Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
200 Cards in this Set
- Front
- Back
|
Action of External AND Internal Abdominal Oblique Muscles
|
-Compresses abdomen
-Flexes trunk -Active in forced respiration |
|
|
Action of Transversus Abdominis Muscle
|
-Compresses abdomen
-Depresses ribs |
|
|
Action of Rectus Abdominis Muscles
|
-Flexes trunk
-Depresses ribs |
|
|
Action of Pyramidalis Muscle
|
Tenses Linea Alba
|
|
|
Action of Cremaster Muscle
|
Retracts testis
|
|
|
In the abdominal region, what layers are strong enough to hold sutures?
|
1) Scarpa's Fascia (membranous layer)
2) Transversalis Fascia |
|
|
Linea Alba and Surgery:
|
Frequent site for incisions to be made
Why? Blood vessels and nerves do not cross midline to any great degree AND incisions can be easily enlarged both superiorly and inferiorly if needed |
|
|
Contents of:
1) Median Umbilical Fold: 2) Medial Umbilical Fold: 3) Lateral Umbilical Fold: |
1) Remnant of Urachus
2) Remnants of Umbilical Arteries 3) Inferior Epigastric A/V |
|
|
Inguinal or Hesselbach's Triangle
|
Boundaries:
Inferior = Inguinal Ligament Medial = Lateral Border of Rectus Abdominis Lateral = Inferior Epigastric Vessels Significance: Location of DIRECT inguinal hernias! |
|
|
Indirect Inguinal Hernia
|
Occur in both sexes, but more common in MALES
Congenital basis Deep Inguinal Ring (lateral to inferior epigastric vessels) --> Inguinal Canal --> Superficial Ring Covered by fascia of spermatic cord, thus is within cord |
|
|
Direct Inguinal Hernia
|
Occur in middle aged to older MALES. RARE IN FEMALES!
Due to loss of muscle tone of lower abdominal wall Exits Inguinal Triangle (medial to inferior epigastric vessels) Covered by peritoneum and transversalis fascia (adjacent to cord) |
|
|
Dermatome Landmarks of Anterior Trunk:
|
T4=Nipple
T6 = Xiphoid Process T10 = Umbilicus |
|
|
What nerves are at risk during an appendectomy procedure?
|
Iliohypogastric Nerve
Ilioinguinal Nerve |
|
|
Cremasteric Reflex
|
Afferent Limb = Ilioinguinal Nerve
Efferent Limb = Genitofemoral Nerve |
|
|
Collateral Route for Return of Blood to Heart WHEN either the superior OR inferior vena cavae become obstructed:
|
Thoracoepigastric Vein
|
|
|
Where are the neurovascular structures supplying the anterior wall of the abdomen found???
|
DEEP to the INTERNAL oblique muscle!
|
|
|
Peritonitis
|
Inflammatory condition caused by perforation of a digestive tract organ
Disrupts smooth surface of peritoneum such that it becomes "sticky" with resultant adhesion of its surfaces |
|
|
Clinical Significance of Greater Omentum
|
1) Frequently prevents inguinal hernias by plugging opening
2) Wraps itself around inflammed organs, walling them off from peritoneal cavity |
|
|
Contents of Hepatoduodenal Ligament: (3)
|
Portal Triad!
Hepatic Artery Portal Vein Bile Duct |
|
|
Pringle Maneuver
|
Clamping of hepatoduodenal ligament to control hemorrhage from traumatic injury to the liver
|
|
|
Where do Vagal trunks of Abdominal Esophagus lie?
|
Left Vagal Trunk = Anterior Surface
Right Vagal Trunk = Posterior Surface |
|
|
Fixed locations of stomach (2):
|
1) Cardia = T11
2) Pylorus = L1 |
|
|
Is the spleen palpable?
|
NOT normally!
Must enlarge ~3-4X |
|
|
Where are percutaneous liver biopsies performed?
|
Midaxillary line at the 10th intercostal space at full expiration
Why? Inferior to pleural cavity, full expiration closes costodiaphragmatic = reduced chance of pneumothorax |
|
|
Approximate location of gallbladder?
|
Intersection of right semilunar light and right costal margin
|
|
|
In which layer of peritoneum can pain sensation be precisely localized?
|
Parietal! It is richly innervated by somatic sensory nerves!
NOT Visceral! This has visceral sensory nerves and pain sensation produced by stretching! |
|
|
Ventral Mesentery Derivatives:
|
LL
Lesser Omentum Liver Ligaments (Falciform, Coronary, Triangular) |
|
|
Dorsal Mesentery Derivatives:
|
GPS TM
Greater Omentum Proper Mesentery Sigmoid Mesocolon Transverse Mesocolon Mesoappendix |
|
|
Action of Quadratus Lumborum Muscle
|
Stabilizes 12th Rib, Flexes Trunk Laterally
|
|
|
Action of Psoas Minor Muscle
|
Aids in Flexing of Trunk
|
|
|
Action of Diaphragm Muscle
|
Lowers Diaphragm
|
|
|
Structures that Pierce the Diaphragm/Where (5):
|
I Eat Apples SharplY Sliced
IVC - T8 Esophagus and Vagal Trunks - T10 Aorta and Thoracic Duct - T12 Sympathetic Trunk - Behind Crura Splanchnics (Greater and Lesser) - Through Crura |
|
|
What happens when ONE SIDE of the diaphragm becomes paralyzed?
|
Moves paradoxically!
