Surface Anatomy - Limbs Flashcards
(175 cards)
1
Q
What is the shape of the clavicle?
A
Medial 1/3 = Convex
Lateral 1/3 = Concave
2
Q
Where does the brachial plexus lie in relation to the clavicle?
A
The trunks of the brachial plexus are in the supraclavicular notch, posterior to the middle 1/3 of the clavicle
3
Q
Where does the coracoid process lie in relation to the clavicle?
A
3cm below the junction of the middle and lateral 1/3s of clavicle
4
Q
What attaches to the coracoid process?
A
Pectoralis minor
Short head biceps brachii
Coracobrachialis
5
Q
Where does the lateral part of the clavicle end?
A
Acromioclavicular joint
6
Q
What happens to the clavicle as the upper limb is raised?
A
Lateral end of clavicle elevates
As limb is raised fully:
- Clavicle rotates backwards
- Normal anterior surface now faces superiorly
7
Q
Where does the medial border of the scapula lie?
A
5cm lateral to the spine of T2-T8 vertebrae
8
Q
Why is the medial border somewhat difficult to palpate?
A
Attachments of muscles such as rhomboids
9
Q
Why is the superior angle of the scapula difficult to palpate?
A
Muscle mass of superficial muscle layer of back
10
Q
Where does the inferior angle of the scapula overlie?
A
Posterolateral parts of the 7th or 8th ribs
11
Q
What happens to the inferior angle of the scapula as the upper limb is moved above shoulder height?
A
Scapula is protracted and inferior angle moves anteriorly and superiorly (upward rotation)
12
Q
Why does the scapula move when the arm is raised?
A
Moves the acromion process superiorly so the head of the humerus does not get restricted by it
13
Q
How can pectoralis major be palpated in the axilla?
A
Place hand at anterior border of axilla and flex the arm
14
Q
How can the latissimus dorsi be palpated in the axilla?
A
Extend the arm and palpate posterior wall of axilla
15
Q
What structures can be palpated moving laterally from the coracoid process of the scapula?
A
Anterior rim of glenoid cavity
Head of humerus
Lesser tubercle of humerus
16
Q
What structure can be palpated in the intertubercular groove of the humerus? How does it feel?
A
Tendon of long head of biceps
Cord-like structure
17
Q
Why is the greater tubercle of the humerus difficult to palpate?
A
Usually covered by deltoid
18
Q
How does the greater tubercle contribute to the palpable shape of the shoulder?
A
Contributes to the rounded shape of the lateral side of the shoulder
19
Q
How can the humeral head be more easily palpated?
A
Laterally rotating the arm
20
Q
Where can the shaft of the humerus be palpated?
A
Halfway down the lateral side of the arm by following the attachment of deltoid
21
Q
What muscle group originates from the lateral epicondyle of the humerus?
A
Extensors of wrist and digits (posterior forearm)
22
Q
What cord-like structure can be palpated in the deep bony groove posterior to the medial epicondyle? What happens when pressure is applied here?
A
Ulnar nerve
Pressure:
- Tingling in medial 1.5 digits
- Tingling in medial palm and dorsum of hand
23
Q
Where does the coronoid process lie in relation to the medial epicondyle of the humerus?
A
Anteromedial
24
Q
What structure prevents further extension of the elbow joint?
A
Olecranon process of ulna
25
Where can the biceps tendon be palpated?
Cubital fossa
26
How can the triceps tendon be palpated?
Ask someone to extend their arm against gentle resistance
| Palpate posterior arm
27
What bone lies immediately distal to the head of the ulna?
Triquetral carpal bone
28
What bone can be palpated on the triquetral bone's anterior surface?
Pisiform
29
What type of joints are the intercarpal joints?
Plane synovial
30
Where can the hook of the hamate be palpated?
1cm distal and slightly lateral to the pisiform
31
Why must the hook of the hamate be palpated carefully?
2 small branches of the ulnar nerve pass close to this bony landmark
32
What bones are located in the anatomical snuffbox?
```
Radial styloid process
Trapezium
Scaphoid
1st metacarpal:
- Base marked by a small tubercle
```
33
How can the tubercle of the scaphoid bone be palpated?
Extend wrist
| Pass fingers to proximal end of thenar eminence, 1cm medial to tip of radial styloid process
34
How can the trapezium be palpated?
Move fingers 1cm distal to where tubercle of scaphoid bone was palpated and press a little deeper
35
What joint can be palpated at the base of the thenar eminence?
