OTC-card Flashcards
Define the terms Arthroscopy, and Arthroplasty
Arthroscopy-Is the process of inserting a small camera into a joint. This often done trhough a small incision to Dx or to help Tx
Arthroplasty- Is the replacement of a joint. Frequently done using an artificial implant. Ex) Hip replacement
Discuss the Tx for Psoriatic arthritis
Psoriatic Arthritis is Dx by blood tests, X-rays, and Joint fluid tests. Erythrocyte sedimentation rate can be used in Dx. Antibody’s are not present w/ PA.
Tx- Anti-flammatory drugs, corticosteroid joint injection, Immunosuppressants, and antirheumatic drugs.
Psoriatic Arthritis
- Symmetric psoriatic arthritis is the most common type, accounting for 50% of all cases. Affects both sides of the body at the same time.
- Asymmetric type, affecting 35%. Is milder form. Occurs on only 1 side of the body, involves fewer joints.
- Arthritis Mutilans,rare and sever. is progressive disease and deforms and destroys the joins over time.
- Spondylitis: Generally affects the spinal column, causing stiffness, but can also occur in the hands and feet. The distal IP predominant type causes inflammation of the joints at the end of the digits. Causing obvious changes in the nails
Spondylolysis
AKA- Pars Defect. Is a condition which involves a fx of the pars interarticularis (Pars Interarticularis: is the the bony ring of the back of the vertebra and the weakest part ) and is generally the result of strain in Hyperextension of the spine repeaeatedly. Most often in children and adolescent due to mutaring spine.
S/s of fx is pain and stiffness in the lower back and the pain may radiate down the legs by pressure on the nerve root.
Dx and Tx of Spondylolysis
Dx- Palpation of spinal column, ROM test Imaging testing, Neuro exam,
Tx- For C-spine Cervical coller but for short time. NSAIDS, Sugical fusion of Vertebrae or removal of disk
Dx and non-surgical Tx for Ulnar nerve Entrapment
Fx, bone spurs, cysts and trauma are risk factors. The site of entrapment may provide location.
S/s- numbness to the ulnar side 4th and 5th digit, muscle weakness and muscle hypotrophy.
Dx- Physical exam, X-ray( bone spurs), Nerve Conduction test,
Tx- Reduction( Fx), Splinting, Anti-inflammatory drugs and Steroids injection
Trigger Finger
trigger thumb, or trigger digit, stenosing tenosynovitis, is a common disorder characterized by catching, snapping or locking of the involved finger flexor tendon, associated with dysfunction and pain. A disparity in size between the flexor tendon and the surrounding retinacular pulley system, most commonly at the level of the first annular (A1) pulley, results in difficulty flexing or extending the finger and the “triggering” phenomenon.The label of trigger finger is used because when the finger unlocks, it pops back suddenly, as if releasing a trigger on a gun. Common in people 40-60 yrs, Diabetes and Rheumatoid Arthritis. Tx splinting, corticosteroids and surgical incision of the tendon sheath mainly A-1 pulley
Gamekeeper’s Thumb
Stretching and tearing to the ulnar ligament of the CMC joint of 1st digit by forceful abduction of the thumb and my accompany avulsion Fx of the1stMc
Tx- Splinting/casting( w/ or W/out fx) or surgical reattachment by anchor to the bone. complication Arthritis
Ankylosing Spondylitis
(AS) AKA Spondylitis- Is a chronic inflammatory arthritis of the Vertebral column and sacroiliac joint eventually to fusion. Restricting movement and causing pain. Striking ages 15-30. and rare above age over 40
S/S of Ankylosing Spondylitis
A type of spondylarthropathy. ( group of disease affecting the spine) Has a variable presentation in individuals.
S/S- Chronic pain and stiffness in spine, In 40% of people may affect the anterior chamber of the eye ( uveitis) causing redness, eye pain, vision loss and floaters and photophobia.
Pt may bend over to relive pain.. Left un-Tx may cause neurological problems.
Enchondroma
Ollier’s disease and Maffucci’s syndrome.Is a cartilage cyst found in the bone morrow, A type of nonmalignant tumor of the bone. Generally develops in the cartilage lining of the bone canal. Mostly affecting the hands and feet but , can affect long bones. Happing manly to 10-20 yrs olds.
