MSK Flashcards
What are the common types of nerve injury?
Neuropraxia
Axonotmesis
Neurotmesis
Features of neurapraxia?
Nerve intact but electrical conduction is affected
Full recovery
Autonomic function preserved
Wallerian degeneration does not occur
Features of Axonotmesis
Axon is damaged and the myelin sheath is preserved. The connective tissue framework is not affected.
Wallerian degeneration occurs.
Features of Neurotmesis?
Disruption of the axon, myelin sheath and surrounding connective tissue.
Wallerian degeneration occurs.
What muscles are being tested in the trendenlenburg test?
The contralateral Abductors (Gluteus Medius & minimus)
If the pelvis tilts to the right its the L abductors that are weak
Where do the rotator cuff muscles insert onto the humerus?
Subscapularis –> Lesser Tubercle
Supraspinatus, Infraspinatus & Teres minor –> Greater Tubercle
What structures are supplied by the following arteries:
- Middle Genicular
- Medial Geniculate
- Medial Femoral Circumflex
- Lateral Femoral Circumflex
Middle Genicular –> ACL
Medical Geniculate –> MCL
Medial Femoral Circumflex –> HEad of femur and neck (fracture –> damage –> necrosis of head of femur)
Lateral Femoral circumflex –> Lateral compartment of thigh
Contents of cubital fossa from Lat to Medial?
- RAdial nerve
- Biceps Tendon
- Brachial Art
- Median Nerve
What vascular structure is found at the sternomanubrial joint level?
Aortic Arch
What articulates with head of radius and ulnar superiorly?
Capitulum with radius
TRochlea with ulna
What structures pass behind the lateral malleolus? (in order from ant to post)
Tibialis Posterior Flexor Digitorum longus Posterior Tibial Artery Posterior Tibial Vein Tibial Nerve Flexor Hallucis Longus
T: tibialis posterior D: flexor digitorum longus A: artery (posterior tibial) V: vein (posterior tibial) N: nerve (tibial) H: flexor hallucis longus
How do you remember the structures passing behind the lateral malleolus?
Tom Dick & Very Nervous Harry:
- Tibialis posterior
- flexor Digitorum Longus
- post tibial Art
- post tibial Vein
- tibial Nerve
- flexor Hallucis longus
What nerves supply sensation to the foot?
Tibial nerve –> Plantar Surface
Superficial Peroneal Nerve –> Dorsum
Deep Peroneal Nerve –> Dorsum, just 1st web space
Sural Nerve –> Lateral foot (a branch of both the tibial and common peroneal nerves)
19yr old patient presents with increasing back stiffness over a period of months, shoulder & back pain and enthesitis in his achilles tendon. What’s the likely diagnosis and what blood test would you run?
Ankylosing spondilytis
Do HLA-B27
Most common presentations are inflammation of sacroiliac joints, achilles enthesitis and plantar fasciitis
what muscle is most heavily involved in testing lower limb coordination by the heel-shin test
Sartorius due to its effect of medial rotation of tibia on the femur
What are the major causes of Acanthosis Nigricans?
1) Obesity related
2) DM
3) Cushing’s
4) PCOS
5) Drugs e.g. insulin
What nerves supply the knee joint?
Femoral
Sciatic
Obturator
What structures attach to the coracoid process?
- Short head of Biceps Brachii
- Coracobrachialis
- Pec minor
- Coracoacromial, -clavicular and -humeral ligaments
Patient presents unable to grasp a piece of paper between finger and thumb. What nerve is damaged and what is this sign called?
Froment’s Sign
Indicative of ulnar nerve palsy
What organism causes most OM in kids?
Staph Aureus (unless sickle cell then its salmonella)
Which nerve supplies which lower leg compartment?
Ant comp = Deep Peroneal (Fibular)
Lat Comp = Sup Peroneal (Fibular)
Post Comp = Tibial Nerve
What muscles are found in the ant lower leg?
Tibialis Ant
Extensor Digitorum Longus
Extensor Hallucis Longus
Peroneus Tertius
What muscles are in lat lower leg?
Fibularis Longus & brevis
What muscles are in deep and superficial post lower leg?
Deep = Tibialis Post, Flexor Hallucis Longus, Flexor Digitorum Longus & Popliteus
Superifical = Plantaris, Soleus & Gastrocnemius
What are the potential complications of Toxic Epidermal Necrosis?
