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MSK Disorders

Terms in this set (108)

chordoma
rare malignant tumor- occurs when remnants of notochord persist, may infiltrate bone, occur most frequently at base of skull
spina bifida occulta
most benign form, no bulge over bony defect and no neurological defects,often associated with patch of hair or skin dimple
spina bifida cystica with meningocele
bulge seen over defect that contains meninges and CSF in subarachnoid space
spina bifida cystica with meningomyelocele
bulge seen over defect that contains meninges, cord, and nerves
spina bifida myeloschisis
most severe form, skin and bony defect with "open" spinal cord, seen as mass of neural tissue, due to caudal neuropore not closing and no skin forming, toxic amniotic fluid can enter and degenerate nervous tissue
meroencephaly
failure of rostral neuropore to close, absence of large part of brain and skull, either miscarriage or do not live longer than a few days
kyphosis
hunchback, abnormal increase in curvature of thoracic spine, vertebral column curves outwards (posteriorly), can lead to compression of spinal nerves, can be secondary condition of tuberculosis (gibbous deformity)
lordosis
abnormal lumbar curvature
scoliosis
common in young adults, abnormal lateral curvature of spine accompanied by rotation of vertebrae, can be secondary condition of muscular dystrophy and polio
herpes zoster (shingles)
can chill in the dorsal root ganglia and wake up under immunocompromisation, it then travels across nerves and usually affects area around a single dermatome spreading a little above and below
ancephaly
failure to close rostral neuropore, incomplete brain
odontoid fracture type I
rare, potentially unstable, just the tip
odontoid fracture type II
most common, occurs at dens with body of axis, unstable because transverse ligament of atlas can become interposed between fragments leading to lack of blood supply and avascular necrosis
odontoid fracture type III
usually stable
Hangman's fracture
caused by hyperextension of the neck, inferior articular process or axis on the pars interarticularis, spondylolysis of C2
hyperextension injury
can result in tearing of anterior longitudinal ligament
hyperflexion injury
can result in tearing of posterior longitudinal ligament
Jefferson fracture
burst of C1 (atlas) caused by compression, can result in spinal cord injury if transverse ligament is affected
wedge/compression fracture
fracture occurring anteriorly or laterally resulting in wedge shape of vertebrae, commonly found in thoracic spine, usually stable
chance fracture
transverse fracture through vertebrae, usually around T12-L2, usually caused by sudden forward flexion
burst fracture
vertebral body seriously compressed, usually occur with great deal of force
spondylolysis
fracture of pars interarticularis
spondylolisthesis
anterior slippage of vertebrae
spinal stenosis
narrowing of spinal canal
herniated disc
rupture of annulus fibrosis causes leakage of nucleus pulpous usually posterior laterally causing impinging of spinal nerves
back pain producers
facet joints, nerve root, ventral dural sheath, annulus fibrosis, posterior longitudinal ligament, muscles
hand of benediction
caused by medial nerve issues, lateral three fingers cannot contract
carpal tunnel
caused by pressure on the median nerve through the carpal tunnel, can be due to overuse or rheumatoid arthritis
contains: 4 tendons flexor digitorum profundus, 4 tendons flexor digit superficialis, tendon flexor pollicis longus
border: flexor retinaculum on top, carpal bone on the bottom

