7. Musculoskeletal Anatomy

Question 1

What is radiology?

Answer 1

The medical discipline that uses medical imaging to diagnose and treat diseases within the bodies of humans.

Question 2

What are the different imaging technologies in current clinical use?

Answer 2

• X-rays
• Computer tomography (CT)
• Magnetic resonance imaging (MRI)
• Radiographic contrast agents -> Barium radiology + Angiography
• Ultrasound

Question 3

What are some radiology safety measures?

Answer 3

• Dose should be kept as low as reasonably achievable (ALARA)
• Radiation techniques should be avoided in pregnancy
• Non-radiation techniques should be used where possible and appropriate

Question 4

In radiology, what is the dose measured in?

Answer 4

mSv

Question 5

Describe the principle on which radiography works.

Answer 5

• High energy EM waves (usually x-rays) are absorbed by different materials to varying extents.
• This means that the detector or film receives different intensities of the waves depening on what they pass through.
• The creation of 2D images using this technique is called projection radiography.

Question 6

What are some advantages and disadvantages of plain x-rays?

Answer 6

ADV:

• Quick
• Cheap
• Great detail
• Widely availabke

DIS:

• 2D image only

Question 7

How are x-rays produced?

Answer 7

High energy electrons striking a tungsten target within a vacuum tube.

Question 8

Is it acceptable to call the image produced by an x-ray an x-ray?

Answer 8

No, it is better to call it a radiograph, image or film.

Question 9

What colour will the following appear on a x-ray/CT image:

• Air
• Fat
• Bone
• Metal
• Calcium
• Organs, Muscles, Soft tissues

Answer 9

• Air -> Black
• Fat -> Black
• Bone -> White
• Metal -> White
• Calcium -> White
• Organs, Muscles, Soft tissues -> Shades of grey

Question 10

In radiography, how are the different views of the image named?

Answer 10

It is named according to the direction of the x-rays, such as the anterposterior, posteroanterior, oblique and lateral views.

Question 11

What are some applications of x-rays?

Answer 11

• Bone fractures
• Basic anatomy checks -> e.g. Dextrocardia of the heart, lung collapse, soft tissues
• Detecting abnormalities, such as tumours

Question 12

Describe the principle on which ultrasound imaging works.

Answer 12

• High frequency ultrasound is passed into the tissue
• At every boundary where there is a change in density, part of the signal is reflected, which is picked up by the detector at the surface and used to produce an image
• The greater the difference in density, the more of the signal is reflected at that boundary.

Question 13

What is the frequency of ultrasound typically used in imaging?

Answer 13

2-15 MHz

Question 14

What are some advantages and disadvantages of ultrasound imaging?

Answer 14

ADV:

• High quality information about soft tissue
• No ionising radiation
• Inexpensive
• Flow information

DIS:

• Gas and bone block US beam
• Obesity degrades image quality
• Operator dependent
• Pixel brightness is not quantitive

Question 15

Check how to interpret an ultrasound scan!!!

Answer 15

Not sure if it detects densities - more likely just differences between them.

Question 16

What are some applications of ultrasound imaging?

Answer 16

• Obstetrics (pre-natal scan)
• Pediatric brain
• Testicle and prostate
• Female pelvis
• Abdomen (liver, kidneys, pancreas, gall bladder) -> Variable appearance can show infection, cancers, etc.
• Vascular disease
• Rotator cuff of the shoulder

Question 17

What is a Doppler ultrasound?

Answer 17

• A form of ultrasound that employs the Doppler effect to generate imaging of the movement of tissues and body fluids (usually blood), and their relative velocity to the probe.
• A colour scale can be used to represent the direction of blood flow.

Question 18

What is another name often used for ultrasound imaging?

Answer 18

Ultrasonography

Question 19

Describe the principles of nuclear imaging.

(Note: This is not core material)

Answer 19

Nuclear imaging involves the use of a radioactive tracer within the body that emits usually gamma radiation. This can be detected by a detector and used to understand internal body structure.

Question 20

What is the most common radionuclide used in nuclear medicine imaging studies?

(Note: This is not core material)

Answer 20

^99mTc -> Half-life of 6 hours and a gamma emitter.

Question 21

What are some of the scan types used in nuclear medicine imaging?

Answer 21

• 2D scintigraphy -> Bone, renal
• 3D -> PET

Question 22

What is a PET CT scan?

Answer 22

A nuclear medicine imaging technique that uses both PET and CT scanning simultaneously. The images are superimposed.

Question 23

What does CT stand for?

Answer 23

Computer tomography

Question 24

Describe the principle on which CT works.

Answer 24

• An x-ray tube rotates around a patient, on the other side of which are multiple rows of detectors. This is used to assemble a cross-section of the patient.
• A CT can take multiple slices per rotation (up to 64).
• In spiral CT, the patient may move past the x-ray tube so that a multi-layer image is formed.
• The detector works by converting the x-rays to a flow of electrons, which is digitised to Hounsfield units (HU).

Question 25

What are the colours on a CT scan homologous to?

Answer 25

The colours on an x-ray, since a CT is essentially just a series of x-ray images.

Question 26

Describe the Hounsfield scale for CT scans.

Answer 26

The scale assigns the following values: * +1000HU = Bone * 0HU = Water * -1000HU = Air

Question 27

What are some advantages and disadvantages of multislice CT?

Answer 27

ADV: * Static or movie images * Noninvasive * Rapid filming gives few motion artifacts * Good spatial resolution DIS: * Expensive

Question 28

What are some applications for CT?

Answer 28

* Trauma * Intercranial haemorrhage * Abdominal injury (especially to organs) * Fractures * Spinal alignment * Diagnosis and staging of cancers * Detection of foreign bodies in joints

Question 29

What are radiographic contrast agents and how do they work?

Answer 29

* Chemicals that absorb radiation in a CT or x-ray scan, so that the tissue of interest can be ssen more clearly * They work by changing the density of the tissue, changing its opacity to x-rays

Question 30

Are radiographic contrast agents the same as radionuclides?

Answer 30

No, radiographic contrast agents do not emit radiation (like radionuclides used in nuclear medicine imaging), but change the opacity of the tissues of interest.

Question 31

Name some radiographic contrast agents and their uses.

Answer 31

* Barium sulphate -\> Gastrointestinal imaging * Iodinated contrasts -\> Vascular snd lymphatic imaging, Contrast CTs, Cavities * Air -\> Used alongside other contrast to provide double contrast, since the air is less opaque than the contrast tissue

Question 32

What is an angiograph and how is it done?

Answer 32

* Imaging technique used to study blood vessels. * Radiographic contrast (iodine) is injected into the blood vessels, which are then imaged using an x-ray based technique.

Question 33

What is an arthrogram and how is it done? (Note: This is not core information)

Answer 33

* An x-ray image or CT scan of a joint after a contrast has been injected into it * The soft tissue is made clearer, so that injuries can be diagnosed more easily

Question 34

What does MRI stand for?

Answer 34

Magnetic Resonance Imaging

Question 35

Describe the principle on which MRI works, including the parts of the machine.

Answer 35

The machine is a tunnel consisting of: * High strength magnets -\> Apply a magnetic field to the patient, polarising the sample * Shim coils -\> Correct the magnetic field * Gradient coils -\> Localise the region to be scanned * Radiofrequency coils -\> Excite the sample and detect the resulting NMR signal The time for each proton to stop resonating determines the type of tissue. The de-excitation of protons occurs in two phases (T1 and T2), each of which releases energy that can be detected.

Question 36

What contrast agents are used in MRI?

Answer 36

Magnetically active agents, such as gadolinium.

Question 37

What are some advantages and disadvantages of MRI?

Answer 37

ADV: * Static or movie images * Multiple plane images * Good contrast * No known health hazards * Good for soft tissue injuries DIS: * More expensive than CT * Long scans are not pleasant for those with claustrophobia

Question 38

Whereas CT and x-ray imaging look at tissue density, what does MRI look at?

Answer 38

Proton energy

Question 39

What colour will the following appear in an MRI scan: * Air * Fat * Bone * Bone Marrow * Organs, Muscles, Soft tissues * Gadolinium * Water

Answer 39

* Air -\> Black * Fat -\> White (or grey in T2) * Bone -\> Dark * Bone Marrow -\> White (or grey in T2) * Organs, Muscles, Soft tissues -\> Shades of grey * Gadolinium -\> White * Water -\> Dark (but WHITE in T2)

Question 40

Describe how a T1 and T2 MRI scan can be differentiated.

Answer 40

Although fat will appear darker in T2, water will appear much brighter, so that, for example, fluids will be much lighter. Overall, T2 scans frequently seen lighter in general.

Question 41

What are some safety precautions taken with MRI?

Answer 41

Aside from no metal being allowed in the room, these are some contraindications: * Pacemakers * Inner ear implants * Cerebral aneurysms clipped by ferromagentic clips * Metallic foreign bodies in and around the eyes * Pregnancy (especially in the 1st trimester)

Question 42

What are some applications of MRI?

Answer 42

* Neuroimaging -\> Detection of tumours (better than CT because it separates grey and white matter * Cardiac * Musculoskeletal -\> Spinal, joints and tumours * Liver and gastrointestinal * Angiography

Question 43

Remember to practise differentiating between an MRI and CT scan, which can look similar.

Answer 43

Do it. ## Footnote This website is very very useful: https://www.embodi3d.com/blogs/entry/373-how-to-easily-tell-the-difference-between-mri-and-ct-scan/

Question 44

Answer 44

CT

Question 45

Answer 45

MRI

Question 46

Answer 46

Ultrasound

Question 47

Answer 47

X-ray

Question 48

What type of tissue is bone?

Answer 48

Connective tissue

Question 49

Give an example of a disease which causes the conversion of one organ systemm to another.

Answer 49

Fibrodysplasia ossificans progressiva (FOP) is a very rare condition where muscle tissue and connective tissue such as tendons and ligaments are gradually replaced by bone (ossified), forming bone outside the skeleton (extra-skeletal or heterotopic bone) that constrains movement.

Question 50

What is the average number of bones in the human skeleton?

Answer 50

206

Question 51

What can alter the number of rib or digits in a human skeleton?

Answer 51

Homeotic mutations

Question 52

What is sesamoid bone? Give an example.

Answer 52

A bone embedded in tendon (or muscle). An example is the patella.

Question 53

Give some examples of variable human skeletal anatomy and how this is useful.

Answer 53

The human skeleton varies by age and geographic variation. Humans are moderately **sexually dimorphic** so on average female bones are smaller than those of males. This has an importance in forensic medicine.

Question 54

Describe the divisions of the skeleton.

Answer 54

* Axial skeleton -\> Head, Neck, Trunk * Appendicular skeleton -\> Upper and lower extremities (including the pectoral and pelvis girdle)

Question 55

What are the pectoral and pelvic girdles?

Answer 55

The skeletal frameworks which provides attachment for the upper and lower limbs respectively. They consist of: * Pectoral girdle = Scapulas + Clavicles * Pelvic girdle = Hip bones, Sacrum + Coccyx

Question 56

Describe some of the functions of the human skeleton.

Answer 56

* Providing a rigid framework * Protection of soft tissues * Facilitation of movement * Resistance to forces (e.g. gravity) * Surface for muscular attachment * Maintenance of blood calcium * Red marrow is important in blood cell formation

Question 57

Describe the basic structure of bone as a tissue.

Answer 57

It is connective tissues so it contains cells embedded within a composite ECM containing: * **Organic matrix** -\> Mostly collagen, which provides tensile strength and some flexibility * **Inorganic material** -\> Hydroxyapatite (mostly calcium phosphate) that gives hardness and rigidity (the crystals impregnate the collagen matrix)

Question 58

What are the two main materials in bone? Describe how the properties of both can be deduced experimentally.

Answer 58

* Collagen -\> Heat can be used to disrupt the peptide bonds, which makes the bone brittle -\> This shows that collagen provides elasticity and tensile strength * Hydroxyapatite -\> Acid can be used to remove the Ca²⁺ ions, which makes the bone curl up and be soft -\> This shows that hydroxyapatite provides hardness and rigidity

Question 60

Give an example of a bone disease caused by abnormal collagen.

Answer 60

Osteogenesis imperfecta ("brittle bone disease")

Question 61

What are the different morphological types of bone?

