Block 12 Flashcards
(372 cards)
1
Q
What are the muscles of the forearm in the superficial flexor compartment? 5
A
Pronator teres Flexor carpi radialis Flexor digitorum superficialis Palmaris longus Flexor carpi ulnaris
2
Q
Flexor digitorum profundus
A
FOREARM - DEEP FLEXOR
Origin: upper 3/4 of anterior and medial ulnar, medial coronoid process, anterior ulnar half interosseous membrane
Insertion: palmar surfaces of base of distal phalanges
Innervation: medial (ring and little finger) = ulnar nerve. Lateral (index and middle fingers) = median C8/T1
Vascular: proximal = ulnar/common interosseous. distal = ulnar, anterior interosseous and median artery
Action: finger flexion. Only muscle to flex distal interphalangeal joint
3
Q
Flexor pollicis longus
A
FOREARM - DEEP FLEXOR
Origin: groove in anterior radius and interosseous membrane
Insertion: palmar surface of distal phalanx of thumb
Innervation: anterior interosseous branch of median nerve C7/8
Vascular: medial = anterior interosseous artery. lateral = radial artery
Action: flexes phalanges of thumb
4
Q
Pronator quadratos
A
FOREARM - DEEP FLEXOR
Origin: oblique ridge on anterior ulna
Insertion: distal 1/4 of anterior border and surface of radius
Innervation: anterior interosseous branch of median nerve C7/8
Vascular: anterior interosseous artery
Action: forearm pronation
5
Q
Brachioradialis
A
FOREARM - SUPERFICIAL EXTENSOR
Origin: proximal 2/3 of lateral supracondylar ridge of humerus
Insertion: lateral side of distal radius
Innervation: radial nerve C5/6
Vascular: radial recurrent artery and radial artery
Action: elbow flexion
6
Q
Extensor carpi radialis longus
A
FOREARM - SUPERFICIAL EXTENSOR
Origin: common tendon of extensors - lateral supracondylar ridge of humerus
Insertion: radial side of dorsal surface of bsae of 2nd metacarpal
Innervation: radial nerve C6/7
Vascular: radial recurrent artery and radial collateral branch
Action: extension and abductor of wrist and midcarpal joints
7
Q
Extensor carpi radialis brevis
A
FOREARM - SUPERFICIAL EXTENSOR
Origin: common tendon of extensors
Insertion: dorsal surface of base of 3rd metacarpal on radial side
Innervation: posterior interosseous nerve C7/8
Vascular: radial recurrent artery and radial artery
Action: extension and abduction of wrist and midcarpal joints
8
Q
Extensor digitorum
A
FOREARM - SUPERFICIAL EXTENSOR
Origin: common extensor tendon
Insertion: dorsum of proximal phalanges
Innervation: posterior interosseous nerve C7/8
Vascular: proximal 1/3 = radial recurrent artery. distal 2/3 = posterior interosseous artery
Action: wrist extension, MCP, PIP and DIP extension
9
Q
Where is the common extensor tendon?
A
lateral epicondyle of humerus
10
Q
What are the muscles of the forearm in the deep flexor compartment? 3
A
Flexor digitorum profundus
Flexor pollicis longus
Pronator quadratas
11
Q
What are the muscles of the forearm in the superficial extensor compartment? 7
A
Brachioradialis Extensor carpi radialis longus Extensor carpi radialis brevis Extensor digitorum Extensor digiti minimi Extensor carpi ulnaris Anconeous
12
Q
What are the muscles of the forearm in the deep extensor compartment? 5
A
Abductor pollicis longus Extensor pollicis longus Extensor pollicis brevis Extensor indicis Supinator
13
Q
What are the names of the carpal bones?
A
Scaphoid Lunate Triquetrum Pisiform Trapezium Trapezoid Capitate Hamate
14
Q
What is the contents of the carpal tunnel?
A
4 tendons of flexor digitorum profundus
4 tendond of flexor digitorum superficialis
tendon of flexor pollicis longus
median nerve
15
Q
What forms the carpal tunnel?
A
Flexor retinaculum
Carpal arch
16
Q
What are the intrinsic muscles of the hand? 11
A
Flexor pollicis brevis Abductor pollicis brevis opponens pollicis adductor pollicis abductor digiti minimi flexor digiti minimi brevis opponens digiti minimi palmaris brevis palmar interossei dorsal interossei lumbricals
17
Q
Pronator teres
A
FOREARM - SUPERFICIAL FLEXOR
2 heads - humeral and ulnar
Origin: common tendon for flexors (medial epicondyle of humerus) and medial side of coronoid process of ulnar
Insertion: midway along lateral surface of radial shaft
Innervation: median nerve C6/7
Vascular: humeral - inferior ulnar collateral artery and anterior ulnar recurrent artery. Ulnar - common interosseous artery
Action: pronation of forearm and weak elbow flexor
18
Q
Flexor carpi radialis
A
FOREARM - SUPERFICIAL FLEXOR
Origin: common flexor tendon (medial epicondyle of humerus)
Insertion: base of 2nd metacarpal
Innervation: median nerve C5/6
Vascular: anterior and posterior ulnar recurrent artery branch
Action: flexes the wrist and helps abduction of the hand
19
Q
Flexor digitorum superficialis
A
FOREARM - SUPERFICIAL FLEXOR
2 heads - humeroulnar and radial
Origin: humeroulnar - common tendon and medial coronoid process. Radial - anterial radial border and radial tuberosity
Insertion: forms 4 long tendons that pass through the carpal tunnel and attach to anterior base of intermediate phalanges 2-5
Innervation: median nerve C8/T1
Vascular: humeral: anterior ulnar recurrent. Anterior radial: ulnar and radial arteries. Posterior: ulnar and median artery
Action: flexor of PIP and MCP and wrist joint
20
Q
Palmaris longus
A
FOREARM - SUPERFICIAL FLEXOR
Origin: common tendon (medial epicondyle of humerus)
Insertion: crosses retinaculum and is incorporated with the palmar aponeurosis
Innervation: median nerve C7/8
Vascular:anterior ulnar recurrent artery
Action: anchor for skin and fascia of hand. Carpal flexion
21
Q
Flexor carpi ulnaris
A
FOREARM - SUPERFICIAL FLEXOR
2 heads - humeral and ulnar (connected by tendinous arch)
Origin: humeral - common tendon. ulnar - medial olecranon and 2/3 posterior border of ulna
Insertion: pisiform bone
Innervation: ulnar nerve C7/8/T1
Vascular: 3 pedicles. proximal - posterior ulnar recurrent, middle &distal - ulnar artery
Action: flexes the wrist and adducts the hand
22
Q
Extensor digiti minimi
A
FOREARM - SUPERFICIAL EXTENSOR
Origin: common extensor tendon
Insertion: dorsal digital expansion of 5th digit
Innervation: posterior interosseous nerve C7/8
Vascular: radial recurrent and posterior interosseous artery
Action: extend joints of the little finger, wrist extension
23
Q
Extensor carpi ulnaris
A
FOREARM - SUPERFICIAL EXTENSOR
Origin: common extensor tendon and posterior border of ulna
Insertion: tubercle on medial side of 5th metacarpal base
Innervation: posterior interosseous nerve C7/8
Vascular:proximal = radial recurrent, distally = posterior interosseous artery
Action: extension and fixation of the wrist
24
Q
Anconeous
A
FOREARM - SUPERFICIAL EXTENSOR
Origin: posterior surface of lateral epicondyle of humerus
Insertion: lateral olecranon
Innervation: radial nerve C6/7/8
Vascular: posterior interosseous recurrent artery
Action: extending elbow
25
Abductor pollicis longus
FOREARM - DEEP EXTENSOR
Origin: posterior surface of ulnar shaft and middle 1/3 posterior radius
Insertion: (2) radial side of 1st metacarpal base and trapezium
Innervation: posterior interosseous nerve C7/8
Vascular: proximally = posterior interossesous artery. distally = anterior interosseous
Action: abducts the wrist and abducts the thumb radially
26
Extensor pollicis longus
FOREARM - DEEP EXTENSOR
Origin: lateral middle 1/3 posterior ulnar shaft
Insertion: base of distal phalanx of the thumb
Innervation: posterior interosseous nerve C7/8
Vascular: superficial = posterior interosseous. deep = anterior interosseous artery
Action: extends distal phalanx of the thumb
27
Extensor pollicis brevis
FOREARM - DEEP EXTENSOR
Origin: posterior surface of radius and adjacent interosseous membrane
Insertion: based of proximal phalanx of the thumb
Innervation: posterior interosseous nerve C7/8
Vascular: posterior and anterior interosseous artery
Action: extends proximal phalanx of thumb and metacarpal
28
Extensor indicis
FOREARM - DEEP EXTENSOR
Origin: posterior surface of ulna
Insertion: ulnar side of tendon of extensor digitorum
Innervation: posterior interosseous nerve C7/8
Vascular: superficial = posterior interosseous artery and deep = anterior interosseous artery
Action:extension of index finger and wrist
29
Supinator
FOREARM - DEEP EXTENSOR
Origin: lateral epicondyle of humerus and supinator crest of ulna.
