quiz #2 - sprains, strains, fractures, CT pathologies Flashcards
grade of SPRAIN:
-minor stretch & tear
-no joint instability on passive testing
-minimal P & swelling
-able to complete ADLs with minor discomfort
-can weight bear
-bruising absent/ slight
grade 1
grade of SPRAIN:
-partial tear of lig.
-increased P
-bruising & swelling
-loss of function due to P
-P on weight bearing
-snapping sound & joints gives way
-passing testing shows hypermobile but stable
grade 2
grade of SPRAIN:
-complete tear
-surgery required
-immobilization in cast
-severe injury
-synovial inflammation & accumulation of synovial fluid = joint effusion
-hemarthrosis if bleeding into joint
-X-ray to rule out avulsion fracture (bone fragment pulls away from bone by lig.)
grade 3
overstretch / tear of ligament
sprain
type ankle sprain: lateral ligaments torn (anterior talofibular, calcaneofibular, calcaneocuboid)
*most common of all sprains
inversion sprain
type of ankle sprain: deltoid ligament torn (anterior tibiotalar, tibiocalcaneal, posterior tibiotalar & tibionavicular – also has two sets of fibers superficial & deep), may cause avulsion fracture if Grade III sprain
eversion sprain
most commonly sprained knee ligament
anterior cruciate ligament (ACL)
most common cause of an injury to the knee affecting all 3 structures: medial meniscus, ACL, MCL
foot is fixed on ground, knee is truck by medial or lateral force
most common cause of a wrist sprain
FOOSH
most common wrist ligament sprained
palmar radiocarpal
most common shoulder ligament sprained
acromioclavicular (AC)
“loose ligaments” – may cause chronic body pain
-when condition affects joints in entire body, it is called generalized joint hypermobility
ligamentous laxity
ligamentous laxity - genetic disease causing abnormal fibrillin
Marfan syndrome
ligamentous laxity - defect in synthesis of collagen, causes progressive deterioration of collagen in different parts of body such as joints, heart valves, organ walls or arterial walls
Ehlers-Danlos syndrome
ligamentous laxity - insufficient production of normal collagen to produce healthy, strong bones
osteogenesis imperfecta (brittle bone disease)
ligamentous laxity - affects collagen, may have distinctive facial appearance, eye abnormalities, hearing loss & joint problems
Stickler syndrome
ligamentous laxity - defects in collagen, found in renal basement membrane, inner ear & eyes, leading to glomerulonephritis, hearing loss & eye disease
Alport syndrome
ligamentous laxity - Beal’s syndrome, similar to Marfan syndrome but with contractures of hip, knee, elbows & ankle joint, crumpled ear
congenital contractural arachnodactyly
ligamentous laxity - a collagen vascular disease
psoriatic arthritis
tear of mm or tendon, commonly affecting lower back, neck & hamstrings
strain
grade of STRAIN:
-few mm fibers damaged
-mild pain at time of injury
-mild swelling, if any
-minimal loss of strength
-P when tissue is stressed
-ADLs can be completed
-heals within 3 weeks
grade 1
grade of STRAIN:
-more extensive damage to fibers or tendon, but mm not completely ruptured
-snapping sound may or may not be present, can sometimes feel gap at injury site
-edema, P (moderate), tenderness at site
-difficulty with ADLs
-loss of strength
-heals in 3-6 weeks
grade 2
grade of STRAIN:
-severe injury with complete mm rupture
-snapping sound accompanies injury
-severe P, edema, bruising
-ADLs cannot be continued
grade 3
complications with grade 3 strains
joint effusion (synovial fluid accumulation) or hemarthrosis (bleeding into joint)
generally sprains heal slowly, 6 weeks to develop fibrotic scar tissue, 6 months for healed tissue to mature fully & regain max strength – radiographs frequently taken to rule out avulsion fracture
crush injury to mm with bleeding into mm & subcutaneous tissues, bruising minor or severe – can track along fascial plane, appearing at distant site – caused by blow or crushing injury to mm & does not break skin
contusion
complications of a contusion
rapid accumulation of mm-derived proteins (like myoglobin) in bloodstream that can lead to damage to kidney & possible kidney failure or shock, called rhabdomyolysis
solid swelling of clotted blood that collects in tissue, outside of blood vessel – damage to wall of artery, vein or capillary causes blood to leak into adjacent tissues & cause inflammation & bruising – violent sneeze/ cough may cause
hematoma
why is a hematoma different from a bruise?
