MSK Pathophys Flashcards
Spinal Pathologies
lower spine vertebral column anatomy
- lumbar: 5 vertebral bodies; L1-L5
- sacrum: 5 segements (fused w/out discs)
- coccyx: 3-4 fused segments
Spinal Pathologies
label anatomy of vertebrae
okay
Spinal Pathologies
ligaments of spine
- anterior longitudinal ligament: connects vertebral bodies anteriorly
- posterior longitudinal ligament: connects vertebral bodies posteriorly
- ligamentum flavum: yellow ligament; connects lamina posteriorly
Spinal Pathologies
anatomy of lumbar discs
- purpose: cushioning between vertebral bodes
- named by vertebral body above/below (L4-5 disc is between L4/L5)
- Annulus Fibrosis: fibrous outer ring of disc
- Nucleous Pulposus: soft inside of disc
Spinal Pathologies
anatomy/phys of spinal cord
- purpose is to transmit information to and from rest of body
- begins at craniocervical junction and ends between T12-L2
- end of sinal cord: conus medullaris (conus)
- cauda equina: end of conus there are spinal nerves that go to LE and bowel/bladder
Spinal Pathologies
nerve roots of spinal cord numbering
- cervical: nerve roots exiting are name based on vertebral body below foramen (except C8 which exits in C7-T1 forament)
- Thoracic/Sacral: named for vertebral body above foramen
Spinal Pathologies
describe spurling test of cervical spine
- dx cervical HNP or spondylosis
- pt seated, laterally flex head, apply pressure downward to increase axial load & cause pain down ipsilateral arm
Spinal Pathologies
describe hoffman reflex for cervical spine
- tests for long tract spinal cord involvement in neck
- pathologic reflex (indicates abnormality w/in cervical spinal cord or higher like UMN lesion or pyramidal sign) for ALS< MS, spinal cord compression
- pos reflex: flexion and adducting the thumb/index finger after flicking the middle finger
Spinal Pathologies
lumbar spine tests
- gait (barefoot) look at Trendelenburg (pelvis level on one foot = normal hip abductor)
- heel-toe walking (tests L4-5, S1 innervated muscles)
- calf/thigh circumfrence/atrophy (asymmetric or atrophy = weakness)
Spinal Pathologies
lumbar SLR tests
- seated SLR: pos test causes pt to lean back
- Supine SLR (lesegue): pos test is radicular pain in leg, not back (HNP or compression) sx at 20deg or less is suggestive of sx amplification
- Slump test: seated, hands behind back, then slump in relaxed position w/ chin to chest; extend leg, dorsiflex fully. examiner gives slight pressure to back of head. pos test is impingement on dura, spinal cord, nerve roots
Spinal Pathologies
red flags in HPI/PE
8
- fever/chills/wt loss (malignancy)
- hx of IV drug use
- progressive weakness; decreasing pain in face of increasing deficit; paraparesis
- bowel/bladder dysfunction; distended/palpable bladder
- trauma
- increasing pain not controlled by simple analgesia
- saddle anesthesia
- unexplained neuro deficits
distended/palpable bladder
lordosis vs kyphosis vs scoliosis
- lordosis: increased lumbar curvature
- kyphosis: increased thoracic curvature
- scoliosis: abnormal sideways curves
Spinal Pathologies
myelopathy vs radiculopathy vs stenosis
- myel: injury/compression of spinal cord
- radi: injury/compression of nerve root
- stenosis: narrowing of passage for spinal cord/nerve root
Compartment Syndrome
causes of compartment syndrome
4
- long bone fractures (tibia or humerus)
- severe contusion/crash injuries
- reperfusion injury after vascular repair
- restrictive cast/dressing
Compartment Syndrome
compartments of LE
- anterior
- lateral
- superficial posterior
- deep posterior
Contents
* each compartment covered by fascia (resistant to expansion and stretch)
* each compartment contains muscles, blood vessels, nerves
Compartment Syndrome
pathogenesis
- interruption of hemostatic pressure gradient causes a disruption in flow and capillary perfusion pressure
- build up of fluid outside of the capillaries increases pressure w/in myofascial compartment
- distribution of oxygen/nutrients and CO2 removal disrupted leading to muscle ischemia and necrosis
Compartment Syndrome
reversibility of sx based on duration?
