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MSK Flashcards

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1
Q

What are the articulating surfaces of the shoulder joint?

A

glenoid fossa

head of the humerus

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2
Q

What acts to increase the joint surface area>

A

glenoid labrum

fibrocartilage rim

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3
Q

where does the glenohumeral joint capsule extend from

A

from the anatomical neck of the humerus to the border of the glenoid fossa

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4
Q

name the synovial bursae of the shoulder

A

subacromial
subscapular
subcoracoid

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5
Q

Where is the subacromial bursa found?

A

inferiorly to the deltoid and acromion,

superiorly to the supraspinatus tendon and the joint capsule.

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6
Q

Where is the subscapular bursa found?

A

Located between the subscapularis tendon and the scapula.

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7
Q

What is the purpose of the coracoacromial ligament of the shoulder

A

prevents superior displacement of humerus

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8
Q

What is the purpose of the coracohumeral ligament of the shoulder

A

supports joint superiorly

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9
Q

What is the purpose of the glenohumeral ligament of the shoulder

A

stabilises joint anteriorly

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10
Q

What is painful arc syndrome?

A

inflammation of supraspinatus tendon and subacromial bursa beneath coracoacromial tendon

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11
Q

What gives the shoulder joint mobility

A

ball and socket
lax joint capsule
shallow glenoid cavity, large head of humerus

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12
Q

What gives the shoulder joint stability

A

ligaments - reinforce joint capsule
glenoid labrum - increases surface area
rotator cuff muscles - pull humeral head into glenoid cavity

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13
Q

What is the most common dislocation of the shoulder

A

anterior

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14
Q

What causes anterior dislocation of the shoulder

A

extension

external rotation

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15
Q

name the rotator cuff muscles

A

supraspinatus
infraspinatus
teres minor
subscapularis

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16
Q

What is the function of the rotator cuff muscles as a group?

A

pull humeral head into the glenoid cavity

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17
Q

name the origin and insertion of the supraspinatus

A

supraspinous fossa

greater tubercle of humerus

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18
Q

name the origin and insertion of the infraspinatus

A

infraspinous fossa

greater tubercle of humerus

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19
Q

name the origin and insertion of the teres minor

A

lateral posterior surface of scapula

greater tubercle of humerus

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20
Q

name the origin and insertion of the subscapularis

A

subscapular fossa

lesser tubercle of the humerus

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21
Q

Which rotator cuff muscles are innervated by the suprascapular nerve

A

supraspinatus

infraspinatus

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22
Q

Which rotator cuff muscles are innervated by the upper and lower subscapular nerves

