Musculoskeletal Disorders Flashcards
1
Q
Musculoskeletal system involve what parts of the body:
A
Bones, joints, cartilage, muscle, ligaments, tendons, fascia, bursa
2
Q
What are the functions of bones
A
to provide: support, protection of internal organs, voluntary movement, blood cell production, mineral storage
3
Q
What part of the musculoskeletal is where the end of two bones meet, is classified according to degree of movement, and is enclosed in a capsule of fibrous CT:
A
joints
4
Q
What part of the musculoskeletal system is a rigid CT in synovial joints, supports soft tissue, provides surface for joint movement, lacks direct bld supply:
A
cartilage
5
Q
What are the 3 types of cartilage:
A
hyaline (trachea, bronchi, articulaar surface of bones), elastic (ear, larynx), fibrous (vertebral disks, protective cushion between bones)
6
Q
What are the types of muscles:
A
cardiac (heart), smooth (airways, gi tract, uterus), skeletal (moves and supports the skeleton
7
Q
What part of the musculoskeletal system attaches bones to bones:
A
ligaments
8
Q
What part of the musculoskeletal system attaches muscles to bone:
A
tendons
9
Q
What part of the musculoskeletal system is composed of dense, fibrous CT, has poor bld supply, and connects bone to bone and muscle to bone:
A
ligaments and tendons
10
Q
What part of the musculoskeletal system is more elastic then tendons, provides stability, and permits controlled movement at the joint:
A
ligaments
11
Q
What part of the musculoskeletal system are layers of CT that can withstand limited stretching, encloses individual muscles, and provides strength to muscles:
A
Fascia
12
Q
What part of the musculoskeletal system consist of small sac of CT lined w/synovial membrane/fluid, is located at bony prominences or joints to relieved pressure, and decreases friction between moving parts:
A
Bursae (if swollen, bursitis may result)
13
Q
What are the gerontologic differences in bone:
A
Decrease in bone density
14
Q
What are the gerontologic differences in joints:
A
Increased risk of cartilage erosion and loss of water from disks
15
Q
What are the gerontologic differences in muscles:
A
Decreased in number and diameter, decreased ability to store and release glycogen, and loss of elasticity (in ligaments/cartilage)
16
Q
What are the types of soft tissue injuries:
A
Sprains, strains, dislocations, and subluxations
17
Q
What are the two most common types of musculoskeletal injuries associated w/abnormal stretching or twisting motions:
A
sprains and injuries
18
Q
What musculoskeletal injury involves the ligamentous structures surrounding a joint resulting in partial or complete tearing of the fibers; caused by wrenching or twisting motions; found usually around the ankles or knee joints:
A
sprain
19
Q
What musculoskeletal injury is caused by excessive pull or stretch (may include the tendons) to the lower back, calf, or hamstrings
A
strain
20
Q
What are some clinical manifestations of strains and sprains:
A
pain, edema, decrease in function, contusion
21
Q
How long does recovery take for strain and sprains:
A
3-6 wks, x-ray may need to be taken to r/o fx, surgical repair may be needed for a severe strain
22
Q
What are the Tx of sprains and strains:
A
RICE, NSAIDs, heat after 24-48hrs
23
Q
What is the emergency management of acute soft tissue injury:
A
Elevate, compression bandage unless dislocation is present, ice packs, immobilize in the postion, NSAIDs, tetanus/diphtheria prophylaxis if skin integrity is breached/open fx, abx prophylaxis for open fx, lrg tissue defects, or mangled extremity
24
Q
Cryotherapy (cold) causes what effects when applied:
A
vasoconstriction and reduction in the transmission/perception of nerve pain impulses
25
Compression application causes what effect and how should it be wrapped:
Compression bandages how to limit swelling; compression bandages should be wrapped distally away from the midline of the body and progressing proximally to encourage fluid return (bandage is too tight if numbness is felt below the area of compression
26
How does heat application affect the injury:
Heat application should be applied after 24-48 hrs to reduce swelling and vasodilate
27
A complete displacement of a bone from a joint that's considered to be a orthopedic emergency is define as:
dislocation
28
Where do dislocations typically occur:
UE: thumb, elbow, shoulder; LE: hip, knee
29
A partial or incomplete displacement of the joint surface is define as:
subluxation (requires less healing time than a dislocation)
30
Patellar dislocations are more common in females. Why:
Females are more at risk to patellar dislocations bc quadricep muscles are not as strong
31
What are the clinical manifestations of dislocations or subluxations:
deformity, asymmetry, local pain/tenderness, decreased mobility, swelling (compartment syndrom or avascular necrosis could occur)
32
What is the Tx of dislocation or subluxation:
