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Joints and fractures.

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1 Joints and fractures

2 Terminology Dislocation: when a joint is not aligned properly
Luxation: A dislocation in which the articulating surfaces of a joint are forced entirely out of position Subluxation: A dislocation where a joint is slightly out of its normal position. Ankylosis: stiffness in a joint, due to bones fusing together from injury or disease. A surgeon repairing a damaged joint must be certain to maintain the shape of the articulating surfaces, because incorrectly apposed articulating surfaces might develop abnormal ankylosis. Most joints have surfaces that match. If an injury occurs and the joint surfaces no longer match, bone spurs may form. The joint cannot alter its shape to adapt.

3 Dislocation (Luxation) of the talus

4 Subluxation of the vertebrae

5 Ankylosis of Spine

SIMPLE (CLOSED) Skin is not broken May just require a cast COMPOUND (OPEN) Bone has broken through the skin Increased chance of infections, which can be life- threatening. Requires surgery, hospitalization and IV antibiotics

INCOMPLETE Only one side of the bone is broken COMPLETE Both sides of bone is broken DISPLACED: The bone fragments don’t line up Produces new and abnormal bone arrangements Non-DISPLACED: The bone fragments stay lined up

Once you have described if the fracture is open or closed, and complete or incomplete, then you describe the fracture shape: Stress (hairline) fracture Greenstick fracture Epiphyseal fracture Transverse fracture Oblique fracture Spiral fracture Comminuted fracture Avulsion fracture Impacted fracture Compression fracture Depression fracture

9 Types of Fractures Fracture Types, Part 1 Fracture Types, Part 2 Compartment Syndrome

10 STRESS FRACTURE STRESS FRACTURE: least serious; it is a tiny, almost invisible break on the surface of the bone. Usually from overexertion. Muscle builds up faster than bone. Six weeks into military basic training camp, there are many stress fractures from too much new running. Can’t see it on x-ray until the third week, when a bone callous forms. It needs to be diagnosed right away. If the patient thinks there is no fracture and they continue to run, it can break all the way through. Diagnose it by placing a tuning fork on the bone, but not at the area of tenderness…the vibration travels down the shaft of the bone until it reaches the fracture site. This will be very painful if it is a stress fracture.

11 Stress Fracture, 3 weeks later

12 GREENSTICK FRACTURE GREENSTICK FRACTURE: most common in children; like breaking a green twig, it’s not completely broken. It breaks on one side but bends on the other. Bones in children are not fully mineralized.


14 EPIPHYSEAL FRACTURE The growth plate in the bone of a child is called the epiphyseal plate. That area is cartilage, which is weaker than bone, so the whole thing can be broken through during an injury. It is very serious because the bone may grow crooked thereafter. May need repeated surgeries to straighten the bone as it grows.


16 TRANSVERSE FRACTURE Bone breaks completely through, right to left, in the transverse plane

17 OBLIQUE FRACTURE Bone breaks completely through, from upper to lower, in an oblique plane

18 SPIRAL FRACTURE: Bone was twisted, such as in skiing or rollerblading.


20 COMMINUTED: The most serious of the closed fractures; bone shatters into three or more pieces. Bone graft might be needed. NOTE: open fractures are the most serious because they are life- threatening





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26 AVULSION FRACTURE A piece of bone is broken off by the sudden, strong contraction of muscle. Common sports injury Often seen with “groin muscle injury” and inversion ankle sprains (5th metatarsal styloid process).

27 Avulsion Fracture The person twisted their ankle and a tendon pulled off a piece of the bone.


29 IMPACTED FRACTURE: Pressure was exerted on both ends of the SAME bone
IMPACTED FRACTURE: Pressure was exerted on both ends of the SAME bone. The bone is crushed Often seen in femur after falling from a height.

30 Impacted fracture of the femur
The person fell from a height, and the head of the femur jammed into the neck of the femur.

31 Femoral Neck Stresses The femoral neck supports 50% of the body’s weight. In the anatomical neck, there is a region of spongy bone, which is weaker. This may be a factor in hip fractures. The fibers (trabeculae) in spongy bone are oriented in particular directions.


33 PATHOLOGICAL FRACTURE: When the bone breaks first, then the patient falls. This is especially common in the hip bone of someone with osteoporosis.

