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Block 4 > Introduction To Limb Musculoskeletal Anatomy > Flashcards

Introduction To Limb Musculoskeletal Anatomy Flashcards

1
Q

What are the different parts of a long bone?

A
  1. Epiphysis: where articulations take place
  2. Metaphysis
  3. Diaphysis: anatomical shaft
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2
Q

What do lumps/bumps and grooves on bones represent?

A

Lumps/bumps = where muscles attach so bone reinforces itself at this point

Grooves = structure is running over the bone at this point e.g. vessel

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3
Q

What are the different types of bone?

A
  1. Long: upper/lower limbs
  2. Short: hands/feet
  3. Sesamoid: tendons e.g. patella
  4. Flat bones e.g. pelvic girdle/skull/scapula
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4
Q

What are the features of sesamoid bones?

A

Bone situated within a tendon (look like free bones in X-rays) to:

  • Reduce the wear of the tendon preventing it rubbing against bone
  • Improve muscle efficiency
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5
Q

What are the features of flat bones?

A
  • Large SA for muscle attachment
  • Weight/force transfer region
  • Protection
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6
Q

What is Wolff’s law?

A

Bone is deposited and reabsorbed (remodels) in accordance with the stresses placed upon it where LESS STRESS = LESS BONE which over time, can cause osteopenia (precursor of osteoporosis) if a bone is not utilised so the body reabsorbs it

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7
Q

What are the 2 types of bone within a bone? Why do we have these?

A
  1. Cancellous/trabecular: low density allowing bone to be flexible under weight bearing (metaphysis region)
  2. Cortical: high density allowing bone to compression bear (edges of diaphysis region)
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8
Q

What makes up the axial skeleton?

A 
More medial structures:
Skull
Ribs
Sternum
Vertebrae
Sacrum
Coccyx
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9
Q

What makes up the appendicular skeleton?

A

More lateral structures:
Hip bones of pelvic girdle
Pectoral girdle
Limbs (upper/lower)

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10
Q

How do the limbs develop?

A
  1. Grow out as buds from week 4/5 forming flippers at top and bottom of embryo
  2. Digits and overall limb shape present by week 8 but hands/feet webbed
  3. Digits form by apoptosis along gaps to separate out the digits
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11
Q

What are the different types of developmental limb defects?

A
  1. Amelia: no limb development
  2. Meromelia/phocomelia: part limb/seal-like limb
  3. Polydactyly: additional digits
  4. Syndactyly: webbed digits
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12
Q

What are the causes of developmental limb defects?

A
  1. Genetic
  2. Teratogenic e.g. Thalidomide (anti-nauseant, sleeping pill) + Retinoids (Vit A derivatives)
  3. Mechanical e.g. amniotic bands strangle tissue cutting of blood supply preventing it developing properly
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13
Q

What are the main functions of the upper limbs?

A

Range of MOVEMENT in preference to strength/stability:

  • Carriage
  • Fine manipulative tasks
  • Feeding
  • MINIMAL locomotion
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14
Q

What are the main functions of the lower limbs?

A

STRENGTH/STABILITY in preference to range of movement:

  • Support body weight
  • Maintain upright posture
  • Locomotion (gait)
  • Accommodate shock loading
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15
Q

What is the same basic layout that limbs share?

A
  1. Girdle: appendage/attachment point)
  2. Single long bone
  3. Paired long bones
  4. Short and long bones: carpals/tarsals, metacarpals/metatarsals + phalanges
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16
Q

Synovial joints predominate in limbs. What are the different types?

A 
Ball + socket
Hinge
Pivot
Ellipsoid
Mixed types
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17
Q

What are the 2 types of bone-to-bone joints of the body?

A
  1. Fibrous (e.g. suture, gomphosis + syndesmosis): relatively stable with little movement
  2. Cartilaginous (e.g. IV discs, epiphysis, symphysis + synovial): relatively fixed and stable to highly mobile respectively
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18
Q

All joints balance stability with mobility. In order of least-most mobile and most-least stable, list them.

