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Unit 2: Musculoskeletal Flashcards

1
Q

what are causes of musculoskeletal damage

A

genetic disorders of bone growth maturation remodeling and maintenance
neoplasms or infection
autoimmune disease
trauma
repetitive strain

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2
Q

what does trauma do to bone

A

fracture = break due to excessive mechanical force
stress fracture = fracture caused by repetitive stress

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3
Q

what are the 3 stages of bone healing

A

inflammatory phase = local bleeding, inflammation, clotting factors formation of fibrin (0-7 days)

reparation phase = soft callus formed 2 weeks after injury and replaced by hard callus and osteoclasts clean up the old bone osteoblasts lay new bone (1 to 5-12 weeks depending on fracture location and other healing factors)

remodeling phase = once the hard callus is laid down osteocytes detect mechanical loading and send signals for bone remolding (4 weeks or months or years)

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4
Q

how are fractures classified

A

by location of the fracture
whether intra articular or extra articular
by the fracture line
by relationship of fragments

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5
Q

what are the types of fractures

A

closed
open = damages to tissue as a result of fracture
comminuted = several pieces
greenstick = typically in children (like a tree branch)
impacted
compression
spiral = twisted
pathologic

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6
Q

what are the 3 fundamental principles of fracture treatment

A

reduction (if needed)
immobilization
preservation of function

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7
Q

what are the 3 ways reduction can be performed

A

by closed manipulation
by mechanical traction with or without manipulation
by open operation

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8
Q

what are the 3 reasons to immobilize a fracture

A

to prevent displacement or angulation
to prevent movement that might interfere with union
to relieve pain

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9
Q

what are the 4 methods of immobilization

A

cast
continuous traction
external fixation
internal fixation

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10
Q

what are the different methods of internal fixation

A

metal plate held or screws
intramedullary nail
dynamic compression screw plate
condylar screw plate
tension band wiring
transfixion screws

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11
Q

what are the complications of a fracture

A

nonunion = failure of bone to unite
delayed union = heals but only after a significant amount of time
malunion = non anatomic position of the bone

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12
Q

what are the different post operative mobilization restrictions

A

NWB = non weight bearing
PWB = partial weight bearing
WBAT = weightbearing as tolerated
FWB = full weightbearing

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13
Q

what are soft tissue injuries

A

all musculoskeletal tissue aside from bone

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14
Q

what does trauma do to a skeletal muscle

A

strain = torn/pulled
contusion = bruise/ruptured capillaries
laceration = cut
complete tears = rupture

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15
Q

what are the grades of a strain

A

grade 1 = still have normal function
grade 2 = see some swelling higher pain
grade 3 = lose function of muscle, pain tender swelling

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16
Q

what are the signs and symptoms of muscle trauma

A

inflammation
decreased ROM
decreased strength
hypermobility or instability

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17
Q

how does muscle heal

A

first 24-48 hours hemostasis and hematoma
6-8 weeks removal of waste myofiber regeneration
final phase regenerated muscle matures

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18
Q

what happens to a muscle if the basement membrane is damaged

A

healing occurs by repair vs regeneration and fibrous tissue is laid down so it scars

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19
Q

what are common innervation for acute muscle injury

A

medication
rupture = immobilization and may need surgery. can do controlled Passive movement 5-28 days later
active range of motion at 8 weeks and resistance increased progressively. full force by 12 weeks

strain = short period immobilization. ROM strength and endurance once swelling subsides and then prevention education

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20
Q

what does trauma do to tendons

A

tendinopathy = tendon thickening and chronic localized tendon pain

strain

spontaneous rupture

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21
Q

what are two types of tendionopathy

A

tendinitis = symptomatic degeneration of the tendon with vascular disruption and inflammatory repair response

tendinosis = intratendinous degeneration inflammation minimal to none

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22
Q

how does a tendon heal

A

hemostasis and debris cleaned away
inflammatory and proliferative phase (48 hours to 3-4 weeks after injury)
maturation and remodeling (begins around 3-4 weeks and the collagen aligns along tensile forces) 12-16 weeks until tendon can be stressed
slow can take 40-50 weeks to get back to full strength
tendons typically heal from scar tissue but can heal by tenoblasts

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23
Q

what does injury do to ligaments

A

sprain/tear
- injury can be classified as 1st 2nd or 3rd degree

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24
Q

how do ligaments heal

A

similar to tendon healing
extra-articular ligaments tend to heal more easily then intra-articular ligaments because of vasularization

