Disorder:
Spina Bifida
Scoliosis
Kyphosis
Lordosis
Manifestations
Failure of the two sides of the vertebral arches to fuse; open vertebral canal
Abnormal lateral curvature of the vertebral column; involves the right and left sided curvature and rotation of one vertebra upon another
Abnormal curvature of the vertebral column in the thoracic region, producing a hunchback deformity
Herniation of Intervertebral Discs
Abnormal curvature of the vertebral column in the lumbar region producing a swayback deformity
A tear can occur within the annulus fibrosis through which the gelatinous material of the nucleus pulposus can track and eventually impinge upon neural structures
Injury
Site of Injury
How does this occur?
Associations Misc.
Clavicle Fracture
Dislocation of
Acromioclavicular
Joint
Junction of the middle and lateral thirds
Acromioclavicular joint
Shoulder separation as a result of direct trauma
Commonly associated with rupture of the coracoclavicular ligament
Most commonly fractured bone
Results in elevation and upward subluxation of the clavicle
Dislocation of
Sternoclavicular
Joint
Sternoclavicular joint
Rare;
Dislocation is typically in the ventral direction
Fracture of the
Humerus
Distal to the deltoid tuberosity
Deviation of the proximal segment laterally by the deltoid and supraspinatous

Fracture of the
Humerus
Rotator Cuff
*Shoulder
Dislocation
Subacromial
Bursitis
Proximal to the
Deltoid tuberosity
Occur in violent or repeated abduction above
90 degrees
Anterior shoulder
(constitute 90% of all shoulder dislocations)
Posterior = 10%
Subacromial
Bursa (located inferior to the
Acute fall on the outstretched hand
Traumatic impact on abducted and laterally rotated arm and extended forearm
Inflammation presents with localized
Produces rupture of one or more of the rotator cuff muscles; Pain = limited ability to abduct the arm
When the arm is abducted and laterally rotated the subscapular muscle moves upward removing the needed muscular protection from the anterior surface of the joint
Associated with supraspinatus tendonitis or and the distal segment superomedially by the pull of the triceps, biceps and coracobrachialis
Deviation of the proximal segment medially
(adducted) by the pull of the
Pec. Major and
Teres major and displacement of the distal segment laterally and superiorly by the pull of the
Deltoid
Rotator cuff tendonitis = elderly
Initially the dislocated humeral head assumes subglenoid position and then it may take subcoracoid position

Paralysis of
Serratus Anterior acromion)
Serratus Anterior pain and tenderness upon abduction from 50 to
130 degrees
Results in protrusion of the inferior angle of the scapula
(Winged-
Scapula) – becomes prominent on protraction tear
Site of Injury
Anterior Brachium – Biceps Brachii
Manifestation
Long head may rupture in swimmers and baseball players as a result of tendonitis and when forceful flexion occurs against excessive resistance
Injury
Fracture of Medial
Epicondyle of the Humerus
Cause
Lateral epicondylitis (tennis elbow)
Supracondylar Fracture of the Distal End of the
Humerus
Occurs secondary to chronic and repeated flexion; usually follows prolonged rotary motion of the forearm
Constant pull on the origin of the extensor muscles
Displacement of the proximal segment is most likely to cause rupture of the brachial artery and injury to the radial and median nerves
Affect
Cause damage to the ulnar nerve
Inflammation of the origin of the common extensor muscle and occasionally of the extensor carpi radialis brevis; pain is felt over the lateral humeral epicondyle and at the elbow
The triceps would pull the distal fragment posteriorly, while the proximal segment would be displaced anteriorly by the biceps brachii and coracobrachialis
Valgus angle between distal end of humerus and proximal ends of the radius and ulna
Fractures of the Head and
Occurs as a result of prior trauma
Occurs upon a fall on Associated with painful

