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Capsule capsule and then um on the bone itself, there's hyaline cartilage at the articulation. And uh the articular cavity is filled with synovial f fluid that helps for um friction, shock absorption. It's very important. So it's a very loud plane passing by. I don't know if you guys can hear it but sorry. Um So there are different types of movements that we can do throughout the body. There's flexion which is narrowing the angle between um two parts and then there's extension which is extending um increasing the angle between two parts, there's pronation which is um having the palmar side down and then there's supination which is having the palmar side up. Um So the way I was thought to remember it is you like you're holding a bowl of soup that's your supination. And then there's abduction which is essentially to take away. So I remember like aliens abduct like abducting you. It's like they're taking you away and then there's abduction which is adding. So bringing back close to the body and then inversion, this happens at the subtalar joint in at the ankle. So this is essentially if your feet are like this it's bringing the soles of your feet together and an E version, it's bringing the soles of your feet away from each other. So we're gonna move on to the back. Um So we'll start with the vertebral column. So, um there are seven for cervical vertebrae. So that's your, essentially your neck vertebrae, 12 thoracic vertebrae and then five lumbar vertebrae. After that, there are five fused sacral vertebrae and 3 to 4 fused coccygeal vertebrae. Um The number for your coccygeal vertebrae depending on the literature that you read will change. Um but it's usually 3 to 4. Um the way to remember like the um cervical thoracic and lumbar vertebras is you wake up at seven, you eat lunch at 12 and you go home at five. So 7, 12, 5, um some curvatures of the spine include kyphosis, lordosis and scoliosis. So the spine as we know is not just completely straight, there is some natural curvature to the spine. So, kyphosis is an um anteriorly concave curvature of the spine. This is a primary curvature because as we are developing as a fetus, we naturally have that it's just one big on anteriorly concave um curvature. And this is known as kyphosis. And um it may um as we grow up, it's maintained in the thoracic sacral and coccygeal regions. Um and but this can also be pathological. Um for example, in senile kyphosis. Um as we get older, sometimes you might notice like some older people have like have a hunch in their back and that's known as senile kyphosis. Um And then there's lower doses and this is concave posteriorly. This is a secondary curvature because this is a curvature. We actually develop as we grow up. So it develops in the cervical region as we start lifting our heads. So as baby, when we're doing that tummy time, we start lifting our heads and that's when we start developing that um lordosis in our spines. And then we also develop it in our lumbar region when we start walk walking. Um and it helps stabilize us. This can also be pathological, for example, in states of extreme obesity or even in pregnancy. Um there is that um curvature can be exaggerated and this can lead to pain and problems. There's also scoliosis which is lateral curvature of the spine. Again, our spine isn't completely straight, but sometimes it could be exaggerated. And um these curvatures can also be um one pathological can also be combined, for example, a kyphoscoliosis. Um and this can have other issues, for example, like decreasing um lung volume. And so you can't breathe as well. So the structures of the vertebral vertebral column, sorry. So um it's essentially the vertebrae is split into two sections. So there's the vertebral body, um which is the round bit, um which is essentially the solu bit and then there's the vertebral arch and that has all the poky bits and then there is the vertebral foramen. Um So in the vertebral arch, you have your two transverse processes and then you have your articular processes um for articulation with the vertebrae above and below. And then when they do articulate, that forms your zygapophyseal joints, and then at the back, you have your spinus process, which um you can actually feel your c seven spinus process. That's your biggest one. You can actually feel that one at the back of your neck. So cervical nerves come out below the vertebrae except for the cervical spine where because in the cervical spine, there are eight, they come out above, except the eighth one comes out below C seven. Um The body gets larger as you go down because it's weight bearing. So the larger the body, the more weight you can bear, um you transmit that weight downwards and foreman the foramina gets smaller. So the way I remember it is big triangle, small circle, small triangle. So your cervical vertebrae will have a big triangle, your thoracic vertebrae will have a small circle and then your lumbar vertebrae will have a small triangle. So there's also intervertebral discs, discs, sorry, they make up 25% of the length of the vertebral column and these are between each vertebrae. Um And in the center of this vertebra disc is the nucleus pulposus. Um This has a lot, a lot of water. Um and it does shrink as you get older also throughout the day, it naturally gets, I mean, it naturally shrinks. So you'll notice that you're taller in the morning than you are at night just due to gravity, but just slightly. And then around that there's the annulus fibrosis, um which is aneural and avascular. This is all for sh sh sorry shock absorption and this is actually stronger than the actual vertebral body, which I find it is a very cool fact. And then there are some ligaments. So there's the anterior longitudinal ligament which prevents um too much hyperextension. And then there's the posterior longitudinal ligament which prevents too much flexion. And then there's the ligamentum Flaum, which we see is the yellow one in the image at the bottom. There's the supraspinous ligament, which is the blue one and then there's the interspinous ligament intermating between which is the red one. So these are the different vertebrae. So um the cervical vertebrae being the first one, the thoracic vertebrae being in the middle and the lumbar. So as you can see, it goes like big triangle, small circle, small triangle for the frain. There are a few exceptions to um the rules described for the vertebrae that I stated earlier. Um The cervical vertebrae, for example, they have a transverse foramen in the transverse processes. Um and these carry vertebral arteries and veins up to the brain. Um You'll probably learn more about this and you'll in kind of neck and neck here. Um And then there's C one which is an abnormal cervical vertebrae. C one is known as the Atlas and this one superiorly articulates with the skull and inferior articulates with C two. It doesn't have a body or a spines process and at the bottom to articulate with C two, C two has a dense that fits into C one for the articulation of the skull. Um It helps you go. Yes, it helps you to nod your head. Yes. So we remember that. Yes, comes before. No, because C one does. Yes and C two does. No. Um When you fracture your C one, this is known as a Jefferson's fracture. And because C one is a ring shape, it actually will tend to fracture in two separate parts. Um And then C two, this one is known as the Atlas and this one has a dens which is essentially a little, it just sticks up and it articulates into C one. And when you get a posterior fracture of your C two, this is known as a hangman's fracture. And then there's C seven. This one doesn't have a fancy name, but um it's spinus process does and it's called the vertebral prominence. So you can actually feel that on the back of your neck. And then uh thoracic vertebrae also have facets