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Y1 Locomotor Anatomy Mei Yen Liew & Jingjing WangContent Upper limb ▶ Bones & joints ▶ Muscles ▶ Blood supply ▶ Nerve innervation Lower limb ▶ Bones & joints ▶ Muscles ▶ Blood supply ▶ Nerve innervation Upper Limb Format ▶ MCQs ▶ Short explanation ▶ Ask questions at any point ▶ Revision rather than didactic style ▶ Not a summary tutorial; more a practice answering questions tutorialShoulder + Upper arm Bones and joints 1. What type of joint is the shoulder joint? A. Hinge B. Ball-and-socket C. Condyloid D. Saddle Bones and joints 1. What type of joint is the shoulder joint? A. Hinge - two bones open and close in one direction only (along one plane) like a door, such as the knee and elbow joints B. Ball-and-socket - rounded head of one bone sits within the cup of another, such as the hip joint or shoulder joint, movement in all directions C. Condyloid - movement without rotation, such as in the jaw or finger joints. D. Saddle - movement back and forth and from side to side, but does not allow rotation, such as the joint at the base of the thumb. Bones and joints A 2. Name the highlighted structures (A and B) A. A - coracoacromial ligament; B - acromion process B. A - acromioclavicular ligament; B - conoid process C. A - coracoclavicular ligament; B - acromion B D. A - acromioclavicular ligament; B - coracoid processBones and joints 2. Name the highlighted structures (A and B) A. A - coracoacromial ligament; B - acromion process B. A - acromioclavicular ligament; B - conoid process C. A - coracoclavicular ligament; B - acromion D. A - acromioclavicular ligament; B - coracoid processBones and joints Learning points: - all in the name - don’t overlook common details - know the finer details briefly Muscles 3. Which of the following is not a rotator cuff muscle? A. teres major B. teres minor C. supraspinatus D. infraspinatus Muscles 3. Which of the following is not a rotator cuff muscle? A. teres major B. teres minor C. supraspinatus D. infraspinatus *SITS Supraspinatus Infraspinatus Teres minor SubscapularisMuscles 4. A 55-year-old man presents to the GP with a six-month history of shoulder pain which is sometimes worse at night. Over the weekend he was playing a basketball game when he "strained his shoulder". On palpation, he complains of pain just below the acromion. You suspect that he has a torn supraspinatus. Which of these functional maneuvers be deficient on examination? A. Initiation of adduction B. Initiation of abduction C. Internal rotation D. External rotationMuscles A. Initiation of adduction B. Initiation of abduction C. Internal rotation D. External rotation Supraspinatus - most common rotator cuff tear - 1st 15 degrees of abduction; >30 degrees primarily by deltoid Adduction - pectoralis major Internal rotation - subscapularis External rotation - infraspinatus and teres minorMuscles 5. Which upper arm deformity will most likely produce this sign? A. Coracoid process avulsion B. Supracondylar humeral fracture C. Brachial artery aneurysm D. Biceps tendon ruptureMuscles 5. Which upper arm deformity will most likely produce this sign? A. Coracoid process avulsion B. Supracondylar humeral fracture C. Brachial artery aneurysm D. Biceps tendon rupture Popeye sign - bulging at muscle belly on elbow flexion Brachialis and supinator muscle compensation - patient usually does not notice any weaknessMuscles Reminder - learn the muscles present in the anterior and posterior compartments of the arm, their function, innervation and blood supply. Blood supply 6. Name the structure A. A. Axillary artery B. Posterior humeral circumflex artery A C. Anterior humeral circumflex artery D. Arcuate artery Blood supply 6. Name the structure A. A. Axillary artery B. Posterior humeral circumflex artery C. Anterior humeral circumflex artery D. Arcuate arteryNerve innervation 7. A 35-year old man presents in the Emergency Department with a dislocated shoulder. He was running to catch the bus when he slipped and fell onto the pavement. He is currently holding his arm in an awkward angle. On examination, he complains of numbness over the lateral side of his upper arm. Which nerve was affected in this scenario? A. Brachial nerve B. Axillary nerve C. Lateral pectoral nerve D. Musculocutaneous nerveNerve innervation A. Brachial nerve B. Axillary nerve C. Lateral pectoral nerve D. Musculocutaneous nerve