exam 2 Flashcards
(137 cards)
1
Q
a. What is the aka for torticollis
A
a. Wry neck
2
Q
b. What is the etiology of torticollis?
A
a. Varies and often cannot be defined
3
Q
c. What is wry neck often associated with? When may onset occur?
A
a. Injury to the SCM muscle on one side at the time of birth, during a difficult delivery. This transforms the muscle into a fibrous cord that cannot lengthen with growing neck
b. May onset at any age.
i. Children –> congenial torticollis
ii. Adult –> acquired torticollis
1) Most often 3rd and 6th decades of life, sudden or of gradual onset
4
Q
d. Woman get affected of wry neck more often than men, T/F
A
a. False, both sexes are equally affected
5
Q
e. What does SCM muscle contraction cause?
A
a. Rotation of the head to the opposite side and flexion of the neck to the same side
6
Q
a. What is the major stabilizer and elevator of the superior angle of the scapula?
A
a. The Levator
7
Q
b. How does the Levator stabilize the scapula?
A
a. Levator produces rotation and side bending of the neck to the same side
i. While acting bilaterally, cervical extension is produced
8
Q
a. Where is the rhomboid minor attachment?
A
a. SP of C7 -T1
9
Q
b. Rhomboid minor has an association with the cervical spine, T/F
A
a. True but slight association
10
Q
c. Where does rhomboid major arise from?
A
a. SP of T1-T5
11
Q
d. Rhomboid major is active during isolated head and neck movement, T/F
A
a. False, it is inactive.
12
Q
a. How many joints does the cervical spine consist of?
A
a. 37
i. Allow for more motion than any other region of the psine.
ii. This degree of mobility comes with a cost of STABILITY
13
Q
b. Why is the cervical spine more vulnerable to both direct and indirect trauma?
A
a. Stability being sacrificed for mobility
14
Q
a. What is the proper dress code for a cervical spine inspection?
A
a. Undress to the waist. Exposing the neck area as well as the entire upper extremity
15
Q
b. Scars on the anterior portion of the neck may indicate for: ?
A
a. Previous thyroid surgery
16
Q
c. What could Pitted scars in the anterior triangle indicate?
A
a. Previous tuberculous adenitis
17
Q
a. What does each pair of vertabrae pair articulate by?
A
a. Zygapophyseal joints
b. Uncovertebral joints
c. IVD
18
Q
b. t the structure of the cervical vertabrae combined with orientation of the zygapophyseal facets provide strong bony stability, T/F \
A
a. False, very little bony stability
19
Q
c. What permit large excursions of motion to the cervical vertegra?
A
a. Lax soft tissue
20
Q
a. At what age does lordotic curve start to develop?
A
a. Usually 3-4 months when child beings to lift head\
b. Response to upright posture
21
Q
b. What does the cervical curve allow?
A
a. Allows the head and the eyes to remain oreinted forward and provieds a shock-absorbing mechanism to counteract the axial compressive force produced by the weight of the head
22
Q
a. What is an anterior head carriage?
A
a. Weight of the head is directly above the center of gravity
23
Q
b. How much weight is produced to the c-spine if head is 3” infront of cog?
A
a. 30 pounds
24
Q
a. Why is bony palpation performed?
A
a. Increase in skin temp
i. Vasomotor changes
b. Localize Swelling sites
c. Identify
i. anatomical structures and their relationship to one another
ii. Pint of tenderness
iii. Soft tissue texture changes or myofascial restriction
d. Locate changes in
i. Muscle tone –>
1) trigger pints
2) Muscle spasm
3) Hypertonicity
4) Hypotonicity
25
a. What level is the hyoid bone?
a. C3
26
b. What level is the thyroid cartilage?
a. C4/C5
27
c. What level is the cricoid ring?
a. C6
28
d. What is the anatomical landmark used for anterior surgery?
a. Carotid tubercle C6
29
a. What is a common bony growth on the frontside of the spine?
a. Osteophytes
b. Can push against the back of the throat
c. Make swallowing difficult
30
a. The Mastoid process is medial to the superior nuchal line T/F
a. False, it is lateral
31
b. What cervical vertebraes can be considered typical?
a. 3-6
| b. 7th is atypical
32
a. How many bones does the wrist have?
a. More than 28
b. 8 core
c. 20 radiocarpal intercarpal and carpometacarpal joints
33
b. How many intercarpal ligaments?
a. 26
34
c. How many parts triangular fibrocartilage complex? (TFCC)
| a. Six or more
a. Six or more
35
a. The hand accounts for 100% of upper limb function, T/F
a. False, 90%.
