pediagenosis: Musculoskeletal
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Showing posts with label Musculoskeletal. Show all posts
Showing posts with label Musculoskeletal. Show all posts

Thursday, November 5, 2020

CONGENITAL KYPHOSIS

CONGENITAL KYPHOSIS

CONGENITAL KYPHOSIS

Congenital kyphosis is due to the same embryologic failure of segmentation or formation of the vertebrae as congenital scoliosis. The direction of the curve (lateral or posterior) depends on the location of the spinal defect. Anterior defects cause kyphosis, and lateral defects cause scoliosis. A combined deformity, kyphoscoliosis, is common. In about 15% of patients, congenital deformities are associated with an anomaly of the neural elements (e.g., diastematomyelia, neurenteric cyst).

SCHEUERMANN DISEASE

SCHEUERMANN DISEASE

SCHEUERMANN DISEASE

Although an exaggerated thoracic kyphosis has been documented for centuries, it was only with the advent of medical radiography that Scheuermann identified the disease. This progressive disorder occurs in patients near puberty, manifested by an increase in the normal kyphosis in the thoracic spine with an abnormal degree of wedging of the vertebrae at the apex of the kyphotic curve. The diagnosis of Scheuermann disease is limited to patients with a kyphotic curve greater than 60 degrees. (Measurements are done in a manner similar to the coronal plane Cobb method; see Plate 1-40.) Typically the curve is measured from T4 to T12 on the lateral view. Normal kyphosis is 20 to 45 degrees in which at least three adjacent vertebrae are wedged 5 degrees or more and where disc space narrowing and end plate irregularity are noted. Although Schmorl’s nodules are common radiographic findings, they are not part of the diagnostic criteria of Scheuermann disease.

SCOLIOSIS

SCOLIOSIS

SCOLIOSIS

Scoliosis is a rotational deformity of the spine and ribs. While in most cases the cause of scoliosis is unknown (idiopathic scoliosis), in excess of 50 genetic markers have been identified as having a major role in adolescent idiopathic curves. Scoliosis may also result from a variety of congenital, neuromuscular, mesenchymal, and traumatic conditions, and it is commonly associated with neurofibromatosis.

CONGENITAL MUSCULAR TORTICOLLIS (WRYNECK)

CONGENITAL MUSCULAR TORTICOLLIS (WRYNECK)

CONGENITAL MUSCULAR TORTICOLLIS (WRYNECK)

Congenital muscular torticollis (congenital wryneck) is a common condition, usually discovered in the first 6 to 8 weeks of life. Contracture of the sternocleidomastoid muscle tilts the head toward the involved side, rotating the chin to the contralateral shoulder. The cause is believed to be ischemia of the sternocleido-mastoid muscle, particularly the sternal head, due to intrauterine positioning, prolonged labor, or increased pressure during passage through the birth canal. The contracture usually occurs on the right side, and 20% of children with congenital muscular torticollis also have congenital dysplasia of the hip. These observations support the hypothesis that both problems are related to intrauterine malpositioning or presentation.

SYNOSTOSIS OF CERVICAL SPINE (KLIPPEL-FEIL SYNDROME)

SYNOSTOSIS OF CERVICAL SPINE (KLIPPEL-FEIL SYNDROME)

SYNOSTOSIS OF CERVICAL SPINE (KLIPPEL-FEIL SYNDROME)

Klippel-Feil syndrome refers to the congenital fusion of two or more cervical vertebrae. In some patients, the entire cervical spine is involved. The fusion is a result of failure of segmentation of the cervical somites during the third to eighth weeks of embryonic development. Although the etiology is not yet determined, the developmental defect is not limited to the cervical spine. Unilateral or bilateral elevation of the scapula occurs in 25% to 30% of patients. Other, less apparent defects in the genitourinary, nervous, and cardiopulmonary systems and hearing loss often occur in patients with Klippel-Feil syndrome.