Anterior shoulder dislocation more common than posterior. Axillary nerve - runs in close proximity to shoulder joint around the surgical neck of the humerus, therefore can be damaged in a shoulder dislocation or with attempted reduction. Injury to axillary nerve - paralysis of deltoid and loss of sensation over regimental badge areaNerve innervation 8. What are the roots of the ulnar nerve? A. C5-T1 B. C7 C. C8-T1 D. C5-C6Nerve innervation 8. What are the roots of the ulnar nerve? A. C5-T1 B. C7 C. C8-T1 D. C5-C6 Really Tired Don’t Care NowElbow + ForearmBones and joints 9. A 6-year old girl presents to the Emergency Department with acute, severe pain in her elbow. Her mother says that she was playing happily at the playground when she slipped and fell. On further examination, her mother is able to describe the fall as ‘falling onto her outstretched hands’. Looking at her arm X-ray, what would your main differential diagnosis be? A. radial head fracture B. supracondylar fracture C. fracture of the olecranon D. fracture of the trochlear notchBones and joints A. radial head fracture B. supracondylar fracture C. fracture of the olecranon D. fracture of the trochlear notch Posterior (pathological) fat pad sign on the X-ray. Displacement of anterior humeral line on X-ray. Typically falling onto outstretched hands, severe pain and reluctance to move affected arm. Urgent orthopaedic review - neurovascular compromise? In adults - Differential of radial head fracture; in children - supracondylar fracture more common Muscles 10. What is the action of the muscle attached to the area labelled A? A A. Adduction B. Pronation C. Flexion D. Extension Muscles A. Adduction B. Pronation C. Flexion A D. Extension Biceps brachii attaches to the radial tuberosity (labelled A) for flexion and supination at the elbow joint. 3B’s bend the elbow: Biceps Brachialis Brachioradialis Extension - triceps brachii Muscles 11. A 25-year old man presents to the Emergency Department with pain at the lateral aspect of his arm. On further history taking, he says that he is a professional sportsman. On examination, there is swelling and inflammation around the lateral aspect of his elbow. His temperature is 37.5 degrees Celcius. What is your main differential diagnosis? A. Golfer’s elbow B. Tennis elbow C. Transient synovitis D. Rheumatoid arthritis Muscles A. Golfer’s elbow B. Tennis elbow C. Transient synovitis D. Rheumatoid arthritis Overuse strain of the common tendon insertion for forearm muscles can result in epicondylitis. Medial - Golfer’s elbow Lateral - Tennis elbow *Think about age and pathology, clues in the question stemBlood supply 12. A 56-year old woman presented to Emergency department 4 days ago with a posterior elbow dislocation due to a fall. She subsequently underwent a closed reduction for the dislocation and an elbow slab cast was applied. Today, she comes in complaining of severe right elbow pain, swelling and numbness of her fingers. On examination, the elbow is swollen, forearm tense. CRT is >2sec with a palpable radial artery pulse, brachial pulse non-palpable, reduced sensation in the fingers. What would your differential diagnosis be? A. Soft tissue infection B. Septic shock C. Compartment syndrome D. Brachial plexus palsyBlood supply A. Soft tissue infection B. Septic shock C. Compartment syndrome D. Brachial plexus palsy The brachial artery transverses the antecubital fossa, therefore can rupture during an elbow dislocation. Most common mechanism - fall onto outstretched hand forcing elbow into hyperextension +/- open fracture. In this case, there is vascular injury due to absence of distal upper limb pulses, diminished sensation, prolonged CRT. Compartment syndrome needs an urgent orthopaedic review. No indication of septic shock or infection. Saturday night palsy - radial nerve compression, typically following deep sleep on the arm after alcohol intoxication, Nerve innervation 13. A 21-year old man comes into the Emergency Department presenting with an inability to bend his right wrist back or straighten his fingers. On enquiry, he was out drinking with his friends last night but could not remember what happened after coming home, apart from sleeping in an awkward upright position on the sofa. What would your main differential diagnosis be? A. Crutch palsy B. Honeymoon palsy C. Squash palsy D. Saturday night palsy Nerve innervation A. Crutch palsy - poorly fitted axillary crutches B. Honeymoon palsy - sleeping on and compressing one’s arm overnight C. Squash palsy - associated with sport squash; happens to players during prolonged period between matches D. Saturday night palsy - falling asleep with one’s arm hanging over the armrest of a chair, compressing the radial nerve at the spiral grooveWrist + Hand Bones and joints A 14. What is the bone labelled A? A. Trapezium B. Trapezoid C. Capitate D. Hamate Bones and joints 14. What is the bone labelled A? A. Trapezium B. Trapezoid C. Capitate D. Hamate Lots of different mnemonics: Some ladles try positions (proximal) that they cannot handle (distal)Bones and joints 15. Bonus question Which of the following bones do not form part of the wrist joint? A. Trapezium B. Triquetrum C. Scaphoid D. LunateBones and joints Bonus question Which of the following bones do not form part of the wrist joint? A. Trapezium B. Triquetrum C. Scaphoid D. Lunate Muscles 16. Which of the following muscles are not innervated by the median nerve? A. Opponens pollicis B. Flexor pollicis longus C. Lateral 2 lumbricals D. Flexor pollicis brevisMuscles A. Opponens pollicis B. Flexor pollicis longus C. Lateral 2 lumbricals D. Flexor pollicis brevis L - Lateral 2 Lumbricals (MCPJ flexion, IPJ extension) O - Opponens pollicis - opposes thumb A - Abductor pollicis brevis - abducts thumb F - Flexor pollicis brevis - flexes thumb Muscles 17. Which muscles form the borders of the anatomical snuffbox? A. Extensor pollicis longus, abductor pollicis longus, extensor pollicis brevis B. Extensor pollicis longus, adductor pollicis longus, flexor pollicis brevis C. Extensor pollicis longus, abductor pollicis longus, flexor pollicis brevis D. Flexor pollicis longus, abductor pollicis longus, extensor pollicis brevisMuscles A. Extensor pollicis longus, abductor pollicis longus, extensor pollicis brevis B. Extensor pollicis longus, adductor pollicis longus, flexor pollicis brevis C. Extensor pollicis longus, abductor pollicis longus, flexor pollicis brevis D. Flexor pollicis longus, abductor pollicis longus, extensor pollicis brevis Medial border - EPL Lateral border - EPB, APL Floor - scaphoid bone Blood supply 18. Which bone can cause avascular necrosis if fractured? A. Lunate B. Capitate C. Trapezoid D. Scaphoid Blood supply A. Lunate B. Capitate C. Trapezoid D. Scaphoid Most commonly fractured carpal bone during a fall onto an outstretched hand. Presentation - pain and tenderness in the anatomical snuffbox Progression into osteoarthritis in later life is missed diagnosis Nerve innervation 19. A 31-year old woman presents to the GP with tingling and numbness in her left fingers over the last few days. She also experiences pain over her left wrist when she goes to bed at night. She is in her third trimester of her pregnancy. On examination, there is reduced power in her left hand, a weak thumb. There is also a swelling noticeable in the left wrist and fingers. Based on your differential diagnosis, which of the following nerves is affected? A. Median nerve B. Ulnar nerve C. Radial nerve D. Cutaneous nerve Nerve innervation A. Median nerve B. Ulnar nerve C. Radial nerve D. Cutaneous nerve Carpal tunnel syndrome can occur in pregnancy. There is swelling in the carpal tunnel, compressing the median nerve which is responsible for the sensation and movement of the thumb, index, and middle fingers and lateral ½ of the ring finger. Median nerve compression - pain, paraesthesia, numbness in the wrist and hand, which worsens when trying to sleep.Lower Limb Format ▶ MCQs with short explanation ▶ Bonus clinical scenario questions ▶ Ask questions as we go ▶ Revision rather than didactic style Discussing: Bones & joints, Muscles, Blood supply, Nerve innervation of: ▶ Hip ▶ Upper leg ▶ Knee ▶ Lower leg ▶ Ankle and FootThe Hip Bones and Joints 1. What part of the pelvis is represented in green? A. Ilium B. Pubis C. Ischium D. AcetabulumBones and Joints 1. What part of the pelvis is represented in green? A. Ilium - The ilium is the widest and largest of the three parts of the hip bone, and is located superiorly. B. Pubis - The pubis is the most anterior portion of the hip bone. It consists of a body, superior ramus and inferior ramus. C. Ischium - The ischium forms the posteroinferior part of the hip bone. It is composed of a body, an inferior ramus and superior ramus. D. Acetabulum - Together, the ilium, pubis and ischium form a cup-shaped socket known as the acetabulum. The head of the femur articulates with the acetabulum to form the hip joint (a ball and socket joint). Bones and Joints 2. What feature of the acetabulum does the arrow point to? A. Acetabular fossa B. Acetabular labrum C. Acetabular notch D. Transverse acetabular ligamentBones and Joints 2. What part of the acetabulum does the arrow point to? A. Acetabular fossa – the depression itself, lined by the hyaline cartilage, B. Acetabular labrum – a fibrocartilaginous collar-like structure that deepens the acetabular fossa, C. Acetabular notch – the place where acetabular labrum is discontinuous, D. Transverse acetabular ligament – closes the two ends of the acetabular labrum over the acetabular notch. Muscles 3. What muscle is the arrow pointing to? A. Pubococcygeus B. Puborectalis C. Coccygeus D. IliococcygeusMuscles 3. What muscle is the arrow pointing to? A. Pubococcygeus - main constituent of the levator ani. They arise from the body of the pubic bone and the anterior aspect of the tendinous arch. The fibres travel around the margin of the urogenital hiatus and run posteromedially, attaching at the coccyx and anococcygeal ligament. B. Puborectalis - The puborectalis muscle is a U-shaped sling, extending from the bodies of the pubic bones, past the urogenital hiatus, around the anal canal. The main function of this thick muscle is to maintain faecal continence – during defecation this muscle relaxes. C. Coccygeus - The coccygeus (or ischiococcygeus) is the smaller, and most posterior pelvic floor component – as the levator ani muscles are situated anteriorly. D. Iliococcygeus - The iliococcygeus has thin muscle fibres, which start anteriorly at the ischial spines and posterior aspect of the tendinous arch. They attach posteriorly to the coccyx and the anococcygeal ligament. Blood supply 4. What is the major artery to the pelvis? A. The internal iliac artery B. Inferior gluteal artery C. Iliolumbar artery D. Obturator artery Blood supply 4. What is the major artery to the pelvis? A. The internal iliac artery B. Inferior gluteal artery C. Iliolumbar artery D. Obturator artery Nerve Innervation 5. What network of nerves supplies whole lower limb? A. The lumbosacral plexus B. Femoral nerve C. Sciatic nerve D. Obturator Nerve Innervation 5. What network of nerves supplies whole lower limb? A. The lumbosacral plexus - a network of nerve fibres that supplies the skin and muscles of the pelvis and lower limb. It is located on the surface of the posterior pelvic wall, anterior to the piriformis muscle. Arises from nerve roots T12 to S3/S4 B. Femoral nerve C. Sciatic nerve D. Obturator Clinical Scenario 6. What presentation is not a result of abnormal functioning of the pelvic floor muscles in women? A. Urinary incontinence B. Fecal incontinence C. Genitourinary prolapse D. Fistulas Clinical Scenario 6. What presentation is not a result of abnormal functioning of the pelvic floor muscles in women? A. Urinary incontinence B. Fecal incontinence C. Genitourinary prolapse D. Fistulas Consider the anatomical importance of the pelvic floor muscles in healthThe Upper Leg Bones and Joints 7. What feature is the arrow pointing to? A. Greater trochanter B. Lesser trochanter C. Intertrochanteric line D. intertrochanteric crest Bones and Joints 7. What feature is the arrow pointing to? A. Greater trochanter – insertion point of gluteus medius, gluteus minimus and piriformis muscles, B. Lesser trochanter – insertion point of iliopsoas muscle, C. Intertrochanteric line (located anteriorly) - bony ridges connecting the two trochanters, serve as attachment point for the hip joint capsule and ligaments D. intertrochanteric crest (located posteriorly) Muscles 8. What compartment of the hip performs hip flexion and knee extension? A. Anterior compartment B. Medial compartment C. Posterior compartment D. Dorsal CompartmentMuscles 8. What compartment of the hip performs hip flexion and knee extension? A. Anterior compartment - Performs hip flexion and knee extension; Supplied by the femoral nerve; Important muscles: quadriceps femoris, iliopsoas, pectineus, sartorius (sartorius is an exception here – it does knee flexion!) B. Medial compartment - Performs hip adduction; Supplied by the obturator nerve; Important muscles (from lateral to medial): adductor brevis, adductor longus, adductor