Musculoskeletal System Flashcards
1
Q
What is the skeleton composed of?
A
Bone and cartilage
2
Q
What type of tissue are bone and cartilage?
A
Specialized forms of connective tissue
3
Q
What are the functions of bone?
A
Support and protection of organs
Calcium metabolism
Red blood cell formation
Attachement for skeletal muscles
4
Q
Through what process do long bones develop?
A
Endochondral ossification
5
Q
What is endochondral ossification?
A
The growth of a bone from the ossification of an initial small hyaline cartilage version.
6
Q
When does bone growth cease?
A
When the growth plate of the hyaline cartilage ossifies.
7
Q
Name the parts of the developing bone.
A
Epiphysis
Epiphyseal growth plate
Metaphysis
Diaphysis
Metaphysis
Epiphyseal growth plate
Epiphysis
8
Q
What is the structure of bone?
A
Outer cortex of dense, compact cortical bone
Inner medulla of porous, spongy trabecullar/cancellous bone
9
Q
Where in the bone is bone marrow found?
A
The medulla.
10
Q
What is the function of bone marrow?
A
Production of red and white blood cells.
11
Q
Which features of the neck of the femur contribute to an increased tendency to fracture?
A
Less compact bone
Thin/angled structure
12
Q
Where is hyaline (articular) cartilage found?
A
At joints (articulations)
13
Q
What is the periosteum?
A
The outer layer of bone.
14
Q
Why is the tearing of the periosteum in a fracture so painful?
A
Because it’s innervated by sensory nerve fibres.
15
Q
Which arteries are found in the periosteum?
A
Periosteal arteries.
16
Q
How is the medulla of bone supplied with blood?
A
Through holes in the periosteum.
17
Q
What is the cavity in the bone medulla known as?
A
Marrow cavity of the medulla.
18
Q
What are the stages in the healing of a fracture?
A
Callus of new bone surrounding fracture line
Callus remodelling (resuming normal shape)
Healed bone
19
Q
How might a fracture be treated surgically?
A
Reduced - bone ends realigned
Fixed - bone ends held in correct alignment
20
Q
Why do bony features develop during bone growth?
A
Bony features develop if:
They are the best shape for their function
An adjacent structure (tendon, blood vessel, nerve, bone) applies a (tensile or compressive) force to the developing bone, moulding its shape. e.g. tuberosity
The bone has to grow around another structure forming a foramen
21
Q
What bony feature is found at the proximal end of the humerus?
A
Greater tubercle (tuberosity) of the humerus.
22
Q
What bony feature is found at the distal end of the radius?
A
Styloid process of the radius.
23
Q
Where can the ischial tuberosity be found?
A
Posteriorly on the superior ramus of the ischium.
24
Q
What is marked by the ischial tuberosity?
A
The lateral boundary of the pelvic inlet.
25
Where can the lesser trochanter be found?
Medially, at the proximal end of the femur.
26
Where can the femoral condyle be found?
Medially at the distal end of the femur.
27
Which bony feature is found at the proximal end of the tibia?
Tibial tuberosity.
28
Which bony feature is found medially at the distal end of the tibia?
Medial malleolus.
29
How is the floor of the cranial cavity divided?
Anterior cranial fossa
Middle cranial fossa
Posterior cranial fossa
30
Which bones make up the axial skeleton?
Bones of the skull
Bones of the neck (including cervical vertebrae & hyoid bone)
Bones of the trunk (chest, abdomen & back)
31
Which bones make up the appendicular skeleton?
Bones of the pectoral girdle (attaching upper limbs to skeleton)
Bones of the upper limbs
Bones of the pelvic girdle (attaching lower limbs to skeleton)
Bones of the lower limb
32
What is special about the hyoid bone?
It has no articulations, but floats in muscle.
33
Along which line does the base of the skull lie?
A line starting superior to the orbits and finishing inferior to the ears.
34
Which bones lie antero-inferior to the base of the skull?
Bones of the facial skeleton (viscerocranium).
35
Which bones lie superior and posterior to the base of the skull?
Bones of the cranial vault (neurocranium).
36
Which bones make up the the cranial vault?
Frontal bone
Parietal bone
Sphenoid bone
Temporal bone
Occipital bone
37
What is the name of the joint between the frontal bone and parietal bone?
Coronal suture.
38
What is the name of the joint between the left and right parietal bones?
Sagittal suture.
39
Which bones make up the base of the skull?
*From anterior to posterior:*
Frontal bone
(with the cribiform plate of the ethmoid bone medial)
Sphenoid bone
Left and right temporal bones
Occipital bone
40
Where is the foramen magnum found and what passes through it?
