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Flashcards in Random Deck (99):
1

What is concentric, isometric and eccentric contraction?

Concentric contraction is the shortening of muscle to cause movement.

Isometric keeping a limb elevated in space, prevent moving.

Eccentric contraction is slowly lengthening.

2

What would use fast anterograde and retrograde transports?

What would use slow anterograde transport?

Fast: vesicles, endosomes mitochondria

Slow: cytoskeleton, proteins,

3

Describe the exocytosis of neurotransmitter.

When an action potential reaches the terminal, it opens calcium channels leading to calcium influx.

Neurotransmitter is in vesicles bound to the terminal web (actin filaments) through synapsin I.

Camodulin dependent protein kinase phosphorylates synapsin I which releases the vesicles and they move into the ACTIVE ZONE.

Then Vsnares (VAMP) and T snares are the fusion process but calcium is what stimulates fusion.

These are thought to be regulated by synaptotagmins.

4

Describe the 4 support cells in the CNS.

Ependymal cells = line ventricles of brain and spinal canal. Most of them are bound together by adhering junctions but in the choroid plexus they are tight junctions. (Choroid plexus is a vascularized, secretory structure that produces cerebrospinal fluid and the ependymal cells will regulate transfer of material and transfer of ions from blood stream. Protruding into the ventricle are cilia that move cerebrospinal throughout the body.

Microglia does not have a CNS origin and they clear dying cells from neural damage, eliminate inactive synapses, neurons, and useless glial, and lastly IMMUNE function by recruiting leukocytes past the blood brain barrier to interact with astrocytes.

Astrocytes: unique structures featuring GFAP (intermediate filament) that link capillaries to neurons.
1-they provide structural support
2-potassium sinks at nodes of ranvier and initial segment (sent to each other via gap junctions
3-segregate synapses, if inactive they move away and allow NT to diffuse, if active they tightly associate.
4-they can be signaled by NT (change their shape, their membrane permeability, their tropic factors)
5-blood brain barrier: although the tight junctions at endothelial cells is what is segregating blood and neurons, the astrocytes release factors to influence the tightness and passage of materials and regulate blood flow to brain.
6. Immune response, they also clean up neuronal debris.

Oligodendrocytes: form myelin sheath (INITIAL SEGMENT IS NOT MYELINATED). One oligodendrocyte wraps like 40-50 axons.
Major dense lines - cytoplasmic faces to one other
Intraperiod lines are the extracellular faces to one another linked by PLP.

Paranodal region: separation of myelin at the major dense lines exposing the cytoplasm allowing for communication with the axon from oligodendrocyte to axon.

5

What is the adhesion protein of intraperiod lines for schwann cell wrapping around on internode.

Po protein.

6

Describe the organization of a nerve in the PNS.

The nerve is wrapped by the epineurium.

Each nerve contains multiple fascicles, each wrapped by the perineurium.

Within the fascicle are a bunch of nerve fibers.

Each nerve fiber is wrapped by endoneurium, then BM, then Schwann cell then axon.

7

For X-rays what is radiopaque and radiolucent?

What is the order of material?

Besides material, what else effects X-rays?

What does a left lateral projection mean?

How does distance from film affect the xray?

Radiopaque refers to brighter items (white)...because it is absorbing all the light.

Radiolucent means the xray goes right through.

From radiopaque to most radiolucent,

Heavy metal, enamel, bone, water density (muscle, cartilage, tendon, blood, nerve, connective tissue), fat, air.

The thickness because the thicker an object is, the more radiopaque. Less light gets through to film.

left lateral projection means the left side is facing the film.

Distance: the farther away from the film, the more light refracts onto the film. So larger and blurrier (lower resolution).

8

What inserts to the radial tuberosity?

What are the origins of the biceps brachi and coracobrachiales?

What does brachiales attach to?

Where do each of the triceps originate and attach.

Where does the latissimus dorsi attach and what is its action?

The biceps brachi inserts into radial tuberosity.

Biceps long head originates in superglenoid tubercle.

Short head originates from the coracoid process.

Coracobrachiales originates from coracoid process.

Brachiales insert into the coronoid process of the ulna.

Triceps long head originates from infraglenoid tubercle and attaches to olecron process of the ulna (elbow)

Triceps lateral and medial head goes from posterior (above and then below radial groove) of humerus to olecron. All three triceps head share a common tendon to olecron.

Latissimus dorsi is interesting. Its huge, attaches to inferior scapula, spine, and iliac crest but it only inserts into the anterior arm. All actions are on arm. Extension, adduction, and internal/medial rotation of arm.

9

What are the walls of the axilla?

Lateral wall is the humerus with bicipital groove.

Medial wall is the serratus anterior (innervated by the thoracoacromial nerve)

Anterior is the pecs

Posterior is the lats, teres major, and subscapularis.

10

Where does the teres minor and major originate and attach.
And what are their movements and innervations?

Teres major originates lateral to the inferior angle and attaches to front part of the humerus (aligned with the lesser tubercle and just superior to the latissimus dorsi attachment)

Innervation: lower subscapular

Teres minor originates from lateral scapula and inserts into GREATER tubercle.

Important for external rotation and adduction of the arm.

Innervation: axillary.

11

What composes the anatomic snuffbox?

