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MSK > MSK Midterm > Flashcards

MSK Midterm Flashcards

1
Q

condyle

A

rounded process that articulates w/another bone

ex- occipital condyle

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2
Q

crest

A

narrow, ridge-like projection

ex- iliac crest

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3
Q

epicondyle

A

projection situated above a condyle

ex- medial epicondyle of humerus

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4
Q

facet

A

small, smooth surface

ex- rib facet of thoracic vertebra

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5
Q

foramen

A

opening for passage of blood vessel/nerves

ex- foramen magnum

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6
Q

fossa

A

relatively deep pit or depression

ex- olecranon fossa

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7
Q

fovea

A

tiny pit or depression

ex- fovea capitis

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8
Q

head

A

enlargement at end of bone

ex- femoral head

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9
Q

linea

A

narrow, line-like ridge

ex- linea aspera of femur

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10
Q

process

A

prominent projection of a bone

ex- mastoid process of temporal bone

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11
Q

ramus

A

branch-like process

ex- ramus of mandible

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12
Q

sinus

A

cavity w/in a bone

ex- frontal sinus

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13
Q

spine

A

sharp projection

ex- spine of scapula

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14
Q

styloid

A

pen-like projection

ex- styloid process of ulna

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15
Q

suture

A

interlocking junction b/w cranial bones

ex- coronal suture

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16
Q

trochanter

A

relatively large process

ex- greater trochanter of femur

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17
Q

tubercle

A

small, knob-like process

ex- tubercle of rib

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18
Q

tuberosity

A

knob-like process larger than a tubercle

ex- tibial tuberosity

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19
Q

meatus

A

tube-like passageway w/in a bone

ex- external auditory meatus

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20
Q

diaphysis

A

shaft

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21
Q

epiphysis

A

joint surface end

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22
Q

epiphyseal plate

A

hyaline cartilage plate in the metaphysis at each end of a long bone

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23
Q

Articulation

A

place of contact between bones, bone/cartilage, or bone/teeth
use names of articulating bones
structure-> mobility and stability
more mobile-> less stable

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24
Q

more mobile articulation

A

less stable

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25
Q

joint classification

A
  1. type of conn tissue
  2. space between
  3. degree of movement
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26
Q

Structural Joint classification

A

Fibrous
Cartilaginous
Synovial

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27
Q

Fibrous joint

A 
structure classification
bones held together by dense regular conn tissue
synarthroses (immovable) or amphiarthroses (slightly movable)
No joint cavity
3 Types
   1. Gomphoses (synarthroses)
   2. Sutures (synarthroses)
   3. Syndesmoses (amphiarthroses)
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28
Q

Cartilaginous joint

A 
structure classification
bones joined by cartilage
no joint cavity
2 Types
   1. Synchondroses
   2. Symphyses
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29
Q

Synovial joint

A 
structure classification
Fluid-filled synovial cavity separates bones
Bones enclosed w/in capsule
Bones joined by various ligaments
freely movable
diarthroses
most commonly known
ex- glenohumeral (shoulder), temporomandibular, elbow, knee
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30
Q

Functional joint classification

A

Synarthrosis
Amphiarthrosis
Diarthrosis

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31
Q

Synarthrosis

A

functional classification

immovable joint

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32
Q

Amphiarthrosis

A

functional classification

slightly movable joint

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33
Q

Diarthrosis

A

functional classification

freely movable joint

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34
Q

Gomphosis

A

fibrous synarthrosis
no joint cavity
ex- tooth root

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35
Q

Suture

A

fibrous synarthrosis
no joint cavity
ex- skull

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36
Q

Syndesmosis

A

fibrous amphiarthrosis
no joint cavity
ex- interosseous membrane

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37
Q

Synchrondrosis

A

cartilagenous synarthrosis

no joint cavity

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38
Q

Symphysis

A

cartilagenous amphiarthrosis

no joint cavity

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39
Q

Synovial features

A 
articular capsule (joint capsule)
joint cavity
synovial fluid
articular cartilage
ligaments (bone to bone)
nerves
blood vessels
bursae
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40
Q

bursae

A

fibrous, saclike structure that contains synovial fluid and is lined by synovial membrane

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41
Q

fatpads

A

distributed along periphery of synovial joint
act as packing material: provide joint protection
fill spaces when bones move and joint cavity changes shape

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42
Q

tendons

A

attaches muscle to bone/skin/muscle
helps stabilizes joints
thick, cord-like
aponeurosis=thin, flat sheet of tendons

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43
Q

dermatome

A

area of skin supplied w/afferent nerve fibers by a SINGLE POSTERIOR spinal ROOT
Epaxial (on axis) + Hypaxial (below axis)
each nerve can have multiple dermatomes

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44
Q

T/F: Dermatomes and nerve maps differ.

