Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Clinical Manifestations Vertebral Column Disorder: Spina Bifida Scoliosis Kyphosis Lordosis Herniation of Intervertebral Discs Manifestations Failure of the two sides of the vertebral arches to fuse; open vertebral canal Abnormal lateral curvature of the vertebral column; involves the right and left sided curvature and rotation of one vertebra upon another Abnormal curvature of the vertebral column in the thoracic region, producing a hunchback deformity Abnormal curvature of the vertebral column in the lumbar region producing a swayback deformity A tear can occur within the annulus fibrosis through which the gelatinous material of the nucleus pulposus can track and eventually impinge upon neural structures Shoulder Joint, Scapular & Pectoral Muscles Injury Site of Injury How does this occur? Associations Misc. Most commonly Clavicle Fracture fractured bone Results in Commonly Shoulder elevation Dislocation of associated with Acromioclavicular separation as and upward Acromioclavicular rupture of the joint a result of subluxation Joint coracoclavicular direct trauma of the ligament clavicle Rare; Dislocation of Dislocation Sternoclavicular Sternoclavicular is typically in joint Joint the ventral direction Deviation of the proximal Fracture of the Distal to the segment Humerus deltoid tuberosity laterally by the deltoid and supraspinatous Junction of the middle and lateral thirds Fracture of the Humerus Proximal to the Deltoid tuberosity Rotator Cuff Occur in violent or repeated abduction above 90 degrees Acute fall on the outstretched hand *Shoulder Dislocation Anterior shoulder (constitute 90% of all shoulder dislocations) Posterior = 10% Traumatic impact on abducted and laterally rotated arm and extended forearm Subacromial Bursitis Subacromial Bursa (located inferior to the Inflammation presents with localized and the distal segment superomedially by the pull of the triceps, biceps and coracobrachialis Deviation of the proximal segment medially (adducted) by the pull of the Pec. Major and Teres major and displacement of the distal segment laterally and superiorly by the pull of the Deltoid Produces rupture of one or more of the Rotator rotator cuff cuff muscles; Pain = tendonitis = limited ability elderly to abduct the arm When the arm is abducted and Initially the laterally rotated dislocated the subscapular humeral muscle moves head upward assumes removing the subglenoid needed position muscular and then it protection from may take the anterior subcoracoid surface of the position joint Associated with supraspinatus tendonitis or acromion) Paralysis of Serratus Anterior Serratus Anterior pain and tenderness upon abduction from 50 to 130 degrees Results in protrusion of the inferior angle of the scapula (WingedScapula) – becomes prominent on protraction tear Axilla and Brachium Site of Injury Anterior Brachium – Biceps Brachii Manifestation Long head may rupture in swimmers and baseball players as a result of tendonitis and when forceful flexion occurs against excessive resistance Antebrachium & Elbow Joint Injury Fracture of Medial Epicondyle of the Humerus Cause Lateral epicondylitis (tennis elbow) Occurs secondary to chronic and repeated flexion; usually follows prolonged rotary motion of the forearm Constant pull on the origin of the extensor muscles Supracondylar Fracture of the Distal End of the Humerus Displacement of the proximal segment is most likely to cause rupture of the brachial artery and injury to the radial and median nerves Valgus angle between distal end of humerus and proximal ends of the radius and ulna Fractures of the Head and Affect Cause damage to the ulnar nerve Inflammation of the origin of the common extensor muscle and occasionally of the extensor carpi radialis brevis; pain is felt over the lateral humeral epicondyle and at the elbow The triceps would pull the distal fragment posteriorly, while the proximal segment would be displaced anteriorly by the biceps brachii and coracobrachialis Occurs as a result of prior trauma Occurs upon a fall on Associated with painful Neck of Radius outstretched hand with forearm flexed and partially pronated Fractures of the Radial Body Radial shaft fractures are nearly always associated with displacement due to muscular pull A fracture line Proximal to the insertion of the pronator teres and distal to the insertion of the biceps brachii The proximal segment supinates and the distal fragment