Elevates with inspiration, descends with expiration! |
|
|
What do the Ureters pass inferior to in males/females?
|
Males - Vas Deferens
Females - Uterine Arteries "Water (the ureter) Under the Bridge" |
|
|
CC
Regions Where Ureters are Narrowed (3): Implications? |
1) Renal Pelvis
2) Ureteric Junction 3) Entrance into Bladder Renal stones (calculi) lodge at these OR at the very least cause intense pain as they pass! ="Loin to Groin Pain" |
|
|
Primary Retroperiotoneal Organs:
|
I ASK U B!
IVC Aorta Suprarenal Glands Kidney Ureters Bladder |
|
|
Secondarily Retroperitoneal Organs:
|
DAD Please
Descending Colon Ascending Colon Duodenum (EXCEPT FIRST PART) Pancreas (EXCEPT TAIL) |
|
|
Suprarenal (Adrenal) Glands Structure/Function:
|
Mesoderm --> Cortex --> Steroid Production
Neural Crest Ectoderm --> Medulla --> Catecholamine Production |
|
|
Venous Drainage of Suprarenal Glands:
|
Right = DIRECTLY into IVC
Left = Left Renal Vein |
|
|
CC
Tumors of Adrenal Medulla |
Called Pheochromocytomas
Produce large amounts of catecholamines --> can produce hypertensive crisis! |
|
|
CC
Lateral Femoral Cutaneous Nerve Damage |
At risk by deep placement of retractors which punch nerve against the ASIS
ALSO at risk during endoscopic hernia repairs in which TISSUE SAMPLING is employed |
|
|
Woman Pelvis Measurements (4):
|
1) True Conjugate = Top of Pubic Symphisis --> Sacral Promontory. ~11 cm. Done Radiologically.
2) Diagonal Conjugate = Bottom of Pubic Symphisis --> Sacral Promontory. Diagonal - 1.5 cm = True. Done manually via Vaginal Examination. 3) Bispinous = Ischial Spine --> Ischial Spine. Done by Physical Examination. 4) Bituberous = Ischial Tuberosity --> Ischial Tuberosity. Done by Physical Examination. |
|
|
CC
Relaxin Hormone |
Ovarian hormone which relaxes pelvic ligaments prior to delivery of baby.
|
|
|
Action of Piriformis and Obturator Internus Muscles:
|
Laterally Rotate Hip
|
|
|
CC
Weakening of Levator Ani Portion of Pelvic Diaphragm: |
May result in Urinary Stress Incontinence, Uterine or Rectal Prolapse
|
|
|
Anal Triangle
|
Boundaries:
Lateral = Lower portion of obturator internus Superior-Medial = Levator Ani Inferior = Skin of Perineum Contents: 1) Anus in Center 2) Ischioanal Fossa (filled with fat) |
|
|
Superficial Perineal Pouch
|
The Space BETWEEN 1) Membranous Layer of Superficial Perineal Fascia (Colle's Fascia) and 2) Perineal Membrane
Contents: 1) External Genitalia 2) Superficial Perineal Muscles 3) Branch of Internal Pudendal Vessels = Perineal Artery 4) Branch of Pudendal Nerve = Perineal Nerve |
|
|
Deep Perineal Pouch
|
The Space BETWEEN 1) Perineal Membrane and 2) Inferior Fascia of Pelvic Diaphragm
Contents: __________________________ BOTH SEXES: 1) Urethra 2) Inferior Portion of Tubular External Urethral Sphincter 3) Branch of Internal Pudendal Vessels = Dirsal Artery 4) Branch of Pudendal Nerve = Nerve of Penis or Clitoris MALES ONLY: 1) Deep Transverse Perineal Muscle + Sphincter Urethrae Muscle 2) Bulbourethral Glands FEMALES ONLY: 1) SMOOTH Deep Transverse Perineal Muscle 2) External Urethral Sphincter w/ Compressor and Urethrovaginal Sphincter Portions |
|
|
CC
Traumatic Rupture of Spongy Penile Urethra |
Extravasation (collection) of Urine into Superficial Perineal Pouch (Space)
Where can this extend to? 1) Scrotum 2) Around the Penis 3) Superiorly into Lower Abdomen Where will the urine NOT extend to? NOT POSTERIORLY! Why? Superficial Fascia attaches to perineal membrane's POSTERIOR edge!) |
|
|
Action of Ischiocavernosus Muscle
|
Compresses Crura, Assisting in Erection
|
|
|
Action of Bulbospongiosus Muscle
|
Compresses Spongiosum to Empty Urethra of Urine or Semen
Assists in Erection via Slow Venous Drainage |
|
|
Action of Smooth Muscle in Dartos Fascia (Superficial Fascia) of the Scrotum
|
Wrinkles the Skin --> Reduces Surface Area --> Assists in Temp Regulation
|
|
|
What are the Gonads (both Testes AND Ovaries) extremely sensitive to?
|
Pressure!
