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MSK Flashcards

1
Q

What are the articulating surfaces of the shoulder joint?

A

glenoid fossa

head of the humerus

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2
Q

What acts to increase the joint surface area>

A

glenoid labrum

fibrocartilage rim

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3
Q

where does the glenohumeral joint capsule extend from

A

from the anatomical neck of the humerus to the border of the glenoid fossa

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4
Q

name the synovial bursae of the shoulder

A

subacromial
subscapular
subcoracoid

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5
Q

Where is the subacromial bursa found?

A

inferiorly to the deltoid and acromion,

superiorly to the supraspinatus tendon and the joint capsule.

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6
Q

Where is the subscapular bursa found?

A

Located between the subscapularis tendon and the scapula.

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7
Q

What is the purpose of the coracoacromial ligament of the shoulder

A

prevents superior displacement of humerus

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8
Q

What is the purpose of the coracohumeral ligament of the shoulder

A

supports joint superiorly

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9
Q

What is the purpose of the glenohumeral ligament of the shoulder

A

stabilises joint anteriorly

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10
Q

What is painful arc syndrome?

A

inflammation of supraspinatus tendon and subacromial bursa beneath coracoacromial tendon

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11
Q

What gives the shoulder joint mobility

A

ball and socket
lax joint capsule
shallow glenoid cavity, large head of humerus

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12
Q

What gives the shoulder joint stability

A

ligaments - reinforce joint capsule
glenoid labrum - increases surface area
rotator cuff muscles - pull humeral head into glenoid cavity

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13
Q

What is the most common dislocation of the shoulder

A

anterior

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14
Q

What causes anterior dislocation of the shoulder

A

extension

external rotation

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15
Q

name the rotator cuff muscles

A

supraspinatus
infraspinatus
teres minor
subscapularis

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16
Q

What is the function of the rotator cuff muscles as a group?

A

pull humeral head into the glenoid cavity

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17
Q

name the origin and insertion of the supraspinatus

A

supraspinous fossa

greater tubercle of humerus

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18
Q

name the origin and insertion of the infraspinatus

A

infraspinous fossa

greater tubercle of humerus

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19
Q

name the origin and insertion of the teres minor

A

lateral posterior surface of scapula

greater tubercle of humerus

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20
Q

name the origin and insertion of the subscapularis

A

subscapular fossa

lesser tubercle of the humerus

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21
Q

Which rotator cuff muscles are innervated by the suprascapular nerve

A

supraspinatus

infraspinatus

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22
Q

Which rotator cuff muscles are innervated by the upper and lower subscapular nerves

A

subscapularis

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23
Q

Which rotator cuff muscles are innervated by the axillary nerve

A

teres minor

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24
Q

Which rotator cuff muscles act to laterally rotate the arm

A

teres minor

infraspinatus

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25
Q

Which rotator cuff muscles act to medially rotate the arm

A

subscapularis

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26
Q

Which rotator cuff muscles act to abduct the arm

A

supraspinatus

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27
Q

State the boundaries of the cubital fossa

A 
medial = pronator teres
lateral = brachioradialis
superior = line between epicondyles of humerus
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28
Q

what are the contents of the cubital fossa

A

biceps tendon
brachial artery
median nerve

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29
Q

What makes up the floor of the cubital fossa

A

brachialis

supinator

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30
Q

What can a supracondylar fracture of the humerus lead to?

A

damage to the brachial artery

Volkmann’s contracture

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31
Q

How does Volkmann’s contracture present?

A

permanent shortening of forearm muscles
gives rise to a clawlike deformity of the hand, fingers, and wrist.
due to ischaemia

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32
Q

What nerve roots contribute to the brachial plexus?

A

C5-T1

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33
Q

State the dermatomes that correspond to C5-T1

A 
C5 - lateral elbow
C6 - posterior thumb
C7 - posterior middle finger
C8 - posterior little finger
T1 - medial elbow
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34
Q

State the myotomes that correspond to C5-T1

A

C5 - elbow flexion, biceps and brachialis
C6 - wrist extension, extensor carpi radialis longus and brevis
C7 - elbow extension, triceps brachii
C8 - middle finger flexion, flexor digitorum profundus
T1 - little finger abduction, abductor digiti minimi

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35
Q

State the nerve roots of the median nerve

A

C5-T1

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36
Q

State the course of the median nerve

A 
axilla
lateral then medial to brachial artery
cubital fossa
between flexor digitorum profundus and superficialis
carpal tunnel
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37
Q

What branches of the median nerve leave in the forearm

A

anterior interosseus

palmar cutaneous

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38
Q

What does the anterior interosseus nerve innervate?