um for ribs to articulate with the, with the vertebrae. So, um you can actually get a prolapsed disc. So this tends to happen at L4 L5 or L5 S one and it tends to be posterolaterally. Um so it to the back but also to the side. Um And if it's directly posteriorly, this is a neurosurgical emergency. So the stages to um this include degeneration, prolapse, extrusion and sequestration. Um I know they taught us like a bunch of definitions, like what go like what each mean, but I feel like if you like remember the steps that's good. Um And then uh they, these affect the traversing nerve, not the exiting nerve because the exiting nerve exits above. And so it's the nerve that continues, that will have an impingement by the um disc. And then you can also get something called caudo quina syndrome. Um And this is a massive posterior disc herniation um at the caudal quina. So this um spinal cord ends at L1. And after that, we have the caudal equina. So if you have a herniation there, um you can get different symptoms, for example, fecal and urinary incontinence, um C anesthesia. So essentially on your groin area, um you'll get a loss of sexual sensation and function, you can get some back pain. And this one is a neurosurgical emergency, some red flag symptoms for back pain. So, we have the Mnemonic tuna fish. So that's trauma, unexplained weight loss, neurological symptoms, age above 50 fever, intravenous drug use, steroid use and a history of cancer. So, um to do a lumbar puncture. This is usually done at the level of L3 L4 or L4 L5. It tends to be done a little lower in Children. But the layers that um you go to go through for lumbar puncture include the skin, subcutaneous tissue, supraspinous ligament, intraspinous ligament, ligamentum, flavum, epidural fatten vein, the dura mater, arachnoid mater and subarachnoid space. So I like to remember it. I made a little mic and it's some saints say I love everyone. Days are short. So spread that love. Um And so there are three muscle groups of the back. Um So, starting off with the superficial group of the back, this is an extrinsic group which means it originates outside of the back and inserts into the back. This is innervated by the anterior ramus and um it connects the upper limb to the trunk. Other muscles included are the trapezius, the lap latissimus, dorsi, the rhomboid minor and major and the levator scapulae. Um After that, there's the intermediate group of the back. This is also an extrinsic group um which means it also it is um originates outside of the back and it is also innervated by the anterior ramus. Um And this one contributes to respiratory movements. So there's the serratus posterior, inferior and superior in the script and then the deep muscles of the back um is intrinsic muscles. So they originate and um insert in the back and this one is innervated by the posterior ramus. So the way I remember it is like essentially going deep. So the deeper you go in your body, the further back you go in their body. So that's how I remember like posterior ramus. Um and um these help maintain posture and control the movements of the bra column. So these are subdivided into three, like three subdivisions and then further subdivided into their own subdivisions. Um So there's the superficial deep, which are your splene muscles. So your splene cervius and capitis, um your splene cervius um joins the vertebra, the vertebrae to the neck and then the C Cervi splenius capitis um join the head to the neck and, and neck to the spine. And then there's the intermediate um deep which are your e electrospin muscles, which include your iliocostalis longissimus or spinalis. Honestly, I just remembered lateral, intermediate and medial. I didn't actually remember the names. Um And then there's your deep deep which are your transversal transversal spinal muscles which include your semi spinalis multiplus and your rotators. I personally just remember like your Splenius electrospin a transversospinal um onto the upper limb. So it's made up of the shoulder, shoulder, girdle, the arm, the forearm and the hand. Um I feel like it's important to um state that we tend to call all of this the arm. But in reality, this is the arm and this is the forearm. So it's important to distinguish that. So there are a few regions of transition in the upper limb. So this includes the ax axilla, the cubital fossa and the carpal tunnel. Um So um the axilla, the borders of the axilla, the posterior um so the post fold of the axilla um is made up by the lama latissimus dorsi and the teres major and the anterior fold of the axilla is made by the pec major and minor. So you can actually feel those folds, like if you like lift your arm, you can like feel like a little like line kind of thing. And those are those folds. And then the boundaries, the anterior boundary is the peck major and minor, posterior is the latissimus dorsi, the subscapularis and teres major, the medial is a serra anterior and the thoracic wall and the lateral is the intertubercular sulcus. And when you actually like, think about it like this makes sense. Um So it's like, even if you can't remember it just like be like, OK. So like what's there if I'm actually looking at my body kind of thing? And then there is the cubital fossa also known as the antecubital fossa. Um The boundaries to this. Um So laterally is the brachial radialis medially is the pronator caries. Um And super superiorly, you draw an imaginary line between the two humeral epicondyles and this one is in the shape of a triangle. Um So the contents include the median nerve, the bifurcation of the brachial artery, the tendon of the bicep muscle and the radial nerve. Um So the way I remember, remember this is M BTR. So median bifurcation, tendon and radial. Um And then there's a carpal tunnel, sorry, those should be tabbed in. But um it attaches to the pisciform. It's, this is at the wrist, it attaches to the pisciform, the hook of the hamate, the scaphoid and the trapezium tubercle. Um And the roof is made by the flexor retinaculum. And this contains the flexor digitorum superficialis and profundus. Um And the, the flexor pollicis longus and the median nerve. This is important for carpal tunnel syndrome which we'll um we'll go into in on another day. So the pectoral girdle. Um So this includes the su superficial muscles of the back. Um So the let Miss Dorsey, the rhomboids, um the labsa and I'm missing one, but if you go earlier, you will see it. Um It includes the teres major, um the deltoid, the ser serratus anterior. Um the cerebri anterior is actually innervated by the long thoracic nerve. And this can cause winging of the scapula, which is essentially your scapula goes out if that nerve is damaged. This is important to remember. And it also includes the pectoralis minor and major. So the clavicle um so typically the middle third is the most oftentimes fractured. Um and then the medial third is the least common fracture. This is because the junction between the lateral and middle third is the weakest. So you'll usually get a fracture between like that junction and it's important to be able to distinguish um between a clavicular fracture and an ac joint. Um dislocation because they do look similar. Um You will notice that in, in the clavicle it's pulled up because the sternal cleidomastoid muscle pulls that up. Um So he has the elevation and it doesn't go as far out as the ac um the chromar sorry joint dislocation. So, um the shoulder, so there's a few um uh things on the shoulder that you wanna be able to identify. So there's the acromion acromion. So that's where the um the scapula comes forwards, essentially uh the coracoid process which you can actually sometimes feel down here. There's the greater tubercle and the lesser tubercle, the greater tubercle is lateral and the lesser tubercle is medial. Um And then between that, there's the inter intertubercular