Insertion: lateral surface of proximal 1/3 of radius
Innervation: posterior interosseous nerve C7/8
Vascular: superficial = radial recurrent and deep = posterior interosseous artery
Action: supination
30
What are the intrinsic muscles of the hand? (11)
```
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
Opponens digiti minimi
Abductor digiti minimi
Flexor digiti minimi brevis
Lumbricals
Palmar interossei
Dorsal interossei
Palmaris brevis
Adductor pollicis
```
31
Flexor pollicis brevis
INTRINSIC MUSCLE OF HAND
2 parts - superficial and deep
Origin: superficial = distal border of flexor retinaculum and distal tubercle of trapezium. deep = trapezoid and capitate bones
Insertion: both on sesamoid bone and base of 1st phalanx
Innervation: superficial = lateral terminal branch of median nerve. deep = deep branch of ulnar nerve C8/T1
Vascular: superficial palamr branch of radial artery
Action: flexes metacarpophalangeal joint of thumb
32
Abductor pollicis brevis
INTRINSIC MUSCLE OF HAND
Origin: flexor retinaculum
Insertion:radial side of proximal phalanx
Innervation: lateral terminal branch of median nerve C8/T1
Vascular: superficial palmar branch of radial artery
Action: draws thumb forwards (90 degrees to hand)
33
Opponens pollicis
INTRINSIC MUSCLE OF HAND
Origin: tubercle of trapezium and flexor retinaculum
Insertion: lateral border, palmar surface of thumb metacarpal
Innervation: lateral terminal branch of median nerve C8/T1
Vascular: superficial palmar branch of radial artery
Action: flexes metacarpal bone of thumb
34
Adductor pollicis
INTRINSIC MUSCLE OF HAND
2 heads - oblique and transverse
Origin: oblique = capitate and base of 2nd and 3rd metacarpal. transverse = distal 2/3 of palmar surface of 3rd metacarpal
Insertion: ulnar side of base of proximal phalanx
Innervation: deep branch of ulnar nerve C8/T1
Vascular: arteria princeps pollicis and arteria radialis indicis
Action: adduction of the thumb (thumb to palm of hand)
35
Abductor digiti minimi
INTRINSIC MUSCLE OF HAND
Origin: pisiform bone
Insertion: ulnar side of base of proximal phalanx of little finger
Innervation: deep branch of ulnar nerve C8/T1
Vascular: deep palmar branch of ulnar artery
Action: abducts little finger
36
Flexor digiti minimi brevis
INTRINSIC MUSCLE OF HAND
Origin: hook of hamate and palmar surface of flexor retinaculum
Insertion: ulnar side of base of proximal phalanx of little finger
Innervation: deep branch of ulnar nerve C8/T1
Vascular: deep palmar branch of ulnar artery
Action: flexion of little finger at metacarpophalangeal joint
37
Opponens digiti minimi
INTRINSIC MUSCLE OF HAND
Origin: hook of hamate
Insertion: ulnar margin of 5th metacarpal bone
Innervation: deep branch of ulnar nerve C8/T1
Vascular: deep palmar branch of ulnar artery and medial deep palmar arch
Action: flexes 5th metacarpal bone (brings little finger to thumb)
38
Palmaris brevis
INTRINSIC MUSCLE OF HAND
Origin: flexor retinaculum and medial border of palmar aponeurosis
Insertion: dermis on ulnar border of hand
Innervation: superficial branch of ulnar nerve C8/T1
Vascular: ulnar end of superficial palmar arch
Action: secures palmar grip
39
Palmar interossei
INTRINSIC MUSCLE OF HAND
lies on the palmar surface of metacarpal bones
Origin: entire length of each metacarpal (not middle finger), each has one that faces the middle finger
Insertion: 1st and 2nd ulnar side, 4th and 5th radial side of metacarpal bone
Innervation: deep branch of ulnar nerve C8/T1
Vascular: deep palmar arch, princeps pollicis artery
Action: adducts fingers,metacarpophalangeal flexion and interphalangeal extension
40
Dorsal interossei
INTRINSIC MUSCLE OF HAND
4 bipennate muscles
Origin: adjacent sides of 2 metacarpal bones, more from the one it attaches to
Insertion: base of proximal phalanges
Innervation: deep branch of ulnar nerve C8/T1
Vascular: dorsal metacarpal arteries (1st-4th), palmar metacarpal arteries (2nd-4th) and radial artery (1st)
Action: abduction of fingers
41
What are the 2 interossei muscles and what are there actions?
```
Palmar = ADDUCTION of fingers
Dorsal = ABDUCTION of fingers
```
42
Lumbricals
INTRINSIC MUSCLE OF HAND
4 small fasciculi from tendons of flexor digitorum profundus
Origin: 1st and 2nd from radial side palmar surface of tendons of index and middle fingers. 3rd - middle and ring and 4th - ring and little.
Insertion: lateral margin of dorsal digital expansion of extensor digitorum
Innervation: 1st and 2nd = median C8/T1. 3rd and 4th = deep ulnar nerve C8/T1
Vascular: 1st and 2nd = first and second dorsal metacarpal and dorsal digital arteries. 3rd and 4th = 2nd and 3rd common palmar digital arteries
Action: extension of interphalangeal joints, proprioception
43
What are the 3 ligaments that hold the hip in place?
- Iliofemoral: from the ASIS to intertrochanteric line, inverted Y appearance, limits extension
- Pubofemoral: iliopubic eminence to the femur, limits abduction
- Ischiofemoral: ischium to the greater trochanter (weakest)
44
What forms the obturator canal and what passes through it?
a) formed by obturator membrane and the obturator foramen
| b) obturator nerve and vessels
45
What forms the greater sciatic foramen and what passes through it?
a) margins: the greater sciatic notch, upper borders of the sacrospinous and sacrotuberous ligaments and lateral sacrum
b) above the piriformis: superior gluteal nerve artery and vein
below the piriformis:
- sciatic nerve
- inferior gluteal nerve, artery and vein
- pudendal nerve
- interal pudendal artery and vein
- posterior femoral cutaneous nerve
- nerve to obturator internus and gemellus superior muscles
- nerve to quadratas femoris and gemellus inferior muscles
46
What passes through the lesser sciatic foramen?
Obturator internus muscle tendon
| Pudendal nerve and internal pudendal vessels
47
What passes through the gap between the inguinal ligament and the pelvic bone
- psoas major, iliacus, pectineus
- femoral artery, nerve and vein
- lymphatics
- femoral branch of gentiofemoral nerve
- lateral cutaneous nerve of thigh
48
What is the fasica lata?
It is the thick stocking like fasica that covers the thigh and leg.
49
What are the margins of the femoral triangle?
Base: inguinal ligament
Medial: adductor longus muscle
Floor: pectineous
Lateral: sartorius
50
What is the contents of the femoral triangle?
femoral nerve, artery and vein
| lymphatics
51
What is covered by the femoral sheath?
femoral artery, nerve and lymphatics
| The femoral nerve lies lateral
52
What are the gluteal muscles? (8)
- Piriformis
- Gemellus superior
- Gemellus inferior
- Gluteus maximus
- Gluteus medius
- Gluteus minimus
- Tensor fascia latae
- Obturator internus
53
What are the muscles of the thigh which lie in the anterior compartment? (8)
- Vastus medialis
- Vastus intermedius
- Vastus lateralis
- Rectus femoris
- Sartorius
- Psoas major
- Psoas minor
- Iliacus
54
What are the muscles of the thigh which lie in the medial compartment? (6)
- Gracilis
- Pectineus
- Adductor longus
- Adductor brevis
- Adductor magnus
- Obturator externus
55
What are the muscles of the thigh which lie in the posterior compartment? (3)
- Biceps femoris
- Semitendinous
- Semimembranous
56
Piriformis
GLUTEAL MUSCLE
Origin: anterior surface of sacrum between the anterior sacral foramina
Insertion: medial side of superior border of greater trochanter
Innervation: Branches from L5, S1, S2
Vascular: superior gluteal and gemellar branches of the internal pudendal artery
Action: laterally rotates the extended femur at the hip and abducts flexed femur at the hip joint
57
Obturator internus
GLUTEAL MUSCLE
Origin: anterolateral wall of true pelvis, deep surface of obturator membrane
Insertion: medial side of the greater trochanter
Innervation: nerve to obturator internus L5, S1
Vascular: extrapelvic - gemellar branches of interal pudendal artery artery. intrapelvic - obturator artery
Action: lateral rotation of the extended femur, abduction of flexed femur
58
Gemellus superior
GLUTEAL MUSCLE
Origin: external surface of ischial spine
Insertion: length of superior surface of obturator internus tendon and medial side of greater trochanter
Innervation: nerve to the obturator internus L5, S1
Vascular: internal pudendal artery and gemellar branches
Action: laterally rotates the extended femur, abducts flexed femur
59
Gemellus inferior
GLUTEAL MUSCLE
Origin: upper aspect of ischial tuberosity
Insertion: length of inferior surface of the obturator internus tendon and medial side of the greater trochanter
Innervation: nerve to quadratas femoris L5, S1
Vascular: medial circumflex femoral artery
Action: laterally rotates extended femur and abducts flexed femur
60
Gluteus minimus
GLUTEAL MUSCLE
Origin: external surface of ilium between inferior and anterior gluteal lines
Insertion: linear fascet on anterolateral aspect of greater trochanter
Innervation: superior gluteal nerve L4,L5,S1
Vascular: superior gluteal and trochanteric anastamoses
Action: abducts femur, medially rotates thigh and prevents pelvic drop
61
Gluteus medius
GLUTEAL MUSCLE
Origin: external surface of ilium between anterior and posterior gluteal lines
Insertion: elongate fascet of lateral surface of greater trochanter
Innervation: superior gluteal nerve L4,L5,S1
Vascular: deep branch of superior gluteal artery
Action: abducts femur, medially rotates thigh, prevents pelvic drop, holds pelvis secure over stance leg
62
Gluteus maximus
GLUTEAL MUSCLE
Origin: fascia covering the gluteus medius, external surface of ilium behind posterior gluteal line, fascia of erector spine, dorsal surface of lower sacrum, external surface of sacrotuberous ligament
Insertion: posterior aspect of iliotibial tract of fasica lata and gluteal tuberosity on the proximal femur
Innervation: inferior gluteal nerve L5, S1, S2
Vascular: inferior gluteal and superior gluteal artery
Action: powerful extensor of the flexed femur, stabiliser of the hip and knee, lateral rotation and abducts thigh
63
Tensor fascia latae
GLUTEAL MUSCLE
Origin: lateral aspect of crest of ilium between the ASIS and tubercle of crest
Insertion: iliotibial tract of fascia latae
Innervation: superior gluteal nerve L4,L5,S1
Vascular: lateral circumflex femoral artery
Action: stabilises the knee in extension
64
Psoas major
THIGH: ANTERIOR COMPARTMENT
Origin: anterior surfaces and lower borders of all lumbar vertebrae
Insertion: lesser trochanter of femur
Innervation: ventral rami of L1 and L2 (sometimes L3)
Vascular: network from lumbar, iliolumbar, obturator, external iliac and femoral
Action: acts with iliacus = iliopsoas
65
Psoas minor
THIGH: ANTERIOR COMPARTMENT
absent in 40%
Origin: side of bodies of T12 and L1 and their intervertebral disc
Insertion: pecten pubis and iliopectineal eminence
Innervation: branch from L1
Vascular: lumbar arteries
Action: weak flexor of the trunk
66
Iliacus
THIGH: ANTERIOR COMPARTMENT
Origin: iliac fossa and inner iliac crest, sacroiliac and iliolumbar ligaments and upper surface of lateral sacrum
Insertion: lesser trochanter of femur
Innervation:femoral nerve brances L2,L3
Vascular: network from lumbar, iliolumbar, obturator, external iliac and femoral arteries
Action: flexes thigh upon pelvis, bends the trunk, balancing trunk while sitting
67
What are the 4 muscles that make up the quadriceps?
