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First aid > msk > Flashcards

msk Flashcards

1
Q

Rotator cuff muscles

A

SItS (small t is for teres minor)

Supraspinatus (suprascapular nerve)- abducts arm initially (before the action of the deltoid) MOST COMMON SItS injury– trauma or degeneration and impingement –> tendinopathy or tear assessed by empty/full can test

Infraspinatus (suprascapular nerve)– externally rotates arm, pitching injury

tERES mINOR (axillary nerve) – adducts and externally rotates arms

Subscapularis (upper and lower subscapular nerves) - internally rotates and adducts arm

Innervated primarily by C5 C6

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2
Q

Arm abduction

A

0-15 Supraspinatus (suprascapular n.)

15-100 Deltoid (Axillary n.)

> 90 Trapezius (Accessory n)
100 Serratus Anterior (Long Thoracic- SALT – winged scapula)

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3
Q

Axillary (C5 C6)

A

Fractured surgical neck of humerus, Anterior dislocation of humerus

Flattened deltoid

Loss of arm Abduction at shoulder >15’
Loss of sensation over deltoid and lateral arm

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4
Q

Musculocutaneous (C5-C7)

A

Upper trunk compression

decreased biceps reflex, weakness of forearm flexion and supination

Loss of sensation over lateral forearm

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5
Q

Radial (C5 T1)

A

Compression of axilla, due to crutches or sleeping with arm over chair (Saturday night palsy)

Midshaft fracture of humerus

repetitive pronation/supination of forearm due to screwdriver use (finger drop)

Wrist drop- loss of elbow, wrist, and finger extension

decreased grip strength wrist extension necessary for max action of flexors

Loss of sensation over posterior arm and fore arm and dorsal hang

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6
Q

Median (C5 T1)

A

supracondylar fracture of humerus–> proximal lesion of the nerve
Carpal tunnel syndrome and wrist laceration

Distal lesion of the nerve

Ape hand and popes blessing, loss of wrist flexion, flexion of lateral fingers, thumb opposition, lumbricals of index and middle fingers

Loss of sensation over thenar eminence and dorsal and palmar aspect of lateral 3/1/1 prox lesion

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7
Q

Ulnar nerve

A

C8 T1, Fracture of medial epicondyle of humerus (funny bone- proximal lesion

Fractured hook of hamate (distal lesion) from fall on outside on outstretched hand)

ulnar claw, Radial deviation of wrist upon flexion

Loss of wrist flexion, flexion of medial fingers, abduction and adduction of fingers (action of medial 2 lumbricles)

Loss of sensation over medial 1 1/2 fingers including hypothenar eminence

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8
Q

Recurrent branch of median nerve (c5 T1)

A

Superficial laceration of palm

Ape hand

loss of thenar muscle group - opposition, abduction, and flexion of thumb

No loss of sensation

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9
Q

Humerus fractures proximally to distally

A

ARM

Axillay
Radial
Median

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10
Q

Brachial plexus lesions

A

Erbs palsy ( waiters tip) Upper trunk C5-C6

Klumpke palsy (claw hand) Lower trunk (C8-T1)

Thoracic outlet syndrome (Compression of lower trunk due to scalenes or excess rib

Winged scapula- C5-C7 Long throracic nerve serratus anterior

Wrist drop- posterior cord

Decreased thumb function- Popes blessing- Median nerve

Intrinsic claw hand

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11
Q

wrist issues

A

scaphoid- anatomical snuff box, most commonly fractured due to fall on out stretched hand, avascular necrosis

dislocation of lunate- acute carpal tunnel

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12
Q

hand muscles

A

Thenar (median) Opponencs pollicis Abductor pollicis brevis, Flexor pollicis brevis , superficial head (deep head by ulnar nerve

Hypothena (ulnar)- opponens digiti mininimi, Abductor digiti minimi brevis

Dorsal (interossei (ulnar) - abduct the finger
Palmar interossei ulnar

DAB- dorsals ABduct

PAD- Palmars ADduct

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13
Q 
Actions of hip muscles
Abductors
Adductors
Extensors
Flexors
Internal rotation
External rotation
A

