Sesamoid bones are small more or less rounded masses embedded in certain tendons and usually related to joint surfaces. Their functions probably are to modify pressure, to diminish friction, and occasionally to alter the direction of a muscle pull. That they are not developed to meet certain physical requirements in the adult is evidenced by the fact that they are present as cartilaginous nodules in the fetus, and in greater numbers than in the adult. They must be regarded, according to Thilenius, as integral parts of the skeleton phylogenetically inherited.66 Physical necessities probably come into play in selecting and in regulating the degree of development of the original cartilaginous nodules. Nevertheless, irregular nodules of bone may appear as the result of intermittent pressure in certain regions, e.g., the “rider’s bone,” which is occasionally developed in the Adductor muscles of the thigh.
Sesamoid bones are invested by the fibrous tissue of the tendons, except on the surfaces in contact with the parts over which they glide, where they present smooth articular facets.
In the upper extremity the sesamoid bones of the joints are found only on the palmar surface of the hand. Two, of which the medial is the the larger, are constant at the metacarpophalangeal joint of the thumb; one is frequently present in the corresponding joint of the little finger, and one (or two) in the same joint of the index finger. Sesamoid bones are also found occasionally at the metacarpophalangeal joints of the middle and ring fingers, at the interphalangeal joint of the thumb and at the distal interphalangeal joint of the index finger.
In the lower extremity the largest sesamoid bone of the joints is the patella, developed in the tendon of the Quadriceps femoris. On the plantar aspect of the foot, two, of which the medial is the larger, are always present at the metatarsophalangeal joint of the great toe; one sometimes at the metatarsophalangeal joints of the second and fifth toes, one occasionally at the corresponding joint of the third and fourth toes, and one at the interphalangeal joint of the great toe.
Sesamoid bones apart from joints are seldom found in the tendons of the upper limb; one is sometimes seen in the tendon of the Biceps brachii opposite the radial tuberosity. They are, however, present in several of the tendons of the lower limb, viz., one in the tendon of the Peronæus longus, where it glides on the cuboid; one, appearing late in life, in the tendon of the Tibialis anterior, opposite the smooth facet of the first cuneiform bone; one in the tendon of the Tibialis posterior, opposite the medial side of the head of the talus; one in the lateral head of the Gastrocnemius, behind the lateral condyle of the femur; and one in the tendon of the Psoas major, where it glides over the pubis. Sesamoid bones are found occasionally in the tendon of the Glutæus maximus, as it passes over the greater trochanter, and in the tendons which wind around the medial and lateral malleoli.
The United States Medical Licensing Examination (USMLE) is a three-step examination for medical licensure in the United States. The Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME) sponsors USMLE.
The Three Steps of the USMLE
Step 1 tests the important concepts of basic sciences basic to the practice of medicine. It also places special emphasis on principles and mechanisms underlying health, disease, and modes of therapy. Step 1 ensures mastery of the sciences that provide a foundation for the safe and competent practice of medicine. It also tests the scientific principles required for maintenance of competence through lifelong learning.
Step 2 CK tests the medical knowledge, skills, and understanding of clinical science essential for the provision of patient care under supervision. It also includes emphasis on health promotion and disease prevention. Step 2 CK ensures that due attention is devoted to principles of clinical sciences and basic patient-centered skills.
Step 2 CS tests your capacity to practice and provide good medical service in real-life situations. It also tests your communication skills.
Step 3 tests your medical knowledge and understanding of biomedical and clinical science essential for the unsupervised practice of medicine. Step 3 provides a final assessment of physicians assuming independent responsibility for delivering general medical care.