Keep in mind during Physical Exam! |
|
|
CC
Open Processus Vaginalis in Young Male Children |
Peritoneal fluid can enter space between tunica vaginalis layers
Fluid can then drain back into the abdominal cavity when the child sleeps This is called a HYDROCELE |
|
|
CC
Vasectomy |
Ductus Deferens is divided bilaterally at the Upper Scrotum where it is about to enter the superficial ring
|
|
|
CC
What part of the female genitalia is torn or incised (episiotomy) during childbirth? |
Frenulum of the Labia Minora (Fourchette)
|
|
|
CC
Urethra Damage During Caterization or Other Instrumentation Procedures |
Membranous Urethra can be perforated because it is the NARROWEST portion
|
|
|
CC
Ramifications of Shortness of the Urethra in Females (~4 cm) |
Bladder Infections (Cystitis) and Urinary Tract Infections (UTIs) are more common in females!
|
|
|
CC
Prostatic Cancer |
Found in LATERAL and POSTERIOR Lobes
When present, cause elevation in Prostatic Specific Antigen (PSA) |
|
|
CC
Enlargement of the Prostate or Benign Prostatic Hyperplasia (BPH) |
Affects the MIDDLE Lobe!
Result: Compresses the bladder neck causing urination difficulties! |
|
|
Most Gravity Dependent Area in Pelvic Cavity (aka where would flow go) in Males vs Females
|
Males: Rectovesical Space (b/w Bladder and Rectum)
Females: Rectouterine Space (b/w Uterus and Rectum) Females also have a space between the Bladder and Uterus but is less dependent. |
|
|
Parts of GI tract located in Pelvis (5)?
|
Lower Ileum
Cecum Appendix Sigmoid Colon Rectum |
|
|
Indication of Ruptured Appendix on a CT:
|
Air and Fluid Behind Cecum
|
|
|
What is worse, an Intraperitoneal or Extraperitoneal Bladder Rupture?
|
Intraperitoneal!
Must treat it quickly, time is critical! |
|
|
What separates the pelvic cavity from the Ischiorectal Fossa?
|
Levator Ani Muscle!
|
|
|
Where does the Rectal/Hemorrhoidal Vein Drain?
|
Most of it drains into IVC
Small portion (upper and middle 1/3) drain into IMA which is a contributory to the Hepatic Portal Vein! Thus, rectal cancer can spread to diff areas because lymphatics follow the venous drainage. |
|
|
Where might testicular cancer spread?
|
Into abdomen (not pelvis). Why?
Testicular/Ovarian Vein comes DIRECTLY off abdominal aorta R-Side Drainage = DIRECTLY to IVC L-Side Drainage = to Left Renal Vein |
|
|
In a male, what would fracture of the pelvis likely damage?
|
PROSTATIC Urethra
|
|
|
Visceral Pain in Abdomen
|
Referred Pain
Dull, Poorly Localized, w/ Emotional Component |
|
|
Locating the Ureter:
|
In retroperitoneum...ALWAYS!
Posterior to Colon Associated with Gonadal Vessels Sigmoid Sulcus Points to LEFT Ureter |
|
|
Peristalsis in Ureters
|
Occurs in BOTH DIRECTIONS
|
|
|
Injury of the Ureter in MALES and Associated Nerve Damage
|
Proximal Injury - Sympathetic Nerves Affected
Result: Retrograde or NO Ejaculation Distal Injury - Parasympathetic Nerves Affected Result: Impotence |
|
|
Upper vs Lower GI Bleeding
|
Boundary is Ligament of Trietz (Suspensory Ligament)!
Upper = Bright Red, Vomitus, Coffee-ground color if blood stays in stomach an hour or two, PAINFUL Lower = Usually NOT PAINFUL, in anal canal IF painful, blood seen in stool |
|
|
Cholecystitis
|
Inflammation of Gall Bladder
Starts as MIDLINE, VISCERAL Pain ONCE it reaches extent of touching the Parietal Peritoneum, get LOCALIZED, SOMATIC pain in RUQ |
|
|
Shoulder Dystocia
|
Babies head delivers and then retracts due to the bony shoulder girdle of the baby getting lodged in the bony pelvis of the mother = "Turtle Sign"
Results: 1) Injury to Baby and/or Mom 2) Hypoxia to Baby 3) Erb's Palsy (Most Common) - Brachial Plexus Injury Increased risk if mother is diabetic and or obese How to resolve? 1) McRobert's and Suprapubic Pressure Maneuvers 2) Delivery of Posterior Arm (dangerous, can fracture humerus) |
|
|
Excessive Traction on Umbilical Cord while the Uterus is STILL ATTACHED to the Placenta
|
Result: Inverted Uterus!
