mobility Flashcards
helps blood calcium levels to promote calcium absorption from GI tract.
Calcitriol
major hormone regulation for calcium
parathyroid and calcitonin hormone
are the bones widening, narrowing, irregular, is there a fracture?
X-ray
usually assess for soft tissue in the bones, the ligaments, the tendons, tumors, extent of fractures
CT
assess for any torn muscles, ligaments, cartilage, herniated discs, as well as any pelvic conditions
MRI
IV contrast injected into joint cavity to visualize the joint structure. if tear is present contrast leaks out of joint
arthrography
if any fluid in joint they’ll aspirate it
arthrocentesis
: bone mineralization. For women and men that have osteoporosis
predicts fracture risk
bone densitometry (DEXA)
contraindicated for patients taking anticoagulants and skin infections. tests for muscles and nerves
electromyography
increased if fracture is present. increased with osetomalacia or paget disease
alkaline phosphatase (ALP)
which 3 lab studies used for bone metabolism
calcitonin, vit d, PTH
increased in muscle damage from trauma. cross fit. being in hospital too long
Creatine kinase (CK)
increased in muscle damage
Aspartate aminotransferase (AST)
rate of bone turnover lab
serum osteocalcin
increased with bone destruction (parathyroid dysfunction, metastatic bone tumors, multiple myeloma)
urine calcium
usually aggravated by activity
low back pain
what are some meds used for lower back pain?
NSAIDS, muscle relaxants
inhibits prostaglandin synthesis by blocking COX 1 and COX-2 receptor sites
-example: ibuprofen
-anti-inflammatory
NSAIDS
NSAIDS SE
headache, dizziness, somnolence, fatigue, rash, nausea, dyspepsia, bleeding, constipation, bone marrow suppression, MI, CVA
Helps CNS to interfere with the reflexes causing muscle spasms
-baclofen
Skeletal muscle relaxants
skeletal muscle relaxants SE
transient drowsiness, dizziness, weakness, fatigue, constipation, headache, insomnia, hypotension, nausea, urinary retention
non-inflammatory, degenerative joint disease
-cartilage in the joints starts to break down and become narrow
-can get osteophytes which are bone spurs
OSTEOARTHRITIS (OA)
Primary OA
idiopathic, it just happens
SECONDARY OA
there was a previous injury or inflammatory disease or joint destruction like rheumatoid arthritis.
most modifiable risk factor for OA
obesity
manifestations of OA
joint pain
stiffness
functional impairment
enlarged joints (bouchard’s and Heberden’s node)
decreased ROM
Crepitus
Joint effusion
how is OA usually diagnosed
X-ray
initial analgesic for OA
Acetaminophen
treatment for moderate to severe OA
Arthroplasty where they do surgery to replace a damaged joint with an artificial one
-inhibits the synthesis of prostaglandins
-Tylenol
-SE: rash and liver toxicity, dont exceed 4g/day
Acetaminophen
metabolic bone disease characterized by decrease in bone density and strength
-increased risk of bone fractures
-becomes porous, brittle, fragile
osteoporosis
primary osteoporosis
affects women after menopause bcs of decrease in estrogen
secondary osteoporosis
is from either meds or disease that affect bone metabolism like if a patient is taking corticosteroids for a long time
risk factors of osteoporosis
-osteopenia (start having low bone mineral density) (precursor)
-small framed female
-meds like corticosteroids
-hormonal imbalances
-nutritional factors
-malabsorption disorders
-autoimmune disorders
-immobility
-alcohol and tobacco
what is the first sign of osteoporosis
fractures like compression fractures, hip, and wrist
diagnosis for osteoporosis
DEXA which measures bone density
management of osteoporosis
-diet rich in calcium and vitamin D
-exercise
-stop alcohol and tobacco
-meds
-used for osteoporosis
-slows the normal and abnormal bone resorption w/o inhibiting bone formation and mineralization
-alendronate (fosamax)
-po daily or monthly
-taken on empty stomach with full glass of water and remain upright for 30 min
Biphosphonates
Biphosphonates SE
abdominal pain, constipation, nausea, diarrhea, increased or recurrent bone pain, esophageal erosion
-for osteoporosis
-increases bone mineral density and modulates effects of estrogen at specific receptor sites
-raloxifene (evista)
-PO once a day
estrogen agonist/ antagonist
estrogen agonist/antagonist SE
VTE, hot flashes, skin rash, n/v, vaginal bleeding, depression, lightheadedness, stroke, PE, high triglycerides, hepatic impairment
-for osteoporosis
-monoclonal antibody that increases bone mineral density and reduces porosity of cortical bone
-denosumab (prolia)
-SQ every 6 months
-DONT JUST STOP
rankl inhibitors
-metabolic bone disease characterized by inadequate mineralization of the bone
-due to deficiency in vitamin D
-pain, tenderness, bowing of legs, pathologic fractures
-Causes: GI disorders, liver and kidney disease, hyperparathyroidism, malnutrition
osteomalacia
diagnosis for osteomalacia
h and p
x-ray
labs: low calcium phosphorus levels, high alkaline phosphate
bone biospy
-for osteomalacia
-a vit d compound that regulates the absorption of calcium and phosphate from the small intestine
-po daily
-se: weakness, headache, nausea, vomiting, dry mouth, constipation, muscle pain, bone pain
-adverse effect: metallic taste
calcitriol (rocaltrol)
medical management for osteomalacia
calcitriol, vitamin D and calcium supplementation, sunlight
-osteitis deformans: chronic bone disorder. rapid bone turnover leading to pathological fractures.
