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Flashcards in adult musculoskeletal Deck (93):
1

strain

stretching and/or partial tear in a MUSCLE or TENDON

2

strain cause

sudden stretching of contracted muscle

3

strain assessment findings

pain, stiffness, local tenderness, swelling

4

sprain

injury to a LIGAMENT or surrounding CAPSULE

5

sprain cause

abnormal, excessive movement

6

sprain assessment findings

pain, rapid swelling, discoloration, limited function

7

joint dislocation

abnormal displacement of articulating surfaces

8

subluxation

partial dislocation

9

dislocation/subluxation cause

congenital, traumatic, pathologic

10

dislocation/subluxation assessment findings

pain, deformity, limited movement, deviation in length and/or rotation of extremity

11

fracture

disruption in continuity of bone
- classified according to location, type, direction/pattern of fracture line
- type further determined by "communication with environment", degree of break, character of fracture pieces

12

fracture cause

sudden trauma, fatigue stress, pathologic stress

13

strains/sprains: intervention

R est
I ce (put something between it and skin)
C ompress (possible immobilization)
E levante

14

dislocation/subluxation: intevention

closed reduction followed by immobilization and strengthening

15

fatigue stress

excess stress applied to normal bone

16

pathologic stress

normal stress applied to bones weakened by disease

17

complete fracture

involves entire width of bone

18

incomplete fracture

does not extend through the full transverse of a bone

19

simple fracture

often used to describe uncomplicated closed fracture

20

avulsion

fracture occurs when a ligament or tendon pulls away part of the bone

21

transverse fracture

complete, break is at a right angle to the axis

22

reduction

replacing bone fragments to near-normal position

23

immobilization

obtains union of the fracture fragments by preventing movement

24

CMS aka NV checks: what & when?

C irculation + C olor
M ovement
S ensation
N euroVascular

for cast care

q 1-2' for 48' then q8

25

external traction

reduction, ALIGNMENT, and immobilization
- noninvasive
- decreases spasms
- stretches adhesions
- prevents deformity

26

internal fixation

the use of metal pins, screws, rods, plates, prostheses to immobilize fracture during healing; surgeon makes incision (open reduction) to gain access to broken bone then implants one or more devices

- reduction and immobilization

27

external fixation

system in which pins or wires are passed through skin and bone and connected to rigid external frame to immobilize a fracture during healing

- reduction and immobilization

28

ORIF

open reduction internal fixation (incision to gain access to broken bone + device implantation)

29

pin care

for external fixation!
- daily inspection

protocol specific:
- daily cleansing
- dressings

30

callus

loose, fibrous, vascular tissue that forms at the site of a fracture as the first phase of healing; normally replaced by hard bone as healing continues

31

fat embolism syndrome

- occurs within 72 hours of LONG BONE or PELVIC fracture
- results from fat droplets in the small blood vessels of lungs or other organs

32

fat embolism: features

respiratory failure, skin petechiae, CNS symptoms

33

fat embolism: s/s

- substernal chest pain
- dyspnea
- tachycardia
- diaphoresis

34

acute compartment syndrome

- increased pressure in limited space (muscle compartment) compromising circulation
- can result in death of nerve, muscle cells

35

acute compartment syndrome: common causes

excessive edema after a crushing injury or bone surgery, vascular injury and bleeding, constrictive dressings/casts, severe burns

36

acute compartment syndrome: hallmark symptom

SEVERE pain that is out of proportion to injury or physical findings

37

acute compartment syndrome: other s/s

- changes in sensation
- diminished reflexes
- eventual loss of motor function

38

acute compartment syndrome: interventions

- cast splitting
- limited elevation of extremity
- if unrelieved: fasciotomy

39

fasciotomy

surgical procedure in which an incision is made through the skin and subcutaneous tissues into the fascia of the affected compartment to relieve the pressure in and restore circulation to the affected area

re: ACUTE COMPARTMENT SYNDROME

40

contracture

permanent shortening of muscle or joint; elastic tissue is replaced by non-stretchy, fiber-like tissue

