Pathology II Flashcards
What 2 tendons are involved in de Quervain’s tenosynovitis?
What repeated motions can lead to the condition?
- Abductor pollicis longus (APL)
- Extensor pollicis brevis (EPB)
Thumb abdcution and extension
Why are new mothers at a higher risk of de Quervain’s tenosynovitis?
What special test is used to diagnose?
Repetitive lifting and carrying of a child (thumb extension and abduction to hold)
Finkelstein’s Test
What motions can lead to disk herniation?
twisting and bending
What occurs with a disk herniation in terms of disk anatomy?
the nucleus pulposus bulges through the exterior wall of the annulus fibrosus
If there is a posterolateral disk herniation at L4/L5 what nerve root is affected?
L5 nerve root
A absence of what proteins is seen in muscular dystrophy?
dystrophin and nebulin
What is the causitive factor with Duchenne Muscular Dystrophy?
an x-linked recessive trait. MOTHER IS A SILENT CARRIER
At what age are children with muscular dystrophy unable to ambulate?
usually between 10-12
What is the primary cause of death in Duchennes Muscular Dystrophy?
cardiopulmonary complications due to cardiac or respiratory muscle involvement
What percent of shoulder dislocations detach the glenoid labrum (bankart lesion-anterior dislocation)?
85%
How long should someone be in a sling following a shoulder dislocation?
3-6 weeks
Tendons become impinged under what structures in the shoulder?
undersurface of the acromion and coracoacromial ligament
Where is the painful arc of motion?
70-120
What percent of shoulder dislocations occur anteriorly?
over 90%
What are the 3 types of JRA? And how are they described?
- Systemic - high fevers, rash that may last for weeks followed by severe myalgia and polyarthritis
- Polyarticular - more than 4 joints, symmetric
- Pauciarticular (Oligoarticular) - four or less joints, asymmetric
What are 3 general symptoms experienced with JIA?
joint swelling, pain, and stiffness
What two blood factors may be present in JIA?
- Rheumatoid Factor (RF)
2. Antinuclear Antibody (ANA)
Which subtypes of JIA have potential for severe joint destruction?
- Polyarticular JIA
2. Systemic JIA
What tendon in particular is often aggravated with Lateral Epicondylitis?
Extensor carpi radialis brevis
ECR Longus attaches higher up than other tendons
Why is Lateral Epicondylitis called tennis elbow?
Because the resistance to Extension and Supination during a tennis backhand lead to this condition
Iontophoresis with which drug may be helpful for lateral epicondylitis?
Dexamethasone
What type of brace may be helpful in lateral epicondylitis?
Counter force bracing in the form of a FOREARM BAND may reduce the degree fo tension in the region of muscular attachment
What is Legg-Calve-Perthes Disease?
What disease process is it associated with?
degeneration of the femoral head due to a disturbance in blood supply
AVASCULAR NECROSIS
What are the 4 stages of Legg-Calve-Perthes disease? how long does it take to go through stages?
- Condensation
- Fragmentation
- Re-ossification
- Remodeling
18-24 months
Initial phase. The femoral head loses its blood supply. The hip joint becomes inflamed, stiff, and painful. Parts of the bone turn into dead tissue. The ball of the thighbone becomes less round. This phase can last from several months up to 1 year.
Fragmentation phase. The body absorbs the dead bone cells and replaces them with new, healthier bone cells. The femoral head begins to re-form into a round shape. The joint is still irritated and painful. This phase can last from 1 to 3 years.
Reossification phase. The femoral head continues to re-form into a round shape with new bone. This phase lasts for 1 to 3 years.
Healing phase. Normal bone cells replace the new bone cells. This last phase can last a few years to complete the healing process.
What are the symptoms of Legg-Calve-Perthes disease? (3)
Insidious onset of knee, groin, thigh, or hip pain
Decreased ROM
Antalgic gait
why is surgery rarely required with an MCL sprain?
MCL is well vascularized
In addition to resisting valgus forces what other forces does the MCL resist?
Resists external rotation of the tibia especially with the knee flexed
What other structure is often involved with a grade II MCL sprain?
the medial capsular ligament
If doing Transverse Friction massage following an MCL sprain what area should be avoided?
do not massage the PROXIMAL attachment of the MCL due to potential bony periosteal disruption
If no other structures are involved how quickly should someone return to their previous functional level following a grade II MCL sprain?
4-8 weeks
Pain with what functional activity could be the result of medial epicondylitis?
What is the common term for this condition?
Gripping
Golfer’s Elbow
The tendons of what two muscles are most often affected with medial epicondylitis?
- Flexor Carpi Radialis
2. Pronator Teres
What is a common mechanism of injury for a truamatic meniscus tear?
twisting of the knee when it is in a semiflexed position and the foot is on the ground
What meniscus is more commonly torn and why?
The medial meniscus because it is more firmly attached to the tibia and capsule
What is Myositis Ossificans?
calcification of the muscle
What is the cause of Myositis Ossificans?
neglecting to properly treat a muscle strain or contusion
failing to apply cod therapy, apply heat, having a massage too soon, or intense therapy too soon
How quickly does bone growth start after an injury with Myositis Ossificans?
2-4 weeks after injury
How is a sponylolisthesis defined?
How do you know which nerve root is involved?
Forward slippage of one vertebra on another
With L4-L5 spondyloisthesis the L4 vertebra slips forward and compress the L4 nerve root
What is the main cause of Degenerative Spondyloisthesis?
The disk loses ability to resist motion with age and vertebral facets increase in size and develop bone spurs to compensate leading to overall weakening the spine
What is the most common site of Degenerative Spondylolisthesis and what other condition can it cause?
L4-L5 level leading to cauda equina symptoms
What is a specific type exercise protocal that can be used with Degenerative Spondylolistehsis?
William’s Flexion Exercises
Where are the menisici thicker and thinner? Where are the more strongly attached?
Menisci are thicker at periphery and thinner at unattached internal edges
what are the first symptoms of Duchenne Muscular Dystropy?
Waddling gait, proximal muscle weakness, clumsiness, toe walking, excessive lordosis, psuedohypertrophy of the calfs, difficulty climbing stairs
