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Nursing Intro > Musculoskeletal System Disorders 2 > Flashcards

Musculoskeletal System Disorders 2 Flashcards

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1
Q

The four basic functions of skeletal muscle

A

Facilitate body movement by muscle contraction
Maintain body position by continuing muscle tone
Stabilize the joints and prevent excessive movement
Maintain body temperature by producing heat through muscle contraction

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2
Q

What are the connective tissue coverings of skeletal muscles?

A

Epimysium - surrounds whole muscle
Perimysium - surrounds the fascicles
Endomysium - surrounds individual muscle fibers

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3
Q

Motor unit

A

The motor neuron of the spinal cord and all the muscle fibers it stimulates

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4
Q

Neuromuscular Junction

A

The synapse between the end of the motor nerve and the receptor site in the muscle fiber where acetylcholine is released

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5
Q

Explain the mechanism for muscle contraction

A

Action potential from motor neuron arrives at the presynaptic terminal
Arrival of the action potential results in depolarization of presynaptic terminal
Depolarization causes calcium influx into presynaptic terminal
Calcium influx causes exocytosis of Ach into synaptic cleft
Diffusion of neurotransmittor to postsynaptic receptor results in muscle action potential
Muscle action potential travel down the t-tubules to cause second messenger activation
Calcium is released from sarcoplasmic reticulum and causes the power stroke
Calcium is transported back into the sarcoplasmic reticulum
Both muscle contraction and relaxation require ATP

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6
Q

What is myoglobin?

A

Binds oxygen in muscle fibers, similar structure to hemoglobin

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7
Q

What is the function of glycogen?

A

Stores glucose, present in muscle fibers

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8
Q

When does anaerobic respiration begin?

A

If the supply of oxygen does not meet demand, glucose is used as a primary energy source

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9
Q

What is an oxygen debt?

A

The amount of oxygen required to restore the muscle cell to its normal resting state, including converting lactic acid to pyruvic acid, glucose or glycogen and replenishing ATP

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10
Q

Tendon

A

The connective tissue covering the muscle extends to form a cordlike structure or tendon

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11
Q

Ligaments

A

Form a direct attachment between two bones

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12
Q

Muscle antagonists

A

One muscle opposes the action of another

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13
Q

What effect does cardio (aerobic or endurance) have on muscle cells?

A

Increases the capillaries and blood flow in a muscle as well as the mitochondria and myoglobin content - efficiency and endurance

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14
Q

What effect does anaerobic or resistance exercise (weight lifting) have on the muscle?

A

Increases muscle strength by increasing muscle mass

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15
Q

Side effects of anabolic steroids

A

Liver damage, cardiovascular disease, personality changes, emotional lability and sterility

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16
Q

Reasons a muscle may atrophy

A

Disuse, Nutritional deficiency (protein), disorders like anorexia and Crohn’s, degenerative changes involving accumulations of fatty or fibrous tissue.

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17
Q

What happens to muscle with age?

A

A decrease in the number of cells and a decrease in the size of the fibers.

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18
Q

What is muscle twitch?

A

Tetany, increased irritability of the motor nerves supplying the muscle.

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19
Q

Synarthroses

A

Type of joint movement, immovable, ex. sutures in skull

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20
Q

Amphiarthrosis

A

Slightly moveable - joints where bones are connected by fibrocartilage or hyaline cartilage. Ex. Symphysis pubis

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21
Q

Diarthroses or synovial

A

Freely movable joints

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22
Q

Articular capusle

A

Composed of the synovial membrane and its outer covering, the fibrous capsule. Tough, protective, extends into the periosteum.

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23
Q

Menisci

A

Moon-shaped fibrocartilage pads

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24
Q

Bursae

A

Fluid-filled sacs composed of synovial membrane and located between structures like tendons and ligaments.

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25
Q

Electromyogram (EMG)

A

Measure electrical charge associated with muscle contraction, helpful in differentiating muscle disorders from neurologic disease.

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26
Q

Arthroscopy

A

Used to visualize joints - insertion of lens into joint

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27
Q

A complete fracture

A

Bone is broken in two

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28
Q

Incomplete fracture

A

Bone is partially broken

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29
Q

Open or compound fracture

A

Skin is broken, more damage to soft tissue including blood vessels and nerves

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30
Q

Closed fracture

A

Skin is not broken at fracture site

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31
Q

SImple fracture

A

A single break, the bone ends maintain alignment and position

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32
Q

Comminuted fracture

A

Multiple fracture lines and bone fragments

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33
Q

Compression fracture

A

Bone is crushed or collapses into small pieces

34
Q

Impacted fracture

A

One end of the bone is forced or telescoped into the adjacent bone

35
Q

Pathologic fracture

A

Weakness in the bone structure due to conditions such as a tumor or osteoporosis

36
Q

Stress fracture

A

From repeated excessive stress

37
Q

Depressed fracture

A

Occurs in the skull when the broken section is forced inward on the brain

38
Q

Spiral fracture

A

A break that angles around the bone

39
Q

Colles’ fracture

A

a break in the distal radius at the wrist, commonly occuring when a person attempts to break a fall by extending the arm and open hand

