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Musculoskeletal Flashcards

1
Q

Why do the number of bones in the body reduce from childhood?

A

Smalls bones fuse together

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2
Q

How many bones in the adult human body?

A

206

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3
Q

What is the purpose of many small bones through childhood?

A

Allows birth and development e.g. cranial softer for birth
Fusion concludes at puberty

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4
Q

What are the two sections of the skeleton?

A

Axial for protection: skull, ribs, sternum, spine
Appendicular for movement

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5
Q

What is bone remodelling?

A

The constant breaking down of old or damaged bone and replacement of new bone

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6
Q

What are bone building cells?

A

Osteoblasts (from osteogenic stem cells
They undergo complex processes to become interconnected osteocytes - bone calcification

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7
Q

What are bone cells called?

A

Osteocytes which form when osteoblasts become interconnected
They have multiple nuclei to regulate busy cell processes

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8
Q

What are bone destroying cells?

A

Osteoclasts break down old/damaged bone cells

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9
Q

Describe the remodelling process?

A
  1. Reabsorption: liberation of minerals from bone breakdown
  2. Reversal: generation of environment to allow bone formation
  3. Formation: new bone forms
  4. Mineralisation: calcium bonds and collagen matrix forms
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10
Q

What is hard/spongey bone?

A

80% Compact/cortical outer: surrounds inner bone and is dense/strong
20% Cancellous/trabecular inner: metabolic processes occur here

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11
Q

What is the epiphysis?

A

Each end of the bone
Spongey bone with hard coating
Has red bone marrow for RBC production
Cartilage lines each end

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12
Q

What is the diaphysis?

A

The middle ‘shaft’ of bone
Has yellow bone marrow
Stores fat and stem cells to help with bone cell formation

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13
Q

What is the metaphysis?

A

Point at each end of the bone where it gets wider and the diaphysis becomes the epiphysis

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14
Q

What is a growth plate?

A

Also called physis
Active fourth region of bone during childhood
Grows bone tissue to add to the epiphysis and diaphysis to lengthen bone

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15
Q

What is the membranous bone cover called?

A

Periosteum

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16
Q

Describe long bone

A

Cylinder shape, longer than wide
Functions to lever
E.g. femur, ulna

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17
Q

Describe short bone

A

Cube shape, roughly equal length/width/height
Function is stability/support, some motion
E.g. carpal, tarsal

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18
Q

Describe flat bone

A

Thin and curved
Function to protect organs
E.g. sternum, cranium

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19
Q

Describe irregular bone

A

Complex shape
Function to protects organs
E.g. vertebra, facial bones

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20
Q

Describe sesamoid bone

A

Small, round, embedded
Function to protect tendons
E.g. patella

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21
Q

What are sutural bones?

A

Extra bones in some people within joints in skull bones

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22
Q

What is osteoporosis?

A

Gradual loss of bone density as bone is lost quicker than it is replaced
SX: fractures, reduced height, stooped posture, pain
TX: lifestyle, vitD, Ca, biophosphonates, selective estrogen receptor modulators, denosumab

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23
Q

What is the vasculature of bone?

A

Highly vascular
Nutrient artery enters via foramen
Supplies central artery which runs through the medulla and branches to supply all cells
Branches converge into central sinus
Blood then exits via venous sinus to central vein and out foramen
(Periosteal arteries also supply blood via foramen)

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24
Q

What are the names and differences between C1 and C2?

A

C1 is atlas and it supports the weight of the skull
C2 is axis and it allows pivoting of the skull