1st CMC joint
36
Why is it difficult to locate other small landmarks in the hand?
Muscle and fascia of wrist and palm
37
What bony features of the ulna can be palpated at the posterior aspect of the wrist?
Head of ulna
| Ulnar styloid process
38
What tendon lies near the ulnar styloid process and can be palpated at the posterior aspect of the wrist?
Tendon of extensor carpi ulnaris
39
During which movement does the ulna styloid process become more prominent?
Wrist abduction
40
Why must care be taken when palpating along the lateral aspect of the forearm the the distal radius?
You may accidentally compress the superficial branch of the radial nerve
41
What tendon runs across the medial side of the dorsal tubercle of the radius?
Extensor pollicis longus tendon
42
If the wrist is flexed and an imaginary line running transversely across the wrist just distal to the radial and ulnar styloid processes is drawn, what does this coincide with?
The posterior surfaces of:
- Scaphoid
- Lunate
- Triquetral
43
Which metacarpals do the following carpal bones lie at the bases of:
- Trapezoid
- Capitate
- Hamate
```
Trapezoid = 2nd metacarpal
Capitate = 3rd metacarpal
Hamate = 4th and 5th metcarpals
```
44
How can the base, shaft and head of each metacarpal and phalanx be palpated?
From the dorsal surface of the hand, if fingers are flexed
45
Where can the tendon of flexor carpi radialis be palpated?
Medial to radial styloid process on anterior wrist
46
What muscle tendon will appear if you clench the fist and flex the wrist? Where?
```
Palmaris longus (if present):
- Just medial to tendon of flexor carpi radialis
```
47
What tendon lies at the medial aspect of the anterior wrist?
Flexor carpi ulnaris
48
If the space between flexor carpi ulnaris tendon and palmaris longus tendon is observed, what tendons can be palpated during the following movements:
- Flexion of MCPJs and PIPJs
- Flexion of MCPJs, PIPJs AND DIPJs?
```
Flexion of MCPJs and PIPJs:
- Tendons of flexor digitorum superficialis
Flexion of MCPJs, PIPJs AND DIPJs:
- Tendons of flexor digitorum profundus
- Medial forearm
- Deep to flexor carpi ulnaris tendon
```
49
What tendons can be identified on the posterior hand when the thumb is extended?
Abductor pollicis longus and extensor pollicis brevis (lateral border snuffbox)
Extensor pollicis longus (medial border snuffbox)
50
Why should a pulse never be palpated with the thumb?
You will feel the pulse of princeps pollicis
51
Why are only part of the courses of upper limb arteries palpable?
They usually lie deep within upper limb tissues
52
What arteries of the upper limb are too deep to palpate?
Brachiocephalic
| Subclavian
53
Where can the subclavian artery be palpated? Why is this difficult to palpate?
Where it passes over the 1st rib posterior to the midpoint of the clavicle:
- Difficult to feel as deep pressure required and it is uncomfortable
54
How can the axillary artery be palpated?
Press upwards and laterally within the axilla:
| - Compresses the artery against the lateral wall of the axilla
55
Why might palpation of the axillary artery be uncomfortable?
May compress some cords of brachial plexus
56
How can the brachial artery be palpated?
Compress the artery against the humerus on the medial side of the biceps tendon
Also palpable just prior to bicipital aponeurosis in cubital fossa
57
What other structures may be palpated when feeling the brachial pulse in the arm?
```
Ulnar nerve (superior to artery)
Median nerve (inferior to artery)
```
58
Where is the radial pulse palpated?
At the wrist:
- Place fingertips on lower border of radius and radial styloid process
- Move 0.5cm medially
59
Between what structures is the radial pulse felt?
Between anterior border of radius and tendon of flexor carpi radialis
60
Where else can the radial artery be palpated?
Against lateral side of scaphoid in anatomical snuffbox:
| - Between tendons of extensor pollicis longus (medially) and tendons of EPB and APL (laterally)
61
Where can the ulnar artery be palpated?
At the wrist:
| - Just lateral to pisiform bone
62
What small arteries in the hand may be palpable?
The metacarpal arteries on the dorsal surface near the metacarpal heads
63
Where can the princeps pollicis artery be palpated?
Cleft between thumb and index finger:
| - On anteromedial side of thumb
64
How else can the princeps pollicis pulse be felt?
By pressing pad of thumb against a hard surface
65
Where can the princeps indicis (radialis indicis) pulse be felt?