34 COMPRESSION FRACTURE TWO bones are forcing a third bone to fracture Middle bone is crushed. Example would be three vertebrae being crushed together from a fall from a height; the middle vertebrae is the one that is crushed. People with osteoporosis (loss of bone minerals) often get this type of fracture spontaneously.

35 Table 6.1

36 DEPRESSION FRACTURE Bone is pressed inward Often seen in skull fracture from blunt object


38 Depression Fracture

39 Colles’ Fracture This is a fracture of the distal radius in the forearm with dorsal (posterior) displacement of the wrist and hand. The fracture is sometimes referred to as a "dinner fork" or "bayonet" deformity due to the shape of the resultant forearm. Often occurs when a runner falls on their outstretched hands.

40 Pisiform Fracture Most commonly the pisiform is injured in a fall on the outstretched hand with the wrist in extension or if the heel of the hand is used like a hammer. The bone may need to be removed surgically. Being an anchor for several ligaments and muscles, when one fractures the pisiform, there is a 50% chance of additional fractures in the distal radius or another carpal bone.

41 Scaphoid Fracture Scaphoid fractures are among the most common injuries. They frequently occur following a fall onto an outstretched hand. X-rays taken soon after the injury may not reveal a fracture, but diagnosis needs to be made quickly to prevent death of this bone. Scaphoid fractures account for 70% of all carpal fractures. 

42 Anatomical Snuffbox The anatomical snuffbox is a triangular deepening on the radial, dorsal aspect of the hand—at the level of the carpal bones, specifically, the scaphoid and trapezium bones forming the floor. The name originates from the use of this surface for placing and then sniffing powdered tobacco, or “snuff.”

43 Anatomical Snuffbox In the event of a fall onto an outstretched hand, this is the area through which the brunt of the force will focus. This results in the scaphoid bone being the most often fractured of the wrist. The scaphoid is a small, oddly shaped bone whose purpose is to facilitate mobility rather than confer stability to the wrist joint, so it is often the weak link. Interestingly, scaphoid fracture is one of the most frequent causes of medico-legal issues.

44 Anatomical Snuffbox An interesting anatomical anomaly in the vascular supply to the scaphoid is that blood enters the scaphoid distally. In the event of a fracture, the proximal segment of the scaphoid will be devoid of a vascular supply, and avascular necrosis (death of tissue from lack of blood supply) will occur if action is not taken. When a bone dies from lack of blood supply the condition is called osteochondritis dessicans. Due to the small size of the scaphoid and its shape, it is difficult to determine, early on, whether or not the scaphoid is indeed fractured with an x-ray. Pain in the anatomical snuffbox is a presumptive diagnosis of a fracture. The patient would then be sent to get an MRI.

45 Fracture Surgery Video

46 Joints and Articulations

47 Joints And Their Classification
A joint, or articulation, is any point at which two bones meet, regardless of whether they are movable at that point The science of joint structure, function, and dysfunction is called arthrology The study of musculoskeletal movement is kinesiology

48 Joints And Their Classification
Kinesiology is the scientific study of human movement. Kinesiology addresses physiological, mechanical, and psychological mechanisms. Applications of kinesiology to human health include: biomechanics and orthopedics, strength & conditioning, sport psychology, rehabilitation, such as physical and occupational therapy, as well as sport and exercise. Individuals who have earned degrees in kinesiology can work in research, the fitness industry, clinical settings, and in industrial environments. Kinesiology is a branch of biomechanics, which deals with a broad range of motions and mechanical processes in the body.

49 Joints are associated with these:
Tendons bind a muscle to bone Ligaments bind bone to bone Both are dense regular connective tissue Muscles origin insertion action

50 CLASSIFICATION OF Joints: Two ways
1. What type of movement does the joint allow? No movement, limited movement, free movement 2. What tissue joins the bones? Fibrous Joints Fibrous connective tissue (dense regular CT) suture, tooth, ligament Cartilaginous Joints Fibrocartilage (vertebral discs, pubic symphysis) Hyaline cartilage, no capsule (epiphyseal plate, costal cart) Synovial: Hyaline cartilage with a capsule

51 Types of Movement Synarthrotic immoveable, allows no movement
Amphiarthrotic allows only limited movement Diarthrotic freely moveable

52 Fibrous Joints A fibrous joint is two bones joined by fibrous connective tissue. Dense regular connective tissue No joint cavity Some fibrous joints are immoveable (sutures and gomphoses) and some are slightly moveable (regular ligaments) A joint with a regular-length ligament is called a syndesmosis.

