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Blue Boxes Flashcards

1
Q

Laminectomy

A

Surgical excision of one+ spinous processes and the adj supporting vertebral laminae; done by removing most of vertebral arch by transecting the pedicles.

Done to gain access to vertebral column during surgery, and to relieve pressure on spinal cord or nerve roots

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2
Q

Dislocation of cervical vertebrae

A

Requires less force than a fracture

Doesn’t damage the spinal cord unless accompanied by fracture

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3
Q

Fracture and Dislocation of the atlas

A

When a lateral force compresses the lateral masses btw the occipital condyles and the axis, fracturing one or both the bony arches

Jefferson burst: rupturing of transverse ligament as well

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4
Q

Fracture and Dislocation of the axis

A

Fractures of vertebral arches are most common injuries

Traumatic spondylolysis of C2 occurs with hyperextension of the head on the neck resulting in fracture of bony column of superior and inferior articular processes

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5
Q

Lumbar spinal stenosis

A

Stenotic (narrow) vertebral foramen in one or more lumbar vertebrae

May cause compression of spinal nerve root

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6
Q

Caudal epidural anesthesia

A

Local anesthetic is injected into fat of the sacral canal that surround proximal portions of the sacral nerves.

Done by several routes:
Sacral hiatus: acts on S2-Co spinal nerves and sensation is lost inferior to epidural block
Posterior sacral foramina: into sacral canal around spinal nerve roots

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7
Q

Abnormal fusion of vertebrae

A

Hemisacralization or sacralization of L5: dissociates from L4 causing pain

Lumbarization of S1🡪S1 separated from sacrum and fused with L5

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8
Q

Coccyx Injury

A

Abrupt fall or trauma may cause subperiosteal bruising or fracture of the coccyx or sacrococcygeal joint

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9
Q

Cervical Ribs

A

Costal element of C7 becomes abnormally enlarged and may place pressure on structures that emerge from the sup thoracic aperture (subclavian artery or brachial plexus)=thoracic outlet syndrome

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10
Q

Effect of aging on vertebrae

A

Decrease in bone density

Articular surfaces gradually bow inward

Superior and inferior surfaces become concave and iv discs convex

Bone spurs commonly develop which impinge spinal nerves

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11
Q

Anomalies of vertebrae

A

Spina bifida occulta🡪laminae of L5/S1 fails to develop normally and fuses posterior to the vertebral column

Location indicated by a tuft of hair

Spina bifida cystica🡪one or more vertebral arches may fail to develop completely

Herniation of the meninges can occur
Meningocele-meningeal cyst
Meningomyelocele-herniation of spinal cord

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12
Q

Aging of intervertebral discs

A

Nuclei pulposi dehydrate and lose elastin and proteoglycans while gaining collagen=more stiff and resistant to deformation

Nucleus may disappear and cause annulus fibrosis to take on the vertical load

Lamellae thickens and develops fissures and cavities
Intervertebral bodies increase in size with age

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13
Q

Herniation of the nucleus pulposus

A

Protrudes through annulus fibrosus causing low back pain and lower limb pain

Occurs with severe hyperflexion of the vertebral column

Always occurs posterolaterally and may compress the spinal cord or nerve roots

Localized back pain (acute) results from pressure on the longitudinal ligaments and periphery of the annulus fibrosus and local inflammation

Chronic pain results from compression of the spinal nerve roots being referred to the area supplied by that nerve

Most occur at L4-L5 or L5-S1 regions

Lumbago (acute middle and low back pain) results from mild posterolateral protrusion of a lumbar IV disc at L5-S1 affecting nociceptive endings

Sciatica (pain in lower back and hip radiating down to the back of the thigh) results from a herniated lumbar disc that compresses the L5 or S1 component of the sciatic nerve

Hyperflexion of cervical region may rupture disc IV most commonly C5-C6 or C6-C7 resulting in pain in neck, shoulder, arm and hand

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14
Q

Injury and Disease of Zygapophysial Joints

A

Injury or osteophytes in this region may result in pain along dermatomes and spasm in the muscles of associated myotomes

Denervation of lumbar zygapophysial joints is used for treatment of back pain caused by these diseases

Directed at articular branches of two adj posterior rami of the spinal nerves

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15
Q

Fracture of the Dens

A

Most common occurs at the base which is unstable bc transverse ligament of the atlas becomes interposed btw fragments and the separated fragment no longer has a blood supply=avascular necrosis

Fractures of vertebral body inferior to the base heals more readily because fragments maintain their blood supply

