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Chiro Pediactric Diplomate > M1.2 — 2 appendicular skeleton > Flashcards

M1.2 — 2 appendicular skeleton Flashcards

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1
Q

In the humerus/shoulder, the proximal end (humeral head, greater and lesser tuberosities) fuse around - yo. The proximal epiphysis closes at __-__yo and the distal epiphysis closes at __-__yo

A

4-6
12-20
11-19

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2
Q

in the radius/ulna, the capitulum, trochlea and lateral epicondyle fuse together to form the conjoint epiphysis at __yo which fuses with the shaft at __yo.
The medial epicondyle fuses separately with the shaft at __yo

A

14
15

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3
Q

which bone is the most common site of growth plate fractures?

A

radius/ulna

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4
Q

the distal epiphysis of the radius fuses around __-__yo and the distal epiphysis of the ulna fuses around __-__yo

A

21-25
21-24

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5
Q

the metacarpal head and phalangeal bases fuse around __-__yo

A

14-19

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6
Q

what is the order/pattern the carpal bones fuse?

A

clock-like pattern away from thumb starting at capitate, hamate, triquetrum, lunate, scaphoid, trapezium, trapezoid

then pisiform

mnemonic for carpal bones = “So Long To Pinky”, “Here Comes The Thumb”

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7
Q

which sex fuses first in the upper extremities? lower extremities?

A

M before F in upper
F before M in lower

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8
Q

In the Femur
The head appears at _ yo, fuses __-__F and __-__M

The greater trochanter appears at _ yo, fuses __-__F and __-__M

The lesser trochanter appears at __-__yo, fuses __-__

The distal epiphysis appears at __-__, fuses __-__F and __-__M

A

head = appears 1yo, fuses 11-16F, 14-19M
greater trochanter = appears 2-5yo, fuses 14-16F, 16-18M
lesser trochanter = appears 7-12yo, fuses 16-17yo
distal epiphysis = appears 36-40 weeks gestation, fuses 14-18 F, 16-19 M

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9
Q

In the Tibia, the proximal fuses at __-__yo, distal at __-__yo and medial malleolus from distal tibial epiphysis __-__yo

A

19-24
16-19
7-10

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10
Q

In the fibula, the proximal fuses at __-__yo and the distal at __-__yo

A

22-24
20-22

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11
Q

In the Pelvis, fusion occurs in the ilium at __-__yo, ischium at __-__yo, pubic at __-__yo, acetabulum (2 centers)__-__yo, iliac crest __-__yo, ASIS __-__yo, AIIS __

A

ilium 7-9
ischium 7-9
pubic 7-9
acetabulum (2 centers) 20-25
iliac crest 15-17
ASIS 19-25
AIIS 16

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12
Q

in the sacrum, fusion occurs in the body by __yo and all segments form one bone by __yo - the center remains unosified up to __yo

A

body by 20
one bone by 25
center unosified up to 50

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13
Q

What is osteochondrosis? what age and sex is most common?

A

developmental orthopedic disease that affects the growth centers in children and adolescents. Result from abnormal growth, injury or overuse

M>F, 10-14yo

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14
Q

What is Leg-calve-per the disease? how common? what sex, age, race is most common?

A

idiopathic avascular necrosis of the proximal femoral epiphysis

1 in 10,000
4-8yo
M>F
caucasian more common

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15
Q

what are the risk factors for leg-calve-perthe disease

A

family history
low birth weight
secondhand smoking
caucasian

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16
Q

what are associated conditions of leg-calve-perthe disease?

A

ADHD in 33% of cases
delayed bone age in 89% of cases

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17
Q

what are exam findings of leg-calve-perthe disease?

A

insidious onset
trendelenburg
painless limp
loss of hip IR and abduction
leg length discrepancy

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18
Q

What does leg-calve-perthe look like on imaging? what view is best?

A

AP pelvis and frog leg view

medial joint space widening
irregular femur head
crescent sign

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19
Q

what is the treatment for leg-calve-perthe disease?

A

co-manage with pediatric orthopedist

relieve weight bearing
- passive ROM with exercise
— focus on surrounding hip muscles
— static and dynamic stretching
— isometric first, then isotonic
— no single leg closed chain exercises

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20
Q

what is the prognosis for leg-calve-perthe disease? which sex has worse prognosis?

