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First Aid 2016 > Musculoskeletal, Skin, and Connective Tissue: Anatomy and Physiology > Flashcards

Musculoskeletal, Skin, and Connective Tissue: Anatomy and Physiology Flashcards

1
Q

Anterior Drawer Sign (Test)

A

Bending knee at 90° angle, increased anterior gliding

of tibia due to ACL injury. Lachman test is similar, but at 30° angle.

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2
Q

Posterior Drawer Sign (Test)

A

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

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3
Q

Abnormal Passive Abduction

A

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

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4
Q

Abnormal Passive Adduction

A

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

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5
Q

McMurray test

A

During flexion and extension of knee with
rotation of tibia/foot:
ƒƒ Pain, “popping” on external rotation –> medial meniscal tear
ƒƒ Pain, “popping” on internal rotation –> lateral meniscal tear

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6
Q

ACL

A

Anterior Cruciate Ligament

Extends from lateral femoral condyle to anterior tibia

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7
Q

PCL

A

Posterior Cruciate Ligament

Extends from medial femoral condyle to posterior tibia

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8
Q

“Unhappy Triad”

A

Common injury in contact sports due to lateral force applied to a planted leg. Classically, consists of damage to the ACL, MCL, and medial meniscus (attached to MCL); however, lateral meniscus injury is more common. Presents with acute knee pain and signs of joint injury/instability.

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9
Q

Prepatellar bursitis

A

Inflammation of knee’s largest sac of synovial fluid (ventral). Can be caused by repeated trauma or
pressure from excessive kneeling.

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10
Q

Baker cyst

A

Popliteal fluid collection in gastrocnemius-semimembranous bursa commonly communicating
with synovial space and related to chronic joint disease.

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11
Q

Rotator cuff muscles

A 
SItS
Supraspinatus (suprascapular nerve)
Infraspinatus (suprascapular nerve)
teres minor (axillary nerve)
Subscapularis (upper and lower subscapular nerves)

Innervated primarily by C5 and C6

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12
Q

Supraspinatus

A 
Rotator cuff muscle
(suprascapular nerve)
Abducts arm initially (before the action
of the deltoid); most common rotator cuff
injury (trauma or degeneration and
impingement Ž--> tendinopathy or tear),
assessed by “empty/full can” test.
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13
Q

Infraspinatus

A

Rotator cuff muscle
(suprascapular nerve)
Laterally rotates arm; pitching injury

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14
Q

teres minor

A

Rotator cuff muscle
(axillary nerve)
Adducts and laterally rotates arm

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15
Q

Subscapularis

A

Rotator cuff muscle
(upper and lower subscapular nerves)
Medially rotates and adducts arm

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16
Q

Medial Epicondylitis

A

Overuse Injury of Elbow
“Golfer’s Elbow”
Repetitive flexion (forehand shots) or idiopathic –>Ž pain near medial epicondyle.

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17
Q

Lateral Epicondylitis

A

Overuse Injury of Elbow
“Tennis Elbow”
Repetitive extension (backhand shots) or idiopathic –> pain near lateral epicondyle

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18
Q

Wrist Bones

A

Scaphoid, Lunate, Triquetrum, Pisiform, Hammate, Capitate, Trapezoid, Trapezium (So Long To Pinky, Here Comes The Thumb)

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19
Q

Scaphoid

A

(palpated in anatomic snuff box)
Most commonly fractured carpal bone (typically from a fall on an outstretched hand) and is prone to avascular necrosis owing to retrograde blood supply

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20
Q

Lunate

A

Dislocation may cause acute carpal tunnel syndrome

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21
Q

Hook of Hamate

A

A fall on an outstretched hand that damages
the hook of the hamate can cause ulnar nerve
injury.

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22
Q

Carpal Tunnel Syndrome

A

Entrapment of median nerve in carpal tunnel; nerve compression Ž paresthesia, pain, and
numbness in distribution of median nerve (thenar eminence atrophies but sensation spared,
because palmar cutaneous branch enters the hand external to carpal tunnel). Associated with
pregnancy, rheumatoid arthritis, hypothyroidism, diabetes, dialysis-related amyloidosis; may be
associated with repetitive use.

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23
Q

Guyon Canal Syndrome

A

Compression of ulnar nerve at wrist or hand. Classically seen in cyclists due to pressure from
handlebars.

