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Musculoskeletal 1 > Musculoskeletal Assessment - Edema and soft tissue > Flashcards

Musculoskeletal Assessment - Edema and soft tissue Flashcards

1
Q

What is edema

A

Abnormal condition of body tissues when they contain an excessive amount of tissue fluid

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2
Q

Where can edema be? and How can the condition be?

A
  • Located in the intercellular OR interstitial spaces
  • Local to a region or diffuse throughout the body
  • Acute or chronic conditions
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3
Q

What are the mechanisms of edema

A
  • increased hydrostatic pressure
  • reduced osmotic pressure
  • increased vascular permeability
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4
Q

How does increased hydrostatic pressure result in edema?
give example

A
  • high pressure in blood vessels pushes fluid into tissue spaces
  • Cardiovascular disease
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5
Q

How does reduced osmotic pressure result in edema

A
  • Osmotic pressure within blood vessels is not high enough to draw fluid from the tissue spaces
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6
Q

How does increased vascular permeability result in edema

A
  • Blood vessel wells become more permeable and fluid drains into tissue spaces
  • Tissue injury
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7
Q

How is infection related to edema

A
  • can cause local or widespread edema
  • Local: wound infection; cellulitis of affected tissue
  • Widespread: sepsis
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8
Q

Examples of how medications, surgeries and medical procedures can be related edema

A

-Meds such as corticosteroids
- Surergy, mastectomy (breast cancer with lymph node removal)
- Medical procedures - IVs can cause edema

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9
Q

How is immobility related to edema

A
  • When you move muscles pump fluid
  • sitting , lying (bedridden) for prolonged periods of time
  • Deep vein thrombosis
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10
Q

What are som common causes of systemic edema

A
  • Cardiovascular or pulmonary diseases (CHF, pulmonary edema, pneumonia, COPD etc)
  • Kidney disease
  • Liver disease
  • Venous insufficiency
  • Diabetes/peripheral neuropathy
  • Lymphatic system dysfunction/obstruction
  • Electrolyte imbalance ie Increase in sodium causes fluid retention
  • Toxins
  • Sepsis
  • Hormonal/pregnancy or prementstrual
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11
Q

Systemic causes of edema signs

A
  • Systemic edema - usually B/L
  • Distal edema in legs, feet, hands especially in dependent positions
  • Chronic edema: with related trophic changes → skin discolored, dry scaly skin, hair loss, thick nails
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12
Q

what is non pitting edema

A
  • no depression when pressure is applied
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13
Q

Pitting edema

A
  • pressure leaves a depression
  • chronic and systemic
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14
Q

Brawny edema

A
  • hard and chronic
  • Associated with venous insufficiency
  • Brownish skin discoloration
  • Ulcers associated with this
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15
Q

Tissue injury and damage stage of acute MSK injury edema

A
  • hemodynamic process
  • bleeding , inflammatory response → swollen/edema warmth
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16
Q

Vasoconstriction stage of acute MSK injury edema

A
  • stop bleeding (hemostasis)
  • platelets, cellular debris, fibrin involved in coagulation/clotting
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17
Q

Vasodilation stage of acute MSK injury edema

A
  • Mediated by mast cells releasing histamine; bradykinins increase vessel permeability and capillary pressure
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18
Q

Transudate edema

A
  • clear
  • water, proteins, electrolytes and cellular elements pushed into interstitium
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19
Q

Exudate edema

A
  • viscous
  • with increased tissue damage, capillary cells separate
  • Plasma proteins and RBCs leak thru capillaries resulting in greater swelling and edema
20
Q

MSK injury edema

A
  • edema resolves in a shorter time
  • progression thru healing stages:
21
Q

what are the stages of healing that are associated with MSK injury healing

A
  • Hemostasis: coagulation
  • inflammatory : transudate, macrophages
  • Fibroblastic: collagen, extracellular matrix (can do controlled mobility to scar tissue)
  • Remodeling: scar maturation and alignment
22
Q

