Musculoskeletal Flashcards
A congenital disorder that causes bones to be extremely fragile resulting in multiple easily fractured bones
Osteogenesis imperfecta - Brittle bone disease
Cause of OI?
*Genetic defect in gene that affects production and formation of collagen type 1
What type of genetic disease is OI? What does it mean?
- Autosomal dominant
* If you have one copy of gene you will have disease
Classic Signs and syptoms of OI
- Blue sclera
- Multiple Bone fx and deformities
- Early hearing loss seen in 50% (r/t formation of ossicles and inner ear)
- Poor dentition r/t collagen
Diagosing OI?
Xrays
Full physical assessment
Skin biopsy
Dna testing
Pharmacologic treatment for OI? What does it do?
Biophosphonates - Increases bone mass, vitamin D, calcium
Nonpharmacologic treatment for OI?
- PT/OT
- Splits/casts
- Surgical treatment
When are sofield Rods indicated for OI patients?
*Repetitive fractures or progressive angular deformities in weightbearing bones
Involves multiple realignment osteotomies and internal fixation
sofield rods
Interventions for OI?
- Safety checks -goal is to prevent fractures
- Skin care
- Assess and note deformities, areas of high stress, Nutrition (weight gain can cause more pressure on bones.)
- Psychosocial
What do you want to avoid when assessing a client with OI and why?
Use of automatic BP cuff, can cause iatrogenic fracture.
Which drug reduces the incidence of fracture and increases bone mineral density, while reducing pain levels and increasing energy levels?
Pamidronate
DDH or _____ is when the _____does not fit into the ____ and it can easily move in and out of socket.
- Developmental (it can happen after birth) dysplasia of the hip
- Head of femur (ball)
- acetabulum (socket)
DDH is most common in?
- Females
- Eastern Europeans
- Native Americans
Causes of DDH?
- Breech deliveries
- Oligohydramnios (lack of amniotic fluid around baby)
- positive family history
- Weak ligaments holding ball within socket
Complications of DDH?
- avascular necrosis of FH
- Loss of ROM/Unstable hip
- Leg-length discrepancy
- Early osteoarthritis
In newborns one sign in diagnosing DDH is _____ when infant is lying _____ with ______ extended.
- Asymmetry of gluteal skin folds
- Supine
- Legs (can also happen when legs are dangling)
How does DDH present in older children?
Trendelenburg gait
performed by flexing an infant’s knees when they are lying down so that the feet touch the surface, and the ankles touch the buttocks. What is this called? What is this assessing? How will a positive present?
- Galeazzi Test
- Assessing hip dislocation r/t DDH
- Affected femur appears shorter where knee is lower
Name the steps in Barlow’s maneuver. What makes it positive?
- Abduct both hips (should be equal but affected one may be more difficult)
- Adduct hips and gently push down and back with thumbs
- if POSITIVE, a clunk will be felt/heard as femoral head moves out of socket (dislocates)
Name the steps in Ortolani’s maneuver. When is this done? What makes it positive
- Done AFTER Barlow
- Abduct thighs and apply gentle pressure forward on greater trochanter to move hip into place. This is positive sign.
- The clunking sensation indicates hip moving in and out of acetebelum. (a click is normal)
drugs used to block bone resorption and lower serum calcium levels in several conditions
Biphosphonates
When do you want to give biphosphonates and with what? Why?
In the morning, half an hour before meals, with a glass of water. This helps avoid esophageal erosion.
Nursing considerations for Biphosphonates?
- Interactions with aspirin and Nsaidds
* Can cause hypocalcemia, monitor serum calcium and ensure adequate Calcium and Vitamin D intake.
Treatement for DDH? Why? How long?
- Pavlik Harness
- promotes development of a functional hip socket and well-formed femoral head through immobilization.
- Worn continuously for 24 hours a day for 6 to 12 weeks (for hip dysplasia) (Can take off for one hour for bath time)
When should client call HCP in regards to Pavlik harness?
- Feet are swollen/blue
- Skin is raw w/rash
- Adjusting of straps
What should you teach caregivers in regards to pavlik harness?
