bone and skeletal

Question 1

Bone infarcts, Location is in multiple sites.

Answer 1

Avascular Bone Necrosis

Question 2

Involves head of the femur and results in destruction

Answer 2

Legg-Calve-Perthes

Question 3

Occurs in young adults/teens – Males more than females – Usually involves metaphysis of long bones

Answer 3

Osteosarcoma

Question 4

• Knee joint in 50% of cases – Metastasizes to lungs – Requires surgery and chemotherapy to achieve a 60% 5 year survival.

Answer 4

Osteosarcoma

Question 5

Infection of the bone (most often bacterial) – Can follow an acute (ill person) or chronic course – Several bacteria can cause but Staph most common * TB, Syphilis, etc.

Answer 5

Osteomyelitis

Question 6

• Staphylococcal aureus pattern most common – Typically infects the vascular metaphysis – Children more than adults and males more than females – The site becomes pus filled and bony pieces become sequestered in the abscess and provide a place for bacteria to live – Long bones and vertebra are common sites – Believed bacteria are initially blood born and then colonize the bone.

Answer 6

Osteomyelitis

Question 7

• Regardless is an important entity for a massage therapist to be aware of as guess what the clinical presentation includes? – Right………back pain – May be ill * Fever, etc. – If chronic mat not be ill and will be a pain that does not respond to MSK treatment.

Answer 7

Discitis

Question 8

Bone defect caused by mutations of the gene for collagen I – ‘Brittle bone disease’

Answer 8

Osteogenesis imperfecta

Question 9

Defined as softening of bones as a result of inadequate mineralization of the organic matrix (osteoid) * Also called ‘rickets’ * Etiology is Vitamin D deficiency –
- bow legged appearance

Answer 9

Osteomalacia

Question 10

• Loss of continuity of bone * Usual due to trauma or high energy event

Answer 10

Fractures

Question 11

fractures that occur when a bone breaks unusually or with minimal to no force due to bone weakening disease

Answer 11

Pathological fracture

Question 12

fracture with no break in skin

Answer 12

Closed fracture

Question 13

fracture with skin broken

Answer 13

Open/ compound fracture

Question 14

Fractured in more than two pieces

Answer 14

Comminuted

Question 15

Partial fracture Impacted One side of fracture driven into the interior of other side.

Answer 15

Greenstick

Question 16

microscopic fissures from repeated strenuous activities.

Answer 16

Stress fracture

Question 17

Formation of fracture hematoma – damaged blood vessels produce clot in 6-8 hours, bone cells die – inflammation brings in phagocytic cells for clean-up duty – new capillaries grow into damaged area

Answer 17

Repair of a Fracture begining

Question 18

Formation of fibrocartilaginous callus formation – fibroblasts invade the procallus & lay down collagen fibers – chondroblasts produce fibrocartilage to span the broken ends of the bone

Answer 18

Repair of a Fracture From day 1 to week 4

Question 19

Formation of bony callus – osteoblasts secrete spongy bone that joins 2 broken ends of bone

Answer 19

Repair of a Fracture From week 4 to month 4

Question 20

Bone remodeling – compact bone replaces the spongy in the bony callus – surface is remodeled back to normal shape

Answer 20

Month 4 to ?

Question 21

Multifactorial disease characterized by absolute reduction of the total bone mass with no known direct cause

Answer 21

Primary Osteoporosis

Question 22

reduction of total bone mass due to another disease process or medication or immobilization

Answer 22

Secondary Osteoporosis

Question 23

Most common osteoporosis fractures are:

Answer 23

HIP

Question 24

Chronic disease of unknown etiology characterized by irregular restructuring of bone and subsequent thickening and deformities of bones – Likely due to malfunctioning osteoclasts

Answer 24

Paget’s Disease (Osteitis Deformans)

Question 25

has a poor blood supply and missed fracture can lead to necrotic bone – Snuff box tenderness

Answer 25

Scaphoid

Question 26

Osteoporosis risk factors:

Answer 26

* Age – Greater risk in those older than 85 years * one third have osteoporosis * Women > men – especially after menopause * Race – Caucasians and Asians at greater risk * Peak bone density * Smoking – Smoker’s have increased risk of osteoporosis * Alcohol * Diet and lifestyle * Hormones * Diabetes mellitus Causes of Secondary Osteoporosis * Hormonal disturbances – excess of cortisol, deficiency of sex hormones * Dietary disorders – vitamin C or calcium deficiency, malabsorption of food * Immobilization – Astronauts * Drugs – anticonvulsants, anticoagulants (e.g., heparin), corticosteroids * Tumors – breast cancer

Question 27

this is reached in 20’s so diet and activity level in youth important in cause/prevention especially in women

Answer 27

Peak bone density

Question 28

Fragile vertebra fracture in a wedge shape * Can be the result of

Answer 28

* Chronic disease of unknown etiology characterized by irregular restructuring of bone and subsequent thickening and deformities of bones – Likely due to malfunctioning osteoclasts

Question 29

* Three phases of Paget’s Disease (Osteitis Deformans)

Answer 29

* Three phases – Destructive phase * Bone is resorbed – Mixed phase * Both bone resorption and abnormal formation – Osteosclerotic phase * Abnormal formation of bone * Irregular shaped osteons.

Question 30

Defined as the breakdown of cartilage due to imbalance of synthesis and degradation with minimal inflammation

Answer 30

Osteoarthritis

Question 31

Involved joints are characterized by – Narrowed joint space – Subchondral sclerosis – Subchondral cysts – Osteophyte formation

Answer 31

Osteoarthritis

Question 32

– Most common joint disease – Also called ‘degenerative joint disease’ – Disease of old age – Affects weight-bearing big joints but also small joints of hands and feet

Answer 32

Osteoarthritis

Question 33

Osteoarthritis most commonly involved.

Answer 33

Most commonly involved joints – Knee – Hip – 1 st MCP joint – DIP joints * Haberden’s nodes – Facet joints of the C spine and L spine.

Question 34

Osteoarthritis Risks include

Answer 34

– Age – Gender * More males than females less than 45 but more females than males greater than 55 – Previous injury – Chronic loading * Laborers who kneel for most of their work have greater risk of OA of the knee – Obesity

Question 35

Osteoarthritis Clinical presentation – Joints feel stiff and sore but are not very swollen or red – Pain is worse both after inactivity and with prolonged activity * Sore in the morning and at the end of the day * Treatment – Improve strength/flexibility around the joint

Answer 35

– Joints feel stiff and sore but are not very swollen or red – Pain is worse both after inactivity and with prolonged activity * Sore in the morning and at the end of the day * Treatment – Improve strength/flexibility around the joint

Question 36

Osteoarthritis treatment

Answer 36

Treatment – Improve strength/flexibility around the joint

Question 37

* Chronic systemic disease of unknown etiology that has autoimmune characteristics and involves: – Chronic, symmetric inflammation of joints

Answer 37

Rheumatoid Arthritis

Question 38

– Significant laboratory findings indicative of immune disorder * Like many thought to be immune disorders a triggering infection is felt to be part of the disease process

Answer 38

Rheumatoid Arthritis

Question 39

– Variable extra-articular findings * Involves more than just joints

Answer 39

Rheumatoid Arthritis

Question 40

* Clinical presentation – Slow onset that often begins with systemic manifestations of fatigue, generalized weakness, myalgias, and arthralgias

Answer 40

Rheumatoid Arthritis

Question 41

– Joints eventually worsen with deformity, loss of ROM, and pain – Variable severity and rapidity of development

Answer 41

Rheumatoid Arthritis

Question 42

Rheumatoid Arthritis * Clinical findings

Answer 42

non joint – Rheumatoid nodules * Likely granulomas that most often form on extensor surfaces of the limbs but can occur anywhere

Question 43

* Massage – Rheumatoid arthritis

Answer 43

suffers can benefit from the effects of massage especially in the maintenance of joint ROM, relief of muscle spasms, and perhaps reduction of edema

Question 44

Massage – Rheumatoid arthritis MUST KNOW

Answer 44

the vulnerability of the C1-C2 joint * Instability and fragility of the ligaments develop over time and care must be taken when treating the neck of a RA patient so that no extreme ROM or stretching is performed.

Question 45

RA vs OS

Answer 45

RA presents with symmetrical joint involvement, prolonged morning stiffness, significant inflammation, and systemic symptoms due to its autoimmune nature. The only axial involvement occurs in the first and second cervical vertebrae and can lead to instability and even neurological complications if not properly managed. OA presents with asymmetrical joint involvement, pain that worsens with activity, shorter Moring stiffness, and localized symptoms due to joint wear and tear.

Question 46

Gout - Podagra – Characteristic presentation of gout

Answer 46

Swelling and pain of first metatarsophalangeal joint of the foot * Hyperuricemia – High levels of uric acid in the blood or rapid elevation of uric acid

Question 47

Deposition of urate crystals in tissues; inflammation of joints * Effects men more than women (post menopausal women get gout) * Uric acid is part of break down of nucleic acids

Answer 47

Gout

Question 48

Bacteria infection of the joint space * Acute onset of red, swollen, painful joint, and low grade fever * Bacteria invade joint from the bloodstream or from introduction to the joint through a break in the skin

Answer 48

Septic Arthritis

Question 49

Rickets is known as

Answer 49

Osteomalacia.

Question 50

* Considered a medical emergency as joint destruction can occur rapidly and permanent damage can result.

Answer 50

Septic Arthritis

Question 51

Thickened and deformed bones due to abnormal restructuring of the bone, is a characteristic of

Answer 51

Paget’s disease.

Question 52

The supplementation with vitamin D is to prevent

Answer 52

osteomalacia.

Question 53

Compression fracture is associated with

Answer 53

osteoporosis.

Question 54

which two concurrent complaints go with discitis

Answer 54

back pain and fever

Question 55

Which joint is NOT a joint usually affected by degenerative joint disease (osteoarthritis)

Answer 55

Elbow

Question 56

When surgery is required to align the bony peaces of a fracture its called

Answer 56

open reduction

Question 57

Inflammation and pain in the 1st metatarsal phalangeal joint of the foot due to gout is known as

Answer 57

podagra

Question 58

when presentation is more likely rheumatoid arthritis

Answer 58

Symmetrical joint involvment

Question 59

Congenital "brittle bone disease" is known as

Answer 59

osteogenesis imperfecta

Question 60

A pathological fracture is important to identify because

Answer 60

the underlying disease must be identified

Question 61

Bacterial infection of the bone is known as

Answer 61

Osteomyelitis

Question 62

Rheumatoid nodules are

Answer 62

granulomas found on extensor surfaces

Question 63

You observe a person drinking coffee and their hands look very malformed. they appear to have ulnar deviation of their wrists with swan neck deformities of their fingers. this person may be suffering from

Answer 63

rheumatoid athritis

Question 64

which metabolic product is the underlying problem in gout

Answer 64

uric acid

Question 65

An imbalance between the synthesis and degradation of cartilage is the underlying cause of

Answer 65

Osteoarthritis