Wednesday, October 21, 2020

ANATOMY OF THE THORACOLUMBAR AND SACRAL SPINE

ANATOMY OF THE THORACOLUMBAR AND SACRAL SPINE

ANATOMY OF THE THORACOLUMBAR AND SACRAL SPINE

THORACIC VERTEBRAE AND LIGAMENTS

The 12 thoracic vertebrae (T1 to T12) are intermediate in size between the smaller cervical and the larger lumbar vertebrae. The heart-shaped vertebral bodies are slightly taller posteriorly than anteriorly, producing a slight wedge shape (see Plate 1-17). Vertebrae are easily recognized by their costal facets on both sides of the bodies and on all the transverse processes except those of T11 and T12. The costal facets articulate with the facets on the heads and tubercles of the corresponding ribs. The spinal canal is smaller and more rounded than in the cervical spine and corresponds to the more circular shape of the spinal cord in the thoracic region. The spinal canal is formed by the posterior surfaces of the vertebral bodies and by the pedicles and laminae forming the vertebral arches. The stout pedicles are directed posteriorly; they have shallow superior and much deeper inferior vertebral notches. The laminae are short and relatively thick and partially overlap each other from above downward.

CLINICAL PROBLEMS AND CORRELATIONS OF THE THORACOLUMBAR SPINE

CLINICAL PROBLEMS AND CORRELATIONS OF THE THORACOLUMBAR SPINE

CLINICAL PROBLEMS AND CORRELATIONS OF THE THORACOLUMBAR SPINE

DEGENERATIVE DISC DISEASE

Low back pain, with or without leg pain, is very common in the population, particularly in middle-aged and older adults. Degeneration of the intervertebral disc and some degree of low back pain and stiffness are nearly universal features of aging. Degenerated discs have decreased height, increased posterior and lateral bulging, and reduced ability to dissipate compression forces. As a result, associated changes occur, including abnormal loading of the facet joints with development of facet arthritis, osteophyte formation, greater stress on adjacent ligaments and muscles, and thickening of the ligamentum flavum. In some patients, these changes may result in back pain, although it is difficult to isolate the primary source of low back pain in most instances. In some cases, back pain may become chronic. Chronic low back pain, defined as persistent symptoms for longer than 6 to 8 weeks, is common among people older than 40 to 50 years of age and those working in occupations requiring frequent bending, lifting, or exposure to repetitive vibration (e.g., truck drivers). Obesity, smoking, and poor physical fitness are all risk factors for disc degeneration.

ADULT DEFORMITY

ADULT DEFORMITY

ADULT DEFORMITY

SCOLIOSIS IN ADULTS

Scoliosis is a coronal curvature of the spine of more than 10 degrees. In adults, scoliosis either presents as the sequela of adolescent idiopathic scoliosis or develops de novo secondary to degenerative changes in the disc, osteoporosis, or both (see Plates 1-36 to 1-39 for congenital scoliosis). Other less common causes include neuromuscular conditions such as post-traumatic paraplegia.

THORACOLUMBAR SPINE TRAUMA

THORACOLUMBAR SPINE TRAUMA

THORACOLUMBAR SPINE TRAUMA

Most thoracic and lumbar fractures result from vertical compression or flexion-distraction injuries. These injuries frequently occur around the thoracolumbar junction (T11-L2), because it represents a transition from the stiffer thoracic to the more flexible lumbar spine. The upper thoracic region (T1-10) is more injury resistant because it is stabilized by the ribs, and the lower lumbar region (L3-5) has larger, stronger, and more injury-resistant vertebra.

CONGENITAL ANOMALIES OF OCCIPITOCERVICAL JUNCTION

CONGENITAL ANOMALIES OF OCCIPITOCERVICAL JUNCTION

CONGENITAL ANOMALIES OF OCCIPITOCERVICAL JUNCTION

The articulation of the atlas (C1) and axis (C2) is the most mobile part of the vertebral column and consequently the least stable. The dens (odontoid process) of the axis acts as a bony buttress to prevent hyperextension of the neck, but the rest of the normal range of motion—and the protection of the spinal cord in the area—is maintained by the integrity of the surrounding ligaments and capsular structures. Atlantoaxial instability may result from occipitalization of the atlas, basilar impression, odontoid malformations, and laxity of the dens-retaining ligaments. It is often associated with Down syndrome (trisomy 21) and some of the skeletal dysplasias that cause dwarfism. The most significant risk is compression of the spinal cord.

