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Anatomy > Limbs > Flashcards

Limbs Flashcards

1
Q

Periodicities of the limb pattern

A

Limb is organised into 3 regions from proximal to distal
Stylopod e.g. humerus and femur
Zeugopod e.g. ulna and radius and tibia and fibula
Autopod e.g. wrist and fingers, ankle and toes
Zeugopod consists of 2 parallel elements along the anteroposterior axis
The autopod contains 3-5 elements along the same axis

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2
Q

What is the skeleton made up of

A

Cartilage
Bone

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3
Q

Axial skeleton

A

Head
Vertebral column
Thoracic cage

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4
Q

Appendicular skeleton

A

2 upper limbs
2 lower limbs

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5
Q

Osteology of the upper limb

A

The upper limb is divided into:
The pectoral girdle (shoulder)
The arm (brachium)
The forearm (antebrachium)
The wrist
The hand

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6
Q

Osteology of the lower limb

A

Has 4 major divisions:
The hip- between the iliac crest and greater trochanter of the femur
The thigh- between the greater trochanter and the knee
The knee joint
The Patella
The leg- below the knee and above foot
The foot

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7
Q

Upper limb skeleton

A

The organ for- reaching movements, grabbing, sensation (tactile)
Significant key adaptations- the wrist, the hand (manus), thumb, high level of manual dexterity
Development of cerebral masses is correlated to dexterity of hand movements

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8
Q

Lower limb skeleton

A

It supports all body weight in the upright posture
It is designed for stability and movement
Injury to it impairs movement and carrying of body weight

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9
Q

The sternoclavicular joint (SC joint)

A

It is formed by articulation of the medial aspect of the clavicle with the manubrium of the sternum
It is generally classified as a plane style synovial joint and has a fibrocartilage joint disc
It is a modified synovial joint
One of the 4 joints that compose the shoulder complex (pectoral girdle)

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10
Q

The articulated shoulder joint

A

Also known as the Gleno-humeral joint
Formed by the articulation of:
Head of the humerus (ball)
Glenoid fossa of the scapula (shallow socket)

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11
Q

A patient with a clavicle fracture would present with

A

Throbbing pain
Swelling
Bruising
Deformity
Inability to move shoulders

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12
Q

Joints of the pelvis

A

2 sacroiliac joints- fibrous joints
1 pubic symphysis- a secondary cartilaginous joint doesn’t ossify
Joints of the pelvis are loosened by the hormone relaxin in prep for childbirth

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13
Q

Innominate bone of the hip

A

Ilium
Ischium
Pubis
Unite to form the cup shaped lateral depression called the acetabulum
Constituent bones of the hip unite at the acetabulum through the tri-radiate cartilage

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14
Q

Layering of tissues in cross section along limb length

A

Skin
Superficial fascia
Periosteum
Bone
Medullary cavity
Endosteum
Deep fascia

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15
Q

Necrotizing fascitis

A

Known as flesh eating bacteria
It can strike anyone at anytime
The bacterium feeds on fascia
Its damage is spread along fascial planes
Can consume an entire person in a space of hours

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16
Q

Fascial planes of the neck

A

The neck is divided into fascial compartments
Ease of movement during movement, swallowing etc
Forming natural planes of tissue packing- surgical planes of access into the body
Determine the spread of infection

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17
Q

Generic tissue layers enveloping any surface of the body

A

Skin
Superficial fascia
Deep fascia- investing layer, intermediate layer of deep fascia
Muscles
Deepest layer of deep fascia

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18
Q

2 main classes of fascia in the neck

A

Superficial cervical fascia
Deep cervical fascia

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19
Q

Deep cervical fascia

A

Investing fascia- surrounds all structures in the neck
Pretracheal fascia - surrounds visceral compartments of the neck (oesophagus, trachea, thyroid)
Prevertebral fascia- forms the boundaries around muscles of the neck and vertebral column
Carotid fascia :alar fascia, carotid sheaths: composed of pre tracheal, pre vertebral and investing fascia surrounds the vascular compartment of the neck (common carotid artery, internal jugular vein, vagus nerve), left and right carotid sheath joined by alar fascia

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20
Q

Muscular compartments of the thigh

A

It is part of the lower limb bounded superiorly by hip joint and inferiorly by knee joint

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21
Q

Tissue layers of the thigh

A

Skin
Superficial fascia
Deep fascia (fascia lata)
Muscles and membrane coverings
Femur (covered between periosteum and endosteum)
Intermuscular septa x3
Neurovascular bundle
Lymph nodes

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22
Q

Deep fascia of the thigh

A

Deep fascia (investing layer)
Iliotibial band or tract- tensor of fascia lata
Medial intermuscular septum
Lateral intermuscular septum
Posterior intermuscular septum

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23
Q

Fascial/ muscular compartments of the thigh

A

Anterior compartment
Medial compartment
Posterior compartment

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24
Q

Compartments of the leg/ thigh

A

Each have of the 3 compartments have:
Own general motor actions
Own muscles
Own nerves supply
Common blood supply from profunda femoris

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25
Q

Compartments of the thigh functional

A

Anterior- knee extensors, quadriceps
Posterior- knee flexors and hip extensors, hamstrings
Medial- hip adductors

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26
Q

Neural innervation of thigh muscular compartments

A

Anterior compartment: femoral nerve, neural root values- L2,3,4
Medial compartment: obturator nerve neural root values L2,3,4
Posterior compartment: sciatic nerve, neural root values L4,5,S1,2,3

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27
Q

Arterial supply of thigh muscular compartments

A

Anterior compartment: femoral artery
Medial compartment: obturator artery
Posterior compartment: perforating branches of profunda femoris

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28
Q

Compartments of the leg

A

Deep fascia investing the leg is continuous with the deep fascia of the thigh
It’s is known as the crural fascia
The deep fascia together with tibia, fibula, interosseus membrane
Divide the leg into 3 muscular compartment

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29
Q

3 compartments of the leg

A

Anterior (extensor: DP nerve)
Lateral (fibular: SP nerve)
Posterior (flexor: T nerve)
Each has its own general action, muscles, blood supply, nerves supply

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30
Q

Posterior compartment of the leg

A

3 muscle groups
Superficial
Intermediate
Deep
These form the calf muscles
The large size of the calf muscles is a distinguishing feature of humans

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31
Q

What is compartment syndrome

A

It occurs when arterial perfusion pressure falls below tissue pressure in a closed anatomical compartment
If left untreated leads to necrosis and ultimately death
Due to either: decreased compartment size, increased fluid content, burns, intraarterial injection, infiltrated infusion, haemorrhage, envenomation

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32
Q

Pathophysiology of compartment syndrome

A

Follows the path of ischaemic injury
When fluid is introduced into a fixed volume or when volume decreases or pressure rises
In the case of CS compartments have a relatively fixed volume
An intro of excess fluid or extraneous constriction increases pressure and decreases tissue perfusion until no O2 is available for cellular metabolism

