MSK Flashcards
Risk factors of Rheumatoid Arthritis?
Environmental factors, diet, socioeconomic status, smoking
Causes of Rhabdomyolysis?
Trauma – crush injuries,
Medications and drugs
Excessive muscle contraction
Infectious agents
Toxins – carbon monoxide
Complications of Rhabdomyolysis? Why?
Hyperkalemia – contents of cell – potassium is released into circulation
Cardiac dysrhythmia
Kidney failure – myoglobin precipitates in tubules, obstructing flow – urine that looks like cocacola
What are shin splints/?
stress on the tibia by overworking your muscles – going too fast to start and not allowing your muscles time to grow
What does RA (rheumatoid arthritis) cause? (symptoms)
Inflammation spreads to joint capsule and surrounding ligaments and tendons causing pain, deformity, & loss of function.
Also causes fever, malaise, rash, lymph node or spleen enlargement
What is Juvenile Idiopathic Arthritis?
Childhood form of rheumatoid arthritis
What is fibromyalgia?
Syndrome of chronic pain and not a disease of inflammation
What is the most reliable indicator of Rhabdomyolysis?
Creatine kinase is also released in increased quantities – elevated CK is most reliable indicator
What is a flash freeze?
4th and final stage of a cold injury
– rapid formation of ice crystals
Common sites for Sprains?
Most common – wrist, ankle, elbow, and knee
Characteristics of a club foot?
Either one or both of the feet are twisted downward and inward with an increased arch and an inward facing heal
What is the flow phase of burns?
Enter a state of hypermetabolic response increase levels of catecholamines, cortisol, glucagon, and insulin correspond to an increase in their increased energy expenditure
What kind of potential injury can be caused with rewarming a cold injury?
Rewarming has potential for reperfusion injury – multiple factors occurring with inflammatory response - edema, redness, and burning pain
What is the rule of 9’s?
Rule of 9s – estimate percentage of body burned
Oblique Vs Spiral fracture?
Oblique breaks on an angle - Spiral – encircles the bone
4 stages of bone healing?
Bleeding at site of fracture and in surrounding tissue – inflammatory process occurring/going on
Hematoma at site forms into a fibrous network – soft callus forms along outer surface of bone and over fractured ends of bone
Osteoblasts within the soft callus synthesize collagen and matrix to form hard callus
Over time remodeling occurs – unnecessary callus is reabsorbed, repair tissues are realigned – bone is going to absorb what they need
What is Cellulitis? Where is it located?
Inflammation that is coming from an infection (bacterial infection)
More on superficial levels of the skin
What is secondary osteoporosis? (what dysfunction is it associated with?)
Secondary osteoporosis can be caused by dysfunction of endocrine system:
Parathyroid hormone, cortisol, thyroid hormone, and growth hormone – most commonly associated with osteoporosis
Other factors include medications, lack of physical activity, abnormal BMI
In JIA what kind of stage is the individual in? What plates can it affect?
In JA the individual is still in a growth stage, JA can affect the epiphyseal plate
Primary risk factors of causing a club foot?
Combination of genetic and environmental factors – can be from fetal positioning in womb
What is going to be obviously seen when there is a dislocation?
Going to see an obvious deformity when there is a dislocation
Disease and tissue risk factors for pressure ulcers?
Impaired perfusion – ischemia
Exposure to moisture – fecal or urinary incontinence
Malnutrition
Dehydration
History of pressure ulcers
Aging
Prolonged steroid use
Chronic diseases
What is a pathological fracture?
caused by weakness within the bone – osteoporosis, tumors, infection – disease process over time – pathological because its not trauma
What tissue is first affected in RA Vs OA? How is it different?
Different than OA, the synovial membrane is the first tissue affected
What is a stress fracture? What are some of its characteristics?
Stress from increase load to the point of breakage or fatigue fracture - repetitive stress or torque on the bone – joggers – muscle grows faster than bone so getting in shape needs to be tempered with time – not a complete fracture
S+S of Rhabdomyolysis?
Typical triad of symptoms - Muscle pain, weakness, and dark urine
Does not always present with muscle pain and weakness – dark urine from myoglobin in urine – not always indicative of rhabdomyolysis
Creatine kinase is also released in increased quantities – elevated CK is most reliable indicator
Structural scoliosis
-Congenital Vs Teratological?
Congenital – attributed to bony deformity
Teratological (study of curvature of the spine) – caused by another systemic syndrome – cerebral palsy – curvature in the spine
80% is idiopathic – unknown cause
S+S of scoliosis?
