week 11 Musculoskelatal

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Questions and Answers

What is a precursor to osteoporosis?

Hypercalcemia

Osteopenia (correct)

Osteosclerosis

Rickets

What factors may interfere with bone mass accrual during adolescence?

Pregnancy during adolescence, eating disorders, poor calcium intake

Bone loss accelerates with menopause.

True

What is the primary role of alkaline phosphatase in bone health?

It is a biochemical marker indicating bone formation. Signup and view all the answers

What symptoms may indicate the need for an MRI for a fracture?

All of the above Signup and view all the answers

What common symptoms are associated with carpal tunnel syndrome?

Numbness in fingers, pain in the volar aspect of the hand, heaviness in hands. Signup and view all the answers

What is Paget's disease characterized by?

Chaotic osteoclast function and increased bone remodeling. Signup and view all the answers

What are the Ottawa ankle rules used for?

To determine if an X-ray is needed for an ankle injury Signup and view all the answers

What does radiculopathy refer to?

A condition where nerves in the spinal column are damaged or pinched. Signup and view all the answers

Vitamin D deficiency can affect bone health.

True Signup and view all the answers

What is a Colles fracture?

Wrist fracture due to fall with outstretched hand Signup and view all the answers

A Reverse Colles fracture occurs from a fall on a flexed hand.

True Signup and view all the answers

What is the primary treatment for a non-displaced fracture?

Thumb splint followed by cast immobilization. Signup and view all the answers

Stress fractures are caused by multiple microfractures due to repeated pressure on a ______.

bone Signup and view all the answers

Which of the following is a secondary sign of fractures?

Joint effusion Signup and view all the answers

What type of fracture is most common in adults at the elbow?

Radial head fracture Signup and view all the answers

The Salter Harris classification for pediatric fractures assesses injuries to the _______.

growth plate Signup and view all the answers

What is the prognosis for a Salter Harris Type I fracture?

Good Signup and view all the answers

What is Brown-Sequard syndrome?

Hemisection of the cord caused by trauma. Signup and view all the answers

Which movement disorder is characterized by abrupt irregular movements?

Chorea Signup and view all the answers

What are common symptoms of Myasthenia Gravis?

Weakness, ptosis, difficulty in swallowing. Signup and view all the answers

Parkinson's disease involves the accumulation of ______ bodies.

Lewy Signup and view all the answers

What is the anatomical basis of Wilson's disease?

Autosomal recessive disorder of copper metabolism. Signup and view all the answers

What is considered a precursor for osteoporosis?

Osteopenia Signup and view all the answers

Which of these factors may interfere with bone mass accrual? (Select all that apply)

Pregnancy during adolescence Signup and view all the answers

What is a common presentation of osteoporosis?

Vertebral compression fractures, Colles fracture, tooth loss, head of femur fracture Signup and view all the answers

Women over 65 should be screened for osteoporosis only if they have risk factors.

False Signup and view all the answers

What is osteoporosis characterized by?

Compromised bone strength leading to an increased risk of fractures Signup and view all the answers

What vitamin deficiency can affect bone health?

Vitamin D Signup and view all the answers

The most common ankle injury is an ______.

ankle sprain Signup and view all the answers

What are the Ottawa ankle rules used for?

Determining if an X-ray is needed for ankle injuries Signup and view all the answers

Which of the following is a symptom of radiculopathy? (Select all that apply)

Weakness Signup and view all the answers

What diagnostic tests are often performed together to assess nerve and muscle function?

Electromyography (EMG) and nerve conduction studies (NCS) Signup and view all the answers

What is a common elastic band symptom associated with carpal tunnel syndrome?

All of the above Signup and view all the answers

What typically causes a Colles fracture?

Fall with outstretched hand Signup and view all the answers

What is a Reverse Colles fracture?

Fall on flexed hand landing on wrist area Signup and view all the answers

What is the typical intervention for a Snuff Box fracture?

Thumb splint Signup and view all the answers

What are the signs of a radial head fracture in adults?

Presence of fat density posteriorly Signup and view all the answers

Which of the following is involved in pediatric fractures?

All of the above Signup and view all the answers

What type of fracture is described as a partial compression of the cortex?

Toris or Buckle fracture Signup and view all the answers

What is a common cause of Chorea?

Huntington's disease Signup and view all the answers

Which symptom is not associated with Parkinson's disease?

Lack of shivering Signup and view all the answers

What is the effect of alpha-synuclein accumulation in Parkinson's disease?

Interferes with signaling Signup and view all the answers

Myoclonus is characterized by sustained muscle contractions.

