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Pathophysiology > Disorders of Musculoskeletal > Flashcards

Disorders of Musculoskeletal Flashcards

1
Q

What is a conusion? (aka. bruise)

A
  • Result of direct trauma
  • Skin remains intact
  • Blood vessel/cell damage
  • Edema, inflammation and ecchymotic (black, blue, yellow)
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2
Q

What is a hematoma?

A
  • Localized emorrhage

- Blood acumulation pressures nerves, causing pain that increases with movement

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3
Q

What is the difference between tendons and ligaments?

A 
Tendon = muscle to bone
Ligament = bone to bone
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4
Q

What is a strain?

A
  • Involves partial tearing of muscle/tendon, often during muscle contraction
  • Common in back, cervical spine, elbow and shoulder; or hips and hamstrings from sports
  • Risk increases with age
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5
Q

What is a sprain?

A
  • Tearing or rupture of supporting ligament or capsule surrounding joint, d/t abnormal/excess joint movement
  • Not visible on x-ray unless bone fragment exists
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6
Q

What are the manifestations of a sprain?

A
  • Pain
  • Rapid swelling limits movement
  • Discoloration
  • Last longer than strain
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7
Q

How do we treat strains or sprains?

A
  • Rest
  • Ice
  • Compression (reduce swelling, provides support)
  • Elevate (immobilization)
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8
Q

Describe the healing of strains and sprains:

A
  • Able to heal to original tensile srength
  • Capillaries bring oxygen/nutrients
  • Fibroblasts produce collagen
  • Collagen bundles strengthen over time
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9
Q

What are the complications of healing in strains and sprains?

A
  • Contractions can pull healing apart and result in lengthened position upon final healing
  • Adhesions
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10
Q

What is a dislocation? What is a subluxation?

A
  • Abnormal displacement of articulating surfaces of joint, common in shoulder and acromioclavicular joint
  • Subluxation is a partial dislocation of joint, some surface contact
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11
Q

What are the causes of dislocations?

A
  • Congential (hip or knee)
  • Traumatic (athletics, falls)
  • Pathologic (complication of infection, RA, neuromuscular disease, etc.)
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12
Q

How do we diagnose a dislocation?

A

History, assessment, x-rays

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13
Q

What are the manifestations of a dislocation?

A
  • Pain
  • Deformity
  • Limited movement
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14
Q

How do we treat dislocations?

A
  • Spontaneous
  • Manipulation
  • Surgical repair
  • Immobilization
  • Physiotherapy
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15
Q

What is a Rotator Cuff Injury?

A
  • Function of cuff is to stabilize the humoral head against the glenoid
  • Shoulder joints are inherently unstable (due to flexibility)
  • Injuries occur due to direct blow or stretch; excessive use/repetition; altered blood supply to tendons; and age-related degeneration
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16
Q

How do we diagnose a shoulder/rotator cuff injury?

A
  • Assessment of active/passive ROM
  • History of injury
  • MRI
  • Arthrroscopic examination
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17
Q

How do we treat a shoulder/rotator cuff injury?

A
  • Anti-inflammatories
  • Corticosteroid (oral, injection)
  • Physiotherapy
  • Surgical repair
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18
Q

What is the most serious of knee injuries?

A

ACL rupture/tear is most common and can have long-lasting effects (ex. Teresa)

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19
Q

What are the manifestations of an ACL rupture/tear?

A
  • “pop” or tearing sensation
  • Sudden pain
  • Loss of weight-bearing
  • Hemorrhage causes swelling
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20
Q

What are the manifestation of a meniscus tear?

A
  • Pain, especially on hyperflexion and hyperextension
  • Edema
  • Instability
  • Locking d/t loose fragment
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21
Q

What are complications of a meniscus tear?

A

Osteoarthritic changes limiting movement

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22
Q

What is a Patellar Subluxation and Dislocation?

A
  • Usually sports related, where patella is dislocated

- Manifestated by pain and swelling

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23
Q

What is a Chondromalacia Patellae?

A
  • Inflammation of the underside of the patella

- Due to sports or knee overuse in older adults

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24
Q

What is Patellofemoral Pain Syndrome

A
  • The most common cause of anterior knee pain
  • Caused by imbalance of forces controlling patella movement; contact of posterior surface of patella with femur; or running, jumping or sitting
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25
Q

What are the manifestationf of Patellofemoral Pain Syndrome?

A
  • Pain
  • Weakness
  • Abscence of edema
  • Can develop into arthritis
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26
Q

What are hip dislocations often due to?

