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FRCA Anatomy > Bone And Joint Anatomy > Flashcards

Bone And Joint Anatomy Flashcards

1
Q

What movements can the spine permit

A

Flex
Extend
Laterally flex
Rotate

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2
Q

What are the primary curves of the spine

A

Concave anteriorly - thoracic and sacral

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3
Q

What are the secondary curves of the spine

A

Concave posteriorly - cervical and lumbar

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4
Q

How is a babies spine shaped at birth

A

Single primary curvature concave anteriorly, the secondary curves develop with age and muscle strength and are postural

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5
Q

What are the components of the vertebral arch

A

Laminae posteriorly

Pedicles anteriorly

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6
Q

What are the processes attached to each vertebral arch?

A

1 Spinous process projecting posteriorly from between the laminae
2 transverse processes projecting laterally from where laminae meet pedicles
4 articular processes - bilateral superior and inferior originating from the lamina

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7
Q

How are the vertebral fascet joints formed

What is the significance of their variable orientation at different levels

A

Articulation of the inferior articular processes with the corresponding superior articular process of the vertebra below.
Variability at different levels determines extent and direction of movement permitted

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8
Q

What are the boundaries of the intervertebral foramene

A

Superior - inferior vertebral notch of pedicle
Inferior - superior vertebral notch of pedicle
Anterior - posterior lateral aspect of veterbral bodies and disc
Posterior - superior and inferior articular processes forming the facet joint

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9
Q

What are the features of C3-7 and why

A
  • Small wide oval body as not carrying much weight
  • Oval flat facet joints for movement
  • Transverse processes pieced by foramen transversarium for artery+ anterior/posterior tubercles for scalene attachment.
  • short bifid spinous processes c3-6, larger singular at c7 forming attachment point for ligamentum nuchae
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10
Q

What makes the bodies of cervical vertebra unique

A

Raised superior edges forming uncinate processes for extra articulation - only found in mammals that can rotate head

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11
Q

How are cervical vertebra facet joints directed

What movement does this allow

A

Superior directed posteriormedially
Inferior directed anteriolaterally
Flexion, extension, lateral flexion

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12
Q

What variant may exist to the anterior tubercles of the transverse process on c7

A

Cervical rib

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13
Q

What is the ligamentum nuchae

Function

A

Tough ligament from occipital protuberance to spinous process of c7
Limits flexion of cspine

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14
Q

Features of atlas c1

A

No body or spinous process
Had an anterior and posterior arch
2 lateral masses with upper and lower facets
Contains the transverse Atlantal ligament

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15
Q

What forms the lateral masses of c1

How are its facet joints shaped?/atriculates

A

Transverse processes
Superior articulate with occipital condyles shaped to allow head to nod
Inferior facets articulate with axis

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16
Q

Features of axis C2

A 
Bifid spinous process
Thick pedicles and lamina
Ordontoid peg
Horizontal superior facets
Small transverse process
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17
Q

Where does the ordontoid peg sit?

A

Anterior to transverse ligament of c1 articulating with anterior arch

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18
Q

What are the characteristics of the thoracic veterbra?

A

Laminae overlap adjacent vertebra
Bodies have costal facets laterally for articulation with ribs
Transverse processes directed posteriolaterally
Articular processes are orientated nearly vertically with superior facing posteriorly and inferior facing anteriorly
Spinous processes are long and angled steeply causally

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19
Q

How do the ribs articulate with the thoracic vertebra?

A

1 - articulates directly with one facet on T1
2-9 articulate with demifacets on two adjacent vertebra (the corresponding and the one above).
10-12 - same as one

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20
Q

What is the structure of the thoracic transverse processes

A

Long, strong, directed posteriorlaterally to behind articular processes
T1-10 have anterior facets for articulation with respective ribs

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21
Q

What is the positioning of the thoracic articular facets

What does this allow

A

Nearly A-P

Rotation but limited flexion

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22
Q

Why are thoracic epidurals challenging? How to overcome this?

A

Steep caudally angulated spinous processes obscure intervertebral space
Approach paramedially

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23
Q

Features of lumbar vertebra

A

No foramen transversarium (c) or costal facets (t)
Large triangular vertebral foramen
Large vertebral bodies
Long slender transverse processes l1-3 becoming shorter and fatter l4-5
Articular processes s - posteriormedial, I- anteriolateral
Short broad spinous processes
Non-overlapping laminae

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24
Q

What is the lumbosacral angle

Significance?

