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Bone and Joint Final
| Question | Answer |
|---|---|
| Who's predisposed to infections>? | immunocompromised, alcoholics, newborns, intravenous drug users, diabetics, hemodialysis, post-surgery |
| What organisms can cause acute suppurative osteomyelitis? | Staph aureus (90%), e. coli, H. influenzae, Klebsiella, Strept B |
| What is the MC way of spread of acute suppurative osteomyelitis? | hematogenous |
| What are 4 ways in which acute suppurative osteomyelitis is spread? | hematogenous, contiguous source, direct implantation, postoperative. |
| What is the mc age group of acute suppurative osteomyelitis? | 2-12 years |
| what are early signs of acute suppurative osteomyelitis? | soft tis swelling, bone destruction, periosteal rxn |
| opening from the soft tissues to the hollow viscerals or outside the skin | sinus tract |
| periosteal new bone formation in osteomyelitis? | involucrum |
| discitis in child, first site of involvment vs adult? | child: disc first, adult: Anterior vert endplate, then vert destruction and secondary disc involvement |
| in osteomyelitis disc invovlement is..... (if in spine) | early |
| in TB disc involvement is..... | late |
| what are the TXs of suppurative osteomyelitis? and prognosis? | antibiotics, brace, surgical debridement late. Prognosis good if dxed early |
| what is a localized aborted form of suppurative osteomyeltiis? | brodies abcess |
| biopsy of brodies abcess may be..? | sterile |
| mc bone affected by brodies abcess? | tibia |
| location of brodies abcess usually? | metaphysis of tubular bones, can cross physis!!! |
| septic arthritis affects ____ joint | single |
| What are the Mc areas of septic arthritis? | hip and knee |
| what are imaging findings of septic arhtritis? | joint effusion which distorts fat pads, rapid loss of joint space, loss of subchondral white bone, motheaten bone destruction, later is boneeyyyy anklyosis |
| What does waldenstroms sign indicate? | intracapsular effusion with infection, LCP, SCFE, Chandlers. |
| What are the measurements of waldenstroms sign? | > 11 mm, or >2 mm difference from side to side |
| other findings of septic arthritis post fist fight//human bite injury | joint space narrowing, periarticular osteopenia, periostitis |
| Where are the areas that undergo septic arthritis d/t pseudomonas in iv drug users? | S JOINTS: spine, si, symphysis, sc, acromioclav |
| What is Marjolins ulcer? | malig degeneration of chronic osteomyelitis into squamous cell carcinoma within the cloaca. |
| What is seen with chronic osteomyelitis? | sclerosis, cortical thickening, periosteal new bone formation, osseous destruction, sequestrum, malig degen |
| What can chronic osteomyeltisis become with malig degen? | fibroscarcoma, squamous cell carc (marjolins ulcer) |
| in what condition might you see gas gangrene? | diabetic osteomyeltisi |
| primary stage tb? | infects lungs, leads to granulomatous rxn, may stay silent for rest of pts life. |
| secondary (post-primary) stg tb? | reactivation of the organism, spreads to other organs and bones via blood |
| what age is skeletal TB mc? | 2-30 |
| skeletal tb is rare in? | first year of life |
| what are sx of skel tb | insidious onset of pain, decreased rom, focal tenderness |
| 50% of tb goes to? | the spine, tuberculous spondylitis, Potts dz |
| where is mc location of tb in the spine? | most common @ L1 - lower t-spine and upper l-spine |
| what is potts paraplegia? | rare, collapse of multi vertebra with tb infection which leads to growth of granulation tissue which narrows spinal canal. |
| what are early imagining findings of tb? | disc space loss, anterior vert body destruction, subligamentous spread |
| what are late potts findings? | pathologic vert collapse, angular kyphosis (gibbus), retropharyngeal, paravert, psoas calcified abcesses. |
| TB can end with ____ ankylosis | fibrous ( septic arthritis is boney) |
| What is Phemisters triad? | With TB: progessive and slow joint space narrowing, juxta-artic osteoporosis, periph erosions of the articular surfaces |
