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MSK Answers 1) For each of the following muscles, state their action & innervation Biceps femoris – extends hip & flexes knee, tibial & common fibular nerves L5-S2 Brachioradialis – flexes forearm at elbow, radial nerve C5-C7 Coracobrachialis – flexion & adduction of arm, musculocutaneous C6-C7 Gluteus medius – abducts thigh & rotates hip in all directions, superior gluteal nerve Gracilis – flexes knee & adducts thigh, obturator nerve L2-L4 Iliacus – flexes thigh, femoral nerve L2-L4 Infraspinatus – laterally rotates arm & stabilises shoulder, suprascapular nerve C5-C6 Palmar interossei – ulnar nerve, C8-T1 Pectoralis major – flexes, medially rotates & adducts humerus, lateral & medial pectoral nerves, C5-T1 Sartorius – flexes & laterally rotates hip & flexes knee, femoral nerve, L2-L4 2) State the borders of the femoral triangle Superior = inguinal ligament Lateral = Sartorius Medial = adductor longus 3) State the contents of the femoral triangle from lateral to medial Femoral nerve, femoral artery, femoral vein, empty space for venous & lymphatic distension, lymphatics NAVEL 4) Describe the muscles of the anterior and medial muscles of the thigh 5) Describe the blood flow from the descending aorta to the ankle 6) State the ligaments of the hip joint -Iliofemoral -Pubofemoral -Ischiofemoral 7) Explain the pathology behind a gait with unilateral pelvic drop Poor contraction of contralateral gluteus medius when standing causes excessive pelvic tilt (positive Trendelenburg) 8) List the deep lateral hip rotators from superior to inferior Piriformis Gemellus superior Obturator internus Gemellus inferior Obturator externus Quadratus femoris 9) In which area of the buttock can IM injections be safely administered? Upper lateral quadrant 10) For each vertebra, state its location in the spine A B C Thoracic Lumbar Cervical 11) Labelled the vertebra below A – spinous process B – lamina C – vertebral foramen D – body E – pedicle F – superior vertebral notch G – superior articular process H – transverse process 12) Name the main ligaments of the knee Medial & lateral collateral Anterior & posterior cruciate (PAMs APpLes – Posterior starts anteriorly on the medial condyle, anterior starts posteriorly on the lateral condyle of the femur) 13) Describe the muscles of the posterior thigh 14) Describe how cruciate ligament damage is examined Anterior & posterior drawer tests 15) List the 3 components of the unhappy triad Torn ACL, tibial collateral & medial meniscus 16) What is a baker’s cyst? Abnormal fluid-filled sac of synoial membrane in the popliteal fossa 17) State the innervation of each compartment of the thigh and their roots Anterior – femoral nerve – L2-L4 Posterior – sciatic nerve – L4-S3 Medial – Obturator nerve – L2-L4 18) A driver fractures the proximal end of their right fibula in a car crash and can no longer walk on their heel. Explain how this has come about Foot drop – damage to the common fibular nerve near the fracture. This leads to denervation of the anterior leg and an inability to dorsiflex the foot. 19) Match the leg muscles below with their compartment Anterior compartment Posterior compartment Lateral compartment Fibularis longus Tibialis anterior Plantaris Extensor hallucis longus Soleus Popliteus Flexor digitorum longus Tibialis posterior Fibularis brevis Extensor digitorum longus Flexor hallucis longus Gastrocnemius 20) List the structures posterior to the medial malleolus from anterior to posterior Tom, Dick And Very Nervous Harry Tibialis posterior tendon Flexor Digitorum longus tendon Posterior tibial Artery Posterior tibial Vein Tibial Nerve Flexor Hallucis longus tendon 21) Describe Hilton’s Law Hilton’s Law = the nerve supplying a muscle will also supply the underlying bone 22) Label the tarsals 23) How many cervical, thoracic and lumbar vertebrae are there? 7, 12 and 5 respectively 24) Describe the 3 axial planes of the body 25) Describe the innervation of shoulder abduction 0-15o = supraspinatus 15-90o = deltoid 90-180o = trapezius and serratus anterior rotate the scapula laterally 26) How does long thoracic nerve damage present? Winged scapula due to lack of impulses to serratus anterior, which stabilised the scapula against the ribcage 27) Describe compartment syndrome If there is a bleed in a space enclosed by fascia of the limbs, pressure builds up and may compress nerves leading to parathesia (tingling). 