COURSE OBJECTIVES
Students will be able to
• identify and explain the nature of abnormalities seen in common musculo- skeletal system diseases in relation to the normal structure and functions;
• outline the principles of therapeutic and behavioural management of patient and families.
• correlate the normal structure and function of musculoskeletal system to the signs, symptoms, pathophysiological states, diagnosis and management of the following conditions: T.B. spine, leprosy, pain knee joint, eczema, flail chest, painful subcutaneous swelling, pain in neck, frozen shoulder, Poliomyelitis, myalgia, tetanus, SLE, Rheumatoid arthritis, myasthenis gravis, osteomyelitis, supra condylar fracture
ANATOMY
Sudents will be able to
• classify bone according to its size, shape, location and development.
• list the characteristics of each of the types;
• define the terms: tuberosity/ tubercle, trochanter, condyle, trochlea, spine/ crest, sulcus/ groove/ fossa/ fovea/ notch
• describe:
• the microscopic anatomy of decalcified bone
• types and composition of cartilage
• functions of cartilage
• describe the development of long bones and process of ossification;
• list the factors involved in growth and ossification; explain the primary and secondary ossification centers; explain the law of ossification.
• classify epiphysis;
• classify muscles according to structure, shape and function;
• describe the light microscopic and ultrastructural features of muscle;
• explain the structural alternations during contraction;
• describe the innervation and blood supply of muscle;
• identify epiphyseal cartilage in bones where ossification is not yet complete;
• describe the structure of a joint;
• classify joints according to structure and movement, give examples of each;
• describe the structure and mechanisms of movement of sternoclavicular joint;
• describe their applied anatomy;
• identify the muscles attached to the scapula, humerus and clavicle;
• relate these muscles to the shoulder joint; movements and the nerves supplying them;
• identify the muscular attachments; mark the radioulnar joints; identify the structures in immediate relation to the bones; list the arteries supplying the bones;
• identify the muscles, related structures, nerves supplying the muscles, capsular attachments, ligaments, reflection of synovial membrane and structures related to the joint in a given specimen of the arm;
• describe the mechanics of movements and the relations of the wrist joint, carpal, carpometacarpal joints;
• identify the attachments of muscles to carpal, metacarpals and phalanges;
• describe the action of the muscles on the metacarphalangeal and interphalangeal joints;
• describe the sequelae to interruption of innervation of the hand;
• describe the fascial spaces in the palm and the surgical approaches to drain pus in infections of the hand;
• describe the mechanics and movements of hip joint;
• describe the surgical approaches to the interior of the hip joint and drainage of fluid from the joint:
• describe diseases in terms of structures that constitute the joint;
• identify the parts of the hip bones and femur in dissected specimens, the structures in immediate relations to them; the structures passing into and from the pelvis, in front and behind the musculature and ligamentous attachments;
• mark capsular attachments of joints in which the bones take part;
• identify the muscles of the gluteal region, the front of the thigh and their attachments, structures related to them and nerves supplying the muscles;
• identify the articular surfaces, capsular attachments, the structures related to the joint, the nerves, and blood vessels supplying the joint;
• describe the mechanics and movements at the knee joint;
• describe the surgical approaches to the interior and drainage of fluid;
• describe diseases in terms of structures that constitute the joint;
• identify the parts of tibia and fibula;
• identify structures in immediate relation to the bones in dissected specimens;
• identify the muscular, ligamentous attachments; capsular attachments of knee joint in which the bones take part; identify the muscles, the structures related to it, the nerves supplying it and the attachments to the bones; correlate with different injuries related to menisci and cruciate ligaments,
• identify the articular surfaces, the capsular attachments, the structures related to the joint, the nerves and vessels supplying the joint, the structures in the interior of the joint;
• describe the mechanics and movements of the ankle and tibiofibular joint;
• describe surgical approaches to the interior of ankle joint;
• describe disease in terms of structures that constitute the joint;
• identify the tarsal, metatarsal and phalanges, their articulations with other bones, their locations and directions;
• identify the attachments of ligaments and muscles to the bones in given specimens;
• identify the muscles, their attachments, nerves and the arteries supplying them, and the structures related to them;
