Fairyburger



*Forgot to put in the graphic that musculocutaneous nerve innervates the anterior compartment of the arm + tends to pierce the coracobrachialis!Erb-Duchenne’s PalsyUpper brachial plexus lesion (superior trunk)Damage to C5, C6 Commonly affects suprascapular n., musculocutaneous n., axillary n.Inability to abductAbduction: supraspinatus (0-15°), deltoid (15-90°)Inability to flex at elbow or supinate forearm"Waiter's tip"?Klumpke's PalsyLower brachial plexus lesion (inferior trunk)Damage to C8, T1Commonly affects intrinsic muscles of the hand, wrist/finger flexors"Claw hand"?Intrinsic Muscles of the Hand"Bye-bye muscles"Flex MCP + extend IPLumbricals1 + 2: innervated by median n.3 + 4: innervated by ulnar n.Closer to the pinky!Interossei"PAD / DAB"Palmar"ADduct"Dorsal"ABduct"Blood Supply-Subclavian artery (before rib #1) -Becomes the Axillary artery (after 1st rib to the end of pectoralis minor) -Becomes the Brachial artery (after pectoralis minor)-Divides at distal end of cubital fossa to form Radial artery (lateral) + Ulnar artery (medial)Main Branches of Axillary Artery“Sally Thompson Loves Sex And Pot”Superior thoracic artery (I don’t think you’re responsible for this one, but it goes into the intercostals space)Thoracoacromial artery (has branches that go to the pecs + the acromion)Lateral thoracic artery (goes toward the serratus anterior muscle)Subscapular artery (has 2 branches!)Circumflex scapular (goes around/under)Thoracodorsal (goes to the latissimus dorsi)Anterior circumflex humeral artery (usually smaller + above the posterior circumflex humeral a.)Posterior circumflex humeral artery (usually fatter + goes posteriorly)-Median cubital vein: most commonly used for blood draws; it’s the connection between the cephalic + basilic veins-Cephalic vein: lateral; passes through the deltopectoral groove-Basilic vein: superficial + medial!The flexor retinaculum + extensor retinaculum mainly just function to hold the flexor/extensor tendons in place so they don’t pop out; that probably wouldn’t be really fun. :/Elbow LigamentsUlnar (medial) collateral ligamentRadial (lateral) collateral ligament)Annular ligament (encircles the head of the radius)If radial head slips out of annular ligament => nursemaid’s elbow (will present with guarding of elbow + inability to supinate)Carpal Bones (8)Proximal row (lat to med): Scaphoid, Lunate, Triquetrum, PisiformDistal row (lat to med): Trapezium, Trapezoid, Capitate, Hamate)“Trapezium” – “Thumb” (they kinda rhyme, so that might help you remember that that’s the “T” that’s closest to the thumb?)“Some Lovers Try Positions That They Can’t Handle”Proximal to distal, lateral to medial for both rows“So Long To Pinky, Here Comes The Thumb”Proximal to distal, lateral to medial => medial to lateralCarpal Tunnel!9 tendons + 1 nerveFlexor digitorum superficialis (4), Flexor digitorum profundus (4), Flexor pollicis longus (1)Median nervePhalen test: hold wrist in complete/forced flexion with dorsal surfaces of both hands pushed togetherTinnel test: lightly tap over the median nervePain/tingling sensation for either of these tests can mean that the pt is (+) for carpal tunnel syndrome“High-Yield” and/or Fun FactsAxillary nerve usually runs with the posterior circumflex humeral artery in the quadrangular spaceCan be damaged by shoulder dislocations + surgical neck fractures on the humerusRadial nerve usually runs with profunda brachii (deep brachial) arteryCan be damaged by humeral shaft fractures / spiral fracturesUlnar nerve = what causes the “funny” sensation you feel when you hit your funny bone (how humerus :O )Damage to the long thoracic nerve causes winged scapula b/c it innervates the serratus anterior“C5 C6 C7, raise your arms to heaven” – to help remember the nerve roots + actionRadial artery runs through floor of anatomical snuffbox, so you can palpate your pulse there too!