Hint: all originate form the posterior forearm.

Anterior wall: tendon of abductor policies longus
Tendon of extensor policis brevis
Tendon of extensor policis longus

Posterior wall: tendon of extensor policis longus.

Medial wall: scaphoid

*You can find the radial artery

(SANDWICH: extensor policis brevis is between extensor longus and abductor policis longus)

12

Where does the subscapular attach. What are its movements and innervations?

Subscapular attaches to the LESSER TUBERCLE. It is aligned with the attachments of the teres major and lats. This is why they all together form the posterior wall of the axilla.

Motion: internal rotation

Nerve: lower and upper subscapular nerves

Arteries: circumflex scapular artery, dorsal scapular artery, suprascapular artery

13

What does pec minor attach to, actions, innervations.

Pec minor originates from the coracoid process.

Nerve: medial pectoral nerve (C8-T1)

Artery: lateral thoracic artery

14

what do the dorsal scapular nerve and artery innervate?

Nerve and artery: rhomboids minor, major and levator scapulae.

Artery: also subscapular anastomosis.

15

what does autonomic neurons supply and what is its path?

Where do you find prevertebral ganglion.

How about parasympathetic efferents?

Autonomic supplies cardiac muscle, smooth muscle, and glands.

To reach a gland in the trunk, leaves lateral horn (T1-L2), leaves ventral root, enters spinal nerve, enters ventral rami, enters the white communicans, synapses on postganglion and then postganglion axon exits the grey communicans into the spinal and then ventral ramus.

Gland of cervix would be same (has to be T1) until you reach the paravertebral, your axon will shoot up, synapse on postganglion in the corresponding segment, then axon will exit gray and exit spinal nerve.

Parasympathetic: cranial and sacral preganglion, synapses really distal at the terminal ganglia of the wall of the organ they innervate.

16

What sensations are conveyed by somatic and visceral afferents.

Where are their cell bodies located?

How would visceral afferents travel? (Referred pain)

Somatic: pain, temperature, touch, propioception

Visceral: hunger, nausea, dissension

Locations:
Somatic: dorsal root ganglia from C2 to coccyx.

Visceral: dorsal root ganglia from T1 and L2

They'd come from the organ and travel down the paravertebral until they reach like T1 or T2, exit via the white communicans and then they synapse at the dorsal horn.

Referred pain: where the visceral afferent synapses, you can feel pain in the dermatome region of the corresponding somatic afferents which also synapse at that dorsal horn.

17

Which muscles are rotators of the arm?

Lateral rotation:

2. Infraspinatus (greater tubercle)
3. Teres minor (greater tubercle)

Medial rotation:

Teres major
Latissimus dorsi
1. Subscapular (lesser tubercle).

Deltoids do both rotation.

18

What are the 4 abductors of the shoulder?

Deltoid, upper and lower trapezius, supraspinatus, serratus anterior.

19

Describe the elbow joint.

Lateral epicondyle is smaller and features your extensors.

Medial epicondyle is larger and features your flexors.

The medial part is your trochlea (groove) which your coronoid process of the ulna fits into (ulna articulates best)

Capitulum is your ball.

Ulna has the olecranon which your triceps tendon) attaches to.

Radial tuberosity is the insertion site for the biceps brachi.

20

what is titin and what is nebulin

What is desmin?

Titin goes from Z line to M line and generates passive tension and prevents overstretching

Nebulin goes from Z band until the end of actin filaments. This is used to regulate thin filament length.

Desmin is an IF that wraps around the Z disk and connects neighboring myofibrils. So there is coordinated contraction of adjacent myofibrils.

21

What does the fibular nerve innervate?

The common fibular nerve: innervates the short head of the biceps femoris directly.

The other branches supplies lateral and anterior compartment of the leg. (Deep and superficial branches).

22

How does hyperkalemia reduce excitability of neurons and muscle cells?

Depolarization will inactivate voltage gated sodium channels

23

Which of the muscles are likely hurt by a nerve injury via a glenohumeral joint dislocation

It would be directed inferioy and affect the axillary nerve which innervates deltoid and teres minor

24

What functional deficit can occur from lesion of the lateral cord with reduced sensation of lateral forearm?

It means there is likely damage to the nerve fibers that become the musculocutaneous. So itll likely affect supination as the biceps are good supinators

25

Person has buldge in anterior arm and popping sound in upper arm when flexing. He has weak flexors and supination.

Avulsion fracture of supraglenoid tubercle which attaches to biceps long head

26

GTO

Only detects tension, not rate. So it may be for contraction but it can also detect passive stretch.

27

Describe the organization of skeletal muscle.

Filaments make up organized sarcomeres. Sarcomeres one after another form the myofilaments. Myofilaments surrounded by sarcoplasmic reticulum become myofibrils. Many myofibrils surrounded by a endomysium become the muscle fiber/cell.

Bundles of myofibers surrounded by the perimysium become a muscle fascicle. Epimysium surrounds many fascicles and this is the muscle

28

How is cardiac muscle different from skeletal muscle?

Skeletal muscle has peripheral nuclei
Cardiac muscle has one or two centrally located nuclei.

Skeletal: fascicles, has connective tissue
Cardiac: no organized connective tissue, so there is more disorganized CT between cells.

