MSK Flashcards
0
Q
What is the innervation of pec major?
A
The lateral and medial pectoral nerves.
Clavicle head - C5,6
Sterno-costal head - C7,8 T1
1
Q
What is the action of pec major?
A
Adduction and medial rotation of humerus. Draws scapula anteriorly and inferiorly.
Clavicular head flexes humerus and Sterno-costal head extends it from the flexed position
2
Q
Innervation of pec minor?
A
Medial pectoral nerve C8 T1
3
Q
Action of pec minor
A
Draws scapula anteriorly and inferiorly against thoracic wall and stabilises it.
4
Q
Innervation of subclavius?
A
Nerve to subclavius C5,6
5
Q
Action of subclavius?
A
Anchors and depresses clavicle.
6
Q
Innervation of serratus anterior?
A
Long thoracic nerve C5,6,7
7
Q
Action of serratus anterior?
A
Protract (abduct) scapula and hold it again the thoracic wall. Rotate scapula medially.
8
Q
What are the function of the clavicle?
A
Connects limb to trunk whilst allowing a range of movements of limb.
Shock absorber from limb/shoulder.
Protects neuromascular bundle supplying upper limb.
9
Q
What is the proximal joint of the clavicle?
A
Manubrium of sternum with the sternal facet at sternoclavicular joint (SC)
10
Q
What is the difference between the superior and inferior surfaces of the clavicle?
A
Superior surface is smooth - subcutaneous tissues
Inferior surface is rough because strong ligaments bind to it?
11
Q
What attaches to the following places of the clavicle?
Inferiorly, lateral - medial:
Trapezoid line
Conoid tubercule
Subclavian groove
Impression for costoclavicular ligament
A
Trapezoid line - trapezoid ligament
Conoid tubercule - Conoid ligament
Subclavian groove - subclavius muscle
Impression for costoclavicular ligament
12
Q
Where is the clavicle most likely to break?
A
Between Middle third and lateral third
13
Q
Where do the scapula and clavicle join?
A
Acromioclavicular joint
14
Q
Where is the deltoid tubercule?
A
Spine of scapula.
15
Q
Describe the locations of the coronoid fossa and radial fossa of the humerus
A
Both distal end, anterior. Coronoid is more medial next to trochlea.
Radial fossa is more lateral and next to the capitulum.
16
Q
What is the condyle of the humerus?
A
Radial fossa coronoid fossa, capitulum, trochlea
17
Q
What is the purpose of the olecranon fossa of the humerus?
A
Allows space for the olecranon of ulna.
18
Q
What are the types of bone?
A
Long short Irregular - may have sinuses (pneumatic) and accessories Sesmoid e.g. Patella Flat
19
Q
What is a apophysis?
A
A normal development outgrowth of bone.
20
Q
What is a facet?
A
A flattened surface for joint/muscle attachment
21
Q
Explain the types of joints fibrous, cartilaginous and synovial
A
Fibrous: held together by fibrous connective tissue
Cartilaginous: held by hyaline cartilage e.g. Pubic symphysis
Synovial: bones with articular cartilage meet within a joint capsule with synovial lining which contains synovial fluid.
22
Q
Explain the types of joints, diarthrosis, synarthrosis and Amphiarthrosis. (Functional classification)
A
Diarthrosis: freely movable (always synovial)
Amphiarthrosis - slight mobility (mostly cartilaginous)
Synarthrosis - little of no mobility (mostly fibrous)
23
Q
Briefly explain the types of synovial joints.
A
Hinge - only flexion and extension
Saddle - concave and concave joint surfaces e.g. 1st MCPJ
Plane - permits some sliding e.g. Acromioclavicular joint
Pivot- rotation, bone into a bony ligamentous socket e.g. Proximal radio-ulnar joint.
Condyloid - flexion, extension Adduction, abduction and circumduction e.g. MCPJ
Ball and socket e.g. Shoulder and hips
24
What comprises the first layer of muscles of the anterior forearm?
Pronator teres - pronates the hand
Flexor Carpi radialis- flexes wrist and abducts
Palmaris longus - flexes wrist
Flexor Carpi ulnaris - flexes wrist and adducts
25
What compromises the second layer of muscles of the anterior forearm?
