Anatomy exam 3

Describe hip fractures and identify the bony structures involved

The femoral neck is broken. When the femoral neck breaks, the pull of the lwer limb muscles causes the left to rotate laterally and shorten by several inches. Fractures of the femoral neck are of two types: interochanteric and subcapital.

Specify the weakest area of the shoulder joint, i.e. the direction of most shoulder dislocations (superior, inferior, anterior, posterior) and explain why

The inferior portion of the joint lacks rotator cuff muscles, causing that area to be weak and the most likely site of injury because there is nothing there to protect it

posterior cruciate ligament

Tibial attachement: posterior tibia, intercondylar eminence

Describe the action(s) of the scapula produced by the following muscles -- trapezius, rhomboids, serratus anterior

Trapezius: elevate, depress, retract, upward rotate rhomboids: retraction and downward rotation serratus anterior: protraction, upward rotation of scapula, holds scapula in place against the thoracic wall

muscles within the quadriceps femoris

Vastus medialis (VM) Vastus lateralis (VL) Vestus intermedius (VI) Rectus femoris (RF)

what articulates with the pubofemoral ligament (ant)

acetabular labrum

what articulates with the ischiofemoral ligament (post)

acetabulum (cup like depression socket)

medial compartment muscles of the thigh

adductor group gracillis

common action of the medial compartment of the thigh

adductors of the thigh/hip

muscles that adduct the hip joint

adductors, gracilis

List the muscles contained in the anterior and posterior compartments of the arm and specify the nerve that innervates each compartment

anterior compartment: -Biceps brachii (BB) • Long Head: supraglenoid tubercle (PX) • Sort Head: coracoid proc. (PX) • Both: radial tuberosity (DS) • Coracobrachialis • Attach: coracoid proc.(PX) • Humerus (DS) • Brachialis • Attach: humerus (PX) • Ulnar tuberosity (DS -innervated of musculocutaneous nerve posterior compartment: Triceps brachii (TB) • Attach: • Lat: humerus (PX) • Med: humerus (PX) • Long: infraglenoid tub. (PX) - innervation at radial nerve

Muscle compartments innervated by femoral nerve

anterior thigh muscles and pectineus

Cutaneous regions innervated by superficial fibular n.

anteroinferior part of leg, most dorsum of foot

Specify the common distal attachment site of the superficial posterior compartment leg muscles (soleus, gastrocnemius) and identify the site

both: calcaneous

Cutaneous regions innervated by tibial n.

branches to the heel, and via its medial and lateral plantar nerve branches (which supply the sole of foot)

Specify the nerve that could be damaged by a fracture at the neck of the fibula

common fibular nerve

innervation of anterior comp of leg

deep fibular nerve

Describe the location and function of the glenoid labrum

deepens socket (rim of fibrocartilage)= needed for mismatch head of humerus and glenoid fossa

Cutaneous regions innervated by deep fibular n.

dorsal interspace between first and second space

Summarize the muscles that perform the following actions at the talocrural joint (aka ankle joint) □ Dorsiflexion □ Plantarflexion

dorsiflexion: tibialis anterior, extensor digitoru,, halluces longus (ant. leg) plantar flexion: soleus, gastrocnemius, tibialis posterior flexor digitorum longus, flexor halluces longus

Summarize the muscles that perform the following actions at the subtalar joint □ Eversion □ Inversion

eversion: fibularis longus, fibularis brevis (lateral leg) inversion: tibialis anterior, tibialis posterior

common action of the ant. comp. of the thigh

extend the knee or flex the thigh

List the muscles located in the leg that flex the toes (2 muscles) and extend the toes (2 muscles)

extend toes: extensor halluces longus, extensor digitorum longus (ant. leg) flex: flexor halluces longus, flexor digitorum longus (post. leg)

innervation of anterior compartment of thigh

femoral nerve

muscles in lateral compartment of leg

fibularis longus and fibularis brevis

Summarize the muscles that perform the following action on the knee joint □ Flexion □ Extension

flex: hamstrings (BF, SM, ST) (post. thigh) and gastrocnemius extension: anterior thigh quadriceps femoris, vastus intermedius, vaastus lateralis, vastus medialis (ant. thigh)

action of lateral comp. of leg

foot eversion

muscles that lateral rotates the hip joint

gluteus maximus

muscles that abduct the hip joint

gluteus medius, gluteus minimus, tensor fasciae lata

shin splints

inflammation can occur in the ant. compartment with overuse mild case: shin splints severe: anterior compartment syndrome

fibular nerve

lateral branch of sciatic nerve

Muscle compartments innervated by superficial fibular nerve

lateral leg

Motor/sensory impairment to deep fibular

loss of dorsiflexion, 1st interdigital cleft numb, toe extension, weak inversion (lose TA)