A

Angle between sacrum and l5
Formed due to wedge shaped l5 body. Increases with lordosis reaching 70o
This can lead to obstruction of local anaesthetic flow after caudal anaesthesia

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25
Q

Layout and permitted movement of lumbar articular processes

A

Superior posteriomedially
Inferior anteriolaterally
Allows flex, extend and lateral flexion but not much rotation

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26
Q

What is the significance of the lumbar laminae compared to other levels

A

Non-overlapping so easier to access spine for injection

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27
Q

What is the hole down the middle of the vertebra called (formed by the body pedicles and lamina)
What about those laterally formed by two adjacent vertebra

A

Vertebral foramen

Intervertebral foramen

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28
Q

How much of hight do intervertebral discs contribute?

A

25%

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29
Q

What is the general shape of the sacrum

A

Irregular triangle

Concave anteriorly convex posteriorly

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30
Q

What happens to the spinous processes in the sacrum

A

Fuse to form median sacral crest

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31
Q

What happens to the articular processes in the sacrum

A

Fuse to create the intermediate/articular crests (4 pairs). The superior S1 processes still articulate with L5 then inferior S5 processes form rounded tubercles - the sacral cornua

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32
Q

Where do the sacral nerves emerge? Made from what?

A

Dorsal and ventral sacral foramina respectively for the dorsal and ventral rami

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33
Q

What do the transverse processes form in the sacrum

A

Lateral sacral crests

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34
Q

What is the term for the lateral aspects of the sacrum lateral to the sacral foramina

A

Lateral mass

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35
Q

What do the vertebral bodies form in the sacrum

A

Transverse ridges

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36
Q

Where does the ilium articulate with the sacrum

A

Upper part of lateral edge of lateral mass

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37
Q

What forms the base of the sacrum

A

S1 (it is the superior aspect!).

The anterior edge projects forward to form a sacral promontory

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38
Q

What sits either side of S1 body on the base of the sacrum - why are they grooved?

A

The ala

Grooved by the passage of the lumbosacral trunk of the sacral plexus

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39
Q

What happens to the vertebral canal in the sacrum

A

Becomes the sacral canal

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40
Q

What is the anatomy of the sacral canal

A

Bounded anteriorly by fused s1-4 bodies and posteriorly by fused laminae and spinous processes
Upper opening at base of sacrum
Ends inferior at sacral hiatus
Opens via dorsal and ventral sacral foramen

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41
Q

What is the sacral hiatus

Borders?

A

End of sacral canal beneath median crest
Failure of fusion of laminae of S5
Superiorly - lower borders of fused S4 laminae
Laterally - medial borders of unfused S5 laminae
Posteriorly - skin and soft tissue inc sacrococcygeal ligament
Inferiorly- coccyx and posterior body of S5

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42
Q

Relevance of sacral hiatus

How is it located

A

Caudle epidural injection
Locate posterior superior iliac spines (underling skin dimples)
Connect them and draw an equilateral triangle pointing down - sacral hiatus at the apex felt as a depression

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43
Q

How many vertebra from the coccyx

How are they connected

A

Usually 4 but 3-5
Disc and lateral synovial joints between coccyx and sacrum
Usually c1 separate then subsequent fused

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44
Q

Parts of intervertebral disc

A

Annulus fibrosis - outside, dense fibrocartilage ring

Nucleus pulposus - inside, avascular semi fluid gelatinous core

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45
Q

What sits between each disc and veterbral body

A

Hyaline cartilage

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46
Q

What are the ligamentous attachments of the intervertebral discs?

