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105 Cards in this Set
- Front
- Back
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extensor retinaculum synovial sheaths numerical mnemonic
2-2-1 2-1-1 |
from radial to ulnar 221 211 i.e. two tendons in first, two in second, one in third... |
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extensor retinaculum synovial sheaths #1 (2) |
ABductor pollicis longus (APL) extensor pollicis brevis (EPB) |
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extensor retinaculum synovial sheaths #2 (2) |
extensor carpi radialis longus (ECRL) extensor carpi radialis brevis (ECRB) |
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extensor retinaculum synovial sheaths #3 (1) |
extensor pollicis longus (EPL) |
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extensor retinaculum synovial sheaths #4 (2) |
tendon sheath for:
extensor digitorum extensor indicis proprius |
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extensor retinaculum synovial sheaths #5 (1) |
extensor digiti minimi (EDM) |
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extensor retinaculum synovial sheaths #6 (1) |
extensor carpi ulnaris |
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attachments of the extensor retinaculum |
lateral: lateral margin of the radius
medial: triquetrum and pisiformis |
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orientation of the extensor retinaculum |
oblique |
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course of radial artery |
-passes inferolaterally under brachioradialis
-lateral to FCR tendon in distal forearm
-winds around lat. aspect of radius
-crosses floor of anatomical snuffbox to pierce first dorsal interosseous muscle |
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origin of radial artery |
smaller terminal branch of brachial artery in antecubital fossa |
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origin of ulnar artery |
larger terminal branch of brachial artery in antecubital fossa |
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course of ulnar artery |
-descends inferomedially, then inferiorly
-deep to superficial and intermediate layers of flexors to reach medial side of forearm
-passes superficial to flexor retinaculum at wrist in ulnar (Guyon) canal to enter hand |
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course of ulnar nerve through forearm |
-passes posterior to medial epicondyle -enters forearm by passing btw heads of FCU -descends forearm between PCU/FDP -becomes superficial in distal forearm |
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origin of median nerve in forearm |
union of:
- lateral root of median nerve (C6/C7, from lateral cord of brachial plex)
- medial root C8/T1 from medial cord
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course of median nerve in forearm |
-enters ACF medial to brachial artery -exits between heads of pronator teres -descends in fascial plane between FDS/FDP -runs deep to palmaris longus tendon as it approaches the flexor retinaculum -transverses the carpal tunnel |
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origin of radial nerve in forearm |
larger terminal branch of posterior cord of brachial plexus (C5-T1) |
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course of radial nerve in forearm |
-enters ACF between brachioradialis and brachialis -divides into terminal superficial and deep branches anterior to the lateral epicondyle |
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origin of ulnar nerve in forearm |
larger terminal branch of medial cord of brachial plexus (C8/T1, some C7) |
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motor innervation of median nerve in forearm |
- flexor compartment, except flexor carpi ulnaris, and FDP to 4/5th digits
-pronator teres, FCR, palmaris longus, FDS, FDP (lat half), FPL, pronator quadratus |
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motor innervation of median nerve in hand mnenomic
LOAF |
Lumbricals 1/2
Opponens pollicis
ABductor pollicis brevis
Flexor pollicis brevis |
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motor innervation of ulnar nerve in forearm |
FCU
FDP (medial half) |
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motor innervation of ulnar nerve in hand |
hypothenar muscles - opponens digiti minimi - ABductor digiti minimi - flexor digiti minimi brevis 3rd/4th lumbricals dorsal/palmar interossei ADductor pollicis FPB, palmaris brevis |
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motor innervation of radial nerve in forearm - muscular branches (4) |
muscular branches of radial nerve -triceps -anconeus -brachioradialis -ECR longus |
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motor innervation of radial nerve in forearm - deep branch (2) |
deep branch of radial nerve - extensor carpi radialis brevis - supinator |
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motor innervation of radial nerve in forearm - posterior interosseous nerve (7) |
extensor digitorum extensor digiti minimi extensor carpi ulnaris ABductor pollicis longus extensor pollicis brevis extensor pollicis longus extensor indicis |
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radial nerve motor supply mnemonic
Try a Big Chocolate Chip Sundae, Double Dip Cherries And Peanuts Preferably Included
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Triceps / Anconeus / Brachioradialis ext. Carpi radialis longus / ext. Carpi radialis brevis / Supinator / ext. Digitorum / ext. Digiti minimi / ext. Carpi ulnaris / ABductor pollicis longus / ext. Pollicis brevis / ext. Pollicis longus ext. Indicis |
