Musculoskeletal/Integument (MSI)TBL Session-specific Learning Objectives by Topic

1. Introduction to Clinical Anatomy

1.1 Anatomical Terminology & Surface Anatomy

1. Describe anatomical position and relate the following terms to this position: superior (cranial), inferior (caudal), anterior (ventral), posterior (dorsal), median, medial, lateral, proximal, distal, superficial and deep.

2. Define the median, sagittal, frontal (coronal) and transverse planes.

3. Define the following terms of laterality: bilateral, unilateral, ipsilateral, contralateral.

4. Distinguish the axial skeleton from the appendicular skeleton.

5. Define the following lines and planes of reference: mid-clavicular line, midaxillary line, transumbilical plane, transpyloric plane.

6. Describe the surface anatomy of the following viscera: heart, liver, gall bladder, stomach, appendix, right kidney, left kidney, spleen.

2. Clinical Anatomy & Imaging of the Back & Spinal Cord

2.1 Spinal Cord & Spinal Nerves

7. List from external to internal the three spinal meninges. Define the subarachnoid space and identify its contents. Define the term cistern as it relates to the subarachnoid space.

8. Define the epidural space and identify its contents. Describe the significance of the internal and external venous plexuses in the spread of cancer to the brain.

9. Be able to identify the following structures of the articulated vertebral column: intervertebral foramina, vertebral canal, sacral hiatus, sacral cornu.

10. Be able to identify the following features of an isolated vertebra: body (centrum), lamina pedicle, spinous process, transverse process, vertebral foramen.

11. Be able to identify the following features of the spinal cord and spinal nerves in the prosected cadaver: spinal cord, medullary cone, dura mater, arachnoid mater, terminal filum, dorsal and ventral spinal nerve roots of cauda equina, spinal nerve, dorsal root ganglion, lumbar cistern.

12. Distinguish the sites of anesthesia delivery in spinal blocks versus epidurals.

13. List the five types of vertebrae and indicate the number of vertebrae of each type. Name the spinal nerve that exits each of the intervertebral foramina in the cervical, thoracic and lumbar regions of the vertebral column.

14. Define laminectomy and identify why they are typically performed.

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15. Describe cauda equina syndrome and the physical exam and diagnostic findings.

2.2 Back & Vertebral Column

16. Be able to identify the following structures of the back in a cadaver: trapezius, latissimus dorsi, thoracolumbar fascia, rhomboid major and minor, levator scapulae, splenius, erector spinae, semispinalis capitis.

17. Be able to identify the following features of the vertebral column in an articulated skeleton: cervical lordosis, lumbar lordosis, thoracic kyphosis.

18. Be able to identify the following features on isolated vertebrae from your bone drawer: superior & inferior articular processes & facets (all vertebral types), anterior & posterior arches of C1, dens (odontoid process) of C2, transverse foramina of cervical vertebrae, costal facets of thoracic vertebrae.

19. Be able to identify the following features of the articulated spinal column in a prosected cadaver: intervertebral discs, interspinous ligaments, supraspinous ligament, ligamentum flavum, posterior longitudinal ligament.

20. Be able to identify the following normal features of the spinal column in AP and lateral conventional radiographs: dens of C2, intervertebral discs, intervertebral (neural) foramina.

21. Be able to identify the following normal features of vertebrae in conventional radiographs: body, spinous process (spine), transverse process, pedicle, lamina, articulating facets, pars interarticularis (oblique view only), vertebral (spinal) canal.

22. Be able to identify the following normal features of the back in T1- and T2-weighted MR sequences: dens of C2, cauda equina, intervertebral disc, intervertebral (neural) foramina, lateral recess, spinal cord & medullary cone, spinal nerves passing through each intervertebral foramen, spinal nerves lying within the lateral recesses of the lumbar spine.

23. Be able to identify the following normal features of the vertebrae in T1- and T2-weighted MR sequences: body, spinous process, transverse process, pedicle, lamina, articulating facets, pars interarticularis, vertebral (spinal) canal.

24. Be able to identify and correctly label the following structures/pathologies observable in CR and/or MR: compression fractures, herniated IV discs, scoliosis, spondylolysis & spondylolisthesis, vertebral osteophytes.

25. List the functions of the vertebral column. Identify the actions of the intrinsic back musculature.

26. Distinguish spondylolysis and spondylolisthesis and identify which portion of a vertebra is affected in each. Identify where in the vertebral column these conditions typically occur. Identify the sports which predispose children to spine fractures.

27. Describe compression fractures of the vertebrae and their underlying etiology. Describe the effect of compression fractures on the normal curvatures of the vertebral column.

28. Define the clinical meaning of the terms kyphosis, lordosis and scoliosis as they apply to the vertebral column.

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29. Identify the potential complications of adolescent idiopathic scoliosis. Identify the indications for bracing.

30. Distinguish degenerative spondylosis from anklylosing spondylosis.

31. List the four ligaments that provide stability of the intervertebral joints throughout the vertebral column. Identify which of these ligaments is injured in hyperextension injuries of the cervical column.

32. Distinguish the movements allowed at the atlanto-occipital and atlanto-axial joints. Describe the functions of the transverse ligament of the atlas and the alar ligaments at these joints.

33. Describe the procedure used to locate the L4 vertebra for lumbar puncture. List in order from superficial to deep the structures the needle will pass through when performing a lumbar puncture.

3. Neck Pain, Back Pain & Radiculopathy

34. Identify the incidence of spine pain in the Unites States and list its common causes.

35. Distinguish the following abnormalities of the IV disc: bulging disc, protruded disc, extruded disc and sequestered disc.

36. Define and recognize the clinical features, e.g., presentation and complications of degenerative joint disease.

37. Describe the typical clinical presentation of a herniated disc, including exacerbating and remitting factors.

38. Identify the most common levels of IV disc herniation along the vertebral column, the spinal nerve affected by these herniations and the general distribution of the dermatome affected.

39. Identify factors that contribute to IV disc herniations.

40. List the symptoms of radiculopathy and be able to differentiate the symptoms of a lumbar radiculopathy from pain originating in the posterior elements of the spine.

41. List and describe the physical examination maneuvers used to diagnose radiculopathies.

42. Describe the Straight Leg Raising Test and discuss its use in the examination of a patient with low back pain.

43. Identify the clinical features of myelopathy.

44. Describe the anatomical basis of the nerve root impingement caused by spondylolisthesis.

45. Identify the classic location (disc versus vertebrae) where adult spine infections arise. List complications of spondylodiscitis.