Neck of Radius outstretched hand with forearm flexed and partially pronated supination; severe fractures are frequently accompanied by posterior dislocation of the elbow joint
Fractures of the Radial
Body
Radial shaft fractures are nearly always associated with displacement due to muscular pull
A fracture line Proximal to the insertion of the pronator teres and distal to the insertion of the biceps brachii
A fracture line distal to the insertion of the pronator teres
*Colles Fracture
Mallet or Baseball Finger
DeQuervain’s
Tenosynovitis
The proximal segment supinates and the distal fragment pronates
The proximal segment remains in situ by the contraction of the biceps and pronator quadratus
Occurs in traumatic fall on an outstretched hand as a result of slipping or tripping
Results from hyperflexion of the distal interphalangeal joint and avulsion of the long extensor tendon at its attachment to the base of the distal phalanx
Repetitive use; wringing;
Pain over the thumb and wrist; positive Finkelstein’s test
Associate with complete transverse fracture of distal part of radius
Distal fragment protrudes proximally and dorsally causing shortening of the lateral part of the hand, giving the appearance of
*DINNER FORK
DEFORMITY due to the reversed relationship between the distal end of the radius and ulna
Ulnar styloid process is usually avulsed
Median nerve may be injured
Commonly occurs when a finger is jammed against a base pad.
Cannot extend the distal interphalangeal joint and the affected finger resembles a mallet
Stenosing tenosynovitis of the Abductor Pollicis
Longus (APL) and
Extensor Pollicis Brevis

Intersection Syndrome
Bursitis “Student’s elbow
Subtendinous Olecranon
Bursitis
Bicipital Bursitis
Dislocation of the Elbow
Joint
Elbow Dislocation
Pulled Elbow
Injury & Site
Scaphoid Fracture
(EPB) distal to the styloid process of the radius
Inflammatory Condition
1 st extensor department
- APL/EPB
Radial wrist extensors
- ECRB/ECRL
Squeakers Syndrome
Inflammation of the subcutaneous olecranon bursa. Occurs as a result of trauma to the elbow as a sequel to fall or repeated and sustained excessive pressure
Results from friction between the triceps and olecranon subsequent to repeated flexion and extension
Occurs between the radial tuberosity and the biceps brachii tendon.
Posterior dislocation occurs as a result of hyperextension or direct blow to the elbow joint that forces the ulna posteriorly and the distal end of the humerus anteriorly through the fibrous capsule
2 nd
most common injury;
Posterolateral Rotatory
Hyperextension
Pain is pronounced during flexion.
Produces pain upon pronation
Associated with rupture of the ulnar collateral ligament, fracture of the head of radius, coronoid or olecranon process of the ulna, and ulnar nerve palsy
LCL complex injury;
MCL is often injured
Stable in flexion; reduce in extension
Characterized by subluxation of the radial head through the annular ligament
Cause
Occurs as a result of sudden jerk on the arm of a child
A fall on the outstretched hand
Wrist sprain as a result of hyperextension injury
Effect
Swelling and tenderness occur over the anatomic snuffbox; may lead to avascular necrosis because of frequent transection of

*Colle’s Fracture – fracture of the distal end of the radius
Lunate – rarely fractures; commonly dislocates
Hamate
*Carpal Tunnel Syndrome
Most common neuropathy of the hand
Gamekeeper’s Thumb
(Skiers Thumb)
Jersey Finger
Dupuytren’s Contracture
(Palmar Fibromatosis)
Fall on outstretched, extended and abducted hand
Fractures = direct trauma to the adducted wrist
Dislocation = fall on the dorsiflexed hand the nutrient artery
The fractured distal segment displaces dorsally and the hand assumes
DINNER FORK appearance;
Distal end of the ulna and scaphoid may fracture
Dislocated lunate produces shortening of the 3 rd metacarpal bone and paresthesia in the cutaneous area of the median nerve
Hamulus of the hamate and pisiform bone forms the canal of Guyon – a common site of ulnar nerve entrapment –
HANDLEBAR neuropathy
A unilateral condition affecting the dominant hand; occurs in pregnancy, heart failure, Colle’s fracture
Characterized by acroparasthesia; nocturnal pain; atrophy of thenar muscles; ape-hand configuration; opposition and thumb abduction are commonly affected
Minor tear or rupture of the ulnar collateral ligament of the MCP joint of the thumb;
Fracture of the base of proximal phalanx due to acute radial abduction may also occur
Patient experiences pain on the ulnar side of the joint and inability to grip
Closed avulsion of the insertion of Flexor
Digitorum Profundus (FDP) tendon on the 5 th
or 4 th
digit
Characterized by progressive painless thickening of the medial bands of the palmar aponeurosis
The FDP maximally contracts while the finger is forcibly extended by acceleration of the opposing player; pain and inability to flex the DIP joint of the injured finger
The fifth and fourth digit assume flexed positions at the MP and PIP joints by the pull of the shortened aponeurotic bands

