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117 Cards in this Set
- Front
- Back
GC mech of action |
They affect transcription of DNA - interfere with protein synthesis - interfere with pge synthesis (main anti inflammatory action but also causes fluid retention) - have to get into cell to have affect |
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GC main uses |
Immunosuppressive - RA (pregnisolone) - psoriasis - crohns - asthma Anti inflammatory - RA |
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GC Problems |
Long term use accelerates bone loss Increased hyperglycaemia Disrupts flora Increased sodium retention Aggression Adrenal suppression |
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Spinal cord vertebral length |
Extends from foramen magnum in occipital bone to the level of the L1 or L2 vertebra |
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Areas of spinal cord enlargement |
The spinal cord is enlarged in two regions in relationship to the innervation of the limbs: The cervical enlargement - C4-T1 The lumbosacral (lumbar) enlargement - T11-S1 |
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Dura mater |
tough outermost layer
forms the dural sac surrounds the nerve roots |
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Arachnoid mater |
fine, delicate, avascular lines dura mater contains CSF no space between the arachnoid and dura mater |
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pia mater |
innermost layer of meninges thin, transparent, vascular membrane covering the surface of the spinal cord ends as the Filum Terminale |
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Spinal nerve roots exit according to vertebral level |
C1-C7 nerve roots exit above the corresponding vertebra C8-coccygeal nerves exit below corresponding vertebra Cauda equina - nerve roots running in vertebral canal below L2 |
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Innervation of zygapophysial joint innervation |
articular branches of the medial branches of the posterior rami |
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Vertebral column innervation |
Recurrent Meningeal Branches of Spinal Nerves (arise from mixed spinal nerve, arising immediately after its formed and before its division into anterior and posterior rami) 2-4 of these fine meningeal branches arise on each side at all vertebral levels |
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Innervation of facet joints |
Dorsai Rami (also innervates intrinsic back muscles) |
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Arteries of the spinal cord |
Longitudinal vessels 1x anterior spinal artery 2x posterior spinal arteries Segmental vessels Enter the IVF at every segmental level Give rise to anterior and posterior radicular arteries |
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Veins of the spinal cord and column |
Usually 3 anterior and 3 posterior longitudinal veins on cord Internal vertebral venous plexus in epidural space External vertebral venous plexus outside vertebra (The plexuses communicate through intervertebral foramina) Large, torturous basivertebral veins form within the vertebral bodies |
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Four main types of vertebral fractures |
Compression/wedge Burst Seatbelt Fracture-dislocation |
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The 3 column Model of Denis |
describes the functional components of the spine which provide stability If a fracture affects one column it's stable If it affects all three columns it's an unstable fracture |
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Anterior Column components in Model of Denis |
Anterior longitudinal ligament Anterior half of vertebral body Anterior annulis fibrosis Anterior disc |
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Middle Column components in Model of Denis |
Posterior half of vertebral body Posterior annulus/posterior disc PLL |
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Posterior Column components in Model of Denis |
Spinous process Laminae Facets Pedicles Posterior ligaments: (ligamentum flavum, intraspinous lig, supraspinous lig) |
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Compression/wedge fracture |
Compression force cause anterior column to collapse Stable unless other columns affected Commonly found in osteoporosis Surgery only required for unstable fractures |
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Burst Fracture (Jefferson's fracture) |
Extreme axial force causes vertebra to fracture in several places (land on head) Unstable At C1 = Jefferson's fracture Up to 50% of people present with neurological symptoms (depends where the fractured bits of bone end up) C1 highly dependent on transverse ligament being intact - if its injured or compromised in any way considered to be very unstable |
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Seatbelt/Chance fracture |
Due to severe flexion force while wearing lap seatbelt Destruction posteriorly, compression anteriorly Damage to all 3 columns Despite damage, fairly stable fracture Consider potential injury to abdominal viscera |