Skeletal: T tubule at A I bands line
Cardiac: T tubule at Z line

Cardiac has special purkinje fibers, spontaneous rhythmic contraction under involuntary control. (They have larger and paler cells)

Specific cell to cell boundaries: intercalated discs, belt desmosomes, spot desmosomes, gap junctions.

Various shapes.

29

How is smooth muscle unique?

indistinguishable cell borders, spindle shapes, almost no CT between cells

One centrally located nuclei

No striations

No t-tubules

Looks like dense connective much many more nuclei.

Surrounds a blood vessel.

They have invaginations called caveolae which has an accumulation of vesicles. Feature gap junctions.

30

What are the only three muscles innervated by the anterior interroseus.

What are the only two muscles innervated by the radial nerve?

What does the radial artery and ulnar artery become distally?

Anterior interosseus nerve: deep anterior forearm:
1. pronator quadratis,
2.medial half of digitorum profundus,
3. flexor pollicis longus

Radial nerve:
1. Brachioradialis
2. Extensor Carpi radialis longus.


Ulnar artery is the main supplier of blood to the hand. It forms the superficial palmar arch.
The radial artery becomes the deep palmar arch.

31

What does the circumflex scapular artery innervate?

The circumflex scapular innervates the teres major, minor and the infraspinatus.

It is a branch of the subscapular artery/

32

What is Erbs palsy and Klumpke's palsy?

Erb's is upper trunk injury due primary to forceful separation between shoulder and neck. Proximal limb structures are affected, intrinsic shoulder muscles, axillary wall muscles.
Limb is held in an extended, adducted, medially rotated, hand is probated (waiter sign) Sensory loss along lateral side of distal arm and proximal forearm (C5-C6) dermatome.

Klumpke's is a lower trunk injury. Caused by upward traction on the upper limb or compression of the thoracic outlet via a cervical rib. Affects the intrinsic muscles of the hand. Thenar, hypothenar and interossei are atrophied. Clawing of digits 2-5, loss of abduction and adduction of fingers and sensory loss along the medial side of forearm and proximal forearm. (C8-T1)

33

Describe a median nerve injury. How it happens, symptoms, variability.

Median injury can be caused by laceration to the wrist, injury to the cubita fossa (supracondylar fracture), inflammation in the carpel tunnel, hypertrophy of the pronator teres it runs under/through.

Symptoms:
Cutaneous sensory loss on lateral side of palm (ulnar is the medial side)

Injury at wrist level: flexion and abduction of thumb is still possible because of flexor pollicis longus (anterior interosseous) and abductor pollicis longus (posterior interosseous). Thenar atrophy, clawing of digits 2 and 3,

loss of opposition - this is the best test for median nerve injury proximal or distal because both would have this symptom.

More proximally: loss of flexor digitorum superficiales, flexor pollicis longus and brevis, radial half of flexor profundas, flexor carpi radiales. Inability to flex fingers 1-3 (Hand of benediction) and wrist flexion would tilt to the ulnar side.

34

What are the medical terms you should know for sensory and muscle weakness?

Paresis: partial weakness of muscle

Paresthesia: numbness and tingling

Hypoesthesia: reduced sensation.

35

Write your presentation for axillary and musculocutaneous nerve.

The musculocutaneous nerve is arises from the lateral cord and contains rami (C5-C7). It innervates the muscles of the anterior arm such as the biceps brachi, the coracobrachiales and the brachiales. A branch of the musculocutaneous is the lateral antebrachial cutaneous nerve and as the name implies, it serves the sensory information for the lateral forearm. Injury to this nerve is uncommon and the most likely cause is a penetrating wound. With weakness of the anterior arm muscles you will get weakness of shoulder flexion, elbow flexion and supination. The brachioradialis will still function as an elbow flexor since it is innervated by the radial nerve.

The axillary nerve arises from the posterior cord and it contains the rami C5-C6. It is found with the posterior humeral circumflex in the quadrangular space which boundaries are the long head of the triceps, teres major and minor, subscapularis and the humerus. It supplies the deltoid and teres minor. Injury to this nerve can occur by glenohumeral dislocation or fracture of the surgical neck of the humerus. Teres minor is a weak lateral rotator compared to other lateral rotators such as the deltoids, infraspinatus. The best test for a nerve injury to the axillary nerve would be abduction as that is the strongest movement for the delts. You would also get sensory of the skin overlying the deltoids. The long term effect would also be atrophy of the deltoids.

36

How would you test flexor digitorum superificiales versus flexor digitorum profundas?

Pull three fingers back. Since the profundas share a common tendon, they're effectively all stretched so if you flex it is only the superficial at work.

37

What composes the femoral triangle?

Lateral: medial border of sartorius (attachment is iliac spine, abduction and flexion of hip, medial rotation at knee, lateral rotation at hip)
Medial: adductor longus (attaches the femur)
Superior: inguinal ligament

The triangle contains the femoral vein, artery, nerve.

Females need a virtuous love. (Nerve is most lateral)

38

Describe the nerves of the thigh

The femoral is a posterior division but innervates the anterior compartment (hip flexors and knee extensors)

The Obturator is a anterior division and innervates the medial thigh. This is for hip adduction

The tibial nerve is an anterior division and innervates the posterior compartment of the thigh (hip extension, knee flexion).

