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1a. Year 2 > 2b. Musculoskeletal Principles > Flashcards

2b. Musculoskeletal Principles Flashcards

1
Q

What are the physiological functions of skeletal muscles?

A 
Maintenance of posture
Purposeful movement
Resipratory Movenemts
Heat production
Contribution to whole body metabolism
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2
Q

Name the striated muscle types…

A

Skeletal and cardiac

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3
Q

Name the unstriated muscle type…

A

Smooth

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4
Q

What causes dark bands to be present in striated muscle?

A

Myosin thick filaments

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5
Q

What causes light bands to be present on striated muscle?

A

Actin thin filaments

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6
Q

What branch of the nervous system innervates skeletal muscle?

A

Somatic nervous system

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7
Q

What branch of the nervous system innervates cardiac and smooth muscle?

A

Autonomic nervous system

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8
Q

What neurotransmitter is present at the neuromuscular junction?

A

Acetylcholine

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9
Q

What is contained with in the motor unit?

A

This includes:
The single alpha motor neuron
All the skeletal muscle fibres that it innervates

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10
Q

What determines the number of muscle fibres that is supplied by a single alpha motor neuron?

A

The function of that muscle e.g. muscles needed for fine motor skills will have fewer muscle fibres per motor unit

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11
Q

What are the two protein molecules contained within the sarcomere?

A

Myosin - thick filaments

Actin - thin filaments

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12
Q

What tissue binds the skeletal muscle fibres into bundles?

A

Connective tissue

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13
Q

What usually attaches skeletal muscles to the skeleton?

A

Tendons

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14
Q

What is the Z-line?

A

The connection between the thin (actin) filaments of two adjacent sarcomeres

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15
Q

What is the A-band?

A

This is made up of thick filaments and the thin filaments that overlap in both ends of the thick filaments

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16
Q

What is the H-zone?

A

This is the lighter area within the A-band where the thin filaments dont reach

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17
Q

What is the M-Line?

A

This extends vertically downwards within the centre of the H-zone

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18
Q

What is the I-band?

A

This is the remaining part of the thin filaments that do not project into the A-band

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19
Q

Where is Ca2+ released from during an action potential?

A

The lateral sacs of the sarcoplasmic reticulum

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20
Q

What are the T-tubules?

A

Extensions of the surface membrane that dip into the muscle fibre

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21
Q

Where does the surface action potential spread?

A

It propagates through the cell membrance and down the transverse (T) tubules

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22
Q

Describe the process of cross bridge formation…

A
  1. Ca2+ binds to troponin which exposes the cross-bridge binding site.
  2. This allows the binding of the myosin cross-bridge to actin which pulls the actin filament inwards during contraction.
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23
Q

What is Ca2+ needed for in in skeletal muscle contraction?

A

To switch on cross-bridge formation

To link the excitation to muscle contraction

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24
Q

What is ATP needed for in skeletal muscle contraction?

A

To power cross bridges and subsequently release them

To pump Ca2+ back into the sarcoplasmic reticulum

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25
Q

What two factors influence the strength of muscle contraction?

A
  1. The number of muscle fibres that can contract within the muscle
  2. The tension developed by each fibre
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26
Q

What can happen to allow a stronger contraction?

A

The summation of multiple muscle twitches

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27
Q

What is tetanus in terms of muscle contraction?

A

A maximum sustained muscle contraction evoked when the motor nerve that innervates a skeletal muscle emits action potentials at a very high rate.

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28
Q

Why can cardiac muscle not be tetanised?

A

There is a long refractory period that means that multiple action potentials cannot occur in quick succession

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29
Q

When can maximal tetanic contraction be achieved?

A

When the muscle is at its optimum length before the onset of contraction

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30
Q

When is the muscle at its optimum length?

A

The resting length of a skeletal muscle is approximately its optimal length

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31
Q

What are the two types of skeletal muscle contraction?

A

Isotonic Contraction - muscle tension remains constant but the length changes
Isometric Contraction - muscle length remains constant but the tension changes

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32
Q

What is an example of isotonic muscle contraction?

