Musculoskeletal Disorders Flashcards
what is the function of the musculoskeletal system
provides protection for vital organs, including brain, heart, and lungs and a framework to support body structures
what makes mobility possible
muscles and tendons hold bone together
joints allow body to move
Movement facilitates…
the return of deoxygenated blood to right side of heart by massaging venous vasculature
serves as a reservoir for…
immature blood cells and essential minerals including Ca, P, Mg, and F
define remodeling
formation of old bone is removed and new bone is added to the skeleton
what stimulates bone formation and remodeling
physical activity particularly weight bearing activity
define reabsorption
removal or destruction of bone however prolonged bed rest causes increased bone resorption from Ca loss
How do you perform the neurovascular exam?
6 P’s
Pain (early sign): worst with passive touch or movement, elevating the limb, or any pressure, stretching increases the pain, and pain meds are not relieving
Paresthesia (early sign): the patient may report it feels like the extremity distal to the fractire feels like its falling asleep “pins and needles”sensation, can they feel you touch their extremity? check unaffected extremity to compare
Pallor: extremity should be pink and have normal capillary refill less than 2 seconds, In compartment syndrome, may appear pale or dusky and have a capillary refill greater than 2 seconds
paralysis: can the patient move the distal extremity from the fracture or has the movement decreased
poikilothermia: occurs when the affected extremity distal from the fracture feels cooler to the touch compared to the unaffected extremity, cannot regulate its temperature
pulselessness: always mark the pulses with a black marker and have a doppler available to monitor the sound of the pulse (this is a late sign)
what is back pain
most common in lumbosacral and cervical vertebrae because these are the areas where vertebral column is most flexible
patients with back pain assess…
gait, spinal mobility, reflexes, leg length, leg motor strength and sensory perception
back pain sign and symptoms
pain
radiculopathy: pain radiating down leg
sciatica: pain radiating from inflamed sciatic nerve
muscle spasm
numbness/tingling
leg weaknes
bowel or bladder incontinence
back pain nursing interventions
physical therapy
hot/cold applications
pharm: NSAIDS/ muscle relaxants; antidepressants/atypical convulsants
surgery
prevention of low back pain/injury
use good posture and safe handling practices with specific attention to bending, lifting, and sitting
assess need for assistance with household chores
participate in regular exercise program,
avoid prolonged sitting and standing
keep weight within 10% of ideal body weight
avoid wearing high-heeled shoes
what is carpel tunnel syndrome
common condition which the median nerve in the wrist becomes compressed causing pain and numbness
signs and symptoms of carpel tunnel
Paresthesias
Numbness
Pain (may be worse at night)
Weak pinch
Clumsiness (dropping things)
Difficulty with fine motor movements
+ Phalen’s test
+ Tinel’s sign
carpel tunnel interventions
Splint / hand brace
Acupuncture
Pharmacological:
NSAIDs: for pain relief and inflammation
Corticosteroid injections
Surgery
health promotion activities to prevent carpel tunnel
Become familiar with federal and state laws regarding workplace requirements to prevent repetitive stress injuries such as carpal tunnel syndrome (CTS)
When using equipment or computer workstations that can contribute to developing CTS, assess that they are ergonomically appropriate, including:
Specially designed wrist rest devices
Geometrically designed computer keyboards
Chair height that allows good posture
Take regular short breaks away from activities that cause repetitive stress, such as working at computers
Stretch fingers and wrists frequently during work hours
Stay as relaxed as possible when using equipment that causes repetitive stress
what is osteoporosis
:a chronic metabolic disease in which bone loss causes decreased density and possible fracture from reduced bone mass, deterioration of bone matrix, and diminished bone architectural strength
define osteopenia
low bone mass
osteoporosis signs and symptoms
Dowager’s hump / kyphosis
“Shorter”
Back pain, especially with activity
Swelling
Malalignment
Constipation
Abdominal distention
Reflux esophagitis
Respiratory compromise
osteopenia and osteoporosis occur when…
osteoclastic (bone resorption) activity is greater than osteoblastic (bone building) activity
osteoporosis diagnostic labs and test
labs:
Serum calcium
Vitamin D3
Phosphorus
Urinary calcium
tests:
BMD testing
Dual x-ray absorptiometry (DXA, orDEXA) scans
X-rays
osteoporosis interventions
Prevention is best and needs to start early in life
Life style modifications
Pharmacological:
Calcium & vitamin D3 supplements
Bisphosphonates: slow bone resorption by binding with crystal elements in the bone
Alendronate (Fosamax), ibandronate (Boniva), and risedronate (Actonel, Atelvia)
Estrogen agonist / hormone therapy ?
