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Block 4 > Musculoskeletal Conditions > Flashcards

Musculoskeletal Conditions Flashcards

1
Q

Dens (C2) Fracture

A

Most common upper cervical spine fracture

car accidents and falls

fracture at base of dens and may result in posterior displacement of dens towards the spinal cord in 15% of cases

blood supply to majority of dens is tenuous - delayed healing

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2
Q

Hyperflexion Teardrop Fracture

A

Cervical fracture where a triangular tear shaped fragment is avulsed by the anterior longitudinal ligament.

Hyperflexion (most serious), severe flexion force, head-on collision in car, vertebral body is posteriorly distracted.

facets are subluxed -> incomplete/partial separation which can lead to compression of spinal cord if it is unstable.

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3
Q

Extension Teardrop Fracture

A

Cervical fracture resulting from blow to the forehead or chin as from a fall.

A bone fragment is avulsed from anterior portion of cervical vertebrae - fall and hit face, usually at C2 or C3 vertebra - attached to anterior longitudinal ligament

Stable, not usually responsible for spinal cord injury

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4
Q

Vertebral Axial Load Burst Fracture

A

Fracture from traumatic injury where compression anteriorly and posteriorly

Falls from a great height - force of fall extends from buttocks to vertebral body - exploding

severe injury frequently injures spinal cord/cauda equina

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5
Q

Jefferson Axial Load Burst Fracture

A

Cervical fracture where vertebra is compressed anteriorly and posteriorly

Usually from direct blow to top of head which fractures both anterior and posterior neural arches of C1

C1 expands, spinal cord injury is uncommon

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6
Q

Cervical Degenerative Disk Disease (OA)

A

Osteoarthritis

intervertebral disc - normal aging, loss of flexibility/ shock absorption

in nucleus pulposus - less proteoglycans

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7
Q

Cervical Disk Herniation

A

Microtears will lead to larger tears

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8
Q

Whiplash Syndrome

A

Sudden force - injury

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9
Q

Atlantoaxial Instability

A

increased mobility of atlantoaxial joint between C1 arch and dens C2

transverse ligament abnormality

subluxation of dens

normal predental space ~3mm

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10
Q

Cervical Radiculopathy

A

Compression/injury to spinal nerve roots - compression, herniation, or osteophytes

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11
Q

Lumbar Degenerative Disk Disease (OA)

A

degenerative disc disease/ osteoarthiritis of lumbar spine

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12
Q

Lumbar Disk Herniation

A

microtears, inflammatory response

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13
Q

Sacroiliac Joint Dysfunction

A

changes in alignment of sacroiliac joint, ligaments cna shorten or become tight or lax

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14
Q

Scoliosis

A

lateral curvature of the spine, thoracic and lumbar regions and associated with rotation of the vertebra.

right: dextroscoliosis
left: levoscoliosis

girls are 7x more likely to have progressive curvature up until puberty

mild<10 degree, not treated
20-30 degrees - monitor for progression, brace to prevent progression: needs to be worn night and day
>40 = severe, surgery

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15
Q

Ankylosing Spondylitis

A

joint fusion/ spinal inflammation

chronic seronegative spondyloarthropathy - axial involvement

associated with class I HLA-B27 gene

sacroiliac joints - sacroillitis

progressive stiffening of the spine, ankylosis, fusion of spinal joints, enthesis inflammation

bamboo spine; more common in men (2-3:1), ~20-30 yr onste, ~ 9 years lapse between onset and diagnosis; 0.2-0.3% incidence in US, worse with rest, better with activity. Later in disease, sacroiliac joints appear widened - sheets of ossification ultimately

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16
Q

Lumbar Muscle Strain

A

muscle strain

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17
Q

Lumbar Spinal Stenosis

A

narrowing of vertebral foramen due to osteophytes

may lead to lumbar radiculopathy - L5, S1 most common

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18
Q

Spondylolysis/Spondylolisthesis

A

Spondylolysis - fracture of pars interartiularis between superior and inferior articular processes of vertebra usually in L5/S1

Spondylolisthesis - slippage of the body of the vertebrae (due to degenerative disc disease in old people, spondylolysis in young people)