A

Moving objects

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33
Q

What is an example of isometric contraction?

A

Maintenance of body posture

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34
Q

What are the three different metabolic pathways for the production of ATP in skeletal muscle?

A

Oxidative Phosphorylation - MAIN - Aerobic
Glycolysis - Anaerobic
Creatine Phosphate - Immediate Source

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35
Q

What are the three types of skeletal muscle fibres?

A 
Slow Oxidative (Type I) - Slow in speed, more resistant to fatigue
Fast Glycolytic (Type IIx) - Fast in speed, vulnerable to fatigue
Fast Oxidative (Type IIa) - Mix of fast and slow
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36
Q

What is the simplest monosynaptic spinal reflex?

A

Stretch Reflex

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37
Q

What is the purpose of the stretch reflex?

A

This resists passive change in muscle length to maintain posture

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38
Q

What is the sensory receptor in the stretch reflex?

A

The muscle spindle

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39
Q

Where do the afferent nerves synapse in the stretch reflex?

A

They synapse in the spinal cord with the alpha motor neurons (efferent nerves)

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40
Q

What does the stretch reflex result in?

A

Contraction of the stretched muscle

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41
Q

What coordinates the stretch reflex?

A

Simultaneous relaxation of antagonist muscle

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42
Q

What are muscle spindles?

A

These are proprioceptors. They are a collection of specialised muscle fibres also known as INTRAFUSAL FIBRES. They are found in the belly of muscles and run parallel to normal fibres. They have sensory nerve endings aks annulospiral fibres.

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43
Q

When do muscle spindles send signals?

A

Discharge from the sensory endings increases as the muscle is stretched.

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44
Q

What efferent neurons supply the muscle spindles?

A

Gamma Motor Neurons

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45
Q

What is the function of the gamma motor neurons?

A

They adjust the level of tension in the muscle spindles which maintains their sensitivity when the muscle shortens during contraction.

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46
Q

What are the three types of joint?

A

Synovial
Fibrous
Cartilaginous

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47
Q

Describe a fibrous joint…

A

United by fibrous tissue
Doesn’t allow any movement - SYNARTHROSIS
e.g. bones in the skull

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48
Q

Describe a cartilaginous joint…

A

United by cartilage
Allows limited movement - AMPHIARTHROSIS
e.g. intervertebral discs

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49
Q

Describe a synovial joint…

A

These are bones separated by a cavity containing synovial fluid and united by a fibrous capsule

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50
Q

What is the synovial membrane composed of?

A

Vascular connective tissue with capillary networks and lymphatics
It contains synovial cells (fibroblasts) which produce synovial fluid.

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51
Q

What covers the articular surfaces of bones?

A

Articular hyaline cartilage

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52
Q

What is a simple synovial joint?

A

A joint with one pair of articular surfaces e.g. metacarpopharyngeal joint

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53
Q

What is a compound synovial joint?

A

A joint with more that one pair of articular surfaces e.g. elbow joint

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54
Q

What are examples of extra-articular structures?

A

These help to support the joint
Bursa - small fluid-filled sacs that reduce friction
Ligaments
Tendons

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55
Q

What is the physiological function of joints?

A

To serve the functional requirements of the musculoskeletal system e.g. structural support and purposeful motion

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56
Q

What are the roles of joints in purposeful motion?

A

Stress distribution
Confer stability e.g. ligaments provide secondary support
Joint lubrication e.g. synovium and cartilage interstitial fluid

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57
Q

What is the function of synovial fluid?

A

Lubricates joints
Facilitates joint movement
Minimises wear and tear
Aids in nutrition of articular cartilage which is an avascular structure

58
Q

The synovial fluid is a static pool - True or False

A

False - The synovial fluid is continuously replenished and absorbed by the synovial membrane

59
Q

What gives synovial fluid its thick viscosity?