A

True

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45
Q

Calcaneal Tendon reflex tests…

A

S1 and S2

if cut-> reflex absent

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46
Q

Patellar reflex tests…

A

fxn of femoral nerve
L2, L3, L4
absence = Westphal’s sign

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47
Q

C1-C2 lesions cause…

A

probably death b/c too close to brain stem

if not-> quadriplegia

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48
Q

C2-C3 lesions cause…

A

diaphragmatic paralysis-> life-threatening

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49
Q

C5-C6 lesions cause

A

incomplete quadriplegia

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50
Q

T1-T2 lesions cause

A

complete paraplegia

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51
Q

posterior head/neck/shoulder dermatomes

A

CN, V
C2, C3, C4
opthalmic nerve

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52
Q

anterior neck/chest/arm/forearm/hand dermatomes

A

C3, C4, C5, C6

C7, C8

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53
Q

anterior forearm, posterior arm/upper back dermatomes

A

T1

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54
Q

chest/arm/torso/back dermatomes

A

T2, T3, T4, T5, T6, T7, T8, T9, T10, T11, T12

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55
Q

groin/back dermatomes

A

L1

S2

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56
Q

anterior groin/thigh, posterior back/leg dermatomes

A

L2, L3, L4

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57
Q

leg/foot dermatomes

A

L5

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58
Q

leg/back/butt dermatomes

A

S1, S2, S3, S4, S5

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59
Q

Autonomic nerve plexuses

A

thoracic
abdominal aortic
mesenteric

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60
Q

Somatic nerve plexus

A 
spinal nerves
Cervical
Brachial
Intercostal
Lumbar
Sacral
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61
Q

Cervical plexus

A

C1, C2, C3, C4, C5

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62
Q

Brachial plexus

A

C5, C6, C7, C8, T1

Upper extremity

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63
Q

Intercostal nerves

A

T1, T2, T3, T4, T5, T6, T7, T8, T9, T10, T11, T12

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64
Q

Lumbar plexus

A 
L1, L2, L3, L4
Lower extremity (lumbosacral)
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65
Q

Sacral plexus

A 
L5, S1, S2, S3, S4
Lower extremity (lumbosacral)
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66
Q

Upper extremity nerves

A 
Brachial plexus
Musculocutaneous nerve
Median nerve
Ulnar nerve
Radial nerve
Medial Brachial Cutaneous nerve
Medial Antebrachial Cutaneous nerve
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67
Q

Musculocutaneous nerve

A

C5, C6, C7

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68
Q

Median nerve

A

C6, C7, C8, T1

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69
Q

Ulnar nerve

A

C8, T1 (same as med antebrach cut n)

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70
Q

Radial nerve

A

C5, C6, C7, C8, T1

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71
Q

Medial Brachial Cutaneous nerve

A

C8, T1, T2

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72
Q

Medial Antebrachial Cutaneous nerve

A

C8, T1 (same as ulnar n)

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73
Q

Lower extremity nerves

A 
Lumbosacral plexus
Femoral nerve
Obturator nerve
Sciatic nerve (Tibial n + Common Fibular n)
Lateral Femoral Cutaneous nerve
Posterior Femoral Cutaneous nerve
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74
Q

Femoral nerve

A

L2, L3, L4 (same as obturator n)

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75
Q

Obturator nerve

A

L2, L3, L4 (same as femoral n)

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76
Q

Sciatic nerve

A

Tibial n: L4, L5, S1, S2, S3

Common Fibular n: L4, L5, S1, S2

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77
Q

Lateral Femoral Cutaneous nerve

A

L2, L3

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78
Q

Posterior Femoral Cutaneous nerve

A

S1, S2, S3

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79
Q

multisegmental myotome

A

multiple nerves/myotomes supply one muscle
severing nerves at root different than distal severing
most muscles

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80
Q

monosegmental

A

entire muscle supplied by 1 ventral nerve root

severing-> complete paralysis of muscle

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81
Q

segmental innervation

A

one nerve goes to one dermatome

ex- skin of trunk

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82
Q

plexus innervation

A

nerves form plexus-> combine to become peripheral nerve-> split again to supply multiple dermatomes
ex- skin of limbs

