Block 12 - Musculoskeletal and nervous system (anatomy) Flashcards
What are the 4 phases of gait?
Heel-strike, Foot flat, Midstance/Swing phase, Push off
What happens to the pelvis during swing phase?
Rotation
What causes a trendelenberg gait?
Weak hip abductors
Define GALS
Global Assessment of the Locomotor System
What is adhesive scaularitis?
Frozen shoulder
Movement only at scapula so abduction is decreased
How do you test finger flexor power?
What injury prevents you from doing this?
Hold the patients fingertips with yours and get them to pull
Elbow injury of the dorsal interosseus nerve
How do you test abduction of the fingers?
Get them to push against yours
How do you test adduction of the fingers?
Pull a piece of paper from between the patients fingers
What nerve supplies the pincer grip?
Radial
What nerve supplies the power grip?
Ulnar
2 causes of fixed flexion deformity
How would you test the right leg?
Osteoarthritis, Severe lumbar lordosis
To test the right leg you would flex the left leg off the couch
Define version, antiversion and retroversion
Version: Angle of the femoral neck relative to the vertical plane
Antiversion: Foot inwards
Reteroversion: Foot outwards
Who is anteversion commonly seen in?
How can this cause problems?
Commonly seen in babies and can cause problems in adolescence if it does not rectify itself
When may the true and apparant leg length differ?
Scoliosis or Lumbar spine disease
What causes genu varum and valgum?
Varum: Arthritis in the medial knee
Valgum: Arthritis in the lateral knee
Define genu recurvarum
1 possible cause
Knee is hyperextended
Neurovascular
2 movements in the ventral portion of the arm
Where do they arise from?
Flexion and adduction
From coracoid
2 movements in the dorsal portion of the arm
Where do they arise from?
Extension and abduction
From scapula
What passes through the intertubular groove?
Biceps tendon
What is the anatomical neck of the humerus?
Epiphysis
What are the 2 (+2) ligaments surrounding the shoulder joint?
What do they do
Coracoacromial ligament: Allows shoulder to move relative to clavicle Coracoclavicular ligements (Trapezoid and Conoid): Maintain stability of the scapula relative to the clavicle
What happens if the intraarticular disc between the clavicle and the sternum tears?
Dislocation
Which muscles’ tendon increases stability of the glenohumeral joint?
Biceps brachii
Where does the teres minor muscle arise?
Arises from the bottom of the scapula blade
Where does the subscapularis muscle arise?
Arises from the subscapular fossa
What are the two painful arcs and what degrees are they felt at?
Acromioclavicular painful arc (170-180 degrees)
Glenohumeral painful arc (60-120 degrees)
What are the 2 bursa’s found around the shoulder?
Under scapula (subscapular bursa) Between the acromion and supraspinatus muscle
What needs to happen for you to fully abduct the arm?
Scapula and humerus need to rotate fully
What vessel does the subclavian artery form and what vessel forms the subclavian vein?
Axillary artery and vein
What are the medial, posterior and anterior borders of the axillary fossa?
Medial: Serratus anterior
Posterior: Subscapular muscles
Anterior: Pectoral muscles
What order do the nerves, arteries and veins enter the axillary fossa?
Subclavian vein directly above clavicle
Behind the vein is the artery
Behind the artery is the nerve
What makes up the roots of the brachial plexus?
Ventral primary rami of cervical spinal nerves
ANTERIOR DIVISIONS OF BRACHIAL PLEXUS:
Nerves
Movements
Skin
Nerves: - Musculocutaneous (upper arm) - Median, Ulnar (forearm and hand) Flexors and Adductors (median is an abductor) Muscles and skin at the FRONT of the arm
POSTERIOR DIVISIONS OF BRACHIAL PLEXUS:
Nerves
Movements
Skin
Nerves: Axillary, Radial
Extensors and Abductors
Muscles and skin at the BACK of the arm
What area of the hand is supplied by the median, ulnar and radial nerve?
Google it babs i can’t draw on here
Another name for a radial nerve injury
Crutch palsy (can be caused by being on crutches)
How do you test the myotome of T1?
Test the intrinsic hand muscles
Explain what happens in Erb’s palsy
Tight birth causes tension on the brachial plexus and the 5th cervical nerve root to tear
Sensation in the lateral part of the arm and shoulder muscles is lost so the arm hangs loosely by the side
Explain what happens in Klumpke’s paresis
Birth or motorbike injury
Damage to T1 so all intrinsic hand movements lost
Lost sensation to the medial side of the forearm
What are the borders of the cubital fossa?
