Notes

Question 1

Loss of achilles tendon reflex/ankle jerk reflex is a deficit at what spinal level?

Answer 1

S1&2 via gastrocnemius + soleus muscles (tibial nerve L4-S3)

Question 2

What spinal levels are responsible for eversion of the foot?

Answer 2

L5, S1, S2 but mostly S1 via the fibularis longus and brevis (superficial fibular nerve)

Question 3

What spinal levels are responsible for abduction of the thigh?

Answer 3

Gluteus medius & minimus, and obturator internus -> superior gluteal nerve -> L4, L5, S1

Question 4

What spinal level supplies sensation of the medial leg and foot ?

Answer 4

L4 via saphenous nerve

Question 5

Patellar reflex tests the integrity of nerves from what spinal levels?

Answer 5

L2-L4

Question 6

What spinal level supplies sensation to the dorsum of the foot?

Answer 6

L5 (would be impacted in a L4-5 intervertebral disc herniation)

Question 7

What spinal level supplies sensation to the lateral side of the foot?

Answer 7

S1 via the sural nerve

Question 8

What nerves supply sensation to the sole, the dorsum, and the skin between the first and second toe?

Answer 8

Tibial nerve (L4-S3) for sole

Superficial fibular nerve (L4-S1) for dorsum

Deep fibular nerve (L4,L5) for skin between first and second toe

Question 9

If the femoral artery is occluded, what will provide collateral circulation to the thigh?

Answer 9

Descending branch of lateral circumflex femoral artery

Question 10

Vertical group of superficial inguinal nodes drain into the superior thigh and receive lymph from what area?

Answer 10

Superficial thigh

Superficial, medial foot and leg

Question 11

Horizontal group of superficial lymph node sreceives lymph from what areas?

Answer 11

Superficial gluteal region

Anterolateral abdominal wall

Question 12

Deep inguinal lymph nodes underneath the fascia lata receive lymph from what area?

Answer 12

Deep gluteal injuries drain here.

Superficial lymphatics on the anterolateral side of the foot and leg and the deep lymphatics of the foot and leg first drain into the popliteal nodes, then the deep inguinal.

Question 13

If the popliteal artery is occluded, what artery can provide collateral to the leg and foot?

Answer 13

Lateral circumflex artery - it gives a branch that runs down the lateral thigh and joins the genicular anastamosis via the superior lateral genicular artery

Question 14

Where can the dorsalis pedis pulse be palpated?

Answer 14

Between the tendons of extensor hallucis and extensor digitorum longus on the dorsum of the foot

Question 15

What is a positive Trendelenburg test?

Answer 15

When the patient is asked to stand on the injured limb, the pelvis descends on the opposite side.

Question 16

Where should gluteal injections be performed to avoid nerve injury?

Answer 16

Anterior and superior to a line between the PSIS and the greater trochanter

Question 17

Until they’re 8yo, childrens’ femur heads are supplied by a direct branch of the ___.

This is later replaced by vessels such as the ___.

Answer 17

Children: Obturator artery (variably, the medial circufmlex artery)

Adults: medial circumflex femoral and branches

Question 18

the sciatic nerve runs through which quadrant of the buttocks?

Answer 18

Lower medial quadrant; avoid duing intragluteal injections

Question 19

What quadrant is the superior gluteal nerve in?

Answer 19

Superomedial quadrant -> if damaged, then trendelenburg’s gait

Question 20

Foot drop is associated with the deep fibular nerve, which innervates teh anterior leg. What motions is it responsible for?

Answer 20

• Toe extension
• Foot dorsiflexion
• Inversion.

Injury causes loss of sensation between first and second toes.

Foot drop.

Question 21

The tibial nerve innervates teh posterior leg. These muscles are responsible for what?

Answer 21

• Knee flexion
• Plantarflexion
• Intrinsic muscle functions fo the foot

Question 22

What muscle is associated with unlocking the knee joint?

Answer 22

Popliteus- when it contracts, it laterally rotates the distal portion of the femur and draws the lateral meniscus posteriorly to protect it when the knee is flexed.

Question 23

Fibularis tertius - what does contraction do?

Answer 23

Foot dorsiflexion, extension, and eversion

Runs from fibula to the dorsum of the base of the 5th metatarsal bone

Question 24

What’s another word for bowleg (knees bowed outwards?)

Answer 24

Genu varus

Question 25

What is this?

Answer 25

**Hallux valgus:** lateral displacement of great toe; AKA bunion; swollen pursal sac at teh metatarsophalngeal joint

Question 26

Housemaid's knee (working on bended knees) results from compression of what bursa?

