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MSK Questions

MSK Questions. Type of collagen in bone?. Type 1 collagen (also in skin) Type 2 collagen in Cartillage ( Collagen + Ground substance / Proteoglycan). What cells produce cartillage & what cells maintain it?. Produce Chondroblasts Maintain Chondrocytes.

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MSK Questions

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  1. MSK Questions

  2. Type of collagen in bone? • Type 1 collagen (also in skin) • Type 2 collagen in Cartillage ( Collagen + Ground substance / Proteoglycan)

  3. What cells produce cartillage & what cells maintain it? • Produce • Chondroblasts • Maintain • Chondrocytes

  4. What are the 3 types of cartilage & where are they • Hyaline • Joint surfaces • Elastic • External ear, Epiglottis • Fibrocartilage • Joints with not much movement • (Pubic symphysis, Intervertebral disks, Glenoid labrum of shoulder)

  5. What is a bursa & what causes bursitis • Bursa • Fluid filled sac • that provides friction free movement between bones & tendons or muscles • around a joint • Bursitis • Inflammation of sac • Due to repetitive use, trauma or systemic arthritis

  6. What is osteoarthritis & what are its risk factors • Osteoarthritis • Degenerative condition • Loss of articular cartilage & synovitis due to inflammation • Risk factors • Idiopathic • Trauma • Inflammatory disease • Joint defects • Age (biggest) • Gender • Race • Bone mass • Obesity

  7. What is Rheumatoid arthritis & Risk factors • RA • Chronic, Systemic inflammation • Involves synovial joints • Risk factors • Autoimmune (RhF + IgG ATTACK) • Gender (Women 2-3x more at risk) • Age • Genetic predisposition Fun Fact: High RF – More severe & active the joint disease

  8. Major RA & OA signs at the joint RA OA Osteophytes (abnormal bony outgrowths) Reduced joint space Bony cysts Eburnation (bone exposed & worn) • Inflammation • Reduced joint space • Lax tendons & ligaments • Erosion of bone • Degeneration of cartillage • See these typically on hand or wrist radiographs All due to Pannus Tissue invasion

  9. What is gout • Hyperuricaemia (high uric acid in the blood) • Causes deposition in joints, tendons & soft tissues & therefore inflammation • (un)Fun Fact • Attack normally occurs in 1st metatarsal joint • This becomes swollen, red & shiny

  10. What is nursemaid’s elbow • Aka – Pulled Elbow • Radial head dislocation • As head isnt fully formed • Dislocates through annular ligament

  11. Identify where the carpal bones are

  12. What are the carpal bone Scaphoid LunateTriquetral Pisiform HamateCapitate TrapezoidTrapezium

  13. Why is a scaphoid fracture bad? • Because it hurts! (Obv) • Avascular Necrosis common complication • Distal blood supply • Therefore closer to wrist, worse outcome

  14. Most common fracture of the thumb • Bennett’s • Proximal metacarpal 1

  15. What is the golden rule of Anterior forearm innervation • Everything is MEDIAN n. • EXCEPT • Flexor Carpi ULNARIS (Ulnar) • Flexor DigitorumProfundus (medial ½ is Ulnar!)

  16. What is the golden rule of Posterior forearm innervation • Everything is RADIAL n.

  17. What are the boundaries to the Cubital Fossa • Floor • Brachialis & Supinator • Roof • Fascia & Bicipitalaponeurosis • VEINS for venepuncture (Median Cubital Vein – which links Cephalic & Basalic)

  18. What can you palpate in anatomical snuffbox • Scaphoid (Tenderness = Fracture!) • Radial artery (palpable pulse) • Radial styloid process • Trapezium • Base of 1st metacarpal

  19. What is the golden rule of hand muscle innervation • Everything is ULNAR n • Except • Thenar muscles (ones by the ….) • Lumbircals 1 & 2

  20. What passes through the carpal tunnel • 9 flexor tendons • Flexor digitorumsuperficialis (x4) • Flexor digitorumprofundus (x4) • Flexor pollicislongus • Median N

  21. What is carpal tunnel syndrome, and how does it cause these symptoms? • Compression of the median n. which runs through the tunnel • Therefore • Sensory loss • Thenar wasting • Ulnar doesn’t go through the tunnel (goes through Guyons canal)

  22. Draw BASIC blood supply forearm & hand

  23. At the wrist, what tendons are these arteries next to • Ulnar • Flexor Carpi ULNARIS - Under or lateral • Radial • Flexor Carpi RADIALIS - Lateral

  24. BONUS Q • Which artery supplies most of the blood to the hand?

  25. How does damage to T1 root present • Wasting of small muscles of the hand • Dorsal Interossei Wasting • Possible cause • Pancoasttumour • Cervical Rib

  26. Nerve to these 3 sensory areas& possible injury to them

  27. X MEDIAN X X RADIAL X X ULNAR X X X X X

  28. How do you lose powerful elbow flexion? • Loss of Musculocutaenous N • Muscles supplies: Brachialis, Bicep Brachi, (coracobrachialis)

  29. What is Klumpke’s Palsy • C8 & T1 Root damage/compression • What happens? • Paralysis & wasting ALL small muscles of hand (1st dorsal interosseus) • Clawing digitis 2-5

  30. What is Erb’s Palsy Erbs Palsy • C5 & C6 damage • E.g. childbirth injury • Results • ‘Waiters tip’ appearance upper limb

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