musculoskeletal Flashcards
normal synovial (diarthrodial) joints
a synovial or diarthrodial joint is any joint that allows movement.
name the 4 major parts that the joint is made out of?
think A&P.
subchondral bone plate.
articular cartilage.
synovium.
joint capsule.
subchondral bone plate.
sub = under
chondral = cartilage
bone just underneath cartilage
articular cartilage.
covers bone of the joint. it provides a smooth slippery surface that allows free movement of joint.
synovium.
the space (synovial cavity) between 2 articulating bones.
there is a synovial membrane that is the inner lining of this cavity.
the synovial membrane secretes synovial fluid that lubricates joint surface and removes debris.
joint (articular) capsule.
surrounds joint.
unites articulating bones
3 phases of bone healing
- inflammatory
- reparative
- remodeling
what happens during the inflammatory phase
(1) hematoma forms at the fracture site (provides stability & aseptic inflammation occurs).
Duration: 1-3 days for hematoma; 3 days- 2 weeks for early repair
what happens during the reparative phase
fibrous cartilage (2)- formation of granular tissue containing blood vessels, fibroblasts, osteoblasts.
callous (3)- formation of callous. when granular tissue has matured.
ossification (4)- space in bone is bridged & fracture ends unite. callus replaced by trabecular bone.
duration: 6 weeks
what happens during the remodeling phase
remodeling (5): bone consolidation with final remodeling. Healing is complete.
when do women experience greater bone loss and at what rate does it continue?
women experience greater bone loss in early menopausal years & it continues at a gradual rate.
who has lower peak density, men or women?
women
who reaches “fracture threshold” earlier, men or women?
women
at around age 30: bone reabsorbed by osteoclast (< or >) bone formed by osteoblasts.
pick > or <.
>
factors that affect bone mass
age
gender
race
genetics
reproductive status
calcium levels
exercise
osteopenia
thinning of the trabecular matrix of the bone before osteoporosis.
t-score of -1 to -2.5
osteoporosis
bone mineral density 2.5 standard deviations below peak bone mass.
“porous bone”, common serious disease.
used when ACTUAL BREAKS in the trabecular matrix have occurred.
how is osteoporosis measured and how are results reported?
measured with DEXA scan.
reported in T-Score
osteoporosis is characterized by….
low density & structural deterioration of the bone
what bones do osteoporosis usually occur in?
the hips, vertebrae, & wrist (trabecular bones)
osteoporosis characteristics
low bone mass.
micro-architectural deterioration.
increase in bone fragility.
susceptibility to fracture is high.
MAJOR risk factors for osteoporosis
aging
female
Caucasian
hx of fracture as an adult
family hx/genetics
body wgt <127 lbs.
smoking
alcohol use
corticosteroid therapy & immunosuppressive drugs.
MINOR risk factors for osteoporosis
thin, small frame.
lack of wgt bearing exercise.
lack of calcium &/or vitamin D.
eating disorders
gastric bypass surgery.
lack of estrogen/testosterone
excessive caffeine consumption.
osteoporosis pathogenesis
increased bone resorption: osteoclast activity increased.
decreased bone formation: osteoblast activity decreased.
problems for osteoporosis can be….
failure to make new bone (osteoblasts).
too much bone resorption (osteoclasts).
both.
early clinical manifestations for osteoporosis
NONE
late clinical manifestations for osteoporosis
fractures
pain
loss of height
stooped posture (kyphosis)
complication of osteoporosis
hip fracture
True or false: osteoporotic hip fractures are linked to increased risk of morality
TRUE. death does not happen because of the fracture, death happens d/t complications & r/t immobility.
complications of a hip fracture
pneumonia, blood clots, sepsis, skin breakdown, immobility.
what age are hip fractures more common?
> 65
are hip fractures more common in men or women?
women
most common location of a hip fracture?
proximal third of the femur
hip fracture: clinical presentation
sudden onset of hip pain before or after a fall.
inability to walk
severe groin pain
tenderness
affected leg is externally rotated and shortened
goal of osteoporosis pharm
reduce fractures
primary prevention of osteoporosis
calcium - diet+supplement (elemental calcium) = 1200 to 2000mg daily
vitamin D- diet+ supplement= 800 to 1,000 IU daily.
treatment of osteoporosis help ……. & ………..
promote bone formation (increase osteoblast) & decrease bone resorption (decrease osteoclasts)
aldendronate
class: biphosphates
MOA: binds permanently to surfaces of bones to INHIBIT OSTEOCLAST ACTIVITY
Indication: osteoporosis, reduces fractures by 50%
SE: GI (N/V/D), esophageal ulcerations
teaching: take with water, DO NOT lie down for 30 minutes after taking, DO NOT take with food, other drinks, calcium, or vitamins for 2hrs (very low bioavailability)
raloxifene
class: selective estrogen receptor modulators (SERMs)
MOA: mimics estrogen by increasing bone density; INHIBITS BONE RESORPTION
INDICATION: prevention & treatment of osteoporosis; reduces risk of spinal fractures by 50%
SE: hot flashes, leg cramping
Black box warning: stroke risk
NC: must take adequate calcium and vitamin D; DC @ least 72hrs before planned procedures (any prolonged immobilization period, high risk of blood clotting); DO NOT smoke, drink alcohol, or use if pregnant.
calcitonin- salmon
class: hormone therapy
MOA: inhibits bone removal by osteoclasts. slows down bone loss & increases spinal bone density.
INDICATION: treatment only
SE: nasal irritation d/t intranasal route.
NC: reduces spinal fractures by 30%, must take for @ least 5yrs to see long term benefits.
define fractures
any break in the continuity of bone that occurs when more stress is placed on the bone that it is able to absorb
causes of fractures
traumatic- fall
fatigue- repeated, prolonged stress
pathologic- weakened bone, possibly spontaneous (high risk in elderly)
open (compound) fracture
fractured bone penetrates skin
closed (simple) fracture
does not break through the skin
transverse fractures
straight line.
90 degree angle to the length of the bone.
most common in traumatic falls
spiral fracture
twisting fracture
comminuted fracture
more than one fracture line & more than 2 fragments
impacted fracture
bone moves into each other
(ex. people who fall and land on their feet)
greenstick fracture
common in children
incomplete break
(think of a bone getting sliced but piece does not detach)
