Musculoskeletal Disorders Flashcards by Liliana Cid

what is the function of the musculoskeletal system

provides protection for vital organs, including brain, heart, and lungs and a framework to support body structures

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what makes mobility possible

muscles and tendons hold bone together
joints allow body to move

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Movement facilitates…

the return of deoxygenated blood to right side of heart by massaging venous vasculature

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serves as a reservoir for…

immature blood cells and essential minerals including Ca, P, Mg, and F

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define remodeling

formation of old bone is removed and new bone is added to the skeleton

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what stimulates bone formation and remodeling

physical activity particularly weight bearing activity

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define reabsorption

removal or destruction of bone however prolonged bed rest causes increased bone resorption from Ca loss

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How do you perform the neurovascular exam?

6 P’s
Pain (early sign): worst with passive touch or movement, elevating the limb, or any pressure, stretching increases the pain, and pain meds are not relieving

Paresthesia (early sign): the patient may report it feels like the extremity distal to the fractire feels like its falling asleep “pins and needles”sensation, can they feel you touch their extremity? check unaffected extremity to compare

Pallor: extremity should be pink and have normal capillary refill less than 2 seconds, In compartment syndrome, may appear pale or dusky and have a capillary refill greater than 2 seconds

paralysis: can the patient move the distal extremity from the fracture or has the movement decreased

poikilothermia: occurs when the affected extremity distal from the fracture feels cooler to the touch compared to the unaffected extremity, cannot regulate its temperature

pulselessness: always mark the pulses with a black marker and have a doppler available to monitor the sound of the pulse (this is a late sign)

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what is back pain

most common in lumbosacral and cervical vertebrae because these are the areas where vertebral column is most flexible

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patients with back pain assess…

gait, spinal mobility, reflexes, leg length, leg motor strength and sensory perception

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back pain sign and symptoms

pain
radiculopathy: pain radiating down leg
sciatica: pain radiating from inflamed sciatic nerve
muscle spasm
numbness/tingling
leg weaknes
bowel or bladder incontinence

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back pain nursing interventions

physical therapy
hot/cold applications
pharm: NSAIDS/ muscle relaxants; antidepressants/atypical convulsants
surgery

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prevention of low back pain/injury

use good posture and safe handling practices with specific attention to bending, lifting, and sitting
assess need for assistance with household chores
participate in regular exercise program,
avoid prolonged sitting and standing
keep weight within 10% of ideal body weight
avoid wearing high-heeled shoes

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what is carpel tunnel syndrome

common condition which the median nerve in the wrist becomes compressed causing pain and numbness

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signs and symptoms of carpel tunnel

Paresthesias
Numbness
Pain (may be worse at night)
Weak pinch
Clumsiness (dropping things)
Difficulty with fine motor movements
+ Phalen’s test
+ Tinel’s sign

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carpel tunnel interventions

Splint / hand brace
Acupuncture
Pharmacological:
NSAIDs: for pain relief and inflammation
Corticosteroid injections
Surgery

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health promotion activities to prevent carpel tunnel

Become familiar with federal and state laws regarding workplace requirements to prevent repetitive stress injuries such as carpal tunnel syndrome (CTS)
When using equipment or computer workstations that can contribute to developing CTS, assess that they are ergonomically appropriate, including:
Specially designed wrist rest devices
Geometrically designed computer keyboards
Chair height that allows good posture
Take regular short breaks away from activities that cause repetitive stress, such as working at computers
Stretch fingers and wrists frequently during work hours
Stay as relaxed as possible when using equipment that causes repetitive stress

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what is osteoporosis

:a chronic metabolic disease in which bone loss causes decreased density and possible fracture from reduced bone mass, deterioration of bone matrix, and diminished bone architectural strength

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define osteopenia

low bone mass

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osteoporosis signs and symptoms

Dowager’s hump / kyphosis
“Shorter”
Back pain, especially with activity
Swelling
Malalignment
Constipation
Abdominal distention
Reflux esophagitis
Respiratory compromise

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osteopenia and osteoporosis occur when…

osteoclastic (bone resorption) activity is greater than osteoblastic (bone building) activity

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osteoporosis diagnostic labs and test

labs:
Serum calcium
Vitamin D3
Phosphorus
Urinary calcium

tests:
BMD testing
Dual x-ray absorptiometry (DXA, orDEXA) scans
X-rays

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osteoporosis interventions

Prevention is best and needs to start early in life
Life style modifications
Pharmacological:
Calcium & vitamin D3 supplements
Bisphosphonates: slow bone resorption by binding with crystal elements in the bone
Alendronate (Fosamax), ibandronate (Boniva), and risedronate (Actonel, Atelvia)
Estrogen agonist / hormone therapy ?

