Musculoskeletal Flashcards
When assessing a patients musculoskeletal system what should you always do?
Compare L and R side
Wrenching or twisting injury to ligaments surrounding joints
Sprain
Joint tenderness and increased pain with movement are symptoms of what type of injury
Sprain
Muscle pull or overuse
Strain
Gradual soreness, sudden pain, or local tenderness are symptoms of what type of injury
Strain
What is the management for strains and sprains
- RICE (rest and ice)
- NSAIDs
- Wraps (towards heart)
Complete displacement
Dislocation
Partial or incomplete displacement
Subluxation
Carpal tunnel syndrome is an example of what type or injury
Repetitive Strain injury (overuse)
Repetitive use of injury to the 4 muscles that generally stabilize the head of the humerus
Rotator cuff injury
ACL injury
Anterior Cruciate Ligament injury
Sports injury or injury that chips/damages the knee cartilage
Meniscus injury
Bursa (cushion) becomes inflamed due to trauma, friction, or extra pressure on the joints
Bursitis
Should you use ice or heat 24-48 hours after an injury occurs
Ice
Break in bone caused by stress greater than it can absorb
Fracture
-crushing force
-sudden twist in motion
-extreme muscle contraction (rare)
-pathological
…can all be causes of what?
A Fracture
-Pain (tenderness at the site)
-Swelling and ecchymosis
-Loss of function
-Crepitus
-Deformity
-Muscle spasm
-Shock with blood loss
… are all manifestations of what?
Fracture
-Traction
-Surgical
-Manipulation
-Cast
-External fixation
… are all interventions for what?
Fractures
Closed reduction is what type of intervention?
Manipulation
What do casts do?
Maintain alignment and immobilization
When is external fixation used?
with a soft tissue injury
An open reduction is what type of intervention?
Surgical
What is the purpose of traction?
- Decrease muscle spasm
- Immobilize and reduce fracture
What are the two type of traction?
- Skin
- Skeletal
-Hazards of immobility (ex: foot drop)
-Delayed or nonunion of healing
-Infection (ex: osteomyelitis)
… are potential complications of what type of intervention ?
Traction
Osteomyelitis is especially a risk with what?
External fixation
Counter traction
maintain opposite pull
What interferes with traction and should be avoided/prevented?
Friction
Should the line of pull when using traction ever be interrupted?
No
Should continuous traction ever be removed without physician ok?
No
What should you maintain when positioning a patient with traction?
Correct body alignment
Weights attache to adhesive and applied to the skin is what type of traction?
Skin
What type of traction exerts a straight pull on limb (most common)?
Buck’s
Is Buck’s traction often used temporarily to immobilize a hip fracture prior to the OR?
Yes
What type of traction involves both lower limbs extended vertically?
Bryant’s
Bryant’s traction is used to do what?
Align a fracture
What type of traction is balanced traction?
Russell
Russell traction used ropes and pulleys and is commonly used for what?
Fractured femurs
Traction that is applied to bone using pins and wires with weights to both ends of pins or wires is called what?
Skeletal traction
What may also be used when using skeletal traction?
a cast
Internal fixation and external fixation are both what types of fixation?
Surgical
Aligning the bone with plates and screws to hold fracture in alignment is what type of surgical fixation?
Internal
Fracture with soft tissue injury or the need of limb-lengthening uses what type of surgical fixation?
External (more complex)
What type of surgical fixation is often used when attempting to save an extremity from being amputated?
External fixation
What is the purpose of a cast?
- maintain alignment
- Immobilize
What is it extremely important to monitor for when using casts?
Compartment syndrome (decreased blood flow to affected area)
What needs to be assessed when someone has a fracture?
- pulses
- CRT
- appearance
- sensation
- etc
You will likely see shortening and external rotation of a limb with what type of fracture?
Hip
-Immobilize
-Cover wounds
-Treat for shock
… are interventions for what?
Fractures
-Emboli
-Compartment syndrome
-Venous thromboembolism
-Infection
… are potential complications with what type of injury?
Fractures
What is it called when the skin is cut open to reduce edema/pressure for healing?
Fasciotomy
-monitor for signs or local and systemic
-major concern for osteomyelitiss
…are things that need to be assessed for what type of fracture complication?
Infection
-AMS
-Chest pain, dyspnea, SOB
-Petechiae
-Pallor, diaphoresis
… are things to assess for with what type of complication that can arise from a fracture?
Emboli (fat or blood)
Edema from a fracture causing increased pressure in fascial compartment, and a decrease in capillary perfusion is called what?
Compartment Syndrome
-Pain
-Pallor
-Parathesia
-Pressure
-Pulselessness
-Paralysis
… are the 6 P’s used to assess for what syndrome?