39

What are the ANTERIOR muscles of the thigh and their attachments plus actions, and innervations

Hip flexion:

1. Iliopsoas attaches to lesser trochanter (L2, L3 + femoral)
2. Tensor fascia lata - iliac spine > iliotibial tract (superior gluteal nerve)
3. Sartorius attaches iliac spine>medial tibia (femoral)
4. Rectus femoris - femur > patella, femoral nerve

Knee extension

Vastus intermedius
Vastus lateralis
Vastus medialies

All three originate from the femur to attach to the patella.

40

Describe the medial thigh muscles

All obturator nerve innervated

Hip adduction:

1. Pectineus (pubis > femur)
2. Adductor longus, brevis, magnus (all pubis > femur) *adductor magnus
3. Gracilis (pubis > medial tibia)

Hip lateral rotation:

1. Obturator externus (external surface of obturator membrane > femur (more posterior for that sexy lateral rotation)

Knee flexion:

1. Gracilis

*Hip extension - innervated by the TIBIAL NERVE

1. Adductor magnus (hamstring part)
*Ischial tuberosity > femur

41

Describe the posterior thigh muscles (all tibular with one exception O.O)

Hip extension:

1. Semitendinosus: (ischial tuberosity > tibia)
2. Semimembranosus (ischial tuberosity > tibia)

3. Adductor magnus
4. Biceps femoris long head

Knee flexion:

1. Semitendinosus (ischial tuberosity > tibia)
2. Semimembranosus
3. Biceps femoris long head
4. *Biceps femoris short head (*common fibular nerve)

Medial rotation of tibia on fixed femur
1. Semimembranosus
2. Semitendinosus
3. Gracilis
4. *popliteus
5. Sartorius

Lateral rotation of tibia on femur
1. Biceps femoris

42

What are the four ligaments of the thigh?

The patellar ligament (Patella to tibial tuberosity)= anterior support and prevent hyperflexion

The oblique popliteal ligament (semimembranosus tendon to lateral joint capsule) = prevents hyperextension of knee

Medial tibial collateral = medial femoral epicondyle to the tibia and medial meniscus (counter valgus stress)

Lateral tibial collateral = lateral femoral epicondyle to the fibula (counters varus stress)

43

What does the superior gluteal innervate?

What does the inferior gluteal innervate?

What does the common fibular innervate?

Which ventral rami do knee extension

Which ventral rami do dorsi flexion?

Which autonomous sensory zone do you need to know?

Both super and inferior are posterior division.
Superior gluteal nerve:
1. gluteus minimus
2. gluteus medius
3. Tensor fascia lata
-hip abductors

Inferior gluteal nerve:
1. Gluteus maximus
-hip extensors

Common fibular:
1. *short head of biceps femoris
2. Deep branch: anterior leg
3. Superficial branch: lateral leg.

Knee extension: L3-L4

Dorsi flexion: L4-L5

Autonomous sensory zone between big toe and second toe: L5

44

Describe the path of the arteries throughout the lower limb

What are the components of the cruciate anastomosis

1. The abdominal splits in two, one for each leg. This is the common iliac artery

2. The common iliac artery splits in the internal iliac artery and the external iliac artery which becomes the femoral. These two are connected at the cruciate anastomosis.
Internal iliac: superior and inferior gluteal and obturator (gluteal region, medial thigh, and head of femur)

3. The deep femoral will branch off the femoral and supply the thigh. The medial femoral circumflex and the lateral femoral circumflex. The medial femoral circumflex is the main supplier of the hip and thigh (head of femur).
-this is why fracture of the femoral neck usually results in tearing the medial circumflex femoral artery. The head of the femur is not well vascularized so a fracture will likely result in avascular necrosis

Perforating arteries off the deep branch supply the posterior thigh

4. The femoral artery travels through the adductor hiatus and goes behind the knee to become the popliteal artery. The genicular artery branches off and supplies the knee.

5. Anterior tibial and posterior tibial branch of the popliteal and supply the anterior and posterior leg.

6. Fibular, medial plantar, and dorsal plantar all branch off the posterior tibial artery. Fibular artery supplies the posterior and lateral leg (so different from the anterior supplying fibular nerve)
Medial plantar supplies medial sole and lateral plantar supplies the lateral sole.
-the fibular artery travels to the lateral foot
-the lateral plantar arch is the main supplier of the foot as the ulnar arch is to the hand.

7. The dorsal pedis is a continuation of the anterior tibial artery and runs between the extensor hallucis longus and extensor digitorum longus

Cruciate anastomosis: medial and lateral circumflex femoral artery, perforating artery and inferior gluteal artery.

45

What are the muscles of the gluteal region

Hip abductors

1. Gluteus medius (ilium to greater trochanter)

2. Gluteus minimus (ilium to greater trochanter)

3. Tensor fascia lata

Medial rotators

1. Gluteus medius
2. Gluteus minimus
3. Tensor fascia lata
-same as hip abductors

Lateral rotators
1. Gluteus maximus
2. Obturator externus
3.. Piriformus (can compress the sciatic nerve)

4. Quadratus femoris (ischial tuberosity)

5. Obturator internis (obturator membrane to greater trochanter)

6. Gemelli
-superior gemelli (ischial spine to greater trochanter)
-inferior gemelli (ischial tuberosity to greater trochanter)

Extensors of thigh at hip
1. Gluteus maximus, hamstring.