Answer 61

* Flat bones * Long bones * Short bones * Irregular bones * Sesamoid bones

Question 62

Where are flat bones found?

Answer 62

* Cranial vault * Thoracic cage * Scapula

Question 63

Where are long bones found?

Answer 63

* Limbs * Hands * Feet

Question 64

Where are short bones found?

Answer 64

* Wrist * Ankle (Tend to be cuboidal)

Question 65

Where are irregular bones found?

Answer 65

* Facial skeleton * Pelvis * Vertebral column

Question 66

What is the function of sesamoid bones?

Answer 66

Act as pulleys and protect the tendons from excessive wear.

Question 67

Describe the histological divisions of bone.

Answer 67

* Bone is divided into woven (immature) and lammellar (mature) * Woven (or immature) bone is the first bone to develop when the skeleton forms, and it is also found in bone repair and tumours * Lammellar (or mature) bone is what makes up all normal adult bones, and is divided into compact and spongy/trabecular bone * Compact bone -\> Dense bone found around the external surfaces of the bone, including the shaft * Trabecular bone -\> Lightweight bone found in the ends of long bones, short bones and in the bodies of vertebrae

Question 68

What are the different names for roughened areas for the attachments of muscle tendons or ligaments?

Answer 68

* Tuberosities * Trochanters * Tubercles * Ridge * Line * Epicondyle

Question 69

What is the purpose of grooves on bones?

Answer 69

They are usually where blood vessels, nerves and tendons lay close to the bone.

Question 70

What are holes in bone called? What is the purpose of these?

Answer 70

Foramina - these are usually the site of passage of nerves or blood vessels through the bone.

Question 71

What is the name for a concave depression in a bone?

Answer 71

Fossa

Question 72

What are condyles and epicondyles?

Answer 72

* Condyles -\> Smooth round surfaces at the ends of bones, usually acting as articulating surfaces * Epicondyles -\> Rough projections on the condyle that act as attachment

Question 73

What two types of bone are adult bones composed of? Describe the location and appearance of each.

Answer 73

1. Compact (a.k.a cortical) bone -\> Dense form of bone with a Haversian canal structure. Found on the external surfaces of the bone, including the shaft. 2. Trabecular (a.k.a. spongy or cancellous) bone -\> Lightweight form of bone with honeycomb structure. Found in the ends of long bones, short bones and in the bodies of vertebrae.

Question 74

Describe the histological structure and parts of adult bone.

Answer 74

* Compact (a.k.a cortical) bone -\> Dense form of bone with a Haversian canal structure. Found on the outside of the bone, including the shaft. * Trabecular (a.k.a. spongy or cancellous) bone -\> Lightweight form of bone with honeycomb structure. Found in the ends of long bones, short bones and in the bodies of vertebrae. * Red bone marrow may be found within trabecular bone. * Medullary cavity (a.k.a. marrow cavity) is in the centre of long bone shafts -\> Contains yellow marrow, which contains fat cells * The periosteum is a layer of dense irregular tissue that covers the entire outside of bones (except the joint surfaces) * The endosteum is like the periosteum, except it lines the inside of the medullary cavity

Question 75

Where is red bone marrow found in bones and what is its function?

Answer 75

* In trabecular bone. * It contains stem cells that ultimately give rise to RBCs, WBCs and platelets.

Question 76

What is the name for the production of blood cells and platelets in the bone marrow?

Answer 76

Haemotopoiesis

Question 77

Where is yellow bone marrow found, what is it made of and how does it change over time?

Answer 77

* In the medullary cavity of long bones * It is made of fat cells * Over time, red bone marrow is converted to yellow bone marrow

Question 78

What are the different areas of a long bone?

Answer 78

* Diaphysis -\> Shaft, which develops from the primary ossification centre * Epiphyses -\> Ends,which develop from secondary ossification centres * Metaphyses -\> Expanded areas of the bone shafts, to which the epiphyses fuse in bone growth

Question 79

Describe the structure of compact bone.

Answer 79

* Consists of units called osteons (or Haversian systems). * Osteons are cylindrical structures that contain a mineral matrix and living osteocytes. * Each osteon consists of lamellae, which are layers of compact matrix that surround a central canal called the Haversian canal. The Haversian canal (osteonic canal) contains the bone’s blood vessels and nerve fibers. * The lamellae are joined by caniculi (microscopic canals). * Osteons in compact bone tissue are aligned in the same direction along lines of stress and help the bone resist bending or fracturing. Therefore, compact bone tissue is prominent in areas of bone at which stresses are applied in only a few directions.

Question 80

Describe the structure of spongy bone.

Answer 80

* Consists of trabeculae, which are lamellae that are arranged as rods or plates. * Red bone marrow is found between the trabuculae. * Blood vessels within this tissue deliver nutrients to osteocytes and remove waste.

Question 81

Describe how bone is adapted for strength and force transmission.

Answer 81

* Compact bone around the outside * Trabecular bone is present in parts of the bone where forces may be exerted in various directions * Trabeculae are also largely arranged in the direction of stress and tension lines

Question 82

Define ossification.

Answer 82

The laying down of bone material by osteoblasts (i.e. bone formation).

Question 83

What are the two types of ossification and where does each occur?

Answer 83

Intramembranous ossfication (rapid): * Bone is deposited directly onto an embryonic connective tissue membrane. * This occurs in parts of the crania, mandible and most of the clavicle. Endochondral ossification (slow): * Hyaline cartilage model of the bone is formed, which is gradually replaced by bone. * This occurs in the rest of the skeleton.

Question 84

Draw a diagram showing where each type of ossification occurs.

Answer 84

Question 85

What are the embryonic derivatives of bone and what does each form?

Answer 85

* Neural crest cells -\> Form the skull, mandible and clavicle (by intramembranous ossification) * Somites (sclerotome) -\> Rest of the _axial_ skeleton (by endochondral ossification) * Lateral plate mesoderm -\> Long bones (by endochondral ossification)

Question 86

How can you remember which type of ossification occurs where in the body?

Answer 86

* Intramembranous ossification is required to form strong bone where it is necessary for protection from early-on, such as in the skull * Endochondral ossification is required for growth over time

Question 87

Describe the process of intramembranous ossification.

Answer 87

* Neural crest derived mesenchymal cells differentiate into osteoblasts and group into ossification centers * Osteoblasts become entrapped by the osteoid they secrete, transforming them to osteocytes * Trabecular bone forms * Mesenchymal cells on the surface form a membrane called the periosteum * Cells on the inner surface of the periosteum differentiate into osteoblasts and secrete osteoid parallel to that of the existing matrix, thus forming layers of cortical bone * Blood vessels in the centre form the red marrow

Question 88

Describe the process of endochondral ossification.

Answer 88

* Mesoderm-derived mesenchymal cells differentiate into chondrocytes and form the cartilage model for bone * Chondrocytes near the center of the cartilage model undergo hypertrophy and alter the contents of the matrix they secrete, enabling mineralization * Chondrocytes undergo apoptosis due to decreased nutrient availability * Blood vessels invade and bring osteogenic cells * Primary ossification center forms in the diaphyseal region of the bone -\> This occurs where the major blood vessel enters * Secondary ossification centers develop in the epiphyseal region after birth

Question 89

What are the two types of growth in a long bone and how does each occur?

Answer 89

* Appositional growth -\> Thickens the bone -\> Bone is reabsorbed at the endosteal surface and added at the periosteal surface * Interstitial growth -\> Makes the bone longer -\> At the epiphyseal plate, cartilage grows towards the extremity of the bone and is replaced by bone

Question 90

When do the primary and secondary ossification centres form?

Answer 90

* Primary -\> Before birth * Secondary -\> After birth (EXCEPT the distal femur and proximal tibia i.e. near the knee)

Question 92

What is the name for the site of lengthening of long bones?

Answer 92

Epiphyseal plate (a.k.a. growth plate)

Question 93

What is the metaphysis?

Answer 93

The section of the bone that is next to the epiphyseal plate, on the side of the diaphysis. It marks the growth of the bone.

Question 94

How many ossification centres do bones have?

Answer 94

* Long bones -\> Two secondary, one primary * Short bones -\> Form from just primary osssification (and may have many primary ossification centres)

Question 95

When does the lengthening of the bone stop and what happens when this goes wrong?

Answer 95

* When the epiphyseal plate stops dividing and the epiphysis fuses with the metaphysis * Premature ossification leads to premature interruption of limb extension

Question 96

Can epiphyseal plates be seen on an x-ray?

Answer 96

They are seen as empty spaces that look sort of like a big fracture, but aren't!

Question 97

Name the divisions of the upper limb.

Answer 97

* Arm * Forearm * Wrist * Hand

Question 98

What bone is in the arm and what does it articulate with?

Answer 98

* Humerus * Articulates with: Scapula, Radius, Ulna

Question 99

What is it worth noting about the upper and lower limb in the anatomical position?

Answer 99

They are rotated differently so that the big toe and thumb are on opposite sides.

Question 100

State some functional differences between the upper and lower limb.

Answer 100

* Glenohumeral joint is capable of a wider range of movement than the hip joint due to joint depth * Forearm bones are capable of pronation and supination, which cannot happen in the leg * Thumb allows opposition, which cannot happen in the foot

Question 101

What are the bones in the wrist and hand what do they articulate with?

Answer 101

* Carpals, Metacarpals, Phalanges (proximal, intermediate, distal) * Carpals articulate with the radius at the wrist

Question 102

What is the proper name for the shoulder joint?

Answer 102

Glenohumeral joint

Question 103

What are all of the bones of the upper limb?

Answer 103

(Shoulder = Scapula + Clavicle) * Humerus * Radius * Ulna * Carpals * Metacarpals * Phalanges (x3)

Question 104

What is the pectoral girdle composed of?

Answer 104

* Clavicle * Scapula

Question 105

What does the clavicle articulate with and what are the names of these joints?

Answer 105

* Medially -\> With manubrium of the sternum (sternoclavicular joint) * Laterally -\> With acromion of scapula (acromioclavicular joint a.k.a. AC joint)

Question 106

What are the main landmarks and attachments of the clavicle?

Answer 106

Landmarks: * Acromial facet (laterally) * Sternal facet (medially) * Conoid tubercle (for coracoclavicular ligament) Muscle attachments: * Trapezius (insertion) * Deltoid (origin) * Pectoralis major (origin) * Subclavius muscle (insertion) * Sternocleidomastoid (origin) Ligment attachments: * Acromioclavicular ligament (laterally) * Coracoclavicular ligament (laterally) * Sternoclavicular ligament (medially) * Costoclavicular ligament (medially)

Question 107

What is the clinical relevance of the clavicle?

Answer 107

The clavicle is a very frequent site of fracture, with fractures most commonly occuring in the middle third of the bone.

Question 108

Is this the anterior or posterior view of the scapula?

Answer 108

Posterior

Question 109

What does the scapula articulate with and what are the names of these joints?

Answer 109

* Humerus -\> Glenohumeral joint * Clavicle -\> Acromioclavicular joint

Question 110

What are the main landmarks and attachments of the scapula?

Answer 110

Landmarks: * Subscapular fossa -\> Subscapularis origin * Coracoid process -\> * *Muscles* - Pectoralis minor (attachment), coracobrachialis (origin) and short head of biceps brachii (origin) * *Ligaments* - Coracoclavicular, coracoacromial, coracohumeral * Glenoid fossa -\> Site of glenohumeral joint (glenohumeral ligaments) * Supraglenoid tubercle -\> Long head of biceps brachii * Infraglenoid tubercle -\> Long head of triceps brachii * Spine -\> Deltoid, Trapezius * Acromion (at end of spine) -\> Site of AC joint (AC ligaments), Coracoacromial ligament * Infraspinous fossa -\> Infraspinatus muscle * Supraspinous fossa -\> Supraspinatus muscle Other muscle attachments: * Latissimus dorsi * Serratus anterior * Teres minor * Teres major * Levator scapulae * Rhomboideus major * Rhomboideus minor Other ligment attachments: * Suprascapular ligament

Question 111

What are the major palpable landmarks of the shoulder? Where are they found?

Answer 111

* Acromion (palpable above shoulder) * Coracoid process (palpable below lateral clavicle)

Question 112

Label this.

