Theme 2 - The Musculoskeletal system Flashcards
What bones make up the pectoral girdle?
Scapula and clavicle
How many bones are there in the hand and what type?
Carpal x8
Metacarpal x5
Phalanges x14
Apply the following labels to the humerus
Greater tubercle Lesser tubercle Deltoid tuberosity Intertubular sulcus/bicipotal groove Lateral epicondyle Medial epicondyle
Apply the following labels to the scapula
Spine Superior angle Inferior angle Coracoid Acromion
Apply the following labels to the radius and ulna
Heads
Styliod processes
Tuberosities
Olecranon
What are the 5 joints of the wrist and hand?
radiocarpal midcarpal carpometacarpal metacarpalpharlageal interphalangeal
Excluding the wrist and hand what are the other main upper limb joints?
glenohumeral
elbow
From where do the flexor muscles of the wrist and digits originate?
Medial epicondyle
From where do the extensor muscles of the wrist and digits originate?
Lateral epicondyle
What are the two types of curves in the spine and at what point do they develop?
Kyphoses - Fetal
Lordoses - Childhood
What are the 3 ligaments in the spinal column?
Anterior longitudional ligament
Posterior longitudional ligament
Ligamentum flava
What ligament of the vertebral column resists hyperextension and what is the clinical significance of this ?
anterior longitudional
This is what’s injured during whiplash
What are the two components of the intervertebral discs ?
Nucleus pulposus
Annulus fibrosus
What are facet joints?
Joints between vertebral arches
What does the type of movement of the facet joints depend on?
Angle of the joint
What are the two divisions of the muscles of the back and what to they broadly do?
Intrinsic - posture vertebral comumn
extrinsic - move upper limbs and ribs
Origin of latissimus dorsi? 3
Thoracolumbar fascia
Spinous processes of lower 6 T
Insertion and function of lattissimus dorsi?
Bicipital groove - Adduction and medial rotation
Origin of trapezius? 2
Occipital protuberance
Spinous processes CVII - TXII
What are the 3 sections of Trapezius and what do they insert into?
Upper - Clavicle
Middle - Acromion
Lower - Spine of scapula
Function of trapezius?
rotates scapula
What muscles are responsible for elevating and retracting the scapula?
Levator scapulae
Rhomboids
What are the 3 layers of deep muscle in the back?
Splenius - most superficial (in neck)
Erector Spinae - main group
Multifidus - deepest
What are the 3 muscle blocks of erector spinae and from where do they originate?
Spinales -
Longissimus
Iliocostalis
Erector Spinae aponeurosis
What are the 3 muscle blocks of erector spinae and from where do they insert?
Spinales - spinous processes
Longissimus - transverse processes
Iliocostalis - ribs
From what do muiltifidous origionate and then insert?
Transverse processes to spinous processes
What is the nerve supply of the extrinsic and intrinsic muscles?
Extrinsic - anterior primary ramus
Intrinsic - posterior primary ramus
What stem artery supplies the upper limb?
Subclavian
What muscle divides the subclavian artery and into how many partys
Scalenus anterior -3
What comes of the 1st/2nd/3rd parts of the subclavian arteries?
1st - Thyrocervical - scapular
3rd - Dorsal scapular artery
Where does the subclavian artery end and what does it become?
As it crosses the border of the first rib
axillary artery
What divides the axillary artery and into how many parts?
Pec minor - 3
Where does the axillary artery end and what does it become?
Boreder of teres major - brachial artery
What significant 2 arteries emerges from the axillary artery and from what section?
3 - subscapular
ant/post circumflex humoral
What is at risk following a fracture to the neck of the humerus?
ant/post circumflex humoral artery
Where does the brachial artery divide and what does it become?
cubital fossa
radial and ulna artery
What branch of the brachial artery supplies the extensor muscles?
Profunda brachii
What nerve accompanies the profunda brachii artery in the spiral groove?
radial nerve
Two arteries run down the forearm, what are they and which way around?
