Musculoskeletal V- Fractures, Pharmacology, Terminology

Question 1

Nonopiod agents- Action

Answer 1

• nonopiod agents provide analgesia and pain relief, produce anti inflammatory effects, and initiate anti-pyretic (reduces fever) properties
• these drugs promote a reduction of prostaglandin formation that decreases the inflammatory process , decreases uterine contractions, lowers fever, and minimizes impulse formation of pain fibers

Question 2

Nonopiod agents- Indications

Answer 2

• mild to moderate pain at various origins; fever, headache, muscle ache, inflammation (except acetaminophen), primary dysmenorrhea, reduction of risk of MI (aspirin only)

Question 3

Nonopiod agents- Side effects

Answer 3

• nausea, vomting, vertigo, abdominal pain, GI distress or bleeding, ulcer formation, potential for Reye syndrome in children (aspiring only)
  
  • Reye- A rare but serious condition that causes confusion, swelling in the brain, and liver damage.

Question 4

Nonopiod agents- Implications for PT

Answer 4

• patients are at increased risk for masked pain that would allow for movement beyond limitation or false understanding of their level of mobility
• complaints of stomach pain should be taken seriously with subsequent referral to a physician

Question 5

Nonopiod agents- Examples

Answer 5

• Tylenol (acetaminophen); Non steroidal anti inflammatories (NSAIDs); Aspirin (acetylsalicylic acid), Aleve (naproxen), Advil (ibuprofen), Celebrex (celecoxib)

Question 6

Opioid agents (Narcotics)- Action

Answer 6

• opioid agents provide analgesia for acute severe pain management
• medication stimulates opioid receptors within the CNS to prevent pain impulses from reaching their destination
• certain drugs are also used to assist with dependency and withdrawal symptoms

Question 7

Opioid agents (Narcotics)- Indications

Answer 7

• moderate to severe pain of various origins, induction of conscious sedation prior to a diagnostic procedure, management of opioid dependence, relief of severe and persistent cough (codeine)

Question 8

Opioid agents (Narcotics)- Side effects

Answer 8

• mood swings, sedation, confusion, vertigo, dulled cognitive function, orthostatic hypotension, constipation, incoordination, physical dependence, tolerance

Question 9

Opioid agents (Narcotics)- Implications for PT

Answer 9

• therapist must monitor the patient for potantial side effects, especially signs of respiratory depression

Question 10

Opioid agents (Narcotics)- Examples

Answer 10

• Roxanol (Morphine), Demerol (Meperidine), OxyContin (oxycodone), Sublimaze (fetanyl), Paveral (Codeine)

Question 11

Glucocorticoid agents (Corticosteroids)- Action

Answer 11

• provide hormonal, anti-inflammatory, and metabolic effects including suppresion of articular and systemic diseases
• these agents reduce inflammation in chronic conditions that can damage healthy tissue through a series of reactions
• vasoconstriction results from stabilizing lysosomal membranes and enhancing the effects of catecholamines

Question 12

Glucocorticoid agents (Corticosteroids)– Indications

Answer 12

• replacement therapy for endocrine dysfunction, anti inflammatory and immunosuppresive effects; treatment of rheumatic, respiratory, and various other disorders

Question 13

Glucocorticoid agents (Corticosteroids)- Side effects

Answer 13

• muscle strophy, GI distress, glaucoma, adrenocortical suppression, drug-induced Cushing syndrome, weakening with breakdown of supporting tissues (bone, tendon, ligament, skin), mood changes, hypertension

Question 14

Glucocorticoid agents (Corticosteroids)- Implications for PT

Answer 14

• therapist must wear a mask when working with patients on glucocorticoid therapy since their immune system is weakened
• patients are at risk for opsteoporosis and muscle wasting
• treatment of an injected joint will require special care due to ligament and tendon laxity or weakening

Question 15

Glucocorticoid agents (Corticosteroids)- Examples

Answer 15

• Dermacort (hydrocortisone or cortisol), Cordrol (prednisone), Pediapred (predisolone), Medrol (methylprednisolone), Decadrol (dexamethasone)