False Signup and view all the answers

What are common signs of Wilson's disease?

Tremor, parkinsonism, cognitive disorders Signup and view all the answers

Which type of fracture classification is typically associated with poor prognosis?

Type V Signup and view all the answers

What is Brown-Sequard syndrome?

Hemisection of the spinal cord Signup and view all the answers

What is a common first-line treatment for Myasthenia Gravis?

Acetylcholinesterase inhibitors Signup and view all the answers

What is a Colles fracture?

A wrist fracture usually due to a fall with an outstretched hand Signup and view all the answers

A Reverse Colles fracture occurs from a fall on an extended hand.

False Signup and view all the answers

What is a Snuff Box fracture associated with?

Outstretched hand and extreme dorsiflexion load on scaphoid bone. Signup and view all the answers

What is the usual treatment for a non-displaced fracture?

Thumb splint followed by cast immobilization Signup and view all the answers

Which type of fracture is typically caused by multiple microfractures from repeated pressure?

Stress fracture Signup and view all the answers

What is a characteristic sign of pediatric incomplete fractures?

Torider or buckle formation Signup and view all the answers

What classification is used for pediatric fractures?

Salter Harris classification Signup and view all the answers

Parkinson's disease is primarily characterized by resting tremors.

True Signup and view all the answers

What accumulates in neurons and contributes to the progression of Parkinson's disease?

Lewy bodies Signup and view all the answers

What causes chorea?

Huntington's disease Signup and view all the answers

What is a major clinical feature of Wilson's disease?

Kayser-Fleischer ring Signup and view all the answers

Brown-Sequard syndrome is caused by which of the following?

Hemisection of the spinal cord Signup and view all the answers

What kind of therapy is administered for myasthenic crisis?

Plasmapheresis and IVIG Signup and view all the answers

What is a precursor for osteoporosis?

Osteopenia Signup and view all the answers

Which factors may interfere with bone mass accrual?

All of the above Signup and view all the answers

What are common presentations of osteoporosis?

All of the above Signup and view all the answers

What age should women be screened for osteoporosis?

Over 65 or under with risk factors Signup and view all the answers

What biochemical markers are tested for in osteoporosis evaluation?

Serum C telopeptide CTX and Urinary NTX Signup and view all the answers

Bone turnover markers are primarily for patients with confirmed osteoporosis.

False Signup and view all the answers

What is the active form of Vitamin D produced in the body?

Calcitriol Signup and view all the answers

What does the Ottawa ankle rule include?

All of the above Signup and view all the answers

What diagnostic tests are often performed together to assess nerve and muscle function?

Electromyography (EMG) and nerve conduction studies (NCS) Signup and view all the answers

What symptoms are commonly associated with radiculopathy?

All of the above Signup and view all the answers

What is the most common ankle injury?

Ankle sprain Signup and view all the answers

Which ligament is most commonly injured in an ankle sprain?

Anterior talofibular ligament (ATFL) Signup and view all the answers

Paget's disease spreads to other bones after those initially affected.

False Signup and view all the answers

Study Notes

Types of Fractures

Colles Fracture: Common wrist fracture due to a fall on an outstretched hand, affecting distal radius and ulna.
Reverse Colles Fracture: Caused by falling on a flexed wrist; treated with surgery or splinting for four weeks.
Snuff Box Fracture: Resulting from extreme dorsiflexion and outstretched hand impacting scaphoid, diagnosed via MRI and treated with a thumb splint.
Non-Displaced Fracture: Treatment involves thumb splint followed by casting, with re-imaging needed weeks later.
Displaced Fractures: Require surgical fixation to safeguard the delicate blood supply to the scaphoid.
Stress Fractures: Caused by repeated microfractures, often undetected on X-rays; diagnosed using MRI or bone scans.
Secondary Signs: Include joint effusion, periosteal reactions, or callus formation indicating potential fractures.
Radial Head Fracture: Most common elbow fracture in adults, correlated with the presence of extra synovial fat; similar signs seen in children as supracondylar fracture.
Hills Sachs Deformity: Associated with anterior shoulder dislocations.
Spiral Fracture: Extending to joint space, posing clinical implications.
Pathologic Fracture: Characterized by bone density abnormalities, often associated with geographic lytic lesions.

