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 1 st 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 1 st 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

X X X X X X X X X X 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 (1 st 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