Week 3: MSK Challenges Flashcards
Describe structure and function of bone
Epiphysis, dyaphisis main-shaft, metaphysis, epiphyseal plate, periosteum fibrous connective tissue, medullary-marrow
Epiphysis
Wiedened area at each end, mostly cancellous (spongy bone), width allows weight distribution, location of muscle attachments covered by articular cartilage
Diaphysis
Main shaft, structural support
Metaphysis
Flared area between epiphysis and diaphysis
Epiphyseal plate
Growth zone between epiphysis and metaphysis, 18-25 years plates harden and metaphysis and epiphysis join
Periosteum fibrous connective tissue that covers bone
Penetrated by blood vessels that nourish underlying bone
Medullary-marrow
centre of diaphysis; contains either red or yellow marrow; child hematopoiesis occurs only in red marrow;
Describe X-ray
X-rays can be used to examine most areas of the body. They’re mainly used to look at the bones and joints, although they’re sometimes used to detect problems affecting soft tissue, such as internal organs. Problems that may be detected during an X-ray include: bone fractures and breaks.
(2D)
Describe CT
(3D) CT scans may be performed to help diagnose tumors, investigate internal bleeding, or check for other internal injuries or damage.
This is done by using multiple X-rays
Describe MRI
an MRI may be used to examine bones, joints, and soft tissues such as cartilage, muscles, and tendons and uses strong magnetic and radio waves to capture this.
Describe Arthrogram
An arthrogram injection is an injection of a radioactive tracer into a joint to allow better visualisation of internal joint structures during a Nuclear Medicine examination.
Describe bone scan
A bone scan involves an injection of a radiopharmaceutical into a vein in the arm. This radiopharmaceutical moves from the blood into your bones, at which point scans are done.
What is an osteoblast?
Bone forming cells
What is an osetocyte?
Mature bone cells
What is an osteoclast?
Break down bone tissue (helds assist with bone remodling by removing old bone like shedding)
What is delayed union
Healing does not occur in expected time
What is nonunion
Healing does not occur at all
What is arthrocentesis? What’s it also called?
Joint aspiration. Doctor uses needle to take fluid out of a joint. For diagnostic and for therapeutic purposes
What is discography?
An imaging test used to evaluate back pain/ X-ray dye is injected under gentle pressure into discs of spine
When a normal disc is injected, you will feel a sense of pressure, but not pain. When an abnormal disc is injected, you will feel pain.
What is DEXA?
Test that uses low levels of x-rays to measure how dense your bones are
What is quantitative ultrasound (QUS)?
Quantitative ultrasound (QUS) is a relatively recent and noninvasive method of estimating bone mineral status at peripheral skeleton. In addition to bone density, QUS methods provide some structural information, which may be important in determining the fracture risk
What is alkaline phosphatase?
Measures amount of ALP in the blood. Commonly used to diagnose liver damage or bone disorders
What is rheumatoid factor test?
Measures amount of rheumatoid factor in your blood. Higher level could indicate rhaumatoid arthritis .If you have this type of arthritis you will have tender, warm and swollen joints
What is eryhtrocyte sedimentation rate?
Blood test that cna reveal inflammatory activity in your body
What is a c-reactive protein test?
A high CRP test is a sign of acute inflammation. Can be due to serious infection or chronic disease
Why are uric acid tests done?
Uric acid can form in blood or urine. If too much uric acid stays in body, hyperuricemia will occur which can cause crystals or uric acid to form. These crystals can settle in the joints and cause gout, a form of very painful arthritis
Stages of fracture healing
hematoma formation
granulation tissue formation
callus formation
consolidation
bone remodelling
Buck’s skin traction
Used for preop for patients waiting for hip fracture repair. Weights attached to foot
What are halo vest’ used for?
Those with a broken neck.
- Daily care required for pin site infection
- Never release clips while in upright position
- Careful with skin breakdown under the vest
What is open reduction internal fixation used for?
Open reduction and internal fixation is a surgical procedure for repairing fractured bone using either plates, screws or an intramedullary (IM) rod to stabilise the bone
Do’s for Hip Fracture Repairs
- use elevated toilet seat
- pillow between legs for 8 weeks when side lying
- hips neutral while walking sitting or lying
- inform dentist of prosthesis so prophylactic antibiotics can be given before dental work
Dont’s for hip fracture repairs
- exceed 90 degrees hip flexion
- adduct
- cross legs
- shoes without adaptive device until 8 weeks
- sit on chairs without arms
- internally rotate hips
Dont’s for hip fracture repairs
- exceed 90 degrees hip flexion
- adduct
- cross legs
- shoes without adaptive device until 8 weeks
- sit on chairs without arms
- internally rotate hips
What is osteomyelitis?
