mobility part 1 Flashcards
Age realted differences in musculoskeletal system
- Effects of aging vary from mild discomfort and ↓’d ability → severe chronic pain/immobility
- decreased bone density = vertebral compression
- Loss of fluid from vertebral disks, narrowing of vertebral spaces
- Cartilage destruction and bone overgrowth at joint margins
- Muscle ↓, fibrous replacement; ↓ ligament elasticity and glycogen storage for quick energy
Exemplars of Mobility Disorders (Part I)
- Soft tissue injuries: sprains/strains, joint dislocations, carpal tunnel syndrome, rotator cuff injury, meniscus injury, ACL injury, bursitis
- Fractures
- Amputation
- Acute and chronic low back pain
- Intervertebral disc disease
Sprains and Strains
- Often sports/work related
- Sprain - injury to ligament around joint, wrenching or twisting (often ankle or wrist)
- Strain: muscle/tendon stretching or tearing
- Repetitive strain injuries common
- Pain, edema, bruising, decreased function
- Complications: avulsion fracture, subluxation or dislocation
joint dialocation
- Often sports/work related
- Sprain - injury to ligament around joint, wrenching or twisting (often ankle or wrist)
- Strain: muscle/tendon stretching or tearing
- Repetitive strain injuries common
- Pain, edema, bruising, function
- Complications: avulsion fracture, subluxation or dislocation
Carapal tunnel syndrome
- Compression neuropathy
- Median nerve in carpal tunnel in wrist
- Trauma/edema from inflammation of tendon
- Usually work related (wrist movement)
- Weakness, numbness, burning pain
- Stop aggravating movement, inflammation, surgery
Rotator cuff injury
- Tear/rupture of 4 rotator cuff muscles that surround the shoulder joint
- Caused by overhead movement (swimming, baseball, tennis) or fall (outstretched hand)
- Shoulder pain, weakness, ROM
- Rest, ice and heat, NSAIDs, corticosteroid injection, arthroscopic repair
Meniscus and ACl injury
Meniscus injury:
- fibrocartilage in knee and other joints is torn or sheared with injury (sports)
- diagnosed by MRI and arthroscopy; surgery for tears
Anterior cruciate ligament injury:
- common sports-related injury of the knee (skiing, hockey, football)
- can be repaired arthroscopically, recovery is faster, pain is less than for open repair
bursitis
- Inflamed bursa (sacs at friction joints lined with synovial membrane/fluid) due to trauma, friction, gout, rheumatoid arthritis, infection
- Warmth, pain, swelling, decreased range of motion (ROM)
- Often hand, knee, hip, shoulder, elbow
- Need to identify cause (repetitive, jogging, prolonged sitting with legs crossed) and avoid and rest
Fractures
- Disruption or break in continuity of the structure of bone
- Majority of fractures from traumatic injuries
- Some fractures secondary to disease process (cancer or osteoporosis)
- Fractures can be classified: open or closed, complete or incomplete, based on direction of fracture line, displaced or nondisplaced, according to location
fractures clinical manifestations
Immediate localized pain, decreased function
Inability to bear weight on or use affected part
* Patient guards and protects extremity
* Fracture may not be accompanied by obvious bone deformity
* Immobilize extremity if fracture is suspected
* (unnecessary movement increases soft tissue damage, may convert closed fracture to open)
fractures healing
- Called union (when healing doesn’t happen properly we refer to delayed union, malunion or non-union)
- Factors affecting healing: age, location, blood supply, infection, implants (for instance hip replacement prostheses), immobilization (need to keep bone pieces together and stable in order for the body to heal the fracture)
