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Jemima Flash Cards > MSK > Flashcards

MSK Flashcards

1
Q

what are the joints of the upper arm

A

glenohumeral joint, the elbow joint, the proximal and distal radioulnar joints and the radiocarpal joint

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2
Q

what is the glenohumeral joint

A

the shoulder joint - a synovial joint made up of the scapula and the humerus

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3
Q

describe the elbow joint

A

synovial hinge joint which joins the distal humerus with the ulna and the radius

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4
Q

what movements can the shoulder joint do

A

flexion, extension, abduction, adduction, medial and lateral rotation and circumduction

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5
Q

what movements can the elbow joint do

A

flexion and extension

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6
Q

what movement can the radioulnar joint do

A

pronation and supination

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7
Q

what movement can the wrist joint do

A

flexion, extension, adduction and abduction

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8
Q

what movement can the fingers do

A

flexion, extension, adduction and abduction

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9
Q

what are the two large superficial muscles of the posterior pectoral girdle

A

the trapezius and the latissimus dorsi

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10
Q

what are the three smaller deep muscles in the posterior pectoral girdle

A

the levator scapulae, rhomboid major and rhomboid minor

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11
Q

what movement does trapezius provide

A

rotation, retraction , elevation and depression of the scapula (towards the midline, up and down)

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12
Q

what is the movement provided by latissimus dorsi

A

extends, adducts and medially rotates the humerus

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13
Q

what is the movement provided by the levator scapulae

A

elevation

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14
Q

what is the movement provided by rhomboid major and minor

A

retraction

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15
Q

what is the nervous innervation of latissimus dorsi

A

the thoracodorsal nerve

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16
Q

what are the muscles of the shoulder

A

the deltoid, the supraspinatus, the infraspinatus the subscapularis, teres major and minor

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17
Q

what are the muscles of the rotator cuff

A

supraspinatus, infraspinatus, subscapularis and teres minor

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18
Q

what movement is provided by the deltoid muscle

A

abducts the shoulder joint (doesnt initiate it)

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19
Q

what is the innervation of the deltoid muscle

A

the axillary nerve (from brachial plexus)

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20
Q

what movement is provided by teres major

A

medial rotation and adduction

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21
Q

what is the nervous innervation of teres minor

A

the axillary nerve

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22
Q

what is the movement provided by the supraspinatus muscle

A

the first 20 degrees of abduction

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23
Q

what is the movement provided by infraspinatus

A

lateral rotation

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24
Q

what is the movement provided by teres minor

A

lateral rotation

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25
Q

what is the movement provided by subscapularis

A

medial rotation

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26
Q

what muscle is found in the posterior compartment of the upper arm

A

the triceps brachii

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27
Q

what are the three heads of the triceps muscle

A

the long, the lateral and the medial

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28
Q

what is the movement provided by the triceps muscle

A

extension, adduction of the shoulder and extension of the elbow

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29
Q

what is the nervous innervation of the triceps

A

the radial nerve

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30
Q

where is the axilla of the arm

A

the anatomical term for the armpit

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31
Q

what is the anterior boundary of the axilla

A

pectoralis major and minor

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32
Q

what is the posterior wall of the axilla

A

the subscapularis, teres major and latissimus dorsi

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33
Q

what is the lateral wall of the axilla

A

the upper humerus

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34
Q

what is the medial wall of the axilla

A

serratus anterior and the chest wall

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35
Q

what is the axillary artery derived from

A

it is a continuation from the subclavian artery

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36
Q

what does the axillary artery give rise to

A

the brachial artery

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37
Q

what spinal nerves does the brachial plexus arise from

A

C5, 6, 7, 8, T1

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38
Q

what are the 5 segments of the brachial plexus

A

roots, trunks, divisions, chords and branches

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39
Q

what are the branches of the brachial plexus

A

musculocutaneous, axillary, medial, radial and ulnar

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40
Q

what are the divisions of the cords of the brachial plexus

A

lateral, posterior and medial cord

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41
Q

what does the axillary nerve supply

A

deltoid and teres minor and some skin on the upper lateral arm

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42
Q

what does the radial nerve innervate

A

the triceps, the muscles in the posterior compartment of the forearm (to digits) and skin of the arm

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43
Q

what does the musculocutaneous nerve innervate

A

Biceps Brachii, brachialis and coracobrachialis as well as skin over the forearm

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44
Q

what does the median nerve innervate

A

most muscles in the anterior forearm, as well as the small muscles of the thumb
sensation to palm of hand and digits to 1/2 of the ring finger

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45
Q

what does the ulnar nerve supply

A

most of the small muscles in the hand as well as skin to the 1/2 of ring finger and the pinky finger

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46
Q

what is the function of biceps

A

flexor of the elbow joint, and is a powerful supinator of the forearm when the elbow is flexed

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47
Q

What are the contents of the cubital fossa

A

the median nerve, the brachial artery, the biceps tendon and the radial nerve

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48
Q

what makes up the borders of the cubital fossa

A

the pronator teres (medial), the brachioradialis (laterally) and a line between the medial and lateral epicondyles (superiorly)

