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The flashcards below were created by user
dmshaw9
on FreezingBlue Flashcards.
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Spondylosis
- Vertebral body osteophyte formation due to Wolff's Law
- "Osis" = diseased/abnormal condition
- Bone growth can interfere w/ exiting nerve root (stenosis)
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Spondylolysis
- "Lysis" = loosening
- "Scotty dog with a collar"
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Spondylolisthesis
- "Listhesis" = slippage
- "Scotty dog decapitated"
- I = 1-25% displacement
- II = 25-50% displacement
- III = 50-75% displacement
- IV = 75-100% displacement
- V = <100% (spondyloptosis)
Standing flexion radiograph: gold standard for diagnosis
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Degenerative Spondylolisthesis
- Occurs due to change in geometry of facets w/ severe degeneration
- Occurs w/o fracture
- Posterior arch encroaches on spinal cord (central cord compression)
- Females > 60 @ higher risk (due to spinal arthritis)
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Marfan Syndrome
- Hypermobility syndrome
- Causes a defect in a glycoprotein involved in a variable expressed elastic connective tissue fibers
- Skin & dura excessively mobile, but hypo elastic
- Excessive growth of long bones t/o body
- Characteristically tall height, long limbs, large hands/feet, and narrow face
- Complications: lungs (pneumothorax), aorta (aneurysm), eyes (cataracts), scoliosis due to laxity
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Ehlers-Danlos Syndrome (EDS): Definition
- a.k.a. Cutis hyperelastica
- A group of several inherited CT disorders related to a collagen synthesis abnormality
- Arterial dissection = most common cause of death
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Ehlers-Danlos Syndrome: Classical Type
- Classical: skin involvement, ranges form mild to moderate
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Ehlers-Danlos Syndrome: Hypermobility Type
Joint hypermobility w/ less severe skin manifestations; joint instability and chronic musculoskeletal pain are prominent
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Ehlers-Danlos Syndrome: Vascular Type
Blood vessels and organs are fragile and prone to rupture; >80% develop life-threatening complications by age 40
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Ehlers-Danlos Syndrome: Kyphoscoliosis Type
Progressive A-P scoliosis, severe muscle weakness, fragile eyes, <60 cases reported
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Ehlers-Danlos Syndrome: Arthrochalasis Type
Extremely loose joints and dislocations, involves both hips, ~ 30 cases reported
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Ehlers-Danlos Syndrome: Dermatosparaxis Type
Extremely fragile and sagging skin, only ~10 cases reported
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Ehlers-Danlos Syndrome: Types (6)
- Classical
- Hypermobility
- Vascular
- Kyphoscoliosis
- Arthrochalasis
- Dermatosparaxis
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Stickler Syndrome
- A group of genetic disorders affecting CT, specifically collagen
- Hallmarks: underdeveloped mid facial bones, various ocular problems, hearing loss, joint pain and hypermobility
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Benign Joint Hypermobility Syndrome
- More common!
- Pain and generalized hypermobility in multiple joints w/o systemic rheumatologic disease
- Thought to be an inherited CT disorder
- May increase risk for joint injury
- Severity diminishes w/ age
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Beighton Hypermobility Scale
- Can you put your hands and feet flat on the floor?
- Can you hyperextend your elbows?
- Can you hyperextend your knees?
- Can you put your thumb to your forearm?
- Can you bend your pinky back at least 90 degrees?
Threshold for joint laxity ranges from 4-6 points (not sufficient for a diagnosis of BJHS)
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Brighton Criteria
(for diagnosis of BJHS)
- Major criteria:
- Beighton score of at least 4/9
- Arthralgia for >3 months in >4 joints
- Minor criteria:
- Beighton score of 1-3
- Arthralgia on 1-3 joints
- History of joint dislocation
- >3 soft tissue lesions
- Marfan-like habits
- Skin striae, hyperextensibility, or scarring
- Eye signs, lid laxity
- History of varicose veins, hernia, visceral prolapse
Diagnosis: (at least) 2 major and 0 minor, 1 major and 2 minor, or 0 major and 4 minor
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Other Conditions Associated w/ Joint Hypermobility
- RA
- Osteogenesis Imperfecta
- Systemic Lupus Erythmatosis
- Polio
- Down Syndrome
- Morquio Syndrome
- Cleidocranial Dysostosis
- Myotonia Congenita
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Clinical Instability (based on surgeon's perspectives)
- Neurological deficit
- Major deformity: gross deformity the pt finds intolerable
- Incapacitating pain: unable to be controlled by non-narcotic drugs
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Lax ligaments allow:
- Greater joint accessory motion (joint play)
- Greater joint angular ROM
- Larger neutral zone
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Intervertebral Hypomobility
- Loss of physiological motion
- Loss of accessory motion at the involved segment
- Increased pain at end range
- Tissue texture abnormalities
- Presence of positional faults
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Intervertebral Hypermobility
- Increased segmental mobility
- Full general spine mobility (may be limited if muscle guarding is present)
- Pain produced by prolonged stretch
- Muscle stiffness follows prolonged stretch (relieved by exercise/movement)
- Ligamentous tenderness in the accessible ligaments
- Joint predisposed to joint locking
- Aberrant motion/devation during ROM assessment
- Full flexion w/ difficulty returning to upright stance (knee flex/thigh climbing)
- Excelling but short-lived relief w/ manipulation
- Hx of trauma, w/ each onset becoming more trivial
- Frequent self-manipulators
- Difficulty holding head up
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Form Closure (standing/kneeling)
- Sacrum = keystone (of the tall arch)
- Gravity wedges sacrum between ilia
- Tightens SI ligaments (ant, post, deep)
- Force vector through femoral neck stabilizes the SIJ
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Stabilization via the Active Subsystem: Force Closure
- (muscle guarding)
- Erector spinae
- Glut max
- Latissimus dorsi
- Biceps femoris
- Transverse abdominis
- Internal obliques
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Neural Stabilization
- Muscles spasm
- Increased muscle tone
- Increased subconscious attention
- Decreased threshold of recruitment
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