53 Types of Fibrous Joints
Sutures (immoveable = synarthrotic) Gomphoses (immoveable = synarthrotic) Syndesmoses (slightly moveable = amphiarthrotic)

54 Suture In sutures and gomphoses, the fibers are very short and allow for no movement.

55 Craniosynostosis Craniosynostosis is a condition in which one or more of the fibrous sutures in an infant skull prematurely fuses by turning into bone (ossification), thereby changing the growth pattern of the skull. It may result in increased intracranial pressure leading possibly to visual impairment, sleeping impairment, eating difficulties, or an impairment of mental development combined with a significant reduction in IQ.

56 Gomphosis Tooth sits like a peg in a socket.
The peridontal ligament holds it in place. This is also immoveable.

57 Syndesmosis A syndesmosis is a joint in which the two bones are connected by a regular length ligament The ligament fibers are longer than a suture or gomphosis These joints are slightly movable (amphiarthrotic)

58 CLASSIFICATION OF Joints: Two ways
1. What type of movement does the joint allow? No movement, limited movement, free movement 2. What tissue joins the bones? Fibrous Joints Fibrous connective tissue (dense regular CT) suture, tooth, ligament Cartilaginous Joints Fibrocartilage (vertebral discs, pubic symphysis) Hyaline cartilage, no capsule (epiphyseal plate, costal cart) Synovial: Hyaline cartilage with a capsule

59 Cartilaginous Joints A cartilaginous joint is two bones joined by cartilage. The cartilage is either fibrocartilage or hyaline cartilage. Fibrocartilage joints (symphyses) are amphiarthrotic (slightly moveable). Examples are intervertebral discs and the pubic symphysis Hyaline cartilage joints (synchondroses) are synarthrotic (immovable). Examples are epiphyseal plates and costal cartilages Therefore, one type of cartilaginous joint is slightly moveable (fibrocartilage) and one type of cartilaginous joint is immovable (hyaline)

60 Symphysis In a symphysis, two bones are joined by fibrocartilage.
A symphysis is amphiarthrotic: slightly moveable

61 Synchondrosis A synchondrosis is a joint in which the bones are bound by hyaline cartilage (with no capsule) A synchondrosis is synarthrotic: not moveable. A synchondrosis is synarthrotic

Function is for shock absorption and a little movement. Made up of outer ring of fibrocartilage called the ANNULUS FIBROSIS, and the middle section is elastic cartilage called the NUCLEUS PULPOSIS, which provides the cushion. Why do we need an annular fibrosis ring? The nucleus pulposis is like a rubber ball. When you compress it, it can be flattened. The ring keeps it from compressing all the way.

63 Intervertebral Discs

64 Intervertebral DiscS

65 Herniated Disc HERNIATED intervertebral disc happens when stress is put on it the wrong way. When you bend forward, the disc compresses anteriorly. If there’s a weakness in the posterior region, the annulus fibrosis tears, and the nucleus pulposis herniates (pokes out) posteriorly. It can press on the spinal nerves or spinal cord and cause a lot of pain or some paralysis. Improper lifting and pushing with the back can cause this. One treatment is to put a metal rod in to maintain the distance between the discs. Another treatment is a laminectomy, where the lamina is removed from the vertebra to make more room for the herniation so the nerves are not pinched.

66 Herniated Disc Herniated Disc Model

67 CLASSIFICATION OF Joints: Two ways
1. What type of movement does the joint allow? No movement, limited movement, free movement 2. What tissue joins the bones? Fibrous Joints Fibrous connective tissue (dense regular CT) suture, tooth, ligament Cartilaginous Joints Fibrocartilage (vertebral discs, pubic symphysis) Hyaline cartilage, no capsule (epiphyseal plate, costal cart) Synovial: Hyaline cartilage with a capsule

68 Synovial Joints The most familiar type of joint and the most common. It allows a wide range of motion so it is functionally classified as a diarthrotic joint (a diarthrosis) Examples include the elbow, knee, knuckles, the joints between the wrist and ankle bones Synovial joints are the most structurally complex type of joint, (having a joint cavity, nerves, blood vessels, ligaments) and are the most likely to develop uncomfortable and crippling dysfunctions.