=> deep palmar arterial arch in the handBut…speaking of the anatomical snuffbox, the borders are made up by the abductor pollicis longus, extensor pollicis longus + extensor pollicis brevis tendonsIf you palpate the snuffbox + feel a whole ton of pain, your scaphoid bone is probably fractured :/This leads to all kinds of bad times and possibly avascular necrosis + poor healing due to lack of blood supply, so try not to fall on an outstretched hand :[Ulnar artery travels with the ulnar nerve + gives off common interosseous artery, which branches into the anterior + posterior interosseous arteriesDifferent from the nerves in that…Radial nerve => posterior interosseous nerve (after it passes through the supinator muscle)Median nerve => anterior interosseous nerve=> superficial palmar arterial arch in the handDuring pronation/supination, the radius is the bone that movesBiceps = your strongest supinatorBrachioradialis, aka your “beer drinking muscle” the only flexor that’s innervated by the radial nerve!Brachial artery = what you’re using to measure BP when you’re taking it in the arm!Recurrent branch of the median nerve innervates the thenar eminence (abductor pollicis brevis, flexor pollicis brevis, opponens pollicis)The adductor pollicis muscle isn’t cool enough to be part of the thenar eminence, so it is instead innervated by the deep branch of the ulnar nerveSheathsMedial digit sheath communicates with common flexor sheathCommon flexor sheath + sheath of pollex tendons communicates with carpal tunnel??Joints (for the most part)Acromioclavicular Joint Type ITear in ACV ligamentType IIComplete tearing of ACV ligament + partial tear to coracoclavicular ligamentType IIIACV joint dislocated ("shoulder separation")Glenohumeral Joint (Rotator Cuff)StabilizationAnteriorSubscapularisPosteriorInfraspinatus, teres minorSuperiorSupraspinatusAxillary nerve at risk for damageTravels through quadrangular space w/ posterior circumflex humeral arteryCan use the “inverted soda can test” to test for impingement, esp. for the supraspinatusElbow"Nursemaid's elbow"Dislocation of elbow joint caused by sudden pull on extended + pronated armHead of radius slips from annular ligamentGuarding of elbowInability to supinateWrist/HandFracture of distal radius in forearmColles' fracturePosterior displacement of wrist + hand"Dinner fork" handTends to happen when falling with outstretched armsScaphoid bone is the most commonly fractured!Can disrupt blood supplyRadial artery runs through anatomical snuffbox (you can palpate your pulse there!)Blood perfuses distal to proximal (retrograde!)HipExtension tightens ligamentsFemur head gets screwed into acetabular fossaDislocationFemoral head dislodged from socketWeak SpotPosterior! (iliofemoral + ischiofemoral ligaments)Affected limb will shorten + internally rotateFractureFracture of femoral neckMuch more commonAngle of inclination decreases with age => greater stress on femoral neckExternal rotation: gluteus maximus, piriformis, quadratus femorisMedial circumflex femoral a. in danger!Supplies majority of blood to femoral head/neckTrendenlenburg GaitContralateral pelvis drop/sag due to inability/difficulty abducting the lower limbAbduction: gluteus medius, gluteus minimusLesion to superior gluteal n.Presentation: leaning to the side of the problemKneesTerms used to describe distal aspect of limb distal to the jointVarus: "bowlegged" | Coxa valgus/Genu varumValgus: "knock-kneed" | Coxa varum/Genu valgumLigamentsAnterior cruciate ligament (ACL)Anterior drawer testLachman testPosterior cruciate ligament (PCL)Cruciate ligaments are not inside synovial joint of kneeMedial collateral ligament (MCL)Lateral collateral ligament (LCL)Swelling/effusion can be seen extending into suprapatellar bursa (superior extension of synovial joint--not a separate bursa)Popliteal (Baker's) CystJoint effusions can push synovial lining out of fibrous joint capsule + create synovial swelling in popliteal fossa"Unhappy Triad"From lateral trauma!Damage to medial meniscus, MCL, ACLMcMurray's test used to check for