MSK Flashcards
(184 cards)
1
Q
What is synadactyl?
A
Fused digits
2
Q
What is polydactyly?
A
Extra digits
3
Q
What is Amelia?
A
Absence of limb
4
Q
What is meromelia?
A
Partial absence of one or more limb structures
5
Q
What is phocomelia?
A
Loss of proximal part of a limb
6
Q
What is most at risk of damage from clavicular fracture?
A
Subclavian artery and vein
7
Q
What is most at risk with a humeral fracture?
A
Radial nerve
8
Q
What is the effect of impingement of the radial nerve?
A
Poor finger and wrist extension
9
Q
What causes the Eb’s palsy?
A
Upper brachial plexus injuries. (C5/C6).
10
Q
What does Eb’s palsy cause?
A
- Loss of sensation of front arm.
- Waiter’s tip.
- Medially rotated due to unopposed action of pectorals major.
- Pronated forearm due to loss biceps brachii.
11
Q
What does Klumpskie’s palsy cause?
A
Loss of sensation on medial side of arm and paralysis of small muscle of the hand.
It causes excessive arm abduction.
12
Q
What causes Klumpskie’s Palsy?
A
Lower brachial plexus injury. (T1)
13
Q
What causes winging of the scapula?
A
Damage to long thoracic nerve damage.
14
Q
What does winging of the scapula cause?
A
Scapula protrudes out of the back when pushing with the arm.
15
Q
What can cause an anterior dislocation of the shoulder?
A
Fall on an abducted arm.
Excessive extension and lateral rotation of arm
The shallow glenoid fossa make it prone to dislocation.
16
Q
Why doesn’t the shoulder dislocate superiorly?
A
The coraco-acromial arch prevents this
17
Q
What is at risk with shoulder dislocations?
A
- Axillary nerve
- Circumflex artery
18
Q
What is a characteristic feature of rotator cuff tendonitis?
A
Painful arc
19
Q
What is painful arc syndrome?
A
Pain in the middle of abduction(50-130 degrees) when the affected part comes to in contact with the acromium.
20
Q
What is rotator cuff tendonitis?
A
Inflammation of the muscle tendons so overtime degenerative changes in the suprascapular bursa and supraspinatous tendon. Causes increased friction in the joint.
21
Q
What causes posterior dislocation of the shoulder?
A
- Electric shock
- Seizure
22
Q
What are some complications of surgical neck fractures?
A
- Axillary nerve
- Posterior circumflex artery
23
Q
What can damage to axillary nerve cause?
A
- Loss of abduction due to paralysis of deltoid and teres minor
- Loss of sensation in the regimental badge area
24
Q
What is at risk with a mid shaft fracture?
A
- Profunda brachii artery damage
- Radial nerve damage (runs in radial groove)
25
What is the effect of damage to radial nerve?
- Unopposed flexion of wrist. This result in wrist drop.
| - Loss of sensation on the posterior surface of the arm and posterior surface of lateral 3 and a half fingers.
26
What damage can a supracondylar and medial epicondyle fractures cause?
- Brachial artery damage
- Ulnar nerve damage
- Radial nerve damage
- Median nerve damage
27
What can proximal ulnar nerve damage cause?
Ulnar claw that looks Better.
- Loss of flexor digitorum profundus innervation so less flexion at the intercarpophalangeal joints.
- Loss of lumbricals so unopposed flexion at the intercarpophalangeal joints and unopposed extension at the metacarpophalangeal joints
- Loss of sensation of medial 1 and half fingers on dorsal and palmar surfaces
28
What can distal ulnar nerve damage cause?
Ulnar claw that looks worse
- Loss of innervation of the lumbricals so unopposed flexion at the intercarpophalangeal joints and extension at the metacarpophalangeal joints.
- Loss of sensation of medial 1 and half fingers on dorsal and palmar surfaces
29
What is an ulnar paradox?
Proximal ulnar nerve injuries loses innervation at the flexor digitorum profundus so less flexion at the interphalangeal joints so doesn't look as bad compared to distal ulnar nerve damage
30
What are indications of impingement of the rotator cuff muscle?