A

deep flexors of the forearm

  • pronator quadratus
  • flexor digitorum profundus (lateral half)
  • flexor pollicis longus
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39
Q

What does the palmar cutaneous branch of the median nerve innervate

A

sensory innervation to the lateral palm of the hand

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40
Q

What branches of the median nerve originate in the hand

A

recurrent branch

palmar digital

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41
Q

What does the recurrent branch of the median nerve innervate

A

thenar muscles

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42
Q

What does the palmar digital branch of the median nerve innervate

A

sensory lateral fingers

lateral lumbricals

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43
Q

How could the median nerve be damaged at the elbow?

A

supracondylar humeral fracture

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44
Q

What functions would be lost if the median nerve was damaged at the elbow

A 
loss pronation
loss flexion of wrist
loss abduction of wrist
loss of thumb movement
loss of flexion at lateral MCP
loss of sensory innervation to lateral hand
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45
Q

What position would the arm be in if median nerve is damaged at the elbow

A

supination
extension
adduction
hand of benediction

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46
Q

What causes the hand of benediction

A

loss of median nerve innervation to lateral two lumbricals (palmar digital)
when tries to make a fist, only medial two fingers can flex at MCP

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47
Q

How would the median nerve be damaged at the wrist

A

laceration proximal to flexor retinaculum

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48
Q

What functions are lost if the median nerve is damaged at the wrist

A

loss of thumb movement
loss of flexion at lateral MCP
loss of sensory innervation to lateral hand

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49
Q

Name the thenar muscles

A

flexor pollicis brevis
abductor pollicis brevis
opponens pollicis

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50
Q

State the nerve roots of the ulnar nerve

A

C8-T1

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51
Q

Describe the course of the ulnar nerve

A 
axilla
medial arm
posterior to medial epicondyle of humerus
alongside ulna
above flexor retinaculum
ulnar (Guyon's) canal
terminates in hand
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52
Q

What branches of the ulnar nerve originate in the forearm

A

muscular
palmar cutaneous
dorsal cutaneuous

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53
Q

What does the muscular branch of the ulnar nerve innervate

A

medial flexor digitorum profundus

flexor carpi ulnaris

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54
Q

What does the palmar cutaneous branch of the ulnar nerve innervate

A

sensory medial palm

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55
Q

What does the dorsal cuteneous branch of the ulnar nerve innervate

A

dorsal medial palm and fingers

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56
Q

What branches of the ulnar nerve originate in the hand

A

deep branch

superficial branch

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57
Q

What does the deep branch of the ulnar nerve innervate

A 
hypothenar eminence
interossei
medial lumbricals
adductor pollicis
palmaris brevis
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58
Q

What is the action of the lumbricals

A

DAB PAD

dorsal - abdcution
palmar - adduction

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59
Q

What does the superficial branch of the ulnar nerve innervate

A

sensory palmar surface medial 1.5 fingers

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60
Q

How is the ulnar nerve damaged at the elbow

A

fracture of medial epicondyle

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61
Q

What functions are lost if the ulnar nerve is damaged at the elbow

A

weakened flexion, accompanied by abduction
loss of adduction
loss of adduction and abduction of fingers
reduced MCP flexion of medial fingers
loss of sensation of medial hand

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62
Q

What is the characteristic sign of ulnar nerve damage at the elbow

A

patient cannot grip paper between fingers

due to loss of innervation to interossei

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63
Q

How is the ulnar nerve damaged at the wrist

A

lacerations to wrist

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64
Q

What functions are lost if the ulnar nerve is damaged at the wrist

A

loss of adduction and abduction fingers
reduced MCP flexion of medial fingers
loss of sensation to medial palmar surface of hand

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65
Q

Which sensory branch of the ulnar nerve is usually maintained in a laceration to the wrist

A

dorsal cutaneous branch

so dorsal sensory function is maintained

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66
Q

What is the sign of long term damage to the ulnar nerve at the wrist

A

ulnar claw

Hyper-extension of the medial MCP due to paralysis of the medial two lumbricals,
Flexion at the interphalangeal joints

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67
Q

What is the ulnar paradox?