A

subscapularis

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23
Q

Which rotator cuff muscles are innervated by the axillary nerve

A

teres minor

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24
Q

Which rotator cuff muscles act to laterally rotate the arm

A

teres minor

infraspinatus

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25
Which rotator cuff muscles act to medially rotate the arm
subscapularis
26
Which rotator cuff muscles act to abduct the arm
supraspinatus
27
State the boundaries of the cubital fossa
``` medial = pronator teres lateral = brachioradialis superior = line between epicondyles of humerus ```
28
what are the contents of the cubital fossa
biceps tendon brachial artery median nerve
29
What makes up the floor of the cubital fossa
brachialis | supinator
30
What can a supracondylar fracture of the humerus lead to?
damage to the brachial artery | Volkmann's contracture
31
How does Volkmann's contracture present?
permanent shortening of forearm muscles gives rise to a clawlike deformity of the hand, fingers, and wrist. due to ischaemia
32
What nerve roots contribute to the brachial plexus?
C5-T1
33
State the dermatomes that correspond to C5-T1
``` C5 - lateral elbow C6 - posterior thumb C7 - posterior middle finger C8 - posterior little finger T1 - medial elbow ```
34
State the myotomes that correspond to C5-T1
C5 - elbow flexion, biceps and brachialis C6 - wrist extension, extensor carpi radialis longus and brevis C7 - elbow extension, triceps brachii C8 - middle finger flexion, flexor digitorum profundus T1 - little finger abduction, abductor digiti minimi
35
State the nerve roots of the median nerve
C5-T1
36
State the course of the median nerve
``` axilla lateral then medial to brachial artery cubital fossa between flexor digitorum profundus and superficialis carpal tunnel ```
37
What branches of the median nerve leave in the forearm
anterior interosseus | palmar cutaneous
38
What does the anterior interosseus nerve innervate?
deep flexors of the forearm - pronator quadratus - flexor digitorum profundus (lateral half) - flexor pollicis longus
39
What does the palmar cutaneous branch of the median nerve innervate
sensory innervation to the lateral palm of the hand
40
What branches of the median nerve originate in the hand
recurrent branch | palmar digital
41
What does the recurrent branch of the median nerve innervate
thenar muscles
42
What does the palmar digital branch of the median nerve innervate
sensory lateral fingers | lateral lumbricals
43
How could the median nerve be damaged at the elbow?
supracondylar humeral fracture
44
What functions would be lost if the median nerve was damaged at the elbow
``` loss pronation loss flexion of wrist loss abduction of wrist loss of thumb movement loss of flexion at lateral MCP loss of sensory innervation to lateral hand ```
45
What position would the arm be in if median nerve is damaged at the elbow
supination extension adduction hand of benediction
46
What causes the hand of benediction
loss of median nerve innervation to lateral two lumbricals (palmar digital) when tries to make a fist, only medial two fingers can flex at MCP
47
How would the median nerve be damaged at the wrist
laceration proximal to flexor retinaculum
48
What functions are lost if the median nerve is damaged at the wrist
loss of thumb movement loss of flexion at lateral MCP loss of sensory innervation to lateral hand
49
Name the thenar muscles
flexor pollicis brevis abductor pollicis brevis opponens pollicis
50
State the nerve roots of the ulnar nerve
C8-T1
51
Describe the course of the ulnar nerve
``` axilla medial arm posterior to medial epicondyle of humerus alongside ulna above flexor retinaculum ulnar (Guyon's) canal terminates in hand ```
52
What branches of the ulnar nerve originate in the forearm
muscular palmar cutaneous dorsal cutaneuous
53
What does the muscular branch of the ulnar nerve innervate
medial flexor digitorum profundus | flexor carpi ulnaris
54
What does the palmar cutaneous branch of the ulnar nerve innervate
sensory medial palm
55
What does the dorsal cuteneous branch of the ulnar nerve innervate
dorsal medial palm and fingers
56
What branches of the ulnar nerve originate in the hand
deep branch | superficial branch
57
What does the deep branch of the ulnar nerve innervate
``` hypothenar eminence interossei medial lumbricals adductor pollicis palmaris brevis ```
58
What is the action of the lumbricals
DAB PAD dorsal - abdcution palmar - adduction
59
What does the superficial branch of the ulnar nerve innervate
sensory palmar surface medial 1.5 fingers
60
How is the ulnar nerve damaged at the elbow
fracture of medial epicondyle
61
What functions are lost if the ulnar nerve is damaged at the elbow
weakened flexion, accompanied by abduction loss of adduction loss of adduction and abduction of fingers reduced MCP flexion of medial fingers loss of sensation of medial hand
62
What is the characteristic sign of ulnar nerve damage at the elbow
patient cannot grip paper between fingers | due to loss of innervation to interossei
63
How is the ulnar nerve damaged at the wrist
lacerations to wrist
64
What functions are lost if the ulnar nerve is damaged at the wrist
loss of adduction and abduction fingers reduced MCP flexion of medial fingers loss of sensation to medial palmar surface of hand
65
