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Orthopaedic Anatomy and Approaches Flashcards

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1
Q

Describe the boundaries of the cubital fossa

A
  • Proximally - imaginary line running between the medial and lateral epicondyles of the humerus
  • Laterally - brachioradialis muscle
  • Medially - pronator teres muscle running from medial epicondyle to lateral aspect of the radial shaft
  • Roof - deep fascia
  • Floor - brachialis and elbow joint capsule
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2
Q

List the contents of the cubital fossa from medial to lateral

A
  • Median nerve
  • Brachial artery with flanking venae comitantes
  • Biceps tendon
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3
Q

Describe the course of the brachial artery

A
  • Continuation of the axillary artery
  • Commences at the lower border of the latissimus dorsi tendon
  • Ends at the level of the radial neck by dividing into ulnar and radial arteries
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4
Q

List the branches of the brachial artery

A
  • Profunda brachii (accompanying the radial nerve)
  • Superior ulnar collateral artery
  • The Nutrient artery (to the humerus)
  • Inferior ulnar collateral artery
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5
Q

Describe the course of the axillary nerve

A

Arises from the posterior cord of the brachial plexus and winds around the surgical neck of the humerus in company with the posterior circumflex humeral vessels through the quadrangular space.

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6
Q

Outline how the brachial plexus is divided

A
  1. 5 Roots
  2. 3 Trunks
  3. 6 Divisions
  4. 3 Cords
  5. 5 Terminal branches
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7
Q

Describe the deforming forces in midshaft clavicle fractures

A
  • SCM pulls medial fragment upward
  • Trapezius moves lateral fragment upward
  • Pectoralis major pulls lateral fragment medially
  • Latissium dorsi pulls arm and lateral fragment downward
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8
Q

Outline the bounds of the Quadrangular space

A
  • Lateral = surgical neck of humerus
  • Medial = long head of triceps
  • Superior = teres minor
  • Inferior = teres major
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9
Q

Contents of the Quadrangular space

A
  • Axillary nerve

- Posterior circumflex humeral artery

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10
Q

Outline the bounds of the Triangular space

A
  • Superior = Teres minor
  • Inferior = Teres major
  • Lateral = Long head of triceps
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11
Q

Contents of the Triangular Interval

A
  • Radial nerve

- Profunda Brachii Artery

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12
Q

Axillary nerve root value

A

C5 and C6 (Posterior Cord)

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13
Q

Branches of the superior trunk of the brachial plexus

A
  1. Suprascapular nerve

2. Nerve to subclavius

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14
Q

Long thoracic nerve root value

A

C5-7

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15
Q

What divides the axillary artery into 3 parts

A

Pectoralis minor muscle

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16
Q

Motor supply of the Axillary nerve

A
  • Deltoid
  • Teres minor
  • Long head of triceps
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17
Q

Radial nerve root value

A

C5-T1 (Posterior cord)

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18
Q

Motor supply of the radial nerve

A
  • Triceps brachii
  • Brachioradialis
  • ECRL
  • Anconeus
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19
Q

Motor supply of PIN

A

All forearm extensors

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20
Q

Describe the path of the radial nerve proper

A
  1. Formed from the posterior cord of the brachial plexus
  2. Moves through the Triangular interval
  3. Moves along the spiral groove of the humerus in the posterior compartment of the arm
  4. Travels with Profunda brachii artery and pierces the lateral intermuscular septum 5cm proximal to the elbow to enter anterior compartment
  5. Lies anterior to the lateral epicondyle before splitting at the level of the radial head
  6. Divides into superficial radial nerve (sensory) and PIN (motor)
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21
Q

Contents of the Triangular space

A

Circumflex scapular artery

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22
Q

Bounds of the Triangular interval

A
  • Medial = surgical neck of humerus
  • Lateral = long head of triceps
  • Superior = Teres major
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23
Q

Describe the path of the superficial radial nerve

A
  1. Runs on the lateral side of the radius beneath brachioradialis
  2. Enters posterior compartment proximal to the wrist
  3. Superficial branches run superficial to the tendons of the snuffbox to supply the dorsum of the hand
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24
Q

Describe the path of the Posterior Interosseous Nerve (PIN)