- < 4 hrs: reversible muscle injury
- > 8 hrs: irreversible muscle injury
- nerve conduction loss: 2 hrs
- irreversible nerve injury: > 8 hrs
Compartment Syndrome
describe procedure of emergency fasciotomy
- long incision to release pressure in affected compartment and adjacent compartments
- wounds are left open and a 2nd procedure for debridement is performed w/in 48-72 hrs
- wound closure w/in 7-10d +/- skin grafting
Osteomyelitis
common bacteria of non-hematogenous vs hematogenous
- Non-Hematogenous Polymicrobial (S. aureus, S.epidermidis, streptococcus spp, gram neg, anaerobes)
- Hematogenous monomicrobial (S. aureus, streptococcus, gram neg, p. aeruginosa, serratia, candida)
Osteomyelitis
bacterial causes due to specific risk factors
- no risk factors: s. aureus
- sexually active: n. gonorrhoeae
- cat/dog bites: p. multocida
- IVDU: p. aeruginosa, s. aureus, candida
- sickle cell: salmonella
- neonates: group b strep
Osteomyelitis
pathophys
- overall poorly understood
- several factors: host immune status, underlying disease, virulence of organisms, vascularity and location of bone
Osteomyelitis
which part of bone most commonly affected in hematogenous spread?
- metaphysis
- due to rich vascular supply of growth plates
Osteomyelitis
XR findings/limitations
- 1st line imaginge, but may not show chagnes in the first 2wks (so normal XR cannot r/o dz)
- disease must extend at least 1 cm and compromise 30-50% of bone mineral content to produce noticeable changes in plain radiographs
- findings: regional osteopenia, loss of trabecular architecture, bone destruction, soft tissue gas, new bone apposition (cortical thickening; increase in diameter of bone)
Septic Arthritis
bacteria associated w/ infection
- S. aureus most common overall
- s. epidermidis
- streps: pyogenes, pneumoniae, agalactiae)
- gram neg: p. aeruginosa, e. coli, k. kingae, n. gonorhoeae (sexually active young pt), h. flu, salmonella (sickle cell)
DeQuervain’s Tenosynovitis
Finkelstein tests
place thumb into palm and ulnar deviate
pain is pos result (expected w/ DeQuervain’s)
Arthritis
purpose of articular cartilage
lings bones, allows for protection and gliding movement
Arthritis- Wrist
what bones are removed w/ proximal row carpectomy
scaphoid, lunate, triquetrum
Trigger Finger
why don’t you release A1 pulley in RA
can cause further ulnar drift
Common Fractures
metacarpal fractures- describe when rotational deformity may be present
- most common in oblique and spiral fracture types
- PIP joints at 90deg flexion normally converage at a point in the proximal carpal bones (scaphoid)
- deviation of 1+ lines suggests a metacarpal fracture
Common Fractures
components of neurovascular for fractures
- repetitively evaluate motor + sensory nerve function and assess for vascular insufficiency
- neuro exam: assess median nerve, AIN, and radial nerve
- vascular exam: temp, color, cap refill
Common Fractures
specifics of neuro exams
- Median: assess for abduction of thumb or flexion of distal phalanx of thumb
- Ant. Interosseous Nerve (AIN): assess for flexion of distal phalanx (OK sign)
- Radial: extension of wirst
Common Fractures
specifics of vascular exam
- eval for color, warmth, cap refill
- eval both radial and ulnar arteries
- emergent surg if: cold, pale, pulseless
Common Fractures
Weber Classification
- describe fibular fracture relative to syndemosis
- A: below syndesmosis
- B: level of syndesmosis
- C: above level of syndesmosis
Common Fractures
Bohler Angle (calcaneal)
- formed by intersection of 2 lines
- Line 1: drawn from superior aspect of post calcaneal tuberosity to the superior subtalar articular surface
- Line 2: drawn from the superior subtalar articular surface to the superior aspect of anterior calcaneal process
Shoulder Disorders
types of shoulder separations
6
- Type I: ligament stretched
- Type II: partial rupture of AC ligaments
- Type III: complete rupture of AC/CC ligaments
- Type IV: clavicle displaced posteriorly over acromion
- Type V: clavicle displaced up (just under skin)
- Type VI: clavicle underneath coracoid (rare, but serious)
Shoulder Disorders
Subacromial impingement/bursitis: describe Neer and Hawkins tests
- Neer Impingement Sign: arm up to ear and rotate, pain w/ flexion and pronation. subacromial impingement or rotator cuff tear.
