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Semester 2 > MSK Session 5 > Flashcards

MSK Session 5 Flashcards

0
Q

What Re the articulations of the humerus?

A 
Trochlea
Capitulum
Olecranon fossa
Coronoid fossa
Radial fossa
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1
Q

What should be considered when examining joints?

A 
Articulations
Capsule
Ligaments
Movements
Neurovascular supply
Bursae
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2
Q

What in the humerus accommodates proximal ulna movement?

A

Olecranon fossa

Corona is fossa

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3
Q

What are the articulations of the ulna?

A

Coronoid process
Trochlear notch
Olecranon process

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4
Q

What are the articulations of the radius?

A

Head

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5
Q

What is the carrying angle?

A

Angle made by the forearm and torso

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6
Q

Who has a greater carrying angle?

A

Women

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7
Q

Which muscles are involved in movement of the elbow joint?

A

Biceps brachii
Triceps brachii
Brachoradialis

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8
Q

What angle is made at full extension of the elbow joint?

A

170 degrees

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9
Q

How is pronation/supination achieved?

A

Head of radius pivots on capitulum of humerus allowing bones to cross in pronation

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10
Q

What is the resting position?

A

Halfway b/w pronation and supination so that palm faces trunk

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11
Q

What do the capitulum and radial head essentially act together as?

A

Ball and socket joint

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12
Q

What maintains joint integrity during stretching in the radioulnar joint?

A

Articular disk which provides an inbuilt recess

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13
Q

What is the sacciform recess?

A

Specialisation of the synovium which allows capsule twisting at the radioulnar joint

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14
Q

Why is the capsule at the elbow weak anteriorly and posteriorly?

A

To allow flexion and extension

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15
Q

What strengthens the capsule in the elbow?

A

Blending of collateral ligaments medially and laterally w/capsule

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16
Q

Which two joints in the forearm share a capsule?

A

Elbow and proximal radioulnar

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17
Q

What lines the fibrous capsule that encloses the humerus in the elbow?

A

Synovium

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18
Q

What lies within the coronoid and radial fossae?

A

Fat pads

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19
Q

What deepens the trochlea notch to stabilise the elbow?

A

Oblique ulnar collateral ligament

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20
Q

What shape is the posterior ulnar collateral ligament?

A

Fan

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21
Q

Which ulnar collateral ligament is the strongest?

A

Anterior

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22
Q

Which ulnar collateral ligament is cord-like, stiff and rigid?

A

Anterior

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23
Q

Describe the radio-collateral ligament.

A

Fan-like

Blends w/annular ligament

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24
Q

What is the annular ligament of the radius?

A

Ligamentous collar arising and inserting into ulna

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25
Q

What is the function of the annular ligament of the radius?

A

Allow movement but prevent subluxation

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26
Q

What causes students elbow?

A

Inflammation of the subcutaneous olecranon bursa

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27
Q

Where is the subcutaneous olecranon bursa located?

A

Overrides the olecranon process

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28
Q

What is the function of the subtendinous olecranon bursa?

A

Protect from friction from triceps tendon on olecranon process

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29
Q

What causes pain upon flexion and on application of pressure to the area in assembly line workers?

A

Inflammation of the subtendinous olecranon bursa

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30
Q

How many bursae are there in the elbow joint?

A

Lots of small ones

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31
Q

How do the nerves travel around the elbow joint?

A

Radial passes anterior to lateral epicondyle

Ulnar passes posteriorly to medial epicondyle

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32
Q

What does Hilton’s law state?

A

A BV passing a structure tends to supply it

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33
Q

What provides blood supply to the elbow joint?

A

Arterial anastomoses formed by collateral arteries and recurrent branches of ulnar, radial and interosseous arteries

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34
Q

Why does occluding one branch in the blood supply to the forearm not cause lots of disruption?

A

There is built-on redundancy of blood supply

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35
Q

What are the three joints present in the forearm?

A

Proximal radioulnar
Interosseous membrane
Distal radioulnar

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36
Q

What articulates to form the proximal radioulnar joint?

A

Head of radius

Radial notch of ulna

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37
Q

Which muscles are used in movement of the radioulnar joints?

A

Supinator
Biceps brachii
Pronator quadratus
Pronator teres

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38
Q

What type of joint is the interosseous membrane?

A

Fibrous

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39
Q

In which direction do the fibres of the interosseous membrane run to allow distribution of force from radius to ulna?

A

Inferio-medially

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40
Q

What articulates in the distal radioulnar joint?

A

Rounded head of ulna
Ulnar notch on medial radial border
Articular disk

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41
Q

What is special about the articular disk in the distal radioulnar joint?