| What is spina ventosa? | AKA tuberculous dactylitis, d/t TB..... diaphyseal expansile lesion in hands and feet. |
| what is potts puffy tumor? | TB of skull (frontal bone) with scalp abcess |
| what is weavers bottom? | TB - subgluteal infective bursitis with direct extension to the ischium ... located on isch tube. |
| I say H vertebra and osteonecrosis and you say? | sickle cell anemia |
| hair on end skull | thalassemia |
| hemophilia, clotting factors?? | 8 and 9 |
| Three features of hemophilia | hemarthroses, deformities, arthropathy |
| What are two growth abnormalities of hemophilia? | early fusion of 2ndary ossification centers, and ballooning of epiphyses |
| hemophilia imaging findings | growth abnormalities, osteopenia, arthropathy, pseudotumors (MC @ ilum) |
| where is the mc arthropathy of hemophilia? | knee |
| what is seen with hemophilia arthropathy? | bloody joint effusion, synovitis, OA, widening of intercondylar notch, squaring of patella (inf pole) |
| dif dx of hemophilia? | JCA |
| what are radiographic findings of leukemia? | osteopenia and radiolucent metaphyseal bands |
| location of bone infarcts | metaphysis and diaphysis |
| location of AVNs | epiphysis |
| pathogenesis of osteonecrosis? | arterial rupture (trauma), arterial blockage (thrombus, emboli, vasculitis), and arterial compression (myeloproliferation) |
| what is unilateral osteonecrosis d/t? | spontaneous, trauma, surgery, gout, infection |
| what is bilateral osteonecrosis dt? | alcohol, corticosteroids (RA, sle), spontaneous, arteriosclerosis, caisson, cushings, hemoglobinopathy, hemophilia |
| what is the clinical latent period of osteonecrosis? | few weeks to 1 year |
| sx of osteonecrosis? | occur as articulating surface collapses, pain, atnalgia, painful rom, mm atrophy |
| What are the 4 phases of avn? | avascular, revascularization, repair & remodeling, deformity |
| feature of avascular stg of avn? | increase joint space, capsular swelling..... therefore in hip would see waldenstrums sign |
| what are features of revascularization phase of avn? | subchondral cysts, sclerosis (bite sign, snowcap), subchondral fx (cresent sign), collapse, flattening of artic surface, fragmentation... EVERYTHING. |
| where and who does sonk occur in? | med condyle, medial surface - wt bearing surface. in 40-60 yrs |
| where and who with ocd? | under 20, med condyle, lat surface |
| group of epiphyseal/apophyseal conditions characterized by fragmentation, sclarosis and irreg artic surfaces | osteochondroses |
| some osteochondroses are real.... | avn, some a post-traumatic deformities, some are developmental variations |
| LCP aka? | coxa plana |
| age of LCP? | 3-12 |
| males or females LCP? | males more, 5:1 |
| ___% bilat LCP | 10% |
| how long does LCP process take? | 2-8 years |
| What is not affected in LCP? | the cartilage |
| Early findings of LCP? | soft tis swelling, wide medial joint space, small fem head, epiphyseal frag, cresent sign, sclerosis |
| Mushroom deformity? | seen in remodeling of LCP |
| sagging rope sign? | seen in remodeling of LCP |
| avn of metatarsal head | freibergs dz |
| mc site of freibergs dz? | 2nd metatarsal head |
| avn of lunate? | kienbocks |
| avn of tibial tuberosity? | osgood-schlatters dz (ebbets <3) |
| other names for scheuermanns dz? | juvenille kyphosis, vertebral epiphysitis |
| mc area of scheuermanns dz? | midthoracic, then thoracolumbar |
| what are the imaging findings of scheuermanns dz? | Anterior wedgings ( more than 5 degrees, 3 contiguus segments 2. irreg endplates (schmorls nodes) 3. loss of disc ht, 4. kyphosis (more than 40 degrees) |
| avn of inf pole of patella? | Jumpers knee (SLJ) |
| avn of vert body> | kummels dz |
| what else is seen with kummels dz? | intravertebral vacuum cleft sign |
| ischiopubic synchrondrosis? | van necks dz |
| blounts dz? | medial epiphysis is wedged or absent, and get adjacent metaphysis with a beak like protuberance - often medially orientated |
| mc site of avn? | fem head |
| avn of talus? | diaz dz |
