Pathophysiology III Flashcards
test 1
What is the definition of a fracture?
any discontinuity of bone - synonymous with break
Define a stress fracture
an incomplete fx that may not break bone into two pieces. occurs in absence of specific acute traumatic event. often associated with overuse, over-training, or microtrauma
T or F?
Fractures can occur when normal stress is applied to an (abnormal) bone
TRUE. Esp. in instances of diseases such as osteoporosis, etc.
What is it called when a fracture happens in a bone due to poor calcium metabolism, osteopenia, osteoporosis
Insufficiency fracture
Is a traumatic or insufficiency fracture more common?
Traumatic
Open fractures:
bone has protruded thru skin or object has punctures skin AKA compound fracture
Closed fracture:
bone is broken all the way through
Types of Complete Fractures
transverse, oblique, spiral, comminuted, longitudinal
What kind of fx? One part is broken, the other side is bent. Most common in children
Greenstick
What kind of fx? Transverse the length of the bone
Transverse
This type of complete fx is splintered or crushed.
Comminuted
A fracture in which the bone has been twisted apart
Spiral fracture
Define compound fracture?
The bone breaks through the skin. Creates a “compound” problem of a broken bone and an open wound.
Define a displaced fracture?
The ends of the bones are out of alignment.
Describe compression fractures?
Bone appears to be “mashed” down. Common in vertebral column. Incidence increases with aging and decreased bone density.
This fx occurs when one fragment of a bone is firmly driven into another fragment
Impacted fracture
When a fragment of bone chipped away from the main bone
Avulsion fracture
A fracture that runs parallel to the long axis of the bone
Longitudinal fracture
Central point of injury forms a star-like pattern
Stellate fracture
How quickly do most bones heal to 80% normal functionality?
Within three months but some could take 18 mo
What forms bone matrix during bone remodeling?
Fibroblasts
What is the first thing that happens in bone healing?
Hematoma - it forms with blood coagulating between broken bone fragments
What brings phagocytes to the area of the broken bone?
The blood vessels that grow into the matrix of the blood clot in the healing area
During remodeling, woven bone is replaced by what?
Lamella bone (mature)
What age population has the highest incidence of UE fractures?
children ages 5-14
What bone fracture is more prevalent after age 50 (and incidence doubles every 5-6 years)?
Hip fractures
Etiology of fractures
Usually caused by stress trauma or disease
What is osteogenesis imperfecta?
An inherited (genetic) bone disorder that is present at birth. AKA brittle bone disease - more susceptible to fractures
How are fractures diagnosed?
physical exam, radiologic imaging (x-ray)
Methods of reduction:
manipulation, traction, surgery
What is reduction?
Attempts to restore integrity of a broken bone
Manipulation (bone reduction):
Attempts to restore integrity of a broken bone
Manipulation (bone reduction)
hands or straps are used to pull/push dislocated skeleton into place
Traction (bone reduction)
slowly pulling, often with straps/weights to pull extremities back in place
ORIF stands for
open reduction, internal fixation
3 ways to maintain a bone reduction:
external fixation, traction, internal fixation
Stages of bone healing (4)
- Inflammatory: Hematoma forms
- Revascularization: soft callus forms
- Modeling phase: hard callus forms
- Remodeling phase
During which phase do neutrophils and monocytes invade, cell debris is removed, and the fibrin clot is degraded?
Inflammatory phase (hematoma formation)
The reparative or revascularization phase is also called
soft callus formation
In the first 7-10 days, what undergoes intramembranous bone formation response?
The periosteum
In what stage does osteoclastic and chondroclastic reabsoprtion take place?
The modeling phase (during hard callus formation)
What is clinical union?
Bridging of a fracture by woven bone
Spongy bone is AKA
cancellous bone or trabecular bone
Compact bone is AKA
cortical bone
PTAs need to know the ____ of the fracture that occurred and ____ immobilization was removed
type, when
What is normal bone immobilization time frame?
3-8 weeks
Bone healing continues for how long?
Up to 1 year
What is Wolff’s law?
A bone grows or remodels in response to forces or demands placed upon it. Bone Remodels along lines of stress.
Complications to be mindful of when rehabbing broken bone:
malunion, non-union, delayed union, associated soft tissue injury, DVT/PE, acute compartment syndrome
When a fracture is due to a disease presence, it is termed what?
A pathologic fracture
Why should PTAs be very aware of red flags when treating fractures? Specifically in OK
Because OK is a direct-access state, so they don’t have to see an MD before PT. Red flags could therefore not be seen by other healthcare providers.
Define Reduction
an attempt to restore the integrity of a broken bone
Define osteomyelitis
Inflammation or swelling of bone, usually the result of an infection
What are three ways to maintain a reduction?
- External Fixation
- Traction
- Internal Fixation
What is the PTAs role in fracture treatment?
- slow re-introduction of activities to obtain. 2. Restoration of function
Where does bone remodel?
Along lines of stress
Inflammatory stage of bone healing:
2-4 weeks after fx. Hematoma forms within first few days. Granulation tissue, vascular tissue, and immature tissue are formed
Repair stage of bone healing
1-2 months post fx. The bone ends become joined and stabilized. New bone tissue forms. Cartilage hardens near end of fx. New blood vessels develop
Remodeling (or late modeling) stage of bone healing
months to year post fracture. Weak material is converted to strong material. Body remodels fx callus. Mechanical stress helps strengthen the new bone.
What are the three phases of RA?
Initiation phase, amplification phase, chronic inflammatory phase
What is pannus and what does it do?
