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Antatomy Exam 3 > Slaby/Rosenstein > Flashcards

Flashcards in Slaby/Rosenstein Deck (91):
1

Review which gluteal muscle is the only gluteal muscle that can extend the thigh at the hip joint.
 

Gluteus maximus – only gluteal muscle that can extend thigh at hip joint

innervation: inferior gluteal nerve

2

Review which gluteal muscles are the chief abductors of the thigh at the hip joint.

Gluteus medius + minimus – chief abductors

innervation: superior gluteal nerve

3

Review the nature of the Trendelenburg sign when examining the strength of a patient’s gluteal
muscles. Review which gluteal muscles are weak or paralyzed when a patient exhibits
a Trendelenburg sign.

Trendelenburg sign = sagging of the pelvis on the side opposite to stance leg – indicates
paresis of the gluteus medius and/or minimus on the contralateral side

__________

Let’s consider now what happens if gluteus medius and minimus on the right side cannot adequately exert their lateral pelvic tilting action.  As the left foot is raised off the ground, the left side of the pelvis drops because of the inadequacy of gluteus medius and minimus on the right side. 

 

Individuals who suffer from weakness or paralysis of gluteus medius and minimus compensate for the loss of the lateral pelvic tilting action of these muscles by adopting an abnormal gait called the gluteus medius gait.  Let’s consider this gait in a person whose gluteus medius and minimus muscles are weak in the right lower limb.  When this person walks, he/she pushes off with the left foot (as the left lower limb passes through the PSW phase) to lean the upper body toward the right and temporarily balance it over the right lower limb as the right lower limb passes through the LR, MST, and TST phases.

4

sagging of the pelvis on the side opposite to stance leg

Trendelenburg sign =indicates
paresis of the gluteus medius and/or minimus on the contralateral side

5

Review the area of a patient’s buttock that is safest for an intramuscular injection.

What is the process the physician should take to identify this area?

Upper lateral quadrant

Why? The sciatic nerve is the single most important gluteal structure at risk of injury by an intramuscular injection in the buttock.  Because the sciatic nerve passes through the lower medial quadrant of the buttock

____

To identify the safest area in the patient’s right buttock, the physician spreads apart the thumb and fingers of his/her left hand and then rests the palm of the left hand on the patient’s right buttock in such a fashion that the tip of the index finger overlies the anterior superior iliac spine and tip of the middle finger overlies the iliac tubercle.  The triangular, gluteal skin area between the physician’s index and middle fingers is the gluteal area safest for intramuscular injections.

6

List the spinal nerve or nerves that control (a) flexion of the thigh at the hip joint

a) L1, L2

Iliapsoas

7

List the spinal nerve or nerves that control (b) extension of the leg at the knee joint

b) L3, L4 (some L2)

Quadriceps femoris

 

8

List the spinal nerve or nerves that control (c) plantarflexion of the foot at the ankle joint

c) S1, S2

 

9

List the spinal nerve or nerves that control (d) extension of the big toe.

d) L5

 

10

Review which spinal nerves contribute nerve fibers to (a) the sciatic nerve

a) Sciatic - L4, L5, S1, S2, S3

11

Review which spinal nerves contribute nerve fibers to (b) the femoral nerve

b) Femoral - L2, L3, L4

12

Review which spinal nerves contribute nerve fibers to (c) the obturator nerve

c) Obturator - L2, L3, L4

13

6. Review the conditions under which the leg can be internally or externally rotated at the knee joint.

After 30° of flexion from the anatomical position

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#1

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Medial malleolus

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#2

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Tibial Plafond

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#3

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Lateral malleolus

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#4

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Talus

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#1

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Tibia

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#2

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Navicular

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#3

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Talus

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21

#4

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Calcaneus

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22

#5

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Cuboid

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23

Review the leg muscles that are (a) the chief dorsiflexors of the foot

Anterior leg muscles (ALM)

  1. tibialis anterior (strongest)
  2. extensor digitorum longus
  3. extensor hallucis longus and
  4. fibularis tertius.
  • Collectively, they act to dorsiflex and invert the foot at the ankle joint.
  • Innervated by sciatic nerve: Common fibular nerve: deep fibular nerve (L4-L5)
  • Blood supply: anterior tibial artery

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24

Review the leg muscles that are (b) the chief plantarflexors of the foot

Superior posterior leg muscles (SPLM)

  1. Gastrocnemius (most superficial, 2 heads)
  2. Soleus (deep to the gastrocnemius)
  3. Plantaris
  • Innervated by the Sciatic nerve: tibial nerve
  • The calcaneal reflex tests spinal roots S1-S2.
  • Blood supply: posterior tibial
  • To minimise friction during movement, there are two bursae (fluid filled sacs) associated with the calcaneal tendon:

    Subcutaneous calcaneal bursa – lies between the skin and the calcaneal tendon.

