39. Musculoskeletal Alterations Flashcards
1
Q
noncommunicating wound between bone and skin
A
closed fracture
2
Q
communicating wound between bone and skin
A
open fracture
3
Q
fracture with multiple bone fragments present
A
comminuted fracture
4
Q
fracture line parallel to long axis of bone
A
linear fracture
5
Q
fracture line at an angle to long axis of bone
A
oblique fracture
6
Q
fracture line perpendicular to long axis of bone
A
transverse fracture
7
Q
fracture line encircling bone
A
spiral fracture
8
Q
fracture fragments pushed into each other
A
impacted fracture
9
Q
fracture at a point where bone has been weakened by disease; can occur with normal weight bearing activity
A
pathologic fracture
10
Q
fragment fo bone connected to a ligament or tendon detaches from the main bone
A
avulsion fracture
11
Q
fracture wedged or squeezed together on one side of bone
A
compression fracture
12
Q
fracture with one, both, or all fragments out of normal alignment
A
displaced fracture
13
Q
fragment close to joint but remains outside of joint capsule
A
extracapsular fracture
14
Q
fragment within joint capsule
A
intracapsular fracture
15
Q
5 types of incomplete fractures
A
- greenstick - torus - bowing - stress - transchondral
16
Q
fracture where bone is broken entirely
A
complete fracture
17
Q
fracture where bone is damaged but still in one piece; occur more often in flexible, growing bones of children
A
incomplete fracture
18
Q
break in one cortex of bone with splintering of inner bone surface; commonly occurs in children and elderly
A
greenstick fracture
19
Q
buckling of cortex of a bone
A
torus fracture
20
Q
bending of a bone
A
bowing fracture
21
Q
microfracture
A
stress fracture
22
Q
separation of cartilaginous joint surface (articular cartilage) from main shaft of bone
A
transchondral fracture
23
Q
diseases that cause pathologic fractures
A
- osteoporosis - RA - Paget disease - osteomalacia - rickets - hyperparathyroidism - radiation therapy - cancer - infection
24
Q
healing that occurs when adjacent bone cortices are in contact with one another; usually due to surgical fixation and restriction of movement between fragments
A
direct/primary healing
25
healing that involves both intramembranous and endochondral bone formation, development of callus, and bone remodeling; occurs in fractures that are treated with non-rigid or semi-rigid bone fixation (casts, braces, etc.)
indirect/secondary healing
26
T/F: both direct and indirect fracture healing involve callus formation
False; only indirect
27
List the 5 steps of callus formation
- hematoma formation - organization of hematoma into fibrous network - invasion of osteoblasts; lengthening of collagen strands and deposition of calcium -callus formation -remodeling: excess callus is reabsorbed and trabecular bone is deposited
28
Signs and symptoms of a bone fracture (7)
- unnatural alignment (deformity) - swelling - muscle spasm - tenderness - pain - imparted sensation - decreased mobility
29
5 treatment methods for fractures
- immobilization - reduction of displaced fractures - traction - closed manipulation - internal/external fixation
30
failure of bone ends to grow together
nonunion
31
union that does not occur until about 8-9 months after fracture
delayed union
32
healing of a bone in an incorrect anatomic position
malunion
33
Purpose of traction
stretches and fatigues muscles that have pulled bone fragments out of place -\> more readily allowing distal fragments to align with proximal fragments
34
procedure in which pins or rods are surgically placed into uninjured bone near fracture site and the stabilized with external frame of bars (used to treat fxs that wouldn't be stabilized well with a cast)
external fixation
35
displacement of one or more bones in a joint in which the opposing joint surfaces entirely lose contact with each other
dislocation
36
contact between articular surfaces is only partially lost
subluxation
37
Conditions associated w/ dislocation/subluxation (4)
- fractures (trauma) - muscle imbalance - incongruities in the articulating surface of bone (RA) - joint instability
38
tear or injury to a muscle tendon
strain
39
tear or injury to a ligament
sprain
40
complete separation of a tendon/ligament from its bony attachment
avulsion
41
inflammation of a tendon
tendinitis
42
inflammation of a bursa that is caused by repeated trauma; can also be septic due to wound infection
bursitis
43
inflammation of a tendon where it attaches to a bone
epicondylitis
44
lateral epicondylitis
tennis elbow
45
medial epicondylitis
golfer's elbow
46
rapid breakdown of muscle that causes release of intracellular contents, including protein pigment myoglobin, into the extracellular space and bloodstream