Motor/sensory impairment to superficial fibular

loss of eversion (eversion sprains), dorsal foot numb, except for 1st interdigital cleft

Motor/sensory impairment to tibial nerve

loss or weakness in plantarflexion, toe flexion, no plantar foot mm. function

List the anterior primary rami that contribute to the lumbar plexus and sacral plexus

lumbar plexus: formed from ventral rami of L1-L4 sacral plexus: formed from L4-S4. located on the anterior surface of the sacrum.

tibial nerve

medial branch of the sciatic nerve supplies motor to posterior thigh: biceps femoris long head, semimembranosus, semitendinosus, posterior leg transmits sensory from plantar foot surface

Muscle compartments innervated by obturator nerve

medial thigh muscles and obturator externus

Motor/sensory impairment to common fibular

most commonly damaged nerve in the lower limb, sever never (mm paralysys), waddling gait, numbness of foot Loss or weakness in dorsiflexion, toe eversion, eversion, weak inversion (lose TA)

innervation of medial compartment of thigh

obturator nerve

sub capital fracture

occur within the hip articular capsule. Occurs in elderly people.

Specify the muscles that contribute to the axillary folds

pectoralis major- forms anterior axillary fold teres major- forms posterior axillary fold

action of posterior comp of leg

plantar flexion of ankle (all), knee flexion (gastrocs), inversion (TP), toe flexion (FHL, FDL)

Muscle compartments innervated by tibial nerve

posterior thigh, posterior leg, plantar foot

Summarize the muscles that produce the following actions of the forearm (pro and sup)

pronation: anterior compartment (pronator quadratus) supination: posterior compartment (supinator), biceps brachii

2nd nerve

radial nerve Crosses post humerus in the radial groove, travels around the lateral epicondyle and travels near radius to post hand. Motor: Muscles in the posterior compartment of arm and forearm. Sensory: skin on the posterior arm, forearm, and posterolateral hand

what nerve is most likely to be damaged from a fracture in the mid shaft of the humerus

radial nerve • Causes: mid-shaft fracture, poor fitting crutches • Symptoms: weak wrist extension, wrist drop, numbness post. Forearm and lateral hand

anatomical snuff box

scaphoid bone in carpals can be palpated

innervation of posterior compartment of thigh

sciatic nerve (tibial nerve)

innervation of lateral compartment of leg

superficial fibular

Cutaneous regions innervated by femoral n.

superomedial thigh

medial collateral ligament

tibial collateral ligament • Medial epicondyle to proximal tibia • Attached to medial meniscus

innervation of posterior compartment of leg

tibial nerve

common distal attachment site of the quadriceps muscles

tibial tuberosity

bones that form the pelvic girdle

two ossa coxae (hip bones) sacrum: right and left side it is attached to the axial skeleton superiorly coccyx

Motor/sensory impairment to gluteal nerve

weak abduction of the hip joint

Motor/sensory impairment to femoral nerve

weakness or loss in hip flexion and knee extension

Differentiate which ligament prevents excessive anterior or posterior movement of the tibia

• Anterior cruciate ligament (ACL)- prevents anterior movement of tibia relative to femur (prevents hyperextension)- orange • Posterior cruciate ligament: prevents posterior movement of tibia relative to femur (prevents hyperflexion)- green

compartment syndrome

• Compress blood vessels and nerves • Can cause tissue death (nerve and muscles)

muscles in the posterior comp. of leg

• Superficial: gastrocnemius, soleus • Deep- tibialis posterior (TP), flexor digitorum longus (FDL), flexor halluces longus (FHL)

anterior cruciate ligament

• Tibial attachment: anterior tibia, intercondylar eminence

□ Specify the common proximal attachment site of the hamstring muscles

□ Common for SM, ST, BFLH= ischial tuberosity □ BFSH= linea aspera

what nerve is most likely to be damaged from a fracture in the surgical neck of humerus

- axillary nerve • Causes: glenohumeral joint dislocation, fracture at surgical neck • Symptoms: weak abduction of arm, numbness at shoulder

muscles in anterior compartment of the leg

-Tibialis anterior (TA) • Extensor digitorum longus (EDL) • Extensor halluces longus (EHL)

Cutaneous regions innervated by common fibular n.