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33
Q

Bursitis

A

A bursa is closed, fluid filled sac that works as a cushion and gliding surface to reduce friction between tissues of the body
Bursitis is inflammation of a bursa
Common causes are overuse, injury. Other causes are infection, tendinitis, arthritis
RICE: Rest, Ice, Compression, Elevation
Anti-inflammatory medicines

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34
Q

Subacromial Bursitis: painful arc syndrome

A

Subacromial pain: 60-90% and 90-120%
Other causes of shoulder impingement or painful arc syndrome are: tendon injury, rotator cuff tendinitis, bone spurs

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35
Q

Olecranon bursitis

A

Inflammation of olecranon bursa (bursitis)

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36
Q

Golfers elbow

A

Medial epicondylitis

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37
Q

Tennis elbow

A

Lateral epicondylitis

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38
Q

Shoulder dislocation

A

Most commonly dislocated major joint
Commonly dislocated anteriorly and inferiorly
Axillary nerve can be injured

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39
Q

Radial head subluxation- pulled elbow

A

Radial head pulled out of annular ligament
When a child is suddenly lifted/ pulled up, head of radius may slip out partially from annular ligament and the ligament is interposed between radial head and Capitulum
Pain and limitation of supination
X-ray is not indicated in classic presentation
Closed reduction with either supination or hyper-pronation technique

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40
Q

Fracture clavicle

A

Most common at the junction of medial 2/3 and lateral 1/3 of the bone
Direct injury or fall on outstretched hand
Support by a sling, pain, medication, physiotherapy

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41
Q

Fractures of humerus

A

Surgical neck - posterior circumflex artery, axillary nerve
Midshaft- deep brachial artery, radial nerve
Supracondylar
Medial epicondyle, avulsion fracture

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42
Q

Supracondylar fracture

A

Look for:
Absence of radial pulse
Ischaemia of hand: pale, cool
Severe swelling in forearm and/or elbow
Open injury
Neurological injury

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43
Q

Distal radial fractures

A

Colles: dinner fork deformity, fall on outstretched hand, exclude median and ulnar nerve injury, compartment syndrome
Smith: garden spade deformity, fall on flexed hand

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44
Q

Scaphoid fracture

A

Fall on outstretched hand
Avascular necrosis of proximal segment
Pain in the anatomical snuffbox

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45
Q

Upper brachial plexus palsy- Erb’s palsy
Waiters tip position

A

C5 and C6 nerve roots are affected
Axillary, musculocutaneous, suprascapular nerves
Loss of sensation over lateral part of arm and forearm
Arm medially rotated, elbow extended, forearm pronated, wrist flexed
Neuropraxia: stretching and damage, reversible fortunately most recover by 3-4 months age
Birth injuries

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46
Q

Klumpke’s palsy- lower brachial plexus palsy
Claw hand

A

C8 and T1 nerve roots affected
Median and ulnar nerves
Loss of sensation in hand over territory of these two nerves

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47
Q

Saturday night palsy, crutch paralysis

A

Radial nerve or part of brachial plexus is under constant pressure aka by use of crutch
Sat night palsy is compression of radial nerve
Wrist drop

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48
Q

What are the 8 carpal bones

A

Scaphoid
Lunate
Triquetral
Pisiform
Trapezium
Trapezoid
Capitate
Hamate

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49
Q

Carpal overuse syndromes carpal tunnel syndrome

A

Entrapment of median nerve
Tinel’s sign= tapping over ventral aspect of wrist produces paresthesia (pins and needles)
Risk factors= pregnancy, hypothyroid, DM, RA
Treatment= splinting, rest, surgical, decompression

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50
Q

Guyon’s canal syndrome

A

Ulnar nerve entrapment syndrome
Numbness and tingling in ring and small finger
Causes= repetitive trauma (handle-bar neuropathy), cyst
Treatment= splint, surgical decompression

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51
Q

Subclavian/axillary venous access

A

The axillary, cephalic and subclavian veins are used to gain central access for placement of pacemaker or defibrillator leads or central venous lines

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52
Q

Hard vs soft signs of vascular injury

A

Hard signs: active arterial (pulsatile) bleeding, pulseless/ischaemia, expanding pulsatile hematoma, bruit or thrill, operation mandatory
Soft signs: minor bleeding, injury in proximity to major vessel, small to moderate size hematoma, associated nerve injury, further w/u

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53
Q

Volkmann’s ischaemic contracture

A

Compartment syndrome of forearm
Complication of elbow/forearm fractures
Increased compartment pressure results in ischaemia of muscles of forearm, typically flexor compartment
Patients complains of pain out of proportion of injury, digit swelling and paresthesias,
Irreversible damage in 6 hours
Treatment: removal of cast, surgical decompression with fasciotomy

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54
Q

Interscalene groove

A

Between scalenus medius and scalenus anterior
The roots/trunks of the brachial plexus emerge between these muscles
Regional anaesthesia: interscalene block-local anaesthetic deployed in interscalene groove to numb brachial plexus

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55
Q

The subacromial space

A

Superior to the head of the humerus; inferior to the acromion
Contains supraspinatus tendon and subacromial bursa
Rotator cuff injuries: rotator cuff tears are common sports injuries; may also follow shoulder dislocation; degenerative tendinitis of supraspinatis common in elderly- tendon may rupture; subacromial bursitis causes painful arc syndrome

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56
Q

Suprascapular notch

A

Impingement under the transverse scapular ligament affects the suprascapular nerve- causing wasting of supraspinatus and infraspinatus and shoulder pain

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57
Q

The quadrangular/ quadrilateral space

A

Bounded by the shaft of the humerus laterally, long head of triceps medially, teres minor superiorly, teres major inferiorly
Axillary nerve and posterior circumflex artery pass through this space
Axillary nerve is at risk of damage in shoulder dislocations

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58
Q

The triangular space (aka upper triangular space)

A

Bounded by the long head of triceps laterally, teres minor superiorly, teres major inferiorly
Circumflex scapular artery (from subscapular artery) passes through it

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59
Q

The triangular interval (aka lower triangular space)

A

Bounded by the lateral head of triceps laterally, long head of triceps medially, teres major superiorly
Radial nerve and profunda brachii artery pass through it

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60
Q

The axilla

A

Space between upper arm and side of thorax; bounded anteriorly and posteriorly by axillary folds
Communicates with posterior triangle of neck above
Floored by axillary fascia
Contains: axillary artery and vein, brachial plexus, lymph nodes and fat
Axillary artery lies in groove between long head of triceps and coracobrachialis; can be palpated in lateral wall of axilla- may be compressed here to prevent excessive bleeding
Cephalic vein pierces clavipectoral fascia above pectoralis minor to drain into axillary vein; often damaged in axilalry wounds- dangerous as bleeds profusely and air emboli may be created
Axillary lymph nodes- become enlarged and tender in infections of upper limb , pectoral region, breast and upper abdominal wall; losing thoracic and thoracodorsal nerves are at risk in axillary lymph node dissection
Brachial plexus injuries- may be produced by disease, stretching, compression or wounds in neck and axilla

