Chapter 12 Flashcards
What could alterations in musculoskeletal conditions result in?
- Impaired mobility
- Chronic pain
- Risk for injury
- Inability to take care of self
What does an increase in muscle size reflect?
increases in individual muscle fibers rather than a greater number of fibers.
What happens when muscles work harder?
they respond by becoming larger and stronger from an increase in contractile protein inside the muscle fiber.
What is kyphosis?
Increase in the curvature of the thoracic spine outward
When does kyphosis develop?
Can develop during the adolescent growth spurts because of poor posture or secondary to osteoporosis
What does kyphosis do to lungs?
Can impair lung expansion and ventilation
What is lordosis?
Exaggerated concave of the lumbar spine.
When does lordosis develop?
Can develop during adolescent growth spurts or because of poor posture.
What can increase the risk of lordosis?
obesity
What is scoliosis?
Lateral deviation of the spine that may affect the thoracic or lumbar area or both.
May also include a rotation of the vertebrae.
Who is scoliosis more common in?
More common in females.
What are the manifestations of scoliosis?
- Vary depending on the degree of curvature and are exaggerated when an affected person bends over
- Include asymmetrical hip and shoulder alignment, asymmetrical thoracic cage, asymmetrical gait, back pain or discomfort, fatigue, and indications of respiratory compromise
What is a fracture?
A break in the rigid structure of the bone
Is a fracture the most or least common?
Most common traumatic musculoskeletal disorder
What are the causes of a fracture?
falls, motor vehicle accidents, sports-related injuries, and conditions that weaken the bone
What is a simple fracture?
a single break with bone ends maintaining their alignment and position
What is a transverse fracture?
straight across the bone shaft
What is an oblique fracture?
at an angle to the bone shaft
What is a spiral fracture?
twists around the bone shaft
What is a comminuted fracture?
multiple fracture lines and bone pieces
What is a greenstick fracture?
an incomplete break in which the bone is bent and only the outer curve of the bend is broken
Who does greenstick fractures commonly occur with?
Commonly occurs in children because of minimal calcification, and often heals quickly
What is a compression fracture?
bone is crushed or collapses into small pieces
What is a complete fracture?
broken into two or more separate pieces
What is an incomplete fracture?
partially broken
What is an open fracture/compound fracture?
skin is broken, and bone fragments or edges may be angled and protrude out of the skin
What is a closed fracture?
skin is intact
What is an impacted fracture?
one end of the bone is forced into the adjacent bone
What is a pathologic fracture?
results from a weakness in the bone structure secondary to other conditions
What is a stress fracture?
occurs from repeated excessive stress
What is a depressed fracture?
occurs in the skull
What is the process of a fracture healing?
- Hematoma forms.
- Necrosis of the broken bone ends occurs.
- Fibroblasts invade the clot within a few days.
- Fibroblasts secrete collagen fibers, which form a mass of cells and fibers called a callus.
- Callus bridges the broken bone ends together inside and outside over 2–6 weeks.
- Osteoblasts invade the callus and slowly convert it to bone in from 3 weeks to several months (usually 4–6 weeks).
What complications could occur after a fracture?
Problems with bone union may occur due to nutrition, blood supply, misalignment, and weight bearing.
What is compartment syndrome?
a serious condition that results from increased pressure in a compartment, usually the muscle fascia in the case of fractures
What is the pathogenesis of compartment syndrome?
Increased pressure within a fascial compartment of the lower extremities or the forearm.
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Compression of nerves and blood vessels
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Nerve damage, loss of motor function and tissue ischemia
What is fat embolism?
fat enters the bloodstream, usually after a long bone fracture
What is osteomyelitis?
infection of the bone tissue
can take months to resolve
What is the etiology of osteomyelitis?
Direct extension from an open wound or fracture
Seeding from the blood
What is Staphylococcus aureus?
the common causative agent of osetomyelitis
What is osteonecrosis/avascular necrosis?
death of bone tissue due to a loss of blood supply
What are the manifestations of fractures?
- deformity
- swelling and tenderness at the site
- inability to move the affected limb
- pain
What is a dislocation?
Separation of two bones at a joint
What are the causes of a dislocation?
sudden impact to the joint, congenital conditions, and pathologic states
What are the manifestations of a dislocation?
- Out-of-place joint
- Limited movement
- Swelling or bruising
- Intense pain
What is a sprain?
Injury to a ligament that often involves stretching or tearing of the ligament
What are the causes of a sprain?
forcing a joint into an unnatural position (e.g., twisting one’s ankle)
Where are sprains most common?
