week 6 : mobility Flashcards
adequate mobility requires what ? and what is the importance of this ?
adequate energy, muscle strength, strength stability, joint function, and neuromuscular coordination in order to carry out desire function
structure dictates what ?
dictates function
what does musculoskeletal system relies heavily on ?
neuromuscular system
Pathophysiology review - the musculoskeletal system ( what undergoes this category ) - recall from anatomy ( suck a nut like i already forgot 😁 )
bones
cartilage
ligaments
tendons
muscles
name the following description :
make up the skeletons that supports our body
bone
what is bone essential for ?
weight bearing
name the functions of a bone
creates a supporting structure
protect underlying organs and tissues
muscles can attach to bone because of tendons
Finish the sentence :
bones are levers for ______
bones contain ____ to produce ____ and ___ blood cells
storage of _____ and phosphate
movement
marrow, red, white
calcium
when structure changes so does it function, name an example of this description and briefly explain it ( include the brain and the lungs, and the heart in your example )
fracture of a bone
it impacts your overall function as our bone connects to muscle by tendons and they act for movement essential for protecting internal structures such as the skull ( protecting the brain ) or bony ribcage to protect vital organs such as lungs or heart
Recall : Bones contain marrow to produce red and white blood cells , go more in depth of this means
bones are responsible for the function of hematopoiesis which is the production of red and white blood cells that are created in bone marrow
functions of joints : name the characteristics that undergoes this category
joints are where two bones meet and move in relation to each other
joints are enclosed in a capsule of fibrous tissue and joints two bones together, forming a cavity
what does synovial membrane contributes in terms of the functioning of joints and cartilage
synovial membrane lines the cavity and secretes synovial fluid
what is synarthorothic joint? what abt alpha arthrodial joints ? and diathrodial or synovial joints ?
synarthorothic joint which are totally IMMOVABLE ( skull )
alpha arthrodial joints which are slightly movable such as what connects the bones of the pelvis together
diarthrodial or synovial joints which are freely movable joints such as elbow and the knee (most common joint in the body)
what is a cartilage ?
rigid connective tissue that supports soft tissue
true or false. Joints are present whenever the bones are meeting in the body, and they have different ranges type of mobility.
this is true
recall that : synovial membrane lines the cavity and secretes synovial fluid, now dig more in depth of what this contributes to mobility
describe joint cavity ( filled with synovial fluid )
lines the cavity or what we also refer to as that intra articular space and the parts that is contained within this space is now filled with a fluid that’s called synovial fluid and this acts as a space lubricant - it helps reduce the friction between the two bones during movement
Recall the diagram of lewis fig 64-2 slide 5
describe the bone and the layer cartilage between them
two bone meeting is not directly bone on bone but there is a layer of cartilage between them
and cartilage is a rigid connective tissue that provides the smooth lubricated surface for articulation for the meeting of two bones and it has a protective factor for bones and help absorb shock
describe how cartilage help protect you from shock ( from walking or running )
the cartilage help protect those two bones that are connecting in your knee from that shock impact while you’re walking or running
what are the 3 types of muscles
- cardiac muscle - myocardium
- smooth muscle - airways, arteries, GI, bladder, uterus
3.skeletal muscle- all other muscles of the body
name the 2 type of muscles that are involuntary
cardiac muscle ( myocardium ), and smooth muscle ( airways, arteries, GI, bladder, and uterus )
what is cardiac muscle : myocardium responsible for
this is the muscle of the heart, responding for contracting and pumping blood into our blood vessels : these muscles are involuntary
recall that smooth muscle : airways, arteries, GI, bladder, uterus , give an example of what this might look like
this is involuntary , for example : bronchioles that can dilate and constrict
within our arteries casing vasoconstrictor or vasodilation
along the gi tract causing peristalsis to occur along the bladder or uterus
they play a normal movement in the air, secretions or bodily fluids throughout the body
true or false. Smooth muscle play a normal movement in the air, secretions or bodily fluids throughout the body, what are the examples
true airways, arteries, GI tract, bladder and uterus are some examples
what is one voluntary act of the muscle
skeletal muscle
( voluntary ) name examples of skeletal muscles
biceps, abs, quadricepts ( all directed connected to skeletal system ) voluntary muscle
what is the skeletal muscles responsible for ?
responsible for overall body movement and mobility
true or false. skeletal muscles has to be a unconscious effort directed towards that muscle impulses in our nervous system in order for the skeletal to contract
false, CONCIOUS since it is voluntary U SUCTION CUP
in order for any muscle to contract, what type of impulse must there be ?
