Pathologies

Question 1

Accessory Navicular

Answer 1

Extra navicularIncorporated into tibialis posterior tendonPossible pain and tenderness in areaAssociated with pes planus, putting strain on tib post tendon, leading to inflammationAlso possible irritation from side of shoes

Question 2

Amyotrophic Lateral Sclerosis (ALS)

Answer 2

Amyotrophic Lateral Sclerosis AKA Lou Gehrig’s DiseaseOne of most common neuromuscular diseases, etiology unknown, not known to be autoimmuneDegeneration of upper and lower motor neuronsUnable to send messages to muscles which they control, which leads to atrophyNerves themselves degenerate, not myelin related (unlike MS)LOSS of ability to control VOLUNTARY movement Muscle Atrophy, Rapidly progressive weaknessSpasticityDysarthria (difficulty speaking)Dysphagia (difficulty swallowing)Dyspnea (difficulty breathing)Cognitive function generally sparedDoes not affect sensationSteady decline, worsening symptomsFatal

Question 3

Arthrogryposis

Answer 3

Congenital joint contracturesRare 1 / 11 000 live birthsGenetic/Environmental- intrauterine, decreased movement in wombAbnormal fibrosis of the muscle tissue, causing shorteningUnable to perform passive extension/flexion in affected joints

Question 4

Autonomic Dysreflexia

Answer 4

Sudden onset of excessively high blood pressureNot treated promptly, may lead to seizures, strokes and deathOften occurs in spinal cord injured individuals with lesions above T6HeadacheFlushed faceSweatingSlow heart rateReaction of autonomic (involuntary) nervous system to overstimulation (triggered by afferent stimuli), BP increases, HR slows and beomes irregular, BP cannot be restored to normal because of spinal cord damageCauses Overfull bladder/bowelUTIPressure soresBroken bonesTight clothing/DEVICES

Question 5

Avascular Necrosis

Answer 5

Cellular death (necrosis) of BONE components due to interruption of blood supplyWithout blood, bone tissue dies/collapsesIf involves bones of a joint, often leads to destruction of joint articular surfaces

Question 6

Blounts Disease

Answer 6

Growth disorder of the tibiaCauses lower leg to angle inward AKA tibial bowing / varaCan be rapidly progressiveThought to be due to effects of weight on the growth plateInner part of the tibia just below the knee fails to develop normally, causing angulation of the boneKAFO, or eventually surgery

Question 7

Bunions/Bunionette

Answer 7

Hallux abducto valgus deformityLateral deviation of the great toeControversial etiologyPoorly fitting shoes, Genetic factorsPressure applied to the side of the big toe, forces it inward toward and sometimes under or over the other toesBump is from swollen bursal sac or osseus anomaly, also part of the first met head tilted outTissue surrounding joint become swollen and tenderFirst met sesamoid bone may also become deviatedOrthotic splintsToe spacers/separatorsOrthotics (accommodative padding/shielding)Surgery

Question 8

Carpal Tunnel Syndrome (CTS)

Answer 8

Median entrapment neuropathyCauses Paresthesia (tingling), Pain, NumbnessPalmar aspect of Thumb, index, middle, radial half of ring fingerWrist painSometimes through the night (seems to be aggravated when sleeping with flexed wrist)Caused by crowding/irritation/compression of the median nerve within the carpal tunnel, thickening from irritated tendons or generalized swelling and irritation in the area can cause CTSCarpal tunnel made up of carpal bones, 9 flexors tendons, connective tissue

Question 9

Charcot Joint

Answer 9

AKA neuropathic arthropathy (joint disease)Progressive degeneration of weight bearing jointBony destructionBony resorptionJoint DeformityDecreased peripheral sensation, proprioception, fine motor controlPathological process can result in UlcerationSuperinfectionLoss of functionAmputationDeathUnderlying Mechanisms (2 theories)Neurotrauma- loss of peripheral sensation- leads to progressive microtrauma to the joint- damage goes unnoticed by patient- resultant inflammatory resorption of traumatized bone renders region weak and susceptible to further trauma-poor fine motor control generates unnatural pressure on certain joints-leading to additional microtraumaNeurovascular- neuropathic patients have dysregulated autonomic nervous system- desensitized joints receive significantly greater blood flow- hyperemia leads to osteoclastic Treatmentimmobilization total contact castPneumatic AFOSurgical correctionTakes 6-9 months for edema/erythema to recede

