Anatomy Lecture 1 Test 2: Thieme Chapters 13, 14, 15, 16

Flexion at PIP (proximal interphalanges)

Flexor digitorum profundus

Flexion at DIP

Flexor digitorum superficialis

Extension of PIP

Extensor digitorum

femoral nerve innervates

ANTERIOR COMPARTMENT of thigh (pectineus, sartorius, quads)

Tibial nerve injury

Tibial nerve injury is unusual because the nerve is well protected in the thigh and posterior leg. Injury in the gluteal region results in the following: - Impaired extension of the hip - Loss of flexion of the knee In the popliteal fossa, it can be affected by aneurysms of the popliteal artery and knee trauma. These can cause the following: - Loss of plantar flexion at the ankle - Loss of plantar flexion, abduction, and adduction of the digits - Loss of eversion of the foot - Weakened inversion of the foot - Loss of sensation on the posterolateral leg to the lateral malleolus, the sole and lateral side of the foot - A shuffling gait with clawing of the toes

triceps surae

gastrocnemius and soleus

pes anserine

medial of tibia, insertion for Sartorius,Gracilis,semitendinosus (SGT)

flexor digitorum brevis

medial plantar nerve

pes anserinus

sartorius, gracilis, semitendinosus (SGT)

Psoas and iliacus muscles

FEMORAL nerve runs btw

Coccygeus

supports pelvic organs. attaches to sacrospinous ligament

posterior deep compartment

tibialis posterior flexor digitorum longus flexor hallucis longus

Joints of the knee

tibiofemoral and patellofemoral modified hinge joint

anterior TALOfibular ligament

Inversion sprain, "Low ankle sprain", most common

sensory radial branches

Its sensory branches of the arm include the posterior brachial cutaneous and inferior lateral brachial cutaneous nerves.

Retinaculum of the ankle

-Strong fibrous retaining band/sheath -Enclosed within a synovial sheath

medial and lateral plantar nerve

cutaneous and motor; skin of 4th and 5th digits, sole of foot, motor foot muscle

Blood supply of lower limb

femoral artery

floor of femoral triangle

iliopsoas and pectineus

superficial fibular nerve

innervates LATERAL compartment of leg

superficial fibular nerve

innervates LATERIAL compartment of leg: peroneal longus and brevis

obturatur nerve

innervates MEDIAL COMPARTMENT (adductor group, gracilis)

radial nerve deep branch

innervation of extensor carpi radialis brevis The deep branch becomes the posterior interosseous nerve as it circles around the radius into the posterior forearm compartment. It innervates all muscles of this compartment.

lesser trochanter of femur

insertion of psoas major

iliotibial tract

insertion of tensor fasciae latae

popliteus muscle

inserts with achilles tendon flexion of knee internal rotation of flexed knee

Navicular

shaped like a boat

vagus nerve

the tenth cranial nerve that innervates digestive organs, heart and other areas. =parasympathetic

medial meniscus

Cartilage in the knee between the femoral condyle and the medial tibial plateau

extensor retinaculum innervation

Extensor tendons from forearm pass deep to this. Radial nerve innervation

carpometacarpal joint function

abduct, adduct, flex metacarpals

gluteus medius

abducts thigh

tensor fasciae latae

abducts/flex thigh Attaches to iliac crest and inserts into iliotibial tract Innervation by superior gluteal nerve (L4,5)

calcaneofibular ligament

an ankle ligament that connects the fibula to the calcaneus

plantar fasciitis

an inflammation of the plantar fascia on the sole of the foot

palmar and dorsal CARPAL arteries

anastomose with branches of the ULNAR artery in the wrist and hand

talocrural joint

ankle joint; articulation between the talus bone of the foot and medial malleolus of the tibia, distal tibia, and lateral malleolus of the fibula; a uniaxial hinge joint that allows only for dorsiflexion and plantar flexion of the foot

Pectineus

anterior compartment

ACL

anterior cruciate ligament of the knee medial to tibial tuberosity prevents anterior translation of tibia on femur more common/activity related

Femoral hernias

Femoral hernias (usually of the small intestine) pass through the femoral ring and femoral canal and appear in the femoral triangle INFERIOR and lateral to the pubic tubercle (below the inguinal ligament). They should be distinguished from inguinal hernias, which occur superior and lateral to the pubic tubercle (above the inguinal ligament).

hip joint bones

Femur and acetabulum

valgus force

Force from the lateral side that causes the knee to go into the valgus position MCL damaged

obturator artery

MEDIAL portion of anterior compartment Origin: Internal Iliac Artery, Course: Passes along lateral pelvic wall to superior part of obturator foramen Passes through obturator canal to reach medial thigh

internal iliac artery

Main artery of the pelvis

Trendelenburg sign

Occurs with severe subluxation of one hip When the child stands on the good leg, the pelvis looks level. When the child stands on the affected leg the pelvis drops toward the good side Collapse of the pelvis to the unsupported side due to weakness or paralysis of gluteus medius "Waddling gait", seen in Duchenne's Muscular Dystrophy, other muscular dystrophies, and congenital hip dysplasia

Posterior drawer sign

PCL tear

Swan neck deformity

PIP hyperextension and DIP flexion extensortendon sheaths contract in rheumatoid arthritis

Bouchard's nodes

PIP swelling

tibial nerve

POSTERIOR compartment of thigh, leg, plantar foot. A division of the sciatic nerve that passes behind the knee. It subdivides and supplies impulses to the knee, the muscles of the calf, the skin of the leg, and the sole, heel, and underside of the toes.

Impairment of motor function occurs only in

PROXIMAL compression or injury, e.g. radial tunnel syndrome.

adduct MCP

Palmer interossei (digits 2, 4, and 5 only)

Femoral neck fracture

Surrounded by anastomases, majority by medial circumflex femoral artery= leads to avascular necrosis of femoral head. women>60 osteoporosis

Tarsal Tunnel Syndrome=TIBIAL

compression of the TIBIAL nerve in the tarsal tunnel burning pain, numb, tingling to heel.

tibfib fracture, compartment syndrome

compromises blood flow-affects dorsal pedal and anterior tibial A Treatment is prompt surgery to decompress the compartment by making long cuts through the fascia (fasciotomy).

sacrospinous ligament

connects sacrum to ischial spine coccygeus muscle attaches to entire ligament

plantar reflex

elicited touching the soles of the feet. toes curl downward. (birth to 8 months)

small saphenous vein

empties into the popliteal vein; ascends along the lateral side of foot and posterior calf

Dorsal carpal synovial tendon sheaths

enclose the extensor tendons as they pass through the dorsal compartments.

extensor hallucis longus

extends great toe

rectus femoris

extends leg and flexes thigh. crosses knee

extensor digitorum longus

extends toes

extensor digitorum longus

extends toes and dorsiflexes foot

act on index finger

extensor indicis

external iliac artery

external iliac artery. becomes femoral artery once enters femoral triangle

femoral triangle contents

femoral nerve, femoral artery, femoral vein (NAV-L) (lat->med)

popliteal travels through adductor hiatus and becomes

femoral vein

Boutonniere ("Buttonhole") Deformity

flexion of PIP and extension of DIP due to tearing of primary attachment of EDtendon to dorsum of middle phalanx

Extensor Halicus Longus

functions to extend the big toe, dorsiflex the foot (bc crosses ankle)

posterior superficial compartment

gastrocnemius, soleus, plantaris

femoral triangle

inguinal ligament, adductor longus, sartorius

femoral triangle

inguinal ligament, sartorius, adductor longus (ISA)

Femoral hernia of the inguinal region

intestines push through femoral triangle, more common in females=strangulated hernia- cannot excrete waste bowel dies and becomes sepsis and wall becomes ischemic

Subtalar Tarsal Joint

inversion/eversion

popliteal artery

once femoral passes through adductor canal (haiatus), it becomes popliteal

anterior inferior iliac spine (AIIS)

origin of rectus femoris

five P's to describe S/S of compartment syndrome

pain pallow pulselessness paresthesia paralysis leg is shiny, tight, pale, swollen= compresses blood vessels/nerves in leg for example: posterior tibial n