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49
Q

what connects the radius and the ulnar in the arm

A

the interosseous membrane

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50
Q

what movements do the proximal and distal radioulnar joints allow for

A

pronation and supination

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51
Q

what is the proximal row of the carpal bones of the wrist

A

the scaphoid, lunate, triquetral and the pisiform

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52
Q

what is the distal row of the carpal bones of the wrist

A

the trapezium, the trapezoid, capitate and the hamate

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53
Q

what are the four muscles in the superior layer of the forearm, lateral to medial (anterior)

A

pronator teres, flexor carpi radialis, palmaris longus and flexor carpi ulnaris

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54
Q

what is the function of pronator teres

A

pronation of the forearm

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55
Q

what is the function of flexor carpi radialis

A

flexes and abducts the wrist

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56
Q

what is the function of palmaris longus

A

flexion of the wrist

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57
Q

what is the function of flexor carpi ulnaris

A

flexes and adducts the wrist

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58
Q

what is found in the middle layer of the forearm (anterior)

A

the flexor digitorum superficialis

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59
Q

what muscles are found in the deep layer of the anterior forearm

A

the flexor digitorum profundus, the flexor pollicis longus and the pronator quadratus

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60
Q

what is the function of flexor pollicis longus

A

flexes the thumb

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61
Q

what forms the roof of the carpal tunnel

A

a fibrous band called the flexor retinaculum

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62
Q

what travels through the carpal tunnel

A

flexor digitorum superficialis, digitorum profundus, pollicis longus, the medial nerve

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63
Q

what are joints found between the carpal bones, metacarpals and phalanges

A

carpometacarpal joints, metacarpophalangeal joints and interphalangeal joints

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64
Q

what are the movements of the fingers

A

flexion, extension, adduction and abduction

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65
Q

what are the movements of the thumb

A

flexion, extension, adduction, abduction and opposition

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66
Q

what are the intrinsic muscles of the hand

A

thenar eminence, hypothenar eminence, lumbricals and interossei
also have the adductor pollicis which is only connected to the thumb

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67
Q

what is the theca eminence

A

fleshy mass on the palm of the hand at the base of the thumb and contains the three muscles that act on the thumb, the flexor pollicis brevis, the abductor pollicis brevis and the opponens pollicis

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68
Q

what nerve supplies the theca eminence

A

the median nerve

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69
Q

what nerve supplies the adductor pollicis

A

the ulnar nerve

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70
Q

what is the hypothenar eminence

A

fleshy mass on the medial side of palm and contains three muscles that act on the little finger, the flexor digiti minimi, the abductor digiti minimi and the opponens digiti minimi

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71
Q

how many lumbricals are there

A

4 - one for each finger

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72
Q

how many interossei are there

A

there are two groups palmar and dorsal
palmar - three muscles
dorsal - four muscles

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73
Q

do the palmer interossei abduct or adduct the fingers

A

they adduct

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74
Q

do the dorsal interossei abduct or adduct the fingers

A

they abduct

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75
Q

what spinal nerves innervate the dermatomes of the arm

A

spinal nerves C5-T1

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76
Q

what spinal nerve supplies the radial side of the arm/hand (dermatome)

A

C6

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77
Q

what spinal nerve supplies the middle finger dermatome

A

C7

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78
Q

what spinal nerve innervates the ulnar side of the arm/hand (dermatome)

A

C8

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79
Q

what is the blood supply to the hand

A

the ulnar and radial arteries anastomose and form a superficial and a deep palmar arch

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80
Q

what are the six superficial muscles of the posterior forearm

A

brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi, extensor carpi ulnaris

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81
Q

what is the function of brachioradialis

A

weak flexor of elbow

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82
Q

what is the nervous innervation of brachioradialis

A

the radial nerve

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83
Q

what is the function of extensor carpi radialis longus and brevis

A

they extend and abduct the wrist

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84
Q

what is the function of extensor carpi ulnaris

A

extends and adducts the wrist

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85
Q

what are the five muscles in the deep layer of the posterior forearm

A

supinator, abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus, extensor indicis

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86
Q

what is the function of the supinator

A

supinates the forearm and the hand - wraps round upper part of the radius

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87
Q

what is the venous drainage of the hand

A

the dorsal venous network - drain into cephalic vein and basilic vein

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88
Q

what is the anatomical snuffbox

A

triangular shaped depression on the lateral aspect of the wrist - base of thumb seen when its extended

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89
Q

what are the boundaries of the anatomical snuffbox

A

medially is the EPL, and the tendons of EPB and APL laterally

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90
Q

what are the three bones in the hip bone

A

the pubic bone, the ilium and the ischium

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91
Q

where do the three pubic bones articulate

A

at the acetabulum

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92
Q

which foramen in the pelvis is covered with a membrane in life

A

the obturator canal

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93
Q

what is the long bone of the thigh called

A

the femur

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94
Q

what are the sites of muscle attachment on the femur

A

the greater and lesser trochanters

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95
Q

what parts of the femur articulate with the proximal tibia

A

the medial and lateral femoral condyles

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96
Q

what are the movements of the hips

A

flexion, extension, abduction, adduction, medial and lateral rotation and circumduction

