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A suppliment to boost your PGMEE preparations.
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(http://pguploads.files.wordpress.com/2013/04/lumbar-triangle-and-hernia2.jpg)
Ref CSDT pg no 794 / 11 ed.
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(http://pguploads.files.wordpress.com/2013/04/rotator-cuff-anatomy.png)
Q2] Which part of rotator cuff is in greatest tension during overhead abduction and hence is most
commonly affected tendon in rotator cuff tendinitis/tear
A] SUPRASPINATUS
B] INFRASPINATUS
C] TERES MINOR
D] SUBSCAPULARIS
ANS [A] SEE FIGURE BELOW
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(http://pguploads.files.wordpress.com/2013/04/rotator-cuff-anatomy-copy.png)
Q3] All of following specificaly indicate complete rotator cuff tear in a patient presenting with
shoulder pain except.
A] Neer impingement sign positive
B] JOBES test positive
C] Contrast flooding subacromial bursa when injected into glenohumeral joint during arthrography.
D] Hyperintense signals on T2 MRI that extends throughout tendon.
E] Diffusely hypoechoic tendon on USG.
ANS: [A] , [B], [E]
[A] = NEER IMPINGEMENT SIGN IS +VE in any cause of anterosuperior impingement as in
subacromial bursitis or partial tendon tear.
[B] JOBES TEST can be +ve in partial tears also.
[E] normally tendon is echoic structure whereas fluid is hypoechoic so diffusely hypoechoic tendon
denotes tendinitis and not tear.
NOTE : ON T2 WATER IS HYPERINTENSE IE WHITE SO TENDON TEAR APPEAR AS
HYPERINTENSE SIGNAL.
SEE FIGURE BELOW:
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(http://pguploads.files.wordpress.com/2013/04/rotator-cuff-anatomy-copy-2.png)
NOTE POINTS: 1] LIFT OFF TEST IS DONE TO ASCESS ISOLATED SUBSCAPULARIS TEAR=
FORGOTTEN TENDON [AI 2010]
2] SHOULDER JOINT CAPSULE HAS 2 OPENINGS ONE FOR LONG HEAD OF BICEPS AND BY
OTHER IT COMMUNICATES WITH SUBSCAPULAR BURSA.
3] THOUGH JOINT CAPSULE IS LEAST REINFORCED INFERIORLY ,MOST COMMON TYPE OF
SHOULDER DISLOCATION IS ANTERIOR OF SUBCORACOID TYPE.
4]In subacromial bursitis pressure over deltoid below acromian in adducted arm produces pain but
this pain dissapears when same test is repeated in abducted position . This sign is clled as
DAWBARNS SIGN.
References [1]. CODT 3ed page 191. [2] BDC vol 1 page 79 4th ed [3] campbells orthopedics 11th ed page 2607
[4] @medscape
Hyoid bone
Posted: April 4, 2013 by Dr Sujeet Kumar in ANATOMY
Tags: ANATOMY, mcq
1
Hyoid bone is present at level of base of mandible & C3 vertebra . It is kept suspended at this level by muscle
and ligament attachment.
DEVELOPMENT : SEE FIGURE BELOW
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(http://pguploads.files.wordpress.com/2013/04/hyoid.jpg)
OSSIFICATION: It ossifies from 6 centres [ 2 primary centre for each greater cornu + 2 secondary centre
for each lesser cornu + 2 secondary for body].
MUSCLE ATTACHMENT :
[A] BODY ;1.anterior surface = geniohyoid + myelohyoid+ hyoglossus(also from greater cornu)
2. upper border = genioglossi & thyrohyoid membrane.
3. lower border = 3 strap muscle = sternohyoid , thyrohyoid( some par extend to greater cornu) ,omohyoid (
note that sternothyroid is also a strap muscle but as the name suggests it is not attached to hyoid)
[B] GREATER CORNU = Thyrohyoid memb (also on body) +digastric pulley + stylohyoid muscle+
thyrohyoid muscle ( also on body)
so hyoglossus originates from body + greater cornua (q)
[C] LESSER CORNU = stylohyoid ligament ( note that stylohyoid muscle originate from greater cornua)
note: Middle constrictor originate from lesser cornua + greater cornua.
NERVE SUPPLY OF STRAP MUSCLE :see the figure below
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(http://pguploads.files.wordpress.com/2013/04/ansa.jpg)
1. superior belly of omohyoid= by superior root ie descending branch of hypoglossal nerve fibres of which are
derived from C1 ventral ramus.
2. sternohyoid + sternothyroid+ inferior belly of omohyoid = ANSA CERVICALIS.
3 NOTE THAT thyrohyoid is not supplied by ansa cevicalis , it alongwith geniohyoid is supplied by C1
through hypoglossal nerve.
Note : hyoid fracture is most likely to occur in THROTTLING > STRANGULATION> HANGING.
REF: bdc 3rd ed page 30, Langman embryology 10ed page 261
diagram : sujeet kumar
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