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Flashcards in AMD Deck (34):
1

MS System

Musculoskeletal system is scaffolding of human body•
Motor function hindered by:
–Injuries–Infections –Disease processes•Most frequently reported injuries in children vs. older adults•Concepts:–Comfort and pain•Affected by ALL disorders of musculoskeletal system–Infection–Inflammation and oxidative stress–Cellular regulation–Mobility•Treatments: Medications for inflammation in NURS 399

2

fractures

break in the bone
results in increase in energy beyond what the bone can tolerate
Direct or indirect force
or due to compression, torsion, pathologic condition

3

Fractures-
risk factors

Age
- younger patients due to sports related injuries
- older patients falls and disease
Presence of bone disease
Poor nutrition - Vit D, Ca, Phosphorus
Lifestyle habits: dangerous activities

4

Fractures: Classification

Direct vs Indirect
Simple/closed: no disruption of skin
compound/open: broken skin
- infection, reduced blood supply, poor healing
Degree: incomplete or complete
Clinical Manifestation:
pain(most common)
deformity
edema
numbness
muscle spasms
skin bruising
hypovolemia
crepitus
Treatment: depends on fracture

5

Incomplete or greenstick

bone fragment partially joined
common in children -> more collagen and less mineralized

6

Complete

bone fragments separate completely
transverse- right angle to bones long axis

oblique- runs at oblique angle to bone

spiral- like stripe on candy cane (twisting motion)

bone fragments separated completely

comminuted- many fragments (greater than 2 bone pieces)
Impacted- bone fragments driven into each other

compression- crushed bones (spinal column)

7

Indirect healing

Inflammatory stage
-Bleeding causes hematoma
-Inflammatory cells degrade debris and bacteria

Reparative stage
-Fibrocartilage formed
-Soft callus joins fractured bone
-Hard callus develops
-Blood vessels form

Remodeling stage
-Lamellar bone replaces woven bone

8

Direct healing

Surgery to realign bone
Fractures that benefit from direct healing
-Long-term complications
-Severely comminuted; threatened vascularity

Surgical procedures
-External fixation
-Internal fixation
-Closed reduction

Hematoma formation & fibrin fill soft tissue  calcium salts in new tissue  tissue remodeled to new shape

9

union

normal healing

10

nonunion

clinically significant progress toward complete healing for at least 3 months according to x-rays

11

delayed union

significantly longer that expected healing time

12

malunion

bone fragments joined in position not anatomically correct

13

Complication of fractures

infection
Common agents
-Pseudomonas
-Staphylococcus
-Clostridium

Those at increased risk
Greater soft tissues damage
Compromised immune system
Treatment
Antibiotics
Proper hygiene of infection site

Fracture blisters
- tense vesicles or bullae arising swollen skin directly overlying fracture
-contain sterile fluid that can contribute to infection

compartment syndrome
fat embolism syndrome

14

Compartment syndrome

Edema & swelling  increased pressure muscle compartment

-Decreased blood flow
-Continual increasing pressure in limb
-Ischemia muscle & nerve damage  amputation

Common: LE & forearm

Prevention:
Ice & elevation

Complications:
Paralysis, Volkmann contracture

Treatment:
Remove cast, bandage, fascia

15

Volkmann's contracture

Cause: Compartment syndrome (significant increased pressure)
Lack of blood flow to forearm
Muscles of forearm severely injured
Deformities of fingers, hand & wrist
Mild: 2-3 fingers, no/limited loss of feeling
Moderate: all fingers bent & thumb stuck to palm, wrist may be stuck, some loss of feeling
Severe: all muscles involved, severely disabling

16

Fat embolism syndrome

Closed long bone or pelvic fractures
Early complication of long bone/pelvis fracture
Fat emboli in pulmonary & dermal capillaries
Large amount fat released from bone marrow into venous system
Respiratory distress - 24-72 hrs. after event
No symptoms most patients
Chest pain & dyspnea, tachycardia, pallor, disorientation cyanosis, low-grade fever, petechiae rash (axilla, conjunctiva, palate)
Key: early assessment (blood gases)
Treatment
O2, Mechanical ventilation
Prophylactic treatment with corticosteroids & early immobilization of injury

17

dislocation and subluxation

ends of bones moved out of normal position, attachment to joint lost

Subluxation: bones of joint remain in partial contact
cause: trauma
Clinical manifestations: pain limb or joint deformity, alterd mobility of affeted joint

Treatment:
General
Manual traction (closed reduction), Open reduction
Dislocations or subluxations of shoulder
Closed reduction and short-term immobilization
Dislocations or subluxations of hip
Immediate reduction to prevent necrosis of femoral head
Bedrest after closed reduction