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61
Q

the cubital tunnel

A

Th ulnar nerve may become compressed behind the medial epicondyle where it passes deep to a fibrous retinaculum stretching between the olecranon and the medial epicondyle
Cubital tunnel syndrome may involve numbness in ring and little finger, forearm pain, weakness in hand

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62
Q

Cubital fossa (aka antecubital fossa)

A

Bounded by a line between the epeicondyles above, medial border of brachioradialis laterally, lateral border of pronation trees medially
Floor-brachialis muscle proximally and supinator distally; roof- skin, deep fascia, bicipital aponeurosis
Contains (medial to lateral): median nerve, brachial artery, biceps tendon, radial nerve, posterior interosseous branch of radial nerve
Brachial pulse felt medially to biceps tendon
Superficial to the fossa- the median antecubital vein is often used for venipuncture or cannulation

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63
Q

Guyon canal

A

Bounded by hamate and pisiform bone; roofed by pisohamate ligament
Ulnar nerve may be impinged here-paraesthesia and muscle weakness- ‘handlebar palsy’

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64
Q

The carpal tunnel

A

Bounded by the carpal tunnel and flexor retinaculum
Median nerve passes through carpal tunnel with deep and superficial digital flexor tendons, FPL- compression produces sensory loss in the lateral 3 1/2 digits and weakness of the thenar muscles

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65
Q

The anatomical snuffbox

A

Bounded by the tendon of epl medially, epb and apl laterally, styloid process of radius proximally
Floor-scaphoid and trapezium (scaphoid palated here in suspected fracture)
Contains- radial artery, superficial branch of radial nerve, Cephalic vein

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66
Q

Major joints of upper limb

A

Sternoclavicular joint
Gleno-humeral joint
Elbow joint
Wrist joints
Joints of hand

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67
Q

Palpating the interscalene groove

A

Clinical significance is to be able to temporarily block all sensations arising from the upper limb by anaesthetising roots of brachial plexus
This is the groove between anterior scalene and middle scales muscles
Anaesthetist inserts needle halfway between the lateral border of the sternocleidomastoid and anterior border of trapezius
At level of cricothyroid membrane
Then making a single injection between scalenes
Positioning needle is guided by US

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68
Q

The Sternoclavicular joint

A

Formed by articulation of the medial aspect of the clavicle with manubrium of sternum
SC joint is classified as plane style synovial joint and has a fibrocartilage joint disk
Modified synovial joint
One of 4 joints composing the shoulder complex (pectoral girdle)

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69
Q

The clavicle

A

Forms a strut between axial skeleton and the upper limb
Lies horizontally across the root of the neck
Takes a medio-lateral position
Extends from manubrium to acromion
It’s sternal end is triangular and articulates with sternum at Sternoclavicular joint
Acromial end is flattened and articulates with the acromion at acromioclavicular joint
Medial 2/3 of body are convex anteriorly
Lateral 1/3 is concave anteriorly
S shape curvature increases resilience

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70
Q

Axilla

A

Anterior border: pectoralis major and minor
Medial border: Serratus anterior and thoracic wall
Posterior border: scapularis, teres major, latissimus dorsi
Lateral border: intertubercular sulcus
Anatomical space of armpit
Provides the under arm sweat glands
Pyramidal in shape
Concave and floor is formed by axillary fascia

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71
Q

Axilla walls

A

Anterior wall: pectoralis major, pectoral fascia, pectoralis minor, clavipectoral fascia
Posterior wall: scapula, subscapularis muscle, teres minor
Medial wall: Serratus anterior and fascia
Lateral wall: convergence of tendons of anterior and posterior axillary folds as they insert into intertubercular groove of the humerus
Apex: its is formed by convergence of bony members of the 3 major walls: clavicle, scapula, first rib

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72
Q

Contents of axilla

A

Axillary sheath:
-brachial plexus
-axillary artery
-axillary vein
Axillary lymph nodes

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73
Q

Cubital fossa

A

Forms the interface between the arm and forearm
It is a triangular interface between arm and forearm
It is also known as the elbow pit and appears on the anterior aspect of the elbow
Also called the antecubital fossa because it lies anteriorly to elbow when in standard anatomical position

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74
Q

Boundaries of cubital fossa

A

Superficial boundary (roof): deep fascia reinforced by bicipital aponeurosis
Deep boundary (floor): brachialis and supinator muscles
Superior (proximal) boundary: imaginary line connecting medial epicondyle and lateral epicondyle of humerus
Medial (ulna) boundary: pronator teres muscle
Lateral (radial) boundary: brachioradialis muscle

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75
Q

Clinical importance of cubital fossa

A

During blood pressure measurements the stethoscope is placed over the brachial artery in the cubital fossa
Also an area used to palpate for brachial pulse
The area just superficial to the cubital fossa is often used for venous access (phlebotomy)
A number of superficial veins can cross this region
Median cubital vein- joins cephalic and basilic veins in cubital fossa

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76
Q

The elbow

A

Primarily a joint
Signifies the region of transition between arm and forearm
Formed between 3 bones: humerus, ulnar, radius
Bones of the joint are palpable: medial epicondyle, lateral epicondyle, olecranon
Olecranon is one of the strongest bony features of body
The ulnar nerve’s course behind the medial epicondyle can lead to it getting pinched, injured when high energy is applied to the elbow region

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77
Q

The flexor retinaculum and Carpal tunnel

A

It’s main function is to buckle down on tendons of muscles of the forearm as they pass wrist into the hand
Prevents ‘bow stringing’ of tendons
Muscles therefore do not lose their purchase on joints of hand
Also known as the transverse carpal ligament, anterior annular ligament
A fibrous band on palmar side of the hand near the wrist
Arches over the carpal bones of the hands, covering them and forming the carpal tunnel

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78
Q

Flexor retinaculum

A

Origin: tubercle of scaphoid and ridge of trapezium
Insertion: pisiform and hook of hamate
Into it: palmaris brevis and longus, palmar aponeurosis
From it: thenor and hypothenar muscles
Over it: ulnar artery and nerve, palmar cutaneous branch of median, palmar branch of radial artery
Deep to it: median nerve

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79
Q

Hand muscles

A

Opponens digiti minimi
Opponens pollicis
Abductor digiti minimi brevis
Flexor digiti minimi brevis
Flexor pollicis brevis
Adductor pollicis
Abductor pollicis brevis

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80
Q

What is junctional anatomy

A

Can be defined as the study of the anatomy where any distinct regions of the body meet
Can also be defined as the study of the body’s anatomy where a minimum of 2 anatomical entities either come together or diverge from each other eg web spaces of hand, where bones change morphology, where blood vessels split or converge
Or where the anatomical layout of tissues changes in accordance with desired functions eg the ankle joint
Zone that spans from root of an extremity to its adjacent body cavity
Eg gross anatomical junctions:
-head meets neck, neck emerges from thorax, upper limbs take root from thorax, lower limbs take root from the pelvic girdle

