Download Anatomy Exam 2 Blue Boxes Joints of Newborn Cranium pg. 28 The

Anatomy Exam 2 Blue Boxes
Joints of Newborn Cranium pg. 28
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The bones of the calvaria of a newborn infant’s cranium do not make fill contact with each other
The sutures form wide areas of fibrous tissue called fontanelles
The anterior fontanelle is the most prominent (soft spot, flat)
Bulging frontanelle may indicate intracranial pressure
Pulsations reflect pulses of cerebral arteries
Depressed fontanelle if dehydrated
Degenerative Joint Disease pg. 28
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Normal aging of articular cartilage occurs on hip, knee, vertebral column, and hands
Degenerative changes in joints cause articular cartilage to become less effective as shock
absorber and lubricated surface
Articulation becomes vulnerable to repeated friction
Stiffness, discomfort, pain
Osteoarthritis common in older people and common in joints that support weight (hips and
knee)
Traumatic infection of joint may be followed by arthritis and septicemia
Arthroscopy pg. 29
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Cavity of a synovial joint can be examined by inserting a cannula and arthroscope
Useful to examine abnormalities in joints and surgical procedures (faster recovery)
Hip and Thigh Contusions pg. 558
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Hip pointer-contusion of the iliac crest which occurs anteriorly ( ie. Sartorius attaches to ASIS)
Contusions cause bleeding from ruptured capillaries and infiltration of blood into the muscles,
tendons, and other soft tissues
May also refer to avulsion of bony muscle attachments
Charley horse- cramping of an individual thigh muscle because of ischemia or to contusion and
rupture of blood vessels sufficient enough to form a hematoma
The most common site of a thigh hematoma is in the quadriceps
Psoas Abscess pg. 558
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A retroperitoneal pyogenic infection in the abdomen or greater pelvis, characteristically
occurring in association with TB of the vertebral column, or secondary to regional enteritis of
the ileum (Crohn disease) may results in the formation of a psoas abscess
Edema can occur in the proximal part of the thigh
Observed in inguinal region
Paralysis of Quadriceps pg. 558
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Cannot extend the leg against resistance and usually presses on the distal end of the thigh
during walking to prevent inadvertent flexion of the knee joint
Chondromalacia Patellae pg. 558
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Runner’s knee
Soreness and aching around patella results from quadriceps imbalance
Can result from blow to patella or extreme flexion of the knee
Patellar Fractures pg. 559
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Transverse patellar fractures may result from a blow to the knee or sudden contraction of the
quadriceps
Proximal fragment is pulled superiorly with quadriceps tendon
Distal fragment remains with patellar ligament
Abnormal Ossification of Patella pg. 559
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Patella is cartilaginous at birth but ossifies during 3rd-6th years
Multiple ossification centers occur and if they remain separated, a bipartite or tripartite patella
may form
Ossification abnormalities are nearly always bilateral so use CT/radiograph to observe both
Patellar Tendon Reflex pg. 559
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Tapping the patellar ligament with a reflex hammer normally elicits the patellar tendon reflex
Knee jerks- leg extends, quadriceps contract
Tests the integrity of the femoral nerve and L2-L4
Diminution or absence of patellar tendon reflex may result from any lesion that interrupts the
innervation of the quadriceps
Transplantation of Gracilis pg. 559
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Weak member of the adductor group
Used to replace a damaged muscle in the hand ( good digital flexion and extension)
Used as replacement for a nonfunctional external anal sphincter
Groin Pull pg. 560
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Injury involves flexor and adductor thigh muscles
Attachment of these muscles are in the inguinal region
Occur in quick start sports and extreme stretching
Injury to Adductor Longus pg. 560
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Occurs in horseback riders and produces pain
Ossification may occur in the tendons and are called riders’ bones
Palpation, Compression, and Cannulation of Femoral Artery pg. 560
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Starts off as common femoral artery then continuation distally called superficial femoral artery
(term not recommended because it is a DEEP artery)
