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Orthopedic Conditions Flashcards

0
Q

What is osteoporosis?

A

Decreased bone density. Porous bone.

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1
Q

Metabolic Bone Diseases

A
  1. Osteoporosis
  2. Osteomalacia (Ricket’s)
  3. Osteomyelitis
  4. Paget’s Disease
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2
Q

Risk factors for osteoporosis. Nonmodifiable.

A
  1. > 50 years
  2. Female
  3. Caucasian
  4. Menopause
  5. Familial history
  6. Northern European ancestry
  7. Long period of inactivity/immobilization
  8. Depression
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3
Q

Risk factors for osteoporosis. Associated diseases and disorders. Endocrine disorders.

A
  1. Hyperthyroidism
  2. Hyperparathyroidism
  3. Diabetes mellitus. Type 2
  4. Cushing’s disease
  5. Male hypogonadism ( testosterone deficiency)
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4
Q

Risk factors for osteoporosis. Associated diseases and disorders. Low body weight. Malabsorption disorders.

A 
Low body weight: 
1. Decrease BMI
2. Small, bony body frame.
Malabsorption disorders:
1. Gastrointestinal disease
2. Gastric surgery.
Hepatic disease.
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5
Q

Risk factors for osteoporosis. Associated diseases and disorders. Medication.

A

Medication:

  1. Corticosteroids/steroids
  2. Immunosuppressants
  3. Heparin/ Coumadin
  4. Methotrexate
  5. Antacids containing aluminum
  6. Anticonvulsants
  7. Buffered aspirin
  8. Some antibiotics
  9. Some chemotherapy medications
  10. Laxatives
  11. Thyroid hormone
  12. Depro-provera ( contraceptive)
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6
Q

Risk factors for osteoporosis. Associated diseases and disorders.

A

Associated diseases and disorders:

  1. Chronic renal failure
  2. Osteogenesis Imperfecta
  3. Cancer/ cancer treatment/ skeletal metastases
  4. Eating disorders
  5. Spinal cord injury
  6. Cerebrovascular accident
  7. Acid-balance disorder (metabolic acidosis)
  8. Depression
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7
Q

Risk factors foe osteoporosis. Associated diseases and disorders. Diet and Nutrition.

A

Diet and nutrition:

  1. Calcium and magnesium deficiency
  2. Vitamin D deficiency
  3. Vitamin C deficiency (assists with calcium absorption)
  4. High ratio of animal to vegetable protein intake
  5. High fat diet ( reduced Ca++ absorption in the gut)
  6. Excess sugar ( depletes phosphorus)
  7. High intake of low Ca++ beverages
  8. Eating disorders
  9. Repeated crash dieting or yo-yo dieting
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8
Q

Signs and Symptoms of Osteoporosis

A

Loss of Height
Postural changes
Back pain
Fracture

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9
Q

Fractures sites that related to osteoporosis

A
  1. Distal radius
  2. Proximal femur
  3. Spine (Loss of height: kyphosis)
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10
Q

Diagnosis of Osteoporosis

A
  1. Blood tests
  2. X-rays
  3. Bone density tests ( DEXA)
  4. Bone biopsy
  5. CT scan
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11
Q

Treatment of Osteoporosis

A
  1. Depends on cause
  2. Diet: Increase dietary calcium
  3. Supplements:
    Calcium
    Vitamin D
    Phosphate supplements
  4. Estrogen replacement therapy (ERT)
  5. Exercise:
    Percussive
    Causes a muscle pull on the bone
    Extension for spinal compression fractures
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12
Q

Prognosis of Osteoporosis

A

Variable
Most prevalent bone disease worldwide
Can cause major orthopedic problems
Affects approximately 1/3 of women in US

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13
Q

Osteomalacia (Disease)

A

Defective mineralization of bone ( in children it is called rickets)

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14
Q

Osteomalacia ( Cause)

A

Lack of Vitamin D ( decreased intake, lack of sunlight, malabsorption)

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15
Q

Signs and symptoms of Osteomalacia

A

Bone pain, loss of height, bending & deformity in weight bearing bones.