What does it mean if edema is pronounced in 2-4 hours

A
  • bleeding is the cause
23
Q

if edema occurs 8-24 hours

A
  • inflammatory response without significant bleeding
24
Q

Ecchymosis

A
  • post injury or trauma and surgery
  • Bleeding, bruising
  • Swelling with discoloration usually red → purple → yellow
25
Q

Hematoma:

A

Muscle trauma: bleeding, swelling, mass of clotted blood in the tissue

26
Q

What happens when blood from hematoma is not reabsorbed

A
  • Myositis ossificans; calcification or blood clot
  • Palpable and hard
  • Detected on X Ray 3-6 weeks
27
Q

Joint effusion

A
  • Excessive fluid in the joint
  • Extrasynovial into capsule
  • Reflex inhibition surrounding muscle
28
Q

Hemarthrosis - what should be done for this and why?

A
  • Blood in joint
  • Aspirate – blood i s descriptive to articular cartilage so it must be taken out
29
Q

Venous insufficiency - signs and symptoms

A
  • edema , varicose veins; pulses present
  • Skin brownish color, onion skin, stasis ulcers
  • Pain with prolonged standing, dependent position
  • Relieved: elevation & compression, compression garments
30
Q

Arterial (PAD) - signs and symptoms

A
  • Extremity cold, pale, bluish
  • Decreased, absent pulses
  • (+)capillary refill test and + rubor dependency test
  • Pain with exercise (vascular claudication)
  • Muscle need blood
31
Q

Where do DVTs commonly occur?

A

iliac, femoral, popliteal

32
Q

when can a DVT occur and cause symptoms

A
  • Prolonged bed rest after surgery, trauma, blood, transfusion
  • immobility , air travel
33
Q

Signs and symptoms of DVT

A
  • ach/pain in calf, heaviness of LE, swelling, redness
34
Q

DVT referral to MD

A
  • Medical referral advised if moderate or greater probability of DVT (with goodman and synder scale)
  • MD: orders doppler studies, venography
  • Treatment: bed rest, anticoagulants, no exercise, activity, massage, filter placement in inferior vena cava
35
Q

Prevention of DVT

A
  • Intermittent pneumatic device compression in bed at hospitals
  • Ankle pumping
  • Exercise
  • Early ambulation after surgery
36
Q

Exam for edema: what to look for during the History, interview and systems review:

A
  • Systemic disease, vascular problems
  • Surgery, trauma/tissue injury, immobility, air travel
37
Q

Exam for edema: Observation:

A
  • Edema = local or diffuse
  • U/L or B/L
  • Color, ulcers/wounds, infection, atrophy, trophic changes
38
Q

Exam for edema: Palpation purpose/findings?

A

amount, pitting, brawny hard, warm temperature, tenderness

39
Q

Exam for edema: Pulses:

A

Pulses:
Femoral, popliteal, dorsalis pedis, posterior tibialis

40
Q

Exam for edema:

A
41
Q

Exam for edema: Capillary refill:

A

Squeeze nail bed - color should return in 3 sec

42
Q

Exam for edema: rubor dependency

A
  • patient supine, check soles of feet is pink/tan color
  • Elevate leg to 60º note color change (white or gray)
  • Have patient sit at table edge and lower leg
  • Color should return 2-3 minutes
  • If it runs bright red color = PAD
43
Q

exam for edema: Measure edema:

A

girth tape measurements or volumetrics

44
Q

Exam for edema/DVT special tests

A
  • Special tests: suspect DVT - wells DVT clinical prediction rule, Homans
45
Q

Interventions for edema (PT)

A
  • PRICE
  • Exercise
  • Edema control/elevation
  • Intermittentent compression pump
  • patient education to avoid dependent positions
46
Q
  • edema control by PT
A
  • retrograde massage,
  • compression with ace bandage, stocking/glove
  • Cuban or string wrap (Fingers and toes)
47
Q
A

Musculoskeletal 1 (42 decks)

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