Spine And Extremities Flashcards by joseph dizon

Deformity

Hormone abnormality secreted by the anterior pituitary gland

Acromegaly

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Deformity

Acromegaly growth occurs after

Epiphyseal closure in which hand , feet, face are enlarged

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Deformity

Where in there is no room for increase in lenght of the long rather, increase in width is observed

Acromegaly

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Deformity

Hormone abnormality caused by tumor in the anterior pituitary (eg. Adenoma)

Gigantism

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Deformity

Gigantism occurs

Before epiphyseal plate closure, enlarged skeleton perfectly proportioned

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Deformity

The growth in length of long bones are proportional with the head and height of the patient

Gigantism

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Deformity

Gigantism and acromegaly are due to overgrowth of bone and soft tissue stimulated by excess of

Somatotropic hormone

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Deformity

All dimensions of hands are increased as in acromegaly but condition accompanied by extreme clubbing of fingers and parrot beak nails

Hypertrophic osteoarthtopathy

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Deformity

Checking for clubbing

Schamrot’s sign

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Deformity

Hypertrophic osteoarthtopathy

How to check schamrot’s sign

Alam mo na yan

+ if absence of diamond shape in between

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Deformity

Hypertrophic osteoarthtopathy

Result from

Chronic Hypoxemia like

COPD
Bronchial asthma
Ventricular/atrial shunting

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Deformity

Hypertrophic osteoarthtopathy

Mixing of oxygenated and deoxygenated blood

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Deformity

Congenital anomaly of obscure cause
Ask if it is familial

Small hands/ acromicria

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Deformity

Spider fingers
Arachnodactyly

Longer slender hands

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Deformity

Longer slender hands

Abnormality in the connective tissue, all long bones are slender and elongated often with hyper-extensible joints

Marfan syndrome

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Deformity

Longer slender hands

Thumb sign

Steinberg sign

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Deformity

Longer slender hands

Patient encircle his own wrist with his thumb and little finger

Wrist sign

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Deformity

Longer slender hands

Results from removal of testis in males

Eunuchoidism

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Short thick hands

With goiter and hypothyroid
Short, thick, and fat hands

Cretinism

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Short thick hands

Patients with trisomy 21
Short and thick hands
Thumb diverges from nearer the wrist than N
Little finger is curved

Mongolism

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Short thick hands

Claw is formed by hyper extension of the metacarpophalangeal joints and flexion of interphalageal articulations

Claw hands

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Claw hands causes

Brachial plexus or ulnar nerve injuries
Muscular atrophy
Spinal cord injury (syringomyelia or acute poliomyelitis )

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Short thick hands

Thumb held in extension by its inability to flex (always straight)

Ape hand

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Ape hand occurs in

Syringomyelia
Progressive muscular dystrophy
Amyotrophic lateral sclerosis ALS

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Short thick hands Pronated hand drops from the wrist from weakness of the extensors

Wrist drop

Wrist drop due to

Radial nerve palsy Poliomyelitis Lead poisoning Arsenic or alcohol

Short thick hands Ring and little fingers are flex while the other digits move normally and may extend to produce toe posture

Benediction hand or preachers hand

Bendiction hand occurs in

Ulnar nerve palsy | Syringomyelia

The palm Yellow color imparted to the skin by carotene Sclera is still white, unlike in jaundice due to impaired bilirubin

Carotenoderma

The palm Lesion of the median nerve

Thenar atrophy

Damage of the ulnar nerve

Hypothenar atrophy

The palm Sign of increased collateral circulation Cirrhosis Pregnancy Valvular heart disease

Palmar erythema

Fingernails Congenital, familial or associated with certain syndromes

Polydactyly (supernumerary)

Fingernails Attached hands or together Congenital or hereditary

Syndactyly

Fingernails Painless nodules in distal finger joints A localized osteoarthritis

Heberden's nodes

Fingernails Middle and proximal finger joints are affected Digital infection

Rheumatoid arthritis (haygarths nodes)

Fingernails Presence of groove on the nails Formed in some period of time where one have undergone physical stress disease that affected the growth of the fingernail

Beau's lines of the nails

Fingernails May include that one is not healthy (not eating or sleeping well)

Beau's lines of the nails

Fingernails Infection of the nail Swollen skin over the mantle of the nail and the lateral folds Painful and tender

Paronychia Usually when chronic it is not painful

Fingernails Abscess of the terminal pulp space Swelling of the fingertip and dull pain Make incision and drain the abscess

Felon

Fingernails Vitamin A deficiency

Egg shell nails

Fingernails Hypertrophy of the nail plates Due to chronic fungal infection or familial