36
b. what digit is involved 40-50% of hand function?
a. Thumb
37
c. what digit is involved 20% of hand function?
a. Index
38
d. What digit is the chiropractic index? How much involved in all hand function? What is it important for?
a. 3rd digit
b. Involved in About 20% of all hand function
c. Imporant for precision and power functions
39
a. What is the distal radio-ulnar joint?
a. A double pivot joint that unites the distal radius and ulna and an articular disc
40
b. What does the rounded ulna head contact latterally and distally?
a. Ulnar notch radius laterally
| b. TFCC distally (articular disc)
41
c. The radial styloid process is approximately 1/2 inch shorter than the ulnar styloid process, T/F
a. False. Ulnar styloid process is approximately 1/2 inch shorter than the radial styloid process.
i. This results in more ulnar deviation than radial deviation.
42
a. What is the AKA for colles fracture?
a. Dinner fork fracture
43
b. What is a colles fracture?
a. Fracture of the radium within 20-35 mm of the wrist joint with posterior angulation of the distal fragment
b. Extension fracture of the radius
44
c. What is smiths fracture?
a. Flexion fracture of the radium
45
a. What is an aka for smiths fracture?
a. Garden spade deformity
46
b. What is a smiths fracture?
a. Fracture of the radius within 20-35mm of the wrist joint with anterior angulation of the distal fragment
47
What is TFCC?
a. Trangular fibrocartilage complex
| b. The fibrocartilage disc in between the medial proximal row and the distal ulna within the medial aspect of the wrist
48
b. What is the primary function of the TFCC?
a. To improve joint congruency and to cushion against compressive forces
49
c. The TFCC transmits about 90% of the axial load from hand to forearm, T/F
a. False, its 20%
50
a. The wrist consists of _ carpal bones and _ metacarpal bases
a. 8; 5
51
b. In the wrist: How to the carpal bones lie in relation to eachother?
a. Two transverse rows
52
c. Of the wrist: From lateral to medial, what are the bones on the proximal row?
a. Scaphoid (navicular), lunate, triquetrum and pisiform
53
d. The wrist: the distal row, what are the bones in order from lateral to medial?
a. Trapezium, trapezoid, capitate and hamate
54
a. What bone of the wrist is most commonly fractured?
a. Navicular
55
b. What is the largest bone of the proximal row of carpals?
a. Navicular (scaphoid)
56
c. What does ulnar deviation help with?
a. To slide in out from under the radial styloid process for palpation
57
a. What bone is the largest and most prominent of the MCP bases?
a. Capitate
| b. Largest of all carpal bones
58
b. What bone is the second most fractured bone of the wrist and most commonly subluxated?
a. Lunate
59
c. What bones are covered by the extensor carpi radialis brevis tendon? Where does the tendon enter into?
a. Lunate, capitate and base of the 3rd metacarpal
| b. Base of the 3rd metacarpal
60
a. Where does the mid carpal join lie between?
a. Two rows of carpals
61
b. T/F, a 'compound' articulation is present because each row has both concave and convex segments.
a. True
62
c. Which row of carpals is convex laterally and concave medially?
a. Proximal
63
d. Which bones are present with a concave surface to the distal row of carpals?
a. Scaphoid
b. Lunate
c. Trapezium
d. Trapezoid
e. Triquetrum
64
e. Scaphoid, capitate and hamate present a convex surface to a reciprocally arranged distal row, T/F
a. True
65
a. What are carpometacarpal joints?
a. Articulation between the distal borders
66
b. What is the stability of the CMC joints provided by?
a. The palmar and dorsal carpometacarpal and intermetacarpal ligaments
67
a. What digits are invovled in MCP? (metacarpophalangeal) joints?
a. 2-5
68
b. T/F, MCP joints only allow flexion-medial-lateral deviation.
a. False, allow flexion-extension and medial-lateral deviation
b. With a slight degree of axial rotation.