Cant pull too hard/ need to wait until the placenta detaches from the uterus to pull the cord |
|
|
Post-Partum (birth) Hemorrhage
|
Most Common Cause = Uterine Atony
Occurs when Uterus fails to contract = Uterine Spiral Arteries NOT Squeezed = Hemorrhage |
|
|
Uterine Blood Supply/Uterine Ligation:
|
1) Uterine Artery (Major)
2) Ovarian Artery (Minor) With ligation of these arteries, MUST be CAREFUL to not damage a URETER ("Water under the Bridge") |
|
|
Tender Abdominal Incision Causes:
|
1)Surgical Site Infection (SSI)
2) Hematoma |
|
|
Abdominal Hematoma
|
Subfacial Hematoma
Usually due to Rectus Abdominis Muscle Thus, usually found in RECTUS SHEATH |
|
|
Colonic Polyp Size
|
Size Matters!
<5 mm = 0% Malig 5-10 mm = 1% Malig 1-2 cm = 10% Malig >2 cm = 50% Malig |
|
|
What does diverticulitis look like on a CT?
|
Thickened Colon Wall!
|
|
|
Where should a feeding tube be inserted?
|
DISTAL to Ligament of Trietz (Lower GI)!
Why? Decreases chances of Aspiration |
|
|
Diagnosis of:
1) Small Bowel Inflammation 2) Dilated Small Bowel |
1) Crohns Disease
2) Inguinal Hernia |
|
|
Porcelain Gall Bladder:
|
Calcified Gall Bladder Wall
|
|
|
What results from an Anterior Abdominal Wall Herniation?
|
SMALL Bowel Obstruction!
|
|
|
Which compartment in the leg lacks a major artery?
|
Lateral (Evertor) Compartment: Fibularis (Peroneus) Longus/Brevis
|
|
|
When the abdomen is opened, are the retroperitoneal structures visible?
|
NO!
As a result, X-Ray evaluation is essential! |
|
|
Adrenal Venous Drainage
|
Right = IVC
Left = Left Renal Vein (Greater Potential for Collateral Circulation than Right) |
|
|
Layers Surrounding External Surface of Kidneys
|
Deep-->Superficial:
Renal Capsule --> Perinephric Fat (Perinephric Space) --> Gerota's Fascia --> Paranephric Space --> Retroperitoneal Fat |
|
|
Tumor Thrombus Staging:
|
1: Renal Vein
2: INFRAhepatic 3: INTRAheptatic 4: SUPRAhepatic |
|
|
Causes of:
1) Intraperitoneal Bladder Rupture 2) Extraperitoneal Bladder Rupture |
1) Direct blow to abdomen when bladder is full of urine - requires surgery
2) Pelvic Fracture - heals with rest |
|
|
Urethral Injuries
|
Most common in males
Posterior urethral trauma almost always associated with Pelvic fracture |
|
|
Primary lymphatic drainage for Testicular Tumors
|
Periaortic Lymph Nodes at level of Renal Hilum
During surgery, Retroperitoneal Sympathetic Nerve Trunks and Ganglia are commonly injured, affecting sexual function! -Normal Erection (Parasympathetic) -No Ejaculate - Due to No Emission or Retrograde Ejaculation! |
|
|
Retroperitoneal Nerves:
|
Superior Hypogastric Plexus: T12-L3 Lumbar SYMPATHETICS
Support emission and anterograde ejaculation (closure of bladder neck at time of ejaculation) |
|
|
Innervation of Perineal Branch of Pudendal Nerve:
|
Superficial Perineal Muscles (3):
1) Superficial Transverse Perineal Muscle 2) Ischiocavernosus Muscle 3) Bulbospongiosus Muscle |
|
|
Components of Spermatic Cord:
|
TV CD PG
Testicular Artery Vas Deferens Cremasteric Artery Deferential Artery Pampiniform Venous Plexus Genital Branch of Genitofemoral Nerve |
|
|
What produces the septum in the scrotum which divides it into 2 cavities?
|
Darto's Fascia!
