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Clinical MSK > Exam 1 > Flashcards

Exam 1 Flashcards

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1
Q

Describe a Jefferson fracture

A

This type of fracture is also known as a burst fracture; there is a fracture in both of the arches of the atlas

caused by a blow to the top of the head from a falling object or diving

This type of fracture will not injure the spinal cord UNLESS the transverse ligament is ruptured, which can injure the spinal cord

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2
Q

Describe the two places in which the axis is susceptible to fracture

A
  1. odontoid process

2. vertebral arch

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3
Q

Describe a Hangman’s fracture

A

fracture of the vertebral arch that is caused by a hyperextension of the head on the neck

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4
Q

Describe fractures of the odontoid process including how they occur and the possibility of healing

A

Caused by a horizontal blow to the head; breaks because the transverse ligament is stronger than the bone

If it breaks at the base: may not heal because the transverse ligament is holding it away from the blood supply

If it breaks inferior to the base, it is more likely to heal

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5
Q

Describe spina bifida

A

Failure of the vertebral lamina to close off the vertebral canal (typically L5-S1)
tuft of hair over the area is common

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6
Q

What happens if there is neural tissue and meninges involvement in spina bifida

A

Spina Bifida Cystica

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7
Q

Describe what makes the cervical vertebrae more susceptible to injury, but how its structure defies this

A

Because the articular facets are more horizontal, they are easier to dislocate BUT the large vertebral foramen does not result in injury to the spinal cord

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8
Q

Define spondylosis

A

Degenerative joint disease that involves calcification of the edges of the vertebral body and can cause localized pain and stiffness

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9
Q

Define Spondylolysis

A

Separation of the vertebra arch from the vertebral body

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10
Q

Define Spondylolithesis

A

anterior displacement of the vertebral body on the inferior vertebral segment

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11
Q

Describe lumbar spinal stenosis

A

narrowing of the lumbar foramen and may cause compression of the spinal nerve roots

can be worsened with disc bulging, arthritis, and ligament degeneration

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12
Q

Describe a lumbar puncture

A

Used to express the cerebral spinal fluid

A needle is inserted between L3/L4 or L4/L5 at the level of the iliac crests. Needle goes through the ligament flavum and passes into the lumbar cistern into the spinal cord and arachnoid mater

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13
Q

Describe sacralization of the L5 vertebra

A

Partial or complete fusion of the L5 vertebral segment and the sacrum

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14
Q

Describe lumbarization of the S1 vertebra

A

The separation of the S1 vertebra from the sacrum

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15
Q

What causes injuries to the coccyx?

A

Childbirth, falls on the lower back

hard to treat and hecka painful

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16
Q

Differentiate between the primary and secondary curvatures of the spine

A

primary: Thoracic and Sacral kyphoses
secondary: cervical and lumbar lordoses

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17
Q

Describe the abnormal curvatures of the back

  1. kyphosis
  2. Lordosis
  3. Scoliosis
A
  1. exaggerated curving of the thoracic vertebral column leading to a humpback
  2. exaggerated curving of the lumbar vertebral column resulting in a sway back
  3. curving to the left or the right
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18
Q

Describe a whiplash injury

A

Hyperextension of the anterior longitudinal ligament that usually occurs as a result of a car accident

recoil can cause a hyper flexion injury as well

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19
Q

Why is the anterior longitudinal ligament important in fractures?

A

It acts as a splint in the event of a vertebral fracture (pt in hyperextended position) and the ligament allows for fracture realignment and healing. It also protects the spinal cord from any further damage

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20
Q

Describe a disc herniation

A

The nucleus pulposus herniates through the annulus fibrosis

typically occurs posterolaterally because that is where the annulus fibrosis receives no support from the anterior and posterior longitudinal ligament

The bulge from the hernia results in stenosis of the nerves

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21
Q

Where is herniation most common?