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83
Q

Muscle functions (5)

A 
Movement
Posture
Temperature regulation
Storage/movement of material
Support
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84
Q

Deep Fascia

A

expansive sheet of dense irregular connective tissue
Separates individual muscles
Binds muscles w/sim fxn
Forms sheaths to help distribute nerves/blood vessels/lymphatic vessels
Fills spaces b/w muscles (intermuscular septa)

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85
Q

aponeurosis

A

tendons forming a thin, flat sheet

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86
Q

Muscle contraction mechanism

A

muscles extend b/w bones and cross movable joints
contraction: 1 bone moves (insertion), other remains fixed (origin)-> insertion pulled toward origin
Origin typically proximal to insertion

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87
Q

origin

A

less movable attachment of a muscle
usually proximal to insertion
insertion pulled towards origin

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88
Q

insertion

A

more movable attachment of a muscle
usually distal to origin
pulled towards origin

89
Q

Fascicle organizational patterns

A
  1. Circular
  2. Convergent
  3. Parallel
  4. Pennate
90
Q

Circular fascicle

A

sphincter

contraction closes off opening

91
Q

Convergent fascicle

A

widespread muscle fascicles that converge on common attachment site
often triangular
ex- pectoralis major

92
Q

Parallel fascicle

A

fascicles run parallel to long axis
central body/belly/gaster
strap-like (ex- SCM muscle) or fusiform (biceps brachii)

93
Q

Pennate fascicle

A

1+ tendons extend through body
fascicles arranged at oblique angle to tendon
unipennate (ex- anterior forearm) or bipennate (rectus femoris) or multipennate (deltoid)
Bipennate most common

94
Q

Lever system types

A

Lever= long bone
Fulcrum= joint
Effort=muscle

  1. Fulcrum in middle
  2. Resistance in middle
  3. Effort in middle
95
Q

First-class lever

A

Load, fulcrum, effort
Load, JOINT, muscle
ex- posterior muscle of neck (pulls down to keep head from falling forward on other side of OA joint)

96
Q

Second-class lever

A

Fulcrum, load, effort
Joint, LOAD, muscle
ex- calf muscle (lifts up on load in center of foot, rotating on ball of foot)

97
Q

Third-class lever

A

Load, effort, fulcrum
Load, MUSCLE, joint
ex- biceps brachii (lifts up in between hand holding something heavy and elbow joint)

98
Q

Muscle action

A
  1. Isometric- no movement (steady contraction)
  2. Concentric- muscle shortens
  3. Eccentric- muscle lengthens
99
Q

Bone

A 
Type I Collagen
specialized conn tiss
Cells, fibers, ground substance
Hydroxyapatite (mineralized ECM)
Dynamic- constant remodeling
100
Q

Compact Bone

A

Lamellar

Outer solid cortex of bone enclosing inner layer of spongy bone

101
Q

Spongy/travecular/cancellous bone

A

Lamellar or woven
Trabeculae
Inner layer of bone w/spaces for bone marrow

102
Q

Bone classification

A

Lamellar v Spongy/non-lamellar

103
Q

Lamellar bone

A 
mature/secondary
regular parallel collagen
only visible as dried/ground section (no H/E dye)
Most adult bone
strong
slow development
104
Q

Spongy bone (non-lamellar)

A

immature/secondary, usually replaced by lamellar
loose collagen
low minerals, high cells
less matrix (ground substance/fibers)
Fracture repair/remodeling: alveolar sockets (teeth-> braces remodel), tendon insertions

105
Q

osteopontin

A

made by osteoblasts

binds calcium, helps mineralize bone (calcium hydroxyapatite

106
Q

Bone Matrix composition

A

65% organic (mostly Type I coll, then proteoglycans and osteocalcin/pontin/nectin)
35% inorganic (calcium hydroxyapatite, Mg, Na, K, CO3, PO4

107
Q

Noncollagenous proteins

A

made by osteoblasts
osteocalcin, osteopontin, osteonectin
bind calcium to help mineralize bone (Ca hydroxyapatite)

108
Q

Types of lamellae

A

interstitial
circumferential
concentric

109
Q

Lamellar bone composition

A

Lamellae (interstitial/circumferential/concentric)
Osteocytes (in b/w lamellae)
Haversian canal (longitudinal, at center of osteon)
Volkmann’s canal (transverse, connects Hav. canals, ends at bone surface)

