W9 Muscoloskeletal dysfunction Flashcards
Describe the main types of joint and muscle injuries and their common causes.
Sprains & strains: forcible mechanical overload, twisting or stretch at joints.
Strains: stretch injury due to mechanical overload of muscle &/or tendon
Sprain: excessive or abnormal movement of join damages ligaments.
Dislocations: displacements or separation of bone ends (joints). Causes: - Congenital - Traumatic - Pathological
Most common sites are shoulder and knee sits. Mostly synovial joints + hinge joints.
Degrees of muscle strain
- Mild (1st degree) : minor swelling and discomfort, little to no change to muscle strength/movement.
- Moderate (2nd degree) strain: Moderate to severe pain, damage to muscle, some loss of strength.
- Severe (3rd degree) strain: tear across muscle belly, severe pain & loss of function, surgical intervention required.
Explain how skeletal trauma develops, outlining the risk factors.
Skeletal fractures occur when the force applied to a bone exceeds the tensile or compressive strength of the bone. → young males (adolecent) → elderly Risk factors: - Bone disease - Poor nutrition
Fracture cause damage to periosteum, blood vessels and other surrounding structures.
Clinical manifestations:
- Unnatural bone alignment
- Initial numbness followed by severe pain
- Impaired sensation
- Muscle spasm
- ALtered mobility
- Tenderness and swelling
PICOutline and describe the types of bone fracture.
- Open (compound)
- Closed
- Complete
- Incomplete
- Spiral - twisting
- Comminuted (bone splinting)
- Longitudinal (runs along length of bone)
- Segmental fracture
- Oblique
- Greenstick
Avulsion: when a sction of bone at the site of ligamnt is torn away with a fragment of bone attached. - Torus: compression and crushing
- Physeal
- Pathophysiological
- Compression
- Depressed: bone pushed inwards
Describe the stages of fracture repair in healthy bone.
- Haematoma
- clot forms in medullary cavity at fracture site.
- Dead bon at fracture site & other debris stimulates inflamation - Fibrocartilgenous callus formation:
- Angiogenesis vascular tissue invads fracture site and blood flow ↑
- Osteoblasts are stimulated and form a procallus - collagen deposition - Ossification:
- Procallus becomes mineralised → callus - Bone remodelling: osteoblasts and osteoclasts continue to reorganise bone and unnecessary callus is resorbed.
Outline three factors that can affect the process of fracture repair.
- General health of the person
- Nutritional status
- Adequacy of initial tx
- Age.
ABNORMAL FRAC repair:
Malunion: incorrect healing resulting i a deformity.
Delayed union: failure of fracture to unite within a normal time period.
Nonunion: failure to unite: leads to pain and fracture side mobility, can result in muscle atrophy and loss of range of motion,
Explain the pathogenesis of rhabdomyolysis and its progression to crush syndrome. Learning
Compartment syndrome: odemoa and swelling cause increased pressure in muscle compartment.
- ↓ blood flow - blood vessel occlusion
- possible muscle and nerve damage
- Ischemia may cause muscles and nerves to die (limb may need to be amputated.
Define osteomyelitis and briefly explain how this condition may be treated.
Acute or chronic infection of the bone due to
- Direct access via open fracture
- blood borne
- skin infections in vascular insufficiency
CAUSE:
_ staphluococcus aureus
- bind to colagen → internalisd osteoblasts.
TX: indentification of infectious organism and tx with parenteral and oral antibiotics, in concert with pain control. May also require surgical debridement and surgical drainage of infection site. Amputation may be required.
Explain how osteoneocrosis may develop and describe the clinical manifestations.
Bone death due to interuption of blood supply.
DUE TO: - Mechanical trauma to vasculator - THrombosis and embolism - Vessel dysfunction - Prior corticosteriod use RISK FACTORS: - Long-term use of steroids - Heavy alcohol intake - Direct injury to bone or join - Chemotherapy or radiation - Organ transplant - Diseases
CLINICAL MANIFSTATIONS
- Insidiois no symptoms
- Pain when prssir or weight applied to joint
- Inability to use limb
- Joint replacement
Define rheumatic disorders and exemplify
Characterised by inflammation that affects the connecting or supporting structures of the body - most commonly the joints but sometimes the tendons, ligaments, bones and muscles.
CLASSIFICATION:
Primary - du to systemic autoimmune response.
Secondary - due to degenerative processes with the joint.
Define osteoarthritis and describe its aetiology
Osteoarthritis (OA): results from th slow destruction of articular cartilage causes bonee to rub on bone.
CLASSIFICATIONS:
- Idopathic OA: wear and teear of joints
- Can be localisd
- Generalised affects 3 or morejoints - Secondary OA: metabolic disorder, congenital or trauma.
Risk facts:
Jobs requires hard labor or repetitive motion
- Obesity
Describe the clinical manifestations of osteoarthritis
Mild symptoms worsn over time. - Pain and stiffness associated with joint degeneration - Worsened by activity and relieved by rest. Joint enlargement - Effusion - Crepitus - Bone spurs - Joint instability
COMMON SITES:
- Hips
- Kns
- Crvical vertebrae
- Proximal/ distal joint of hands.
DIAGNOSIS:
- x-ray, MRI, ultrasound.
TX: analgesics
- anti-inflammatory drugs
- chondroprotective injections
NON-DRUG: heat and cold application
Describe the manifestations, diagnostic and tx of osteoporosis
Diagnosis: DEXA scan - Not diagnosd until fracture happens itself. PREVENTION: - Smoking cessation - Reduction of cola-cased bevs - ↑ calcium vit D TREATMENT: Drugs to prevent/slow bone resorption - gonadal hormones - Calcitonin - fluroides - bisphosphonates
BISPHOSPHONATES:
- Inhibit digestion of bon by encouraging osteoclasts to ndeergo apoptosis, thus slowing bone loss.
- Side effect: osteonecrosis > 2 years
Define rheumatoid arthritis and describe its aetiology
Theumatoid arthritis: autoinmmune disorder involving a chronic inflammatory response. SEEN IN BOTH JOINTS. Bilateral involvement of joints. The cause of the chronic inflammation uncrtain.
- Chronic systemic autoimmun disordre,
- most common form of autoimmune arthritis
- Cause is unknown
- Various factors may b involved
Explain the pathogenesis of rheumatoid arthritis
Involves the early changes occuring within the synovium and disease progression that leads to erosion and the formation of pannus.
- Antibodies in RA bind with other proteins and tissues.
- Create immune complexes that cause inflammation
- Enzymes cause further joint tissue degradation
- Pannus forms
- Osteoclasts cause underlying bone to demineralize
Describe the clinical manifestations of rheumatoid arthritis
The most commonly affects joints are fingers, feet, wrists, elbows, ankles & knees.
Inflammation causes pain, tenderness, swelling, stiffness, warmth, joint deformity and loss of function.
Loss of function is followed by muscle atrophy
- Dislocation of joints can occur.
EXTRA-ARTICULAR SYSTEMIC MANIFESTATIONS OF RA:
- Fatiguee, anorexia, wight loss, generalised aching, low grade fever
- Anamia
- Rheumatoid nodules
