musculoskeletal review
Terms
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- Klumpke paralysis
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can occur during delivery
baby is breach w/ arms extended
->stretches lower brachial plexus from C8-T1
paralysis of intrinsic hand muscles, numbness along inner aspect of hand - Erb palsy
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can occur during delivery
damage to C5-C6
causes 'waiter's tip arm'
->loss of flexion and supination by the biceps muscle - radial nerve lesions
- cause wrist drop
- ulnar nerve lesions
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cause clawing of ring and little fingers
wasting of hypothenar muscles - Becker muscular dystropy
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dystrophin mutation
->point mutations permit residual fxn of dystrophin molecule
(so better Px than Duchenne) - osteopetrosis
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genetic deficiency of CAI-II
due to osteoclast dysfxn
manifests in infancy or childhood with bone fragility and recurrent fractures - peroneal nerve
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common = neck of fibula
two branches:
->superficial: skin of dorsum of foot
->deep: dorsiflexion of the foot, toe extension, foot inversion - stapedius muscle is innervated by
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the facial nerve
paralysis = hyperacusis - source of bone-forming cells following a fracture
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damaged periosteum
-some of these cells can become lost and form inappropriate bone that impairs joint movement [heterotopic ossification] - hyaline cartilage is very vulnerable to infection because
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it is relatively avascular
so immune system can't access it
also, cartilage is not innervated - lower trunk of the brachial plexus
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C8, T1
intrinsic muscles of hand
->ad and abduction of digits
->opposition of the thumb
*injured when reaching up forcefully - upper trunk of brachial plexus
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C5, C6
muscles in proximal upper limb, shoulder and axilla
does not innervate hand muscles - deltoids
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arises from clavicle and acromion
innervated by axillary nerve
->damaged by fracture/dislocation of humeral neck - clubbing is associated with
- lung cancer, mesothelioma, bronchiectasis, cirrhosis
- other flexors of the elbow besides the long head of the biceps tendon
- brachialis and brachioradialis
- muscle that protects underlying structures of the clavicle [subclavian vessels and brachial plexus]
- subclavius muscle
- aphthous ulcer
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very painful lesions of oral mucosa
unclear etiology
more common in age 10-20
recurrent shallow ulcers w/erythematous border - injury to long thoracic nerve
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=winging of the scapula
(innervates serratus anterior) - skin epithelial stem cells are located
- in hair follicles and sweat glands of the dermis
- how does Botox weaken muscle?
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prevents fusion of motor neuron secretory vesicles with the nerve membrane (via cleavage of v-SNARE)
->prevents release of ACh - pancytopenia suggests what?
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decrease in marrow cavity size
may be due to bony overgrowth (in processes like osteopetrosis)
*anemia is refractory to Tx - spongiotic dermatitis
- seen in cases of contact dermatitis (like poison ivy)
- interosseus muscles are innervated by
- the ulnar nerve
- median nerve innervates
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all thenar muscles:
--abductor pollicus brevis
--flexor pollicus brevis
--opponens pollicus - dermatitis herpetiformis
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strongly ass'd with celiac disease
life long, intermittent course
papules and vesicles on an erythematous base
->extensor surfaces of the extremities and buttocks
histo: papillary dermal poly abscesses w/IgA and C3 deposits
Tx: dapsone - Gaucher crisis
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acute ischemia to the bone, usually in pelvis, femoral head
pain sudden, progressive, >2 wks
usually follows viral infxn
also see osteosclerotic bone and corticomedullary osteonecrosis - fibromyalgia [fibrositis]
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women btwn 20-50
widespread chronic muscle pain that improves w/exercise
chronic fatigue and severe headaches also seen
phys exam = 'trigger points'
objective/lab signs of inflammation are absent
Tx: TCAs [amitriptyline] - acanthosis nigricans
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looks like moles, warts but is due to epidermal hyperplasia
seen in obesity, DM, and in pts with underlying visceral adenocarcinomas - buccinator muscle paralysis
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compression of the facial nerve w/in the facial canal [Bell's palsy]
food and saliva accumulate btwn teeth and cheek - structures in intercostal space
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from superior to inferior:
vein
artery
nerve [most likely to be damaged] - obturator nerve
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innervates muscles of medial compartment of the thigh
->adductor longus, brevus and magnus, and gracilus - cephalic vein
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arises from elbow along anterolateral surface of arm
found in deltopectoral groove
->btwn deltoid + pect major
(diagonally below clavicle) - most common site for development of embryonal rhabdomyosarcoma
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head and neck
also develops in GU tract and extremities - how do corticosteroids contribute to fractures?
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inhibit proliferation and fxn of osteoblasts
stimulate formation and activity of osteoclasts - bone disease associated with McCune Albright syndrome
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polyostic fibrous dysplasia
->local bony defects with unmineralized whorls of connective tissue
*also see Coast of Maine cafe au lait spots and precocious puberty - Trendelenberg sign
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tests gluteus medius and minimus
ask pt to stand on one leg, and they fall to the opposite side - myositis ossificans
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usually occurs in young adults following trauma
area of damage heals with fibroblastic proliferation that ossifies
Xray= flocculant radiodensities surrounding a radiolucent center - hallmark of osteomalacia/rickets
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widened osteoid seams due to poor mineralization of the bone
trabeculae are normal in number and size but don't mineralize effectively - most common form of skin cancer in albinism
- squamous cell
- HLA type associed with psoriasis
- HLA-B13
- allopecia areta
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autoimmune attack on hair follicles
has a wide range of clinical severity: more severe can involve the entire body surface - silver sulfadazine cream
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bacteriacidal for gram positives, negatives and fungi
prevention/Tx of wound sepsis in 2nd and 3rd degree burn pts