A
  • Trauma (MVA, fall)
  • Emergency
  • Disrupton of blood and nerve supply (avascular necrosis resulting in necrosis of bone tissue)
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27
Q

What are the risk factors for hip fractures?

A
  • Age
  • Women
  • Physical inactivity
  • Alcohol excess
  • Psychotropic medications
  • Institutionalization
  • Visual impairments
  • Polypharmacy
  • Osteoporosis
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28
Q

What are the surgical options for a hip fracture?

A
  • Total hip replacement (THA)
  • Hemi-arthroplasy
  • Open Reduction, Internal Fixation (OPIF)
  • Revision
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29
Q

What is the difference between a sudden and stress fracture?

A
  • A sudden fracture occurs suddenly, often with acute injury

- Stress fractures can occur over time due to stress on bones that cause incomplete fractures (ex. fatigue fractures)

30
Q

What is a Pathological fracture?

A

A fracture of the bone that occurs in response to events that typically would not cause a fracture; often underlying pathological condition weakening bone and predisposing to injury

31
Q

How do we classify fractures?

A
  • Positon on bone (ex. head/neck, proximal/distal)
  • Degree of communication with outside environment (ex. open/compound, closed)
  • Degree of break (ex. greenstick)
  • Character of fracture pieces
  • Direction of break (ex. transverse, oblique, sprial, twist)
32
Q

What are the five different characters of fracture pieces?

A

1) Comminuted (multiple pices)
2) Compression (crushing of 2 bones)
3) Impacted (fragments wedged together, telescoping)
4) Butterfly (triangular bone piece fracture)
5) Avulsion (when the tendon or ligament tears off of a piece of bone)

33
Q

What are the manifestations of fractures?

A
  • Pain/tenderness
  • Swelling
  • Loss of function/mobility
  • Deformity (ex. shortening of extremity, fragments damaging tissue)
  • Blood loss
  • Crepitus
  • Nerve function impairment
34
Q

How do we treat fractures?

A
  • Reduction of fracture (closed or open)
  • Immobilization: splint, case, extrenal fixation device, traction)
  • Preservation and restoration of function
  • PT
35
Q

What is the process of bone healing?

A

1) Hematoma formation
2) Fibrocartilaginous callus formation
3) Bony callus formation (ossification)
4) Remodeling

36
Q

Describe Hematoma formation in bone healing:

A
  • First 1-2 days when bone/tissue blood vessels rupture

- Fibrin clot forms, providing foundation for inflammatory cells

37
Q

Describe the Fibrocartilaginous callus formation in bone healing:

A
  • Fibroblasts begin repair

- Takes 2-3 weeks, but still weak

38
Q

Describe the bony callus formation in bone healing:

A
  • Osteoblasts form and calcium salts deposit
  • Cartilage converts to bony callus
  • Begins 3-4 weeks after injury, takes months
39
Q

Describe remodeling in bone healing:

A
  • Dead cells removed
  • Compact bone replaces spongy bone
  • Possible “scar”
40
Q

What are the complications of bone healing?

A

1) Delayed union (failure to heal in usual time)
2) Malunion (deformity)
3) Nonunion (failure to heal)

41
Q

What is a fracture blister?

A
  • Complication of fracture
  • Epidermal necrosis d/t fluid separating it from dermis
  • Often where minimal s/c tissue between epidermis and bone
  • Chance of infection of broken
42
Q

What is compartment syndrome?

A

Increased intraosseus pressure within a limited space due to decreased size, increased volume of contents or both

43
Q

What can cause decreased size or increased volume of contents in compartment syndrome?

A

DECREASED SIZE: constrictive dressings, casts and burns

INCREASED VOLUME: trauma, fluid/edema, vascular injury/bleeding, venous obstruction

44
Q

In compartment syndrome, the amount of pressure is dependent on what?

A
  • Duration
  • Metabolic rate
  • Vascular tone
  • Local blood pressure
45
Q

What are the manifestations of compartment syndrome?

A
  • Severe pain
  • Sensation change (burning, tingling, loss)
  • Diminished reflexes, motor function loss (compression of nerves)
  • Decreases/loss peripheral pulses
46
Q

How do we assess compartment syndrome?

A

Pain, sensory and motor function

47
Q

What are the six P’s of neurovascular assessment?

