MSK REVISION NIGHTS

Question 1

1. What muscle inserts into the thoracolumbar facia? A – Deltoid B – Triceps C - Latissimus Dorsi D – Flexor digitorum profundus E – Trapezius F – Popliteus G– Iliopsoas

Answer 1

Lattisumus dorsi

Question 2

What nerve supplies the lattisumus dorsi, the trapezium and the serratus anterior?

Answer 2

Lattisus=mus dorsi - thoracodorsal nerve Trapezium - spinal accessory nerve (CN XI) Serratus anterior - long thoracic nerve (C5,6,7)

Question 3

2. What muscle unlocks the knee joint?

Answer 3

The popliteus

Question 4

3. What is ruptured to cause this deformity? A – Lumbricals B – Opponens pollicis C - Flexor policus longus D – Flexor digitorum profundus E – A 1 pulley F – Extensor apparatus G– Flexor digitorum minimi

Answer 4

F - extensor apparatus

Question 5

What is this known as and how does it usually occur?

Answer 5

This is known as mallet finger Uusally due to a ball or sport hitting the extensor tendon and causing it to rupture - patient is unable to extend DIPJ

Question 6

Describe each deformity?

Answer 6

Mallet finger - hyperflexion at the DIPJ Swan neck deformity - hyperextension at the PIPJ and hyperflexion at the DIPJ Boutonierre deformity - hyperflexion at PIPJ and hyperextension at distal

Question 7

4. How would you assess for axillary nerve dysfunction in a trauma patient A – Internal rotation at the shoulder B – External rotation at the shoulder C - Extension at the elbow D – Extension at the shoulder E – Sensation over lateral aspect of the arm over deltoid F – Sensation at ring finger G – Froment’s test

Answer 7

E - sensation over lateral aspect of the arm over deltoid

Question 8

What is the patch on the lateral aspect of the arm the axillary nerve supplies known as? what two muscles does the axillary nerve supply?

Answer 8

This is known as the badge patch

Axillary nerve supplies the deltoid and the teres minor

Question 9

What injury to the shoulder can cause axillary nerve palsy? What is the function of the deltoid and the teres minor?

Answer 9

Shoulder dislocation can caause axillary nerve palsy Deltoid causes flexion/extension and abduction of the shoulder Teres minor causes external rotation of the shoulder - attaches to greater tubercle

Question 10

What shoulder dislocation is more common, anterior or posterior?

Answer 10

Anterior shoulder dislocation is more common than posterior (anterior can happen due to seizures and is usually bilateral)

Question 11

5. What of the below can cause numbness of the numb and first 2 and a half fingers? A – Dislocation of the lunate B – Fractured hook of hammate C – Anterior dislocation of the shoulder D – Fracture through the surgical neck of the humerus E – Fracture through the spiral grove of the humerus F – Damage to the posterior cord G– Cubital tunnel syndrome.

Answer 11

Dislocation of the lunate

Question 12

What else can cause median nerve palsies?

Answer 12

Supracondylar fracture (usually in children) Colle’s fracture Carpal tunnel syndrome

Question 13

Median nerve provides sensory innervation to the thumb and first 2 and a half fingers What are the two branches of the nerve that provide this?

Answer 13

Palmar cutaneous branch and digital cutaneous branch

Question 14

What nerve roots make up the musculocutaneous nerve? What muscle does it pierce and what muscles does it supply?

Answer 14

C5,6 and 7 nerve roots Pierces the coracobrachialis Supplies the coracobrachialis, biceps brachii and brachialis

Question 15

What nerve roots make up the axillary nerve? What does it innervate?

Answer 15

Nerve roots C5 and 6 Innervates the deltoid, teres minor and the regimental badge patch

Question 16

What nerve roots make up the median nerve? Which lumbricals does it innnervate?

Answer 16

C6,7,8 and T1 Innervates the two lateral lumbricals

Question 17

Which nerve roots make up the radial nerve? What on the hand is the sensory innervation from the radial nerve?

Answer 17

C5,6,7,8 and T1 Innervates the posterior arm, and the anatomical snuffbox + lateral dorsum of thumb and 2.5 fingers

Question 18

What makes up the ulnar nerve?

What muscles of the anterior forearm does the ulnar nerve supply?

Answer 18

C8 and T1

Supplies the flexor carpi ulnaris and the medial 2 branches of the flexor digitroum profundus

Question 19

What nerve innervates the serratus anterior?

Answer 19

The long thoracic nerve

Question 20

Damage to either of what two nerves can cause scapular winging?

Answer 20

Serratus anterior - long thoracic nerve Trapezium - spinal accessory nerve palsy

Question 21

What two muscles does the spinal accessory nerve supply?

Answer 21

Supplies the sternocleidomastoid muscle and the trapezium muslces

Question 22

7 – How would you manage a minimally displaced Colles fracture?

Answer 22

Reduce and splint

Question 23

What is a colles fracture?