Volkmann’s Ischemic
Contracture
Fibrosis of the muscles of the forearm as an end result of ischemic necrosis
Caused by tight cast at the elbow or tourniquet on the upper arm
FDP and FDS muscles are shortened leading to wrist flexion contracture and clawing of the fingers; passive extension of the fingers usually produces pain in the forearm;
Pain, swelling, pallor, pulselessness, and paralysis
Mallet Finger
Deformity that results from rupture of the extensor digital expansion that attaches to the base of the distal phalanx
Avulsion fracture of the base of the distal phalanx and dislocation of the DIP joint may occur
Swan Neck Deformity
Chronic case of mallet finger, spasticity and malunion of the fracture of the middle phalanx
Drooping of the DIP joint and extensor imbalance in the affected finger:
Characterized by hyperextension of the PIP joint, flexion of the metacarpal and DIP joints
Disorder
Craniosynostosis
Scaphocephaly (abnormally elongated skull)
Bell’s Palsy
Dislocation or Hardening of TMJ or
Manifestation
Premature closure of one or more of the cranial sutures
Premature closure of the sagittal suture allows growth of the skull parallel to the sagittal suture
Brachycephaly (abnormally broad skull) Premature closure of the coronal suture
Skull that results from premature fusion
Acrocephaly of the coronal and lambdoid sutures
Craniofacial dystosis
Premature closure of all sutures and is associated with hydrocephalus
Trauma to Scalp
May cause extravasated blood to enter the loose connective layer and seeps anteriorly toward the orbit and eye producing “black eye”
The loose CT layer communicates with emissary veins allowing for a route of spread of infection from the extracranium to the cranial cavity
Paralysis of the buccinator muscle leading to accumulation of food between the cheek and teeth
This can injure the auricotemporal nerve

Fracture
Epidural Hematoma
Mandibular Nerve Palsy
Neck Wounds
Torticollis (Wryneck)
Exudates posterior to the Prevertebral
Fascia
*Thoracic Outlet Syndrome and causes pain that radiates to the ear and external acoustic meatus
Temporary loss of consciousness; lucid intervals; ICP increase – Papilloedema; uncal herniation; oculomotor nerve palsy
(fixed-dilated pupil); acute epidural hematoma exhibits convexity toward the brain in CT scan
Deviation of the mandible; atrophy of muscles of mastication; hyporeflexia
(Jaw-jerk reflex)
Neck wounds require the platysma to be sutured with skin to enhance healing and prevent large scar formation
Spasmodic contracture of the SCM that produces twisting of the neck and slanting of the head away from the affected side; results commonly from fibroma pre or postnatally; excessive pull on the head of infant during delivery may damage the
SCM and produces torticollis; children with chronic trochlear nerve palsy may develop compensatory torticollis as a result of constant bending of the neck; dystonia involving the cervical muscles also produces torticollis; irritation of the spinal accessory nerve may also produce torticollis
Exudates as a result of TB, osteomyelitis, cancer or epidural metastasis may spread to the posterior neck, axilla, and posterior mediastinum, guided by the fascial continuation
Could result in pseudotumor, anterior cervical disc herniation, etc.
- Constellation of neurovascular manifestations associated with the root of the neck
- Occurs in individuals with cervical rib, healed clavicular fracture, abnormalities associated with the insertions of the anterior scalene muscle
- Fibrosis at the point of insertion of the anterior scalene can result in compression of the subclavian artery and inferior trunk of the brachial plexus (Scalene anticus

