Musculo-Skeletal System Flashcards
At what level is the hyoid bone?
C2-C3
cricoid cartilage
Below the thyroid cartilage
C6
The root of the spine of the scapula
T3
The inferior angle of the scapula
T7
The posterior superior iliac crest
S2
The spinal cord extends to
L2
Sternal angle or angle of Louis
The angle of Louis is the eponymous name given to the sternal angle which is the palpable anatomical feature formed from the manubriosternal junction.
Body of 2nd rib and T5
Termination of Aorta
L4
Scapula
Infraspinatus fossa, supraspinatus fossa, inferior angle, lateral border, medial border, glenoid fossa
On the neck of the humerus
Greater and lesser tubercle
Gives us the intertubercular groove where the long head of the biceps ride.
What does the ulna articulate with?
The trochlea, radius, and cartilage (distally)
carpal bones
Some lovers try positions
That they can’t handle
Scaphoid lunate triquetral
Pisiform
Trapezium Trapezoid Capitate Hamate
Two holes in the mandible
What passes through it?
Mental foramen
Mental nerve
What makes the hard palate?
Palatine processes of the maxillary bones and the palatine bone proper (posterior)
What is the clivus?
Part of the occipital bone in front of the magnum foramen
Pteryeon
Meeting of the coronal temporoparietal, and sphenoid sutures.
This is the area through which the medial meningeal artery passes by. It is commonly ruptured when a person gets hit on the side of the head
What is the hardest cartilage in the body?
Fibrocartilage then hyaline cartilage
Hyaline cartilage
Lines the articular surfaces of the synovial joints.
Leftover from the fetal skeleton.
Remember
Vertebral foramen is in every vertebrae
Transverse foramen are only in the cervical vertebrae and they are for the vertebral artery.
Curves of the spine
Primary and secondary
Primary is the fetal curve - kyphosis
Secondary are the lordotic curves
Fibula
Serves as an attachment point for muscles rather than weight-bearing bone.
Distally, the tibia forms the lateral malleolus
Eversion ankle sprain
The deltoid ligament is affected
Inversion ankle sprain
The anterior talofibular ligament
Remember
The glenoid only interact with the long head of the two muscles.
Supraglenoid tubercle - biceps
Infraglenoid - triceps
Subacromial bursa
Allows for rotation
Under the acromion process
Does the ulna articulate with the bones of the wrist?
No, it articulates with the radius, humerus, and the articular disk
Gastrocnemius
Origin: proximal to articular surfaces of lateral condyle of the femur and medial condyle of the femur.
Insertion: Tendo-calcaneus (achilles tendon)
Menisci
Figure 8
There are wholes in them which the tibia and femur articulate in. There is hyaline cartilage between the bones obviously.
Anterior and posterior cruciate ligaments
They are named on the origin of the tibia
What are the muscles that close the jaw?
Medial pterygoid muscle, masseter, and temporalis
What are the muscles that open the jaw?
Digastric and lateral pterygoid
What nerve innervates all of these muscles mentioned previously?
CN5 - Facial nerve
What vertebra has the dens?
C2 - the atlas vertebra
Where is the first vertebral disk found?
Between the C2 and C3
Remember
ALL is on the front part of the body of the vertebra, the PLL is posterior to the body of the vertebra.
The ligamentum flavum
Found posterior to the vertebral foramen.
The PLL in this case would be anterior to the vertebral foramen.
Osteomyelitis
Osteo = bone
Myel = bone marrow
-itis + inflammation
Inflammation of the bone or bone marrow results from an infection.
Bacteria that reach the bone by:
trauma, surgery, infection from one area, a combination of these.
Chronic - affected bone becomes necrotic and separates - sequestrum.
Layers of bone:
Periosteum - where muscles, tendons, and ligaments are attached
Cortical bone - composed of multiple osteons which have Haversian canal which has blood supply and innervation.
Spongy bone - have the trabeculae which gives structural support
Osteoblast
Synthesises bone matrix
Osteoclast
Osteoclasts are the cells that degrade bone to initiate normal bone remodeling and mediate bone loss in pathologic conditions by increasing their resorptive activity.
Tuberculous osteomyelitis
Tuberculous osteomyelitis is an uncommon infection that usually involves the vertebrae
Osteoporosis
Osteo = bones
porosis = pores
Pores of the bone
Higher breakdown of bone in comparison to the formation of new bones.
Meaning, a decrease in bone density
Primary: menopausal, reduction of bone mass/matrix, and demineralization.