- Hawkin Impingement Test: to test for subacromial impingement or rotator cuff tendonitis abduct the shoulder to 90 deg, forward flex to 30 deg, and forcibly internally rotate (induced pain!)
Shoulder Disorders
rotator cuff muscles & their jobs
- supraspinatus: abduction
- infraspinatus: external rotation
- teres minor: external rotation
- subscapularis: internal rotation
Shoulder Disorders
Pos PE tests for rotator cuff tears + describe them all
4
- Neer Impingement Sign: arm up to ear and rotate, pain w/ flexion and pronation. subacromial impingement or rotator cuff tear.
- Hawkin Impingement Test: to test for subacromial impingement or rotator cuff tendonitis abduct the shoulder to 90 deg, forward flex to 30 deg, and forcibly internally rotate (induced pain!)
- Drop Arm Test: from fully abducted position, slowly lower the arm to the side, noting pain starting at approx 90deg followed up sudden drop of arm.
- Empty Can Test: supraspinatus muscle isolation; with arm straight and shoulder abducted to 90deg and forward flexed 30deg, point thumb at ground and lift arm against resistance
Shoulder Disorders
Pos PE tests for labral tear
- Apprehension Test: shoulder abducted to 90 deg and elbow flexed to 90 deg, examiner then externally rotates the shoulder and looks for signs of apprehension on pt’s face
Shoulder Disorders
Pos PE tests for shoulder dislocation
- Apprehension Test: shoulder abducted to 90 deg and elbow flexed to 90 deg, examiner then externally rotates the shoulder and looks for signs of apprehension on pt’s face
Shoulder Disorders
dislocated shoulder appearances on XR
- posterior: humeral head appears superior to glenoid cavity on AP film
- anterior: humeral head appears inferior to glenoid cavity on AP film (MUCH MORE COMMON)
Shoulder Disorders
posterior approach for shoulder joint aspiration
- palpate posteior lateral edge of acromion process
- mark spot 2cm inferior to edge
- inject shoulder w/ 10mL of anestetic targeting coracoid process
Shoulder Disorders
ways to reduce anterior shoulder dislocations
- Stimson
- Scapular Manipulation
- Leidelmeyer
- Milch
- Traction-counter traction
Shoulder Disorders
describe Stimson reduction
- Prone position
- Arm hanging
- Traction in forward flexion using 5, 10 or 15 pound weight (15-30 min)
- Use with scapular manipulation
Shoulder Disorders
describe scapular manipulation
- Stimson technique
- Scapular tip medially
- Slight dorsal displacement of scapular tip
- Reduction may be subtle
Shoudler Disorders
describe Leidelmeyer reduction
- Supine
- Arm adducted
- Elbow flexed 90°
- Gentle external rotation
Shoulder Disorders
describe Milch reductions
- Forward flexion or abduction until arm is directly overhead
- Longitudinal traction
- Slight external rotation
- Manipulate humeral head upward into glenoid fossa
Shoulder Disorders
Traction- Countertraction Reduction
- Supine
- Bed sheets tied
- Slight abduction of arm
- Continuous traction
- Gentle external rotation
- Gentle lateral force to humerus
- Change degree of abd
Shoulder Disorder
Pos PE test for Bicepital Tendonitis
- speed’s test: with elbow fully extended and palm forward, flex shoulder against resistance
Knee Disorders
most common location for OCD of the knee?
