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MSK Flashcards

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0
Q

What are the causes of Klumpke palsy? What nerves, muscles, motor and sensory functions are affected and what are the signs?

A 
Excessive abduction of arm - falling from a tree and catching a branch/pulling baby out by arm
T1: ulna and median nerve
Small muscles in hand don't work
Medial side of arm loses sensation
Clawed hand
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1
Q

What are the causes of Erb’s palsy? What nerves, muscles, motor and sensory functions are affected and what are the signs?

A

Difficult birth/blow to shoulder
C5-C6 root: musculocutaneous, axillary, suprascapular, nerve to subclavius
Supraspinatus, infraspinatus, subclavius, biceps brachii, brachialis, coracobrachialis, deltoid, teres minor
Abduction and flexion of shoulder, lateral rotation of arm and supination affected
Lateral side of arm loss of sensation
Waiters tip: medially rotated and pronated

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2
Q

What are the likely causes of damage to the axillary nerve? What muscles, motor and sensory functions are affected and what are the signs?

A

Anterior dislocation of humerus at glenohumeral joint, fracture of humerus at surgical neck
Deltoid, teres minor - can’t abduct shoulder
Regimental badge area
Deltoid atrophy so deltoid tuberosity can be palpated

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3
Q

What are the likely causes of damage to the radial nerve?

A

Damaged in axilla - dislocate humerus at glenohumeral joint, fracture proximal humerus or excess pressure on axilla
Damaged in radial groove - mid shaft fracture
Deep branch - radial head fracture or posterior radial dislocation at elbow
Superficial - stabbing or lacerations

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4
Q

What are the motor and sensory functions affected if the radial nerve was damaged in the axilla, radial groove, deep branch or superficial?

A

Can’t extend at elbow and wrist drop / back or arm and some of hand
Wrist drop / hand
No wrist drop as extensor carpi radialis works / none
None / hand

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5
Q

What is the likely cause of damage to the musculocutaneous nerve? What muscles, motor and sensory functions are affected and what are the signs?

A

Stabbed in axilla
Coracobrachialis, brachialis and biceps brachii so weakened flexion at shoulder (pec major) and elbow (brachioradialis) and weakened supination (supinator)
Lateral forearm

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6
Q

What are the likely cause of damage to the median nerve? What muscles, motor and sensory functions are affected and what are the signs?

A

Suprancondylar fracture of humerus
Flexors and pronators paralysed (except FCU and FDP) so constant supination, weak flexion with adduction, no thumb flexion and can’t flex and MCP joint
Hand
Atrophy of thenar muscles and hand of benediction when attempting to make fist
If caused at wrist (lacerations) only affects thenar/lumbricals

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7
Q

What is the likely cause of damage to the ulnar nerve? What muscles, motor and sensory functions are affected and what are the signs?

A

Medial epicondyle fracture
Flexor carpi ulnaris and medial half of flexor digitorum profundus so wrist flexion is accompanied by abduction. Interossei so no ab/adduction of fingers. Lateral lumbricals (little and ring finger)
Medial half of hand
Can’t grip paper
If at wrist (lacerations) just interossei and lumbricals affected and only palmar, medial one and a half fingers lose sensation.
Prolonged get ulnar claw

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8
Q

What innervates the trapezius and what is its function?

A

Accessory nerve
Upper - elevate and rotate scapula during abduction
Middle - retract scapula
Lower - pull scapula inferiorly

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9
Q

What innervates the latissimus dorsi and what is its function?

A

Thoracodorsal nerve

Extension and adduction of arm at shoulder. Medially rotate arm

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10
Q

What innervates the levator scapulae and what is its function?

A

Dorsal scapula nerve

Elevate scapula and rotate to tilt glenohumeral joint inferiorly

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11
Q

What innervates the rhomboids (major/minor) and what is its function?

