Anterior drawer sign
ACL injury - posterolateral femur to anterior tibia
Posterior drawer sign
PCL injury - medial femur to posterior tibia
Posterior knee dislocation
Damage to popliteal artery
McMurray test
Pain/popping on external rotation (medial meniscal tear), internal rotation (lateral meniscal tear)
Abnormal passive abduction
MCL injury
Abnormal passive adduction
LCL injury
Unhappy triad
Lateral force applied to planted leg - ACL, MCL, medial meniscus
Prepatellar bursitis
Housemaid’s knee - extensive kneeling (affects perineal nerve)
Baker cyst
Popliteral flud collection - chronic joint disease
Hip flexion muscles
Iliopsoas (iliacus, psoas major/minor), rectus femoris, tensor fascia lata
Hip extension muscles
Gluteus maximus, semitendinosus, semimembranosus, biceps femoris long head
Hip abduction muscles
Gluteus medius/minimus
Hip adduction muscles
Adductor longus/brevis/magnus
Rotator cuff muscles
Supraspintaus (suprascapular n - abducts arm initially), Infraspintaus (suprascapular n - laterally rotates, pitching injury), Teres minor (axillary n - adducts, laterallly rotates), Subscapularis (subscapular n - medially rotates and adducts) - All innervated by C5-6
Medical epicondylitis
Golfer’s elbow - repetitive flexion
Lateral epicondylitis
Tennis elbow - repetitive extension
Wrist bones
SO (Scaphoid) LONG (Lunate) TO (Triquetrum) PINKY (Pisiform), HERE (Hamate) COMES (Capitate) THE (Trapezoid) THUMB (Trapezium) (proximal L to M, distal M to L)
Most commonly fractured carpal bone
Scaphoid (anatomic snuff box), fall on outstretched hand, avascular necrosis
Dislocation of lunate
Acute carpal tunnel syndrome
Damage to hook of hamate
Ulnar nerve injury
Carpal tunnel syndrome
Median nerve compression - pregnancy, rheumatoid arthritis, hypothyroidism
Guyon canal syndrome
Compression of ulnar nerve in cyclists
Axillary nerve injury
C5-C6 - fractured surgical neck of humerus, anterior dislocation of humerus - flattened deltoid, loss of arm abduction > 15 degress, loss of sensation over deltoid and lateral arm
Musculocutaneous nerve injury
C5-C7 - loss of forearm flexion and supination, loss of lateral forearm sensation
Radial nerve injury
C5-T1 - midshaft humerous fracture, compression of axilla (crutches) - wrist drop, decreased grip strength, loss of sensation over posterior forearm/arm/dorsal hand
Nursemaid elbow
Radial nerve injury - deep branch only so wrist drop but no sensory loss
Median nerve injury
C5-T1 - Supracondylar fracture of humerus, carpal tunnel syndrome - ape hand and Pope’s blessing, loss of wrist flexion/fexion of lateral fingers/thumb opposition, loss of sensation over thenar eminence and lateral 3 1/2 fingers, Tinel sign (tingling on percussion in carpal tunnel)
Ulnar nerve injury
C8-T1 - Funny bone fracture (medial epicondyle), fractured hook of hamate - ulnar claw, radial deviation of wrist on flexion, loss of wrist flexion/flesion of medial fingers, abduction/adduction of fingers - loss of sensation of medial 1 1/2 fingers and hypothenar eminence
Recurrent branch of median nerve injury
Superficial palm laceration - Ape hand, loss of thenar muscle group
Brachial plexus parts
RANDY TRAVIS DRINKS COLD BEER - Roots, Trunks, Divisions, Cords, Branches
Erb Palsy
Waiter’s tip - tear of upper trunk (C5-6) - lateral traction on neck during delivery - deltoid/supraspinatus (no abduction), infraspintaus (no lateral rotation), biceps (no flexion or supination)
Klumpke palsy
Tear of lower trunk (C8-T1) - upward force on arm during delivery, fall grabbing a tree branch - intrinsic hand muscles (total claw hand)
Thoracic oulet syndrome
Compression of lower trunk and subclavian vessels - pancoast tumor - atrophy of intrinsic hand muscles
Winged scapula
Long thoracic nerve lesion - axillary node dissection after mastectomy, stab wound - serratus anterior - can’t abduct arm above 90 degrees
Interossei muscles
DAB PAD - Dorsal AB duct and Palmar AD duct
Obturator nerve injury
L2-L4 - pelvic surgery - decreased medial thigh sensation and decreased adduction
Femoral nerve injury
L2-L4 - pelvic fracture - decreased thigh flexion and leg extension
Common peroneal nerve injury
L4-S2 - trauma or compression of lateral leg, fibular neck fracture (very superficial) - foot drop (ineverted and plantarflexed), loss of sensation on dorsum of foot
Tibial nerve injury
L4-S3 - knee trauma, Baker cyst - inability to curl toes and loss of sensation on sole of foot
Superior gluteal nerve injury
Injury during intramuscular injection (superomedial quadrant), pelvic trauma, hip surgery - Trendelenburg sign
Trendelenburg sign
Pelvis tilts toward unaffected side - lesion is contralateral to hip that drops (superior gluteal nerve)
Inferior gluteal nerve injury
L5-S2 - posterior hip dislocation - difficulty climbing stairs and rising from a seated position
Pudendal nerve block
S2-S4 - ischial spine as landmark
Sciatica
Weak posterior thigh and all muscles below the knee, decreased ankle reflex, patellar reflex is normal
L3-L4 disc herniation
L4 nerve - weak knee extension, decreased patellar reflex
L4-L5 disc herniation
L5 nerve - weak dorsiflexion, difficult heal walking
L5-S1 disc herniation
S1 nerve - weak plantarflexion, difficult toe walking, decreased Achilles reflex
Muscle cotnraction causes shortening of
H and I bands and between Z lines (HIZ shrinkage), A band is Always the same
Ca binds to ____ on muscle cells
Troponin C - moving tropomyosin out of myosin binding groove on actin
Sarcomere organization
An Interesting Zoo Must Have Mammals - Actin in I band attached to Z line, Myosin in H band attached to M line
Smooth muscle contraction
Ca binding Calmodulin causes Myosin-light chain kinase to phosphorylate and lead to contraaction
Smooth muscle relaxation
Nitric Oxide activates Guanylate cyclase activating Myosin light chain phosphatase to dephosphorylate
Parathyroid hormone
Low levels causes anabolic effects, chronically increased PTh levels causes catabolic effects
Radial head subluxation
Damage to annular ligament - children present with injured arm at side, elbow extended, and pronated – occurs with sharp pull of hand when arm is extended and pronated (walking holding hands)
Bone specific ALP measures
Osteoblast activity
Tartrate resistant acid phosphatase, urinary hydroxyproline, and urinary deoxypyridinoline measure
Osteoclast activity
Surgical neck of humerus artery/nerve
Axillary nerve/posterior circumflex artery
Midshaft of humerus artery/nerve
Radial nerve/Deep brachial artery
Distal humerus/cubital fossa artery/nerve
Median nerve/Brachial artery
Popliteal fossa artery/nerve
Tibial nerve/Popliteal artery
Posterior to medial malleolus artery/nerve
Tibial nerve/Posterior tibial artery