quiz #2 - sprains, strains, fractures, CT pathologies

Question 1

grade of SPRAIN:
-minor stretch & tear
-no joint instability on passive testing
-minimal P & swelling
-able to complete ADLs with minor discomfort
-can weight bear
-bruising absent/ slight

Answer 1

grade 1

Question 2

grade of SPRAIN:
-partial tear of lig.
-increased P
-bruising & swelling
-loss of function due to P
-P on weight bearing
-snapping sound & joints gives way
-passing testing shows hypermobile but stable

Answer 2

grade 2

Question 3

grade of SPRAIN:
-complete tear
-surgery required
-immobilization in cast
-severe injury
-synovial inflammation & accumulation of synovial fluid = joint effusion
-hemarthrosis if bleeding into joint
-X-ray to rule out avulsion fracture (bone fragment pulls away from bone by lig.)

Answer 3

grade 3

Question 4

overstretch / tear of ligament

Answer 4

sprain

Question 5

type ankle sprain: lateral ligaments torn (anterior talofibular, calcaneofibular, calcaneocuboid)
*most common of all sprains

Answer 5

inversion sprain

Question 6

type of ankle sprain: deltoid ligament torn (anterior tibiotalar, tibiocalcaneal, posterior tibiotalar & tibionavicular – also has two sets of fibers superficial & deep), may cause avulsion fracture if Grade III sprain

Answer 6

eversion sprain

Question 7

most commonly sprained knee ligament

Answer 7

anterior cruciate ligament (ACL)

Question 8

most common cause of an injury to the knee affecting all 3 structures: medial meniscus, ACL, MCL

Answer 8

foot is fixed on ground, knee is truck by medial or lateral force

Question 9

most common cause of a wrist sprain

Answer 9

FOOSH

Question 10

most common wrist ligament sprained

Answer 10

palmar radiocarpal

Question 11

most common shoulder ligament sprained

Answer 11

acromioclavicular (AC)

Question 12

“loose ligaments” – may cause chronic body pain
-when condition affects joints in entire body, it is called generalized joint hypermobility

Answer 12

ligamentous laxity

Question 13

ligamentous laxity - genetic disease causing abnormal fibrillin

Answer 13

Marfan syndrome

Question 14

ligamentous laxity - defect in synthesis of collagen, causes progressive deterioration of collagen in different parts of body such as joints, heart valves, organ walls or arterial walls

Answer 14

Ehlers-Danlos syndrome

Question 15

ligamentous laxity - insufficient production of normal collagen to produce healthy, strong bones

Answer 15

osteogenesis imperfecta (brittle bone disease)

Question 16

ligamentous laxity - affects collagen, may have distinctive facial appearance, eye abnormalities, hearing loss & joint problems

Answer 16

Stickler syndrome

Question 17

ligamentous laxity - defects in collagen, found in renal basement membrane, inner ear & eyes, leading to glomerulonephritis, hearing loss & eye disease

Answer 17

Alport syndrome

Question 18

ligamentous laxity - Beal’s syndrome, similar to Marfan syndrome but with contractures of hip, knee, elbows & ankle joint, crumpled ear

Answer 18

congenital contractural arachnodactyly

Question 19

ligamentous laxity - a collagen vascular disease

Answer 19

psoriatic arthritis

Question 20

tear of mm or tendon, commonly affecting lower back, neck & hamstrings

Answer 20

strain

Question 21

grade of STRAIN:
-few mm fibers damaged
-mild pain at time of injury
-mild swelling, if any
-minimal loss of strength
-P when tissue is stressed
-ADLs can be completed
-heals within 3 weeks

Answer 21

grade 1

Question 22

grade of STRAIN:
-more extensive damage to fibers or tendon, but mm not completely ruptured
-snapping sound may or may not be present, can sometimes feel gap at injury site
-edema, P (moderate), tenderness at site
-difficulty with ADLs
-loss of strength
-heals in 3-6 weeks

Answer 22

grade 2

Question 23

grade of STRAIN:
-severe injury with complete mm rupture
-snapping sound accompanies injury
-severe P, edema, bruising
-ADLs cannot be continued

Answer 23

grade 3

Question 24

complications with grade 3 strains

Answer 24

joint effusion (synovial fluid accumulation) or hemarthrosis (bleeding into joint)

generally sprains heal slowly, 6 weeks to develop fibrotic scar tissue, 6 months for healed tissue to mature fully & regain max strength – radiographs frequently taken to rule out avulsion fracture

Question 25

crush injury to mm with bleeding into mm & subcutaneous tissues, bruising minor or severe – can track along fascial plane, appearing at distant site – caused by blow or crushing injury to mm & does not break skin

Answer 25

contusion

Question 26

complications of a contusion

Answer 26

rapid accumulation of mm-derived proteins (like myoglobin) in bloodstream that can lead to damage to kidney & possible kidney failure or shock, called rhabdomyolysis

Question 27

solid swelling of clotted blood that collects in tissue, outside of blood vessel – damage to wall of artery, vein or capillary causes blood to leak into adjacent tissues & cause inflammation & bruising – violent sneeze/ cough may cause

Answer 27

hematoma

Question 28

why is a hematoma different from a bruise?