Flexor digitorum superficialis - flexes middle and proximal joints of four digits.
26
What comprises the third layer of muscles of the anterior forearm?
Flexor digitorum profundus - flexes distal phalanges
Flexor pollicis longus - flexes thumb
Underneath:
Pronator quadratus - pronates hand and holds ulna and radius.
27
What is the innervation of the muscles of the forearm?
All median nerve apart from:
Flexor Carpi ulnaris
Flexor digitorum profundus (medial part)
28
Origin of musculocutaneous?
C5,6,7
29
Innervation by musculocutaneous?
Anterior muscles of the arm. Biceps brachii, coracobrachialis and brachialis.
30
Origins of radial nerve?
C5-T1
31
Innervation by radial nerve?
Posterior arm and forearm all muscles (part of dorsum of hand)
32
Origins of median?
C6-T1
33
Innervated by median?
Muscles of anterior forearm (apart from FCU and FDP) and some intrinsic muscles of Palm.
34
Ulnar origins?
C8 and t1 with sometimes t7
35
Innervation by ulnar
FCU, FDP, most intrinsic muscles of hand
36
Origin of axillary?
C5,6
37
Innervation by axillary?
Teres minor, deltoid. GH joint
38
Describe the layers and muscles of the posterior forearm
Superficial:
Brachioradialis, extensor Carpi radialis longus, extensor Carpi radialis brevis, extensor digitorum, extensor digiti minimi, extensor Carpi ulnaris
Deep:
Supinator, extensor indices
Thumb (outcropping of deep layer):
Abductor pollicis longus, extensor pollicis longus, extensor pollicis brevis
39
What is the action of brachioradialis?
Weak flexion of forearm (maximised in mid-protonated)
40
How can ulnar nerve motor function be tested?
Test Palmer interossi- pinch a piece of paper via Adduction.
Test dorsal interossi- hold 2,3 digits and ask patient to abduct.
41
What is the difference in function between the dorsal interossei and the Palmar interossei?
Dorsal abduction 2-4. Palmer Adduction 2,4 &5 (makes sense as how could 3 by adducted?).
Both deep branch of ulnar nerve and both assist in flexing MCJ and extending interphalangeal joints.
42
What is the innervation of the thenar muscles and adductor pollicis?
All recurrent branch of median nerve but deep branch of flexor pollicis brevis is ulnar nerve.
Adductor pollicis is deep branch of ulnar nerve.
43
What is the innervation of the hypothenar muscles?
Deep branch of ulnar nerve
44
What is the innervation of lumbricles and interossei?
1-2 lumbricles median nerve. Deep branch of ulnar nerve everything else.
45
Name all the carpel bones
Some lovers try positions that they can't handle.
R to L starting bottom row.
```
Scaphoid
Lunate
Triquetrum
Pisiform
Trapezium
Trapezoid
Capitate
Hamate
```
46
Describe the causes, effects and specific test for winged scapula
Damage to serratus anterior or the long thoracic nerve.
Scapula medial boarder protrudes. Pain on flexion/ abduction of shoulder.
Serratus wall test - push against wall with plasm sat wrist level.
47
What is the hand of benediction?
Compression or injury of median nerve
| Cannot flex, digits 2 and 3.
48
What is ulnar claw?
Damage of ulnar nerve
Loss of 3/4 lumbricles
Un opposed extension at MCP and flexion at the IP joint
49
In a typical clavicular fracture, it which directions are both the parts of the bone pulled?
Lateral downwards due to weight of the arm. Medial displaced upwards by sternocleidomastoid muscle.
50
What is the test for axillary motor function?
Abduction (deltoid)
51
What is found in the radial groove?
Radial nerve and deep branch of brachial artery
52
Describe the contents of the cubital fossa
Median nerve, brachial artery, tendon of biceps brachi, radial nerve.
Medial to lateral.
53
What is the purpose of the coronoid fossa and where is it?
Medial to radial fossa on humerus.
| Allows room for coronoid process of ulna during flexion.
54
Describe the problems associated with a supra epicondyle fracture.