PPP
70% in the posterior lateral aspect of the medial femoral condyle
Knee Disorders
PE differences for patellar and quad tendon ruptures
- patellar: difficulty w/ knee flexion, patella alta)
- quad: difficulty w/ SLR, can’t extend knee, patella baja
Knee Disorders
bursa of the knee
- suprapatellar
- pre-patellar
- infrapatellar
- pes anserine
Knee Disorders
location of pes anserine bursa
deep to the gracilis, sartorius, and semitendinosus tendons at the lower medial knee
Knee Disorders
pos special tests for ACL tear
- Anterior Drawer Test: for ACL tear; flex knee to 90 deg and sit on pt’s foot; attempt to pull tibia anteriorly toward you (ACL tear = anterior tibia shift); and then repeat with the tibia in internal rotation to test posteriolateral joint capsule and in external rotation to test posteriomedial joint capsule
- Lachman Test: for ACL tear; flex knee to approx 20 deg; grasp lower leg, with one hand, use other hand to grasp thight; pull tibia foward while pushing femur back
Knee Disorders
pos special tests for PCL tear
- Posterior Drawer Test: for PCL tear- flex knee to 90 deg and sit on pt’s foot; attempt to push tibia posteriorly away you (PCL tear = posteior tibia shift)
- Sag Sign for PCL tear: inspect if tibia sags posteriorly when knee is relaxed at 90 deg flexion
Knee Disorders
pos special tests for meniscus tears
- Medial McMurray Test: fully flex knee, then hold foot in external rotation and apply valgus force to knee while extended knee
- Lateral McMurray Test: fully flex knee, hold foot in internal rotation and apply varus force to knee while extending knee
- Apley’s Meniscal Compression Test: with patient prone, grind tibia against femur in rotating motion to see if it elicits meniscal pain
- Apley’s Meniscal Distraction Test: same as above, except tibia is pulled away from femur; pain may indicate ligamentous injury or malingering rather than meniscal injury.
Scoliosis
differentiate dextroscoliosis and levoscoliosis
- Dextro: spinal curvature to R
- Levo: spinal curvature to L
Scoliosis
describe purpose of and technique for scholiometer
- measures angulation of spine while individual bends forward to determine degree of truncal rotation
- pt bend forward, deviation of teh ball from center is measured
- measurements of >5deg is abnormal, f/u with spinal XR
Raynaud’s
pathophys of each phase
- Ischemic: arterial vasospasm causing distal blanching and transient numbness
- Hypoxic: dilation of capillaries and venules containing deoxygenated blood causing cyanosis
- Hyperemic: rewarming and resolution of vasospasm leading to oxygenated blood being delivered to dilated capillaries and venules leading to erythema
Raynaud’s
clinical presentation primary vs secondary
- Primary: mild cuase, middle 3 fingers most commonly affected, episodic < 20 min
- Secondary: more severe, asymmetric or unilateral, trophic changes (scarring, ulceration, gangrene), sclerodactyly (puffy digits w/ skin tightening)
Raynaud’s
normal vs abnormal nailfold capillary microscopy
- Normal: vessels thin, uniform, evenly spaced, symmetric; capillary loops have hairpin appearance
- Abnormal: absent (dropout areas) or dilated capillary loops; vessels are irregular, tortuous, elongated, bizarre, bushy, engorged, corkscrew in appearance; spacing between loops may be uneven
Raynaud’s
vasoconstrictive meds to avoid
- nasal decongestants
- amphetamines
- methylphenidate sumatriptan
Radial Head Subluxation
supination/flexion technique
- Warn caregivers that the maneuver will hurt and the child will likely cry
- Child can be seated in parent’s or caregiver’s lap
- Fully extend and supinate elbow and then take elbow intoflexion
- This procedure is done while maintaining slight pressure over the radial head; often, the provider will feel a “click” in the elbow
- Typically, the child will be moving thearmnormally within 15 minutes
