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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
Q

Fat Embolism Syndrome S/S

A
  • Dyspnea
  • Tachypnea
  • Hypoxemia
  • Headache, lethargy, confusion
  • Red, brown petechiae: Measles like rash may appear over the neck, upper arms, chest.
26
Q

Fat Embolism Syndrome Treatment

A

-Oxygen Admin
- Mechanical Vent
- Prophylactic treatment with corticosteroids and early immobilization of injury.

27
Q

What is the most common fracture in older adults?

A
  • Hip!
  • Osteoporosis is the biggest risk factor
28
Q

Hip Fracture Interventions

A

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
Q

Types of Hip Fractures

A
  • Intertrochanteric
  • Subtrochanteric
  • Femoral neck
  • Subcapital
  • Intracapsular
  • Extracapsular
30
Q

Lower 2/3 of femur
: usually from trauma

A
  • Casting is seldom
  • ORIF is treatment of choice
  • 6+ months
31
Q

Tibia- Fibula Fracture

A
  • Closed reduction with casting ( 6-10 weeks )
  • Internal fixation… followed by leg cast
  • Non weight bearing
32
Q

Ankle Fracture

A
  • 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
Q

Foot / Phalanges Fracture

A
  • May be more painful but are not as serious
  • Crutches are used.
34
Q

Pelvis Fractures

A
  • 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
Q

Pelvic Injuries

A
  • 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
Q

Amputation S/S

A
  • Monitor neurovascular status
  • Skin, edema, ulcerations, necrosis, hair distribution

Phychosocial Assessment:
- Do not underestimate loss of smaller body part

Diagnostic:
- ABI
- Doppler

37
Q

Complications of Amputations
1. Hemorrhage –> Hypovolemic Shock

A
  • From surgery or trauma, major blood vessels are severed which causes hemorrhage.
  • Uncontrolled bleeding can put the patient at risk for hypovolemic shock.
38
Q

Complications of Amputations
2. Infection

A
  • As with surgical procedures or trauma, infection can occur in the wound or the bone
39
Q

Complications of Amputations
3. Phantom limb pain

A
  • PLP refers to ongoing painful sensations that seem to be coming from the part of the limb that is no longer there.
40
Q

Complications of Amputations
4. Neuroma

A
  • Disorganized growth of nerve cells
  • Common after amputations of arm or leg.
41
Q

Complications of Amputations
5. Flexion contractures

A
  • Hip/ knee most common
42
Q

Amputation Interventions

A
  • Direct pressure
  • Ice Water
  • Opioid
  • Beta blockers
  • TENS
  • Figure 8 bandage, stump cover *
43
Q

Carpal Tunnel

A
  • Median nerve in the wrist becomes compressed, causing pain and numbness.
    Causes:
  • Computer work
  • Needlepoint
  • Jackhammer
44
Q

Carpal Tunnel S/S

A
  • 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
Q

Carpal Tunnel Diagnosis

A

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
Q

Carpal Tunnel Intervention

A
  • NSAIDS
  • Corticosteroid injections
  • Immobilization of wrist
  • Laser therapy
  • Wrist stretching
  • Surgery: Carpal tunnel release
47
Q

Sprains

A
  • 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
Q

Sprain Treatment

A
  • RICE ( Rest, ICE, Compression, Elevation )
  • NSAIDS
  • Cast, splints
  • Physical therapy
49
Q

Strains

A

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
Q

ACL Injuries

A
  • 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
Q

ACL S/S

A
  • 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
Q

Rotator Cuff

A

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
Q

What happens with a rotator cuff tear?

A
  • Tendon supporting one or several of these muscles rips or tears from bone
54
Q

Causes of Rotator Cuff injuries

A
  • Falls
  • Throwing a ball
  • Heavy lifting

Older adults:
- Aging
- Repetitve motions
- Falls

55
Q

Rotator Cuff Injuries S/S

A
  • 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
Q

Rotator Cuff Diagnosis

A
  • Eval of shoulder joint ROM
  • Pain / weakness occur when patient moves the arm
  • Passive ROM

Testing:
- X rays, MRI, CT
- Arthrogram

57
Q

Rotator Cuff Interventions

A
  • NSAIDS
  • Steroid injections
  • PT
  • Activity limitations
58
Q

Rotator Cuff Patients
Surgery may be indicted if….

A
  • 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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