Musculoskeletal Conditions

Question 1

Dens (C2) Fracture

Answer 1

Most common upper cervical spine fracture

car accidents and falls

fracture at base of dens and may result in posterior displacement of dens towards the spinal cord in 15% of cases

blood supply to majority of dens is tenuous - delayed healing

Question 2

Hyperflexion Teardrop Fracture

Answer 2

Cervical fracture where a triangular tear shaped fragment is avulsed by the anterior longitudinal ligament.

Hyperflexion (most serious), severe flexion force, head-on collision in car, vertebral body is posteriorly distracted.

facets are subluxed -> incomplete/partial separation which can lead to compression of spinal cord if it is unstable.

Question 3

Extension Teardrop Fracture

Answer 3

Cervical fracture resulting from blow to the forehead or chin as from a fall.

A bone fragment is avulsed from anterior portion of cervical vertebrae - fall and hit face, usually at C2 or C3 vertebra - attached to anterior longitudinal ligament

Stable, not usually responsible for spinal cord injury

Question 4

Vertebral Axial Load Burst Fracture

Answer 4

Fracture from traumatic injury where compression anteriorly and posteriorly

Falls from a great height - force of fall extends from buttocks to vertebral body - exploding

severe injury frequently injures spinal cord/cauda equina

Question 5

Jefferson Axial Load Burst Fracture

Answer 5

Cervical fracture where vertebra is compressed anteriorly and posteriorly

Usually from direct blow to top of head which fractures both anterior and posterior neural arches of C1

C1 expands, spinal cord injury is uncommon

Question 6

Cervical Degenerative Disk Disease (OA)

Answer 6

Osteoarthritis

intervertebral disc - normal aging, loss of flexibility/ shock absorption

in nucleus pulposus - less proteoglycans

Question 7

Cervical Disk Herniation

Answer 7

Microtears will lead to larger tears

Question 8

Whiplash Syndrome

Answer 8

Sudden force - injury

Question 9

Atlantoaxial Instability

Answer 9

increased mobility of atlantoaxial joint between C1 arch and dens C2

transverse ligament abnormality

subluxation of dens

normal predental space ~3mm

Question 10

Cervical Radiculopathy

Answer 10

Compression/injury to spinal nerve roots - compression, herniation, or osteophytes

Question 11

Lumbar Degenerative Disk Disease (OA)

Answer 11

degenerative disc disease/ osteoarthiritis of lumbar spine

Question 12

Lumbar Disk Herniation

Answer 12

microtears, inflammatory response

Question 13

Sacroiliac Joint Dysfunction

Answer 13

changes in alignment of sacroiliac joint, ligaments cna shorten or become tight or lax

Question 14

Scoliosis

Answer 14

lateral curvature of the spine, thoracic and lumbar regions and associated with rotation of the vertebra.

right: dextroscoliosis
left: levoscoliosis

girls are 7x more likely to have progressive curvature up until puberty

mild<10 degree, not treated
20-30 degrees - monitor for progression, brace to prevent progression: needs to be worn night and day
>40 = severe, surgery

Question 15

Ankylosing Spondylitis

Answer 15

joint fusion/ spinal inflammation

chronic seronegative spondyloarthropathy - axial involvement

associated with class I HLA-B27 gene

sacroiliac joints - sacroillitis

progressive stiffening of the spine, ankylosis, fusion of spinal joints, enthesis inflammation

bamboo spine; more common in men (2-3:1), ~20-30 yr onste, ~ 9 years lapse between onset and diagnosis; 0.2-0.3% incidence in US, worse with rest, better with activity. Later in disease, sacroiliac joints appear widened - sheets of ossification ultimately

Question 16

Lumbar Muscle Strain

Answer 16

muscle strain

Question 17

Lumbar Spinal Stenosis

Answer 17

narrowing of vertebral foramen due to osteophytes

may lead to lumbar radiculopathy - L5, S1 most common

Question 18

Spondylolysis/Spondylolisthesis

Answer 18

Spondylolysis - fracture of pars interartiularis between superior and inferior articular processes of vertebra usually in L5/S1

Spondylolisthesis - slippage of the body of the vertebrae (due to degenerative disc disease in old people, spondylolysis in young people)