Which sensory branch of the ulnar nerve is usually maintained in a laceration to the wrist
dorsal cutaneous branch | so dorsal sensory function is maintained
66
What is the sign of long term damage to the ulnar nerve at the wrist
ulnar claw Hyper-extension of the medial MCP due to paralysis of the medial two lumbricals, Flexion at the interphalangeal joints
67
What is the ulnar paradox?
If the ulnar nerve is damaged at the elbow, the ulnar claw is less pronounced this is because the medial half of the flexor digitorum profundus is paralysed, which would usually act to flex DIP so there is no flexion at distal IP joints There is only hyperextension at the MCP and flexion at PIP which is less noticeable!
68
State the nerve roots of the radial nerve
C5-T1
69
State the course of the radial nerve
axilla posterior to axillary artery radial groove anterior to lateral epicondyle of humerus cubital fossa splits into superficial and deep branches
70
What muscles does the radial nerve innervate before it reaches the forearm?
triceps brachii brachioradialis extensor carpi radialis longus
71
Name the three sensory branches of the radial nerve that arise proximal to the elbow
lateral cutaneous nerve of the arm posterior cutaneous nerve of the arm posterior cutaneous nerve of the forearm
72
What area does the lateral cutaneous nerve of the arm, originating from the radial nerve, innervate
sensory innervation to the lateral arm, inferior to the area supplied by the axillary nerve
73
What area does the posterior cutaneous nerve of the arm, originating from the radial nerve, innervate
posterior arm
74
What area does the lateral cutaneous nerve of the forearm, originating from the radial nerve, innervate
strip of skin posteriorly on the forearm
75
What is the function of the deep branch of the radial nerve
innervates the posterior muscles of the forearm
76
What does the deep branch of the radial nerve become when it penetrates through the supinator?
posterior interosseous nerve
77
What is the function of the superficial branch of the radial nerve
sensory innervation to dorsum of lateral 3.5 digits
78
How can the radial nerve be damaged in the axilla
shoulder dislocation | fracture of proximal humerus
79
Describe the presentation of radial nerve damage at the axillla
wrist drop! - unopposed flexion unable to extend elbow unable to extend wrist unable to extend at MCP loss of sensation at lateral and posterior arm, posterior forarm and lateral dorsum of hand
80
How can the radial nerve be damaged in the arm
fracture of the shaft of the humerus | radial nerve lies in radial groove
81
Describe the presentation of radial nerve damage in the radial groove
wrist drop = unopposed flexion at wrist and fingers weakened extension at elbow unable to extend wrist unable to extend fingers loss of sensation to lateral dorsum of hand
82
Which muscles are innervated by the radial nerve before it enters the radial groove
long and medial heads of the triceps brachii
83
Which sensory branches of the radial nerve arise before it enters the radial groove
lateral cutaneous nerve of the arm posterior cutaneous nerve of the arm posterior cutaneous nerve of the forearm
84
How can the superficial branch of the radial nerve be damaged?
stabbing or laceration of forearm
85
Describe the presentation of damage to the superficial branch of the radial nerve
loss of sensation to lateral dorsum of hand
86
How can the deep branch of the radial nerve be damaged?
posterior dislocation of radius | fracture of radial head
87
Describe the presentation of damage to the deep branch of the radial nerve
weakened extension of the wrist NO WRIST DROP the extensor carpi radialis is not innervated by the deep branch, and maintains some innervation no loss of sensation
88
State the nerve roots of the femoral nerve
L2-L4
89
Describe the course of the femoral nerve
``` lumbar plexus through psoas major behind iliac fascia under inguinal ligament - midpoint of inguinal ligament femoral triangle adductor canal ```
90
Which branches of the femoral nerve leave in the femoral triangle
anterior division | posterior division
91
What is the function of the anterior division of the femoral nerve
innervates hip flexors - sartorius - pectineus - iliacus sensory to anteromedial thigh
92
What is the function of the posterior division of the femoral nerve
knee extensors - vastus medialis - vastus intermedius - vastus lateralis - rectus femoris saphenous nerve - sensory to medial leg and foot
93
What nerve does the femoral nerve transition into?
saphenous
94
Which area of the leg does the saphenous nerve provide sensory innervation to?
medial leg and foot
95
Which vessel lies closely to the saphenous nerve?
long saphenous vein
96
What problems can damage to the saphenous nerve cause?
pain, paresthesia or loss of sensation to medial leg and foot
97
How is the saphenous nerve often damaged?
stripping of the long saphenous vein eg. varicose vein op
98
State the nerve roots of the sciatic nerve
L4-S3
99
Describe the course of the sciatic nerve
``` lumbosacral plexus greater sciatic foramen inferior to piriformis deep to long head of the biceps femoris popliteal fossa splits to form tibial and common fibular nerves ```
100
What structures does the sciatic nerve innervate in the thigh
hamstring portion of adductor magus biceps femoris - long head and short head semimembranosus semitendinosus