Vastus medialis
Vastus intermedialis
Vastus lateralis
Rectus femoris
68
Vastus medialis
THIGH: ANTERIOR COMPARTMENT
Origin: femur - medial part of intertrochateric line, pectineal line and medial lip of linea aspera, medial supracondylar line
Insertion: quadriceps femoris tendon and medial border of patella
Innervation: femoral nerve L2,L3,L4
Vascular: superficial femoral artery
Action: extends leg at knee joint
69
Vastus intermedius
THIGH: ANTERIOR COMPARTMENT
Origin: femur - upper 2/3 of anterior and lateral surfaces
Insertion: quadriceps femoris tendon and lateral margin of patella
Innervation: femoral nerve L2,L3,L4
Vascular: lateral - artery of quadriceps, medial - profunda
Action: extends leg at the knee joint
70
Vastus lateralis
THIGH: ANTERIOR COMPARTMENT
Origin: femur - lateral part of intertrochanteric line, margin of greater trochanter, lateral margin of gluteal tuberosity and lateral lip of linea aspera
Insertion: quadriceps femoris tendon
Innervation: femoral nerve L2,L3,L4
Vascular: lateral circumflex femoral and artery of quadriceps, profunda femoris artery
Action: extends the leg at the knee joint
71
Rectus femoris
THIGH: ANTERIOR COMPARTMENT
Origin: straight head - ASIS, reflected head - ilium just superior to the acetabulum
Insertion: quadriceps femoris tendon
Innervation: femoral nerve L2,L3,L4
Vascular: artery of quadriceps and lateral circumflex femoral
Action: flexes thigh at hip and extends leg at knee joint
72
Sartorius
THIGH: ANTERIOR COMPARTMENT
Origin: ASIS
Insertion: medial surface of tibia just inferomedial to tibial tuberosity
Innervation: femoral nerve L2,L3
Vascular: femoral system - common, superficial or lateral circumflex
Action: flexes thigh at hip and flexes leg at knee
73
Gracilis
THIGH: MEDIAL COMPARTMENT
Origin: external surface of body of pubis, inferior pubic ramus and ramus of ischium
Insertion: medial surface of proximal shaft of tibia
Innervation: Obturator nerve L2,L3
Vascular: artery of adductors of profunda
Action: adducts thigh at hip and flexes knee
74
Pectineus
THIGH: MEDIAL COMPARTMENT
Origin: pectineal line and adjacent bone of pelvis
Insertion: oblique line from lesser trochanter to linea aspera
Innervation: femoral nerve L2,L3
Vascular: medial circumflex femoral and common femoral artery
Action: adducts and flexes thigh at the hip joint
75
Adductor longus
THIGH: MEDIAL COMPARTMENT
Origin: external surface of the body of pubis (depression inferior to the pubic crest and lateral to the pubic symphysis)
Insertion: linea aspera on middle 1/3 of femur
Innervation: obturator nerve L2,L3
Vascular: artery of adductors and profunda femoris artery
Action: adducts and medially rotates thigh at the hip
76
Adductor brevis
THIGH: MEDIAL COMPARTMENT
Origin: external surface of body of pubis and inferior pubic ramus
Insertion: posterior surface of proximal femur and upper 1/3 of linea aspera
Innervation: obturator nerve L2,L3
Vascular: profunda femoris and artery of adductors
Action: adducts thigh at hip
77
Adductor magnus
THIGH: MEDIAL COMPARTMENT
Origin: ischiopubic ramus
Insertion: linea aspera, medial supracondylar line, post proximal femur
Innervation: obturator nerve L2,L3,L4
Vascular: obturator, profunda femoris and superficial femoral artery
Action: adducts and medially rotates the thigh at the hip joint
78
Obturator externus
THIGH: MEDIAL COMPARTMENT
Origin: medial 2/3 of external surface of anterior pelvic wall
Insertion: trochanteric fossa of femur
Innervation: posterior branch of obturator nerve L3, L4
Vascular: obturator and medial circumflex femoral artery
Action: lateral rotation of the femur
79
Biceps femoris
THIGH: POSTERIOR COMPARTMENT
2 heads - long and short
Origin: long head - inferiomedial part of the upper area of ischial tuberosity. short head - lateral lip of linea aspera
Insertion: head of fibula
Innervation: sciatic nerve L5,S1,S2
Vascular: profunda femoris artery, inferior gluteal and popliteal artery
Action: flexes leg at the knee; extends and laterally rotates thigh at hip and laterally rotates the leg at the knee joint
80
Semitendinous
THIGH: POSTERIOR COMPARTMENT
Origin: inferiomedial part of the upper area of the ischial tuberosity
Insertion: medial surface of proximal tibia
Innervation: sciatic nerve L5,S1,S2
Vascular: profunda femoris artery, inferior gluteal and popliteal artery
Action: flexes leg at knee, extends thigh at hip and medially rotates thigh at hip and leg at the knee
81
Semimembranous
THIGH: POSTERIOR COMPARTMENT
Origin: superolateral imoression on ischial tuberosity
Insertion: groove and adjacent bone on medial and posterior surface of medial tibial condyle
Innervation: sciatic nerve L5, S1, S2
Vascular: posterior obturator artery
Action: flexes leg at knee and extends thigh at hip; medially rotates thigh at hip joint and leg at the knee joint
82
What muscles are responsible for flexion at the hip? [4] What spinal levels are responsible?
Iliopsoas
Rectus femoris
Sartorius
Pectineous
L2,L3
83
What muscles are responsible for extension at the hip? [4] What spinal levels are responsible?
Gluteus maximus
Biceps femoris
Semitendinous
Semimembranous
L4,L5
84
What muscles are responsible for abduction at the hip? [7] What spinal levels are responsible?
```
Piriformis
Obturator internus
Gemellus inferior
Gemellus superior
Gluteus minimus
Gluteus medius
Gluteus maximus
```
L4,L5
85
What muscles are responsible for adduction at the hip? [5] What spinal levels are responsible?
```
Gracalis
Pectineus
Adductor longus
Adductor brevis
Adductor magnus
```
L2,L3
86
What muscles are responsible for lateral rotation at the hip? [8]
```
Piriformis
Obturator internus
Obturator externus
Gemellus superior
Gemellus inferior
Quadratas femoris
Gluteus maximus
Biceps femoris
```
87
What muscles are responsible for medial rotation at the hip? [6]
```
Gluteus minimus
Gluteus medius
Adductor longus
Adductor magnus
Semitendinous
Semimembranous
```
88
What are the ligament involved in the shoulder joint [8]
- Coracoacromial ligament
- Sternoclavicular ligament
- Costoclavicular ligament
- Acromioclavicular ligament
- superior transverse ligament
- transverse humeral ligament
- coracohumeral ligament
- glenohumeral ligament
89
Pectoralis major
SHOULDER - thick fan shaped muscle
Origin: anterior sternal clavicle, anterior sternum, true rib cartilage
Insertion: greater tubercle of humerus
Innervation: medial and lateral pectoral nerves C5-T1
Vascular: thoracoacromial artery, pectoral branch from axillary
Action: adduction and medial rotation of humerus
90
Pectoralis minor
SHOULDER - thin triangular muscle deep to pec major
Origin: Ribs 3-5
Insertion: coracoid process of scapula
Innervation: medial and lateral pectoral nerves C5-T1
Vascular: pectoral and deltoid branches of thoracoacromial and thoracic arteries
Action: draws scapula down and dperesses point of shoulder
91
Subclavius
SHOULDER - small triangular muscle tucked between clavicle and first rib
Origin: junction of 1st rib and its costal cartilage
Insertion: inferior middle third of clavicle
Innervation: subclavian branch of brachial plexus C5-C6
Vascular: clavicular branch of thoracacromial artery and suprascapular artery
Action: pulls shoulder down
92
Trapezius
SHOULDER - large flat triangular muscle of back
Origin: occipital bone, ligamentum nuchae, spinous processes T1-T12
Insertion: Lateral third of clavicle, acromion and spine of scapula
Innervation: accessory nerve (CN11) and cervical plexus C3-C4
Vascular: upper 1/3 = transverse occipital, middle 1/3= superficial cervical, lower 1/3 = dorsal scapular
Action: steading scapula, maintaining poise. Retracts scapula and bends head backwards
93
Deltoid
SHOULDER - 3 heads: anterior, middle and posterior
Origin: anterior = lateral 1/3 of clavicle, middle = acromion, posterior = scapula spine
Insertion: deltoid tuberosity on lateral body of humerus
Innervation: axillary nerve C5-6
Vascular: acromio and deltoid branches of thoracoacromial artery
Action: lateral and medial rotation of humerus. Abduction of humerus.
94
Latissimus dorsi
SHOULDER - large flat triangular muscles of the lower back
Origin: spinous process T7-L5
Insertion: intertubercular groove of humerus
Innervation: thoracodorsal nerve from posterior cord C6,7,8
Vascular: Thoracodorsal artery
Action: medial rotation, adduction and extension of humerus
95
Serratus anterior
SHOULDER - large muscular sheet
Origin: upper 8 ribs
Insertion: medial border of scapula
Innervation: long thoracic nerve C5-7
Vascular: superior and lateral thoracic arteries
Action: upward rotation of scapula. Elevation of ribs when scapula fixed
96
Infraspinatus
SHOULDER - thick, triangular muscle in infraspinous fossa
Origin: medial 2/3 of infraspinous fossa of scapula
Insertion: middle fascet of greater tubercle of humerus
Innervation: suprascapular nerve C5&6
Vascular: suprascapular and circumflex scapular arteries
Action: lateral rotation of humerus
97
Supraspinatus
SHOULDER
Origin: supraspinus fossa
Insertion: greater tubercle of humerus
Innervation: suprascapular nerve C5&6
Vascular: suprascapular and dorsal scapular arteries
Action: initiates abduction of humerus. Stabilise head of humerus
98
Subscapularis
SHOULDER - bulky, triangular muscle that fills subscapular fossa
Origin: costal surface of scapula
Insertion: lesser tubercle of humerus
Innervation: subscapular nerve C5-6
Vascular: subscapular, axillary and suprascapular arteries
Action: medial rotation of humerus. stabilise head of humerus.
