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173 Cards in this Set
- Front
- Back
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What is the embryonic origin of limbs?
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Somatic mesoderm (body wall) - lateral plate
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AER
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Determines proximo-distal polarity
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ZPA
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Determines pre-postaxial polarity
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What is FGF? What inhibits FGF? What is the result?
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Signal for AER.
Thalidomide. Kids with deformed limbs. |
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What is dorsoventral patterning? What intrinsic signals are responsible for it?
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i.e. Nails vs. soft bed of fingers
WNT7, LMZX1 = dorsal ENG-d = ventral |
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What are the two types of bone growth? Give examples of each.
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1. Intramembranous ossification - cranial vault, clavicle
2. Endochondral ossification - diaphysis-epiphysis |
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What is the embryonic origin of limb muscle?
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Somitic (paraxial mesoderm)
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Are limbs hypomere or epimere? What does that imply?
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Hypomere. All innervated by ventral rami.
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Dorsal compartment
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Extensor (usually); Posterior nerve division
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Properties of Ventral compartment
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Flexor (usually); Anterior nerve division
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Forelimb - anterior division nerves
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Musculocutaneous
Median Ulnar |
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Forelimb - posterior division nerves
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Radial
Axillary |
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Hindlimb - anterior division nerves
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Tibial division of sciatic
Obturator |
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Hindlimb - posterior division nerves
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Fibular
Femoral |
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3 Types of Joints
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1. Fibrous (synarthrosis)
2. Cartilagenous (amphiarthrosis) 3. Synovial (diarthrosis) |
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Examples (2) of fibrous joints
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1. Cranial vault (synostosis)
2. Interosseus membranes (syndesmosis) |
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Examples (2) of cartilaginous joints
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1. Pubic symphysis
2. Intervertebral |
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Examples (2) of synovial joints
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1. Shoulder
2. Hip |
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What are the 3 axes of motion?
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1. Mediolateral
2. Anteroposterior 3. Long axis |
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What are the 3 types of ovoid joints?
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1. Plane - flat, gliding; biaxial (intercarpal)
2. Condyloid - curvature of one > other; biaxial (wrist, phalangeal) 3. Spheroid - ball + socket; multiaxial (hip, shoulder) |
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What are the 2 general shapes of joints?
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1. Ovoid
2. Sellar (saddle-shaped) |
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What is the difference between intrinsic and extrinsic ligaments?
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Intrinsic - on joint capsules
Extrinsic - NOT on joint capsules |
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What are the ACL/PCL and what do they do?
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Anterior cruciate ligament - prevents tibia from sliding forward away from femur
Posterior cruciate ligament - prevents femur from sliding forward away from tibia |
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What does a synergist muscle do?
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Acts at the same time as protagonist but prevents unwanted movement
e.g. wrist extensors keep wrist extended while fingers flex |
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What are the joints of the shoulder? What kind of joints are they?
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1. Glenohumoral - spheroid
2. Acromioclavicular - ovoid (plane) 3. Coracoclavicular - fibrous 4. Sternoclavicular - sellar |
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What gives the glenohumoral joint its range of motion?
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Thin capsule
Spheroid (ball + socket) shape |
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What are the ligaments of the glenohumeral joint and what do they do?
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1. Glenohumeral ligaments (superior, middle, inferior) - loose
2. Coracoacromial and coracohumeral - Form "roof" to prevent humerus from popping out = very strong! |
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What are the muscles of the rotator cuff, what is their action and nerve supply?
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1. Subscapularis - medial rotator, subscapular n.
2. Supraspinatus - abduction - suprascapular n. 3. Infraspinatous - lateral rotation - suprascapular n. 4. Teres minor - lateral rotation - axillary n. |
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What happens if you tear your coracoclavicular ligament?
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Separated shoulder!
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What are the 4 steps of scapulohumeral rhythm?
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1. Abduction of the humerus.
2. Lateral rotation of the humerus. 3. Upward rotation of the scapula. 4. Rotation/elevation of the clavicle at the sternoclavicular joint. |
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What muscles/joints are responsible for abduction of the humerus?
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Glenohumeral joint
Supraspinatous, deltoid |
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What muscles/joints are responsible for lateral rotation of the humerus?
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Glenohumeral joint
Infraspinatous, teres minor, deltoid |
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What muscles <b>and joints</b> are responsible for protraction/retraction of the scapula?
