Ch 39 - Alteration in Musculoskeletal Function Flashcards
What type of musculoskeletal injuries is associated with the leading cause of death in individuals 1-44 yrs old?
Skeletal trauma
Majority of occupational injuries in a hospital are _____ _____
registered nurses
Majority - 70% of hospital visits come from _____
fractures
What is the first line of defense againts external forces?
Musculoskeletal system
What does the musculoskeletal system enables? (2pts)
- mobility
- protection of internal organs
The damage to musculoskeletal system results in?
difficult and painful movement
What skeletal trauma is usually associated with break in bone, accompanied by surrounding tissue damage?
fractures
What is the highest incidence for fractures?
males = 15-24 yrs old
adults = less than 65 yrs old
What is the trauma is someone has a fracture?
bone subjected to stress greater than it can absorb
What are the most common fracture for YOUNG ADULTS, WORK PLACE, & OLDER INDIVIDUALS?
For young adults: CLAVICLE, tibia, and humerus
In workplace: hands and feet
Older individuals: humerus, femur, VERTEBRA, PELVIS
What age does skeletal trauma most common?
1-44 yrs old
Fractures in older individuals can be linked to what bone disease?
osteoporosis
What terms is associated with stress on TIBIA by overworking your MUSCLES like starting TOO FAST and not allowing muscles time to grow and warm up?
shin splints
Describe the main fracture types.
Complete fracture (CF)
Incomplete fracture (IF)
Open fractures (OF)
Comminuted
Linear
Oblique
Spiral
Transverse
Greenstick
CF: bone entirely broken
IF: bone damaged but still in one piece
OF: skin is open
Comminuted: bone breaks into more than 2 fragments
Linear: runs parallel to long axis of bone
Oblique: occurs at slanted angle
Spiral: encircles bone
Transverse: straight across bone
Greenstick: bone cracks on one side only
What is pathological fracture?
break at a site of pre-existing abnormality due from force that would not fracture a normal bone
What are the signs and symptoms for fracture? (9 pts)
swelling, pain, deformity, dislocation, ab position, crepitus, bruising, nerve damage, pulselessness at site.
Description of pain when having fracture.
muscle spasm that continues until bone fragments are immobilized
What is crepitus?
rubbing of bone fragments against each other
What does nerve damage lead for people with fractures?
impaired sensation
When vessels are compressed, there is _______ at site. A symptom for people with ______
pulselessness; fracture
What is the difference between dislocation and subluxation?
dislocation: joint surfaces LOSE CONTACT with each other
subluxation: PARTIAL CONTACT between opposing joint surfaces
T or F: Subluxation is the complete joint disruption whereas Dislocation can damage ligaments, nerves and cartilage.
FALSE; other way around (Dislocation, Subluxation)
What are the causes of dislocation and subluxation?
developing joint, muscular imbalance, trauma & joint instability
Define the 4 causes of dislocation and subluxation.
DJ: ligaments not full developed
Trauma:
MI: unbalanced exercise programs, bad posture
JI: repetitive dislocations, stretched ligaments from previous injury
What type of causes of dislocation and subluxation is associated with REPETITIVE dislocations, STRETCHED ligaments from previous injury
joint instability
What are the cautions for dislocation and subluxation that could lead to permanent disability?
numbness and tingling
What are the tx for skeletal trauma? (3pts)
Fixation, splints, & traction
What is fixation?
PIN or ROD placed in uninjured bone to help stabilize fracture site
Define autograft, allograft and xenograft. Which tx are these associated?
autograft: bone graft from the individual
allograft: bone graft from a cadaver
xenograft: bone graft taken from another species
These three are associated with fixation
What are the bone substitutes for fixation tx?
artificial joints
What are the 2 types of traction tx?
skin & skeletal traction
What is skin traction?
- TAPE applied to skin to hold bone in place; used in pt waiting in operating room
What is the most common bone for skeletal traction?
femur
What is skeletal traction?