A

50% fully recover without long-term sequence

50% develop pain and disability in their 40s and 50s and DJD of the hip leading to hip replacement

younger age of onset (<6 yo)= better outcome

females have worse prognosis

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21
Q

what is osgood schlatters disease? who is affected?

A

knee apophysitis/ osteochondrosis of the tibial tubercle

10-15 yo athletes

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22
Q

what is Singig Larson Johansson disease? who is affected?

A

knee apophysitis/osteochondrosis of the distal pole of patella

10-13 yo athletes

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23
Q

knee apophysitis/ osteochondrosis is more common in which sex? bilateral or unilateral? what types of sports?

A

M>F
bilateral 20-30%
jumping sports

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24
Q

What are exam findings for knee apophysitis/ osteochondrosis?

A

insidious onset of pain during or after activity
tenderness, swelling at apophysis

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25
what is the treatment for knee apophysitis/ osteochondrosis?
decrease activity stretch quads, hamstrings adjust to improve biomechanics soft tissue management gradual increase in workload recovery is slow but it is self-limiting
26
What is Sever’s disease? who gets it?
overuse injury to the calcaneal apophysis 12-16 yo in running and jumping sports - typical just before or during peak growth season
27
what are contributing factors to Sever’s disease?
increased activity, tight heal cord, weak ankle dorsiflexion, bad shoes, running on hard surfaces
28
what is seen on exam with Sever’s disease?
unilateral or bilateral heel pain, worse during and after activity pain at the posterior calcaneus may have swelling and tenderness pain with passive dorsiflexion pain with compression of posterior calf, standing tiptoes no bruising
29
what is the imaging for Sever’s disease?
imaging is not routine
30
what is the treatment for Sever’s disease?
active rest KT take ice adjust foot for better biomechanics heel cup achilles tendon stretches
31
What is Frieberg’s disease? who does is affect? symptoms and treatment?
disordered ossification of the metatarsal head (most typically in the 2nd) girls 4:1, 13-18yo, dancers and ballet pain with weight bearing and activities, stiffness treatment = activity modification, met pads and good supportive footwear
32
What is Kohler’s disease? who gets it? symptoms and treatment?
avascular necrosis of the navicular (navicular bone is the last one to ossify in the foot) boys 4x more than girls, 4-7 yo midfoot P with limp - weight onto lateral foot treatment = anti-inflammatories, walking boot
33
what is Little Leageur’s elbow? where is it located?
a constellation of abnormalities in the elbow of young pitchers resulting from shearing, inflammation, traction and abnormal bone growth 3 potential sites of injury - medial epicondyle stress fracture - ulnar collateral ligament (UCL) - flexor pronator mass strain
34
with little leageur’s elbow, younger patients are more likely to have ________ injuries, rather than ________ injuries
apophysitis or avulsion rather than UCL sprain
35
what is found on the exam with Little Leageur’s Elbow?
- elbow P in throwing arm - decreased throwing speed, accuracy distance - swelling, P and tenderness to palpation about medial elbow - P with valgus stress - instability in valgus stress notes more severe involvement (should be check at varying degrees)
36
what is the imaging for Little Leageur’s elbow?
Xray AP, lateral - widened physis, fragmentation or avulsion of medial epicondyle MRI only to confirm UCL insufficiency
37
what is the treatment for little leageur’s elbow?
- 4-6 weeks rest from throwing - adjust - shoulder, full spine - soft tissue management - IASTM - rehab - limit pitches - surgery indicated for medial epicondyle avulsion fracture or UCL disruption
38
What is Panner’s disease? causes? who?
osteochondritis dessicans (AVN) of the humeral capitellum. Repetitive valgus stress on elbow result in compression of the radio-capitellum joint. Repetitive overhead and upper extremity weight bearing 7-12yo boys>girls
39
what does the exam show with Panner’s disease?
dull ache in lateral elbow swelling decreased elbow extension occasional locking of the elbow
40
what is the imaging for Panner’s disease?
Xray AP and lateral - irregular epiphysis, OCD is well-defined subchondral lesion
41
