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124 Cards in this Set

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What are the three types of scoiosis? WHich is more prevalaent and when does this happen?
deveopmental- cartilage does't develop symmatrically

trained- older athletes who did one motion over and over again without weight training would get imbalanced scoliosis

idiopathic- happens to people during puberty and we don't know why
What test do you use to measure scoliosis angle? Why does this work?
the adam's test
the adam's test
if you are sidebent left with scoliosis, which side of your back will ome up higher?
the right side (fryette's laws!)
Where does scoliosis usually happen?

Where are the compensations usually?

WHat is the keystone vertebra?
thoracic and both cervical and lumbar compensate, but moreso lumbar

the vertebra at the apex is the keystone
What sign may you see on an AP x ray of a person with scoliosis?
a scotty dog sign because there is some rotation with the sidebending
In what pattern around the spine does the apophysis of the spine fuse?
from anterior to posterior
WHat deficits may you get if you don't tx your scoliosis?
respiratory restriction and GI restriction
What is spondylosis?
Spondylosis is a term referring to degenerative osteoarthritis of the joints of the spine
What is spondylosis of the facets called?
facet syndrome
is there always gonna be rotaion with sidebending?
no, Dr. Carsia had only sidebending because of trauma
What is spondylolithesis vs pseudospondylolithesis?

What happens to the location of the spinous process in each?
spondylolithesis- slippage of vertebra due to isthmus fracture. Spinous process of that level stays in line with the bottom vertebra.

pseudospondylolithesis- slippage of vertebra die to degeneration of zygapohyseal joints. Spinous process of th...
spondylolithesis- slippage of vertebra due to isthmus fracture. Spinous process of that level stays in line with the bottom vertebra.

pseudospondylolithesis- slippage of vertebra die to degeneration of zygapohyseal joints. Spinous process of that level moves forward
Which part of the vertebra will slip forward always in the lumbar?
the top part
Where is the most common spondylolithesis? why?
L5-S1 because there is such an extreme angle for slippage here
Which vertebra does the disc move with? Why?
the top vertebra because it has stronger attachments here
the top vertebra because it has stronger attachments here
Where do neoplasias vs metastatic cancer usually develop in the spine? WHy?
neoplasia- anywhere

metastatic- in the vertebral bodies because they are so heavily vascularized
What are the arteries of Adamkiewics again?
arteries coming of the left of the aorta that go to supply the spinal cord around T9-T12
what is this? what is dissoving and what is retained?
what is this? what is dissoving and what is retained?
metastatic vertebral body cancer. note that the discs are preserved because they don't have as much bloof supple
WHat are schmorl nodes?

WHy may they happen?
protrusions of the disc into the vertebral bodies... may be dur to weakness of the bones
protrusions of the disc into the vertebral bodies... may be dur to weakness of the bones
What is this. What is the key word to describe it.
What is this. What is the key word to describe it.
multiple myeloma with a punched out appearance
What can that be mistaken for?
schmorl nodes, which are much more benigh
WHy does multiple myeloma do that to the vertebral bodies?
they have marrow inside which produces lymphocytes for the caner
What should you look for in an x ray for cancer? how obvious is this versis how much dmage there actually is?
blurring of pedicles, which can be very subtle but reflect a big change in the bone

here is a cancer with xray and then MRI
blurring of pedicles, which can be very subtle but reflect a big change in the bone

here is a cancer with xray and then MRI
What should you suspect if a woman who had breast cancer presents with lower back pain? why?
metastatic osteosarcoma because the breast cancer likes to metastasize to the lumbar vertebrae
What is the classic appearance of vertebra from metastatic prostate disease? Why?
they appear more white like IVORY because this cancer encourages bone growth (osteoblastic metastasis)
they appear more white like IVORY because this cancer encourages bone growth (osteoblastic metastasis)
What does clouding of the discs indicate>
What does clouding of the discs indicate>
infection at the discs
WHat is Pott's disease?
when tubberculosis invades the spine
when tubberculosis invades the spine
What is happening here?
What is happening here?
the vertebrae are bulging out like a pott and flattening out
what is that line? what are they trying to get me to see at the arrow?

