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Musculo-skeletal System (ESA 2) > SCRUBS work > Flashcards

SCRUBS work Flashcards

1
Q

ligaments of wrist

A

radial and ulnar collateral ligaments -> limit ulnar and radial deviation

palmar radiocarpal -> limit extension

dorsal radiocarpal -> limit flexion

Intercarpal and carpometacarpal -> intrinsic

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2
Q

palmaris brevis

A

ulnar nerve

protects ulnar artery and nerve

deepens cup of palm

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3
Q

wrist frxs

A

Distal radius/ulna:

  • Colles’ frx: hyperexternsion, fall on oustretched hand, dinner fork deformity, distal fragment displaced posteriorly w/ posterior tilt
  • Smith’s/Reverse Colles’ frx: hyperflexion, garden spade deformity, distal fragment displaced anteriorly w/ anterior tilt
  • scaphoid: fall on outstretched hand, frx across waist of bone, pain in anatomical snuff box, difficult to diagnose on x-ray, treatment: splint and immobilise, risks: avasc. necrosis of prox. segment, non union, surgery may be necessary
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4
Q

hand frxs

A

MC frx: direct axial force/ compressive force, pain and swelling - possible angular/rotational deformity, management: RICE (rest, ice, compression, elevation), analgesics followed by xrays, deformity is reduced, splinting, unstable frx may need to be surgically pinned

-boxer’s frx (pic): frx of 5th MC w/ volar (palm of hand) displacement of MC head, due to striking an object w/ a clenched fist

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5
Q

Dupuytren’s contracture

A

cause: progressive thickening/shortening of palmar fascia, nodules develop in palmar aponeurosis, limiting finger extension, ultimately causing flexion deformity

S&Ss:often develops in 4/5th finger, flexion deformity at MCPJs and Prox. IPJs

management: surgical excision of fibrotic tiss

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6
Q

tenosynovitis

A

pain, swelling, difficulty in movement, spread of infection from 1st and 5th flexor sheaths into the forearm

inflammation of synovial sheath

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7
Q

ulnar nerve injury at wrist

A

causes: compression between pisiform and hamate - handlebar neuropathy, penetrating wound, injury posterior of medial epicondyle

sensory loss: hypoesthesia in med. 1.5 digits

motor loss: weakness of intrinsic muscles ulnar nerve supplies

deformity: prominent ulnar claw
- 4th and 5th MCPs hyperextended (due to unopposed ex. dig.)
- 4th and 5th IPs flexed (unopposed FDS and FDP)
- flat hypothenar eminence
- > however, in ulnar paradox, the ulnar nerve is lacerated further up the arm beyond the point where it innervates the FDP -> the med. 2 digits are extended and look better when in fact the injury is worse

Treatment: padding (gloves), ice, NSAIDs

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8
Q

articulations and ligaments of elbow joint

A

Articulations: ant: head of radius w/ capitulum of humerus, trochlea of humerus w/ trochlear notch of ulnar

post.: olecranon process of ulna w/ olecranon fossa of humerus

Ligaments: 2 radial ligaments, 1 ulnar ligament - anterior, posterior, oblique, annular ligament around head of radius, all stabilise

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9
Q

pulled elbow

A

in children esp girls, eg when pulled up a kerb

weak annular ligament and under development of head of radius, forearm is abducted and med. rotated

subluxation of joint

gentle supination and compression needed and, after a few days, the radius pops back in

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10
Q

4 frxs to humerus and nerves damaged

A

frx to surgical, anatomical neck of humerus, axillary

mid humeral frx, radial

supracondylar frx, median

ulnar nerv is also vulnerable as it lies unprotected behind the medial epicondyle

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11
Q

nerve routes passing distal humerus

A

radial: anterior to lat. epicondyle
median: anterior to med. epicondyle
ulnar: posterior to med. epicondyle

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12
Q

medial and lateral epicondylitis

A

medial/golfer’s elbow: repeated use of flexors, pulls on periosteum of med. epicondyle

lateral/tennis elbow: repetitive use of superficial extensors of forearm, pain radiates down post. apsect of forearm as it can lead ot radial nerve compression

-inflammation of periosteum of lateral epicondyle (ie the epicondylitis)

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13
Q

student’s elbow

A

repeated pressure on and inflammation of olecranon bursa, local anaesthetics, drainage, steroids, surgical excision