pronates A fracture line distal to the insertion of the pronator teres The proximal segment remains in situ by the contraction of the biceps and pronator quadratus *Colles Fracture Occurs in traumatic fall on an outstretched hand as a result of slipping or tripping Mallet or Baseball Finger Results from hyperflexion of the distal interphalangeal joint and avulsion of the long extensor tendon at its attachment to the base of the distal phalanx DeQuervain’s Tenosynovitis Repetitive use; wringing; Pain over the thumb and wrist; positive Finkelstein’s test supination; severe fractures are frequently accompanied by posterior dislocation of the elbow joint Associate with complete transverse fracture of distal part of radius Distal fragment protrudes proximally and dorsally causing shortening of the lateral part of the hand, giving the appearance of *DINNER FORK DEFORMITY due to the reversed relationship between the distal end of the radius and ulna Ulnar styloid process is usually avulsed Median nerve may be injured Commonly occurs when a finger is jammed against a base pad. Cannot extend the distal interphalangeal joint and the affected finger resembles a mallet Stenosing tenosynovitis of the Abductor Pollicis Longus (APL) and Extensor Pollicis Brevis (EPB) distal to the styloid process of the radius Intersection Syndrome Bursitis “Student’s elbow Subtendinous Olecranon Bursitis Bicipital Bursitis Dislocation of the Elbow Joint Inflammatory Condition - 1st extensor department - APL/EPB - Radial wrist extensors - ECRB/ECRL - Squeakers Syndrome Inflammation of the subcutaneous olecranon bursa. Occurs as a result of trauma to the elbow as a sequel to fall or repeated and sustained excessive pressure Results from friction between the triceps and olecranon subsequent to repeated flexion and extension Occurs between the radial tuberosity and the biceps brachii tendon. Posterior dislocation occurs as a result of hyperextension or direct blow to the elbow joint that forces the ulna posteriorly and the distal end of the humerus anteriorly through the fibrous capsule Pain is pronounced during flexion. Produces pain upon pronation Associated with rupture of the ulnar collateral ligament, fracture of the head of radius, coronoid or olecranon process of the ulna, and ulnar nerve palsy Elbow Dislocation 2nd most common injury; Posterolateral Rotatory Hyperextension LCL complex injury; MCL is often injured Stable in flexion; reduce in extension Pulled Elbow Characterized by subluxation of the radial head through the annular ligament Occurs as a result of sudden jerk on the arm of a child Anatomy of the Hand Injury & Site Cause Scaphoid Fracture A fall on the outstretched hand Wrist sprain as a result of hyperextension injury Effect Swelling and tenderness occur over the anatomic snuffbox; may lead to avascular necrosis because of frequent transection of *Colle’s Fracture – fracture of the distal end of the radius Lunate – rarely fractures; commonly dislocates Hamate *Carpal Tunnel Syndrome Most common neuropathy of the hand Gamekeeper’s Thumb (Skiers Thumb) Jersey Finger Dupuytren’s Contracture (Palmar Fibromatosis) the nutrient artery The fractured distal segment displaces dorsally and the hand assumes Fall on outstretched, DINNER FORK extended and abducted hand appearance; Distal end of the ulna and scaphoid may fracture Dislocated lunate produces Fractures = direct trauma to shortening of the 3rd the adducted wrist metacarpal bone and Dislocation = fall on the paresthesia in the dorsiflexed hand cutaneous area of the median nerve Hamulus of the hamate and pisiform bone forms the canal of Guyon – a common site of ulnar nerve entrapment – HANDLEBAR neuropathy Characterized by A unilateral condition acroparasthesia; nocturnal affecting the dominant pain; atrophy of thenar hand; occurs in pregnancy, muscles; ape-hand heart failure, Colle’s configuration; opposition fracture and thumb abduction are commonly affected Minor tear or rupture of the ulnar collateral ligament of the MCP joint of the thumb; Patient experiences pain Fracture of the base of on the ulnar side of the proximal phalanx due to joint and inability to grip acute radial abduction may also occur The FDP maximally contracts while the finger Closed avulsion of the is forcibly extended by insertion of Flexor acceleration of the Digitorum Profundus (FDP) opposing player; pain and tendon on the 5th or 4th digit inability to flex the DIP joint of the injured finger