Compartment Syndrome
Early detection and treatment of compartment syndrome is necessary in order to prevent what type of longterm damage?
neurovascular
Avascular necrosis is seen commonly with what type of frequent medication use?
Steroids
-Relieve pain
-Improve mobility
-Correct deformity
… are indications for what type of surgery?
Joint replacement
What type of fracture is at risk of avascular necrosis?
Intrascapular
-Maintaining abduction depending on anterior or posters approach is important for what type of surgery?
Joint replacement (posterior need to maintain abduction)
-Pillows
-Raised toilet seat
-high straight back chair
… are all ways to avoid what with a joint replacement?
Adduction and flexing the hip (ex: no crossing legs or low sitting)
Ability to bear weight after a joint replacement is dependent on what?
MD ok
-Circulatory impairment
-Trauma
-Infection
-Congenital disorders
… are indication for what to happen to a limb?
Amputation
Arterial insufficiency can be a result of what conditions?
- DM
- Heart disease
- Traume
- Injury
- Etc
Does a persons psychological health need to be assessed prior to and after and amputation?
Yes
“Phantom sensation” in which an individual feels pain in part of the limb that was removed is most often after what?
Above knee amputation (AKA)
What is the drug treatment for Phantom limb pain?
- Opioids
- Beta blockers (for dull burning)
- Anticonvulsants (for knife-like pain)
- *Gabapentin
What type of therapy can also help with phantom limb pain?
Mirror
After an amputation the limb should be elevated for 12-24 hours to decrease edema, but flat after this time to do what?
- Promote functional alignment
- Prevent flexion contractures
After amputation the patient should lie prone how often?
Every 3-4 hours for 20-30 minutes
-Shrinking
-Shaping
-Toughening
… is called what?
Stump conditioning
Is ambulation important after an amputation?
Yes with assistive devices if necessary
Should a amputation stump be evaluated daily for irritation and pressure injuries?
yes
Washing every NOC with bacteriostatic soap should be done for the management of what?
A amputation stump
Should lotions and powders be avoided with a amputation stump unless ok’d by the MD?
Yes
Should a stump sock be changed daily?
Yes
The use of a prothesis should be avoided if what occurs?
Irritation of the stump
-Lumbosacral strain
-Osteoarthritis
-Herniation or intervertebral disk degeneration
… can be causes of what type of pain?
Low back
Acute low back pain is typically due to what?
- Stress
- muscle spasm
-Analgesics
-NSAIDS *
-Steroids
-Muscle relaxants
-Local ice or heat
-PT
… are forms of conservative treatment of what type of low back pain?
Acute
Chronic low back pain is typically due to what?
- Structural
- Disease
Radiating pain in the buttocks and the leg commonly experienced with positive straight leg raises (passive ROM where leg is lifted above 60 degrees) is seen with what type of low back pain?
Chronic
Epidural injections in addition to the conservative treatment used for acute low back pain is also used for what?
Chronic low back pain
Prior to back surgery what is it essential to have done?
Baseline assessment
A baseline assessment should be compared with what after a patient has back surgery?
Post op assessment
-Peripheral neurovascular/sensory status
-Maintaining alignment
-Bone graft or fusion may need brace, monitor donor site
-Log-roll
-Pain management (PCA)
-Monitoring for CSF leak
… are all things that should be done postoperatively for what type of surgery?
back surgery
Yellowish drainage accompanied by a headache raise concern for what?
CSF leak
What is the name for a chronic progressive metabolic bone disease, “silent disease”?
Osteoporosis (decalcification)
Low bone mass and density is seen in what disease?
Osteoporosis
The strength and structure of bones is ruined in what disease?
Osteoporosis
-Long-term use of steroids*
-Thyroid hormone
-Heparin
-Long-acting sedatives
-Anti-seizure meds
… are risk factors for what bone disease?
Osteoporosis
-Advanced age (>65)
-Female
-Low body weight
-White or asian
-Current cigarette smoking
-Inactive lifestyle
-Family history
-Low calcium diet or vit D deficiency
-Excessive alcohol intake (>2 drinks a day)
-Postmenopausal
… are all risk factors for what bone disease?
Osteoporosis
Why does menopause place a women at higher risk for osteoporosis?
Reduction in estrogen, estrogen helps keep vitamin C in the bone
-Bone loss w/o symptoms
-Fractures
-Collapsed vertebrae
-Height loss
-Sinal deformities (ex: kyphosis)
-Stooped posture
… are manifestation of what bone disease?
Osteoporosis
A bone mineral density test is used to diagnose what?
Osteoporosis
-Adequate Ca intake
-Vit D
-Moderate weight bearing exercise (walking)
… are all ways to prevent what bone disease?