What would cause this?
what is that line? what are they trying to get me to see at the arrow?

What would cause this?
this is the left paraspinal line made by the aorta pushing the mediastinum away to make room for soft tissue.

there is a bulge of it at the arrow, which indicates infection.
What kind of infection cause a left parasponal bulge?
many tgubgs! TB, lymphoma, or even a vertebral f bleeding into the space
Is there a right paraspinal line on CXR?
no because there is no aorta on the right
show how a fx can cause a PSB
what does antebrachial mean?
the forearm
why is there a cubital and antecibital fossa?
they can't decide who it belongs to
what is the cartilage in the GC joint? what does it do?
the LABRUM which makes the groove deeper
what does the trochlea look like?
a spool
why does the deltoid need the supraspinous to start abdution for it?
it originates in the acromion so it is originally pulling at a 180 degree angle
is the f/e of the thumb the same as opposition? What defines it?
no because opposition involved tge carpal-metacarpal joint
synonym for volar?
palmar
What is hemarthrosis?
bleeding inside a joint capsule
What is the rule for examination of a long bone fracture?

WHy is this important?
the two joint rule- take x rays of the joint above and below

there may be dislocations here that are not apparent and don't cause complaints. it's much harder to reduce it after it has been healing for a while
WHy should we "leave the ulna alone" in repairing a fx?
because you could cause the interosseous membrane to scar over or fuse to the radius, leaving supination and pronation severely impaired.
What is fusing of two bones called?
syn- together
osto- bone

sysostosis
WHat kind of reduction can you do immediately after injury vs after 2 weeks?
closed vs open when prolonges
Which two wrist bones actually articulate with the radius and take the brunt of the force?
the first two- scaphoid and lunate
the first two- scaphoid and lunate
what does volar mean throughout the entire arm and even the scapula?
anterior
what the heck is preaxial vs postaxial on the limb?
in reference to where that body part was in relation to the axial skeleton in development before our arms turned out.

lateral- preaxial
medial = postaxial
in reference to where that body part was in relation to the axial skeleton in development before our arms turned out.

lateral- preaxial
medial = postaxial
how tight are the compartments in the upper limb going from proximal to distal? How do you know?
they get tighter as you go down and are able to tolerate less mass goiong in.

this is why carpal tunnel is so common?
What are the 4 sx of compartment syndrome? do they all necessarily present? WHY?
the 4 P's
1. Pallor
2. paresthesias
3. pulselessness
4. paralysis

pulselessness is not as reliable because arteries have high pressure and can stay open for much longer.
What motions create more pain in compartment syndrome?
stretching those muscles
What is the basic concept behind fasciotomy?
relieve the pressure, wait for swelling to go down, and close the skin back up
how can you confirm compartment syndrome?
stick a needle in to measure pressure
when does the subclavian turn into the axillary and when does that turn into the brachial?
after the 1st rib

after teres minor
What palmar arches do the ulnar vs radial give off? is this intuitive?
no, opposite of what I thought because radial is superficial
no, opposite of what I thought because radial is superficial
where does most of the blood from the hand drain?
to the dorsal side (just look at it!)
are arteries or veins mmore variable?
veins
where do the lymph nodes tend to be when you are looking superficial vs deep?
superficial- follow veins

deep- follow arteries
why are these axillary lymph nodes named for levels?
why are these axillary lymph nodes named for levels?
the higher the level, the worse the cancer
the higher the level, the worse the cancer
name boundaries of the axilla
name boundaries of the axilla
Can you palpate the brachial plexus? where?
yes, above the pulse of the subclavian artery
Where do we typically insert central lines and why?
the right axillary artery because it does straight tot he heart
what happens to the axillary nerves, arteries, and veins after the clavicle?
they become bundled in a sheath
what clinical significance does this have? say interms of an aneurysm or trauma?
high probability of forming fistulas because blood from the artery goes right into the vein
where would you inject anesthetic to block the whole arm? what do you have to be careful not to accidentally do?
at the brachial plexus either aboce or below the clavicle to get all of it. (be careful not to inject it into the subclavian artery though!!!)
What is this? What causes it?
What is this? What causes it?
Looser's line from people with extreme osteomalacia from the blood vessels that run accrpss the scapula

