Clinical Boxes Flashcards
fractures, injuries, conditions
Spondylosis
- degeneration of jt, involves calcification
- local pain and stiffness
Spondylolysis
- involves fracture (lamina of pedicle, part of arch)
- seperation of vertebral arch from body
Spondylolesthesis
fracture w/ spondylolysis and now vertebrae is displaced
Jefferson Fracture:
Where does it occur?
Causes?
- fracture on posterior or anterior arch
1. vertical compressive force on occipital condyles (blow to head, diving)
2. C1 squeezes laterally
*fracture alone won’t hurt spinal cord, only if transverse ligament has been ruptured, the Odontoid process could injure spinal cord
-
Hangmans Fracture
Where does it occur?
Causes?
- fracture of pars interarticularis
- hyperextension of head
Dens fracture Type 1
superficial dens
*in dens fractures, transverse ligament breaks. if dens breaks at base, it won’t heal bc transverse ligament cuts off blood. if dens breaks inferior to bone (type 1), more likely to heal
Dens Fracture Type 2
fracture of the base of the dens
Dens Fracture Type 3
fracture includes the dens and part of the AXIS body
Spinda bifida occulta
Causes ?
Symptoms?
- developmental abnormality in which verterbral lamina L5-S1 FAIL to fuse
- may occur without any apparent clinical features or presence of hair tuft over defect
Spina bifida cystica
Causes?
What are the types?
- failure of one or more vertebrae to close completely AND neural tissue and meninges problem
(meningocele): meninges bulges out
(myelomeningocele): spinal cord and meninges bulge
(could cause motor or sensory defecits
myelocele: spinal cord exposed to environment
Where do you perform a lumbar puncture?
L3/L4
or
L4/L5
Whiplash:
What is the injury?
Causes?
- tearing of the anterior longitudinal ligament
- Hyperextension from car accident or excessive stretch
Herniation
What is it?
Where does it commonly occur?
- protrusion of nucleus pulposis due to herniation of annulus fibrosis, ruptures posterolaterally
- common at L4/5 or L5/S1 (b/c discs are larger and more mobile)
*seconday rule
Why is cervical dislocation less likely to happen?
presence of large vertebral foramen decreases likelihood of dislocation
Where does lumbar puncture take place?
Why?
What structures must the needle pass?
- L3-4 or L4-5
- spinal cord stops at L2
ORDER:
skin,
fat
thoracolumbar aponeurosis
supraspinous ligament
interspinous ligament
ligamentum flavuum
epidural space (has internal vertebral venous plexus),
dura,
arachnoid,
subarachnoic space (CSF here)
Describe a back spain
- injury to ligaments
- usually bc of inadequate stretching
Describe a back strain
- involves muscle
- tearing of muscle fibers produced by an overly strong muscular contraction, excessive stretching
Name the spinal cord injury:
no function below the head
C-1-C3
Name the spinal cord injury?
no fxn of limbs, respiration capable
C4-5
Name the spinal cord injury?
loss of hand and upper limb fxn
C6-C8
Name the spinal cord injury?
paralysis of both lower limbs
T1-T9
name the spinal cord injury?
some thigh function, may walk with LONG leg brace
T10-T11
name the spinal cord injury?
limb fxn present, may walk with SHORT leg brace
L2-3
Common cause of muscular pain?
spasm of muscular tissue producing ischemia
Common cause of joint pain?
osteoarthritis or disease arthritis
Common cause of fibroskeletal pain?
fractures and dislocation of ligamentous structures
What are the 5 varities of back pain?
- fibroskeletal pain
- muscular
- joint
- spinal cord/ nerves
- meninges
Which anatomical structures involved in back pain are innervated by posterior rami?
- synovial joints
- spinal nerves
- intrinsic back muscles
Which anatomical structures involved in back pain are innervated by recurrent meningeal NN?
- fibroskeletal
- meninges
manner in which clavicle is often fractured in children
FOOSH
falling directly on shoulder
greenstick fracture
- not complete break, bone is soft (seen in infants and young kids)
- fracture of radius and/or ulna
Why are there 2 “necks” on a humerus?
- surgical neck fracture is most common (esp in older adults with osteoporosis)
- anatomical neck is where anatomists think it is
What does the upper extremity consist of?
- shoulder, axillary region, brachium, antebrachium, axillary region
How are epicondyles related to avulsion fractures and compression on ulnar nerve?
- severe abduction of extended elbow can result in avulsion of medial humeral epicondyle
- groove for ulnar N. houses the nerve and is painful when compressed (think funny bone)
Cause of avulsion fractures of the olecranon process of ulna?
common in falling bc foreful nature of triceps brachii m.
Colle’s fracture
What is often associated with this fracture?
- fractures of distal end of radius (from breaking falls)
- avulsion of styloid process
*think dinner fork
What bones are susceptible to injury as a result of trying to break a fall?
clavicle
distal end of radius
scaphoid
(scaphoid is most commonly fractured carpal bone from FOOSH. fracture often misdiagnoed as a severe sprain bc not visible in Xray.