40
Q

Pott’s fracture

A

A fracture of the lower fibula due to excessive stress on the ankle

41
Q

Steps to bone healing

A

A hemotoma or clot forms in the medullary canal
Necrosis occurs at the ends of the broken bone
Inflammatory response as a reaction to trauma and debris
The hematoma becomes a fibrin network into which granulation tissue grows.
New capillaries extend into the tissue
Phagocytic cells and fibroblasts (lay down new collagen fibers) migrate.
Chondroblasts begin to form cartilage
The two bone ends become splinted together by a procallus or fibrocartilagionous callus.
Osteoblasts from periosteum and endosteum begin to generate new bone, forming a body callus.
Subsequent motnhs - repaired bone is remodeled by osteoblastic and osteoclastic actviity in response to mechanical stresses

42
Q

Steps to bone healing summarized

A

Hematoma, granulation tissue, procallus (fibrocartilage) bony callus, remodeling.

43
Q

Complications related to healing of bone:

A

Muscle spasm - can pull bone fragments out of position
Infections such as tetanus or osteomyelitis - threat to compound fractures or when surgery needed
Ischemia - cast can compromise circulation
Compartment syndrome - may develop shortly after the fracture occurs when there is inflammation, such as with crush injuries. Increased pressure of fluid within the fascia compresses the nerves and blood vessels cause ischemia of the muscle.
Fat emboli - when fatty marrow escapes from the bone marrow into a vein - can travel to the lungs and cause obstruction - behavioural changes, confusion, disorientation
Nerve damage
Failure to heal
Fractures in and near a joint may have long-term effects like osteoarthritis or stunted growth if near epiphyseal plate.

44
Q

Physiological manifestations of severe pain

A

Pallor, diaphoresis, hypotension, tachycardia

45
Q

Reduction of a fracture

A

Puts the bones back into alignment

46
Q

Subluxation

A

If a bone is only partially displaced, with partial loss of contact between the bones.

47
Q

Sprain

A

A tear in a ligament

48
Q

Strain

A

Tear in a tendon

49
Q

Avulsion

A

When ligaments and tendons are completely separated from their bony attachments

50
Q

Degrees of muscle tears

A

First - small % of muscle
Second - stops short of being a complete tear. Muscle can only partially contract
Third - complete tear across muscle width, muscle unable to contract

51
Q

Repetitive strain injury

A

Disorders affecting muscles, tendons, and nerves. Repeated forceful or precision movements. Rapid repetition of certain movements interferes with circulation to the area and damages soft tissues with cumulative effects.
Pain, weakness, numbness.

52
Q

Tendinitis

A

A repetitive strain injury. Inflammation or injury of the tendon and sheath

53
Q

Risk factors for osteoporosis

A 
Aging - decreased osteoblast activity
Decreased mobility
Hormonal factors = hyperparathyroidism, Cushing's syndrome, glucocorticoids like prednisone
Deficits of calcium, D, protein
Smoking
Caffeine
Light bone structure
54
Q

Therapeutic measures for osteoporosis

A

Supplements of calcium and vit D
Fluoride supplements promote bone deposition
Bisphoshonates can inhibit osteoclast activity
Calcitonin
Injected human parathyroid hormone to decrease bone resorption
Weight bearing exercise
Surgery to reduce kyphosis.

55
Q

Rickets and Osteomalacia

A

Result from deficit of Vit D and phosphates required for bone mineralization
Leads to lack of calcification of cartilage leading to weak bones and deformities

56
Q

Paget’s disease

A

Progressive
Excessive bone destruction
Bone replaced by fibrous tissue and abnormal bone
Structural abnormalities, thickening

57
Q

Osteomyelitis

A

Bone infection caused by bacteria, sometimes fungi
Local inflammation and bone pain
Fever and excessive sweating, chills, malaise

58
Q

Lordosis

A

Spine curving significantly inward at lower back

Caused by achondroplasia, obesity, discitis, slipping forward to vertebrae

59
Q

Kyphosis

A

Hunchback

Poor posture, spina bifida, congenital defects, spinal tumors or infections, Scheuermann’s disease

60
Q

Scoliosis

A

Curve to spine.

Can be inherited

61
Q

Osteosarcoma

A

A primary malignant neoplasm that usually develops in the metaphysis of the femur, tibia, or fibula

62
Q

Ewing’s sarcoma

A

A malignant neoplasm occurs in diaphysis of long bones

63
Q

Chondrosarcoma

A

Arise from cartilage cells, usually pelvic bone or shoulder girdle at points of muscle attachment and eventually metastasize to the lung.

