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112 Cards in this Set
- Front
- Back
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How many degress of flexion does the ulnotrochlear joint allow for?
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140°
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What determines the carrying angle of the elbow?
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The humeroulnar articulation
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What are the carrying angles for males and females?
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Males: 5-10°
Females: 10-15° |
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What ligaments assist with medial stability of the elbow?
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Anterior and Posterior Bundles of the Medial (ulnar) Collateral Ligament
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What ligament provides lateral stability?
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The Lateral (radial) Collateral Ligament
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What ligament does not contribute to the stability of the elbow?
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The transverse oblique bundle of the Medial Collateral Ligament
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What are the four parts of the Lateral Collateral Ligament?
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Lateral Ulnar collateral Ligament
Radial Collateral Ligament Annular Ligament Accessory Lateral collateral Ligament |
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What is the function of the annular ligament?
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It stabilizes the radius to the ulna allowing pronation/supination
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Why does the whole capsule swell during a ligament injury?
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Because most ligaments are intracapsular
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What is Gunstock deformity a sign of?
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Supracondylar fracture
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What muscle provides greater lateral stability than the Lateral Collateral Ligament?
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Anconeus Muscle
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What degree of supination/pronation and flexion are needed to perform the ADLs?
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50° supination/pronation
30-100° flexion |
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What percentage of compressive forces is distributed to the lateral side of the elbow during throwing?
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60%
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What group is affected by medial epicondylitis?
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Wrist flexors and forearm pronators
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A compressive force to the elbow could lead to:
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Injury (fracture) of the capitellum
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What is the chief mechanism of injury of the elbow?
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Valgus stress with forced extension
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What are the clinical manifestations of Medial Collateral Sprains?
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Medial elbow pain (tenderness over the MCL)
Feeling of instability (+ ligament instability test in valgus direction) Effusion (significant injury, pts will hold elbow at 70°) ROM decreased with painful arc in flexion |
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What needs to be strengthened after a MCL sprain in the elbow?
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Forearm
Wrist flexors and extensors Medial flexor-pronator group |
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Why would surgery be indicated in a MCL sprain in the elbow?
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Acute rupture
Chronic instability Debridement Recurring pain and instability |
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What is medial epicondylitis?
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Tendinitis associated with flexor/pronator tendons
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What are the clinical manifestations of medial epicondylitis?
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Localized pain at the flexion/pronation mass that is exacerbated by flexion and pronation of the wrist
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What is lateral epicondylitis?
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Tendinitis of the extensor carpi radialis brevis and extensor /supinator group
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What are the clinical manifestations of Lateral Epicondylitis?
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35-60 yo (most often an athlete)
Gradual onset of pain with activity (pain over the elbow) Myotogenous radiation down the forearm Coffee cup sign Pain with active and resisted wrist extension and supination and passive wrist flexion with elbow extended |
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Triceps tendinitis manifests as:
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Posterior elbow pain and tenderness at the triceps insertion
Pain with active and resisted extension and passive flexion |
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Biceps tendinitis manifests as:
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Anterior elbow pain and tenderness along the tendon
Swelling and ecchymosis Provoke chief complaint with active and resisted flexion and supination and passive extension and pronation |
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What are the causes of olecranon bursistis?
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Pain at the affected site exacerbated by pressure
Posterior elbow swelling (goose egg), mobile and fluctuates End ROM may be limited due to pain |
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What is the second most common peripheral entrapment neuropathy?
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Cubital tunnel syndrome
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What are the four sites of Ulnar Nerve compression?
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Epicondylar groove
Cubital tunnel Fascia overlying the flexor carpi ulnaris Arcade of Struthers (epicondylar groove) |
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What is the cubital tunnel formed by?
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Fibroosseous canal (medial condyle, ulnar collateral ligament and flexor carpi ulnaris)
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What is the cause of cubital tunnel syndrome?