Oncyhauxis

Fingernails Nails of hepatolenticular degeneration

Red half moon in nail beds

Fingernails Separation of the nail

Onycholysis

Fingernails Subungual hemorrhage Subacute bacterial endocarditis, trichinosis

Splinter hemorrhages

Wrist Inspect and palpate for

Swelling Tenderness Deformities

Wrist Palpate or auscultate for

Crepitus or crackling sound

Wrist Check for visible

Skin lesions Mass Discoloration

Wrist Motion

Dorsiflexion Palmar flexion Slight anatomic medial and lateral movement

Wrist Feeling of thickening at the wrist joint Then followed by paresthesias and tingling sensation Then pain

Carpal tunnel syndrome

Wrist Carpal tunnel syndrome Due to nerve compression, particularly

Median nerve

Wrist Carpal tunnel syndrome Part of the pain is caused by

Ischemia of blood vessels

Wrist Carpal tunnel syndrome Sluggish of the movement due to

Compression of the ligament

Wrist Carpal tunnel syndrome Involvement of the median nerve will be manifested at the

Lateral portion of the hand (thumb, index, middle, half of ring)

Wrist Carpal tunnel syndrome If becomes chronic, there may be some atrophy of the muscles observed

Thenar atrophy

Wrist Carpal tunnel syndrome Percuss the medial side of the palmaris longus tendon to produce paresthesia

Tinel's sign

Wrist Carpal tunnel syndrome Causes

``` Overuse of the hand Repetitive motion Trauma Aging Amyloid deposits Sarcoidosis Gouty tophi Soft tissue swelling in pregnancy Myxedema ```

Forearm

With radius and ulnar bone

Forearm Covered by different

Flexor and extensor muscles

Forearm Motion

Supination | Pronation

Forearm Fracture of the distal portion of the radius Displacement of the hand dorsally in relation to the forearm

Smith's fracture

Forearm May also compress the nerve and blood vessels so expect for some numbness, paresthesias

Silver fork deformity

Elbow Swelling

More common on extensors or lateral side

Elbow Rheumatoid nodules

Found in the olecranon bursa

Elbow Motion

Extension and flexion - movt of hemeroulnar joint | Pronation and supination - humero-radial and distal radio- ulnar joints

Elbow Deformity of the elbow, the normal angle is

170 degree, reference part is the hand

Elbow Angle 160 degree Deviation laterally

Cubitus valgus Valgus=Laterally

Elbow Angle >170 Deviation from the line of the arm

Cubitus Vagus

Elbow Tennis elbow secondary to tendonitis

Arthritis of the elbow

Elbow Due to bacterial infection, may be accompanied by fever and with possibility of pus

Suppurative arthritis

The upper arm Includes

Shaft of the humerus Biceps Triceps

The upper arm Traumatic rupture of biceps brachi occurs suddenly from

Lifting excessive weight

The upper arm Fracture of the humeral shaft Caused by a direct blow, there is unmistakable angular deformity

Transverse function

The upper arm Fracture of the humeral shaft No deformity, due to fall on the hand

Spiral function

The upper arm Fracture of the humeral shaft In all case of fractures humerus, feel the __________ and ________ to assess if the brachial plexus is damaged.

Radial artery pulse | Radial nerve injury

Shoulder joint and girdle Includes

Scapula-humeral joint

Shoulder joint and girdle Sub acute inflammation of the entire rotator cuff Overuse of the particular shoulder

Arthritis | Frozen shoulder

Shoulder joint and girdle Sits muscle

Arthritis | Frozen shoulder

Shoulder joint and girdle Paralysis of long thoracic nerve

Winged scapula

Shoulder joint and girdle Test for winged scapula

Push the wall | If shoulder blade is protruding = lack of innervations of long thoracic nerve

Shoulder joint and girdle Congenital condition with unilateral or bilateral winged scapula

Sprengel's deformity

Shoulder joint and girdle Raise both arms to a vertical position at the sides of the head Both hands behind the neck Elbow out to the side

Internal rotation and | Abduction

Shoulder joint and girdle Both hands behind to the small of the back

External rotation

Shoulder joint and girdle Inspect the scapulae and related muscles posteriorly

No joint dse Arthritis Complete rupture of suprapinatus tendon Partial and chronic suprapinatus tendon

Shoulder joint and girdle Pain in shoulder

Shoulder joint- arthritis Tendon - suprapinatus tendonitis Muscle- muscle strain

Shoulder joint and girdle Pain in shoulder 2

Bones- fracture of humeral neck Nerves- compression Vascular- aneurysm

Shoulder joint and girdle Pain referred to the shoulder

CVS - angina pectoris Respiratory system - pneumonia GIT - gastritis, peptic ulcer GUT- cholelithiasis

Shoulder joint and girdle Tip of the most prominent portion of the lateral side of the clavicle up to the tip of the middle finger

Length of arm

Shoulder joint and girdle From anterior superior iliac spine to the tip of medial malleolus with the tape crossing the patella

Length of lower extremity

The spine 7 cervical vertebrae; 3 are specialized

C1 - atlas C2- axis C7- vertebral prominence

The spine Movement

Rotation - atlas and axis only Flexion Extension Lateral flexion

The spine Pancoast syndrome/superior Pulmonary sulcus syndrome Tumor in

Pulmonary apex Upper mediastinum Superior thoracic aperture

The spine Pancoast syndrome/superior Pulmonary sulcus syndrome Ssx

