Upper Extremity
What part of the brachial plexus passes between the anterior and middle scalene muscles and what are the levels?
The roots (ventral rami) C5–T1
This bone articulates with the femur to form the knee joint and with the talus to form the ankle joint. What bone is it?
Tibia
This vertebra lacks a spinous process.
C1 (atlas)
The ligament that resists hyperflexion and disc herniation posteriorly is this structure.
Posterior longitudinal ligament
Which autonomic division slows GI motility and reduces secretion?
Sympathetic nervous system
"Fight or flight" GI inhibition
Which vessel drains the majority of venous blood from the brain?
Internal jugular vein
What is the origin and insertion of the only muscle in the rotator cuff that produces internal rotation at the shoulder?
Origin: Subscapular fossa (anterior surface of the scapula)
Insertion: Lesser tuberosity on the proximal humerus
Which artery is commonly palpated posterior to the medial malleolus?
Posterior tibial artery
This bone forms the posterior-inferior portion of the skull. What bone is it?
Occipital bone
This spinal region normally has a primary kyphotic curve. Which region is it?
Thoracic
Which nerve injury would most directly impair the voluntary component of defecation?
Pudendal nerve
What structure connects the right and left anterior cerebral arteries?
Anterior communicating artery
This space transmits the axillary nerve and posterior circumflex humeral artery.
Quadrangular Space
This ligament prevents excessive eversion of the ankle.
Deltoid ligament
Weakness in tongue protrusion with deviation toward the injured side indicates dysfunction of this nerve.
Cranial nerve XII (Hypoglossal nerve)
Which pelvic landmark serves as the attachment for the hamstrings? Name them from medial to lateral.
Ischial tuberosity
Lateral: Biceps femoris
Intermediate: ST
Medial: SM
Name three structures in the RUQ.
Liver
Gallbladder
Duodenum
Head of the pancreas
Right kidney/adrenal
Hepatic flexure of the colon
Proximal ascending colon
Proximal transverse colon
What are the two arteries that arise from the basilar arteries?
1. Posterior cerebral
2. Superior cerebellar
The anatomical snuffbox floor is formed by these two carpal bones.
Scaphoid and trapezium
This joint allows inversion and eversion of the foot. What joint is it?
Subtalar joint
Inability to elevate the scapula and rotate the head away from the affected side suggests injury to this nerve.
CN XI (Spinal accessory nerve)
Which structure forms the true anatomical joint of the sacroiliac articulation?
Auricular surfaces of the ilium and sacrum
Left shoulder pain following splenic rupture is explained by irritation of this nerve.
Phrenic nerve
Compression at the transverse foramen of C6 most threatens this artery.
Vertebral artery
Pronation and supination of the forearm occur through rotation of the radial head within a fibro-osseous ring formed by a ligament and an adjacent ulna landmark. Which joint permits this motion and what ligament keeps the bone in place?
Proximal radioulnar joint
Annular ligament
A patient presents with difficulty clearing the foot during swing phase and demonstrates foot slap during initial contact. What muscle is mostly likely involved? Which nerve is most likely involved?
Tibialis anterior
Deep fibular (peroneal) nerve
Weak jaw opening against resistance most directly implicates this muscle.
Lateral pterygoid
A patient presents with numbness over the lateral thigh with no motor deficits. Which nerve is most likely involved?
Lateral femoral cutaneous nerve
Ascites represents abnormal fluid accumulation in this anatomical space.
Peritoneal cavity
The diencephalon forms the central core of the forebrain and surrounds the third ventricle.
Name the major anatomical components of the diencephalon (3).
Then, identify the structure that lies immediately inferior to the diencephalon and list its major subdivisions from superior to inferior.
1. Thalamus
2. Hypothalamus
3. Epithalamus
Brainstem sits immediately inferior to the diencephalon. From superior to inferior:
1. Midbrain
2. Pons
3. Medulla oblongata
A patient presents after a posterior shoulder dislocation with:
Inability to extend the elbow, Wrist drop, Sensory loss over the posterior arm and dorsum of the hand, Preserved elbow flexion and intrinsic hand strength.
Questions:
1. Which level of the brachial plexus is most likely injured?
2. Which terminal nerve is primarily involved?
3. Name two muscles whose dysfunction explains this pattern.
Plexus Level Injured: Posterior cord
Primary Terminal Nerve: Radial nerve
Two Muscles Explaining the Deficit:
Triceps brachii
Extensor digitorum
Anconeus
Brachioradialis
ECRL
ECRB
Supinator
A patient presents with medial knee pain just inferior to the joint line and reports sharp tenderness with resisted knee flexion and tibial internal rotation. Palpation reveals a broad, flattened tendinous structure on the anteromedial proximal tibia.