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Enlargement of the nerve or narrowing of the space that the nerve runs through
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What occupations are at risk for cubital tunnel and why?
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Musicians because of prolonged elbow flexion with movement of finger flexion
Throwing athletes because of stress on the ulnar nerve during wind-up |
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What are the symptoms of cubital tunnel syndrome?
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Medial elbow pain that radiates
Chief complaint exacerbated by elbow flexion, that can cause intermittent paresthesias (cutaneous distribution) Symptoms can wake up patients Sensory changes in the ulnar nerve distribution |
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What are the three phases of Low Back Pain according to Kirkaldy-Willis?
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Dysfunction phase (jt. Hypomobility and disc involvement)
Unstable phase (hypermobiliy-HNP, facet syndrome, stenosis) Stabilization phase (new bone production) |
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What are specific risk factors for Low Back Pain?
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Static work postures
Seated work postures Frequent bending and twisting Lifting, pulling and pushing Vibration Compressive loads Psychosocial factors |
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How is the SI joint classified?
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Anatomically= diarthroidal
Functionally= amphiarthroidial |
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What are the clinical manifestations of SI Joint Pain?
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Localized, diffused or radiating pain
Pain does not go above L5, radiates in the buttocks, Lower Extremity and anterior aspect of the pelvis May have a functional leg length discrepancy Thoracolumbar ROM is decreased, Hip ROM is decreased |
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What is the piriformis innervated by?
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S1, S2 spinal roots
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What are the actions of the piriformis?
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External rotator in erect position
Abductor in supine position Weak hip flexor during walking |
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How is Piriformis syndrome classified?
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Primary (intrinsic pathology)
Secondary (symptoms of posterior buttock pain) |
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What are the clinical manifestations of piriformis syndrome?
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Buttock pain with or without radiation to the posterior thigh
Possible paresthesias into ipsilateral leg, scrotum or labia majora |
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What is the most common diagnosis attributed to lower back pain?
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Lumbar sprain/strain
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What are the clinical manifestations of lumbar sprain/strain?
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Acute onset with activity
Prior LBP Pain may diminish with rest Stiffness Stretch of muscle or ligament will provoke pain Slow, guarded gait with possible antalgia |
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What can help chronic lumbar sprain/strain?
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Rest, heat, analgesics, mild stretching and positions
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Chronic sprain/strain pain is described as:
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Dull ache to severe pain that may radiate but not below the knee
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What is the prognosis of a grade 1 or 2 sprain/strain?
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If addressed appropriately pain will subside within a few days and full ADLs and activities in 2-3 weeks
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What is facet syndrome?
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When the Facet joints support a greater amount of the body’s weight than what is intended (no more than 20% of the body’s weight)
Overriding of the facets of the adjacent vertebrae. IVF becomes narrowed creating lateral canal stenosis |
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Describe the movements of the lumbar spine:
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Axial compression (movement during weight bearing/upright)
Axial distraction Flexion (unfolding or straightening of the lumbar lordosis) Extension Axial rotation Lateral flexion |
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In an unhealthy spine how much weight can the facet joints carry?
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Up to 70% of the load
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What happens to the vertebral body during lumbar flexion?
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Anterior sagittal rotation and forward translantion
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What happens to the vertebral body during lumbar extension?
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Posterior sagittal rotation and small posterior translation
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What happens in axial rotation?
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Torsion of the IVDs and impaction of the facet joints
Maximal amount of rotation without injury is 3° |
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What are the causes of facet syndrome?
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Hyperextension: contact between the SPs leading to periositis (Baastrup’s disease)
Hyperflexion: causes a sprain in the capsule or injures the facets Axial rotation (excessive): fracture of the joint, capsule sprain Pathologic bone disease Postural problems that lead to compression of the joints |
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What is the most common location for facet syndrome in the lower back and what's it due to?
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L5/S1, due to:
Transitional area Joints are more coronal Bears weight of the torso Center of gravity |
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At what age does facet syndrome occur?