46

What are the three ligaments that support the hip?

Iliofemoral ligament
Ischiofemoral ligament
Pubofemoral ligament

And weak ass round ligament of femur

Iliofemoral is the strongest

All of them prevent hyperextension.

47

Describe pelvic tilt

When one leg is unsupported, your center of gravity shifts toward that unsupported limb and so your pelvic is being tilted toward the unsupported limb.

Well then you can imagine its the hip abductors that keep the pelvis leveled

Weakness of the abductors results in Tredenlenberg gait.

48

What is the pattern for leg dermatomes?

Basically wraps downward while going laterally. L5 is lateral leg, L4 is practically all anterior leg. S1 is ankle, Then the S's go in concentric circles to the anus. Wow zeros.

49

What goes through the greater and lesser sciatic foramens?

Greater sciatic foramen: piriformis, superior and inferior gluteal nerves, sciatic nerve, pudendal nerve.

Inferior sciatic foramen: pudendal nerves leave via the greater sciatic but enter the inferior sciatic foramen.

50

What are the anterior muscles of the leg? They are the dorsiflexors and foot inversions.

Dorsi flexion:

1. Tibialis anterior
2. Extensor hallucinating longus
3. Extensor digitorum longus
4. Peroneus tertius

All supplied by deep fibular nerve

Foot inversion
1. Tibialis anterior

Digit extension
1. Extensor hallucinating longus
2. Extensor digitorum longus.

51

What are the lateral leg muscles

All innervated by superficial fibular nerve

All do foot eversion

1. Peroneus longus
2. Peroneus brevis

52

Posterior legs are the foot flexors and knee flexors. What are they? There are two layers.

Everything are tibial nerve yo

Superficial - all attach to the calcaneus

Knee flexion:
1. Gastrocnemius (attaches to lateral head, lateral FEMORAL condyle and medial head + medial femoral condyle)
2. Plantaris (lateral femur above condyle)

Foot Plantar flexion
1. Gastrocnemius
2. Plantaris
3. Soleus (head of fibula)

Deep

unlocking
1. Popliteus - (lateral femoral condyle to tibia) -anterior sliding

Digit flexion
1. Flexor hallucinating longus
2. Flexor digitorum longus

Foot plantar flexion:
1. Tibialis posterior
2. Flexor hallucinating longus (fibula)
3. Flexor digitorum longus (fibula and tibia)

Foot inversion
1. Tibialis posterior (interosseous membrane, tibia, fibula > distal tarsal bones, metatarsals)

53

Describe the ligaments of the ankle and maybe the ones you fucked up lol

*Medial collateral (deltoid) - resists eversion
1. Tibia to the talus
2. Tibia to calcaneus
3. tibia to navicular
4. Talus to calcaneus

Lateral collateral - resists inversion
1. * the Anterior talor fibular ligament - Fibula to talus
-usually torn in ankle sprain (one you torn)

Plantar calcaneonavicular (SPRING)
-goes from the sustentaculum tali to the navicular bone.
-everytime you take a step, the head of the talus wants to fall out and this is preventing that.

Plantar fascia: (improves friction with any surface we step on). calcaneus, cuboid and lateral 3 metatarsals
-provides support to lateral arch of foot.

54

What does the radial nerve and its branches innervate?

All superficial muscles originate from the lateral epicondyle.

Extensor pollicis brevis is a sandwich between american and eat

Radial nerve:
1. Brachioradialis
2. Extensor carpi radialis longus

Deep radial nerve
1. Supinator
2. Extensor carpi radialis brevis muscles

Posterior interosseous nerve
1. Extensor indices
2. Extensor digitorum
3. Extensor pollices longus and brevis
4. Extensor digitorum minimi
5. Extensor carpi ulnaris
6. Abductor pollicis longus

55

Where does the median nerve pass by?

Lateral to palmaris longus.

So between palmaris longus and flexor carpi radials.

56

Which muscles are important for depression of the scapula?

Which muscles are important for upward and downward rotation of the scapula?

Depression:
Pec minor, inferior trapezius

Upward rotation:
Serratus anterior
Upper and lower trapezius fibers

Downward rotation:
Levator scapulae
Rhomboids
All dorsal scapular artery and nerve. Mucho importance.

57

Which muscles are primarily responsible for adduction?

Medial rotation?

Adduction: pec major, lats, teres major.

Medial rotation: pec major, lats, teres major, anterior deltoid, subscapularis

Lateral rotation: teres minor, infraspinatus, posterior deltoid.

58

How does the subclavian anastomose with the axillary?

Suprascapular and dorsal scapular attach to the circumflex scapular on the posterior scapula.

59

What venous vasculature occurs at the cubita fossa?

The lateral (cephalon vein) connects to the medial basilic vein at the median cubital vein.

60

What are the dorsum and plantar nerves?

The deep fibular nerve runs in the anterior leg

61

What is the order of members in the posterior to the medial malleolus that run anterior to posterior.

