ch 29 notes

Question 1

physiologic effects of immobilization

Answer 1

atrophy
joint contracture
deep vein thrombosis

Question 2

atrophy

Answer 2

muscle disuse leads to tissue breakdown and loss of muscle mass

Question 3

joint contracture

Answer 3

. A joint contracture begins when the
arrangement of collagen, the main structural protein of connective tissues, is altered, resulting in a
denser tissue that does not glide as easily. Eventually, muscles, tendons, and ligaments can shorten
and reduce joint movement, ultimately producing contractures that restrict function. The major
musculoskeletal consequences of immobilization are:
• Significant decrease in muscle size, strength, and endurance
• Bone demineralization leading to osteoporosis
• Contractures and decreased joint mobility

Question 4

deep vein thrombosis

Answer 4

Deep vein thrombosis (DVT) involves the formation of a thrombus in a deep vein, such
as the iliac and femoral veins, and can cause significant morbidity if it remains undetected and
untreated. The larger the portion of the body immobilized and the longer the immobilization, the
greater the risks of immobility

Question 5

soft-tissue injury

Answer 5

contusions, dislocations, sprains, strains

Question 6

contusions

Answer 6

A contusion (bruise) is damage to the soft tissue, subcutaneous structures, and muscle. The tearing
of these tissues and small blood vessels and the inflammatory response lead to hemorrhage, edema,
and associated pain when the child attempts to move the injured part

Question 7

ecchymosis

Answer 7

the escape of blood into the tissues is observed as ecchimosis, a black and blue discoloration

Question 8

myositis ossificans

Answer 8

Myositis ossificans may occur from deep contusions to the biceps or quadriceps
muscles; this condition may result in a restriction of flexibility of the affected limb.

Question 9

subungual hematoma

Answer 9

The subungual hematoma can be released by creating a hole at the
proximal end of the nail with a special cautery device or a heated sterile 18-gauge needle.

Question 10

dislocations

Answer 10

Long bones are held in approximation to one another at the joint by ligaments. A dislocation occurs
when the force of stress on the ligament is so great as to displace the normal position of the
opposing bone ends or the bone end to its socket. The predominant symptom is pain that increases
with attempted passive or active movement of the extremity. In dislocations, there may be an
obvious deformity and inability to move the joint.

Question 11

nursemaid’s elbow

Answer 11

A common injury in young children is subluxation, or partial dislocation, of the radial head, also
called pulled elbow or nursemaid’s elbow. In the majority of cases, the injury occurs in a child
younger than 5 years old who receives a sudden longitudinal pull or traction at the wrist while the
arm is fully extended and the forearm pronated. It usually occurs when an individual who is
holding the child by the hand or wrist gives a sudden pull or jerk to prevent a fall or attempts to lift
the child by pulling the wrist or when the child pulls away by dropping to the floor or ground. The
child often cries, appears anxious, complains of pain in the elbow or wrist, and refuses to use the
affected limb. The practitioner manipulates the arm by applying firm finger pressure to the head of
the radius and then supinates and flexes the forearm to return the bone structure to normal
alignment. A click may be heard or felt, and functional use of the arm returns within minutes.
Immobilization is not required. However, the longer the subluxation is present, the longer it tak