A

L4/L5 or L5/S1

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22
Q

Describe the second number rule

A

In the case of the lumbar and the cervical nerves, the nerve that comes out between two vertebrae will correspond with the second number that is involved

Therefore herniation will affect the nerve that matches the number of the disc that lies below the nerve

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23
Q

Differentiate between a back sprain and a back strain

A

A back sprain is caused by injury to the ligament attachments between bones

A back strain is caused by excessive stretching or tearing of fibers from an overly contracted muscle

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24
Q

Describe the result of a spinal cord injury at C1-C3

A

No function below the head, respirator needed for life

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25
Describe the result of a spinal cord injury at C4-C5
No function of the limbs; respiration is capable
26
Describe the result of a spinal cord injury at C6-C8
loss of hand and upper limb function; could use a wheelchair
27
Describe the result of a spinal cord injury at T1-T9
paralysis of lower limbs
28
Describe the result of a spinal cord injury at T10-L1
some thigh function, walking with long leg braces
29
Describe the result of a spinal cord injury at L2-L3
most leg functions present, lower leg braces
30
Describe the five categories of the structures that are innervated by the recurrent meningeal nerve and posterior rami of the posterior rami of the spinal nerves
1. fibroskeletal structures 2. synovial joints 3. intrinsic back muscles 4. spinal nerves and roots that are innervated by the posterior rami 5. meninges that are innervated by the recurrent meningeal nerve
31
Describe a greenstick fracture
Fracture of the clavicle that is common in kids. Results in the bone not completely breaking, but splintering like a stick
32
Where is the humerus most susceptible to fracture? To an avulsion fracture?
1. Surgical neck is the most common site of fracture | 2. Greater tubercle is susceptible to avulsions by the supraspinatius, infraspinatus, and theres minor insertions
33
You hit your funny bone, what happens?
The ulnar nerve strikes against the surface and the ulnar groove, causing pain to the area
34
Describe how an avulsion fracture can occur at the medial humeral epicondyle
SEVERE abduction of an extended elbow
35
Describe a Colle's fracture
Fractures of the distal end of the radius that is typically caused by a fall on outstretched hands (FOOSH) that results in a "dinner fork" fracture --- styloid process is often avulsed with this injury as well
36
Someone falls onto their hand... 1. What is the most commonly fractured bone in the wrist? 2. Describe it more; diagnosis and possible problems
1. scaphoid 2. it is difficult to see on a radiograph; the distal end is more susceptible to necrosis as it can be separated from its blood supply
37
Describe Carpal Tunnel syndrome
The carpal tunnel is formed underneath the flexor retinaculum When the tendons get inflamed, they swell and compress the median nerve, which leads to issues; aka carpal tunnel syndrome
38
Describe Guyon tunnel and the problems that can occur here
The Guyon canal is in the depression between the pisiform and hamate where the ulnar nerve passes, if the surrounding tendons become inflamed, the nerve can become compressed loss of sensation and weakness
39
Describe a Boxer's fracture
A fracture to the 5th metacarpal that is typically following a push to an object with a closed fist
40
What injury is commonly seen when fingers are closed in a door?
Fractures of the distal phalanges... must be realigned carefully
41
Where and why does the glenoid labrum tear?
Common in throwing motions Caused by the sudden contraction of the biceps brachii to the anterosuperior part of the labrum
42
Describe shoulder separation
Caused by the separation of the acromioclavicular joint; can occur with or without the tearing of the coracoclavicular ligament
43
Describe a shoulder dislocation
the shoulder is susceptible to dislocation because of its instability. A dislocation is when the humeral head comes out of the glenoid cavity; typically anteriorly or inferiorly
44
Describe an elbow dislocation
usually occurs secondary to a force along the long axis of the forearm, which typically results in an ulnar collateral tear
45
What are the two bursa that are commonly inflamed?
Olecranon bursa and Bicipitoradial bursa
46
Describe subcutaneous olecranon bursitis
olecranon bursitis becomes inflamed from excessive friction between the skin and the olecranon
47
Describe nursemaids elbow
Radial head is dislocated out of the annular ligament; usually secondary to pulling
48
Describe "bull riders thumb"
