MSK Session 5 Flashcards
0
Q
What Re the articulations of the humerus?
A
Trochlea Capitulum Olecranon fossa Coronoid fossa Radial fossa
1
Q
What should be considered when examining joints?
A
Articulations Capsule Ligaments Movements Neurovascular supply Bursae
2
Q
What in the humerus accommodates proximal ulna movement?
A
Olecranon fossa
Corona is fossa
3
Q
What are the articulations of the ulna?
A
Coronoid process
Trochlear notch
Olecranon process
4
Q
What are the articulations of the radius?
A
Head
5
Q
What is the carrying angle?
A
Angle made by the forearm and torso
6
Q
Who has a greater carrying angle?
A
Women
7
Q
Which muscles are involved in movement of the elbow joint?
A
Biceps brachii
Triceps brachii
Brachoradialis
8
Q
What angle is made at full extension of the elbow joint?
A
170 degrees
9
Q
How is pronation/supination achieved?
A
Head of radius pivots on capitulum of humerus allowing bones to cross in pronation
10
Q
What is the resting position?
A
Halfway b/w pronation and supination so that palm faces trunk
11
Q
What do the capitulum and radial head essentially act together as?
A
Ball and socket joint
12
Q
What maintains joint integrity during stretching in the radioulnar joint?
A
Articular disk which provides an inbuilt recess
13
Q
What is the sacciform recess?
A
Specialisation of the synovium which allows capsule twisting at the radioulnar joint
14
Q
Why is the capsule at the elbow weak anteriorly and posteriorly?
A
To allow flexion and extension
15
Q
What strengthens the capsule in the elbow?
A
Blending of collateral ligaments medially and laterally w/capsule
16
Q
Which two joints in the forearm share a capsule?
A
Elbow and proximal radioulnar
17
Q
What lines the fibrous capsule that encloses the humerus in the elbow?
A
Synovium
18
Q
What lies within the coronoid and radial fossae?
A
Fat pads
19
Q
What deepens the trochlea notch to stabilise the elbow?
A
Oblique ulnar collateral ligament
20
Q
What shape is the posterior ulnar collateral ligament?
A
Fan
21
Q
Which ulnar collateral ligament is the strongest?
A
Anterior
22
Q
Which ulnar collateral ligament is cord-like, stiff and rigid?
A
Anterior
23
Q
Describe the radio-collateral ligament.
A
Fan-like
Blends w/annular ligament
24
What is the annular ligament of the radius?
Ligamentous collar arising and inserting into ulna
25
What is the function of the annular ligament of the radius?
Allow movement but prevent subluxation
26
What causes students elbow?
Inflammation of the subcutaneous olecranon bursa
27
Where is the subcutaneous olecranon bursa located?
Overrides the olecranon process
28
What is the function of the subtendinous olecranon bursa?
Protect from friction from triceps tendon on olecranon process
29
What causes pain upon flexion and on application of pressure to the area in assembly line workers?
Inflammation of the subtendinous olecranon bursa
30
How many bursae are there in the elbow joint?
Lots of small ones
31
How do the nerves travel around the elbow joint?
Radial passes anterior to lateral epicondyle
| Ulnar passes posteriorly to medial epicondyle
32
What does Hilton's law state?
A BV passing a structure tends to supply it
33
What provides blood supply to the elbow joint?
Arterial anastomoses formed by collateral arteries and recurrent branches of ulnar, radial and interosseous arteries
34
Why does occluding one branch in the blood supply to the forearm not cause lots of disruption?
There is built-on redundancy of blood supply
35
What are the three joints present in the forearm?
Proximal radioulnar
Interosseous membrane
Distal radioulnar
36
What articulates to form the proximal radioulnar joint?
Head of radius
| Radial notch of ulna
37
Which muscles are used in movement of the radioulnar joints?
Supinator
Biceps brachii
Pronator quadratus
Pronator teres
38
What type of joint is the interosseous membrane?
Fibrous
39
In which direction do the fibres of the interosseous membrane run to allow distribution of force from radius to ulna?
Inferio-medially
40
What articulates in the distal radioulnar joint?
Rounded head of ulna
Ulnar notch on medial radial border
Articular disk
41
What is special about the articular disk in the distal radioulnar joint?