Femoral pulse may be palpated midway between the ASIS and pubic symphysis
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Compression can be done by pressing posteriorly against the superior pubic ramus, psoas major,
and femoral head
In left cardial angiography, a catheter is inserted into artery and passed up the external iliac
artery, common iliac artery, and aorta to the left ventricle of the hear
Blood may be taken for blood gas analysis
Laceration of Femoral Artery pg. 560
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Arteriovenous shunt- artery and vein lacerated in anterior thigh wounds
Cruciate anastomosis is a four-way common meeting of the medial and lateral circumflex
femoral arteries with the inferior gluteal artery superiorly, and the first perforation artery
inferiorly, posterior to the femur (supplies blood to the lower limb)
Potentially Lethal Misnomer pg. 560
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Femoral vein is DEEP
Pulmonary emboli originate in deep veins
Risk of embolism can be reduced by anticoagulant treatment
Saphenous Varix pg. 561
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A localized dilation of the terminal part of the great saphenous vein
May cause edema in femoral triangle
Location of Femoral Vein pg. 561
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Inferior to the inguinal ligament
Femoral artery is lateral to the vein
In varicose vein operations, it is important to identify the great saphenous vein correctly (it is
more superficial)
Cannulation of Femoral Vein pg. 561
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Right cardiac angiography- catheter inserted into the femoral vein as it passes through the
femoral triangle (through external and common iliac veins into the inferior vena cava and right
atrium)
Secure blood samples and take pressure recordings from the chambers of the right side of the
heart
Femoral Hernias pg. 561
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Femoral rings is the usual originating site of a femoral hernia- a protrusion of abdominal viscera
through the femoral ring into the femoral canal
Hernia is bounded by the femoral vein laterally and the lacunar ligament medially
Compresses contents of the femoral canal
More common in females because of wider pelves
Strangulation of a femoral hernia may occur because of the sharp, rigid boundaries of the
femoral ring, particularly the concave margin of the lacunar ligament
Can cause necrosis
Replaced or Accessory Obturator Artery pg. 562
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Enlarged pubic branch of the inferior epigastric artery either takes the place of the obturator
artery (replaced obturator artery) or joins it as an accessory obturator artery
Could be involved in a strangulated femoral hernia
Surgeons placing staples during endoscopic repair of both inguinal and femoral hernias must be
concerned with the presence of this common arterial variant
Popliteal Abscess and Tumor pg. 604
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Tend to spread superiorly and inferiorly because of the toughness of the popliteal fascia
Popliteal Pulse pg. 604
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Popliteal artery is deep so it may be difficult to feel pulse
To find pulse, person is in prone position with knee flexed to relax the popliteal fascia and
hamstrings
Best felt in the inferior part of the fossa
Weakening of pulse is a sign of femoral artery obstruction
Popliteal Aneurysm and Hemorrhage pg. 604
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Popliteal aneurysm (abnormal dilation of all or part of popliteal artery) usually causes edema
and pain in the popliteal fossa
Palpable pulsations (thrills) and abnormal arterial sounds (brutis) detectable with stethoscope
An aneurysm may stretch the nerve or compress it blood supply (vasa vasorum)
Fractures of the distal femur or dislocations of the knee may rupture the artery causing
hemorrhage
Injury to Tibial Nerve pg. 605
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Uncommon because of its deep and protected position in the popliteal fossa
Posterior dislocation of the knee joint can damage nerve
Severance of the tibial nerve produces paralysis of the flexor muscles in the leg and the intrinsic
muscles in the sole of the foot
Unable to plantarflex their ankle or flex their toes
Loss of sensation occurs on the sole of the foot
Containment and Spread of Compartmental Infections in the Leg pg. 605
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Increased volume consequent to infection with suppuration increases intracompartmental
pressure
Infection in lateral compartment can ascend proximally into popliteal fossa
Fasciotomy (incision of fascia) may be necessary to relieve pressure and debride pockets of
