back ingury Flashcards
CONCEPT OF MOBILITY
provides form,support, stability and movement to the body.it is made up of the bones of the skeleton, muscles,tendons,ligaments, joints, and other connective tissue that supports and binds tissues and organs
GENETIC/LIFESPAN CONSIDERATIONS
- bones and muscles adapt as individual ages
- some bones fuse during infancy while others grow as child developes
- this growth is then turned off during adulthood (bones undergo remodeling)
- older adults undergo physiologic changes(decrease strength and mobility)
ALTERATIONS TO MOBILITY
CHANGES IN THE FUNCTION OF THE MUSCULOSKELETAL:
- back problems (back pain)
- fractures
- osteoarthritits
- multiple sclerosis
- Parkinson disease
- spinal cord injury
- amputations
BACK PROBLEMS -PAIN
BACK PAIN- most common medical problem in America
BACK PAIN MAY RESULT IN:
- decreased quality of life
- decreased mobility
- increased pain and frustration
- loss of work hours
back pain often results from years of improper body mechanics with incident acting as “the straw that broke the camel’s back”
BACK PAIN CAUSES
- bad posture
- low fitness level
- pregnancy
- obesity
- athletic injuries
- degenerative disorders
- occupational risk factors
- referred pain from GI/GU/AAA
- backpack use
PREVENTION
- posture
- lifting
- body mechanics
- rest
- exercise
WHEN STANDING FOR LONG PERIODS OF TIME
shift weight frequently from side to side if required to stand for long periods of time
VERTEBRAL SEGMENTS AND INNERVATIONS
- CERVICAL: c1- c7, head and neck, diaphragm, upper limbs
- THORACIC: t1-t12, chest muscles, abdominal muscles, some back muscles
- LUMBAR:l1-l5, lower abdomen and back parts of lower limbs
HERNIATED DISC
- refers to a problem of the rubbery cushions between the individual bones that make up your spine
- occurs when nucleus pulposus ruptures and protrudes
- allowing fluids to leak out and irritate nerves
- compression of the nerve roots and cord shrinking the disc
- results in pain, numbness, or weakness in arm or leg
- most people do not need surgery
DISC HERNIATION TYPES
ABRUPT:
- nerve root compression
- severe pain
- muscle spasms
GRADUAL:
- slow onset pain
- associated with neurological symptoms(weakness/tingling)
RISK FACTORS
-most common between ages 30-50
- heavy lifting
- bending /twisting improperly
- overweight
- smoking
- genetic factors
- previous back problems
CLINICAL MANIFESTATIONS: LUMBAR
- low back pain
- radiating down the buttock and below the knee
- sciatic nerve pain
- weakness of the leg, foot, or toes
- bowel and bladder incontinence
- impotence
CAUDA EQUINA SYNDROME (CES)
- latin for “horse’s tail”
- compression of the nerve roots of this part of the spine
- may be permanent neurological impairment
- urinary incontinence and paralysis
- caused by massive lumbar disc herniation, spinal stenosis and trauma
MEDICAL EMERGENCY!!!