tears in meniscusPatellar DislocationPatella dislocates (usually laterally)Pain "inside knee cap" + tendency to flex leg even when relaxedPatellar Tendon RuptureWill be able to see patella moving further up quadricepsDifficulty/inability extendingComplete TearTendon separates completely from top of tibiaInability to straighten legPartial TearSome fibers of patellar tendon tornPatellar TendonitisTendon torn in middle due to damage from overuseFeet :[Foot DropDamage to common fibular n. or paralysis of muscles in anterior compartment of lower legWeakness in dorsiflexionHigh-stepping gaitWaddling gaitSwinging out of leg gaitAchilles Tendon RuptureMost commonly injured despite being the strongest/thickest tendonOften occurs by sudden plantarflexion or forced dorsiflexion outside ROMLateral Ankle LigamentsDuring inversion, tendons on lateral side get stretched + will rupture if inversion is forceful enough.Ligaments will rupture in this order:Anterior talofibularCalcaneofibularPosterior talofibularInversion injuries most common b/c deltoid ligament on medial side is one strong son-of-a-gun (medial malleolus typically tears away before it ruptures)Further eversion will fracture distal tibulaPott's fractureProximal tibiofibular joint is a separate synovial joint at the kneeOPP CorrelateCheck for fibular head dysfxn by gliding fibular head anterolaterally + posteromediallyFibular head anterior S/D: fibular head posteromedial glide restrictionExternal rotation of tibia or Eversion of the foot carries distal fibula posteriorly + glides fibular head anteriorlyThey should be opposite of one another!Butt/ThighSuperior Gluteal MusclesGluteus maximusExtends + laterally rotates thighInferior gluteal nerve (since it’s so big, it can actually reach the inferior portion – “big butts hang low,” if that helps?)Superior + inferior gluteal arteriesGluteus medius/minimusAbduction, medial rotation, prevent pelvic tilt w/ gait*These are kinda like the “rotator cuff” muscles of the hip!Superior gluteal nerveSuperior gluteal arteryTensor fascia lataStabilizes the knee in extensionSuperior gluteal nerve*Trendelenburg gait: gluteus medius or minimus damaged or weak, so you end up with “hip drop,” where your hip drops on the side that you’re not standing on4815205226060Deep Gluteal Muscles (short lateral rotators that stabilize the femoral head) – “PGOGOQ” from superior to inferiorPiriformisSciatic nerve usually runs under it, so it hypertrophies or if sciatic n. runs through it instead of underneath it, it’ll get compressed + lead to sciatica (can eventually lead to weakness/loss of fxn of certain muscles)Nerve to the piriformisGemellus superiorUsually darker in colorThe “GOG” makes up the “oreo” (dark-light-dark)Obturator internusDives around to attach to the femur; tends to be lighter in color since it’s mostly tendon hereNerve to obturator internus innervates this + gemellus superior!Gemellus superior/inferior = hitchhiking gemelli brothers, so they don’t get their own innervations!Gemellus inferiorSits on the outside of the obturator foramen; usually darker in color; super deep!Obturator externusYou can’t really see this one from a posterior view, but if you move the pectineus out of the way + look reallyyyy deep, it’ll be thereQuadratus femorisSquare-shaped + underneath the “oreo”!Nerve to quadratus femoris innervates this + gemellus inferior!Posterior Thigh (“butt kickers!” – extend thigh/flex leg) – tibial n. (except the short head!!!) / deep femoral a.Biceps FemorisLong headShort headThis one’s the odd one out! It’s too short, so it can only flex the leg + is innervated by the common fibular/peroneal n.Fibular/peroneal = the same thingSemitendinosusHas a really long tendonSemimembranosusLooks really shinyMost medial (membranosus/medial)Anterior Thigh – femoral n. / femoral a.Sartorius“Hacky sack” muscle – flexes/laterally rotates thigh + flexes legLongest muscle in the body!Quadriceps femorisRectus femorisRectus = “straight,” so…it’s the straight one in the middle of the anterior thighThe only one in this group that flexes the thigh as well as extends the leg!!Vastus lateralisMost lateralVastus medialisMost medialVastus intermediusIn the middleIliopsoasNot exactly a muscle of the anterior thigh, but it’s a major hip flexorMedial Thigh (adductors!) – obturator n. (except the hamstring part of adductor magnus!)