S/S pain and lead to fx of the affected bone, deformities .
Dx and Tx of enchondroma
Dx- Physical exam, X-rays, Fx,
Tx- usually just watch for growth, Tx of fx or surgery.
Boutonniere Deformity
Inflammation that forces the PIP into flexion position, stretching the central slip and rupturing. Increasing tension of the Dip extensors into hyperextension. Causes- Acute trauma, burns, infections, and arthritis
Erosive Osteroarthritis
( Inflammatory Osteroarthritis )Most common form of Osteoarthristis and hereditary.
S/S swelling , pain, cyst formation in finger joints.
Dx-X-rays Tx- splinting, NsAIDS, corticosteroids, reconstruction surgery or fusion of bones.
Chondrosarcoma
A type of bone cancer that forms in cartilaginous cells. Is rare under the age of 20, common among 50-70 yrs. has a grade rate of growth 1-4.
S/S fx, pain, swelling and bone deformities
Dx and Tx of Chondrosarcoma
Dx- Biopsy, x-ray, ct, MRI, and NM bone scans. Can evole from cartilage tumors but usually originates in norm cartilage cells.
Tx- surgical removal, Chemotherapy, radiation, amputation and in some cases proton therapy
Pathological of Bone healing problems
Causes- Inadequate immobilization (poor formation of hematoma), Distraction( separation) of bone fragments, inadequate blood supply (vascular necrosis), infection, and interposition of soft tissues ( granular tissue filling th gap between bone. One or all can cause one another. .
Bone healing
Fx should normally take 4- or 8-12 weeks ( 2-3 months) Are 5 stages of healing
Stage 1- Inflammation, Stage 2- cellular proliferation( hematoma ), Stage 3- Callus formation, Stage 4-Ossification and stage 5- remodeling ( normal bone maintenance .
Bolster dressing
Wet-to-dry dressing
Thyroid collar
Bolster dressing ( Stent )-A dressing that is sutured into place. Often used over a graft site to ensure even pressure over new graft
Wet-to-dry dressing- application of a wet dressing on a wet wound, use as a form of wound debridement.
Thyroid collar- a neck wrap applied to hold the dressing over a thyroid incision.
Arthrodesis Arthrocentesis Laminectomy Synovectomy Disarticulation
Arthrodesis- the surgical fusion of a joint. Use to tx pain, and increase stability of the joint. Mostly on wrists and ankles.
Arthrocentesis- aspiration of a synovial joint fluid by needle. Use to Dx and Tx
Laminectomy- surgical removal the lamina ( posterior vertebral arch) of vertebrae to relive pressure on nerve root.
Synovectomy- surgical removal of the synovial membrane w/in a joint. Use to tx rheumatoid arthritis
Disarticulation- Amputation through the joint.
Attire
OR contains a semirestricted area. different attire is required depending on function. surgical attire
Menisci of the knee
Has to meniscus, lateral and medial, that absorb and cushion the knee. Are fluid filled crescent shaped disk of cartilage that sits atop the tibia. The borders are attach to the lining of knee. Are divided into Anterior, body and posterior horn. Are avascular except for the borders. Making only the borders heal tears. Damages result from twisting or direct hits tithe knee. Medial common injury
Arthrotomy Desmotomy myotomy neurotomy tenotomy Artrectomy Ostectomy Sequestrectomy Arthrodesis Synostosis
Arthrotomy- An incision into joint Desmotomy-an incision of a ligament myotomy- An incision of muscle neurotomy- Incision of nerve Osteotomy- cutting of bone tenotomy- Incision of tendon Artrectomy- Incision of joint Ostectomy- excision of bone Sequestrectomy- excision of dead bone Arthrodesis- Removal of cartilage of a jopint to promote bone fusion Synostosis-Fusion of bone that are normally separated.
Adhesion
Plica
Atrophy
Bifurcation
Adhesion-The joing together of normmally sepatated tissue. Can be cause by inflamation, injury, or surgical..
Plica-Is a fold, ridge or pleat in synovial tissue of a joint capsule. Often resulting from injry.
Atrophy- The wasting away of tissue or body part. Can be cause by Poor nutrition, circulation, nerve supply decrease hormone levels, disease and lack of use.
Bifurcation- The splitting of an anatomical structure into 2 parts.