``` Pain in posterior part of shoulder and axilla Shooting pain down the arm Acor paresthesias Paresis Atrophy of the arm Horners syndrome ```

Ssx of Horners syndrome

``` Ptosis Anhydrosis Miosis Enopthalmus Loss ciliospinary reflex ```

The spine Described the complications from degeneration of the vertebra and their intervertebral disks with traumatic rupture or degeneration of the nucleus pulposus

Cervical spondylosis/cervical osteoarthritis

Spine Cervical spondylosis/cervical osteoarthritis Ssx

``` Pain in the neck, shoulder, occipital, scalp or down the arm Numbness and tingling of the hands Muscle atrophy Crepitus Degenerative disease of cervical spine ```

Spine Begins in the occipital region

Nuchal headache

Spine Sudden forceful, hyper extension of the neck with the flexion recoil

Post traumatic neck pain and headache Eg. Whiplash

Spine Whiplash the ________ is ruptured. Rarely then spine of ____ is fractured

Ligamentum nuchae | C7

Spine Post traumatic neck pain and headache Ssx

Neck pains Spasm of the neck muscle Torticollis

Spine C5 function for hyper flexion Eg. Drivers strikes his head on the bottom

Flexion fracture of the neck

Spine Result in immediate death or quadriplegia if the patient survives

Flexion fracture of the neck

Spine A fall or blow on forehead may hyperextend the neck, Rupture anterior longitudinal ligament

Partial dislocation from hyper extension

Spine If immediate death does not result, the patient is unable to nod the head and there will be severe occipital pain Resulting neck pain and paraplegia

Fracture of the atlas (c1)

Examination of the spine From the side

Inspect the spinal profile | Note cervical, thoracic and lumbar curves

Examination of the spine From behind

Inspect for lateral curves, take note of heights of shoulder, iliac crest

Examination of the spine Imaginary line at

T1 gluteal cleft

Examination of the spine Percuss the spine for tenderness by thumping it with the

Ulnar surface of the fist

Examination of the spine Overlies the posterior iliac spine and guides us to the sacroiliac joint

Skin dimple

Thoracolumbar spine and pelvis

12 T 5 L 5 S 4 C

Thoracolumbar spine and pelvis 4 curves of vertebral column viewed laterally

Cervical curve- C2- T2 Thoracic curve - T2- T22 Lumbar curve - T12- lumbosacral joint Pelvic curve - lumbosacral joint - tip of coccyx

Spine Forward co cavity of the thoracic curve is accentuated producing q hunched back

Kyphosis

Spine Kyphosis Smooth curve result from Rigid kyphosis of adolescence

Scheuermann's Kyphosis

Spine Kyphosis Smooth curve Ankylosing spondylitis

Marie strumpell disease

Spine Kyphosis Smooth curve Osteitis deformans

Paget's disease

Spine Kyphosis Smooth curve Others

Faulty posture | Senile osteoporosis

Spine Kyphosis Angular curved (gibbus) caused by

Collapse of bodies of vertebra from compression fracture Metastatic CA Infectious spondylitis

Spine Accentuated posterior con cavity of the lumbar spine Deep between lumbar para spinous muscles Pot belly

Lordosis

Spine Lordosis causes

Pregnancy Flexion contractures of the hips Short Achilles' tendon

Spine Lateral curvature of the spine

Scoliosis

Spine Scoliosis note for

Loss of symmetry Compare tips of scapula Top of hips Dimples of venus

Spine Occurs in congenital deformities Paralysis of back or abdominal muscle

Structural scoliosis

Spine Examination

Thomas - for lordosis | Gaenslens sign -

Test for the hip joint

Straight leg raising test Patrick's test - flexion, abduction, external rotation Dislocation of the hip/trendelenburg sign

Knee Patient standing

Inspect for Deformities Swelling Muscle atrophy Position of patella

Knee Patient supine

Test for extension and flexion

Knee Leg deviate toward the midline and knees are farther apart

Genu varum ( bow leg)