Transverse fracture across two epicondyles which occurs by falling on a flexed elbow. May damage brachial artery (hypoxia), median, ulna or radial nerves.
55
Describe epicondylitis (tennis or golfer's elbow)
All muscles from forearm are attach to similar places, either lateral or medial epicondyles. Sports players can develop an overuse strain of the common tendon causing pain and inflammation. Tennis - lateral. Golf- medial.
56
What is the ulnar paradox?
Ulnar injury at wrist or below looks worse than ulnar injury at elbow or higher due to the loss of flexor digitorum profundus, so basically no flexion or extension of IP joints on 4 and 5
57
What is the difference of dislocation and subluxation?
Dislocation is where articular surfaces of a joint no longer in contact. Subluxation is where there is a partial or incomplete displacement of the joint surface.
58
Give an example of a common subluxation injury in the upper limb
Radial head subluxation - caused by pulling on a pronated arm
Slipping of radial head under the annular ligament.
59
Describe scapula fractures
Rare as it is protected and able to move e.g. RTA
| Most common is scapula neck (parallel to GF), body or Glenoid (chips or extensions of neck fractures) fractures
60
What is the C shape of the vertebral column known as in early life?
The primary curvature
61
What is an exaggerated primary curvature known as?
Kyphosis
62
Describe the curvature of the vertebral column in a hound adult.
```
2 anterior flexions (primary) and 2 posterior (secondary)
Cervical - secondary
Thoracic - primary
Lumbar - secondary
Sacral/coccygeal (pelvic) - primary
```
63
Where are articular junctions/processes found on a vertebrae?
At junctions of lamina and pedicle
64
Where are the intervertebral foramen and the vertebral foramen found.
Vertebral - centre of vertebrae, posterior to body, surrounded by the vertebral arch.
Intervertebral, formed between articulating vertebrae from notches above and below the pedicle. Segmented nerves pass through these and dorsal root ganglia.
65
Where are intervertebral disks found
C2-3 and L5-S1 (account for secondary curvature)
66
Describe the structure of the intervertebral disk
Nucleus pulposus in centre surrounded by the annulus fibrosus.
Annulus fibrosus has a strong fibro-cartilaginous inner section and the outer is largely cartilaginous (stronger than vertebral body but also a shock absorber).
Nucleus pulposus has a high osmotic pressure so varies in size throughout the day.
67
What is a slipped disk?
Nucleus pulposus herniates through annulus fibrosus. Compresses spinal nerves causing pain/ paralysis.
68
What is reactive marginal osteophytosis?
Bones grow at joints often in response to increase in a damaged joints surface area.
In the spine it can occur due to dehydration of IVD leading to a larger articulating SA.
The osteophytosis can lead to osteoarthritis of facet joints and narrowing of the interventricular foramen which can compress nerves.
69
What is degenerative disk disease?
Degeneration of nucleus pulposus or annulus fibrosus.
70
Describe the ligaments of the vertebral column
Anterior transverse ligament - talus to upper sacrum. Attached to vertebral bodies (continuous with periosteum) and loose over disks. Thicker as you go lower. Strongest.
Posterior transverse has serrated margins, either united with vertebrae or separated with veins.
Ligamentum flavum - connects adjacent lamina
Supraspinous ligament- connects adjacent spinous processes ends.
Interspinous ligaments - connects along adjacent boarders (weak).
Ligamentum nuchae - back of head to thoracic supra/inter ligaments. Connects to all spinous processes in between. Supports head, maintains curvature and holds trunk muscles.
71
Describe the cervical vertebrae
Bifid spinous process
Transverse foramen for the vertebral artery (C7 for veins)
Large vertebral foramen
72
Describe the thoracic vertebrae
Demi facets on body for body of ribs and facets on transverse process for tubercule of ribs.
Small ventricular foramen
73
Describe the lumber vertebrae
No facets/ bifid spinous process.
| Small triangular ventricular foramen.
74
Describe the atlas C1 and the axis C2
Atlas: no body or spinous process. Very strong vertebral arch.
Axis: connected to atlas via dens/odontoid process. Large spinous process. Rugged lateral processes. Prevents horizontal displacement of atlas. No body. Fractures in hangmans fracture.