nerve impulse
motor nerve fiber stimulating a skeletal muscle fiber is what we refer to as what ?
motor end plate
what is the junction between the axon of the nervce cell adn the adjacent muscle cell ?
neuromuscular junction
neurotransmitter molecules, acetylcholine specifically are released from the ____
describe what this mean
neuron synaptic vessels and it diffuses across the synaptic cleft - they stimulate receptors in the motor end plate region of the sarcolemma
muscle skeletal system is closely connected to where ?
neurological system
give an example given in the neuromuscular junction
organs containing smooth muscles : GI tract this can be affected by a poor signal that automatic signal, ( those signals are involuntary )
recall that: organs containing smooth muscles : GI tract this can be affected by a poor signal that automatic signal, ( those signals are involuntary ) how is it going to impact the muscle ?
the ability of those smooth muscles in the GI tract to contract and cause peristalsis, if we have poor automatic signal or disruption in that impulse, it’s going to impact how well that muscle is able to contract and perform that function of peristalsis
what is ligaments and tendons composed of ?
dense, fibrous connective tissue
true or false. tendons attach muscle to bone
true
recall that tendons attatch a muscle to a bone. Name an example: and what can we do with this ? and define the description
for example : achilles tendons
tendons we can assess for reflexes, if they are struck with a mallet, they will trigger movement of the muscle they are attached to and move that bone
What does ligaments connect? and what does it do ?
ligaments connect bones to bones, provide stability but also enable movement at the joint
how are ligaments and tendons different ? and how are they similar?
these are similar and that they both support bones , different in the fact that they have different insertion and joints
name an example of ligament supporting healthy joint
the knee joints has numerous ligaments attaching in multiple different ways in order to create every strong support network to weight bear an individual’s weight when they’re walking
ligaments and tendons have low blood supply?
yes this is true
recall that ligaments and tendons have low blood supply, now what could happen if you have an injury ?
Low blood supply, which means it takes longer for healing when there is an injury
true or false. tendons and ligaments is composed of dense fibrous connective tissue which is great for supporting our muscles and bone and holding everything in place.
true
is fracture considered as a medical condition ?
yes it is
what is this description describing : break in the structure of the bone
fractures
fracture has classification : what is fractures classified as ? (hint there is a couple of them)
open or closed
complete or incomplete
direction of fracture line
if the skin has a broken and it has a bone sticking out what type of fracture is this considered as ?
open fracture
true or false. The skin is a tiny bit open, however it is still considered as an open fracture
this is true, once its open ( ITS OPEN )
most fractures are closed or open ?
closed
where could we see open fractures ?
high impact traumas such as car accidents or falls from significant heights
opening in the skin creates what type of opportunity (recall what she said in the lecture )
creates an opportunity for blood loss and there is a big enough vessel –> this could be a significant amount of blood loss that happens during this open fracture
how do you really identify an open fracture ?
the increased risk of infection that exists once the skin is exposed
what is the biggest risk for an open fracture ? explain
infection
skin is protective barrier against infection, once that barrier is open, allowing that external bacteria can penetrate into the wound and into the bone leading to infection
what is a complete fracture and what is an incomplete ?
complete fracture- if the break is completely though the bone
incomplete fracture- if the fracture occurs partially and the bone somewhat still remains in one piece
recall that the direction of the fracture can also be another way to classify a fracture : name an example
transverse across the bone of if it spirals along it
true or false. fractures can be surgical or non surgical
well no shaaaat the fack, it can be both
recall that fractures can be surgical or non surgical: some fractures can be displaced means the bone when it’s broken is misaligned for healing require intervention to realign referred to as
reeduction
when fixing a misalignment: name some intervention
can be sedation by pulling on that broken bone and manually realigning those bones during the casting process potentially require surgery with the insertion of surgical pins and rods to properly realign that bone.
Fractures can also occur without trauma or with very minimal impact in patients who have heart disease. would this be a true or false statement ?
bruh hell naw , its osteoporosis
Fractures can also occur without trauma or with very minimal impact in patients who have osteoporosis which we talk about further on and these are called
other than osteoporosis, these type of fracture is also common in what type of pts?
pathological fractures
cancer pts
what are the clinical manifestations of fractures
localized pain or bony tenderness
decreased function of the bone - think abt weight bearing
edema/swelling
- crepitus
- bruising
decreased function of the bone in terms of fractures clinical manifestations also means ….
decreased range of motion and decrease mobility to weight bear
this is a sound crucnhing noise meaning that the bone is not lined correctly, and two bones are grinding together
crepitus
why does bruising occur during a fracture ?
there’s blood vessels within the bone, so when there is a trauma to the inside of the bone this will show up
name the fractures complications
infection
compartment syndrome
venous thromboembolism
fat embolism
true or false. once you have that open fracture, the bacteria cannot penetrate through the sterile environment.