- Positive Hawkins test
- Tender over tuberosity
- Low painful arc
31
What is the cause of calcification supraspinatus tendonitis?
Calcium hydroxyapatite deposit. Leads to subacromial impingement if large. If it bursts, it leads to acute calcific tendinitis.
32
What are indications of rotator cuff tears?
- Signs of impingement
- Supraspinatus test weak
- Infraspinatus test weak
- Subscapularis push off and belly weak
- Progressive functional loss with size of tear
33
What are the indications of osteoarthritis at shoulder?
- High painful arc
- Joint is tender
- NSAIDS required
34
What are the borders of the cubital fossa?
Superior - Imaginary line between the humeral epicondyles
Medial - Lateral side of Pronator teres
Lateral - Medial side of Brachioradialis
35
What are the contents of the cubital fossa?
-Radial nerve
-Brachial artery
-Median nerve
lateral to medial
36
What is a purpose of cubital fossa in medical field?
- Common site for blood test. Commonly use side veins.
| - Brachial pulse
37
What is a student elbow?
Inflamed bursa
- Subcutaneous olecranon bursa
- Subtendinous olecranon bursa
38
What causes subtendinosus bursitis?
Repeated flexion and extension of the forearm. Flexion can be more painful with more pressure on bursa.
39
What causes subcutaneous bursitis?
Repeated friction and pressure on the bursa can cause it to be inflamed. Can become infected because it is superficial
40
What causes tennis elbow?
Straining of posterior forearm muscle. Pain is at the lateral epicondyle
41
What is colles' fracture?
- Falling onto an outstretched hand
| - Distal fragment is displaced posteriorly
42
What is smith's fracture?
- Falling on the wrist in flexion
| - Anterior displacement of the distal fragments
43
What are the borders of the anatomical snuffbox?
- Lateral: Extensor pollicis brevis and abductor pollicis longus
- Medial: Extensor pollicis longus
- Roof: Skin
- Proximal: Styloid process of radius
- Floor: Carpal bones, scaphoid and trapezium
44
What are the contents of the anatomical snuffbox?
- Radial artery
- Branch of radial nerve
- Cephalic vein
45
What is the most likely cause of pain/tenderness in the anatomical snuffbox?
Scaphoid fracture
46
What is the risk of scaphoid fracture?
Avascular necrosis due to blood supply to proximal portion due to unique blood supply that runs from distal to proximal.
47
What are the contents of the carpal tunnel?
- Flexor digitorum superficialis
- Flexor digitorum profundus
- Flexor pollicis longus
- Median nerve
48
What cause carpal tunnel syndrome?
Compression of the median nerve. This causes wasting of the thenar eminence.
49
What are the clinical features of carpal tunnel syndrome?
Tingling, Numbness and Pain in the distribution of the median nerve.
Symptoms can wake patients and are worse in the morning.
50
What are treatment for carpal tunnel syndrome?
Surgical release of the flexor superficial retinaculum
51
What is boxer's fracture?
- Fracture at the 5th metacarpal neck.
- Caused by punching a hard object with a clenched fist
- Distal part of the fracture is displaced posteriorly producing shortening of the affected finger
52
What is de Quervain's tenosynovitis?
- Pain to turn wrist, grab and make a fist
| - Inflammation of sheath that surrounds thumb tendons (extensor pollicis brevis and adbuctor pollicis longus)
53
What can become compressed in Guyon's canal?
Ulnar nerve
54
What does ulnar nerve compression in Guyon's canal result in?
- Loss of sensation of ulnar innervated hand
| - Loss of motor function of ulnar innervated intrinsic hand muscles
55
What is dupuytrens contracture?
- Thickening of the palmar fascia due to fibrosis
- Patient cannot fully extend their fingers the affected fingers and may find difficulty in gripping objects
- Flexion contracture of fingers in towards the palm.
56
What is reflex sympathetic dystrophy?
- Pain, tenderness and swelling of an extremity
- Associated with sweating, flushing, temperature changes and shiny skin
- Regional pain syndrome
57
What does an intracapsular fracture of femur have a risk of?
-Avascular necrosis due to the interruption of blood supply from the medial circumflex artery
58
How does the lower limb present in both an intracapsular fracture and extra capsular fracture?