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20-50 years
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What are the clinical manifestations of facet syndrome?
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Lower back pain and possible unilateral or bilateral lower extremity symptoms
Acute joint lock Standing, walking, rest helps relieve the symptoms Catching, cramp-like, deep dull achy pain over the joints Pain is difficult to localize and may radiate to the buttocks, posterolateral thigh, groin and rarely goes below the knee (scleratogenous) Stiffness and possible paresthesias |
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What is the scleratogenous pain pattern for L5/S1?
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Possible referral to coccyx, hip, posterior thigh, and along inguinal ligament into the groin
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What is the scleratogenous pain pattern for L4/L5?
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Possible referral to posterior hip and thigh
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What is the scleratogenous pain pattern for L3/L4?
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Possible referral to the thoracic spine, around the flank, groin and anterior thigh
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What part of the annulus fibrosis is innervated?
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The outer third
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Torsion injury of the disc results in:
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No neurological signs
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Compression injury of the disc results in:
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Neurological deficit
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At what age is lumbar disc disease common?
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30-50 years
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In 90% of cases where is the disc herniation?
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L4/L5, L5/S1
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What are the clinical manifestations of herniated discs?
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Back pain with or without leg pain
Peripheralization of the pain: back pain disappears as the leg pain appears Achy dull pain (bulge or protrusion) Sharp, lancinating, shock-like, burning pain (protrusion, extrusion or sequestration) Pain increases with Dejerine’s triad (sneezing, coughing, straining) |
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Where is the disc bulge if the patient is antalgic away from the side of the bulge?
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Posterolateral
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Where is the disc bulge if the patient is antalgic towards the side of the bulge?
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Posteromedial
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If the patient is leaning forward the bulge is?
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Central
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What are the neurological signs seen in disc herniations?
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Sensory changes (dermatomal pattern)
Motor weakness and atrophy (myotomal pattern) Hypo/hyper-reflexia |
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What are the indications for herniated disc surgery?
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Loss of bowel or bladder function
Gross motor weakness Evidence of increasing impairment of nerve conduction Severe sciatic pain after 6 weeks of conservative care |
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What is the normal range of thoracic kyphosis for growing adolescents?
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20-40°
Any kyphosis in the thoracolumbar/lumbar is abnormal |
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What causes most compression fractures in older patients?
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Osteoporosis or Cancer:
35% d/t menopause 30% d/t corticosteroid use 8% hyperthyroidism 2% d/t CA |
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What indicates an unstable compression fracture?
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Collapse of the anterior margin less than ½ the height of the posterior margin
20° of wedging |
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What causes thoracic postural syndrome?
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Imbalance between the anterior and posture muscles of the thorax
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What is scoliosis?
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Lateral deviation of the spine that exceeds 10° (usually combined with a rotary component)
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What is a functional scoliosis?
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The spine maintains flexibility and curve disappears when patient flexes or lays down
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What is functional scoliosis caused by?
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Postural problem
Nerve root irritation Leg length Psychological problem Inflammatory condition Contractures |
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What is a structural scoliosis?
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The curve is present in all positions and motions with limited ROM, rib hump
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What is the most common type of scoliosis?
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Idiopathic (70%)
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Infantile idiopathic scoliosis is associated with:
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Plagiocephaly, bat-ear deformity, congenital muscular torticollis and developmental hip dysplasia
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What is the curve pattern found in infantile idiopathic scoliosis?
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Left convexity
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What is the curve pattern found in juvenile idiopathic scoliosis?
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Right thoracic convexity or double major curve
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What is the curve pattern found in adolescent idiopathic scoliosis?
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Right thoracic convexity
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What are some other causes of structural scoliosis?
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Neuromuscular (neuropathic or myopathic)
Congenital (Spinal, ribs/pelvic) |
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What is considered gold standard for evaluating scoliosis?
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Cobb-Lipman angle
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What are the primary treatment goals when managing scoliosis?
