Spine, Joints, and Pediatric Orthopedics

Question 1

What spinal nerve roots are responsible for the following reflexes?
Biceps
Brachioradialis
Triceps
Patellar
Achilles

Answer 1

Biceps - C5
Brachioradialis - C6
Triceps - C7
Patella - L4
Achilles - S1

Question 2

What does herniation of the disc between L3/L4 cause?

Answer 2

Remember it affects the nerve exiting above but not below:

L4 symptoms:

1. Weakness of knee extension (femoral nerve)
2. Decreased strength of patellar reflex

Question 3

What does herniation of the disc between L4/L5 cause?

Answer 3

L5 pathology:
Deep peroneal nerve (primarily L5, to tibialis anterior) is affected

Weakness of dorsiflexion, difficulty in heel-walking

Question 4

What does herniation of the disc between L5/S1 cause?

Answer 4

S1 pathology primarily:

Decreased achilles reflex (tibial nerve affected), weakness of plantar flexion, and difficulty of toe walking

Question 5

How is vertebral osteomyelitis best seen early on? Who is most affected?

Answer 5

Via MRI, which will show contrast enhancement due to inflammation.

Most susceptible: diabetics, immunocompromised, HIV, IV drug users

Question 6

What spinal cord infection has a much worse prognosis than osteomyelitis?

Answer 6

Epidural abscess -> gg cuz removal will probably seed the spinal cord with infection

Question 7

What is the likely diagnosis if you see a vertebral osteomyelitis eating not only thru the vertebral bodies but also into the surrounding soft tissues and spinal cord?

Answer 7

Spinal tuberculosis (Pott disease) -> very locally invasive and can also spread hematogenously

Question 8

What is the most common cause of lumbar spine impingement / stenosis in the elderly?

Answer 8

Ligamentum flavum hypertrophy -> see pg. 432

Question 9

What is the definition of scoliosis and at what degree measurement does it become progressive?

Answer 9

Greater than 10 degrees curvature of the spine

Becomes progressive if curves are >40 degrees in adolesence

Question 10

What are the symptoms of severe scoliosis?

Answer 10

> 70 degrees = cardiopulmonary dysfunction, pain, and early death.
Happens if you were >40 degrees curvature in adolescence

Question 11

What are the treatments for scoliosis?

Answer 11

Curve >25 degrees, wear a brace for 14-16 hours per day

Curve >40 degrees, fusion of back vertebrae with rods.

Question 12

What is a common cause of knee and hip arthritis which was emphasized?

Answer 12

Corticosteroid use -> leads to avascular necrosis of femoral head. Joint space narrowing and osteosclerosis

Question 13

How is septic arthritis diagnosed and what is the #1 symptom that tells you that’s what it is?

Answer 13

Swollen, red, painful joint which has pain with range of motion

Diagnosed via arthrocentesis showing purulent fluid (WBC >50,000). Need to differentiate from gout / pseudogout via culture, cell count, and crystals.

Question 14

What other vital signs will patient have with septic arthritis?

Answer 14

Fever, tachycardia, hypotension -> infection

WBC counts may be elevated, with positive APPs including CRP and ESR elevations.

Question 15

What is compartment syndrome?

Answer 15

Trauma to soft tissues leads to bleeding / edema in soft tissues
-> fascia and skin keep the swelling and bleeding contained, but prevent venous return, thus causing possible hemorrhagic necrosis

Question 16

How is compartment syndrome best diagnosed and treated?

Answer 16

1 symptom: pain out of proportion to amount of stimulation. I.e. moving their big toe will make them jump everywhere cuz the muscle has nowhere to move.

Treatment is fasciotomy (emergency within 6 hours)

Question 17

What is slipped capital femoral epiphysis (SCFE) and who gets it?

Answer 17

A fracture between the epiphysis and metaphysis of the femur -> most common hip disorder of children. When the epiphysis sits in the acetabulum, but the metaphysis is moved out of the way -> “ice cream falling off the cone” sign. “Capital” = head of the femur

Often occurs in obese African Americans children with diabetes or hypothyroidism

Question 18

What are the complications of SCFE?

Answer 18

Trouble walking, progressive arthritis, and avascular necrosis of the femoral head is common (pg. 436)

Question 19

What artery primarily supplies the femoral head?

Answer 19

Medial circumflex femoral artery

Question 20

What is Legg-Calve-Perthes disease? “Perthes”

Answer 20

Idiopathic avascular necrosis of the femoral head

-> a common cause of avascular necrosis of the hip in young children