TESTS- further compress carpal tunnel to see if pain arises
Tinel's sign- tap on flexor retinaculum
Phalen's test- put back of hands together with fingers down
Erb Duchenne palsy
caused by upper trunk lesions (damage to upper brachial plexus C5-C6), obstetrical trauma or fall onto shoulder
Klumpke's palsy
caused by lower trunk lesions (damage to lower brachial plexus C8-T1), obstetrical injury (pull out by arms) or reaching for tree branch
claw hand
causes by ulnar nerve issues, medial two fingers cannot contract
Saturday Night Palsy (wrist drop)
caused by issues with radial nerve
Pacemaker insertion
cephalic vein
goes to: axillary, subclavian, brachiocephalic, superior vena cava, right atrium
Nursemaid's elbow
radial head slips from annular ligament, occurs commonly in young children
surgical neck fracture
affects axillary nerve, puts deltoid and teres minor muscle in danger, can also affect posterior circumflex artery
mid shaft humerus fracture (spiral groove, posterior)
radial nerve, extensors can be affected, leads to wrist drop
supracondylar fracture
median nerve, flexors can be affected, brachial artery
medial epicondyle fracture
ulnar nerve, paralysis of FCU (hand deviates laterally), cannot flex ring and little fingers at PIP and MCP, claw hand, sensory loss on palmar and dorsal little and ring fingers
golfer's elbow
medial epicondyle, flexor tendonitis
tennis elbow
lateral epicondyle, extensor tendonitis
Horner's syndrome
caused by issues in sympathetic nervous pathway, characterized by: constricted pupils, sunken eyes, drooping eyelid (ptosis), dry skin
sacrococcygeal teratoma
persistence of the primitive streak in the caudal end of the embryo, tumor can be filled with derivatives of all three germ layers (hair, teeth, muscle), more common in females
Petit's hernia
issues with triangle of petit, borders: iliac crest, lat dorsi, external obliques
Smith's fracture
fall on flexed wrist- fracture on distal radius with anterior displacement of distal fragment- often displaces the lunate bone
Colle's fracture
fall on extended hand fracture of distal radius with posterior displacement of distal fragment
scaphoid fracture
most common fracture of metacarpal bones, in floor of anatomical snuff box- can injure radial artery- issues can include non union and avascular necrosis
Dupuytren's contracture
flexion contracture of hand, thickening and contraction of palmar aponeurosis, nodule formation, unable to extend fingers
trigger finger (stenosing tenosynovitis)
fibrosis and tightening of tendon sheath at level of metocarpophalageal joint, inflammation and nodule formation in flexor tendons, nodules make it difficult for tendon to move thus excessive force is required to flex
shoulder separation
either or both the acromioclavicular and coracoclavicular ligaments can be torn, the acromioclavicular joint can be interrupted causing clavicle to deviate upward
shoulder dislocation
head of humerus displaced antero-inferiorly, on examination there is "squaring" of the shoulder due to flattened deltoid muscle, closing of quadrangular space so axillary nerve and posterior humeral circumflex artery can be damaged
mid shaft fracture clavicle
can be associated with pneumothorax and damage to the subclavian vein and artery
Volkmann's ischemic contracture
consequence of supracondylar fracture, injury to brachial artery leads to ischemic flexor contracture of muscles in anterior compartment
Froment's test
test for ulnar nerve injury, grip piece of paper, patient cannot hold on to paper with adductor pollicis muscle so much hold on by flexing
fracture hook of hamate
can injure ulnar nerve and artery in Guyon's canal
Allen test
test for radio-ulnar collateral circulation
Lambert-Eaton
auto-immune disease against presynaptic Ca2+ channels, reduces release of ACh causing paralysis, can be unmasked by widespread paralysis after using Botox
myasthenia-gravis
auto-immune disease against Nm receptors causing receptor internalization and reduced transmission at the NMJ
Guillain-Barre
demyelinating auto-immune disease in PNS, nerve cells have large accumulation of lymphocytes, macrophages, and plasma cells, leads to loss of muscle coordination and cutaneous sensation
multiple sclerosis
demyelinating auto-immune disease in CNS, myelin is detached from axon and destroyed as oligodendrocytes are damaged, three stages
1. myelin breakdown associated with lymphocytes and macrophages in affected area lead to plaque
2. astrocytes proliferate
3. there is a reduced cellularity and astrocytes reduce in size
gastroschisis
failure of abdominal wall to close during embryonic development, end up with internal organs outside the body, main concern is heat loss
direct and indirect inguinal hernia
pass ABOVE inguinal ligament

direct- passes through superficial ring, does not pass through deep ring, MEDIAL to inferior epigastric vessels

indirect- passes through superficial and deep ring, LATERAL to inferior epigastric vessels, most hernia in females, can be congenital
diaphragmatic hernias
sliding: esophagus and portion of stomach slides through hiatus and moves back and forth, mostly asymptomatic

paraesophogeal: bad one, part of stomach herniates through hiatus alongside esophagus, pain and gastric reflux are common
thoracic outlet syndrome
can be caused by extra cervical rib, causes issues in lower brachial plexus (specifically T1), numbness fourth fifth digit and problem firing gun overhead or holding luggage
pleurisy
inflammation of the pleura, can lead to sharp pain during inspiration, pleural friction sounds can be heard
thoracentesis
removes fluid from the pleural space, needle placed slightly upwards superior to rib 10 to get into 9th intercostal space during expiration from the side (midaxillary), rib 6-8 from the front (midclavicular), rib 10-12 from the back (parasternal)
McBurney's point
dissection line 2/3 between point from umbilicus to anterior superior iliac spine, overlies base of appendix, muscle fibers are separated from each other NOT cut, avoid ilioinguinal and iliohypogastric nerve
AP compression diastasis
pubic symphysis and sacroiliac joint widened, "open book", sacrotuberous and sacrospinal ligaments can also be torn, can result from a head-on car accident
lateral compression injury
can disrupt iliopectinal and ilioischial lines, buckle fracture on sacrum, result of side impact
vertical shear injury
fall from height onto your feet, force directed inferior to superior, force can drive one or both hemipelvis upwards, disrupts the SI joint, the sacrospinous and sacrotuberous ligaments and the pubic symphysis, if SI joint is not disrupted there will be a vertical fracture through the wing of the ilium
Trendelenburg sign
if superior gluteal nerve is damaged gluteus minimus and medius cannot work properly to abduct the pelvis to the supported side leading to a "lengthening" of the unsupported side and a waddling gait
intra-capsular femur fracture
can damage retinacular arteries leading to avascular necrosis, results in external rotation of leg with shortening, acquired coxa vara, common in older individuals
extra-capsular femur fracture
does not pose damage to arteries, results in external rotation of leg with shortening, acquired coxa vara, common in older individuals
femoral hernia
passes through femoral ring, BELOW inguinal ligament
rickets
Vitamin D deficiency leads to impaired calcium absorption and bones cannot ossify properly, pressure on weak bones leads to bowed legs and curved bones as well as lump joints
achondroplasia
auto dominant, defect in FGFR3, epiphyses fuse prematurely
syndactyly
failure of formation of notches between digital rays, cutaneous- webbing between digits
osseous- fusion of bones between digits
polydactyly
extra digits, result of disruption of anterior-posterior pattern
club foot
foot is turned medially and inverted
amelia and meromelia
absence or partial absence of limbs, suppression of either the limb bud development in the 4th week or growth in 5th week
cleft hand and foot (ectrodactyly)
absence of one or more central digits, result of the failure of development of digital rays
amniotic band syndrome
tears in the amnion create bands that may encircle fetal limbs and digits leading to issues
VACTERL syndrome
vertebral defects, anal atresia, cardiac defects, trachea-esophogeal fistula, renal anomalies, limb abnormalities
hip dislocation
usually posterior as ischiofemoral ligament is the weakest, can injure the sciatic nerve and gluteal vessels, limb is adducted, internally rotated and flexed at the knee
unhappy triad
lateral pressure on the knee, can lead to tearing of medial (tibial) collateral ligament, ACL, and medial/lateral meniscus
tibial plateau fracture
can injure the collateral ligaments and meniscus
cruciate ligament tear
posterior: patient has issues walking downhill
anterior: patient has issues walking uphill