Produces Scrotal Raphe externally |
|
|
What is the name for the space BETWEEN the Labia Majora?
|
Pudendal Cleft
|
|
|
Extension of Labia Minora ANTERIOR to Clitoris:
POSTERIOR to Clitoris: |
ANTERIOR = Prepuce of Clitoris
Posterior = Frenulum of Clitoris |
|
|
Male:Female Genital Homologs
1) Scrotum: 2) Spongy Urethra: 3) Penis: 4) Bulb of Penis: 5) Prostate Gland: 6) Bulbourethral Glands: 7) Gubernaculum Testis: 8) Testis: |
1) Labia Majora
2) Labia Minora 3) Clitoris 4) Bulb of Vestibule 5) Paraurethral Gland (of Skene) 6) Greater Vestibular Glands (of Bartholin) 7) Round Ligament of Uterus 8) Ovary |
|
|
Ligaments Supporting Bladder in Males vs Females:
|
Males = PuboPROSTATIC
Females = PuboVESICAL |
|
|
Most muscular organ of the body relative to its size?
|
Vas Deferens!
|
|
|
Salpingitis
|
Inflammation of Uterine Tubes
Caused by the spread of peritonitis (since the uterine tubes open into peritoneal cavity) Can cause scarring, a major cause of infertility |
|
|
Posterior Femoral Cutaneous Nerve Innervation:
|
Sensory over the Ischioanal Fossa
|
|
|
Great Saphenous Vein Uses Clinically
|
Commonly used for Coronary Artery Bypass Surgery
Why? Readily accessible (very superficial), long, walls are fairly muscular If used, vein is reversed so that the valves do not obstruct bloodflow |
|
|
Function of Ligaments of the Hip Joint?
|
Limit EXTENSION
|
|
|
Dislocations of Hip Joint
|
Weakest Part = Inferior Aspect of Joint
Most commonly occur in traffic accidents producing a direct impact on the knee Causes femur to be driven posteriorly |
|
|
Blood Supply to Head and Neck of Femur
|
Majority, if not all, comes from Medial Circumflex Femoral Artery which joins Lateral Circumflex Femoral Artery on posterior surface
Damage to Medial Circumflex Femoral results in avascular necrosis of head of femur Blood flow through the artery of the Ligamentum Teres is NOT sufficient to sustain the bone |
|
|
Femoral Nerve Innervation
|
(Anterior Compartment of Thigh Except for Psoas Major and Tensor Fasciae Latae)
1) Iliacus 2) Sartorius 3) Rectus Femoris 4) Vastus Medialis 5) Vastus Intermedius 6) Vastus Lateralis |
|
|
Nerve Innervation of Psoas Major Muscle
|
Ventral Rami of Lumbar Nerves L1, L2, L3
|
|
|
What lies between the Anterior and Posterior Divisions of the Obturator Nerve?
|
Adductor Brevis Muscle!
|
|
|
Action of Iliacus Muscle
|
Flexes and Rotates Thigh Laterally
|
|
|
Action of Psoas Major Muscle
|
Flexes and Stabilizes Thigh at Hip Joint
Flexes Trunk |
|
|
Action of Sartorius Muscle
|
Flexes and Rotates THIGH Laterally
Flexes and Rotates LEG Medially |
|
|
Action of Rectus Femoris Muscle
|
Flexes THIGH
Extends LEG |
|
|
Action of Vastus Medialis/Intermedius/Lateralis
|
Extends Leg
|
|
|
Action of Tensor Fasciae Latae
|
Flexes, Abducts, Rotates Thigh Medially
|
|
|
Innervation of Obturator Nerve?
|
Medial Compartment of Thigh
1) Adductor Longus 2) Adductor Brevis 3) Adductor Magnus (+ Sciatic Nerve) 4) Pectineus (+ Femoral Nerve) 5) Gracilis 6) Obturator Externus |
|
|
Action of Adductor Longus/Brevis
|
Adducts, Flexes, and Rotates Thigh Laterally
|
|
|
Action of Adductor Magnus
|
Adducts, Flexes, and Extends Thigh
|
|
|
Action of Pectineus Muscle
|
Adducts and Flexes Thigh
|
|
|
Action of Gracilis Muscle
|
Adducts and Flexes THIGH
Flexes and Rotates LEG Medially |
|
|
Femoral Triangle
|
Boundaries:
Inguinal Ligament, Sartorius Muscle, Adductor Longus Muscle Floor = Iliopsoas and Pectineus Muscles Contents: NAVEL (Lateral-->Medial) N = Femoral Nerve A = Femoral Artery V = Femoral Vein E = Empty Space L = Lymphatics |
|
|
Route for Cannulation of the Heart:
|
Left Side of Heart = Through Left Femoral ARTERY
Right Side of Heart = Through Right Femoral VEIN |
|
|
Function of Femoral Sheath?
|
Allows Femoral Vessels to Glide Deep to the Inguinal Ligament during movements of the hip joint
|
|
|
Contents of Femoral Sheath?