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19
Q

Spinal Compression - Osteoporosis

A
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20
Q

Spinal Compression - Trauma

A

traumatic - falls, more collapsed, more pain

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21
Q

Cervical Muscle Strain

A

neck pain/ headaches

tension in paraspinal muscles - compress greater occipital nerve C2

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22
Q

Cervical Spinal Stenosis

A

narrowing of cervical spinal canal

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23
Q

Cervical roots and corresponding pain or sensation changes

A

C5 - point of shoulder

C6- thumb

C7 - midlde finger

C8 - little finger

T1 - medial forearm

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24
Q

Cervical roots and Movement Deficitis

A

C5 - shoulder abduction

C6 - elbow flexion, wrist extension

C7 - elbow extension

C8/ T1 - intrinsic hand muscles

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25
Q

Lumbar Spinal Compression

A

in osteoporosis, collapsing and crushing of bone

severity varies

typically at thoracic (thoracic lumbar junction)

26
Q

Lumbar Roots and associated Pain Location

A

L2-3 - anterior and mid-thigh

L4 - knee and medial malleolus

L5 - Web between 1st and 2nd toe

S1 - lateral malleolus

27
Q

Lumbar Roots and Movements

A

L2-4 - knee extension, hip adduction

L5- Ankle dorsiflexion, big toe extension

S1- Ankle plantarflexion, knee flexion

28
Q

Humeral Surgical Neck Fracture

A

most common proximal humerus fracture - often caused by falling onto an outstretched hand or direct impact to the shoulder (elderly people with osteoporosis are at greatest risk)

most commonly injured nerve is the axillary nerve - injury to the axillary nerve results in sensory change over the deltoid muscle and weakness with abduction of shoulder joint

29
Q

Humerus midshaft fracture

A

pathologic

bone has been weakened by pathologic lesion, trivial pressure on humerus can cause this fracture

(benign/malignant neoplasms, osteomyelitis, Paget’s disease)

depending on fracture location, may cause injury to radial nerver resulting in loss of sensation over dorsum of the hand and weakness on wrist extension

30
Q

Clavicle Fracture

A

very common and most common childhood fractures since the clavicle does not completely ossify until the late teens, ~80% of clavicular fractures occur in middle 1/3 of clavicle

proximal fragment will typically displace upward because of pull of the sternocleidomastoid muscle

direct force applied to the lateral aspect of shoulder as a result of a fall onto outstretched hands

31
Q

Shoulder Instability and Dislocation

A

less than 1/3 head of humerus is in contact with glenoid cavity - labrum, joint capsule, capsular ligaments, adn rotator cuff muscle tendons

ligament laxity (developmental from repeated injuries, age-related degeneration)

inferior glenohumoral ligament is most common ligament that becomes lax and predisposes individual to anterior dislocation

result of acute trauma to anterior shoulder - posterior transitory force on flexed shoulder joint

exam: locally tender muscles, and + sulcus sign

clinical inspection: obvious asymmetry and deformity if dislocated, limited range of motion, diffuse tenderness

NSAIDS, opiods, joint reduction, strength training of surrounding muscles, avoid combination movesments of shoulder abduction and external rotation (throwing motion, volleyball spike)

32
Q

Acromioclavicular (AC) Joint Injury

A

AC joint injuries commonly result forma fall or blow to top of shoulder - acromion driven to the ground, variable ligament injuries

Grade I: AC joint sprain - limited injury to AC joint ligaments but strong coracoclavicular ligaments are not injured, no separation of clavicle from acromion

Grade II: AC joint separation - both AC joint ligament and coracobacromial ligaments are injured, partial separation of clavicle from acromion

Grade III AC joint separation - most serious, complete separation of clavicle from acromion

If sprained - some swelling/tenderness, loss of shoulder movement, especially adduction due to pain, separation causes severe pain

33
Q

Adhesive Capsulitis

A

frozen shoulder, chronic immobility of the shoulder joint, scarring, thickening, and possible inflammation of shoulder joint capsule

progressive loss of range of motion

2 cateogories of patients:

  1. patients w/o pre-existing shoulder condition - limited shoulder movement from other conditions (stroke, muscle weakness, brain injury)
  2. patients with pre-existing shoulder conditions (shoulder impingement, OA of shoulder, had surgery)

age 40-70yrs, 3% of the population tend to develop this within a lifetime, and females more than males

dull, deep ache at shoulder joint, gradual, increased pain with shoulder movement and difficulty sleeping on affected side