Question 19

Spinal Compression - Osteoporosis

Question 20

Spinal Compression - Trauma

Answer 20

traumatic - falls, more collapsed, more pain

Question 21

Cervical Muscle Strain

Answer 21

neck pain/ headaches

tension in paraspinal muscles - compress greater occipital nerve C2

Question 22

Cervical Spinal Stenosis

Answer 22

narrowing of cervical spinal canal

Question 23

Cervical roots and corresponding pain or sensation changes

Answer 23

C5 - point of shoulder

C6- thumb

C7 - midlde finger

C8 - little finger

T1 - medial forearm

Question 24

Cervical roots and Movement Deficitis

Answer 24

C5 - shoulder abduction

C6 - elbow flexion, wrist extension

C7 - elbow extension

C8/ T1 - intrinsic hand muscles

Question 25

Lumbar Spinal Compression

Answer 25

in osteoporosis, collapsing and crushing of bone severity varies typically at thoracic (thoracic lumbar junction)

Question 26

Lumbar Roots and associated Pain Location

Answer 26

L2-3 - anterior and mid-thigh L4 - knee and medial malleolus L5 - Web between 1st and 2nd toe S1 - lateral malleolus

Question 27

Lumbar Roots and Movements

Answer 27

L2-4 - knee extension, hip adduction L5- Ankle dorsiflexion, big toe extension S1- Ankle plantarflexion, knee flexion

Question 28

Humeral Surgical Neck Fracture

Answer 28

most common proximal humerus fracture - often caused by falling onto an outstretched hand or direct impact to the shoulder (elderly people with osteoporosis are at greatest risk) most commonly injured nerve is the axillary nerve - injury to the axillary nerve results in sensory change over the deltoid muscle and weakness with abduction of shoulder joint

Question 29

Humerus midshaft fracture

Answer 29

pathologic bone has been weakened by pathologic lesion, trivial pressure on humerus can cause this fracture (benign/malignant neoplasms, osteomyelitis, Paget's disease) depending on fracture location, may cause injury to radial nerver resulting in loss of sensation over dorsum of the hand and weakness on wrist extension

Question 30

Clavicle Fracture

Answer 30

very common and most common childhood fractures since the clavicle does not completely ossify until the late teens, ~80% of clavicular fractures occur in middle 1/3 of clavicle proximal fragment will typically displace upward because of pull of the sternocleidomastoid muscle direct force applied to the lateral aspect of shoulder as a result of a fall onto outstretched hands

Question 31

Shoulder Instability and Dislocation

Answer 31

less than 1/3 head of humerus is in contact with glenoid cavity - labrum, joint capsule, capsular ligaments, adn rotator cuff muscle tendons ligament laxity (developmental from repeated injuries, age-related degeneration) inferior glenohumoral ligament is most common ligament that becomes lax and predisposes individual to anterior dislocation result of acute trauma to anterior shoulder - posterior transitory force on flexed shoulder joint exam: locally tender muscles, and + sulcus sign clinical inspection: obvious asymmetry and deformity if dislocated, limited range of motion, diffuse tenderness NSAIDS, opiods, joint reduction, strength training of surrounding muscles, avoid combination movesments of shoulder abduction and external rotation (throwing motion, volleyball spike)

Question 32

Acromioclavicular (AC) Joint Injury

Answer 32

AC joint injuries commonly result forma fall or blow to top of shoulder - acromion driven to the ground, variable ligament injuries Grade I: AC joint sprain - limited injury to AC joint ligaments but strong coracoclavicular ligaments are not injured, no separation of clavicle from acromion Grade II: AC joint separation - both AC joint ligament and coracobacromial ligaments are injured, partial separation of clavicle from acromion Grade III AC joint separation - most serious, complete separation of clavicle from acromion If sprained - some swelling/tenderness, loss of shoulder movement, especially adduction due to pain, separation causes severe pain

Question 33

Adhesive Capsulitis

Answer 33

frozen shoulder, chronic immobility of the shoulder joint, scarring, thickening, and possible inflammation of shoulder joint capsule progressive loss of range of motion 2 cateogories of patients: 1. patients w/o pre-existing shoulder condition - limited shoulder movement from other conditions (stroke, muscle weakness, brain injury) 2. patients with pre-existing shoulder conditions (shoulder impingement, OA of shoulder, had surgery) age 40-70yrs, 3% of the population tend to develop this within a lifetime, and females more than males dull, deep ache at shoulder joint, gradual, increased pain with shoulder movement and difficulty sleeping on affected side

