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120 Cards in this Set
- Front
- Back
- 3rd side (hint)
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How many pairs of spinal nerves are there |
31 |
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What is a spinal nerve formed from |
Union of anterior root and dorsal root at the intervertebral foramen |
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Which vertebrae do autonomic fibres pass between |
T1 - L2 S2 - S4 |
2 regions |
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What do the spinal nerves split into after passing through the intervertebral forament |
Anterior ramus Posterior ramus |
2 |
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At what vertebral level are the brachial plexus and lumbo-sacral plexus |
Brachial plexus: C5 - T1 Lumbo-sacral plexus: L2 - S3 |
CT LS |
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Spinal nerves of which levels supply: Neck Upper limbs Trunk Lower limb Perineum |
Neck: C1-C4 Upper limbs: C5 - T1 Trunk: T2 - L1 Lower limbs: L2 - S3 Perineum: S2 - C1 |
CC CT TL LS SC |
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Where does the femoral nerve arise from |
L2 - L4 posterior fibres |
LL |
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What does the femoral nerve innervate |
Iliopsoas Anterior compartment of the thigh |
2 I A |
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Where does the obturator nerve arise from |
L2 - L4 anterior fibres |
LL |
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What does the obturator nerve innervate |
Medial compartment of the thigh |
1 M |
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Where does the sciatic nerve arise from |
L3 - S3 anterior and posterior fibres |
LS |
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What does the sciatic nerve innervate |
Posterior compartment of the thigh Posterior leg Intrinsic foot |
3 P L F |
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Where does the superior gluteal nerve arise from |
L4 - S1 |
LS |
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What does the superior gluteal nerve innervate |
Gluteus medius Gluteus minimus Tensor fascia lata |
3 G G T |
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Where does the inferior gluteal nerve arise from |
L5 - S2 |
LS |
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What does the inferior gluteal nerve innervate |
Gluteus maximus |
1 G |
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Describe the segmental motor supply to the limbs |
Innervated by groups of motor nerve cell bodies in the spinal cord
Brachial (C5 - T1) Lumbosacral (L2 - S3) Anterior divisions supply flexor muscles Posterior divisions supply extensor muscles Each muscle is supplied by two adjacent segments Muscles with the same action on a joint have a common nerve supply Opposing muscles have nerves supplies 1-2 segments below/above More distal in the limb the more caudal in the spine |
Definition Plexi Anterior divisions supply what Posterior divisions supply what Each muscle is supplied by which segments Describe nerve supply of muscles with the same action Compare innervation of muscles with opposing action Describe the level of the spinal roots with how distal on the limb the muscle is |
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Spinal roots responsible for hip flexion |
L2 L3 |
L L |
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Spinal roots responsible for hip extension
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L4 L5 |
2 |
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Spinal roots responsible for knee flexion |
L5 S1 |
2 L S |
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Spinal roots responsible for knee extension |
L3 L4 |
2 L L |
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Spinal roots responsible for ankle dorsiflexion/extension |
L4 L5 |
2 L L |
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Spinal roots responsible for plantar flexion/flexion |
S1 S2 |
2 |
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Describe the function of axial lines |
Shows dermatomes supplied by a nerve segment since they are not linked at the spinal level |
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Describe the dermatomes of the leg |
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L1 L2 L3 L4 L5 C1 S4 S3 S2 S1 |
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Location of the obturator nerve cutaneous innervation |
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Branches of the lumbar plexus (L1 - L4 anterior rami) |
Iliohypogastric + Ilio-inguinal nerve Genitofemoral nerve Lateral cutaneous nerve of the thigh Femoral nerve Obturator nerve Lumbosacral trunk |
6 I + I G L F O L |
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What is the sacral plexus derived from |
Lumbosacral trunk (L4, L5 anterior rami) S1 - S4 anterior rami |
2 |
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Branches of the sacral plexus |
Sciatic nerve Nerve to piriforms Posterior cutaneous nerve Pelvic splanchnic nerve Pudendal nerve Nerve to obturator internus Superior gluteal nerve Inferior gluteal nerve |
8 S N P P P N S I |
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Spinal root of the iliohypogastric and ilio-inguinal nerve |
L1 |
1 |
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Spinal root of genitofemoral nerve |
L1 L2 |
2 L L |
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Spinal root of lateral cutaneous nerve of thigh |
L2 L3 |
2 L L |
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Spinal root of femoral nerve |
Anterior divisions of L2 L3 L4 |
3 L L L |
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Spinal root of obturator nerve |
Posterior divisions of L2 L3 L4 |
3 |
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Spinal root of lumbosacral trunk |
L4 L5 |
2 |
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Spinal root of sciatic nerve |
L4 L5 S1 S2 S3 |
5 |
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Spinal root of nerve to piriforms |
S1 S2 |
2 |
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Spinal root of posterior cutaneous nerve |
S1 S2 S3 |
3 |