Pectinius Insertion

pectineal line of femur

femoral vein passes adductor haitus and becomes

popliteal vein

ball and socket joint

shoulder and hip head of femur at acetabulum

false pelvis

superior to pelvic brim

medial femoral circumflex artery

supplies most of the blood to the neck and head of the femur. branches from produnda femoris. anastomosis- connects inferior gluteal artery to supply blood to fem head and neck

internal pudendal artery

supplies perineum branch of the anterior division of the internal iliac artery

fibular artery

supplies the lateral compartment of the leg

anterior superior iliac spine (ASIS)

where sartorious and lateral hip muscle (tensor fascia lata) originate

soleus

plantar flexion

gracilis

adducts thigh

obturator internus

laterally rotates thigh

muscles of calf

soleus is deep to gastracnemius

Gastrocnemius

assists biceps femoris in flexion of knee

gluetus maximus

extends hip

tibial tuberosity

point where the patellar ligament attaches

ankle mortise

"hinge" that connects the ends of the tibia and fibula to the talus. STABLE joint

popliteus action

"unlocks" extended knee to initiate knee flexion by internal rotation of the tibia (normal) or external rotation of femur (reverse)

anterior knee pain

- commonest knee pain - mostly patellofemoral dysfunction -Osgood Schlatter's Disease -pes anserine bursitis -ITB Friction syndrome

Ankle joint (talocrural joint)

- hinge or ginglymus-type joint - talus, distal tibia, and distal fibula

Levator ani muscle group

- located in pelvic diaphragm - innervated by n. to pelvic diaphragm - ilicoccygeus - pubococcygeus - puborectalis

Peroneus Tertius

-Origin distal anterior surface of the fibula also the interosseous membrane -Insertion dorsal surface of metatarsal 5 -Nerve *deep fibular nerve* -Actions *dorsiflexion and eversion of the foot*

Knee Joint Ligaments

-extracapsular ligaments: located outside the capsule -capsular ligaments: attached to the capsule -intracapsular ligaments: located internal to the capsule

Gracilis (origin, insertion, action) (part of SGT pes anserinus)

-origin: ischioPUBIC ramus -insertion: medial proximal tibia (pes anserinus) -action: hip ADduction

subtalar joint axis

-very oblique; a little bit of x, y, & z -supination is a combination of inversion, adduction, & PF -pronation is a combination of eversion, abduction, & DF

plantarflexion/dorsiflexion

Extension/flexion of the ankle

1. During a practice match, a heavyweight prizefighter endured an illegal hit to the left flank. Following the match, a focused assessment with sonography for trauma (FAST) exam revealed that blood from a renal laceration had tracked inferiorly and accumulated in the groove between the psoas major and iliacus muscles. What nerve would you expect to be irritated by blood in this location? A. Sciatic B. Femoral C. Obturator D. Superior gluteal E. Lateral femoral cutaneous

1. B The femoral nerve runs in the groove between the psoas and iliacus muscles A The blood accumulated above the pelvic brim in a muscular pocket of the false pelvis. The sciatic nerve does not pass through the false pelvis. C The obturator nerve passes medial to the psoas muscle and not in the groove between the psoas and iliacus muscles. D The superior gluteal nerve is a branch of the sacral plexus and does not pass through the false pelvis where the blood accumulated. E The lateral femoral cutaneous nerve crosses the iliacus muscle in the iliac fossa and passes under the inguinal ligament close to the anterior superior iliac spine to innervate the skin of the lateral thigh.

anterior compartment of leg

1. quadriceps group: rectus femoris, vastus lateralis, vastus intermedius, vastus medialis 2. sartorius 3. pectineus

2. Which one of the following statements best describes the muscles of the pelvis? A. The obturator internus muscle leaves the pelvis through the greater sciatic foramen. B. The levator ani muscle is composed of the pubococcygeus, puborectalis, and iliococcygeus. C. The pelvic diaphragm is a sling of muscle that separates the true pelvis from the false pelvis.

2. B The levator ani muscle is composed of the pubococcygeus, puborectalis, and iliococcygeus muscles A The obturator internus muscle covers the sidewall of the pelvis and perineum. Its tendon passes from the perineum to the gluteal region through the lesser sciatic foramen. C The pelvic diaphragm separates the true pelvis from the perineum, which lies below it. D The piriformis muscle forms the posterior muscular wall of the pelvis. E The coccygeus muscle attaches to the sacrospinous ligament along its entire length.

24. The inferior gluteal nerve innervates the A. gluteus maximus B. gluteus medius C. gluteus minimus D. piriformis E. All of the above

24. A The inferior gluteal nerve innervates only the gluteus maximus muscle B The superior gluteal nerve innervates the gluteus medius and minimus and tensor of the fascia lata. C The superior gluteal nerve innervates the gluteus medius and minimus and tensor of the fascia lata. D The piriformis is innervated by the S1 and S2 branches of the sacral plexus. E B, C, and D are incorrect

25. Which of the following muscles insert on the iliotibial tract? A. Gluteus maximus B. Gluteus medius C. Gluteus minimus D. Quadratus femoris E. None of the above

25. A The upper fibers of the gluteus maximus insert onto the iliotibial tract (Section 16.2). B Gluteus medius inserts onto the lateral surface of the greater trochanter of the femur. C Gluteus minimus inserts onto the anterolateral surface of the greater trochanter of the femur. D Quadratus femoris inserts onto the intertrochanteric crest of the femur. E Not applicable.

26. Your 13-year-old son who studies martial arts is particularly flexible and is praised for his high kicks. After several weeks of training in preparation for an upcoming tournament, he complains of tenderness in his lower buttocks during practice and even when he sits on the hard stadium benches. As his pediatrician, how do you explain his problem? A. Inflammation of the ischial tuberosity B. Rupture of the obturator internus tendon from its insertion C. Compression of the sciatic nerve in the gluteal region D. Irritation of the tibial nerve in the thigh E. Irritation of the inferior gluteal nerve

26. A The hamstring muscles originate at the ischial tuberosity and insert on the tibia and fibula. Repetitive stretching of these muscles over two joints (the flexed hip and extended knee) can irritate the site of origin B Pain from a tear at the insertion site of the obturator internus tendon would be focused over the greater trochanter of the femur. C The sciatic nerve emerges from behind the piriformis muscle and can be compressed at this location. However, pain would reflect the sensory areas of the tibial and common fibular nerves, which include the anterolateral and posterior leg and the dorsum and lateral edge of the foot. D Irritation of the tibial nerve would manifest as pain in the sole of the foot. E The inferior gluteal nerve does not have a sensory component. Injury to the nerve would affect the gluteus maximus muscle and manifest as weakened extension and lateral rotation.

29. An 18-year-old marathon runner finished fourth in the Detroit marathon but limped away from the finish line. He had been suffering from excruciating pain on the sole of his foot and immediately sought advice from the medical volunteers. Following a thorough exam, the EMTs explained that the muscle tendons running through his tarsal tunnel had swollen and were compressing the nerve that accompanies them. What bones form the wall of this tunnel? A. Navicular and talus B. Cuboid and calcaneus C. Talus and calcaneus D. Medial malleolus of the tibia and calcaneus E. Talus and base of the 1st metatarsal

29. D The tarsal tunnel is formed by the flexor retinaculum and its attachments to the calcaneus and medial malleolus of the tibia A The navicular and talus lie distal to the tarsal tunnel, and neither provide attachment for the flexor retinaculum, which forms the roof of the tunnel. B The cuboid lies on the lateral side of the foot; the tarsal tunnel lies on the medial side of the ankle. C The talus is not part of the tarsal tunnel. E Neither the talus nor the 1st metatarsal is part of the tarsal tunnel.

3. Typically, the posterior division of the internal iliac artery supplies A. structures of the perineum B. muscles of the medial thigh C. meninges of the sacral spinal roots D. uterus and uterine tubes E. prostate

3. C The posterior division supplies parietal branches to the posterior abdominal wall, some gluteal muscles, and the meninges of the sacral spinal roots A The internal pudendal artery, a branch of the anterior division of the internal iliac artery, supplies most structures of the perineum. B The obturator artery, a branch of the anterior division of the internal iliac artery, supplies muscles of the medial thigh. D The uterine artery, a branch of the anterior division of the internal iliac artery, supplies the uterus and uterine tubes. E The prostatic arteries, usually branches of the inferior vesical arteries, are derived from the anterior division of the internal iliac artery.