41

osteoporosis*

primary disorder most often associated with AGING*

secondary disorder often linked to CHRONIC MEDICATION USE

characterized by decreased bone density, strength; data suggests resoprtion exceeds formation, but causation largely unknown

result: minimal stress results in fractures

42

osteoporosis: associated risk factors

smoking, high alcohol intake, lack of exercise, estrogen deficiency, deficient calcium intake

43

osteoporosis: s/s

sudden onset skeletal fracture, loss of height, kyphosis

44

osteoporosis: prevention

- regular exercise
- adequate Ca, Vitamin D intake
- weight bearing exercises
- early detection
- meds

45

osteoporosis: pharm interventions (list)

- calcium supplements
- biphosphates
- estrogen agonists/antagonists
- thyroid hormone (calcitonin)

46

calcium supplements for...?

osteoporosis

47

biphosphates are/for...?

slows resorption; osteoporosis

48

estrogen agonist/antagonist are/for...?

stimulates bone formation in post-menopausal women; osteoporosis

CONTROVERSIAL

49

thyroid hormone (calcitonin) is/for...?

decreases bone loss; osteoporosis

50

osteomalacia

inadequate mineralization of bone resulting in softening

primary cause: vitamin D deficiency

not common in US

51

osteoarthritis

AKA degenerative joint disease
- progressive, degenerative disease of the joint surfaces that is characterized by EROSION OF ARTICULAR CARTILAGE, underlying bone density, osteophyte formation

52

osteophyte

small, abnormal bony outgrowth

53

articular cartilage

smooth, white tissue that covers the end of bones where they come together to form a joint; consists of collagent fiber matrix impregnated with complex ground substance

54

articular cartilage

smooth, white tissue that covers the end of bones where they come together to form a joint; consists of collagent fiber matrix impregnated with complex ground substance

55

osteoarthritis: assessment findings

- joint PAINT that improves with rest
- swelling and joint enlargement
- joint crepitus
- decreased range of motion
- muscular atrophy

56

osteoarthritis: pharm interventions (list)

- NSAIDS
- steroids
- adjunctive analgesics

57

osteoarthritis: surgical options (list) + goal

- arthroscopic debridement
- arthroplasty
- osteotomy
- arthrodesis

pain relief, restoration of motion, correction of deformities

58

arthroscopic debridement

trim rough edges and remove loose fragments

for osteoarthritis

59

arthroplasty

partial or total joint replacement

for osteoarthritis

60

osteotomy

wedge of bone removed near damaged joint

for osteoarthritis

61

arthrodesis

joint fusion (restores stability and alignment)

for osteoarthritis

62

rheumatoid arthritis

chronic, inflammatory autoimmune connective tissue disease

often results in long-term damage to the joints resulting in chronic pain, loss of function, disability

63

rheumatoid arthritis: causes

transformed antibodies (rheumatoid factors) attack healthy tissue (especially synovium); it thickens and a pannus forms. this erodes cartilage and destroys bone.

64

pannus

vascular granulation tissue

65

rheumatoid arthritis: s/s

inflammation of the lining of the joints (synovium) ,bony calcification, secondary osteoporosis

- ulnar deviation
- fingers are spindle-like
- on palpation joints feel soft (effusions with fluid)
- decreased range of motion

66

rheumatoid arthritis: 3 classes of drugs for treatment

- NSAIDS
- corticosteroids
- DMARDS

67

DMARDs

Disease Modifying Anti-Rheumatic Drugs

for rheumatoid arthritis
- slow progression of rheumatoid arthritis by reducing signals to the immune system resulting in less inflammation
- takes 4 to 6 weeks to begin to decrease inflammatory symptoms

most common: methotrexate (Rheumatrex)

68

methotrexate (Rheumatrex)

