msk, lymphatics, s/t, and abd wall

List the types of muscles

fusiform, unipennate, bipennate, multipennate, and circular

Which kind of tissue in the body contracts, produces movement or maintains the position of the body?

muscles

What do muscles work in conjunction with? For what?

tendons and ligaments, to push and pull

Define adduction.

movement towards the body

Define abduction.

movement away from the body

Name the structure that is a tough band of fibrous tissue that connects muscles to bones.

tendons

What do tendons move?

A limb when associated muscle contracts

Where is a common site of injury for tendons?

rotator cuff in the shoulder

Name the structure that is a tough band of fibrous tissue that connects bones to bones.

ligaments

What do ligaments provide support for?

maintaining relative position of bone-to-bone interfaces

Where is a common site of injury for ligaments?

cruciate ligaments in the knee

Ligaments and tendons both?

heal slowly because of fewer blood vessels

Name the small sacs of fluid that can be found in joint spaces.

bursae

Bursae act as?

cushion between tendon, ligaments, and bones

Where is the greater tuberosity located?

on lateral and superior surface of humerus

List the site of insertion for three rotator cuff muscles

supraspinatus, infraspinatus, teres minor

(also subscapularis)

Name the spinous projection of scapula that connects with the clavicle.

acromion process

Where does the supraspinatus originate from?

supraspinatus fossa of scapula

Where does the supraspinatus insert at?

passes under acromion to insert at superior portion of greater tuberosity

What is the action of the supraspinatus?

abduction of humerus

Where does the infraspinatus originate from?

infraspinatus fossa of scapula

Where does the infraspinatus insert at?

middle portion of greater tuberosity

What is the action of the infraspinatus?

external rotation of the humerus

Where does the teres minor originate from?

lateral surface of scapula

Where does the teres minor insert at?

posterior portion of greater tuberosity

What is the action of the teres minor?

external rotation of the humerus

Where does the subscapularis originate from?

anterior surface of scapula

Where does the subscapularis insert at?

lesser tuberosity of humerus

What is the action of the subscapularis?

internal rotation of the humerus

Rotator cuff tendons connect to what?

the correlating rotator cuff muscles to the humeral head

List the rotator cuff tendons.

supraspinatus tendon, infraspinatus tendon, teres minor tendon, subscapularis tendon

Which tendons in the rotator cuff in the shoulder can be evaluated during ultrasound?

supraspinatus and infraspinatus

Why is the subscapularis muscle strain a common injury?

due to overuse by athletes (those in throwing sports)

Which tendon in a (partial/complete) rotator cuff tear is commonly injured?

supraspinatus tendon

Indications for shoulder exam include…

-shoulder pain/pain with shoulder rotation,

-decreased shoulder range of motion

-shoulder weakness with abduction or elevation

Which muscles merge to form the Achilles tendon?

soleus muscle and gastrocnemius muscle

Where does the soleus muscle lie?

posterior to the gastrocnemius

Which is the most superficial calf muscle?

gastrocnemius muscle

Where does the Achilles tendon insert?

posterior surface of the calcaneus (heel bone)

What is the largest tendon of the body?

Achilles tendon

How long is the Achilles tendon?

15 cm

How does the Achilles tendon help you move?

foot downward to push off when walking or rise on toes

Which activities stress your Achilles tendon?

jumping and starting/stopping

What is the Achilles tendon limited by? What is the result of this limitation?

limited blood supply, increases risk for injury and slow healing

Thompson test evaluates the?

Achilles tendon rupture

How do you position the patient in order to perform a Thompson test?

prone on exam table with foot hanging off the edge

How is the Thompson test performed on the patient?

clinician squeezes the calf muscle

How can a clinician tell if there is an Achilles tendon rupture?

if there is no foot movement, rupture is suspected

How does a clinician know if the patient’s Achilles tendon is intact?

if foot moves after being squeezed from Thompson test

List indications for Achilles exam.

-abnormal Thompson’s test

-trauma

-heel pain for more than 4 weeks

-knot/bulge over proximal tendon

-x-ray shows displacement of Kager’s fat pad

-post-operative monitoring

What is the name of the fat pad deep in Achilles tendon?

