Anatomy-->Exam 1 Lecture Ailments

Front 1

Kyphosis

Back 1

Excess kyphotic curvature of the thoracic region

Front 2

Lordosis

Back 2

Excess lordotic curvature of the lumbar vertebrae

Front 3

Scoliosis

Back 3

Abnormal lateral curvature of the vertebral column

Front 4

Compression Fx

Back 4

Compression Fx secondary to osteoporosis
MC in elderly, females
Often no significant trauma
→ increasd kyphosis
Aka Dowager’s hump

Front 5

Herniated Disk

Back 5

Protrusion of the gelatinous nucleus pulposus into or through the anulus fibrosus into intervertebral foramina(pinches nerves)
Usually in lower lumbar and lower cervical regions
Mechanism of injury: Flexion and rotation of spinal cord
Symptoms: Back pain, ↑ w/ sneezing, coughing, sitting
Radiating pain, paresthesia
Muscle weakness & atrophy (later stages)

Front 6

Rupture of transverse ligament of atlas

Back 6

Dens is free
Atlantoaxial joint can dislocate resulting in spinal cord damage, particularly during flexion
e.g. rheumatoid conditions, Down’s syndrome

Front 7

What Causes Back Pain?

Back 7

Trauma
Malignancy
Infection
Congenital Malformations
Musculoskeletal / Biomechanical issues
Idiopathic

Front 8

Dermatomes

Back 8

Regions of the body associated with specific segments of the spinal cord

Essentially, it is a slice of the body in a quadrupedal position

This is an essential bit of knowledge to determine what spinal cord levels may be affected in patients with neurological complaints

Front 9

Lumbar puncture Used for

Back 9

Diagnose meningitis, subarachnoid hemorrhage, multiple sclerosis, hydrocephalus, etc.
Puncture usually done between L3/L4 or L4/L5

Front 10

Clavicle Fractures

Back 10

Caused by:
A direct blow to the clavicle
A fall onto the shoulder
A fall on the outstretched arm*(“classic” MOI)

Front 11

Shoulder Separation

Back 11

AC joint problem (vs. shoulder dislocation)

Commonly occurs after a fall or a sharp blow to the top of the shoulder

AC joint is relatively weak (to allow mobility)
Most support of joint comes from the coracoclavicular ligaments

After separation, weight of the arm displaces clavicle from acromion

Front 12

Erb’s palsy/Erb-Duchenne paralysis

Back 12

upper brachial plexus injury resulting from excessive separation of the neck and shoulder during a fall or difficult delivery
Causes:Waiters Tip position

Front 13

“waiter’s tip” position

Back 13

Due to Erb's Palsy: Is characterized by the arm hanging at the side in medial rotation with the forearm pronated and the fingers and wrist flexed, the

Front 14

Klumpke’s paralysis

Back 14

Is a lower brachial plexus injury (C8-T1) resulting from a violent upward pull on the arm or from compression or stretching of the lower trunk; it results in claw hand

Front 15

supracondylar fracture of the humerus

Back 15

The distal fragment of bone may be pulled anteriorly by the brachialis or posteriorly by the triceps brachii
The brachial artery may be injured, producing a compartment syndrome in the forearm

Front 16

fracture of the midshaft of the humerus=

Back 16

resulting in inability to extend the wrist (wristdrop ) and metacarpophalangeal (MP) joints

Front 17

olecranon bursitis

Back 17

may become inflamed from repeated friction to produce >Student's elbow

Front 18

Subluxation or dislocation of the radial head

Back 18

Radius is pulled out of the Annular ligament.
During extention of elbow and pronation of the wrist. nursemaid’s elbow or pulled elbow

Front 19

Carpal Tunnel

Back 19

The flexor retinaculum converts the concavity formed by the carpal bones into the carpal tunnel.
contents:
forearm flexor tendons in common flexor sheath
median nerve
If area becomes inflamed, compression of the median nerve can occur, leading to carpal tunnel syndrome.

