overview Flashcards
(91 cards)
1
Q
what is te function of the upper limbs
A
move the hands
2
Q
what is te function of the lower limbs
A
locomotion and support weigt
3
Q
what is the axial skeleton
A
the axis of the head, neck and trunk
contains skull, spinal column and rib cage
4
Q
what is the appendicular skeleton
A
limbs
5
Q
what level of the spinal column is the upper and lower limbs associated with
A
c5-t1 - upper
l2-s3 - lower
6
Q
where are the flexor and extensor muscles in the upper limb
A
flexor anterior - in anatomical position
extensers posterior
7
Q
where are the flexor and extensor muscles in the lower limb *
A
lower limb rotates internally during development below the hip
so flexers are posterior and extensers are anterior
so moving leg forward is a flexion
8
Q
where are the dermatomes in the lower limbs *
A
lower limb rotates internally during development below the hip - the limb picks up nerve supply before rotation occures = there is a twist in the dermatome fields so they are oblique
9
Q
wat is the same within a limb compartment
A
hhave same distinct function eg all floexor or extensor
have same nerve supply
blood supply
10
Q
what is the upper arm
A
between elbow and shoulder
11
Q
what is the forearm
A
between elbow and wrist
12
Q
what are the compartments of the upper limb
A
pectoral (chest) girdle muscles - pectoral girdle is the clavical and scapular
intrinsic soulder muscles
anterior (upper) arm muscles - flexers - boen is humorous
posterior (upper) arm muscles - extensers
anterior forearm muscles - flexers - bones are radius and ulnar
posterior forearm muscles - extensors
intrinsic hand muscles - bones are carpus, metacarples adn phalanges
13
Q
what is an attachment for upper limb muscles
A
the pelvis
14
Q
describe movements of the pectoral girdle
A
movements of teh arm relative to the scapular at the shoulder joint, and movements of scapula relative to the chest wall
15
Q
describe te muscles of te pectoral girdle
A
have attachments in te neck, anterior chest, back and arm
detoid - intrinsic muscle of the shoulder
trapezius - supplied by cranial nerves (accessory) and acts on scapular and clavical
pectoralis major- has broad attachments on the sternum, clavical and humerous
scapular is hub for muscle attacment - rotator cuff muscles of shoulder - for movement of the shoulder and scapular in relation to trunk
16
Q
descrieb cross sections of muscles in te arm
A
deltoid present then disappears becasue it attaches to the lateral side of the humerous
biceps small at top but thicker lower down where the bellies fuse
17
Q
what are te comaprtments of te lower limb *
A
hip abducters - gluteal
hip extensers - gluteal
hip flexors
anterior thigh muscles - extensers
medial tigh muscles - adductors
posterior thigh muscle - flexor
anterior leg muscle - extensors - dorsiflexors
lateral leg muscle - foot evertprs
posterior leg muscle - flexors - plantarflexors
intrinsic foot muscles - variety of functions
18
Q
what is the thigh
A
hip to knee
19
Q
what is he leg
A
knee to ankle
20
Q
what are the bones in lower limb
A
hip attach to trunk via sacroiliac joint
ten have femor
then tibia and fibia in lower limb
then tarsus, metarsals, phalanges
21
Q
what part of teh body is the glutamus maximus part of
A
the lower limb
22
Q
describe the muscles of te lower limb that attach in te abdo and pelvic cavities
A
iliacus and psoas muscles - form the iliopsoas muscle
psoas attaches to L1-5
psoas fibres comnverge wit iliacus that lines the inner surface of the iliac bone
they attach to the inferior tubercle
23
Q
describe cross sectional view of muscles in the lower limbs
A
adducters are medial
soleus and gastrocnemiuss muscles are the thigh muscles
24
Q
why is blood supply to the limbs important
A
DVT
arteries adn veins are used to access the heart
take pulse to assess teh blood supply in vascular disease
25
summarise the arterial supply to the upper limb
aorta becomes subclavian
becomes axillary when enter axillary area
changes name to be brachial - in arm
which becomes deep brachial artery which divides at tehh elbow joint
then radial and ulnar arteries
then hand palmer branches - cross wrist - deep and superficial
then metacarpel and digital arteries
have circumflex branches around neck of the humourus
26
what is teh cubital fossa and what is its relevance
it is the space in front of the elbow
where you access veins and arteries - access median cubital vein for venepuncture
27
where can you take pulses form the upper limb
brachial artery - medial side of arm