Answer 28

blood vessels that are damaged are larger & damage is worse

Question 29

injury to joint where surfaces are not congruent or separated – very painful & causes immobilization of joint – most common in shoulders & fingers, also elbows, knees & hips – most return to normal function after healing

Answer 29

dislocation *subluxation = partial dislocation

Question 30

break in the bone -can be due to trauma, overuse, microtrauma or stress

Answer 30

fracture

Question 31

causes of fractures

Answer 31

falls, sports, accidents & low bone density caused by disease increased forces on bones that exceed limits

Question 32

fractures affecting epiphyseal growth plates – applies to children only before plate fusion

Answer 32

Salter-Harris fracture

Question 33

type I-V: salter-harris fracture

Answer 33

Type I: transverse fracture through growth plate (also known as physis) Type II: fracture through plate & metaphysis Type III: fracture through plate & epiphysis Type IV: fracture through plate, epiphysis & metaphysis Type V: compression fracture of growth plate

Question 34

fracture: parallel to long axis of bone

Answer 34

linear

Question 35

fracture: right angle to bone’s long axis

Answer 35

transverse

Question 36

fracture: twisting of bone, causing a fracture

Answer 36

spiral

Question 37

fracture: two or more fragments of bone from fracture

Answer 37

comminuted

Question 38

fracture: bone/bone fragments crushed into each other

Answer 38

impacted

Question 39

fracture: bone compressed as in vertebral body

Answer 39

compression

Question 40

fracture: usually of skull

Answer 40

depression

Question 41

complications of fractures

Answer 41

nerve compression, vascular damage, infection, disuse atrophy, joint stiffness & limitation of ROM, delayed union, non-union, malunion

Question 42

bone does not unite (heal) within expected time frame – may be caused by inadequate circulation, hypermobility, infection, drugs or smoking

Answer 42

delayed union

Question 43

bone does not heal, even after repair process has “given up” – large gap, bone destruction & general poor bone health

Answer 43

non-union

Question 44

union of bone, unacceptable deformity leading to altered biomechanics

Answer 44

malunion

Question 45

Osteoma Osteochondroma Endochondroma Osteoid osteoma Giant cell tumour Aneurysmal bone cyst Fibrous dysplasia

Answer 45

benign bone tumors

Question 46

Osteosarcoma Chondrosarcoma Fibrosarcoma Malignant fibrous histocytoma Ewings’ sarcoma Multiple myeloma

Answer 46

malignant bone tumors

Question 47

benign slow growing bone tumor, usually around 1.5 cm in size – usually found in cortex of long bones (osteoid osteoma) or more commonly in skin (jaw & sinuses) – often in young men – X-rays used to diagnose & main symptom is pain – 3 types: compact, spongy combined

Answer 47

osteoma (osteoid osteoma)

Question 48

benign tumor affect children & adolescents 1-2 cm in size – abnormal growth or outgrowth at surface of bone near metaphyseal region of growth plate – made up of bone & cartilage – may be one tumor or many – continues to grow as child grows & stops when child stops growing

Answer 48

osteochondroma

Question 49

benign tumor of cartilage often affects long bones of hands & feet, but also femur, humerus or tibia – mostly affects adults

Answer 49

enchondroma

Question 50

rare, aggressive benign tumor, in young adults 20-40 years, often occurs near a joint at end of a long bone in metaphysis – common at knee, & in general in arms & legs or breastbone or pelvis

Answer 50

giant cell tumor

Question 51

benign blood filled cyst inside a bone that grows & expands quickly while destroying bone tissue – cysts are fragile & fracture easily – may occur anywhere, but commonly in knee, pelvis & spine

Answer 51

aneurysmal bone cyst

Question 52

replacement of normal bone with fibrous bone tissue, may affect one bone (most often) or multiple bones – common in femur, tibia, humerus, skull, ribs & pelvis – weakens normal bone tissue & may cause deformity or fracture – common in children & adolescents

Answer 52

fibrous dysplasia

Question 53

cancer of bone forming cells, common in 10-30 years, commonly affects long bones of legs mostly & arms – Terry Fox had this type of bone cancer (malignant)

Answer 53

osteosarcoma

Question 54

begins in bones or in soft tissue surrounding bones, very rare – often in pelvis, hip & shoulder – these cancer cells produce cartilage (malignant)

Answer 54

chondrosarcoma

Question 55

effects fibroblasts, cells that produce collagen in fibrous tissue or soft tissue, creating fibrous tissue where it doesn’t belong – may affect nerves, tendons, ligaments, blood vessels, lymphatic vessels, fat or mm – most common in legs or trunk (malignant)

Answer 55

fibrosarcoma

Question 56

cancer found in soft tissues like mm & tendons (may sometimes invade bone also), mostly in adults, often occurs late in life – common in arms & legs (specifically metaphysis of long bones) but may occur anywhere (malignant)

Answer 56

malignant fibrous histiocytoma

Question 57

in bones or soft tissue surrounding bones, commonly in leg & pelvis bones, less common soft tissues of chest, abdomen or limbs – most common in children & adolescents but can occur at any age (malignant)