4. The components of the pelvic splanchnic nerves are most similar to the components of the A. lumbar splanchnic nerves B. sacral splanchnic nerves C. pudendal nerve D. vagus nerve E. hypogastric nerves

4. D The pelvic splanchnic nerves represent the sacral component of the parasympathetic system; the vagus nerve represents the cranial component of the parasympathetic system A Lumbar splanchnic nerves arise from the lumbar sympathetic trunk and carry postganglionic sympathetic fibers. B Sacral splanchnic nerves arise from the sacral sympathetic trunk and carry postganglionic sympathetic fibers. C The pudendal nerve nerve arises from the sacral plexus and carries somatic sensory and motor fibers. E Hypogastric nerves derive from the superior hypogastric plexus carrying postganglionic sympathetic fibers to the pelvic plexus.

4 dorsal metacarpal arteries run along the metacarpals and then divide into

8 dorsal digital arteries

16. The adductor magnus muscle A. extends and adducts the hip joint B. is innervated by the femoral and obturator nerves C. inserts on the linea aspera of the femur and adductor tubercle of the tibia D. forms the anterior wall of the adductor canal E. originates from the superior pubic ramus

A The adductor magnus is the largest adductor of the hip but also works with the gluteus maximus to provide powerful extension of the hip joint (Section 16.4a). B The adductor magnus has a dual innervation, the obturator and tibial nerves. C The adductor magnus inserts entirely on the femur; the adductor tubercle is a feature on the distal femur. D The adductor canal passes between the anterior and medial thigh compartments. The vastus medialis forms the anterior wall, and the adductor muscles form the posterior wall. E The adductor magnus originates on the ischiopubic ramus, which includes the inferior pubic ramus and ischial ramus.

The inferior gluteal nerve innervates the A. gluteus maximus B. gluteus medius C. gluteus minimus D. piriformis E. All of the above

A The inferior gluteal nerve innervates only the gluteus maximus muscle B The superior gluteal nerve innervates the gluteus medius and minimus and tensor of the fascia lata. C The superior gluteal nerve innervates the gluteus medius and minimus and tensor of the fascia lata. D The piriformis is innervated by the S1 and S2 branches of the sacral plexus.

20. Which fibrous structure on the sole of the foot originates at the calcaneus and continues distally as digital fibrous sheaths? A. Plantar aponeurosis B. Plantar calcaneonavicular ligament C. Long plantar ligament D. Short plantar ligament E. Deltoid ligament

A The plantar aponeurosis is a thick fibrous band on the sole that is continuous with the deep fascia of the leg B The plantar calcaneonavicular ligament, or spring ligament, supports the head of the talus and maintains the medial side of the longitudinal arch of the foot. C The long plantar ligament supports the lateral side of the longitudinal arch of the foot and extends from the calcaneus to the bases of the 1st, 2nd, and 3rd metatarsals. D The short plantar ligament, or plantar calcaneocuboid ligament, supports the lateral arch of the foot. E The deltoid ligament is a four-part ligament that supports the medial side of the ankle joint.

30. An experienced 24-year-old backpacker has spent the last 4 months hiking the entire Appalachian trail. Although he has sturdy hiking boots, he often changes to the lightweight sneakers he brought as a backup. For the last few miles of the trek, he's been experiencing shooting pain along the side of his foot at the apex of his medial arch. What structure is probably the cause of the pain? A. Plantar calcaneonavicular (spring) ligament B. Deltoid ligament C. Posterior talofibular ligament D. Superior extensor retinaculm E. Tendon of fibularis longus Answers and Explanations

A The plantar calcaneonavicular ligament supports the head of the talus, which forms the apex of the medial longitudinal arch B The deltoid ligament is the collateral ligament on the medial side of the ankle. It is not associated with the medial arch. C The posterior talofibular ligament is part of the lateral ligament of the ankle and is not associated with the medial arch. D The superior extensor retinaculum restrains the tendons on the dorsum of the foot (dorsiflexors). E The tendon of the fibularis longus supports the transverse arch on the lateral side of the sole of the foot.

Which of the following muscles insert on the iliotibial tract? A. Gluteus maximus B. Gluteus medius C. Gluteus minimus D. Quadratus femoris E. None of the above

A The upper fibers of the gluteus maximus insert onto the iliotibial tract B Gluteus medius inserts onto the lateral surface of the greater trochanter of the femur. C Gluteus minimus inserts onto the anterolateral surface of the greater trochanter of the femur. D Quadratus femoris inserts onto the intertrochanteric crest of the femur.

deep vein thrombosis (DVT)

A blood clot in a deep vein, most often extremity like thigh or leg occludes blood flow back to heart and lungs= swelling is distal to clot (redness, pain) can be life threatening (part of clot thombus can break off and go back to lungs= pulmonary embolism)

Radiocarpal joint (wrist)

A condyloid (ellipsoid) synovial joint Located at level of radial and ulnar styloid processes (proximal wrist crease) Joint is between radius and scaphoid + lunate + triquetrum Flexion and adduction of the wrist

Ligamentous Injuries of Knee

A forceful blow to the lateral side of the knee can strain the medial collateral ligament and, because of their intimate relationship, tear the medial meniscus as well. A similar injury can result from excessive lateral rotation of the knee and is often accompanied by rupture of the anterior cruciate ligament (often called the "unhappy triad").

Anterior drawer sign

ACL tear

medial compartment of thigh

ADDUCT thigh. adductor longus, adductor brevis, adductor magnus, pectineus, gracilis

Ilipsoas

ANTERIOR comp. flexes hip (ilium, sacrum, tendon of psoas major)

Acquired hip dislocation

Acquired hip dislocation usually occurs as a result of trauma that causes the femoral head to be displaced out of the acetabulum; anterior dislocations are rare, but posterior dislocations are common. Typically, in a head-on motor vehicle accident, the knees strike the dashboard, forcing the femoral head posteriorly through the joint capsule and onto the lateral surface of the ilium. The affected limb appears shortened and internally rotated. The sciatic nerve is particularly vulnerable to injury in these cases.

Genu Varum and Genu Valgum

Although the femur lies diagonally within the thigh, the tibia is nearly vertical in the leg. This creates a Q angle at the knee between the long axes of the two bones. The angle varies with developmental stage and sex, but it can also be altered by disease. Normally, the head of the femur sits over the center of the knee joint, distributing weight evenly on the tibial plateau. In genu varum (bowleg), the Q angle is smaller than normal because the femur is more vertical. This increases the weight on the medial side of the knee, putting additional stress on the medial meniscus and medial (tibial) collateral ligament. When standing upright with feet and ankles together, the knees are wide apart. In genu valgum (knock knee), the Q angle is larger because the femur is more diagonal. Greater weight is put on the lateral side of the knee, stressing the lateral meniscus and lateral (fibular) collateral ligament. In the upright position, the knees touch, but the ankles do not.

13. "Footdrop" occurs when the plantar flexor muscles are unopposed. This condition may be caused by damage to which of the following nerves? A. Superficial fibular B. Deep fibular C. Sural D. Tibial E. Medial plantar

B Footdrop is caused by an injury to the deep (or common) fibular nerve causing paralysis of the dorsiflexor muscles in the foot, leaving the plantar flexor muscles unopposed (Section 15.4d). A Injury to the superficial fibular nerve will result in an inability to evert the foot and therefore an overall loss of balance and loss of sensation on the dorsum of the foot. C Injury to the sural nerve will cause loss of sensation over the skin on the lateral side of the foot. D Injury to the tibial nerve would cause paralysis of all of the muscles of the posterior thigh (except the short head of the biceps femoris) and posterior leg. E Injury to the medial plantar nerve will cause paralysis of the muscles on the medial side of the foot and loss of sensation over a large area of skin on the medial side of the foot and the medial three and a half digits.

