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Pathophysiology I > Disorders of the Skeletal System > Flashcards

Disorders of the Skeletal System Flashcards

1
Q

Explain what a contusion is.

A

It is a bruise

Skin remains intact
Blood vessel and muscle damage

results in edema, inflammation, and ecchymosis

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2
Q

What is ecchymosis

A

escape of blood form capillaries and vessels into the tissue resulting in black/blue to brown/yellow colouration.

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3
Q

Explain what hematoma is

A

localized hemorrhage

Blood accumulation results in pressure on nerve and pain inc with movement or pressure

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4
Q

What are the two types of soft tissue injuries?

A

contusion (bruise)

hematoma

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5
Q

What are the 4 types of joint injuries?

A

Strains

Sprains

Dislocations

Shoulder/rotator cuff

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6
Q

Where is the most common location of joint injuries

A

knees and hips

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7
Q

Describe what tendons bind.

A

muscles to bone

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8
Q

Describe what ligaments bind.

A

bone to bone

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9
Q

What causes joint damage?

A

mechanical overloading or forcible stretching/twisting

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10
Q

What are the two body components involved in strain?

A

Muscle and tendon

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11
Q

Explain what tendon strain is

A

it is a PARTIAL tear of the tendon

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12
Q

What often causes tendon strain?

A

sudden stretch during muscle contraction

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13
Q

How does the risk of tendon strain relate to age? explain why

A

it increases with age

Collagen fibers in tendon become less elastic

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14
Q

What are the 4 common locations of strain

A

back
cervical spine
elbow
shoulder

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15
Q

What are the three common sites of strain caused by sports injuries?

A

the large muscles

hip
hamstring
quadriceps

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16
Q

Describe the manifestations of tendon strain.

A

often no obvious signs unless inflammation

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17
Q

What are the 4 manifestations of strain?

A

Pain (inc with stretching)
stiffness
swelling
tenderness

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18
Q

Explain what a sprain is

A

tearing or rupture of supporting LIGAMENT or capsule surrounding joint

d/t to abnormal/excess joint movement

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19
Q

Is a sprain visible on an x-ray?

A

no unless there is a bone fragment

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20
Q

List the 3 manifestations of a sprain

A

1) Pain
2) Restricted movement (d/t rapid swelling)
3) Discoloration

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21
Q

What lasts longer a strain or a sprain?

A

a sprain

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22
Q

How are sprain/strains treated? (5, acronym)

A

R est
I ce
C ompression
E levation

Immobilzation

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23
Q

Can sprains and strains heal to original strength?

A

yes

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24
Q

Describe the process of healing for strains and sprains

A

1) capillaries bring oxygen and nutrients
2) fibroblasts produce collagen
3) collagen bundles strengthen over time

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25
Q

What are the two complications of strains and sprains

A

1) contraction can pull injured tendons apart causing it to heal in lengthened position
2) adhesions

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26
Q

Explain what a dislocation is

A

abnormal displacement of articulating surfaces of joint such that surfaces are no longer in contact

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27
Q

What is a subluxation?

A

a partial dislocation; some of the surface is in contact

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28
Q

what are the 2 most common joints for dislocations?

A

glenohumeral
(when arm is extended)

acromiclavicular
(common athletic injury)

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29
Q

What are the three types of causes of dislocations?

A

1) Congenital
2) Traumatic
3) Pathologic

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30
Q

What joints are commonly affected by congenital dislocations?

A

hip or knee

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31
Q

Explain what 4 things can cause pathological dislocations

A

when it is a complication of…

1) infection
2) rheumatoid arthritis
3) neuromuscular disease
4) paralysis

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32
Q

explain how dislocations are diagnosed

A

with hx, assessment, and x-ray

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33
Q

What are the three manifestations of dislocations

A

1) pain
2) deformity
3) limited movement

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34
Q

What are the 5 treatments for dislocations

A

1) Spontaneous (goes back on own)
2) Manipulation: force back into place
3) Surgical repair
4) immobilization
5) physiotherapy

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35
Q

How is a fracture of the clavicle treated? what age group is this common in?

A

immobilization with a sling

common in children

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36
Q

What are the two joints in the shoulder that are commonly injured and in what circumstances do these occur?

A

Acromioclavicular joint:
common athletic injury

Glenohumeral joint:
common dislocation when arm is extended

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37
Q

What is the function of the rotator cuff?

A

to stabilize the humoral head against the glenoid cavity

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38
Q

Why are shoulder joints unstable?