Characterized by The fifth and fourth digit progressive painless assume flexed positions at thickening of the medial the MP and PIP joints by bands of the palmar the pull of the shortened aponeurosis aponeurotic bands Volkmann’s Ischemic Contracture Fibrosis of the muscles of the forearm as an end result of ischemic necrosis Caused by tight cast at the elbow or tourniquet on the upper arm FDP and FDS muscles are shortened leading to wrist flexion contracture and clawing of the fingers; passive extension of the fingers usually produces pain in the forearm; Pain, swelling, pallor, pulselessness, and paralysis Mallet Finger Deformity that results from rupture of the extensor digital expansion that attaches to the base of the distal phalanx Avulsion fracture of the base of the distal phalanx and dislocation of the DIP joint may occur Chronic case of mallet finger, spasticity and malunion of the fracture of the middle phalanx Drooping of the DIP joint and extensor imbalance in the affected finger: Characterized by hyperextension of the PIP joint, flexion of the metacarpal and DIP joints Swan Neck Deformity Head and Neck Disorder Craniosynostosis Scaphocephaly (abnormally elongated skull) Brachycephaly (abnormally broad skull) Acrocephaly Craniofacial dystosis Trauma to Scalp Bell’s Palsy Dislocation or Hardening of TMJ or Manifestation Premature closure of one or more of the cranial sutures Premature closure of the sagittal suture allows growth of the skull parallel to the sagittal suture Premature closure of the coronal suture Skull that results from premature fusion of the coronal and lambdoid sutures Premature closure of all sutures and is associated with hydrocephalus May cause extravasated blood to enter the loose connective layer and seeps anteriorly toward the orbit and eye producing “black eye” The loose CT layer communicates with emissary veins allowing for a route of spread of infection from the extracranium to the cranial cavity Paralysis of the buccinator muscle leading to accumulation of food between the cheek and teeth This can injure the auricotemporal nerve Fracture Epidural Hematoma Mandibular Nerve Palsy Neck Wounds Torticollis (Wryneck) Exudates posterior to the Prevertebral Fascia *Thoracic Outlet Syndrome and causes pain that radiates to the ear and external acoustic meatus Temporary loss of consciousness; lucid intervals; ICP increase – Papilloedema; uncal herniation; oculomotor nerve palsy (fixed-dilated pupil); acute epidural hematoma exhibits convexity toward the brain in CT scan Deviation of the mandible; atrophy of muscles of mastication; hyporeflexia (Jaw-jerk reflex) Neck wounds require the platysma to be sutured with skin to enhance healing and prevent large scar formation Spasmodic contracture of the SCM that produces twisting of the neck and slanting of the head away from the affected side; results commonly from fibroma pre or postnatally; excessive pull on the head of infant during delivery may damage the SCM and produces torticollis; children with chronic trochlear nerve palsy may develop compensatory torticollis as a result of constant bending of the neck; dystonia involving the cervical muscles also produces torticollis; irritation of the spinal accessory nerve may also produce torticollis Exudates as a result of TB, osteomyelitis, cancer or epidural metastasis may spread to the posterior neck, axilla, and posterior mediastinum, guided by the fascial continuation Could result in pseudotumor, anterior cervical disc herniation, etc. - Constellation of neurovascular manifestations associated with the root of the neck - Occurs in individuals with cervical rib, healed clavicular fracture, abnormalities associated with the insertions of the anterior scalene muscle - Fibrosis at the point of insertion of the anterior scalene can result in compression of the subclavian artery and inferior trunk of the brachial plexus (Scalene anticus *Thoracic Outlet Syndrome syndrome) - 90% of patients primarily present with neurogenic symptoms due to compression of the inferior trunk that include fatigue of the forearm muscles, paresthesia in the medial arm, intermittent or constant neck and shoulder pain. Hand pain is primarily restricted to the medial one and half of the hand - Vascular manifestations include diminished radial pulse, pallor, coolness, and sensitivity to cold temperatures, and ischemic pain - Hyperabduction of the arm may exacerbate the symptoms and diminishes radial pulse - Adson’s