21. A man was on a hunting trip with friends when he was accidentally shot in the midthigh. He bled profusely from his femoral artery until his friends applied constant pressure over the wound and drove him to a local emergency clinic. Although examination of the wound site in surgery revealed a badly torn femoral artery, the man continued to have distal pulses in his leg. What vessel arises proximal to the injury site and can provide collateral blood supply to the distal limb? A. Medial circumflex femoral artery B. Lateral circumflex femoral artery C. Obturator artery D. Descending genicular artery E. Popliteal artery

B The lateral circumflex femoral artery arises from the deep artery of the thigh in the proximal thigh. It supplies structures around the hip as well as a descending branch that anastomoses with the genicular arteries at the knee. Reverse flow in these branches could supply the popliteal artery and its branches in the leg (Section 15.4a). A The medial circumflex femoral artery arises from the deep artery of the thigh and supplies the hip joint. It does not anastomose with the popliteal artery or other branches of the knee and leg. C The obturator artery supplies the medial compartment of the thigh and does not anastomose with vessels of the leg. D The descending genicular artery is a branch of the femoral artery, but it arises distal to the site of injury and therefore cannot provide collateral circulation. E The popliteal artery anastomoses with the proximal femoral artery only through the lateral circumflex femoral artery

11. The deep plantar arch of the foot is an anastomosis between the dorsal pedal artery and the following structure on the sole of the foot: A. Fibular artery B. Lateral plantar artery C. Plantar metatarsal arteries D. Plantar digital arteries E. Arcuate artery

B The lateral plantar artery, similar to the ulnar artery in the hand, is the largest branch of the posterior tibial artery. It supplies the lateral side of the foot and forms the deep plantar arch with the dorsal pedal artery A The fibular artery supplies muscles in the posterior and lateral compartments of the leg and forms an anastomosis with the anterior tibial artery at the ankle, but it has no branches on the sole of the foot. C The plantar metatarsal arteries arise from the deep plantar arch. D Proper digital arteries arise from the plantar metatarsal arteries, which are branches of the deep plantar arch. E The arcuate artery, a branch of the dorsal pedal artery, forms a loop on the dorsum of the foot and supplies the 2nd, 3rd, and 4th dorsal metatarsal arteries.

18. During a street fight between two local gangs, one boy received a violent blow to the anterior knee that knocked him to the ground. In the emergency department, the physical exam of his knee revealed a positive posterior drawer sign. What structure appears to be injured? A. Anterior cruciate ligament B. Posterior cruciate ligament C. Patellar ligament D. Medial collateral ligament E. Lateral collateral ligament

B The posterior displacement of the tibia is a positive posterior drawer sign that indicates an injury to the posterior cruciate ligament A Injury to the anterior cruciate ligament is recognized by the positive anterior drawer sign in which the tibia can be pulled anteriorly from under the femur. C A positive drawer sign suggests anterior or posterior displacement of the tibia relative to the femur. Rupture of the patellar ligament destabilizes the knee joint but does not disrupt the alignment of the tibia and femur. D Although the medial collateral ligament may be damaged by a forceful blow, it is not diagnosed by a posterior drawer sign. E The lateral collateral ligament is unlikely to be damaged by a blow to the anterior knee and is not diagnosed by either anterior or posterior drawer signs.

The radial nerve is most vulnerable to injury from a midhumeral fracture where the nerve courses along the radial groove.

Because radial branches to the triceps brachii are usually proximal to the injury, elbow flexion is unaffected. Other effects include the following: • Loss of wrist extension • Loss of extension at the metacarpophalangeal (MCP) joints • Weakened pronation • Flexed wrist and fingers producing the "wrist drop" position

A young girl has recovered well from the severe injuries she sustained in a motor vehicle accident 9 months ago, but because of some lingering nerve problems, she still has difficulty walking. She is balanced during the midstance phase but has difficulty bringing her limb forward to initiate movement. What nerve seems to be affected? A. Superior gluteal B. Inferior gluteal C. Femoral D. Obturator E. Tibial

C Forward movement at the beginning of the swing phase depends on the action of her hip flexors, particularly the rectus femoris, which is innervated by the femoral nerve A The superior gluteal nerve innervates the abductors of the hip. Damage to this nerve would cause a sagging of the hip on the contralateral side just before the midstance. B The inferior gluteal nerve innervates the gluteus maximus. Injury to this nerve would affect the deceleration of the swing phase. D Injury to the obturator nerve, which innervates the adductors of the hip, would cause an outward swing of the limb but would not inhibit acceleration of the thigh. E The tibial nerve innervates the hamstring muscles of the posterior thigh, which are responsible for the deceleration at the end of the swing phase.

10. The dorsal pedal artery is a continuation of the A. posterior tibial artery B. fibular artery C. anterior tibial artery D. popliteal artery E. inferior medial genicular artery

C The anterior tibial artery descends within the anterior crural compartment and emerges onto the dorsum of the foot as the dorsal pedal artery (Section 15.4a). A The posterior tibial artery descends within posterior crural compartment and branches into the medial plantar and lateral plantar arteries that supply the sole of the foot. B The fibular artery arises in the lateral part of the posterior leg and anastomoses with the anterior tibial artery to supply the ankle. D The popliteal artery lies posterior to the knee. It gives rise to the genicular and tibial arteries. E The inferior medial genicular artery is a branch of the popliteal artery and supplies blood to the patella and insertions of the sartorius, gracilis, and semitendinosus.

28. The lateral border of the femoral triangle is formed by the A. tensor fasciae latae B. femoral nerve C. sartorius D. adductor longus E. rectus femoris

C The borders of the femoral triangle are the sartorius, adductor longus, and inguinal ligament A The tensor fasciae latae is the lateral boundary of the anterior thigh. The femoral triangle lies between the anterior and medial thigh compartments. B The femoral nerve is one of the contents (lateral) of the femoral triangle but not a boundary. D The adductor longus is the medial border of the triangle. E The rectus femoris is lateral to the femoral triangle and lies inside the anterior compartment of the thigh

8. Sensation along the lateral side of the first toe is transmitted by branches of the A. saphenous nerve B. medial plantar nerve C. deep fibular nerve D. superficial fibular nerve E. lateral plantar nerve

C The deep fibular nerve, a branch of the common fibular nerve, supplies cutaneous innervation to the first web space, including the skin adjacent to the first and second digits. It also supplies motor innervation to the muscles of the anterior compartment of the leg (Section 15.4d). A The saphenous nerve transmits sensation from the medial side of the foot. B The medial plantar branch of the tibial nerve supplies cutaneous innervation to a large area of skin on the medial side of the foot and the medial three and a half digits. D The superficial fibular nerve supplies cutaneous innervation to the dorsum of the foot. E The lateral plantar branch supplies cutaneous innervation to the lateral foot and the lateral one and a half digits.

3. Structures at the knee that are not attached to the joint capsule include the A.medial meniscus B. medial collateral ligament C. lateral collateral ligament D. patellar retinacula E. All of the above (A-D) are attached to the joint cavity.

C The lateral (fibular) collateral ligament is an extracapsular ligament that extends from the lateral epicondyle of the femur to the head of the fibula and remains separate from the joint capsule of the knee A The medial and lateral menisci attach along their outer rims to the joint capsule. B The medial (tibial) collateral ligament is a capsular ligament that extends from the medial epicondyle of the femur to the medial condyle and superior part of the medial tibia. It attaches to the joint capsule and to the medial meniscus. D The patellar retinacula are fibrous expansions of the tendons of the quadriceps femoris muscle. They form the joint capsule on either side of the patella. E Only the lateral (fibular) collateral ligament (C) is correct.

5. An elderly woman shopping with her daughter fell in the mall parking lot. After examining the woman, the paramedics who responded to the call noted that the limb was pulled upward, and the hip was rotated laterally. They confided to the daughter that it appeared that the woman had fractured her femoral neck. Which of the following muscles would be responsible for the lateral (external) rotation? A. Gluteus medius B. Tensor of the fascia lata C. Pectineus D. Vastus lateralis E. All of the above

C The pectineus in the medial thigh compartment adducts and laterally rotates the hip A The gluteus medius is an abductor of the hip. B The tensor fascia lata abducts, flexes, and internally rotates the hip. D The vastus lateralis extends the knee and has no influence over the hip joint.

7. A young man running on the beach severely lacerated his foot when he accidentally stepped into a pit with broken glass left by late-night partygoers. Surgery was required to remove the glass fragments and treat the lacerations. You opt to use regional anesthesia, injecting anesthetic near each of the nerves that cross the ankle. Where would you anesthetize the sural nerve? A. Anterior to the medial malleolus B. Posterior to the medial malleolus C. Posterior to the lateral malleolus D. Anterior to the lateral malleolus E. First web space

C The sural nerve innervates the lateral side of the foot and runs POSTERIOR to the lateral malleolus A The saphenous nerve runs anterior to the medial malleolus. B The tibial nerve courses through the tarsal tunnel posterior to the medial malleolus. D The superficial fibular nerve runs onto the dorsum of the foot anterior to the lateral malleolus. E The deep fibular nerve accompanies the dorsal pedal artery onto the dorsum of the foot. It innervates the skin of the first web space.