: dorsal interspace between first and second toe and anteroinferior part of leg, most dorsum of foot

Explain the consequence of the highly mobile glenohumeral joint

A highly mobile joint means low stability. As a result the highly mobile glenohumeral joint, which is made of the humerus and glenoid cavity, is prone to dislocating or falling out of it's socket.

Identify the ligaments involved in a shoulder separation

AC Joint and Ligament, and Coracoclavicular Ligament. or coracoacrimial ligament, glenohumeral ligaments, rotator cuff

Is ACL or PCL more vulnerable to injury

ACL is more vulnerable than PCL • PCL stronger than ACL

Differentiate between the attachment sites of the anterior cruciate ligament and posterior cruciate ligaments on the tibia

ACL: tibial attachment; attached to the anterior tibia, intercondylar eminence PCL: tibial attachment; posterior tibia, intercondylar eminence

muscles in the adductor group

Adductor longus Adductor brevis Adductor magnus

action of anterior comp. of leg

Anterior: dorsiflexion (all), toe extension (EDL and EHL), inversion (TA)

Specify the bones that articulate to form the radiocarpal joint

Articulation occurs among three proximal carpal bones: scaphoid, lunate, and triquetrum. The distal articular surface of the radius, and a fibrocartilaginous articular disc.

Lumbar Plexuses

Femoral nerve: passes deep to inguinal ligament, transmits sensory from the anterior thigh, medial surface of leg and medial foot obturator nerve: enters the obturator foramen, motor to medial thigh muscles. Carries sensory from skin of medial thigh.

Specify the muscles that produce the following actions of the glenohumeral joint

Flexion (arm flexion)- deltoid, pectoralis major, biceps brachii, coracobrachialis extension: latissimus dorsi, LH triceps brachii, deltoid abduction: deltoid, supraspinatus adduction: latissimus dorsi, teres major, pectoralis major medial (internal) rotation: deltoid, subscapularis

List the actions normally allowed at the radiocarpal joint

Flexion and extension Abduction and adduction

Sacral Plexus

Gluteal nerve: branches of sacral plexus, superior supplies motor to gluteus medius and maxiumus and tensor fasciae lata. Inferior supplies motor to gluteus maximus. sciatic pudendal

muscles in the posterior compartment of the thigh

Hamstring group: Semitendinosus (ST) Semimembranosus (SM) Biceps femoris (LH, SH)

Specify the bony features that articulate to form the hip joint and list the main ligaments that support the joint

Iliofemoral ligament: head of femur Ischiofemoral ligament (post): acetablum Pubofeoral ligament (anterior): acetabular labrum

Identify the muscle most commonly injured muscle in a rotator cuff tear

Repetitive stress (motions above horizontal) • Tear of the tendon of supraspinatus m.

Muscle compartments innervated by common fibular nerve

SH of biceps femoris

articulations of the pelvic girdle

Sacroiliac- b/t ilium (auricular surface) and sacrum (attaches lower limb to axial skeleton) o Pubic symphysis- b/t R and L hip bones o Hip joint- b/t hip bone acetabulum and head of femur

Define compartment syndrome and explain why the anterior leg compartment is most commonly affected by describing the anatomical structures that surround the leg compartment

Shin splints and compartment syndrome anterior compartment boundaries are very tight

List the actions normally allowed by the proximal and distal radioulnar joints

Supination-palms face anteriorly (anatomical position) o Pronation-palms face posteriorly o Proximal RU- head of radius spins in the annular lig (both) o Distal RU- radius rolls over the ulna (pronation)

