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MSK Part 2 > Anatomy MSK > Flashcards

Anatomy MSK Flashcards

1
Q

What is the gray matter of the spinal cord used for?

A

Integrative area of cord for reflexes.

Have sensory, anterior motor, and inter neurons.

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2
Q

Which Rexed Laminae zones are in each location of the gray matter

A

1-6 in dorsal horn
7 in intermediate gray zone
8-9 in ventral horn
10 central canal

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3
Q

What do laminate 1 and 2 contain?

A

1: dorsal root fibers that mediate pain, temp, and touch
2: substantial gelatinosa neurons that have very low mylination nerve fibers. They modulate activity of pain and temperature Afferent fibers.

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4
Q

What do laminae 3 and 4 do?

A

Contain the proper sensory nucleus (nucleus propius)

Receives inputs from substantia gelatinosa.
Contributes to spinthalamic tracts mediating pain, temperature, and crude touch.

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5
Q

Which laminae are main receiving areas for cutaneous sensation?

A

1-4

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6
Q

What do laminae 5 and 6 do?

A

5: Neck of dorsal horn.
- Recieve descending fibers from corticospinal and rubrospinal tracts.
- Give rise to axons contributing to spinothalamic tracts

6: Present only in cervical and lumbar segments.*****
- Lateral segment receives descending corticospinal and rubrospinal fibers
- Medial segment receives afferents from muscle spindles and joint afferents

These 2 receive most of the Proprioception fibers and corticospinal projections = Regulation of movement.

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7
Q

What does lamina 7 do, and what is its nickname?

A

Intermediate Zone

Contains nucleus dorsalis of Clarke
-Extends from C8 through L2 (only Clarke, 7 is everywhere)

  • Receives muscle and tendon afferents
  • Origin of dorsal spinocerebellar tract (relays information to cerebellum ipsilaterally)
Other important neurons
-intermediolateral cell column (T1-L2)
SYMPATHETICS!!!
-Parasympathetic neurons (S2-S4)
-Interneurons such as Renshaw cells
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8
Q

Which Lamina houses the autonomic preganglionic neurons?

Which part of the gray matter are they located?

A

Lamina 7.

sympathetics are in lateral portion of the intermediate zone of the Lateral Horn (Only for sympathetics)

Parasympathetics in the lateral part of lamina 7.

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9
Q

What do lamina 8-10 do?

A

8 and 9:
Receive inputs from descending motor tracts
-Neurons somatotopically arranged
-Contain alpha and gamma motor neurons (lower motor neurons) and interneurons. 9 is mostly just interneurons.

10:

  • Surrounds central canal
  • Site of convergence for somatic and visceral afferents.
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10
Q

Explain the somatotopic organization of the motor neurons in the ventral horn

A

More posterior innervate flexors
More anterior innervate extensors
Medial innervate axial and limb girdle
Lateral innervate distal parts of extremities

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11
Q

Explain alpha and gamma A motor neurons

A

Alpha motor: give rise to large type A alpha motor nerve fibers that synapse on extrafusal fibers (all other skeletal muscle)

Gamma motor: give rise to smaller type A gamma motor nerve fibers synapse on intrafusal fibers. (Muscle Spindle)

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12
Q

What are Renshaw cells, and what do they do?

A

They are interneurons that make inhibitory synapse on A motor neurons.

Lateral Inhibition
Steps:
1. A motor neuron is excited
2. A motor neuron then activates Renshaw cells via excitiatory (cholinergic) axon collaterals
3. In turn, Renshaw cells inhibit via glycinergic or GABA synapses, the A motor neuron.

Helps to sharpen the intended signal of A motor neurons.

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13
Q

What is the general function of muscle sensory receptors?

A

It is almost entirely for the purpose of intrinsic muscle control. (Respond to what is happening in the muscle)

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14
Q

Explain Muscle Spindles

A

Sense length and velocity of muscle.

Organized around intrafusal fibers. Nuclei are either located in the center (NUCLEAR BAG FIBERS) or in single file (NUCLEAR CHAIN FIBERS)

Have 2 types of sensory endings
-Primary afferent fibers (Group 1a) innervate the central part of the spindle.
—-They respond to slow changes in the length (static response)
—-Also responds to rapid rate of change of length (dynamic response)

-Secondary afferent fibers (Group 2) innervate one or both ends of nuclear chain fibers ONLY.
—-Responds to slow change in length (static response)

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15
Q

Explain the Golgi Tendon Organ

A

It will stop the tendon from resisting if the tension gets to high. It also regulates extensor activity required for maintaining vertical support and posture.

