Conditions Flashcards
1
Q
Paracentral disc herniation is the same thing as a Prolapsed intervertebral disc.
If you have a L4/L5 paracentral disc herniation, what nerve root will be compressed?
Describe what a paracentral disc herniation is.
A
L5 nerve root in the intervertebral foramen will be compressed because the nucleus pulposus will herniate posterolaterally
2
Q
Describe the 4 stages of disc herniation
A
Don’t Push Ese Sabrina
Degeneration:
Disc is old so it dehydrates and bulges
Prolapse:
Nucleus pulposus breaks through the spinal canal and protrudes into the annulus fibrosus
Extrusion:
Nucleus pulposus breaks through the annulus fibrosus but remains in the disc SPACE
Sequestration:
Nucleus pulposus enters the spinal canal
3
Q
Name 5 red flag symptoms in Cauda equina syndrome
A
- Saddle anaesthesia/perianal numbness
- Bilateral sciatica
- Erectile dysfunction
- Painless urinary retention
- Faecal/urinary incontinence
4
Q
State 3 causes of spinal canal stenosis
A
- Disc bulging
- Spondylolisthesis
- Ligamentum flavum hypertrophy
5
Q
What causes degenerative spondylolisthesis?
A
Weakening of the facet joints so you get a forward slipping vertebrae
6
Q
Describe a cause of kyphosis
A
Osteoporotic compression fractures in the anterior column of the spine
7
Q
What are 4 symptoms of Spondylolisthesis?
A
- Neurogenic claudication
- Incapacitating mechanical pain
- Lower back pain
- Sciatica due to compression of nerve roots
8
Q
Describe the consequences of damage to the superior gluteal nerve
A
Get weakness of gluteus medius and gluteus minimus (on the effected side) due to the loss of the innervation from the superior gluteal nerve. Thus get atrophy of those muscles so these muscles will not be able to stabilise the opposite hip so get a positive Trendelenburg’s sign (have Trendelenburg gait)
9
Q
What is subchondral bone cysts (found in osteoarthritis)?
Name 2 causes.
A
Subchondral bone cystic degredation is a fluid filled space in one of the bones that forms the joint caused by bone necrosis or intrusion of synovial fluid
10
Q
What causes osteophytes (found in osteoarthritis)?
A
Bone metaplasia (formation of bone from another tissue type) leading to irregular outgrowth of bone
11
Q
Name 4 signs seen on a xray of an osteoarthritic hip
A
Subchondral sclerosis
Subchondral bone cysts
Osteophytes
Reduced joint space
12
Q
In an intracapsular fracture of the neck of the femur, why would you get avascular necrosis?
A
Due to the blood supply to the head of the femur from the medial circumflex femoral artery being lost and the blood supply from the ligamentum teres artery not being enough
13
Q
Give 3 descriptions of how the affected leg of a neck of femur fracture would appear?
A
Abducted, externally rotated and shortened
14
Q
Sciatic nerve palsy and femoral nerve palsy can occur in a head of femur dislocation.
Posterior dislocation can cause one of these palsies and an anterior dislocation can cause the other. State which palsy belongs to which dislocation and compare how the effected leg would look in each palsy.
A
Posterior dislocation: Sciatic nerve palsy Flexed Internally rotated Adducted
Anterior dislocation: Femoral nerve palsy Flexed Externally rotated Abducted
15
Q
What artery could be damaged in a distal femoral fracture and a dislocation of the knee joint?
A
Popliteal artery
16
Q
Due to the tibial articular cartilage always being damaged in a proximal tibial fracture, what can this cause in the LT?
A
Osteoarthritis
17
Q
What is the unhappy triad?
A
The blown knee is when the medial meniscus, medial collateral ligament and anterior cruciate ligament are all injured.
(Damage to the medial collateral ligament then leads to damage to the medial meniscus as they are attached).
18
Q
If the ACL is ruptured, what can happen to the tibia?
