Chapter 39, 40, 41 - Alterations in Musculoskeletal and Integumentary Function Flashcards
Skeletal trauma is the leading cause of death in individuals age __ to ___
1 to 44
____% of hospital visits come from fractures
70%
The majority of occupational injuries in a hospital are…
registered nurses
What is the first line of defence against external forces?
musculoskeletal system
What is the role of the musculoskeletal system?
-mobility
-internal organ protection
Damage to the musculoskeletal system results in _______ and _______ movement
difficult and painful
What is a bone fracture?
a break in bone, usually accompanied by surrounding tissue damage
_____ have a higher incidence of fractures especially age ___-___
males; 15-24
Adults >____ yoa also have a high incidence of fractures
65
Where do fractures occur in most young people?
clavicle, tibia, and humerus
Workplace accidents occur most commonly in ______ and ______
hands and feet
Which areas do fractures occur commonly in older people?
humerus, femur, vertebra, pelvis
Fractures in older individuals are linked to _________
osteoporosis
What are shin splints?
stress on tibia from overworking your muscles (starting too fast, not allowing time to grow, not warming up)
Complete Bone Fracture
Bone entirely broken
Incomplete fracture
bone damaged but still in one piece
Open fractures
skin is open
Comminuted fracture
bone breaks into more than two fragments
Linear fracture
runs parallel to the long axis of the bone
Oblique fracture
occurs at a slanted angle
Spiral fracture
encircles bone
Transverse fracture
straight across bone
Greenstick fracture
bone cracks only on one side
What is a pathological fracture?
a break at a site of pre-existing abnormality and resulting from force that would not fracture a normal bone
Signs and Symptoms of Fracture
-swelling
-pain
-deformity
-dislocation
-crepitus
-bruising
-nerve damage
-pulselessness
Swelling at fracture site occurs due to soft tissue _______ and ________
edema; hemorrhage
Pain from fractures occurs due to…
muscle spasms
Fracture pain occurs until bone fragments are __________
immobilized
Crepitus
rubbing of bone fragments against each other
Bruising
bleeding into tissue
Nerve Damage
impaired sensation
Why does pulselessness at fracture site occur?
compressed vessels
What is a dislocation?
when joint surfaces lose contact with each other or a complete joint disruption
What is a subluxation?
partial contact between opposing joint surfaces
Subluxation can damage ________, ________, and ________
ligaments, nerves, cartilage
Dislocation and subluxation occur in developing joints when…
ligaments are underdeveloped
Dislocation and Subluxation causes:
-trauma
-muscular imbalance (exercise or posture)
-joint instability from repetitive dislocations or ligament stretching
_________ and __________ can lead to permanent disability
numbness and tingling
Splints protect the injured body part from moving and provide either…
a) restrictive movement
or
b) complete immobilization
What is skin traction?
a short term treatment where tape is applied to skin to hold the bone in place (used in patients waiting in OR)
What is skeletal traction?
pins drilled in the bone distal to the fraction
Skeletal traction uses larger ______ to keep the bone in alignment and _____ weight to counter traction force
weight; body
What is the most common bone where skeletal traction is used?
femur
Autograft
bone graft from the individual
What is fixation?
a pin or rod placed in uninjured bone to help stabilize fracture site due to too much injured bone
Allograft
bone graft from a cadaver
Xenograft
bone graft taken from another species
What is an example of a bone substitue?
artificial joint
What are the 4 stages of bone healing?
hematoma, soft callus, hard callus, remodeling
Hematoma Stage
bleeding at the site of injury or surrounding tissue
Soft Callus Stage
hematoma at site forms fibrous network and a soft callus forms on the outer bone surface over the fracture
Hard Callus Stage
osteoblasts within soft callus synthesize collagen to form hard callus
Remodelling Stage
unnecessary callus is reabsorbed and repaired tissues are realigned
How often do x-rays of an injury need to be done?
at injury, 2 months after, 8 months after, and then 10 years after
Most fractures heal in __-__ weeks
4 to 8
________ and general health can prolong fracture healing time
osteoporosis
Bone can form new bone without forming ___ _____
scar tissue
What is a strain?
