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Group Dorsal Extensor expansion: bye bye muscles *** Thenar Adductor Hypothenar Central Muscle Interosseous Function Blood Nerve Abductor pollicis brevis Opponen pollicis Flexor pollicis brevis Adductor pollicis – oblique and transverse heads Abductor digiti minimi Flexor digiti minimi brevis Opponens digiti minimi Abducts the thumb Opposes the thumb Flexes the thumb Superficial branch of radial artery Median nerve Lumbricals – first and fourth Lumbrical Adducts thumb Deep branch of ulnar Abducts pinky Flexes pinky Opposes pinky Ulnar Flex metacarpophalangeal and extend interphalangeal First – recurrent branch of the median nerve; Fourth – deep branch of ulnar nerve Fibrous digital sheath Flexor digitorum profundus tendon Flexor digitorum superficialis tendon Dorsal interoosei - 4(DAB) Interossous Extend interphalangeal, flex metaphalangeal Dorsal metacarpal artery, palmar metacarpal artery Deep branch of ulnar Palmar interossei - 3(PAD) Thickened fascia ** Extensor retinaculum Palmaris brevis Palmaris longus Brachioradialis Extensor carpi radialis longus Extensor carpi radialis brevis Superficial extensor group of arm Extensor digitorum Extensor digiti minimi Extensor carpi ulnaris Holds the extensor muscles in place Wrinkle skin of palm Flexes wrist Forearm flexor Extensor at wrist joint; abducts the hand at the wrist Extension of hand and fingers Extends little finger at all joints Extends and adducts the Ulnar artery Radial nerve Radial Posterior interosseus artery and ulnar artery Ulnar Superficial branch of ulnar Median nerve Radial recurrent artery Radial Deep branch of radial nerve Posterior interossei nerve Abductor pollicis longus wrist Abductsm extension the thumb Extensor pollicis brevis Deep extensor group of arm Extensor pollicis longus Extensor indicis Supinator Gracilis Adductor longus Adductor brevis Addcutor compartment of thigh (Medial) Adductor magnus** Obturator externus Biceps femoris – long** Flexor compartment of thigh (Posterior) Biceps femoris – short** Semitendinosus Semimembraneosus Sartorius “tailor’s” Extensor compartment of thigh (Anterior) Iliopsoas Pectineus** Q.f – Rectus femoris Q.f – Vastus medialis Extends thumb at metacarpophalangeal joint and interphalangeal joints Extend second digit and help extend hand at rest Supinate forearm Adductor – weak. Used for grafting. Flexion and medial rotation of knee Adduction of hip Adduction of hip Adductor portion – adduction of hip Hamstring portion – extension of hip Lateral rotation of hip, steadies femoral head in acetabulum Flexes leg at knee joint, laterally rotates knee when flexed; extends hip joint (long head only) Flexes knee; extends hip joint; medially rotate leg Flexion of hip and knee, assists in abduction and lateral roation of hip joint Chief flexor of hip Flexion, medial rotation and adduction of hip Extension of knee; flexion of hip Extension of hip Posterior interosseous artery Radial recurrent artery Obturator Obturator Obturator and deep femoral Obturator Tibial part of sciatic nerve Obturator Tibial part of sciatic nerve Inferior gluteul artery, perforating artery, popliteal artery Common fibular part of sciatic Tibial part of sciatic nerve Profundus femoris; gluteul artery Sciatic Femoral Femoral Femoral (L2, L3, L4) and obturator Femoral Femoral Q.f. – vastus lateralis Q.f – Vastus intermediius Superfical gluteul muscles Gluteus maximus Extends thigh Superficial branch of superior glueteal artery; inferior gluteal artery Gluteus medius Gluteus minimus Abduct and medially rotate thigh; keep pelvis level when other leg is raised Deep branch of superior gluteal artery Superior gluteul nerve Inferior and superior glutueal artery; lateral sacral artery Branches of the anterior ramie S1, S2 Tensor fascia lata Piriformis Deep glutuel muscles Superior gemellus Obturator internus Inferior gemellus Quadtratus femoris Semitendonous Semimembranous Hamstrings Biceps femoris Tibialis anterior Anterior compartment of leg Lateral compartment of leg Posterior – Superifical compartment of leg Extensor hallucis longus Extensor digitorum longus Peroneus tertius Peroneus longus Peroneus brevis Gastrocnemuis Soleus (peripheral