Question 10

Charcot Marie Tooth (CMT)

Answer 10

Hereditary Motor and Sensory Neuropathy, Demyelinating neuropathyOne of most common inherited neurological disorders affecting approx 1 / 2500 Characterized by Progressive loss of muscle tissueTouch sensationSymptoms usually begin late childhood, early adulthoodInitial symptom is foot dropClaw toe/Pes CavusAtrophy muscle tissue in legsWeakness in hands and forearmsLoss of touch sensationNeuropathic painPossible respiratory/GI problemsMust avoid prolonged periods of immobility as it can accelerate symptoms of CMTMutations cause defects in neuronal proteinsCause Demyelinating neuropathySCHWANN CELLS demyelinated, Myelin sheath may be damaged, may lead to axonal degenerationSchwann/Myelin/Axon damage leads to poor nerve conduction

Question 11

Chondromalacia Patella (CMP)

Answer 11

Inflammation of underside of the patella and cartilage softeningAKA patellofemoral pain syndromeCondition may result from acute injury to the patella or chronic friction between the patella and groove in the femur through which it passes during knee flexionOveruse, injury, neuromas, malignment, patellar maltracking etc. can cause deterioration and break down of the cartilageCartilage no longer smooth, making movement painful

Question 12

Club foot - Talipes Equinovarus

Answer 12

Congenital deformity involving one foot or bothInversion of subtalar joint, complete hindfoot inversionAdduction of forefoot at talonavicular joint and calcaneo cubiod joinitEquinus and varus ankleSupination of entire fototPlantarflexedMay appear to be walking on ankles, lateral sides of their feetNo single known cause, usually single isolated birth defect, associated with other birth defects such as spina bifidaSerial casting has shown to be effectiveFollowed by AFO orthosis to hold feet in plantargrade positionDenis Browne Bar, AFO, FOSurgery usually not necessary however 2 are performedTenotomy- release of achilles tendonAnterior tibial tendon transfer- tendon moved from first ray to the first ray to the third ray in order to release inward traction of foot

Question 13

Compartment Syndrome

Answer 13

An acute (trauma) or chronic (repetitive activity) condition affecting an upper or lower extremityCharacterized by increased pressure within a muscle compartment causing severe painSwelling within compartment contained by fascia causes increased intracompartmental pressureCompression of muscles, nerves and blood vessels within a closed space can lead to muscle, nerve and circulatory system damageIf left untreated, extensive tissue death can occur, amputation may be necessaryCan lead to volksmans contracture

Question 14

Congenital Diaphragmatic Hernia (CDH)

Answer 14

Congenital malformation of the diaphragmMost common type is Bochdalek hernia (95% of cases) - hole is posterolateral corner of diaphragm, allows passage of abdominal viscera into chest cavityMalformation of diaphragm allows abdominal organs to push into the proper lung formationLife threatening pathology in infantsCauses death due to 2 complicationsPulmonary hypolasia- incomplete development of the lungsPulmonary hypertension - excessively high blood pressure in pulmonary artery/veinAssociated with scoliosis

Question 15

Depuytren’s Contracture

Answer 15

Fixed flexion contracture of the hand due to palmar fibromatosis (palmar fascia abnormally thick)Inherited proliferative connective tissue disorderPalmar fascia thickens and shortens so that tendons connected to fingers cannot move freelyFingers bent toward the palm, cannot be fully extendedDecreased ability to grip objectsUsually painlessRing and little finger most commonly affected, middle finger in more advanced cases, index and thumb usually sparedContractures progress slowlyTable top test for diagnosis, hand on table, see if fingers touch the table