110
Q

Lamellar bone osteocytes

A

bone cells that support the matrix
occupy a lacuna
have radiating canaliculi that penetrate the lamellae
use gap junctions

111
Q

Haversian canal

A

longitudinal canals in lamellar bone that house capillaries and post-capillary venules
center of osteons
connected by volkmann’s canals

112
Q

Volkmann’s canal

A

transverse vascular channels that connect haversian canals

end up on outer surface of bone, aid in distributing blood throughout inner/outer areas

113
Q

canaliculi

A

radiates from lacunas to house radiating cytoplasmic processes of osteocytes (for communication w/each other)

114
Q

lacuna

A

houses an osteocyte

115
Q

interstitial lamellae

A

between osteons
separated from osteon by cement line
remnants from remodeling osteons

116
Q

cement line

A

separates interstitial lamellae from osteons

117
Q

Osteon

A

haversian system
concentrically arranged lamellae around a longitudinal vascular channel (haversian canal)
lamella rings alternate orientation to prevent shearing forces and provide mechanical strength

118
Q

Outer circumferential lamellae

A

external surface of compact bone

under periosteum

119
Q

inner circumferential lamellae

A 
internal surface of bone 
subjacent to (surrounded by) endosteum
120
Q

woven bone

A

mineralized, but weaker than osteon formation

non-lamellar

121
Q

Periosteum

A

2 layers
Inner: preosteoblasts, osteogenic
Outer: blood vessel/nerve-rich, fibroblasts, collagen fibers, Sharpey’s fibers

122
Q

Sharpey’s fibers

A

part of outer layer of periosteum
anchor periosteum to lamellae
anchoring collagen fibers penetrate outer circumferential lamellae

123
Q

Endosteum

A

covers spongy walls
extends into all bone cavities
osteoprogenitor cells, reticular stromal cells (bone marrow), conn tiss fibers
by marrow

124
Q

Osteoprogenitor cells

A

precursor cells that self-replicate, or differentiate into bone-forming cells
Adult stem cells

125
Q

Osteoblast

A

bone-forming cell that deposits osteoid and controls mineralization
High ALKALINE PHOSphatase on cell membrane to help mineralize Ca hydroxyapatite
Marks bone disease
Endosteum and periosteum
Involved in growth/fracture repair

126
Q

Osteocyte

A

modified osteoblast that becomes surrounded by newly formed bone
Mature osteoblast now surrounded by matrix

127
Q

Osteoclast

A

macrophage-type cells (differentiate from monocyte) that resorb bone in remodeling process
Multi-nucleated
High ACID PHOSphatase and COLLAGENASE
Howship’s lacuna (small)

128
Q

red marrow

A

hematopoietic

129
Q

yellow marrow

A

adipocytes

130
Q

Osteomalacia

A

bone disorder characterized by dec mineralization of newly formed osteoid at sites of bone turnover (bone-> soft)
No Ca-> muscle contraction probs and weak bones
Causes: low dietary vit D, lack of sun, GI disease (USA)
S/Sx: bone/joint pain, musc weakness/spasms/cramps, fracture, walking probs, waddling gait
Cells most affected: osteoblasts (no Ca for bone mineralization)
Blood levels: Low Ca, Low/normal P, High Alk Phosphatase, High PTH
X-ray: Looser-Milkman psuedofractures

131
Q

Parathyroid hormone

A

PTH

activates osteoclasts to increase Ca in bloodstream

132
Q

Looser-Milkman pseudofractures

A

X-ray indication of osteomalacia

thin areas of bone that show up as dark on x-ray, usually in weight-bearing areas of bone

133
Q

Osteomalacia- affected cells

A

osteoblasts

No Ca-> no mineralization of bone (by osteoblasts)

134
Q

Osteomalacia- blood Ca

A

decreased due to lack of vitamin D

MAY be normal

135
Q

Osteomalacia- blood P

A

decreased or normal

need vit D to absorb P

136
Q

Osteomalacia- blood Alkaline Phosphatase

A

Increased b/c osteoblasts are trying hard to inc Ca

137
Q

Osteomalacia- blood PTH

A

increased b/c osteoblasts are trying hard to inc Ca

138
Q

Osteomalacia X-ray

A

Looser-Milkman pseudofractures (thin areas of bone that show up as dark on x-ray, usually in weight-bearing areas of bone)

