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MSK Anatomy Flashcards

1
Q

Joint types

A

Fibrous: cranial sutures, interosseus membrane

Cartilagenous:

  • Primary (hyaline only): ossify - growth plates
  • Secondary (+ fibrocartilage): midline - pubic symphysis

Synovial:

  • Plane
  • Hinge
  • Condylar
  • Ball and socket
  • Saddle
  • Pivot
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2
Q

Joint stability

A
  • Articular surface
  • Capsule and ligaments
  • Muscles
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3
Q

Cartilage Structure

A

Superficial layer: flattened chondrocytes that produce collagen and glycoproteins (lubricin) - parallel collagen

Transitional layer: round chondrocytes that produce proteoglycans (aggrecan)

Deep layer: horizontal collagen

75% water

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4
Q

Cartilage Function

A

Provide a smooth, lubricated surface for low friction articulation and facilitation of load transmission

  • Glycoproteins (lubricin):&raquo_space; protein
  • Proteoglycans (aggrecan)&raquo_space; carb
  • GAGs (hyaluronic acid)&raquo_space;> carb
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5
Q

Synovial fluid components and function

A
  • Hyaluronic acid
  • Lubricin
  • Blood plasma

Nutrition of cartilage, waste removal, lubrication (boundary, hydrodynamic, weeping)

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6
Q

Bursae

A

Fluid-filled sacs that reduce friction

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7
Q

Bone development

A
  1. Hyaline cartilage model
  2. Primary ossification centre develops at centre
  3. Secondary ossification centre develops at ends
  4. Medullary cavity forms in primary ossification centre
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8
Q

Bone structure

A

Epiphysis: articular cartilage, spongy/cancellous bone
Epiphyseal growth plate
Metaphysis
Diaphysis: medullary cavity, compact/cortical bone

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9
Q

Cortical/compact bone

A

Lamellae

  • Concentric: central canal with blood vessels
  • Interstitial
  • Circumferential

Biologically inactive
Resists bending and torsion

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10
Q

Spongy/cancellous bone

A

Trabeculae

  • Resists/absorbs compression
  • Very biologically active - osteoclasts, osteoblasts, osteocytes
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11
Q

Tendon structure and function

A

Collagenous structure
- Vinculum: blood supply

Connects muscle to bone

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12
Q

Ligament structure and function

A

Collagenous structure

Connects bone to bone (span a joint)

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13
Q

Axilla boundaries

A

Apex: lat. border of 1st rib, scapula, clavicle
Base: axillary fascia
Anterior: pectoralis major + minor
Posterior: subscapularis, teres major, latissimus dorsi
Medial: thoracic wall, serratus anterior
Lateral: neck/shaft of humerus

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14
Q

Axilla contents

A
  • Axillary artery
  • Axillary vein
  • Brachial plexus
  • Axillary lymph nodes
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15
Q

Brachial plexus roots

A

C5-T1

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16
Q

Brachial plexus trunks

A
  • Superior: C5-6
  • Middle: C7
  • Inferior: C8-T1
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17
Q

Brachial plexus cords

A

Named for position in relation to axillary artery

  • Lateral cord: anterior divisions of upper and middle trunk
  • Posterior cord: posterior divisions of all trunks
  • Medial cord: anterior division of lower trunk
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18
Q

Musculocutaneous nerve

A

C5-7

  • Originates from lateral cord
  • Anterior compartment of arm (BBC)

Course:

  1. Perforates coracobrachialis
  2. Descends between biceps brachii and brachialis
  3. Crosses elbow
  4. Terminal branch in forearm: lateral cutaneous nerve
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19
Q

Axillary nerve

A

C5-6

  • Originates from posterior cord
  • Deltoid and teres minor

Course:

  1. Exits axilla via quadrangular space
  2. Passes medially to surgical neck of humerus
  3. Divides into 3 terminal branches: anterior, posterior, articular
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20
Q

Radial nerve

A

C5-T1

  • Originates from posterior cord
  • BEST: brachioradialis, extensors (wrist), supinator, triceps (posterior compartment of arm)

Course:

