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Musculoskeletal, Skin and Connective tissue basic science, lower extremity…
Musculoskeletal, Skin and Connective tissue basic science
lower extremity nerves
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sciatic(坐骨神経): L4-S3
motor---semitendinosus, semimembranosus, biceps femoris, adductor magnus
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femoral(大腿神経): L2-L4
sensory---anterior thigh, medial leg
motor---quadriceps, iliacus(腸骨筋), pectineus(恥骨筋), sartorius(縫工筋)
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obturator(閉鎖神経): L2-L4
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motor---obturator externus(外閉鎖筋), adductor longus(長内転筋), adductor brevis(短内転筋), gracilis(薄筋), pectineus(恥骨筋), adductor magnus(大内転筋)
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common peroneal: L4-S2
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foot drop: inverted and plantarflexed(底屈) at rest, loss of eversion(外向) and dorsiflexion
tibial(脛骨神経):L4-S3
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motor---biceps femoris, triceps surae(下腿三頭筋), plantaris(足底筋), popliteus(膝窩筋), flexor muscles of foot
action of hip muscles
extensors: gluteus maximus, semitendinosus, semimembranousus
flexors: iliopsoas(腸腰筋), rectus femoris, tensor fascia latae, pectineus, sartorius
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internal rotation: gluteus medius/minimus, tensor fascia latae
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external rotation: iliopsoas, gluteus maximus, piriformis(梨状筋), obturator(閉鎖筋)
common disorder
limb compartment syndrome: ↑pressure within a fascial compartment of a limb→venous outflow obstruction and arteriolar collapse→anoxia and necrosis
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medial tibial stress syndrome; shin splint: cause of shin(むこうずね) pain and diffuse tenderness in runners and military recruits
De Quervain tenosynovitis(腱鞘炎): noninflammatory thicking of abductor pollicis longus and extensor pollicis brevis tnedons
iliobital band syndrome(腸脛靭帯症候群): overuse injury fo lateral knee, primarily in runner
ganglion cyst: fluid-filled sqelling overlyying joint or tendon sheath, common at dorsal side of wrist, arise from herniation of dense connective tissue
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motoneuron action
- tropomyocine block myosin-binding sites on actin filament, Ca bind to troponin C then expose myosin binding sites
- ATP hydrolysis cause myosin head returning
- muscle shortening occur, shortening of H,Ibands and Z line, ADP is released at end
- open presynaptic Ca channel, inducing ACh release
- depolarization travel via T-tubule
- conformation changes in dihydropyridine receptor and ryanodine receptor→Ca²⁺ release sarcoplasmic reticulum into cytoplasm
- myosin head bind to actin, Pi is then released
- ACh binding lead to muscle cell depolarization at motor end plate
- binding of new ATP cause detachment
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wrist region
carpal tunnel syndrome
thenar eminence (母指球) atrophies but sensation spared (palmar cutaneous branch enters hand external to carpal tunnel)
Tinel sign, Phalen maneuver
nerve compression→paresthesia(感覚異常), pain, numbness(しびれ)
associated with pregnancy, rheumatoid arthritis, hypothyroidism, diabetes, acromegaly, dialysis-related amyloidosis
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component
flexor digitorum superficialis(浅指屈筋) tendon, and flexor digitorum profundus tendon, and median nerve in carpal tunnel
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Guyon canal(尺管); ulnar nerve and ulnar artery, and flexor carpi radialis(頭側主根屈筋) tendon in flexor retinaculum (屈筋支帯)
components
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scaphoid (palpable in anatomic snuff box) is the most commonly fractured, complication of proximal scaphoid fractures include avascular necrosis and nonunion
scaphoid(舟状骨), lunate(月状骨), triquetrum(三角骨), pisifprm(豆状骨), hamate(有鈎骨), capitate(有頭骨), trapezoid(小菱形骨), trapezium(大菱形骨)
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hand muscles
thenar(median nerve)
opponens pollicis(母子対立筋), abductor pollicis brevis (短母指外転筋), flexor pollicis brevis(短母指屈筋)
hypothenar(ulnar nerve)
opponens digiti minimi(小指対立筋), abducter digiti minimi(小指外転筋), flexor digiti minimi brevis(短小指屈筋)
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lumbrical(虫様筋); median(1st,2nd), ulnar(3rd,4th); flex at MCP, extend PIP and DIP
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arm abduction(外転)
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,>100°: serratus anterior(前鋸筋); long thoracic nerve(長胸神経)
,>90°: trapezius(僧帽筋); accessory nerve(副神経)
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dermatology
epithelial skin junction
desmosome: intermediate filament interactions, cytokeratin, desmoplakin, autoantibodies to desmoglein→pemphigus vulgaris(尋常性天疱瘡)
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adherens junction: actin filament, E-cadherin
hemidesmosome: at basement, connect keratin to basement membrane, autoantibody→bullous pemphigoid(類天疱瘡)
tight junction: prevent paracellular movement of solutes, include claudin and occludin
integrin: maintain integrity by binding to collagen, laminin, fibronectin in basement membrane
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knee exam
test
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McMurray test
pain, popping on external rotation→medial meniscal(内半月板) tear
pain, popping on internal rotation→lateral meniscal(外半月板) tear
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type of muscle fiber
type1
slow, red, endurance training
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type2
fast, white, weight training, sprint
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bone formation
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membranous ossification
calvarium(頭蓋冠), facial bone, clavicle, woven bone form directly, remodeled to lamellar bone