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Scapulothoracic, sternoclavicular, acromioclavicular joints
Trapezius Serratous anterior Pectoralis major Pectoralis minor Rhomboids |
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What muscles are responsible for elevation/depression of the scapula?
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Trapezius
Levator scapulae Pectoralis minor Subclavius |
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What muscles are responsible for flexion of the shoulder?
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Pectoralis major
Deltoid Coracobrachialis Biceps |
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What muscles/joints are responsible for adduction of the arm?
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Pectoralis major
Pectoralis minor Latissimus dorsi Teres major |
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What muscles are responsible for medial rotation of the arm?
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Teres major
Subscapularis Pectoralis major Latissimus dorsi Deltoid |
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What are the borders of the subclavian artery and what are the branches within?
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1) Medial to anterior scalene m.
- Vertebral a. - Internal thoracic a. - Thyrocervical trunk: *Inferior thyroid a. *Suprascapular a. *Transverse cervical a. 2) Posterior to anterior scalene m. - Costocervical trunk 3) Lateral to anterior scalene m. - Dorsal scapular a. |
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Which vessel is posterior to the anterior scalene muscle?
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Subclavian ARTERY
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What structures border the SCA, SCV, brachial plexus? What is the clinical concern?
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1st rib, clavicle
Pinching of the vessels/nerves (e.g. hypertrophic muscles) |
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What are the borders of the axillary artery? What is its relationship to pectoralis minor?
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Start: lateral border of 1st rib
Stop: inferior border of teres major Posterior to pectoralis minor |
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What are the 3 boundaries of the branches of the axillary artery?
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1) Lateral 1st rib to medial pec minor
2) Posterior to pec minor 3) Lateral pec minor to inferior teres major |
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What are the branches of the axillary artery?
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1) Superior thoracic a.
2) Thoracoacromial a. Lateral thoracic a. 3) Subscapular a. Anterior circumflex humeral a. Posterior circumflex humeral a. |
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What does the superior thoracic artery supply? Where does it come from?
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- 1st and 2nd intercostals
- Serratous anterior - 1st part of axillary artery |
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What are the 4 branches of the thoracoacromial a.?
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Deltoid
Pectoral Clavicular Acromial |
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What does the lateral thoracic a. supply and where does it come from?
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- Lateral breast
- Serratous anterior - Pectoralis 2nd part of axillary artery |
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What are the branches of the subscapular artery? Where does it come from?
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Circumflex scapular a.
Thoracodorsal a. 3rd part of axillary artery |
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What part do the circumflex humeral arteries encircle?
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Surgical neck of the humerus
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What are the borders of the brachial artery?
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Start: Inferior border of teres major
Stop: Cubital fossa Anterior to triceps, brachialis m. |
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What are the branches (not divisions!) of the brachial artery?
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1) Muscular arteries
2) Deep artery of the arm/profunda brachii 3) Superior ulnar collateral a. 4) Inferior ulnar collateral a. |
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What are the borders of the cubital fossa?
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Superior: medial-lateral epicondyle axis
Lateral: brachioradialis m. Medial: pronator teres m. Floor: brachialis and supinator m. Roof: brachial + antebrachial fascia, bicipital aponeurosis |
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What are the branches of the brachial artery in the forearm?
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Radial a.
Ulnar a. |
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What are the branches of the ulnar artery in the forearm?
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Common interosseus a. (anterior and posterior)
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Where is the radial artery? Does it travel with the radial nerve? Is it palpable?
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Medial to brachioradialis
Travels partly with superficial radial nerve Readily palpable |
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Where is the ulnar artery located relative to muscle? Does it travel with the ulnar nerve? Is it palpable?
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Deep to pronator teres
Travels with ulnar nerve Palpable between flexor carpi ulnaris and flexor digitorum superficialis tendons |
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What are the nerves/arteries of the anterior flexor-pronator compartment of the forearm?
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1) Radial artery, superficial radial nerve
2) Ulnar artery and nerve 3) Anterior interosseous artery, nerve 4) Median nerve |
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What are the nerves/arteries of the posterior extensor-supinator compartment of the forearm?
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Posterior interosseous artery, nerve
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What are the divisions of the ulnar and radial arteries in the hand?
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Ulnar a. - superficial - superficial palmar arch
Radial a. - deep - deep palmar arch |
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What do the superficial and deep palmar arch supply?
