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
2
Q
what is the glenohumeral joint
A
the shoulder joint - a synovial joint made up of the scapula and the humerus
3
Q
describe the elbow joint
A
synovial hinge joint which joins the distal humerus with the ulna and the radius
4
Q
what movements can the shoulder joint do
A
flexion, extension, abduction, adduction, medial and lateral rotation and circumduction
5
Q
what movements can the elbow joint do
A
flexion and extension
6
Q
what movement can the radioulnar joint do
A
pronation and supination
7
Q
what movement can the wrist joint do
A
flexion, extension, adduction and abduction
8
Q
what movement can the fingers do
A
flexion, extension, adduction and abduction
9
Q
what are the two large superficial muscles of the posterior pectoral girdle
A
the trapezius and the latissimus dorsi
10
Q
what are the three smaller deep muscles in the posterior pectoral girdle
A
the levator scapulae, rhomboid major and rhomboid minor
11
Q
what movement does trapezius provide
A
rotation, retraction , elevation and depression of the scapula (towards the midline, up and down)
12
Q
what is the movement provided by latissimus dorsi
A
extends, adducts and medially rotates the humerus
13
Q
what is the movement provided by the levator scapulae
A
elevation
14
Q
what is the movement provided by rhomboid major and minor
A
retraction
15
Q
what is the nervous innervation of latissimus dorsi
A
the thoracodorsal nerve
16
Q
what are the muscles of the shoulder
A
the deltoid, the supraspinatus, the infraspinatus the subscapularis, teres major and minor
17
Q
what are the muscles of the rotator cuff
A
supraspinatus, infraspinatus, subscapularis and teres minor
18
Q
what movement is provided by the deltoid muscle
A
abducts the shoulder joint (doesnt initiate it)
19
Q
what is the innervation of the deltoid muscle
A
the axillary nerve (from brachial plexus)
20
Q
what movement is provided by teres major
A
medial rotation and adduction
21
Q
what is the nervous innervation of teres minor
A
the axillary nerve
22
Q
what is the movement provided by the supraspinatus muscle
A
the first 20 degrees of abduction
23
Q
what is the movement provided by infraspinatus
A
lateral rotation
24
Q
what is the movement provided by teres minor
A
lateral rotation
25
what is the movement provided by subscapularis
medial rotation
26
what muscle is found in the posterior compartment of the upper arm
the triceps brachii
27
what are the three heads of the triceps muscle
the long, the lateral and the medial
28
what is the movement provided by the triceps muscle
extension, adduction of the shoulder and extension of the elbow
29
what is the nervous innervation of the triceps
the radial nerve
30
where is the axilla of the arm
the anatomical term for the armpit
31
what is the anterior boundary of the axilla
pectoralis major and minor
32
what is the posterior wall of the axilla
the subscapularis, teres major and latissimus dorsi
33
what is the lateral wall of the axilla
the upper humerus
34
what is the medial wall of the axilla
serratus anterior and the chest wall
35
what is the axillary artery derived from
it is a continuation from the subclavian artery
36
what does the axillary artery give rise to
the brachial artery
37
what spinal nerves does the brachial plexus arise from
C5, 6, 7, 8, T1
38
what are the 5 segments of the brachial plexus
roots, trunks, divisions, chords and branches
39
what are the branches of the brachial plexus
musculocutaneous, axillary, medial, radial and ulnar
40
what are the divisions of the cords of the brachial plexus
lateral, posterior and medial cord
41
what does the axillary nerve supply
deltoid and teres minor and some skin on the upper lateral arm
42
what does the radial nerve innervate
the triceps, the muscles in the posterior compartment of the forearm (to digits) and skin of the arm
43
what does the musculocutaneous nerve innervate
Biceps Brachii, brachialis and coracobrachialis as well as skin over the forearm
44
what does the median nerve innervate
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
45
what does the ulnar nerve supply
most of the small muscles in the hand as well as skin to the 1/2 of ring finger and the pinky finger
46
what is the function of biceps
flexor of the elbow joint, and is a powerful supinator of the forearm when the elbow is flexed
47
What are the contents of the cubital fossa
the median nerve, the brachial artery, the biceps tendon and the radial nerve
48
