Term
| As a result of an automobile accident, a woman suffers a fracture of the right superior pubic ramus of her pelvis. What nerve passing superiorly to the ramus is in jeopardy from such an injury? |
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Definition
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Term
| List the muscles that are innervated by the femoral nerve? |
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Definition
1. Rectus femoris
2. Vastus lateralis
3. Vastus intermedius
4. Vastus medialis (including VMO)
5. Pectinius |
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Term
| For each of the muscles innervated by the femoral nerve, list its primary action at the hip and/or knee: |
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Definition
1. Rectus femoris flexes the hip
2. Pectinius adducts the hip
3. Rectus femoris and the vasti extend the knee |
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Term
| What muscles comprise the hamstrings? |
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Definition
1. Long head of biceps femoris
2. Semitendinosus
3. Semimembranosus |
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Term
| What innervates the muscles of the hamstrings? |
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Definition
| Tibial n. (of the sciatic) |
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Term
| What is(are) the principle action(s) of the hamstring muscles? |
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Definition
| Extension of the hip and flexion of the knee |
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Term
| The human lower limb is characterized by physiologic genu valgus. What does this mean in laymen's terms? |
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Definition
| The thigh is slightly oblique so that our knees are closer together than our hip joints |
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Term
| Describe how the genu valgus in humans is expressed quantitatively |
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Definition
| Q-angle: Angle formed by line from ASIS to the patella, and a line from the patella to the tibial tuberosity |
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Term
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Definition
| Anterior Superior Iliac Spine |
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Term
| What useful purpose does the Q-angle (or genu valgus) serve? |
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Definition
| It places our foot more nearly directly under our center of momentum when standing on one foot. Important because walking involves intervals of single limb support |
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Term
| Explain how the genu valgus of the human lower limb can have negative consequences. |
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Definition
| Because the femur is oblique, the line of action of the quadriceps femoris is also oblique. Line of action resolves into a vertical component that extends the knee, and lateral component that displaces the patella. This is compensated by the action of the VMO. |
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Term
| Describe in anatomical terms what the femoral canal and femoral ring are, and explain their clinical significance |
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Definition
| The femoral canal is the medial compartment of the femoral sheath, and the femoral ring is its superior opening. While the other compartments of the sheath are filled with substantial structures, here there is only lymphatics and fat in the canal, which can be pushed aside by a loop of bowel |
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Term
| What occupies the medial compartment of the femoral canal? |
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Definition
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Term
| What occupies the lateral and intermediate compartments of the femoral canal? |
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Definition
| Femoral artery (lateral) and femoral vein (intermediate) |
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Term
| What structure is most important in helping to prevent lateral patellar displacement? |
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Definition
| Vastus medialis obliquus (VMO) and higher lateral lip of the patellar groove |
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Term
| What purpose does the higher lateral lip of the patellar groove serve? |
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Definition
| Helps prevent lateral patellar displacement |
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Term
| What anatomical structure is most important in helping to prevent the rotation of tibia on the femur? |
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Definition
| ACL, PCL, MCL, and lateral collateral ligament |
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Term
| What anatomical structure is most important in helping to prevent collapse of the pedal longitudinal arch |
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Definition
| Plantar aponeurosis, spring ligament, long and short plantar ligaments |
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Term
| What nerve and muscle(s) are most likely to be associated with severe weakness in eversion of the foot |
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Definition
Superficial peroneal n.
Peroneus longus and brevis |
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Term
| What nerve and muscle(s) are most likely to be associated with severe weakness in thigh abduction |
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Definition
Superior gluteal n.
Gluteus medius and minimus, tensor fasciae latae |
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Term
| What muscles are located in the anterior tibial compartment? |
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Definition
| Tibialis anterior, extensor hallucis longus, extensor digitorum longus, peroneus tertius |
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Term
| What is the action of peroneus tertius? What innervates it? |
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Definition
| Weak dorsiflexor of the foot and assists with eversion. Deep peroneal n. |
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Term
| What nerve supplies the muscles of the anterior tibial compartment? |
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Definition
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Term
| What sensory test could you perform to determine whether the deep peroneal n. has been damaged? |
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Definition
| Pin prick to skin on the dorsal side of web between the first and second toes |
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Term
| What motor test could you perform to determine whether the deep peroneal nerve has been damaged? |
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Definition
| Have person stand or walk on their heels, or have him/her dorsiflex their ankle against resistance |
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Term
| What artery supplies the anterior tibial compartment? |
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Definition
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Term
| Where would you feel for a pulse to determine whether blood was flowing through the anterior tibial artery? |
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Definition
| Dorsalis pedis artery: On dorsum of foot, lateral to the tendon of extensor hallucis longus, just proximal to first intermetatarsal space |
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Term
| During walking, the patient allows his right knee to extend completely at heel-strike, then he leans forward ever so slightly during the first half of right limb support phase. What nerve and muscle(s) have been damaged and explain why the patient displays this type of gait. |
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Definition
Right femoral n and quadriceps femoris.