It is vascular granulation tissue. It dissolves collagen as it extends over joint cartilage. It leads to adhesions, fibrosis, and bone akylosis
Pleuritis, anemia, valvulitis, lung fibrosis, kidney problems, cardiovascular problems, glaucoma…are all related to what?
Rheumatoid Arthritis
How many joints are in the cervical spine?
37 joints
Is the C spine more stability or mobility focused?
Mobility and therefor more vulnerable to direct/indirect trauma
What are the two functional units that make up the C spine?
Craniovertebral (CV) complex and Occipitoatlantal (OA) complex
What is the CV (craniovertebral) complex in the C spine?
the bony structures of the foramen magnum, occiput, atlas, axis, and supporting ligaments
What is the OA (occipitoatlantal) functional unit in the C spine?
it is formed between the occipital condyles and superior articular facets and atlas *note it is inherently stable
What composes the AA (atlantoaxial) joint?
it is the two lateral facet joints and median joint (dens) at C1 and C2
Intervertebral discs (IVDs), lie between adjacent vertebral bodies and are composed of what:
Inner nucleus pulposus and an outer annulus and limiting cartilage
What are unconvertebral joints and what do they do?
Nonsynovial clefts between uncinate processes of adjacent vertebral bodies. They limit lateral and posterior translation while guiding motions of flexion and extension.
What is the zygopophyseal joint?
Joint between articular facets of vertebrae. Planar (gliding).
What commonly becomes impinged at zygapophyseal joints?
fibroadipose meniscoids
What are located between vertebrae and contribute to 20-25% of the length of a spinal column?
IVDs (intervertebral discs)
What is an IVD composed of?
- An inner nucleus pulposus
- Outer annulus fibrosus
- Limiting cartilage end plates
What anchors an IVD to the vertebral body?
Annulus and end plates
What is the function of an IVD?
Facilitate motion and provide stability
Each spinal nerve is named for the vertebra ____ where it exits the spint
BELOW
The upper C spine is responsible for roughly how much motion in the C spine?
Roughly 50%
What is the primary motin at the OA joint?
flexion and extension
What is the primary motion at the AA jt:
axial rotation
What can also occur at the AA and to how many degrees?
flexion/extension for 10-15 degrees
The total range of head motion is the sum of what?
The range of head movement and the range of neck movement
A cervical stain or sprain may be caused by…
an overload injury to the cervical muscle tendon unit due to excessive forces
T or F?
Many cervical muscles don’t end in tendons but attach directly to bones via myofascial tissue
TRUE
What are the s&s of cervical strains and sprains?
pain, stiffness, tightness in upper back, occipital headaches
What is an acceleration-deceleration mechanism of energy transfer to the head and neck through either blunt impact and/or inertial loading?
Whiplash-associated disorders
Define: Malingering
The intentional production of FALSE symptoms or exaggeration of symptoms that truly exist
The amount of injury sustained in a whiplash event is dependent on:
occupant characteristics, pre-event factors, event-related factors
Degenerative disc disease sx:
pain in neck and UE, aggravated pain with neck motion, coughing, sneezing, paresthesia in dermatome of nerve root, weak grip, radiating pain, vertigo, blurred vision, decreased ROM, sensory changes
Where is the most common site for herniation in DID?
C6-C7
Excessive anterior positioning of the head with increased upper cervical spine lordosis and decreased lower cervical spin lordosis, sometimes including rounded shoulders with thoracic kyphosis is known as:
Impaired Posture
Protracted scapulae with tight anterior muscles and stretched posterior muscles, jaw protrusion and cervicothoracic kyphosis between C4 and T4 additional postural adaptions of what condition?
Impaired posture. These are in addition to main s&s.
For every 1” that the head is anterior to the CoG, the stress load is ____
doubled
A chronic degenerative condition of the C spine that affects the joint complexes (IVD, facets, vertebral bodies), of the neck as well as contents of the spinal canal, is known as:
Cervical Spondylosis
Zygapophyseal joint dysfunction is AKA Acute Cervical joint lock (facet impingement)
a “crick” in the neck
A clinical syndrome characterized by symptoms attributable to compression of neural or vascular anatomic structures (brachial plexus and/or subclavian artery or vein)
Thoracic Outlet Syndrome
*this is named based on its potential cause for compression i.e., cervical rib syndrome, scalenus anticus syndrome, etc.
Cervical discs may become painful due to degenerative cascade from repetitive microtrauma or from an excessive single load and this can cause:
Cervical Disc Lesions
What is cervical radiculopathy?
A dysfunction involving compression and irritation of the spinal nerve root
What is the most common nerve root affected by cervical radiculopathy?
7th and 6th nerve roots
Acute Torticollis (acute wry neck) usually presents with:
painful neck spasms, limited ROM of the neck, may hold head in comfort position toward the affected side
T or F?
Acute torticollis can be congenital
True. Etiology is not fully clear
Define Spontaneous Atlantoaxial Subluxation:
the atlas shifts anteriorly on axis. caused by laxity of ligaments
In what conditions are spontaneous atlantoaxial subluxation common?
Down syndrome, RA of the spine, congenital abnormality
What are the symptoms of spontaneous atlantoaxial subluxation?
neck stiffness, pain, torticollis, hyperactive reflexes
Fibromyalgia:
Chronic disease -
nonspecific inflammation of muscles, ligaments, and fascial tissue.
What are the three cardinal features of Temporomandibular Joint Dysfunction?
- Restricted Jaw function (intermittent or progressive limited mouth opening)
- Joint noises (soft or hard crepitus)
- Orofacial pain (masticatory myalgia)
Where are fibroadipose meniscoids commonly found?
In the cervical zygapophyseal joints
*these can be impinged