- PINS drilled into bone DISTAL to fracture
What are splints?
protect injured body part from moving
T or F: Traction can provide restrictive movement or complete immobilization.
FALSE; Splints
Name the 4 bone healing stages?
a. hematoma
b. soft callus
c. hard callus
d. remodeling
Which stage of bone healing is associated with OSTEOBLASTS within soft callus sythesize collagen to form hard callus?
hard callus
Which stage of bone healing is associated with unnecessary callus is reabsorbed and repaired tissues are realigned?
remodeling
Which stage of bone healing is associated with BLEEDING at site of injury and surrounding tissue?
hematoma
Which stage of bone healing is associated with hematoma at site forms FIBROUS network?
soft callus
T or F: Hard callus forms on outer bone surface over fracture.
FALSE; Soft callus
T or F: Bone can form new bone without forming scar tissue.
TRUE
Timeframe for the healing of most fractures?
4-8 weeks
What are the support structures?
strains, sprains, Rhabdomyolysis, & Compartment syndrome
What is the difference between sprain and strains?
Strains: tearing or stretching of MUSCLE/ TENDON
Sprain: tearing of a LIGAMENT
In which part of the body are strains and sprains most commonly found?
Strains: hands, feet, knees, upper arm, thigh, ankle
Sprain: wrist, ankle, elbow, knee
What are the three degrees of injury for strains/sprains?
- fibers stretched; muscle and joint stable
- more tearing of tendon or ligament – muscle weakness/ joint instability
- inability to contract muscle
T or F: For the third degree of injury, full recovery is expected but potential for arthiritis.
TRUE
How many months are required for stability of joint?
3 months
Excessive stretching could damage _____. Result in scar tissue or poor tendon/ligament function.
recovery
How long does healing tendon/ligament lacks strength to withstand some levels of stress after injury?
4-5 weeks
What is Rhabdomyolysis?
rapid breakdown of muscle cause release of INTRACELLULAR contents (myoglobin, enzymes, potassium) into ECF & blood.
T or F: Rhabdomyolysis is a serious medical condition that can be fatal and lead to permanent damage.
TRUE
Causes of rhabdomyolysis?
- trauma: crash injuries/ meds & drugs
- excessive muscular contractions; infectious agents; toxins: CO
What are the complications for rhabdomyolysis?
hyperkalemia, cardiac dysrhythmia & kidney failure
What is hyperkalemia? Which musculoskeletal injuries is this associated?
- excess K+ released into circulation; rhabdomyolysis
What are the signs and symptoms for rhabdomyolysis?
- muscle pain, weakness ,dark urine
- CREATINE KINASE
What are the triad of symptoms for rhabdomyolysis?
muscle pain, weakness, dark urine
Where does the dark urine of rhabdomyolysis comes from?
myoglobin
T or F: Dark urine is not always indicative of rhabdomyolysis.
TRUE
What is the most reliable indicator of rhabdomyolysis?
Creatine Kinase
What is the function of Creatine Kinase?
add phosphate to ADP to rephosphorylate ATP and maintain cellular ATP homeostasis
What tx goal for rhabdomyolysis?
maintain urinary output and prevent kidney failure
What are tx for rhabdomyolysis?
-rapid IV fluids to maintain urine output
- may require hemodialysis to deal with hyperkalemia
What is compartment syndrome?
damage WITHIN compartment but FASCIA encircling compartment is intact
What term is associated with well-defined compartment containing muscle and associated nerves and blood vessels enclosed by fascia?
muscle compartment
In compartment syndrome, increased pressure caused decreased blood supply = ______ = necrosis
hypoxia
What is the cause of compartment syndrome?
Increased compartment CONTENT (e.g., bleeding) or decrease volume of compartment (e.g., cast/ bandage that is too tight)
The increased compartment content and decrease volume of compartment result in?
disturbance of muscles MICROVASCULATURE
What conditions can increase compartmental pressure?
burns, snake or insect bites
What are the 6Ps manifestation for compartment syndrome?