tearing or stretching of a muscle or tendon
What are common areas of a strain?
hands, feet, knees, upper arm, thigh, ankle
What is a sprain?
tearing of a ligament
What are common areas of a sprain?
wrist, ankle, elbow, knee
1st degree muscle injury
fibres are stretched but the muscle and joint remain stable
2nd degree muscle injury
more tearing of tendon/ligament with muscle weakness and joint instability
3rd degree muscle injury
inability to contract muscle with significant joint instability
With 3rd degree injuries __________ may be required to…
surgery; suture ends back together
With surgery for muscle injuries, recovery is expected but there is a potential for _______
arthritis
How long after a strain/sprain does a healing tendon/ligament take where it can only withstand minor stress?
4-5 weeks
How many months are required for joint stability?
3
Excessive stretching with a muscle injury can damage recovery and result in…
scar tissue or poor function
What is rhabdomyolysis?
rapid breakdown of muscle that causes the release of intracellular contents such as enzymes, myoglobin (like Hb but in heart and muscles and only holds 1 O2 molecule), potassium into ECF and blood
Rhabdomyolysis can be _______ or result in _____ _______
fatal; permanent disability
What can cause rhabdomyolysis?
-trauma from crash injuries
-medications or drugs
-excessive muscular contractions
-infectious agents
-toxins like CO
Hyperkalemia, cardiac dysrhythmia, and kidney failure are complications of ____________
rhabdomyolysis
Hyperkalemia
excess potassium released into circulation
What is the triad of symptoms associated with rhabdomyolysis?
-muscle pain
-weakness
-dark urine
What causes dark urine with rhabdomyolysis?
myoglobin
Is myoglobin in urine always associated with rhabdomyolysis?
no
What is the most reliable indicator of rhabdomyolysis?
high levels of creatine kinase
What is the function of creatine kinase?
add a phosphate to ADP to rephosphorylate ATP and maintain cellular ATP homeostasis
What is the goal of treatment for rhabdomyolysis?
maintain urinary output and prevent kidney failure
Rapid ___ fluids are necessary to maintain urine output
IV
Hemodialysis may be needed to deal with __________
hyperkalemia
What is a muscle compartment?
a well-defined structure compartment containing muscle and associated nerves and blood vessels enclosed by fascia
What is compartment syndrome?
damage within the compartment but with an intact fascia
With compartment syndrome, increased pressure causes decreased blood supply and can lead to…
hypoxia and maybe necrosis
What can cause compartment syndrome?
-increased compartment content (bleeding)
-decreased volume of compartment (cast too tight)
-burns
-snake or insect bites
Compartment syndrome results in a disturbance to the muscle’s __________
microvasculature
What are the “6 P’s” used to diagnose?
compartment syndrome
What are the 6 Ps
pain, pressure, paresthesia, paresis, pulselessness, poikilothermia
Pain
out of proportion to injury
Pressure
swelling, tenderness to affected area
Paresthesia
numbness/tingling due to nerve impingement
Paresis
muscle weakness
Pulselessness
inadequate blood perfusion to compartment
Poikilothermia
inability to maintain a constant core temperature independent of ambient temperature
Which of the 6 Ps are most suggestive of compartment syndrome?
-pain with radiation to fingers and toes
-paresthesia
Diagnosis of compartment syndrome:
manometer to measure intra-compartmental pressure
What is the treatment for compartment syndrome?
cutting fascia to relieve pressure
What is osteoporosis?
decreased bone mineral density and increased risk of fractures
Osteoporosis is a _______ disease
chronic
Is osteoporosis related to aging?
not necessarily, but it progresses silently for decades
With osteoporosis, old bone is __________ faster than new bone is made
reabsorbed
What are the most common sites of osteoporosis?
hip, wrist, and spine
Postmenopausal osteoporosis is caused by an __________ deficicency
estrogen
Secondary osteoporosis is caused by _________ dysfunction
endocrine
Which hormones are commonly associated with osteoporosis?
parathyroid hormone, cortisol, thyroid hormone, growth hormone
Medication, lack of physical activity, and abnormal BMI increase risk for _________
osteoporosis
When does bone mass peak?
around 30 yoa
After 30, risk of fractures increases and 1/6 ______ and 1/12 _____ sustain a vertebral fracture
women; men
What are the signs and symptoms of osteoporosis?
