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LEA Practical 2 > LEA Written Quiz 10 > Flashcards

LEA Written Quiz 10 Flashcards

1
Q

What is the medial arm of the FHB from? Lateral?

A

Medial: slip from TP

Lateral: cuboid + lateral cuneiform

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2
Q

Combined tendons of FHB contribute to what?

A

Extensor expansion of hallux

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3
Q

Where does the oblique head of adductor hallucis originate? The transverse?

A

Oblique: MT 2-4 bases and shafts + peroneal sheath (from LONG PLANTAR lig)
Transverse: fibrous capsule + plantar MTPL of 3-5, deep transverse MT ligament

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4
Q

What is the origin of FDMB?

A

MT 5 base, perineal sheath, promontory of cuboid

*overlap 3rd PI ligament, covered by AbDM + PA

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5
Q

Where does FDMB insert?

A

MTPJ capsule, extensor expansion, MT 5 head, PP5 base (AbDM)

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6
Q

What does the superficial branch of the LPN innervate?

A

FDMB
4th dorsal IOM
3rd plantar IOM

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7
Q

What does the deep branch of the LPN innervate?

A

AdH
1-3 dorsal IOM
1-2 plantar IOM
2-4 lumbricals

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8
Q

What is the 1st and 2nd DAB innervated by?

A

DFN

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9
Q

What are the origins of dorsal IOM?

A

2 heads from adj. MT + perineal sheath

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10
Q

What are the origins of the plantar IOM?

A

medial side of MT 3-5 and peroneal sheathe

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11
Q

Where do IOM insert?

A

Sling portion of extensor expansion

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12
Q

What is the relationship of the IOM to the deep transverse metatarsal ligament?

A

IOM pass superiorly/dorsally to DTMTL

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13
Q

What is the action of IOM?

A

Simultaneously plantarflex MTPJS 2-5, dorsiflex IP and DP 2-5

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14
Q

Why no DIOM for 1st digit? Why 2 for 2nd digit?

A

1st digit has abductor hallucis

2nd digit ha 2 bc medial or lateral movement

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15
Q

What 5 things are composed of the extensor expansion?

A 
S/L extensor tendons
Interossei
Lumbricals
PA
Fascia dorsali pedis
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16
Q

Where is the proximal portion of the expansion sling? What direction does it run and what does it attach to?

A

MTPJ in sling

Fibers run transversely covering extensor tendons and attach to MTPJ capsule, deep transverse MT ligament, plantar MTPJL and PP on each side

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17
Q

What is the distal portion of the extensor wing formed by? Where does it run and attach to?

A

Formed by triangle sheets forming on dorsal edges to fuse w/ extensor tendons

Attached to sides of PP, distal is free

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18
Q

What is the purpose of the extensor expansion?

A

EDL to dorsiflex PP

Attachment for IOM and lumbricals

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19
Q

What do interossei and lumbricals attach to on extensor expansion?

A

Interossei sling

Lumbricals wing

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20
Q

What contributes to the EE on the hallux?

A

Dorsal- EHL (no EHB)
Medial- AbH + FHB (medial head)
Lateral- AdH+FHB (lateral head)

Only lateral sling attaches to DTMTL

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21
Q

What contributes to the EE on the 5th digit?

A

Dorsal EDL (no EDB)
Medial 4th Lumbrical + 3rd PI
Lateral- AdDM + FDMB

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22
Q

During heel strike, what muscles are active?

A

Anterior dorsiflexors to control descent of anterior foot

Lateral everters to prevent excessive inversion

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23
Q

What do weak ankle dorsiflexors result in? Paralyzed?

A

Weak - apropulsive gait

Paralyzed - high stoppage

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24
Q

What is the sequence of toes MT touching the ground during foot flat to midstance

