Musculoskeletal Flashcards
4 Basic Skeletal Muscle Functions
- Facilitate body movement
- Maintain body position by muscle tone
- Stabilize joints to prevent excessive movement
- Maintain body temp
Synarthroses
Immovable joints
Amphiarthroses
Slightly movable joints
Diarthroses or synovial
Freely movable joints
Diagnostic tests for musculoskeletal disorders (8)
X-rays
Bone scans
Electromyograms
Biopsy
Arthroscopy
MRI
Synovial fluid aspiration
Test blood for creatine kinase (CK)
Electromyograms
Used to test electrical charge of muscle contraction to differentiate between nervous or muscular system or damage
Arthroscopy
Insertion of lens into joint to visualize it
Classification of fractures
Complete-Incomplete
Open -Closed
Number of fracture lines (simple, comminuted, compression)
Impacted
Pathologic
Stress
Depressed
Direction of fracture (transverse, linear, oblique, spiral)
Comminuted fracture
Multiple fracture lines and bone fragments
Compression fracture
Crushed bone, collapses into small pieces (e.g. Vertebrae)
Impacted fracture
One end of bone forced into adjacent bone
Pathologic fracture
Fracture due to weakness of bone due to pathology
Stress fracture
Fracture resulting from excessive stress on the bone
Colles’ fracture
Break at the distal radius at the wrist
Usually occurs from trying to stop oneself when falling.
Pott’s fracture
Fracture in lower fibula due to excessive stress on ankles.
Greenstick fracture
Common in softer bones of children, shaft of bone is bent (a type of incomplete fracture)
Segmented
A piece in middle of the bone breaks
Where does necrosis occur after break?
At the end of broken bones, because blood vessels cannot continue to delivery of nutrients
What immediately forms after a break?
A hematoma in the medullary canal
5 steps of bone repairment
- Hematoma forms with fibrin network around it
- Granulation tissue grows in fibrin network. Capillaries extend into new tissue and fibroblasts migrate into it
- Chondroblasts begin to form cartilage, connecting the 2 parts of the bone
(Weak attachment)
Attachment known as a procallus or fibrocartilaginous callus - Osteoblasts generate new bone, replacing the procallus with bony callus
- Bone is remodeled by osteoclasts and osteoblasts. Excessive bone removed, compact bone laid down again, and appearance returns to normal
4 factors affecting the bone healing
- The extent of local damage done to bone and nearby tissues. Prolonged inflammation or extensive damage to periosteum or blood vessels impairs healing.
- The more closely the broken ends of the bone are, the faster healing
- Any secondary problem, such as infection, delays healing
- Numerous systemic factors affect healing as well, such as anemia, circulatory issues, nutritional deficits etc..
8 complications of fractures
- Muscle spasms that occur as pain and irritation. (This spasm pulls bone fragments, causing deformity, tissue damage, inflammation, and bleeding.)
- Infections such as tetanus or osteomyelitis.
- Ischemia due to a cast being too tight.
- Compartment syndrome
- Fat emboli- fatty marrow from bone marrow escapes into a vein (more common in its w/ pelvic/long bone fractures)
- Nerve Damage
- Failure to heal or healing with deformity
- Fractures near joints can cause damage such as stunted growth (children) or osteoarthritis.
Signs and symptoms of fracture
(DOTS)
Deformity
Open wound
Tenderness
Swelling
Pain due to nerve compression
Crepitus-sound of two bones rubbing against each other
Sometimes, shock may occur with extreme pain, along with pallor, diaphoresis (sweating), hypotension and tachycardia.
Nausea and vomiting sometimes occur.
Diagnostic tests for fracture
X-ray confirms diagnosis
Treatment of Fractures
-Immediate splinting and immobilization of fracture
-If necessary, reduction (putting bones back in correct position) occurs
-Open reduction-surgery
-Closed reduction-through force or pressure
Reduction
Putting bones back in position, either through surgery of pressure
Crepitus
Sound of two bones rubbing together
Dislocation
When a bone is detached from its articulating bone
Subluxation
Partial dislocation
Cause of dislocation (predisposing factors)
Trauma.