46. Need objectives on the following here:

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Surgical & nonsurgical treatment of cervical disc herniationsSCIWORASyndromes related to C5-C6 and C7 disc herniationsAppearance of the former in MRIDistinction between spondylolisthesis caused by pars defect and spondylolisthesis caused by osteoarthritis

4. Orthotics

47. Define Orthosis.

48. Know the appropriate technique and rationale for applying a cervical collar in an emergency situation and how physicians clear a cervical spine radiographically and on physical examination.

49. Recognize how different spine orthotics can be used to limit range of motion (ROM) of the spine to allow for healing.

50. Describe the postures that exacerbate vertebral compression fractures and identify the orthotics that are used to prevent them.

51. Describe considerations for the fitting of an orthotic including avoidance of nerve and vascular compression, comfort and skin integrity.

52. List complications that occur with orthotics and identify an imaging modality that would be helpful in their diagnosis.

TBL Session 2: Skeletal Muscle, Musculoskeletal Function & Exercise, Neuromuscular Pathology, Anatomy of the ANS, Thermoregulation, Introduction to Dermatology

1. Bioenergetics, Skeletal Muscle Metabolism & Exercise Physiology

53. Calculate the daily energy expenditure (DEE) based on physical activity and estimated basal metabolic rate (BMR).

54. Review the concepts of cellular energy transformation (bioenergetics).

55. Relate the concept of Gibbs free energy (ΔG) to the potential for ATP to provide energy for mechanical and transport work in muscles cells and the generation of ATP from metabolic processes under anaerobic and oxidative conditions.

56. Review the response of all of the metabolic pathways below to energy demand (ATP, ADP, and AMP levels), oxygen availability (indicated by NADH, NAD+), Ca2+, feedback regulation, and allosteric regulation. Recall important coenzymes and cofactors in these pathways: glycolysis, glycogenolysis, TCA cycle, oxidative phosphorylation, oxidation of fatty acids and ketones.

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57. Relate the fuel utilization and function of the different muscle fiber types to their content of mitochondrial, myoglobin, glycogen, and glycolytic enzymes.

58. Review creatine synthesis in the body and its activation by creatine (phospho)kinase in muscle.

59. Apply the principles of bioenergetics to explain how creatine phosphate is used for energy storage and ATP production.

60. Describe the biological activation of creatine phosphate and indicate why it is a better energy reservoir than ATP.

61. Discuss how creatine (phospho)kinase and creatinine are used in clinical diagnosis.62. Describe the differences in metabolic regulation between skeletal muscle and liver,

including specific tissue responses and hormonal responses.

63. Review the sources of glucose used by muscle during exercise and how this relates to the enzyme defects underlying glycogen storage diseases that affect skeletal muscle function.

64. Review the fuel metabolism of resting muscles in the fed and starved state. Compare this with the fuel metabolism of muscles at different intensities and durations of exercise.

65. Review how fuel utilization changes during exercise with changes in hormone release.

66. Describe the relationship between aerobic exercise and insulin requirements. Identify its underlying basis.

67. Discuss how fuel utilization changes during exercises with changes in blood flow.

68. Review the regulation of glycogenolysis, glycolysis, TCA cycle and fatty acid oxidation, including the regulation of pathway enzymes and carnitine-mediated transport of fatty acids into mitochondria.

69. Review the role of the Cori cycle during anaerobic muscle metabolism.

70. Review branched-chain amino acid metabolism and identify the coenzyme-requiring steps and the anapleoric roles of the metabolites in the TCA cycle.

71. Discuss how skeletal muscle is more “equipped” for branched-chain amino acid metabolism than is the liver.

72. Review the role of the glucose/alanine cycle in providing fuel for muscle and elimination of nitrogen.

73. Discuss the metabolism of aspartate by the purine nucleotide cycle and the importance of this cycle in exercising muscle.

74. Review the production of glutamine from other amino acids and the physiological purpose of glutamine export from muscle to the liver and kidney.

75. Discuss/review the metabolic basis of the muscular symptoms and clinical findings associated with the following conditions or diseases. Where applicable consider how the enzyme, nutrient, or biological factor deficiencies lead to altered muscle function and exercise physiology:

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glycogen storage diseasesmyoadenylate deaminase deficiency

mitochondrial myopathies (MERRF, MELAS, recurrent myogloburias)iron deficiencycarnitine deficiencycarnitine plamitoyl transferase II deficiencybranched-chain aminoacidurias.

2. Introduction to the Musculoskeletal System

2.1. Anatomy, Function & Imaging of Synovial Joints

76. Distinguish the following features of a synovial joint: capsule, synovial membrane, articular cartilage, fibrocartilage.

77. Distinguish intrinsic vs. extrinsic accessory ligaments of synovial joints.

78. Describe the innervation of joints and the muscles that act upon them.

79. Compare the vascularity and healing potential of the different tissues that form synovial joints.

80. Define bursae and describe their function. Define bursitis.

81. Describe what is meant by joint “stability” and relate this concept to a joint’s mobility and susceptibility to injury. Distinguish passive from dynamic stabilization of joint.

82. Be able to distinguish synovial fluid, fat, bone, cartilage, ligaments and muscles in T1- and T2-weighted MR images.

2.2. Joint Mechanics & Kinesiology

83. Understand the coordination of synergists and antagonists on the skeletal framework.

84. Identify the normal range of motion of the shoulders, hips and knees and describe how to test each.

2.3 Tendon & Ligaments

2.3.1. General Concepts

85. Distinguish regular and irregular dense connective tissues.

86. Identify the types of fibers present in tendons and describe their typical arrangement. Identify the function of tendons.

87. Characterize the attachment of tendons to cartilage, bone and muscle.

88. Discuss the turnover, repair, healing potential and graft of tendons.

89. Describe the different healing potential of a paratenon tendon and a mesotenon tendon.

2.3.2. Clinical Concepts

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90. Need objectives on the effect of steroids and quinolones on tendons.

91. Quinolones contraindicated in the pediatric patient.

3. Overuse Injuries and Soft-tissue Trauma

3.1. Muscle Healing & Rehabilitation

92. Define overuse injury and repetitive strain injury.

93. Describe the self-repair of muscle fibers following microtrauma.

94. Identify the physiological effects of excessive force on muscle fibers.

95. Identify indications for the use of heat and cold to treat musculoskeletal injuries.

96. Discuss the rationale of RICE (Rest, Ice, Compression and Elevation) in the treatment of acute musculoskeletal injuries.

97. Define ergonomics. Discuss the role of Physical and Occupational Therapy in preventing occupational injury.

3.2. Treatment of Musculoskeletal Over-Use Injuries

3.2.1. Muscle Relaxants: Direct-acting Cholinergic Agents (Curare, Nicotine, Succinylcholine, Tubocurarine, Cisatracurium, Rocuronium, Mivacarium)

98. Describe the physiology and pathophysiology of transmission at the neuromuscular junction as it relates to pharmacology.

