Orthopedics Flashcards
Brachial Plexus injury most commonly occurs as a result of ______ ______
birth trauma
Where is the injury in Erb’s palsy? What are the clinical features?
Upper brachial plexus injury involving the C5 and C6 nerve roots
Clinical features includ a flaccid arm and an asymmetric Moro reflex; Arm held in internal rotation with the elbow extended and forearm pronated (waiters tip)
Where is the injury in Klumpke’s palsy? What are the clinical features?
Lower brachial plexus injury involving C7 and C8 nerve roots
Clinical features include a claw hand owing to the unopposed finger flexion and decreased ability to extend the elbow and flex the wrist
How is congenital aplasia of the brachial plexus (Erb’s and Klumpke’s) diagnosed?
Diagnosis is on basis of history and physical examination
May include a plain radiograph of the shoulder to evaluate for associated clavicular fracture
EMG and nerve conduction studies to assess for neuropathy or myopathy
For congeital brachial plexus aplasias, improvement is often noted within ______ hours
48
What is nursemaid’s elbow? What is the mechanism of injury?
Subluxation of the radial head; Upward force on the arm causes the radial head to slip out of the annular ligament which normally keeps it in place
What are the clinical features of Nursemaid’s elbow?
- Sudden onset of pain which is difficult to localize
- Elbow is held flexed and no swelling is present; hand function is normal
What is the management for nursemaids elbow? Why is radiograph not needed?
Management: Treatment of the subluxation is to reduce it by simultaneously flexing the elbow and supinating the hand
Diagnosis is on the basis of clinical presenation; if a film is ordered, the technologist may accidentally reduce the subluxation in the process of positioning the arm for the radiograph
How are anterior shoulder dislocations diagnosed?
Diagnosis is based on radiographs (axillary view) of the glenohumeral joint to visualize the dislocation
What is the treatment of anterior shoulder dislocation? What is the recurrence rate in adolescents?
Treatment is immobilzation after closed reduction
Recurrence of dislocation approaches 90% in the adolescent population
What is torticollis?
Tilting of the head to one side; either congenital or acquired
What causes congenital torticollis?
Usually the result of uterine constraint or birth trauma, either of which causes conracture of the sternocleidomastoid muscle
Can also be caused by Klippel-Feil syndrome, a cervical spine deformity
What are the clinical features of torticollis?
- Head is tilted toward the affected side with the chin pointed away from the contracture
- Decreased range of motion and stiffness are noted when stretching the head to the opposite side
What is the management for Torticollis?
Treatment includes stretching exercises to relieve the muscle contracture; if head asymmetry is noted, helmet therapy must be initiated by 4-6 months of age to correct head shape as the head grows
What can cause acquired torticollis?
Causes may include cervical adenitis, peritonsillar or retropharyngeal abscess, cervical diskitis or osteomyelitis….
What is atlantoaxial instability?
Caused by an unstable joint between the occiput and the first cervical vertebrae or between the first and second cervical vertebrae
What are the clinical features of atlantoaxial instability?
Physical exam is usually normal and patients are usually asymptomatic
Spinal cord injury may occur if a patient with instability sustains injury
How is atlantoaxial instability diagnosed?
How is it managed when severe?
Diagnosis is made on the basis of lateral flexion-extension radiographs of the cervical spine
Mangement includes fusion of C1 and C2
What is Klippel-Feil syndrome?
Failure of normal vertebral segmentation that results in relative fusion of the involved vertebrae
What is Sprengel’s deformity (associated with Klippel-Feil syndrome)?
Congenital abnormality of the scapula in which the scapula is rotated laterally leading to should asymmetry and diminished shoulder motion
What are the clinical features of scoliosis?
Asymmetry of the shoulder height, scapular position and the waistline may be present; Pain is absent
What positional should radiographs be taken to diagnose scoliosis? What is calculated to measure the degree of scoliosis?
Standing posterior-anterior (PA) and lateral radiographs of the spine
Cobb angle
Describe the management for the following levels of scoliosis
- 10-20° of scoliosis:
- 20-40° of scoliosis:
- >40° of scoliosis:
- 10-20° of scoliosis: Follow up scoliosis film is obtained 4-6 months later; 5° of progression is considered significant
- 20-40° of scoliosis: Bracing is indicated
- >40° of scoliosis: Surgery is indicated
After growth has concluded, surgery is considered if scoliosis is > __°
50°