Infection in a bone
**Complications of hip fractures that include infection can lead to what?
Osteomyelitis
What is compartment syndrome?
Pressure in confined myofascial compartment; compromised function of blood vessels, nerves and tendons
What can cause compartment syndrome/
Decreased compartment size; too tight cast
or
Increased compartment contents; bleeding, edema, IV infiltration
**Clinical manifestations of compartment syndrome? 6 P’s.
- pain on passive stretch & distal to injury not relieved by opioids and pain on passive stretch of muscle through compartment,
- Pressure Increase
- Paresthesia (numbness & tingling)
- Pallor with coolness
- Paralysis
- Pulselessness
What output assessment should nurses assess with compartment syndrome?
Urine output assessment (i.e. renal tubules may be damaged due to release of myoglobin from damaged muscle (ie. myglobinuria); urine dark, reddish-brwn
With compartment syndrome, what are 2 major things you should NOT do?
- do not elevate extremity above heart (lowers venous pressure and slows arterial perfusion)
- do not apply cold therapy because of vasoconstriction
What is fasciotomy?
Can be used for compartment syndrome. IT is a surgery to relieve swelling and pressure in a compartment of the body
What is fasciotomy?
Can be used for compartment syndrome. IT is a surgery to relieve swelling and pressure in a compartment of the body
**What are two major complications that come with fractures?
Venous thromboembolism and fat embolism syndrome
** Venous thromboembolism how do we prevent it?
Prevention-antiembolism hose, sequential compression devices, ROM exercises, prophylactic anticoagulants (e.g. warfarin; LMWH (e.g. enoxaparin; rivaroxaban)
*** Fat embolism
Fat embolizes to organs (lungs nad brain) after traumatic skeletal injury. (Fatal in 5-15% of patients).
-A fat embolism happens when there is fat in the circulatory system, including the veins or arteries. It usually happens after a bone injury, when fat surrounding the bone and muscle gets into broken blood vessels.
Amputations indications
- PVD, trauma, burns, malignant tumours, osteomyelitis, diabetes
What are indications for hip and knee athroplasty
- Osteoarthritis (OA); rhuamatoid arthritis (RA), avascular necrosis (AVN) and congenital deformities
Hemiarthroplasty
Replacement of a part of a joint
Surgical reshaping
Of bone and joints
Resurfacing arthroplasty
Head of femur is retained, reshaped and capped
What is osteoporosis?
Chronic, progressive metabolic bone disease, characterized by low bone mass and structural deterioration of bone tissue, leading to increased bone fragility
Osteoporosis is more common in what gender and why?
Women:
- less calcium
- less bone mass
- bone resorption begins at earlier age
- pregnancy depletes low Ca+
Risk factors for osteoperosis
- over 65 y/o
- family history
- fragility
- vertebral compression
- hyperparathyroidism
- falls
- osteopenia (Low BD)
- early menopause
- rehaumatoid arthritis
- hyperthyroidism
- low body weight
- vitamin d deficciency
- excessive caffeine
**Drug therapies for Osteoporosis
Estrogen replacement therapy, calcitonin, biophosphonates, selective estrogen receptor modulators, monoclonal antibody, calcium and vitamin D supplementation
What is the most common form of joint disease in North America? Describe it
Osteoarthritis.
- Slowly progressive non-inflammatory disorder of synovial or diarthrodial joint
Obesity can be linked to what joint disease?
Osteoarthritis
Osteoarthritis results from cartilage damage that triggers a metabolic response. What happens to the cartilage?
- Dull yellow and granular
- Soft and less elastic
- LEss able to resist wear with heavy use
Osteoarthritis diagnostic studies
- Bone scan, CT, MRI: useful in early OA
- X-rays: show joint space narrowing
- Blood studies: no diagnostic biomarkers
- Synovial fluid analysis: remains clear yellow with no signs of inflammation
Arthroscopic surgery is effective when?
In reducing pain and improving function when it is used to repair ligament tears and remove bone bits or cartilage
Summary: osteoarthritis results in what?
Bone ends rub together, and cartilage is thinned
What is rheumatoid arthritis?
“a chronic, systemic autoimmune disease characterized by inflammation of connective tissue in the diarthrodial (synovial) joints” (
Summary: rheumatoid arthritis results in what?
Swollen and inflammed synovial membrane, and bone erosion
What is GOUT?
“type of recurring acute arthritis characterized by accumulation of uric acid crystals on one or more joints”; hyperuricemia