The lower limb is laterally rotated and shortened
59
How do dislocations at the hip joint present?
The leg is shortened and medially rotated
60
What causes anterior dislocation of femur?
Result of traumatic extension, abduction and lateral rotation.
Femoral head is displaced inferiorly and anteriorly in relation to acetabalum
61
What is a posterior dislocation of the femur?
Femoral neck is displaced posteriorly where the joint is weakest
62
What is at risk with a posterior dislocation of femur?
Sciatic nerve as it runs posteriorly to the hip joint.
63
What is sciatic nerve path using bony landmarks ?
- Posterior suprior illiac spine as it leaves the pelvic cavity
- Descends vertically at the midpoint between ischial and greater trochanter as it enters the thigh
64
What are the signs and symptoms of osteoarthritis?
- Joint pain
- Crepitis
- Joint deformity
- Osteophytes
- Joint stiffness
65
What are the key features on an X ray for osteoarthritis?
- Narrowed joint space
- Bony spurs
- Subchondral sclerosis
- Subchondral cysts
66
What are the risk factors of osteoarthritis?
- Obesity
- Past injury in a joint
- Occupational factors
- Genetic arthritis
67
What muscles are affectedly injury to superior gluteal nerve?
- Gluteus medius
| - Gluteus minimus
68
What is actions are restricted by injury to the superior gluteal nerve?
- Abduction
- Stabilisation of pelvis
- Medial rotation
69
What is trendelenburg sign?
When lifting the leg, gravity causes the pelvis to drop under the weight of the leg. Contralateral gluteus medius and gluteus minimus normally contract to stabilise the hip
70
What occurs normally when the leg is raised?
The pelvis remains level or raised on the side of the raised leg due to the action of gluteus medius and minimus
71
What occurs with a superior gluteal nerve injury?
There is a drop toward the side of the rise limb as the muscles of the standing limb are wekeaned or paralysed. (+ve Trendelenburg sign)
72
What is the purpose of the deep acetabulum?
Enables stability by deepening the articulating surface via the acetabular labrum
73
What is the purpose of the menisci?
Fibrocartilage that depends articulation surface and distributes shock
74
When does locking and unlocking of the knee joint occur?
- Locking is when the Femur medially rotates on Tibia. Most stable
- Unlocking is when the Femur laterally rotates on the Tibia
75
What is housemaids bursitis?
Pre-patellar bursitis. Caused by leaning forward on knees
76
What is a clergyman's bursitis?
Infra-patellar bursitis
77
What causes supra patellar bursitis?
Rapid extension of the knee joint irritates the region and cuts above the knee
78
What is a baker's cyst?
Semimembranous cyst
79
Why is the medial menisci more likely to tear?
- Poorer blood supply
- Edges are further apart
- Not as mobile
80
How does a meniscal damage present?
Presents as a locked knee as torn part gets trapped stopping movement of bones on each other
81
Which ligament is weaker at the knee joint?
Anterior Cruciate Ligament
82
What is the effect of the ligament damage at the knee joint?
Limits anterior movement of femur on tibia
83
When does the ligament damage occur in knee joint?
Occurs in football, rugby etc. Generally sports where weight is born on an unstable knee
84
What is the unhappy triad?
Tear in the anterior cruciate ligament, medial meniscus and medial collateral ligament.
85
Why does the unhappy triad occur?
Valgus force when the knee is flexed. ACL is weak and taut in this position. Medial collateral ligament tears under the force and it is attached to the medial meniscus which also tears
86
What is Pott's fracture?
- The injury is caused by a combined abduction external rotation from an eversion force.
- This action strains the sturdy medial (deltoid) ligament of the ankle, often tearing off the medial malleolus due to its strong attachment.
- Talus moves laterally shearing the lateral malleoli. Bi malleolar fracture.
- Sometimes the if tibia is carried anteriorly, the posterior margin of the distal end of the tibia is also sheared off by the talus
87
How does a ankle sprain occur?
Due to damage to the ligaments when the foot is in its weakest position, plantar flexed. Anterior Talofibular ligament most at risk
88
What is a bi-malleolar fracture and tri-malleolar fracture?