99. Differentiate between depolarizing and competitive neuromuscular anatogonists.

100. Compare and contrast depolarizing and competitive neuromuscular antagonists with respect to their use, limitations and adverse effects.

101. Explain the rationale for the combination use of antimuscarinic and anticholinesterase agents in reversal of neuromuscular blockade.

102. Discuss the mechanism of action and clinical applications of botulinum toxin. Describe possible side effects associated with the use of this drug.

103. Explain why nicotine is not used clinically (except as a smoking deterrent), and its historical, social and toxicological significance.

3.2.2. Agents Used to Treat Tendonitis and Bursitis

3.2.2.1. Nonsteroidal Anti-Inflammatory Agents (Introduced in MCM)

104. Review the biosynthesis, physiological and pharmacological effects of the eicosanoids, with emphasis on the role of prostaglandins and leukotrienes as mediators of inflammation.

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105. Review the mechanism of action common to all nonsteroidal anti-inflammatory drugs (NSAIDs).

106. Review the adverse affects and drug interactions of the following nonsteroidal anti-inflammatory drugs (NSAIDS):

Salicylic acid derivativesIndole and indene acetic acidsHeteroaryl acetic acidsPropionic acidsOxicams

107. Review the therapeutic uses and adverse effects of the celecoxib.

108. Compare and contrast the pharmacological properties of selective cyclooxygenase-2 inhibitors with non-selective cyclooxygenase inhibitors.

109. Review the pharmacodynamics, pharmacokinetics, therapeutic uses, and adverse effects of acetaminophen.

110. Compare and contrast the pharmacological properties of acetaminophen with those of NSAIDs.

111. Need additional objectives specific to uses in the treatment of tendonitis and bursitis.

3.2.2.2. Glucocorticoids (betamethasone, hydrocortisone, cortisone, dexamethasone – introduced in MCM)

112. Review the chemistry and structure, pharmacokinetics and pharmacodynamic actions of glucocorticoids in relation to their use as anti-inflammatory agents.

113. Review the toxicities associated wit the use of glucocorticoids.

114. Need additional objectives specific to uses in the treatment of tendonitis and bursitis.

4. Compression Neuropathy

115. Define neurapraxia, axonotmesis and neurotmesis.

116. Describe the effects of focal demyelination on nerve conduction and its appearance in EMG.

117. Identify the recovery time involved in acute compressive neuropathies such as Saturday night palsy or crutch palsy of the radial nerve.

118. Identify common nerve entrapment syndromes and the functional deficits expected with each.

5. Introduction to the Autonomic Nervous System

5.1. General Concepts

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119. Identify the three divisions of the autonomic nervous system and compare their functions and general distribution.

120. Compare the somatic and autonomic systems with respect to the number of motor neurons required to innervate effector organs. Distinguish the preganglionic nerve/fiber from the postganglionic nerve/fiber in terms of location of the neuronal cell body and myelination of axons.

121. Compare and contrast the sympathetic and parasympathetic subdivisions of the ANS in terms of the locations of preganglionic and postganglionic neuron cell bodies. Distinguish paravertebral (chain), prevertebral (pre-aortic) and terminal ganglia.

122. Compare and contrast sympathetic and parasympathetic preganglionic and postganglionic neurons with respect to the neurotransmitters they release and the receptors targeted.

5.2. Autonomic Innervation of Body Wall Viscera

123. List the three types of body wall viscera innervated by the sympathetic system. Compare the innervation of sweat glands to that of blood vessels and arrector pili muscles.

124. Identify where, along a spinal nerve, the cell bodies of the postganglionic sympathetic neurons destined to innervate body wall viscera reside. Distinguish a paravertebral ganglion from a dorsal root ganglion anatomically and functionally.

125. Identify the spinal cord segments that contain preganglionic sympathetic neurons. Identify the region of the gray matter in which these cells reside. For a single spinal cord segment, identify the route the fiber of a preganglionic sympathetic neuron takes to exit the spinal cord and reach its corresponding paravertebral ganglion.

126. Describe the formation of the sympathetic chain by the ascending and descending fibers of preganglionic sympathetic neurons. Identify the location of the sympathetic chain relative to the vertebral column.

6. Development, Clinical Anatomy & Imaging of the Upper Limb

6.1. Shoulder

6.1.1. Anatomy & Imaging of the Shoulder

127. Be able to identify the following muscles of the back and shoulder in a cadaver: deltoid, infraspinatus, latissimus dorsi, levator scapulae, biceps brachii (long and short heads), rhomboid major and minor, pectoralis major, pectoralis minor, serratus anterior, supraspinatus, teres major, teres minor, trapezius, triceps brachii (long and lateral heads).

128. Be able to identify the following neurovascular structures of the shoulder in a cadaver: axillary nerve, cephalic vein, lateral thoracic artery, posterior humeral circumflex artery, spinal accessory nerve, thoracoacromial artery, transverse cervical artery.

129. Be able to identify the following osteological features of the acromioclavicular and glenohumeral joints in an articulated specimen and in bones from your bone drawer: lateral, middle and medial thirds of clavicle; spine, acromion, coracoid process and glenoid cavity of scapula; head, greater and lesser tubercles, intertubercular (bicipital) groove, anatomical neck, surgical neck.

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130. Be able to identify the following features of the acromioclavicular and glenohumeral joints in a shoulder model and in a prosected shoulder: acromioclavicular, coracoacromial and coracoclavicular ligaments, glenoid labrum, glenohumeral ligaments, tendon of the long head of biceps brachii in intertubercular groove.

131. Be able to identify the following normal features of the adult shoulder in conventional radiographs: acromioclavicular joint, clavicle.

132. Be able to identify the following normal features of the scapula in conventional radiographs: medial and lateral borders, superior and inferior angles, glenoid cavity (fossa), coracoid process, spine, acromion (acromion process).

133. Be able to identify the following normal features of the humerus in conventional radiographs: head, greater and lesser tubercles, intertubercular (bicipital) groove, anatomical neck, surgical neck, deltoid tuberosity

134. Be able to identify the following normal features of the adult shoulder in sagittal and coronal MR images: clavicle, acromion, spine & glenoid cavity of scapula, head & greater tubercle (tuberosity) of humerus; glenoid labrum; infraspinatus; supraspinatus, supraspinatus tendon, glenohumeral joint space.

135. Be able to identify and correctly label the following structures/pathologies observable in CR and/or MR: acromioclavicular joint subluxation, clavicular fracture, rotator cuff tear, shoulder dislocation.

