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First AID

MUSCULOSKELETAL

TermDefinition
teres minor (axillary nerve)— adducts and externally rotates arm. ƒ
Subscapularis (upper and lower subscapular nerves) —internally rotates and adducts arm. Innervated primarily by C5-C6.
Serratus Anterior Long Thoracic (SALT) arm abduction > 100 degrees injured in mastectomy
Scaphoid (palpable in anatomic snuff box ) the most commonly fractured carpal bone, typically due to a fall on an outstretched hand. Complications; - avascular necrosis - nonunion due to retrograde blood supply from a branch of the radial artery..
Thenar muscles median nerve Opponens pollicis, Abductor pollicis brevis, Flexor pollicis brevis, superficial head (deep head by ulnar nerve).
Hypothenar (ulnar) —Opponens digiti minimi, Abductor digiti minimi, Flexor digiti minimi brevis.
Lumbricals (1st/2nd, median; 3rd/4th, ulnar)— - flex at the MCP joint, - extend PIP and DIP joints.
Axillary (C5-C6) Fractured surgical neck of humerus Anterior dislocation of humerus Flattened deltoid Loss of arm abduction at shoulder (> 15°) Loss of sensation over deltoid muscle and lateral arm
Musculocutaneous (C5-C7) Upper trunk compression < biceps (C5-6) or triceps (C7) reflex - Weakness of forearm flexion - supination Loss of sensation over lateral forearm
Radial (C5-T1) 1.) Compression of axilla, - crutches , (“Saturday night palsy”) 2.) Midshaft fracture of humerus 3.)Repetitive pronation/supination of forearm, eg, due to screwdriver use (“ finger drop”)
Axillary (C5-C6) nerve injury presentation Wrist drop: loss of elbow, wrist, and finger extension grip strength - wrist extension necessary for maximal action of flexors Loss of sensation over posterior arm/forearm and dorsal hand
Median (C5-T1) Supracondylar fracture of humerus proximal lesion Carpal tunnel syndrome and wrist laceration distal lesion of the nerve
Median (C5-T1) nerve injury presentation Ape hand” and “Pope’s blessing” Loss of wrist flexion, loss of flexion of lateral fingers, loss of thumb opposition, lumbricals of index and middle fingers Loss of sensation ; - over thenar eminence. - dorsal and palmar aspects of lateral 31⁄2 ngers with proximal lesion
Ulnar (C8-T1) Fracture of medial epicondyle of humerus “funny bone” (proximal lesion) Fractured hook of hamate (distal lesion) from fall on outstretched hand
Ulnar (C8-T1) nerve injury - “Ulnar claw” on digit extension - Radial deviation of wrist upon flexion (proximal lesion) Loss of wrist flexion, flexion of medial fingers, abduction and adduction of fingers (interossei), actions of medial 2 lumbrical muscles Loss of sensation over medial 11/2 fingers including hypothenar eminence
Recurrent branch of median nerve (C5-T1) Superficial laceration of palm “Ape hand” Loss of thenar muscle group: opposition, loss of abduction, and flexion of thumb No loss of sensation
Erb palsy (“waiter’s tip”) C5-C6 roots Infants—lateral traction on neck during delivery Adults—trauma Deltoid, supraspinatus, Infraspinatus, Biceps brachii (arm hangs by side) (arm medially rotated) (arm extended and pronated)
Klumpke palsy lower trunk: C8-T1 roots Infants—upward force on arm during delivery Adults—trauma (eg, grabbing a tree branch to break a fall) Intrinsic hand muscles: lumbricals, interossei, thenar, hypothenar Total claw hand
Thoracic outlet syndrome Compression of lower trunk and subclavian vessels, Cervical rib (, Pancoast tumor) - Atrophy of intrinsic hand muscles; - ischemia, pain, - edema due to vascular compression
Winged scapula Lesion of long thoracic nerve, roots C5-C7 -Axillary node dissection - stab wounds Serratus anterior - Inability to anchor scapula to thoracic cage - cannot abduct arm above horizontal position
Iliohypogastric (T12-L1) Sensory—suprapubic region Motor—transversus abdominis and internal oblique injury -Abdominal surgery presents as Burning or tingling pain in surgical incision site radiating to inguinal and suprapubic region
