MSK Conditions (18-25) Flashcards
1
Q
Why must foot act as shock absorber and as rigid lever?
A
Shock absorber - to dissipate GRF
Rigid lever to propel body
2
Q
What is the role of sesamoids bone?
A
- reduce pressure in WB
- incr mechanical advantage of flexor tendons
- sliding pulley for tendons (decreases friction)
3
Q
What is function of 1st MT?
A
main WB support for walking/running
4
Q
What are the tarsal bones
A
- calcaneous
- talus
- navicular
- cuboid
- cuneiforms - medial, intermediate, lateral
5
Q
What is role of arches of foot
A
- support in WB
- absorb shock
- space for plantar nerves, blood vessels, muscles
6
Q
- What is main supporting ligament for medial longitudinal arch?
- What does it do
- What muscle supports this ligament
A
- Plantar Calcaneonavicular Ligament (Spring)
- returns arch to normal position after stretch
- Tib Post
7
Q
The talus position control ________
A
calcaneus and navicular
8
Q
What bones form Lisfranc joint
A
base of MTs, cuboid, all 3 cuneiforms
9
Q
What are combined movements of pronation in WB?
A
PF, Add, Calc Ev
10
Q
What are combined movements of supination in WB?
A
DF, Abd, Calc Inv
11
Q
- What joints make up Choparts Joint (midtarsal)
2. What is directly related to this joint?
A
- calcaneocuboid and talonavicular
2. Subtalar - if subtalar is pronated, midtarsal is hypermobile. if supinate - midtarsal is hypo
12
Q
What muscles allow DF?
A
Tib Ant, EHL, EDL, Peroneus Tertius
13
Q
What muscles allow PF?
A
Gastroc, Soleus, Plantaris, Peroneus Longus/Brevis, Tib Post, FDL, FHL
14
Q
What muscles do Inversion, Adduction, Supination?
A
Muscles along medial mall
Behind - Tib Post, FDL, FHL
Infront - Tib Ant, EHL
15
Q
What muscles do Eversion, Abduction, Pronation?
A
Muscles along lateral mall
Behind - Peronus Longus/Brevis, Peroneus Tertius
Infront - EDL
16
Q
What is function of extensor retinculum?
A
Provides pulleys for tendons to maximize pull
17
Q
- What is nerve supply of foot
2. What is blood supply
A
- Medial and Lateral Plantar nerves - branch of Tibial Nerve
- Anterior, Posterior Tib Art
18
Q
What are 5 phases of Gait?
What happens during each phase
A
- Initial contact - ER Tibia, Sup
- Load response - IR tibia, Pro
- Midstance
- Terminal stance
- Pre Swing/Toe off - ER Tibia, Sup
19
Q
What are 3 periods of swing phase
A
Initial Swing
Mid Swing
Terminal Swing
20
Q
What is Forefoot varus?
What does it cause
A
Talus PF, Add, Calc Ev
causes deformities associated w/ excessive pronation
21
Q
What is forefoot valgus?
What does it cause
A
Talus DF, Abd, Calc Inv
- causes deformities associated w/ excessive supination
22
Q
Where is anatomical weakness of tibia?
A
Lower ⅓ of shaft
23
Q
What movements occur at subtalar joint?
A
Pronation, supination, Inversion, Eversion
24
Q
what movements occur at talocrural joint?
A
DF PF
25
What are the ankle lateral ligaments
ATFL - prevent ANT movt of talus
PTFL - prevent POST movt of talus
CFL - prevent inversion calcaneus
26
Name deltoid ligaments
What arch does it support?
- anterior and posterior tibiotalar, talonavicular, tibiocalcaneal
Medial longtitudinal arch
27
What muscles make up anterior compartment of leg?
| nerve and artery?
Dorsiflexors - Tib Ant, EHL, EDL, Peroneus tertius
Ant tibial N, Tibial artery
28
What muscles make up lateral compartment of ankle?
| Nerves?
