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221 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Anterior Compartment of Thigh
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Extends the knee and flexes the hip, Femoral nerve
Femoral artery Sartorius - flexes hip and FLEXES knee Rectus femoris - flexes hip and extends knee Vastus group (medialis, lateralis and intermedialis) extend the knee Pectineus Also receives innervation from the obturator nerve. Its main action is to adduct the thigh. |
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Posterior compartment of the thigh
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Extends the hip and flexes the knee
Tibial and Peroneal (fibular) nerve, Penetrating branches of the profunda femoris artery Semitendinosus, Semimembranosus and the long head of the biceps femoris all extend the hip, AND flex the knee. And all are innervated by the tibial nerve. The short head of the biceps femoris is innervated by the common peroneal nerve and ONLY flexes the knee. |
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Adductor Compartment of the thigh
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Adducts the thigh
Obturator nerve Obturator artery Pectineus Adducts the thigh Gracilus Adducts the thigh Obturator extenus Lateral rotator, adducts the thigh Adductor Longus Adducts the thigh Adductor Brevis Adducts the thigh Adductor Magnus Adducts the thigh and flexes the knee. Also receives innervation from the tibial nerve. |
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Anterior compartment of the leg
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dorsiflexion, inversion of the foot and extension of the toes.
Deep peroneal (fibular) nerve Anterior tibial artery. Tibialis anterior (dorisflexion) Extensor digitorium longus Extensor hallucis longus |
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Posterior compartment of the leg
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plantar flexes, flexes the knee and flexes the toes.
Tibial nerve. Posterior tibial artery Knee Flexion and Plantarflexion: Gastrocnimius Soleous (only plantar flexes) Plantaris Digital Flexion and Plantarflexion: Popliteus Tibialis posterior Flexor digitorium longus Flexor hallucis longus |
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Lateral compartment of the leg
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Everts the foot.
Superficial peroneal nerve. Peroneal artery Peroneus longus (everts the foot) Peroneus brevis (everts the foot) |
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Main Flexor of Hip
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Iliopsoas
Innervation: ventral rami of lumbar nerves (L1, L2, and L3) |
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Severed femoral Nerve
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hip flexion weak , knee extension lost (quads), sensation lost over anterior thigh and medial leg and foot
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Severed obturator:
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thigh adduction lost, sensation lost over medial thigh
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Lateral rotator group
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Piriformis: n. to the piriformis (S1-S2)
Superior gemellus: n. to the obt. internus & sup. gemellus (L5-S2) Obturator internus: n. to obt. internus & sup. gemellus (L5-S2) Inferior gemellus: n. to quadratus femoris & inf. gemellus (L4-S2) Quadratus femoris: n to quadratus femoris & inf. gemellus (L4-S2) |
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Severed common peroneal:
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"Ankle Drop"
"steppage gait" foot eversion lost, dorsiflexion lost, toe extension lost (inverted foot and foot drop during walking), sensory lost anterolateral leg and dorsum of foot |
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Severed Tibial: (in popliteal fossa)
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inversion weak, plantarflexion lost
TIP (Tibial Inverts and Plantarflexes - if lost can’t stand on TIP-toes) |
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Popliteal Artery Branches
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Genicular arteries
2- Anterior Tibial artery terminates as the dorsalis pedis artery in the foot 3- Posterior Tibial artery a) Fibial/peroneal artery (behind lateral mallelolus) b) medial plantar artery c) lateral plantar artery (forms plantar arch, anastomoses to dorsalis pedis) |
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Medial Foot Muscles
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Medial Plantar
(from Tibial nerve) Abductor hallucis Flexor hallucis brevis |
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Lateral Foot Muscles
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Lateral Plantar
(from Tibial nerve) Abductor digiti minimi brevis Flexor digiti minimi brevis |
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Central Foot Muscles
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Medial Plantar
Flexor digitorium brevis Medial lumbrical Lateral Plantar Lateral three lumbricals Quadratus plantae |
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Dorsal Foot Muscles
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Deep peroneal
Extensor digitorium brevis Extensor hallucis brevis |
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Y Chromosome Factor and Effect
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Sry Gene
Initiates and Produces Testis |
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No Y Chromosome
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Gonads: Ovaries
External Genitalia: Female Ducts: Female |
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Sertoli Cells of Testis Factor
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Muellerian Inhibiting Factor (MIF)
Inhibits Female/Pasamesonephric Ducts |
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MIF Deficiency
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Uterus may cause hernia
Gonads: Testis External Genitalia: Male Ducts: Both |
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Leydig Cells of Testis Factor
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Testosterone
1. Masculanizes mesonephric ducts in utero 2. Masculanizes external genitalia at puberty |
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Androgen (Testosterone) Receptor Insensitivity
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"XY Female with Testes"
Gonads: Undescended Testes External Genitalia: Female Ducts - Neither/Incomplete |
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Testosterone Biosynthesis Deficiency
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Gonads: Undescended Testes
External Genitalia: Ambiguous/Female Ducts - Neither/Incomplete |
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5 alpha reductase
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Converts testosterone to dihydrotestosterone (DHT)
Masculanizes External Genitalia in utero |
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5 alpha reductase deficiency
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Gonads: Testes
External Genitalia: Ambiguous/Female at birth, Male at puberty Ducts - Male |
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Hyperactive Adrenal Glands
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Produce Excess Testosterone (Female)
Female Intersex CAGS = Congenital Adrenogenital Syndrome Gonads: Ovaries External Genitalia: Masculanized (varies), Large Clitoris Ducts - Female |
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Pronephric Duct
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Primitive Kidney
Disintegrate in both |
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Mesonephric Duct
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Males: Vas deferens, epididymus, seminal vesicles, ejaculatory duct
Females: Obliterated |
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Paramesonephric Duct
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Males: Disintegrate (appendix of testis)
Females: Uterus, Proximal Vagina, Fimbrae, Fallopian Tubes |
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Ureteric Bud / Metanephric Diverticulum
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Collecting System: Ureter, major calyces, renal pelvis
Induces development of metanephros from undifferentiated mesoderm |
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Metanephros
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Definitive Kidney/Excretory System:
Nephrons |
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Superior UG Sinus
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Bladder
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Intermediate UG Sinus
