Disorders of the Skeletal System Flashcards
Explain what a contusion is.
It is a bruise
Skin remains intact
Blood vessel and muscle damage
results in edema, inflammation, and ecchymosis
What is ecchymosis
escape of blood form capillaries and vessels into the tissue resulting in black/blue to brown/yellow colouration.
Explain what hematoma is
localized hemorrhage
Blood accumulation results in pressure on nerve and pain inc with movement or pressure
What are the two types of soft tissue injuries?
contusion (bruise)
hematoma
What are the 4 types of joint injuries?
Strains
Sprains
Dislocations
Shoulder/rotator cuff
Where is the most common location of joint injuries
knees and hips
Describe what tendons bind.
muscles to bone
Describe what ligaments bind.
bone to bone
What causes joint damage?
mechanical overloading or forcible stretching/twisting
What are the two body components involved in strain?
Muscle and tendon
Explain what tendon strain is
it is a PARTIAL tear of the tendon
What often causes tendon strain?
sudden stretch during muscle contraction
How does the risk of tendon strain relate to age? explain why
it increases with age
Collagen fibers in tendon become less elastic
What are the 4 common locations of strain
back
cervical spine
elbow
shoulder
What are the three common sites of strain caused by sports injuries?
the large muscles
hip
hamstring
quadriceps
Describe the manifestations of tendon strain.
often no obvious signs unless inflammation
What are the 4 manifestations of strain?
Pain (inc with stretching)
stiffness
swelling
tenderness
Explain what a sprain is
tearing or rupture of supporting LIGAMENT or capsule surrounding joint
d/t to abnormal/excess joint movement
Is a sprain visible on an x-ray?
no unless there is a bone fragment
List the 3 manifestations of a sprain
1) Pain
2) Restricted movement (d/t rapid swelling)
3) Discoloration
What lasts longer a strain or a sprain?
a sprain
How are sprain/strains treated? (5, acronym)
R est
I ce
C ompression
E levation
Immobilzation
Can sprains and strains heal to original strength?
yes
Describe the process of healing for strains and sprains
1) capillaries bring oxygen and nutrients
2) fibroblasts produce collagen
3) collagen bundles strengthen over time
What are the two complications of strains and sprains
1) contraction can pull injured tendons apart causing it to heal in lengthened position
2) adhesions
Explain what a dislocation is
abnormal displacement of articulating surfaces of joint such that surfaces are no longer in contact
What is a subluxation?
a partial dislocation; some of the surface is in contact
what are the 2 most common joints for dislocations?
glenohumeral
(when arm is extended)
acromiclavicular
(common athletic injury)
What are the three types of causes of dislocations?
1) Congenital
2) Traumatic
3) Pathologic
What joints are commonly affected by congenital dislocations?
hip or knee
Explain what 4 things can cause pathological dislocations
when it is a complication of…
1) infection
2) rheumatoid arthritis
3) neuromuscular disease
4) paralysis
explain how dislocations are diagnosed
with hx, assessment, and x-ray
What are the three manifestations of dislocations
1) pain
2) deformity
3) limited movement
What are the 5 treatments for dislocations
1) Spontaneous (goes back on own)
2) Manipulation: force back into place
3) Surgical repair
4) immobilization
5) physiotherapy
How is a fracture of the clavicle treated? what age group is this common in?
immobilization with a sling
common in children
What are the two joints in the shoulder that are commonly injured and in what circumstances do these occur?
Acromioclavicular joint:
common athletic injury
Glenohumeral joint:
common dislocation when arm is extended
What is the function of the rotator cuff?
to stabilize the humoral head against the glenoid cavity
Why are shoulder joints unstable?
because of the wide range of motion and anatomical positioning
What are the 4 causes of injury to the rotator cuff
1) direct blow or stretch
2) excessive use/repetition
3) altered blood supply to tendons
4) Age-related degeneration
What are three common conditions under rotator cuff injuries?
1) tendonitis
2) subacromial bursitis
3) partial/complete tears
List the 4 manifestations of rotator cuff injuries
1) Pain
2) Tenderness
3) Difficulty abducting/rotating arm
4) muscle atrophy
Describe the 4 ways that shoulder/rotator cuff injuries are diagnosed
1) assessment of active and passive ROM
2) hx of mechanism of injury
3) MRI
4) arthroscopic examination
What are the 4 ways that shoulder/rotator cuff injuries are treated. (2 pharmacologic, 2 others)
1) anti-inflammatories
2) corticosteroid
3) physiotherapy
4) surgical repair
What is the most serious type of knee injury?
knee ligamentous injuries
What is the most common type of knee ligamentous injuries?
ACL tear
What are the 4 manifestations of an ACL tear/rupture?
