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Modified: Tuesday, 18-Oct-2005 20:42:39 EDT
The Structural Basis of Medical Practice (SBMP) - Human Gross Anatomy, Radiology, and Embryology
Answer Guide for Back and Upper Limb (36 pts) - September 22, 2005
The College of Medicine at The Pennsylvania State University
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Review the anatomy of the glenohumeral (shoulder) joint. Include bones, articular surfaces,
cavities, capsules, contents, muscles, movements, limitations of movement, vascularization,
innervation, relationships, and lymphatic drainage. Include mention of shoulder dislocations
and nerve injury. (12 pts)
- General Comments
- Extremely Unstable - "Golf ball and Tee"
- Bones
- Glenoid Fossa and Humerus
- Articular surfaces
- Glenoid fossa - cartilage
- Head of humerus - cartilage
- Glenoid labrum
- Cavities
- Synovial joint cavity
- Subacromial Bursa
- Capsules and ligaments
- Fibrous joint capsule
- Glenohumeral ligaments
- Musculocutaneous Cuff (rotator Cuff)
- Contents
- Muscles
- Rotator Cuff, Deltoid
- Pectoralis major, teres major, latissimus dorsi
- coracobrachialis, long and short head of biceps, long head of triceps
- Movements
- Medial rotation
- Lateral rotation
- Abduction
- Adduction
- Flexion
- Extension
- Limitations of movement
- Glenohumeral ligaments
- Antagonistic muscles
- Vascularization
- Anterior and Posterior humeral circumflex arteries
- Deltoid and acromial branches of thoracoacromial trunk
- Suprascapular artery and Circumflex scapular artery
- Ascending branch of profunda brachii
- Innervation
- Axillary Nerve
- Upper lateral cutaneous nerve of arm
- Hilton's law - Axillary, suprascapular, and lower subscapular nerves
- Hilton's law continued - musculocutaneous, radial, median, and ulnar nerves
- Relationships
- Coracoacromial arch
- Long head biceps tendon
- Clavical
- Coracoid process
- Lymphatic drainage
- Shoulder injury and dislocation
- Traction injury of axillary nerve
- Clinical test for upper lateral cutaneous nerve
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Review the anatomy and stability of the vertebral column and the spinal canal. Include bones,
articulations, ligaments, spaces, contents, muscles (omit detailed accounts of transversospinalis muscles),
movements, limitations of movement, vascularization, innervation, relationships, and lymphatic drainage.
Include mention of the anterior displacement of the L5 vertebra relative to the S1 vertebra in nerve
injuries. Include mention of the fascial layers penetrated during lumbar puncture (spinal tap). (12 pts)
- General Comments
- Seven cervical, 12 thoracic, 5 lumbar, 5 sacral, 4 coccygeal = 33 (9 fused)
- Bones
- Vertebral body, pedicle, lamina, spine, articular facets, costal facets
- Intervertebral foramen
- articulations
- Intervertebral disk
- Zygapophyseal joint
- Costotransverse and costovertebral joints
- Ligaments
- Anterior and posterior longitudinal ligaments
- Ligamentum flavum
- Supraspinous and interspinous ligaments
- Denticulate ligament - pia mater
- Spaces
- Spinal canal - spinal cord, cauda equinus, filum terminale, radicular arteries
- Epidural space - fat and internal vertebral venous plexus
- Subarachnoid space - CSF
- Contents
- Spinal cord, cauda equinus, filum terminale, radicular arteries
- Internal vertebral venous plexus
- Muscles
- Erector Spinae
- Psoas major and quadratus lumborum (optional comment)
- Longissimus cervicis and capitus
- Splenius cervicis and capitus
- Longus colli and capitus (optional comment)
- Movements
- Flexion
- Extension
- Lateral flexion
- Rotation
- Limitations of movement
- Vascularization
- Radicular arteries and medullary arteries
- Innervation
- Dorsal rami, ventral rami, zygapophyseal branches
- Relationships
- Lymphatic drainage
- Anterior displacement of the L5 vertebra
- "Scotty Dog" fracture, fractures pars articularis
- Fascial layers and lumbar puncture
- skin, tela subcutanea, supraspinous ligament, interspinous ligament, ligamentum flavum,
epidural space, dura mater, arachnoidia, subarachnoid space (CSF), pia mater
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Review the anatomy of the palm of the hand (omit the carpal tunnel). Include bones, articulations,
ligaments, spaces, contents, muscles, movements, independence of movement, limitations of movement,
vascularization, innervation, relationships, and lymphatic drainage. Include mention of comperession
injury to the hamate bone in nerve injuries. (12 pts)
- General Comments
- Bones
- Carpal, metacarpal, phalanges
- Articulations
- Carpometacarpal for the thumb
- Metacarpophalengeal - proximal and distal
- Ligaments
- Superficial and Deep transverse metacarpal ligaments
- Capsular ligaments
- Spaces
- Communications between the tendon sheaths - spread of infection
- Contents
- Muscles
- Thenar
- Hypothenar
- Intrinsic
- Long tendons
- Movements
- Flexion, extension, adduction, abduction, opposition (pronation and "ape hand")
- Independence of movement
- Long tendons pass deep to split in short tendons
- Limitations of movement
- Intrinsic muscles prevent hyperextension of metacarpophalengeal joints ("claw hand")
- Vascularization
- Ulnar artery - superficial and deep
- Radial artery and superficial palmar arch - common digital and proper digital arteries
- Deep palmar arch - palmar metacarpal arteries, carpal arteries, communicating
- Innervation
- Intrinsic median nerve motor - thenar muscles and first two lumbricals
- Intrinsic ulnar nerve motor - hypothenar, abductor digiti minimi, adductor pollicis, intrinsic mm, palmaris brevis
- Relationships
- long versus short tendons
- thenar and hypothenar muscles
- Pisiform bone, hamate, and ulnar nerve and artery
- Deep palmar arch and the interossei
- Lumbricals and long tendon relationships
- Lumbricals and deep transverse metacarpal ligament
- Lymphatic drainage
- Compression Injury to the Hamate
- Damage to ulnar nerve - claw hand, adduction, abduction, flex MP while extend IP
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The Structural Basis of Medical Practice - Human Gross Anatomy
The College of Medicine
of the The Pennsylvania State University
Email: lae2@psu.edu
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