A

Dorsal scapula nerve

Retract scapula and rotate it so tilt glenohumeral joint inferiorly

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12
Q

What innervates the deltoid and what is its function?

A

Axillary nerve
Anterior - flex arm at shoulder
Posterior - extend arm at shoulder
Middle - abduct arm after 15 degrees

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13
Q

What innervates the teres major and what is its function?

A

Lower subscapular nerve

Adduction of arm at shoulder and medially rotate

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14
Q

What innervates the Supraspinatus and what is its function?

A

Suprascapular nerve

First 15 degrees of abduction

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15
Q

What innervates the infraspinatus and what is its function?

A

Supra scapular nerve

Lateral rotation

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16
Q

What innervates the subscapularis and what is its function?

A

Upper and lower subscapular nerves

Medial rotation

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17
Q

What innervates the teres minor and what is its function?

A

Axillary nerve

Laterally rotate arm

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18
Q

Explain rotator cuff tendonitis

A

Sub acromial bursa supraspinatus tendon degenerate and causes pain in middle of abduction “painful arc”
Irritating the coraco-acromial arch inflames rotator cuffs

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19
Q

What innervates pectoralis major and what is its function?

A

Medial and lateral pectoral nerve

Adduct, medially rotate and flex arm at shoulder

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20
Q

What innervates pectoralis minor and what is its function?

A

Medial pectoral nerve

Depress shoulder

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21
Q

What innervates serratus anterior and what is its function?

A

Long thoracic nerve

Rotate scapula to allow abduction over 90 degrees. Hold scapula against ribcage

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22
Q

Explain the winging of scapula

A

Scapula protrudes out of back due to trauma or repetitive movements of the shoulder or inflammation damaging the long thoracic nerve

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23
Q

What is a Colles’ fracture?

A

Fall on outstretched hand

Fracture distal radius and the distal fragment is displaced posteriorly (dinner fork)