Answer 112

Question 113

What is some clinical relevance related to the appearance of the scapula?

Answer 113

* The scapula may be winged when pushing with the arm * This usually indicates damage to the long thoracic nerve, which innervates the serratus anterior muscle * The serratus anterior muscle is responsible for holding the scapula close to the ribcage

Question 114

What does the humerus articulate with?

Answer 114

* Scapula (glenohumeral joint) * Head of radius + Trochlear notch of ulna (elbow joint)

Question 115

What are the main landmarks and attachments of the humerus?

Answer 115

Landmarks: * Head -\> Glenohumeral joint * Greater tuberosity (lateral) -\> Supraspinatus, Infraspinatus, Teres minor * Lesser tuberosity (anterior) -\> Subscapularis * Bicipital groove (a.k.a. intertubercular groove) -\> Tendon of long head of biceps passes through this, Latissimus dorsi, Pectoralis major and Teres major attaches here * Deltoid tuberosity (lateral side of shaft) -\> Deltoid * Radial groove (diagnal on posterior surface) -\> Radial nerve and profunda brachii artery run through this * Medial and lateral supracondylar ridge -\> Lateral is rough and provides attachment for forearm extensor muscles * Medial and lateral epicondyles -\> Medial is larger and features a groove where the ulnar nerve passes through * Trochlea (more medial) -\> Articulates with trochlear notch of ulna * Capitulum (more lateral) -\> Articulates with head of radius * Radial and coronoid fossa -\> Receive forearm bones during flexion * Olecranon fossa -\> Receives olecranon of ulna during extension Other muscle attachments along shaft: * Anteriorly: Coracobrachialis, deltoid, brachialis, brachioradialis. * Posteriorly: Medial and lateral heads of triceps Ligaments: * Medial collateral * Lateral collateral * Glenohumeral ligaments

Question 116

Describe the position of the greater and lesser tubercles of the humerus. What attaches to each?

Answer 116

Greater tubercle: * Lateral, with both posterior and anterior surfaces * Supraspinatus attaches to superior facet * Infraspinatus attaches to middle facet * Teres minor attaches to inferior facet Lesser tubercle: * More medial, with anterior surface only * Subscapularis attaches here

Question 117

How can you remember the attachments of at the lips of the bicipital groove (intertubercular groove)?

Answer 117

"A lady between two majors" The latissimus dorsi muscle attaches between the pectoralis major and teres major.

Question 118

What are the two necks of the humerus? What is the significance of each?

Answer 118

* Anatomical neck -\> Just below the head * Surgical neck -\> Further down the humerus -\> It is a frequent point of fracture

Question 119

Why might a knock to the elbow elicit a tingling feeling?

Answer 119

The ulnar nerve passes posterior to the medial epicondyle of the humerus, where it is very superficial and can easily be stimulated.

Question 120

What is often seen with a fracture at: * Surgical neck of the humerus * Shaft of the humerus

Answer 120

* Surgical neck of humerus -\> Damage to the axillary nerve * Shaft of humerus -\> Radial nerve

Question 121

Label this:

Answer 121

Question 122

Label this:

Answer 122

Question 123

What does the radius articulate with?

Answer 123

Proximally: * With capitulum of humerus (elbow joint) * With radial notch of ulna (proximal radioulnar joint) Distally: * With head of ulna (distal radioulnar joint) * With scaphoid and lunate (radiocarpal / wrist joint)

Question 124

What does the ulna articulate with?

Answer 124

Proximally: * Trochlea of humerus (elbow joint) * Head of radius (proximal radioulnar joint) Distally: * Ulnar notch of radius (distal radioulnar joint)

Question 125

What are the main landmarks and attachments of the radius?

Answer 125

Landmarks: * Head -\> Site of elbow joint (with capitulum of humerus) * Radial tuberosity -\> Biceps brachii * Shaft * Styloid process (lateral) -\> Radial collateral ligament of the wrist + Site of radiocarpal joint * Ulnar notch -\> Site of distal radioulnar joint (with head of ulna) Other muscles: * Pronator teres * Pronator quardatus * Supinator teres * Finger and thumb flexors and extensors * Brachioradialis Other ligaments: * Radial collateral ligament (at elbow) * Radial collateral ligament (at wrist) * Radiocarpal ligaments Note the intraosseous membrane between the radius and ulna.

Question 126

What are the main landmarks and attachments of the ulna?

Answer 126

Landmarks: * Trochlear notch - Site of elbow joint (with trochlea of humerus) * Olecranon - Triceps brachii * Coronoid process - Brachialis + Ulnar collateral ligament of elbow * Ulnar tuberosity - Brachialis * Radial notch - Site of proximal radioulnar joint + Annular ligament * Styloid process - Ulnar collateral ligament of wrist * Head - Site of distal radioulnar joint (with ulnar notch of radius) Other muscles: * Supinator * Anconeus * Finger and thumb flexors and extensors Other ligaments: * Radiocarpal ligaments * Ulnar collateral ligament (wrist)

Question 127

Does the head of ulna articulate with the bones of the wrist?

Answer 127

No, it is prevented from doing so by a cartilaginous articular disc.

Question 128

Give some clinical relevance of the radius.

Answer 128

* Colles' fracture * Most common type of radial fracture * Caused by fall on outstretched hands * Fracture at distal end, so that the wrist area is dislocated posteriorly -\> Gives dinner fork appearance * Smith's fracture * Opposite of Colles' fracture * Caused by fall on back of hands

Question 129

Label this image.

Answer 129

Question 130

What must you remember exists between the radius and ulna?

Answer 130

Interosseous membrane

Question 131

Which way does the palm face in pronation and supination of the forearm?

Answer 131

* Pronation -\> Down * Supination -\> Up

Question 132

During pronation and supination of the forearm, which bone rotates?

Answer 132

Radius

Question 133

Describe all of the types of bones in the hand, starting from the tip of a finger.

Answer 133

* Distal phalanges * Middle phalanges * Proximal phalanges * Metacarpals * Carpals

Question 134

Describe all of the joint in the hand, starting from the tip of a finger.

Answer 134

* Distal interphalangeal joint (DIP) * Proximal interphalangeal joint (PIP) * Metacarpophalangeal joint * Carpometacarpal joints

Question 135

Describe the bones in the thumb.

Answer 135

There is one metacarpal (as with the other fingers), but only two phalanges (there are 3 in the other fingers).

Question 136

Label this.

Answer 136

Question 137

How many carpals are there?

Answer 137

8

Question 138

Name all of the carpals, starting from the side of the thumb.

Answer 138

Distal: Trapezium, Trapezoid, Capitate, Hamate Proximal: Scaphoid, Lunate, Triquetrum, Pisiform

Question 139

Give a good mnemonic for remembering the carpals.

Answer 139

Some lovers try positions that they can't handle.

Question 140

Out of the triquetrum and pisiform, which is on the palmar side of the hand?

Answer 140

Pisiform

Question 141

Describe how a scaphoid fracture might occur, symptoms and why it is dangerous.

Answer 141

* Occurs when falling onto outstretched hand * Characterised by pain in the anatomical snuffbox * In many people the blood supply to the scaphoid is only in the distal to proximal direction, so a fracture can cause avascular necrosis of the proximal portion of the scaphoid

Question 142

What stops the ulna articulating with the carpals?

Answer 142

An articular disc.

Question 143

What is the wrist joint?

Answer 143

Articulation between the lower end of the radius and the articular disc covering the distal ulna, with the scaphoid, lunate and triquetrum.

Question 144

Describe how the fingers are numbered.

Answer 144

From 1 to 5, with the thumb being number 1.

Question 145

What are the divisions of the lower limb? What are the bones in each?

Answer 145

* Thigh -\> Femur * Leg -\> Tibia, patella and fibula * Ankle * Foot -\> Tarsals, metatarsals and phalanges

Question 146

What are some adaptations of the lower limb that make it different to the upper limb?

Answer 146

* Hip joint is deeper than shoulder joint, which allows for greater stability + Rigid pelvic girdle * Bicondylar angle of the femur allows for the centre of gravity to be directly above the knee, so that walking can happen * Knee joint reinforced by internal ligaments * Leg bones do not rotate around each other like the forearm bones do

Question 147

What is another name for the hip bone?

Answer 147

Os coxae or innominate bone

Question 148

What bones make up the hip bone? What is the position of each?

Answer 148

* Ilium -\> Top * Ischium -\> Bottom, Back * Pubis -\> Bottom, Front

Question 149

Describe the structure of the pelvis.

Answer 149

* Made up of two hip bones and the sacrum * Each hip bone consists of the ilium, ischium and pubis, while the sacrum fits between the ilium of each hip bone * The coccyx may be considered part of the pelvis too

Question 150

Where are the three bones of the hip bone all united?

Answer 150

Acetabulum

Question 151

Note that for the lower limbs I have not gone into as much detail about landmarks, ligaments and muscles as I have with the upper limb.

Answer 151

Ok.

Question 152

What is the function of the pelvis?

Answer 152

It protects the lower abdominal and pelvic organs and forms points of articulation with the lower limbs.

Question 153

Compare the pelvis and pelvic girdle.

Answer 153

The pelvis also includes the sacrum, while the pelvic girdle does not.

Question 154

What does the pelvis girdle (two hip bones) articulate with?

Answer 154

* Sacrum (sacroiliac joint) * Head of femur (hip joint One hip bone also articulates with the other at the pubis symphysis.

Question 155

Describe the development of the hip bone.

Answer 155

The three bones all have their own primary ossification centre and then eventually fuse together around the ages of 16 to 18.

Question 156

What are the main landmarks of the hip bone?

Answer 156

Ilium: * Iliac crest (palpable) * Anterior superior iliac spine (ASIS) (palpable) * Posterior superior iliac spine (PSIS) (palpable) * Anterior inferior iliac spine (AIIS) * Greater sciatic notch Ischium: * Ischial spine * Ischial tuberosity (palpable) Pubis: * Pubic tubercle (palpable) All 3: * Acetabulum -\> Articulates with head of femur

Question 157

Name some important palpable landmarks of the hip bone.

Answer 157

* Iliac crest * Anterior superior iliac spine (ASIS) * Posterior superior iliac spine (PSIS) * Ischial tuberosity * Pubis tubercle

Question 158

What is some clinical significance of the iliac crest?

Answer 158

A line drawn between the highest point on each iliac crest crosses at the level of the spine of the L4 vertebrae, which is useful when finding the spot to insert a lumbar puncture needle.

Question 159

What is the significance of the ischial tuberosity?

Answer 159

The ischial tuberosities are what you sit on.

Question 160

What is the acetabulum?

Answer 160

It is the point on the hip bone where the femur articulates.

Question 161

What does the femur articulate with?

Answer 161

* Acetabulum of hip bone (hip joint) * Tibia and patella (knee joint)

Question 162

What are the main landmarks of the femur?

Answer 162

* Head -\> Articulates with acetabulum * Neck * Greater trochanter (lateral and slightly posterior) -\> Gluteus medius and minimus * Lesser trochanter (medial and posterior, below neck) -\> Powerful hip flexor iliopsoas * Linea aspera (posterior) -\> Adductors * Lateral and medial epicondyles -\> Articulate with tibia

Question 163

What is the danger of a fracture of the neck of the femur?

Answer 163

If the fracture is inside the joint capsule, blood supply to the femoral head might be disrupted.

Question 164

Name all of the articulations at the knee.

Answer 164

* 2 x Femur with the tibia * 1 x Femur with the patella

Question 165

Label this.

Answer 165

Question 166

Is the fibula part of the knee joint?

Answer 166

No, it is sort of off to the side.

Question 167

Name the surfaces that articulate between the femur and tibia.

Answer 167

The lateral and medial femoral condyles articulate with the lateral and medial tibial condyles. There is a raised intercondylar eminence on the tibia.

Question 168

What type of bone is the patella?

Answer 168

Sesamoid

Question 169

Give an interesting piece of information about the sesamoid bones near the knee.

Answer 169

A small fraction of people have a very small sesamoid bone that exists in the calf muscle tendon. It is called the fabella (small bean).

Question 170

What is a name for the top of the tibia?

Answer 170

The tibial plateau

Question 171

What does the tibia articulate with?