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Superficial palmar arch - common palmar digital arteries (each digit has 2x - medial and lateral)
Deep palmar arch - palmar metacarpal arteries |
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What are the most common hand/wrist fractures (i.e. from falling on an outstretched hand)?
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Distal radius
Scaphoid - may have proximal avascular necrosis because blood supply is distal |
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What are the articulations of the elbow/wrist?
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Trochlea - ulna
Capitulum - radius Radius - scaphoid/lunate |
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What is the job of the flexor retinaculum?
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Closes off carpal tunnel (between hook of hamate and tubercle of trapezium)
Holds down flexor tendons |
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What are the three joint types of the hand and what are their ranges of motion?
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1) Carpometacarpal
- Flexion/extension - Abduction/adduction - Rotation 2) Metacarpophalangeal - Flexion/extension - Abduction/adduction 3) Interphalangeal - Flexion/extension |
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What muscles (in general) originate from the medial epicondyle of the humerus? Lateral epidondyle?
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Flexor
Extensor |
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What muscles border the cubital fossa?
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Pronator teres
Brachioradialis |
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Why is it significant that the pronator teres m. is the first off the cubital fossa?
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Gets the best angle for torque (pronation)
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What is significant about the brachioradialis m.?
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Extensor compartment (radial n.) BUT flexor of elbow
*Doesn't cross wrist joint (attaches to styloid process of radius) *Can also pronate/supinate to halfway position (karate chop) |
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What are the muscles of pronation? What bones move during pronation?
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Pronator teres
Pronator quadratus Ulna stationary; radius pivots on capitulum. |
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What muscles of the forearm are superficial flexors? Deep flexors?
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Pronator teres
Palmaris longus Flexor carpi radialis Flexor carpi ulnaris Flexor digitorum superficialis Flexor digitorum profundus Pronator quadratus Flexor pollicis longus |
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What is significant about palmaris longus m.?
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Vestigial (15% don't have it)
Terminates as palmar aponeurosis = fascial support in the palm *Fibrosis of aponeurosis = contraction of fingers over time |
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What are the flexors of the digits?
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Flexor digitorum superficialis - 4 tendons to proximal interphalangeal (PIP) joint
Flexor digitorum profundus - 4 tendons to distal interphalangeal (DIP) joint |
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What are synovial tendon sheaths? How are they structurally?
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Visceral and parietal layer of sheath with synovial fluid
Mesotendon (vinculae) supply blood vessels Reduces friction! |
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What are fibrous tendon sheaths?
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Hold tendons + synovial sheaths to the phalanges
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What is significant about the common flexor synovial sheath?
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Continuous with pinky synovial sheath, so an infection in the little finger can spread to palm.
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What are the differences of the extensor compartment compared to the flexor compartment of the forearm?
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- TWO extensor carpi radialis - longus and brevis
- ONE extensor digitorum, but: *Extensor indicis - pointer *Extensor digiti minimi - pinky - Thumb muscles: *Extensor pollicis longus/brevis *Abductor pollicis longus (brevis is in thenar compartment) |
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Where is the anatomical snuff box and why does anyone care?
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Between extensor pollicis longus and brevis.
It contains the RADIAL ARTERY. |
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What is "tennis elbow"?
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Overuse of extensor muscles - tears or swelling of the compartment
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What are the muscles controlling finger motion?
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Dorsal interosseus - abduction
Palmar interosseus - adduction Lumbrical - radial deviation |
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What does the median nerve innervate?
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- Flexor compartment (EXCEPT FCU, last 2 digits of f. digitorum prof.)
Lateral 2 lumbricals Opponens pollicis Abductor pollicis brevis Flexor pollicis brevis |
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What does the ulnar nerve innervate?
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- Intrinsic hand muscles:
*Palmar interossei - adduct 2,4,5 *Dorsal interossei - abduc 2,4; 3 moves in both dir. (thumb/pinky have own abductors) *Lumbricals - lateral deviations (except lateral 2 = median n.) - Cutaneous - ulnar side of hand, digit 5 and half of 4 - FCU, f. digitorum prof. for 4/5 |
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What does ulnar nerve deficit cause?
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- Loss of sensation
- "Claw hand" - abducted thumb, extended MCP joints, flexed IP joints; *can't hold paper between fingers |
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What does the radial nerve innervate?
