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Pharm 2 > Exam #3 Acute MSK Disorders > Flashcards

Exam #3 Acute MSK Disorders Flashcards

1
Q

Complete Fracture

A

The break is across the entire width of the bone in such a way that the bone is divided into 2 distinct sections.

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2
Q

Displaced Fracture

A

If bone alignment is altered or disrupted.
- The ends of bone sections can damage surrounding nerves, blood vessels and other soft tissues.

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3
Q

Non-Complete Fracture

A

The fracture does not divide the bone into 2 portions because the break is through only part of the bone.
- Not typically displaced

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4
Q

Greenstick Fracture

A

Occurs when a bone bends and cracks, instead of breaking completely.

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5
Q

Open
( Compound )

A

Skin surface over the broken bone is disrupted which causes an external wound

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6
Q

Closed
( Simple )

A

Does not extend through the skin and therefore has no visible wound.

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7
Q

Fragility Fracture

A

Occurs after minimal trauma to a bone that has been weakened by disease
Ex: Bone cancer, osteoporosis

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8
Q

Stress Fracture

A

Results from extensive strain and stress on the bone
Ex: Common in athletes

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9
Q

Compression Fracture

A

Produced by loading force applied to the long axis of cancellous bone

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10
Q

Direct Healing

A
  • Use of surgical procedure to realign bone
  • Fractures that benefit from direct healing:
  • Long term complications
  • Severely comminuted; threatened vascularity
  • Surgical procedures: External fixation, Internal fixation, closed reduction
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11
Q

Indirect Healing

A

-Union: Normal healing
-Nonunion: No clinically significant progress toward complete healing for at least 3 months according to x-rays.
- Delayed union: Significantly longer than expected healing time
- Malunion: Bone fragments joined in a position not anatomically correct

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12
Q

Stage 1
Bone Healing

A
  • Within 24-72 hrs after injury hematoma forms
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13
Q

Stage 2
Bone Healing

A
  • 3 days to 2 weeks when granulation tissue begins to invade the hematoma
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14
Q

Stage 3
Bone Healing

A
  • Result of vascular and cellular proliferation. A callus formation occurs within 3-6 weeks
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15
Q

Stage 4
Bone Healing

A
  • Callus is reabsorbed and transformed into bone. Usually takes 3-8 weeks
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16
Q

Stage 5
Bone Healing

A
  • Consolidation and remodeling of bone continue to meet mechanical demands. Can continue for up to 2 years.
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17
Q

Fracture S/S

A
  • Pain is most common symptom
  • Deformity
  • Edema
  • Numbness
  • Muscle Spasms
  • Bleeding
  • Bruising
  • Crepitus
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18
Q

Fracture Treatment time
( Phalanges )

A

Take up to 3 weeks to heal

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19
Q

Fracture Treatment time
( Femur )

A

Takes 12 weeks

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20
Q

Fractures Treatment

A

Acute:
- Emergency Care
- IV opioids, fentanyl, morphine, NSAIDS

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21
Q

Fracture Complications

A
  1. VTE including DVT and PE.
  2. Infection: Pseudomonas, Staph, Clostridium
  3. Fat emboli
    - Treatment: Antibiotics, proper hygiene
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22
Q

Compartment Syndrome

A
  • Edema and swelling cause increased pressure in muscle compartment
  • Decreased blood flow
  • Possible muscle and nerve damage
  • Ischemia may cause muscles and nerves to die
  • Most common in lower leg and forearm
  • Prevent: Elevate + Ice
  • S/S: Pain, pallor, paralysis, no pulse, parathesia
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23
Q

Compartment Syndrome
Complications and Treatment

A

Comp:
- Paralysis
- Need for amputation
- Volkmann Contracture: A deformity of hand, fingers and wrist caused by injury to the muscles of the forearm.

Treatment:
- Elevate
- Remove cast
- Fasciotomy
- Incision through the fascia to relieve pressure and tension on vital blood vessels and nerves.
- Heals from inside out