Answer 171

* Femur (tibiofemoral / knee joint) * Fibula (x2) (proximal and distal tibiofibular joints) * Talus (ankle joint) Note that there is also an interosseous membrane between the tibia and fibula.

Question 172

What are the main landmarks of the tibia?

Answer 172

* Tibial plateau -\> Articulates with femur * Intercondylar eminence -\> ACL and PCL, Menisci of tibia * Medial and lateral tibial condyles * Tibial tuberosity (anterior) -\> Quadriceps * Tibial shaft * Medial malleolus -\> Articulates with talus

Question 173

What does the fibula articulate with?

Answer 173

* Tibia (x2) (proximal and distal tibiofibular joints) * Talus (ankle joint)

Question 174

What are the main landmarks of the fibula?

Answer 174

* Head of fibula -\> Articulates with tibia * Fibula shaft * Lateral malleolus -\> Articulates with talus

Question 175

Compare the main functions of the tibia and fibula.

Answer 175

* Tibia -\> Weight bearing * Fibula -\> Muscle attachments

Question 176

Label this.

Answer 176

Question 177

Describe the articulations at the ankle joint.

Answer 177

The medial malleolus of the tibia and the lateral malleolus of the fibula "grip" the talus (a tarsal) bone.

Question 178

Describe the bones in the foot.

Answer 178

* 7 tarsals -\> Talus, Calcaneus, Cuboid, Navicular, Cuneiforms (x3) * 5 metatarsals * 14 phalanges (only 2 in the hallux) Therefore the structure is homologous to the hand.

Question 179

Name all of the tarsals.

Answer 179

* Calcaneus (forms the mass of the heel, very large) * Talus (forms ankle joint) * Cuboid * Navicular * Cuneiforms x 3 (Medial, intermediate, lateral)

Question 180

Give the clinical relevance of the tubersity on the 5th metatarsal.

Answer 180

It is prone to an aversion fracture when the foot is everted excessively.

Question 181

What is the technical name for the big toe?

Answer 181

Hallux

Question 182

Do inversion and eversion of the foot happen at the ankle joint?

Answer 182

No, it is a hinge joint. Inversion and eversion happen at the joints between the tarsals.

Question 183

Label this.

Answer 183

Question 185

What are the three bones in the shoulder girdle?

Answer 185

Clavicle, scapula and humerus

Question 186

Label this.

Answer 186

Question 187

What are some features of the clavicle?

Answer 187

* First bone to ossify * Among the last the fuse * Most commonly fractured bone * Only bony attachment of the upper extremity is via the sternoclavicular joint

Question 188

\* What component affects the direction of a break in the clavicle?

Answer 188

* Ligament action pulls the fragments in specific directions (medial fragment drawn upwards) * These breaks aren’t overly benign as close to lung and brachial plexus - has been shown that fixing them surgically is a better treatment than just leaving them to recover

Question 189

What type of joint is the sternoclavicular joint?

Answer 189

Synovial - with articular disc

Question 190

Which ligament tears in a medial clavicle dislocation?

Answer 190

The ligament between the sternum and the clavicle No operating on this kind of dislocation, just try and reduce it

Question 191

What is the AC joint?

Answer 191

The acromioclavicular joint - between the clavicle and the acromium process

Question 192

How many ligaments are there that attach to the coracoid process and what are they?

Answer 192

There are 3: * Coracoacromial ligament, between acromium and coracoid processes (both on scapula) * Coracoclavicular ligament -\> Trapezoid and conoid ligaments, attach the clavicle to the coracoid process

Question 193

How can you remember the order of the coracoclavicular ligaments?

Answer 193

Medial to lateral: "CT" scan to diagnose (conoid then trapezium)

Question 194

What is an acromioclavicular separation?

Answer 194

This is where the coracoclavicular ligaments tear, but the AC joint is only partially damaged

Question 195

What happens in an AC dislocation?

Answer 195

Both the AC and coracoclavicular ligaments tear, resulting in full dislocation of the distal end of the clavicle

Question 196

What type of joint is the AC joint?

Answer 196

Synovial, but with little movement

Question 197

\* What is a good indication for the side to which a scapula belongs?

Answer 197

The direction in which the coracoid process is pointing - it will always be pointing towards the arm and is on the front/anterior side of the bone

Question 198

\* How are humeral head fractures treated?

Answer 198

Conservative management is disproportionately successful (length/alignment/rotation), use a collar and cuff. Alternatively, surgical intervention can be used.

Question 199

Where is and what are some characteristics of the glenohumeral joint?

Answer 199

The joint between the humeral head and the glenoid fossa/cavity Shallow joint, stability improved by the glenoid labrum and the ligaments Manipulated by the rotator cuff muscles amongst others Synovial joint, ball and socket

Question 200

What are the three ligaments in the glenohumeral joint?

Answer 200

* SGHL: superior glenoid-humeral ligament * MGHL: medial glenoid-humeral ligament * IGHL: inferior glenoid-humeral ligament

Question 201

How do the shoulder and hip joints compare? (In one sentence)

Answer 201

They are opposites - hip has a more restricted range of movement but is more stable, shoulder has a larger range of movement but is less stable. Shoulder is likened to a golfball on a golf tee

Question 202

Which ribs articulate with the scapula?

Answer 202

Ribs 2-7 Major contributors to shoulder motion - bursas are present

Question 203

What is a bursa?

Answer 203

Small fluid-filled sac contained within synovial joints - act as a cushion

Question 204

How many muscles attach the upper limb to the axial skeleton?

Answer 204

17 Ones we need to know are: * Deltoid * Rotator cuff muscles (x4) * Biceps/attachment of the biceps tendon

Question 205

What is innervated by the axillary nerve?

Answer 205

Deltoid and teres minor (amongst others)

Question 206

What happens if the axillary nerve is damaged?

Answer 206

Shoulder is weakened, ability to abduct is severely lessened

Question 207

What are the four rotator cuff muscles?

Answer 207

Subscapularis, infraspinatus, supraspinatus, teres minor

Question 208

What innervates supraspinatus and infraspinatus?

Answer 208

The suprascapular nerve

Question 209

What innervates teres minor?

Answer 209

The axillary nerve

Question 210

What innervates subscapularis?

Answer 210

The subscapular nerve

Question 211

What acronym can be used to remember the four rotator cuff muscles/tendons?

Answer 211

SITS: * Supraspinatus * Infraspinatus * Teres minor * Subscapularis

Question 212

Where do the rotator cuff muscles attach?

Answer 212

* Supraspinatus, infraspinatus and teres minor attach to the greater tuberosity of the humerus * Subscapularis attaches to the lesser tuberosity of the humerus (only one) The other ends of the muscles attach to the scapula.

Question 213

What is the function of the rotator cuff muscles?

Answer 213

* Move shoulder joint * Provides stability (stops dislocation) * Keeps deltoid from pulling humeral head up

Question 214

Why is the biceps muscle called the biceps?

Answer 214

Bi - two Ceps - cephalus, means ‘head’ The biceps has two ‘heads’, the long head and the short head - long head goes over the humeral head, short goes anteriorly, both attach to the scapula.

Question 215

Where are the origins and insertions of the biceps muscle?

Answer 215

Origins: * Long head: Supraglenoid tuberosity (of scapula) * Short head: Coracoid process Insertions: * Distal biceps tendon: Radius (at radial tuberosity)

Question 216

What are the origins and insertions of the brachialis muscle?

Answer 216

Origins: * Halfway up the humerus Insertions: * Coronoid process and tuberosity of the ulna.

Question 217

\* What is the failsafe mechanism of the biceps?

Answer 217

There are two heads, so if one ruptured the muscle is still functional as the other remains attached - contraction still results in movement of the bone. Results in ‘popeye’ muscle

Question 218

\* What are some of the problems that can occur within the shoulder?

Answer 218

* Adhesive capsulitis (frozen shoulder) * Impingement syndrome * Rotator cuff tears * Dislocation * Arthritis

Question 219

\* How can age affect outcome of shoulder dislocations?

Answer 219

* Younger patients have a higher dislocation rate * Older patients have a higher rate of rotator cuff tears

Question 220

\* How should you manage a dislocated shoulder?

Answer 220

* Best to reduce the dislocation at time of accident, then short period of immobilisation (though external rotation splint or simple sling) * Can be managed surgically, usually after recurrent dislocations (labrum can tear and will need to be repaired).

Question 221

What is the most commonly dislocated joint?

Answer 221

The shoulder - inherently unstable (shallow joint)

Question 222

\* What is adhesive capsulitis?

Answer 222

Aka frozen shoulder, inflammation and thickening of the shoulder capsule eventually results in hugely reduced range of movement (especially external rotation). Associated with diabetes, but often idiopathic (arises spontaneously with unknown cause). Not self limiting (so won’t resolve itself without treatment), just stops hurting over time, doesn’t really improve.

Question 223

\* How can you treat adhesive capsulitis?

Answer 223

* Used to be conservative treatment/‘wait and see’ * Now can have glenohumeral injections * More and more commonly manipulated under anaesthesia - only in stiff phase, and these is a slight risk of humeral fracture * Generally resolved with time (1-2 years), residual stiffness is expected. But can only get it once in each shoulder!

Question 224

What is shoulder impingement?

Answer 224

This is where the rotator cuff tendons within the coracoacromial arch are impinged - trapped or limited mobility of tendons, or inflamed bursa within the shoulder. This affects nearby nerves and causes pain. Association with ‘hooked’ acromion (specific shape, morphologically hooked around joint therefore increases risk of impingement)

Question 225

What are the risk factors for shoulder impingement?

Answer 225

* Can occur at any age * Classically involves anterior 1/3 of acromion * Incidence does occur with age

Question 226

What is the treatment for shoulder impingement?

Answer 226

* Usually conservative - subacromial injections and physio * 2/3 resolve (but only 1/2 in over 60s) * Can also have surgical decompression

Question 227

What happens if a rotator cuff tendon is torn?

Answer 227

The patient will be unable to elevate their arm fully as only deltoid is able to work on the humerus - other abductors are compromised. Incidence increases with age, and management is hotly debated.

Question 228

What is another word for arthroscopic surgery?

Answer 228

Keyhole surgery

Question 229

What is current treatment for damaged rotator cuff muscles?

Answer 229

Therapy to strengthen the remaining cuff, traditional open or mini-open repair (both arthroscopic)

Question 230

How common is glenohumeral arthritis?

Answer 230

Least common of the major joints

Question 231

What is glenohumeral arthritis?

Answer 231

This is joint inflammation of the shoulder, where the space between the glenoid fossa and the humeral head is greatly reduced, causing pain. Can be secondary to trauma, chronic rotator cuff deficiency and necrosis of the humeral head (this can occur when a fracture cuts off blood supply)

Question 232

How can a massive rotator cuff tear cause glenohumeral arthritis?

Answer 232

The rotator cuff muscles help to hold the humerus down/oppose the action of the deltoid muscle - when the rotator cuff tears, the deltoid can draw up the humerus, reducing joint space and therefore causing arthritis

Question 233

What are the treatments for glenohumeral arthritis?

Answer 233

Conservative: injections Operative: replacement

Question 234

What position is the humeral head in relation to the transepicondylar axis of the distal humerus?

Answer 234

Humeral head is retroverted (tilted backwards) relative to the transepicondylar axis - joint is most unstable anteriorly, to by turning shoulder back by ~30 degrees improves stability

Question 235

Where does pectoralis major insert?

Answer 235

To the bicipital groove and the deltoid tuberosity on the humerus (lateral to the intertubercular groove)

Question 236

Where does latissimus dorsi insert?

Answer 236

Floor of the intertubercular groove

Question 237

Where does teres major insert?

Answer 237

The medial lip of the intertubercular groove

Question 238

How can the order of the insertions of pectoralis major, latissimus dorsi and teres major be remembered?

Answer 238

‘A lady between two majors’, pectoralis is the most lateral, latissimus is in the middle, teres major the most medial

Question 239

What attaches to the greater tuberosity of the humerus?

Answer 239

Supraspinatus, infraspinatus, teres minor (C5-C6)

Question 240

What attaches to the lesser tuberosity humerus?

Answer 240

* Subscapularis - allows for internal/medial rotation and adduction * Upper (C5) and lower (C6) subscapular nerve ???

