Block 12 - Musculoskeletal and nervous system (other) Flashcards
Define ABCDE
Airway, Breathing, Circulation, Disability, Exposure, Environment
Where is crepitus between?
The bone and cartilage
3 reasons you would repair a soft tissue injury
Suspected nerve or vascular damage
Reduced tendon function
Washed if heavily contaminated or in the joint cavity
Define a colles fracture
FOOSH
Bone displaced posteriorly
Define a smiths fracture
Falls onto flexed wrists
Bone displaced anteriorly
What fracture is a sign of abuse?
Spiral
Define comminuted fracture
Part of the bone breaks off
Another name for an undisplaced fracture
Oblique fracture
Define avulsion fracture
Bone displaced due to failed muscle/ligament action/tension
What can happen if a patient suffers from Paget’s disease or bone cysts?
The bone can weaken and the risk of fracture increase
What are the 2 types of stress fractures?
Repeated abnormal stresses to normal bone (e.g. marathon)
Abnormal bone subjected to normal stresses (e.g. cast taken off too early so re-fracture)
What are the 3 stages of open wound management?
Protection: Assess, Temporary dressing, IV antibiotics, Tetanus
Debridement: Wash wound in sterile theatre
Stabilisation: May be provisional
(Pretty Damn Soon)
Define reduction
What is the difference between open and closed reduction?
Surgical procedure to repair a fracture or dislocation to the correct allignment
Open = pins or cast outside
Closed = pins inside
What are the two types of reduction/stabilisation
Closed: Traction (slowly pulling back into place) or Manupulation
Open: Surgical reduction
How fast is the onset of rheumatoid arthritis?
Slow
What are the 4 main joints affected by rheumatoid arthritis?
MCP, PIP, MTP, wrists
Define rheumatoid arthritis
A chronic, symmetrical inflammatory, deforming, polyarthritis
What 3 things do you test for rheumatoid arthritis?
CRP: C-Reactive Protein
Anti-CCP: Anti-Cyclic citrullinated peptide
RF: Rheumatoid factor
Where does inflammation occur in rheumatoid arthritis?
Synovium
MOA of rheumatoid arthritis
T cell is triggered –>
- B cell produces RF antibodies
- Fibroblasts inhibit TGF, IL4 and IL10
- Macrophages activate TNF and IL –> cytokines, chemokines and adhesion molecules –> cell infiltration
–> Inflammation and tissue damage
7 effects of chronic systemic inflammation
Dementia, Insulin resistance, Osteoporosis, Pain sensitisation, Increased cholesterol, Atherosclerosis, Ischaemic heart disease
What joints are affected with oestoarthritis? (6)
DIP, PIP, CMC, MTP,
Axial skeleton, Large weight bearing joints
9 risk factors for osteoarthritis
Age, Female, Family, Obesity, Increased oestrogen, Bone mineral density
Trauma, Occupation, Pre-existing abnormality
What age is gout most common in?
Older age
What drugs increase the risk of gout?
Aspirin, Diuretics, Cytotoxic drugs, Levodopa, Ethambutol, Pyrazinamide
How is urate produced?
Adenosine –> Xanthine –> Urate
by the enzyme xanthine oxidase
How does urate cause gout?
In the right conditions, urate mobilises to the joint and precipitates out forming crystals and causing inflammation
3 causes of increased urate
Increased purines in the diet/being produced (e.g. cancer)
Kidney disease stops excretion
What triggers gout attacks (7)
Mobilisation of gout due to changes in serum urate levels
e.g. trauma, illness, surgery that triggers the acute phase response, dehydration, acidosis, medication, rapid weight loss
What is the main protein fibre found in bone?
Collagen
What type of connective tissue is bone?
BONE
2 roles of osteoclasts
Break down worn out bone
Increase serum calcium levels
What happens to how well a bone heals if you break it and have osteoporosis?
Broken osteoporotic bones heal as normal
Explain how osteoclasts break down bone
Bind to bone between 2 integrins which link to the cytoskeleton forming a sealing zone
Protons pumped into the bone casuing acidic degradation
Lysosomal enzymes break down collagen and extracellular matrix proteins
Calcium is released into the blood
Explain how osteoclasts regulate osteoblasts
+ve: osteoblasts –> RANKL –> osteoclast precursors
-ve: osteoblasts –> OPG –> block RANKL
Explain the mechanism of action of calcitonin
Released from the thyroid gland and reduces blood calcium levels when they increase too much
Increase osteoblast activity
Decrease intensine Ca absorption
Decrease renal calcium reabsorption
Explain the mechanism of action of parathyroid hormone
Release from the parathyroid glands and increases blood calcium levels when they fall too low
Increases osteoclast activity
How does oestrogen protect against calcium reabsorption?