Secondary: due to disease (advanced hyperthyroid, PTH Dz. states…)
Bone remodeling
Spongy bone is replaced every 3-4 years
Compact bone is replaced every 10 years
Highly dependent on serum calcium levels.
Parathyroid hormone
Hormones responsible for the balance of bone structure are the parathyroid, calcitonin, and vitamin D.
It stimulates the resorption of calcium and phosphate from the bone to the bloodstream.
Calcitonin
Calcitonin is a man-made hormone that works by slowing bone loss and maintaining normal calcium levels in the blood. It may also help to reduce bone pain in people who have Paget’s disease.
Osteomalacia
Inadequate bone mineralization
Bone softening
Due to deficient or impaired metabolism of vitamin D, phosphate, or calcium.
Femur
made out of two epiphyses and one diaphysis
Between the epiphysis and diaphysis, there is the metaphysis where the epiphyseal plate is.
What does calcitriol, the active form of vitamin D, does in the tubules of the kidneys?
It increases renal tubular reabsorption.
It increases the intestinal absorption of Calcium and phosphate.
Osteochondroma
Osteochondroma is an overgrowth of cartilage and bone that happens at the end of the bone near the growth plate. Most often, it affects the long bones in the leg, the pelvis, or the shoulder blade. Osteochondroma is the most common noncancerous (benign) bone growth.
A lump in the bone.
Paget’s disease of bone
Disorder of lots of bone remodeling.
Excessive bone resorption and growth.
This leads to deformities and potential fractures
The exact cause is unclear
Triggered by infection such as the measles virus.
Involves the skull, lumbar vertebrae, pelvis, and the femur.
Phase 1 - lytic phase - osteoclasts starts to demineralize the bone 20x faster
Phase 2: mixed phase (lytic + blastic phase) - rapid, but disorganized proliferation of new bone tissue.
Phase 3 - the sclerotic phase where new bone formation exceeds resorption
Bones get misshaped.
Paramyxovirus
Bone tumors
Bone cell divides uncontrollably forming tumors.
Confined and doesn’t spread = benign.
Invades tissues and metastasizes = malignant.
Malignant can be primary or secondary
Primary: arise from bone cells
Secondary: metastasized and spread to the bones.
What are the most common places for metastasis?
Bone, liver, and brain
Bone is very common.
Osteoid osteoma
arise from osteoblasts
from a nidus - small < 1.5 cm, surrounded by sclerotic bone which produces prostaglandins (responsible for the sensation of pain)
Does not erode the surrounding bone
Osteoblastoma
Arise from osteoblasts.
form a nidus which is large > 1.5 cm
Erode the surrounding bone
Osteosarcoma
Primary bone cancer
Secondary to Paget’s in elderly, knee hip, humerus
Arise from osteoblasts of different sizes.
Often forms in the metaphysis
Affects adolescents
Known mutations
pRB seen in familial retinoblastoma
p53
SECOND MOST COMMON PRIMARY MALIGNANT BONE CANCER!
Erwin’s sarcoma
Common in adolescents 10-20 years Arise from NEUROECTODERMAL cells Associated with chromosomal mutations 22 11 Extremely malignant Metastatic Viscous liquid-like pus in the marrow, sheets of
Osteoarthritis
Osteo = bone
Arthr = joint
-itis = inflammation
OA is wear and tear degenerative arthritis with a lot of erosion
Progressive erosion of articular cartilage
Subchondral cysts, osteophytes, hips, knees, lumbar, cervical
Synovial joints
Bouchard’s nodes at PIP
Heberden’s nodes at DIP
Risk:
- age
- Weight
- Inflammaiton: IL-1, IL-6, TNF
Rheumatoid arthritis
Rheumatism = musculoskeletal illness Arthr = joints -itis = inflammation Chronic inflammation disorder mostly affects joints, but lungs and skins can be affected. Synovial joints RF positive Nodules at the PIP joints Pannus - inflamed synovial tissue Neutropenia Baker's cyst Normally 3 or more symmetrical arthritic joints
Synovial fluid
remove debris and lubricate joint
Chondromalacia
Softness of the articular (Hyaline) cartilage, usually involving the patella. Apparently caused by unbalancing elements of the quadriceps with patellar misalignment during movement.
Osteochondritis
Rib pain
Knee pain, ankle,
Older teenagers, young adults - people who are more active
This is caused due to injury or repetitive movement. Blow to the chest for instance. Auto accident
Osgood-Schlatter’s disease - pain in the knee area, primarily in the tibial tuberosity due to repetitive movement - sports.