magnus, gracilis, C. Posterior compartment - Performs hip extension and knee flexion; Supplied by the sciatic nerve; Important muscles: hamstrings (biceps femoris, semimembranosus, semitendinosus) D. Dorsal compartment - another name for posterior Blood supply 9. What main artery supplies the thigh? A. Femoral artery B. Obturator artery C. Gluteal arteries D. Profunda femoris arteryBlood supply 9. What main artery supplies the thigh? A. Femoral artery - It is a continuation of the external iliac artery (terminal branch of the abdominal aorta). The external iliac becomes the femoral artery when it crosses under the inguinal ligament and enters the femoral triangle. B. Obturator artery - The obturator artery arises from the internal iliac artery in the pelvic region. It descends via the obturator canal to enter the medial thigh, bifurcating into two branches: Anterior branch & Posterior branch C. Gluteal arteries - The gluteal region is largely supplied by the superior and inferior gluteal arteries. These arteries also arise from the internal iliac artery, entering the gluteal region via the greater sciatic foramen. D. profunda femoris artery - in the femoral triangle, the profunda femoris artery arises from the posterolateral aspect of the femoral artery. It travels posteriorly and distally, giving off three main branches: Perforating branches, Lateral femoral circumflex artery, Medial femoral circumflex artery Nerve Innervation 10. Where is the femoral nerve derived from? A. Posterior rami of nerve root L2, L3 and L4. B. Anterior rami of nerve root L2, L3, L4 and L5 C. Posterior rami of nerve root L2, L3, L4 and L5 D. Anterior rami of nerve root L2, L3 and L4 Nerve Innervation 10. Where is the femoral nerve derived from? A. Posterior rami of nerve root L2, L3 and L4. B. Anterior rami of nerve root L2, L3, L4 and L5 C. Posterior rami of nerve root L2, L3, L4 and L5 D. Anterior rami of nerve root L2, L3 and L4Clinical Scenario 11. What type of neck of femur fractures (NOFs) lead to avascular necrosis of the femoral head? A. Intracapsular B. intertrochanteric C. Subtrochanteric D. ExtracapsularClinical Scenario 11. What type of neck of femur fractures (NOFs) lead to avascular necrosis of the femoral head? A. Intracapsular B. intertrochanteric C. Subtrochanteric D. Extracapsular NOFs are increasingly common and tend to be sustained by the elderly population as a result of low energy falls in the presence of osteoporotic bone. They are more prevalent in women. In younger patients they tend to occur as a result of high energy accidents. These fractures can be broadly classified into two main groups: a. Intracapsular – occurs within the capsule of the hip joint. It can damage the medial femoral circumflex artery – and cause avascular necrosis of the femoral head. b. Extracapsular – the blood supply to the head of femur is intact, so avascular necrosis is a rare complication.The Knee Bones and Joints 12. What feature is the arrow pointing to? A. Posterior cruciate ligament B. Anterior cruciate ligament C. Meniscus D. Collateral ligamentBones and Joints 12. What feature is the arrow pointing to? A. Posterior cruciate ligament - Posterior cruciate ligament (PCL) – from posterior intercondylar region to medial femoral condyle, prevents posterior tibial displacement. B. Anterior cruciate ligament - from anterior intercondylar region to lateral femoral condyle, prevents anterior tibial displacement, C. Meniscus - 2 fibrocartilaginous crescent shaped structures found within the joint capsule. Medial meniscus – attached to the medial collateral ligament and less directly associated with the ACL as well. Lateral meniscus – doesn’t have any ‘extra’ attachments D. Collateral ligament - stabilise the joint outside of articular surfaces, prevent some degree of lateral and medial displacement. They both tighten when the knee is extended and loosen up when the knee is flexed, Medial collateral ligament – flat, forms a part of the knee joint capsule, Lateral collateral ligament – cord-like, is extracapsular. Bones and Joints 13. What feature of the patella is the arrow pointing to? A. Apex B. Base C. Medial articular facet (surface) D. Lateral articular facet (surface)Bones and Joints 13. What feature of the patella is the arrow pointing to? A. Apex – located inferiorly, connected to the tibial tuberosity by the patellar ligament B. Base – located