Pediatric Fractures

Growth Plate Considerations: Pediatric fractures often involve the epiphyseal "growth plate" categorized by Salter-Harris classification.
Salter-Harris Classification:
- Type I: Through growth plate, good prognosis.
- Type II: Through growth plate and metaphysis, also good prognosis, most common.
- Type III: Through growth plate and epiphysis; risk of premature fusion and osteoarthritis.
- Type IV: Through growth plate, epiphysis, and metaphysis; similar risks as Type III.
- Type V: Crush injury to growth plate with poor prognosis and possible vascular injury.

Incomplete Fractures

Characteristics: Common in children, involve partial cortex damage.
Toris/Buckle Fracture: Involves bulging or compression without definitive fracture lines; treated with immobilization and pain control.
Greenstick Fracture: Involves partial cortex; often requires complete breakage for proper healing, long-term immobilization follows.
Supracondylar Fracture: Most prevalent elbow fracture in children, identified by posterior fat pad sign; requires immediate ortho consultation due to neurovascular risk.
Apophyseal Avulsion Fracture: Occurs with muscle overuse, e.g., at anterior superior iliac crest in athletes.
Toddler's Fracture: Spiral fracture of distal tibia, typically due to aggressive pivoting; not indicative of child abuse.

Secondary Signs on X-Ray

Healing Indicators: Include periosteal reactions, soft and hard callus formations around fractures.
Discontinuity and Displacement: Identify fractures via heterogeneous cortical and trabecular bone patterns; abnormal fat pad elevations serve as additional indicators.

Parkinson's Disease Characteristics

Nature: Progressive neurodegenerative disorder affecting movement due to dopaminergic neuron loss in the substantia nigra.
Symptoms: Include tremors (resting), rigidity, and bradykinesia, along with balance issues.
Pathophysiology: Degeneration of neurons in the direct pathway leads to disrupted motor control due to the accumulation of Lewy bodies consisting of alpha-synuclein.
Risk Factors: Include pesticide exposure, heavy metal inhalation, and trauma; more common in males.

Definition: Involuntary, abrupt movements; linked to Huntington’s and Wilson’s diseases, and influenced by toxic and immunologic factors.
Dystonia: Hyperkinetic disorder characterized by sustained muscle contractions leading to abnormal postures; can be idiopathic or secondary to other neurological diseases.
Myoclonus: Sudden, brief muscle contractions; managed with medications like clonazepam and valproate.
Tics: Stereotyped movements or vocalizations, can be suppressed; treated with dopamine agonists or SSRIs.
Tremors: Vary by type, including resting (Parkinson's), postural (essential tremor), and action tremors tied to cerebellar lesions.

Wilson's Disease Pathophysiology

Genetics: Autosomal recessive disorder leading to copper accumulation in organs due to defective metabolism.
Clinical Signs: Brown-green Kayser-Fleischer rings in the iris, with symptoms resembling hyperkinetic movements, cognitive impairments, and movement disorders.
Diagnosis: Includes serum copper levels, ceruloplasmin, and 24-hour urine copper testing; liver biopsy can confirm.
Symptom Acronym ABCD:
- A: Asterixis
- B: Basal ganglia degeneration
- C: Cirrhosis and corneal deposits
- D: Dementia

Brown-Sequard Syndrome

Description: Condition caused by hemisection of the spinal cord, leads to ipsilateral weakness and sensory loss, with contralateral loss of pain and temperature perception.

Management and Diagnosis of Conditions

ALS Clinical Presentation: Limb weakness, muscle cramps, and speech difficulties; asymmetrical to symmetrical muscle weakness over time; features spasticity and atrophy.
Myasthenia Gravis (MG): Characterized by muscle weakness, can be ocular or generalized; treated with acetylcholinesterase inhibitors and potential thymectomy.
Indications for MRI in Fractures: MRI is preferred for complex or suspected soft tissue injuries, such as stress fractures or when X-ray results are unclear.

Factors Affecting Bone Health in Women

Osteopenia and Osteoporosis: Causative factors include decreased estrogen and lifestyle; screening advisable for women over 65 or those with risk factors.
Vitamin D Deficiency: Key factor in calcium metabolism, primarily sourced from diet and sun exposure.

Ottawa Ankle Rules

Criteria: Assess when to obtain X-ray imaging; includes pain over specific malleoli or along distal tibia/fibula, serving as a guideline for injury evaluation.

Electromyography (EMG) and Nerve Conduction Studies (NCS)

Purpose: Diagnostic tools that measure electrical activity in muscles, providing insights into nerve and muscle function during rest and contraction.