*Thoracic Outlet Syndrome syndrome)
- 90% of patients primarily present with neurogenic symptoms due to compression of the inferior trunk that include fatigue of the forearm muscles, paresthesia in the medial arm, intermittent or constant neck and shoulder pain. Hand pain is primarily restricted to the medial one and half of the hand
- Vascular manifestations include diminished radial pulse, pallor, coolness, and sensitivity to cold temperatures, and ischemic pain
- Hyperabduction of the arm may exacerbate the symptoms and diminishes radial pulse
- Adson’s test : diminution of radial pulse upon rotation of the head toward the ipsilateral side
Disorder
Appendicitis
Portal Hypertension
Manifestation
Initial phase produces pain in the paraumbilical area
Paraumbilical veins are distended and commonly associated with liver cirrhosis due to chronic alcoholism
Meckel’s Diverticulum
Referred Pain
Scarpa’s Fascia
Remnant of the vitelline duct
Assume the form of a cyst, open canal or fibrous cord
Inflammation mimics signs and symptoms of appendicitis
Pleural irritation as a result of inflammation of the pleura may cause pain sensation in the anterior abdominal wall
Dislocation of the ribs may also produce pain that radiates to the abdomen
Periumbilical pain is associated with the initial phase of appendicitis
Rupture of the urethra can result in extravasation of blood and urine into the superficial perineal pouch
Accumulated blood and urine within this pouch spread into the anterior abdominal wall guided by the

Conjoint Tendon
Processus Vaginalis
Cryptorchidism
***Hernia
Umbilical Hernia
Omphalocele
Inguinal Hernia
Indirect Inguinal Hernia continuation of Colle’s fascia with the
Scarpa’s fascia
Attaches to the pubic crest posterior to the superficial inguinal ring, providing a natural barrier that prevents the occurrence of inguinal hernias
Failure of the processus vaginalis to close allows part of a viscera to protrude through the deep inguinal ring and follow the course of the inguinal canal to the superficial inguinal ring, producing INDIRECT inguinal hernia
Maldescent of the testis; assume abdominal, inguinal, femoral and perineal testis
Refers to protrusion of viscera or part of viscera through a weak area which normally does not traverse
Herniation may occur through the inguinal canal, lumbar trigone, femoral canal, or the umbilicus or as a postsurgical complication
Protrusion of the herniated sac through the umbilicus
Physiologic herniation that occurs around the 6 th
week of development
Involves herniation of intestine that returns into the abdominal cavity around the 10 th
week
Retention of the herniated intestine beyond the 10 th
week leads to the formation of omphalocele
Refers to protrusion of a viscera or part of a viscera from the superficial inguinal ring•
Indirect inguinal hernia denotes a hernial sac that follows the entire course of the inguinal canal from the deep inguinal ring to the superficial inguinal ring
Direct Inguinal hernia or it passes only through the superficial inguinal ring without pursuing the hernia
Indirect inguinal hernial sac
Protrudes through the area lateral to

Direct Inguinal Hernia
Direct Inguinal Hernia
Femoral Hernia the inferior epigastric vessels and descends to the scrotum in the male and major labium in the female
Indirect inguinal hernia is common in all ages and both sexes
Hernial sac
Passes through the superficial inguinal ring only
May pass medial, lateral to or through the conjoint tendon
Hernial sac that pierces the conjoint tendon will be covered by the peritoneum as well as the conjoint tendon
Direct inguinal hernia occurs through Hesselbach's (inguinal)
triangle, which is bounded medially by the rectus abdominis, laterally by the inferior epigastric vessels, and inferiorly by the inguinal ligament
Direct inguinal hernia is less common than indirect inguinal hernia, usually affecting men over age 40, and is rare in women Hernial sac rarely extends to the scrotum and generally protrudes anteriorly
Protrudes inferior to the pubic tubercle through the space between the lacunar ligament and the femoral vein
Pubic tubercle acts as a bony landmark between the site of inguinal and femoral hernia Femoral hernias are more common in females due to the shape of the pelvis
Disorder/Injury
Head of Femur (Neck Fracture
Manifestation
Prone to avascular necrosis when the subcapital femoral neck fracture occurs
Coxa Vara
Coxa Vulga
(90-110 degrees): Occurs in adduction injuries, Slipping of the epiphysis & osteomalacia
(150-160 degrees): occurs abduction

