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Questions and Answers

What characterizes the condition of Osgood-Schlatter disease?

Fracture through the vertebral arch

Weakening of bones due to poor mineralization

Overgrowth of bone at the tendon attachment site (correct)

Joint fusion at birth

Which stage of fracture healing involves the formation of a blood clot?

Hard Callus Formation

Hematoma Formation (correct)

Remodeling

Soft Callus Formation

What type of healing occurs when a fracture is stable and minimally displaced?

Secondary Bone Healing

Delayed Union Healing

Primary Bone Healing (correct)

Soft Callus Healing

What is a common characteristic of spondylolisthesis?

A 'step-off' deformity caused by vertebra slipping Signup and view all the answers

What process describes a fracture that takes longer than expected to heal?

Delayed Union Signup and view all the answers

What defines nonunion in fracture healing?

Fracture fails to heal completely Signup and view all the answers

Which enzyme plays a significant role in the inflammatory response during bone healing?

Cox-2 Signup and view all the answers

In the context of skeletal muscle fiber types, which statement is accurate?

Different muscle fibers have varying characteristics. Signup and view all the answers

What is increased as a result of improved neural factors during strength gains?

Increased recruitment and rate of firing of motor units Signup and view all the answers

Which of the following conditions is characterized by a temporary loss of nerve conduction?

Neurapraxia Signup and view all the answers

What occurs during muscle hypertrophy?

Increased density of capillary beds Signup and view all the answers

What is a likely consequence of muscle atrophy?

Decreased muscle mass Signup and view all the answers

Which of the following describes axonotmesis?

Damage to the axon with intact nerve sheath Signup and view all the answers

What is the result of increased oxygen cost during orthopedic impairments?

Increased energy cost of walking Signup and view all the answers

Which type of nerve injury involves Wallerian degeneration in the distal segment?

Neurotmesis Signup and view all the answers

What effect does decreased gait efficiency have in individuals with orthopedic impairments?

It increases the energy cost of walking. Signup and view all the answers

What effect does a larger cross-sectional area of a muscle have?

It increases the generation of force. Signup and view all the answers

What role does an antagonist play in muscle movement?

It opposes the action of the agonist. Signup and view all the answers

What is passive insufficiency?

A multi-joint muscle is stretched from both ends, limiting motion. Signup and view all the answers

What generally happens to muscle mass as a person ages?

Muscle mass declines due to sarcopenia. Signup and view all the answers

What are synergists responsible for during muscle contraction?

They assist the agonist in performing a movement. Signup and view all the answers

Which type of muscle primarily operates across a single joint?

Single joint muscles. Signup and view all the answers

Which factor affects the optimal length of a muscle during contraction?

The length-tension relationship. Signup and view all the answers

What is co-contraction in muscle activity?

Both agonist and antagonist muscles contract simultaneously. Signup and view all the answers

What is the primary characteristic of idiopathic scoliosis?

It has no known cause. Signup and view all the answers

Which type of scoliosis requires surgical intervention?

Severe scoliosis Signup and view all the answers

Which of the following conditions is characterized by a fusion of two or more cervical vertebrae?

Klippel-Feil Syndrome Signup and view all the answers

What is a common association found with VACTERL Syndrome?

Vertebral anomalies Signup and view all the answers

Which of the following outcomes describes a feature of low-frequency ultrasound?

Deeper tissue penetration Signup and view all the answers

Which type of spina bifida is characterized by a protrusion of both the meninges and spinal cord covered by skin?

Myelomeningocele Signup and view all the answers

What is a defining feature of scoliosis?

Lateral curvature of the spine Signup and view all the answers

What is a common symptom associated with Klippel-Feil Syndrome?

Short, webbed neck Signup and view all the answers

What does a Cobb angle greater than 10 degrees indicate?

Presence of scoliosis Signup and view all the answers

What is the primary treatment for congenital kyphosis?

Surgery Signup and view all the answers

At what Cobb angle is surgery suggested for scoliosis?

45 degrees Signup and view all the answers

What respiratory issue is associated with a scoliosis Cobb angle greater than 50 degrees?

Respiratory compromise Signup and view all the answers

What is VACTERL Syndrome associated with?

Congenital deformities of the spine Signup and view all the answers

Which of the following statements about spina bifida is true?

Many individuals have hydrocephalus Signup and view all the answers

What device is used to measure spinal curvature?

Scoliometer Signup and view all the answers

What is a notable characteristic of Klippel-Feil Syndrome?

High scapula (Sprengel's Deformity) Signup and view all the answers

What is a potential consequence of an injury at the cubital tunnel?

Weakness in finger flexion of the 4th and 5th fingers Signup and view all the answers

What area is commonly referred to as the 'money distribution area' in the hand?

The area supplied by the median nerve Signup and view all the answers

Which joint is categorized as a ball-and-socket joint?

Hip joint Signup and view all the answers

Which of the following is true regarding radiography (X-ray)?

Is widely available and relatively inexpensive Signup and view all the answers

What type of joint allows for dorsiflexion and plantarflexion?