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Stop progression
Control complications Reverse curve |
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If the child has completed growth and has a Risser sign of 4 or 5 then:
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Active treatment is not necessary
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When is immediate bracing required?
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When the curve is 30-40° and the child is still growing
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At what degree is a curve sent out for surgical consult?
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40°+
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How long should bracing be continued?
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Girl: 2 years post menarche and Risser 4
Boy: Risser 5 |
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What are the goals of scoliosis surgery?
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Correct deformity
Stabilize the spine Achieve compensation |
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What is the most common mechanism for rib fracture?
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Blunt trauma
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What are the signs and symptoms of a rib fracture?
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Pain over involved area with increased coughing, breathing and motions of the thorax
Dyspnea and possible visceral involvement |
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What is costochondritis?
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Inflammation of the costochondral or constosternal joints causing pain
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What are the symptoms of costochondritis?
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Insidious onset of pain of the anterior chest exacerbated by deep breathing
Localized sharp, nagging, aching, pressure-like pain |
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What causes intercostals neuritis?
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Muscle spasm
Rib subluxation |
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What are the symptoms of intercostals neuritis?
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Radiation pain following the intercostals nerve
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What muscles are involved in thoracic muscle strain?
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Pec. Major and minor, serratus anterior, and intercostal muscles
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What is DeQuervian’s disease?
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Tenosynovitis of the abductor pollicis longus and the extensor pollicus brevis
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What are the clinical manifestations of DeQuervian’s disease?
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Soreness around the anatomical snuff box
Pain radiates into the forearm and thumb Use of hand becomes painful Tenderness with palpation |
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What is the most common peripheral neuropathy of the upper extremity?
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Carpal tunnel syndrome
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What factors create cumulative trauma that leads to Carpal tunnel syndrome?
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Angle or body position (flex, exten, deviation)
Impact and vibration Static holding Force (on grip or pinch muscles) Repetition Rubber gloves |
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What are early symptoms of Carpal tunnel syndrome?
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Intermittent numbness, tingling and pain in the medial nerve distribution
Wake patient up at night, shake hands to get the feeling back |
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What are intermediate symptoms of carpal tunnel syndrome?
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Hyperesthesia
Clumsiness Loss of dexterity and pinch strength Burning pain worse at night or with activity Mild atrophy and weakness |
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What are the advanced symptoms of carpal tunnel syndrome?
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Severe, long standing carpal tunnel syndrome
Thenar wasting Loss of dexterity and 2-pt discrimination Functional impairment |
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What muscles are assessed when diagnosing carpal tunnel syndrome?
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Adductor pollicis brevis
Flexor pollicis brevis Opponens pollicis |
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How should you splint the wrist in carpal tunnel syndrome?
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At night in the neutral position or 10° dorsiflexion
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What is the tunnel of Guyon Syndrome?
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Entrapment neuropathy of the ulnar nerve in the tunnel of Guyon due to chronic repetitive trauma
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Describe the types of Tunnel of Guyon Syndrome:
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Type 1: mixed sensory and motor ( weakness in all intrinsic muscles innervated by the ulnar, sensory loss 5th and 4th digits)
Type 2: pure motor (weakness in all intrinsic muscles innervated by the ulnar n.) Type 3: pure sensory ( sensory loss in 4th and 5th digits) |
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What causes mallet finger?
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Rupture of the extensor tendon at the DIP due to forcible flexion of the extended DIP joint
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What is trigger finger?
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Finger or thumb gets locked into a flexed position and then snaps into an extended position due to swelling of the flexor tendon (d/t arthritis)
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What is claw hand?
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Ulnar nerve lesion below mid-forearm, 4th and 5th fingers are hyperextened at MP joints, but flexed at interphalangeal joints
Can also be associated with a median nerve injury |
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What is ape hand deformity?
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Median nerve injury that leads to thenar atrophy
Loss of opposition and flexion movements |