List the proximal (origin) and distal (insertion) attachments of the 4 rotator cuff muscles

Supraspinatous (supraspinous fossa- PX attach) • Infraspinatous (infreaspinous fossa- PX attach) • Teres minor (inf angle- PX attach, DS attach: greater tubercle) • Subscapularis (attach: subscapular fossa (PX) and lesser tubercle (DS)

Describe the action of each of the rotator cuff muscles

Supraspinatous: abduction • Infraspinatous: lateral rotation • Teres minor: lateral rotation • Subscapularis: medial rotation

Specify the structure that provides the most support for the glenohumeral joint

The Rotator Cuff (muscles surrounding the joint) provides the most strength. The rotator cuff muscles surround the joint and work as a group to hold the head of the humerus in the glenoid cavity. The tendons of these muscles encircle the joint (except for the inferior portion) and fuse with the articular capsule

List the 5 terminal branches (nerves) that are formed by the brachial plexus

Axillary nerve, median nerve, musculocutaneous nerve, radial nerve, ulnar nerve

Specify the compartments and cutaneous areas (skin) innervated by the 5 terminal branches (nerves) of the brachial plexus

Axillary nerve: superolateral arm Median nerve: palmar aspects and dorsal tips of lateral 3-1/2 digits Musculocutaneous nerve: lateral region of the forearm Radial nerve: posterior region of arm, posterior region of forearm, dorsal aspect of lateral three digits Ulnar nerve: dorsal and palmar aspects of medial 1-1/2 digits

Explain the relationship between mobility and stability as it applies to the glenohumeral joint

Ligaments provide little stability, highly mobile

Differentiate which structure(s) would be damaged by an inversion injury to the ankle versus an eversion injury to the ankle

Sprain= tears in ligament fibers. An ankle sprain results when the foot is twisted, almost always due to overinversion. Fibers of the lateral ligaments are either stretched (in mild sprains) or torn (in more severe sprains). Overeversion sprains rarely occur due to the strength of the deltoid ligament. If overeversion does occur, healing process takes a very long time.

intertrochanteric fracture

distal or outside of hip articular capsule. Occurs in younger and middle-aged individuals, usually in response to trauma.

Identify the bones commonly fractured in the wrist

-The scaphoid bone is one of the more commonly fractured carpal bones. A fall on the outstretched hand may cause the scaphoid to fracture into two separate pieces. When this happens, only one of the two pieces maintains its blood supply. -A Colles fracture is a fracture of the distal radius. This type of fracture typically occurs when a person extends a hand (and thus the forearm is pronated) while trying to break a fall. The force of the fall on the outstretched hand fractures the distal radius, which is displaced posteriorly. The force can be transmitted via the interosseous membrane to the ulna and may also result in a distal ulna fracture.

List the actions normally allowed by the elbow joint

-flexion: biceps brachii, brachialis (anterior arm) -extension (radiohumeral joint); triceps brachii (posterior arm)

Specify the externally palpable features of the pelvis

-iliac crest -anterior superior iliac spine -pubic region

List the bones and bony regions that form each upper limb articulation

-scapulothoracic joint: the scapula does not directly articulate with the axial skeleton (movement is great and important) -acromioclavicular joint: axial rotation and anteroposterior movement. there are no muscles attached to this joint, so all movement is passive and initiated by the movement of other joints. Plane- synovial -sternoclavicular joint: only attachment of upper limb to axial skeleton Elevation - shrugging shoulders Depression - dropping shoulders Upward Rotation - jumping jack Downward Rotation - pull up Protraction - Bad posture, hunching Retraction - squeeze shoulder blades together Saddle Type- Synovial

Describe the functional and structural class of the joints in the upper limb

-structure: all synovial (hing, ball & socket, plane, pivot) -functional: all diarthrodial (vary in range of motion dramatically)

Identify the location of the following bones in anatomical terms: scapula, clavicle, humerus, ulna, radius, scaphoid, carpals, metacarpals, phalanges.

..

Specify the name of the ligament between the patella and tibia and the attachment point for this ligament on the tibia

...PATELLAR TENDON?

