CLINICAL MSK

Question 0

Where do avulsion fractures occur?

Answer 0

At apophyses (bony prominences lacking secondary ossification centres) and where muscles attach e.g ischial tuberosities

Question 1

What is an avulsion fracture?

Answer 1

Fracture where a small part of bone with a piece of tendon or ligament attached is torn away (avulsed)

Question 2

What kind of activities can cause avulsion fractures?

Answer 2

Sports requiring sudden acceleration and deceleration e.g sprinting football basketball hurdles martial arts

Question 3

What are coxa vara and coxa Valga?

Answer 3

Coxa vara is a decreased angle of inclination of the femoral neck
Coxa apvalga is an increased angle of inclination of the femoral head

Question 4

Where is the most common site for tibia breaks?

Answer 4

Narrowest part which is the border between the inferior and middle third

Question 5

What are metatarsal fractures often caused by?

Answer 5

Heavy weight falling on foot or when run over

Question 6

What are the main deep veins of the lower limb?

Answer 6

Anterior- anterior tibial vein, dorsal venous arch,

Posterior- plantar arch, posterior tibial vein fibulae vein, popliteal vein, femoral vein, profunda femoral vein

Question 7

What are the main superficial veins of the lower limb?

Answer 7

Great saphenous vein, femoral vein small saphenous vein

Question 8

Where does the great saphenous vein travel?

Answer 8

Connects to dorsal venous arch and travels up medial side of leg with the saphenous nerve then continues up the medial thigh and joins with the femoral vein

Question 9

What can cause compartment syndrome?

Answer 9

Trauma to muscles or vessels from burns or intense use or blunt trauma can cause haemorrhage oedema and inflammation
Because of the septa and deep fascia separating compartments being strong and not elastic, the intracompartmental pressure increases which can crush nerves and vessels damaging areas distal and within the compartment causing ischaemia and loss of motor function

Question 10

What are the 6Ps of compartment syndrome?

Answer 10

Pallor
Pulselessness
Perishingly cold
Parasthesia
Paralysis
Pain

Question 11

What is a varicose vein?

Answer 11

A vein that is dilated so that the cusps of its valves do not close so blood can flow backwards

Question 12

Why is the great saphenous veins used for coronary artery bypasses.q

Answer 12

Readily accessible
Sufficient distance between tributaries and and perforating veins so usable lengths can be harvested
Walls contain higher percentage of muscle and elastic fibres than other superficial veins
Doesn’t disturb venous drainage of lower limb due to there being many other veins

Question 13

What is a saphenous cutdown and when is it used?

Answer 13

Used when veins are poorly visible in infants and the obese or collapsed in people in shock
Procedure in which a skin incision is made anterior to the medial malleolus and used to insert a cannula for prolonged administration of blood, electrolytes or drugs.

Question 14

What complication can occur in saphenous cut downs?

Answer 14

The saphenous nerve accompanies the great saphenous vein in this area and if this is cut the patient may experience numbness along the medial border of the foot

Question 15

Why is pain sensation used to test dematomes?

Answer 15

Because sensory innervation of dematomes Overlaps but pain doesn’t

Question 16

How is parasthesia in the femoral nerve treated?

Answer 16

Femoral nerve block 2cm inferior to inguinal ligament

Question 17

What muscles are used in maintaining a relaxed standing position?

Answer 17

Erector spinae
Iliopsoas
Plantar flexor muscles (triceps surae)

Question 18

Why are only minor postural adjustments of a few muscles needed to maintain a relaxed standing position.

Answer 18

Because the ligaments of the hip and knee are being tightly stretched to provide passive support

Question 19

What movements of what muscles stops us falling forwards due to the instability of the ankle joints?

Answer 19

Plantar flexion via bilateral contraction of calf muscles

Question 20

What muscles counter lateral sway?

Answer 20

Hip adductors

Question 21

What muscles are used in the heel strike phase of walking?

Answer 21

Lowering of forefoot- eccentric ankle dorsiflexor action e.g tibial is anterior
Continued deceleration-hip extemsors e.g gluteus maximus

Question 22

What is eccentric contraction?

Answer 22

The contraction of a muscle as it lengthens, increasing tension. This often occurs when muscle is opposing a stronger force causing it to lengthen as it contracts

Question 23

What happens in the loading response of gait?(flat foot)

Answer 23

Knee extensors- quadriceps accept weight
Ankle plantar flexors decelerate mass
Gluteus minimus and medius (hip abductors) stabilise pelvis along with tensor fascia latae

Question 24

In mid stance what is the most important mechanical goal?

Answer 24

Stabilisation of the pelvis by glut min and med

Question 25

What muscle movements occur in preswing( toe off) part of gait?

Answer 25

Long flexors of digits- flexor hallucis longus and flexor digitorum longus accelerate mass lifting toes
Thigh is decelerated by eccentric contraction of hip flexors iliopsoas and rectus femoris

Question 26

What muscles are used in the swing phase of gait?

Answer 26

Flexors of hip- iliopsoas and rectus femoris accelerate thigh
Ankle dorsiflexors like tibialis anterior clear foot
Then on termination of swing
Eccentric contraction of hip flexors (glut max and hamstrings) and knee flexors (hamstrings) decelerate thigh and leg
Ankle dorsiflexors like TA then position foot and quadriceps extend the knee to prepare for contact

Question 27

What is the adductor hiatus?

Answer 27

Hole between distal attachments of adductor part and hamstring part of adductor magnus that transmits the femoral artery and vein from the adductor canal to the popliteal fossa. It is just lateral and superior to the adductor tubercle of the femur

Question 28

What forms the floor of the femoral triangle?

Answer 28

Pectineus and iliopsoas

Question 29

What forms the roof of the femoral triangle?

Answer 29

Fascia latae, subcutaneous tissue, skin