Lateral - radial
Medial - ulnar
Through what anatomical feature does the radial artery pass and what does it form in the hand?
Snuff box
Deep palmer arch
What artery forms the superficial palmar arch
Ulnar
What is the venous return in the forearm and what does it drain into?
Deep veins - Paired veins, Venae comitantes
Superfical - Cephalic, basilic
Axillary vein
Label the superficial veins
Dorsal venous arch
basilic
cephalic
median cubital
Draw the brachial plexus including all supplies
Roots Trunks Divisions Cords Terminal Branches
Sketch the dermatomes of the upper limb?
C4. C5, C6, C7, C8, T1, T2
What does altered sensation in a dermatome region indicate?
damage to specific spinal nerve of spinal cord segment (i.e. proximal nerve injury)
Draw the cutaneous innervation by the terminal branches
axillary radial musculocutaneous medial cutaneous ulnar median
Label the ligaments of the shoulder joint.
Acromioclavicular Coracoacromial Glenohumeral - Superior - Middle - Inferior Coracoclavicular
Origin, insertion and nerve supply of deltoid
Spine of scapula + acromion + clavicle
Deltoid tuberosity
Axillary nerve
Label the elbow joint
Olecranon Capitulum Trochlea Trochlea notch Radial notch Head of radius
Label the ligamenets of the elbow
Radial collateralligament Annular ligament Ulnar collateral ligament Lateral epicondyle Medial epicondyle
Label the Cubital fossa
Lateral epicondyle Brachioradialis Pronator teres Lateral cutaneous nerve to the forearm Brachialis Brachial artery Median nerve
Thye median cubital vein is a branch of what vein?
Basilic
Label what 4 muscles origionate from the common felxor origin in the forearm?
Pronator teres
Flexor carpi radialis
Palmaris longus
Flexor carpi ulnaris
What clinical condition is associated with the common flexor origin in the forearm?
Golfers elbow - epicondylitis at the CFO
Label the intermediate layer of the forearm
Flexor digitorum superficialis
Label deel flexor layer of the forearm
Flexor pollicis longus
Flexor digitorum profundus
Label superficial extensor muscles
Extensor carpi radialis longus/brevis
Extensor digitorum
Extensor digiti minimi
Extensor carpi ulnaris
What clinical condition is assocciated with the common extensor origin?
Tennis elbow - epicondylitis ot CEO
What is the function of brachioraidilis
Flexion when half pronated - beer drinking
Label the deep layer extensor muscles
Supinator Abductor pollicis longus Extensor pollicis brevis Extensor pollicis longus Extensor indicis
What two muscles are involved in wrist abduction?
Flexor carpi radialis
- Extensor carpi radialis (longus + brevis)
What two muscles are involved adduction of the wrist?
Flexor carpi ulnaris
- Extensor carpi ulnaris
Label the muscles involved in pronation and supernation
Pronator teres
Pronator quadratus
Biceps brachii
Supinator
Label the contents of the carpal tunnel
Median nerve
Flexor policis longus
Flexor digitorum superficialis
Flexor digitorum profundus
What is carpal tunnel syndrome?
Compression of the median nerve
What does the median nerve supply?
Motor supply to anterior compartment except FCU/medial part of FDP
Sensory supply to lateral palm + d1, d2, d3, ½ d4
label the carpal bones
Lunate Scaphoid Triquetral/triquetrium Trapezium Trapezoid Capitate Hamate Pisiform
What is the most common fracture to the carpal bones?
Scaphiod fracture
Label the joints of the hand
Saddle joint Wrist (radiocarpal) Metacarpal/intercarpal Carpometacarpal Metacarpophalangeal Interphalangeal
What ligaments reinfoce the radiocarpal joint?
Ulnar and radial collateral ligaments (limits abduction/adduction)
Ligaments on the palmar/dorsal surfaces (limits extension/flexion)
What movement does the saddle joint enable
Opposition
What are the Condylar joints?
MCP
What are the hinge joints?
