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Hip flexors, insertion? • Iliacus • Psoas major • Rectus femoris All muscle inserted in lesser trochanter of femur [image: 1774946544312-f2149d04-f967-47f2-b5b6-76313eaa3d3d-image.jpeg] Nerve passing medial to Lesser trochanter? Lateral cutaneous nerve of thigh (lateral femoral cutaneous nerve) (L2, 3) Condition caused by its compression Meralgia paresthetica Muscles attached to ASIS? Sartorius (origin) Tensor fasciae latae (origin) Identify pubic tubercle. Number 24 Origin and insertion of gluteus medius Origin Ilium between posterior and anterior Insertion Greater trochanter of femur gluteal lines What is its function during walking? Support the body when walking Prevent the pelvis from drooping to the opposite side What are the main flexors of the hip? Iliacus Psoas major (main one) Rectus Femoris Where is it inserted? Lesser trochanter of femur What is the origin and Insertion of quadratus femoris? Origin Ischial tuberosity Insertion Intertrochanteric crest of femur

Blood supply of pancreas?ArterialVenous<ul><li>Superior pancreaticoduodenal artery (from gastroduodenal artery) supply head</li><li>Inferior pancreaticoduodenal artery (from SMA) supply head & uncinate process</li><li>Pancreatic branches (from splenic artery) supply tail & body</li></ul><ul><li>Superior pancreaticoduodenal vein</li><li>Inferior pancreaticoduodenal vein</li><li>Veins drain to splenic vein</li></ul> Course of splenic arteryArise from celiac, pass above pancreas, behind stomach (separated from it by lesser sac), lienorenal ligament then ends by terminal branch in splenic hilum. Describe ductal drainage system of pancreas?Main pancreatic duct (of Wirsung):drains head, body and tail $\rightarrow$ opens into major duodenal papilla.Accessory pancreatic duct (of Santorini):drains the uncinate process $\rightarrow$ opens into minor duodenal papilla. Vessel presents behind body of pancreas?Splenic vein Space between stomach and pancreas?Lesser sac Vessel present behind neck?Portal vein Peritoneal relations of the duodenum?The first part of the duodenum lies within the peritoneum, but its other parts are retroperitoneal. Vessels present in front and behind the third part of duodenum?In frontSuperior mesenteric artery & veinBehindIVCAortaRight gonadal vein Hepatic artery runs in which part of peritoneum?Lesser omentum

Rotators of the scapula, origin, insertion & nerve supply? Upward rotators -Trapezius -Serratus anterior Downward rotators -Rhomboids minor -Rhomboids major Levator scapulae Muscle Origin Insertion Action Innervation Trapezius SP C7-T12 Clavicle, scapula (acromion, SP) Rotating scapula Cranial nerve XI Serratus anterior Ribs 1-9 Scapula (ventral medial) Preventing winging Long thoracic nerve Latissimus dorsi SP T6-S5, ilium Humerus (ITG) Extending, adducting, internally rotating humerus Thoracodorsal nerve Rhomboid minor SP C7-T1 Scapula (medial spine) Adducting scapula Dorsal scapular nerve Rhomboid major SP T2-T5 Scapula (medial border) Adducting scapula Dorsal scapular nerve Levator scapulae Transverse process C1-C4 Scapula (superior medial) Elevating, rotating scapula C3, C4 nerves Brachioradialis muscle demonstrate on yourself action & NS: Action: Flex forearm Nerve Supply (NS): Radial nerve Show C5 reflex Biceps reflex Name three muscles supplied by musculocutaneous nerve. Nerve root. Muscles: BBC Biceps brachii Brachialis Coracobrachialis Nerve root: C5, C6, C7 External rotators of arm Supraspinatus Infraspinatus Teres minor Axillary nerve cutaneous Skin to the lower half of deltoid Axillary nerve muscle supply Deltoid Teres minor Shoulder abductor muscles? Supraspinatus (0−15 ) Deltoid (middle fibres) (15−90 ) Trapezius and serratus anterior (over 90 ): which will require upward rotation of the scapula with lateral rotation of the humerus.

