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Pathophysiology > Chapter 41- Alterations in Musculoskeletal Function > Flashcards

Chapter 41- Alterations in Musculoskeletal Function Flashcards

1
Q

Who has highest incidence of fractures?

A

young males 15-24 y/o and older persons > 65 y/o

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2
Q

Most common fracture sites of healthy bones in young people and why

A

tibia, clavicle, lower humerus from trauma

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3
Q

Most common fx sites in older adults and why

A

upper femur, upper humerus, vertebrae, pelvis d/t osteoporosis

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4
Q

complete fracture

A

bone broken entirely

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5
Q

incomplete fracture

A

bone damaged but still in one piece

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6
Q

open fractures

A

formerly compound; skin is OPEN; can be complete or incomplete

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7
Q

closed fractures

A

If skin is not open; complete or incomplete

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8
Q

comminuted fracture

A

bone breaks into more than 2 fragments

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9
Q

linear fracture

A

fracture line runs parallel to long axis of bone

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10
Q

oblique fracture

A

direction of fracture line slanted angle to shaft of bone

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11
Q

spiral fracture

A

fracture line encircles the bone

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12
Q

transverse fracture

A

fracture line occurs straight across the bone

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13
Q

who do incomplete fractures occur most commonly in

A

children; more flexible growing bones

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14
Q

greenstick fracture

A

perforates one cortex and splinters the spongy bone
think young tree branch that’s bent sharply; outer surface disrupted but inner remains intact
bends/cracks
most common in children

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15
Q

where do greenstick fxs usually occur

A

metaphysis or diaphysis of tibia, radius, ulna

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16
Q

Torus fx

A

cortex buckles but doesn’t break

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17
Q

Bowing fractures

A

when longitudinal force applied to bone= bending of bone; usually occurs in pair (one bowed, one fx)

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18
Q

Why is bowing fx hard to correct

A

resists reduction/correction because force to correct must equal force that caused; bowed bone interferes w/ reduction of fx bone

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19
Q

Who does bowing fx occur in and what bones

A

children; paired radius-ulna or fibula-tibia

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20
Q

Pathologic/insufficiency/fragility fracture

A

break at site or preexisting abnormality resulting from force that wouldn’t fx normal bone; CAN occur with NORMAL weight bearing/activity

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21
Q

What causes pathologic fx

A

any disease that weakens a bone (esp. cortex)

Ex: osteoporosis, cancer, infection, RA, Paget disease, osteomalacia, rickets, hyperparathyroidism, radiation

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22
Q

stress fx

A

repeated strain like in sports’ normal or abnormal bone. Forces on bone cumulative eventually causing fx; tiny cracks in a bone

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23
Q

Fatigue fx

A

repetitive sometimes abnormal stress/torque applied to bone w/ normal ability to deform and recover
Usually in individuals who engage in a new/different activity that is both strenuous and repetitive
Muscle strength faster than bone strength

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24
Q

transchondral fx

A

fragmentation and separation of portion of articular cartilage (It allows the bones to glide over each other with very little friction.)
single or multiple sites; cartilage alone or cartilage + bone

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25
Q

typical sites transchondral fx and who affected more

A

distal femur, ankle, patella, elbow, wrist
Adolescents

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26
Q

direct/primary healing

A

intramembranous bone formation occurs when adjacent bone cortices are in contact with one another like with SURGICAL fixation devices
***NO callus formation

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27
Q

indirect/secondary healing

A

both intramembranous and endochondral bone formation, development of CALLUS, and eventual remodeling of solid bone

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28
Q

Endochondral bone formation

A

bone formation that begins with an underlying cartilage scaffold

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29
Q

When is secondary/indirect healing mostly seen

A

non-operative fracture treatment; fracture treated w/ cast

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30
Q

how are calluses formed

A

bone tissue adjacent to fx dies, osteoblasts synthesize collagen and matrix, becomes mineralized= callus

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31
Q

s/s fx

A

unnatural alignment (deformity), swelling, muscle spasm, tenderness, pain/impaired sensation, decreased mobility

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32
Q

INITIAL sx following fx

A

numbness at fx site d/t nerve trauma x several mins then subsequent pain is severe

