Musculoskeletal Flashcards
hormonal disturbances that alter bone function: calcitonin, estrogen, parathyroid, vitamin D
calcitonin- inhib osteoclasts (bone-crushing) (prevent bone breakdown) (inc calcitonin= stronger bones)
estrogen- stim osteoblast (bone building0
parathy- cause bones release Ca (can be weakened if overactive)
vitamin D- enhance Ca absorb
weight-bearing exercises
promote bone density (not incl swimming)
adl v iadl
adl- grooming, toileting, bathing, dressing and eating
iadl- instumental (phone, meds, shopping, transpor, meal prep and housework)
physical assessment
CMS posture, gait, joint mobility/abnormal pulse assessment sensation muscle tone/ strength curvature of spine
cms assessment
circulation- pulses, cap refil, temp and color
movement- paralysis?
sensation- inc pain, assess for paresthesia
lab- Ca
8.5-10.5 mg/dl
source- bones
indicates bone integrity or density
lab- phosphorus and vitamin d
2.5-5 mg/dl
d- 35-40 ng/ml
assess bone health, rely on renal system
kidney failure- dec Ca absorb (kidneys activate vitam D)
sources phos- nuts and meat (anything high in protein)
diary/ leafy greens
lab- estrogen
dec estrogen after menop inc risk fx
assessed through urine
xray
bone density, degen dis, joint irreg, spurs
CT
muscle and bone disorders (tumors and fx)
MRI
disk dis
osteomyelitis and ligamentous tears
soft tissue dis (musc, tendon, nerves, fat)
use of contrast dye
see vascularity of areas (ex tumor)
DEXA
bone mineral density study for id of osteopenia/ osteoporosis monitors trtmnt T score > -1 = normal < -2.5=OA
bone scan
find bone damage, dis or infection
radioactive IV
cold spots- cancer
hot- infection
role of aging on bones
dec bone mass and mineralization around age 30
dec ca avaliable
joint cartil dec (inc fx)
CT ligaments/tendons lose water content become more rigid
sarcopenia
dec muscle mass and strength
factors for fall risk
eyesight, dec coord, balance, polypharm, mentation, sensation, home environment
Osteoporosis- def
deterioration of bone tissue and density
Osteoporosis- risk factors
genetics- female, sm frame, white, asian
age- post meno females, low testosterone
low Ca, vitam D and phosp
low physical, non-weight bearing exercise
caffine, alcoh, smoking (nicotine impairs absorb zca, dec osteob fun and dec blood supply bones)
meds- corticosteroids, anti-seizure, heparin and thyroid
malabsorption (bariatric surgery), renal failure and hyperthyroidism
recommended Ca and vitamin D
Ca 1200mg
D- 800-1,000 (sunlight, supplements)
osteopor- patho
osteoclastic act> osteoblastic act
calcitonin (protective)dec
estrogen lvls dec (dec bone formation)
inc parathyroid (inc osteoclastic activity)
osteop- clincial manif
silent dis fx occur in spine (compression)= change height, posture progressive curvature of spine kyphosis- rounding in cervial lordosis- inward curving of lumbar spine
osteopor- prevention
prevention
FRAX- fracture risk assessment
labs- serum ca, phos, vit D, tesosterone (men)
if Ca abn then PTH
osteop- management
weight b exercise
vit d and ca supplements (post meno higher dose than pre)
meds slow bone absorption (bisphosphonates)
estrogen replacement
serms (selective estrogen receptor modulators)
calcitonin (dec bone resorption, not taken chronically)
bisphosphonates
inhib bone breakdown (stop osteoc)
serms
mimic estrogen effects
*better than direct estrogen (risk MI, stroke, breast ca, dvt)
selective estrogen recep modulators
low back pain- patho
lumbar region inc P from poor body mechanics most flexible portion of spine l4-5 and l5-s-1 common w/ age as discs degen
LBP- risk
occupations, obesity, age
radiculopathy
pain radiating down extremities form area of back affected
disc abnormal
degen- genetic, metab change assoc w/ aging, repeated stress or trauma (shrinks in size)
bulge- swelling
herniated- tears or cracks of disc (inc P on nerve root)
thinning- dec h2o and protein w/ aging
disc abnorm- s/s
radiculopathy, paresthesias (numbness and tingling)
LBP- management
35+ age= inc change of spine seen on MRI
(typically try o/ trtmnts before this)
lasts longer 6-12 wks use diagnostic imaging
analgesics and inflamm reduction (nsaids, ice, transcutaneous electrical nerve stim (TENS))
encourage mvmnt- sitting makes worse
LBP- prevention
good body mech, proper shoes, good diet
LBP- manif
dull pain lower back area
muscl spasms, paid radiating down leg or into butt
LBP- immediate care
sudden loss function bowel/bladder
loss of feeling saddle area (inner thighs)= spinal infection or cancer
traumatic injury
OA- patho
*most common degen joint dis
loss of cartilage (collage), causes surface ulcerations and deep fissures in joint
OA- management
analgesics- acetamin, cox-2 inhib, topical nsaids, corticosteroid injections
exercise
surgery (last resort)
NSAIDS- contraindicated for active peptic ulcer dis, gi bleed, impaired renal func, or hx hypersen rxn
RA- def/
autoimmune, inflamm dis (systemic)
affects CT
genetic componenet
wmn>men
RA-patho
wbc release toxins
synovitis of joints (inflamm)
RA- s/s
