Musculoskeletal Disorders Flashcards
what is a fracture? patho? CM?
Break in continuity of bone, epiphyseal plate, or cartilaginous joint surface
Pathogenesis
-Periosteum & blood vessels disrupted
-Hematoma formed -> Inflammatory reaction
-Site invaded by osteoclasts & osteoblasts
-Avascular bone replaced by living bone via resorption & bone deposition.
-Callus formation creates new bone at edges of periosteum.
-Remodeling is replacement of mature lamellar bone.
Clinical Manifestations
-Unnatural alignment
-Swelling
-Muscle spasm
-Tenderness, pain
-Impaired sensation
Treatment—stabilization.
what are complications in bone healing? etiology? tx?
Delayed healing can include:
-Delayed union: 3mo-1yr bone tenderness
-Malunion: Improper alignment
-Nonunion: Not healed in 4-6 mo.
Etiologies: Non-approximated fragments, infection, smoking, malnutrition, poor circulation
Tx: Bone graft, internal/external fixation, electrical bone stimulation, or a mixture of these
what is fat embolism syndrome? CM
-Cause of pulmonary insufficiency
-Most common with Fx of pelvis, tibia, femur, ribs
-Fat globule released into circulation -> lodge in small blood vessels of lungs, kidneys, brain, and other organs
Clinical Manifestations: Change in LOC; restless, agitated, confusion, stupor (near unconsciousness), dyspnea, increased resp rate, tachycardia, Fever, petechial skin rash, crackles
what is compartment syndrome? etiology? CM?
D/t trauma to soft tissue caused by impact
Etiologies: decreased compartment size, increased compartment content, or externally applied pressure
-Edema causes increase in pressure in compartment; pressure reduces capillary flow; muscle & nerves become ischemic
Manifestations: pain, paresthesia, pale skin, and diminished pulse
what are dislocations and subluxations?
Dislocation: Complete separation of joint articulating surfaces
Subluxation: Partial separation
-Considerable amt. of tissue damage occurs with both
-Evaluation for fx is necessary
what are sprains and strains? Patho? CM?
Strain: Tear in tendon
Sprain: Tear in ligament
Pathogenesis:
-Inflammation, granulation tissue, collagen formation
Clinical Manifestations
-Pain
-Soft tissue swelling
what are the types of soft tissue injuries?
Types:
Contractile tissue: Is involved in cxn of muscle & includes not only muscle but tendon & bony insertion.
Inert tissue: Has no ability to contract or relax.
what is blunt trauma?
Can cause bleeding into the muscle belly; may lead to inability to contract the muscle; may coagulate and calcify; results in myositis ossificans
Calcification prevents normal & strong contraction of muscle involved
what are joint capsule injuries?
Joint capsule: stabilizes synovial joint.
-Injury in joint causes scarring in capsule.
-Thick capsule prevents full ROM.
-Synovial fluid unable to flow through cartilage, causing compression & distention.
-“frozen shoulder”
what are injuries to fasciae and bursae?
Fasciae: Connective tissues arranged in sheaths that envelop muscles.
Bursae: Pockets of connective tissue lined with synovium in areas between muscles or between tendon & bone.
Injuries cause pain & restriction of movement of M/S system
what are injuries to tendons?
Tendinitis: From infection, direct injury or repetitive motion
-Stress on tendon greater than fibers can tolerate
Categorized by severity of injury
Grade I: minute tear
Grade II: Large tear
Grade III: total rupture
what are injuries to ligaments?
Ligaments: Connect bone to bone.
-Loading exceeds physiologic range of motion (ROM).
-Classified as mild, moderate, severe.
Symptoms: Pain with wt. bearing & acute swelling.
Tx: Depends on degree of tear; surgical restoration of ligament continuity may be required in severe injury.
what is osteomyelitis? etiology? patho?
Severe infection of bone & local tissue
-Staphylococcus aureus most common pathogen
Etiologies: Bacteremia (systemic infxn), burns, sinus disease, trauma, malignant tumor necrosis, periodontal infection or an infected pressure ulcer. Direct infection from open fx, penetrating wounds, surgical contamination, insertion of prosthesis, metal plates, or screws
Pathogenesis:
-Bacterial growth causes bone destruction & abscess formation
-From abscess cavity pus spreads into medulla of bone
-Necrotic bone becomes trapped
-Sinuses develop in bone & allow pus to escape outside of bone
what is infectious arthritis? CM? tx?
Joint infection most often d/t bacteria via bloodstream
Clinical Manifestations: D/t localized infection & systemic manifestation of inflammation-warm swollen joint
Tx: Abx over 4-6 wks with therapeutic joint aspiration, arthroscopy or surgical drainage
Joint Prosthesis Infection
-Bacterial arthritis
-Staphylococcus epidermidis is common agent
-Removal of prosthesis followed by IV abx tx for 4-6 wks.
-Prosthesis may be replaced when wound cultures show no growth.
what is scoliosis?
Lateral curvature of spine causes S- or C-shaped spinal column
Functional: Resolves when pt. bends to affected side
Structural: Fails to correct itself on forced bending against curvature & has vertebral rotation
Tx: Bracing, exercises, or surgical interventions with spinal alignment, fusion, & internal fixation
what is osteoporosis? etiology? RF? patho? CM? tx?