A
  1. Pierces the supinator 3cm distal to the radial head
  2. Lies in the extensor forearm compartment beneath the IO membrane to the wrist
  3. Supplies supinator and all forearm extensors
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25
List the short external rotators from superior to inferior
- Piriformis - Superior gemellus - Obturator internus - Inferior gemellus - Quadratus femoris
26
Innervation of gluteus maximus
Inferior gluteal nerve
27
Origin and insertion of gluteus maximus
- O = ilium posterior to posterior gluteal line, dorsal surface of sacrum and coccyx - I = Iliotibial tract
28
Origin and insertion of gluteus medius
- O = external surface of ileum | - I = lateral surface of GT
29
Origin and insertion of gluteus minimus
- O = external surface of ileum | - I = anterior surface of GT
30
What muscles does the superior gluteal nerve inervate
- Gluteus medius - Gluteus minimus - TFL
31
What muscles form the tricep of the hip
1. Obturator internus 2. Superior gemellus 3. Inferior gemellus
32
What does the piriformis divide
Superior and inferior gluteal nerves and vessels
33
Origin of sciatic nerve
L4-S3
34
Describe the course of the sciatic nerve
- Originates from L4-S3 - Emerges from greater sciatic foramen below the piriformis - Crosses posterior surface of ischium - Descends on adductor magnus deep to the hamstrings - Crossed by long head of biceps femoris - Divides into tibial and common peroneal nerve
35
Outline the incision and dissection of the anterior (Smith-Peterson) approach
- Incision = anterior half of iliac crest and down - Sup. dissection = window between TFL and sartorius - Deep dissection = window between rectus femoris and gluteus medius
36
What structures must you be wary about in the anterior (Smith-Peterson) approach?
- Femoral nerve (medial) | - Lateral femoral cutaneous nerve (lateral)
37
Outline the incision and dissection of the anterolateral (Watson-Jones) approach
- Incision = 2.5cm posteroinferior to ASIS and curving over GT - Sup. dissection = interval between TFL and gluteus medius - Deep dissection = detach abductor mechanism
38
What structures must you be wary of in the anterolateral (Watson-Jones) approach?
- Femoral nerve | - Femoral artery
39
Outline the incision and dissection of the lateral (Hardinge) approach
- Incision = centred over GT - Sup. dissection = through TFL to expose GT - Deep dissection = gluteus medius and minimus taken off as a cuff
40
What structures are at risk during a lateral (Hardinge) approach?
- Superior gluteal nerve | - Femoral nerve
41
Outline the incision and dissection in the posterior (Moore and Southern) approach
- Incision = 2.5cm posterior to GT - Sup. dissection.= vastus lateralis and gluteus maximus split - Deep dissection = short ERs are detached
42
What structures are at risk during the posterior (Moore and Southern) approach?
- Sciatic nerve | - Inferior gluteal artery
43
What forms the posterior sacroiliac complex
- Anterior SI ligament - Interosseous ligament - Posterior SI ligament - Iliolumbar ligament
44
Origin of the gluteal arteries
Both superior and inferior originate from internal iliac
45
Describe the course of the axillary artery
- Begins at the lateral border of the 1st rib as a continuation of the subclavian artery - Ends at the inferior border of the teres major, becoming the brachial artery
46
Outline the branches of the axillary artery
- 1st part = superior thoracic - 2nd part = lateral thoracic, thoracoacromial - 3rd part = anterior and posterior circumflex humeral, subscapular
47
List the ligaments of the GH joint
- Glenohumeral (IGHL, MGHL, SGHL) - Coracohumeral - Transverse humeral - Coraco-acromial
48
List the static restraints of the GH joint
- Bony anatomy - Capsule - Labrum (contributes 50% of glenoid depth)
49
List the dynamic restraints of the GH joint
- Rotator cuff | - Long head of biceps tendon
50
What does anterior shoulder stability rely on?
- SGHL - MGHL - IGHL (main)
51
Supraspinatus OIIA
``` O = supraspinatus fossa I = superior facet of GT I = suprascapular nerve (C4-6) A = initiates abduction ```
52
Infraspinatus OIIA
``` O = infraspinatus fossa I = middle facet of GT I = suprascapular nerve (C5/6) A = ER ```
53
Teres minor OIIA
``` O = middle part of lateral scapular border I = inferior facet of GT I = axillary nerve A = ER ```
54
Subscapularis OIIA
``` O = subscapular fossa I = lesser tubercle of humerus I = IR A = upper and lower subscapular nerves ```
55
Describe the route of the radial nerve in the arm
Formed by C5-T1 nerve roots and originates from the posterior cord of the plexus. Passes through the triangular space with profunda brachii, winds around the back of the humerus to descend in the spiral groove between the medial and lateral heads of the triceps, it pierces the intermuscular septum 8cm proximal to the lateral epicondyle, it then passes anterior to the lateral epicondyle and splits into PIN and superficial radial nerve at the level of the radial head.