Proximal interphalangeal joints
distal interphalangeal joints
What muscle is the palmar aponeurosis continuous with?
palmaris longus
What are the flexor tendons in the hand,and which digits do they flex?
Flexor digitorum superficialis (d2-5)
Flexor digitorum profundus (d2-5)
Flexor pollicis longus (d1)
What prevents bowing of the hand tendons?
Flexor retinaculum
To where on the digit does the flexor digitorum profundus attach?
base of distal phalanx
To where on the digit does the flexor digitorum superficialis attach?
base of middle phalanx
What are the extensor tendons to digits 2-5?
Extensor digitorum
Extensor indicis
Extensor digiti minimi
What are the extensor tendons to digit 1?
Extensor pollicis longus
Extensor pollicis brevis
Abductor pollicis longus
Label the borders of the anatomical snuffbox
Abductor pollicis longus
Extensor pollicis brevis
Extensor pollicis longus
What artery passes through the anatomical snuffbox?
Radial
What bands of the extensor digitoris tendons insert into the middle and distal phalanges?
Medial band (into middle phalanx) Lateral band (into distal phalanx)
What muscles insert into the extensor hoods?
Lumbricals and interossei
What do the lumbrical muscles do?
Extend interphalangeal joints and flex MCP joints
- Precision grip (hold pen / pinch)
How many palmar interossei muscles are there and what do they do?
3 (no D1 or D3)
Adduct metacarpals
How many dorsal interossei muscles are there and what do they do?
4 (D2, D3x2, D4)
Abduct metacarpals
What do the thenar and hypothenar muscles do?
fine movements of the D1 and D5
Label the thenar muscles
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
Label the hypothenar muscles
Opponens digiti minimi
Abductor digiti minimi
Flexor digiti minimi
Label the head, origins and insertions of adductor pollicus
Oblique head Transverse head Base 2nd and 3rd metacarpal + carpal bones 3rd metacarpal Proximal phalanx
What artery supplies the DEEP palmar arch and which digits does it supply?
radial
1 and 1/2 of 2
What artery supplies the SUPERFICIAL palmar arch and which digits does it supply?
ulna
1/2 of 2 and 3,4,5
What will possibly happen to the hand following injury to the ulnar nerve?
Clawed hand
Label the pelvis
ASIS AIIS Pubis Ischiopubic ramus Obturator foramen Ischial tuberosity Greater sciatic foramen Acetabulum
Label the femur
Neck Head Lesser trochanter Linea aspera Gluteal tuberosity Greater trochanter Intertrochanteric crest Lateral/medial condyles Medial epicondyle Lateral epicondyle Intertrochanteric line
Label the tibia, fibula and foot
Lateral and medial condyles Tibial tuberosity Medial malleolus Lateral malleolus Tarsals Metatarsals Phalanges
From shallow to deep what are the gluteal muscles?
Gluteus maximus
Gluteus medius
Gluteus minimus
How the function of the gluteal muscles differ>
maximus extends and medially rotates
medius and minimus abduct and medially rotate
What is the origin, insertion and innervation of gluteus maximus?
Ilium
gluteal tuberosity/iliotibial tract
Inferior gluteal nerve
What is the origin, insertion and innervation of gluteus medius and minumus?
Ilium
greater trocanter
superior gluteal nerve
What muscle form the equivelant of the rotator cuff in the hip?
Piriformis
What is the origin, insertion and innervation of piriformis?
Sacrum
greater trocanter
sacral plexus
What muscles make up the anterior compartment of the thigh?
Quadracepts (VVVR)
Sartorious
What muscles make up the quadracepts?
Rectus femoris
vastus lateralis
vastus medialis
vastus intermedius
label the muscles of the anterior compartment of the thigh
Rectus femoris vastus lateralis vastus medialis vastus intermedius Sartorious
What is the origin, insertion and innervation of the quadracepts?
AIIS and femus
Tibial tuberosity
femaoral nerve
What is the origin, insertion and innervation of the sartorious?
ASIS
tibia
femoral artery
What muscles make up the hamstrings?