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motor innervation of musculocutaneous nerve (3) |
coracobrachialis biceps medial brachialis |
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radial nerve injury at axilla |
-loss of extension of forearm -weakness of supination -loss of extension of hand/fingers -wrist drop -loss of sensation to lateral arm, posterior forearm, radial half of dorsum of hand and dorsal aspect of radial 3.5 digits |
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radial nerve injury at mid-arm e.g. mid-shaft humeral fracture |
M: weakness of supination, wrist drop, loss of hand/finger extension
S: post forearm, rad half of dorsum of hand dorsal aspect of radial 3.5 digits |
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radial nerve injury immediately distal to elbow e.g. radial neck fracture, elbow dislocation |
M: weakness in extension of hand, finger drop, partial wrist drop (ECRL/brachioradialis still work)
S: none |
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radial nerve injury at distal forearm e.g. wartenberg's syndrome |
M: no deficit
S: parasthesia radial half of dorsum of hand and dorsal aspect of radial 3.5 digits |
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wartenberg's syndrome |
- mononeuropathy of superficial branch of radial nerve - numbness, tingling, weakness at posterior aspect of thumb |
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ulnar nerve injury at elbow |
M: -weakness in wrist flexion, loss of flexion of 4/5th digits, loss of ability to cross fingers -claw hand deformity due to hyperextension of 4/5th digits at MCPJ and flexion at IPJs S: parasthesiae in ulnar half of palm/dorsum of hand and palm/dorsum of medial 1.5 digits |
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ulnar nerve injury at wrist |
M: - loss of flexion of 4/5th digits, inability to cross digits - claw hand deformity
S: -parasthesia in ulnar half of palm with dorsal sparing |
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why is there dorsal sparing with ulnar nerve injury at the wrist? |
the posterior cutaneous branch of the ulnar nerve is given off higher up in the forearm and does not reach the wrist |
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The Ulnar Paradox
'the closer to the Paw, the worse the Claw' |
-ulnar n innervates ulnar half of FDP -a more proximal injury denervates FDP, so flexion at IPJs is weakened -4/5th fingers remain paralyzed in extension -this reduces claw-like appearance of hand -usually a more proximal injury is more debilitating than is a distal one |
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what lies immediately medial to the tubercle of the radius / Lister's tubercle |
extenso pollicis longus |
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where does the cephalic vein arise? |
anatomical snuffbox |
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radial nerve sensory innervation of hand |
superficial branch of radial nerve |
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ulnar nerve sensory innervation of hand |
palmar cutaneous branch of ulnar nerve |
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median nerve sensory innervation of hand |
palmar cutaneous branch of median nerve |
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relationship between simple pronation, ulnar and radius |
simple pronation occurs without movement of the ulna |
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which tendon hooks around the radial (lister's) tubercle? |
extensor pollicis longus |
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THENAR & HYPOTHENAR MUSCLES MNEMONIC
thenar
'A OF A' |
THENAR, lateral to medial
ABductor pollicis brevis
Opponens pollicis Flexor pollicis brevis
ADuctor pollicis
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THENAR & HYPOTHENAR MUSCLES MNEMONIC
hypothenar
'OF A' |
HYPOTHENAR, lateral to medial
Opponens digiti minimi Flexor digiti minimi
ABductor digiti minini |
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THENAR MUSCLE
opponens pollicis PA/DA/N/A |
PA- flexor retinaculum and tubercles of scaphoid and trapezium DA- lateral side of 1st metacarpal N- recurrent branch of medial nerve A- opposes thumb, rotates 1st metacarpal medially |
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THENAR MUSCLE
ABductor pollicis brevis PA/DA/N/A |
PA- flexor retinaculum and tubercles of scaphoid and trapezium DA- lateral side of base of prox phalanx of thumb N- recurrent branch of medial nerve A- ABducts thumb |
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THENAR MUSCLE
flexor pollicis brevis PA/DA/N/A |
PA- flexor retinaculum and tubercles of scaphoid and trapezium DA- lateral side of base of prox phalanx of thumb
N- recurrent branch of medial nerve (deep head by deep branch of ulnar nerve)
A- flexes thumb |
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THENAR MUSCLE
ADuctor pollicis PA/DA/N/A |
PA- bases of 2/3rd metacarpals, capitate, carpals (transverse head at shaft of 3rd metacarpal)
DA- medial side of base of prox phalanx of thumb N- deep branch of ulnar nerve A- ADducts thumb toward lateral border of palm |
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HYPOTHENAR MUSCLE
ABductor digiti minimi - PA/DA/N/A
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PA- pisiform DA- base of proximal phalanx of 5th finger N- deep branch of ulnar nerve A- ABducts 5th finger, flexes prox phalanx |
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HYPOTHENAR MUSCLE
opponens digiti minimi - PA/DA/N/A |