Carpal Tunnel Syndrome Assessment

Overview: Evaluated based on median nerve compression signs, can involve physical examination techniques to confirm diagnosis.### Carpal Tunnel Syndrome
Predisposing factors: obesity, female gender, short stature, and history of fractures.
Common symptoms include numbness in the radial 3 and ½ digits, heaviness in hands, and decreased grip strength.
Pain is typically felt in the volar aspect of the hand.
Patients may experience electric shock sensations, particularly at night.
Tinel's sign is positive if tingling occurs when tapping over the median nerve.
A compression test can replicate symptoms by fully compressing the carpal tunnel.
Electromyography (EMG) studies are used to confirm diagnosis.

Paget's Disease

Prevalent in the UK, Australia, South Africa, and the USA.
Characterized by chaotic osteoclast function leading to increased, but weaker, bone remodeling.
Etiology remains unclear, and hypervascularity is noted.
Often results in asymmetrical enlargement of one or more bones (pelvis, lumbar spine, skull, femur).
90% of patients remain asymptomatic; however, bowed lower extremities and enlarged skull may occur.
Increased risk of fractures in femur, tibia, and radius.
Uncommon effects include hearing loss, vertigo, and hypercalcemia during immobilization.
Elevated levels of IGF1 and alkaline phosphatase (often exceeding 500) are significant markers.
X-ray findings include various phases: osteoporosis, mixed phases, and sclerosis.
Treatment options include bisphosphonates, alendronate, and risendronate.

Ankle Sprain Management

Ankle sprains are the most common ankle injury, usually caused by inversion or supination stress.
The anterior talofibular ligament is the most frequently injured.
Symptoms include swelling, decreased range of motion (ROM), warmth, visible deformity, and bruising.
Ottawa ankle rules guide the need for X-rays based on specific pain points and weight-bearing capacity.
Treatment involves PRICE: Protection, Rest, Ice, Elevation, along with potential use of air or gel casts, acupuncture, and NSAIDs.
Injuries may be accompanied by tibiofibular interosseous membrane strain and posterior fibular head malfunction.
Myofascial release may help some cases but should be avoided in acute sprains or fractures.

Radiculopathy

Radiculopathy, commonly referred to as a pinched nerve, occurs when spinal nerves are damaged or compressed.
Can affect cervical, thoracic, or lumbar regions of the spine.
Symptoms vary based on the nerve roots affected and commonly include pain, weakness, numbness, altered sensation, and difficulty controlling muscles.

Types of Fractures

Colles Fracture: Common wrist fracture due to a fall on an outstretched hand, affecting distal radius and ulna.
Reverse Colles Fracture: Caused by falling on a flexed wrist; treated with surgery or splinting for four weeks.
Snuff Box Fracture: Resulting from extreme dorsiflexion and outstretched hand impacting scaphoid, diagnosed via MRI and treated with a thumb splint.
Non-Displaced Fracture: Treatment involves thumb splint followed by casting, with re-imaging needed weeks later.
Displaced Fractures: Require surgical fixation to safeguard the delicate blood supply to the scaphoid.
Stress Fractures: Caused by repeated microfractures, often undetected on X-rays; diagnosed using MRI or bone scans.
Secondary Signs: Include joint effusion, periosteal reactions, or callus formation indicating potential fractures.
Radial Head Fracture: Most common elbow fracture in adults, correlated with the presence of extra synovial fat; similar signs seen in children as supracondylar fracture.
Hills Sachs Deformity: Associated with anterior shoulder dislocations.
Spiral Fracture: Extending to joint space, posing clinical implications.
Pathologic Fracture: Characterized by bone density abnormalities, often associated with geographic lytic lesions.

Pediatric Fractures

Growth Plate Considerations: Pediatric fractures often involve the epiphyseal "growth plate" categorized by Salter-Harris classification.
Salter-Harris Classification:
- Type I: Through growth plate, good prognosis.
- Type II: Through growth plate and metaphysis, also good prognosis, most common.
- Type III: Through growth plate and epiphysis; risk of premature fusion and osteoarthritis.
- Type IV: Through growth plate, epiphysis, and metaphysis; similar risks as Type III.
- Type V: Crush injury to growth plate with poor prognosis and possible vascular injury.

Incomplete Fractures

Characteristics: Common in children, involve partial cortex damage.
Toris/Buckle Fracture: Involves bulging or compression without definitive fracture lines; treated with immobilization and pain control.
Greenstick Fracture: Involves partial cortex; often requires complete breakage for proper healing, long-term immobilization follows.
Supracondylar Fracture: Most prevalent elbow fracture in children, identified by posterior fat pad sign; requires immediate ortho consultation due to neurovascular risk.
Apophyseal Avulsion Fracture: Occurs with muscle overuse, e.g., at anterior superior iliac crest in athletes.
Toddler's Fracture: Spiral fracture of distal tibia, typically due to aggressive pivoting; not indicative of child abuse.