56
Describe the route of the radial nerve in the forearm
Radial nerve splits into the superficial radial nerve which lies between brachioradialis and FPL, following the course of these muscles distally until it passes to the dorsal aspect of the wrist and gives off its terminal branches. The other branch is the PIN which passes through the supinator muscle and supplies the wrist and finger extensors of the forearm
57
Describe the route of the ulnar nerve in the arm
Formed from C8-T1 nerve roots and originates from the medial cord. Descends on the posteromedial aspect of the humerus, pierces the intermuscular septum 8cm proximal to the medial epicondyle to pass from anterior to posterior compartment, it passes posterior to the medial epicondyle through the cubital tunnel then exits through the ulnar and humeral head of FCU
58
Describe the route of the ulnar nerve in the forearm
Ulnar nerve passes from the elbow to the wrist under FCU medial to the ulnar artery and enters the palm of the hand through Guyon's canal (between pisiform and hook of hamate) along with the deep branch of the ulnar artery
59
Describe the route of the median nerve in the arm
Formed from the lateral and medial cords of the brachial plexus. Descends lateral to the brachial artery then crosses to the medial side mid-humerus, it then passes through the antecubital fossa medial to the biceps tendon and brachial artery
60
Describe the route of the median nerve in the forearm
Exits the antecubital fossa through the humeral and ulnar heads of the pronator teres and gives off the AIN at this level which supplies FPL, pronator quadratus and radial half of FDP. The median nerve proper then continues in the forearm between FDS and FDP and gives off a palmar cutaneous branch before passing through the carpal tunnel.
61
What does the distal radius articulate with?
- Scaphoid - Lunate - Distal ulna
62
Describe the 3 columns of the distal forearm
- Radial column = radial styloid and scaphoid fossa - Intermediate column = lunate fossa - Ulnar column = TFCC and distal ulna
63
Outline the ossification centres of the elbow
- C = capitellum (2 years) - R = radial head (4 years) - I = internal epicondyle (6 years) - T = trochlea (8 years) - O = olecranon (10 years) - L = lateral epicondyle (12 years)
64
When is the radial nerve susceptible to injury
- Trauma of middle 1/3rd of humerus - Radial head fracture - Compression between supinator heads - Crutch and Saturday night palsy
65
When is the median nerve susceptible to injury?
- Supracondylar fracture - Wrist laceration - Carpal tunnel syndrome - Pronator teres syndrome
66
When is the musculocutaneous nerve susceptible to injury
- Deltopectoral approach to shoulder | - Compression between coracobrachialis and biceps brachii
67
When is the ulnar nerve susceptible to injury?
- Medial epicondyle fracture - Wrist laceration - Cubital tunnel syndrome - Guyon canal cyst
68
Describe Guyon's canal borders
Fibro-osseous tunnel transmitting the ulnar nerve from the forearm to the hand. It is bordered by: - Medial = pisiform, FCU, abductor digiti minimi - Lateral = hook of hamate - Roof = palmar carpal ligament - Floor = flexor retinaculum
69
What is are the contents of Guyon's canal?
- Ulnar nerve - Ulnar artery - Venae comitantes - Lymphatics
70
Describe the borders of the cubital tunnel
- Medial = medial epicondyle of humerus - Lateral = olecranon of ulna - Floor = elbow joint capsule - Roof = cubital tunnel retinaculum
71
List the attachments of the transverse carpal ligament
- Medial = hook of hamate and pisiform | - Lateral = scaphoid and trapezium
72
What is the contents of the carpal tunnel?
- 4 FDS tendons - 4 FDP tendons - 1 FPL tendon - Median nerve
73
Muscles of the anterior compartment of the arm
- Biceps brachii - Brachialis - Coracobrachialis
74
Muscle of the posterior compartment of the arm
- Triceps brachii | - Anconeus
75
Biceps Brachii OIIA
- O = SH (tip of coracoid), LH (supraglenoid tubercle) - I = radial tuberosity and bicipital aponeurosis - I = musculocutaneous nerve - A = supinates forearm, flexes forearm when supine
76
Coracobrachialis OIIA
- O = tip of coracoid - I = middle 1/3rd of medial humerus - I = musculocutaneous nerve - A = flex and adducts arm
77
Brachialis OIIA
- O = distal 1/2 of anterior humeral surface - I = coronoid process and ulna tuberosity - I = musculocutaenous nerve - A = flexes forearm in all positions
78
Triceps Brachii OIIA
- O = LH (infraglenoid tubercle), Lat H (posterior surface of humerus), MH (posterior surface of humerus) - I = olecranon - I = radial nerve - A = extends forearm
79
Anconeus OIIA
- O = lateral epicondyle of humerus - I = lateral surface of olecranon - I = radial nerve - A = assists extension