Front 20

Varicose Veins

Back 20

Occur in superficial veins when either the deep fascia or valves of perforating veins are incompetent
Blood flow slows, go from deep to superficial veins and collects in the superficial vein, causing a bulge

Symptoms:
pain, achiness, and heaviness of affected leg, worsened by standing
Alleviated by sitting down and/or wearing elastic stockings
Major treatments:
Sclerotherapy: injecting a sclerosing agent to cause vein to shrink and close
Surgery: vein stripping or removal, or ligation of great saphenous v. at entrance to femoral v. in femoral triangle/ small sephanous v. at popliteal fossa

Front 21

Sciatica

Back 21

A non-specific term commonly used by the lay-person

Refers to an generalized pain in the distribution of the sciatic nerve

Often caused by herniated or protruded intervertebral disc pressing on nerves roots of lumbosacral plexus

Front 22

Hip Pointer

Back 22

Contusion of iliac crest by direct blow or fall

Front 23

Avulsion Fracture

Back 23

Ischial tuberosity, anterior superior and inferior iliac spines in immature skeleton

Front 24

Pelvic fractures

Back 24

Head of femur driven through acetabulum. fall on greater trochanter or from height on feet

Front 25

Hip Fractures

Back 25

Neck fx are most frequent

retinacular branches of the medial femoral circumflex artery may be torn, resulting in avascular necrosis of the femoral head (bone dies)
Risk of deep vein thrombosis & pulmonary embolism

Front 26

Avascular necrosis of femoral head

Back 26

Sickle cell disease
alcoholics or long-term use of corticosteroids
Legg-Calvé-Perthes : epiphyseal ossification centers of the femoral head in children

Front 27

Avulsion fracture of lesser trochanter

Back 27

from pull of iliopsoas are frequent in adolescent
adult > sign of metastatic carcinoma

Front 28

Posterior hip dislocation

Back 28

can damage sciatic nerve & cause paralysis of muscles of posterior thigh and muscles below knee

Front 29

Positive Trendelenburg Sign

Back 29

Results from paralysis or weakness of the gluteus medius and mimimus
Pelvis drops on opposite side when the affected side is supporting the body
Opposite side of weakness shows the hip drop
altered gait pattern: patient does a “hip hicking”

Front 30

Piriformis Syndrome

Back 30

The sciatic nerve may become irritated or compressed by the piriformis muscle, often creating pain and/or paresthesia in the gluteal region and posterior thigh

An early division of the sciatic n. occurs in about 12% of the population and may predispose a person to this condition

Hypertrophy of the piriformis plays a role as well
Dancers, ice skaters, cyclists, etc.

Front 31

Hamstring strains

Back 31

are relatively common and third degree strains (complete rupture of tendon) do occur (as shown here) when sprinting or kicking

Front 32

Tibial shaft fracture

Back 32

Frequent
often open (compound fracture) > osteomyelitis
Nonunion & delayed union common in adult

Front 33

Stress Fx

Back 33

Microfracture in the bone

Front 34

Shin splints

Back 34

Leg pain common in athletes who run on hard surfaces
Stress reaction of periosteum or muscles attachment to repetitive use

Front 35

Ankle Sprain -->

Back 35

Usually inversion and plantarflexion. Also possible avulsion fracture of 5th metatarsals by fibularis brevis tendon.

Front 36

Pott’s fracture

Back 36

Occurs when foot is forcibly everted
Avulsion of medial malleolus or tear of medial ligament
Shear off lateral malleolus
Can shear off posterior margin of distal tibia end

Front 37

Fibular fracture

Back 37

Occurs with excessive inversion of foot
Avulsion of lateral malleolus or tear of lateral ligament
Can fracture tibia at higher level

Front 38

Compartment Syndrome

Back 38

Acute medical problem following injury or surgery in which increased pressure (usually caused by inflammation) within a muscle compartment of lower limb* that impairs blood supply
Can lead to nerve damage and muscle death because of necrosis
Left untreated when acute, can lead to death