99
Teres major
SHOULDER - thick flat muscle
Origin: dorsal surface of inferior scapular angle
Insertion: intertuberous sulcus of humerus
Innervation: lower subscapular nerve C5-7
Vascular: thoracodorsal branch of subscapular artery
Action: draws humerus backwards. medial rotation
100
Teres minor
SHOULDER - narrow elongated muscle
Origin: upper 2/3 lateral border of scapula
Insertion: greater tuberosity of humerus
Innervation: axillary nerve C5-6
Vascular: circumflex scapular artery
Action: lateral rotation, weak adduction of humerus
101
Levator scapulae
SHOULDER
Origin: transverse process of C1-C4 in straps
Insertion: superior medial scapula spine
Innervation: direct branches of C3-5
Vascular: transverse and ascending cervical arteries (thyrocervical trunk)
Action: elevates scapula medially and upwards
102
Rhomboid major
SHOULDER
Origin: spinous process T2-T5
Insertion: medial border of scapula
Innervation: dorsal scapula nerve C5
Vascular: dorsal scapula artery
Action: retract medial border of scapula superiorly
103
Rhomboid minor
SHOULDER
Origin: spinous processes of C7-T1
Insertion: medial border of scapula
Innervation: dorsal scapula nerve C5
Vascular: dorsal scapula artery
Action: retract medial border of scapula superiorly
104
Describe the sternoclavicular joint
Synovial sellar joint
Between sternal end of clavicle and clavicular notch of sternum
Fibrous capsule - weak superiorly and inferiorly
Anterior and posterior sternoclavicular ligaments.
Interclavicular ligament
105
Describe the acromioclavicular joint
Synovial plane joint
Between acromial end of clavicle and medial acromial margin
Fibrous capsule lined by a synovial membrane
```
Acromioclavicular ligament
Coracoclavicular ligament (trapezoid/anterolateral and conoid/posteriomedial parts)
```
106
Describe the glenohumeral joint
Synovial multiaxial spheroidal joint
Between hemispherical head of humerus and glenoid fossa of scapula
Glenoid labrum deepens the glenoid fossa
Fibrous capsule. Hyaline cartilage.
Ligaments
- coracohumeral ligament
- transverse humeral ligament
- glenohumeral ligaments (3) - superior, middle, inferior
107
What muscles are in the rotator cuff? [4]
- Supraspinatus
- Infraspinatus
- Teres minor
- Subscapularis
108
Coracobrachialis
UPPER ARM AND ELBOW
Origin: apex of coracoid process
Insertion: midway along medial border of humeral shaft
Innervation: musculocutaneous nerve C5-7
Vascular: axillary artery
Action: flexes arm forward and medially
109
Biceps brachii
UPPER ARM AND ELBOW - 2 heads (short and long)
Origin: short head = coracoid apex. long head = supraglenoid tubercle of scapula within capsule of shoulder joint
Insertion: posterior radial tuberosity
Innervation: musculocutaneous nerve C5-6
Vascular: varies between: superior/inferior ulnar collaterol, subscapular, axillary, ulnar or radail artery. Originates from brachial artery
Action: supination, elbow flexion`
110
Brachialis
UPPER ARM AND ELBOW
Origin: lower half of the front of humerus
Insertion: cubital articular surface
Innervation: musculocutaneous nerve C5-6 and radial nerve C7
Vascular: superior = brachial artery. inferior = superior ulnar collateral/brachial
Action: elbow flexor
111
Triceps
UPPER ARM AND ELBOW - 3 heads = long, lateral, medial
Origin:
- long = infraglenoid tubercle of scapula
- lateral = posterior surface of humeral shaft
- medial = entire posterior surface of humeral shaft
Insertion: all converge to common tendon - upper olecranon
Innervation: radial nerve C6-8
Vascular: profunda brachii and superior ulnar collateral artery
Action: arm extensor
112
Describe the elbow joint
Synovial joint
2 articulations
- humeroulnar (trochlea of humerus and ulnar trochlear notch)
- humeroradial (capitellum of humerus and radial head)
113
Ligaments in the elbow joint
- ulnar collateral ligament (3 parts - anterior, posterior and inferior)
Connects medial epicondyle to the proximal tubercle of coronoid margin.
- radial collateral ligament : connects lateral epicondyle to the annular ligament
114
Desribe proximal (superior) radioulnar joint
Uniaxial pivot joint
Articulating between the circumference of the radial head and fibro-osseous ring made by the ulnar radial notch and annular ligament
115
Describe annular ligament
encircles radial head, holding it against the radial notch of the ulna.
external surface of the anular ligament blends with the radial collateral ligament.
116
What are the borders of the cubital fossa
```
Superior: imaginary line between 2 epicondyles of humerus
Medial: pronator teres
Lateral: brachioradialis
Roof: superficial fascia
Floor: brachialis and supinator
```
117
Define chronic pain
Pain lasting longer than 3 months
| Often affects mood and social functioning
118
Describe neuropathic pain
- Associated with abnormal sensation
- Structural neural damage or abnormal processing
- Responds poorly to conventional analgesics
119
Define allodynia
small stimulus causes a pain response
120
Define hyperalgesia
increase in pain from a lower stimuli
121
Define radiculopathy
dysfunction of spinal nerve roots/ spinal nerves causing paralysis or paresis of myotomes. Paraesthesia of dermatomes
122
Define axonotmesis
Disruption of nerve cell axon - only damage to the myelin sheath
123
Define neuropraxia
Compression of named nerve
124
Define neurotmesis
Cutting of entire nerve
125
Where are the common sites of nerve injury? Generic
- proximity to bone
- proximity to skin
- tightly enclosed regions
126
Common nerve injuries to axillary nerve and what are the effects?
Runs behind and around the surgical neck of humerus
- Fractures of surgical neck of humerus
- Anterior glenohumeral dislocation
Weak lateral rotation and loss of abduction to 90 degrees
127
Common nerve injuries to radial nerve and what are the effects?
Sensory to posterior forearm
- Common to injure in axilla and spiral groove
- Midshaft humeral fracture
- Poorly fitting crutches
- Falling asleep over an arm chair
Wrist drop and sensory loss in posterior arm. Problems with grip due to lack of extension
128
Common nerve injuries to musculocutaneous nerve and what are the effects?
Supplies anterior brachial compartment
- common to injure in midshaft of humerus
- humeral shaft fracture
- penetrating injury
Weakness or lack of elbow flexion.
Weakness of forearm supination
Sensory loss in lateral forearm
129
Common nerve injuries to median nerve and what are the effects?
Supplies all thenar muscles and 6.5 forearm flexors
- common to injure in cubital fossa and carpal tunnel
- supracondylar fractures
- wrist slashing
Ulnar deviation on wrist flexion
PIP/DIP and MCP joint dysfunction in lateral 3 digits
Loss of thumb movement and thenar atrophy
Sensory loss in median nerve
130
Common nerve injuries to ulnar nerve and what are the effects?
Supplies all intrinsic hand muscles and some skin
- Common injuries in medial epicondyle and Guyons canal
- fracture of medial epicondyle
- handlebar palsy and wrist slashing
Radial deviation.
Loss of abduction and adduction of fingers.