• identify the articular surfaces, the capsular and ligamentous attachments, the structures related to the joint especially the ankle joint, the nerves and vessels supplying the joints;
• describe the architecture of foot and conditions affecting the floor such as flat foot and talipes with reference to anatomical structures involved;
• identify:
• the muscles of the foot, their attachments and the structures associated with them;
• the long tendons coming from the leg in the sole and the dorsum; the ligaments, their attachments;
• identify the arches of the foot and the structures that maintain the arches;
• describe the muscles of facial expression their innervations and the sequelae to interruption of nerve supply;
• identify;
• the bones in the anterior, superior, lateral and posterior aspects of the skull and in the walls of the orbit;
• the foramina and the articulations of the bones of the skull;
• the muscular, capsular and ligamentous attachments to the bones;
• nerves and vessels in immediate relation to the mandible; identify cranial fossae and the fissures that originate from them;
• identify;
• the muscles of facial expression;
• the structures related to them especially in the region of the angle of the eye;
• the structures in the region of the cheek;
• the nerves supplying the muscles;
• the origin of these nerves from the trunk of the facial nerve in the given specimen;
• describe the structure mechanics and movements of the temporomandibular joint;
• muscles of mastication;
• sequelae to interruption of their nerve supply;
• applied anatomy of dislocation of the joint;
• describe the nerve supply and action of individual and group of muscles of the eyeball;
• relate applied anatomy to abnormality in movement of the eyeball;
• identify the muscles of the eyeball in given specimen;
• describe the structure, mechanics and movements of the occipital and atlantoxial joints;
• describe different parts of the vertebral column;
• identify the parts of cervical, thoracic, lumbar and sacral vertebrae;
• describe the gross arrangement of the musculature of the back in relation to the vertebral column as a whole;
• describe the arrangement of intervetebral joints, with mechanism of movement, nerve and vascular supply; explain in brief the development of vertebral column,
• describe the mechanics of and movements at the joints of the pelvic girdle;
• describe the applied anatomy of the structure and relations of the sacroiliac joint;
• identify bones of pelvic girdle, their articulation, muscles and the ligaments attached to them, the viscera and nerves and vessels related to them,
• identify;
• the muscles of the abdominal wall;
• the rectus sheath and its contents;
• the boundaries and contents of the inguinal canal;
• the muscles of the pelvic floor and perineum, and
• posterior abdominal wall.
• describe the mechanism of action of muscles of the abdominal wall;
• describe their role in control of intra-abdominal pressure;
• describe the applied anatomy involved in abdominal hernia;
CLINICAL PHYSIOLOGY
Function & Structure of Muscle
Students will be able to
• classify and describe general functions of muscle.
• describe the organization of muscle into fibers and fibrils.
• draw a diagram showing the sarcomere in detail; compare and contrast the organization and properties of skeletal muscle, smooth muscle, and cardiac muscle
Neuromuscular Transmission:
Students will be able to
• describe the structure of a neuromuscular junction.
• enumerate the properties and describe the sequence of events occurring at the
• N-M junction.
• describe the different neuromuscular blockers: classification, mechanism of action, clinical importance.
Molecular Basis of Muscle Contraction and Relaxation:
Students should be able to
• describe excitation- contraction coupling in a skeletal muscle.
• describe the sliding filament theory: cross-bridge formation between actin and myosin, role of ATP and Calcium- ions, power stroke.
• differentiate isotonic and isometric contraction.
Factors Influencing the Force of Contraction in a skeletal muscle:
Students will be able to
• describe the types of muscle: slow/oxidative/red and fast/glycolytic/white muscle.
• describe the effect of frequency of stimulation.
• describe motor unit recruitment (quantal summation) and fatigue.
Energy Requirements for Muscle Contraction:
Students will be able to
• differentiate between aerobic and anaerobic contraction.
• show the role of ATP and phosphorylcreatine.
Applied Physiology of Skeletal Muscle:
Students will be able to
• define muscle tone, atrophy and hypertrophy.
• describe the effect of denervation: fibrillation and fasciculation.
• describe the effect of exercise and training.
• describe the clinical application of neuro-muscular blockers, myasthenia gravis.
• describe the principles of EMG and its clinical application.
CLINICAL BIOCHEMISTRY
Students will be able to
• recall the structure of skeletal muscle.
• list the names of contractile proteins.
• explain the molecular basis of muscle contraction.