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14
Q

subtendinous bursitis

A

not common, deeper bursa, triceps tendon and olecranon involced, can lead to tendon calcification, deeper bursa than one in student’s elbow

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15
Q

olecranon frx

A

fall on elbow, triceps pulls olecranon prximally, surgical intervention - pin, ulnar nerve can be damaged

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16
Q

ligaments of shoulder joint

A

gleno humeral ligaments reinforce anterior aspect of capsule, coracohumeral and coracoacromial strengthen superiorly

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17
Q

shoulder dislocation

A

normally anterior, fall on outstretched hand

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18
Q

painful arc syndrome

A

supraspinatus tendinitis, subacromial bursitis

on ACTIVE abduction, scapulo-humeral rhythm is disturbed

pain is worsened on abduction between ~60-120 degrees, either side of this pain is not there

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19
Q

origins and insertions of rotator cuff muscles

A

Supraspinatus: supraspinous fossa of scapula -> superior facet of greater tubercle of humerus

Infraspinatus: infraspinous fossa of scapula -> middle facet of greater tubercle

Teres minor: middle part of lat. border of scapula -> inferior facet of greater tubercle

Subscapularis: subscapular fossa -> lesser tubercle of humerus

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20
Q

whiplash associated disorder/WAD

A

h.flexion -> h.extension -> sp/train cervical tissues, can occur when going slowly - 10mph, 1-4 seriousness (4 most), cervical spine most at risk from sideways impact (less ligamentous support), cervical lateral x ray - loss of lordosis due to neck muscles spasming, may have a lack of symptoms for a few weeks

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21
Q

ligaments of the spine

A

Anterior Longitudinal ligament: stronger than PLL, gets broader from cervical -> lumbar spine, attaches to periosteum of vert. bodies and does not attach to intervert. discs

Posterior Longitudinal Iigament: weaker than ALL, narrower from cervical -> lumbar spine, serrated margins which attach to the intervert. discs but are free over the vert. bodies, separated from vert. bodies by basivertebral veins

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22
Q

differences between vertebral bodies: atlas and axis

A

atlas/C1: no body or spinous process, large lateral masses w/ widest transverse processes of cervical vertebrae to hold up the cranium

axis/C2: strongest of cervical vert., two large superior articular facets that the atlas can rotate on, dens/odontoid process projuects superiorly, held in place against post. aspect of ant. arch of the atlas by transverse ligament of the atlas

23
Q

differences between cervical, thoracic and lumbar:

A

cervical: small oval body, large triangular vertebral foramen, transverse process had transverse foramina containing vertebral artery and vein, short and bifid spinous process (C3-6)

Thoracic: heart shaped body w/ 1/2 costal facets for articulation w/ ribs, circular and smaller vertebral foramen than cervical, long and strong transverse process w/ a decreasing length between T1-12, long spinous process that slopes postero-inferiorly

Lumbar: massive kidney shaped body, triangular foramen that is larger than thoracic’s but smaller than cervical’s, long and slender transverse process, short, thick and sturdy spinous process

OVERALL: as you go down the vertebral column, the foramen gets smaller, the body gets bigger

24
Q

kyphosis and lordosis commonly due to

A

K: OP (anterior wedging of thoracic vertebrae)

L: pregnancy, obesity, or weak abdominal muscles

25
Q

OA (of spine in particular)

A

degeneration (wear and tear) or articular cartilage and underlying bone, often affects unilateral joints, aggravated by movement, relieved by rest

-xray findings: joint space narrowing, subchondral sclerosis, osteophytes, subarticular cysts, bone spurs in spine

commonest form of arthritis, risk factors include age, obesity, previous trauma

mainly affects knee, hand, hip and pine joints (whereas RA is mainly hands

26
Q

RA (of spine in particular)