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Male:
Prostatic and Membranous Urethra Female: Membranous Urethra |
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Lower UG Sinus
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Male:
Penile Urethra Female: Vestibule of Vagina |
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Endoderm of Urethra
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Male:
Prostate, Bulbourethral Glands |
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Vaginal Development
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Point of contact of paramesonephric ducts and UG Sinus (endoderm)
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Sex Cords
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Male:
Medulla - Sertoli Cells Cortex - Degenerates Female: Medulla - degenerates Cortex - primary follicles |
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Adult Homolog of Genital Tubercule
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Male:
Glans Penis Female: Clitoris |
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Adult Homolog of Labiosacral Swellings
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Male:
Scrotal Sac Female: Labia Majora |
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Adult Homolog of UG Folds
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Male:
Shaft Female: Labia Minora |
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Pelvic Kidney
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Kidney never rises
May be mistaken for pathological mass |
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Horseshoe Kidney
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Fusion of distal kidney poles
Can't ascend due to IMA |
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No Kidney
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Failure of Contact between ureteric bud and mesoderm
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Double Ureter
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A double ureter on one side due to an embryologic division of the ureteric bud
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Two Kidneys on One Side
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Division of Ureteric Bud
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1 Kidney, on 1 side, 2 Ureters
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One kidney crosses while ascending, both kidneys fuse
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Urachus in adult?
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Median Umbilical Ligament
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Umbilical Artery in adult?
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Medial Umbilical Ligament
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Testis Determining Factor
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?
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Divided Uterus
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No fusion of upper paramesonephric ducts
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Double uterus, double upper vagina, "Didelphic uteri"
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No fusion of paramesonephric cords
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Hypospadias
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Urethra open on bottom of penis due to imcomplete fusion of urethral/UG folds
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Epispadias
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Urethra open on top of penis due to imcomplete fusion of urethral/UG folds
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Female pseudohermaphrodite/intersex
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Ovary with male phenotype
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Male Intersex/Pseudohermaprodite
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Testis with Female phenotype
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Dorsal Scapular Nerve
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C5
Rhomboids -Retract scapula Levator Scapula -Raise Scapula |
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Phrenic Nerve
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C5 Root
Diaphragm |
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Long Thoracic Nerve
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Roots C5/C6/C7
Serratus Anterior - Runs with lateral thoracic artery |
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Medial Brachial Cutaneous Nerve,
Medial Antebrachial Cutaneous Nerve |
Medial Cord C8/T1
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Medial Pectoral Nerve
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Medial Cord C8/T1
Pec Major -Flexes, adducts, and medially rotates humerus Pec Minor -Draws scapular inferiorly and anteriorly |
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Lateral Pectoral Nerve
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Lateral Cord C5/C6/C7
Pec Major -Flexes, adducts, and medially rotates humerus |
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Thoracodorsal Nerve
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Posterior Cord C6/C7/C8
Latissimus Dorsi -Extension of arm, Medial rotation arm, ADduct arm Runs with thoracodorsal artery |
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Upper and Lower Subscapular Nerves
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Posterior Cord C6/C7/C8
Subscapularis - Medial Rotation Teres Major - Internal Rotation |
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Subclavius Nerve
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Upper Trunk C5/C6
Subclavius Muscle |
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Suprascapular Nerve
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Upper Trunk C5/C6
Supraspinatus - ABduction of arm Infraspinatus -ADduction of arm, external rotator of glenohumeral joint |
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Musculocutaneous Nerve
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Anterior C5/C6/C7
Anterior Arm Forearm Flexion Coracobrachialis Bicephs Brachii Brachialis |
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Ulnar Nerve
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Anterior C8/T1
Intrinsic Muscles of the Hand: Palmar interossei - ADduct digits 2, 4, and 5, Dorsal interossei - ABduct digits 2, 4, and 5, Half Lumbricals -Beauty Wave, Flex MCP joints Hypothenar Muscles: Opponens, ABductor, and Flexor Digiti Minimi Adductor Pollicis -Adducts Thumb Palmaris Brevis -Palm concavity Exceptions: Flexor Carpi Ulnaris - flexes and adducts hand Half Flexor Digitorum Profundus - flexes distal phalanx Thenar Muscles (Radial) Half Lumbricals (Median) |
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Radial Nerve
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Posterior C5/C6/C7/C8
Extensor and Supinator Muscles Lateral Epicondyle Triceps -extend shoulder and forearm Anconeus -Forearm extension Extensors of Forearm (Superficial) Brachioradialis Flexes elbow Extensor carpi radialis longus Extends, abducts wrist Extensor carpi radialis brevis Extends, abducts wrist Extensor digitorum Extend digits 2-5, wrist Extensor digiti minimi Extends digit 5 Extensors of Forearm (Deep) Abductor pollicis longus Abducts thumb and wrist Extensor pollicis brevis Extends thumb Extensor pollicis longus Extends thumb Extensor indicis Extends digit 2 Supinator Supinates forearm |
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Axillary Nerve
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Posterior C5/C6
Deltoid -Shoulder abduction, flexion, extension Teres Minor -Lateral Rotation and ADduction |
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Median Nerve
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Anterior C6/C7/C8/T1
Medial Condyle Flexors and Pronators of Forearm Pronator teres pronates hand, flexes forearm Flexor carpi radialis Flexes and abducts hand Palmaris longus flexes hand Flexor digitorum superficialis flexes middle phalanx of digits 2-5 Flexor digitorum profundus flexes distal phalanx at digits 2-5 Flexor pollicis longus flexes thumb Pronator quadratus pronates hand Exceptions in forearm: Flexor Carpi Ulnaris (Ulnar) Half Flexor Digitorum Profundus (Ulnar) Thenar Muscles: Opponens, ABductor, and Flexor Pollicus (Brevis) 1st & 2nd Lumbricals -flex MCP joints |
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Upper Trunk
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C5/C6
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Middle Trunk
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C7
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Lower Trunk
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C8/T1
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Main Supinator Muscle?
