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4. Gastrointestinal > 15.2, 15.4, 15.6 > Flashcards

15.2, 15.4, 15.6 Flashcards

1
Q

4 joints of shoulder complex:

A

Sternoclavicular joint.
Acromioclavicular joint.
Glenohumeral joint.
Scapulothoracic joint.

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2
Q

The clavicle curves forwards in the ___ 2/3s and then curves backwards.

A

Medial

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3
Q

Fractures of clavicle occur a the change of curvature between ___ 2/3s and ___ 1/3

A

Medial 2/3s and lateral 1/3s where clavicle changes direction

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4
Q

There is a ___ ___ in the sternoclavicular joint

A

Intraarticular disc

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5
Q

There is a band of ligamentous fibres from ___ rib to undersurface of clavicle, creating a ___

A

First rib
Creates tubercle
Forms costoclavicular ligament - the main stabiliser of the sternoclavicular joint (note that this joint is also reinforced by sternoclavicular ligament, but this is not then main stabiliser).

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6
Q

The ___ joint is rarely disrupted due to its stability, which is good because the ___ vessels are directly posterior to it!

A

Sternoclavicular joint

Subclavian artery and vein

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7
Q

There is a ___ joint at the lateral end of the clavicle

A

Acromioclavicular joint (synovial), NOT a strong joint!

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8
Q

The acromioclavicular joint is not a strong joint, so subluxation of this joint is more common c.f. ___ ____

A

Sternoclavicular joint

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9
Q

The main stabiliser of the acromioclavicular joint is the ___ ___

A

Coracoclavicular ligament
This attaches to the coracoid process, and has two parts.
Note there is an acromioclavicular ligament but this is NOT the main stabiliser at the joint.

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10
Q

Grades of acromioclavicular subluxation:

A

Grade 1 - acromioclavicular ligaments are stretched but not torn
Grade 2 - AC ligaments are torn
Grade 3 - AC AND coracoclavicular ligaments (the main stabilisers at this joint) are both torn!

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11
Q

Layers of glenohumeral joint:

A 
1 - bones
2 - labrum
3 - capsule
4 - tendons ("rotator cuff")
5 - coraco-acromial (accessory) ligament/arch and subacromial bursa
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12
Q

The shoulder joint has the ___ range of movement of all joints in the body

A

Greatest

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13
Q

Deficiencies in capsule of shoulder joint?

A

One for tendon of long head of biceps to come out of joint.

One for bursa (subscapular) - note this communicates with joint!

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14
Q

Muscles of rotator cuff?

A

Supraspinatus
Infrapsinatus
Subscapularis
Teres minor

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15
Q

When rotator cuff muscles contract, they ___ the capsule and increase ___

A

Tighten
Increase stability
So main role as stabilisers, but also involved in prime movement

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16
Q

To access the shoulder joint, ___ muscle passes under the ___ ligament in a small space

A

Supraspinatus muscle/tendon

Coracoacromial ligament

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17
Q

If rotator cuff muscles are weak, and deltoid contracts - pulls up the ___ which can impinge on the tendon of ___

A

Humerus

Supraspinatus

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18
Q

Impingement of supraspinatus tendon can lead to an ___ reaction

A

Avascular

Formation of calcium deposits in tendon!

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19
Q

If instability at shoulder joint and deltoid contracts to pull up humerus, the ___ can be impinged against by bone or ligament

A

Subacromial bursa!

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20
Q

The shoulder joint is unstable and susceptible to either ___ or ___

A

Subluxation

Dislocation

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21
Q

When the arm is in an ___ position, it is esp. vulnerable

A

Abduction

Small amount of head of humerus in contact with glenoid fossa

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22
Q

The most common dislocation at the shoulder joint is ___ and ___

A

Anterior and inferior

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23
Q

In shoulder dislocation, the ___ nerve is esp. susceptible to injury

A

Axillary nerve
Because it passes under head of humerus - so if humerus dislocates anterior and inferiorly, it is esp. susceptible to injury

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24
Q

Axillary nerve passes through a ___ space bounded by:

A

Quadrangular/quadrilateral

Bounded by shaft of humerus, long head of triceps, teres major and subscapularis

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25
Q

If you suspect dislocation of the shoulder, do not let patient ___ the arm!

