Week 3 Flashcards
(151 cards)
1
Q
Groups of anteiror arm muscle
A
Thenar
Hypothenar
Lumbricals
Interossei
2
Q
List thenar muscle
List hypothenar muscle
Innervation?
A
Thenar muscles - median
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
Hypothenar muscles - ulnar
Opponens digiti minimi
Abductor digiti minimi
Flexor digiti minimi (brevis)
Ulnar nerve
3
Q
What passes through the carpal tunnel
A
Medial nerve
Flexor pollicus longus
Flexor digitorum superficialis
Flexor digitorum profundus
4
Q
Name the compartments
A
5
Q
Dupuytren’s Contracture
A
A disease of the palmar fascia resulting in thickening and shortening of fibrous bands on the palmar surface of the hand and fingers.
6
Q
Arrangement of tendon sheats in palm
A
thenar (2)
midpalmar (3+4)
7
Q
Fibrous Digital Sheaths
Attachement and their location?
Importance?
A
Bands A2 and A4 are on the proximal and middle phalanx respectively
A1,A3, and A5 are near the MP, PIP and DIP respectively
A2 and A4 Bands are most important to prevent bowstringing. A1 band is involved in trigger finger.
8
Q
Lumbirical muscles
Origin?
Insertion?
Innervation?
Function
A
Originate from the flexor digitorum profundus tendons
Insert in the extensor hoods
9
Q
Interosseus Muscle
2 types?
Function
Origin?
Insertion?
Innervation
A
Dorsal and palmar
Originate from metacarpals
Insert on the extensor hoods
PaD / DaB
Ulnar
10
Q
Fracture of Scapoid
Complications?
A
Most common wrist fracture
Non-union
Avascular necrosis
11
Q
Dermatomes in the upper limb
A
12
Q
Cutaneous Innervation of the Upper Limb
A
13
Q
Segmental Innervation of the Upper Limb
A
14
Q
Innervation to
Anterior arm?
Anterior forearm?
Shoulder?
Posterior arm?
Posterior forearm?
A
Anterior compartment
anterior arm-musculocutaneous
anterior forearm-all median except FCU+2 heads of FDP (ulnar)
anterior hand-all ulnar except thenar comp muscles + lumbricals to the functional midline on radial side (median)
Posterior compartment
Shoulder-axillary (deltoid and teres minor)
posterior arm & forearm-radial
15
Q
Erb-Duchenne Paralysis
Cause?
Symptoms?
A
Damage to upper trunk of the brachial plexus
Shoulder movements are affected most dramatically
16
Q
Klumpke’s Paralysis
Cause?
Symptoms?
A
Damage of lower trunk of the brachial plexus
Hand movements are affected most dramatically
17
Q
Damage to
Axillary?
Musculocutaneous?
Radial?
A
Axillary nerve-severely weakened abduction, weakened lateral rotation
Musculocutaneous nerve- almost no forearm flexion, weakened arm flexion
Radial nerve-no forearm extension, arm may be slightly flexed
(note also has major effect on forearm and hand, see later)
18
Q
Mid humeral shaft fracture damage to what?
A
Radial Nerve
19
Q
Elbow fracture damage to what?
A
Median Nerve Damage
20
Q
Ulnar Nerve Damage
Location?
Phenotype?
A
Fracture of the medial epicondyle can cause trauma to the ulnar nerve.
Hyperextension with flexion
21
Q
Jersey finger
Tendon injury Flexor Profundus vs. Superficialis?
A
Tear of the FDP off the distal phalanx
Profundus-passively extend MP and PIP while trying to flex the DIP
Superficialis-passively extend unaffected fingers while trying to flex
22
Q
Extensor Tendon Injuries
Mallet finger?
Boutonniére deformity?
A
23
Q
Axis of Rotation for Upper Limb Joints
A
- *Glenohumeral**-AP (ab and adduction), vertical (rotation), transverse (flex and extend)
- *Humeroulnar**-transverse (flex and extend)
- *Humeroradial**-transverse (flex and extend), vertical, rotation (pronate and supinate)
- *Radioulnar**-vertical, rotation (pronate supinate)
- *Radiocarpal**-transverse (flex and extend), AP (ab and adduct
24
Q
Axis of rotation
Fingers?
Thumb?
Often arthiritis where?