  1. Enters anterior to medial head of triceps and runs with profunda brachii artery
  2. Descends down midshaft humerus in radial groove
  3. Lies between brachialis and brachioradialis
  4. Anterior to lateral epicondyle
  5. Cubital fossa and then terminates (deep and superficial branch)
    a. Deep branch (aka posterior interosseus nerve) runs deep to supinator (pierces to enter posterior compartment)
    b. Superficial branch runs deep to brachioradialis and enters hand above anatomical snuff box (dorsum of hand)
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21
Q

Median nerve

A

C5-T1

  • Originates from lateral and medial cord
  • Anterior compartment of forearm

Course:

  1. Descends along lateral side of axillary/brachial artery
  2. Crosses to medial brachial artery in middle part of arm
  3. Enters cubital fossa
  4. Heads under pronator teres
  5. Descends between flexor digitorum superficialis and profundus
  6. Enters carpal tunnel deep to flexor retinaculum
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22
Q

Ulnar nerve

A

C8-T1

  • Originates from medial cord
  • Intrinsic muscles of the hand

Course:

  1. Descends along medial side of brachial artery
  2. Enters posterior compartment of arm through medial intermuscular septum and runs along medial head of triceps
  3. Passes medial epicondyle posteriorly
  4. Passes between heads of flexor carpi ulnaris
  5. Descends to wrist medial to ulnar artery
  6. Enters hand superficial to flexor retinaculum
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23
Q

Arterial supply of upper limb

A
  1. Subclavian
  2. Axillary - at lateral border of the 1st rib
  3. Brachial - lower margin of teres major. Gives off profunda brachii (passes deep to triceps with radial nerve)

Radial (lateral)

  • Starts under brachioradialis
  • Runs over pronator teres, flexor pollicis longus and distal radius
  • Forms deep palmar arches

Ulnar (medial)

  • Runs distal with ulnar nerve between flexor carpi ulnaris and flexor digitorum profundus
  • Runs through wrist and forms superficial palmar arch

Palmar arches anastomose

Common digital artery
Proper palmar digital artery
Posterior interosseus artery - branch of ulnar artery

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24
Q

Venous drainage of upper limb

A
  • Dorsal venous arch
  • Cephalic (lateral)
  • Basilic (medial)
  • Median cubital (communicating vein in ante-cubital fossa:
    cephalic -> basilic)
  • Axillary vein
    Cephalic vein pierces clavipectoral fascia
    Basilic vein becomes axillary at lower border of teres minor
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25
Q

Dermatomes of upper limb

A 
C5 - deltoid (regimental badge)
C6 - thumb
C7 - middle finger
C8 - little finger
T1 - medial antecubital fossa
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26
Q

Lymphatic drainage of upper limb

A

Axillary lymph nodes:

  • Anterior/Pectoral: anterior thoracic wall
  • Posterior/Subscapular: posterior thoracic wall
  • Lateral/Brachial: lateral axillary wall
  • ^^ all drain to central nodes at base of axilla.
  • ^^ drains to apical nodes at apex of axilla
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27
Q

Pectoral (shoulder) girdle

A

Connect bilateral upper limbs to axial skeleton

  • Clavicle
  • Scapula
  • Acromioclavicular joint (plane)
  • Sternoclavicular joint (plane with fibrocartilage disc)
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28
Q

Clavicle

A

Connects to manubrium of sternum (SC) and acromion of scapula (AC).

  • Shaft is weakest
  • Conoid tubercle on inferior surface
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29
Q

Scapula

A
  • Acromion
  • Coracoid process
  • Spine and spinous process
  • Supra/infraspinous fossa (posterior)
  • Subscapular fossa, lateral/medial border and superior/inferior angle (anterior)
  • Glenoid cavity and supra/infraglenoid tubercles
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30
Q

Coracoid process attachments

A

3 muscles

  • Pectoralis minor
  • Biceps brachii (short head)
  • Coracobrachialis

3 ligaments

  • Coracohumeral
  • Coracoacromial
  • Coracoclavicular
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31
Q

Scapulo-humeral rhythm

A

Abduction

  • First 30 degrees caused by muscles acting at gleno-humeral joint
  • > 30 degrees requires scapula-thoracic movement: elevation and lateral rotation
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32
Q