A

Anterior and posterior longitudinal ligaments

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47
Q

How do discs contribute to the vertebral column

A

Shape - wedge shaped in cervical and lumbar (thick anteriorly) contributing to lordosis
Height - around 25% in youth - getting less with age
Flexibility
Cushioning

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48
Q

Features of posterior longitudinal ligament

A

Runs over posterior bodies and discs - widens over discs and narrows over bodies

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49
Q

Location of anterior longitudinal ligament

A

2nd cervical vertebra to sacrum

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50
Q

What ligament connects adjacent lamina in the spine - in what direction does it pass

A

Ligamentum flavum

From lower inner surface of superior lamina to upper outer of inferior

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51
Q

What ligament lies between spinous processes

What ligament lies posterior to the spinous processes (between which vertebra - what is it contiguous with)

A

Interspinous

Supraspinous - c7 to sacrum becoming ligamentum nuchae superiorly

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52
Q

What ligaments link transverse processes

A

Intertransverse ligaments

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53
Q

What vertebral level is the larynx

A

C4-6

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54
Q

What is the vertebral level of the xiphisternum and umbilicus

A

T10

L3/4

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55
Q

What vertebral level is the tip of the scapula when arms by side

A

T7

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56
Q

What vertebral level are the top of the iliac crests? What can change this?

A

L4
Elderly, vertebral body #s, drop of spine into pelvis
Obesity can make top of hips seem more cephalad due to fat

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57
Q

What vertebral level are the skin dimples at top of buttocks

What do they overly

A

S2

Posterior superior iliac spines

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58
Q

What are the types of spina bifida with description

A

Occulta - failure of fusion of vertebral arch but all nervous tissue/meninges in normal place
Meningocele - posterior protrusion of meningeal sac
Myelomeningocele - nervous tissue (spine and or nerve roots in menigeal sac)
Myelocele - failure of neural tube to fuse so open to surface - fatal

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59
Q

Bones that make up the face

A 
Frontal
Zygomatic
Maxillary
Mandible
Nasal
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60
Q

Where does the mandible articulate

A

Glenoid fossa of temporal bone

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61
Q

What are the 3 main sutures of the bones of the cranium

A

Sagittal (interparietal)
Coronal (frontoparietal)
Lambdoid (parietoccipital)

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62
Q

What is the area of the frontal bone found between the two orbits called

A

Glabella

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63
Q

What is the junction between the frontal nbone and the nasal bones called

A

Nasion

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64
Q

What is the opening in the skull for the nose called

A

Piriform apateur

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65
Q

What foramen is located in the middle of the body of the maxilla
What passes through it

A

Infraorbital foramen

Infraorbital nerve and vessels

66
Q

What are the two parts of the mandible

How are they separated

A

Body
Ramus
Angle of the jaw and oblique line

67
Q

What is the swelling at the front of the mandible in the midline? What sits either side? What passes through?

A

Mental protruberance
Mental foramen
Mental nerve and vessels

68
Q

What foramen is found on the medial surface of the jaw? What passes through it to where?

A

Mandibular foramen
Inferior alveolar nerve supplying sensation to lower teeth and jaw
Passes through mandibular canal

69
Q

What are the upward projections on the superior border of the mandibular rami. What are their functions

A

Anterior coronoid process - attachment of temporalis muscle

Posterior condylar process - articulation at TMJ

70
Q

What ligaments anchor the tmj and where do they go?

A

Sphenomandibular ligament - lingua of medial ramus to sphenoid bone
Lateral - articular tubercle to ramus
Stylomandibular - styloid process of temporal bone to posterior ramus

71
Q

Movements possible at tmj?

A

Opening and closing of mouth
Side to side
Anterior subluxation of jaw (protrusion

72
Q

What muscles are involved in mandibular opening

A

Digasteic
Geniohyoid
Mylohyoid

73
Q

What muscles are involved in mouth closure?

A

Masseter
Temporalis
Medial pterygoid

74
Q

What muscle causes mandibular protrusion

A

Lateral pterygoid

75
Q

What are the classifications of facial #

A

Le Fort I - across maxilla under nose
Le Fort 2 - along superior border of maxilla (over nose)
Le Fort 3 - over frontal bone and through eye sockets

76
Q

How many tarsals, metatarsals and phalanges per leg

A

8 tarsal bones
5 metatarsals
14 phalanges

77
Q

Movements possible at hip

A

Flex, extend, adduct, abduct, internal rotate, external rotate

78
Q

Bones that make up the acetabulum

A

Ilium
Pubis
Ischium

79
Q

What muscles stabilise the hip when the opposite leg is lifted?
Sign of deficient?
Relevance to anaesthesia?

A

Gluteus medius and minimus
Trendelenburg sign
When lifting legs into lithotomy do both together as no stabilisation thus can strain SI or lumbar joints.

