Injury and Trauma of Musculoskeletal Structures Flashcards
What is a contusion?
A bruise.
What is the difference between a contusion and a hematoma?
A contusion causes blood vessel/cell damage. A hematoma is a localized hemorrhage that puts pressure on local nerves.
What is the similarity between a contusion and a hematoma?
The skin remains intact.
What is the difference in colour between a contusion and a hematoma?
Contusion is usually blue, black, or yellow. Hematoma is red because of hemorrhage.
What is a strain?
A partial tear of a muscle or tendon.
Where are the most common locations of strains?
Back, cervical spine, elbow, and shoulder. In sports: hip, hamstring, quadriceps.
Why does age increase risk for strains?
Collagen fibres become less elastic with aging.
What are the manifestations of a strain?
Pain, increasing with stretching. Stiffness, swelling. Sometimes no obvious signs unless inflamed.
What is a sprain?
Tearing or rupture of supporting ligament or capsule surrounding a joint.
What are manifestations of a sprain?
Pain, rapid swelling that limits movement, discoloration.
What is the difference between a sprain and a strain?
Sprain is a complete tear of ligament, while strain is partial tear. Sprains take longer to heal than strains.
What is the treatment for sprains and strains?
RICE - rest, ice, compression, elevation (immobilization)
Describe the healing process of sprains and strains.
Capillaries bring oxygen and nutrients. Fibroblasts produce collagen. Collagen bundles strengthen over time.
What are some complications that can occur from improper sprain/strain healing?
Contraction can pull healing apart, resulting in lengthened position upon final healing. Adhesions.
What is a dislocation?
Abnormal displacement of articulating surfaces of a joint.
What is the difference between dislocation and sublaxation?
Sublaxation is only a partial dislocation. There is still some contact between the articulating surfaces of the joint.
What are the three causes of joint dislocation?
Congenital, traumatic, and pathologic.
What is a pathologic dislocation?
A dislocation that occurs as a complication of another pathological condition eg. infection, rheumatoid arthritis, neuromuscular disease, etc.
Which joint is most commonly dislocated in an MVA?
Hip.
Which joints are most commonly dislocated as sports injuries?
Shoulder, knee
Which joints are most commonly dislocated due to a fall?
Wrist, ankle.
What are the manifestations of a dislocation?
Pain, deformity, and limited movement.
How is a joint dislocation treated?
Manipulation. Surgical repair. Immobilization. Physiotherapy. The dislocation may spontaneously correct itself as well.
What is a common shoulder injury that occurs in children?
Fractured clavicle
How is a fractured clavicle treated?
Usually not needing surgery. Immobilize with sling.
What is the function of the rotator cuff?
Stabilizes the humoral head against the glenoid
Why are shoulder joints inherently unstable?
They have a huge range of motion and a shallow socket.
What are four general causes of rotator cuff injury?
Direct blow or stretch. Excessive use. Altered blood supply to tendons. Age-related degeneration.
What are some common conditions that result from a rotator cuff injury?
Tendinitis, subacromial bursitis, partial/complete tears.
What are some manifestations of rotator cuff injuries?
Pain, tenderness, difficulty abducting and rotating arm, muscle atrophy.
How is a shoulder or rotator cuff injury diagnosed?
Assessment of active and passive range of motion. History of injury (important!), MRI, arthroscopic examination.
What is the treatment for shoulder and rotator cuff injuries?
Anti-inflammatories, corticosteroids (oral or injected), physiotherapy, surgical repair.
What are the most serious knee injuries?
Knee ligamentous injuries.
Which is the most common knee ligament injury?
ALC rupture/tear
What are the manifestations of an ALC rupture or tear?
“pop” or tearing sensation, sudden pain, loss of weight-bearing, hemorrhage causes swelling.
What are manifestations of a meniscus tear?
Pain, especially on hyperflexion and hyperextension. Edema. Instability. Locking due to a loose fragment
What is a complication that can occur as a result of a meniscus tear?
Osteoarthritic changes limiting movement.
What are manifestations of patellar sublaxation and dislocation?
Weakness, swelling, crepitus, stiffness, loss of range of motion.
What is crepitus?
a grating sound or sensation produced by friction between bone and cartilage or the fractured parts of a bone.
What is chondromalacia patellae?
Inflammation of the underside of the patella.
What causes chrondomalacia patella?
Knee overuse in older adult, sports.
What is the most common cause of anterior knee pain?
Patellofemoral Pain Syndrome
What causes Patellofemoral Pain Syndrome?
Imbalance of forces controlling patella movement. Contact of posterior surface of patella with femur. Running, jumping, sitting.
What are the manifestations of Patellofemoral Pain Syndrome?