Question 241

Patient with a subscapularis rupture would have what findings?

Answer 241

* Positive Gerber lift off test (arrange hand so that it is behind the back, back of hand touching back of the person. Ask the patient to try and lift their hand from their back - if positive, patient should be unable to do this with either inability or pain as a limiting factor). * Weak internal rotation * Increased passive external rotation

Question 242

What is the triangular space in the shoulder?

Answer 242

The space formed between the teres minor (superiorly), teres major (inferiorly) and long head of triceps (laterally). The scapula circumflex vessels pass through here (axillary, subscapular and scapular circumflex arteries).

Question 243

What is the quadrangular space in the shoulder?

Answer 243

The space formed by the teres minor (superiorly), teres major (inferiorly), long head of triceps (medially) and neck of humerus (laterally). The axillary nerve and the posterior circumflex humeral artery + vein pass through here EVERYTHING THROUGH THIS GAP EITHER HAS 4 SYLLABLES OR 4 WORDS

Question 244

What provides the blood supply to the humeral head?

Answer 244

Anterior circumflex humeral artery Posterior circumflex humeral artery

Question 245

On the upper limb, where is the relative position of the neurovascular bundle?

Answer 245

Medial

Question 246

What is flexion?

Answer 246

Movement that decreases the angle between two body parts

Question 247

What is extension?

Answer 247

Movement that increases the angle between two body parts

Question 248

What is dorsiflexion?

Answer 248

The action of moving the foot/toes upwards/towards the shin (remember this through the idea of creating a dorsal fin)

Question 249

What is plantarflexion?

Answer 249

The action of moving the foot/toes downwards/towards the ground if the foot was suspended (remember this through the idea of 'planting' your foot on the ground)

Question 250

To what body part are dorsi- and plantarflexion specific?

Answer 250

The ankle joint/foot

Question 251

What is abduction?

Answer 251

The action of moving a body part away from the midline/laterally (remember this through the idea of abduction as stealing a human)

Question 252

What is adduction?

Answer 252

The action of moving a body part towards the midline/medially (remember this through a-d-duction, 'adding')

Question 253

What is eversion?

Answer 253

Movement of the foot so that the sole is facing outwards/has been moved away from the midline

Question 254

What is inversion?

Answer 254

Movement of the foot so that the sole is facing inwards/has been moved inwards - this is what happens when you twist your ankle

Question 255

Why are inversion and eversion useful?

Answer 255

Important for walking across uneven ground

Question 256

What is lateral flexion?

Answer 256

This is the bending of the neck or body away from the midline, i.e. to the left or right

Question 257

What is medial rotation?

Answer 257

The rotating of a joint so that it faces more internally

Question 258

What is lateral rotation?

Answer 258

The rotating of a joint so that it faces more externally

Question 259

What is rotation?

Answer 259

Movements made about the longitudinal axis and in the transverse plane

Question 260

What is pronation?

Answer 260

The act of rotating the forearm so that the palm is facing down (remember: the whip sequence)

Question 261

What is supination?

Answer 261

The act of rotating the forearm so that the palm is facing upwards (remember: lying down as if supine)

Question 262

What is circumduction?

Answer 262

The movement of a limb or extremity so that the distal end completes a circle whereas the proximal end remains in one place (performed best at ball and socket joint)

Question 263

What are the different movements of the scapula?

Answer 263

* Elevation (moving upwards) * Depression (moving downwards) * Retraction (moving inwards) * Protraction (moving outwards) * Medial rotation * Lateral rotation

Question 264

What are the movements of the pollux/thumb?

Answer 264

* Abduction (movement away from the hand along sagittal plane) * Adduction (movement towards the hand along sagittal plane) * Extension (movement away from the hand along the coronal plane) * Flexion (movement towards and across the hand along the coronal plane) * Opposition (UNIQUE, ability to touch little finger with thumb) * Reposition (UNIQUE, ability to return hand to normal shape after opposition)

Question 265

What are the three types of joint and all their subtypes?

Answer 265

* Fibrous * Suture (flat bones) * Syndesmosis (long bones) * Cartilaginous * Synchondrosis (primary) * Symphysis (secondary) * Synovial * Uniaxial * Biaxial * Multiaxial

Question 266

What are the movements of the fingers?

Answer 266

* Abduction - splaying the fingers * Adduction - closing the fingers

Question 267

What are the different types of fibrous joint, where are they made of and where are they found?

Answer 267

* Suture * Join together flat bones * Made of dense connective tissue * Syndesmosis * Between long bones * Made of dense connective tissue

Question 268

What are the different types of joint that are lined with hyaline cartilage?

Answer 268

* Plane joint (small gliding movement e.g. between cuneiform bones of foot) * Saddle joint (e.g. interphalangeal) * Hinge joint (e.g. knee) * Pivot joint (e.g. wrist) * Ball and socket joint (e.g. shoulder, hip) * Ellipsoid/condylar joint (e.g. where the radius and ulna meet the wrist)

Question 269

What is the function of a fibrous joint?

Answer 269

Hold bones very tightly together, allowing very little movement.

Question 270

What are the different types of cartilaginous joint, where are they found and what are they made of?

Answer 270

* Primary cartilaginous (synchondroses) * In developing bone, seen in epiphyseal plates * Made of hyaline cartilage * Secondary cartilaginous (symphyses) * Midline joints/intervertebral discs (annulus fibrosus) * Made of hyaline cartilage AND fibrocartilage composite

Question 271

Describe the general structure of a secondary fibrocartilaginous joint.

Answer 271

It is a composite fibrocartilaginous and hyaline joint: * Articulating bones covered with hyaline cartilage * Thick, fairly-compressible pad of fibrocartilage between them

Question 272

What defines a synovial joint?

Answer 272

The presence of synovial fluid within the joint capsule.

Question 273

What tends to strengthen a hinge joint?

Answer 273

Collateral ligaments

Question 274

What are the ligaments involved in the pectoral girdle?

Answer 274

* Coracoacromial ligaments * Acromioclavicular ligaments (AC) * Coracoclavicular ligaments * Glenohumeral ligaments

Question 275

\* Where does osteoarthritis usually occur? What are the risk factors?

Answer 275

In weight bearing joints Risk factors: - Age - Bodyweight

Question 276

\* What causes osteoarthritis?

Answer 276

Destruction of articular cartilage (and/or bone) at a joint, presents as a severely reduced joint space in imaging and pain/reduced mobility of the joint

Question 277

\* Where does rheumatoid arthritis usually occur?

Answer 277

In smaller joints, is also usually symmetrical

Question 278

\* What causes rheumatoid arthritis?

Answer 278

Autoimmune of synovial membrane, articular cartilage and bone

Question 279

What is the purpose of the coracoacromial ligament?

Answer 279

To prevent superior dislocation of the humerus, connects the acromion process of the scapula to the coracoid process of the scapula.

Question 280

How is the scapula held in place?

Answer 280

By muscles - its only attachment to the axial skeleton is through the clavicle, it has no real attachment to the thorax.

Question 281

What are the two components of the coracoclavicular ligament?

Answer 281

From medial to lateral: * Conoid * Trapezoid (Remember, diagnose using a CT scan)

Question 282

\* How can the coracoclavicular ligaments be disrupted?

Answer 282

Through dislocation of the acromioclavicular joint

Question 283

What is the purpose of the coracoclavicular ligament?

Answer 283

* Helps to suspend a lot of the weight of the limb from the clavicle * Stabilises the acromioclavicular (AC) joint

Question 284

What is the general function of the pectoral girdle?

Answer 284

* To give the upper limb a greater range of movement, allowing it to carry out roles of grasping and manipulating objects now that it has been freed from locomotion * Alters the position of the glenoid fossa of the scapula and suspends it away from the thorax to allow greater movement

Question 285

What deepens the glenoid fossa?

Answer 285

The glenoid labrum -\> Fibrocartilaginous ring that is around the fossa, adding stability to the joint

Question 286

\* How can you tell that a clavicle has been broken rather than dislocated?

Answer 286

Both will show deformities, but length of clavicle should be equal on both sides - if lengths are unequal, then there is likely to have been a break. Ligaments attached to a clavicle can draw it upwards if it is broken

Question 287

What are the glenohumeral ligaments?

Answer 287

* Superior, medial and inferior glenohumeral ligaments * Pass from the margins of the glenoid cavity to the humerus and support the joint anteriorly

Question 288

What is the should joint at great risk of?

Answer 288

Dislocation - joint is relatively lax which makes it prone to this

Question 289

How is the lower part of the glenohumeral joint capsule adapted to improve movement?

Answer 289

Lower part is lax and folded

Question 290

What is the most common direction for a shoulder dislocation and why?

Answer 290

Anteriorly, due to lack of joint support in this region

Question 291

How can a shoulder dislocation be identified?

Answer 291

- Acromion will be prominent - Shoulder flattened - Bulge of humeral head seen

Question 292

What type of joint is the glenohumeral joint and what does this allow?

Answer 292

Multiaxial synovial ball and socket joint, allows a huge range of mobility

Question 293

What downside does the hypermobility of the shoulder joint have?

Answer 293

Causes the joint to be inherently weak and prone to dislocation (especially in comparison to the hip joint)

Question 294

What are bursae?

Answer 294

Sacs filled with synovial fluid that act as cushions to reduce friction where tendons and muscles lie close to the bone

Question 295

What is the most important bursa near the glenohumeral joint?

Answer 295

The subacromial (subdeltoid) bursa that separates the coracoacromial arch from the tendon of supraspinatus and the glenohumeral joint

Question 296

What are the four rotator cuff muscles?

Answer 296

* Supraspinatus * Infraspinatus * Teres minor * Subscapularis

Question 297

Where do the four rotator cuff muscles attach?

Answer 297

* Supraspinatus, infraspinatus and teres minor: Greater tuberosity of the humerus * Subscapularis: Lesser tuberosity of the humerus

Question 298

What are the main stabilising factors of the shoulder joint?

Answer 298

The rotator cuff muscles, they form a musculotendinous cuff that extends around the glenohumeral joint, stabilising it

Question 299

What movement does supraspinatus aid?

Answer 299

Assists with initial arm abduction

Question 300

What movement do infraspinatus and teres minor aid?

Answer 300

Lateral shoulder rotation

Question 301

What movement does subscapularis aid?

Answer 301

Medial shoulder rotation

Question 302

What type of capsule surrounds the elbow joint and where is it weakest?

Answer 302

Fibrous capsule, weakest anteriorly and posteriorly

Question 303

What are the proper names for the elbow joint?

Answer 303

Humeroulnar joint and humeroradial joint make up the elbow

Question 304

What are the ligaments in the elbow joint?

Answer 304

* Lateral (radial) collateral ligament * Medial (ulnar) collateral ligament * Anular/annular ligament

Question 305

What other joint is also in the proximity of the elbow?

Answer 305

The proximal radioulnar joint

Question 306

What movement does the anular/annular ligament allow?

Answer 306

Allows the pivoting/rotation of pronation and supination - joint capsule is attached to this rather than directly to the radius, allowing the freedom of movement between the radius and ulna. Is also circular, wraps around the radial head to form a pivot joint.

Question 307

What type of joint is the elbow and what movements does it allow?

Answer 307

Synovial hinge joint, allows flexion and extension

Question 308

Where does the medial/ulnar collateral ligament run from and to?

Answer 308

From the medial epicondyle of the humerus to the ulna

Question 309

Where does the lateral/radial collateral ligament run from and to?

Answer 309

From the lateral epicondyle of the humerus to the radial notch of the ulna and the anular ligament, NOT the radius itself

Question 310

How is the elbow joint stabilised?

Answer 310

- Stable shape of articulating surfaces - Strong collateral ligaments - Surrounding cuff of muscles (including triceps brachii, brachialis and biceps brachii)

Question 311

\* In what position is the elbow joint at its most stable?

Answer 311

90 degrees flexion, in a position of mid pronation-supination

Question 312

What movement do the radioulnar joints permit?

Answer 312

Pronation and supination

Question 313

What type of joint is the interosseous membrane?

Answer 313

Fibrous joint

Question 314

What type of joint is the distal radioulnar joint?

Answer 314

Synovial pivot joint (allows pronation and supination)

Question 315

What type of joint is the radiocarpal/wrist joint?