A

If the ulnar nerve is damaged at the elbow, the ulnar claw is less pronounced

this is because the medial half of the flexor digitorum profundus is paralysed, which would usually act to flex DIP
so there is no flexion at distal IP joints

There is only hyperextension at the MCP and flexion at PIP which is less noticeable!

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68
Q

State the nerve roots of the radial nerve

A

C5-T1

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69
Q

State the course of the radial nerve

A

axilla
posterior to axillary artery
radial groove
anterior to lateral epicondyle of humerus
cubital fossa
splits into superficial and deep branches

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70
Q

What muscles does the radial nerve innervate before it reaches the forearm?

A

triceps brachii
brachioradialis
extensor carpi radialis longus

71
Q

Name the three sensory branches of the radial nerve that arise proximal to the elbow

A

lateral cutaneous nerve of the arm
posterior cutaneous nerve of the arm
posterior cutaneous nerve of the forearm

72
Q

What area does the lateral cutaneous nerve of the arm, originating from the radial nerve, innervate

A

sensory innervation to the lateral arm, inferior to the area supplied by the axillary nerve

73
Q

What area does the posterior cutaneous nerve of the arm, originating from the radial nerve, innervate

A

posterior arm

74
Q

What area does the lateral cutaneous nerve of the forearm, originating from the radial nerve, innervate

A

strip of skin posteriorly on the forearm

75
Q

What is the function of the deep branch of the radial nerve

A

innervates the posterior muscles of the forearm

76
Q

What does the deep branch of the radial nerve become when it penetrates through the supinator?

A

posterior interosseous nerve

77
Q

What is the function of the superficial branch of the radial nerve

A

sensory innervation to dorsum of lateral 3.5 digits

78
Q

How can the radial nerve be damaged in the axilla

A

shoulder dislocation

fracture of proximal humerus

79
Q

Describe the presentation of radial nerve damage at the axillla

A

wrist drop! - unopposed flexion

unable to extend elbow
unable to extend wrist
unable to extend at MCP

loss of sensation at lateral and posterior arm, posterior forarm and lateral dorsum of hand

80
Q

How can the radial nerve be damaged in the arm

A

fracture of the shaft of the humerus

radial nerve lies in radial groove

81
Q

Describe the presentation of radial nerve damage in the radial groove

A

wrist drop = unopposed flexion at wrist and fingers

weakened extension at elbow
unable to extend wrist
unable to extend fingers

loss of sensation to lateral dorsum of hand

82
Q

Which muscles are innervated by the radial nerve before it enters the radial groove

A

long and medial heads of the triceps brachii

83
Q

Which sensory branches of the radial nerve arise before it enters the radial groove

A

lateral cutaneous nerve of the arm
posterior cutaneous nerve of the arm
posterior cutaneous nerve of the forearm

84
Q

How can the superficial branch of the radial nerve be damaged?

A

stabbing or laceration of forearm

85
Q

Describe the presentation of damage to the superficial branch of the radial nerve

A

loss of sensation to lateral dorsum of hand

86
Q

How can the deep branch of the radial nerve be damaged?

A

posterior dislocation of radius

fracture of radial head

87
Q

Describe the presentation of damage to the deep branch of the radial nerve

A

weakened extension of the wrist

NO WRIST DROP
the extensor carpi radialis is not innervated by the deep branch, and maintains some innervation

no loss of sensation

88
Q

State the nerve roots of the femoral nerve

A

L2-L4

89
Q

Describe the course of the femoral nerve

A 
lumbar plexus
through psoas major
behind iliac fascia
under inguinal ligament - midpoint of inguinal ligament
femoral triangle
adductor canal
90
Q

Which branches of the femoral nerve leave in the femoral triangle

A

anterior division

posterior division

91
Q

What is the function of the anterior division of the femoral nerve

A

innervates hip flexors

  • sartorius
  • pectineus
  • iliacus

sensory to anteromedial thigh

92
Q

What is the function of the posterior division of the femoral nerve

A

knee extensors

  • vastus medialis
  • vastus intermedius
  • vastus lateralis
  • rectus femoris

saphenous nerve - sensory to medial leg and foot

93
Q

What nerve does the femoral nerve transition into?