-proliferation of osteoclasts followed by bone replacement
-usually affects ppl greater than 50, commonly men
-cause is unknown but can be genetic
paget disease
clinical manifestations of pagets
-skeletal deformity. skull may be thickened, hats may not fit.
-legs may be bowed
-misalignment of hips, knees, ankle, and spine is usually bent forward and rigid
-tenderness and warmth due to increased vascularity
labs for pagets would show
elevated alkaline phosphate
x rays for pagets would show
demineralization and bone overgrowth
bone scans for pagets would show
the extent of disease
medical management for pagets
-NSAIDS for pain
-Biphosphates to stabilize the rapid bone turnover
-walking aids
-show lifts for gait instability or misalignment
-obese patients should lose weight
-increase vit D and calcium
-infection of the bone
-usually caused by MRSA
-results in inflammation, necrosis, and formation of a new bone
osteomyelitis
hematogenous osteomyelitis
bloodborne spread from another site of infection. So they could have an infection in the kidneys and then it goes to the bone.
contiguous-focus osteomyelitis
direct bone contamination. so from like a trauma or a joint replacement
osteomyelitis with vascular insufficiency
diabetes, PVD
risk factors for osteomyelitis
-older adults
-poor nutrition
-obesity
-chronic illness (diabetes, RA)
-impaired immune systems
-long term corticosteroid or immunosuppressive therapy
-IV drug users
hematogenous osteomyelitis clinical manifestations
-sudden onset of s/s of sepsis
-fever, chills, tachycardia, malaise
-pain, swelling, tenderness
contiguous focus osteomyelitis clinical manifestations
-no s/s of sepsis
-area swollen, warm, painful and tender to touch
vascular insufficiency osteomyelitis clinical manifestations
non healing ulcer over infected bone
how can a fracture lead to organ damage?
rib fracture can puncture a lung. skull fracture can lead to brain damage
complete fracture
all the way through
partial fracture
only a portion of the bone is fractured and the other side sometimes bends, use that in a green stick fracture which is very common in children because their bone is still developing.
comminuted
more than 2 bone fragments
bone fragment that pulls away from the tendon
evulsion
closed or simple fracture
doesn’t cause disruption in skin
open or compound fracture
bone comes through the skin. at risk for infection. seen in vehicle accidents
intra-articular fracture
fracture that extends into the joint
nondisplaced fracture
when the bone breaks but remains in alignment
displaced fracture
when the bone breaks into separate pieces and they no longer align
pathological fracture
occurs in an area of diseased bone. example is someone with osteoporosis
spiral fracture
occurs during twisting. sports injuries. seen in child abuse
what does reduction mean for management of fractures?
to place the bone back in alignment
closed reduction (external)
if we have a break thats nondisplaced and properly aligned we could put a cast on it, a splint, or put them in traction
open reduction
would be a surgery where they place pins or screws or plates to realign the fracture like ORIF surgery
fat embolism syndrome (complication of fractures)
usually at the time of the fracture there’s fat globules that can get released into circulation and they kind of act as a thrombus so they can lead to the occlusion fo some small blood vessels.
delayed union
fracture that doesn’t heal in the normal anticipated time frame.
nonunion
incomplete healing so the ends of that fracture don’t line up correctly and doesn’t heal properly because those ends don’t unite
malunion
fracture that heals in a malaligned or deformed position. Sometimes u can see a bump where that fracture hasn’t properly aligned but its healed so its partially healed but theyre not aligned.
heterotopic ossification
benign bone growth. Growth that happens in the soft tissue which is an area we wouldn’t expect.
a fracture that is open so the bone breaks and pokes through the skin.
compound fracture
initial treatment for compound fracture
make sure its not bleeding and then cover it with a sterile dressing to prevent infection.
treatment for compound fracture
tetanus vaccine, IV antibiotics, bone grafting, vacuum assisted closure, wound irrigation and debridement
potential complications of compound fracture
-osteomyelitis
-tetanus
-gas gangrene very lethal infection
complications of casts, splints, braces
acute compartment syndrom: increased pressure in a confined space which confines blood flow.
-pressure injuries
-disuse syndrome: deterioration of a body system as a result of musculoskeletal inactivity. Educate on isometric and ROM exercises.
-painful, results from increased pressure in those compartments. Can be due to bleeding. Can lead to a decrease on the compartment size which is cutting off circulation. Can lead to permanent muscle and nerve damage
-manifestations: the five Ps
-deep throbbing pain, not relived by meds, intensifies with ROM. Pain that Is disproportionate to the injury.
compartment syndrome
treatment for compartment syndrome
univalve or bivalve cast, fasciotomy
5 Ps
-pain
-pallor
-pulselessness
-paresthesias
-paralysis
stable pelvic fracture
usually only one break in pelvic ring and the alignment of pelvis is maintained
unstable pelvic fracture
2 or more breaks in pelvic ring and bones are displaced and misaligned which can lead to rotational instability
95% are due to fall
hip fracture
extracapsular hip fracture
trochanteric, intertrochanteric, subtrochanteric
intracapsular hip fracture
femoral head and neck
extracapsular manifestations
extremity will be shortened, externally rotated, muscle spasms, ecchymosis
intracapsular manifestations
-may or may not be shortened, adducted, may or may not be externally rotated
intial treatment for hip fracture
traction and then orif