- Immobilizationis unnecessary after first episode
Radial Head Subluxation
hyperpronation reduction technique
- Warn caregivers that the maneuver will hurt and the child will likely cry
- Child can be seated in parent’s or caregiver’s lap
- While applying mild pressure over the radial head, the provider holds the elbow in a flexed position and hyperpronates theforearm
- A click may be felt whendisplacementis reduced
- Typically, the child will be moving thearmnormally within 15 minutes
anatomy of apophysis
- normal secondary ossifications center
- located in NWB part of bone
- site of tendon or ligament attachment
- AKA traction epiphysis
- eveentually fuses w/ major portion of bone in 2nd decade of life
Ankle Sprain
sprain vs strain
- sprain: injury to ligament caused my tearing of the fibers of a ligament
- strain: injury in which the muscle is stretched too much and tears
Ankle Sprain
ligaments of the ankle
- deltoid (strong, medial ligament)
- anterior/posterior talofibular (lateral ligaments)
- calcaneofibular (lateral ligament)
Ankle Sprain
grading ankle sprains
1st degree – mild ankle sprain
* Minimal pain and swelling
* Ankle is weakened and prone to reinjury
* Healing: 1-2 wks
2nd degree – moderate to severe ankle sprain
* Swelling often associated with ecchymosis
* Walking produces pain and is often difficult
* Healing: 2-3 wks
3rd degree – severe ankle sprain
* Diffuse swelling and ecchymosis
* Unable to bear weight
* Ankle instability
* +/-nerve damage
* Healing: 6-8 wks
Ankle Sprain
Ottawa Ankle Rules- ankle vs foot imaging
An ANKLE radiograph should be performed if there is pain in the malleolar region with any of the following:
* Bone tenderness at the posterior edge of the distal 6 cm or tip of the lateral malleolus
* Bone tenderness at the posterior edge of the distal 6 cm or the tip of the medial malleolus
* Inability to bear weight for at least 4 steps both immediately after injury and at the time of evaluation
A FOOT radiograph should be performed if there is pain in the midfoot region with any of the following:
* Bone tenderness at the navicular bone
* Bone tenderness at the base of the 5th metatarsal
* Inability to bear weight for at least 4 steps both immediately after injury and at the time of evaluation
Ankle Sprains
Ankle Anterior Drawer Test
- Performed to evaluate the stability of the anterior talofibular ligament (differentiate between 2nd and 3rd degree lateral ankle sprains)
- Positive test: anterior movement of the foot = 3rd degree tear
Performing the Test
* place the pt’s ankle into 20deg plantar flexion
* with one hand, stabilize the anterior aspect of the distal leg
* cup the calcaneous and attempt to displace it anteriorly detecting the total amount of anterior translation in the lateral part of the ankle
Ankle Sprains
proper use of posterior leg splint
- use with grade 2-3 ankle sprains, isolated fractures of tibia or fibula, lisfranc, or metatarsal fractures
- origin: posterior surface of leg, 2 in below fibular head to avoid common peroneal nerve compression
- insertion: plantar aspect of metatarsal heads
- position: ankle in 90deg dorsiflexion, pt in prone position to prevent shortening of Achilles
Metatarsal Fractures
types of fractures
- Pseudojones/Dancer’s fracture: occurs in zone I; fracture through base (tuberosity) of 5th metatarsal due to plantar flexion/inversion
- Jones Fracture: occurs in zone II; fracture at metaphyseal-diaphyseal junction that occurs w/ ankle sprains; high risk for non-union due to zone being avascular
- Stress Fracture: zone III
Bursitis
define bursa
- synovium lined, sac like structure containing small amount of fluid
- found throughout the body
- acts as a cushion and gliding surface to reduce friction
- located near bony prominences or between bones, muscles, tendons, or ligaments
Bursitis
describe olecranon bursitis