| avn of humeral head? | hass dz, 2nd mc site of avn |
| avn of navicular and patella? | kohlers dz |
| avn of scaphoid? | preisers dz |
| avn of capitellum? | panners dz |
| avn of calcaneal apophysis? | severs dz |
| three causes of mocnkebergs medial sclerosis? | DM, SLE, HPT |
| what is monckebergs medial sclerosis? | sclerosis of tunica media |
| MC deenerative arterila dz? | atherosclerosis |
| where is the plaquing of atherosclerosis found within the bv | intimal and subintimal layers |
| what arteries typically have atherosclerosis? | aorta, iliac, subclav, carotid, coronary, femoral |
| poor correlation b/w amount of calcifcation and what in atherosclerosis? | and % of narrowing of artieries |
| good correlation b/w amount of abdominal aorta calcifcation and what? | risk of stroke |
| diameter greater than ___ is an AAA | 3 cm |
| referral for ultrasonographic doppler @ ____ cm with an AAA | 3.5-3.8 cm |
| best and 2nd best way to dx AAA? | 1. ultrasonography 2. CT |
| what % of AAAs will calcify and show on film? | 75% |
| If AAA 7 cm, ___% will rupture in 5 years | 75% |
| RFs of AAA | high BP, smoking, high cholesterol, obesity, emphysema, genetic facors, having a penis. |
| what % of males @ age 80 have an AAA? | 7-9% |
| prophylactic surgery of AAA at ___ cm? | 5.5 cm |
| TX of AAA? | endovascular stent, vascular graft (such as Dacron) |
| reduction of bone quantity with normal quality of bone | osteoporosis |
| reduction in quality of bone | osteomalacia |
| osteopenia is not necessarily caused by? | osteoporosis |
| poverty of bone, seen as increased radiolucency | osteopenia |
| mc generalized osteoporosis? | senile or post menopausal |
| congenital disorders with osteoporosis? | OI and mucopolysaccharidoses |
| vascular disorders with osteoporosis? | SC anemia, thalaseemia |
| nutritional disoders with osteoporosis | scurvy, rickets, osteomalacia, hypervitamin A |
| metabolic and endocrine disoders with osteoporosis | HPT, hyperthyroidism, cushings dz |
| neoplastic disorders with osteoporosis | mult myeloma, lytic mets, leukemia |
| iatrogenic causes of osteoporosis | corticosteroids, anticoagulants |
| 2 other causes of osteoporosis generalized | alcoholism and paralysis |
| F to male ratio of senile osteoporosis in 5th & 6th decades, and 7th and8th decades | F:M 5th and 6th - 4:1, 7th and 8th is = |
| after 35 yrs, __% cortical and ___% medullary bone loss per year | 1% cortical and 2% medullary |
| @ menopause ___% bone loss per year | 3-6% |
| senile osteoporosis aka? | senescent osteoporosis |
| MC location of senile osteoporosis? | axial skel |
| where are fxs usually with senile osteoporosis? | tl spine, hip, distal radius, prox humerus |
| ____ hip fx annullay | 240,000 |
| ___% die within year of fx (hip) | 12-20% |
| pseudo-hemanigoma with what? | senile osteoporosis |
| what is dexa? | low dose xrays to quantify bone mass |
| cDXA vs pDXA? | c = central, spine, hips p = periph, radius, calcaneus |
| what is the t-score? | bone density compared with young adult of same gender, and gives risk of fx |
| what is z-score? | bone density compared with other ppl of same age, size, and gender |
| what is a normal t-score reading? | 0 to -1 |
| what is a t-score of osteoporosis | -2.5 or less |
| bone densitometry uses no? | radiation |
| Mc cause of regional osteoprosis? | disuse osteoporosis |
| What are the 3 patterns of disuse osteoporosis? | generalized osteoporsis, band like metaphyseal or epiphyseal radiolucency, spotted radiolucency (permeative or moth eaten pattern of bone destruction loook) |
| What are the other names for complex regional pain syndrome? | reflex sympathetic dystrophy syndrome, post-traumatic osteoporsis, sudecks atrophy, causalgia, shoulder-hand syndrome |
| Who and what age does transient osteoporosis of the hip occur in? | males, 20-40 |
| Sx of transient regional osteoporosis, and what about its recovery? | sudden onset of pain antalgia, and limp..... self limiting: full recovery within 3-12 months |