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24
What is a Smith's fracture?
Fall on back of hand. Distal segment to fracture is displaced anteriorly
25
How can the radial head be fractured?
Forced into capitulum and shatters
26
What is a Monteggia's fracture?
Blow behind the ulna causing the ulna to fracture and radial head to dislocate at elbow
27
What is a Galeazzi's fracture?
Radius fractures and ulnar head dislocates at the distal radial ulnar joint
28
How can the ulna fracture and what happens to the fragments?
Blow to ulna. Proximal section pulled posteriorly | Fall on flexed elbow. Triceps displace proximal posteriorly
29
What is a Boxer's fracture
Fracture of the 5th metacarpal neck usually from punching something Distal portion displaced posteriorly
30
What is a Bennett's fracture?
Fracture of first metacarpal base caused by hyperabduction of thumb
31
What innervates the gastrocnemius and what is its function?
Tibial nerve | Plantarflexion of foot and flex knee
32
What innervates the plantaris and what is its function?
Tibial nerve | Plantarflex ankle and flex knee. Not vital
33
What innervates the soleus and what is its function?
Tibial nerve | Plantarflexes ankle
34
What innervates the popliteus and what is its function?
Tibial nerve | Laterally rotate femur unlocking the joint so flexion can occur
35
What innervates the tibialis posterior and what is its function?
Tibial nerve | Invert and plantarflex foot and maintain medial arch of foot
36
What innervates the flexor digitorum longus and what is its function?
Tibial nerve | Flex the lateral four toes
37
What innervates the flexor hallucis longus and what is its function?
Tibial nerve | Flex the great toe
38
What innervates the tibialis anterior and what is its function?
Deep fibular nerve | Dorsiflex and invert foot
39
What innervates the extensor digitorum longus and what is its function?
Deep fibular nerve | Extend lateral four toes and dorsiflex foot
40
What innervates the extensor hallucis longus and what is its function?
Deep fibular nerve | Extend great toe and dorsiflex foot
41
What innervates the fibularis tertius and what is its function?
Deep fibular nerve | Evert and dorsiflex foot
42
What innervates the fibularis longus and what is its function?
Superficial fibular nerve | Eversion and plantarflexion of foot. Support lateral and transverse arches of foot
43
What innervates the fibularis brevis and what is its function?
Superficial fibular nerve | Eversion of foot
44
Explain footdrop
Anterior leg muscles are paralysed, usually due to damage to the common fibular nerve. Therefore there is unopposed plantarflexion May flick affected foot while walking
45
Explain ruptured calcaneal tendon
More likely with calcaneal tendinitis. Due to sustained forceful plantarflexion of the foot Can't plantarflex so permanently dorsiflexed Large lump in calf due to soleus and gastrocnemius
46
What innervates the gluteus maximums and what is its function?
Inferior gluteal nerve | Extend thigh and laterally rotate. Only used when force is required such as climbing or running
47
What innervates the gluteus medius and what is its function?
Superior gluteal nerve | Abduct and medially rotate lower limb. Secure pelvis when walking
48
What innervates the gluteus minimus and what is its function?
Superior gluteal nerve | Abduct and medially rotate lower limb. Secure pelvis when walking
49
What innervates the piriformis and what is its function?
Nerve to piriformis | Lateral rotation and abduction
50
What innervates the obturator internus and what is its function?
Nerve to obturator internus | Lateral rotation and abduction
51
What innervates the gemelli and what is its function?
Superior - nerve to obturator internus Inferior - nerve to quadratus femoris Lateral rotation and abduction
52
What innervates the quadratus femoris and what is its function?
Nerve to quadratus femoris | Lateral rotation
53
What innervates the biceps femoris and what is its function?
Sciatic nerve | Flexion at the knee. Also extends leg at hip and laterally rotate hip and knee
54
What innervates the semitendinosus and what is its function?
Sciatic nerve | Flexion of the knee, extension of the thigh at the hip, medially rotate at hip and knee joint
55
What innervates the semimembranosus and what is its function?
Sciatic nerve | Flexion of the knee, extension at the hip and medially rotate thigh and leg at hip and knee
56
What innervates the iliopsoas and what is its function?
Psoas major - anterior rami L1-3 Iliacus - femoral nerve Flex lower limb at hip and laterally rotate
57
What innervates the vastus muscles and what is its function?
Femoral nerve | Extend at knee
58
What innervates the rectus femoris and what is its function?
Femoral nerve | Flex at hip and extend at knee
59
What innervates the sartorius and what is its function?
Femoral nerve | Flex, abduct and laterally rotate hip. Flex at knee
60
What innervates the pectineus and what is its function?
Femoral nerve | Adduction and flexion at the hip
61
What innervates the adductor magnus and what is its function?
Adductor part - obturator nerve Hamstring part - tibial nerve Adduct thigh, flex thigh and extend thigh
62
What innervates the adductor longus and what is its function?
Obturator nerve | Adduction and medial rotation of thigh