A

It is a specialisation of ligaments, not a typical disk

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42
Q

What separates the cavity of the radioulnar joint and the wrist?

A

Articular disk

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43
Q

What is dislocation?

A

Complete loss of contact of the joint surfaces

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44
Q

What is subluxation?

A

Partial dislocation of a joint so that the bone ends are misaligned but are still in contact

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45
Q

What causes pulled elbow?

A

Upwards force on fully abducted arm causing loss of articulation b/w radial head and capitulum

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46
Q

What subluxation from the annular ligament in pulled elbow?

A

Radial head

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47
Q

Why is pulled elbow more commonly seen in children?

A

Ligaments more flexible

Annular ligament has not yet fully adopted funnel-like arrangement

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48
Q

Which joints are involved at the wrist?

A

Radiocarpal

Distal radius and proximal row of carpal bones except pisiform

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49
Q

What is the radiocarpal joint?

A

Articulation of distal radius and articular disk w/proximal carpal bones

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50
Q

Is there any ulna involvement at the wrist?

A

Nope

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51
Q

What are the collateral ligaments of the wrist?

A

Radial and ulnar

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52
Q

What is the function of the palmar radiocarpal ligament?

A

Ensures hand follows radius during supination

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53
Q

What is the function of the dorsal radiocarpal ligament?

A

Ensures hand follows radius during pronation

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54
Q

What limits abduction of the wrist?

A

Styloid process

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55
Q

What is another term for abduction/adduction of the wrist?

A

Radial deviation/ulnar deviation

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56
Q

What movements can occur at the wrist joint?

A

Flexion
Extension
Abduction
Adduction

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57
Q

What happens in a Colles fracture?

A

Fracture of distal radius causing posterior displacement of distal fragment as force not dispersed to ulna

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58
Q

What is a possible sequelae of scaphoid fracture?

A

Avascular necrosis due to distal blood supply

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59
Q

Where is tenderness felt in scaphoid fracture?

A

Over anatomical snuffbox

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60
Q

What holds the vertebral column together?

A

Ligaments

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61
Q

Why do changes in vertebral column structure cause noticeable changes in height?

A

It accounts for ~42% of height

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62
Q

What motion describes flexion of the vertebral column?

A

Bowing

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63
Q

What motion describes extension of the vertebral column?

A

Leaning backwards

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64
Q

What are the five gross function of the vertebral column?

A

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

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65
Q

What line does the spine twist around?

A

Centre of gravity

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66
Q

How is the weight of the body projected into the lower limbs?

A

About the vertical line

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67
Q

What is the function of bone attachment in the upper part of the vertebral column?

A

Bear/support the head

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68
Q

What is the function of bone attachment in the central part of the vertebral column?

A

Support ribs

Indirectly support UL

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69
Q

What is the function of bone articulation in the lower part of the vertebral column?

A

Articulates w/hip bones to bear most of body weight

70
Q

How do trunk muscles determine upright posture?

A

Attachment to vertebral column and continuous low-level contraction

71
Q

Other than the vertebral column, where else do trunk muscles attach?

A

UL

72
Q

What type of nerves travel from brain to body?

A

Efferents

73
Q

What are afferent nerves?

A

Nerves that pass from the body to the brain

74
Q

What does the vertebral column allow segmental nerves to do?

A

Leave or join the cord at specified points to supply their targets

75
Q

How is the vertebral column arranged in the foetus?

A

Flexed in a single curvature in a ‘C’ shape

76
Q

What is a primary curvature of the spine?

A

Anterior concavity

77
Q

Where is the primary curvature of the foetal spine retained throughout life?

A

Thoracic, sacral and coccygeal parts

78
Q

What causes remodelling of the primary concave curvature?

A

Limiting of head by cervical spine

79
Q

At what stage does remodelling of the primary curvature of the foetal spine take place?

A

~3 months

80
Q

What is the shape of the spine in the young adult?

A

4 distinct curves give a figure of ‘S’ shape w/sinusoidal profile

81
Q

Why are 2 anterior and 2 posterior concavities developed in the young adult spine?

A

To increase resilience

82
Q

What is a secondary curvature?

A

Posterior concavity

83
Q

What causes the lumbar spine to open up at ~6 months of age?

A

Crawling and walking

84
Q

What is a kyphosis?

A

Abnormally exaggerated anterior concavity of spine

85
Q

What is a lordoses?

A

Normal posterior concavity of spine

86
Q

What starts to disappear in the vertebral column in old age?

A

Secondary curvatures

87
Q

What is the overall change in vertebral column arrangement in old age?