wrist 0 ulnar and radial arteries - better laterally which is the radial artery
28
describe the venous drainage of teh upper limb
there are superficial and deep systems
deep veins run with the arteries
palmar venosu plexus and palmar digital form a network
have dorsal venous arch - superficial vein in hand
from network in hands have - cephalic (lateral) and basilic (medial) veins - superficial
median cubital connects the cephalic and basilic veins in the cubital fossa - blood taken from here - can use other superficial veins if not present
venae comitantes - pair the deep veins, they pass along the brachial artery and drain into the axillary vein
basilic merge with deep vessels = axillary vein is deep, cephalic joins the axillary (brachial goes deep but cephalic stays superficial)
axillary pass under clavical and become subclavian vein
superior vena cava
29
describe the arterial supply of the lower limb \*
aorta spilts into the common iliac arteries - split into internal and external iliac arteries - both supply lower limb
internal iliac supplies the contents of the pelvis
most of the lower limb supply is from external iliac artery, internal supplies medial part of thigh
external iliac passes under thhe inguinal ligament - becomes teh femoral artery -just under inguinal ligament feel femoral pulse - access heart to put a stent in here
femoral artery gives off branch in thigh - profunda femoris artery which supplies the posterior compartment of thigh and continues as superficial femoral artery
deep femoral artery goes anterior and medially then posterior behind the knee
superficial femoral artery then passes through the hiatus of adductor magnus muscle to the back of the knee where it becomes the popliteal artery - area behind knee is the popliteal fossa
popliteal artery gives off local branches in the popiteal fossa
then gives off anterior and posterior tibeal arteries and perineal/fibular artery
anterior tibeal artery is artery of anterior compartment of the leg - passes over foot anteriorly as the dorsalis pedis - supply anterior of foot
posterior tibial artery - artery of the posterior component of leg - passes behind medial malleolus of ankle - pulse taken here- divides in foot to become medial and lateral plantar arteries
fibular goes behind teh lateral malleolus - inconsistantly anastomososes with the anterior tibial artery in distal leg
give plantar arches derived from anterior and psoterior tibial arteries (plantar surface is sole of foot) - supply foot
30
what are the pulses of the lower limb \*
femoral
popliteal
anterior and posterior tibial artery
dorsalis pedis
31
why are there more pulses in lower than upper limbs
lower limbs affeected first when arteries go
32
describe the vwnous drainage of the lower limb \*
mirrors the aretrial supply
deep - anterior and posterior tibeal venae comitantes, popliteal vein -\> superficial femoral vein which is joined by venae comunicantes of profunda femoris artery -\>femoral vein -\> external iliac vein -\> drain into the vena cava
superficial - venous arches in foot - on medial limb crosses anteriorly to medial malleolus up leg behind knee and drain into inguinal region this is long saphrenous vein,
superficial - behind lateral malleolus, posterior of calf - pierce fascia over popiteal fossa and drain into popiliteal vein - this is short saphrenous vein
venae comitantes - pair of veins that closely accompany arteries so the pulses of the arteries aid venous return also cool venous blood is warmed by the arteries - artery and vein joined by connective tissue
saphrenous veins arise from venous network of dorsum of foot - long saphrenous drains anterior to medial mallelous and continues up medial side of limb into femoral vein at groin, short into popliteal vein and popliteal fossa
perferating vessels connect deep and superficial veins
33
what is the femoral traingle
in inguinal region
both femoral artery and vein here
where femoral artery is accessed - through this access the cardiac vessels for angiograms and angioplasty
feel pulse here
34
why are lower limb veins important clinically
perforating veins connecting superficial and deep veins contain a valve - only allow flow from superficial to deep
if valve damaged - blood flows from deep to superficial - varicose veins (dilated veins)
35
how does movement help venous return from the lower limbs
deep vessels between muscles
contraction of muscles in movement squeeze veins, open valves and pump blood up this is the calf pump