test: diminution of radial pulse upon rotation of the head toward the ipsilateral side Anterior Abdominal Wall & Inguinal Region Disorder Appendicitis Portal Hypertension Meckel’s Diverticulum Referred Pain Scarpa’s Fascia Manifestation Initial phase produces pain in the paraumbilical area Paraumbilical veins are distended and commonly associated with liver cirrhosis due to chronic alcoholism Remnant of the vitelline duct Assume the form of a cyst, open canal or fibrous cord Inflammation mimics signs and symptoms of appendicitis Pleural irritation as a result of inflammation of the pleura may cause pain sensation in the anterior abdominal wall Dislocation of the ribs may also produce pain that radiates to the abdomen Periumbilical pain is associated with the initial phase of appendicitis Rupture of the urethra can result in extravasation of blood and urine into the superficial perineal pouch Accumulated blood and urine within this pouch spread into the anterior abdominal wall guided by the Conjoint Tendon Processus Vaginalis Cryptorchidism ***Hernia Umbilical Hernia Omphalocele Inguinal Hernia Indirect Inguinal Hernia continuation of Colle’s fascia with the Scarpa’s fascia Attaches to the pubic crest posterior to the superficial inguinal ring, providing a natural barrier that prevents the occurrence of inguinal hernias Failure of the processus vaginalis to close allows part of a viscera to protrude through the deep inguinal ring and follow the course of the inguinal canal to the superficial inguinal ring, producing INDIRECT inguinal hernia Maldescent of the testis; assume abdominal, inguinal, femoral and perineal testis Refers to protrusion of viscera or part of viscera through a weak area which normally does not traverse Herniation may occur through the inguinal canal, lumbar trigone, femoral canal, or the umbilicus or as a postsurgical complication Protrusion of the herniated sac through the umbilicus Physiologic herniation that occurs around the 6th week of development Involves herniation of intestine that returns into the abdominal cavity around the 10th week Retention of the herniated intestine beyond the 10th week leads to the formation of omphalocele Refers to protrusion of a viscera or part of a viscera from the superficial inguinal ring• Indirect inguinal hernia denotes a hernial sac that follows the entire course of the inguinal canal from the deep inguinal ring to the superficial inguinal ring Direct Inguinal hernia or it passes only through the superficial inguinal ring without pursuing the hernia Indirect inguinal hernial sac Protrudes through the area lateral to Direct Inguinal Hernia Direct Inguinal Hernia Femoral Hernia the inferior epigastric vessels and descends to the scrotum in the male and major labium in the female Indirect inguinal hernia is common in all ages and both sexes Hernial sac Passes through the superficial inguinal ring only May pass medial, lateral to or through the conjoint tendon Hernial sac that pierces the conjoint tendon will be covered by the peritoneum as well as the conjoint tendon Direct inguinal hernia occurs through Hesselbach's (inguinal) triangle, which is bounded medially by the rectus abdominis, laterally by the inferior epigastric vessels, and inferiorly by the inguinal ligament Direct inguinal hernia is less common than indirect inguinal hernia, usually affecting men over age 40, and is rare in women Hernial sac rarely extends to the scrotum and generally protrudes anteriorly Protrudes inferior to the pubic tubercle through the space between the lacunar ligament and the femoral vein Pubic tubercle acts as a bony landmark between the site of inguinal and femoral hernia Femoral hernias are more common in females due to the shape of the pelvis Gluteal Region & Posterior Thigh Disorder/Injury Head of Femur (Neck Fracture Coxa Vara Coxa Vulga Manifestation Prone to avascular necrosis when the subcapital femoral neck fracture occurs (90-110 degrees): Occurs in adduction injuries, Slipping of the epiphysis & osteomalacia (150-160 degrees): occurs abduction Femoral Neck Fractures Fractures of the Femoral Body: Proximal Fracture Fractures of the Femoral Body: Middle Third Femoral Fracture Fractures of the Femoral Body: Distal Third Anterior Hip Dislocation fractures Advanced age, Osteoporosis and Impaction fractures Subcapital fracture-IntracapsularTranscervical (Mid neck) -capsular arteries Both types are associated with delayed healing and subsequent avascular