Abductors- gluteus medius, minimus
Adductors- Adductors magnus, longus, brevis
Extensors- Gluteus maximus, semitendinosus, semimembranous
Flexors- iliopsoas, rectus femorus, tensor fascia lata, pectineus, sartorius
Internal rotation- gluteus medius, minimus, tensor fascia latae
External rotation- iliopsoas, gluteus maximus, piriformus, obturator

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14
Q

iliohypogastric (T12-L1)

A

Sensory- suprapubic region
Motor- transversus abdominis and internal oblique

Abdominal surgery lacerates it

Burning or tingling pain in surgical site radiating to inguinal and suprapubic region

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15
Q

Genitofemoral nerve (L1-L2)

A

Sensory- scrotum/labia majora, medial thigh

Motor- cremaster

Laproscopic surgery

Decreased upper medial thigh sensation beneath the inguinal ligament (lateral part of the femoral triangle, absent cremasteric reflex

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16
Q

Lateral fermoral cutaneous (L2-L3)

A

Sensory, anterior and lateral thigh

tight clothing, obesity, pregnancy, pelvic procedures

decreased thigh sensation (anterior and lateral)

17
Q

Obturator (l2-L4)

A

Sensory Medial thigh
Motor Obturator externus, adductor longus, adductor brevus, gracilis, pectineus, adductor magnus

Pelvic surgery
Decreased thigh sensation, medial, and adduction

18
Q

Femoral (L2-L4)

A

Sensory - anterior thigh, medial leg

Motor- quadriceps, iliacus, Pectineus, sartorius

Pelvic fracture

decreased leg extension (decreased patellar reflex)

19
Q

Sciatic L4-S3

A

Motor- Semitendinosis, semimembranous, biceps femoris, adductor magnus

Herniated disc, posterior hip dislocation

Splits into common peroneal and tibial nerves

20
Q

Common (fibular) peroneal (L4-S2)

A

Superficial peroneal nerve- Sensory (dorsum of foot- except webspace between hallux and 2nd digin). Motor- perneus longus and brevis.

Deep peroneal nerve- Sensory (webspace between hallux and 2nd digit), Motor- tibialis anterior

Trauma or compression of lateral aspect of leg, fibular neck fracture

PED- Peroneal everts and dorsifexes, if injured, foot dropPED. Loss of sensation on dorsum of foot, Foot drop (inverted and plantarflexed at rest, loss of eversion and dorsiflexion. steppage gait

21
Q

Tibial (L4-S3)

A

Sensory- sole of foot
Motor- biceps femoris (long head) triceps surae, plantaris, popliteus, flexor muscles of foot

Knee trauma, baker cyst (proximal lesion), tarsal tunnel syndrome (distal lesion)

TIP- Tibial inverts and plantarflexes, if injured cant stand on TIP toes

Inability to curl toes and loss of sensation on sole , in proximal lesions, foot everted at rest with loss of inversion and plantar flexion

22
Q

Superior gluteal (L4-S1)

A

motor- gluteus medius, gluteus minimus, tensor fascia latae

Iatrogenic injury during IM to supermedial gluteal region
Prevent by superolateal quadrant, pregerably anterolatal gion

Trendelenbur sign/ gait pelvis tils bc no stabilixato

Lesion is contralateral to hip dip

23
Q

Inferior gluteal (L5-S2)

A

Motor- gluteus maximus

Posterior hip dislocation

Difficuly climbing stairs, rising from seated position, loss of hip sensation

24
Q

Pudendal (S2-S4)

A

Sensory- perineum
Motor- external urethral and anal sphicters

Stretch injury during delivery, prolonged cycling
Horseback riding

Decreased sensation in perineum and genital area, can cause fecal and/or urinary incontinence

Can be blocked with local anesthetic during childbirth using ischial spine as a landmark for injection

25
Q

Knee exam

A

Lateral femoral to condyle to anterior tibia (ACL) LA
Medial femoral to condyle to posterior Tibia (PCL) MP

LAMP

Anterior drawer sign due to ACL injury, LAchman test also test ACL (more sensitive

