Quiz 4 Flashcards
Whiplash
Acceleration-deceleration
Cervical flexion-extension sprain-strain
QTF Whiplash classification
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)
Torticollis
Abnormal positioning of the head and neck, relative to the body (Wry Neck)
Can be:
Acute acquired
Congenital
Spasmodic
Acute acquired torticollis
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
Congenital torticollis
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.
Spasmodic Torticollis
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
Cervical Rib
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
C1 Fracture
AKA Jefferson Fracture
Fall on head from height (yeesh)
Occipital condyles may spit or burst the ring of atlas
C7 Fracture
AKA Clay Shoveler’s fracture
Avulsion (of SP) fracture due to hyperflexion injury
TMJ dysfunction
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
Pectus excavatum
Most common deformity of the chest wall.
AKA funnel chest
Congenital
Midline depression of sternum
Pectus carinatum
AKA pigeon chest
Congenital
anterior protrusion of the sternum
Barrel chest
Acquired increase in the AP dimensions of chest wall.
Most commonly associated with emphysema
Dowager’s hump
Excessive curvature of the upper T spine; most commonly a result of osteoporosis; also DJD
Wedge compression fracture
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
Straight Back Syndrome
Reduced thoracic kyphosis
Decreased AP chest dimensions
Heart and mediastinal structures compressed between T spine and sternum
Functional heart murmur
Flat Back Syndrome
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
Hyperlordosis
Increase in normal lumbar lordotic curve with increased anterior pelvic tilt.
May be concurrent with spondyloisthesis
May lead to compensatory hyperkyphosis, head forward posture.
Reduced thoracic kyphosis
Straight back syndrome
Decreased lumbar lordosis
Flat back syndrome
Increase in lumbar lordotic curve
Hyperlordosis
Stenosis
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
Spondylolysis
Pars defect.
Interruption of the pars interarticularis, usually L5-S1
Idiopathic – congenital, traumatic, degenerative, pathologic
May be asymptomatic
May lead to spondylolsthesis
What is the pars interarticularis?
Portion of the spine that joins together the upper and lower facet joints
Lies between lamina and pedicle
Spondylolisthesis
Gap in pars defect widens
L5 shifts anteriorly on sacrum
May be asymptomatic; may cause pain, hyperlordosis or neurological symptoms
Degenerative disc disease
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
Herniation
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
Four stages to disc herniation
- Degeneration
- Prolapse
- Extrusion
- Sequestration
Lumbarization
Nonfusion of the first and second segment of the sacrum
One additional articulated vertebrae (L6)
One fewer sacral vertebrae
Sacralization
S1 fused with L5
Leads to extra long sacrum and four lumbar vetebrae
Cauda Equina Syndrome
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
Sciatica
Pain felt in low back and along distribution of sciatic nerve
DJD, compression, trauma, piriformis syndrome
Klippel-Feil Syndrome
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.
Synostosis
Congenital fusion of two bones.
GH hypermobility
Due to physiological laxity of CT
Usually in individuals involved in overhead throwing or lifting.
Shoulder fractures are commonly associated with injuries of what nerve?
Radial
Shoulder dislocation
GH joint
Most commonly anterior dislocation
Shoulder separation
AC joint
Can be partial or complete ligamentous injury due to forceful trauma.
Shows up as step deformity.
Three types of step deformity
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
Subdeltoid and subacromial bursitis
Due to wear and tear on joint
Acute: symptoms same as supraspinatus tendonitis
Rotator cuff injuries
Most common in athletes die to vigorous circumduction, most common at supraspinatus tendon
Impingement Syndrome
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
Stages of Impingement Syndrome
Stage 1: Edema, hemorrhage into subacromial bursa
Stage 2: tendonitis and fibrosis
Stage 3: tendonitis rupture (complete or incomplete).
Infraspinatus tendonitis
Occurs near Musculotendinous junction
Painful arc with overhead or forward motions
Can be asymptomatic. Pain can refer to deltois and triceps.
Bicipital tendonitis/tenosynovitis
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.
Possible causes of winging scapula
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
Radial nerve injury
Symptoms: impaired sensation yo back of arm, forearm, hand.