Femoral Neck Fractures
Fractures of the Femoral Body:
Proximal Fracture
Fractures of the Femoral Body:
Middle Third Femoral Fracture
Fractures of the Femoral Body:
Distal Third
Anterior Hip Dislocation fractures
Advanced age, Osteoporosis and
Impaction fractures
Subcapital fracture-Intracapsular-
Transcervical (Mid neck) -capsular arteries
Both types are associated with delayed healing and subsequent avascular necrosis
Distal segment overrides the proximal segment- leads to shortening of the lower extremity
Trochanteric/ Intertrochanteric
Fractures occur in direct trauma-
Favorable outcome
1. Upper segment is abducted (lesser gluteals), Flexed (iliopsoas) and laterally rotated (gluteus maximus, piriformis, obturator internus, gemelli
& quadratus femoris)
2. Lower segment move medially by the action of the adductors
Associated with shortening of the limb
- Proximal segment displaces laterally and anteriorly by gluteus maximus and medius as well as the quadriceps femoris
- Distal segment is pulled medially and posteriorly by the action of the gastrocnemius
Fracture of the distal third is rare.
1. Proximal segment moves medial and anterior to the distal segment by the pull of the adductors and quadriceps
2. Distal segment displaces posteriorly by the gastrocnemius; may injure the popliteal artery
Femoral head dislocations are fairly uncommon
Anterior dislocation forms 10-15% of hip dislocations. Usually associated with acetabular fracture subsequent to trauma
In anterior dislocation the femoral

Posterior Hip Dislocation
Gluteus Maximus Palsy
Ischial Bursitis (Weaver’s Buttock)
Trochanteric Bursitis
Lesser Gluteal Muscles Palsy
Pulled Hamstrings
Pes Anserine Bursitis (site of Pes anserinus muscles) head dislocates medial to the
Iliofemoral ligament, and moves close to the Obturator foramen, inferior to the pubis
Occurs when the thigh is adducted and flexed and medially rotated- tear in the acetabular labrum and
Ligamentum teres femoris; Femoral head rests upon the ischium
• Loss of thigh extension
•
Inability to climb stairs
•
Atrophy of the Gluteus maximus
•
Loss of contour of the buttock
Inflammation of the ischial bursa between the ischial tuberosity and gluteus maximus
Occurs as a result of prolonged sitting on hard surface
Inflammation of the bursa between the greater trochanter and the gluteus maximus
Occurs as a result of repetitive contraction of the gluteus maximus:
Climbing stairs or running on a elevated treadmill
Refers to paralysis of the Gluteus
Medius and Minimus
Results in tilting of the pelvis toward the unsupported side when the foot is off the ground during walking
(Positive Trendelenburg Sign)
Tearing or avulsion of the hamstrings from the ischial tuberosity, and is associated hematoma
Incidence of pes anserine bursitis is higher among obese middle-aged women. This prevalence of women may be because of the broader female pelvis and greater angulation of the leg at the knee, placing additional stresses on these structures
Disorder/Injury Manifestation
Osgood-Schlatter Disease
Tibia could be the site of Osgood-
Schlatter disease that affects age (10-

Fractures of the Tibia
Fractures of the Tibia
March Fractures (Tibia Fracture)
Bumper Fractures
Spiral Fracture
Neck of Fibula
Potts Fracture
Osteochondritis
Patella
Genu Valgum
Genu Varum
15) due excessive pull of the patellar ligament on the tibial epiphysis
Fractures that involve the nutrient canal compromise union of the fractured fragments
Fractures and rickets commonly occur at the narrowest area of the tibial body (junction of middle and lower
1/3)
Long walk; sudden turning of the body when the foot is fixed
Direct trauma; anterior or posterior fall can also cause tibial fracture
Severe torsion during skiing and impact of ski boots applied to the tibia
Prone to fracture; encircled by the common peroneal nerve
Distal third of the shaft of fibula is most likely to fracture as a result of slipping while the foot is rigidly held in everted position, the tibia is internally rotated and the talus is pressed against the fibula
Osteochondritis occurs frequently, roughens the articular surface and produce pain. Fragments may cast off into the joint cavity, leading to painful internal derangement that locks the knee (inability to fully extend the knee)
Patellar fractures- usually simple transverse type
Patellar dislocation-uncommon
(knock knee): less common, may occur as a result of:
1. abnormal down growth of the medial femoral diaphysis. Self correct by the age of 9 year
2. complication of poliomyelitis or
Rickets
In this condition the foot is laterally deviated, everted and flattened
( talipes valgus )
(bow-leg) occurs in toddlers and is self correcting. Persistence of the condition is seen in tibial