-bone deformity and pain from fractures
-kyphosis from vertebral fractures
______ often expose presence of osteoporosis
falls
Kyphosis
humpback
How is osteoporosis diagnosed?
-x-ray to determine bone mineral density
-DXA scanner
By the time osteoporosis is diagnosed, ___% of bone tissue could be lost
30%
What is a DXA scanner?
two x-ray beams - one high and one low and the amount of x-ray from each beam passing through bone is measured
Treatment for osteoporosis includes:
-fracture prevention
-medication to prevent bone reabsorption
-limited alcohol and caffeine
-stop smoking
-moderate weight bearing exercises to stimulate bone formation
Paget’s disease aka ______ _______
osteitis deformans
What is Paget’s disease?
increased metabolic activity that leads to localized abnormal and excessive bone remodelling
Paget’s disease results in enlarged ____ bones and neurological problems
soft
Men older than ___ and women older than ___ are at risk for Paget’s disease
55; 40
How is asymptomatic Paget’s disease diagnosed?
x-ray
Up to 25% of Paget’s cases involve…
family members
Paget’s is caused by genetic and environmental factors (ie. _______)
-viruses (mumps and measles)
-Human Parainfluenza Virus (involves respiratory tract but not related to influenza)
Paget’s disease involves excessive __________ of spongy bone which is replaced with disorganized bone at an increased rate
reabsorption
With Paget’s, _______ diminish and bone marrow is replaced by extremely vascular ______ tissue
trabeculae; fibrous
Paget’s causes disorganized _______ fibres
collagen
Where does mineralization extend with Paget’s?
bone marrow
Paget’s disease results in…
-increased bone fragility
-increased risk of bone tumours
How does Paget’s affect cranial bones?
-asymmetrical appearance
-compress brain and lead to dementia and altered consciousness
How does Paget’s affect long bones?
-both ends affected
-produces lateral curvature
Osteomyelitis is an _________ bone disease
infectious
Osteomyelitis can be caused by…
-bacteria
-virus
-fungi
-parasite
What is the most common cause of osteomyelitis?
bacteria
What is hematogenous osteomyelitis?
osteomyelitis cause by a pathogen that is carried in the blood stream
Hematogenous osteomyelitis is more common in ________
children
What is contiguous osteomyelitis?
osteomyelitis where the infection spreads from adjacent bones
Contiguous
sharing common border
What is the primary pathogen that causes osteomyelitis?
Staphylococcus aureus
What are some specific causes of osteomyelitis?
-open fracture
-penetrating wound
-surgery
-diabetes
-smoking
-alcohol
-drug abuse
-chronic illness
-immunosuppressive medications
Why is osteomyelitis associated with Sickle cell anemia?
SCA reduces immune ability to clear blood infections
With osteomyelitis, pathogens provoke an immune response and S. aureus produces a ______ that destroys _______
toxin; neutrophils
Why are implants a risk of osteomyelitis?
biofilms adhere to surfaces
Biofilms and inflammation result from an imbalance between ________ and ________
osteoblasts and osteoclasts
What do osteoblasts do?
create bone
What do osteoclasts do?
break down bone
With osteomyelitis, how does vessel leakage create an exudate?
fluid leaks out of blood vessels seals the small channels of bone called canaliculi
What is a sequestrum and how is it created?
a sequestrum is a piece of dead bone that has separated from surrounding bone and it is created by inflammatory exudate that extends into the bone marrow cavity
With osteomyelitis, osteoblasts lay new bone over ___________ bone
infected
What is the treatment for osteomyelitis?
debridement of infected bone (surgery to remove infected and some healthy bone)
What is the most common form of arthritis?
osteoarthritis
What causes osteoarthritis?
physical wear and tear of a joint over time
What is the primary defect of osteoarthritis?
loss of articular cartilage
Thinning cartilage results in underlying bone becoming sclerotic meaning…
it becomes dense and hard
Osteoarthritic cysts that develop on bone are under lots of pressure and their contents are forced into the ____ _____
synovial cavity
What are joint mice?
bone projections that break off into synovial fluid
How does osteoarthritis reduce joint ROM?
by thickening the joint capsule and adhering it to deformed bone
What are the signs and symptoms of osteoarthritis?