Thursday, September 24, 2020

CLINICAL PROBLEMS AND CORRELATIONS OF SUBAXIAL CERVICAL SPINE

CLINICAL PROBLEMS AND CORRELATIONS OF SUBAXIAL CERVICAL SPINE

CLINICAL PROBLEMS AND CORRELATIONS OF SUBAXIAL CERVICAL SPINE

CERVICAL SPONDYLOSIS

Of all the pathologic processes found in the cervical spine, cervical spondylosis is the most common (see Plates 1-12 and 1-13). It can be found to some extent in all humans as we age. Spondylosis starts with the normal degeneration of the intervertebral disc. As this occurs, the disc progressively loses the ability to maintain its water content. Disc dehydration and other molecular changes to the disc composition result in a decrease in disc height. With loss of disc height, its normal biomechanical characteristics change. As spondylosis progresses, osteophytes form ventrally and posteriorly and the uncovertebral and facet joints hypertrophy. This process occurs to some degree at every spinal functional unit, and it may result in neural compression. It is important to remember, however, that most people remain clinically asymptomatic during this process.

ANATOMY OF SUBAXIAL CERVICAL SPINE

ANATOMY OF SUBAXIAL CERVICAL SPINE

ANATOMY OF SUBAXIAL CERVICAL SPINE

BONY ANATOMY

The subaxial cervical spine consists of five cervical vertebrae. These vertebrae begin with C3 and end at C7. The overall balance of the cervical spine is slightly lordotic, which contributes to normal global sagittal alignment with the head appropriately aligned over the pelvis. This transition begins at the cervicothoracic junction, where the normal kyphosis of the thoracic spine gives way to the lordotic cervical spine. The cervical vertebrae have a common fundamental design but are unique from all other vertebral types owing to the presence of their transverse foramen and uncovertebral joints.

CLINICAL PROBLEMS AND CORRELATIONS OF CRANIOVERTEBRAL JUNCTION

CLINICAL PROBLEMS AND CORRELATIONS OF CRANIOVERTEBRAL JUNCTION

CLINICAL PROBLEMS AND CORRELATIONS OF CRANIOVERTEBRAL JUNCTION

DENS FRACTURES

Among pathologic entities at the craniocervical junction, one of the most common is the dens fracture, which may constitute nearly 20% of all fractures of the cervical spine. It is the most common cervical fracture in the elderly patient. The mean age at onset of odontoid fractures is 47, with a bimodal distribution. Younger patients tend to present with dens fractures as a com- ponent of a constellation of severe injuries that result from a high-speed, high-energy injury. Elderly patients comprise the second, larger peak group of those affected. These fractures are typically the result of a low-speed trauma such as falls from the standing position. A high proportion of the dens volume is cancellous bone, and osteopenia and osteoporosis predispose older people to these types of fractures. The latter deserve special consideration in the elderly, in whom mortality rates have been reported as high as 40%.

ANATOMY OF CRANIOCERVICAL JUNCTION

ANATOMY OF CRANIOCERVICAL JUNCTION

ANATOMY OF CRANIOCERVICAL JUNCTION

BONY ANATOMY

The craniocervical junction consists of the occiput and the first two cervical vertebrae (C1 and C2). It is the complex bony and ligamentous articulations  of  this region that facilitate its unique biomechanical properties, accounting for 25% of flexion and extension and 50% of rotation of the neck. The occiput is the skull’s most inferior bone, and it retains a cupped shape posteriorly that gives way to the triangular foramen magnum inferiorly. This foramen harbors the cervical spine cord as it ascends and transitions into the medulla and upper brainstem. At the anterolateral border of the foramen magnum are the occipital condyles, which are articulation points for the atlas (C1). These articulations are relatively flat so as to limit axial rotation of the atlantooccipital joint.

