Alteraitons In Musculoskeletal Function Flashcards
MSK injuries
Skeletal Trauma
-Fractures
-Dislocations
Support structure trauma
-Sprains and strains
-Tendinopathy and bursitis
Muscle strains
Fractures
-Break in the continuity of a bone
-Incidence for specific bones Varys by age and gender
-Only body tissue (besides liver) that regenerates itself
Fractures classification
-Classified as complete, incomplete, open (compound), closed (simple), comminuted
-Also classified as linear, oblique, spiral, transverse or green stick
Pathological fracture
Break at the site of a pre-existing abnormality
Stress fracture
Due to being subjected to repeated stress eg athletics.
-Fatigue - abnormal stress eg dancing
-Insufficiency - lack of normal ability to deform and recover
Transchondral fracture
Fragmentation and separation of portion of articulation cartilidge
Steps in a fracture (9)
- Periosteum and blood vessels disrupted
- Bleeding from ends and neighboring soft tissue
- Clot forms in medullary canal
- Adjacent bone tissue dies - stimulates intense inflammatory response
- Within 48hrs vascular tissue invades area - blood flow to bone increases
- Bone- forming cells activated to produce subperiosteal procallus along bone shaft and over break
-Osteoblasts synthesize collagen and matrix
-This forms callus
-Remodelling occours, traeculae formed along lines of stress
Fractures Clinical Manifestations
-Vary according to type of fracture, site and associated soft tissue damage
-S&S include impaired function, unnatural alignment, swelling, muscle spasm, tenderness, pain and impaired sensation
-Position of bone affected by pull of attached muscles, gravity, direction and magnitude of fracture force
-Immediate pain d/t trauma, secondary pain d/t soft tissues or muscles
Fractures Treatment
-Must realign the bone fragments (reduction) and hold fragments in place (immobilization)
-Most done by close reduction
-Traction to accomplish or maintain reduction (Skin or skeletal)
-External fixation used external frame of clamps
-Open reduction - a surgical procedure
Dislocation & subluxation definition
Dislocation: a temporary displacement of 2 bones in which the bone surfaces loose contact entirely
Subluxation: the contact is only partially lost
Dislocation and subluxation
-Usually occurs in those <20yrs
-Shoulder, elbow, wrist, finger, hip and knee are most commonly dislocated
-Often accompany a fracture
-Usually bruise nerves, vessels, ligaments, supporting structure, soft tissue occours as well
-Pain, edema, limitation in motion, deformity are s&s
Tendon
Fibrous connective tissue that attaches skeletal muscle to bone
Ligament
A band of fibrous connective tissue that connects bones to a joint
Strain
A tear in a tendon
Sprain
A tear in a ligament
Tendons and ligaments patho
-Inflammation exudate develops between the torn ends
-Granulaiton tissue forms containing macrophages, fibroblasts, and capillary buds
-Within 5 days, collagen forms unorganized and then later interweave with existing fibres
-A healing tendon is unable to withstand a pull for 5 weeks
-The entire process could take years to repair a tendon or ligament (longer than a break)
Tendons and ligaments CM
-Pain
-Edema
-Changes in tendon or ligament contour
-Dislocation and subluxation of bones
-Tenderness
Bursitis
-Numerous bursa in body
-Shoulder, elbow, hip, and knee best know
-May require drainage or injection
Muscle tears
-Muscle fibres are torn resulting in bleeding
-Fibres do not heal, other fibres compensate
Osteoarthritis types (2)
-Idiopathic (primary): no known cause but may be inherited (most common)
-Secondary: associated with joint stress, congenital abnormalities or joint instability caused by trauma
Osteoarthritis
-Erosion of articular cartilage
-Subchondral sclerosis (thickening and hardening) of bone underneath cartilage
-Formation of bone spurs (osteophytes)
Osteoarthritis (2)
-Worse with aging
-Most often affects hands, wrists, neck, lower back, hip, knees, ankles and feet
-Associated with trauma, long term stress, inflammation, joint instability, neurological disorders, congenital, hematologic or endocrine drugs
-All accelerate cartilage loss
Osteoarthritis: loss of articular cartilage (7)
-Cartilage becomes yellow or brownish grey
-Surface areas flakes off
-Becomes thin or may be absent in some areas
-Bone is unprotected - becomes sclerotic
-Cartridge-Coated osteophytes may grow outwards
-Peices of spur break off - irritate synovial membrane
-Joint capsule becomes thickened
Osteoarthritis CM
-Usually appear in 50s or 60s
-Pain or stiffness in one or more major joints (predominant sign)
-Aggravated by weight-bearing and relived by stress
-Nocturnal pain not relived by resting
-Pain may be chased by articular distension (stretching of a joint capsule or fibrous shrinking irritated by movement)
-joint stiffness (difficulty initiating joint movement)
-Dissipates within 30 minutes
-Limited ROM
-Crepitus (granting or creaking)