Menisci of the knee

C shaped disks Prevent side to side rocking Medial and Lateral

congenital hip dislocation

Congenital hip dislocation (also known as hip dysplasia) is a common problem that occurs when the femoral head is not properly seated in the acetabulum. Hip abduction is impaired, and, since the femoral head sits higher than normal, the affected limb is shorter than the contralateral limb, resulting in a positive Trendelenburg test. In routine neonatal screenings, a dislocated hip will "click" when it is adducted and pushed posteriorly.

14. As she was riding her bike home from her job as a camp counselor, Kristin was sideswiped by a large pickup trunk. She suffered multiple bruises, a fractured tibia, and a fractured pelvis. Several months later she still had an area of numbness on the medial side of her thigh and walked with a lateral swing to her gait. Which muscle was affected by her injury? A. Gluteus medius B. Gluteus maximus C. Semimembranosus D. Adductor longus E. Rectus femoris

D A lateral swinging gait is caused by unopposed hip abduction, which occurs when the adductors are paralyzed. The obturator nerve innervates the adductor muscles of the thigh and can be injured by pelvic fractures. The area of numbness on the medial thigh also suggests an obturator nerve injury A The gluteus medius is an abductor of the hip. Injury to this muscle would result in a gluteal, or waddling, gait. B The injury to the inferior gluteal nerve, which innervates the gluteus maximus, would impair extension of the hip but would not cause any sensory loss. C Injury to the semimembranosus or its nerve, the tibial nerve, would impair hip extension, knee flexion, and sensation on the sole of the foot. E Injury to the femoral nerve, which innervates the rectus femoris, would weaken flexion of the hip and extension of the knee. There would be a sensory loss from the anterior thigh and the medial side of the leg and foot.

22. An elderly woman slipped on a patch of ice in her driveway when she went to pick up the morning newspaper. Her neighbor witnessed the accident and called an ambulance. In the ER, X-rays revealed that she had fractured the neck of her femur. Her physician explained to her that avascular necrosis was a common complication of this injury in elderly women and convinced her to agree to a hip replacement. What vessel contributes most significantly to the blood supply of the hip joint? A. Obturator B. Superior gluteal C. Inferior gluteal D. Medial circumflex femoral E. Lateral circumflex femoral

D Although the medial and lateral circumflex femoral arteries and inferior gluteal artery anastomose around the hip, branches that supply the hip joint arise primarily from the medial circumflex femoral artery A The obturator artery supplies the medial thigh muscles and a small artery to the head of the femur. It is not a significant blood supply to the joint. B The superior gluteal artery supplies muscles of the gluteal region but does not supply the hip joint. C The inferior gluteal artery contributes to an anastomosis around the hip and primarily supplies muscles of the gluteal region. E The lateral circumflex femoral artery anastomoses with the medial circumflex artery around the femoral neck, but it contributes less to the hip joint and more to the muscles of the lateral thigh.

22. An elderly woman slipped on a patch of ice in her driveway when she went to pick up the morning newspaper. Her neighbor witnessed the accident and called an ambulance. In the ER, X-rays revealed that she had fractured the neck of her femur. Her physician explained to her that avascular necrosis was a common complication of this injury in elderly women and convinced her to agree to a hip replacement. What vessel contributes most significantly to the blood supply of the hip joint? A. Obturator B. Superior gluteal C. Inferior gluteal D. Medial circumflex femoral E. Lateral circumflex femoral

D Although the medial and lateral circumflex femoral arteries and inferior gluteal artery anastomose around the hip, branches that supply the hip joint arise primarily from the medial circumflex femoral artery A The obturator artery supplies the medial thigh muscles and a small artery to the head of the femur. It is not a significant blood supply to the joint. B The superior gluteal artery supplies muscles of the gluteal region but does not supply the hip joint. C The inferior gluteal artery contributes to an anastomosis around the hip and primarily supplies muscles of the gluteal region. E The lateral circumflex femoral artery anastomoses with the medial circumflex artery around the femoral neck, but it contributes less to the hip joint and more to the muscles of the lateral thigh. 23. E The femoral nerve enters the anterior thigh through

9. Superficial veins of the lower limb A. lie deep to the fascia lata B. include the great saphenous vein that terminates at the popliteal vein C. include the small saphenous vein whose course runs anterior to the lateral malleolus D. drain to deep veins via perforating veins E. originate from the plantar venous arch on the sole

D Similar to superficial veins of the upper limb, superficial veins of the lower limb drain to deep veins via perforating veins A Superficial veins lie in the subcutaneous tissue, superficial to the deep fascia (fascia lata). B The great saphenous vein pierces the fascia lata at the saphenous hiatus in the proximal thigh and terminates in the femoral vein. C The small saphenous vein runs posterior to the lateral malleolus and superiorly to the popliteal fossa. E The large superficial veins, the great and small saphenous veins, originate from the venous arch on the dorsum of the foot.

27. Which of the following muscles are involved in knee flexion? A. Flexor hallucis longus B. Soleus C. Tibialis posterior D. Biceps femoris E. Rectus femoris

D The biceps femoris is one of the hamstring muscles (biceps femoris, semitendinosus, semimembranosus), which are the primary flexors of the knee A The flexor hallucis longus flexes the 1st digit and plantar flexes the foot. B The soleus does not cross the knee joint and only plantar flexes the foot at the ankle. C The tibialis posterior plantar flexes and inverts the foot. E The rectus femoris extends the leg at the knee.

15. In anatomy laboratory you have just dissected the gluteal region of your cadaver. You are surprised to discover that in your cadaver the lateral component of the sciatic nerve passes through the piriformis muscle instead of inferior to it. Being a dedicated student, you investigate this further and find this anomaly can cause a piriformis syndrome in which the nerve is compressed by contraction of the muscle. What symptom might this particular patient have experienced? A. Paresthesia (tingling) on the sole of the foot B. Loss of knee flexion C. Loss of knee extension D. Footdrop E. Sagging of the unsupported hip when walking

D The common fibular nerve is the lateral component of the sciatic nerve. Compression will affect the dorsiflexors of the anterior leg compartment (through its deep fibular branch), resulting in footdrop A Paresthesia on the sole of the foot would be a consequence of compression of the tibial nerve. B The tibial nerve, the medial component of the sciatic nerve, innervates the hamstring muscles, which flex the knee. This action would remain intact. C The knee extensors on the anterior thigh extend the knee and would not be affected by this anomaly. E Sagging of the unsupported hip is characteristic of an injury to the superior gluteal nerve

A young woman searching for driftwood walked several miles on the soft sandy beach of a Caribbean island. While walking on this uneven surface, the balance between inversion and eversion at her subtalar joint was maintained by the opposing actions of the fibularis longus and the A. fibularis brevis B. fibularis tertius C. soleus D. tibialis anterior E. extensor digitorum longus

D The tibialis anterior and tibialis posterior are the strong inverters of the foot that counter the action of the fibularis longus and fibularis brevis A The fibularis brevis, in the lateral crural compartment, inserts on the base of the 5th metatarsal, which allows it to evert the foot. B The fibularis tertius, a muscle of the anterior crural compartment, inserts on the base of the 5th metatarsal and everts the foot. C The soleus, in the posterior crural compartment, plantar flexes the foot. E The extensor digitorum, in the anterior crural compartment, everts the foot.

Heberden's nodes

DIP swelling

branches in forearm

Deep radial or posterior interosseous nerve - motor Superficial radial nerve - sensory

extensor Hallucis longus muscle

Dorsiflexion of ankle Extension of great toe at metatarsophalangeal & interphalangeal joints Weak inversion of foot

Flat Foot (Pes Planus)

Due to flattening of the Medial Longitudinal Arch forefoot everts and abducts, putting stress on plantar calcaneonavicular (spring) ligament. commonly in old people who stand for long time. normal in 3 yr olds.

dupytren's diseae

Dupytren's disease is the progressive fibrosis and contracture of the longitudinal bands of the palmar fascia to the 4th and 5th digits, causing flexion of these fingers. It presents as painless nodular thickenings that progress to raised ridges on the palm. Surgical excision is usually required to release the bands.