Realign via closed (performed under conscious sedation to relax the muscles as the bones are realigned), open reduction (surgery is required), immobilization, pain management, ROM exercises (pt w/dislocated joints are at more risks of repeated dislocations)
33
What musculoskeletal injury is caused by prolonged force, repetitive movements, awkward postions, repetitive trauma disorder caused by poor workplace ergonomics, badly designed workplace equipment, and repetitive heavy lifting:
repetitive strain injury or cumulative trauma disorder (RSI)
34
What can prevent repetitive strain injury:
education and ergonomics (consideration of the interaction of humans and their work environments e.g: keeping hips and kees flexed at 90 degrees with feet flat, wrists straight to type, and having the top of the monitor even with the forehead)
35
What are the common clinical manifestations of Repetitive Strain Injuries:
pain, weakness, inflammation, swelling, and impaired motor function
36
What are the Tx for repetitive strain injuries:
modifications of equipment/activities, cold/heat applications, NSAIDs, rest, physical therapy, and lifestyle changes
37
What musculoskeletal injury is caused by compression of the median nerve, is the most common compression neuropath; and is associated w/continuous wrist movement:
carpal tunnel syndrome (CTS-caused by compression of the median nerve, which enters the hand through the confines of the carpel tunnel)
38
What are the clinical manifestations of carpal tunnel syndrome:
weakness of the thumb, burning pain, numbness/tingling, impaired sensation or clumsiness in fine motor movements
39
What are the dx exams done on carpal tunnel syndrom (CTS):
Tinel's sign=tapping over the median nerve that elicits a tingling sensation; Phalen's sign=allowing the wrists to fall freely into maximum flexion and maintaing that postion >60 sec will elicit a tingling sensation over the median nerve of the hand
40
What are the most common Tx of carpal tunnel syndrome (CTS):
prevent CTS by using adaptive devices (splints to relieve pressure), ergonomic changes (workstation modification), activity modification (frequent breaks during work), immobilization (in the early stages), impaired sensation may occur so stay away from heat, corticosteroid INJ into the carpal tunnel; open release surgery (incision is made through the wrist and the carpal tunnel is cut to enlarge the width), and endoscopic carpal tunnel release (wrist is punctured to insert a camera and the carpal ligamant is cut)
41
What musculoskeletal injury is caused by a tear within muscle or tendinoligamentous structure around the shoulder; is a complex of four muscles in the shoulder (supraspinatus, infraspinatus, teres minor, subscapularis):
Rotator Cuff Injury
42
What may cause a rotator cuff injury:
aging process, repetitive overhead motions, falling onto outstretched arm, blow to upper arm, heavy lifting, repetitive work motions
43
What are some clinical manifestations of rotator cuff injuries:
shoulder weakness, pain, decreased ROM
44
What tests are done to confim a rotator cuff injury:
drop arm test (the arm falls suddenly after th pt is asked to slowly lower the arm to the side after abduction), MRI to confirm tear
45
What are some common rotator cuff injury Tx:
Partial tea/cuff inflammation=RICE, NSAIDs, corticosteroid INJ, PT; Unresponsive to Tx/complete tear=surgical repai of the tear, acrominoplasty (surgical removal of a part of the acromion to relieve compression)
46
What musculoskeletal injury is caused by an injury to the crescent-shaped fibrocartilage of the knee characterized by popping, clicking, tearing sensation, effusion, and swelling; closely associated w/ligament sprains that occurs amongst athletes:
Meniscus injury
47
What may cause a meniscus injury:
sports, blow to the knee, occupations that require squatting/kneeling, degenerative tears in older pts
48
What are the common clinical manifestations in a meniscus injury:
localized tenderness, pain, swelling, joint instability, subjective (locking, click, pop, give way)
49
What tests confirm a meniscus injury:
McMurray test=pain upon flexion, internal rotation, and extension of the knee); MRI=confirm tear
50
What are the common Tx for a meniscus injury:
Prevented by warm-ups; ice, immobilizations, assisted devices (crutches), surgical repair via arthroscopy (meniscectomy)
51
What musculoskeletal injury is caused by non-contact when the athlete pivots, lands from a jump, or slows down when running causing a twisting, and then a pop of the knee followed by acute knee pain:
Anterior Cruciate Ligament Injury (ACL)
52
How are anterior cruciate ligament injuries classified:
partial tear, complete tear, avulsion (tearing away)
53
What are the common Txs for an anterior cruciate ligament injury (ACL):
rest, immobilization, ice, NSAIDs, use of assistive devices, PT, reconstructive surery, CPM (MACHINE THAT MOVES THE JOINT FOR THE PT)
54