DMARD for rheumatoid arthritis

69

gout

aka "gouty arthritis" - systemic disease in which urate crystals deposit in joints, other body tissues, causing inflammation

primary & secondary gout

easy to treat, diagnose in early phases; chronic gout NOT as common in US (due to treatment availability)

70

gout: interventions

drug therapy is KEY!
- acute v chronic gout drugs DIFFERENT
- nutrition therapy is controversial
- avoid aspirin, diuretics (may precipitate attack)
- excess physical, emotional stress
- drink lots of water

71

primary gout

most common type of gout, results from several inborn errors of purine metabolism.
- uric acid production exceeds excretion capability of kidneys
- sodium urate deposited in synovium and other tissues = inflammation
- can be X-linked trait; middle-aged/older men
+ post-menopausal women

72

uric acid

end product of purine metabolism excreted by kidneys; involved in primary gout

73

secondary gout

hyperuricemia caused by another disease or factor
-- renal insufficiency, diuretic therapy, crash diets, certain chemo agents - decreased normal excretion of uric acid, other waste products
-- multiple myeloma, certain carcinomas = increased production of uric acid due to greater turnover of cellular nucleic acids

- affects people of all ages

74

hyperuricemia

excess of uric acid in the blood; involved in secondary gout (often seen in older patients with cardiovascular health problems)

75

primary gout: clinical stages of disease

1: asymptomatic hyperuricemia
2: acute gouty arthritis
3: chronic or tophaceous gout

76

primary gout: asymptomatic hyperuricemia stage

FIRST STAGE
patient usually unaware unless serum uric acid level done (elevated, but no obvious signs of disease present)

- no treatment needed

77

primary gout: acute gouty arthritis stage

SECOND STAGE
first "attack" begins this stage: excruciating pain, inflammation in one or more small joints (usually podagra)
- erythrocyte sedimentation rate usually increased as result of inflammatory process
- months or years may pass before additional attacks occur
- patient asymptomatic, no abnormalities found during examination of joints

78

podagra

inflammation of metatarsophalangeal joint of great toe that typically begins acute gouty arthritis stage (2) of primary gout

79

primary gout: chronic tophaceous gout stage

THIRD STAGE
follows repeated episodes of acute gout; deposits of urate crystals develop under skin, within major organs (esp. renal system)

- urate kidney stone formation is more common than renal insufficiency
- can begin anywhere between 3 and 40 years after initial gout symptoms occur

80

most common finding of acute gout

joint inflammation, usually so painful patient seeks medical care immediately; inflamed area usually too painful, swollen to be touched, moved

81

tophi

deposits of sodium urate crystals in skin due to chronic gout; hard on palpation, irregular in shape, may discharge yellow, gritty substance if irritated and broken open

commonly appear on the outer ear but can happen anywhere (other common: arms, fingers near joints)

82

chronic gout: s/s

- joint inflammation (most common)
- renal calculi
- renal dysfunction (severe pain, changes in UOP)

83

acute gouty attacks

inflammation subsides spontaneously within 3 to 5 days, though most patients can't tolerate pain for that long)

84

acute gout: drug therapy

combo of colchicine (Colsalide) + NSAID (like indomethacin, Indocin -or- ibuprofen, Motrin)
- take PO until inflammation subsides (usually 4-7 days)

85

allopurinol, febuxostat

xanthine oxidase inhibitors that prevent conversion of xanthine to uric acid
- promote uric acid excretion or to

86

colchicine + indomethacin

for acute gout

87

refractory gout: drug therapy

pegloticase (IV dose q 2 weeks)

88

refractory gout

severe gout that does not respond to drugs

89

pegloticase

for refractory gout, given IV, enzyme that works directly on uric acid and converts it to allantoin (can be excreted immediately by kidneys)

is protein that is foreign to the body so monitor for anaphylaxis and other allergic reactions

90

synovium

soft tissue between joint capsule and articular cartilage of joint

91

cartilage

dense connective tissue

92

tendon

connect bone to muscle

93

ligament

connect bones or support various organs