A
  • Pain
  • Pulselessness
  • Paralysis
  • Paresthesia
  • Polar
  • Palor
48
Q

What is Fat Embolism Syndrome? (FES)

A
  • A complication of fractures that is different from fat emboli
  • Common but fewer people have symptoms or complications
  • Fat droplets from bone and adipose tissue circulate through venous system to body
49
Q

What are the manifestations of FES?

A
  • Respiratory failure (dyspnea, cyanosis, tachycardia, angina)
  • Cerebral dysfunction (mentation/behaviour changes, seizures, encephalopathy)
  • Skin/mucosa petechiae (rash 2-3 days later)
50
Q

What are the general complications of soft-tissue injury?

A

Skin, muscle, nerve and adipose/bone

51
Q

What is Osteomyelitis?

A
  • Infection of the bone, often through direct contamination, skin lesions or through the blood (hematogenous)
  • Staphlyococcus aureus most common; adheres to bone, attacks cells, evades host defenses, and colonizes
52
Q

What is the affect of Hematogenous Osteomyelitis in children?

A
  • Affects long bones
  • Purulent exudate inside bone
  • Damages arteries supplying bone
  • May penetrate skin or involve joints
53
Q

What is the affect of Hematogenous Osteomyelitis in adults?

A
  • In vertebrae, sternoclavicular and sacroiliac joints, or pubic symphysis
  • Tends to affect joint space
54
Q

What are the manifestations of hematogenous osteomyelitis?

A
  • Signs of bacteremia
  • Fever/chills
  • Pain on movement of area
  • Tenderness
  • Erythema
  • Edema
  • Malaise
55
Q

What is chronic osteomyelitis?

A
  • Usually occurs in adults
  • Usually secondary to open wound
  • Sequestrum (infected dead bone in center of bone, separated by “sheath” preventing breakdown)
  • Difficult to detect when near a joint prosthesis
56
Q

What is Osteonecrosis? What are the causes?

A
  • Bone destruction d/t interruption in blood flow
  • Idiopathic
  • Bone injury
  • Thrombosis/embolism
  • Vessel injury
  • Increased intraosseous pressure
  • Corticosteriod associated (unclear) (risk of osteoporosis?)
57
Q

What are the manifestations of osteonecrosis?

A

Chronic pain, unrelated to movement

58
Q

What is the treatment for osteonecrosis?

A
  • Dependent on cause
  • Immobilization
  • Anti-inflammatories
  • Exercise
  • Surgery often needed for hip involvement
59
Q

What are benign bone tumors?

A
  • Confined to bone
  • Well-defined borders
  • Seldom cause fractures
  • Seldom require treatment or surgery
60
Q

What is a Osteoma?

A

Small bony tumor on bone surface (benign)

61
Q

What are fibrous tumors?

A
  • Benign
  • Common in growing bones
  • Usually asymptomatic
  • Resolve in 2-3 years
62
Q

What is a Chondroma?

A
  • Benign
  • Tumor made of cartilage
  • Short bones; solitary lesion
  • Onset @ 20-40 years of age
  • Asymptomatic or painful
63
Q

What is a Osteochondroma?

A
  • Benign
  • Cartilage-capped tumor, most common (especially in knees)
  • Bony stalk attaches it to bone
  • Slow-growing, solitary mass
64
Q

What is a Osteoclastoma?

A
  • Giant cell tumor that behaves like a malignant tumor (metastasizes via bloodstream, recurs after removal) (benign)
  • May invade bone and cause bone destruction
  • Pathological fractures common
65
Q

What is an Osteosarcoma?

A
  • A malignant bone tumor that is most common, metasizes early often to lung
  • Tends to be in areas wit fastest bone growth
  • UKE, but genetic condition
  • Peak ages: women
66
Q

What is a Chondrosarcoma?

A
  • Can arise from pre-existing benign cartilaginous tumor
  • Mid to late adulthood
  • Slow-growing
  • Responds to early excision
67
Q

What is an Ewing Sarcoma?

A
  • Densley packed small cells, malignant
  • Children and young adults
  • Men > women
68
Q

What is Metastastic Bone Disease?

A
  • Skeletal metastasis is the most common bone cancer

- 50% of all cancers metastasize to the bone (most often in trunk bones)

69
Q

What are the manifesations of metastatic bone disease?

A
  • Pain **
  • Pathological fracture
  • Hypercalcemia d/t bone destruction
70
Q

What are the general manifestations of bone cancer?

A
  • Changes in organ function (organ damage, inflammation, failure)
  • Local effects of tumors (compression, stretching)
  • Nonspecific signs of tissue breakdown (protein wasting, bone breakdown)

Pathophysiology (4 decks)

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