A
Thumb
Carpometacarpal multiaxi
MP uniaxial
Finger
MP biaxial
1st CMC
25
Join definition
UNION BETWEEN TWO OR MORE RIGID ELEMENTS OF THE SKELETON – BONE OR CARTILAGE
26
Two types of joints
**SYNOVIAL**: the skeletal elements are separated by a joint cavity or space that contains synovial fluid.
“freely movable”
**NONSYNOVIAL**: the skeletal elements are directly connected or continuous with each other.
“non-movable”
27
Types of non-synovial joints: fibrous joints
Connection by?
Types/Examples?
Movemement?
Connective tissue
Suture, tooth, interosseous membrane
No movement (except interosseus membrane)
28
Nonsynovial: Cartilaginous Joints
Connection by?
Types/Examples?
Movemement?
Cartilage
Pubic symphisis, intervertebral disks
Slight movements
29
Joint ligaments types
Extracapsular
Capsular
Intracapsular
30
Name the structure
31
Name the sturcutre
32
Common of bursitis in glenohumeral cavity?
Name?
Bicipital tenosynovitis
33
Elbow joints parts
Humeroulnar
Humeroradial
Proximal radioulnar
34
Ligaments of Elbow
Name?
Function?
**Radial collarteral** - prevents adduction of forearm
**Unlar collateral** - prevents abduction
**Annular ligaments** - surrounds radius head
35
36
Disclocation of radius in elbow
37
Three joints between radius and ulna
38
Does ulna articulates with carpals
No it is separated by a disc
39
Where does transverse carpal ligament attaches to?
Scaphoid and trapezium laterrall
pisiform and hamate medially
40
Carpals
**Proximal Row**
S scaphoid (oid first in the 1st row)
L lunate
T triquetrum
P pisiform
**Distal Row**
T trapezium (by the thumb)
T trapezoid (oid second in the 2nd row)
C capitate
H hamate
41
Function of transverse metacarpal ligaments
Transverse metacarpal ligaments stabilize the hand in single metacarpal fractures
42
Mesoderm sublayers in embryo
paraxial - somites
intermediate - GU
lateral - splanchnic and sometic
43
Skeletal derivatives from:
Somites
Neural crest cells
Lateral plate mesoderm
Vertebra and ribs, skull behind prechordal plate (rostal end of notochord)
Skull in front of precordal plate
Long bones, pelvic and shoulder girdles
44
Which becomes bone sclerotome/dermotome?
What makes dermis?
What somtimes differentiate into?
Sclerotome
Dermatomyotome
Sclerotome/dermatomytome
45
Spina bifida
46
Genes that control limbs development?
The day of the formation of limb buds in lateral plate somatic mesorderm?
Direction of progression?
HOX genes
24 upper limb 28 lower limb
To caudal / distal
47
What is the type of bone formation of the gridles minus clavicle? From where?
Where does limb muscularture is derived from?
Endocondral ossification from lateral plate mesoderm
Somitic mesoderm
48
How is dermatomyotome divided?
Differentiations?
DML (drosomedial lip) =\> epimere =\> expasial musculature (back muscles)
Dermatome (intermediate)
VLL (ventrolateral lip) =\> hypomere =\> hypaxial muscules (limbs and anterior and lateral body wall)
49
How muscles become innervated? Why not simple?
Nerves follow the muscle
Signalling from adjacent connective tissue
50
AER (Apical Epidermal Ridge) gene function?
ZPA (only on caudal) gene function?
Regulates continued growth
Cephaic and caudal organization
51
Syndactyyl?
Meromelia?
Suspetible time to teratogens to limbs?
Associated symptoms?
Amniotic bands?
Fused fibers
Short limbs
4-5th week
Cardio, GI, cranio-facial
Can cause amputations
52
Limb abnormality
53
Prune-belly
Lateral and anterior muscle not migrating properly
54
Level of:
Femoral/Obturator
Sciatiatic
L2,3,4
L4,5+S1,2,3
55
Anteior (flexor) division nerves?
Posterior (extensor) division nerves?
tibial (thigh, leg, foot); obturator (thigh)
femoral (thigh); gluteals (hip); peroneal (fibular) (thigh, leg, foot)
56
Medial rotaiton of the limb
57
Nerves and compartments
Posterior vs. Anterior
Upper / Lower limb
58
Spinal cord segments estimates to upper and lower limb
59
Dermatome of the little toe
Dermatome of the big toe
S1
L4/5
60
Name the structures:
61
Naming fractures of femur
62
Compartments of thigh
63
Fascia lata
64
What travels along great saphanous verin?