75
What is scoliosis and how may it happen?
Unbalanced muscle mass. C shape, L or R
76
Describe the main actions of Sartorius
Tailors muscle - cross legs
Lateral rotation (but medial when knee is flexed). Abduction at hip and flexion.
Flexion at knee
77
What is the action and innervation of psoas minor, illopsoas/ psoas major and iliacus?
Flexion and hip joint and stabs listing.
Psoas = anterior rami of lumbar nerves
Iliacus= femoral nerve
78
Name the adductors of the thigh (from top to bottom), innervation and other actions they have
Pectineus- medial rotation
Adductor brevis -
Adductor longus -
Adductor Magnus (posterior to brevis/longus as on ischeal tuberosity) - flexes thigh, hamstring part extends.
Gracialis - medial rotation as attached to anterior of tibia, flexes leg.
All obturaroe nerve apart from hamstring part of Magnus which is tibial part of sciatic nerve
79
Describe the functions of obturator externus.
Laterally rotates thigh, steadys head of femur in acetabulum.
80
What is the ulnar paradox?
Ulnar injury at wrist or below looks worse than ulnar injury at elbow or higher due to the loss of flexor digitorum profundus, so basically no flexion or extension of IP joints on 4 and 5
81
What is the difference of dislocation and subluxation?
Dislocation is where articular surfaces of a joint no longer in contact. Subluxation is where there is a partial or incomplete displacement of the joint surface.
82
Give an example of a common subluxation injury in the upper limb
Radial head subluxation - caused by pulling on a pronated arm
Slipping of radial head under the annular ligament.
83
Describe scapula fractures
Rare as it is protected and able to move e.g. RTA
| Most common is scapula neck (parallel to GF), body or Glenoid (chips or extensions of neck fractures) fractures
84
What is the C shape of the vertebral column known as in early life?
The primary curvature
85
What is an exaggerated primary curvature known as?
Kyphosis
86
Describe the curvature of the vertebral column in a hound adult.
```
2 anterior flexions (primary) and 2 posterior (secondary)
Cervical - secondary
Thoracic - primary
Lumbar - secondary
Sacral/coccygeal (pelvic) - primary
```
87
Where are articular junctions/processes found on a vertebrae?
At junctions of lamina and pedicle
88
Where are the intervertebral foramen and the vertebral foramen found.
Vertebral - centre of vertebrae, posterior to body, surrounded by the vertebral arch.
Intervertebral, formed between articulating vertebrae from notches above and below the pedicle. Segmented nerves pass through these and dorsal root ganglia.
89
Where are intervertebral disks found
C2-3 and L5-S1 (account for secondary curvature)
90
Describe the structure of the intervertebral disk
Nucleus pulposus in centre surrounded by the annulus fibrosus.
Annulus fibrosus has a strong fibro-cartilaginous inner section and the outer is largely cartilaginous (stronger than vertebral body but also a shock absorber).
Nucleus pulposus has a high osmotic pressure so varies in size throughout the day.
91
What is a slipped disk?
Nucleus pulposus herniates through annulus fibrosus. Compresses spinal nerves causing pain/ paralysis.
92
What is reactive marginal osteophytosis?
Bones grow at joints often in response to increase in a damaged joints surface area.
In the spine it can occur due to dehydration of IVD leading to a larger articulating SA.
The osteophytosis can lead to osteoarthritis of facet joints and narrowing of the interventricular foramen which can compress nerves.
93
What is degenerative disk disease?
Degeneration of nucleus pulposus or annulus fibrosus.
94
Describe the ligaments of the vertebral column
Anterior transverse ligament - talus to upper sacrum. Attached to vertebral bodies (continuous with periosteum) and loose over disks. Thicker as you go lower. Strongest.
Posterior transverse has serrated margins, either united with vertebrae or separated with veins.
Ligamentum flavum - connects adjacent lamina
Supraspinous ligament- connects adjacent spinous processes ends.
Interspinous ligaments - connects along adjacent boarders (weak).
Ligamentum nuchae - back of head to thoracic supra/inter ligaments. Connects to all spinous processes in between. Supports head, maintains curvature and holds trunk muscles.