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33
Q

s/s pathologic fx

A

angular deformity, painless swelling, generalized bone pain

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34
Q

s/s transchondral fx

A

asx
painful during ROM
limited RPM and crepitus

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35
Q

dislocation

A

displacement 1 or more bones in joint in which opposing joint surfaces entirely lose contact with one another

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36
Q

subluxation

A

contact between opposing joint surfaces partially loss (partial dislocation)

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37
Q

who is more at risk for dislocation and subluxation

A

< 20 y/o and generally associated w/ fx

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38
Q

s/s dislocation or subluxation

A

pain
swelling
limited ROM
joint deformity

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39
Q

what causes pain in fx

A

muscle spasms
overriding of fx segments
damage to adjacent soft tissue

40
Q

what causes pain in dislocation or subluxation

A

effusion of inflammatory exudate into joint
nerves
tendon/ligament injury
muscle contraction

41
Q

tendon

A

connects skeletal muscle to bone or another structure; meant to connect skeleton for movement
area of attachment= enthesis

42
Q

ligament

A

connects bone to bone where they meet in JOINT, meant to keep things held together/stabilized

43
Q

strain/where common

A

tearing/stretching of muscle or tendon most common in hands, feet, knee, upper arm, thigh, ankle, heel (akilles)

44
Q

sprain/where common

A

ligament tears most common in wrist, ankle, elbow, knee

45
Q

avulsion/who commonly affects

A

complete separation of tendon/ligament from bony attachment
young athletes- sprinters, hurdlers, distance runners

46
Q

s/s tendon/ligament injury

A

soft tissue swelling
change in tendon/ligament contour
disclocation/subluxation bones
SHARP localized pain
tenderness persists over distribution of tendon/ligament
movement/weight bear increases pain

47
Q

s/s lateral epicondylopathy/tennis elbow & medial epicondylopathy/golfer’s elbow

A

localized to one side of joint
local tenderness, more pain with ACTIVE ROM than passive
tissue degradation
loss of grip, strength, pain

48
Q

bursitis

A

inflamed sacs of synovial fluids (meant to separate/lubricate/cushion structures)
middle age d/t trauma
shoulder, hip, knee, elbow (less often spine, wrist, foot, ankle)

49
Q

*rhabdomyolysis/myoglobinuria

A

rapid breakdown muscle that causes release intracellular contents like myoglobin into extracellular space & bloodstream

50
Q

*s/s rhabdomyolysis

A

muscle pain and weakness
dark urine

51
Q

**labs in rhabdomyolysis

A

1= high CK (normal 5-25 women, 5-35 men) 5-10x upper limit

myoglobin in urine
high K (norm 3.6 to 5.2)
high phosph.
low BUN

52
Q

*complications rhabdomyolysis

A

ARF
disseminated intravascular coagulation (DIC)
cardiac arrythmias

53
Q

*when is ARF likely in rhabdomyolysis

A

CK > 15,000

54
Q

*s/s hyperkalemia (> 5.2)

A

Abdominal (belly) pain and diarrhea.
Chest pain.
Heart palpitations or arrhythmia (irregular, fast or fluttering heartbeat).
Muscle weakness or numbness in limbs.
Nausea and vomiting

55
Q

s/s hypernatremia (> 145)

A

excessive thirst
lethargy
confusion
muscle twitching or spasms

56
Q

s/s hyponatremia ( < 135)

A

Nausea and vomiting
Headache
Confusion
Loss of energy, drowsiness and fatigue
Restlessness and irritability
Muscle weakness, spasms or cramps
Seizures
Coma

57
Q

s/s compartment syndrome

A

6 P’s:
pain
pressure
pallor
paresthesia
paresis (impaired function)
pulselessness

58
Q

what is and s/s malignant hyperthermia

A

prolonged release intracellular Ca
hypermetabolism: high body temp, muscle rigidity, rhabdomyolysis
respiratory acidosis (high tidal end Co2)
tachycardia
masseter & skeletal muscle spasm

59
Q

osteoporosis

A

most common bone disease
decreased bone mineral density, thinner more porous, increased risk of fractures bc alterations in bone microarchitecture
disrupted bone resorption & formation
NOT consequence of aging (but is risk)