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Fracture-dislocation |
Dislocation - separation of the joint surfaces Cx dislocation can occur without fracture C5 and 6 most common Slight dislocation likely to damage spinal cord Fractures are generally associated with less risk of neurological symptoms due to fracture allowing more room for spinal cord to move instead of being compressed |
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C2 fractures |
Hangmans fracture - fracture of the pars interarticularis Fracture of the dens - Unstable fractures - Can cut blood supply to dens |
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Lumbar Pars Fracture |
Stress fracture Repeated hyperextension Common in gymnasts L5 most common region Spondylolysis - just fracture Spondylolisthesis - bilateral and vertebra slips forward on inferior vertebra |
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IVD definition |
The nucleus pulpous protrudes into or through the annulus fibrosis IVD forms lower anterior border of IVF in Tx and Lx regions Nucleus pulpous usually extend posterolaterally, where the annulus fibrosis is relatively thin and does not receive support from either the PLL or ALL |
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IVD causes |
Flexion and Rotation forces Smoking, poor posture and repeat sitting activities increase risk Because the IV discs are the largest in the Lx and lumbosacral regions, where movements are consequently greater, posterolateral herniations are most common here (~90%) |
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What causes the pain from IVD? |
Pressure on the longitudinal ligaments and periphery of the annulus fibrosus and from local inflammation caused by chemical irritation by substances from the ruptured nucleus pulposus |
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Function of the Extrinsic muscles of the back |
Superficial Movements of upper limbs Intermediate Respiratory function |
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What divides the extrinsic and intrinsic muscles of the back? |
thoracolumbar fascia |
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Functions of the Intrinsic muscles of the back |
Movement and stability of the vertebral column and head |
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Extrinsic Back Muscles: Superficial Layer + innervation |
Trapezius Latissimus dorsi Levator scapulae Rhomboids major and minor Innervated by anterior rami of cervical nerves Trapezius receives motor fibres from spinal accessory nerve (CN XI) |
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Extrinsic Back Muscles: Intermediate Layer + innervation |
Serratus posterior superior Serratus posterior inferior Superior by first four intercostal nerves and inferior by last four intercostal nerves |
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Intrinsic Back Muscles: Groups |
Superficial - spinotransverseales muscles
Intermediate - Erector spinae muscles Deep - Transversospinalis muscles |
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Intrinsic Back Muscles: Superficial layer (spinotransverales muscle group) + innervation |
Splenius Capitus Rotate head to same side Innervated by posterior rami of spinal nerves C3-4 Splenius Cervicis Rotate head to same side Innervated by posterior rami of lower Cx spinal nerves Working together can also act to extend the head and neck |
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Intrinsic Back Muscles: Intermediate layer (Erector Spinae muscle group) + innervation |
Iliocostalis Longissimus Spinalis Together produce extension and lateral flexion of the spine - common tendinous origin Posterior rami of spinal nerves |
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Intrinsic Back Muscles: Deep layer (Transverospinalis muscle group) + innervation |
Semispinalis (3 regions - capitis, carvicis, thoracis) Multifidus Rotatores Short muscles provide stability for the spine - may produce some extension and rotation Posterior rami of spinal nerves |
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Segmental Muscles (minor deep intrinsic muscles) action + innervation |
Interspinales Stabilises vertebral column Intertransversari Stabilises vertebral column Levatores costarum Elevtaes the ribs Posterior rami of spinal nerves |
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Suboccipital Triangle - What is it? - Where is it? |
- A muscle "compartment" deep to the superior part of the posterior cervical region, underlying the traps, sternocleidomastoid, spenius and semispeinalis muscles - A pyramidal space inferior to the external occipital prominence of the head that includes the posterior aspects of vertebra C1 and C2 |
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Muscles of the sub occipital region + innervation |
Lie deep to the semispinalis captious muscles and consist of: - 2 rectus capitis posterior (major and minor) - 2 obliquus capitis muscles (inferior and superior) Innervated by posterior rams of C1 (suboccipital nerve) |