95
Describe the cervical vertebrae
Bifid spinous process
Transverse foramen for the vertebral artery (C7 for veins)
Large vertebral foramen
96
Describe the thoracic vertebrae
Demi facets on body for body of ribs and facets on transverse process for tubercule of ribs.
Small ventricular foramen
97
Describe the lumber vertebrae
No facets/ bifid spinous process.
| Small triangular ventricular foramen.
98
Describe the atlas C1 and the axis C2
Atlas: no body or spinous process. Very strong vertebral arch.
Axis: connected to atlas via dens/odontoid process. Large spinous process. Rugged lateral processes. Prevents horizontal displacement of atlas. No body. Fractures in hangmans fracture.
99
What is scoliosis and how may it happen?
Unbalanced muscle mass. C shape, L or R
100
Describe the main actions of Sartorius
Tailors muscle - cross legs
Lateral rotation (but medial when knee is flexed). Abduction at hip and flexion.
Flexion at knee
101
What is the action and innervation of psoas minor, illopsoas/ psoas major and iliacus?
Flexion and hip joint and stabs listing.
Psoas = anterior rami of lumbar nerves
Iliacus= femoral nerve
102
Name the adductors of the thigh (from top to bottom), innervation and other actions they have
Pectineus- medial rotation
Adductor brevis -
Adductor longus -
Adductor Magnus (posterior to brevis/longus as on ischeal tuberosity) - flexes thigh, hamstring part extends.
Gracialis - medial rotation as attached to anterior of tibia, flexes leg.
All obturaroe nerve apart from hamstring part of Magnus which is tibial part of sciatic nerve
103
Describe the functions of obturator externus.
Laterally rotates thigh, steadys head of femur in acetabulum.
104
How does limb development begin?
Ectoderm and mesenchyme activated from from lateral mesoderm (somatic). Start developing at the end of 4 weeks.
105
What is the role of AER
Apical ectoderm all ridge.
Keeps mesenchyme undifferentiated and so controls proximal/distal differntiation.
Control dorsal/ventral differentiation.
Induces formation of digits then regresses.
106
What is zpa?
Zone of polarising activity
Control over AER
Controls anterior and posterior and found posterior to the AER
107
How are digits formed?
Digit rays form from mesenchyme condensations which become cartilaginous models of digital bones
AER regresses to just over digit rays
Apoptosis between digit rays
108
Describe the development of the musculature in the limbs
Myogenic precursors from somites migrate into developing limb to form ventral and dorsal muscle masses. Individual muscles then split. Upper limb supination and lower limb plantation. Flexors diff
109
Explain the brachial plexus.
Nerves enter in development as needed.
As the muscles regroup in the ventral/dorsal compartments so do the nerves but all ventral= medial and lateral chords and all dorsal = posterior chords.
110
Explain simply the developmental basis of some common abnormalities of the limbs
Syndactyly - fusion of CT/ bone of digits
Polydactyly- extra digits, recessive
Amelia- complete absence of a limb
Meromelia- partial absence of one or more limb structures e.g. Phocomelia caused by the tetratogen: thalidamide
111
Which muscles flex the thigh?
Illiopsoas, psoas minor and Rectus femoris
112
What is the linear aspera?
Line along femur.
113
Boarders of the femoral triangle?
```
Medial- adductor longus
Lateral Sartorius, Rectus femoris
Superior - illio tendon
Posterior - Pectineus, iliopsoas
Remember NAVY
```
114
Name the action and innervation of obturator internus, inferior gemellus, piriformis and superior gemellus.
Lateral rotation when extended. Abduction when flexed.
OI and SG, nerve to obturator internus
IG femoral nerve
Pit I is anterior rami of s1/2
115
Give the action and innervation of tensor fasciae latae, gluteus minimus and gluteus medius
Medial rotate thigh. Abduction.
| Superior gluteal nerve
116
Action and innervation of gluteus Maximus
Extensor and lateral rotation
| Inferior gluteal nerve
117
Action and innervation of quadratus femoris
Laterally rotates thigh. Steadies femoral head in acetabulum.
Nerve to quadratus femoris
118
Full extension of elbow joint at what angel?