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16
Q

Treatment of Osteomalacia

A

Correction of deficiency

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17
Q

Prognosis of Osteomalacia

A

Curable but depends on cause/ Adequate dietary intake of Vitamin D

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18
Q

Osteomyelitis (Disease)

A

Infection of bone -forming tissue; begins as acute but can become chronic

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19
Q

Cause of osteomyelitis

A

Trauma; acute bacterial infection, STAPHYLOCOCCUS

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20
Q

Signs and symptoms of Osteomyelitis

A

Dependent on which bones are affected and virulence of bacteria; include sudden onset of fever, chills, malaise, sweating, pain, tenderness, swelling over bone

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21
Q

Osteomyelitis (Diagnosis)

A

Blood cultures, aspiration, x-rays, bone scan

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22
Q

Treatment of Osteomyelitis

A

Bed rest, antibiotics, surgical drainage

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23
Q

Prognosis of Osteomyelitis

A

Frequently resolves favorably; if chronic, poor prognosis/ Take extreme care with standard precautions during surgery or after trauma

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24
Q

Paget’s Disease (Disease)

A
  1. Chronic metabolic skeletal disease
  2. High rate of bone turnover
  3. New bone growth outpaces breakdown of old bone
  4. New bone is thicker & weaker
  5. Primarily men over 40
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25
Q

Paget’s Disease/ Cause

A

Idiopathic

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26
Q

Paget’s Disease / Signs and Symptoms

A 
1. Pain: Depends on bones affected or extent
Headache
Radicular
Osteoarthritic
Muscular
2. Asymptomatic
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27
Q

Paget’s Disease/ Diagnosis

A

X-rays, bone scan, bone marrow biopsies; blood analysis, UA

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28
Q

Paget’s Disease/ Treatment

A

Symptomatic; High-protein diet with calcium & vitamin D supplements

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29
Q

Paget’s Disease/ Prognosis

A

Complications include fractures and deformity ( spinal curve, genu varus…)

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30
Q

Joint Diseases

A
  1. Osteoarthritis
  2. Rheumatoid arthritis
    Adult
    Juvenile
  3. Goat
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31
Q

Osteoarthritis (DJD)/ Disease

A

(DJD) Degenerative process of joints

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32
Q

Osteoarthritis/ Cause

A
  1. Abnormal cartilage
  2. Related to aging
  3. “Wear and tear”
  4. Obesity
  5. 90% of adults show some X-ray changes
  6. Secondary osteoarthritis may occur following injury
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33
Q

Osteoarthritis/ Signs & Symptoms

A
  1. Insidious onset
  2. Deep, aching joint pain, relieved by rest
  3. Stiffness, aching during weather changes
  4. Crepitation
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34
Q

Osteoarthritis/ Diagnosis

A
  1. History & physical exam
  2. X-rays
  3. Bone scans
  4. MRI
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35
Q

Osteoarthritis/ Treatment

A
  1. Minimize pain ( medication/surgery)
  2. Decrease inflammation (Medication)
  3. Minimize disability
  4. Maintain joint function ( Strengthening)
  5. Decrease risk factors
36
Q

Osteoarthritis/ Prognosis

A

Depends on site and severity

Progression varies

37
Q

Osteoarthritis……..nodes

A

Heberden’s nodes

38
Q

Rheumatoid Afthritis (RA)/ Disease

A

Chronic, systemic, inflammatory condition affecting synovial membranes of multiple joint
Destruction of cartilage
Erosion of bone
Deformity of joints
Remissions/ Exacerbations
Affects multiple joint usually some symmetry is involved

39
Q

Rheumatoid Arthritis (RA)/ Cause

A

Autoimmune disease

40
Q

Rheumatoid Arthritis (RA)/ Signs and Symptoms:

A
  1. Tender, warm, swollen joints.
  2. Symmetrical pattern. For example, if one knee is affected, the other one is also.
  3. Joint inflammation often affecting the wrist and finger joints closest to the hand; other affected joints can include those of the neck, shoulders, elbows, hips, knees, ankles, and feet
41
Q

(RA) cont. Signs and Symptoms:

