Olinger Clinical Notes / Diseases

Question 1

A blow to the top of the head from a falling object or diving accident can fracture both arches of the Atlas. This fracture alone will not typically injure the Spinal Cord. However, if the Transverse L. is ruptured the Odontoid Process may injure the Spinal Cord.

Answer 1

Known as a Jefferson, or burst fracture

Question 2

The Axis is susceptible to fracture in primarily two places, the Odontoid Process and the Vertebral Arch. Fracture of the Vertebral Arch, occurs usually as a result of hyperextension of the Head on the neck (not of the Head and Neck as in whiplash). Fracture of the Odontoid Process may occur after a horizontal blow to the Head, and since the transverse L. is stronger than the Odontoid Process it breaks.

Answer 2

Hangman’s fracture

Question 3

A bony occurs in 24% of the population, refers to a developmental abnormality in which the Vertebral Lamina fail to fuse and close off the Vertebral Canal. This condition commonly occurs atL5 and S1, where it can go undetected due to the overlying skin. Often a tuft of hair exists over the defect. The condition also incorporates neural tissue.

Answer 3

It is referred to as Spina Bifida Cystica.

Question 4

Since articulating facets of the cervical vertebrae are more horizontal then other vertebrae and require less force to disclocate, why do they often not cause damage to the Spinal Cord?

Answer 4

They have a large vertebral foraman.

Question 5

How does each rib articulate with the vertebral column?

Answer 5

The Head of each Rib articulates with the Inferior Costal Demifacet of the Thoracic Vertebral segment above the Rib number and the Superior Costal Demifacet of the Thoracic Vertebral segment of the same number. The Costal Articulating Facet of the Tubercle articulates with the Thoracic Vertebral segment that is the same as the rib number.

Question 6

This is a degenerative joint disease which involves calcification of the edges of the vertebral body and can cause localized pain and stiffness. Separation of the Vertebra Arch from the Vertebral Body is a condition known as ______.

Answer 6

Spondylolysis

Question 7

Condition that occurs secondary to Spondylosis and involves the anterior displacement of the vertebral body on the Inferior Vertebral Segment.

Answer 7

Spondylolisthesis

Question 8

Narrowing of the Lumbar Vertebral Foramen is known as ________ and may cause compression of one or ore Spinal Nerve Roots. When this condition is further compounded with Intervertebral Disc bulging, Arthritic Proliferation and Ligamentous Degeneration the Vertebral Canal is considerably more compromised.

Answer 8

Lumbar Spinal Stenosis

Question 9

________is the partial or complete incorporation of the L5 Vertebral Segment into the Sacrum. ________ of the S1 Vertebra is the separation of the S1 vertebra from the Sacrum.

Answer 9

Sacralaization

Lumbarization

Question 10

What causes coccygeal trauma and coccygodynia?

Answer 10

Abrupt falls on the lower back and difficult child birth can result in bruising, dislocation or fracture of the Coccyx, Coccygodynia can follow coccygeal trauma, it is painful and difficult to treat.

Question 11

What are the curvetures of the spine?

Answer 11

The primary curvatures are the Thoracic and Sacral Kyphoses, the Secondary curvatures are the Cervical and Lumbar Lordoses.

Question 12

How are abnormal comformations of the spane named?

Answer 12

Abnormal curvatures of the spine are similarly named to the curvature they represent.

Kyphosis refers to exaggerated curving of the Thoracic Vertebral Column resulting in “hump- back.”

Lordosis refers to exaggerated curving of the Lumbar Vertebral Column resulting in “sway-back.”

Scoliosis refers to lateral curving of the spine, either to the right of left.

Question 13

Sprain of the Lateral Collateral L. and even avulsion of the lateral Part of the Proximal Phalanx of the Thumb.

Answer 13

An injury common to individuals who ride a Mechanical Bull and is therefore known as “Bull Rider’s Thumb.”

Question 14

Laxity or rupture of both collateral ligaments of the 1st Metacarpophalangeal Joints results in a hyperabduction of that joint.

Answer 14

“Skier’s Thumb,” or “Game-keeper’s Thumb.”

Question 15

Sudden hyperflexion of the Distal Interphalangeal Joint can avulse the attachment of the long extensor tendon with that tendon away from the Distal Phalanx.

Answer 15

A condition known as “Mallet Finger,” or “Baseball Finger.”

Question 16

Irritation of the Synovial Sheaths can cause an accumulation of mucopolysaccharide fluid that can form a usually painless lump known as a _________. Infections of the Synovial Sheath can cause swelling in very specific and characteristic configurations that follow the shapes of these sheaths.

Answer 16

Synovial, or Ganglion Csyt.

Question 17

A disease resulting in the shortening, thickening and fibrosis of the Palmar Aponeurosis and Palmar Fascia, that results in a partial flexion of the 4th and 5th Digits.

Answer 17

Dupuytren Contracture

Question 18

_______ is the most common fracture site on the Humerus is at the Surgical Neck.

________ is also susceptible to avulsion by the Supraspinatus, Infraspinatus and Teres minor Ms. that insert there.

Answer 18

The surgical neck

The greater turbicle

Question 19

_________ houses the Ulnar N. and when compressed is painful. This is the origin of the expression “funny-bone” relating to the presence of the Ulnar N. in this groove on the Humerus (humorous = funny).

Answer 19

The Groove for the Ulnar N.

Question 20

Severe abduction of the extended elbow, an abnormal movement at this joint, can result in _________

Answer 20

Avulsion of the Medial humeral Epicondyle.

Question 21

________ is common in cases of falling, because of the forceful nature of the Triceps Brachii M. this is considered an avulsion
fracture and is difficult to repair.

