Blue Boxes Flashcards
bicipital myotatic reflex
deep tendon reflex routinely tested
patient has relaxed limb passively pronated and partially extended at elbow
examiner’s thumb placed at biceps tendon
reflex hammer tapped on base of nail bed
normal (+) response = involuntary contraction of biceps
confirms integrity of musculocutaneous nerve and C6 and C6 spinal cord segments
abnormal (-) response = excessive, diminished, or prolonged response possibly indicating CNS or PNS disease or metabolic disorders (thyroid disease)
biceps tendinitis
inflammation of tendon of long head of biceps resulting from microtears when the musculotendinous unit is acutely loaded and associated with degeneration of tendon, vascular disruption, and inflammatory repair response
result of: repetitive microtrauma (throwing, raquet sports)
symptoms: shoulder pain
exam: tenderness and crepitus (crackling)
biceps tendinosis
degeneration within the tendon’s collagen causing disorganization of collagen in response to poor vascularization, chronic overuse, or aging
NO INFLAMMATORY RESPONSE
result of: repetitive microtrauma (throwing, raquet sports)
symptoms: shoulder pain
exam: tenderness and crepitus (crackling)
dislocation of tendon of long head of biceps brachii
causes pain, sensation of popping or catching felt during arm rotation
dislocation from the intertubercular sulcus in the humerus
young people during traumatic separation of the proximal epiphysis of the humerus
older people with history of biceps tendinitis
rupture of tendon of long head of biceps brachii
caused by wear and tear of inflamed tendon as it moves back and forth in the intertubercular sulcus of the humerus (forceful flexion or prolonged tendonitis)
repetitive overhead motion (swimmers, baseball pitchers)
usually >35 yo
traumatic rupture associated with a snap or pop
muscle forms ball in anterior distal arm (popeye deformity)
interruption of blood flow in brachial artery
measures blood pressure
hemostasis during surgery - medial to humerus because arterial anatomoses around elbow. provide collateral circulation.
sudden complete occlusion or laceration of brachial artery creates surgical emergency because paralysis of muscles results from ischemia of elbow and forearm within a few hours (up to 6 hours)
ischemic compartment syndrome
caused by occlusion or laceration to brachial artery after 6 hours. fibrous scar tissue replaces necrotic tissue and causes involved muscles to shorten permanently, producing flexion deformity.
loss of hand power.
midhumeral fracture
may injure radial nerve in radial groove of humeral shaft. Not likely to paralyze triceps because of the high origin of the nerves to two of three heads.
supra-epicondylar fracture
fracture of the distal part of the humerus near the supra-epicondylar ridges. bone may be displaced anteriorly or posteriorly. muscles pull distal over proximal fragments, shortening limb. may cause nerve or brachial vessel damage.
injury to musculocutaneous nerve
usually inflicted by a knife
causes paralysis of the coracobrachialis, biceps brachii, and brachialis.
weak flexion at flenohumeral joint. flexion of elbow joint and supination of forearm are weakened, but not lost.
loss of sensation on the lateral surface of forearm supplied by lateral cutaneous nerve of forearm.
injury to radial nerve
causes paralysis of triceps, brachioradialis, supinator, and extensor muscles of wrist and fingers.
loss of sensation in skin.
exam: wrist drop
venipuncture in cubital fossa
select median cubital vein from cephalic vein to basilic vein
vertebral body osteoporosis
common metabolic bone disease detected during routine radiographic studies
net demineralization of the bones caused by a disruption of the normal balance of calcium deposition and resorption
quality of bone is reduced and atrophy of skeletal tissue occurs
most affected areas: neck of the femur, bodies of vertebrae, metacarpals, and radius
early: diminished radiodensity of trabecular bone of vertebral bodies causing thinned cortical bone to appear prominent
late stage: compression fractures and increased thoracic kyphosis
laminectomy
surgical excision of one or more spinous processes and the adjacent supporting vertebral laminae
done to gain access to the vertebral canal for exposure to spinal cord or roots of spinal nerves
purpose: relieve pressure on the spinal cord or nerve roots caused by tumor, herniated disc, or bony hypertrophy
dislocation of cervical vertebrae
requires less force than fracture
slight dislocation without damaging spinal cord
severe dislocations or fracture dislocations can injure spinal cord
“facet jumping” (locking of displaced articular process) will not self-reduce
jefferson (burst) fracture
fracture of atlas (C1)
caused by vertical compressing forces (hitting head on the bottom of pool)
dimension of bony ring increases
rupture of transverse ligament may cause spinal cord injury
hangman’s fracture
40% of cervical vertebral injuries
usually in bony column formed by the superior and inferior articular processes of the axis
AKA traumatic spondylolysis of C2
caused from hyperextension of the head on the neck
results in quadriplegia or death
whiplash injury
hyperextension of the head and neck
fractures of the dens
common axis injury (40-50%)
results from horizontal blow to the head or from complication of osteopenia
lumbar spinal stenosis
narrow vertebral foramen in one or more lumbar vertebrae
may be hereditary anomaly that makes person more vulnerable to age-related degenerative changes
treatment: decompressive laminectomy
cervical rib
common anomaly in 1-2% of people
rib at C7, normally becomes a small part of transverse process
may cause thoracic outlet syndrome by pressing on subclavian artery or inferior trunk of the brachial plexus
caudal epidural anesthesia or analgesia
anesthetic or analgesic agents are injected into the fat of the sacral canal that surrounds the proximal portions of the sacral nerves.
sacral hiatus is located between the sacral cornua and inferior to the S4 spinous process or median sacral crest
sensation lost inferior to the epidural block
injury of coccyx
fall on buttocks or childbirth
surgical removal of fractured bone may be required if there is dislocation
may be followed by coccygodynia
hemisacralization
L5 is partly incorporated into the sacrum
sacralization of the L5 vertebra
L5 is completely incorporated into the sacrum
L5-S1 is strong, L4-L5 degenerates and is painful
lumbarization of S1 vertebra
S1 is separated from sacrum and fused with L5 vertebra
effect of aging on vertebrae birth-5yo 5 yo-13 yo 18-25 middle age and older
birth-5yo body of vertebra increases in height threefold
5-13 yo increases 45-50%
18-25 longitudinal growth completed
middle age and older: decrease in bone density and strength. vertebrae concave, IV discs convex.
osteophytes develop
spina bifida occulta
neural arches of L5 and/or S1 fail to develop normally and fuse posterior to vertebral canal (24% of population)
small dimple with tuft of hair at lower back
spina bifida cystica
one or more vertebral arches may fail to develop completely, associated with meningocele and/or meningomyelocele
aging of IV discs
nuclei pulposi dehydrate and lose elastin and proteoglycans while gaining collagen
lose turgor
increase size with age –> increasingly convex
AP diameter increases, height increases
