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Ortho Path 300 > Quiz 4 > Flashcards

Quiz 4 Flashcards

1
Q

Whiplash

A

Acceleration-deceleration

Cervical flexion-extension sprain-strain

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2
Q

QTF Whiplash classification

A

Grade 1: Pain but no physical signs

Grade 2: Neck complaints, pain, decreased ROM, point tenderness

Grade 3: Like Grade 2 with neurological symptoms

Grade 4: Like Grades 2/3, with bone injury (fracture, dislocation, spinal cord injury)

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3
Q

Torticollis

A

Abnormal positioning of the head and neck, relative to the body (Wry Neck)

Can be:
Acute acquired
Congenital
Spasmodic

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4
Q

Acute acquired torticollis

A

Painful, unilateral shortening of the neck muscles (esp SCM) resulting in abnormal head position.

Usually sudden onset. Pain, especially with movement .
Also tinnitus, nausea, lacrimation, referred pain

Can be caused by activation of latent TrPs, sublux of C1-2 (!!?!), infection or inflammation, pain from DJD or DDD

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5
Q

Congenital torticollis

A

Umm.. congenital.
Unilateral contracture of SCM.
Idiopathic. Maybe birth trauma, maybe malposition in utero

Palpable mass in muscles.
Can cause compression on cranial nerves and arteries; TMJ issues; C-spine DDD and OA.

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6
Q

Spasmodic Torticollis

A

Localized dystonia resulting in torticollis. Worse under stress. Can be recurring. Twitchy.

Idiopathic.

Can be due to CNS lesions, C0-C1 issues, postural dysfunction, trauma, iatrogenic causes.

Improved by certain positions

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7
Q

Cervical Rib

A

Extra bone that articulates with the TVP of one or more cervical vertebrae (most commonly C5/6/7)
More common in females

Often asymptomatic until middle age when shoulders begin to droop

May result in TOS

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8
Q

C1 Fracture

A

AKA Jefferson Fracture

Fall on head from height (yeesh)

Occipital condyles may spit or burst the ring of atlas

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9
Q

C7 Fracture

A

AKA Clay Shoveler’s fracture

Avulsion (of SP) fracture due to hyperflexion injury

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10
Q

TMJ dysfunction

A

Disorder of the muscles of mastication, TM joint, associated structures

Temporalis, masseter, pterygoids, digastric, mylohyoid, geniohyoid, infrahyoid.

More common in women; onset typically between 20-50

Can be caused by muscle imbalances and/or overuse, C-spine or cranial misalignment, posture, stress, etc. etc.

Contributing factors include playing instruments and chewing gum.

Can present with decreased ROM, catching/locking, ear dysfunction, tinnitus, inflammation, lacrimation, paresthesia, DJD

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11
Q

Pectus excavatum

A

Most common deformity of the chest wall.

AKA funnel chest

Congenital

Midline depression of sternum

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12
Q

Pectus carinatum

A

AKA pigeon chest

Congenital

anterior protrusion of the sternum

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13
Q

Barrel chest

A

Acquired increase in the AP dimensions of chest wall.

Most commonly associated with emphysema

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14
Q

Dowager’s hump

A

Excessive curvature of the upper T spine; most commonly a result of osteoporosis; also DJD

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15
Q

Wedge compression fracture

A

Decreased height of anterior portion of vertebral body, most commonly T12-L1

Most common L spine fracture

Usually due to trauma and/or pathology; commonly associated with osteoporosis

S/S include hyperkyphosis, decreased stature, neurological symptoms

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16
Q

Straight Back Syndrome

A

Reduced thoracic kyphosis

Decreased AP chest dimensions

Heart and mediastinal structures compressed between T spine and sternum

Functional heart murmur

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17
Q

Flat Back Syndrome

A

Decreased lumbar lordosis

Flattened appearance to low back; posterior pelvic tilt

May be due to slouching, and accompany hyperkyphosis

May result in pain due to overstretched PLL and decreased shock absorption

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18
Q

Hyperlordosis

A

Increase in normal lumbar lordotic curve with increased anterior pelvic tilt.

