clinical applications Flashcards
section 1 cumulative
with respect to the spinal curve, how can pathogenic curvatures arise?
congenital, disease or postural in origin
name the pathogenic curvatures we covered in class?
scoliosis, hyperkyphosis, hyperlordosis
what is scoliosis?
lateral curvature, most often in thoracic region
what is hyper kyphosis?
exaggerated thoracic curvature (hunchback)
what is hyper lordosis?
exaggerated lumbar curvature (swayback) and often the result of compensating for carrying extra abdominal weight
with respect to the vertebrae, what are the examples of the clinically correlations we covered in class?
spinal stenosis and laminectomy
what is spinal stenosis?
abnormal narrowing of vertebral foramen
what is a laminectomy?
removal of one or more of the spinal processes and their supporting lamina or pedicle
how can vertebral discs be affected clinically?
herniated disc, which compresses the spinal cord or spinal nerves
with respect to the thoracic wall, what are the ways it can be impacted clinically?
changes due to age, congenital anomalies, traumatic injuries, surgical procedures
how and what are the changes that affect the thoracic wall due to changes in age?
the costal cartilages become calcified with advance age and the xiphoid process ossifies in the early 40s and is often due to a hard lump
so we mentioned that the thoracic wall can be affected due to changes in age, what happens in particular to the individuals who have the costal cartilages that have been calcified with age?
they becomes more radiopaque and they become less resilient and so this increases a greater chance of fracture
what are the congenital anomalies that affect the thoracic wall?
complete sternal cleft, partial sternal cleft, and sternal foramen as sternal defects, pectus excavated, pectus carinatum, bifid rib, and supernumerary ribs
what is a complete sternal cleft?
can allow heart to protrude through thoracic wall (ectopic cordis)
what is a partial sternal cleft?
produces U- or V-shaped clefts in manubrium/superior sternal body and can be repaired during infancy or childhood
what is a sternal foramen?
small circular opening due to improper fusion and so this appears like a healed bullet wound in X-rays
what is pectus excavutum?
due to abnormal growth of multiple ribs and sternum (sunken chest)
what is pectus carinatum?
due to overgrowth of costal cartilages (pigeon chest)
what is bifid rib?
sternal portion of rib cleaved into two portions»_space; usually asymptomatic
what are the traumatic injuries that can affect the thoracic wall?
rib fractures, flail chest, rib dislocation, rib separation
what commonly causes rib fractures?
direct blows and the ribs can be broken anywhere, but keep note that just anterior to the costal angle, this is the weakest point
which ribs are not generally fractured?
1st and 2nd ribs because they are protected by the clavicles
what decreases the likelihood of rib fracture?
because the ribs are not connected anteriorly and this allows for more mobility decreasing the likelihood of fracture
which ribs are most commonly fractured?
ribs 7 and 10
what is flail chest?
when mulitple rib fractures allow the segment of the thoracic wall to move freely and so this is a paradoxical movement during respiration
what are the effects of a flail chest?
extremely painful and impairs ventilation and treatment usually requires hooks and wires
what is rib dislocation?
dislocation of sternocostal or interchondrial joints and manifests as a painful lump over site
what is rib separation?
dislocation of costal chondrial junction and usually tears tough fibrous covering and separated ribs move to overlap superior ribs
what are the surgical procedures done that affect the thoracic wall?
sternal biopsy, thorocotomy, median sternotomy
what is sternal biopsy?
subcutaneous position of spongy bone allows for bone marrow biopsies; uses = marrow transplants, or biopsy for metastatic cancer or blood disorders
what is a thoracotomy?
surgical entrance through thoracic wall into the pleural cavity
what the types of thoracotomy?
anterior thoracotomy, posterior thoracotomy and median thoracotomy
what is anterior thoracotomy?
entrance through the costal cartilage
what is the posterior thoracotomy?
this allows posterolateral access through the 5th-7th intercostal spaces
how is the posterior thoracotomy performed?
H shaped incision made to peel of periosteum, then removal of rib to gain access sparing intercostal muscles, then the periosteum is placed back into position and this allows for the regeneration of bone into rib
what is the median sternotomy?
splitting and retracting of the sternum into the medial plane and this is used to gain access to the mediastinum
how can the paranasal sinuses be affected?
sinusitis
what is sinusitis?
inflammation of a paranasal sinus due to allergy or infection and so the inflamed mucosa can block ostium
how does sinusitis develop?
through the infection of the ethmoid cells and so this leads to the potential for infection to break though the thin wall into the medial orbit causing blindness due to the proximity of the optic canal; infection of the maxillary sinus
where can the infection of the ethmoid occur?
subdivided into the anterior, middle, and posterior ethmoid sinus each with own ostia or opening
what is an infection of the maxillary sinus?
sinus infection of the maxillary and the most common site
in terms of the maxillary sinus infection what happens if the ostia are infected superiorly?
with head erect drainage cannot occur
in terms of the maxillary sinus infection what happens if the ostia are infected medially?
results in nights rolling from side to side if both maxillary sinus are inflamed
what is in close proximity to the maxillary sinus? why is this significant?
the molars; fracture of molar»_space; care must be taken not to invade maxillary sinus during extraction»_space; opening would allow for infection, very little separation between tooth and sinus and infection of maxillary sinus happens and it feels like a tooth ache; also if molar is extracted and root breaks off, if you break through the wall and now drainage from sinus to mouth and potential from mouth to sinus can occur through bacteria
what is the transillumination of the sinuses?
allows direct observation of fluid, mucous or masses within maxillary and frontal sinuses
what happens if the supraorbital margin is affected by blunt trauma to the face?
blow to supraorbital margin causes bruising»_space; tissue fluid and blood leak into connective tissue»_space; gravitate into superior eyelid (can also be caused by bone fractures in region)
what happens if the mastoid process is infected, what is this called and define it?