Knee Genu varum Occurs in

Rickets Pa gets disease Occupational cowboys Jockeys

Knee Lateral deviation of the leg from midline

Genu valgum (knock knee)

Knee Knees fixed in hyper extension with little ability to flex

Genu recurvatum

Knee Synovial fluid in the knee joint

Effusion or hydroarthrosis

Knee Blood in the joint cavity

Hemarthosis

Knee Pus in the joint cavity

Pyarthrosis

Knee Housemaid knees

Prepatellar bursitis

Knee Clergyman's knee

Intrapatellar bursitis

Knee minimal swelling in popliteal fossa Knee hold in partial flexion to relieve pain Extension is painful

Popliteal abscess

Knee Pressure diverticulum of synovial sac protruding thru the joint capsule of knee Complication of RA Popliteal artery entrapment syndrome

Morrant Baker's Cyst

The leg Trauma causing extreme dorsiflexion of foot Severe pain and tenderness

Soleus tear

The leg Injury incurred when body weight is forcefully applied tothe ball of the foot in plantar flexion

Rupture of Achilles' tendon

The leg Squeeze calf muscles transversely No motion when tendon is severed

Simmonds test

The leg Due to fall on the leg Direct blow to anterior tibia Sever pain Leg cannot bear weight

Fracture of tibial shaft

The leg Direct blow on the anterolateral aspect of leg Pain on anterior leg Patient can walk

Fracture of fibular shaft

The leg Most common cause of compound fracture Foot turned inward in obvious deformity

Fracture of both tibia nd fibula

The ankle joint Swelling or effusion

Subcutaneous edema

The ankle joint Rupture of joint capsule Arthritis will also give you lateral inflammation of the ankle joint

Lateral ankle pain

The ankle joint Swelling of the ankle joint

Effusion into the ankle joint

The ankle joint Post traumatic lateral ankle pain Injury done when you suddenly trip while walking

Rupture of joint capsule

The ankle joint Motion

Dorsiflexion | Plantar flexion

Foot Motion

Inversion/eversion | Abduction/adduction

Foot Inward deviation Inversion of the foot

Talipes or club foot

Foot Club foot Eversion

Talipes valgus

Foot Club foot Plantar flexion Always on tip toes

Talipes equinus

Foot Club foot Dorsiflexion, heel bone making contact with the ground Manifest a defect on the neural arch

Talipes calcaneus

Foot Club foot Hollowing on the insteps Sever aching of the foot

Pes cavus

Foot One or more of the pedal arches are lowered Makes a person become unstable

Pes planus

Foot Arch is lowered only while bearing weight

Relaxed flat foot

Foot Caused by bone or fibrous ankylosis

Rigid flat foot

Foot From the contraction of the paromel

Spasmodic flat foot

Foot Flattening of the skin in the toes

Cutaneous lesion

Foot Thickening of the dorsal of the foot resulting in conical portion

Corn

Foot Undue pressure on the thin skin, especially the covering of the shoes produces a conical structure of keratin pointing into the dermis where it causes pain

Hard corn | Heloma durum

Foot Corn on an inter digital surface that undergoes laceration due to moisture and infection

Soft corn | Heloma mollis

Foot Thickening of the soles of the foot as a result of continous pressure

Callus

Foot Examination Normal

Lateral part of shoes start to wear out

Foot Examination Flat foot

Medial side of the shoes gets worn out

Foot Examination The toe portion of the shoes due to the tip toed movement

Talipes equinus

Foot Examination Has a cut area of the big toe, laterally due to lateral deviation of the big toe

Hallus vagus

The toes Lateral deviation of the great toe Produces abnormal prominence of the lateral metotarsophalangeal joint

Hallus valgus

The toes Inflamed bursa over the prominent metatarsophalageal joint Toes deviate laterally

Bunion

The toes Matatarsalgia from transverse flat foot

Spaly foot

The toes Stiffened great toe Chronic arthritis or epiphysis of the first metatarsophalageal joint from injury or wearing short shoes

Hallus rigidus May causes ankylosis

The toes Fixation of the 2nd toe in flexion 2nd toes is the one affected because it is the longest

Hammer toe

The toes Secondary to rheumatoid arthritis

Hammer toe

Toenails Ingrown toe nails Excessive transverse growth of the nail plate causes the lateral edge to lacerate the nail fold is painful,

Onychocryptosis

Toenails Rams horn nails Overgrowth of toe nails Nail becomes thickened, growth in a conical or on top of the other so that it is irregular and curved like horn of a ram

Onychogryphosis

Toenails Great toe is involved Arises from the dorsal surface of the distal phalanx to penetrate the distal half of the nail bed Not common

Sub- ungual exostosis

Involves only

Inspection and palpation