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Biceps Brachii (Musculocutaneous)
Also Supinator (Median) |
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Main Flexor of Elbow?
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Brachialis (Musculocutaneous)
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1st Axillary Section
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Superior Thoracic
-1st and 2nd Intercostal |
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2nd Axillary
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Thoracoacromial Trunk
-Acromial, Pectoral, Clavicular, Deltoid Lateral Thoracic Artery -Serratus Anterior -Runs with Long Thoracic Nerve |
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3rd Axillary
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Subscapular
-supplies subscapularis -1. Circumflex Scapular -Teres Minor and Major -2. Thoracodorsal -Latissimus Dorsi Posterior Circumflex Humeral -around surgical neck of humerus -passes through quadrangular space with axillary nerve -larger than anterior c.h. Anterior Circumflex Humeral -passes around surgical neck of humerus |
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Embryological rotation of limbs
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Upper limb: Medial Rotation
Lower Limb:Lateral Rotation |
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Autonomous Areas of Upper limb
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C5: Deltoid
C6: Thenar Eminence C8: Hypothenar Eminence T1: Medial Forearm T2: Axilla |
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Autonomous Areas of Lower limb
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L2: Medial Thigh
L4: Big Toe S1: Little Toe S2: Back of leg S3: Back of thigh |
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Obturator Nerve
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Anterior L2/L3/L4
Leaves the Pelvis thru Obturator Foramen Innervates ADductor Muscles on Medial Thigh: Adductor longus Adductor brevis (Thigh Flexor) Adductor magus (Flex or Ext Thigh) Gracilis (Flex Leg) Obturator Externus (Lateral Rotator of Thigh) |
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Femoral Nerve
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Posterior L2/L3/L4
Largest Branch of Lumbar Plexus Runs within the Psoas Major, then runs lateral to the Femoral Artery/Vein, but outside of the sheath Also: Lateral Femoral Cutaneous (Posterior L2/L3): Lateral Anterior Thigh Femoral N: Inferior to Inguinal Ligament, splits into several branches: Anterior Cutaneous (Anterior Medial Thigh) Saphenous (Medial Leg) Thigh Flexors: Psoas minor Psoas major Iliacus Pectineus (Thigh Abudction and Medial Rotation) Extend Leg: Quadriceps: Rectus Femoris (Thigh Flexor) Vastus Lateralis Vastus Medialis Vastus Intermedius Sartorius: Flex thigh, ABd thigh Lat rot thigh, Flex leg |
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Pudendal Nerve
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Anterior S2/S3/S4
1. Inferior Rectal (External Anal Sphincter) 2. Perineal (to scrotum) 3.Dorsal Nerve of Penis/Clitoris (External Urethral Sphincter) |
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Sciatic Nerve
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Tibial (Anterior L4/L5/S1/S2/S3)
+ Common Fibular/Peroneal (Posterior L4/L5/S1/S2) Starts at inferior border of piriformis Leaves pelvis thru greater sciatic foramen Divides into tibial and common peroneal halfway down thigh Tibial Sciatic Nerve innervates Hamstrings to extend thigh: Semitendinosus (Flex, med rot flexed leg) Semimembranosus (Flex, med rot flexed leg) Biceps Femoris (Flex, lat rotation of leg) Innervates ischial head of adductor magnus |
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Tibial Nerve
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Anterior L4/L5/S1/S2/S3
Homolog of Radial Nerve Medial Branch of Sciatic Nerve Descends though the middle of the popliteal fossa, posterior to the popliteal vein and artery At tibialis posterior, runs with posterior tibial artery and vein to foot At medial malleolus, divides to medial and lateral plantar nerves Leg Flexion and Plantarflexion: Gastrocnemius Plantaris Soleus Popliteus Plantarflexors: Tibialis posterior (Foot inversion) Flexor digitorium longus (Digit Flex) Flexor hallucis longus (Big Toe Flex) |
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Common Fibular/Peroneal Nerve
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Posterior L4/L5/S1/S2
Lateral Branch of Sciatic N Very superficial, easy to injure Splits into Deep Peroneal and Superficial Peroneal as it curls below head of fibula (lateral) posterior to anterior |
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Superior Gluteal Nerve
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Posterior L4/L5/S1
Leaves the pelvis through the superior part of the greater sciatic foramen, superior to the piriformis muscle, with the superior gluteal artery. Innervates Thigh abductors and Thigh Medial Rotators: Gluteus Medius Gluteus Minimus Tensor Fascia Latae |
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Erb Duchenne Paralysis / Waiter's Tip
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Upper Trunk Lesion (C5/C6)
-Distension of Head at Birth -Fall on Shoulder Presentation 1. Shoulder Adduction and Medial Rotation 2. Waiter's tip hand 3. Slight Elbow Flexion No Abduction of Humerus -Deltoid (Axillary) -Supraspinatus (Suprascapular) No Lateral Rotation of Shoulder -Teres Minor (Axillary) -Infraspinatus (Suprascapular) Weakness in Flexion of Elbow Biceps, Coracobrachialis, Brachialis (Musculocutanous) -Brachioradialias and digit/carpi flexors still functional Loss of Elbox extension -Triceps Sensory Loss: Preaxial Arm/Forearm |
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Klumpke's Paralysis / Straphanger's Syndrome
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Loss of C8/T1 Roots
-Holding on to subway strap -Arm pulled upwards "Simian Hand" Loss of intrinsic hand muscles (Ulnar and Median) Weak finger flexion - flexor digitorum profundus and superficialis MAP if T1 is lost |
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Radial Nerve Palsy / Saturday Night Palsy
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Falling asleep on arm, compressing radial nerve
"Wrist drop" -Loss of wrist extension, finger extension,hand supination, elbow extension |
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Shoulder Abduction
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0 to 30 degrees - supraspinatus (suprascapular, C5/C6)
30 to 90 - Deltoid (axillary, C5/C6) 90 to 180 - Serratus Anterior (long thoracic C5/C6/C7) |
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What passes through the lesser sciatic foramen?
