ONE STOP DOC M u s c u l o s k e l e t a l S y s t e m One Stop Doc Titles in the series include: Cardiovascular System – Jonathan Aron Editorial Advisor – Jeremy Ward Cell andMolecular Biology – Desikan Rangarajan and David Shaw Editorial Advisor – Barbara Moreland Endocrine and Reproductive Systems – Caroline Jewels and Alexandra Tillett Editorial Advisor – Stuart Milligan Gastrointestinal System – Miruna Canagaratnam Editorial Advisor – Richard Naftalin Nervous System – Elliott Smock Editorial Advisor – Clive Coen Metabolism and Nutrition – Miruna Canagaratnam and David Shaw Editorial Advisors – Barbara Moreland and Richard Naftalin Renal and Urinary System and Electrolyte Balance – Panos Stamoulos and Spyridon Bakalis Editorial Advisors – Alistair Hunter and Richard Naftalin Respiratory System – Jo Dartnell and Michelle Ramsay Editorial Advisor – John Rees ONE STOP DOC M u s c u l o s k e l e t a l S y s t e m Wayne Lam BSc(Hons) Fifth year medical student,Guy’s,King’s and St Thomas’ Medical School,London,UK Bassel Zebian MBBS BSc(Hons) GKT Graduate and Pre-Registration House Officer in General Medicine, Medway Maritime Hospital,UK Rishi Aggarwal MBBS Senior House Officer in General Medicine, Queen Elizabeth Hospital,London,UK Editorial Advisor:Alistair Hunter BSc(Hons) PhD Senior Lecturer in Anatomy,Guy’s,King’s and St Thomas’ School of Biomedical Sciences,London,UK Series Editor:Elliott Smock BSc(Hons) Fifth year medical student,Guy’s,King’s and St Thomas’ Medical School,London,UK Hodder Arnold AMEMBER OF THE HODDER HEADLINE GROUP First published in Great Britain in 2005 by Hodder Education, a member of the Hodder Headline Group, 338 Euston Road, London NW1 3BH http://www.hoddereducation.co.uk Distributed in the United States of America by Oxford University Press Inc., 198 Madison Avenue, New York, NY10016 Oxford is a registered trademark of Oxford University Press © 2005 Edward Arnold (Publishers) Ltd All rights reserved. Apart from any use permitted under UKcopyright law, this publication may only be reproduced, stored or transmitted, in any form, or by any means with prior permission in writing of the publishers or in the case of reprographic production in accordance with the terms of licences issued by the Copyright Licensing Agency. In the United Kingdom such licences are issued by the Copyright Licensing Agency: 90 Tottenham Court Road, London W1T 4LP. Whilst the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. In particular, (but without limiting the generality of the preceding disclaimer) every effort has been made to check drug dosages; however it is still possible that errors have been missed. Furthermore, dosage schedules are constantly being revised and new side-effects recognized. For these reasons the reader is strongly urged to consult the drug companies’ printed instructions before administering any of the drugs recommended in this book. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data A catalog record for this book is available from the Library of Congress ISBN-10: 0 340 88505X ISBN-13: 978 0 340 88505 5 1 2 3 4 5 6 7 8 9 10 Commissioning Editor: Georgina Bentliff Project Editor: Heather Smith Production Controller: Jane Lawrence Cover Design: Amina Dudhia Illustrations:Cactus Design Index: Indexing Specialists (UK) Ltd Hodder Headline’s policy is to use papers that are natural, renewable and recyclable products and made from wood grown in sustainable forests. The logging and manufacturing processes are expected to conform to the environmental regulations of the country of origin. Typeset in 10/12pt Adobe Garamond/Akzidenz GroteskBE by Servis Filmsetting Ltd, Manchester Printed and bound in Spain What do you think about this book? Or any other Hodder Education title? Please visit our website at www.hoddereducation.co.uk CONTENTS PREFACE vi ABBREVIATIONS vii SECTION 1 OVERVIEW OF THE MUSCULOSKELETAL SYSTEM 1 SECTION 2 THE HEAD AND NECK 19 SECTION 3 THE TRUNK 35 SECTION 4 THE VERTEBRAL COLUMN 55 SECTION 5 THE UPPER LIMB 81 SECTION 6 THE LOWER LIMB 109 INDEX 134 PREFACE From the Series Editor, Elliott Smock From the Authors, Wayne Lam, Bassel Zebian and Rishi Aggarwal Are you