69 Synovial Joint characteristics
Enclosed chamber, flexible fibrous capsule (dense irregular CT) A cavity filled with fluid, synovial fluid An inner membrane that produces lubricating fluid, synovial membrane Articular cartilages covering ends of bones Reinforcing ligaments to stabilize Innervated (nerves go to the joint) and vascular

70 Synovial Joint Structure
These surfaces are separated by a narrow space, the joint (articular) cavity, containing a slippery lubricant called synovial fluid. This fluid is rich in albumin (a protein) and hyaluronic acid (an oil), which give it a viscous, slippery texture. It nourishes the articular cartilages, removes their wastes, and makes movements at synovial joints almost friction-free. In synovial joints, the facing surfaces of the two bones are covered with articular cartilage, a layer of hyaline cartilage about 2 mm thick. The SYNOVIAL MEMBRANE lines the inside of the capsule and is what makes the SYNOVIAL FLUID.

71 SYNOVIAL fLUID Lubricates the joint, allows smooth movement. Its viscosity (thickness) changes with pressure, so bones will never touch, even when you jump up and down. Nourishes articular cartilage (which is avascular). Every movement puts pressure on joint, forcing nutrients into cartilage. Therefore, you need pressure on joints to feed the cartilage. DEMO with cornstarch

72 Capsule The capsule is connective tissue (articular capsule) encloses the cavity and retains the fluid. It has an outer fibrous layer, which acts like a sleeve; it is continuous with the periosteum of the adjoining bones, and an inner layer, cellular synovial membrane.

73 Synovial Joint Structure
In several synovial joints, fibrocartilage grows inward from the joint capsule and forms a pad between the articulating bones. When the pad crosses the entire joint capsule it is called an articular disc, or a MENISCUS. Some joints (such as the knee) use these MENISCI to act as a guide for movement of the bones to prevent unwanted movement such as lateral movement in the knee (Common injury).

74 LIGAMENTS The joint capsule alone is not strong enough, so there are reinforcing LIGAMENTS, which provide most of the strength of holding the bones to bones. They are dense regular connective tissue. In the knee joint, the collateral ligaments are the main ligaments that keep the knee from moving medially to laterally.

75 Ligaments take a long time to heal if torn because they do not have blood vessels of their own, like bones do. They already have enough fibroblasts (which make collagen), so they eventually can heal. It might be better to break a bone than tear a ligament because bones have a better blood supply and heal faster. SPRAINS: are tears in a ligament, and are fairly serious. When a ligament is sprained, it can take 6 months to heal (or maybe never), and may even need surgery. Even with a partial tear, you have to be careful; the joint becomes unstable and can easily be re-injured. STRAIN: is a tear in a muscle, and is not as bad because it has good circulation and heals faster. If you can walk on it and it heals in a couple of days, it’s a strain.

76 Ligaments of the Ankle Joint

77 Ligaments of the Ankle Joint

78 BURSAE A BURSA is a sack of synovial fluid that is involved in lubrication by serving as a cushion between a muscle/ligament or tendon/bone, etc. It does not need to be attached to any bone; it is like a pillow between the muscle and bone. Bursae cushion muscles, help tendons slide more easily over the joints, and sometimes enhance the mechanical effect of a muscle by modifying the direction in which its tendon pulls. The inside of a bursa is lined by a synovial membrane which makes the synovial fluid inside the bursa. This fluid can be produced in excess during overuse, causing the bursa to swell and pinch the nerves in the area. What’s an inflamed bursa called? Bursitis. Crackling sounds in joints (cracking your knuckles or back) are from the release of nitrogen gas bubbles in the synovial fluid. It does not lead to arthritis.