80
How is the anterior compartment of the forearm divided?
- Superficial layer - Intermediate layer - Deep layer
81
Muscles of the superficial layer of the forearm
- FCR - FCU - Palmaris longus - Pronator teres
82
Muscles of the intermediate layer of the forearm
FDS
83
Muscles of the deep layer of the forearm
- FDP - FPL - Pronator quadratus
84
Pronator teres OIIA
- O = UH (coronoid), HH (medial epicondyle) - I = lateral radial surface - I = median nerve - A = pronates and flexes forearm
85
FCR OIIA
- O = medial epicondyle - I = base of 2nd metacarpal - I = median nerve - A = flexes and abducts wrist
86
Palmaris longus OIIA
- O = medial epicondyle - I = distal half of flexor retinaculum - I = median nerve - A = flexes hand at wrist and tenses palmar aponeurosis
87
FCU OIIA
- O = HH (medial epicondyle), UH (olecranon) - I - pisiform, hook of hamate, 5th met - I = ulnar nerve - A = flexes and adducts wrist
88
FDS OIIA
- O = medial epicondyle - I = shafts of medial phalanges of medial 4 digits - I = median nerve - A = flexes middle phalanges at PIPs and MCPs
89
FDP OIIA
- O = anterior surface of ulna and IO membrane - I = bases of distal phalanges of medial 4 digits - I = AIN - A = flexes DIPs
90
FPL OIIA
- O = anterior surface of radius and IO membrane - I = base of distal phalanx of thumb - I = AIN - A = flexes phalanges of thumb
91
Pronator quadratus OIIA
- O = distal 1/4 of anterior surface of ulna - I = distal surface of anterior 1/4 radius - I = AIN - A = pronates forearm
92
Brachioradialis OIIA
- O = supraepicondylar ridge of humerus - I = lateral surface of distal radius - I = radial nerve - A = weak forearm flexion when mid-pronated
93
ECRL OIIA
- O = lateral supra-epicondylar ridge of humerus - I = dorsal aspect of base of 2nd metacarpal - I = radial nerve - A = extend and abduct wrist
94
ECRB OIIA
- O = lateral epicondyle - I = dorsal aspect of base of 3rd metacarpal - I = PIN - A = extend and abduct wrist
95
Extensor digitorum OIIA
- O = lateral epicondyle q - I = extensor hood of medial 4 digits - I = PIN - A = extends MCPs
96
Extensor digiti minimi OIIA
- O = lateral epicondyle - I = extensor hood of 5th digit - I = PIN - A = extends 5th MCP
97
ECU OIIA
- O = lateral epicondyle - I = dorsal aspect of 5th metacarpal - I = PIN - A = extends and adducts wrist
98
Supinator OIIA
- O = lateral epicondyle - I = proximal 1/3rd of lateral radius - I = PIN - A = supinates
99
Extensor indices OIIA
- O = posterior surface of distal 1/3rd ulna - I = extensor hood of 2nd digit - I = PIN - A = independent extension of index finger
100
APL OIIA
- O = posterior surface of proximal radius and ulna - I = base of 1st metacarpal - I = PIN - A = abducts thumb
101
EPL OIIA
- O = posterior surface of proximal radius and ulna - I = dorsal aspect of base of distal phalanx of thumb - I = PIN - A = extends distal phalanx of thumb
102
EPB OIIA
- O = posterior surface of distal 1/3rd radius - I = dorsal aspect of base of proximal phalanx of thumb - I = PIN - A = extends proximal phalanx of thumb
103
List the thenar muscles
- APB - FPB - Opponens pollicis - Adductor pollicis
104
List the hypothenar muscles
- Palmaris brevis - ADM - FDM - Opponens digiti minimi
105
Describe the course of the brachial artery
- Continuation of axillary artery | - Begins at inferior border of teres major and ends in cubital fossa opposite radial neck
106
Describe the course of the basilic vein
- Originates from dorsal venous network - Ascends medial aspect of upper limb - Combines with brachial veins to form axillary vein at border of teres major
107
Describe the course of the cephalic vein
- Arises from dorsal venous network - Ascends anterolateral aspect of upper limb - Travels between deltoid and pec major - Enters axilla via clavipectoral triangle - Empties into axillary vein
108
Describe the course of the ulnar artery in the forearm
- Larger terminal branch of brachial artery - Descends inferomedially deep to superficial and intermediate layers of anterior forearm - Medial to ulnar nerve - Passes through Guyons canal to enter hand
109
Describe the course of the radial artery in the forearm
- Commences at level of radial neck, lying on biceps tendon - Overlapped by brachioradialis - Lies between brachioradialis and FCR where it is closely related to radial nerve - Passes deep to APL and EPB tendons to enter anatomical snuffbox
110
List the contents of the anterior compartment of the leg
- Deep peroneal nerve - Anterior tibial artery - Tibialis anterior - EHL - Extensor digitorum longus - Peroneus tertius
111
List the contents of the lateral compartment of the leg
- Superficial peroneal nerve - Peroneal artery - Peroneus longus - Peroneus brevis
112
List the contents of the deep posterior compartment of the leg
