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Pathophysiology > Chapter 39 - Alteration In Musculoskeletal Function > Flashcards

Chapter 39 - Alteration In Musculoskeletal Function Flashcards

1
Q

Leading cause of death in individuals 1-44 yoa

A

Skeletal trauma

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2
Q

Majority (70%) of hospital visits come from

A

Fractures

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3
Q

Majority of occupational injuries in hospitals are

A

Registered nurses

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4
Q

Musculoskeletal system

A

First line of defence against external forces
-mobility, protects internal organs

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5
Q

Fractures

A

Break in bone, usually accompanied by surrounding tissue damage

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6
Q

Highest incidence of fractures

A

Males 15-24 yoa, adults >65 yoa

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7
Q

Trauma

A

Bone subjected to stress greater than it can absorb

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8
Q

Most common fractures in YP

A

Clavicle, tibia and humerus

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9
Q

Older people most common fractures

A

Humerus, femur, vertebra and pelvis (linked to osteoporosis)

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10
Q

Shin splints

A

Stress on tibia by overworking your muscle
-starting too fast and not allowing your muscle time to grow and warmpip

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11
Q

Complete fracture

A

Bone is entirely broken

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12
Q

Incomplete fracture

A

Bone damaged but still in one piece

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13
Q

Open fracture

A

Skin is open

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14
Q

Comminuted fracture

A

Bone breaks into more than two fragments

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15
Q

Linear fracture

A

Runs parallel to long axis of bone

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16
Q

Oblique fracture

A

Occurs at slanted angle

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17
Q

Spiral fracture

A

Encircles bone

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18
Q

Transverse fracture

A

Straight across bone

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19
Q

Greenstick fracture

A

Bone cracks on one side only

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20
Q

Pathological fracture

A

Break at a site of pre existing abnormalities
-resulting form force that wold not fracture a normal bone

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21
Q

Fracture s/s: swelling

A

Site of injury due to soft tissue edema, and hemorrhage into muscles and joints

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22
Q

Fracture s/s: pain

A

Muscle spasms which will continue until bone fragments are immobilized

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23
Q

Fracture s/s: crepitus

A

Rubbing of bone fragments against each other

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24
Q

Fracture s/s: bruising

A

Bleeding into tissue

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25
Q

Fracture s/s: nerve damage

A

Impaired sensation

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26
Q

Fracture s/s: pulselessness at site

A

Vessels are compressed

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27
Q

Dislocation

A

Joint surfaces lose contact with each other
-complete joint disruption

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28
Q

Subluxation

A

Partial contact between opposing joint surfaces
-can damage ligaments, nerves, cartilage

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29
Q

Causes of dislocation and subluxation

A

-developing joint
-trauma
-muscular imbalance
-joint instability

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30
Q

What does numbness and tingling signal in dislocation and subluxation

A

Can lead to permanent disability

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31
Q

Splints

A

Protect injured body part from moving
-can provide restrictive movement or complete immobilization

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32
Q

Skin traction

A

Tape applied to skin to hold bone in place (short term)
-used in patients waiting in operating room

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33
Q

Skeletal traction

A

Pins drilled into bone distal to fracture
-larger weight supplied to keep bone in alignment
-body weight counters fraction force

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34
Q

Skeletal traction is most commonly in

A

Femur

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35
Q

Fixation

A

Pin or rod placed in uninsured bone to help stabilize fracture site due to too much bone being injured

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36
Q

Autograft vs allograft vs xenograft

A

Auto: bone graft from the individual

Allo: bone fracture from a cadaver

Xeno: bone graft taken from another species

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37
Q

Bone healing stages: hematoma

A

Bleeding at site of injury and surrounding tissue

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38
Q

Bone healing stages: soft callus

A

Hematoma at site forms fibrous network
-soft callus forms on outer bone surface over fracture

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39
Q

Bone healing stages: hard callus

A

Osteoblasts within soft callus synthesize collagen to from hard callus

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40
Q

Bone healing stages: remodeling

A

Unnecessary callus is reabsorbed and repaired tissues are realigned

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41
Q

Most fractures heal within

A

4-8 weeks

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42
Q

Bone can form…

A

New bone without forming scar tissue

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43
Q

Strains

A

Tearing or stretching of a muscle/tendon
-most commonly found in hands, feet, knees, upper arm, thigh and ankle

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44
Q

Sprain

A

Tearing of a ligament
-most commonly in wrist, ankle, elbow, knee

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45
Q

Grade 1 (sprain/strain)

A

Fibres stretched, muscle and joint remain stable

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46
Q

Grade II (sprain/strain)

A

More tearing of tendon or ligament = muscle weakness and joint instability

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47
Q

Grade III (sprain/strain)

A

Inability to contract muscle = significant joint instability
-surgery may be required
-full recovery expected, but potential for arthritis

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48
Q

Healing tendon/ligament lacks strength to withstand some levels of stress for ____ weeks after injury

A

4-5

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49
Q

___ months required for stability of joint

A

3

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50
Q

What could damage recovery, or result in scar tissue/ poor tendon and ligament function?