what makes up the borders of the cubital fossa
the pronator teres (medial), the brachioradialis (laterally) and a line between the medial and lateral epicondyles (superiorly)
49
what connects the radius and the ulnar in the arm
the interosseous membrane
50
what movements do the proximal and distal radioulnar joints allow for
pronation and supination
51
what is the proximal row of the carpal bones of the wrist
the scaphoid, lunate, triquetral and the pisiform
52
what is the distal row of the carpal bones of the wrist
the trapezium, the trapezoid, capitate and the hamate
53
what are the four muscles in the superior layer of the forearm, lateral to medial (anterior)
pronator teres, flexor carpi radialis, palmaris longus and flexor carpi ulnaris
54
what is the function of pronator teres
pronation of the forearm
55
what is the function of flexor carpi radialis
flexes and abducts the wrist
56
what is the function of palmaris longus
flexion of the wrist
57
what is the function of flexor carpi ulnaris
flexes and adducts the wrist
58
what is found in the middle layer of the forearm (anterior)
the flexor digitorum superficialis
59
what muscles are found in the deep layer of the anterior forearm
the flexor digitorum profundus, the flexor pollicis longus and the pronator quadratus
60
what is the function of flexor pollicis longus
flexes the thumb
61
what forms the roof of the carpal tunnel
a fibrous band called the flexor retinaculum
62
what travels through the carpal tunnel
flexor digitorum superficialis, digitorum profundus, pollicis longus, the medial nerve
63
what are joints found between the carpal bones, metacarpals and phalanges
carpometacarpal joints, metacarpophalangeal joints and interphalangeal joints
64
what are the movements of the fingers
flexion, extension, adduction and abduction
65
what are the movements of the thumb
flexion, extension, adduction, abduction and opposition
66
what are the intrinsic muscles of the hand
thenar eminence, hypothenar eminence, lumbricals and interossei
also have the adductor pollicis which is only connected to the thumb
67
what is the theca eminence
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
68
what nerve supplies the theca eminence
the median nerve
69
what nerve supplies the adductor pollicis
the ulnar nerve
70
what is the hypothenar eminence
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
71
how many lumbricals are there
4 - one for each finger
72
how many interossei are there
there are two groups palmar and dorsal
palmar - three muscles
dorsal - four muscles
73
do the palmer interossei abduct or adduct the fingers
they adduct
74
do the dorsal interossei abduct or adduct the fingers
they abduct
75
what spinal nerves innervate the dermatomes of the arm
spinal nerves C5-T1
76
what spinal nerve supplies the radial side of the arm/hand (dermatome)
C6
77
what spinal nerve supplies the middle finger dermatome
C7
78
what spinal nerve innervates the ulnar side of the arm/hand (dermatome)
C8
79
what is the blood supply to the hand
the ulnar and radial arteries anastomose and form a superficial and a deep palmar arch
80
what are the six superficial muscles of the posterior forearm
brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi, extensor carpi ulnaris
81
what is the function of brachioradialis
weak flexor of elbow
82
what is the nervous innervation of brachioradialis
the radial nerve
83
what is the function of extensor carpi radialis longus and brevis
they extend and abduct the wrist
84
what is the function of extensor carpi ulnaris
extends and adducts the wrist
85
what are the five muscles in the deep layer of the posterior forearm
supinator, abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus, extensor indicis
86
what is the function of the supinator
supinates the forearm and the hand - wraps round upper part of the radius
87
what is the venous drainage of the hand
the dorsal venous network - drain into cephalic vein and basilic vein
88
what is the anatomical snuffbox
triangular shaped depression on the lateral aspect of the wrist - base of thumb seen when its extended
89
what are the boundaries of the anatomical snuffbox
medially is the EPL, and the tendons of EPB and APL laterally
90
what are the three bones in the hip bone
the pubic bone, the ilium and the ischium
91
where do the three pubic bones articulate
at the acetabulum
92
which foramen in the pelvis is covered with a membrane in life
the obturator canal
93
what is the long bone of the thigh called
