B2 MSK Flashcards
Dislocation of AC joint
shoulder separation
direct blow to shoulder
acromion more prominent, clavicle can go superior
most severe when AC & coracoclavicular ligaments torn
Calcific scapulohumeral bursistis
calcium deposits in tendon
repeat ooverhead activity
inflammation of subacromial bursa
shoulder dislocate
anterior most common
abduct, ext rotate, ext arm
can damage axillary nerve
assoc with labrum tear, fracture glenoid fossa/humeral head
labrum tears
SLAP
anterosuperior part of labrum typically
overhead athlete & manual labors
deep pain @ night/rest
pop/lock
frozen shoulder
inflammatory stiff, pain, loss passive ROM
idiopathhic
loss ROM start with external rotation
high spontaneous recovery rate 1.5-2.5 years
intratendinous bursa
tendon of triceps brachii
subtendinous bursa
olecranon & triceps tendon
subcutaneous bursa
over olecranon
Avulsion fracture medial epicondyle
tendon/ligament pull away bone
young baseball pitchers
fall with severe abduction & ext elbow
UCL tear fragment of epicondyle
Tommy John reconstruction
autologous harvest of palmaris longus or plantaris tendon
tunnel ulna & humerus
thread graft through tunnels
secure graft with suture/screw
elbow dislocate
posterior dislocate when kids fall on hand with lbow flex
distal end of humerous driven anterior part of joint as radius/ulna posterior
injury to ulnar N
fracture of radius head, coronoid process, olecranon process
Nursemaid elbow
transient sublux radial head
upper limb jerk up with forearm pronated
can tear attachment of annular ligamentm (can be impinged under head & capitulum
extend elbow, supinate forearm, flex with gentle radial pressure
scaphoid fracture
most frequent carpal fracture
fall on palm with abduction
misdiagnose severe sprain wrist
can lead to necrosis
Skier thumb
UCL injury of thumb
hyperabduction of MP of thumb
partial/full rupture/laxity of UCL of 1 MP
can be avulsion fracture too
Monteggia fracture
proximal third of ulna
anterior dislocation of radius
Galeazzi fracture
distal third of radius
subllux ulna
Colles fracture
fracture & posterior displace distal radius
Pronator syndrome
nerve entrapment of median
trauma, muscular hypertrophy from repetitive pronatioin, fibrous band
pain proximal anterior forearm, parathesia palmar of lateral 3.5 digit
cubital tunnerl syndrome
ulnar nerve entrap compression
arch is FCU tendon
antrior interosseous syndrome
thenar muscles not affected
paresis of FDP * FPL
can’t make OK as nno flex IP thumb or DIP of index
Dupuytren contract
palmar fascia pulled by 4th and 5th finger into partial flex @ MP/PIP
nodular thickenings
bilateral
Ulnar carnal syndrome
compression, inflammation, trauma, vascular insufficency by pisiform/hook hammate arch
ulnar nerve divisions
ganglionic cyst can cause
hypothesia in medial 1.5 digit
paresis
clawing 4/5 digits
tennis elbow
lateral epicondylitis
inflame of extensor tendons from repeat move
pain with activity, stiff, ache, weakness
mallet/baseball finger
sudden severe tension long extensor, caan avulse
DIP extreme flexionpa
patellar tendon reflex
knee jerk
integrity of femoral nerve
monosynaptic reflex where general somatic afferent fiber of muscle spinle in quad send impulse to spinal cord
General somatic efferent fibers sund impulse bacl to quad
gracilis in reconstructive surgery
weak aductor that can be transplanted
facial reanmiation, damaged hand muscles, anal incontinence, perineal/vaginal repair
groin pull/strain
strain/stretch/tear proximal attach of thigh adductor & flexors
sudden/fprceful overertion
Deep Venous Thrombosis
blood clot in large vein typically legg
from incompetent loose fascia so no resistance to muscle expansion,e xternal pressure, muscular inactivity
D dimer blood test & dopple US
compressive stockingf
femoral hernia
protrusion ab viscera through femoral ring into canal
tender mass in femoral triangle
common in female after multiple preggos
strangulation of intestine due to rigid boundaries (lack blood and necrosis can occur)
Sciatica
Irritate or compress one or more spine roots
Spinal stenosis, spondetheliosis, piriformis syndrome, tumor, obesity
Pain in low back and radiate down, increase when raising leg while laying down
Intramuscular injection
injection in superolateral quadrant are safe
superior to line from PSIS to superior ggreater trochanter
also be given safe in anterolateral thigh where needle go in glute med
