First Aid - MSK Flashcards
Unhappy triad- involved anatomy and usual cause
ACL, MCL, meniscus (classically medial, lateral technically more common)
sports injury: lateral force to planted leg
ACL/PCL/LCL/MCL - nomenclature refers to which attachment?
sites of tibial attachment
Pudendal nerve block location and use
ischial spine
relieve delivery pain
Appendix (McBurney’s point) location
2/3 of way from umbilicus to ASIS
Lumbar puncture location
iliac crest (L4)
Rotator cuff muscles and actions
SITS:
Supraspinatus - abducts
Infraspinatus - laterally rotates
Teres minor - adducts and laterally rotates
Subscapularis - medially rotates and adducts
Rotator cuff innervation
C5-C6
Wrist bones (ulnar to radial)
So Long To Pinky, Here Comes the Thumb:
proximal row: scaphoid, lunate, triquetrium, pisiform
distal row: hamate, capitate, trapezoid, trapezium
1st row ulnar to radial, 2nd row radial to ulnar
Most commonly fractured wrist bone and common complication
scaphoid
prone to avascular necrosis
Dislocation of which bone may lead to acute carpal tunnel?
lunate
Waiter’s Tip (Erb’s palsy)
Upper trunk (C5/C6) lesion infants following delivery trauma
Claw hand (Klumpke’s palsy)
Lower trunk (C8/T1) lesion embryologic childbirth defect or thoracic outlet syndrome
Wrist drop
Posterior cord lesion
Winged scapula
Long thoracic (C5-T1) lesion
Saturday night palsy (wrist drop)
Radial branch lesion
Deltoid paralysis
Axillary branch lesion (C5/6)
Difficulty flexing at elbow
Musculocutaneous branch lesion
Claw hand (intrisinc hand muscles)
Ulnar branch
Brachial plexus levels
Randy Travis Drinks Cold Beer: Roots (C5-T1) Trunks (upper, middle, lower) Divisions (crossing over occurs here Cords (lateral, posterior, medial) Branches (axillary, radial, musculocutaneous, ulnar)
Axillary nerve levels
C5/6
Axillary nerve - typical injury
surgical neck of humerus (fracture)
dislocation of humeral head
Axillary nerve - motor and sensory deficit
arm abduction above shoulder
sensory loss over deltoid muscle
Radial nerve levels
C5-T1
Radial nerve - typical injury
midshaft of humerus (fracture)
Saturday night palsy
Radial nerve - motor deficit
BEST extensors:
brachioradialis, extensors of wrist/fingers, supinator, triceps
Radial nerve - sensory deficit
posterior arm
dorsal hand
Median nerve - typical injury
supracondylar humerus fracture (proximal)
Median nerve - motor deficit
wrist flexion
opposition of thumb
lateral finger flexion (digits 1+2)
Median nerve - sensory deficit
dorsal and palmar aspects of lateral 3.5 fingers (through part of ring finger)
thenar emminence
Ulnar nerve - typical injury
medial epicondyle fracture (“funny bone”)
Ulnar nerve - motor deficit
medial (4+5) finger flexion
wrist flexion
Ulnar nerve - sensory deficit
medial 1.5 fingers (ring and pinky)
hypothenar emminence
Musculocutaneous nerve - typical injury
upper trunk compression
Musculocutaneous nerve - motor deficit
flexion at elbow (biceps, brachialis, corachobrachialis)
Musculocutaneous nerve - sensory deficit
lateral forearm
Inability to extend digits 4/5 when opening hand
Ulnar claw: ulnar nerve at hook of hamate (FOOSH)
Inability to extend digits 2/3 when opening hand
Median claw: carpal tunnel or dislocated lunate (distal median nerve)
Unable to flex digits 2/3 when making fist
Pope’s blessing: proximal median nerve injury
Unopposable thumb (can’t abduct)
Ape hand: proximal median nerve injury
Inability to extend any fingers (clawing of all digits)
Klumpke’s total claw: lower trunk (C8-T1) lesion
Obturator nerve - levels
L2-L4
Obturator nerve - typical injury
anterior hip dislocation
Obturator nerve - motor deficit
thigh adduction
Obturator nerve - sensory deficit
medial thigh
Fermoral nerve - levels
L2-L4
Femoral nerve - typical injury
pelvic fracture
Femoral nerve - motor deficit
thigh flexion
leg extension
Femoral nerve - sensory deficit
anterior thigh and medial leg
Common fibular (peroneal) nerve - levels
L4-S2
Common fibular nerve - typical injury
trauma/compression of lateral leg
fibular neck fracture
Common fibular nerve - motor deficit
foot eversion and dorsiflexion (foot drop presents)
Common fibular nerve - sensory deficit
anterolateral leg and dorsal foot
Tibial nerve - levels
L4-S3
Tibial nerve - typical injury
knee trauma
Tibial nerve - motor deficit
foot inversion and plantarflexion
toe flexion
Tibial nerve - sensory deficit
sole of foot
Superior gluteal nerve - levels, injury and motor deficit
L4-S1, posterior hip dislocation, thigh abduction (+ Trendelenberg sign)
Inferior gluteal nerve - levels, injury and motor deficit
L5-S2, posterior hip dislocation
can’t jump, climb stairs or rise from seat (push inferiorly)
Osteoblast function
build bone (secrete collagen and catalyze mineralization)
Osteoclast function
mlutiucleated cells that dissolve bone
Parathyroid hormone function
low, intermittent levels: anabolic effect on bone
chronic high levels (osteitis fibrosa cystica): cataloic effect on bone
Estrogen effects on bone
inhibits apoptosis of osteoblasts, induces apoptosis of osteoclasts