Musculoskeletal Flashcards
Developmental Dysplasia of Hip treatments
surgery, Pavlik harness, Bryants traction, Spica cast
Children with DDH have to wear pavlik harness for how long?
3-6months
Spica cast
cast that covers one whole leg and part of the other. Used in DDH
Clubbed foot treatments
cast application, corrective shoes, surgical correction
Scoliosis
permanent lateral curvature of spine
scoliosis problems
breathing
Idiopathic scoliosis treatment <20 degrees
none
idiopathic scoliosis treatment 20-40 degrees
milwaukee brace to prevent further curvature
Milwaukee brace is used for
scoliosis. wear 23/24 hrs a day
idiopathic scoliosis treatment >40 degrees
Harrington rods are put in place
Harrington rods are used for?
idiopathic scoliosis treatment >40 degrees
Osteogenesis Imperfecta (OI)
brittle bone fractures with minimal stress. Defect collagen synthesis
Defect collagen synthesis
OI
OI symptoms
blue sclera, deafness, dentinogenisis (tooth probs)
OI treatments
IM rods, reclast (biophosphonate), NO BPs, encourage independence
Reclast (biophosphonate) is used for?
OI & osteoporosis It decreased serum calcium, decreases fractures
Slipped Capital Femoral Epiphysis
slipping of the femoral head in relation to neck
Slipped Capital Femoral Epiphysis usually occurs in what kinds of people?
obese or rapidly growing kids
Slipped Capital Femoral Epiphysis symptoms
hip, knee, groin pain (long duration), Limp, decreased ROM
Hallmark sign of Slipped Capital Femoral Epiphysis
Lack of internal rotation
Slipped Capital Femoral Epiphysis treatment
bedrest, NWB, crutches, surgical pinning, teach s/s for other hip
Legg-Calve-Perthes Disease
avascular necrosis of the head of femur
age of peak incidence for Legg-Calve-Perthes Disease
4-8 years old
Legg-Calve-Perthes Disease symptoms
pain in the hip accompanied by spasm and limited motion, progress thru 4 stages, knee of thigh pain, limp
Legg-Calve-Perthes Disease diagnostics
arthrogram (they put dye into body to see where it builds up)
Legg-Calve-Perthes Disease treatment
Hip spica cast for left hip for Legg-Calve-Perthes, petrie brace
petrie brace
metal bar that goes between legs for Legg-Calve-Perthes Disease
Osgood-Schlatter Disease
thickening and enlargement of tibial tuberosity. Athletes
Osgood-Schlatter Disease symptoms
painful swelling, cosmetic deformity. They will grow out of it
Osgood-Schlatter Disease treatments
Rest, ice, stretch hamstrings, casting, they’ll grow out of it
Osgood-Schlatter Disease diagnostics
x-ray
Rheumatoid Arthritis
chronic, systemic, inflammation of connective tissue in joints.
RA etiology
EBV initiates autoimmune response
RA symptoms
fatigue, anorexia, weight loss, generalized stiffness, fever, warmth, redness, swelling, weak muscles, ligaments, tendons
RA diagnostics
Synovial fluid aspiration, CBC, ESR, X-ray
CBC will show what with RA
anemia
ESR will be what with RA
elevated d/t inflammatory response
RA goals
reduce pain & inflammation, preserve function, prevent deformity
Plasmaphoresis is used with RA inorder to
to reduce autoimmune response by removing circulating antibodies
RA treatment
1.) give NSAIDS/corticosteriods 2.) DMARD’s (Disease-modifying antirheumatic drugs, surgery
DMARDs
Gold, D-penicillamine, Antimalarial agents (Plaquenil)-monitor visual acuity q 6 months sulfasalzine
Plaquenil
antimalarial agent used for RA & SLE. Causes visual probs
types of surgery for RA
Synovectomy, arthrodesis, arthroplasty
Arthrodesis
the fusion of two bones. Used for RA surgery
Arthroplasty
surgery to reshape, reconstruct or replace a diseased or damaged joint
JRA polyarticular
effecting many joints
JRA pauclarticular
4 or fewer joints are effected. screening q 6 months
JRA systemic s/s
high fever, rashswollen lymph nodes
JRA s/s
eye inflammation, stiff and painful joints, decreased appetite, poor weight gain, slow growth
JRA exercise
ROM, bike, swim
JRA treatment
NSAIDS, DMARDs, Cytotoxic (methotrexate), steriods
Cytotoxic (methotrexate) is used for
JRA. Used in chemo. Are we going to set them up for cancer later on?