Bakers Cyst or Popliteal Cyst
Tibial (Medial) Collateral Ligament
Fibular (Lateral) Collateral Ligament
Anterior Cruciate Ligament
Posterior Cruciate Ligament
Medial Mensicus
Lateral Meniscus
Tibialis Anterior Overuse
Anterior Compartment Syndrome osteochondrosis. Rickets should be ruled out
Herniation and synovial effusion seen in rheumatoid or degenerative disease
Ruptures when violent abduction strain is applied
Tears occur in violent adduction force applied to the extended knee
Complete tear may endanger the common peroneal nerve
Torn by violent hyperextension of the knee, anterior dislocation of the tibia on femur or posterior dislocation of femur on the tibia
Tears when the tibia dislocates posteriorly on the femur with the knee flexed
Ruptures in conjunction with the tibial collateral and the anterior cruciate ligament (unhappy triad) when the flexed knee is forcible abducted and externally rotated
It may be torn by a severe strain that involves adduction and internal rotation
Overuse produces shin splints
An acute increase in pressure in the anterior compartment of the leg
Bleeding or edema in this compartment causes severe ischemic changes to muscles, and compression of the nerves and blood vessels
Patients exhibit pain, pallor in the anterior leg
Diminished or complete loss of pedal pulse
Treatment- Fasciotomy
Torn in forceful and sudden inversion Peroneus (Fibularis Longus)
Disorder/Injury
Injury to the Common Fibular (peroneal) nerve
Manifestation
Paralysis of all muscles in the anterior and lateral compartments
Foot-drop
High stepping gait
Disorder/Injury
Manifestation

Lateral Collateral Ligament
Anterior talofibular ligament
Posterior talofibular ligament
Calcaneofibular ligament
Ankle Sprain
Eversion sprains (Potts fracture)
Talus Fracture
Calcaneous Fracture
Cuboid & Cuneiform
Metatarsals:
Limits inversion and plantar flexion
Commonly injured ligament weakest, prone to rupture in ankle inversion when the foot is plantar flexed strongest, resists anterior displacement of fibula; avulsed in dislocation can be torn in severe sprains, lateral ankle disability occurs when concomitant tear involves the calcaneofibular and the anterior talofibular ligaments
Sprains of ankle are the most common trauma affecting the ankle joint
Tear of a ligament with a concomitant fracture is known as a sprain fracture
Most sprains are of inversion type with a concomitant tear of the lateral collateral ligament (calcaneofibular and anterior talofibular ligaments)
Eversion sprains with a possible tear or avulsion of the medial collateral
(deltoid) ligament may be associated with pull off the medial malleolus and fracture of the distal end of the fibula as a result of downward and lateral displacement of the talus against the lateral malleolus (Pott’s fracture)
Fractures of the talus occur in violent dorsiflexion of the foot against the anterior edge of the distal tibia
Body fractures occur as a result of jumping from height
Falls from height drives the talus downward against the calcaneus and produce calcaneal compression fractures
Skin over the posterior surface of the calcaneus is a common site of decubiti
Fractures of the cuboid and cuneiforms seldom occur because of their protected position
Fatigue (stress, march) fractures in

5 th
metatarsal more prone to fracture
Phalanges
Metatarsophalangeal joints
Tarsal Joints
Hallux Valgus
Pes Planus (flat-foot)
Pes Cavus (claw foot) the metatarsals occur in young adults unaccustomed to vigorous physical activity and are radiographically invisible until healing calus appears
Phalangeal fractures are very common and usually results from violent crushing or stubbing injuries
First metatarsophalangeal joint is commonly affected in gout
Restricted movement of the second metatarsal bone at the MP joint makes it prone to stress (fatigue) fractures in strenuous activities
Mid (transverse) tarsal joint- consists of the talocalcaneonavicular and calcaneocuboid, allows inversion and eversion- subject to torsion injuries
Talocalcaneonavicular Joint - supported by the plantar calcaneonavicular (spring) ligamen
Refers to lateral deviation and deformation of the great toe at the MP
Joint and is associated with:
1. Short first metatarsal bone
2. Ill-fitting pointed shoes
3. aggravated by the pull of the flexor and extensor hallucis longus muscle
1. Depressed or collapsed longitudinal arch
2. Talus shifts medially between the calcaneus and navicular bones
3. Supporting ligaments and muscles are permanently stretched occurs as a result of muscle imbalance, e.g. secondary to poliomyelitis