aka milk man's pseudo fractures (not actully fractures)
show the anastomosis of the scapula
So is it a big deal to the arm if you cut out the subclavian artery?
I guess not! there are some surgeries that take out a section of it
Who may get impingement of the axillary artery?
people who use pec minor a lot like pitchers
show the axillary artery in angiography
in the armput
in the armput
What artery does the anterior and posterior interosseous come off of? How long does each one run for?
they come off the ulna as the common interosseous.

posterior- goes down and sprays out immediately
anterior- stays for a longer run
they come off the ulna as the common interosseous.

posterior- goes down and sprays out immediately
anterior- stays for a longer run
better view!

is radial or ulnar artery larger? Why?

why is the anterior interosseous longer?
ulnar artery is larger because it supplies mpre things, esp in the superficial palmar arch

anterior interosseous supplies more muscle in the distal forarm
ulnar artery is larger because it supplies mpre things, esp in the superficial palmar arch

anterior interosseous supplies more muscle in the distal forarm
what artery do some people have that failed to involute during development?
median artery going down the anterior forarm
What should doctors always do before doing hand surgery?
get an arteriogram in case the pt has a median artery because that needs to be additionally clamped
What is the angle of the radius? why is this important?
it slants in to make room for the carpal bones (esp lunate to move around)
it slants in to make room for the carpal bones (esp lunate to move around)
WHat happens if the radius is stright and not slanted?
you can get erosion of the lunate
What ARE the roots of the brachial plexus?
the ventral rami
what kinds of fx can impinge on the brachial plexus?
clavicle
does everyone havebrchial plexus C5 to T1?
some people have it moved up or down one
What is thedanger if it is shifted one down?
T1 already has to come up a little to fo over the first rib. T2 will have to come up even more and is prone to stretching.
is there more nerves necessary for the volar or dorsal upper limb?
the volar side because we need more fine control of your fingers
Which nerves will go to the dorsal vs the volar side? (general)
the ones in the posterior cord will go to the dorsal UE
name what lesions in these areas are called. give an alternate name for it being proximal or distal to the plexus.

Which one is most common?
name what lesions in these areas are called. give an alternate name for it being proximal or distal to the plexus.

Which one is most common?
proxial to the plexus can also be called a preplexus lesion. This is most common with pulling or wrenching movements

distal is post plexus lesion.
proxial to the plexus can also be called a preplexus lesion. This is most common with pulling or wrenching movements

distal is post plexus lesion.
so preplexus lesion and radiculopathy arent the same thing. WHat is the difference?
the radiculopathies happen at the spinal roots (not the plexus roots, which are further along)
are plexopathies common? When may you see them?
no because this is very well protected.

however, you may see it in cancer.
what is another name for plexopathy?
intraplexus lesion
How is the degree of motor and sensory change different in mononeuropathies vs preplexopathies?
they are more distinct (anesthesia vs hypoesthesia) because they serve a discrete set of muscles.
why would hanging on a tree damage the lower brachial plexus?
because you are pulling the ribcage up (via serratus anterior and atissimus dorsi) and the first rib will barrel through the brachial plexus that way
describe the motor and sensory deficit of pre vs post pplexus lesions/
pre- more myotomal and dermatomal in distribution (with overlaps). weakness of muscles and hypoesthesia more proximal with anesthesia in autonomous points.

post- anesthesia of the cutaneous zones and severe paralysis
What two nerves kinda join to make the median nerve? (or rather what coe out of the branches)
musculocutaneous and ulnar
musculocutaneous and ulnar
what we will go over now
what we will go over now
alright! BRACHIAL PLEXOPATHIES!
What pathology cause cause dennervation atrophy of your trapezius?
Parsonage-turner that is initiated by something (trauma, infection) which gets better and then for some reason returns to kill CN11 and the other shouldler nerves.
what life event may cause a brachial plexopathy?

what predisposes you to this?

is it permanent?
hereditary brachial plexus neuropathy that happens post partum..

it is inherited.
What type of cancer can cause a brachial plexopathy? Which part of the plexus? Why?
breast cancer compressing the bottom part (T1)
What is neuropraxia? What can it be caused by?

dissect the name.
temporary loss of nerve function without loss of any structures. person recovers well like after being stunned.

praxis= everything intact, but just doesn't workW
What does -tmsesis mean?
to cut apart
What is Axonotmesis?