steps of a healing fracture
Fractures – Healing
A. Bleeding at broken ends of the bone with subsequent hematoma formation.
B. Organization of hematoma into fibrous network (osteoid).
C. Invasion of osteoblasts, lengthening of collagen strands, and deposition of calcium.
D. Callus formation: new bone is built up as osteoclasts destroy dead bone.
E. Remodeling is accomplished as excess callus is reabsorbed and trabecular bone is laid down
fracture a closed reduction intervention
- Nonsurgical, manual realignment of bone fragments to previous anatomical position
- Local or general anaesthesia
- Traction and counter-traction manually applied to bone fragments to restore position, length, and alignment
- Traction, casting, splints, or orthoses (braces) to immobilize to maintain alignment until healing occurs
fraction traction intervention
- Application of a pulling force to an injured or diseased part of body or extremity, while counter-traction pulls in opposite direction
- Prevent or ↓ muscle spasm
- Immobilize joint or part of body
- ↓ a fracture or dislocation
- Treat a pathological joint condition
- To expand a joint space - during arthroscopic procedures or before major joint reconstruction
fracture immobilization - casts
Temporary circumferential immobilization
Able to perform most activities of daily living
Cast materials are natural, synthetic acrylic, fibreglass-free, latex-free polymer, or hybrid
Application incorporates joints above and below fracture
Restricts tendinoligamentous movement - assists with joint stabilization while fracture heals
casts do
Do’s
- Once thoroughly dry, edges may need to be petalled to avoid skin irritation
- Dry cast after exposure to water
- Elevate extremity above level of heart for first 48 hours
- Move joints above and below cast regularly
casts donts
Don’ts
- Get plaster cast wet
- Fresh plaster should never be covered with a blanket, no direct pressure, no fingertips
- Remove any padding
- Insert any objects inside cast
- Bear weight on new cast for 48 hours (not all casts are weight bearing)
- Cover cast with plastic for prolonged periods
fracture immoblization - slings
Placement should not put undue pressure on posterior neck
Encourage patient to move fingers and non-immobilized joints of the upper extremity
Fracture Immobilization – Body Brace
Immobilization/support for stable spine injuries of thoracic or lumbar spine
Assess patient for cast syndrome (brace is applied too tightly) - abdominal pain, abdominal pressure, nausea, and vomiting
Observation of respiratory status
Bowel and bladder function
Areas of pressure over bony prominences
Fractures – Open Reduction intevention
Correction of bone alignment through surgical incision
Includes internal fixation (ORIF) with use of wires, screws, pins, plates, intramedullary rods, or nails
Facilitates early ambulation, promotes fracture healing with gradually increasing increments of stress
Possibility of infection, complications associated with anaesthesia, effects of pre-existing medical conditions
fracture external fixation intervention
- Pins into bone and then attached to rods and frame to reduce/stabilize fracture or to apply traction
- Used for simple fractures, fractures with ++ soft tissue damage, correction of congenital bony defects, nonunion or malunion issues, limb lengthening
- Can be used in severely complex fractures
- Used when closing the wound is not possible (or not prudent due to risk of infection)
amputation
- Causes – circulatory impairment, traumatic or thermal injuries, malignancies, infection, congenital disorders
- Try to preserve as much limb as possible
- Closed (to create weight bearing residual limb) or open stump (in cases of infection/drainage)
- Complications maybe due to comorbidities
- Phantom limb pain (90% will have)
- Prosthesis can be fitted right away or later
- Physio/OT for ambulation and ADLs
low back pain
- Common, has probably affected 70% to 85% of adults at least once during their lifetime
- Second only to headache as the most common pain complaint
- Low back pain common because lumbar region:
- bears most of the weight of body
- is the most flexible region of the spinal column
- contains nerve roots that are vulnerable to injury or disease
- has an inherently poor biomechanical structure
Low back pain – Risk Factors
- Lack of muscle tone, decreased activity/exercise
- Excess body weight
- Poor posture
- Prolonged sitting
- Jobs requiring repetitive heavy lifting, vibration (such as a jackhammer operator)
- Stress
- Smoking
- Most often due to musculoskeletal problems
Acute Back Pain
- Lasts 6 weeks or less
- Usually associated with some type of activity that causes undue stress (often hyperflexion) on the tissues of the lower back
- One diagnostic test is straight-leg raise, positive for disk herniation when radicular pain (pain that radiates into a lower extremity) occurs
- Symptoms often do not appear at time of injury but develop later – gradual increase in muscle spasm, increase in pressure on a nerve by an intervertebral disk
- Treated on an outpatient basis if not severe and debilitating – analgesics, muscle relaxants, massage, back manipulation, hot/cold compresses
Brief period of rest at home may be necessary
Most persons do better with continuation of their regular activities
Prolonged bed rest should be avoided
Should avoid activities that aggravate pain: bending, lifting, twisting, prolonged sitting
Most cases improve in 2 weeks
acute back pain nursing education dos
- Act as a role model, nurse should use proper body mechanics at all times
- Assess patient’s use of body mechanics, offer advice when activities could produce back strain
- Place a foot on a step or stool during prolonged standing
- Use a lumbar roll or pillow for sitting
- Maintain appropriate body weight, exercise regularly
- Avoid sleeping in a prone position
acute back pian nursing education donts
- Lean forward without bending knees
- Lift anything above level of elbows
- Stand in one position for prolonged time
- Sleep on abdomen or on back or side with legs out straight
- Exercise without consulting health care provider if having severe pain
Chronic Low Back Pain
Lasts longer than 3 months or is a repeated incapacitating episode
Same causes as for acute; osteoarthritis (OA) of lumbar spine can be cause > 50, OA of thoracic or lumbar spine < 50
Discomfort is ↑ following periods of inactivity, particularly on awakening or after long periods of sitting
Chronic Low Back Pain - Management
Formal back pain program
Rest and local heat application when cold, damp weather aggravates back pain
Mild analgesics to decrease pain and stiffness
Weight reduction
Sufficient rest periods
Exercise and activity throughout day
Antidepressants
Surgery if pain is severe, do not respond to conservative care, and/or have neurological deficits
Chronic Low Back Pain - Spinal Stenosis
- Common cause of chronic or recurrent low back pain
- May be congenital, more often acquired through degenerative or traumatic changes to spine
- Narrowing of vertebral canal or nerve root canals caused by encroachment of bone on space
- Compression of nerve roots can result with subsequent disk herniation
- Pain often starts in low back and radiates to buttock and leg, worsens with walking, particularly standing without walking
Intervertebral Disc Disease
- Natural disk degeneration or repeated stress
- Degenerative disc disease or herniated disc
- Nucleus pulposus rupture: L4-5, L5-S1,
- C5-6-7
- Compression of nerve roots and cord may occur
- Manifestations: low back pain radiating down buttock/below knee along sciatic nerve
Intervertebral Disc Disease - Diagnostics
- Straight leg raise test
- Decreased reflexes
- Parathesias (pins and needles sensation) or muscle weakness in legs/feet/toes
- Bowel or bladder incontinence from nerve compression
- X-ray, myelogram
- MRI, CT
Intervertebral Disc Disease - Management
- Limit mobility (brace), local heat/ice, ultrasound, massage, transcutaneous nerve stimulation, strengthening exercises
- NSAIDS, muscle relaxants, short-term narcotics
- Surgery if has radiculopathy and/or incontinence
- Laminectomy, discectomy, percutaneous laser discectomy, replacement, spinal fusion