Question 16

Dequervain’s Tenosynovitis

Answer 16

Pain inflammation of 2 tendons in the thumb (extensor pollicus brevis, abductor pollicus Longus) Pain, swelling, tenderness over thumb side of the wrist and base of the thumbMotion may be difficult and painful especially when pinching/grasping objectsDifficulty grippingFrom Overuse, Repetitive Hand or wrist movement, or possibly trauma Finkelstein TestMake fist with thumb placed in palmWrist ulnarly deviated

Question 17

Down’s Syndrome

Answer 17

Genetic disorder caused by presence of all or part of a third copy of chromosome 21Most common chromosome abnormality in humansPhysical growth delaysMuscle hypotoniaExcessive joint laxity, atlanto-axial instabilityExcessive space between large toe and second toe

Question 18

Lateral Epicondylitis

Answer 18

AKA Tennis elbowPainful condition of elbow caused by OVERUSE (racquet sports or other activity) or traumaNON inflammatory, Degeneration of tendon’s attachment, weakening of anchor site, placing greater stress on areaPoint of soreness/tenderness over lateral epicondylePain from gripping movements of the wrist, especially wrist extensionExtensor muscles/tendons on lateral epicondyle of humerus damaged from overuseTendon usually involved is Extensor Carpi Radialis Brevis (ECRB)

Question 19

Medial Epicondylitis

Answer 19

AKA golfer’s elbow, pitcher’s elbowOveruse injury (or trauma) affecting flexor-pronator muscles originating on medial epicondyleRepetitive flexing, gripping, swing, can cause microtears in tendonsPain and inflammation of tendons

Question 20

Femoral Anteversion/Retroversion

Answer 20

Anteversion - Inward twisting of the femurRetroversion- Outward twisting of the femurOften occurs symmetricallyIn toeing gait, look to see if patella turned inwardBow-legged appearanceCaused by position in uterus, genetic?Normal child born with 40 degrees femoral anteversionGradually decreases to 10 to 15 degrees at adolescense

Question 21

Guilian-Barre

Answer 21

Rare neurological disorder where body’s immune system attacks its own peripheral nervesOften follows viral/bacterial infection3 / 100 000, mostly age 30-50Results in inflammation of the myelin and blockage of nerve conductionMotor, sensory, autonomic nerve failureAcute symptoms can take place over few hours or daysMuscle weakness/paralysisDifficultly breathing/swallowingInability to move eyesShortness of breathSensation may be affectedSeverity of nerve damage range greatly, most experience ascending symmetrical muscle weakness in lower and upper extremityFollowing acute onset of condition, most patients gradually improve and recover, but some are left with life long disabilityOrthoses to aid in weakness (most commonly drop foot), prevent contracture

Question 22

Haglunds Deformity

Answer 22

Bony Enlargement at the back of the heelAlso swelling and redness at back of heelMost often leads to painful bursitis (inflammation of fluid filled sac between tendon and bone)Soft tissue near the Achilles tendon insertion becomes irritated when bony enlargement rubs against shoes”pump bump”

Question 23

Hammer toes

Answer 23

Deformity of PIP joint of the 2nd, 3rd or 4th toe, causing it to be permanently bent, resembling a hammerMost frequently results from wearing poorly fitting shoes Having toes flex for long periods can cause muscles to shortenDoctor can prescribe orthosis to push down on toes to force them to stretch out musclesPhysical therapy, shoes with soft spacious toe boxes, surgeryRelated to claw toeswhich is dorsiflexion of MTP joint and flexion of PIP and DIP

Question 24

Kohlers Disease

Answer 24

Rare pediatric bone disorder of the footFound in children between 6-9. typically boysAvascular necrosis of the navicularNavicular bone temporarily loses blood supply, Tissue in bone dies and bone collapsesPain, tenderness and swelling in in-stepTreatment usually involves resting affecting foot, pain relievers, avoid putting pressure on footSometimes cast that stops below the knee is worn for 6-8 weeksWhen cast is taken off, patient prescribed arch support for 6 monthsOnce navicular returns to normal, symptoms abateWhen treated, causes no long term problems in most casesRarely, can return in adults

