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

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)

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

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

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

High RF – More severe & active the joint disease

Fun Fact:

Major RA & OA signs at the joint

RA

• 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

OA

• Osteophytes (abnormal bony outgrowths)

• Reduced joint space• Bony cysts• Eburnation (bone

exposed & worn)

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

What is nursemaid’s elbow• Aka – Pulled Elbow• Radial head dislocation

• As head isnt fully formed• Dislocates through annular ligament

Identify where the carpal bones are

What are the carpal bone

Scaphoid Lunate Triquetral Pisiform Hamate Capitate Trapezoid Trapezium

Why is a scaphoid fracture bad?• Because it hurts! (Obv)• Avascular Necrosis common complication

• Distal blood supply• Therefore closer to wrist, worse outcome

Most common fracture of the thumb• Bennett’s

• Proximal metacarpal 1

What is the golden rule of Anterior forearm innervation• Everything is MEDIAN n.• EXCEPT

• Flexor Carpi ULNARIS (Ulnar)• Flexor Digitorum Profundus (medial ½ is Ulnar!)

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

What are the boundaries to the Cubital Fossa

Floor- Brachialis & Supinator

Roof- Fascia & Bicipital aponeurosis- VEINS for venepuncture

(Median Cubital Vein – which links Cephalic & Basalic)

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

What is the golden rule of hand muscle innervation

• Everything is ULNAR n• Except

• Thenar muscles (ones by the ….)• Lumbircals 1 & 2

What passes through the carpal tunnel

• 9 flexor tendons- Flexor digitorum superficialis (x4)- Flexor digitorum profundus (x4)- Flexor pollicis longus

• Median N

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)

Draw BASIC blood supply forearm & hand

At the wrist, what tendons are these arteries next to

• Ulnar• Flexor Carpi ULNARIS - Under or lateral

• Radial• Flexor Carpi RADIALIS - Lateral

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

 

 

How does damage to T1 root present• Wasting of small muscles of the hand

• Dorsal Interossei Wasting

• Possible cause• Pancoast tumour• Cervical Rib

Nerve to these 3 sensory areas& possible injury to them

XX

X

X

XX

X

XXX

MEDIAN

RADIAL

ULNAR

How do you lose powerful elbow flexion?

• Loss of Musculocutaenous N• Muscles supplies: Brachialis, Bicep Brachi, (coracobrachialis)

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

What is Erb’s Palsy• C5 & C6 damage

• E.g. childbirth injury• Results

• ‘Waiters tip’ appearance upper limb

Erbs Palsy