Secondary Signs on X-Ray

Healing Indicators: Include periosteal reactions, soft and hard callus formations around fractures.
Discontinuity and Displacement: Identify fractures via heterogeneous cortical and trabecular bone patterns; abnormal fat pad elevations serve as additional indicators.

Parkinson's Disease Characteristics

Nature: Progressive neurodegenerative disorder affecting movement due to dopaminergic neuron loss in the substantia nigra.
Symptoms: Include tremors (resting), rigidity, and bradykinesia, along with balance issues.
Pathophysiology: Degeneration of neurons in the direct pathway leads to disrupted motor control due to the accumulation of Lewy bodies consisting of alpha-synuclein.
Risk Factors: Include pesticide exposure, heavy metal inhalation, and trauma; more common in males.

Definition: Involuntary, abrupt movements; linked to Huntington’s and Wilson’s diseases, and influenced by toxic and immunologic factors.
Dystonia: Hyperkinetic disorder characterized by sustained muscle contractions leading to abnormal postures; can be idiopathic or secondary to other neurological diseases.
Myoclonus: Sudden, brief muscle contractions; managed with medications like clonazepam and valproate.
Tics: Stereotyped movements or vocalizations, can be suppressed; treated with dopamine agonists or SSRIs.
Tremors: Vary by type, including resting (Parkinson's), postural (essential tremor), and action tremors tied to cerebellar lesions.

Wilson's Disease Pathophysiology

Genetics: Autosomal recessive disorder leading to copper accumulation in organs due to defective metabolism.
Clinical Signs: Brown-green Kayser-Fleischer rings in the iris, with symptoms resembling hyperkinetic movements, cognitive impairments, and movement disorders.
Diagnosis: Includes serum copper levels, ceruloplasmin, and 24-hour urine copper testing; liver biopsy can confirm.
Symptom Acronym ABCD:
- A: Asterixis
- B: Basal ganglia degeneration
- C: Cirrhosis and corneal deposits
- D: Dementia

Brown-Sequard Syndrome

Description: Condition caused by hemisection of the spinal cord, leads to ipsilateral weakness and sensory loss, with contralateral loss of pain and temperature perception.

Management and Diagnosis of Conditions

ALS Clinical Presentation: Limb weakness, muscle cramps, and speech difficulties; asymmetrical to symmetrical muscle weakness over time; features spasticity and atrophy.
Myasthenia Gravis (MG): Characterized by muscle weakness, can be ocular or generalized; treated with acetylcholinesterase inhibitors and potential thymectomy.
Indications for MRI in Fractures: MRI is preferred for complex or suspected soft tissue injuries, such as stress fractures or when X-ray results are unclear.

Factors Affecting Bone Health in Women

Osteopenia and Osteoporosis: Causative factors include decreased estrogen and lifestyle; screening advisable for women over 65 or those with risk factors.
Vitamin D Deficiency: Key factor in calcium metabolism, primarily sourced from diet and sun exposure.

Ottawa Ankle Rules

Criteria: Assess when to obtain X-ray imaging; includes pain over specific malleoli or along distal tibia/fibula, serving as a guideline for injury evaluation.

Electromyography (EMG) and Nerve Conduction Studies (NCS)

Purpose: Diagnostic tools that measure electrical activity in muscles, providing insights into nerve and muscle function during rest and contraction.

Carpal Tunnel Syndrome Assessment

Overview: Evaluated based on median nerve compression signs, can involve physical examination techniques to confirm diagnosis.### Carpal Tunnel Syndrome
Predisposing factors: obesity, female gender, short stature, and history of fractures.
Common symptoms include numbness in the radial 3 and ½ digits, heaviness in hands, and decreased grip strength.
Pain is typically felt in the volar aspect of the hand.
Patients may experience electric shock sensations, particularly at night.
Tinel's sign is positive if tingling occurs when tapping over the median nerve.
A compression test can replicate symptoms by fully compressing the carpal tunnel.
Electromyography (EMG) studies are used to confirm diagnosis.