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16
Q

Rupture of transverse ligament of the atlas

A

Atlantoaxial subluxation🡪when the ligament ruptures resulting in incomplete dislocation of the median atlantoaxial joint

Also caused by softening of the transverse and adj ligaments from disorders of connective tissue and inflammation in the craniovertebral area

Causes spinal cord compression

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17
Q

Rupture of Alar ligaments

A

Combined flexion and rotation of the head may tear one or both alar ligaments resulting in range of movement to the contralateral side

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18
Q

Compression of C2 spinal ganglion

A

Caused by atlantoaxial rotation when the neck is severly hyperextended while turned to one side compressing the nerves opposite it

Results in severe headaches and excruciating cervico-occipital pain

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19
Q

Fractures and dislocations of the vertebrae

A

Crush/compression fracture of the body-caused by forceful flexion of one or more of the vertebrae

If anterior movement occurs with it, vertebra may be displaced anteriorly to vertebra inferior to it

Causes dislocation and fracture of articular facets and ruptures interspinour ligaments

Hyperextension-injures posterior parts of vertebra crushed (vertebral arches)

Whiplash-Longitudinal ligament is severely stretched

Facet jumping-hyperextension followed by hyperflexion causing dislocation of the vertebral arches of cervical spine

Rupture of anterior longitudinal ligament and adj annulus fibrosus of the c2 c3 iv disc=separation of cranium, c1, and dens/body of c2 from rest of axial skeleton and spinal cord severely severed

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20
Q

Abnormal curvatures of the vertebral column

A

Osteoporosis-demineralization of the bones caused by disruption of normal amts of calcium. Mostly affects neck of the femur, vertebrae, metacarpals and radius

Kyphosis-abnormal increase in curvature of thoracic spine caused by erosion of ant vertebrae
-Dowager’s hump

Lordosis-abnormal increase in lumbar curvature (swayback) caused by ant rotation of the pelvis

Scoliosis-abnormal lateral curvature accompanied by rotation of the vertebrae caused by assymetrical weakness of intrinsic back muscles, failure of half of vertebrae to develop, and a difference in the length of lower limbs

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21
Q

Back Pain

A

Fibroskeleton: periosteum, ligaments, annuli fibrosi of IV discs (meningeal sn)

Localized back pain
Fracture pain=periosteum
Dislocation pain=ligaments

Meninges:covering of spinal cord (meningeal sn)
Synovial joints: capsules of zygapophysial joints (dorsal rami)

Localized back pain

Joint pain associated with aging or disease

Intrinsic back muscles (dorsal rami)

Localized back pain

Related to ischemia and guarding

Spinal nerves or nerve roots from IV foramina🡪pain referred to dermatome innervated by that nerve

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22
Q

Compression of lumbar spinal nerve roots

A

Nerves increase in size from superior to inferior, but foramina decrease in size=susceptibility of L5 roots to become impinged if herniation occurs

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23
Q

Development of meninges and subarachnoid space

A

Pia mater+arachnoid mater=leptomeninges

Fluid filled spaces form within the layer and becomes subarachnoid space

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24
Q

Lumbar spinal puncture

A

Extraction of (subarachnoid space) CSF from lumbar cistern to evaluate CNS disorders

Usually done btw L3 L4 or L4 L5

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25
Q

Spinal Block

A

Anesthetic agent injected into CSF

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26
Q

Epidural Block

A

Anesthetic agent injected into the extradural (epidural) space in L3 L4 location

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27
Q

Ischemia of Spinal cord

A

Interference of spinal and medullary arteries may lead to muscle weakness and paralysis

Obstructive arterial disease🡪cause circulatory impairment

Can be used during surgery

Iatrogenic paraplegia-caused by cross clamping of the aorta

(greater segmented medullary artery of Adamkiewicz)

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28
Q

Spinal cord injuries

A 
Lumbar spondylosis🡪group of bone and joint deformities causing localized pain and stiffness
Transection:
-C1-c3—paralysis below head level
-C4-c5—quadriplegic
-C6-c8—loss of hand and some upper limb function
-T1-t9—paraplegic, some trunk control
-T10-l1—some thigh function
-L2-l3—most leg function retained
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29
Q

Back strains and sprains

A

Sprain-ligamentous tissue or attachment of ligament to bone is involved caused by excessive extension or rotation

Strain-overly strong muscular contraction causes microtears in muscle tissue
Can cause muscle spasm

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30
Q

Reduced blood supply to the brainstem

A

Arteriosclerosis causing vertebral artery blood flow occlusion resulting in dizziness, light-headedness, etc