101
Which muscles are most medial in the posterior thigh
semimembranosus | semitendinosus
102
What is the relevance of the sciatic nerve in terms of giving IM injections in the gluteal region
you don't want to hit it! divide into quadrants - one line between horizontal halfway between ischial tuberosity and highest point iliac crest - one line vertically from highest point iliac crest go in lateral upper quadrant
103
State the nerve roots of the tibial nerve
L4-S3
104
Describe the course of the tibial nerve
``` sciatic nerve popliteal fossa deep to soleus posterior to tibia posterior to medial malleolus beneath flexor retinaculum (tarsal tunnel) splits into terminal branches ```
105
Name the terminal branches of the tibial nerve
medial calcaneal medial plantar lateral plantar
106
Which branch of the tibial nerve leaves in the popliteal fossa
sural nerve
107
What area does the sural nerve provide sensory innervation to?
posterolateral leg | lateral foot
108
Which muscles does the tibial nerve provide innervation to?
deep - flexor digitorum longus - flexor hallucis longus - popliteus - tibialis posterior superficial - soleus - gastrocnemius - plantaris
109
What area does the medial calcaneal nerve provide sensory innervation to?
heel
110
What area does the medial plantar nerve provide sensory innervation to?
medial 3.5 toes and sole
111
What area does the lateral plantar nerve provide sensory innervation to?
lateral 1.5 toes and sole
112
Describe tarsal tunnel syndrome
tibial nerve compressed posteriorly to medial malleolus in tarsal tunnel causing paresthesia in sole of foot, worsened by exercise
113
Name the contents of the tarsal tunnel
``` Tibialis posterior tendon flexor Digitorum longus tendon posterior tibial Artery posterior tibial Vein tibial Nerve flexor Hallucis longus tendon ```
114
What can cause tarsal tunnel syndrome
ostetoarthritis RA post trauma ankle deformities
115
What is the surgical management of tarsal tunnel syndrome?
flexor retinaculum cut
116
How can the tibial nerve be damaged
entrapment direct trauma compression over long period of time
117
What are the problems caused by damage to the tibial nerve
loss of plantar flexion loss of sensation to sole of foot loss of toe flexion weakened inversion (tibialis posterior lost)
118
State the nerve roots of the common fibular nerve
L4-S2
119
Describe the course of the common fibular nerve
popliteal fossa medial border of biceps femoris superficial to lateral head gastrocnemius around the neck of the fibula between attachments of fibularis longus muscle splits into terminal branches
120
What branches does the common fibular nerve split into?
deep fibular | superficial fibular
121
What muscles does the common fibular nerve innervate in the thigh
short head of the biceps femoris
122
name the branches of the common fibular nerve that originate over the lateral head of the gastrocnemius
sural communicating branch | lateral sural cutaneous
123
Which area does the sural communicating branch of the common fibular nerve provide sensory innervation to?
posterolateral leg (as sural nerve)
124
Which area does the lateral sural cutaneous branch of the common fibular nerve provide sensory innervation to?
upper lateral leg | above sural area
125
State the nerve roots of the superficial fibular nerve
L4-S1
126
Describe the course of the superficial fibular nerve
head of the fibula between fibularis musles, lateral to extensor digitorum longus pierces deep crural fasia enters foot
127
Which muscles does the superficial fibular nerve innervate?
fibularis longus | fibularis brevis
128
What are the terminal cutaenous branches of the superficial fibular nerve
medial dorsal cutaneous nerve | intermedial dorsal cutaenous nerve
129
What area do the medial and intermedial cutaneous branches of the superficial fibular nerve provide sensory innervation to?
dorsum of the foot
130
What area does the superficial fibular nerve provide sensory innervation to?
anterolateral leg
131
Describe how superficial fibular nerve entrapment presents
pain and paresthesia over anterolateral leg and dorsum of foot
132
What causes superficial fibular nerve entrapment
twisting/spraining ankle - stretches nerve in lower leg | nerve entrapment in deep crural fascia
133
What causes superficial fibular nerve damage
fracture of the fibula, or by a perforating wound to the lateral side of the leg.
134
Describe how superficial fibular nerve damage presents
loss of eversion. | loss of sensation over the majority of the dorsum of the foot and the anterolateral aspect of the lower leg
135
State the nerve roots of the deep fibular nerve
L4-L5
136
Describe the course of the deep fibular nerve
common fibular nerve alongside anterior tibial artery superiorly: between tibialis anterior and extensor digitorum longsus inferiorly: between tibialis anterior and extensor hallucis longus anterior to distal tibia, beneath extensor retinaculum
137
What muscles does the deep fibular nerve innervate?
tibialis anterior extensor hallucis longus extensor digitorum longus fibularis tertius
138
State the terminal branches of the deep fibular nerve
medial terminal branch | lateral terminal branch
139
What is the function of the medial terminal branch of the deep fibular nerve
sensory to skin between 1st and 2nd toes
140
What is the function of the lateral terminal branch of the deep fibular nerve