aching, edema, tenderness, bilat joint inflamm (swam neck/nodules), limited ROM
fatigue, weight loss, skeletal muscl atrophy, cardiac inflamm, spenomegaly
can progress from bones to muscl (vasc system lungs)
RA v OA
RA- systemic, autoimm
periods remission and exacerb
swan neck defom (hyperextension of joints)
bilat joints
RA management
balance btw exercise and rest
encourage indep adls
suppression inflamm process
nsaids, mild analgesics, corticosteroids, dmards (dis. modifying anti-rheumatic drugs)
surgery- replace joints but moves to diff parts of body
fx- s/s
localized edema, shortening
fx- patho/ epidem
young and eldelry
patho- excess force applied on bones
fx- types
avulsion- from overstretching
compression- bone collapses on itself
obliquie- 45 degree angle
fx pattern importance
need make sure pattern matches injury
fx-management
immob/splint distal and proximal joints physical assessment confirmation by imaging narcotics, anti-inflamm meds neurovasc assessment b4 and after immobilization (CMS) tetanus (if open fx)
open v closed fx
open- can incl plates, screws
closed- realign w/o surgery
fx- post-op care
assess surgical site for s acute bleeding (daily) and infection
infection happens 5-7 days later
bleeding -1-3 days
amnt, color drainage every shift pain severity, and if expected neurovasc assessment (CMS) analgesia (transition to po asap), acetomin, muscle relaxants early ambulation IS
factors that inhibit healing
bone loss, smoking, fm, RA/OA (d/t immunosupp meds), malalignment fx, inaccurate immob
cast considerations
monitor for compartment syndrome keep limb elevated apply ice check pulses, sensation keep clean and dry isometric exercises (circulation (improve skin integ) and musc strength)
stages of healing-1
hematoma formation 1-2 days
inflamm, vasodil, hemorrhaging
localized necorisi, inc inflamm
fibroblasts, lymphocytes, macrophages migrate to site
stages of healing-2
fibrocartil callus formation 48h
base for bone growth
tissue granulation replaces hematoma
stages of healing-3
bony callus
3-4wks
gradual mineralization of matrix
stages of healing- 4
remodeling
removal excess callus (replaced by mature bone cells)
compact bone replaces spongy
can take cast off at beginning of this stage*
fx- complications
compartment synd neurovasc compromise dvt fat emboli hemorrage avascular necrosis infection
compartment syndrome def
dec blood flow
edema and hemorrh occur
fascia envelopes muscle- nerves and blood compressed
compartm syndrome- s/s
inc pain and p
dec pulses, pallor
paresthesia, paralysis (dev later on, can incl permanent damage)
cyanotic nails beds, cool skin, rhabdomyolysis (proteinuria)
compart synd- trtmnt
fasciotomy, alleviate p, emergent cast removal
fat embolism syndrome- def
fatty acids released from fx bone (pelvis and femur)
clog vessels and attract platelets
fat embol- greatest risk (time)
from long bone/ multi-trauma
24/72 h after is peak
fat embo- s/s
respir distress, irreg pulse fever, thrombocytopenia fatty globules in urine petechiae arms/chest (dysfunction of microcirc) fever, change in cns (drowsy)
fat embol- trtmnt
supportive only
oxygen, hydration (dec platelet aggreg), dvt prophylaxis, gi prophyla, cortiosteroids (dec inflamm),
high fowlers position
reasons for joint replacement
joint destruction, dysfun and deformity
immobility, pain, inflamm RA/OA
care for pt w/ joint replacement
prophylactic antib 30 prior to surgery analgesics blood transfusion neurovasc checks (CMS) compression stockings is early ambulation aseptic dressing chnge
need for blood transfusion
s/s- dec bp, inc hr
h/h hemoglobin <7
lethargic, dizzy, syncope, SOB
total hip precautions
risk for dislocation
watch for popping, groin pain and shortening of leg
no flexion past 90 degrees
no crossing legs, avoid abduction and adduction
osteomyelitis- patho
bone inflamm from infection
*complication of joint replacement
inc vasculrity it affected area= edema
thrombus of vessels -ischemia, and necrosis of bone and tissue
osteomy- time frame
dev w/in 3 mon of surgery
ostemyeli- s/s
edema, inc wbc, fever, abnormal inc pain
highest risk pt w/ dm
fever, nausea, chills, sepsis
osteomy- diagnosis
hard bc labs are nonspecific
wbc
crp (c reactive protein, general inflamm)
esr (erthrthrocyte segmentation rate) elevated if infected
blood culture
xray- bone deformities after 14 days
bone biopsy, ct/mri
osteomyl- management
infection meds - iv antib 4-6 wks surgical debridement pain control nutrition (vit a,c, zinc and protein) if trtment fails can result in sepsis and amputation
amputation- need for (elective)
periph vasc dis (assoc w/ dm and atherosclerosis)
malignant neoplasm
infections
amputation- complications
hemorrh/bleeding
infection (inc risk w. dm and vasc dis (dec blood supply)
contracture- dont put pillow under leg, stretch regularly, change positions
phantom limb pain- sharp, burning (severed nerves), trt/ w/ lyrica/gabapentin
prosthetic considerations
training- inc compression gradually
caution w/ elevation (inc risk contracture)
work distal to proximal
ROM