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16
Q

Describe the stretch reflex

A

Monosynaptic reflex (2 neuronal arc)

  1. Muscle is stretched
  2. Intrafusal fibers deform stimulating the 1a afferent fibers
  3. 1a afferent fiber synapses with alpha motor neuron eliciting contraction of (homonymous) stretched muscle.
  4. 1a fibers also synapse with inhibitory interneurons which synapses with alpha motor neuron innervating an antagonist muscle (lateral inhibition)
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17
Q

What are the dynamic and static stretch reflexes?

A

Dynamic are elicited by rapid change in length, and it opposes sudden change in muscle length. Over very quick

Static continues for period of time after dynamic, elicits by continuous static signals transmitted by primary and secondary afferent fibers. Causes degree of muscle contraction to remain relatively constant.

Prevents the jerkiness of body movement

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18
Q

What is a hyperactive stretch reflex?

A

When descending motor pathways are damaged, it results in increased neuronal excitability or a hyperactive reflex leading to tremors or CLONUS.

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19
Q

What does the inverse stretch reflex deal with?

A

It is inverse of stretch reflex. Golgi tendon sends info via 1b sensory afferents to interneurons.
Interneurons inhibits alpha motor neuron that innervates the same muscle.
Muscle stops contracting/stretching

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20
Q

What is rhabdomyolysis?

A

Destruction of skeletal muscle that results in injury to myocyte and release of intracellular contents into circulation.

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21
Q

What are the two causes of Rhabdomyolysis

A

Direct damage to the skeletal muscle

Depletion of ATP within the myocyte.

Results in unregulated increase in intracellular calcium that leads to eventual necrosis and cell death.

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22
Q

Which medications can cause rhabdomyolysis

A

Statins: lipid lowering agents in the class of HMG-CoA reductase inhibitors.

Can cause decrease in ATP and lead to cell death.

Also: Alcohol: direct toxicity

  • Sedatives cause immobilization and can lead to ischemia
  • Sympathomimetic medications: cocaine, amphetamines, meth, PCP
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23
Q

What are the signs and symptoms of rhabdomyolysis

A 
Myalgia/muscle pain
Weakness
Red or brown urine
Traumatic injury (obvious sign)
Drug or alcohol overdose
Compartment syndrome
Patient on statin medication
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24
Q

With skeletal muscle death, what contents can be released into the blood?

A

Myoglobin

Electrolytes- K and phosphorus

Enzymes: creatine kinase (CK)
aspartame aminotransferase, alanine transminase, lactate dehydrogenase, Aldolase.

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25
Q

Which enzyme in the blood is diagnostic of rhabdomyolysis

What else can be checked, but is harder to measure?

A

Creatinine Kinase (CK)

Usually over 5 times the upper normal limit of 300. Around 1500 and usually greater than 5000.

Starts 2-12 hrs after injury lasts 3-5 days.

Myoglobin

Rises within 1 hr after damage, results take longer than CK.

Tested with urine dipstick, and looked at under microscope to get firm diagnosis

26
Q

Explain rhabdomyolysis related renal failure

A

Renal tubes can be obstructed from Uris acid and myoglobin. Myoglobin breakdown products are directly toxic to kidneys.

Other factors can be from dehydration, heat stress, and trauma with renal failure. Can slow blood flow through the kidney.

27
Q

Are are the effects of hyperkalemia?

A

Elevated K can cause arrhythmia. T waves peak, QRS complex widen, and P wave flattens or may disappear.

28
Q

What can you do to treat rhabdomyolysis

A

Maintain urine output. (1-3 ml/kg/hr). Give IV fluid 1-2 L

Be aware of possible Metabolic acidosis

Monitor electrolyte abnormalities.

29
Q

What is the pathophysiology of compartment syndrome?

A

Increased pressure of a closed non-expandable compartment.

Puts pressure on tissue and venous pressure. It is greater than capillary pressure and will cause tissue hypoxia.

Histamine is released to dilate capillaries making them even more leaky, and further increasing membrane leaking of proteins and fluid, and increasing pressure.

Normal Compartment pressure is 0-10 mm Hg, pain and parethesia 20-30 mm Hg, Ischemia is greater than 30 mm Hg

Difference between Diastolic and compartment pressure of less than 30 is concerning**

30
Q

What are the signs of compartment syndrome in clinic?