What travesl along small saphanous vein?
Saphanous nerve
Sural nerve
65
What supplies posterior compartment of the thigh?
Profunda femoris
66
Cruciate anastomosis members (collateral circulation arounbd the hip joint)
Inferior gluteal
Medial femoral circumflex
Lateral femoral circumflex
1st profunda femoris
67
Origin / insertion of
Sartorius
Rectus femoris
Vastus
Iliac spine / Patella
Illium / Patella
Femur / Tibia
68
Where do all posterior thigh muscle attach to?
What attaches to tibia?
What attaches to fibula?
Ischial tuberosity
T: ST, SM
F: BF
69
Where do all medial muscles begin?
Conntect?
Pubis
Linea aspara: AL, AB, AM
Gracialist connects to Tibia
70
Order of vessels in femoral sheath
Femoral nerve?
Artery, vein, lymphatics
Lateral to the sheath
71
Femoral trianble
Ingual ligament
Sartorius
Adductor longus
72
73
How femoral artery gets access to posterior compartment?
Adductor foramen
74
Where does the psoas and illiacus muscle attach to?
Functions of psoas and iliacus
Lesser trochanter
Flexion (flexion) and lateral rotation
75
Sartorius function
Flexion of knee
Medial rotation of knee (only when it if flexed)
Flexion of hip joint
Lateral rotation of hip joint
76
Tendon Fasia lata function
innervation
Flexes
Medial rotator
77
Medial thigh muscles function
Adduction
Medial rotation
78
Adductors vs. Hamstrings of adductor magnus
What is special about obturator externul?
Where is the insertion?
Obturator - adductors, hamstrings - sciatic
Medial muscle but lateral rotator
Interchochanter
79
Innervations of the butt
80
Gluteal muscles
Gluteus maximus
Guteus medius
Gluteus minimus
Tensor fasciae latae
81
Where do gluteal muscle originate/insert?
Gluteal surface & lines of ala (wing) of ilium & Gluteal tuberositytuberosity - gluteal maximum
Ilium, sacrum, sacrotuberous ligament - Greater trochanter - gluteus medius and minimus
82
Most power extensor
83
Tensor fasciae latae
Medial rotation
Flexion
84
Trandelenburg gait
85
What is innervated by
superior gluteal nerve?
inferior gluteal nerve?
above piriformis: gluteaus medius, minimus and tensor fasciae latae
below the piriformis innervates gluteus maxium
86
What are lateral rotators innervated by?
Lumbosacral plexus branches
87
Innervation of hamstring muscle
biceps group peronial (common fibular)
semi group tibial
88
Superior border of popliteal fossa
sup (L) Biceps femoris (M) Semi
inf (L) Gastrocnemius.lateral (M) medial
89
Order of vessels in popliteal fossa
lat-\>med
nerve, vein, artery
90
Mallet finger
Location of injury?
Result?
Treatment
DIP
Lack of flexion at DIP
Splint 8wks
91
What felxes
MCP
PIP
DIP
Lumbrical
FDS
FDP
92
Boutonniere Deformity
Result?
Treatment
Volar migration of lateral bands (Boutonniere Deformity)
Extension of PIP joint
93
Swan neck deformity
Cause?
Autoimunne or injury (losing ligament collateral ligament between metacarap and proximal phalanx)
94
Trigger figner
tenosynovitis?
pully?
cause?
Treatment?
Aggrevating factors?
Feeling?
Inflamation of a tendon (flexor tenosynovitis)
A1 @ MP
nodeule on flexor
rest, NSAIDs, corticosteroid, surgical release
am, activity, female, diabete, gout, RA, ring
@ PIP
95
DeQuervain’s Tenosynovitis
Location?
What gets inflamed?
First dorsal compartment
EPB APB (same concept as tibialis interior extensor digitorum\_
96
Hand infections:
Paronychia
Felon
Skin infection involving fingernail folds
infection involving the digital pulp
Septic tenosynovitis
97
What are four Kanavel's sign?
If not treated?