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Spinal root of pelvic splanchnic nerve |
Parasympathetic S2 S3 S4 |
3 |
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Spinal root of pudendal nerve |
S2 S3 S4 |
3 S S S |
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Spinal root of nerve to obturatos internus |
L5 S1 S2 |
3 |
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Spinal root of superior gluteal nerve |
L4 L5 S1 |
3 |
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Spinal root of inferior gluteal nerve |
L5 S1 S2 |
3 |
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Femoral nerve |
Supplies: Iliopsoas Anterior thigh muscles Sensory to the front of the thigh Terminal branch is the saphenous nerve (sensory to medial aspect of the leg) |
What does is supply Where does it receive sensory information What is its terminal branch |
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Obturator nerve |
Supplies adductor muscles of the thigh Sensory to parts of the pelvis and medial aspect of thigh |
What does it supply
Where does it receive sensory information (2) |
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Sciatic nerve |
Passes through greater sciatic foramen - posterior compartment of thigh - divides above the knee joint - tibial + common peroneal nerve Supplies hamstrings Sensory to back of thigh |
Path At what level does it divide What does it divide into What does is supply Where does it receive sensory information |
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Common peroneal nerve |
Passes around the neck of the fibula - easily damaged Supplies anterior and lateral compartments of the leg Sensory to anterior and lateral aspects of leg and dorsum of foot Divides into the superficial and deep peroneal nerves Sural nerve is an important branch |
Path What does it supply Where does it receive sensory information What does it divide into Important branch |
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What does the deep peroneal nerve innervate |
EDL EHL Tibialis anterior Peroneus tertius EDP |
E E T P E |
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Tibial nerve |
Supplies the posterior compartment of the leg and most intrinsic muscle of the foot (Gastrocnemius, soleus, plantaris, popliteus, tibialis posterior, FHL, FDL, FDB, anductor hallusic, THB, all interossei and lumbricals) Sensory to back of leg and sole of foot |
What does it supply Where does it receive sensory information from |
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5 Modalities of assessing nerve function
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Motor Sensory Reflex Autonomic Trophic |
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Describe the effect on the 5 modalities of nerve function in: Prolapsed intervertebral disc at L5/S1, causing pressure on the right S1 nerve root |
Segmental loss as follows: Motor - Loss of eversion of the foot + weakness elsewhere Sensory - Loss of sensation along lateral border of foot Reflex - Loss of right ankle jerk Autonomic - Abnormalities of sweating in the S1 Dermatome Trophic - Trophic changes on lateral aspect of foot in long standing lesions |
Motor (2) Sensory (1) Reflex (1) Autonomic (1) Trophic (1) |
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Describe the effect on the 5 modalities of nerve function in: Damage to the peroneal nerve at the level of the fibular neck from pressure against an operating table |
Motor - Foot drop (paralysis of the anterior and lateral compartments of the leg Sensory - Loss of sensation in the distrubution of the common peroneal nerve e.g. dorsum of foot Reflex - no loss since ankle jerk is mainly provided by tibial nerve Autonomic - Abnormal sweating in peroneal dermatome Trophic - Damage to sole of foot due to pressure effects of foot drop in chronic cases |
Motor Sensory Reflex Autonomic Trophy |
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Describe ways the femoral nerve can be damaged |
Relatively superficial in groin rarely damaged except iatrogenically Commonest injury via traction injuries during hip replacement and laproscopic repairs of inguinal hernias Can also be damaged during erroneous cannulation of femoral artery/vein |
How often is it damaged Most common methods of injury (2) Another way it can be damaged |
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Describe ways the lateral cutaneous nerve of the thigh can be damaged |
Passes 2cm medial to the ASIS at the level on the inguinal hernia - can be compressed at this level - meralgia parasthetica - Bernhardt-Roth syndrome - numbness and pain in outer thigh |
Path How this means it can be damaged What does this cause What are the symptoms |
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Describe Bernhardt-Roth syndrom |
Also called Meralgia Parasthetic Numbness and pain in outer thigh |
What is it also called What are the symptoms |
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Describe ways the obturator nerve can be damaged |
Rarely damaged Pain in its distribution - indicative of malignant pelvic disease |
How often is it damaged Symptoms of obturator nerve damaged What disease does this indicate |
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What does damage to the superior gluteal nerve cause |
Trendelenburg gait Pelvis lurches during gait |
2 |
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How is the SGN (superior gluteal nerve) most commonly damaged |
Hip replacement Nerve lies approx. 5cm proximal to the tip of the greater trochanter, approaches to the hip joint should not extend more than this |
2 |
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How is the sciatic nerve most commonly damaged |
Most commonly damaged after hip replacement |
1
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Which division of the sciatic nerve is more vulnerable |
Common peroneal division is more vulnerable than tibial division |
1 |
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How do you avoid damaging the sciatic nerve in IM injections |
Give the injection in the UOQ of the buttock instead of the LIQ where the nerve is most likely to lie
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2 |