sprain of the lateral collateral ligament or an avulsion to the lateral part of the proximal phalanx of the thumb
49
Describe a skiers or a gamekeepers thumb
laxity of BOTH collateral ligaments of the 1st metacarpophalangeal joints that results in hyperabduction of the joint
50
Describe mallet finger
sudden hyper flexion of the distal interphalangeal joint that can avulse the long extensor tendon
51
Describe a ganglion cyst
Inflammation of the tendon sheaths that results in an accumulation of the mucopolysaccharide fluids that form a lump to the area can become infected
52
Describe a Dupuytren contracture
disease resulting in the shortening, thickening and fibrosis of the palmar aponeurosis and the palmar fascia; partial flexion of the 4th and 5th digits
53
Describe what an injury in the long thoracic nerve causes including which muscle group is affected and the anatomical consequence
Paralysis of the serratus anterior and winging of the scapula away from the thoracic wall pt cannot abduct the upper limb above a certain point
54
What is the purpose of the rotator cuff muscles? Which muscles are they?
To maintain the stability of the joint, if one of the muscles tears, then there will be instability in the joint. Supraspinatus, infraspinatus, teres minor, and subscapularis
55
If the bicipital myotactic reflex is not present- meaning the tendon does not tighten up, what injury could this suggest?
Injury to the musculocutaneous or the C5 and C6 anterior rami
56
Describe biceps tendonitis
Inflammation to the tendon of the biceps secondary to the muscle constantly moving through the intertubercular groove of the humerus; leads to crepitus
57
What leads to the popeye deformity?
The biceps tendon dislocating from the groove causing the muscle to ball up in the arm
58
Describe tennis elbow
Pain over the lateral epicondyle and down the posterior forearm; caused from repeated extension and flexion of the wrist
59
If there was an issue with opposition of the thumb, which nerve would be suspect?
Injury to the median nerve can cause this even a cut to the superficial aspect of the palm can cause injury to the medial recurrent nerve, which can result in the opposition issue
60
A pitcher comes to the clinic complaining of pain and decreased sensation to his right arm, his pitching arm. What do you suspect?
The patient could have a aneurysm in the first part of his axillary artery that is causing compression of the brachial plexus
61
In order to cut off the blood flow to the entire arm, where would you have to cut the artery?
Ligation must be distal to the sub scapular artery of the axillary artery, because of the circumflex arteries
62
Why is the median cubital vein a common target for blood draw?
Because the bicipital aponeurosis protects everything and helps the vein to be punctured
63
If somebody falls in a way that dramatically increases the angle between the neck and the shoulder, what would you expect to happen? How would they present clinically?
An injury to the superior part of the brachial plexus, specifically C5 and C6. Adducted, medially rotated, and extended elbow (era-duchenne or a waiters tip position)
64
Describe an injury to the inferior part of the brachial plexus?
Dramatically increasing the angle between the trunk and the upper limb; affects the short muscles of the hand and results in a claw hand when the individual tries to make a fist (Klumpke paralysis)
65
What is common in people who constantly work in an overhead position?
The can get a compression in the brachial plexus, leading to radiating pain, loss of sensation and tingling and weakness of the hands
66
Describe what would happen in the even of an axillary nerve injury
atrophy of the deltoid muscles and loss of sensation over the superolateral arm, where the superior lateral brachial cutaneous nerve is
67
What is the cause of an Ape hand?
Injury in the median nerve at the wrist , which causes an adducted thumb
68
What is the cause of a hand of benediction?
Injury of the median nerve at the elbow; inhibits flexion of the 2 and 3 digits and the sx of the ape hand
69
What are the four places that an injury to the ulnar nerve can occur? What are the clinical sx?
1. posterior to the medial humeral epicondyle 2. between the ulnar and humeral heads of the FCU muscle 3. wrist 4. hand Loss of sensory and motor control in the hand; claw hand when the pt tried to make fist
70
Describe Handlebar neuropathy
ulnar nerve compression when there is pressure placed on the hamulus of the hamate, like when riding a bike sensory loss on the medial side of the hand and weakness of the hand muscles
71
Describe a "wrist drop"
Injury of the radial nerve, which results in impairment of elbow extension and thumb abduction and extension

Clinical MSK (2 decks)

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