Bi-malleolar fracture - Medial and Lateral malleoli
| Tri-malleolar fracture - Medial, lateral malleoli and distal tibia
89
What is a calcaneal Lover's fracture?
Crush type injury
| Weight is born upon the hell when falling from a height
90
What are varicose vein?
Dilated torturous veins due to incompetent valves.
91
What are the ideal sites for injection in the gluteal region and why?
Ventrogluteal - Used in children
Fingers in ASIS and iliac crest in V shape. Injection point in between knuckle of index fingers and middle finger
Dorsagluteal - Upper outer region
92
What is Parasthetica neuralgia?
Compression of lateral cutaneous nerve of the thigh
93
What are the contents of the femoral sheath?
- Femoral artery
- Femoral vein
- Deep lymph node
Nerve is lateral to femoral sheath
94
How do you identify the femoral vein?
Palpate for Femoral pulse at mid inguinal point and then move medially from the artery.
95
What are the borders of the femoral triangle?
Superior Border - Inguinal ligament
Lateral Border - Medial border of the sartorius
Medial border - Medial border of adductor longus
Floor - ADducttor longs, Pectineus and Iliopsoas
Roof - Fascia Lata
96
What is the contents of the femoral triangle?
- Femoral nerve
- Femoral Artery
- Femoral Vein
- Empty space
- Lymphatics
NAVEL
97
What are the border of femoral canal?
```
Medial border – Lacunar ligament.
Lateral border – Femoral vein.
Anterior border – Inguinal ligament.
Posterior border – Pectineal ligament, superior ramus of the pubic bone, and the pectineus muscle
Superior Border – Femoral Ring
```
98
What are the contents of the femoral canal?
Lymphatic vessels – draining the deep inguinal lymph nodes.
Deep lymph node – the lacunar node.
Empty space.
Loose connective tissue
99
What are the contents of the adductor canal?
- Femoral Artery & Vein
- Saphenous nerve
When leaving this region becomes the popliteal artery and popliteal vein
100
What are the borders of the adductor canal?
Anterior: Sartorius.
Lateral: Vastus medialis.
Posterior: Adductor longus and adductor magnus
101
What are the contents of the popliteal fossa from medial to lateral?
- Popliteal artery
- Popliteal vein
- Tibial nerve (superficial)
- Common Fibular nerve (superficial)
102
What are the borders of the popliteal fossa?
Superomedial border - Semimembranosus
Superolateral border - Biceps femoris.
Inferomedial border - Medial head of the gastrocnemius.
Inferolateral border - Lateral head of the gastrocnemius and plantaris
103
What is the importance of the arches of the foot?
Vital Shock absorber & enable the foot to accommodate hitting the floor with varying degrees of force.
104
What is a Lurching gait?
When the pelvis drops to one side the trunk will lurch to the opposite side to keep the pelvis level
105
What is an antalgic gait?
Shorter stance phase as there is an inability to bear weight in some regions (Chronic MSK related pain)
106
What is Hemiparetic Gait?
As a result of a CNS lesion or stroke, there is an inability to co-ordinate movements.
107
What is Foot-drop and High Steppage Gait ?
- Effects the swing phase
- Damage to the common fibular nerve results in the inability to dorsiflex (foot drop)
- Therefore foot cannot clear the ground, in attempt to counteract this person will lift one leg higher than the other to allow the foot to clear the ground by excessive hip flexion.
108
What is parkinsonian gait?
- Neurological disease - (Parkinsons)
- Results in shuffling
- Forward flexed
- No arm swing
- Festinant : hard to stop and falling into short shuffle
109
What is diplegic gait?
- Neuromuscular disorders such as cerebral palsy
- Scissoring of legs
- Tight muscle groups - Psoas/Adductors/HS/Calf
- Ankle is plantar flexed
- Forefoot initial contact
110
What are the muscles of the thenar eminence?
Abductor pollicis brevis, opponens pollicis, flexor pollicis brevis
111
What are the muscles of the hypothenar eminence?
Abductor digiti minimi, Opponens digiti minimi, flexor digiti minimi brevis
112
What is the hand of benediction?