Pain
Pressure
Paralysis
Parasthesia
Pulselessness
Poikilothermia
What is paresthesia?
numbness/tingling due to nerve impingement
What is paresis?
muscle weakness
What is pulselessness in compartment syndrome?
inadequate blood perfusion to compartment
What is the diagnosis for compartment syndrome?
measurement of intra-compartmental pressure with MANOMETER
What does manometer measure?
pressure
Out of the 6 Ps of Compartment Syndrome, _____ with radiation to fingers/ toes of affected limb, and _____ are most suggestive of compartment syndrome.
pain; parethesia
What is the tx for compartment syndrome?
cutting FACIA to relieve pressure
What disorder of bones is associated with decreased bone mineral density (BMD) and increased risk of fractures?
osteoporosis
What is the most common bone affected by osteoporosis?
hip, wrist & SPINE
What is the difference between postmenopausal and secondary osteoporosis?
Postmenopausal: caused by ESTROGEN deficiency
SECONDARY: caused by ENDOCRINE dsyfunction
What hormones are associated with secondary osteoporosis?
parathyroid hormone, thyroid hormone, and growth hormone
What are other factors to get osteoporosis?
meds, lack of physical activity, ab BMI
T or F: Osteoporosis is a chronic disease that progresses silently for decades but not necessarily related to aging.
TRUE
In osteoporosis, old bone reabsorbed ___ than new bone is made.
faster
What is the peak bone mass?
around 30 yrs old
After 30, there is increased risk of _____:
fractures
How many women and men will sustain a vertebral fracture?
women: 1/6
men: 1/12
What are the signs and symptoms of osteoporosis?
- bone deformity, and pain due fractures
- vertebral fractures can cause KYPHOSIS
- occurence of osteoporosis exposed by fall
What is kyphosis?
humpback
What are the diagnosis for osteoporosis?
BMD using x-ray
DXA scanner
What does DXA scanner measures?
amount of x-ray from each beam passing through bone
DXA scanner utilizes two x-ray beams, what are they?
one HIGH energy and one LOW energy
When diagnosing osteoporosis, by the time diagnosed, ___% of bone tissue could be lost.
30
What are the tx of osteoporosis? (5 pts)
meds, limit alcohol and caffeine, stop smoking, moderate weight-bearing exercise, prevent fracture.
Another name for Paget’s Disease?
osteitis deformans
What disorder of bones is associated with increased metabolic activity which leads to localized ab and excessive bone modelling?
Paget’s Disease
What is the result of localized ab and excessive bone remodelling? (Paget’s disease)
enlarged but soft bones/ neurological problems
T or F: Paget’s disease can occur in one bone or multiple bones.
TRUE
What are the causes of Paget’s disease?
GENETICS & environmental factors
Who are at risk for Paget’s disease?
Men older than 55 yrs old; women older than 40 yrs old
If Paget’s disease are asymptomatic it can be diagnosed using __-___
x-ray
For Paget’s disease, familial is up to ___% of cases involve family members.
25%
What are some environmental causes for Paget’s disease?
- viruses like mumps& measles
- Human Parainfluenza – not related to influenza
Pathophysiology of Paget’s Disease:
Excessive ____ (1) of spongy bone and replaced with disorganized bone at increased rate.
_____ (2) diminish, bone marrow is replaced by extremely vascular ___ (3) tissue.
Collagen fibers are disorganized, and mineralization of bone extends into bone marrow.
Result in increased bone ___ (4) and increased risk of bone ____ (5)
- reabsorption
- Trabeculae
- Fibrous
- Fragility
- Tumours
The manifestations of Paget’s disease ___ upon site. What are the two types of manifestations for Paget’s disease.
depend.
cranium & long bones
Describe the manifestations of Paget’s disease: Cranium and long bones.
Cranium: asymmetrical appearance; brain compression = dementia and altered consciousness.