A
It can slide anteriorly, under the femur
19
Q
What is the pathophysiology behind the dislocation of the knee joint
A
(High energy trauma) leading to rupture of at least 3 of the 4 ligaments (ACL, PCL, LCL, MCL)
20
Q
What is the medical terms for:
- Housemaid’s knee
- Clergyman’s knee
- Knee effusion
A
HMK: Prepatellar bursitis
CMK: Superficial infrapatellar bursitis
KE: Suprapatellar bursitis
21
Q
Knee effusion definition
A
Accumulation of fluid inside the joint
22
Q
What is the medical term for bleeding inside a joint space (a type of effusion)
A
Haemarthrosis
23
Q
What do you always assume the cause of an haemathrosis to be, until proven otherwise?
A
An ACL rupture (anterior cruciate ligament)
24
Q
What do you always assume the cause of a lipo-haemathrosis (blood and fat in joint space) to be, until proven otherwise?
A
Bone fracture (fat released from bone marrow)
25
Name 4 causes of knee effusion
1) Infection - Septic arthritis
2) Rheumatoid arthritis
3) Osteoarthritis
4) Gout
26
What is the medical term for a disease caused by inflammation of the patellar ligaments insertion site into the tibial tuberosity?
Osgood-Schlatter’s disease
27
Describe how crepitus can be felt in osteoarthritis
Loss of articular cartilage leads to increased friction between bones as they grate against each other more frequently and directly.
(Increased friction is felt as crepitus)
28
In a patellar dislocation, which way does a patellar typically dislocate?
Why?
Laterally
Due to the angle of the pull of the quadriceps femoris forming a Q angle with the line of the pull of the patellar ligament so when the quadriceps muscle contracts it tries to pull the patella out of the trochlear groove by pulling it superolaterally.
29
What muscle fibres typically contract to contradict the patella dislocation?
Contraction of the inferior vastus medialis fibres (they pull the patella medially)
30
What symptom triad is typically seen in septic arthritis?
- reduced range of movement
- fever
- pain
31
Why do patients with osteoarthritis complain of their knee buckling?
Describe the pathophysiology that causes this.
1. Knee pain causes reduced knee joint movement (in order to reduce pain)
2. So Quadriceps femoris weaken
3. When you then want to extend your knee flexion muscle power > extensor muscle power
4. So your knee will flex/buckle instead
32
What ligament in the foot is most likely to be injured due to hyperinversion?
Anterior talofibular ligament
33
What is the treatment for compartment syndrome?
Fasciotomy
34
What are 3 LT consequences of compartment syndrome?
Volkmann’s ischaemic contracture
CKD
Rhabdomyolysis (muscle necrosis)
35
What are 3 ST consequences of compartment syndrome?
AKD
Loss of peripheral pulse
Ischaemia of nerve fibres (leading to loss of motor function)
36
In a severe sprain of the ankle, why is it not uncommon to find that the patient has an avulsion fracture of their fifth metatarsal tuberosity?
As the fibularis brevis tendon is attached to a tubercle on the base of the 5th metatarsal so in an inversion injury, the fibularis brevis muscle is under TENSION so pulls off a piece of the 5th metatarsal
37
What is the medical term for bunions?
Hallux valgus
(you get vaRus deviation of the 1st metatarsal and vaLgus deviation of the hallux/great toe/1st proximal and distal phalanges)
38
What is hallux rigidus?
Osteoarthritis of the 1st metatarsophalangeal joint
39
In hallux rigidus, which motion can’t be done?
Dorsiflexion or plantarflexion
Dorsiflexion
40
Describe the changes that happen to foot joints in claw toes
- Hyperextension of the MTPJ (Metatarsophalangeal joint)
- Flexion at PIPJ (proximal interphalangeal joint)
- Flexion at DIPJ (distal interphalangeal joint)
(Claw toe is basically a combination of mallet toe and and hammer toe)
41
What is the difference in joint flexion between mallet toe and hammer toe?
In hammer toe, the PIPJ is flexed, whereas in mallet toe the DIPJ is flexed
42
Injury to the common fibular nerve and tibial nerve will show what respective foot signs?
PED: see foot drop when try to evert subtalar joint and dorsiflex ankle
TIP: can’t stand on TIPtoes, inversion of subtalar joint and plantar flexion of ankle joint will be lost
43
What condition is a diplegic gait seen in?
Cerebral palsy (can also have a hemiplegic gait with this condition)
44
Name 2 conditions that will have a high steppage gait that has foot drop
1. Common fibular nerve palsy
| 2. Sciatica
45
What is a Jefferson’s fracture?
