ANATOMY DEPARTMENT
PRACTIAL EXAM
MUSCULOSKELETAL BLOCK
1
Q1
A 23-year-oldsoldier presents with
shrapnel wound in the lateral wall of his
chest. Few months later, his physical
therapist observed his scapula moves
away from the chest.
Which nerve is likely damaged?
…………………………………….
What is the root value of this nerve?
…………………………………….
Which muscle is probably affected?
……………………………………
Q1
A 23-year-oldsoldier presents with
shrapnel wound in the lateral wall of his
chest. Few months later, his physical
therapist observed his scapula moves
away from the chest.
Which nerve is likely damaged?
Long thoracic nerve or nerve to serratus
anterior or nerve of bell.
What is the root value of this nerve?
-C5,C6 and C7 (root of brachial plexus)
Which muscle is probably affected?
serratus anterior
Action: which called the boxer muscle
because it rotate scapula forward, and it
rotate scapula outward (when raising the
arm above 90 degree)
Origin: Upper eight ribs.
Insertion: Medial border of scapula
Q2
• A 17-years old student examined by
his family physician as he has sever
pain in the root of his left thumb, after
a basket ball game.
• The physician exacerbates his pain as
he applied pressure on the anatomical
snuff box as shown in the next photo.
• Which bones the physician suspect
injury?
…………………………………….
• …………………………………….
• Which artery runs in the floor of this
area?
…………………………………….
• there are two tendons in the snuff
box:
…………………………………….
Q2
• A 17-years old student examined by
his family physician as he has sever
pain in the root of his left thumb, after
a basket ball game.
• The physician exacerbates his pain
as he applied pressure on the
anatomical snuff box as shown in the
next photo.
• Which bones the physician suspect
injury?
• Styloid process of radius. (proximal)
• Scaphoid.(distal)
• Which artery runs in the floor of
this area?
• Radial artery.
• there are two tendons in the snuff
box:
• Medial: extensor pollicis longus,
Lateral: extensor pollicis brives,
abductor pollicis longus.
Q3
• On evaluation of the hand
function the physician holds 3
fingers in extended position and
asked the patient to flex the
proximal interphalangeal joint of
the middle finger.
• Which muscle is the doctor
testing?
• …………………………………….
• .
• Which nerve is supplying this
muscle?
» …………………………………….
Q3
• On evaluation of the hand
function the physician holds 3
fingers in extended position and
asked the patient to flex the
proximal interphalangeal joint of
the middle finger.
• Which muscle is the doctor
testing?
• Flexor digitorum superficialis.
• Which nerve is supplying this
muscle?
• Median nerve.( c5,6,7,8 ,T1 )
• All the Flexor muscle are supplied
by Median nerve , Except: Flexor
carpi ulnaris and medial 1 and 1/2
of flexor digitorum profundus
Q4
• A 33-year-old male had a fracture of
his left humerus at the level of the
spiral groove. 2 months later he
cannot extends his left wrist or the
left fingers.
• Which nerve is most likely
injured?
(5 marks).
» …………………………………….
• Describe the area of cutaneous
loss?
» …………………………………….
Q4
• A 33-year-old male had a fracture
of his left humerus at the level of
the spiral groove. 2 months later he
cannot extends his left wrist or the
left fingers.
• Which nerve is most likely
injured?
(5 marks).
• Radial nerve (posterior cord)
• Describe the area of cutaneous
loss?
• Lateral 2/3 of dorsal aspect of the
hand and lateral 3 and 1/2 fingers
up to the middle phalanges.
Q5
• A physician performs a tendon
reflex.
• Which tendon reflex he is
testing?
» …………………………….
• What is the nerve supply of the
tested muscle?
• ……………………………………..
• Which cord gives this nerve?
» …………………………………….
Q5
• A physician performs a
tendon reflex.
• Which tendon reflex he is
testing?
• Biceps reflex.
• What is the nerve supply of
the tested muscle?
• Musculocutaneous nerve.
• Which cord gives this nerve?
• Lateral cord. (C5, C6 and C7)
Q6
On evaluation of the hand
function, the physician asked the
patient to flex the terminal
phalanx of the right index finger.
Which muscle the physician is
testing?
…………………………………….
What is the nerve supply he is
testing?
…………………………………….
Q6
On evaluation of the hand
function, the physician asked the
patient to flex the terminal
phalanx of the right index finger.
Which muscle the physician is
testing?
Flexor digitorum profundus.
What is the nerve supply he is
testing?
Median nerve.
FDP inserted into the base of the distal
medial four fingers -> the medial one
and half finger is supplied by Ulnar
nerve , the rest by median nerve
Station “1”
• Identify each of the 2
following muscles and
its nerve supply:
1-……………………. 3
» Its nerve: ……………
2- Subscapularis.