A

saphenous

94
Q

Which area of the leg does the saphenous nerve provide sensory innervation to?

A

medial leg and foot

95
Q

Which vessel lies closely to the saphenous nerve?

A

long saphenous vein

96
Q

What problems can damage to the saphenous nerve cause?

A

pain, paresthesia or loss of sensation to medial leg and foot

97
Q

How is the saphenous nerve often damaged?

A

stripping of the long saphenous vein eg. varicose vein op

98
Q

State the nerve roots of the sciatic nerve

A

L4-S3

99
Q

Describe the course of the sciatic nerve

A 
lumbosacral plexus
greater sciatic foramen
inferior to piriformis
deep to long head of the biceps femoris
popliteal fossa
splits to form tibial and common fibular nerves
100
Q

What structures does the sciatic nerve innervate in the thigh

A

hamstring portion of adductor magus
biceps femoris - long head and short head
semimembranosus
semitendinosus

101
Q

Which muscles are most medial in the posterior thigh

A

semimembranosus

semitendinosus

102
Q

What is the relevance of the sciatic nerve in terms of giving IM injections in the gluteal region

A

you don’t want to hit it!

divide into quadrants

  • one line between horizontal halfway between ischial tuberosity and highest point iliac crest
  • one line vertically from highest point iliac crest

go in lateral upper quadrant

103
Q

State the nerve roots of the tibial nerve

A

L4-S3

104
Q

Describe the course of the tibial nerve

A 
sciatic nerve
popliteal fossa
deep to soleus posterior to tibia
posterior to medial malleolus beneath flexor retinaculum (tarsal tunnel)
splits into terminal branches
105
Q

Name the terminal branches of the tibial nerve

A

medial calcaneal
medial plantar
lateral plantar

106
Q

Which branch of the tibial nerve leaves in the popliteal fossa

A

sural nerve

107
Q

What area does the sural nerve provide sensory innervation to?

A

posterolateral leg

lateral foot

108
Q

Which muscles does the tibial nerve provide innervation to?

A

deep

  • flexor digitorum longus
  • flexor hallucis longus
  • popliteus
  • tibialis posterior

superficial

  • soleus
  • gastrocnemius
  • plantaris
109
Q

What area does the medial calcaneal nerve provide sensory innervation to?

A

heel

110
Q

What area does the medial plantar nerve provide sensory innervation to?

A

medial 3.5 toes and sole

111
Q

What area does the lateral plantar nerve provide sensory innervation to?

A

lateral 1.5 toes and sole

112
Q

Describe tarsal tunnel syndrome

A

tibial nerve compressed posteriorly to medial malleolus in tarsal tunnel

causing paresthesia in sole of foot, worsened by exercise

113
Q

Name the contents of the tarsal tunnel

A 
Tibialis posterior tendon
flexor Digitorum longus tendon
posterior tibial Artery
posterior tibial Vein
tibial Nerve
flexor Hallucis longus tendon
114
Q

What can cause tarsal tunnel syndrome

A

ostetoarthritis
RA
post trauma ankle deformities

115
Q

What is the surgical management of tarsal tunnel syndrome?

A

flexor retinaculum cut

116
Q

How can the tibial nerve be damaged

A

entrapment
direct trauma
compression over long period of time

117
Q

What are the problems caused by damage to the tibial nerve

A

loss of plantar flexion
loss of sensation to sole of foot
loss of toe flexion
weakened inversion (tibialis posterior lost)

118
Q

State the nerve roots of the common fibular nerve

A

L4-S2

119
Q

Describe the course of the common fibular nerve

A

popliteal fossa
medial border of biceps femoris
superficial to lateral head gastrocnemius
around the neck of the fibula
between attachments of fibularis longus muscle
splits into terminal branches

120
Q

What branches does the common fibular nerve split into?