A

Move back to foetal shape with fully continuous primary curvature so that the vertebral column closes up

88
Q

Why does limiting the head become more difficult in old age?

A

Secondary curvatures start to disappear

89
Q

Where are points of weakness in the vertebral column?

A

C1+2
C7 + T1
L5 + S1

90
Q

What determines the location of points of weakness in the vertebral column?

A

Where it meets the centre of gravity

91
Q

What happens to the vertebrae as you move inferiorly?

A

They decrease in height

92
Q

How many discrete vertebrae are there in the spine?

A

24

93
Q

What are the two innominate structures formed by fused vertebrae?

A

Sacrum

Coccyx

94
Q

How many vertebrae are fused in the sacrum and coccyx to give the total 9 fused vertebrae in the spine?

A 
Sacrum = 5 (+/-1)
Coccyx = 4 (+/-1)
95
Q

What allow synovial joints between arches and adjacent vertebrae in the vertebral arch?

A

4 articular processes at the junction of lamina and pedicel lined by cartilage

96
Q

Where are the two transverse processes of the vertebral arch found?

A

Laterally on each side of midline

97
Q

Where is the spinous process found on the vertebral arch?

A

Posteriorly in midline

98
Q

Where is the lamina of the vertebral arch?

A

B/w transverse and spin our processes

99
Q

What reduces the pedicle height to form intervertebral foramen?

A

2 vertebral notches

100
Q

What is found at the intervertebral foramina?

A

Dorsal root ganglia

101
Q

What is the vertebral body lined with?

A

Hyaline cartilage

102
Q

What alternates between C2 to S1?

A

Vertebral disks and bodies

103
Q

What is usually the main weight bearer in the vertebral column?

A

Vertebral body

104
Q

How does the size of vertebral body change as you move inferiorly?

A

Increases

105
Q

What do the discrete vertebrae form between adjacent neural arches to prevent anterior displacement, allow movement and weight bearing?

A

Facet synovial joints

106
Q

What reinforces weight bearing on uprighting of the vertebral column?

A

Ligamentum flavum

107
Q

What is the intervertebral disc?

A

Disc of tissue forming secondary cartilaginous joints

108
Q

What are the intervertebral discs responsible for?

A

Flexibility of vertebral column

Shock absorbers to dampen impacts to skull

109
Q

What happens to the size of intervertebral discs moving superior to inferior?

A

Increase

110
Q

What feature of the intervertebral discs accounts for secondary curvature of the spine?

A

Their wedge shape in lumbar and thoracic levels

111
Q

Describe the wedge shape of lumbar and thoracic level intervertebral discs.

A

Thickest anteriorly

Thinnest posteriorly

112
Q

What approximate proportion of the vertebral column is accounted for by the intervertebral discs?

A

25%

113
Q

Why do we change in height throughout the day?

A

High water content of the intervertebral discs changes

114
Q

Why do we decrease in height with age?

A

Intervertebral discs shrink

115
Q

What are the two components of the intervertebral disc?

A

Nucleus polposus

Annulus fibrosus

116
Q

What is the nucleus polposus?

A

Jelly-like water reservoir which has high osmotic pressure

117
Q

How does the location of the nucleus polposus vary with age?

A

Centrally located in infant

Posteriorly located in adult

118
Q

When will the nucleus polposus herniate causing a ‘slipped disc’?

A

Annulus fibrosis degeneration

119
Q

What is the difference in effects in posterior and lateral herniation of the nucleus polposus?

A 
Posteriorly = paralysis
Laterally = treat w/rest
120
Q

What is the annulus fibrosus?

A

Highly complex design made from a series of annular bands w/varying orientations

121
Q

How do the outer bands of the annulus fibrosus compare to the inner bands?

A 
Outer = collagenous
Inner = fibro-cartilaginous
122
Q

How does the strength of the annulus fibrosis compare to that of the vertebral body?

A

Stronger irrespective of direction of force

123
Q

What leads to reactive marginal osteophytosis (bone spurs) in the spine?

A

Dehydration of the nucleus polposus w/age altering load stresses

124
Q

What causes osteoarthritis of the facet joints in the spine?

A

Decreased disc space causing increased stress of joints

125
Q

What happens to the intervertebral foramen in nucleus polposus degeneration?

A

Become congested

126
Q

What happens to segmental nerves in nucleus polposus degeneration?

A

Become compressed

127
Q

What does degenerative annular disease lead to?

A

Marginal osteophytosis at the endplates

128
Q

What happens to the height of the disc space in degenerative annular disease!

A

Largely preserved

129
Q

Where is degenerative annular disease usually seen?

