Msk - Gait, Arthritis

Front 1

Describe the 2 types of isotonic contraction.

Back 1

Concentric contraction – muscle shortening eg picking up a cup of tea
Eccentric contraction – muscle lengthening eg walking down hill

Front 2

Outline the step cycle

Back 2

Step cycle – 2 unequal phases carried out by 1 limb
- 60% stance phase is weight bearing: heel strike, loading response, heel off, toe off
- 40% is swing phase: push off to heel strike

Front 3

List the hip flexors -9

Back 3

Iliopsoas, tensor facia latae, rectus femoris, pectineus, Sartorius, adductor longus, adductor brevis, adductor magnus (adductor part), gracillis

Front 4

List the hip extensors

Back 4

Gluteus maximus, hamstrings – semimembranosus, semitendinosus, biceps-long head, adductor magnus – hamstring part

Front 5

List the hip lateral rotators

Back 5

P- GO –GO-Q
Piriformis, gemellus superior & inferior, obturator externus, gluteus maximus, obturator internus, and quadriceps femoris.

Front 6

List the medial rotators of the hip

Back 6

Gluteus medius, gluteus minimus, iliopsoas and tensor facia lata

Front 7

List the abductors of the hip

Back 7

Gluteus medius and minimus and tensor fascia lata

Front 8

List the adductors of the hip

Back 8

pectineus ( femoral nerve) Adductor longus, adductor brevis, adductor magnus ( adductor part)

Front 9

List the flexors of the knee

Back 9

Semimembranosus, semtindinosus, biceps –long and short head,

Front 10

List the extensors of the knee

Back 10

Sartorius, rectus femoris, vastus lateralis, vastus medialis, vastus intermedialis.

Front 11

Describe the muscle actions used in stance

Back 11

1. Heel strike
Hip flexion, Knee extension, Ankle dorsiflexed
2. Loading response – flat foot
Knee extension, ankle plantarflexors, hip abductors
3. Heel off
Ankle plantarflexion, hip abduction
4. Toe off
Hip flexion, flexion of toes

Front 12

Describe the muscle actions involved in swing phase

Back 12

Initial swing – hip flexion, ankle dorsiflexion
Mid swing – ankle dorsiflexion
Terminal swing – hip extension, knee flexion, ankle dorsiflexion
Finish with knee extension to place foot.

Front 13

Give examples of compression injury to the nerve in the arm and the leg.

Back 13

Carpal tunnel syndrome – compression of median nerve
Cubital tunnel syndrome – compression of ulnar nerve ( posterior to medial epicondyle as it passes over the elbow)
Meralgia paraesthetica – compression of lateral cutaneous nerve of thigh by inguinal ligament
Tarsal tunnel syndrome – compression of tibial nerve

Front 14

Describe neuropraxia.

Back 14

Neuropraxia is transcient interruption in neural conduction, often caused by compression of nerve. Regeneration occurs without walerarian degeneration (degeneration of distal part not attached the cell body).

Front 15

Describe axontemesis.

Back 15

Axontemesis is the loss of continuity of the axon and myelin sheath due to a severe crush or contusion greater than neuropraxia. Wallerian degerenation takes place. Epineurium and perineurium or conserved.

Front 16

Describe neurotmesis.

Back 16

Neurotmesis is caused by a severe contusion, stretch or lacerations. The Axon, myelin sheath and encapsulating connective tissue all lose their continuity. Distal and retrograde proximal Wallerian degeneration occurs. Complete loss of motor, sensory and autonomic function.

Front 17

Give examples of anoxia.

Back 17

Dead leg, Saturday night palsy, compartment syndrome

Front 18

Which nerves are vulnerable to injury in pelvic fractures, posterior dislocation of the hip and in fracture of fibula neck.

Back 18

Pelvic fractures – femoral and obturator nerves are at risk
Posterior dislocation – sciatic nerve is at risk
Fracture of fibular neck – common fibular nerve.

Front 19

What causes gait abnormalities?

Back 19

Nerve lesions, instability or immobility of joints and pain

Front 20

Describe trendenleburg’s gait.

