Musculoskeletal Function Flashcards
Skeletal Trauma
Fractures and Dislocations
Support Structure Trauma
Sprains and strains
Tendinopathy and bursitis
Muscle strains
What is a Fracture
A break in the continuity of a bone
Classifications of bones
Complete, Incomplete, Open (compound), Closed (simple), Comminuted
What else can a fracture be classified under
Linear, oblique, spiral, transverse or greenstick
What is a pathologic fracture
Break at the site of a preexisting abnormality
What is a Stress fracture
Due to being subjected to repeated stress
EX. Athletics
What are the 2 types of stress fractures
Fatigue- abnormal stress
Insufficiency- lack normal ability to deform and recover
What is a transchondral fracture
Fragmentation and separation of portion of articular cartilage
What are the 2 parts of the body that can regenerate itself
Fractures (bones)
Liver
What are the steps in a fracture (4)
- Periosteum and blood vessels disrupted
- Bleeding from ends and neighbouring soft tissue
- Clot forms in medullary canal
- Adjacent bone tissue dies which stimulates intense inflammatory response
How long does it take for vascular tissue to invade the area which leads to blood flow to increase to the bone
48 hours
How is a fracture healed
- Bone forming cells activated to produce subperiosteal procallus along the bone shaft and over the break
- Osteoblasts synthesize collagen and matris to form a callus
- Remodelling occurs, tebeculae formed along lines of stress
Clinical manifestation of Fractures
- Vary according to type of fracture, site and associated soft tissue damage
Signs and symptoms of fractures
Impaired function, unnatural alignment, swelling, muscle spasm, tenderness, pain and impaired sensation
What is the position of bone affected by
pull of attached muscles, gravity, direction and magnitude of fracture force
What is the immediate pain due to in a fracture
trauma
What is the secondary pain due to in a fracture
soft tissue or muscles
Treatment of fractures
Must realign bone fragments (reduction) (most done by closed reduction)
Traction to maintain reduction
External fixation used external frame of clamps
Open reduction- Surgery
What are the 2 types of traction
Skin or skeletal
What is a dislocation
A temporary displacement of 2 bones in which the bone surfaces lose contact entirely
Often accompany a fracture
What is a subluxation
The displacement of 2 bones in which the bone surfaces contact is only partially lost
Often accompany a fracture
What age are dislocations and subuxations most common
Below the age of 20
What bones are most common for dislocations & subluxations
Shoulder, elbow, wrist, finger, hip and knee
What often also occurs when a dislocation and subluxation is present
A fracture, bruised nerves, vessels, ligaments, supporting structure, soft tissues, pain, edema, limited motion and deformity
What is a ligament
A band of fibrous connective tissue that connects bones at a joint
What is a tendon
Tendon: fibrous connective tissue that attaches skeletal muscle to bone
What is a strain
A tear in a tendon
What is a sprain
A tear in a ligament
What happens when you injure a tendon or ligament
Inflammation develops between the torn ends, granulation tissues form containing macrophages, fibroblasts and capillary buds
Within 5 days, collagen forms
When can a tendon start to withstand pull
After 5 weeks but the entire process could take years to repair (longer than a break)
What is a rotator cuff tear
A tear through supporting tendons
Signs and symptoms of tendon and ligament tears
Pain, edema, changes in tendon or ligament contour, dislocation and subluxation of bones, tenderness
Where can bursas be found in the body
Can occur in the shoulder, elbow, hip or knee
What can be done for bursitis
Drainage or injection
What happens in a muscle tear
Muscle fibres are torn resulting in bleeding
Do fibres heal
No, other fibres compensate
What is primary osteoarthritis
Idiopathic: may be inherited (no known cause)
What is secondary osteoarthritis
Associated with joint stress, congenital abnormalities or joint instability caused by trauma
What is osteoarthritis
Erosion of articular cartilage
What is subchondral sclerosis
Thickening and hardening of bone underneath cartilage
What are osteophytes
Formation of bone spurs
What makes osteoarthritis worse
aging
Where does osteoarthritis affect the most
Hands, wrists, neck, lower back, hip, knees, ankles and feet
What can osteoarthritis be associated with
Trauma, long term stress, inflammation, joint instability, neurological disorders, congenital, hemtological disorders, congenital, hematologic or endocrine, drugs
(all accelerate cartilage loss)
What happens to cartilage in osteoarthritis
Cartilage turns yellow, brownish, surface areas flake off, becomes thin or absent, bone becomes unprotected (sclerotic), cartilage coated osteophytes can grow outwards, joint capsules become thickened
What happens when spurs break off with osteoarthritis
Irritate synovial membrane
Clinical manifestations of osteoarthritis
Occurs in 50s or 60 year olds, pain and stiffness in one or more joints, aggravated by weight bearing and relieved by rest, nocturnal pain not relieved by resting
What could pain be caused by in osteoarthritis
articular distention
What is articular distention
Stretching of joint capsule or fibrous shrinking irritated by movement
What could cause joint effusion be caused by
osteophyte fragments in synovial cavity, drainage of cysts from diseased subchondral bone or acute trauma to joint structures
What is joint effusion
Why could there be inflammation exudate or blood in the synovial cavity
What can happen in osteoarthritis
Limited range of motion, crepitus (grating or creaking), changes in ambulation, affected joint more symptomatic after use