-pain
-stiffness
-decreased ROM
-muscle wasting
-deformity
-swelling (due to osteocyte fragments)
How is osteoarthritis diagnosed?
x-ray
Conservative osteoarthritis treatment:
-exercise
-weight loss
-medication
What medication is used for osteoarthritis?
Chondroitin
In severe cases of osteoarthritis, surgery is used to:
-correct joint misalignment
-implant artificial joints
Rheumatoid arthritis is a chronic _________ disease that focuses on joints
autoimmune
Rheumatoid arthritis destroys _______ joints and in severe cases results in premature death
synovial
________ factors contribute to rheumatoid arthritis
genetic
What is the difference between osteoarthritis and rheumatoid arthritis?
-the synovial membrane is the first tissue affected with rheumatoid arthritis
-with RA, joint degradation is symmetrical
Signs and Symptoms of Rheumatoid Arthritis
-stiffness (mostly in the morning)
-fixed flexion of small hand joints - swan neck and boutonniere
With RA, macrophages initiate the inflammatory response which causes pannus…
the thickening of synovial fluid
Pannus invades _____ tissue causing abnormal remodelling and invasion of _______ connective tissue
bone; fibrous
Which areas are affected by RA?
fingers, feet, wrists, elbows, ankles, knees, and tissues of the heart, lungs, and kidneys
What is the most common inflammatory arthritis worldwide?
Gout
Gout aka “disease of _____”
kings
Gout results from an overproduction/underexcretion of _____ acid
uric
Gout has a strong _______ association
genetic
90% of Gout cases are from an _____________ of uric acid
underexcretion
Gout involves inflammation and joint pain, usually of the ____ ____
big toe
How does gout form?
uric acid crystallizes when it reaches a specific limit and forms precipitates that deposit in joints
What brings on the “gouty arthritis” pain?
crystallization that initiates the inflammatory depositys
Risk factors for gout:
-older male
-alcohol
-red meat
-fructose
-increasing BMI
Signs and Symptoms of gout:
-kidney stones
-sluggish urine output
-crystals harden and erode bone and cartilage, increasing the size of the joint
Uric acid is a breakdown product of _______ nucleotides (_______ and _______)
purine (guanine and adenine)
How does the body normally get rid of uric acid?
kidneys
How to WBCs contribute to gout inflammation?
WBCs engulf crystallized urate which causes them to rupture
What is a contracture?
loss of full passive range of motion
____________ occur secondary to joint, muscle, and soft tissue limitations
contractures
Physiological contracture:
-absence of muscle action potential
-calcium pump failure (even in presence of ATP) shortens muscles
Physiological contracture is present in _____ disease
McArdle’s
Physiological contracture can be ________
temporary
Pathological contracture is _________ muscle shortening caused by muscle spasms or weakness
permanent
What is an example of a pathological contracture?
achilles tendon
Pathological contractures occur despite plentiful _____ and normal ______ _____
ATP; action potential
Are lower or upper extremity pathological contractures more common?
lower
___________ contractures are common with strokes and neuromuscular diseases like ________ _______
pathological; muscular dystrophy
Disuse atrophy is muscle wasting to to reduction in muscle fibre size from…
prolonged inactivity
Disuse atrophy can occur within ______ of inactivity
weeks
A normal individual on bed rest loses muscle strength at a rate of ___%/day
3%
________ can also cause muscle atrophy and weakness
aging
How is disuse atrophy treated/prevented?
