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Clin Med 4 > MSK 1 - General Principles > Flashcards

MSK 1 - General Principles Flashcards

1
Q

what are the 2 types of bone?

A

cortical and cancellous

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2
Q

what bone is the “hard” outer surface?

A

cortical bone

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3
Q

what does the cortical bone support? what is it the site of attachment for?

A

provides skeletal support and is site of attachment for tendons and ligaments

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4
Q

what is the “spongy”/trabecular bone?

A

cancellous bone

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5
Q

where is cancellous bone found?

A

at ends of long bones, pelvis, ribs, skull, and vertebrae

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6
Q

what does the cancellous bone contain?

A

red/yellow bone marrow

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7
Q

cortical bone is also known as what type of bone?

A

compact bone

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8
Q

what change does cortical bone and cancellous bone undergo?

A

both undergo continuous change d/t biochemical and mechanical forces

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9
Q

which type of bone contains bone marrow?

A

cancellous bone

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10
Q

what does red bone marrow produce? at 30 y/o, where is it mostly?

A

produces precursors of RBCs

at 30 y/o mostly in axial skeleton

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11
Q

what does yellow bone marrow contain? at 30 y/o, where is it mostly?

A

contains fat

at 30 y/o mostly in appendicular skeleton

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12
Q

what are the 3 parts of bone?

A

metaphysics, diaphysis, epiphysis

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13
Q

what is the shaft of the bone?

A

diaphysis

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14
Q

what part of bone contains the growth plate?

A

epiphysis

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15
Q

what part of the bone is the transition zone?

A

metaphysis

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16
Q

what are tendons and what do they attach?

A

fibrous cords of tissue that attach muscles to bone

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17
Q

what are ligaments and what do they attach?

A

fibrous cords of tissue that attach bone to another bone

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18
Q

what are the 3 most common MSK conditions reported each year?

A

trauma, back pain, arthritis

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19
Q

what is key to MSK clinical presentation?

A

history

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20
Q

acute MSK injury?

A

< 6 weeks

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21
Q

chronic MSK injury?

A

> 6 weeks

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22
Q

what is an example of atraumatic MSK injury?

A

degenerative (ex: arthritis)

overuse syndrome

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23
Q

examples of acute MSK injuries?

A

fractures, dislocations, ligament strains/sprains, septic joints

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24
Q

examples of chronic MSK injuries?

A

overuse syndromes, tendonitis, osteoarthritis, osteomyelitis

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25
Q

what is valgus?

A

get hit from side and knee goes medial -> knock-kneed

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26
Q

what is varus?

A

knee goes lateral -> bow legged

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27
Q

what is indirect force?

A

force impacts one end of a limb and damage transmitted to a distant point

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28
Q

physical exam for MSK injuries?

A

deformity, swelling, painful/decreased ROM (active vs passive), pain with palpation, neuromuscular status

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29
Q

what are the 3 special tests to assess joints?

A

Provocative tests, stress tests, functional testing

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30
Q

what is provocative testing for assessing joints?

A

recreate mechanism of injury to reproduce patient’s pain

ex: Lochman’s

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31
Q

what is stress testing for assessing joints?

A

apply load to test ligament stability

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32
Q

what is functional testing for assessing joints?

A

useful to assess injury severity and ADLs

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33
Q

what is the definition of a fracture?

A

loss of continuity of structure of bone

-cortical integrity is interrupted

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34
Q

what can happen to the vessels throughout the bone with a fracture?

A

they may get torn/ruptured and bleed

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35
Q

definition of a closed fracture

A

fracture not exposed to environment

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36
Q

all fracture have some degree of what type of injury?

A

soft tissue injury - don’t underestimate it as it affects tx and outcome

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37
Q

open fracture leads to?

A

communication of environment with fracture

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38
Q

degree of open fracture based on?

A

length/size of wound

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39
Q

when is surgical tx recommended for tx of open fractures?

A

within 6 hours

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40
Q

what is a comminuted fracture?

A

fracture has >2 pieces

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41
Q

injury variables with fractures?

A

Location, Severity, Energy of Injury, Morphology of the fracture, Bone loss, Blood Supply, Other injuries

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42
Q

what is the goal of fracture immobilization?

A

Maintain anatomic position

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43
Q

Principles of Fracture Immobilization

A

Maintain anatomic position

Prevent movement of fracture

Protect from further injury

Limit neuro injuries (bones have nerves)

Pain control

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44
Q

what is the first method of fracture immobilization?

A

Splinting

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45
Q

Methods of fracture immobilization

A

Splinting (first method)

Casting

Closed Reduction Percutaneous Pinning (CRPP)

Open Reducing Internal Fixation (ORIF)

External Fixator (“Ex-Fix”)

Intramedullary (IM) Rodding

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46
Q

what do you worry about with casting a fracture?