69
a. CMC joint is the most important of the thumb, T/F
a. True
| b. Base of metacarpal and the distal aspect of the TRAPEZIUM
70
a. First CMC has the following motions:
a. Flexion/extension
b. adduction/abduction
c. opposition
d. Varying amounts:
i. Flexion,internal rotation and palmar adduction
71
a. What is bennett's fracture?
a. Fracture through the base of the first metacarpal neck with dorsal and radial displacement of the SHAFT
72
a. MCP joint of thumb: what kind of joint? What kind of surfaces?
a. Hinge joint
b. Convex surface on the head of metacarpal
c. Concave surface on the base of the phalanx
73
a. How many phalanges ?
a. 14
| b. Consists of base, shaft and head
74
b. What mark that the concave proximal bases of the phalanges?
a. Two shallow depressions, which correspond to the pulley-shaped heads of the adjacent phalanges, mark the concave proximal bases
75
c. What produce the pulley-shaped configuration of the phalangeal heads?
a. Two distinct convex condyles
76
a. What is a bar room fracture?
a. Fracture of the fourth or fifth metacarpal neck with anterior displacement of the head
77
a. What is a boxer's fracture?
a. Fracture of the second or third metacarpal neck with anterior displacement of the head.
78
a. What contributes greatly to finger joint stability?
a. Congruency of the IP joint surfaces
79
b. Both PIP and DIP (distal and proximal interphalangeal) joint hinge and capable of only flexion, T/F
a. False.
b. PIP extension and flexion
c. DIP similar to PIP but less stable and allows some hyperextension
80
a. Heberdens nodes can be found on all fingers, T/F
a. False, one or more fingers except thumb
81
b. What are heberdens nodes?
a. Painless nodules
b. Process is a localized osteoarthritis
c. Involvement of several joints is more common in women in whom they appear at the menopausal age
d. In men, single joint is more common
i. Usually result from trauma
82
a. Bouchard's nodes: what are then?
a. Abnormal fusiform enlargement at the PIP joint which can indicate synovitis secondary to Rheumatoid arthritis
83
1. What is a swan neck deformity?
a. PIP joint deforms into hyperextension and the DIP joint is flexed.
b. MOI = RA
84
a. What is boutonniere deformity?
a. Is when the central slip of the extensor digitorum communis tendon is avulsed from the insertion into the base of the middle phalanx,
b. The PIP is flexed and the DIP is extended
85
b. For someone that has boutonneire deformity, what is going on with their PIP and DIP?
a. PIP is flexed
| b. DIP is extended
86
a. What are the major ligaments of the wrist?
a. Palmar intrinsic ligaments
b. Volar extrinsic
c. Dorsal extrinsic and intrinsic ligaments
87
b. What ligaments of the wrist provide major stability?
a. Extrinsic palmar ligaments
88
c. What wrist ligaments serve as severe rotational restraints?
a. Intrinsic ligaments
| b. Binding the proximal row into a unit of rotational stability
89
d. What are the medial and lateral collateral ligaments of the fingers named?
a. Clelands and graysons ligaments
90
a. What is the radiocarpal joint formed by?
a. The large articular concave surface of the distal end of the radius
b. The scaphoid and lunate of the proximal carpal row
c. The TFCC
91
a. What is the antebrachial fascia?
a. A dense connective tissue "bracelet" that encases the forearm
b. Maintains the relationship of the tendons that cross the wrist
92
a. What does the extensor retinaculum serve to do?
a. To prevent the tendons from "bow stringing" when the tendons turn a corner at the wrist
93
b. What is the fibro-osseous compartments?
a. The tunnel-like structures formed by the retinaulum and the underlying bones
94
a. What tendons do the extensor retinaculum compartments contain from lateral to medial?
a. Abductor pollicis longus and extensor pollicis brevis
b. Extensor carpi radialis longus and brevis
c. Extensor pollicis longus
d. Extensor digitorum and indicis
e. Extensor digiti minimi
f. Extensor carpi ulnaris
95
a. T/F, the flexor retinaculum transforms the carpal arch into a tunnel
a. True.
