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Sem2 > Ses 1 Basics And Radiology Msk > Flashcards

Ses 1 Basics And Radiology Msk Flashcards

1
Q

Functions of bone

A

Support • Protection • Metabolic • Storage

Movement (i.e.
joints- bone acts as attachment point for muscles and tendons which use the bone as levers)
Haematopoiesis

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2
Q
  • Functions of skeletal muscle
A

Locomotion(contraction acting across a joint leads to movement)
Posture
Metabolic(eg glycogen storage)
Venous return
Heat production - shivering
• Continence

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3
Q
  • Functions of connective tissues
A

Tendon
• Force transmission muscle-bone

Ligament
• Support bone-bone  Support joint and prevent excessive movement 

Fascia (sheets of connective tissue)
• Compartmentalisation
• Protection - are tough

Cartilage
• Articular(hyaline)- fluid means friction less movement  Fibrocartilage
• Shock absorption
• Increase bony congruity - create complementary shape of bony surfaces to improve stability. Eg menisci of knee

(Synovial membrane)
• Secretes synovial fluid for joint and tendon lubrication

(Bursa)
• Synovial fluid-filled sacs to protect tendons, ligaments etc from friction
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4
Q

Types of bones and eg

A

Flat bones - ribs
Long bones - femur
Sesamoid - patella
Irregular - vertebrae
Short - carpal bones

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5
Q

Bone surface features

A

Bony prominences - muscle attachment
Spiral groove
Notch
Pharemyna

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6
Q

3 types of joints

A

Fibrous
– Cartilaginous
– Synovial

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7
Q

Fibrous joint features

A

collagen fibres joining bones

Very limited mobility so high stability
Present in skull
Usually between flat bones

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8
Q

Cartilaginous joints

A

Cartilage acts as ‘glue’ holding bones together
Limited mobility, less stable than fibrous
Typically found at the ends of growing bones or along the midline of the adult body
Growth plate of children

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9
Q

Synovial joints structure
Look at notion

A
  1. Joint cavity containing synovial fluid. Provides lubrication.
  2. Articulating surfaces usually covered by hyaline cartilage called articulating cartilage.
  3. Joint capsule:
    Inner part is Synovial membrane which produces fluid
    Outer is Fibrous capsule that is continuation of periosteum. So it is periosteum that links the 2 bones.

Bursa is a small sac that is lined by synovial membrane and contains fluid. Is a cushion between bones and tendons and/or muscles. Reduces friction.
Tendon sheaths are elongated bursae that wrap around tendons.

Frequently highly mobile, least stable

Found all over the skeleton

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10
Q

Types of synovial joint

A

Plane • Hinge • Pivot • Saddle • Condyloid • Ball and socket

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11
Q

Joints as levers
Classes of levers

A

First - neck
Second - ball of foot
Third - elbow

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12
Q

Lever trade off

A

Longer lever means more force but less movement

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13
Q

Origin definition

A

stationary proximal anchor
point

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14
Q

Insertion definition

A

mobile distal attachment
point

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15
Q

Muscle types of contraction

A

Only pull

• Concentric contraction – muscle pulls while shortening (e.g. biceps curl)
• Eccentric contraction – muscle pulls while lengthening (e.g. knee extensors walking downhill)
• Isometric contraction – muscle pulls while staying same length (e.g. carrying a load)

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16
Q

Connective tissue types

A

Fascia
Tendon
Ligament
Aponeurosis-sheet like tendons

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17
Q

Fascia compartments

A

• Similar action • Usually identical innervation • Similar blood supply

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18
Q

Hilton’s law

A

Nerves supplying the muscles moving the joint also supply the joint capsule and the skin overlying the insertions of these muscles.

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19
Q

Homeotic mutants

A

Mutation in Hox genes

20
Q

Processes of bones

A

Processes - prominent projections of the bone
Can be articulating or non-articulating (due to traction on the developing bone by muscles, ligaments)

Non-articulating:
Epicondyle
Trochanter
Tubercle
Tuberosity
Crest
Line
Spine

Articulating:
Head - projection supported by neck
Condyle
Facet

21
Q

Depression

A

Depressions - provide passage for blood vessels and soft tissues

Fovea
Groove
Fossa
Cavity
Notch

22
Q

Openings

A

Openings - blood vessels and nerves pass through or into the bones

Fissure
Foramen
Canal

23
Q

Describe the typical blood supply of long bones
Also look at pic in notion

A

4 arteries in child and 3 in adult:
Nutrient artery - supplies most of the cortex and marrow. Enters the diaphysis.