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Obturator Internis Tendon and pudendal neurovascular bundle
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Innervation of Pelvic Diaphragm?
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Somatic nerves S2/S3/S4
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What comprises the male urogenital diaphragm / deep perineal pouch?
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Superficial fascia
Sphincter Urethrae (Perineal Branch of Pudendal Nerve, voluntary) Membranous Urethra Bulbourethral Glands -Male only Part of Vagina -Female Only Deep Transverse Perineal muscle Internal Pudendal Artery and Vein Branches to Penis/Clitoris/Labia Dorsal Nerve to Penis Branch of Pudendal Nerve/Clitoris Deep Fascia |
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Difference above / below pectinate line in the anal canal?
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Above
Derived from: Endoderm Arteries: superior and middle rectal Vein: Portal, superior rectal Lymph: Deep Nodes Innervation: Somatic, hypogastric plexuses Below Derived from: Ectoderm Arteries: Inferior Rectal ( Int. Pudendal) Vein: Caval, Inf. Rectal Lymph: Superficial Innervation: |
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Internal Anal Sphincter
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Circular Muscle
Involuntary Sympathetic |
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External Anal Sphincter
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Voluntary
Inferior Rectal Branch of Pudendal Nerve Inferior Rectal Branch of Pudendal Artery Attaches to Perineal Body, Coccyx and Puborectalis Muscle |
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Contents of Ischiorectal Fossa
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Pudendal Nerve
Internal Pudendal Artery Internal Pudendal Vein |
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Contents of the superficial perineal pouch?
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The pouch is enclosed by the superficial fascia of the UG diaphgram/perineal membrane (deep), the Colles' fascia (superficial) and the ischial tuberosities (lateral)
Root of Penis/Clitoris Bulbospongiousus Muscle -covers bulb of penis/vestibule and vestibular glands -compresses penile urethra/deep dorsal vein of clitoris -1 in males, 2 in females Ischiocavernosus Muscle -retards venous return in erection Vestibular / Paraurethral Glands -Females only Superficial Transverse Perineal Muscle -fixes perineal body in center Perineal body -fibrous mass Perineal Branches of Internal Pudendal Nerve |
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What attaches to perineal body?
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Bulbospongiousus M.
External Anal Sphincter Superficial Transverse Perineal M. Deep Transverse Perineal M. |
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Corpus Spongiosum
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Erectile Tissue
Covered by bulbospongiosus muscle - compresses deep dorsal vein 1 in males, 2 in females Continuation of bulb of penis, contains urethra, ends in glans penis |
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Corpus Cavernosum
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Erectile Tissue
2 Cover crura of penis/clitoris Covered by ischiocavernosus muscle |
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Divisions of Male Urethra
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Prostatic
-Inside Prostate Gland -Ejaculatory duct receives sperm from vas deferens and secretions from seminal vesicle -Prostatic duct collects secretions from prostate Membranous -Thru UG Diaphgram/Deep Perineal Pouch -Bulbourethral glands empty into urethra here Spongy -Thru corpus spongiosum |
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Levator Ani Origin?
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Tendinous arch of obturator internus muscle
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Are the erectile tissues in the superficial or deep perineal pouch?