- caused by injury or repetitive pressure on elbow
- pain w/ flexion
Bursitis
describe trochanteric bursitis
- caused by injury, overuse, arthritis, surgery
- pain w/ lying or sleeping on affected side
- most common in middle age/older women
Bursitis
describe pre-patellar bursitis
- caused by repetitive pressure on knees
Bursitis
describe retrocalcaneal bursitis
- caused by uphill running or wearing tight fitting shoes
Foot Disorders
anatomy of the foot
- tarsals, metatarsals, phalanges
- arches function to distribute/absorb body wt, provide foot w/ elasticity and resilience, adapt to uneven surfaces, and protect neurovasculature
Elbow Disorders
Elbow anatomy
- synovial hinge joint
- 3 joints which form functional unite w/in single articular capsule: humeroulnar joint, humeroradial joint, proximal radioulnar joint
- motions of elbow: extenion/flexion; pronation/supination
Elbow Disorders
define Cozen and Maudsley tests
- Cozen: resisted wrist extension with elbow extended and forearm pronated
- Maudsley: resisted extension of middle finger
Elbow Disorders
5 muscles that form the common flexor tendor + their innervations
Innervated by Median Nerve
* pronator teres
* flexor carpi radialis
* palmaris longus
* flexor digitorum superficialis
Innervated by Ulnar Nerve
* flexor carpi ulnaris
Bone Tumors
children vs adult
- peds: most are benign; if malignant suspect osteosarcoma, Ewing sarcoma
- adults: metastatic 100x more common; metastases commonly from breast, lung, thyroid, prostate, or renal cancers
Bone Tumors
proto-onco genes
- genes that promote normal cell growth
- with mutations, proto-oncogenes become oncogenes which overstimulate cell growth
Bone Tumors
tumor suppressor genes
help balance cell growth by promoting apoptosis of mutated cells
Bone Tumors
primary malignant bone tumors
4
- multiple myeloma
- chondrosarcoma
- ewing sarcoma
- osteosarcoma
Bone Tumors
how multiple myeloma destroys bone
- Lytic Lesions: plasma cells activate osteoclasts which promote bone destruction
- Hypercalcemia: increased bone destruction leads to increased serum calcium
Bone Tumors
osteoma vs osteoblastoma
- osteoma: < 1.5 cm
- osteoblastoma: > 1.5 cm
Osteoporosis
pathophys
- bone is continually being formed and resorbed (formation = resoprtion)
- peak bone mass around age 30 and plateaus for 10 yrs
- bone loss then occurs at a rate of 0.3-0.5% each year until menopause then there is a 3-5% loss in bone density for 5-7 yrs
- osteoporotic bone loss affects cortical and spongy/trabecular bone leading to a fragile/porous bone
Osteoporosis
describe fragility fractures
- occur after less trauma than might be expected to fracture a bone (ex: fall while standing, falling out of bed, coughing)
- common sites: distal radius, spine, femoral neck, proximal humerus, pelvis
Osteoporosis
types of primary osteoporosiss
- overall: 95% of post-menopausal women; 80% of male cases
- Type 1: estrogen deficiency (increased osteoclasts, reduced osteoblasts)
- Type 2: age-related loss of bone mineral density
Osteoporosis
secondary osteoporosis
- overall: 5% of female cases; 20% of male cases
- can be caused by disease (bone marrow/endocrine disorders), deficiency (malabsorption, vit D), drugs
Osteoporosis
biggest med risks for secondary osteoporosis
3
steroids, PPIs, aromatase inhibitors (block estrogen)
Osteoporosis
purpose of DEXA scans
- define osteopenia and osteoporosis by providing a quantitative measure of bone loss
- predicts risk of fracture
- monitors patients undergoing tx
Osteoporosis
DEXA T vs Z score
- T score: standard deviation differenec between the patient’s BMD and reference BMD of younger population of same sex/ethnicity/race
- Z Score: standard deviation difference between pt’s BMD and that of an age-matched population of the same sex/race/ethnicity
Osteoporosis
interpreting T vs Z scores
T: if -1 to -2.5 SD: osteopenia; if <-2.5 SD: osteoporosis