139
Q

Osteogenesis

A

Intramembranous Ossification- mesenchymal template-> frontal/parietal bones, part of occipital/temporal/mandible/maxilla/clavicle
Endochondral Ossification- cartilage template-> portions of basicranium, long bones, pelvic/pectoral girdles, ribs

140
Q

mesenchyme

A

embryonic conn tissue

mesoderm + other cells

141
Q

Intramembranous ossification

A

type of osteogenesis that uses a MESENCHYMAL template

forms frontal/parietal bones, part of occipital/temporal/mandible/maxilla/clavicle

142
Q

Endochondral ossification

A

type of osteogenesis that uses a CARTILAGE template

forms portions of basicranium, long bones, pelvic/pectoral girdles, ribs

143
Q

Intramembranous Ossification steps

A
  1. mesenchyme cells condense-> soft sheet permeated w/capillaries
  2. Osteoblasts secrete osteoid tissue on mesenchyme, trapped osteoblasts become osteocytes, periosteum forms around osteoblasts, osteoblast border/periosteum forms trabecula
  3. Cont mineral deposition (by osteoblasts/cytes) -> trabeculae fuse-> form spongy bone
  4. Bone deposition-> surface spongy bone becomes compact (middle stays spongy), periosteum still on surface
144
Q

Endochondral Ossification steps

A
  1. Mesenchyme-> hyaline cartilage + perichondrium covering
  2. Perichondrium stops making chondrocytes, starts making osteoblasts
    Chondrocytes in middle enlarge (1 oss center), dye
    Osteoblasts form thin collar around diaphysis
  3. Blood vessels enter collar and 1 oss center-> 1 marrow cavity (diaphysis)
  4. Osteoblasts-> osteoid-> spongy bone
  5. Cartilage death + osteoclasts towards bone ends (+ chondrocytes enlarge)-> enlarged marrow cavity-> 2 oss center at ends
  6. Blood vessels enter collar and 2 oss center-> 2 marrow cavity (epiphysis)
  7. Osteoblasts-> osteoid-> spongy bone
  8. Cartilage death + osteoclasts (+ chondrocytes enlarge)-> enlarged marrow cavity
  9. Epiphysis fills w/spongy bone, cartilage at epiphyseal plate
145
Q

chondrocyte

A

cartilage cell

146
Q

Zones of Endochondral Ossification

A

at epiphyseal plate (from inside out)

  1. Reserve cartilage
  2. Cell prolif
  3. Cell hypertrophy
  4. Calcification
  5. Bone deposition
147
Q

Zone 1 of Endochondral Ossification

A

Reserve cartilage

resting hyaline supply for Zone 2

148
Q

Zone 2 of Endochondral Ossification

A 
Cell Prolif (growth in length)
chondrocytes multiply, line up in rows (vertical and parallel columns) of small/flat lacunae
149
Q

Zone 3 of Endochondral Ossification

A

Cell Hypertrophy
chondrocytes stop mitosis, start enlarging
lacuna walls thin

150
Q

Zone 4 of Endochondral Ossification

A

Calcification

temporary calcification of cartilage matrix b/w lacunae

151
Q

Zone 5 of Endochondral Ossification

A 
Bone Deposition
lacuna walls breakdown-> open channels
chondrocytes die
osteoblasts deposit bone-> trabeculae-> spongy bone
Vascular zone
152
Q

Rickets

A

deficient mineralization of cartilage at growth plate
architectural disruption of growth plate
Ca deficiency-> Calcipenic Rickets
Causes: low vit D intake or insufficient vit D metabolism OR low Ca intake/absorption (but normal vit D)
S/Sx: delayed fontanelle closure, parietal/frontal bossing, craniotabes (soft skull bones), wrist widening, distal radial/ulnar bowing, progressive lateral femur/tibia bowing
Cells most affected: chondrocytes of growth plate (can’t mineralize cartilage)
Blood levels: low/normal Ca and P, high Alk Phosphatase and PTH

153
Q

bossing

A

frontal/parietal bones bow out/protrude-> prominent forehead

symptom of Rickets

154
Q

craniotabes

A

soft skull bones

symptom of Rickets

155
Q

Calcipenic Rickets causes

A

low vit D intake or insufficient vit D metabolism OR low Ca intake/absorption (but normal vit D)