Match the features of the radius and ulna that articulate with the capitulum, trochlea, and olecranon fossa of the humerus

Capitulum: is located laterally and articulates with the head of the radius (proximal end) -Articulates with the radius and ulna at the elbow Trochlea: is located medially and articulates with the trochlear notch of the ulna Olecranon fossa: posterior depression that accommodates the olecranon of the ulna -Articulates with olecranon and forms the posterior "bump" of the elbow

Identify the joints involved in a shoulder separation and in a shoulder dislocation

Dislocation = articulating bones have separated. Most shoulder dislocations occur at the acromioclavicular joint or the glenohumoral joint. Shoulder separation = dislocation of acromioclavicular joint. The AC ligament can be torn or sprained and/ or the coracoclavicular ligament. The humerus head is dislocated anteriorly and inferiorly to the glenohumeral joint capsule. The humerus must be popped back into the glenoid cavity.

Compare the orientation of the great toe versus the thumb

Great toe is medial (hallux) thumb is lateral (pollex). Dorsum of the foot is the shoe lace side. Dorsum of the hand is the back of the hand. ANATOMICAL POSITION

List the actions normally allowed by the hip joint

Hip flexion: sagittal plane forward, The flexion of the hip depends on whether the knee is flexed. This relaxes the hamstring muscles and increases the range of flexion. Hip extension: sag plane backward, Extension is limited by the joint capsule and the iliofemoral ligament. o Hip abduction: frontal plane, away from midline o Hip adduction: frontal plane, towards midline o Hip lateral rotation: ant surface lat. Rot. o Hip medial rotation: ant surface med. Rot. o Circumduction= move in circle

List the normal actions allowed by the subtalar join

Joint between talus and calcaneus • Joint type= plane (gliding) joint Motions: • Inversion=sole of foot inward • Eversion= sole of foot turning outward

Describe the location of any regions of the skin that may be affected by carpal tunnel syndrome

Lateral region of the hand and the muscles that move the thumb

List the normal actions allowed by the talocural joint

Plantar flexion (point your toes, stand on ball of foot, gas pedal) o Dorsiflexion (heels down, toes up)

Specify the bony features of the radius and ulna that articulate to form the proximal and distal radioulnar joints

Proximal RU: head of radius and radial notch of ulna, near elbow Distal RU: head of ulna and ulnar notch of radius, near wrist

List the 4 muscles that make up the rotator cuff

SltS S- Supraspinatous : ABDUCTION (LIFT ARMS) Attach: Supraspinous fossa → Greater tubercle I-Infraspinatous: LATERAL ROTATION Attach: Infrapsinous fossa → Greater tubercle T- Teres Major: LATERAL ROTATION Attach: Inferior angle → Greater Tubercle S- Subscapularis: MEDIAL ROTATION Attach: Only anterior muscle: Subscapular fossa → Lesser tubercle *When you view subscapularis, it is behind the humerus

Specify the articulation that connects the pectoral girdle to the axial skeleton

Sternoclavicular joint- articulation between the manubrium of the sternum and the sternal end of the clavicle -gliding movement

Specify the tendon that contains the patella and the bone the patella articulates with

The articular capsule only encloses the medial, lateral and posterior regions of the knee joint. The Quadriceps femoris muscle tendon passes over the anterior surface of the patella; this tendon is embedded within this tendon. Sesmoid bone

Explain why the biceps brachii is a strong supinator compared to the brachialis, which does not supinate the arm.

The biceps brachii flexes the forearm and is a powerful supinator of the forearm when the elbow is flexed. (An example of this supination movement occurs when you tighten a screw with your right hand.) The tendon of the long head of the biceps brachii crosses the shoulder joint, and so this muscle helps flex the humerus as well (albeit weakly)

Describe how the muscles of the thumb (thenar group) are affected by carpal tunnel syndrome

The median nerve supplies the muscles of the thumb so they may atrophy as their nerve supply is diminished. Causes: • Tendonitis • Repetitive activity Symptoms: • Weak grip • Lose thumb opposition • Loss of sensation in lateral digits

Describe the primary actions of the muscles located in the anterior and posterior compartments of the forearm and identify the nerve(s) that innervate each compartment

anterior compartment: -flexion (wrist and fingers) -pronation (radioulnar joint)- pronator muscles - attach at medial epicondyle of humerus -innervated by median nerve posterior compartment: -extension in wrist and fingers -supination (radioulnar joint) -attack at lateral epicondyle -innervated by radial nerve

