Musculoskeletal, skin, connective tissue anatomy and phys

Question 1

What is the unhappy triad?

Answer 1

Common injury in sports due to lateral force on a planted leg.

Damage to ACL, MCL, and medial meniscus (attached to MCL)

Question 2

What can cause a prepatellar bursitis?

Answer 2

Excessive kneeling on the knee leading to inflammation of the prepatellar bursa.

Question 3

What is a bakers cyst?

Answer 3

Fluid collection in the popliteal space related to chronic joint disease.

Question 4

What muscles form the rotator cuff?

Answer 4

SItS (small t is for teres minor)
Supraspinatus abductor and most common injury test with empty full can test..
Infraspinatus Laterally rotates arm – pitching injury
Teres minor - adducts and laterally rotates arm
Subscapularis – medially rotates and adduct arm.

Question 5

What nerve primarily innervates the rotator cuff muscles?

Answer 5

C5-C6

Question 6

What is golfers elbow?

Answer 6

Excessive flexion causing pain to medial condyle.

As opposed to tennis elbow caused by excessive extension and pain at lateral condyle.

Question 7

What are the proximal bones in the wrist?

Answer 7

Scaphoid, Lunate, Triquetrum, Pisiform
“So Long To Pinky”
From lateral to medial.

Question 8

What are the distal bones in the wrist?

Answer 8

Hammat, Capitate, Trapezoid, Trapezium
“Here Comes The Thumb”
From medial to lateral

Question 9

Which wrist bone is most commonly fractured?

Answer 9

The scaphoid found in the snuff box.

Question 10

Dislocation of which wrist bone can cause acute carpal tunnel syndrome?

Answer 10

The lunate

Question 11

What nerve is damaged on an outstretched hand following pisiform fracture?

Answer 11

The ulnar nerve.

Question 12

What is Guyon canal syndrome?

Answer 12

Compression of the ulnar nerve at the wrist typically seen in cyclists due to handlebar pressure.

Question 13

If there is a shoulder injury and the deltoid begins to flatten out which nerve should you suspect is damaged?

Answer 13

The axillary nerve C5-C6

Question 14

If there is a loss in forearm flexion and supination and loss of sensation over the lateral forearm which nerve should you suspect is damaged?

Answer 14

Musculocutaneous C5-C7

Question 15

the use of crutches, or compression of the axilla causing “Saturday night palsy” Is common following the compression of which nerve?

Answer 15

Compression of the radial nerve.
Leads to wrist drop/ loss of wrist, elbow, and finger extension.
As well as decreased grip strength and sensation over posterior arm and forearm.

Question 16

Damage to which nerve will result in an apes hand or popes blessing with loss of wrist flexion, flexion of th lateral three fingers, thumb aposition?

Answer 16

Median nerve C5-T1

Question 17

If you have an ulnar claw on digit extension which nerve should you suspect to be gone?

Answer 17

Ulnar nerve

Question 18

How will the wrist deviate with flexion if the ulnar nerve is gone?

Answer 18

Radial deviation.

Question 19

A superficial laceration of the hand will result in which form of muscle loss?

Answer 19

Ape hand with loss of the thenar muscle group including oposition abduction and flexion of the thumb.

Here it is the recurrent branch of the median nerve being damaged.

Question 20

Which hand nerve is responsible for innervating most of the intrinsic muscles of the hand?

Answer 20

The ulnar nerve.

Damage results in the popes blessing with loss of hand intrinsics.

Question 21

What is erbs palsy/ Waiters palsy?

Answer 21

Loss of the arm flexors resulting in severe extension of the arm and flexion of the wrist.
Think damage to musculocutaneous or babies that had lateral traction of the neck during delivery effecting C5 and C6.

Question 22

What is klumpskey palsy?

Answer 22

Traction or tear of lower trunk C8-T1 root.
Think of an upward force on an infants arm during delivery. Damages the ulnar nerve leading to loss of hand intrinsics and a total claw hand.

Question 23

How will thoracic outlet syndrome present?

Answer 23

Just like klumpskeys with total hand claw because of damage to the ulnar nerve.