the femur
94
what are the sites of muscle attachment on the femur
the greater and lesser trochanters
95
what parts of the femur articulate with the proximal tibia
the medial and lateral femoral condyles
96
what are the movements of the hips
flexion, extension, abduction, adduction, medial and lateral rotation and circumduction
97
what muscles flex the thigh at the hip joint
the anterior thigh
98
what muscles adduct the thigh at the hip joint
the medial thigh
99
what muscles extend the thigh at the hip joint
the posterior thigh
100
what are the movements of the knee
flexion and extension
101
what muscles allow for extension of the knee
anterior thigh muscles
102
what muscles allow for flection of the knee
the posterior thigh muscles
103
what is the anterior muscles of the thigh innervated by
the femoral nerve
104
what are the muscles found in the anterior compartment of the thigh
quadriceps femoris (rectus femoris, vastus lateralis, medialis and intermedius), sartorius, iliopsoas and pectineus
105
what do the quadriceps femoris converge into
the quadriceps tendon
106
what is action provided by the rectus femoris
flexion of the hip
107
what is the action provided by sartorius
flexes and laterally rotates the hip joint, it can also flex the knee
108
what is the action provided by iliopsoas
prime flexor of the hip joint
109
what is the action provided by pectineus
flexes and adducts the hip
110
what muscle does the femoral nerve run down
the iliopsoas muscle
111
what muscles are found in the medial compartment of the thigh
adductor brevis, longus and magnus, gracillis and obturator externus
112
what action does the muscle in the medial thigh provide
they help to draw back the leg towards the midline as we walk
113
what are the muscles in the medial thigh innervated by
the obturator nerve
114
what does the adductor magnus split into
an adductor part and a hamstring part
115
what movement does gracilis provide
weak adductor and flexor of the hip and weak flexor of the knee
116
what movement does obturator externus provide
stabilises and laterally rotates the hip
117
what is the femoral artery a continuation of
the external iliac artery
118
what are the branches of the femoral artery
the profunda femoris, and the popliteal artery
119
what is the obturatior artery a branch of
a branch of the internal iliac artery
120
what spinal nerves is the femoral nerve from
the L2-4 spinal nerves
121
what is the saphenous nerve a branch of
the femoral nerve
122
what spinal nerves is the obturator nerve from
the L2-4 spinal nerves
123
what are the three boundaries of the femoral triangle
lateral - sartorius
medial - adductor longus
superior - inguinal ligament
124
what is the contents of the femoral triangle
femoral nerve, artery, vein and lymphatics
125
what are the notches found on the posterior ilium and ischium
the greater and lesser sciatic notches
126
what are the superior gluteal muscles
gluteus maximus, medius and minimus and tensor facia latae
127
what is the movement supplies by the gluteus maximus
extensor of the hip and is important for standing from sitting. it also laterally rotates the hip
128
what is the movement supplied by gluteus medius
abduct and medially rotate the hip
129
what is the movement supplied by gluteus minimus
abduct and medially rotates it
130
what role does gluteus medius and minimus play in walking
when we stand on one leg, mdius and minimus in the limb we are standing on contracts and holds the pelvis level
131
what movement is supplied by tensor fascial latae
contraction of the muscle tenses fascia lata and the iliotibial band. stabilises the knee and flexes hip joint
132
what are the superficial gluteal muscles innervated by
the gluteal nerve (leaves the sacral plexus)
| - all bar maximus is innervated by superior gluteal nerve. maximus is innervated by the inferior gluteal nerve
133
what are the deep gluteal muscles
piriformis, superior and inferior gemelli, obturator internus and quadratus femoris
134
why is the piriformis a key landmark
the nerves of the sacral plexus lie over it in the pelvis
135
what does the sciatic nerve divide into in the posterior thigh
the tibial and the common peroneal/fibular nerve
136
what are the four muscles of the posterior thigh
semimembranosus, semitendinosus, biceps femoris (long and short head) and hamstring part of adductor magnus
137
what muscles in the posterior thigh are called the hamstrings
semimembranosus, semitendinosus and the long head of biceps femoris