6.1.2. Clinical Anatomy of the Shoulder

136. Identify the joint involved and the ligaments injured in the various grades of “shoulder separation”.

137. Identify the most common site of clavicular fracture and describe its typical presentation.

138. List the four rotator cuff muscles and identify their innervation. Identify the function of these muscles in glenohumeral joint stabilization.

139. Distinguish the subacromial bursa from the subscapular bursa. Describe the relationship of the subacromial bursa to the supraspinatus tendon and the coracoacromial ligament.

140. List the six principal movements allowed at the glenohumeral joint and the muscles involved in each. Identify the innervation of these muscles.

141. Identify the role of scapular movement in glenohumeral joint function. Identify the muscles that laterally and medially rotate the scapula. Identify the innervation of these muscles. Describe “winged” scapula and identify its cause.

142. List the joints involved and the muscle activity required to abduct the arm 180 degrees.

143. Identify the nerve at risk of injury in shoulder dislocations and in fractures of the surgical neck of the humerus and identify the functional deficits that may result from its injury.

144. Need objectives re: surgical & nonsurgical treatments for common shoulder injuries here

6.2. Arm & Elbow

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6.2.1. Anatomy & Imaging of the Arm and Elbow

145. Be able to identify the following muscles of the arm and elbow in a cadaver: biceps brachii (long & short heads, bicipital aponeurosis), brachioradialis, coracobrachialis, extensor carpi radialis longus & brevis, extensor carpi ulnaris, extensor digiti minimi, extensor digitorum, flexor carpi radialis, flexor carpi ulnaris, flexor digitorum superficialis, palmaris longus, pronator teres, triceps brachii (long & lateral heads).

146. Be able to identify the following neurovascular structures of the arm & elbow in a cadaver: brachial artery, deep brachial artery, lateral cutaneous nerve of the forearm, median nerve, musculocutaneous nerve, radial nerve, ulnar nerve.

147. Be able to identify the following features of the distal humerus in an articulated skeleton, an isolated humerus from your bone drawer, and in conventional radiographs: trochlea, capitulum, medial & lateral epicondyles, olecranon fossa.

148. Be able to identify the following features of the radius and ulna in an articulated skeleton, in isolated specimens from your bone drawer, and in conventional radiographs: head, neck and tuberosity of radius, olecranon, coronoid process and trochlear notch of ulna.

149. Be able to identify the following features of the elbow joint in a model: trochlea and capitulum of humerus, radial head, trochlear notch of ulna, radial and ulnar collateral ligaments.

150. Be able to identify the following features of the proximal radioulnar joint in a model: capitulum of humerus, radial head, radial neck, annular ligament.

151. Be able to identify the following normal features of the adult elbow in conventional radiographs: humeroradial and humeroulnar joints.

152. Be able to identify and correctly label the following structures/pathologies observable in CR: medial epicondyle avulsion, olecranon fracture, posterior dislocation of elbow, supracondylar fracture.

6.2.2. Clinical Anatomy of the Arm & Elbow

153. List the muscles in the anterior and posterior compartments of the arm and distinguish the actions of anterior and posterior compartment muscles at the elbow. Identify the nerve supply of anterior and posterior compartment muscles.

154. Distinguish the functions of the biceps brachii muscle at the glenohumeral and elbow (humeroradial and humeroulnar) joints. Describe the relationship of the tendon of the long head of biceps brachii to the glenohumeral joint. Describe the “Popeye deformity” and bicipital tendonitis.

155. Identify the spinal cord segments assessed by the biceps reflex and the triceps reflex.

156. Distinguish the subcutaneous olecranon bursa from the subtendinous olecranon bursa anatomically. Identify which bursa is involved in “student’s bursitis”.

157. Identify the three major superficial veins of the upper limb and describe, in general terms, their courses. Discuss the clinical significance of the median cubital vein.

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158. Identify the nerve at risk of injury in midshaft fractures of the humerus.

159. Need objectives re: surgical & nonsurgical treatments for common arm injuries.

6.3 Forearm, Wrist & Hand

6.3.1. Anatomy & Imaging of the Wrist and Hand

160. Be able to identify the following muscles of the wrist and hand in a cadaver: abductor pollicis longus & brevis, adductor pollicis, dorsal & palmar interossei, extensor digiti minimi, extensor digitorum (& extensor expansion), extensor indicis, extensor pollicis longus & brevis, flexor digitorum profundus, flexor digitorum superficialis, flexor pollicis brevis, flexor pollicis longus, lumbricals 1-4, opponens pollicis, pronator quadratus, supinator.

161. Be able to identify the following neurovascular structures of the wrist and hand in a cadaver: median nerve, anterior interosseus nerve, common digital branches of median nerve, proper digital branches of median nerve, recurrent median nerve, radial nerve, superficial & deep branches of radial nerve, posterior interosseous nerve, superficial & deep branches of ulnar nerve, brachial artery, radial artery, ulnar artery, anterior & posterior interosseous arteries, superficial and deep palmar arches.

162. Be able to identify the following osteological features of the wrist and hand in an articulated skeleton and in conventional radiographs: scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate, styloid process of distal radius, head and styoid process of distal ulna, metacarpals 1-5, proximal, intermediate and distal phalanges of digits 2-5; proximal and distal phalange of digit 1.

163. Be able to identify the following joints of the wrist and hand in conventional radiographs: metacarpophalangeal (MCP) joints 1-5, interphalangeal joint of digit 1; proximal and distal interphalangeal joints (PIP & DIP) of digits 2-5.

164. Be able to identify and correctly label the following fractures of the wrist and hand in conventional radiographs: boxer, Colles, scaphoid.

6.3.2. Clinical Anatomy of the Wrist & Hand

165. List the four movements allowed at the wrist (radiocarpal and midcarpal joints) and the muscles involved in each. Identify the innervation of these muscles (Be specific). Describe “wrist drop” and identify its cause.

166. Distinguish the sites of origin of the flexors and extensors of the wrist and interphalangeal joints. Distinguish tennis elbow from golfers elbow.

167. Identify the joints involved in pronation and supination of the forearm. Discuss the significance of the annular ligament in subluxation and dislocation of the radial head (i.e., “Nursemaid’s elbow).

168. List the muscles that pronate and supinate the forearm. Identify the innervation of these muscles (Be specific).

169. Describe the courses of the radial, median and ulnar nerves around the elbow.

170. Identify the bones involved in a Colle’s fracture and identify its typical presentation.

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171. Describe an open fracture of a forearm and the treatment sequence.