Sometimes, fracture causes dislocation
Predisposing factors: muscular disease, rheumatoid arthritis, torn ligaments…
Effects of dislocation
Dislocation causes soft tissue damage (to ligaments, nerves, blood vessels)
Bleeding and inflammation
Severe pain, swelling, and tenderness
Deformity
Diagnosis of dislocation
X-ray confirms diagnosis
Treatment of dislocation
Reduction, immobilization during healing, and therapy to maintain joint mobility. Healing could be slow if the ligaments are extensively damaged.
Sprain
Tear in a ligament
Strain
Tear in a tendon
Avulsion
Ligament or tendon is completely separated from bone
Signs and symptoms of sprain/strain
Inflammation, redness, tenderness, limited mobility, and often bruising due to hematoma
Diagnosis of sprain/strain
X-ray and other tests done to rule out fracture
Treatment of sprain/strain
Rest, limited mobility of joint.
Heals like a fracture-hematoma collagen fibers
Extensive damage requires surgery
Complication of sprain/strain
if stress is put on the sprain/strain in first few weeks of healing, it could reopen tear, causing excess scar tissue, joint issues, less strength…
Muscle tears- 3 types
First Degree: Involves small amount of muscle. Pain is minimal and no major loss in strength or mobility occurs.
Second Degree: A large tear involving most of the muscle. Pain is severe and substantial loss of strength and mobility is present.
Third Degree: Complete tear across the width of the muscle. Unable to contract, internal bleeding. Surgery may be required.
Treatment for muscle tears
Immediately stop activity related to muscle.
Cold should be applied to stop internal bleeding.
Compression bandage applied to affected area.
Complications of muscle tears
Repeated tears can cause early development of osteoarthritis or tendinitis
Repetitive strain injury
Repeated injury due to stress or overuse of muscle/ligament/tendon.
Affects 30-50 year olds.
Signs and symptoms of RSI
Disability
numbness
pain
weakness
Diagnosis of RSI
X-ray, history, and at times, arthroscopy
Treatment of RSI
Rest, application of cold/heat, anti-inflammatory drugs (non-steroidal), and physiotherapy.
Osteoporosis (2 types)
Metabolic disorder characterized as decrease in bone mass and density. Affects older individuals.
Primary: postmenopausal, idiopathic, or senile
Secondary: Due to an infection or primary disorder (e.g. Cushing’s syndrome)
Diagnosis of osteoporosis
X-rays and bone density scans which demonstrate the decrease in bone mass
Predisposing factors for osteoporosis (7)
- Aging (postmenopausal-less estrogen & osteoblastic activity less effective with age)
- Sedentary lifestyle (either due to illness, or lifestyle choices)
- Hormonal factors (hyperparathyroidism, Cushing’s syndrome…)
- Nutritional issues- deficit in vitamin D or protein due to diet, or malabsorption
- Cigarette smoking
- Small light bone structure
- Excessive caffeine intake.
Signs and symptoms of osteoporosis
Back pain
Kyphosis or Scoliosis
Loss of height
Frequent fractures in femur or pelvic area-slow healing
Kyphosis
outward curve of spine- rounded upper back
Causes: Poor posture, spina bifida, congenital defects, spinal tumors or infections, scheuermann’s disease.
Lordosis
inward curve of spine at lower back
causes: Achondroplasia, obesity, discitis, slipping forward of vertebrae
Scoliosis
Irregular twisty curve of spine
Treatment of Osteoporosis
- Therapy to limit bone loss
- Dietary supplements of Ca, Vit D, and protein
- Fluoride supplements (promotes bone deposition)
- Med to inhibit osteoclastic activity and bone resorption
- Calcitonin
- Injected parathyroid hormones
- Weight bearing exercise
- Estrogen replacement therapy
- Surgery to reduce kyphosis and realign vertebral column
Rickets and Osteomalacia
Rickets-children
Osteomalacia-post-puberty
disease due to the deficit of phosphate and Vitamin D due to diet or malabsorption, lack of sun..