UH U GOTTA BE THE MOST SUCKED IN of course its compromised now since its open ( infection has entered the chat )
name what undergo infection in terms of fracture complications
open fracture high risk
open wound
surgery opens the wound to potential contaminants
what are the signs of inflammation when the pt is experiencing an infection due to fracture complication
warmth, redness, swelling, increased pain, and fever
true or false. even if there is an establishment of rules during surgery, there is no risk at all since it is a professional environment and precautions are made.
false, even if there is a precaution there is still a risk because AGAIN again I WANNA EMPHI that its still open
People who are immunocompromised are more susceptible to infection for fracture complications. Name examples
diabetes, HIV< or on meds that can cause immunocompromised ( steroids –> prednisone ) pts are at high risk
what are the specific neurovascular findings of comparment syndrome
The 6 P’s
1) Pain *out of portion, passive stretching
2) Pressure
3) Paresthesia
4) Pallor
5) Pulselessness
6) Paralysis * latest finding, loss of muscle function
true or false. ashen and pale or an not consistent with their individual is an clinical manifestation of compartment syndrome.
true
Compartment syndrome is only limited to leg and the forearm. true or false?
false, can happen in any part of the body, but is most common in leg and forearm
what is occurring during a comapartment syndrome?
As muscle are losing that circulation and becoming ischemic with that compartment syndrome this can be a very painful process
describe what pressure is under compartment syndrome
feel that space filling up and have that loss of mobility and range of motion due to that feeling of having in that area
what clinical manifestation is this describing: if there’s compression on the nerves, this will change their function, and pts can have decreased sensation, sometimes describing it as that feeling of pins and needles
paresthesia
this is bad sign, loss entire circulation to an area completely : what type of clini mani is this describing in terms of compartment syndrome
pulselessness
When compartment syndrome occurs, does this happen rapidly or progression?
when compartment syndrome occurs it can happen very quickly and can progress very rapidly
compartment syndrome :
muscle and nerve cells are damaged due to what ?
due to ischemia within 4 to 8 hrs ( HUGE RED FLAG ) for msk injuries and should be reported right way ( MAJOR PART OF ASSESMENT in surgery as well)!!!
true or false. Muscle group is divided into compartment.
true
with compartment syndrome there is an increase in pressure of that compartment and this can be due to multiple different factors: name those factors , what is the end result
It can be internal factors such as an increase in bleeding or swelling
it can be related to external factors such as a cast that’s inappropriately placed or way too tight.
Either way the end results in obstruction in blood flow and ischemia will result.
venous thromboembolism
this is life threatening an immediate intervention is needed
major associated with clot formation
venous thromboembolism : name characteristics
hip fractures, hip and knee surgery
after it forms it can travel
- unilateral leg pain, unilateral leg swelling
- pts are often anti coagulated to prevent the formation of a clot
what does prophylaxis mean ?
means we’re trying to prevent something
lying horizontally in a hospital bed ( allows pulling of blood ) this is one aspect of what we refer to as virchow’s triad , define how it correlates to DVT
outlines the three biggest riks factors for development of DVT
What are the 2 outlines of virchow’s triad that outlines DVT
1) immobility and venous stasis
2) endothelial damage ( refers to the lining of the inside of the blood vessels ) can become damaged with trauma that caused the fracture –> activates clotting factors and platelets which start that clotting process
what is the last of virchow’s triad that outline DVT
if a patient has blood
hyper coagulability = state where there is that imbalance of clotting mechanisms which could be due to medical conditions or potentially drugs that the patient is taking.
a serious condition when the DVT clot breaks off and travels into vital organs such as the lungs, the heart, or the brain. A clot there could become life-threatening very quickly. is this true or false.