May be concurrent with spondyloisthesis
May lead to compensatory hyperkyphosis, head forward posture.

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19
Q

Reduced thoracic kyphosis

A

Straight back syndrome

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20
Q

Decreased lumbar lordosis

A

Flat back syndrome

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21
Q

Increase in lumbar lordotic curve

A

Hyperlordosis

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22
Q

Stenosis

A

Narrowing of the spinal canal

Can be primary (congenital) or secondary (due to DJD, sublux, edema, etc.)

Symptoms can include bowl and bladder changes, numbness, tingling, weakness in LB. Bilateral

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23
Q

Spondylolysis

A

Pars defect.
Interruption of the pars interarticularis, usually L5-S1

Idiopathic – congenital, traumatic, degenerative, pathologic
May be asymptomatic

May lead to spondylolsthesis

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24
Q

What is the pars interarticularis?

A

Portion of the spine that joins together the upper and lower facet joints

Lies between lamina and pedicle

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25
Q

Spondylolisthesis

A

Gap in pars defect widens
L5 shifts anteriorly on sacrum

May be asymptomatic; may cause pain, hyperlordosis or neurological symptoms

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26
Q

Degenerative disc disease

A

Degenerative joint changes (of volume, shape, structure and composition) at the intervertebral disc

With age, nuclear pulposis breaks down, inner annulis expands.

Common musculoskeletal condition, most often in L spine.

Can be asymptomatic; may be painful due to tears in annulus fibrosis; radicular pain

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27
Q

Herniation

A

Disc injury that results from the rupture of annular fibres
Mostly L4/5, L5/S1

MOI flexion and torsional force

Bulges disc posterior or posteriolaterally - may compress nerve roots

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28
Q

Four stages to disc herniation

A
  1. Degeneration
  2. Prolapse
  3. Extrusion
  4. Sequestration
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29
Q

Lumbarization

A

Nonfusion of the first and second segment of the sacrum
One additional articulated vertebrae (L6)
One fewer sacral vertebrae

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30
Q

Sacralization

A

S1 fused with L5

Leads to extra long sacrum and four lumbar vetebrae

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31
Q

Cauda Equina Syndrome

A

Compression of the cauda equina

Nerve roots caudal to the levell of spinal cord termination at L2

Trauma, infection, tumour, AS, DJD, idiopathic

Pain, numbness and tingling, mm weakness, poor reflexes, saddle anaesthesia, positive babinski

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32
Q

Sciatica

A

Pain felt in low back and along distribution of sciatic nerve

DJD, compression, trauma, piriformis syndrome

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33
Q

Klippel-Feil Syndrome

A

Failure of vertebral segmentation of C-spine

Synostosis of of 2 or more cervical vertebrae

Rare. Idiopathic.

Neck is short, stiff and webbed. Head tilted, high scapula (Sprengel’s deformity)
Associated with scoliosis, Spina bifida, heart defects.

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34
Q

Synostosis

A

Congenital fusion of two bones.

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35
Q

GH hypermobility

A

Due to physiological laxity of CT

Usually in individuals involved in overhead throwing or lifting.

36
Q

Shoulder fractures are commonly associated with injuries of what nerve?

A

Radial

37
Q

Shoulder dislocation

A

GH joint

Most commonly anterior dislocation

38
Q

Shoulder separation

A

AC joint

Can be partial or complete ligamentous injury due to forceful trauma.

Shows up as step deformity.

39
Q

Three types of step deformity

A

Type 1: strain of AC ligament
Type 2: rupture of AC ligament; involvement of conoid and trapezoid ligaments
Type 3: rupture of AC, conoid and trapezoid ligaments

40
Q

Subdeltoid and subacromial bursitis

A

Due to wear and tear on joint

Acute: symptoms same as supraspinatus tendonitis

41
Q

Rotator cuff injuries

A

Most common in athletes die to vigorous circumduction, most common at supraspinatus tendon

42
Q

Impingement Syndrome

A

Space decreased, usually between acromion and humeral head. (Between AC and GH jts).

Repetitive overhead movements, or blow or stretch injury.

