Bones, Joints, Soft Tissue Tumors Flashcards
Function of bone
- support
- transmission of forces generated by muscle
- protection of viscera
- mineral homeostasis
- blood cell production
What is bone matrix made up of?
- organic component
- mineral component
What is the organic component of bone called?
Osteoid
What are the three major types of bone cells?
- osteoblasts
- osteocytes
- osteoclasts
is the bone matrix extracellular or intracellular
extracellular
What is the role of the three major cell types?
production and maintenance of the matrix
Where are osteoblasts located?
surface of the matrix
What is the function of osteoblasts
Bone matrix:
- synthesize
- transport
- assemble
And to regulate mineralization
Where are osteocytes located?
within the bone matrix
Function of osteocytes
- control calcium/phosphate levels
- detect mechanical forces and translate them into biological activity
Where are osteoclasts located?
surface of bone
What is the function of osteoclasts?
bone reabsorption
Bone disorder categories
- Congenital disorders
- Metabolic disorders
- Acute conditions
What is an example of a metabolic bone disorder?
Osteoporosis
What is an example of a acute bone disorder?
fractures
What is a fracture?
Loss of bone integrity
What causes a fracture?
- mechanical injury
- diminished bone strength
Why is it important for the NP to know different bone fracture types?
So the NP can properly communicate to patients and colleagues
Which fracture is the most visibly severe?
compound fractures
Which fracture is the most subtle?
greenstick fractures
Is a greenstick fractures subtle even on xray?
yes
Which fracture is common in athletes?
stress fracture
How does a stress fracture occur?
slowly
Why does a stress fracture occur slowly?
r/t repetition
What is an example of a stress fracture?
Long distance runners get stress fractures in their feet
What types of fractures can be displaced?
Any type of fracture can also be displaced
How do most fractures heal?
Casting
Which fractures usually require a healing method other than casting?
displaced fractures
How are displaced fractures healed?
manipulation or surgery
Are dislocations considered fractures?
no
What is a dislocation?
- The displacement or separation of bone ends with loss of articulation
- the bone itself is not fractured
Compound fracture
the bone communicates with the skin surface
Compound fracture is also known as
an open fracture
Comminuted fracture
The bone is fragmented
Displaced fracture
The ends of the bone at the fracture site are not aligned
Stress
A slowly developing fracture that follows a period of increased physical activity in which the bone is subjected to repetitive loads
Greenstick
Extending only partially through the bone, common in infants when bones are soft
Osteomyelitis
Inflammation of bone and marrow
What causes osteomyelitis?
Secondary or Primary infection
Is secondary or primary infection more common in osteomyelitis?
Secondary
How does secondary infection occur in osteomyelitis?
Infections spread to the bone from an infection travelling in the blood stream or through nearby tissue
How does primary infection occur in osteomyelitis ?
When injury to the bone itself becomes exposed and exposes the bone to bacteria
Who is at a higher risk for contracting osteomyelitis?
- diabetes
- smokers
Osteonecrosis
Infarction/death of bone and marrow cells
What causes osteonecrosis?
Lack of blood supply to gone
What is another name for osteonecrosis is what?
aka avascular necrosis
What can osteonecrosis lead to?
Tiny breaks in bone leading to eventual collapse
What are the three mechanisms by which osteonecrosis occurs?
- Mechanical disruption of vessels
- Thrombotic occlusion
- Extravascular compression
What does NOT cause osteonecrosis?
Unlike osteomyelitis it is NOT caused by infection
Compartment Syndrome
When excessive pressure builds up inside an enclosed muscle space in the body
What causes compartment syndrome?
bleeding or swelling after an injury such as a fracture
How long does it take for compartment syndrome to occur?
- RAPIDLY
- hours to days
When deciding how to treat a fracture what is important to remember when considering compartment syndrome?
Place a looser splint/aircast instead of immediately placing a cast
Phantom Limb Pain
Pain that feels like it’s coming from a body part that’s no longer there
Is phantom limb pain truly felt by the pt with an amputation?
Yes
Patho of phantom limb pain
the end of a regenerating nerve becomes trapped in the scar tissue at the amputation site
Who gets amputations?
- veterans
- diabetes
Where does phantom pain originate?
spinal cord
What type of pain is felt when amputaion is AKA
cramping
What type of pain is felt when amputaion is BKA
Shooting/stabbing
What type of pain is felt when amputaion is below the ankle?
Burning
How are osteopenia and osteoporosis similar?
osteoporosis is the worsening of osteopenia
What is the difference between osteopenia and osteoporosis?
PENIA- bone density has begun to dwindle but not yet dangerous
POROSIS- density levels become critical and frequent fractures likely
What can cause fractures in osteoporosis?
Simply bending over or coughing can cause a fracture
Where do most fractures occur in osteoporosis?
hip, wrist or spine
Patho of osteoporosis?
Creation of new bone can’t keep up with the loss of old bone
As a clinician what is an important action when treating someone with osteoporosis?
Document height and spinal alignment
Why do pts with osteoporosis loose height over time?
Loss of height over time d/t micro fractures
Who most commonly gets osteoporosis?
older, white and Asian women after menopause
Why does osteoporosis effect women more commonly?
- less estrogen after menopause
- lower bone density than men
- absorb less calcium then men
Paget Disease
- Local areas of excessive bone turnover
- Disorganized osteoid formation
- Essentially structural unsound bone
What is the hallmark sign of Paget disease?
Mosaic pattern of lamellar bone
Is pagets disease unique?
yes
How does pagets disease progress?
in 3 phases
What happens in the 3 phases?
symptoms progress
What age group does pagets occur in?
late adulthood
What causes pagets?
