Locomotor Flashcards
(157 cards)
1
Q
Movements at the talocrural joint
A
Dorsiflexion and plantarflexion
2
Q
Movements at the subtalar joint
A
Eversion and inversion
3
Q
In which position is the ankle most stable?
A
Dorsiflexion due to the talus being wider anteriorly
4
Q
What are the medial ankle ligaments?
A
Deltoid ligament that is made up of 4 adjacent continuoua ligaments attaching the medial malleolus to the calcaneous and navicular bones
5
Q
What are the lateral ankle ligaments?
A
Anterior talofibular
Posterior talofibular
Calcaneofibular
6
Q
Dorsiflexor and toe extensors
A
Tibialis anterior, extensor digitorum longus and extensor hallucis longus
7
Q
Everters
A
Fibularis longus and brevis
8
Q
Plantarflexors
A
Gastrocnemius, soleus and plantaris
9
Q
Toe flexors
A
Flexor digitorum longus, flexor hallucis longus, tibialis posterior
10
Q
Inverters
A
Tibialis anterior and posterior
11
Q
Medial arch support
A
Spring ligament, deltoid ligament, tendon of tibialis posterior
12
Q
Lateral arch support
A
Long plantar ligament and tendons of extensor muscles
13
Q
Elbow bursae
A
Intratendinous - in triceps tendon
Subtendinous - between olecranon and tendon
Subcutaneous - between bone and skin
14
Q
Carrying angle
A
5-15 in men
10-25 in women
15
Q
Elbow flexors
A
Biceps, brachialis, brachioradialis
16
Q
Elbow extensors
A
Triceps, anconeus
17
Q
Supinators
A
Biceps, supinator
18
Q
Pronators
A
Pronator teres, pronator quadratus
19
Q
Nursemaid’s elbow
A
Dislocation of the elbow where the radius pops out of teh annular ligament
Common in children
20
Q
Cubital fossa boundaries
A
Superior = between epicondyles Medial = pronator teres Lateral = brachioradialis Floor = brachialis and supinator Roof = antebrachial fascia
21
Q
Cubital fossa contents
A
Brachial artery and vein
Median nerve
Biceps tendon
Radial nerve
22
Q
Reasons for hip stability
A
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
Q
Acetabular labrum
A
Rim of fibrocartilage that is incomplete inferiorly where blood vessels can pass through
24
Q
Ligaments of the hip
A
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
