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Flashcards in Locomotor Deck (157):
1

Movements at the talocrural joint

Dorsiflexion and plantarflexion

2

Movements at the subtalar joint

Eversion and inversion

3

In which position is the ankle most stable?

Dorsiflexion due to the talus being wider anteriorly

4

What are the medial ankle ligaments?

Deltoid ligament that is made up of 4 adjacent continuoua ligaments attaching the medial malleolus to the calcaneous and navicular bones

5

What are the lateral ankle ligaments?

Anterior talofibular
Posterior talofibular
Calcaneofibular

6

Dorsiflexor and toe extensors

Tibialis anterior, extensor digitorum longus and extensor hallucis longus

7

Everters

Fibularis longus and brevis

8

Plantarflexors

Gastrocnemius, soleus and plantaris

9

Toe flexors

Flexor digitorum longus, flexor hallucis longus, tibialis posterior

10

Inverters

Tibialis anterior and posterior

11

Medial arch support

Spring ligament, deltoid ligament, tendon of tibialis posterior

12

Lateral arch support

Long plantar ligament and tendons of extensor muscles

13

Elbow bursae

Intratendinous - in triceps tendon
Subtendinous - between olecranon and tendon
Subcutaneous - between bone and skin

14

Carrying angle

5-15 in men
10-25 in women

15

Elbow flexors

Biceps, brachialis, brachioradialis

16

Elbow extensors

Triceps, anconeus

17

Supinators

Biceps, supinator

18

Pronators

Pronator teres, pronator quadratus

19

Nursemaid's elbow

Dislocation of the elbow where the radius pops out of teh annular ligament
Common in children

20

Cubital fossa boundaries

Superior = between epicondyles
Medial = pronator teres
Lateral = brachioradialis
Floor = brachialis and supinator
Roof = antebrachial fascia

21

Cubital fossa contents

Brachial artery and vein
Median nerve
Biceps tendon
Radial nerve

22

Reasons for hip stability

Deep insertion of femoral head into socket
Strong tight articular capsule
Strong ligaments around capsule
Powerful muscles around joint
Ligamentum teres within articular capsule
Reciprocal pull of medial and lateral rotators
Twisting of fibres in articular capsule

23

Acetabular labrum

Rim of fibrocartilage that is incomplete inferiorly where blood vessels can pass through

24

Ligaments of the hip

Anterior iliofemoral = strongest
Pubofemoral
Ischiofemoral
Posterior ligaments weaker and do not completely cover the femoral neck

25

Hip flexors

Iliopsoas, sartorius, pectineus, quadriceps

26

Hip extensors

Gluteus maximus, hamstrings

27

Hip abductors

Gluteus medius and minimus, tensor fascia lata

28

Hip adductors

Adductor compartment

29

Hip lateral rotation

Gluteus maximus, sartorius, piriformis, obturator internus

30

Hip medial rotation

Gluteus medius and minimus and pectineus

31

Fracture to the neck of the femur

Can disrupt blood supply and lead to avascular necrosis

32

Sizes of IV discs

Cervical = 3mm
Thoracic = 5mm
Lumbar = 9-11mm

33

IV disc components

Annulus fibrosus = criss cross arrangement of fibrocartilage
Nucleus pulposus = central gelatinous mass

34

Anterior longitudinal ligament

Strong fibrous band covering the anterior sides of the vertebral bodies and IV discs that extends from C1 to the sacrum
Prevents excessive extension

35

Posterior longitudinal ligament

Narrower weaker band within the vertebral canal attached mainly to IV discs extending from C2 to the sacrum
Prevents excessive flexion

36

Ligamentum flava

Extends between the lamina of two adjacent vertebrae and resists separation
Prevents excessive flexion and helps with straightening after flexion

37

Types of fibrous joints

Sutures - skull
Syndesmosis - sheet of fibrous tissue between bones - tibia and fibula
Gomphosis - cone shaped peg in socket - teeth