groove or sulcus. Um And then on the back of the scapula, there's the supraspinous fossa, the spine of the scapula and then the intra infraspinous fossa. Um and then there's the inferior angle, the lateral border and the medial border. And then you can also see where the chromia starts on the back and then um ends up anteriorly. Um There are multiple movements you can do at the shoulder which include flexion extension, a abduction, abduction, medial and lateral rotation. And we see the muscles that um are responsible for those actions. Um knowing the degrees for abduction of what muscle does, what is important um for uh the painful Arc syndrome. Um and just knowing that uh like the different muscles are included in um abduction of the shoulder at different points. So the 1st 15 degrees are by your supraspinous um muscle and then 15 to 9 degrees, they're by your deltoid. And then above that, you get other muscles helping out um which include the s anterior and the trapezius. And you have to rotate the scapulas to be able to do that fully. So the glenohumeral joint also known as shoulder joints. This is a highly mobile but unstable joints. So you'll notice the more mobile a joint tends to be the less stable it will be. Um and this is made by the head of the humerus and the glen glenoid cavity, sorry of the scapula. Um And it's deepened by the glenoid labrum to add some um stability. Um because it is a very shallow um joint. Um It's important to know why it's unstable. So knowing that it is a shallow joint, um and that the head of the humerus doesn't fit perfectly into the glenoid cavity is important. Um However, there are some ligaments that help uh stabilize this joint as well. So there is the coracoacromial ligament um which is the most important ligament. So that's go that goes between the coracoid process and the acromion. And then there's the coracohumeral ligament which goes between the coracoid process and the humerus, there's the coracoclavicular which goes um from the coracoid process to the clavicle. Um And then there's the transverse humeral ligament um which goes across essentially on the humerus. Um And then there are some intrascapular ligaments. Um So there is the superior, middle and inferior glenohumeral ligaments and in the coracoacromial arch, um this is important to know. Um this is made of the coracoacromial ligament, the coracoid process and the chrom um and this is important because it helps prevent upper displacement of the shoulder. Um And so, as I mentioned earlier, there are syndrome. And so this is when you get pain between 60 100 and 20 degrees of shoulder abduction due to rubbing of the supraspinous ligaments under the cortico aromia arch. Um And if you were to get a dislocation of the shoulder, this tends to be um anterior inferior because that's where there's the least amount of support for the shoulder. Um a posterior dislocation is possible but it's very rare that has to be an extremely high impact um accident. Um So it's pretty rare and when you get that anterior inferior dislocation of the shoulder, um on an x-ray, you'll be able to see that the head of the hum the head of the humerus will actually lie under the correo process. Um So the rotator cuff muscles include the supraspinous, the infraspinous teres minor and the subscapularis. Um So the supraspinous is um supplied by the subscapular nerve and it's involved in the 1st 15 to 20 degrees of shoulder abduction. There's the infraspinous um which is also provided by the sub suprascapular nerve, sorry. Um And this is lateral um arm rotation. The teres minor um is provided by the axillary nerve and this is lateral shoulder rotation as well. And then the subscapularis um is provided by the upper and lower subscapular nerve. Um and this is for medial shoulder rotation, so lateral and medial shoulder rotation. Um So the humerus. So on the humerus, like I mentioned earlier, there's um those uh greater and lesser cubicles with the intertubercular groove. And then it's important to know the um ana um anatomical neck versus the surgical neck of the um humerus. So, on that picture at the bottom and I feel like it's very well demarcated. So that top top one is the anatomical neck and the bottom one is the surgical neck and um the surgical neck as a surgical neck fracture is very important because it can result in axillary axillary nerve damage. And with this one, you'll get a loss of sensation in your regimental badge area. So if you think of a uniform, the badge goes right here. So you lose sensation right here. Um you can also get a loss of motor function, but this will typically be too painful to test. So you don't actually test that one. And um there uh it uh in um articulates inferiorly with the radius and the ulna, which is your forearm bones and superiorly with the glenoid, as mentioned earlier. So there's a annular ligament between the radius and the ulna at the top. And then um laterally, you have your radial collateral ligament and then medially you have your ulnar collateral ligaments and then there are also your medial and lateral epicondyles. These are important for epicondylitis, um golfers and tennis elbow. Um But we will go into that end of the day at the back. There is your electron process. Um It's not actually technically part of the humerus, it's technically part of the ulna, but there is a, a groove, I guess for um your ocal process from your ulna onto your humerus. Um and there's a bursa there. And so when that gets inflamed, um it's often um eron non bursitis, it's oftentimes called medical student's elbow because we're oftentimes studying and we're on our elbows and then that pressure um can irritate it and cause it to be inflamed. There's also a subtendinous bursa which between the tricep tenon and the look that can also get inflamed. Um If you look at the picture at the bottom, right, you'll see um that on the bottom of the humerus, there are the two epicondyles and then there is the capitulum and then there's the troch trochlea, sorry. Um, the trochlea, um articulates with the ulna media medially and the capitulum articulates with the radius laterally. There's also the supracondylar ridge. Um And yeah, so who can name if you guys wanna put in the chart? I won't be able to see the chat, but maybe Joie can read it out for me. Um What muscles are responsible for those movements of at the elbow and which nerves are um innervate those muscles. There was a bit of, of a hint of the one on that one. But yeah, if we've got uh for flexion, the triceps muscles, perfect flexion. You said tricep, yeah, triceps muscles. And see what else musculocutaneous and biceps. Is that also for flexion as well? Yes. Also for flexion. Ok. Yeah, great try. Um So flexion because it's decreasing the angle and a muscle only contracts um like it can relax, but like the action of a muscle is to contract. So it to shorten. So it would actually be anteriorly. So for um for flexion, you have your bicep, brachial muscle, your brachialis and your brachial radialis. Um So most of it is innervated by the musculocutaneous nerve as someone said, great job. But the brachial radialis is actually innervated by the radial nerve and we'll go more into this later um because it breaks the rules a little bit. Um and extension is actually the tricep muscle. So when you contract that tricep, it extends the arm and then when you pronate um these ones that finally, they made something easy for us, it's your pronators. So your pronator, teres and your pronator chords. Um This is innervated by the median nerve and then when you s supinate, um this is by your bicep brachii and your supinator and this is um your bicep brachii is innervated by the musculocutaneous nerve and the supinator by the radial nerve. Um So, which is stronger pronation or supination and why you got supination, any justification for supination c supination because of the