- Hypothermia
- 2nd* infection
- Fluid loss
- Electrolyte Imbalance
Within which tendon is the pisiform found?
Flexor Carpi ulnaris
Its a sesamoid bone
What tendons are affected in de quervains tenosynovitis?
APL & EPB
what forms the boundaries of the greater sciatic foramen and what passes through it?
Anterolaterally = Greater sciatic notch of the ilium Posteromedially = Sacrotuberous ligament Inferior = Sacrospinous ligament and the ischial spine Superior = Anterior sacroiliac ligament
Pudendal Nerve
What does the pudendal nerve do?
Sensation to genitals, perineum and around anus
Motor to some pelvic muscles including ext urinary sphincter and ext anal sphincter
What tumour is a Codman’s triangle on X-ray associated with?
Osteosarcoma
Codman’s triangle is an elevation of periosteum
What is targeted by infliximab and rituximab?
Infliximab - TNF-alpha
Rituximab - CD20
which of the following muscles don’t insert onto the radius?
- Pronator Quadratus
- Biceps
- Brachioradialis
- Brachialis
- Supinator
Only the brachialis doesn’t insert onto the radius, it inserts onto the ulna instead
Osteonecrosis of jaw is a risk of which drug?
Bisphosphonates e.g. Alendronate
What passess through the greater and lesser sciatic foramina?
PIN:
- Pudendal Nerve
- Internal Pudendal Art
- Nerve to Obturator Internus
What effect does the trapezius have on scapular movement?
Retraction and upward rotation/elevation
Which muscle is tested in froment’s test?
Adductor Pollicis
What protein is affected in Marfan’s Syndrome?
Fibrillin
What nerve supplies the hamstrings?
Tibial division of Sciatic Nerve
Whats the significance of the ischial spine and tuberosity?
They attach the sacrospinous and sacrotuberal ligaments which form the greater and lesser sciatic foramina
Sacrotuberal is more superficial and inf when viewed from behind
What do we call the lateral fascia lata?
Iliotibial tract
What do we call the bone notches that contribute to the sciatic foramina?
Greater and lesser sciatic notches
Osteogenesis Imperfecta is an autosomal dominant condition affecting collagen Type 1, how does it present?
presents in childhood fractures following minor trauma blue sclera deafness secondary to otosclerosis dental imperfections are common
What is Ehler’s Danlos Syndrome?
Autosomal Dominant CT disorder affecting Type 3 collagen
How does Ehler’s-Danlos Syndrome present?
elastic, fragile skin
joint hypermobility –> recurrent joint dislocation
easy bruising
aortic regurgitation, mitral valve prolapse and aortic dissection
subarachnoid haemorrhage
angioid retinal streaks
In what condition is collagen Type 4 affected?
Goodpasture’s Syndrome
Where do the rotator cuff muscles insert?
Onto the greater tuberosity of the humerus
Bar the subscapularis which inserts onto the lesser tuberosity
What are hard bony nodes forming on the interphalangeal joitns of the fingers?
Proximal = Bouchards Distal = Heberdens
They are features of OA
What conditions would be suggested by joint/back pain that worsens in the morning and is relieved by exercise?
Inflammatory e.g. RA or Ankylosing Spondylitis
What function does the serratus ant have on the arm?
Abduction
What forms the roof of the adductor canal?
Sartorius
Where does the sartorius insert?
Onto the medial upper part of the tibia
which rotator cuff muscles are responsible for int vs ext rotation?
Subscapularis is the only int rotator
All the rest are ext
where does the biceps originate and insert?
Long head = Supraglenoid Tubercle of scapula
Short head = Coracoid process
Insertion = RAdial Tuberosity
what muscles insert onto the intertubecular sulcus of the humerus?
Pec major
Lats
What ligament connects the head of the radius to the ulna?
Annular Ligament
What is Sjogren’s syndrome and what is it a complication of?
Its an autoimmune condition against exocrine glands –> Dry mucosal membranes
–> dry mouth, vagina, COPD, bronchiectasis etc
Its a complication of RA
Whats the most common finding in paget’s disease?
Raised ALKP
What’s deposited in Pseudogout?
Calcium Pyrophosphate Dihydrate
Treatment for Gout?
1st) NSAIDs or Colchicine
2nd) Steroids (Oral or IA)
Allopurinol as long-term therapy
Whats the most common benign bone tumour?
Osteochondroma
Most common malignant boen tumour?
Osteosarcoma