Signs & Symptoms:
The 5 "P's" Pallor (lack of color), pulse deficit, paralysis, paresthesias (tingling/itching), and pain on passive motion
CURE: cut the fascia to relieve the pressure, can also happen in the thigh

Front 39

Deep Vein Thrombosis (DVT)

Back 39

Large clot develops in vein (usually in calf)
Clot breaks off and enters circulatory system> pulmonary embolus
Classic triad etiology:
Venous stasis
Injury to vessel wall
Hypercoagulable state
Difficult to detect since there may be no clinical signs
Common causes:
Surgery
Travel (economy class syndrome)

Front 40

Tarsal Tunnel

Back 40

Posteriomedial side of ankle
Held by flexor retinaculum

Passage of structures (deep posterior compartment of leg) around base of tibia to plantar surface
except for anterior tibial artery and deep & superficial fibular nerves (anterior to ankle)
From anterior to posterior: tendon of Tibialis posterior, tendon of flexor Digitorium longus, posterior tibial Artery, tibial Nerve & tendon of flexor Hallucis longus > Nemnonic (Tom Dick ANd Harry)

Front 41

TARSAL TUNNEL SYNDROME

Back 41

Entrapment and compression of tibial nerve by flexor retinaculum that causes pain
Results from edema & thighness involving synovial sheaths of tendons of muscles from posterior compartment of leg

Front 42

Calcaneal fractures

Back 42

Most frequent
Fall on heel (e.g. from ladder)*
Often comminuted
Disrupt subtalar joint
Often accompanied by vertebral compression fractures (most frequent L2)

Front 43

Fractures of talar neck

Back 43

Severe dorsiflexion (e.g. put brake during head-on collision)
Can cause avascular necrosis of talar body bc it goes through the artery

Front 44

Metatarsal & phalangeal fractures

Back 44

Heavy object falls on foot, ballet dancer loses balance
Stress fractures of metatarsals in endurance athletes

Front 45

Avulsion fractures

Back 45

Avulsion(bone pulled off bone by tendon or ligaments) of tuberosity of 5th metatarsal by fibularis brevis tendon during forced inversion of foot
Avulsion of calcaneal tuberosity by achille tendon during forced dorsiflexion

Front 46

Clubfoot

Back 46

Clubfoot (talipes) is a combination congenital deformity of the foot
most common form (1:1000 live births) is talipes equinovarus:
Involve subtalar & transverse tarsal joint
Associated with thighness of tendons of long extensors
characterized by plantarflexion, inversion, and forefoot adduction

Front 47

Hallux valgus

Back 47

a degenerative joint disease
lateral deviation of the big toe at MP joint

Front 48

Bunion

Back 48

Subcutaneous bursa forms, when inflamed

Front 49

Corn

Back 49

Associated with elliptical callus of dead skin with funnel-shaped hard core

Front 50

Pes Planus (Flat Feet)

Back 50

Acquired flat feet > fallen arches:
Dysfunction of tibialis posterior
Causes: Trauma, degeneration with age or denervation
Mechanisms: Displacement of talar head
Common in older people
Weight gain
Unaccustomed standing

Front 51

Plantar Fasciitis

Back 51

Pain due to straining and inflammation of the plantar aponeurosis, may result from overuse or high-impact exercise
Associated with:
Obesity, weight gain, jobs that require a lot of walking on hard surfaces, shoes with little or no arch support
Flat foot: predisposition
State of constant inflammation causes heel spur on calcaneus

Front 52

Morton’s Neuroma

Back 52

Enlarged common plantar nerve
Usually between 3rd & 4th toes
Spot where lateral/medial plantar nerve unite
Can become sandwiched between deep transverse metatarsal ligament during “push-off”
Resulting in compression of nerve
Pain
Swelling

Front 53

Frozen shoulder

Back 53

Adhesive capsulitis--> pt can't raise arm above horizontal-pt substitutes another movement when asked to flex or abduct arm

Front 54

Nursemaid's elbow

Back 54

Dislocation of Radius from Annular ligament

Front 55

Piriformis syndrome

Back 55

sciatic nerve gets pinched by piriformis due to sciatic nerve dividing too early, either going through the muscle or above and below it. creating pain and/or paresthesia in the gluteal region and posterior thigh.