A

Thoracolumbar spine >50 y.o.

130
Q

What are examples of degenerative annular disease?

A

Spondylosis deformens

Senile ankylosis

131
Q

What is the umbrella term used for both nucleus polposus degradation and degenerative annular disease?

A

Degenerative disc disease

132
Q

Clinically, does it matter which type of of degenerative disc disease a patient is suffering from?

A

Nope

133
Q

What are the six ligaments of the spine?

A 
Anterior longitudinal 
Posterior longitudinal
Ligamentum flava
Supraspinous
Interspinous
Ligament nuchae
134
Q

How is the anterior longitudinal ligament arranged?

A

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
Q

What does the anterior longitudinal ligament prevent?

A

Anterior herniation of intervertebral disc

136
Q

Is the anterior or posterior longitudinal ligament of the spine stronger?

A

Anterior

137
Q

How is the posterior longitudinal ligament arranged?

A

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
Q

What separates the posterior longitudinal ligament and vertebral bodies?

A

Emerging basivertebral veins

139
Q

Why is posterior IV disc herniation more likely?

A

Freer relationship b/w posterior longitudinal ligament and discs

140
Q

Why is the ligamentum flavum yellow?

A

Lots of elastic fibres

141
Q

What does the ligamentum flava join?

A

Laminae of adjacent vertebrae

142
Q

How is the ligamentum flava arranged?

A

Attached to front of upper lamina and back of lower lamina

143
Q

What stretches the ligamentum flava?

A

Spine flexion

144
Q

What is the supraspinous ligament?

A

Strong bands of white fibrous tissue that join adjacent tips of spinous processes

145
Q

How does the supraspinous ligament change in flexion and extension of the spine?

A

Lax in extension

Taut in flexion

146
Q

What is the action of the supraspinous ligament in full flexion of the spine?

A

Effectively prevents erector spinae from extending spine

147
Q

What do the supraspinous and interspinous ligaments provide?

A

Support of vertebral column

148
Q

What is the interspinous ligament?

A

Relatively weak sheets of fibrous tissue that unite spinous borders along adjacent border

149
Q

In which region is the interspinous ligament well developed?

A

Lumbar

150
Q

What does the interspinous ligament fuse with?

A

Supraspinous ligament

151
Q

What does the ligament nuchae attach to?

A

Occiput
Interspinous ligament
Supraspinous ligament
Spinous processes of all cervical vertebrae

152
Q

What is the function of the ligament nuchae?

A

Maintain secondary curvature of spine
Support head
Major attachment of neck and trunk muscles

153
Q

Which vertebrae are the smallest?

A

Cervical

154
Q

What are the features of cervical vertebrae?

A

Form skeleton of neck
Bifid spinous process
Oval transverse foramen in transverse process
Large vertebral foramen

155
Q

What is unique about C7 vertebra?

A

No bifid spinous process

156
Q

Why might a broken neck be sub-clinical?

A

Large formaen of vertebrae

157
Q

What are the characteristics of thoracic vertebrae?

A 
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
Q

What is the exception to T11+12?

A

Have costal facets for articulations w/tubercle of ribs instead of facets on transverse process

159
Q

What are the characteristics of lumbar vertebrae?

A

Largest
No foramina on transverse process
No costal facets on side of body
Vertebral foramina are triangular and small

160
Q

What does the atlas (C1) articulate with?

A

Skull at atlanto-occipital joint

Axis at atlanto-axial joint

161
Q

Which joint is used in nodding of the head?

A

Atlanto-occipital

162
Q

Which joint is used in shaking the head?

A

Atlanto-axial joint

163
Q

What are the characteristics of atlas?

A 
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
Q

What forms the Dens process?

A

Body of atlas fused w/that of axis

165
Q

What are the characteristics of axis (C2)?

A

Strongest cervical vertebra
Rugged lateral mass
Large spinous process

166
Q

What prevents anterior dislocation of axis?

A

Dens process

167
Q

What is hangman’s fracture?

A

Fracture and dislocation of axis

168
Q

What injuries is the cervical spine susceptible to?

A

Whiplash in RTA

Sport injuries in contact sports

169
Q

What injuries is the lumbar spine susceptible to?

A

Herniation of L4/L5 or L5/S1 IV discs

170
Q

Why does rheumatoid arthritis particularly affect the atlanto-axial joint?

A

Complex arrangement of synovium around transverse ligament of joint

171
Q

What do side-to-side curvatures of the spine result from?

A

Unbalanced muscle tone of trunk on L and R sides

172
Q

What is scoliosis?

A

Lateral deviation of the spine

Semester 2 (45 decks)

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