Answer 26

Prepatellar bursa

Question 27

Bursas of the knee

Answer 27

Question 28

High stepping gait indicates injury to what nerve?

Answer 28

Deep fibular nerve

Question 29

Waddling gait and numbness at the anterolateral side of the leg are assocaited with what nerves?

Answer 29

Superficial fibular and lateral sural cutaneous nerves

Question 30

The **talocrural/tibiotalar/ankle joint** is responsible for what movements?

Answer 30

Plantar flexion and dorsiflexion

Question 31

Compression at the popliteal fossa will compress which nerve first?

Answer 31

Tibial nerve | (16)

Question 32

**Lateral plantar nerve** supplies the ____ hallucis muscle. **Medial plantar nerve** supplies the __ and __ hallucis brevis muscle.

Answer 32

Lateral plantar nerve --\> adductor hallucis Medial plantar nerve --\> abductor & flexor hallucis brevis

Question 33

What structure is most important in shifting load from wrist to elbow or radius to ulna?

Answer 33

Central band

Question 34

What musclse are responsibel for supination?

Answer 34

**Biceps brachii (**main supinator): long head attached to glenoid, short head attached to coracoid (short head is slightly better supinator) **Supinator** wraps around the radius

Question 35

Pronator teres vs Pronator quadratus location

Answer 35

pronator teres more important

Question 36

Radiocarpal joint vs midcarpal joint

Answer 36

In flexion, it's 50/50 radiocarpal and midcarpal. In extension, 0-60 degrees is radiocarpal, then 60+degrees is midcarpal

Question 37

Two important ligaments of the wirst on the palmar side

Answer 37

Scaphoid lunate - flexion lunotriquetral - extension

Question 38

The dorsal wrist ligaments all go toward the

Answer 38

triquetrum

Question 39

Describe scaphoid vascularity

Answer 39

Retrograde flow from branches of **radial artery** ## Footnote 80% from **dorsal carpal branch** 20% from **superficial palmart branch** Note how the proximal part has no vascularity --\> blood has to go from distal to proximal or else necrosis & less likely to heal

Question 40

Perilunate dislocation

Answer 40

Disruption of the scapholunate and lunotriquetral ligaments--\> the rest of the carpal bones get dislocated, but the lunate stays in place.

Question 41

Terminal tendon helps extension at the ___ IP joint. The central slip helps extension at the ___ IP joint.

Answer 41

**Terminal tendon** extends at DIP **Central slip** extends at PIP

Question 42

Horseshoe abcess

Answer 42

Infection in the flexor sheath (radial bursa) can travel into the carpal tunnel and inefct everything in there and your pinky.

Question 43

Why is pain in your palm unrelated to carpal tunnel?

Answer 43

The palmar cutaneous branch from the median nerve travels superficial the flexor retinaculum.

Question 44

Cubital tunnel syndrome is compression of what nerve?

Answer 44

Ulnar nerve

Question 45

AIN innervates what?

Answer 45

**AIN** from the median nerve innervates the deep layer of the anterior compartment of the forearm (except for 1/2 of the extensor digitorum profundus innervated by the ulnar nerve)

Question 46

PIN innervates what?

Answer 46

PIN from radial nerve innervates everything in the posterior compartment of the forearm except for the mobile wad (radial nerve, wrist extensors)

Question 47

Distal cut to the ulnar nerve --\> loss of sensation & can't cross fingers Proximal cut to ulnar nerve --\> loss of sensation & can't wiggle pinky

Question 48

3 contents of the **cubital fossa** lateral to medial

Answer 48

**Biceps brachii tendon** **Bracial artery** **Median nerve**

Question 49

Vincula longa

Answer 49

Slender, bandlike connections form the deep flexor tendons to the phalanx that carry blood supply to the tendons. 30

Question 50

What branches of the median nerve are responsible fo rinnervating the lumbrical muscles and carrying sensation to their respective digits?

Answer 50

Palmar digital branches

Question 51

Weakness of what muscle is responsible for **Froment's sign**: can't hold a piece of paper between thumb and lateral side of index finger without flexing the distal joint of the thumb

Answer 51

Adductor pollicis (ulnar nerve)

Question 52

Ulnar nerve enters the forearm by passing between the two heads of the ______ and descends between it and the ___ muscle.

Answer 52

Passes between the two heads of the **flexor carpi ulnaris**, then descends between it and the **flexor digitorum profundus**

Question 53

The radial pulse is best located on the forearm just proximal to the wrist joint between what two tendons?