A

deep fibular

superficial fibular

121
Q

What muscles does the common fibular nerve innervate in the thigh

A

short head of the biceps femoris

122
Q

name the branches of the common fibular nerve that originate over the lateral head of the gastrocnemius

A

sural communicating branch

lateral sural cutaneous

123
Q

Which area does the sural communicating branch of the common fibular nerve provide sensory innervation to?

A

posterolateral leg (as sural nerve)

124
Q

Which area does the lateral sural cutaneous branch of the common fibular nerve provide sensory innervation to?

A

upper lateral leg

above sural area

125
Q

State the nerve roots of the superficial fibular nerve

A

L4-S1

126
Q

Describe the course of the superficial fibular nerve

A

head of the fibula
between fibularis musles, lateral to extensor digitorum longus
pierces deep crural fasia
enters foot

127
Q

Which muscles does the superficial fibular nerve innervate?

A

fibularis longus

fibularis brevis

128
Q

What are the terminal cutaenous branches of the superficial fibular nerve

A

medial dorsal cutaneous nerve

intermedial dorsal cutaenous nerve

129
Q

What area do the medial and intermedial cutaneous branches of the superficial fibular nerve provide sensory innervation to?

A

dorsum of the foot

130
Q

What area does the superficial fibular nerve provide sensory innervation to?

A

anterolateral leg

131
Q

Describe how superficial fibular nerve entrapment presents

A

pain and paresthesia over anterolateral leg and dorsum of foot

132
Q

What causes superficial fibular nerve entrapment

A

twisting/spraining ankle - stretches nerve in lower leg

nerve entrapment in deep crural fascia

133
Q

What causes superficial fibular nerve damage

A

fracture of the fibula, or by a perforating wound to the lateral side of the leg.

134
Q

Describe how superficial fibular nerve damage presents

A

loss of eversion.

loss of sensation over the majority of the dorsum of the foot and the anterolateral aspect of the lower leg

135
Q

State the nerve roots of the deep fibular nerve

A

L4-L5

136
Q

Describe the course of the deep fibular nerve

A

common fibular nerve
alongside anterior tibial artery
superiorly: between tibialis anterior and extensor digitorum longsus
inferiorly: between tibialis anterior and extensor hallucis longus
anterior to distal tibia, beneath extensor retinaculum

137
Q

What muscles does the deep fibular nerve innervate?

A

tibialis anterior
extensor hallucis longus
extensor digitorum longus
fibularis tertius

138
Q

State the terminal branches of the deep fibular nerve

A

medial terminal branch

lateral terminal branch

139
Q

What is the function of the medial terminal branch of the deep fibular nerve

A

sensory to skin between 1st and 2nd toes

140
Q

What is the function of the lateral terminal branch of the deep fibular nerve

A

motor to
extensor digitorum brevis
extensor hallucis brevis

141
Q

What nerve is damaged in foot drop?

A

common fibular

or deep fibular

142
Q

How is the deep fibular nerve damaged?

A

anterior leg muscles have been excessively used and so are compressing the nerve within the anterior compartment. The patient will experience pain in the anterior leg.

tight-fitting shoes, compressing the nerve beneath the extensor retinaculum. The patient will also experience pain in the dorsum of the foot

143
Q

How does damaged to the deep fibular nerve present?

A

pain in anterior leg or dorsum of foot

loses the ability to dorsiflex the foot, so with unopposed plantarflexion, their foot drops.

144
Q

What kind of gait does foot drop produce?

A

difficulty in clearing the ground during the swing phase of walking.

the foot will slap down on the floor when the patient walks, because it can’t be lowered in a controlled manner.

145
Q

How is the common fibular nerve damaged?

A

fracture of fibula

a tight plaster cast.

146
Q

How does damage to the common fibular nerve present?

A

lose the ability to dorsiflex the foot at the ankle joint. Hence the foot will appear permanently plantarflexed – known as footdrop.

loss of sensation over the dorsum of the foot, and lateral side of the leg.

147
Q

State the definition of sciatica

A

symptoms of pain, tingling, and numbness
which arise from impingement of lumbosacral nerve roots as they emerge from the spinal canal,
and are felt in the distribution of the nerve root (dermatome).