60
Q

most common fx site osteoporosis

A

spine, femoral neck, wrist

61
Q

causes osteoporosis

A
  1. postmenopausal 2. secondary 3. regional (confined to segment skeleton, no known cause)
    endocrine disorders (thyroid, growth, parathyroid, cortisol like cushing)
    meds (PPO, glucocorticoids… )
    menopause (decreased estrogen)
    low vit D & Ca
    family hx
    obesity
    smoking
    diet
62
Q

s/s osteoporosis and common fx sites

A

pain & bone deformity d/t fx
kyphosis, decreased height
fx long bones (femur), distal radius, ribs, vertebrae

63
Q

*osteomalacia

A

ADULT bone
metabolic disease characterized by inadequate delayed mineralization of osteoid in mature compact and spongy bone
It is a disorder of decreased mineralization, which results in bone breaking down faster than it can re-form
NO mineral calcification and deposition
a problem with vitamin D, which helps your body absorb calcium

64
Q

cause osteomalacia

A

***low vit D
= decreased Ca absorption > low phos.
HIV, liver, cancer, kidney, nutrient disorders can cause low D > osteomalacia

65
Q

*s/s osteomalacia

A

diffuse muscular/skeletal pain and tenderness especially in HIPS= hesitant to walk
waddling gait (muscular weakness)
facial deformities
bowed legs, knocked knees
fragility fx: bone fx, vertebral collapse w/ min trauma
low back pain eaerly
UREMIA

66
Q

*lab osteomalacia

A

high BUN/Cr
norm/low Ca
high phos.
high alkaline phos. & PTH

67
Q

rickets

A

like osteomalacia but in children

68
Q

Paget Disease/osteitis deformans (PBD)

A

second most common bone disease after osteoporosis
state of increased metabolic activity in bone characterized by localized abnormal and EXCESSIVE bone remodeling
Enlarged softened bone= bowing deformity, fx, neuro problems

69
Q

most commonly affected bone paget disease

A

vertebrae, skill, sacrum, sternum, pelvis, femur

70
Q

risk paget disease

A

men > 55, women > 40

71
Q

s/s & labs paget disease

A

asx often
irregualr bone trabeculae w/ thick/disorganized pattern
HA
frontal, occipital skull thickness/asymmetrical
altered mentation/dementia from compression on brain by thick skull
sensory abnormalities, deaf, motor function, optic nerve, lacrimal duct all from skull compression on nerves
thick mandible/maxilla
stress fx BLE
spastic quadriplegia
elevated serum alkaline phosphatase or abnorm. xray
high PINP

72
Q

*osteomyelitis, most common pathogen, & two types

A

bone infection caused usually by bacteria ***staph. aureus (esp. in human bite). Can be fungi, parasite, virus also

  1. hematogenous
  2. contiguous
73
Q

hematogenous osteomyelitis & s/s

A

pathogens through blood > bone infect. *Children
fever
pain
voluntary immobility of affected limb
kids: cutaneous, sinus, ear, dental infections primary source
adults: spine, pelvis, small bones

74
Q

contiguous osteomyelitis & s/s

A

infection spreads to adjacent bone often caused by open fx, penetrating wounds, surgery, metabolic/vascular disease, age, lifestyle
*males

75
Q

*s/s osteomyelitis

A

insidious onset, vague sx
fever
malaise
anorexia & wt loss
pain in/around infected areas
maybe/maybe not edema
recent infection or instrumentation precedes
abscesses (Brodie abscesses)
lymphadenopathy
in chronic= silent between exacerbations

76
Q

Brodie abscesses

A

abscesses in subacute or chronic osteomyelitis
circumscribed lesions 1-4cm ends of long bones and surrounded by dense ossified bone matrix
evidence pathogen less virulent or immune system somewhat successful

77
Q

*labs osteomyelitis

A

elevated WBC
C-reactive protein (CRP)

78
Q

osteoarthritis (OA) what is it? patho? affected?