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osteoporosis complications

Osteoporosis results in more than 1.5 million fragility fractures each year
A woman who experiences a hip fracture has a 4 times greater risk for a second fracture
The mortality rate for older patients with hip fractures is very high, especially within the first 6 months, and the debilitating effects can be devastating
The reported 1-yearmortality aftersustaining ahip fracturehas been estimated to be 14% to 58%

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what is osteomalacia

is loss of bone related to a vitamin D deficiency; causing softening of the bone resulting from inadequate deposits of calcium and phosphorus in the bone matrix
Osteomalacia is the adult equivalent ofrickets,or vitamin D deficiency, in children

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osteomalacia signs and symptoms

Muscle and bone weakness
Spinal kyphosis and bowed legs
Waddling and unsteady gait
Bone pain/tenderness

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osteomalacia diagnostic labs and test

Low serum calcium
Low phosphorus
Low urine excretion of calcium
X-rays

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osteomalacia interventions

Prevention
For all at-risk patients, teach them about which high calcium and vitamin D foods to eat and the importance of adequate daily sunlight
Pharmacological:
Active vitamin D (calcitriol)
Adequate daily sunlight
Pain management

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what is osteoarthritis

also called degenerative joint disease (DJD); is a noninflammatory, localized progressive deterioration and loss of cartilage and bone in one or more joints
It is not systemic and it is not an autoimmune disease
As cartilage and the bone beneath the cartilage begin to erode, the joint space narrows andosteophytes(bone spurs) form
Secondary jointinflammationcan occur when joint involvement is severe

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osteoarthritis signs and symptoms

Joint stiffness/pain
Pain that diminishes after rest and worsens with activity
Functional impairment
Possible tenderness
Crepitus
Heberden’s nodes
Bouchard’s nodes
Joint effusions

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osteoarthritis interventions

Supportive care
Pain management
Acetaminophen, NSAIDs or COX2 inhibitors, opioids
Cortisone injections Q3 months ?
Topical analgesic agents such as diclofenac sodium gel, capsaicin and methylsalicylate
PT / OT (exercise!)
Surgery / joint arthroplasty

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explain joint arthroplasty

refers to the surgical removal of an unhealthy joint and the replacement of joint surfaces with metal or synthetic materials. Total joint arthroplasty, also known as total joint replacement, involves the replacement of all components of an articulating joint

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with joint replacement, patients may expect…

pain relief, return of joint motion, and improved functional status and quality of life. The scope of these improvements depends in part on patients’ preoperative soft tissue condition and general muscle strength

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post-op care of older adult patient with total hip arthroplasty

Use an abduction pillow or splint to prevent adduction after surgery if the patient is very restless or is confused
Keep the patient’s heels off the bed to prevent pressure ulcers
Do not rely on fever as a sign of infection; decreased mental status is a better indicator in the elderly
Move the patient slowly to prevent orthostatic hypotension
Encourage the patient to cough and deep breathe and use the incentive spirometry
As soon as permitted, get the patient up and out of bed
Anticipate the patient’s need for pain relief
Expect a temporary change in mental state immediately after surgery as a result of the anesthetic and unfamiliar sensory stimuli - reorient the patient frequently

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post-op care of adult with total knee arthroplasty

Apply the continuous passive motion (CPM) machine as soon as it is ordered
Manage the patient’s pain to provide comfort, increase participation in activity, and improve joint mobility
Maintain the knee in a neutral position and not rotate internally or externally
Teach the patients that they can partially weight bear unless their prosthesis is not cemented

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complications of total joint arthroplasty

Dislocation
Venous thromboembolism (VTE)
Infection
Anemia
Neurovascular compromise

what is osteomyelitis

an infection in the bone; caused by bacteria, viruses, or fungi; that can be severe and difficult to treat

name and define the types of osteomyelitis

Vascular insufficiency: seen most commonly with diabetes, PVD, most commonly affecting the feet

Hematogenous: in which organisms are carried by the bloodstream from other areas of infection in the body