Answer 315

Synovial ellipsoid joint

Question 316

What type of joint are the midcarpal joints?

Answer 316

Synovial plane joints, but are important for wrist flexion and extension

Question 317

\* What is 'nursemaid's' or 'pulled elbow'?

Answer 317

Radial subluxation or dislocation, especially common in children due to ossification not being completely finished. Once fracture is excluded, can be easily reduced

Question 318

What happens to the radius during supination and pronation?

Answer 318

The radius rotates around the ulna - during supination they lie parallel, during pronation the radius crosses over the ulna

Question 319

How is the distal radioulnar joint separated from the radiocarpal (wrist) joint?

Answer 319

By a fibrocartilage articular disc

Question 320

What articulations occur in the proximal radiohumeral joint?

Answer 320

The radius articulates with the radial notch on the ulna, and is able to rotate within a fibrosseous ring formed by this notch and the anular ligament

Question 321

What articulations occur in the distal radiohumeral joint?

Answer 321

The head of the ulna articulates with the ulnar notch of the radius

Question 322

What is the interosseous membrane?

Answer 322

- Extremely strong fibrous sheet between the two bones - Transmits forces from the hand onto the elbow joint/humerus - Site of attachment for deep muscles of forearm compartments

Question 323

What articulation in the radiocarpal/wrist joint?

Answer 323

- Concave distal radius - Articular disc of ulna - Convexities of the scaphoid, lunate and triquetrum

Question 324

What movements are allowed by the radiocarpal/wrist joint?

Answer 324

- Flexion - Extension - Radial deviation - Ulnar deviation (Last two are abduction and adduction, but different depending on which way the arm is facing so it is clearer to use these terms)

Question 325

Where are the midcarpal joints found?

Answer 325

Between the distal and proximal rows of carpal bones

Question 326

What type of joint is the first carpometacarpal joint (base of thumb) and what movement does this allow?

Answer 326

Synovial saddle joint, allows opposition and reposition

Question 327

What are the major differences between the hand and the foot?

Answer 327

- Orientation of hallux (big toe) and pollux (thumb) differs greatly - Different shapes of joints (carpometacarpal joint is a completely different shape compared to the tarsometatarsal joint) These differences relate to function - big toe cannot carry out opposition and has no need to

Question 328

What movements does opposition include?

Answer 328

- Flexion - Abduction - Rotation - Adduction

Question 329

What type of joint are the second, third, fourth and fifth carpometacarpal joints (between the wrist and the four fingers)?

Answer 329

Plane synovial joints

Question 330

What movement does the metacarpophalangeal joint of the thumb not allow?

Answer 330

Abduction/adduction - this is instead allowed by the first hypermobile carpometacarpal joint

Question 331

Draw the joints of the hand.

Answer 331

Question 332

What limits movements in the second to fifth carpometacarpal joints?

Answer 332

The action of the palmar and dorsal ligaments

Question 333

What type of joint are the second to fifth metacarpophalangeal joints and what movements does this allow?

Answer 333

Synovial ellipsoid joints, allow: - Flexion/extension - Abduction/adduction

Question 334

What stabilises the second to fifth metacarpophalangeal joints?

Answer 334

Collateral ligaments, muscles and tendons

Question 335

What joints exist between the phalanges of the fingers?

Answer 335

- Distal interphalangeal joint (DIP) - Proximal interphalangeal joint (PIP)

Question 336

What type of joints are the distal and proximal interphalangeal joints and what stabilises them?

Answer 336

Synovial hinge joints, stabilised by collateral ligaments

Question 337

\* What is a way to remember the name 'acetabulum'?

Answer 337

Acetic acid = vinegar, acetabulum = vinegar cup, the romans used to drink vinegar from the acetabulum of a hip bone

Question 338

What is the hip joint?

Answer 338

The articulation between the acetabulum of the hip bone and the head of the femur

Question 339

What type of joint is the hip joint?

Answer 339

Synovial ball and socket

Question 340

What movements are permitted by the hip joint?

Answer 340

- Flexion/extension - Abduction/adduction - Circumduction - Medial/lateral rotation

Question 341

What is the function of the hip joint?

Answer 341

- Locomotion - Transmission of weight whilst standing and moving (therefore must be strong/stable and still allow movement)

Question 342

What bones form the acetabulum?

Answer 342

The three bones of the hip, the pubis, ilium and ischium

Question 343

What is the acetabular labrum?

Answer 343

A ring of fibrocartilage that deepens the acetabulum socket, attaches to the transverse acetabular ligament

Question 344

Compare the shoulder and the hip joint.

Answer 344

- Features are shared, both synovial ball and socket joints with labrums deepening the socket - Both are supported by muscles, ligaments and (to only some extent in the shoulder) bone shape - Wider range of movement in shoulder is sacrificed for stability (shoulder is less stable than hip) - Hip combines motility and transmission of weight, arm only has to manage its own weight/is freely suspended

Question 345

What is the femoral head lined with?

Answer 345

Hyaline cartilage, except for a section which attaches to the femoral head ligament

Question 346

What ligament bridges the acetabular notch?

Answer 346

The transverse acetabular ligament (supports and stabilises joint)

Question 347

What is the lunate surface?

Answer 347

The articular surface of the acetabulum, lined with hyaline cartilage

Question 348

What are the main ligaments that stabilise the hip?

Answer 348

* Iliofemoral ligament * Pubofemoral ligament * Ischiofemoral ligament * Transverse acetabular ligament

Question 349

Where does the iliofemoral ligament lie?

Answer 349

Lies interiorly between the ilium and the region between the greater and lesser trochanters of the femur (intertrochanteric line), this is allowed by the ligament's Y or V shape

Question 350

Where does the pubofemoral ligament lie?

Answer 350

Between the pubis and the intertrochanteric line (between the greater and lesser trochanters of the femur)

Question 351

Where does the ischiofemoral ligament lie?

Answer 351

Between the ischium and the greater trochanter

Question 352

How do the ilio-, ischio- and pubofemoral ligaments responds to flexion and extension?

Answer 352

- Flexion: relax/loosen - Extension: tighten In this way they limit the movement/extension of the hip joint

Question 353

Why is dislocation of the hip rare?

Answer 353

* Deep acetabulum * Acetabular labrum * Three stabilising hip ligaments * Thick fibrous capsule (strengthened anteriorly by fused tendons of quadriceps and laterally by the iliotibial tract, a thick fibrous band)

Question 354

\* Which direction of dislocation in the hip is most common and why?

Answer 354

Posteriorly, most likely to occur when hip is flexed/ligaments are lax, e.g. when passengers are seated in a high speed car accident

Question 355

What are and what is the function of the menisci?

Answer 355

* Crescent-shaped pieces of fibrocartilage on the tibial condyles (in the knee joint) * Reduce friction, increase congruency and disperse weight * Both medial and lateral menisci are present

Question 356

What is the patella?

Answer 356

- A sesamoid bone (in the quadriceps femoris tendon) that articulates with the femoral condyles at the patellofemoral joint. - Smooth oval facet on posterior is covered in hyaline cartilage for articulation

Question 357

What are the two ligaments that originate from the epicondyles of the femur?

Answer 357

* Medial (tibial) collateral ligament, from medial epicondyle to the shaft of the tibia * Lateral (fibular) collateral ligament, from the lateral epicondyle to the head of the fibula, shaped like a rounded cord

Question 358

What ligament is the medial meniscus attached to?

Answer 358

Medial collateral ligament (this means that damage to the ligament can also damage the meniscus)

Question 359

Is the lateral meniscus attached to a ligament?

Answer 359

No, it is separate from the fibrous joint capsule by the tendon of the popliteus muscle

Question 360

What locks the knee during extension?

Answer 360

The medial femoral condyle

Question 361

What is 'close packed' position of the knee?

Answer 361

This is where the knee joint is fully extended, the ligaments of the knee are tightened and the knee is stabilised

Question 362

What muscle 'unlocks' the knee?

Answer 362

The popliteus muscle, laterally rotates the femur on the tibia when initiating flexion

Question 363

What are the two cruciate ligaments?

Answer 363

* Anterior cruciate ligament (ACL) * Posterior cruciate ligament (PCL) (Cruciate means 'crossing')

Question 364

What are the ligments of the knee?

Answer 364

* Collateral ligaments * Cruciate ligaments

Question 365

What is the function of the anterior cruciate ligament (ACL)?

Answer 365

Prevents excessive anterior movement of the tibia relative to the femur above

Question 366

Where does the anterior cruciate ligament (ACL) lie?

Answer 366

From the anterior part of the intercondylar area of the tibia and attaches to the inner surface of the lateral condyle of the femur (lateral wall of the intercondylar fossa) Remember through putting 'hands in pockets' - lateral to medial, posterior to anterior, proximal to distal

Question 367

What is the function of the posterior cruciate ligament (PCL)?

Answer 367

Prevents excessive posterior movement of the tibia relative to the femur above

Question 368

Where does the posterior cruciate ligament (PCL) lie?

Answer 368

Attaches to the posterior part of the intercondylar region of the tibia to the lateral surface of the medial medial condyle of the femur

Question 369

Are the cruciate ligaments prone to tears?

Answer 369

Yes, an ACL tear in particular is a common injury. They can tear in both contact and non-contact sports

Question 370

What is the talocrural joint?

Answer 370

Aka the ankle joint, between: * The distal ends of the tibia/fibula * The talus bone of the ankle

Question 371

What type of joint is the talocrural (ankle) joint and what movement does this allow?

Answer 371

Synovial hinge joint that allows: * Dorsiflexion * Plantarflexion

Question 372

How is the joint capsule of the talocrural (ankle) joint adapted to allow dorsi- and plantarflexion?

Answer 372

* Thin and weak capsule posteriorly and anteriorly * Lined by a loose synovial membrane

Question 373

What are the joints between tarsal bones called and what movements are they important for?

Answer 373

* Intertarsal joints * Important for inversion and eversion

Question 374

What is the subtalar joint?

Answer 374

The joint between the talus and the calcaneus.

Question 375

What is the midtarsal joint?

Answer 375

Complex articulations between the: * Talus, calcaneus and navicular bones * Calcaneus and cuboid

Question 376

How is the ankle joint strengthened medially and laterally?

Answer 376

By collateral ligaments (4 of them)

Question 377

What secretes the synovial fluid at a synovial joint?

Answer 377

Synovial membrane

Question 378

Describe the structure of a synovial joint.

Answer 378

* Fibrous joint capsule (continuous with the periosteum) * Joint cavity containing synovial fluid * Articulating surfaces lined with hyaline cartilage * Synovial membrane lines the cavity (where hyaline cartilage is not present) * Ligaments are present within joint capsule (but can be around it)

Question 379

Draw the structure of the glenohumeral joint.

Answer 379

Question 380

Draw the structure of the elbow joint.

Answer 380

Question 381

What is the medial deltoid ligament?

Answer 381

- A ligament formed from four bands - Radiates/reaches from the medial malleolus of the tibia to the talus, calcaneus and navicular bones

Question 382

What is the lateral collateral ligament of the ankle?

Answer 382

- Made from three bands - Passes from the lateral malleolus of the fibula to the talus (x2 connections) and the calcaneus

Question 383

Draw the hip joint.

Answer 383

Note that there is also the transverse acetabular ligament.

Question 384

Draw the transverse acetabular ligament.

Answer 384

Question 385

Draw the knee joint (not including the cruciate ligaments).

Answer 385

Question 386

Draw the cruciate ligaments of the knee.

Answer 386

Question 387

Draw the bones involved in the joints in the foot.

Answer 387

Question 388

Draw all of the ligaments in the ankle and foot that you need to know about.

Answer 388

Question 389

Why are ankle sprains more likely to occur medially?

Answer 389

Because the medial deltoid ligament is stronger than the lateral collateral ligament Ankle sprains will usually involve the anterior talofibular part of the lateral collateral ligament

Question 390

Give some examples of fibrous joints.

Answer 390

* Sutures * Sutures between flat bones of the skull * Syndesmoses * Inferior tibiofibular joint * Interosseous membrane between radius and ulna

Question 391

What are some examples of cartilaginous joints?

Answer 391

* Primary (synchondroses) * Epiphyseal plates * Secondary (symphyses) * Manubriosternal joint * Intervertebral discs * Pubic symphysis

Question 392

Where are secondary cartilaginous (symphyses) joints usually found?