Line between the lateral and medial epicondyles
Brachioradialis on the lateral border
Pronator teres on the medial border
What makes up the floor and the roof of the cubital fossa?
Floor: Brachialis
Roof: Skin and superficial fascia
POSTERIOR COMPARTMENT OF THE FOREARM: Ventral or dorsal Movements Nerve Where do they arise?
Dorsal aspect
Extensors of the wrist and digits
Radial nerve
Arises at the lateral epicondyle
ANTERIOR COMPARTMENT OF THE FOREARM: Ventral or dorsal Movements Nerve Where do they arise?
Ventral aspect
Flexors of the wrist and digits
Median and ulnar nerve
Arises at the medial epicondyle
How does the extensor digitorum insert
Ends in 4 tendons which pass over the MCP joint and insert into the middle phalanx
Tendon splits into lateral and medial slip which pass around the MCP joint and insert into the distal phalanx
Where is the anatomical snuffbox?
Between the extensor pollices brevis/longus and the abductor pollices longus
What does the anatomical snuffbox contain?
Pulse of the radial artery
What causes tenderness in the snuffbox?
FOOSH
Fractures the neck of the scaphoid
What is the mneumonic to remember the ulnar and median nerve supply of the forearm?
LOAF
Median nerve supplies the Lateral 2 lumbricals, Opponens pollices, Abductor pollices brevis, Flexor pollices brevis
All the other are ulnar
What branches off the deep and superficial palmar arch?
Deep:
Principes pollicis artery (thumb)
Radial artery of the index finger
Superficial:
Common palmar digital arteries
Proper palmar digital arteries
What passes through the carpal tunnel (2)
Tendons and the median nerve
2 things which can cause compression of the median nerve
Arthritis or swelling in the wrist
How do you test the flexor digitorum profundus?
Hold the wrist and digits in expansion and flex the dip joint
How do you test the flexor digitorum superficialis?
Pull the digits into extension to stop the produnfus then flex the finger
What do the tests of the flexor digitorum profundus and superficialis also flex?
They also flex the wrisp, mcp and the profundus the pip as the tendon passes over all of these joints
What movement do the long flexors and extensors of the wrist allow?
Flexors flex the wrist
Extensors extend the wrist
What is another name for adduction and abduction of the wrist?
Which muscles allow these movements
Abduction = radial deviation (radial flexors and extensors) Adduction = ulnar deviation (ulnar flexors and extensors)
Explain what happens in a pulled elbow
Annular ligaments usually hold the radius against the ulnar head but in a child they are less stable
Swinging/pulling a child’s hand dislocated the radius within the annular ligament
What is the role of the lumbrical muscles? (3)
Balance tension between the flexor and extensor tendons
Also control fine movement and independent control of joints
What is the role of the palmar aponeurosis?
Palmaris longus tendon binds to the flexor retinaculum and skin of the palm allowing the skin of the palm to cup
What are the muscles of the hypothenar eminence?
Where are they found?
Abductor, flexor and opponens digiti minimi
Base of the little finger
What are the muscles of the thenar eminence?
Where are they found?
Abductor, flexor and opponens pollicis brevis
Base of the thumb
How many DORSAL interosseus muscles are there?
Where are they found?
4
Dorsal space between the metacarpals
Explain how the muscles of the finger are abducted
Little finger abducted by abductor digiti minimi
Ring abducted by muscle arising on radial side of 5th metacarpal and ulnar side of 4th metacarpal inserting into the ulnar side of the 4th digit
Middle abducted in both directions. Muscle from radial 4th and ulnar 3rd inserting to 3rd. Muscle from radial 3rd and ulnar 2nd inserting to 3rd.
Index finger abducted by muscle from radial 2nd and ulnar thumb inserting to 2nd digit
How many PALMAR interosseus muscles are there?
Where are they found?
3
Palmar space between the metacarpals
Explain how the muscles of the finger are adducted
2 muscles from the radial side of the 4th and 5th metacarpal adduct the little and ring finger towards the middle
Muscle from the ulnar side of the 2nd metacarpal adducts the index finger towards the middle finger
What does variable nerve supply mean?
Opponens pollicis and flexor pollicis brevis can be supplied by the median or ulnar nerve (should be median)
Abduction is always median