How is osteoarthritis diagnosed
Through clinical assessment, X-ray, CT scan, MRI
What is the conservative treatment of osteoarthritis
Rest, ROM exercises, use of aids, weight loss, analgesic and inflammatory drugs
Treatments for osteoarthritis
Conservative treatment
Surgical treatment
What is rheumatoid arthritis
Autoimmune disease, chronic inflammation of connective tissue, affects synovial membrane by lining the joint cavity, inflammation spread to other tissues, causes pain, joint deformity and loss of function
What are the most affected rheumatoid arthritis joints
Fingers, feet, wrists, elbows, ankles, knees
May affect lungs, heart, kidneys, skin
What group does Rheumatoid Arthritis most often affect
Women
*lessens during pregnancy but exacerbated during postpartum
*increases with age
What happens in Rheumatoid Arthritis
Autoantibodies attack host tissue (are called rheumatoid factors)
What obscures Rheumatoid Arthritis
Genetics, environmental factors, hormonal factors, reproductive system
Signs and symptoms from Rheumatoid Arthritis
Stiff, tender and painful joints, Morning stiffness that last more than 1 hour
Progresses from smaller joints to weight bearing joints
Joint swelling that is widespread and symmetric
Joint deformities, loss of joint motion, contractures, muscle atrophy, Rheumatoid nodules found in areas of pressure or trauma,
What are Rheumatoid nodules
Swellings
aggregates of inflammatory cells and are usually in the elbows and fingers, scalp, back, hands and feet
*Can be found in the skin, heart, lungs and spleen
What is the diagnosis for Rheumatoid Arthritis
Diagnosis on PE, x-ray, blood tests
What is the treatment for Rheumatoid Arthritis
Conservative: rest of joint and body, heat and cold, physical therapy, hi calorie and vitamin rich diet
Drugs: corticosteroids, anti-inflammatory, immunosuppressants
Surgery: decrease inflammatory effusion and remove pannus, fix deformity or replace joint
What is ankylosing Spindylitis
Chronic inflammatory joint disease characterized by fusion of spine and sacroiliac joints
Who is more susceptible to getting Ankylosing Spondylitis
3:1 male to female ratio
What is the most known symptom of Ankylosing Spondylitis
Bamboo spine
What is Gout
Excess uric acid in blood that causes precipitation of urate crystals in joints
How is Gout treated
NSAID’s, Allopurinol and water
What is a contracture
Shortening of muscles
Can be physiological or pathological
What is a Physiological contracture
Occurs in the absence of muscle action potential
What is Pathological contractures
May be a response to pain or secondary to scar formation (burns)
What is the diagnosis and treatment for physiological contractures
Failure of calcium pump in presence of ATP- temporary if underlying pathology reversed
What is Osteomyelitis
Infectious bone disease caused by bacteria, viruses, fungi or parasites
Why is Osteomyelitis hard to treat
Bone contains multiple channels that encourage proliferation of infectious cells (natural defenses do not penetrate), Tiny vessels (easy damaged and obstructed easily), bone cells destroyed by infection are not easily replaced
How is Osteomyelitis categorized
By pathogen
What is Exogenous osteomyelitis
Infection from the outside of the body- spread from soft tissues to bone
What is endogenous osteomyelitis
Infection carried in blood from other sites within the body- spreads from bone to soft tissue
What are special characteristics of endogenous osteomyelitis (3)
- Most often caused by staph aureus
- Most commonly from subcutanous, sinus, ear or dental infection
- Spine, pelvis and small bones most often affected
What are special characteristics of Exogenous osteomyelitis (3)
- often caused by shallow human bites or fist blows to the mouth
- most common pathogen is staph aureus
- direct contamination with bone can occur with fractures, surgery with implants, or IV sites of drug users
Diagnosis and treatment of osteomyelitis
- elevated WBC
-Bone scan very sensitive - CT, MRI
- IV antibiotics
- If chronic use surgical debridement
- Hyperbaric O2 therapy
What is Osteoporosis
Reduced bone mass or density
What is a BMD of a patient with osteoporosis
BMD of -2.5 SD
Severe osteoporosis is below -2.5 SD
When is peak bone mass acheived
mid 20s
What are the symptoms of Osteoporosis
Back pain, kyphosis, height loss, improper fit of clothing, protruding abdomen, negative body image
Risk factors for osteoporosis
Smoking, lack of physical activity, excess alcohol consumption, low calcium and vitamin D, thinness, genetics, premature menopause
Main factors for those at risk of osteoporosis
BMD, fracture history, age, family history
Clinical manifestations of osteoporosis
Dependant on bones involved, pain, fractures, bone deformity
What is bone generation directly related to
Physical activity, calcium intake, vitamin D, hormone levels
Secondary treatment of osteoporosis
HRT- estrogen allows for bone to absord
Calcitonin- acts as an anti-resorptive agent
Bisphosphonates- effects osteoclasts
What is the acronym for treatment of osteoporosis
C- calcium
D- Vitamin D
E- exercise
F- prevent falls
G- gain weight
S- stop smoking
what medication should a patient with osteoporosis go on
statins- lovostatin
significantly increases bone growth
Osteoporosis diagnosis
Bone mineral density test, x-ray, ct scan, serum test (calcium, phosphorus, alkaline phosphatase
What is the treatment for osteoporosis
prevent bone loss with vitamin supplements of Ca and vit D, fracture prevention, weight bearing exercises
Who should have the bone mineral density test done
women over 65, people who are under 65 and have 1 major symptom or 2 minor symptoms
What are the different kinds of bone tumors
Fibroblasts (osteoblasts, chondroblasts and fibroblasts)
Reticulum (blood cell precursors)