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81
Q

Major junctional areas of the body

A

Atlanto-occipital joint
Root of the neck
The axilla and shoulder joint
The hip joint

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82
Q

Anatomical creases of skin and anatomical regions

A

Langer’s lines- correspond to the natural orientation of the collagen fibres in the dermis usually lie parallel to underlying muscle fibres, if incisions made in direction of langers lines they tend to heal better and produce less scarring
Lines of cleavage

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83
Q

Overview of anatomy of lower limb

A

Can be divided into sub regions:
Gluteal region
Inguinal region
Thigh
Leg
Ankle
Foot

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84
Q

Iliac crests

A

Highest points of left and right iliac bones
Signify the highest anatomical points of lower limbs
Iliac crests are joined in the horizontal plane by an imaginary anatomical plane : the supracrestal plane

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85
Q

The supracristal plane

A

Approx level with body L4
Inter individual variation represents level of l3/l4 intervertebral disc
Vertebral level that a lumbar puncture can be carried out safely
Also where epidural anaesthesia can be administered in regional blocks
Landmark for determining sites for aspiration of bone marrow

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86
Q

The greater trochanter

A

A subcutaneous, lateral bony prominence of the lower limb
Readily palpable
It’s position is clinically important in the examination of the lower limb
It’s position signifies change of direction of bone from neck of femur to shaft of femur
Indirect landmark for:
- the position of hip joint
-outlines of the capsule of hip joint
-extracapsular ligaments of the hip are at this level too

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87
Q

Posterior dislocation of hip joint

A

In ~90% cases of hip dislocation the femur is pushed out socket in backward direction
Leaves the affected Lower limb appearing shorter in a fixed position with the knee and foot external rotation the middle of the body
Hip dislocations are often accompanied by other related injuries such as fractures in the pelvis, tear of the acetabular labrum etc
Most frequently occurs in the setting of significant trauma eg car crash

88
Q

Anatomical neck of the femur

A

Joins head of femur to shaft of femur
Transfer body weight from head of femur to its shaft
The neck of femur is therefore under severe stress in the upright posture at all times because of translation
The neck of femur is at an angle of 125 degrees from the shaft
In patients with osteoporosis the neck of femur can fracture spontaneously as a result of this continuous stress

89
Q

Femoral neck fractures

A

Fractures of neck of femur are divisible into 2 broad categories
Intracapsular: occur proximal to boundary of joint capsule, surgical approach to their repair
Extracapsular: occur distally to boundary of joint capsule, if the fracture line extends below the lesser trochanter the term “subtrochanteric” fracture is often used , surgical approach

90
Q

Anterior superior iliac spine

A

ASIS
Subcutaneous bony landmark of the superior, anterior margin of the pelvis
Can be readily palpable
Clinically important landmark

91
Q

McBurney’s point

A

Name given to the point over the right side of the abdomen that is one third of the distance from the ASIS to the umbilicus
This point corresponds to the most common location of the base of the appendix where its attached to the caecum

92
Q

Inguinal ligament

A

Also known as pouparts ligament
It is a reinforced fibrous inferior border of the anterior abdominal wall
It attaches:
Superolaterally to ASIS
Inferomedially to pubic tubercle
An important anatomical landmark, defines border between abdomen and lower limb
Site for normal passage of anatomical structures between these regions
Also site for potential tissue herniation

93
Q

Inguinal ligament and femoral triangle

A

Structures that pass deep to the inguinal ligament include:
From medial to lateral:
-femoral canal
-femoral sheath
-femoral nerve

94
Q

Inguinal ligament and lateral cutaneous nerve of thigh

A

The lateral femoral cutaneous nerve of thigh can sometimes be compressed by Inguinal ligament as it passes under it
This can lead to a neurological condition of a painful patch of numbness on the side of the upper part of thigh called Meralgia Paraesthetica

95
Q

Structures that pass deep to inguinal ligament

A

Psoas major, iliacus, pectineus
Femoral nerve, artery and vein
Femoral canal
Lateral cutaneous nerve of thigh
Lymphatics

96
Q

Inguinal canal

A

Short passage that extends inferiorly and medially through inferior part of abdominal wall
Superior and parallel to inguinal ligament
Joins deep inguinal ring to superficial inguinal ring
Serves as a pathway through which structures can pass from abdominal wall to external genitalia
Transmits the spermatic cord in male or round ligament in female
It’s floor is the in rolled lower edge of the Inguinal ligament and reinforced medially by the lacunar ligament and laterally by the transversalis fascia

97
Q

Bony landmarks of ankle joint

A

Medial malleolus -tibia
Lateral malleolus -fibula
Saphenous cut down
— greater saphenous vein
Posterior tibial pulse
Pott’s fracture

98
Q

The femoral triangle

A

Triangular space at root of lower limb
Important in clinical procedures: detection of femoral pulse, cannulation of the femoral artery for various surgical procedures
Anatomical boundaries:
Superior: Inguinal ligament
Lateral: medial border of sartorius muscle
Medial: medial border of adductor longus muscle
Floor: iliacus,psoas major, pectineus and adductor longus
Roof: superficial fascia, deep fascia of thigh

99
Q

Contents of femoral triangle

A

Femoral sheath: femoral artery, femoral vein
Profunda femoris artery lies deeper to femur
Femoral nerve
Femoral canal contains lymphatics
Saphenous opening- hiatus in deep fascia thigh to enable great saphenous vein to drain into femoral vein
Femoral lymph nodes
Femoral hernia- abdominal contents herniate into femoral canal

100
Q

Arterial supply to lower limb

A

Supplied mainly by the femoral artery
Common iliac artery is direct continuation of the descending aorta L3-4
External iliac originates from the common iliac artery L5 or pelvic inlet
Femoral artery is a direct continuation of the external iliac artery
External iliac artery becomes femoral artery as it dives under inguinal ligament

101
Q

The femoral artery

A

Extends from the level of the inguinal ligament to the Adductor canal
It runs midway between ASIS and pubic symphysis
Can be palpated at the mid-inguinal line
The first 3-4cm of artery are enclosed with femoral vein in femoral sheath
In the upper 3rd of the thigh it is contained in the femoral triangle (Scarpas triangle)
In the middle of thigh its contained in the adductor canal (Hunters canal)
It’s accompanied by its vein throughout its length

102
Q

Midpoint of inguinal ligament vs mid-inguinal line

A

Midpoint of inguinal ligament: midpoint between ASIS and pubic tubercle, just lateral to mid-inguinal line
It’s an important surgical landmark that signifies the position of deep inguinal ring, lies 0.5 inches above midpoint of Inguinal ligament
Mid-inguinal line/point: an important surgical landmark that lies at midpoint of imaginary line that joins ASIS and pubic symphysis, deep to this point the external iliac artery continues as femoral artery, external iliac artery passes from pelvic cavity to lower limb, palpation of femoral artery is only possible below Inguinal ligament