A

autoimmune, systemic inflammatory disease, affects large joint bilaterally, atlanto-axial instability, commonly affects hand joints

x ray findings: decreased joint space (like OA), marginal erosions (different to OA), osteopenia (low bone mineral density), joint subluxation, soft tissue swelling

in picture the axis and atlas have sublaxed

27
Q

scoliosis

A

lateral deviation

structural causes: fixed, fails to correct, can be due to hemivertebra (vertebra not completely developed on one side, wedge shaped), OP, developmental problems

non structural causes: can be due to leg length inequality, weak muscles

28
Q

ankylosing spondylitis

A

fusion of joints, similar to RA in that it affects 2 joints and gets better after exercise and worse after rest

a systemic inflammatory disease most likely in young males, linked w/ UC and chron’s (HLA-B27 antigen)

when severe it can lead to fusion of facet joints, SI (sacroiliac) joints

tiredness, malaise, initial weight loss

tests: blood CRP, HLA-B27, MRI

29
Q

herniation of IV discs

A

nucleus pulposus ruptures through the annulus fibrosis (jam doughnut analogy), most commonly at L5/S1, then L4/5, commonly leads to flexion

compression of ventral root -> motor symptoms

classic sciatica symptoms (compression of spinal roots that lead to sciatic nerve), ventral and dorsal horn affected

assess the neurological function of limbs (sensory, motor, reflex), SLR (straight leg raise), palpate spine

SLR: lie on back, relax leg in hand, raise leg, pain above 30 degrees

30
Q

cauda equina

A

medical emergency, need urgent decompressive surgergy

centro-posterior herniation of IV discs or spinal tumour

symptoms: saddle anaesthesia (numbness around genitalia and buttocks), urinary a/o faecal incompetence (due loss of anal tone, though it may just be changing bowel habit), neurological deficit - functional abnormality of a body area due to a decrease in the function of the brain, spinal cord, muscles or nerves (normally bilateral)

31
Q

relationship between spinal nerves and vertebra

A

there are 7 cervical vertebrae, but 8 cervical nerves -> the nerves are always located on top of the vertebra

nerve C8 lies between vertebrae C7 and T1

after that, the nerve lies underneath its vertebra

32
Q

roles of the ligaments of the hip joint

A

iliofemoral: ant. and sup., prevents h.extension
pubofemoral: ant. and inf., prevents over abduction
ischiofemoral: post., weakest and has little function

ligament of the head of the femur: from acetabular notch -> fovea for the ligament of the head of the femur, little function in strengthening joint, but contains the artery to the head of the femur, which supplies the epiphysis especially in children

33
Q

femoral canal

A

borders: anterosuperiorly inguinal ligament, post. pectineal ligament lying anterior to the superior pubic ramus, med. lacunar ligament, lat. femoral vein

canal has space for the femoral vein to dilate during exercise, also contains lymphatic vessels and lymph nodes embedded in areolar tissue

34
Q

mid inguinal point/midpoint of inguinal ligament

A

midpoint directly between ASIS and pubic symphysis, femoral pulse found here/midpoint along the inguinal ligament length, used for a femoral nerve block (injection of local anaesthetic for pain relief)

35
Q

types of hip frx

A

subcapital: intracapsular, high up neck, near head, can tear and damage joint capsule and disrupt blood supply
cervical: neck, w/in margins of capsule
- in either of these, retinacular arteries from medial circumflex artery disrupted -> blood supply halted -> avascular necrosis as only artery to head of femur remains
- >commonest in elderly, injured limb appears shorter and laterally rotated (frx large injury -> lat. rotated, disloc. medium injury -> med. rotated)
pertrochanteric: extracapsular, intertrochanteric region

36
Q

dislocations of hip

A

acquired: posterio-inferior dislocation - when hip is flexed + adducted + medially rotated
- presentation is limb shortening and med. rotation
- can cause compression of sciatic nerve leading to paralysis of hamstring muscles and muscles distal to knee, sensory deficits in leg
congenital: due to abnormal angle of neck of femur, most common in girls

37
Q

+ve trendelenburg

A

caused by superior gluteal nerve lesion, frx of greater trochanter (glut med attaches here), dislocation of hip joint

abductors maintain a level position when opposite limb is unsupported (in swing phase), results in waddling gait (raising pelvis), steppage gait (lifting foot) or swing-out gait (foot out laterally)

38
Q

possible causes of swelling in popliteal fossa

A

popliteal aneurysm (pulsatile swelling)

baker’s cyst (swelling of semimembranosus tendon or herniation of synovial membrane)

abscess

tumour

enlarged lymph nodes

39
Q

unhappy triad

A

lateral impact during extension

medial meniscus, medial collateral and anterior cruciate damaged

can tell by performing ant/post draw test, collaterals

40
Q

menisci tears

A

in young people it can be due to a sporting injury, twist of knee/direct tackle, in the elderly it is weakened w/ age