138
what movements do the biceps muscles provide
extend the hip, flex the knee
139
what are the hamstring muscles innervated by
the tibial nerve
140
what is the short head of the biceps innervated by
common peroneal nerve
141
what movement does the short head of the biceps provide
flexion of the knee
142
what movement does the hamstring part of the adductor magnus provide
extension of the hip
143
what is the hamstring part of the adductor magnus innervated by
the tibial nerve
144
what vessels are the gluteal muscles supplied by
superior and inferior gluteal arteries
145
what vessels are the hamstring muscles supplied by
perforating arteries that arise from the profunda femoris
146
what spinal nerves makes up the sciatic nerve
L4-S3
147
what is the popliteal fossa
a diamond shaped depression behind the knee joint
148
what are the superior boundaries of the popliteal fossa
semimembranosus and semitendinosus medially
| biceps femoris laterally
149
what are the inferior borders of the popliteal fossa made up of
two heads of the gastrocnemius
150
what are the contents of the popliteal fossa
popliteal artery, popliteal vein, tibial nerve and the common fibular nerve
151
what arteries does the popliteal artery give rise to
the anterior and posterior tibial arteries
152
what does the proximal part of the tibia form
the tibial condyles
153
does the fibular contribute to the knee joint
no
154
what is the ankle joint made up of
the tabular and fibula, talus and calcaneus
155
what are the tarsal bones in the foot made up of
the talus, calcaneus (heel bone), navicular, cuboid and three cuneiforms (medial, intermediate and lateral)
156
what bone articulates with the tibia and fibula at the ankle joint
the talus
157
what bones of the foot are make up the hindfoot
the talus and the calcaneus
158
what bones make up the midfoot
the navicular, cuboid and cuneiforms
159
what bones make up the forefoot
the metatarsals and phalanges
160
how many interphalangeal joints are there in the big toe
1 joint, as there is only two phalanges
161
how many interphalangeal joints are there in toes 2-5
two joints, as they contain three phalanges
162
what movements can the foot do
dorsiflexion (extension), plantarflexion, inversion, eversion
163
what movements can toes do
flexion, extension, abduction and adduction
164
what vessel supplies the dorsalis pedis pulse in the foot
the anterior tibial
165
what are the muscles in the anterior compartment of the leg
the tibialis anterior, the extensor hallucis longus and extensor digitorum longus
166
what movement is provided by the tibialis anterior
dorsiflexion and inversion of the foot
167
what movement is provided by the extensor hallucis longus
dorsiflexion of the foot at the ankle
168
what happens if there is damage to the common perineal nerve
foot drop
169
what is the movement provided by the extensor digitorum longus
dorsiflexes the foot and extends the toes 2-5
170
what are the muscles found in the lateral compartment of the leg
peroneus longus and brevis (fibularis)
171
what are the muscles in the lateral leg supplied by
the superficial peroneal nerve
172
what are the muscles in the anterior compartment of the leg supplied by
the deep peroneal nerve
173
what is the blood supply of the anterior compartment of the leg
the anterior tibial artery
174
what is the lateral compartment of the leg supplied by
the fibular artery (branch of the posterior tibial artery )
175
what is the nervous supply of the lateral leg
the superficial perineal nerve
176
what is the nervous supply of the anterior leg
the deep perineal nerve
177
what muscle is found at the dorsum of the foot
the extensor digitorum brevis - supplies toes 2 -5
178
what is the nervous supply of the extensor digitorum brevis
the deep peroneal nerve
179
what is the nervous supply of the posterior compartment of the leg
the tibial neve
180
what is the action of the muscles of the posterior compartment of the leg
act as plantarflexors of the foot at the ankle joint and flexors of the toes
181
what are the three superficial muscles of the posterior compartment of the leg
Gastrocnemius, soleus and plantaris
182
what is the most superficial muscle in the posterior compartment
the gastrocnemius
183
what movement is supplied by the gastrocnemius
flex the knee and plantarflexing the ankle
184
what movement is supplied by the soleus muscle
it contracts and is important for venous return
185