    Deep bursa of the calcaneal tendon – lies between the tendon and the calcaneus

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25

Review the leg muscles that are (c) the chief supinators of the foot

Anterior Leg Muscle: Tibialis anterior

  • Innervated by sciatic nerve: Common fibular nerve: deep fibular nerve (L4-L5)
  • Blood supply: anterior tibial artery

26

Review the leg muscles that are (d) the chief pronators of the foot.

Lateral leg muscles (LLM)

  1. Fibularis longus
  2. Fibularis brevis
  • Innervated by Sciatic nerve: common fibular nerve: superficial fibular nerve
  • Blood supply: anterior tibial

27

Review the ligamentous and meniscus injuries that can occur in the Unhappy Triad of the knee
joint.

common mechanisms by which the knee joint is injured in contact sports.  It is relatively common in contact sports such as football, rugby, and lacrosse for a player to be hit on the lateral aspect of the knee by the body of a second player.  The momentum of the second player’s body imposes a powerful, medially-directed force across the first player’s knee.  If the first player’s foot is firmly planted on the ground below, the medially-directed force acts to abduct the leg at the knee; in other words, the medially-directed force attempts to swing the leg laterally, or outward, at the knee.  A medially-directed force which acts to abduct the leg at the knee is called a valgus force.

net result of a severe valgus force at the knee is thus a triad of injuries:

  1. a completely torn MCL,
  2. a ruptured ACL, and
  3. a torn meniscus.

28

Review the spinal cord segments at which reflex activity occurs during (a) the quadriceps femoris tendon reflex

a) L2, L3, L4

29

Review the spinal cord segments at which reflex activity occurs during (b) the Achilles tendon reflex test

b) S1, S2

30

Review how the location of muscle pain in a patient with intermittent claudication helps localize
the location of atherosclerotic plaques in lower limb arteries.

  1. Occlusions of the external iliac artery diminish blood supply to almost all the lower limb’s muscles, and thus produce exertion-dependent pain extending distally from the buttock.
  2. Occlusions in the femoral artery immediately proximal to the origin of the deep artery of the thigh diminish blood supply to thigh and leg muscles, and thus produce exertion-dependent pain extending distally from the thigh.
  3. Occlusions in the femoral artery distal to the origin of the deep artery of the thigh or occlusions in the popliteal artery diminish blood supply to leg muscles, and produce exertion-dependent pain in the leg muscles. 
  4. Progressive obstruction in the anterior tibial artery or the posterior tibial artery does not diminish blood supply to leg muscles, and thus does not produce intermittent claudication

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31

  • ____________ is a condition in which medium or larger arteries of the limbs become occluded by plaques. 
  • The most common initial symptom of the disease in a lower limb is muscular pain or fatigue that occurs with exercise but abates with rest; such a symptom is called ________________.

  • peripheral atherosclerotic occlusive disease (PAD)
  • intermittent claudication

32

Review how the location of muscle pain in a patient with intermittent claudication helps localize
the location of atherosclerotic plaques in lower limb arteries.

Which artery?

  • produce exertion-dependent pain extending distally from the buttock.

Occlusions of the

  • external iliac artery

diminish blood supply to almost all the lower limb’s muscles

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33

Review how the location of muscle pain in a patient with intermittent claudication helps localize
the location of atherosclerotic plaques in lower limb arteries.

Which artery?

  • produce exertion-dependent pain extending distally from the thigh.

Occlusions in the

  • femoral artery immediately PROXIMAL to the origin of the deep artery of the thigh

diminish blood supply to thigh and leg muscles

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34

Review how the location of muscle pain in a patient with intermittent claudication helps localize
the location of atherosclerotic plaques in lower limb arteries.

Which artery?

  • produce exertion-dependent pain in the leg (calf) muscles

Occlusions in the

  • femoral artery distal to the origin of the deep artery of the thigh or
  • occlusions in the popliteal artery

diminish blood supply to leg muscles

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35

Review how the location of muscle pain in a patient with intermittent claudication helps localize
the location of atherosclerotic plaques in lower limb arteries.

Which artery?

  • does not produce intermittent claudication

Progressive obstruction in the

  • anterior tibial artery or
  • the posterior tibial artery

does not diminish blood supply to leg muscles, and thus does not produce intermittent claudication

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36

The onset and progression of PAD in the lower limbs can be assessed by ____________

  • measuring the ankle-brachial index, or ABI (the anatomical term brachial refers to the arm). 