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97
Q

what muscles flex the thigh at the hip joint

A

the anterior thigh

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98
Q

what muscles adduct the thigh at the hip joint

A

the medial thigh

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99
Q

what muscles extend the thigh at the hip joint

A

the posterior thigh

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100
Q

what are the movements of the knee

A

flexion and extension

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101
Q

what muscles allow for extension of the knee

A

anterior thigh muscles

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102
Q

what muscles allow for flection of the knee

A

the posterior thigh muscles

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103
Q

what is the anterior muscles of the thigh innervated by

A

the femoral nerve

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104
Q

what are the muscles found in the anterior compartment of the thigh

A

quadriceps femoris (rectus femoris, vastus lateralis, medialis and intermedius), sartorius, iliopsoas and pectineus

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105
Q

what do the quadriceps femoris converge into

A

the quadriceps tendon

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106
Q

what is action provided by the rectus femoris

A

flexion of the hip

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107
Q

what is the action provided by sartorius

A

flexes and laterally rotates the hip joint, it can also flex the knee

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108
Q

what is the action provided by iliopsoas

A

prime flexor of the hip joint

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109
Q

what is the action provided by pectineus

A

flexes and adducts the hip

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110
Q

what muscle does the femoral nerve run down

A

the iliopsoas muscle

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111
Q

what muscles are found in the medial compartment of the thigh

A

adductor brevis, longus and magnus, gracillis and obturator externus

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112
Q

what action does the muscle in the medial thigh provide

A

they help to draw back the leg towards the midline as we walk

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113
Q

what are the muscles in the medial thigh innervated by

A

the obturator nerve

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114
Q

what does the adductor magnus split into

A

an adductor part and a hamstring part

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115
Q

what movement does gracilis provide

A

weak adductor and flexor of the hip and weak flexor of the knee

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116
Q

what movement does obturator externus provide

A

stabilises and laterally rotates the hip

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117
Q

what is the femoral artery a continuation of

A

the external iliac artery

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118
Q

what are the branches of the femoral artery

A

the profunda femoris, and the popliteal artery

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119
Q

what is the obturatior artery a branch of

A

a branch of the internal iliac artery

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120
Q

what spinal nerves is the femoral nerve from

A

the L2-4 spinal nerves

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121
Q

what is the saphenous nerve a branch of

A

the femoral nerve

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122
Q

what spinal nerves is the obturator nerve from

A

the L2-4 spinal nerves

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123
Q

what are the three boundaries of the femoral triangle

A

lateral - sartorius
medial - adductor longus
superior - inguinal ligament

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124
Q

what is the contents of the femoral triangle

A

femoral nerve, artery, vein and lymphatics

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125
Q

what are the notches found on the posterior ilium and ischium

A

the greater and lesser sciatic notches

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126
Q

what are the superior gluteal muscles

A

gluteus maximus, medius and minimus and tensor facia latae

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127
Q

what is the movement supplies by the gluteus maximus

A

extensor of the hip and is important for standing from sitting. it also laterally rotates the hip

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128
Q

what is the movement supplied by gluteus medius

A

abduct and medially rotate the hip

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129
Q

what is the movement supplied by gluteus minimus

A

abduct and medially rotates it

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130
Q

what role does gluteus medius and minimus play in walking

A

when we stand on one leg, mdius and minimus in the limb we are standing on contracts and holds the pelvis level

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131
Q

what movement is supplied by tensor fascial latae

A

contraction of the muscle tenses fascia lata and the iliotibial band. stabilises the knee and flexes hip joint

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132
Q

what are the superficial gluteal muscles innervated by

A

the gluteal nerve (leaves the sacral plexus)

- all bar maximus is innervated by superior gluteal nerve. maximus is innervated by the inferior gluteal nerve

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133
Q

what are the deep gluteal muscles

A

piriformis, superior and inferior gemelli, obturator internus and quadratus femoris

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134
Q

why is the piriformis a key landmark

A

the nerves of the sacral plexus lie over it in the pelvis

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135
Q

what does the sciatic nerve divide into in the posterior thigh

A

the tibial and the common peroneal/fibular nerve

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136
Q

what are the four muscles of the posterior thigh

A

semimembranosus, semitendinosus, biceps femoris (long and short head) and hamstring part of adductor magnus

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137
Q

what muscles in the posterior thigh are called the hamstrings

A

semimembranosus, semitendinosus and the long head of biceps femoris

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138
Q

what movements do the biceps muscles provide

A

extend the hip, flex the knee

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139
Q

what are the hamstring muscles innervated by

A

the tibial nerve

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140
Q

what is the short head of the biceps innervated by

A

common peroneal nerve

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141
Q

what movement does the short head of the biceps provide

A

flexion of the knee

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142
Q

what movement does the hamstring part of the adductor magnus provide

A

extension of the hip

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143
Q

what is the hamstring part of the adductor magnus innervated by

A

the tibial nerve

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144
Q

what vessels are the gluteal muscles supplied by

A

superior and inferior gluteal arteries

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145
Q

what vessels are the hamstring muscles supplied by

A

perforating arteries that arise from the profunda femoris

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146
Q

what spinal nerves makes up the sciatic nerve

A

L4-S3

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147
Q

what is the popliteal fossa

A

a diamond shaped depression behind the knee joint

148
Q

what are the superior boundaries of the popliteal fossa

A

semimembranosus and semitendinosus medially

biceps femoris laterally

149
Q

what are the inferior borders of the popliteal fossa made up of

A

two heads of the gastrocnemius

150
Q

what are the contents of the popliteal fossa

A

popliteal artery, popliteal vein, tibial nerve and the common fibular nerve

151
Q

what arteries does the popliteal artery give rise to

A

the anterior and posterior tibial arteries

152
Q

what does the proximal part of the tibia form

A

the tibial condyles

153
Q

does the fibular contribute to the knee joint

A

no

154
Q

what is the ankle joint made up of

A

the tabular and fibula, talus and calcaneus

155
Q

what are the tarsal bones in the foot made up of

A

the talus, calcaneus (heel bone), navicular, cuboid and three cuneiforms (medial, intermediate and lateral)