A
  1. Fibrous: very stable with no movement so do not dislocate/fracture
  2. 1o and 2o cartilaginous: quite stable and slightly mobile e.g. pubic symphysis softens and parts slightly to allow for childbirth
  3. Synovial: not very stable because it is highly mobile making them more prone to dislocation
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19
Q

What are the structural features of synovial joints from innermost to outermost?

A

Hyaline cartilage: smooth articular surface between bones

Joint/synovial cavity: surrounds cartilage and contains synovial fluid to lubricate joint

Synovium (serous membrane): sheet of fibrous connective tissue that secretes synovial fluid

Joint capsule: ligament that protects and supports all of this connecting bone-bone

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20
Q

For a joint to increase its constraining forces and become more stable, what must it do?

A

DECREASE JOINT MOBILITY - why the hip joint is more stable than the shoulder

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21
Q

What is the pectoral girdle?

A

Mobile structure (scapula + clavicle) with only one joint with the axial skeleton (all join to sternum anteriorly) - girdle mobility increases overall range of limb motion:

  • Compressive forces are transmitted via the clavicle (e.g. if fall with hands outstretched it will fracture the clavicle)
  • Tension is transmitted via muscles
  • Scapula fracture uncommon
22
Q

What must you worry about if a patient has fracture their scapula?

A

Patient needs high impact blunt force trauma in order to damage the scapula so a scapula fracture would most likely be the least of your worries - there would likely be internal damage

23
Q

What is the pelvic girdle?

A

Rigid ring of bone partly formed by axial skeleton and has a rigid connection with it:

  • Distributes weight of axial body to lower limbs
  • Enables locomotion and standing
  • Force transmission mostly via compression
24
Q

What is the mobility and stability of the pectoral girdle vs the pelvic girdle?

A

Pectoral:
Motion = high
Stability = low

Pelvic:
Motion = medium
Stability = medium/high

25
Q

How might you fracture the pelvic girdle?

A

Posterior dislocation due to fracture as a result of high force trauma from road traffic incidents as the dashboard may hit it and hip is least stable when sitting down

26
Q

How can inherent stability of a joint be altered?

A

If properties of the supportive anatomy are altered i.e. if joint is stretched increasing its mobility making it more prone to dislocation (e.g. when a patient trains themselves to do the splits)

27
Q

What are bursae?

A

Pockets of synovium and synovial fluid found in regions of friction/wear and allowing free motion where some are isolated and others communicate with joint spaces e.g. over patella and elbow

28
Q

What are the symptoms and treatment of bursitis?

A

Symptoms: localised pain and tenderness to palpation with increased wear of bursae

Treatment: bursae can be aspirated/injected with steroid

29
Q

What are synovial sheaths?

A

Synovium and synovial fluid that surrounds tendons at the point of wear/friction/direction change that can be individual or shared BUT can act as routes for infection spread e.g. common flexor sheath of hand extends through palm and carpal tunnel into proximal forearm

30
Q

What problems can occur with synovial sheaths?

A 
Synovitis = synovium inflammation
Tenosynovitis = inflammation of sheath AND tendon

Symptoms: pain on use and possible tendon rupture

31
Q

What are nerve plexi?

A

Regions where ventral rami of spinal nerves join and exchange neurons - most named nerves of limbs that arise from a plexus contain neurons from multiple spinal nerves:

  • Brachial plexus = upper limb
  • Lumbar and sacral plexus = lower limbs
32
Q

What is a dermatome?

A

Area of skin innervated by a single spinal nerve - neurons from a spinal nerve can travel to dermatome via multiple routes/nerves due to nerve plexi SO spinal nerve damage (e.g. of C5) = dermatomal sensory loss

33
Q

What is a cutaneous nerve area?