PA- hook of hamate, flexor retinaculum DA- medial border of 5th metacarpal N- deep branch of ulnar nerve A- opposes 5th finger by drawing 5th metacarpal anteriory and medially rotating it |
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HYPOTHENAR MUSCLE
flexor digiti minimi brevis- PA/DA/N/A
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PA- hook of hamate, flexor retinaculum DA- base of proximal phalanx of 5th finger N- deep branch of ulnar nerve A- flexes prox phalanx of 5th finger |
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innervation of dorsal and palmar interossei |
deep branch of ulnar nerve C8T1 |
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DAB action of dorsal interossei |
Dorsal interossei ABduct 2-4th finger from axial line
also assist lumbricals in flexion of MCPJ and extension of IPJ |
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PAD action of palmar interossei |
Palmar interossei ADduct 2nd, 4th and 5th fingers toward axial line
also assist lumbricals in flexion of MCPJ and extending IPJ |
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innervation of 1st and 2nd lumbricals |
median nerve C8T1 |
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innervation of 3rd and 4th lumbricals |
deep branch of ulnar nerve C8T1 |
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action of lumbricals |
- flex MCPJ
- extend IPJ of 2nd-5th fingers |
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INNERVATION OF HAND
median nerve O/D |
O- two roots - lateral and medial cord of brachial plexus (C6/C7 and C8/T1)
D- thenar muscles (except ADductor pollicis and deep head of flexor pollicis brevis), lateral lumbricals (2 & 3), sensation to skin of palmar and distal dorsal aspects of radial 3.5 digits |
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INNERVATION OF HAND
recurrent branch of median nerve O/D |
O- arises from median nerve as soon as exits flexor retinaculum
D- ABducor pollicis brevis, opponens pollicis, superficial head of flexor pollicis brevis |
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INNERVATION OF HAND
lateral branch of median nerve O/D |
O- arises as lateral division of median nerve as it enters palm
D- 1st lumbrical, skin of palmar and distal dorsal aspects of thumb and radial half of 2nd finger |
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INNERVATION OF HAND
medial branch of median nerve O/D |
O- arises as medial divison of median nerve as it enters the palm
D- 2nd lumbrical, skin of palmar and distal/dorsal aspects of adjacent sides of 2nd-4th fingers
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INNERVATION OF HAND
palmar cutaneous branch of median nerve O/D |
O- arises from median nerve immediately proximal to flexor retinaculum
D- skin of central palm |
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INNERVATION OF HAND
ulnar nerve O/D |
O- terminal branch of medial cord of brachial plexus (C8T1)
D- most of the intrinsic muscles of the hand (except LOAF), sensation to palmar and distal dorsal aspects of medial 1.5 digits/palm |
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INNERVATION OF HAND
palmar cutaneous branch of ulnar nerve O/D |
O- arises from ulnar nerve near middle of forearm
D- skin at base of medial palm, overlying the medial carpals |
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INNERVATION OF HAND
dorsal branch of ulnar nerve O/D |
O- arises from ulnar nerve 5cm proximal to flexor retinaculum
D- skin of medial aspect of dorsum of hand and proximal portions of little and medial half of ring finger |
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INNERVATION OF HAND
superficial branch of ulnar nerve O/D |
O- ulnar nerve at wrist as it passes between pisiform and hamate
D- palmaris brevis and sensation to skin of palmar/distal/dorsal aspects of digit 5, ulnar side of digit 4, proximal portion of palm |
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INNERVATION OF HAND
deep branch of ulnar nerve O/D |
O- ulnar nerve at wrist as it passes between pisiform and hamate
D- hypothenar muscles, lumbricals (4/5), interossei, ADductor pollicis, deep head of flexor pollicis brevis |
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INNERVATION OF HAND
superficial branch of radial nerve O/D |
O- radial nerve in the cubital fossa
D- skin of radial half of dorsal aspect of hand/thumb, proximal portions of dorsal aspects of digits 2/3, radial half of digit 4 |
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attachments of flexor retinaculum |
medial: pisiform and hamate lateral: scaphoid and trapezium superficial: volar carpal ligament deep: palmar aponeurosiss
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carpal tunnel borders |
deep: carpal arch (lateral to medial) scaphoid, trapezium, hamate, pisiform
superficial: flexor retinaculum, originates on lateral side and inserts on medial side of carpal arch |
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contents of carpal tunnel |
9 tendons and median nerve
- flexor pollicis longus - 4 tendons of FDP - 4 tendons of FDS |
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blood supply of hip joint |
branches from the deep artery of the thigh:
- medial circumflex femoral artery
- lateral circumflex femoral artery
- artery to head of femur (branch of obturator) - this traverses the ligament of the head |
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blood supply to head of femur and clinical consequences re; #NOF |
- the retinacular arteries arising from medial c.flex femoral artery are torn when #NOF or in hip dislocations - following some #NOF, the artery to the ligament of the femoral head may be the only remaining blood supply to prox frag. - this artery is frequently inadequate for maintaining the femoral head -> avas. necrosis |