79 Bursae and Tendon Sheaths
Tendon sheaths are also filled with synovial fluid, and can become inflamed with overuse.

80 Synovial Joint Bursitis is inflammation of a bursa, usually due to overexertion of a joint. Tendinitis is a form of bursitis in which a tendon sheath is inflamed

81 Types of Synovial Joints
There are six types of synovial joints, characterized by the motion allowed by the shapes of the bones. Plane Hinge Pivot Condyloid Saddle Ball and socket

82 Plane Joints Movement in only one plane: transverse or frontal plane.
Examples: The carpal and tarsal bones The superior and inferior articular processes between vertebrae.

83 Hinge Joints Movement in only one plane: sagittal plane. Examples:
The elbow, knee, and IPJ = interphalangeal (finger and toe) joints

84 Pivot Joints Allows only rotational movements, and the rotational movement is in only one plane: transverse plane. Examples: Axis and Atlas vertebrae Proximal radioulnar joint, where the annular ligament on the ulna encircles the head of the radius

85 Condyloid Joints One bone is shaped like a rounded flask, the other like a cup. Movement in two planes (biaxial) Example: Metacarpal-phalangeal joints (MPJ’s): these are biaxial condyloid joints

86 Saddle Joints Movement in two planes (biaxial)
Each joint surface is both convex in one plane and concave in the other. They fit together like a rider on a saddle. Examples are at the base of the thumb (between the trapezium and metacarpal I). Saddle joints are biaxial joints; in primate anatomy, allows for the opposable thumb

87 Ball and Socket Joints Movement in all three planes
Shoulder and hip joints are ball and socket. This type of joint is multiaxial.

88 Important Synovial Joints
Tempomandibular Joint Knee Joint Hip Joint Shoulder Joint

89 The Temporomandibular Joint (TMJ)
Figure 9.9a, b

90 Dislocatable TMJ VIDEO

91 Common Causes of Elbow Pain
Fractures, ligament sprains and muscle and tendon tears Dislocation; usually caused by a fall. Children may dislocate the head of the radius from being pulled by the arm (nursemaid’s elbow). Tennis elbow (lateral epicondylitis) from forceful extension of wrist; wrist extension is painful. Diagnose by resisting extension of third finger, creating pain in lateral epicondyle. Golfer's elbow (medial epicondylitis) from repeatedly flexing wrists or clenching fingers Olecranon bursitis — inflammation of a small sac of fluid (olecranon bursa) on the tip of your elbow Nursemaid’s Elbow

92 Treatment of Elbow and Wrist Pain
Splinting Forearm support bands Taping Ultrasound Oral anti-inflammatory medicines Cortisone injections

93 Elbow and Wrist Splints
Tennis elbow splint Carpal Tunnel forearm splint

94 The Knee Joint The largest and most complex diarthrosis of the body
Hinge joint, but has movements of gliding, rolling and rotation 3 articulations: Lateral condyles of femur and tibia Medial condyles of femur and tibia Patella and femur. Note: Fibula does not articulate with the femur, only with the tibia.

95 Extracapsular ligaments OF THE KNEE
Patellar ligament (patellar tendon) Medial collateral ligament Lateral collateral ligament

96 Two ligaments lie outside the joint capsule:
tibial (medial) collateral ligament. fibular (lateral) collateral ligament The two collateral ligaments prevent the knee from rotating when the joint is extended.

97 Intracapsular ligaments of the knee
There are two ligaments that lie inside the joint capsule. They are deep within the joint cavity, but they are not inside the fluid-filled synovial cavity. These ligaments cross each other in the form of an X: anterior cruciate ligament (ACL) posterior cruciate ligament (PCL)

98 Intracapsular ligaments
Anterior cruciate ligament (ACL) Weaker of the two cruciates Slack when knee is flexed, taut when fully extended Prevents posterior displacement of femur and hyperextension of knee joint Posterior cruciate ligament (PCL) Taut during flexion, prevents anterior displacement of femur on the tibia Is the main stabilizing factor when weight-bearing during flexed knee position (ie. Walking downhill.)


100 Menisci of the knee Medial and Lateral Menisci Crescent (C-) shaped plates of fibrocartilage located over the medial and lateral tibial condyles They attach to the intercondylar eminance on the top of the tibia. Act like shock absorbers Thicker laterally, taper to thin unattached edges at interior of the joint.