| What are some causes of rickets? | lake of vit D in diet, not enough UV light, intestinal malabsorption of vit d, kidney or liver dz, anticonvulsant medication (Dilatin, conveinently starts with a D..) |
| image findings of rickets | Widened physis (failure of growth plates to ossify), generalized osteopenia, bowing deformities, irreg growth plates (paint brush metaphysis, cupping, fraying metaphysis), pseudofxs, path fxs |
| who gets cupping and fraying metaphyses? | rickets |
| rachitic rosary seen in? | rickets |
| 4 clinical features of scurvy | cutaneous petechiae, bleeding gums, joint swelling, irritability |
| scurvy dt? | lack of vit c, chronic deficiency of ascorbic acid |
| image findings of scruvy? | osteopenia, white line of frankel (dense zone of calcification), ring epiphysis of wimberger, pelkens spurs, scorbutic zone (trummerfeld zone) |
| 90% of HPT dt? | benign parathyroid adenoma |
| Lab tests of HPT? | hypercalcemia, hypercalciuria, hypophosphatemia, hyperphosphaturia |
| lab findings of secondary hpt | hypocalcemia, hypercalciruia, hyperphopsphatemia, hypophaturia |
| image findings of hpt? | osteopenia, bone resorption (subperiosteal, subligamentous, subcondral, endosteal), fxs, soft tis and vasc calc, osteoclastomas (brown tumors) |
| hallmark of hpt? | subperiosteal resorptions |
| salt and pepper skull? | hpt |
| what is renal osteodystrophy? | 2ndary hpt with osteomalacia/rickets |
| rugger jersey spine? | 2ndary hpt |
| clinical features of acromegaly? | malocclusion, prominent forehead, thickened tongue, borad large hands, headache, carpal tunnel syndrome, degen arthritis |
| measurements for sella turcica enlargement | > 16 mm width, and > 12 mm ht |
| early acromegaly finding? | widenened joint spcces |
| late acromegaly finding? | accelerated degen arthritis |
| increased heel pad findings in males and females | > 23 mm for F and >25 mm for M |
| mc congenital dwarfism? | achondroplasia |
| what type of growth is abnormal in achondroplasia? | enchondral growth and maturation, with normal intramembranous ossification |
| achondroplasia is an autosomal ____ disturbance | dominant, with sporadic mutation in 80% of cases |
| achondroplasias have normal what? | normal mentation and lifespan |
| what is average ht of achondroplasia? | 50 inches |
| what are features of the head of an achondroplast? | large head (prominent forehead), depressed nasal ridge, small foramen magnum (leads to hydrocephalus) |
| what are the clin features of the trunk of achondroplast? | normal length spine, protuberant abdomen, prominet butt, hyperlordosis, tl kyphosis |
| what are the features of the spine with achondroplasia? | spinal stenosis: post body scalloping, narrowed interpedicular distance, short thick pedicles. TL Gibbus: bullet vertebra |
| features of the pelvis with achondroplasia? | champagne glass pelvic bowl, small pelvis, short flat ilia, horizontal acetabulum, short fem necks |
| feature of hand with achondroplasia? | short, trident config |
| cleidocranial dysostosis d/t? | autosomal dominant, mutation on chromosome 6 |
| how common is celidocranial dysostosis? | 5 per 1 million births |
| what type of ossification is faulty in cleidocranial dysostosis? | intramembranous |
| what are some clin features of cleidocranial dysostosis? | large head, and small face, abnormal teeth, drooping hypermobile shoulders, neural arch defects, hemivert, diastasis of symph pubis, reduced ht, narrow cone shaped thorax |
| what are the skull findings of cleidocranial dysostosis? | multiple wormian bones, widened persistent metopic suture, widened diameter of sagittal and coronal sutures (hot cross bun appearance, bracycephaly), small face d/t underdeveloped facial bones |
| What are image findings of cleidocranial dysostosis in the thorax? | absent (10%) or hypoplastic clavicles, pseduoarthrosis (mid portion missing), scapulae (small, winged, elevated), narrow coneshaped chest. |
| what are some image findings in the pelvis of cleidocranial dysostosis? | small underdeveloped bones in pelvis, pubic symph diastasis, coxa vara or valga |
| what are findings in the spine with cleidocranial dysostosis? | multi sbos, and hemiverts |