heart) Plantaris Popliteus Posterior – Deep compartment of leg Tibialis posterior Flexor hallucis longus Flexor digitorum longus Laterally rotate extended thigh; steady femoral head in acetabulum inferior gluteal artery inferior gluteal artery Main extensors of the hip used in normal walking; maintain the relaxed standing position; rotation of the flexed knee Strong inverter; dorsiflexor Inferior gluetul nerve Nerve to the obturator internus Nerve to the quadratus femoris inferior gluteal artery (superficial); perforating arteries of femoral artery Tibial division of sciatic nerve Deep peroneal nerve Dorsiflexion Anterior tibial artery which continues to the dorsalis pedis artery Eversion, plantar flexion Peroneal artery Superficial Peroneal nerve Plantar flexion, flexes leg at knee joint Posterior tibial artery Medial rotation and flexion of knee Inversion of foot; planter fexion Flexes big toe; plantar Flexes the digits Popliteal artery Posterior tibial artery Peroneal artery Posterior tibial artery Tibial Medial Layer 1 Abductor hallucis Abducts and flexes great toe Medial plantar nerve Medial Layer 2 Medial Layer 3 Flexor hallucis brevis Central Layer 1 Flexor digitorum brevis Central layer 2 Quadratus plantae Lumbricals Central Layer 3 Adductor hallucis Lateral Layer 1 Abductor Digiti minimi Flexes proximal phalanx of great toe Flexes lateral four digits Assists FDL in flexing lateral four toes Flex proximal phalanges, extend middle and distal phalanges of the lateral 4 toes Adducts 1st digit; assists in transverse arch of foot Abducts and flexes little toe MPN Medial planter nerve Lateral plantar nerve MPN – 1; LPN – 3 LPN – Deep branch Lateral plantar nerve Lateral Layer 2 Lateral Layer 3 Flexor digiti minimi brevis Interosseous (Layer 4) Plantar interossei – 3 Dorsal interossei – 4 Dorsal (Layer 5) Extensor digitorum brevis Extensor hallucis brevis Carpals: Some lovers take Bone Scaphoid Flexes proximal phalanx of 5th digit; thereby assisting with its flexion PAD; flex MP joints DAB; flex MP joints Aids the extensor digitorum longus in extending the four medial toes at the MP and IP joints Aids the extensor hallucis longus in extending the great toe at the metatarsophalangeal joint Placement First row of carpals LPN – Superior branch LPN Deep fibular nerve Description positions that they cannot handle Femur Tibia Patella Tibia Fibula Forefoot Midfoot Lunate Triquetrum Pisiforms Trapezium Trapezoid Capitate Hamate Long neck Shaft Greater trochlear Lesser trochlear Fovea of head Adductor tubercle Medial epicondyle Medial condyle Lateral epicondyle Laterl condyle Patellar surface Tuberosity Anterior surface Articular surface Ischial tuberosity Trochanteric fossa Greater trochanter Lesser trochanter Gleuteal tuberosity Tibial condyles Tibial tuberosity Anterior border of tibia Medial malleolus Head of fibula Neck of fibula Lateral malleolus Metatarsals Phalanges Navicular Cuboid Second (distal) ros of carpals Hook tells us it is palmar Lots of blood supply. Can be used for grafting 5 14 Hindfoot Talus Landmark Cuneforms Talus Calcaneous Head Neck Trochlea 3 of them No muscular or tendinous attatchments Borders (If any) Carpal tunnel Importance Contents: Median nerve, four tendons of the flexor digitorum superficialis muscles, four tendons of the digitorum profundus muscle, tendons of the flexor policis longus muscle Palmar aponeurosis Fibrous digital sheath Metacarpophalangeal joint PIP joint DIP joint Thickened band. Weaker over the eminences. Thick in the center. Forms osseo teunnels Allows movement Palmar fascia Sinnovial sheath Palmar aponeurosis Thenar space Midpalmar space Central compartment Medial fibrous septum Superficial Palmar Arch Deep palmar arch Iliotibial tract Deep to flexor tendons and 1st lumbrical muscle Deep to flexor tendons and lumbrical muscles Continous with the foreaarm Thickening of deep fascia of thigh between the illium and tibia. Effects the stability of knee joint. Use this when you force yourself to straighten your leg. Base – inguinal ligament Lateral border - Sartorius Contents: Femoral nerve (4 inches), artery, vein and canal (bigger in women) and cloquets Rider’s bones Femoral triangle Medial – Adducotr longus Roof – skin, superficial fascia Saphonous opening Mid-inguinal point Adductor canal/hunters/subsartorial Compartments of Femoral sheath Roof and medial border– sartorius Lateral border– vastus medialis Floor border – adductor longus and magnus Lateral Intermediate Medial – also called the femoral canal Greater sciatic foramen Lesser sciatic foramen Gluteal bursae Muscular tripod Pes Anserinus Gluteal aponeurosis Os trigonum Popliteal fossa Membraneous sac lined by a synovial membrane containing a capillary layer of fluid located in areas subject to friction Sartorius – Lateral rotator Gracilis – adductor ST – Medial rotator Upper medial surface of tibia Thickening of the fascial lata that spans from the iliac crest to the superior border of the gluteus maximus muscle Secondary ossification center Semitendous, semimembranousus – supra medial border? Biceps femoris – Supra lateral border Medial head os gastrocnemius – infer-medial border Lateral head of gastrocnemius – infer-lateral border Roof: thick Superficial fascia (a vein and 3 cutaneous nerves), skin lymph nodes (important because it drains glands clitorus/penis) Where the femoral artery begins Contents: femoral artery (6 inches) and vein, saphonous nerve, nerve to vastus medialis, descending genucular artery Contains femoral artery Contains femoral vein Contains lymphatics. Proximal opening is called femoral ring. Superior gluteal vessels & nerve piriforms; inferior gluteal vessel; sciatic nerve; nerves to the quadratus femoris (PIN) Obturator internus; PIN All flex the knee Contains: Popliteal artery, popliteal vein, branches of the sciatic nerve - common peroneal nerve and tibial nerve and shot saphenous vein (division happens at the junction of upper 2/3 and lower 1/3 of the fossa) Disease Scaphoid fracture Body part involved What’s wrong Symptoms Go ventrally and interferes with everything Lunate displace Notes Most commonly fractured Most commonly displaced Claw hand Hand infection Swelling usually appear on the dorsum of hand Dupuytren contracture Shorterning, thickening and fibrosis of palmar fascia Permanent contracture of metacarpophalangeal proximal interphalangeal joints of 4th and 5th finger. Tenosynovitis tendon and synovial sheath Inflammation Reynaud’s syndrome Fingers Ischemia Fractures of neck of femur Fascial spaces determine the extent of spread of pus. Untreated infection can spread to foreaarm through capal tunnel anterior to pronator quadratus Bilateral and common in males over 50 Treatment: surgical excision of fibrotic tissue. Untreated infection can spread to palmar space Causes: Emotiona, anatomical, cold If fragment is not impacted Considerable displacement Distal fragment pulled upward Leg shorter Lateral rotation of distal fragment Toes point laterally Varicose veins Deep fascia of thigh Patellar reflex Femoral nerve Valves in veins are not properly functioning. Blood flows from deep to superficial. Blood flows from femoral to Saphenous vein Tap the knee More common than in women than men. Femoral hernia Gower’s syndrome Rectus femoris, adductor, hamstring muscles Trenlenberg’s gait? Gluteus maximus Paralysis of gluteus maximus Person can’t stand up from sitting; have to get up gradually supporting Trendelberg’s test Trochanteric bursitis Ischial bursitis Sciatic hernia Sciatic nerve block Superior gluteal nerve Movements of glueus maximus over the greater trochanter Iscial bursa and the ischial tuberosity Nerve damaged themselves Unilaterally-lurching gait Bilaterally – waddling gait Diffuse pain in the lateral thigh Excessive friction Behind the knee Sciatic nerve Pressing on the nerve Reducible painless swelling in the buttock Sciatic nerve Injection of an anesthetic agent a few centimeters inferior to the mipoint of the line joining the PSIS and the superior border of the greater trochanter Sciatic nerve injuries Arteria comitans nervi ichiadi (ACNI) Piriformis syndrome Hamstring strains hamstrings Popliteal artery palpation Popliteal fossa Penetrating injuries; posterior dislocation of the hip; paralysis of hamstrings and all the muscles of the leg and foot; loss of all movements and sensations below the knee joint with foot drop deformity. Artery in the sciatic nerve