immobility = less efficient venous return from foot and leg - sluggish venous return cause DVT
36
how can you prevent DVT after surgery
socks that compress the superficial veisn so push blood into deep veins
mean you ahve more vigorous venous flow - prevents DVT
37
how many spinal nerves do we have in each section
8 - cervical
12 t
5 l
5 s
1 or 2 coccygeal
38
which spinal nerves are associated with which region
c1-4 neck
c5-t1 - upper limb - so upper limb has 5 spinal roots
t2-l1 trunk
l2-s3 lower limb - 7 spinal roots
s2-s4 - perineum
39
what does the brachial plexus supply
upper limb
40
describe plexuses
plexus is a network of nerves fromed from spinal nerves - merge and intermingle - make new peripheral nerve therefore fibres have \>1 spinal root
41
descrive the path of the brachial plexus
start in neck - from anterior rami of c5 to t1 spinal nerves
goes under the clavical to axilla
42
describe the nerves to the lower limb
from the lumbosacral plexus - originated from teh lumbar and sacral rami
femoral nerve supplies the anterior compartment of the thigh - comes under the inguinal ligament
obturator nerve supplies medial (adductor) compartment of thigh, passes through obturator foramen
sciatic nerve (or its terminal branches - tibeal and common peroneal nerves) supply posterior thigh, anterior and posterior leg and foot
43
what are the 2 types of innervation
segmental and peripheral
44
describe segmental motor innervation of lower limbs
referring to myotomes
there are groups of motor cell bodies in spinal chord
there is a plexi for each limb
anterior and posterior divisions of anterior and posterior rami:
anterior divisions - flexor muscles
posterior divisions - extensor muscles
45
describe prinicples of the segmental nerve supply to muscles
muscles are generally supplied by 2 adjacent spinal segments
muscles wit te same action on a joint generallly ave te same nerve supply
opposing muscles ie flexors and extensers are usually 1 or 2 segments above or below
the more distal the muscle is in the limb, the more caudal te spinal segment is
46
what is the segmental motor supply to the shoulder
abduction - C5
adduction - C6, 7, 8
external rotation C 5
internal rotation C 6, 7, 8
47
what is the segmental motor supply to the elbow
flexion - C5 6
extension C 7 8
48
what is the segmental motor supply to the forearm
supination (turn to face palm upwards) C6
pronation C7 or 8
49
what is the segmental motor supply to the wrist
flexion C6 7
extension C6 7
50
what is the segmental motor supply to the long tendons to hand
flexion C7 8
extension C 7 8
51
what is the segmental motor supply to the intrinsic hand
T1
52
what is the segmental motor supply to the hip
flexion L2 3
extension L4 5
53
what is the segmental motor supply to the knee
extension L3 4
flex L5 S1
54
what is the segmental motor supply to the ankle
dorsiflex L4 5 (foot towards you)
plantarflex s1 s2 (foot away from you)
55
what is te difference between segmental and cutaneous nerve supply
segmental - all nerves in that dermatome get there from 1 spinal level
cutaneous - all nerves from that spinal level get to that dermatome throug differnt peripheral nerves eg C5 dermatome has cutaneous innervation from axillary and anterior cutaneous nerve
56
what is te segmental SENSORY supply to te infraclavicular region
c4
57
what is te segmental SENSORY supply to lateral arm
c5
58
what is te segmental SENSORY supply to lateral forearm adn thumb
c6
59
what is te segmental SENSORY supply to middle finger
c7
60
what is te segmental SENSORY supply to little finger and medial forearm
c8
61
what is te segmental SENSORY supply to medial arm
t1
62
what is te segmental SENSORY supply to axilla and trunk
t2
63
what is te segmental SENSORY supply to nipple
t4
64
what is te segmental SENSORY supply to umbilicus
t10
65
what is te segmental SENSORY supply tolower abdo
t12
66
what do you assess wen you assess nerve function
motor function
sensory function
reflex function
autonomic function
67
what would be te effect of a prolapsed intervertebral disk at L5/s1 (spinal root injury(
motor - loss of eversion - turn soul of foot out when walk on uneven ground
sensory - loss of sensation outer border of foot
reflex - loss of ankle jerk (this is s1 effect)
autonomic - minimal effects
68
what does the sciatic nerve divide into and where
teh common perineal and tibial nerve
just above the knee
69
what is the effect of damage to the common perineal nerve (peripheral nerve injury)
inability to raise foot = high step/swinging gait - nerve supply to teh anterior of leg tat raises foot
