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Pathopharm 2 > Alteraitons In Musculoskeletal Function > Flashcards

Alteraitons In Musculoskeletal Function Flashcards

1
Q

MSK injuries

A

Skeletal Trauma
-Fractures
-Dislocations

Support structure trauma
-Sprains and strains
-Tendinopathy and bursitis
Muscle strains

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2
Q

Fractures

A

-Break in the continuity of a bone
-Incidence for specific bones Varys by age and gender
-Only body tissue (besides liver) that regenerates itself

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3
Q

Fractures classification

A

-Classified as complete, incomplete, open (compound), closed (simple), comminuted
-Also classified as linear, oblique, spiral, transverse or green stick

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4
Q

Pathological fracture

A

Break at the site of a pre-existing abnormality

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5
Q

Stress fracture

A

Due to being subjected to repeated stress eg athletics.
-Fatigue - abnormal stress eg dancing
-Insufficiency - lack of normal ability to deform and recover

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6
Q

Transchondral fracture

A

Fragmentation and separation of portion of articulation cartilidge

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7
Q

Steps in a fracture (9)

A
  1. Periosteum and blood vessels disrupted
  2. Bleeding from ends and neighboring soft tissue
  3. Clot forms in medullary canal
  4. Adjacent bone tissue dies - stimulates intense inflammatory response
  5. Within 48hrs vascular tissue invades area - blood flow to bone increases
  6. 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
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8
Q

Fractures Clinical Manifestations

A

-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

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9
Q

Fractures Treatment

A

-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

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10
Q

Dislocation & subluxation definition

A

Dislocation: a temporary displacement of 2 bones in which the bone surfaces loose contact entirely

Subluxation: the contact is only partially lost

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11
Q

Dislocation and subluxation

A

-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

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12
Q

Tendon

A

Fibrous connective tissue that attaches skeletal muscle to bone

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13
Q

Ligament

A

A band of fibrous connective tissue that connects bones to a joint

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14
Q

Strain

A

A tear in a tendon

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15
Q

Sprain

A

A tear in a ligament

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16
Q

Tendons and ligaments patho

A

-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)

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17
Q

Tendons and ligaments CM

A

-Pain
-Edema
-Changes in tendon or ligament contour
-Dislocation and subluxation of bones
-Tenderness

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18
Q

Bursitis

A

-Numerous bursa in body
-Shoulder, elbow, hip, and knee best know
-May require drainage or injection

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19
Q

Muscle tears

A

-Muscle fibres are torn resulting in bleeding
-Fibres do not heal, other fibres compensate

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20
Q

Osteoarthritis types (2)

A

-Idiopathic (primary): no known cause but may be inherited (most common)
-Secondary: associated with joint stress, congenital abnormalities or joint instability caused by trauma

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21
Q

Osteoarthritis

A

-Erosion of articular cartilage
-Subchondral sclerosis (thickening and hardening) of bone underneath cartilage
-Formation of bone spurs (osteophytes)

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22
Q

Osteoarthritis (2)

A

-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

23
Q

Osteoarthritis: loss of articular cartilage (7)

A

-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

24
Q

Osteoarthritis CM

A

-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

25
Q

Osteoarthritis DX

A

-Clinical assessment
-X-ray
-CT-scan
-MRI

26
Q

Osteoarthritis treatment

A

Conservative
-rest, ROM exercises, use of aids, weight loss, analgesic and anti-inflammatory drugs

Surgical
-Improve joint movement
-Correct deformity
-Replace joint

27
Q

Rheumatoid Arthritis patho

A

-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

28
Q

RA joints most affected

A

-Fingers
-Feet and wrists
-Elbows
-Ankles
-Knees
-May also affect lungs, heart, kidneys, and skin

29
Q

RA disease process

A

-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)

30
Q

RA - CM

A

-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

31
Q

RA dx

A

-Based on PE, x-ray, blood tests

32
Q

RA tx

A

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

33
Q

Ankylosing Spondylitis

A

-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

34
Q

Gout

A

-Excess uric acid in blood that causes precipitation of urate crystals in joints
-Treat with NSAID’s, allopurinol, and WATER

35
Q

Contractures

A

-Shortening of muscles
-Can be physiologic or pathologic

36
Q

Physiologic contracture

A

-Due to failure of calcium pump in presence of ATP - temporary if underlying pathology reversed
-occours in the absence of muscle action potential

37
Q

Pathologic contracture

A

-Permanent, caused by muscle spasms or weakness
-May be a response to pain or secondary to scar formation (burns)

38
Q

Osteomyleitis

A

-Infectious disease cuased by bacteria, viruses, fungi, and parasites
-Further catagorized according to the pathogen

39
Q

Why is osteomyletis difficult to treat?

A

-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.

40
Q

Exogenous Osteomylelitis

A

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

41
Q

Endogenous osteomyelitis

A

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

42
Q

Osteomyleitis Dx

A
  • Look for Elevated WBC
    -Bone can be very sensitive
    -May use CT and MRI to examine bones
43
Q

Osteomyleitis Tx

A

-Use IV antibiotics initially
-Chronic may use surgical debridement with continous wound irrigaiton following
-Hyperbaric O2 therapy
-May need to remove implants

44
Q

Osteoperosis

A

-Defined as reduced bone mass or density
-Present with BMD -2.5 below the young adult mean

45
Q

Osteoperosis Risk Factors

A

-Smoking
-lack of physical activity
-Excess alcohol consumption
-Low calcium and vitiman D intake
-Thinness
-Family History
-Premature Menopause

46
Q

Osteoperosis CM

A

-dependant on bones involved
-Pain
-Fractures
-Bone deformity
-kyphosis (hunchback)

47
Q

Osteoperosis Tx

A

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)

48
Q

Osteoperosis Dx

A

-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

49
Q

Bone Tumours

A

Fibroblasts
-Osteoblasts
-Chondroblasts
-Fibroblasts

Reticulum
-Blood cell precursors

50
Q

Osteoblasts

A

-Osteosarcoma
-Osteoblastoma

51
Q

Chondrobalsts

A

-Endochondroma
-Osteochondroma
-Chondrosarcoma

52
Q

Fibroblasts

A

-Fibroma
-Fibrosarcoma

53
Q

Blood cell precursors

A

-Giant cell tumor
-Ewing sarcoma
-Multipule Myeloma

Pathopharm 2 (4 decks)

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