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Musculoskeletal and Skin > MSS-Week 2 > Flashcards

MSS-Week 2 Flashcards

1
Q

Limb Development

A

Mesenchyme: Somatic mesoderm, somitic mesoderm
surface ectoderm
Upper limb ahead of lower by 1-2days
Week 4: limb fields of somatic mesoderm
Budding: apical ectodermal ridge (AER), mesoderm thickening
Week 5-9: lengthening, epithelial-mesenchymal interactions at AER interface
Differentiation: proximal->distal
somatic mesoderm->cartilage
somite derived myoblasts-> skeletal muscle

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2
Q

Limb development Axes

A

Proximal-distal: elongation, segment formation
Anterior-Posterior: digit devo (zone of polarizing activity- posterior border of limb)
Dorsal-ventral: compartments, muscles and neurovascular

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3
Q

Scaphoid fracture

A

FOOSH (fall onto outstretched hand)
snuffbox tenderness
immobilize w splint
can have problem with necrosis bc retrograde blood supply through bone

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4
Q

Femoral head fracture

A

Like scaphoid, can have blood supply probs bc medial circumflex may be disrupted

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5
Q

Recurrent shoulder dislocations

A

pain from all motion
crepitus, strength wnl
positive apprehension sign
Arthritis bc of recurrent trauma

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6
Q

Arthritis

A

stiffness (esp after rest)
worse again after prolonged use
joint line tenderness, mild swelling, deformity
NSAIDs, cortisone, surgery, PT, hyaluronic acid injection

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7
Q

Capsulitis

A

Joint capsule thickening, inflammation, scarring
risk factors: injury, diabetes, thyroid dx
Limited ROM, painful early (freeze), then non-painful (frozen), then non-painful with increasing ROM (thaw)
Gradually tightening endpoint w/ decreased ROM
Takes 2 yrs, maintain ROM, pain control

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8
Q

Bicep tendon rupture

A

pop in shoulder while pulling
FROM, normal strength
muscle bulge

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9
Q

Enthesopathy

A

Disorder of muscular or tendinous bony attachment

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10
Q

Tendititis

A

Acute inflammation of tendon

traumatic blow or pull

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11
Q

Tendinosis

A

Chronic degenerative condition of tendon

submaximal repititive irritation

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12
Q

Strain

A

Muscle fiber damage from overstretching
usually from eccentric loading
stiffness, bruising, swelling, soreness

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13
Q

Acromioclavicular sprain

A 
most common fall directly onto shoulder
pain with overhead motion, deformity of shoulder
pain with cross-body adduction
Grade I: AC ligament injury
Grade II: AC tear and CC stretch
Grade III: AC+CC tear
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14
Q

Sprain

A 
Ligamentous damage from overloading
instability or laxity, swelling
Grade I: micro damage
Grade II: partial tear
Grade III: complete tear
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15
Q

Shoulder dislocation

A

Most common: anterior (subcoracoid) (90%), open-arm tackle
Should check sensation of axiallary and musculocutaneous nerves
apprehension test
Vacuum (capsule pressure) is most effective passive stabilizer

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16
Q

Carpal tunnel syndrome

A

median nerve compression in wrist
flexor retinaculum
after long time, thenar wasting, parasthesias

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17
Q

Pathologic fractures

A

e.g. from bone cancers

when something that shouldnt have broken a bone breaks a bone

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18
Q

Myotomes

A 
C5- elbow flex (bicep)
C6- wrist extend (brachioradialis)
C7- elbow extend (triceps)
C8- distal finger flex
T1- little finger abduction
L2- hip flexor
L3- knee extend
L4- ankle dorsiflex (quadracep)
L5- big toe extend (medial hamstring)
S1- ankle plantarflex (gastroc)
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19
Q

Dermatomes

A 
C3- supraclavicular fossar
C4- AC joint
C5- lateral antecubital fossa
C6- thumb
C7- long finger
C8- little finger
T1- medial antecubital fossa
T4- nipples
T10- umbilicus
T12/L1- inguinal/groin
L3- medial femoral condyle
L4- medial malleolus
L5- foot dorsum
S1- lateral heel
S2- popliteal fossa
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20
Q

Muscle strength scale

A 
5/5= normal
4/5= against gravity and mod resistance
3/5= against gravity
2/5= movement but not against gravity
1/5= trace movements
0/5= no contraction
21
Q

Reflex test scale

A 
0= absent
1= less than normal
2= low end of normal
3= high end of normal
4= more than normal/clonus
22
Q

Lhermitte’s sign

A

passive anterior cervical flexion-> electric-like sensation down spine/extremities
implies cervical spinal cord pathology

23
Q

Spurling’s Neck Compression test

A

Cervical spine extension, rotation, lateral flexion-> radicular sx
nerve root pathology

24
Q

Hoffman’s sign

A

Flick middle finger distal phalanx-> flexion-adduction of ipsilateral thumb and index finger
upper motor neuron problem

25
Q

Straight-leg raising test

A

lie supine, raise leg with knee extended-> pain at 30-70deg-> lumbar nerve root path (L5 or S1)