Long bones: produces lateral curvature in the tibia and femur
Which infectious bone disease is most often caused by bacteria but also virus, fungi and parasites?
osteomyelitis
What are the 2 types of osteomyelitis?
HEMATOGENOUS osteomyelitis & Contiguous osteomyelitis
What is the difference between hematogenous and contiguous osteomyelitis?
Hematogenous osteomyelitis: caused by pathogen carried in blood stream
Contiguous osteomyelitis: infection spreads from adjacent bones.
Which type of osteomyelitis is common in children?
hematogenous osteomyelitis
What is the primary pathogen that causes osteomyelitis?
Staphylococcus aureus
Osteomyelitis is associated with what blood disorder since both reduces immune ability to clear blood infections?
sickle cell anemia
What are some causes of osteomyelitis?
- open fractures, penetrating wounds, surgical procedures
- DIABETES, smoking, alcohol, drug abuse
- chronic illnesses, IMMUNOSUPPRESSIVE meds.
What is the tx for osteomyelitis?
debridement of infection bone
Explain debridement of infected bone.
surgery to remove infected bone and small amount of healthy bone
In the pathophysiology of osteomyelitis, S. aureus produces toxins that destroys what type of WBC?
neutrophils
What is the difference between osteoblast and osteclasts
osteoblast - creating bone
osteoclasts - breaking down bone
What term describes a fluid that leaks out of blood vessel?
exudate
What is sequestrum?
piece of devitalized dead bone separated from surrounding bone
In pathophysiology of osteomyelitis, what is the risk of biofilms adhering to surfaces?
risk of implants
What is the most common form of arthritis?
osteoarthritis
What disorder of joints is caused by physical wear and tear on a joint over time?
osteoarthritis
What is the primary defect of osteoarthritis?
loss of articular cartilage
In pathophysiology of osteoarthritis, articular cartilage breaks down, it leads to underlying bone to become _____(1). Then ____ (2) develop on bone and its contents forced into ____ (3) cavity. The underlying bone develops projects that break off into synovial fluid called ___ ___ (4). ___ (5) capsule becomes thickened and adheres to deformed bone = reduced motion.
sclerotic (1), cysts (2), synovial (3), joint mice (4), Joint (5)
What does sclerotic mean?
dense and hard
Diagnosis for osteoarthritis?
x-ray
What are the signs and symptoms of osteoarthritis?
- pain, stiffness, decreased ROM, muscle wasting, and deformity
- swelling of joint due osteocyte fragments in synovial
What are tx for osteoarthritis?
- exercise, weight loss, meds (CHONDROITIN)
- If severe: surgery like implantation of artificial joints
What are the most common artificial joints?
hip and knee
What disorder of joints is associated with chronic autoimmune disease focusing on joints?
rheumatoid arthritis
What is the difference between osteoarthritis and rheumatoid arthritis?
synovial membrane is first tissue affected in RA
What are the signs and symptoms for rheumatoid arthritis?
- joint degradation is SYMMETRICAL
- stiffness most pronounced in morning
- fixed flexion of small hand joints
What are the 2 types of fixed flexion of small hand joints?
swan neck and boutonniere
What are some characteristics of rheumatoid arthritis?
- joint swelling and tenderness
- destruction of synovial joint – if severe can result in premature death
- genetic factors
What are the 4 stages of rheumatoid arthritis?
- Synovitis
- Pannus
- Fibrous ankylosis
- Bony ankylosis
In pathophysiology of rheumatoid arthritis (stage 2), what is the result of macrophages initiating inflammatory response?
thickening synovial fluid
What do you call to the thickening of synovial fluid?
pannus
In pathophysiology of rheumatoid arthritis (stage 3), as pannus invades bone tissue leads to ab bone remodelling which result in?
invasion of fibrous connective tissue
What body parts affected by rheumatoid arthritis?
fingers, feet, writs, elbow, ankles, knees, also tissue of HEART, LUNG & KIDNEYS
What is disorder of joints is the most common inflammatory arthritis world wide? AKA ____ of ____
gout; Disease of Kings
What is the caused of gout?
overproduction or undersecretion of uric acid
T or F: Gout has no genetic association.