4. A woman in her early 40s discovered a small lump at the top of her thigh that was later diagnosed as a femoral hernia. Where would this hernia be located? A. Retroinguinal space B. Femoral canal C. Femoral sheath D. Femoral ring E. All of the above

E A vascular compartment of the retroinguinal space contains the femoral sheath and the femoral canal. The femoral ring defines the upper edge of the femoral canal. A femoral hernia protrudes into the femoral canal

17. Which muscle(s) of the lower limb is/are capable of producing flexion at one joint and extension at a second joint? A. Semimembranosus B. Rectus femoris C. Lumbricals of foot D. Long head of biceps femoris E. All of the above (A-D)

E Semimembranosus (A) produces flexion at the knee joint and extension at the hip joint. Rectus femoris (B) produces flexion at the hip joint and extension at the knee joint. The lumbricals of the foot (C) produce flexion of the metatarsophalangeal (MTP) joints of the 2nd to 5th toes and extension of the interphalangeal (IP) joints of the 2nd to 5th toes. The long head of the biceps femoris (D) produces extension of the hip joint and flexion of the knee joint

19. A single woman looking for adventure signed up for a walking tour of the Scottish highlands. She was unprepared for the effort that it required but kept up with the more experienced walkers. After a few days she began to experience extreme tenderness in her anterior leg deep to the ridge of the tibia. The tour guide had seen this in previous clients and suggested that her pain was due to shin splints. Her pain originated from overuse of the A. extensor digitorum longus B. extensor digitorum brevis C. extensor hallucis longus D. fibularis tertius E. tibialis anterior

E Shin splints are a result of inflammation of the tibialis anterior and small tears of the periosteum where the muscle attaches to the bone (Section 16.6b). A The extensor digitorum originates from the head of the fibula, lateral condyle of the tibia, and interosseous membrane. B The extensor digitorum brevis is an intrinsic muscle of the foot. It arises from the calcaneus. C The extensor hallucis longus arises from the middle of the fibular shaft and the interosseous membrane. D Fibularis tertius is a lateral muscle that arises from the distal fibula

23. Which of the following spaces contain the femoral nerve? A. Femoral sheath B. Adductor hiatus C. Popliteal fossa D. Femoral canal E. Retroinguinal space

E The femoral nerve enters the anterior thigh through the muscular compartment of the retroinguinal space. It branches immediately to innervate the muscles of the anterior thigh A The femoral sheath encloses only the femoral artery and vein. B The femoral artery and vein pass through the adductor hiatus into the popliteal fossa. C The popliteal fossa contains the tibial and common fibular nerves. D The femoral canal lies medially within the femoral sheath and contains only loose connective tissue, fat, and lymph nodes.

Which of the following spaces contain the femoral nerve? A. Femoral sheath B. Adductor hiatus C. Popliteal fossa D. Femoral canal E. Retroinguinal space

E The femoral nerve enters the anterior thigh through the muscular compartment of the retroinguinal space. It branches immediately to innervate the muscles of the anterior thigh A The femoral sheath encloses only the femoral artery and vein. B The femoral artery and vein pass through the adductor hiatus into the popliteal fossa. C The popliteal fossa contains the tibial and common fibular nerves. D The femoral canal lies medially within the femoral sheath and contains only loose connective tissue, fat, and lymph nodes.

6. The strongest and most supportive ligament of the hip joint is the A. transverse ligament of the acetabulum B. ligament of the head of the femur C. pubofemoral ligament D. ischiofemoral ligament E. iliofemoral ligament

E The iliofemoral ligament attaches proximally to the anterior inferior iliac spine and rim of the acetabulum and distally to the intertrochanteric line of the femur. It supports the hip joint during standing A The transverse ligament completes the rim of the C-shaped acetabulum inferiorly. B The ligament of the head of the femur attaches to the acetabulum within the joint but provides little support. A small artery runs within the ligament to the femoral head. C The pubofemoral ligament runs laterally from the inferior aspect of the acetabular rim to merge with the iliofemoral ligament. It assists the iliofemoral ligament and limits abduction of the joint. D The ischiofemoral ligament is the weakest of the three ligaments of the capsule. It arises from the ischial part of the acetabular rim and spirals anteriorly to insert on the femoral neck.

12. An obese female patient suffers from peripheral edema (swelling of the legs) and large varicose veins in her leg. Which of the following might be coexisting symptoms related to her condition? A. Incompetent valves in the great saphenous vein B. Reversed flow in the perforating veins C. Deep vein thrombosis D. Thrombophlebitis E. All of the above

E Varicose, or dilated, veins can occur in conjunction with deep vein thromboses. When the deep veins are obstructed, the normal superficial-todeep flow in the perforating veins reverses. With the increased volume, the superficial veins dilate, and their valves become incompetent. Thrombophlebitis, or venous inflammation, often occurs with thrombus formation

Lateral epicondylar attachment

Extensor carpi radialis brevis Extensor digitorum Extensor digiti minimi Extensor carpi ulnaris

Lateral supracondylar ridge attachment

Extensor carpi radialis longus Brachioradialis

hamstring strains

Forced high kicks, especially with an extended knee, may avulse the muscle tendons from their origin at the ischial tuberosity. Symptoms include sudden, sharp pain in the back of the thigh during physical activity, a popping or tearing feeling in the muscle, swelling, muscle weakness, and an inability to bear weight on the affected leg.

Static Stability

Forces and moments on the body caused by a disturbance tend initially to return the body toward its equilibrium position. hip joint and shoulder

osteoarthritis in fingers node swelling

H-Dip B-Pip

Circumduction

HIP JOINT. circular movement of a limb at the far end. allows all movements.

sciatic nerve innervates

Hamstrings

Cuboid

Having the shape of a cube.

radial nerve in hand

In the hand, the radial nerve has NO motor branches.

Sublaxation of radial head (nursemaid's elbow)

In young children the immature radial head can be subluxated when the child's arm is jerked upward. The movement tears the lax distal attachment of the annular ligament around the neck of the radius and allows the distal displacement of the radial head. The injured arm is held in a flexed and pronated position. Supination of the flexed elbow returns the joint to the correct orientation.

Femoral nerve injury

Injuries of the femoral nerve can result in the following: - Weakened flexion of the hip - Loss of knee extension - Loss of sensation on the medial side of the leg and foot - Instability of the knee

superficial and deep fibular nerve injury

Injury to the SUPERFICIAL fibular nerve only affects EVERSION of the foot and sensation over the lateral leg and most of the dorsum of the foot. Injury to the DEEP fibular has greater functional consequences, including the loss of all DORSIFLEXION. This results in FOOTDROP and the compensating high-stepping gait.

obturator nerve injury

Injury to the obturator nerve is most commonly associated with pelvic surgery or pelvic fractures and results in the following: - Weakened ADDUCTION of the hip (e.g., inability to move the leg from the gas pedal to the brake) - Weakened external rotation of the hip - Loss of sensation over a palm-size area on the medial side of the thigh - Instability of the pelvis; lateral SWING of the limb with locomotion

fibular nerve injury

Injury to the superficial fibular nerve only affects eversion of the foot and sensation over the lateral leg and most of the dorsum of the foot. Injury to the deep fibular has greater functional consequences, including the loss of all dorsiflexion. This results in footdrop and the compensating high-stepping gait.

intramuscular gluteal injections

Intramuscular injections are commonly given in the gluteal region. The injection site must be in the superior lateral quadrant or above the line connecting the posterior superior iliac spine and the top of the greater trochanter to avoid the large sciatic nerve and gluteal vascular structures.

