MS: Acute Disorders Flashcards
concepts related to musculoskeletal
comfort/pain infection inflammation/oxidative stress cellular regulation mobility
fractures
break in a bone
result of increase in energy beyond what a bone can tolerate
direct vs indirect
fracture risk factors
age (younger = sports; older = falls/disease)
bone disease
poor nutritions (vitamin D, calcium, phosphorus)
lifestyle habits
fracture classifications
direct vs indirect
simple/closed
compound/open (broken skin/infection–reduced blood supply/poor healing)
degree (incomplete or complete)
fracture s/s
pain deformity edema numbness muscle spasms skin bruising hypovolemia crepitus
fracture types
incomplete/greenstick (fragments partially joined, common in children due to more collagen/less mineralized)
complete (fragments separate completely)
complete fracture types [transverse oblique spiral comminuted impacted compression]
transverse- right angle to cone’s long axis
oblique - runs at oblique angle to bone (diagonal)
spiral - stripe on candy cane (twisting motion)
comminuted –many fragments (over 2)
impacted – bone fragments driven into each other
compression – crushed bones (often spinal column)
indirect healing fractures
[inflammatory > reparative > remodeling]
inflammatory stage (bleeding causes hematoma, inflammatory cells degrade debris/bacteria) reparative stage (fibrocartilage formed > soft callus joins fractured bone > hard callus develops > blood vessels form) Remodeling stage (lamellar bone replaces woven bone)
Direct healing fractures
surgery to realign bone
best for severely comminuted/threatened vascularity (less long-term complications)
external fixation/internal fixation (/closed reduction)
hematoma forms/fibrin fills > soft tissue > calcium salts in new tissue > tissue remodeled to new shape
Union vs nonunion vs delayed union vs malunion
normal healing
no clinically significant progress for at least 3 months according to X-rays
significantly longer than expected healing time
bone fragments joined in incorrect position
fracture complications: infection
common agents (pseudomonas/staphylococcus/clostridium)
greater soft tissue damage/compromised immune system
TX: ABX/proper hygiene
Fracture blisteres
tense vesicles or bullae arising swollen skin directly overlying fracture
contain sterile fluid that can contribute to infection
fracture complications
compartment syndrome
fat embolism syndrome
compartment syndrome
edema & swelling > increased pressure in muscle compartment
causes:
decreased blood flow
continual increasing pressure in limb
ischemia (muscle/nerve damage) > amputation
compartment syndrome common sites/prevention/complications/tx
LE & forearm
ice/elevation
paralysis/volkmann contracture
remove cast/bandage/fascia
volkmann’s contracture
cause
mild/moderate/severe
cause: compartment syndrome (lack of blood flow to forearm)
forearm muscles severely injured (deformities in fingers/hand/wrist)
mild: 2-3 fingers/no or limited loss of feeling
moderate: all fingers bent & thumb stuck to palm, wrist may be stuck/some loss of feeling
severe: all muscles involved, severely disabling
fat embolism syndrome
closed long bone/pelvic fractures
early complication of ^
large amount of fat released from bone marrow into venous sytem
respiratory distress 24-72 hrs after event
no symptoms in most patients
fat embolism syndrome s/s and tx
chest pain dyspnea tachycardia pallor disorientation cyanosis lo-grade fever petechiae rash (axilla/conjunctiva/palate) early assessment: blood gases tx: O2, mechanical ventilation prophylactic tx: corticosteroids & early immobilization of injury
dislocation
ends of bones moved out of normal position
attachment to join lost
cause; trauma
subluxation
bones of joint remain in partial contact
cause: trauma
dislocation/subluxation s/s
pain
limb/joint deformity
altered mobility of affected joint
dislocation/subluxation tx [general/shoulder/hip]
manual traction (closed reduction) or open reduction closed reduction and short-term immobilization immediate reduction to prevent necrosis of femoral head then bedrest after closed reduction
carpal tunnel syndrome
neuropathy causing nerve damage & muscle weakness or atrophy
caused by repetitive use injury
median nerve compressed by inflammation & swelling of synovial lining of tendon sheaths
most prone where nerves pass over rigid areas/through narrow canals
carpal tunnel syndrome s/s
numbness & tingling of thumb/index finger/lateral ventral surface of middle finger
hand weakness
carpal tunnel dx
tinel’s test
phalen maneuver
nerve conduction studies w/ ultrasound
carpal tunnel tx
splinting & application of ice/heat
surgery to enlarge tunnel
tingel’s test
light percussion over irritated median nerve to elicit a tingling sensation (bone on open palm bottom by wrist)
phalen’s test
maintained flexion of wrist @ 90 degreees for 30-60 sec elicits tingling/pain
bursitis
inflammation of bursa (small fluid sac of synovial joint)
results from overuse of joint/trauma to joint
bursitis s/s
tenderness of surrounding area
pain with extension/flexion of joint
warm/red/swollen skin over bursa
bursitis tx
rest compression elevation NSAIDs ice (acute inflammation) gentle stretching/strengthening exercises corticosteroid injection arthroscopic surgery ABX (if infection is cause)
strain
overstretching injury to muscle or muscle-tendon unit
forces muscle to extend beyond capacity = microscopic tears
usually lower back or neck
sprain
ligaments around joint stretched/torn
oppositional forces cause ligaments to overstretch & tear
most common site: ankle
sprain/strain tx
RICE NSAIDs casts splints immobilizers/slings surgery if severe PT
strain s/s
immediate pain reduced ROM muscle spasms edema muscle weakness bleeding swelling bruising
