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Questions and Answers
What is a key feature of scoliosis?
What is a key feature of scoliosis?
What treatment is commonly used for Klippel-Feil syndrome?
What treatment is commonly used for Klippel-Feil syndrome?
Which of the following conditions is characterized by anal atresia and cardiac defects?
Which of the following conditions is characterized by anal atresia and cardiac defects?
Which option refers to the failure of the neural tube to close completely?
Which option refers to the failure of the neural tube to close completely?
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Which treatment method is NOT typically associated with managing scoliosis?
Which treatment method is NOT typically associated with managing scoliosis?
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What is one of the key characteristics of Klippel-Feil syndrome?
What is one of the key characteristics of Klippel-Feil syndrome?
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Which condition involves vertebral anomalies and often requires multidisciplinary care?
Which condition involves vertebral anomalies and often requires multidisciplinary care?
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What is a treatment option for spina bifida?
What is a treatment option for spina bifida?
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What effect does a larger cross-sectional area of a muscle have on its force generation?
What effect does a larger cross-sectional area of a muscle have on its force generation?
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What is the primary muscle responsible for a movement called?
What is the primary muscle responsible for a movement called?
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What is the primary disadvantage of active insufficiency in multi-joint muscles?
What is the primary disadvantage of active insufficiency in multi-joint muscles?
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What type of muscle contraction is characterized by the simultaneous contraction of both agonist and antagonist?
What type of muscle contraction is characterized by the simultaneous contraction of both agonist and antagonist?
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How does age affect muscle mass?
How does age affect muscle mass?
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Which pattern of muscle fiber arrangement is known to influence force production?
Which pattern of muscle fiber arrangement is known to influence force production?
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What do multi-joint muscles primarily control?
What do multi-joint muscles primarily control?
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What is the term for the muscle that opposes the action of the agonist?
What is the term for the muscle that opposes the action of the agonist?
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What muscle weakness is associated with injury at the cubital tunnel?
What muscle weakness is associated with injury at the cubital tunnel?
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Which of the following sensory deficits would occur with median nerve injury?
Which of the following sensory deficits would occur with median nerve injury?
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What is the primary joint classification of the knee joint?
What is the primary joint classification of the knee joint?
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What component of the lower extremity includes the tarsals, metatarsals, and phalanges?
What component of the lower extremity includes the tarsals, metatarsals, and phalanges?
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Which imaging modality provides good visualization of bone structures but has limited soft tissue detail?
Which imaging modality provides good visualization of bone structures but has limited soft tissue detail?
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What advantage does computed tomography (CT) have over radiography?
What advantage does computed tomography (CT) have over radiography?
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What is the clinical significance of dermatome mapping?
What is the clinical significance of dermatome mapping?
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Which spinal nerve root supplies an area of skin with sensory innervation?
Which spinal nerve root supplies an area of skin with sensory innervation?
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What is the primary method used for the development of long bones?
What is the primary method used for the development of long bones?
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Which of the following best describes the process of membranous ossification?
Which of the following best describes the process of membranous ossification?
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What do sclerotomes contribute to in bone development?
What do sclerotomes contribute to in bone development?
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Which statement about Wolff's Law is accurate?
Which statement about Wolff's Law is accurate?
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What is a consequence of increased mechanical stress on bone?
What is a consequence of increased mechanical stress on bone?
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What condition is most likely to occur in individuals who are sedentary?
What condition is most likely to occur in individuals who are sedentary?
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What impact does immobilization have on joints?
What impact does immobilization have on joints?
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Why is fetal movement important for joint development?
Why is fetal movement important for joint development?
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What are the primary characteristics of Type I muscle fibers?
What are the primary characteristics of Type I muscle fibers?
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Which muscle fiber type is primarily associated with quick, powerful movements but fatigues easily?
Which muscle fiber type is primarily associated with quick, powerful movements but fatigues easily?
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What is the primary functional unit of muscle contraction?
What is the primary functional unit of muscle contraction?
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How are motor units recruited during muscle contraction?
How are motor units recruited during muscle contraction?
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What is a significant consequence of poliomyelitis on muscle function?
What is a significant consequence of poliomyelitis on muscle function?