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25
What is the general structure of vertebrae?
Central vertebral body Spinous process (posterior) Transverse processes on each side allow muscle attachment Vertebral foramen houses cord Cartilage disks in-between
26
Where in the spine does the cord end?
L1/L2 Here it forms a group of nervous tissue called cauda equina
27
What is SCI?
Spinal cord injury Not all spine fractures result in SCI Swelling in the column can cause transient symptoms
28
What issues can occur with spinal discs?
Wear = bone-on-bone Slip from position and be pinched by vertebra
29
What parts make up the pelvis?
Hips, pubis, ischium, ilium, sacrum, coccyx
30
What is the greater pelvis?
False pelvis Holds intestines, uterus, ovaries and tubes
31
What is the lesser pelvis?
True pelvis Holds rectum, bladder, vagina/cervix, prostate
32
How do the female and make pelvis differ?
Male: denser, carries more weight Female: wider, greater arch, flexible coccyx
33
What is cartilage?
A firm and flexible connective tissue Provides support, structure, cushioning/absorption and joint movement
34
What is the makeup of cartilage?
Chondrocytes in a matrix of collagen fibres (strength) and proeoglycans (water balance)
35
What are the 3 types of cartilage?
Hyalin: on bone ends to allow smooth movement and line respiratory tract Elastic: shape/support and deform/recoil e.g. ears, larynx Fibrocartilage: tough/durable to provide shock and resist compression e.g. vertebral discs
36
Why are cartilage injuries slow to heal?
Cartilage is avascular
37
What is a synovial joint?
Joint which permits free movement -cushioning between bones (cartilage) -ligaments on each side to stabilise -muscles and tendons -synovial fluid in a cavity
38
What is a hinge joint?
One direction of movement only E.g. elbow, knee
39
What is a ball-and-socket joint?
Movement in multiple directions E.g. shoulder, hip
40
What is a pivot joint?
Allows rotation around a central axis E.g. between C1 and C2
41
What is a gliding joint?
Allows slide movement between joint surfaces E.g. carpals in wrist
42
What is a saddle joint?
Allows movement in two planes E.g. the thumb’s base joint
43
What are cartilaginous joints?
Have cartilage between bones that restrict movement E.g. rib-sternum
44
What is a fibrous joint?
Connected by fibrous tissue to reduce movement E.g. cranial bones
45
What is osteoarthritis and rheumatoid arthritis?
Osteo: inflammation in joints from wear and tear Rheumatoid: autoimmune causes inflammation of synovial membrane SX: pain, swell, deform, stiff TX: lifestyle, cold/hot tx, NSAID, methotrexate, sulfasalazine, leflunomide
46
What is the structure of muscle?
A single muscle fibre wrapped in endomysium is made from myoblasts Each fibre has nerve and vascular supply A bunch of fibres wrapped in perimysium is a fascicle (compartments) A bunch of fascicles wrapped in epimysium is a muscle
47
What is the structural unit of a muscle cell?
A sarcomere Contains long fibres called myofibrils which contain strands of actin + myosin
48
How does muscle contraction occur?
Sliding filament theory ATP is consumed to release calcium ions Calcium creates linkages between filaments of actin + myosin They bind together and uncouple repeatedly to produce movement
49
What is rigor mortis?
Calcium floods cells activating actin + myosin but ATP is no longer being produced so the calcium cannot be pumped back out - therefore prolonged contraction occurs 1. Onset 2-6h>death: contractions begin in small muscles and eventually occur in all 2. Peak 12-24h>death: fully rigid 3. Resolution 24-48h>death: contraction gradually resolves
50
What is muscular dystrophy?
Group of genetic diseases affecting muscle causing weakness and degeneration over time Caused by abnormal proteins
51
What is motor neuron disease?
(ALS/Lou Gehing) Disease affecting nerve cells that control muscle resulting in weakness and paralysis
52
What are tendons?
Connect muscle to bone Function to allow movement and stabilise Primarily collagen fibres Dense, avascular, strong
53
What are ligaments?
Connect bone to bone Function to reduce excess ROM and stabilise Primarily collagen fibres Elastic, band structure
54
What is tetanus?
Bacterial clostridium infection that releases toxins that interfere with NTs causing continual contractions and spasms SX: stiff (jaw/neck), sore, fever, dysphagia, spasms, arched back, stiff abdomen, dyspnoea TX: transport to ED for antitoxin, AB, wound care and vax
55
What is the insertion point (movement)?
Point where tendon attaches to the most mobile or distal part of the bone This point will be pulled toward the origin during contraction
56
What is the origin point (movement)?
Point where tendon attaches to a more stable or proximal point on the bone Provides a stable point for the muscle to pull against to create movement
57
What is an agonist muscle?
Creates specific movement Generates force to move the joint E.g. bicep is agonist when bending elbow
58
What is an antagonist muscle?
Opposes agonist muscle to return the joint to original position E.g. tricep is antagonist when bending elbow
59
What is a stabilising muscle?
Supports during movement to prevent excessive ROM Maintains control and allows for smooth movement
60
What is an isometric movement?
Muscle contracts without changing length E.g. posture, holding something
61
What is an isotonic movement?
Muscle contracts and changes length Eccentric: lengthens (when putting down a weight) Concentric: shortens (when lifts a weight)
62
What are the 3 phases of a muscle twitch?
Latent: AP travels neuron and stimulates membrane of muscle Contraction: calcium is released = actin + myosin. Contraction occurs and force generated Relaxation: calcium pumped back. Contraction stops and fibre returns to rest
63
How does the paediatric musculoskeletal system differ?
Growth plate active so fracture here may result in deformation If struck by a car, more likely to be head injury and knocked underneath Joints and ligaments are more relaxed Bone is less dense and more flexible so greenstick fracture more likely. Also means they can absorb more traumatic energy so tissue injuries may also occur
64
How does the geriatric musculoskeletal system differ?
Low calcium reduces bone density Reduced stability/coordination increases falls Joint cartilage wear and tear = pain Reduced synovial fluid = stiff joints Reduced height from discs reducing
65
What are the symptoms of a fracture?
Pain Swelling Bruising Deformation Reduced movement Bleeding Crepitus (sounds when moving from bone on bone)
66
What are the treatment goals with fractures?
Control bleeding: splint for internal/bandage for external Stabilise/immobilise to align and hold: reduce pain and further injury Analgesia Refer minor to X-ray clinic; transport severe
67
What is a closed or open fracture?
Closed: bone stays in skin Open: bone protrudes skin (may retract so need thorough assessment)
68
What is a transverse and oblique fracture?
Transverse: occurs at right angel to bone axis Oblique: occurs at a different angle. Surrounding muscles may cause bone to slide into nearby tissues
69
What is a spiral fracture?
Twisting force causes fracture which wraps around bone
70
What is an impacted fracture?
Caused by compressive forces
71
What is a comminuted fracture?
Fractures into multiple fragments
72
What is a greenstick fracture?
Common in children due to softer bones Fracture breaks half the bone and may split up/down
73
What is a sprain?
Ligament stretch or tear Usually from physical activity
74
What is a strain?
Muscle/tendon stretch or tear Usually from overuse
75
What are the SX of strain/sprain injury?
Pain Swelling Bruising Reduced movement or weight bearing
76
What is the treatment for strain/sprain?
Rest Ice (20mins, QID) Compress Elevate (6-10inch above heart)
77
What is malignant hyperthermia?
Reaction to methoxyflurane Causes mass release of calcium into cells causing muscle contraction and metabolism SX: hyperthermia, tachycardia, tachypnoea, hypercapnoea, rigid, acidosis TX: stop med, cooling, transport urgently

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