Which anatomical structure is involved?
Name the three muscles that form it, give the shared insertion, and describe their primary combined actions.
1. Sartorius
2. Gracilis
3. Semitendinosus
Shared insertion: Anteromedial surface of the proximal tibia, just inferior to the medial tibial condyle
Shared action: Knee flexion and tibial IR
A patient demonstrates difficulty maintaining cervical stability during deep chin-tuck testing with visible substitution by the SCM. Weakness of the deep neck flexor group is likely affected. Where are they located and name all 4.
1. Longus colli
2. Longus capitis
3. Rectus capitis anterior
4. Rectus capitis lateralis
During strength testing, a patient demonstrates:
Strong knee extension
Strong plantarflexion
Marked weakness of great toe extension
Sensation over the dorsum of the foot is slightly diminished
Which nerve root is affected, and which single muscle test is the most specific for confirming your diagnosis?
L5 nerve root
Specific muscle test: Extensor hallucis longus (EHL) - testing great toe extension
A 32-year-old strength athlete is performing a heavy single-arm farmer’s carry in the RIGHT hand. The pelvis remains relatively level while the trunk subtly rotates to maintain forward progression. Video analysis shows the athlete trying to resist collapsing into right rotation as the load oscillates.
Which specific oblique muscle pairing is acting as the primary force-couple to control this asymmetrical load, and what is the dominant trunk motion they are controlling?
A. Right external oblique + right internal oblique - resisting trunk flexion
B. Right external oblique + left internal oblique - resisting right trunk rotation
C. Left external oblique + left internal oblique - resisting left lateral flexion
D. Left external oblique + right internal oblique - resisting trunk extension
Answer: B Right external oblique + left internal oblique - resisting right trunk rotation
During a right-hand loaded farmer’s carry, the external torque imposed on the trunk includes:
A right trunk rotation moment due to unilateral load and gait-based perturbations
To resist right trunk rotation, the body must generate a LEFT rotation torque. This would be achieved by contraction of the R external oblique and L internal oblique muscles.
A patient presents with a complex brainstem lesion affecting multiple adjacent cranial nerves. Before localizing the lesion, you are asked to demonstrate full mastery of cranial nerve functional classification.
Task:
List ALL TWELVE cranial nerves (I–XII) in order and correctly classify each as:
Sensory
Motor
Both
Pure sensory nerves:
CN I - Olfactory
CN II - Optic
CN VIII - Vestibulocochlear
Pure motor nerves:
CN III - Oculomotor
CN IV - Trochlear
CN VI - Abducens
CN XI - Spinal Accessory
CN XII - Hypoglossal
Mixed (sensory and motor nerves)
CN V - Trigeminal
CN VII – Facial
CN IX – Glossopharyngeal
CN X – Vagus
You palpate the lowest point of the scapula and follow it medially to the spinous process it aligns with in neutral posture. What two landmarks are you identifying?
Inferior angle of the scapula
T7
While palpating the medial ankle, you identify a prominent bony process and then slide posteriorly into the tarsal tunnel. Deep to the flexor tendons, you feel a horizontal, shelf-like bony projection that supports the head of the talus.
What are the bony process you first palpated, the long bone it belongs to, and the shelf-like projection beneath it?
Medial malleolus
Distal end of the tibia
Sustentaculum tali
While palpating just inferior and anterior to the external auditory canal, you feel a large, rounded bony prominence at the base of the skull. You then trace inferiorly along a narrow bony projection until you reach the first palpable cervical process.
What is the bony prominence you first palpated and the vertebra whose bony prominence you identified?
Mastoid process
Transverse process of C1 (Atlas)
With the patient standing, you place your hands on the pelvis so that your palms rest on the iliac crests and your thumbs fall back onto the dimples in the low back. From the level of the iliac crests, you trace medially until your fingers land on a midline spinous process that serves as a key lumbar landmark.
What is the first pelvic landmarks you identified, and which specific vertebral level corresponds to the spinous process at the level of the iliac crests?
Posterior superior iliac spines (PSIS)
L4 spinous process
With your fingers just inferior to the suprasternal (jugular) notch, you palpate the broad upper portion of the sternum. You then trace laterally and slightly inferiorly to the first bony prominence in the area as it curves toward the axilla beneath the clavicle.