A

Abduct!
Negative effects on axillary nerve.
Test cutaneous supply by military badge area!

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26
Q

There are ___ ligaments from medial and lateral epicondyles

A

Collateral ligaments

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27
Q

The radial tuberosity on the radius is the attachment for

A

Biceps!

Located anteromedial

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28
Q

If ligaments/muscles attach, there are ___ epiphyses

A

Traction

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29
Q

In children, the ligament is often ___ than the bony attachment

A

Stronger - risk of avulsion

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30
Q

Epiphyses of bones at elbow joint form at different ___

A

Ages
E.g. capitulum at 2 years
E.g. epicondylar epiphysis at 8 years

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31
Q

The ___ joint and ___ ___ joint SHARE THE SAME CAPSULE

A

Elbow joint and proximal radioulnar joint

32
Q

There are ___, ___ fat pads in the anterior and posterior fossae of the elbow joint

A

Intracapsular, extrasynovial

33
Q

The medial collateral ligament attaches to __

A

Ulna

34
Q

The lateral collateral ligament does NOT attach to ___, but attaches to the ___ ligament

A

Bone

Attaches to annular ligament to form 2/3s of circle around neck of radius.

35
Q

When the forearm is extended, the medial ___, ___ and lateral ___ are all in the same line from medial-lateral and lateral-medial

A

Epicondyle
Olecranon
Epicondyle

36
Q

There is a ___ angulation when elbow is extended - forearm at angle of approx ___ degrees

A

Valgus angulation

15 degrees

37
Q

Valgus angulation disappears in ____

A

Flexion

38
Q

If there is an increase in valgus angulation, there can be additional tension on structures on the ___ side

A

Medial e.g. medial collateral ligament, but esp. on structures that pass BEHIND medial epicondyle like the ULNAR NERVE!

39
Q

Radioulnar joints control ___ and ___ of the forearm

A

Pronation and supination!

40
Q

There is a ___ disc in the joint cavity of the inferior radioulnar joint

A

Fibrocartilaginous

41
Q

Note - the ___ does NOT extend as far distally as the ___

A

Ulna less far than radius.

So ulna is NOT articular at wrist joint, it is separated by fibrocartilaginous disc

42
Q

Fracture of one bone out of ___ and ___ is commonly associated with dislocation or fracture of the other - called the ‘___’ principle due to interosseous membrane

A

Ulna or radius

Ring principle

43
Q

There are 2 pronators and 2 supinator muscles contributing to movements at radioulnar joints:

A

2 pronators: pronator teres and pronator quadratus

2 supinators: supinator and biceps brachii

44
Q

Remember - there is a ___ in the olecranon fossa

A

Bursa!
Susceptible to irritation if contact with hard/rough surfaces
Called student’s elbow!

45
Q

At the elbow joint, the most common direction of dislocation is ___

A

Posterior

46
Q

Volkmann’s ischaemia

A

If posterior dislocation of elbow, can cause significant stretch on brachial artery causing the lumen to narrow -> ischaemia of forearm musculature!

47
Q

Pisiform bone is a ___ bone i.e. it lies inside a ___

A

Sesamoid

Inside a tendon

48
Q

The distal wrist crease is the ___ attachment of the ___ ___

A

Proximal attachment of flexor retinaculum

49
Q

The proximal wrist crease marks the ___ joint

A

Wrist

50
Q

___ and ___ (carpal bones) are articular at the wrist

A

Scaphoid and lunate

51
Q

Falls on an outstretched hand can transmit force via the capitate into the ___ and ___

A

Scaphoid and lunate

52
Q

Some carpal bones project forwards: ___, ___, ___, ___ (STOP)

A

Tubercle on scaphoid, tubercle on trapezium, hook of hamate and pisiform.
Important for attachment of flexor retinaculum.