Tom Dick and Very Nervous Harry

Tibialis posterior

Flexor digitorum

Artery

Tibial Nerve

Flexor hallucis longus

62

On the medial side of the cubita fossa what are the three members and their relative positions? '

Where is the median nerve and brachial artery running?

TAN

Biceps Tendon (most lateral)

Brachial Artery (middle)

Median Nerve (most medial)

Median nerve is running deep to the FLEXOR DIGITORUM SUPERFICIALES

The brachial artery is running in between the brachioradialis and thhe pronator teres

63

How does the radial nerve and deep brachial artery run relative to each other in the triangular interval

How does posterior humeral circumflex and axillary artery run in the quadrangular space.

Both nerves will run superior to their arteries.

64

How does the suprascapular artery and suprascapular nerve run relative to one another?

The suprascapular ARTERY runs OVER the superior transverse scapular ligament.

The suprascapular NERVE runs UNDER the superior transverse scapular ligament.

65

How do the radial nerve, artery and ulnar artery/nerve run in the forearm?

What about the tendons of the flexor carpi ulnaris and flexor carpi radialis.

Radial nerve in the forearm is the superficial branch.

The deep branch becomes the posterior interosseus nerve which does a lot.

The nerves run outer most.

So superficial branch of radial nerve/ radial artery/ulnar artery/ ulnar nerve

The ulnar nerve becomes the deep ulnar nerve in the hand

The tendon of the flexor carpi radialis is medial to the radial artery.

The tendon of the flexor carpi ulnaris is medial to the ulnar artery.

Flexor carpi ulnaris tendon > ulnar nerve > ulnar artery > flexor carpi radialis tendon > radial artery > radial nerve.

66

Where is the posterior interosseous nerve and artery running relative to each other in the posterior forearm?

The posterior interosseous nerve the termination of the deep radial nerve and is coming out from the SUPINATOR.

The posterior interosseous artery is SUPERFICIAL to the nerve

67

What is the anatomic snuffbox?

Anteriorly - you have the tendons of the abductor pollicis longus, extensor pollicis brevis

Posteriorly - you have the tendon of the extensor pollicis longus

The floor is the scaphoid

The radial artery is traveling under the extensor retinaculum to the dorsal side of the wrist.

68

Where is the tibial nerve running in the posterior thigh?

Where is it relative to the popliteal artery and vein?

It is running deep to the biceps femoral long head

it is between the biceps femoris short head and the semimembranosus.

The popliteal artery is the most medial, then vein, then nerve.

Its still the same as it was up in the femoral triangle.

69

What is the complete order of tendons and vasculature from extensor digitorum longus to the achilles tendon at the medial side

Dorsum (extensor digitorum longus)

1. Extensor hallucis longus
2. Tendon of the tibialis anterior
3. Tendon of the tibialis posterior
4. Tendon of the flexor digitorum longus
5. Posterior tibial artery (which then branches into the medial and lateral plantar arteries)
6. Tibial nerve
7. Flexor hallucis longus.

70

What occurs in compartment syndrome?

Because the crural fascia is so tight and inelastic and the vasculature is right against the interosseous membrane, for any muscle swelling or hypertrophy, you will compress the vasculature.

In the anterior leg it would be the deep fibular and the anterior tibial artery.

This could result in acute venous thromboembolism because it causes blood clots.

The treatment is a fasciotomy to relieve the pressure and allow fluid to be released.

71

What are the three joints of the ankle?

Talocrural (wedge)

-talus and the groove created by the lateral and medial malleolus
-only allows two movements, dorsiflexion and plantar flexion.

Subtalar
-talus and calcaneous
-it's a hinge joint allowing for inversion/eversion at the ankle

Transverse Tarsal (2 joints)
-between the calcaneous and the cuboid + navicular bones.
-allows for inversion and eversion in the midfoot.

72

What is a supinator and pronator of walking?

Place your hand flat on the table to mimic a foot. What is easier? Further pronation or supination?
Same goes for the foot. Supination is easier.


Pronator- foot is dorsiflexed, abducted, and everted

Inner edge is worn out.

Supination - foot is plantar flexed, adducted and inversion.

Outer heal contacts floor

73

What is the innervation of the foot?

Dorsum

Motor: deep fibular (Extensor digitorum longus)

Sensory: superficial fibular (L5)
**Deep fibular (the webbing of the big toe)

Plantar

Motor: Tibial (flexor digitorum longus and plantar flexion)

Sensory: Tibial nerve becoming the medial and lateral plantar nerves (medial plantar runs medial)

So they run with the plantar arteries as well.

One way to think of it is that the posterior tibial artery is giving off the fibular artery to supply the posterior deep and superficial compartment of the leg along with the lateral leg as is what the superficial fibular nerve also innervates. Superficial fibular and fibular artery run together likely and then the deep fibular and anterior tibial artery run together. And then continuing to become the arches.

74

Which comes first, motor or sensory loss?

Sensory loss (hypoesthesia) will PRECEDE motor loss (paresis)

If brought to the ED quick enough after injury, you will see this. So sensory loss will tell us the expected motor loss.

75

What is the cutaneous sensation of the hand?

3.5 fingers (palmar and dorsum-*except the dorsum of the thumb) traced to the wrist through the palm is all median nerve.