103
Q

Gluteal region

A

Occupies: superior, posterior and lateral surface
Boundaries:
Superior- iliac crest
Inferior- gluteal fold
Characterised by:
-a prominent posterior convexity known as buttock
-sharply defined gluteal fold
The posterior conveys bulge is due to: a thick layer of fat (known as panniculus adiposus), lower part of muscle (gluteus maximus), transverse crease of skin (gluteal fold)

104
Q

Clinical importance of gluteal region

A

Muscles important in walking, Gait
Straight leg raise test, sciatic nerve passes through this region
Major site for intramuscular drug administration:
Pharmacological agents
Innoculations (vaccines)
It’s also implicated in sciatica
Gluteal prominence will disappear in major proximal lesions of the nerves of the back
Intramuscular injections in region can threaten sciatic nerve
To make safe injections: palpate greater trochanter and ischial tuberosity, draw an imaginary horizontal line joining them dividing gluteal region into 2, the sciatic nerve will be found below a point halfway between bony landmarks, drawn another imaginary line vertically bisecting horizontal which runs course of sciatic nerve dividing into 4 quadrants UI, UO, LI, LO
Safe injections only made in upper outer quadrant containing the gluteus medius and minimus muscle

105
Q

Popliteal fossa

A

Diamond shaped space behind knee
Covered in deep popliteal fascia
Clinically important, arterial pulse can be taken
Nerves: tibial nerve (midline), common peroneal nerve follows tendon of biceps femoris, posterior femoral cutaneous nerve (midline)
Popliteal artery, branches to give geniculate branches, lesser saphenous vein ascends to end in popliteal vein
Popliteal vein- areolar connective tissue and fat cover the popliteal vessels
Popliteal lymph nodes

106
Q

Anterior tibial artery

A

Commences at the bifurcation of the popliteal artery
In the upper 2/3 it rests on interosseus membrane
In the lower 3rd upon front of tibia and anterior ligament of ankle joint
It gives rise to dorsalis pedis beyond the extensor retinaculum

107
Q

Dorsalis pedis

A

Passes forwards from the ankle joint along the tibial side of the dorsum of foot to the first intermetarsal Space
It then divides into 2 branches:
The first dorsal metatarsal artery
Deep plantar

108
Q

Posterior tibial artery

A

Larger of the terminal branches of popliteal artery
Descends deep to soleus then becomes superficial in lower 3rd of leg
Then passes behind medial malleolus between tendons of FDL and FHL
Below ankle it divides into medial and lateral plantar arteries which constitute principal blood supply to foot

109
Q

Great or long saphenous vein

A

Longest vein
Drains the medial part of venous plexus in foot
Begins in medial marginal vein of foot
Ends in femoral vein 3cm below inguinal ligament
Ascends in front of medial malleolus
Ascends along medial side of leg
Ascends in relation to saphenous nerve
Has 10-20 valves

110
Q

Small or short saphenous vein

A

Begins behind lateral malleolus
Drains the lateral side of the venous plexus of the foot
Begins as a continuation of lateral marginal vein of the foot
Ascends along lateral margin of tendo calcaneous
Then crosses obliquely to reach middle of back leg
Perforates deep fascia in popliteal fossa to end in popliteal vein between heads of gastrocnemius
Before piercing deep fascia it gives a branch that runs upwards and forwards to join the great saphenous vein

111
Q

Movements of the scapula

A

Adduction
Abduction
Protraction
Retraction

112
Q

Movements of the arm at the glenohumeral joint

A

Flexion
Extension
Abduction
Adduction
Medial rotation
Lateral rotation
Circumduction

113
Q

Movements of the forearm at elbow joint

A

Flexion
Extension
Pronation
Supination

114
Q

Movements of hand at wrist joint

A

Adduction
Abduction
Flexion
Extension
Circumduction

115
Q

Joint between metacarpal I and carpal bone of thumb

A

Biaxial saddle joint
And no ligamentous connection between metacarpal I and II
So thumb has greater freedom of movement

116
Q

Metacarpophalangeal joints

A

Biaxial condylar joints (ellipsoid joints)
Abduction
Adduction
Flexion
Extension
Circumduction

117
Q

Interphalangeal joints

A

Hinge joints
Flexion
Extension

118
Q

Dermatomes tested for sensation upper limb brachial plexus

A

Upper lateral region of arm- C5
Palmar pad of thumb -C6
Pad index finger- C7
Pad little finger- C8
Skin on medial aspect of elbow- T1

119
Q

Selected movements tested for myotomes brachial plexus

A

Abduction of arm at glenohumeral joint- C5
Flexion of forearm at elbow joint -C6
Extension of forearm at elbow joint- C7
Flexion of fingers -C8
Abduction and Adduction of index, middle, ring fingers- T1

120
Q

Somatic sensory and motor functions of spinal cord levels can be tested using tendon reflexes
Unconscious patient

A

A tap on tendon of biceps in cubical fossa tests mainly C6
A tap on tendon of triceps posterior to elbow tests mainly C7

121
Q

Musculocutaneous nerve

A

C5-7
Innervates all muscles in anterior compartment of the arm
Innervates skin on the anterolateral side of the forearm

122
Q

Median nerve

A

C5-T1
Innervates muscles in anterior compartment of the forearm except flexor carpi ulnaris and the medial half of flexor digitorum profundus which are innervated by ulnar nerve
Innervates the Palmar surface of the lateral three and one half digits

123
Q

Ulnar nerve

A

C8-T1
Innervates most intrinsic muscles in the hand except for thenar muscles and 2 lateral lumbricals which are innervtaed by median nerve
Innervates palmar surface of medial one and half digits

124
Q

Radial nerve

A

C5-T1
Innervates all muscles of posterior compartment of arm and forearm
Supplies skin on posterior surface of the forearm and dorsolateral surface of hand

125
Q

Nerves related to humerus

A

Axillary nerve which supplies the deltoid muscle and teres minor(abductor) passes around posterior aspect of upper part of humerus (the surgical neck)
Radial nerve supplies all extensors of upper limb passes diagonally around posterior surface of shaft of humerus in radial groove
Ulnar nerve passes posteriorly to medial epicondyle on medial side of distal end of the humerus

126
Q

Veins in superficial fascia of upper limb

A

Cephalic and basilic veins originate from dorsal venous network on back of hand
Cephalic vein originates over anatomical snuffbox at the base of the thumb passes laterally around distal forearm to reach anterolateral surface of limb and continues proximally, crosses elbow and passes up arm into clavipectoral triangle, penetrates deep fascia below clavicle to pass into axilla
Basilic vein originates from medial side of dorsal venous network passes proximally up posteromedial surface of forearm, passes onto anterior surface of limb just inferior to elbow then continues proximally to penetrate deep fascia midway up arm
At elbow the Cephalic and basilic veins are connected by median cubital vein which crosses roof of cubital fossa