A
  1. Fatigue, occasional fever, a general sense of not feeling well (malaise)
  2. Pain and stiffness lasting for more than 30. Minutes in the morning or after a long rest
  3. Symptoms that can last for many years
  4. Symptoms in other parts of the body besides the joints
  5. Variability of symptoms among people with the disease
42
Q

Rheumatoid Arthritis (RA)/ Diagnosis

A 
1. Blood tests
RA factor
Erythrocyte sedimentation rate (ESP)
Complete blood cell (CBC) count
2. X-rays
43
Q

Rheumatoid Arthritis (RA)/ Treatment

A
  1. Medication
    Anti-inflammatory
    Disease modifying
    Biologic Response ( Tumor necrotizing factor)
    Pain
  2. Preserve joint function (Exercise)
  3. Prevent joint deformities ( splinting, joint protection)
44
Q

Rheumatoid Arthritis/ Prognosis

A
  1. Variable course
  2. Can be good is diagnosed early because of new medical management
  3. Fatal for a small number of patients
    Cardiac
    Pulmonary fibrosis
45
Q

Pannus

A
  1. A sheet of inflammatory granulation tissue that spreads from the synovial membrane and invades the joint.
  2. Considered the most destructive element affecting joints in the patient with rheumatoid arthritis.
  3. Attack articular cartilage and destroys it.
  4. Can destroy the soft subchondral bone once the protective articular cartilage is gone.
46
Q

Goat/Disease

A
  1. Chronic uric acid metabolic disorder

2. Crystals of uric acid in synovial fluid

47
Q

Gout/ Cause

A

Metabolic, renal, or both

48
Q

Gout/ Signs & Symptoms

A
  1. Sudden onset of excruciating pain of joints of big toe (or other joints).
  2. Erythema
  3. Warmth
  4. Extreme tenderness
49
Q

Gout/ Treatment

A
  1. Medication
  2. Dietary: Decrease intake of purines
    Beer, other alcoholic beverages
    Anchovies, sardines in oil, fish roes, herring
    Yeast
    Organ meat (liver, kidneys, sweetbreads)
    Legumes ( dried beans, peas)
    Meat extracts, consommé, gravies
    Mugs
    Mushrooms, spinach, asparagus, cauliflower
    Decrease intake of alcohol
  3. Weight loss
50
Q

Gout/ Prognosis

A

Prognosis: Chronic condition that needs to be managed

51
Q

Juvenile Diseases of the Bone

A
  1. Osteogenesis Imperfecta

2. Arthrogryposis Multiplex Congenita

52
Q

Osteogenesis Imperfecta/ Disorder

A 
Congenital disorder of the collagen synthesis affecting bone and collagen
4 types (I-IV) with I being the most common and mildest form
53
Q

Osteogenesis Imperfecta / Cause

A

Genetic - autosomal dominate

54
Q

Osteogenesis Imperfecta / Clinical Manifestations:

A
  1. Brittle bones
  2. Shortened stature
    Abnormal development of the epiphyseal growth plates
    Deformity after fractures
    Osteoporosis
    Vertebral collapse
  3. Tendency to fracture decreases after puberty: Cortical bone density increases though trabecular density remains low
55
Q

Osteogenesis Imperfecta / Clinical manifestations:

A
  1. Blue or tinted ( purple or grey) sclerae
  2. Thin skin
  3. Deformity of the bony auditory structures – Hearing impairment
  4. Scoliosis/ pectus deformity
56
Q

Osteogenesis Imperfecta/ Treatment

A
  1. Orthopedic Management
  2. Medications used for osteoporosis
  3. New and developing: Bone marrow transplants of mesenchymal cells (Progenitors of osteoclasts). Gene therapy
57
Q

Osteogenesis Imperfecta / Prognosis

A
  1. I/IV have a milder course and have a relatively normal life span
  2. II Perinatal fatal
  3. III Cardiorespiratory failure secondary to kyphoscoliosis
58
Q