what are the muscles found in the deep compartment of the posterior leg
popliteus, tibialis posterior, flexor hallucis longus and flexor digitorum longus
186
what movement is supplied by popliteus
small degree of rotation of the knee
187
what movement is supplied by the tibialis posterior
plantarflexion and inversion of the foot
188
what movement is supplied by the flexor hallucis longus
flexes the big toe and plantarflexes the foot
189
what is the movement provided by the flexor digitorum longus
flexion of the toes and also plantarflexes the foot
190
what are the muscles of the sole of the foot supplied by
the medial and lateral plantar nerves
191
what artery supplies the posterior compartment of the leg and sole of the foot
the posterior tibial artery
192
what artery supplies the lateral compartment of the leg
the fibular artery
193
what nerve supplies the muscles in the posterior compartment of the leg and the plantar surface of the foot
the tibial nerve
194
what nerves supply the skin of the foot
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
what are the arterial supply to the hip joint
from the profunda femoris
196
what are the ligaments that stablise the hip joint
the iliofemoral, the pubofemoral and the ischiofemoral
197
what are menisci
C shaped cartilage that lie on the tibial plateaus
198
what are the important ligaments in the knee joint
the collateral and the cruciate ligaments
199
what is the importance of the collateral ligaments
the medial and lateral joints support the knee and resist sideways movements of the tibia on the femur
200
what do the cruciate ligaments connect to
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
what does the anterior cruciate ligament prevent?
prevents the tibia moving anteriorly relative to the femur
202
what does the posterior cruciate ligament prevent
prevents the tibia moving posteriorly relative to the femur
203
what are the three key lateral ligaments in the ankle joint
anterior talofibular, posterior talofibular and calcaneofibular
204
what is the medial ligament of the ankle
the deltoid ligament
205
what are the 7 key functions of bone
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
what are long bones
they are tubular in shape, with a hollow shaft and have expanded, have articulate ends
207
what bones are long bones
femur, tibia, fibula, metatarsals, humerus, ulna, radius, metacarpals, phalanges
208
what are short bones
they are cuboidal in shape
209
what bones are short bones
carpals and tarsals
210
what are flat bones
they are plates of bone which are often curved. they are protective
211
what bones are flat bones
sternum, ribs, scapula, cranial bones
212
what are irregular bones
their shapes vary and is often specific to a certain function
213
what bones are irregular bones
mandible and vertibrae
214
what are sesamoid bones and give an example
they are round, they contain nodules for tendon attachment
| - patella
215
what are primary bones
these are woven bones, they have a disorganized structure. they are made quickly
216
what is secondary bone
it is lamellar bone, made slower and is organised, it is clearly structured
217
what is cortical bone
it is compact bone, which is dense and solid, it incorporates spaces for blood vessels and cells
218
what is trabecular bone
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
what is the diaphysis of a bone
it is the main body of a bone
220
what is the epiphysis of a bone
it is the ends of a bone
221
what is ossification
it is the bone forming process
222
what is endochondral ossification
where bone forms from hyaline cartilage precursor. it occurs during foetal development, ling bone formation and fracture healing
223
what is intramembranous ossification
where bones form directly form mesenchyme, and occurs in foretal development to form flat or irregular bones
224
describe the process of endochondral ossification
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
describe the process of intermembranous ossification
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
what is the epiphysial plate
it is the growth plate allowing for continued growth of long bones in children
227
what causes the size of the growth plate to increase
constant chondrocyte division
228
what is mineralisation of bone
when hydroxyapatite crystals are deposited into the bones fibrous matrix. it hardens the bone and is vitamin D and PTH mediated
229
what are the 5 steps involved in bone remodelling
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