Answer 57

Ewing's sarcoma

Question 58

cancer of a specialized white blood cell called a plasma cell - normal plasma cells make antibodies that attack pathogens, but these cancerous plasma cells make abnormal proteins - cells accumulate in bone marrow & crowd out healthy cells

Answer 58

multiple myeloma

Question 59

form of skeletal dysplasia, arm & leg bones are shorter than normal, average adult height of 4’ - 4’4” – also have an enlarged head with prominent forehead

Answer 59

achondroplasia / dwarfism

Question 60

brittle bone disease from gene mutation inherited or present at birth, bones soft & fracture easily – gene is responsible for collagen production in bone tissue, with dysfunctional or less collagen, bones are weakened

Answer 60

osteogenesis imperfecta

Question 61

foot abnormalities present at birth (congenital), foot is twisted or out of position – 50% of children have it in both feet – tendons & ligaments in foot are shorter than normal – may be mild or severe

Answer 61

club foot

Question 62

also known as “lupus” – chronic, inflammatory autoimmune disease that affects skin, bones, joints, nervous system & brain, kidneys, lungs & other organs – blood vessels also affected leading to Raynaud’s phenomenon with lowered levels of RBCs & platelets – butterfly rash is most distinctive symptom

Answer 62

systemic lupus erythematosus (SLE)

Question 63

what triggers lupus (SLE) if you are genetically predisposed?

Answer 63

sunlight, infections & medications

Question 64

syndrome involving a complication of diabetes & neuropathy – uncontrolled inflammation causes destruction of tissues due to impaired nerve pain perception

Answer 64

neurogenic arthritis - Charcot's disease

Question 65

chronic disease that affects CTs & internal organs – main effect is overproduction & accumulation of collagen leads to fibrosis or scarring & inflammation causing skin & superficial fascia to thicken & harden

Answer 65

scleroderma

Question 66

clinical features of scleroderma

Answer 66

tightness of skin of face “mask-like” appearance, mouth may not open or close completely, hands red, pale & swollen & fingers become tapered and flexed, skin is hard, shiny & stretched

Question 67

clinical features of scleroderma going deeper & affecting internal organs

Answer 67

may affect heart; cause arrhythmias or respiratory failure, renal failure, esophageal or intestinal blockage or perforation and damage to vascular walls (Raynaud’s phenomenon)

Question 68

scleroderma - types & subtypes

Answer 68

localized: affects skin, fascia, mm & sometimes bone generalized: affects multiple systems -limited: affects skin of face & fingers, slow onset (5-10 years), milder, symptoms are C.R.E.S.T. -diffuse: affects more areas of skin & may involve organs, sudden onset, more severe

Question 69

what does CREST stand for? (scleroderma)

Answer 69

C - calcinosis R - raynaud's phenomenon E - esophageal dysfunction S - sclerodactyly T - telangiectasias

Question 70

blood vessel disease characterized by inflammation of medium sized arteries or muscular arteries, also called vasculitis -prevents adequate oxygenation of tissues & organs, causes hypoxia and ischemia

Answer 70

polyarteritis nodosa (PAN) or vasculitis

Question 71

polyarteritis nodosa (PAN) or vasculitis is strongly associated with...

Answer 71

hepatitis B infection

Question 72

inflammation of blood vessels (vasculitis) in nose, eyes, ears, sinuses, throat, lungs, heart, skin & kidneys – prevents adequate oxygenation of tissues and organs and causes hypoxia and ischemia

Answer 72

Wegener's granulomatosis or granulomatosis with polyangiitis

Question 73

genetic disorder that affects proteins that contribute to elasticity & strength of CTs – most commonly affects heart, eyes, blood vessels & skeleton – person tall in stature with abnormally long extremities – normal lifespan with medical intervention

Answer 73

Marfan's syndrome

Question 74

bands of scar like tissue, causing nearby organs & tissues to stick together

Answer 74

adhesions

Question 75

fibrotic scarring, dysfunctional wound healing process where CT or fibrotic tissue replaces normal tissues – excess deposition of extracellular matrix mostly collagen

Answer 75

fibrosis

Question 76

tightening of CT in mm, tendon, ligaments or skin, preventing normal movements, often caused by severe burns – skin becomes scarred & loses its elasticity

Answer 76

contractures

Question 77

inflammation of plantar fascia – often due to repetitive sports & inadequate stretching

Answer 77

plantar fasciitis

Question 78

chronic pain syndrome characterized by heightened pain response with diffuse soft tissue pain that feels muscular in nature with multiple tender points – pain lasts longer than 3 months & often accompanied by insomnia & memory problems – total of 18 tender points in body, diagnosis is made if 11 – commonly, there are periods of remission & exacerbation – mostly affects women in middle age

Answer 78

fibromyalgia

Question 79

pressure within fascial compartments around mm builds to dangerous levels & causes pain and swelling that may decrease blood flow to area, damaging tissues & causing hypoxia and ischemia

Answer 79

compartment syndrome