156
Q

what bone articulates with the tibia and fibula at the ankle joint

A

the talus

157
Q

what bones of the foot are make up the hindfoot

A

the talus and the calcaneus

158
Q

what bones make up the midfoot

A

the navicular, cuboid and cuneiforms

159
Q

what bones make up the forefoot

A

the metatarsals and phalanges

160
Q

how many interphalangeal joints are there in the big toe

A

1 joint, as there is only two phalanges

161
Q

how many interphalangeal joints are there in toes 2-5

A

two joints, as they contain three phalanges

162
Q

what movements can the foot do

A

dorsiflexion (extension), plantarflexion, inversion, eversion

163
Q

what movements can toes do

A

flexion, extension, abduction and adduction

164
Q

what vessel supplies the dorsalis pedis pulse in the foot

A

the anterior tibial

165
Q

what are the muscles in the anterior compartment of the leg

A

the tibialis anterior, the extensor hallucis longus and extensor digitorum longus

166
Q

what movement is provided by the tibialis anterior

A

dorsiflexion and inversion of the foot

167
Q

what movement is provided by the extensor hallucis longus

A

dorsiflexion of the foot at the ankle

168
Q

what happens if there is damage to the common perineal nerve

A

foot drop

169
Q

what is the movement provided by the extensor digitorum longus

A

dorsiflexes the foot and extends the toes 2-5

170
Q

what are the muscles found in the lateral compartment of the leg

A

peroneus longus and brevis (fibularis)

171
Q

what are the muscles in the lateral leg supplied by

A

the superficial peroneal nerve

172
Q

what are the muscles in the anterior compartment of the leg supplied by

A

the deep peroneal nerve

173
Q

what is the blood supply of the anterior compartment of the leg

A

the anterior tibial artery

174
Q

what is the lateral compartment of the leg supplied by

A

the fibular artery (branch of the posterior tibial artery )

175
Q

what is the nervous supply of the lateral leg

A

the superficial perineal nerve

176
Q

what is the nervous supply of the anterior leg

A

the deep perineal nerve

177
Q

what muscle is found at the dorsum of the foot

A

the extensor digitorum brevis - supplies toes 2 -5

178
Q

what is the nervous supply of the extensor digitorum brevis

A

the deep peroneal nerve

179
Q

what is the nervous supply of the posterior compartment of the leg

A

the tibial neve

180
Q

what is the action of the muscles of the posterior compartment of the leg

A

act as plantarflexors of the foot at the ankle joint and flexors of the toes

181
Q

what are the three superficial muscles of the posterior compartment of the leg

A

Gastrocnemius, soleus and plantaris

182
Q

what is the most superficial muscle in the posterior compartment

A

the gastrocnemius

183
Q

what movement is supplied by the gastrocnemius

A

flex the knee and plantarflexing the ankle

184
Q

what movement is supplied by the soleus muscle

A

it contracts and is important for venous return

185
Q

what are the muscles found in the deep compartment of the posterior leg

A

popliteus, tibialis posterior, flexor hallucis longus and flexor digitorum longus

186
Q

what movement is supplied by popliteus

A

small degree of rotation of the knee

187
Q

what movement is supplied by the tibialis posterior

A

plantarflexion and inversion of the foot

188
Q

what movement is supplied by the flexor hallucis longus

A

flexes the big toe and plantarflexes the foot

189
Q

what is the movement provided by the flexor digitorum longus

A

flexion of the toes and also plantarflexes the foot

190
Q

what are the muscles of the sole of the foot supplied by

A

the medial and lateral plantar nerves

191
Q

what artery supplies the posterior compartment of the leg and sole of the foot

A

the posterior tibial artery

192
Q

what artery supplies the lateral compartment of the leg

A

the fibular artery

193
Q

what nerve supplies the muscles in the posterior compartment of the leg and the plantar surface of the foot

A

the tibial nerve

194
Q

what nerves supply the skin of the foot

A

the tibial innervates most of the plantar surface of the foot, and the common fibular innervates the skin on the lateral leg and the dorsum of the foot

195
Q

what are the arterial supply to the hip joint

A

from the profunda femoris

196
Q

what are the ligaments that stablise the hip joint

A

the iliofemoral, the pubofemoral and the ischiofemoral

197
Q

what are menisci

A

C shaped cartilage that lie on the tibial plateaus

198
Q

what are the important ligaments in the knee joint

A

the collateral and the cruciate ligaments

199
Q

what is the importance of the collateral ligaments

A

the medial and lateral joints support the knee and resist sideways movements of the tibia on the femur

200
Q

what do the cruciate ligaments connect to

A

the anterior and posterior ligaments connect the tibia to the femur. relax when the knee is flexed and taut when the knee is extended

201
Q

what does the anterior cruciate ligament prevent?