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Which captious muscle has no attachment to the cranium? |
Obliquus capitis inferior |
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What is the thoracolumbar fascia? |
3 layers in lumbar region (anterior, middle and posterior layers) covers the deep muscles of the back Provides attachment for transversus abdomens and internal oblique muscles |
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What are true ribs? |
Vertebrocostal 1st-7th ribs Attach directly to the sternum through their own costal cartilage |
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What are false ribs? |
Vertebrochondral, free ribs 8th, 9th, and usually 10th ribs Their cartilages are connected to the cartilage of the rib above them; thus their connection with the sternum is indirect |
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What are floating ribs? |
Vertebral, free ribs 11th, 12th and sometimes 10th ribs The rudimentary cartilages of these ribs do not connect even indirectly with the sternum; instead they end in the posterior abdominal musculature |
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Components of Typical Ribs |
3rd- 9th ribs - Wedge-shaped head with two facets - Has a neck connecting the head of the rib with the body at the level of the tubercle - Has a tubercle at the junction of the neck & body - Thin, flat and curved body/shaft, curved most markedly at the costal angle where the rib turns anterolaterally |
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Why is 1st rib atypical? |
Broadest (body is widest and nearly horizontal) Shortest and most sharply curved of the 7 true ribs Single facet on its head for articulation with the T1 vertebra and has 2 transversely directed grooves crossing its superior surface for the subclavian vessels Also has scalene tubercle and ridge |
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Why is 2nd rib atypical? |
Has a thinner, less curved body and is substantially longer than the 1st Has 2 facets for articulation with bodies of T1 and T2 Main atypical feature is a rough area on its upper surface, the tuberosity for serratus anterior |
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Why are the 10th-12th ribs atypical? |
Like the 1st rib, have only one facet on their heads and articulate with a single vertebrae |
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Why are the 11th and 12th ribs atypical? |
Short and have no neck or tubercle |
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What is the angle of Louis? |
The manubrium and body of sternum lie in slightly different planes superior and inferior to their junction, then manubriosternal joint; hence their junction forms a projecting sternal angle (of Louis) |
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Why is the xiphoid process an important landmark in the median plane? |
It is a midline marker for the superior limit of the limit, the central tendon of the diaphragm, and the inferior boarder of the heart |
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What is Thoracic Outlet Syndrome? |
Thoracic outlet syndrome (TOS) is a condition caused by compression of nerves or blood vessels in the thoracic outlet Causes of enlargement of the tissues may include:Trauma or injury, Weight lifting, Cervical rib (an extra rib extending from the neck present at birth), Weight gain or Growth of a tumor |
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Name the 8 muscles of the thoracic wall |
Serratus Posterior Superior - Elevate ribs Serratus Posterior Inferior - Depress ribs Levator Costarum - Elevate ribs Subcostal - Elevate ribs Transverse Thoracic - Depress ribs Intercostals (external, internal and innermost) |
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What are the 3 arterial supplies of the Tx wall? |
Thoracic aorta - through posterior intercostal and subcostal arteries Subclavian artery - through internal thoracic and supreme intercostal arteries Axillary arteries - through superior and lateral thoracic arteries |
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Venous drainage of the Tx wall? |
The intercostal veins accompany the intercostal arteries and veins Posterior intercostal veins drain into the azygos and hemi-azygos system The anterior intercostal veins drain into the internal thoracic veins which are the accompanying veins of the internal thoracic artery |
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Neural supply of Tx wall? |
The 12 pairs of thoracic spinal nerves supply the thoracic wall As soon as they leave the IV foramina in which they are formed, the mixed Tx nerved divide into anterior and posterior (primary) rami or branches The anterior rami of nerves T1-T11 form the intercostal nerves in intercostal spaces The anterior rami of T12 is the the subcostal nerve |
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What are the 3 main apertures through the diaphragm? |
Oesophageal opening (T10) Aortic opening (T12) Caval opening (T8) |
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Caval opening position and contents (Vena Caval Foramen) |