| What are some complications of cleidocranial dysostosis? | hearing loss, severe dental probs, dislocations (hip and shoulder), resp distress in children, scolosis |
| What is the name of the autosomal dominant form of chondrodysplasia punctata? | Conradi-hunermann syndrome |
| Which type of chondrodysplasia punctata is fatal in first few yrs of life? | autosomal recessive |
| stippled calcifcation of multiple epyphyseal centers in the 1st yr of life is? | chondrodysplasia punctata |
| what are clinical features of chondrodysplasia punctata? | similar appearance to achondroplastic dwarfs |
| What are imaging features of conradi-hunermann syndrome? | stippling at the end of long bones, can be seen at the endplates and ribs, can lead to asymmetric limb shortening |
| What is dysplasia epiphysealis hemimelica aka? | trevors dz |
| what is focal osteocartilaginous overgrowth of a portion of the epiphysis? | trevors dz/ dysplasia epiphysealis hemimelica |
| trevors dz can be what three things? | monostotic, polyostotic, and gerenalized |
| where is the mc location of trevors dz? | medial femoral condyle - get genu valga |
| when is trevors dz present? and does it affect males or females more? | during first decade of life, affects males more 3:1 |
| where does trevors dz typically affect? | only one limb affected in the LE |
| What causes marfans syndrome? | autosomal dominant - defect on chromosome 15. |
| marfans is a failure to produce? | normal collagen |
| how common is marfans? | 4-6 per 100,000 births |
| life expectancy with marfans? | halved |
| systems involved with marfans? | skeleteal (mainly extremities), ocular, cardiovasc |
| sex ratio of marfans | = |
| Skeletal features of marfans | arachnodactly, thin gracile bones, thin cortices, delicate trabecular pattern, scoliosis (>50%), acetabular protrusion (>50%), pectus excavatum or carinatum, joint lax and dislocs |
| ocular problem with marfans? | >50% have disloc of lens |
| mc cardiovasc defect of marfans? | atrial septal defect |
| marfans is ___% of congen heart dz? | 33% |
| What cardiovasc problems are with marfans? | aortic dissection and rupture, pulm artery rupture, aortic valve incompetence, ASD |
| What are imaging features of a Marfans spine? | tall vert, kyphoscoliosis, doub major or RT thoracic scoliosis (early in childhood), widened spinal canal - 50%, post scalloping of bodies, thin pedicles |
| what are complications of marfans/ | cardiac abnormalities, aneurysms, dental probs, SCFEs, transverse lig rupture |
| OI is a defect in what type of collagen? | collagen type I |
| how is OI transmitted? | autosomal dominant |
| What are the clinical diagnostic criteria of OI (4)? | 1. osteoporosis and skel fragility, 2. blue sclerae, 3. abnormal denition (dentinogenesis imperfecta), 4. premature otosclerosis |
| do ppl with osteogenesis imperfecta tarda have a normal life expectancy? | yes |
| male to fem ratio of OI? | = |
| what % of OI tarda have blue sclera? | 90% |
| features of OI tarda? | less severe form, fxs following trivial trauma, kyphoscoliosis, deformities |
| Imaging features of OI | diffuse osteopenia, pencilthin cortices, mult fxs, deformities |
| Resembles wax flowing down a lighted candle | melorheostosis |
| what is the male to fem ratio of melorheostosis? | = |
| when do sx occur in melorheostosis? | late childhood, early adolescenes |
| what are sx of melorheostosis? | pain, joint contractures and deformities, progessive hyperostosis, swelling, skin changes |
| Where is melorheostosis? | LE |
| does melorhesotosis involve one or multiple limbs? | usually one (monomelic) |
| what are the imaging features of melorheostosis? | streaked or wavy cotrical thicekning, endosteal and periosteal bone production |
| What is osteopathia striata a variant of? | osteopoikilosis |
| what is osteopathia striata? | linear bands of dense bone in diaphysis and metaphysis of long bones and in pelvis ( usually bilat) |
| what appearance does osteopathia striata make in the pelvis? | sunburst effect |