Biceps femoris (ong and short head)
Semitendinosus
Semimembranosus
What is the origin, insertion and innervation of the hamstrings?
ischial tuberosity
tibia fibula
sciatic nerve
Label the medial compartment of the thigh
Pectineus Adductor Longus Gracilis Adductor Brevis Adductor Magnus
What is the origin, insertion and innervation of the medial compartment of the thigh?
pubis and ischium
Linea aspera
obturator nerve
One of the medial muscles of the thigh has two parts, which one and what are these?
Adductor magnus
adductor part and hamstring part
What muscles are involve in flexion of the thigh?
Rectus femoris
Sartorius
Iliopsoas
What musles are involed in extension of the thigh?
Gluteus maximus
Hamstrings
Hamstring part of adductor magnus
What muscles are involed in abdcution of the thigh?
Gluteus medius
Gluteus minimus
What muscles are involved an adduction of the thigh?
Adductor longus Adductor brevis Adductor part of adductor magnus Pectineus Gracilis
From what plexus the femoral nerve origionate?
Lumbar L2-L4
From what plexus the obturator nerve origionate?
Lumbar L2-L4
From what plexus the sciatic nerve origionate?
Sacral L4-S3
Label the sciatic nerve and its branches
Sciatic nerve
Tibial nerve
Sural nerve
Common fibular nerve
What does the commun fibula nerve divide into?
Superficial fibular
Deep fibular
Label the femoral triangle
Femoral nerve Sartorius Inguinal ligament Femoral artery/vein Adductor longus
What are the two “gateways” at either end of the femoral artery?
inguinal ligament
adductor hiatus
What are the two major superficial veins in the limb?
Short and long saphenous vein
What does the great spahenous vein dran and where does it lead to?
Dorsal medial arch of foot into femoral vein
What does the short spahenous vein dran and where does it lead to?
dorsal lateral arch of foot into popliteal vein
What bony factors help strengthen the knee joint?
Bony expansions
- Locking mechanism
- Femoral angle
What soft tissue factors help strengthen the knee joint?
Ligaments
- Menisci
- Muscles
Label the bony expansions of the knee
Femoral condyles
Epicondyles
Intercondylar fossa
Tibial condyles (tibial plateau)
What is the puropse of the knee’s locking mechanism?
Reduces amount of energy required when extended
What is genu varum?
Bow legged - Medial displacement of the tibia
What is Genu valgum?
knock knees - lateral displacement of tibia
What are the extracapsular ligaments of the knee?
Medial collateral
Lateral collateral
What are the intracapsular ligaments of the knee?
Anterior cruciate
Posterior cruciate
What does the lateral colateral ligamant do?
Prevents medial displacement of tibia
What does the medial colateral ligamant do?
Prevents lateral displacement of tibia
What do the anterior and posterior cruciate ligaments do?
Anterior -Prevents anterior displacement of tibia on femur
Posterior - Prevents posterior displacement of tibia on femur
How is the anterior cruciate ligament often injured and what test could you perfom to confirm this?
sharp twisting of knee
Lachman test
What 3 functions do the menisci perform in the knee?
Deepen the articulating surfaces/stability
Shock absorbers
Provides smooth viscous film for joint
What do the menisci attach to?
intercondylar area of tibia
What 3 ligaments is a rugby tackle to the lateral side of the knee likely to damage?
ACL
Medial collateral
medial meniscus
label the attachment and ligaments of the patella
Quadriceps tendon Lateral patellar retinaculum Medial patellar retinaculum Tibial tuberosity Patellar ligament
What does the patella do?
Protects quadriceps tendon from stresses during locomotion
What does the popliteus do, how?
Unlocks the knee by laterally rotating the femur
What are bursae?
Synovial fluid filled sac lined by synovial membrane
label the bursae
Suprapatellar bursa
Prepatellar bursa
Infrapatellar bursa
What is Bursitis?
