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Pathophysiology 210 > Disorders of the Skeletal System: Chapter 43 > Flashcards

Disorders of the Skeletal System: Chapter 43 Flashcards

1
Q

What is a soft tissue injury?

A 
Contusion/Bruise
- Result of direct trauma
- Skin remains intact
- Blood vessel/cell damage
- Edema, inflammation
- Ecchymotic (black, blue, brown, yellow)
Hematoma
- Localized hemorrhage
- Blood accumulation pressures nerves 
- Pain, increasing with movement/pressure
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2
Q

Describe a strain and list its manifestations.

A

Involves muscle/tendon
Partial tear, often during muscle contraction
Risk increases with age
- Collagen fibers less elastic

Common in back, cervical spine, elbow, shoulder
Sports injuries: hip, hamstring, quadriceps
> Manifestations
Often no visible signs unless inflammation
Pain, increasing with stretching
Stiffness, swelling, tenderness

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3
Q

Describe a sprain and its manifestations

A 
Tearing or rupture of supporting ligament or capsule surrounding joint
d/t abnormal/excess joint movement
Diagnosis
Not visible on X-ray unless bone fragment
> Manifestations
Pain
Rapid swelling limits movement
Discoloration
Last longer than strain
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4
Q

Strain/sprain treatment

A 
Rest	
Ice
Compression	
Reduces swelling
Provides support
Elevation 	
Immobilization
- Strains if severe
- Sprains  x weeks
Immobilization
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5
Q

Strain/sprain healing and complications

A

Able to heal to original tensile strength
Capillaries bring oxygen/nutrients
Fibroblasts produce collagen
Collagen bundles strengthen over time
> Complications
Contraction can pull healing apart and result is lengthened position upon final healing
adhesions

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6
Q

Describe a dislocation and where do dislocations often occur?

A 
Abnormal displacement of articulating surfaces of joint
Subluxation
Partial dislocation
Some surface contact
Common joints
Shoulder 
Acromioclavicular
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7
Q

Dislocations Classifications

A 
1. Congenital
Hip or knee usual
2. Traumatic
MVA: hip
Athletics: shoulder, knee 
Fall: wrist, ankle
3. Pathologic
- Complication of infection, rheumatoid arthritis, neuromuscular disease, etc.
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8
Q

Dislocation diagnosis, manifestations, and treatment

A 
> Diagnosis
History, assessment, x-rays
> Manifestation
Pain
Deformity
Limited movement
> Treatment
Spontaneous (can pop joint back into place)
Manipulation
Surgical repair
Immobilization
Physiotherapy
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9
Q

Shoulder injury

A 
Clavicle fracture common d/t childhood falls/blow
Most resolve without surgery
Immobilize with sling
> Acromioclavicular joint
- Common athletic injury
> Glenohumeral joint 
Very common dislocation
E.g. when arm extended
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10
Q

What is a rotator cuff injury and common resulting conditions.

A

Function of cuff is to stabilize the humoral head against the glenoid

Injuries are a result of a combination of:
Direct blow or stretch
Excessive use/repetition (common)
Altered blood supply to tendons
Age-related degeneration

Common resulting conditions
Tendinitis
Sub-acromial bursitis
Partial/ complete tears

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11
Q

Rotator cuff manifestations

A

Pain
Tenderness
Difficult abducting/rotating arm
Muscle atrophy

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12
Q

Shoulder/Rotator cuff diagnosis and treatment

A 
> Diagnosis
Assessment of active & passive ROM
History of injury is important
MRI
Arthroscopic examination
> Treatment
Anti-inflammatories
Corticosteroid (oral, injection)
Physiotherapy
Surgical repair
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13
Q

Knee ligamentous injuries and manifestations

A

Most serious of knee injuries
- ACL rupture/tear is most common

Manifestations of ACL rupture/tear
“pop” or tearing sensation
Sudden pain
Loss of weight-bearing
Hemorrhage causes swelling
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14
Q

What are the manifestations and complications of meniscus tears?

A

> Manifestations
pain, especially on hyperflexion & hyperextension
Edema
Instability
Locking d/t loose fragment
Complications
- Osteoarthritic changes limiting movement.

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15
Q

Patellar Subluxation & Dislocation manifestations

A 
Usually sports related
Manifestations
Weakness
Swelling 
Crepitus
Sound you hear when tissue is rubbing against each other and they shouldn’t be
Stiffness
Loss of ROM
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16
Q

What is chondromalacia patellae and what causes this?