156
Q

Calcipenic Rickets symptoms

A

delayed fontanelle closure, parietal/frontal bossing, craniotabes (soft skull bones), wrist widening, distal radial/ulnar bowing, progressive lateral femur/tibia bowing

157
Q

Calcipenic Rickets- cells affected

A

chondrocytes of growth plate

can’t mineralize cartilage (in hypertrophic zone)

158
Q

Calcipenic Rickets- blood Ca

A

decreased/normal

159
Q

Calcipenic Rickets- blood P

A

decreased/normal

160
Q

Calcipenic Rickets- blood Alkaline Phosphatase

A

increased

trying to grow more bone, but can’t

161
Q

Calcipenic Rickets- blood PTH

A

increased

trying to grow more bone, but can’t

162
Q

Achondroplasia

A

most common skeletal dysplasia that causes short-limb dwarfism
Long bones affected (cranial/vertebral bones spared)
Cause: overexpression of FGFR3 (chrom 4)-> early signal for stopping chondrogenesis-> inhibited cartilage synth-> dec endochondral bone formation, premature ossification of growth plates
Proliferative zone affected
Ass symptoms: obesity, trident hands (short fingers in 3 groups), short/broad feet, frontal/parietal bossing, limb bowing, lumbar lordosis, limited elbow flexion

163
Q

Achondroplasia mechanism

A

overexpression of FGFR3 (chrom 4)-> early signal for stopping chondrogenesis-> inhibited cartilage synth-> dec endochondral bone formation, premature ossification of growth plates
Proliferative zone affected

164
Q

trident hands

A

short fingers in 3 groups

symptom of achondroplasia (short-limb dwarfism)

165
Q

Osteoporosis

A

low bone mass, microarchitectural disruption, skeletal fragility -> decreased bone strength, inc fracture risk
postmenopausal Caucasian women, elderly
S/Sx: none until fracture (or low bone density on bone density test)
Cells: osteoblasts and osteoclasts (osteoblast activity

166
Q

Osteoporosis- cells affected

A

osteoclast activity outweighs osteoblast activity

167
Q

Osteoporosis- blood Ca

A

normal

168
Q

Osteoporosis- blood P

A

normal

169
Q

Osteoporosis- blood alkaline phosphatase

A

normal
cells aren’t doing anything differently (like in Rickets), just doing a little more, but not enough to cause overcompensation

170
Q

Osteoporosis- blood levels

A

Ca/P/alk phosphatase normal
vitamin D could be low or normal (based on person)
Dietary absorption still functioning, covering up any physiological process problems
Will see HORMONE imbalance

171
Q

Trabecula-> Osteon

A
  1. Ridges in periosteum-> groove for periosteal blood vessel
  2. Periosteal ridges fuse-> endosteum-lined tunnel
  3. Osteoblasts in endosteum-> build new CONCENTRIC lamellae INWARD (towards center of tunnel)
  4. Bone grows OUTWARD, osteoblasts in periosteum build new CIRCUMFERENTIAL lamellae
  5. New periosteal ridges fold over blood vessels-> repeat process
172
Q

Bone Remodeling

A 
Compact bone (w/in osteon)
Trabecular bone (on endosteal surface)
173
Q

Compact bone remodeling

A
  1. Osteoclast precursors recruited to haversian canal-> differentiate, line lamella facing canal-> resorb bone from inner to outer lamellae
  2. More precursors recruited-> lamellar resorption slightly past orig osteon boundary, (occupy Howship’s lacunae)-> recruit osteoblasts
  3. Osteoblasts organize layer inside resorption cavity-> secrete osteoid (cement line=newly organized lamella)-> bone deposition towards osteon center
  4. Trapped osteoblasts in center of mineralized bone matrix-> differentiate-> osteocytes
  5. Newly formed osteon leaves behind interstitial lamellae
174
Q

Trabecular bone remodeling

A
  1. Osteoclast precursors recruited to trabecular endosteal surface-> differentiate-> form resorption space limited by cement line
  2. Osteoblasts recruited-> line cement line surface-> deposit osteoid
  3. New bone closes resorption space
175
Q

Bone Fracture Healing

A
  1. Fracture hematoma
  2. Fibrocartilaginous callus
  3. Bony callus
  4. Bone remodeling
176
Q

Fracture hematoma formation

A

1st phase of bone fracture healing
Blood accumulates b/w fracture ends
Osteocytes + marrow cells -> necrosis-> INFLAMMATION
Macrophages + Granulocytes -> form granuloma-> STABILIZATION of fracture