Level of T9 within the central tendon Contents: IVC, right phrenic artery, lymphatics The IVC is adherent to the margin of the openings; consequently when the diaphragm contracts during inspiration, it widens and dilates the IVC - increasing venous return to the heart |
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Oesophageal Hiatus position and contents |
Level of T10, in the right crus of the diaphragm as it decussates distal to the hiatus forming a functional sphincter Occasionally (30%) left crus forms part of the hiatus Contents: oseophagus, and related vessels, anterior and posterior vagal trunks |
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Aortic Hiatus position and contents |
Level of T12, technically posterior to the diaphragm This means there is no insufficiency of blood flow caused by contractions of the diaphragm Contains: Aorta, thoracic duct and azygos vein |
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Nerve supply of the diaphragm |
Supplied from the levels of C3, C4 and C5 "3, 4 and 5 keep the diaphragm alive" The phrenic nerves are also responsible for their half of the diaphragm |
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Muscles of the anterolateral abdominal wall + innervation |
All innervated by thoracoabdominal nerves External oblique (+ subcostal nerves) Internal oblique (+first lumbar nerves) Transversus abdominus (+first lumbar nerves) Rectus abdominus |
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Muscles of the posterior abdominal wall, actions + innervation |
Psoas major (A.Rami of lumbar nerves L1-3) works with iliacus to flex thigh and trunk; can also flex vertebral column laterally Iliacus (Femoral nerve (L2-L4) Flexes thigh and stabilises hip joint Quadratus Lumborum (A. branches of T12, L1-4 nerves) Extends and laterally flexes vertebral column; fixes rib during inspiration |
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Why does the knee "lock" when standing? |
Medial rotation of the femoral condyles on the tibial plateau (the "screw-home mechanism" The thigh and leg muscles can relax briefly when the leg is locked without making the knee joint too unstable |
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How to unlock the knee? |
Contraction of the popliteus causes rotation of the femur laterally on the tibial plateau so that flexion of the knee can occur |
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Primary and Secondary muscles producing extension of the knee |
1 - Quadriceps femoris 2 - Tensor of fascia lata Quads most effective when hip joint is extended |
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Primary and Secondary muscles producing flexion of the knee |
1 - Hamstrings & short head of biceps 2 - Gracilis, sartorius, gastrocnemius, popliteus Normally role of gastroc is minimal but in presence of supracondylar fracture, it rotates (flexes) distal fragment of femur |
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Primary and Secondary muscles producing medial rotation of the knee |
1 - Semitendinosus and semimembranosus when the knee is flexed; popliteus when non-weight bearing knee is extended 2 - Gracilis, Sartorius (When extended knee is bearing weight, action of popliteus laterally rotates femur; when not bearing weight popliteus medially rotates patella) |
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Primary and Secondary muscles producing medical rotation of the knee |
1 - Biceps femoris when knee is flexed |
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Features of the Medial Meniscus |
C shaped, broader posteriorly than anteriorly Firmly adheres to the deep surface of the TCL Because of its widespread attachments laterally to the tibial intercondylar area and medially to the TCL, the medial meniscus is less mobile on the tibial plateau than the lateral meniscus |
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Features of the Medial Meniscus |
Nearly circular, smaller and more freely moveable than the medial meniscus |
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What are the five extra-capsular ligaments of the knee? |
Patellar ligament Fibular collateral ligament Tibial collateral ligament Oblique popliteal ligament Arcuate popliteal ligament |
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Features of the patellar ligament |
Distal part of the quadriceps tendon The anterior ligament of the knee joint |
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Features of the collateral ligaments of the knee |
Taut when the knee is fully extended Contributing to stability when standing As flexion proceeds they become increasingly slack, permitting and limiting (serving as check ligaments for) rotation of the knee Includes the FCL, TCL, oblique popliteal ligament and arcuate popliteal ligaments |
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Features of Fibular collateral ligament (Lateral collateral ligament) |
Cord like extra-capsular ligament Strong It extends inferiorly from the lateral epicondyle of the femur to the lateral surface of the fibular head The tendon of the biceps is split in half by this ligament |