Paget's Disease

Prevalent in the UK, Australia, South Africa, and the USA.
Characterized by chaotic osteoclast function leading to increased, but weaker, bone remodeling.
Etiology remains unclear, and hypervascularity is noted.
Often results in asymmetrical enlargement of one or more bones (pelvis, lumbar spine, skull, femur).
90% of patients remain asymptomatic; however, bowed lower extremities and enlarged skull may occur.
Increased risk of fractures in femur, tibia, and radius.
Uncommon effects include hearing loss, vertigo, and hypercalcemia during immobilization.
Elevated levels of IGF1 and alkaline phosphatase (often exceeding 500) are significant markers.
X-ray findings include various phases: osteoporosis, mixed phases, and sclerosis.
Treatment options include bisphosphonates, alendronate, and risendronate.

Ankle Sprain Management

Ankle sprains are the most common ankle injury, usually caused by inversion or supination stress.
The anterior talofibular ligament is the most frequently injured.
Symptoms include swelling, decreased range of motion (ROM), warmth, visible deformity, and bruising.
Ottawa ankle rules guide the need for X-rays based on specific pain points and weight-bearing capacity.
Treatment involves PRICE: Protection, Rest, Ice, Elevation, along with potential use of air or gel casts, acupuncture, and NSAIDs.
Injuries may be accompanied by tibiofibular interosseous membrane strain and posterior fibular head malfunction.
Myofascial release may help some cases but should be avoided in acute sprains or fractures.

Radiculopathy

Radiculopathy, commonly referred to as a pinched nerve, occurs when spinal nerves are damaged or compressed.
Can affect cervical, thoracic, or lumbar regions of the spine.
Symptoms vary based on the nerve roots affected and commonly include pain, weakness, numbness, altered sensation, and difficulty controlling muscles.

Types of Fractures

Colles Fracture: Common wrist fracture due to a fall on an outstretched hand, affecting distal radius and ulna.
Reverse Colles Fracture: Caused by falling on a flexed wrist; treated with surgery or splinting for four weeks.
Snuff Box Fracture: Resulting from extreme dorsiflexion and outstretched hand impacting scaphoid, diagnosed via MRI and treated with a thumb splint.
Non-Displaced Fracture: Treatment involves thumb splint followed by casting, with re-imaging needed weeks later.
Displaced Fractures: Require surgical fixation to safeguard the delicate blood supply to the scaphoid.
Stress Fractures: Caused by repeated microfractures, often undetected on X-rays; diagnosed using MRI or bone scans.
Secondary Signs: Include joint effusion, periosteal reactions, or callus formation indicating potential fractures.
Radial Head Fracture: Most common elbow fracture in adults, correlated with the presence of extra synovial fat; similar signs seen in children as supracondylar fracture.
Hills Sachs Deformity: Associated with anterior shoulder dislocations.
Spiral Fracture: Extending to joint space, posing clinical implications.
Pathologic Fracture: Characterized by bone density abnormalities, often associated with geographic lytic lesions.

Pediatric Fractures

Growth Plate Considerations: Pediatric fractures often involve the epiphyseal "growth plate" categorized by Salter-Harris classification.
Salter-Harris Classification:
- Type I: Through growth plate, good prognosis.
- Type II: Through growth plate and metaphysis, also good prognosis, most common.
- Type III: Through growth plate and epiphysis; risk of premature fusion and osteoarthritis.
- Type IV: Through growth plate, epiphysis, and metaphysis; similar risks as Type III.
- Type V: Crush injury to growth plate with poor prognosis and possible vascular injury.

Incomplete Fractures

Characteristics: Common in children, involve partial cortex damage.
Toris/Buckle Fracture: Involves bulging or compression without definitive fracture lines; treated with immobilization and pain control.
Greenstick Fracture: Involves partial cortex; often requires complete breakage for proper healing, long-term immobilization follows.
Supracondylar Fracture: Most prevalent elbow fracture in children, identified by posterior fat pad sign; requires immediate ortho consultation due to neurovascular risk.
Apophyseal Avulsion Fracture: Occurs with muscle overuse, e.g., at anterior superior iliac crest in athletes.
Toddler's Fracture: Spiral fracture of distal tibia, typically due to aggressive pivoting; not indicative of child abuse.

Secondary Signs on X-Ray

Healing Indicators: Include periosteal reactions, soft and hard callus formations around fractures.
Discontinuity and Displacement: Identify fractures via heterogeneous cortical and trabecular bone patterns; abnormal fat pad elevations serve as additional indicators.

Parkinson's Disease Characteristics

Nature: Progressive neurodegenerative disorder affecting movement due to dopaminergic neuron loss in the substantia nigra.
Symptoms: Include tremors (resting), rigidity, and bradykinesia, along with balance issues.
Pathophysiology: Degeneration of neurons in the direct pathway leads to disrupted motor control due to the accumulation of Lewy bodies consisting of alpha-synuclein.
Risk Factors: Include pesticide exposure, heavy metal inhalation, and trauma; more common in males.