can use anterior/posterior drawer test
Baker's cyst
collection of synovial fluid forms sac in popliteal space
compartment syndrome
build up of tissue pressure (can be caused by tibial fracture) can cause issues with neurovasculature- 6 Ps (pain, parasthesia, pallor, paresis, pulselessness, cold)- check distal pulse from either the dorsalis pedus medially or the posterior tibial laterally
compartment syndrome
can be caused by tibial fracture, tissue pressure causes issues with neurovasculature and surgery is required to release
6Ps (pain, paresthesias, pallor, paresis, pulselessness, cold)
check via dorsalis pedis pulse (anteriorly lateral to extensor hallicus, medial to extensor digitorum) or posterior tibial (posteriorly to medial malleolus)
deep vein thrombosis/pulmonary embolism
swollen leg that may be accompanied with shortness of breath- Virchow's Triad (stasis, hyper coagulability, endovascular injury)
varicose veins
caused when perforating branch valves are not effective and cause flow of blood from deep to superficial veins leading to engorgement
fibular neck fracture
can cause issues with common fibular nerve (leads to deep and superficial fibular nerve)- can lead to issues with dorsiflexion, eversion, and loss of sensation on dorsum of the foot as well as a high-stepping gait
medial malleolus fracture
can cause issues with tibial nerve (gives off medial and plantar nerves) and tibial artery
inversion injury
stress lateral ligaments (posterior and anterior talofibular and calcaneofibular), can tear off tip of lateral malleolus, can cause shearing force on medial malleolus
eversion injury
stress medial ligaments (deltoid- anterior and posterior tibiotalar, tibiocalcaneal, tibionavicular) and medial malleolus
hypercalcemia
can be caused by excessive PTH production, hypervitaminosis, excessive calcium intake
osteoarthritis
joint surface wears away and stimulate joint lining to produce fluid, causing the knee to swell, the articular cartilage eventually wears away and the bones become exposed
osteoporosis
critical lose of bone mass associated with either GH deficiency (senile) or estrogen deficiency (post menopausal), lack of estrogen leads to upsurge of IL-1 which stimulates osteoclasts that chew bone
duchenne muscular dystrophy
muscle cells get replaced by adipose tissue
mitochondrial myopathy
symptoms can include muscle weakness, heart failure, dementia. movement disorders, stroke-like episodes, deafness, blindness, droopy eyelids, one case involves ragged red fibers- skeletal muscle fibers are affected by sub sarcolemmal aggregates of mitochondria
bronchial asthma
during attacks smooth muscle spasms (smooth muscle thickening via hypertrophy and hyperplasia) and excessive mucus secretion can close off airways
Zellweger syndrome
peroxisomal storage disease, peroxisomes are the place where plasmalogen (most abundant phospholipid in myelin) is formed
Hirschsprung's disease
MEGACOLON, faulty migration of neural crest cells leads to lack of myenteric plexus and decreased peristaltic movements of the gut
astrocytoma
in CNS damage, astrocytes proliferate to form scar tissue that is characterized by presence of glial fibrillary acidic protein (GFAP), cause of 80% of brain tumors
Vitamin D resistant rickets
defect in 1,25-(OH)2 D (calcitriol) receptor on intestines, symptoms are the same as regular rickets
pneumothorax
air enters pleural cavity and causes the lung to collapse in the chest

tension: gas accumulates and mediastinum is pushed to the other side, compromising the other lung- requires surgical treatment ASAP
flail chest
break multiple ribs, patient showed slow labored breathing, usually from motor vehicle accident
osteomalacia
softening of bones due to Vitamin D or calcium deficiency
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