Periosteal artery - supplies outer third of cortex and periosteum

Metaphyseal artery - only in some bones - enter at site of attachment of capsule. In a child it does not cross the growth plate.

Epiphyseal artery (forms anastomosis with metaphyseal artery in adults). Supplies secondary ossification centre.

24
Q

Briefly describe the embryological development of a synovial joint

A

In the 6th week areas of mesenchyme begin to differentiate into hyaline cartilage for endochondral ossification.
Mesenchyme that are going to form joints become even more condensed.
Synovial joint forms between adjacent cartilage models in the joint interzone.
Cells at the interzone undergo apoptosis to form the joint cavity.
Surrounding perichondrium becomes the joint capsule and ligaments.

25
Q

Describe the factors affecting the range of motion of joints

A

Structure or shape of the articulating bones
Strength and tension of the joint ligaments
Arrangement and tone of muscles around the joint
Apposition of neighbouring soft tissues (i.e. are they restricting
movement?)
Effect of hormones (e.g. relaxin relaxes pelvic joints toward the end of
pregnancy)
Disuse of a joint

26
Q

Briefly describe how the muscles and joints work as a system of
levers, fulcrums and pulleys

A

First class lever = fulcrum in middle eg in neck
Spine is fulcrum. Head is load. Effort is muscles of neck?
Second = load in middle eg heel
Third = effort in middle eg elbow

Levers are seesaws made of fulcrum, effort and load

For see saws - f1 x d1 = f2 x d2

27
Q

Understand the difference between superficial and deep fascia

A

Superficial fascia is a subcutaneous fatty layer.
It serves as a storage medium for fat and water, a passageway for lymphatics, nerves and blood vessels and as a protective padding for organs.
Whereas deep fascia is thickened epimysium and envelops muscle compartments. It contains collagen bundles, elastic fibres.

28
Q

Understand the difference between tendons, ligaments and
aponeuroses

A

Tendons - regular DCT fascicles enclosed within irregular DCT. Anchored to bone by Sharpey’s fibres.
Low ratio of elastin to collagen. Poor blood supply, low water content so limiting diffusion of nutrients so poor healing.

29
Q

Outline prenatal limb development
Look at notion

A

Limb buds appear as small projections on the lateral body wall during the fourth week of development. At the tip of the bud the ectodermal cells divide to form an apical ectodermal ridge.

The limb buds elongate by the proliferation of mesenchyme.

As bones are forming, myoblasts aggregate and develop a large muscle mass in each limb bud. In general, this muscle mass separates into dorsal (extensor) and ventral (flexor) components.

Upper limbs rotate 90 degrees laterally. Later, Lower limbs rotate almost 90 degrees medially. This means at first palms of hand and soles of feet are pointing toward each other. Then they rotate so elbows are downwards and knees are upwards.

30
Q

Explain the developmental basis of some
common abnormalities of the limbs

A

Segmentation is controlled by Hox genes. Expressed in a craino-caudal axis. Hox genes governing digit development can mutate and result in extra digits. This is a homoeotic mutation.

31
Q

Understand some fundamental concepts regarding muscle action

A

Muscles can only pull. They cannot push.

Muscles can only act on joints that they (or their tendons) cross.

The action of a muscle on a joint depends on orientation of its fibres and where they are compared to the joint.

The action of a muscle is a function of the starting position of the joint.

Muscles are contained within fascial compartments.
The muscles within a compartment usually share a common innervation and action.

32
Q

Understand the concepts of the origin and insertion of a muscle, and relate these to its actions

A

Muscle contraction is symmetrical, so equal force on the origin and insertion. The stabilisation of the ‘origin’ (e.g. by contraction of other muscles) leads to the ‘insertion’ becoming the only mobile attachment point.
If the usual insertion point becomes fixed and the usual origin becomes mobile,
the position of the origin and insertion will become inverted.

33
Q

Describe the structure and organisation of skeletal muscle fibres
Look at notion

A

Parallel: subdivided into strap, fusiform and fan-shaped (triangular or convergent).
Pennate: subdivided into unipennate, bipennate and multipennate
Circular

34
Q

Understand the different roles muscles can play in co-ordinated movement e.g. agonist, antagonist, synergist, neutraliser and fixator.