177
Q

Fibrocartilaginous callus formation

A 
2nd (reparative) phase of bone fracture healing
Periosteal-derived and medullary artery-derived capillary buds extend into granuloma-> form cartilage (soft callus)-> STABILIZES fractured ends
Woven bone (trabeculae) replaces cartilage-> MINERALIZATION
178
Q

Bony callus formation

A

3rd (reparative) phase of bone fracture healing
Osteoblasts form bony/hard callus
Periosteal + internal hard callus envelope fractured ends

179
Q

Bone remodeling phase

A

last phase of bone fracture healing
Osteoclasts reabsorb excessive/misplaced trabeculae
Osteoblasts lay down new bone-> compact bone along stress lines
Haversian systems/osteons and Volkmann’s canals formed-> house blood vessels

180
Q

X-Ray mechanism

A

W photons pass through body-> recording plate
More exposure=dark (ex- air)
More absorption=white (ex- bone)
Cons: hard to observe thickness/depth/overlay
Positioning: object further from plate (closer to x-ray source) = enlarged

181
Q

Fluoroscopy

A

view real-time movement w/continuous stream of x-rays
X-ray source below, image intensifier/data capture above
C-arm allows rotation for 3D info
Peripheral vascular studies: 2-3 frames/sec
Coronary artery studies: 15-30 frames/sec

182
Q

Computed Tomography

A 
CT Scan (usually Iodine contrast)
Rotating x-ray tube-> pass through body helically-> collected on opposite side
Math: reconstruct transverse plan images from data-> 3D images
Hounsfield Scale: capture image, then mess with data (window width) to produce diff contrasts
183
Q

Hounsfield Scale

A

density numbers used in computed tomography
water=0, air=-1000, compact bone=+3095
most soft tissue -100 to +100
window width: range of gray scale mapped (only 256 shades, below=black, above=white)

184
Q

window width (Hounsfield Scale)

A

range of gray scale mapped in computed tomography (only 256 shades)
below=black, above=white
wide window for bone (large changes in density)
narrow window for soft tissue (small changes in density)

185
Q

Magnetic Resonance Imaging

A

MRI
No ionizing radiation
Manipulate magnetic fields around patient-> H protons-> radiofreq energy as they return to equilibrium from spin alignment w/field (relaxation time)
Nuclear spin: atoms align w/magnetic field
Diff tissues have diff relaxation time
T1 weighted and T2 weighted

186
Q

T1 Weighted MR

A

Dark: inc water/edema, tumor, inflam/infection, hyperacute/chronic hemorrhage
Light: fat, subacute hemorrhage, melanin, protein-rich fluid, slow blood

187
Q

T2 Weighted MR

A

Dark: Calcification, fibrous tissue, protein
Bright: water/edema, tumor, inflam, infection, subdural collection

188
Q

Femoral Sheath

A

funnel-shaped fascial tube w/femoral artery, vein, and canal
allows vessels to glide smoothly during hip movement
continuous w/loose conn tissue/fascia
ends 4-10 cm distal to inguinal ligament

189
Q

Femoral sheath compartments

A

2 vertical septa

  1. Lateral- artery
  2. Intermed- vein
  3. Medial/Femoral canal- lymph node
190
Q

Femoral Canal

A 
short, conical medial compartment of femoral sheath
lymph vessels, loose conn tiss, fat
allows fem vein expansion
extends distally-> saph opening
prox opening = FEMORAL RING
191
Q

Femoral Ring

A

proximal opening of femoral canal (medial compartment of femoral sheath
~1 cm wide
covered by parietal peritoneum
can find herniations of abdominal viscera here

192
Q

Femoral Hernia

A

femoral ring is weak area in anterior abdominal wall

loop of small intestine can protrude through ring into femoral canal

193
Q

Inguinal herniae

A

Direct: small intestine projects through inguinal ring (lateral to epigastric vessels)
Indirect: small intestine projects though abdominal wall
Hesselbach’s Triangle

194
Q

Inguinal lymph nodes

A

drain lymph from lower limb, perineum, anal canal, anterior abdominal wall
Superficial (prox/hor and dist/vert) and Deep
Drain to external iliac lymph nodes

195
Q

Superficial inguinal lymph nodes

A

Prox/hor: inferior to inguinal ligament
Dist/vert: along great saphenous vein

Both: deep to inguinal ligament, drain to external iliac lymph nodes

196
Q

Deep inguinal lymph nodes

A

1-3 lymph nodes in femoral canal (medial compartment of femoral sheath)
drain to external iliac lymph nodes