Front 56

Femoral fractures

Back 56

Fractures of distal femur
Can injure popliteal artery
complicated by separation of condyles results in misalignment of knee joint
Fractures involving epiphyseal plates can cause growth disturbance
Fracture of shaft can cause fatal fat emboli that travel to lung or brain

Front 57

Birth fractures of femur

Back 57

Difficult delivery
Osteogenesis imperfecta: multiple fractures including femur due to mutation of type I collagen genes

Front 58

Osteosarcoma

Back 58

common primary malignant tumor occurs in distal femur or proximal tibia, with 50% involving knee joint (75% patients under 20yrs)

Front 59

Osgood-Schlatter Disease

Back 59

Partial Avulsion of tibial tuberosity from epiphyseal plate
Characterized by inflammation of the patellar tendon and surrounding soft tissues at the point where the tendon attaches to the tibia
Common in adolescents, particularly athletes
Caused by repetitive stress or tension on part of the growth area of the upper tibia

Front 60

Prepatellar bursitis

Back 60

is due to friction between skin & patella.

Front 61

Osteoarthritis

Back 61

MC type - ~21 million Americans

Articular cartilage broken down
Typically associated w/ aging

Can be brought on earlier and more severely w/ an injury that affects joint structure

Mainly affects weight bearing & high-use joints like hip & knee

Front 62

Rheumatoid Arthritis

Back 62

An autoimmune disorder

Has some genetic components

Synovial membrane is attacked

Usually concentrated in the small joints

Often bilateral & symmetrical

A systemic problem, joint dysfunction is a symptom

Front 63

The unhappy triad”

Back 63

Injury to TCL, ACL & miniscus
Blow to extended knees or twisting of flexed knees while running (football)

Front 64

ACL rupture

Back 64

Sport like skiing
Free tibia slides forward when leg pulled: anterior drawer sign

Front 65

PCL rupture

Back 65

Land on tibial tuberosity when knee flexed
Free tibia slides backward when leg is pushed: posterior drawer sign

Front 66

PSOAS ABCESSS

Back 66

Infection caused by tuberculosis of the lumbar vertebrae or a fistula related to diverticulitis of sigmoid colon may track along the psoas fascia deep to the inguinal ligament, producing a bulge in the upper thigh and referred pain to the hip and/or knee joints

Front 67

Groin Pull

Back 67

Groin pull: lay term for strain to the tendons of the hip adductors
Commonly occurs when an accidental stress abducts the thigh during a powerful contraction of the adductors.
These muscles also may be injured from overuse in an unconditioned patient.
Local pain is noted at the inferior pubic ramus and the ischial tuberosity. Extension, abduction, and adduction of the hip are painful.

Front 68

Femoral Hernia

Back 68

Abdominal content pass through the femoral ring into the femoral canal and through saphenous opening
Much more common in females than in males
Prone to strangulation
Aberrant obturator artery* is in danger from hernia or its repair
However, indirect inguinal hernia is the most common type of hernia in both sexes

Front 69

Referred pain

Back 69

Because articular branches of the femoral(L2-L4) and obturator(L2-L4) nerves innervate both the hip and knee joints, hip pain often is referred to the knee; on the other hand, pain may be referred to the hip from the vertebral column & sacroiliac joint

Front 70

Pes Anserinus (Goose's Foot)

Back 70

Insertion of conjoined tendons of 3 muscles onto the anteromedial surface of the proximal tibia (A to P):
Sartorius (S)
Gracilis (G)
Semitendinosus (T)
Nmemonic : Say Grace before Tea
Minor protective element of medial knee :
Superficial to medial collateral ligament
Pes anserinus bursitis
Associated bursa inflamed

Front 71

Popliteal (Baker’s) cyst

Back 71

Synovial lining of knee joint herniates through capsule into popliteal fossa
Rupture causes sudden calf pain & swelling similar to deep venous thrombosis