A

Inflammation of the underside of the patella
Sports
Knee overuse in older adult

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17
Q

What are the causes and manifesations of patellofemoral Pain Syndrome?

A 
Most common cause of anterior knee pain
> Causes
Imbalance of forces controlling patella movement
Contact of posterior surface of patella with femur
Running, jumping, sitting
> Manifestations
Pain 
weakness
Absence of edema
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18
Q

Cause of hip injuries

A 
Dislocation
d/t trauma
Emergency
Disruption of blood and nerve supply
Avascular necrosis: interruption of blood supply resulting in necrosis of bone tissue = collapse of bone
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19
Q

What are risk factors for hip fractures?

A 
Risk Factors
Age
Women d/t osteoarthritis
Physical inactivity
Alcohol excess
Psychotropic medications
Institutionalization
Visual impairments
Polypharmacy
Osteoporosis.
20
Q

What are surgical options for hip fractures?

A

Total hip replacement (THA)
Hemi-arthroplasty (ball and socket replacement)
ORIF (open reduction internal fixation- hold bones together with pins)
Revision

21
Q

Fractures in general

A 
Sudden Injury /or/
Stress Fractures
Incomplete fractures 
Fatigue fracture
Any weight-bearing bone
E.g. tibia SF can be mistaken for “shin splint”
Pathologic fracture
Bone weakened by previous disease/tumor
22
Q

Fractures: classifications

A 
> Position on bone
Proximal/mid-shaft/distal
Head/neck
Near prominence (malleolus)
> Degree of communication with outside environment
Open/compound
Closed
> Degree of break
Greenstick
- Young, soft immature bone
23
Q

Fractures: classifications cont’d

A

> Character of fracture pieces
- Comminuted: multiple pieces

  • Compression: crushing of 2 bones
  • Impacted: fragments wedged together
  • Butterfly: triangular bone piece, typically long bones
  • Avulsion: when the tendon or ligament tears off a piece of the bone
> Direction of break
Transverse (all the way across bone)
Oblique
Spiral (result of opposite movement)
Twist, torque
24
Q

What are the manifestations of fractures?

A 
Pain/tenderness
Swelling
loss of function/mobility
Deformity
Angulated fragments damage tissue
Shortening of extremity
Rotational 
Crepitus 
Blood loss (bones are very vascular-can lose up to a liter of blood from hip fracture-internally)
Nerve function impairment or loss
- Local shock (numbness, flaccid muscles)
25
Q

Fractures diagnosis and treatment

A

> Diagnosis
Assessment
X-ray

> Treatment
Reduction of fracture
Closed or open
Immobilization: splint, cast, external fixation devices, traction
Preservation & restoration of function
Physiotherapy

26
Q

Describe the process of bone healing

A 
1.  Hematoma formation
First 1-2 days
Bone/tissue blood vessel rupture 
Fibrin network (clot) forms
- Provides foundation for inflammatory cells
  1. Fibrocartilaginous callus formation
    Fibroblasts begin repair
    Takes 2-3 weeks, but still weak
27
Q

Bone healing cont’d

A 
3. Bony callus formation: ossification
Osteoblasts form; calcium salts deposit
Cartilage converts to bony callus
Begins 3-4 weeks after injury, takes months
4. Remodelling 
Dead cells removed
Compact bone replaces spongy bone; callus shrinks
Possible “scar”.
28
Q

What are some complications of healing?

A 
1. Delayed union
Failure to heal in usual time, but eventually does
2. Malunion
Deformity 
3. Nonunion
Failure to heal
29
Q

Complications of fractures: Fracture Blisters

A
  • Epidermal necrosis d/t fluid separating it from dermis
  • Often where minimal s/c tissue between epidermis and bone
  • Chance of infection if broken
30
Q

Complications of fractures: compartment syndrome

A 
> Increased intra-osseus pressure within a limited space due to:
Decreased size
Constrictive dressings
Casts
Burns 
Increased volume of contents
Trauma
Fluid/edema
Vascular injury/bleeding
Venous obstruction
Both
31
Q

Compartment syndrome pressure is dependent on…

A 
> Amount of pressure dependent upon: 
Duration
Metabolic rate
Vascular tone
Local blood pressure

> Result of increased pressure
Compression of vessels = ischemia, necrosis

Compression of nerves = paresthesis, paralysis

32
Q

What are the manifestations of compartment syndrome and what assessments should be performed?