• list the fuels of skeletal muscle.
• describe the functions of purine nucleotide cycle of skeletal muscle.
• explain effect of training exercise on skeletal muscle metabolism.
• explain:
• effect of low serum potassium
• Duchene’s muscular dystrophy
• Luft’s syndrome (poor respiratory control)
• deficiency of carnitine palmityl transferse
• list the distribution of calcium and phosphrous in body and dietary sources.
• describe the absorption and excretion of calcium and phosphrous.
• list biological roles of calcium (neuromuscular, blood coagulation, membrane, enzyme regulation, release of hormone).
• explain the role of Vitamin D in calcium homeostasis.
• list the sites and mode of action of Vitamin D.
• describe the source, site and mode of action of calcitonin.
• explain the control of secretion of calcitonin.
• describe the source and physiological functions and control of parathormone (PTH).
• list the diseases associated with hyper and hypocalcaemia and hypo and hyperphosphataemia.
PATHOLOGY
Students will be able to
• describe healing process of wounds and fractures.
• apply the principle of inflammation to the musculo-skeletal system.
• describe the etiopathogenesis, pathological features and complications of pyogenic and tuberculous osteomyelitis.
• describe the causes and morphological features of osteoporosis.
• describe the etiopathogenesis, pathological features and complications of Paget’s disease (osteitis deformans).
• Describe the bone disorders due to vitamin D deficiency and hyperparathyroidism.
• list the tumors and tumor-like lesions of bone.
• describe pathological features of osteoma, osteosarcoma, osteochondroma, chondroma, chondrosarcoma, giant cell tumors and Ewing’s sarcoma.
• Describe the etiopathogenesis and pathological features of osteoarthritis, rheumatoid arthritis and infectious arthritis (tuberculous arthritis).
• explain the etiopathogenesis, pathological features and complications of gout and gouty arthritis.
• classify soft tissue tumors.
• describe the pathological features of rhabdomyosarcoma, leiomyosarcoma,. nodular fasciitis, fibrosarcoma, lipoma, liposarcoma, and fibro-histiocytic tumors.
• Describe the pathological features of dermatitis, psoriasis, lichen planus, pemphigus and lupus erythematosus.
• describe etiopathogenesis and pathological features of leprosy.
• list the tumors of skin.
• describe the gross and microscopic features of naevus, basal cell carcinoma, squamous cell carcinoma, and malignant melanoma of skin.
• describe different types of muscular dystrophies.
CLINICAL MICROBIOLOGY
Students will be able to
• list and describe the important pathogens affecting the Musculoskeletal system;
• describe the morphology, pathogenesis, laboratory diagnosis, transmission & prevention of the following organisms:
Bacteria:
1. Staphylococcus
2. Actinomyces
3. Mycobacterium leprae
4. Anaerobes with special reference to CI. perfringens
Viruses
1. Herpes virus
2. Oncogenic virus
Fungi:
1. Trichophyton
2. Microsporum
3. Epidermophyton
Parasite:
1. Toxoplasma gondi
CLINICAL PHARMACOLOGY
Skeletal muscle relaxants
Students will be able to
• classify muscle relaxants.
• describe the mechanism of action, therapeutic indications and adverse reactions of these drugs.
• define the therapeutic role of neuromuscular blocking agents as adjuncts to anaesthesia.
• name the drugs and describe their mechanism of action in the treatment of myasthenia gravis.
Drugs used in arthritis and soft tissue swellings
Students will be able to
• list drugs used to treat inflammatory disorder.
• describe their mechanism of action and adverse reactions and contraindications.
Drugs used in common skin diseases
Students will be able to
• describe the present concept of types of histamine receptors.
• discuss the responses of histamine that are antagonized by H1 receptor antagonists.
• list antihistamines based on their sedative properties.
• give the therapeutic indications of H1 antagonists and their adverse reactions.
• list antifungal agents.
• Describe their mechanism of action, therapeutic indications and adverse reactions.
• list the drugs used in the treatment based on types of leprosy.
• explain the concept of multi drug therapy (MDT) in the treatment of leprosy.
• describe their mechanism of action and adverse reactions.
• describe different local anti-infective agents.
• uses of drugs for scabies, pediculosis, psoriasis, acne and vitiligo