127
Q

Clavipectoral triangle (deltopectoral triangle)

A

Triangular depression
Between pectoralis major, deltoid and clavicle

128
Q

frozen shoulder

A

Adhesive capsulitis
Inflamed joint capsule glenohumeral joint
Leads to pain and limited movement

129
Q

Popeyes sign

A

Tendon rupture of long head of biceps brachii due to overuse
Swelling on arm, more prominent when flex elbow
Absence of biceps tendon in bicipital groove during ultrasound examination

130
Q

Plain radiography

A

A plain radiograph is A static image generated following the passage of X-rays through a patient
Fluoroscopic images are used to describe dynamic images eg swallowing

131
Q

CT scan acquisition

A

Patient lies on table
X-rays produced by the X-ray tube and pass through the patient to the detector
Detector circles patient as table moves through
Patient movement during the scan will cause image blurring
A computer reconstructs the data into greyscale image

132
Q

Hounsfield unit scale

A

The computer assigns a hounsfield unit to each part of the patient depending on how many X-rays were absorbed by that part of the patient
X-rays absorbed at varying degrees by different tissues
Eg bone has high hounsfield unit as radiopaque

133
Q

Windowing

A

You can change the grey scale setting to concentrate on different tissue eg soft tissue or bone

134
Q

CT descriptive terms

A

High attenuation/density e.g bone
Low attenuation/density e.g CSF, water
Contrast enhancement- increased attenuation post contrast administration

135
Q

Fractured clavicle

A

Cause: indirect trauma eg fall on outstretched hand or blow to shoulder, direct trauma to clavicle which normally leads to comminution (lots of fragments)
Middle third is most commonly injured
Proximal fragment is displaced superiorly due to the action of sternocleidomastoid

136
Q

What indicates shoulder dislocation

A

Squaring off shoulder

137
Q

Anterior dislocation of shoulder

A

Most common
Moves anteriorly and inferiorly
Associated injuries: injury to neurovascular bundle in axilla , injury to axillary nerve, associated fracture to humeral head

138
Q

Axillary nerve injury

A

Also called circumflex nerve as it hooks round neck of humerus
Posterior cord of brachial plexus
Supplies deltoid and teres minor
Supplies skin over the deltoid, regimental badge area

139
Q

Fracture shaft of humerus

A

Can be spiral/oblique or transverse depending on whether injury is direct or indirect
Associated with radial nerve injury
Resulting in wrist drop

140
Q

Fat pad sign

A

Elbow joint
Posterior fat pad is not visible normally becomes visible if there’s effusion (increased fluid in joint)
Anterior fat pad is normally visible becomes elevated if there’s joint effusion
Small effusions may elevate anterior fat pas without disturbing posterior fat pad

141
Q

Anterior humeral line

A

A line drawn down the anterior humerus will pass through the middle third of the capitulum= anterior humeral line
The AHL will not pass through middle third of capitulum in a supracondylar fracture

142
Q

Radiocapitellar line

A

A line bisecting the radial shaft should pass through capitulum on all views
If it doesn’t radial head dislocation or capitulum displacements is suspected

143
Q

Supracondylar fracture

A

Children landing on outstretched hand will lead to hyperextension and a supracondylar fracture
After injury once the arm returns to normal position the fracture line is hard to detect
Complications:
Early: compartment syndrome, brachial artery injury (acute volkmanns ischemia), median, ulnar, radial nerve injury
Late: stiffness, volkmanns ischaemic contracture, heterotopic calcification, mal-union -fractured bone doesn’t heal properly (cubitus valgus)

144
Q

Coronoid process

A

Coronoid avulsion is rare
Caused by avulsion of brachialis muscle

145
Q

Carpal fractures

A

Usually caused by:
Compressive loads to hyperextended wrist
Hyper Flexion
Rotation loading against fixed wrist
Scaphoid is commonest then lunate

146
Q

Distal 1/3 radial fractures

A

Dorsal displacement- Colles, common, radius goes down
Volar displacement- Smiths, radius up

147
Q

Definition of avulsion

A

Where they joint capsule, ligament, tendon or muscle attachment site is pulled off from bone usually taking a fragment of cortical bone
Eg the ASIS

148
Q

Hip joint capsule

A

Attaches to acetabular labrum, bony acetabulum, base of femoral neck at intertrochanteric line

149
Q

What rotation can you see more of the lesser trochanter

A

External rotation

150
Q

Shenton line

A

Imaginary curved line drawn along inferior border of superior pubic ramus and along inferomedial border of neck of femur

151
Q

Posterior hip dislocation

A

Most common
Femoral head is displaced superiorly and posteriorly
Femur is internally rotated resulting in decreased prominence of lesser trochanter
More prominence of greater trochanter
Triangular fragment of posterior acetabular wall

152
Q

Anterior hip dislocation

A

Femoral head is displaced superiorly
Lesser trochanter is more prominent reflects external rotation

153
Q

What supplies femoral head

A

Medial and lateral Circumflex arteries which are branches of the profunda femoris (deep femoral artery)
At risk in intracapsular fractures

154
Q

Femoral neck fractures

A

Intracapsular: subcapital and midcervical (trans cervical)
Extracapsular: basicervical (base of neck), intertrochanteric and subtrochanteric

155
Q

What are apophyses

A

Outgrowths of a bone away from articulating joint portion
Can be avulsed

156
Q

Human height

A

Mainly vertebral column and femur
Sensitive to anything that affects:
Articulation of bones of vertebral column
Articulation between vertebral column and femur
Length of vertebral column
Length of femur

157
Q

Intervertebral disc

A

Central region: nucleus pulposus, has high osmotic power, responsible for water retention and size of IVD
Peripheral region: annulus fibrosus, confers strength to IVD
Water content of IVD changes with 24 hour cycle due to changes in water retention so height also changes with 24 hour cycle
25% length VC

158
Q

Clinical measurement of height

A

Measured 3 times in 24 hours, 8 hour intervals
Clinical height is calculated from an average of the 3 measures taken in 24 hour cycle

159
Q

ASIS and limb length

A

Used in measurement
Apparent length of lower limb
True length of lower limb

160
Q

True length of lower limb

A

Measure distance between left limb and ASIS and medial malleolus
When true limb length measurements are not same- true limb length discrepancy

161
Q

Apparent length of lower limb

A

Measure distance between umbilicus and left lower limb medial malleolus
Repeat on right
Should be same
When not- apparent limb length discrepancy

162
Q

Causes of apparent shortening of lower limb

A

One limb appears shorter than other
Causes:
Posterior dislocation of hip joint
Congenital causes of hip dislocation
Tilt of hip due to other causes eg scoliosis

163
Q

Causes of apparent true shortening of lower limb

A

Limb has a shorter distance between ASIS and medial malleolus
Causes:
Congenitally shorter lower limb compared to opposite
Fracture of one of more of the long bones of the lower limb fracture bony elements overlap
Disorders of growth of skeletal apparatus of body
Scoliosis