Posterior drawer sign- PCL injury

26
Q

Valgus vs Varus stress

A

Varus stress- < > (Medial force)

VaLgus stress- >< (lateral force)

27
Q

Ankle sprains

A

Anterior TaloFibular ligament- most common ankle sprain overall, low ankle sprain. Due to overinversion/supination of foot,

Anterior inferior tibiofibular ligament- most common high ankle sprain,

Always Tears First

28
Q

Signs of lumbosacral radiculopathy

A

Paresthesia and weakness related to specific lumbosacral spinal nerves, interventricular disc (nucleus pulposus) herniates posterolaterally through and thicker annulus fibrosus (outer ring) into central canal due to thin posterior longitudinal ligament and thicker anterior longitudinal ligament along midline of vertebral bodies, nerve affected is usually below the level of herniation

L4 (L3-L4) - weakness of knee extenstion decreased patellar reflex

L5 (L4-L5) - weakness of dorsiflexion (difficultu in heel walking)

S1- Weakness of plantar flexion difficulty in the walking decreased toe walking, decreased achilies reflex

29
Q

Motorneuron action potential to muscle contraction

A

T tubules are extensions of plasma membranes in contact with the Sarcoplasmic Reticulum, allowing for coordinated contraction of striated muscles

AP opens Presynaptic voltage gated Ca channels, inducing Ach release

Post synaptic Ach binding lead to muscle cell depolarization at the motor end plate

Depolarization travels over the entire muscle cell and deep into the muscle via T tubules
Membrane depolarization Activates the DHPR to pull on Ryanodine Receptor -> releases Ca into the cell from sracoplasmic reticulum

Tropomyosin is blocking myosin binding sites on actin filament, released CA++ binds to troponin C, shifting tropomyosin to expose the myosin-binding sites

The myosin head binds strongly to actin, forming a crossbrige, Pi is then released initiating the power stroke

During powerstroke force is produced as myosin pulls on the thin filament, Muscle shortening occurs, shortening of H and I bands and between Z lines (HIZ shrinkage) ADP is released at the end of the power stroke

Binding of a ner ATP molecule causes detachement of myosin head from actin filament and Ca is resepuestered

ATP hydrolysis into ADP and P result sin myosin returning to high energy state (cocked, , myosin binds a new site on actin if CA is available

30
Q

types of muscle fibers

A

Type 1 slow red fibers Oxidative phospohorylation –> sustained contraction

Increased mitochondria myoglobin, endurance training

Type 2- fast white, anaerobic glycolyisi, Decreased weight/resistance training sprinting

31
Q

Muscle proprioceptors

A

Muscle spindle- Increased length and speed of stretch–> DRG–> activation of inhibitory interneuron and a motor neuron–> simultaneous inhibittion of antagonist muscle , prevents overstretching and activation of agonist

muscle type 1a and 2 sensory axons, increased muscle stretch

Golgi tendon organ–> increased tension –> DRG–> activation on inhibitory neuron–> inhibition of agonist muscle and tendon

Tendons /type 1b sensory axons, increased muscle force

32
Q

Cell bio of bone

A

Osteoblast bultds bone by secreting collagen and catalyzing mineralization in alk environment vial ALP (bone ALP, osteocalcin and propeptides of type 1 porcollagen

Osteoclast Dissolves crushes bone by secreting Hand collagenase, differentiates from a fusion of monocytes and macrophages lineage precursors, RANK r on osteoclasts are activated by RANK L on osteoblasts, OPG (a RANKL decoy binds RANKL to prevent RANK-RANKL interaction–> decreased osteoclast activity)

PTH- at low anabolic on osteoblasts and osteoclasts inderect, chronically increased PTH levels (1’ hyperparathyroidism) cause oseitis fibrosa cystica)

Estrogen- inhibits apoptosis in bone formin osteoblasts and induces apoptosis in bone resorbing osteoclasts, cause closure of epiphyseal plate during puberty, menopause–> increased cycles of remodeling and bone resorption –> osteoporosis

First aid (12 decks)

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