|
Femoral Vessels
NOT the Femoral Nerve! |
|
|
Innervation of Superior Gluteal Nerve
|
Gluteus Medius
Gluteus Minimus Tensor Fasciae Latae |
|
|
Innervation of Inferior Gluteal Nerve
|
Gluteus Maximus
|
|
|
Nerve to Obturator Internus Innervation
|
Obturator Internus
Superior Gemellus |
|
|
Nerve to Quadratus Femoris
|
Quadratus Femoris
Inferior Gemellus |
|
|
Action of Gluteus Maximus Muscle
|
Extends and Rotates Thigh Laterally
|
|
|
Action of Gluteus Medius/Minimus
|
Abducts and Rotates Thigh Medially
|
|
|
Action of Piriformis, Superior Gemellus, Inferior Gemellus, Quadratus Femoris, Obturator Externus
|
Rotates Thigh Laterally
|
|
|
Action of Obturator Internus Muscle
|
Abducts and Rotates Thigh Laterally
|
|
|
Pes Anserinus
|
Structure formed by Tendons of Sartorius, Semitendinosus and Gracilis Muscles inserting together on Medial Surface of Tibia
|
|
|
Action of Semitendinosus, Semimembranosus, and Biceps Femoris Muscles
|
Extends THIGH
Flexes and Rotates LEG Medially |
|
|
1) Tibial Division of Sciatic Nerve Innervation
2) Common Fibular Nerve Division of Sciatic Nerve Innervation |
1) Semitendinosus, Semimembranosus, LONG head of Biceps Femoris
2) SHORT head of Biceps Femoris |
|
|
Hurdlers Injury
|
Avulsion of Ischial Tuberosity
May be caused by forcible flexion of the hip with an extended knee |
|
|
What does ACL Prevent?
PCL? |
ACL - Hyperextension at Knee, A Displacement of Tibia, P Displacement of Femur
PCL - Hyperflexion at Knee, P Displacement of Tibia, A Displacement of Femur |
|
|
Terrible Triad
|
Most commonly damaged knee structures:
1) Medial Meniscus 2) ACL 3) Medial Collateral Ligament |
|
|
What Muscle is Affected with an Avulsion Injury to the ASIS?
AIIS? Ischial Tuberosity? |
ASIS = Sartorius
AIIS = Rectus Femoris Ischial Tuberosity = Hamstrings |
|
|
Segond Fracture
|
Avulsion of LATERAL Tibial Condyle
Associated with ACL Injury Common in Dancers/Football Players who twist on pivot |
|
|
Direction of Patellar Dislocation (Subluxation)
|
Lateral!
Why? Lateral Facet is LONGER and more HORIZONTAL in direction |
|
|
Most commonly torn Menisci?
|
Medial!
However, Discoid Lateral Menisci is most commonly torn in Children! |
|
|
Sensory Exam for Compartment Syndrome:
1) Anterior 2) Lateral 3) Superficial Posterior 4) Deep Posterior |
1) Deep Peroneal (Fibular) Nerve- First Web Space
2) Superficial Peroneal (Fibular) Nerve - Dorsum of Foot 3) Sural Nerve - Internal Foot 4) Posterior Tibia Nerve - Sole of Foot |
|
|
Compartment Syndrome Myths (3):
|
1) Lose Pulses - False, this is a late finding!
2) Elevate Leg - False, do NOT elevate! 3) Will not evolve - False, it WILL evolve! |
|
|
Pressure and Compartment Syndrome
|
Diastolic BP - Compartment Pressure < 30 mmHg = Compartment Syndrome!
|
|
|
What is the ONLY major branch of the Femoral Nerve that continues BELOW the Knee?
|
Saphenous Nerve!
Cutaneous Innervation of Skin on Medial Surface of Leg/Foot |
|
|
What gives rise to the following:
1) Medial and Lateral Plantar ARTERIES: 2) Medial and Lateral Plantar NERVES: |
1) Posterior Tibial Artery
2) Tibial Nerve |
|
|
Joints of Ankle (2):
|
1) TRUE ANKLE JOINT - Articulation of Tibia and Fibula w/ Talus - Plantar/Dorsi-Flexion
2) SUBTALAR JOINT - Posterior Talcalcaneal Joint + Talocalcaneonavicular Joint - Inversion and Eversion |
|
|
Medial Collateral Ligament of Ankle AKA Deltoid Ligament (4):
|
1) Tibionavicular Ligament
2) Anterior Tibiotalar Ligament 3) Posterior Tibiotalar Ligament 4) Tibiocalcaneal Ligament |
|
|
Lateral Collateral Ligament of Ankle (3):
|
Weaker than Medial Collateral Ligament!
1) Anterior Talofibular Ligament 2) Posterior Talofibular Ligament 3) Calcaneofibular Ligament |
|
|
Deep Fibular Nerve Innervation (6):
|
Anterior Compartment of Leg (4):
1) Tibialis Anterior 2) Extensor Hallucis Longus 3) Extensor Digitorum Longus 4) Fibularis Tertius Muscles on Dorsum of Foot (2): 1) Extensor Digitorum Brevis 2) Extensor Hallucis Brevis |
|
|
1) Action of Tibialis Anterior
2) Action of Fibularis Tertius |
1) Dorsiflexes and INVERTS Foot
2) Dorsiflexes and EVERTS Foot |
|
|
Action of Extensor Hallucis Longus
|
Extend Big Toe
Dorsiflexes and Inverts Foot |
|
|
Action of Extensor Digitorum Longus
|
Extends Toes
Dorsiflexes Foot |
|
|
Superficial Fibular Nerve Innervation:
|
Lateral Compartment (2):
1) Fibularis Longus 2) Fibularis Brevis |
|
|
Action of Fibularis Longus/Brevis:
|
Plantarflexes and Everts Foot
|
|
|
Where do Longus/Brevis Extensors Attach on the Foot?
