above hip Flashcards
vertebrae features
cervical: superior facing facet joints
- movement along transverse plane
thoracic: prominent spinous processes, posterior facet orientation, movement along frontal plane
lumbar: prominent transverse processes, for attachment of stabalizing muscles, facet orientation lateral, movement along sagittal plane
what can cause a stress fracture of vertebra and where does it happen?
force applied by spinous process below in extension can cause stress fx to pedicle
when are intervertebral disc herniations common?
in 40s b/c of lost muscular tone and ability to react quickly
which disc herniation is typically asymptomatic?
anterior-no nerve at front
compression fx of C-spine
=cervical vertebral bodies break at weakest part and can cause lesion to cord itself
MX: axial load to cervical vertebral bodies
cause: landing on crown of head (30 DEGREES FLEXION) or spearing
=when spine is straight so natural curvature is not there to be a spring
spondylitis
spondylolysis
spondylolystesis
- generic inflammation
- stress fx to pedicle
- split facet joints from extreme extension so that they no longer move with each other
- gymnastics, chronic injury
functional scoliosis
S shaped spine, when bent over spinous processes pull into a straight line
- functional from loading too heavily/improperly before stabilizers are ready
- could be pulled by musculature from improper stability or could be too tight or lose on one side
- difficult to get rid of b/c can’t isolate a few levels of spinal mm
stingers/burners
-unilateral
mx: stretch to brachial plexus by depression of shoulder girdle and side flexion of neck–>transient loss of depolarization and lower limb use
sx: loss of motor and sensory function
tx: remove from participation, strengthen sternocleidomastoid by resisted flexion
- stay out of activity until grip strength is equal on both sides
stingers/burners
-bilateral
- from compression/axial load to nerve roots like crown of head hit
sx: loss of sensation on both sides
tx: doctor, correct mistake (nothing in sport should put them at that kind of risk) - high rate of reoccurance
thoracic muscle spasm
diaphragm spasm
- can’t breathe out
- wind knocked out of you
- reduce anxiety and make sure no pain in ribs after
- diaphragm usually from solar plexus blow
which joint has the greatest range of motion in the body?
shoulder,+ most unstable
why is the shoulder unstable
- glenoid fossa small and flat, humerus can slide
- glenoid labrum (not articular cartilage) doesn’t make the joint too much deeper
what is the best position for the hands when the shoulder is bearing weight?
externally rotated
what is the least stable position of the shoulder?
90 deg abducted and externally rotated
-why you shouldn’t catch yourself
causes of shoulder dislocation
- eccentric pec contraction + weak rotator cuff makes axis of rotation change from shoulder to hand when catching yourself
- hit to throwing arm-changes axis of rotation to hand/where you are being hit
- skidding on the ground (capsule and tricpes are the only things to stop the humerus from moving down)
- nothing to stop ant. motion except capsule and biceps
shoulder-static stabilizers
-anterior
- corco-acromio lig prevents head of clavicle from superior excursion
- coraco-clavicular lig-restricts elevation of shoulder
- acromio-clavicular lig-horizontal plane
- sterno-clavicular lig
dynamic shoulder stabilizers
biceps (long head) triceps (long head) -coracobrachialis -pectoralis major -rotator cuff muscles
rotator cuff
- teres minor
- supraspinatus
- infraspinatus
- subscapularis
function: fix head of humerus to glenoid cavity and stabilize shoulder - important to activate stability in rotator cuff muscles as well as strengthening them by internal/external rotation exercises
which muscle is indicated when there’s pain below the head of the humerus?
which muscle when it’s higher?
- teres major and lat dorsi (attach where pec tendon is)
- supraspinatus-attaches on top
posterior shoulder stabilizers
supraspinatus, infraspinatus, teres minor, teres major, triceps, deltoid
how does the arm get to 180?
120 degrees of abduction comes from gleno-humeral motion
60 remaining comes from rotation split evenly b/t AC and SC joint
-pins or screws in clavicle can cause loss of ROM from lift in SC or AC joint
throwing tendonitis
mx: blocked humeral rotation, acceleration (pec major) or deceleration
(rotator cuff issue)
-sx: pain during acceleration phase
-prevention: strong rotator cuff, long follow through, warm up and stretching
what would indicate a labral tear instead of throwing tendonitis?