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Which of the following ligaments are important for knee stability?
Which of the following ligaments are important for knee stability?
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What commonly occurs in individuals suffering from post-polio syndrome?
What commonly occurs in individuals suffering from post-polio syndrome?
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What is the primary function of the rotator cuff muscles?
What is the primary function of the rotator cuff muscles?
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Which of the following statements about motor units is true?
Which of the following statements about motor units is true?
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Which muscle group is likely to have smaller motor units to facilitate fine movements?
Which muscle group is likely to have smaller motor units to facilitate fine movements?
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What is a characteristic presentation of Erb-Duchenne Palsy?
What is a characteristic presentation of Erb-Duchenne Palsy?
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Which nerve is primarily responsible for supplying the extensor muscles of the wrist and fingers?
Which nerve is primarily responsible for supplying the extensor muscles of the wrist and fingers?
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Injury to the suprascapular nerve primarily results in weakness of which movements?
Injury to the suprascapular nerve primarily results in weakness of which movements?
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What type of injury typically affects the upper trunk of the brachial plexus?
What type of injury typically affects the upper trunk of the brachial plexus?
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Which nerve provides sensory innervation to the little finger and half of the ring finger?
Which nerve provides sensory innervation to the little finger and half of the ring finger?
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The glenohumeral joint is classified as which type of joint?
The glenohumeral joint is classified as which type of joint?
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Study Notes
Bone Development
- Two main pathways: endochondral ossification and membranous ossification
- Endochondral Ossification: Cartilage is replaced by bone, primary method for long bone development (e.g., tibia, femur)
- Diaphysis: Primary ossification center, forms during fetal development
- Epiphysis: Secondary ossification center, forms after birth
- Sclerotomes: Mesenchymal cells that give rise to the vertebral column and contribute to bone development
- Membranous Ossification: Mesenchyme directly differentiates into bone, process for flat bone development (e.g., skull bones)
Wolff's Law
- Principle describing how mechanical stress influences bone growth and remodeling
- Bone adapts to forces placed upon it
- Long bones: Thinner shafts compared to cancellous/head areas, growth only occurs with compression
- Stunted growth: in children with developmental disorders like cerebral palsy or spina bifida, may experience stunted growth due to reduced stress
- Calcium levels: Increased stress leads to increased calcium deposition in bone
- Osteopenia: After age 30, calcium levels naturally decline, bone density decreases
- Osteoporosis: Most likely to occur in inactive or wheelchair-bound individuals
- Fetal development: Movement crucial for joint development in utero
Bone Pathology
- Conditions affecting bone health and development
- Rickets/Osteomalacia: Poor bone mineralization
- Osgood-Schlatter Disease: Overgrowth at tendon attachment site due to repetitive stress
- Spondylolysis: Fracture through pars interarticularis (vertebral arch)
- Spondylolisthesis: One vertebra slips forward on the vertebra below
- Arthrogryposis Multiplex Congenita: Rare condition of fused joints
Fracture Healing
- Process by which fractured bone repairs itself
- Primary bone healing: Occurs when fracture is stable and minimally displaced
- Stages:
- Hematoma formation: Blood clots at fracture site
- Soft callus formation: Fibrocartilage and collagen fibers bridge the gap
- Hard callus formation: Soft callus replaced by woven bone
- Remodeling: Woven bone remodeled into lamellar bone, similar to original structure (can take up to two years)
- Secondary Bone Healing: Occurs with unstable/displaced fractures
- Closed Reduction: Procedure to realign fracture fragments without surgery