18

Carpal Tunnel Syndrome

Nerve entrapment
Neuropathy causing nerve damage & muscle weakness or atrophy
Body areas most prone
Where nerves pass over rigid areas or through narrow canals
Etiology & pathogenesis
Repetitive use injury
Median nerve compressed by inflammation & swelling of synovial lining of tendon sheaths
Clinical manifestations
Numbness & tingling of thumb, index finger, & lateral ventral surface of middle finger; Hand weakness
Diagnosis
Tinel’s test
Phalen maneuver
Nerve conduction studies with ultrasound
Treatment
Splinting & application of ice or heat
Surgery to enlarge tunnel

19

Tinels

light percussion over irritated median nerve elicits a tingling sensation

20

phalends

maintained flexion of wrist at 90 degrees for 30-60 sec elicits tingling/pain

21

Bursitits

-inflammation of the bursa
- results from overuse of joint, direct trauma to joint

clinical manifestations:
-tenderness of area around
-pain with extension and flexion of joint
- warm, red, swollen skin over bursa

Treatment:
-rest, compression, elevation, NSAIDS, ice (acute inflammation), gentle stretching and strengthening exercises, corticosteroid injection arthroscopic surgery, antibiotics (infectious causes)

22

strains and sprains

strain: overstretching injury to muscle or muscle-tendon unit
-forces muscle to extend beyond capacity, resulting in microscopic tears
-most common sites is lower back or neck

Sprain: ligaments around joint stretched or torn
oppositional forces cause ligament to overstretch and tear
most common site: ankle

Treatment:
-RICE, NSAIDS
-cast, splints immobilizers, or slings
-surgery for severe injuries
-physical therapy

Clinical manifestations:
Immediate pain, reduced ranged of motion (ROM)
Muscle spasms
Edema
Muscle weakness
Bleeding, swelling, bruising

Clinical manifestations of sprains
Severely hindered ROM
“Pop” or “rip” when injury occurs
Bruising, pain, immediate swelling

23

Anterior Cruciate Ligament

ACL- one of four major ligaments connecting femur to tibia
injuries occur when stressed, strained, torn

Etiology: decelerating while running; twisting or jumping

Patho: tear down middle of ligament
ligament torn completely from femur

Clinical manifestations:
-intense pain, felling that knee "popped" and "gave out" , swelling

Diagnosis:
x-ray, MRI

Treatment:
-Ice, elevation, NSAIDs; Rest & no weight bearing; crutches; Elastic bandage; NSAIDs; Physical therapy ; Arthroscopic surgery

24

Meniscus

Injury to cartilage located between femur & tibia
Results from forced twist or rotation
Clinical manifestations
Popping sound at knee joint
Pain when knee touched
Edema
Restricted joint mobility
Knee “locks up” or does not move smoothly
Knee feels weak or is “buckling”
Diagnosis
ROM assessment
Testing (x-ray, MRI, ultrasound)
Treatment
Ice, elevation, NSAIDs; Rest & no weight bearing; crutches; Elastic bandage; NSAIDs; Physical therapy ; Arthroscopic surgery

25

Achilles Tendon Rupture

Achilles: connect to heel (largest tendon)
Etiology:
Sudden pivoting or rapid acceleration
More common in tennis, basketball, softball
Pathogenesis:
Recurrent microtrauma causes degeneration  damaged tendon becomes calcified, thickened, inelastic, fibrotic  shear stress (stop & go)  tear/rupture
Fluroquinolones  typically w/in 1 week of start of ABX
Clinical Manifestations:
“pop”, pain, feel struck violently in back of ankle
Diagnosis:
Clinical exam, U/S, MRI (U/S best imaging)
Treatment:
Ice, NSAIDS, APAP, Rest (non-weightbearing w/crutches), immobilization, Surgical Repair

26

Osteochondral Lesions

Occur at end of bone
Causes
Lack of blood supply
Direct trauma to joint
Repetitive use
Clinical manifestations
Pain with weight bearing
Swelling
Tenderness
Limited mobility; occasional “locking” of knee
Treatment
NSAIDs & use of growth hormone; Weight loss; Rest; Ice ; Use of assistive devices to walk; Physical therapy; Nutritional supplements; Arthroscopic surgery

27

Shoulder: Rotator Cuff Tears

Tendon supporting muscle(s) rips / tears from bone
Causes
Fall on shoulder; Attempt to break fall with outstretched hand; Repeated overhead motions
Clinical manifestations
Dull ache in joint from microscopic tears
Weakness when raising arm
Inability to reach behind back
Diagnosis
Shoulder ROM assessment; X-ray; CT scan or MRI; Ultrasound or arthrogram
Treatment
Rest, application of cold or heat to area, NSAIDs, electrical stimulation of muscles; Cortisone injections; Surgery