- Tibial nerve - Posterior tibial artery - Tibialis posterior - FHL - Flexor digitorum longus - Popliteus
113
List the contents of the superficial posterior compartment
- Sural nerve - Gastrocnemius - Soleus - Plantaris
114
List the structures that pass behind the medial malleolus
- Tibialis posterior - Flexor digitorum longus - Tibial artery - Tibial nerve - Flexor hallucis longus
115
List the structures that pass behind the lateral malleolus
- Sural nerve - Peroneus longus - Peroneus brevis - Short saphenous vein
116
Tibialis anterior OIIA
- O = lateral condyle and tibia - I = medial surface of medial cuneiform and 1st met base - I = deep peroneal - A = dorsiflexion and inversion
117
Deep fibular nerve root
L4, L5
118
EDL OIIA
- O = lateral condyle of tibia - I = middle and distal phalanges of lateral 4 digits - I = deep fibular - A = extends lateral 4 digits and dorsiflexes
119
EHL OIIA
- O = middle part of anterior fibula - I = distal phalanx of hallux - I = deep fibular - A = extends great toe and dorsiflexes
120
Peroneus tertius OIIA
- O = inferior 1/3rd of anterior tibia - I = dorsum of base of 5th met - I = deep fibular - A = dorsiflexion and eversion
121
Peroneus longus OIIA
- O = lateral superior fibula - I = base of 1st met and medial cuneiform - I = superficial fibular - A = eversion
122
Peroneus brevis OIIA
- O = lateral mid-fibula - I = 5th met tuberosity - I = superficial fibular - A = eversion
123
Gastrocnemius OIIA
- O = LH (lateral femoral condyle), MH (popliteal surface of femur) - I = calcaneal tendon - I = tibial nerve - A = plantarflexion, leg flexion
124
Soleus OIIA
- O = fibula head and soleal line - I = calcaneal tendon - I = tibial nerve - A = plantarflexion independent of knee position
125
Plantaris OIIA
- O = oblique popliteal ligament - I = calcaneal tendon - I = tibial nerve - A = weak plantarflexion
126
Popliteus OIIA
- O = lateral femoral condyle and meniscus - I = posterior tibia - I - tibial nerve - A - unlocks knee
127
FHL OIIA
- O = inferior posterior fibula and IO membrane - I = base of distal phalanx of great toe - I = tibial nerve - A = flexes great toe at all joints
128
FDL OIIA
- O = posterior tibia - I = base of distal phalanges of lateral 4 digits - I = tibial nerve - A = flexes lateral 4 digits
129
Tibialis posterior OIIA
- O = posterior tibia and IO membrane - I = tuberosity of navicular - I = tibial nerve - A = plantarflexion and inversion
130
Course of the popliteal artery
- Continuation of femoral artery at adductor hiatus - Passes through popliteal fossa to leg - Ends at lower border of popliteus - Divides into anterior and posterior tibial
131
Course of anterior tibial artery
- Branch of popliteal - Passes between tib and fib into anterior compartment - Descends IO membrane between TA and EDL
132
Course of posterior tibial artery
- Branch of popliteal - Passes through posterior compartment of leg - Terminates as medial and lateral plantar arteries
133
Course of the peroneal artery
- Branch of posterior tibial | - Descends in posteriro compartment adjacent to posterior intermuscular septum
134
Course of the long saphenous vein
- Commences at medial side of dorsal venous arch - Ascends in front of medial malleolus with saphenous nerve - Ascends medial aspect of thigh - Terminates at femoral vein at the saphenous opening
135
Course of the short saphenous vein
- Commences on lateral side of the dorsal venous arch - Passes BEHIND lateral malleolus - Enters popliteal vein at over popliteal fossa
136
Course and distribution of the saphenous nerve
- Originates from femoral nerve - Descends with femoral vessels through adductor canal - Course anterior to medial malleolus - Supplies medial foot and ankle
137
Course and distribution of sural nerve
- Branch of tibial AND common fibular - Descends between heads of gastroc and becomes superficial at mid leg to pass inferior to lateral malleolus - Supplies posterior and lateral aspect of leg and lateral foot
138
Course and distribution of tibial nerve
- Originates from sciatic - Runs on tib post in posterior compartment - Supplies posterior muscles of leg and knee joint
139
Course and distribution of common peroneal nerve
- Originates from sciatic - Forms at apex of pop fossa - Follows medial border of biceps femoris to pass posterior to head of fibula and wind around neck - Supplies skin on lateral part of posterior aspect of leg via lateral cutaneous nerve
140
Course and distribution of superficial peroneal nerve
- Originates from common fibular - Arises between peroneus longus and neck of fib - Descends in lateral compartment - Subcutaneous in distal 1/3rd
141
Course and distribution of deep peroneal nerve
- Originates from common fibular - Arises between peroneus longus and neck of fib - Passes though EDL and on IO membrane - Crosses distal tibia and enters dorsum of foot - Supplies anterior muscles of foot and 1st webspace