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Other causes of damage to the sciatic nerve |
Trauma: -Hip dislocation -Acetabular fractures Pelvic disease |
3 |
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Describe ways the common peroneal nerve of the thigh can be damaged |
Can be damaged at the level of the hip Highly vulnerable at the level of the fibular neck Causes of damage include: Trauma Knee replacement External pressure (plaster/during surgery) |
At which levels can it be damaged and at which is it most vulnerable Causes of damage (3) |
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Describe ways the tibial nerve can be damaged |
Rarely damaged in isolation because it is very deep |
1 |
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Describe ways the lateral saphenous nerve of the thigh can be damaged |
Commonly injured Can be damaged at the medial malleolus - after varicose vein surgery At the level of the knee |
How often is it injured At which levels can it be injured and a cause for one of these levels |
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Give 4 examples of nerve blocks |
Femoral nerve blocks Sciatic nerve blocks Ankle blocks Lateral cutaneous nerve blocks |
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Function of nerve blocks |
To aid or substitute general anaesthetics during surgery |
1 |
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At what level does the aorta split into the common iliac arteries |
L4 |
L4 |
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At what level do the common iliac arteries bifurcate and into what |
Pelvic brim into the Internal iliac artery (gives off obturator artery) External iliac artery |
3 |
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At what level does the external iliac artery become the femoral artery |
Inguinal ligament |
1 |
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Path of the femoral artery in pelvic region |
Passes beneath the mid point of inguinal ligament At this point it lies upon the psoas tendon and can be easily palpated Can also be cannulated here |
Where does it pass What can you do with the femoral artery in this region (2) |
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Four branches of the femoral artery in the thigh, just below the inguinal ligament |
Superficial circumflex iliac artery Superficial epigastric artery Superficial external pudendal artery Deep external pudendal artery |
S S S D |
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Path of the femoral artery after giving off the four branches just below the inguinal ligament |
Gives off the profunda femoris artery Passes into the adductor canal |
Branch Path |
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Profunda femoris artery |
Arises 4cm distal to the inguinal ligament from the femoral artery Major branches are Perforating arteries Medial femoral circumflex arteries Lateral femoral circumflex arteries |
Origin Major branches (3) |
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What does the Femoral artery become in the adductor canal |
Popliteal artery |
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Where can the popliteal artery be palpated |
At the level of the popliteal fossa |
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At what level does the popliteal artery bifurcate and into what |
Bifurcates in the distal portion of the popliteal fossa Posterior tibial artery (tibioperoneal trunk) Anterior tibial artery |
P P A |
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Path of the anterior tibial artery |
Passes into the anterior compartment of the leg running on interosseous membrane |
2 |
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Where does the anterior tibial artery end, what does it become and how can this artery be palpated |
At the level of the foot Becomes the dorsalis pedis artery Palpable between the first and second metatarsals (between tendons of extensor hallucis longus and extensor digitorum longus) |
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Path of posterior tibial artery |
Passes into posterior compartment of the leg and runs alongside tibialis posterior Passes behind the medial malleolus (can be palpated) Divides into the medial and lateral plantar arteries at the level of the foot Gives off the peroneal artery which runs in the lateral compartment of the leg |
Which compartment of the leg Runs alongside what Passes behind what Where can it be palpated What does it divide into at what level What branch does it give off and what does this branch run |
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Which venous arch receives most of the blood from the foot |
Dorsal venous arch |
D |
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How does the long saphenous vein start |
Starts as the continuation of the medial portion of the dorsal venous arch of the foot |
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Where does the long saphenous vein lie in the ankle |
2 cm anterior and 2 cm proximal to medial malleolus |
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Where does the long saphenous vein run in the leg and knee |
Runs proximally along the medial aspect of the leg passing behind the medial femoral condyle of the knee |
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What is the name of the tributaries of the long saphenous vein as it runs up the leg |
Perforating veins |
P |
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Describe the cause of varicose veins |
Physiologically blood should flow from the superficial to deep system. When there is a lack of/incompetent valves you get backflow - varicose veins |
3 |
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Path of the long saphenous vein in the thigh |
Runs along medial thigh Passes through the cribriform fascia (saphenous opening) 3cm below and lateral to pubic tubercle to merge with the femoral vein |
4 |
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Describe the number of valves and their distribution in the long saphenous vein |
Around 20 Most below the knee |
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What does the short saphenous vein drain |
Drains the lateral aspect of the dorsal venous arch |