A

MT 4 -> medial MT -> lateral hallux + toes

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25
What are is compressed during foot flat to mid stance
medial longitudinal arch
26
During foot flat, what does the lateral compartment do? What does the superficial posterior compartment do?
Lateral aids in pronation Superficial posterior compartment controls ankle dorsiflexion thru out midstance
27
What does deep posterior compartment do during foot flat?
Supports medial longitudinal arch against too much compression
28
During heel up/heel off, what is the sequence of leaving the ground?
Heel first to leave, followed by lateral digits
29
What is the windlass mechanism and when is it activated?
Activated during heel off/heel up Supports the MLA, supports re-supination and stabilizing midfoot in preparation for forefoot propulsion
30
What does the triceps surae do during heel off/heel up?
Produce heel up/heel off
31
What do the TP/FHL/FDL + intrinsic muscles of the foot do during heel off/heel up?
Support MLA and toe flexors stabilize the digits against the ground as passive MTPJ dorisflexion
32
Paralysis of the posterior compartment results in what gait?
Apropulsive gait
33
What are the last digits to leave the ground during toe off?
Hallux or second digit
34
What do TP, FHL, FDL and intrinsic muscles of the foot do during toe off?
Support MLA and stabilizes toes against ground as passive MTPJ takes place
35
How does MLA during early stance phase change?
Heel strike, foot is supinated, everters counter the inversion Foot becomes weigh bearing during foot flat, pronation + MLA flattens. Inverters moderate MLA compression
36
What happens in early stance phase to MLA during pronation?
MLA reduction
37
What do everters to to MLA during early stance phase?
flatten MLA
38
In late stance phase, what needs to happen for forefoot to become rigid level for propulsion?
Resupination needs to take place -> happens when inverters + digital plantar flexors + windlass mechanism work to heighten MLA
39
What happens in late stance phase to MLA during supination?
MLA accentuation
40
What do inverters and WM do to MLA in late stance phase?
heighten MLA
41
During initial/midswing swing phase, what does the anterior compartment do? What does it do during
Ensures foot clears the ground during intitial/midswing Terminal swing readies the foot for heel strike
42
Destructive lesion to what nerve would lead to paralysis of ankle dorsiflexors? What would this lead to and what would be the compensatory gait?
deep fibular nerve Toe drag High steppage gait
43
What are the 3 muscles of the 3rd compartment?
FHB, ADH, FDMB
44
What it the innveration of the FHB?
MPN
45
What is the innervation of Adductor hallucis?
Deep branch of LPN
46
What muscle is formed when some fibers of FDMB distinctly insert onto lateral MT 5?
Opponens digiti mini
47
What are 2 extrinsic tendons and 2 intrinsic muscles in the 4th compartment?
TP, Peroneus longus, dorsal interosseous, plantar interosseous
48
What is the origin of DIOM?
adjacent MT shafts 1-5 | Peroneal sheath
49
Where do DIOM insert?
MTPJ capsule, extensor expansion, PP base Digit 2- both sides Digit 3/4- lateral
50
What is the innervation of DIOM?
LPN (deep 1-3, superficial 4) 1-2nd also DFN
51
What is the origin of PIOM?
Medial surface of shaft, plantar aspect of base MT 3-5
52
What is the innervation of the insertion of the PIOM?
MTPJ capsule, extensor expansion, medial PP base 3-5
53
What is the innveration of the PIOM?
LPN (deep 1-2, superficial 3)
54
What nerves supply the skin of the second digit?
Dorsomedial side- DFN Dorsolateral side- SFN Distal dorsal + plantar= MPN
55
Skin of second digit is supplied by what nerve BRANCHES?
Dorsomedial side- 1 proper dorsal digital Dorsolateral- 1 proper dorsal digital n. Distal dorsum + plantar aspect of digit- 2 proper plantar digital nerve
56
What position (o'clock) are the nerves for digital blocks?
10, 2 (2 PDDN) 4,77 (2 PPDN)
57
What is supplied by the medial plantar nerve?
``` Lab HD Baby 1st lumbrical Abductor hallucis FHB FDB ```
58
What is the rami of MPN?
L4-S3
59
What cutaneous innervation is the MPN?
Sole, medial 3 toes, medial 4th toe, dorsum of 3 1/2 toes
60
What is the relationship between the MPN and AbH? The fascia between AbH/FDB?
MPN courses DEEP to AbH to enter sole Travels between fascial plane between AbH/FDB?
61
At the diversion of AbH and FDB, what does the MPN turn into?
PPDN to medial side of the hallux
62
At the MT bases, what does the MPN turn into?
3 common plantar nerves (each gives off 2 proper plantar digital nerveS)
63
What is the course of the LPN?
Deep to AbH, pierces medial inter muscular septum, distally/laterally to FDB/QP, pierces lateral intermuscular septum, divides at MT 5 base
64
What is Baxter's nerve?
Inferior calcanea nerve, 1st branch of LPN
65
What does the Baxter nerve innervate?
FDB, QP, AbDM
66
Where are the two entrapment sites of Baxter's nerve?
Site 1: lateral area between QP, thick fascia of AbdH Site2: Anterior towards medial calcaneal process where spur is developed
67
What is Morton's neuroma?
Interdigital nerve entrapment - most often between 3rd common digital branch
68
What is Mulder's test?
For detecting Morton's neuroma, compress forefoot w/ direct pressure