Question 25

Legg Calve Perthes Disease

Answer 25

Childhood hip disorder Initiated by a interruption of blood flow to the femoral headDue to lack of blood flow, bone dies (avascular necrosis)Healing occurs when new blood vessels revascularize dead bone, removing dead bone, however leads to loss of bone mass and weakening of headCan lead to deformity of the femoral headSecondary changes to the shape of the hip socket Treatment - TractionMuscle/ligaments around hip usually very tightCannot properly position head in acetabulumTraction gradually stretches muscles allow femur to position itself well in socketSecondly, child is casted or braced to hold position in placeGoalsHold head of thigh bone in hip socket, so that head can remold itself in round shapePermit limited joint ROMScottish Rite OrthosisToronto Legg Perthes Orthosis (tries to get internal rotation)Trilateral socket hip abduction orthosis (ischial weight bearing)Best success if child < = 6 yr old

Question 26

Median Nerve Palsy

Answer 26

Median nerve damagedCaused by deep, penetrating injuries to the arm, forearm, or wristMay also be due to blunt force trauma or neuropathyLack of ability to abduct and oppose thumb due to paralysis of the thenar muscles, “ape hand deformity”Sensory loss in the thumb, index finger, long finger, and radial aspect of ring fingerWeakness in forearm pronation, wrist and finger flexionADLs difficult (brushing teeth, tying shoes, turning door knobs etc.)Dynamic splint which pulls thumb into opposition can help prevent further deformityResting WHO maintains C-spaceThumb spica for functionTendon transfers shown to be effective in restoring function

Question 27

Mortons Neuroma

Answer 27

AKA Morton’s metatarsalgiaBenign neuroma of an intermetatarsal plantar nerveMost commonly between 2nd - 3rd3rd - 4thCharacterized by pain and/or numbness when weight bearingBurning, paresthesiae (tingling)Direct pressure between the metatarsal heads will replicate the symptomsAs will compression of the forefoot between the finger and thumb, as to compress the transverse arch of the foot (Mulder’s sign)Foot orthotics prescribed, arch support and metatarsal pad positioned under the space between the two affected metatarsalsPad helps splay metatarsal bones, create more space for nerve so as to relieve pressure and irritationSometimes corticosteroids prescribed to relieve inflammation and to help end symptoms

Question 28

MRSA

Answer 28

Methicillin-Resistant Staphylococcus AureusBacterium responsible for several difficult to treat infections in humansThrough process of natural selection, has become resistant to antibioticsWeakened immune systems are at greater risk of infection than general publicTypically colonizes respiratory tract, open wounds, urinary tract, cathetersCan cause small red bumps accompanied by fever, rash can become deep, pus-filled boilsCan also infect vital organs and lead to widespread infection (sepsis), necrotizing pneumonia

Question 29

Osteogenesis Imperfecta

Answer 29

Congenital bone disorderGenetic, 1 / 20 000 live birthsCharacterized by brittle bones that are prone to fracture, loose joints, poor muscle toneDefective connective tissue, or absent ability to make it, usually Type I Collagen deficiency8 TypesNo cureTreatment aimed at increasing overall bone strength to prevent fracture and maintain mobility

Question 30

Patella Femoral Syndrome

Answer 30

Pain caused by patella being pushed against side of femoral grooveCause of pain often results fromAbnormal forces, increased pull of vastus lateralis relative to vastus medialis, with acute or chronic lateral patello femoral subluxation/dislocation)ORProlonged repetitive compressive or shearing forces (running or jumping) on PF jointThinning and softening of articular cartilage under patella (chondromalacia) or medial or lateral femoral condylesSynovial irration/inflammationSubchondral bony changes in distal femur or patellaTypically seen in active populations (runners, bikers, basketball players etc.) presenting as localized anterior knee painTreatment, strengthen vastus medialis to balance out lateralis forceRestOrthosisKO may allow patella to track better, reduce lateral drift of patellaFO arch support may reduce over pronation which reduces knee balgus