96
b. What nerve passes through the carpal tunnel?
a. Median nerve
| b. And some tendons.
97
c. Where does the flexor retinaculum attach proximally and distally?
a. Proximally attaches to the tubercle of the scaphoid and the pisiform
b. Distally attaches to the hook of the hamate
98
d. What is going on when someone has "carpal tunnel syndrome" ?
a. Median nerve is compressed in the carpal tunnel
99
a. Describe a jersey finger:
a. Avulsion of the flexor digitorum profundus tendon
b. MOI= the finger gets caught in an object and actively flexed DIP joint is suddenly and forcible extended resulting in a rupture
100
a. How many flexor tendons are found in the carpal tunnel?
a. 9
101
b. What ligaments are found on the floor of the carpal tunnel?
a. Palmar radiocarpal ligament
| b. Palmar ligament complex
102
c. What ligaments are found on the roof of the carpal tunnel?
a. Flexor retinaculum (transverse carpal ligament)
103
d. What is found on the ulnar and radial borders of the carpel tunnel?
a. Trapezium (ulnar)
| b. Hook of hamate (radial)
104
e. Within the carpal tunnel, the median nerve divides into motor branch and distal sensory branches, T/F
a. True
105
a. What is the tunnel of guyon? Where is it located?
a. A depression superficial to flexor retinaculum,
b. Serves as a passage way for the unlar nerve and artery into the hand
c. Located between the hook of the hamate and the pisiform bones
106
b. What nerve and artery is found in the tunnel of guyon?
a. Ulnar nerve
| b. Ulnar artery
107
a. What is cyclist hand?
a. Ulnar nerve and artery compression injuries between the pisiform and the hook of the hamate
108
b. What other activities could elicit same cyclist hand problems?
a. Crutch use
| b. Weight lifting
109
a. What is the palmar aponeurosis?
a. Dense fibrous structure continuous with the palmaris longus tendon and fascia covering the thenar and hypothenar muscles
110
b. What is Dupuytren's contracture?
a. Is a fibrotic condition of the palmar aponeurosis that results in nodule formation or scarring of the aponeurosis and which may ultimately cause finger flexion contractures
111
a. There is evidence of small painless nodule that can be palpated in the palmar aponerurosis near the base of the digit in a Dupuytren's Contracture, T/F
a. True
112
a. When Dupuytren's Contracture is present, what may be found during palpation?
a. Palpation of the palm reveals a hard cord over the flexor tendon
b. Passive extension of the finger raises the cord taut where it can be readily seen
c. small painless nodule that can be palpated in the palmar aponerurosis near the base of the digit
113
a. What is an extensor hood?
a. A complex tendon, which covers the dorsal aspect of the digits is formed from a combination of the tendons of insertion from extensor digitorum, extensor indicis, and extensor digiti minimi
114
b. Extensor hood creates a "cable system" that provides a mechanism for _a__ the MCP and IP joints. What does this allow?
a. Extending
| b. Allows the lumbrical and possibly interosseous muscles to assist in the flexion of the MCP joints
115
a. What during inspection can be found to denote underlying neurologic or bony pathologies?
a. Skin markings
i. Lipomatas
ii. Hairy patches
iii. Café-au-lait spots
iv. Birth marks
116
a. What is neurofibromatosis?
a. Heredity disorder that produces pigmented spots
| b. And pedunculated soft tissue nodules clustered along nerve sheaths
117
b. When do neurofibromatosis nodules develop?
a. During childhood, growing to more than 0.5cm in size
| b. Nodules grow throughout individuals life reaching 1.5cm or more in size
118
a. Where are café-au-lait patches usually seen over?