brachialis muscle being more proximal? Ok. Yeah, great job. So you're absolutely correct. It is supination. Um But it's stronger because of the bicep break eye because if you think about it, your bicep brachii is a nice big strong muscle, especially when you go to the gym. Um And um your pronators are smaller muscles, um much smaller muscles actually. So you have a nice big muscle that's helping you supinate. So um that bicep, so supination is um stronger than pronation, good job. Um So, uh uh there are compartments of the arm and these are excuse me, um enclosed in a deep facial sheath. Um And so there's the anterior and the posterior compartment. So upper limb is two, lower limb will be three. And so the anterior compartment tends to be for flexion and pronation. Um Oh, I'm sorry, I might have gotten that backwards. Um And the exterior, the posterior compartment is for extension of the arm. Um So I think that's just the flexion and super, but we'll move on. Um Yeah. So, uh the anterior um has the bicep brachii, the coracobrachialis and the brachialis muscle and is innervated by the brachial artery and the musculocutaneous nerve. And then posteriorly um we have the tricep rachi and the anconeus excuse me. Um And this is um uh um the blood supply to, this is the profunda brachii. Um and the ulnar collateral arteries and the innervation for the entire um posterior compartment is a radial nerve. So a few good reflexes to remember um the tricep um reflex is um integrated by C seven C eight. The brachial radialis is by C five C six and the bicep tendon is C five C six. So there's a little saying you can say which is like C five C six, pick up sticks, C seven C eight, push the gate. Um Just to remember which one is which. So the blood supply to the arm. So, as you can see, there's your profunda um brachial arteries um and your um that goes on the arm at the back. Um So that is why it supplies the posterior. Um And then at the top, uh you can see there's uh the um well at the front, you can see the brachial artery. Um and then there's actually the circum circumflex artery that goes around the head of the humerus. Um So this goes from the subclavian to the end to the brachial artery. Um And then at the bottom um in that antecubial fossa, like we mentioned, we have the bifurcation of the brachial artery. And so that bifurcates into the radial artery laterally and the ulnar lateral um ulnar artery medially. Um So there are also lymph nodes in the um axilla um and in the upper limb. So, the drainage goes from humeral um subscapular and the pectoral. And those drain into the apical apical um lymph nodes and that drains into the sub supraclavicular lymph nodes. Um and you can get lymphedema in the upper limb after surgical removal of cancerous lymph nodes. Because now that lymph node has a really hard time draining and you get um an accumulation of lymphatic fluid in your limbs. Um This will usually be, for example, like with breast cancer, um they can do um a removal and then you can get some lymphedema post that surgery. So if you look at the image on the bottom, on the right hand side, you can see she has one arm that's normal and then one arm that's really, really swollen. Um And that's just because there's an accumulation of lymphatic fluid in that arm. So the brachial plexus, I know how much we love this one. So it goes from C five to T one, it innervates um pretty much the entire upper limb. Um So the musculocutaneous, the um branches at the end which is your endpoint um is innervated by C five to C seven. The median from C five to T one axillary from C five to C six radial, from C five to T one and um ulnar from C eight to T one. So you start off at the roots and you work your way to the branches. So those roots trust divisions, ch branches and the way to remember that is red toucans don't come back. Um And then we also have dermatomes uh that are innervated by um the nerves, Obviously, these nerves of the brachial plexus and a dermatome is an area of the skin supplied by a cutaneous branch of a single spinal nerve. Um and a few that you want to know how to test, where to test would be for your um axillary nerve. It's over here, that's your C five and that's essentially on your regimental badge area. And then for your um median nerve, it's um at the tip of your index and then your ulnar nerve is at the tip of your pinky. And then in that first dorsal web space will be for your radial nerve. Um So you test back here. Um So there are a few injuries I can get to the brachial plexus. There's Er's palsy and clumpy, palsy. So, Er's palsy is an axillary nerve, um palsy um due to an excessive angle between the neck and the shoulder. So like this, um and this can be during delivery, they can they push the head of the baby as it's being delivered onto the side. Um, and they get this waiter tips appearance. So it, the arm is media rotated, the shoulder is abducted. Um, the elbow is at the, um extended and there's flexion at the wrist. So that top picture, um, that is your waiter's tip appearance and then you have your clumpy palsy, which is um, an ulnar nerve palsy. Um, and this is from upper traction of the upper limb, for example. Um, they, sometimes they, they, if they pull the arm of the baby during the delivery, um and because it's an ulnar nerve palsy, they'll get that claw hand. Um also compression of C eight and T one can cause um this palsy. Um yeah. And so they get this claw hand deformity and it usually affects the short muscles of the hand. So onto the forearm. Um There are um two bones in the forearm. There is your radius laterally and your ulna immediately and there is an interosseous membrane between the two and inferiorly. Um They um articulate the radius with the scaphoid lunate with the tube. Um and the trichopi with the ulna. Um and actually between the ulna and the arti bone, the carpal bones, they articulate with, there's an articular disc. This is important to remember especially during x-rays because it might look, there's a space between and there's um you can't see the disc because there's no calcium in it. And so it might look like a break or a fracture but it's normal. It's just the articular disc that's between the two and these bones essentially also join a ring shape, um form a ring shape. So if one side breaks the other side is also likely to break. Um So for the forearm, it's also divided into anterior and posterior compart compartments. Um again, that shouldn't say supination. But um um it's mostly innervated by the median nerve, but also the ulnar nerve and this is divided into three layers. So the first layer, I'm sure you learned like this trick. So there's the pronator teres, flexor, carpi, radialis, palmaris, longus, and flexor carpi, ulnaris. Um And they're all innervated by the median nerve except for the flexor carpi ulnaris. And then in the second layer, there's the um flexor digitorum superficialis. So then that one goes um right by the pip, right after the pip, the proximal endale joint. And then in the third layer, there's the flexor poly longus, flexor digit to profundus. So that um goes right after the distal interphalangeal joint, allowing the tip of your finger to bend. Um And then there's the pronator quadratus. Um So I like to over like three with three. Yeah, and everything in is innervated by the mean nerve other than the flexor digitorum profundus. Um in the ex um the posterior compartment, you'd think it'd be a little easier because there's two layers, but there are so many more muscles, in my opinion. Uh So this I got it backwards again. It's extension pronation, um and thumb abduction. So taking it away um and it's innervated by the radial nerve. So the first layer layer has the anconeus extensor digitorum extensor di digiti minimi for your pinky um extensor carp naris and then your extensor carpi, radialis longus and brevis. Um I like that. There's