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Flashcards in MSK Deck (48):
1

Erb Palsy

Which injury?

What causes the injury?

What is the muscular deficit?

How does it present?

 

 

Which injury?

  • Traction or tear of upper (“Erb-er”) trunk: C5-C6 roots

What causes the injury?

Infants—lateral traction on neck during delivery

Adults—trauma

What is the muscular deficit?

Deltoid, supraspinatus, Infraspinatus, Biceps brachii

How does it present?

Waiter's tip

2

What are the bones of the wrist?

Scaphoid, Lunate, Triquetrum, Pisiform, Hamate, Capitate, Trapezoid, Trapezium

3

What are the rotator cuff muscles and what are their actions?

Supraspinatus - abduction

Infraspinatus - externally rotates

Teres minor - adducts and externally rotates

Subscapularis - internally rotates and adducts arm

4

Which nerve innervates the hypothenar eminence?

ulnar nerve

5

Musculocutaneous

What is the nerve root?

What is the cause of injury?

How does injury present?

What is the nerve root?

(C5-C7)

What is the cause of injury?

Upper trunk compression

How does injury present?

Loss of forearm flexion and supination

Loss of sensation over lateral forearm

6

Recurrent branch of median nerve

What is the nerve root?

What is the cause of injury?

How does injury present?

What is the nerve root?

C5-T1

What is the cause of injury?

Superficial laceration of palm

How does injury present?

  • “Ape hand”
  • Loss of thenar muscle group: opposition, abduction, and flexion of thumb
  • No loss of sensation

7

What is carpal tunnel syndrome?

Entrapment of median nerve in carpal tunnel 

Thenar eminence atrophies but sensation spared, because palmar cutaneous branch enters hand external to carpal tunnel. 

 

8

What is a Baker cyst?

Popliteal fluid collection

9

Median

What is the nerve root?

What is the cause of injury?

How does injury present?

What is the nerve root?

C5-T1

What is the cause of injury?

  • Supracondylar fracture of humerus (proximal lesion)
  • Carpal tunnel syndrome and wrist laceration 

How does injury present?

  • “Ape hand” and “Pope’s blessing”
  • Loss of wrist flexion, flexion of lateral fingers, thumb opposition, lumbricals of 2nd and 3rd digits
  • Loss of sensation over thenar eminence 

10

What are the muscles of the hypothenar eminence?

Opponens digiti minimi

Abductor digiti minimi

Flexor digiti minimi brevis

11

Obturator

What is the nerve root?

What does it innervate?

How is it commonly injured?

How does the injury present?

What is the nerve root?

L2-L4

What does it innervate?

Sensory—medial thigh

Motor—obturator externus, adductor longus, adductor brevis, gracilis, pectineus, adductor magnus

How is it commonly injured?

Pelvic surgery

How does the injury present?

decreased thigh sensation (medial) and adduction

12

Ulnar

What is the nerve root?

What is the cause of injury?

How does injury present?

What is the nerve root?

C8-T1

What is the cause of injury?

  • Fracture of medial epicondyle of humerus “funny bone” (proximal lesion)
  • Fractured hook of hamate (distal lesion) from fall on outstretched hand

How does injury present?

  • “Ulnar claw” on digit extension
  • Radial deviation of wrist upon flexion (proximal lesion)
  • Loss of wrist flexion, flexion of medial fingers abduction and adduction of fingers (interossei),  
  • Loss of sensation over medial 11/2 fingers including hypothenar eminence 

13

Extensors of the hip

Gluteus maximus

Semitendinosus

Semimembranosus

14

Lateral femoral cutaneous

What is the nerve root?

What does it innervate?

How is it commonly injured?

How does the injury present?

What is the nerve root?

L2-L3

What does it innervate?

Sensory—anterior and lateral thigh

How is it commonly injured?

Tight clothing, obesity, pregnancy, pelvic procedures

How does the injury present?

decreased thigh sensation (anterior and lateral)

15

Thoracic outlet syndrome

Which injury?

What causes the injury?

What is the muscular deficit?

How does it present?

Which injury?

Compression of lower trunk and subclavian vessels

What causes the injury?

Cervical rib fracture, Pancoast tumor

What is the muscular deficit?

Same as Klumpke 

How does it present?

Atrophy of intrinsic hand muscles; ischemia, pain, and edema due to vascular compression

16

Tibial

What is the nerve root?