< upper medial thigh and anterior thigh sensation beneath the inguinal ligament (lateral part of the femoral triangle); absent cremasteric reflex Genitofemoral nerve (L1-L2) innervation - Sensory—scrotum/labia majora, medial thigh Motor—cremaster injury -Laparoscopic surgery
decrease thigh sensation (anterior and lateral) Lateral femoral cutaneous (L2-L3) injury due to Tight clothing, obesity, pregnancy, pelvic procedures Sensory—anterior and lateral thigh
decrease thigh sensation (medial) and adduction Obturator (L2-L4 injury due to Pelvic surgery Sensory—medial thigh Motor—obturator externus, adductor longus, adductor brevis, gracilis, pectineus, adductor magnus
decrease leg extension ( decrease patellar reflex) Femoral (L2-L4) injury due to Pelvic fracture Sensory—anterior thigh, medial leg Motor—quadriceps, iliacus, pectineus, sartorius
Splits into common peroneal and tibial nerves Sciatic (L4-S3) Motor—semitendinosus, semimembranosus, biceps femoris, adductor magnus injury Herniated disc, posterior hip dislocation
foot drop inverted and plantar flexed at rest, Common peroneal (L4-S2)
— loss of eversion and dorsiflexion; “steppage gait” Common peroneal (L4-S2) injury; Trauma or compression of lateral aspect of leg, fibular neck fracture
Inability to curl toes and loss of sensation on sole; in proximal lesions, Tibial (L4-S3) injury injured in; Baker cyst (proximal lesion);
Tibial (L4-S3) Sensory—sole of foot Motor—biceps femoris (long head), triceps surae, plantaris, popliteus, flexor muscles of foot injured in ; Knee trauma, tarsal tunnel syndrome (distal lesion) results in - foot everted at rest with loss of inversion and plantar flexion
Difficulty climbing stairs, rising from seated position; loss of hip extension Motor—gluteus maximus Inferior gluteal (L5-S2) Posterior hip dislocation
Flexors of hips Iliopsoas, rectus femoris, tensor fascia lata, pectineus, sartorius
Internal rotation Gluteus medius, gluteus minimus, tensor fascia latae
External rotation Iliopsoas, gluteus maximus, piriformis, obturator
Extensors Gluteus maximus, semitendinosus, semimembranosus
Abductors Gluteus medius, gluteus minimus
Endochondral ossification Bones of axial skeleton, appendicular skeleton, and base of skull. Defective in achondroplasia.
Membranous ossi cation Bones of calvarium, facial bones, and clavicle. Woven bone formed directly without cartilage . Later remodeled to lamellar bone.
OPG (osteoprotegerin, a RANKL decoy receptor) binds RANKL - prevents RANK-RANKL interaction - decreased osteoclast activity. RANK receptors on osteoclasts RANK ligand, expressed on osteoblasts)
osteitis fibrosa cystica Chronically PTH levels (1° hyperparathyroidism) cause catabolic effects
leflunomid Reversibly inhibits dihydroorotate dehydrogenase --> prevents pyrimidine synthesis. Suppresses T-cell proliferation. RX; Rheumatoid arthritis, psoriatic arthritis. AVR; Diarrhea, hypertension, hepatotoxicity, teratogenicity.
Bisphosphonates Pyrophosphate analogs; bind hydroxyapatite in bone --> inhibiting osteoclast activity. Alendronate, ibandronate, risedronate, zoledronate Osteoporosis, hypercalcemia, Paget disease of bone, metastatic bone disease, osteogenesis imperfecta.
Teriparatide recombinant PTH analog. increases osteoblastic activity when administered in pulsatile fashion. Osteoporosis. Causes bone growth compared to antiresorptive therapies
Pegloticase Recombinant uricase catalyzing uric acid to allantoin allantoin is more water-soluble preventive Rx
Febuxostat Inhibits xanthine oxidase. preventive treatment
Probenecid and high-dose salicylates inhibit tubular reabsorption of uric acid
Etanercept Fusion protein (decoy receptor for TNF-α + IgG1 Fc) Rheumatoid arthritis, psoriasis, ankylosing spondylitis
Supraspinatus (suprascapular nerve)— - abducts arm initially (before the action of the deltoid); - most common rotator cuff injury - tea in cup or assessed by “empty/full can” test
Infraspinatus (suprascapular nerve)— externally rotates arm; pitching injury. ƒ
Created by: beccao