Weakened bone, decreased mass/density
-Bone density > 2.5 SD below standardized young adult mean
Etiology/ Risk Factors
-Age
-Race (Caucasian, Asian)
-Gender
-Body Mass
-Hormone deficiencies (estrogen, androgen)
-Sedentary occupation
-Aluminum antacids, thyroid rx
-Smoking
-Poor Ca+ intake
-Prolonged bed rest
-Reduced weight bearing, lack of use
Pathogenesis: Rate of Bone absorption > bone formation.
-Cycle takes 4 mos in healthy adult, 2 yrs in osteoporosis.
Clinical Manifestations:
-DEXA Scan (Dual Energy X-ray Absorptiometry)
-X-ray—25-35% of bone mass lost before able to visualize
-Blood & urine tests not helpful
-History—fractures
1. decreased height, back pain
2. Dowager’s hump
3. Difficulty bending over
Tx: Ca+ / Vit. D supplements, exercise, estrogen replacement tx, bisphosphonates, or recombinant human parathyroid hormone
what is osteoarthritis? etiology? patho? CM/ tx?
-Local degenerative joint disorder associated with aging, wear & tear from repetitive stress
-Characterized by loss of articular cartilage, synovitis, wear of underlying bone
-Weight-bearing joints often affected
Etiologies: Unknown, stress on joint, family hx, weight increases stress on knees, hormonal status, hx of joint injury
Pathogenesis
-Cartilage changes: rough surfaces & bony surfaces come closer together
-Inflammation of synovial membrane may follow.
-New bone formed at joint margin, decreases mobility of joint.
Clinical Manifestations
-Bony enlarged joints
-Crepitus with movement
-Pain with function
-Heberden’s & Bouchard’s nodules
Tx: Improve function with PT. Reduce pain with acetaminophen or NSAIDs & intra-articular injections of corticosteroids
what is myasthenia gravis? etiology? patho? CM?
Chronic autoimmune disease; affects neuromuscular function of voluntary muscles & characterized by profound muscle weakness & fatigue
Etiology: Autoimmune, Thymic tumors
Pathogenesis
-Defect in nerve impulse transmission at neuromuscular junction
-Destruction of acetylcholine receptor sites
Clinical manifestations
-Insidious onset
-Fatigue after exercise
-Diagnosis made with Tensilon
-Unpredictable progression
-Muscles of eyes, face, mouth, throat, neck first affected
what is fibromyalgia syndrome?
-Cause remains unknown
-Characterized by widespread pain in all quadrants of body; additional symptoms may include fatigue, insomnia, depression, stiffness & concentration problems
Tx: Multidimensional including exercise, counseling, & drug tx to improve sleep, mood, & pain
what is rheumatoid arthritis? etiology? patho? CM? tx?
Etiology: Possibly autoimmune in genetically predisposed. May be triggered by viruses.
Juvenile disease: Peak onset 2-5 & 9-12, Girls>boys
Adult disease: Peak onset 30-50, women 2-3x > men
Pathogenesis
-Immune complexes change chemical make-up of tissue
-Hydrolytic enzymes released into joint fluid -> inflammation of synovium
Clinical Manifestations
(4 or more)
-Morning stiffness
-Soft tissue swelling of 3 or more joint areas
-Swelling of 1 wrist, MCP, PIP
-Simultaneous symmetrical swelling of joints
Subcutaneous Rheumatoid nodules
-Rheumatoid factor present
-ESR—elevated
-Radiologic erosions
Tx: NSAIDs, corticosteroids, and biological agents
what is systemic lupus erythematosus? tx?
Chronic multisystem, inflammatory, autoimmune disease characterized by periods of exacerbations & remission with multiple organs affected
-Common features; arthralgias & synovitis
Tx:
Topical corticosteroids, avoidance of sun, NSAIDs and/or antimalarial drugs & immunosuppressive agents
what is scleroderma? CM?
Multisystem inflammatory connective tissue disease characterized by skin thickening & deposition of collagenous tissue resulting in severe fibrosis
Clinical manifestations:
Raynaud phenomenon, poly arthritis, macular rash, & internal organ involvement
what is ankylosing spondylitis? CM?
Arthritis of sacroiliac (where spine meets pelvis) joints
Clinical Manifestations: lower back pain, severe morning stiffness, & limited ROM.
what is gout? etiology? patho?
Disturbance of uric acid metabolism
Etiology: Lack of enzyme uricase needed to break down uric acid
Pathogenesis:
Uric acid production exceeds removal -> hyperuricemia -> urate salts accumulate in articular, periarticular & subcutaneous tissue
what is acute gouty arthritis?
Gout attack; joints are warm, red, tender to palpation (most often in big toe)
-Most common early clinical sign.
-Risk increases with age
-May cause renal impairment & uric acid calculi
-Initial attacks can last 1-14 days; later become more frequent.
what are pediatric joint disorders? Nonarticular rheumatism? Hyper mobility of joints? Juvenile idiopathic arthritis?
-Nonarticular rheumatism: common soft tissue syndrome with nocturnal pain; also known as ‘growing pains’
-Hypermobility of joints: may cause pain in joints
-Juvenile idiopathic arthritis (juvenile rheumatoid arthritis [JRA]): chronic inflammatory disease affecting the synovium