What musculoskeletal injury is caused by a disruption or break in the continuity of the structure of the bone (mostly caused by traumatic injuries)
Fx
55
What are the classifications of fx:
open/compound=skin is broken; closed/simple=skin is intact; complete=break is completely through the bone; incomplete=the bone is still in one piece; displaced=two ends of the bone are separated from each other and out of normal position; nondisplaced=bone is still intact and the bone is in alignment
56
What are the types of fxs:
transverse; spiral; greenstick; comminuted; oblique; pathologic; stress
57
What is a transverse fx:
line extends across the bone shaft
58
What is a spiral fx:
line extends in a spiral direction along the shatf (child abuse fx)
59
What is a greenstick fx:
incomplete fx on one side of the bone splintered and the other side bent
60
What is a comminuted fx:
more than two fragments and the fragments appear to be floating
61
What is an oblique fx:
line of fx extends in an angled direction down the shaft
62
What is a pathologic fx:
spontaneous fx found at the site of bone disease
63
What is a stress fx:
fx that occurs to either normal or abnormal bone due to repeated stress (jogging/running)
64
What are the clinical manifestations of fxs:
edema/swelling, pain/tenderness, spasms, deformity (cardinal sign of fx), ecchymosis, loss of function, crepitation (grating/crunching)
65
What are the six processes of fx healing:
hematoma, granulation, callus, ossification, consolidation, remodeling
66
How does hematoma cause fx healing:
bleeding/clotting occurs after 72 hrs of injury
67
How does the granulation phase cause fx healing:
phagocytosis and hematoma causes the osteoid to be produced after 3-14 days post injury
68
How does the callus formation cause fx healing:
After minerals and new bone matrix are deposited in the osteoid, a network of cartilage, osteoblasts, Ca, and phosphorus appears by the 2nd week and can be verified by x-ray
69
How does ossification phase cause fx healing:
prevents movement of the bone; continues from 3-6 wks and until the bone is healed; cast can come off during this point
70
How does the consolidation phase cause fx healing:
Bony union occurs as the distance between the bone fragments diminish; occurs up to a year post injury
71
How does the remodeling phase cause fx healing:
where excess bone material is reabsorbed into the final stage of bone healing; union is complete; remodeling responds to Wolf's law (stress) so that new bone is deposited into sits of stress
72
What are some factors that affect the healing time of bone fx:
as age increases, length of healing is longer; displacement of fx; blood supply to the area; immobilization; implants, infection, and hormones can weaken bones
73
A non-surgical, manual realignment of bone fragments to their previous anatomic position utilizing traction and countertraction are manually applied and alignment needs to be retained is defined as:
closed reduction
74
The correction of bone alignment through a surgical incision that includes internal fixation of the fx w/the use of wires, screws, pins and a CPM machine is defined as:
Open reduction or open reduction internal fixation (ORIF)
75
What are the benefits of having ORIF (open reduction internal fixation):
Provides early ambulation which decreases risk r/t ambulation and promotes fx healing
76
Machines that provide continuous passive movements to joints that aid in rapid healing time are defined as:
Continuous Passive Motion machines (CPM)
77
The application of a pulling force to an injured or diseased part of the body while a countertraction pulls in the opposite direction is defined as
traction (two most common are skin and skeletal tractions)
78
This type of traction is applied as a short term tx (48-72 hrs); uses weights of 5-10 lbs; it's purpose is to maintaing alignment, assist in reduction, and decrease spasms, applied to he skin:
skin traction (balkan traction)
79
What are the purpose of tractions (skin or skeletal):
prevent/reduce pain/spasms, immobilization; reduce dislocation or fx; Txs pathological joint condition
80
This type of tracttion is a long-term pull, pins and wire are inderted into the bone; weights are 5-45lbs; purpose is to align bones, immobilize, treat contractors:
skeletal traction (buck traction)
81
Common traps of tractions are:
Buck traction for skeletal traction; balkan traction for skin traction
82
What are some traction considerations:
inspect skin/pins for infection, ensure weights are hanging free off the floor, provide overhead trapeze
83
This type of traction is used only in ICU, traction is applied to tongs attached to pins in the skull, may have a sheep-skinned vest attached to it; neuro checks should be done every two hrs:
cervical skeletal traction (gardner-wells tongs)
84
What are some cervical traction considerations:
neurochecks q 2hr (ICU) or 4 hr (halo vest), respiratory status; skin integrity/infection; pin dislodgment; HOB elevated; never use vest to turn pt
