Musculotendinous pathologies Flashcards
abnormal fusion of at least two spinal bones in neck is called ?
Klippel-Feil Syndrome
- short neck, low hairline at back of head and restricted cervical spine movement
a congenital anomaly - elvated, dysplastic (underdeveloped and smaller scapula) restricting shoulder ROM
Sprengel’s Deformity
- in early fetal development, failure of the scapula to descend
- restricts movement of arm, one sh noticeably elevated
failure of fusion of the ventral aspects of the vertebrae during embryogenesis
Butterfly Vertebrae
often just 1 vertebra mostly in thoracolumbar spine
- ossification sites fail to form
- often asymptomatic, LB P, MB P
1/2 of vertebral body fails to form causing a wedge shaped vertebrae
Hemivertebrae
- can cause scoliosis
- commonly in mid-thoracic region (T8)
- embryo 3-6th week, failure of normal segmentation or formation
- neural tube defect due to lack of blood supply
- often asymptomatic, is severe - limb weakness, paralysis, incontinence, spinal pain
disc protrudes through the vertebral end plate into vertebral body causing inflammation and swelling
Schmorl’s Nodes
degenerative: weakness in endplate of vertebral body, nucleus pulposos of disc protrudes into vertebral body
- back pain, edema, herniated disc
- in 75% of people
-thoracolumbar spine - in aged spine
- gymnasts
vertebrae grow unevenly during childhood while growth is occurring causing a wedging of vertebra = causes spine to curve more than normal
Scheurermann’s Disease
- avascular necrosis of cartilage ring of vertebral body interrupting bone growth during growth sports
clinical features = early teens, slouching posture, mid-low BP worse w forward flexion, kyphosis develops over time
- home care = erector strengthening - supermans
cogenital anomaly of the chest wall causing 4-5 ribs on each side and the sternum to grow inward forming a DEPRESSION in the chest
Pectus Excavatum
- more common in boys, worsens in puberty
- rarely severe enough to interfere w heart & lungs functions
- associated w Marfans, Ehlers-Danlos, turner syndrome, osteogenesis imperfect
Features = indentation in chest
congenital anomaly of the chest wall causing 4-5 ribs on each side and the sternum to grow outward making it jut out
Pectus Carinatum
- worsens in puberty
- breast bone STICKS OUT
rounded, bulging chest like a barrel, appears inflated at all times
Barrel Chest
- may indicated COPD, osteoarthritis of ribs and sternum joints, occurs with kyphosis
- lungs are chronically overinflated
features: distention of rib cage, painless, difficulty breathing, SOB, stiffness, reduced O2 / increased CO2
cogenital anomaly where TVP L5 fuses to sacrum or ilium on one or both sides
Sacralization
- often L5/S1 is thin and narrow
- occurs in embryonic development
- mutated gen causes dysfunction in embryo when vertebra begin to ossify
features: often asymptomatic, LBP, arthritis at fusion site, bursitis, disc degeneration, limited ROM, postural imbalances, scoliosis, leg/butt pain
cogenital anomaly where the 1st and 2nd segments of the sacrum fail to fuse and are freely moveable
Lumbarization
- appears lumbar spine has 6 vertebra, 6th vertebra is called transitional, sacrum only has 4 segments
features: often asymptomatic, LBP, arthritis at fusion site, bursitis, disc degeneration, limited ROM, postural imbalances, scoliosis, leg/butt pain
ball and socket of hip doesn’t form properly in children/infants, the socket isn’t deep enough so hip is dislocated
Congenital Hip Dysplasia
- from crowding in the womb in last trimester may cause the hip joint to be pushed out of position
features: depending on age, one hip is less flexible, limping, osteoarthritis, labral tear
femoral neck deformity
Coxa Vara - deformity of femoral neck of hip, normal is 135-145, Vara is LESS than 110-120
Coxa Valga - angle in INCREASED
- from a failure of growth in epiphyseal plate
features: limb length discrepancy, femoral head subluxation, prominent greater trochanter, limited in abduction & internal rotation of hip
pubic symphysis joint is dislocated w/o fracture, ligaments are partially or completely torn
Pubic Symphysis Disruption
- in pregnant women, relaxin hormone makes ligaments stretchier
- looser ligs cause unstable joint to sublux
features: difficulty walking w severe P in pubic area, LBP
birth defect where the sacrum is underveloped w a large variation in severity
Sacral Dysplasia
- 3rd week of embyro formation of lower back/sacrum
features: partial loss of tail bone, asbsense of lower vertebrae, abnormal sized sacrum
reduced movement at SI joint, causing unilateral back or butt pain - can radiate down leg
Sacroiliac Hypomobility
- pain while sitting - achy/ stabbing/ shooting
increased / abnormal movement at SI joint causing unilateral back/butt pain that can radiate down leg
Sacroiliac Joint Hypermobility
- ligaments are loose, leads to instability
- pain while sitting, burning achy, shooting
degenerative osteoarthritis between centres of spinal vertebral joints around discs and the vertebral bodies at end plates
bone spurs grow
Spondylosis
- degeneration over time