Loss of extension at DIP and PIP of ring and little fingers
Mild claw hand
Sensory loss over ulnar area
131
Describe Erb's palsy
Loss of C5 and C6 due to violent stretch between head and shoulder
Can't adduct shoulder
Unopposed medial rotation
Elbow extension due to loss of biceps
Pronation - loss of biceps
132
Describe the ligaments in the knee joint
Anterior cruciate ligament - attaches to medial surface of lateral epicondyle (stops anterior displacement)
Posterior cruciate ligament - attaches to lateral surface of medial epicondyle (stops posterior displacement)
Collateral ligaments
- Fibular - attached to lateral femoral epicondyle and depression on lateral surface of fibular head
- Tibial - medial epicondyle of femur and adductor tubercle
133
Describe the knee joint
2 femoral condyles articulate with the tibial condyles
Femoral condyles
- curved in flexion
- flat in extension
Surfaces covered in hyaline cartilage
Synovial membrane attaches to margins of articular surfaces
134
Descibe the locking mechanism of the knee
Locking the knee when standing reduces energy required
- Change in shape and size of femoral surfaces that articulate with the tibia
- flexion curved and extension is flat
- Joint surfaces become larger and more stable in extension
- medial rotation of femur on tibia
- in extension, centre of gravity passes anterior to knee joint
Unlocked by popliteus muscle initiating lateral rotation
135
What muscles are in the posterior compartment of the leg? Superficial [3] and Deep [4]
Superficial
- Gastrocnemius
- Plantaris
- Soleus
Deep
- Popliteus
- Flexor hallucis longus
- Flexor digitorum longus
- Tibialis posterior
136
Gastrocnemius
LEG - 2 heads (medial and lateral)
Origin: medial = posterior surface of distal femur just superior to medial condyle. lateral = upper posterolateral surface of lateral femoral condyle
Insertion: via calcaneal tendon, to posterior surface of calcaneus
Innervation: tibial nerve S1, S2
Vascular: popliteal artery
Action: plantar flexes foot and flexes knee
137
Plantaris
LEG
Origin: inferior part of lateral supracondylar line of femur and oblique popliteal ligament of knee
Insertion: via calcaneal tendon to posterior surface of calcaneus
Innervation: tibial nerve S1,S2
Vascular: sural branch of popliteal, posterior tibial and peroneal
Action: plantar flexes foot and flexes knee
138
Soleus
LEG
Origin: soleal line and medial border of tibia; posterior aspect of fibular head and adjacent surfaces of neck and proximal shaft; tendinous arch
Insertion: via calcaneal tendon, to posterior surface of calcaneus
Innervation: tibial nerve S1,S2
Vascular: peroneal and posterior tibial artery
Action: plantar flexes the foot
139
Popliteus
LEG
Origin: lateral femoral condyle
Insertion: posterior surface of proximal tibia
Innervation: tibial nerve L4,S1
Vascular: medial inferior genicular branch of popliteal artery
Action: stabilises knee joint (resists lateral rotation of tibia on femur). Unlocks knee (laterally rotates femur)
140
Flexor hallucis longus
LEG
Origin: posterior surface of fibula and interosseous membrane
Insertion: plantar surface of distal phalanx of big toe
Innervation: tibial nerve S2,S3
Vascular: muscular branch of peroneal and posterior tibial artery
Action: flexes great toe
141
Flexor digitorum longus
LEG
Origin: medial side of posterior surface of tibia
Insertion: plantar surfaces of bases of distal phalanges of the lateral 4 toes
Innervation: tibial nerve S2,S3
Vascular: muscular branch of posterior tibial artery
Action: flexes lateral 4 toes
142
Tibialis posterior
LEG
Origin: posterior surfaces of interosseous membrane and adjacent tibia and fibula
Insertion: tuberosity of navicular and adjacent region of medial cuneform
Innervation: tibial nerve L4,L5
Vascular: posterior tibial artery
Action: inversion and plantar flexion of foot; support of medial arch of foot during walking
143
What are the muscles in the lateral compartment of the leg? [2]
Fibularis longus
| Fibularis brevis
144
Fibularis longus
LEG - lateral
Origin: upper lateral surface of fibula, head of fibula and occasionally the lateral tibial condyle
Insertion: undersurface of lateral sides of distal end of medial cuneform and base of metatarsal 1
Innervation: superficial fibular nerve L5,S1,S2
Vascular: fibular (peroneal) artery
Action: eversion and plantar flexion of foot; supports arches of foot
145
Fibularis brevis
LEG
Origin: lower 2/3 of lateral fibula shaft
Insertion: lateral tubercle at base of metatarsal 5
Innervation: superficial fibular nerve L5,S1,S2
Vascular: fibular (peroneal) and anterior tibial artery
Action: eversion of the foot
146
What are the muscles in the anterior compartment of the leg? [4]
Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus
Fibularis tertius
147
Tibialis anterior
LEG
Origin: lateral surface of tibia and adjacent interosseous membrane
Insertion: medial and inferior surfaces of medial cuneiform and adjacent surface on base of metatarsal 1
Innervation: deep fibular nerve L4,L5
Vascular: anterior tibial artery
Action: dorsiflexion of foot at ankle, inversion of foot, dynamic support of medial arch of foot
148
Extensor hallucis longus
LEG
Origin: middle 1/2 of medial surface of fibula and adjacent 10 membrane
Insertion: dorsal surface of distal phalanx of great toe
Innervation: deep fibular nerve L5,S1
Vascular: anterior tibial artery
Action: extension of great toe and dorsiflexion of foot
149
Extensor digitorum longus
LEG
Origin: proximal 1/2 of medial surface of fibula and related surface of lateral tibial condyle
Insertion: via dorsal digital expansions into bases of distal and middle phalanges of lateral 4 toes
Innervation: deep fibular nerve L5,S1
Vascular: anterior tibial artery
Action: extension of lateral 4 toes and dorsiflexion of the foot
150
Fibularis tertius
LEG
Origin: distal part of medial surface of fibula
Insertion: dorsomedial surface of base of metatarsal 5
Innervation: deep fibular nerve L5,S1
Vascular: anterior tibial artery
Action: dorsiflexion and eversion of foot
151
Name the tarsal bones [7]
Proximal: talus and calcaneus
Intermediate: navicular
Distal: cuboid, cuneiform (lateral, medal and intermediate)
152
Describe talocrural joint
Ankle joint - synovial
| Involves the talus, tibia and fibula
153
What are the 3 lateral ligaments in the ankle?
Anterior talofibular
Posterior talofibular
Calcaneofibular
154
What forms the tarsal tunnel?
Formed on posteromedial side of ankle by:
- depression formed by medial malleolus of tibia, medial and posterior surfaces of talus and medial surface of calcaneus
- overlying flexor retinaculum
155
What are the contents of the tarsal tunnel?
```
Tendon of flexor hallucis longus
Tibial nerve
Posterior tibial artery
Tendon of flexor digitorum longus
Tendon of tibialis posterior
```
156
What methods are used to maintain postural control?
Ankle strategy
Hip strategy
Stepping strategy
157
What is involved in sensing the position of the centre of gravity?
Somatosensory (60-70%)
Proprioceptive
Visual (10-20%)
Vestibular (10-20%)
158
What is acupuncture and how effective is it?
Acupuncture is a traditional Chinese medicine technique where fine needle are inserted into trigger points.
Control of underlying life energy called qi "chi"
Effectiveness 5/5 - 31 trials
159
What is osteopathy and how effective is it?
It is a strengthening of the musculoskeletal network through manipulation. Relieves muscle tension and increase blood supply.
Effectiveness 3/5 - Amber safety
160
What are the CAMs recommended by NICE for back pain?
Acupuncture
Spinal manipulation
Spinal mobilisation
Massage
161
What is the nervous supply to the auricle?
The centre is supplied by the vagus nerve.
| The outer edge is supplied by the facial nerve.
162
What is the blood supply to the external ear?
Posterior auricular artery - from external carotid
Anterior auricular artery - from superficial temporal artery
163
Describe external ear?
Covered with skin and hair
Covered in modified sweat glands that produce cerumen (earwax)
Wider laterally
Sensory innervation from mandibular V3 and vagus X, minor from facial VII
164
Describe the tympanic membrane
Sloped medially from top to bottom
Outside lined with connective tissue
Inside lined with mucous membrane
Fibrocartilaginous ring attaches it to the surrounding temporal bone
Concavity produced by attachment of handle of malleus - point of attachment is umbo of tympanic membrane
Sensory innervation to outer surface = mandibular V3 with some vagus
To inner surface = glossopharyngeal IX
165
What are the boundaries of the middle ear?
- Roof: thin layer of bone that separates from middle cranial fossa (tegmen tympani)
- Floor: thin layer of bone that separates from internal jugular vein
- Lateral: bont lateral wall of epitympanic recess
- Posterior: partially complete. Bony partition between tympanic cavity and mastoid air cells+ aditus to mastoid antrum
- Anterior: partially complete, bone separating tympanic cavity from internal carotid
166
What is the pharynotympanic tube and what is its function?
Connect middle ear with nasopharynx
Equalises pressure on both sides of tympanic membrane
Outer 1/3 is bony, inner is cartilaginous
Innervated from tympanic plexus and glossopharyngeal nerve
167
What are the 3 auditory ossicles in the middle ear?
Malleus
Incus
Stapes
168
What are the 2 muscles found in the middle ear?
Tensor tympani
| Stapedius
169
Tensor tympani
EAR
Origin: cartilaginous part of phayngotympanic tube; greater wing of sphenoid
Insertion: part of handle of malleus (upper)
Innervation: branch of mandibular nerve V3
Function: contraction pulls handle of malleus medially
170
Stapedius
EAR
Origin: attached to inside of pyramidial eminence
Insertion: neck of stapes
Innervation: branch of facial nerve VII
Function: contraction
171
What are the 2 components of the inner ear?
```
Bony cavities (labyrinth)
Membranous ducts and sacs (membranous labyrinth)
```
172
What are the components of the bony labyrinth?
Vestibule
3 semicircular canals
Cochlea
Lined with periosteum and contains a clear fluid called perilymph
173
What are the components of the membranous labyrinth?
semicircular ducts, cochlear duct, utricle and saccule
Filled with endolymph
174
What are the 3 canals formed from the cochlear duct?
Scala vestibuli
Scala tympani
Scala media
175
What is the organ of corti?
On the surface of the basiliar membrane
Contains a series of electromechanically sensitive hair cells that generate nerve impulse in response to vibration
176
Describe the basiliar membrane
Fibrous membrane in the inner ear
Contains 20000-30000 basiliar fibres that project from the centre of the cochlea
- fibres are stiff and free at one end to vibrate
- length increases to the tip of cochlea
- thick short fibres = very high frequency at base
- long thin fibres = low frequency at tip of cochlea
177
Outline the physiology of hearing
- vibrations of tympanic membrane transmits sound to ossicles
- malleus and incus act as single lever
- articulation of incus with stapes causes the stapes to push forward on the oval window and cochlear fluid on other side
- causes basilar membrane to bend in direction of round window
- organ of corti senses vibration in basilar membrane and generates nerve impulses
- synapse with cochlea nerve endings
- spiral ganglion of corti
- cochlear nerve
178
What is the central auditory path for hearing?
- cochlear nerve
- medulla (trapezoid body)
- pons (superior olivary nuclei & nucleus of lateral lemniscus)
- Midbrain (inferior colliculus and medial geniculate nucleus)
- Brain - primary auditory cortex
179
At what points in the central auditory path does decussation occur?
- in trapezoid body
- between 2 nuclei of lateral lemniscus
- in commissure connecting inferior colliculi
Transmission is greater contralaterally
180
What are the 2 parts to the auditory cortex and what excites these areas?
Primary auditory cortex - directly excited by projections from medial genticulate
Auditory association cortex - excited by primary and thalamic association areas
181
How is sound frequency determined?
Place principle
Different sound frequencies are detected by determining position of excitation along the basilar membrane
182
How is loudness determined?
Spacial summation
As the sound becomes louder, the amplitude of vibration of the basilar membrane increases.
Hairs excite nerve endings more rapidly
183
What is the role of the stereocilia?
Stereocilia project up from hair cells and touch the tectorial membrane.
Bending stereocilia one way depolarises and hyperpolaries the other way - excites auditory nerves
184
How is sound attenuated?
When a loud sound is transmitted - reflex causing contraction of stapedius and to a lesser extent tensor tympani
Stapedius pulls stape outwards
Tensor tympani pulls malleus inwards
Causes rigidity to reduce ossicular conduction of low frequencies
Protects cochlea from damaging vibrations
Masks low frequency noise in background
185
How is sound direction determined?
Time lag between ear entry and differences in intensities
Starts in superior olivary nuclei (medial and lateral)
Medial detects time lag
Lateral detects intensity
186
What are the 2 types of deafness and define?
Nerve/ sensorineural deafness - caused by an impairment of the cochlea or auditory nerve
Conduction deafness - caused by an impairment of physical structures of the ear
187
Causes of sensorineural deafness?
```
Age
Loud noises
Viral infections of inner ear (measles, mumps)
Viral infections of auditory nerve (mumps, rubella)
Menieres
Meningitis
Encephalitis
MS
Stroke
Chemotherapy
```
188
Causes of conductive deafness?