why does bone remodelling occur
```
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
what stimulates increased osteoclast activity
RANK ligand
232
how does RANK L increase osteoclast activity
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
what factor inhibits osteoclast activity
Osteoprotegerin
234
how does osteoprotegerin reduce osteoclast activity
Produced by osteoblasts and stromatolites cells
Binds to RANK L, preventing osteoclast activation
Decreases reabsorbtion rates
235
what is Wolffs law
In a healthy individual, bone will adapt to the loads under which it is placed
236
what is the action of parathyroid hormone on bone
PTH increases bone remodelling rates and calcium resorption
237
what is the Vitamin D pathway or activation
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
what cells produce calcitonin
the thyroid gland C cells
239
what is calcitonin released in response to
released in response to increased serum calcium
240
what is the most important regulator of serum phosphate
FGF-23
241
where is FGF-23 produced
it is produced by osteocytes
242
what is FGF-23 released in response to
rise in serum PO4-, presence of PTH and presence of calcitriol
243
what is the action of FGF 23
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
what happens to extracellular phosphate
either used for bone formation or it is excreted
245
what is the dietary form of phosphate
meat, dairy, nuts and seeds
246
what is the dietary sources of calcium
dairy, vegetables and oily fish
247
what are the different types of fracture
transverse, linear, oblique non displaced and oblique displaced, spiral, greenstick, comminutes and avulsion
248
what is the first step in fracture healing
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
what is the second step in fracture healing
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
what is stage three in fracture healing
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
what is the 4th/final step in fracture healing
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
what is a synarthroses joint
an immobile joint that is mostly fibrous (e.g between the skull)
253
what is a amphiarthroses joint
a slightly mobile joint, mostly cartilaginous (e.g intervertebral discs)
254
what is a diarthroses joint
it is a freely mobile joint which is mostly synovial (e.g hip and shoulder joint)
255
what is a fibrous joint
one held together by fibrous tissue
256
what is a cartilaginous joint
one held together by cartilage
257
what is a synovial joint
held together by a synovial fluid filled capsule, all have articulations, a joint capsule, a joint cavity, synovial fluid and reinforcing ligaments
258
what are the classifications of synovial joints
```
ball and socket
condyloid
hinge joint
pivot
saddle
gliding
```
259
how is collagen synthesised
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
what are the 4 phases of stress/strain in tendons and ligaments
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
where are tendons found
muscle to bone
262
where are ligaments found
bone to bone
263
what are the differences between tendons and ligaments
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
what is a fibrous attachment
Formed via intramembranous ossification
| Tendon or ligament attached to bone via sharpey’s fibres
265
what is a fibrocartilagenous attachment
Formed via endochondral ossification
Tendon or ligament attached to the bone through a gradual change from collagenous ligament, to fibrocartilage, to mineralised bone
266
what are the fibre components of contraction
actin, myosin, troponin and tropomyosin
267
what are the three types of troponin
C, I, and T
268
how does sarcomere contraction occur
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
what is the structure of cortical bone
it is compact and made of osteons
270
what are osteons
they are layers of lamellae which is surrounding a haversian canal
271
what directions do haversian canals run
horizontal across the bone
272
what do osteocytes receive blood through
through canaliculi
273
where are osteoblasts locates in the bone
in the endosteum and the periosteum
274
where is the endosteum found
on the inside of the cortical layer of the bone
275
what does mineralised bone stain
pink staining
276
where do osteoblasts lie
between mineralised and unmineralised bone
277
are osteoblasts small or big
they are small single nucleated cells
278