STRAIGHT LEG TEST
-back or leg pain may be reproduced by raising the leg and flexing the foot at 90 degrees
DIAGNOSTIC STUDIES
- L-spine x-ray
- MRI
- CT
- EMG: nerve irritation/neuropathy
- myelogram
- blood tests
CHRONIC LOW BACK PAIN TREATMENT
- low back exercises/PT
- rest
- local heat/cold application
- pain relievers
- weight reduction
- surgery
NON- PHARMACOLOGIC TREATMENT
- brace
- massage
- traction
- physical therapy
PHARMACOLOGIC THERAPY
- salicylates
- NSAIDs
- skeletal muscle relaxants (Baclofen,methocarbamol)
-neuropathic pain: gabapentin,pregabalin, and duloxetine
- corticosteroids
- epidural injections
INTRATHECAL MORPHINE PAIN PUMP IMPLANT
- intrathecal drug delivery, or “pain pump” is a method of giving medication directly to your spinal cord
- because of this, symptoms can be controlled with a much smaller dose than is needed with oral medication
- the goal of a drug pump is to better control your symptoms and to reduce oral medications thus reducing associated side effects
- risk for the intrathecal pain pump is low
LAMINECTOMY
surgical removal of part of the posterior arch of the vertebrae to allow for removal of the disk
DISCECTOMOY
-micro surgical procedure that allows the surgeon to visualize the disk and disk space better for easier removal of the herniated portion
LASER DISCECTOMY
- outpatient procedure
- the laser is used on the herniated portion of the disk
SPINAL FUSION
- TSOL while out of bed
- surgical and graft site if used
- avoid sitting or standing for long periods of time
- encourage walking, lying down and shifting weight
- no twisting the spine
SPINAL FUSION OVERVIEW
- used for unstable spinal areas by creating a connecting vertebrae with a bone graft
- fibula or iliac crest
- rods,plates and screws
- infuse bone graft/cage (regeneration)
VERTEBROPLASTY
- outpatient
- used to stabilize vertebral bone fractures
POST OP CARE
- vital signs
- signs of circulation
- signs of bleeding
- position
- pain
- emotional support
- safety
- sterile technique
- signs of infection
- compression dressings
- paralytic ileus common,start Po intake slowly
POST OP CARE
- proper alignment at all times
- log roll
- pain control
- pillows under legs
- neuro checks q 2-4 hours
- paralytic ileus
- Turn cough deep breathe every hour while awake
NEUROVASCULAR ASSESSMENT
CIRCULATION
- color/temperature
- capillary refill
- pulses
- edema
MOTOR FUNCTION
- flexion
- extension
- abduction
DISCHARGE INSTRUCTIONS
- bathing/incision care
- discomfort(pain control)
- restrictions
- activity
- when to call the doctor
SCOLIOSIS
- diagnosed if the sideway curvature measures more than 10 degrees
- congenital, acquired , idiopathic
CLINICAL MANIFESTATIONS OF SCOLIOSIS
- spinal curvature to one side
- uneven shoulders and hips
- differences in leg length
- tiredness of the spine
- prominent shoulder blade and rib bump
- severe scoliosis( heart and lung problems)
DIAGNOSTIC TESTS FOR SCOLIOSIS
- school screening for children ages 10-15 Adam forward bend test
- observation
- x-ray cobb method
CLINICAL MANIFESTATIONS OF SCOLIOSIS THERAPIES
MILD SCOLIOSIS
-observation every 3-6 months
MODERATE
-bracing 12-23 hours /day
SEVERE
-surgical correction
SCOLIOSIS SURGERY
- involves spinal fusion with insertion of metal rod
- infections can compromise outcome of the deformity correction and delay recovery
POST OP CARE FOR SCOLIOSIS
- TLSO BRACE
- limit activity for 6-8 months post surgery
- learn to perform simple task without bending or twisting
FRACTURES
- a broken bone
- it can range from a thin crack to a complete break. bone can fracture crosswise, lengthwise, in several places, or into many pieces. most fractures happen when a bone is impacted by more force or pressure than it can support
FRACTURE SYMPTOMS
- most fractures are accompanied by intense pain when the initial injury occurs
- a snap or grinding sound when the injury occurs
- swelling, redness, and bruising in the injured area
- difficulty supporting weight with the injured area
- visible deformity in the injured area
- in some cases , you may see broken bone exposed
FRACTURE TYPES
- OPEN
- CLOSED
- COMPLETE
- INCOMPLETE
CAUSES/RISK FACTORS OF FRACTURES
- falls
- direct body strikes
- traumatic events, such as car accidents or gunshot wounds
- injury from sports
- bone density
- age
- osteoporosis
- endocrine or intestinal disorders
- smoker
- alcohol
- physically inactive
- taking corticosteroids
DIAGNOSTIC TESTS/TREATMENT FOR FRACTURES
- X ray to determine fracture severity
- traction/splint
- surgery if necessary
- pain control
- healing time
COMPLICATIONS OF FRACTURES
- knees pain
- compartment syndrome
- DVT
- fat embolism
- infection
PREVENTION
- diet
- exercise
- supplements
- education