38

Types of cartilaginous joints

Synchrondosis - connected by hyaline cartilage - epiphyseal growth plate
Symphysis - connected by fibrocartilage - pubic symphysis and IV discs

39

Articular capsule structure

Outer fibrous capsule
inner synovial membrane

40

Q-angle

14 in males
17 in females

41

Articularis genu

From vastus intermedialis to suprapatellar bursa
Prevents it from becoming trapped behind patella

42

Housemaid's knee

= prepatella bursitis

43

Baker's cyst

Swelling behind the knee joint

44

Lateral collateral ligament

Strong fibrous cord
Prevents knee adduction

45

Medial collateral ligament

Broad flat ligament
Prevents knee abduction

46

Anterior cruciate ligament

Medial anterior tibia to lateral posterior femur
Prevents tibia moving forward on femur

47

Posterior cruciate ligament

Medial posterior tibia to lateral anterior femur
Prevents tibia moving backward on femur and prevents external rotation

48

Knee flexors

Hamstrings

49

Knee extensors

Quadriceps

50

Unlocking of the knee

By the muscle popliteus
Unlocks by rotating femur laterally on fixed tibia
Allows flexion to proceed

51

Genu varum

= bow legged

52

Genu valgus

= knock kneed

53

Carpal tunnel contents

Median nerve
4 tendons of FDS
4 tendons of FDP
Tendon of FPL

54

Lumbricals

Flex MCP and extend IP joints of digits 2-5

55

Dorsal interossei

Abduct digits 2-4

56

Palmar interossei

Adduct digits 2,4,5

57

Dupuyten's contracture

Fixed flexion of the hand due to thickening of palmar fascia

58

When does the subclavian artery become the axillary artery?

At the lower border of the first rib

59

When does the axillary artery become the brachial artery?

At the inferior border of teres major

60

Brachial pulse palpation point

Medial to biceps tendon

61

Superficial palmar arch

Main contribution from ulnar artery

62

Deep palmar arch

Main contribution from radial artery

63

Radial pulse palpation point

Lateral to FCR tendon

64

Ulnar pulse palpation point

Lateral to FCU tendon

65

Cephalic vs basilic veins

Cephalic drains lateral arm
Basilic drains medial arm

66

Erb-Duchenne palsy

C5-C6 damage
Loss of lateral arm sensation
Paralysis of deltoid, biceps, brachialis
Caused by backpacking, thrown from motorbike, excessive neck stretching during birth

67

Klumpke's palsy

C8-T1 damage
Paralysis of small muscles of the hand
Caused by upper limb being pulled superiorly

68

Axillary nerve palsy

Paralysis of deltoid
Loss of sensation over deltoid
Dislocated shoulder or fracture of neck of the humerus

69

Radial nerve palsy

Wrist drop
Loss of sensation to 1st dorsal interosseous web
Fracture to mid shaft of the humerus

70

Ulnar nerve palsy

Claw hand
Loss of sensation to little finger
Medial epicondyle fracture

71

Musculocutaneous nerve palsy

Paralysis of BBC
Deep injury

72

Median nerve palsy

Thenar atrophy
Loss of thumb sensation
Supracondylar fracture or wrist laceration

73

Dorsalis pedis palpation point

Lateral to EHL tendon

74

Posterior tibial palpation point

Half way between medial malleolus and calcaneal tendon

75

Control of venous return

Muscular pumping
Respiratory pumping
Valves
Venoconstriction

76

Femoral nerve

L2-4
Motor to quadricpes
Sensory to anterior thigh and medial and anterior leg

77

Lateral cutaneous nerve

L2-3
Sensory to lateral thigh

78

Obturator nerve

L2-4
Adductor compartment
Sensory to medial thigh

79

Superior gluteal nerve

L4-S1
Gluteus medius and minimus and tensor fascia lata

80

Inferior gluteal nerve

L5-S2
Gluteus maximus

81

Tibial nerve

L4-S3
Quadriceps
Posterior calf
Sensory to posterior leg and sole of foot

82

Common peroneal nerve

L4-S2
Superficial --> everters
Deep --> dorsiflexors
Sensory to lateral leg and dorsum of foot