Evertors: Peroneus longus and brevis
Peroneal N (superficial)
29
What makes up Superficial Posterior Compartment?
Plantarflexors: Gastroc, Soleus, Plantaris,
30
What makes up Deep Posterior Compartment?
Tib Post, FDL, FHL
Post Tib Artery
31
What ankle ROM required for normal gait?
DF 10 degrees
| PF 20 degrees
32
What are Ottawa Ankle Rules
1. Inability to WB 4 steps
2. Tenderness distal fibula
3. Tenderness medial mall
4. Tenderness navicular
5. Tenderness base of 5th
33
What is Potts #?
Bimalleloar # from inversion sprain
- avulsion of lateral mall
- fracture medial mall
34
What holds the peroneal tendon in place
Fibularis retinaculum
35
Name joint mobilizations to increase
1. DF
2. PF
3. Inversion/Eversion
DF - Ant tibial glide or post talar glide
PF - Post tibial glide or ant talar glide
Inv/Ev - glide subtalar med / lat
36
What is shape of Medial Meniscus?
| What attaches to it
C-shape
semiM, jt capsule
deep fibers of MCL
37
What is shape of Lateral Meniscus?
| What attaches to it
O shaped
| jt capsule, popliteal tendon
38
What is blood supply to meniscus?
| what ⅓ is avascular
Medial Genicular Artery
| inner ⅓ is the white zone
39
What is arcuate ligament?
thickened posterior jt capsule knee - attaches to the LCL popliteal fascia and lateral meniscus
40
what muscles stabilize knee laterally
ITB
popliteus
biceps femoris
41
What structures reinforce the 4 corners of the knee joint capsule
Postlat - ITB, biceps fem, popliteus, LCL, arcuate ligament
Postmed - SemiM, SemiT, MCL, post oblique ligament
Antlat - lateral retinaculum, patella tendon, ITB
Antmed - patella tendon, MCL
42
What muscles do Flx, Ext, ER and IR of knee
Flx - Biceps fem, SemiM, SemiT, sartorius, gracilis, gastroc, poplitus, plantaris
Ext - rectus femoris, vastus lat, intermedius, VMO
ER - biceps fem
IR - poplitues, semiT, semiM, sartorius, gracilis
43
Name the knee bursae
| function?
```
suprapatella
prepatellar
infrapatella
pretibial
gastroc
- to reduce friction
```
44
What is name of knee fat pad
Function?
Infrapatellar
| cushions front of knee, separates patellar tendon from capsule
45
Name the nerve inneverations
- hamstrings and gastrocs
- biceps femoris (short head)
- quadriceps and sartorius
1. Tibial N
2. Peroneal N - exposed at head of fibula
3. Femoral N
46
What is main blood supply to knee
Femoral artery --> popliteal artery
| medial/lat sup/in genicualar artery
47
What is screw home mechanism
WB when extending - femur IR bc medial condyle is larger than lateral
last 15 degrees of extension - Tibia ER (CPP, lock knee, increase stability)
- popliteus contracts to ER femur to unlock knee
48
How to measure leg length discrepancy?
ASIS to med mall = structural
| Navel to med mall = functional
49
What does Apleys distraction test identify
Meniscus tear vs Joint capsule/collateral ligament
Pain on traction/rotn = MCL/LCL joint capsule
50
What does a Slocum IR vs ER test
IR - ACL, post-lat
| ER - ACL, post-med, MCL
51
What rotation does McMurray test
ER - medial
| IR - Lateral
52
Name the 5 areas of girth measurement of knee
1) 8-10cm above jt line
2) 2cm above patella
3) Jt line
4) Tib tubercule
5) Gastrocs
53
What are normal Q angles for men and women
| What does abnormal Q angle identify risk of
Males - 10
Females - 15
Q angle > 20 incr of improper patella femoral tracking
54
```
What nerves supply..