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- Deep branch = Extensor compartment
- Superficial branch = cutaneous on radial side |
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What are the borders of the midpalmar space?
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Flexor tendons and interosseus muscles
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What are the borders of the thenar space?
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Thenar compartment and adductor pollicis
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Why do we care about hand spaces?
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Potential sites for spread of infection
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What is the carpal tunnel? What's in it? What is carpal tunnel syndrome? Does it cause ulnar n. compression?
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- Space in wrist; flexor retinaculum stretches over pisiform and scaphoid
- Inside are tendons of FDS, FDP, f. pollicis longus - Carpal tunnel syndrom = median nerve compression - No ulnar nerve compression because ulnar n., a. pass anteriorly |
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Upper Brachial Plexus Injury (Erb's Palsy)
1) Causes? 2) Site of injury? 3) Effects and anesthesia? |
1) Excessive separation of neck and shoulder (e.g. land on shoulder; pull on newborn's head)
2) C5, C6 3) Waiter's tip (wrist flexed, prone, arm extended, shoulder extended) Anesthesia of lateral arm, forearm |
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Lower Brachial Plexus Injury (Klumpke's Palsy)
1) Causes? 2) Site of injury? 3) Effects and anesthesia? |
1) Forceful upward pull on shoulder (grasp something while falling; pulling newborn by arm when head is stuck; cervical rib)
2) C8, T1 3) Mostly ulnar nerve damage Decreased wrist and finger movements (internal hand muscles) = Claw Hand Anesthesia of medial forearm, arm |
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What is the nerve of the scapula?
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Long thoracic nerve (C5,6,7)
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Long Thoracic/Thoracodorsal Nerves
1) Causes? 2) Site of injury? 3) Effects and anesthesia? |
1) Mastectomy, thoracic surgery
2) C5,6,7; C6,7,8 3) Long thoracic: loss of protraction, upward rotation of scapula = winging Thoracodoral = loss of extention, adduction, medial rotation of arm = can't use crutches No sensory loss |
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Axillary Nerve
1) Causes? 2) Site of injury? 3) Effects and anesthesia? |
1) Humeral surgical neck fracture; shoulder dislocation (=stretch)
2) C5, C6 3) Loss of abduction of arm (deltoid) Decreased lateral rotation of arm (teres minor) Anesthesia - lateral surface of shoulder |
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What is lateral rotation of the arm decreased and not lost in axillary nerve deficit?
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Infraspinatous is main lateral rotator, not teres minor, and it is unaffected by the axillary nerve.
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Musculocutaneous nerve
1) Causes? 2) Site of injury? 3) Effects and anesthesia? |
1) Penetrating wounds
2) C5,6,7 3) Decreased forearm flexion Decreased supination Decreased arm flexion Anesthesia - lateral surface of forearm (lateral cutaneous antebrachial n.) |
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Radial Nerve
1) Causes? 2) Site of injury? 3) Effects and anesthesia? |
1) Humeral shaft fracture;
Compression in radial groove; Pooly-fitting cruches 2) C5,6,7,8, T1 3) Decreased extensors of the forearm, wrist = wrist drop! Anesthesia on radial half of posterior hand |
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Median Nerve
1) Causes? 2) Site of injury? 3) Effects and anesthesia? |
1) Wrist slashing; carpal tunnel; pronator syndrome (compression b/w 2 heads of pronator teres)
2) C5,6,7,8,T1 3) Ape hand (atrophy of thenar muscles, no thumb abduction) Hand of benediction (hard to flex 2/3 digits) Anesthesia on radial half of palm, radial 3.5 digits |
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Ulnar Nerve
1) Causes? 2) Site of injury? 3) Effects and anesthesia? |
1) Medial epicondyle fracture; Compression in ulnar groove; Tunnel of Guyon (deep to palmar aponeurosis)
2) C8, T1 3) Ulnar = all intrinsic hand muscles + FCU + ulnar half of FDP. = Claw Hand. Anesthesia - ulnar side of hand + ulnar 1.5 fingers. |
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How would you distinguish Lower Brachial Plexus injury from Ulnar nerve injury?
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Sensory!
Lower brachial plexus = medial forearm + hand Ulnar = hand + fingers |
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What contributes to hip joint stability?
