MSK Flashcards

Question

psoriatic athritis

Answer 1

a** seronegative inflammatory joint disease** affecting 20% people who have psoriasis -periarticular bone erosin and joint destruction -progress slow --> more nuisance than disabiling -2/3 decades of life -children: 9-12 -90% of getting if have 1st degree relative clinical manifestation -**oligoarticular or polyarticular arthritis** -common in **DIP ** **-Claw deformity** -edematous thickened digits because joint changes and flexot tenosynovitis -axial skeleton joint can be affected -Sacroiliits (unilateral in contrast to AS thats bilateral) extraarticular manifestations: -inflammatory eye disease -->conjuctivitis,iritis, renal disease, pitting of nails and onchylosis **-predilection for girls** -multiple **assymetric** joint involved -**hip joint **most common in children involved **pitting of nail beds --> psoriasis onycholysis --> reactive arthritis** a separation of nail plate beg at free margin and progress inward

Answer 2

occurence of an **acute, aseptic inflammatory** arthropathy arising after an infectious process but at the site remote from primary infection -assymetric more than one joint -**uveitis and enthesitis, conjuctivitis, sacroilltis** -oncholysis, dactylitis (sausage like swell)

Answer 3

classic triad of **athritis, urethritis, conjuctivits** (reiter syndrome) -follows venereal disease or bacillary dystentery -keratitis and uveitis -assymetric and acute -decreased lumbar flexion

Answer 4

acute, **monoarticular**, inflammatory arthritis manifested by equisite joint pain at **night** **-uric acid --> hyperuriecemia** -urate crystals (trophi) -middle age men -diet: **purines,** shellfish, trout, anchovies, meat -**alcohol consumption** , obesity, fasting, meds, HTN, hypothyrodism, hyperparathyroidism all can decrease excretion of uric acid txt: meds, diet change, weight loss, moderate alcohol intake after initial episode person enters asymptomati c phase --> intercritical period gouty attacks: increase frequency, sudden

Answer 5

an articular abnormality related to neuro deficits (charcot joint, neurotropic, neuropathic joint disease, neuropathic osteoarthropathy) -early joint changes -advanced neuroarthropathy: enlarged or presistent effusion, minimal sublux, fracture, fragmentation -microfractures can progress quick into gross fragmentation -malalignment with angular deformity, sublux, dislocation --> increase stress on articular bone

Answer 6

-common related to age related changes in Intervertebral disk materials can produce radiculopathy, limited spine stability, disability **-result in neck and LBP ** incidence: -can occur before 20 -elite athletes --> repetitive loading of spine from trunk rotation, kicking, jumping, repeated spinal flexion and extension -begins early in life macroscopic change visible at 30 -half of all americans >40 affected by DDD -men present with sciatica **Risk: familial aggreagating and genetic inheritance ** -age -body wt -excessive forces etiology: -progressive **decline in arterial supply** to periphery of disk and **impairment of nutrient delivery **across cartilaginous endplate contribute to reduced nutritional supply to the cells, affecting cellular function -reduced cellular waste removed and increase lactic acid -spinal stenosis and degerative spondylolisthesis are associated with this (65 and older) -as disk lose height --> annulus bulge circumferentially and ligamentum falvum buckles -ostephytes on vertebral bodies or articular processes clinical manifestations: -LBP -assymptomatic in 1/3 -MRI findings poorly coorelate with S&S -gradual onset of increase severe midline lower back pain -pain spread to butt, thigh -radiculopathy in lumbar spine = sciatic pain and restricted SLR -centralization of radiating pain is characteristic of sciatica from disc protrusion or herniation txt: conservative care, surgery

Answer 7

DS: due to disk degeneration and degenerative changes of the posterior facet joints marked by anterior slippage of one vertebe over another with an** intact posterior neural arch** *L4-L5 most common lytic: a separation common in younger. marked by anterior slippage of one verteba over another with a **defective posterior neural arch**. *L5-Sl

Answer 8

****-degerative processes and space occupying lesions involved in annulus fibrosis or nucleus pulposus -cervical DDD can include annular tears, nuclear disc material degradation and loss of disc height -**cervical spine herniated nucleus pulposus** HNP: occurs when disc material extends **beyond posterior** margin of vertebral body **disc bulge:** NP **bulges **into AF and disc margin extends beyond endplates of adjacent vertebral levels **disc protrusion:** NP from the disc **tear**s through small portion of AF **disc extrusion: **NP **breaks **past outer lamina of NG into space beyond **disc sequestration:** NP becomes **detached** from AF and then usually resides within SC -slow degenerative process not direct trauma -aging; degeneration occur 2nd decade -hx of neck pain S&S -diffuse, vague, over CS nondermatomal -radiate in arm in dermatomal -pain past AC joint --> screen for neuro -morning stiff >30 mins --> improve in day --> end of day increase -decrease motor control and deep neck flexor with increase superficial muscle activity -muscular imbalance in cervical and scapulothoracic region -somatic referral pattern aggravating: -sitting prolonged -neck motions -driving -sleep prone of sidelying -cough/sneeze easing: -lying down -pain meds -cervical spine support -sleep with head supported either in sidelying or supine -walking -modalities txt: disectomy/microdisectomy -anterior/posterior fusion