A

most common age-related disorder of synovial joints
***loss/damaged cartilage & bone spurts
*inflammation, new bone of joint margins, subchondral bone change, variable degrees synovitis, thickening capsule joint
LOAD-BEARING AREAS= hips, hands, spine
> 40 y/o, women
stress on joints

79
Q

*clinical manifestations osteoarthritis

A

5th/6th decade of life
#1- pain in 1+ joints using w/ weight/load bear or use; RESTING RELIEVES
*stiffness < 30 min
crepitus, creeking, grating
swelling/enlargement
tender
limited ROM
muscle waste
partial dislocation
deformity
limp
synovitis (inflam. joint lining)
nocturnal pain unrelieved and w/ paresthesia
referred pain like sciatic nerve back of thigh
brachial neuralgia (pain in arm) w/ neck movement
lack of sleep= more stress chronic pain

80
Q

heberden and bouchard nodes

A

bone enlargement in hands w/ osteoarthritis

81
Q

*rheumatoid arthritis (RA)

A

chronic, systemic, inflammatory autoimmune disease, joint swelling and tenderness and destruction of synovial joints leading to disability
thickened synovial tissue invades bone and acts like localized tumor & bone destruction
spreads to surrounding ligaments, tendons
IgM IgG antibodies , T & B cells

82
Q

synovial membrane

A

A layer of connective tissue that lines the cavities of joints, tendon sheaths, and bursae
Inflamed in RA

83
Q

*clinical manifestations rheumatoid arthritis

A

insidious usually, 15% acute
general systemic of inflammation: fever, fatigue, weakness, anorexia, weight loss, general aching/stiffness
joints painful, tender, stiff (pain d/t pressure from swelling in early stage)
later pain from from sclerosis of subchondral bone & new bone formation
stiffness d/t synovitis
warm joints, boggy synovial membrane
*skin over joint ruddy, cyanotic hue, thin and shiny
lost ROM/mobility

84
Q

2 complications chronic RA from excessive inflammatory exudate in synovial cavity

A
  1. cysts in articular cartilage or subchondral bone
  2. rupture of cyst or synovial joint
85
Q

rheumatoid nodules

A

30%
extra-articular manifestations
elbows & fingers usually
risk of invading skin, cardiac valves, pericardium, pleura, lung, spleen

86
Q

Caplan syndrome

A

Can occur w/ RA
pulmonary nodules & pneumoconiosis (chronic inflam. lungs from inhalation of dust)
swelling (inflammation) and scarring of the lungs.

87
Q

*Ankylosing Spondylitis

A

most common of group of inflammatory arthropathies known as spondyloarthropathies (SpAs)

chronic autoimmune inflammatory joint disease characterized by stiffening and fusion (ankylosis) of spine & sacroiliac joints

88
Q

Difference between RA and AS

A
  1. RA inflammation is synovial membrane so synovial joints
  2. AS excessive bone formation occurs and the inflammation is at enthesis (where ligaments, tendons, joint insert into bone) and end results sacroiliac & vertebral column fuse at joint
89
Q

Who does AS occur in

A

MEN > women
Later adolescence, peaks 20 y/o
secondary affects older groups & associated w/ inflammatory diseases
associated with HLA

90
Q

*s/s AS

A

bamboo spine (square appearing vertebral body)
low back pain & stiffness (esp. early AM)
insidious pain then persistent
**worse after rest, alleviated by activity
loss of ROM in AM d/t inflammation and muscle spasm
kyphosis
costovertebral= pain worse inspiration
sitting on hard seat unbearable
limp
elevated ESR, CRP
IgA kidney disease

91
Q

*fibromyalgia

A

chronic musculoskeletal syndrome characterized by diffuse joint and muscle pain, fatigue, and increased sensitivity to touch called tender points

92
Q

s/s fibromyalgia (FM)

A

*diffuse chronic pain (starts in one location like neck/shoulders, then more generalized)
fatigue (esp. arising from sleep & midafternoon)
HA
irritable bowel
sensitivity to cold
non-restorative sleep
anxiety & depression
widespread tenderness in all body regions, increased sensitivity to numerous stimuli: heat, cold, electrical, light, sound

93
Q

Who does FM affect

A

women
30-50 y/o

94
Q

*epicondyle

A

bony prominence at end of bone where tendons or ligaments attach

95
Q

epicondylopathy

A

when force causes microtears in tissue; a painful irritation of tendon insertions of the forearm muscles.
repetitive load-bearing activities or acute injuries involving flexion, extension, pronation, supination of elbow and forearm
- lateral (tennis elbow)= overstretching ECRB tendon & forearm muscles
- medial (golfer’s elbow)= forearm muscles responsible for forearm flexion and pronation

96
Q

why are really old and really young at risk for fx

A
97
Q

nonunion

A

failure of bone ends to grow together

Pathophysiology (7 decks)

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