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24
Q

Fat Embolism Syndrome

A
  • Fat globules are released from the yellow bone marrow into the bloodstream within 12-48 hours after injury.
  • These globules clog small blood vessels that supply vital organs, most commonly the lungs, and impair oxygen perfusion.
25
Fat Embolism Syndrome S/S
- Dyspnea - Tachypnea - Hypoxemia - Headache, lethargy, confusion - Red, brown petechiae: Measles like rash may appear over the neck, upper arms, chest.
26
Fat Embolism Syndrome Treatment
-Oxygen Admin - Mechanical Vent - Prophylactic treatment with corticosteroids and early immobilization of injury.
27
What is the most common fracture in older adults?
- Hip! - Osteoporosis is the biggest risk factor
28
Hip Fracture Interventions
Pre-OP: IV Morphine, Hydromorphone after admission for pain control. Post-OP: ORIF ( open reduction and internal fixation ) surgery is treatment of choice. - Traction - Acute Delirium - Fall prevention
29
Types of Hip Fractures
- Intertrochanteric - Subtrochanteric - Femoral neck - Subcapital - Intracapsular - Extracapsular
30
Lower 2/3 of femur : usually from trauma
- Casting is seldom - ORIF is treatment of choice - 6+ months
31
Tibia- Fibula Fracture
- Closed reduction with casting ( 6-10 weeks ) - Internal fixation... followed by leg cast - Non weight bearing
32
Ankle Fracture
- ORIF performed using 2 incisions: one on the medial aspect of the ankle and one on the outer side. Several screws, nails are placed into tibia. Compression plate keeps fibula in alignment
33
Foot / Phalanges Fracture
- May be more painful but are not as serious - Crutches are used.
34
Pelvis Fractures
- Pelvis is among the strongest structure in the human body injury: - Requires significant force... - Motor vechile crass - Fall from distance - Crushing blow - Associated with high degree of mortality and morbidity! - Abdominal injury ( 52% mortality ) - Head injury ( 50% mortality ) - Hypotension at time of admission ( 42% ) - Patients with anteroposterior pelvic fracture have 800% increased rate of aortic rupture.
35
Pelvic Injuries
- Shearing injury / major disruption of pelvic ring: - Causes laceration to many blood vessels in pelvis - Provides major source of blood loss - 90% of hemorrhage from venous bleeding from bony structures - Other injuries: - GI - GU - Spinal cord - Fractures of pelvis - Weight bearing vs non weight bearing
36
Amputation S/S
- Monitor neurovascular status - Skin, edema, ulcerations, necrosis, hair distribution Phychosocial Assessment: - Do not underestimate loss of smaller body part Diagnostic: - ABI - Doppler
37
Complications of Amputations 1. Hemorrhage --> Hypovolemic Shock
- From surgery or trauma, major blood vessels are severed which causes hemorrhage. - Uncontrolled bleeding can put the patient at risk for hypovolemic shock.
38
Complications of Amputations 2. Infection
- As with surgical procedures or trauma, infection can occur in the wound or the bone
39
Complications of Amputations 3. Phantom limb pain
- PLP refers to ongoing painful sensations that seem to be coming from the part of the limb that is no longer there.
40
Complications of Amputations 4. Neuroma
- Disorganized growth of nerve cells - Common after amputations of arm or leg.
41
Complications of Amputations 5. Flexion contractures
- Hip/ knee most common
42
Amputation Interventions
- Direct pressure - Ice Water - Opioid - Beta blockers - TENS - Figure 8 bandage, stump cover *
43
Carpal Tunnel
- Median nerve in the wrist becomes compressed, causing pain and numbness. Causes: - Computer work - Needlepoint - Jackhammer
44
Carpal Tunnel S/S
- Weakness when gripping objects with 1 or both hands - Pain / numbness in one / both hands - Burning / tingling in fingers, especially thumb and index - Pain or numbness that is worse at night - Pain is alleviated by rubbing hand and wrist * - Swelling
45
Carpal Tunnel Diagnosis
Diagnosis: -Tinel Test: performed by lightly tapping over the median nerve to elicit a sensation of tingling or "pins and needles" - Positive if tingling / prickling is felt. - Phalen Test: press the back of the hands and fingers together with wrists flexed in completion and fingers pointed down. 1-2 mins. - Positive if tingling / numbness in fingers when flexed
46
Carpal Tunnel Intervention
- NSAIDS - Corticosteroid injections - Immobilization of wrist - Laser therapy - Wrist stretching - Surgery: Carpal tunnel release
47
Sprains
- Ligaments around the joint stretched or torn - Most common: Ankle S/S : Severely hindered ROM, "pop" or "rip" when injury occurs, bruising, pain, immediate swelling
48
Sprain Treatment
- RICE ( Rest, ICE, Compression, Elevation ) - NSAIDS - Cast, splints - Physical therapy
49
Strains
Over stretching injury to muscle - tendon unit - Most common: lower back, neck S/S: - Immediate pain - Reduced ROM - Muscle spasms - Edema - Muscle weakness - Bleeding, swelling Treatment: - RICE - NSAIDS - Cast, splints - Physical therapy
50
ACL Injuries
- One of the four major ligaments that connects femur to tibia. - Tear down middle of ligament, ligament torn from femur - Causes: Decelerating while running, twisting or jumping
51
ACL S/S
- Intense pain - Feeling that knee " popped " , " gave out " - Swelling - Diagnosis: X ray Treatment: - Ice, elevation, pain medication ( NSAIDS ) -Non weight bearing until swelling subsides - PT
52
Rotator Cuff
Is a group of muscles and tendons that surround the shoulder joint, keeping the head of your upper arm bone firmly within the shallow socket of the shoulder.
53
What happens with a rotator cuff tear?
- Tendon supporting one or several of these muscles rips or tears from bone
54
Causes of Rotator Cuff injuries
- Falls - Throwing a ball - Heavy lifting Older adults: - Aging - Repetitve motions - Falls
55
Rotator Cuff Injuries S/S
- Patient will have shoulder pain and cannot easily abduct the arm - When the arm is abducted, the patient will drop the arm - Pain: More intense at night, mobility reduced
56
Rotator Cuff Diagnosis
- Eval of shoulder joint ROM - Pain / weakness occur when patient moves the arm - Passive ROM Testing: - X rays, MRI, CT - Arthrogram
57
Rotator Cuff Interventions
- NSAIDS - Steroid injections - PT - Activity limitations
58
Rotator Cuff Patients Surgery may be indicted if....
- Who do not respond to normal treatment for 3-6 months - Pts with full thickness tear - Severe arm weakness - Surgery: re-attaching the tendon to the head of the humerus - Partial: Debridement: partial smoothing - Complete tear: stitching the tendon back to original site

Pharm 2 (10 decks)

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