Definition: Involuntary, abrupt movements; linked to Huntington’s and Wilson’s diseases, and influenced by toxic and immunologic factors.
Dystonia: Hyperkinetic disorder characterized by sustained muscle contractions leading to abnormal postures; can be idiopathic or secondary to other neurological diseases.
Myoclonus: Sudden, brief muscle contractions; managed with medications like clonazepam and valproate.
Tics: Stereotyped movements or vocalizations, can be suppressed; treated with dopamine agonists or SSRIs.
Tremors: Vary by type, including resting (Parkinson's), postural (essential tremor), and action tremors tied to cerebellar lesions.

Wilson's Disease Pathophysiology

Genetics: Autosomal recessive disorder leading to copper accumulation in organs due to defective metabolism.
Clinical Signs: Brown-green Kayser-Fleischer rings in the iris, with symptoms resembling hyperkinetic movements, cognitive impairments, and movement disorders.
Diagnosis: Includes serum copper levels, ceruloplasmin, and 24-hour urine copper testing; liver biopsy can confirm.
Symptom Acronym ABCD:
- A: Asterixis
- B: Basal ganglia degeneration
- C: Cirrhosis and corneal deposits
- D: Dementia

Brown-Sequard Syndrome

Description: Condition caused by hemisection of the spinal cord, leads to ipsilateral weakness and sensory loss, with contralateral loss of pain and temperature perception.

Management and Diagnosis of Conditions

ALS Clinical Presentation: Limb weakness, muscle cramps, and speech difficulties; asymmetrical to symmetrical muscle weakness over time; features spasticity and atrophy.
Myasthenia Gravis (MG): Characterized by muscle weakness, can be ocular or generalized; treated with acetylcholinesterase inhibitors and potential thymectomy.
Indications for MRI in Fractures: MRI is preferred for complex or suspected soft tissue injuries, such as stress fractures or when X-ray results are unclear.

Factors Affecting Bone Health in Women

Osteopenia and Osteoporosis: Causative factors include decreased estrogen and lifestyle; screening advisable for women over 65 or those with risk factors.
Vitamin D Deficiency: Key factor in calcium metabolism, primarily sourced from diet and sun exposure.

Ottawa Ankle Rules

Criteria: Assess when to obtain X-ray imaging; includes pain over specific malleoli or along distal tibia/fibula, serving as a guideline for injury evaluation.

Electromyography (EMG) and Nerve Conduction Studies (NCS)

Purpose: Diagnostic tools that measure electrical activity in muscles, providing insights into nerve and muscle function during rest and contraction.

Carpal Tunnel Syndrome Assessment

Overview: Evaluated based on median nerve compression signs, can involve physical examination techniques to confirm diagnosis.### Carpal Tunnel Syndrome
Predisposing factors: obesity, female gender, short stature, and history of fractures.
Common symptoms include numbness in the radial 3 and ½ digits, heaviness in hands, and decreased grip strength.
Pain is typically felt in the volar aspect of the hand.
Patients may experience electric shock sensations, particularly at night.
Tinel's sign is positive if tingling occurs when tapping over the median nerve.
A compression test can replicate symptoms by fully compressing the carpal tunnel.
Electromyography (EMG) studies are used to confirm diagnosis.

Paget's Disease

Prevalent in the UK, Australia, South Africa, and the USA.
Characterized by chaotic osteoclast function leading to increased, but weaker, bone remodeling.
Etiology remains unclear, and hypervascularity is noted.
Often results in asymmetrical enlargement of one or more bones (pelvis, lumbar spine, skull, femur).
90% of patients remain asymptomatic; however, bowed lower extremities and enlarged skull may occur.
Increased risk of fractures in femur, tibia, and radius.
Uncommon effects include hearing loss, vertigo, and hypercalcemia during immobilization.
Elevated levels of IGF1 and alkaline phosphatase (often exceeding 500) are significant markers.
X-ray findings include various phases: osteoporosis, mixed phases, and sclerosis.
Treatment options include bisphosphonates, alendronate, and risendronate.