osteoporosis complications
Osteoporosis results in more than 1.5 million fragility fractures each year
A woman who experiences a hip fracture has a 4 times greater risk for a second fracture
The mortality rate for older patients with hip fractures is very high, especially within the first 6 months, and the debilitating effects can be devastating
The reported 1-yearmortality aftersustaining ahip fracturehas been estimated to be 14% to 58%
what is osteomalacia
is loss of bone related to a vitamin D deficiency; causing softening of the bone resulting from inadequate deposits of calcium and phosphorus in the bone matrix
Osteomalacia is the adult equivalent ofrickets,or vitamin D deficiency, in children
osteomalacia signs and symptoms
Muscle and bone weakness
Spinal kyphosis and bowed legs
Waddling and unsteady gait
Bone pain/tenderness
osteomalacia diagnostic labs and test
Low serum calcium
Low phosphorus
Low urine excretion of calcium
X-rays
osteomalacia interventions
Prevention
For all at-risk patients, teach them about which high calcium and vitamin D foods to eat and the importance of adequate daily sunlight
Pharmacological:
Active vitamin D (calcitriol)
Adequate daily sunlight
Pain management
what is osteoarthritis
also called degenerative joint disease (DJD); is a noninflammatory, localized progressive deterioration and loss of cartilage and bone in one or more joints
It is not systemic and it is not an autoimmune disease
As cartilage and the bone beneath the cartilage begin to erode, the joint space narrows andosteophytes(bone spurs) form
Secondary jointinflammationcan occur when joint involvement is severe
osteoarthritis signs and symptoms
Joint stiffness/pain
Pain that diminishes after rest and worsens with activity
Functional impairment
Possible tenderness
Crepitus
Heberden’s nodes
Bouchard’s nodes
Joint effusions
osteoarthritis interventions
Supportive care
Pain management
Acetaminophen, NSAIDs or COX2 inhibitors, opioids
Cortisone injections Q3 months ?
Topical analgesic agents such as diclofenac sodium gel, capsaicin and methylsalicylate
PT / OT (exercise!)
Surgery / joint arthroplasty
explain joint arthroplasty
refers to the surgical removal of an unhealthy joint and the replacement of joint surfaces with metal or synthetic materials. Total joint arthroplasty, also known as total joint replacement, involves the replacement of all components of an articulating joint
with joint replacement, patients may expect…
pain relief, return of joint motion, and improved functional status and quality of life. The scope of these improvements depends in part on patients’ preoperative soft tissue condition and general muscle strength
post-op care of older adult patient with total hip arthroplasty
Use an abduction pillow or splint to prevent adduction after surgery if the patient is very restless or is confused
Keep the patient’s heels off the bed to prevent pressure ulcers
Do not rely on fever as a sign of infection; decreased mental status is a better indicator in the elderly
Move the patient slowly to prevent orthostatic hypotension
Encourage the patient to cough and deep breathe and use the incentive spirometry
As soon as permitted, get the patient up and out of bed
Anticipate the patient’s need for pain relief
Expect a temporary change in mental state immediately after surgery as a result of the anesthetic and unfamiliar sensory stimuli - reorient the patient frequently
post-op care of adult with total knee arthroplasty
Apply the continuous passive motion (CPM) machine as soon as it is ordered
Manage the patient’s pain to provide comfort, increase participation in activity, and improve joint mobility
Maintain the knee in a neutral position and not rotate internally or externally
Teach the patients that they can partially weight bear unless their prosthesis is not cemented
complications of total joint arthroplasty
Dislocation
Venous thromboembolism (VTE)
Infection
Anemia
Neurovascular compromise
what is osteomyelitis
an infection in the bone; caused by bacteria, viruses, or fungi; that can be severe and difficult to treat
name and define the types of osteomyelitis
Vascular insufficiency: seen most commonly with diabetes, PVD, most commonly affecting the feet
Hematogenous: in which organisms are carried by the bloodstream from other areas of infection in the body
Contiguous: in which bone infection results from contamination from surgery, open fracture, or traumatic injury
signs and symptoms of acute osteomyelitis
Fever (usually above 38.3), tachycardia, general malaise, swelling around the affected area, erythema of the affected area, increased heat in that area, tenderness of the affected area, bone pain that is constant, localized, and pulsating that intensifies with movement
signs and symptoms of chronic osteomyelitis
Foot ulcer(s), sinus tract infection, localized pain, drainage from the affected area
osteomyelitis diagnostic labs and tests
labs:
Leukocytosis
Elevated ESR
Blood cultures/wound cultures
tests:
nuclide scans
MRI
osteomyelitis interventions
Prevention
General supportive measures (hydration, diet high in vitamins and protein, etc.)