A

prevents the tibia moving anteriorly relative to the femur

202
Q

what does the posterior cruciate ligament prevent

A

prevents the tibia moving posteriorly relative to the femur

203
Q

what are the three key lateral ligaments in the ankle joint

A

anterior talofibular, posterior talofibular and calcaneofibular

204
Q

what is the medial ligament of the ankle

A

the deltoid ligament

205
Q

what are the 7 key functions of bone

A

storage of minerals, transmission of body weight, protection of vital organs and structures, anchorage, determines body shape, rises body from ground against gravity, houses bone marrow to facilitate haematopoiesis

206
Q

what are long bones

A

they are tubular in shape, with a hollow shaft and have expanded, have articulate ends

207
Q

what bones are long bones

A

femur, tibia, fibula, metatarsals, humerus, ulna, radius, metacarpals, phalanges

208
Q

what are short bones

A

they are cuboidal in shape

209
Q

what bones are short bones

A

carpals and tarsals

210
Q

what are flat bones

A

they are plates of bone which are often curved. they are protective

211
Q

what bones are flat bones

A

sternum, ribs, scapula, cranial bones

212
Q

what are irregular bones

A

their shapes vary and is often specific to a certain function

213
Q

what bones are irregular bones

A

mandible and vertibrae

214
Q

what are sesamoid bones and give an example

A

they are round, they contain nodules for tendon attachment

- patella

215
Q

what are primary bones

A

these are woven bones, they have a disorganized structure. they are made quickly

216
Q

what is secondary bone

A

it is lamellar bone, made slower and is organised, it is clearly structured

217
Q

what is cortical bone

A

it is compact bone, which is dense and solid, it incorporates spaces for blood vessels and cells

218
Q

what is trabecular bone

A

also called spongy or cancellous it is formed from a network of struts and has a spongy appearance. it has many spaces filled with bone marrow

219
Q

what is the diaphysis of a bone

A

it is the main body of a bone

220
Q

what is the epiphysis of a bone

A

it is the ends of a bone

221
Q

what is ossification

A

it is the bone forming process

222
Q

what is endochondral ossification

A

where bone forms from hyaline cartilage precursor. it occurs during foetal development, ling bone formation and fracture healing

223
Q

what is intramembranous ossification

A

where bones form directly form mesenchyme, and occurs in foretal development to form flat or irregular bones

224
Q

describe the process of endochondral ossification

A

Chondrocytes produce a cartilaginous precursor
Primary ossification centre is formed as osteoblasts lay bone onto the cartilage
Osteoclasts break down the cartilage
POC is vascularised as blood vessels invade
Periosteum collar is formed outside the bone as perichondrium is broken down
Parts of the spongy bone making up the POC are broken down to form the medullary cavity
Process repeats at ends of long bones to form secondary ossification centre
Some layers of cartilage remain between the SOC and POC, known as the epiphyseal (growth) plate

225
Q

describe the process of intermembranous ossification

A

Mesenchymal stem cells replicate, forming clusters called nidus
Stem cells in nidus become osteoprogenitor cells
Osteoprogenitor cells differentiate into osteoblasts
Osteoblasts produces extracellular matrix containing T1 Collagen fibres
Some osteoblasts become trapped in matrix, forming osteocytes
Bone spicules form via mineralisation
Spicules grow and fuse to form trabeculae, around which periosteum is now formed

226
Q

what is the epiphysial plate

A

it is the growth plate allowing for continued growth of long bones in children

227
Q

what causes the size of the growth plate to increase

A

constant chondrocyte division

228
Q

what is mineralisation of bone

A

when hydroxyapatite crystals are deposited into the bones fibrous matrix. it hardens the bone and is vitamin D and PTH mediated

229
Q

what are the 5 steps involved in bone remodelling

A

Activation
Monocytes on bone surface differentiate to become osteoclasts
Reabsorbtion
Osteoclasts secrete acid to dissolve the bone mineral
Reversal

Osteoblasts are stimulated/recruited
Formation
Osteoblasts secrete osteoid to form bone matrix
5. Quiescence 
Without stimulation there is no action
230
Q

why does bone remodelling occur

A 
Forming bone shape
Replacing woven bone with lamellar 
Reorientation of fibrils and trabeculae to reinforce mechanical strength
Response to load
Calcium release
Damage repair
231
Q

what stimulates increased osteoclast activity

A

RANK ligand

232
Q

how does RANK L increase osteoclast activity

A

Secreted by osteoblasts
Binds to RANK receptors on monocytes
Monocytes differentiate to osteoclasts which actively reabsorb bone
Osteoblasts secrete more RANK L in the presence of oestrogen (as well as other hormones, GFs, and cytokines)

233
Q

what factor inhibits osteoclast activity

A

Osteoprotegerin

234
Q

how does osteoprotegerin reduce osteoclast activity

A

Produced by osteoblasts and stromatolites cells
Binds to RANK L, preventing osteoclast activation
Decreases reabsorbtion rates