_________

  • The ABI is calculated by simultaneously measuring the blood pressure in a patient’s arm and ankle as the patient lies supine on an examination table. 
  • When a patient lies supine, the patient’s heart, arm, and ankle all lie at the same level, and thus the blood pressure in the arm and at the ankle should be roughly the same and representative of the pressure of the blood at it is ejected from the heart. 
  • The ABI is calculated by dividing the blood pressure recorded at the ankle by the blood pressure recorded in the arm. 
  • An ABI of 1.0-1.4 is considered to be normal.  An ABI of 0.9 to 1.0 is acceptable.  Whereas an ABI of 0.5 to 0.8 indicates moderate PAD, an ABI less than 0.5 indicates severe PAD.

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37

Review where arterial pulses can be palpated around the ankle joint.

  • dorsalis pedis: anterior to the ankle joint immediately lateral to the insertion tendon of extensor hallucis longus
  • posterior tibial: posteroinferiorly to the medial malleolus (the pulsations are most easily palpated if the foot is both dorsiflexed and inverted).

38

Review the structure of the knee joint.

REFER TO KNEE JOINT NOTES

39

What are common shoulder injuries?

  1. Broken clavicle,
  2. separated shoulder,
  3. dislocated shoulder,
  4. injuries to the rotator cuff,
  5. winged scapular,
  6. wrist drop

40

What is the difference between a shoulder separation vs dislocation?

  • Dislocated shoulder – the humerus is displaced inferiorly out of its socket
  • Separated shoulder – injury to the acromioclavicular joint

41

the humerus is displaced inferiorly out of its socket

 

Dislocated shoulder –

42

injury to the acromioclavicular joint

Separated shoulder –

43

Explain wing scapula.

Caused by damage to the long thoracic nerve, which in turn causes weakening of the serratus anterior and prevents the muscle from holding the scapula in place

44

What are the muscles of the rotator cuff?

  1. Supraspinatus,
  2. infraspinatus,
  3. teres minor,
  4. subscapularis

45

Why is the supraspinatus muscle important?

  • Initial abduction of arm;
  • it is the most commonly torn rotator cuff muscle

46

Explain Herb’s palsy (waiter’s tip palsy).

  • Herb’s palsy = injury to C5, C6
  • Occurs when a person falls off their motorocycle or off a roof & injure their shoulder at the space where the head meets the neck (where C5 and C6 meet)

47

What are the major nerves that come out of the brachioplexus?

  1. Musculotaneous,
  2. axillary,
  3. radial,
  4. median,
  5. ulnar

48

Where do the nerves of the brachioplexus contact the humerus?

C5, C6, C7, C8, T1

49

Know what goes through the carpal tunnel and forms the carpal tunnel.

  1. Median nerve,
  2. 9 tendons from 3 forearm muscles
  3. Formed from the flexor retinaculum and carpal bones

50

What is carpal tunnel syndrome?

Set of symptoms that can have different pathologies, but present as:

  1. (initial sensory) Pain + tingling + sensory deficits in palmar surfaces of thumb, index, middle finger
  2. (subsequent motor) Flattening of thenar eminence, thumb is unable to oppose

Severe: If you sever the median nerve at the wrist, fingers can still flex, but thumb will not be able to oppose, thenar eminence is flattened, and person will be unable to pick something up using their thumb
- Presents as a severe case of carpal tunnel

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51

Explain wrist drop

  • Nerve injury
  • Clinical presentation
  • Impaired function
  • Causes

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52

Explain claw hand

  • Nerve injury
  • Clinical presentation
  • Impaired function
  • Causes

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53

Explain ape hand

  • Nerve injury
  • Clinical presentation
  • Impaired function
  • Causes

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54

Explain Saturday night palsy

Compression to the radial nerve, caused by falling asleep with one’s arm over the back of a
chair

55

What 3 major nerves innervate the thumb and which muscles do they innervate?

  1. Median,
  2. ulnar, and
  3. radial nerves

______________________

  • - Sever median nerve – Ape hand--inability to abduct, flex, or rotate thumb
  • - Sever ulnar nerve –Claw hand-- inability to adduct thumb
  • - Sever radial nerve –Wrist drop (Saturday night palsy)- inability to abduct or extend thumb

_______________

Median nerve

  1. (deep anterior forearm muscle) Flexor pollicis longus=thumb IP flexion=Median nerve
  2. (intrinsic hand muscle-thenar eminance) abductor pollicis brevis=abducts thumb=median nerve
  3. (intrinsic hand muscle-thenar eminance) opponens pollicis=opposition=median nerve

Deep radial nerve

  1. (deep posterior forearm muscle) Abductor pollicis longus=thumb abduction=deep radial nerve
  2. (deep posterior forearm muscle)  Extensor pollicis bravis=thumb extension=deep radial nerve
  3. (deep posterior forearm muscle)  extensor pollicis longus=thumb IP extension=deep radial nerve

Deep Ulnar Nerve

  1. (intrinsic hand muscle-thenar eminance)  adductor pollicis=only muscle to adduct thumb=deep ulnar

 

