MSK disorders Flashcards
What is a sprain?
When a ligament gets traumatized.
Attach bone to bone.
Ligament
Ligament pulls loose a fragment of bone.
Avulsion fracture
A partial dislocation of bone.
subluxation
Hemarthrosis
Bleeding into a joint space or cavity
What is the difference between a first, second and third degree sprain?
First - over-stretching of ligament
Second - Partial tear of the ligament
Third - Complete ligament tear
What is some health teaching that we can provide to prevent strains from occuring?
What teaching can we do for an unstable/weak joint?
Stretching and warm up exercises to prevent
Use elastic support or adhesive wrapping to support the joint if weak
What is the acronym for treatment of a sprain? What does each letter stand for?
RICE
R - rest and limit movement of the limb
I - ice (first 24-48 hours); heat after 48 hours (20 mins on, 20 mins off)
C - Compression to control swelling and pain
E - elevation of extremity above heart level to control swelling and improve circulation
The R part of RICE indicates to rest and limit the movement of the _____, not of the ______.
limb, joint
What is the proper ankle wrap technique?
Twice around the foot, low around the ankle, back around the heel, spiral up the leg at 50% stretch, and 50% overlap.
What is a strain?
Stretching or tearing of a muscle or tendon
What does a tendon connect?
Muscle to bone
An RSI would be what kind of injury?
A rotator cuff injury?
Meniscus injury?
Strain (x3)
Carpal tunnel is a large issue in our parents generation, what may plague the younger generation?
Texting thumb - tendonitis (tendosynoviolitis) of the thumb
What nerve is impinged in carpal tunnel syndrome?
Median nurve that runs along the palmar suface
What is the treatment for carpal tunnel?
Rest, analgesics, splint, steroid injections
Surgery is curative
Describe Tinel’s sign for testing for the presence of carpal tunnel syndrome.
Tap over the location of the median nerve - if tingling/burning sensations (parasthesia) occurs, positive for test
Describe Phalen’s test for carpal tunnel syndrome.
Place back of both hands together and hold the wrists in forced flexion for a full minute (stop if sharp pain occurs)
If numbness or pins and needles along the thumb side of half of the hand, client has median nerve entrapment = carpal tunnel
Synovial fluid sacs between tendons and bones near joints
Bursa(s)
Inflamation of the bursa; often precipitated by arthritis, infection, injury, or excessive or traumatic exercise or effort
Bursitis
What is the treatment for bursitis?
rest, analgesics, anti-inflammatories, cold/heat, steroid injections, surgery
What fractures are the most common in pediatrics?
Torus - no dislocation of bone; and Greenstick are the most common
the fracture extends through a portion of the bone, causing it to bend on the other side
Greenstick fracture
The topmost layer of bone on one side of the bone is compressed, causing the other side the bend away from the growth place. There is no separation.
Torus facture
Fracture of the distal radius; one of the most common in adults (put hand out to break fall)
Colles fracture (also common in elderly)
What are the most common sites of fractures in children?
forearm and wrist
When a person puts their hand out to break their fall, if the extension is outward, the resulting fracture is a ______; if inward, it is a ______ fracture.
Colle’s
Smith
Healing of a fracture without complication is difficult - may develop _______, reduced _____, etc.
arthritis
ROM
Only __% of pediatric fractures require reduction.
20
Describe a nurse’s role in pin care.
Clean around pin site with sterile saline and Q tips once a day; may apply antibiotic ointment if ordered
When a bone communicates with the outside world
open or compound fracture
What are the two types of traction?
Skin traction
Skeletal traction
Manipulation of the bone fragments without surgical exposure of the fragments - i..e pulling on bone and snapping it back into place.
Closed reduction
Once we manipulate the bone, we want it stabilized so that it may become a ______ fracture and heal.
What are our options?
Cast
traction (skin or skeletal)
External fixation (pins) or internal fixation
For skin traction, this is used for the ____-term. Here the weight cannot exceed __-__ lbs.
The apparatus is stuck to the skin or ______ to the limb.
short-term
7-10 lbs
velcroed
Describe skeletal traction.
Requires a pin - holed burred into skin and hardware attached to the pins
can put anywhere from 5-45lbs of weight
Manipulation of the fracture that creates a surgical wound and uses sutures to close the area.
Open reduction
What will be important for external fixation in terms of the nursing role?
keeping the pins clean - use sterile water or saline - check a couple times a day - may have blood but should not be purulent
Open fractures require _______ debridement.
surgical
What will we ask a patient if they have an open fracture?
If they have received their tetanus booster
What is another word for skin traction?
Buck’s traction.
Post-operative knee immobilizer. A canvas knee support with velcro closures.
Zimmer splint
A zimmer splint locks the knee in ______ and prevents motion of the joint
extension
Tape that is placed around the edges of the cast to create a smooth edge that is less likely to injure skin.
Moleskin tape
Cast care:
- Takes ___-____ to dry
- Handle with ____ of hands, rest on _____
- Do not cover with blanket, or plastic, do not get _____
24-72 hours (3 days)
palms, pillows
wet (while drying)
Nurses perform QA on casts, what do they look for?
Check to make sure cast is even and pedaled (moleskin tape)
Should be able to put two fingers in easily - good fit (else risk compartment syndrome)
Ensure that padding (e.g. orthopedic wool) extends beyond the cast and is wrapped over it
What are some client teaching that we do related to casts?
Do not insert objects inside cast (e.g. for itching)
Do not put weight on it for 48 hours
Use gravity to minimize swelling (i.e. above heart level)
Move the joints above and below the injury to improve circulation
Have patient report increased pain, swelling, discoulouration, tingling, sores or foul odours
Most common complication of a cast. Often due to poor QA from the nurse and the resident putting the cast on too tight.
Compartment syndrome
Progressive development of ARTERIAL compression and reduced blood supply within the myofascial compartment.
Compartment syndrome
Compartment syndrome:
- ______creates sufficient pressure to obstruct circulation
- Pressure increased in compartment (__-__ torr)
- Normal intra-compartmental pressure is (_-__ torr)
There are ____ compartments in the upper and lower extremities.
edema
30-40 torr
0-8 torr
38
Who measures the pressure in the compartments?
If someone develops compartment syndrome, what happens?
PT
Fasciotomy is completed
What are the six P’s if impending Compartment syndrome?
Pain Pallor Poikilothermia Paralysis Parasthesia Pulselessness
Describe the six P’s of impending compartment syndrome.
Pain - distal to injury - unrelieved by narcotics and pain on passive muscle stretch (+Homan’s sign)
Pallor - pale extremity distal to injury
Poikilothermia - cool limb
Paralysis - numbness
Paresthesia - numbness and tingling
Pulselessness - decreased/absent peripheral pulses
Which of the six Ps are early signs?
Which are late?
early = pain that is unrelieved by narcotics
Late:
Poikilothermia
Pulselessness
paralysis+parasthesia
What is Homan’s sign?
Positive result when deep calf pain results from abrupt dorsiflexion of the ankle (i.e. foot to nose).
What is a positive Homan’s sign usually a result of?
Pain results from venous thromobosis or inflammation of the calf muscles
(usually indicative of DVT)