Answer 392

Along the midline of the body.

Question 393

What type of joint is theproximal radioulnar joint joint?

Answer 393

Pivot joint (synovial)

Question 394

How many interphalangeal joints does the thumb have?

Answer 394

Only one

Question 395

What are the different shapes of skeletal muscles?

Answer 395

* Circular * Pennate -\> Unipennate, Bipennate, Multipennate * Parallel * Fusiform * Convergent

Question 396

What are circular muscles? Give examples and their function.

Answer 396

* Example: Orbicularis oris * Function: Sphincter muscles allowing opening and closing of an opening, in this case, the mouth.

Question 397

What are unipennate muscles? Give examples and their function.

Answer 397

* Example: Extensor digitorum longus (unipennate) * Function: Allow for a significant amount of power to be generated across the joint, since the fibres are oriented at an angle to muscle’s line of action (high muscle fibre density) and rotate as they shorten.

Question 398

What are bipennate muscles? Give examples and their function.

Answer 398

* Example: Rectus femoris * Function: Allow for a significant amount of power to be generated across the joint, since the fibres are oriented at an angle to muscle’s line of action (high muscle fibre density) and rotate as they shorten.

Question 399

What are multipennate muscles? Give examples and their function.

Answer 399

* Example: Deltoid muscle * Function: Allow for a significant amount of power to be generated across the joint, since the fibres are oriented at an angle to muscle’s line of action (high muscle fibre density) and rotate as they shorten.

Question 400

What are parallel muscles? Give examples and their function.

Answer 400

* Example: sartorius, sternocleidomastoid * Function: Fibres oriented parallel to the line of action of the muscle. Usually long muscles, bringing about large but typically weaker movements than pennate muscles.

Question 401

Compare parallel and pennate muscle functions.

Answer 401

* In pennate muscles, the fibres are not arranged along the line of action of the muscle (and they may function around a joint), while in parallel muscles they are arranged along the line of action. * This means that parallel muscles produce LONGER but WEAKER movements

Question 402

What are fusiform muscles? Give examples and their function.

Answer 402

* Example: Biceps brachii * Function: Spindle-shaped muscles containing a “muscle belly” that is wider than the points of origin and insertion. Provide large ranges of motion.

Question 403

What are convergent muscles? Give examples and their function.

Answer 403

* Example: Pectoralis major * Function: Triangular/fan-shaped muscles with wide origins and narrow points of insertions. Wide variation in muscle fibre angles allow for multiple actions across joints.

Question 404

What are origins and insertions of muscles?

Answer 404

* The origin is the attachment site that doesn't move during contraction, while the insertion is the attachment site that does move when the muscle contracts. * The origin is usually proximal, while the insertion is usually distal.

Question 405

What is a bursa and what is the function?

Answer 405

* A small fluid-filled sac lined by synovial membrane with an inner layer of synovial fluid * It provides a cushion between bones and tendons and/or muscles around a joint. * This helps to reduce friction between the bones and allows free movement. Bursae are found around most major joints of the body.

Question 406

Draw the structure of the bursa, bone and tendon at a joint.

Answer 406

Question 407

What is flexion?

Answer 407

A movement in the sagittal plane, causing a decrease in the anterior angle between the bones of the joint.

Question 408

What is extension?

Answer 408

A movement in the sagittal plane, causing an increase in the anterior angle between the bones of the joint.

Question 409

What is abduction?

Answer 409

A movement of a limb in the coronal plane, away from the midline of the body.

Question 410

What is adduction?

Answer 410

A movement of a limb in the coronal plane, towards the midline of the body.

Question 411

What is medial (internal) rotation?

Answer 411

Turning a limb inwardly, or towards the midline of the body.

Question 412

What is lateral (external) rotation?

Answer 412

Turning a limb outwardly, or away from the midline of the body.

Question 413

What is an agonist (in terms of muscles)?

Answer 413

The muscle that provides the primary force driving the joint to perform the movement in question.

Question 414

What is an antagonist (in terms of muscles)?

Answer 414

A muscle in opposition to the agonist, providing some resistance to the agonist muscle and may reverse the movement in question.

Question 415

What is a synergist (in terms of muscles)?

Answer 415

A muscle that assists the agonist muscle in performing the movement in question.

Question 416

In elbow flexion, what is the agonist, antagonist and synergist muscle?

Answer 416

* Agonist: Biceps brachii * Antagonist: Triceps brachii * Synergist: Brachialis

Question 417

What movements are possible at the hip and what muscle groups enable these?

Answer 417

* Flexion -\> Quadriceps + Iliopsoas * Extension -\> Hamstrings + Gluteus maximus * Abduction -\> Abductors * Adduction -\> Adductors * Medial rotation -\> Medial rotators * Lateral rotation -\> Lateral rotators

Question 418

Where do hip flexors insert?

Answer 418

Proximal femur

Question 419

Where do hip extensors insert?

Answer 419

Femur, tibia or fibula

Question 420

Where do hip abductors insert?

Answer 420

Femur

Question 421

Where do hip adductors insert?

Answer 421

Femur

Question 422

What muscle group flexes the knee?

Answer 422

Hamstrings

Question 423

What muscle group extends the knee?

Answer 423

Quadriceps

Question 424

What are the different compartments of the thigh and what are their functions?

Answer 424

* Anterior -\> Hip flexors and knee extensors * Posterior -\> Hip extensors and knee flexors * Medial -\> Hip adductors

Question 425

What are the different compartments of the leg and what are their functions?

Answer 425

* Anterior -\> Dorsiflexion of foot * Lateral -\> Foot eversion * Superficial posterior -\> Plantarflexion of foot * Deep posterior -\> Plantarflexion of foot

Question 426

Compare the number of compartments in the thigh and the leg.

Answer 426

* Thigh -\> 3 * Leg -\> 4 (because there is a deep and superficial posterior compartment)

Question 427

What is compartment syndrome and how can it be treated?

Answer 427

* The deep fascia surrounding the muscles of the lower limb encourages venous return, but can be problematic if the pressure within these muscle compartments increases. * Bleeding into or swelling of these tissues can cause compression of the deep veins, resulting in further oedema and raised compartmental pressure. * It can be treated by four compartment fasciotomy to release the pressure in each compartment.

Question 428

What movements are possible at the shoulder?

Answer 428

* Flexion * Extension * Abduction * Adduction * Medial Rotation * Lateral Rotation

Question 429

Describe the position of shoulder flexors.

Answer 429

Muscles crossing the joint anteriorly to insert into the proximal humerus flex the shoulder joint.

Question 430

Describe the position of shoulder extensors.

Answer 430

Muscles passing posterior to the joint to insert into the humerus extend the shoulder joint.

Question 431

Describe the position of shoulder abductors.

Answer 431

Muscles crossing the joint to insert into the lateral proximal humerus abduct the shoulder joint.

Question 432

Check that you have flashcards on the rotator cuff muscles. Add some if not.

Answer 432

Do it.

Question 433

Give some examples of rotator cuff injuries. [EXTRA?]

Answer 433

Question 434

Describe the position of elbow flexors.

Answer 434

Muscles crossing the joint anteriorly to insert into the proximal radius.

Question 435

Describe the position of elbow extensors.

Answer 435

Muscles passing posterior to the joint to insert into the proximal radius and ulna.

Question 436

What are the compartments of the forearm and what is their function?

Answer 436

* Anterior -\> Flexion of the wrist and pronation of the forearm [CHECK] * Posterior -\> Extension of the wrist and supination of the forearm * Mobile wad

Question 437

Label this.

Answer 437

Question 438

At what joint do pronation and supination of the forearm happen?

Answer 438

Proximal radioulnar joint

Question 439

What muscles bring about forearm pronation?

Answer 439

Pronator teres and pronator quadratus of the anterior compartment.

Question 440

What muscles bring about forearm supination?

Answer 440

Supinator of the posterior compartment.

Question 441

What is tennis elbow? [EXTRA]

Answer 441

Question 442

What is golfers' elbow? [EXTRA]

Answer 442

Question 443

What structures hold tendons in place?

Answer 443

* Retinaculum -\> Band of thickened deep fascia around tendons that holds them in place. * Tendon sheath -\> Layer of synovial membrane around a tendon. It permits the tendon to stretch and not adhere to the surrounding fascia.

Question 444

How many cranial nerves are there?

Answer 444

12 (I-XII)

Question 445

How many spinal nerves are there and what are the divisions?

Answer 445

31: * 8 cervical nerves (C1-8) * 12 thoracic nerves (T1-12) * 5 lumbar nerves (L1-5) * 5 sacral nerves (S1-5) * 1 coccygeal nerve (Co)

Question 446

Draw the cross section of the spinal cord showing how it produces nerve roots.

Answer 446

Question 447

What happens to spinal nerves after they emerge from the spinal cord?

Answer 447

They split into primary rami: anterior and posterior rami.

Question 448

What do the anterior and posterior rami supply? [IMPORTANT]

Answer 448

* Anterior -\> Limbs and ventral trunk * Posterior -\> Spinal extensors and overlying skin

Question 449

When spinal nerves divide into anterior and posterior rami, do the sensory and motor fibres divide also?

Answer 449

No, there are both sensory and motor fibres in each rami.

Question 450

Draw a diagram to show how a nerve root can supply a level of the thorax and connect with the sympathetic trunk.

Answer 450

Question 451

What is a dermatome?

Answer 451

Unilateral area of skin receiving innervation from a single spinal nerve.

Question 452

Draw a diagram to show the dermatomes of the human body.

Answer 452

Question 453

Are dermatomes precisely mapped?

Answer 453

No, they are overlapping and hard to map.

Question 454

Describe which way limbs rotate during development and how this is demonstrated by dermatomes.

Answer 454

* UPPER LIMB rotates LATERALLY (dorsally) * LOWER LIMB rotates MEDIALLY (ventrally) Growth and rotation distort the segmental dermatome pattern -\> Particularly in lower limb.

Question 455

What is a myotome?

Answer 455

Unilateral portion of skeletal muscle receiving innervation from a single spinal nerve.

Question 456

Can a muscle receive innervation from more than one nerve root?

Answer 456

Yes.

Question 457

Name all of the nerve roots controlling the different upper limb movements.

Answer 457

Question 458

Name all of the nerve roots controlling the different lower limb movements.

Answer 458

Question 459

What nerve roots control shoulder abduction and adduction?

Answer 459

* Abduction -\> C5 * Adduction -\> C6, C7, C8

Question 460

What nerve roots control shoulder flexion and extension?

Answer 460

* Flexion -\> C5 * Extension -\> C6, C7, C8

Question 461

What nerve roots control elbow flexion and extension?

Answer 461

* Flexion -\> C5, C6 * Extension -\> C6, C7, C8

Question 462

What nerve roots control forearm pronation and supination?

Answer 462

* Pronation -\> C7, C8 * Supination -\> C6

Question 463

What nerve roots control wrist flexion and extension?

Answer 463

* Flexion -\> C6, C7 * Extension -\> C6, C7

Question 464

What nerve roots control finger flexion, extension, abduction and adduction?

Answer 464

* Flexion -\> C7, C8 * Extension -\> C7, C8 * Abduction -\> T1 * Adduction -\> T1

Question 465

What nerve roots control hip flexion and extension?

Answer 465

* Flexion -\> L2, L3 * Extension -\> L4, L5

Question 466

What nerve roots control hip abduction and adduction?

Answer 466

* Abduction -\> L5, S1 * Adduction -\> L2, L3

Question 467

What nerve roots control medial and lateral hip rotation?

Answer 467

* Medial -\> L2, L3 * Lateral -\> L5, S1

Question 468

What nerve roots control knee flexion and extension?

Answer 468

* Flexion -\> L5, S1 * Extension -\> L3, L4

Question 469

What nerve roots control plantarflexion and dorsiflexion?

Answer 469

* Plantarflexion -\> S1, S2 * Dorsiflexion -\> L4, L5

Question 470

What nerve roots control foot inversion and eversion?

Answer 470

* Inversion -\> L4, L5 * Eversion -\> L5, S1

Question 471

Draw the anatomical basis for the patellar tendon reflex.