-Changes in ambulation and gait
-Affected joint more symptomatic after use
Osteoarthritis DX
-Clinical assessment
-X-ray
-CT-scan
-MRI
Osteoarthritis treatment
Conservative
-rest, ROM exercises, use of aids, weight loss, analgesic and anti-inflammatory drugs
Surgical
-Improve joint movement
-Correct deformity
-Replace joint
Rheumatoid Arthritis patho
-Autoimmune disease
-Chronic inflammation of connective tissues
-Affects synovial membrane (lines the joint cavity)
Inflammation spreads to other tissues
-Causes pain, joint deformity, loss of function
RA joints most affected
-Fingers
-Feet and wrists
-Elbows
-Ankles
-Knees
-May also affect lungs, heart, kidneys, and skin
RA disease process
-More common in women (3:1) (lessen during pregnancy, increase postpartum)
-Frequency increases with age
-Cause is obscure (genetic, environmental, hormonal, reproductive)
-Autoantibodies (antibodies that attack host tissue) these transformed antibodies are termed rheumatoid factor)
RA - CM
-Joints become painful, tender, and stiff
-Morning stiffness lasting more than 1 hour
-Progresses from smaller joints > weight bearing joints
-Joints swelling widespread and symmetric
-Joint deformities > loss of joint motion > contractures > muscle atrophy
-Rheumatoid nodules (or swellings) - found in areas of pressure or trauma
-These are aggregates of inflammatory cells and are usually in the elbows and fingers, scalp, back, hands, and feet
-Can be found in the skin, heart, lungs, and spleen
RA dx
-Based on PE, x-ray, blood tests
RA tx
Conservative tx
-Rest of joint and body
-heat and cold
-PT
-Hi-calories and Vitiman rich diet
Drugs
-Corticosteroids, anti-inflammatory, immunosuppressants
Surgery
-To decrease inflammatory effusion and remove pannus, fix deformity or replace a joint
Ankylosing Spondylitis
-Chronic, inflammatory joint disease characterized by fusion (ankylosis) of spine and sacroiliac joints
-3:1 male to female ratio
-HLA B27 genotype associated
-Form classic bamboo spine
Gout
-Excess uric acid in blood that causes precipitation of urate crystals in joints
-Treat with NSAID’s, allopurinol, and WATER
Contractures
-Shortening of muscles
-Can be physiologic or pathologic
Physiologic contracture
-Due to failure of calcium pump in presence of ATP - temporary if underlying pathology reversed
-occours in the absence of muscle action potential
Pathologic contracture
-Permanent, caused by muscle spasms or weakness
-May be a response to pain or secondary to scar formation (burns)
Osteomyleitis
-Infectious disease cuased by bacteria, viruses, fungi, and parasites
-Further catagorized according to the pathogen
Why is osteomyletis difficult to treat?
-bones contain multipule channels that encourage proliferaiton of infectious cells - natural defenses do not penetrate
-Tiny vessels 1) are easily damaged 2) make obstruction by bacteria easy, leads to necrosis
-Bone cells destroyed by infection are not easily replaced, bone production lags behind bone resorption osteoclasts.
Exogenous Osteomylelitis
Infection form outside the body, spreads from soft tissues to bone (open fracture, surgery)
-May be caused by human bites or fist blows to mouth
-Body parts of IV drug abusers
Endogenous osteomyelitis
Infection carried in blood from other sities within the body, spreads form bone to soft tissues
-Staph aureus is most common bacteria causing.
-Most common sources of bacteria - cutaneous, sinus, ear, and denatl infections
-Vulnurability of a bone depends on the vascular supply
-Bones commonly affected - Spine, pelvis, and small bones
Osteomyleitis Dx
- Look for Elevated WBC
-Bone can be very sensitive
-May use CT and MRI to examine bones
Osteomyleitis Tx
-Use IV antibiotics initially
-Chronic may use surgical debridement with continous wound irrigaiton following
-Hyperbaric O2 therapy
-May need to remove implants
Osteoperosis
-Defined as reduced bone mass or density
-Present with BMD -2.5 below the young adult mean
Osteoperosis Risk Factors
-Smoking
-lack of physical activity
-Excess alcohol consumption
-Low calcium and vitiman D intake
-Thinness
-Family History
-Premature Menopause
Osteoperosis CM
-dependant on bones involved
-Pain
-Fractures
-Bone deformity
-kyphosis (hunchback)
Osteoperosis Tx
HRT
-Estrogen allows for bone to absorb
Calcitonin
-Acts as an anti-resorptive agent by acting on osteoclasts
Bisphosphonates
-Effect Osteoclast apoptosis
-Calcium and vitiman D
-Statins (Lovostatin)
Osteoperosis Dx
-Bone scan (bone mineral density test)
-X-ray after 25% of bone tissue lost
-CT Scan
-Serum tests for calcium, phosphorous, Alkaline phosphates
-All women over 65 shoudl be tested
Bone Tumours
Fibroblasts
-Osteoblasts
-Chondroblasts
-Fibroblasts
Reticulum
-Blood cell precursors
Osteoblasts
-Osteosarcoma
-Osteoblastoma
Chondrobalsts
-Endochondroma
-Osteochondroma
-Chondrosarcoma
Fibroblasts
-Fibroma
-Fibrosarcoma
Blood cell precursors
-Giant cell tumor
-Ewing sarcoma
-Multipule Myeloma