It is a specialisation of ligaments, not a typical disk
42
What separates the cavity of the radioulnar joint and the wrist?
Articular disk
43
What is dislocation?
Complete loss of contact of the joint surfaces
44
What is subluxation?
Partial dislocation of a joint so that the bone ends are misaligned but are still in contact
45
What causes pulled elbow?
Upwards force on fully abducted arm causing loss of articulation b/w radial head and capitulum
46
What subluxation from the annular ligament in pulled elbow?
Radial head
47
Why is pulled elbow more commonly seen in children?
Ligaments more flexible
| Annular ligament has not yet fully adopted funnel-like arrangement
48
Which joints are involved at the wrist?
Radiocarpal
| Distal radius and proximal row of carpal bones except pisiform
49
What is the radiocarpal joint?
Articulation of distal radius and articular disk w/proximal carpal bones
50
Is there any ulna involvement at the wrist?
Nope
51
What are the collateral ligaments of the wrist?
Radial and ulnar
52
What is the function of the palmar radiocarpal ligament?
Ensures hand follows radius during supination
53
What is the function of the dorsal radiocarpal ligament?
Ensures hand follows radius during pronation
54
What limits abduction of the wrist?
Styloid process
55
What is another term for abduction/adduction of the wrist?
Radial deviation/ulnar deviation
56
What movements can occur at the wrist joint?
Flexion
Extension
Abduction
Adduction
57
What happens in a Colles fracture?
Fracture of distal radius causing posterior displacement of distal fragment as force not dispersed to ulna
58
What is a possible sequelae of scaphoid fracture?
Avascular necrosis due to distal blood supply
59
Where is tenderness felt in scaphoid fracture?
Over anatomical snuffbox
60
What holds the vertebral column together?
Ligaments
61
Why do changes in vertebral column structure cause noticeable changes in height?
It accounts for ~42% of height
62
What motion describes flexion of the vertebral column?
Bowing
63
What motion describes extension of the vertebral column?
Leaning backwards
64
What are the five gross function of the vertebral column?
Provides for the centre of gravity of the body
Attachments for bones
Attachments for trunk muscles
Protection and passage of the spinal cord
Segmental innervation of the body
65
What line does the spine twist around?
Centre of gravity
66
How is the weight of the body projected into the lower limbs?
About the vertical line
67
What is the function of bone attachment in the upper part of the vertebral column?
Bear/support the head
68
What is the function of bone attachment in the central part of the vertebral column?
Support ribs
| Indirectly support UL
69
What is the function of bone articulation in the lower part of the vertebral column?
Articulates w/hip bones to bear most of body weight
70
How do trunk muscles determine upright posture?
Attachment to vertebral column and continuous low-level contraction
71
Other than the vertebral column, where else do trunk muscles attach?
UL
72
What type of nerves travel from brain to body?
Efferents
73
What are afferent nerves?
Nerves that pass from the body to the brain
74
What does the vertebral column allow segmental nerves to do?
Leave or join the cord at specified points to supply their targets
75
How is the vertebral column arranged in the foetus?
Flexed in a single curvature in a 'C' shape
76
What is a primary curvature of the spine?
Anterior concavity
77
Where is the primary curvature of the foetal spine retained throughout life?
Thoracic, sacral and coccygeal parts
78
What causes remodelling of the primary concave curvature?
Limiting of head by cervical spine
79
At what stage does remodelling of the primary curvature of the foetal spine take place?
~3 months
80
What is the shape of the spine in the young adult?
4 distinct curves give a figure of 'S' shape w/sinusoidal profile
81
Why are 2 anterior and 2 posterior concavities developed in the young adult spine?
To increase resilience
82
What is a secondary curvature?
Posterior concavity
83
What causes the lumbar spine to open up at ~6 months of age?
Crawling and walking
84
What is a kyphosis?
Abnormally exaggerated anterior concavity of spine
85
What is a lordoses?
Normal posterior concavity of spine
86
What starts to disappear in the vertebral column in old age?
Secondary curvatures
87
What is the overall change in vertebral column arrangement in old age?
Move back to foetal shape with fully continuous primary curvature so that the vertebral column closes up
88
Why does limiting the head become more difficult in old age?
Secondary curvatures start to disappear
89
Where are points of weakness in the vertebral column?
C1+2
C7 + T1
L5 + S1
90
What determines the location of points of weakness in the vertebral column?