What can cause it?

What happens after? how is recovery?
cutting of the axon, but not the endoneurium. (schwann tube). recovery is good at the rate of anterograde transport/regeneration)

You can get it from leaning over something for too long.
What is neurotmesis?

recovery?
cutting of the axon and endoneurium.

you would need surgery to repair and gain back partial function by matching up the neurolemma.
What should you do for the pt while waiting for an axonotmeis lesion to regrow?
stimulate the muscle elctronically to mae sure it doesn't atrophy.
what is happening in the muscle in PARESIS?
only some of the muscle fibers are being denervated. (all or nothing with fibers)
is paralysis common?
nope, it would have to be a pretty severe lesion
what is the definition of a paresthesia?
sensations your nerve registers that aren't being externally stimulated.
where is the C5 dermatome? How is this different from what I studied?
it ends before the forearm. Instead of C5, C6 and C7 come and wrap up where I thought i was.
it ends before the forearm. Instead of C5, C6 and C7 come and wrap up where I thought i was.
how can you use dermatomes to determine what roots are in a nerve?

example- what roots are in the MC?
how can you use dermatomes to determine what roots are in a nerve?

example- what roots are in the MC?
lateral natebrachial from MC covers C6 and C7 so MC must contain both of those to bring them there.
what inervates the serratus anterior?

what are nerves that come off the plexus that aren't part of the terminal 5 called?
long thoracic nerve

collateral nerves
why are some roots in red?
why are some roots in red?
because they represent the majority innervation
What controls the scapula and shoulder joint mainly?
C5
C5
What roots control the pecs?
C8, T1
C8, T1
So what regions can you generalize to the upper preplexus and the lower?
upper- shoulder, scapula, and lateral UE
lower- pecs, medial UE
What does the thoracodorsal nerve innervate?
latissimus dorsi
what nerve does the medial anterbrachial come off of?
the ulnar nerve
What muscles does the dorsal scapular innervate?

What level is it?

WHat movement does it control?
muscles: levator scapulae and rhomboids

C5

it will retract, elevate, and downwardly rotate the scapula. lesions are rare.
What does the suprascapular nerve innervate?

roots?

motor deficits?
supra and infraspinatous

C5, C6

can't abdct first 15 degrees of arm and weak externa rotation
What levels are the long thoracic nerve?
C6, C7
What is the deficit you would see with a lesion and why?

most common causes of lesions?
it hold the medial scapula to the ribcage and pulls it down. You would get wingingout and up without it.

most often injured backpacking or with an axillary lymadenectomy.
what level is the subclavious?
C5
What will a distal vs proxmimal CN 11 lesion do?
prximal- SCM and trapezius injured

distal- just trapezius
What may people do to make up for a supraspinatous deficit?
bend so that gravity starts the first 15 degrees of abduction
What is the main muscle preventing scapular wining?
serratus anterior
how is the LTN most commonly injured?
breast cancer surgery (going throgh the anterolateral torso)
What is the common cause of apinching off the suprascapular nerve?
SUPRASCAPULAR NOTCH SYNDROME- in old people, the suprascapular notch may become clacified and pinch this off. they will have atrophy of the two spinatous muscles.
SUPRASCAPULAR NOTCH SYNDROME- in old people, the suprascapular notch may become clacified and pinch this off. they will have atrophy of the two spinatous muscles.
wHAT ARE THE MUSCES AND sensory innervations of the axillary nerve>
muscle- deltoid and teres minor

cutaneous0 upper lateral brachial cutaneous (makes sense)
Wat are some common causes and effects of axillary palsy?
fx of humeral surgical neck

causes anesthesia and paralysis/atrophy of upper lateral shoulder