172. List the ten structures that pass through the carpal tunnel. Describe the relationship of these structures to the common flexor sheath (ulnar bursa) and the radial bursa. Identify the relationships of the two tendon bursae at the wrist with the digital tendon sheaths.

173. Distinguish the functions of the flexor digitorum superficialis, flexor digitorum profundus and flexor pollicis muscles of the forearm and correlate these with their sites of insertion on the digits. Identify the innervation of each of these muscles (Be specific). Identify the functional deficits expected in the hand with injury to the anterior interosseous nerve.

174. Identify the wrist and hand movements that increase pressure within the carpal tunnel. Describe the Tinel’s test and the Phalen’s test. Describe how a night splint can alleviate the symptoms of carpal tunnel syndrome.

175. Describe the condition known as “Dupuytren’s contracture” and describe its typical presentation.

176. Distinguish the thenar muscles from the hypothenar muscles of the palm. List the muscles of the thenar group and identify their actions. Distinguish these from the action of the flexor pollicis longus and the adductor pollicis muscle. Identify the innervation of each of the muscles that acts on the thumb.

177. Distinguish the functional deficits expected in an injury to the median nerve at the elbow from an injury to the median nerve at the wrist.

178. Distinguish the functional deficits associated with compression of the median nerve within the carpal tunnel with those resulting from a laceration of the recurrent median nerve.

179. Distinguish the functional deficits expected in an injury of the ulnar nerve at the elbow with those following injury to the ulnar nerve at the wrist.

180. Identify the actions of the lumbricals and the palmar and dorsal interossei muscles. Identify the innervation of these muscles.

181. List the muscles in the posterior compartment of the forearm that act on the digits. Identify the innervation of these muscles (Be specific).

182. Identify the tendons contained within each of the six synovial tendon sheaths (“dorsal compartments”) on the dorsum of the hand. Identify the tendons involved in De Quervain’s tenosynovitis. Identify the most common site of development of a synovial cyst.

183. List the three muscle tendons that bound the anatomical snuff box and identify the carpal bone that can be palpated within it.

184. Identify the structure damaged in mallet or baseball finger and the functional deficits that will result.

185. Distinguish the cutaneous domains of the hand innervated by the radial, ulnar and median nerves.

186. Identify the dermatomes of the thumb, index finger and little finger.

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187. Need objectives re: surgical & nonsurgical treatments for common forearm, wrist & hand injuries.

6.4 Brachial Plexus & Upper Limb Blood Supply

6.4.1. Anatomy of the Axilla

188. Be able to identify the following muscles associated with the axilla in a cadaver: latissimus dorsi, teres major, pectoralis major, pectoralis minor, subscapularis.

189. Be able to identify the following features of the brachial plexus in a cadaver: lateral, medial & posterior cords, axillary nerve, radial nerve, musculocutaneous nerve, lateral cutaneous nerve of the forearm, ulnar nerve, medial cutaneous nerve of the arm, medial cutaneous nerve of the forearm, median nerve, lateral and medial branches to the median nerve, medial & lateral pectoral nerves, long thoracic nerve, upper & lower subscapular nerves, thoracodorsal nerve

190. Be able to identify the following arteries in the axilla, shoulder and arm of a cadaver: axillary, brachial, deep brachial, lateral thoracic, anterior & posterior humeral circumflex, subscapular, circumflex scapular, thoracodorsal, radial, ulnar.

191. Be able to identify the following features of the root of the neck in cross-sectional images of a cadaver: anterior & middle scalene muscles, trunks of brachial plexus, subclavian artery & vein, apex of lungs.

6.4.2. Clinical Anatomy of the Axilla

192. List the ventral primary rami that contribute to the brachial plexus and describe the distribution of these fibers into superior, middle and inferior trunks. List the three cords of the brachial plexus and the branches of each.

193. Identify the branches of the brachial plexus composed entirely of fibers from the superior trunk and list the muscles these nerves supply. List the functional deficits expected following injury to the superior trunk. Distinguish these deficits from those associated with injury to the axillary nerve.

194. Identify the branches of the brachial plexus composed entirely of fibers from the inferior trunk and list the muscles these nerves supply. List the functional deficits expected following injury to the inferior trunk. Distinguish these deficits from those associated with injury to the ulnar nerve at the elbow.

195. Distinguish the cutaneous domains of the following nerves: axillary, musculocutaneous, radial, medial, ulnar, medial cutaneous of the arm, medial cutaneous of the forearm.

196. Identify where the following nerves are susceptible to injury and list the functional deficits associated with each: axillary, radial, median, ulnar. Define “Saturday Night Palsy”, “Crutch Palsy” and “Tardy Ulnar Palsy”.

197. Identify the landmarks of transition from the subclavian artery to the axillary artery and from the axillary artery to the brachial artery. Describe the two collateral routes of blood around the scapula.

198. Identify the pulse points of the upper limb and the arteries involved.

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199. Identify where the arterial supply of the upper limb can be compressed to stop profuse bleeding from the palmar arches.

200. Define thoracic outlet syndrome (TOS) and identify the structures affected.

201. Identify the neurovascular structures at risk of injury in the following conditions: clavicular fracture, dislocation of the shoulder, fracture of the surgical neck of the humerus, midshaft fracture of the humerus, supracondylar fracture of humerus, avulsion of the medial epicondyle.

6.5. Embryonic Development of the Limbs

202. Define the following terms: meromelia, amelia, brachydactyly, syndactyly, polydactyly, cleft hand.

203. Describe the developmental basis of meromelia, amelia, syndactyly and polydactyly.

204. Describe the significance of epiphyseal plates to long bone growth.

TBL Session 3: Dermatology Cont., Cartilage, Bone, Joints, Growth & Aging, Impairment & Disability

1. Growth of the Skeletal System

205. Discuss the significance of endochondral ossification to elongation of long bones during growth.

206. Describe the regulation of growth of long bones by circulating hormones and local factors.

207. Identify which drugs affect the immature growth plate and should be avoided in pediatric patients.

208. Describe the role of sutures in the expansion of the neurocranium and facial capsules.

209. Compare the growth sutures with that of synchondroses and other “growth cartilages” of the skull. List the principal growth cartilages of the skull.

210. Describe the process of periosteal bone formation in the growth of bones.

2. Bone & Joint Health

211. Discuss the critical life stages of bone and relate the stages to maintenance of bone health by nutrient absorption and physical activity.

212. Identify the types of exercise most beneficial to bone health and the general guidelines for adult physical activity.

213. Assess the changes with increasing age for the adequate intake (AI) for calcium and Vitamin D and the recommended daily allowance (RDA) for phosphorus. Identify major

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food and supplemental sources for calcium and Vitamin D and note the recommended method of intake for ensuring effective nutrient absorption.