Answer 23

Dinner fork deformity Extra articular fracture of the distal radius within 1inch of the articulation with dorsal angulation or displacement

Question 24

8 Neonate has positive Barlow’s and Ortilani’s test. How would you investigate and manage?

• A – X-ray + conservative
• B – X-ray + Ponseti method
• C – X-ray + Pavlic harness
• D – X-ray + fix hip with a screw
• E – Ultrasound + conservative
• F – Ultrasound + Ponseti method
• G– Ultrasound + Pavlic harness

Answer 24

F - Ultrasound + Pavlic harness

Question 25

Describe how ortalni’s and barlow’s tests are performed?

Answer 25

Barlow - adduct the hip and push posteriorly Ortalani - already Out so abduct the hip and push anteriorly to relocate hip joint

Question 26

What is the Ponseti technique used in the treatment of?

Answer 26

Use ponseti technique in the treatment of clubfoot - talipes equinovarus

Question 27

9 – 9 Year old girl presents with an intracapsular Neck of femur fracture. What is the management? (discuss others) A – Hemiarthoplasty B – Total hip replacement C – External fixation D – Dynamic hip screw E – Conservative management F – Femoral nail G– Cannulated screw

Answer 27

G - cannulated scrw Do not want to be doing arthroplasty on someone so young Dynamic hip screw is for extracapsular hip fractures Conservative would not work Femoral nail (intrameduallary nail) - for femoral shaft fractures

Question 28

10 – What muscle crossed two joints? A – Deltoid B – Short head of biceps C – flexor digitorum profundus D – Psoas E – Soleus F – Gastrocnemius G– Vastus lateralis

Answer 28

F - Gastrocnemius

Question 29

11 – Trauma patient presents with painful lower leg. More painful on passive stretching. Pulses are intact. Limb is cold, leg is tense. Presumed fracture. What would you do? (you are an orthopaedic surgeon) A – Analgesia B – X-ray to confirm fracture C – 2 compartment decompression D – Reduce the fracture E – Check reflexes F – Place foot in below knee cast G– 4 compartment fasciotomy

Answer 29

G - 4 compartment fasciotomy

Question 30

12 – A gentleman has been in a below knee cast and now has foot drop. What structure has been damaged?

Answer 30

Common pernoeal nerve

Question 31

13 – What innervates the first web space of the foot?

Answer 31

Deep fibular (pernoeal) nerve

Question 32

Which bones make up the shoulder and elbow joint?

Answer 32

Shoulder - humerus and glenoid fossa of scapula Elbow - humerus, radius (radiocapitellar) and ulna (trochlea into trochlear notch)

Question 33

Proximal & distal Radioulnar are made from what?

Answer 33

The radius and ulna and allow for supination and pronation

Question 34

Which bones form the wrist joint and what is the joint known as?

Answer 34

The radius and carpals (scaphoid, lunate, triquetrum) Known as an ellipsoidal (condyloid) joint

Question 35

From subclavian artery, name the artery supply to the hand?

Answer 35

Subclavian - axillary - brachial - radial and ulnar - deep and superfical palmar arches

Question 36

When does the subclavian artery become the axillary artery? When does the axillary artery becomes the brachial artery?

Answer 36

Subclavian becomes axillary artery at the lower border of Rib 1 Axillary becomes brachial at the inferior border of the teres major

Question 37

Which dermatome supplies the badge patch region? Which nerve? Which injury?

Answer 37

C5 dermatome Axillary nerve Fracture to the surgical neck of humerus or anterior shoulder dislocation

Question 38

Which nerve supplies the muscles of the posterior arm and forearm? How is it injured? What is its sensory innervation? What does the deformity look like?

Answer 38

The rdial nerve Injured during a humeral shaft fracture Sensory innervation is to the posterior and forearm and thumb and lateral 2.5 fingers of the hand Looks like a wrist drop deformity

Question 39

Ulnar nerve supplies the medial 1.5 fingers of the hand with sensory innervation Median nerve supplies the lateral 3.5 fingers of the hand with sensory innervation Describe the different features in a medial and ulnar nerve palsy?

Answer 39

Ulnar nerve - patient presents with a claw hand Claw hand - hyperextension at the MCP joint with hyperflexion at the PIP and DIP joints Median nerve - patinet presents with hand of benediction Hand of benediction - hyperfelxion at MCP, PIP, and DIP joints

Question 40

What is the function of the lumbricals? Why does median nerve palsy therefore present with a hyperextended MCP and flexed interphalangeal?

Answer 40

To flex the MCP joints and extend the interphalngeal joints Ulnar nerve palsy presents with the features as the lumbricals i supplies are not working

Question 41

Hand is unable to flex the MCP and IP joints when trying to make a fist in the lateral 3 digits What is this?

Answer 41

This is hand of benediction - median nerve palsy

Question 42

What is the function of the gluteus maximus?

Answer 42

Extension of the hip and external rotation

Question 43

What is the function of the gluteus medius and minmus?

Answer 43

Abduction of the hip and medial rotation