repetition in this one. So there's like your two radialis extensors and then there's your ulnaris. So out of all of those, you only need to like you remember, like there's two radialis, one ulnaris. So that's already three taken out that you have to remember and the way I remember it is murder, but like with an A instead of a instead of ae and then in your second layer, you have your supinator, um your extensor, pollicis Longus and Brevis. I might be a little confused. Um And then your extensor indices and your abductor pollicis Longus. Um So something I realize is when there's your pinky, there's no thumb and when there's a thumb there's no pinky um in your layers. So for example, like you'll have your exons or di digiti mini me and then on the other side, like in another layer, you'll have your thumb. Um And so, as we mentioned earlier, there's the brachial radialis. Um So there's like the br times five. So this is the, the brachial radialis is a beer raising muscle. It breaks rules, it's a flexor, but radial nerve innervates it um uh it's behind the radial nerve behind radial nerve and the cubital fossa and it attach to the bottom of the radius. Um So the foreign nerves, so you have your ulnar nerve and um that's mostly most medial, your median nerve that is kind of central, still medial. Um and then your radial nerve that's lateral um and dermatomes, as we mentioned earlier. Um There's your C five, C eight, C seven and C seven that you can test on your hands. So those are your dermatomes and onto the hands. Um It's made of phalanges, which is your fingertips. Um your metacarpals which is in the middle of your hands and then your carpal bones which are in your wrist. Um So in the bottom layer, there's your scaphoid lunate trichy and your pisciform. And then above that, there's your Trapezius, trapezoid, trapezoid, um Capitate and Hamate the way I remember it is she likes to play, try to catch her. Um So yeah, and then there's your anatomical snuff box and that the borders of that are made by the extensor Pulis Longus medially and the extensor pulse is brevis and abductor Pulis Longus laterally. Um So, if you bring your thumb backwards, you can, you put your hand right here, you can actually feel like a little dip. Um And you can actually feel your scaphoid in here. So when there's pain in here, um and they've like falling on outstretched hand. That's what push stands for. Um That can indicate a scaphoid fracture and the cutaneous innervation um of the hand. So m um the median nerve is the lateral 3.5 and then 1.5, a medial is the ulnar nerve and then at the back, you have some radial nerve innervation. Um So um who can name the contents of the extensor compartment of the hand wrist. Sorry, this is a tough one. I know uh give it a couple more seconds. Oh, but the ulnar compartment has extensor digiti minimi and extensor carpi ulnaris. Ok. So I guess like five and six we're talking about I Yeah, I, yeah, I think so. And then yeah, perfect. So yeah, so the first one is your um extensor pulses, brevis and your abductor pulsus longus. Um And then your second one, you have your two radialis. So your extensor carpi radialis, longus and Brevis. And then in your third com compartment, you have your extensor pulsus Longus. Um In your fourth, you have your extensor digitorum and extensor indices, which is for your index. Um And then in the fifth, you have your extensor digit me as mentioned. Um and in the sixth, there's your extensor carpi ulnaris. So the way I remember it, it's like I feel like I used to have like a hard time starting it off and then when you start it off, you can keep going. So for your first one, it's like apple. So when you hold an apple, um so you start off with your apple, your actor abductor, Paul is Longus and your exons or Paul is Brevis. And then you know, you have to have your radialis because you're still pretty laterally and there's two in there. Um And then I would go to the other ulnar side now cause then you have your ulnar extensor and then beside that you have your pinky and then I go back to three. And then because you had your extensor pois brevis, now you have your extensor pois longus and then you finish off with four with your fingers and your index. That's just the way I remember it. But yeah, I just remember apple. Um So there are the intrinsic muscles of the hand which means that these originate in the hands. Um They are mostly innervated by the ulnar nerve. Um And just a couple are innervated. Just a few are innervated by the median nerve. So the palmaris brevis, the inner ostii muscles between the bones, um A adductor polycysts. Um the hypothenar muscles and the medial two lumbrical are innervated by the ulnar nerve. So the inner os inner ossi muscles, we wanna remember pad and dab so posterior ab duct, aba D duct and then um dors dors, sorry, I yeah, dorsal abduct A B duct. So, posterior abdu abduct and anterior and dorsal abduct. Um and then your lumbrical, they um flex at the metacarpophalangeal joints and they extend at the pip and at the dip and then there's um just a few innervated by your median nerve. So your lateral two lumbrical um that again, do this movement and then your thenar muscles onto the lower limb. Um It's made of the pelvis, the thigh, the leg and the foot. So again, just like the upper limb, how this is the arm and this is the forearm. In the lower limb, we have the thigh and then at the bottom we have the leg. Um So there are a few areas of transition. Um So there's the femoral triangle, the popliteal fossa and the tarsal tunnel. So the border, the boundaries of the femoral triangle include the sartorius laterally, the abductor, longus medially and the inguinal ligament superiorly. So this forms a triangle. Um The contents include the femoral nerve artery vein and lymph nodes. So I remember this by naval um and it in um it opens into the popliteal fossa and it is conduct um continuous with the adductor canal. Um and then there's the pelvic seal fossa. And the boundaries include the, this one is more of a diamond shape. Um So it is the semitendinosis post like superiorly, um medially, the bicep femora superiorly laterally, the medial head of the gastric NEMIS inferiorly medially and the lateral head of the gastric NEMIS inferiorly laterally. So it makes a diamond shape and this one contains the tibial nerve the pal tail artery and vein and then finally, there's the tarsal tunnel. Um So the roof of this is made by the flexor retinaculum just like in the carpal tunnel. Um And the floor is made by the cal calcaneus um which is the heel bone and the medial Maale allis which is um from the tibia. Um It contains um oh, that's what say contain, it's not contras, sorry. Um The tendons of the tibialis, posterior, the tendon of the flexor digitorum longus, posterior, um tibial artery and vein, um the tibial nerve, the tendon of the flexor helicis longus. Um So the way to remember this is tom dick and very nervous Harry. Um And I used to have a hard time understanding like why it would be flexor um and not extensive, but it's like when you think about it, when you curl your toes, you're flexing your toes and that is posteriorly. Um So the lumbosacral plex plexus, I feel like this one isn't as um important to know as the brachial plexus. You're gonna learn one. I say learn the brachial plexus. Um But the lumbar plexus is from L1 to L4. This one is mostly anteriorly. Um and the way to remember the nerves is by um II, get lunch on Fridays. So the iliohypogastric ilio inguinal genitofemoral obturator and femoral nerve and then the sacral plexus is L4 S four. And this is mostly posterior and the way to remember the nerves of this is some Irish sailors pester poly. So there's a sciatic nerve, inferior gluteal, superior gluteal, posterior femoral cutaneous and the pudendal nerve. Um and when it comes to dermatomes, a way to remember which ones