In the midline of the occipital bone.
The brain stem.
41
Which bones make up the facial skeleton?
Right and left nasal bones
Right and left zygoma (zygomatic bones) forming the prominence of the cheeks
Right and left maxilla
Right and left sides of the mandible
42
What the are Le Fort fractures of the facial skeleton?
Le Fort I - laterally along the maxilla
Le Fort II - laterally across the nasal bones and superior-posteriorly down the left and right maxilla
Le Fort III - across the base of the skull
43
What are the parts of the mandible?
Coronoid process (superior & anterior)
Head and neck of the ondylar process (superior & posterior)
Ramus
Angle
Lower border of the (R/L) side of the mandible
Body
Mental foramen
Mental process
44
How are the vertebrae of the spine distributed?
7 cervical (C1-C7)
12 thoracic (T1-T12)
5 lumbar (L1-L5)
5 sacral - fused to form the sacrum
4 coccygeal - fused to form the coccyx
45
What are the curvatures of the spine?
*From superior to inferior:*
Secondary curvature (cervical)
Primary curvature (thoracic)
Secondary curvature (lumbar)
Primary curvature (sacrum & coccyx)
46
What are the features of a typical vertebrae?
Spinous process - ligament & muscle attachments
Transverse processes - ligament, muscle & rib articulations
Superior and inferior articular processes - synovial facet joints with adjacent vertebrae
Verterbral arch - pedicles and laminae
Vertebral foramen - spinal cord
Vertebral body
47
Which part of the vertebrae may be affected by arthritis?
Facet joints.
48
What are the intervertebral foraminae?
Foraminae formed between two adjacent vertebrae, bounded by the body and arch of the vertebrae, protecting the spinal nerve connecting to the spinal cord.
49
What is the name given to the C1 vertebra and what is special about it?
Atlas
It has neither body nor spinous process, but instead has anterior and posterior arches
50
What is the name given to the C2 vertebra and what is special about it?
Axis
It has an odontoid process (the body of C1)
51
What is special about the cervical vertebrae?
They all have a foramina in each transverse process.
52
When examining the spine from superior to inferior which is the first readily palpable spinous process?
C7
(sometimes known as the **vertebra prominens**)
53
How are the ribs attached to the sternum?
True ribs (1 - 6) - via their costal cartilage
False ribs (7 - 10) - via the costal cartilage above
Floating ribs (11 & 12) - no attachment to sternum
54
Why is the first rib less likely to fracture than the others?
It is protected by the clavicle.
55
Which bones comprise the pectoral girdle?
Left and right scapulae
Left and right clavicles
56
Which bones make up the pelvic girdle?
Left and right hip bones.
57
How is the upper limb subdivided?
Arm (between shoulder and elbow joint)
Forearm (between elbow joint and wrist joint)
Hand (distal to the forearm)
58
How is the lower limb subdivided?
Thigh (between hip and knee joint)
Leg (between knee and ankle joint)
Foot (distal to the ankle)
59
What does the direction of movement depend on?
The side (aspect) on the joint the muscle spans.
60
Which side of the shoulder joint does the biceps brachii span and what movement does it produce?
Anterior aspect
Flexion of the shoulder joint
61
What are the three types of joint?
Fibrous
Cartilaginous
Synovial
62
What are the two types of fibrous joint?
Sutures
Fibrous sheets
63
Where are suture joints found?
In the cranium
64
Which are the only non-suture joints in the skull?
Temperomandibular joint
Joints between the teeth
65
What are the features of fibrous joints?
Limited mobility
Highly stable
66
Give an example of a fibrous sheet (syndesmosis).
Interosseus membranes
67
Give examples of interosseus membranes.
Between radius and ulna
Between tibia and fibula
68
What types of cartilaginous joint are there?
Primary (epiphyseal growth plate)
Secondary (syphysis)
69
What are the features of cartilaginous joints?
Fairly limited mobility
Relatively stable
Can slip
70
Give an example of a secondary cartilaginous joint
Intervertebral discs of fibrocartilage
71
Give an example of a primary cartilaginous joint.
Femoral epiphysis
72
What are fontanelles?
Wide sutures in the suture joints of newborns allowing the head to be moulded (bones can slide over each other) to pass through the birth canal.
73
How much of the height of the verterbral column is made up of intervertebral discs?
25% of height
74
Describe an intervertebral disc.
Outer fibrous **annulus fibrosus**
Inner soft **nucleus pulposus** (up to 90% water in young people)
75
Where are intervertebral discs found?