-lower pain, humerus is pulled forward and rotator cuff mm must hold the joint together
shoulder dislocation types
anterior: subcoracoid-humerus under coracoid process
subglenoid
posterior: post lip of scapula makes post dislocation difficult b/c humerus has to go out and around the back
-possible by hitting a tree or something
what’s the difference b/t a shoulder dislocation and separation
separation=at AC joint (ie still a joint dislocation or subluxation)
shoulder dislocation
mx: direct blow, change in shoulder fulcrum from blocking fall or throw)
sx: extreme pain, obvious loss of joint conformation, humerus in axilla
tx: monitor vital signs distally (pull arm away from body b/c humerus could be lying on top of a blood vessel), emergancy
recurrent dislocations
-rotator cuff, capsule, or labrum damage possible
shoulder separation
A-C separation
mx: scapular retraction or depression
cause:
- fall on outstretched arm (inward scapular rotation, acromion compresses A-C joint)
- front of shoulder (retraction of scapula and distracts joint), fall on point of shoulder (scapula rotates downward and distracts the joint)
shoulder separation grades
grade 1-minor distension, no tearing/obvious deformity, reduced ROM
grade 2-typically no damage to coraco-clavicular ligaments, loss of function, pain, visable lift to AC joint
3-loss of function and strut (shoulder falling on rib cage), clavicle can be flipped in the air, usually pain negative
RTA when pain is tolerable except grade III (surgical)
shoulder impingement
could be from
1. subacromial bursitis
2. coracoacromial ligament
3. supraspinatus tendon
abduction causes compation of these (bursa protects ligaments)
-many swimmers have subacromial bursa removed so they can internally rotate and abduct but this puts the tubercle further under the acromion and cause more bone on bone action
forearm extensors
forearm flexors
- extensors from lateral epicondyle
- from medial epicondyle
medial epicondylitis
little league elbow
mx: traction on apophysis
sx: pain w/ resisted wrist flexion
tx: ICER, strength and flexibility
- not at all common in adults
lateral epicondylitis
tennis elbow
mx: eccentrics during backhand (ball hitting racket) or repetitive extension of wrist
sx: pain w/ resisted extension of middle digit
tx: RICE, strength and flexibility-freefall weights and catch
elbow dislocation
mx: hyperextension, rotation
sx: shortened arm, obvious deformity, pain
tx: immobilize and transport, ice
forearm fx
radius breaks higher
ulna breaks lower
-radius bears force b/c bigger bone distally, force is transferred through the interosseus membrane at the elbow b/c the ulna is bigger
ulnar deviation might cause
radial might cause
-styloid fx
-scaphoid (isthmus), high incidence of non-union b/c of minimal pain
can tell scaphoid fx from no power in opposition
scaphoid fx
mx: hyperextension or radial deviation
sx: painful ROM or opposition
tx cast and immobalization for 12 weeks then tape w/ contact wrist
metacarpal fx
mx: axial load, transverse blow
cause: punching something
sx: swelling, pain
tx: ORIF (if phalange is rotated it will mess up grip/fist
finger dislocation
mx: hyperextension, axial load
sx: deformity, pain
tx: reduction, spilint, ice
- if side to side, collateral ligament is damaged
mallet finger
ruptured extensor tendon
mx: hyperflexion
cause: ball on end of finger causing hyperflexion
sx: lack of DIP extension
tx: refer for splint
swan neck deformity
mx progression from mallet finger from rupture of extensor hood mechanism
-tendon contraction pulls PIP into hyperextended position
sx deformity
tx: refer to orthopaedic
boutinniere deformity
mx: hyperflexion of PIP
cause: arthritis?
sx: hyperextension of DIP
tx: refer for splinting
wrist fractures
cause: fall on outstretched arm, rolling into hyperflexion (smith’s)
smith’s=flexion fx of radius
colles=extension fx of radius
tx: emerg/immobalize
meninges
dura mater, venous supply arachnoid, subarachnoid space (w/ arterial supply), pia mater
