musculoskeletal part 2 (2) Flashcards
what is avasculer necrosis of the femoral head, where blood supply to the femoral epiphysis is interrupted
legg-calve perthes disease
how many stages does legg-calve perthes disease progress through and how long does that take?
4 stages through 1-4 years
what ages does legg-calve perthes disease occur in, and what is the average age?
2-12 y.o., average of 7
what gender is more likely for legg-calve perthes disease?
boys (5x more)
what races doe legg-calve perthes disease mostly effect?
caucasian, least in east asians
Case study
hx of…
-breech birth
-low birth weight
-smoker parents
-injury to leg
presents with…
-mild pain anterior thigh
-limp worse with activity
pain/limp relieved with rest
patient probably has…..?
legg-calve perthes disease
what stage of legg-calve perthes disease is when injury or coagulation disorder causes loss of blood to femoral head?
prenecrosis
what stage of legg-calve perthes disease is the avascular stage, asymptomatic, x rays show normal, femur is intact but avascular?
necrosis (I)
what stage of legg-calve perthes disease has pain and limited mvmt, new bone deposits, dead bone reabsorption, fx and deformity of femur can occur. lasts 1-4 years
revascularization (II)
what stage of legg-calve perthes disease is where reossification takes place and pain decreases (healing stage)
bone healing (III)
what stage of legg-calve perthes disease is where the process is over, there is no pain and improved joint function
remodeling (IV)
what is the size difference is a thigh affected wih legg-calve perthes disease?
2-3 cm
how long does treatment for legg-calve perthes disease take
2 years
what will a child with legg-calve perthes disease be placed in?
traction and bracing
what kind of meds are people with legg-calve perthes disease on
anti-inflammatory
what is important to tach abot in legg-calve perthes disease
skin care
case study…
david 14 y.o. obese
-hx of mild aching pain in right hip for 4 weeks, pain in right knee, recent growth spurt, limps, dec. ROM right hip
what is the diagnosis?
slipped capital femoral epiphysis (SCFE)
how is slipped cpital femoral epiphysis (SCFE) diagnosed?
history and xray
what classifies chronic SCFE?
longer than 3 weeks
what happend after a SCFE disgnosis?
becomes an emergency! need to keep weight off
which of the following best describes SCFE?
1. Pain caused by sudden growth of the bone during a growth spurt
2. A congenital malformation of the hip joint
3. The femoral had is displaced from the femoral neck
4. avascular necrosis of the femoral head
3
between what ages is SCFE seen in?
adol. growth spurt, 10-16 in boys
What gender is SCFE seven more in?
boys
Which races is SCFE more seen in?
Black, Hispanic, Pacific Islanders
what things increase the risk for SCFE?
Overweight, injured, other trauma, radiation or endocrine disease
describe stable versus unstable SCFE?
stable = can walk
unstable= cant walk
Which of the following are complications of SCFE?
1. Synovial membrane becomes inflamed, edematous, and painful
2. callous formation can occur
3. hip deformity develops
4. limited rom of hip
all!
how is SCFE usually treated? (stable vs. unstable)
stable = 1 screw outpatient
unstable = more screws
nurse care post-op for SCFE
- adequate nutrition (inc. protein)
- med admin
- traction management
which of the following may be phyically observed in scoliosis?
1. uneven shoulders/hips
2. prominent scapula
3. truncal asymmetry
4. one sided rib hump
all
what is a lateral c or s shaoed curve of the spine usually associsted with roatational deformityof spine/ribs
scoliosis
what are the 2 classifications of scoliosis?
idiopathic or compensatory
curves of the spine greater than what degree are abnormal?
10°
what is the dignosis for scoliosis?
- radiology
- screening (5-7 grade)
- standing up
- adams test
what is the adams test for scoliosis
forward bend, arms togehter
what degree classifies mild scoliosis
10-20
non surgical treatment for scoliosis?
exercise for posture/miscle tone. maintain or decrease degree of curvature
goal of scoliosis treatment
build strength on outside of curve while stretching the inside
what is worn 23 hours a dayafter diagnosis of scoliosis to maintain spinal curvature
boston brace
what stimulates msucles to contract to help correct spinal curvature, is used overnight instead of boston brace
electrical stimulation
what degree of curvature is severe scoliosis
40°-50°
Realignment or straightening of the spine with internal fixation or instrumentation combined with bony fusion of the realigned spine
spinal fusion with instrumentation
what is a huge downside of spinal fusion with instrumentation surgery for scoliosis
lots of blood loss
when and how do you turn a patient after scoliosis surgery
log roll q2h, prevent twisting
how long is activity limited for after scoliosis surgery depending on the doc?
6-8 months