WEELLLL NO F ING SHAAT it is
We always want to prevent virchow’s triad , for ex: someone who just finished surgery ( we must prevent blood clot forming )
yes true
fat embolism : SATA
a. early recognition is important for preventing death
b. usually develop symptoms within 24-48 hrs
c. symptoms usually include bradycardia, bradypnea, and dyspnea
d. neurological changes may also occur which include confusion, irritability, and restlessness
a b and d is correct
c is incorrect : it’s tachycardia, tachypnea and dyspnea that occurs ( remember SNS )
how can fat embolism occurs ?
can occur when a bone breaks and it’s often if it’s a long bone
fracture such as in the ribs or the pelvis
true or false. 90% of people with the fracture that experience a fat emboli are often going to
have minimal symptoms. It’s fairly insignificant on their health.
true
fat embolism - potential for these emboli to become serious because they could still potentially travel to areas of vital organs such as the lung, the heart, or the
brain.
true
name other clini mani of fat embolism that can occur
respiratory distress ( if we havean impact in pulm. circulation ) chest pain, cyanosis, and decreased oxygen sat
what is an arthritis, and what is the three type of it in terms of mobility ? also be referred as rheumatoid disease
refers to inflammation of the joint or many joint
1) osteoarthritis
2) rheumatoid arthritis
3) gout
this is the most common arthritis , and define what it is
osteoarthritis, degenerative disease which mean that this occurs in the general onset and typically get worse overtime
what are the risk factors for OA
obesity ( increase in pressure )
trauma
repetitive use
post menopausal ( as natural estrogen increase )
family hcx
with time there is a sig. thickening of the articular bone of that fricture no longer smooth cartilage ( bone on bone ) - is this the possibility for osteoarthritis?
true
osteoarthritis clinical manifestations : name them
not systemic
joint pain
stiffness in the AM
Joint deformity
- heberden nodes
- bouchard nodes
crepitus
asymmetrical
what is this describing : this is localize to the area of the damage and therefore do not see systemic change
osteoarthritis
osteoarthrithis clini mani: explain why joint pain and stiffness in the am occur
joint pain - repetive or continous use of that joint
stiffness in the AM - as a decrease in their range of motion , worse with use and better in rest
true or false. Osteoarthritis-> Better in the morning - rest and worse throughout the day ( with use )
true
Explain heberden nodes
these occur at the distal interphalangeal joint which is the joint just below the fingernail. this is very common site for osteoarthritis
explain what bouchard nodes
occurs right under that within middle interphalangeal joint
True or false. Both of nodes ( heberden and bouchard ) ,can be red swollen and painful. Crepitus might also be present when that joint is moved
true
Crepitus - this is an assessment finding that’s that
crunching sound of bone-on-bone caused by an osteoarthritis, that small joint space, presence of osteophytes, and absence of cartilage with that more bone-on bone contact.
true or false.
true
what type of arthritis is this describing : chronic and autoimmune disease
RA ( rheumatoid arthritis )
what causes RA?
environmental triggers
genetics
essentially with RA the body’s immune system is attacking the joints, is that true ?
true
RA : this is a system remission ( decrease or absense of symptoms ) and exacerbations, is this true or false.
true
describe RA as a first progression to it’s final stage
1) lymphocyte which has been activated by the immune system, infiltrating the joint space
2) we start to see formation of granulation tissue and destruction of that important cartilage
3) thickening of the joint capsules, and the edges of the actual bone can erode, and
there is a loss of bone density. so the bones can become more porous and more
therefore susceptible to injury.
rheumatoid arthritis are believed to be genetic. true or false.
true
RA clinical manifestations: what are the general manifestations
fatigue
fever
anorexia
weight loss
generalized stiffness
unlike osteoarthrithis define the pain level in RA
pts with RA will have pain first thing in the morning, when they wake up along with stiffness ( it will improve throughout the day with use)
RA clini mani : localized
- Pain is worse in the AM
- Multiple joints Bilaterally, usually in the smaller joints (hands and feet)
- Flares (swelling, heat)
- Stiffness in the morning
- Limitation of movement
- Heat
- Swelling
heat and swelling is a part of localized clini mani of RA, define why
due to those autoimmune inflammatory process
figure 67.4 on slide 23 must be studied but i cant add on photos so just study it, and DONT BE UGH.
MWAHH thank yew
the onset of this is very quick : what is this describing
gout
gout define the characteristics
accumulation of uric acid crystals in one or more joints
purines can be exogenous or endogenous
what are the risk factors of gout
male, obesity, HTN , diuretic use, excessive alcohol , kidney disease, diet in high purine rich foods
how are uric acid created
purines are broken down in the body and a purine is a chem compound
gout : kidneys excrete uric acid. is this true or false
true
Would ingested such as food we eat be considered as exogenous or endogenous?
exo DUHHHHHHH
the pathophysiology behind gout can be explained by three major concepts, what are they?