FALSE; GOUT HAS A STRONG GENETIC ASSOCIATION
What are characterizes gout?
inflammation and joint esp BIG TOE
Choose: (Overproduction) or (Underexcretion) of uric acid is responsible for ___% of gout cases.
underexcretion; 90%
Who are at risk for gout?
OLDER male, alcohol, red meat, fructose and increase BMI
What are the signs and symptoms for gout
- kidney stones
- joint enlargement
Pathophysiology of gout: When UA reach a specific limit it crystalizes forming ___ (1) that deposit in joints. The crystallization initiates inflammatory process = pain, known as ____ ____ (2). As inflammatory process increased, there is increased in ___ (3) which also an increased in ______(4)/neutrophils. The WBC engulf crystalized urate leads to ___ (5) of WBC = increased inflammation
- precipitates
- gouty arthritis
- cytokines
- macrophage
- rupture
What is the breakdown product of uric acid?
purine nucleotides (GUANINE & ADENINE)
What organ excrete uric acid from body?
During gout, urate excretion is ____
kidneys; sluggish
What disorder of skeletal muscle is associated with loss of FULL passive range of motion?
contractures
Where does contractures most likely to occur?
secondary to joint, muscle and soft tissue limitations
T or F: Contracture is a chronic disorder.
FALSE; Contracture can be temporary
T or F: Contractures are composed of Physiological & Pathological.
TRUE
Contractures Physio:
Muscle contraction occurs in _____ (1) of muscle action potential. Thus muscle shortening happens bec of __ (2) pump failure (even in presence of plentiful ATP).
Contractures are present in ____’s (3) disease.
absence (1), Ca (2) & McArdle (3)
Contractures Patho:
Permanent muscle shortening caused by ___ ____ (1) or _____ (2). _____ (3) tendons contractures are examples.
Contractures occur despite plentiful ATP and ___ (4) action potential. Most common in ___ (5), neuromuscular diseases like _____ (6) dystrophy.
muscle spasm (1), weakness (2), achilles (3), normal (4), stroke (5), muscular (6).
T or F: Lower extremity contractures are more common.
TRUE
Which disorder of skeletal muscle is associated with muscle wasting due to REDUCTION in muscle fibers size after PROLONGED INACTIVITY form bed , rest, trauma or local nerve damage?
disuse atrophy
T or F: Disuse Atrophy can occur within days of inactivity.
FALSE; Disuse Atrophy can occur within WEEKs of inactivity.
For disuse atrophy, normal individual on ____ (1) rest will lose muscle strenght at a rate of ___%/day (2) (One week = 21)
bed (1) & 3 (2)
T or F: Normal aging cna also cause muscle atrophy and weakness
True
What are the tx for disuse atrophy? (4 pts)
- fq forceful contractions
- passive lengthening exercises
- brisk walking
- after one year, regeneration of muscle fibers becomes impaired
Which disorder of skeletal muscle is associated with chronic musculoskeletal syndrome characterized by DIFFUSE pain, fatigue and increased SENSITIVITY TO TOUCH?
fibromyalgia (FM)
Why does fibromyalgia often misdiagnosed?
Due to the absence of systemic or localized inflammation
Who are affected by the fibromyalgia disorder?
90% women, range 30-50 yrs old
Where does pain begin in fibromyalgia?
begins in neck and shoulders then becomes generalized
What is the genetic involvement of fibromyalgia?
FM alterations in genes affect serotonin, catecholamines, dopamine — all involved in STRESS RESPONSE and SENSORY PROCESSING
FM appears to be result in ___ (1) dysfunction when there is an _____ (2) of pain transmission and interpretaion
CNS (1) & amplification (2)