Structures behind medial malleolus? Mnemonic: Tom Does Very Nice Hats Tibialis posterior tendon Flexor Digitorum longus posterior tibial Vessels posterior tibial Nerve Hallucis longus (Flexor) Identify structure number 12 on the XR:Sustentaculum tali [image: 1774873069532-c5fb34b2-5f30-497e-a458-327738cfc48b-image.jpeg] What is the component of ankle joint? Tibia Fibula Talus What is the type of this joint?Synovial hinge joint [image: 1774872996205-e65126fc-f271-4426-94f8-c444d7a0cc53-image.jpeg] Movements of this joint? Plantarflexion Dorsiflexion At which movement is it more stable? Why? Ankle joint is most stable in dorsiflexion, because the talus is wider anteriorly and narrower posteriorly. (Note: In dorsiflexion, the wider anterior part of the talar trochlea wedges tightly into the mortise formed by the tibia and fibula.) Components of subtalar joint? Talus and calcaneus What are the movements at the joint? Inversion and eversion of foot Identify the Deltoid ligament, calcaneofibular ligament, posterior talofibular ligament: SpoilerDeltoid ligament (6) Calcaneofibular ligament (3) Posterior talofibular ligament (19) Demonstrate pulses of the foot?The dorsalis pedis pulse is found between the first two metatarsal bones. The posterior tibial pulse is found 2cm-3cm below and behind the medial malleolus. What does the midtarsal joint do?The midtarsal joint, consisting of the talonavicular and the calcaneocuboid joints, is presumed to be responsible for the foot being both flexible and rigid during different parts of the stance phase of gait.

Vagus Nerve Course in Thorax & Abdomen Thorax:Left Vagus NerveRight Vagus NerveCrosses in front of the left subclavian artery. Enters the thorax between the left common carotid and subclavian arteries.Crosses in front of the first part of the subclavian artery.Descends on the left side of the aortic arch. Travels behind the phrenic nerve.Travels behind the innominate vessels. Reaches the thorax on the right side of the trachea.Courses behind the root of the left lung. Deviates medially and downwards to reach the esophagus and form the esophageal plexus with the right vagus nerve.Inclines behind the hilum of the right lung. Courses medially towards the esophagus to form the esophageal plexus with the left vagus nerve. Abdomen:The esophageal plexus, formed by the union of the right and left vagus nerves. The vagus nerve enters the abdomen through the esophageal hiatus at the level of the tenth thoracic vertebra (T10). It divides into the anterior and posterior vagal trunks, which innervate the stomach, small intestine, liver, gallbladder, pancreas, and spleen. Nerves in esophageal hiatus?Ant & post vagal trunks. What do they supply?Stomach, duodenum, jejunum, ileum, cecum, ascending colon, medial 2/3 of transverse colon, spleen, pancreas, gall bladder. Muscle dissected to see thyroid?Sternohyoid muscle

Vagus nerve course in thorax & abdomen? Thorax: Left vagus nerve SpoilerCrosses in front of the left subclavian artery. Enters the thorax between the left common carotid and subclavian arteries. Descends on the left side of the aortic arch. Travels behind the phrenic nerve. Courses behind the root of the left lung. Deviates medially and downwards to reach the esophagus and form the esophageal plexus with the right vagus nerve. Right vagus nerve SpoilerCrosses in front of the first part of the subclavian artery. Travels behind the innominate vessels. Reaches the thorax on the right side of the trachea. Inclines behind the hilum of the right lung. Courses medially towards the esophagus to form the esophageal plexus with the left vagus nerve. Abdomen: SpoilerThe oesophageal plexus, formed by the union of the right and left vagus nerves, The vagus nerve enters the abdomen through the oesophageal hiatus at the level of the tenth thoracic vertebra (T10). It divides into the anterior and posterior vagal trunks, which innervate the stomach, small intestine, liver, gallbladder, pancreas, and spleen. Nerves in oesophageal hiatus? SpoilerAnt & post vagal trunks. What do they supply? SpoilerStomach, duodenum, jejunum, ileum, cecum, ascending colon, medial 2/3 of transverse colon, spleen, pancreas, gall bladder Muscle dissected to see thyroid? SpoilerSternohyoid muscle