Answer 471

Question 472

What spinal root does the biceps jerk reflex test? [IMPORTANT]

Answer 472

C5/C6

Question 473

What spinal root does the knee jerk reflex test? [IMPORTANT]

Answer 473

L3/L4

Question 474

Where do named peripheral nerves (e.g. obturator nerve) originate from?

Answer 474

They are formed by the joining of ventral rami (meaning that a peripheral nerve may have may spinal nerve roots).

Question 475

What are the two important nerve plexuses you need to know about?

Answer 475

* Brachial plexus * Lumbosacral plexus

Question 476

What nerve roots form the brachial plexus?

Answer 476

C5-T1

Question 477

What nerve roots form the lumbosacral plexus?

Answer 477

L1-S3

Question 478

What are the main upper limb nerves?

Answer 478

* Musculocutaneous * Median * Ulnar * Axillary * Radial

Question 479

What are the main lower limb nerves?

Answer 479

* Femoral * Obturator * Sciatic * Tibial * Common, deep and superficial peroneal (fibular)

Question 480

Draw a diagram to show the innervation of the main body compartments [although you don't need to know most of these probabaly].

Answer 480

Question 481

Draw the structure of the brachial plexus. [EXTRA]

Answer 481

Question 482

What are the nerves that supply the flexor and extensor compartments of the upper limb? Include nerve roots. [IMPORTANT]

Answer 482

* Flexor -\> Musculocutaneous (C5-C7) * Extensor -\> Radial (C5-T1)

Question 483

What are the nerves that supply the flexor and extensor compartments of the lower limb? Include nerve roots. [IMPORTANT]

Answer 483

* Flexor -\> Sciatic (L4-S3) * Extensor -\> Femoral (L2-L4)

Question 484

Do you need to know the innervation of the whole upper and lower limbs?

Answer 484

No, the spec doesn't specify this. It only really specificies the innervation of the extensor and flexor compartments.

Question 485

Draw the sensory territories of the different upper limb nerves.

Answer 485

Question 486

For the musculocutaneous nerve, draw a diagram to show which muscles are innervated by it.

Answer 486

Question 487

For the median nerve, draw a diagram to show which muscles are innervated by it. [EXTRA?]

Answer 487

Question 488

For the ulnar nerve, draw a diagram to show which muscles are innervated by it. [EXTRA?]

Answer 488

Question 489

For the radial nerve, draw a diagram to show which muscles are innervated by it.

Answer 489

Question 490

For the femoral and obturator nerves, draw a diagram to show which muscles they innervate.

Answer 490

Question 491

For the sciatic nerve, draw a diagram to show which muscles it innervates.

Answer 491

Question 492

For the tibial nerve, draw a diagram to show which muscles it innervates. [EXTRA?]

Answer 492

Question 493

For the fibular (a.k.a. peroneal) nerves, draw a diagram to show which muscles they innervate.

Answer 493

Question 494

Draw the sensory territories of the lower limb.

Answer 494

Question 495

How many vertebrae are there?

Answer 495

33

Question 496

How many of each type of vertebrae are there?

Answer 496

* Cervical -\> 7 * Thoracic -\> 12 * Lumbar -\> 5 * Sacral -\> 5 (fused) * Coccygeal -\> 4

Question 497

To what vertebral level does the spinal cord descend?

Answer 497

L1-L2

Question 498

Label this vertebra.

Answer 498

Question 499

What are the important structures of a typical vertebra?

Answer 499

* Body * Pedicle * Canal * Lamina * Transverse and spinous processes * Articulation facets

Question 500

What is the body of a vertebra?

Answer 500

The thick oval segment of bone forming the front of the vertebra (also called the centrum).

Question 501

What is a pedicle of a vertebra?

Answer 501

* The two pedicles are the two short columns of bone that connects the lamina to the vertebral body to form the vertebral arch. * They form a hollow archway that protects the spinal cord.

Question 502

What is the canal of a vertebra?

Answer 502

It is the opening through which the spinal cord passes. It is also known as the foramen.

Question 503

What is a lamina of a vertebra?

Answer 503

The lamina is the part of the vertebra that connects the spinous process and the transverse process. There are two laminae, located on either side of the spinous process.

Question 504

What are the two types of process on a vertebra?

Answer 504

* Spinous * Transverse

Question 505

What is the spinous process of a vertebra and what is the function?

Answer 505

* Spinous process is a bony projection off the posterior of each vertebra. * The spinous process protrudes where the laminae of the vertebral arch join and provides the point of attachment for muscles and ligaments of the spine.

Question 506

What are the transverse processes of vertebra and what is their function?

Answer 506

* Small bony projections off the right and left side of each vertebrae. * The two transverse processes of each vertebrae function as the site of attachment for muscles and ligaments of the spine as well as the point of articulation of the ribs (in the thoracic spine).

Question 507

What are the articulation facets of a vertebra and what is their function?

Answer 507

* Each vertebra has two sets of facet joints. * One pair faces upward (superior articular facet) and one downward (inferior articular facet). * There is one joint on each side (right and left). Facet joints are hinge–like and link vertebrae together.

Question 508

Describe the curvature of the different parts of the spine.

Answer 508

* Cervical -\> Lordosis * Thoracic -\> Kyphosis * Lumbar -\> Lordosis * Sacral -\> Lordosis

Question 509

Describe how spinal curvature changes with age.

Answer 509

Question 510

What are some forms of abnormal curvature of the spine?

Answer 510

Question 511

What are the 3 different embryological origins of different parts of the skeleton?

Answer 511

* Craniofacial -\> Neural crest * Axial skeleton -\> Somites * Limb skeleton -\> Lateral plate mesoderm

Question 512

From what embryological origin does the axial skeleton develop?

Answer 512

Somites (a.k.a. paraxial mesoderm)

Question 513

What ossification process does the axial skeleton form by?

Answer 513

Endochondral ossification

Question 514

Describe what induces the axial skeleton to form. How does it form?

Answer 514

* Notochord expresses Shh which induces medial somitic cells to form the sclerotome * Sclerotome cells then migrate to surround the neural tube and form vertebrae by endochondral ossification

Question 515

Describe in detail the formation of the vertebrae when the sclerotome surrounds the neural tube.

Answer 515

Notice how a fissure in each somite followed by fusion of adjacent segments leads to the inter-vertebral contents (e.g. the nucleus pulposus) existing between the vertebrae.

Question 516

What patterns the vertebrae in a cranio-caudal direction?

Answer 516

Hox genes

Question 517

What are the effects of Hox gene deletions on the axial skeleton?

Answer 517

* Result in skeletal abnormalities * Mice in which Hox D4 has been knocked out show a transformation of the axis vertebra (C2) to an atlas-like (C1) structure

Question 518

What are some examples of conditions caused by abnormal spinal development?

Answer 518

* Spina bifida * Hemivertebrae * Abnormal curvature (e.g. scoliosis)

Question 519

What causes spina bifida?

Answer 519

* Failure of neural tube closure: * This occurs when the spines and arches of one or more vertebrae don't fully develop

Question 520

What are some structural specialisations of cervical vertebrae?

Answer 520

* Small bodies * Large vertebral foramina * Foramina transversaria -\> Small foramina in the pedicles that allow passage of an artery and vein

Question 521

Which cervical vertebrae is most prominent?

Answer 521

C7

Question 522

What are some structural specialisations of thoracic vertebrae?

Answer 522

* Small vertebral foramen * Long spines * Costal facets for rib articulation (on transverse processes)

Question 523

What are some structural specialisations of lumbar vertebrae?

Answer 523

* Large bodies

Question 524

What are some structural specialisations of sacral vertebrae?

Answer 524

* Fused * Large surface of articulation with the pelvis

Question 525

What are some structural specialisations of the coccygeal vertebrae?

Answer 525

* Lower 3 are fused

Question 526

What type of vertebra is this?

Answer 526

Thoracic

Question 527

What type of vertebra is this?

Answer 527

Sacral

Question 528

What type of vertebra is this?

Answer 528

Coccygeal

Question 529

What type of vertebra is this?

Answer 529

Lumbar

Question 530

What type of vertebra is this?

Answer 530

Cervical

Question 531

What determines the directions of movement that are possible between different vertebrae?

Answer 531

The shapes of articulation facets on the superior and inferior side.

Question 532

Describe the movements that are possible at different regions of the spine. [IMPORTANT]

Answer 532

* Cervical -\> Flexion/Extension * Thoracic -\> Rotation (and almost no flexion/extension) * Lumbar -\> Flexion/Extension

Question 533

Which parts of the spine have a lordosis? [IMPORTANT]

Answer 533

Lumbar and sacral (these are the only ones mentioned in the spec)

Question 534

What is the name for the C1 and C2 vertebrae?

Answer 534

* C1 -\> Atlas * C2 -\> Axis

Question 535

What does the atlas articulate with superiorly?

Answer 535

Occipital condyles

Question 536

What is the name of the process that points vertically upwards from the axis? What is its function?

Answer 536

Dens -\> Allows rotation of the atlas on top of the axis.

Question 537

What is the most distinct feature of the atlas as a vertebra?

Answer 537

It has no spinous process and it has large facets for articulation with the condyles of the occipital bone.

Question 538

Draw the structure of the atlas.

Answer 538

Question 539

Draw the structure of the axis.

Answer 539

Question 540

Draw all of the ligaments that hold the dens of the axis in place.

Answer 540

Question 541

Describe how ribs articulate with the vertebrae.

Answer 541

* Articulate with the thoracic vertebrae. * Each rib forms two joints: * Costotransverse joint -\> Between the tubercle of the rib, and the transverse costal facet of the corresponding vertebrae. * Costovertebral joint -\> Between the head of the rib, superior costal facet of the corresponding vertebrae, and the inferior costal facet of the vertebrae above.

Question 542

Where does the skull articulate with the vertebral column?

Answer 542

The occipital condyles articulate with the superior facets of the atlas.

Question 543

Where does the pelvis articulate with the vertebral column?

Answer 543

At the sacrum.

Question 544

What is the joint type of the atlanto-occipital joint? What movements are perimitted?

Answer 544

* Synovial joints between occipital condyles and atlas * Movements: Flexion, Extension, Lateral flexion

Question 545

What is the joint type of the atlanto-axial joint? What movements are perimitted?

Answer 545

* Synovial joints between odontoid process and lateral masses of axis and the atlas * Movements: Rotation

Question 546

What are the two joint types between vertebrae? What is the structural type of joint of each?

Answer 546

* Synovial joints between articular processes * Secondary cartilaginous joints between bodies

Question 547

What is the joint type of intervertebral discs? Describe the structure.

Answer 547

Secondary cartilaginous: * Nucleus pulposus -\> Gelatinous with high water content * Anulus fibrosus -\> Fibrocartilage

Question 548

Describe the different ligaments stabilising the spine.

Answer 548

Question 549

What are some muscles that enable movement of the spine?

Answer 549

Question 550

At what points does the spinal cord enlarge?

Answer 550

Cervical and lumbar

Question 551

What is the name for the lower tip of the spinal cord?

Answer 551

Conus medullaris

Question 552

After the spinal cord ends, what do the nerve roots continue as?

Answer 552

Cauda equina

Question 553

At what vertebral level does the subarachnoid space end at?

Answer 553

S2

Question 554

How many nerve roots are there?

Answer 554

31 (There are C1-C8 nerve roots, even though there are only 7 cervical vertebrae, and there is only 1 coccygeal nerve. So there are 31 nerve roots and 33 vertebrae.)

Question 555

At what points do spinal nerves leave the vertebral canal?

Answer 555

Via the inter-vertebral foramina.

Question 556

What is the consequence of intervertebral disc prolapse?

Answer 556

The prolapsed discs may compress nerve roots.

Question 557

In which regions of the spine is a disc prolapse most common?

Answer 557

* Lower lumbar * Lower cervical

Question 558

What intervertebral disc prolapse direction is most common?

Answer 558

Postero-lateral

Question 559

What is the site and direction for lumbar puncture?

Answer 559

* L4/L5 * Direction: From **_L_**amina to **_P_**edicle (Lumbar Puncture)

Question 560

Describe lumbar puncture.

Answer 560

Question 561

What is sciatica?

Answer 561

Any sort of pain caused by irritation or compression of the sciatic nerve, which runs from your hips to your feet.