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25
how are ligament injuries treated
rest immobilization pain relief surgical repair
26
what does trauma do to cartilage
wear - articular joint surfaces in osteoarthritis and other joint conditions tears = of the knee menisci
27
how does cartilage heal
in adults it is replaced by scar tissue or fails to heal at all
28
what does normal joint stability depend on
contours of opposing joint surface integrity of capsule and ligaments protective power of muscles around the joint
29
how does trauma impact joints
subluxation = disruption of the anatomical relationship of the joint dislocation - complete loss of joint integrity injury to joint capsules/synovium
30
what does joint injury intervention may include
rest surgical repair splinting or bracing ROM joint replacement healing time will vary with number and extent of tissues involved
31
what is bursitis
bursa = the pad-like sac of fluid often found in areas of the body subject to friction, particularly joints can become inflamed due to repeated excessive pressure commonly occurs in shoulder elbow and knee
32
who is at risk of bursitis
repeated physical activity using excessive force RA and gout are risk factors acute or chronic infection
33
what is treatment of brusitis
heat, rest and immobilization corticosteroids if conservative treatment is not effective
34
what are scar adhesions
normal physiological process fibroblasts synthesize collagen collagen fibers are oriented in a random manner due to the imbalance between the rate of collagen deposition and that of collagen destruction begins in the proliferative phase and continues to mature and remodel for one to two years
35
what are deforming forces on a fracture
when a fracture occurs the fracture fragments are pulled out of position based on the tendon/muscle tension put on the bone fragments the tension that pulls the bone fragments out of alignment are called deforming forces so the deforming forces for hand fractures is the tendon muscle tension
36
how to immobilize fractures in the hand
immobilize above and below the fracture as well as the adjacent fingers (joints)
37
what is treatment for a hand fracture
splinting and immobilization use a protective splint the splint position should reduce the pull of the deforming forces of the tendons/muscle on the fracture site allowing it to heal
38
what is the safe position splint
AKA intrinsic plus position wrist in 20-30 degrees extension include the involved and adjacent digit MCPs in 70-90 degrees of flexion IP joints in extension or free
39
why use the safe splint position
in MCP extension the collateral ligaments are the shortest but not very tight in MCP flexion the collateral ligaments are the longest and tight PIP in extension they are at maximum stretch you want your ligaments to get tight in their longest position (remember this is a bone injury not a ligament injury)
40
what are signs and symptoms of a hand tendon injury
pain. tenderness, edema presence of a laceration loss of grip/grasp loss of flexion cascade extensor lag
41
how many zones are there for flexor tendon injuries
5
42
how many zones are there for extensor tendon injuries
8
43
flexor tendon injury requires immobilization of what digits
all of them
44
extensor tendon injury requires immobilization of what digits
more insertion points so we can treat some joints independently and may even be able to treat the injured digit in isolation
45
what does the strength of repair depend on in hand tendon injuries
suture style material and location number of sutures tendon quality stage of healing
46
how are hand flexor tendons repaired
surgically the sooner the better goal is to have high level strength and low friction in the repair
47
why is sone 2 recovery more difficult in a flexor tendon injury
because of the close proximity of FDS FDP and the flexor sheath
48
which pulleys in the hand are mechanically the most critical to ensure function of the tendon
A2 A3 A4
49
what is the management of flexor tendon repairs
splinting (24/7 during proliferative phase) the splint needs to immobilize digits (except the thumb) and it also needs to include the wrist a flexor repair should stay in flexion edema control functional activity guidelines and adaptations wound care durans passive range of motion
50
what is Duran passive range of motion
indicated for almost all types of repairs can be initiated at any time post operatively preferably 3-5 days post op early passive exercises in the splint promote tendon glide without putting tension on the repair
51
what is extensor lag
during a extensor tendon repair there may be extensor lag which can lead to joint changes such as swan neck deformity or boutonniere deformity
52
what does injury do to spinal roots and peripheral nerves
compression ischemia partial or complete laceration traction injury
53
how do nerves heal following laceration
if a peripheral nerve is cut it does have the capacity to grow back upon laceration the parts of the nerve retract from each other the distal nerve undergoes swells breaks down and dies macrophages clear away the debris the cell body also undergoes changes and may die
54
how does a nerve resprout
a damaged axon can resprout if the cell body is intact occurs at a rate of about 1mm of growth per day collateral = branches of intact axons sprout to innervate a denervated neuron. exercise began 5 days after injury can increase axonal regeneration regenerative = injured axon sprouts sideways to innervate a nearby neuron because the neuron it used to innervate has died due to the period of innervation
55
how is a nerve laceration treated
splinting to relieve pressure or prevent precipitating activities and allow healing surgical repair with or without splinting
56
what are complications of nerve laceration
hypersensitivity causalgia (burning pain) residual paralysis
57
what is the most common nerve injury other than a laceration injury
compression injury a nerve stretch is also possible
58
what is treatment for a compression injury
rest reduce inflammation maintenance of ROM and nerve gliding exercises
59
how long is a nerve injury
3-4 months
60
what are common compression injuries of the radial nerve
radial nerve palsy (Saturday night palsy) carpal tunnel syndrome cubital tunnel syndrome
61
what is muscular dystrophy
includes several genetic conditions presenting with muscle weakness and wasting
62
what is the pathophysiology of muscular dystrophy
causes changes in the biochemistry and structure of the surface and internal membranes of the muscle cells muscle fibers progressively degenerate despite the innervation being present gradual loss of muscle fibers results in increasing weakness muscle fibre loss cannot be prevented duchenne = dystrophin is absent because the responsible gene fails to make this protein becker = dystrophin is synthesized by is abnormal
63
diagnosis of muscular dystrophy
bloodwork = creatine kinase may leak into circulation electromyography = evaluate electric activity produced by muscle muscle biopsy = examine cellular makeup of muscle to determine type of dystrophy
64
what is medical management for muscular dystrophy
supportive corticosteroids anticonvulsants respiratory support
65
what are the two types of arthritis
rheumatoid = chronic inflammatory joint disease causing bone and cartilage damage, autoimmune disease osteoarthritis = most common form of arthritis and often the result of wear and tear
66
what are the 2 types of osteoarthritis
primary = no known cause secondary = identifiable cause such as injury
67
what is the pathophysiology of osteoarthritis
deterioration of articular cartilage within joints reactive bone formation
68
what is RA
systemic condition autoimmune disease immune system erroneously attacks own body (primarily joints) chronic systemic inflammatory condition primary feature = synovitis synovial cells produce degrading enzymes that destroy cartilage and bone joint swelling = from excess synovial fluid thickening joint capsule scar tissue forms which makes joints rigid
69
what are typical hip precautions after a hip replacement
no hip flexion past 90 degrees, no internal rotation and no adduction past midline typically for 8 weeks

Health Conditions (3 decks)

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