Its nerve: ……………...
2- ………………………….
1
Its nerve: ……………….
Station “1”
• Identify each of the 2
following muscles and
its nerve supply:
1-latissimus dorsi. 3
Its nerve: Thoracodorsal
nerve or nerve to
latissimus dorsi.
2- Subscapularis. 1
Its nerve: upper and lower
subscapular nerves.
2- teres major.
Its nerve: lower
subscapular.
• On evaluation of the peripheral
circulation of diabetic patient, the
physician put his fingers as shown
in the next photo.
• Which artery he is trying to feel?
» …………………………………….
• Which tendons descends on
both sides of the artery in this
area?
» …………………………………….
…………………………………….
• On evaluation of the peripheral
circulation of diabetic patient, the
physician put his fingers as shown
in the next photo.
• Which artery he is trying to feel?
• Dorsalis pedis artery
• (main blood supply for the toes)
• Which tendons descends on
both sides of the artery in this
area?
• Extensor hallucis longus. (medial)
• Extensor digitorum longus.
(lateral)
• On evaluation of the foot function,
the physician asked the patient to
raise his heel from the ground as
shown in the next photo.
• Enumerate 2 muscles perform
this action?
» …………………………………….
» …………………………………….
» …………………………………….
» …………………………………….
» …………………………………….
• .
• What is the nerve supply of each?
» …………………………………….
• On evaluation of the foot function,
the physician asked the patient to
raise his heel from the ground as
shown in the next photo.
• Enumerate 2 muscles perform
this action?
• 1-Gastrocnemus .
• 2-Soleus.
• 3-Plantaris.
• 4-tibialis posterior.
• 5-flexor digiturm longus.
• What is the nerve supply of each?
• Tibial nerve.(for gastrocnemus and
Soleus)
Station “2”
1
• Identify each of the
following muscles
2
and its nerve
supply:
• 1-……….
• Its nerve:-……...
• 2-……………..
• Its nerve:-
………………
Station “2”
1
• Identify each of the
following muscles
and its nerve supply: 2
• 1-Deltoid.
• Its nerve:-Axillary. (it
also supplies teres
minor)
• 2-Pectoralis major.
• Its nerve:-Lateral
and medial pectoral
nerves.
• On evaluation of the knee
function, the physician asked
the patient to flex the knee
against resistance as shown
in the next photo.
• Which group of muscles
produces this function?
• …………………….
• What is the nerve supply of
this group?
• …………………………………
……………………
• On evaluation of the knee
function, the physician asked
the patient to flex the knee
against resistance as shown
in the next photo.
• Which group of muscles
produces this function?
• -Hamstring muscles.
• What is the nerve supply of
this group?
• Sciatic nerve (tibial branch)
• except the short head of
biceps: Common pernoeal
nerve
• Identify the muscle
attached to the marked
area “1”
• ……………………..
• What is its nerve supply?
• ……………………….. 1
• Where it is inserted?
• ………………………………
………
• Identify the muscle
attached to the marked
area “1”
• 1-Subscapularis
• What is its nerve supply?
• Upper and lower
subscapular nerves. 1
• Where it is inserted?
• Lesser tuberosity of
humerus.
• Action: Medial rotation.
• A 67 –year- old man recently
underwent a coronary bypass
operation, after he recovered
he experienced burning
sensation in the marked area in
the next photo.
• Which nerve supply this area?
• ……………………….
• From which nerve this nerve
originates?
• …………………………
• Which vein is used in the
bypass operation?
• ………………………
• A 67 –year- old man recently
underwent a coronary bypass
operation, after he recovered
he experienced burning
sensation in the marked area in
the next photo.
• Which nerve supply this
area?
• Saphenous nerve.
• From which nerve this nerve
originates?
• Femoral nerve.
• Which vein is used in the
bypass operation?
• Great saphenous vein ( long
saphenous vein)
Station “4” 1
• Identify the muscles
attached to the marked area
and what is its nerve supply:
• 1-……………...
• Its nerve:-………………….
• 2-…………………..
• Its nerve: ……………………..
2
Station “4” 1
• Identify the muscles
attached to the marked
area and what is its nerve
supply:
• 1-Biceps brachii.
• Its nerve:-Musculocutanous
nerve.
• 2—Pronator quadratus.
• Its nerve: anterior interosseus 2
nerve from Median nerve.
• A 75-year- old man recently has
coronary bypass. After recovery
he noticed numbness and
paraesthesia in the marked area
in the given photo.
• Which vein is used in the
bypass operation?