28) Draw the brachial plexus from its roots to its branches 29) Describe the 3 parts of the axillary artery First part – inferior to the clavicle and superior to pec minor Second part – posterior to pec minor Third part – inferior to pec minor & continues into the cubital fossa 30) What are the borders of the axilla? Medial – serratus anterior & thoracic ribs Anterior – pec major, pec minor & subclavius Posterior – subscapularis, teres major & latissimus dorsi 31) Which landmark on the developing limb drives its elongation? Apical ectodermal ridge 32) State the borders of the cubital fossa Superior – imaginary line between the epicondyles of the humerus Medial – lateral border of pronator teres Lateral - medial border of brachioradialis 33) Name the 4 rotator cuff muscles Supraspinatus, infraspinatus, teres minor, subscapularis (SITS) 34) List the ligaments of the glenohumeral joint Intracaspular ligaments: glenohumeral Extracapsualr ligaments: coracoacromial, coracohumeral, transverse humeral 35) Demonstrate the dermatomes on yourself Keegan & Garrett Model Foerster Model 36) Describe the following groups of the anterior compartment of the forearm: Superior group (medial to lateral): flexor carpi ulnaris, palmaris longus, flexor carpi radialis, pronator teres Intermediate group: flexor digitorum superficialis Deep group: flexor digitorum profundus, flexor pollicis longus & pronator quadratus 37) Briefly describe the muscular areas of the upper limb innervated by each of the following: Musculocutaneous nerve – arm flexors Radial nerve – posterior arm & forearm Median nerve – flexors in the anterior forearm except FCU & FDP. Also innervates thenar muscles, lateral 2 lumbricals, lateral 2 interossei & lateral half of FDP Ulnar nerve – FCU, medial half of FDP, medial 2 lumbricals, medial 2 interossei & hypothenar muscles 38) Distinguish between tennis elbow and golfer’s elbow Tennis elbow = lateral epicondylitis Golfer’s elbow = medial epicondylitis 39) Which ligament prevents dislocation of the radial head? Ulnar collateral ligament 40) Describe a Colles’ fracture -A colles’ fracture traverses the entire width of the radius within 2cm of its distal end -Usually caused by falling on an oustretched hand -Leads to a dinnerfork deformity due to posterior displacement of the distal fragment 41) Describe the superficial and deep groups of the posterior compartment of the forearm 42) Which nerve is at risk in a shoulder dislocation and how is this tested? Axillary nerve – tested at its peripheral nerve territory on the lateral arm in the regimental badge area 43) How does denervation to the medial lumbricals and flexor digitorum profundus present? Ulnar claw 44) Which tendons pass through the carpal tunnel? 4 tendons of flexor digitorum superficialis 4 tendons of flexor digitorum profundus 1 tendon of palmaris longus 45) Name the test used to diagnose carpal tunnel syndrome and explain how it works Phalen’s test Forced flexion of the dorsal wrists against each other. This causes increased pressure in the carpal tunnel. Positive test = paraesthesia of the median nerve 46) Give 5 causes of carpal tunnel syndrome Myxoedema Edema (oedema) premenstrually Diabetes Idiopathic Acromegaly Neoplasm Trauma Rheumatoid arthritis Amyloidis Pregnancy 47) List the thenar and hypothenar muscles Thenar Opponens pollicis Abductor pollicis brevis Flexor pollicis brevis Aductor pollicis longus (originates in forearm) Hypothenar Opponens digiti minimi Abductor digiti minimi Flexor digiti minimi brevis 48) Demonstrate hand of benediction on yourself and explain how it comes about Median nerve damage leads to: -Loss of flexion at PIP of digits 1-3 due to denervated FDS -Loss of flexion at PIP of digits 4 & 5 due to denervated FDP -Loss of flexion at MCP of digits 2-3 due to denervated lumbricals 49) Which tendons create the anatomical snuffbox and which artery can be palpated here? Tendons of abductor pollicis longus, extensor pollicis longus & extensor pollicis brevis Radial artery