214. Identify nutrients, aside from calcium, vitamin D and phosphorus, that benefit bone and also identify dietary components that may negatively impact bone health.

215. Need objectives on joint health

3. Bone Fractures

3.1. General Concepts

216. Define each of the following types of fractures, including common locations and potential complications where applicable: simple, greenstick, displaced, comminuted, open, stress, compression.

217. Describe the morphological sequence of bone repair following fracture of a long bone. Indicate the way(s) in which age, mobility, nutritional state and infection influence the repair process.

3.2. Pediatric Fracture Considerations

218. Identify the growth plates of the upper and lower limbs, describe their sequence of closure and their relative contribution to overall limb growth.

219. Be able to distinguish bone fractures from epiphysial plates in CR images of children and adolescents.

220. Describe the different type of growth plate fractures seen in children and the implications on growth.

221. Identify the primary causes of growth plate fractures in children.

222. Identify the fractures indicative of child abuse. Identify their typical causes.

223. Define a fibrous cortical defect and identify its clinical and radiographic features. Formulate a treatment plan for this condition.

224. Discuss the incidence and potential complications of slipped capital femoral epiphysis.

3.3. Treatment of Bone Fractures (including stress fractures)

225. Describe the significance of immobilization in the healing of fractures or sprains.

226. Describe the wound considerations in the treatment of open fractures.

227. Need additional objectives

4. Osteonecrosis

228. Define osteonecrosis. Describe the morphology and clinical course of osteonecrosis.

229. Build a differential diagnosis for common causes of osteonecrosis.

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230. Discuss the anatomical basis of avascular necrosis (AVN) of the femoral head. Describe the clinical presentation of patients with AVN of the femoral head.

231. Identify systemic diseases, drugs and injuries that predispose patients to AVN of the femoral head. Identify the surgical intervention to treat AVN of the femoral head.

232. Identify bones at risk for avascular necrosis following fracture.

233. Define Legg-Calve-Perthes disease and explain how the blood supply to the femoral head changes during growth.

234. Describe Panner’s syndrome of the elbow.

5. Joint Replacement

235. Need objectives

5.1. Prosthetic Joint Infections

236. Describe the risk of prosthetic joint infections after dental procedures.

237. Describe the evaluation of a patient with a prosthetic knee replacement who presents with a 2- day history of a swollen painful knee without history of trauma.

6. Clinical Anatomy & Imaging of the Lower Limb

6.1. Anterior & Medial Thigh

6.1.1. Anatomy & Imaging of the Anterior & Medial Thigh

238. Be able to identify the following muscles of the anterior & medial aspects of the thigh in a cadaver: adductor longus, brevis and magnus, gracilis, iliopsoas, pectineus, psoas major, sartorius, rectus femoris, vastus lateralis, medialis & intermedius, quadriceps tendon (& patellar ligament)

239. Be able to identify the following neurovascular structures of the anterior & medial aspects of the thigh in a cadaver: femoral artery & vein, femoral nerve, great saphenous vein, deep femoral artery, medial & lateral femoral circumflex arteries, saphenous nerve, obturator artery (anterior & posterior branches), obturator nerve (anterior & posterior branches).

240. Be able to identify the following osteological features of the pelvis in an articulated skeleton, an articulated pelvis model, isolated specimens from your bone drawer, and in conventional radiographs: ilium, ischium, pubis, acetabulum, iliac fossa, iliac crest, anterior superior iliac spine (ASIS), anterior inferior iliac spine (AIIS), ischiopubic ramus, obturator foramen,

241. Be able to identify the following osteological features of the femur and tibia in an articulated skeleton, isolated specimens from your bone drawer, and in conventional radiographs: head, neck, greater & lesser trochanters of proximal femur, medial & lateral

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condyles & epicondyles of distal femur, medial & lateral condyles and tuberosity of proximal tibia.

242. Be able to identify the following features of the femur on an articulated skeleton and in an isolated specimen from your bone drawer: linea aspera, adductor tubercle, patellar groove.

6.1.2. Clinical Anatomy of the Anterior & Medial Thigh

243. List the muscles in the anterior and medial compartments of the thigh and distinguish the actions of anterior and medial compartment muscles at the hip joint. Identify the innervation of these muscles.

244. Identify the origins of the psoas major and iliacus muscles in the abdomen and their insertion of the lower limb. Define an iliopsoas abscess. Distinguish psoas abscesses from femoral hernias.

245. Distinguish the functions of the quadriceps femoris muscle at the hip and knee. Identify the origin of the rectus femoris portion of the quadriceps femoris muscle.

246. Identify the spinal cord segments assessed by the patellar tendon (knee jerk) reflex.

247. Compare and contrast Osgood-Schlatter disease and chondromalacia patellae.

248. Identify the spinal cord segments that contribute fibers to the femoral and obturator nerves.

249. Identify where the femoral nerve is susceptible to injury and list the functional deficits that result.

250. Identify common causes of obturator nerve injury and list the functional deficits that result.

251. Identify the landmarks of transition from the external iliac artery to the femoral artery and from the femoral artery to the popliteal artery.

252. Identify where the femoral artery can be located in the femoral triangle. Describe the relationship of this structure to the femoral vein and femoral canal.

253. Distinguish the most common sites of acute and chronic arterial occlusion in the lower limb.

254. Describe the role of the perforating veins and the lower limb musculature in propelling venous blood to the heart against gravity (the “musculovenous pumps”). Identify the direction of flow within the perforating veins.

255. Describe the significance of valves in the superficial veins in the return of venous blood from the lower limb and in the development of varicose veins.

256. Define a deep vein thrombosis (DVT). Indicate to which heart chamber a released DVT will travel. Describe the route from this chamber to the lungs.

6.2. Gluteal Region & Posterior Thigh

6.2.1. Anatomy of the Gluteal Region & Posterior Thigh

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257. Be able to identify the following muscles of the gluteal region and posterior thigh in a cadaver: gluteus maximus, gluteus medius & minimus, piriformis, quadratus femoris, superior & inferior gemelli, obturator internus tendon, tensor fascia latae & iliotibial tract, biceps femoris (long and short heads), semimembranosus, semitendinosus.

258. Be able to identify the following neurovascular and ligamentous structures of the gluteal region and posterior thigh in a cadaver: superior & inferior gluteal arteries, superior & inferior gluteal nerves, sciatic nerve, common fibular nerve, tibial nerve, sacrospinous ligament, sacrotuberous ligament.

259. Be able to identify the following features of the pelvis in an articulated skeleton, an articulated pelvis model and in an isolated specimen from your bone drawer: ilium, ischium, pubis, ischial spine, ischial tuberosity, greater sciatic notch, lesser sciatic notch,

260. Be able to identify the following features of the proximal fibula in an articulated skeleton and in an isolated specimen from your bone drawer: head, neck.