Contiguous: in which bone infection results from contamination from surgery, open fracture, or traumatic injury

signs and symptoms of acute osteomyelitis

Fever (usually above 38.3), tachycardia, general malaise, swelling around the affected area, erythema of the affected area, increased heat in that area, tenderness of the affected area, bone pain that is constant, localized, and pulsating that intensifies with movement

signs and symptoms of chronic osteomyelitis

Foot ulcer(s), sinus tract infection, localized pain, drainage from the affected area

osteomyelitis diagnostic labs and tests

labs:
Leukocytosis
Elevated ESR
Blood cultures/wound cultures

tests:
nuclide scans
MRI

osteomyelitis interventions

Prevention
General supportive measures (hydration, diet high in vitamins and protein, etc.)
Improve physical mobility with avoidance of stress on that bone
Pharmacological:
Antibiotics
Pain management
Wound care
Surgery / debridement

define contusions

a soft tissue injury produced by blunt force, such as a blow, kick, or fall, causing small blood vessels to rupture and bleed into soft tissues (ecchymosis or bruising)
A hematoma develops from bleeding at the site of impact, leaving a characteristic “black and blue” appearance

contusions signs and symptoms

Local symptoms includepain, swelling, and possible discoloration

contusion management

are managed withPRICE therapy, an acronym that refers to protection,rest,ice,compression, andelevation

define strain

excessive stretching of a muscle or tendon when it is weak or unstable. Strains are sometimes referred to as muscle pulls

state the three classifications of strains and explain each

First-degree (mild) strain causes mild inflammation but little bleeding. Swelling, ecchymosis (bruising), and tenderness are usually present

Second-degree (moderate) strain involves tearing of the muscle or tendon fibers without complete disruption. Muscle function may be impaired

Third-degree (severe) strain involves a ruptured muscle or tendon with separation of muscle from muscle, tendon from muscle, or tendon from bone. Severe pain and disability result from severe strains and surgery may be needed

strain management

Cold and heat applications, exercise, activity limitations, NSAIDs and/or muscle relaxants

a sprain is

excessive stretching of a ligament; caused by a twisting motion or hyperextension (forcible) of a joint
They are also classified according to severity similar to strains

sprain management

First degree: PRICE therapy

Second degree: immobilization, such as elastic bandage and an air stirrup ankle brace or splint, and partial weight bearing while the tear heals

Third degree: immobilization for 4 to 6 weeks is necessary; and arthroscopic surgery may be done

dislocation of the joint occurs when…

when the ends of two or more bones are moved away from each other and no longer in anatomic alignment
Subluxed: when the joint is only partially dislocated

joint dislocation signs and symptoms

Usually, there is pain, decreased mobility, deformity, and deviation in length and rotation of the extremity

joint dislocation management

Immobilization
Closed reduction of the joint
Pain management

a fracture is…

a break or disruption in the continuity of a bone that often affects mobility and sensory perception

complete fracture

the break is through the bone in such a way that the bone is divided into two distinct sections

incomplete fracture

the fracture is through only part of the bone

open (compound) fracture

the skin surface over the broken bone is disrupted; so there is an external wound

closed (simple) fracture

does not extend through the skin and therefore has no visible wound

pathologic (spontaneous) fracture

occurs after minimal trauma to a bone that has been weakened b disease

fatigue (stress) fracture

results from excessive strain and stress on the bone

compression fracture

produced by a loading force applied to the long axis of cancellous bone

fractures signs and symptoms

Moderate to severe pain
Muscle spasm, paresthesias
Loss of function
Ecchymosis, edema
Deformity, shortening of the extremity
Subcutaneous emphysema, crepitus

emergency care of an extremity fracture:

Assess ABC’s, and perform a quick head-to-toe assessment
Immobilize the extremity by splinting, including joints above and below injury
Remove the clothing to inspect the affected area
Remove jewelry on the affected extremity in case of swelling
Apply direct pressure if there is bleeding
Keep the patient warm and in a supine position
Assess neurovascular status (check 6 P’s)
Cover any open wounds with a sterile dressing

fracture interventions

Reduce and immobilize
Traction
Splints or casts
Assess neurovascular and neuromuscular system frequently
PRICE therapy
Pain management
Non-opioid and opioid analgesics with anti-inflammatory drugs and muscle relaxants
Surgery

immobilization devices potential complications

Compartment syndrome
Pressure ulcers
Infection
Disuse syndrome
Immobility
Anxiety

complications from fractures

Acute compartment syndrome
Crush syndrome
Hypovolemic shock
Fat embolism syndrome
Venous thromboembolism
Infection
Chronic complications such as ischemic necrosis or delayed union

acute compartment syndrome (ACS)

increased pressure within one or more compartments encased by bone or fascia, which reduces circulation to the area