True locking: something physically gets in the way stopping extension eg meniscus, stuck in about 20-30 degrees of flexion, can flex beyond that, but extension is stopped

Pseudo locking: pain inhibits knee movement, can be due to inflam arthritis, gout, septic arthritis

41
Q

dislocation of patella

A

direct blow/sudden twist of knee

weakness invastus medialis causes the patella to dislocate laterally w/ a lot of pain and effusion (seeping of fluid into body cavity)

more common in women due to an increased q angle (angle between line from ASIS -> patella and patella -> tibial tuberosity, in women it should be less than 22 degrees, in men less than 18)

42
Q

pulled hamstring

A

common in those who run a/o kick hard eg running, jumping, football

violent muscular exertion can tear part of the prox. attachments to the ischial tuberosity

extremely painful

43
Q

bursa/bursitis of knee

A

pre-patellar bursa -> housemaid’s knee (caused by one off large injury eg fall onto knee, or many minor injuries commonly from kneeling)

subcutaneous infrapatellar bursa -> clergyman’s knee (from kneeling a lot again, esp. on hard surfaces which is what clergymen used to do)

suprapatella bursa

deep infrapatellar bursa

44
Q

compartment syndrome

A

raised intra-compartmental pressure -> intra arterial pressure -> arterial occlusion -> ischaemia

presentation: 6 Ps: pain, paresthesia, perishing cold, pallor, pulselessness, paralysis

45
Q

roots of sciatic nerve, supply and termination

A

sacral plexus (anterior and post. divisions of ant. rami of L4-S3)

supplies all hamstrings and hamstring portion of adductor magnus

-also indirectly lower leg and foot sensory innervation

bifurcates into tibial (all hamstrings) and common fibular (short head of biceps femoris)

46
Q

roots of gluteal nerves, supply and termination

A

Superior: post. L4-S1, glut med, min and TFL, enters sup. to piriformis and goes as far as TFL

Inferior: post L5-S2, glut max, divides into several branches at the inf. part of glut. max.

47
Q

pott’s frx

A

mech. forced foot eversion

deltoid ligament pulls on med. mall. and causes avulsion

talus displaced lat. and post. and causes avulsion of lat. mall., bimalleolar frx

48
Q

varicose veins

A

long dilated tortuous superficial veins due to incompetent valves at sapheno-femoral/-popliteal or perforator junctions (where perforator veins enter muscles)

-venous stasis/stagnation is a cause of this, and can be due to a) incompetent/loose fascia that fails to resist muscle expansion, b) external pressure eg bedding in hospital or a tight cast or c) muscular inactivity eg from a long flight

risk factors: prolonged standing, obesity, pregnancy, family history, oral cont. pill

surgery can be used

49
Q

medial malleolus relations to vessels

A

posterior: Tom (tibialis posterior), Dick (FDL) and (post. tibial artery) very/bloody (posterior tibial vein) nervous (tibial nerve) Harry (FHL)
anterior: long saphenous vein, saphenous nerve

50
Q

apparent and true limb shortening

A

Apparent: xiphisternum/xiphoid process or umbilicus-> med. malleolus

-looks at eg fixed joint deformity, pelvic tilt

True: from greater trochanter of femur/ or ASIS -> med. malleolus

-looks at actual loss of bone length

51
Q

why does a peripheral nerve lesion -> skin becoming red -> dry and scaly?

A

peripheral contains sensory, efferent and autonomic fibres, loss to SyNS fibres can lead to loss of vasoconstriction to skin -> vasodilation and redness from increased blood flow to the skin

-> loss of innervation to sweat glands -> dry then scaly

52
Q

flexor retinaculum attachments

A

medially: pisiform and hook of hamate
laterally: tubercle of scaphoid and med. part of volar surface and ridge of trapezium

53
Q

femoral ring borders and contents

A

lat. : vert. septum between femoral canal and vein
post. : superior ramus of pubis covered by pectineus muscle and fascia
med. : lacunar ligament
ant. : med. part of inguinal ligament
contents: base of the femoral canal

Musculo-skeletal System (ESA 2) (20 decks)

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