170
119
Describe ligaments of elbow joint
Ulna (amterior, posterior, oblique) collateral ligaments attaching to transverse ligament of ulna and medial epicondyle.
Radial collateral ligament blends with annular and is fan like which attaches to lateral epicondyle.
Articular capsule
120
Vascular supply of elbow joint
Anastomoses between collateral arteries and recurrent branches of radial, ulnar and interosseus arteries.
121
What type of joint is the radial ulna?
Fibrous
122
Articular disk function?
Allows supination and pronation of wrist as it moves with the radius and articulates with anterior carpel bones (not hamate)
123
Causes of carpel tunnel syndrome
Repeated pressure.
| Diabetes, obesity, trauma, hyperthyroidism
124
Signs and symptoms
Median nerve compression- buring in middle fingers with numbness, pain at wrist. Loss of grip strength.
Extendended time leads to atrophy of thenar muscles.
125
Difference between colles' and smith's?
Apostrophe!
Colles is dinner fork (dorsal displacement of wrist)
Smiths is ventral
126
Describe a Bennett's fracture
Proximal part of 1st metacarpal bone.
Proximal part is displaced.
Dislocation/subluxation of carpometacarpel joint.
127
Describe erb's palsy
Damage to roots of brachial plexus, C5 most common.
Paralysis of limb leading to waiters tip mainly due to loss of biceps as normally musculocutaneous and axillary nerves affected.
From child birth- pulling on shoulders or clavicular break, wound (e.g. Gunshot) or excessive stretching.
128
Describe klumpke's paralysis
Lower roots of brachial plexus.
Muscles of hand and flexors of wrist (ulna) so claw hand.
From childbirth? Traction on abducted brachial plexus on catching on branch of tree
129
What is mallet finger/ baseball finger?
Damage to extensor digitorum tendon of fingers while catching a ball.
130
Where does biceps tendon rupture normally occur?
Proximally e.g. Too many corticosteriods.
| Muscle mass moves distally, little loss of function.
131
What is dupuytrens contracture?
Disorder of Palmer fascia. Fixed flexion. Normally ring and little.
Inherited.
132
What is handlebar palsy?
Damage to ulna nerve from compression of handlebars.
Clawing
Loss of finger function and pain
133
Where does the axillary artery start and end?
Starts at lateral boarder of 1st rib from subclavian.
| Ends at inferior boarder of teres major.
134
Innervation of latissimus dorsi, trapezius, rhomboid major and minor, levator scapulae
Lat d - thoracodorsal nerve
Trapezius- spinal accessory nerve and C3/4 spinal nerves
Rhomboids- dorsal scapula nerve
Levator scapulae - dorsal scapula nerve and C3/4 spinal nerves
135
Innervation of subscapularis and teres major
Sub- lower and upper subscapular nerves. Teres major, lower subscapular nerve
136
Boarders of the anatomical snuff box
Medially EPL tendon
Laterally tendons of APL and EPB.
Floor scaphoid and trapezium.
Proximally radial styloid process can be felt and distally the base of the 1st metacarpal.
137
What is the lunate surface?
Articular area of acetabulum
138
What is found in the acetabular notch?
Fat pad surrounded by synovial membrane, ligament of head of femur (with artery to head of femur in the middle)
139
Where is the transverse acetabular ligament found?
Inferior- completes acetabulum, where there in so labrum
140
Describe the intrinsic ligaments of the hip joint capsule
```
Illio femoral, anterior superior protection
Pubofemoral, anterior inferior (from lesser trochanter)
Ischealfemoral posterior (weakest)
```
141
Where is the acetabular notch?
Inferior, not lunate surface
142
Blood supply to the hip joint?
Medial and lateral circumflex arteries (retinacular arteries from these).
Artery of the head of the femur.
143
Action and innervation of quadratus externus
Laterally rotates thigh and steadies head in acetabulum. Obturator nerve
144
Action and innervation of psoas muscles and Pectineus
Pectineus, medial rotation and Adduction. Femoral nerve.
Psoas major and minor, flexion of hip joint. Anterior rami of lumbar nerves L1/2
Iliacus, flexion of hip. Femoral nerve.