Question 31

Peripheral Vascular Disease

Answer 31

Obstruction of large arteries Causes acute or chronic ischemiaCan result from atherosclerosis, inflammatory processes leading to stenosis/embolism/thrombus formationClaudication- pain, weakness, numbness, cramping of musclesImpaired healing Sores, wounds, or ulcers heal slowly or not at allDiminished hair growth and nail growth on affected limb and digitsCauses- smoking, diabetes, high cholesterol, hypertension

Question 32

Plantar Fascitis

Answer 32

Painful inflammatory process of the plantar fascia, connective tissue, or ligament on the plantar surface of the footPain usually felt on underside of heelOften most intense with first steps of the dayOveruse of plantar fascia10% will experience it in their lifetimeAssociated with long periods of weight bearing, hyper-pronated, flat feetAlso associated with heel spurs, small bony calcification on the calcaneus (plantar fasciitis causes spur no vice versa)TraumaLack of fat padAbnormal biomechanics (over-pronation)

Question 33

Psoriatic Arthritis

Answer 33

Type of inflammatory arthritis that appears in people with skin disease psoriasis10-30 % of individuals with psoriasis will get itCause unknownPain, swelling, warmth in jointsSwelling in fingers and toesPain in and around feet and anklesAchilles tendinopathy/ Plantar FasciitisExtreme exhaustion that does not go away with adequate restArthritis may be mild, or may progress to more destructive joint diseaseNo cure

Question 34

Radial Nerve Palsy

Answer 34

AKA wrist dropPerson cannot extend wrist, hangs flaccidlyPenetrating wound (at or below clavicle, damage to posterior cord which terminates as the radial nerve)Humerus fractureLead poisoningRepetitive injury, applying pressure along route of the radial nerve Depending on level of lesion (diagnosis with nerve conduction test)Inability to abduct shoulder beyond 15 degreesInability to extend forearmReduced ability to supinate handReduced ability to abduct thumbSensory loss Dynamic splint

Question 35

Reflex Sympathetic Dystrophy

Answer 35

AKA Complex regional pain syndrome (CRPS)Intense burning pain, stiffness, swelling, discoloration that most often affects the handsArms legs pain can also be affected2 Types1 - occurs after an illness or injury that did not directly damage nerve in the affected area2- follows a distinct nerve injuryCause unknown, commonly occur after injury or surgery, pressure on nerve, infection, cancer, stroke etc.Orthosis for protection?

Question 36

Sever’s Disease

Answer 36

AKA calcaneal apophysitisInflammation of growth plate at the back of the heel heel (wear Achilles attaches) of growing children, typically adolescents, during growth spurtPain in the heel Caused by repetitive stress on achilles tendon, damages growth plate to heel Thus particularly common with physically active children

Question 37

Shin Splints

Answer 37

AKA medial tibial stress syndrome pain in lower part of leg between knee and anklecaused by repeated trauma to connective muscle tissue surrounding tibiaUsually attributed to overloading of muscles of the lower extremities or to biomechanical irregularitiesMuscle imbalance, inflexibilityIncreasing activity/intesity/duration too quickly can lead shin splintsTendons and muscles unable to absorb impact of shock forces as they fatigueDisruption of Sharpey’s fibers connecting medial soleus fascia to periosteum of tibia, impact force eccentrically fatigues soleus, create tibial bending or bowingExcessive pronation at subtalar joint is associated factor, causes tibial twisting and overstretching of lower extremity muscles

Question 38

Spondylosis

Answer 38

Degenerative osteoarthritis between center of spinal vertebrae and or neural foraminaAs space between 2 adjacent vertebrae narrows, compression of nerve roots emerging from spinal cord can cause subsequent sensory/motor disturbances (radiculopathy)PainParesthesiaeMuscle weaknessDirect pressure on spinal cord can cause myelopathyGlobal weaknessGait dysfunctionLoss of balanceLoss of bladder/bowel controlLabelled by area of back involved (cervical, thoracic, lumbar)