sprain s/s
severely hindered ROM pop/rip when injury occurs brusing pain immediate swelling
ACL tears
one of 4 major ligaments connecting femur to tibia
occurs when stressed/strained/torn
decelerating while running/twisting or jumping
tear down middle of ligament
ligament torn completely from femur
ACL tears s/s
intense pain
feeling that knee popped or gave out
swelling
ACL dx and tx
x-ray/mri
ice elevation NSAIDs, non-weight bearing until swelling subsides, PT, surgery
Meniscus injury
injury to cartilage between femure & tibia
results from forced twist/rotation
meniscus injury s/s
popping wound at knee pain when knee touched edema restricted joint mobility knee locks up/doesn't move smoothly knee feels weak/buckling
meniscus dx
ROM assessment
testing (x-ray MRI ultrasound)
meniscus tx
ice elevation NSAIDs no weight bearing (crutches) elastic bandage PT arthroscopic surgery
achilles tendon rupture
achilles = largest tendon connecting to heel
sudden pivoting/rapid acceleration
common in tennis, BBall, softball
occurs with recurrent microtrauma (degeneration) > damaged tendon becomes calcified/thickened/inelastic/fibrotic > shear stress > tear/rupture
can be caused by fluroquinolones
achilles tendon rupture s/s
pop
pain
feel struck violently in back of ankle
achilles tendone rupture dx/tx
clinical exam, U/S, MRI (U/S = best)
ice, NSAIDS, APAP, rest (non-weightbearing w/ crutches), immobilization, surgical repair
osteochondral lesions
occur at end of bone
lack of blood supply/direct trauma to joint/repetitive use
osteochondral lesions s/s
pain w/ weight bearing
swelling
tenderness
limited mobility (occasional locking of knee)
osteochondral lesions tx
NSAIDS use of growth hormone weight loss rest ice use of assistive devices to walk PT nutritional supplements arthroscopic surgery
Rotator cuff tears
tendon supporting muscle rips/tears from bone
causes:
fall on shoulder, attempt to break fall with outstretched hand, repeated overhead motions
rotator cuff tears s/s
dull ache in joint from microsopic tears
weakness when raising arm
inability to reach behind back
rotator cuff tears dx/tx
shoulder ROM assessment, X-ray, CT scan, MRI, ultrasound/arthrogram
rest, heat/cold, NSAIDS, electrical stimulation of muscle, cortisone injections, surgery
adhesive capsultitis
frozen shoulder
acute inflammation of ligaments in shoulder joint capsule
shoulder bones unable to freely move in joint
not completely understood (inflammation of capsule)
adhesive capsulitis causes
primary (idiopathic)
thyroid disease, dyslipidemia, prolonged immobilization, stroke, autoimmune disease
rare: parkinsons, HIV tx (protease inhibitors)
adhesive capsulitis s/s
self-imposed immobility of shoulder due to pain
stiffness
continued loss of motion
unable to move arm above head or behind back
adhesive capsulitis dx and tx
shoulder ROM assessment, x-ray to rule out other things, MRI
NSAIDS, steroid injections, PT, arthroscopic surgery
can resolve w/in 2 years with minimal lasting damage w/out tx
impingement syndrome
swimmer’s shoulder
acute shoulder injury
due to repeated movement
rotator cuff tendon trapped under acromion
compression between humeral head & undersurface of acromion joint or arch
impingement s/s
pain when raising arm above head or behind back
impingement dx/tx
pain relief w/ anesthetic, x-ray to rule out others
ice, NSAIDS, PT, steroid injections, arthroscopic surgery
osteomyelitis
penetrating wound from blood infection/skin breakdown/joint replacement/internal fixation surgeries
infection carried to bone from bacteria/fungi/parasites/viruses
osteomyelitis s/s
local: bone pain, drainage, ulceration, swelling, redness, warmth, tenderness
systemic: lymph node swelling, fever w/ chills, general malaise, tachycardia, nausea, vomiting, anorexia
osteomyelitis dx
abscess/bone changes/bone destruction (X-ray/bone scan/MRI)
WBC count
blood cultures
bone biopsy/tissue samples
osteomyelitis tx
ABX
surgery
drainage tubes inserted into bone
procedure to fill dead tissue space w/ muscle
osteonecrosis
avascular necrosis, aseptic necrosis, ischemic necrosis
reduced blood flow to joint
bone breakdown outpaces replacement
cause: fracture, thrombosis/embolism, vessel injury, compartment syndrome, steroid therapy
osteonecrosis risk factors
long-term use of steroids heavy alcohol intake direct injury to bone/joint chemo organ transplantation disease
osteonecrosis s/s
insidious
no symptoms
pain when pressure/weight applied to joint
inability to use limb
osteonecrosis dx
x-rays mri ct scan bone scan bone biopsy measurement of bone pressure
osteonecrosis tx
NSAIDS nonweight bearing ROM electrical stimulation surgery
bone tumors benign
abnormal growth of normal tissue
doesn’t metastasize w/ body organ fx
affected by growth hormones
lump associated w/ ache or pain
benign bone tumor tx
tumor heals when fracture heals
stops growing when growth hormones slows
surgery
malignant bone tumors
come from cartilage/cone cells/collagen/bone marrow
exact cause unknown
r/t high bone growth/bone overstimulation by disease, radiation, bone marrow transplant, osteolysis
most common in adolescents under 20
malignant bone tumors s/s
deep bone pain
skin over mass warm
erythematous
malignant bone tumors dx/tx
x-rays, CT scans, MRI, bone biopsy, alk phos & calcium levels
surgery, chemo, radiation
metastatic bone disease
cancer from another part of the body that migrates to bone
most common in spine/pelvis/thigh
metastatic bone disease s/s
sometimes asymptomatic bone pain fractures changes in urinary/bowel continence limb weakness
metastatic bone disease dx
x-rays ct scans MRI blood tests bone/positron emission tomography scan
metastatic bone disease tx
radiation
chemotherapy