Elevation (superomedial) of scapula

A
  1. Trapezius (superior fibres)
  2. Levator scapulae
  3. Rhomboid minor and major

All medial border of scapula insertion

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33
Q

Depression of scapula

A
  1. Gravity
  2. Latissimus dorsi
  3. Serratus anterior
  4. Pectoralis major and minor
  5. Trapezius (inferior fibres)
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34
Q

Protraction (forward movement) of scapula

A
  1. Serratus anterior

2. Pectoralis major and minor

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35
Q

Retraction (backward movement) of scapula

A
  1. Trapezius (middle fibres)
  2. Rhomboid major and minor
  3. Latissimus dorsi
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36
Q

Lateral (upward) rotation - elevate glenoid cavity

A
  1. Trapezius

2. Serratus anterior

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37
Q

Medial (downward) rotation - depress glenoid cavity

A
  1. Gravity
  2. Levator scapulae
  3. Rhomboids
  4. Pectoralis minor
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38
Q

Gleno-humeral joint

A

Ball and socket synovial joint.

Glenoid labrum is a rim of cartilage that deepens the socket providing stability

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39
Q

Ligaments of shoulder joint

A
  • Coracoacromial arch (superior)
  • Coracohumeral (superior)
  • Glenohumeral (anterior)
  • Transverse humeral (stabilises long head of biceps)
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40
Q

Bursae of shoulder joint

A

Subacromial (subdeltoid)

  • Between infra-/supraspinatus muscles and deltoid to reduce friction beneath deltoid (promoting movement of rotator cuff muscles)
  • Injury by repetitive overhead movements

Subscapular
- Communicate with joint cavity

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41
Q

Rotator Cuff muscles (SITS)

A

Stabilise the gleno-humeral joint
Innervation: C5-6

External (lateral) rotators:

  1. Infraspinatus
    - Infraspinous fossa
    - Greater tuberosity of humerus
  2. Supraspinatus
    - Supraspinous fossa
    - Greater tuberosity of humerus
  3. Teres minor
    - Lateral border of scapula
    - Greater tuberosity of humerus

Internal (medial) rotator:

  1. Subscapularis
    - Subscapular fossa of scapula
    - Greater tubercle of humerus (anterior)
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42
Q

Shoulder dislocation

A

Weakest part of capsule is anteroinferior.
Anterior more common
Axillary nerve damage (loss of sensation at regimental badge area)

43
Q

Deltoid muscle

A
  • Origin: lateral spine of scapula
    Passes across acromion to lateral third of clavicle
  • Insertion: deltoid tuberosity of humerus
  • Function: flexion, abduction and extension
  • Innervation: axillary nerve
44
Q

Pectoralis major

A
  • Origin: medial third of clavicle, sternum and costal cartilage of ribs 1-6 and rectus sheath
  • Insertion: lateral lip of bicipital groove of humerus
  • Function: adduct, flex and medially rotate humerus
45
Q

Pectoralis minor

A
  • Origin: 3-5th ribs
  • Insertion: coracoid process
  • Function: stabilise scapula (with serratus anterior), splits axillary artery into 3
46
Q

Serratus anterior

A

Stabilise and protraction of scapula.

  • Long thoracic nerve (C5-7)
  • Dysfunction leads to winging (long thoracic nerve damage during breast surgery common)
47
Q

Trapezius

A
  • Origin: occipital, spinous process T1-12
  • Insertion: lateral 1/3 clavicle, acromion, spine of scapula
  • Function: elevate (superior), retract (middle) and depress (inferior) scapula
  • Innervation: CNXI
48
Q

Flexion of shoulder

A
  1. Deltoid
  2. Pectoralis major
  3. Corachobrachialis
49
Q

Extension of shoulder

A
  1. Deltoid
  2. Latissimus dorsi
  3. Teres major and minor
50
Q

Adduction of shoulder

A
  1. Pectoralis major
  2. Latissimus dorsi
  3. Teres major
  4. Triceps brachii
51
Q

Abduction of shoulder

A

0-90: supraspinatus, deltoid

90-180: trapezius, serratus anterior

52
Q

Medial/internal rotation of shoulder

A
  1. Subscapularis
  2. Latissimus dorsi
  3. Pectoralis major
  4. Teres major
53
Q

