Supplemental Lecture Notes

Question 1

Shoulder

-Herpes zoster aka Shingles

Answer 1

1. infection with herpes zoster virus (chickenpox related)
2. severe neuralgic pain
3. sometimes chills and fevers
4. malaise and lethargic
5. erythema of skin
6. tender regional lymph nodes
7. clear crops of vesicles along course of cutaneous nerve
8. always unilateral and does not cross midline of body
9. vesicles burst and slowly heal

Question 2

Shoulder

-Erb’s Palsy aka Erb-Duchenne Paralysis

Answer 2

1. upper brachial plexus (C5-C6)
2. forceful depression of the shoulder during birth
3. trauma to the shoulder later in life
4. internally rotated and adducted
5. biceps reflex is lost and there is muscle wasting
6. some motions of the elbow and hand may be present
7. “waiters tip” position of the arm

Question 3

Shoulder

-Klumpke’s Palsy aka Klumpke-Dejerine Paralysis

Answer 3

1. lower brachial plexus injury (C8 & T1)
2. forceful pulling of the upper arm during brith
3. stretching or tearing inferior part of the brachial plexus
4. impairment of wrist flexion and movements of the intrinsic muscles of the hand

Question 4

Shoulder

-Sheuermann’s Disease aka Juvenile Kyphosis

Answer 4

1. Kyphosis is evident in the mid and lower thoracic regions in which at least three contiguous involved vertebrae are wedged anteriorly more than 5 degrees
2. a slight male predominance
3. adolescent (13 to 17 years old)
4. etiology unknown
5. cosmetic deformity with a predisposition to thoracic disc herniation and premature degenerative changes
6. characteristic radiological features
   a. anterior vertebral wedging
   b. irregular vertebral end plates
   c. loss of intervertebral disc heights

Question 5

shoulder

-Sprengel’s Deformity

Answer 5

1. congenital abnormality
2. partially undescended scapula
3. condition develops prior to the 3rd month of skeletal development
4. a 2:1 female predominance
5. examination of patient shows elevation of scapula with reduction of the arm

Question 6

shoulder

-scoliosis

Answer 6

1. some 60%-80% of cases occur in females
2. initial complaint may be fatigue in the lumbar region after sitting and standing for a long period. This may be followed by muscular backaches in areas of strain, such as the lumbosacral angle. Pain, a late manifestation, may become more persistent as irritation of the ligaments increases
3. lateral curvature of the thoracic spine is usually accompanied by some rotation of the vertebral bodies
4. many person with severe curvatures suffer from cardiovascular and pulmonary disease secondary to reduced thoracic cage volume

Question 7

shoulder

-Tietze’s syndrome aka costochondritis

Answer 7

1. etiology is unknown
2. pain and swelling of one or more costicartilages may occur gradually or suddenly
3. overlying skin is reddened
4. pain may radiate to the shoulder, neck or arm
5. swelling may persist for months after the pain and tenderness subside
6. x-ray findings are lacking
7. direct trauma or coughing can irritate these junctions

Question 8

Shoulder

-Frozen Shoulder

Answer 8

1. an inflammation of the synovial layers causing an outpouring secretion of exudate, which contains protein. the microscopic fibers attach from adjacent synovial layers which, then multiply, thicken and shorten (adhesive process)
2. Pain increases to such an extent that patient is prevented from sleeping on affected side
3. no glenohumeral motion, only scapulothoracic motion
4. progressive limitation of motion continues until complete encloses stops the pain
5. men 50-60, women 40-50
6. concomitant muscle atrophy

Question 9

shoulder

-scapular winging

Answer 9

1. paralysis of the serratus anterior muscle due to trauma to the long thoracic nerve
2. injury is usually caused by stretching during heavy lifting, severance of the nerve during surgery (mastectomy) or a direct trauma to the side of the neck to the base of the cervical vertebrae

Question 10

Elbow

-Little Leaguer’s Elbow

Answer 10

avulsion of the medial epicondyle . usually associated with sports requiring strong throwing motions

Question 11

Elbow

-Monteggia Fracture

Answer 11

a fracture of the ulnar near the junction of its proximal and middle thirds associated with discoloration of the radial head. These fractures are often classified by the direction of radial head dislocation:

Type 1: the radial head is dislocated anteriorly, with palmar angulation of fractured shaft of the ulna. Occurs 60% of the time

Question 12

Elbow

-Pulled Elbow

Answer 12

the result of a sudden pull on the hand of a child ages 2-5 by an impatient adult. The lesion is due to the radial head slipping out from under the annular ligament, trapping the ligament in the radiohumeral articulation

Question 13

Elbow

-Olecranon Bursitis aka Miner’s Elbow aka Students Elbow

Answer 13

1. a fall on the tip of the elbow or a direct blow to the olecranon can cause swelling (synovial fluid, pus, blood) into the bursa or bursa
2. chronic olecranon bursitis can result from repeated blows to the olecranon as in football, hockey or repeated weight bearing forces
3. patient presents with elbow held in semi-flexion position

Question 14

Elbow

-osteoarthritis (OA) aka Degenerative Joint Disease (DID)

Answer 14

1. primarily disorder of hyaline cartilage and subcondral bone
2. most common got all articular disorders
3. men and women equally affected
4. ages 40 and up
5. etiology is unknown
6. non-inflammatory usually involving one to a few joints
7. pain is the earliest symptom made worse by exercise
8. fingers, hips, knees, elbows, cervical and lumbar spine

Question 15

Elbow

-Myosistis Ossificans

Answer 15

1. traumatic myositis ossificans represents a heterotopic bone formation in the soft tissue
2. process occurs most often in muscle but may also occur in fascia, tendons, joint capsules and ligaments
3. most occur following any local injury sufficient to cause bruising or frank hemorrhage within a muscle
4. most common sites are the brachial anterior (elbow), quadriceps femurs (thigh), adductor muscles of the thigh, and the medial collateral ligament of the knee
5. pellergini-steida disease- myositis ossificans of the medial collateral ligament of the knee
6. Prussian’s disease- myositis ossificans of the adductor magnus of the thigh

Question 16

Elbow

-Tennis Elbow aka Lateral Epicondylitis

Answer 16

1. repetitive tension overload of the forearm and wrist extensors
2. aching or burning pain in region of lateral epicondyle
3. extensor carpi radialis brevis muscle/tendon
4. symptoms exacerbated with activity and improve with rest

Question 17

Elbow

-Golfer’s elbow aka Medial Epicondylitis

Answer 17

pain at/over the medial epicondyle

Question 18

elbow

-thrower’s elbow aka baseball elbow

Answer 18

medial collateral ligament sprain