blood vessels that are damaged are larger & damage is worse
injury to joint where surfaces are not congruent or separated – very painful & causes immobilization of joint – most common in shoulders & fingers, also elbows, knees & hips – most return to normal function after healing
dislocation
*subluxation = partial dislocation
break in the bone
-can be due to trauma, overuse, microtrauma or stress
fracture
causes of fractures
falls, sports, accidents & low bone density caused by disease
increased forces on bones that exceed limits
fractures affecting epiphyseal growth plates – applies to children only before plate fusion
Salter-Harris fracture
type I-V: salter-harris fracture
Type I: transverse fracture through growth plate (also known as physis)
Type II: fracture through plate & metaphysis
Type III: fracture through plate & epiphysis
Type IV: fracture through plate, epiphysis & metaphysis
Type V: compression fracture of growth plate
fracture: parallel to long axis of bone
linear
fracture: right angle to bone’s long axis
transverse
fracture: twisting of bone, causing a fracture
spiral
fracture: two or more fragments of bone from fracture
comminuted
fracture: bone/bone fragments crushed into each other
impacted
fracture: bone compressed as in vertebral body
compression
fracture: usually of skull
depression
complications of fractures
nerve compression, vascular damage, infection, disuse atrophy, joint stiffness & limitation of ROM, delayed union, non-union, malunion
bone does not unite (heal) within expected time frame – may be caused by inadequate circulation, hypermobility, infection, drugs or smoking
delayed union
bone does not heal, even after repair process has “given up” – large gap, bone destruction & general poor bone health
non-union
union of bone, unacceptable deformity leading to altered biomechanics
malunion
Osteoma
Osteochondroma
Endochondroma
Osteoid osteoma
Giant cell tumour
Aneurysmal bone cyst
Fibrous dysplasia
benign bone tumors
Osteosarcoma
Chondrosarcoma
Fibrosarcoma
Malignant fibrous histocytoma
Ewings’ sarcoma
Multiple myeloma
malignant bone tumors
benign slow growing bone tumor, usually around 1.5 cm in size – usually found in cortex of long bones (osteoid osteoma) or more commonly in skin (jaw & sinuses) – often in young men – X-rays used to diagnose & main symptom is pain
– 3 types: compact, spongy combined
osteoma (osteoid osteoma)
benign tumor affect children & adolescents 1-2 cm in size – abnormal growth or outgrowth at surface of bone near metaphyseal region of growth plate – made up of bone & cartilage – may be one tumor or many – continues to grow as child grows & stops when child stops growing
osteochondroma
benign tumor of cartilage often affects long bones of hands & feet, but also femur, humerus or tibia – mostly affects adults
enchondroma
rare, aggressive benign tumor, in young adults 20-40 years, often occurs near a joint at end of a long bone in metaphysis – common at knee, & in general in arms & legs or breastbone or pelvis
giant cell tumor
benign blood filled cyst inside a bone that grows & expands quickly while destroying bone tissue – cysts are fragile & fracture easily – may occur anywhere, but commonly in knee, pelvis & spine
aneurysmal bone cyst
replacement of normal bone with fibrous bone tissue, may affect one bone (most often) or multiple bones – common in femur, tibia, humerus, skull, ribs & pelvis – weakens normal bone tissue & may cause deformity or fracture – common in children & adolescents
fibrous dysplasia
cancer of bone forming cells, common in 10-30 years, commonly affects long bones of legs mostly & arms – Terry Fox had this type of bone cancer (malignant)
osteosarcoma
begins in bones or in soft tissue surrounding bones, very rare – often in pelvis, hip & shoulder – these cancer cells produce cartilage (malignant)
chondrosarcoma
effects fibroblasts, cells that produce collagen in fibrous tissue or soft tissue, creating fibrous tissue where it doesn’t belong – may affect nerves, tendons, ligaments, blood vessels, lymphatic vessels, fat or mm – most common in legs or trunk (malignant)
fibrosarcoma
cancer found in soft tissues like mm & tendons (may sometimes invade bone also), mostly in adults, often occurs late in life – common in arms & legs (specifically metaphysis of long bones) but may occur anywhere (malignant)
malignant fibrous histiocytoma
in bones or soft tissue surrounding bones, commonly in leg & pelvis bones, less common soft tissues of chest, abdomen or limbs – most common in children & adolescents but can occur at any age (malignant)
Ewing’s sarcoma
cancer of a specialized white blood cell called a plasma cell - normal plasma cells make antibodies that attack pathogens, but these cancerous plasma cells make abnormal proteins - cells accumulate in bone marrow & crowd out healthy cells
multiple myeloma
form of skeletal dysplasia, arm & leg bones are shorter than normal, average adult height of 4’ - 4’4” – also have an enlarged head with prominent forehead
achondroplasia / dwarfism
brittle bone disease from gene mutation inherited or present at birth, bones soft & fracture easily – gene is responsible for collagen production in bone tissue, with dysfunctional or less collagen, bones are weakened
osteogenesis imperfecta
foot abnormalities present at birth (congenital), foot is twisted or out of position – 50% of children have it in both feet – tendons & ligaments in foot are shorter than normal – may be mild or severe
club foot
also known as “lupus” – chronic, inflammatory autoimmune disease that affects skin, bones, joints, nervous system & brain, kidneys, lungs & other organs – blood vessels also affected leading to Raynaud’s phenomenon with lowered levels of RBCs & platelets – butterfly rash is most distinctive symptom
systemic lupus erythematosus (SLE)
what triggers lupus (SLE) if you are genetically predisposed?