A

Pain that is out of proportion with physical findings***** Best sign!!!!

Pain on passive stretching

Five Ps:

  1. Pain
  2. Paresthesia
  3. Pallor: lack of blood flow. Appears white
  4. Pulselessness
  5. Paralysis
31
Q

When should a fasciotomy be done for compartment syndrome?

A

When the diastolic pressure - compartment is less than 30.

58-30 = 28 May need fasiciotomy

32
Q

What is Volkmanns contracture?

A

Associated with supracondylar fracture of the elbow.

It is muscle wasting in the forearm because of the fracture.

33
Q

What is treatment for compartment syndrome?

A

Remove tight casts, splints, or bandages

Maintain affected area at level of heart.

May need immediate fasciotomy

Hydration with IV fluids

34
Q

Fibromyalgia

Risk Factors?

Pathophysiology?

A

Widespread pain, chronic fatigue, sleep disturbance, no objective signs of inflammation

7-9 more likely in women than men. 1/2 have co-morbid depression and anxiety. 2-3% of US population have it.

Family history, female, infection, stress, physical trauma

Pathophysiology: Central sensitivity syndrome, genetic predisposition, Sleep abnormalities, ANS dysfunction, CNS sensitization

35
Q

What are the diagnostic criteria for fibromyalgia?

A 
Pain and symptoms over the past week
-Fatigue
-Waking unrefreshed
-Cognitive (memory or thought) problems
Symptoms for 3 months
No other health problem explains symptoms

Widespread pain index (0-19)
Symptom Severity Index (0-12)

Positive Tests
WPI greater than 7, SSI Greater than 5, symptom duration greater than 3 months
OR
WPI: 3-6, SSI greater than 9, Symptom duration greater than 3 months.

36
Q

What is the Labs and treatment for Fibromyalgia?

A

Labs: Not a requirement to confirm diagnosis.

Order tests relevant to the history: Lyme Disease, HCV,
Relevant blood tests: CBC, Thyroid (TSH) electrolytes.

Treatment: No cure, symptom relief- can reduce symptoms by 30-50% over 2-3 years

  • Aerobic Exercise
  • Cognitive Behavioral therapy
  • OMT-Myofascial release, Massage

Pharmacological treatment

  • Prgabalin, duloxetine, milnacipram
  • Anti-depressants, Anti-epileptic
  • Muscle relaxants, NSAIDS
  • Vitamin D, Mg, Omega 3
37
Q

What is Myofascial Pain Syndrome, and what are the distinguishing factors?

A

Pain limited to one area or quadrant of the body. Aggravated by myofascial tigger points in skeletal muscle.

Trigger point: Tender spot found with palpating + radiation pattern of pain (taut band of tissue)

Epidemiology: Affects more women than men. Affects 85% of population at some point in their lives. Prevalence during 30-60. Leading cause of Musculoskeletal pain*****

Pathophysiology: Leakage of acetylcholine in dysfunctional motor end plates
-Will shorten sarcomeres (knot or band in muscle)

Diagnosis: Trigger point +/- referred pain

  • Recognized by patient during palpation of tender spot.
  • Other conditions ruled out.

Treatment: No widely accepted guidelines

  • Acupuncture, dry needling
  • Yoga
  • Massage, chiropractic care, MFR, Mind/body/therapy
  • Exercise, Biomechanical therapy, sleep hygiene, diet, Can do pharmaceuticals if needed.
38
Q

What is Complex Regional Pain Syndrome?

A

Aka: Reflex Sympathetic Dystrophy. Causalgia

Chronic pain characterized by spontaneous or evoked regional pain usually precipitated by an injury.
Pain condition of extremities causing regional pain out of proportion inciting event.

Autonomic and vasomotor instability. Limb is bright red.

Type 1: minor injury preceding symptoms
Type 2: Injury to major peripheral nerve.

Signs and symptoms: continuous burning pain localized to extremity, swelling, color and temp disturbance, dystrophic changes skin and nails.

Diagnostic: Continuing pain disproportionate to inciting event. Must report at least 1 symptom in more than 3 categories, and at least 1 sign in more than two categories must be present at the time of evaluation.

Treatment: Mulitdisciplinary approach

  • Can use bisphosphonate for inflammation
  • Gabapentin, corticosteroids, IV ketamine
39
Q

What is the difference between strain and sprain?