142
What are the borders of the popliteal fossa?
- Above and medial = semimembranosus - Above and lateral = biceps femoris tendon - Below and lateral = lateral head of gastroc - Below and medial = medial head of gastroc - Roof = skin and superficial fascia, deep fascia - Floor = popliteus and posterior knee joint and femur
143
What does the superficial fascia over the popliteal fossa contain
Short saphenous vein
144
List the contents of the popliteal fossa
- Sciatic nerve above that divides into common peroneal nerve and tibial nerve - Popliteal vein - Popliteal artery, divides into anterior and posterior tibial arteries at inferior border of popliteus - Lymph nodes - Fat - Bursa
145
Pectineus OIIA
- O = superior ramus of pubis - I = pectineal line of femur - I = femoral nerve - A - adducts and flexes thigh
146
Psoas major OIIA
- O = sides of T12-L5 - I = lesser trochanter - I = anterior rami of lumbar nerves L1-3 - A = flexes thigh
147
Psoas minor OIIA
- O = sides of T12-L1 - I = pectineal line - I = anterior rami of lumbar nerves L1/2 - A = flexes thigh
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Iliacus OIIA
- O = iliac crest and fossa - I = tendon of psoas major - I = femoral nerve - A = flexes thigh
149
Sartorius OIIA
- O = ASIS - I = medial tibia - I = femoral nerve - A = flexes, abducts, LR thigh
150
Rectus femoris OIIA
``` O = ASIS and ileum superior to acetabulum I = quads tendon I = femoral nerve A = extends knee ```
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Vastus lateralis OIIA
- O = GT - I = quads tendon - I = femoral nerve - A = extends knee
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Vastus medialis OIIA
- O = intertrochanteric line - I = quads tendon - I = femoral nerve - A = extends knee
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Vastus intermedius OIIA
- O = anterior surface of femoral shaft - I = quads tendon - I = femoral nerve - A = extends knee
154
Semitendinosus OIIA
- O = ischial tuberosity - I = medial tibia - I = tibial division of sciatic nerve - A = extends thigh and flexes leg
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Semimembranosus OIIA
- O = ischial tuberosity - I = medial condyle of tibia - I = tibial division of sciatic nerve - A = extends thigh and flexes leg
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Biceps femoris OIIA
- O = LH (ischial tuberosity), SH (linea aspera) - I = lateral fibula head - I = LH (tibial division of sciatic), MH (common peroneal division of sciatic) - A = flexes leg and extends thigh
157
What is the pes anserinus
Common tendinous insertion for: - Semitendinosus - Sartorius - Gracilis
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Course and distribution of femoral artery
- Continuation of external iliac inferior to inguinal ligament - Bisects femoral triangle - Courses through adductor canal - Becomes popliteal artery as it traverses adductor hiatus
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Course and distribution of profunda femoris
- Originates from femoral artery 1-5cm inferior to inguinal ligament - Passes deep between pectineus and adductor longus, descends posterior to latter on medial side - Contains 3 perforating arteries that pass through adductor magnus to supply muscles in posterior, medial, and lateral thigh
160
Course and distribution of the medial circumflex artery
- Originates from profunda femoris - Passes medially and posterior between pectineus and iliopsoas - Enters gluteal region - Gives off retinacular vessels that supply head and neck of femur
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Course and distribution of the obturator artery
- Originates from internal iliac - Passes through obturator foramen to enter medial compartment of thigh - Divides into anterior and posterior branches that pass on respective sides of adductor brevis - Anterior branch supplies obturator externus, pectineus, adductors, gracillis - Posterior branch supplies muscles attached to ischial tuberosity
162
Describe the course of the femoral nerve
- Originates L2-4 - Passes through psoas major, emerging on lateral aspect - Passes under inguinal ligament on iliopsoas - 5cm below inguinal ligament it breaks into terminal branches
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What are the branches of the femoral nerve
- Quads - Sartorius - Pectineus - Medial cutaneous nerve of the thigh - Intermediate cutaneous nerve of the thigh - Saphenous nerve
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Descibe the lateral cutaneous nerve of the thigh
- Arises directly from the lumbar plexus
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List the adductor muscles
- Adductor longus - Adductor brevis - Adductor magnus - Gracilis - Obturator externus
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Describe the adductor hiatus