85
Metal pins inserted into the bone and attached to an external rod; used to apply traction or compress fx fragments; often used to salvage a limb:
external fixation
86
What are the MAIN complication of external fixation:
pin loosening, and infection
87
What is the ordered solution for pin care and what's LAC + USC procedure:
order is 1/2 hydrogen peroxide with 1/2 NS; procedure is sterile technique, cotton swabs soaked in solution, circular motion around pin sites and one swab per pin
88
A temporary circumferential immobilization device that's commonly applied after closed reduction; incorporates joints above or below fx; can be made with either plaster or synthetic material is defined as:
casts
89
What are the types of casts:
log/short arm casts; sugar-tong cast; body jacket; hip spica; long/short leg casts; cylinder cast; joint ressing
90
This type of cast is often usd to for acute wrists injuries that will accommodate major swelling:
sugar-tong splint cast (the sides are open to allow for swelling)
91
This type of cast is used to tx stable wrist or metacarpal fx; aluminum finger splint can be inserted into the cast; permits unrestricted elbow mobilization
short-arm cast
92
This type of cast is commonly used to stable the forearm or elbow fxs and unstable wrist fx; cast extends over the humerus:
long-arm cast
93
This type of cast is commonly used to immobilize/support spin injuries of the lumbar or thoracic areas:
body casts
94
This type of cast is commonly used to tx femoral fx by immobilizing the trunk and the affected extremity securely:
hip spica cast
95
When casts are applied too tightly; compresses the superior mesenteric artery against the duodenum; pt will c/o abd pain/pressure/ N/V; and commonly occurs w/the body jacket or hip spica casts is defined as:
cast syndrome
96
Common cast care includes:
frequent neuro checks; extremities above heart level w/in the 1st 48hrs; ice applications covered in plastic w/in 24 hrs; DON"T remove padding/NO weight; blot with towel or use hair dryer if cast gets wet; reposition joints above/below casts regularly; use hair dryer if pt is itchy
97
What is the nutritional Tx for pts with fx and in casts that is needed for tissue and bone repair:
protein=1 g/kg of body weight; vitamins=B/C/D; Minerals=Ca, phos, mg
98
What's the difference between 3 lrg meals and 6 smaller meals for pts with fx and casts:
3 lrg meals for regular cast/splints; 6 sm meals for pts wearing a body jacket or hip spica casts due to bloating
99
How are neuro checks assessed:
pain, pressure, paralysis, paresthesia (abnormal sensation), pallor, and pulselessness
100
What are the most common complications of fxs:
infection, compartment system, venous thromboembolism, fat embolism syndrome, hemorrhage, non-union fx
101
This complication of fx is increased d/t open fx and soft tissue injury; dead/contaminated tissue is ideal medium for bacteria; requires debridement, irrigated abx solution, or applied abx-impregnated beads is defined as an:
infection
102
This complication of fx is a condition in which an elevated pressure w/in a confined myofascial compartment compromises neurovascular function by causing cap perfusion to be reduced below a level necessary for tissue viability; associated with fxs of the distal humerus or proximal tibia; delayed dx can cause irreversible muscle/nerve damage is defined as:
compartment syndrome
103
Compartment syndrome is caused by what two reasons:
deceased compartment size d/t cast being to tight; increased compartment size d/t bleeding or internal swelling
104
What are the clinical manifestations of compartment syndrome:
6 Ps: pain (distal pain not relieved by meds), pressure (increase compartment pressure), paresthesia (numbness/tingling), pulselessness, pallor (coolness/loss of color), paralysis
105
What are the common Tx for compartment syndrome:
No elevation or ice compressions, loosen bandage by bivalve cast (slit in cast), reduce traction weight, fasciotomy (surgical decompression leaving site open for several days) amputation if S/S of compartment syndrome are missed
106
This complication of fx is is a thrombus formation in the LE and hip fxs are highly susceptible to this type of complication:
Venous thromboembolism
107
What is the prophylaxis for VTE:
heparin, compression stockings (TED hose), sequential compression device (SCDs), ROM, dorsiflex/plantar flex
108
This complication of fx is characterized by the presence of systemic fat globules from fxs that are distributed into the tissues/organs after a traumatic skeletal injury; contributes to many deaths associated in fxs; tissues of lungs, kidneys, brain, heart, are most affected, symptoms occur w/in 24-48 hrs after injury:
Fat embolism syndrome (FES)
109
What are the clinical manifestations of FES:
acute respiratory distress syndrome and changes in mental status d/t hypoxemia (hemorrhagic interstitial PNA=chest pain, tachypnea, dyspnea, cyanosis...)