Lateral side of the metacarpal of the index finger
66
Where do the superficial veins of the upper limb originate?
From dorsal venous arch on hand
67
How can the dorsal venous arch of the hand be made more prominent?
Hand arm by side and apply light pressure to the medial aspect of the arm
68
What is the course of the cephalic vein?
Runs from lateral side of dorsal venous arch
Runs through roof of anatomical snuffbox
Runs along lateral border of forearm
Passes anterior to head of radius at cubital fossa
Runs on lateral side of biceps brachii
Enters deltopectoral groove
69
What is the course of the basilic vein?
Runs from medial side of the dorsal venous arch
Along medial side of the forearm
Passes anterior to the medial condyle of the humerus and along the medial side of the arm
Pierces the deep fascia to join with the brachial veins to form the axillary vein
70
Where are the cephalic and basilic veins most easy to identify?
Close to hand and distal forearm
71
What communication may be visible between the cephalic and basilic veins and where?
Median cubital/median antebrachial vein
| In skin covering cubital fossa
72
How do nerves feel on palpation?
Cord-like structures
73
Why must palpation of nerves be gentle?
Too deep a pressure will result in unpleasant tingling sensations or pain
74
Why may the nerves of the upper limb only be palpated in specific areas?
Are deep within the tissues
75
What nerves of the upper limb cannot be palpated?
Axillary nerve
| Musculocutaneous nerve
76
Where can the trunks of the brachial plexus be palpated?
Above medial part of clavicle
| Close to lateral border of SCM
77
What nerves can be palpated in the lateral wall of the axilla when compressing the axillary artery?
Median nerve
| Ulnar nerve
78
Where can the radial nerve be palpated?
Rolled against surface of humerus halfway down lateral side of arm:
- Below insertion of deltoid
- Anterior to lateral head of triceps brachii
79
Where can the superficial branch of the radial nerve be palpated?
On the distal half of the lateral surface of the radius as it passes from under brachioradialis and onto the dorsum of the hand
80
Where can the ulnar nerve be palpated at the elbow?
Behind medial epicondyle of humerus as it crosses over medial collateral ligament of the elbow
81
Where does the ulnar nerve pass under in the forearm?
Fibrous arch of flexor carpi ulnaris
82
Where does the ulnar nerve become superficial again in the forearm? Is it palpable here?
7cm above the wrist, lateral to flexor carpi ulnaris
| Not easily
83
What can the distal branches of the ulnar nerve be compressed agains?
Hook of hamate bone:
| - Distal to pisiform
84
Where can the median nerve be palpated?
Between tendons of flexor carpi radialis and flexor digitorum superficialis on the anterolateral aspect of the wrist
85
What may cause difficulty in palpation of the median nerve in some people?
May be covered by palmaris longus tendon
86
What structures are vulnerable during dislocation of the shoulder joint?
Axillary nerve
| Glenoid labrum
87
What structures are vulnerable in a mid-shaft fracture of the humerus?
Radial nerve (in radial groove)
88
What structures are vulnerable in a fracture of the humeral condyles?
```
Ulnar nerve (medial condyle)
Brachial artery and median nerve (supracondylar)
```
89
What structures are vulnerable in a fracture of the distal radius and ulna?
Median nerve
| Radial and ulnar arteries
90
What structures are vulnerable in incisions/lacerations to the thenar eminence?
Median nerve
91
What structures are vulnerable in incisions/lacerations to the hypothenar eminence?
Ulnar nerve
92
What structures are vulnerable in mid-palm incisions/lacerations?
Palmar arches
93
Why are only some of the bony features palpable in the hip region?
Large amount of muscle and other soft tissues in hip region
94
What bony feature if palpable by placing hands on your waist and sliding them down until a large bony ridge is felt?
Iliac crests
95
What bony feature is palpable at the anterior ends of the iliac crests?
ASIS
96
What structures attach to the ASIS?
Sartorius
Inguinal ligament
Tensor fascia latae
97
What can be palpated 5-7cm posterior to the ASIS?
The tubercle of the crest that gives attachment to the iliotibial tract
98
Where is the AIIS located?
2cm above the rim of the acetabulum
| Located by finding the ASIS and following the border of the ilium down
99
How is the greater trochanter of the femur located?
Locate the most lateral point of the iliac crest
| Pass fingers down 10cm onto surface of thigh
100
Why can the greater trochanter of the femur be palpated?