- Opening between the aponeurotic adductor part of adductor magnus and tendinous distal part of hamstring part - Contains femoral artery and vein
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Contents of the adductor canal
- Femoral artery - Femoral vein - Saphenous nerve
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Borders of the adductor canal
Passes from apex of femoral triangle to popliteal fossa - Posterior = adductor longus and magnus - Anteromedial = sartorius forming roof - Anterolateral = vastus medialis
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Gluteus maximus OIIA
- O = ilium, sacrum, coccyx, sacrotuberous ligament - I = iliotibial tract - I = inferior gluteal nerve - A = extends thigh and LR
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Gluteus medius OIIA
- O = ileum - I = lateral surface of GT - I = superior gluteal nerve - A = abductor
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Gluteus minimis OIIA
- O = ileum - I = anterior surface of GT - I = superior gluteal nerve - A = adbuctor
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TFL OIIA
- O = ASIS and anterior iliac crest - I = iliotibial tract to lateral condyle of femur - I = superior gluteal nerve - A = abductor
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Piriformis OIIA
- O = anterior sacrum - I = superior surface of GT - I = branches of S1/2 - A = ER
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Obturator internus OIIA
- O = obturator membrane - I = medial surface of GT (trochanteric fossa) - I = nerve to obturator internus - A = ER
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Superior and inferior gemellus
- O = superior (ischial spine), inferior (ischial tuberosity) - I = medial surface of GT - I = superior (nerve to obturator internus), inferior (nerve to quadratus femoris) - A = ER
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Quadratus femoris OIIA
- O = lateral border of ischial tuberosity - I = quadrate tubercle - I = nerve to quadratus femoris - A = ER
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Describe the blood supply to the lower limb
- Femoral artery arises from internal iliac at mid-inguinal point - Femoral artery divides into SFA and profunda femoris below femoral sheath - Profunda femoris is main arterial supply to thigh and branches into medial and lateral circumflex - SFA has no branches in the thigh and passes through adductor - SFA becomes popliteal artery at adductor hiatus - Popliteal artery runs deep in popliteal fossa and gives off genicular branches - Beneath the arch of soleus it divides into anterior tibial and tibioperoneal trunk - Posterior tibial artery runs in the posterior compartment of the leg and passes behind medial malleolus before dividing into medial and lateral plantar arteries - Anterior tibial artery runs in the anterior compartment of the leg and crosses the ankle anteriorly to become dorsalis pedis
178
Outline the layers of foot musculature
Dorsal: - 1 layer = EDB, EHB Plantar: - 1st = Abductor hallucis, FDB, Abductor digiti minimi - 2nd = Quadratus plantae, lumbricals - 3rd = FHB, adductor hallucis, flexor digiti minimi brevis - 4th = Plantar interossei, dorsal interossei
179
Extensor digitorum brevis OIIA
- O = calcaneus, extensor retinaculum - I = proximal phalanx of great toe and extensor tendons of toes 2-4 - I = deep peroneal nerve - A = aids EDL in extending lateral 4 toes at MTPJ and ITPJ
180
Extensor hallucis brevis OIIA
- O = calcaneus, extensor retinaculum - I = base of proximal phalanx of great toe - I = deep peroneal nerve - A = aids EHL in extending great to at MTPJ
181
Abductor hallucis OIIA
- O = medial tubercle of calcaneus, flexor retinaculum, plantar aponeurosis - I = medial base of proximal phalanx of great toe - I = medial plantar nerve - A = abducts great toe
182
Flexor digitorum brevis OIIA
- O = medial tubercle of calcaneus and plantar aponeurosis - I = middle phalanges of lateral 4 digits - I = medial plantar nerve - A = flexes lateral 4 digits at ITPJs
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Abductor digiti minimi brevis OIIA
- O = medial and lateral tubercles of the calcaneus and plantar aponeurosis - I = lateral base of proximal phalanx of 5th toes - I = lateral plantar nerve - Abducts and flexes 5th digit
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Quadratus plantae OIIA
- O = medial and lateral plantar surfaces of calcaneus - I = tendons of FDL - I = lateral plantar nerve - A = assists FDL in flexing lateral 4 digits
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Lumbricals OIIA
- O = tendon on FDL - I = extensor hoods of lateral 4 digits - I = medial and lateral plantar - A = flexes MTPJ whilst extending ITPJ
186
Flexor hallucis brevis OIIA