6.2.2. Clinical Anatomy of the Gluteal Region & Posterior Thigh

261. Distinguish the action of the gluteus maximus from that of the lesser gluteals (gluteus medius & minimus) during walking. Identify the innervation of each of the gluteal muscles.

262. Identify common causes of injury to the superior and inferior gluteal nerves and distinguish the functional deficits that will result from injury to these nerves.

263. Describe the typical presentation of a positive Trendelenburg sign.

264. Identify the quadrant of the buttock where intramuscular injections can be made without risking injury to major nerves and vessels.

265. Identify the common causes and symptoms of ischial and trochanteric bursitis.

266. List the muscles of the posterior compartment of the thigh and identify the action of posterior compartment muscles at the hip joint. Identify the innervation of each of these muscles.

267. Identify the muscles of the posterior compartment of the thigh collectively referred to as the “hamstring muscles” and distinguish their actions at the hip and knee. Identify their point of origin from the pelvis.

268. Identify the spinal cord segments that contribute fibers to the following nerves: sciatic, tibial, common fibular.

269. List the symptoms that characterize sciatica and identify its underlying cause. Distinguish sciatica from pseudosciatica.

6.3. Hip

6.3.1. Anatomy & Imaging of the Hip

270. Be able to identify the following osteological features of the hip joint in a model of an articulated pelvis and in isolated specimens from your bone drawer: acetabulum, lunate

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surface, acetabular fossa and acetabular notch of pelvis; head, fovea and neck of proximal femur.

271. Be able to identify the following features of the hip joint in a model and prosected cadaver: acetabular labrum, ligament of the femoral head, ileofemoral ligament of fibrous capsule.

272. Be able to identify the following normal features of the pelvis in conventional radiographs: sacrum, sacroiliac joint, pubic symphysis, iliac crest, anterior superior iliac spine (ASIS), anterior inferior iliac spine (AIIS), ischial tuberosity, obturator foramen, acetabulum.

273. Be able to identify and correctly label the following structures/pathologies of the hip observable in conventional radiography: dislocation of hip, femoral neck fracture, Legg-perthes disease.

6.3.2. Clinical Anatomy of the Hip

274. List the six principal movements allowed at the hip joint and the muscles involved in each. Identify the innervation of these muscles.

275. Describe the Barlow and Ortolani tests for assessing congenital hip location.

276. Distinguish intracapsular fractures from extracapsular fractures. Identify the artery at risk of injury in intracapsular fractures and the consequences of such an injury in adults.

277. Describe the typical presentation of an individual who has suffered a femoral neck fracture.

278. Distinguish the nerves at risk of injury in anterior and posterior dislocations of the hip.

279. Define “hemorrhagic shock” after a pelvis fracture.

280. Need objectives re: surgical & nonsurgical treatments for common hip injuries.

6.4. Knee & Popliteal Fossa

6.4.1. Anatomy of the Popliteal Fossa

281. Be able to identify the following muscles associated with the popliteal fossa in a cadaver: gastrocnemius, plantaris, popliteus, biceps femoris, semimembranosus, semitendinosus.

282. Be able to identify the following neurovascular structures of the popliteal fossa in a cadaver: sciatic nerve, common fibular nerve, tibial nerve, popliteal artery & vein.

6.4.2. Anatomy & Imaging of the Knee

283. Be able to identify the following osteological features of the knee joint in an articulated skeleton, a model of a knee joint, isolated specimens from your bone drawer and in conventional radiographs: patella, medial and lateral condyles of femur, intercondylar notch of femur, medial and lateral condyles, tibial plateau, intercondylar eminence and tuberosity of tibia, head of fibula.

284. Be able to identify the following features of the knee joint in a model of a knee joint and in a prosected cadaver: medial & lateral menisci, tibial & fibular collateral ligaments, patellar ligament, anterior & posterior cruciate ligaments.

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285. Be able to identify the following normal features of the adult knee in sagittal and coronal MR images: medial & lateral femoral condyles, tibial plateau, patella, quadruceps tendon, patella tendon, medial & lateral menisci, anterior & posterior cruciate ligaments, medial & lateral collateral ligaments.

286. Be able to identify and correctly label the following structures/pathologies of the knee observable in CR and MR images: anterior cruciate ligament tear

6.4.3. Clinical Anatomy of the Knee

287. List the muscles responsible for flexion and extension at the knee. Identify the innervation of these muscles.

288. Describe the role of the popliteus muscle in knee function.

289. Describe the relationships of the medial and collateral ligaments of the knee with the medial and lateral menisci.

290. Describe the movements the anterior cruciate and posterior cruciate ligaments normally prevent and the method of testing each.

291. List the three structures involved in the “unhappy (terrible) triad”.

292. Identify the blood supply of the menisci of the knee and relate this to the ability of the menisci to heal following injury.

293. Define a “bucket handle mensical injury and identify its typical presentation.

294. Identify the bursa involved in “Housemaid’s knee”. Identify the location of the suprapatellar bursa.

295. Define the Q-angle. Compare the Q-angles of males and females.

296. Need objectives re: surgical & nonsurgical treatments for common knee injuries.

6.5. Leg & Ankle

6.5.1. Anatomy of the Leg

297. Be able to identify the following muscles and tendons of the leg in a cadaver: gastrocnemius, soleus, calcaneal tendon, plantaris, flexor digitorum longus, flexor hallucis longus, fibularis longus & brevis, tibialis anterior & posterior, extensor digitorum longus, extensor hallucis longus.

298. Be able to identify the following neurovascular structures of the leg in a cadaver: common fibular nerve, superficial and deep branches of the fibular nerve, tibial nerve, popliteal artery, anterior tibial artery, posterior tibial artery, fibular artery.

6.5.2. Anatomy & Imaging of the Ankle

299. Be able to identify the following osteological features of the ankle (talocrural joint) in an articulated specimen, isolated specimens from your bone drawer and in conventional

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radiographs: medial malleolus of tibia, lateral malleolus of fibula, calcaneus, talus, calcaneal tuberosity, head, neck and trochlea of talus.

300. Be able to identify the following features of the talocrural joint on a model of the ankle: anterior & posterior talofibular ligaments, calcaneofibular ligament, deltoid ligament, calcaneal (Achilles) ligament.

301. Be able to identify the following structures of the ankle in a cadaver: Achilles tendon, flexor digitorum longus, flexor hallucis longus, fibularis longus & brevis, tibialis anterior & posterior, extensor digitorum longus, extensor hallucis longus, anterior & posterior tibial arteries, posterior tibial vein, tibial nerve.