features: mild pain, stiffness, grinding sound, weakness in hands/legs, numbness and tingling, poor coordination, mm pain, spams, headaches, loss of bladder/bowel control
defect in the pars interarticularis of vertebral arch on a vertebra
Spondylolysis
- bone is affected by repititive stress and common in lumbar spine
- weakened bone
features: asymptomatic, back pain that gets worse w activity or radiate and increase on back extension
- would palpate L5 pushed posteriorly
forward displacement of a vertebra on the one below, most often the 5th lumbar vertebra, common after break/fracture due to degeneration and wear and tear
Spondylolisthesis
- congenital, often acquire from sports
- wear & tear to lumbar spine
features: persistent low back pain, stiffness in legs (tight hamstrings, thigh pain
nonunion of ossification centres of a bone, most often affecting right side of body in girls
Upper Extremity Congenital Pseudarthrosis
Clavicle, Radius, Ulna
- subclavian artery malfunction
- failure of multiple ossification centres to join a complete bone during embryogenesis
features: asymptomatic, diagnosed at birth, bony abnormality usually visible
painful shoulder w restricted ROM occurring in 3 stages
Adhesive Capsulitis (frozen shoulder)
- Freezing stage - any movement causes pain, ROM decreases
- Frozen stage - pain diminishes, shoulder becomes stiffer
- Thawing stage - ROM begins to improve
synovial capsule covering the GH joint thickens and tightens
features: pain, stiffness, worsens over time then resolves over 1-3 years
ulnar collateral ligament is partially or completely torn from repetitive work/injuries
Ulnar Collateral Ligament Thumb / Gamekeepers thumb
pathogenesis: radially directed force causing hyperabduction of thumb
deformity of the finger caused by damage to extensor tendon, finger is bent
Mallet Finger
features: finger tip droops, cannot straighten, pain
injury to ligaments that straighten the middle joint of a finger causing deformity
Boutonniere Finger
- a forceful blow to the dorsal side of a flexed joint
- cannot straighten finger
rupture of flexor digitorum profundus (FDP) tendon where it attaches on the distal phalanx - most often 4th finger
Jersey Finger
- excessive force on tendon insertion
- FDP mm belly in maximal contraction during DIP extension
fracture at the base of the 1st metacarpal bone into CMC bone from forced ABDUCTION at 1st metacarpal
Bennet Finger
- intra-articular fracture at CMC joint causing subluxation or dislocation
- forced abduction at 1st metacarpal
compression neuropathy of the median nerve at the elbow by pronator teres mm
Pronator Teres Syndrome
features: pain, weakness of flexor pollicis longus, abductor pollicis brevis, sensory loss
Anterior Interosseous (nerve) syndrome
ulnar nerve is compressed through the narrow tunnel of Guyon
Ulnar Tunnel Syndrome
- common from ganglion cyst, hamate fracture
disruption of a nerve pathway in the sympathetic division of the ANS system for the brain to the face and eye on one side
Horner’s Syndrome
- decreased pupil size (miosis), drooping eyelid (ptosis) decreased sweating (anhidrosis) on one side of the face
radial nerve compression caused by improper & prolonged use of crutches
Crutch Palsy
- radial nerve winds around the spiral groove of the humerus in the extensor mm compartment of the forearm affecting the posterior interosseous branch causing finger and wrist drop
compression of the radial nerve in the axilla caused by resting the arm at the back of the chair for prolonged time
Saturday Night Palsy
- tricep and brachioradialis weakness, arm numbness, wrist and finger drop, weakness of thumb abductor, pinch and grio weakness, sensory loss on dorsum of hand and forearm
axillary nerve compression due to inflammation and swelling of a shoulder dislocation or traction forces
Axillary Nerve Palsy
features- ant. deltoid, teres minor weakness, sensory loss below shoulder, loss of movement
compression of the superficial branch of the radial nerve often where it lies between the brachioradialis and extensor capri radialis longus
Cheiralgia Paresthetica
- burning, shooting pain, numbness and tingling at dorsolateral aspect of hand
compression of suprascapular nerve causing weakness and pain in shoulder
Suprascapular Nerve Entrapment
- pain and weakness in arm/shoulder, burning radiation pain, pain worsens w shoulder movement, atrophy of infraspinatus
excessive traction or direct causes damage to the MOTOR ONLY long thoracic nerve causing weakness or paralysis
Long Thoracic Nerve Entrapment
- long thoracic nerve runs from the brachial plexus to various points on serratus anterior mm that holds the scapula against rib cage - when innervation is interupted it atrophies causing winged scapula
traction or compression injury to upper trunk of brachial plexus at C5/C6
Erb’s Palsy
nerves affected = axillary, musculocutaneous, suprascapular
- “waiter’s tip deformity - arm is medially rotated, forearm extended and pronated and wrist flexed
traction or compression injury to lower trunk of brachial plexus at C8/T1
Klumpke’s