1) hyperuricemia
2) underexcretion of uric acid
3) diet in high in purines
what is this describing : essentially refers to an increase in uric acid production. How can this accumulate ?
hyperuricemia
brough on by alcohol use, particularly beer.
dehydration can also be a culprit of this and also a very protein rich meal
how quickly the body is essentially able to eliminate that uric acid and prevent it from building up crystallizing and getting stuck in those small joint spaces. This is thought to be
the most common contributing factor affecting about 90% of those who experience
gout: what is this describing
under excretion of uric acid
diet high in purines : define the description
purines are broken down unto uric acid and they are found in many foods. Examples : are organ meats, alcohol, and seafood
how can under excretion also occur ?
can be a result of decreased kidney function
it can also occur from fasting or excessive alcohol use both of which can create keto acids which actually inhibit the elimination of uric acid from the body.
Gout : clini mani
acute gout : what is it triggered by ?
Acute gouty arthritis is triggered by trauma, surgery, stress, infection, alcohol ingestion
acute gout clini mani
Inflammation of the big toe (Podagra)
Symptoms begin at night swelling + pain + low grade fever
Symptoms peak within several hours and the exacerbation subsides within 2-10 days
True or false. So many frequent repeated acute gout attack flares over time can eventually lead to
chronic gout if these acute attacks happen frequently and often enough and lead to
those structural changes associated with chronic gout
true
Gout : clini mani
Chronic
Multiple joint involvement
Visible deposits called tophi (develop years after onset of disease)
Tophi occur in the synovium, along tendons, and in the skin and cartilage
1) Typically painless
2) Decreased mobility
3) Can become infected
Chronic Gout : Structural changes including cartilage destruction can lead to secondary OA
is this a true statement
true
what does osteoporosis mean
osteo- bone
porosis - pores
what is this describing : bones are going to be more porous and therefore more fragile and more susceptible to fractures
osteoporosis
true or false. bones as a living and changing tissue and is constantly changing
true
this is a disease of cellular regulation
osteoporosis
define the characteristics of osteoporosis
- Low bone mass – disease of cellular regular
- Peak Bone Mass occurs at age 30, stable till
age 50 then declines at a rate of 1%/year - Women, after menopause, have an accelerated rate of decline at about 2-3% lost per year
what is osteoclast and osteoblast
osteoclasts responsible for bone reabsorption and
osteoblasts are responsible for new bone formation
osteoporosis, the breakdown of bone by osteoclasts is faster than the new
formation by osteoblasts and the result is lower bone density or porous bones.
Bone mineral density is the amount of strength and it usually peaks between age 25 and 30. After that peak age range, the osteoclastic activity exceed osteoblastic activity and bone mineral density starts to decline.
define if these statements are true
both true
Risk Factors for ↑ loss of bone
mass
(low calcium/vitamin D, low estrogen, smoking, etoh, drugs, physical inactivity
- Primary (natural ageing, environment) vs secondary (drugs and medical conditions)
- Secondary - Diseases (turners, Cushings, diabetes, RA)
true or false. osteoporosis can be classified as being primary or secondary when it comes to risk factors
yes, that is true
attributed to that onset of osteoporosis being triggered by a drug or a disease
process and it can occur at any age and again ultimately whatever is triggering
this secondary osteoporosis is causing what ?
the quicker reabsorption of bone than the bone production and this can sometimes be seen with chronic diseases such as
diabetes and rheumatoid arthritis.
factors that can affect and help protect peak bone mass include
nutrition, strength change, training, and some hormones such as estrogens and androgens.
clinical manifestations of osteoporosis
- Pathological fractures (vertebral/compression)
- Pain
- Loss of vertebral height & changes to the spinal column: Kyphosis
what is usually the placement for pathological fractures ( vertebral/compression ) when it comes to osteoporosis
wrist, hip, and spinal cord
pain is usually associated with what in osteoporosis?
fragility of bone, the pain associated with activity
what is this describing : forward bending of that thoracic spine
kyphosis
what is the impact of chronic pain
Quality of life
* ADLs
* Anxiety, depression
* Fatigue, insomnia
* Fear, anger
* Affects social relationships
Financial
* Unable to work
* Medications
* OT/PT
* Supportive devices
true or false impact of chronic pain : They can experience fatigue and insomnia as pain may keep them up at night and prevent them from sleeping and have impacts on their mental health including fear and anger.
true