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Features of tibial collateral ligament (Medial collateral ligament) |
Strong, flat, intrinsic (capsular) band that extends from the epicondyle of the femur to the medial condyle and medial surface of tibia At midpoint, fibres are firmly attached to the medial meniscus Weaker than the FCL and more often damaged Resultantly, the TCL and medial meniscus is more commonly torn during contact sports |
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What are the intracapsular ligaments of the knee? |
Cruciate ligaments and menisci |
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Features of both cruciate ligaments |
Crisscross within the joint capsule but outside the synovial cavity During medial rotation of the tib on fib, the cruciate ligs wind around each other; limiting medial rotation to about 10 degrees In every position one, or both ligaments is tense They maintain contact with the femoral and tibial articular surfaces during flexion of the knee |
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Features of Anterior Cruciate Ligament (ACL) |
Weaker of the two Relatively poor blood supply Limits posterior rolling of the femoral condyles on the tibial plateau during flexion - covering it to spin Prevents posterior displacement of femur on tibia and hyperextension of knee joint Prevents anterior movement of tibia when knee is flexed |
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Features of Posterior Cruciate Ligament (PCL) |
Stronger of the two Limits anterior rolling of the femur on the tibial plateau during extension, covering it to spin Prevents anterior displacement of the femur on the tibia AND posterior displacement of the tibia on the femur Prevents hyperflexion of knee Main stabilising factor for the femur in weight bearing flex knee (going down hill) |
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Role and features of the menisci |
Deepen the surface of the tibial articulation in the knee and play a role in shock absorption Thicker at external margins and thin intra-condylar External margins attach to joint capsule of the knee Transverse lig joins anterior edges of the menisci and tethers them together during knee movements |
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What does the strength of the knee rely on? |
1 - the strength and actions of the surrounding muscles and their tendons 2 - the ligaments that connect the femur and tibia |
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What is the most stable position of the knee? |
Erect, extended position In this position the articular surfaces are most congruent, the primary ligaments for the joint (collateral and cruciates) are taut, and the many tendons surrounding the joint provide a splinting effect |
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What is the blood supply of the knee? |
The genicular branches of the femoral, popliteal, and anterior and posterior recurrent branches of the anterior tibial recurrent and circumflex arteries |
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Which artery branch supplies the cruciate ligaments, synovial membrane, and peripheral margins of the menisci? |
The middle genicular branches of the popliteal artery penetrate the fibrous layer of the joint capsule and supply the cruciate ligaments, synovial membrane, and peripheral margins of the menisci |
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Nerves of the knee |
(Pretty much all) Articular branches from the femoral (anterior), tibial (posterior) and common fibular nerves (lateral) Obturator and saphenous (cutaneous) - articular branches to medial aspect |
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Differentiate between Grade I, II and III knee injuries |
Grade I - No laxity Grade II - Partial rupture; laxity Grade III - Complete rupture |
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MCL Sprains |
Valgus force + twisting force Can be torn though both MCL and TCL and potentially ACL and PCL as well |
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ACL rupture - Mechanism of Injury |
Occurs then bones of the leg twist in opposite directions under full body weight Non-contact Jumping, cutting (sudden change of direction) Deceleration/valgus + rotation Hyperextension |
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ACL associated injuries |
Ligament sprains (MCL) Meniscus tears - medial more than lateral Chondral lesions Bone bruising |
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Clinical signs of ACL rupture |
Anterior drawer sign Free tibia slides anteriorly under flexed femur |
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PCL - Mechanism of Injury |
Posterior directed force to tibia (dashboard injury) Forced hyeprflexion Forced hyperextension Significant values/varus force |
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PCL rupture clinical signs |
Posterior sag/Posterior drawer PCL ruptures allow the free tibia to slide posteriorly under the fixed femur |
