Exam 2 Flashcards
What are the 3 classifications of scoliosis according to age?
Infantile (0-3 y.o)
Juvenile (3-10 y.o)
Adolescent (Over 10 y.o)
What is the most common type of scoliosis?
Adolescent (usually females over 10 y.o)
T/F: Functional scoliosis can be corrected w/ forward and lateral bending.
True
Scoliosis due to muscle spasm or pain is considered functional or structural?
Functional
What is a segmental hemivertebra?
Partial vertebra that is not attached to another (makes up it’s own segment) as compared to nonsegmental, which is still attached to a separate, complete vertebra
A thoracic curvature in which direction is typically associated with spinal cord abnormalities?
Left Thor Curve
Café au lait spots are associated with what condition?
Neurofibromatosis
What is the most common tumor that causes painful scoliosis?
Osteoid osteoma
If a lateral curve persists upon lateral bending, is the problem structural or non-structural?
Structural
Risser’s Sign uses which site of ossification to grade skeletal maturity?
Iliac apophyses
Greulich and Pyle use which feature to grade skeletal maturity?
(Left Hand); the number of carpals minus one=age…works up to six years old
Bracing is recommended for scoliosis in which 3 instances?
- Curves progressing to larger than 25 deg
- Curves between 30-45 deg
- Risser Sign 0, 1, 2 and less than 6 months from the onset of menses in girls
What is the CAT in CATBITES?
Congenital
Arthritis
Trauma
What is the BITES in CATBITES?
Blood Infection Tumor Endocrine Soft Tissue
What is the #1 arthritis in the US?
Osteoarthritis
Which arthritis incidence is actually decreasing?
Rheumatoid; OA and Gout are increasing in incidence
Which arthritis incidence is actually decreasing?
Rheumatoid; OA and Gout are increasing in incidence
Is rheumatoid arthritis degenerative or inflammatory?
Inflammatory–>possible ankylosis
If a patient is under the age of 20, what arthritis is most likely to occur?
Juvenile rheumatoid arthritis
What is the significance of the ‘bare area’?
Area of a joint not covered by cartilage, typically is the location of first signs of erosion
Females are more likely to have DJD in their ___ & ___.
Hands and knees
Obese individuals have an increased incidence of DJD in the __ & ___.
Knees and Hips
What are osteophytes?
Bony outgrowths in the locality of capsular insertion
What are osteophytes?
Bony outgrowths in the locality of capsular insertion
What is subchondral sclerosis?
Localized thickening of existing trabeculation, usually due to increased mechanical stress
What is another term for subchondral sclerosis?
Eburnation
Enlarged soft tissue nodes of the DIP joints in the hand are also called ____’s nodes
Heberden’s Nodes -DIP
Enlarged soft tissue nodes of the PIP joints in the hand are also called ___’s nodes.
Bouchard’s Nodes -PIP
Which variant of DJD is unusually inflammatory, therefore is often confused with rheumatoid?
Erosive Osteoarthritis, MC in middle aged females
‘Gull-Wing’ appearance of the DIP joints is associated with which condition?
Erosive osteoarthritis
What would hallux rigidus present with?
Pain and stiffness in the area of the 1st metatarsal-phalangeal joint
What would hallux rigidus present with?
Pain and stiffness in the area of the 1st metatarsal-phalangeal joint
An enthesopathic change at the inferior aspect of the calcaneus goes by the common name of ___ ___.
Heel spur
Does DJD typically attack the glenohumeral joint?
Not without prior trauma
Osteophytes from which joint can impinge upon the rotator cuff tendons?
Acromioclavicular joint
Superior migration of the humerus due to unopposed deltoid may result from which condition?
Rotator cuff arthropathy
Hydroxyapatitie Deposition Disease is most common within which tendon?
Supraspinatus tendon
What are the three compartments of the knee joint?
Medial tibiofemoral
Lateral tibiofemoral
Retropatellar
Which area of the knee takes the most weight-bearing responsibility?
Medial Tibiofemoral
Is ‘bowlegged’ individual considered genu valgus or genu varus?
Genu Varus
Where would you find pelligrini-steida calcifications?
Medial Tibial Collateral Ligament
What is the sesamoid bone found within the lateral head of the gastrocnemius?
Fabella
What are the two other names for intraarticular fragments?
Joint mice, loose bodies
What is SOM?
Synovial tissue metaplasia produces cartilaginous masses (joint mice) that may ossify; common in the knee
What is the slow growing, benign tumor of the synovium often affecting young to middle-aged adults?
PVNS (Pigmented Villonodular Synovitis)
What is buttressing?
Thickening of the cortex associated with DJD of the medial femoral neck
Which area of the hip joint takes the most strain from walking?
Superior compartment
What is malum coxae senilis?
Literally means bad old hip; referring to osteoarthritis of the hips
What is a geode?
Large subchondral cyst
What is acetabular protrusion?
Severe medial hip migration that can be measured with the Koehler’s Line
What are the 2 synonyms for protusio acetabuli?
Acetabular Protrusion
Otto’s Pelvis
In which individuals may acetabular protrusion be considered a normal variant?
Females
The type of neuropathic arthropathy that affects weight bearing joints?
Hypertrophic
Which joints are likely affected by hypertrophic neurotrophic arthropathy complicated by diabetes?
Talonavicular
Talometatarsal
A ‘licked candy stick’ appearance is associated with what arthropathy?
Atrophic neurotrophic arthropathy (also associated with the ‘cutoff’ sign)
Where is DDD most common in the cervical spine? And in the lumbar spine?