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Strong ligaments - iliofemoral and ischiofemoral
Deep acetabulum |
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What compartment and nerve is usually associated with hip flexors?
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Anterior, femoral nerve
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What compartment and nerve is usually associated with hip extensors?
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Posterior, tibial branch of sciatic nerve
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What compartment and nerve is usually associated with hip adductors?
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Medial, obturator nerve
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What muscles are responsible for hip flexion?
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Rectus femoris
Sartorius Pectineus Iliopsoas - accessory flexor |
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What muscles are responsible for hip extension?
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*Gluteus maximus (inferior gluteal nerve)
Hamstrings - Semitendinosus - Semimembranosus - Long head of biceps femoris **Adductor magnus hamstring portion |
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What muscles are responsible for hip adduction?
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Gracilis
Adductors - Magnus - Longus - Brevis Obturator externus Pectineus - anterior, femoral nerve |
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What muscles are responsible for hip abduction? How do they help with balance?
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Gluteus medius, minimus
Tilt pelvis away from "falling" during walking |
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What muscles are responsible for hip lateral rotation?
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Piriformis
Gemellus superior, inferior Obturator internus, externus Quadratus femoris Sartorius |
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What muscles are responsible for hip medial rotation?
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Gluteus medius, minimus
Adductor magnus, longus Pectineus |
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What kind of joint is the knee joint?
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Bicondylar
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What is the meniscus?
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Cartilaginous pads on knee joint - medial and lateral
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What are the major ligaments of the knee joint?
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Anterior cruciate ligament
Posterior cruciate ligament (Patellar tendon) Medial collateral ligament (femur-tibia) Lateral collateral ligament (femur-fibula) |
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What compartment is primary responsible for knee extension?
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Anterior, femoral nerve
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What compartment is primary responsible for knee flexion?
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Posterior, tibial nerve
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What muscles are responsible for knee extension?
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Quadriceps femoris (rectus femoris, vastus lateralis, vastus medialis, vastus intermedius)
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What muscles are responsible for knee flexion?
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Hamstrings (semimembranous, semitendinosus, biceps femoris)
Gracilis (medial) Sartorius (anterior) Gastrocnemius (lower leg) |
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What muscles are responsible for knee rotation?
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Lateral:
- Popliteus - tibial nerve, unlocks knee - Biceps femoris Medial: - Sartorius - Gracilis - Semitendinosus - Semimembranosus |
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What ligaments prevent sideways motion of the upper ankle joint?
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Medial collateral (deltoid) - prevents excessive eversion
Lateral collateral (calcaneofibular) - prevents excessive inversion |
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What muscles are plantar flexors of the foot? What compartments/nerves?
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Tibial n., posterior superficial:
- Gastrocnemius - Soleus - Plantaris Tibial n., posterior deep: - Tibialis posterior - Flexor digitorum longus - Flexor hallucis longus |
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What muscles are dorsiflexors of the foot? What compartments/nerves?
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Deep fibular n., anterior
- Tibialis anterior - Extensor digitorum longus - Extensor hallucis longus |
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What muscles are invertors of the foot? What compartments/nerves?
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Tibialis anterior (deep fibular, anterior)
Tibialis posterior (tibial, posterior) |
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What muscles are evertors of the foot? What compartments/nerves?
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Fibularis longus
Fibularis brevis Superficial fibular n., lateral compartment **Fibularis tertius - anterior, deep fibular n. |
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What muscles are digital extensors of the foot? What compartments/nerves?
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Extensor digitorum longus
Extensor hallucis longus Deep fibular n., anterior |
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What muscles are digital flexors of the foot? What compartments/nerves?
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Flexor digitorum longus
Flexor hallucis longus Tibial n., posterior deep |
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What is the tarsal tunnel?
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Like the carpal tunnel:
Tom, Dick, ANd Harry (medial to lateral): <b>T</b>ibialis posterior flexor <b>D</b>igitorum longus posterior tibial <b>A</b>rtery tibial <b>N</b>erve flexor <b>H</b>allicus longus |
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What are the dorsal intrinsic muscles of the foot? What nerve innervates them?
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Extensor digitorum brevis
Extensor hallucis brevis Deep fibular n. |
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What is the 1st layer of the plantar muscles of the foot? Which are MPN-innervated?
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Abductor hallucis**
Flexor digitorum brevis** Abductor digiti minimi |
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What is the 2nd layer of the plantar muscles of the foot? Which are MPN-innervated?