A 
> Manifestations
Severe pain
Sensation change: burning/tingling/loss
Diminished reflexes, motor function loss
Decreases/loss peripheral pulses
> Assessment
Pain 
Sensory
Motor function
33
Q

What are the 6 p’s of a neurovascular assessment?

A
  1. Pain
  2. Pulselessness
  3. Paralysis
  4. Paresthesia
  5. Polar (temp)
  6. Pallor (colour)
34
Q

Complications of Fractures: Fat Embolism Syndrome (FES)

A

Common but few people have symptoms or complications
Fat droplets from bone & adipose tissue circulate though venous system to body

Not the same as a “fat emboli”

35
Q

FES manifestations

A 
Respiratory failure
Dyspnea, pallor, cyanosis
Angina, tachycardia, diaphoresis 
Cerebral dysfunction
Early or late sign
Mentation/behaviour changes
Focal deficits, encephalopathy, seizures
Skin/mucosa petechiae
Rash 2-3 days post event
36
Q

Complications of Soft-Tissue Injury

A 
> Skin injury
- Fracture blisters
> Muscle injury
- Compartment syndrome
> Nerve injury
- Paresthesia, paralysis
> Adipose/bone injury
- Fat emboli, FES
37
Q

What is osteomyelitis and what bacteria most commonly causes this?

A

> Infection of bone
Direct contamination
Hematogenous (thru blood)
Via skin lesion

> Staphylococcus aureus most common
Adheres to bone, attacks cells
Evades host defenses and colonizes

38
Q

Decribe hematogenous osteomyelitis in children and in adults.

A 
> In children
Affects long bones
Purulent exudate inside bone
Damages arteries supplying bone
May penetrate skin or involve joints
> In adults
In vertebrae, sternoclavicular and sacroiliac joints, or pubic symphysis
Tends to affect joint space
39
Q

What are hematogenous osteomyelitis manifestations?

A 
Manifestations
Signs of bacteremia 
Fever, chills, malaise
Pain on movement of area
Tenderness 
Erythema 
Edema
40
Q

Chronic osteomyelitis

A 
Usually adults
Usually secondary to open wound
Sequestrum
Infected dead bone
Separated by sheath 
Difficult to detect when near a joint prosthesis.
41
Q

Osteonecrosis

A 
> Bone destruction d/t interruption in blood flow
Idiopathic 
Bone injury
Thrombosis/embolism
Vessel injury
Increased intraosseous pressure
Corticosteroid associated (unclear)
42
Q

Osteonecrosis manifestations and treatment

A

> Manifestations
Chronic pain, unrelated to movement

> Treatment
Dependent on cause
Immobilization, anti-inflammatories, exercise
Surgery often needed for hip involvement

43
Q

Benign bone tumors

A 
Confined to bone
Well-defined borders
Seldom cause fractures
Seldom require treatment or surgery
1. Osteoma
Small bony tumor (new bone tissue) on bone surface
2.  Fibrous tumors
Common in growing bones
Usually asymptomatic
Resolve in 2-3 years
44
Q

Benign bone tumors cont’d

A
  1. Chondroma (tumor made of cartilage)
    Short bones; solitary lesion
    Onset @ 20-40 years of age
    Asymptomatic or painful
4. Osteochondroma (cartilage-capped tumor) 
Bony stalk attaches it to bone
Most common
Slow-growing, solitary mass
Knee is common
5. Osteoclastoma (giant cell tumor)
Behaves like malignant
Metastasizes via bloodstream
Recurs after removal
May invade bone and cause bone destruction
Knee is common
Pathological fractures common
45
Q

Malignant Bone Tumors

A 
1. Osteosarcoma (most common)
Tends to be in areas with fastest bone growth
Unknown etiology, but genetic connection
Peak ages:  women 
Metastasizes early, often to lung
2. Chondrosarcoma
Can arise from pre-existing benign cartilaginous tumor
Mid to late adulthood
Slow-growing
Responds to early excision
3. Ewing sarcoma
Densely packed small cells
Children & young adults
Men > women
46
Q

Metastatic Bone disease and manifestations

A

Skeletal metastasis is the most common bone cancer
50% of all cancers metastasize to the bone
Most often in trunk bones
Manifestations
Pain
Pathologic fracture
Hypercalcemia d/t bone destruction

47
Q

Manifestations of bone cancer

A
  • Changes in organ function (organ damage, inflammation, and failure):
  • Local effects of tumors (e.g., compression of nerves or veins, stretching of periosteum):
  • Nonspecific signs of tissue breakdown (e.g., protein wasting, bone breakdown):

Pathophysiology 210 (4 decks)

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