MSK corrections Flashcards
which classification of neck of femur fracture is more common in women and elderly?
intracapsular
what is the function of the inguinal ligament?
acts as a flexor retinaculum (retinaculum is a band of fibrous connective tissue)
where does the femoral artery cross the inguinal ligament?
mid-inguinal point
A Baker’s cyst is a benign swelling of which structure?
semimembranosus bursa
what movement will be compromised as a result of damage to the tibial nerve in the popliteal fossa?
weakened plantar flexion
where are the base and apex of the patella?
the base is o the superior aspect
the apex is on the inferior aspect
which part of the tibia gives attachment to the interosseous membrane?
lateral border
what type of fascia is the fascia latta of the lower limb?
deep fascia
what is the name given to the deep fascia of the leg (anatomical leg)?
crural fascia (this is the inferior continuation of the fascia lata of the thigh)
The majority of the arterial supply to the muscles of the gluteal region is derived from which major blood vessel?
internal iliac artery
which gluteal muscles allow for medial rotation of the hip?
gluteus medius
gluteus minimus
tensor fascia lata
what movements does the sartorius allow at the hip?
flexion
abduction
lateral rotation
what are the innervations of the pectinius?
femoral + obturator nerve
69-year-old lady comes to GP. She says she has swollen visible veins on the medial side of her leg. You suspect varicose veins. What vein is she most likely describing?
great saphenous veins
what feature of the knee is most affected by sudden twisting?
meniscus (presents with no swelling but knee keeps locking)
what are the X-ray signs of suspected osteoarthritis?
L - loss of joint space
O - osteophytes
S - Subchondral Sclerosis
S - Subchondral cysts
where does inversion + eversion of the foot take place?
subtalor joint
calcaneocuboid joint
talorcalcaneonavicular joint
what are the arteries of the lower leg?
popliteal artery
anterior tibial
tibiofibular trunk
fibular artery
posterior tibial
dorsalis pedis artery
what is compartment syndrome?
increased pressure in fascia results in the compression of nerves and blood vessels
what are the 4 different toe deformities?
mallet toe
hammer toe
claw toe
curled toe
what causes mallet toe?
flexion at the distal internalphalangeal joint
what causes hammer toe?
flexion of proximal interphalangeal joint
what causes claw toe?
hyperextension of metatarsalphalangeal joint
flexion of proximal interphalangeal joint
what’s the difference between the femoral triangle + canal?
the femoral canal is contained within the femoral triangle:
femoral nerve
femoral artery
femoral vein
femoral canal (lymphatics)
what are the common signs + symptoms of compartment syndrome?
severe pain in limb which is a lot for the degree of injury
pain not relieved by analgesia
pain exasperated by passive stretch of muscle
what is an avulsion fracture?
A part of bone is displaced by the pulling of a muscle tendon (usually affects teenagers)
how does a neck of femur fracture present?
Shortened, abducted, externally rotated leg at the hip
A girl is throwing a ball up in the air and attempting to catch it herself. Which movement of her wrist will occur following her throw to allow her to more successfully catch the ball?
supination
which nerves innervate the palm of the hand?
median nerve - innervates palmar surface, thumb and first 2 finger
ulnar nerve - innervates the palmar surface, ring and pinky finger
which brachial plexus nerve passes through the Guyon’s Canal?
ulnar nerve
Guoyons canal AKA ulnar canal
which nerves are most affected by a lower brachial plexus injury involving C8-T1?
ulnar and median nerves
what is the brachial plexus?
network of nerves of the anterior rami of C5-T1 which supply the skin and muscles of the upper limb
Jefferson’s Fracture:
a) What part of C1 vertebrae is fractured?
b) What is the mechanism of injury?
c) What are the symptoms of a Jefferson’s fracture?
a) Anterior + Posterior arches of the C1 vertebrae
b) Axial loading - injury to the head
c) Burst fracture widens spinal canal so spinal cord are unaffected so no neurological injuries
Hangmans Fracture:
a) What part of C2 vertebrae is fractured?
b) What is the mechanism of injury?
c) What are the symptoms of a Hangman’s fracture?
a) fractures pars interarticularis (bilateral breakage)
b) hyperextension
c) neck pain, numbness, weakness and no spinal cord damage so no neurological issue
Odontoid Process Fracture:
What is the mechanism of injury?
hyeprflexion and hyperextension
what is the function of the gastrocnemius?
plantar flexes the ankle joint + knee flexion
which muscle flexes the hallux?
flexor hallucis longus
what is the function of popliteal muscle?
unlock knee
Femoral shaft fractures present with a massively swollen thigh due to…
bleeding
what is meralgia paresthetica?
a disorder characterized by tingling, numbness, and burning pain in the lateral thigh
what is crepitus?
creaking or grinding of a joint - usually seen in osteoarthritis
A blow to the back of the knee is likely to tear which ligament?
anterior cruciate ligament, since this ligament is furthest from the force
what does excessive hypertrophy of vastus medials cause?