Question 39

Spondylolysis

Answer 39

Defect of pars interarticularis of the vertebral archFracture in thin piece of bone that connects upper and lower segments of the facet jointsGreat majority of cases occur in lowest of lumbar vertebrae (L5), but can occur in other lumbar and thoracic vertebraeMay be asymptomatic for a long timeSymptoms often appear during teenage growth spurt, often those participating in sports involving hyperextension of back (gymnastics, weightlifting, football etc.)Pain spreads across lower backGenerally worse with vigorous exercise or activityBack orthosis for support (intraabdominal pressure) and prevention of flexion/anterior translation

Question 40

Spondylolysthesis

Answer 40

Spondylolysis with anterior translation of the superior vertebrae over the inferior one

Question 41

Tar Syndrome

Answer 41

Rare genetic disorderCharacterized by absence of radius bone in forearmDramatically reduced platelet count, can lead to bruising and potentially life-threatening hemorrhage

Question 42

Tibial Torsion

Answer 42

Inward twisting of tibiaMost common cause of intoeingMedial torsion improves with timeLateral torsion worsensCan occur due to position of the baby in the uterusDenis-Browne Bar worn at night

Question 43

Torticolis

Answer 43

Abnormal, asymmetrical, fixed or dynamic tilt, rotation or flexion of the head and/or neckVariety of causesCongenital- etiology uncertain, birth positioningDamage to sternocleidomastoid muscleShortening, excessive contractionSometimes sternocleidomastoid tumor, may disappear but leaves musce fibroticAcquiredMuscular- pain to neck muscles (sternocleidomastoid, trapezius)Tumors in base of the skullInfections (ear, posterior pharynx)Certain DrugsTOT collar- irritant, encourages child to laterally flex and rotate to the opposite sideSoft PVC tubing with tubes positioned anterior and posterior to crest of the trapezius

Question 44

Triple Arthrodesis

Answer 44

Surgical procedure whose purpose is to Relieve pain in the rear part of the footImprove stability of the footCorrect deformity of the foot Commonly carried out on patients with joint degeneration resulting from arthritis or severe flat foot deformityCreation of a stable, balanced, plantargrade foot for ambulationFuses 3 main joints of the hindfoot:Subtalar jointCalcaneocuboid jointTalonavicular joint

Question 45

Ulnar Nerve Palsy

Answer 45

Decreased sensation to little finger part of ring fingerPainTingling, NumbnessWeaknessCauseIllness that damages nerveDirect traumaLong term pressure on the nerve, could be caused by swelling or injury of nearby body structureFroments SignSpecifically test adductor pollicis (innervated by ulnar)Patient holds flat object like piece of paper between thumb and index fingerExaminer attempts to pull object out of the subject’s hand

Question 46

Wind Swept Deformity

Answer 46

Describes abnormal valgus deformity in one knee in association with varus deformity in the otherMay also occur at the hip Abduction and external rotation of one hip with opposite hip in adduction and internal rotation, may occur in association with hip dislocation and scoliosis

Question 47

Ehlers Danlos syndrome

Answer 47

Inherited connective tissue disorderDefect in collagen leading to hypermobilityAbnormal collagen renders skin, joints, muscles, ligaments, blood vessels more elasticSeverity of mild to life threateningJoints may subluxate/dislocate easily, braces can help control ROM to prevent unnatural joint positionsBracing also helps to support injuries/pain related to the condition

Question 48

Pectus Carniatum

Answer 48

AKA pigeon chestDeformity of the chest characterized by a protrusion of the sternum and ribs (oppose is pectus excavatum)Overgrowth of cartilage cause sternum to protrude forwardsUsually occurs- post open heart surgery, way that it heals- congenital- during male puberty growth spurtRelatively common, Occurs 1/400Heart and lung function may be affectedAssociated with scoliosisMay be a cosmetic issue, self imageCustomized orthosis Direct pressure applied over protruding area can produce excellent outcomesFront and back compression plates anchored to aluminum bars bound by tightening mechanismCan be worn under clothes