• …………………………..
• Which nerve supply the skin in
the marked area?
• …………………………….
• A 75-year- old man recently has
coronary bypass. After recovery
he noticed numbness and
paraesthesia in the marked area
in the given photo.
• Which vein is used in the
bypass operation?
• Small saphenous vein.
• Which nerve supply the skin in
the marked area?
• Sural nerve. (from the tibial nerve)
Station “5”
• Identify the muscles 1
attached to the marked
areas”1 & 2”And its 2
nerve supply
• 1- …………………..
Its nerve:- ………………
• 2-………………..
• Its nerve: ………………..
Station “5”
• Identify the muscles 1
attached to the marked
areas”1 & 2”And its 2
nerve supply
• 1- Flexor digitorum
profundus.
Its nerve:- Medial 2 fingers
Ulnar nerve.
Lateral 2 fingers median
nerve.
• 2-Flexor digitorum
superficialis.
Its nerve: Median nerve.
Station “6”
• 1-What is the nerve
supply of the green
area.
• ………………………
……………………
Station “6”
• 1-What is the nerve
supply of the green
area.
• 1-Radial nerve.
• Root value:
(c5,6,7,8,T1)
Station “7”
1- Identify the muscle attached to
red area.
…………………………………………
……………………………………..
2-Where it is inserted?
………………………………………
3- What is its nerve supply?
……………………………….
4- Its main action:
………………………………..
Station “7”
1- Identify the muscle attached to
red area.
1- Medial head of triceps.
Lateral head: above the spiral groove.
Long head: from infraglenoid tubercle.
Brachialis: corresponding to the media head from
the anterior aspect, it’s inserted in the coronoid
process of the ulna.
2-Where it is inserted?
2-Olecranon process.
3- What is its nerve supply?
Radial nerve.
4- Its main action:
Extension of the forearm or elbow.
Station “8”
• What is the nerve
in danger in case
of this fracture?
• ………………………
…………………..
Station “8”
• What is the nerve
in danger in case
of this fracture?
• Radial nerve (in the
spiral groove)
• Also the profundal artery
Common fractures of the
humerus :
• Surgical neck: axillary nerve.
• Medial epicondyle: ulnar nerve.
• Spiral groove: radial nerve.
• Distal end (supracondyler fracture) :
median nerve.
Station “9”
• 1- Identify the structure “A”
• …………………………..
• 2-Enumerate 2 nerves passing
superficial & 2 tendon deep to it.
• ……………………………………………
……………………………………………
……………………………………………
……………………………………………. A
Station “9”
• 1- Identify the structure “A”
• Flexor retinaculum
• 2-Enumerate 2 nerves passing
superficial & 2 tendon deep to it.
• Superficial:
1-Ulnar nerve.(also the ulnar artery)
2-Palmar cutaneous branch of ulnar and
median nerves. A
(also the tendon of palmaris longus)
• Deep:
1-Flexor digitorum superficialis and profundus.
2-Flexor pollicis longus. Flexor carpi ulnaris : is
(also median nerve) not superficial
to flexor retinaculum.
• Identify the marked areas.
• Identify one structure
attached to each area.
1- 2
……………………………………………
……………………………………………
2-
……………………………………………
…………………………………………..
3-
…………………………………………… 1
……………………………………………
3
• Identify the marked areas.
• Identify one structure
attached to each area.
1- Shaft of femur: 2
Muscle attached: vastus intermedius
Nerve supply : femoral nerve
2-Greater trochanter :
Muscles attached:
Anterior surface: gluteus minimus.
Lateral surface: gluteus medius. 1
Both supplied by: superior gluteal nerve.
Medial surface: Obturator internus.
Supplied by: nerve to obturator internus.
3-upper part of medial surface of Tibia :
(SGS )
Surtorries: femoral nerve
Gracillis: obturator nerve
Semitendinosus: tibial portion of sciatic
nerve.
3
Station “11”
Identify these nerves:
1. ………………………… 1
2. …………………………
3. ……………………….. 2
3
What is the nerve supply to
the lateral side of the foot:
……………………
Station “11”
Identify these nerves:
1-Common peroneal nerve. 1
2- Musculocutaenous, or
superficial peroneal. (lateral) 2
3- Deep peroneal or anterior
3
tibial. (medial)
What is the nerve supply to
the lateral side of the foot:
Sural nerve.
Station “12”
1
Identify these structures: 2
1. ………………..
2. ……………….
3. ………………… 3
What is the nerve supply
for 1 &2.
……………………………
…………………………..
Station “12”
1
Identify these 2
structures:
1-Glutes maximus.
2-Tensor fascia lata. 3
3-Iliotibial tract.