Lateral/external rotation of shoulder

A
  1. Infraspinatus
  2. Supraspinatus
  3. Teres minor
54
Q

Latissimus dorsi

A
  • Origin: broad - T7-12 spinous processes, ileal crest, ribs 9-12
  • Insertion: Intertubercular sulcus of humerus (anterior)
  • Function: Depression, internal rotation, adduction, extension
55
Q

Humerus

A

Anterior:

  • Greater (SIT) and lesser tubercle
  • Intertubercular groove (t. major and lat dorsi)
  • Deltoid tuberosity
  • Coronoid fossa
  • Radial fossa
  • Trochlea
  • Capitulum

Posterior:

  • Head
  • Neck (anatomical then surgical)
  • Shaft
  • Radial groove
  • Olecranon fossa
  • Medial epicondyle
56
Q

Elbow joint

A

Synovial hinge (180 degrees)

  • Trochlear notch (ulna) and trochlea
  • Head of radius and capitulum

Bursae: intratendinous, subtendinous, subcutaneous (olecranon)

57
Q

Elbow ligaments

A
  • Radial collateral ligament (medial epicondyle and coronoid process -> olecranon of ulna)
  • Ulnar collateral ligament (lateral epicondyle -> annular ligament of radius)
58
Q

Epicondylitis

A

Repetitive overused of forearm muscles results in inflammation of muscle tendons attached to epicondyles
Lateral: tennis elbow
Medial: golfer’s elbow

59
Q

Radio-ulnar joints

A
  • Proximal (annular ligament keeps radius in place) and distal
  • Pivot-type to allow supination and pronation
60
Q

Anterior compartment of the arm

A

Biceps brachii, coracobrachialis and brachialis

  • Musculocutaneous (BBC) nerve
  • Flexion
61
Q

Biceps brachii

A
  • Long head: supraglenoid tubercle (intertubercular groove)
  • Short head: coracoid process
  • Radial tuberosity
  • Bicipital aponeurosis to deep fascia of forearm
  • Flexion of elbow + arm
  • Supination of forearm
62
Q

Coracobrachialis

A
  • Coracoid process
  • Mid-shaft humerus (medial)
  • Flexion and adduction of arm
63
Q

Brachialis

A
  • Distal shaft humerus (anterior)
  • Coranoid process of ulna
  • Flexion of elbow
64
Q

Posterior compartment of arm

A

Triceps brachii and anoceus

  • Radial nerve
  • Extension of forearm (+ arm)
65
Q

Triceps brachii

A
  • Long head: Infraglenoid tubercle
  • Lateral head: Posterior humerus (above radial groove)
  • Medial head: Posterior humerus (below radial groove)
  • Olecranon process of ulna
66
Q

Ancoceus

A
  • Lateral epicondyle of humerus

- Olecranon process of ulna

67
Q

Cubital fossa

A

Boundaries

  • Lateral: medial brachioradialis muscle
  • Medial: lateral border of pronator teres muscle
  • Superior: imaginary line between epicondyles
  • Floor: brachialis and supinators
  • Roof: skin and fascia

Contents:

  • Radial nerve
  • Biceps tendon
  • Brachial artery - bifurcation at radial neck
  • Median nerve

Note: Median cubital vein lies anterior. Cephalic lies laterally and basilic lies medially

68
Q

Supination

A

Biceps brachii and supinator

69
Q

Pronation

A

Pronator teres and pronator quadratus

70
Q

Anterior compartment of the forearm

A

Flexion of wrist and pronation of forearm

Superficial:

  • Brachioradialis
  • Pronator teres
  • Flexor carpi radialis
  • Flexor carpi ulnaris
  • Palmaris longus

Intermediate:
- Flexor digitorum superficialis

All except brachioradialis originate from medial epicondyle (common flexor origin)

Deep:

  • Flexor digitorum profundus
  • Flexor pollicis longus
  • Pronator quadratus

All median nerve except ulnaris, brachioradialis and some of FDP

71
Q

Pronator teres

A

Anterior compartment of forearm

  • Medial epicondyle
  • Radius (lateral)
  • Pronation and elbow flexion
  • Median nerve
72
Q