80
Q

What is the path of the inguinal ligament

A

ASIS to pubic tubicle

81
Q

Where is the asis

A

Anterior end of iliac crest

82
Q

What ligaments span the back exit of the pelvis? What do they help form?

A

Sacrotuberous - from ischial tuberosity on posterior of ischium to the posterior iliac spines and margins of sacrum/coccyx
Sacrospinous - from the ischial spine on the posterior of ischium to coccyx

Form the greater and lesser sciatic foramen

83
Q

How much blood can be lost into the pelvis in trauma
What blood vessels are often involved?
How can it be controlled

A

All of it
Internal iliac arteries and veins at back
External iliac arteries and veins passing over pubic rami
Control with pelvic binder and tying feet together into internal rotation

84
Q

Proximal route of sciatic nerve

A

Exits pelvis though greater sciatic foramen

Moves down and out crossing slightly medial to a line between ischial tuberosity and great trochanter

85
Q

Name for protuberances at distal end of femur

A

Med and lat epicondyle

86
Q

Potential blood loss from a femur fracture

A

1-2 litres

87
Q

Main muscle group of anterior thigh

Contents?

A 
Quadriceps muscles
Rectus femoris
Vastus lateralis
Vastus medialis 
Vastus intermedius
88
Q

Muscles of the medial thigh

A 
Adductor muscles:
Gracilis
Pectineus 
Adductor longus
Adductor brevis 
Adductor Magnus
Obturator externus
89
Q

Muscle group in the posterior compartment of thigh

A

Hamstrings

90
Q

Nerves that supply the knee joint

A

Obturator
Femoral
Tibial
Common fibular

91
Q

Main ligaments of the knee

A

Med and lat collateral

Ant and pot cruciate

92
Q

Boundaries of the popliteal fossa

A

Superior medial - semitendinosus
Superior lateral - semimembranosus
Inferior med and lat - heads of the gastrocnemius

93
Q

Contents of popliteal fossa medial to lateral

A

Popliteal artery, popliteal vein, tibial nerve

94
Q

Significance of superficial route of common peroneal nerve around neck of fibula

A

Vulnerable to injury causing foot drop

Can be used for nerve stimulation causing foot dorsiflexion

95
Q

What is contained in the anterior and lateral compartments of the lower limb

A

Foot dorsiflexors, everters and abductors
Common peroneal nerve
Popliteal artery

96
Q

What is contained in the posterior compartment of the lower leg

A

Muscles that plantar flex, adductor and invert the foot
Tibial nerve
Posterior tibial artery

97
Q

Causes of compartment syndrome in lower leg

Main symptom? Subsequent symptoms

A 
High energy injuries
Fractures to long bones
Tight dressings
Burns 
Vascular damage
Prolonged unconsiousness (eg midazolam od)

Main symptom pain, then pulse less, pale, paraesthesia, cold, paralysis

98
Q

What tissue pressure leads to compartment syndrome

A

> 35 mmhg

99
Q

What articulation is present at the distal end of the tib/fib with the foot. Type of joint and movement allowed

A

Mortis joint with talus

Allows ankle plantar and dorsiflexion

100
Q

Where do foot ab/aducution and in/eversion occur? What movements are paired?

A

At the subtalar joint between talar and navicular and other joints of the forefoot.
Abduction paired with eversion and adduction with inversion.

101
Q

What important structures pass anterior and posterior to the medial malleolus?

A

Anterior - long saphenous vein, saphenous nerve

Posterior - posterior tibial artery, tibial nerve

102
Q

What important structures pass anterior and posterior to the lateral malleolus?

A

Anterior - superficial peroneal nerve

Posterior - Sural nerve

103
Q

Names of the tarsal bones

A 
Talus - superior proximal
Calcanious - inferior proximal 
Navicular - medial midlayer
Cuboidal - lateral midlayer/distal layer
Medial, internediate and lateral cuneiforms - distal layer
104
Q

Arterial supply to the foot

A

Dorsalis pedis artery

Posterior tibial artery

105
Q

Main nerves of the foot

A

Medial and lateral planters (from tibial)
Deep and superficial fibular
Sural
Saphenous

106
Q

How do the sensory nerves approach the toes?

Clinical significance?

A

Terminal sensory branches run between the metatarsals of each toe
Can be blocked at the distal end of the metatarsal space or at the digits by injection into the web space.

107
Q

What is at the distal end of the spine of the scapula?