What is a typical cause?
Fracture of the anterior and posterior arches of C1 vertebra caused by axial loading (road collision accident, diving head first into shallow water)
(Polo mint snapping)
46
What is a Hangman’s fracture and what is its cause.
Fracture of the pars interarticularis of the C2 vertebra typically caused by hyperextension (hanging, road collision accidents)
47
What is cervical spondylosis?
Chronic degenerative osteoarthritis affecting the intervertebral joints of the cervical spine
48
What is osteophytosis?
Osteophytes forming at the end plates of the vertebral body
49
What is the pathophysiology of cervical spondylosis?
Primary cause is age related disc degeneration followed by osteophytosis
50
Narrowing of the intervertebral foramen in cervical spondylosis can cause radiculopathy.
What is radiculopathy?
List 3 symptoms
Compression of the spinal nerve ROOT
Sensory:
Paraesthesia (or numbness)
```
Pain:
Radicular pain (this may or may not be present) (described as a constant burning, strap-like, deep pain)
```
Motor:
Myotomal motor weakness
51
Myelopathy can be caused by what?
Compression of the spinal cord (in the spinal canal)
52
Name 4 symptoms of myelopathy
Urinary/faecal incontinence
Loss of balance
Gait abnormality
GLOBAL motor weakness
53
What ligament prevents superior dislocation of the shoulder?
Coraco-acromial ligament
54
What ligaments prevent anterior dislocation (the most common dislocation) of the shoulder?
Superior, middle and inferior glenohumeral ligaments
55
Fracture to the surgical neck of the humerus can damage what structure and paralyse what 2 muscles?
Axillary nerve
Deltoid and teres minor
56
In an anterior shoulder dislocation, what position would the arm be in?
Abduction and external rotation
57
What are 2 common sites of anterior shoulder dislocation?
Subcoracoid location
Subglenoid location
58
What is a Bankart lesion?
Anterior tear of glenoid labrum
| Occurs during anterior dislocation of shoulder
59
What is a Hill-Sach’s lesion?
Posterolateral indentation fracture of humeral head
| Due to strength of teres minor and infraspinatus forcing the anteriorly dislocated humerus onto the glenoid labrum
60
What is the medical term for frozen shoulder?
Describe where in the shoulder is affected.
Adhesive capsulitis
Glenohumeral joint is inflamed and stiff
61
If there is damage to the radial (spiral) groove of the posterior humerus, out of all the tricep heads, why would only the lateral head be paralysed?
Due to the radial nerve innervating the long and medial head before it enters the spiral groove, where as it innervates the lateral head WITHIN the spiral groove
62
In posterior elbow dislocations (the most common elbow dislocation), what direction and through what structure does the distal humerus move through?
What ligament and nerve are likely to be damaged?
Distal humerus moves anteriorly through the joint capsule.
Ulnar collateral ligament and thus ulnar nerve are likely to be damaged.
63
Describe what a Nursemaid’s/Pulled elbow is
Subluxation (partial dislocation) of the radial head due to a tear of the annular ligament of the radius
64
Describe the pathology behind tennis elbow/lateral elbow tendinopathy/lateral epicondylitis
Overuse of the Extensor carpi radialis brevis (ECRB) muscle leads to micro tears of its tendon at the site of attachment to the common extensor origin at the lateral humeral epicondyle (thus leading to inflammation and pain)
65
What are 2 other terms for golfer’s elbow?
Where is the common site of pathology?
Medial epicondylitis and medial elbow tendinopathy
Interface between the pronator teres and flexor carpi radialis
66
What site does cubital tunnel syndrome occur at?
What structure is affected?
Proximal tendinous arch of the 2 heads of the flexor carpi ulnaris muscle joining can be inflamed, thus compressing the ulnar nerve that passes through this arch
67
Why do waist scaphoid fractures have a high rate of non/mal-union and proximal pole avascular necrosis?
Due to the retrograde blood supply from the Dorsal carpal branch of the radial artery.
Retrograde blood supply means that the distal scaphoid is supplied with blood first then the proximal scaphoid receives a weak/tenuous blood supply
68
When you get a scaphoid bone fracture, what area in the hand, do patients typically complain of pain?