Most common in the ankle and knee
What are the manifestations of a sprain?
edema, pain, bleeding, joint stiffness
What is a strain?
Injury to a muscle or tendon that often involves stretching or tearing of the muscle or tendon.
What causes a strain?
Results from an awkward muscle movement or excess force.
Where is the most common site for a strain?
The lower back is the most common site.
What are the manifestations of strains?
- pain
- stiffness
- difficulty moving the affected -muscle
- edema
Does a herniated intervertebral disk occur suddenly or gradually?
either one
What is impaired with a herniated disk?
Sensory, motor, or autonomic function may be impaired depending on the location.
What is the most common region for a herniated disk?
Most frequently involves the lumbosacral region.
What can result from a herniated disk?
Can result in permanent neurologic damage.
What are the causes of a herniated disk?
improper body mechanics, lifting heavy objects, repetitive use, trauma, and degenerative changes
What are the manifestations of a herniated disk?
- May be asymptomatic
- Sciatica
- Pain, weakness
- Low back pain or leg pain that worsens with movement
- Limited mobility
What is osteopenia?
Decreased bone
What is osteoporosis?
Decreased bone mass and decreased spongy bone aka strength
What can cause osteoporosis?
- Metabolic condition characterized by a progressive loss of bone calcium that leaves the bones brittle.
- Can occur due to multiple pathogenetic mechanisms that interact to cause either a decrease in osteoblast activity or an increase in osteoclast activity.
- Spongy bone becomes porous, particularly in the vertebrae and wrist, and the compact bone becomes thin.
What are the causes of osteoporosis?
genetic, dietary imbalances, hormonal fluctuations
What are the risk factors of osteoporosis?
age, being female, being underweight, undergoing gastrointestinal procedures, smoking, excessive alcohol or caffeine consumption, being asian or caucasin
What are the complications of osteoporosis?
pathological fractures (typically in the wrist, hip, and spine)
What are the manifestations of osteoporosis?
Often asymptomatic in early stages
Include osteopenia, bone pain or tenderness, fractures with little or no trauma, low back and neck pain, kyphosis, and height reduction (as much as 6 inches) over time
What are rickets?
soft, weak bones in children, usually because of an extreme and prolonged vitamin D, calcium, or phosphate deficiency.
What is osteomalacia?
adult form of rickets; Minerals shift out of the bone if the blood levels become too low, leading to weak and soft bones.
What are the risk factors of rickets and osteomalacia?
vitamin D deficiency, dietary imbalances, genetic influences, renal disease.
What does osteomalacia and rickets result in?
Bone pain and tenderness
Fractures
Deformities
What are the manifestations of rickets and osteomalacia?
- Develop slowly as the bones weaken
- Fractures
- Skeletal deformities
- Delayed growth in height or limbs
- Dental problems
- Bone pain
- Muscle cramps or weakness
What is paget’s disease?
Progressive metabolic condition characterized by excessive bone destruction that occurs along with the replacement of bone.
What does pagets result in?
Results in fragile, misshapen bones.
What pones does pagets disease often involve?
Often involves long bones, skull, pelvis, and vertebrae
What is the cause of pagets disease?
The exact cause is unknown, but it is thought to be caused by a virus capable of increasing osteoclast activity or genetic defects.
Who is pagets more common in?
More common in men, those of central European descent, and persons with a family history.
What are the complications of pagets disease?
- pathologic fractures
- osteoarthritis
- heart failure
- osteosarcoma
- nerve compression
What are the manifestations of pagets disease?
- Bone pain
- Skeletal deformities
- Fractures
- Joint pain or stiffness
- Neck pain
- Reduced height
- Warmth over the affected bone
- Pain in the affected region
- Hypercalcemia
What is osteoarthritis?
Degenerative joint disease characterized by deterioration of cartilage and its underlying bone as well as bony overgrowth.
What happens with osteoarthritis?
Cartilage surface becomes rough and worn.
Osteophytes and cartilage pieces break off into the synovial cavity, further increasing irritation.
What areas of the body are commonly affected by osteoarthritis?
The knees, hips, and joints in the hands and spine are most commonly affected.
How does inflammation occur with osteoarthritis?
Not inflammatory in origin, but inflammation results from the tissue irritation.
What are the causes of osteoarthritis?
idiopathic and excessive mechanical stress on the joint.
Who is most likely to get osteoarthritis?
More common in women.
What are the manifestations of osteoarthritis?
Joint pain, tenderness, stiffness
Joint swelling
Limited joint range of motion
Crepitus
What is rheumatoid arthritis?
Systemic, autoimmune condition involving multiple joints.