Flexor carpi radialis

A

Anterior compartment of forearm

  • Medial epicondyle
  • Metacarpals 2-3
  • Wrist flexion, abduction (radial deviation)
  • Median nerve
73
Q

Flexor carpi ulnaris

A

Anterior compartment of forearm

  • Medial epicondyle
  • Pisiform, hamate, metacarpal 5
  • Wrist flexion, adduction (ulnar deviation)
  • Ulnar nerve
74
Q

Flexor digitorum superficialis

A

Anterior compartment of forearm (intermediate)

  • Medial epicondyle
  • Intermediate phalanges of digits 2-5. Note: makes tunnel for FDP tendons
  • Wrist and finger flexion
  • Median nerve
75
Q

Flexor digitorum profundus

A

Anterior compartment of forearm (deep)

  • Ulna + interosseus membrane
  • Distal phalanges 2-5 (palmar)
  • Flexion: metacarpophalangeal, interphalangeal, wrist
  • Dual nerve supply: median (2-3) and ulnar (4-5)
76
Q

Flexor pollicis longus

A

Anterior compartment of forearm (deep)

  • Radius + interosseus membrane
  • Distal phalanx of thumb
  • Flexion of thumb: metacarpophalangeal, interphalangeal
  • Median nerve
77
Q

Pronator quadratus

A

Anterior compartment of forearm (deep)

  • Distal anterior ulna
  • Distal anterior radius
  • Pronation (with pronator teres)
  • Median nerve
78
Q

Brachioradialis

A
  • Lateral supracondylar ridge of humerus
  • Styloid process of radius
  • Elbow flexion (lies in posterior compartment) and pronation
  • Radial nerve
79
Q

Carpal tunnel

A

Passageway from forearm to hand passing deep to the flexor retinaculum (fibrous band)
- 4 carpal bones: scaphoid and trapezium (lateral) and pisiform and hamate (medial)

Function: transmits structures

  • 4 FDS tendons
  • 4 FDP tendons
  • 1 tendon of FPL
  • Median nerve
80
Q

Thenar compartment of the hand

A

Control thumb movement

  • Abductor pollicis brevis
  • Flexor pollicis brevis
  • Opponens pollicis (deep)
  • Median nerve
  • Ulnar nerve: deep belly of FPB
81
Q

Hypothenar compartment of the hand

A

Control 5th digit movement

  • Abductor digiti minimi
  • Flexor digiti minimi
  • Opponens digiti minimi
  • Ulnar nerve
82
Q

Central compartment of the hand

A
  • Flexor tendons from forearm: FDS, FDP, FPL
  • Lumbricals - 4 muscles that arise from the medial and lateral aspects of the FDP tendon between the 1st-5th metacarpals

Lumbricals:

  • Flexion at metacarpophalangeal 2-5
  • Extend at interphalangeal 2-5
  • 3,4 - ulnar
  • 1,2 - median
83
Q

Adductor compartment of the hand

A

Adductor pollicis

  • Oblique and transverse head
  • Adduction of thumb
  • Ulnar nerve
84
Q

Interosseus compartment of the hand

A

Lie between metacarpal bones

4 dorsal: abduct fingers (DAB)

  • 1 -> 2nd digit
  • 2,3 -> 3rd digit
  • 4 -> 4th digit

3 palmar: adduct fingers (PAD)

  • 1 -> 2nd digit
  • 2 -> 4th digit
  • 3 -> 5th digit
  • Ulnar nerve (deep branch)
85
Q

Upper limb motor nerve testing

A

Axillary: abduct shoulders (deltoid)
Musculocutaneous: flex elbow (ant. compartment arm)
Radial: extend wrist (post. compartment forearm)
Ulnar: spread your fingers (intrinsic hand)
Median: thumb towards nose (abductor pollicis brevis)

86
Q

Upper limb sensory nerve testing

A

Axillary: regimental badge area
Musculocutaneous: lat. aspect of forearm
Radial: post. arm, forearm, dorsal lateral 3 1/2 fingers
Ulnar: palmar/dorsal aspect of medial 1 1/2 fingers
Median: palmar lateral 3 1/2 fingers