Adductor Canal Compression Syndrome - this can lead to paraesthesia (compression of the saphenous nerve) and claudication (compression of the femoral artery)
what is the pattern in which spinal nerves exit the vertebrae?
- cervical spine: the spinal nerves exit above the associated vertebrae e.g. C5/C6 vertebrae prolapse would compress C6 vertebrae
- however, when it gets to C7/T1 vertebrae the C8 spinal nerve exits above T1 so in a C7/T1 disc prolapse the C8 spinal nerve is damaged
- rest of spine: spinal nerves exit below associated vertebrae e.g in a T1/T2 vertebrae T1 is damaged
what deepens the articlation between the humeral head and the glenoid fossa?
the glenoid labrum
what movement does the latissimus dorsi muscle allow?
extends, adducts and internally rotates arm
what movement does the deltoid muscle allow?
anterior fibres = felxion of arm
posterior fibres = extension of arm
what movement does the pectoralis major muscle allow?
flexes and adducts the arm
what movement does the trapezius muscle allow?
rotate and elevate the scapula
what movement does the pectoralis minor muscle allow?
pronation of scapula
what are the different borders of the axilla?
Lateral wall – formed by intertubercular groove of the humerus.
Medial wall – consists of the serratus anterior and the thoracic wall (ribs and intercostal muscles).
Anterior wall – contains the pectoralis major and the underlying pectoralis minor and the subclavius muscles.
Posterior wall – formed by the subscapularis, teres major and latissimus dorsi.
what supplies the blood to the shoulder joint?
anterior and posterior circumflex humeral arteries - branches of the axillary artery
Branches of the suprascapular artery - branch of the thyrocervical trunk
what is meant by the term neural level?
lowest level of intact motor/sensory function
if patient presents with indications of L5 spinal nerve damage then the the neural level is L4
where does the axillary artery begin?
border of the first rib
In a radial head/neck fracture, what does a ‘fat pad’/‘sail’ sign indicate?
joint effusion is present (presence of increased intra-articular fluid)
which nerve supplies the lateral aspect of the forearm?
lateral cutaneous nerve - a branch of the musculocutaneous nerve
Which condition is often caused by shoulder dystocia during birth?
Erb’s/Duchenne’s palsy
which type of hip dislocation is likely to damage the sciatic nerve?
posterior hip dislocation
If a patient stands on their right leg and their left hip falls, what nerve is damaged?
Left side drops so the site of damage is on the right side
Right superior gluteal nerve damaged
What are the nerve roots of the inferior gluteal nerve?
L5, S1, S2
What are the nerve roots for the sciatic nerves?
L4, L5, S1, S2, S3
What is the nerve roots for femoral nerve?
L2, L3, L4
What forms the obturator nerve?
Anterior division of second, third and fourth lumbar nerve in the lumbar plexus
What are the nerve roots of the deep fibular nerve?
L4,5
What are the nerve roots of the saphenous nerve?
L3,4
In carpal tunnel syndrome the ulnar nerve is compressed between 2 heads of which muscle?
Flexor carpi ulnaris
What is the cubital tunnel and what are its borders?
Tunnel through which ulnar nerve passes posterior to medial epicondyle
Lateral border = olecranon
Medial border = medial epicondyle
Roof = arcuate ligament betwen medial and lateral epicondyle
Floor = elbow joint capsule + medial collateral ligament of elbow
Which microorganism is responsible for causing septic arthritis in adults?
Staph aureus, gram positive cocci
What is the function of posterior cruciate ligament?
Prevent posterior displacement of tibia relative to femur
What is the function of medial collateral ligament?
Resist valgus strain
Where on tibia does ACL attach?
Anterior medial aspect
which ligament is most likely to be sprained in an over inversion accident?
anterior talorfibular ligament
what are the sensory nerve supplies of the leg by region?
- deep fibular nerve supplies the 1st webbed space between the 1st and 2nd toe
- common fibular nerve supplies the posterolateral portion of the leg and knee joint
- saphenous nerve supplies the medial portion of knee and leg
- superficial fibular nerve supplies the anterolateral aspect of the leg and the greater part of the dorsum of the foot (except 1st webbed space)
- sural nerve supplies the posterolateral aspect of the distal third of the leg, lateral aspect of the foot, heel and ankle
where do you palpate for the posterior tibial pulse?
posterior to the medial malleolus
part of the tarsal tunnel:
* Tom = tibialis posterior
* Dick = flexor digitorum longus
* And = tibial artery
* Very = tibial vein
* Nervous = tibial nerve
* Harry = flexor hallucis longus
What is unique about the thoracic vertebrae?
Costal facets
What joint is most commonly affected by osteoarthritis in the hand?
