Pathologies Flashcards

Question

Legg Calve Perthes Disease

Answer 1

Childhood hip disorder Initiated by a interruption of blood flow to the femoral head Due to lack of blood flow, bone dies (avascular necrosis) Healing occurs when new blood vessels revascularize dead bone, removing dead bone, however leads to loss of bone mass and weakening of head Can lead to deformity of the femoral head Secondary changes to the shape of the hip socket Treatment - Traction Muscle/ligaments around hip usually very tight Cannot properly position head in acetabulum Traction gradually stretches muscles allow femur to position itself well in socket Secondly, child is casted or braced to hold position in place Goals Hold head of thigh bone in hip socket, so that head can remold itself in round shape Permit limited joint ROM Scottish Rite Orthosis Toronto Legg Perthes Orthosis (tries to get internal rotation) Trilateral socket hip abduction orthosis (ischial weight bearing) Best success if child < = 6 yr old

Answer 2

Median nerve damaged Caused by deep, penetrating injuries to the arm, forearm, or wrist May also be due to blunt force trauma or neuropathy Lack of ability to abduct and oppose thumb due to paralysis of the thenar muscles, "ape hand deformity" Sensory loss in the thumb, index finger, long finger, and radial aspect of ring finger Weakness in forearm pronation, wrist and finger flexion ADLs difficult (brushing teeth, tying shoes, turning door knobs etc.) Dynamic splint which pulls thumb into opposition can help prevent further deformity Resting WHO maintains C-space Thumb spica for function Tendon transfers shown to be effective in restoring function

Answer 3

AKA Morton's metatarsalgia Benign neuroma of an intermetatarsal plantar nerve Most commonly between 2nd - 3rd 3rd - 4th Characterized by pain and/or numbness when weight bearing Burning, paresthesiae (tingling) Direct pressure between the metatarsal heads will replicate the symptoms As will compression of the forefoot between the finger and thumb, as to compress the transverse arch of the foot (Mulder's sign) Foot orthotics prescribed, arch support and metatarsal pad positioned under the space between the two affected metatarsals Pad helps splay metatarsal bones, create more space for nerve so as to relieve pressure and irritation Sometimes corticosteroids prescribed to relieve inflammation and to help end symptoms

Answer 4

Methicillin-Resistant Staphylococcus Aureus Bacterium responsible for several difficult to treat infections in humans Through process of natural selection, has become resistant to antibiotics Weakened immune systems are at greater risk of infection than general public Typically colonizes respiratory tract, open wounds, urinary tract, catheters Can cause small red bumps accompanied by fever, rash can become deep, pus-filled boils Can also infect vital organs and lead to widespread infection (sepsis), necrotizing pneumonia

Answer 5

Congenital bone disorder Genetic, 1 / 20 000 live births Characterized by brittle bones that are prone to fracture, loose joints, poor muscle tone Defective connective tissue, or absent ability to make it, usually Type I Collagen deficiency 8 Types No cure Treatment aimed at increasing overall bone strength to prevent fracture and maintain mobility

Answer 6

Pain caused by patella being pushed against side of femoral groove Cause of pain often results from Abnormal forces, increased pull of vastus lateralis relative to vastus medialis, with acute or chronic lateral patello femoral subluxation/dislocation) OR Prolonged repetitive compressive or shearing forces (running or jumping) on PF joint Thinning and softening of articular cartilage under patella (chondromalacia) or medial or lateral femoral condyles Synovial irration/inflammation Subchondral bony changes in distal femur or patella Typically seen in active populations (runners, bikers, basketball players etc.) presenting as localized anterior knee pain Treatment, strengthen vastus medialis to balance out lateralis force Rest Orthosis KO may allow patella to track better, reduce lateral drift of patella FO arch support may reduce over pronation which reduces knee balgus

Answer 7

Obstruction of large arteries Causes acute or chronic ischemia Can result from atherosclerosis, inflammatory processes leading to stenosis/embolism/thrombus formation Claudication- pain, weakness, numbness, cramping of muscles Impaired healing Sores, wounds, or ulcers heal slowly or not at all Diminished hair growth and nail growth on affected limb and digits Causes- smoking, diabetes, high cholesterol, hypertension

Answer 8

Painful inflammatory process of the plantar fascia, connective tissue, or ligament on the plantar surface of the foot Pain usually felt on underside of heel Often most intense with first steps of the day Overuse of plantar fascia 10% will experience it in their lifetime Associated with long periods of weight bearing, hyper-pronated, flat feet Also associated with heel spurs, small bony calcification on the calcaneus (plantar fasciitis causes spur no vice versa) Trauma Lack of fat pad Abnormal biomechanics (over-pronation)