sunlight, infections & medications
syndrome involving a complication of diabetes & neuropathy – uncontrolled inflammation causes destruction of tissues due to impaired nerve pain perception
neurogenic arthritis - Charcot’s disease
chronic disease that affects CTs & internal organs – main effect is overproduction & accumulation of collagen leads to fibrosis or scarring & inflammation causing skin & superficial fascia to thicken & harden
scleroderma
clinical features of scleroderma
tightness of skin of face “mask-like” appearance, mouth may not open or close completely, hands red, pale & swollen & fingers become tapered and flexed, skin is hard, shiny & stretched
clinical features of scleroderma going deeper & affecting internal organs
may affect heart; cause arrhythmias or respiratory failure, renal failure, esophageal or intestinal blockage or perforation and damage to vascular walls (Raynaud’s phenomenon)
scleroderma - types & subtypes
localized: affects skin, fascia, mm & sometimes bone
generalized: affects multiple systems
-limited: affects skin of face & fingers, slow onset (5-10 years), milder, symptoms are C.R.E.S.T.
-diffuse: affects more areas of skin & may involve organs, sudden onset, more severe
what does CREST stand for? (scleroderma)
C - calcinosis
R - raynaud’s phenomenon
E - esophageal dysfunction
S - sclerodactyly
T - telangiectasias
blood vessel disease characterized by inflammation of medium sized arteries or muscular arteries, also called vasculitis
-prevents adequate oxygenation of tissues & organs, causes hypoxia and ischemia
polyarteritis nodosa (PAN) or vasculitis
polyarteritis nodosa (PAN) or vasculitis is strongly associated with…
hepatitis B infection
inflammation of blood vessels (vasculitis) in nose, eyes, ears, sinuses, throat, lungs, heart, skin & kidneys – prevents adequate oxygenation of tissues and organs and causes hypoxia and ischemia
Wegener’s granulomatosis or granulomatosis with polyangiitis
genetic disorder that affects proteins that contribute to elasticity & strength of CTs – most commonly affects heart, eyes, blood vessels & skeleton – person tall in stature with abnormally long extremities – normal lifespan with medical intervention
Marfan’s syndrome
bands of scar like tissue, causing nearby organs & tissues to stick together
adhesions
fibrotic scarring, dysfunctional wound healing process where CT or fibrotic tissue replaces normal tissues – excess deposition of extracellular matrix mostly collagen
fibrosis
tightening of CT in mm, tendon, ligaments or skin, preventing normal movements, often caused by severe burns – skin becomes scarred & loses its elasticity
contractures
inflammation of plantar fascia – often due to repetitive sports & inadequate stretching
plantar fasciitis
chronic pain syndrome characterized by heightened pain response with diffuse soft tissue pain that feels muscular in nature with multiple tender points – pain lasts longer than 3 months & often accompanied by insomnia & memory problems – total of 18 tender points in body, diagnosis is made if 11 – commonly, there are periods of remission & exacerbation – mostly affects women in middle age
fibromyalgia
pressure within fascial compartments around mm builds to dangerous levels & causes pain and swelling that may decrease blood flow to area, damaging tissues & causing hypoxia and ischemia
compartment syndrome