101 In the knee, two fibrocartilages extend inward from the left and right but do not entirely cross the joint Each is called a meniscus Menisci absorb the shock of the body weight on the knee and prevent the femur from rocking from side to side on the tibia.

102 Anterior View of Flexed Knee
Figure 9.14e, f


104 Hip Joint The main factor responsible for stabilizing the hip joint is not the ligament at the fovea capitis inside the articular capsule. It is also not stabilized by the deep socket. The ligaments around the head of the femur give it stability. Figure 9.13a, b

105 Posterior View of the Hip Joint
Figure 9.13c, d

MPJ: Metacarpal phalangeal joints (fingers) or metatarsal phalangeal joints (toes). IPJ: Interphalangeal joints (knuckles of fingers and toes) There are two types of IPJ’s DIPJ: distal knuckles PIPJ: proximal knuckles The thumb (pollex) and big toe (hallux) knuckle is just called its IPJ, but the knuckles of the other digits are identified specifically as a DIPJ or PIPJ


108 osteoaRTHRITIS OSTEOARTHRITIS: more common the older you get.
The articular cartilage begins to break down, and bone spurs start to grow. The surface is no longer smooth, and movement now causes pain and crepitus (creaking sound). It is also known as “wear and tear” arthritis. This is the most common disorder of joints. Can be mild to severe, needing joint replacement. These people can actually predict the weather, since the synovial fluid is under pressure. As air pressure changes, fluid expands and hurts more. Right before a rain, the pressure builds up and hurts more. As soon as it starts raining, pressure goes down and the pain is better.

109 Hip Replacement

110 RHEUMATOID ARTHRITIS RHEUMATOID ARTHRITIS: not a disease of old age. It’s an autoimmune disease where body attacks and destroys the cartilage in synovial joints. It is not known for spur formation, unlike osteoarthritis. It is degenerative in nature. They swell and become unusable, causing knarled hands and feet. Usually need joint replacements, but artificial joints only last about 15 years. If the first replacement is at age 60, that is ok, but if the first replacement is at age 30, the next at age 45, the next at age 60, the bone will degrade on the third one, and may no longer take the stem of the implant. The stem of the implant will break through the shaft of the bone.

111 Rheumatoid Arthritis

Gout is caused by a genetic error in the metabolism of uric acid. A gouty episode is triggered by eating too much red meat or other protein. It was more common years ago when people ate nothing but meat. The breakdown product of proteins is urea, which leads to uric acid crystals in the cooler areas of the body, especially the MPJ’s (metatarsal-phalangeal joints) of the base of the big toes. The crystals poke the cartilage like needles and cause the joint to swell up. Gout is not known for spur formation, unlike osteoarthritis Gout Prevention Diet a-simple-gout-prevention-diet/

113 OTHER BONE DISORDERS Osteomalacia (“malformed bones”) is a genetic malformation of the bones. The epiphyseal plates are particularly affected. Rickets is a type of osteomalacia that is NOT genetic; it is caused by lack of vitamin D. Like all types of osteomalacia, rickets also particularly affect the epiphyseal plates.

114 OTHER BONE DISORDERS Osteomalacia (genetic) Rickets (not genetic)

115 Osteomyelitis is an infection of bone.
OTHER BONE DISORDERS Osteomyelitis is an infection of bone.

116 OTHER BONE DISORDERS Achondroplasia is a genetic condition where the bones don’t develop properly, especially in the epiphyseal plates, and causes a type of dwarfism.

Means a problem with the cartilage of the patella. Chondromalacia patella is a condition in which the patella rubs on the femur in the knee joint, becomes scratched or deformed, causing pain. Don’t get this confused with achondroplasia, which is dwarfism! Exercises for chondromalacia Resurfaced patella, post-op

118 World’s smallest people
World’s Smallest Man World’s Smallest Women

119 It is characterized by excessive bone deposition.
OTHER BONE DISORDERS Paget’s disease is more common in older persons, and may be related to a viral infection. It is characterized by excessive bone deposition.

120 Paget’s disease

121 OTHER BONE DISORDERS ANKYLOSING SPONDYLITIS (AS): is a disorder in which vertebrae bind strongly together to limit the flexibility of the spine.