What does it innervate?

How is it commonly injured?

How does the injury present?

What is the nerve root?

L4-S3

What does it innervate?

Sensory—sole of foot Motor—biceps femoris (long head), triceps surae, plantaris, popliteus, flexor muscles of foot

How is it commonly injured?

Knee trauma, Baker cyst 

How does the injury present?

TIP = Tibial Inverts and Plantarflexes; if injured, can’t stand on TIPtoes Inability to curl toes and loss of 

17

Abductors of the hip

Gluteus medius

Gluteus minimus

18

What causes abnormal passive adduction of the knee?

Knee either extended or at ~ 30° angle, medial (varus) force Ž lateral space widening of tibia 

LCL injury.

19

Genitofemoral nerve 

What is the nerve root?

What does it innervate?

How is it commonly injured?

How does the injury present?

What is the nerve root?

(L1-L2)

What does it innervate?

Sensory—scrotum/labia majora, medial thigh

Motor—cremaster

How is it commonly injured?

Laparoscopic surgery

How does the injury present?

  • decreased anterior thigh sensation 
  • absent cremasteric reflex

20

Which nerve innervates the thenar eminence?

median nerve

21

Adductors of the hip

Adductor magnus

Adductor longus

Adductor brevis

22

What is the posterior drawer sign?

Bending knee at 90° angle, posterior gliding of tibia due to PCL injury.

23

What is cauda equina syndrome?

  • Compression of spinal roots L2 and below, often due to intervertebral disc herniation or tumor.
  • Unilateral radicular pain, absent knee and ankle reflex, loss of bladder and anal sphincter control, saddle anesthesia. 

24

Common peroneal 

What is the nerve root?

What does it innervate?

How is it commonly injured?

How does the injury present?

What is the nerve root?

L4-S2

What does it innervate?

Sensory - dorsum of foot

Motor—peroneus longus

How is it commonly injured?

Trauma or compression of lateral aspect of leg, fibular neck fracture

How does the injury present?

PED = Peroneal Everts and Dorsiflexes; if injured, foot dropPED
Loss of sensation on dorsum of foot

Foot drop—inverted and plantarflexed at rest, loss of eversion and dorsiflexion; “steppage gait”

 

25

Iliohypogastric nerve

What is the nerve root?

What does it innervate?

How is it commonly injured?

How does the injury present?

What is the nerve root?

T12-L1

What does it innervate?

Sensory—suprapubic region

Motor—transversus abdominis 

How is it commonly injured?

Abdominal surgery

How does the injury present?

Burning or tingling pain in surgical incision site radiating to the inguinal and suprapubic region

26

Flexors of the hip

Iliopsoas

Rectus femoris

Tensor fascia lata

Pectineus

Sartorius

27

What do the ACL and PCL tendons connect?

Lateral femoral condyle to anterior tibia: ACL.

Medial femoral condyle to posterior tibia: PCL.

LAMP.

28

Superior gluteal 

What is the nerve root?

What does it innervate?

How is it commonly injured?

How does the injury present?

What is the nerve root?

L4-S1

What does it innervate?

Motor—gluteus medius, gluteus minimus, tensor fascia latae

How is it commonly injured?

Iatrogenic injury during intramuscular injection to superomedial gluteal region (prevent by choosing superolateral quadrant, preferably anterolateral region)

How does the injury present?

  • Trendelenburg sign/gait— pelvis tilts because weight-bearing leg cannot maintain alignment of pelvis through hip abduction
  • Lesion is contralateral to the side of the hip that drops, ipsilateral to extremity on which the patient stands

 

29

What causes abnormal passive abduction of the knee?

  • Knee either extended or at ∼ 30° angle, lateral (valgus) force
  • medial space widening of tibia
  • MCL injury.

30

Inferior gluteal

What is the nerve root?

What does it innervate?

How is it commonly injured?

How does the injury present?

What is the nerve root?

L5-S2

What does it innervate?

Motor—gluteus maximus

How is it commonly injured?

Posterior hip dislocation

How does the injury present?

Difficulty climbing stairs, rising from a seated position; loss of hip extension

31

Femoral

What is the nerve root?

What does it innervate?

How is it commonly injured?

How does the injury present?

What is the nerve root?

L2-L4

What does it innervate?