is, you stand on S one. and you sit on S3. So if you look um at the picture on the far right, you'll see that S3 um is a dermatome around the butt, um, the butt region and then, um S one is on the heel. Um And when it comes to reflexes, your ankle reflex is L1 L2 and your knee reflex, sorry, your ankle reflex is S one S two and your knee reflex is L3 L4. So I get the L and the S is confused. Um So it's s one S two, buckle my shoe, L3 L4, kick the door. Um So, yeah, so that's a way to remember it. So then we put the upper limb and the lower limb ones. It's C five C six, pick up sticks, C seven, C eight. Push the gate. L1 L no, um S one S two. buckle my shoe, L3 L4 kick the door. Um So the blood supply venous drainage and lymphatics to the lower limb. Um, the blood supply in, um, it goes from the external iliac onwards for the lower limb. The internal iliac is more for your pelvic organs. Um and this comes from the descending aorta and then it goes down to the common iliac and then that bifurcates, it's an internal and external, excuse me. And the venous drainage. Um I like to remember superficial distal to proximal, um and medially the great saphenous vein, um drains immediately and then this drains into the femoral vein and then laterally the short saphenous vein, um drains laterally and then drains into the popliteal vein. Um The venous drainage is actually aided by muscle pump. So, um when you walk, uh your muscles can and then this helps push that blood up because it does have to go against gravity. So it gets that aid. Um which is why when you're sitting down for a long time, you can get pulling. Um I know it's around the exam season right now. So we're sitting all day and you might notice like some swollen ankles, it because you haven't had that contraction of those muscles to help push that blood back up. Um And you can get varicose veins. Um So this is due to valve incompetence. Um So you um can't prevent that backflow. So you get that backflow and then it goes into your superficial veins. Um And then those veins become tortuous, um should say tortuous after become my apologies. And there are a few risk factors for varicose veins and this includes pregnancy, obesity and um an age greater than 65. Um You can also get a deep vein, thrombosis. If a blood clot forms in the deep veins, causing a B blockage. And then this vein, I mean, this clot sorry, can break off, move to the lungs and can lead to a pulmonary embolism. Um And then for the lymphatics, just a quick um line, it's just, it drains, it also drains superficial to deep distal to proximal. So the gluteal region. So in the middle, um you have the gluteal cleft. Um and then at the bottom, you have the gluteal fold. Um And that's the demarcation essentially of each subgluteal of each like glu but cheek. Um And so you have the superficial abductors and extensors of the hip, which include the gluteus, maximus, medius and minimus, as well as the tra tensor fascia lata, the glute medius minimus and the tensor fascial lata are by the superior gluteal artery and nerve and the glute max is by the inferior gluteal artery and nerve. And then you have your deep lateral rotators, which includes the piriformis, the Gemellus Perin and inferior, the quadris for femoris and the obturator internus. Uh The piriformis is very important because the sciatic nerve um it di divides the greater sciatic foramen into the supra and infra psa like pisciform parts and the sciatic nerve passes through it. So the hip and the pelvis. Um so it is made of three bones, the ilium, the ichum and the pubis, as you can see in the picture at the top, right, there's your ileum, which is your nice big bone. At the top of that, there was your iliac crest. I like to remember it as your elephant ears. Um And then there's your iium which is that blue part and then your pubis, which is that pink part. Um And all those come together to form the acetabulum. Um And then there are a few pelvic differences to keep in mind. So there's a gynecoid pelvis and an android pelvis, the gynecoid pelvis tends to be a female pelvis, but it's not exclusive. Um And then this one has a more rounded pelvic inlet and the a more wider pubic angle. Um So essentially the ischium uh ischial tuberosities are further apart. Um And this um aids essentially with childbirth. And you'll also notice that the coccus is shorter and doesn't point inwards as much. And then there's the android pelvis, which is typically male, but again, as I mentioned, not exclusive and it has a more heart shaped pelvic inlet and a narrow pubic angle. So angle. So between the atrial tuberosity, it tends to be more narrow. Um So there are a few joints for the pelvic girdle. Um that includes the lumbosacral joint um between L5 and S one, the sacral iliac joint and the pubic symphysis. Yeah. Excuse me. Um So for the hip joint, there's the joint between the acetabulum, which as I mentioned is those three bones. Um So the acetabulum and the head of the femur, those three bones are actually known as the innominate bones. I had a really hard time remembering that but if you can kudos to you, um and um it's deepened by the labrum of the acetabulum, this joint is less mobile but it is more stable. Um So, dislocation is not as common. So you hear a lot more shoulder dislocations than you do of hip dislocations. And the ligaments of this um of the joint include the ilio excuse me, iliofemoral. This is a Y shaped ligament and it is the strongest ligament and it prevents hyperextension of the hip. So bringing that hip too far back there is the pubofemoral um which prevents against hyper adu. So bring that hip that leg too far out. Um And then there's the ischiofemoral which also prevents against hyperextension, bringing that leg too far back as well. You might be wondering why there's nothing for hyperflexion just because your body is naturally there. You can only go so far. So you don't really need to um anything to block hyperflexion. Um Some structural changes that happen at the sacroiliac joint. Um It's in the bottom right corner in the blue. I feel like this is important to know this is to come up on our exams and I completely blanked. Um So this is something that you might want to remember. So the thigh, um there's one bone in the thigh and this is the femur bone. This is the largest and the strongest bone of the human body. Um The blood supply is by the femoral artery and the obturator, excuse me artery at the um neck of the femur, there's a lateral and the medial circumflex arteries. And this is very important because if you get an intracapsular um neck of femur fracture and this can lead to avascular necrosis. Um The nerves of the thigh included the femoral um nerve that goes in under the inguinal ligament. The excuse me, the sciatic nerve which goes through the greater sciatic notch and the obturator which goes through the obturator canal. So I just told you what the biggest bone in the body was. Who can tell me what the smallest bone in the body is. Jody, if you'd like to read that out, we've got. And uh I said ins and go on sties. Ok. Yeah. Um So great job. It is indeed the staph. So that is located in the ear. Um The ear has three teeny tiny bones, which you'll learn about later. Um But yeah, the stapes is the smallest one of them, but great job you guys both. Uh it'd be the ear bones. I think it's, it's also an ear bone. Um So the compartments of the thigh. Um So it gets, there are more compartments in the lower limb. There are three, these are also wrapped in fascia um in the thigh. There's anterior posterior and medial. Um So the innervation for the anterior is the femoral nerve. Um It's supplied by the femoral artery and this tends to be for knee extension and hip flexion. Um and this includes the iliopsoas, um which is made up of the iliacus and the psoas major, the sartorius um which helps you essentially cross your