quiz #1 - musculoskeletal pathologies Flashcards by gabi beselt

-degeneration of joints articular cartilage along high stress lines that causes inflammation
-cartilage softens & lose elasticity/ resiliency
-joint pain with crepitus
*Herben’s nodes: found at DIP joints in women – hard/ bony swellings over joint

osteoarthritis

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fusion of joint through osteophyte formation & calcifications, insidious onset with low back pain that is worse in morning/ with inactivity → has lasted at least 3 months
defect in gene: human leukocyte antigen; HLA-B27 (90% of sufferers)

ankylosing spondylitis

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-joint stiffness, swelling & pain triggered by bacterial infection
-pain felt in low back, ankles, knees, feet & IP joints
-enthesitis common
-if involving eye (uveitis)/ urinary symptoms & follows chlamydia (urethritis/) = “Reiter’s syndrome”
-associated with HLA-B27
-improves on its own, not contagious

reactive arthritis

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-chronic arthritis, affects people with psoriasis 20-30% of the time
-skin conditions & joints
-red patches with silvery scales, may affect nails
-remission & flare up periods
-first symptoms are fingers & toes/ asymmetrical
-may cause dactylitis (“sausage finger”)
-from environmental factors
-immune system attacks healthy cells causing production of IL-23, a cytokine that produces chronic inflammation

psoriatic arthritis

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-arthritis that causes pain, swelling, tenderness & redness at a joint, often big toe (1st MTP)
-caused by crystallization of uric acid inside a joint forming a tophi or tophus surrounding joint – tophus is a deposit of monosodium urate crystals with macrophages & lymphocytes

gout

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-invasion of a single joint space (monoarticular) with pathogenic microorganisms like bacteria, virus or fungi
-often involve knee, shoulder, hip or elbow
-invasion causes one acutely painful & swollen joint
-most common organisms causing this = staphylococcus aureus (56% of cases)
-swelling, fatigue, mild fever, erythema, tenderness & decreased ROM – may have pre existing rheumatoid arthritis

infectious or septic arthritis

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activation of T helper cells that produce cytokines, then activate B cells to produce antibodies – 80% of RA sufferers have an autoantibody (an antibody against our own antibody = IgG) called ‘rheumatoid factor’

rheumatoid arthritis

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how does ankylosing spondylitis typically affect the spine curve and which areas?

-insidious or gradual onset of low back pain
-sacroiliac involvement
-cause vertebrae to fuse

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primary differences between osteoarthritis and rheumatoid arthritis

OSTEOARTHRITIS = degeneration

RHEUMATOID ARTHRITIS = autoimmune disease

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role of HLA-B27 antigen in ankylosing spondylitis

cause of AS unknown, but may have a defect in the gene called human leukocyte antigen or HLA-B27 – 90% of sufferers have this gene mutation

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-imbalance between bone deposition (bone making) & bone decomposition (bone break down) causing bone tissue to become “porous”
-more bone being decomposed than deposited, making bone tissue weak & brittle
-activity of osteoclasts increased & osteoblasts decreased – may be caused by calcium metabolism disorders/ from inadequate intake of calcium or Vitamin D – loss of estrogen for menopausal women decreases osteoblastic activity

osteoporosis

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-genetic or heritable disease in which bones fracture (break) easily, often with no obvious cause or minimal injury
-can be cause of “pectus excavatum” (chest wall grows inward)

osteogenesis imperfecta

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degeneration of a joints articular cartilage along high stress lines that causes inflammation

osteoarthritis

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bone infection, almost always caused by a bacteria

osteomyelitis

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how does Paget’s disease of bone typically present radiographically?

-dysfunction in bone remodelling process, where bone is replaced faster than it is broken down

bone usually appears larger & denser than a normal bone – may also have a deformed shape

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Paget’s disease treatment

biphosphates or calcitonin

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-degenerative osteoarthritis between centers of spinal vertebral joints around discs, bodies, & end plates
-bone spurs grow & change movement in spine – common in mild form

spondylosis

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inflammation of the intervertebral joints

spondylitis

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-defect in PARS of interarticularis of vertebral arch
-may be congenital or acquired (stress fracture) – weakened bone/ fractures/ cracks from repetitive stress
-bone affected most by repetitive stress → common in lumbar spine

spondylolysis

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-forward displacement of vertebra on one below, most often 5th lumbar vertebra
-most commonly occurring after a break/ fracture, causing low back pain
-due to degeneration/ wear & tear

spondylolisthesis

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difference in presentation between adhesive capsulitis and rotator cuff tendonitis