Housemaids knee or clergymens knee - Inflammation of bursae
Due to repetitive movements or direct pressure
Leaning forward on the knees brings the prepatellar bursa in contact with floor
back on heels leads to contact with infrapatella
Label the bones of the foot
Calcaneus Talus Cuboid Navicular Cuneiforms Sesamoid bones Sustentaculum tali Calcaneal tuberosity
What type of joint is the ankle joint and what movements are there?
Synovial hinge joint
Dorsi/plantar flexion
What ligaments stabilise the ankle?
Lateral ligament – lateral malleolus to talus/calcaneus
Medial/deltoid ligament – medial malleolus to talus/calcaneus/navicular
What is the subtalar joint between and what does it do?
Between talus and calcaneus (+ navicular)
Allows inversion/eversion during locomotion
What movement does the transverse tarsal joint allow?
Allows eversion/inversion and pronation/supination
What is the function of the arches of the foot? 3
Shock absorbers during locomotion
Act as springboards
Distribution of weight
What is pes planus?
Fallen medial longitudinal arch can lead to pes planus (flat feet)
What are the compartments of the lower leg and what muscle supplies them?
Anterior - Deep fibular nerve
Posterior - Tibial
Lateral - Superficial fibular nerve
Label the anterior compartment of the leg
Tibialis anterior
Extensor digitorum longus
Extensor hallucis longus
What do the leg anterior compartment leg muscles inser into?
Extensor digitorum longus - Middle + distal phalanges Tibialis anterior - Medial cuneiform + 1st metatarsal Extensor hallucis longus - Distal phalanx of great toe
Label the superficial posterior compartment of the lower leg
Soleus
Plantaris
Tendo calcaneus
Gastrocnemius
What is th origin of Gastrocnemius?
condyles of femur
Origin of plantaris?
Femur
Origin of soleus?
tibia and fibia
Label the deep posterior compartment of the lower leg
Flexor digitorum longus
Tibialis posterior
Flexor hallucis longus
Flexor retinaculum
Lable the insertion of the porterior compartment leg muscles
Flexor digitorum longus
Tibialis posterior
Flexor hallucis longus
label the lateral compartment of the leg
Fibularis longus
Fibularis brevis
Fibular retinaculum
Label the insertions for the lateral compartment of the leg
Fibularis longus
Fibularis brevis
Label the long tendons of the foot (lateral)
Extensor digitorum longus Extensor hallucis longus Fibular retinaculum Extensor retinaculum Fibularis longus/brevis
Label the long tendons of the foot (medial)
Flexor digitorum longus Flexor hallucis longus Tibialis posterior Flexor retinaculum Tibialis anterior
label the blood supply to the posterior compartmnt of the leg?
Popliteal artery
Anterior tibial artery
Posterior tibial artery
Fibular artery
What is the origin, insertion and innervation of the deltoid?
Spine of scapula, acromion and clavicle
Deltiod tuberosity
Axillary nerve
What is the origin, insertion and innervation of the biceps?
Long head - supraglenoid tuberosity
Short - coracoid process
radial tuberosity
Muscocutaneous nerve
What are the rotator cuff muscles?
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
The rotator cuff muscles surround the joint on all sides except which side and what is the significance of this?
Inferior
Most common dislocation
Label the rotator cuff muscles
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
Label the origins of the rotator cuff muscles
Supraspinous fossa
Spine
Infraspinous fossa
Where do the 3 posterior rotator cuff muscles insert onto?
Greater tubercle
Origin and insertion of subscapularis?
Subscapular fossa and lesser tubercle
Label the rotator cuff muscles (slide 23)
Supraspinatus
Infraspinatus
Teres minor
What is the function of supraspinatus
Initiates abduction
What is the origin, insertion and innervation of teres major?
Inferior angle of scapula
Medial lip of bicipital groove
Lower subscapular
Give an example of a common rotator cuff injury
Supraspinatus impingement
Common in throwers
What cord of the brachial plexus is associated with supply to Subscapularis, teres major and lat dorsi
Posterior
What forms the borders of the anatomical snuffbox?
Extensor pollicis brevis
Extensor pollicis longus
Abductor pollicis longus
What disease affects the palmar fascia?