what is the treatment for Panner’s disease? how long to recover?
active rest 3-6 weeks with slow progression back to activity over 6-12 weeks 6-18 months for full recovery? 50% develop long term arthritis in the joint
42
What is Scheuermann disease? when is the onset? who?
rigid kyphosis d/t anterior wedging (during growth spurt) onset 10-12 yo males 2:1
43
what is the imaging for scheuermann disease?
Xray - 5 degrees wedging on at least 3 adjacent vertebra
44
what is the treatment for Scheuermann disease?
extension-based exercises hamstring stretching adjust soft tissue management
45
what is a Salter-Harris fracture? when and why does it happen? how common is it? who gets it?
a growth plate fracture in a long bone - most often occur during growth spurt when the physis is weakest - ligament and joint capsule are stronger and more stable than the physis 15-30% of all pediatric bone injuries active children, boys>girls girls 11-12, boys 12-14
46
What is Salter-Harris classification? which is most common? least common? prognosis?
SALTER type I = Straight across the physis (good) type II = Above (75%) (good) type III = Lower or below (poor) type IV = Through (poor) type V = ERaser of growth plater/crush (1%) (worst)
47
What is Myositis Ossificans? who? where
formation of bone in atypical, extreskeletal soft tissue from local trauma, neurological injury (TBI, stroke, SCI), post-surgical complication M>F young, active 15-35 most common in quad, brachialis and glutes
48
49
what is the history like for myositis ossificans?
pain, swelling, tenderness, decreased ROM, palpable mass (can grow in size over several months)
50
what is the treatment for myositis ossificans?
rest, ROM exercises, no passive stretching active stretching only, cold laser
51
What is bipartite patella?
congenital failure of patella to fuse on the superolateral aspect - incidental findings bilateral 50%
52
what is the treatment for bipartite patella?
active rest, immobilize with brace in 30 degrees flexion, isometric quad sets
53
what are osteochondrodysplasias? which is most common?
abnormal bone or cartilage growth leading to skeletal misdevelopment most common = achondroplasia and hypochondroplasia - both are autosomal dominant
54
what is achondroplasia?
most common skeletal dysplasia mutation of fibroblast growth factor 3 (FGFR3)
55
what are characteristics of achondroplasia?
average intelligence, shortened life span (average 61 years), large head, frontal bossing, small nasal bridge, rhizomelia (proximal bones shorter), short digits, triden configuration of hands, bow legs
56
what are some clinical significance of achondroplasia?
foramen magnum stenosis (leads to sleep apnea, trouble swallowing, lower cranial nerve palsies, hyperreflexia, generalize hypotonia, weakness and clonus hearing impairedment (middle ear dysfunction, conductive hearing loss, 50% will require tubes, tympanostomy) pseudoclaudication (discomfort while standing and difficult walking for prolonged periods, leg paresthesia, and subjective weakness may be observed later in life
57
what is hypochondroplasia?
an abnormal bone or cartilage growth caused by genetic mutation to FGFR3 but milder symptoms than achondroplasia
58
what are characteristics of hypochondroplasia?
appear normal at birth very short stature, large head, accentuated lordosis, short arms and legs, and broad, short hands and feet, limited ROM in elbows
59
What is osteogenesis imperfecta?
abnormalities in the synthesis of processing of type I collagen - results in increased susceptibility of bone fractures and decreased bone density 9 different types ranging from very mild to severe skeletal manifestations
60
what are the clinical features of osteogenesis imperfecta?
blue sclera, hearing loss, dentinogenesis imperfecta, ligament laxity, short stature, easy bruising
61
What is Marfan’s syndrome?
congenital connective tissue disorder caused by autosomal dominant mutation Fibrilan-1 (FBN1) gene on chromosome 15
62
what are the clinical features of Marfan Syndrome
scoliosis, arachodactyly, cardiac abnormalities, ligament laxity, superior lens dislocation of th eye, spontaneous pneumothorax, pectus excavatum
63
what is seen on the physical exam of Marfan’s Syndrome?
- arm span is greater than height - long fingers and toes - thumb sign (thumb does past medial palm when bent) - wrist sign (thumb hoverlap pinky finger around opposite wrist) - scoliosis, pes planus

Chiro Pediactric Diplomate (15 decks)

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