infection
Tibialis Anterior Strain (Shin Splints) pg. 605
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Edema and pain in the area of the distal two thirds of the tibia
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Results from repetitive microtrauma of the tibialis anterior which causes small tears in the
periosteum covering the shaft of the tibia and/or of fleshy attachments to the overlying deep
fascia of the leg
Mild form of anterior compartment syndrome
Fibrularis Muscles and Evolution of the Human Foot pg. 605
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Feet of humans are everted (pronated)
Fibularis longus and fibrularis tertius attached to the base of the 5th metatarsal developed
Injury to Common Fibular Nerve and Footdrop pg. 605
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Most often nerve injured in the lower limb because it winds around the fibular neck
Paralysis of all muscles in the anterior and lateral compartments of the leg
Loss of dorsiflexion of the ankle causes footdrop, making the limb too long (toes do not clear
ground)
Can be compensated by: 1. Waddling gait- hikes the hip
2. Swing out gait- swung out laterally (adducted)
3. Steppage gait- extra flexion employed at hip and knee to
raise foot
Braking action produced by eccentric contraction of dorsiflexors also lost (foot “clops”)
Deep Fibular Nerve Entrapment pg. 606
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Pain in the anterior entrapment, dorsum of foot, web space btwn 1st and 2nd toes
Nerve passes deep to the inferior extensor retinaculum and extensor hallcus brevis
Ski boot syndrome
Superficial Fibular Nerve Entrapment pg.606
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Chronic ankle sprains
Pain along lateral side of the leg and the dorsum of the ankle and foot
Numbness and paresthesia
Fabella in Gastrocnemius pg. 606
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Lateral head of the gastrocnemius may contain a sesamoid bone, the fabella which articulates
with lateral femoral condyle
3-5% people have it
Calcaneal Tendinitis pg. 606
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Occurs in running injuries
Repetitive activities, poor footwear or training surfaces
Microscopic tears of collagen fibers in the tendon
Ruptured Calcaneal Tendon pg. 607
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Associated with history of calcaneal tendinitis
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Audible snap during a forceful push off (plantarflexion with the knee extended) followed
immediately by sudden calf pain and sudden dorsiflexion of the plantarflexed foot
Gastrocnemius, soleus, and plantaris affected
Cannot plantarflex against resistance and dorsiflexion is excessive
Lump appears in the calf owing to shortening of the triceps surae
Calcaneal Tendon Reflex pg. 607
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Ankle jerk reflex/triceps surae flex
Normal result is plantarflexion of the ankle joint
Tests the S1 and S2 nerve roots
Absence of Plantarflexion pg. 607
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If muscles of calf paralyzed, calcaneal tendon ruptured, or normal push off is painful, you can
still push off (from midfoot) by the actions of the gluteus maximus and hamstrings in extending
the thigh at the hip joint and the quadriceps in extending the knee
Gastrocnemius Strain pg. 607
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Partial tearing of the medial belly of the gastrocnemius at or near its musculotendinous junction
Caused by overstretching the muscle by concomitant fill extension of the knee and dorsiflexion
of the ankle joint
Calcaneal Bursitis pg. 607
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Inflammation of the deep bursa of the calcaneal tendon
Pain posterior to the heal
Venous Return from Leg pg. 607
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Venous plexus deep to the triceps surae is involved in the return of blood from the leg
Contraction of the calf muscles pumps blood superiorly in the deep veins
Musclovenous pump is improved by the deep fascia that invests the muscles like an elastic
stocking
Accessory Soleus pg. 608
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In 3% of people
Appears as a distal belly medial to the calcaneal tendon
May be associated with pain and edema during prolonged exercise
Posterior Tibial Pulse pg. 608
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Can be palpated between the posterior surface of the medial malleolus and the medial border
of the calcaneal tendon
Have the person invert the foot to relax the retinaculum (examine both simultaneously)
Occlusive peripheral arterial disease- intermittent claudication (leg pain and cramps) develops
during walking and disappears after rest