Anatomical snuff box
69
Definition of a Colles’ fracture?
Distal radial metaphysis fracture with dorsal angulation and impaction
70
What fracture is also associated with Colles’ fractures in 50% of cases?
Ulnar styloid process fracture
71
Why are Colles’ fractyres typically seen in post-menopausal women?
Higher incidence of osteoporosis (in this age group and sex)
72
Colles’ fracture complications:
A) What nerve palsy can occur?
B) What syndrome can occur?
C) What muscle tendon can tear?
A) Median nerve palsy
B) (Post traumatic) carpal tunnel syndrome
C) Extensor pollicis longus tendon
73
Definition of a Smith fracture
Distal radial fracture with palmar/volar angulation of the distal fractured fragment
74
Describe how 3 hand joints will be effected in Swan neck deformity and in Boutonniere deformity - complications of rheumatoid arthritis
Swan neck deformity:
- Hyperextension of the PIPJ
- Flexion of MCPJ and DIPJ
Boutonniere deformity:
- Hyperextension of MCPJ and DIPJ
- Flexion of PIPJ
75
Onycholysis definition.
Name an AI condition that can have onycholysis.
Separation of the nail from the nail bed.
Seen in psoriatic arthritis (mainly effects DIPJ on hands). (Can also occur in hyperthyroidism and fungal nail infection)
76
DIPJ are common sites of osteoarthritis in the hand.
What other joint is a common site for osteoarthritis in the hand? And, why would you get ‘squaring of the hand’, in later stages of osteoarthritis of this joint?
1st Carpometacarpal joint.
Squaring of the hand:
Subluxation of the first metacarpal in the ulnar direction
77
In distal interphalangeal joint osteoarthritis of the hand, describe the pathophysiology of Heberden’s node formation.
What are these nodes called if they occur on the PIPJ?
Sudden pain and cystic swelling on the dorsolateral DIPJ. Cysts are full of gelatinous hyaluronic acid. Pain and inflammation subside and you are left with osteophytes.
PIPJ - Bouchard’s nodes
(The nodes are osteophytes)
78
Why is sensation in the palm spared in carpal tunnel syndrome?
Due to the ‘palmar cutaneous branch of the median nerve’ branching off proximal (before) to the carpal tunnel and entering the palm superficial/above the carpal tunnel
79
What 3 muscles will undergo weakness and atrophy in carpal tunnel syndrome?
1. Superficial head of flexor pollicis brevis
2. Opponens pollicis
3. Abductor pollicis brevis
80
If the superficial head of flexor pollicis brevis is weak in carpal tunnel syndrome, give 2 reasons why patients are still able to flex their thumbs.
1. Flexor pollicis longus is innervated by the anterior interosseous branch of the median nerve,in the forearm (isn’t trapped in the carpal tunnel)
2. Deep head of flexor pollicis brevis is innervated by ulnar nerve (passes through Guyon’s canal - which is above the carpal tunnel)
81
Describe Dupuytren’s contracture
Thickening and contracture of the palmar aponeurosis leading to flexion of the adjacent finger
82
In a radial nerve injury in the spiral groove, describe the wrist and fingers positions when the wrist is pronated. Explain why
Will see wrist drop. Wrist and fingers will be flexed due to unopposed flexor muscles (overpowering extensor muscles). Extensor muscles in the wrist and fingers and Brachioradialis will all be paralysed.
83
In a high median nerve injury, typically in the arm, when you ask the patient to make a fist, what sign would you see if the injury is:
A) more recent
B) a long-standing lesion?
A) Hand of Benediction
B) Ape hand deformity
84
In a low ulnar nerve injury, e.g. compression of the Guyon’s canal, describe the hand deformity and describe the positions of 3 joints in the hand
Claw hand deformity
Of ring and little finger:
- hyperextension of metacarpohalangeal joints
- flexion of PIPJs and DIPJs
85
Describe why the MCPJs are hyperextended in low ulnar nerve injuries and why PIPJs and DIPJs are flexed.