A

Excessive stretching

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51
Q

Rhabdomyolysis

A

Rapid breakdown of muscle causes release of intracellular contents (myoglobin, enzymes, potassium) into ECF and blood

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52
Q

___ is a serious medical condition that can be fatal and result in permanent disability

A

Rhabdomyolysis

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53
Q

Causes of Rhabdomyolysis

A

-trauma: crash, medications, drugs
-excessive muscular contractions
-infectious agents
-toxins (carbon monoxide)

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54
Q

Complications of Rhabdomyolysis

A

-hyperkalemina (excess potassium released into circulation)
-cardiac dysrhythmia
-kidney failure

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55
Q

S/s of Rhabdomyolysis : the triad of symptoms

A

Muscle pain, weakness, dark urine

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56
Q

Dark urine comes form what? In Rhabdomyolysis

A

Myoglobin in urine
-this may not always be indicative of Rhabdomyolysis

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57
Q

What is the most reliable indicator of Rhabdomyolysis

A

Creatine kinase
-released in inc quantities

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58
Q

Function of creatine kinase

A

Add a phosphate to ADP to rephosphorylate ATP and maintain cellular ATP homeostasis

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59
Q

TX for Rhabdomyolysis

A

Treatment is meant to maintain urinary output and prevent kidney failure
-rapid IV fluids to maintain urine output
-may require hemodialysis to deal with hyperkalemia

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60
Q

Compartment syndrome

A

Damage within compartment but fascia encircling compartment is intact

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61
Q

Muscle compartment

A

Well defined compartment containing muscle and associated nerves, and blood vessels enclosed by fascia

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62
Q

Increased pressure caused

A

Decreased blood supply = hypoxia = necrosis

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63
Q

Causes of compartment syndrome

A

Inc compartment content (bleeding) or decrease volume of compartment (bandage that is too tight)

64
Q

Result of compartment syndrome

A

Disturbance of muscles microvasculature

65
Q

What can inc compartment syndrome

A

Many conditions like burns, snakes or insect bites

66
Q

Six P’s of compartment syndrome

A
  1. PAIN
  2. PRESSURE
  3. PARESTHESIA
  4. PARESIS
    5.PULSELESSNESS
  5. POIKILOTHERMIA
67
Q

Pain

A

Out of proportion to injury

68
Q

Pressure

A

Swelling, tenderness, to affected area

69
Q

PARESTHESIA

A

Numbness tingling due to nerve impingement

70
Q

Paresis

A

Muscle weakness

71
Q

Pulselessness

A

Inadequate blood perfusion to compartment

72
Q

POIKILOTHERMIA

A

Inability to maintain a constant core temperature independent of ambient temperature

73
Q

What are the most suggestive P’s of compartment syndrome

A

Pain with radiation to finger and toes, and PARESTHESIA

74
Q

Diagnosis of compartment syndrome

A

Measurement of intracompartmental pressure with a manometer
-measures pressure

75
Q

TX of compartment syndrome

A

Cutting facia to relieve pressure

76
Q

Osteoporosis

A

Decreased bone mineral density and increase risk of fractures

77
Q

Chronic osteoporosis

A

Progresses silently for decades but not neccesarily related to aging
-old bone reabsorbed faster than new bone is made

78
Q

Most common chronic osteoporosis

A

Hip, writs,t and spine

79
Q

Post menopausal osteoporosis

A

Caused by estrogen deficiency

80
Q

Secondary osteoporosis

A

Caused by endocrine dysfunction

81
Q

Most associated things with secondary osteoporosis

A

Parathyroid hormone, cortisol, thyroid hormones and growth hormone

82
Q

Other factors associated with secondary osteoporosis

A

Medication, lack fo physical activity, abnormal BMI

83
Q

Peak bone mass of osteoporosis around

A

30 yoa

84
Q

After 30 yoa (osteoporosis)