what is the cell characteristics of osteoclasts
these are large multinucleated cells
279
where do osteoclasts lie
they lie within howships lacuni / resorption bay
280
what movements can the shoulder do
flexion, extension, medial and lateral rotation
281
what are the three chest muscles
pectoralis major, minor and serratus anterior
282
what is the nerve innervation of pectoralis major
the medial and lateral pectoral nerve
283
what is the nerve innervation of pectoralis minor
the medial pectoral
284
what is the nerve innervation of serratus anterior
long thoracic nerve
285
what happens if there is damage to the long thoracic nerve
it causes a winged scapula
286
where are the two origins of pectoralis major
clavicular head from the anterior clavicle
| sternocostal head from the sternum and first 6 ribs
287
where does pectoralis major insert
onto the greater tubercle of the humerus
288
what is the action of pectoralis major
it flexes the humerus, as well as adduction, extension and external rotation
289
where is the origin of pectoralis minor
ribs 3-5
290
where does pectoralis minor insert
on the coracoid process of the scapula
291
what is the action of pectoralis minor
it stabilises the scapula by drawing it anteriorly
292
what is the origin and insertion of serratus anterior
origin is the lateral aspect of ribs 1-8
| insertion is the medial border of the scapula
293
what is the action of the serratus anterior
it rotates the scapula to allow arm abduction and holds the scapula against the ribcage
294
what bone pronates and supinates the arm
the radius - moves over the ulnar
295
what is the origins of trapezius
the external occipital protuberance, spinous processes C1-6 and spinous processes T4-12
296
where does trapezius insert
lateral 1/3 of the clavicle, spine of the scapula and the acromion
297
what is the nerve innervation of latissimus dorsi
the thoracodorsal nerve
298
what is the action of latissimus dorsi
extension, adduction and medial rotation of the arm at the shoulder
299
what are the origins of latissimus dorsi
vertebrae, ilium and ribs 9-12, and inferior angle of the scapula
300
what is the insertion of latissimus dorsi
anterior of humerus in the intertubercular sulcus
301
what is the nervous innervation levator scapula
the dorsal scapular nerve
302
what is the origin and insertion of the levator scapula
origin is C1-4
| insertion is the superior part of the medial border of the scapula
303
what is the nervous innervation of the rhomboids
the dorsal scapular nerve
304
what are the origins and insertions of the rhomboids
the origins are vertebrae C7-T1 for minor and T2-5 for major
the insertion is the medial border of the scapula
305
what is the action of the rhomboids
it draws the scapular superomedially
306
how many sections does the deltoid muscle have
three portions, anterior, middle and posterior
- anterior flexes and rotates
- middle abducts
- posterior extends and laterally rotates
307
what are the origins and insertions of deltoid
origins - clavicle, acromion and spine of scapula (SAC posterior to anterior)
- all insert onto the lateral aspect of the humerus
308
what is the nervous innervation of teres major
the lower subscapular nerve
309
what is the action of teres major
it adducts, and extends at the shoulder joint as well as medial rotation of the arm
310
where is the origin and insertion of teres major
origin is the inferior angle of the scapula and the insertion is the anterior humerus
311
where is the axilla
in the upper arm
312
what are the borders of the axilla
anterior - pectoralis major/minor
posterior - scapularis, teres major, latissimus dorsi
medial - serratus anterior and thoracic wall
lateral - intertubercular sulcus
313
what is found within the axilla
axillary artery and vein, the short head of biceps brachii, coracobrachialis and the cords of the brachial plexus
314
what in the shoulder joint helps reduce friction
the bursae and the synovial fluid
315
what is the most common direction to dislocate your arm
anterior (can damage axillary nerve)
316
what are the insertions of the muscles of the rotator cuff
all bar subscapularis insert into the greater tubercle, which attaches onto the lesser tubercle
317
why is the posterior branches of the brachial plexus called posterior
because it goes posterior to the axillary artery
318
what are the nerve roots of the musculocutaneous nerve
C5-7
319
what are the nerve roots of he axillary nerve
C5-6
320
what are the nerve roots of the medial nerve
C6-T1