VERTEBRAL COLUMN

VERTEBRAL COLUMN

VERTEBRAL COLUMN

The vertebral column is built from individual units of alternating bony vertebrae and fibrocartilaginous discs. These units are intimately connected by strong ligaments and supported by paraspinal muscles with tendinous  attachments  to  the  spine.  The individual bony elements and ligaments are described in Plates 1-9 to 1-18.

Tuesday, August 25, 2020

REPLANTATION

REPLANTATION


REPLANTATION
Replantation is defined as the reattachment of a completely severed part. The first successful replantation of an above-elbow amputation was reported in 1962 by Malt and McLehman. In 1965, Komatsu and Tamai reported the successful replantation of a thumb. The development of this type of microsurgery has been greatly aided by advances in optical instrumentation and especially in the manufacture of needles and sutures fine enough to repair vessels 1 mm in diameter or less. Replantation is not suitable or possible for all patients with amputations. Great care must be given to the assessment of patients and their requirements. The surgical technique is exacting and the postoperative care prolonged and difficult. However, with an experienced team and a well-informed and motivated patient, the procedure can produce good functional and cosmetic results.
AMPUTATION IN THE HAND

AMPUTATION IN THE HAND


AMPUTATION IN THE HAND
Amputations in the hand are almost always traumatic in origin; only rarely is amputation required to treat gangrene, infection, or tumor. Traumatic injuries to the hand are quite common, particularly in persons who use power tools in the workplace or the home. The general principles of amputation apply to procedures in the hand, and preservation of length is especially critical. Every effort should be made to salvage as much of each digit as possible.
INJURY TO HAND AND FINGERS-REHABILITATION AFTER INJURY TO HAND AND FINGERS

INJURY TO HAND AND FINGERS-REHABILITATION AFTER INJURY TO HAND AND FINGERS


INJURY TO HAND AND FINGERS-REHABILITATION AFTER INJURY TO HAND AND FINGERS
Failure to identify a significant hand injury may result in prolonged disability due to excessive scarring, which can significantly reduce hand and finger motion. Early diagnosis and treatment and proper rehabilitation are needed to establish full function (see Plate 4-56). The goal of treatment of hand and finger injuries is to promote healing of the injured structures while maintaining a functional range of motion and preventing the formation of joint contractures. Because certain structures of the hand are fragile, the rehabilitation team must clearly understand the extent and severity of the injury and take appropriate precautions, as identified by the attending hand surgeon, before initiating rehabilitation therapy.
INJURIES TO THE FINGERTIP

INJURIES TO THE FINGERTIP


INJURIES TO THE FINGERTIP
As the sensory input to the upper extremities, the fingertips encounter their environment first and are often unfortunately injured. Whether it be on a sporting field or in the workplace the fingertips are subject to cuts, burns, punctures, and sudden impact and crushing injuries. It is of paramount importance to try and restore the fingertips for optimal hand and upper extremity function.
DISLOCATION OF PROXIMAL INTERPHALANGEAL JOINT

DISLOCATION OF PROXIMAL INTERPHALANGEAL JOINT


DISLOCATION OF PROXIMAL INTERPHALANGEAL JOINT
The proximal interphalangeal joint is basically a hinge joint supported by the architecture of the bone and by strong collateral ligaments on either side, which are, in turn, reinforced by a strong volar ligament or plate. The dorsal capsule of the proximal interphalangeal joint is strengthened by the central slip of the extensor tendon and by the insertions of the lateral bands of the extensor tendon hood. Ligament injuries of the proximal interphalangeal joint, the most common injuries of the hand, include simple sprains of the collateral ligament or the volar plate (most common), complete dislocations, and the most severe injuries-fracture-dislocations.

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