145
Describe hip dysphasia
Abnormal growth of hip joint leading to unstable joint prone to dislocation or subluxation.
Bilateral in half of cases
146
Describe a slipped upper femoral epiphysis
Femur rides up. Stable, still largely in place, unstable, large slip.
Normally 10-16 year olds
147
Describe acquired hip dislocations
Rare due to good support.
| Leg rotated medially Shorterened. Can be damage to sciatic nerve
148
Describe the types of trochanteric (extra capsular) and femoral neck fractures (intra capsular)
Femoral neck- often elderly, blood supply can be reduced. In the unhealthy it requires a replacement. Leg appears shortened and externally rotated
E.g. Capital, sub capital and transcervical (away from point increasingly)
Trochanteric- less risk of osteonecrosis and can be fixed with dynamic hip screw
E.g. Inter trochanteric and subtrochanteric
149
Where is the inguinal ligament found?
Anterior superior iliac spine to pubic tubercule (but I think changes name)
150
Describe common areas of bursitis in hip
Trochanteric - from RA or something else.
Ischiogluteal- near ischeal tuberosity from bike or horse riding
Iliopsoas bursitis- inferior to inguinal ligament, swelling.
151
What muscles may be affected if trendelenburg sign?
Abductors e.g. Medialis and minimus.
152
Where is the ideal injection site on the bum?
Posterior, just posterior and inferior to the lateral part of the iliac crest.
153
Where can the femoral plus be taken?
Mid inguinal point between the pubic symphysis and anterior iliac spine
154
Describe the superficial venous drainage of the lower limb.
Great saphenous vein from femoral vein, runs medially and becomes dorsal venous arch. Small saphenous vein starts from popliteal vein and runs posteriorly- becomes plantar venous network.
155
Describe deep venous drainage of the lower limb
Femoral vein ends at inguinal ligament and becomes external iliac vein
Femoral vein, splits just after ilium to make the profunda femoris vein which drains most of the thigh. Lateral and medial circumflex veins also come off around here.
Femoral vein becomes popliteal vein (note above and below is medial/lateral superior/inferior veins of the knee).
Splits after knee to anterior tibial vein and fibular vein (remains posterior). The posterior tibial vein also comes off the fibular vein. The two come together to make the plantar arch and the anterior tibial vein makes the dorsal venous arch
156
Describe arteries of lower limb
External iliac artery becomes femoral at inguinal ligament, profunda femoris artery with perforating arteries comes off this. Medial and lateral circumflex arteries also come off this with posterior retinacular arteries to femoral head.
Femoral artery through adductor hiatus to become popliteal artery.
Then same as venous, at lower boarder of popliteus it becomes anterior and posterior tibial arteries (except this is fibular vein). Fibular artery comes off posterior tibial.
157
Describe venous drainage of the upper limb.
Superficial- cephalic and basillic veins come off of axillary vein (becomes basillic and brachial come off). They go either side of biceps brachii. Median cubical vein connects. Continue both anteriorly and form superficial venous Palmer arch.
Deep- brachial veins from axillary., produnda in radial groove. Collateral and recurrent radial veins. Become ulna, radial and interosseus (only one found posterior) veins for deep/ superficial venous Palmer arches and dorsal network.
158
Give the muscles of the anterior and lateral compartments of the leg with their action and innervation
Anterior:
Tibialis anterior - dorsi flexion
Extensor digitorum longus - dorsiflexion and extension of 2-5 digits.
Extensor hallucis longus - dorsiflexion and extension of big toe.
Fibularis tertius- weak dorsiflexion and eversion
All deep fibular never.
Lateral:
Fibularis longus- eversion
Fibularis brevis- eversion
Superficial fibular nerve.
159
Describe the action and innervation of all posterior leg muscles.
Superficial
Gastrocnemius - flexion of knee, plantar flexion.