Rotators of the scapula, origin, insertion & nerve supply? Upward rotators: SpoilerTrapezius Serratus anterior Downward rotators: SpoilerRhomboids minor Rhomboids major Levator scapulae Muscle Origin Insertion Action Innervation SpoilerTrapezius SP C7-T12 Clavicle, scapula (acromion, SP) -Rotating scapula Cranial nerve XI Serratus anterior Ribs 1-9Scapula (ventral medial) - Preventing winging Long thoracic nerve Latissimus dorsi SP T6-S5, iliumHumerus (ITG)-Extending, adducting, internally rotating humerus Thoracodorsal nerve Rhomboid minor SP C7-T1 Scapula (medial spine) - Adducting scapula Dorsal scapular nerve Rhomboid major SP T2-T5 Scapula (medial border)- Adducting scapula Dorsal scapular nerve Levator scapulae Transverse process C1-C4 Scapula (superior medial) - Elevating, rotating scapula C3, C4 nerves Brachioradialis muscle demonstrate on yourself action SpoilerFlex forearm Nerve Supply (NS): !Radial nerve Show C5 reflex SpoilerBiceps reflex Name three muscles supplied by musculocutaneous nerve. Nerve root. Muscles (BBC): SpoilerBiceps brachii Brachialis Coracobrachialis Nerve root: SpoilerC5, C6, C7 External rotators of arm SpoilerSupraspinatus Infraspinatus Teres minor Axillary nerve cutaneous SpoilerSkin to the lower half of deltoid Axillary nerve muscle supply SpoilerDeltoid Teres minor Shoulder abductor muscles? SpoilerSupraspinatus (0-15) Deltoid (middle fibres) (15-90) Trapezius and serratus anterior (over 90): which will require upward rotation of the scapula with lateral rotation of the humerus.

What is the most common part of the duct that is involved in a stone? SpoilerMiddle 1/3 Why is this site most affected? SpoilerDue to looping of lingual nerve around duct, and thick mucus secretion and have to pour secretion in floor of mouth against gravity What are digastric triangle boundaries and their nerve supply? SpoilerSuperior: Inferior border of the mandible Anterior: Anterior belly of the di gastric muscle Posterior: Posterior belly of the digastric muscle Nerve supply SpoilerThe anterior belly of the digastric muscle is innervated by the mylohyoid nerve, which is a branch of the mandibular nerve The posterior belly of the digastric muscle is innervated by the digastric branch of the facial nerve. Names & actions of extrinsic muscles of the tongue SpoilerGenioglossus: protrusion of the tongue & depression of the tongue tip Hyoglossus: retraction of the tongue & depression of the lateral margins of the tongue Styloglossus: retraction of the tongue & elevation of the sides of the tongue Palatoglossus: Elevation of the posterior part of the tongue If you have injury of Hypoglossal, lingual or marginal mandibular what will the patient have? Marginal mandibular SpoilerDrippling of saliva from corner of affected side Poor speech articulation (slurred speech) Asymmetry on smiling or crying Hypoglossal SpoilerParalysis and atrophy in ipsilateral side Deviation to ipsilateral side on protrusion Poor speech articulation Lingual SpoilerLoss of general sensation from ant 2/3 of tongue and floor of mouth Loss of taste sensation from tongue only Boundaries of Posterior Triangle SpoilerBoundary Description Apex Sternocleidomastoid and the Trapezius muscles at the Occipital bone Anterior Posterior border of the Sternocleidomastoid Posterior Anterior border of the Trapezius Base Middle third of the clavicle [image: 1773944974415-596e7a43-c73e-42b3-bc28-fcbd5be83066-image.jpeg] Origin & Insertion of Omohyoid SpoilerOrigin - Insertion Inferior belly superior border of scapula near suprascapular notch - intermediate tendon Superior belly intermediate tendon - body of hyoid bone Study Notes Hypoglossal nerve SpoilerBecause the genioglossus muscle on the healthy side "pushes" the tongue, it will deviate toward the side of the injury when the patient sticks it out. Why lingual nerve injury causes loss of taste, even though it primarily carries general sensation? SpoilerWhile the Lingual nerve is a branch of the Mandibular nerve and carries general sensation (touch, pain, temperature), it also acts as a "highway" for taste fibers.The Chorda Tympani Connection. The reason a lingual nerve injury (specifically if it occurs after the two nerves join) causes loss of taste is due to the Chorda Tympani, a branch of the Facial nerve (CN VII). The Join: High up in the infratemporal fossa, the Chorda Tympani "hitches a ride" with the Lingual nerve. The Shared Path: From that point forward, they travel together as one physical cord. Omohyoid, remember that its two bellies are held together by an intermediate tendon. This tendon is actually tethered to the clavicle by a deep layer of fascia. This is why when the muscle contracts, it doesn't just pull the hyoid down; it also helps maintain the patency of the internal jugular vein!

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