rhabdomyolysis (myoglobinuria)
47
Classic triad of rhabdomyolysis
- muscle pain - weakness - dark urine (sometimes only thing present)
48
Most important lab value for rhabdomyolysis
serum creatinine kinase (CK) level
49
Normal CK level
- men: 5-25 - women: 5-35
50
causes of rhabdomyolysis
- electrical injury/burns - blunt trauma - drugs (EtOH, PCP, amphetamines, heroin, cocaine) - DKA - heat stroke - status epilepticus - tetanus - strenuous exercise
51
Goals of treatment for rhabdomyolysis
maintaining adequate urinary flow (IV hydration) and prevention of kidney failure
52
result of increased pressure within a muscle compartment
compartment syndrome/crush injury
53
causes of compartment syndrome
- bleeding after fracture (increases pressure) - decrease compartment volume (tight bandage or cast) - combination both conditions
54
Explain the pathophysiology of compartment syndrome
- limb compression -\> local pressure -\> tamponade - muscle/capillary necrosis - edema -\> rising compartment pressure -\> compartment tamponade - muscle ischemia/infarction - neural injury -\> Volkmann ischemic contracture
55
explain pathophysiology of crush syndrome
- muscle infarction due to compartment syndrome - myoglobinemia -\> renal failure - ECF shift -\> shock - acidosis/hyperkalemia -\> cardiac dysrhythmia
56
treatment for compartment syndrome
fasciotomy
57
decreased bone mineral density (BMD) and increased risk of fractures because of alterations in bone microarchitecture
osteoporosis (porous bone)
58
causes of osteoporosis
- decreased levels of estrogen (main hormone) and testosterone - decreased activity level - inadequate levels of vitamin D, C, and Mg
59
based on the number of standard deviations that differ from the mean bone mineral density of a young-adult reference population
bone density
60
Bone density for: - normal bone - osteopenic bone - osteoporosis
- normal bone: 0 to -0.99 - osteopenic bone: -1.0 to -2.49 SD - osteoporosis: \<2.5 SD
61
bone histology for osteoporosis
usually normal but bone lacks structural integrity
62
What type of vertebral structural abnormality is common with osteoporosis
kyphosis (hunchback)
63
How does osteoporosis generally appear in men vs women?
- men: thinning of trabecular bone (usually have greater mass) - women: complete loss/perforation of bone
64
progressive softening and bending of bone (decreased mineralization of osteoid)
osteomalacia
65
causes of osteomalacia
- deficiency of vitamin D -\> lowers absorption of calcium from intestines
66
clinical manifestations of osteomalacia
- pain - bone fractures - vertebral collapse - bone malformations (bowed legs or "knock-knees") - muscular weakness -\> waddling gait
67
state of increased metabolic activity in bone characterized excessive resorption of spongy bone and accelerated formation of softened bone
Paget disease
68
Which bones are most often affected by Paget disease?
axial skeleton (vertebrae, skull, sacrum, sternum, pelvis)
69
characteristics of Paget diseased bone
- disorganized - thickened - soft (BM replaced by vascular fibrous tissue)
70
thickened bones from Paget disease causes what?
- abnormal bone curvature - brain compression - imparted motor function - deafness - atrophy of optic nerve
71
bone infection most often caused by staphylococcal infection
osteomyelitis
72
bone infection caused by pathogens carried through the bloodstream
hematogenous (endogenous) osteomyelitis
73
bone infection that occurs when infection spreads to adjacent bone due to open wounds (most common) or surgical procedures
contiguous (exogenous) osteomyelitis
74
clinical manifestations of osteomyelitis
- acute/chronic inflammation - fever - pain - necrotic bone
75
Treatment for osteomyelitis
- antibiotics - debridement - surgery - hyperbaric O2 therapy
76
area of dead/devitalized bone
sequestrum
77
new layer of of bone surrounding infected bone
involucrum
78
generation and loss of articular cartilage, sclerosis of bone underneath cartilage, and formation of bone spurs (osteophytes)
osteoarthritis
79
manifestation of OA
- pain - stiffness - enlargement of joint - tenderness - limited ROM - deformity
80
3 causes of joint effusion
- presence of osteophyte fragments in synovial cavity - drainage of cysts from diseased subchondral bone - acute trauma to joint structures (hemorrhage or inflammatory exudation)
81
chronic, systemic, inflammatory autoimmune disease distinguished by joint swelling and tenderness and destruction of synovial joints
rheumatoid arthritis (RA)
82
What is activated in RA that develop an exaggerated immune response?
