Patho Musculoskeletal System Flashcards
Two functions of Skeletal System
Protection- supports organ systems; bone functions as levers for muscles to pull on
Production- blood cells produced; mineral storage and metabolism
Corticol Bone
(Compact bone)
- outer portion of bone
- bulk of diastasis of bones
- tolerates compression and shearing forces
Cancellous Bone
(Spongy bone)
- inside long bones and marrow cavities
- can’t tolerate compression forces
- tolerates shearing (toritional) stresses
Transverse Fracture
straight line, 90 degrees to longitudinal axis
Spiral Fracture
- due to rotational force
- S-shape
- wrap itself around corticol surface on outside of bone in spiral fashion
- not easy to fix
Longitudinal Fracture
- along bone length
- run up and down length of bone
Oblique Fracture
- due to rotational forces
- doesn’t circulate around bone
- at angle in between transverse and longitudinal without spiraling or rotation
Comminuted Fracture
- more than one fracture line and the bone is going to be broken into more than 2 fragments
- 1+ fracture line and 2+ bone fragments
- happens commonly in feet
Impacted Fracture
- telescoping of fragment into another
- typically in long bones
- creates internal damage of bone and makes it very hard to reduce bones back into place
Greenstick Fracture
- incomplete fracture with intact corticol side flexed
- cortex stays intact, but is going to be flawed
- little broken off piece of bone
Stress Fracture
- failure of one corticol surface
- crack developing in the bone with no real separation between 2 bone fragments
Avulsion
- separation at site of attachment of ligament or tendon
- common in knee cap
Displaced Fracture
- ends of fracture are separated
- greater damage to surrounding soft tissue
- harder to realign when it comes time to fix
Non-displaced Fracture
- fragments remain in alignment and position
- easy to fix
Complete Fracture
disrupts continuity through whole bone
Incomplete Fracture
- cortex buckles/cracks
- no loss of continuity
- bone ends still together
Open (compound) Fracture
- bone exposed outside integument
- open wound from outside world into skin
- increased rate of infection
Closed (simple) Fracture
bone contained inside integument
Delayed Healing
Delayed Union
Malunion (fracture improperly repaired)
Nonunion
Soft Tissue Complication
primary damage and damage during immobilization
Compartment Syndrome
Neurovascular Injury
Dislocation
- displacement of bone from normal
- articulating surfaces lose contact
- lead joint beyond anatomical limits
- significant soft tissue damage
Sublaxation
- displacement
- articulating surfaces partially lose contact, but don’t completely separate
- lead joint beyond anatomical limits
- significant soft tissue damage
Non-Structural Scoliosis
- resolves when patient bends to affected side
- curve resolves itself when patient bends to affected side
- no rotation of vertebral column along with lateral curvature
- usually due to inflammation, legs of different lengths without corrective footwear, poor posture
Structural Scoliosis
- lateral curve fails to correct on forced bending against curvature
- vertebrae start to rotate around axis along with curvature
- more serious form of scoliosis
- hip, shoulder, rib cage start to change position
Osteoporosis
- common metabolic disorder
- Reabsorption rate greater than formation (osteoclasts outpace osteoblasts)
- fragile, fracture susceptible bones due to decrease in density, width, mass
- cancellous (spongy) lost faster than corticol (compact)
- Risk factors: age, genetics, estrogen
Disuse Osteoporosis
- bones degrade if person is not putting stress on bone (i.e. bed rest pt)
- bones will start growing again once stress the bones
Rickets & Osteomalacia
- rickets=child; osteomalacia= adult rickets
- Deficit in mineralization of osteoid leading to the production of soft osteopenic bone
- Vitamin D deficiency prevents normal calcium & phosphorus maintenance
- worse in children because bones are growing
Paget’s Disease
- Osteitis deformans (i.e. deformed bone)
- Progressive, slow, metabolic disorder
- Excess bone resorption followed by excessive bone formation
- Disorganized bone matrix - overproduction of cancellous bone
- Fragility leads to deformities and fractures
- Unknown cause
Soft Tissue Injuries
- soft tissue injuries are very common with sublaxation, dislocations and fractures
- trauma due to stress
- contractile and non-contractile types of injuries
Non-contracile (Inert) Soft Tissue Injuries
- have no ability to contract and can’t relax