A

because of the wide range of motion and anatomical positioning

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39
Q

What are the 4 causes of injury to the rotator cuff

A

1) direct blow or stretch
2) excessive use/repetition
3) altered blood supply to tendons
4) Age-related degeneration

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40
Q

What are three common conditions under rotator cuff injuries?

A

1) tendonitis
2) subacromial bursitis
3) partial/complete tears

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41
Q

List the 4 manifestations of rotator cuff injuries

A

1) Pain
2) Tenderness
3) Difficulty abducting/rotating arm
4) muscle atrophy

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42
Q

Describe the 4 ways that shoulder/rotator cuff injuries are diagnosed

A

1) assessment of active and passive ROM
2) hx of mechanism of injury
3) MRI
4) arthroscopic examination

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43
Q

What are the 4 ways that shoulder/rotator cuff injuries are treated. (2 pharmacologic, 2 others)

A

1) anti-inflammatories
2) corticosteroid
3) physiotherapy
4) surgical repair

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44
Q

What is the most serious type of knee injury?

A

knee ligamentous injuries

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45
Q

What is the most common type of knee ligamentous injuries?

A

ACL tear

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46
Q

What are the 4 manifestations of an ACL tear/rupture?

A

1) pop or tearing sensation
2) sudden pain
3) loss of weight bearing
4) swelling due to hemorrhage

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47
Q

What is a meniscus?

A

the C shaped plates of fibrocartilage between condyles

there are lateral and medial meniscus

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48
Q

What are the 4 manifestations of meniscus injuries

A

1) Pain (esp on hyperflexion and hyperextension)
2) Edema
3) instability
4) knee locking and instability d/t loss fragment

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49
Q

What is a complication of meniscus injuries?

A

osteoarthritic changes limiting movement

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50
Q

What is the usual cause of patellar subluxation and dislocation

A

sports injury

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51
Q

What are the 6 manifestations of patellar subluxation and dislocation?

A

1) Weakness
2) Swelling
3) Crepitus (cracking sound)
4) Stiffness
5) loss of ROM
6) popping sensation

52
Q

Describe what chondromalacia patella is

A

Inflammation of the underside of the patella and softening of the cartilage

53
Q

What are 2 common causes of chondromalacia patella?

A

sports

knee overuse in older adults

54
Q

What is the most common cause of anterior knee pain?

A

Patellofemoral pain syndrome

55
Q

What are the three causes of patellofemoral pain syndrome?

A

1) imbalance of forces controlling patella movement
2) Contact of posterior surface of patella with femur
3) Running, jumping (volleyball), sitting

56
Q

What are the 2 manifestations of patellofemoral pain syndrome and what is an important manifestation of other injuries that is NOT present

A

1) Pain
2) Weakness

there is no SWELLING

57
Q

What can hip dislocation cause?

A

disruption of blood and nerve supply can lead to….

Avascular Necrosis:
necrosis of bone tissue causing it to collapse on itself

58
Q

List 9 risk factors for hip fractures

A

1) age
2) women
3) physical inactivity
4) excess alcohol
5) psychotropic meds
6) institutionalization
7) visual impairments
8) polypharmacy
9) osteoporosis

59
Q

What are the three common hip fracture sites

A

1) Neck
2) intertrochantric
3) subtrochantric

60
Q

List and explain the 4 surgical options for hip fractures

A

Total Hip Replacement (THA):
replace the femur and socket

Hemi-Arthroplasty:
do not replace the socket, just femur

ORIF (Open Reduction and Internal Fixation):
open it up, align bones and secure them in place

Revision:
removing old implant and inserting new

61
Q

What are the three categories of fractures?

A

1) sudden injury
2) fatigue stress fracture
3) pathologic stress fracture

62
Q

what are the five ways that fractures are classified

A

Location

Character of fracture pieces (type)

Communication with outside environment

Degree of break

Direction

63
Q

What are the three types of classifications of fractures by location?

A

Proximal, midshaft, distal

64
Q

What are the two types of classification of fractures by degree of communication with outside environment

A

Open (COMPOUND)

Closed

65
Q

What is an example of a classification of fracture based on degree of break? what age group is this common in?

A

Green stick

common in children (soft immature bones)

66
Q

List and explain the 4 types of classifications of fracture based on fracture characteristics (type)

A

COMMINUTED: multiple pieces

COMPRESSION:
two bones compressed

IMPACT:
one of the fragments is driven into another

BUTTERFLY:
triangular bone piece, typically long bones

67
Q

What is an avulsion fracture?

A

when ligament tears off a piece of the bone

68
Q

What are the 4 types of classifications of fractures by direction?

A

1) transverse (across)
2) oblique (diagonal)
3) Spiral
4) twist/torque

69
Q

What are the 4 manifestations of fractures?