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Quadratus plantae
Lumbricals** (most medial one) |
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What is the 3rd layer of the plantar muscles of the foot? Which are MPN-innervated?
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Flexor hallicus brevis**
Adductor hallicus Flexor digiti minimi brevis |
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What is the 4th layer of the plantar muscles of the foot?
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Interossei
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What does quadratus plantae do?
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Synergist muscle
Contracts with flexor digitorum longus - keeps toes curling <i>straight</i> rather than at FDL's angle |
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What are the divisions of the tibial nerve at the foot? What muscles do these nerves innervate?
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Medial plantar nerve
- Abductor hallucis - Flexor hallucis brevis - Flexor digitorum brevis - Most medial lumbrical Lateral plantar nerve - Everything else |
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What anatomical landmark marks the beginning of the common femoral a.?
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lnguinal ligament
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How can you find the common femoral a. (i.e. for a code)?
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2 finger breadths lateral to the pubic tubercle.
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What are the boundaries of the femoral triangle? What's in it?
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Sartorius
Adductor longus Inguinal ligament Iliopsoas, pectineus Common femoral a., v. Femoral n. Femoral sheath Greater saphenous v. |
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What are the branches of the common femoral a.?
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Deep artery of the thigh (profunda femoral a.)
Superficial femoral a. |
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What does the profunda femoral a. supply? What are its branches?
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All parts of the thigh EXCEPT anterior.
Perforator arteries - wrap posteriorly around femur Circumflex arteries - Medial - head, neck - Lateral - lateral thigh (ascending, descending, transverse) |
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What is the path of the superficial femoral a. from the femoral triangle?
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Enters adductor canal, exits via adductor hiatus (aponeurosis of adductor manus) where it becomes popliteal a.
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What does the superficial femoral a. supply?
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Anterior, anteromedial thigh
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What separates the superficial femoral a. and the profunda femoral a.?
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Adductor longus
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What are the borders of the popliteal fossa?
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Biceps femoris
Gastrocnemius Semimembranosus, semitendinosus |
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What are the contents of the popliteal fossa?
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Poplitea a., v.
Lesser saphenous v. Tibial n. + Common fibular n. Lymph nodes, lymphatics |
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Where does the popliteal artery begin? Where does it end?
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Adductor hiatus
Inferior border of popliteus m. |
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What are the branches and divisions of the popliteal a.?
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Anterior tibial a.
Tibioperoneal trunk Genicular arteries (5): Superior lateral + medial Middle Inferior lateral + medial |
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What are the divisions of the tibioperoneal trunk?
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Posterior tibial a.
Peroneal a. |
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What is the order of the anterior tibial a., posterior tibial a. and peroneal a.?
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Medial to lateral:
Posterior tibial a. Peroneal a. Anterior tibial a. |
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What happens to the anterior tibial a. in the foot?
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Becomes dorsalis pedis a.
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What happens to the peroneal a. in the foot?
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Terminates around the ankle
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Where does the posterior tibial a. run in the ankle?
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Posterior to medial malleolus
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How many compartments does the calf have?
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4!
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What are the muscles of the anterior compartment of the lower leg? Arteries/veins? Nerves?
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Tibialis anterior
Extensor digitorum longus Extensor hallicus longus Anterior tibial a., v. Deep fibular n. |
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What are the muscles of the lateral compartment of the leg? Nerves?
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Fibularis longus
Fibularis brevis Superficial fibular n. |
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What are the muscles of the posterior superficial compartment? Nerves?
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Gastrocnemius
Soleus Plantaris Medial cutaneous sural n. (innervated by tibial n.) |
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What are the muscles of the posterior deep compartment? Arteries/veins? Nerves?
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Popliteus
Tibialis posterior Flexor digitorum longus Flexor hallicus longus Posterior tibial a., v. Fibular a., v. Tibial n. |
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What are the branches of the dorsalis pedis a.?
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Lateral tarsal a.
Medial tarsal a. Arcuate a. --> dorsal metatarsal a. Deep plantar a. |
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What are the branches of the posterior tibial a.?
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Lateral plantar a.
Medial plantar a. = plantar arch --> plantar metatarsal a. **plantar arch comes from lateral and medial plantar a. AND deep plantar a. from DP = anastomosis |
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What should you do to feel the dorsalis pedis pulse? Posterior tibial?