-forceful contractions
-passive lengthening exercises
-brisk walking
At what point does regeneration of muscle fibres become impaired?
after 1 year
What is fibromyalgia?
a chronic musculoskeletal syndrome characterized by diffuse pain, fatigue, and increased sensitivity to touch
Why is fibromyalgia often misdiagnosed?
absence of systemic or localized inflammation
Who is most affected (90%) by fibromyalgia?
women age 30-50
New research on fibromyalgia suggests role of __________
inflammation
FM is a result of _____ dysfunction with amplification of _____ transmission and interpretation
CNS; pain
FM alteration in genes affect s_____, c________, d_______ (NTs involves in stress and sensory processing)
serotonin, catecholamines, dopamine
Where does FM pain begin?
neck and shoulders (then becomes generalized)
What is scoliosis?
abnormal rotational curvature of the spine
Scoliosis is more common in which age group?
adolescent girls
What are “non-structural” causes of scoliosis?
causes other than the spine itself
What are “structural” causes of scoliosis?
vertebral rotation
What are the 3 types of scoliosis?
- idiopathic
- congenital (bone deformity prior to birth)
- teratological
Idiopathic scoliosis accounts for ___% of cases
80%
What is teratological scoliosis?
scoliosis caused by another systemic syndrome like cerebral palsy
When does the scoliosis curvature progress?
during growth periods
Idiopathic scoliosis rapidly progresses during ______ _______
growth spurts
Efficacy of scoliosis treatment depends on…
hours the brace is worn
______ are 5x more likely to have a case of curvature becoming greater than 20%
girls
What is kyphosis?
spinal curve over 50%
Kyphosis requires a _______ __________ to stop progression
spinal fusion
Bracing is less effective in _________ and ________ scoliosis and surgery is often required
congenital and teratological
Reduced pulmonary function occurs with curvatures >___°
60
Risk of right-side heart failure occurs with curvatures >___°
80
______ disturbances occur due to thoracic and lumbar deformity
GI
What are the two types of muscular dystrophy?
Duchenne and Myotonic
DMD is causes by an ___ linked mutation in ________ gene that causes alterations or deletions of the muscle protein dystrophin
X; dystrophin
What is the most common childhood dysrophy?
Duchenne Muscular Dystrophy
What does dystrophin do?
anchors actin cytoskeleton to muscle fibres of the basement membrane
What happens to poorly anchored muscle fibres?
they tear during repeated contraction causing free CALCIUM to enter the cell and kill it
How does Duchenne Muscular Dystrophy (DMD) present?
-muscle weakness (pre-school children)
-difficulty walking
-large calves
-weakness starting in pelvic area
Why do large calves occur with DMD?
muscle fibres are replaced with fat and connective tissue
How is DMD diagnosed?
-blood creatine kinase level
-if positive, genetic testing of dystrophin gene
With DMD, the blood creatine kinase level can increase to _____ times the normal level
100
Type 1 Myotonic Muscular Dystrophy (MMD) occurs due to a mutation on the ______ gene
DMPK
Type 2 Myotonic Muscular Dystrophy occurs to a mutation on the ________ gene
CNBP
What is the “anticipation” mechanism of type 1 MMD?
where children of mothers who have MMD have a more severe form of MMD
The disease hallmark of MMD is myotonia meaning…
difficulty relaxing after a contraction
What are the symptoms of MMD?
-muscle weakness
-cataracts
-cardiac conditions
-wheelchair
How is MMD diagnosed?
-genetic testing
-test for repeated expression of CTG triplet
________ are ineffective at treating MMD
steroids
Treatment for MMD:
-ROM exercises
-bracing
-surgical release of contractures
What causes pressure ulcers?
-unrelieved pressure
-shearing forces
-friction
-moisture
What is a decubitus ulcer?
when pressure interrupts normal blood flow to the skin and underlying tissue
Risks for pressure wounds include:
-immobilization
-prolonged moisture exposure
-neurological disorders
-malnutrition
-dehydration
Redness from prolonged pressure on the skin returns to normal with…
repositioning or stimulation
If pressure continues and blood flow is blocked, the tissue becomes __________
hypoxic
Shearing or friction of hypoxic tissue can cause __________ and _________
detachment and necrosis
Stage 1 Pressure Wound
-skin inflamed but unbroken
-ulceration can be prevented with repositioning
Stage 2 Pressure Wound
-broken skin
-site is tender and painful
-epidermis and dermis involved
Stage 3 Pressure Wound
-below dermis
-fat tissue involves
Stage 4 Pressure Wound
-visible muscle, bone, ligaments, or tendons
The best treatment for pressure wounds is…
early detection and prevention
Pressure Ulcer Treatment:
-frequent skin assessment
-repositioning
-promoting movement
-special beds to prevent friction and moisture
-nutrition
-hydration
First degree burns require _____ treatment and usually heal within ___ to ____ days with no scarring
no; 3-5
Possible 1st degree burn symptoms:
-nausea
-vomiting
Who is vulnerable to first degree burns?