ACS signs and symptoms

Sensory perceptiondeficits or paresthesia (usually 1st sign)
Pallor, pulses weaken
Affected area is palpably tense
Pain with movement
Then cyanosis, numbness, paresis, paralysis and necrosis

ACS management

fasciotomy

crush syndrome

systemic manifestation of muscle cell damage resulting from pressure or crushing
Systemic manifestations are caused by a traumatic rhabdomyolysis due to muscle reperfusion injury when compressive forces on the tissues are released
This can cause local tissue injury, organ dysfunction, and metabolic abnormalities, including acidosis, hyperkalemia, and hypocalcemia
Prevention of renal failure is important
Alkaline diuresis and mannitol therapy is recommended. Hemodialysis is also recommended for acute renal failure

hypovolemic shock

from a loss of blood
The bone is very vascular, and bleeding is a risk
In addition, trauma can cut nearby arteries and cause hemorrhage

hypovolemic shock management

Stabilize the fracture to prevent further bleeding
Restore blood volume and circulation
Provide proper immobilization and protect from further injury
Pain relief

fat embolism syndrome (FES)

fat globules are released from the yellow bone marrow into the bloodstream causing clots

FES signs and symptoms

Hypoxemia, dyspnea with tachypnea
Decreased LOC, agitation, confusion
Petechial rash (late sign)

FES management

Reduce the risk with immobilization and maintenance of fluid and electrolytes
Supportive care with mechanical ventilation, vasopressors and corticosteroids

venous thromboembolism (VTE)

includes deep vein thrombosis (DVT) and pulmonary embolism (PE) and its major complications
It is the most common complication of lower extremity surgery or trauma and the most often fatal complication of musculoskeletal surgery

VTE risk factors

Cancer or chemotherapy, surgical procedures > 30 minutes, smoking, obesity, heart disease, prolonged immobility, oral contraceptives, history of VTE, older adults

Type of infections and causes

Osteomyelitis: is most common with open fractures in which skin integrity is lost and after surgical repair of a fracture
Wound infections are the most common type of infection resulting from orthopedic trauma
They range from superficial skin infections to deep wound abscesses
Infection can also be caused by implanted hardware used to repair a fracture surgically, such as pins, plates, or rods

avascular necrosis

blood supply to the bone is disrupted causing decreased perfusion and death of bone tissue
This problem is most often a complication of hip fractures or any fracture in which there is displacement of bone. Surgical repair of fractures also can cause necrosis because the hardware can interfere with circulation

delayed union

is a fracture that has not healed within 6 months of injury
Some fractures never achieve union; that is, they never completely heal
Malunion: when the bone heals incorrectly

amputations

is the removal of a part of the body
Amputation is considered only after other interventions have not restored circulation, sometimes referred to as limb salvage procedures
The circulatory status of the limb is evaluated through physical examination and diagnostic studies. Muscle and skin perfusion is important for healing

amputations signs and symptoms

Poor circulation (6 Ps!)
Discolored skin
Edema
Ulcers
Necrosis
Hair distribution

amputation diagnostic test

Ankle-brachial index (ABI)
Doppler ultrasonography
Laser doppler flowmetry
Transcutaneous oxygen pressure (TcPO2)

amputation interventions

Monitor for signs of sufficient tissue perfusion
Monitor and control for bleeding and infection
Control edema though compression dressings
Prevent joint contractures
Pain management
Analgesics + beta blockers, antiepileptic drugs, antispasmodics, antidepressants
Collaborate with rehab to improve ambulation and self-care
Psychological and behavioral health

complications from amputations

Hemorrhage
Infection
Phantom limb pain
Flexion contractures
Skin breakdown

phantom limb pain (PLP)

when sensation is felt in the amputated part and it persists and is unpleasant or painful
Often described as intense burning, crushing, cramping, or that the part is in a distorted or uncomfortable position
For most patients, the pain is triggered by touching the residual limb or by temperature or barometric pressure changes, concurrent illness, fatigue, anxiety, or stress

PLP management

IV infusions of calcitonin (Miacalcin, Calcimar) during the week after amputation can reduce phantom limb pain

flexion contractures

occur usually in the hip or knee in patients with amputations of the lower extremity
This complication must be avoided so that the patient can ambulate with a prosthetic device
Proper positioning and active range-of-motion exercises help prevent this complication

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Musculoskeletal Disorders Flashcards

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