83

Sciatic nerve palsy

Foot drop
Wasting of hamstrings, calf muscles and dorsiflexors
Loss of Achilles reflex
Posterior hip dislocation

84

Common peroneal nerve palsy

Foot drop
Loss of sensation to lateral leg
Neck of fibula fracture, tight leg casts

85

Tibial nerve palsy

Paralysis of plantarflexors
Sensory loss to posterior leg and sole of the foot
Fracture of the tibia or tarsal tunnel compression

86

Femoral nerve palsy

Paralysis of quadriceps
Sensory loss to anterior thigh
Pelvic fractures or anterior hip dislocations

87

Sternoclavicular ligaments

Anterior sternoclavicular
Costoclavicular
Interclavicular

88

Scapular elevation

Trapezius, levator scapulae

89

Scapular depression

Trapezius

90

Scapular protraction

Serratus anterior, pectoralis minor

91

Scapular retraction

Trapezius

92

Scapular upward rotation

Trapezius, serratus anterior

93

Scapular downward rotation

Latissimus dorsi

94

Reasons for large range of movement at the glenohumeral joint

Large, baggy joint capsule
Shallow glenoid cavity and large humeral head
Physiological scapulothoracic joint
Strong rotator cuff muscles keep humerus head in contact with glenoid cavity
Glenoid labrum

95

Shoulder flexion

Deltoid, pectoralis major

96

Shoulder extension

Deltoid, latissimus dorsi

97

Shoulder abductors

Deltoid, supraspinatous

98

Shoulder adductors

Pectoralis major, latissimus dorsi

99

Shoulder medial rotator

Subscapularis

100

Shoulder lateral rotator

Infraspinatous

101

Which rotator cuff attaches to the lesser tuberosity whereas all the others attach to the greater?

Subscapularis

102

Shoulder dislocations

Mainly anterior
Strong flexors and adductors pull humeral head anteriorly
Axillary nerve injury

103

Clinical landmark for lumbar puncture

Hand on iliac crests
Marks L4

104

Sciatic nerve surface marker

Halfway between greater trochanter and ischial tuberosity

105

Number of vertebrae

33

106

Primary back curves

Thoracic and sacral kyphoses

107

Secondary back curves

Cervical and lumbar lordoses

108

Cervical vertebrae distinctive feature

Transverse foramina
Bifid spinous process

109

Thoracic vertebrae distinctive feauture

Costal facets
Inferiorly projecting spinous process
Heart shaped vertebral body

110

Lumbar vertebrae distinctive feauture

Large kidney shaped vertebral body
Sturdy laminae

111

Changes when going from double to single support

Abductors of supporting leg become active
Prevent the hip dropping

112

Stages of stance phase of walking cycle

Heel strike
Loading response
Midstance
Terminal stance
Preswing (toe off)

113

Stages of swing phase of walking cycle

Initial swing
Midswing
Terminal swing

114

Shuffling gait

Short shuffling steps
Rigidity in hip and knee extensors
Parkinson's disease

115

Scissor gait

Thigh swings across body
Difficulty putting heel on the ground
Stroke
Cerebral palsy

116

High stepping gait

Knee lifted high in swing phase
Prevents dragging of foot due to foot drop
Peroneal nerve palsy

117

Staccato gait

No forward thrust
Unaffected limb never advances beyond affected limb
Tibial nerve palsy

118

Two types of bone

Cortical around the outsides
Trabecular bone in the middle

119

Stages of bone maturity

New bone = woven
Mature bone = lamellar

120

What is found on the surface of trabecular bone?