mastoiditis and this is the inflammation of mastoid air cells typically due to middle ear infection leading to infection of the brain
what types of injuries can result to the nasal bones?
deviated nasal septum,trauma, damaged cribiform plate
what is deviated nasal septum?
occurs in a junction of the bone and cartilage which can be congenital or traumatic, blockages (partial or complete) and this could be due to chronic sinusitis, chronic sinus headaches, chronic nose bleeds
what is the cause of trauma to the nasal bones?
usually due to sports or automobile injury
how does the traumatic injury to the nasal bones affect the body?
severe injuries may displace cartilage and or bones and serves as the potential to also fracture cribiform plate leading to cerebral spinal fluid rhinorhea.
what is the effect if the cribiform plate gets damaged?
sense of smell is lost, also if the meninges can also be damaged and CSF can leak due to brain hitting inside of the skull
what happens as a result of improper fused maxillae?
improper fusion leads to cleft lip/palate
how does the dislocation of the temporomandibular joinr occur?
occurs when attempting to take a large bite or when yawning, and so the mandibular condyle slides anterior of mandibular fossa and outstretched muscles hold mandible fully depressed
what are the fractures of the upper extremities?
clavicle, scapula, humerus, colles fracture, hand
how does the fracture of the clavicle occur?
often due to indirect force of falling on an outstretched arm
with respect to the fracture of the clavicle where is the weakest point?
usually in the S region and when it breaks, it slides in not out and this is usually the result when the weight of the limb causes depression of shoulder and muscle action causes overriding of fractured ends
how can a fracture of the clavicle be misdiagnosed?
genetic defect of 1 and 2 ossification centers not fusing which normally fuse by 31
how often does a fracture of the scapula occur?
rarely outside of sever trauma and can often heal on themselves
what is the most important consideration of a humeral fracture?
nerve damage
where is the most common fracture site of the humerus?
the surgical neck and among the elderly, even with low impact falls
name the common types of fracture to the humerus?
impacted fracture, avulsion fracture, transverse fracture, spiral fracture, intercondylar fracture
often times with a humerus why do we need to consider that the periosteum is strong and surrounded by muscle?
because the bone fragments usually unite well
what is the colles fracture of the radius?
when the distal fragment of the radius is dislocated dorsally usually resulting in the dinner fork deformity; avulsion of the styloid process of the ulna is a common co-occurrence and typically produced by hyperextension of the hand while breaking a fall and is common fracture site in patients over 50 with osteoporosis
where are common fracture sites of the hand?
scaphoid, hamate, metacarpals and phalanges
how does the scaphoid of the hand fracture?
by breaking fall on abducted and/or hyperextended hand, pain is immediate but fracture may not initially show on radiograph until 10-14 days later
what can result due to injury of the scaphoid?
so poor vascularization can occur and this leads to the slowing of the healing process with increased risk of avascular necrosis
how does injury to the hamate occur?
hook of the hamate most commonly fractured in sports using a tennis racket, bat or club
what nerve can be affect due to hamate injury?
ulnar nerve and damage of hamate due to its close proximity can result in loss of innervation to intrinsic hadn’t muscles and so loss of grip and surgery required because the action of attached muscles can inhibit reunions of fractures
how can the metacarpals and phalanges be fractured
due to crushing or hyperextension
what is the most common site of femur fractures?
the neck
keep in mind the Q angle is used to determine knee pathologies, what happens if the Q angel is greater or less than the normal value for men and women? how is it determined?
for men and women, if Q value is greater than 12 (men) or 17 (women) degrees, you have genu valgum or knock knees and if its less, than you have genu varum or bowed legs; Q angle - angle formed by a line drawn from the anterior superior iliac spine through the center of the patella and a line drawn from the center of the patella to the center of the tibial tubercle
what type of injuries develop from the patella?
patellofemoral stress syndrome which is also known as runner’s knee caused by the over use of improper tracking of patella over femur
what are the clinical applications of the arches of the foot?
flat foot, per caves, congenital talipes, bunion
what is flat foot?
(1) can be an asymptomatic anatomical variant
(2) can also occur due to loosening of tendons and ligaments that support the arch
(3) typically not treated if not associated with pain
what is pes cavus?
high arches and this can be a normal asymptomatic anatomical variant or can be due to different neurological disorders
what is congenital talipes?
club foot and this is when the feet are turned medially and inverted, genetic factors plus in utero positioning thought to play a role
what is a bunion?
lateral deviation of the hallux
(1) genetic in origin»_space; improper bone structure, loose tendons, etc.
(2) genetic deformities lead to bunion symptoms»_space; bursitis, corns, arthritis, etc.
(3) aggravated by footwear
what is osteomalacia?
gradual softening of the bone due to failure of the bone to calcify
what is osteopenia?
decreased calcification of bone or a reduced bone mass
what is osteoporosis?
an age related disorder characterized by decreased bone mass and increased susceptibility to fractures. It occurs when resorption outpaces bone formation
what is osteopetrosis?
abnormally dense bone, obliterating the marrow cavity, due to defective resorption of immature bone
what is osteoarthritis?
a noninflammatory degenerative joint disease characterized by degeneration of the articular cartilage and osseous outgrowth at the margins
what is rheumatoid arthritis?
inflammation disease of the joints, which is an autoimmune disease in which the immune system attacks the synovial membrane and articular structures leading to deformities and disability
Gout?
a painful form of arthritis and caused by too much uric acid in the blood
what is thoracic outlet syndrome?
the compression of neurovascular structures in the thoracic outlet (a space between the clavicle and first rib) causing a combination of pain, numbness, tingling, or weakness, and also fatigue in the upper limb caused by pressure on the brachial plexus by a cervical rib.