young and old experiencing dehydration
A 2nd degree superficial partial thickness burn presents as ______ ______ _______ that develop within minutes of injury
fluid-filled blisters
With 2nd degree superficial partial thickness burns, _______ sensors remain intact
pain
How long do second degree superficial partial thickness burns take to heal? Is there scarring?
3-4 weeks; scarring unusual
What do 2nd degree deep partial thickness burns look like?
waxy white
How long do 2nd degree deep partial thickness burns take to heal?
weeks
How is necrotic tissue dealt with for second degree deep partial thickness burns?
surgical removal
With 2° deep partial thickness burns, a ________ of own skin may be required
graph
2nd degree deep partial thickness burns may have hypertrophic scarring which is?
a thick, raised scar
Third degree burn characteristics:
-full thickness
-dry, leathery
-loss of dermal elasticity
Third degree burns require escharotomy which is?
cutting through burned skin to release pressure and prevent compartment syndrome
What is eschar?
dead tissue that forms over healthy skin
With 3rd degree burns all ______ ________ have been destroyed
nerve endings
Fourth degree burns require _____ _______ or reconstructive surgery
skin grafting
_____ and _____ degree burns are considered medical emergencies
3rd and 4th
What is the rule of 9s?
a surgery requirement of 4th degree burns to estimate the total % of body surface burned
All areas of the body constitute 9% of total body area except for the…
groin area which is 1%
How many burn phases are there?
3; burn shock, Ebb, flow
What is the burn shock phase?
phase of combination of CV hypovolemia and cellular hypovolemia
With the burn shock phase, massive fluid loss increases capillary permeability and fluid shifts to…
interstitial spaces
Burn shock phase results in… (2)
-decreased blood volume
-decreased cardiac output
Why are several litres of fluid lost to evaporation each day of the burn phase?
integumentary and pulmonary damage = loss of ability to regulate water evaporation
In the Ebb phase, blood is shunted away from the _______, _________, and ______ in the first 24 hours
liver, kidneys, and gut
In the Ebb phase, after 24 hours capillary integrity is restored and edema resolves signalling…
the end of the burn shock phase
The flow phase is a state of hypermetabolic response of increased…
catecholamines, cortisol, and glucagon
____________ occurs in the flow phase due to increased insulin resistance and muscle loss
hyperglycemia
The flow phase can last up to ___________
2 years
What is the goal of burn treatment?
fluid resuscitation and nutrition
With burn treatment, the first ________ is critical
24 hours
How is fluid restoration done? Why is it important to monitor?
IV; prevention of fluid overload
How is fluid overload prevented?
Parkland formula
Parkland formula: ____ mL of Ringer’s lactate per __________ of body weight per % ________ burned
4; kilogram; total body surface area (TBSA)
The amount of IV fluids given is ______ during the first 8 hours post injury and the rest in the next ____ hours
half; 16 - (total = 24hrs)
What is Ringer’s lactate?
IV fluid for dehydration, having surgery, or receiving IV meds
What is frostnip?
superficial frostbite with pain increasing during rewarming
What is chilblains?
partial thickness frostbite
Chilblains has a _______ tone
purple
With chilblains chronic ________ can form
vasculitis
What is vasculitis?
inflammation of blood vessels
What is frostbite?
-frozen tissue
-ice crystals formed
Frostbitten tissue has a ______ appearance
white
Frostbitten tissue is numb with no sense of _______
pain
Is frostbite reversible?
potentially
What is flash freeze?
rapid formation of ice crystals associated with contact with cold metals or volatile liquids