The endosteum comprising on a later of osteoprogenitor cells

121

Function of canaliculi

Allow osteocytes to obtain nutrients from the Haversian canals and connect osteocytes together

122

Periosteum structure

Inner periosteum is lined by osteoprogenitor cells
Can develop into a later of cuboidal osteoblasts can develop during bone growth

123

Zones of cartilage at the epiphyseal growth plate

Resting
Proliferation
Hypertrophy and maturation
Degeneration and calcification
Osteogenesis

124

Appositional growth

= growth in width

125

Interstitial growth

= growth in length

126

What are Sharpey's fibres?

Dense collagen bundles that insert into the bone matrix at the broad areas of muscle anchorage

127

Proportions of type of bone

Cortical = 80%
Trabecular = 20%

128

Bone matrix composition

Type 1 collagen
Proteoglycans
Calcium hydroxyapatite
Water

129

When does ossification begin?

6th-7th week of intrauterine life

130

Reasons for bone remodelling

Renews before deterioration
Redistributes bone matrix along lines of mechanical stress

131

Which bone is faster to remodel and why?

Trabecular
3x faster than cortical
Due to larger surface area

132

How do osteoclasts resorb bone?

Attach to bone and from a seal
Release proteolytic enzymes to break down collagen
Release HCl to dissolve bone minerals

133

Action of parathyroid hormone

Kidney - increases calcium reabsorption and phosphate excretion
Bone - increases number and actviity of osteoclasts
Gut - increases calcium absoprtion by promoting synthesis of 1,25(OH)2vitD

134

How does PTH increase osteoclast activation?

Osteoblasts have receptor for PTH
Causes osteoblasts to express RANK ligand
Osteoclast precursors activated by RANKL and differentiate

135

Calcitonin

Released from thyroid gland (C cells) in response to increased plasma calcium levels
Inhibit osteoblast activity

136

Oestrogen and bone metabolism

Gut - increased calcium absorption
Bone - inhibits osteoclasts

137

Glucocorticoids and bone metabolism

Gut - decreased calcium absorption
Bone - increased resorption and decreased formation

138

Type of calcium channels in nerve terminals

N-type

139

Type of calcium channels in cardiac cells

L-type

140

What can block N-type calcium channels

Conotoxin

141

Enzyme that reforms ACh

Choline acetylase

142

Molecule responsible for vesicle recycling

Clathrin

143

Botox toxin

Prevents vesicle docking by blocking SNARE proteins

144

Conotoxin

Block presynaptic calcium channels

145

Curare - tubocurarine

Competitive nicotinic receptor antagonist

146

Succinylcholine

Depolarising blocker - binds to receptor and activates it but does not detach

147

Neostigmine, physostigmine

Anticholinesterase

148

Synoviocytes

Type A = bone marrow derived macrophage - immune surveillance
Type B = fibroblast like connective tissue cell - makes proteoglycans to add to synovial fluid

149

Synovial membrane subintima

Connective tissue layer containing a dense network of fenestrated capillaries

150

Synovial fluid

= ultrafiltrate of blood with added hyaluronic acid

151

Synovial fluid composition

pH = 7.38
Hyaluronate
Glucose = 4.0
Lubricin

152

Function of synovial fluid

Reduces friction between cartilages
Distributes force across joint surfaces
Forms reserve volume
Nourishes articular cartilage

153

Synovial fluid biomechanics

Thixotropic - gel at rest and becomes less viscous with movement

154

Lubricin

Water soluble glycoprotein produced by chondrocytes and synoviocytes
Repels joint surfaces to prevent contact of articular cartilage

155

Articular cartilage structure

Hyaline cartilage - type II collagen, proteoglycans - forms gel
Aneural and avascular

156

Articular cartilage function

Caps bones in synovial joints
Acts as a shock absorber
Reduces friction

157

Layers of articular cartilage

Superficial zone with flat chondrocytes - collagen parallel to surface
Middle zone with oval chondrocytes - collagen randomly arranged
Deep zone with round chondrocytes - collagen perpendicular to surface
Tide mark
Calcified zone - smaller cells
Subchondral bone
Cancellous bone