- genetic
- environmental
What is a commonality between the cause of genetic and environmental pagets disease?
50% of familial cases and 10% of sporadic cases share a mutation in the SQSTM1 gene
What is a common symptom you will find in every pt with pagets disease?
Pain is localized in the effected bone
What is common about rickets and Osteomalacia?
Both are manifestations of Vitamin D deficiency or its abnormal metabolism.
What is different between rickets and Osteomalacia?
- rickets= children
- ostemalacia= adults
Patho of rickets
- Vit D deficiency interferes with bone deposition in the growth plates
- Softens/weakens the bone
- legs bow
Patho of osteomalacia
- bone forms during remodeling
- under mineralized
- legs bow
Rheumatoid arthritis
- chronic
- inflammatory disorder
- autoimmune origin
What does Rheumatoid arthritis effect?
Principally attacks the joints
What happens to the joints in Rheumatoid arthritis?
nonsuppurative proliferation/inflammatory synovitis
synovitis
when the synovium of a joint becomes inflamed
nonsuppurative
not involving pus
proliferation
rapid increase in numbers.
What is are characteristic signs of Rheumatoid arthritis?
- swan-neck deformity
- boutonnière deformity
What can Rheumatoid arthritis lead to?
- destruction of the articulate cartilage
- ankylosis
- adhesion of joints
What contributes to the development and progression of Rheumatoid arthritis?
- genetic predisposition
- environmental factors
What contributes to almost all autoimmune diseases?
- genetic predisposition
- environmental factors
Patho of Rheumatoid arthritis
- antibodies react against self antigens
- T helper cells secrete cytokines
- inflammation
Is Rheumatoid arthritis a slow or fast progressing disease?
Slow
Early symptoms of Rheumatoid arthritis
- Malaise/fatigue
2. Generalized musculoskeletal pain
Symptoms of Rheumatoid arthritis after weeks to months of onset
Joints become involved
In what pattern do symptoms progress in Rheumatoid arthritis once joints are involved?
Symmetrically
Symptoms in the involved joints in Rheumatoid arthritis
- swollen
- warm
- painful joints
What becomes inflamed in Rheumatoid arthritis?
- tendons
- ligaments
- adjacent skeletal muscle (sometimes)
What does swelling in Rheumatoid arthritis cause to happen?
In fingers:
- ulnar deviation
- flexion hyperextension
Ankylosing spondylitis
- Chronic
- systemic
- inflammatory disease
Symptoms of Ankylosing spondylitis
- low back pain
- spinal immobility
Product of Ankylosing spondylitis
Inflammatory erosion where tendons and ligaments attach to bone
Where does Inflammatory erosion in ankylosing spondylitis typically occur
sacroiliac joints
Patho of ankylosing spondylitis
- Undefined antigen (possibly an infection) cross reacts with antigen expressed on cells of musculoskeletal system
- T cell response
- Immune mediated response
Osteoarthritis is aka
Degenerative Joint Disease
Osteoarthritis
degeneration of cartilage
Result of Osteoarthritis
structural and functional failure of synovial joints
Characteristic symptoms of Osteoarthritis
- Joints stiff when first rising in AM or following inactivity
- Heberden’s nodes
- Bouchard’s nodes
What are Heberden’s nodes?
deformity of the distal interphalangeal joints (DIP)
What are Bouchard’s nodes?
deformity of the proximal interphalangeal joints (PIP)
Way to remember differnce between Heberden’s and Bouchard’s nodes.
- HD- like high deff TV
- h= herberders d=distal
Gout
Crystal Induced Arthropathy
Patho of gout
- urate crystals deposited within and around joints
- stimulates production of cytokines
- cytokines recruit leukocytes
- inflammation
- attacks of acute arthritis
What is a common feature associated with gout?
Excessive Uric Acid in tissues and body fluids
How long does uric acid accumulation take to cause gout?
20-30 years
Other than urate crystals what contributes to gout?
increased age
Who is at higher risk of gout?
- genetic
- drugs
- alcohol
- certain foods
- obesity
Which drugs cause higher risk of gout?
Thiazides
Why do Thiazides cause higher risk of gout?
they reduce excretion of urate
Polymyalgia Rheumatica
An inflammatory disorder
Characteristics of Polymyalgia Rheumatica
- muscle pain
- stiffness
Where does pain/stiffness in Polymyalgia Rheumatica commonly occur?
- shoulders
- hips
Where does pain/stiffness in Polymyalgia Rheumatica commonly occur?
- shoulders
- hips
Who does Polymyalgia Rheumatica effect?
people 65+ y/o
Who does Polymyalgia Rheumatica rarely effect?
people < 50 y/o
What condition can Polymyalgia Rheumatica lead to?
giant cell arthritis
giant cell arthritis is aka
temporal arthritis
What does giant cell arthritis affect?
ophthalmic arteries
What can giant cell arthritis result in?
blindness
Symptoms of giant cell arthritis
- temporal headaches
- vision difficulties
- jaw pain
- scalp tenderness
Is it possible to have Polymyalgia Rheumatica and giant cell arthritis at the same time?
Yes
Teacher’s pearl-giant cell arthritis
- Older woman in her 70s
- Had seen 5 other providers - Experiencing prolonged shoulder pain, stiffness with temporal headaches and severe vision impairment.
- No one knew what was happening to her
- She was afraid she was going to go blind
- Teacher was listening to podcast and heard about this giant cell arthritis
- Sent pt for biopsy
- Was positive for giant cell arthritis
- Saved her vision