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24
Q

Axillary Nerve (C5-C6)

A

Upper extremity nerve
Causes of injury: Fractured surgical neck of humerus; anterior dislocation of humerus
Presentation: Flattened deltoid; loss of arm abduction at shoulder (>15 degrees); loss of sensation over deltoid muscle and lateral arm

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25
Q

Musculocutaneous Nerve (C5-C7)

A

Upper Extremity Nerve
Causes of Injury: upper trunk compression
Presentation: loss of forearm flexion and supination; loss of sensation over lateral forearm

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26
Q

Radial Nerve (C5-T1)

A

Upper Extremity Nerve
Causes of injury: Midshaft fracture of humerus; compression of axilla, eg, due to crutches or sleeping with arm over chair (“Saturday night palsy”)
Presentation: Wrist drop: loss of elbow, wrist, and finger
extension; decreased grip strength (wrist extension necessary for maximal action of flexors); Loss of sensation over posterior arm/forearm and dorsal hand

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27
Q

Median Nerve (C5-T1)

A

Upper Extremity Nerve
Causes of injury: Supracondylar fracture of humerus (proximal lesion); carpal tunnel syndrome and wrist laceration (distal lesion)
Presentation: “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 and dorsal and palmar aspects of lateral 31⁄2 fingers with proximal lesion; Tinel sign (tingling on percussion) in carpal tunnel syndrome

28
Q

Ulnar Nerve (C8-T1)

A

Upper extremity Nerve
Causes of Injury: Fracture of medial epicondyle of humerus “funny bone” (proximal lesion); fractured hook of hamate (distal lesion)
Presentation: “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), actions of medial 2 lumbrical muscles; Loss of sensation over medial 11/2 fingers including hypothenar eminence

29
Q

Recurrent branch of median nerve (C5-T1)

A

Upper extremity nerve
causes of injury: Superficial laceration of palm
Presentation: “Ape Hand”; Loss of thenar muscle group: opposition, abduction, and flexion of thumb; no loss of sensation

30
Q

RTDCB

A

Randy Travis Drinks Cold Beer

Roots Trunks Divisions Cords Branches

31
Q

Erb Palsy

A

“Waiter’s Tip”
Injury: Traction or tear of upper (“Erb-er”) trunk: c5-c6 roots
Causes: Infants - lateral traction on neck during delivery
adults - trauma
Muscle deficit: deltoid, supraspinatus –> functional deficit: abduction (arm hangs by side)
Infraspinatus –> functional deficit: lateral rotation (arm medially rotated)
Biceps Brachii –> functional deficit: Flexion, supination (arm extended and pronated)

32
Q

Klumpke palsy

A

Injury: Traction or tear of lower trunk: C8-T1
Causes: Infants - upward force on arm during delivery
Adults - trauma (e.g., grabbing a tree branch to break a fall)
Muscle deficit: Intrinsic hand muscles: lumbricals, interossei, thenar, hypothenar –> functional deficit: total claw hand: lumbricals normally flex MCP joints and extend DIP and PIP joints

33
Q

Thoracic outlet syndrome

A

Injury: compression of lower trunk and subclavian vessels
Causes: Cervical rib, pancoast tumor
Muscle Deficit: Same as Klumpke Palsy (Intrinsic hand muscles: lumbricals, interossei, thenar, hypothenar) –> Atrophy of intrinsic hand muscles; ischemia, pain, and edema due to vascular compression

34
Q

Winged Scapula

A

Injury: Lesion of long thoracic nerve
Causes: Axillary node dissection after mastectomy, stab wounds
Muscle deficit: Serratus anterior–> inability to anchor scapula to thoracic cage –> cannot abduct arm above horizontal position

35
Q

Distortions of the Hand

A

At rest, a balance exists between the extrinsic flexors and extensors of the hand, as well as the
intrinsic muscles of the hand—particularly the lumbrical muscles (flexion of MCP, extension of
DIP and PIP joints).
“Clawing”—seen best with distal lesions of median or ulnar nerves. Remaining extrinsic flexors
of the digits exaggerate the loss of the lumbricals –> Ž fingers extend at MCP, flex at DIP and PIP
joints.
Deficits less pronounced in proximal lesions; deficits present during voluntary flexion of the digits.