A

compartment syndrome d/t swelling - reason why you don’t put on cast right away

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47
Q

how many days in splinting used for? is it permanent or temporary?

A

used for 1-5 days

usually temporary until follow-up

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48
Q

Principles of splinting?

A

immobilize affected extremity/area

prevent further injury

pain control

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49
Q

2 types of splint types?

A

orthoglass, plaster

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50
Q

for splinting, what joint must you immobilize?

A

must immobilize joint above/below the injury

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51
Q

what does immobilizing joint above/below the injury, minimizes what?

A

movement which decreases pain

additional soft tissue injury

risk of closed fracture becoming open

blood loss

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52
Q

when applying splint that wraps an extremity, where do you wrap from? what does this technique do?

A

wrap from distal to proximal

-minimizes trapping of blood distal to the injury

53
Q

what do you evaluate before and after splinting?

A

evaluate distal circulation, motor function, and sensation

54
Q

when do you evaluate distal circulation, motor function, and sensation with splinting?

A

before and after splinting

55
Q

cast is for what type of fracture?

A

ONLY stable fractures!!!

56
Q

what does casting do?

A

maintains position to provide for bone healing

prevents displacement of fracture

protects from further injury

57
Q

how long is a cast usually on?

A

4-6 weeks

58
Q

when is a cast changed?

A

at 3 weeks if no movement of fracture

59
Q

for what fractures do you use a short arm cast (SAC)?

A

wrist fracture

60
Q

for what fractures do you use a long arm cast (LAC)?

A

forearm fracture, unstable wrist fracture

61
Q

what does a long arm cast prevent?

A

prevents supination/pronation

62
Q

for what fractures do you use a thumb spica cast?

A

scaphoid fracture, radial styloid fracture

don’t want thumb moving

63
Q

what is a better option for casting lower extremities than casting?

A

splints/walking boots

64
Q

casting lower extremities used more in who?

A

children to protect from themselves

65
Q

what is closed reduction of a fracture? what do you recreate in it?

A

reduces bone to near anatomic position

recreate the fracture to align

66
Q

what type of fracture must it be to do closed reduction?

A

must be a stable fracture for closed reduction

67
Q

what is very important to have when doing closed reduction of fracture?

A

sedation/pain control

68
Q

what does closed reduction percutaneous pinning do for fracture?

A

reduce/hold unstable closed fracture if casting not able

69
Q

benefits of closed reduction percutaneous pinning of fracture?

A

holds unstable fracture (don’t need a plate)

reduces need for ORIF

70
Q

risks of closed reduction percutaneous pinning of fracture?

A

skin infection around pins, nerve/vessel injury

71
Q

differences between CRPP and ORIF?

A

CRPP has no incisions with skin, skin is intact
-just put pins in

ORIF you make an incision thru skin

72
Q

what does open reduction internal fixation (ORIF) do?

A

reduces and holds unstable fractures - open or closed

73
Q

ORIF acts as?

A

internal splint

74
Q

what do ORIF plates/screws do?

A

allow for anatomic reduction of fracture

provide internal, non-moving repair of unstable fracture

75
Q

what is a definitive fracture fixation?

A

ORIF plates/screws

76
Q

need how many cortices above and below the fracture?

A

6

77
Q

what do intramedullary rods do?

A

prevents anterior/posterior movement of bone

78
Q

what do intramedullary locking screws do?

A

prevent bone from rotating around rod

79
Q

use iron rods for what fractures? why?

A

femurs and tibial fractures b/c they are LOAD SHARING DEVICES - can put weight on them

80
Q

when do you use an external fixator for a fracture?

A

when major non-lifesaving procedures must be avoided

81
Q

external fixator for a fracture is a bridge to what?

A

to definitive internal fixation

82
Q

how long does it take most patients to heal from a fracture?

A

6 weeks

83
Q

what are the 3 stages of fracture healing?

A
  1. Inflammatory phase (hematoma and granulation tissue)
  2. Reparative phase (fibrocartilaginous callus formation)
  3. Bone remodeling
84
Q

what forms in the inflammatory phase of fracture healing?

A

hematoma and granulation tissue

hematoma = bleeding as stopped

85
Q

when does blood clot form at fracture site?

A

within 8 hours

86
Q

what removes necrotic tissue at fracture site in inflammatory phase?

A

phagocytes (neutrophils and macrophages) and osteoclasts

87
Q

how long does inflammatory phase last?

A

2 weeks

88
Q

what forms in the reparative phase of fracture healing?

A

fibrocartilaginous callus

89
Q

how is fibrocartilaginous callous formed in reparative phase of fracture healing?