ADHESIVE CAPSULITIS: pain, stiffness, begin gradually & worsen over time, then resolve (often over 1-3 years), more common in diabetics

ROTATOR CUFF TENDINITIS: dull deep ache at rest, unable to lift arm, disturbs sleep, arm weakness

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4 compartment syndromes of the lower leg

-anterior
-superficial posterior
-deep posterior
-lateral

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what is lower extremity compartment syndrome?

groups of mm with nearby blood vessels & nerves contained in a compartment by fascia – if inflammation or swelling, pressure inside compartments increases to the point that it restricts blood flow to the region, possibly causing damage to mm, nerves & all other nearby structures

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how is osteogenesis imperfecta genetically inherited?

-gene causes body to not make enough collagen – leads to weak bones that break easily
-most inherit gene from one parent or they occur for first time in the person – child has to inherit a mutation in a gene from both parents

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acute pain at one joint (monoarticular) with swelling, fatigue, mild fever, erythema, tenderness & decreased ROM affecting that one single joint – may have pre existing rheumatoid arthritis

septic arthritis

which nerve is affected in: upper extremity - saturday night palsy, cheiralgia paresthetica, crutch palsy

radial nerve

which nerve is affected in: entrapment, Erb’s palsy

suprascapular nerve

which nerve is affected in: entrapment, weakness in shoulder with minor pain, “winged scapula”

long thoracic nerve

which nerve is affected in: pronator teres syndrome, anterior interosseous nerve syndrome

median nerve

which nerve is affected in: lower extremity - meralgia paresthetica

lateral femoral cutaneous nerve

differences between Dupuytren’s contracture & Volkman’s contracture

DUPUYTREN’S: slow gradual, fibrosis of palmar fascia that creates shortening & thickening of 3, 4, 5 digits – causing them to be flexed VOLKMAN’S: permanent shortening of forearm mm including hand, fingers & wrist (may also occur in foot) results in a claw-like deformity due to ischemia

cause of: Klumpke's

stretching or neuropraxia, tearing, scarring of the nerve – nerve damage interrupts nerve impulse transmission

cause of: Erb's palsy

birth trauma – causes inflammation & interrupts nerve transmission

cause of: horner's syndrome

cause unknown, possible underlying causes: stroke, tumor or spinal cord injury – disruption of nerve pathway to face & eye

cause of: saturday night palsy

pressure injury, inflammation – inflammation disrupts nerve impulses

compression neuropathy of the "median nerve" at the elbow by the pronator teres muscle

pronator teres syndrome

anterior interosseous nerve is a terminal motor branch of the median nerve that branches between two heads of pronator teres & runs deep along interosseous membrane – this nerve becomes entrapped causing compression & symptoms

anterior interosseous syndrome

compression of the motor posterior interosseous nerve where it passes through the musculotendinous radial tunnel – may cause paralysis of the digit & thumb extensor muscles

posterior interosseous syndrome

compression of the ulnar nerve in the cubital tunnel (made of mm, ligament & bone) – this causes pain, swelling & inflammation

cubital tunnel syndrome

inflammation of patellar ligament on tibial tuberosity commonly in adolescents (especially during growth spurt) – painful bump just below the knee – worsens with activity & improves with rest – Episodic pain → from repetitive stress

osgood schlatters

pain at & around patella, called “runner’s knee”, common in active people

patellofemoral syndrome

softening & breakdown of cartilage tissue on the underside of patella, causing anterior knee pain

chondromalacia patella

repetitive movements causing constant friction, loss of elasticity & increased microtears, injury like a direct fall – causes inflammation & swelling

prepatellar bursitis

signs & symptoms of Horner's syndrome

subtle symptoms, decreased pupil size, drooping eyelid & decreased sweating on one side of face

reactive arthritis causes joint stiffness, swelling & pain, its triggered by a _____ infection & shows up _____ weeks after infection

bacterial 2-6

2 types of scoliosis

1. structural: spine curved 2. functional: mm cause curvature

5 stages of RA

Stage 1: Synovitis: inflammation Stage 2: Pannus formation: granulation tissue Stage 3: Cartilage erosion: creates unstable joint Stage 4: Fibrosis: calcifies & joint space is obliterated Stage 5: Ankylosis: joint fixation & deformity develop

what type of disease is RA?