motor to extensor digitorum brevis extensor hallucis brevis
141
What nerve is damaged in foot drop?
common fibular | or deep fibular
142
How is the deep fibular nerve damaged?
anterior leg muscles have been excessively used and so are compressing the nerve within the anterior compartment. The patient will experience pain in the anterior leg. tight-fitting shoes, compressing the nerve beneath the extensor retinaculum. The patient will also experience pain in the dorsum of the foot
143
How does damaged to the deep fibular nerve present?
pain in anterior leg or dorsum of foot loses the ability to dorsiflex the foot, so with unopposed plantarflexion, their foot drops.
144
What kind of gait does foot drop produce?
difficulty in clearing the ground during the swing phase of walking. the foot will slap down on the floor when the patient walks, because it can’t be lowered in a controlled manner.
145
How is the common fibular nerve damaged?
fracture of fibula | a tight plaster cast.
146
How does damage to the common fibular nerve present?
lose the ability to dorsiflex the foot at the ankle joint. Hence the foot will appear permanently plantarflexed – known as footdrop. loss of sensation over the dorsum of the foot, and lateral side of the leg.
147
State the definition of sciatica
symptoms of pain, tingling, and numbness which arise from impingement of lumbosacral nerve roots as they emerge from the spinal canal, and are felt in the distribution of the nerve root (dermatome). There may be accompanying motor weakness in a corresponding myotomal distribution
148
What are some of the causes of lumbar radiculopathy
disc hernation spinal stenosis Spondylolisthesis
149
What is spondylolisthesis
proximal vertebra moves forward relative to a distal vertebra.
150
What is the characteristic nature of the pain in spinal stenosis?
relieved by forward flexion and worsened with extension
151
What are the signs of lumbar radiculopathy
+ve straight leg raise test | Numbness, paraesthesia, muscle weakness, or loss of tendon reflexes in the distribution a single nerve root.
152
Describe the presentation of L4 nerve root compression
loss of sensation over medial ankle and foot weakened ankle dorsiflexion loss of patellar reflex
153
Describe the presentation of L5 nerve root compression
loss of sensation in dorsal foot | weakened extension great toe
154
Describe the presentation of S1 nerve root compression
loss of sensation on sole and lateral ankle weakened plantarflexion loss of ankle reflex
155
What is the management for disc herniation
conservative: NSAIDs + PPI, drug for neuropathic pain, exercise, physiotherapy Keep active, resume normal activities, return to work. Should return to normal in 4-6wks Spinal decompression - discectomy if pain and function have not resolved
156
What are the red flags for back pain?
``` >50y previous cancer or infection (TB, UTI) weight loss fever night sweats thoracic pain pain at night neurological problems incontinence saddle anaesthesia ```
157
What is cauda equina syndrome?
compression of the terminal spinal nerve roots of the cauda equina L2-S4
158
What can cause cauda equina syndrome
disc herniation spinal stenosis (insidious onset) cancer trauma
159
What are the symptoms of cauda equina syndrome
``` back pain unilateral or bilateral leg pain saddle anaethesia sensorimotor loss painless urinary retention overflow incontinence ```
160
What are the signs of cauda equina syndrome?
``` palpable bladder sensorimotor loss in lower limbs decreased or absent reflexes loss of sensation in perianal area decreased/lost perianal tone / loss cough reflex contraction on DRE ```
161
What is the key investigation in cauda equina syndrome
spinal MRI
162
What is the management of cauda equina syndrome
emergency surgical decompression
163
What is spinal stenosis
narrowing of spinal canal or neural foramina leading to neurogenic claudication and root ischaemia
164
What can cause spinal stenosis
degeneration of discs osteophytes hypertrophic ligamentum flavum spondylolisthesis
165
What are the symptoms of lumbar spinal stenosis
back pain leg pain on walking or standing, relieved by flexion/sitting down weakness
166
what investigations are needed in suspected spinal stenosis
lumbar xray | MRI
167
What is the treatment for spinal stenosis
NSAIDs, physio, steroid and anaethetic injections | surgical decompression
168
What spinal infections can you get?
discitiis epidural abscess osteomyelitis
169
What are the risk factors for a spinal infection
``` recent infection TB immunosupression IVDU diabetes ```
170
What are the symptoms of a spinal infection
severe localised back pain fever raised inflammatory markers
171
What investigations should be done in suspected spinal infection
Bedside: Bloods: FBC, U+E, CRP, ESR, Micro: blood cultures, cultures from potential primary infection sites Imaging: MRI
172
What cancers can cause a spinal lesion
multiple myeloma | metastasis from breast, prostate, lung, thyroid and kidney
173
What are the symptoms of a spinal tumour?
``` thoracic pain pain worse at night localised pain weight loss malaise ```
174
What investigations should be done in suspected spinal cancer
Bloods: LFTs, Ca, Phos, alkaline phosphatase, ESR Imaging: CTCAP, MRI Special tests: Bence-Jones in urine (multiple myeloma)

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