53
Q

Carpal bones can only be used to determine age of child up to approx. ___ years old

A

13

54
Q

Typically long bones ossify at both ends, but ___ only ossify at one end!

A

Metacarpals - but still a long bone

55
Q

The ___ of the metacarpal is proximal and the ___ of the metacarpal is distal

A

Base
Head (ossification centres at head!)
BUT in other bones, usually ossification centres are proximal, not distal!

56
Q

Bones articulating at wrist:

A

Scaphoid, lunate and distal radius.

57
Q

Bones distal to articulating bones at wrist:

A

Trapezium, trapezoid, capitate, hamate (TTCH)

58
Q

Flexion at wrist is ___ than extension, and ulnar deviation at wrist is ___ than radial deviation

A

Greater and greater

59
Q

Why is flexion at wrist greater than extension?

A

Because posterior part of radius projects more distally than the anterior aspect.

60
Q

Why is ulnar deviation at wrist greater than radial deviation?

A

In radial deviation, the radial styloid blocks movement!

61
Q

The carpal bones are all connected by ___ ligaments

A

Interosseous

62
Q

In the intercarpal joints:
Extension is ___ than flexion
Radial deviation is ___ than ulnar deviation
BUT low ROM anyway c.f. wrist.

A

Greater
And greater
(I.e. opposite of wrist).

63
Q

Anteriorly, there are palmar ligaments attaching to ___ and pass ___ across front of wrist, as far as metacarpals.

A

Radius, pass obliquely to metacarpals.

Palmar/volar radiocarpal ligament and palmar ulnocarpal ligament.

64
Q

Posteriorly, there is a dorsal radiocarpal ligament that passes from ___, in ___ direction to carpal bones

A

Radius, obliquely to carpals

65
Q

Palmar ligaments are ___ than dorsal ligaments

And radiocarpal ligaments are ___ than ulnocarpal ligaments

A

Stronger
Stronger
They act to prevent carpal bones from sliding medially.

66
Q

Ligaments of carpal bones are stabilisers AND transmit ___ ___

A

Blood vessels to bones!

67
Q

Specialised ligament - radio-scapho-lunate ligament:

A

Band from radius, over scaphoid and attaching to lunate.

Holds scaphoid and lunate in position, esp. lunate because tends to sublux into space on medial aspect.

68
Q

___ ___ ___ attaches to pisiform

A

Flexor carpi ulnaris

69
Q

6% of all fractures in the body are in the ___ radius and ___ bones

A

Distal radius and carpal bones

70
Q

In fracture of scaphoid, can sometimes lead to ___ ___ of proximal pole of scaphoid

A

Avascular necrosis

Due to distribution of vascular supply

71
Q

The first metacarpal is separated from other 4 metacarpals - metacarpals 2-5 are connected by a deep ___ ___ ligament

A

Deep transverse metacarpal ligament

The 1st metacarpal is free - for flexion/ extension/ abduction/ adduction.

72
Q

The carpometacarpal joint of the thumb is a ___ joint

A

Saddle - for opposition!

73
Q

The lateral boundary of the anatomical snuff box is formed by 2 tendons:

A

Abductor pollicis longus (most lateral)

Extensor pollicis brevis

74
Q

Fracture at base of 1st metacarpal:

A

Bennett’s fracture

75
Q

Fracture at neck of 5th metacarpal:

A

Boxer’s fracture

76
Q

Metacarpophalangeal joints are ___ joints

A

Condyloid

77
Q

Why is there greater extent of abduction at MCP joints in extension at MCP c.f. in flexion at MCP

A

In flexion, the collateral ligaments tighten!
If injuries of patient’s hand - stabilise hand in FLEXION - so ligaments are tight
If they are lax, then they will tighten! - Difficult to recover.

4. Gastrointestinal (13 decks)

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