Osteomyelitis Osteonecrosis Osteoma Osteoporosis Osteopenia
Osteomyelitis- an acute or chronic inflammation and infection of bone.
Osteonecrosis- death of bone tissue. Post-traumatic, non-traumatic or idiopathic. Cause from avascular
Osteoma- bone tumor
Osteoporosis- loss of bone density resulting from a loss of calcium. Resulting in weak brittle bone that Fx easily.
Osteopenia- loss of bone mass to an abnormally low level.
Ankle joint
The true ankle joint- Tibia, fibula and Talus bones. That allow dorsiflexion and plantarflexion.
Subtalar joint- Talus and calcaneous bones allow lateral side-to-side motion. On the lateral the tibiofibular ligament connects the fib w/ the calcaneouse ( lateral stability. Medial side the Deltoid Ligament joins the tibiaand talus to the calcaneous ( stabilizing the medial side.
Orthopedic implants
Include screws, plates, wires, pins, nails, rods, and joint components. Different alloys such asTitanium, stainless steel, and cobait-chromium. All implants most be made of the same alloy. Some alloy my corrode others alloys.
Fibrosis Erysipelas Cornification Keratosis Edema
Conditions that can occur w/ lymphedema
Fibrosis- hardening of soft tissue
Erysipelas- Greek for red skin. Result of an acute streptococcal infection of the skin and adipose tissue
Cornification- changing of normal skin cells into a hard keratin cells
Keratosis- growth of thick scaly bumps on skin
Surgical handwashing procedure
Remove all jewelry, examine fingers, hands and forearms for open wounds and soiling. Use nail pick to clean under each nail.Start water, grab scrub brush and wet up past two inches of the elbow. Scrub under nails w/ side of brush, Scrub all sides of the fingers, hands, and forearms. Rinse from finger tips to elbow allowing excess water to drip off.
Hemostatic agents in ortho surgery
Used to stop bleeding during surgery. Glefoam (pad form, mositen applied), Avitene ( Dry padding apllied to bone), ThrombinBovine product that comes in liquied or powder and use topically.), and bone wax( Sterile beeswax and rolled on to apply.
Lasers in Ortho surgery
Corbon dioxide laser( use to reomve methacrylate/ Bone cement) and the Nd;YAG laser use during arthroscopies of the knee.
Methyl Methacrylate
Bone cement. Use during total joint replacement, by stabilizing the implant and holding it in place. Bonding the implate w/ the bone. Prep in surgery w/ sterile H2o and powder. Fumes can irritate mucos membrans.
Types of joints
Synarthrosis joint-Immovable joints, connected by thin cartilage ex) cranial bones
Amphiarthrosis joint- slightly movable joint. Ex) pubic symphysis and vertebral joints
Diarthrosis joint- freely movable joint
Types- ball-&-socket, condyloid, gliding, hinge, pivot and saddle joints.
Fovea Head Process Trochanter Tubercle Tuberosity
Fovea- cup-shape depression on bone.
Head- proximal end of bone
Process- natural projection from bone
Trochanter- Lg. process on femur serves as muscle attachments. Greater & lesser trochanters.
Tuberosity- small projection of bone. Compared to troch
Tubercle- smallest process or nodule of bone.
Internal derangment of the Knee
A chronic condition that covers a number of abnormality structures that disrupt normal joint function. Involing structures: Collateiral ligaments , cruciate ligament and semiluner cartilage ( Meniscis). Most common MCL, next ACL and Medial meniscis of the knee.
S/S- Pain, swelling, and funcitional impairment.
Tx- Dx and Tx by MRI, Antroscopic surgery.
Bucket Handle Tear
A type of meniscal tear that results from trauma, Is the tearing of the rim. The middle part resembles a bucket handle, may become wedge in the joint. Preventing ROM ( locking ) Tx- Arthroscopic surgery to remove meniscus fragment.
Dupuytren’s disease
A progressive disease that has an inherited component higher risk w/ Northern European descent. Involes the shirking and thickening of fascia of the palm and fingers. Resulting in abnormal flexion of digits and causing bumps and depression in the skin. Commonly affecting the 5th and 4th digits. Severity varies in individuals.