87
Q

Radius and ulna

A

Radius

  • Radial tuberosity
  • Styloid process
  • Head

Ulna

  • Olecranon process
  • Trochlear notch
88
Q

Wrist

A

Carpal bones

  • Scaphoid (most commonly fractured) and lunate - articulates with radius
  • Triquetrum
  • Pisiform
  • Hamate
  • Capitate
  • Trapezoid
  • Trapezium

Between ulna and carpal bones is triangular fibrocartilage complex (TFCC)

89
Q

Movements of wrist

A

Flexion: anterior compartment of forearm
Extension: posterior compartment of forearm
Adduction (ulnar deviation): flexor/extensor carpi ulnaris
Abduction (radial deviation): flexor/extensor carpi radialis
Circumduction

90
Q

Hand

A

Carpals
- Carpometocarpal joint
Metacarpals
- Metacarpophalangeal joint

Proximal phalanges
Middle phalanges - 2-5 only
Distal phalanges
- Interphalangeal joint

91
Q

Posterior compartment of forearm

A

Extend wrist joint

  • Extensor carpi radialis longus - abduct
  • Extensor carpi radialis brevis - abduct
  • Extensor carpi ulnaris - adduct

Extend medial 4 digits

  • Extensor digitorum
  • Extensor indices
  • Extensor digiti minimi

Extend or abduct thumb

  • Abductor pollicis longus
  • Extensor pollicis longus
  • Extensor pollicis brevis

Supinator - supination

  • Radial nerve (C5-8)
92
Q

Medial epicondyle attachments

A 
Pronator teres
Flexor carpi radialis 
Palmaris longus 
Flexor carpi ulnaris 
Flexor digitorum superficiales
93
Q

Lateral epicondyle attachments

A

Extensor carpi radialis brevis
Extensor carpi ulnaris
Extensor digitorum
Supinator

94
Q

Anatomical snuff box

A

Medial: Extensor pollicis longus (EPL) tendon (inside)
Lateral: Extensor pollicis brevis tendon and abductor pollicis longus tendon (outside)

Floor: scaphoid and trapezium and radial artery
Proximal: styloid process of radius

95
Q

Dorsal digit (extensor) expansion

A

Formed by flattening of four extensor digitorum tendons

  • At base of proximal phalanx
  • Extensor digitorum carries on and crosses base of middle (middle conjoint tendon) and distal (terminal conjoint tendon) phalanx.

Muscles attached to extensor expansion:

  • Lumbricals
  • Interosseus
  • Flexor digitorum superficialis
  • Flexor digitorum profundus
96
Q

Extensor retinaculum

A

Provides stability and a tunnel for extensor tendons

97
Q

Curvature in the spine

A

Cervical (1-7) and lumbar (1-5): lordosis

Thoracic (1-12): kyphosis

98
Q

Vertebrae structure

A
  • Superior/inferior articular process (facet synovial joint)
  • Lamina of vertebral arch
  • Intervertebral foramen
  • Intervertebral disc (secondary cartilaginous)
  • Spinous process
  • Transverse process
  • Vertebral body
99
Q

Spinal muscles

A
  • Longissimus/semispinalis capitis
  • Longissimus/semispinalis/iliocostalis cervicis
  • Longissimus/semispinalis/iliocostalis/ spinalis thoracis
  • Erector spinae: longissimus, iliocostalis, spinalis
  • Iliocostalis/quadratus lumborum
  • Multifidus
  • External oblique
  • Psoas major and minor
100
Q

Ligaments of the spine

A
  • Anterior/posterior longitudinal ligaments
  • Ligamentum flavum
  • Inter/supraspinous ligaments
  • Intertransverse ligaments
101
Q

Myotome

A

Group of muscles innervated by a single spinal nerve

102
Q

Dermatome

A

Area of skin innervated by a single spinal nerve

103
Q

Spinal cord

A

Ends at L1

- becomes conus medularis

104
Q

Intervertebral disc

A
  • Secondary cartilaginous joint
  • Structure: annulus fibrosis and nucleus pulposus
  • Function: shock absorber, resists rotation
  • Ageing: decreased water content -> degenerative changes

Systems (9 decks)

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