Vol.3-Ch.13 "Nontraumatic Musculoskeletal Disorders"

Question 1

Most nontraumatic musculoskeletal disorders are _____ or _____ in nature.

Answer 1

Most nontraumatic musculoskeletal disorders are INFLAMMATORY or AUTOIMMUNE in nature.

Question 2

How many bones are in the body?

What are the 4 classes of bones and where are they found?

Answer 2

There are 206 bones in the body

The 4 classes are:

• Long Bones: found in the extrimities
• Short Bones: found in the wrists and ankles
• Flat Bones: skull, ribs, & sternum
• Irregular Bones: joints and spine

Question 3

Bones joined together by ____ form joints

Muscles connect to bone via _____

Answer 3

Bones joined together by LIGAMENTS form joints

Muscles attach to bones via TENDONS
think tenderloins are muscles with tendons left in

Question 4

What are the 6 classes of joints?

What kind of movement does each allow?

Answer 4

• Gliding Joints:
  contain flat, plate like surfaces found in wrists and
  ankles that allows for SLIGHT gliding back and forth
• Hinge Joints:
  permit angular movements in a singular plane, found
  in elbows and knees
• Saddle Joints:
  contain articular faces that fit together like a rider on
  a saddle that allows angular movement but restricts
  rotation. This is found at the base of the thumb.
• Pivot Joints:
  Found between the Atlas (C-1) and Axis (C-2) that
  allows for ROTATION ONLY; also found in the forearm
  that allows for pronation and supination of the wrist
• Ellipsoidal Joints:
  Allows for movement in 2 planes. This is found where
  the radius connects to the proximal carpal bones of
  the wrist; and where the phalanges connect to the
  metatarsal bones in the foot
• Ball-and-Socket Joints:
  Round head of a bone fits into a cut shaped
  depression in another bone. This allows for
  multiplane movement, these are found in the
  shoulder and hips

EXAMPLE PICTURES ON PAGE 489

Question 5

What is cartilage and what does it do?
Cartilage is also AVASCULAR, what does that mean?

(not asking for the 3 types of cartilage)

Answer 5

Cartilage is a form of flexible connective tissue that provides support and structure for the joint and provides a cushioning effect.

Cartilage is Avascular which means it is not supplied by blood. Instead it gets its nutrients from a Cartilage MATRIX.

Question 6

What are the 3 types of Cartilage?

Answer 6

• Hyaline Cartilage:
  Is the most common form found in the body. It lines
  the bones and joints. It allows for smooth joint
  movement by reducing friction.
• Elastic Cartilage:
  More flexible than the others and is found in the outer
  ear and the larynx.
• Fibrocartilage:
  Strongest and most rigid. It is what the vertebral disks are made of. It is found in high stress areas like at tendons and ligaments.

Question 7

What is Synovial Fluid and Bursae?

Answer 7

Synovial fluid is an oily, straw colored fluid that fills the joint space and reduces fiction.

Bursae a fluid filled sac filled with Synovial Fluid that act as cushions for tendons and bones and reduce friction to allow for free movement. There are more than 150 throughout the body but mostly in the elbow, knee, and hip.

Question 8

Where do tendons attach to bones?

Answer 8

In the Periosteum

Question 9

How many skeletal muscles are there in the body and what are the major 5 functions of muscles?

Answer 9

There are approx. 700 skeletal muscles

The 5 major functions are:

• Allow for movement
• Support the soft tissues
• Maintaining posture and body positions
• Protecting the entrances and exits of the digestive
  and urinary tracts
• Maintaining body temperature

Question 10

What is the most common and frequent signs and symptoms of nontraumatic musculoskeletal injury?

Answer 10

Pain and Tenderness

Question 11

What is Repetitive-Motion injuries caused by?

What will the pt symptoms be b/c of this?

Answer 11

They are caused by the repetitive use of muscles and tendons that can cause microscopic tears that aren’t aloud to heal properly because of continued use after damage

Pt will experience pain and tenderness as well as a loss of range of motion b/c of swelling or pain

Question 12

What is Tendonitis and what type of injury is it?

What are 2 common types of tendonitis?

Answer 12

Tendonitis is a type of Repetitive-Motion Injury

It is an inflammation of a tendon

Two common types:

• Tennis Elbow aka Lateral Epicondylitis
  (will cause radiating pain to forearm and weak grasp)
• Golfer’s Elbow aka Medial Epicondylitis

Question 13

What is Tenosynovitis and what type of injury is it?

Answer 13

Tenosynovitis is close to tendonitis except it is the inflammation of the lining of the sheath (synovium) that surrounds the tendon

Tenosynovitis is a type of Repetitive-Motion Injury

Question 14

What is Bursitis and what type of injury is it?

Answer 14

Bursitis is a type of Repetitive-Motion Injury commonly but can also be infectious or secondary to gout

It is Inflammation of the bursae

Question 15

What is Myalgias and what type of injury is it?