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Path of the short saphenous vein |
Passes with sural nerve at the back of the leg, midline Passes into the popliteal vein and the popliteal fossa Communicates on several levels with the long saphenous vein |
4 |
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Path/organisation of deep veins |
Lie within deep fascia Usually two veins running alongside an artery |
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How is the popliteal vein formed |
From the venae comitantes of: Anterior tibial artery Posterior tibial artery Popliteal artery |
3 |
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Position of the popliteal vein in the popliteal fossa |
Between the popliteal artery and tibial nerve (also receives the short saphenous vein here) |
P T |
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Position/Path of the femoral vein relative to the femoral artery |
Passes behind the femoral artery and lies medial to it at the level of the inguinal ligament |
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Where does the femoral vein and what does it become |
Forms the external iliac vein When it passes beneath the inguinal ligament |
2 |
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Where does the profunda femoris vein join the femoral vein |
At the level of the ischial tuberosity |
I |
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Relative positions of the femoral artery, vein and nerve at the level of the inguinal ligament |
Femoral artery lies between the femoral vein and femoral nerve Femoral vein is medial Femoral nerve is lateral |
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Where does the femoral canal lie and which structures lie in it |
Medial side of femoral vein A lymph node (canal through which a femoral hernia passes) |
2 |
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Where do you palpate for a femoral artery pulse |
Mid-inguinal point |
M |
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Where do you palpate for a popliteal artery pulse |
Inferior part of the popliteal fossa Against the posterior surface of the tibia |
2 |
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Where do you palpate for a posterior tibial artery pulse |
Behind the medial malleolus |
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Where do you palpate for a dorsalis pedis artery pules |
Dorsum of foot Lateral to extensor hallucis longus tendon |
2 |
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Likely causes of an embolism in the lower limb |
Sudden occlusion of an atherosclerotic vessel Thrombus from atrial fibrillation |
2 |
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Intermittent claudication |
Gradual occlusion of arteries within the limb, usually atherosclerotic Muscles supplies distal to the occlusion become deprives of blood during exercise - limited walking distance before pain occurs |
Definition Symptoms |
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Compartment syndrome |
Most common in the true leg Compartments of the leg are each bound by very tight fascia which resist over swelling of muscle during contraction If the pressure is too high arterial and venous flow are disrupted resulting in muscle death |
Where is it most common Definition |
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Acute compartment syndrome |
Occurs after trauma to a limb Treated with a fasciotomy Arterial pulse is not lost in acute compartment syndrome |
When does it normally occur How is it treated Is arterial pulse lost |
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Normal tissue pressure and pressure that causes compartment syndrome |
Tissue pressure is 25mmHg 50-60mmHg causes compartment syndrome |
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Chronic compartment syndrome |
Occurs in athletes where muscle swells during exercise |
Which people are most susceptible When does it occur |
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Venous calf pump |
Deep veins are between layers of calf muscle so blood is force along during walking and running |
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Cause of varicose veins |
Incompetent valve at the sapheno-femoral junction in the groin Blood flows back into the superficial venous system Leads to dilated and tortuous superficial veins |
Valve Blood flow Effect on veins |
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How are varicose veins treated surgically |
Most operations involve tying off the spaheno-femoral junction |
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Symptoms of varicose veins |
Painful Aching discomfort on standing Skin changes such as lipodermatosclerosis and skin ulcers due to increased pressure in superficial circulation |
4 |
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DVT symptoms |
Swelling in the calf or proximal thigh |
1 |
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Why is a proximal DVT particularly dangerous |
High risk of propagation of the clot to the lungs |
1 |
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What is DVT associated with |
Immobility Trauma Surgery in the abdomen, pelvis or limbs Obesity Malignancy Pregnancy Oral contraceptive pill |
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Consequences of DVT |
Propogation of clot to PE (anti-coagulants) Increased back pressure in deep veins - venous insufficiency an dleg ulcers (post-phlebitic syndrome) Superficial vein inflamation.infection - Superficial thrombophlebitis (symptomatic treatment) |
3 |
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Femoral vein/artery cannulation |
Done at the groin Cardiac arteriography (artery) Resuscitation (vein) |
Where Why would you cannulate the artery Why would you cannulate the vein |
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Anatomical surface marking of the long saphenous vein at the ankle |
2cm above and proximal to the tip of the medial malleolus (Good site for a venous cutdown) |
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Examples of superficial vein grafts in elective surgery |
CABG (Coronary artery bypass grafting) Arterial by-pass surgery |
2 |