What is the nerve supply
for 1 &2.
1. Inferior gluteal nerve.
2.Superior gluteal nerve.
Station “13” Medius
• Identify the marked
muscles and the 2
nerve supply of each:
1
• 1-…………………….
• Nerve:-………….
3
• 2-…………………..
• Nerve:-
…………………
• 3- ……………………..
• Nerve:- ……………….
Station “13” Medius
• Identify the marked
muscles and the 2
nerve supply of each:
1
• 1-Piriformis muscle.
• Nerve:-S1 &2.
3
• 2-Gluteus minims.
• Nerve:-sup. Gluteal n.
• 3- Quadratus femoris.
• Nerve:- Nerve to
quadratus femoris.
Identify:
a) …………
b) …………
c) …………
d) …………
e) …………
f) …………
g) …………
h) …………
i) …………
j) …………
Identify:
A: Sacrum
B: Head of femur
C: Lesser trochanter
D: Obturator foramen
E: Pubic symphysis
F: Ischial tuberosity
G: Greater trochanter
H: Acetabulum
I: Anterior superior iliac
spine
J: Iliac crest
Lateral elbow joint x-ray
Identify:
4
1. …………
2. …………
1
3. ………… 3
6
4. …………
5. …………
6. …………
5
2
Lateral elbow joint x-ray
Identify: 4
1) Coronoid
process.
1
2) Ulna.
6 3
3) Radial (bicipital)
tuberosity.
4) Humerus.
5) Olecranon
6) Radial head.
5
2
Frontal knee x-ray
1
Identify:
1) ………… 2
2) …………
3) …………
4) …………
8 3
5) …………
7 4
6) …………
7) …………
8) ………….
6 5
Frontal knee x-ray
1
Identify:
1) Femur. 2
2) Interchondylar notch.
3) Medial condyle
4) Medial tibial spine
( medial tibial eminence) 8 3
5) Tibia 7 4
6) Fibula
7) Lateral tibial spine
( lateral tibial eminence )
8) Lateral condyle.
6 5
Identify:
A. …………
B. …………
C. …………
D. …………
E. …………
F. …………
Identify:
A: Superficial peroneal
nerve
B: Lateral malleolus
C: Lesser saphenous vein
D: Dorsal venous arch
E: Great saphenous vein
F: Medial malleolus
A
B
Identify:
A. …………
B. …………
C. …………
D. …………
E. ………… C
E
A
B
Identify:
A: Plantaris
B: Gastrocnemius
C: Soleus
D: Achilles tendon
E: Calcaneum C
E
Identify:
A.…………
B.…………
C.…………
D.…………
E.…………
F. …………
G.…………
H.…………
Identify:
A: Pectineus
B: Psoas major
C: Sartorius
D: Rectus femoris
E: Vastus lateralis
F: Vastus Medialis
G: Femoral vessels
H: Adductor longus
E
Identify:
A. …………
B. …………
C. …………
D. …………
E. …………
E
Identify:
A: Ulnar artery
B: Radial artery
C: Superficial palmer
arch
D: Ulnar nerve
E: Median nerve
Identify:
A. …………
B. …………
C. …………
D. …………
E. …………
F. …………
G. …………
H. …………
Identify:
A: Median nerve
B: Thenar muscles
C: Flexor retinaculum
D: Fibrous flexor sheath
E: Ulnar artery
F: Hypothenar eminence
G: Flexor synovial sheath
H: Tendon of flexor
digitorum profundus
The structure of superficial Flexor
retinaculum from Medial to Lateral
1. …………
2. …………
3. …………
4. …………
5. …………
6. …………
The structure of superficial Flexor
retinaculum from Medial to Lateral
1- Tendon of Flexor carpi ulnaris.
2- Ulnar nerve.
3- Ulnar artery.
4- Palmar cutaneous branch of ulnar nerve.
5- Palmaris longus tendon.
6- Palmar cutaneous branch of median nerve.
Structure of Extensor retinaculum
From medial to lateral:
1. …………
2. …………
3. ……….
4. …………
5. …………
6. …………
To memorize:
Tom Has Very Nice Dog and Pigeon
Structure of Extensor retinaculum
From medial to lateral:
1. Tibialis posterior
2. extensor hallucis longus
3. dorsalis pedis artery (vessels)
4. deep peroneal nerve
5. extensor digitorum longus
6. peroneos tertius
To memorize:
Tom Has Very Nice Dog and Pigeon
Thanks for checking our work,
Done by:
• GHAIDA ALJAMILI
• MONIRAH ALSALOULI
• NOUF ALRSHEED
• RIFAN HASHIM
Thanks for team 434