What is carpal tunnel?
(ligament, nerve, bones)
L: inflammation of transverse carpal l.
N: median nerve
B: carpal bones
Where does supraepicondylar fracture occur?
distal part of humerus
Ulnar tunnel syndrome/guyon’s canal syndrome
(ligament, nerve, bones)
L: transverse carpal ligament, palmar carpal ligament
- B: depression b/w pisiform and hamulus of hamate
- ulnar n. passes through this canal & susceptible to compression –> loss of senstation and muscular weakness
Which fracture would result in avascular neurosis?
scaphoid fracture
What is boxer’s fracture ?
head of fifth metacarpal is susceptible to fracture when punching something with CLOSED fist
Cause of distal phalanges fracture?
often a result of fingers being closed by a door bc of relationship btwn phalanges and flexor tendons
What injuries is glenoid labrum susceptible to and what activities lead to these injuries?
- tears in ppl repeatedly throwing a ball, usually in response to a sudden contraction of biceps brachii m. and occurs in anterosuperior part of labrum
What are the four cartilaginous joints in the upper extremity?
- sternoclavicular
- acromioclavicular
- glenoid humeral
- articular disc of distal radioulnar jt
What causes Shoulder seperation?
What is involved: joint, ligament, bones?
injury from falling on shoulder or FOOSH
J: acromioclavicular joint
L: coraclavicular ligament
B: clavicle and acromion (scapula)
Direction of dislocation of glenohumeral jt ?
Why its susceptible to dislocation?
Direction: due to presence of coracoacromial arch, dislocation is often anteriorly or inferiorly
Susceptible b/c: mobility and instability
(spheroidal joint)
What causes dislocation of elbow joint?
What ligament is compromised?
- falling on hands with elbow flexed
- tear in ulnar collateral l.
What are the bursae of the elbow?
Which ones are MOST susceptible to inflammation?
- olecranon bursae (subtendinous olecranon bursa, intratendinous olecranon bursa, subcutaneous olecranon bursa)
- subcutaneous bursal of medial humeral epicondyle
- subcutaneous bursal of the lateral humeral epicondyle
- bursa of the anconeus
- bursa at origin of extensor carpi radialis brevis
- bicipitoradial bursa
most susceptible: subcutaneous olecranon bursa and bicipitoradial bursa
What is student’s elbow/dart thrower’s elbow/miner’s elbow
- subcutaneous olecranon bursitis
- excessive friction btwn skin and olecranon
What is pulled elbow/nursemaid’s elbow?
Cause?
- radial head gets dislocated out of annular L.
- incomplete dislocation/subluxation
- usually from pulling kid’s arm
What condition is associated with sprain of 1st metacarpophalangeal jt?
Ligaments associated?
Causes?
- Bull rider thumb
sprain of lateral collateral l. and even avulsion of lateral proximal phalanx of thumb
- What is Skier’s thumb?
- Ligaments involved?
- Cause?
1./2. Laxity or rupture of 1st metacarpophalangeal jt,
3. hyperabduction of the jt.
What is the cause of mallet finger/baseball finger?
What gets damaged ?
1.hyperflexion of distal interphalangeal jt
2. extensor tendon damaged
What synovial sheaths are associated with muscle tendons of hand and antebrachium?
- in hand (fibrous digital sheaths, digital synovial sheaths)
- in antebrachium (synovial tendon sheaths, common flexor sheath)
-
Dupuyren Contracture mechanism and structures involved?
- palmar aponeurosis and palmar fascia shortern, thicken, and there’s fibrosis
- results in partial flexion of 4th and 5th digits
shoulder and axilla fascia
- pectoral fascia
- axillay fascia
- clavipectoral fascia
- costocoracoid membrane
- suspensory l. of the axilla
- deltoid fascia
- supraspinous fascia
- infraspinous fascia
What makes up the brachium fascia?
- brachial fascia
- medial intermuscular septum
- lateral intermuscular septum
antebrachium fascia
- interosseous membrane
- extensor retinaculum - focal thickening (holds things together), thicker on post side
- synovial tendon sheaths
- palmar carpal l. (on ant side of extensor retinaculum, homolog)
- flexor retinaculum/transverse carpal l. (forms carpal tunnel)
- common flexor sheath
hand fascia
- palm fascia
- palmar aponeurosis (protects palm)
- superficial transverse metacarpal l.
- retinacula cutis (attaches palmar aponeurosis to skin)
- medial fibrous septum
- lateral fibrous septum
- palmar aponeurosis (protects palm)
- dorsal fascia
What are the compartments of the hand?
hypothenar, central compartment, thenar compartment, adducutor compartment, interosseous comparment
Explain how irritation of the synovial sheaths result in synovial cysts?
- accumulation of mucopolysaccharide fluid forms(synovial/gan glion cyst).
- infections of synovial sheath = specific swelling in the shape of sheath
The greater humeral tubercle is also susceptible to avulsion by which muscles?
supraspinatous M, infraspinatous M, and teres minor M. that insert there.