64
Q

Muscular Dystrophy

A

A group of inherited disorders
Degeneration of skeletal muscle
Duchenne’s or pseudohypertrophic is the most common
Affects young boys
Caused by a deficit of dystrophin (a muscle cell membrane protein) leads to degeneration and necrosis of the cell
Muscle fibers are replaced by fat and fibrous connective tissue

65
Q

Signs of muscular dystrophy in children

A

Motor weakness
Waddling gait
Difficulty attaining upright posture
Tendon reflexes reduced
Majority develop cardiac abnormalities and mental retardation
Death usually by 20 from respiratory or cardiac failure.

66
Q

Primary Fibromyalgia Syndrome

A

Group of disorders
Pain and stiffness affecting muscles, tendons, and surrounding soft tissues
No obvious signs of inflammation or degeneration
Cause not known
Aggravated by: sleep deprivation, stress and fatigue.

67
Q

Osteoarthritis

A

Degenerative, “wear and tear” joint disease
Articular cartilage of weight-bearing joints like hips and knees are damaged and lost through structural fissures and erosion resulting from excessive mechanical stress.
Surface of cartilage becomes rough and worn and interferes with joint movement
Tissue damage causes the release of hormones, which accelerates the disintegration
Subchondral bone may be exposed and damaged, cysts and osteophytes or new bone spurs develop
Pieces of the osteophytes and cartilage break off into the synovial cavity causing further irritation
joint space becomes narrower
Congenital abnormalities can predispose
Joint movement limited, the joint can appear enlarged and hard as osteophytes develop

68
Q

Rheumatoid Arthritis

A

Autoimmune
Chronic systemic inflammatory disease
Progressive damage to joints
Abnormal immune response, causing inflammation of the synovial membrane with vasodilation, increased permeability and formation of exudate, causing typical red, swollen, painful joint called synovitis.
Characterized by remissions and exacerbations

69
Q

How does rheumatoid arthritis progress?

A

Synovitis - inflammation, synovial cells proliferate
Pannus formation - granulation tissue from the synovium spreads over the articular cartilage, releases enzymes destroying cartilage.
Cartilage erodes
Pannus cuts off nutrients from synovial fluid
Pannus between the bone ends becomes fibrotic and limits movements, then calcifies and removes joint space.
Ankylosis - joint fixation and deformity develop

70
Q

Other complications from rheumatoid arthritis

A

Atrophy of muscles
Alignment of bones in joint shifts
Inflammation and pain can cause muscle spasm further drawing bones out of allignment
Contractures and deformity
Systemic effects from circulating immune factors, causing fatigue, depression, malaise, anorexia, fever, iron deficiency,

71
Q

Juvenile Rhematoid Arthritis

A

Usually more acute than adult form, systemic effects are more marked, rheumatoid nodules are absent. Large joints frequently affected.

72
Q

Infection Septic Arthritis

A

Usually develops in a single joint
Red, swollen, painful, decreased range of movement.
Purulent exudate
Caused by blood-borne baceria

73
Q

Lyme disease

A

Caused by a spirochete and transmitted by ticks
Characterized by a migratory arthritis and rash developing several weeks to months after the tick bite
Knee and other large joints most often involved

74
Q

Gout (gouty arthritis)

A

Results from deposits of uric acid and urate crystals in the joint that then cause an acute inflammatory response
Uric acid is usually excreted through the kidneys, excess amount causes hyperuricemia.
Often affects a single joint, damages articular cartilage, redness and swelling.

75
Q

Tophus

A

A large, hard nodule consisting of urate crystals that have been precipitated in soft tissue or bone causing a local inflammatory reaction. Usually occur after first year of gout

76
Q

Ankylosing Spondylitis

A

Chronic, progressive inflammatory condition, affects the sacroiliac joints, intervertebral spaces, and costovertebral joints.
Autoimmune disorder.
Vertebral joints become inflamed, then fibrosis and calcification or fusion of joints follows.
Ankylosis means fixation
Causes a straight back as spine fuses.
Kyphosis develops from postural changes necessary because of rigidity of spine
Osteoporosis

77
Q

Bursitis

A

Inflammation of the bursae associated with bones, muscles, tendons and ligaments of various joints. Can be caused by regular repetitive movements.

78
Q

Synovitis

A

Inflammation of the synovial membrane lining the joint
Movement of joint is restricted and painful due to swelling as the synovial sac fills with fluid. Joint becomes swollen, red, and warm.

79
Q

Tendinitis

A

Irritation or inflammation of tendon.
Dull ache at site of tendon attachment, tenderness, milk swelling.
Likely from repetitive motions or actions.

80
Q

What characteristic do rheumatoid arthritis, juvenile arthritis, and ankylosing spondylitis have in common that often requires aggressive treatments?

A

These joint disorders all have systemic effects. Rheumatoid arthritis causes fever, fatigue, and anorexia. Juvenile arthritis forms cause uveitis, fever, rash, lymphadenopathy, hepatomegaly, and joint involvement. Ankylosing spondylitis can cause osteoporosis and restrict lung expansion.

Nursing Intro (16 decks)

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