Soleus- plantarflexion- steadying
Plantaris- plantarflexing
Deep:
Tibialis posterior - plantiflexion, inversion
Flexor digitorum longus - plantiflexion, flexion of digits, inversion
Flexor hallucis longus- plantiflexion, flexion of digits, inversion
Popliteus- flexion against locking at knee but rotating femur 5
All tibial nerve
160
Ligaments and sciatic foramen? Superior to inferior
Greater sciatic notch with foramen
Sacrospinous ligament and ischial spine
Less sciatic notch with foramen
Sacrotuberous ligament on ischial tuberosity
161
Describe bursas of the knee
Suprapatella between Rectus femoris and the femur
Subpatellar- between the apex of the patella and the skin.
Superficial infrapatella- between tibial tuberosity and the skin.
Deep infrapatella between the patella tendon and the tibia
162
What is housmaids knee
Prepatella bursitis.
163
Describe the unhappy triad of injuries
Lateral blow to knee with fixed foot.
| ACL, MCL and medial (sometimes lat) menisci tears/ injury
164
Cutaneous innervation of lower limb
Thigh-
posterior = posterior cutaneous nerve of thigh.
Lateral = lateral cutaneous nerve of thigh.
Medial/ anterior = anterior cutaneous branches of femoral nerve. (Medial also cutaneous branch of obturator nerve)
Leg-
Medial half- saphenous nerve
Lateral half - lateral sural cutaneous nerve
Between on posterior - medial sural cutaneous nerve.
Inferior posterior- sural nerve
Posterior surface of heel- medial calcaneal branches of tibial nerve
Dorsal foot- lateral dorsal cutaneous nerve
Dorsal 2 toes- deep fibular nerve.
Lateral plantar - lateral plantar nerve
Medial plantar - medial plantar nerve.
165
Diagnosis of osteoarthritis on xray?
Joint space narrowing, osteophytosis, sub handrail sclerosis and cysts
166
3 types of gait from foot drop
Waddling- leaning- hiking the hip
Swing out- abduction
Stepping gait - flexion at knee and hip
167
Name the bones of the foot
Talus calcaneus, navicular, cuboid, cuneiforms
168
Describe the bones of the ankle joint and the type of joint they form
Fibula laterally, tibia superiority and medially, talus inferiorly. Fibula and tibia are bound by strong tibiofibular ligaments producing a bracket shaped socket known as a mortise.
Talus widens as it comes anteriorly. Known as a tenon (stronger in dorsiflexion)
169
Describe the ligaments of the ankle
Medial ligament/ deltoid ligament. Made of superior ligaments tibionavicular, tibiocalcaneal and anterior tibiotalar. Deep ligaments attach to medial side of talus. All medial malleolus.
Lateral ligaments- anterior talofibular, posterior talofibular and calcaneofibular. All lateral malleolus.
170
Normal injury in an ankle sprain?
Anterior talofibular ligament. When plantar flexed and inversion occurs. Lateral side is weaker than medial side.
171
Describe a typical pott's fracture
Any bimalleolar fracture. Often caused by forced eversion causing a avulsion fracture of the medial malleolus. This results in the talus moving laterally and breaking off the lateral malleolus or breaking the fibular superior to the syndesmosis. The tibia is then forced anteriorly and breaks it's distal, proximal portion against the talus.
172
Name the ligaments that form the tibiofibular syndesmosis
Anterior ligament of the lateral malleolus
Posterior ligament of the lateral malleolus
Interosseus membrane of leg.
173
Causes of an antalgic gait?
Stiffness in joints, a limp
175
Explain phases of walking and main muscles involved
Heel strike - gluts and dorsi flexors
Loading response - quads to accept weight,
Mid stance - abductors for stability, plantarflexion begins
Terminal stance - plantar flexors and abductors
Preswing - flexors of digits, flexors of hip- Rectus femoris
Initial swing -Illiopsoas and RF, ankle dorsi to clear
Mid swing - clear foot
Terminal swing- dorsiflexors for position knee extensors
176
Tetanus symptoms
```
Muscle spasms (jaw_
Fever
Sweating
Headache
10% mortality
```
177
Tetanus bacteria
Clostridium tetani - soil, saliva, dust, manure
178
Treatment of tetanus
Tetanus immunoglobulin
IV metronidazole
IV or oral diazepam
179
What is radicular pain?
Along a dermatome
180
Yellow flags back pain
attitudes, beliefs, compensation, diagnosis, emotions, family, work (school)