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DP - b/w 1st and 2nd digit extensors; dorsiflex for pulse
PT - deep to flexor retinaculum, posterior to medial malleoulus; invert to feel pulse |
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What are the four types of veins?
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Deep - thin walled, go with arteries
Superficial - thicker walled Penetrating - connect superficial and deep Sinusoids - muscle pump mechanism in skel. m. |
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Where is the greater saphenous vein and where does it empty?
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Posterior to medial condyle of femur
Anterior to medial malleolus Empties into femoral v. |
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Where is the lesser saphenous vein and where does it empty?
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Posterior to lateral malleolus
Empties into popliteal fossa |
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How do perforating veins prevent backflow?
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Valves
Oblique angles |
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Lateral femoral cutaneous n.
1) Site of injury? 2) Causes? 3) Effects and anesthesia? *What is the special name for the effects of this nerve deficit? |
1) L2, 3
2) Pressure on inguinal ligament (e.g. pregnancy, fat, hip jeans) 3) Anterolateral thigh paresthesia, pain, numbness Meralgia paresthetica |
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Femoral n.
1) Site of injury? 2) Causes? 3) Effects and anesthesia? |
1) L2,3,4
2) Above inguinal ligament: - Retroperitoneal tumor - Hemorrhage Below inguinal ligament - Perforating wound 3) Decreased hip flexion, , loss of knee jerk reflex (knee extension) Anesthesia - anteromedial thigh, medial leg and foot |
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Obturator n.
1) Site of injury? 2) Causes? 3) Effects and anesthesia? |
1) L2,3,4
2) Above inguinal ligament: - Retroperitoneal tumor - Hemorrhage Below inguinal ligament - Perforating wound 3) Loss of adductor muscles = widened gait Insignificant sensory loss |
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Superior Gluteal n.
1) Site of injury? 2) Causes? 3) Effects and anesthesia? |
1) L4, L5, S1
2) Penetrating wounds 3) Loss of hip abduction = pelvis drop to other side (Trendelenburg's sign) |
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Inferior gluteal n.
1) Site of injury? 2) Causes? 3) Effects and anesthesia? |
1) L5, S1, S2
2) Penetrating wounds 3) Decreased hip extension = hard to stand up, climb stairs *May not affect gait |
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Sciatic n.
1) Site of injury? 2) Causes? 3) Effects and anesthesia? |
1) L4, L5, S1, S2, S3
2) Retroperitoneal hemorrhage Femoral fracture Posterior hip dislocation Misplaced IM injection 3) Decreased knee flexion Foot-drop, flail-foot - Can't stand on heel (fib.) or toes (tibial) Anesthesia below the knee (except medial leg + foot = saphenous n.) |
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Tibial n.
1) Site of injury? 2) Causes? 3) Effects and anesthesia? |
1) L4, L5, S1, S2, S3
2) Tarsal tunnel syndrome Penetrating wound 3) Decreased plantar flexion Decreased adduction, abduction, flexion of toes Decreased Inversion - Can't stand on toes => increased concavity of longitudinal arch of foot => claw toes Anesthesia - sole of foot + toe surfaces - like walking on pillows |
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Common fibular n.
1) Site of injury? 2) Causes? 3) Effects and anesthesia? |
1) L4, L5, S1, S2
2) Fracture of fibular neck Compression (i.e. cast) 3) Decreased dorsiflexion, eversion, toe extension = foot drop, steppage gait - Can't stand on heel - Sensory loss: * Deep fibular - small space b/w 1st and 2nd toes * Superficial fibular - anterolateral leg, dorsum of foot, toes |
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What is cadence? When does increasing cadence transition to running?
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Steps/min
180 steps/min, 4.5mph |
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What is hip flexion contracture? How does it affect gait?
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Cannot extend hip
Decreases step length |
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What is PF joint contracture?
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Cannot dorsiflex (walk on tiptoes)
*in cerebral palsy |
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What is Trandelenburg gait?
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Hip abduction weakness - hip falls to opposite side of step, compensated by leaning to same side
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How does weak quadriceps affect gait?
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Leg hyperextended, use adductors to swing leg forward.
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What are the compensations for foot drop gait? (4)
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Steppage gait
Circumduction Hip hiking Vaulting --> make one leg relatively shorter! |