122 Psoriatic arthritis Develops in about 30% of people who have the chronic skin condition psoriasis. Diagnostic feature is a “Pencil in cup” appearance on X-ray on the MPJ’s Often accompanied by psoriatic nails, which look like fungus but are not.

123 OTHER JOINT DISORDERS Synovitis is inflammation of the synovial tissues. May need cortisone injections. Arthroplasty is a surgical procedure to repair or remodel a damaged joint. Lyme disease is an inflammatory arthritis of the knee joint, caused from a bacterial infection after a tic bite.

124 Polydactyly (Many digits)
The extra digit is usually a small piece of soft tissue; occasionally it contains bone without joints; rarely it may be a complete, functioning digit. The extra digit is most common on the ulnar (little finger) side of the hand, less common on the radial (thumb) side, and very rarely within the middle three digits. These are respectively known as postaxial (little finger), preaxial (thumb), and central (ring, middle, index fingers) polydactyly. Polydactyly can occur by itself as an autosomal dominant mutation in a single gene. But, it usually is one feature of a syndrome of congenital anomalies. 1 in every 500 live births

125 Polydactyly (Many digits)

126 Polydactyly (Many digits)

127 Born with two thumbs!



130 Syndactyly (Fused digits)
In fetal development, syndactyly is normal. At about 16 weeks of gestation, an enzyme dissolves the tissue between the fingers and toes, and the webbing disappears. In some fetuses, this process does not occur completely between all fingers or toes and some residual webbing remains. Simple syndactyly can be full or partial, and is present at birth (congenital).

131 Syndactyly (Fused digits)
Due to an abnormal gene on chromosome 2, 6, or 7, depending on which fingers are fused. Syndactyly can be simple or complex. In simple syndactyly, adjacent fingers or toes are joined by soft tissue. In complex syndactyly, the bones are fused. Syndactyly can be complete or incomplete. In complete syndactyly, the skin is joined all the way to the tip of the finger In incomplete syndactyly, the skin is only joined part of the distance to the fingertip.

132 Syndactyly (Fused digits)

133 Syndactyly (Fused digits)
Complex syndactyly occurs as part of a syndrome (such as Apert's syndrome) and typically involves more digits. Apert Syndrome is syndactyly with malformations of the skull, caused by an abnormal gene on chromosome 10.

134 Apert syndrome

135 Syndactyly (Fused digits)
Fenestrated syndactyly means the skin is joined for most of the digit but in a proximal area there is gap in the syndactyly with normal skin. This type of syndactyly is found in amniotic band syndrome.

136 Amniotic band syndrome
Congenital disorder caused by entrapment of fetal parts (usually a limb or digits) in fibrous amniotic bands while in utero.

137 Polysyndactyly

138 This man fell off a 50 foot cliff while rock climbing











149 The rest of this PPS is NOT on the exam
The rest of this PPS is NOT on the exam. It is for your information only!

150 There is a disc between each bone in the spine.
The nerves exit the bone to supply all the parts of the body.

151 If you choke off a nerve by twisting the bone around it,
the bone starts to crush the nerve. Just like a light with a dimmer switch; if you turn the electrical current down, the light won’t shine as brightly. If you cut off some of the nerve supply to an organ, the organ isn’t going to function as well.

152 The discs are made out of something like jelly
The discs are made out of something like jelly. As long as your spine is aligned, the jelly will stay in the center. But if the spine becomes twisted, the jelly will get pushed in the opposite direction, and the shock absorption will be lost.

153 TEARS IN THE DISC If you lift a box while you are standing and twisting, that’s when you get tears in the disc. The fluid in the disc begins to leak out the side of the disc.

154 “Wear and Tear” Arthritis Or Degenerative Arthritis
Osteoarthritis Also Known As: “Wear and Tear” Arthritis Or Degenerative Arthritis Occurs when cartilage wears away, leaving raw bone to rub against raw bone.

Phone headset for hands-free use Computer at eye level and 18-25” away from your face Chair with good lumbar support or $10 lumbar pillow Keyboard pad under your wrists The front of the chair should drop off Adjustable seat: Feet flat to the floor Or a foot rest under the feet



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