63
What innervates the adductor brevis and what is its function?
Obturator nerve | Adduction of the thigh
64
What innervates the obturator externus and what is its function?
Obturator nerve | Laterally rotate thigh
65
What innervates the gracilis and what is its function?
Obturator nerve | Adduction at the hip and flexion at the knee
66
What are the general functions of the vertebral column?
Protection - shield spinal cord Support - carry weight of body above pelvis Axis - central axis Movement
67
What is the general structure of a vertebrae?
Vertebral body - anterior. Weight-bearing. Increase in size going down column. Hyaline cartilage lines inferior and superior part. Separated by fibrocartilaginous intervertebral disc Vertebral arch - lateral/posterior. Gap between arch and body = vertebral foramen. They all line up to give vertebral canal containing spinal cord. Consists of spinous process, lamina, superior articular processes, transverse processes and pedicles. Intervertebral discs - fibrocartilaginous. Shock absorb and flexibility. Jelly like nucleus pulposus surrounded by tough annulus fibrosus
68
What are the individual features of the cervical vertebrae?
7 of them Bifid spinous process Foramen transversium in transverse process containing vertebral arteries Triangular vertebral foramen
69
What are the individual features of thoracic vertebrae?
12 of them Demi and costal facets for ribs Spinous process slants inferiority and anteriorly Circular foramen
70
What are the individual features of lumbar vertebrae?
5 of them Large bodies Triangular foramen
71
What are the features of the sacrum and coccyx?
Sacrum - 5 fused. Upside down triangle | Coccyx - no arch
72
What are the unique vertebrae and what's special about each one?
C1 (atlas) - articulates with skull and axis. No body or spinous process C2 (axis) - Dens, lateral mass is rugged, large spinous process. Stops axis displacing, fractures in hanging C7 - spinous process doesn't bifurcate
73
What are the ligaments at vertebral joints?
Anterior (stop hyper extension) and posterior (stop hyper flexion) longitudinal ligaments Ligamentum flava - between lamina Infraspinous and supraspinous - between spinous processes Intertransverse - between transverse ligaments
74
What are 4 medical conditions to do with spinous deformities?
Kyphosis - excess thoracic curvature Lordosis - excess lumbar curvature Scoliosis - lateral curvature Cervical spondylosis - smaller vertebral foramen puts pressure on nerves
75
In general what innervates and what is the main function of muscles in the anterior thigh, medial thigh and posterior thigh?
Anterior - femoral - extend knee Medial - obturator - adduction Posterior - sciatic - flex knee
76
List the muscles in the medial thigh
Gracilis, obturator externus, adductor brevis, adductor longus and adductor magnus
77
List the muscles in the posterior thigh
Biceps femoris, semitendinosus and semimembranosus
78
List the muscles in the anterior thigh
Iliopsoas, quadriceps, sartorius and pectineus
79
List the muscles in the gluteal region
Gluteus maximus, medius and minimus | Piriformis, gemellus superior, obturator internus, gemellus inferior, obturator externus and quadratus femoris
80
What are the muscles in the anterior section of the leg, what innervates them and what is their general function?
Tibialis anterior, extensor digitorum longus, extensor hallucis longus and fibularis tertius Dorsiflex and invert foot Deep fibular nerve
81
What are the muscles in the lateral portion of the leg, what innervates them and what is their function?
Fibularis longus and fibularis brevis Superficial fibular nerve Plantarflexion and eversion of the footy
82
What are the superficial muscles in the posterior portion of the leg, what is their function and what innervates them?
Gastrocnemius, soleus and plantaris Plantarflexion Tibial nerve
83
What are the deep muscles of the posterior leg, what innervates them and what is their function?
Popliteus, flexor digitorum longus, flexor hallucis longus and tibialis posterior Flex toes and plantarflexion Tibial nerve
84
Outline arterial supply to the lower limb
External iliac becomes femoral after Inguinal ligament which gives off the deep femoral artery which in turn gives off medial and lateral circumflex as well as perforating arteries. Femoral then becomes popliteal after adductor hiatus which gives off genicular arteries and becomes the anterior tibial (and then Dorsalis pedis) and posterior tibial which becomes fibular and the medial and lateral plantar arteries. Internal iliac gives off superior and inferior gluteal artery as well as the obturator artery
85
Explain intermittent claudication
Pain on walking which is relieved by rest and then comes back quicker. Due to occlusion of artery from atherosclerosis. Find occlusion by palpating pulses or arteriogram. Treat with aspirin and other treatments to lower risk factors
86
How might acute ischaemia of the lower limb occur?
Plaque rupture and thrombus formation | Compartment syndrome due to bleed
87
Compare the great and small saphenous vein
Found anterior to medial malleolus/posterior to lateral malleolus Median calf/posterior calf Drains into femoral vein/popliteal vein

ESA 2 (4 decks)

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