Note: thumb muscles have pollicis in their name

56

Thumb innervation: inability to abduct, flex, or rotate thumb

Sever median nerve

Ape hand

Median nerve

  1. (deep anterior forearm muscle) Flexor pollicis longus=thumb IP flexion=Median nerve
  2. (intrinsic hand muscle-thenar eminance) abductor pollicis brevis=abducts thumb=median nerve
  3. (intrinsic hand muscle-thenar eminance) opponens pollicis=opposition=median nerve

 

57

Thumb innervation: inability to adduct thumb

Sever ulnar nerve

Claw hand

 

Deep Ulnar Nerve

  1. (intrinsic hand muscle-thenar eminance)  adductor pollicis=only muscle to adduct thumb=deep ulnar

 

 

58

Thumb innervation: inability to abduct or extend thumb

Sever radial nerve

Wrist drop (Saturday night palsy)

Deep radial nerve

  1. (deep posterior forearm muscle) Abductor pollicis longus=thumb abduction=deep radial nerve
  2. (deep posterior forearm muscle)  Extensor pollicis bravis=thumb extension=deep radial nerve
  3. (deep posterior forearm muscle)  extensor pollicis longus=thumb IP extension=deep radial nerve

59

Where is blood commonly drawn from the arm?

Median cubital vein

60

Explain blood supply to the hand.

  • Superficial palmar arch (ulnar artery),
  • deep palmar arch (radial artery)

Ulnar artery enters hand superficial to flexor retinaculum, branches into:
- Deep ulnar
- Superficial palmar arch à anastomoses to lateral side of hand (remember we’re in anatomical
position so this is the side with the thumb)

_______________
Radial artery enters hand on the dorsum, branches into:
- Superficial branch
- Deep palmar arch à anastomoses to medial side of hand (side with pinky)
o Gives rise to princeps pollicis – major artery of the thumb

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61

#1

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patella

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62

#2

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medial femoral condyle

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#3

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medial tibial condyle

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#4

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lateral femoral condyle

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65

#5

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lateral tibial condyle

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#6

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head of fibula

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67

Yellow

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medial femoral condyle

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68

orange

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lateral femoral condyle

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69

#1

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talus

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#2

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navicular

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#3

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calcaneus

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#4

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cuboid

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#5

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base of 1st metatarsal

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#6

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head of 1st metatarsal

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#7

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shaft of proximal phalyx of big toe

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#8

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shaft of distal phalyx of big toe

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77

asterisks

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sesamoid bones

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78

#9

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shaft of 5th metatarsal

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79

#1

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Joint space

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#2

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Head of femur

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#3

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Neck of femur

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#4

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Greater Trochanter

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#5

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Lesser Trochanter

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#6

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Ischial Tuberosity

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THE LEFT HIP JOINT SHOWS THE THREE CLASSIC SIGNS OF ‘BAD’ HIP JOINT OSTEOARTHRITIS:

DIMINISHED JOINT SPACE, OSTEOSCLEROSIS OF ACETABULUM, AND OSTEOPHYTES

86

A, B

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Fractures of superior pubic rami

87

C, D

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Fractures of inferior pubic rami

88

To identify the safest area in the patient’s right buttock, the physician spreads apart the thumb and fingers of his/her left hand and then rests the palm of the left hand on the patient’s right buttock in such a fashion that the tip of the index finger overlies the __________ and tip of the middle finger overlies the _________.  The triangular, gluteal skin area between the physician’s _________ fingers is the gluteal area safest for intramuscular injections.

  • index finger=anterior superior iliac spine
  • middle finger=iliac tubercle
  • index and middle

89

Thumb muscles

Median nerve

  1. (deep anterior forearm muscle) Flexor pollicis longus=thumb IP flexion=Median nerve
  2. (intrinsic hand muscle-thenar eminance) abductor pollicis brevis=abducts thumb=median nerve
  3. (intrinsic hand muscle-thenar eminance) opponens pollicis=opposition=median nerve

Deep radial nerve

  1. (deep posterior forearm muscle) Abductor pollicis longus=thumb abduction=deep radial nerve
  2. (deep posterior forearm muscle)  Extensor pollicis bravis=thumb extension=deep radial nerve
  3. (deep posterior forearm muscle)  extensor pollicis longus=thumb IP extension=deep radial nerve

Deep Ulnar Nerve

  1. (intrinsic hand muscle-thenar eminance)  adductor pollicis=only muscle to adduct thumb=deep ulnar

 

Note: thumb muscles have pollicis in their name

  1.  

90

Review where arterial pulses can be palpated around the ankle joint.

  • anterior to the ankle joint immediately lateral to the insertion tendon of extensor hallucis longus

 

dorsalis pedis:

91

Review where arterial pulses can be palpated around the ankle joint.

  • posteroinferiorly to the medial malleolus (the pulsations are most easily palpated if the foot is both dorsiflexed and inverted).

 

posterior tibial: