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
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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
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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
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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
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Incomplete or greenstick
bone fragment partially joined
common in children -> more collagen and less mineralized
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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)
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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
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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
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union
normal healing
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nonunion
clinically significant progress toward complete healing for at least 3 months according to x-rays
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delayed union
significantly longer that expected healing time
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malunion
bone fragments joined in position not anatomically correct
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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
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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
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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
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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
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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
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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
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Tinels
light percussion over irritated median nerve elicits a tingling sensation
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phalends
maintained flexion of wrist at 90 degrees for 30-60 sec elicits tingling/pain
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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)
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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