Question 24

What nerve is damaged in a winged scapula?

Answer 24

Long thoracic nerve (C5-C6, C7) damaged leading to inability to anchor scapula to thoracic cage.

Question 25

Why is clawing made so prominent?

Answer 25

With distal lesions of the median or ulnar nerves the intrinsics of the hand are taken out. The extrinsics are still functional and exagerate the loss of the lumbricals.

Question 26

When would deficits in the hand due to nerve injury be very minor/under pronounced?

Answer 26

Proximal lesions in the arm would result in less prominant hand distortions compared to distal lesions.

Question 27

When trying to extend the fingers, only the lateral three are able to extend out of flexion. Where is the lesion?

Answer 27

Lesion is ulnar and the pinky and ring finger are unable to extend leading to whats known as the “ulnar claw”

Question 28

When making a fist, the thumb, second, and third finger are unable to flex. What has been damaged?

Answer 28

The median nerve proximally, this makes what is known as the popes blessing.

Question 29

Atrophy of the thenar eminance causing an unnoposable thumb is seen with damage to what?

Answer 29

Median nerve lesions.

Known as an ape hand.

Question 30

Atrophy of the hypothenar emanance (pinky side) is seen with what sort of nerve lesions?

Answer 30

Ulnar nerve lesions.

Question 31

How will an injury to the superior gluteal nerve present?

Answer 31

Presents with trendelenburg sign with the pelvis tilting on the contralateral side of the lesion.

Question 32

What landmark in the pelvis can be used when blocking the pudendal nerve?

Answer 32

The ischial spine aka location of the greater sciatic foramen!

Question 33

When there is a lumbosacral radiculopathy, which nerve is damaged relative to the vertebral body?

Answer 33

The nerve below the spinal level.

AKA if the L3 L4 vertebral disk is damaged, the L4 nerve is damaged with it.

Question 34

What direction do intervertebral discs tend to herniate?

Answer 34

Tend to herniate posteriorly due to thin posterior longitudinal ligament compared to anterior.

Question 35

Describe what weaknesses would be seen with nerve impingement at disc levels L3-L4?

Answer 35

Leg extension weakened, weakened patellar reflex.

Question 36

Describe what weaknesses would be seen with nerve inpingment at L4-L5 discs

Answer 36

Weakness in dorsiflexion/ difficulty heel walking.

Question 37

Describe what weaknesses would be seen with disc interuption at L5-S1

Answer 37

Weakness of plantarflexion and difficulty toe flexing with decreased achilles reflex.

Question 38

Describe the full cycle leading to muscle conduction and contractions

Answer 38

Muscle cleft is depolarized and travels down the T-tubules.
The depolarization activates ryanidine receptors in the T-tubules leading to calcium release through the sarcoplasmic reticulum.

Calcium binds to troponin C moving tropomysin out of the way allowing actin to bind to myosin.

Question 39

In the muscle sarcomere, contraction leads to shortening of which bands?

Answer 39

H and I bands and between Z lines.
“HIZ shrinkage”
A BAND IS ALWAYS THE SAME LENGTH

Question 40

Binding of ATP causes the … to release from the …. in the sarcomere.

Answer 40

Causes the Myosin head to release from the actin and becomes cocked for the next contraction cycle.

Question 41

What are type 1 muscle fibers?

Answer 41

Slow twitch red fibers.
Lots more mitochondria and myolobin.
“1 slow ox”

Question 42

What are type 2 muscle fibers?

Answer 42

These are fast twitch white fibers resulting from degreased mitochondra and myoglobin.

Weight training increases fast twitch muscles!!!`

Question 43

What type of bones in the human body generally undergo membranous ossification?

Answer 43

Bones of the calvarium and facial bones. Woven bone generally formd without cartilage and later remodeled to lamellar bone.

Question 44

What stem cells do osteoblasts differentiate from?

Answer 44

Mesenchymal stem cells in the periosteum.

Osteoclasts come from macrophages and monocytes.

Question 45

How does estrogen effect bone growth?

Answer 45

It prevents apoptosis of osteoblasts and promotes apoptosis of osteoclasts.
Thus it is bone saving in effect.