legs. Uh The tensor fascial laa which is supplied by the superior gluteal nerve, the vastus um lateralis, intermedius and medialis. Um and your rectus pmos so that those last four are your quadriceps. So quad for four. So those four groups together are your quadriceps and then posteriorly, it is innervated by your sciatic nerve supplied by the deep femoral artery and those of your knee flexors, rotators and your hip extensors. Um And this includes the semi 10 aosis, semimembranosus and your bice femoris. Um And those are your hamstrings. Um And then immediately it's supplied by the ur nerve and the alterative artery. And those tend to be your hip adductors to bring that closer to the body. Um the midline and it includes the adductor, longus, eye doctor Magnus and AUC Brevis, as well as the Pectineus. Um There's also the gracilis, um which also helps bring your legs close to the um center line, midline and the ator externus. So, in the leg, which is the lower part, which is below the hip, I mean, sorry, the thigh. Um There are two bones in that one. There's your tibia and your fibula. So your tibia is your weight bearing bone. Um And that it gets that weight from the femur and then it pushes that weight down to the foot. Um and it articulates with the femur superiorly. Um the talus inferiorly, um the fibula, it's um laterally in uh superior and inferior. And arguably the patella, some literature says, yes, some literature says no. Um and there's the um fibula which is a non um non wearing nonweightbearing bone um is actually not part of the knee joint, it doesn't articulate within um and within the knee joints. Um this one helps stabilize the ankle and at the bottom, it goes a little further down and that forms your lateral malleolus. So you have your middle and lateral malleolus, which you can actually feel a little like bumps on the side of your ankle and then also on your leg right below your knee, you can actually feel your tibial tuberosity and that's a little bump on the tibia. So the knee, um so there are three official articulations. Um There are two tibiofemoral um between the medial and lateral um parts of the femur with the tibia inferiorly and there is the patellofemoral. Um And as I mentioned earlier, the patella is a sesamoid bone. So it actually ars it's within, it lies within a tendon. Um the movements of the knee um include extension and flexion and there's lateral and medial rotation slightly. Um So actually, when you completely extend your knee that will slightly laterally rotate, um when you lock it and then it immediately rotates when you, um like unlock your knee, when you start, um flexing it. And the way I remember which way is, which is ll you lock laterally. Um So that's how I remember which one. And there are quite a few ligaments, very important ligaments in the knee if you've ever had a knee injury, you know how important these are. Um And so there are the medial and the lateral collateral um ligaments and you test these by the vals and barriss stress test. Um So essentially valgus is pushing the distal part away from the midline and Barres is pushing the distal part towards the midline. And then there are the anterior and posterior cruciate um ligaments which are tested by the anterior and posterior drawer test or the Lachman's test. The Lachman's test is actually more sensitive than the anterior um jaw test. And essentially um you for the Lachman's, you have your leg at 20 degrees. For the anterior jaw, you have it at 90 degrees and you essentially hold and pull the knee. Um and or for a posterior, you can also just um you'll have like a, like a sag if there's a tear in your posterior to um cruciate and then there are the lateral and medial menisci. These aren't cartilage. I mean, there are cartilage, not ligaments. Um But they're extremely important in the knee. Um And these are shock absorbers. The knee also has a few bursa. Um So there's the prepatellar bursa, which is in front of the patella, the subcutaneous and the deep infrapatellar bursa. And then there is the suprapatellar bursa which is above the patella. So you can actually see in the image that's on the left, you can actually see I've highlighted those bursa. Um and then the um blood supply is by the genicular branches of the femoral and popliteal arteries of um of the knee. And genu pretty much just means knee. Um So that's how you remember them. So, um there are three compartments, excuse me of the leg. Um So it's similar to the thigh but just flipped. So there's anterior, posterior and lateral instead of anterior, posterior and medial. Um So the anterior is responsible for dorsi flexion extension of the di digits and inversion, which is bring those soles of the feet together. Um It is supplied by the deep fibular nerve um and the anterior tibial artery and the muscles in this include the tibialis anterior, the extensor digitorum longus and extensor Haasis, longus in the posterior compartment. Um This is responsible for plantar flexion. Um So bringing that the um like bottom of your foot back and where the flexion bring the um up. So, plantar flexion inversion as well. Um So bring those um put the sole of the feet together. Um flexion of the digits um and it is innervated by the tibial nerve. Um and the blood supply is from the posterior tibial artery. And this has two layers. This has a superficial and the deep layer. So in the superficial layer, um there's the gastrocnemius and the soleus and then in the deep layer, there's the popliteus right at the top. Um the flexor digitorum longus, the tibialis posterior and the flexor haus is longus. Um And then laterally um that one is the only one responsible for aversion. So, bringing the soles of the feet away from each other and you have a superficial tibial nerve that some supplies it and the fibular artery and the muscles in this one are just the pro prone longest in bra. So the way I remember um innervation and blood supply, if you start at the back and move your way like forward, you go posterior lateral anterior, it goes like tibia, tibia, fibula, fibula, tibia fibula. Um So that's the way I used to remember. Um innervation and blood supply for the um compartments of the leg. Uh So, onto the foot, um there are quite a few bones in the foot, just like the hands, you have your phalanges, um your metatarsals instead of metacarpals and your tarsal bones instead of your carpal bones. Um So the way I remember the carpal bone, carpal bones is CCC called the Navy Captain. So you have your three K forms your medial a lateral and intermediate and then you have your Yeah, sorry. Just going back to the uh previous slide. Uh We have a question. Would the lateral be superficial fibular nerve, fibular nerve, sorry. Yeah. Not tibial nerve, sorry. Yeah, superficial fibular nerve, sorry. Or if you don't wanna confuse them good c sorry. But yeah, so um back to the um the foot. So you have your three C forms and then you have your cuboidal and then your navicular articulates with all three of those C forms and the cuboidal. And then you have the Calcaneus which that I mentioned the heel bone and then the paus which um articulates um at the ankle, ankle and that's where you have your inversion and inversion at that subtalar joint. Um So there are quite a few joints here. But um it's similar in the hands as your hips and your hips and then you have your metatarsal um Phala phalangeal joints. And then you have um you're like, for example, like you're in navicular can form you navicular cuboidal joints, loss of joints in the foot. Um And so the blood supply is um supplied by the plantar arteries, the medial 1.5. Um uh there's the medial 1.5 and then the lateral 3.5 plantar arteries. Um And then there are three arches of the foot. There is the lateral and the medial longitudinal um arch and then there's the transverse arch. So if the foot's like this, um this would be the