197
Q

Femoral Nerve

A

L2-L4
largest branch of lumbar plexus, in psoas major
Entry: thigh lat to inguinal ligament midpoint and femoral vessels
Inn: ant thigh musc, hip/knee jt (iliacus, sartorius, quadriceps femoris, pectineus)
terminal cutaneous branch= SAPHENOUS NERVE

198
Q

Lateral femoral cutaneous nerve

A 
may be affected by anterior hip dislocation (along w/femoral nerve)
Meralgia Paresthetica (compression under ing lig)
199
Q

Meralgia Paresthetica

A

compression of lateral femoral cutaneous nerve as it passes under inguinal ligament-> PAIN along LAT THIGH
sometimes impinged where it emerges from fascia lata

200
Q

Saphenous nerve

A

anterior/inferior w/great saph vein
becomes superficial b/w sartorius and gracilis
Inn: skin of ant/med knee/leg, med foot
terminal cutaneous branch of femoral nerve

201
Q

Adductor Canal

A

intermuscular passage/fascial tunnel: femoral vessels-> popliteal fossa
Start: fem triangle apex
End: adductor hiatus
saph nerve/artery (branch of desc gen art) exit medially

202
Q

Adductor hiatus

A

opening in tendon of add magnus: fem vessels-> popliteal fossa

203
Q

Femoral Artery

A

main arterial supply to lower limb
Enters fem triangle: lat to fem vein (deep to ing lig midpt)
Fem triangle-> iliopsoas-> pectineus-> add longus-> bisects fem triangle apex (deep to sartorius)
inferior thigh-> DESC GENICULAR ART-> articular and saphenous branch

204
Q

femoral artery palpation

A

2-3 cm inferior to inguinal ligament midpoint (which is b/w ASIS and pubic tubercle)
used for radiographic visualization of left heart and coronary vessels
femur head posterior to femoral artery

205
Q

Profunda Femoris Artery

A

AKA Deep Femoral Artery
largest branch of femoral artery
chief artery to thigh, descends behind add longus
-> medial/lateral CIRCUMFLEX ARTeries

206
Q

Lateral Circumflex artery

A

branch of deep femoral artery
goes under sartorius and rectus femoris
supplies femur head and lat thigh muscle
-> 3 branches: ascending, transverse, descending

207
Q

femoral artery progression

A

femoral a-> deep fem/profunda femoris a + fem a
deep fem a-> lat/med circumflex a + deep fem a (-> perforating a-> adductors/hamstrings)
lat circumflex a-> ascending/transverse/descending branches
deep fem a-> popliteal artery (adductor hiatus)

208
Q

Medial Circumflex artery

A

branch of deep femoral artery
goes between iliopsoas and pectineus to posterior thigh
MAIN SUPPLY OF FEMUR HEAD/NECK

209
Q

Femoral Vein

A

Enters fem triangle: medial to fem a
Fem triangle apex: deep to fem a
saphenous opening: just below inguinal ligament, branches anterior and down to great saphenous vein and ant fem cutaneous vein

210
Q

Great Saphenous vein

A

Uses: administer blood/electrolytes/drugs, coronary bypass surgery
Access to veinous sys: incision anterior to medial malleolus (“saphenous cutdown”)

211
Q

Saphenous cutdown

A

incision made anterior to med malleolus

may cause pain along medial border of foot (due to saph nerve)

212
Q

anterior muscles of thigh

A 
Iliopsoas (Psoas major/minor, iliacus)
Pectineus
Sartorius
Rectus Femoris
Vastus medialis/intermedius/lateralis
213
Q

Psoas major innervation

A

L1/2/3 (ventral rami)

214
Q

chief hip flexor

A

iliopsoas

215
Q

Psoas minor innervation

A

L1/2 (ventral rami)

216
Q

Iliacus innervation

A

L2/3/4 (femoral nerve)

217
Q

iliopectineal bursitis

A

inflammation of bursa between iliopsoas and pectineus
due to overuse (cycling, running)
hard to treat b/c hard to access

218
Q

Hilton’s law

A

joint is innervated by same nerves that supply muscles moving the joint and skin over the joint

219
Q

adductor gait

A

one leg crosses in front of other due to damaged superior gluteal nerve

MSK (2 decks)

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