ready to face your looming exams? If you have done loads of work, then congratulations; we The aim of this book is to review and simplify hope this opportunity to practice SAQs, EMQs, information concerning the musculoskeletal system MCQs and Problem-based Questions on every part in a question and answer format. This book covers of the core curriculum will help you consolidate what the principles of musculoskeletal physiology and you’ve learnt and improve your exam technique. If anatomy, as well as some biochemistry and you don’t feel ready, don’t panic – the One Stop Doc pharmacology that are relevant to your future clinical series has all the answers you need to catch up and studies. It gives you an opportunity to have a quick pass. tour of all the important topics concerning the musculoskeletal system and gives you exam There are only a limited number of questions an experience. examiner can throw at a beleaguered student and this text can turn that to your advantage. By getting Inthis book, we have also tried to highlight some key straight into the heart of the core questions that come questions which concern the basic principles of the up year after year and by giving you the model topic. Some related clinical scenarios have also been answers you need this book will arm you with the discussed. We found the musculoskeletal system to knowledge to succeed in your exams. Broken down be a very challenging aspect of medicine and we hope into logical sections, you can learn all the important that this book will provide a complete and simplified facts you need to pass without having to wade review for your learning. through tons of different textbooks when you simply don’t have the time. All questions presented here are From the Author, Wayne Lam ‘core’; those of the highest importance have been Many thanks to my parents for being the best parents highlighted to allow even sharper focus if time for in the world. I would also like to thank my brother revision is running out. In addition, to allow you to (Tim) for all his practical jokes to cheer me up during organize your revision efficiently, questions have been the long writing sessions, and Ami who made me tea grouped by topic, with answers supported by detailed and coffee to keep me awake. integrated explanations. From the Author, Bassel Zebian On behalf of all the One Stop Doc authors I wish To my father, mother, brother and sister – I am you the very best of luck in your exams and hope eternally grateful for your continuous support over these books serve you well! the years. Many thanks to Wayne and Rishi for all the hard work you put in. Thank you Tash for being there when it counted. Finally, thank you Miss Barnes for all your help. Preface vii From the Author, Rishi Aggarwal Most of all, we would all like to thank the real brain I would like to thank my good friend Bassel who box behind the book, Dr Hunter. He kindly asked me to become an author in the first place. I supervised every stage of the project with great would also like to mention my parents who will no patience. Without him this book would not have doubt boost sales by letting everyone know that their been possible. We would like to thank Elliott for son is now an author. Finally, thank you to my letting us participate in a project that is sure to be brother (Rupesh) and sister (Roshni) for providing very successful. Thanks everyone at Hodder Arnold laughter during the long sessions of writing. Health Sciences Publishing (especially Heather) for putting in a great amount of time and effort in bringing the book together. ABBREVIATIONS ACh acetylcholine ATP adenosine triphosphate Ca2+ calcium ion CN cranial nerve GP general practitioner K+ potassium ion Na+ sodium ion PO 3− phosphate 4 OVERVIEW OF THE 1 SECTION MUSCULOSKELETAL SYSTEM • OVERVIEW OF THE MUSCULOSKELETAL SYSTEM 2 • BONES 4 • JOINTS 6 • SKELETAL MUSCLES AND MUSCLE CONTRACTION AT CELLULAR LEVEL 8 • SKELETAL MUSCLE CONTRACTION AT MOLECULAR LEVEL (i) 10 • NERVOUS SIGNAL TRANSDUCTION 12 • NEUROMUSCULAR TRANSMISSION 14 • CLINICAL SCENARIOS 16 • SKELETAL MUSCLES AND MUSCLE CONTRACTION AT MOLECULAR LEVEL (ii) – THE CROSS-BRIDGE CYCLE 18