34
Q

Shoulder Impingement Syndrome

A

rotator cuff tendonitis, supraspinatus tendonitis, subacromial bursitis, calcific bursitis, or tendonitis

shoulder impingement - result of degenerative process in shoulder joint region that is exacerbated by overuse

previous injury, ischemia to rotator cuff tendons, (supraspinatus), microtears, acute inflammation - repair, increased vascularization, granulation tissue and deposition of calcium crystals = begins to collect beneath subacromial bursa, where additional inflammatory response takes place. full thickness tears in rotator cuff tear - more cytokines erode bony surfaces, gradual onset of anterior and lateral shoulder pain exacerbated by reaching overhead

muscle atrophy from disuse, positive Hawkin’s and Neer’s sign

MRI outstanding at providing high res tears

35
Q

Thoracic Outlet Syndrome

A

common condition that results from compression of lower trunk of brachial plexus and/or subclavian vessels as they course through narrow space between clavicle and first rib

secondary to developmental abnormalities

women 2-50 most commonly affected

compression of brachial plexus: pain, paresthesias along aspect of forearm, hand, medial 2 fingers

intermittent swelling and discoloration from compressed vessels, worse wth arm overhead

recommend home exercise promoting muscle strengthening and proper posture

36
Q

Brachial Plexopathy

A

nerve traction injury to shoulder area - weakness/sensory loss are symptoms - type and degree of injury and which parts (trunks, divisions, cords, nerves)

most common, upper trunk of brachial plexus

traction force applied to C5-6 nerve roots when shoulder is forcefully depressed and head tilted to opposite side = Erb’s Palsy - baby’s head is being pulled: arm hangs uselessly, paralysis of the shoulder girdle and biceps, loss of extension at wrist (waiter’s tip deformity)

burners/stingers - transient injuries to upper trunk involving C5-6 nerve roots = from contact sports

injury to lower trunk : Klumpke’s palsy, poor prognosis

Klumpke’s palsy - traction applied to C8-T1 nerve roots when arm is abducted (grabbing ledge when falling from a height) - “claw hand” - intrinsic muscles involved in leaving flexors unopposed

37
Q

Suprascapular Nerve Entrapment

A

arises in lateral aspect of the upper trunk of brachial plexus, courses across posterior triangle of the neck together with suprascapular artery passes through suprascapular notch of the superior border of the scapula

supplies supraspinatus, enters the infrascapular fossa and supplies the infraspinatus

a strong tight suprascapular ligament closes over the free margin of the suprascapular notch - nerve can become entrapped if pressure is placed on the ligament - from carrying a heavy purse or backpack

38
Q

Radial Nerve Entrapment

A

Upper arm - radial nerve is terminal branch of posterior cord of brachial plexus

cna be compressed in the axilla (crutches) and lead to tricep weakness and sensory abnormalities

radial groove deep to triceps brachii - hang arm over back of chair while sleeping = saturday night palsy

sensory changes - radial side of wrist and dorsum of lateral 3.5 fingers, not tips

motor deficits - inability to extend wrist, thumb and fingers

“wrist drop”

39
Q

Supracondylar Fracture

A
40
Q

Ulnar Shaft Fracture

A
41
Q

Radial Head Dislocation (Monteggia)

A
42
Q

Radial Head Fracture

A
43
Q

Greenstick Fracture

A
44
Q

Torus Fracture of Radius

A
45
Q

Colles’ Fracture

A
46
Q

Scaphoid Fracture

A
47
Q

Metacarpal #5 Angulated Neck Fracture

A
48
Q

Phalanx Growth Plate Injury

A
49
Q

Distal Phalanx Fracture

A
50
Q

Nursemaid’s Elbow

A
51
Q

Wrist and Hand Rhematoid Arthritis

A
52
Q

Hand Osteoarthritis

A
53
Q

Scapholunate Dissociation

A
54
Q

Medial Epicondylitis

A
55
Q

Lateral Epicondylitis

A
56
Q

Olecranon Bursitis

A
57
Q

DeQuervain Tenosynovitis

A
58
Q

Trigger Finger

A
59
Q

Carpal Tunnel Syndrome

A
60
Q

Cubital Tunnel Syndrome

A
61
Q

Radial Tunnel Syndrome

A
62
Q

Guyon Tunnel Syndrome

A

Block 4 (5 decks)

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