Question 49

Peripheral Neuropathy

Answer 49

Damage or disease of nerves of the Peripheral nervous systemCausesDiabetesAlcoholismImmune system diseaseInfectionTraumaMotor/sensory loss

Question 50

Plagiocephaly

Answer 50

Misshapen infant head Develops in response to prenatal and postnatal force acting on infants headPlagio- parallelogram shapeScapho- long A-PBrachy - wide M-LCauseMultiple birthsFirst bornPremature birthVacuum/Forceps deliveryTorticolisSleep position preferenceFlattened side corresponds with anterior positioning of ipsilateral ear and foreheadAppropriate time to treat with helmet is 4-6 monthsOrthotist creates space between helmet and skull over short dimensionInfant’s head grows in path of least resistance

Question 51

Neurofibromytosis

Answer 51

Genetic disorder that disturbs cell growth in your nervous systemCauses tumor to form in nerve tissue, usually benign (non cancerous)Possible symptomsBowed legsBone abnormalities (scoliosis)HypotoniaMotor Incoordination

Question 52

Parkinson’s disease (PD)

Answer 52

Degenerative disorder of the CNSResult from death of dopamine generating cells in substantia nigra, region of midbrainLack of formation and activity of dopamineLeads to ParkinsonismTremorRigidity- stiffness from increased muscle toneHypokinesia- decreased bodily movementBradykinesia -slowness of movementPostural InstabilityDifficulty walkingCause is unknown

Question 53

Huntington’s Disease

Answer 53

Neurodegenerative genetic disorderAffects muscle coordination and leads to cognitive decline and psychiatric problemsChoreaAbnormal involuntary writhing movements

Question 54

Erb’s Palsy

Answer 54

Paralysis of arm caused by injury to upper group of brachial plexus, specifically upper trunk (C5-C6)Most commonly occurs in infants due to difficult delivery (1-2/1000 live births)-forceps delvery-prolonged birth-breach birth4 types- Neuropraxia- stretches but does not tear nerves, usually heals on its own- Neuroma - damages some nerve fibers, causes scar tissue that may impinge remaining tissue- Rupture - nerve torn, will not heal on its own- Avulsion - nerve torn from spinal cord, impossible to repairSigns and Symptoms- paralysis of structures innervated by C5-C6 nerve roots, most commonly suprascapular, musculocutaneous, and axillary nerves- paralysis of subscapularis, deltoid, biceps, brachialis- loss of sensation of the arm- arm hangs, shoulder medially rotates, elbow extended, forearm pronatedSurgical treatmentGunslinger brace

Question 55

Congenital Hip Dysplasia AKA Developmental Hip Dysplasia

Answer 55

Refers to continuum of abnormalities of the immature hipDiagnosed after birthSubluxation, Dislocation, Acetabular dyplasia (shallow acetabulum), Unstable hip (excessive laxity, prone to subluxation)If left untreated can lead to painful debilitating degenerative arthritisExact cause not known, possible genetic predispositionOrtholani Test- put back in, medially against greater trochanter audible clunkBarlow’s Test- try to push out laterally and posteriorly against lesser trochnaterHip flexion of 90 degrees and abduction of 45 is best to seat femoral head well into acetabulumPavlik HarnessFreika PillowPossible use of Scottish Rite Orthosis, for older ambulatorsTreatment time 3,4 months

Question 56

Volksmann’s ischemic contracture

Answer 56

Lack of blood flow to forearmUsually due to increased pressure from compartment syndromeTrauma to the arm can also be a causeDecreased blood flow causes muscle damage, leaves them scarred and shortenedDecreased sensation//weaknessMIld- contracture of 2 or 3 fingersModerate - all fingers flexed, thumb stuck in palm, loss of some feeling in handSevere- muscles in forearm that both flex and extend the wrist are involved