Clinical Significance

Question 0

Kyphosis “Hunch-back”

Answer 0

• Accentuated flexion of thoracic spine.

* Aetiology: poor posture, osteoporosis.

Question 1

Scoliolis

Answer 1

• Accentuated lateral and rotational curve of the thoracic or lumbar spine.
• Aetiology: genetic, trauma, idiopathic; occurs in adolescent
girls more than boys

Question 2

Lordosis “Sway-back”

Answer 2

• Accentuated extension of lumbar spine.

* Aetiology: weakened trunk muscles, late pregnancy, obesity.

Question 3

Osteoarthritis

Answer 3

• Progressive erosion of cartilage in joints of spine, fingers, knee 
and hip (most commonly).  
 • In spine => can lead to spinal nerve impingement

Question 4

Spondylolysis

Answer 4

• Affects 3-6% population.
• Defect where vertebral arch becomes separated from it’s body.
• 85-95% cases at L5; 5-15% at L4.

Question 5

Spondylolithesis

Answer 5

• Anterior or posterior displacement of vertebrae in relation to vertebrae below.

Question 6

IV disc herniation

Answer 6

• Peripheral tears (mostly posterolateral) of anulus fibrous allows for extrusion and herniation of nucleus pulposus which may
impinge spinal nerves.

• Lumbar disc herniations are common and result in pain over SI joint, hip, posterior thigh and leg.

Question 7

Spinal nerve root irritation

Answer 7

• Pain in affected dermatome.
• Sensory losses in affected dermatome.
• Motor deficits in “indicator” muscles.
• Reflexes associated with affected segment are diminished or
absent.

Question 8

Lesions of spinal cord and peripheral nerves

Answer 8

• Dorsal root lesions will lead to sensory disturbances in dermatomes.
• Ventral root lesions will lead to motor disturbances = weakness (paresis) because muscles usually receive innervation from several segments.

Question 9

Median nerve palsy

Answer 9

Median nerve lesion result in inability to flex thumb, index and
middle finger at MCP joint.

Ring and little fingers still flexed because the ulnar nerve is intact.

Question 10

Ulnar nerve palsy “ claw hand”

Answer 10

Ulnar nerve lesion results in inability to flex the DIP joint of ring and little finger.
Patients can’t make a complete fist. Also can’t extend interphalangeal joints to straighten fingers.

Question 11

Radial nerve palsy “wrist drop”

Answer 11

Radial nerve lesion results in denervation of extensor muscles in forearm. Because forearm flexor muscles no longer opposed, wrist drops.

Question 12

Anatomical snuff box lies between which two tendons?

Answer 12

Extensor pollicis longus and extensor pollicis brevis

Question 13

Neurovascular bundle contains what?

Answer 13

Axillary artery 
Axillary veins 
Median nerve
Ulnar nerve
Brachial artery

Question 14

Rotator cuff injury

Answer 14

• Wear & tear.
• Degeneration of subacromial bursa => degeneration of underlying supraspinatus muscle.
• Tearing of supraspinatus tendon.
• Difficulty in initiating rotation (movement).

Question 15

Carpal tunnel contains what structures

Answer 15

• 4 tendons of flexor digitorum profundus (deep)
• 4 tendons of flexor digitorum superificialis
• Tendon of flexor pollicis longus
• Median nerve

Question 16

Cubital tunnel

Answer 16

Cubital tunnel Passageway between medial epicondyle of
humerus and olecranon process of ulna.

Ulnar nerve passes posterior to medial epicondyle.

Compression of ulnar nerve as it passes beneath the ulnar collateral ligament between two heads of flexor carpi ulnaris.

Effects on motor branch to FCU, FDP (medial 1⁄2), intrinsic muscles of hand, hypothenar eminence and sensory branches to skin on ring (medial 1/2) and little finger.

Treatment may involve moving ulnar nerve from posterior to anterior