| How is osteopoikilosis spread? | autosomonal dominant |
| location in bone of osteopoikilosis? | epiphysis and metaphysis |
| 1/4 of pts with osteopoikilosis have what? | skin lesions |
| osteopetrosis is a lack of what? | resorption of primitive osteochondral tissue |
| what does osteopetrosis inhibit? | formation of normal meduallary canal and bone marrow |
| What is osteopetrosis aka? | Albers-Schonberg dz, marble bones, chalk bones. |
| What are clinical features of severe forms of osteopetrosis? | maybe still born or die in first 2 yrs, anemia, multi fxs of brittle bones, blindness and cranial nerve defects |
| What are clinical features of bengin forms of osteopetrosis? | 50% asymptomatic, anemia, hepatosplenomegaly, facial palsises, deafness, dental caries (osteomyelitis of mandible) |
| What are lab findings with osteopetrosis? | anemia (poor correlation with sclerosis), thrombocytopenia, serum calcium may be elevated |
| spine imaging features of osteopetrosis? | diffuse sclerosis or striated bones, spondylolysis, spinal stenosis - cerivcal myelopathy |
| complications of osteopetrosis? | path fxs esp in femur, hemorrhage, infection, blindness, deafness, leukemia and sarcoma |
| spondylolysis def | interruption of pars interarticularis |
| Mc level of spondylolysis? | L5 (90%) |
| If have SBOs __x more likely to have spondylolysis? | 13 times |
| ethnicity most likely to have a spondylolysis? | 28-40% eskimo (inuit) |
| etiologies of spondylolysis? | stress/fatigue fx, congenital, acute fx |
| What is the name of the classification system of spondylolisthesis? | Wiltse classification |
| Type I spondylolisthesis | dysplastic |
| Type II spondylolistehesis | isthmic (pars) |
| type III sondylolisthesis | degenerative |
| type IV spondylolisthesis | traumatic |
| type V spondylolisthesis | pathologic |
| Dysplastic, type I spondylolisthesis is? | congenital abnormality of post elements - NOT INCLUDING PARS |
| MC type of spondylolisthesis is? | Type II, isthmic |
| types of isthmic spondylolisthesis? | Stress fx of pars, Elongation of pars, Acute pars Fx |
| degen spondylolisthesis mc at what level? | l4 |
| degen spondylolistehesis commonalities | fifty - over fifty, female - mc in females, 4 - l4, facet - severe facet arthrosis |
| type IV spondylolisthesis, trauma except for... | except @ the pars!!!! (That'd be type II - acute or stress fx of pars) |
| Type II A | fatigue stress fx of pars |
| Type II A, no correlation b/w pain and ___ | degree of slippage |
| Most pts are ___ at the time of discovery of Type II A | asymptomatic (inactive spondylolysis) |
| Active pars defects should be visualized where? | on SPECT scan or MRI (sagittal STIR) |
| what is given to a pt to restrict LS extension with an active pars defect? | orthosis (boston overlap brace) for 3-6 months |
| What are risk factors of displacement assoicated with Type II A ? | SBO, trapezoidal shape of L5 body (back shorter than front), dome shape (rounding) of S1, high grade slip |
| What age does type II A displacement and instability occur? | between 5 and 10-15 |
| Good prognosis of Type II A with displacement when? | butterssing, male, over age 18 |
| A grade 5 spondylolisthesis is also called what? | spondyloptosis |
| What are the clinical features of spondylolistehsis | hyperlordosis, prominent buttocks, step defect, crepitus, tight hamstrings, pelvic waddle |
| Meyerding classifcations - %s of each | 1: 0-25%, 2: 26-50% 3 - 51-75% 4: 76-100%, 5: >100% |
| When is Bowline of brailsford seen, and what are other names for it? | Seen with grade 3 or greater, aka gendarmes cap, and inverted napoleons hat |
| Instability eval of spondylos? | f/e, and compression traction - more than 4 mm translation, and more than 11 degrees of extensive angular motion is bad. |
| What is Wilkinson syndrome? | sclerotic pedicle d/t unilateral spondylolysis |
| unilat spondylolysis outcome? | may heal or progress to bilat defects |
| unilat spondylolysis is less common than _____, and has no ____ visualized | less common than bilateraly, and has no spondylolistehsis visualized |