|
Longus Extensors - Distal Phalanges
Brevis Extensors - Middle Phalanges |
|
|
1) Action of Extensor Digitorum Brevis:
2) Action of Extensor Hallucis Brevis: |
1) Extends Toes
2) Extends BIG Toe |
|
|
Tibial Nerve Innervation (7):
|
Superficial Posterior Leg (3):
1) Gastrocnemius 2) Soleus 3) Plantaris Deep Posterior Leg (4): 1) Popliteus 2) Flexor Hallucis Longus 3) Flexor Digitorum Longus 4) Tibialis Posterior |
|
|
Action of Gastrocnemius
|
Plantar Flexes Foot
Flexes Knee |
|
|
Action of Soleus
|
Plantar Flexes Foot
|
|
|
Action of Plantaris and Popliteus
|
Flexes and Rotates Leg Medially
|
|
|
Action of Flexor Hallucis Longus
|
Flexes Distal Phalanx of Big Toe
|
|
|
Action of Flexor Digitorum Longus
|
Flexes Lateral Four Toes
Plantar Flexes Foot |
|
|
Action of Tibialis Posterior
|
Plantar Flexes and Inverts Foot
|
|
|
Common Fibular Nerve Injury
|
Most Injured Nerve in Lower Limb due to Superficial Position
Results: 1) Loss of Eversion 2) Loss of Dorsiflexion 3) Loss of Sensation on Anterolateral Aspect of Leg AND Dorsum of Foot |
|
|
Arrangement of Tendons/Vessels at Medial Malleolus
|
Anterior --> Posterior
Tom Dick and A Very Nervous Harry tendon of the Tibialis posterior tendon of the flexor Digitorum longus posterior tibial Artery and Vein tibial Nerve tendon of flexor Hallucis longus |
|
|
Medial Plantar Nerve Innervation (4):
|
Layer 1:
1) Abductor Hallucis 2) Flexor Digitorum Brevis Layer 2: 1) First Lumbrical Layer 3: 1) Flexor Hallucis Brevis |
|
|
Lateral Plantar Nerve Innervation:
|
Layer 1:
1) Abductor Digiti Minimi Layer 2: 1) Quadratus Plantae 2) Second, Third, and Fourth Lumbricals Layer 3: 1) Adductor Hallucis, Oblique Head 2) Adductor Hallucis, Transverse Head 3) Flexor Digiti Minimi Brevis Layer 4: 1) Plantar Interossei (3) 2) Dorsal Interossei (4) |
|
|
1) Action of Abductor Hallucis
2) Action of Abductor Digiti Minimi |
1) Abducts Big Toe
2) Abducts Little Toe |
|
|
Action of Flexor Digitorum Brevis
|
Flexes Middle Phalanges of Lateral Four Toes
|
|
|
1) Action of Flexor Hallucis Brevis
2) Action of Flexor Digiti Minimi Brevis |
1) Flexes Big Toe
2) Flexes Little Toe |
|
|
Action of Quadratus Plantae
|
Aids in Flexing Toes
|
|
|
Action of Lumbricals
|
Flex Metatarsophalangeal Joints
Extend Interphalangeal Joints |
|
|
Action of Adductor Hallucis Oblique Head AND Transverse Head
|
Adduct Big Toe
|
|
|
1) Action of Plantar Interossei
2) Action of Dorsal Interossei |
Both Sets:
Flex Proximal Phalanges Extend Distal Phalanges 1) ADduct Toes 2) ABduct Toes |
|
|
1) COG of Entire Body:
2) COG of Portion Superior to Hip Joint: |
1) S2
2) T11 |
|
|
What prevents the trunk from falling into Hyperextension?
|
Iliofemoral Ligament
Iliopsoas |
|
|
Quiet Upright Posture and Knee Joint Locking/Unlocking
|
Locks via MEDIAL Rotation of Femur on Tibia
Unlocks via Popliteus Muscle causing LATERAL Rotation of Femur on Tibia |
|
|
What prevents Dorsiflexion of Ankle during Quiet, Upright Posture?
|
Soleus Muscle!
