week 11 Musculoskelatal

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.

Chorea and Related Movements

• 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.

Chorea and Related Movements

• 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.

Chorea and Related Movements

• 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.