A

Increased risk of fractures
-1/6 women
-1 1/2 men will sustain vertebral fracture

85
Q

S/s of osteoporosis

A

-bone deformity and pain due to fractures
-vertebral fractures can cause kyphosis (humpback)
-occurrence of osteoporosis is usually exposed by fall

86
Q

Diagnosis of osteoporosis

A

Bone mineral dentistry using Z rya
-by the time of diagnosis 30% of bone tissue could be lost

87
Q

DXA scanner

A

Utilizes two X-ray beams, one high energy and one low energy
-measures amount of X-ray from each beam passing through bone

88
Q

TX for osteoporosis

A

-prevent fractures
-medication to prevent bone reabsorption
-limit alcohol and caffeine
-stop smoking
-moderate weight bearing excel sizes stimulating bone formation

89
Q

Paget’s disease

A

Increased metabolic activity = localized abnormal and excessive bone remodeling

90
Q

Paget’s disease is otherwise known as

A

Osteitis deformans

91
Q

Result of Paget’s disease

A

Enlarged but soft bones and neurological problems

92
Q

Paget’s disease can occur in

A

One bone or multiple bones

93
Q

Who is at risk for Paget’s disease

A

Men older than 55 yoa and women older than 40 yoa

94
Q

If Paget’s disease is asymptomatic how can it be diagnosed

A

Via x ray

95
Q

Is Paget’s disease familial?

A

Up to 25% of cases involve family members

96
Q

Cause of Paget’s disease

A

Genetics and environmental factors

97
Q

Environmental causes of Paget’s disease

A

-viruses (mumps, measles)
-human parainfluenza virus (respiratory tract virus) despite name, not related to infleunza (the flu)

98
Q

What exactly is Paget’s disease

A

Excessive reabsorption of spongy bone and replaced with disorganized bone at increased rate

99
Q

In Paget’s disease ___ diminish and bone marrow is replaced by

A

Trabeculae
-extremely vascular fibrous tissue

100
Q

Collagen fibres in Paget’s disease

A

Are extremely disorganized nad mineralization of bone extends into bone marrow

101
Q

Result of Paget’s disease

A

Increased bone fragility and increased risk of bone tumours

102
Q

Manifestations of cranium Paget’s disease

A

Take on a symmetrical appearance
-brain compression = dementia and altered consciousness

103
Q

Paget’s disease in long bones

A

Affects both ends of long bones, producing lateral curvature in the tibia and femur

104
Q

Osteomyelitis

A

Infection most often caused by bacteria, but also virus, fungi or parasites

105
Q

Hematogenous osteomyelinitis

A

Caused by a pathogen carried in blood stream (more common in children)

106
Q

Contiguous osteomyelitis

A

Infections spread from adjacent bones
-contiguous=sharing common border

107
Q

Causes of osteomyelitis

A

-open fractures, penetrating wounds and surgical procedures
-diabetes, smoking, alcohol, drug abuse
-chronic illness, immunosuppressive medications

108
Q

Primary pathogen in osteomyelitis

A

Staph. Aureus

109
Q

Osteomyelitis is associated with what

A

Sickle cell anemia
-since SCA reduced immune ability to clear blood infections

110
Q

Osteomyelitis: s.aureus produces

A

Toxins that destroy neutrophils
-biofilms adhere to surface = inc risk of implants

111
Q

Osteomyelitis: biofilm and inflammation =

A

Alteration of balance between osteoblast (creating bone) and osteoclasts (breaking down bone)

112
Q

Osteomyelitis: vessel leakage creates

A

Exudate which seals bone canaliculi
-fluid that leaks out of blood vessels

113
Q

Osteomyelitis: inflammatory exudate extends into

A

Marrow cavity and creates sequestrum (a piece of devitalized bone separated from surrounding bone)

114
Q

Osteomyelitis: osteoblasts

A

Lay new bone over infected bone

115
Q

TX for Osteomyelitis

A

Debridement of infected bone
-surgery to remove infected bone plus a small amount of heathy bone to ensure all infection is removed

116
Q

Osteoarthritis is caused by

A

Physical wear and tear on a joint over time

117
Q

Most common form of arthritis

A

Osteoarthritis

118
Q

Primary defect of Osteoarthritis

A

Articular cartilage

119
Q

Osteoarthritis

A

Articular cartilage breaks down
-results in underlying bone becoming sclerotic (dense and hard)