A

Area of skin innervated by a named cutaneous nerve - can innervate all of dermatome, part of one or all of dermatome plus parts of another SO peripheral nerve damage (e.g. femoral n. carries L2, L3 + L4 spinal nerves so supplies these dermatomes) = cutaneous sensory loss

34
Q

What is the relevance of fascial limb compartments?

A

Allows you to determine function of a muscle:

  • Anterior compartment = mostly flexor function
  • Posterior compartment = mostly extensor function
35
Q

What is compartment syndrome? What must be done about it?

A

Syndrome that causes raised pressure in thick deep fascia limb compartment due to bleeding for example - medical emergency where you must incise through skin and fascia to release pressure and leave it open for days to prevent limb loss

36
Q

What is found in the anterior thigh compartment?

A

Hip flexor and knee extensor
Innervated by femoral n. (L2, L3 + L4)
Supplied by femoral artery

37
Q

What are spaces?

A

Contained spaces created by fascia that are important in infection localisation and spread

38
Q

What are retinacula?

A

Thick bands of fascia that prevents tendon bowstringing and keep tendons in proximity of a joint enabling functioning through range of joint motion

39
Q

What problems can occur with spaces and retinacula?

A
  1. Paronychia: infection around nail beds
  2. Felon: infection in bound spaces of digits
  3. Cellulitis: can mimic other conditions in this system but also be the result of these infections - tracking rash up hand/foot then limbs
40
Q

What is the general pattern of blood supply to the limbs?

A
  1. Main artery going in at attachment point
  2. Splitting off into 2 above 1st joint line
  3. Splitting off into 2 again below 1st joint line
  4. Forming interconnecting collateral blood supply called arches in the hands/foot
41
Q

What is the arterial supply to the upper limb?

A
  1. Subclavian artery -> axillary artery
  2. Splits in profundal branchii artery + brachial artery above elbow
  3. At elbow, brachial artery splits into radial and ulna artery
  4. At wrist these become palmar arches
42
Q

What is the arterial supply to the lower limb?

A
  1. Femoral artery splits into profunda femoris artery + popliteal artery above knee
  2. Popliteal artery splits into anterior + posterior tibial artery at knee
  3. Posterior tibial artery gives off a branch called the fibular artery
  4. At the ankle:
    - Anterior tibial -> dorsalis pedis
    - Fibular -> arcuate
    - Posterior tibial -> deep plantar arch
43
Q

What are the pulse points of the limbs?

A
  1. Brachial artery in medial upper arm
  2. Brachial artery at anterior elbow
  3. Radial artery on R side of wrist
  4. Ulna artery on L side of wrist
  5. Femoral artery at groin
  6. Popliteal artery posterior to knee
  7. Dorsalis pedis on R side of foot
  8. Deep plantar arch on L side of foot
44
Q

What is the venous drainage of limbs?

A

Superficial veins start as arches on dorsum of hand/foot and eventually pierce the deep fascia and drain to deeper veins

45
Q

Why must you be careful when cannulating superficial veins?

A

They often run close to cutaneous nerves so these can be damaged

46
Q

What are venae comitantes?

A

Veins that run with and wrap around arteries and between muscles in muscular compartments

47
Q

What is the lymphatic drainage of the upper limb?

A
  1. Cubital fossa
  2. Around axilla region:
    - Humeral
    - Subscapular
    - Pectoral
    - Central
    - Apical
    - Supraclavicular
48
Q

What is the lymphatic drainage of the lower limb?

A
  1. Popliteal fossa

2. Inguinal nodes (superficial and deep)

49
Q

When must you feel the axillary lymph nodes?

A

If a patient has a cancer of the chest wall or breast tissue that may have metastasized

50
Q

What is the difference between insertion and origin points of muscles?

A 
Origin = generally more fixed and proximal
Insertion = more mobile point and distal
51
Q

Why it is important to know the attachment points of some key muscles?

A
  1. Sometimes muscles can pull off of attachment point causing an avulsion fracture
  2. Helps you determine what the muscle does and consequences of loss
  3. Clinical testing

Block 4 (33 decks)

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