Week 6: Musculoskeletal Flashcards
skeletal trauma
fractures & dislocations
support structure trauma
sprains and strains
tendinopathy and bursitis
muscle strains
a fracture is a
break in the continuity of a bone
incidence for specific bones varies by
age and gender
fractures are classified as
complete incomplete open closed comminuted linear oblique spiral transverse greenstick
pathologic fracture
break at the site of a preexisting abnormality
stress fracture
d/t being subjected to repeated stress – e.g. athletics
transchondral fracture
fragmentation and separation of portion of articular cartilage
steps in fracture healing
Periosteum and blood vessels disrupted
Bleeding from ends and neighbouring soft tissue
Clot forms in medullary canal
Adjacent bone tissue dies – stimulates intense inflammatory response
Within 48 hours vascular tissue invades area – blood flow to bone
Bone-forming cells activated to produce subperiosteal procallus along bone shaft and over break
Osteoblasts synthesize collagen and matrix
This forms callus
Remodeling occurs, trabeculae formed along lines of stress
fracture clinical manifestations
- S & S include impaired function, unnatural alignment, swelling, muscle spasm, tenderness, pain and impaired sensation
- Position of bone affected by pull of attached muscles, gravity, direction and magnitude of fracture force
- Immediate pain d/t trauma, secondary pain d/t soft tissues or muscles
tx of fractures
- Must realign the bone fragments (reduction) & hold fragments in place (immobilization)
- Most done by closed reduction
- Traction to accomplish or maintain reduction (skin or skeletal)
- External fixation used external frame of clamps
- Open reduction – a surgical procedure
dislocation
a temporary displacement of 2 bones in which the bone surfaces lose contact entirely
subluxation
the contact bw two bones is partially lost
most commonly dislocated
shoulder, elbow, wrist, finger, hip, and knee
dislocation and subluxation cm
- bruise nerves, vessels, ligaments, supporting structure, soft tissues occurs as well
- Pain, edema, limitation in motion, deformity
ligament
band of fibrous ct that connects bones at a joint
tendon
fibrous ct that attaches skeletal muscle to bone
strain
tear in tendon
sprain
tear in ligament
sprain and strain steps in healing
Inflammation exudate develops between the torn ends
Granulation tissue forms containing macrophages, fibroblasts, and capillary buds
Within 5 days, collagen forms unorganized and then later interweave with existing fibres
A healing tendon in unable to withstand pull for 5 weeks
The entire process could take years to repair a tendon or ligament (longer than a break)
sprains and strains cm
pain edema changes in tendon or ligament contour dislocation and subluxation of bones tenderness
muscle tears
muscle fibres are torn resulting in bleeding
fibres do heal but other fibres compensate
idiopathic oa
no known cause but may be inherited
secondary oa
associated with joint stress, congenital abnormalities or joint instability caused by trauma
oa most often affects
hands wrists neck lower back hip knees ankles feet
loss of articular cartilage patho
- Cartilage becomes yellow or brownish grey
- Surface areas flake off
- Becomes thin or may be absent in some areas
- Bone is unprotected – becomes sclerotic
- Cartilage-coated osteophytes may grow outwards
- Pieces of spur break off- irritate synovial membrane
- Joint capsule becomes thickened
oa clinical manifestations
pain and stiffness in joints aggravated by weight bearing and relieved by rest nocturnal pain not relieved by resting limited ROM crepitus changes in ambulation and gait
joint effusion, inflammatory exudate or blood in synovial cavity caused by
- presence of osteophyte fragments in synovial cavity
- drainage of cysts from diseased subchondral bone
- acute trauma to joint structures
oa dx
clinical assessment, xray, ct scan, mri
oa tx
rest, ROM exercises, use of aids, weight loss, analgesics, antiinflammatories, and surgery
rheumatoid arthritis
autoimmune disease, chronic inflammation of connective tissue that affects the synovial membrane
RA joints most affected
fingers, feet, wrists, elbows, knees, ankles
may also affect lungs, heart, kidneys, and skin
RA cm
- Joints become painful, tender and stiff
- Morning stiffness lasting more than 1 hour
- Progresses from smaller joints -> weight-bearing joints
- Joint swelling widespread and symmetric
- Joint deformities -> loss of joint motion -> contractures -> muscle atrophy
- formation of nodules
RA dx
PE, xray, blood tests
RA tx
- rest of joints and body, heat and cold, PT, high calorie intake and vitamin rich diet
- drugs - corticosteroids, antiinflammatories, and immunosuppressants
- surgery
ankylosing spondylitis
chronic inflammatory joint disease characterized by fusion of spine and sacroiliac joints
genotype assoc. with ankylosing spondylitis
HLA B27
gout
excess uric acid in blood that causes precipitation of urate crystals in joints
physiologic contracture
d/t failure of calcium pump in presence of ATP - temporary if underlying pathology reversed
occurs in the absence of muscle action potential
pathologic contracture
permanent - caused by muscle spasm or weakness
may be a response to pain or secondary to scar formation (burns)
osteomyelitis
infectious bone disease caused by bacteria, viruses, fungi, and parasites
osteomyelitis is difficult to treat bc
bone contains multiple channels that encourage proliferation of infectious cells - natural defenses do not penetrate
tiny vessels 1) are easily damaged, and 2) make obstruction by bacteria easy, leads to necrosis
bone cells destroyed by infection are not easily replaced, bone production lags behind bone resorption by osteoclasts
exogenous osteomyelitis
infection from outside the body - spreads from soft tissues to bone
endogenous osteomyelitis
infection carried in blood from other sites within the body - spreads from bone to soft tissues
most common sources of bacteria in OM
cutaneous, sinus, ear, and dental infections
OM dx
elevated WBC, bone scan, CT, and MRI
OM tx
iv antibiotics, surgical debridement, hyperbaric O2 therapy, may need to remove any implants
osteoporosis
present with a BMD -2.5 SD below the young adult mean
osteoporosis symptoms
back pain, kyphosis, height loss, improper fit of clothing, protruding abdomen, negative body image
osteoporosis risk factors
smoking, lack of physical activity, excess alcohol, low calcium and vitamin D intake, thinness, family hx, premature menopause
bone generation is directly related to
physical activity, calcium intake, vitamin D, hormone levels
osteoporosis dx
bone scan, xray, CT scan, serum tests
osteoporosis tx
prevent bone loss with vitamin supplements (Ca & Vit. D) and fracture prevention, weight bearing exercises
best way to test BMA
dual energy xray absorptiometry
