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)

Ewings 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

Suprascapular nerve: Arises from trunk of C5/C6. Runs laterally beneath trapezius and omohyoid and
enters supraspinatus fossa through suprascapular notch. Passes 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 joint. 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:

Klumpkes palsy: If T1 is involved Remember to look out for Horners syndrome!!!

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