necrosis Distal segment overrides the proximal segment- leads to shortening of the lower extremity Trochanteric/ Intertrochanteric Fractures occur in direct traumaFavorable outcome 1. Upper segment is abducted (lesser gluteals), Flexed (iliopsoas) and laterally rotated (gluteus maximus, piriformis, obturator internus, gemelli & quadratus femoris) 2. Lower segment move medially by the action of the adductors Associated with shortening of the limb - Proximal segment displaces laterally and anteriorly by gluteus maximus and medius as well as the quadriceps femoris - Distal segment is pulled medially and posteriorly by the action of the gastrocnemius Fracture of the distal third is rare. 1. Proximal segment moves medial and anterior to the distal segment by the pull of the adductors and quadriceps 2. Distal segment displaces posteriorly by the gastrocnemius; may injure the popliteal artery Femoral head dislocations are fairly uncommon Anterior dislocation forms 10-15% of hip dislocations. Usually associated with acetabular fracture subsequent to trauma In anterior dislocation the femoral Posterior Hip Dislocation Gluteus Maximus Palsy Ischial Bursitis (Weaver’s Buttock) Trochanteric Bursitis Lesser Gluteal Muscles Palsy Pulled Hamstrings Pes Anserine Bursitis (site of Pes anserinus muscles) head dislocates medial to the Iliofemoral ligament, and moves close to the Obturator foramen, inferior to the pubis Occurs when the thigh is adducted and flexed and medially rotated- tear in the acetabular labrum and Ligamentum teres femoris; Femoral head rests upon the ischium • Loss of thigh extension • Inability to climb stairs • Atrophy of the Gluteus maximus • Loss of contour of the buttock Inflammation of the ischial bursa between the ischial tuberosity and gluteus maximus Occurs as a result of prolonged sitting on hard surface Inflammation of the bursa between the greater trochanter and the gluteus maximus Occurs as a result of repetitive contraction of the gluteus maximus: Climbing stairs or running on a elevated treadmill Refers to paralysis of the Gluteus Medius and Minimus Results in tilting of the pelvis toward the unsupported side when the foot is off the ground during walking (Positive Trendelenburg Sign) Tearing or avulsion of the hamstrings from the ischial tuberosity, and is associated hematoma Incidence of pes anserine bursitis is higher among obese middle-aged women. This prevalence of women may be because of the broader female pelvis and greater angulation of the leg at the knee, placing additional stresses on these structures Anterolateral Leg & Knee Joint Disorder/Injury Osgood-Schlatter Disease Manifestation Tibia could be the site of OsgoodSchlatter disease that affects age (10- Fractures of the Tibia Fractures of the Tibia March Fractures (Tibia Fracture) Bumper Fractures Spiral Fracture Neck of Fibula Potts Fracture Osteochondritis Patella Genu Valgum Genu Varum 15) due excessive pull of the patellar ligament on the tibial epiphysis Fractures that involve the nutrient canal compromise union of the fractured fragments Fractures and rickets commonly occur at the narrowest area of the tibial body (junction of middle and lower 1/3) Long walk; sudden turning of the body when the foot is fixed Direct trauma; anterior or posterior fall can also cause tibial fracture Severe torsion during skiing and impact of ski boots applied to the tibia Prone to fracture; encircled by the common peroneal nerve Distal third of the shaft of fibula is most likely to fracture as a result of slipping while the foot is rigidly held in everted position, the tibia is internally rotated and the talus is pressed against the fibula Osteochondritis occurs frequently, roughens the articular surface and produce pain. Fragments may cast off into the joint cavity, leading to painful internal derangement that locks the knee (inability to fully extend the knee) Patellar fractures- usually simple transverse type Patellar dislocation-uncommon (knock knee): less common, may occur as a result of: 1. abnormal down growth of the medial femoral diaphysis. Self correct by the age of 9 year 2. complication of poliomyelitis or Rickets In this condition the foot is laterally deviated, everted and flattened (talipes valgus) (bow-leg) occurs in toddlers and is self correcting. Persistence of the condition is seen in tibial Bakers Cyst or Popliteal Cyst Tibial (Medial) Collateral Ligament Fibular (Lateral) Collateral Ligament Anterior Cruciate Ligament