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Superficial
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Internal Urethral Sphincter
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Only in Males
Above Prostate Under sympathetic Control Contract During emission, to prevent retrograde ejaculation into bladder |
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Nitric Oxide
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Neurotransmitter that causes relaxation of smooth muscle during erection, allowing erectile tissue to fill up
Released by parasympathetics |
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Gluteus Maximus, Medius and Minimus, Tensor Fascia Latae
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Inferior Gluteal Nerve (post L4/L5/S1)
-Gluteus Maximus Superior Gluteal Nerve (post L5/S1/S2) Superior Gluteal Artery ABduct thigh Hip extensors Medial rotation of thigh |
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Sartorius
Quadriceps Femoris: Rectus Femoris Vastus Lateralis, Medialis, Intermedius |
Femoral Nerve (posterior L2/L3/L4)
Branches of Femoral Artery Knee Extension Some thigh flexion -Rectus Femoris Anterior Thigh Component |
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Peroneus Longus and Brevis
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Superficial Peroneal Nerve (L4/L5/S1)
Anterior Tibial Artery Plantarflexion Eversion of Foot Lateral Leg Compartment |
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Tibialis anterior
Extensor Digitorum Longus Extensor Hallucis Longus, Peroneus Tertius |
Deep Peroneal Nerve (L4/L5)
Anterior Tibial Artery Plantarflexion Eversion Anterior Leg Compartment |
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Extensor Hallicus Brevis
Extensor Digitorum Brevis |
Deep Peroneal Nerve (L4/L4)
Lateral Tarsal Branch of Dorsal Pedis Artery Extension of Toes Intrinsic Foot Extensors! |
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Iliacus
Psoas Major and Minor Pectineus |
Femoral Nerve (S2/S3/S4)
Iliolumbar branch of Internal Iliac Artery Hip Flexion Medial Hip rotation |
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ADductor Longus, Magnus and Brevis
Gracilis Pectineus |
Obturator Nerve (Anterior L2/L3/L4)
Obturator Artery Adduction Some Knee Flexion Some Medial Rotation Medial Thigh Compartment "Adductors" |
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Obturator Internus and Externus
Superior and Inferior Gemellus Quadratus Femoris Piriformis |
Obturator Interus Nerve
Quadratus Femoris Nerve Obturator Nerve Branches of Anterior Interior Iliac Artery Lateral Rotation of Hip Some Thigh Abduction Location? |
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Semitendinosus
Semimembranosus Biceps Femoris |
"Hamstrings"
Tibial Sciatic Nerve (Anterior L4/S1/S2/S3) (Short head of biceps innervated by common peroneal) Femoral Artery Flex Leg Posterior Thigh Compartment |
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Gastrocnemius
Plantaris Soleus Popliteus |
Tibial Nerve (Anterior L4/L5/S1/S2/S3)
Posterior Tibial Artery Flexion of Ankle Some flexion of knee Popliteus rotates knee medially Superficial posterior compartment of leg |
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Tibialis Posterior
Flexor Hallucis Longus Flexor Digitorum Longus |
Tibial Nerve (Posterior L4/L5/S1/S2/S3)
Peroneal and Posterior Tibial Arteries Plantarflexion Some digit flexion Tibialis posterior- foot inversion when not bearing weight Deep posterior Compartment of Leg |
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Abductor Hallucis
Flexor Hallucis Brevis \ |
"Thenar Muscles" - no opponens
Medial Plantar Nerve Medial Plantar Artery Big Toe flexion and ABduction \ |
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Abductor Digiti Minimi
Flexor Digiti Minimi |
"Hypothenar" - no opponens
Lateral Plantar Nerve Lateral Plantar Artery ABduction and flexion of little toe |
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Embroyological/Simple Pelvic Innervation
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Somatic: Pelvic Floor Muscle and External Sphincters
Sympathetic: Internal Sphincters Parasympathetic: Smooth muscles in wall and erectile tissues |
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Somatic Innervation of Bladder/Rectum
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Motor (S2/S3/S4):
External Anal Sphincter External Urinary Sphincter Pelvic Floor Muscles Tonic Voluntary Control Inhibition - Relaxation Sensory: All motor structures, anal canal, prosthetic urethra (sensitive to distension) |
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Sympathetic Innervation of Bladder/Rectum
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Motor (T12/L1/L2)
Internal Anal Sphincter Internal Urinary Sphincter -Contracts during emission Also contracts ductus deferens, seminal vesicles, and prostatic muscles Sensory: Over-Distension of Bladder |
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Parasympathetic Innervation of Bladder/Rectum
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Motor (S2/S3/S4):
Contraction of detrusor muscle -tonically relaxed, contacts to push out urine Contraction of rectal muscles During erection, fibers relax smooth muscle to allow blood into the erectile tissue (Nitric Oxide) Sensory: Normal Bladder and Rectal Distension |
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Ejaculation Innervation
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Rhythmic Contraction of Bulbospongiosus and Ischiocavernosus Muscles
Controlled by Pudendal Nerve Cyclists can compress pudendal nerve and have weak ejaculation |
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Pelvic Splanchnic Nerves
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Parasympathetic and Somatic Nerves that innervate Bladder and Rectum
S2/S3/S4 |
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Sympathetic Pelvic Innervation
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L1/L2
Lumbar Splanchnic nerves leave at L1/L2 and travel down Aorta, some to superior hypogastric plexus Pelvic Splanchnic travel down sympathetic chain and leave at S2/S3 level to inferior hypogastric plexus (mixed parasympath Both meet to innervate bladder/rectum |
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Inferior Hypogastric Plexus
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Sympathetic and Parasympathetic
Branches to other plexuses of pelvis |
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Superior Hypogastric Plexus
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Sympathetic
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Hypogastric Nerve
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Carries Sympathetic fibers from superior to inferior hypogastric plexus
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Features of the human pelvis that are different from that of a chimpanzee and contribute to efficient bipedal locomotion
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Wide sacrum
Relatively closed sciatic notch Wide, A-P oriented ilium Posteriorly placed ischial tuberosity |
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Median Umbilical Ligament
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Obliterated Urachus (Empties fetal bladder into allantois)
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Medial Umbilical Ligament
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Obliterated Umbilical Arteries
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Lymph Drainage of Scrotum/Testes
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Scrotum - Superficial Inguinal
Testes - Deep paraaortic |
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Transurethral Prostatectomy
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"TURP" procedure- long metal instrument inserted in urethra through to bladder. Hypertrophied prostate is removed. Danger is damage to the internal urethral sphincter resulting in retrograde emission
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Shoulder Abduction
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0-30 degrees
30-90 Degrees 90-180 Degrees |
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Lymph Drainage of Scrotum/Testes
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?