Lower Limb Ischemia:

Ischemia of the lower extremity is almost always related to atherosclerotic disease. Intermittent claudication is a symptom of chronic ischemic disease characterized by pain while walking, which intensifies over time and disappears at rest The six signs (P signs) of acute ischemia are pain, pallor, pulse-lessness, paresthesia, paralysis, and poikilothermy.

quadriceps femoris group

KNEE EXTENSION. bc they ALL cross knee joint. rectus femoris(only hip flexion), vastus lateralis, vastus medialis, vastus intermedius

lateral femoral cutaneous nerve

L2-L3 Skin of lateral thigh crosses iliac

femoral nerve

L2-L4

superior gluteal nerve

L4-S1, branch of sacral plexus gluteus medius, gluteus minimus, tensor fascia lata

Dermatomes of leg and foot

L5 S1

common fibular nerve (peroneal)

LATERAL and anterior lower leg

anterior tibiofibular ligament

Ligament that is injured with a "high" ankle sprain

posterior hip dislocation

Limb will be: Shortened Internally rotated Adducted

lesser sciatic foramen

Means by which obturator internus exits pelvis

greater sciatic foramen (nerve)

Means by which piriformis exits pelvis

plantaris muscle

O - Posterior lateral condyle of femur I - posterior calcaneus A - very weak assist in knee flexion and ankle plantar flexion N - Tibial Nerve; L4, L5, S1

intercondylar notch of femur

On the posterior side of the femur, between the medial and lateral condyles where cruciate ligaments lie

anterior tibial artery

One of the popliteal arteries (the other is the posterior tibial artery) that supplies blood to the lower leg muscles and to the muscles and skin on the top of the foot and adjacent sides of the first and second toes. This artery continues to the foot where it becomes the dorsalis pedis artery.

long head of biceps femoris

Origin: ISCHIAL TUBEROSITY Insertion: Head of fibula Action: Flexes Knee and extends hip

short head of biceps femoris

Origin: LINEA ASPERA Insertion: head of fibula Action: flexes knee

quadriceps tendon

Origin: Muscles of Quadriceps Femoris Insertion: Base of Patella

profunda femoris artery

Origin: femoral artery (largest branch) in femoral triangle. supplies anterior compartment through adductor magnus

adductor hiatus

Popliteal artery and vein (previously the femoral artery and vein).

adductor hiatus contents

Popliteal artery and vein (previously the femoral artery and vein).

Lateral Epicondylitis

Repetitive use of the forearm extensors can inflame the attachment of the common extensor tendon at the lateral epicondyle (lateral epicondylitis). Pain is focused over the tendon insertion but radiates along the extensor forearm and is exacerbated by stretching of the extensor tendons by pronation and wrist flexion. Tennis elbow

anatomic snuffbox- act on pollex (thumb)

Right hand, radial view. The three-sided "anatomic snuffbox" (shaded light yellow) is bounded by the tendons of insertion of the abductor pollicis longus and the extensor pollicis brevis and extensor pollicis longus.

Rupture of the calcaneal tendon

Rupture of the calcaneal tendon tends to occur following sudden forced plantar flexion of the foot, unexpected dorsiflexion of the foot, or violent dorsiflexion of a plantar-flexed foot in people unaccustomed to exercise or who exercise intermittently. The rupture disables the gastrocnemius, soleus, and plantaris muscles, rendering the patient unable to plantar flex the foot.

pelvic splanchnic nerves

S2-S4= parasympathetic

shin splints

Shin splints result from chronic trauma of the tibialis anterior In what is considered a mild form of anterior compartment syndrome, small tears of the periosteum cause pain and swelling over the distal two thirds of the tibial sha ft.

pelvic diaphragm

Structure that separates pelvis and perineum consists of levator ani and coccygeus

The anatomic snuffbox is a small triangular depression on the radial side of the dorsum of the wrist

Tendons of the extensor pollicis longus, extensor pollicis brevis, and abductor pollicis longus form the borders. The scaphoid and trapezium form its floor. • The radial artery passes through the snuffbox. • The cephalic vein and superficial branch of the radial nerve cross the snuffbox superficially.

Lachman test (ACL)

The Lachman test is used to demonstrate instability of the knee joint resulting from rupture of the cruciate ligaments. Excessive anterior translation of the free-hanging tibia from under the stabilized femur is a positive anterior drawer sign, indicating anterior cruciate rupture. Posterior displacement of the tibia is a positive posterior drawer sign, indicating rupture of the posterior cruciate ligament.

posterior tibial artery

The artery just behind the medial malleolus; supplies blood to the foot.

Common fibular nerve injury

The common fibular nerve is the most vulnerable of the peripheral nerves due to its exposed location around the neck of the fibula. Injuries result in the following: - Loss of eversion of the foot - Loss of dorsiflexion at the ankle and digits - Weakened inversion of the foot - Loss of sensation over the lateral leg and dorsum of the foot - FOOT DROP compensated by a high-stepping GAIT; instability on uneven surfaces

Knee Joint Muscles

The knee joint consists of the femur (thigh bone), tibia and fiblua bones of the lower leg and the patella or kneecap. The muscles which flex and extend (bend and straighten) the joint are the quadriceps muscles (rectus femoris, vastus lateralis, vastus medialis) and the hamstring muscles at the back of the thigh (semitendinosis, semimembranosus and semitendinosis)

patellar tendon reflex

The patellar tendon reflex is initiated by tapping the patellar tendon to elicit contraction of the quadriceps femoris muscle (extension of the knee). It tests the integrity of the L2-L4 spinal cord segments carried by the femoral nerve.

Sciatic nerve injury

The sciatic nerve can be injured by compression by the piriformis muscle, misplaced intramuscular injections in the gluteal region, pelvic fractures, or surgical procedures such as hip replacements. An injury in the gluteal region would affect muscles of the posterior thigh and all muscular compartments of the leg, the combined effects of damage to the tibial and common fibular nerves.

Piriformis Syndrome

The sciatic nerve normally passes into the gluteal region inferior to the piriformis muscle. Tightening or shortening of the muscle can compress and irritate the sciatic nerve, causing pain and paresthesia (tingling and numbness) in the buttocks and posterior thigh. In some cases the sciatic nerve, or its common fibular component, is compressed as it passes through the muscle. Piriformis syndrome should be distinguished from sciatica in which the pain and paresthesia result from compression of lumbar nerve roots by a herniated intervertebral disk.

popliteal vein

The small saphenous vein is a tributary to the

Lower Leg- Anterior Compartment

Tibialis anterior Extensor hallicus longus Extensor digitorum longus Peroneus (fibularis) tertius +arteries, veins, nerves of lower leg (shank)

deep vein thrombosis (DVT)

Thromboses (blood clots) in the deep veins of the leg result from stasis, the slowing or pooling of blood. This can result from prolonged inactivity (extended airplane travel, immobilization following surgery) or anatomic abnormalities such as laxity of the crural fascia. Thrombi from the legs can break off and travel to the heart and lungs, lodging in the pulmonary arterial tree as pulmonary emboli. Large clots can severely impair lung function and even cause death. Thrombophlebitis is the inflammation of a vein caused by thrombosis.

modified hinge joint

What type of joint is the knee joint? flex/ext PLUS MODIFIED slight internal and external rotation

superior gluteal nerve damage

When one foot is lifted off the floor, as happens during the gait cycle, abduction of the hip by the contralateral gluteus medius and gluteus minimus muscles (the supported side) maintains the pelvis in the horizontal position. With injury to the superior gluteal nerve, the loss of abduction on that side allows the pelvis on the opposite (unsupported) side to drop. This results in a characteristic "gluteal gait" in which the weight of the trunk is shifted toward the nerve-damaged side to maintain the center of gravity. The Trendelenburg test assesses the stability of the hip and its ability to support the pelvis when standing on one leg. The test is positive when the pelvis falls on the side of the unsupported leg, indicating an injury to the superior gluteal nerve and paralysis of the gluteus medius and gluteus minimus. Fractures of the greater trochanter (the site of distal attachment of the gluteus medius) or upward displacement of the greater trochanter will also result in a positive test.

sural nerve

Which cutaneous nerve supplies impulses to the skin on the outer side and back of the foot and leg?

Medial Collateral Ligament (MCL)

a flat longitudinal band found on the medial side of the knee joint compared to medial collateral, it is more a part of synovial joint capsule and has BLOOD flow (better healing) valgus force injury runs from medial femoral condyle to tibia

subtalar joint

a joint in the ankle found between the talus and calcaneus gliding motion

varicose veins

abnormally swollen, twisted veins with defective valves; most often seen in the legs Varicose disease of the superficial veins of the lower limb is the most common chronic venous disease. Degeneration of the wall of the vein leads to dilated, tortuous vessels and incompetent venous valves. Varices also develop when chronic occlusion of the deep veins causes a reversal of flow through the perforating veins. (Normal venous drainage flows from superficial to deep systems.) As the superficial veins dilate with increased volume, valve leaflets separate and become incompetent.

ligamentum teres

acetebum to head of femur protects blood flow to hip joint inserts foveal artery within ligamentum teres which protects this artery. in hip dislocation, that ligament is stretched and artery is damaged and bone will die or fracture.

common triad of acl injury

acl, mcl, medial meniscus lateral bone bruise

popliteal passes through

adductor haitus to become: femoral vein

obturator nerve innervates

adductors, gracilis (medial to psoas)

distal tibiofibular joint

articulation between the distal fibula and the fibular notch of the tibia syndesmotic joint