Posterior Cruciate Ligament Medial Mensicus Lateral Meniscus Tibialis Anterior Overuse Anterior Compartment Syndrome Peroneus (Fibularis Longus) osteochondrosis. Rickets should be ruled out Herniation and synovial effusion seen in rheumatoid or degenerative disease Ruptures when violent abduction strain is applied Tears occur in violent adduction force applied to the extended knee Complete tear may endanger the common peroneal nerve Torn by violent hyperextension of the knee, anterior dislocation of the tibia on femur or posterior dislocation of femur on the tibia Tears when the tibia dislocates posteriorly on the femur with the knee flexed Ruptures in conjunction with the tibial collateral and the anterior cruciate ligament (unhappy triad) when the flexed knee is forcible abducted and externally rotated It may be torn by a severe strain that involves adduction and internal rotation Overuse produces shin splints An acute increase in pressure in the anterior compartment of the leg Bleeding or edema in this compartment causes severe ischemic changes to muscles, and compression of the nerves and blood vessels Patients exhibit pain, pallor in the anterior leg Diminished or complete loss of pedal pulse Treatment- Fasciotomy Torn in forceful and sudden inversion Posterior Leg Disorder/Injury Injury to the Common Fibular (peroneal) nerve Manifestation Paralysis of all muscles in the anterior and lateral compartments Foot-drop High stepping gait Foot & Ankle Joint Disorder/Injury Manifestation Lateral Collateral Ligament Anterior talofibular ligament Posterior talofibular ligament Calcaneofibular ligament Ankle Sprain Eversion sprains (Potts fracture) Talus Fracture Calcaneous Fracture Cuboid & Cuneiform Metatarsals: Limits inversion and plantar flexion Commonly injured ligament weakest, prone to rupture in ankle inversion when the foot is plantar flexed strongest, resists anterior displacement of fibula; avulsed in dislocation can be torn in severe sprains, lateral ankle disability occurs when concomitant tear involves the calcaneofibular and the anterior talofibular ligaments Sprains of ankle are the most common trauma affecting the ankle joint Tear of a ligament with a concomitant fracture is known as a sprain fracture Most sprains are of inversion type with a concomitant tear of the lateral collateral ligament (calcaneofibular and anterior talofibular ligaments) Eversion sprains with a possible tear or avulsion of the medial collateral (deltoid) ligament may be associated with pull off the medial malleolus and fracture of the distal end of the fibula as a result of downward and lateral displacement of the talus against the lateral malleolus (Pott’s fracture) Fractures of the talus occur in violent dorsiflexion of the foot against the anterior edge of the distal tibia Body fractures occur as a result of jumping from height Falls from height drives the talus downward against the calcaneus and produce calcaneal compression fractures Skin over the posterior surface of the calcaneus is a common site of decubiti Fractures of the cuboid and cuneiforms seldom occur because of their protected position Fatigue (stress, march) fractures in 5th metatarsal more prone to fracture Phalanges Metatarsophalangeal joints Tarsal Joints Hallux Valgus Pes Planus (flat-foot) Pes Cavus (claw foot) the metatarsals occur in young adults unaccustomed to vigorous physical activity and are radiographically invisible until healing calus appears Phalangeal fractures are very common and usually results from violent crushing or stubbing injuries First metatarsophalangeal joint is commonly affected in gout Restricted movement of the second metatarsal bone at the MP joint makes it prone to stress (fatigue) fractures in strenuous activities Mid (transverse) tarsal joint- consists of the talocalcaneonavicular and calcaneocuboid, allows inversion and eversion- subject to torsion injuries Talocalcaneonavicular Joint supported by the plantar calcaneonavicular (spring) ligamen Refers to lateral deviation and deformation of the great toe at the MP Joint and is associated with: 1. Short first metatarsal bone 2. Ill-fitting pointed shoes 3. aggravated by the pull of the flexor and extensor hallucis longus muscle 1. Depressed or collapsed longitudinal arch 2. Talus shifts medially between the calcaneus and navicular bones 3. Supporting ligaments and muscles are permanently stretched occurs as a result of muscle imbalance, e.g. secondary to poliomyelitis