A

Strain is muscle or tendon injuries

Sprain is a ligamentous injury

40
Q

What are the degrees of a sprain?

A

First: Tear of minimal fibers. Tender, but normal ROM

Second: Partial tear of ligament. Some loss of function, joint reaction and swelling. Pain may be significant.

Third: Complete ligament tear. Abnormal motion, swelling, and functional disability.

41
Q

ACL injuries?

A

Associated with rotation.

Hemarthrosis often occurs within two hours. Palpable effusion, because of good blood supply to ACL

Much more common in women.

42
Q

PCL injuries?

A

Posterior draw sign.

There isn’t a classic pop, and there isn’t a lot of loss of function. Some do require surgical repair

43
Q

What is the unhappy triad?

A

MCL, Medial meniscus, ACL injuries.

New data shows LCL is more common with ACL tear.

44
Q

Treatment for different degrees of ACL tears?

A

1st and 2nd deg are crutches and PT.

3rd is surgical repair. Using cadaver or allograft.

45
Q

What are the Ottawa knee rules?

NOT ON TEST

A

When to obtain knee xrays:

Age over 55
Tenderness at fibulae head
Unable to flex knee to 90 deg
Unable to bear weight immediately or in the clinic
Isolated tenderness of patella.
46
Q

How do you treat meniscal injury?

A

Without ligamentous injury can be treated with rest and PT

Persistent symptoms from tears may require surgery.

Medial Meniscus are more likely to tear. Happens from squatting and standing up.

47
Q

What is the most common patella dislocation?

A

It moves Laterally usually, and usually due to structural abnormality.

Use apprehension test to push laterally and look for guarding or high mobile patella.

48
Q

Describe knee dislocations

A

It refers to tibiofemoral dislocation

50% of these dislocations are reduced spontaneously, but damage to the popliteal artery and common fibulae nerve run in the popliteal fossa and can be injured without a hematoma (it drains)

Injury to Common fibulae will affect eversion and dorsiflexion.

Assess the CIRCULATION!!!! Stabilize the knee. If no pulse is present= immediate surgery.

49
Q

Explain Achilles’ tendon ruptures

A

No plantar flexion. Rupture tends to occur 2 to 6 cm above the end on insertion at calcaneus.

Positive Thompson test

50
Q

What are the antibiotics associated with tendon ruptures?

A

Fluoroquinolones

51
Q

How can you tell the difference between hip fracture or dislocation upon exam?

What are complications

A

Fracture hip is externally rotated

Dislocation: shortened leg, addicted and internally rotated.

Acetabular fractures, sciatic nerve injuries, OA, or avascular necrosis due to delay in reduction.

52
Q

What are the 2 main phases of gait?

A

Stance and Swing phase

Stance phase is 60% in walking
Swing is 40% in walking

Stance is 40% in running, swing 30%, and Floating 15%

53
Q

I like my tea presweetend in my teapot

A

Pneumonic for Gait

Initial contact
Loading response
Midstance
Terminal Stance
Preswing 
Initial
Mid swing
Terminal swing.
54
Q

In gait what is the pelvic lateral, vertical, and rotational shift?

What is the base width?

Step Length?

Speed/Cadence

A

Lateral and vertical 1-2 in.

Pelvic Rotation around 8 deg.

2-4 inches

15 inches long

3mph and 90-120 steps/min

55
Q

Explain Backward Trunk Lean

A

Gluteus Maximus Gait

Weak hip extensors, use Gluteus Maximus instead

Reduce need for active hip extension

56
Q

Explain the Trendelenburg Gait with and without Compensation

A

Gluteus Medius Gait w/ or w/o compensation

Contralateral pelvis drops compared to stance. Weak Gluteus Medius

W/ compensation the pt. will lean with the stance leg to compensate the weakness.

57
Q

Explain Gene Recurvatum Gait

A

Knee hyperextension during stance phase. Suspect weak quad, lax ligaments or knee arthritis.

58
Q

Explain Footdrop gait

A

Dorsiflexion weakness that helps functionally shorten the leg.

May hear slap or have extreme hip flexion

59
Q

Explain Antalgic Gait

A

Painful stance leg so stance phase is shortened. Quicker offload with painful leg.

60
Q

Explain Arthrogenic gait

A

Hip hike and hip circumduction. Stiffness of the joint may cause pt. To functionally shorten the Swing leg

61
Q

What is an ankle foot orthosis used for?

A

Foot drop

Ankle instability

MSK Part 2 (8 decks)

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