A

Pain/tenderness
Swelling
Loss of function
Deformity

70
Q

Explain the three types of deformity from fractures and what can result from having a deformity

A

1) tenting from fragments pushing into soft tissue
2) shortening of extremity from bones overlapping
3) rotational deformity from twisting

deformities can result in:
Crepitus
Blood loss
Nerve function impairment or loss

71
Q

how are fractures diagnosed?

A

assessment

x-ray

72
Q

List the three treatments of fractures

A

1) reduction (closed or open)
2) immobilization
3) preservation and restoration of function (physio)

73
Q

list the 4 stages of bone healing

A

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

74
Q

Describe the hematoma formation stage of bone healing. What stage is this?

A

Stage 1
first 1-2 days

Bone/tissue blood vessels rupture

Fibrin network (clot) forms providing foundation for inflammatory cells, seals off fracture site, and initiates angiogenesis

75
Q

Describe the fibrocartilaginous callus formation stage of bone healing. What stage is this?

A 
Stage 2 (also called procallus)
2-3 wks

Fibroblasts begin repair, but not strong enough to weight bear

76
Q

Describe the bony callus formation (ossification) stage of bone healing. What stage is this?

A

Stage 3
begins 3-4 weeks after and takes months

osteoblasts convert fibrocartilage to spongy bone (bony callus)

77
Q

Describe the remodeling stage of bone healing. What stage is this?

A

stage 4

Dead bone removed by osteoclasts

compact bone replaces spongy bone

possible scar thickened area on bone surface

78
Q

what are the 3 complications of bone healing?

A

DELAYED UNION

MALUNION

NONUNION

79
Q

Describe what Delayed Union is and list contributing factors

A

Failure of fracture to heal within predicted time

Contributing Factors:
Large displaced fracture
inadequate immobilization
inadequate circulation

80
Q

Describe what non-union is and list contributing factors

A

Failure of bone to heal before the process of bone repair stops

Contributing Factors:
Soft tissue between bone frags
infection
inadequate circulation
severe trauma
81
Q

Explain what a fracture blister is.

A

epidermal necrosis d/t fluid separating it from dermis

Found in feet or ankles

Often where minimal SC tissue between epidermis and bone

82
Q

What is a possible complication of a fracture blister?

A

infection if broken so must be left alone

83
Q

What are the two types of fracture blister fluid?

A

CLEAR:
upper layers of epidermis (heals faster)

HEMORRHAGIC:
epidermis separated from dermis (lasts longer and is deeper)

84
Q

What are the three main complications of fractures?

A

fracture blisters

compartment syndrome

fat embolism syndrome

85
Q

what is compartment syndrome?

A

increased pressure within a limited space resulting in:

Compression of vessels: ischemia, necrosis

Compression of nerves: paresthesia, paralysis

86
Q

What are the two ways that compartment syndrome can be caused by? List some things that can cause each

A

DEC COMPARTMENT SIZE:
constrictive dressings
casts
burns (inelastic and constricting scabs, dec size of underlying compartments)

INC VOLUME OF CONTENTS:
trauma
fluid/edema
vascular injury or bleeding
venous obstruction

CAN BE BOTH

87
Q

What is the amount of pressure in compartment syndrome dependent on?

A

Duration
Metabolic rate
Vascular tone
Local BP

88
Q

What are the 4 manifestations of compartment syndrome?

A

Pain

Sensation change (burning, tingling, loss)

Hyporeflexia, loss of motor function

Dec/loss of peripheral pulses

89
Q

What are the three aspects of assessment for compartment syndrome?

A

Pain
Sensory
Motor function

90
Q

List the six P’s of a neurovascular assessment

A

1) Pain
2) Pulselessness
3) paralysis
4) paresthesia
5) polar (hot or cold)
6) pallor

91
Q

Explain what fat embolism syndrome is

A

Fat droplets from bone and adipose tissue from venous system enter microcirculation of lung or other organs

very common, but few have symptoms or complications

92
Q

List the manifestations of fate embolism syndrome (3 categories based on location)

A

RESPIRATORY FAILURE:
dyspnea, pallor, cyanosis
angina, tachycardia, diaphoresis

CEREBRAL DYSFUNCTION
(early or late sign)
mentation/behavioural changes
focal deficits, encephalopathy, seizures

SKIN/MUCOSA PETECHIAE
rash 2-3 days post event

93
Q

What are the complications of skin soft tissue injury?

A

fracture blisters

94
Q

What is the complication of muscle soft tissue injury?