A

The presence of HYALURONIC ACID (mucin) produced by the synovial cells

60
Q

What are the other components of synovial fluid?

A

Uric Acid - derived from blood plasma

Few cells - mainly mononuclear leucocytes

61
Q

What does rapid movement do to synovial fluid viscosity and elasticity?

A

Decreased viscosity and increased elasticity

62
Q

What colour is normal synovial fluid?

A

Clear and colourless

63
Q

What does increased synovial fluid WBC indicate?

A

Inflammatory and septic arthritis

64
Q

What causes synovial fluid to turn red?

A

Traumatic synovial tap and haemorrhagic arthritis

65
Q

What are the main functions of articular cartilage?

A

Low friction gliding surface

Distributes contact pressure to subchondral bone

66
Q

What are the zones of the articular cartilage?

A 
Superficial zone (10-20%)
Middle zone (40-60%)
Deep zone (30%)
Calcified zone
67
Q

What are the properties of articular cartilage?

A

Usually hyaline cartilage
Elastic, sponge-like proterties
Covers the surface of articular bones
Special extracellular matrix - water, collagen and proteoglycans

68
Q

What is the purpose of water in cartilage?

A

~70% cartilage wet weight
Maintains the resiliency of the tissue
Contributes to the nutrition and lubrication system

69
Q

What is the purpose of collage in cartilage?

A

~20% of the cartilage wet weight
Mainly type II collagen
Maintains cartilage architecture
Provides tensile stiffness and strength

70
Q

What is the purpose of proteoglycan in cartilage?

A

~10% of cartilage wet weight
Composed mainly of glycosaminoglycan
Responsible for the compressive properties e.g. load bearing

71
Q

What synthesises, organises and degrades the extracellular matrix of cartilage?

A

Chrondrocytes

72
Q

How do chondrocytes receive nutrition?

A

Articular cartilage is an avascular structure therefore chondrocytes receive nutrition and O2 via the synovial fluid

73
Q

What leads to the development of joint disease?

A

The rate of extracellular degradation exceeds the rate of its synthesis

74
Q

What are the catabolic factors of cartilage matrix turnover?

A

These stimulate proteolytic enzymes and inhibit proteoglycan synthesis
Tumour Necrosis Factor- Alpha
IL-1

75
Q

What are the anabolic factors of cartilage matrix turnover?

A

These stimulate proteoglycan synthesis and counteract the effects of IL-1
Tumour Growth factor - beta
Insulin-like growth factor -1

76
Q

What is a fascicle of skeletal muscle?

A

Bundle of parallel muscle fibres

77
Q

What are the three layers of connective tissue that surround the muscle?

A

Epimysium - surrounds the entirety of a muscle
Perimysium - surrounds a single fascicle
Endomysium - surrounds a single muscle fibre

78
Q

Where are the nuclei found on the muscle fibre?

A

There are multiple nuclei per muscle fibre.
They are at the peripheries
This is opposite to cardiac muscle where they are at the centre.

79
Q

What is a myofibril?

A

A single muscle fibre - this consists of many muscle fibres placed end-to-end

80
Q

What is a sarcomere?

A

The basic contractile unit of muscle fibre - they contain actin and myosin
This extends from one Z-line to the next

81
Q

The fibres in a motor unit are scattered in the muscle - True or False?

A

True - they are not bunched together

82
Q

What are lacuna?

A

These are the space within the extracellular matrix where the chondrocytes live

83
Q

What is type II collagen?

A

Finer collagen that forms a meshwork

84
Q

Describe hyaline cartilage…

A

Most common form of cartilage

e.g. cartilage rings in the trachea, articular cartilage

85
Q

Describe elastic cartilage…

A

The addition of elastic fibres make it quite flexible. A lot of the ECM collagen is taken out and replaced with elastic fibres
e.g. ear

86
Q

Describe fibrocartilage…

A

This is a hybrid between tendon and hyaline cartilage.
It contains bands of densely packed type I collagen and rows of chondroctes with a small amount of cartilaginous ECM
e.g. pubic symphysis, intervertebral discs

87
Q

What is red bone marrow?