What are the sternal structure you began on and the specific rib you traced to laterally?
Manubrium
First rib
While palpating just lateral to the trachea at the level of the upper cervical spine, you feel a strong arterial pulse deep to the sternocleidomastoid. You then trace superiorly toward the bony landmark where this artery bifurcates.
What artery are you palpating and what vertebral level landmark marks its bifurcation?
Common carotid artery
C4 vertebrae
With the patient’s forearm pronated and resting on a table, you resist wrist flexion combined with radial deviation while palpating just proximal to the wrist on the anterior-radial side of the forearm. The tendon becomes prominent and can be traced proximally toward its origin.
Which muscle are you palpating? Give its origin, insertion, action, and innervation.
Muscle: Flexor Carpi Radialis
Origin: Medial epicondyle of the humerus (common flexor tendon)
Insertion: Base of the 2nd metacarpal (often also slips to the 3rd)
Action: Wrist flexion and radial deviation
Innervation: Median nerve (C6–C7)
With the patient prone and the knee flexed to 90°, you resist knee flexion while palpating the posterior thigh near the lateral aspect of the popliteal region and along the tendon approaching the fibular head. You adjust limb position to selectively increase tension in the lateral hamstring compared to the medial hamstrings.
Which muscle are you palpating? Provide its origin, insertion, action, and innervation, and describe how you would biomechanically bias this muscle during palpation to distinguish it from the medial hamstring muscles.
Muscle: Biceps femoris (lateral hamstring)
Origins:
Long head → Ischial tuberosity
Short head → Linea aspera & lateral supracondylar line of femur
Insertion: Head of the fibula (with small expansion to lateral tibial condyle)
Actions: Knee flexion, Tibial external rotation (with knee flexed), Hip extension (long head only)
Innervation:
Long head → Tibial division of sciatic nerve (L5–S2)
Short head → Common fibular division of sciatic nerve (L5–S2)
How to Bias During Palpation:
Patient prone
Knee flexed ~90°
Add tibial external rotation
Apply resisted knee flexion
Palpate posterolaterally near fibular head
With the patient supine, you gently cradle the occiput and sink your fingertips into the short, dense muscle layer just inferior to the occipital ridge and lateral to the spinous process of C2. Name all four muscles of this group, give their common innervation, and describe their primary collective actions.
1. Rectus capitis posterior major
2. Rectus capitis posterior minor
3. Obliquus capitis superior
4. Obliquus capitis inferior
Suboccipital nerve (dorsal ramus of C1)
Upper cervical extension, Ipsilateral side-bending, Ipsilateral rotation (primarily via obliquus capitis inferior at C1–C2), Segmental stabilization and fine motor control (+ proprioception) of the atlanto-occipital and atlanto-axial joints
With the patient in single-leg stance on the tested limb, you palpate just superior to the greater trochanter while observing for contralateral pelvic drop. You then resist hip abduction in standing to make the muscle firm under your fingers.
Which muscle are you palpating? Give its origin, insertion, action, and innervation.
Muscle: Gluteus *medius*/min
Origin: Outer surface of ilium between anterior and posterior gluteal lines
Insertion: Lateral surface of greater trochanter
Action: Hip abduction, pelvic stabilization in single-limb stance
Innervation: Superior gluteal nerve (L4–S1)
With the patient supine, you palpate immediately adjacent to the linea alba while resisting a slow, segmental trunk curl-up with a controlled posterior pelvic tilt. As the trunk flexes, you feel a paired, vertically oriented muscle belly firm beneath your fingers on both sides of midline. Which muscle is being assessed? Provide its origin, palpate its insertion, demonstrate its action, and verbalize its innervation
Rectus abdominis
Origin: Pubic crest, Pubic symphysis
Insertion: Xiphoid process: Costal cartilages of ribs 5–7
Actions: Primary trunk flexion, Posterior pelvic tilt, Abdominal compression, Assists with forced expiration
Innervation: Thoracoabdominal nerves T7–T12
With the patient clenching the jaw, you palpate a large fan-shaped muscle on the lateral skull that tightens beneath your fingers. You discuss how repetitive hyperactivity here may influence regional scalp and cranial blood flow.
Name the muscle, give its innervation and actions, and identify the arterial branch it arises off of.
Muscle: Temporalis
Innervation: Trigeminal nerve, mandibular division (CN V3)
Primary Actions: Elevation of mandible, Retraction of mandible
Artery: Temporal arteries coming off the external carotid system