muscoloskeletal Flashcards
Coronoid what attaches
: AMCL (anterior bundle of the medial collateral ligament)
: mid 1/3 of capsule
: deep head of brachialis
LCL complex (think PLRI) - 4 components
: LUCL ( inserts at tubercle, primary restraint)
: LRCL (inserts in annular )
: ALCL
: Annular ligament
varus stress test
performed by stabilizing the femur and palpating the lateral joint line
MCL complex (think (posteromedial rotational instability) PMRI)- 3 components
: AOL/ AMCL (0 – 90 flexion)
: POL (> 90 flexion )
: Transverse (coopers ligament) useless
Primary stabilisers
: Ulnohumeral (Bony)
: MCL complex
:LCL complex
Secondary constraints
: Radiocapitellar joint
: AP Capsule
: common flexors and extensors origins
Cubitus valgus
a medical deformity in which the forearm is angled away from the body to a greater degree than normal when fully extended
Cubitus varus
a common deformity in which the extended forearm is deviated towards midline of the body
Ulnar neuritis, or cubital tunnel syndrome
inflammation of the ulnar nerve in the arm that results in numbness or weakness in the hand
elbow
look and compare
feel
range of motion
strength
suppurative flexor tenosynovitis
tenderness along tendon sheath
fusiform swelling
finger held in flexion
pain with massive flexion
motor actions of nerves
Radial nerve: thumb extension
Median nerve: thumb abduction
Ulnar nerve: cross finger, abduct fingers
Dupuytren’s contracture
hand deformity that usually develops over years. The condition affects a layer of tissue that lies under the skin of your palm. Knots of tissue form under the skin — eventually creating a thick cord that can pull one or more fingers into a bent position
signs in thumb
Froments sign - It tests the strength of the adductor pollicus of the thumb, which is innervated by the ulnar nerve and is weakened in ulnar nerve palsy
Wartenberg sign- involuntary abduction of the fifth (little) finger
Jeane sign - weak and unstable pinch with hyperextension of the thumb metacarpophalangeal
Glenohumeral Joint Stability
Static Articular congruency Scapular inclination Labrum (50% depth) Vacuum effect Glenohumeral ligaments
Dynamic
Rotator cuff
Long Head of Biceps
T-sign (Neer‟s sign)
Impingement against coracoacromial arch
Pain between 70-110º
Popeye sign
a pronounced bulging muscle in the distal aspect of the biceps region of the arm. It is clinically apparent with a complete long head of biceps tendon tear which causes distal migration of the long head of biceps muscle
MRI use on shoulder
Best for soft tissue evaluation and bone oedema
T1 weighted sequences (Fat bright, fluid/bone dark)- Useful for Hill-Sachs lesion
T2 weighted sequences (Fluid bright, bone dark)- Rotator cuff and labral pathology
Ultrasound of shoulder
Excellent to assess rotator cuff
Limited value for intraarticular structures
Neurological examination
must test for senstation, motor and reflexes
C5- deltoid and biceps
C6- biceps, wrist extensors
C7- triceps, wrist flexorss, finger extensors
C8- interossei mm, figer flexors
T1- interossei mm
Examine for myelopathy
L’hermitte’s Finger escape Grip and release Hoffman’s- Indicative of corticothalamic dysfunction Radial reflex
Thoracic outlet syndrome
a group of disorders that occur when blood vessels or nerves in the space between your collarbone and your first rib (thoracic outlet) are compressed.
This can cause pain in your shoulders and neck and numbness in your fingers
Carpal tunnel syndrome
symptoms usually start gradually and include: Tingling or numbness. You may notice tingling and numbness in your fingers or hand. Usually the thumb and index, middle or ring fingers are affected
Neurological Examination of spine
L4- tibialis ant
L5- extensor hallucis longis
cervical myelopathy
Some causes includes degenerative mostly like osteophytes, trauma, tumours, epidural abscesses or cervical kyphosis.
Neck pain and stiffness, extremety paresthesias
Gait imbalance, clumsiness of the hands
Rheumatoid cervical spondylitis
Present in 90% of patients with RA
Atlantoaxial subluxation
Basilar invagination
Subaxial subluxation >4mm or 20% may indicate cord compression
Ankylosing spondylitis/ Bechterew’s disease
strikes before 45yrs some but not all pts are HLA- B27 M>W treat with NSAIDs and biologics can cause: uveitis, IBD, psoriasis
Scheuermann’s disease
self-limiting skeletal disorder of childhood where the vertebrae grow unevenly with respect to the sagittal plane; that is, the posterior angle is often greater than the anterior causing kyphosis.
Spondylolisthesis
causes one of the lower vertebrae to slip forward onto the bone directly beneath it
82% L5 S1; 11% L4 L5
Complain of axial back pain, leg pain due to radiculopathy, neurogenic claudication
Most patients treated nonoperatively. AAA, lifestyle modifications and Physio
Cauda Equina syndrome
Bilateral leg pain, bowel and bladder dysfunction and saddle anesthesia as well as lower limb sensory motor changes
Disc herniations, spinal stenosis, tumours, trauma, spinal epidural haematoma, epidural abscess.
Patient requires urgent surgical decompression within 48 hours
With delayed presentation sexual dysfunction, urinary dysfunction requiring catheterization, chronic pain and persistent leg weakness will occur
Spinal TB
begins in metaphysis of anterior vertebral body
May spread via the Anterior longitudinal ligament to contiguous bodies and in 15% to non contiguous or skip lesions
Paraspinal abscess formation occurs in more than 50%
Severe kyphosis can form in chronic conditions-gibbus
vertebra plana
also known as the pancake or silver dollar or coin-on-edge vertebra, is the term given when a vertebral body has lost almost its entire height anteriorly and posteriorly, representing a very advanced compression fracture
causes of vertebra plana
Infection Malignancy/Multiple Myeloma Eosinophylic Granuloma Lymphoma/Luekemia TB/Trauma
Radicular pain, or radiculitis
pain “radiated” along the dermatome (sensory distribution) of a nerve due to inflammation or other irritation of the nerve root (radiculopathy) at its connection to the spinal column