A

Agonist - move
Antagonist - oppose movement
Synergists - assist agonists
Neutralisers - prevent unwanted action of muscle
Fixators - stabilise joint

35
Q

Types of muscle contraction

A

Concentric (shortening)
• Eccentric (lengthening)
• Isometric (same length)

36
Q

How to predict muscle action

A

Where does it attach (origin and insertion)?
• How many joints does it cross?
• How is it related to the joint(s) i.e. crossing anterior, posterior etc?
• Which direction do the fibres run in?

37
Q

Understand the role of X-ray in imaging the musculoskeletal
system - image in notion

A

The denser the object, more radiation absorbed, whiter.
Can see cortical and medullary bone of long bones.
Articular cartilage is radiolucent so appears as space.

Quick
Inexpensive

Radiation
Poor soft tissue contrast resolution

Imaging of choice for skeletal trauma
Initial evaluation of chronic bone or joint pathologies

38
Q

How are fractures classified. Be able to recognise simple fractures on an X-ray - notion

A

Oblique
Transverse
Linear
Compression
Spiral
Green stick
Epiphyseal separation

Displaced or not

39
Q

Describe the radiographic changes that are seen in the limbs during childhood

A

At birth, long bones contain separate ossification centres in the epiphyses(primary) and the diaphysis (shaft - secondary).

These are separated by growth/epiphyseal plates. Seen as dark lines. As the child grows they become closed. Caused by hormones. Delayed by malnutrition.

The carpal bones (small bones in the wrist) are not ossified at birth and ossify gradually from birth to 12 years of age.

40
Q

Recognise the radiographic appearance of healing fractures - 8 stages

A

Inflammatory phase - hrs to days
• Haematoma - pool of blood containing immune cells
• Tissue death
• Inflammation/cellular proliferation

Reparative phase - days to weeks
• Angiogenesis / granulation / procallus formation - uncalcified tissue between bone ends
• Soft (fibrocartilaginous) callus formation - fluffy appearance. Intramedullary callus also develops at the same time but this cannot be seen on an X-ray film.
• Hard callus formation

Remodelling phase - months to yrs
Replacement of hard callus with mature bone.

41
Q

Understand the role of CT in imaging in MSK

A

Produces slices of an object that are reassembled to make 2d and 3d images.
Better than X-ray for soft tissue.
Any soft tissues in one slice.
Used for guiding injections and biopsies.
Higher radiation, motion artefacts, cannot fit obese patients, allergic reaction to contrast.
Anything less dense or equal to water is black.

42
Q

Understand the role of MRI in imaging msk

A

It is better than CT and X-ray for imaging soft tissues but is poor at showing the micro-architecture of bone.
No radiation and multiplanar images.
T1 and T2 imaging - in T1 only one thing is bright and in T2, 2 things are bright. Fat is always bright.
In a STIR sequence (a fluid-sensitive sequence), the signal from fat is supressed and it appears dark, whilst fluid appears bright.
Gadolinium injected to aid diagnosis.
Metal moves due to magnet, claustrophobia, longer time staying still.

43
Q

Understand the role of ultrasonography in imaging MSK

A

Uses high-frequency sound waves to produce images. The sound waves are produced by a transducer and travel through the patient. Tissues deflect the waves back to the transducer and are then analysed to create an image.
No radiation, used to image soft tissues and fluid collections, target injections and perform aspirations of joints.
dependent on a skilled operator for interpretation of images; resolution of deep tissues is poor; and it has limited suitability for bone and intra-articular imaging.

44
Q

Understand the role of nuclear medicine in imaging the
musculoskeletal system

A

biologically active drugs that are administered to the patient to serve as a marker of biologic activity.
The images produced are a collection of radiation emissions from the isotopes.
They are used to assess areas of metabolically active bone such as when trying to localise metastatic disease, healing fractures

45
Q

Understand the importance of utilising radiation safely

A

Radiation is ionising and can deposit energy in tissues that lead to DNA damage. Rapidly dividing cells are most susceptible to radiation-induced neoplasia so children and fetuses are especially susceptible.
Medical personnel should wear lead aprons and exposure should be monitored using film badges.
Use low doses and only when necessary.

Sem2 (23 decks)

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