Impingement between four SITS tendons, bursa and cartilage.

Symptoms: aching, pain (abduction, reaching behind in car), catching sensation. Painful arc

43
Q

Stages of Impingement Syndrome

A

Stage 1: Edema, hemorrhage into subacromial bursa

Stage 2: tendonitis and fibrosis

Stage 3: tendonitis rupture (complete or incomplete).

44
Q

Infraspinatus tendonitis

A

Occurs near Musculotendinous junction

Painful arc with overhead or forward motions

Can be asymptomatic. Pain can refer to deltois and triceps.

45
Q

Bicipital tendonitis/tenosynovitis

A

Degenerative changes in the tendon of the long head of the biceps.

Common with overhead activities

Symptoms: local tenderness, pain with passive abduction and resisted elbow flexion.

46
Q

Possible causes of winging scapula

A

Loss of serratus anterior function (may be issue with long thoracic nerve)

Loss of trapezius muscle function (may be spinal accessory nerve)

Weakness of scapular stabilizers (esp in muscular dystrophy)

Injury to scapular suspensory ligaments (coracoclavicular and acromioclavicular) – GH jt injury

Shoulder instability
Pain at GH jt
Brachial plexus injury

47
Q

Radial nerve injury

A

Symptoms: impaired sensation yo back of arm, forearm, hand.

Variations include crutch palsy, Saturday night palsy

48
Q

Erb’s (Duchenne’s) Palsy

A

AKa brachial plexus injury (C5-6)

Often occurs in newborns due to birth trauma

Symptoms include waiters tip, paralysis of shoulder and arm

49
Q

Olecranon bursitis

A

“Students elbow”

Constant pain at Olecranon. Swelling, limited mobility.

May result from trauma, constant pressure, inflammatory conditions (EA, PA, gout)

50
Q

Lateral epicondylitis

A

Tennis elbow

Degeneration of CET

Pain at lateral epicondyle, referring down forearm.

51
Q

Medial epicondylitis

A

Golfers elbow

Inflammation of CFT

Often associated with ulnar nerve issues.

52
Q

Radial nerve lesions

A

Continuation of brachial plexus
Affects elbow, wrist and extrinsic finger extensors (plus abductor poll long)

Crutch palsy, supinator syndrome

53
Q

Symptoms of radial nerve lesion

A 
Wrist drop (complete nerve lesion)
Flaccid wrist extensors
Muscle wasting
Sensation dysfunction (posterior arm, thumb, digits 2, 3 half of 4) 
Anesthesia in web space
54
Q

Ulnar nerve lesions

A

Medial chord of brachial plexus

Travels under pec minor, through ulnar groove on medial elbow, deep to FCU, over carpal tunnel and through tunnel of Guyon

Affects FCU, FDP,, 3rd and 4th lumbricals, hypothenar, interossei, add poll

55
Q

Tunnel of Guyon

A

Aka ulnar tunnel

Between hook of hamate and pisiform

56
Q

Symptoms of ulnar nerve lesion

A

Claw hand (digits 4 & 5 don’t extend after flexion)

Froment’s sign – weak pincer grasp (weak add poll) so use FPL to flex at IP

Muscle wasting

Altered sensation on ulnar side of hand

57
Q

Tunnel of Guyon

A

Aka ulnar tunnel

Between hook of hamate and pisiform, transverse and posthaste ligaments.

58
Q

Symptoms of ulnar nerve lesion

A

Claw hand (digits 4 & 5 don’t extend after flexion)

Froment’s sign – weak pincer grasp (weak add poll) so use FPL to flex at IP

Muscle wasting

Altered sensation on ulnar side of hand

59
Q

Ulnar tunnel (Tunnel of Guyon) syndrome

A

Handlebar syndrome

Numbness, pain, tingling on ulnar side of hand.

60
Q

Median nerve lesion

A

Median nerve innervates flexor muscles of forearm and hand

Originates from brachial plexus. Travels with axillary artery and goes through carpal tunnel.