Between all vertebrae except C1 and C2, and in the coccyx and sacrum.
76
What is herniation of an intervertebral disc?
Commonly known as a 'slipped disc'
Nucleus pulposus escapes from the anulus fibrosus and presses on the spinal cord or nerves connecting to the spinal cord
77
What are typical features of synovial joints?
2 or more bones articulating with each other
Articular surface covered with hyaline cartilage (reduce friction)
Capsule wrapping around the joint
Joint cavity
Ligaments
Skeletal muscle tendons
Bursae
78
How are joint capsules formed?
Outer strong fibrous layer
Inner synovial membrane which secretes synovial fluid
79
What does the joint cavity contain?
Synovial fluid which cushions against stress and provides lubricant and nutrients for hyaline cartilage.
80
What are ligaments?
Fibrous bands connecting from one bone to another, strengthening the fibrous capsule and improving joint stability.
81
What are tendons?
Fibrous bands connecting skeletal muscle to bones.
82
What is the function of bursae?
To prevent friction around a joint during movement.
83
What are the two types of bursae?
Synovial fluid filled extensions of the joint capsule
Closed sacs of synovial membrane containing synovial fluid near to, but separate from, the joint cavity
84
What is a unique features of the knee joint?
Menisci (fibrocartilaginous discs) to improve stability.
85
What are the 5 types of synovial joint?
Pivot joint
Plane joint
Ball and socket joint
Hinge joint
Biaxial joint
86
Name a pivot joint.
Atlantoaxial joint between C1 and C2
87
What type of movement does the atlantoaxial joint allow?
\>45º rotation (shaking head)
88
What movement does a plane joint allow?
Minimum movement in a single plane.
89
Give an example of a plane joint.
Acromioclavicular joint.
90
Give an example of a ball and socket joint.
Hip joint.
91
Describe the movement allowed by ball and socket joints.
Reasonable to very good range of multi-axial movement.
92
Give an example of a hinge joint.
Elbow joint.
93
What range of movement does a hinge joint allow?
Reasonable range of movement in a single plane.
94
Give an example of a biaxial joint.
In hands and feet.
95
What types of movement is allowed by a biaxial joint?
Reasonable range of movement in one plane, and less in another.
96
What are the articulations of the knee joint?
2 femerotibial articulations
femeropatellar (patellofemoral) articulation
97
Which bones articulate in the knee joint?
Patella
Tibia
Femur
98
How many menisci are there in the knee joint?
2
99
Name the bursae of the knee joint.
Suprapatellar bursa (extension of joint capsule)
Subcutaneous prepatellar bursa (sac)
Subcutaneous infrapatellar bursa (sac)
Deep infrapatellar bursa (sac)
100
What are the 5 major ligaments of the knee joint?
Patellar ligament
Tibial collateral
Fibular collateral
Anterior cruciate
Posterior cruciate
101
What are the articular parts of the femur?
Medial and lateral femoral condyles.
102
What are the articular parts of the tibia?
Medial and lateral tibial condyles.
103
Which parts of the knee joint are replaced in a total knee replacement?
Femoral condyles replaced by femoral prosthesis
Tibial condyles replaced by tibial plate
104
Why is the shoulder joint more mobile but less stable than the hip joint?
Because the ball and socket of the hip are a much tighter fit, giving increased stability but less flexibility.
105
What is the normal range of movement of the shoulder joint?
180º flexion
90º extension
180º abduction
45º adduction
90º internal rotation
60º external rotation
106
What is the normal range of movement of a hip joint?
135º flexion
15º extension
45º abduction
30º adduction
35º internal rotation
45º external rotation
107
What is subluxation?
Reduced area of contact between two articular surface.
108
What is disclocation?
Complete loss of contact between articular surfaces.
109
Which joints commonly disclocate?
Craniovertebral joints
Temperomandibular joints
Acromiocravicular joints (rugby)
Shoulder joints
Elbow joints
Interphalangeal joints (PIP and DIP)
Knee joints
Hip joints (especially after replacement)
Pubic symphysis (under influence of placental hormone relaxin)
Ankle joints (traumatic fracture-dislocation)
110
What are the articulations of the temperomandibular joint?
Mandibular fossa
Articular tubercle of the temporal bone
Head of the condylar process of the mandible
111
What is the special feature of the TMJ?
Articular disc between the superior and inferior articular cavities
112
What happens to the head of the condylar process of the mandible in dislocation of the TMJ? What is the result of this?