Biceps Femoris
Quadriceps
SemiM
SemiT
Popliteus
Adductors
```
```
Biceps fem - sciatic L5-S3
Quads -Femoral L2-L3
SemiM - tibial (branch of sciatic)
SemiT- tibial
Popliteus - Tibial
Adductors - obturator L3-L4
```
55
What arteries serve the thigh
Femoral Artery
| Circumflex Artery - femur head
56
How do you manage a Quad contusion?
place knee in 120 Knee flx to prevent shortening
57
What are grades of quad contusion
Gr 1 - no ROM restriction
Gr 2 - cant flx knee more than 90
Gr 3 - cant flx between 45-90
Gr 4 - cant flex more than 45
58
What position does femoral fracture show in
Hip will be ER, slightly add and shortened
59
What ligaments reinforce hip joint
| What does it restrict
Iliofemoral - prevent hyperext, restrain ER, Add
Pubofemoral - prevent Abd
Ischiofemoral - prevent IR and Add
60
What does transverse ligament in hip cover
Covers acetabular notch
61
What are direction of femur head
Ant, Med, Sup
62
Name 6 deep external rotators of leg
What is the role?
Piriformis, Superior Gemellus, Inferior Gemellus, Oburtator Internus, Obturator Externus, Quadratus Femoris
- stabilize femur in acetabulum
63
1. Where does femoral nerve emerge from?
| 2. Where does sciatic nerve emerge from? What does it branch to?
1. Lumbar plexus
| 2. Sacral plexus. Lead to Tibial and Peroneal N
64
Name 2 bursa of hip
1. Iliopsoas bursa
| 2. Deep trochanteric bursa
65
Where are stress fractures in hip most common
inf pubic ramus
femur neck
subtrochanter femur
66
What Hip ROM do these mobs increase
- Inf Glide
- Post Glide
- Ant Glide
1. Hip Flx, Abd
2. Hip Flx
3. Hip Ext
67
Name 4 ligaments of Sternoclavicular joint
Anterior SC
Posterior SC
Interclavicular
Costoclavicular
68
Where does subacromial bursa get compressed
coracoacromial arch in OH activity
69
What is the brachial plexus nerve supply
```
C5-6 Axillary
C5-6 Subscapular
C6-6 Suprascapular
C5-C7 Musculocutanous
C5 Dorsal Scapular
C5-T1 Pectoral
C5-T1 Radial
```
70
What blood vessels serve the arm
Subclavian artery --> Axillary artery --> brachial artery
71
What are the actions of RC in shoulder overhead movment
Supraspinatus compresses humeral head
Infraspinatus, Teres minor and Subscap depress humeral head with OH movement
- RC and LH biceps are dynamic stabilizers of arm
72
Describe ROM of scap during OH movement
0-30 - GH abd 30
30-90 - GH Abd 30, Scap UR 30
90-150 - GH Abd 30, Scap UR 30, GH ER 70-90
150-80 - GH Abd 30
73
Name tests for GH Instability
1. Load and Shift
2. Anterior, Posterior Drawer Tests
3. Sulcus Sign
4. Clunk test - labral tear
5. OBrien Test - SLAP lesion
6. Apprehension and Relocation
74
Name tests for Shoulder Impingement
Neers
| Hawkins Kennedy
75
Name tests for supraspinatus weakness
Drop Arm test
| Empty Can
76
Name tests for TOS
1. Adson test - rotate head towards
2. Hyperabuction Test - rotate head away
3. Military Brace - rotate head away
77
Where does the following TOS tests identify compression?