Hinge joint Signup and view all the answers

Which imaging technique is used to create detailed cross-sectional images of the body?

Computed Tomography (CT) Signup and view all the answers

Dermatome mapping is significant in clinical practice for what reason?

To identify spinal nerve injury levels Signup and view all the answers

What is a disadvantage of using radiography for imaging?

Ionizing radiation exposure Signup and view all the answers

Study Notes

Bone Development

Bone forms through two pathways: endochondral and membranous ossification
Endochondral Ossification: Cartilage is replaced by bone, primary method for long bones (e.g., tibia, femur)
- Diaphysis: Primary ossification center, forms during fetal development
- Epiphysis: Secondary ossification center, forms after birth
- Sclerotomes: Mesenchymal cells that form the vertebral column, contribute to bone development.
Membranous Ossification: Mesenchyme directly differentiates into bone, process for flat bones (e.g., skull bones)

Wolff's Law

Mechanical stress influences bone growth and remodeling
Mechanical Stress: Bone adapts to forces placed on it
Long Bones: Thinner shafts compared to wide heads, growth occurs with compression
Stunted Growth: Can occur in children with developmental disorders (e.g., Cerebral Palsy, Spina Bifida) due to reduced stress
Calcium Levels: Increased stress leads to increased calcium deposition
Osteopenia: After age 30, calcium levels naturally decline leading to bone density decrease
Osteoporosis: More likely in inactive or sedentary individuals, or wheelchair-bound individuals
Immobilization: Can cause joint contracture (stiffening of joints)
Fetal Development: Fetal movement is crucial for joint development

Bone Pathology

Conditions affecting bone health and development
Rickets/Osteomalacia: Poor bone mineralization, weak bones
Osgood-Schlatter Disease: Overgrowth of bone at tendon attachment site, often due to repetitive stress
Spondylolysis: Fracture through the pars interarticularis (portion of vertebral arch)
Spondylolisthesis: "Step-off" deformity where one vertebra slips forward
Arthrogryposis Multiplex Congenita: Rare, autosomal recessive condition, fused joints

Fracture Healing

Fracture healing process
Primary Bone Healing: Fracture is stable and minimally displaced
- Stages: Hematoma formation, soft callus formation, hard callus formation, remodeling
Secondary Bone Healing: Fracture is unstable or displaced
- Procedures: Closed reduction, open reduction and internal fixation (ORIF)
- Complications: Malunion (improper alignment), delayed union (slower than expected healing), nonunion (failure to heal)

Skeletal Muscle Fiber Types

Different muscle fiber types with varying characteristics and functions
Type I (Slow Twitch): Low power output, fatigue resistant, high mitochondrial content, oxidative phosphorylation
- Examples: Postural muscles, soleus (calf muscle), finger flexors
Type IIA (Fast Twitch): Intermediate between Type I and IIB
Type IIB (Fast Twitch): High power output, glycolytic metabolism, easily fatigued
- Examples: Gastrocnemius (calf muscle), finger extensors

Motor Units

Functional unit of muscle contraction, consisting of a motor neuron and all the muscle fibers it innervates
Motor Unit: One alpha motor neuron and all the muscle fibers it innervates
Muscle Fiber Type: All muscle fibers within a motor unit are the same type (e.g., slow twitch, fast twitch)
Size: Smaller motor units for fine movements (e.g., eye muscles), larger motor units for gross movements (e.g., lumbricals)
Recruitment: Motor units recruited based on size, smallest first, largest last

Poliomyelitis

Viral infection damaging alpha motor neurons, leading to muscle weakness and paralysis
Alpha Motor Neuron Death: Virus destroys alpha motor neurons
Initial Function: Individuals may initially function normally, but as they age, the surviving motor neurons may not be able to maintain metabolic activity to innervate the extra muscle fibers.
Post-Polio Syndrome: Muscle weakness, fatigue, and pain years after polio
Axon Degeneration: Axons to extra muscle fibers die, causing muscle weakness

Muscle Force Generation

Factors influencing muscle force
Cross-Sectional Area: Larger area, greater force
Myoarchitecture: Arrangement of muscle fibers
Pennation Patterns: Angle of muscle fibers relative to the tendon
Sex: Men generally have more muscle mass than women
Age: Muscle mass declines with age (sarcopenia)

Muscle Contraction Types

Different types of muscle contractions and their roles in movement
Agonist: Primary muscle for a movement
Antagonist: Muscle opposing the agonist
Co-Contraction: Simultaneous contraction of both agonist and antagonist to stabilize a joint
Synergist: Muscles assisting the agonist in performing a movement
Substitution: Use of a muscle to carry out a movement a different primary muscle would usually perform

Factors Affecting Muscle Function

Factors influencing muscle function
Single Joint Muscles: Primarily responsible for movements at a single joint
Multi-Joint Muscles: Control complex movements involving multiple joints
Length-Tension Curve: Muscle generates greatest tension at optimal length
Passive Insufficiency: Multi-joint muscle stretched from both ends, limiting range of motion
Active Insufficiency: Multi-joint muscle contracted from both ends, limiting range of motion