- Harness should be snug (not tight)
- Change diaper w/ baby in harness
- Baby should sleep on back
- Check skin folds for areas of breakdown
- Wash w/ mild detergent and air dry
_____ is lateral curvature of the spine that exceeds __ degrees. ___ becomes misshapen.
- Scoliosis
- 10 Degrees
- Rib cage
For scoliosis early detection with early screening starting at ___ to ___years of age. Children who are diagnosed prepuberty are at greater risk for _____. Most common in _____
- 10 to 16 years
- progressively worsening curvature
- Adolescent girls
3 types of casues of scoliosis
- Idiopathic- (unknown)/ may be genetic
- congenital- deformity presents at birth
- Neuromuscular- secondary to nm condition (e.g. cerebral palsy)
Diagnosis for scoliosis?
- Early screening - EARLY DETECTION IS KEY
- Xray of thorax
- Cobbs angle (Degree of side to side spinal curve)
- Adams forward bend test
Range of degrees considered to be slight/mild?
10-15 degrees
Range of degrees considered to be mild? Intervention?
15-40 degrees- bracing to decrease progression
Range of degrees considered to be severe? Intervention?
> 40 - surgical correction with rod placement
in Adams forward bend test, how does the child need to stand?
bends forward with the feet together and knees straight while dangling the arms.
Treatment for scoliosis is aimed at what?
- Preventing progression of curve
* Decreasing impact on pulmonary/cardiac function
A scoliosis brace that is usually worn under clothing and is one method used to try to improve the exaggerated curvature of the spine as seen in scoliosis
Boston Brace - Thoracolumbosacral Orthosis (TLSO)
A traditional or standard scoliosis brace that is most often used in the treatment of thoracic or major double curves
that has a visible neck piece
Milwaukee brace - Cervicothoracolumbosacral Orthosis (CTLSO)
Teaching for scoliosis braces?
- Worn for 23 hours a day
* SKIN CARE - wear cotton shirt underneath brace
Used to stabilize and reduce the size of the curve and stop the curve from getting worse by permanently joining the vertebrae into a solid mass of bone
Spinal fusion
When is spinal fusion recommended? When is not recommended?
- When pulmonary function is compromised
* Not recommended until child is older (Can stop spinal growth)
____ are anchored in spine to help correct and maintain spinal curvature. Children have to have another surgery every ___To____ to lengthen rods to keep up with ____,
- Growing rods
- 6 to 12 months
- Growth
________is pressure on the median nerve.
The pressure occurs in the ____ and can be either the ____ directly or the ______.
- Carpal Tunnel Syndrome (CTS)*
- Tunnel
- Nerve
- Tendons
Where does the pressure in CTS stem from?
Inflammation and edema
CTS is most common in who? At what age?
Women over the age of 50
the most common type of CTS is?
repetitive stress injury (RSI)
Is CTS considered chronic or acute? Is it curable?
- Mostly chronic, acute cases do exist
* May or may not be cured
Risk factors for CTS?
- Female
- Increasing age
- wrist trauma/injury/repetitive motion
- Exposure to vibrations/cold
- conditions - overactive pituitary gland, hypothyroidism, rheumatoid arthritis, diabetes
During an examination, the HCP might find numbness and tingling where?
palm, thumb, index finger, third finger
and thumb side of the fourth (ring) finger
Why are wrist x-rays conducted when diagnosing CTS?
rule out other problems such as arthritis
When conducting an US to diagnose CTS, what is the most common finding?
enlarged median nerve within the carpal tunnel
What is Tinnels sign test and what makes it positive?
- Direct percussion over median nerve at wrist
* Positive if pain, burning, tingling occurs along nerve
What is Phalens test and what makes it positive?
- Hold both hands back to back while flexing the wrist in 90 degrees, hold for 60 seconds
- If numbness/pain are produced, test is positive
Nonsurgical treatment for CTS?
- Drug therapy - Coritcosteroids, NSAIDS
* Immobilization - wrist splinting
a. More common, less invasive, and more expensive
b. Small incision and an endoscope is inserted
c. The surgeon uses a laser (or other instrument) to free the trapped median nerve
What surgery is this?
Endoscopic Carpal Tunnel Release (ECTR)
Synovectomy is done to?
remove excess synovium when CTS is exacerbated from RA
After CTS surgery you want to Use an ______ to reduce swelling for the first _____. Leave the ice pack on for_____ and off for ______.
- Ice pack
- 48 hours
- 20 min on, 20 min off