Adsons - compress subclavian artery bw anterior and middle scalenes
Hyperabuction - compression pec minor
Military brace - costoclavicular compression
78
What shoulder movement causes Anterior GH DL
ER, Abd. Ext
79
What is Bankart lesion
avulsion ant-inf labrum @ inf GH ligament
| 1-5 pm
80
What is Hill-Sachs Lesion
Defect posterior lateral humeral head #
81
What is SLAP lesion
superior labrum anterior posterior
| - LH biceps tendon attach
82
What is Reverse Hill-Sachs lesion
ant-med humeral head #
| from a posterior DL (forced Add and IR)
83
What structures are compressed in Shoulder Impingement?
| Where?
subacromial bursa
supraspinatus tendon
LH biceps tendon
coracoacromial arch
84
What does SICK scapula stand for
Scapula malposition
Inferior Medial Scap winging
Coracoid tenderness
Kinesis abnormalities
85
What ROM is painful for shoulder bursitis?
Abd,Flx, IR
+ impingement test
86
Name 4 reasons for TOS
1. Compression of nerves/BV bw 1st rib and clavicle (costoclavicular syndrome)
2. Compression bw anterior and middle scalenes (Anterior Scalene syndrome)
3. Compression bw pec minor and coracoid (hyperabduction test)
4. Presence of cervical rib
87
What is the capsular pattern of Adhesive capsulitis ROM lost
ER > Abd > IR
88
What is the condition of a Linebacker Arm or Blocker Exotososi called?
myositis ossificans - contusion to humerus
89
```
What joint mobs increase the GH ranges
Abd
Flx
IR
ER
```
Abd - Inf Glide
Flx - Post glide
IR - post glide
ER - ant glide
90
Which bones in the humerus articulate with in the radius/ulna?
Capitulum articulate with radial head
| Trochlea articulate with trochlear notch (ulna)
91
What does UCL elbow protect against
| Which band is strongest
1. valgus force
| 2. anterior
92
What does lateral elbow stability depend on
1. RCL ligament
| 2. annular ligament
93
where does RCL elbow attach from
lateral epicondyle to annular ligament
94
name 2 bursa in elbow
1. olecranon
| 2. bicipital
95
name nerves that serve elbow
musculucutaneous C5-6
median C6-7
radial C7-C8
ulnar C8-T1
96
what is blood supply of elbow
Subclavian artery --> axillary artery --> brachial artery
97
What are normal carrying angles for M and W
W 10-15 degrees
| M 5-10 degrees
98
what does pinch grip test?
anterior interosseous nerve entrapment (bw heads of pronator)
99
What does Cozens test do?
lateral epicondylitis
| resist wrist ext
100
What muscles are over used in Lateral Epicondylitis
ECRB, extensor carpi radialis brevis
| EDC extensor digitorum communis
101
What muscles are over used in Medial Epicondylitis
Pronator teres
FCU - flexor carpi ulnaris
FCR - flexor carpi radialis
palmaris longus
102
What is Panners disease?
avascular necrosis of radial head/capitulum in 10-15 year olds
103
What is Little League Elbow
Avulsion UCL
104
What are signs of Cubital Tunnel syndrome
tingling into 4th and 5th digit
worse with hyperflexion
ulnar N irritation or sublux from valgus load
105
WHat is pronator teres syndrome
Median N entrapment in pronator
106
What mobs increase elbow flexion? elbow extension?
Flexion - ant glide radial head
| Extension - post glide radial head
107
Where do Deep Flexors of wrist arise from?
Superficial flexors?
Extensors?
Deep Flexors- radial, ulna, interosseous anteriorly
Superficial - medial epicondyle
Extensors- lateral epicondyle
108
Name wrist extensors
| wrist flexors
WE: ECRB, ECRL, ECU
Flexors: FCR, FCU,
109
What is Nerve supply to wrist muscles
| Blood supply?
MEDIAN N - serves flexors (except FCU and flexor digitorum profundus)
RADIAL N - serve extensors
Brachial --> Radial, Ulnar artery
110
What are forearm fractures at risk of
Volkman contracture
111
What is MOI of Colles #?