164
Q

Straight leg raise test and test for meningism

A

Aim to stretch the sciatic nerve directly
This will stretch the nerve
Also used to test meningitis (as this will directly pull and irritate the meninges of spinal cord)

165
Q

Popliteal fossa boundaries

A

Superomedial border: semimembranosus, semitendinosus on top
Superolateral border: biceps femoris
Inferomedial border: medial head of gastrocnemius
Inferolateral border: plantaris and lateral head of gastrocnemius
Floor:capsule of the knee joint, oblique popliteal ligament, fascia of popliteus, popliteal surface of distal femur
Roof: skin, superficial and deep fascia, small saphenous vein passes through the roof receives blood supply from venous dorsal arch of foot passes between heads of gastrocnemius to drain into popliteal vein
Contents: popliteal artery- deepest, popliteal vein, tibial nerve and common peroneal nerve (common fibular nerve)
The tibial nerve and common fibular nerve are branches of the sciatic nerve
Popliteal vein exits popliteal fossa superiorly passing through adductor hiatus in the adductor Magnus muscle to enter anterior compartment of the thigh drains to the femoral vein

166
Q

Cervical superficial fascia contains

A

Subcutaneous fat
Platysma muscle
Cutaneous veins, arteries and nerves branches from cervical plexus

167
Q

Cervical deep investing fascia

A

Arises from nuchal ligament
Envelopes the trapezius and the sternocleidomastoid
Forms roof of posterior triangle- between the SCM and trapezius
Pierced by cutaneous branches of cervical plexus and the external jugular vein
Boundaries: mandible and hyoid and sternum anteriorly, clavicle and scapula laterally and occipital bone, nuchal ligament and trapezius posteriorly

168
Q

Cervical deep pre tracheal fascia

A

Forms visceral compartment
Thyroid, trachea, recurrent laryngeal nerves, oesophagus, pharynx and parathyroid glands
Posterior border- Buccopharyngeal fascia- involves buccinator and pharyngeal constrictor muscles, from skull to mediastinum
Borders; hyoid, thyroid, laryngeal cartilages, into pericardial sac
Between pretracheal and Buccopharyngeal fascia= trachea, oesophagus and pharynx

169
Q

Cervical deep pre vertebral fascia

A

Muscular compartment and vertebral column
Longus coil/capitus, scalenes , levator scapulae, paraspinals
Sympathetic trunk in front
Phrenic nerve in front anterior scalene
Cervical/brachial plexus arises from interscalene groove between middle and anterior scalenes
Forms axillary sheath around brachial plexus and subclavian and axillary artery
Forms floor of posterior triangle
Alar fascia- anterior subdivision of pre vertebral fascia fuses with Buccopharyngeal fascia between T1-T4

170
Q

Cervical deep fascia carotid sheath

A

Formed by adjacent fascia sleeves- deep investing, prevertebral, pretracheal fascia
Vascular compartment: contains internal jugular vein, common carotid artery and vagus nerve, deep cervical nodes, carotid sinus nerves
Ansa cervicalis within the wall C1 C2 C3

171
Q

Infra hyoid muscles fascia

A

Some say Subset of pretracheal fascia
Some say subset of investing fascia of sternocleidomastoid
Some say its it own fascia layer- middle layer of deep cervical fascia

172
Q

Retropharyngeal space

A

Buccopharyngeal- alar fascia
Permits movements of pharynx, larynx, oesophagus during swallowing
Potential anatomical space
Expands due to: abscesses and infections may bulge anteriorly restricting swallowing and restricting breathing
Infections could spread into the mediastinum

173
Q

Danger space

A

Between alar fascia and pre vertebral fascia
Infection could spread from skull base to mediastinum
Potential space
Alar fascia separates the retropharyngeal space from danger space
In healthy patients alar fascia not visible

174
Q

Hip joint

A

Ball and socket synovial joint
Articulating bones: innominate bone of pelvis forming acetabular fossa and the head of the femur

175
Q

Ligaments of the hip joint

A

Iliofemoral ligament- anterior side triangular shaped
Pubofemoral ligament- anteroinferior surface triangular
Ischiofemoral- posterior aspect of fibrous membrane

176
Q

Hip fractures

A

Commonest surgically treated fracture
Common in elderly
Low energy fall
Precipitant factors: osteoporosis, pathological fractures
Significant associated morbidity
More common in females

177
Q

Vascular supply to head of femur

A

Vascular ring of medial and lateral circumflex femoral artery around femoral neck
Mainly retinacular vessels supplying head of femur
Obturator artery- branch artery to ligamentum teres- ligament of head of femur arises from fovea capatis
Fracture of neck of femur can cause avascular necrosis of head

178
Q

Intracapsular and extra capsular fractures

A

Intracapsular- above intertrochanteric line in femoral neck. Subcapital, cervical, basal. More prone to avascular necrosis
Extracapsular- in the intertrochanteric area above shaft

179
Q

Loss of normal curve of Shenton’s line is a sign of

A

Fractured neck of femur or fracture of superior pubic ramus
Fractured neck of femur: shortening of femoral neck, bone overlapping causes increased density, more prominent external rotation- lesser trochanter

180
Q

Signs of fractured femoral neck

A

External rotation
Shortening of limb
Iliopsoas contraction

181
Q

Basic management principles of fractured femoral neck

A

Resuscitation
Analgesia
Investigate cause: precipitating factors
Surgery: urgent reduction and internal fixation
Preservation of head possible or not
3 screws to treat a non displaced femoral neck fracture
Displaced fracture- partial hip replacement replacing head of femur

182
Q

Hip dislocations

A

Most commonly posterior
Posterior: flexed, internally rotated, adducted, shortening leg
Anterior: minimally flexed, abduction, external rotation
Sciatic nerve damaged, compression, femoral vessels stretched
Avascular necrosis
Trauma
Total hip replacements

183
Q

Compartment syndrome of leg

A

Decompression of all 4 leg compartments
Anterolateral incision and posteromedial incision
Access to all compartments

184
Q

Femoral artery

A

In femoral triangle
Femoral pulse
Compression of artery just below mid inguinal point, against superior pubic ramus
Mid inguinal point is where the external iliac artery continues as femoral artery

185
Q

Dorsalis pedis artery

A

Popliteal artery- posterior and anterior tibial artery
Anterior tibial artery— dorsalis pedis
Next to extensor hallucis longus tenon
Palpable proximally more superficial

186
Q

Tarsal tunnel

A

Flexor retinaculum between medial malleolus and calcaneus
Contents from medial malleolus to calcaneus:
Tibialis posterior, flexor digitorum longus, posterior tibial artery, tibial nerve, flexor hallucis longus tendon

187
Q

Perforator veins connecting superficial to deep veins

A

Hunterian perforators in proximal thigh
Dodd perforators in distal thigh
Boyds perforators aorund knee
Cocketts perforators of posterior arch vein

