Loco Flashcards
Large range of movement at shoulder
Large humeral head - 4:1 ratio Support from glenoid labrum Physiological scapulothoracic joint Large joint cavity Rotator cuff stabilise
Shoulder ligaments
Superior, middle and inferior glenohumeral
Coracohumeral
Coracoacromial
Which rotator cuff muscle attaches to the lesser tubercle?
Subscapularis
SLAP tears
Type 1 = partially tear
Type 2 = completely detached glenoid labrum
Type 3 = labrum hanging into joint cavity
Type 4 = labrum hanging into joint cavity and affecting biceps tendon
Basilic vs cephalic vein
Basilic = drains medial Cephalic = drains lateral
Risk factors for DVT
Old age Sedentary periods Major surgery Trauma Contraceptive pill Pregnancy
Symptoms of DVT
Tenderness Pain Swelling Eryhthema Oedema
Diclofenac
Inhibitor of COX2
Prevents formation of prostagladins, leukotrienes
Enoxaparin sodium
Low molecular weight heparin
Binds to antithrombin
Inactivates factor Xa
Warfarin
Vitamin K antagonist
Rachitic rosary chest
Prominent knobs of bone at the costochondral joints
Due to lack of mineralisation due to vitamin D or calcium deficiency
Harrison’s sulcus
Horizontal groove along where the diaphragm inserts into the ribs showing bone weakness
Rickets symptoms
Bone tenderness Increased frequency of fractures Muscle weakness Bowed legs Skeletal malformations
Rickets treatment
Calcium, phsophate and vitamin D supplements
Increased sunlight exposure
Vitamin D fortified milk for infants
Zones of cartilage growth
Resting Proliferating Hypertrophy and maturation Degeneration and calcification Osteogenesis
Vitamin D pathway
ProD3 found in skin
Converted to D3 by UVB light
Vitamin D3 –> 25(OH)vitD in the liver
25(OH)vitD –> 1,25(OH)2vitD in the kidney
Action of 1,25(OH)2 vitamin D
Binds to nuclear receptor and acts as transcription factor tp promote many processes
Increases calcium and phosphate reabsorption in the gut
Increases calcium mobilisation from the bones
Increased calcium reabsorption from the kindeys
How is bone resorption stimulated?
PTH and vitamin D stimulate RANKL expression in osteoblasts
Activates osteoclasts and causes them to mature
What hormone is released when calcium plasma levels are low?
PTH
What does PTH cause?
Kidney calcium reabsorption and phosphate excretion
Increased calcium release from bones by activating RANKL
Conversion of 25(OH)vitD –> 1,25(OH)2vitD to stimulate increased calcium reabsorption from the gut
Process of bone resorption
Osteoclast attaches to bone
Secretes proteolytic enzymes and HCl
Bone products exit in interstitial fluid
Osteoblasts secrete new bone matrix into cleared space
Calcification of new matrix in 7-10 days
Effect of oestrogen on bone growth
Increases gut calcium reabsorption
Inhibits osteoclasts
Effect of glucocorticoids on bone growth
Decreases gut reabsorption
Increases bone resorption and inhibits formation
Ergocalciferol
Vitamin D2
Cholecalciferol
Vitamin D3
Lateral ankle ligaments
Anterior talofibular
Posterior talofibular
Calcaneofibular
Medial ankle ligaments
Deltoid ligament
4 fused ligaments
From medial malleolus –> calcaneous and navicular
Signs of compartment syndrome
Pallor Pain Pulselessness Paralysis Parasthesia Polar
Diagnosis of compartment syndrome
Intracompartmental pressure >30mmHg
Treatment of compartment syndrome
Fasciotomy
Removal of restriction
IV saline drip for hydration
Rhabdomyolysis
Breakdown of striated muscle
In this case due to ischaemia
Releases muscle contents into blood
Increased creatine kinase, myoglobin, potassium, calcium
Define compartment
Group of muscles with the same function and with a common nerve and blood supply that are surrounded by deep fascia
Functions of skeletal muscle
Support soft tissues - shield organs Guard entrances and exits - anal sphincters Maintain body temperature Store nutrient reserves Breathing
Consequences of sarcopenia
Worsening of posture Immobility due to weakness Increased bone loss --> osteoporosis Falls more likely More likely to get fractures
Sarcopenia theories
Neuromuscular ageing - loss of motor neurones, NMJs and vesicles
Hormone levels - decrease in GH, oestrogen, testosterone, thyroxine and insulin and increase in cortisol
Cellular senescence
Inflammatory factors
Loss of myokines
Obesity
Sarcopenia epidemiology
Mean age = 73
7-8% prevalence
30% of over 50s
Sarcopenia treatment
Dietary - creatine, whey protein, vitamin D
Hormone replacement therapy
Resistance training
Strength training