superiorly, insertion point of the quadriceps tendon C. Medial articular facet (surface) – located posteriorly, articulates with the medial condyle D. Lateral articular facet (surface) – located posteriorly, articulates with the lateral condyle. The lateral articular facet is bigger than the medial one, so if the patella is lying on its posterior surface, it will slightly tilt laterally. Muscles 14. Which muscle bordering the popliteal fossa is represented in red? A. Semimembranosus B. gastrocnemius & plantaris C. Soleus D. Biceps femorisMuscles 14. Which muscle bordering the popliteal fossa is represented in red? A. Semimembranosus B. gastrocnemius & plantaris C. Soleus D. Biceps femoris The popliteal fossa is diamond shaped with four borders. These borders are formed by the muscles in the posterior compartment of the leg and thigh. ▶ Superomedial border – semimembranosus. ▶ Superolateral border – biceps femoris. ▶ Inferomedial border – medial head of the gastrocnemius. ▶ Inferolateral border – lateral head of the gastrocnemius and plantaris. Clinical Scenario 15. What is not affected in the unhappy triad (blown knee)? A. Medial collateral ligament B. Medial meniscus C. Anterior cruciate ligament D. Posterior cruciate ligament Clinical Scenario 15. What is not affected in the unhappy triad (blown knee)? A. Medial collateral ligament B. Medial meniscus C. Anterior cruciate ligament D. Posterior cruciate ligament As the medial collateral ligament is attached to the medial meniscus, damage to either can affect both structure’s functions. A lateral force to an extended knee, such as a rugby tackle, can rupture the medial collateral ligament, damaging the medial meniscus in the process. The ACL is also affected, which completes the ‘unhappy triad’.The lower leg Bones and Joints 16. What feature is the arrow pointing to? A. Intercondylar eminence B. Tibial tuberosity C. Fibular articular facet D. Malleolar fossaBones and Joints 16. What feature is the arrow pointing to? A. Intercondylar eminence – composed of medial and lateral intercondylar tubercles, here is where menisci, ACL and PCL attach B. Tibial tuberosity – inferior to where patella sits, it’s an attachment site for the patellar ligament C. Fibular articular facet – site for articulation with the fibula to form the proximal tibiofibular joint D. Malleolar fossa – faces posteriorly, hence useful for orientation of the fibula Muscles 17. What compartment of the leg performs plantar-flexion at the ankle? A. Anterior compartment B. Posterior compartment C. Lateral compartment D. Medial CompartmentMuscles 17. What compartment of the leg performs plantar-flexion at the ankle? A. Anterior compartment - Performs dorsiflexion at the ankle; Supplied by the common peroneal (fibular) nerve; Important muscles: tibialis anterior, extensors hallucis longus, extensor digitorum longus B. Posterior compartment - Performs plantar-flexion at the ankle; Supplied by the tibial nerve; Important muscles: gastrocnemius, tibialis posterior, flexor digitorum longus, flexor hallucis longus, popliteus C. Lateral compartment - Performs foot eversion; Supplied by the common peroneal (fibular) nerve; Important muscles: peroneal (fibularis) longus, peroneal (fibularis) brevis. D. Medial compartment Clinical Scenario 18. What compartment of the leg is affected in foot drop? A. Anterior compartment B. Posterior compartment C. Lateral compartment D. Dorsal compartmentClinical Scenario 18. What compartment of the leg is affected in foot drop? A. Anterior compartment - Foot drop is a clinical sign indicating paralysis of the muscles in the anterior compartment of the leg. It typically occurs as a consequence of damage to the common fibular (peroneal) nerve – from which the deep fibular nerve arises. The unopposed pull of the muscles in the posterior leg produce permanent plantar-flexion. This can interfere with walking - to circumvent this, the patient can flick the foot outwards while walking – known as an ‘eversion flick‘. B. Posterior compartment C. Lateral compartment D. Dorsal compartmentThe Ankle & Foot Bones and Joints 19. Which below are movements of the talocrural joint (ankle joint)? A. Plantarflexion/dorsiflexion B. Inversion/Eversion C. Abduction/Adduction D. Inversion/dorsiflexionBones and Joints 19. Which below are movements of the talocrural joint (ankle joint)? A. Plantarflexion/dorsiflexion B. Inversion/Eversion