Median nerve supply lost
Patient tries to make fist
Cannot flex 1st/2nd digits (3rd and 4th digits have ulnar innervated flexor digitorum profundus)
113
What are the X-ray fathers o rheumatoid arthritis?
- Narrowing joint space
- Periarticular ostepenia
- Juxta-articular bony erosion
- Sublxation and gross deformity
114
What is rheumatoid arthritis?
An autoimmune disorder whee antibodies attack synovial leading to a panes. Joint erosion and deformity. There is damage to other organs such as the yes, skin, legs, heart, kidneys and blood.
115
What are the lordosis?
- Cervical lordosis (appears when child lift the head)
| - Lumbar lordosis
116
What is senile kyphosis?
Secondary curvatures start to disappear in old age and continuous primary curvature is re-established
117
What is an example of a physiological curvature?
Exaggeration of lumbar lordosis during pregnancy
118
What is the most suitable vertebral level at which a needle should be inserted for a lumbar puncture?
L3/L4 or L4/L5. After the conus medullar is so only mobile spinal nerve roots not cord. Least chance of neurological damage
119
In a lumbar puncture, what are the structure through which the needle will pass in order to get from the skin to the subarachnoid space?
```
Skin
Subcutaneous tissue
Supraspinatous ligament
Interspinous ligament
Ligamentum flavus
Epidural fat and vein
Dura mater
Arachnoid mater
Subarachnoid space
```
120
What is mechanical back pain?
- Pain when the spine is loaded
- Worse with exercise and relived by rest
- Intermittent and triggered by innocuous activity
- Predisposition overweight, unhealthy lifestyle, deconditioned core muscle
121
What is disc degeneration and marginal osteophytosis?
- Nucleus pulpous can dehydrate with age
- Height of IV disc decrease
- Load stresses on the IV disc alter. This leads to reactive marginal osteophytosis adjacent to affected endplates
- As disc space decreases in height, increased stress is also placed on the facet joints which leads to osteoarthritis
- Decreased size of intervertebral foramen and compression of spinal nerves
122
What is the process resulting in a slipped disc?
- Disc degeneration: chemical changes associated with raging causes discs to rehydrate and BULGE
- Prolapse: protrusion of the nucleus pulpous with slight impingement into the spinal canal
- Extrusion: uncles pulposus breaks through annulus fibrosis but remains within the disc space
- Sequestration: nucleus pulpous breaks through annulus fibrosis and separates from the main body of the disc in the spinal canal
123
Where does a slipped disc commonly occur and what does it result in?
L4/L5 or L5/S1
Usually herniates posterolaterally causing compression of spinal nerve roots.
124
What is sciatica?
Sciatica is compression of the nerve roots which contribute to the sciatic nerve
125
What is caudal equine syndrome?
Canal filling compressing the lumbar and sacral nerve roots. Occurs in 30-50 year olds.
126
What are the symptoms of cauda Equina syndrome?
- Perianal numbness
- Painless retention of urine
- Urinary/Faecal incontinence
127
What is claudication and its pathophysiology?
Pain in legs when walking
- Neurogenic
- Vascular
Caused by venous engorgement
128
What is spondylolithesis?
A slip forward of the vertebra above the vertebra below
129
What are the types of spondylolisthesis?
- Dysplastic: abnormality in the shape of the facet joints
- Isthmic: Defect in pars interarticularis
- Degenerative
- Iatrogenic
- Pathological
130
How does degenerative spondylolisthesis present?
-Posterior with claudication as posterior arch intact therefore develop stenosis
131
How does Isthmic spondylolisthesis present?
-Present with back pain and L5 sciatica as arch is not intact and no central canal stenosis
132
What is a neural level?
Last functioning level
133
What is cervical spondylosis?
Degenerative osteoarthritis of intervertebral joints in cervical spine
134
What is the effect of cervical spondylosis on the nerve roots?
Radiculopathy
- Dermatomal sensory
- Myotomal motor weakness
135
What is the effect of cervical spondylosis on the cord?
Myelopathy
- Global weakness
- Gait dysfunction
- Loss of balance
- Loss of bladder and bowel control
136
What is a hangman's fracture?