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extracapsular ligaments of knee joint (5) |
patellar ligament LCL MCL oblique popliteal ligament arcuate popliteal ligament |
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retinacular arteries of hip joint |
-arise as branches of the circumflex femoral arteries
-mostly from medial circumflex femoral artery -those arising from lateral circumflex femoral artery must penetrate the iliofemoral ligament therefore are smaller and fewer |
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patellar ligament O/I |
O: apex and adjoining margins of patella
I: tibial tuberosity |
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retinacula of knee |
-make up joint capsule of knee each side of patella -role in maintaining patellar alignment -medial retinaculum from vastus medialis -lateral retinaculum from vastus lateralis |
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LCL (fibular collateral ligament) O/I |
O: lateral epicondyle of femur
I: lateral surface of fibular head
-not attached to lat. meniscus due to underlying tendon of popliteus |
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MCL (tibial collateral ligament) O/I |
O: medial epicondyle of femur
I: medial surface of tibia
-at mid point, deep fibres attached to med. meniscus |
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oblique popliteal ligament of knee |
recurrent expansion of tendon of semimembranosus that strengthens knee joint posteriorly as it spans the intracondylar fossa
O: central part of posterior joint capsule I: posterior to medial tibial condyle |
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arcuate popliteal ligament of knee |
strengthens knee joint posterolaterally
O1: intercondylar region of tibia ->popliteus O2: lateral epicondyle of femur -> gastroc. I: posterior aspect of fibular head |
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ACL O/C/I |
O: posteromedial aspect of lateral condyle of femur
C: extends superiorly, posteriorly and laterally
I: anterior intercondylar region of tibia |
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PCL O/C/I |
O: anterolateral aspect of medial condyle of femur
C: passes superiorly, anteriorly
I: posterior intercondylar region of tibia |
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coronary ligaments of knee |
portions of joint capsule extending between margins of menisci and periphery of tibial condyles |
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transverse ligament of knee |
joins the anterior edges of the menisci, tethering them together during knee movements |
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medial meniscus |
-c-shaped -broader posteriorly>anteriorly -anterior horn attached to anterior intercondylar region of tibia -posterior horn attached to posterior intercondylaer region -adheres to MCL |
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lateral meniscus |
-nearly circular -more mobile than medial meniscus -medial part of popliteal tendon attaches to posterior limb of lateral meniscus -posterior meniscofemoral ligament joins lateral meniscus to PCL and medial femoral condyle |
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knee flexion ROM |
120' hip extended 140' hip flexed 160' passive |
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knee medial rotation ROM |
10' with knee flexed 5' with knee extended |
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knee lateral rotation ROM |
30' |
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largest tarsal bone |
calcaneus |
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damage to L5 (3) |
loss of sensation to lateral calf loss of sensation to dorsum of foot foot drop |
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cutaneous nerve to lateral aspect of foot |
sural nerve |
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muscles attaching to GT (5) |
-obturator internus -gemelli -piriformis -gluteus minimus -gluteus medius |
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what area does the short saphenous vein drain? |
lateral margin of foot |
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where does the saphenous vein commence? |
medial end of dorsal venous arch |
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dermatome supplying great toe |
L5 |
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bones making up medial arch, posterior to anterior (4) |
calcaneus navicular medial cuneiform 1st metatarsal |
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bones making up lateral longitudinal arch, posterior to anterior (3) |
calcaneus cuboid metatarsals |
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which plantar nerve supplies a greater area? |
medial |
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saphenous vein origin/drainage |
-formed by union of dorsal vein of great toe and dorsal venous arch
-drains into femoral vein at SFJ |
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saphenous vein course |
-ascends anterior to medial malleolus -passes posterior to medial condyle of femur -anastomoses with the small saphenous vein -traverses the saphenous opening in the fascia lata |
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what is froment's sign |
-tests for ulnar nerve palsy by testing adductor pollicis -patient holds paper between thumb and index finger, examiner pulls it away -normal test it is held with ADduction of thumb -positive froment's sign the patient flexes the FPL/interphalangeal joint to hold paper
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