Muscle Responses to Changes in Activity

Muscle adapts to changes in activity level
Initial Response (Gains of Strength): Increased recruitment, synchronization, and activation of motor units, decreased activation of antagonists
Losses of Strength (Neural Factors): Decreased activity leading to mobilization or atrophy, delayed response
Hypertrophy of Muscle Fibers: Increased synthesis of contractile proteins, increased density of capillary beds
Muscle Atrophy: Decrease in muscle mass
Muscle Contracture: Shortening and stiffening of muscle, often due to immobilization

Peripheral Nerves

Nerves transmitting signals to periphery from CNS
Peripheral Nerve Injuries:
- Neurapraxia: Temporary loss of nerve conduction (nerve still intact)
- Axonotmesis: More severe injury (axon damaged, nerve sheath intact), Wallerian degeneration distal to injury site
- Neurotmesis: Complete severance of the nerve, Wallerian degeneration in distal segment
Wallerian Degeneration: Degeneration of axon and Schwann cells distal to a nerve injury

Energy Expenditure in Orthopedic Impairments

Increased energy cost of walking with orthopedic impairments
Decreased Gait Efficiency: Impairments lead to less efficient walking patterns.
Increased Oxygen Cost: The body requires more oxygen to maintain a certain walking speed.
Increased Heart Rate: The heart works harder to compensate for the increased energy demands.
Amputation Level: Higher level of amputation has greater oxygen cost and slower walking speed
Effects of Aging on the MSK System:
- Sarcopenia: Loss of muscle mass
- Osteoporosis: Decrease in bone density
- Stiffness: Reduced range of motion
- Decreased Strength and Endurance: Reduced muscle strength and ability to perform physical activities

Clinical Anatomy Review

Review of clinically relevant anatomical structures and their relationships
Glenohumeral Joint:
Reinforcing Ligaments: Coracohumeral and glenohumeral ligaments
SITS Muscles: Supraspinatus, infraspinatus, teres minor, subscapularis (rotator cuff muscles)
Erb Palsy: Brachial plexus injury affecting nerves supplying the shoulder and arm
Suprascapular Nerve Injury: Weakness in supraspinatus and infraspinatus muscles

Radial, Ulnar, Median Nerves

Radial Nerve: Extensor muscles of wrists and fingers; injury leads to loss of wrist and finger extension, weakness in supination
Ulnar Nerve: Flexor muscles of the 4th and 5th fingers, intrinsic muscles of the hand, sensory innervation of the little finger and half of the ring finger; injury leads to weakness of 4th and 5th finger flexion, wrist flexion, loss of interossei and hypothenar eminence muscles
Median Nerve: Flexor muscles of the wrist and fingers (except the little finger), thenar muscles, sensory innervation of the thumb, index, middle, and half of the ring finger; injury leads to sensory innervation deficits in the “money distribution” area of the hand

Lower Extremity

Anatomy and function of lower extremities
Hip Joint: Ball-and-socket, wide range of motion
Knee Joint: Hinge joint, flexion and extension
Ankle Joint: Hinge joint, dorsiflexion and plantarflexion 
Foot: Composed of tarsals, metatarsals, and phalanges

Dermatomes

Areas of skin innervated by a specific spinal nerve root

Imaging of the MSK System

Different modalities evaluating musculoskeletal system
Radiography (X-Ray): Visualizes bone structures, ionizing radiation exposure
Computed Tomography (CT): Detailed images of bone and soft tissues, higher radiation exposure than X-ray
Magnetic Resonance Imaging (MRI): Detailed soft tissue images, no ionizing radiation exposure
Ultrasound: Images of soft tissues, non-ionizing radiation exposure, portable
Uses/Indications: Fractures, dislocations, arthritis, bone tumors, infections, complex fractures, spinal stenosis, ligament/tendon injuries, muscle tears, nerve entrapment

Nuclear Medicine

Uses radioactive tracers to create images of metabolic activity
Used to evaluate bone tumors and infections

X-Ray Densities

Different tissue densities visible on radiographs
Air: Least dense (black) - Fat: Slightly denser than air (dark gray) - Water: Denser than fat (gray) - Bone: Denser than water (white) - Metal: Most dense (very white)

Ultrasound Frequencies

Relationship between ultrasound frequency and image resolution
Low frequency: Penetrates deeper but lower resolution
High frequency: Penetrates shallower but higher resolution

Congenital Deformities of the Spine and Scoliosis

Congenital deformities including scoliosis, lordosis, kyphosis

Scoliosis Treatment

Treatment options based on severity of curve.
- Mild (<20 degrees): Conservative (observation, physical therapy, osteopathic manipulative therapy)
- Moderate (20-45 degrees): Bracing
- Severe (>45 degrees): Surgery

Random Other Things

Additional Information on congenital deformities
Caudal Regression Syndrome: Incomplete development of lower spine and limbs
Klippel-Feil Syndrome: High-yield association with Sprengel's Deformity (abnormally high scapula)

Spina Bifida Association

Many have hydrocephalus (fluid buildup in the brain).
Table of congenital deformities, descriptions, key features, and treatments.

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