Answer 9

Type of inflammatory arthritis that appears in people with skin disease psoriasis 10-30 % of individuals with psoriasis will get it Cause unknown Pain, swelling, warmth in joints Swelling in fingers and toes Pain in and around feet and ankles Achilles tendinopathy/ Plantar Fasciitis Extreme exhaustion that does not go away with adequate rest Arthritis may be mild, or may progress to more destructive joint disease No cure

Answer 10

AKA wrist drop Person cannot extend wrist, hangs flaccidly Penetrating wound (at or below clavicle, damage to posterior cord which terminates as the radial nerve) Humerus fracture Lead poisoning Repetitive injury, applying pressure along route of the radial nerve Depending on level of lesion (diagnosis with nerve conduction test) ``` Inability to abduct shoulder beyond 15 degrees Inability to extend forearm Reduced ability to supinate hand Reduced ability to abduct thumb Sensory loss ``` Dynamic splint

Answer 11

AKA Complex regional pain syndrome (CRPS) Intense burning pain, stiffness, swelling, discoloration that most often affects the hands Arms legs pain can also be affected 2 Types 1 - occurs after an illness or injury that did not directly damage nerve in the affected area 2- follows a distinct nerve injury Cause unknown, commonly occur after injury or surgery, pressure on nerve, infection, cancer, stroke etc. Orthosis for protection?

Answer 12

AKA calcaneal apophysitis Inflammation of growth plate at the back of the heel heel (wear Achilles attaches) of growing children, typically adolescents, during growth spurt Pain in the heel Caused by repetitive stress on achilles tendon, damages growth plate to heel Thus particularly common with physically active children

Answer 13

AKA medial tibial stress syndrome pain in lower part of leg between knee and ankle caused by repeated trauma to connective muscle tissue surrounding tibia Usually attributed to overloading of muscles of the lower extremities or to biomechanical irregularities Muscle imbalance, inflexibility Increasing activity/intesity/duration too quickly can lead shin splints Tendons and muscles unable to absorb impact of shock forces as they fatigue Disruption of Sharpey's fibers connecting medial soleus fascia to periosteum of tibia, impact force eccentrically fatigues soleus, create tibial bending or bowing Excessive pronation at subtalar joint is associated factor, causes tibial twisting and overstretching of lower extremity muscles

Answer 14

Degenerative osteoarthritis between center of spinal vertebrae and or neural foramina As space between 2 adjacent vertebrae narrows, compression of nerve roots emerging from spinal cord can cause subsequent sensory/motor disturbances (radiculopathy) Pain Paresthesiae Muscle weakness Direct pressure on spinal cord can cause myelopathy Global weakness Gait dysfunction Loss of balance Loss of bladder/bowel control Labelled by area of back involved (cervical, thoracic, lumbar)

Answer 15

Defect of pars interarticularis of the vertebral arch Fracture in thin piece of bone that connects upper and lower segments of the facet joints Great majority of cases occur in lowest of lumbar vertebrae (L5), but can occur in other lumbar and thoracic vertebrae May be asymptomatic for a long time Symptoms often appear during teenage growth spurt, often those participating in sports involving hyperextension of back (gymnastics, weightlifting, football etc.) Pain spreads across lower back Generally worse with vigorous exercise or activity Back orthosis for support (intraabdominal pressure) and prevention of flexion/anterior translation

Answer 16

Spondylolysis with anterior translation of the superior vertebrae over the inferior one

Answer 17

Rare genetic disorder Characterized by absence of radius bone in forearm Dramatically reduced platelet count, can lead to bruising and potentially life-threatening hemorrhage

Answer 18

Inward twisting of tibia Most common cause of intoeing Medial torsion improves with time Lateral torsion worsens Can occur due to position of the baby in the uterus Denis-Browne Bar worn at night

Answer 19

Abnormal, asymmetrical, fixed or dynamic tilt, rotation or flexion of the head and/or neck Variety of causes Congenital- etiology uncertain, birth positioning Damage to sternocleidomastoid muscle Shortening, excessive contraction Sometimes sternocleidomastoid tumor, may disappear but leaves musce fibrotic ``` Acquired Muscular- pain to neck muscles (sternocleidomastoid, trapezius) Tumors in base of the skull Infections (ear, posterior pharynx) Certain Drugs ``` TOT collar- irritant, encourages child to laterally flex and rotate to the opposite side Soft PVC tubing with tubes positioned anterior and posterior to crest of the trapezius

Answer 20

Surgical procedure whose purpose is to Relieve pain in the rear part of the foot Improve stability of the foot Correct deformity of the foot Commonly carried out on patients with joint degeneration resulting from arthritis or severe flat foot deformity Creation of a stable, balanced, plantargrade foot for ambulation Fuses 3 main joints of the hindfoot: Subtalar joint Calcaneocuboid joint Talonavicular joint