Perforated ear drum
Otosclerosis - abnormal bone growth, decreases mobility
Injury/trauma
Cholesteatoma - abnormal skin cell collection
Otitis media or externa with effusion
Excess ear wax
189
Describe Rinne's test and what is shows
Tuning fork in front of ear and on mastoid process - determining which is louder
POSITIVE - air louder than bone - sensorineural or normal
NEGATIVE - bone louder than air - conductive
190
Describe Weber's test and what is shows
Tuning fork in middle of forehead, which is louder
NORMAL - same in both ears
SENSORINEURAL - louder in unaffected ear
CONDUCTIVE - louder in affected ear
191
What are the 3 layers of the eye?
Outer fibrous layer - sclera posteriorly and cornea anteriorly
Middle vascular layer - choroid posteriorly and ciliary body & iris anteriorly
inner layer - optic retina
192
What are the 2 muscles in the iris and what is the innervation?
Sphincter pupillae - fibres in circular pattern - contraction constrict the opening. Parasympathetic innervation (oculomotor)
Dilator pupillae - fibres in radial pattern - contaction increases the opening - sympathetic innervation (superior cervical ganglion T1)
193
What is the optic disc?
Where optic nerve leaves the retina, no light receptor cells in this area - blind spot
194
What is the macula lutea?
Lateral to the optic disc with a hint of yellow colouration.
Central depression is the fovea centralis.
Higher visual sensitivity due to fewer rods, more cones
195
What is the ciliary body?
extended from anterior border of choroid and forms a complete ring around the eyeball
Ciliary muscles are controlled by parasympathetics (oculomotor) and contraction decreases the size of the ring formed by the ciliary body.
Ciliary processes are longitudinal ridges projected from the inner surface of ciliary body
Collectively forms the suspensory ligament of the lens
Contaction = decreased ring size = decreased tension = more rounded lens
196
What are the extrinsic muscles of the eye? [7]
```
Levator palpebrae superioris
Superior rectus
Inferior rectus
Medial rectus
Lateral rectus
Superior oblique
Inferior oblique
```
197
Levator palpebrae superioris
EYE
Origin: lesser wing of sphenoid anterior to optic canal
Insertion: anterior surface of tarsal plate; a few fibres to skin and superior conjunctival fornix
Innervation: oculomotor nerve III (superior branch)
Function: elevation of upper eyelid
198
Superior rectus
EYE
Origin: superior part of common tendinous ring
Insertion: anterior half of eyeball superiorly
Innervation: oculomotor nerve III (superior branch)
Function: elevation, adduction, medial rotation of eyeball
199
Inferior rectus
EYE
Origin: inferior part of tendinous ring
Insertion: anterior half of eyeball inferiorly
Innervation: oculomotor branch (superior branch)
Function: depression, adduction, lateral rotation of eyeball
200
Medial rectus
EYE
Origin: medial part of common tendinous ring
Insertion: anterior half of eyeball medially
Innervation: oculomotor nerve (inferior branch)
Function: adduction of the eyeball
201
Lateral rectus
EYE
Origin: lateral part of common tendinous ring
Insertion: anterior half of eyeball laterally
Innervation: abducent nerve VI
Function: abduction of eyeball
202
Superior oblique
EYE
Origin: body of sphenoid, superior and medially to optic canal
Insertion: outer posterior quadrant of eyeball (superior surface)
Innervation: trochlear nerve IV
Function: depression, abduction, medial rotation of eyeball
203
Inferior oblique
EYE
Origin: medial floor of orbit posterior rim, maxilla lateral to nasolacrimal duct
Insertion: outer posterior quadrant of eye (superior surface)
Innervation: oculomotor nerve III (inferior branch)
Function: elevation, adduction, lateral rotation
204
How is aqueous humor produced and what is the flow pattern?
Secreted by ciliary processes - formed by active secretion
Begins with active transport of Na+ into spaces between cells
Na+ pulls Cl- and HCO3- ions along to maintain neutrality
Water follows
From ciliary processes --> canals of Schlemm
Outflow is controlled by resistance in the trabeculae
205
What are the 7 layers of the retina?
```
Stratum opticum
Ganglion cell layer
Inner plexiform layer
Inner nuclear layer
Outer plexiform layer
Outer nuclear layer
Pigmented layer
```
206
What are the different cells in the retina?
```
Amacrine cells
Ganglion cells
Horizontal cells
Bipolar cells
Rods
Cones
```
207
Describe rods and cones
Rods are narrower and longer than cones.
Each has membrane cells in the outer segment
Mitochondria are found in the inner segment
Light sensitive photochemical is found in outer segment
Rods = rhodopsin
Cones - 1 of 3 colour proteins
208
Causes of cataracts
```
Galactosemia
Wilson disease
Corticosteroids
Trauma
Diabetes
Atopic dermatitis
Radiation
```
209
Define cataracts
Lenticular opacities that can be congential or acquired
210
Define open angle glaucoma
Aqueous humor has complete physical access to trabecular meshwork and elevation in intraocular pressure is from increased resistance to aqueous outflow
211
Define angle-closure glaucoma
Peripheral zone of iris adheres to trabecular meshworks and physically impedes the egress of humor from the eye
212
What causes secondary open angle glaucoma?
Particulate material:
- proteins from phogolysis
- red cells after trauma
- iris epithelial pigment granules
- necrotic tissues
Can clog trabecular meshwork
213
What is the most common type of glaucoma?
Primary open angle
214
What can cause primary closed angle glaucoma?
eyes with shallow anterior chambers - hyperopia
apposition of iris to anterior lens - pupillary block
continues aqueous humor production elevates pressure
Can damage lens epithelium
Minute anterior subcapsular opacities
Can produce corneal oedema
215
What are the risk factors for glaucoma?
```
Females (4x increase)
aged 60+ years
Chinese and south asian
Family history
Myopia
Retinal disease
hypertension
diabetes
```
216
What are the symptoms of glaucoma?
```
Progressive pain in eye
Blurred vision -> vision loss
Nausea and vomiting
Headache
Coloured halos around lights
```
217
Define stroke
Acute episode of focal loss of cerebral function due to vascular disease lasting more than 24 hours
218
Define TIA
transient ischaemic attack
Acute episode of focal loss of cerebral or monocular function due to embolic or thromboting vascular disease lasting less than 24 hours
219
Define primary prevention
avoidance of disease, no signs or symptoms
220
Define secondary prevention
Avoidance of progression, signs and symptoms present
221
Risk factors for stroke
```
Age (older)
Gender (female)
Race (afrocarribean)
Family history
Hypertension
Diabetes
AF
Smoking
Obesity
Hyperlipidaemia
```
222
What is the CHAD 2 Score?
Measures the risk of getting a stroke
```
Congestive heart failure =1
Hypertension =1
Age >75 = 1
Diabetes = 1
Prior stroke/TIA = 1
```
223
What are the 2 ascending tracts?
Spinothalamic
| Dorsal column medial lemniscus
224
Describe the path and function of the spinothalamic tract
Pain, temperature and crude touch
- 1st order neuron enters dorsal horn
- Decussates at spinal level
- Fibres run contralaterally
- 2nd order synapse in ventral posterior nucleus of thalamus
- 3rd order synapse in primary somatosensory area
225
Describe the path and function of the DCML tract
Fine touch, proprioception, vibration
- 1st order neuron enters dorsal horn
- Above T6 = cuneate
- Below T6 = gracalis
- Fibres run ipsilaterally to medulla
- 2nd order decussate in medulla - thalamus via medial lemniscus of midbrain
- 3rd order from thalamus to cerebrum
226
What are the names of the ventromedial descending tracts? What is the function?
- pontine reticulospinal
- tectospinal
- vestibulospinal
postural and girdle muscles
227
What are the names of the dorsolateral descending tracts? What is the function?
Corticospinal
Rubrospinal
distal muscles and fine movement
228
Describe the path of the pontine reticulospinal
IPSILATERAL
Motor cortex - pontine reticulospinal - spinal cord
Large movements of trunk and limbs, excites extensors, inhibits flexors
Runs in genu of internal capsule
229
Describe the path of the tectospinal tract
CONTRALATERAL
superior colliculus - anterior horn of cervical spinal cord
Orientation and navigation - turn head to stimuli
230
Describe the pathway of vestibulospinal tract
IPSILATERAL
Vestibular nuclei (pons and medulla) - spine
Keeps upright, balance and quick movements
231
What happens if you damage the ventromedial tracts?
```
loss of righting reaction
no navigational control
forward slump
can't reach
can flex elbow and digits
```
232
Describe the corticospinal tract
85% CONTRALATERAL 15% IPSILATERAL
- premotor, motor and primary sensory -> contralateral anterior horn
Independent flexion of distal joints and skilled motor
Runs through posterior limb of internal capsule
233
Describe the rubrospinal tract
CONTRALATERAL
Mesencephalic red nuclei (midbrain) and decussates
Control and coordination of movement
234
What happens if you injure the dorsolateral descending tracts?
Reach by shoulder circumduction
Fingers flex together
Arms hang limply
235
Define traumatic brain injury
non-degenerative, noncongenital insult to the brain from an external mechanical force which can lead to permanent or temporary impairment of cognitive, physical or psychosocial functions
236
Mechanisms of primary TBI
```
Impact Loading
Impulsive loading
skull fracture
auditory/vestibular dysfunction
intracranial haemorrhages
coup and contrecoup contusions
concussion
diffuse axonal injury
```
237
What is secondary injury in TBI and examples of how it occurs?
Further cellular damage from effects of primary injury
- elevated excitatory amino acids that cause swelling, vasodilation and neuronal death
- endogenous opioid peptides can exacerbate neuronal damage by modulating the presynapitic release of EAA neurotransmitters (inflammation)
- increased ICP
- hydrocephalus
238
What are the different types of brain herniation? [5]
- supratentorial
- subfalcine: frontal lobe is pushed beneath falx cerebri (MOST COMMON)
- Central transtentorial: midbrain through tentorial notch, cerebral hemispheres downward
- Uncal: displacement of uncus over ipsilateral edge of tentorium cerebelli foramen - midbrain compression
- Cerebellar: cerebellum pushed through foramen magnum
239
Define dysphasia - what are the 2 types?
Impaired ability to understand or use the spoken word.