The patient cannot prevent his knee from collapsing into flexion during 1st half of support phase when the center of momentum is behind the knee. By leaning forward over the extended knee he uses the shifted line of action of his COM to keep his knee extended |
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Term
| During walking, the patient takes short steps with her left limb, ending stance phase before the limb extends past vertical. What nerve and muscle(s) have been damaged and explain why the patient displays this type of gait. |
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Definition
Left tibial n. and triceps surae muscle.
The patient cannot prevent her ankle from collapsing into dorsiflexion during the second half of support phase when the line of action of her COM is in front of her ankle. By taking short steps she avoids letting her ankle pass behind her COM |
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Term
| During walking, the patient's right thigh and knee seem to flex more than usual during swing phase, and swing phase ends with right forefoot touching the ground before the heel. What nerve and muscle(s) have been damaged and explain why the patient displays this type of gait. |
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Definition
Right deep peroneal n. Tibialis anterior, extensor hallucis longus, extensor digitorum longus, and peroneus tertius.
Since he cannot dorsiflex ankle at beginning of swing phase, he flexes his hip and knee more to lift toes off of the ground. He can't control plantarflexion at toe off, so he lands forefoot first. |
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Term
| Explain why fractures of the neck of the femur are associated with a significant incidence of death of the femoral head |
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Definition
| Most of the blood supply to the femoral head is derived from a branch of the medial femoral circumflex artery, which passes along the femoral neck. Fractures of the femoral neck sever this branch leading to necrosis of the femoral head. Fractures can also lead to intracapsular swelling, which can compress the vessels and lead to the same result |
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Term
| Name the muscle(s) that are attached to the anterior superior iliac spine |
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Definition
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Term
| Name the muscle(s) that are attached to the adductor tubercle |
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Definition
| Ischiocondylar part of adductor magnus |
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Term
| Name the muscle(s) that are attached to the tibial tuberosity |
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Definition
| Patellar tendon of quadriceps femoris |
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Term
| Name the muscle(s) that are attached to the lesser trochanter |
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Definition
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Term
| A woman suffered a pelvic fracture in an automobile accident. In a follow-up exam she displayed a positive Trendelenberg sign when standing on her right limb. Describe the appearance of this sign |
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Definition
| Her left hip drops (contralateral) and her right hip collapses into adduction; her trunk flexes laterally toward the right (ipsilateral) |
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Term
| A woman suffered a pelvic fracture in an automobile accident. In a follow-up exam she displayed a positive Trendelenberg sign when standing on her right limb. What has been damaged? |
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Definition
| Superior gluteal n. and/or lesser gluteal muscles (gluteus minimus and medius). |
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Term
| What anatomical structure is most important in helping to prevent distal displacement of the radius relative to the ulna? |
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Definition
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Term
| What anatomical structure is most important in helping to prevent shoulder separation (dislocation of acromioclavicular joint)? |
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Definition
| Coracoclavicular ligaments |
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Term
| First part of axillary artery is blocked, however pt. suffers no symptoms associated with ischemia of the limb. Trace one alternative route of blood flow bypassing the obstruction. |
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Definition
Subclavian-->Thyrocervical trunk-->Suprascapular
-->circumflex scapular-->subscapular-->axillary |
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Term
| Due to a fall from her bicycle, a young woman suffers a fracture of the surgical neck of her humerus. What nerve is in jeopardy from the fracture? |
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Definition
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Term
| If the axillary nerve is injured, what muscles would be affected? |
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Definition
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Term
| What motor test could you perform to test for damage to the axillary nerve? |
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Definition
| Ask patient to elevate arm against resistance and compare strength to that of the uninjured arm. |
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Term
| If the musculocutaneous nerve was damaged at the point where it comes off of the brachial plexus, what muscles would be affected? |
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Definition
| Coracobrachialis, biceps brachii, bracialis |
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Term
| Describe the motor deficits you would see if the musculocutaneous nerve was damaged at the point where it comes off of the brachial plexus. |
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Definition
| Severe weakness in elbow flexion |
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Term
| Where would you test for loss of sensation due to damage of the musculocutaneous nerve? |
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Definition
| Skin over the lateral side of the forearm |
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Term
| A man stumbles and falls, breaking the medial epicondyle of his humerus. What nerve is in jeopardy from this fracture? |
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Definition
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Term
| What impact would a fracture to medial epicondyle of the humerus have on a person's ability to flex his/her elbow? |
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Definition
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Term
| What impact would a fracture to medial epicondyle of the humerus have on a person's ability to flex the wrist? |
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Definition
| Wrist flexion would be accompanied by radial deviation |
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Term
| What impact would a fracture to medial epicondyle of the humerus have on a person's ability to abduct/adduct his/her fingers? |
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Definition
| Unable to either adduct or abduct digits 2-5. Unable to adduct thumb. |
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Term
| What nerve and muscle(s) are most likely to be associated with marked weakness of lateral rotation of the upper arm? |
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Definition
Suprascapular n.
Infraspinatus and supraspinatus |
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Term
| What nerve and muscle(s) are most likely to be associated with inability to extend the elbow against resistance? |
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Definition
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