It is the most lateral bony prominence of the hip joint
101
How can the ischial tuberosities be palpated?
Sit down in a chair and place your hands under your gluteal regions
You will feel the large bony tuberosities press against your hands
102
What structures attach to the ischial tuberosities?
```
Posterior thigh (hamstrings):
- Except short head biceps femoris
AND
Hamstring part of adductor magnus
AND
Sacrotuberous ligament
```
103
What is the easiest structure to palpate at the knee?
Patella
104
What lies at the superior and inferior borders of the patella?
```
Superior = Quadriceps tendon
Inferior = Patellar tendon
```
105
How does the patella move when the knee is flexed?
Posteroinferiorly
106
When is the patella quite mobile?
When the knee is extended
107
What lies at the inferior end of the patellar tendon and can be palpated?
Tibial tuberosity
108
What can be palpated on either side of the patella when the knee is flexed?
Medial and lateral condyles of the femur
109
What small tubercles can be palpated on the medial and lateral condyles of the femur?
Medial and lateral epicondyles
110
What other tubercle is present on the medial side of the femur?
Adductor tubercle
111
What structures are palpated by first palpating the medial and lateral femoral condyles then moving your fingers inferiorly?
Medial and lateral tibial condyles
112
Where can the head of the fibula be palpated?
1cm posterolateral to the lateral condyle of the tibia
113
Why must care be taken when palpating the head of the fibula?
Common fibular nerve passes down the posterior surface of the head of fibula
114
Why is the anterior border of the tibia so easily palpable?
Is subcutaneous as far as the medial malleolus
115
How can the tendon of biceps femoris be located?
As someone to flex their knee against gentle resistance
Tendon of biceps femoris will be on posterolateral side of knee:
- Passes down to insert onto head of fibula
116
How can the tendon of semitendinosus be palpated?
Ask someone to flex their knee against gentle resistance
| Tendon of semitendinosus at posteromedial side of knee
117
Where can semimembranosus be palpated? How?
Either side of semitendinosus tendon:
- Place fingers on semitendinosus tendon
- Ask them so flex and extend knee
- Feel semimembranosus moving under fingers
118
Starting at the lateral malleolus, how far up the leg can the fibula be traced?
15cm (before it disappears into the muscle mass of the leg)
119
How can the sustentaculum tali be palpated?
Palpate tip of medial malleolus
| Pass fingers inferiorly by 1cm
120
What structure is palpated by passing fingers from the anterior end of the sustentaculum tali?
Tubercle of the navicular bone
121
How can the head of the talus be palpated?
Place right hand on left ankle:
- Index finger on lateral malleolus
- Thumb on medial malleolus
- Bring finger and thumb together (and slightly forward)
122
What bone is palpable immediately distal to the head of the talus?
Navicular bone
123
What bone is palpable immediately distal to the navicular bone?
Medial cuneiform
124
What bone can be palpated from the distal aspect of the medial cuneiform?
1st metatarsal
125
Which 2 tendons attach to the medial cuneiform and the base of the 1st metatarsal?
Fibularis longus
| Tibialis anterior
126
What bone is encountered by following the 5th metatarsal proximally?
Cuboid
127
What is palpated by starting at the lateral malleolus and moving fingers forward and dowards by 1cm?
Fibular tubercle of the lateral side of the calcaneous
128
If the foot is everted, what structures may be palpable either side of the fibular tubercle of the calcaneus?
```
Fibularis brevis (superiorly)
Fibularis longus (inferiorly)
```
129
Where can the calcaneofibular ligament be palpated?
Just inferior and posterior to the tip of the lateral malleolus
130
What nerve roots does the achilles tendon reflex test?
S1 and S2
131
Where can the long extensor tendons of the foot be palpated?
Dorsal surface of ankle
132
What is the most medial tendon on the dorsal ankle?
Tibialis anterior
133
What tendon lies lateral to the tibialis anterior tendon?
Extensor hallucis longus
134
How can the tendon of EHL be followed to its insertion? Where is this insertion?
By extending the big toe
| Inserts on base of distal phalanx of 1st digit (great toe)
135
What tendon can be palpated lateral to EHL tendon on the dorsal ankle?
Extensor digitorum longus
136
Where might a visible swelling indicating the small extensors of the digits of the foot be seen?
2cm anterior to lateral malleolus on dorsum of foot
137
Where is the femoral artery palpable?
In the groin area just below the midpoint of the inguinal ligament
138
What is the course of the femoral artery?