Due to a lesion of dominant hemisphere and can include impaired ability to read and write
Receptive and expressive
240
Define receptive dysphasia
language fluent with normal rhythm and articulation but meaningless - Wernickes
241
Define expressive dysphasia
language not fluent, difficulty forming words, difficulty finding the right words but understand what is being said.
Broca's
242
Define dysarthria
Caused by upper motor neuron lesions of the cerebral hemispheres or lower motor neuron lesions of brain stem
difficult or unclear articulation of speech that is otherwise linguistically normal
243
Symptoms of head injury
```
Seizures and fitting
Altered level of consciousness
Post traumatic amnesia
Vomiting
Pain
Dizziness
```
244
What is the Cushing reflex?
Increase in blood pressure to maintain cerebral perfusion pressure
245
What is the Monroe-Kellie doctrine?
There is a degree of compensation within the skull for increased ICP.
This is due to movement of CSF into spine and venous blood into JVP
Works up to a point
246
After a head injury what causes the progressive damage?
- Damage to lipid bilayer
- ATP pump failure
- Movement of Ca2+ ions
- Free oxygen radical formation
- This causes cellular damage
247
What are the different methods for imaging the brain? [6]
- CT (computerised tomography)
- EEG (electroencephalography)
- MRI (magnetic resonance imaging)
- MEG (magnetoencephalography)
- PET (positron emission tomography)
- TMS (transcranial magnetic stimulation)
248
What are the causes of a stroke?
- Embolisation 25%
- Occlusion 50%
- Haemorrhage 20%
- Other 5% (venous infarction, demyelination)
249
If there is a blockage to the posterior inferior cerebellar artery - what happens?
Ipsilateral ataxia and horners syndrome
Contralateral hemiparesis and spinothalamic sensory loss
250
If there is a large vessel occulation to the carotid artery - what happens?
Contralateral hemiplegia and hemisensory disturbance
Gaze palsy - eyes deviate to side of lesion
If in the dominant hemisphere - global aphasia
251
What is involved in the rehabilitation service for stroke?
```
Assessment
Goal setting
Education
Speech and language therapy
Psychologist
Physio
OT
MDT
Nutrition
Swallowing assessment
Medication and therapies to prevent a reoccurence
```
252
What is cranial nerve 1?
Where does it exit the skull?
What is its function?
Olfactory nerve
Exits skull at cribiform plate of ethmoid bone
Function = smell
Afferent fibres
253
What is cranial nerve 2?
Where does it exit the skull?
What is its function?
Optic nerve
Exits skull at the optic canal
Function = vision
Afferent fibres
254
What is cranial nerve 3?
Where does it exit the skull?
What is its function?
Oculomotor nerve
Exits skull at superior orbital fissure
Functions:
- innervates levator palpebrae superioris, superior rectus, inferior rectus, medial rectus, inferior oblique
- innervates sphincter pupillae and ciliary muscle
Efferent fibres
255
What is cranial nerve 4?
Where does it exit the skull?
What is its function?
Trochlear nerve
Exits skill at superior orbital fissure
Function = innervates superior oblique muscle
Efferent fibres
256
What is cranial nerve 5?
Where does it exit the skull?
What is its function?
Trigeminal
1 - opthalmic
2 - maxillary
3 - mandibular
Exits skull at:
1 - superior orbital fissure
2- foramen rotundum
3 - foramen ovale
Functions=
1 - sensory to eyes, nasal cavity, orbit, upper eye lid and anterior scalp
2- sensory to nasopharynxc, palate, nasal cavity, upper teeth, maxillary sinus, lower eyelid, cheek, upper lip
3 - sensory to skin of lower face and lip, tongue, external acoustic meatus, lower teeth
Innervates temporalis, masseter, pterygoids, tensory tympani, mylohyoid
257
What is cranial nerve 6?
Where does it exit the skull?
What is its function?
Abducens
Exits skull at superior orbital fissure
Function: innervates lateral rectus muscle
Efferent fibres
258
What is cranial nerve 7?
Where does it exit the skull?
What is its function?
Facial nerve
Exits skull through stylomastoid foramen, leaves through internal acoustic meatrus and branches in the facial canal
Functions
- sensory from exteral acoustic meatus and deep auricle
- taste from anterior tongue
- innervates lacrimal and salivary glands (not parotid), palate and mucous membrane in nose
- innervates facial muscles, stapedius and stylohyoid muscles
Efferent and afferent
259
What is cranial nerve 8?
Where does it exit the skull?
What is its function?
```
Vestibulocochlear
Exits skull through internal acoustic meatus
Function
- vestibular = balance
- cochlear = hearing
```
afferent
260
What is cranial nerve 9?
Where does it exit the skull?
What is its function?
Glossopharyngeal
Exits skill through jugular foramen
Function
- sensory from carotid body and sinus
- innervation to posterior tongue, tonsils and oropharynx
- taste from posterior tongue
- innervates parotid salivary gland
Afferent and efferent
261
What is cranial nerve 10?
Where does it exit the skull?
What is its function?
Vagus nerve
Exits skull through jugular foramen
Functions:
- sensory from larynx, deep auricle, external acoustic meatus, aotic body and baroreceptors, oesophagus, bronchi, lungs, heart, abdominal viscera
- taste from epiglottis and pharynx
Efferent and afferent
262
What is cranial nerve 11?
Where does it exit the skull?
What is its function?
Accessory nerve
Exits skull at jugular foramen
Function: innervates sternocleidomastoid and trapezius muscle
Efferent
263
What is cranial nerve 12?
Where does it exit the skull?
What is its function?
Hypoglossal
Exits skull through hypoglossal canal
Function: innervates tongue muscles
Efferent
264
What are the symptoms of Alzheimers?
Early - insidious impairment of higher intellectual function, alterations in mood and behaviour
Later
- progressive disorientation
- memory loss
- aphasia
- severe cortical dysfunction
Even later
- profoundly disabled
- mute and immobile
265
What are the different types of dementia?
Alzheimers 50%
Vascular 15%
Dementia with lewy bodies 5-10%
Frontotemporal 2-5%
266
In dementia what changes occur in the brain?
- Decreased brain volume
- Ventricular enlargement (compensatory)
- Neuritic plaque
- Neurofibrillary triangles
- Neuronal loss
267
What are the 5A's of clinical features of dementia?
```
Amnesia
Aphasia
Apraxia
Agnosia
Associated features
```
268
Describe the neuritic plaques in dementia
spherical collections of neuritic processes often centred around an amyloid core
found in hippocampus, amygdala and neocortex
relative sparing of primary motor and sensory cortices
269
Pathogenesis of plaques in demenia
APP - amyloid precursor protein undergoes cleavage
If at the beta secretase site = pathogenic
alpha secretase = normal
Formed A beta peptides which aggregate, cause inflammation and cause neurotoxic dysfunction
270
Why are people with Downs syndrome at higher risk of getting dementia?
Amyloid precursos protein gene is found on chromosome 21
271
What are the clinical features of frontotemporal dementia?
```
Lose inhibitions
Lose motivation
Lose sympathy/empathy
Repetitive/compulsive behaviour
Craving for sweet or fatty food
```
272
What are the clinical features of vascular dementia?
```
Problems with speed of thinking, concentration and communication
Memory problems
Symptoms of stroke
Seizures
Confusion
Depression
Anxiety
```
273
What are the clinical features of dementia with lewy bodies?
```
Subtle initial symptoms
Some from Alzheimers
Some from Parkinsons
Attention alters
Visual hallucinations
```
274
Define epilepsy
Condition in which seizures recur, usually spontaneously
275
Define seizure
abnormal paroxysmal discharge of cerebral neurons sufficient to cause clinically detectable intermittent disturbance of consciousness, behaviour, emotion, motor or sensory function
276
What are the 4 types of generalised seizures - describe them
Tonic clonic -
Tonic phase - all muscles contract, breathing patterns change, loss of consciousness
Clonic phase - limbs jerk as muscles relax and contract in turn, loss of bladder control
Absence - unconscious for a few seconds e.g. day dreaming
Myoclonic - muscle jerking in arms/head.Very brief. Unconscious briefly. Happen in morning
Atonic - lose all muscle tone and drop to the floor. Very brief, no confusion
277
When does limb development begin and when does it end?
Day 26 to week 12
278
Which limb bud appears fist in embryological development?
Upper limb appears first
279
What embryonic tissues contribute to the developing limb?
somatic lateral mesoderm covered by ectoderm
280
What is the apical ectodermal ridge?
Forms at apex of each limb
Ectodermal thickening
Multilayered epithelial structure induced by mesochyme
Influences limb mesenchyme
Initiates growth and development in proximo-distal axis
281
What embryonic tissues give rise to muscles of developing limb?
Mesenchyme
282
Describe rotation of limbs in development
Upper - rotate laterally by 90 degrees
| Lower - rotate medially by 90 degrees
283
What ligaments contribute to the stability at the acromioclavicular joint?
Acromioclavicular (superior and inferior)
Coracoacromial
Coracoclavicular
284
What muscle tendons pass under the acromion?
rotator cuff muscles
285
Which is the most common direction of dislocation of the shoulder? Why?
Anterior
| Weaker anterior ligaments
286
What are the different lymph nodes in the axilla?
```
Anterior
Lateral
Central
Posterior
Apical
```
287
Where do the axillary lymph nodes drain?
Subclavian lymph trunk (from apical)
| Right jugular trunk or thoracic duct
288
Where do finger flexor tendons insert?
Flexor digitorum superficialis - intermediate phalanges
| Flexor digitorum profundus - distal phalanges
289
What is the function of the lumbricals?
Flex MCP and extend IP joints simultaneously
290
Describe the superficial palmar arch
Formed from the ulnar artery
Splits into common palmar digital arteries
Splits into proper palmar digitial arteries (one down each side of finger)
291
Describe the deep palmar arch
Formed mainly from the radial artery with some input from ulnar
Forms palmar metacarpal arteries
Also forms princeps pollicis to thumb and radialis indicis to finger
292
What bone can be felt in the depths of the snuff box?
Scaphoid
293
What is common complication of #FOOSH?
Scaphoid fracture
| Avascular necrosis of scaphoid
294
What artery traverses the anatomical snuff box?
Radial
295
What effects would paralysis of lumbricals and interossei have on the hand?
Proximal phalanges are hyperextended
Distal and middle phalanges are hyperflexes
Claw hand (ulnar nerve damage)
296
What is mallet finger?