1. Sausage digit
2. Pain with passive extension
3. Pain along tendon sheath
4. Flexed resting posture
Scaring and LOF
98
Septic Tenosynovitis
Cause?
Spread of infection?
Treatment?
Trauma or bite wound
Tendon sheath (osseofibrous tunnel)
Surgery
99
Compartment Syndrome
Space?
Thenar, HypoThenar, Adductor,
100
FOOSH
Fall on outstreched hand
101
Describing the bone fracture
If aligned? If all displaced?
View, bone, displacement
Nondisplaced / 100% displaced
102
Where is the radius head pointed at?
Capitilum
103
Galeazzi Injury
Displaced radial shaft fracture with dislocated distal radioulnar joint
104
Monteggia Injury
displaced ulnar shaft fracture with dislocated proximal radioulnar joint
105
Elbow stability
Osseus part?
Soft tissue?
Coronoid (posterior/anterior medial displacement)
Radial (varus, PLRI)
Ulnar collateral (Varus, PLRI)
Medial collateral (Valgus) AB
106
Terrible traid
elbow dislocation
radial head fracture
coronoid fracture
107
Clavicle fractures
Acromioclavicular joint injuries
Glenohumeral dislocations
Rotator cuff injuries
Proximal biceps tendon rupture
Adhesive capsulitis
108
AC joint importance?
Cause?
Symptoms?
Treatment?
Only one bony connection
direct blow, fall on shoulder or outstretched arm
Point tenderness, deformity
Treatment- middle 1/3 immobilization, some ORIF, distal 1/3 with coracoclavicular ligament tear- surgical repair
109
Acromioclavicular Joint Injuries
**Type I-** sprain acromioclavicular ligaments, X-ray wnl
**Type II-** tear ACL, sprain coracoclavicular ligaments, wide AC on X-ray
**Type III-** tear ACL, tear CCL
110
Rotator cuff disorders
Cause?
Treatment?
Most common site of injury?
Very common, insidious (ganglion cyst - infraspinatus) or traumatic
rest, PT, NSAIDs, injection, surgical reapair
Superaspinatus
111
Proximal Biceps Tendon Rupture
Tear in the long head
112
Adhesive Capsulitis
What is it?
Cause?
Stages?
Painful restricted shoulder ROM
Idiopathic, diabetes mellitus, trauma, immobilization, thyroid disorder
Freezing, frozen, thawing
113
Function of interossi
Palmer Adduct(PAD)
Dorsal Abduct(DAB)
MP flexion
PIP extension
114
Guyon’s Canal
Zone of damage?
Effect?
Zone I:Proximal to bifurcation - Mixed motor and sensory
Zone II: distal to bifurcation deep motor - Motor only
Zone III:Distal to bifurcation superficial - Sensory only
115
Carpal Tunnel Syndrome
Symptoms?
Treatment?
Thenar Wasting
Paresthesias and numbness aching pain in Median Nerve
Bracing, steroid, release
116
Posterior Interosseous nerve palsy
Radial head or elbow dislocation
Traction injury
Loss of thumb and finger extension
Wrist extension intact as radial nerve branches proximal to PIN
117
Creatine I
Location? Requirement? Function? Edurance? Cost?
Creatine II
Function?
95% in muscle. 2g, ATP regenration, no impact, 10-15/day
Enhances recovery and training intensity, variable response, side effects (GI/muscle cramping, water retention, weight gain)
118
Caffeine
Effect?
Intake?
No effect in?
increased lipolysis, glycogen sparing, FFA mobilization
100-300mg (3-15mg/kg)
No benefit in untrained, recreational athlete
119
Ergogenic Supplements
Anabolic steroids
HMB (beta-hydroxy-beta-methylbutyrate)
Human growth hormone
Erythropoietin
Stimulants (amphetamines)
120
Anabolic steroids
Effectivenes?
Side effect?
Yes (strenght, power, recover)
Dangerous (acne, testicular atrophy, liver cancer, rage and depression)
121
Dehydroepiandrosterone (DHEA)
Legality?
Function?
Effectivenss?
Banned as drug by FDA, sold as supplement
May be converted to testosterone/estrogen, increased IGF-1 nad GH secretion,
increased muscle mass, decreased fat (if exercise)
122
Beta-Hydroxy-Beta-Methylbutyrate (HMB)
What is it?
Function?
Effect?