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Transurethral Prostatectomy
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?
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Shoulder Abduction
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0-30 degrees Supraspinatous
30-90 Degrees Deltoid 90-180 Degrees Serratus Anterior |
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Autonomous Innervation of the Lower Limb?
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L2 - Medial Thigh
L4 - Thenar S1 - Hypothenar S2 - Back of leg S3 - Back of thigh |
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Which spinal root innervates the intrinsic muscles of the foot?
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S3
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Anterior Compartment of the Arm
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Musculocutaneous Nerve (Anterior C5/C6/C7)
Brachial Artery Elbow Flexion Biceps Brachii (also supinator) Brachioradialis Coracobrachialis (also ADductor) |
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Posterior Compartment of the Arm
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Radial Nerve (Posterior C5/C6/C7/C8)
Deep Brachial Artery Triceps (shoulder and elbow extensor) Anconeus |
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Anterior Compartment of the Forearm
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Median Nerve (Anterior C6/C7/C8/T1)
Ulnar Artery Flexion and Pronation of Hand Pronator teres Flexor carpi radialis (abducts) Palmaris longus Flexor carpi ulnaris (Ulnar N) Flexor digitorum superficialis Flexor digitorum profundus Abductor pollicis longus Flexor pollicis brevis Flexor pollicis longus Pronator quadratus |
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Lateral Compartment of the Forearm
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Radial Nerve (Posterior C5/C6/C7/C8)
Radial Artery Brachioradialis Flexes elbow Extensor carpi radialis longus/brevis: Extends, abducts wrist |
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Posterior Compartment of the Forearm
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Radial Nerve (Posterior C5/C6/C7/C8)
Extensor carpi radialis brevis Extensor digitorum Extensor digiti minimi Extensor carpi ulnaris Abductor pollicis longus Extensor pollicis brevis Extensor pollicis longus Extensor indicis Supinator |
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Posterior Femoral Cutaneous Nerve
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Posterior S1/S2, Anterior S2/S3
Posterior Thigh |
Couldn't find info about anterior/posterior branches- you sure?
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Sural Nerve
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Anastamoses of Tibial and Peroneal Nerves
Cutaneous Innervation of Posterior Lateral Leg |
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Contents of the Popliteal Fossa?
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* popliteal artery, which is a continuation of the femoral artery
* popliteal vein * tibial nerve * common peroneal nerve * Six or seven popliteal lymph nodes are embedded in the fat The roof contains a portion of the small saphenous vein and posterior cutaneous nerve of the thigh. |
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Deep Peroneal/Fibular Nerve
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Runs with Anterior Tibial Artery
Dorsiflexors: Tibialis anterioir (foot inversion) Extensor digitorum longus Extensor hallucis longus Peroneus tertius (Foot Eversion) At ankle divides into Lateral and Medial Deep Peroneal/Fibular Nerves Lateral Deep Peroneal Nerve innervates intrinsic extensors of foot: Extensor hallucis brevis Extensor digitorum brevis |
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Superficial Fibular Nerve
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Runs lateral and superficial to deep peroneal nerve
Innervates Foot Everters and Plantarflexors Peroneus longus Peroneus brevis Cutaneous innervation of lateral leg and median dorsal foot |
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Medial Plantar Nerve
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Innervates intrinsic thenar flexor muscles of foot:
Abductor hallucis Flexor hallucis brevis and flexor: Flexor digitorum brevis Lumbricals (4) |
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Lateral Plantar Nerve
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Innervates intrinsic flexors of the foot, etc.:
Adductor hallucis Flexor accessorius Plantar interossei (3) Dorsal interossei (4) Innervates intrinsic hypothenar muscles of the foot: Abductor digiti minimi Flexor digiti minimi brevis |
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Inferior Gluteal Nerve
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Posterior L5/S1/S2
Innervates Gluteus Maximus, Thigh extender and lateral rotator |
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Differences between male and female pelvises?
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Subpubic Angle
Greater Sciatic Notch Shape of the pelvic inlet Iliac flare |
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Contents of Carpal Tunnel
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Median Nerve
Flexor digitorum profundus (four tendons) Flexor digitorum superficialis (four tendons) Flexor pollicis longus (one tendon) Kinda - Flexor carpi radialis (one tendon) |
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Quadrangular Space
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Between Teres Minor and Teres Major
Lateral to Long Head of Triceps Axillary Nerve Posterior Circumflex Humeral Artery |
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Medial Triangular Space
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Between Teres Minor and Teres Major
Medial to Long Head of Triceps Circumflex Scapular Artery/Vein |
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Lateral Triangular Space/Triangular Interval
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the triangular interval is bounded by: superiorly - teres major; laterally - humerus and lateral head of triceps; medially -long head of triceps
Radial Nerve Deep Brachial Artery |
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What are the primordial tissues of the limb?
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Ectoderm - Skin
Lateral Plate Somatopleur Mesoderm - Dermis and Connective Tissue Somites - Muscle and Dermis Neural Crest Mesenchyme - Dermis |
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Embryological Anterior/Posterior Bone Division
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Anterior: Coracoid process, clavicle, superglenoid tubercle, pubis, ischium
Posterior::Scapula, ilium |
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What determines the Dorsal/Ventral Axis?
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Epithelial(Ectoderm)/Mesethelial(Lateral Plate) Interaction
Ventral Ectoderm produces - Engrailed 1 Dorsal Ectoderm produces - Wnt 7A |
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What determines the Proximal/Distal Axis?
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Apical Ectodermal Ridge (AER) interacts with Progress Zone (PZ) of mesenchyme.