Sensory—anterior thigh medial leg

Motor—quadriceps, iliacus, 

How is it commonly injured?

Pelvic fracture

How does the injury present?

decreased thigh flexion and leg extension

 

32

Which muscles are responsible for the abduction of the arm and what are their nerves

Supraspinatus - Suprascapular

Deltoid - Axillary

Trapezius - Accessory

Serratus Anterior - Long Thoracic 

33

34

Axillary nerve

What is the nerve root?

What is the cause of injury?

How does injury present?

What is the nerve root?

(C5-C6)

What is the cause of injury?

Fractured surgical neck of humerus

Anterior dislocation of humerus

How does injury present?

Flattened deltoid
Loss of arm abduction at shoulder (> 15°)
Loss of sensation over deltoid muscle and lateral

35

What is a Trochanteric bursitis?

Inflammation of the gluteal tendon and bursa lateral to greater trochanter of femur. 

36

Sciatic

What is the nerve root?

What does it innervate?

How is it commonly injured?

How does the injury present?

What is the nerve root?

L4-S3

What does it innervate?

Motor—semitendinosus, semimembranosus, biceps femoris, adductor magnus

How is it commonly injured?

Herniated disc, posterior hip dislocation

How does the injury present?

Splits into common peroneal and tibial nerves

37

Q image thumb

A image thumb
38

What are the tests for carpal tunnel syndrome?

Tinel's test

Phalen maneuver

39

Radial

What is the nerve root?

What is the cause of injury?

How does injury present?

What is the nerve root?

C5-T1

What is the cause of injury?

  • Compression of axilla, eg, due to crutches or sleeping with arm over chair (“Saturday night palsy")
  • Midshaft fracture of humerus
  • Repetitive pronation/supination of forearm due to screwdriver use (“finger drop”)

How does injury present?

  • Wrist drop: loss of elbow, wrist, and finger extension, decreased grip strength 
  • Loss of sensation over posterior arm/forearm and dorsal hand

40

Pudendal

What is the nerve root?

What does it innervate?

How is it commonly injured?

How does the injury present?

What is the nerve root?

(S2-S4)

What does it innervate?

Sensory—perineum

Motor—external urethral and anal sphincters

How is it commonly injured?

Stretch injury during childbirth

How does the injury present?

  • decreased sensation in perineum and genital area; can cause fecal or urinary incontinence
  • Can be blocked with local anesthetic during childbirth using ischial spine as a landmark for injection

 

41

Klumpke palsy

Which injury?

What causes the injury?

What is the muscular deficit?

How does it present?

 

Which injury?

Traction or tear of lower trunk: C8-T1 root

What causes the injury?

Infants—upward force on arm during delivery

Adults—trauma 

What is the muscular deficit?

Intrinsic hand muscles: lumbricals, interossei, thenar, hypothenar

How does it present?

Total claw hand: lumbricals normally flex MCP joints and extend DIP and PIP joints

42

What are the muscles of the thenar eminence?

Opponens pollicis

Abductor pollicis brevis

Flexor pollicis brevis

43

Which ligament is most commonly damaged in an ankle sprain?

Anterior TaloFibular ligament—most common ankle sprain overall, classified as a low ankle sprain. 

Due to overinversion/supination of foot. Always Tears First.
Anterior inferior tibiofibular ligament—most common high ankle sprain.

44

Winged scapula

Which injury?

What causes the injury?

What is the muscular deficit?

How does it present?

Which injury?

Lesion of long thoracic nerve, roots C5-C7 (“wings of heaven”)

What causes the injury?

Axillary node dissection after mastectomy, stab wounds

What is the muscular deficit?

Serratus anterior

How does it present?

Inability to anchor scapula to thoracic cage - cannot abduct arm above horizontal position

45

Which muscles abduct and adduct the fingers?

Dorsal interossei (ulnar)—abduct the fingers.

Palmar interossei (ulnar)—adduct the fingers.

46

Internal rotation of the hip

Gluteus medius

Gluteus minimus

Tensor fascia latae

47

What does the McMurray test diagnose?

Pain, “popping” on external rotation - medial meniscal tear (external rotation)

Pain, “popping” on internal rotation - lateral meniscal tear (internal rotation stresses lateral meniscus)

48

What is the anterior drawer sign?

  • Bending knee at 90° angle, anterior gliding of tibia (relative to femur) due to ACL injury.