a. Trunk, pelvis and flexor creases of the elbows and knees
119
b. Bone changes may result in skeletal deformities: scolios, T/F
a. True
b. May lead to:
i. Vertebral body scalloping
ii. Fibrous dysplasia
iii. Tibial pseudoarthrosis
iv. Sphenoid bone deformity
v. Mental impairment
vi. Seizures
vii. Hearing loss
viii. Exophthalmosis
ix. Decreased visual acuity
x. GI bleeding eventually occur
120
a. When a patient is standing an inclination or listing to one side or the other may be a sign for what?
a. Possible sciatic scoliosis
| b. Secondary to herniated disc
121
a. What is a dorsal wrist?
a. Occasionally a cystic, pea-sized swelling (ganglion)
b. Can occur on the dorsal or volar aspect of the wrist
c. Small tiny tear in the joint capsule allowing fluid to escape
122
b. What causes dorsal wrist?
a. Perhaps biomechanical alterations
123
a. What is a mallet finger?
a. Terminal phalanx of the finger is permanently flexed at the DISTAL joint
b. Cannot be voluntarily extended
124
a. What causes a mallet finger?
a. Rupture of the extensor tendon that inserts on the terminal phalanx
b. Possibly a fracture of the distal phalanx
125
a. In relationship to the contour of the palmar surface: what are the "hills and valleys" ?
a. Hills are the neurovascular bundles that supply the fingers and lumbrical muscles
b. Valleys are the paths of the flexor tendons at the point where they cross the joint
126
a. What are synovial sheaths?
a. Long narrow balloons filled with synovial fluid
b. Wrap around a tendon so that one part of the balloon wall is directly on the tendon
c. The other part of the balloon wall is separate
127
a. What are the flexor pulleys?
a. Annular and cruciate pulleys
i. Restrain flexor tendons to the MCPs and phalanges and contribute to fibroosseous tunnels through which tendons travel
128
b. List the annular pulleys and state where they pull from
a. A1 - From MP joint and volar plate
b. A2 - from the proximal phalanx
c. A3 - from the PIP joint volar plate
d. A4 - from the middle phalanx
e. A5 - from the DIP joint volar plate
129
a. What is the surgical no mans land?
a. Distal palmar crease to the PIP joints
| b. This is where 2 flexor tendons run into 1 sheath
130
a. What is a trigger finger
a. Either 4th or 5th finger
b. Flexion of the finger feels normal
c. Extension is accompanied by a painful snap that the patient sometimes refers to dorsum of hand
131
a. How many wrist and forearm intrinsic muscles?
a. 19
| b. Arise and insert WITHIN the hand
132
b. How many wrist and forearm extrinsic muscles?
a. 24
| b. Originate in the forearm and insert within the hand
133
a. What are the anterior superficial muscles of the arm?
a. Pronator teres
b. Flexor carpi radialis
c. Palmaris longus
d. Flexor carpi ulnaris
134
a. What are the anterior intermediate/deep muscles of that forearm/wrist?
a. Intermediate
i. Flexor digitorum superficialis
b. Deep
i. Flexor pollicis longus
ii. Flexor digitorum profundus
iii. Pronator quadratus
135
a. What are the posterior superficial muscles of the wrist/forearm?
a. Extensor carpi radialis longus
b. Extensor carpi radialis brevis
c. Extensor digitorum and extensor digit minimi
d. Extensor carpi ulnaris
136
a. What are the posterior deep muscles of the forearm
a. Deep
i. Abductor pollicis longus
ii. Extensor pollicis brevis
iii. Extensor pollicis longus
iv. Extensor indicis
137
a. What are the tendons that form the anatomic snuff box?
a. Abductor pollicis longus
b. Extensor pollicis brevis
c. Ulnar border formed by extensor pollicis longus
d. The floor:
i. Deep branches of the radial artery and the tendinous insertion of the extensor carpi radialis longus
ii. Scaphoid and trapezium bones found underneath