Osteogenesis Imperfecta / Implications of the PTA

A
  1. Careful handling
  2. Gentle stretching in straight planes - rotational forces are contraindicated
  3. Strengthening for disuse weakness and loss of bone stock
    Avoid placing weight near joint lines
    Long lever arms need to be avoided with resistance
    Swimming
    Standing at 10-14 month: Watch for lower extremity bowing
    Mobility
59
Q

Arthrogryposis Multiplex Congenita / Disease

A 
Multiple contracture present at birth.
3 types:
1. Contracture syndrome
2. Amyoplasia ( lack of muscle formats or development)
3. Distal arthrogryposis ( Hands/ Feet)
60
Q

Arthrogryposis Multiplex Congenita / Cause

A

Unknown, underlying condition that causes decreased fetal movements
Neuro
Muscular

61
Q

Fractures Closed/Simple

A

Break with no external wound to skin

62
Q

Fractures Open/ Compound

A

Break with open wound or bone piece protrudes skin

63
Q

Fractures Greenstick

A

Bone per tidally bent, split, children

64
Q

Fractures/ Comminuted

A

Bone is broken or splintered into pieces

65
Q

Fractures/ Impacted

A

One end of bone is forced into another

66
Q

Fractures/Incomplete

A

Fracture line does not include the whole bone

67
Q

Disease of the Muscles and Connective Tissue

A
  1. Polymyositis
  2. Systemic Lupus Erythematosus
  3. Duchenne Muscular Dystrophy
68
Q

Polymyositis /Disease

A

Chronic, progressive disease of connective tissue, inflammation, degeneration of skeletal muscles

69
Q

Polymyositis / Cause

A

Idiopathic, viral, autoimmune

70
Q

Polymyositis /Signs and Symptoms

A
  1. Insidious onset, muscle weakness in hips, thighs
  2. Difficulty with stairs, kneeling
  3. Dyspnea
  4. Respiratory difficulties
71
Q

Polymyositis/ Diagnosis

A

Muscle biopsy, elevated ESR

72
Q

Polymyositis /Treatment

A

Corticosteroid drugs; physical rehabilitation

73
Q

Polymyositis /Prognosis

A

Variable, worsens with age/ None known

74
Q

Systemic Lupus Erythematosus (SLE) D/S

A

Chronic, inflammatory connective tissue disorder, cells, tissue are damaged by auto-antibodies, immune complexes; more common in women

75
Q

SLE E/T

A

Autoimmune, genetic, environmental, hormonal factors

76
Q

SLE Signs & Symptoms

A
  1. Butterfly rash on neck, face, scalp
  2. Photo sensitivity of skin
  3. Joint, muscle pain
  4. Joint deformities
  5. Malaise
  6. Fever
  7. Anorexia
  8. Weight loss
77
Q

SLE /Diagnosis

A 
Blood test (CBC, ESR, antinuclear antibody...)
Physical examination
78
Q

SLE /Treatment

A
  1. Anti-inflammatory drugs

2. Corticosteroid creams to skin rashes

79
Q

SLE /Prognosis

A

Improves with early detection, poor with cardiovascular, renal, neurological complications, high death rate within 5 years/ None known

80
Q

Childhood Disease of the Musculoskeletal System

A

Duchenne Muscular Dystrophy

81
Q

Duchenne Muscular Dystrophy D/S

A

Progressive bilateral wasting of skeletal muscles - shoulder and pelvic girdle

82
Q

Duchenne Muscular Dystrophy E/T

A

Result of x-linked recessive disorder: affects male children

83
Q

Duchenne Muscular Dystrophy S/S

A

Exhibits waddling gait, toe-walking, lordosis. Falls easily, contractures

84
Q

Duchenne Muscular Dystrophy D/X

A

Family history, clinical picture, muscle biopsy, EMG

85
Q

Duchenne Muscular Dystrophy T/X

A

None known, treatment to correct, preserve mobility, PT, orthopedic appliances, surgery

86
Q

Duchenne Muscular Dystrophy P/P

A

Poor, death results from cardiac or respiratory complications/ Genetic counseling for carriers

87
Q

Gower’s maneuver

A

Due to weakness of pelvic muscles with MD

Pathology (6 decks)

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