Dupuytren’s
What causes a trigger finger?
Flexor tendon gets caught at A1 pulley
Usually by degenerative nodule
4 signs of ulnar nerve damage
clawing
wasting hypothenar web spaces
forearm wasting
paradoxical thenar wasting
If someone has subacromial impingement where/what movements are going to cause them pain?
Abduction and rotation
pain over deltoid
Extrinsic and intrinsic causes of subacromial impingement?
Extrinsic - bony spurs
Intrinsic - tendonopathy
Treatment of subacromial impingement
Non-surgical - physio and activity modification
Surgical - subacromial decompression/debridement
Which rotator cuff muscles are most likely to tear?
supra and infra spinatus
Two types of shoulder replacement
Anatomic
Reverse
Symptoms any typical demographics of frozen shoulder
stiffness
loss of passive motion
normal x-ray
Female 40-60 diabetic
Treatment of frozen shoulder
Non surgical -Natural history 2 years
-hydrodilation
Surgical -Capsular release
What horn does the lower motor neuron arise from?
Anterior
What myotome and movement is associated with each of these roots?
C5, C6, C7, C8, T1
C5 - deltoid - abduction
C6 - anterior - elbow flexion
C7 - posterior - elbow extension, wrist flex/ext
C8 - posterior forearm - finger extension and flexion
T1 - intrinsic hand - finger abduction
Which nerve roots correspond with the following reflex tests? Biceps, supinator, triceps
C5 - biceps
C6 - supinator
C7 - triceps
What could cause a nerve root impingement?
Herniated disc
4 types of nerve injury
Avulsion - tear from attachment to spinal cord
Rupture - tear but not on attachment to spinal cord
Neuroma - tumor
Neurapraxia - myelin damage
4 types of injury to the brachial plexus
Erbs Palsy - babbys on delivery (waiter’s tip)
Pancoasts tumor
Inflammatory - brachial neuritis
Thoratic outlet syndrome
What are the tree sires of compression for thoracic outlet syndrome?
Between anterior and middle scalene muscles
Beneath clavicle in the costoclarvicular space
Beneath tendon of Pectorlis minor
Two types of thoracic outlet syndrome and their symptoms
Neurigenic - pain, numbness, parethesia
Vascular - forearm fatige, swelling cyanosis
What and muscles are innervated by the median nerve?
L ateral 2 lumbricals
O pponens pollicis
A bductor pollicis brevis
F lexor pollicis brevis
What is thenar wasting a possible sign of?
Carpal tunnel syndrome
Possible causes of carpal tunnel syndrome
Diabetes Pregnancy Hypothyroidism Rheumatoid arthritis Repetitive strain
Draw the differences in sensory innervation loss in carpal tunnel vs lesion in forearm
Loss of palmar sensation in carpal tunnel
Is ulnar clawing more severe when the lesion is proximal or distal?
Distal
“Saturday night palsy” relates to which nerve?
Radial
Where is the conus medularis?
L1/2
Main differences between lesion on conus medularis vs cauda equina>
Cauda equina - Pain more severe, asymeteric losses. Bladder and sexual function loss later and less severe.
Conus medularis - Pain less severe, bilateral losses, bladder and sexual function loss earlier and more severe
Draw the lumbar plexus
L2, L3, L4 - femoral nerve
L4, L5 Obturator
Draw the sacral plexus
L4 - S3 - Sciatic
L4, L5, S1 - Superior gluteal
S1, S2 - inferior gluteal
Draw Posterior leg innervation
Sciatic
Sural - medial/lateral
Lateral dorsal cutaneous
What does ATOMFC stand for?
A ir Obstruction T ension pneumothorax O pen pneumothorax M assive haemothorax F lail chest C ardiac tamponade
Another name for bunions?
Hallux Valgus
Type of drug that prevents bone loss - up to 3 examples.
Bisphosphonates
Allendronate
Zolendronate
dosidium pamidronate
Two drugs that treat gout
Allopurinol
Colchicine