Some people use Gastrocnemius which also prevents HYPEREXTENSION of Knee |
|
|
Muscle Function during Walking
|
Function more to Control Effects of Gravity and Momentum RATHER THAN to Propel Body Forward
How? Muscle's ability to RESIST Lengthening (Isometric Contraction) RATHER THAN Active Contraction (Isotonic Contraction) |
|
|
Muscles Involved in GAIT
|
Phase 1: Swing Initiation
-Iliopsoas - Early Swing/Late Stance Phase 2: Swing -Hamstring - Just prior to Heel Strike through a short time after (prevents HYPEREXTENSION on contact) -Hamstring + Gluteus Maximus - Prevent Trunk from Jack-Knifing -Sartorius - Flexes Knee at Toe-off and well into swing phase Phase 3: Stance -Quadriceps - Early stance just after heel-strike - Prevents knee from collapsing into Flexion Phase 4: Toe Off -Triceps Surae (Gastrocnemius + Soleus) - Latter Half of Stance - Prevents collapse of Ankle into Dorsiflexion |
|
|
Which flexor of knee is NOT used during Swing Phase of walking?
|
Gastrocnemius!
Why? Also Plantar Flexes Foot, which is bad while walking! |
|
|
Ankle Inversion caused by Toe-Out Walking is resisted by what?
|
Fibularis Longus and Brevis!
|
|
|
Gluteus Muscles and GAIT
|
Gluteus Medius/Minimus - Prevent dipping of Pelvis on Swing Side during Stance Phase - Acts on Stance Side!
Gluteus Maximus - Fairly Silent in GAIT |
|
|
Trendelenburg Sign
|
When standing on one leg, opposite side sags downward --> indicates weakened or non functional Gluteus Medius on Supported Side
|
|
|
High Stepping or Steppage Gait
|
Injury to Deep Fibular Nerve of Anterior Compartment of Leg = Loss of Dorsiflexion of Foot
Compensation: Patient picks limb up higher than normal via excessive flexion of hip Stance Phase Begins with Foot Landing Flat, NOT Heel Strike |
|
|
Splanchnic (Sympathetic Ganglia -->White Rami Communicantes-->Symathetic Trunk--> Splanchnics) Nerves Formed From (4):
|
T5-9 = Greater Thoracic Splanchnic
T10-11 = Lesser Thoracic Splanchnic T12 = Least Thoracic Splanchnic L1-2 = Lumbar Splanchnic |
|
|
POST-SYNAPTIC SYMPATHETIC NERVE Plexuses of Abdomen/Pelvis and General Innervations (8):
|
College Students Rent Apartments In Student Heavy Populations
C = Celiac Plexus - Foregut S = Superior Mesenteric Plexus - Midgut R = Renal Plexus - Kidney A = Aortic Plexus - Between SMA/IMA I = Inferior Mesenteric Plexus - Hindgut S = Superior Hypogastric Plexus - Continuation of Aortic Plexus TO Pelvic Brim H = Hypogastric Plexus - Continuation of Superior Hypo AROUND Rectum INTO Pelvis P = Pelvic AKA Inferior Hypogastric Plexus - Pelvic Organs |
|
|
What region of abdomen and or pelvis is innervated by PARASYMPATHETICS?
|
Vagus
________ 1) FOREGUT Organs 2) MIDGUT Organs Sacral (S2,3,4) ______________ 3) Hindgut 4) Pelvic Organs |
|
|
What Ganglia(s) do PARASYMPATHETIC Fibers Pass THROUGH?
|
1) Celiac Ganglion
2) Superior Mesenteric Ganglion 3) Aorticorenal Ganglion Do NOT Synapse though! |
|
|
Splanchnic Nerves are ALWAYS _______, but EITHER ________ OR ____________.
|
Presynaptic
Sympathetic Parasympathetic |
|
|
What Nerve Plexuses are a MIX of both Presynaptic PARA Parasympathetic and POST-Synaptic Sympathetic Fibers?
|
1) Celiac
2) Superior Mesenteric 3) Inferior Hypogastric (AKA Pelvic) |
|
|
Visceral Pain Sensation Confusion w/ Somatic Pain Sensation
|
Visceral Afferent Fibers Return to the SAME Spinal Cord Levels from which their SYMPATHETIC Innervation Arose
Problem? So do the SOMATIC Pain Afferent Fibers! Visceral/Somatic Afferent Pain Fibers probably synapse on the SAME INTERNEURON for Conscious Pain Sensation. Result: Pain Sensation ARISING from an Internal organ is PERCEIVED as coming from Skin/Muscle Why Somatic? There is Good Cerebral Cortex Representation for Somatic Areas (better than Visceral) AND Somatic Pain is BETTER Localized |
|
|
Referred Pain:
1) Appendix 2) Gall Bladder 3) Pancreas 4) Diaphragm 5) Stomach |
1) Epigastric or Paraumbilical Region
2) Ribs 6-9 and THEN Inferior Angle of Scapula on RIGHT Side 3) Upper Abdomen and/or Back at T10-L2 4) Referred to Shoulder Region 5) Epigastric Region |
|
|
General Pathways for:
1) Visceral Pain 2) Vague Sensations of Distention and Nausea |
1) Sympathetics
2) Parasympathetics |
|
|
Blood Supply of Regions of Stomach:
1) Cardiac 2) Fundus |
Cardiac = Left Gastric Artery
Fundus = Short Gastric Arteries |