synovial fibroblasts (SFs)
83
main 2 classes of immunoglobulins that are part of rheumatoid factors (RF)
- IgM and IgG - occasionally IgA
84
What will be present in joint fluid with RA?
inflammatory exudate
85
Explain the pathogenesis of RA
- CD4 T helper cells and others in synovial fluid activated -\> release cytokines - activation of B lymphocytes -\> formation of RF -\> formation of autoimmune complexes and probable deposition in joint tissue - inflammatory cytokine release - RANKL release and osteoclast activation - angiogenesis in the synovium
86
synovium converted to a thick abnormal layer of granulation tissue (when T cells interact with synovial fibroblasts)
pannus (seen in RA)
87
Pt is said to have RA if the have 4 or more of the following:
- morning joint stiffness - arthritis in 3 or more joints - arthritis in hand joints - symmetric arthritis - rheumatoid nodules - abnormal amounts of serum RF - radiographic changes
88
Hand changes seen in late stage RA
- Boutonniere deformity of thumb - ulnar deviation of metacarophalangeal joints - swan-neck deformity of fingers
89
systemic, immune, inflammatory joint disease of the spine or sacroiliac joints causing stiffening and fusing of the joints
ankylosing spondylitis
90
explain the pathophysiology of ankylosing spondylitis
- inflammation of fibrocartilage (mainly in vertebrae and sacroiliac joint) - inflammatory cells infiltrate and erode fibrocartilage - repair begins -\> scar tissue ossifies and calcifies - joint eventually fuses
91
clinical manifestations of ankylosing spondylitis
- low back pain - stiffness - restricted ROM - loss of normal lumbar curvature
92
Metabolic disorder that disrupts the body’s control of uric acid production or excretion
gout
93
when uric acid crystals occur in synovial fluid
gouty arthritis
94
type of metabolism gout is related to
purine (adenine and guanine) metabolism -\> uric acid is end product
95
How is uric acid generated and eliminated
- generated through diet and recycled after cell breakdown - eliminated via intestinal and renal excretion
96
3 stages of gout
- asymptomatic hyperuricemia - acute gouty arthritis - tophaceous gout
97
stage of gout; serum urate level is elevated but arthritic symptoms, tophi, and renal stones not present
asymptomatic hyperuricemia
98
stage of gout; attacks develop w/ increased serum urate concentrations; tends to occur w/ sudden/sustained increases in hyperuricemia but can be triggered by trauma, drugs, and alcohol
acute gouty arthritis
99
stage of gout; progressive inability to excrete uric acid expands to curate pool until monosodium rate crystal deposits (tophi) appear in cartilage, synovial membrane, tendons, and soft tissue
tophaceous gout
100
muscle fiber shortening without action potential; caused by failure of SR even w/ ATP
contracture
101
associated w/ chronic anxiety
stress induced muscle tension
102
symptoms of stress induced muscle tension
- neck stiffness - back pain - clenching teeth - hand grip - headache
103
reduction in normal size of muscle cells as a result of prolonged inactivity
disuse atrophy
104
causes of disuse atrophy
- bedrest - trauma - casting - nerve damage
105
chronic widespread joint and muscle pain with associated increased sensitivity to touch, absence of inflammation, fatigue, and sleep disturbances
fibromyalgia (FM)
106
possible factors associated w/ fibromyalgia
- flu-like viral illness - chronic fatigue syndrome - HIV - Lyme disease - medications - physical/emotional trauma
107
osteoblasts (bone cell precursor) cause what type of bone tumor
osteogenic tumors (ex. osteosarcoma)
108
chondroblast (cartilage cell precursor) cause what type of bone tumor
chondrogenic tumors (ex. chondrosacroma)
109
fibroblasts (collage-producing cells) cause what type of bone tumor
collagen tumors (ex. fibroma, fibrosarcoma)
110
various blood cell precursors in bone marrow can cause what type of bone tumor
myelogenic tumors
111
osteosarcoma is predominant in what pts
- adolescents and young adults - elderly if they have a Hx of radiation therapy
112
non-calcified bone matrix and callus seen in osteosacroma
streamers
113
Where are majority of osteosarcomas found?
located in the metaphyses of long bones; about half occur around the knees
114
most common symptoms of osteosarcoma
pain with an enlarging mass
115
malignant tumor of striated muscle; highly malignant w/ rapid metastasis
rhabdomyosarcoma
116
What muscles most commonly develop rhabdomyosarcoma?
- tongue, neck, larynx, nasal cavity, axilla, vulva, and heart