A

Bone marrow that is responsible for producing blood

88
Q

What is yellow bone marrow?

A

Bone marrow that does not produce blood.

This is filled with fat

89
Q

What is the rough composition of bone?

A

23% Type 1 collagen
2% Non-collagen proteins
10% Water
65% Bioapatite - a form of calcium phosphate

90
Q

Describe the outer shell of bone…

A

Diaphysis

Dense cortical bone

91
Q

Describe the ends of the bone…

A

Epiphyses

Cancellous or trabecular bone - fine meshwork

92
Q

What are the haversian canals?

A

They surround blood vessels and nerve fibres throughout the bone and communicate with osteocytes.
They run along the axis of a long bone

93
Q

What are volkmans canals?

A

The small channels in bone that transmit blood vessels from the periosteum into the bone and that lie PERPENDICULAR to and communicate with the haversian canals.

94
Q

What are canaliculi?

A

These are tiny pores in the bone filled with tiny cell processes

95
Q

What are cement lines in the bone?

A

These are lines that are often visible surrounding the osteon.
They are not present in original development and only occur in osteons that have undergone remodelling

96
Q

Describe trabecular bone…

A

This is bone that contains osteocytes but lacks haversian canals. The osteocytes receive their nutrition because the struts are thin therefore the osteocytes can survive from contact with the marrow spaces.

97
Q

What are osteoprogenitor cells?

A

Cells located on bone surfaces e.g. under periosteum.

They are a reserve pool of osteoblasts

98
Q

What are osteoblasts?

A

Bone forming cells found on the surface of developing bone.

They have plentiful RER and prominent mitochondria

99
Q

What are osteocytes?

A

A cell of mature bone.

They are bone cells trapped with in the bone matrix.

100
Q

What are osteoclasts?

A

Large multinucleated cells found on the surface of bone that are responsible for bone resorption
BREAK DOWN BONE

101
Q

What is an osteoid?

A

An unmineralized organic tissue that eventually undergoes calcification and is deposited as lamellae or layers in the bone matrix.
This will then become mineralised over time

102
Q

What is the principle mineral of bone?

A

Calcium Phosphate Crystals

Particularly HYDROXYAPATITE

103
Q

What is the name of the end of the presynaptic alpha motor fibres?

A

Terminal boutons

104
Q

What part of the terminal bouton do the synaptic vesicles reside in awaiting release?

A

Active zones

105
Q

What is opposite the active zones on the post synaptic membrane?

A

Nicotinic Acetylcholine Receptors

106
Q

What are the key steps in neuromuscular transmission?

A
  1. Synthesis of ACh in the cytoplasm of the terminal bouton
  2. Uptake of ACh into synaptic vesicles for concentration and storage
  3. Ca2+ dependent release of ACh into synaptic cleft by exocytosis
  4. Brief activation of nicotinic ACh receptors by reversible binding of ACh
  5. Rapid termination of transmitter action by acetylcholinesterase within the synaptic cleft
107
Q

What is the function of acetylcholinesterase?

A

Breaks acetyl choline to choline and acetate/

108
Q

How is Acetylcholine synthesised?

A

Acetyl coenzyme A and choline are combined by the enzyme ACETYLTRANSFERASE

109
Q

What process occurs when the ACh is released from the synaptic vesicles?

A

Exocytosis

110
Q

How many molecules of ACh are required to activate each nicotinic ACh receptor?

A

Two

111
Q

What are nicotinic acetylcholine receptors formed of?

A

5 glycoprotein subunits which form a pore containing a gate.

112
Q

What moves through the nicotinic acetylcholine receptors when they are opened by ACh binding?

A

K+ moves outwards
Na+ moves inwards
INWARD FLOW DOMINATES CAUSING DEPOLARISATION AND SIMULTANEOUS OPENING OF MANY MORE nAChRs

113
Q

How do we summate e.p.p?