235
Q

what is Wolffs law

A

In a healthy individual, bone will adapt to the loads under which it is placed

236
Q

what is the action of parathyroid hormone on bone

A

PTH increases bone remodelling rates and calcium resorption

237
Q

what is the Vitamin D pathway or activation

A

7-dehydroxycholesterol is synthesised directly from ingested cholesterol (found in fatty foods)
This is converted to Vitamin D3, facilitated by UVB radiation from the sun
Vitamin D3 is converted to 25-hydroxyvitamin D (aka CALCIDIOL) in the liver, via the cytochrome P450 system
Calcidiol is converted to 1,25-dihydroxyvitamin D (aka CALCITRIOL) in the presence of PTH
The presence of calcitriol can then go on and promote gut calcium ion absorption

238
Q

what cells produce calcitonin

A

the thyroid gland C cells

239
Q

what is calcitonin released in response to

A

released in response to increased serum calcium

240
Q

what is the most important regulator of serum phosphate

A

FGF-23

241
Q

where is FGF-23 produced

A

it is produced by osteocytes

242
Q

what is FGF-23 released in response to

A

rise in serum PO4-, presence of PTH and presence of calcitriol

243
Q

what is the action of FGF 23

A

It binds to Klotho-FGF receptors, resulting in decreased expression of Na+ cotransporters in renal tubules
It also decreases calcitriol formation
Resulting in increased PO4- excretion & decreased reabsorption
FGF-23 secretion is inhibited by PHEX when serum phosphate levels fall

244
Q

what happens to extracellular phosphate

A

either used for bone formation or it is excreted

245
Q

what is the dietary form of phosphate

A

meat, dairy, nuts and seeds

246
Q

what is the dietary sources of calcium

A

dairy, vegetables and oily fish

247
Q

what are the different types of fracture

A

transverse, linear, oblique non displaced and oblique displaced, spiral, greenstick, comminutes and avulsion

248
Q

what is the first step in fracture healing

A

haematoma formation - traumatic fracture ruptures blood vessels at fracture site, and there is bleeding which causes a haematoma. there is a reduced blood supply to bone cells starving them of nutrients

249
Q

what is the second step in fracture healing

A

new capillaries grow at the fracture site and supplies nutrients for repair. the dead tissue undergoes phagocytosis and connective tissue form a repair tissue, splinting the bone

250
Q

what is stage three in fracture healing

A

osteoblasts and osteoclasts migrate to the fracture site and divide. they replace the soft fibrocartilage with spongy bone to form a hard callus forming a bulge at the fracture site

251
Q

what is the 4th/final step in fracture healing

A

bone remodelling occurs where the bony callus is remodelled in response to mechanical stress. there is a strong permanent patch at the fracture side and the new bone is stronger and more compact

252
Q

what is a synarthroses joint

A

an immobile joint that is mostly fibrous (e.g between the skull)

253
Q

what is a amphiarthroses joint

A

a slightly mobile joint, mostly cartilaginous (e.g intervertebral discs)

254
Q

what is a diarthroses joint

A

it is a freely mobile joint which is mostly synovial (e.g hip and shoulder joint)

255
Q

what is a fibrous joint

A

one held together by fibrous tissue

256
Q

what is a cartilaginous joint

A

one held together by cartilage

257
Q

what is a synovial joint

A

held together by a synovial fluid filled capsule, all have articulations, a joint capsule, a joint cavity, synovial fluid and reinforcing ligaments

258
Q

what are the classifications of synovial joints

A 
ball and socket 
condyloid 
hinge joint 
pivot 
saddle 
gliding
259
Q

how is collagen synthesised

A

3 collagen models come together to form a triple helix called tropocollagen
It is secreted from a fibroblast, here it’s terminal polypeptides are removed
Tropocollagen molecules then form covalent cross links between one molecules lysine, and another’s adjacent hydrolysine - this process forms microfibrils
Microfibrils combine forming fibrils
Fibrils combine to form fibres
Fibres form fascicles which are enclosed in the endotendon
The tendon is enclosed in the epitendon

260
Q

what are the 4 phases of stress/strain in tendons and ligaments

A

phase 1 = increased load results in crumpled collagen fibres
phase 2 = fibres straighten and stiffness rapidly increases with loading
phase 3 = maximum deformation and ultimate tensile stress - progressive fibre failure
phase 4 = complete failure of connective tissues to support loads

261
Q

where are tendons found

A

muscle to bone

262
Q

where are ligaments found

A

bone to bone

263
Q

what are the differences between tendons and ligaments

A

ligaments contain low type 1 collagen, high elastin and are randomly organised with a blood supply from insertion points.
tenson has high type 1 collagen, with low elastin and is highly organised, and is mainly avascular with some blood from surrounding sheath

264
Q

what is a fibrous attachment

A

Formed via intramembranous ossification

Tendon or ligament attached to bone via sharpey’s fibres

265
Q

what is a fibrocartilagenous attachment

A

Formed via endochondral ossification
Tendon or ligament attached to the bone through a gradual change from collagenous ligament, to fibrocartilage, to mineralised bone

266
Q

what are the fibre components of contraction

A

actin, myosin, troponin and tropomyosin

267
Q

what are the three types of troponin

A

C, I, and T

268
Q

how does sarcomere contraction occur

A

Ca2+ ions from the sarcoplasmic reticulum bind to troponin C, resulting in a conformational change of troponin
Troponin moves, exposing actin filament binding sites
Myosin head binds to actin, forming cross links - power stroke is formed, shortening the sarcomere
ATP binds to myosin head and is hydrolysed, this releases energy, breaking the cross links, resulting in detachment of actin and myosin
Myosin head reattaches to the next actin binding site and the cycle is repeated, continuing sarcomere shortening and muscle contraction