110
The goal of amputation surgery is to:
preserve extremity length and function; remove all infection, pathologic tissue
111
This type of amputation is where soft tissue padding covers residual limb to create a weight bearing stump:
closed amputation
112
This type of amputation is where the residual limb is not covered with skin for control of infection and then later covered w/skin:
open amputation
113
What is the nsg consideration for phantom limb sensation:
mirror therapy (to show amputation) and pain management
114
What are the types of prosthetics for UE:
arm and hook, cosmetic hand
115
What are the types of prosthetics for LE:
importance of proper fit (make certain the inside is wiped out and dry before fitting
116
What is the purpose of using prosthetics:
function
117
Are the elderly typically considered good candidates for prosthetics:
No, they don't have enough energy for it
118
A surgical reattachment of a body part by microsurgical means to restore function; utilizes restrictive dressings, repositioning to promote venous drainage, leeches, and heparin is defined as:
replantation for the purpose of a functioning limb
119
This type of fx is common in older adults, 90% caused to falls, occurs more in women, 30% die w/in year of fx is defined as:
hip fx
120
what are the clinical manifestations of a hip fx:
external rotation, pain/tendrness, decreased bld flow=vascular necrosis d/t no tx, one limb may be shorter than the other
121
How are hip fxs treated:
surgical=hemiarthoplasty, total hip arthroplasty, hip resurfacing
122
What type of arthroplasty will older adults have:
cemented arthroplasty d/t less active older adults w/decreased bone density
123
What type of arthroplasty will younger adults have:
cementless arthroplasty d/t providing long-term implant stability, to facilitate ingrowth as younger adults are more active
124
What are the precautions for hip fx:
elevated toilet seat, abduction pillow, use assistive devices, nver cross legs, avoid rotation and 90 degree flexion for 4-6 wks
125
What are the tx for hip fx in the elderly:
Ca and vitamin D supplements, setrogen replacement, bisphosphonate drug therapy
126
The nurse suspects an ankle sprain when the pt relates: A) being hit by another soccor player; B) having ankle pain after sprinting, C) dropping a 10 lb weight on LE, D) twisting his ankle while running:
D: twisting ankle
127
The nurse explains to the pt w/a distal tibia fx who is returning for a 3-week check up that healing is indicated by: A) formation of a callus, B) complete bony union, hematoma at fx site, D) presence of granulation tissue:
A: formation of a callus
128
A pt w/a comminuted fx of the femur is to have open reduction with internal fixation of the fx. The nurse explains to the pt that ORIF is indicated when: A) the pt is unable to tolerate prolonged immobilization, B) the pt cannot tolerate the surgery of a closed reduction, C) A temporary cast would be too unstable to provide normal mobility, D) adequate alignment cannot be obtained by other non-surgical methods:
D: cannot be obtained by non-surgical methods
129
An indication of a neurovascular problem noted during assessment of the pt w/a fx is: A) exaggeration of strength in movement, B) increased redness and heat below surgery, C) decreased sensation distal to the fx site, D) purulent drainage at the site of open fx:
C: decreased distal sensation
130
A pt with stable, closed fx of the humerus caused by trauma to the arm has a temp splint w/bulky padding applied w/an elastic bandage. The nurse suspects compartment syndrome and notifies the MD when the pt experiences: A) increased edema of the limb, B) muscle spasms of the lower arm, C) rebounding pulse at the fx site, D) pain when passively extending the fingers
B: muscle spasms
131
A pt with a fx of the pelvis should be monitored for: A) changes in urinary output, B) petechiae on the abd, C) a palpable lump on the buttock, D)sudden decrease in BP
A: change in urinary output
132
During the post-op period, the nurse instructs the pt w/an above knee amputation that the residual limb should not be elevated bc this position promotes: A) hip flexion contractures, B)skin irritation/breakdown, C) clot formation at incision site, D) increased risk of wound dehiscence:
A: hip flexion contractures
133
A pt w/RA is scheduled for a total hip arthroplasty. The nurse explains that the purpose of this procedure (select all that applies) A) fuse the joint, B) replace the joint, C) prevent further damage, D) improve/maintain ROM, E) decrease amount of destruction in the joint
B=replace joint, D=ROM
134
In teaching a pt scheduled for a total ankle replacement, it is important that the nurse tells the pt that after surgery he should avoid: A) lifting heavy objects, B) sleeping on the back, C) abduction exercises on the affected ankle, D) bearing weight on the affected ankle for 6 wks:
D: avoid weight on ankle for 6 weeks