Bowman’s syndrome

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31
Q

Variations of the clavicle

A

Can be pierced by branch of supraclavicular nerve

Right usually stronger and shorter than the left

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32
Q

Fracture of clavicle

A

Most frequently fractured

Indirect force transmitted from an outstretched hand through the bones of the forearm and arm to shoulder

Weakest part is junction of middle and lateral thirds

Sternocleidomastoid muscle elevates the medial fragment of bone, shoulder drops

Greenstick fracture—in kids, one side of bone is broken the other is bent

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33
Q

Ossification of clavicle

A

First to ossify during 5th and 6th embryonic wks, but last of the epiphysis of long bones to fuse (usually btw 25-30 yrs old)

Congenital defect in which ossification doesn’t occur and bony defect forms btw lateral and medial 1/3s

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34
Q

Fracture of Scapula

A

Result of severe trauma accompanied by fractured ribs and involve protruding acromion

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35
Q

Fractures of the humerus

A

Proximal end🡪fractures of the surgical neck

Impacted fracture🡪Fragment being driven into spongy bone of the other

Result from fall on hand

Avulsion of greater tubercle of humerus🡪pulling tubercle away from humeral head, usually seen in elderly patients

Results from fall on acromian

In younger ppl, from fall on hand when arm is abducted

Subscapularis pulls arm into medial rotation

Transverse fracture of shaft🡪direct blow to arm

Deltoid pulls proximal fragment laterally

Spiral fracture of shaft🡪fall on outstretched hand, can result in foreshortening

Intercondylar fracture🡪severe fall on the elbow, olecranon driven btw medial and lateral parts of condyle, separating from humeral shaft

Connections w/nerves

  • Surgical neck—axillary
  • Radial groove—radial nerve
  • Distal end—median
  • Medial epicondyle—ulnar
36
Q

Fracture of radius and ulna

A

Fracture of distal radius-common in women and ppl>50

–Colles fracture🡪distal 2cm of radius is most common.
Distal fragment is displaced dorsally and comminuted (broken into pieces) caused by forced dorsiflexion.

  • —Ulnar styloid can be avulsed (broken off)
  • —Causes shortening of radius and posterior angulation in forearm proximal to wrist=dinner fork deformity
37
Q

Absense of Pectoral muscles

A

Absence of sternocostal part of pec major has no disability but ant axillary fold is absent on affected side and causes nipple to be more inferior than the other

Poland syndrome-both pec major and minor are absent resulting in breast hypoplasia and absence of 2 to 4 rib segments

38
Q

Paralysis of serratus anterior

A

Winged scapula-Injury to long thoracic nerve causes medial border of scapula to move laterally and posteriorly

Upper arm can’t be abducted above horizontal position

39
Q

Triangle of auscultation

A 
Near inf angle of scapula
Borders are:
-Sup border of lats
-Medial border of scapula
-Inferolateral border of traps
40
Q

Injury to accessory nerve 11

A

Accessory nerve palsy-ipsilateral weakness when shoulders are elevated against resistance

41
Q

Injury of thoracodorsal nerve

A

Susceptible to injury during surgery near axillary region such as lymphectomy in scapular region

Paralysis of lats causes person to not be able to raise trunk with upper limb, can’t use axillary crutch

42
Q

Injury to dorsal scapular nerve

A

Affects actions of rhomboids, if only one side is affected, scapula moves more laterally from midline

43
Q

Injury to axillary nerve

A

Deltoid atrophies, and can be injured during fracture of surgical neck or dislocation of glenohumeral joint and compression

Loss of sensation over lateral part of proximal side of arm (sup lat cutaneous nerve)

44
Q

Fracture/dislocation of proximal humeral epiphysis

A

Direct blow causes fracture, shaft can displace but head stays articulated with glenoid cavity

45
Q

Rotator cuff injuries and supraspinatus

A

Injury or disease damages musculotendinous rotator cuff causing instability of glenohumeral joint

Trauma most often causes tears in supraspinatus

Degenerative tendonitis of rotator cuff

46
Q

Arterial anastomoses around scapula

A

Ligations:

Axillary btw 1st rib and subclavian-reversal of blood flow in subscapular enabling blood flow in third part of axillary

47
Q

Aneurysm of axillary artery

A

First part enlarges and compresses trunks of brachial plexus causing pain and anesthesia in skin
—-Occurs in baseball pitchers