188
Q

Deep vein thrombosis

A

Common in lower limb veins
Abnormal Blood flow: immobility (post surgical, long haul flights, obesity, pregnancy)
Hypercoagulability: malignancy, previous DVT
Endothelial injury: atherosclerosis, trauma
Variable presentation: swollen, tender calf, fever
Complications: pulmonary embolism
Management: risk assessment, anticoagulation

189
Q

Patella

A

Has a facet for medial condylar and lateral condyle of femur

190
Q

Intercondylar area of femur

A

Cruciate ligaments attach

191
Q

Knee joint

A

Synovial hinge joint modified
Some rotation- lock and unlock mechanism
Movements: flexion and extension
Role of ligaments and menisci: static stability
Role of muscles and tendons: dynamic stability

192
Q

What bursa separates the medial collateral ligament and the tendons of sartorius, gracilis and semitendinosus

A

Pes anserine bursa

193
Q

Cruciate ligament tear

A

Anterior Cruciate ligament prevents excessive external rotation .Prevents femur sliding backwards on tibia
Posterior Cruciate ligament: much stronger, prevents tibia sliding backwards or femur anterior displacement
Anterior Cruciate ligament tear more common ACL

194
Q

Anterior drawer test

A

Patient supine on table, hip flexed 45 degrees, knee 90 degrees. Examiner sits on foot to stabilise it places hands each side upper calf and firmly pulls tibia forward movement of 5mm of more is positive result result compared to that for normal limb which is tested first

195
Q

Posterior drawer test

A

Same as anterior push tibia backwards
Significant posterior movement suggests posterior Cruciate ligament laxity or rupture

196
Q

Coronary ligaments of knee

A

Connect the menisci to tibial condyles apart from meniscal root attachments

197
Q

Menisci

A

Fibrocartilage
Semilunar between the tibia and femur condyles
Distribute weight and improve stability of the joint
Shock absorbers

198
Q

which meniscus is more prone to injury

A

Medial meniscus
It’s firmly attached to the medial collateral ligament and joint capsule
Lateral is more circular in shape and more mobile as no attachment to lateral collateral ligament or joint capsule
Usually injured as a result of sudden knee flexion with a component of knee internal or external rotation

199
Q

Meniscal tear

A

Softening of menisci with age
Severe trauma
Forceful twisting injury
Osteoarthritis
Diagnosis- MRI
Treatment- surgical arthroscopy
Meniscopexy/ meniscectomy

200
Q

Stretching of the capsule

A

Anteriorly- vastus intermedius
Laterally- popliteus
Medially- semimembranosus

201
Q

Hiltons law

A

The nerve suppling the muscles extending directly over and acting at given joint also innervates the joint and skin overlying muscle

202
Q

Palpitation

A

Patella
Medial and lateral joint lines
Tibial tuberosity, head of fibula
Popliteal fossa
Test for joint effusion ( incase of arthritis or ligament rupture): patellar tap
Active and passive movements (flexion 140, extension 180)
Cruciate ligament tests- Lachmans test, anterior drawer test

203
Q

Spinal canal and intervertebral foramen

A

Intervertebral foramen: between inferior vertebral notch one vertebrae and the superior vertebral notch of inferior vertebrae anteriorly- intervertebral disc and posteriorly capsule of facet joint- ligamentum flavum

Spinal canal- anteriorly body vertebrae and intervertebral discs, posteriorly lamina and spinous processes, laterally- pedicles ligamentum flavum

204
Q

Intervertebral disc

A

Forms fibrocartilaginous joint (symphysis) to allow slight movement vertebrae, ligament holding together, shocks absorber
Nucleus pulposus in middle- jelly like distributes forces in radial fashion when compressed, resists compression
Annulus fibrosis - alternating directed lamellae, collagenous and tough, tensile force shock absorbing

205
Q

Nerve root anatomy

A

Cervical spine: nerve roots exit above corresponding pedicle C8 roots exits from above T1
Thoracic spine: nerve root travel below pedicle
Lumbar spine: nerve roots travel below pedicle, cauda equina roots travel many vertebral levels before exiting

206
Q

Plexuses

A

Ventral rami
Cervical- C1-C5
Brachial- C5-T1
Lumbar- L1-L4
Lumbosacral trunk- L4/L5
Sacral plexus- L4 L5 S1-S4
T2-T12- intercostal nerves no plexuses
T1 contributes to brachial plexus and continues as 1st intercostal nerve

207
Q

Sciatic nerve

A

Exits inferiorly to piriformis muscle
Sciatica: pain radiating down lower limb with or without back pain, pain/numbness/tingling over posterior aspect of thigh/leg, weakness movement knee and ankle. most common causes herniated IVD
L5 S1 most commonly compressed
Nerve roots in cauda equina pass over multiple IVD
Lateral herniation may compress one or two roots usually passing through IVF just below it
Large posterior herniation may compress cauda equina causing paraplegia- paralysis to whole trunk
In severe cases paraesthesia of actual sensory loss occur
Pressure on anterior motor roots will cause muscle weakness

208
Q

Dermatome

A

Area of skin supplied by a single pair of spinal nerves
Useful to help localise neurological levels in radiculopathies
Viral infections like herpes zoster- pain along the dermatome

209
Q

Myotome

A

Group muscles supplied by single pair spinal nerves
Injury to one pair can cause weakness of muscles of that myotome

210
Q

Dermatomes and myotomes affected: S1 root compressed

A

Pain is radiating to the back of the right leg, aggravated when bending forward or in reaching out position
Patchy loss sensation on right lateral foot and posterior lateral leg

211
Q

Clinical examination sciatica

A

Inspection: standing position and bending forwards position
Palpation of spine
Straight leg raise test on right caused severe pain radiating from buttock to ankle
Sensory testing
Motor testing

212
Q

Treatment disc herniation

A

Pain management
Physiotherapy
70% recover with conservative management
Depends on degree of disc prolapse
Surgical decompression: discectomy, laminectomy

213
Q

Abdominal hernias

A

Abdominal protrusion of abdominal viscera through potentially weak area
Reducible
Incarcerated- irreducible
Strangulated- needs to prevent necrosis of hernia content
Hernia of Linea alba, umbilical hernia, hernia at Linea semilunaris, incisional hernia- scars

214
Q

Richters hernia

A

Associated with small intestine
Single wall of small intestine protrudes due to defect

215
Q

Femoral hernia

A

Through femoral triangle
Relatively uncommon
More common in females due to wider pelvis
Complications common so surgical repair advised

216
Q

Ligaments of the knee

A

Extracapsular: patellar ligament, medial and lateral retinacula, tibial (medial) and fibular (lateral) collateral ligaments, oblique popliteal ligament, Arcuate popliteal ligament, anterolateral ligament
Intracapsular : anterior and posterior cruciate ligaments, medial and lateral meniscus

Anatomy (9 decks)

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