Length of time in PZ/# of cell divisions determines fate : more divisions/longer time = more distal AER produces FBF2 PZ produces Sonic Hedgehog PZ age, not AER, controls limb bud growth |
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Steps in embryological proximal end differentiation
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a. Condensation.
b. Differentiation into chondocytes (future bones) and fibroblasts (future investing fascia and tendons). c. Chondrification. d. Ossification. e.Somitic hypomeres invade the anterior and posterior compartments to form muscle f. Ventral rami of the corresponding spinal nerves invade, blocked by lateral plate mesoderm, split into anterior and posterior nerves |
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Embryological Arteries and Veins
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Arteries down the middle/axial
Veins around the edges/ pre and post axial Pre Axial Veins - basilic/small saphenous Post Axial Veins - cephalic/great saphenous |
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What determines the Preaxial/Postaxial axis?
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Zone of Polarizing Activity forms postaxial structures via Sonic Hedgehog
Retinoic Acid has same effects HoxD genes mediate effects |
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Phocomelia
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Limb Bud Malformation (Very Short Arms)
Outgrowth of limb bud prevented so cells stay under influence of AER for an extended time resulting in only distal components. Thalidomide |
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Mirror Image Digits
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Multiple ZPA centers. Postaxial structures formed on both sides.
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Relation of Line of Support and Major Joints
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Posterior to Hip : Countered by Iliofemoral Ligament (AIIS)
Anterior to Knee : Popliteal Ligaments and Knee Locking Mechanism Anterior to Ankle : Countered by Soleus Muscle |
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Knee Locking
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Locked Knee - medial rotation of femur on knee
To unlock knee, lateral rotation by popliteus and biceps femoris |
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Steps in Swing Phase
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1. Flex Hip : Iliopsoas and Rectus Femoris (Femoral Nerve)
2. Flex Knee : Hamstrings(Semimembranosus, Semitendinosus, Biceps Femoris) (Tibial Sciatic Nerve) 3. Dorsiflex Ankle :Tibialis Anterior (Deep Peroneal Nerve) 4. Extend Knee : Quadriceps Femoris (Femoral N.) |
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Steps in Stance Phase
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1. Hip Extension : Gluteus Maximus (Inferior Gluteal Nerve)
2.Abductors/Medial Rotators Keep weight in middle : Gluteus Medias and Minimus (Superior Gluteal Nerve) 4. Plantar Flexion on big toe : Flexor Hallicus Longus (Tibial) and Flexor Hallicus Brevis (Medial Plantar) **Weight transfers from Lateral Heel to Medial Digit |
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Carrying Angle
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Angle of Femur, Allows smaller distance between feet, Brings center of gravity over planted foot
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Ejaculatory Duct
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Seminal Vesicle and Ductus Deferens
Opens in Prosthetic Urethra |
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What osteological landmark of the pelvis would you use in order to identify the pudendal nerve before anesthetizing it transvaginally preceding childbirth?
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Ischial Spine
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Paralysis of Brachial Plexus
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From pulling baby out during birth
Motor Loss to Entire Arm Sensory Loss from Arm except medial arm from T2 Miosis, Anhydrosis, Ptosis |
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MAP
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Miosis : Constriction of Pupil
Anhydrosis : Dryness of surrounding skin Ptosis : Drooping of eyelid MAP indicates the loss of the T1 root, which provides the sympathetic innervation to most of the head and neck region. This means a concomitant loss of pupil dilation and sweat gland secretions. |
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Carpal Tunnel Syndrome
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Reduction in size of the carpal tunnel compresses the median nerve
Lump proximal to Carpal Tunnel Atrophy of Thenar Muscles (Flexor Pollicus Brevis, Abductor Pollicus Brevis and Opponens Pollicus) and Lumbricals Cutaneous Innervation lost to palmar median 3 and a half digits; dry and red due to sympathetics loss |
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Median Nerve Injury at the Elbow
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Thenar Atrophy
Lumbrical Atropy Loss (or major weakness) in the long wrist and finger flexors arising from the medial epicondyle (Flexor Digitorum Longus, Flexor Pollicus Longus) Loss of pronation Cutaneous : Anterior and Posterior Medial Forearm |
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Ulnar Nerve Injury at the Wrist
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Presentation: Sign of Benediction
- - When asked to make a fist -MP joints extended, IP joints flexed in 4th and 5th digits -Hollowing of dorsal interosseus muscles, esp between thumb and index finger Loss of Lumbricals Flexor Digitorum Longus still Active **If you can still flex your fingers, the injury is proximal to wrist |
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Hollowing of space between thumb and index finger
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Atrophy of Lumbricals
Ulnar Nerve Injury |
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Clawhand
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MP joints extended, IP joints flexed
Hollowing out of dorsal interosseus spaces esp between thumb and index finger Loss of Ulnar and Median Nerves |
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Where to test for cutaneous innervation of brachial plexus nerves/autonomous areas?
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Radial nerve: test skin at the web between the thumb and index finger, on the dorsum of the hand (at the location of the dorsal interosseous).
Median nerve: test skin at the tip of the index finger. Ulnar nerve: test skin at the tip of the little finger. Musculocutaneous: not tested in the hand. |
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Superior Gluteal Nerve Injury
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During walking, the patient shifts his/her torso over the planted leg in order to keep the center of gravity over her line of support.