302. Be able to identify the following normal features of the adult ankle in sagittal and coronal MR images: Achilles tendon, calcaneofibular ligament, deltoid ligament, fibularis (peroneal) longus tendon, flexor digitorum longus tendon, flexor hallucis longus tendon, posterior tibialis longus tendon, talar dome (trochlea of talus).

6.5.3. Clinical Anatomy of the Leg and Ankle

303. List the muscles in the anterior and superficial posterior compartments of the leg and distinguish the actions of anterior and posterior compartment muscles at the ankle. Identify the innervation of these muscles.

304. Define compartment syndrome. Identify the structures at risk of injury in anterior compartment syndrome.

305. Identify the location of the retrocalcaneal bursa.

306. Identify the spinal cord segments assessed by the calcaneal tendon (ankle jerk) reflex.

307. Distinguish the cutaneous domains of the leg supplied by the saphenous, tibial and common fibular nerves.

308. Identify the bones of the hindfoot, midfoot and forefoot. Distinguish the subtalar and tranverse tarsal joints.

309. List the muscles in the deep posterior and lateral compartments of the leg. Identify the actions of deep posterior and lateral compartment muscles at the ankle. Identify the innervation of these muscles.

310. List the muscles of the leg capable of everting and inverting the foot. Identify the structures at risk of injury in hyperinversions of the foot. Identify the injury that typically results from hypereversion of the foot.

311. Identify where in the lower limb the common fibular nerve is particularly susceptible to injury and list the motor and sensory deficits that result.

312. Distinguish the symptoms of common fibular nerve palsy from those of sciatica.

313. Identify where in the lower limb the tibial nerve is susceptible to injury and list the motor and sensory deficits that result.

314. Identify the nerve at risk of injury in a saphenous cutdown.

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315. Define “foot drop” and discuss the role of EMG in diagnosing its etiology.

316. Describe how to diagnose compartment syndrome of the lower extremity after a tibia fracture.

317. Need objectives re: surgical & nonsurgical treatments for common leg/ankle injuries.

6.6. Foot

6.6.1. Anatomy & Imaging of the Foot

318. Be able to identify the following osteological features of the foot in an articulated skeleton (or articulated foot skeleton) and in conventional radiographs: calcaneous, talus, navicular, curboid, medial cuneiform, intermediate cuneiform, lateral cuneiform, metatarsals 1-5, proximal, intermediate & distal phalanges of digits 2-5; proximal and distal phalanx of digit 1; medial and lateral sesamoids in flexor hallucis brevis tendons, metatarsophalangeal (MTP) joints 1-5, proximal and distal interphalangeal (PIP and DIP) joints of digits 2-5, interphalangeal (IP) joint of digit 1.

319. Be able to identify the following structures of the dorsum of the foot in a cadaver: arcuate artery, dorsalis pedis artery, extensor hallucis brevis.

320. Be able to identify the following structures of the sole of the foot in a foot model: medial & lateral plantar arteries, medial & lateral plantar nerves, plantar calcaneoclavicular (spring) ligament, tendon of the tibialis posterior muscle.

321. Be able to identify and correctly label the following injuries of the foot and ankle observable in conventional radiographs: eversion injuries, inversion injuries.

6.6.1. Clinical Anatomy of the Foot

322. List the three arches of the foot. Identify the four structures that passively support the arches of the foot.

323. Identify the three muscles of the leg that provide dynamic support to the arches of the foot. Identify which of these muscles is most commonly involved in acquired flatfoot.

324. Identify the nerve involved in tarsal tunnel syndrome and describe its common symptoms.

325. Describe the significance of the extensor digitorum brevis in diagnosing ankle sprains.

326. Describe the procedure used to elicit the plantar reflex. Describe a positive Babinski sign.

327. Distinguish the cutaneous domains of the foot supplied by the following nerves: saphenous, superficial fibular, deep fibular, tibial.

328. Define hallux valgus and bunions.

329. Identify the pulse points of the lower limb and the arteries involved.

330. Need objectives re: surgical & nonsurgical treatments for common foot injuries.

331. Identify the complications that may result in the foot due to loss of skin sensation. Identify means of their prevention.

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332. Describe how repetitive joint trauma can lead to the development of neuroarthropathic (Charcot’s) joints.

333. Describe the clinical features of collapsed arch and Charcot foot. Describe the physical examination procedures used to diagnose these conditions.

7. Gait

7.1. General Concepts

334. Describe the concept of base of support. Explain the difference between single-limb and double-limb support.

335. Define running and walking.

336. Define and use in proper context the following terms used to describe the gait cycle: step, stride, swing phase, stance phase, cadence.

337. Describe how the gait cycle changes with aging and indicate how these changes interact with other musculoskeletal disorders to increase fall risk in the elderly.

338. Identify the percentage of the gait cycle a single limb is spent in stance phase and in swing phase.

339. Describe the following abnormal gait patterns: circumduction, hip hiking, and vaulting.

340. Define antalgic gait and recognise why it is used.

341. Describe how an ankle foot orthosis (AFO) helps the gait pattern in a patient with foot drop.

7.2. Assistive Devices

342. Describe how the concept of base of support influences the choice of assistive device for ambulation.

343. Explain why a cane is used on the sound side of the body.

344. Identify the factors which must be considered in fitting patients with canes and crutches. Identify the injuries that can result from improper fitting of crutches.

8. Amputation

345. Need objectives on the following topics:

Significance with respect to diabetesBest practice methods?Etc.

8.1 Prostheses

8.1.1. General Concepts

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346. Need additional objectives re: choice of prosthetic and when prosthesis is indicated.

347. Describe the increase in energy required for ambulation with a below knee amputation prosthesis and compare it to above the knee amputation prosthesis.

348. Describe the importance of the need of adequate soft tissue coverage of a lower extremity amputation stump.

9. Impairment and Disability

9.1. General Concepts

349. Define impairment, disability and handicap.

9.2. Psychosocial and Economic Considerations

350. Define the concept of body image and discuss how loss of limbs and function can impact it.

351. Identify the clinical signs and symptoms of depression.

352. Outline questions that can be used in your history taking to help evaluate a patient with a chronic disability for depression.

353. Identify the conditions under which a disabled individual should be referred to a psychologist, neuropychologist or psychiatrist.

354. Discuss the incidence/prevalence of chronic back pain (CBP) and the loss of revenue and jobs due to CBP.

355. List the benefits offered through the Workers’ Compensation system.

356. Describe how the Medicare system applies to patients with chronic disabling conditions.

357. Describe the purpose of Americans with Disabilities Act.

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