Can injure nerve, hematoma, abscess formation
Trochanteric Bursitis
repeat actions with climb, stairs with heavy
separate superieor glute max from greater trochancter
deep diffuse pain along IT from tubercle to tibia with point tenderness over great trochanter
Ischial bursitis
repeat hip extension while seat (row, cycle)
separate inferioir glute max from ischial tuberosity
local pain over ischial tuberosity with glute max move
calcification can occur in bursa
Trendelenburg sign
injury to superior gluteal nerve, cause glute medius limp (also be trochanter fractuer & hip dislocate)
compensate for weak thigh abduct by glute med/min
tip down to unaffected side
Piriformis sybdrome
deep pain in buttocks worsen with sit, stairs, squats
Flexion, Adduction, Internal Rotation (FAIR test)
Shin Splints
repeat microtrauma of anterior tibialis muscle
pain on shine with mild swell
common in those with change to activity
treat with ice, rest, shoes
Foot drop
damage to deep filbular nerve paralyze muscles ant/lat compartment leg
can’t heel strike
high steps
loss senssation anterolateral/dorsal foot
Dorsalis Pedis artery pulse
evaluate peripheral vasculature
will be diminshed if insufficient due to arterial disease
occlusion: 5 P (pain, pallor, parasthesia, poikilothermia, pulse deficit)
could be congential bilateral where replace by perforating fibular
Ectopic pregnancy
implant zygote outsice uterus
(peritoneal cavity or fallobian tube)
non-viable but can cause abdominal bleed to mom
anencephaly
failure brain to develop
face and skull develop normal
spina bifida cystica
defect of vertebral canal where no arches on vertebraes allowing cyst to form either with meninges only or spinal cord in cyst too
spina bifida occulata
defect of vertebral canal where no arches on vertebrase
remain normla position and seem hidden from outside
may be marked b y patch of hair
meningeocelle
defect close skull
only meninges herniate
meningoencephalocele
defect close skkulll
meninges & brain tissue herniate
meningohydroencephhalocele
defect close skull
meninges, ventricle, brain tissue herniate
Spondylothoracic & spondylocostal dystosias
defect throughout spine
cleft vertebrae, hemi vertebrae (fail fuse each side)
cervical dysostosis
fused cervical vertebrae
algalille syndrome
butterfly vertebrae @ midline cleft
congentital scoliosis
dystosis that causes scoliosis only
Cleft sternum
failure fuse all midline so thoracic organ cover only by skin
pectus excavatum
depressed sternum
pectus carinatum
anteruor sternum
osteogenesis imperfexta
widespread skeltal issues with insufficient ossification
failure close ribs, form long bones, cranial defect
Hox gene & digits
digit 1 Shh independent
digit 2 Paracrine Shh signal
digit 3 autocrine/paracrine signal
digit 4, 5 autocrine Shh signal
Duplication defect
possible caused by ecotopic Shh expression pattern
Syndactyly
homogenous hox gene mutatiion
in wrist/hand
amelia
lack of formation of long bones in limbs
from chemical teratogens
Triceps Surae involved in injuries
gastrocnemius 2 heads & soleus
involved in calf strains
contribute to achilles tendinopathy (high force output/frequent use)
Calcaneal tendinosis
chronic, degenerative pain and thickening of tendon
from repeat microtrauma and inadequate healing
calcaneal tendinitis
acute, inflammatory of tendon
from sudden increase in activity or trauma to tendon
Ruptured calcaneal tendon
sudden forced plantarflexion, direct trauma, long-standing tendinopathy
popping or snapping sensation
calcaneal tendon reflex
ankle jerk testing S1 &2 nerve roots
leg dangling in relax postion
should see brief plantarflex
absence/reduction indicate s1 nerve root compression/peripheral neuropathy
hyperactive indicate upper motor neuron lesions
posterior tibial pulse
behind and below medial malleolous
strength ca vary and absence can ididcate arterial insufficiecy
calf muscle pump
contract calf help venous return to heart
in contraction deep veins are cmopressed, push blood against gravity
crucial to prevent DVT
plantarflex mechanism
push off/propel movement
triceps surae are mainn plantarflexors
plantaris, tibialis posterior, flexor hallucis longus, flexor digitorum llongus are secondary plantarflexors
ankle sprain
most often sudden inversion and planttarflexion of foot
peroneal muscles help prevent excess inversion & if weak can predispose sprains
strong tibialis posterior help stabilize the most