Children-height below normal. Bowed legs.
Paget’s Disease
progressive bone disease in adults over 40
may be related to childhood infection
Excessive bone destruction with abnormal replacement. Leads to deformed bones, pathological fractures, kyphosis, or increased intracranial pressure.
Osteomyelitis
Bone infection due to bacteria or fungus.
Blood born or due to surgery
Signs and symptoms of osteomyelitis
Local swelling and bone pain
Fever and excessive sweating
Chills
General malaise
Treatment of osteomyelitis
Antibiotics
If prolonged infection, surgery may be required to remove damaged tissue
Osteosarcoma
Primary malignant tumor at metaphysis of the femur, tibia, or fibula in children or young adults
Ewing’s sarcoma
Malignant tumor in diaphysis of long bones
Common in adolescents
Osteosarcoma and Ewing’s sarcoma
Often metastasize to the lungs
Often revealed through pathological fracture.
Bone pain at rest that gradually increases is a common symptom.
Treatment: Surgical amputation or excision of tumor. Chemotherapy.
Chondrosarcoma
Tumor in the cartilage. More common in adults over 30.
Metastasize to lungs, usually develops in shoulder girdle or pelvic areas. Pain not present until late
Muscular Dystrophy
Group of inherited disorders causing degeneration of skeletal muscles.
Caused by lack of dystrophin (a muscle cell membrane protein), causing necrosis of tissue, which is replaced by fat and fibrous connective tissue.
Causes hypertrophy appearance of muscle. Function gradually lost.
Cardiomyopathy is common.
Duchenne’s Dystrophy
Most common type of muscular dystrophy. Common in young boys. (X-linked disease). CK levels are elevated,
Signs and symptoms of Duchenne’s Dystrophy and other muscle dystrophy
motor regression and weakness apparent at around 3 years old.
Initial weakness in pelvic girdle.
Gower’s movement- way child gets into upright position.
Tendon reflexes reduced
Vertebral deformities
Respiratory insufficiencies and infections are common.
Cardiac abnormalities and mental retardation develop
Diagnostic tests of muscular dystrophy
Test for genetic factors
Elevated CK levels
Electromyography
muscle biopsy
Treatment of muscular dystrophy
No treatment available.
Try to maintain motor function with moderate exercise and supportive appliances.
Occupational therapy
Primary Fibromyalgia Syndrome
Group of disorders regarding pain and stiffness affecting muscles, tendons, and surrounding soft tissues (not joints).
More common in women, age 20-50
Signs and symptoms of Primary Fibromyalgia Syndrome
Fatigue, sleep disturbances, depression
generalized aching pain
Sometimes, IBS or urinary symptoms are present
Treatment of Primary Fibromyalgia Syndrome
Stress reduction
Regular early morning exercise
Rest
local application of heat or massage
antidepressants (low dosage)
Anti-inflammatories
occupational therapy
Osteoarthritis
- articular cartilage is damaged and lost
- Surface of cartilage becomes rough and worn, interfering with easy joint movements
- Tissue damage causes the release of enzymes with accelerates disintegration of cartilage
- Bone may be exposed and damaged-cysts and osteophytes (bone fragments) can develop around bone
- Pieces of osteophytes break away into cavity-causing further irritation
- Joint space becomes more narrow
- At times, secondary inflammation occurs in surrounding tissues due to altered movement.
No systemic effects
Causes of osteoarthritis
Obesity, aging
injury or abuse
congenital musculoskeletal disorders
Signs and symptoms of osteoarthritis
Mild pain with weight bearing and movement (pain becomes more severe and disease advances)
limited joint movement- such as walking
sometimes-bony enlargement of fingers
crepitus may be present
Treatment of osteoarthritis
Minimize stress on joints
use aids-canes, walkers
Physiotherapy and massage therapy
surgery to replace joints
pain relievers…
Rheumatoid Arthritis
Autoimmune disease-causing chronic systemic inflammatory disease.