Cervicals= C5 & C6
Lumbars=L4 & L5
What is the difference between outer disc degeneration (spondylosis deformans) and inner disc degeneration (intervertebral chondrosis)?
Outer-has osteophytes
Inner-has reduced IVD space
In what direction do osteophytes form?
First horizontally, then vertically; sometimes producing the claw-like osteophytes
What are the 4 signs associated with degenerative disc disease?
Decr. disc height
Osteophytes
Endplate sclerosis
Vacuum (Knutson’s Phenomenon)
What is Knutson’s Phenomenon?
Radiolucent (dark) collections of nitrogen gas within annulus; best seen at anterior margin of IVD
In the cervical spine, type __ modic changes are more common. Whereas in the lumbar spine, type __ modic changes are more common.
C- Type 1 Modic changes (dark T1, bright T2)
L- Type 2 Modic changes (bright T1 and T2)
What do each of the type of modic changes represent?
Type 1= inflammation–>instability
Type 2= fat–>stability
Type 3= sclerosis
What are the associations for posterior subluxation and anterior subluxation, respectively?
Posterior sublux= DDD
Anterior sublux= Posterior joint arthrosis
What are the 3 F’s of Degenerative Spondylolisthesis?
Fourth Lumbar (L4)
Forty & Up (40+ y.o)
Female
What areas are prone to degeneration of the zygapophyseal joints?
Lower lumbar
Mid cervicals
Upper and middle thoracic spine
What is an intercalary ossicle and what is it commonly confused with?
Ossification within outer annulus; may look like a fractured osteophyte
What is the average age of onset for Scheuermann’s Disease?
13-17 y.o
What are Schmorl’s Nodes?
Radiolucent (dark) IVD displacement into the cancellous bone of the vertebral body; typically non-significant finding in children
What is ochronosis?
Very dense central calcification of the disc (Nucleus puplosus)
What 3 conditions could present with annulus fibrosis calcification of the IVD?
Pseudogout
Hemochromatosis
Hypervitaminosis D
What is DISH?
(Diffuse Idiopathic Skeletal Hyperostosis)
Hypertrophic changes to anterior vertebral body margins, mostly notes along the ALL
What are the 2 other names for DISH?
Ankylosing Hyperostosis
Forestier’s Disease
With what group is DISH most common in?
Males over 50; high incidence in diabetics
What is enthesopathy?
Osseous development at tendon or ligament insertion sites
What disease is also known as ‘Japanese Disease’?
Ossification of the Posterior Longitudinal Ligament (OPLL)
OPLL is also found in what percent of DISH patients?
40-50%
What symptoms would bring an OPLL patient into your office?
Sensory or motor disturbances of the legs
Difficulty walking
Paresthesia or diminished senses over gradually increasing areas
What is the majority of mechanical low back pain due to?
Lumbar sprain/strain
What is the most serious side effect of a disc herniation?
Cauda Equina Syndrome
What is cauda equine syndrome?
Compression of multiple nerve roots; symptoms of altered bowel/bladder fx, impotence, saddle paresthesia
What is Lhermitte’s Sign?
Flexion of the neck causing electric-like shock that radiates down spine and limbs; RED FLAG of myelopathy
Lateral disc herniations of the cervical spine affect which nerve root?
The nerve root below; C5 disc herniation affects C6 nerve root
In the lumbar spine, what is the difference between a midline disc herniation and a foraminal disc herniation?
Midline- affects nerve root BELOW
Foraminal- affects nerve root at SAME level
What is the gold standard when trying to image a disc?
MRI
What is the difference between a disc protrusion and a disc extrusion?
Protrusion has a wide base coming off the IVD whereas the extrusion has a narrow base coming off the IVD (think sessile vs. pedunculated bone tumors)
What is spinal stenosis?
Narrowing of the spinal canal or IVF; may be congenital or acquired
What is the measurement for stenosis of the C spine? The L spine?
C- less than 12mm
L- less than 15mm
What is the correlation between the size, type and location of disc herniations to the outcome/pain/function?
Sorry. No correlation!
What are the 4 Rheumatoid types (seropositive) of arthritis we discussed?
Rheumatoid
SLE
Scleroderma
Jaccouds
What are the 4 Rheumatoid variants (seronegative) of arthritis we discussed?
Ankylosing Spondylitis
Reiter’s Disease (Reactive Arthritis)
Psoriatic
Enteropathic
What is the most common inflammatory arthritis?
Rheumatoid; inflammatory, hyperplastic synovitis (pannus)
What group is MC affected by rheumatoid arthritis?
Young to middle aged females
What is the Boutonniere deformity?
(Associated with rheumatoid) PIP flexion with DIP extension
What is Swan neck deformity?
(Ass. with rheumatoid) PIP extension with DIP flexion
What are Haygarth’s nodes?
(Ass. w/ rheumatoid) soft tissue swelling at the MCP joints
Dot-dash appearance, rat bites, and baker’s cysts are all associated with which arthritis?
Rheumatoid again
What is the Jelling Phenomenon?
Stiffness or swelling after inactivity (in the morning usually)
What is RF?
Rheumatoid Factor; a measurement of the reactive IgM antibodies
OA commonly affects the (proximal/distal) joints of the hand whereas Rheumatoid affects the (proximal/distal) joints.
OA-Distal (DIP & PIP)
RA- Proximal (PIP & MCP)
Where are rat bites usually seen?
Bare area of joints (usually superolateral aspect)