48
Q

Injuries to axillary vein

A

Caused by wounds in axilla, especially dangerous in proximal portion

49
Q

Enlargement of axillary lymph nodes

A

Lymphangitis-Infection in upper limb causes nodes to become tender, inflamed

Involves humeral group first

  • Warm red tender streaks in skin of limb develops
  • Also caused by infection in pec region and breast
50
Q

Dissection of axillary lymph nodes

A
  • necessary for staging cancer
  • can result in lymphedema of upper limb
  • long thoracic and thoracodorsal nerve at risk for injury
51
Q

Variations of brachial plexus

A

small contributions from c4 or t2
-c4-c8=prefixed
-c6-t2=postfixed
inferior trunk can be compressed by 1st rib producing neurovascular symptoms in upper limb

52
Q

Brachial plexus injuries

A

affect movement and cutaneous sensations in upper limb
caused by disease, stretching, and wounds in lateral cervical region or in axilla

Injuries to superior c5 and c6 caused from excessive increase in angle btw neck and shoulders

Waiter’s tip (erb-duchenne)🡪paralysis of deltoid, biceps, brachialis, and brachioradialis causes arm to hang with shoulder adducted, medially rotated arm, and extended elbow

Can also occur during delivery

Backpacker’s palsy🡪muscle spasm from motor and sensory deficits in musculocutaneous and radial nerves

Acute brachial plexus neuritis🡪sudden onset of severe pain around shoulder, usually occurring at night and with muscular dystrophy

Compression of cords btw coracoid process and pec minor tendon results from prolonged hyperabduction of arm

Pain radiates down arm, numbness, paresthesia, erythema, and weakness of hands

Injuries to inferior c8-t1 (klumpke paralysis) occur when upper limb is pulled superiorly
—-Claw hand

53
Q

Brachial plexus block

A

Injection of anesthetic into or around axillary sheath blocks sensation in upper limb and skin distal to middle arm

54
Q

Biceps tendonitis

A

Inflammation caused by repetitive microtrauma like in sports involving throwing

55
Q

Dislocation of the tendon of the long head of biceps

A

Occurs during separation of proximal epiphysis of humerus resulting in sensation of popping or catching during arm rotation

56
Q

Rupture of tendon of long head of biceps

A

Results from wear of inflamed tendon in ppl >35

Tendon is torn from supraglenoid tubercle and muscle belly forms a ball in distal anterior arm (popeye deformity)

57
Q

Interruption of blood flow in brachial artery

A

Hemostasis-manual or surgical control of blood flow

Best place is medial to humerus near middle of the arm

Blood flows through radial and ulnar arteries

Ischemic compartment syndrome (Volkmann) flexion deformity of muscle when blood flow to brachial artery is occluded for 6+ hrs

58
Q

Fracture of humeral shaft

A

Midhumeral fracture injures radial nerve

Supraepicondylar fracture🡪fracture of distal part, displacing bone ant/post
—Distal fragment is pulled over proximal fragment shortening the limb

59
Q

Injury to musculocutaneous nerve

A

Paralysis of coracobrachialis, biceps, and brachialis
Flexion and supination of elbow and forearm is weakened
Loss of sensation in lateral surface of forearm

60
Q

Injury to radial nerve

A

Paralysis of triceps, brachioradialis, supinator, extensor muscles

Injury in radial groove area doesn’t affect triceps

Involves wrist drop—can’t extend wrist

61
Q

Venipuncture in cubital fossa

A

Involves median cubital vein or basilic vein

Involved with cardiac catheters

62
Q

Elbow tendonitis

A

Repetitive use of superficial extensor muscles of forearm
Pain in lateral epicondyle and radiates down post forearm
Inflammation of the periosteum of the lateral epicondyle

63
Q

Fracture of olecranon

A

Pulled away by active and tonic contraction of triceps

64
Q

Subluxation and dislocation of radial head

A

Incomplete temporary dislocation of radial head
Nursemaids elbow
Occurs in children when they are lifted by the upper limb while forearm is pronated
Anular ligament is torn

65
Q

Fracture of Scaphoid

A

Results from fall on the palm when the hand is abducted, occurring across the narrow part
Pain occurs on the lateral side of the wrist in dorsiflexion and abduction
Initial xray may not show it
Vaxular necrosis of prox frag could produce degenerative joint disease of the wrist

66
Q

Fracture of the Hamate

A

May result in nonunion of the fractured bony parts due to traction produced
Ulnar nerve may be injured decreasing grip strength

67
Q

Fracture of metacarpals

A

Isolated and heal rapidly
Severe crushing=multiple fractures
Boxer’s fracture=fracture of 5th metacarpal, head rotates over distal end of the shaft