Answer 15

Myalgias is a common SYMPTOM of Repetitive-Motion Injury

Myalgia = “muscle pain”

Question 16

What is Carpal Tunnel Syndrome (CTS) and what type of injury is it

Answer 16

Carpal Tunnel Syndrome (CTS) is a type of Repetitive-Motion Injury (there are other causes but this is the most common)

It is a condition caused by pressure on the median nerve of the wrist and is a common workplace injury that causes tingling, numbness, weakness, or pain of the fingers and or hand

Question 17

What is a degenerative condition or disorder?

Answer 17

It results from a disturbance in normal functioning of the affected tissues or organ system due to age or wear and tear

Question 18

What is Osteoarthritis and what type of disorder/disease is it?

Answer 18

Osteoarthritis is a Degenerative Condition/Disease

AKA Degenerative Joint Disease

It is a common condition caused by wear and tear of the joints that causes pain and stiffness of the joints. Especially in the mornings but is noted to get better through the day.

Obesity is one condition that exacerbates this especially in the weight bearing joints.

NSAIDs may help with pain but since it is chronic only physical therapy modalities, exercise, and weight loss will cause lasting aid

Question 19

What is Osteoporosis and what type of disorder/disease is it?

Answer 19

Osteoporosis is a Degenerative Condition/Disease

It is the MOST COMMON form of bone disease; and is a thinning of bone tissue and loss of bone density (from mineral loss, calcium and phosphate are huge).

A major factor is estrogen and testosterone loss; females over 50 and men over 70 are at increased risk

Another big clue to if a pt has this is that osteoporosis ill cause vertebral body collapse and compression so a pt may loose up to 6inches in height or develop “Dowager’s Hump”

Question 20

What is Degenerative Disk Disease and what type of disorder/disease is it?

Answer 20

Degenerative Disk Disease is sort of a Degenerative Condition but it is primarily just a result of age-related changes in the spinal disks.

When young the vertebral disks are about 80% water but with age they dehydrate and become stiff. The outer layer may even crack and leak a jellylike substance causing the disk to bulge or herniate which places pressure on the spinal nerves causing pain and weakness. There is also no direct blood supply so it is slow to repair itself.

The most common symptoms are back or neck pain

Question 21

How many vertebral disks are in the body?

What is the outer and inner portion of the vertebral body called?

Answer 21

There are 23 spinal disks

The outer portion is called the Annulus Fibrosus and is a tough circular structure that gives the disk its shape

The inner portion is called the Nucleus Pulposus and contains a network of fibers in a jellylike substance.

Question 22

What are Inflammatory Joint Diseases and what are the characteristic signs and symptoms?

Answer 22

Inflammatory Joint Diseases are a group of rheumatologic conditions that result from inflammation within the joint.

They typically cause:

• pain
• stiffness
• erythema
• warmth
• swelling
• effusion (increased fluid within a joint)

Question 23

What is Rheumatoid Arthritis and what kind of disorder/disease is it?

Answer 23

Rheumatoid Arthritis is a Inflammatory Joint condition caused by an Autoimmune Disease

The immune system attacks the synovium and surrounding tissues causing inflammation and damage.

The joints will eventually become swollen and loose range of motion or in severe cases can cause a deformity known as “Burned Out” RA. Also in severe cases it can affect the kidneys, eyes, or other structures.

• This can occur at any age but commonly effects
  women more than men. Usually found in the wrists,
  fingers, knees, ankles, and feet
• Medications, surgery, and exercise can all be viable
  treatment. However most medications for this can
  become toxic.
• From an EMS standpoint, the most common
  complaints will be pain and general malaise

Question 24

What is Ankylosing Spondylitis and what kind of disorder/disease is it?

Answer 24

Ankylosing Spondylitis is a form of inflammatory arthritis ( Inflammatory Joint Disease) that primarily effects the spine

New bone forms as a part of the healing process that will eventually lead to a fully fused spine in severe cases called “Bamboo Spine”. The spine also typically forms in a flexed position so they must walk bent over.

This fused spine is EXTREMELY FRAGILE and can easily lead to a spinal cord injury if broken so EMS must change how they handle these pts especially with airway management, often non visual required airways must be used

Question 25

What is Systemic Lupus Erythematosus?

Answer 25

It is an autoimmune disease where the immune system attacks healthy cells and tissues causing chronic inflammation. Commonly in the fingers, wrists, and knees.

Most commonly effects women and can occur at any age, as well as runs in families.

Generally the patients will have joint pain and swelling and may lead to Rheumatoid Arthritis. like RA it is a chronic disease and treatment is aimed at mitigating symptoms and stopping disease progression.

Question 26

What is Gout?

Answer 26

Gout is a form of inflammatory arthritis that occurs when Uric Acid accumulates in the joints. Uric Acid is a normal byproduct of the breakdown of Purine.