Wrist hyperextension
| - radius is posteriorly displaced
112
Name Carpal bones
Scaphoid - Lunate - Triquetrum - Pisiform
| Trapezium - Trapezoid - Capitate - Hamate
113
Where is TFCC located
between ulna and triquetrum
114
Name ligaments of wrist and where they attch
UCL - styloid of ulna to pisiform/triquetral
RCL - styloid radius to scaphoid
Transverse Carpal Ligament - across anterior carpal. forms roof of carpal tunnel
115
What nerves are injured in the following hand conditions
1. Bishops Deformity
2. Clawhand deformity
3. Drop Wrist
4. Ape hand
1. ulnar N , hypothenar and intrinsic muscles of 4th,5th finger
2. Median and Ulnar
3. Radial
4. Median N
116
What is Presiers disease
AVN scaphoid
117
What are the following fingernail deformities a sign of?
- Clubbing and cyanosis
- Scaling/ridging
- Spooning/depression
- vertical ridges
1. Congenital heart disorder, Respiratory disease
2. Psoriasis
3. thyroid problems, iron deficiency. anemia
4. nutritional deficiency
118
Why does C2 (axis) have increased mobility in rotation?
Articular facets are flat. SP is horizontal
119
What is the projection in C2 called?
Dens - odontoid process
120
Directions of articular facets?
Superior face medial
| Inferior face lateral
121
What are components of disc?
Annulus fibrosus
| Nucleus pulposus
122
Name the spinal ligaments and what movements they restrict
ALL - restrict extension
PLL - restrict flexion
Supraspinous - attach to SPs , called Ligamentun Nuchae in cervical
Interspinous - bw SP - limits rotation and flexion
123
What are the sacral ligaments called
Sacrotuberous
| Sacrospinous
124
Name superficial erector groups
Iliocostalis - longissimus, thoracis, cervicis
Longissimus - thoracic, cervicus, capitus
Spinalis - thoracic, cervicus
125
Name Deep erector muscles
```
Interspinales
Multifidus
Rotators
Semispinalis - thoracic, cervicus, capitus
Splenius - capitus and cervicus
```
126
Each nerve has anterior and posterior root join to form spinal Nerve. Where does ant vs post root lead to
Anterior - motor
| Posterior - sensory
127
What are the 5 nerve plexuses
```
Cervical - C1-C4
Brachial - C5-T1
Lumbar L1-L4
Sacral - L4-S4
Coccygeal S4-S5
```
128
what are positive signs of Vertebral Artery test?
Dizzy
Nystagmus
Nausea
means VA is occluded
129
What does pain at different ranges mean for SLR
30 - nerve, disc
30-60 - Sciatic N
with DF - L3-L4, S1-S3
70-90 - SI jt
130
What is Central Cord Syndrome?
bleeding or ischemia in central portion of cord
| - causes quadriplegia, sensory loss, loss of sexual and bowel/bladder
131
What is Brown-Sequard cord Syndrome
injury to one side of spinal cord
| - loss of motor function, touch, vibration, pain, temp on OTHER side of body
132
What is Anterior Cord Syndrome?
injury to anterior 2/3 cord
- loss motor function, pain, temperature
- sexual and bowel/bladder present
133
What is Posterior Cord Syndrome
injury to posterior cord
- difficulty coordinating limb movement
- good strength, pain, temp
134
What is Schuermans DIsease
wedge # of 5 degrees or more in 3+ Vertebral bodies
- incr in kyphosis
injury to epiphysis can cause AVN
135
What is the difference between
1. Prolapse disc
2. Extruded
3. Sequestered
Prolapse - nucleus moves through annulus
Extruded - nucleus into spinal canal, contact with NR
Sequesterd - nucleus migrate from disc
136
What is difference between Spondylolysis and Spondylolisthesis
Spondylolysis - stress # to pars interarticularis in LS
| Spondylolyisthesis - slipped vertebrae, step deformity