sensory - decrease of sensation at the dorsum of foot and maybe elsewhere
reflex- none
autonomic - minimal
70
describe te anterior compartment of the arm \*
muscles: brachialis, biceps and coraco-brachialis
c5 6 7 nerve supply get there by te musculocutaenous nerve
deep brachial artery
flexes elbow
biceps strong supinator to forearm throughh attachment to radius bone
71
describe compartment syndrome
muscle groups confined in their compartments and are separated by fibrous septa
therefore can get ischemia due to trauma/inflammation induced increase in pressure in 1 compartment - commonly anterior, posterior, lateral compartment of leg
normal tissue bp (out of bv) is 20mmHg - only need 50-60mmHg to collapse small vessels so muscles not getting supplied - tis is above what you need to collapse big bv so still have pulse (ie tissue bp still lower than inside the vessels)
acute compartment syndrome is trauma associated
chronic is exercise induced
impairs venous drainage and arterial output - muscles and nerves die
72
how do you treat acute compartment syndrome
emergancy fasciotomy (open up compartment to relieve pressure) - to prevent deat of muscles in affected compartment
73
muscles in the anterior compartment of the arm \*
biceps
brachalis
coracobrachialis
74
innervation of teh anterior compartment of the arm
\*
the musculocutaneous nerve
75
what does the brachial artery supply \*
the upper arm
76
what is a major branch of the brachial artery \*
the profunda brachial artery
77
what is a branch of the ulnar artery and what are divisions of this \*
common interosseous
this divides into anterior interosseous artery and posterior interosseous artery
78
what is venous graft harvesting 8
where a vein is taken and used to bypass a block in a coronary artery
79
list 3 muscoskeletal patologies
\*
fractures
tendon/ligament sprains
arthritis and other joint problems
80
describe how the dermatomes are formed in the upper limb \*
the skin has been 'borrowed' from te trunk and from c5 to t1
teh segmental nerves get to the upper limb by te bracial plexus
81
describe how te dermatomes are formed in the lower limb \*
skin is borrowed from t12 to s3
82
describe teh autonomic nerve supply to the limbs \*
no pns supply to limbs
sns for upper limbs t2-t6
lower limbs t11-l2
83
what are axial lines
\*
where dermatomes do not follow axial outflow
eg s2 and l2 are next to each other in posterior thigh
84
describe the sensory innervation of the thumb \*
The sensory nerves fibres pass from the skin in both the median and radial nerves, via the brachial plexus to the C6 spinal segment.
segmental supply is c6
peripheral supply is median nerve anteriorly and radial nerve posteriorly
85
what regions is the upper arm split into and what divides it into these regions \*
shoulder, arm, forearm, hand
shoulder is upper limb attachment to trunk
arm - between shoulder (axilla) elbow joints (cubital fossa)
forearm - between elbow and wrist joints (flexor retinaculum)
hand is distal to the wrist joints
86
summarise the anterior compartment of the arm \*
Brachialis, biceps and coraco-brachialis
C5,6,7 segmental supply
Musculocutaneous nerve
Deep brachial artery
Flexes the elbow
Biceps is also a strong supinator of the forearm through its attachment to the radius bone
87
summarise the posterior compartment of the arm \*
triceps brachii
c6 7 8
radial nerve
extensor of elbow
profunda brachii artery
88
summarise the anterior compartment of the forearm \*
FCU PL FCR PT FDS FDP PQ FPL
median nerve mainly and some ulnar nerve
c6 7 8
flex wrist and pronation
ulnar and radial arteries
89
summarise the posterior compartment of the forearm \*
brachioradialis ECRL ECRB extensor digitorum, extensor digiti minimi, ECU anconeus, supinator, ABL, EPB, EPL, extenor indicis
radial nerve
c6 7 8
extensor of the wrist and digits
radial, posterior interosseous, anterior interosseous artery
90
describe the facia that separates the compartments in the arm & forearm \*
arm - anterior and posterior are separated by medial and lateral intermuscular septa which are continuous with the deep facia enclsoing the arm and attach to the sides of the humerus. brachial fascia encloses posterior adn anterior compartments of the arms
forearm - anterior and posterior compartments are separated by lateral intermuscular septum and the interosseous membrane
91
symptoms of an ischemic limb from compartment syndrome \*
pain more than expected
pallor of limb, patchy
limb is cool
pulses absent
passive extension is painful