1) pop or tearing sensation
2) sudden pain
3) loss of weight bearing
4) swelling due to hemorrhage
What is a meniscus?
the C shaped plates of fibrocartilage between condyles
there are lateral and medial meniscus
What are the 4 manifestations of meniscus injuries
1) Pain (esp on hyperflexion and hyperextension)
2) Edema
3) instability
4) knee locking and instability d/t loss fragment
What is a complication of meniscus injuries?
osteoarthritic changes limiting movement
What is the usual cause of patellar subluxation and dislocation
sports injury
What are the 6 manifestations of patellar subluxation and dislocation?
1) Weakness
2) Swelling
3) Crepitus (cracking sound)
4) Stiffness
5) loss of ROM
6) popping sensation
Describe what chondromalacia patella is
Inflammation of the underside of the patella and softening of the cartilage
What are 2 common causes of chondromalacia patella?
sports
knee overuse in older adults
What is the most common cause of anterior knee pain?
Patellofemoral pain syndrome
What are the three causes of patellofemoral pain syndrome?
1) imbalance of forces controlling patella movement
2) Contact of posterior surface of patella with femur
3) Running, jumping (volleyball), sitting
What are the 2 manifestations of patellofemoral pain syndrome and what is an important manifestation of other injuries that is NOT present
1) Pain
2) Weakness
there is no SWELLING
What can hip dislocation cause?
disruption of blood and nerve supply can lead to….
Avascular Necrosis:
necrosis of bone tissue causing it to collapse on itself
List 9 risk factors for hip fractures
1) age
2) women
3) physical inactivity
4) excess alcohol
5) psychotropic meds
6) institutionalization
7) visual impairments
8) polypharmacy
9) osteoporosis
What are the three common hip fracture sites
1) Neck
2) intertrochantric
3) subtrochantric
List and explain the 4 surgical options for hip fractures
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
What are the three categories of fractures?
1) sudden injury
2) fatigue stress fracture
3) pathologic stress fracture
what are the five ways that fractures are classified
Location
Character of fracture pieces (type)
Communication with outside environment
Degree of break
Direction
What are the three types of classifications of fractures by location?
Proximal, midshaft, distal
What are the two types of classification of fractures by degree of communication with outside environment
Open (COMPOUND)
Closed
What is an example of a classification of fracture based on degree of break? what age group is this common in?
Green stick
common in children (soft immature bones)
List and explain the 4 types of classifications of fracture based on fracture characteristics (type)
COMMINUTED: multiple pieces
COMPRESSION:
two bones compressed
IMPACT:
one of the fragments is driven into another
BUTTERFLY:
triangular bone piece, typically long bones
What is an avulsion fracture?
when ligament tears off a piece of the bone
What are the 4 types of classifications of fractures by direction?
1) transverse (across)
2) oblique (diagonal)
3) Spiral
4) twist/torque
What are the 4 manifestations of fractures?
Pain/tenderness
Swelling
Loss of function
Deformity
Explain the three types of deformity from fractures and what can result from having a deformity
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
how are fractures diagnosed?
assessment
x-ray
List the three treatments of fractures
1) reduction (closed or open)
2) immobilization
3) preservation and restoration of function (physio)
list the 4 stages of bone healing
1) Hematoma formation
2) fibrocartilaginous callus formation
3) Bony callus formation (ossification)
4) Remodeling
Describe the hematoma formation stage of bone healing. What stage is this?
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
Describe the fibrocartilaginous callus formation stage of bone healing. What stage is this?
Stage 2 (also called procallus) 2-3 wks
Fibroblasts begin repair, but not strong enough to weight bear
Describe the bony callus formation (ossification) stage of bone healing. What stage is this?
Stage 3
begins 3-4 weeks after and takes months
osteoblasts convert fibrocartilage to spongy bone (bony callus)
Describe the remodeling stage of bone healing. What stage is this?
stage 4
Dead bone removed by osteoclasts
compact bone replaces spongy bone
possible scar thickened area on bone surface
what are the 3 complications of bone healing?
DELAYED UNION
MALUNION
NONUNION
Describe what Delayed Union is and list contributing factors
Failure of fracture to heal within predicted time
Contributing Factors:
Large displaced fracture
inadequate immobilization
inadequate circulation
Describe what non-union is and list contributing factors
Failure of bone to heal before the process of bone repair stops
Contributing Factors: Soft tissue between bone frags infection inadequate circulation severe trauma
Explain what a fracture blister is.
epidermal necrosis d/t fluid separating it from dermis
Found in feet or ankles
Often where minimal SC tissue between epidermis and bone
What is a possible complication of a fracture blister?
infection if broken so must be left alone
What are the two types of fracture blister fluid?
