Musculoskeletal Flashcards
how many bones are there in the human body
206
what are the functions of bones
- structural support
- storage of minerals
- production of blood cells
- protection of body organs
- provision of leverage and movement
what are the types of bone cells
- osteoblast
- osteoclast
- osteoprogenitor cells
- osteocyte
what is the job of modeling within the bones?
osteoblast cells build/grow the skeleton through osteoblastic activity
= modeling
what is the job of remodeling within the bones?
once the bone reaches maturity, osteoclasts breakdown and renew it
osteoblast and osteoclast activity functioning together is known as what?
basic multicellular unit (BMU)
how many BMU are active at one time in adults?
about 1 million BMU
when is peak bone mass achieved?
early adulthood (30-35)
around age 30, what happens to the bone activity?
the amount of bone resorbed by osteoclasts exceeds the bone formed by osteoblasts
= there will be a steady decrease in bone mass as we age
what influences bone mass?
- nutrition
- physical activity age
- age
- hormonal status
- vitamin D
what does locomotion require of our skeleton?
locomotion requires our skeleton to have moveable joints and muscles acting on the bones
what are the 3 types of muscles
- skeletal muscles
- smooth muscles
- cardiac muscles
describe skeletal muscles
muscles that connect to the bone
describe smooth muscles
lines the walls of hallow organs and tubes
- involuntary
describe cardiac muscles
make up the heart
- involuntary
what attaches muscle to bone?
tendons
- tough cords or bands of dense connective tissue
what is the function of tendons
attaches muscles to bones and transmit load from muscles to bones = joint motion
what is the function of ligaments
attach bone to bone, helps in the mechanical stability of the joint
describe how tendon injuries occur
tendons can be subjected to injuries particularly overuse
= tendinopathy, a result of inflammation, degeneration and weakening of the tendons
= TENDON RUPTURE
describe how ligament injuries occur
ligaments can rupture too, most common is the knee
what is the healing process like for a ligament
similar to scar formation, the healed ligament is weaker in providing joint stability and prone to re-injury
what is a traumatic musculoskeletal injury
fracture - a break in the continuity of the bone
what are the most common causes to a fracture
- primary:
- falls
- MVA
- sports-related injury - secondary from conditions that weaken the bone
- osteoporosis
- Paget’s disease
- bone cancer
what are the different categories used to classify fractures
- complete vs incomplete
- open vs closed
- impacted
- pathologic
- stress
- depressed
describe a complete vs incomplete fracture
- complete: bone is broken into 2 or more separate pieces
- incomplete: bone is partially broken
describe an open vs closed fracture
- open or compound fracture = the skin is broken
- closed fracture = the skin is intact
describe an impacted fracture
one end of the bone is forced into the adjacent bone
describe a pathologic fracture
this is the result from weakness in bone structure secondary to bone tumors or osteoporosis
describe a stress fracrture
occurs from repeated excessive stress
- common in tibia, femur, and metatarsals
describe a depressed fracture
occurs in the skull when a broken piece is forced inward to the brain
describe the pathway of the body fixing a fracture
- break in the bone
- blood from damaged vessels pour into the fracture and produce a hematoma and blood clot
- within a few days, fibroblasts invade the clot
- fibroblasts secrete collagen fibers and form mass of cells and fibers called callus
- callus bridges the broken bone ends together (takes 2-6wks)
- osteoblasts from the periosteum invade the callus and slowly convert the callus to bones (4-6wks)
- callus begins as a large mass
- osteoclasts gradually remodel the bone by removing the excess bone until it leaves little to no evidence that a fracture occurred (can take up to a year)
describe fibroblasts
connective tissue from periosteum
clinical manifestations while the body is fixing a fracture
- deformity (shortening appearance/rotation)
- swelling at the site
- inability to move the affected limb
- crepitus (grating sound or sensation during movement)
- pain
- paresthesia
factors that affect bone healing
- age
- nutritional status
- blood supply
- fracture type
complications of bone healing
- compartment syndrome
- fat embolism
- osteomyelitis
- osteonecrosis
describe compartment syndrome
- this is a serious condition due to increased pressure within a “compartment” usually the muscle fascia as a result of fracture
- the pressure impinges the nerves and blood vessels within that part of the body compromising distal part of the affected area
clinical manifestations of compartment syndrome
- extreme pain beyond what is expected!!!
- 5 P’s
1. pain
2. paresthesia
3. paralysis
4. pulselessness
5. pallor
treatment of compartment syndrome
- remove the cast
- perform a fasciotomy to release the pressure
describe a fat embolism
- happens when fat has an opportunity to enter the bloodstream.
- in long bones, fatty marrow can the the culprit
- the fat emboli can travel to vital organs like lungs, brain, heart
= can be fatal!!
prevention of a fat embolism
early immobilization of the fracture
describe osteomyelitis
infection of the bone tissue
- can take months to cure
treatment:
- antibiotics
describe osteonecrosis (aka avascular necrosis)
death of bone tissue due to loss of blood supply
treatment:
- surgical removal and replacement of the necrotic bone or joint
general treatment of traumatic musculoskeletal injury
- realignment (reduction) should be done ASAP b/c tissue swelling tends to increase 6-12hrs after injury
- can be done with open or close reduction or with traction - pain management
describe close realignment/reduction
done through manual manipulation which allows realignment of the broken bone without visualization
describe open realignment/reduction
involves surgery within 24-48 hrs in medically-stable patient
describe traction
used to realign broken bone
- after fracture is in its normal anatomical position, alignment is maintained by immobilizing the extremity with a cast or splint
what pain management is used for treating traumatic musculoskeletal injuries
- narcotics
- NSAIDS
what is a musculoskeletal disorder
fibromyalgia
describe fibromyalgia
syndrome characterized by a widespread muscular pain and fatigue
- affects the joints, muscles, tendons, and surrounding tissues
- linked to sleeping problems, fatigue, headaches, depression, and anxiety
what are the 18-fibromyalgia pressure point
pressure points where pain or tenderness can be stimulated in the
- neck
- shoulder
- trunk
- limbs
what is the cause of fibromyalgia
the exact cause is unknown, can be related to altered central neurotranmission that results in a sensitivity to substance P
- it is postulated that the brains pain receptors develop pain memory and become very sensitive to pain signals
how do we diagnose fibromyalgia
based on the presence of widespread pain at least 3 months duration and tenderness on at least 11/18 pressure points
treatment of fibromyalgia
- focus on minimizing s/s and improving health overall
1. stress reduction
2. adequate rest
3. proper nutrition
4. heat application
5. massage therapy; acupuncture
6. physical therapy
7. analgesics - NSAIDs (non- steroidal anti-inflammatory drugs) like Ibuprofen, naproxen
8. antidepressants
9. muscle relaxants
10. antiseizure (specifically pregabalin)
what are 2 common myths about fibromyalgia
- fibromyalgia is an autoimmune disease
- There is no evidence that it follows the pattern of autoimmunity - fibromyalgia is a psychological problem
- it is physical disorder with real, measurable biological abnormality
- While depression can cause physical pain and fatigue, NOT all pain and fatigue are caused by depression
- but if fibromyalgia is not addressed early, it can cause depression!