1st carpometocarpal joint
- at what level is a lumbar puncture performed?
- what layers does the needle pass through from superficial to deep?
- what can a lumbar puncture be used for?
- L3 - L4 (or L4 - L5) found by locating the plane transecting the highest point of iliiac crest
- skin - subcutaneous tissue - supraspinous L - inferspinous L - L flavum - epidural fat - dura matar - arachnoid matter - subarachnoid space
- remove some intercranial fluid to test for illness like meningitis or multiple sclerosis
how does erbs palsy present?
internal (medial) rotation of with an adducted arm and extended elbow
how does Klumpke’s palsy present?
‘claw hand’ with hyperextension of all of the metacarpophalangeal joints, flexion of the interphalangeal joints, abduction of the thumb and wasting of the interossei.
- what is the quadrangular space?
- what is the medial border of the quadrangular space?
- what is the lateral border of the quadrangular space?
- what is the inferior border of the quadrangular space?
- what is the anterior border of the quadrangular space?
- intermuscular space through which the axillary nerve and posterior circumflex humeral artery (a branch of the axillary artery) pass to encircle the surgical neck of the humerus
- long head of triceps brachii
- surgical neck of humerus
- teres major
- subscapularis
what are the different lymph nodes of the axilla?
A Anterior
P Posterior
I Infraclavicular
C Central
A Apical
L Lateral (receive most of the lymph)
what are the 4 stages of a disc herniation?
- disc protrusion -
- prolapsed disc
- disc extrusion
- sequestered disc
what is hiltons law?
the nerves supplying the muscles moving the joint also supply the joint capsule and the skin overlying the insertions of these muscles
What are the different MRI weighting’s?
Altering the way in which pulses are delivered alters weighting of image:
On a T1 weighted image, fat appears bright and fluid appears dark.
On a T2 weighted image, both fat and fluid appear bright.
In a STIR sequence (a fluid-sensitive sequence), the signal from fat is supressed and it appears dark, whilst fluid appears bright.
at what week of gestation do limb buds form?
Week 4
What are the similarities and differences between rheumatoid arthritis and osteoarthritis?
RA = pain improves with movement vs OA = pain worse with movement
RA = rapid onset vs OA = chronic history
RA = no osteophytes vs OA = osteophytes
1) what are the nerve roots of the genitofemoral nerve?
2) what are the nerve roots of the lateral femoral cutaneous nerve?
3) what are the nerve roots of the obturator and femoral nerve?
4) what are the nerve roots of the superior gluteal nerve?
5) what are the nerve roots of the inferior gluteal nerve?
1) L1 - L2
2) L2 - L3
3) L2, L3, L4
4) L4, L5, S1
5) L5, S1, S2
What is the function of the posterior cruciate ligament?
Prevent posterior displacement of tibia relative to femur
What are the common signs and symptoms of septic arthritis?
Inability to weight bear, joint is warm and erythematous
How does diabetes mellitus cause peripheral vascular disease, diabetic eye disease and peripheral vascular disease?
Uptake of glucose into these areas is regulated by glucose concentration
Increased glucose in cell increases activity of aldose reductase which depletes NADPH
increases cell risk of oxidative damage
Protein aggregation since disulphide bonds form altering the structure and function of proteins
What occurs in the embryological development of the dermatome?
- CNS develops in a segmental way through paired somites
- each pair of somite differentiates to form a dermomyotome
- these develop in association with a specific neural level of a spinal cord
- therefore associated with a specific spinal nerve
- the dermatome portion of dermomyotome results in formation of skin innervated by a particular spinal nerve
The sciatic nerve is severed in an injury then sutured in surgery.
What happens to the proximal axons as they attempt to reinervate the affected muscle?
Axons sprout from proximal part of severed nerve
The sprout enters the vacated Schwann cell sheath which guide them to denervated muscles
which nerve is injured resulting in winged scapula?
long thoracic nerve (a branch of the axillary nerve) which innervates serratous anterior
which rotator cuff muscles are responsible for lateral rotation?
teres minor
infraspinatous
- where do you palpate the ulnar pulse?
- where do you palpate the radial pulse?
- where do you palpate the brachial pulse?
- palpated lateral to flexor carpi ulnaris
- palpated lateral to flexor carpi radialis
- medial to the tendons of the biceps
where does the brachial artery start?
inferior border of teres major muscle
what is the mechanism of action of corticosteroids?
diffuse across the plasma membrane + bind to cytoplasmic proteins before entering the nucleus
what superficial vein is used for venepuncture in the cubital fossa?
median cubital vein
which adductor muscle has a hamstring portion?
adductor magnus
which adductor muscle has a hamstring portion?
adductor magnus
How does diabetes cause loss of peripheral sensation?
Chronic hyperglycaemia causes micro vascular complications
Results in peripheral neuropathy
Reduced sensation