- Hyperextension of head-on neck
- Axis fractures through pars interarticularis
- Unstable fracture
- Forward displacement of C1 and body of C2 on C3
137
What is a Peg fracture?
- Blow to back of head
e. g. falling against a wall when balance is compromised
- Results in a Odontoid fracture
138
What is a Jefferson's fracture?
- Fracture of anterior and posterior arches of atlas
- Axial load e.g. diving into shallow water, impact against the roof of a vehicle, falls from playground equipment
- Typically causes pain but no neurological signs
139
What arteries could a Jefferson's fracture damage and what might this lead to?
May damage arteries at the base of skull with secondary neurological sequelae e.g Horner's syndrome(miosis, ptosis) and ataxia
140
Why is the cervical spine prone to whiplash injury?
It has high mobility and low stability. This makes it prone to hyperextension and hyperflexion which occurs in whiplash
141
What myotome perform shoulder abduction?
C5
142
Which myotome perform shoulder adduction?
C6,C7,C8
143
Which myotome perform elbow flexion?
C5,C6(main)
144
Which myotome performs elbow extension?
C7(main),C8
145
Which myotome performs supination?
C6
146
Which myotome performs pronation?
C7,C8
147
Which myotome performs wrist extension?
C6
148
Which myotome performs wrist flexion?
C7
149
Which myotome performs finger flexion?
C8(main), C7
150
Which myotome performs finger extension?
C7,C8
151
Which myotome performs abduction and adduction of the fingers?
T1
152
What does L2 perform?
Hip flexion
153
What does L3 perform?
Knee extension and hip adduction
154
What does L4 perform?
Ankle dorsiflexion
155
What does L5 perform?
- Great toe extension
- Ankle inversion
- Hip abduction
156
What does S1 perform?
- Ankle plantar flexion
- Ankle eversion
- Hip extension
157
What does S2 perform?
- Knee flexion (some sources say S1 for this)
| - Great toe flexion
158
What are the borders of the axilla?
Apex – Lateral border of the first rib, Superior border of scapula, Posterior border of the clavicle.
Lateral wall – Intertubercular groove of the humerus.
Medial wall – Serratus anterior, Thoracic wall (ribs and intercostal muscles).
Anterior wall – Pectoralis major, Pectoralis minor, Subclavius muscles.
Posterior wall – Subscapularis, Teres major and Latissimus dorsi.
159
What is piriformis syndrome?
Sciatica symptoms as a result of overlying pririformis muscle.
Overuse of the muscle leads to spasm
Diagnosis of exclusion and treatment is mostly about activity modification
160
What does damage to deep peroneal nerve result in?
- Weakness in ankle dorsiflexion so foot drop
| - Sensory loss in the 1st web space
161
What is the result of sural nerve injury?
Loss of sensation to the sole of the foot
162
What is the result of the superficial perineal nerve injury?
Sensory loss over most of skin of dosurm of the foot and anterolateral calf
Weakness in eversion
163
What is the result of a tibial nerve injury?
- Weakness in plantar flexion
| - Unopposed pull of dorsiflexion and everters
164
What is meralgia paraesthetica?
-Compression of the lateral cutaneous nerve of the thigh
as it passes through the inguinal ligament or as it pierces the fascia latae
-Burning or stinging sensation in distribution of the nerve over the anterolateral aspect of the thigh. Aggravated by walking or standing. Relieved by lying dow with hip flexed
-Tinel's sign possibly
165
What is hallux rigidus?
-Arthritis of the big toe
166
What is planovalgus/pes?
- Flat foot
- Loss of medial longitudinal arches
- During standing platter ligament and planter aponeurosis stretch under body weight. If ligament is abnormally stretched, the calcaneonavicular ligaments can no longer support the head of the talus. The talus is displaced inferomedially causing flattening of the medial longitudinal arch
167
How does diabetes mellitus affect the foot?
- Loss of sensation
| - Foot is less protected and can lead to severe infections
168
What is meralgia paraesthetica?
-Compression of the lateral cutaneous nerve of the thigh
as it passes through the inguinal ligament or as it pierces the fascia latae
-Burning or stinging sensation in distribution of the nerve over the anterolateral aspect of the thigh. Aggravated by walking or standing. Relieved by lying dow with hip flexed
-Tinel's sign possibly
169
What can cause meralgia parasethetica?