Ankle Sprain Management

Ankle sprains are the most common ankle injury, usually caused by inversion or supination stress.
The anterior talofibular ligament is the most frequently injured.
Symptoms include swelling, decreased range of motion (ROM), warmth, visible deformity, and bruising.
Ottawa ankle rules guide the need for X-rays based on specific pain points and weight-bearing capacity.
Treatment involves PRICE: Protection, Rest, Ice, Elevation, along with potential use of air or gel casts, acupuncture, and NSAIDs.
Injuries may be accompanied by tibiofibular interosseous membrane strain and posterior fibular head malfunction.
Myofascial release may help some cases but should be avoided in acute sprains or fractures.

Radiculopathy

Radiculopathy, commonly referred to as a pinched nerve, occurs when spinal nerves are damaged or compressed.
Can affect cervical, thoracic, or lumbar regions of the spine.
Symptoms vary based on the nerve roots affected and commonly include pain, weakness, numbness, altered sensation, and difficulty controlling muscles.

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week 11 Musculoskelatal

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Questions and Answers

What is a precursor to osteoporosis?

What factors may interfere with bone mass accrual during adolescence?

Bone loss accelerates with menopause.

What is the primary role of alkaline phosphatase in bone health?

What symptoms may indicate the need for an MRI for a fracture?

What common symptoms are associated with carpal tunnel syndrome?

What is Paget's disease characterized by?

What are the Ottawa ankle rules used for?

What does radiculopathy refer to?

Vitamin D deficiency can affect bone health.

What is a Colles fracture?

A Reverse Colles fracture occurs from a fall on a flexed hand.

What is the primary treatment for a non-displaced fracture?

Stress fractures are caused by multiple microfractures due to repeated pressure on a ______.

Which of the following is a secondary sign of fractures?

What type of fracture is most common in adults at the elbow?

The Salter Harris classification for pediatric fractures assesses injuries to the _______.

What is the prognosis for a Salter Harris Type I fracture?

What is Brown-Sequard syndrome?

Which movement disorder is characterized by abrupt irregular movements?

What are common symptoms of Myasthenia Gravis?

Parkinson's disease involves the accumulation of ______ bodies.

What is the anatomical basis of Wilson's disease?

What is considered a precursor for osteoporosis?

Which of these factors may interfere with bone mass accrual? (Select all that apply)

What is a common presentation of osteoporosis?

Women over 65 should be screened for osteoporosis only if they have risk factors.

What is osteoporosis characterized by?

What vitamin deficiency can affect bone health?

The most common ankle injury is an ______.

What are the Ottawa ankle rules used for?

Which of the following is a symptom of radiculopathy? (Select all that apply)

What diagnostic tests are often performed together to assess nerve and muscle function?

What is a common elastic band symptom associated with carpal tunnel syndrome?

What typically causes a Colles fracture?

What is a Reverse Colles fracture?

What is the typical intervention for a Snuff Box fracture?

What are the signs of a radial head fracture in adults?

Which of the following is involved in pediatric fractures?

What type of fracture is described as a partial compression of the cortex?

What is a common cause of Chorea?

Which symptom is not associated with Parkinson's disease?

What is the effect of alpha-synuclein accumulation in Parkinson's disease?

Myoclonus is characterized by sustained muscle contractions.

What are common signs of Wilson's disease?

Which type of fracture classification is typically associated with poor prognosis?

What is Brown-Sequard syndrome?

What is a common first-line treatment for Myasthenia Gravis?

What is a Colles fracture?

A Reverse Colles fracture occurs from a fall on an extended hand.

What is a Snuff Box fracture associated with?

What is the usual treatment for a non-displaced fracture?

Which type of fracture is typically caused by multiple microfractures from repeated pressure?

What is a characteristic sign of pediatric incomplete fractures?

What classification is used for pediatric fractures?

Parkinson's disease is primarily characterized by resting tremors.

What accumulates in neurons and contributes to the progression of Parkinson's disease?

What causes chorea?

What is a major clinical feature of Wilson's disease?

Brown-Sequard syndrome is caused by which of the following?

What kind of therapy is administered for myasthenic crisis?

What is a precursor for osteoporosis?

Which factors may interfere with bone mass accrual?

What are common presentations of osteoporosis?

What age should women be screened for osteoporosis?

What biochemical markers are tested for in osteoporosis evaluation?

Bone turnover markers are primarily for patients with confirmed osteoporosis.

What is the active form of Vitamin D produced in the body?

What does the Ottawa ankle rule include?

What diagnostic tests are often performed together to assess nerve and muscle function?

What symptoms are commonly associated with radiculopathy?

What is the most common ankle injury?

Which ligament is most commonly injured in an ankle sprain?

Paget's disease spreads to other bones after those initially affected.

Study Notes

Types of Fractures