A

Multiple vesicles release ACh simultaneousy to reach the threshold

114
Q

How is the action potential spread along the muscle fibre without losing amplitude?

A

The muscle fibre has many voltage activated Na+ channels.

An action potential propagates from the endplate over the length of the. muscle fibre

115
Q

How does the action potential result in contraction?

A
  1. The AP propagates over the surface membrane and enters the T tubules.
  2. These T tubules are in close contact with the sarcoplasmic reticulum where Ca2+ is stored.
  3. AP triggers release of Ca2+ causing contraction.
116
Q

How does the action of ACh terminate?

A

Hydrolysis of ACh by acetylcholinesterase.

This hydrolyses ACh to acetate and choline.

117
Q

What happens to acetate after AP?

A

Diffuses from the synaptic cleft

118
Q

What happens to choline after the AP?

A

Taken up by a choline transporter

119
Q

What is another name for depolarisation in skeletal muscle?

A

End plate potential

120
Q

What are the four distinct processes in the physiology of pain?

A

Transduction
Transmission
Modulation
Perception

121
Q

What is the transduction process of pain?

A

Translation of harmful stimulus into electrical activity as the peripheral nociceptor

122
Q

What is the transmission process of pain?

A

Propagation of pain signal as nerve impulses through the nervous system

123
Q

What is the modulation process of pain?

A

Modification/hindering of pain transmission in the nervous system.
This is why we experience different levels of pain

124
Q

What is the perception process of pain?

A

Conscious experience of pain. This causes physiological and behavioural responses.

125
Q

What are the three factors that stabilise joints?

A

Shape of the articulating bone
Ligaments
Muscle tone

126
Q

What does failure of the mechanisms to stabilise joints lead to?

A

Subluxation - partial dislocation

Dislocation

127
Q

What is the lateral collateral ligament?

A

This attaches to the lateral epicondyle of the humerus and annular ligament

128
Q

What is the annular ligament?

A

Stabilises proximal radioulnar joint by holding radius against the radial notch of ulna

129
Q

What are the muscles of the shoulder girdle?

A 
Trapezius - CNXI
Latissimus dorsi - Thoracodorsal nerve
Rhomboid minor
Rhomboid major - Dorsal scapular nerve
Levator scapular - dorsal scapular nerve
Serratus anterior - Long thoracic nerve
Pectoralis minor - Medial pectorial nerve
Pectoralis major - Medial and lateral pectoral nerves
Rotator cuff muscles
Deltoid - Axillary nerve
Teres major - lower subscapular nerve
130
Q

What are the four rotator cuff muscles?

A

Supraspinatus
Infraspinatus
Teres minor - greater tuberosity attachment
Subscapularis - lesser tuberosity attachment

131
Q

What are the three compartments of the upper limb?

A

Anterior
Posterior
Lateral

132
Q

What are the anterior arteries, veins and nerves of the arm?

A

Brachial artery
Brachial nerve
Musculocutaneous nerve

133
Q

What are the posterior arteries, veins and nerves of the arm?

A

Profunda brachii artery
Ulnar collateral artery
Profunda brachii vein
Radial nerve

134
Q

What are the anterior arteries, veins and nerves of the forearm?

A 
Radial Artery
Ulnar artery
Venae comitantes
Median nerve
Ulnar nerve
135
Q

What are the posterior arteries, veins and nerves of the forearm?

A

Interosseous muscle
Venae comitantes
Radial nerve

136
Q

What are the arteries, veins and nerves of the hand?

A

Deep and superficial palmar arches
Ulnar nerve
Median nerve

137
Q

What are the muscle of the anterior compartment of the arm?

A

Biceps brachii
Brachialis
Coracobrachialis

138
Q

What does the median collateral ligament resist?

A

Valgus Stress

139
Q

What does the lateral collateral ligament resist?

A

Varus stress

140
Q

What does the anterior cruciate ligament resist?

A

Anterior subluxation of the tibia and internal rotation of the tibia in extension

1a. Year 2 (10 decks)

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