Answer 21

Fracture of the Olecranon, often referred to as “Fractured Elbow”

Question 22

Fractures of the Distal End of the Radius (from breaking falls) are common and are referred to as ________. The Styloid Process of the Ulna is often also avulsed in this situation.

Answer 22

Colle’s fracture

Question 23

__________ is the most commonly fractured Carpal Bone, and is usually the result of trying to break a fall, often the fracture in not visible on a radiograph and therefore misdiagnosed as a severe sprain. The distal fragment of bone is susceptible to avascular necrosis since it is usually separated from its blood supply.

Answer 23

The Scaphoid

Question 24

The depression between the Pisiform and Hamulus of the Hamate is known as _______ and the Ulnar N. passes through this canal and is susceptible to compression, which manifests as loss of sensation and muscular weakness.

Answer 24

The Ulnar Canal (Guyon Tunnel)

Question 25

The Head of the 5th Metacarpal is susceptible to fracture when an individual punches something with a closed fist, this condition is sometimes referred to as _______.

Answer 25

Boxer’s Fracture

Question 26

_________ are commonly the result of fingers being closed in a door, because of the intricate relationship between Phalanges and flexor tendons bone fragments must be realigned carefully to maintain function.

Answer 26

Fractures of the Distal Phalanges

Question 27

__________ commonly tears in individuals repeatedly throwing a ball, usually in response to a sudden contraction of the Biceps Brachii M. and occurs in the anterosuperior part of the Labrum.

Answer 27

The Glenoid Labrum

Question 28

Between what vertebrae is a needle inserted in lumbar puncture? What space are you trying to enter?

Answer 28

L3/L4 or L4/L5.

Get through the ligamentum flavin, pass into the lumbar cistern deep to the spinal dura and arachnoid matter.

Question 29

Describe the most common types of back pain.

Answer 29

Muscular pain is often the result of spasm in muscular tissue producing ischemia (inadequate blood supply)

Joint pain is usually the result of osteoarthritis or disease arthritis.

Fibroskeletal pain is usually a result of fractures and dislocation of ligamentous structures.

Question 30

The _____________ is susceptible to dislocation due to its mobility and relative instability. Due to the presence of the Coracoacromial Arch dislocation of the _____________ most commonly occurs anteriorly or inferiorly.

Answer 30

Glenohumeral Joint

Question 31

The _____________ is susceptible to injury and separation, often referred to as “_____________,” and is capable of separating with or without rupture of the Coracoclavicular L.

Answer 31

Acromioclavicular joint

Shoulder seperation

Question 32

Two of the more common Bursae to become inflamed are the __________ and the ____________.

Answer 32

Subcutaneous Olecranon

Bicipitoradial Bursa

Question 33

The Elbow is capable of being dislocated posteriorly in response to force transmitted along the long axis of the Forearm, this usually involves a tear in the __________.

Answer 33

Ulnar collaterol ligament

Question 34

Sometimes called “Student’s Elbow,” “Dart thrower’s Elbow” and “Miner’s Elbow” results from excessive friction between the Skin and the Olecranon.

Answer 34

Subcutaneous Olecranon Bursitis

Question 35

The Radial Head is capable of being dislocated out of the Annular L. to varying degrees, this injury typically occurs from pulling on the arm of a child. This is called _______

Answer 35

“Nursemaid’s Elbow” or “Pulled Elbow.”

Question 36

Injury to the superior part of the Brachial Plexus (Upper Plexus Injuries) typically affect C5 and C6 Anterior Rami.

Answer 36

An individual with an Upper Plexus Injury will have an Adducted and Medially Rotated Arm and an Extended Elbow, also known as Erb-Duchenne Palsy or “Waiter’s Tip Position.”

Question 37

Injury to the inferior part of the Brachial Plexus that is less common than Upper Plexus Injury and is usually the result of dramatically increasing the angle between the trunk and upper limb.

Answer 37

This typically affects the short muscles of the Hand and results in “Claw Hand” when the individual tries to make a fist, also known as Klumpke Paralysis.

Question 38

Compression of the Cords of the Brachial Plexus usually result in what?

Answer 38

Prolonged periods of working with the upper limb extended over the Head, this results in pain radiating down the Arm, loss of sensation, tingling of the arms and weakness of the Hands.

Question 39

Injury to the Musculocutaneous N. (rare) causes what?

Answer 39

While rare is possible with blunt force trauma and renders the anterior Brachial muscles paralyzed.

Question 40

Injury to the Axillary N results in what?

Answer 40

Atrophy of the Deltoid M. and loss of sensation over the superolateral Arm, where the Superior Lateral Brachial Cutaneous N. exists.

Question 41

What does injury to the ulnar nerve cause?

Answer 41

Claw hand

Question 42

Ulner nerve injury occurs where?

Answer 42

Posterior to the Medial Humeral Epicondyle, between the Ulnar and Humeral Heads of the Flexor Carpi Ulnaris M. (the so- called Cubital Tunnel), at the Wrist or in the Hand.

Question 43

What causes “Handle Bar Neuropathy”?

Answer 43

The Ulnar N. can be compressed when pressure is placed on the Hamulus of the Hamate B., like when riding a bike.

This can produce sensory loss on the medial side of the hand and weakness of the intrinsic hand muscles

Question 44

Injury to the Radial N. results in what?

Answer 44

“Wrist Drop”

Question 45

Describe the neurological effects of lesions in the spinal cord.

Answer 45

Question 46

In a Hangman’s fracture when is the Ondontoid process most likely to heal?

At it’s base or inferior to it’s base?

Answer 46

If the Odontoid Process breaks at its base it will usually not heal, because the Transverse L. is holding it away from its blood supply. If the Odontoid Process breaks inferior to the base it is much more likely to heal.

Question 47

Pope’s hand causes what?

Answer 47

Median nerve damage.