which bleeds quite sharply when nerve is cut during AK amputation Compression of the nerve by piriformis; excessive use of the gluteal muscles Contusion and tearing of muscle fibers; hematoma with tight fascia lata Has to be done with semi- Pain in the butt Very painful Running up hills, climbing stairs Calcification in chronic burtitis Can be distinguished from the pernial hernia by the way of direct of reduction together with palpable defect in the pelvic floor. Barium enemia can be used to distinguish. Popliteal aneurysm Baker’s cyst Compound fracture of tibia and fibula Pott’s fracture (trimalleolar fracture) flexed knee s Localized dilation of artery Tibia and fibula Leg splits in two Lateral malleolus, medial malleolus, posterior inferior tibia You can slip and have your ankle invert Fracture of tubersity of the 5th metatarsal Injury to common peroneal nerve Foot drop/pes equina Congenital Talipes Equinus varus Compartment syndrome Slip with inverted foot Common peroneal nerve Deep peroneal nerve “Club foot” Depends on which compartme Hagland’s syndrome Tarsal tunnel syndrome Anterior and lateral compartment of leg will be paralyzed Tibial nerve and flexor retinaculum Hypertrophy of muscles and so compression of the fossa Combination of retrocalcaneal bursitis and achilles tendonitis compression Tibial nerve injury Pes calcaneus Posterior tibial artery pulse Fractures of calaneal Caceneal bone Fracture of talar neck Dancer’s fracture Fatigue fracture Talar neck Metatarsals Metatarsals Avulsion fracture metatarsals Phalanges fracture Fall on heels/communuted fracture Severe dorsiflexion of ankle Due to enpointe posture Prolonged walking Violently inverted by fibularis brevis muscle Sharp radiating pain into the arch of the foot, heel and sometimes toes. Pins and needles Walk on your heel Disrupts the subtalar joint “Jogger’s foot”. Diagnosed by Tinnel’s test Treatment: setting Buddy taping Sesamoid bone fracture Crushing injury Feet slightly dorsiflexed located lateral the EHL tendon Invert the foot – relax the retinaculum. Palpate between medial maleolus and calcaneal tendon Normal – flexion of toes Squished feet in heels Proximal phalanx dorsiflexed at MP joints; middle phalanx is plantar flexed at PIP joints; weak lumbricals and interosseous muscles Hyper-extension at MP joints flexion at DIP joints Dorsalis pedis pulse Posterior tibial pulse Plantar reflex Hallux Valugus Hammer toe Claw toe Congenital Dislocation of hip joint Acquired dislocation of hip joint Hip joint Damaged head of femur Hip joint Defect in the acetabulum Heels Treatment: series of POP casts for about 6 weeks – apply pressure on the subtalar joints and ligaments Lateral rotation and no adduction; hip and KNEE pain. Central Hip joint Fracture of neck of femur Abnormal – babinksi sign Bunion Plantar flexed, inverted and forefoot adducted Club foot Osteoarthritis Diminished/absent pulse – arterial occlusion Head of femur Anterior Posterior Foot drop, Flexed and adducted; Medial rotation and shortening Fracture Shortening, lateral rotation Due to osteoporosis; option is total hip replacement Femoral artery Superficial Deep Joint Name Ligaments Circumflex iliac Epigastric External pudendal External pudendal Profunda femoris Bones connected Movement Coracoacromial Flexion Coracohumeral Extension Transverse humeral Abduction Adduction Shoulder Medial rotation Lateral rotation Capsule Elbow Radial collateral Annular Ulnar collateral Annular Flexion Extension Muscles Bursa involved Pec major; Ant. Deltoid Lats; tere’s major Delts; supraspinatous Pec major; Subacromial; lats; tere’s subscapular major Pecs major; subscapularis’ Ant. Delts Supra and infra spinatous; tere’s minor Brachialis; Subcutaenous biceps brachii olecranon Triceps brachii Radioulnar Wrist Palmar Flexion Flexor carpi Cavity names Glenoid Cavity and glenoid lambrum Anastamosis Diseases Notes radiocarpal Radio collateral Extension Ulnar collateral Abduction Dorsal ulnocarpal Dorsal radiocarpal Intercarpal Adduction radialis and ulnaris Extensor carpi radialis (L and B) and ulnaris Fl. Carpi radialis; Ex. Carpi radialis LB Fl. And Ex. Carpi ulnaris QuickTime™ and a TIFF (LZW) decompressor are needed to see this picture. 1