Improve physical mobility with avoidance of stress on that bone
Pharmacological:
Antibiotics
Pain management
Wound care
Surgery / debridement
define contusions
a soft tissue injury produced by blunt force, such as a blow, kick, or fall, causing small blood vessels to rupture and bleed into soft tissues (ecchymosis or bruising)
A hematoma develops from bleeding at the site of impact, leaving a characteristic “black and blue” appearance
contusions signs and symptoms
Local symptoms includepain, swelling, and possible discoloration
contusion management
are managed withPRICE therapy, an acronym that refers to protection,rest,ice,compression, andelevation
define strain
excessive stretching of a muscle or tendon when it is weak or unstable. Strains are sometimes referred to as muscle pulls
state the three classifications of strains and explain each
First-degree (mild) strain causes mild inflammation but little bleeding. Swelling, ecchymosis (bruising), and tenderness are usually present
Second-degree (moderate) strain involves tearing of the muscle or tendon fibers without complete disruption. Muscle function may be impaired
Third-degree (severe) strain involves a ruptured muscle or tendon with separation of muscle from muscle, tendon from muscle, or tendon from bone. Severe pain and disability result from severe strains and surgery may be needed
strain management
Cold and heat applications, exercise, activity limitations, NSAIDs and/or muscle relaxants
a sprain is
excessive stretching of a ligament; caused by a twisting motion or hyperextension (forcible) of a joint
They are also classified according to severity similar to strains
sprain management
First degree: PRICE therapy
Second degree: immobilization, such as elastic bandage and an air stirrup ankle brace or splint, and partial weight bearing while the tear heals
Third degree: immobilization for 4 to 6 weeks is necessary; and arthroscopic surgery may be done
dislocation of the joint occurs when…
when the ends of two or more bones are moved away from each other and no longer in anatomic alignment
Subluxed: when the joint is only partially dislocated
joint dislocation signs and symptoms
Usually, there is pain, decreased mobility, deformity, and deviation in length and rotation of the extremity
joint dislocation management
Immobilization
Closed reduction of the joint
Pain management
a fracture is…
a break or disruption in the continuity of a bone that often affects mobility and sensory perception
complete fracture
the break is through the bone in such a way that the bone is divided into two distinct sections
incomplete fracture
the fracture is through only part of the bone
open (compound) fracture
the skin surface over the broken bone is disrupted; so there is an external wound
closed (simple) fracture
does not extend through the skin and therefore has no visible wound
pathologic (spontaneous) fracture
occurs after minimal trauma to a bone that has been weakened b disease
fatigue (stress) fracture
results from excessive strain and stress on the bone
compression fracture
produced by a loading force applied to the long axis of cancellous bone
fractures signs and symptoms
Moderate to severe pain
Muscle spasm, paresthesias
Loss of function
Ecchymosis, edema
Deformity, shortening of the extremity
Subcutaneous emphysema, crepitus
emergency care of an extremity fracture:
Assess ABC’s, and perform a quick head-to-toe assessment
Immobilize the extremity by splinting, including joints above and below injury
Remove the clothing to inspect the affected area
Remove jewelry on the affected extremity in case of swelling
Apply direct pressure if there is bleeding
Keep the patient warm and in a supine position
Assess neurovascular status (check 6 P’s)
Cover any open wounds with a sterile dressing
fracture interventions
Reduce and immobilize
Traction
Splints or casts
Assess neurovascular and neuromuscular system frequently
PRICE therapy
Pain management
Non-opioid and opioid analgesics with anti-inflammatory drugs and muscle relaxants
Surgery
immobilization devices potential complications
Compartment syndrome
Pressure ulcers
Infection
Disuse syndrome
Immobility
Anxiety
complications from fractures
Acute compartment syndrome
Crush syndrome
Hypovolemic shock
Fat embolism syndrome
Venous thromboembolism
Infection
Chronic complications such as ischemic necrosis or delayed union
acute compartment syndrome (ACS)
increased pressure within one or more compartments encased by bone or fascia, which reduces circulation to the area
ACS signs and symptoms
Sensory perceptiondeficits or paresthesia (usually 1st sign)
Pallor, pulses weaken
Affected area is palpably tense