68
Q

Fracture of the phalanges

A

Crushing of distal phalanges is common and painful
Distal phalanx fracture is comminuted and a hematoma develops
Fractures of prox or middle phalanges due to crushing or hyperextension

69
Q

Mallet or Baseball finger

A

Long extensor tendon avulsed from attachment to phalanx
Results from distal IP joint being forced into extreme flexion
Can’t extend distal IP joint and mallet deformity of finger

70
Q

Synovial cyst of the wrist

A

Cyst in dorsum of wrist, or ECRB tendon of 3rd metacarpal containing clear fluid
May result from mucoid degeneration
Flexion makes the cyst enlarge and could by painful
Known clinically as “ganglion”
Could compress median nerve

71
Q

Median nerve injury

A

Severed in elbow region

  • Flex of proximal IP joints of 1-3 fingers and distal IP of 2-3 is lost and 4-5 are weakened
  • 2-3 fingers remain partially extended when making a fist=hand of benediction
  • Thenar muscle function lost
72
Q

Pronator syndrome

A

Nerve entrapment syndrome caused by compression of the median nerve near the elbow

Compressed btw heads of pronator teres as result of trauma, hypertrophy, or fibrous bands

First present with pain in prox aspect of ant antebrachium

73
Q

Ulnar nerve damage

A

Injury occurs:

  • Post to medial epicondyle of humerus (most common)
  • In cubital tunnel formed by tendinous arch connecting humeral and ulnar heads of FCU
  • At the wrist
  • In the hand

Produces numbness and tingling of medial part of the palm and medial one and half fingers

Results in claw hand

74
Q

Cubital tunnel syndrome

A

Ulnar nerve entrapt in cubital tendon formed by tendinous arch joining humeral and ulnar heads of attachment of FCU

75
Q

Radial nerve injury in forearm

A

Penetrating wounds to forearm
Results in inability to extend thumb and MP joints of other digits
No sensory lost

76
Q

Dupuytren contracture of palmar fascia

A

Disease of palmar fascia resulting in progressive shortening, thickening, and fibrosis of fascia and aponeurosis

Degeneration of long bands of palmar apon on medial side pulls 4 and 5 fingers into partial flex at MP and IP joints

Bilateral in men >50

77
Q

Hand infections

A

Appear on dorsum of the hand

Pus can accumulate in certain compartments

78
Q

Tenosynovitis

A
  • Inflammation of tendon and synovial sheath
  • Infection confined if in 2-4 fingers
  • Little finger is cont with common flexor sheath, so inf here can spread through the palm and carpal tunnel
  • inf in thumb may spread to radial bursa
  • Quervain tenovaginitis stenosans-fibrous thickening of sheath and stenosis of osseofibrous tunnel from gripping and wringing
  • —-Pain radiates prox to forearm and distally to thumb
  • —-If occurs proximally to tendons of FDS and FDP, person is unable to extend fingers=digital tenovaginitis stenosans
79
Q

Laceration of the palmar arches

A

Profuse bleeding occurs

May be necessary to compress brachial artery due to numerous anastomoses

80
Q

Ischemia of the fingers

A

Brought on by cold and emotional stimuli

  • Raynaud syndrome=idiopathic
  • Perform presynaptic sympathectomy🡪excision of a segment of sympathetic nerve to dilate digital arteries
81
Q

Carpal Tunnel

A

Lesion reducing the size of the carpal tunnel or increase the size of the nine structure passing through it

Caused by fluid retention, infection and excessive exercise of the fingers
Compression of median nerve results in 
--Paresthesia—tingling
--Hypesthesia—diminished sensation
--Anesthesia—absense of sensation

Sensation to central palm is unaffected

Unable to oppose the thumb, sensory changes radiate into forearm and axilla

82
Q

Ulnar canal syndrome

A

Compression btw pisiform and hook o fhamate
Canal here is guyon tunnel
Hypoesthesia in medial one and half fingers results in clawhand of 4-5 fingers

83
Q

Handlebar neuropathy

A

People who ride for long distances on bikes compress ulnar nerve and results in sensory loss on medial side of hand

84
Q

Dermatoglyphics

A

Studying ridge patterns of the palm

85
Q

Serratus anterior palsy is a dysfunction that is characteristic of traumatic, non-traumatic, and idiopathic injury to the long thoracic nerve.[1]

Two types

A

Medial winging is more common, being caused by serratus anterior paralysis.[1] This is typically due to damage (i.e. lesions) of the long thoracic nerve.

Lateral winging which is caused by injury of the spinal accessory nerve.

Extras (23 decks)

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