269
Q

what is the structure of cortical bone

A

it is compact and made of osteons

270
Q

what are osteons

A

they are layers of lamellae which is surrounding a haversian canal

271
Q

what directions do haversian canals run

A

horizontal across the bone

272
Q

what do osteocytes receive blood through

A

through canaliculi

273
Q

where are osteoblasts locates in the bone

A

in the endosteum and the periosteum

274
Q

where is the endosteum found

A

on the inside of the cortical layer of the bone

275
Q

what does mineralised bone stain

A

pink staining

276
Q

where do osteoblasts lie

A

between mineralised and unmineralised bone

277
Q

are osteoblasts small or big

A

they are small single nucleated cells

278
Q

what is the cell characteristics of osteoclasts

A

these are large multinucleated cells

279
Q

where do osteoclasts lie

A

they lie within howships lacuni / resorption bay

280
Q

what movements can the shoulder do

A

flexion, extension, medial and lateral rotation

281
Q

what are the three chest muscles

A

pectoralis major, minor and serratus anterior

282
Q

what is the nerve innervation of pectoralis major

A

the medial and lateral pectoral nerve

283
Q

what is the nerve innervation of pectoralis minor

A

the medial pectoral

284
Q

what is the nerve innervation of serratus anterior

A

long thoracic nerve

285
Q

what happens if there is damage to the long thoracic nerve

A

it causes a winged scapula

286
Q

where are the two origins of pectoralis major

A

clavicular head from the anterior clavicle

sternocostal head from the sternum and first 6 ribs

287
Q

where does pectoralis major insert

A

onto the greater tubercle of the humerus

288
Q

what is the action of pectoralis major

A

it flexes the humerus, as well as adduction, extension and external rotation

289
Q

where is the origin of pectoralis minor

A

ribs 3-5

290
Q

where does pectoralis minor insert

A

on the coracoid process of the scapula

291
Q

what is the action of pectoralis minor

A

it stabilises the scapula by drawing it anteriorly

292
Q

what is the origin and insertion of serratus anterior

A

origin is the lateral aspect of ribs 1-8

insertion is the medial border of the scapula

293
Q

what is the action of the serratus anterior

A

it rotates the scapula to allow arm abduction and holds the scapula against the ribcage

294
Q

what bone pronates and supinates the arm

A

the radius - moves over the ulnar

295
Q

what is the origins of trapezius

A

the external occipital protuberance, spinous processes C1-6 and spinous processes T4-12

296
Q

where does trapezius insert

A

lateral 1/3 of the clavicle, spine of the scapula and the acromion

297
Q

what is the nerve innervation of latissimus dorsi

A

the thoracodorsal nerve

298
Q

what is the action of latissimus dorsi

A

extension, adduction and medial rotation of the arm at the shoulder

299
Q

what are the origins of latissimus dorsi

A

vertebrae, ilium and ribs 9-12, and inferior angle of the scapula

300
Q

what is the insertion of latissimus dorsi

A

anterior of humerus in the intertubercular sulcus

301
Q

what is the nervous innervation levator scapula

A

the dorsal scapular nerve

302
Q

what is the origin and insertion of the levator scapula

A

origin is C1-4

insertion is the superior part of the medial border of the scapula

303
Q

what is the nervous innervation of the rhomboids

A

the dorsal scapular nerve

304
Q

what are the origins and insertions of the rhomboids

A

the origins are vertebrae C7-T1 for minor and T2-5 for major
the insertion is the medial border of the scapula

305
Q

what is the action of the rhomboids

A

it draws the scapular superomedially

306
Q

how many sections does the deltoid muscle have

A

three portions, anterior, middle and posterior

  • anterior flexes and rotates
  • middle abducts
  • posterior extends and laterally rotates
307
Q

what are the origins and insertions of deltoid

A

origins - clavicle, acromion and spine of scapula (SAC posterior to anterior)
- all insert onto the lateral aspect of the humerus

308
Q

what is the nervous innervation of teres major

A

the lower subscapular nerve

309
Q

what is the action of teres major

A

it adducts, and extends at the shoulder joint as well as medial rotation of the arm

310
Q

where is the origin and insertion of teres major

A

origin is the inferior angle of the scapula and the insertion is the anterior humerus

311
Q

where is the axilla

A

in the upper arm

312
Q

what are the borders of the axilla

A

anterior - pectoralis major/minor
posterior - scapularis, teres major, latissimus dorsi
medial - serratus anterior and thoracic wall
lateral - intertubercular sulcus

313
Q

what is found within the axilla

A

axillary artery and vein, the short head of biceps brachii, coracobrachialis and the cords of the brachial plexus

314
Q

what in the shoulder joint helps reduce friction

A

the bursae and the synovial fluid

315
Q

what is the most common direction to dislocate your arm

A

anterior (can damage axillary nerve)

316
Q

what are the insertions of the muscles of the rotator cuff

A

all bar subscapularis insert into the greater tubercle, which attaches onto the lesser tubercle