This tends to run in families but occurs in men more than women. And usually occurs at the joint between the foot and the big toe

Diuretic drugs can often worsen the condition.

Signs and symptoms usually consist of pain, swelling, and erythema

Question 27

What are 5 types of Soft Tissue Infections?

Soft tissues include skin, fascia, tendons, and muscle

Answer 27

• Cellulitis:
  Is an infectious disease of the skin. Not often serious
  and can be cured with antibiotics, pain meds, and
  sometimes surgical drainage. S&S often include
  swelling, tenderness, exudate (pus), and erythema.
• Fasciitis:
  Inflammation and infection of the fascia found
  surrounding muscles, muscle groups, blood vessels,
  nerves, etc. This is usually not sever unless it
  develops into Necrotizing Fasciitis (“Flesh-Eating
  Disease”) which has a very high mortality rate and is
  caused by multiple bacteria that release toxins that
  destroy tissue. These bacteria are often drug resistant
• Tenosynovitis:
  (is also a repetitive motion disorder but can be
  infectious) Inflammation of the fibrous sheath that
  surrounds tendons but is often treatable with
  antibiotics or surgical drainage
• Gangrene:
  This follows soft tissue infection and is the death of
  tissue that occurs when blood supply is interrupted.
  This causes no pain normally, but discoloration (blue
  or black), a foul smelling discharge loss of sensation.
  It often requires surgery to remove dead tissue and
  restore blood supply or in severe cases amputation.
• Diabetic Foot:
  Results in the feet and sometimes hands second to
  uncontrolled Diabetes Mellitus. B/c diabetes mellitus
  adversely effects peripheral blood vessels and nerves
  if there is a cut or skin ulcer on the feet it can lead to
  an infection that spreads to the bone causing
  Osteomyelitis. Another complication of Diabetes
  Mellitus is Neuropathic Arthropathy or “Charcot Joint
  Disease” which is a degenerative disease in weight
  bearing joints causing bone destruction and deformity

Question 28

What are the 2 major Bone and Joint Infections?

Answer 28

• Osteomyelitis:
  An infection of the bone usually by bacterial infection,
  and usually occurs secondary to a spread of infection
  starting at another place especially chronic wounds or
  skin ulcers. Often treated with long term antibiotics or
  surgical drainage.
• Septic Joints:
  Aka “Septic Arthritis” is an infection of a joint by multiple microorganisms. Usually bacteria split into two categories: Gonococcal and Nongonococcal. Pts with prosthetic joints are at higher risk and usually present with joint pain, swelling, redness, low fever, and joint immobility.

Question 29

What is a Neoplasm?

What is Primary VS Secondary Musculoskeletal tumor?

Answer 29

Neoplasm is an abnormal growth of body tissue and is often called a TUMOR.

Primary Musculoskeletal tumor is one that ARISES FROM muscle, bone, or one of the associated tissues

Secondary Musculoskeletal tumor is one the SPREADS TO the muscle or bone.

Question 30

What is the most common benign bone tumor?

What is the most common malignant bone tumor?

Answer 30

Most common benign bone tumor is OSTEOCHONDROMAS

Most common malignant bone tumor is SARCOMAS

Question 31

What is chronic pain syndrome?

What are its six Ds?

Answer 31

It is pain that is consistent for 3-6 months

• Dramatization of complains
• Drug misuse
• Dysfunction/disuse
• Dependency
• Depression
• Disability

Question 32

What is Fibromyalgia?

Answer 32

Fibromyalgia is also called Central Sensitivity Syndrome (CSS) and is a chronic pain disorder causing pain in the muscles and soft tissues throughout the body for an unknown reason

Diagnosed by the requirement of at least 11-18 different predefined tender points (aka trigger points)

also commonly causes fatigue and difficulty sleeping

Question 33

What is Reflex Sympathetic Dystrophy?

Answer 33

It is a chronic pain condition characterized by diffuse pain, swelling, and limited movement following an injury to an arm or leg. It is considered to be a type of Complex Regional Pain Syndrome (CRPS)

Symptoms are often out of proportion to actual injury

This also leads to an abnormal sympathetic reflex that causes vasoconstriction in the affected joint that can cause ischemia and escalating pain

Question 34

What are two pediatric specific musculoskeletal diseases?

Answer 34

• Osgood-Schlatter Disease:
  A painful swelling of the anterior tibial tubercle, often
  in both legs (the bump just below the knee. Thought
  to be the result of repetitive injury to the area before
  bone growth is complete. Often requires rest, ice,
  and NSAIDs.
• Slipped Capital Femoral Epiphysis:
  A separation of the ball of the hip joint from the
  femur. (epiphysis = growth plate). Requires surgical
  pins be placed to stabilize the bone. Often in boy
  ages 11-15