Shift towards injured side Loss of innervation to lesser gluteal muscles (medius and minimus), which contract during the stance phase so that the pelvis doesn’t collapse to the unsupported side. Use Trendelenberg Test |
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Trendelenburg Test
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Test for Superior Gluteal Nerve Injury
Have the patient stand on one leg. If pelvis stays basically horizontal, no injury If pelvis tilts to the unsupported side, there is an injury to the superior gluteal nerve. The patient will also exhibit a shifting of the upper body over the planted leg in order to compensate for the pelvic tilt. |
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Synovial Joint
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Empty Cavity between articulating cartilage
Articular Cartilage Joint is enclosed in a capsule. i. Outer layer is fibrous. ii. Inner layer is a synovial membrane which secretes lubricating synovial fluid. |
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Parallel vs Oblique Muscle Fibers
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Parallel - Greater Range of Contraction, Less force (Sartorius, Brachialis)
Oblique - Angle to Tendon, Greater Force (Semimembranosus, Rectus Femoris, Deltoid) |
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Labrum
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Cartilaginous Ring @ synovial joint
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Bones of the Foot
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Navicular
Calcaneus Cuboid Cuneiform (3) Talus |
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Pronation
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Radius crosses over ulna
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Flexor Retinaculum
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Fibrous Band
Roof of carpal tunnel In Between Flexor Carpi Radialis and Ulnaris |
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Shoulder / Hip Ligaments
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Supraspinatus ligament tear most frequent in rotator cuff injuries
Iliofemoral ligament most important in hip- limits hyperextension and lateral rotation |
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Mensci of the Knee
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Medial and Lateral
In Between Tibia and Fibia Shock absorbers |
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Medial Collateral Ligament
Lateral Collateral Ligament |
MCL - Resists Lateral motion
LCL - Resists Medial motion Run outside the knee cavity, curving around, up and down. |
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Anterior cruciate ligament
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Runs from the posteromedial aspect of the lateral femoral condyle to the anterior intercondylar ridge of the tibia
Taut when knee is extended Resists anterior displacement of the tibia with respect to the femur and also prevents hyperextension |
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Posterior cruciate ligament
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Stronger than ACL
Runs from the anteromedial aspect of the medial femoral condyle to the posterior intercondylar ridge of the tibia Taut when knee is flexed Resists tibia moving posterior on the femur Also prevents hyperflexion of the knee. |
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Terrible Triad of O'Donague
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Lateral Blow to a Flexed Knee
ACL, MCL and Medial Meniscus are injured |
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Drawer Test
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Patient supine with the hips flexed to 45 degrees, the knees flexed to 90 degrees and the feet flat on table. T
Examiner sits on the patient's feet and grasps the patient's tibia and pulls it forward (anterior drawer test) or backward (posterior drawer test). If the tibia pulls forward or backward more than normal, the test is considered positive. Pulling - ACL test Pushing - PCL test |
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MCL/LCL Test
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Flex Knee 30 degrees
One hand stabilizes thigh above knee One hand grasps leg at ankle and moves leg lateral and medial to test MCL/LCL stability |
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Differences in human and ape anatomy
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A-P expanded ilium : puts g. maximus posterior to hip, increased force in extension
Sacroiliac and hip joints brought towards midline: more stable in bipedalism Posteriorly projecting ischial tuberosity: better lever arm for hamstrings G. medius and g. minimus put in lateral position: so now can act as abductors Curve in lumbar spine |
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Rupture of the urethra superior to the UG diaphragm
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Urine collects in the Pelvic Cavity
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Rupture of the urethra inferior to the UG diaphragm
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Urine collects in the anterior abdominal wall
Colles' Fascia is continuous with Scarpa's Fascia |
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Superior Vesical Artery
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Branch of Uterine Artery
Supplies bladder and ureter |
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Relation of Clavicle to Brachial Plexus
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Roots and Trunks are supraclavicular
Divisions are deep to clavicle Cords and Branches subclavicular |
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Trapezius Muscle
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Accessory Scapular Nerve (C XI)
Shoulder Shrugs |
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Capitellum / Trochlea
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Ulna + Trochlea
Radius + Capitellum |
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Recurrent Median Nerve
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Innervates Thenar Muscles
Superficial |
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Gunshot wound tests
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A: Axilary n, posterior circumflex humoral a. Test abduction of arm from 30-90°
B: Radial n , Deep artery of arm. Wrist drop (test extension of wrist), sensation on dorsum of hand between 1st and 2nd digits C: Median n , Brachial a . Test opposition of thumb, strength of pronation, sensation on tip of 2nd digit. D: Ulnar n . Test abduction and adduction of digits 2-5, sensation on hypothenar eminence |
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Partial Claw Hand vs Sign of Benediction
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Sign of Benediction - Median N Injury
Partial Claw Hand - Ulnar N Injury Sign of Benediction only when asked to make a fist. |
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Fusiform vs Pennate
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Pennate - pen like
- rectus femoris - lumbricals Fusiform - candy wrapper - biceps |
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Hip Extension
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Gluteus Maximus (Inferior Rectal)
Hamstrings (Sciatic Tibial) |
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Knee Flexion
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Sartorius
Hamstrings |
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Hip Flexion
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Iliopsoas
Rectus Femoris |
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Extra Digit
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sonic hedgehog gradient too wide from ZPA
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Biceps Femoris
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Nerve
long head: tibial nerve short head: common peroneal nerve Actions flexes knee joint, laterally rotates knee joint (when knee is flexed), extends hip joint (long head only) |
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Collateral Circulation of the Foot
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Deep plantar arch between medial and lateral plantar arteries
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Collateral Circulation of the Hip
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Medial / Lateral Circumflex Humeral
-also provide nutrition to humerus |
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Collateral Circulation of the Knee
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Geniculars, Anterior and Posterior Tibial
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Froment's sign
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When making the OK sign with thumb and index finger.
Can't flex proximal phalanx of thumb loss of thenar muscles due to median nerve injury |
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