Pain, weakness. (Absence of edema).
Why is a hip dislocation a medical emergency?
It disrupts the blood and nerve supply to the leg, which can cause avascular necrosis.
What is avascular necrosis?
Interruption of blood supply resulting in necrosis of bone tissue, and collapse.
What are the risk factors for osteoporosis? (There are 9 of them)
Age. Women. Physical inactivity. Alcohol excess. Psychotropic medications. Institutionalization. Visual impairments. Polypharmacy. Osteoporosis.
What are the three common sites of hip fracture?
Neck, intertrochanteric, subtrochanteric
What are the surgical options for treating hip fracture?
Total hip replacement, Hemi-arthroplasty, Open reduction internal fixation, Revision.
What are the two causes of fractures?
Sudden injury and/or stress fractures.
What is a pathologic fracture?
Bone weakened by previous disease or tumor.
How are fractures classified?
Position on bone, degree of communication with outside environment, degree of break, character of fracture pieces, direction of break.
What are the different fracture classifications according to the position on the bone?
Proximal/midshaft/distal. Head/neck. Near prominence (malleolus).
What are the different fracture classifications according to the degree of communication with the outside environment?
Open/compound. Closed.
What is a greenstick fracture?
Partial break that occurs with young, soft, immature bone.
What are the classifications of fractures according to the character of fracture pieces?
Comminuted. Compression. Impacted. Butterfly. Avulsion.
What is a comminuted fracture?
A fracture with multiple pieces.
What is a compression fracture?
Crushing of 2 bones.
What is an impacted fracture?
Fragments wedged together.
What is a butterfly fracture?
Triangular bone piece. Typically occurs on long bones.
What is an avulsion fracture?
When the tendon or ligament tears off a piece of the bone.
What are the classifications of fractures according to direction of the break?
Transverse, oblique, spiral, twist/torque
What are the manifestations of fractures?
Pain/tenderness, swelling, loss of function/mobility, deformity, crepitus, blood loss, nerve function impairment or loss.
How is a fracture diagnosed?
Assessment and X-ray
How is a fracture treated?
Reduction (closed or open). Immobilization. Preservation and restoration of function. Physiotherapy.
What are some examples of immobilization devices for fractures?
Splint, cast, external fixation devices, traction.
What are the stages of bone healing?
Hematoma formation. Fibrocartilagnous callus formation. Bony callus formation. Remodeling.
What occurs during the “hematoma formation” stage of bone healing?
Bone tissue/blood vessel rupture. A fibrin network (clot) forms. This provides a foundation for inflammatory cells.
How long does the “hematoma formation” stage of bone healing take?
1-2 days.
What occurs during the “fibrocartilaginous callus formation” stage of bone healing?
Fibroblasts begin repair.
How long does the “fibrocartilaginous callus formation” stage of bone healing take?
2-3 weeks
What occurs during the “bony callus formation” stage of bone healing?
Osteoblasts form, and calcium salts deposit. Cartilage converts to bony callus.
When does the “bony callus formation” stage of bone healing begin?
3-4 weeks after injury.
How long does the “bony callus formation” stage of bone healing take?
Months
What is another word for “bony callus formation”?
Ossification
What occurs during the “remodeling” stage of bone healing?
Dead cells are removed. Compact bone replaces spongy bone.
Name three complications of bone healing.
Delayed union, malunion, nonunion.
What is delayed union in bone healing?
Failure to heal in usual time, but eventually does.
What are fracture blisters?
Epidermal necrosis due to fluid separating the epidermis from the dermis.
Why should the blisters remain intact?
High chance of infection if blisters are broken.
What is compartment syndrome?
Increased intraosseus pressure within a limited space due to decreased size, increased volume of contents, or both.
What four things determine the amount of pressure during compartment syndrome?
Duration, metabolic rate, vascular tone, and local blood pressure.
What is the result of increased pressure in compartment syndrome?
Compression of blood vessels and nerves. This can lead to ischemia, necrosis, paresthesis, and paralysis.
What are the manifestations of compartment syndrome?
Severe pain, senstion change (burning, tingling, loss of senstion), diminished reflexes, loss of motor function, decrease or loss of peripheral pulses.
What are the six P’s that indicate compartment syndrome?
Pain, pulselessness, paralysis, paresthesia, polar, palor
What is fat embolism syndrome?
Fat droplets from bone and adipose tissue circulate through venous system in the body.
What are the manifestations of fat embolism syndrome?
Respiratory failure (dyspnea, pallor, cyanosis, angina, tachycardia, diaphoresis). Cerebral dysfunction (mentation/behavioural changes, focal deficits, encephalopathy, seizures). Skin/mucosa petechiae (rash 2-3 days post event).