Answer 53

Flexor carpi radialis & brachioradialis

Question 54

The radial artery travels on the distal radius between the flexor carpi radialis and brachio radialis tendons, but how does it enter the palm ?

Answer 54

Through the anatomic snuff box Then, pierce through the two heads of the first DAB to enter the deep palm.

Question 55

The **PIN** of the deep radial nerve is responsible for extensors. It passes between the two heads of what muscle?

Answer 55

Supinator muscle. Thus, it's likely to be compressed by a hematoma between a fractured radius and supinator muscle.

Question 56

Where does the ulnar nerve become the **deep ulnar nerve**?

Answer 56

Where it enters teh hand: superficial to teh flexor retinaculum and lateral to the pisiform bone

Question 57

Dorsal compartments of the wrist

Answer 57

1st = abudctor pollicis longus & extensor pollicis brevis 2nd = extensor carpi radialis longus & brevis 3rd = extensor digitorum & extensor indicis 6th = extensor carpi ulnaris

Question 58

Fracture of the upper third of the right radius, with the distal fragment of the radius and hand pronated. The proximal end of the fractured radius deviates laterally. Which muscle is primarily responsible for the lateral deviation?

Answer 58

**Supinator muscle**. ## Footnote The distal end of the radial fragment & hand are pronated because pronator teres & pronator quadratus are unopposed. The proximal end are laterally deviated because the supinator is unopposed.

Question 59

If the ulnar nerve is cut at the \_\_\_\_, then you don't lose sensation to the ulnar part of the hand.

Answer 59

Wrist. ## Footnote You'll lose motor to dabs/pads and medial lumbricals, but keep sensation to ulnar hand.

Question 60

Guyon's canal (holds ulnar nerve) anatomy

Answer 60

Pisiform medially Flexor retinaculum dorsally Deep fascia of wrist ventrally

Question 61

The interosseus membrane joint between the radius and ulna is what type of joint?

Answer 61

**Synarthrosis joint**: fibrous connection with minimal to no movement

Question 62

Volkmann's contracture

Answer 62

Flexion deformity of the fingers and sometimes the wrist from ischemic necrosis of the forearm flexor muscles.

Question 63

Lymph from the thenar muscles drains into what axillary nodes?

Answer 63

**Lateral axillary nodes** \> subclavian nodes \> central axillary nodes

Question 64

Lymph from the upper back and shoulder drain into what axillary nodes?

Answer 64

**Posterior axillary nodes** \> subclavian nodes \> central axillary

Question 65

Pronator syndrome describes damage to what nerve?

Answer 65

Median nerve as it passes between the 2 heads of a hypertrophied pronator teres muscle. -\> loss of opposition, atrophied thenar, flexion difficulty of digits, sensory loss

Question 66

Popeye sign

Answer 66

Rupture of long head of Biceps tendon (likely at the intertubercular groove). Not much weakness due to action of the brachialis and supinator muscles

Question 67

The **supraspinatus muscle** inserts on the __ tubercle of the humerus, initiates abduction of arm at the shoulder, is is supplied principally by spianl nerve \_\_\_

Answer 67

Inserts on greater tubercle C5

Question 68

What's the only muscle that inserts on the lesser tubercle of the humerus? What is its function?

Answer 68

**Subscapularis-** *internal* rotation

Question 69

The teres ___ originates from the lateral border of the scapula The teres ___ originates from the region of the inferior angle and lateral border of the scapula

Answer 69

The teres **minor** originates from the lateral border of the scapula The teres **major** originates from the region of the inferior angle and lateral border of the scapula

Question 70

Most common pediatric fracture

Answer 70

Clavicle

Question 71

Flattened & sensory loss to deltoid prominence indicates what kind of injury?

Answer 71

**Anterior dislocation of the humerus:** head of humerus is displaced anteriorly and inferiorly. * flattened deltoid prominence * protruding acromion * anterior axillary fullness * injury to *axillary nerve*

Question 72

Pain on passive adduction of the right arm across the chest and dislocated shoulder. Which ligamentous strutures must have been stretched/torn? * AC joint capsule and coracoclavicular ligament * AC joint capsule and coracoacromial ligament * STernoclavicular joint capsule and coracoacromial ligament * Coracoclavicular ligament and transverse scapular ligament * Coractoclavicular ligament and coracoacromial ligament

Answer 72

AC joint capsule and coracoclavicular ligament **Coracoclavicular ligament**: provides weight-bearing support for the upper limb on the clavicle; attaches to coracoid process **Acromioclavicular joint ligament** attaches to the acromion to the clavicle.