26
Q

Femoral nerve stretch test

A

pt prone, flex knee, extend hip-> pain on anterior thigh

upper lumbar nerve root path (L2-L4)

27
Q

Lumbar strain

A

axial low back pain after acute injury, better with rest, muscle problem
localized muscle tenderness, reduced ROM, normal neuro
tx: rest, NSAIDs, PT

28
Q

Radiculopathy

A

usually posterolateral disc herniation
affects nerve root of the higher number (e.g. L3-L4 disc hernia pinches L4 nerve root)
Most common: C6,7 and L5,S1
Both physical/mechanical and biochemical irritation of nerve root
sx: myotomal weakness, dermatomal pain/numbness, decreased reflex, spurling or SLR positive
tx: lass activity (no bedrest), pain meds, PT, epidural steroids for pain, sometimes surgery if refractory or bowel/bladder issues

29
Q

Ankylosing Spondylitis

A

Sx: chronic back stiffness, worse in morning/after rest, gradually progressive, decreased ROM, normal neuro
Early: widening of sacroiliac joints, adjacent sclerosis, sacroiliitis
Late: fusion of both sacroiliac joints
Chronic inflammatory disease of sacroiliac and axial skeletal joints (3:1 male)
Labs: elevated CRP, Sed
Tx: NSAIDs, PT, sometimes anti-TNFa agents

30
Q

Facet joint arthropathy

A

axial low back pain, gradual onset,, cervical worse with extension, lumbar worse walking
degenerative changes/osteoarthritis of facet joints
pain on active extension, relieved with flexion
Tx: NSAIDs, PT, joint steroid injections

31
Q

Lumbar stenosis

A

Slowly progressive pain in back and legs, worse walking, relieved with flexion
narrowing of spinal canal (disc, osseous thickening, ligament flavum thickening)
Tx: PT, gait aid (walker), NSAIDs, epidural steroids, sometimes surgery

32
Q

Compression fracture (spine)

A

usually in weaker anterior triangle part of lumbar vertebre
usually with osteoporosis, many asymptomatic
sudden onset, worse with flexion/movement
usually no leg pain
local tenderness, painful ROM, normal neuro
Tx: NSAIDs, acetaminophen, calctonin, mild opiods, bracing, workup osteoporosis or malignancy suspect

33
Q

Cauda Equina Syndrome

A

Leg pain, numbness, weakness, saddle anesthesia, bowel/bladder dysfunction
usually herniated disc compressing cauda equina
absent reflexes, weakness, decreased rectal tone
Tx: surgical emergency

34
Q

Cervical myopathy

A

loss of fine motor skills, gait disturbance, BB dysfunction, motor weakness, LE numbness, >50yo
upper and lower motor neuron findings, hyperreflexia
Lhermitte, Romberg +
wide base, ataxic
spinal cord compression, uaually osteophyte
Tx: surgery, laminectomy

35
Q

Scoliosis

A

lateral and rotational curve of spine

36
Q

Kyphosis

A

hunchback, flexion of thoracic spine

37
Q

Lordosis

A

Swayback, accentuated extension of lumbar spine

38
Q

Spondylolysis

A

congenital defect or acquired stress fracture of the lamina, usually L5-S1 site
Scottie dog with a collar

39
Q

Spondylolisthesis

A

Bilateral (dislocation) and anterior displacement of L5 body body and transverse process
Scottie dog with broken neck

40
Q

Slipped Capital Femoral Epiphysis (SCFE)

A

overweight early adolescent with groin and knee pain, often bilateral
repititive overload, vague sx, worse with activity
limited hip internal rotation, visible on XRay
Tx: surgery

41
Q

Transient Synovitis of the hip

A

ages 3-10, usually viral, post-vaccine, or drug induced
holds hip flexed and external rotated, motion causes pain
test: sed rate increased, leukocytosis
Tx: NSAIDs

42
Q

Septic Joint

A 
from gonorrhea or skin flora
swollen, painful joint
ROM extreme pain
red, hot joint, usually systemic signs
Tx: surgical drainage+ IV antibiotics
43
Q

Osgood-Schlatter Condition

A

Muscle pulls off a small piece of bone due to weak immature skeleton
Tibial tubercle

44
Q

Apophysitis

A

Pain and inflammation of ossification centers from repetitive tension (can lead to bony knob on anterior knee)
Tx: activity, stretching, NSAIDs

45
Q

Effusions vs Bursitis vs Ganglions

A

Effusion: fluid in joint, uniform and diffuse, non-mobile
Bursitis: usually squishy, localized and mobile
Ganglion: fluid filled soft tissue mass, usually hard, common on wrist, relatively small

46
Q

Unhappy Triad

A

Rupture of ACL, MCL, and lateral meniscus

47
Q

Lachman test

A

Knee slighlty bent, pull forward on tibia-> ACL tear

48
Q

Compartment syndrome

A

When pressure builds inside a compartment enough to cut off blood supply
can be due to edema or exertional
Exertional: anterior tibia most common

Musculoskeletal and Skin (4 decks)

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