Ganglion
Cystic tumor developing on a tendon or aponeurosis
Arises from cystic or myxoid degeneration of connective tissue
Infectious Arthritis
GC, staph, strep, TB, Lyme
Acute painful swollen single joint, fever
Common post-trauma
Gouty arthritis
Hyperuricemia, uric acid in and around joints. 1st MTP tophi in olecranon, prepatellar, calcaneal tendon, pinna
Ankylosing spondylitis
joining of joint areas
Marie-Stumpell disease, adolescents males
Sternocleidomastoid muscle
Divides the two triangles of the neck on each side.
Posterior and anterior triangle
Suboccipital triangle
The vertebral artery passes through it
avoid injection there as it goes straight to the brain.
Rectus capitus posterior major and minor
Oblique capitus superior and inferior
Muscle types
Fast muscles are for rapid, powerful actions and slow muscles are for prolonged activity (body posture, marathon).
Red skeletal muscle = slow
White skeletal muscle = fast
Muscle spindle (intrafusal fibers)
Measures the muscle length
Activates alpha motoneuron when stretched
y efferent
1A affarent
Golgi tendon
Measures muscle tension
Inhibits alpha motoneuron
1B afferent
PAD DAB
Palmar adduction
Dorsal abduction
the thumb is innervated by
Median nerve - dorsal side all the way to the middle of the ring finger
From the middle of the meddle of the ring finger,
Innervation:
Starting from the pinky on the palmar side to the pink on the dorsal side
UMRU
Ulnar, median, radial, ulnar
Snuffbox
Extensor pollicis longus, extensor pollicis brevis, radial artery, scaphoid bone, cephalic vein, abductor pollicis longus
What passes through the carpal tunnel?
Median nerve
Four flexor digitorum profundus, superficialis, and flexor pollicis longus.
No vasculature
What wraps the carpal tunnel?
Transverse carpal ligament or flexor retinaculum
Tunnel of Guyon
The ulnar tunnel is where the ulnar artery and ulnar nerve pass through.
Brachial plexus
my mother usually always right
Hamstrings
Composed of two muscles
Biceps femoris - largest and strongest, long head and short head
O: long head from Ischial, short head from line aspera of femur tuberosity
I: head of the fibula
A: lateral rotation an, knee flexion, hip extension
Semitendinosus
O: Ischial tuberosity
Semimembranosus
Pes anserine is composed of what muscles?
Sartorius, semitendenosus, and gracilis.
Femoral triangle
3D space, think it as a pyramid
Contents inside of the triangle:
Femoral nerve, artery, vein, and lymph chain
What makes up the floor of the femoral triangle
Pectineus, psoas, and adductor longus
What makes up the roof of the femoral triangle
Fascia lata
The main artery of the lower limbs
Femoral artery
What are the contents that are wrapped by the femora sheath?
Artery, vein, and femoral canal
Nerves of the hip
Flexors are all femoral nerve.
Medial compartment all of the adductor are innervated by the obturator nerve.
Lateral abductors are innervated by superior gluteal nerve.
Hip flexors muscles
femoral nerve
Iliacus Psoas Pectineus Rectus femoris Sartorius
Hip adductors
obturator nerve
Adductor longus, magnum, and brevis
Gracilis
Pectineus
Obturator ext.
Hip abductors
Gluteus medius, minimus, and TFL
Remember
Posterior belly of digastric has CN 7innervation and anterior has CN 5
Erector Spinae muscle
“I Love Spaghetti”
Iliocostalis , Longissimus, Spinalis
Diaphragm
Innervated by phrenic nerve - “C3, C4, C5 keeps the diaphragm alive)”
Duchenne’s Muscular Dystrophy
The most common muscular dystrophy in children.
Duchenne muscular dystrophy is a genetic disorder characterized by the progressive loss of muscle. It is a multi-systemic condition, affecting many parts of the body.
Can start at age 3
No known cure
Gower’s sign
X-linked meaning it will be expressed in males
Pseudo-hypertrophy of the calves
Death at the age of 20
Myotonic Dystrophy
Myo = muscle tonic = poorly nourished dys = bad trophy = nourish Poorly nourished and weak muscle contracted, unable to relax Autosomal dominant genetic mutations Most common in adults Starts with facial atrophy
Congenital Myopathies
“Floppy infant syndrome”
Due to hypotonia
Nonprogressive disease
Myasthenia Gravis
Auto immune receptor attack
They are responsible for opening up sodium channels for muscle contraction. If I have this disease, I will not have a lot of muscle contraction
Females, antibodies to ACH receptors
Fatiguability (worse exertion)
Thymomas, thymic hyperplasia
Tensilon test for dx