- Open Reduction and Internal Fixation (ORIF): Surgical procedure to realign and stabilize with implants
- Malunion: Fracture heals in improper alignment
- Nonunion: Fracture fails to heal completely
- Cox-2: Enzyme involved in inflammatory response and bone healing
Skeletal Muscle Fiber Types
- Different types of muscle fibers with varying characteristics and functions
- Type I (Slow Twitch): Low power output, fatigue resistant, high mitochondrial content, oxidative phosphorylation (e.g., postural muscles, soleus)
- Type IIA (Fast Twitch): Intermediate between Type I and IIB
- Type IIB (Fast Twitch): High power output, glycolytic metabolism, easily fatigued (e.g., gastrocnemius)
Motor Units
- Functional unit of muscle contraction; consists of a motor neuron and all muscle fibers it innervates
- Motor unit: One alpha motor neuron and all the muscle fibers it innervates
- Muscle fiber type: All muscle fibers within a motor unit are the same type (e.g., slow twitch, fast twitch)
- Size:
- Smaller motor units: Fewer muscle fibers, finer movements (e.g., eye muscles)
- Larger motor units: More muscle fibers, gross movements (e.g., lumbricals)
- Recruitment: Motor units are recruited based on size, smallest recruited first
Poliomyelitis
- Viral infection that damages alpha motor neurons, leading to muscle weakness and paralysis
- Alpha motor neuron death: Virus destroys alpha motor neurons
- Initial function: Individuals may initially function normally, but as they age, the surviving motor neurons may not be able to maintain metabolic activity to innervate the extra muscle fibers
- Post-Polio Syndrome: A condition that develops years after polio, characterized by muscle weakness, fatigue, and pain
- Axon Degeneration: Axons to extra muscle fibers die, causing muscle weakness
Muscle Force Generation
- Factors influencing muscle force generation
- Cross-sectional area: Larger area = greater force generation
- Myoarchitecture: Arrangement of muscle fibers
- Pennation patterns: Angle of muscle fibers relative to tendon
- Sex: Men generally have higher muscle mass than women
- Age: Muscle mass declines with age (sarcopenia)
Muscle Contraction Types/Roles
- Different types of muscle contractions
- Agonist: Primary muscle responsible for movement
- Antagonist: Muscle that opposes the agonist
- Co-contraction: Simultaneous contraction of both agonist and antagonist to stabilize a joint
- Synergist: Muscles that assist the agonist in movement
- Substitution: Use of a muscle to carry out a movement when it is not the prime mover
Factors Affecting Muscle Function
- Factors that influence muscle function and performance
- Single joint vs. multi-joint muscles
- Single joint muscles: Primarily responsible for movements at a single joint
- Multi-joint muscles: Control/perform complex movements involving multiple joints
- Length-tension curve: Muscle generates greatest tension at optimal length
- Passive insufficiency: Multi-joint muscle stretched from both ends, limits range of motion at each joint
- Active insufficiency: Multi-joint muscle contracted from both ends, limits range of motion at each joint
Muscle Responses to Changes in Activity
- Muscle adaptation to changes in activity levels
- Initial response: Increased recruitment and firing rate of motor units, increased synchronization of motor units, increased activation of agonists, decreased antagonist activation, improved coordination
- Losses of strength: Decreased activity, mobilization, atrophy, delayed response
- Gains of strength: Hypertrophy of muscle fibers, increased synthesis of contractile proteins, increased capillary density
- Losses of strength: Muscle atrophy, decreased muscle mass, muscle contracture
Peripheral Nerves
- Nerves that transmit signals from the central nervous system to the periphery
- Peripheral nerve injuries:
- Neurapraxia: Temporary loss of nerve conduction at injury site (nerve is intact)
- Axonotmesis: More severe, axon is damaged, nerve sheath is intact (Wallerian degeneration distal to injury)
- Neurotmesis: Complete severance of nerve (Wallerian degeneration in both segments)
Energy Expenditure in Orthopedic Impairments
- Increased energy cost of walking with orthopedic impairments
- Decreased gait efficiency: Impairments lead to less efficient walking patterns
- Increased oxygen cost: Body requires more oxygen to maintain a certain walking speed
- Increased heart rate: Heart works harder to compensate for increased energy demands
Clinical Anatomy Review
- Review of clinically relevant anatomical structures
- Glenohumeral joint: Joint between humerus and glenoid fossa (socket of scapula)
