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Dysmorphology

Back

QuestionAnswer
How many vertebrae are there? 33
How many cervical spine vertebrae are there? 7
How many thoracic vertebrae are there? 12
How many lumber? 5
How many sacral? 5
Vertebral anatomy 1. Spinous Process 2. Transverse processes 3. Foramina 4. Body (Cancellous/spongy bone and cortical rim)
What do the three foramina do? 2 on side are for nerves and the large on in the middle if for the spinal cord
What is the largest vertebrae? C7
Where does the spinal cord exit the brain? At the foramen magnum at the base of the skull
Where does the spinal cord end? At the conus medullaris (L3 in child and L1-L2 in adult
What lay between the vertebrae? The cartilaginous disks
External landmarks of the back 1. Spinous processes 2. Scapulae 3. Iliac crests 4. Sacrum 5. Coccyx
Examination technique- Inspection 1. General configuration 2. Symmetry 3. Depressions, hair at midline, sacrum 4. Changes in skin texture, pigmentation 5. Curvature of the spine
Curvature of the spine: Kyphosis Convex, normal is 30 degrees to 50 degrees
Curvature of the spine: Lordosis concave curvature
Curvature of the spine: Scoliosis Lateral curvature
Postural kyphosis Usually presents in adolescence
Schuermann kyphosis Usually presents in adolescence - Often familial -abn. growth of vertebrae - "wedge-shaped" -One side grows faster than the otther
Congenital kyphosis Malformation of vertebrae
Paralytic disorders associated with kyphosis MD, CP, etc.
Lordosis is often caused by... 1. Achondroplasia 2. Benign 3. Spondylolisthesis (misalignment of the lumbar vertebrae, congenital (rare)
Scoliosis 1. uneven shoulders and hips 2. unilateral rib hump 3. infantile scoliosos is a deformation caused neurologic DOs
Examination techniques- Palpation For dimples, depressions of the spinal processes and sacrum
Minor variants/anomalies of the back 1. Sacral dimples 2. Pigmentation 3.
Sacral dimples 1. 2-3% of all newborns 2. Blind 3. Usually midline 4. Must be differentitated from spinal dysraphism
Minor anomaly: pigmentation (Nevi, Mongolian spots, hematomas) -"Stork bites" "angel kisses" etc. -Evaluated for tethered cord, spina bifida occulta
Dysplasias of the back 1. Gibbus 2. Platyspongyly 3. Winged scapulas
Malformations of the back 1. Scoliosis 2. Scapular abnormalities 3. Hypoplastic scapulas 4. Pilonidal dimple/sinus/cysts 5. Arnold-Chiari malformation 6. Midline masses 7. Spinal dysraphism
Minor variants/anomalies -Relative trunk length: height- Normal lumbar lordosis of toddlerhood- bifid spinous process-Sacral dimples and others mentioned above
Disruptions None
Deformations of the back 1. Scoliosis
Deformation scoliosis is due to severe intrauterine constraint
Other deformations that present with scoliosis are (Joint contractures)... Arthogryopsis multiplex congenital
What is a gibbus? -Dysplasia- Severe kyphosis; humpback; curvature is not smooth
What is polyspondyly? -Dysplasia-Flattening of vertebral body> shortened trunk
When does a Gibbus occur? (syndrome) -Hunter syndrome
When does platyspondyly occur? OI, MPS, skeletal dysplasias
What syndromes are associated with winged scapulas? Muscular dystrophy, cleidocranial dysplasia, EDS
Describe scapular abnormalities 1. Malformations2. Sprengel sequence3. Failure of normal scapula descent; hypoplastic
Scapular abnormalities are typically seen in what syndrome? Klippel-Feil
What syndrome is hypoplastic scapulas (chondrodystrophies) typically seen in? Campomelic dysplasia
Describe Pilonidal dimple/sinus/cyst - Malformation of the back- Found in natal cleft- Often have hair, may drain fluid- Evaluate for tethered cord(1)Caudal end of spinal cord attached to bone by connective tissue (2) As spine grows, cord is stretched downward
Arnold-Chiari malformations -Can be caused by tethered cord-Herniation of the cerebellum through the foramen magnum- Symptoms range from none to obstructive hydrocephalus
2 types of midline masses (malformations) (1) lipomas (2) sacrococcygeal teratoma
Lipomas (1) can be irregulary shaped (2) move with the skin, firm (3) benign, fat cells (4) may signifiy underlying spina bifida(5) may extend into the spinal cord
Sacrococcygeal teratoma (1) most common newborn tumor (2) 1:35,000-40,000 LBs (3) composed of many types of cells
4 Types of spinal dysraphism (malformation) (1) SB occulta (2) meningocele (3)myelomeingocele (4)Spinal rachischisis
Spina Bifida occulta -Mildest form of Spinal dysraphism-Usually no clinical signs-Sometimes marked by lipomas, hemangioma, hairy patch
Meningocele -Spinal membrance protrude through spinal canal-Usually lower lumbar or sacral-Usually no neurological sequelae
Myelomenigocele -Most serious form of spina bifida-Spinal cord and meninges protrude-Problems with movement and sensation below the level of the defect
Spinal rachischisis -Failure of fusion of a large part of neural tube-Incompatible with life-Most common in thoracic region-Anencephaly/inencephaly
Created by: KChatham
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