120
Q

Osteoarthritis: cysts develop on bone and pressure builds up in cysts =

A

Cysts contents forced into synovial cavity (opening from bone into synovial cavity)

121
Q

Osteoarthritis: underlying bone develops projections

A

Which break off into synovial fluid
-bone projections called joint mice

122
Q

Osteoarthritis: joint capsule becomes

A

Thickened and adheres to deformed bone = reduced range of joint motion

123
Q

S/s of Osteoarthritis

A

Pain, stiffness, decreased ROM, muscle wasting and perhaps deformity

124
Q

Osteoarthritis swelling is due to

A

Osteocytes fragments in synovial cavity

125
Q

Diagnosis fro Osteoarthritis

A

X-ray

126
Q

TX Osteoarthritis

A

-exercise, weight loss, medication (Chirondroitin)
-surgery/implantation of artificial joints

127
Q

Rheumatoid arthritis

A

Chronic autoimmune disease focusing on joints
-joint swelling and tenderness
-destruction of synovial joints
-genetic factors

128
Q

Difference between Osteoarthritis and rheumatoid arthritis

A

In RA, synovial membrane is the first tissue affected

129
Q

S/s of rheumatoid arthritis

A

-Join degradation is symmetrical
-stiffness mostly in morning
-fixed flexion of small hand joints (swan neck and boutonniere)

130
Q

Rheumatoid arthritis: what becomes activated

A

Synovial cells including macrophages

131
Q

Rheumatoid arthritis: macrophages will initiate

A

Inflammatory response = thickening synovial fluid called pannus

132
Q

Rheumatoid arthritis: pannus invades

A

Bone tissue causing abnormal bone remodeling = invasion of fibrous connective tissue

133
Q

What is effected in Rheumatoid arthritis

A

Fingers, feet, wrists, elbows, ankles, knees, tissues of heart lung and kidney

134
Q

The disease of kinds
-most common inflammatory arthritis world wide

A

Gout

135
Q

Gout

A

Over production and underexcretion of uric acid
-genetic
-inflammation and joint pain (especially big toe)

136
Q

90% of Gout cases are due to

A

Under excretion of uric acid

137
Q

Gout: when uric acid reaches a specific limit…

A

It crystallizes forming precipitates that deposit into joint
-initiates inflammatory process = pain = gouty arthritis

138
Q

Risk of Gout

A

Older male, alcohol, red meat, fructose, inc BMI

139
Q

S/s of Gout

A

-kidney stones
-joint enlargement (crystals harden, erode bone and cartilage)

140
Q

Gout: uric acid is a breakdown product of

A

Purine nucleotides
-guanine and adenine

141
Q

Gout: rate of kidney excretion of uric acid

A

Urate excretion if sluggish

142
Q

Gout: inc cytokines =

A

Inc macrophage and neutrophils

143
Q

Gout: WBC engulf crystallized urate =

A

rupture of WBC = inc inflammation

144
Q

Contractures

A

Loss of full passive range of motion
-occurs secondary to joint, muscle and soft tissue limitations

145
Q

Muscle contraction occurs in

A

Absence of muscle action potential

146
Q

Muscle shortening happens because fo

A

Calcium pump failure
-even if there is ATP

147
Q

Contractures are present in

A

McArdles disease

148
Q

Contractures patho

A

-permanent muscle shortening can be caused by muscle spams or weakness
Eg= Achilles tendon

149
Q

Contractures are more common in

A

most common in stroke, neuromuscular disease and lower extremities

150
Q

Disuse atrophy

A

Muscle wasting due to reduction in muscle fibres size after prolonged inactivity from bed rest, traumat or local nerve damage
-can take weeks

151
Q

Normal individual on bed rest will lose muscle strength at a rate of ____ per day

A

3% per day

152
Q

Fibromyalgia

A

Chronic musculoskeletal syndrome characterized by diffuse pain, fatigue and inc sensitivity to touch
-often misdiagnosed due to lack of inflammation

153
Q

Most affected women in fibromyalgia

A

90% are women 30-50

154
Q

Fibromyalgia appears to be result of

A

CNS dysfunction where there is an amplification of pain transmission and interpretation

155
Q

Genetic involvement in Fibromyalgia

A

Affect serotonin, catecholamines and dopamine
-all of which are involved in stress response and sensory processing

156
Q

Fibromyalgia and pain

A

Begins in neck and shoulders, then becomes generalized

Pathophysiology (20 decks)

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