Process of disease:
1. Synovitis (recurring)
2. Pannus formation. Pannus=granulation tissue from synovium spreads over articular cartilage. Pannus releases enzymes and causes inflammation, destroying the cartilage
3. Cartilage erosion. Pannus causes nutrient cutoff to cartilage. This causes unstable joint
4. Fibrosis
5. Ankylosis- joint fixation and deformity
Changes in joint due to Rheumatoid Arthritis
- Atrophy of muscle due to disuse
- Alignment of bones in joints shift
- Inflammation and pain may cause muscle spasms (further misaligning bones)
- Deformity and contractors with subluxation develops
Cause of Rheumatoid Arthritis
Some genetic factors
May be linked to some viral infections
Signs and symptoms of rheumatoid arthritis
general discomfort
inflammation (in fingers and wrists)
redness, pain, swelling, sensitive to touch…
Joint pain gets better with activity (more painful in morn..)
daily activities are hard
with progression of disease, joint isn’t inflamed but deformed and fixed.
Systemic signs: fatigue, anorexia, mild fever, lymphadenopathy, and generalized aching
Rheumatoid nodules may develop
Diagnostic test for rheumatoid arthritis
Synovial Fluid analysis (demonstrating inflammatory process)
Rheumatoid factor may be present in serum
Treatment for Rheumatoid Arthritis
- Balance between rest and activity. P.T. and O.T.
- Analgesics anti-inflammatories for pain
- Heat or cold modalities
- Splinting of joint during acute episodes
- Assistive devices
- Surgical intervention to remove pannus, replace damaged tendons, reduce contractures or replace joints.
Juvenile Rheumatoid Arthritis
Similar to the adult version. Some differences:
- No rheumatoid nodules
- More acute version
- Rheumatoid factor usually not present
- larger joints usually affected
Still’s Disease
most common form of Juvenile rheumatoid arthritis
It develops with a fever, rash, and some organ diseases.
Child usually ends up handicapped
Infectious (septic) arthritis
Only affects one joint
Joint is red, painful swollen. Limited movement.
Synovium is swollen
Purulent exudate forms.
Diagnostic tests for septic arthritis
Aspiration of synovial fluid
culture and sensitivity tests
Causes for septic arthritis
bacteria
spread of a previous disease
Treatment for septic arthritis
immediate aggressive antimicrobial treatment
Gout
common in men over 40
from uric acid and urate crystal deposits in the joints which causes acute inflammation
The inflammation damages the articular cartilage.
Cause of gout
Hyperuricemia due to renal abnormality or metabolic abnormality (e.g. lacking enzyme uricase)
Signs and symptoms of gout
Redness, swelling, pain in a single joint
Diagnostic tests for gout
Examination of synovial fluid and blood tests
Treatment for gout
Reduce serum uric acid levels with drugs
increase fluid intake to increase uric acid secretion
drugs to relief inflammation and pain
preventative drugs
Ankylosis Spondylitis
6 step process of development
Most common at 20-30 years
Fusing of vertebral bones
1. Vertebral joints become inflamed
2. Fibrosis, calcification, and fusion of joints follow, losing mobility
3. Inflammation of lower back begins and progresses up the spine
4. Kyphosis develops
5. Osteoporosis is common
6. Lung expansion is limited, and respiratory issues develop
Signs and symptoms of Ankylosis Spondylitis
- Low back pain and morning stiffness
- Pain while lying down, which may travel to leg. Relieved by mild exercise
- Spine rigidity
- Systemic signs common- fatigue, fever, weight loss
Treatment of Ankylosis Spondylitis
Drugs to relieve pain and limit inflammation
Appropriate daily exercise
Bursitis
Inflammation of the bursa-fluid filled sac in synovial membrane
Synovitis
Inflammation of synovial membrane lining a joint
Tendinitis
Inflammation of the tendon