Pain with movement
Then cyanosis, numbness, paresis, paralysis and necrosis
ACS management
fasciotomy
crush syndrome
systemic manifestation of muscle cell damage resulting from pressure or crushing
Systemic manifestations are caused by a traumatic rhabdomyolysis due to muscle reperfusion injury when compressive forces on the tissues are released
This can cause local tissue injury, organ dysfunction, and metabolic abnormalities, including acidosis, hyperkalemia, and hypocalcemia
Prevention of renal failure is important
Alkaline diuresis and mannitol therapy is recommended. Hemodialysis is also recommended for acute renal failure
hypovolemic shock
from a loss of blood
The bone is very vascular, and bleeding is a risk
In addition, trauma can cut nearby arteries and cause hemorrhage
hypovolemic shock management
Stabilize the fracture to prevent further bleeding
Restore blood volume and circulation
Provide proper immobilization and protect from further injury
Pain relief
fat embolism syndrome (FES)
fat globules are released from the yellow bone marrow into the bloodstream causing clots
FES signs and symptoms
Hypoxemia, dyspnea with tachypnea
Decreased LOC, agitation, confusion
Petechial rash (late sign)
FES management
Reduce the risk with immobilization and maintenance of fluid and electrolytes
Supportive care with mechanical ventilation, vasopressors and corticosteroids
venous thromboembolism (VTE)
includes deep vein thrombosis (DVT) and pulmonary embolism (PE) and its major complications
It is the most common complication of lower extremity surgery or trauma and the most often fatal complication of musculoskeletal surgery
VTE risk factors
Cancer or chemotherapy, surgical procedures > 30 minutes, smoking, obesity, heart disease, prolonged immobility, oral contraceptives, history of VTE, older adults
Type of infections and causes
Osteomyelitis: is most common with open fractures in which skin integrity is lost and after surgical repair of a fracture
Wound infections are the most common type of infection resulting from orthopedic trauma
They range from superficial skin infections to deep wound abscesses
Infection can also be caused by implanted hardware used to repair a fracture surgically, such as pins, plates, or rods
avascular necrosis
blood supply to the bone is disrupted causing decreased perfusion and death of bone tissue
This problem is most often a complication of hip fractures or any fracture in which there is displacement of bone. Surgical repair of fractures also can cause necrosis because the hardware can interfere with circulation
delayed union
is a fracture that has not healed within 6 months of injury
Some fractures never achieve union; that is, they never completely heal
Malunion: when the bone heals incorrectly
amputations
is the removal of a part of the body
Amputation is considered only after other interventions have not restored circulation, sometimes referred to as limb salvage procedures
The circulatory status of the limb is evaluated through physical examination and diagnostic studies. Muscle and skin perfusion is important for healing
amputations signs and symptoms
Poor circulation (6 Ps!)
Discolored skin
Edema
Ulcers
Necrosis
Hair distribution
amputation diagnostic test
Ankle-brachial index (ABI)
Doppler ultrasonography
Laser doppler flowmetry
Transcutaneous oxygen pressure (TcPO2)
amputation interventions
Monitor for signs of sufficient tissue perfusion
Monitor and control for bleeding and infection
Control edema though compression dressings
Prevent joint contractures
Pain management
Analgesics + beta blockers, antiepileptic drugs, antispasmodics, antidepressants
Collaborate with rehab to improve ambulation and self-care
Psychological and behavioral health
complications from amputations
Hemorrhage
Infection
Phantom limb pain
Flexion contractures
Skin breakdown
phantom limb pain (PLP)
when sensation is felt in the amputated part and it persists and is unpleasant or painful
Often described as intense burning, crushing, cramping, or that the part is in a distorted or uncomfortable position
For most patients, the pain is triggered by touching the residual limb or by temperature or barometric pressure changes, concurrent illness, fatigue, anxiety, or stress
PLP management
IV infusions of calcitonin (Miacalcin, Calcimar) during the week after amputation can reduce phantom limb pain
flexion contractures
occur usually in the hip or knee in patients with amputations of the lower extremity
This complication must be avoided so that the patient can ambulate with a prosthetic device
Proper positioning and active range-of-motion exercises help prevent this complication