Kager's fat pad

Describe a normal appearance of the Achilles tendon in long.

thin, tendon attaches to calcaneus, uninterrupted striations

Describe a normal appearance of the Achilles tendon in transverse.

oval (active adults), round (sedentary adults)

Describe signs of a torn Achilles tendon on ultrasound.

gap between torn segments fill with hypoechoic fluid,

tendon does not wrap around calcaneum,

Achilles tendon can appear thickened due to retraction,

hyperechoic with small amount of surrounding fluid

Network of organs, vessels, and tissues that move lymph back into the bloodstream is the?

lymphatic system

First step of the lymphatic system:

plasma flows out of capillaries to deliver oxygen and nutrients

2nd step of the lymphatic system:

tissues absorb nutrients and leave waste products behind

3rd step of the lymphatic system:

plasma picks up waste and most of it flows back into the bloodstream

4th step of the lymphatic system:

remaining fluid is now called lymph, then lymph is removed via the lymphatic system

5th step of the lymphatic system:

lymph moves through the lymphatic vessels until it drains into the subclavian veins

List the functions of the lymphatic system.

collects excess fluid, helps absorb fat, and lymph node immune response

What does the lymphatic system collect?

leftover lymph that the capillary system did not reabsorb

Why and how does the lymphatic system help absorb fat?

fat molecules too large to travel through capillary system,

so lymphatic system collects fluid from intestines that have these molecules and then transports it into the bloodstream

How does the lymphatic system immune response work?

filters waste product abnormal cells from lymph, releases lymphocytes and other immune cells

Small, bean shaped nodes are located?

throughout the lymphatic vessel network

How many lymph nodes does the body have?

400-800

List the groups of lymph chains.

neck, midchest, paraaortic, mesenteric, groin, armpits

List lymphatic organs.

spleen, thymus, MALT, bone marrow

What does the spleen do for the lymphatic system?

removes damaged cells

What does the thymus do for the lymphatic system?

site where T-cells fully mature

What does MALT(Mucosa Associated Lymphoid Tissue) do for the lymphatic system?

any mucous membranes that destroy germs (tonsils, airways, appendix)

What does the bone marrow do for the lymphatic system?

makes WBC

Name the pathology that involves swelling of lymph nodes due to infection, inflammation, cancer, or other disease processes.

lymphadenopathy

How does one develop lymphadenopathy?

more lymphocytes are made when actively fighting an issue which causes swelling of the lymph node

List signs that lymph node is malignant.

larger than normal, round instead of oval, loss of central fatty hilum, heterogeneous

Name the pathology in which there is an accumulation of lymph in the tissues, most commonly in arms and legs.

lymphedema

What is lymphedema caused by?

blockage or damage to lymphatic system

(tumor can press on lymph vessel; lymph nodes removed to treat cancer)

What is a risk that patients with lymphedema can get?

serious deep skin infections

List the layers of soft tissue from superficial to deep.

epidermis/dermi, subcutaneous fat, fascia, muscle, bone

List common s/t pathology.

abscess, cellulitis, lipoma, ganglion cyst, baker’s cyst

Describe baker’s cyst.

collection of fluid in posterior popliteal fossa that can extend into lower thigh or upper calf

What is common with rheumatoid arthritis?

baker’s cyst

List the symptoms of baker’s cyst.

swelling/mass in knee/calf,

knee pain,

knee tightness/stiffness,

asymptomatic

How does a baker’s cyst look like if assoc. w/ rheumatoid arthritis?

mimics solid mass and has lack of flow within cyst (distinguishes it from solid mass)

How do baker’s cyst look on ultrasound?

anechoic/ hypoechoic with possible internal echoes

Name the most common soft tissue mass in the hands and wrist.

ganglion cyst

Where do ganglion cysts attach to?

tendons, but can be found within muscles and bones

Are ganglion cysts painful?

if pressure is placed on nearby nerve

Name the benign tumor composed of fat cells, in which it is soft and painless. Additionally, it can change with weight fluctuation.

lipoma

How do lipomas look on ultrasound?

hyperechoic, or isoechoic, may see capsule

Infection of the skin and subcutaneous tissue with no fascial or muscle involvement is which pathology?

cellulitis

List the symptoms for cellulitis.

pain, redness, edema, warmth

How does the initial stage of cellulitis look like in ultrasound?

slightly echogenic tissue, hazy, thickened skin

How does the late stage of cellulitis look like in ultrasound?

edema builds up to make cobble stone appearance, thickened skin

Name the pathology in which it is a localized collection of pus, typically caused by an infection.

abscess

List the three components of an abscess.

-central core of necrotic inflammatory cells

-halo of WBC

-peripheral dilated blood vessles

What layers of the abd wall can you list.

skin, subcutaneous fat, fascia, muscles

List the abdominopelvic muscles.

rectus abdominus,

external oblique

internal oblique,

transversus abdominis

What are the abd wall functions?

protect abd organs, provide scaffold for all internal contents, stablization and rotation of the trunk, increase intra-abd pressure for coughing, pooping, valsalva