C. Abduction/Adduction D. Inversion/dorsiflexion The ankle joint is a (modified) hinge synovial joint. Inversion and eversion of the foot happen at different joints, namely the subtalar and transverse talar joints. Bones and Joints 20. Which feature does the arrow point to? A. Tarsals B. Metatarsals C. Proximal phalanges D. Middle phalangesBones and Joints The foot has 26 bones in total 20. Which feature does the arrow point to? A. Tarsals – (8) talus, calcaneus, navicular, medial cuneiform, intermediate cuneiform, lateral cuneiform, cuboid. ‘Tiger Cub Needs MILC’ which gives you your tarsals roughly from posterior to anterior. B. Metatarsals (5) C. Proximal phalanges (5) D. Middle phalanges – (4 due to the fact that the great toe (just like the thumb) has only proximal and distal phalanges) Muscles 21. What muscle is not involved in dorsiflexion of the foot? A. Extensor digitorum longus B. Tibialis anterior C. Posterior tibialis D. Extensor hallucis longus Muscles 21. What muscle is not involved in dorsiflexion of the foot? A. Extensor digitorum longus B. Tibialis anterior C. Posterior tibialis D. Extensor hallucis longus Dorsiflexion – produced by the muscles in the anterior compartment of the leg Muscles 22. What intrinsic muscle is in the dorsal aspect of the foot? A. Extensor digitorum brevis B. Abductor Hallucis C. Abductor hallucis brevis D. Flexor Digitorum Brevis Muscles 22. What intrinsic muscle is in the dorsal aspect of the foot? A. Extensor digitorum brevis B. Abductor Hallucis C. Abductor hallucis brevis D. Flexor Digitorum Brevis Blood supply 23. What artery doesn’t supply the ankle? A. Anterior tibial artery B. Posterior tibial artery C. Dorsalis pedis artery D. Fibular artery Blood supply 23. What artery doesn’t supply the ankle? A. Anterior tibial artery B. Posterior tibial artery C. Dorsalis pedis artery D. Fibular artery Supply is by the malleolar branches of the three arteries Nerve Innervation 24. What nerve innervates the dorsal aspect of the intrinsic muscles of the foot? A. Dorsalis pedis nerve B. Deep fibular nerve C. Medial plantar nerve D. Lateral plantar nerve Nerve Innervation 24. What nerve innervates the dorsal aspect of the intrinsic muscles of the foot? A. Dorsalis pedis nerve B. Deep fibular nerve C. Medial plantar nerve D. Lateral plantar nerve The dorsal aspect is mainly innervated by the deep fibular nerve. The plantar aspect is innervated either by the medial plantar nerve or the lateral plantar nerve,Clinical Scenario 25. Which ligament of the ankle joint is least likely to be injured in an ankle sprain? A. Deltoid ligament B. Anterior talofibular ligament C. Posterior talofibular ligament D. Calcaneofibular ligament Clinical Scenario 25. Which ligament of the ankle joint is least likely to be injured in an ankle sprain? A. Deltoid ligament B. Anterior talofibular ligament C. Posterior talofibular ligament D. Calcaneofibular ligament The ankle joint is stabilised by two sets of ligaments: lateral, and medial. The deltoid ligament (Anterior tibiotalar, Posterior tibiotalar, Tibiocalcaneal, Tibionavicular) is much stronger than the lateral ligaments. Hence, the lateral ligaments above are more likely to be injured. It’s also less likely to injure your deltoid ligament rather than your lateral ligaments due to the position of the lateral malleolus. The lateral malleolus restricts excessive eversion movements.That’s a wrap! ▶ Slides will be provided ▶ Anatomy just requires practice - break it down into chunks ▶ For actions of muscles: think about what joints the muscle crosses, and picture what would happen to the joint if you pulled on the muscle ▶ Acland’s online anatomy is really useful for videos of prosections: https://aclandanatomy.com/SignInShibboleth.aspx ▶ Websites like https://teachmeanatomy.info/ have tons of images and useful clinical info ▶ Gray’s Anatomy flashcards are usefulFeedback feedback form:minute now before you leave to fill in a quick https://app.medall.org/feedback/anonymous ?organisation=accessibility-in-medicine&keyw ord=469f32139105007c04d4d2c8&fbclid=IwAR 18k7PtFFb4LaAo5_2s_Ii6bwg_fLY4oZFiaVZVI_1 NGWT65mnVBWWHKkY AIM Facebook Page ▶ Give our Facebook page a like for updates and opportunities,just search @AIMEdinburgh Thank you for coming! ▶ If you have any more questions, feel free to email us at s1917205@ed.ac.uk, s1705439@ed.ac.uk, or email accessibilityinmedicine@gmail.com