SLE does what to the body
attacks the organs
SLE s/s
joint pain, butterfly rash, oral ulcers, alopecia, renal failure, seizures, depression,
SLE teaching
avoid sun exposure, limit stress,
SLE treatments
Plaquenil, Cytoxan (immunosuppressive drugs), NSAIDS, high dose steriods
Osteoarthritis
degenerative joint disease. Bone on bone rubbing
Osteoarthritis(DJD) diagnostics
x-ray, bone scan, CT, MRI
Osteoarthritis treatments
Opioids, heat, cold, joint arthroplasty, TENS, NSAIDs, Glucosamine, ASA, corticosteriods, Surgery if nothing else works
For a Total joint Arthroplasty (TJA) what is stopped 1 week before the surgery and what is given 1 hour before surgery
NSAIDS are stopped 1 week before surgery and an IV antibiotic is given 1 hour before surgery
With a Total Hip Arthroplasty (THA) a patient can become…
hypotensive. After 4 or 5 hip revisions there isn’t much you can do
THA postoperative care
abductor pillow, turn patient with pillow between legs. don’t let legs cross, don’t want knee to go higher than hip
THA discharge instructions
No driving for 6 weeks, resume sexual activity when comfortable, prophylactic antibiotic coverage for invasive procedures (dental work)
TKA discharge instructions
no driving, continue dvt prophalyxsis, antibiotics for dental work, home care c physical therapy, don’t put a pillow under knee cap
Osteoporosis
most common, porous bone
How does estrogen effect Bone mass density
An estrogen deficiency rapidly decreases BMD, up to 20% during the first 5-7 yrs post-menopause
Surgically induced menopause does what to BMD
it results in severe decrease in BMD
type 1 osteoporosis
postmenopausal, accelerated bone loss
type II osteoporosis
senile. male & female, age >70 related to nutrition, decreased physical activity, non-accelerated bone loss
Secondary osteoporosis
male & femal, occurs at any age. Its a result of a disease process or medical treatment
osteoporosis: which fractures are seen with elderly men
vertebral compression fractures
osteoporosis risk factors
smoking, sedentary, alcohol use
Osteoporosis prevention
weight bearing exercises, medications, proper nutrition, education
recommended amount of Calcium D for 35-50 yr olds
1000mg
recommended amount of Calcium D for pregnant women
1200-1500mg
recommended amount of Calcium D for 51-64 yrs old on ERT/ 51+ not on ERT
1000mg/1500mg
Calcium bicarbonate vs. Calcium Citrate
relief of indigestion, heart burn vs adjunct in the prevention of postmenopausal osteoporosis
Estrogen replacement therapy should be started when?
within 3 years of menopause
Estrogen replacement therapy increases which risk and what should be added in no hysterectomy?
increases endometrial cancer. Progesterone must be added if no hysterectomy
Osteoporosis meds
Antiresorptive meds that slow bone loss (bisphosphonates, calcitonin, denosumab, estrogen/estrogen agonists/antagonists-Evista) & Anabolic drugs that increase the rate of bone formation (PTH- Fortteo)
bisphosphonates, calcitonin, denosumab, estrogen do what?
antiresorptive meds that slow bone loss
PTH-Fortteo do what?
Anabolic drugs that increase the rate of bone formation
Bonica, Reclast, Actonel, Fosamax are what kinds of drugs
Bisphosphonates. Osteonecrosis of the jaw (ONJ) is a side effect
Kyphotic deformity
seen with osteoporosis. Its the normal posterior curvature of the thoracic and sacral spine
What GI/Bowel alterations will you see with a patient with osteoporosis?
a protrusion of the abdomen
When would you do surgery for HIVD?
if leg pain longer than 6 weeks.
What surgical interventions are there for HIVD
minimally invasive discectomy, laminectomy (remove part of lamina), spinal fusion (realign vertebra)
HIVD postop complications
CSF leakage (look for yellow fluid), nerve root injury, bowel bladder changes, hematoma
Conservative treatment for HIVD
rest 3 days max, ice or heat, analgesics, physical therapy, epidural steriods
what do you look at postop for HIVD
Need to look at orthostatic hypotension. Log rolling
Gout is what kind of disorder?
metabolic
what is elevated in Gout?
serum uric acid-hyperuricemia >7.5, ESR levels/sed rate
With Gout, urate crystals are found in..
synovial fluid, surrounding tissues. Uric acid excrete in urine <800 mg/24hrs
Gout diagnostics
x-ray, urate crystal aspiration
Hammer toe
claw toe is the dorsiflextion of the 1st phlanx with plantar flexion of the 2nd and 3rd phlanges
Zyloprim, Colchicine, NSAIDS (Indocin), corticosteroids are meds to treat?
Gout
Hallux Valgus
Bunion. Enlargement and lateral displacement of the first metatarsal. Congenital but most from wearing pointed shoes
daily colchicine and urosuric agents(allopurinol) are for?
Chronic Gout