Where it meets the centre of gravity
91
What happens to the vertebrae as you move inferiorly?
They decrease in height
92
How many discrete vertebrae are there in the spine?
24
93
What are the two innominate structures formed by fused vertebrae?
Sacrum
| Coccyx
94
How many vertebrae are fused in the sacrum and coccyx to give the total 9 fused vertebrae in the spine?
```
Sacrum = 5 (+/-1)
Coccyx = 4 (+/-1)
```
95
What allow synovial joints between arches and adjacent vertebrae in the vertebral arch?
4 articular processes at the junction of lamina and pedicel lined by cartilage
96
Where are the two transverse processes of the vertebral arch found?
Laterally on each side of midline
97
Where is the spinous process found on the vertebral arch?
Posteriorly in midline
98
Where is the lamina of the vertebral arch?
B/w transverse and spin our processes
99
What reduces the pedicle height to form intervertebral foramen?
2 vertebral notches
100
What is found at the intervertebral foramina?
Dorsal root ganglia
101
What is the vertebral body lined with?
Hyaline cartilage
102
What alternates between C2 to S1?
Vertebral disks and bodies
103
What is usually the main weight bearer in the vertebral column?
Vertebral body
104
How does the size of vertebral body change as you move inferiorly?
Increases
105
What do the discrete vertebrae form between adjacent neural arches to prevent anterior displacement, allow movement and weight bearing?
Facet synovial joints
106
What reinforces weight bearing on uprighting of the vertebral column?
Ligamentum flavum
107
What is the intervertebral disc?
Disc of tissue forming secondary cartilaginous joints
108
What are the intervertebral discs responsible for?
Flexibility of vertebral column
| Shock absorbers to dampen impacts to skull
109
What happens to the size of intervertebral discs moving superior to inferior?
Increase
110
What feature of the intervertebral discs accounts for secondary curvature of the spine?
Their wedge shape in lumbar and thoracic levels
111
Describe the wedge shape of lumbar and thoracic level intervertebral discs.
Thickest anteriorly
| Thinnest posteriorly
112
What approximate proportion of the vertebral column is accounted for by the intervertebral discs?
25%
113
Why do we change in height throughout the day?
High water content of the intervertebral discs changes
114
Why do we decrease in height with age?
Intervertebral discs shrink
115
What are the two components of the intervertebral disc?
Nucleus polposus
| Annulus fibrosus
116
What is the nucleus polposus?
Jelly-like water reservoir which has high osmotic pressure
117
How does the location of the nucleus polposus vary with age?
Centrally located in infant
| Posteriorly located in adult
118
When will the nucleus polposus herniate causing a 'slipped disc'?
Annulus fibrosis degeneration
119
What is the difference in effects in posterior and lateral herniation of the nucleus polposus?
```
Posteriorly = paralysis
Laterally = treat w/rest
```
120
What is the annulus fibrosus?
Highly complex design made from a series of annular bands w/varying orientations
121
How do the outer bands of the annulus fibrosus compare to the inner bands?
```
Outer = collagenous
Inner = fibro-cartilaginous
```
122
How does the strength of the annulus fibrosis compare to that of the vertebral body?
Stronger irrespective of direction of force
123
What leads to reactive marginal osteophytosis (bone spurs) in the spine?
Dehydration of the nucleus polposus w/age altering load stresses
124
What causes osteoarthritis of the facet joints in the spine?
Decreased disc space causing increased stress of joints
125
What happens to the intervertebral foramen in nucleus polposus degeneration?
Become congested
126
What happens to segmental nerves in nucleus polposus degeneration?
Become compressed
127
What does degenerative annular disease lead to?
Marginal osteophytosis at the endplates
128
What happens to the height of the disc space in degenerative annular disease!
Largely preserved
129
Where is degenerative annular disease usually seen?
Thoracolumbar spine >50 y.o.
130
What are examples of degenerative annular disease?
Spondylosis deformens
| Senile ankylosis
131
What is the umbrella term used for both nucleus polposus degradation and degenerative annular disease?
Degenerative disc disease
132
Clinically, does it matter which type of of degenerative disc disease a patient is suffering from?
Nope
133
What are the six ligaments of the spine?