A

fibrovascular tissue invades hematoma

fibroblasts develop into chondroblasts and produce fibrocartilage -> results in fibrocartilaginous “callus”

90
Q

how long does callus in reparative phase of fracture healing last?

A

3-4 months

91
Q

what happens in the bone remodeling stage of fracture healing?

A

compact bone replaces spongy bone around fracture periphery

remaining dead fracture portions reabsorbed osteoclasts

92
Q

most important fracture healing-systemic factors?

A

Presence of underlying disease (DM and uncontrolled HTN)***

Smoking - don’t get blood flow b/c vasoconstrictor

93
Q

what is a sprain?

A

stretching/tearing of ligaments

94
Q

sprain mechanism of injury?

A

inversion or eversion

95
Q

what is the MOST COMMON site of a sprain? how?

A

ankle - inversion with plantar flexion (M/C)

96
Q

what is a strain?

A

injury to muscle or muscle and tendon

muscle fibers tear

97
Q

what is a strain caused by?

A

overextension or over stretching

98
Q

what’s the pain like in a strain?

A

pain typical to that experienced from muscle overuse

99
Q

strain sx’s?

A

pain - worse with use

muscle spasm/weakness

swelling, cramping

100
Q

sprain/strain tx?

A

RICE

splinting, NSAIDs, early ROM, physical therapy

101
Q

what does RICE stand for?

A

Rest, Ice, Compression, Elevation

102
Q

how long do you Ice for?

A

30 min at a time; not just for first 48 hours

103
Q

elevate above ___

A

heart level

104
Q

typical appearance of dislocation?

A

joint found in abnormal appearance with deformity and possible swelling

pain and tenderness present

can’t move extremity

loss of distal pulses increases the severity of the injury (need to reduce ASAP)

105
Q

evaluate ____ before AND after reduction of dislocation

A

neuromuscular status

106
Q

reason to reduce dislocation ASAP?

A

b/c can have loss of distal pulses

107
Q

tx for dislocation

A

evaluate NV status before and after reduction

antispamotics - Valium; analgesia

REDUCE

splint for pain relief

gentle ROM

follow-up

108
Q

where does tendinitis cause pain and tenderness?

A

at or just outside joint

109
Q

tendinitis is most common where?

A

shoulders, elbows (ex: tennis elbow), wrists, knees

110
Q

tennis elbow is tendinitis of what?

A

lateral epicondylitis - extensors

111
Q

medial epicondylitis is?

A

inflammation of the flexors

112
Q

tx tendinitis?

A

rest, ice cube massage, brace, NSAIDs, PT, Cortisone (can be done later)

113
Q

contributing conditions of tendon rupture?

A

injection of steroids into tendon

use of fluoroquinolone abx

114
Q

4 most common sites of tendon rupture?

A

achilles’, biceps (proximal > distal), rotator cuff, quad

115
Q

ligament rupture is a common injury with what?

A

sport injury

116
Q

ligament rupture results from?

A

valgus stress or direct fall onto joint

ex: valgus stress, stresses the MCL

117
Q

ACL rupture occurs more common in who?

A

young athletic women

118
Q

what is the first-line pharmacologic therapy for arthritis?

A

Acetaminophen (also preferred for older people b/c of renal fxn)

119
Q

how much of acetaminophen and how often is it given?

A

325-650 mg q 4-6hrs

120
Q

max dose of APAP? max dose if chronic alcoholic or underlying liver disease?

A

max dose = 4g/day

max dose if chronic alcoholic or underlying liver disease = 3g/day

121
Q

when do you use caution with APAP?

A

liver disease/ETOH

122
Q

what NSAID is preferred over Ibuprofen for arthritis?

A

Naproxen b/c only needs to be taken BID rather than QID

123
Q

always tell patient to take NSAIDs with?

A

food - will reduce dyspepsia

124
Q

when do analgesic effects of NSAIDs occur? when do anti-inflammatory benefits occur?

A

analgesic effects begin w/in 1-2 hours

anti-inflammatory benefits require 2-3 weeks of continuous therapy

125
Q

topical NSAID? how does it work? available only through?

A

topical diclofenac

acts primarily by local inhibition of COX-2 enzymes

Available only through PRESCRIPTION

126
Q

dose of corticosteroid injection for large joints?

A

1 ml of 80mg of Depo-Medrol

2 ml of Lidocaine w/out Epi and 2 ml of 0.25% Marcaine

127
Q

dose of corticosteroid injection for medium joints?

A

1 ml of 80mg of Depo-Medrol

1 ml of 1% Lidocaine without Epi and 1 ml of 0.25% Marcaine

128
Q

dose of corticosteroid injection for small joints?

A
  1. 5 ml of 80mg of Depo-Medrol

0. 5 ml of 1% Lidocaine without Epi

Clin Med 4 (11 decks)

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