Musculotendinous pathologies Flashcards by ash box

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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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reduced movement at SI joint, causing unilateral back or butt pain - can radiate down leg

Sacroiliac Hypomobility

pain while sitting - achy/ stabbing/ shooting

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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

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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

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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

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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

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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

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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

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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

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deformity of the finger caused by damage to extensor tendon, finger is bent

Mallet Finger

features: finger tip droops, cannot straighten, pain

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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