List the bones that make up the pectoral girdle

attaches upper limb to axial skeleton Clavicle and Scapula

3rd nerve

axillary nerve Wraps around the surgical neck of humerous (posterior) Motor: Deltoid Muscle Sensory: skin over deltoid/shoulder

what forms the carpal tunnel

carpal bones and flexor retinaculum

lateral (external) rotation

deltoid, infraspinatus

List the actions normally allowed by the knee joint

flexion and extension

Summarize the muscles that produce the following actions of the elbow joint

flexion: anterior compartment (at shoulder and elbow) -biceps brachii (elbow flex, shoulder/arm flex) -coracobrachialis (adduct, flex arm) extension: posterior compartment (shoulder and elbow) • Triceps brachii (TB)

common action of the posterior compartment of the thigh

flexors of the knee and extensors of the thigh

muscles that extend the hip joint

gluteus maximus, biceps femoris (LH), semitendinosus, semimembranosus (post. thigh)

muscles that medial rotates the hip joint

gluteus medius, gluteus minimus

what articulates with the iliofemoral ligament (ant and post) of the hip joint

head of femur

muscles in the anterior compartment of the thigh

iliopoas sartorius- crosses over the anterior thigh quadriceps femoris

muscles that flex the hip joint

iliopsoas, rectus femoris

List the 3 bones that fuse to form the hip bone (aka os coxae)

ilium, ischium, pubis

List the actions normally allowed at the glenohumeral joint (aka shoulder)

is a ball and socket articulation between the head of the humerus and the glenoid cavity of the scapula Flexion (forward) vs. extension (normal hands to side)- sag plane o Abduction (away from body) vs. adduction (towards body)- frontal plane o Medial rotation (moving bent arm towards middle of body vs. lateral rotation (moving bent arm away from body)

Describe the location of the brachial plexus and its anatomical relationships to the neck, first rib, and axilla

location: upper trunk and shoulder region, 'root' of the neck (axilla), deep to the clavicle Extend laterally from the neck, pass superior to the first rib, and then continue into the axilla. Each brachial plexus innervates the pectoral girdle and the entire upper limb of one side.

List the major ligaments that stabilize the ankle

medial (deltoid) ligament of ankle: reinforces joint medially - 4 parts; from tibia to tarsals -very strong lateral ligament of ankle: reinforces joint laterally -from fibula to tarsals

what structures are inside the carpal tunnel

medial nerve and 9 flexor tendons

4th nerve

median nerve Travels near BB and brachialis muscles and between the forearm flexor muscles Motor: Muscles in the anterior forearm, tenor muscles Sensory: skin on the lateral palm & lateral digits

1st terminal branch (nerve) that is formed

musculocutaneous nerve Travels between BB and brachialis muscle Motor: muscles in the arm anterior compartment of the arm. Sensory: skin on the lateral forearm.

Identify the common proximal attachment for the muscles located in the posterior and anterior compartments of the forearm

posterior: radial nerve anterior: median nerve

List the anterior rami that contribute to the brachial plexus

spinal nerves C5 to T1

Specify the anatomy involved in a dislocation of the radius "pulled elbow" and what population this occurs in

ubluxation or "pulled elbow" is an incomplete dislocation in which the contact between the bony joint surfaces is altered, but they are still in partial contact. The head of the radius is pulled out of the anular ligament. This injury is common and almost exclusively in children (younger than 5) because a child's anular ligament is thin and the head of the radius is not fully formed. Tip: The lower arm (radius bone) is pulled or slips out of its normal position at the elbow joint.

5th nerve

ulnar nerve Travels near BB and brachialis muscle and medially around medial epicondyle, travels between forearm flexor muscles. Motor: hypothenar muscles & other intrinsic hand muscles Sensory: skin on medial hand/palm and medial digits

what nerve is most likely to be damaged from a fracture in the medial epicondyle

ulnar nerve • At elbow "funny bone' • Causes; fractured medial epicondyle, it is compressed b/t medial epicondyle and an object • Symptoms: weak grip, numbness of medial 1.5 digits