autoimmune

most common cutaneous lesion in RA

rheumatoid nodules

in which pathology do vertebrea grow unevenly during childhood while growth is still occurring, & it causes a wedging of vertebrae thus causing spine to curve more than normal

Scheuermann's disease

cause of psoriatic arthritis

unknown, high genetic link with environmental factors, considered autoimmune disease, immune system attacks healthy cells thinking they are foreign invaders - causes inflammation in joints & overproduction of skin cells - production of IL-23

calcium pyrophosphate crystal deposition disease (CPPD) or "pseudogout" has similar crystal deposition as gout joints, but the crystals are made of _______

calcium pyrophosphate dihydrate

causes of central canal stenosis/ spinal stenosis

degeneration (osteoarthritis)

typical cause of tendinitis

repetitive movements

medications for gout & pseudogout

gout: medications can block uric acid production pseudogout: NO medications to prevent joint damage

which pathology is known as tuberculosis of the spine?

Pott's disease

what is a contracture?

permanent shortening of mm/ soft tissues crossing a joint

inflammation of the achilles ligament where it attaches to the growth plate on the calcaneus commonly in adolescents (especially during a growth spurt)

Sever's

in childhood (4-10yrs) interruption of blood supply to femoral head causing avascular necrosis & tissue death - bone is weakened & fractures easily - blood supply is improved & bone begins to heal & grows back again

legg-calve perthes

congenital anomaly, elevated, dysplastic (underdeveloped & smaller) scapula restricting shoulder ROM

Sprengel's deformity

half of the vertebral body fails to form causing a wedge shaped vertebrae

hemivertebrae

an extra rib that forms above the first rib usually asymptomatic - may cause thoracic outlet syndrome (TOS)

cervical rib

congenital anomaly where two vertebrae are fused or partially fused together through the disc

block vertebrae

cause of Paget's disease

unknown, but suspect environmental (virus) or genetic factors contribute or work together

symptoms in cauda equina

severe low back pain, pain in both legs, saddle anaesthesia, motor weakness & sensory loss, bladder dysfunction, bowel incontinence, sexual dysfunction & may cause permanent neurological damage

symptoms in meralgia paresthetica

compression of lateral femoral cutaneous nerve causing burning pain, numbness & tingling in upper lateral thigh that may extend to knee - worsened by walking or standing for long periods

treatment for rotator cuff tear

80% non surgical tx is adequate, rest, NSAIDS, activity modification, strengthening exercises, steroid injection, 20% require surgery

treatment for adhesive capsulitis

ROM exercises, mobilization, injected steroids, surgery

which nerve is affected in: axillary nerve palsy, Erb's palsy

axillary nerve

traction or compression injury to the lower trunk of the brachial plexus at C8 & T1

Klumpke's

traction or compression injury to the upper trunk of the brachial plexus at C5 and C6

Erb's palsy

nerves affected in Erb's palsy

axillary nerve, musculocutaneous, suprascapular nerves

sacralization vs. lumbarization

sacralization: congenital anomaly where TVP L5 fuses to sacrum or ilium on one side or both - often L5/S1 disc is thinner & narrow lumbarization: congenital anomaly where first & second segments of sacrum fail to fuse & are freely movable - appears lumbar spine has 6 vertebrae

injury of a growth plate affecting adolescents - causes abnormal growth around ossification centres (Legg-Calve-Perthes, Osgood Schlatter, Sever’s)

juvenile osteochondrosis

nonunion of ossification centres of a bone, most often affecting right side of body & girls

upper extremity: congenital pseudarthrosis (clavicle, radius, ulna)

causes of heel spurs

repetitive stresses, or sudden increases in activity -calcium deposits at insertion site of plantar fascia into calcaneal bone

pain on posteromedial border of tibia bone due to overuse & repetitive stresses like running & jumping - periostitis occurs in tibia & surrounding musculature (including tendons & ligaments) become damaged & inflamed, with not enough time to heal in between activities - sports activities are number one cause

shin splints or medial tibial stress syndrome

compression of the superficial branch of the radial nerve, a sensory only nerve, often where it lies between brachioradialis & extensor carpi radialis longus, also when it flows more superficially is susceptible to a crush injury from the skin

cheiralgia paresthetica