317
Q

why is the posterior branches of the brachial plexus called posterior

A

because it goes posterior to the axillary artery

318
Q

what are the nerve roots of the musculocutaneous nerve

A

C5-7

319
Q

what are the nerve roots of he axillary nerve

A

C5-6

320
Q

what are the nerve roots of the medial nerve

A

C6-T1

321
Q

what are the nerve roots of the ulnar nerve

A

C8-T1

322
Q

what are the nerve roots of the radial nerve

A

all of them (C5-T1)

323
Q

what is the flow of blood in the arm

A

subclavian artery - axillary artery - brachial artery - radial and ulnar arteries - palmer arches

324
Q

what is the vein drainage of the arm

A

dorsal veins - deep radial and ulnar veins - brachial veins - subclavian vein

325
Q

what is the spinal nerve reflex of the biceps brachii

A

C6

326
Q

where is the origin of the biceps brachii

A

both heads originate from the scapula

327
Q

where does the biceps brachii insert

A

onto the radius

328
Q

what is the action of the coracobrachialis

A

causes flexion of the arm and shoulder and weakly abducts the arm

329
Q

what is the insertion and origin of coracobrachialis

A

originates from cricoid process of scapula

inserts onto the medial humerus (half way down)

330
Q

what is the insertion and origin of brachialis

A

origin is the anterior surface of the humerus and it inserts onto the coronoid process of the ulnar

331
Q

what is the action of brachialis

A

flexion of the elbow

332
Q

what is the action of the triceps brachii

A

causes extension of the arm at the elbow

333
Q

what is the tendon reflex of the triceps caused by

A

C7

334
Q

where are the origins of the three heads of the triceps

A

long head - infraglenoid tubercle
medial head - below the radial groove
lateral head - above the radial groove

335
Q

where is the insertion of the triceps brachii

A

the olecranon process of the ulnar (pointy bit)

336
Q

what are the ligaments either side of the elbow that help stabilise it

A

the collateral ligaments (anterior and posterior)

337
Q

what are the contents of the cubital fossa

A

radial nerve, biceps tendon, brachial artery, medial nerve

338
Q

where does the ulnar nerve run in the elbow joint

A

posterior to the medial epicondyle

339
Q

what are the bones of the hand - lateral to medial

A

1st row
scaphoid, lunate, triquetrum, pisiform

2nd row
trapezium, trapezoid, capitate, hamate

340
Q

what is the sesamoid bone found in the hand

A

the pisiform bone

341
Q

what is the vascular supply to the hand

A

= ulnar artery gives off the superficial palmar arch (major digital arteries to fingers)
- radial artery enters behind the thumb into palm to make the deep palmar arch, (main supply to the thumb)

342
Q

what nerve is found in the carpal tunnel

A

the median nerve

343
Q

what is flexion of the fingers

A

making a fist

344
Q

what is it called when you touch your thumb to a finger

A

opposition

345
Q

what are the supinators of the arm

A

the supinator muscle on the radial side, and the biceps when the arm is flexed

346
Q

what are the pronators of the arm

A

pronator teres
pronator quadratus (ulnar side)
brachioradialis

347
Q

where does the brachioradialis originate from and insert

A

the lateral epicondyle - origin

styloid process of radius - insertion

348
Q

what is the origin of pronator teres

A

the ulnar head and median epicondyle

349
Q

what are the wrist flexors

A

flexor carpi radialis, flexor carpi ulnaris and palmaris longus

350
Q

what inserts onto the medial epicondyle

A

the flexors of the wrist (superficial and flexor digitorum superficialis)

351
Q

where do the deep muscles of the forearm originate from

A

the bone rather than epicondyles

352
Q

what muscles do finger flexion

A

flexor digitorum superficialis and profundus

353
Q

where does flexor digitorum superficialis and profundus insert

A

superficialis - the middle phalanx

profundus - the distal phalanx (moves through superficialis)

354
Q

what muscles are involved in finger flexion

A 
extensor digitorum (superficial) 
extensor digiti minimi (superficial) 
extensor indicis (deep) 
lumbricals - intrinsic muscles of the hand
355
Q

where do the extrinsic extensors of the fingers insert onto

A

they insert onto the proximal phalanx

356
Q

where do the intrinsic extensors of the hand (lumbricals and interossei) insert

A

they bind into the extensor hood of the fingers

357
Q

what is the action of the dorsal interossei

A

they abduct the fingers

358
Q

what is the action of the palmer interossei

A

they adduct the fingers

359
Q

what is thumb flexion achieved by

A

flexor pollicis longus and brevis

360
Q

what is thumb extension achieved by

A

extensor pollicis longus and brevis

361
Q

what is opposition achieved by

A

opponens pollicis and opponens digiti minimi

362
Q

what is the medial border of the snuffbox

A

extensor pollicis longus

363
Q

what is the lateral border of the snuffbox

A

extensor pollicis brevis and abductor pollicis longus

364
Q

what is the floor of the snuffbox

A

the scaphoid and trapezium

365
Q

what is the contents of the snuffbox

A

radial nerve and artery

366
Q

what are the muscles of the thenar eminence

A

abductor pollicis brevis, flexor pollicis brevis and opponens pollicis

Jemima Flash Cards (9 decks)

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