Metabolite of leucine
Decreased catabolism, regulates protein metabolism
Increased muscle mass but no evidence for perforamce or strength increase (bodybuilding)
123
Human Growth Hormone
Effectiveness?
Is synthetic version availible?
Side effects?
Effective (increased muscle mass, stregnth, and decreased body fat)
Yes
Dangerous (acromegaly, cardiomyopathy, diabetes)
124
Erythropoietin (EPO)
Effectiveness?
Side effects?
Stimulates red blood cell formation, increased oxygen carrying capacity
Dangerous (stroke, myocardial infarction)
125
Amphetamines
Effective?
Side effects?
Effective (physical power, mental edge, loss of body fat)
Headaches, sleep loss, anxiety; Dangerous (myocardial infarction, hyperthermia
126
Ergogenic supplements
Sodium citrate/bicarbonate?
Sodium phosphate?
Glutamine?
NO?
Dimethylamylamine (DMAA)
Buffers for acidosis
Shifts oxygen dissociation curve to right
Cellular repair, ehanced immunity
Arginine + alpha ketoglutarate, muscle pump
127
Genes
GW1516
AICAR
**peroxisome-proliferator-activated receptor agonist** (Conversion of type II to type I myofibers)
**AMP-activated protein kinase, increases adenosine availability** (Increased levels of glycogen, GLUT4, mitochondrial enzymes)
128
Supplement Use in Women
Anabolic-androgenic steroids (0.1 – 4.8%)
DHEA
Tamoxifen (53% of bodybuilders)
hGH (0.1 – 0.2%)
Ephedra (26%, higher than men, weight loss)
Creatine (0.4%)
129
Inadvertent Doping
Ephedra, Ma Huang
Methylhexaneamine (same as DMAA)
Anabolic steroids (15%)
Clenbuterol
Selective androgen receptor modulators (SARMs)
NY attorney general data recent studies of amphetamine contamination
Hepatoxicity
130
Pyknosis
Karorrhexis
Karyolysis
Shrunken and dark nucleus
Fragmentation of nucleus
Dissolution of nucleus
131
Examples
Cagulative necrosis locations?
Liquifactive necrosis? Where tipical?
Fat necrosis?
Caseous necrosis?
Gangrenous
Heart, kidney
Lung (where lots of lipid e.g. Brain or abscess with lots of inflammatory cells)
Pancreas
Lung (tuberculosis) cavity formation
132
Mallory's bodies (hyaline)
Present in liver dur to alcoholism
Intermediate fillaments
133
Neurofibrillary Tangles
Cytoskeletal filaments are grouped together in elongated pink tangles
134
Fatty Change
Deranged lipoprotein transport from injury (most often alcoholism) leads to accumulation of lipid in the cytoplasm of hepatocytes
135
Cirrhosis
136
Amyloid
137
Lipid ((Glycosylceremide))
Gaucher disease
Fat accumulation in spleen
no glucocerebrosidase enzyme
most common lysozomal storage disease
138
Lipochrome (Lipofuscin)
Accumulation in heart liver / heart - wear and tear
Autophagocytosis - intracellular debris sequestered
139
Hemosiderin
Material in macrophages here - clear up and recycle
breakdown of RBCs
140
Hemosiderin
On iron stain, in hepatocytes and Kupffer cells - iron recycling
141
Bilirubin Cholestasis
In small bile ductules -- hepatic cholestasis
142
Anthracotic Pigment
Accumulation in lungs (macrophages)
143
Dystrophic Calcification
Calcium deposits in damaged tissues
144
Fibrin Mesh
causes
"tumor"
145
Types of effusions
**•Serous:** a transudate with mainly edema fluid and few cells.
**•Serosanguinous:** an effusion with red blood cells.
**•Fibrinous (serofibrinous):** fibrin strands are derived from a protein‐rich exudate.
**•Purulent:** numerous neutrophils are present. Also called "empyema" in the pleural space.
146
Chylous peritoneal Effusion
Accumulation of lymph
147
148
Abscess
Localized collection of neutrophils
149
Ulceration
Loss of epithelium
150
Components of granulomatous inflammation
epithelioid macrophages, giant cells, lymphocytes, plasma cells, and fibroblasts
151
Carpal Tunnel Syndrome
Increase in size of the nine (9) structures or their coverings [e.g., inflammation of synovial sheaths].