Extensor damage
Hyperflexion of extensor digitorum tendon
Hyperflexion of DIP
297
What is a boutonniere deformity?
PIP flexion with DIP hyperextension
| Interruption to central slip of extensor tendon
298
What does limb development begin and end?
Day 26- week 12
299
Which limb develops first?
upper
300
What embryonic tissues contribute to developing limb?
Parietal (somatic) mesoderm
| Covered by ectoderm
301
What is the apical ectodermal ridge?
```
Forms at the apex of the limb
Ectodermal thickening
Multilayered epitherlial structure
Directs limb growth via various fibroblast growth factors
Especially in proximodistal axis
```
302
What are the 3 axis in the developing limb?
Proximodistal (shoulder to hand)
Dorsoventral (back of hand to palm)
Pre/post axial (thumb to pinky)
303
Describe limb rotation in embryological development?
Upper limb rotates 90 degrees laterally
Lower limb rotates 90 degree medially
Week 7
304
Outline embryological formation of limbs
Day 26 - week 12
Upper limb first, lower limb 2-10 days later
parietal (somatic) layer of lateral plate mesoderm
covered by ectoderm
Apical ectodermal ridge
Apoptosis for digit formation
90 rotation at week 7
305
What is the intracapsular ligament of the hip?
Ligament of the head of femur
Acetabular fossa to fovea
Contains obturator artery
306
What are the factors the stabilise the hip?
Ligaments
Muscles
Acetabulum
Acetabular labrum
307
What is the blood supply to the femoral head?
Media circumflex femoral artery (some lateral)
branches of profunda femoris artery
Forms an anastamoses
Fracture can cause avascular necrosis
308
What is the saphenous opening?
Oval opening in supramedial fascia lata
3-4cm inferolateral to pubic tubercle
Transmits great saphenous vein and other small vessels & gentiofemoral nerve
309
Why is the saphenofemoral valve clinically important?
A failed valve can contribute to varicose veins
310
What are the boundaries of the popliteal fossa?
Lateral
- Upper = biceps femoris
- Lower = gastrocnemius (lateral) and plantaris
Medial
- Upper = semimembranous
- Lower = gastrocnemius (medial)
Floor - popliteus muscle
311
What are the contents of the popliteal fossa from superficial to deep?
```
Tibial nerve
Popliteal vein
Popliteal artery
Small saphenous vein
Common fibular nerve
Popliteal lymph node
```
312
Describe the process of fracture healing
```
Haematoma
Inflammation
Granulation
Soft callus formation (cartilage)
Hard callus formation (calcium and phosphate production)
Bone remodelling
```
313
What is a pathological fracture?
Caused by disease
| Weakness of bone structure
314
Which tumours commonly metastasise to bone?
prostate
breast
lung
315
What helps to keep the patella on track during flexion and extension?
Prominence of anterior femoral condyles
Retinacular fibres of patella
Vastus lateralis and medialis
316
What is Osgood Schlatter's disease?
Irritation of patellar ligament at the tibial tuberosity.
| Painful lumps just below the knee.
317
Which collateral ligament attaches to the meniscus?
Tibial/ medial collateral
318
Describe the attachments of the anterior cruciate ligament
Attaches to a fascet on anterior part of intercondylar area of tibia and attaches to lateral wall of intercondylar fossa of femur
Stops anterior displacement
319
Describe the attachments of the posterior cruciate ligament
Posterior aspect of intercondylar area and attaches to the medial wall of intercondylar wall of fossa
Stops posterior displacement
320
What are the 2 openings between middle and inner ear?
Oval window - plugged by stapes
| Round window - covered by fibrous tissue
321
What is the pars flaccida?
Lies above malleolar folds attached to the petrous bone
Thin superior part of the membrane
322
What is the chorda tympani?
Runs from taste buds through the middle ear and carries taste messages
323
Histology of the middle ear and auditory tube?
Simple squamous
| Gradually becomes ciliated pseudostratified columnar
324
What is the role of hair cells in the organ of Corti?
Electromechanically sensitive and generate nerve impulses in response to vibration
325
How does the organ of corti function?
Hairs move due to movement of endolymph
Hair cells synapse with cochlea nerve endings
Stereocilia project from hair cells and touch tectorial membrane
Bending of hair cells causes depolarisation or hyperpolarisation
Excites auditory nerve fibres
326
What are the saccule and utricle?
part of balancing apparatus located in bony labyrinth
327
What is the macula (ear)?
| What is its function?
Thickening in wall of saccule and utricle
Contains vestibular hair cells
Perceive changes in longitudinal acceleration as well as effects of gravity
328
What are the otoliths and where are they found?
Structure in saccule or utricle in vestibular labyrinth
Sensitive to gravity and linear acceleration
329
What is the crista ampullaris?
| What is its function?
Sensory organ of rotation in semicircular canal
It senses angular acceleration ad deceleration
330
What is the microscopic anatomy of crista ampullaris?
Hair cells covered by gelatinous mass called the cupula
Rotation causes endolymph to deflect cupula against the hair cells
This causes nerve stimulation
331
What movements are possible at the ankle proper?
Dorsiflexion and plantar flexion
In plantar flexion (some rotation, abduction and adduction)
332
What ligaments are likely to be injured in forced ankle inversion?
Anterior talofibuar
Calcaneofibular if very severe
On the lateral side of ankle
333
What ligaments are likely to be injured in forced ankle eversion?
Deltoid
334
How do you test the integrity of the calcaneal tendon?
Thompson test
Prone patent. Leg flexed to 90 degrees
Squeeze gastrocnemius
Plantar flexion
335
What are the 3 arches in the foot?
Transverse
Medial longitudinal
Lateral longitudinal
336
What bones are involved in the medial longitudinal arch of foot?
```
Calcaneous
Talus
Navicular
Cuneiforms
MT1-3
```
337
What bones are involved in the lateral longitudinal arch of foot?
calcaneous
cuboid
MT 4 5
338
What nerves are involved in the cutaneous innervation of the sole of the foot?
```
Medial plantar
Lateral plantar
Sural
Saphenous
Medial calcaneal
```
339
What is Morton's neuralgia?
Affects common plantar digital nerves (commonly between 4th and 5th MT) and causes pain, numbness and tingling
340
What are the layers of the scalp?
```
Skin
Connective tissue
Aponeurosis
Loose areolar tissue
Pericranium
```
341
What is intramembranous ossification?
No cartilage formed in the formation of bones
Skull repair and suture fusing
Formation of bone spicules
Fuse to become trabeculae
342
Which parts of the neurocranium ossify in cartilage?
Sphenoid
| Ethmoid
343
Where would you feel the pain if frontal and maxillary sinusitis?
Maxillary - cheeks, teeth, headache
| Frontal - behind eyes, headache
344
What are the surface marking of the middle meningeal artery?
Midway between frontozygomatic suture and zygomatic arch
345
What nerves and vessels are related to the cavernous sinus?
Internal carotid
| Cranial nerve 3 4 5(1&2) 6
346
What are the dural sinuses?
```
Cavernous
Inferior petrosal
Superior petrosal
Transverse
Inferior sagittal
Superior sagittal
Straight
Occipital
Sigmoid
```
347
Where do the dural sinuses drain?
Cavernous into inferior and superior petrosal
Inferior sagittal into straight
Superior petrosal, straight, occipital and superior sagittal into transverse
Transverse into sigmoid
348
What are the different layers of the meninges?
Periosteal layer of dura
Meningeal layer of dura
Arachnoid
Pia
349
What is hydrocephalus?
Excess and abnormal accumulation of CSF in the ventricles raising ICP
350
How would damage to the left optic tract present?
Homonymous hemianopia
| Loss of vision on right hand side of both eyes
351
If the cervical sympathetic trunk is damaged, what will the effect of the eye be?
Miosis - constriction of the pupil
Ptosis - drooping of eyelid
Anhydrosis
352
If the oculomotor nerve is damaged what effects will it have on the pupil an eye lid?
Eyes down and out
Pupil dilation
Ptosis
353
What nerves are responsible for the pupil reflex?
CN2 optic
| CN3 oculomotor
354
What are the branches of the facial nerve?
```
Temporal
Zygomatic
Buccal
Marginal mandibular
Cervical
```
355
What are the 6 eye muscles?
```
Medial rectus
Lateral rectus
Superior rectus
Inferior rectus
Superior oblique
Inferior oblique
```
356
Medial rectus
Action?
Innervation?
Adduction
| Oculomotor
357
Lateral rectus
Action?
Innervation?
Abduction
| Abducens
358
Superior rectus
Action?
Innervation?
Elevation
Adduction
Oculomotor
359
Inferior rectus
Action?
Innervation?
Depression
Adduction
Oculomotor
360
Superior oblique
Action?
Innervation?
```
Intorsion
Depression
Abduction
DOWN AND OUT
Trochlear
```
361
Inferior oblique
Action?
Innervation?
Extortion
Elevation
Adduction
UP AND IN
Oculomotor
362
What is the sensory innervation to the eyelid?
```
Infratrochlear
Supratrochlear
Supraorbital
Lacrimal
Opthalmic
```
Inferior lid
Infratrochlear
Infraoribital
Maxillary
363
What are the layers of the eye lid?
```
Skin
Subcutaneous tissue
Orbicularis oculi
Orbital septum
Tarsal plates
Palpebral conjunctiva
```
364
What is the palpebral fissure?
Elliptical space between medial and lateral canthi of 2 open lids
365
Describe the pathway of a tear
```
Lacrimal gland
Punctum
Canaliculi
Lacrimal sac
Nasolacrimal duct
Inferior meatus
```
366
What is the canal of Schlemm?
Channel in eye that collects aqueous humour from anterior chamber and drains it
367
If there is a nerve 3 palsy, what effect would it have on accommodation?
Blurred vision for near objects, unable to focus the eye
368
What happens in accommodation of the eye?
Oculomotor nerve
Constricts cilliary body
Relaxes tension on lens
Round lens
Accomodation for near vision
369
What is the optic disc?
Blind spot, where axons exit eye as optic nerve
370
What is the fovea?
Centre of macula
High percentage of cone cells
Sharp central vision
371
What are the 3 layers of the lens?
capsule
epithelium
fibres
372
What type of epithelium lies over the cornea?
Columnar (deep)
Wing cells (middle)
Squamous (superficial)