1.5 fingers (palmar and dorsum) to wrist is ulnar which also wraps around to include the ulnar portion of the dorsum of hand

Radial nerve - picks up what the median doesn't, the median half of the dorsum of the hand, and the dorsum of the thumb.

76

What runs together?

1. Saphenous nerve (continuation of the femoral nerve) and great saphenous vein.
2. Obturator nerve and obturator artery (branch of internal iliac)
3. Deep fibular nerve runs with anterior tibial artery
4. Superficial fibular nerve runs with fibular artery (branch of posterior tibial artery)
5. Medial plantar and lateral plantar nerves (branches of tibial nerve) run respectively with the medial and lateral plantar arteries (branches of the posterior tibial artery)
6. Posterior to the medial malleolus - posterior tibial artery runs with tibial nerve.
7. Suprascapular artery runs above the suprascapular nerve separated by the superior transverse ligament
8. The spinal accessory nerve and the transverse cervical artery run together to supply the trapezius
9. The lateral thoracic artery runs with the long thoracic nerve to supply the serratus anterior and pecs.
10. The dorsal scapular nerve and dorsal scapular artery run together to supply the levator scapulae and rhomboids
11. The axillary nerve runs superior with the posterior humeral circumflex to supply the deltoids
12. The radial nerve runs with the deep brachial artery in the triceps hiatus
13. The radial and ulnar nerves run outside the radial and ulnar arteries in the forearm
14. The median nerve runs media to the brachial artery in the cubital fossa
15. Superior and inferior gluteal nerve and arteries run together (branch of internal iliac)
16. Tibial and common fibular nerves run together in the sciatic nerve. (They split at the popliteal)

77

What attaches to the greater trochanter and what is the only thing that attaches to the lesser trochanter and what does it do?

Greater are all the Hip abductors and rotators (lateral and medial)

Lesser is only the iliopsoas (hip flexor)

The adductors will attach to some intertrochanteric line which is what?.. i dunno.

78

Which muscles are responsible for the following actions

Hip flexion

Hip extension

Knee flexion

Knee extension

Hip adduction

Hip abduction

Medial rotators

Lateral rotators

Hip flexion:
Rectus femoris, gluteus minimi and medius, tensor fascia lata, illiopsoas
Minor-pectineus, sartorius adductors

Hip extension: gluteus maximus, semitendinosus, semimembranosus, biceps femoris (long head only), adductor magnus (has some tibial running through it)

Knee flexion - biceps femoris short head, biceps femoris long head, semitendinosus, semimembranosus, gracilis (medial side of the thigh)
Hamstring = semitendinosus, semimembranosus, biceps femori,

Knee extension- vastus muscles (thats it)

Hip abductors - gluteus medius, minimi, tensor fascia lata
Minor: sartorius, PIRIFORMIS, obturator externus

Hip adductors - adductor longus, brevis, magnus,
Minor: PECTINEUS, gracilis

Medial rotation: gluteus minimus, medius, tensor fascia lata (THATS IT)

Lateral rotation: obturator internus (so externus is abduction and lateral rotation), obturator externus, gemelli, QUADS

79

What is the only thing the common fibular innervates?

The biceps femoris short head.

80

what is the order of muscles in the femoral triangle from lateral to medial?

1. Iliopsoas (hip flexor)
2. Pectinius
3. Adductor longus
4. Gracilis

Deep the those are the brevis
And even deeper is the magnus which extends almost all the way to the fibula.

81

What is the order of the muscles in the deep layer from the iliac crest going inferior

1. Gluteus minimus
2. Piriformis
3. Sciatic nerve
4. Gemellus superior
5. Tendon of obturator internus
6. Gemellus inferior
7. Quadratus femorus
8. Adductor magnus

82

What articulates on the tibial tuberosity?

The patellar ligament.

83

What is the layout of the bones?

From tip of the toes to the heel

5 pairs of phalanges

5 Metatarsals

3 Cuneiforms (only first three toes)

Other two get a cuboid bone

3 Cuneiforms attach to a navicular bone

Tarsus attaches to navicular bone
Calcaneous attaches to the cuboid bone.

The tarsus rests on the sustentaculum tali

84

Which muscles are responsible for dorsiflexion?

Tibialis anterior and extensor digitorum longus.

85

When you are standing still what is gravity trying to do at the joints and what is the resistance

Add in swaying

Hip - the gravity vector is behind so hyperextension of the hip
-this is resisted by the iliofemoral and ischiofemoral and pubofemoral ligaments. If you swayed posteriorly, you would get the additional help of the illiopsoas and rectus femoris
-anterior sway, pelvis wants to roll on femur and cause flexion. That would be resisted by the hamstrings and the gluteus maximus which is recruited with a lot of force.

Knee - the gravity vector is in front of the knee (only standing) so it wants hyperextension of the knee. This is resisted by the posterior joint capsule and the oblique popliteal ligament. If you sway even more anteriorly, then the knee flexors (semitendinosus, semimembranosus, biceps femoris will kick in)
-posterior sway - would want to cause the femur to roll on the tibia and cause knee flexion, knee extensors, the quads would resist

Ankle. - gravity vector is in front so you want dorsi flexion. (This is resisted by the gastrocnemius and soleus.)
-posterior sway - would want plantar flexion resisted by the extensor digitorum longus and the tibialis anterior

86

Generally describe the stance and swing phases of the gait cycle

Heel strike - heel contacts the ground

Flat foot - plantar flexion to flatten foot

Midstance - the leg is directly under the torso

Heel off - heel comes off

Toe off - toe comes off and this starts the swing cycle.