Answer 9

-failure of either NP or AF of any of the disc in the thoracic region -**protrusion, prolapse,extrusion,sequestration** primarly degenerative rarely acute trauma MOI: -degenerative repetitive f/e activities coupled with compressive loading such as bending/lifting objects -increased thoracic kyphosis -fall on butt -sudden strain cough/sneeze -asymotomatic -stiffness and pain in morning >20 mins increase during day if sit too long -intermmitent backache -acute thoracic lumbago **-restricted neck and back ROM -postive neural tension test -SLR, slump test, femoral nerve stretch, scapular retraction ** Neuro: nerve root palsy, decreased dermatomic sensation, altered DTR, UMN signs -thoracic pain or paresthsia -SC compression symptoms aggravating: cough, sneeze, bear down easing: standing, lying supine PT: encourage walking thoracic extension prone ad thoracic stablization exercises

Answer 10

-pain generating source located toward posterior elements of spine behind intervertebral foramen and associated nerve root -degerative pain can be cause CF: **-degeneration through normal aging or traumatic event ** -history of MVA or trauma -poor posture -occupations with repetitive activites of neck such as house painter or violin **primary facet pathology: ** -older -degeneration or change in joint -osteophytes, bone spurs to intrude zygo -history of trauma to neck **secondary facet pathology: ** -younger adult <40 -trauma -MVA -whiplash hyperextension S&S -diffuse nonspecific neck pain in posterior neck or scapular area exaterbated with closing pattern -limited cervical spine ROM -morning stiff decrease day end of day increase stiff -decreased motor control and deep neck flexor recruitment with increase sup muscle activity -muscular imbalance -absense of neuro findings -evidence of cervical spondylosis,narrowing intervertebral foramina, may be asymptomatic aggravating: -closing pattern, extension,left sidebend,left rotation for symptomatic left sided neck complaint -repetitive motions -substained prolonged positiions without movement -different sleeping positions such as prone or sidelying easing: lying down, opening (flexion,left sidebend, left rotation for right sided pain)

Answer 11

soft tissue injury surrounding musculature of cervical spine that can be caused by variety of incidents like falls, MVA, blow to head, trauma of muscle or ligamentous disruptions via excessive stretch/compressive forces -incidious episode with progressive pain and immobility from sleeping awkwardly or having head in prolonged position -past hx of muscle strain -poor posture S&S -neck pain -pain and stiff in morning -limited ROM -tender -muscle spasm aggravating: -cervical ROM that stretch or elongate tissue -prolonged sit/drive easing: -supine or lying down

Answer 12

spinal nerve root dysfunction -due to degenerative changes found within spine that can create foraminal impingement -younger than 40 -older -->degenerative -posture and occupation --> sitting,lifting manual labor S&S numbness in arm -->dermatomal on UE weak hand muscules pain in cervical,scap,intrascap pain with limited ROM agg: closing pattern easing: open placing arm on top of head

Answer 13

breakdown of cervical spine facet articular surface with loss of cartilage -result of wear and tear -breakdown of articular hyaline cartilage leads to resultant inflammatory cascade -thickening and sclerosis of the subchondral bone and dev of osteophyres or bone spurs -narrow joint, loss shock absoprtion, pain S&S -unilateral pain -stiffness first 10-15 mins stifff again at night -cracking,crunch,crepitus -localized paraspinal and UT pain -TMJ dysfunction agg: inactivity leads to stiff inactivity allows inflammation to pool which increase pressure leading to discomfort and loss of avaliable movement

Answer 14

MOI not really pathology the use of seatbelts has decreased numer of fatalities but with increasing usage of seatbelts has come an increase in more severe forms of whiplash injuries -rear end crashes more likely to casue than frontal impact -rearend or side impact #1 cause of whiplash ***hyperextension -falls -head trauma -child abuse -quick sudden movement of neck S&S -neck pain -HA -shoulder pain ROM initially limited in all directions -guarding in trapezius posteriorly and scaleens and SCM anteriorly -morning stiff -increase symptoms in evening -diff sleeping

Answer 15

-lateral curve >10 using Cobb -idiopathic scoliosis: structural curve with no clear underlying cause **-onset before 3 years: infantile idiopathic scoliosis -onset between 3-10 years: juvenile -onset after 10 years: adolescent ** **functional scoliosis: **abnormalities in body secondarily impact spine. absence of abnorm spine normal. ex: LLD or protective scoliosis secondary to lumbar disc herniation **neuromuscular scoliosis:** develops secondary to problems during dev of spine. bones will not form completely or fail to separate ex: marfan, muscular dystrophy, CP **degenerative scoliosis:**occurs as body ages. disc herniation, fractures, osteophtesm other spinal changes. unlike functional, the spinal curves are result of ACTUAL CHANGES IN SPINE *adolescent idiopathic scoliosis: majority cases 1. small curves ---> no surgery 2. <25 no treatment 3. 25-40 brace 4. >40 surgery ratio b/g = with curves 10 degrees 10:1 girls >30 girls 10x higher risk of cruve progression txt: >45 or worse surgery functional,mild idiopathic, degenerative scoliosis: observe--> no progression--> nothing mild neuro: does not correct itself; if doesnt worse --> nothing degenerative: only addressed if symptoms present --> focus on injury neuro: greates poor outcome (surgery) infantile: better w/o intervention. no brace or surgery **juvenile idiopathic scoliosis: highest risk for poor outcomes of all of the idiopathic types of scoliosis** 1. brace 2. require 24 hr bracing remove only bathing

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