musculoskeletal Flashcards
fracture
is a break in the continuity of a bone
- complete: totally broken
- incomplete: hairline fracture
- open - through the skin
- closed - stays inside skin
- comminuted: broken into many pieces
- linear: extends the length of the bone
- oblique: diagnal through the bone
- spiral: twisting fracture
- transverse: across the bone
Greenstick facture
perforates one cortex and splinters the spongy bone. outer breaks and inside just bends (kids)
Torus fracture
buckling of cortex of the bone (kids)
Bowing
bone bends but does not break (kids)
pathologic bone breaks
a disease causes the bones to break, not trauma
stress facture
stress on the bone is cumulative and ultimately causes a fracture
fatigue fracture
bigger muscles than bones and causes micro fractures to develop in the cortex of the bone
hip fracrures
- intertrocanteric fracture: breaks at the neck of the hip bone, easy fix
- intercapsular fracture: breaks at the head of the femur in the pelvic socket. all blood dies and needs a hip replacement NECROSIS
Bone Fractures
- cause damage to the surrounding tissue, periosteum, blood vessels in the cortex and marrow
- bone tissue destruction triggers an inflammatory response
- procallus formation
callus formation
- hematoma fracture
- blood clot
- procallus. blood clot replaced by fibroblasts that lay down collagen
- osteoblast activity. new bone. fracture callus
- osteaoclasts and phagocytes create healed and healthy bone
Bone Fracture Manifestations and treatment
manifestations: unnatural alignment, swelling, muscle spasm, tenderness, pain, impaired sensation, possible muscle spasms
Treatment: surgery, reset bones. closed manipulation, traction (pull muscles), open reduction. internal and external fixation (pins put in)
if improper reduction or immobilization = nonunion, delayed union, melanin
dislocation
temorary displacement of two bones. loss of contact between articular cartilage
subluxation
contact between articular surfaces is only partially lost (some contact still exists)
tendon
muscle to bone
ligaments
bone to bone
strain
tear or injury to a TENDON or muscle
sprain
tear or injury to a LIGAMENT
avulsion
complete separation of a tendon or ligament from its bony attachment site
muscle strain
sudden, forced motion causing the muscle to become stretched beyond normal capacity
- local muscle damage
- muscle strains can also involve the tendons
care for strains and sprains
Rest, ice, compression, elevation
tendinitis
inflammation of the tendon
tendinosis
painful degradation of collagen fibers
bursitis
inflammation of a bursa (joint)
- skin over bone, skin over muscle, muscle and tendon over bone
- caused by repeated trauma
- septic bursitis is caused by a wound infection
epicondylitis
inflammation of tendon where it attached to a bone
- Tennis elbow: lateral epicondyle (backhand, lateral)
- golfers elbow: medial epicondyle. medial, swing in front
rhabdomyolusis
life-threatening complication of severe muscle trauma with muscle cell loss
- skeletal muscle breaks open. overexageration of muscles with heavy weights. kidney damage
crush syndrome
crushing trauma, car accident.
compartment syndrome
releases myogolbin into blood
- volkman ischemic contracture = forearm.
- leaves in permanent flexed state
- pressure in compartments cuts of blood supply and causes necrosis
osteoporosis
porous bone
- pooly mineralized bone
- bone density = <648mg/cm2
- reduced bone mass/density, imbalance of bone resorption and formation
- bone histology usually normal but lacks structural integrity.