- Claw Hand - forearm supinatedm wrist and fingers flexed
permanent shortening of a mm causing the joint to be flexed and fixated
Contracture
- mm atrophy, spasm, loss of skin elasticity, nerve damage, weakness, paralysis
slow gradual fibrosis of palmar fascia that creates a shortening and thickening of the 3,4,5 digits causing them to flexed
Dupuytren’s Contracture
- fibrotic process occurs causing shortening of flexor digits w hand deformity
nodules develop first in the palm then form longitudinal cord separate from nearby tendons
permanent shortening of forearm mm’s including hand, fingers, wrist resulting in claw deformity
Volkmann’s Contracture (Ischemic)
painful tendonitis affecting the radial side of the wrist below the thumb
De Quervain’s Tenosynovitis
- pain and swelling at base of thumb
posterior tibial nerve is compressed within the tarsal tunnel that runs between medial malleolus and flexor retinaculum
Tarsal Tunnel
- pain radiating into the foot on the medial side worsened by weight bearing, numbness, burning, tenderness
what does the Tarsal tunnel contain
tibialis posterior tendon
flexor digitorum tendon
posterior tibial artery and vein
tibial nerve
flexor hallucis longus tendon
compression or entrapment of the fibular (peroneal) nerve commonly at the knee
Fibular (Peroneal) Nerve Syndrome
- weakened ankle dorsiflexors, everters, foot drop, pain, sensory changes on the lateral side of the lower leg and foot
compression of lateral femoral cutaneous nerve causing burning pain and numbness in upper lateral thigh
Meralgia Paresthetica
- compression of nerve interrupts nerve impulse transmission
Cauda Equina Syndrome
collection of nerve roots that are compressed and inflamed causing motor/sensory symptoms to LE and bladder
- severe LB P, P in BL legs, saddle anesthesia, motor weakness, sensory loss, bladder dysfunction, bowel incontinence, sexual dysfunction
“Jumpers knee” pain between patella and tendon insertion on tibia
Patellar tendinitis
“runners knee” pain at and around patella
Patellofemoral Syndrome
pain around patella that worsens w activity, pain when walking up/down stairs
softening and breakdown of cartilage tissue on underside of patella causing anterior knee pain
Chondromalacia Patella
- cartilage degenerates causing swelling, friction, erosion of hyaline cartilage on patella
features: anterior knee pain worsened by weight bearing activities, minor swelling, weak vastus medialis and high Q angle
before growth plates are closed, the femoral head moves or slips off neck of femur
Slipped Capital Epiphysis
- head of femur remains in the acetabulum but rest of femur has shifted
- starts during growth spurt
- weakened growth plate at an oblique angle
groups of mm’s w nearby blood vessels and nerves are contained together in a compartment by fascia
restricts blood flow to the region causing mm damage
Compartment Syndrome
4 main compartments:
1. anterior
2. superfical posterior
3. deep posterior
4. lateral
acute= inflamm and swelling, pain, tingling/burning, numbness
chronic= develops slowly, cramping pain during exercise
** look for shiny surface on leg*
pain on posteromedial border of the tibia bone due to overuse and repetitive stress
periostitis occurs in tibia
Shin Splints or Medial Tibial Stress Syndrome
features: dull pain on distal 2/3 of the posteromedial border of tibia, often bilateral, worse on weight-bearing
bony outgrowth or osteophyte and calcium deposits on the calcaneus at attachment site of plantar fascia , type of avulsion that doesn’t fracture
Heel Spurs
calcaneal pain (especially first steps getting out of bed)
mm pain on mild exertion described as ache, cramp, caused by insufficient blood flow
Intermittent Claudication
- caused by peripheral artery atherosclerosis or cardiovascular disease
most often in calf muscle
- pain, ache, fatigue, cramp often in thighs, calves, butt, hips, feet - pain begins w exercise and improves w rest
injury of a growth plate affecting adolescents causing abnormal growth around ossification centres
Osteochondrosis
inflammation of patellar ligament on tibial tuberosity common in adolescent, painful bump just below the knee
Osgood Schlatter
- tenderness at tibial tubercle swelling, tight quads, hammys
repetitive traction pulls on the tuberlce and the growth plate leading to inflammation inside the growth plate
inflammation of achilles ligament where it attaches to the growth plate on calcaneus
Sever’s
repetitive traction pulls on the tuberlce and the growth plate leading to inflammation inside the growth plate
heel pain and tenderness under the heel
in childhood (4-10) an interruption of blood supply to the femoral head causing avascular necrosis and tissue death
Legg-Calve_Perthes
bone is weakened and fractures easily
pain in hip or groin worsens w activity, relieved by rest, mm spasms, intermittent
birth defect (congenital anomaly) from a neural tube defect
neural tube becomes the brain and spinal cord in a developing embryo
Spina Bifida
lack of B9 or folic acid
life threatening - spinal canal is open protruding the meninges and the spinal cord is exposed , open to infection