Shortness of breath – impeded gas exchange – can lead to deformed lungs
Reduced pulmonary function – if thoracic curve > 60 degrees
Fatigue, back pain – muscles pulling on spine
Curvature of the spine is going to cause the prominent curve of spine, one shoulder will be higher, and asymmetry of the thoracic cage
Kyphosis – rotation causes prominence along thoracic spine
Right sided heart failure – if curve > 80 degrees
GI disturbances- due to thoracic and lumbar deformity
What is rhabdomyolysis? What does it cause?
Rapid breakdown of muscle that causes the release of intracellular contents including myoglobin, enzymes, and potassium into extracellular space and blood stream – working out to fast
Damage to muscle causing a relase
What is hematogenous osteomyelitis? what population is it more commonly seen in?
caused by a pathogen carried in the blood stream – more common in children
What is Contiguous osteomyelitis?
– caused by infection spreads from adjacent bone
S+S of hematogenous osteomyelitis? what precedes the onset?
Vague – fever, malaise, anorexia, weight loss, and pain in or around infected area
Recent infection precedes onset
What is Necrotizing Fasciitis?
-Severe form of cellulitis
– rare but potentially fatal dependent on area infected – pain gets out of control (abnormal pain response to the infection)
What is Kyphosis? Where is it seen in?
Seen in patients with scoliosis
Kyphosis – rotation causes prominence along thoracic spine
S+S of osteoporosis?
Bone deformity and pain due to fractures – vertebral fractures can cause kyphosis – hump back
Fractured hip – fracture of neck of femur due to osteoporosis can caused the fall – did fall cause fracture or did the fracture cause the fall
Causes of dislocations and subluxations?
Developing joint – ligaments may have developed looser
Trauma
See it more under the age of 20
Muscular imbalance – unbalanced exercise program, bad posture, inactivity
Incongruities in surfaces – rheumatoid arthritis
Joint instability – repetitive dislocations – stretching of ligaments in previous injury
What is a greenstick fracture?
Stress from increase load to the point of breakage or fatigue fracture - repetitive stress or torque on the bone – joggers – muscle grows faster than bone so getting in shape needs to be tempered with time – not a complete fracture
What is Osteoarthritis? What is it caused by?
Loss of protective cartilage
Osteoarthritisis caused by physical use – wearandtear of ajointover time (or, occasionally, over a short time as a result of an injury).Wear and tear of joint over time
What kind of different signs and symptoms can pathological and stress fractures have?
Pathological – can potentially have asymptomatic deformity and swelling, or have more of a generalized bone pain
Stress – pain can occur during repetitive injury resolved with rest
Open Vs closed fracture? What are we particularly worried about with each fracture?
skin is open or if there has not been an interruption in the skin worried about compartment syndrome if close infection if open
what are the 4 stages of a cold injury?
1.) Frostnip
2.) Chilblains
3.) Full thickness frost bite
4.) Flash Freeze
What areas of the body are most susceptible for cold injuries?
Toes, ears, nose and cheeks most susceptible
What is fibromyalgia linked to? Why?
No clear explanation for what causes Fibromyalgia
Abnormally low levels of serotonin – typically reduces pain signals – sleep pattern is affected due to low serotonin as well
Linked to serotonin levels
Firing pian without known cause
Not treated traditionally
Stage 1 -4 of pressure ulcers
Stage 1 – non-blanchable erythema – red in colour – still can prevent ulceration with skin care and repositioning
Stage 2 – partial thickness skin loss – skins breaks open or wears away – site is tender and painful – epidermis or dermis involved
Stage 3 – extends to tissues below skin – may see fat tissue, but not muscle, tendon, or bone
Stage 4 – full thickness – muscle, bone, ligaments, or tendons visible
Unstageable – full thickness tissue loss but the base of the ulcer is covered with slough (thick yellow/white coating within the wound bed) and/or eschar (dead tissue in the wound bed)
what is a subluxation?
Contact between opposing joint surfaces is only partially lost
subluxation(a partialdislocationfollowed by relocation) partial contact between opposing joint surface can damage the ligaments, nerves, joint surfaces (cartilage), as well as the bones that make up the joint.
What are the characteristics of an effected club foot?
Less flexible
Shorter leg length
Smaller shoe and calf size
Risk factors for club foot?
Abnormal intrauterine positioning
Neuromuscular or vascular problems
Maternal smoking
Genetics
Who is at greatest risk for developing osteomyelitis?
Chronically ill, diabetics, alcoholics, individuals on high doses of steroids or immunosuppressive medications
Direct Vs Indirect bone healing?
Direct healing – bone cortices are in contact with each other
Indirect healing – development of callus and eventual remodeling of solid bone