Variations include crutch palsy, Saturday night palsy
Erb’s (Duchenne’s) Palsy
AKa brachial plexus injury (C5-6)
Often occurs in newborns due to birth trauma
Symptoms include waiters tip, paralysis of shoulder and arm
Olecranon bursitis
“Students elbow”
Constant pain at Olecranon. Swelling, limited mobility.
May result from trauma, constant pressure, inflammatory conditions (EA, PA, gout)
Lateral epicondylitis
Tennis elbow
Degeneration of CET
Pain at lateral epicondyle, referring down forearm.
Medial epicondylitis
Golfers elbow
Inflammation of CFT
Often associated with ulnar nerve issues.
Radial nerve lesions
Continuation of brachial plexus
Affects elbow, wrist and extrinsic finger extensors (plus abductor poll long)
Crutch palsy, supinator syndrome
Symptoms of radial nerve lesion
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
Ulnar nerve lesions
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
Tunnel of Guyon
Aka ulnar tunnel
Between hook of hamate and pisiform
Symptoms of ulnar nerve lesion
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
Tunnel of Guyon
Aka ulnar tunnel
Between hook of hamate and pisiform, transverse and posthaste ligaments.
Symptoms of ulnar nerve lesion
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
Ulnar tunnel (Tunnel of Guyon) syndrome
Handlebar syndrome
Numbness, pain, tingling on ulnar side of hand.
Median nerve lesion
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
Symptoms of median nerve lesions
- Ape hand (thumb can’t adduct)
2. Pope’s blessing/hand of benediction/ oath hand (cannot fleet digits 1&2 because of lumbricals)
What passes through the carpal tunnel?
Nine tendons (4 x fdp; 4 x fds; 1 x FPL) Median nerve
Carpal tunnel syndrome
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.
Complications of lunate dislocation
Often anterior dislocation
Avascular necrosis (Keinbock’s)
Median nerve compression
DJD
Mallet finger
Avulsion injury to DIP (extensor dig,)
Can extend entire finger except DIP.
Boxer’s/Brawler’s fracture
Fracture of 5th MC
Bennett’s fracture
Fracture-dislocation of first carpal-metacarpal joint.
Reverse Bennetts Fracture
Fracture-dislocation of fifth carpalmetacarpal joint
Scaphoid fracture
High incidence of complication, including delayed Union, nonunion, avascular necrosis and DJD
Smith’s Fracture
Reverse Colles
Fracture of radius with ventral displacement. (Spoon)
Colles fractures
Fracture of distal radius with dorsal displacement.
Madelung’s deformity
Deformity of radius typically affecting distal radius (ulnar side)
Radius grows palmarly and radially.
Ganglion cyst
Thin walled synovial-lined lesion
Commonly on dorsal hands and feet
Can cause local discomfort and compress median and ulnar nerve d
Trigger finger
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”
Gamekeepers thumb
Tear or rupture of ulnar collateral ligament at the 1st MCP joint
Due to abduction and extension
Adhesive capsulitis
Frozen shoulder
More often women than men
Restrictions usually in ER and Abduction
Idiopathic
Stages of Adhesive Capsulitis
- Acute stage. Freezing/painful/first stage
- up to 9 months
- inflammation and progressive stiffness - Subacute/frozen/stiffening/second phase
- stiffness in abduction, IR, ER - Chronic/thawing/resolution/third phase
Nursemaids elbow
Sublux of radial head from annular ligament.
Olecranon Bursitis
Students elbow
Keinbock’s disease
Idiopathic avascular necrosis of lunate
Osteochondrosis
Can lead to permanent loss of grip strength and wrist motion.
Dupuytren’s contracture
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
Claw hand (ulnar)
Inability to extend digits 3 & 4
Due to ulnar damage –> third and fourth lumbricals don’t work
Ape hand
Inability to abduct and oppose thumb
Distal median nerve dysfunction –> paralysis of thenar muscle.
Pope’s hand/oath hand/ hand of benediction
Cannot flex digits 4 & 5 at PIP
Median nerve dysfunction
Loss of lateral lumbricals action.
Froments sign
Ulnar nerve compromise
Cannot pinch paper with thumb because adductor pollicis not working. IP flexion instead because FPL compensates.
