Vol.3-Ch.13 "Nontraumatic Musculoskeletal Disorders" Flashcards
Most nontraumatic musculoskeletal disorders are _____ or _____ in nature.
Most nontraumatic musculoskeletal disorders are INFLAMMATORY or AUTOIMMUNE in nature.
How many bones are in the body?
What are the 4 classes of bones and where are they found?
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
Bones joined together by ____ form joints
Muscles connect to bone via _____
Bones joined together by LIGAMENTS form joints
Muscles attach to bones via TENDONS
think tenderloins are muscles with tendons left in
What are the 6 classes of joints?
What kind of movement does each allow?
- 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
What is cartilage and what does it do?
Cartilage is also AVASCULAR, what does that mean?
(not asking for the 3 types of cartilage)
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.
What are the 3 types of Cartilage?
- 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.
What is Synovial Fluid and Bursae?
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.
Where do tendons attach to bones?
In the Periosteum
How many skeletal muscles are there in the body and what are the major 5 functions of muscles?
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
What is the most common and frequent signs and symptoms of nontraumatic musculoskeletal injury?
Pain and Tenderness
What is Repetitive-Motion injuries caused by?
What will the pt symptoms be b/c of this?
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
What is Tendonitis and what type of injury is it?
What are 2 common types of tendonitis?
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
What is Tenosynovitis and what type of injury is it?
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
What is Bursitis and what type of injury is it?
Bursitis is a type of Repetitive-Motion Injury commonly but can also be infectious or secondary to gout
It is Inflammation of the bursae
What is Myalgias and what type of injury is it?
Myalgias is a common SYMPTOM of Repetitive-Motion Injury
Myalgia = “muscle pain”
What is Carpal Tunnel Syndrome (CTS) and what type of injury is it
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
What is a degenerative condition or disorder?
It results from a disturbance in normal functioning of the affected tissues or organ system due to age or wear and tear
What is Osteoarthritis and what type of disorder/disease is it?
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
What is Osteoporosis and what type of disorder/disease is it?
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”
What is Degenerative Disk Disease and what type of disorder/disease is it?
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
How many vertebral disks are in the body?
What is the outer and inner portion of the vertebral body called?
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.
What are Inflammatory Joint Diseases and what are the characteristic signs and symptoms?
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)
What is Rheumatoid Arthritis and what kind of disorder/disease is it?
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
What is Ankylosing Spondylitis and what kind of disorder/disease is it?
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
What is Systemic Lupus Erythematosus?
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.
What is Gout?
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
What are 5 types of Soft Tissue Infections?
Soft tissues include skin, fascia, tendons, and muscle
- 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
What are the 2 major Bone and Joint Infections?
- 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.
What is a Neoplasm?
What is Primary VS Secondary Musculoskeletal tumor?
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.
What is the most common benign bone tumor?
What is the most common malignant bone tumor?
Most common benign bone tumor is OSTEOCHONDROMAS
Most common malignant bone tumor is SARCOMAS
What is chronic pain syndrome?
What are its six Ds?
It is pain that is consistent for 3-6 months
- Dramatization of complains
- Drug misuse
- Dysfunction/disuse
- Dependency
- Depression
- Disability
What is Fibromyalgia?
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
What is Reflex Sympathetic Dystrophy?
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
What are two pediatric specific musculoskeletal diseases?
- 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