Susceptible to compression by pronator teres, FCR and FDS

Innervates pronator Teres, FCR, FDS, FDP, PL, FPL, PQ, thenars, lumbricals 1&2

61
Q

Symptoms of median nerve lesions

A
  1. Ape hand (thumb can’t adduct)

2. Pope’s blessing/hand of benediction/ oath hand (cannot fleet digits 1&2 because of lumbricals)

62
Q

What passes through the carpal tunnel?

A 
Nine tendons (4 x fdp; 4 x fds; 1 x FPL)
Median nerve
63
Q

Carpal tunnel syndrome

A

Compression of median nerve where it passes through carpal tunnel.

Most common entrapment syndrome in the arm.

Weakness numbness pain
Problem with fine motor movement of hand
Wasting of thenar eminence

Tests: phalens and reverse phalens.

64
Q

Complications of lunate dislocation

A

Often anterior dislocation

Avascular necrosis (Keinbock’s)
Median nerve compression
DJD

65
Q

Mallet finger

A

Avulsion injury to DIP (extensor dig,)

Can extend entire finger except DIP.

66
Q

Boxer’s/Brawler’s fracture

A

Fracture of 5th MC

67
Q

Bennett’s fracture

A

Fracture-dislocation of first carpal-metacarpal joint.

68
Q

Reverse Bennetts Fracture

A

Fracture-dislocation of fifth carpalmetacarpal joint

69
Q

Scaphoid fracture

A

High incidence of complication, including delayed Union, nonunion, avascular necrosis and DJD

70
Q

Smith’s Fracture

A

Reverse Colles

Fracture of radius with ventral displacement. (Spoon)

71
Q

Colles fractures

A

Fracture of distal radius with dorsal displacement.

72
Q

Madelung’s deformity

A

Deformity of radius typically affecting distal radius (ulnar side)

Radius grows palmarly and radially.

73
Q

Ganglion cyst

A

Thin walled synovial-lined lesion

Commonly on dorsal hands and feet

Can cause local discomfort and compress median and ulnar nerve d

74
Q

Trigger finger

A

Thickening of fibrous sheath that surrounds flexor tendons (deep and superficial) –> stenosis –> contracture

Idiopathic and spontaneous.

Unable to actively extend

Passive extension and active flexion “snap”

75
Q

Gamekeepers thumb

A

Tear or rupture of ulnar collateral ligament at the 1st MCP joint

Due to abduction and extension

76
Q

Adhesive capsulitis

A

Frozen shoulder
More often women than men
Restrictions usually in ER and Abduction

Idiopathic

77
Q

Stages of Adhesive Capsulitis

A
  1. Acute stage. Freezing/painful/first stage
    - up to 9 months
    - inflammation and progressive stiffness
  2. Subacute/frozen/stiffening/second phase
    - stiffness in abduction, IR, ER
  3. Chronic/thawing/resolution/third phase
78
Q

Nursemaids elbow

A

Sublux of radial head from annular ligament.

79
Q

Olecranon Bursitis

A

Students elbow

80
Q

Keinbock’s disease

A

Idiopathic avascular necrosis of lunate
Osteochondrosis

Can lead to permanent loss of grip strength and wrist motion.

81
Q

Dupuytren’s contracture

A

Progressive fibrous tissue contracture of palmar fascia on medial hand. Abnormal collagen composition and fibroblast activity.

Can involve feet

Most common in men over 50

Usually presets as contracture of digits 4&5 at MCP and PiP

Can develop secondary co fractures and DJD

82
Q

Claw hand (ulnar)

A

Inability to extend digits 3 & 4

Due to ulnar damage –> third and fourth lumbricals don’t work

83
Q

Ape hand

A

Inability to abduct and oppose thumb

Distal median nerve dysfunction –> paralysis of thenar muscle.

84
Q

Pope’s hand/oath hand/ hand of benediction

A

Cannot flex digits 4 & 5 at PIP

Median nerve dysfunction
Loss of lateral lumbricals action.

85
Q

Froments sign

A

Ulnar nerve compromise

Cannot pinch paper with thumb because adductor pollicis not working. IP flexion instead because FPL compensates.

Ortho Path 300 (7 decks)

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