Ortho Mrcs 1hf3h

Orthopaedics  Bone resorption (inc serum ca): PTH, cortisol, glucocorticoids, androgens, thyroid hormones, prostaglandins  Bone deposition: Estrogen, bisphosphonates, calcitonin  Osteoid osteoma commonest in femur and tibia  radiolucent core with radioopaque sclerotic rim  Giant cell tumour: lytic lesion, involves epiphysis and erodes thru into soft tissue. Common in 20s-30s, always recur after surgical excision. Treatment: curettage, KIV bone graft or cement to pack the defect  Commonest benign bone tumour under age 21  exostosis (osteochondroma)  Ewing’s  small blue cell tumour in teens Painful swelling. Onion skin appearance  Bone mets: Bronchus, lung, prostate, breast, kidney, thyroid, seldom colon  Septic arthritis: 1) HI 2) SA in <5yo, 1) SA> 5yo and >50yo, NG <50yo, Salmonella in SCA  Osteomyelitis: HS <5yo  Supracondylar #: AIN  FPL and FDP of thumb, no sensory component.  Pec minor depresses the glenoid fossa. Arises from 3/4/5 ribs Inserts at coracoids process of scapula. Innervated by medial anterior thoracic nerve (C8, T1)  Teres major and subscapularis are supplied by Lower subscapular nerve. Subscapularis attaches to crest of lesser tubercle.  Dorsal scapular n. C5 supplies rhomboids & levator scapula tt elevate & retract e scapula (same A)  Accessory n supplies trapezius  Transverse cervical artery supplies trapezius, accessory nerve supplies trap 

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Suprascapular nerve: Arises from trunk of C5/C6. Runs laterally beneath trapezius and omohyoid and enters supraspinatus fossa through suprascapular notch. es beneath supraspinatus and curves around lat border of spine of scapula to the infraspin. fossa. 2 branches in supraspin fossa – i) supraspinatus muscle, ii) shoulder t. 2 branches in infraspin fossa – i) infraspinatus muscle, ii) shoulder. Hypothenar: Palmaris brevis, ODM, ABDM, FDM Pectineus: Quadrangular piece of muscle at medial aspect of thigh. Supplied by L2,3,4. Femoral nerve supplies anterior thigh via anterior cutaneous branches. Peroneus brevis/longus (lateral compartment): Supplied L4,5, S1 thru superficial peroneal n (terminal br of common pero) Peroneus tertius: Supplied by L5, S1 thru deep peroneal nerve Attachment of PCL: posterior intercondyloid fossa of tibial to anterior medial condyle of femur post\ant ACL:

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Klumpke’s palsy: If T1 is involved  to look out for Horner’s syndrome!!!

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Sensory nerve supply of LL: Sural nerve from tibial nerve (pure sensory) arises 1cm posterior to distal fibular, supplies lateral part of leg and foot. Deep peroneal nerve from common peroneal / common fibular nerve, supplies 1st webspace. Superficial peroneal nerve: rest of dorsum. TIbial nerve supplies sole and posterior leg LN of lower limb. Skin  superificial inguinal. Testes/ovaries  Lumbar/paraaortic. LL  ext iliac. Gluteal and pelvis to internal iliac. Bladder,rectum,prostate  sacral. Line connecting iliac crests = supracrestal line = L4