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Associated Injuries with Anterior Knee Dislocations |
Anterior dislocation particularly damages popliteal artery and nerve |
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Which meniscus tears more commonly and why? |
The medial meniscus because of its lack of mobility. The lateral meniscus is more mobile and can 'get out of the way' of compressive/destructive forces |
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Treatment of meniscal tears |
Peripheral tears can often be repaired or may heal due to the generous blood supply to this area Other tears which will not heal are usually remove - no mobility is lost however the knee may be less stable and the tibial plateaus may undergo inflammatory reactions |
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Rotator Cuff Intrinsic Impingement |
(intrinsic = with tendon) Tear Calcific Tendinopathy Secondary Swelling |
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Rotator Cuff Extrinsic Impingement |
(extrinsic = outside tendon) Acromion Bursa ACJ osteophyte Tuberosity Instability |
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What is Adhesive Capsulitis |
"Frozen Shoulder" - Inflammation and fibrosis in capsule causing restrictions to ROM - Progressive pain and stiffness (joint contractors may result) - May run for 18 months - Usually 40-60yo, women > men - Trivial trauma, poor sleep |
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What is Calcific Tendonitis? |
- Deposition of hydroxyapatite crystals in critical zone - Fibrocartilage metaplasia - Intense inflammation and vascular reaction leads to swelling - Insidious, rapid onset often after minor trauma - Presents as acute pain or secondary impingement |
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Arthritis in the shoulder - Types - Common causes |
Primary OA - often multi joint Secondary OA - post instability or trauma (fracture - people who have recurring trauma have 20x risk of OA later in life), massive rotator cuff tear Inflammatory - RA |
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Pathology resulting from Shoulder Trauma |
Fractures of clavicle, proximal humerus, glenoid and scapula Joint instabilty (A-C and G-H joints) Soft tissue injury to rotator cuff, other local muscles/tendons/ligament |
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Mechanism of Acromio-clavicular joint injury |
Medicalisation of shoulder girdle on a fixed clavicle, driving the accordion down Get downward sag of shoulder - manage non-operatively Common when football players land on shoulder tip - most common shoulder injury in contact sports |
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What nerve is compressed in cubital tunnel syndrome? |
Ulnar nerve |
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What are the two promotors of the forearm? |
Pronation teres Pronator quadorum |
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What are the two supinators of the forearm |
Supinator Biceps - especially when elbow is flexed |
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Is supination or pronation a more powerful movement? |
Supination because of involvement of the biceps |
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Flexors of wrist |
Flexor carpi radialis Flexor carpi ulnaris
Palmaris longus is minor flexor runs between other two - frequently absent |
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Extensors of the wrist |
Extensor carpi radialis: brevis, longus Extensor carpi ulnaris
All pass under extensor retinaculum Act together to extend the wrist
Produce radial or ulnar abduction when working separately |
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Which is the joint which the fingers become separate from the hand? |
MP JOINT |
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Which is the joint which the fingers become separate from the hand? |
MP JOINT |
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Which joint gives the thumb its special movement (opposition) and position in relation to the other fingers? |
CMC joint |
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Muscles that perform flexion of the fingers |
Extensor digitorum superficialis Extensor digitorum profundus
They have four separate tendons, the superficialis splits in half and let's the profundus come through so it can insert on middle phalanx, the superficialis then goes to insert distally
Profundus extends both joints and superficialis extend distal IP? |
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Extensor muscles of the fingers |
Big one is extensor digitorum Extensor digiti minimi Extensor indicis (extends middle finger)
Produce extension at all three joints of finger |
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Muscles of thumb movement |
Flexor pollicis longus (mp and ip) Abductor pollicis longus Extensor pollicis brevis Extensor pollicis longus |
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Muscles of thumb movement |
Flexor pollicis longus (mp and ip) Abductor pollicis longus Extensor pollicis brevis Extensor pollicis longus |