Inhibits PTH
Give 9 features of cushing’s syndrome
Aseptic necrosis of the femoral head Cataracts CVD risk Decreased wound healing Increased intraocular pressure Intracranial hypertension Metabolism change (weight gain) Osteoporosis Pancreatitis
Define posture
Orientation of a body segment relative to the gravitational vector
e.g. amount of forward lean relative to a vertical position
Define balance
The dynamics of body posture to prevent falling
Related to the characteristics of the body segment and the forces acting upon it
Define centre of mass
Anatomical position = abdominal area
Arms up it rises; arms to the right it moves to the right
Doesn’t have to be in the physical limits of the body
Define centre of gravity
Vertical projection of the centre of mass onto the ground
Define centre of pressure
Location of the body vertical ground reaction force on the floor
Standing = between feet
Standing on R leg = under R foot
Define postural set
A learned response where the body establishes an anticipated response in relation to the type of pertubation which changes based on postural orientation
Explain the stretch (myotatic) reflex
Muscle spindles are stretch receptors located in skeletal muscle
When they stretch, an afferent nerve sends a signal to the CNS
Motor neurones activate the agonist/antagonist to increase the movement
Explain how the ankle postural strategy works
What surface can it be used on?
Shifts the CoG around the ankle joint
Surfaces with decreased resistance to shear forces
Explain how the hip postural strategy works
What surface can it be used on?
Shifts the CoG around the hip joint by flexion/extension
Surfaces that have decreased resistance to torque (not on slippery surfaces)
Explain how the stepping postural strategy works
What surface can it be used on?
Shifts the CoG around the hip joint by flexion and extension
Realigns BOS under new CoG with rapid steps
What does the systems model describe?
How the CNS locates the body’s CoG
What are the 4 sensory components of balance?
What do they gather information from?
Somatosensory: info from skin receptors (motion of body with respect to support surface)
Proprioceptive: info from muscle spindles (motion of body segments relative to each other)
Visual system: info from eyes (motion of body with respect to space)
Vestibular system: info from inner ear (head acceleration)
How do you measure centre of pressure?
Using force platforms
What moves the centre of pressure anteriorly?
What moves the centre of pressure laterally?
Anteriorly: Increased plantar flexor activity
Laterally: Increased invertor activity
What is EQUITEST?
A clinical diagnostic tool for vestibular/somatosensory disorders
Measures the effects of a disease on the postural control
Define pain
An unpleasant sensory and emotional experience associated with actual or potential tissue damage
What is the difference between somatic and visceral pain?
Somatic: Peripheral and localised, easy to describe
Visceral: Poorly localised and described
Explain peripheral sensitisation
Tissue damage stimulates peripheral nociceptors and releases inflammatory mediators
These reduce the threshold for neuronal activation
Explain central sensitisation
Release of glutamate and substance P from nociceptors target NMDA receptors in the CNS (process painful info)
Calcium influx causes phosphorylation and transcriptional changes
Define neuroplasticity
Variable relationship between injury and pain response depending on experiences due to sensitisaton, reorganisation and chronic pain states
Define allodynia
Pain when it is a non painful (normal) stimulus
Define hyperalgesia
Little pain is very painful
Explain what happens during central reorganisation
Neuronal sprouting in the dorsal spinal cord
Altered corticol sensory matrix
Established chronic pain state
4 yellow flags for pain
- Fear that the pain is harmful/severely disabling
- Fear avoidance behaviour (avoiding activity)
- Reduced mood and social withdrawal
- Expectation that passive treatment (drugs) will help more than active (exercise)
5 red flags for pain
- Cancer history
- Pain which radiates
- Recent bacterial infection
- Immunosupression
- Constitutional symptoms (fever, chills, weight loss)
Define mindfulness
Relaxed and non-judgemental awareness of thoughts, feelings and sensations
Give 3 examples of CBT coping strategies
Pacing, relaxation, thought diversion
5 physical therapies to help pain
Exercise Hydrotherapy Manipulation Acupuncture TENS