Swing

Acceleration - once it is off, your trunk is anterior to the leg so your leg needs to accelerate to catch up

Mid swing - the leg swings directly under the trunk

Deceleration - you need to slow down for heel strike.

87

What happens at heel strike?

Hip joint: center of gravity is in front of the hip joint so you want flexion of the hip

Knee joint: center of gravity is behind the knee joint so you want flexion of the knee

Ankle joint: center of gravity is behind the ankle joint (because of heel strike) so you want plantar flexion.

Hip: resisted by hamstrings + gluteus maximus

Knee joint: resisted by quadriceps.

Ankle joint: resisted by tibialis anterior.

What would you see in patients that have each of these injured?

Inferior gluteal nerve injury: they would tilt forward so they would throw shoulders backwards everytime they step with the side of the weak gluteus maximus

Femoral nerve injury: they would tilt forward to prevent flexion at the knee. However you tilt forward just at the hip already so thats out of the picture. Instead bring the axis of rotation at the knee closer to you. Use the force of gravity and pushing at the thigh since quads are knee extensors.

Segmental nerve injury (weakened tibialis): they would not have controlled dorsiflexion so they would foot slap

88

What happens at midstance

One foot is planted directly below the trunk and the other is in the air.

Planted foot has no movement at hip, wants flexion at knee (typical) and wants dorsiflexion at ankle (typical)

Quads + gastrosoleus

The thing to take into account is the weak abductors. Pelvis will tilt to unsupported side but without abductors you will have the tilt.

Remedy of patient is to tilt shoulder toward the supported side so that gravity is acting as an abductor.

89

What happens during mid swing?

Hip is no movement, the foot is passing directly under you. Behind the knee so knee flexion.

Infront of the ankle so dorsiflexion.

So still quads and gastrosoleus

The interesting thing about this is that during swing, your ankle is always dorsiflexed (tibialis anterior and extensor digitorum longus). If you can't you would go toe first or because your leg is longer with toe out, you will hit the ground mid swing.

They have a steppage gait because they elevate their foot to step so that they don't hit their toe during treading.

90

What would happen to gait with a common fibular injury near the fibula head?

You would injure your superficial and deep branches. You would not only get a paralysis of the tibialis anterior and therefore get steppage gait, you would also affect you ability to evert (fibularis longus and brevis). These are lateral leg muscles and innervated by the superficial branch. You lack tibialis anterior, an inverter but you still have tibialis posterior, (innervated by the posterior tibial nerve). Their gait would also have their foot slightly inverted and that would be supinator walk.

91

What does supination and pronation mean for the foot?

Supination is inversion

Pronation is eversion.

92

What attaches to the tibial tuberosity?

The patellar ligament which attaches to the quadriceps tendon proximally.

93

What is intermittent claudication

What may erectile dysfunction be a result of?

It is a result of occlusive disease due to increased demand of blood flow during an activity.

Pain will be felt distal to the occlusion.

Aortoiliac occlusion will have pain in the buttocks and thigh.

Femoral occlusion will have pain in the calf

Occlusive disease in the popliteal artery, tibial, or fibular arteries will result in pain in foot.

Aortoiliac occlusion may lead to erectile dysfunction because external and internal pudendal arteries come from the iliac artery or common femoral artery. They both supply the scrotum and penis so yeah.

94

What are the muscles of the anterior forearm?

From radial to ulnar
Superficial: pronator teres > flexor carpi radialis > palmaris longus > flexor carpi ulnaris (ulnar nerve)
Intermediate: flexor digitorum superficiales
Deep: pronator quadratus, flexor pollicis longus (carpel tunnel), flexor digitorum profundas

95

What muscles are in the Posterior forearm?

Radius to ulnar

Brachioradialis > extensor carpi longus > extensor carpi brevis > extensor digitorum > extensor digiti minimi > extensor carpi ulnaris

Deep
Supinator (where the posterior interosseous emerges from)> Abductor pollicis longus > extensor pollicis brevis > extensor pollicis longus > extensor indices.

96

where does the anterior tibial artery run between?

It runs between the muscles of the extensor digitorum (LATERAL) and extensor hallucis longus (MEDIAL)

97

As a sesamoid bone, the pisiform is part of which tendon?

Tendon of the flexor carpi ulnaris muscle

98

What passes through the greater sciatic foramen?

What passes through the lesser

Greater sciatic foramen:
Piriformis muscle and the superior and inferior gluteal vessels.

Above the piriformis - superior gluteal nerve

Below the piriformis - inferior gluteal nerve
Pudendal nerve
Sciatic nerve.

Lesser sciatic foramen:

Internal pudendal vessels, pudendal nerve, obturator internus tendon and its nerve.

99

What is the order of vasculature in the popliteal fossa?

Medial

Popliteal artery- popliteal vein - tibial nerve (lateral)