quiz #1 - musculoskeletal pathologies Flashcards
-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
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
-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
-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
-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
-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
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
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
primary differences between osteoarthritis and rheumatoid arthritis
OSTEOARTHRITIS = degeneration
RHEUMATOID ARTHRITIS = autoimmune disease
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
-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
-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
degeneration of a joints articular cartilage along high stress lines that causes inflammation
osteoarthritis
bone infection, almost always caused by a bacteria
osteomyelitis
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
Paget’s disease treatment
biphosphates or calcitonin
-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
inflammation of the intervertebral joints
spondylitis
-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
-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
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
4 compartment syndromes of the lower leg
-anterior
-superficial posterior
-deep posterior
-lateral
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
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
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
- structural: spine curved
- 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