It get stucks anterior to the articular tubercle of the temporal bone.
Mouth is wide open and cannot be closed.
113
What feature would suggest a bilateral TMJ?
If the chin stays in the midline.
114
What are arterial anastamoses and what is their importance in the blood supply to joints?
Connections between arteries.
Periarticular arterial anastamoses are common as they ensure a continued blood supply during all movements of the joint.
115
Which sensations are detected by the sensory receptors of the joints?
touch
temperature
pain
proprioception
116
Which joints are most prone to wear and tear damage?
Weight bearing joints:
vertebral column
sacroiliac
lower limb
117
What are the three types of muscle?
Cardiac
Smooth muscle
Skeletal muscle
118
Which types of muscle are not under voluntary control?
Cardiac and smooth muscle.
119
Which types of muscle are striated?
Cardiac and skeletal muscle.
120
Give some examples of smooth muscle.
Walls of blood vessels
Walls of airways
Walls of hollow organs such as the stomach
Ducts
121
How is skeletal muscle made up?
Fascicles
## Footnote
Muscle fibres (myocytes)
Bundles of myofibrils
Actin and myosin filaments
122
What is a pulled/strained muscle?
When muscle fibres are torn - the more fibres torn, the worse the strain.
123
What is special about skeletal muscle fibres?
They have multiple nuclei.
124
What causes the striated appearance of skeletal muscle?
The overlapping segments of myosin and actin.
125
What are the types of skeletal muscle?
Flat muscle with aponeurosis (flattened tendon)
Unipennate
Bipennate
Multipennate
Fusiform
Quadrate
Circular or sphincteral
126
What makes up the muscle belly?
The contractile muscle fibres.
127
What happens to the muscle belly during contraction?
It shortens and thickens.
128
Where are aponeurosis tendons normally found?
On flat muscle, for example the muscles of the anteroateral abdominal wall.
129
What is special about aponeuroses?
They attach to other soft tissue rather than bone.
For example, the aponeuroses of the muscles of the anterolateral abdominal wall attach to each other in the midline.
130
What are the points of attachement of skeletal muscles to bone?
**Origin**(s) - the area of attachment that moves *least* during contraction
**Insertion**(s) - the area of attachment that moves most during contraction
131
What happens to the origin and insertion during contraction.
They **approximate** (become closer together)
132
What is flexion?
Movement produced by a muscle spanning the anterior aspect of a joint.
133
Which groups of fibres does the deltoid consist of and which movement do they make?
Posterior fibres - extension of the shoulder
Middle fibres - abduction of the shoulder
Anterior fibres - flexion of the shoulder
134
What are the origin of the deltoid muscle?
Spine of scapula
Acromion process of scapula
Lateral 1/3 of clavicle
135
What is the insertion point of the deltoid muscle?
Deltoid tuberosity of humerus
136
What are the articulations of the humerus and ulna?
Trochlea of the distal humerus
Trochlear notch of the proximal ulna
137
What are the two main reflexes associated with skeletal muscles?
Stretch reflex
Flexion withdrawal reflex
138
What type of reflex are the biceps jerk, triceps jerk, knee jerk and ankle jerk?
Stretch reflexes.
139
What is the reflex arc?
Sensory nerve from muscle
Synapse in spinal cord between sensory and motor nerves
Motor nerve to muscle
Neuromuscular junction
140
How are overly brisk reflexes subdued?
Descending controls from the brain.
141
What does a normal stretch reflex indicate?
Muscle
Sensory nerve fibres
Motor nerve fibres
Spinal cord connection between sensory and motor nerves
Neuromuscular junction
Descending controls
*are all intact and functioning normally*
142
What is muscle paralysis?
Muscle without functioning motor nerve.
143
How would a paralyzed muscle appear on examination?
It would have reduced tone (floppy).
144
What is muscle spasticity?
When the muscle has an intact and functioning motor nerve but the descending controls from the brain aren't working.
145
How would a spastic muscle appear on examination?
Increased tone (tight).
146
What is muscle atrophy?
When the individual muscle fibres become smaller, reducing the muscle's bulk.
147
Where are skeletal muscles?
Below the deep fascia.
148
What are the compartments of the thigh?
Anterior, medial and posterior.
149
What are the compartments of the lower leg?
Anterior, posterior and lateral.
150
What are the compartments of the arm?
Anterior and posterior.
151
What are the compartments of the forearm?
Anterior and posterior.
152
What are the features of compartment syndrome?
Intact skin
Increasing swelling
Pain at rest
**Pain most severe on passive stretching of compartment's muscles**
