibula
- medial and under surface of the medial cuneiform bone and base of the first metatarsal bone
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What does the extensor digitorum longus act on?
- all toes except from the hallux
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What does the extensor hallucis longus act on?
- exclusively on th ebig toe
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What muscles are found in the lateral compartment of the leg?
- peroneus longus
- peroneus brevis
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What is the blood supply to the lateral compartment of the leg?
- peroneal artery
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Which nerve supplies the lateral compartment of the leg?
- superficial peroneal nerve -\> branch of the common peroneal nerve
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What is the role of the muscles of the lateral compartemnt of the leg?
- everting the foot
- also contribute to dorsiflexion
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What are the muscles found in the posterior compartment of the leg?
o ankle plantarflexors which are:
• superficial
- gastrocnemius
- soleus
- plantaris
• deep
- popliteus
- flexor Digitorum Longus
- flexor Hallucis Longus
- tibialis Posterior
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What is the blood supply to the posterior compartment of the leg?
- posterior tibial artery
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Which nerve supplies the muscles of the posterior compartment of the leg?
- tibial nerve
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Where do the superficial psterior compartment of the leg muscles act?
- across the ankle joint
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Where do deep muscles of the posterior compartment of the leg act?
- across the ankle and flexor digits
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What are the attachments of the gastrocnemius?
- has two heads -\> attach across the knee joint, at the lateral and medial epicondylar regions
- heads fuse to form a common tendon that attaches to the posterior of the calcaneus bone -\> contributes to the calcaneal tendon (Achilles tendon)
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What are the attachments of the soleus?
- a broad attachment on the upper part of fibula, on tibia, and the interosseous membrane
- joins with the two heads of gastrocnemius to help form the Achilles tendon.
325
What is the tricep surae?
- the gastrocnemius (2 heads) and soleus (1 head) form the tricep surae
- their distal tendon is the tendocalcaneus (calcaneal tendon) aka the achilles tendon
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What are the attachments of the popliteus muscle?
- posterior surface of tibia proximal
- soleus line
327
What is the role of the intrinsic muscles of the foot?
- generally act as shock absorbers and help the foot adjust to uneven surfaces
- made up of 4 layers
- can be trained to carry out fine movements such as writing
328
What nerve supplies the intrinsic muscles of the foot?
- tibial nerve
329
What is the role of the quadratus palntae?
- helps modify and keep straight the flexor digitorum longus because it comes in at an angle
330
Which muscle do the two sesamoid bones of th efoot grow in?
- flexor hallicus brevis
331
What is the popliteal fossa?
- the diamond shaped space posterior to the knee joint
332
What are the boundaries of the popliteal fossa?
- biceps Femoris
- semimembranosus
- lateral head of gastrocnemius
- medial head of gastrocnemius
- skin and fascia
- femur
333
What is the contents of the popliteal fossa?
- popliteal artery and vein
- tibial Nerve and Common Peroneal Nerve
- short saphenous vein
- popliteal lymph nodes
334
What kind of joint is the knee joint?
- primarily a hinge-type synovial joint with some gliding, rolling and rotation
- the largest joint in the body
335
Describe the stability of the knee joint?
- the bones (tibia and femur) don't predict a stable joint -\> has been described as two balls sitting on a warped table
- hence has lots of ligamental support
336
Name the 4 ligaments on the knee?
- anterior cruciate ligament
- posterior cruciate ligament
- medial collateral ligament
- lateral Collateral Ligament
337
What is bursitis?
- inflammation of the bursa -\> very painful
338
What joints are there in the leg and foot?
- knee joint
- proximal and distal tibio-fibular joints
- ankle joint
- subtalar joint
- midtarsal joint
- metatarso-phalangeal joints
- interphalangeal joints
339
Describe the proximal tibiofibular joint.
- a plane type synovial, but is has capsular ligaments which limits movement -\> there is a little bit of movement during dorsiflexion and plantarflexion at the ankle
340
Describe the distal tibiofibular joint.
- a fibrous joint
- slight movement during dorsiflexion/plantarflexion of the foot
341
What ligaments is injured in a sprained ankle?
- collateral ligaments of the ankle
342
What is weight bearing at the ankle joint?
- the talus via it’s superior articulation with tibia -\> fibula is not weight-bearing, but it’s distal lateral malleolus, with tibia’s medial malleolus, forms the square socket of the ankle joint
343
Name the 3 arches of the foot.
- medial longitudinal arch
- lateral longitudinal arch
- transverse metatarsal arch
344
Describe all 3 arches of the foot.
- the shape of the foot bones, and how they fit together, contributes to the formation and stability of the arches of the foot
- the medial arch is slightly higher
- on the lateral side, it is harder to see the arch (appears flat) due to fascia
- the transverse arch is across the tarsals
345
What stabilises the arches of the feet?
- the ligaments of the foot -\> particularly the plantar aponeurosis
346
Describe the gait cycle.
347
Describe the patway of the popliteal artery.
- gives of the genicular (knee branches) before splitting
o popliteal trifurcation
- \> anterior tibial artery -\> anterior compartment
- \> posterior tibial artery -\> posterior compartment
- \> peroneal artery -\> lateral compartment
348
Describe the blood supply to the sole of the foot.
- the medial and lateral plantar arteries -\> are branches of posterior tibial artery
349
Describe the blood supply to the dorsum of the foot and digits.
- the dorsalis pedis artery -\> a continuation of the anterior tibial artery
350
State the superficial veins of the knee, leg and feet.
- dorsal venous arch
- long saphenous vein
- short saphenous vein
- perforating veins to the deep system (mainly in the calf)
351
State the deep veins of the knee, leg and feet.
- deep calf veins -\> venae comitantes of arteries
- popliteal vein
- femoral vein
- external iliac vein
- sapheno-femoral junction
- venae comitantes of the profunda femoris artery
352
Describe the sensory segmental supply to th knee, leg and feet.
- “L3 to the knee and L4 to the floor”
- L5 to the great toe
- S1 to the lateral side of the foot
- S1 to the sole of the foot
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