321
what are the nerve roots of the ulnar nerve
C8-T1
322
what are the nerve roots of the radial nerve
all of them (C5-T1)
323
what is the flow of blood in the arm
subclavian artery - axillary artery - brachial artery - radial and ulnar arteries - palmer arches
324
what is the vein drainage of the arm
dorsal veins - deep radial and ulnar veins - brachial veins - subclavian vein
325
what is the spinal nerve reflex of the biceps brachii
C6
326
where is the origin of the biceps brachii
both heads originate from the scapula
327
where does the biceps brachii insert
onto the radius
328
what is the action of the coracobrachialis
causes flexion of the arm and shoulder and weakly abducts the arm
329
what is the insertion and origin of coracobrachialis
originates from cricoid process of scapula
| inserts onto the medial humerus (half way down)
330
what is the insertion and origin of brachialis
origin is the anterior surface of the humerus and it inserts onto the coronoid process of the ulnar
331
what is the action of brachialis
flexion of the elbow
332
what is the action of the triceps brachii
causes extension of the arm at the elbow
333
what is the tendon reflex of the triceps caused by
C7
334
where are the origins of the three heads of the triceps
long head - infraglenoid tubercle
medial head - below the radial groove
lateral head - above the radial groove
335
where is the insertion of the triceps brachii
the olecranon process of the ulnar (pointy bit)
336
what are the ligaments either side of the elbow that help stabilise it
the collateral ligaments (anterior and posterior)
337
what are the contents of the cubital fossa
radial nerve, biceps tendon, brachial artery, medial nerve
338
where does the ulnar nerve run in the elbow joint
posterior to the medial epicondyle
339
what are the bones of the hand - lateral to medial
1st row
scaphoid, lunate, triquetrum, pisiform
2nd row
trapezium, trapezoid, capitate, hamate
340
what is the sesamoid bone found in the hand
the pisiform bone
341
what is the vascular supply to the hand
= 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
what nerve is found in the carpal tunnel
the median nerve
343
what is flexion of the fingers
making a fist
344
what is it called when you touch your thumb to a finger
opposition
345
what are the supinators of the arm
the supinator muscle on the radial side, and the biceps when the arm is flexed
346
what are the pronators of the arm
pronator teres
pronator quadratus (ulnar side)
brachioradialis
347
where does the brachioradialis originate from and insert
the lateral epicondyle - origin
| styloid process of radius - insertion
348
what is the origin of pronator teres
the ulnar head and median epicondyle
349
what are the wrist flexors
flexor carpi radialis, flexor carpi ulnaris and palmaris longus
350
what inserts onto the medial epicondyle
the flexors of the wrist (superficial and flexor digitorum superficialis)
351
where do the deep muscles of the forearm originate from
the bone rather than epicondyles
352
what muscles do finger flexion
flexor digitorum superficialis and profundus
353
where does flexor digitorum superficialis and profundus insert
superficialis - the middle phalanx
| profundus - the distal phalanx (moves through superficialis)
354
what muscles are involved in finger flexion
```
extensor digitorum (superficial)
extensor digiti minimi (superficial)
extensor indicis (deep)
lumbricals - intrinsic muscles of the hand
```
355
where do the extrinsic extensors of the fingers insert onto
they insert onto the proximal phalanx
356
where do the intrinsic extensors of the hand (lumbricals and interossei) insert
they bind into the extensor hood of the fingers
357
what is the action of the dorsal interossei
they abduct the fingers
358
what is the action of the palmer interossei
they adduct the fingers
359
what is thumb flexion achieved by
flexor pollicis longus and brevis
360
what is thumb extension achieved by
extensor pollicis longus and brevis
361
what is opposition achieved by
opponens pollicis and opponens digiti minimi
362
what is the medial border of the snuffbox
extensor pollicis longus
363
what is the lateral border of the snuffbox
extensor pollicis brevis and abductor pollicis longus
364
what is the floor of the snuffbox
the scaphoid and trapezium
365
what is the contents of the snuffbox
radial nerve and artery
366
what are the muscles of the thenar eminence
abductor pollicis brevis, flexor pollicis brevis and opponens pollicis