Osteoporosis
How much calcium should be taken daily for premenopausal women?
1000mg/day
How much calcium should be taken daily for postmenopausal women not on estrogen?
1500mg/day
Bisphosphonates (Fosamax) is used in the treatment of what?
Osteoporosis
The risk of esophagitis is seen with what medication used in the treatment of osteoporosis?
Bisphosphonates
Hormone replacement therapy can also be used to treat what type of bone disease?
Osteoporosis
Can you use hormone replacement therapy is you have the risk for great cancer, CVD, or stroke?
No
Bone loss that is not as bad as osteoporosis but can be seen as a warning sign for osteoporosis is called what?
Osteopenia
What is the bone disorder that is seen with wear and tear/ use and abuse?
Osteoarthritis
-Increasing pain
-Progressive loss of function
-Joint stiffness after rest or static position
-Advanced: gross deformity and subluxation
-Herberden’s nodes
-Bouchard’s nodes
… are all manifestations of what bone disease?
Osteoarthritis
-Not smoking
-Maintaining a healthy weight
-Treating injuries as they arise
-Regular exercise
… are all ways to prevent what bone disease?
Osteoarthritis
What is the drug therapy for osteoarthritis?
- Acetaminophen (1gm 4x’s daily)
- NSAIDS (oral or topical)
- Intraarticular hyaluronic acid
- Intraarticular corticosteroids
A systemic autoimmune disease with remission and exacerbations, that is more common in women is what?
Rheumatoid arthritis
-Pain
-Stiffness upon arising after inactivity
-Limited movement
-Joint inflammation
-Late deformities
… are all joint manifestations of what?
Rheumatoid arthritis
-Ulnar drift
-Swan neck
-Hallux valgus
-Boutonniere
… are all late deformities seen in what?
Rheumatoid arthritis
-Vasculitis
-Peripheral neuropathy
-Myopathy
-Cardiopulmonary
-Ischemic skin ulcers
… are systemic extraarticular (outside of joint) manifestations of what?
Rheumatoid arthritis
-NSAIDs
-Hydroxychloroquine
-Intraarticular or systemic corticosteroids
-Methotrexate
-Enbrel, Remicade, Humira: Biological response modifiers
… are drugs used in the treatment of what?
Rheumatoid arthritis
Hydroxychloroquine and Methotraxate are what types of drugs?
Disease modifying antirheumatic drug (DMRADs)
Hydroxychloroquine is also currently being used to treat what?
COVID 19
Disease that is caused by overproduction or inability to excrete excess amounts of uric acid? (defect of purine metabolism)
Gout
Uric acid crystalizes where causing gout to be painful?
At joints
If uric acid crystalizes in the renal tubules what can be caused?
Kidney problems
Can gout be primary meaning it is inherited?
Yes
Can gout also be secondary meaning it caused by another disease process?
Yes (cancer, alcoholism, obesity)
-Severe pain in joints and commonly the great toe
-Inflammation
-Urate crystals in synovial fluid
-Increase in uric acid in 24 hr urine
… are manifestations of what?
Gout
What is the drug of choice for acute gout attacks?
Indomethacine
What are other drugs besides indomethacin use in acute gout attacks?
- NSAIDs
- Colchicine
What drugs are used in the maintenance therapy for gout?
- Allopurinl
- Probenecid
People with gout should avoid what foods?
- Liver
- Wine
- Beer
- Red meat
Chronic multisystem inflammation of connective tissue is what disease?
Systemic Lupus Erythematosus (SLE)
Is Systemic Lupus Erythematosus (SLE) more common in women?
yes
Is Systemic Lupus Erythematosus (SLE) an autoimmune disease that has remissions and exacerbations?
Yes
-Skin
-Joints
-Membranes of lungs
-Pericardium
-Kidneys
-Eyes
… are examples of the mutlisystem inflammation seen in what?
Systemic Lupus Erythematosus (SLE)
Besides an H and P, what is the main way Systemic Lupus Erythematosus (SLE) is diagnosed?
Anti-DNA and ANA will be elevated
A butterfly rash is seen in what disease?
Systemic Lupus Erythematosus (SLE)
Immune deposits in skin and joints, trigger inflammation and then degeneration is seen in what disease?
Systemic Lupus Erythematosus (SLE)
What is the drug management for Systemic Lupus Erythematosus (SLE)?
- NSAIDs with mild disease (monitor GI and renal)
- Steroid-sparing drugs (methotrexate)
- Antimalarial drugs (Hydroxychloroquine)
- Corticosteroids (exacerbations and severe disease)
- Immunosupressive drugs (*azathiprine)