- Joint capsules, ligaments, bursae, fasciae, dura mater, nerve roots
- Includes ligament injuries; joint capsule injuries; internal joint derangement; injuries to fascia and bursae
Ligament Injuries
- injury when load exceeds physiology range of motion
- stretched ligament= sprained ankle
- Total failure - damage to surrounding tissues in which lose ability to keep 2 tissues together
- have loose ligaments once damaged
- Classified by extent of tear
Joint Capsule Injury
- swelling and tissue scarring decreases the range of motion
- occurs during immobilization
- swelling–> lack nutrient flow and ischemia
- if arm is bent at minimal joint angle, capsule will shrink
Internal Joint Derangement
- injury to inert soft tissue in joint leading to restriction of motion & pain
- example: torn meniscus in knee or TMJ
Injuries to fasciae & bursae
- Fasciae and bursae normally there to reduce friction
- Pain with restriction of motion
- Bursitis - inflammation of bursae at stress point
Contractile Soft Tissue Injuries
- involve tissues actually involved in contraction: muscle, tendon, and bony insertion point that tendon is going to attach to
- if get too damaged, can affect ability of that part to contract
- Include: Injury to tendons, Muscle & tendon strains, Blunt trauma, Compartment syndrome
Injury to Tendons
- strain to rupture
- Tendonitis - inflammation of tendon sheath (essentially bursae underneath tendon)
- Loss of function, pain, inflammation
Muscle & tendon strains
-minor to major tear in muscle due to abnormal muscle contraction
Grade I - minute tear, no loss of continuity
Grade II - large portion of contractile unit torn, maintain continuity but need surgical repair
Grade III - loss of continuity of contractile unit; surgical repair necessary
Blunt trauma
- contusion or crush injury to soft tissue can compromise contractile structures
- Bleeding into muscle leads to inability to contract
- Hemorrhage - leads to myositis ossificans (blood pools lead to calcifications)
Compartment syndrome
- Soft tissue trauma due to unyielding structure of inert tissues (i.e. joint capsule)
- Decreased compartment size, increased compartment content, externally applied pressure
- All cause pressure - ischemia & pain leading to medical emergency
Muscular Dystrophy
Group of genetic myopathies that lead to progressive muscle weakness and degeneration
Duchenne’s Muscular Dystrophy
- common, severe, X-linked
- Muscle cells lack dystrophin (structural protein underneath plasma membrane) leading to weakened cell structures that get replaced with fatty tissues
- don’t live past 14 because diaphragm stops working
Becker Muscular Dystrophy
- mild, inherited, X-linked
- Reduced production of abnormal dystrophin
Facioscapulohumeral Muscular
-inherited, autosomal dominant, face and shoulder affected
Myasthenia Gravis
- chronic autoimmune disease of neuromuscular function
- Voluntary muscle weakness & fatigue
- ACH receptor antibodies
Fibromyalgia syndrome
- unknown etiology
- Pain syndrome - chronic muscle pain
- everyone has same threshold of pain but what may be physiological reason and people with this have a lower threshold than most (so stimulus can be less to stimulate muscle fibers)
Osteoarthritis
- Degenerative, progressive, non-inflammatory disease
- Loss of articular cartilage
- Formation of thick subchondral bone and new bone
- More prevalent with age and everyone gets it
- Etiology varies: Biochemical, biomechanical, inflammatory & immunologic factors
- non inflammatory disease- once person has it, the actual disease does not cause inflammation in the joints (does not mean it can not be caused by inflammation)
Symptoms of Osteroarthritis
- Bony enlargement of joints
- crepitus
- Morning stiffness,
- pain w/function
Rheumatoid Arthritis
- Systemic inflammatory disease
- Unknown etiology (infectious or abnormal autoimmune response)
- Characterized by inflammation in joint cavity
- Stimulate edema, neovascularization, synovial proliferation
- Hypertropied synovium invades surrounding tissue - granulation tissue forms - pannus formation which erodes articular cartilage
Symptoms of Rheumatoid Arthritis
- Morning stiffness for 1 hr
- Soft tissue swelling of 3 or more joint areas
- Swelling of at least one wrist, MCP or PIP joint
- Simultaneous symmetric swelling in joints
- Subcutaneous rheumatoid nodules
- Presence of rheumatoid factor
- Radiographic erosions and/or periarticular osteopenia in hand and/or wrist joints
Depressed Fracture
- fragment displaced below leek if surface of bone
- skull is most common