What does the inflammatory response affect with Rheumatoid arthritis?
Inflammatory process primarily affects the synovial membrane, but can also affect other organs.
How does Rheumatoid arthritis start?
Usually starts with an acute inflammatory episode after which the joint may appear to recover.
What is the cause of rheumatoid arthritis?
it is unknown
What are the risk factors of rheumatoid arthritis?
being female, family history, advancing age, and smoking.
What is pannus formation?
Destructive synovial granulation tissue that extends from the synovial to the unprotected bone
What is pannus?
Pannus is the feature of RA that distinguishes it from all other forms of inflammatory arthritis
What are the clinical manifestations of rheumatoid arthritis?
Symmetrical symptoms involving multiple joints
-Joint pain and stiffness
-Limitation of joint motion
-Progressive joint
destruction
-Joint dislocation
-Joint swellingWhat is Gout?
Inflammatory disease resulting from deposits of uric acid crystals in tissues and fluids.
What is Uric Acid?
Uric acid is a by-product of breaking down purines.
what does gout result from?
uric acid build up in the body because of increased production and not enough excretion
Do all people with hyperuricemia have gout?
No
Who is most likely to get Gout?
Males
What are the causes/risk factors of Gout?
inborn error in metabolism, being overweight or obese, consuming alcohol, medications, and eating a diet rich in meat
What are the clinincal manifestations of Gout?
Acute attacks
Chronic inflammation
Tophi
What is Ankylosing Spondylitis?
(crooked vertebra) Progressive inflammatory disorder which starts in the lower back and progresses up the spine.
What happens when someone develops Ankylosing Spondylitis?
New bone forms in an attempt to remodel the inflammatory damage.
What does Ankylosing Spondylitis result in?
Results in joint fibrosis and calcification.
Joints become ankylosed (fused).
Who is more likely to get Ankylosing Spondylitis?
More common in males, and typically appears between 20 and 40 years of age.
What are the complications of Ankylosing Spondylitis?
Endocarditis and uveitis.
What are the manifestations of Ankylosing Spondylitis?
Pain, kyphosis, weight loss, fatigue
What can help Ankylosing Spondylitis?
exercise
What is Muscular Dystrophy?
Degeneration of skeletal muscle fibers
What is the most common and most severe form?
Duchenne’s
What is Duchenne’s Muscular Dystrophy (DMD)?
- X-linked recessive disorder
- 1/3 cases mother is not the carrier (mutation has occured)
What are the causes of Duchenne’s Muscular Dystrophy (DMD)?
Genetic defect
Abnormal dystrophin protein
what is the pathogenesis of dmd?
Weak muscle attachment
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Fiber tearing with repeated use
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Muscle cell regeneration (initially) produces more defective cells
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Later - muscle necrosis Replacement with adipose and fibrous tissue
What are the clinical manifestations of dmd?
Age 3-5
-Postural muscles in the hips
& shoulders affected
-Frequent falling
Age 7-12
-Imbalances between
muscle groups
-Kyphoscoliosis,
contractures & joint
immobility
-Wheelchair dependent
-Cardiomyopathy
-Bowel & bladder control is
maintainedWhat is Fibromyalgia?
Syndrome predominately characterized by widespread muscular pains and fatigue.
What does fibromyalgia affect?
Affects muscles, tendons, and surrounding tissue.
How many pressure points can be found with fibromyalgia and where are they?
Eighteen fibromyalgia-specific pressure points, where pain or tenderness may be stimulated, have been identified in the neck, shoulder, trunk, and limbs.
What are the manifestations of fibromylagia?
Characterized by pain, typically described as a constant, dull muscle ache.
May also include fatigue, sleep disturbances, depression, irritable bowel syndrome, headaches, and memory problems.
Other conditions that may be present include rheumatoid arthritis, systemic lupus erythematosus, and ankylosing spondylitis.
Are majority of bone tumers malignant or benign?
The majority are malignant and occur due to metastasis.
What are the risk factors of bone tumors?
Risk factor: Paget’s disease, other cancerous growths.
What are the manifestations of bone tumors?
Manifestations: bone pain, fractures
What are the 4 bone tumor types?
1) Osteochondroma
2) Osteosarcoma
3) Ewing’s sarcoma
4) Chondrosarcoma
What is Osteochondroma?
A benign tumor that develops adjacent to growth plates
What is Osteosarcoma?
Aggressive tumor that begins in the bone cells
What is Ewing’s Sarcoma?
Aggressive tumor, may begin in nerve tissue within the bone
What is Chondrosarcoma?
Slow-growing tumor, frequently affects older adults