A

The acromion process

108
Q

What is the anterior projection of the scapula superiomedial to the glenoid cavity

A

Coracoid processs

109
Q

Where does the suprascapular nerve run on the scapula?

A

A groove superior to the spine of the scapula

110
Q

Where does the clavicle articulate?

A

Manubrium of sternum at sternoclavicular joint

Acromion of scapula at acromioclavicular joint

111
Q

What are the protuberances at the neck of the humerous termed
What muscles attach to them?

A

Greater and lesser tubercles

The rotator cuff - supraspinatous, infraspinatous, teres minor, subscapularis)

112
Q

What structures are at risk on fracture of the neck of humerus

A

Axillary nerve and posterior circumflex artery

113
Q

What are the structures at the distal end of the humerous

A

Medial and lateral epicondyles either side of the condyle

114
Q

What enlarges the glenoid cavity to accommodate the head of humerus

A

Glenoid labrum

115
Q

Origin and insertion of the trapezius

A

Origin - occipital protuberance, superior nuchal line, ligamentum nuchae, spinous processes of c7-t12
Inserts - spine and acromion of scapula and lateral third of clavicle

116
Q

Actions of trapezius

A

Upper fibres lift scapula rotating it to allow humerous to abduct beyond midline
Lower fibres depress scapula
Middle fibres retract scapula

117
Q

Origin and insertion of deltoid

Action

A

Scapula spine and acromion and distal clavicle to insert on deltoid tuberosity of humerous
Abducts the arm

118
Q

What muscles run from the midline to the posterior scapula causing elevation (from superior to inferior)

A

Levator scapulae
Rhomboid minor
Rhomboid major

119
Q

Origin and insertion of coracobrachialis

Action

A

Coracoid process to midshaft humerous

Shoulder flexion

120
Q

Muscular walls of the axilla?

A

Anterior - pec major and minor, subclavious
Medial - serratous anterior,
Lateral - no muscles, just humerous
Posterior - subscapularis, latissimus dorsi, teres major, long head of triceps

121
Q

Which nerves are vulnerable to injury on abduction of the arm more than 90o?
How can this be reduced

A

Median and ulnar

Pronation of hand

122
Q

How is the radial nerve most commonly injured

A

Pressure in axilla, eg crutch or Saturday night palsy

123
Q

How does the radius articulate with the humerus

A

Radial head articulates with capitellum (lateral part of condyle of humerus)

124
Q

What nerve is vulnerable on fracture or dilation of radial head

A

Posterior interosseous

125
Q

Where do the biceps muscle insert

A

On the radial tuberosity at upper end of radius

126
Q

Which wrist bones does the radius articulate with

A

Scaphoid and lunate

127
Q

Anatomy of proximal ulnar

A

Posterior olecronon
Anterior Coronoid process
In between trochlear notch
Lateral radial notch

128
Q

Processes on distal radius and ulnar palpable through skin

A

Styloid processes

129
Q

Articulations and movements of the elbow joint

A

Trochlear notch of ulnar to humeral condyle - hinge joint for flex and extend
Radial head with capitellum of humerous - pivots to allow pronation and supination
Proximal radioulnar joint - also permitting pronation and supination

130
Q

Where are the radial and median nerve vulnerable to tourniquet damage

A

Distally on the humerus where they are superficial

131
Q

What are the anterior flexors of the upper arm and their route and action

A

Coracobrachialis - coronoid process to radius - flex’s arm at shoulder
Brachialis - shaft of humerus to ulna - elbow flexion and supination of forearm
Biceps brachialis - scapula to radial tuberosity of ulna - elbow and shoulder flexion

132
Q

What muscles are In the posterior upper arm, route, action

A

Triceps brachii
Long head from scapula, medial and lateral from humerus, inserts onto olecronon process
Long head extends and adducts arm at shoulder and all extends arm at humorous

133
Q

Pronators of the forearm and route

A

Pronator teres - medial epicondyle and lateral radius

Pronator quadratus- distal radius to ulnar

134
Q

Supinatiors of the forearm

A

Biceps brachii

Supinator

135
Q

Muscles of anterior compartment forearm

A

Deep - pronator quadratus, flexor digitorum profundus, flexor pollicis longus
Middle - flexor digitorum superficialis,
Superficial - flexor carpi ulnaris, palmar is longus, flexor carpi radialis, promimally pronator teres