MCPJ hyperextension:
Extensor digitorum extending the MCPJs, without any opposed flexion (ED is innervated by posterior interosseous branch of radial nerve)
PIPJ and DIPJ flexion:
Extensor digitorum dissipates too much energy in the MCPJ extension, that it uses little energy to extend the IPJs, thus Flexor digitorum superficialis (hyper)flexes the PIPJs and Flexor digitorum profundus (hyper)flexes DIPJs with little opposition from ED
86
In high (elbow - medial epicondyle) and low (wrist - Guyon’s canal) ulnar nerve injuries, majority of muscles innervated in the hand are paralysed - due to majority of these muscles being innervated by the ulnar nerve.
However, there are 2 muscles in the forearm that are paralysed in only one of these conditions.
Which condition is it (high or low)?
Name the 2 muscles.
High ulnar nerve injury.
1) Flexor carpi ulnaris
2) Ulnar half of Flexor digitorum profundus
(Palmar and dorsal ulnar branches are also lost so lose sensations in its respective areas in the hands)
87
Explain why, in a high ulnar nerve injury, the DIPJ is not affected.
(Still have a claw hand but it is less pronounced - still have hyperextension of MCPJ of little and ring finger and flexion of PIPJ of little and ring finger)
Due to paralysis of Ulnar half of Flexor digitorum profundus so DIPJs cannot be flexed.
88
Describe Neurapraxia.
What class does it belong to according to the Seddon’s classification.
What is Wallerian degeneration?
Does Neurapraxia have Wallerian degeneration?
Belongs to Class I.
Conduction block- no damage to axon but have damage to myelin sheath thus have conduction block only at the site of injury. Distal to the conduction block there is sensory and motor dysfunction. Neurapraxia does not have Wallerian degeneration.
Wallerian degeneration is when the axon distal to the site of injury degenerates (occurs 24-36 hours after injury).
89
What recruits the macrophages to phagocytose the neural debris in Wallerian degeneration 10-14 days after the neural injury?
Schwann cells
90
What creates the Bands of Bunger and what is the function of the Bands of Bunger?
(Within 3 days of neural injury) Schwann cells begin to proliferate and form lines of cells (by the 3rd week) and this is the Bands of Bunger.
Bands of Bunger function is to dictate the direction of AXONAL regeneration.
91
Describe Class II of Seddon’s classification. (Discuss the status of the axon, myelin sheath and nerve)
Does Wallerian degeneration occur here?
Wallerian’s degeneration does occur here.
Axonotmesis (Axons divided) is when at the site of the injury and distal to it, there is degeneration of the axon and myelin sheath. However the nerve surrounding the axon and myelin sheath is intact. (Nerve layers are epineurium, perineurium and endoneurium).
92
Describe Class III of Seddon’s classification.
Does Wallerian degeneration occur here?
Wallerian degeneration occurs distal to the site of the nerve injury.
Neurotmesis (Nerve divided) is when you get partial or complete division of the axons, myelin sheath and all 3 layers of the nerve.
93
What prevents regeneration in Neurotmesis.
Scar tissue deposition/fibrosis between the divided fascicles
94
What is the pathophysiological difference between Sciatica and Piriformis syndrome?
Sciatica is compression of L4-S3 nerve roots whereas Piriformis syndrome is compression of the sciatic nerve by the piriformis muscle
95
What is the medical term for injury to the lateral cutaneous nerve of thigh?
Describe its pathophysiology.
Meralgia paresthetica is compression of the lateral femoral cutaneous nerve of thigh as it pierces the inguinal ligament (on its descent to the thigh).
96
Describe a positive Tinel’s sign
Tapping the nerve at the site of compression and patient agrees to feeling tingling/paraesthesia in the distribution of the nerve.
97
Pain from the glenohumeral joint and rotator cuff is typically felt where?
Upper arm
98
With tennis elbow, what movement typically exacerbates the pain?
Where is the pain typically felt?
Extension of the wrist.
Pain is felt on the lateral elbow.
99
What is Fibromyalgia?
Widespread musculoskeletal pain accompanied
100
Name 6 symptoms/conditions that are typically accompanied with Fibromyalgia?
Mood issues (depression, anxiety)
Temporomandibular joint disorders
Fatigue, Sleep issues (sleep apnea, restless leg syndrome)
Memory issues
Tension headaches
IBS
101
Give 4 signs of degenerative disc disease
1. Hypomobility
2. Contraction of paraspinal muscles
3. Spine tenderness
4. Painful extension of back or neck