36
Q

“Ulnar claw”

A

3rd/4th fingers bent while 1st/2nd straight
Context: while extending fingers or at rest
Location of Lesion: distal ulnar nerve

37
Q

“Pope’s Blessing”

A

3rd/4th fingers bent while 1st/2nd straight
Context: while making a fist
Location of lesion: proximal median nerve

38
Q

“Median Claw”

A

1st/2nd fingers bent while 3rd/4th straight
Context: while extending fingers or at rest
Location of lesion: distal median nerve

39
Q

“OK gesture”

A

digits 1-3 are flexed
Context: While making fist
Location of lesion: Proximal ulnar nerve

40
Q

Median Nerve Lesions

A

“pope’s blessing,” “median claw,” and “ape’s hand” (unopposable thumb) due to atrophy of the thenar eminence

41
Q

Ulnar Nerve Lesions

A

“OK gesture,” “ulnar claw,” and atrophy of the hypothenar eminence

42
Q

Hand Muscles

A

DAB = Dorsals ABduct
PAD = Palmars ADduct
Thenar (median) = Opponens pollicis, Abductor pollicis brevis, Flexor pollicis brevis, superficial head (deep head by ulnar nerve).
Hypothenar (ulnar) = Opponens digiti minimi,
Abductor digiti minimi, Flexor digiti minimi
brevis.
-both groups perform the same functions: Oppose, Abduct, and Flex (OAF)
Dorsal interossei—abduct the fingers.
Palmar interossei—adduct the fingers.
Lumbricals—flex at the MCP joint, extend PIP
and DIP joints.

43
Q

Obturator Nerve (L2-L4)

A

Lower Extremity Nerve
Cause of injury: Pelvic Surgery
Presentation: decreased thigh sensation (medial) and decreased adduction

44
Q

Femoral Nerve (L2-L4)

A

Lower Extremity Nerve
Cause of injury: Pelvic fracture
Presentation: decreased thigh flexion and leg extension

45
Q

Common peroneal nerve (L4-S2)

A

Lower Extremity Nerve
Cause of Injury: Trauma or compression of lateral aspect of leg, fibular neck fracture
Presentation: Foot drop - inverted and plantarflexed at rest, loss of eversion and dorsiflexion. “Steppage Gait.” Loss of sensation on dorsum of foot

PED = Peroneal Everts and Dorsiflexes; if injured foot dropPED

46
Q

Tibial Nerve (L4-S3)

A

Lower Extremity Nerve
Cause of injury: Knee trauma, Baker cyst (proximal lesion); tarsal tunnel syndrome (distal lesion)
Presentation: Inability to curl toes and loss of sensation on sole of foot. In proximal lesions, foot everted at rest with loss of inversion and plantarflexion

TIP = Tibial Inverts and Plantarflexes; if injured, can’t stand on TIPtoes

47
Q

Superior gluteal nerve (L4-S1)

A

Lower extremity nerve
Cause of injury: Iatrogenic injury during intramuscular injection to upper medial gluteal region
Presentation: Trendelenburg sign/gait - pelvis tilts because weight-bearing leg cannot maintain alignment of pelvis through hip abduction. Lesion is contralateralto side of the hip that drops, ipsilateral to extremity on which the patient stands

Innervates gluteus medius, gluteus minimus, and tensor fascia latae.
Choose a superolateral gluteal quadrant as intramuscular injection site to avoid nerve injury.

48
Q

Inferior gluteal nerve (L5-S2)

A

Lower extremity Nerve
Cause of injury: posterior hip dislocation
Presentation: difficulty climbing stairs, rising from seated position. Loss of hip extension

Innervates gluteus maximus.

49
Q

Sciatic nerve (L4-S3)

A

Innervates posterior thigh, splits into common peroneal and tibial nerves

50
Q

Pudendal nerve (S2-S4)

A

innervates perineum. Can be blocked with local anesthesia during childbirth using the ischial spine as a landmark for injection

51
Q

Signs of Lumbosacral Radiculopathy

A

(Disease involving the lumbar spinal nerve route, normally caused by compression)
Paresthesias and weakness in distribution of specific lumbar or sacral spinal nerves. Often due to intervertebral disc herniation in which the nerve associated with the inferior vertebral body is impinged (e.g., herniation of L3-L4 disc affects the L4 spinal nerve)

Disc Level –> Findings
L3-L4 –> Weakness of knee extension, decreased patellar reflex
L4-L5 –> Weakness of dorsiflexion, difficulty in heel-walking
L5-S1 –> Weakness of plantarflexion, difficulty in toe-walking, decreased Achilles reflex

52
Q

Direction of Intervertebral Disc Herniation

A

Intervertebral discs generally herniate posterolaterally, due to the thin posterior longitudinal ligament and thicker anterior longitudinal ligament along the midline of the vertebral bodies.