Back 20

Trendenleburg’s gait is the tilting of the pelvis on standing and walking.
It may be caused by a lesion of the superior gluteal nerve which supplies the gluteus medius and minimus. These muscles are required for abduction of the hip and medial rotation, thus they prevent pelvis tilting on walking. Paralysis of these muscles would cause a positive trendenleburg’s test.
The gait also might be caused due to hip instability such as congenital hip displacement. This is caused by hypoplasia of the acetabulum and femoral head, commonly due to breach delivery.

Front 21

Describe gait seen due to foot drop

Back 21

.
Lesion of the common fibular nerve can cause loss of dorsiflexors and thus foot drop.
- The high steppage gait might be used where someone has to use extra flexion of hip and knee to keep toes off the ground.
- The waddling gait – the individual leans to the side opposite the long limb
- The swing out gait – the long limb is swung out laterally to allow to toes to clear the ground.

Front 22

Describe an antalgic gait.

Back 22

The stance phase is abnormally shortened relative to swing phase. It is an indication of pain on weight bearing as they try to walk in a manner that reduces painful sensations.
Conditions associated with antalgic gait include
- Osteoporosis
- Tarsal tunnel syndrome
- Trauma

Front 23

Describe osteoarthritis.

Back 23

Osteoarthritis is the destruction of articular cartilage in joints. Normal joint use prompts the release of cartilage-damaging enzymes. If cartilage destruction exceeds cartilage replacement, we’re left with roughened, cracked, eroded cartilages. Eventually bone tissue thickens, sclerosis and forms osteophytes that can restrict movement and rub together to form crepidis on movement.
Osteoarthritis is most common in Cervical and Lumbar spine ( secondary curvature – lordosis), fingers, knuckles, knees, and hips

Front 24

What are the features associated with osteoarthritis that can be seen on an x-ray?

Back 24

- Narrowed joint space
- Osteophyte formation -> crepidis
- Subchondral sclerosis – increased bone density
- Subchondral cyst formation – filled filled sacs

Front 25

What is the treatment for osteoarthritis?

Back 25

- NSAIDS
- Steroid injection
- Glucosamine injections
- Physical therapy

Front 26

Describe rheumatoid arthritis.

Back 26

Rheumatoid arthritis is an autoimmune disease which produces antibodies that attack the synovium of joints causing chronic inflammation. The synovial membrane can inflame and eventually thicken into a pannus which is an abnormal tissue that clings to the articular cartilage, eroding it and eventually fibrous scar tissue replaces the cartilage and connects the 2 ends. The scar tissue can ossify and fuse the ends together – ankylosis.

Front 27

List the features of rheumatoid arthritis.

Back 27

4 out of the 7 below are needed to diagnose as RA
- Morning stiffness lasting longer than 1 hour
- Arthritis of at least 3 areas lasting more than 6 weeks
- Arthritis of hand joints
- Symmetrical arthritis
- Rheumatoid nodules
- Serum rheumatoid factor
- Radiographic changes

Front 28

Describe the management for rheumatoid arthritis

Back 28

- Education
- Physical therapies
- Drugs: analgesics, NSAIDs, DMARDs, Immunotherapies, Steroids ia, po, im, iv
- Surgery

Front 29

Describe gouty arthritis.

Back 29

Gouty arthritis is caused by inflammation due to accumulation of urate crystals in soft tissue.
Urate crystals are formed when uric acid concentration in the blood builds up due to increased production or decreased excretion

Front 30

Describe septic arthritis

Back 30

Septic arthritis is caused by a bacterial infection in joints usually staphylococcal or streptococcal infectiosn. Antibiotics are given and the joint is washed out.Risk factors include immunosuppresant drug takers, artificial joint

Front 31

Name 2 muscles of the medial compartment of the thigh which are not innervated by the obturator nerve.

Back 31

The pectineus is supplied by the femoral nerve L2-L4. It flexes, adducts and medially rotates.
The hamstring part of the adductor magnus is supplied by the tibial division of the sciatic nerve L4-S3