Snuffbox borders

aspect of the dorsoradial wrist where the radial artery is palpable

extensor tendon rupture= mallet finger

avulsion of ED. Traumatic finger injuries can cause tendon ruptures Rupture of the extensor tendon at the distal phalanx prohibits extension of the distal interphalangeal (DIP) joint. "mallet finger" distal phalanx remains flexed

test whether its isolated iliopsoas during hip flexor test

bend the knee (using just that muscle to lift leg)

patella,femur,tibia

bones forming the knee joint

lateral meniscus

cartilage in the knee between the lateral femoral condyle and the lateral tibial plateau

Iliac muscle

connects with inguinal ligament

Hand of Benediction

damage to MEDIAN nerve resulting in loss of flexion

lateral malleolus of fibula

distal end of fibula

Lateral Collateral Ligament (LCL)

distal end of the femur to the proximal end of the fibula (may also touch the tibia as well); main purpose is to prevent the knee from varus (force from inside) LCL injury not as common

abduct MCP

dorsal interossei palmar adduct (fist with palm) dorsal abduct (outside of hand, spread fingers)

Anterior tibial artery becomes

dorsalis pedis artery

tibialis anterior

dorsiflexes and inverts foot

tibialis anterior

dorsiflexes and inverts foot. crosses ankle joint

medial meniscus tear

forceful torsion of the knee w/ foot planted popping sound severe pain at time of injury mcmurray's sign +

Deltoid ligament of ankle

formed by Anterior tibitalar, tibiocalcaneal, posterior tibiotalar, and tibionavicular ligaments provides medial support,,,,,resist eversion of the talus

femoral artery is nice way to do less invasive cardiac surgeries

from femoral art to heart

ball and socket allow

highly stable, highly mobile, static stability, functional stability

Acetabulum

hip socket femur inserts

Cruciate and collateral ligaments

hold the knee together. Cruciates - within joint capsule, AKA intercapsular ligaments and form a "cross", named for this and attaching on tibia Collaterals - located on sides of joint

extensor retinaculum

holds tendons of extensor muscles in place

joint congruency

how well joint surfaces match or fit

Posterior division of internal iliac artery

iliolumbar, lateral sacral, superior gluteal

if one thigh raises off table when you lift the other

iliopsoas is tight

Osgood-Schlatter disease

inflammation of the tibia at its point of attachment with the patellar tendon. (in prepubescents)

Popliteal (Baker's) Cyst

impairs flexion and extension of knee joint -collection of fluid in politeal fossa Often they result from a herniation of the bursae deep to the gastrocnemius or semimembranosus muscles. The sacs protrude through the fibrous layer of the joint capsule but maintain a communication with the synovial cavity. Some cysts may be asymptomatic, but others are painful and can impair flexion and extension of the knee joint.

Patellar Tendonitis

inflammation of the patellar tendon (jumper's knee)

compartment syndrome

involves the compression of nerves and blood vessels due to swelling within the enclosed space created by the fascia that separates groups of muscles loss of DISTAL pulses in affected limb requires fasciotomy (make cut thru fascia to decompress)

Ulnar Tunnel (Guyon's Canal)

is a narrow passageway on the medial side of the anterior wrist .allows ulnar n through

Pes Anserine Bursitis

is an inflammation of the bursa located between the shinbone (tibia) and three tendons of the hamstring muscle at the inside of the knee (SGT). It occurs when the bursa becomes irritated and produces too much fluid, which causes it to swell and put pressure on the adjacent parts of the knee.

adductor magnus origin

ischial and pubic rami and ischial tuberosity

shoulder sacrifices stability for mobility

labrum is big part of that

posterior talofibular ligament

lateral

extensors come from

lateral side

Tensor Fascia Latae insertion

lateral tibia, gurdy's tubercle

posterior tibial artery branches

laterally into fibular artery

ACUTE compartment syndrome is a surgical emergency and

limb-threatening release pressure by opening most severe is in Anterior region.

adductor magnus insertion

linea aspera and adductor tubercle

adductor magnus insertion

linea aspera and adductor tubercle of femur

adductor longus, brevis, and magnus insertion

linea aspera of femur

great saphenous vein

longest vein in body; drains blood from foot, leg, and thigh; drains into femoral vein (at proximal point of femoral triangle)

mri of the knee joint

look for congruency of lines and dark color white line through black triangle or cloudy=meniscal tear

psoas major origin

lumbar vertebrae and lesser trochanter

extension of pip and dip

lumbricals and interossei

flexion of metacarpophalangeal joints

lumbricals and interossei and 5th digit

iliopsoas and rectus femoris

major hip flexors

semitendinosus insertion

medial aspect of upper tibial shaft

deep fibular (peroneal) nerve

medial branch of common fibular nerve, innervates anterior crural muscles, passes into dorsum of foot: tibialis anterior, extensor hallucis longus, extensor digitorum longus

Iliopsoas

median side of femur, on lesser trochanter

dynamic stability

mobility with steadiness of a joint rotator cuff is a primary dynamic stabilizer in shoulder

Popliteal aneurysm

most common peripheral arterial aneurysm. distal leg ischemia from acute embolization or thrombosis. Fifty percent of patients with a popliteal aneurysm have an aneurysm in the contralateral artery, and 25% have an aortic aneurysm. They can be distinguished by a thrill (palpable pulse) and bruits (abnormal arterial sounds) overlying the popliteal fossa. Because the artery lies deep to the tibial nerve, an aneurysm may stretch the nerve or occlude its blood supply.

deep radial nerve becomes

motor). The deep branch becomes the posterior interosseous nerve as it circles around the radius into the posterior forearm compartment. It innervates all muscles of this compartment.

hip sacrifices mobility for stability

needs stability to manage daily forces of weight bearing and ambulation

The upper limbs extend from the body wall with C7-8 dermamyotomes leading the way. C6 and T1 segments close in behind to form

noncontiguous lines of dermatome supply along the proximo-distal limb axis.

talocrural joint axis

oblique axis - through fibular malleolus, body of talus, and medial malleolus - axis is angled and tipped

obturator nerve

passes through obturator foramen to innervate adductor muscles

piriformis muscle

passes through the great sciatic foramen and is invovled in external hip rotation. Muscle injury or hypertrophy can cusae compression of the sciatic nerve. forms posterior muscular wall of pelvis

greater sciatic foramen

pelvic opening formed by the greater sciatic notch of the hip bone, the sacrum, and the sacrospinous ligament

popliteal splits into

posterior and anterior tibial A

PCL

posterior cruciate ligament prevents posterior translation rotational stability common in car accidents, crash knee against dashboard

dorsal pedal pulse

pulse palpated on the top of the foot absence suggests arterial occlusion in peripheral vasculature

mainly flex thigh

rectus femoris and iliopsoas

if knee kicks out

rectus femoris is tight

Inserts on tibial tuberosity

rectus femoris, vastus lateralis, vastus medialis, vastus intermedius

3 vascular zones of meniscus

remove damaged tissue in white zone bc no blood flow if you remove the entire meniscus= bone on bone, and you lose joint congruency red-red- heals by itself bc blood flow white-red- asymptomatic. let it be. watch and wait and if symptomatic= remove

ITB friction syndrome

rubbing of ITB over lateral epicondyle of the femur, + OBERS test, usually runners

radiocarpal joint articulates with

scaphoid and lunate

superficial radial nerve

sensory

most superficial of popliteal fossa

small saphenous v, medial sural cutaneous n, lateral sural cutaneous n.

posterior hip joint ligaments

spiraling of ligament allows finer motions of rotation

calcaneonavicular ligament

spring ligament

Hip Flexor Test

tests isometric contraction of hip flexors and extension

patellofemoral joint

the point where the kneecap and femur are connected in the trochlear groove

most weight bearing part of lower leg

tibia, bot fibula

ankle sprain

torn ligaments. caused by forced inversion of foot= damages lateral talocrural ligament (severity anterior to posterior) the anterior talofibular ligament is mot easily injured. Fracture of the lateral malleolus can also accompany inversion injuries.

claw hand

ulnar nerve

small saphenous vein

very superficial, back of leg

Pelvis and Perineum

what areas does the hypogastric plexuses send their nerves to

Six small dorsal compartments form on the posterior surface of the wrist

• The extensor retinaculum forms their roof, and the dorsal surfaces of the distal radius and ulna form their floor. • Extensor tendons of forearm muscles pass through the compartments onto the dorsum of the hand.