Tx surgical and may reacur
Ball-&-socket joint
Spheroidal joint) is a joint in which the ball-shaped surface of one rounded bone fits into the cup-like depression of another bone. The distal bone is capable of motion around an indefinite number of axes, which have one common center. An Enarthrosis is a special kind of spheroidal joint in which the socket covers the sphere beyond its equator
Examples-Hip and in the glenohumeral joint of the shoulder.
Condyloid joints
condylar, ellipsoidal, or bicondylar ) is an ovoid articular surface, or condyle that is received into an elliptical cavity. This permits movement in two planes, allowing flexion, extension, adduction, abduction, and circumduction
Gliding joint
A plane joint, arthrodial joint, plane articulation) is a synovial joint which, under physiological conditions, allows only gliding movement. Permit sliding or gliding movements in the plane of articular surfaces. The opposed surfaces of the bones are flat or almost flat, with movement limited by their tight joint capsules. They are numerous and are nearly always small, such as the acromioclavicular joint between the acromion of the scapula and the clavicle. Typically, they are found in the wrists, ankles & between the 2nd and 7th sternocostals, vertebral transverse and spinous processes.2
Hinge Joints
(Ginglymus) is a bone joint in which the articular surfaces are molded to each other in such a manner as to permit motion only in one plane.
The direction which the distal bone takes in this motion is seldom in the same plane as that of the axis of the proximal bone; there is usually a certain amount of deviation from the straight line during flexion.
The articular surfaces of the bones are connected by strong collateral ligaments.
Ex- interphalangeal joints and elbow.
Pivot Joint
(trochoid joint, rotary joint, Lateral Ginglymus) is a type of diarthrosis. The axis of a convex articular surface is parallel with the longitudinal axis of the bone. Pivot and hinge joints can be both considered cylindrical joints.Allows for rotation or internal or called pronation and supination. In the standard anatomical position
Soft tissue structures of the knee
The patella is located w/in the quadriceps tendon. The patella tendon originates superior knee joint and inserts to the posterior knee joint. over the patella. The Anterior (ACL) and posterior (PCL) cruciate ligament located in the middle of the joint and stabilize it. PCL attaches medial condyle of the femur and posterior tibia, prevents anterior displacement of femur to the tibia. ACL attaches to the posterior lateral condyle of the femur and a notch to the tibial condyles, prevents posterior displacement of the femur. Prevent hyperextension and rotation of the femur. The meniscus attaches to the top of the tibia.
Knee capsule
Is attached to the femur, tibia, and fibula. Proximal attaches to the femur lateral and medial condyles. Distally attaches to the tibia lateral and medial condyles. Also attaches to the superior portion of the fibula. Is stabilized by the patellar and quadriceps tendon, medial and and lateral collateral ligaments, popliteus M. and Gastrocnemius M. Internal LIgaments- Arcuate Popliteal Ligament and the medial ( prevent lateral patellar dislocation) and lateral Patellar retinacular fibers.
Medial Meniscus
Semi-Circular shape, anterior end is thin and pointed that attaches to the anterior intercondyloid fossa of the tibia. The posterior end attaches to the posterior intercondyloid fossa of tibia. Is unable to slide around very much and tears under stress
Lateral Meniscus
Almost circular and covers the articular surface of the tibia. The lateral side has grooves to accommodate the tendon of the popliteus. Anterior portion attaches in the front tibias intercondyloid eminence. Lateral position is not attaché.
Carpal Tunnel and CTS
A narrow passageway in the wrist. Formed by carpal bones and the transverse carpal ligament. The median nerve and 9 flexor tendons run through the CT. Flexion of the wrist causes decrease the CT .
CTS - is caused by inflammation and/or compression of the medial nerve through the CT. Result from inflammation or thickening of the transverse carpal ligament. also an acquired or congenital deformity can cause CTS
Soft tissues of the wrist
Formed by the distal end of the radius and Proximal Carpals bones ( Radiocarpal ) followed distally by the midcarpal joint.
Ligaments- Volar radiocarpal ligament, Dorsal radiocarpal ligament, Ulnar collateral ligament and radial collateral ligament.
Synovial membrane extends distally of the radius to the proximal end of the articular carpals, that have numerous folds and loose to allow movement.
ROM- adduction, abduction, extension ( at the midcarpal joint) , flexion (radiocarpal joint) and circumduction.