Z: <-2.0 SD: osteoporosis
Osteoporosis
FRAX Score
- Fracture Risk Assessment Score which predicts the 10 yr probability of major osteoporotic fractures
- Based on: age, gender, race, hx of fragility fracture, RA, family hx hip fracture, low BMI, hx steroid use, EtOH, current smoker, BMD of femoral neck
- Screen all pt >50 w/ FRAX
do not memorize, just be familiar
Osteoporosis
indications for pharmacotherapy in women and men
3 each
- women: hx fragility fracture, T score <-1, elevated 10 yr risk via FRAX
- men: fragility fracutres, FRAX estimations, BMD measurements
Osteoporosis
bisphosphonates overview
- end in “dronate” or “dronic acid”
- bind to hydroxyapatite binding sites on bone (areas w/ active resorption by osteoclasts)
- bone turnover reduced at 3 mo and reduced fx risk at 1 yr
- take on empty stomach w/ 8oz water (can cause esophageal irritation)
Osteoporosis
Hormonal replacement overview
- Estrogen + progesterone: not always given due to risk of thromboembolism, endometrial cancer, CAD, breast cancer
- Testosterone: replace in hypogonadal men
Osteoporosis
Misc Therapies
- Raloxifene: estrogen-agonistic effect on bone leading to increased bone mineral density and mass by decreasing bone resorption
- Denosumab: monoclonal ab against receptor activator of RANKL which is secreted by osteoblasts
- Calcitonin: opposes action of PTH leading to inhibited osteoclast activity and reduced bone resorption
Osteoarthritis
characteristics of synovial joints
- Articular Cartilage: made of hyaline, covers ends of bones, provides shock absorption/stability/lubrication
- Synovial Membrane: loose/vascularized connective tissue, secretes synovial fluid into joint cavity for lubrication
- Joint/Articular Capsule: fibrous connective tissue that surrounds the bony ends forming the joint
Osteoarthritis
primary vs secondary
- Primary: idiopathic
- Secondary: due to obesity, repeated trauma/surgery, infection, congenital abnormalities, metabolic disorders, bone disorders
Osteoarthritis
XR/PE evidence of osteophytes
- DIPs: Heberden’s nodes
- PIPs: Bouchard’s nodes
- 1st CMC: thumb squaring
Osteoarthritis
Stages of Osteoarthritis
- Stage 0: normal joint
- Stage 1: 10% cartilage loss
- Stage 2: joint space narrowing + osteophyte formation
- Stage 3: moderate joint space narrowing (crepitus) + continued osteophyte formation
- Stage 4: > 60% cartilage loss + severe joint space narrowing + large osteophytes
Pediatric Hip Disorders
describe being breech as a risk factor for DDH
- Frank Breech highest risk: both knees extended (i.e. bent in half)
- if a female baby is born breech, they should ALL undergo US screening for DDH
Pediatric Hip Disorders
DDH hip XR H line
- drawn horizontally through the inferior portion of the iliac bones at the triradiate cartilages
Pediatric Hip Disorders
DDH PE tests as newborn & describe
- Barlow: dislocation of hips at rest; child’s hips adducted while applying posterior force –> positive when femoral head is felt slipping (posteriorly) our of the acetabulum
- Ortolani: reduction of the hips at rest; from an adducted position, the child’s hip is abducted while the trochanter is pushed anteriorly –> positive when “hip clunk” is felt or if the hip is reduced
Pediatric Hip Disorders
DDH PE tests as infants age & describe
- Galeazzi: child lays supine w/ hips flexed to 45deg and knees at 90deg; pos if one knee is higher than the other (indicates possible posterior displacement of the femur)
- Klisic: place a finger on the greater trochanter and the ASIS –> draw “line” through both fingertips –> if the line is below the umbilicus, the test is pos
Pediatric Hip Disorders
endocrine & renal work up for who? includes what?
- children < 10 yrs and wt < 50th percentile
- TSH, free T4, BUN, creatinine
Pediatric Hip Disorders
SCFE Drehmann sign
external rotation w/ passive hip flexion to 90deg