Lies relatively superficial in the femoral triangle
Then runs under sartorius
Runs through adductor hiatus
Become popliteal artery in the popliteal fossa
139
How can the popliteal artery be palpated?
Bend knee to 45 degrees to release tendon of surrounding tendons
Palpate in popliteal fossa
140
Where is the anterior tibial artery palpable?
On anteromedial aspect of ankle joint
Between tendons of:
- EHL
- EDL
141
Where is the dorsalis pedis artery palpable?
In the space between the 1st and 2nd metatarsals
142
What is the dorsalis pedis a branch of?
Anterior tibial artery
143
Where does the posterior tibial artery lie?
Deep in the posterior compartment under gastrocnemius and soleus
144
Where is the posterior tibial artery palpable?
Posterior to medial malleolus between tendons of:
- Flexor digitorum longus
- Flexor hallucis longus
(Medial to tibial nerve)
145
What does the posterior tibial artery branch into?
Medial and lateral plantar arteries in sole of foot
146
What do the deep veins of the lower limb accompany?
The arteries of the lower limb
147
Can the deep veins of the lower limb be palpated?
No
148
Where do the superficial veins of the lower limb originate?
Dorsum of the foot from the dorsal venous arch
149
When is the dorsal venous arch of the foot more prominent and more visible?
If you are standing
150
Where does the great saphenous vein originate?
Medial side of the dorsal venous arch
151
What is the course of the great saphenous vein?
Passes over anterior surface of medial malleolus
Runs over medial aspect of leg
Crosses knee posterior to medial condyles of tibia and femur (3-4 fingerbreadths from patella)
Ascends medial surface of thigh
Drains into femoral vein
152
Where is the great saphenous vein most easily located?
At or near medial malleolus (even in people who are overweight)
153
Where does the small saphenous vein originate?
From the lateral side of the dorsal venous arch
154
What is the course of the small saphenous vein?
Passes posterior to lateral malleolus
Passes along lateral side of tendocalcaneus
Passes onto posterior aspect of calf
Drains into popliteal vin at popliteal fossa
155
Why are the nerves of the lower limb difficult to palpate?
Run deep within the lower limb
156
Where does the femoral nerve lie?
Most laterally in the femoral triangle
157
Where does the obturator nerve lie?
Deep in medial compartment
158
Where does the sciatic nerve lie?
Deep in the posterior comaprtment of the thigh
159
Where does the tibial nerve lie and run?
Lies within popliteal fossa
| Passes deep to gastrocnemius and soleus
160
Where does the tibial nerve become palpable?
At posterior surface of the medial malleolus
161
What does the tibial nerve form in the foot?
Medial and lateral plantar nerves
162
What is the course of the common fibular nerve?
Formed from sciatic nerve in thigh
| Passes down medial side of tendon of biceps femoris
163
Where does the common fibular nerve become palpable?
As it passes around head of fibula:
| - Easier to palpate on the posterior surface
164
Where does the deep fibular nerve lie?
Deep in anterior compartment of leg until it crosses anterior surface of ankle
165
Where can the deep fibular nerve be palpated?
Lateral to dorsalis pedis artery
Between tendons of:
- EHL
- EDL
166
Where does the superficial fibular nerve become palpable?
Medial to the anterior border of the lateral malleolus
| After it emerges between fibularis longus and brevis
167
What structures are vulnerable if there is damage to the area inferior to the inguinal ligament?
Femoral nerve
Femoral artery
Femoral vein
168
What structures are vulnerable if there is damage to the area at the head of the fibula?
Common fibular nerve
169
What structures are vulnerable if there is damage to the area at the medial malleolus?
```
Posterior tibial artery
Saphenous nerve
Great saphenous vein
Tibial nerve
TP, FDL and FHL tendons
```
170
What structures are vulnerable if there is damage to the area of the gluteal region?
Superior gluteal nerve
| Sciatic nerve
171
What structures are vulnerable if there is damage to the posterior compartment of the thigh?
Hamstrings
| Sciatic nerve
172
What structures are vulnerable if there is damage to the popliteal fossa?
Tibial nerve
| Popliteal artery
173
What structures are vulnerable if there is damage to the lateral malleolus?
Small saphenous vein
| Superficial fibular nerve
174
What structures are vulnerable if there is damage to the dorsum of the foot?
Dorsalis pedis artery
175
What structures are vulnerable if there is damage to the cleft between the 1st and 2nd digits?
Deep fibular nerve