- Obesity
- Pregnancy
- Tight clothing
- Wearing a tool belt
170
What is the function of the extensor retinaculum at the Anke?
-Hold tendons of the muscle down in then anterior and lateral compartment to prevent them from bowstringing during movements at the ankle
171
Where can dorsalis pedis artery be palpated?
-Between extensor hallucis longus and extensor digitorum longus to the second toe
172
What is compartment syndrome?
- Compartments of limbs are bound by bone and deep fascia and contain muscle with their nerves and vessels to more distal parts of the limb.
- Trauma to the fascial compartment may lead to haemorrhage and/or oedema.
- This can cause a rise in intra compartmental pressure
173
What are the clinical sign off compartment syndrome?
- Severe pain in the limb, excessive for the degree of injury
- Unrelived by analgesia
- Pain exemrcabated by passive stretch of the muscles
174
What are the short term consequences of compartment syndrome if not adequately treated?
- Increase in intracompartmental pressure leads to decreased perfusion of muscle
- Ischaemic muscle releases mediators which causes increase capillary permeability. Exarcebates the rise in intracompartmental pressure
- In severe untreated cases can lead to rhabdomyolysis and acute kidney injury
- Neurovascular sign develop late in the process.
- If the compartment pressure exceeds the systolic arterial blood pressure, there will be a loss of peripheral pulses and increased capillary refill time
- Nerve fibres are susceptible to ischaemia; thin cutaneous nerve fibres are affected more quickly than motor fibres so distal parasthesia precedes loss of motor function
175
What are the long term consequences of compartment syndrome if left untreated?
- Rhabdomyolosis can result in acute kidney injury which may become chronic
- Necrotic muscle may also undergo fibrosis leading to volkmanns contracture, a permanent painful and disabling contracture of affected muscle groups.
176
What are the surface marking of the long and short saphenous veins at the ankle?
- Long saphenous vein: Anterior to medial malleolus
| - Short saphenous vein: Posterior to the lateral malleolus
177
Why might a patient that has undergone stripping of the long saphenous vein develop loss on medial aspect of their foot?
The saphenous nerve runs in close proximity to the long saphenous vein. Nerve may be damaged during stripping of the long saphenous vein
178
What are the pathological changes that occur in the tendons that increases risk of rupture as you get older?
- Calcium deposition
- Decreased arterial perfusion
- Loss of elasticity due to decreased elastin, decreased proteoglycans and water content of the tendon. Increased collagen cross linkage as well
- Decreased collage turnover/synthesis. Decreased ability to repair damaged collagen
179
What is hallux valgus?
- Deviation of the great toe away from the midline
| - Bunions
180
What factors contribute to the stability and mobility of the veterbral column?
- Thickness and compressibility of the intervertebral disc
- Shape and orientation o the intervertebral facet joints
- Tone of back muscle
- Resistance of the ligaments of the vertebral column
181
Define the terms kyphosis, lordosis, scoliosis?
Kyphosis: Anterior flexion curvature of the spine
Lordosis: Posterior flexion curvature of the spine
Scoliosis: Lateral curvature of the spine
182
What is the anatomical abnormality in the bone of the vertebral column in spina bifida occulta?
Laminate of the lumbar vertebrae(L5) and the upper sacral vertebrae(S1) fail to fuse completely.
No physical abnormality so usually never detected
183
What is meningocele?
- Protrusion of the meninges through the cleft in the vertebrae
- Often spinal fluid fills the protrusion causing a cyst-like structure on the child’s back
- Can be surgically treated but Could be some residual damage to spinal cords causing lower limb weakness and faecal/urinary incontinence
184
What is meningomyelocele?
- Meninges protrude from the vertebral cleft and the spinal cord also herniates through the hole. This leads to significant spinal cord dysfunction
- The brainstem is often pulled downward into the spinal canal at the base of the skull, obstructing the flow of cerebrospinal fluid and causing hydrocephalus.
- A child with this form of spina bifida will often have learning difficulties as well as paralysis/weakness of the lower limbs and incontinence.