69
What are the branches of the posterior tibial artery?
``` Nutrient artery of tibia Fibular artery Communicating branch Posterior medial malleolar medial calcaneal branches ```
70
What 3 muscles are supplied by the medial plantar ARTERY?
AbH FDB First DIOM
71
What is the path of the LPA thru the plantar of the foot?
``` Deep to AbH Piece medial inter muscular septum Run lateral/distal between FDB/QP Pierces lateral inter muscular septum PPDA to lateral side of 5th toe goes to MT5 base to bc the DEEP PLANTAR ARCH ```
72
What is the path of MPA thru the plantar of the foot?
Deep to AbH Btw AbH and FDB At MT1 base -> PPDA which joins 1st PMTA to form the PPDA to medial side of hallux Superficial branches join the 1st-3rd plantar MTA
73
Dorsal MTA run along where? Plantar MTA?
DMTA-> inter muscular spaces PMTA-> along midline of MT shaft
74
What do posterior dorsal perforating arteries come off? Posterior plantar perforating arteries?
PDPA-> dorsal MTA PPPA-> Deep plantar arch
75
The MPN lies ____ to the MPA. The LPN lies ____ to the LPA
*artery lies on the outside, closest to the skin MPA lies lateral to MPN LPA lies medial to LPN
76
What is the boundary between the superficial and deep veins?
Deep fascia SF veins are in SF fascia w/ cutaneous
77
Do superficial or deep veins have valves?
both, deep tend to hav more
78
What kind of veins connect the SF to deep venous system?
Communicating/perforating w/ values to direct blood from SF to deep
79
Two or more deep veins w/ an artery are called what?
Venae comitantes
80
What major arteries do not have van comitantes?
Femoral Deep femoral Popliteal
81
How does the dorsal SF venous system work?
Starts w/ dorsal digital veins and ends w/ great and large saphenous veins?
82
How does the deep system dorsal venous work?
Veins w/ dorsalis pedis + branches
83
How does the SF plantar venous system work?
Extremely superficial, intradermal + subnormal mesh Joints dorsal on medial + lateral side of the foot
84
How does the deep plantar venous system work?
Veins accompanying the medial/lateral plantar arteries and branches
85
Why are valves in the pedal limbs?
Absence of valves
86
What is the cause of varicose veins?
SF veins become distended bc valves incompetent
87
What is lymphedema?
Swelling bc drainage function of lymphatics are disturbed
88
Where do SF and deep systems of lymphatics unite?
Popliteal fossa | Femoral triangle
89
What is the medial portion of the leg/foot draining?
Follows great saphenous vein Drains SF medial dorsum of foot, medial leg, thigh Superficial inguinal nodes
90
What does the lateral portion of the leg/foot drain lymphatics?
Follows small saphenous vein SF lateral dorsum of foot, posterior leg Popliteal lymph nodes
91
Lymphatics of the deep system terminate where?
Popliteal nodes
92
From the popliteal nodes, lymph drains into what nodes?
Deep inguinal nodes
93
What do the horizontal lymph nodes drain?
SF inguinnal lymph nodes, proximal group
94
What do vertical lymph nodes drain?
SF inguinal lymph nodes, distal group
95
Where the deep inguinal lymph nodes? What are they called? Where do they get lymph
Deep 1-3 nodes w/ femoral sheathe, medial to femoral 1st in femoral ring (gland of cloquet) 2nd/3rd within femoral canal Recieve lymph from lower extremity and from popliteal nodes
96
How does lymph rom the SF medial side of the foot drain?
Lymph from SF medial side of leg follow GSV > SF inguinal > external iliac
97
How does lymph from SF lateral side of foot and posterior lateral leg drain?
Small saphenous > popliteal nodes > deep inguinal > external iliac
98
The autonomic supply to limbs is exclusively ____
symphathic
99
What spinal level do sympathetics of LL originate?
T10-L2
100
How do postganglionic fibers leave the sympathetic trunk?
grey communicating rami
101
Gray rami communicating along what portions of the sympathetic chains distribute postganglionic fibers to lower limb?
Lumbar and sacral ventral rami which form nerves
102
After first traveling w/ peripheral nerves, post-ganglionic sympathetics then join?
Blood vessels
103
What do postganlgionic symphonic fibers innervate in the lower limb?
Constrict of veins + arteries Arrestor pili muscles-> sebaceous glands Sweat glands
104
What is keratoderma planters?
Keratin cracks + ulcerations due to sweat/oil gland dysfunction
105
If there is damage to lumbar plexus, what muscle groups are affected?
Right hip flexors Right knee extensors Right adductors of thigh
106
What skin is affected if lumbar plexus damage | ?
Anterior/medial thigh Anteriomedial+ posteriomedial leg Medial plantar of foot including hallux
107
If damage to right lumbar plexus, what would happen to sweat/vessels?
Decrease sweating | Vasodilation of right
108
What arteries supply the interossei?
medial plantar for DI #1, LPA + dorsal MTA for DIOM 2-4, lateral plantar for all PIS
109
What is claw foot primary and secondary deformity?
Primary - MTPJ hyperextension | Secondary - PIP flexion
110
Where is hammer toe?
primary-PIPJ flexed
111
Where is mallet toe?
primary- DIPJ flexed
112
What is opponens digiti minimi?
distinct muscle belly that originates w/ FDMB and inserts onto lateral aspect of MT 5

LEA Practical 2 (9 decks)

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