| What is management of stable/inactive Type II A? | chiro manipulation (L4/L5, and SI joints), biomech eval -pelvis and LE |
| What is managment and of unstable Type II A? | boston antilordotic brace (acute, and surgical arthrodesis (chronic) |
| Causes of cervical spondylolistehsis? | congenital (MC), traumatic (dislocs, hangmans fx), degen |
| What is MC level of congen cerv spondylolistehsis? | c6 |
| features of congen cerv spondylolisthesis? | SBO, hyoplastic pedicles and articular processes |
| dextroscolisos | rt sided scolisos |
| double major scoliosis | 2 curves of approx same degree in 2 dif spinal regions |
| double primary scoliosis | 2 curves of approx same degree in same spinal region |
| levoscoliosis | left sided scolisos |
| major curve | largest curve |
| minor curve | smallest curve |
| rib hump | structural scoliosis |
| rotoscolosis | coupled rotation with scoliosis, structural |
| end vertebra | determines where scoliosis is |
| classification of structural scoliosis | fails to correct on forward or lat bending, rib humps, large rotational component |
| non-struc/functional scoliosis classifications | corrects itself on bending, diasppears when cause is removed, minimal rotation |
| structural scoliosis d/t? | idiopathic, neuromm, myopathic, congenital, neurofibromatosis, trauma |
| non-struc scoliosis d/t? | postural, limb length in=, hip contractures, antalgic (nerve root irritation, inflamm) |
| most common type of idiopathic scoliosis is? | adolescent |
| most infantile idiopathic scoliosis will? | resorb |
| age range of infantile scoliosis? and mc sex? | 0-3, more in men |
| age range of juvenille idiopathic scoliosis? and avg age? and mc sex? | 3-10, avg@ 7, and 4:1 f:m |
| age of adolescent idiopathic scoliosis? and mc sex? | 10- skel maturity, F:M 9:1 |
| most common curve pattern of adolescent idiopathic scoliosis? | rt thoracic, then rt thoracolumbar, left lumbar, left lumbar and rt thoracic |
| what age is the critical time for progression of adolescent idiopathic scoliosis? | 12-16 |
| when is one skel mature? | fusion of iliac apophysis |
| if one had adolec idiopath scoliosis degeneration in later life may lead to ____ increase of scoliosis | 15 degrees on average |
| What is the incidence of congen heart dz when idiopathic curve is >20 degrees? | 10 times greater |
| what is often reduced with adolescent idiopathic scoliosis? | all the normal curves of the spine |
| what % of pts with idiopathic scholio have a fam member affected? | 30% |
| What is the hueter-volkman principle? | lateral wedge remodeling deformity of vert bodies (on concave side) |
| What are the causes of congenital scoliosis? | hemivert, block vert, SBO, vertebral bars, rib fusion |
| what is the MC cause of congen scoliosis? | hemivert |
| Congen scoliosis has a ___ C curve | short C curve |
| congen scolisis may be ___ progressive | rapidly |
| what anomalies are common with congen scoliosis? | genitourinary |
| neuromuscular scoliosis has a ____ C curve | long c curve |
| neuromuscular scoliosis runs from __ to ___ | scarum to lower c spine, and is a severe curve |
| neuromusc scoliosis has ___ prgression from what age range? | rapid from 12-18 |
| what is the MC cause of neuropathic scoliosis? | poliomyelitis |
| what are the causes of neuropathic scoliosis? | poliomyelitis, cerebral palsy, syringomyelia, spinal cord tumor, trauma, dysautonomia. |
| What is the MC cause of myopathic scoliosis? | duchenne msucular dystrophy |
| what the 3 causes of myopathic scoliosis? | duchenne muscular dystrophy, arthrogryposis, and congen hypotonia |
| neuromusc scoliosis has <2% present to the ____ which are more likely to be assoicated with what? | to the left, associated with underlying pathology |
| In a pt under 11 what degree of scoliosis should concern you of underlying patho? | 15 degrees or more |
| scoliosis is mc bony abnormality in what inherited congenital disorder? | neurofibromatosis |