Answer 21

Decreased sensation to little finger part of ring finger Pain Tingling, Numbness Weakness Cause Illness that damages nerve Direct trauma Long term pressure on the nerve, could be caused by swelling or injury of nearby body structure Froments Sign Specifically test adductor pollicis (innervated by ulnar) Patient holds flat object like piece of paper between thumb and index finger Examiner attempts to pull object out of the subject's hand

Answer 22

Describes abnormal valgus deformity in one knee in association with varus deformity in the other May also occur at the hip Abduction and external rotation of one hip with opposite hip in adduction and internal rotation, may occur in association with hip dislocation and scoliosis

Answer 23

Inherited connective tissue disorder Defect in collagen leading to hypermobility Abnormal collagen renders skin, joints, muscles, ligaments, blood vessels more elastic Severity of mild to life threatening Joints may subluxate/dislocate easily, braces can help control ROM to prevent unnatural joint positions Bracing also helps to support injuries/pain related to the condition

Answer 24

AKA pigeon chest Deformity of the chest characterized by a protrusion of the sternum and ribs (oppose is pectus excavatum) Overgrowth of cartilage cause sternum to protrude forwards Usually occurs - post open heart surgery, way that it heals - congenital - during male puberty growth spurt Relatively common, Occurs 1/400 Heart and lung function may be affected Associated with scoliosis May be a cosmetic issue, self image Customized orthosis Direct pressure applied over protruding area can produce excellent outcomes Front and back compression plates anchored to aluminum bars bound by tightening mechanism Can be worn under clothes

Answer 25

Damage or disease of nerves of the Peripheral nervous system ``` Causes Diabetes Alcoholism Immune system disease Infection Trauma ``` Motor/sensory loss

Answer 26

Misshapen infant head Develops in response to prenatal and postnatal force acting on infants head Plagio- parallelogram shape Scapho- long A-P Brachy - wide M-L ``` Cause Multiple births First born Premature birth Vacuum/Forceps delivery Torticolis Sleep position preference ``` Flattened side corresponds with anterior positioning of ipsilateral ear and forehead Appropriate time to treat with helmet is 4-6 months Orthotist creates space between helmet and skull over short dimension Infant's head grows in path of least resistance

Answer 27

Genetic disorder that disturbs cell growth in your nervous system Causes tumor to form in nerve tissue, usually benign (non cancerous) Possible symptoms Bowed legs Bone abnormalities (scoliosis) Hypotonia Motor Incoordination

Answer 28

Degenerative disorder of the CNS Result from death of dopamine generating cells in substantia nigra, region of midbrain Lack of formation and activity of dopamine Leads to Parkinsonism ``` Tremor Rigidity- stiffness from increased muscle tone Hypokinesia- decreased bodily movement Bradykinesia -slowness of movement Postural Instability Difficulty walking ``` Cause is unknown

Answer 29

Neurodegenerative genetic disorder Affects muscle coordination and leads to cognitive decline and psychiatric problems Chorea Abnormal involuntary writhing movements

Answer 30

Paralysis of arm caused by injury to upper group of brachial plexus, specifically upper trunk (C5-C6) Most commonly occurs in infants due to difficult delivery (1-2/1000 live births) - forceps delvery - prolonged birth - breach birth 4 types - Neuropraxia- stretches but does not tear nerves, usually heals on its own - Neuroma - damages some nerve fibers, causes scar tissue that may impinge remaining tissue - Rupture - nerve torn, will not heal on its own - Avulsion - nerve torn from spinal cord, impossible to repair Signs and Symptoms - paralysis of structures innervated by C5-C6 nerve roots, most commonly suprascapular, musculocutaneous, and axillary nerves - paralysis of subscapularis, deltoid, biceps, brachialis - loss of sensation of the arm - arm hangs, shoulder medially rotates, elbow extended, forearm pronated Surgical treatment Gunslinger brace

Answer 31

Refers to continuum of abnormalities of the immature hip Diagnosed after birth Subluxation, Dislocation, Acetabular dyplasia (shallow acetabulum), Unstable hip (excessive laxity, prone to subluxation) If left untreated can lead to painful debilitating degenerative arthritis Exact cause not known, possible genetic predisposition Ortholani Test- put back in, medially against greater trochanter audible clunk Barlow's Test- try to push out laterally and posteriorly against lesser trochnater Hip flexion of 90 degrees and abduction of 45 is best to seat femoral head well into acetabulum Pavlik Harness Freika Pillow Possible use of Scottish Rite Orthosis, for older ambulators Treatment time 3,4 months

Answer 32

Lack of blood flow to forearm Usually due to increased pressure from compartment syndrome Trauma to the arm can also be a cause Decreased blood flow causes muscle damage, leaves them scarred and shortened Decreased sensation//weakness MIld- contracture of 2 or 3 fingers Moderate - all fingers flexed, thumb stuck in palm, loss of some feeling in hand Severe- muscles in forearm that both flex and extend the wrist are involved