```
Anterior longitudinal
Posterior longitudinal
Ligamentum flava
Supraspinous
Interspinous
Ligament nuchae
```
134
How is the anterior longitudinal ligament arranged?
Flat band that passes from the anterior tubercle of atlas to sacrum
Broadens as it moves inferiorly
Firmly united to periosteum of vertbral bodies
Free over intervertebral discs
135
What does the anterior longitudinal ligament prevent?
Anterior herniation of intervertebral disc
136
Is the anterior or posterior longitudinal ligament of the spine stronger?
Anterior
137
How is the posterior longitudinal ligament arranged?
Back of body of axis to clonal of sacrum
Continued above axis as membrana tectoria
Narrows as it moves inferiorly
Serrated edges
Broadest over IV discs which it is firmly united with
138
What separates the posterior longitudinal ligament and vertebral bodies?
Emerging basivertebral veins
139
Why is posterior IV disc herniation more likely?
Freer relationship b/w posterior longitudinal ligament and discs
140
Why is the ligamentum flavum yellow?
Lots of elastic fibres
141
What does the ligamentum flava join?
Laminae of adjacent vertebrae
142
How is the ligamentum flava arranged?
Attached to front of upper lamina and back of lower lamina
143
What stretches the ligamentum flava?
Spine flexion
144
What is the supraspinous ligament?
Strong bands of white fibrous tissue that join adjacent tips of spinous processes
145
How does the supraspinous ligament change in flexion and extension of the spine?
Lax in extension
| Taut in flexion
146
What is the action of the supraspinous ligament in full flexion of the spine?
Effectively prevents erector spinae from extending spine
147
What do the supraspinous and interspinous ligaments provide?
Support of vertebral column
148
What is the interspinous ligament?
Relatively weak sheets of fibrous tissue that unite spinous borders along adjacent border
149
In which region is the interspinous ligament well developed?
Lumbar
150
What does the interspinous ligament fuse with?
Supraspinous ligament
151
What does the ligament nuchae attach to?
Occiput
Interspinous ligament
Supraspinous ligament
Spinous processes of all cervical vertebrae
152
What is the function of the ligament nuchae?
Maintain secondary curvature of spine
Support head
Major attachment of neck and trunk muscles
153
Which vertebrae are the smallest?
Cervical
154
What are the features of cervical vertebrae?
Form skeleton of neck
Bifid spinous process
Oval transverse foramen in transverse process
Large vertebral foramen
155
What is unique about C7 vertebra?
No bifid spinous process
156
Why might a broken neck be sub-clinical?
Large formaen of vertebrae
157
What are the characteristics of thoracic vertebrae?
```
Intermediate in size
Increase in size moving inferiorly
Facets on sides of body - transverse process
Demifactes for articulating w/ribs
Vertebral foramen is small and circular
```
158
What is the exception to T11+12?
Have costal facets for articulations w/tubercle of ribs instead of facets on transverse process
159
What are the characteristics of lumbar vertebrae?
Largest
No foramina on transverse process
No costal facets on side of body
Vertebral foramina are triangular and small
160
What does the atlas (C1) articulate with?
Skull at atlanto-occipital joint
| Axis at atlanto-axial joint
161
Which joint is used in nodding of the head?
Atlanto-occipital
162
Which joint is used in shaking the head?
Atlanto-axial joint
163
What are the characteristics of atlas?
```
Lacks vertebral body
Lacks spinous process
Widest cervical vertebra
Mobile due to no IV disc
Neural arch thick to form a powerful lateral mass
```
164
What forms the Dens process?
Body of atlas fused w/that of axis
165
What are the characteristics of axis (C2)?
Strongest cervical vertebra
Rugged lateral mass
Large spinous process
166
What prevents anterior dislocation of axis?
Dens process
167
What is hangman's fracture?
Fracture and dislocation of axis
168
What injuries is the cervical spine susceptible to?
Whiplash in RTA
| Sport injuries in contact sports
169
What injuries is the lumbar spine susceptible to?
Herniation of L4/L5 or L5/S1 IV discs
170
Why does rheumatoid arthritis particularly affect the atlanto-axial joint?
Complex arrangement of synovium around transverse ligament of joint
171
What do side-to-side curvatures of the spine result from?
Unbalanced muscle tone of trunk on L and R sides
172
What is scoliosis?
Lateral deviation of the spine