medial longitudinal, this would be the lateral, longitudinal and this would be the transverse. Um And as I mentioned earlier, inversion and inversion occur at the subtalar joints. Um So at the ankle, there are quite a few, there are a couple um ligaments. Um So there's the deltoid ligament, which is um the medial collateral ligaments and then the lateral collateral ligaments. Um So the deltoid ligaments are nice and strong and those prevent excessive e um eer and then the lateral collateral ligaments prevent excessive inversion and um out of the lateral collateral ligaments. Um I feel like the most important one to know is the angio talofibular. Um because this one is the most um commonly injured and you test this one with the drawer test. And so the way I remember it is ATF is ATF so the anti talofibular is always torn first. Um And then there are a couple um uh intrinsic muscles of the foot. So there's the long planter, the short planter, the spring ligament, which is exactly what it is. That's the spring up. Um And the transverse metatarsal which goes between the metatarsals and the foot. Um And there are some intrinsic muscles um in the foot and those originate in the foot and there are some extrinsic muscles and those don't originate in the foot. Um And they are used to support the arches of the foot and the digits. Um I didn't go into too much detail for the intrinsic muscle of the foot because I don't know that you really need to know of that much. Um And then there's the plantar fascia, this is subdivided into three parts. There's the medial part, the lateral part and the central part. And um you get the most um problems at the attachment of the plantar fascia onto the calcaneus. Um So for example, you can get a plantar fasciitis and that can cause pain and inflammation. Um There are compartments of the foot as well. I didn't go into too much detail in this presentation. Um but just know that there's a lateral, medial, superficial and deep. So, as long as you know, like two, you know, the other two, and these are just important to know because there is the risk of compartment syndrome due to um an infection in one of the compartments. Um So here we can actually see the ligaments of the foot. So the long plantar, short plantar spring ligament, which is for propulsion and the transverse metatarsal ligament. Um So there are a few pulses you can feel on the foot. Um So there's the dorsalis pedis and the posterior tibial pulse. Um So the dorsalis pedis is from the anterior tibial artery and it felt on the dorsum of the foot. Um It's felt between the extensor helicis longus and extensor digitorum. Um I find it easiest to find if you flex the big toe and you get that look, that bump and you just go right to the side of that bump. I feel like it's, it's a lot easier to feel there. Um Otherwise it's a, it's a bit of a, it's a very light pulse. It's a bit of a hard one to find. And then there's a posterior tibial pulse which is felt right behind the medial malleolus. So there are a few different types of injuries. Um And it create include sprains, fractures, subluxations, dislocations and fracture dislocations, which is a combination of the two sprain. They're for more for tendons and ligaments, fractures are for the bones. Subluxation is a complete loss of alignment in a joint disloc um No, as partial loss, sorry dislocation is a complete loss and then you can get um of alignment and you can get a combination. Um So for reviewing x-rays, um it's important to have a, an organized approach. Um Something you always wanna start off by doing is checking details. So you wanna check the patient name, the date of birth, the hospital or NHS number if we've had any previous x-rays when this x-ray was taken. Um And what area of the body you're in, what view do you have? So if it's ap pa lateral or a leak and you always want at least two views. So there's something they say it's that one view is one view too few So you always want at least two views. Um You also wanna assess adequacy. Um You wanna make sure that you have the joint above and below. Um So for, for example, looking at an X ray of the thigh, you wanna look at, you wanna have the knee and the hip included and then there's your ABC S um which the A is for alignment. So you look for dislocation, sublocation or if it's misaligned. Um your BS are for your bones. So you look at your density, your joint space or deformities, for example, like osteophytes, bone cysts, um your CS for cortices. So you wanna look for any discontinuation or fractures. Um And then the S is for soft tissue. So you wanna see if there's any swelling and you also wanna see if there's any um foreign bodies. Um So if there, all right, can you go back to slides? Yeah. Um Maha, was this the slide that you were talking about with the foot ligaments? Oh It might have been. Oh That's fine. Maybe. Uh after the slide, was there a specific question that you had had? Maha, but you just missed them. OK. That's fine. So you guys are aware this is recorded. So you'll be able to access the slides and um the recording. Uh Thank you KJ. You can continue. Thank you. Um Yeah. So, um back to descriptions of fractures. Um So if there is a fracture, you wanna sit um state the site. So where it is, um always remember to um state the side as well. Um That's something I tend to forget. Um You wanna say if it's complete or incomplete. So a complete fracture goes along the whole bone width. Um If it's open or closed, um So open, it is if it's penetrated the skin, um sometimes because after you fracture a bone, it can be an open fracture, but that muscle contraction can pull that bone back in. Um So the bone might not stay sticking out. That's something to remember. And if it is an open fracture, you want to clean dirt. So you want to clean it. You wanna do debridement, um IV antibiotics, you wanna reduce it and you wanna check tetanus status. Um My friend actually gave me that mnemonic and it's actually very helpful. Um And you wanna see if there's any displacement or not of the bone. Um So who can name some types of fractures? There are quite a few to pick from. Yeah. So we've got spiral fla fractures, complex fractures, oblique fractures. Absolutely sorry. Oh I think just to name some. Yeah, absolutely. Great job guys. So um this is what we have what a normal bone bone looks like. And then we have quite a few fractures. Um So we have a transverse fracture which is straight and then we have an oblique fracture which is oblique. So on an angle, we have a spiral fracture from a twisting type. Um We have a com comminuted fracture, which is just a fracture that has multiple pieces. Um We have a green stick fracture, which is, um, we tend to see more in Children because their bones are a little softer. Um, and it can be from bending and then they'll just get a fracture just on one side of um the, of the bone and then we have an impacted. So if you um have a fall from a, from a tall, from a height, um you can get an impacted fracture and um you have an avulsion fracture which is essentially um breaking off the tip of the bone. Um And that tends to be from like a ligament tear and yeah, so that's it for me. Thank you so much for sticking it out with me. Um If there are any questions, um feel free to put them in the chat or a mute. Um Yeah. Are there any questions? Uh It doesn't seem like we have any. Um But thank you so much KJ for this revision session. It was very helpful and I hope that you guys found it super useful. Uh Like I said earlier, the slides and the recording will be available on Met All. And um in a few moments, I'm going to put into the group chat, a uh feedback form for KJ. So she can add it to her portfolio if you guys wouldn't mind filling that out. And yeah, if no one has any questions, I will stop the recording now and you guys are free to go. Thank you again so much. KJ. Thank you.