53
Q

Axilla/Lateral thorax (name nerve and artery)

A

Long thoracic nerve

lateral thoracic artery

54
Q

Surgical neck of humerus (name nerve and artery)

A

Axillary Nerve

Posterior circumflex artery

55
Q

Midshaft of humerus (name nerve and artery)

A

Radial Nerve

Deep Brachial Artery

56
Q

Distal Humerus/cubital fossa (name nerve and artery)

A

Median Nerve

Brachial Artery

57
Q

Popliteal fossa (name nerve and artery)

A

Tibial Nerve

Popliteal Artery

58
Q

Posterior to medial malleolus (name nerve and artery)

A

Tibial Nerve

Posterior Tibial Artery

59
Q

Muscle Conduction to Contraction

A

T-tubules are extensions of plasma membrane juxtaposed with terminal cisternae of the sarcoplasmic reticulum.
In skeletal muscle, 1 T-tubule + 2 terminal cisternae = triad.
In cardiac muscle, 1 T-tubule + 1 terminal cisterna = dyad.
1. Action potential depolarization opens presynaptic voltage-gated Ca2+ channels, inducing
neurotransmitter release.
2. Postsynaptic ligand binding leads to muscle cell depolarization in the motor end plate.
3. Depolarization travels along muscle cell and down the T-tubule.
4. Depolarization of the voltage-sensitive dihydropyridine receptor, mechanically coupled to the
ryanodine receptor on the sarcoplasmic reticulum, induces a conformational change in both
receptors, causing Ca2+ release from sarcoplasmic reticulum.
5. Released Ca2+ binds to troponin C, causing a conformational change that moves tropomyosin
out of the myosin-binding groove on actin filaments.
6. Myosin releases bound ADP and Pi Ž–> displacement of myosin on the actin filament (power
stroke). Contraction results in shortening of H and I bands and between Z lines (HIZ
shrinkage), but the A band remains the same length (A band is Always the same length) A .
7. Binding of a new ATP molecule causes detachment of myosin head from actin filament.
Hydrolysis of bound ATP –>Ž ADP, myosin head adopts high-energy position (“cocked”) for the
next contraction cycle.

60
Q

Type 1 Muscle

A

Slow Twitch; red fibers resulting from increased [mito] and [Mb] (increased oxphos) –> sustained contraction. Proportion increases after endurance training.
“1 slow red ox.”

61
Q

Type 2 Muscle

A

Fast twitch; white fibers resulting from decreased [mito] and [Mb] (increased anaerobic glycolysis). Proportion increases after weight/resistance training.

62
Q

Endochondral Ossification

A

Bone formation.
Bones of axial skeleton, appendicular skeleton, and base of skull. Cartilaginous model of bone is first made by chondrocytes. Osteoclasts and osteoblasts later replace with woven bone and then remodel to lamellar bone. In adults, woven bone occurs after fractures and in Paget disease. Defective in achondroplasia.

63
Q

Membranous Ossification

A

Bone formation.

Bones of calvarium and facial bones. Woven bone formed directly without cartilage. Later remodeled to lamellar bone.

64
Q

Osteoblast

A

Builds bone by secreting collagen and catalyzing mineralization in alkaline environment via ALP.
Differentiates from mesenchymal stem cells in periosteum.

65
Q

Osteoclast

A

Dissolves bone by secreting H+ and collagenases. Differentiates from a fusion of monocyte/macrophage lineage precursors.

66
Q

Parathyroid hormone

A

At low, intermittent levels, exerts anabolic effects (building bone) on osteoblasts and osteoclasts (indirect). Chronically  PTH levels (1° hyperparathyroidism) cause catabolic effects (osteitis fibrosa cystica).

67
Q

Estrogen

A 
Inhibits apoptosis in bone-forming osteoblasts and induces apoptosis in bone-resorbing osteoclasts.
Estrogen deficiency (surgical or postmenopausal), excess cycles of remodeling, and bone resorption lead to osteoporosis.

First Aid 2016 (8 decks)

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