28

Adhesive Capsulitis (Frozen Shoulder)

Acute inflammation of ligaments in shoulder joint capsule
Shoulder bones unable to move freely in joint
Etiology:
Primary (idiopathic)
Thyroid disease, dyslipidemia, prolonged immobilization, stroke, autoimmune disease
Rare: Parkinson disease, HIV antiretroviral therapy (protease inhibitors)
Pathogenesis: Not completely understood  Inflammation of capsule
Clinical manifestations
Self-imposed immobility of shoulder because of pain
Stiffness, more pain, continued loss of motion
Unable to move arm above head or behind back
Diagnosis
Shoulder ROM assessment; X-ray to rule out other disease processes; MRI
Treatment
NSAIDs & steroid injections; Physical therapy ; Arthroscopic surgery
Can resolve within 2 years with minimal loss of shoulder function without treatment

29

Impingement syndrome

AKA Swimmer’s Shoulder
Etiology:
Acute shoulder injury
Repeated movement
Swimmers & throwing in baseball, football, javelin & tennis serves
Pathogenesis:
Rotator cuff tendon trapped under acromion
Compression between humeral head & undersurface of acromion, acromioclavicular joint, or coracoacromial arch
Clinical Manifestations:
Pain when raising arm above head or behind back
Diagnosis
Pain relief with anesthetic
X-rays to rule out other processes
Treatment
Ice, NSAIDs, physical therapy, Steroid injections, Arthroscopic surgery

30

Osteomyelitis

Etiology:
Bacteria, fungi, parasites, viruses; Infection carried to bone
Pathogenesis: Bone infection
Penetrating wound, from blood infection, skin breakdown
Joint replacement & internal fixation surgeries
Clinical manifestations
Local indications: bone pain; drainage & ulceration; swelling, redness, warmth, tenderness
Systemic indications: Lymph node swelling; Fever with chills, general malaise; Tachycardia; Nausea, vomiting; Anorexia
Diagnosis
Abscess / bone changes/bone destruction (X-ray, bone scan, MRI); WBC count & sed rate; blood cultures; bone biopsy/tissue samples
Treatment
Antibiotics (systemic), Surgery (for severe ischemia); Drainage tubes inserted in bone; Procedure to fill dead tissue space with muscle

31

Osteonecrosis

Avascular necrosis, aseptic necrosis, ischemic necrosis
Etiology & Pathogenesis
Reduced blood flow to joint
Bone breakdown occurs faster than replacement
Causes: bone fracture, thrombosis/embolism, vessel injury, compartment syndrome, steroid therapy
Risk factors
Long-term use of steroids; Heavy alcohol intake; Direct injury to bone / joint ; Chemotherapy / radiation; Organ; transplantation; Diseases
Clinical manifestations
Insidious; no symptoms; Pain when pressure / weight applied to joint; Inability to use limb
Diagnosis
X-rays, MRI, CT scan; Bone scan; Bone biopsy; Measurement of bone pressure
Treatment
NSAIDs; Non-weight bearing status; ROM exercises; Electrical stimulation; Surgery

32

Benign Bone Tumor

Abnormal growth of normal tissue
Do not metastasize/interfere with body organ function
Affected by growth hormones
Clinical manifestations
Lump associated with ache or pain
Treatment
Tumor heals when fracture heals
Stops growing when growth hormone slows
Surgery

33

Malignant Bone Tumor

Come from cartilage, bone cells, collagen, bone marrow
Etiology: Exact cause unknown
Pathogenesis: Possibly related to
High bone growth or bone overstimulation by disease
Radiation, bone marrow transplantation
Osteolysis
Osteosarcoma is most common in adolescents (75%<20 y/o)
Clinical manifestations
Deep bone pain; Skin over mass warm, erythematous
Diagnosis
X-rays; CT scans; MRI; Bone biopsy; Alk phos & calcium levels
Treatment
Surgery; Chemotherapy; Radiation

34

Metastatic Bone Disease

Cancer from another body site that migrates to bone
Most common in spine, pelvis, thigh
Clinical manifestations
Sometimes asymptomatic
If symptomatic
Bone pain; Fractures; Changes in urinary & bowel continence; Limb weakness
Diagnosis
X-rays; CT scans; MRI; Blood tests; Bone or positron emission tomography scan
Treatment
Radiation; Chemotherapy