136
Q

Muscles of posterior forearm

A

Deep - abductor pollicis longus, extensor pollicis brevis and longus, extensor indicis, supinator
Superficial - brachioradialis, extensor carpi radialis longus and brevis, extensor digitorum, extensor digitorum minimise, extensor carpi ulnaris, aconeus

137
Q

What are the carpel bones

A

Lateral to medial proximal row first

Scaphoid, lunate, triquetrum, pisiform
Trapezium, trapezoid, capitate, hamate

138
Q

How does the ulnar nerve enter the wrist

What does stimulation of it activate

A

Posterior to ulnar styloid process then radial to pisiform the across hook of hamate

Contraction of adductor pollicis and hypothenar muscles

139
Q

Route of radial nerve into hand

A

Through anatomical snuff box

140
Q

What forms the carpel tunnel

A

The flexor retinaculum spanning between pisiform and trapezium

141
Q

What is within the carpel tunnel

A

Tendons of flexor muscles

Median nerve

142
Q

What muscles of the hand perform fine movments of the fingers
Main actions

A

Anterior and posterior interosseous muscles - ab and adduction of fingers

143
Q

What nerves supply the small muscles of the hand

A

Ulnar nerve - interosseous muscles and hypothenar eminance, medial 2 lumbericles, adductor pollicis
Median nerve - thenar eminence

144
Q

What is the nerve supply to the fingers

A

Digital nerve either side which divide into dorsal and ventral branches mid way down the first phalanx

145
Q

Where is the p6 point, what it is used for?

A 
2 cun (width of patients thumb) above transfers skin crese on palmer side of wrist between palmaris longus and flexor carpi radialis
Antiemetic on aquapuncture!
146
Q

Risk factors for patient positioning injury

A

Patient - DM, RA, male, age, atherosclerosis, obesity, cachexia
Anaesthetic - prone, lateral or lithotomy positioning, long operation time, hypovolaemia, hypotension, hypoxia, hypothermia
Surgical - tourniquet use, neck or axillary surgery (many vulnerable nerves)

147
Q

How can nerves become damaged interop?

A 
Direct trauma
Ischaemia
Compression, 
Angulation
Traction or strain
148
Q

Why is the ulnar nerve particularly vulnerable to interop damage

A

Superficial over bone so vulnerable to compression injury

Transverses elbow leaving open to angulation injury

149
Q

Manifestation of ulnar nerve injury

A

Motor - weak flexion of medial fingers, weak finger abduction and adduction, weak thumb adduction
Sensory impairment over medial third of hand and 1.5 fingers

150
Q

What can reduce interop injury / pressure sores

A 
Appropriate padding (not just a blanket role but specially designed materials)
Automatic or manual repositioning, redistribution of padding or movement
Avoidance of hypotension, hypovolaemia, hypothermia
151
Q

Risks to eyes interop

A

Corneal abrasions from direct trauma
Pressure injuries
Chemical injury from cleaning fluids

152
Q

Ideal padding materials interop

A 
Take a variety of loads
Adequate thickness
Prevent bottoming out
Fire and infection resistant 
Antiallergenic
153
Q

What is the ideal supine position

A

Supine with arms semi abducted around 45o, mid pronation
Padded under elbows and heels
Head on standard hospital pillow

154
Q

What should be the non-compressible thickness of a surgical table mattress

A

11cm

155
Q

What is the risk of arm flexion interop

Where needs to be padded

A

Ulnar nerve under great traction and potential pressure

Ensure padded under elbow

156
Q

What are the risks of lithotomy positioning

A

Damage to sciatic and obturator form positional traction
Damage to common peroneal and saphenous nerves from direct pressure
Compartment syndrome due to pressure related muscle ischaemia with reduced arterial inflow.

157
Q

Definition of neuropraxia

A

Mild insult with loss of impulse conduction across effected segment of nerve - heals rapidly

158
Q

Definition of axonotmesis

A

More severe axonal disruption - requires neuronal regeneration - 1-4mm per day

159
Q

Definition of neurotmesis

A

Total section of nerve following direct trauma and laceration, rarely fully heals, may need surgical apposition for recovery

160
Q

How long after surgery does an ulnar nerve injury tend to present

A

48 hrs

FRCA Anatomy (3 decks)

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