A

compartment syndrome

95
Q

What is the complication of nerve soft tissue injury

A

paresthesia, paralysis

96
Q

What is the complication of adipose/bone injury?

A

fat emboli syndrome

97
Q

What is osteomyelitis?

A

infection of the bone

98
Q

What are the three different ways that osteomyelitis can occur (pathway)

A

direct contamination

hematogenous (through blood)

Via skin lesion

99
Q

What is the most common cause of osteomyelitis?

A

Staphylococcus aureus

adheres to bone and attacks cells. evades host defences and colonizes

100
Q

Describe hematogenous osteomyelitis in children?

A

affects long bones

purulent exudate inside bone, damages arteries supplying bone, may penetrate skin or involve joints

101
Q

Describe hematogenous osteomyelitis in adults

A

in vertebrae, sternocalvicular and sacroiliac joints, or pubic symphysis

tends to affect joint space

102
Q

List the 6 manifestations of hematogenous osteomyelitis

A

1) signs of bacteremia
2) fever/chills
3) pain on movement/tenderness
4) erythema
5) edema
6) malaise

103
Q

What age group does chronic osteomyelitis occur in?

A

adults

104
Q

What is the usual cause of chronic osteomyelitis

A

Secondary to open wound

105
Q

Describe what sequestrum is

A

it occurs in chronic osteomyelitis

area of infected dead bone becomes separated by sheath of new bone called INVOLUCRUM

difficult to detect when near joint prosthesis

106
Q

What is osteonecrosis

A

Bone destruction d/t interruption in blood flow

107
Q

What are the 6 different causes of osteonecrosis

A

1) idiopathic
2) bone injury
3) thrombosis/embolism
4) vessel injury
5) increased intraosseous pressure
6) corticosteroids

108
Q

What is the manifestation of osteonecrosis (1)

A

chronic bone pain unrelated to movement

109
Q

Describe the 4 treatment methods for osteonecrosis

A

Dependent on cause

1) immobilization
2) anti-inflammatories
3) exercise
4) surgery often needed for hip involvment

110
Q

Describe the 2 characteristics of benign bone tumors

A

confined to bone with well defined borders

111
Q

Do benign bone tumors cause fractures, require treatment or surgery?

A

not usually

112
Q

What are the five types of benign bone tumors?

A

Osteoma

Fibrous tumors

Chondroma

Osteocondroma

Osteoclastoma

113
Q

Describe what an osteoma is

A

small bony tumor on surface of bone

114
Q

Describe what fibrous tumors are

A

they are common in GROWING bones

usually asymptomatic

resolve in 2-3 yrs

115
Q

Describe the characteristics of Chondroma

A

Tumor made of cartilage

Common in short bones
onset 20-40 yrs
can be asymptomatic or painful

116
Q

Describe the charactistics of osteochondroma

A

Cartilage capped tumor

bony stalk attaches it to bone
MOST COMMON
slow growing solitary mass
knee is common

117
Q

Describe the characteristics of osteoclastoma

A

Giant cell tumor

behaves like malignant

  • metastasizes via bloodstream although benign
  • recurs after removal

may invade bone and cause destruction

knee is common
pathological fractures are common

118
Q

What are the three types of malignant bone tumors?

A

Osteosarcoma

Chondrosarcoma

Ewing sarcoma

119
Q

What is the most common malignant bone tumor?

A

Osteosarcoma

120
Q

Describe the characteristics of osteosarcoma?

A

occurs in areas with fastest bone growth

UKE, but genetic connection

Peak ages <20 or elderly

men over woman

metastasizes early often to lung

121
Q

Describe the characteristics of chonrosarcoma?

A

Can arise from pre-existing benign cartilaginous tumor

onset mid to late adult

slow growing

responds early to exision

122
Q

Describe the characteristics of ewing sarcoma

A

Densely packed small cells

children and young adults

men over woman

123
Q

What is the most common bone cancer?

A

metastatic bone disease (skeletal metastasis)

124
Q

What percentage of cancers metastisize to bone? what is the most common location?

A

50 percent

Most often trunk bones

125
Q

What are the three manifestation of metastatic bone disease?

A

Pain
Pathological fracture
Hypercalcemia d/t bone destruction

126
Q

What are the 3 general categories of bone cancer?

A

CHANGES IN ORGAN FUNCTION:
organ damage, inflammation, failure, pathological fracture

LOCAL EFFECTS OF TUMOR:
compression syndrome, stretching of periosteum, pain and weakness

NONSPECIFIC SIGNS OF TISSUE BREAKDOWN:
protein wasting, bone breakdown, hypercalcemia

Pathophysiology I (16 decks)

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