CLEAR:
upper layers of epidermis (heals faster)
HEMORRHAGIC:
epidermis separated from dermis (lasts longer and is deeper)
What are the three main complications of fractures?
fracture blisters
compartment syndrome
fat embolism syndrome
what is compartment syndrome?
increased pressure within a limited space resulting in:
Compression of vessels: ischemia, necrosis
Compression of nerves: paresthesia, paralysis
What are the two ways that compartment syndrome can be caused by? List some things that can cause each
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
What is the amount of pressure in compartment syndrome dependent on?
Duration
Metabolic rate
Vascular tone
Local BP
What are the 4 manifestations of compartment syndrome?
Pain
Sensation change (burning, tingling, loss)
Hyporeflexia, loss of motor function
Dec/loss of peripheral pulses
What are the three aspects of assessment for compartment syndrome?
Pain
Sensory
Motor function
List the six P’s of a neurovascular assessment
1) Pain
2) Pulselessness
3) paralysis
4) paresthesia
5) polar (hot or cold)
6) pallor
Explain what fat embolism syndrome is
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
List the manifestations of fate embolism syndrome (3 categories based on location)
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
What are the complications of skin soft tissue injury?
fracture blisters
What is the complication of muscle soft tissue injury?
compartment syndrome
What is the complication of nerve soft tissue injury
paresthesia, paralysis
What is the complication of adipose/bone injury?
fat emboli syndrome
What is osteomyelitis?
infection of the bone
What are the three different ways that osteomyelitis can occur (pathway)
direct contamination
hematogenous (through blood)
Via skin lesion
What is the most common cause of osteomyelitis?
Staphylococcus aureus
adheres to bone and attacks cells. evades host defences and colonizes
Describe hematogenous osteomyelitis in children?
affects long bones
purulent exudate inside bone, damages arteries supplying bone, may penetrate skin or involve joints
Describe hematogenous osteomyelitis in adults
in vertebrae, sternocalvicular and sacroiliac joints, or pubic symphysis
tends to affect joint space
List the 6 manifestations of hematogenous osteomyelitis
1) signs of bacteremia
2) fever/chills
3) pain on movement/tenderness
4) erythema
5) edema
6) malaise
What age group does chronic osteomyelitis occur in?
adults
What is the usual cause of chronic osteomyelitis
Secondary to open wound
Describe what sequestrum is
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
What is osteonecrosis
Bone destruction d/t interruption in blood flow
What are the 6 different causes of osteonecrosis
1) idiopathic
2) bone injury
3) thrombosis/embolism
4) vessel injury
5) increased intraosseous pressure
6) corticosteroids
What is the manifestation of osteonecrosis (1)
chronic bone pain unrelated to movement
Describe the 4 treatment methods for osteonecrosis
Dependent on cause
1) immobilization
2) anti-inflammatories
3) exercise
4) surgery often needed for hip involvment
Describe the 2 characteristics of benign bone tumors
confined to bone with well defined borders
Do benign bone tumors cause fractures, require treatment or surgery?
not usually
What are the five types of benign bone tumors?
Osteoma
Fibrous tumors
Chondroma
Osteocondroma
Osteoclastoma
Describe what an osteoma is
small bony tumor on surface of bone
Describe what fibrous tumors are
they are common in GROWING bones
usually asymptomatic
resolve in 2-3 yrs
Describe the characteristics of Chondroma
Tumor made of cartilage
Common in short bones
onset 20-40 yrs
can be asymptomatic or painful
Describe the charactistics of osteochondroma
Cartilage capped tumor
bony stalk attaches it to bone
MOST COMMON
slow growing solitary mass
knee is common
Describe the characteristics of osteoclastoma
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
What are the three types of malignant bone tumors?
Osteosarcoma
Chondrosarcoma
Ewing sarcoma
What is the most common malignant bone tumor?
Osteosarcoma
Describe the characteristics of osteosarcoma?
occurs in areas with fastest bone growth
UKE, but genetic connection
Peak ages <20 or elderly
men over woman
metastasizes early often to lung
Describe the characteristics of chonrosarcoma?
Can arise from pre-existing benign cartilaginous tumor
onset mid to late adult
slow growing
responds early to exision
Describe the characteristics of ewing sarcoma
Densely packed small cells
children and young adults
men over woman
What is the most common bone cancer?
metastatic bone disease (skeletal metastasis)
What percentage of cancers metastisize to bone? what is the most common location?
50 percent
Most often trunk bones
What are the three manifestation of metastatic bone disease?
Pain
Pathological fracture
Hypercalcemia d/t bone destruction
What are the 3 general categories of bone cancer?
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