- Reinforcing ligaments: Coracohumeral ligament and glenohumeral ligaments
- SITS muscles: Rotator cuff muscles (supraspinatus, infraspinatus, teres minor, subscapularis)
- Erb palsy: Brachial plexus injury, affecting nerves supplying shoulder and arm
- Suprascapular nerve injury: Can cause weakness in supraspinatus and infraspinatus muscles
Radial Nerve Injury
- Can occur due to midshaft humerus fracture
- Loss of wrist and finger extension, weakness in supination
Ulnar Nerve Injury
- Can occur at cubital tunnel (elbow)
- Weakness in finger flexion of 4th and 5th fingers, wrist flexion, loss of interossei and hypothenar muscles
Median Nerve Injury
- Can occur in carpal tunnel
- Sensory innervation deficits in the "money distribution" area of the hand
Femoral Head Blood Supply
- Important for femoral head health
Femoral Triangle
- Region containing femoral artery, vein, and nerve
ACL vs. MCL
- Anterior cruciate ligament (ACL) and medial collateral ligament (MCL) are important knee ligaments
Common Fibular Nerve vs. Tibial Nerve
- Common fibular and tibial nerves are the two main branches of the sciatic nerve
Upper Extremity - Shoulder
- Anatomy and function of the shoulder joint
- Glenohumeral joint: Ball-and-socket joint, wide range of motion
- Rotator cuff muscles: Stabilize the shoulder joint and control movement
- Scapulothoracic joint: Articulation between scapula and thoracic cage
- Acromioclavicular joint: Joint between acromion process of scapula and clavicle
Erb-Duchenne Palsy
- Brachial plexus injury, affects nerves supplying shoulder and arm
- Injury to upper trunk of brachial plexus, typically caused by traction or stretching
- Presentation: "Waiter's tip" deformity (arm adducted, internally rotated, forearm pronated)
Suprascapular Nerve
- Supplies supraspinatus and infraspinatus muscles
- Injury: Compression or trauma
- Presentation: Weakness in shoulder abduction and external rotation
Radial vs. Ulnar vs. Median Nerve
- Description of the three main nerves of the forearm and hand, with distinct functions
- Radial nerve: Extensor muscles of the wrist and fingers
- Ulnar nerve: Flexor muscles of 4th and 5th fingers, intrinsic muscles of hand, sensory innervation of little/half of ring finger
- Median nerve: Flexor muscles (except little finger), thenar muscles, sensory innervation of the thumb, index, middle, and half of ring finger
Lower Extremity
- Anatomy and function of the lower extremity
- Hip joint: Ball-and-socket joint
- Knee joint: Hinge joint
- Ankle joint: Hinge joint
- Foot: Composed of tarsals, metatarsals, and phalanges
Dermatomes
- Areas of skin innervated by a specific spinal nerve root
Imaging of the MSK System
- Different imaging modalities for musculoskeletal system evaluation
- Radiography (X-ray): Ionizing radiation to visualize bones and some soft tissues
- Computed Tomography (CT scan): X-rays for cross-sectional images of bone and soft tissues
- Magnetic Resonance Imaging (MRI): Strong magnetic field and radio waves for detailed soft tissue images
- Ultrasound: Sound waves to visualize soft tissues and bones
Nuclear Medicine
- Uses radioactive tracers to image metabolic activity. Useful in evaluating bone tumors or infections
X-Ray Densities
- Different densities of tissues visible on radiographs
- Air: Least dense, appears black
- Fat: Slightly denser than air, appears dark gray
- Water: Denser than fat, appears gray
- Bone: Denser than water, appears white
- Metal: Most dense, appears very white
Congenital Deformities of the Spine and Scoliosis
- Congenital deformities of the spine
- Scoliosis: Lateral curvature of the spine
- Normal spinal curvatures: Natural curves of the spine (kyphosis, lordosis)
- Idiopathic scoliosis: Most common type of scoliosis, no known cause
- Pathologic scoliosis: Scoliosis related to a specific condition (e.g., tumor)
Bracing
- For moderate curves
- Surgery for severe curves
Spina Bifida Association
- Hydrocephalus (fluid buildup in brain) commonly associated
Table of Congenital Deformities
- Table summarizing various conditions, descriptions, key features, and treatment options.
(other topics)
- VACTERL Syndrome, Caudal Regression Syndrome, Klippel-Feil Syndrome
- **
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Description
Explore the key concepts of bone development, including endochondral and membranous ossification, and the principles of Wolff's Law. Understand how mechanical stress affects bone growth and the implications for conditions like cerebral palsy. Test your knowledge on these fundamental topics in bone biology.