| features of neurofibromatosis? | hyperkyphosis, IVF enlargement, post vert scalloping, cafe-au-lait (coast of cali), fibroma mulluscum, intraspinal, intracrania and intercostal and soft tis neurofibromas |
| What dzs have post scalloping of vert bodies? | ehlers danlos, acromegaly, marfans, achondroplasia, neurofibromastoais |
| What level of spine are post-traumatic scoliosis common in? | thoracolumbar spine |
| what is post-traumatic scoliosis? | lateral compression fxs, in osteoporotic pts |
| what side is the fx on in post-traumatic scoliosis? | concave side |
| what side is most degen scoliosis on? | concave side of longstanding curve |
| what is seen with degen scoliosis? | asymmetric disc thinning, and apophyseal joint oA |
| what side of the scoliosis is osteoid osteoma found? | concave side of pedicle |
| which dzes have rapidly progressing double thoracolumbar curves? | Ehlers-danlos, and marfans |
| what two dzs may cause short leg syndrome? | blounts dz, and SCFE |
| most cases of short leg syndrome are? | idiopathic and asymptomatic |
| short leg syndrome should be measured with? | orthoroetgenogram or scaogram (relative dif b/w legs) |
| short leg syndrome clinical significance of <__ cm discrepancy is debated | 1 cm |
| non-tx comlications of scoliosis? | cardiopulmonary, degeneration, progression, fatigue, joint dysfunction, radiation exposure (kids get 22 films), pregnancy |
| complications with tx of scoliosis? | psychological, braces, skin irriation, nerve compression, instrument failure, infection |
| Avg pt with scoliosis gets how many films ? with an ___% increase in risk of breast cancer | 22 films, 110% increase in breast cancer |
| What is the best method of scoliosis measurement? | cobb-lippman |
| which method of scolio measurement takes in the apical vert? | risser-ferguson |
| What is the most accepted assessment of rotation? | pedicle method |
| What is the pedicle method aka? | nash-moe method |
| how is the pedicle method graded? | grade 0-4+ |
| why not use the spinous method for rotation? | many morphological variations, prone to errors |
| left hand and wrist method of skel maturity is compared with what? | the greulich and pyle atlas |
| why left hand and wrist method works for skel maturity? | dist radial epipysis closes @ the same time as the vert body epiphysis |
| fusion of what is the most accurate indicator of completed spinal growth? | vert ring epiphysis |
| Iliac apophysis beings to cap ilium @ what age in girls and boys | girls: 14, boys: 16 |
| when does the iliac apophysis completely fuse in boys and girls? | @ skel maturity: 18-19 boys, 16-17 girls (up to age 20 or more) |
| What rissers sign grade signals end of curve progression in females and males? | females"4 and 5 in males |
| What are 4 indicators of likely prgoression of scolio? | 1. age of onset (young), 2. onset of menarche (early), 3. rissers sign (absent, or early), 4. magnitude of curve (over 20 degrees) |
| what % of curves will progress? | 25% |
| What are the most likely patterns of scoliosis to prgoress? | 1. double primary, and 2. primary lumbar with compensatory thoracic |
| What are the 3 conventional managements of scoliosos? | 1. observation 2. bracing 3. surgery |
| management of 0-20 degree curves | 1. close observation 2. may progess rapidly 3. re-radiograph every 3 months until mature 4. more than 5 degrees between xray consider bracing 5. rotation and rib hump consider bracing |
| managment of 20-40 degree curves | 1. bracing indicated in curves that are felxible, skel immature and prgressive 2. milwaukee brace common, 3. prevent profression |
| what is the thoraco-lumbo-sacral brace? | boston brace |
| what is the cervico-thoraco-lumbo-sacral brace? | milwaukee |
| what is the nightime brace/ | charleston brace |
| surgical intervention of scolio when? | rapid progression in immature spine, curve over 40 degrees, underlying abdnomality can be treated |
| what are the surgical procedures for curves 40-50 degrees or more? | harrington rods, luque rods, dwyer procdure. |
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margaretrhager
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