- overaction of osteoCLASTS
- compression fractures in discs
- potential causes: decreased levels of estrogen and testosterone, decreased activity levels, inadequate vitamin d, c or mg++
- post-menopausal women
osteoclasts
break down bone
osteoblasts
make new bone
latrogenic osteoporosis
cuased by mediation or physician
regional osteoporosis
confined to a certain section, dissuse or immobilization of a limb
postmenopausal osteoporosis
bone loss occurs in middle-aged women. estrogen deficiency
glucocorticoid-induced osteoporosis
steroid-induced
age-related bone loss
older age
kyphosis
- exaggerated rounding of thoracic and coccyx
HUNCHBACK
lordotic
- abrnomal inward curvature of cervical and lumbar
SWAYBACK
osteomalacia
deficiency of vitamin d
- inadequate or delayed mineralization
- SOFT BONES
- rickets
- pain, bone fractures, vertebral collapse, bone malformation
osteomyelitis
caused by stapholacoccus infection
- open wound is most common cause, also can be from blood born infection
- sepsis
manifestations: acute and chronic inflammation, fever, pain, necrotic bone
Treatment: antibiotics, surgery, hyperbaric o2 therapy
synovial joints
- moveable, fluid-filled
- articular cartilage
- articular capsule
- thickening in fibrous capsule = ligaments
inflamm vs. non-inflamm joint disease
- absence of synovial membrane inflame
- lack of systemic signs and symptoms
- normal synovial fluid analysis
osteoarthritis (ONLY NON-INFLAMM)
- degeneration and loss of articular cartilage, sclerosis of bone underneath cartilage, formation of bone spurs (osteophytes)
- DEGENERATIVE JOINT DISEASE
- incidence increases with age
- Bone to bone rubbing!
- idiopathic - we don’t know why it happens
- knees, back, hips
osteoarthritis
local areas of damage and loss of articular cartilage, new bone formation to joints
- manifestations - pain, stiffness, enlargement of the joint, tenderness, limited motion, deformity
- not sistemic, isolated in certain areas
rheumatoid arthritis
- inflammatory joint disease - autoimmune
- systemic autoimmune damage to connective tissue, primarily in joints (synovial membrane)
- fever, leukocytosis, malaise, anorexia, hyperfibrinogenemia
- an be infectious or not infectious: did it start with inflammatory or come from infection or genetics or environment?
- presence of RA or RF
- antibodies IgG and IgM against antibodies. antibodies against antibodies
- systemic, symmetrical in presenting symptoms
PATHOGENESIS: cd4 helper t cells becomes activated in the synovial going and release cytokines - recruitment and retention of inflame cells in the joint subliming - cycle of altered cytokine and signal transduction pathways
RA Evaluation
4 or more of the following:
- morning joint stiffness lasting at least 1 hour
- arthritis of three or more joint areas
- arthritis of hand points
- symmetric arthritis
- rheumatoid nodules
- abnormal amounts of serum RA factor
- radiographic changes
ankylosing spondylitis
inflamm joint disease of the spine or sacroiliac joints causing stiffening and fusion of the joints
- systemic, immune inflame disease
- joint can become fixed through joint fusing. seen in spine when lose posture and flexibility
ENTHESIS; site where ligaments, tendons and joint capture are inserted into bone
- unknown cause
- symptoms: low back pain, stiffness, pain, restricted motion, loss of normal lumbar curvature
Gout
- URIC ACID body’s control disrupted for production or excretion
- high levels UA and then CRYSTALIZES
- US = byproduct of protein breaking down
- crystals deposited in connective tissue throughout the body
Mechanisms for crystal deposition: lower body temps, decreased albumin, changes in ion concentration and PH, trauma
Clinical Stages: asymtomatic hyperuricemia, acute gout arthritis, tophaceous gout
disorders of skeletal muscle
contracture: loss of blood flow at upper extremity. shortening or contraction of muscle without stimulus
stress-induced muscle tension: neck stiffness, back pain, clenching teeth, hand grip, headache. chronic anxiety
disuse atrophy
reduction in normal size of muscle cells as a result of prolonged inactivity = bed rest, trauma, casting, nerve damage
Treatment: isometric movements, passive lengthening exercises
Fibromyalgia
chronic widespread joint and muscle pain
- vague symptoms: sensitivity to touch, absences of inflammation, fatigue, sleep disturbances
toxic myopathies
most common = alcohol abuse
- acute attack of muscle weakness, pain and swelling
- chronic weakness in a drinker of long duration
- necrosis of individual muscle fibers `
bone tumors
originate from bone cells, cartilage, fibrous tissue, marrow, vascular tissue
- osteosarcome = most common form