There may be accompanying motor weakness in a corresponding myotomal distribution

148
Q

What are some of the causes of lumbar radiculopathy

A

disc hernation
spinal stenosis
Spondylolisthesis

149
Q

What is spondylolisthesis

A

proximal vertebra moves forward relative to a distal vertebra.

150
Q

What is the characteristic nature of the pain in spinal stenosis?

A

relieved by forward flexion and worsened with extension

151
Q

What are the signs of lumbar radiculopathy

A

+ve straight leg raise test

Numbness, paraesthesia, muscle weakness, or loss of tendon reflexes in the distribution a single nerve root.

152
Q

Describe the presentation of L4 nerve root compression

A

loss of sensation over medial ankle and foot
weakened ankle dorsiflexion
loss of patellar reflex

153
Q

Describe the presentation of L5 nerve root compression

A

loss of sensation in dorsal foot

weakened extension great toe

154
Q

Describe the presentation of S1 nerve root compression

A

loss of sensation on sole and lateral ankle
weakened plantarflexion
loss of ankle reflex

155
Q

What is the management for disc herniation

A

conservative: NSAIDs + PPI, drug for neuropathic pain,
exercise, physiotherapy

Keep active, resume normal activities, return to work. Should return to normal in 4-6wks

Spinal decompression - discectomy if pain and function have not resolved

156
Q

What are the red flags for back pain?

A 
>50y
previous cancer or infection (TB, UTI)
weight loss
fever
night sweats
thoracic pain
pain at night
neurological problems
incontinence 
saddle anaesthesia
157
Q

What is cauda equina syndrome?

A

compression of the terminal spinal nerve roots of the cauda equina L2-S4

158
Q

What can cause cauda equina syndrome

A

disc herniation
spinal stenosis (insidious onset)
cancer
trauma

159
Q

What are the symptoms of cauda equina syndrome

A 
back pain
unilateral or bilateral leg pain
saddle anaethesia
sensorimotor loss
painless urinary retention
overflow incontinence
160
Q

What are the signs of cauda equina syndrome?

A 
palpable bladder
sensorimotor loss in lower limbs
decreased or absent reflexes
loss of sensation in perianal area
decreased/lost perianal tone / loss cough reflex contraction on DRE
161
Q

What is the key investigation in cauda equina syndrome

A

spinal MRI

162
Q

What is the management of cauda equina syndrome

A

emergency surgical decompression

163
Q

What is spinal stenosis

A

narrowing of spinal canal or neural foramina leading to neurogenic claudication and root ischaemia

164
Q

What can cause spinal stenosis

A

degeneration of discs
osteophytes
hypertrophic ligamentum flavum
spondylolisthesis

165
Q

What are the symptoms of lumbar spinal stenosis

A

back pain
leg pain on walking or standing, relieved by flexion/sitting down
weakness

166
Q

what investigations are needed in suspected spinal stenosis

A

lumbar xray

MRI

167
Q

What is the treatment for spinal stenosis

A

NSAIDs, physio, steroid and anaethetic injections

surgical decompression

168
Q

What spinal infections can you get?

A

discitiis
epidural abscess
osteomyelitis

169
Q

What are the risk factors for a spinal infection

A 
recent infection
TB
immunosupression
IVDU
diabetes
170
Q

What are the symptoms of a spinal infection

A

severe localised back pain
fever

raised inflammatory markers

171
Q

What investigations should be done in suspected spinal infection

A

Bedside:
Bloods: FBC, U+E, CRP, ESR,
Micro: blood cultures, cultures from potential primary infection sites
Imaging: MRI

172
Q

What cancers can cause a spinal lesion

A

multiple myeloma

metastasis from breast, prostate, lung, thyroid and kidney

173
Q

What are the symptoms of a spinal tumour?

A 
thoracic pain
pain worse at night
localised pain
weight loss
malaise
174
Q

What investigations should be done in suspected spinal cancer

A

Bloods: LFTs, Ca, Phos, alkaline phosphatase, ESR
Imaging: CTCAP, MRI
Special tests: Bence-Jones in urine (multiple myeloma)

Finals (32 decks)

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