- O = plantar surface of the cuboid and lateral cuneiform - I = base of proximal phalanx of great toe - I = medial plantar nerve - A = flexes proximal phalanx of great toe at MTPJ
187
Adductor hallucis OIIA
- O = oblique head (base of 2/3/4 met), transverse head (plantar ligaments of MTPJs) - I = base of proximal phalanx of great toe - I = deep branch of lateral plantar nerve - A = adducts great toe, assists in forming the transverse arch
188
Flexor digiti minimi brevis OIIA
- O = base of 5th metatarsal - I = base of proximal phalanx of 5th digit - I = superficial branch of lateral plantar nerve - A = flexes proximal phalanx of 5th digit
189
Plantar interossei action
Adduct digits 3-5 and flex MTPJs
190
Dorsal interossei action
Abduct digits 2-4 and flex MTPJs
191
List the articulations of the talus
- Tibiotalar joint - Subtalar joint - Talonavicular joint
192
Describe the blood supply to the talus
- Posterior tibial artery via dorsal canal - Anterior tibial artery - Perforating peroneal artery via artery of tarsal sinus
193
Describe the subtalar joint
The talus articulates with the calcaneus via 3 facets: - Posterior - Middle - Anterior
194
What does the calcaneus articulate with
- Talus | - Cuboid
195
What does the navicular articulate with
- Talus - 3 cuneiforms - Cuboid
196
What does the cuboid articulate with
- Calcaneus - 4th and 5th mets - Lateral cuneiform - (Navicular in 25%)
197
What muscles attach to the medial cuneiform
- Tibialis anterior | - Parts of tibialis posterior and peroneus longus
198
What muscle inserts into the navicular
Tibialis posterior
199
What forms the medial longitudinal arch of the foot
- Calcaneus - Talus - Navicular - 3 cuneiforms - 3 medial metatarsals
200
What muscles support the medial longitudinal arch of the foot
- Tibialis anterior - Tibialis posterior - Peroneus longus - FDL - Flexor hallucis - Intrinsic muscles of the foot
201
What forms the lateral longitudinal arch of the foot
- Calcaneus - Cuboid - 4th and 5th metatarsals
202
What muscles support the lateral longitudinal arch of the foot
- Peroneus longus - FDL - Intrinsic foot muscles
203
What forms the transverse arch of the foot
- Metatarsals - Cuboid - 3 Cuneiforms
204
What muscles support the transverse arch of the foot
- Peroneus longus | - Tibialis posterior
205
What forms the deltoid ligament
- Tibiotalar (posterior) - Tibiosustenacular - Tibio-spring - Tibionavicular
206
What is the spring ligament
Thick and strong ligament from the susternaculum talki to the navicular
207
What forms the lateral collateral ligament of the ankle
- ATFL - Calcaneofibular - PTFL
208
What are the functions of the vertebral column
- Protection - Support - Axis - Movement
209
Describe the typical cervical vertebrae
- C3-C6 - Large triangular foramen - Transverse foramina within the processes - Bifid spinous process - Short transverse process
210
Describe the atlas
- Ring-like bone structure lacking a spinous process or body - Two lateral masses connected by anterior and posterior arches
211
Describe a thoracic vertebrae
- Increasing in size from superior to inferior - Demifacets superior and inferior on its body - Transverse processes contain costal facet - Oblique facing spinal process - Circular foramen
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Describe a lumbar vertebrae
- Kidney-shaped body - Triangular foramen - Short spinous process
213
List the vertebral ligaments
- Anterior longitudinal ligament - Posterior longitudinal ligament - Ligamentum flavum - Interspinous ligament - Supraspinous ligament
214
Describe the ligamentum flavum
Lies on the posterior aspect of the spinal canal where the lamina meets the spinous process
215
Describe an intervertebral disc
- Form a secondary cartilaginous joint - Inner nucleus pulposus of mucoprotein - Outer annulus fibrosis of fibrocartilage
216
At what level does the spinal cord end
L2
217
What levels does the lumbar cistern span
L2 to S2
218
Outline the upper limb myotomes
- C4 = shoulder shrugs - C5 = elbow flexion - C6 = wrist extension - C7 = elbow extension - C8 = finger flexion - T1 = finger abduction
219
Outline the lower limb myotomes
- L2 = hip flexion - L3 = leg extension - L4 = ankle dorsiflexion - L5 = big toe extension - S1 = plantarflexion
220
Outline the upper limb dermatomes
- C4 = over ACJ - C5 = regimental badge - C6 = palmar side of thumb - C7 = palmar side of middle finger - C8 = palmar side of little finger - T1 = medial aspect of ACF - T2 = apex of axilla
221
Outline the lower limb myotomes
- T12 = inguinal ligament - L1 = inguinal region at top of thigh - L2 = middle of anterior thigh - L3 = medial epicondyle of femur - L4 = medial malleolus - L5 = dorsum of foot - S1 = lateral calcaneus - S2 = midpoint of popliteal fossa - S3 = horizontal gluteal crease

Interview Preparation (9 decks)

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