Question 34

Shoulder Impingement Syndrome

Answer 34

rotator cuff tendonitis, supraspinatus tendonitis, subacromial bursitis, calcific bursitis, or tendonitis shoulder impingement - result of degenerative process in shoulder joint region that is exacerbated by overuse previous injury, ischemia to rotator cuff tendons, (supraspinatus), microtears, acute inflammation - repair, increased vascularization, granulation tissue and deposition of calcium crystals = begins to collect beneath subacromial bursa, where additional inflammatory response takes place. full thickness tears in rotator cuff tear - more cytokines erode bony surfaces, gradual onset of anterior and lateral shoulder pain exacerbated by reaching overhead muscle atrophy from disuse, positive Hawkin's and Neer's sign MRI outstanding at providing high res tears

Question 35

Thoracic Outlet Syndrome

Answer 35

common condition that results from compression of lower trunk of brachial plexus and/or subclavian vessels as they course through narrow space between clavicle and first rib secondary to developmental abnormalities women 2-50 most commonly affected compression of brachial plexus: pain, paresthesias along aspect of forearm, hand, medial 2 fingers intermittent swelling and discoloration from compressed vessels, worse wth arm overhead recommend home exercise promoting muscle strengthening and proper posture

Question 36

Brachial Plexopathy

Answer 36

nerve traction injury to shoulder area - weakness/sensory loss are symptoms - type and degree of injury and which parts (trunks, divisions, cords, nerves) most common, upper trunk of brachial plexus traction force applied to C5-6 nerve roots when shoulder is forcefully depressed and head tilted to opposite side = Erb's Palsy - baby's head is being pulled: arm hangs uselessly, paralysis of the shoulder girdle and biceps, loss of extension at wrist (waiter's tip deformity) burners/stingers - transient injuries to upper trunk involving C5-6 nerve roots = from contact sports injury to lower trunk : Klumpke's palsy, poor prognosis Klumpke's palsy - traction applied to C8-T1 nerve roots when arm is abducted (grabbing ledge when falling from a height) - "claw hand" - intrinsic muscles involved in leaving flexors unopposed

Question 37

Suprascapular Nerve Entrapment

Answer 37

arises in lateral aspect of the upper trunk of brachial plexus, courses across posterior triangle of the neck together with suprascapular artery passes through suprascapular notch of the superior border of the scapula supplies supraspinatus, enters the infrascapular fossa and supplies the infraspinatus a strong tight suprascapular ligament closes over the free margin of the suprascapular notch - nerve can become entrapped if pressure is placed on the ligament - from carrying a heavy purse or backpack

Question 38

Radial Nerve Entrapment

Answer 38

Upper arm - radial nerve is terminal branch of posterior cord of brachial plexus cna be compressed in the axilla (crutches) and lead to tricep weakness and sensory abnormalities radial groove deep to triceps brachii - hang arm over back of chair while sleeping = saturday night palsy sensory changes - radial side of wrist and dorsum of lateral 3.5 fingers, not tips motor deficits - inability to extend wrist, thumb and fingers "wrist drop"

Question 39

Supracondylar Fracture

Question 40

Ulnar Shaft Fracture

Question 41

Radial Head Dislocation (Monteggia)

Question 42

Radial Head Fracture

Question 43

Greenstick Fracture

Question 44

Torus Fracture of Radius

Question 45

Colles' Fracture

Question 46

Scaphoid Fracture

Question 47

Metacarpal #5 Angulated Neck Fracture

Question 48

Phalanx Growth Plate Injury

Question 49

Distal Phalanx Fracture

Question 50

Nursemaid's Elbow

Question 51

Wrist and Hand Rhematoid Arthritis

Question 52

Hand Osteoarthritis

Question 53

Scapholunate Dissociation

Question 54

Medial Epicondylitis

Question 55

Lateral Epicondylitis

Question 56

Olecranon Bursitis

Question 57

DeQuervain Tenosynovitis

Question 58

Trigger Finger

Question 59

Carpal Tunnel Syndrome

Question 60

Cubital Tunnel Syndrome

Question 61

Radial Tunnel Syndrome

Question 62

Guyon Tunnel Syndrome