/ obturator a.PectineusAdductor brevisAdductor longusAdductor magnusHamstring part of adductor magnusExtends the thigh (it basically acts like a posterior thigh muscle)Tibial n.! because it’s so ginormus, it reaches the back + tibial generally gets all of the posterior thigh musclesGracilisLong + skinny!Leg*Other than fibularis brevis, there are no other “brevis” muscles in this section! :]Posterior Compartment (plantarflexion (mainly)!) – tibial n. / posterior tibial a.SuperficialGastrocnemiusSoleusThink of a slab of fish sitting underneath the gastrocnemius?PlantarisTiny; practically looks like a nerve, but don’t be fooled! :ODeep (“Tom, Dick And Nervous Harry”) Anterior to Posterior: tibialis posterior, flexor digitorum longus, posterior tibial artery, tibial nerve, flexor hallucis longusFlexor hallucis longusFlexor digitorum longusTibialis posteriorAnterior Compartment (dorsiflexion) – deep fibular n. / anterior tibial a. Medial to Lateral: “Tom’s Hairy Dog Fornicates”Tibialis anteriorAlso helps with inversion of footThis tends to be what gets inflamed when you get shin splints!Extensor hallucis longusAlso extends great toeExtensor digitorum longusAlso extends digits 2-5Fibularis tertiusAlso helps with eversion of footLateral Compartment (eversion/plantarflexion) – superficial fibular n. / perforating branches of fibular a.Fibularis longusFibularis brevisGreater saphenous vein: medial; travels anterior to medial malleolus + terminates in femoral vein in femoral triangleLesser saphenous vein: lateral; runs between the 2 heads of the gastrocnemius m. + empties into popliteal v.FootTarsal Bones (“Tiger Cubs Need MILC”) (R foot, superior to inferior, medial to lateral)TalusArticulates w/ tibia + fibula to form ankle jointCalcaneusHeel bone (largest!)NavicularCuneiform (Medial, Intermediate, Lateral)CuboidPlantar Compartment – medial + lateral plantar n. / medial + lateral plantar a.1st layer (Superficial)Abductor hallucisFlexor digitorum brevisAbductor digiti minimi2nd layerQuadratus plantaeLumbricals3rd layerFlexor hallucis brevisAdductor hallucisFlexor digiti minimi brevisBlood SupplyFemoral arteryPopliteal arteryAnterior tibial arteryDorsalis pedis artery (where you take the dorsalis pedis pulse)Communicates w/ deep plantar arterial arch via deep plantar arteryPosterior tibial arteryFibular arteryLateral plantar artery (forms deep plantar arterial arch on sole of foot)Medial plantar arteryInnervationSciatic nerveTibial nerve3187065159385Medial plantar n.Lateral plantar mon fibular nerveSuperficial fibular n.Deep fibular n.Random Other Stuff (Possibly High-Yield)Femoral TriangleBoundaries (“SAIL”)Lateral: Sartorius*Medial: Adductor longusSuperior: Inguinal Ligament*I think your book might have something different for the medial border(?), so if that’s the case, please default to your lab sheet. :OContentsMedial to lateral: VAN (femoral vein, femoral artery+deep femoral artery, femoral nerve)Or…lateral to medial: NAVEL (Nerve, Artery, Vein, Empty space, Lymph)Medial circumflex femoral artery = main blood supply to the femoral head, so if you knock that out (e.g. hip fracture) => necrosis :[Common iliac arterySplits into external + internal iliac arteries[Common] Femoral artery = continuation of external iliac a. at the inguinal ligamentCalled the superficial femoral artery after the deep femoral artery splits offBecomes the popliteal artery after it goes through the adductor hiatus + comes out of the adductor canalBifurcates into anterior + posterior tibial arteries ................
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