Question 16

Disease-modifying anti-rheumatic agents- Action

Answer 16

• DMARDs slow or halt the progression of rheumatic disease
• used early during the disease process to slow the progression prior to widespread damage of the affected joints
• they act to reduce remission by modifying the pathology and inhibiting the immune response responsible for rheumatic disease

Question 17

Disease-modifying antirheumatic agents- Indications

Answer 17

• rheumatic disease, preferably during early treatment

Question 18

Disease-modifying anti-rheumatic agents- Side effects

Answer 18

• nausea, headache, joint pain swelling, toxicity, GI distress, sore throat, fever, liver dysfunction, hair loss, potential for sepsis, retinal damage

Question 19

Disease-modifying anti-rheumatic agents- Implications for PT

Answer 19

• therapists should recognize that many of the agents have a high incidence of toxicity

Question 20

Avulsion fracture

Answer 20

• portion of a bone becomes framented at the site of tendon attachment due to a traumatic and sudden stretch of the tendon

Question 21

Closed fracture

Answer 21

• break in a bone where the skin over the site remains intact

Question 22

Comminuted fracture

Answer 22

• bone that breaks into fragments at the site of injury

Question 23

Compound fracture

Answer 23

• a break in a bone that protrudes through the skin

Question 24

Greenstick fracture

Answer 24

• break on one side of a bone that does not damage the periosteum on the opposite side
• often seen in children

Question 25

Nonunion fracture

Answer 25

• break in a bone that has failed to unite and heal after 9-12 months

Question 26

Stress fracture

Answer 26

• break in a bone due to repeated forces to a particular portion of the bone

Question 27

Spiral fracture

Answer 27

• break in a bone shaped like an “S” due to torsion and twisting

Question 28

Bursitis

Answer 28

• condition caused by acute or chronic inflammation of the bursae
• symptoms may include a limitation in AROM secondary to pain and swelling

Question 29

Contusion

Answer 29

• a sudden blow to a part of the body that can result to a mild to severe damage to superficial and deep structures
• Tx- AROM, Ice, and Compression

Question 30

Edema

Answer 30

• increased volume of fluid in the soft tissue outside of a joint capsule

Question 31

Effusion

Answer 31

• increased volume of fluid within a joint capsule

Question 32

Genu Valgum

Answer 32

• condition where the knees touch while standing with the feet seperated
• genu valgum will increase compression of lateral tibial condyle and increase stress to the medial structures
• “knock-kneed”

Question 33

Genu Varum

Answer 33

• condition where there is bowing of the legs with space between the knees while standing with the feet together
• Will increase compression of the medial tibial condyle and increase stress to the lateral structures
• “Bowleg”

Question 34

Kyphosis

Answer 34

• excessive curvature of the spine in a posterior direction
• usually identified in thoracic spine
• common causes:
  
  • osteoporosis
  • compression fractures
  • poor posture secondary to paralysis

Question 35

Lordosis

Answer 35

• excessive curvature of the spine in an anterior direction
• usually identified in the cervical or lumbar spine
• common cause:
  
  • weak abdominal muscles
  • pregnancy
  • excessive weight in abdominal area
  • hip flexion contracture

Question 36

Q angle

Answer 36

• degree of angulation present when measuring from the midpatella to the ASIS and the tibial tubercle
• normal Q angle measured in supine with knee straight is 13 degrees for a male and 18 degrees for a female
• abnormal can lead to bad tracking and pathology

Question 37

Sprain- Grades

Answer 37

• Grade I-
  
  • mild pain and swelling, little to no tear of ligament
• Grade II-
  
  • moderate pain and swelling, minimal instability of the joint, minimal to moderate tearing of the ligament, decreased ROM
• Grade III-
  
  • severe pain and swelling, substantial joint instability, total tear of the ligament, substantial decrease in ROM

Question 38

Strain- Grades

Answer 38

• Grade I-
  
  • localized pain, minimal swelling, and tenderness
• Grade II-
  
  • localized pain, moderate swelling, tenderness, and impaired motor function
• Grade III-
  
  • palpable defect of the muscle, severe pain, and poor motor function

Question 39

Tendonitis

Answer 39

• condition caused by acute or chronic inflammation of a tendon, symptoms may include gradual onset, tenderness, swelling, and pain