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NMS Anatomy Exam 1

Terms

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Attachments to ischial tuberosity
hamstrings
Attachments to tibial tuberosity
patella tendon
Attachments to greater trochanter
external/lateral hip rotators and abductors of the thigh
Attachments to lesser tuberosity
iliopsoas
Attachments to base of 5th metatarsal
for fibularis brevis
Trapezius
elevate, depress, retract scapula

- spinal accesssory (C3, C4)

Latissimus dorsi
extend, adduct, medially rotate arm

- thoracodorsal (C6, C7, C8)

Levator scapulae
elevation of scapula

- dorsal scapular (C5)

Rhomboids
retraction of scapula

- dorsal scapular (C5)

Erector spinae muscles
unilateral: ipsilateral sidebend

bilateral: extension

- posterior rami of spinal nn



semispinalis capitis and cervicis
unilateral: contralateral rotation

bilateral: extension

- posterior rami of spinal nn



multifides
local stabilization of vertebrae

- posterior rami of spinal nn

Rotators
proprioceptive

- posterior rami of spinal nn

splenius capitis and cervicis
unilateral: laterally flex, ipsilateral rotation

bilateral: extension/look-up

- posterior primary rami of spinal nn



Obturator internus
lateral rotation of thigh, abduction of thigh when hip flexed

- nerve to obturator internus (L5, S1)

Gemelli twins
lateral rotation of femur

superior: obturator nerve
inferior: quadratus femoris


Quadtratus femoris
lateral rotation of femor

- nerve to quadratus femoris (L5, S1)

Vastus lateralis, medialis, and intermedius
Extension of knee

- femoral n (L2, L3, L4)

Sartorius
hip flexion, lateral rotation, abduction

- femoral n (L2, L3)

Tensor fascia lata
abduct and flex hip

- superior gluteal n (L4, L5)

Psoas major
hip flexion, lateral rotation

- ventral rami (L1-L3)

Pectineus
adduction, flexion of hip

- femoral n (L2, L3, L4).. (obturator?)

Obturator externus
adduction, lateral rotation of femur

- obturator (L3, L4)

Adductor longus
adduction, flexion, & lateral rotation of thigh

- obturator n (L2, L3, L4)

Adductor brevis
adduction, lateral rotation of thigh

- obturator n (L2, L3, L4)

Gracilis
adduction, flexion of knee

- obturator (L2, L3)

Tibialis anterior
dorisflex, toe extend, inversion

- deep fibular n (L4-S1)

Extensor digitorum longus
dorisflex, extend lateral 4 toes, eversion

- deep fibular nerve (L5-S1)

Extensor hallucis longus
dorsiflex, extend great toe, inversion

- deep fibular nerve (L5-S1)

Peroneus longus and brevis
eversion and plantar flexion

- superficial fibular n (L5-S1)

Soleus
plantarflex foot

- tibial n (S1, S2)

Flexor digitorum longus
plantarflex & invert foot, flex lateral 4 toes

- tibial nerve (S2, S3)

Flexor hallucis longus
plantarflex & invert foot, flex great toe

- tibial n (S2, S3)

Tibialis posterior
plantarflex and invert foot

- tibial n (L4, L5)

Abductor hallucis
abduct and flex great toe

- medial plantar n (S2, S3)

Myotome
group of tissue that develop from somites which will differentiate into muscle groups

..these groups are served by a single nerve that can be mapped

Myotome: abdominal wall muscles
C6-T12
Myotome: hip extension
(L5) S1
Myotome: hip flexion
L2, L3, (L4)
Myotome: hip abduction
L5, (S1)
Myotome: hip adduction
L2, L3, L4
Myotome: knee extension
(L2) L3, L4
Myotome: knee flexion
(L5, S1)
Myotome: ankle dorsiflexion
(L4), L5
Myotome: ankle plantarflexion
(L5), S1
Myotome: foot inversion
(L4), L5, (S1)
Myotome: foot eversion
L5, (S1)
Myotome: intrinsic foot motions
S1, (L2)
Femoral nerve injury (L2, L3, L4)
Sensory: loss on medial thigh & leg
- loss to MEDIAL FOOT

Motor:
- extension at knee lost (difficulty walking up and down stairs)



Obturator nerve injury (L2, L3, L4)
Sensory: loss on medial thigh

- ADduction of thigh impaired
.. limb swings laterally during swing phase


Superior gluteal injury ..L5, (S1)
Sensory: no loss, except in joints

Motor:
- ABduction of thigh impaired
- (+) Trendelenberg sign, or waddling gait



Inferior gluteal injury (L5) S1
Sensory: none

Motor: extension of thigh and trunk impaired
- Lurching gait = inability to arise from a seated position (put pateitn on stomach and flex knee, then lift thigh up off table)


Sciatic nerve injury (L4, L5, S1)
Sensory: loss inferior to knee

Motor: extension of thigh impaired and flexion of leg impaired

- ALL foot and ankle movements lost!



Tibial nerve injury L5, S1
popliteal fossa:
- sensation in sole of foot & toes lost
- plantarflexion of foot lost
- inversion weak
(come up on toes 10x)

distal leg:
- sensation in sole of foot lost
- intrinsic plantar foot muscles lost









Common fibular nerve injury (L4-S1)
Sensory: lost on dorsum of foot

Motor:
- dorsiflexion (foot drop)
- eversion of foot and tendency fo lateral ankle sprains
...turn foot out and up!!




Deep peroneal nerve (L4, L5, S1)
*extend toe*

sensory: dorsal between 1st and 2nd toes lost

motor: inversion imparied and heel turns laterally (valgus) in walking



Superficial peroneal nerve (L5, S1)
sensory: dorsum of foot lost.. EXCEPT between 1st and 2nd toes

motor:
- eversion of foot lost (no foot drop), heel turned medially in walking


Neurologic level L4 testing
Muscle: knee extension

Sensation: medial side of FOOT

Neurologic level L5 testing
Muscle: ABduction of hip

Sensation: dorsum and sole of foot

Neurologic level S1 testing
Muscle: calf muscles (tibial) nerve.. *up on toes*

Reflex: achille's tendon

Sensation: lateral malleolus and lateral side and plantar surface of foot!



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