Chapter 39 - Alteration In Musculoskeletal Function Flashcards
(156 cards)
1
Q
Leading cause of death in individuals 1-44 yoa
A
Skeletal trauma
2
Q
Majority (70%) of hospital visits come from
A
Fractures
3
Q
Majority of occupational injuries in hospitals are
A
Registered nurses
4
Q
Musculoskeletal system
A
First line of defence against external forces
-mobility, protects internal organs
5
Q
Fractures
A
Break in bone, usually accompanied by surrounding tissue damage
6
Q
Highest incidence of fractures
A
Males 15-24 yoa, adults >65 yoa
7
Q
Trauma
A
Bone subjected to stress greater than it can absorb
8
Q
Most common fractures in YP
A
Clavicle, tibia and humerus
9
Q
Older people most common fractures
A
Humerus, femur, vertebra and pelvis (linked to osteoporosis)
10
Q
Shin splints
A
Stress on tibia by overworking your muscle
-starting too fast and not allowing your muscle time to grow and warmpip
11
Q
Complete fracture
A
Bone is entirely broken
12
Q
Incomplete fracture
A
Bone damaged but still in one piece
13
Q
Open fracture
A
Skin is open
14
Q
Comminuted fracture
A
Bone breaks into more than two fragments
15
Q
Linear fracture
A
Runs parallel to long axis of bone
16
Q
Oblique fracture
A
Occurs at slanted angle
17
Q
Spiral fracture
A
Encircles bone
18
Q
Transverse fracture
A
Straight across bone
19
Q
Greenstick fracture
A
Bone cracks on one side only
20
Q
Pathological fracture
A
Break at a site of pre existing abnormalities
-resulting form force that wold not fracture a normal bone
21
Q
Fracture s/s: swelling
A
Site of injury due to soft tissue edema, and hemorrhage into muscles and joints
22
Q
Fracture s/s: pain
A
Muscle spasms which will continue until bone fragments are immobilized
23
Q
Fracture s/s: crepitus
A
Rubbing of bone fragments against each other
24
Q
Fracture s/s: bruising
A
Bleeding into tissue
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Fracture s/s: nerve damage
Impaired sensation
26
Fracture s/s: pulselessness at site
Vessels are compressed
27
Dislocation
Joint surfaces lose contact with each other
-complete joint disruption
28
Subluxation
Partial contact between opposing joint surfaces
-can damage ligaments, nerves, cartilage
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Causes of dislocation and subluxation
-developing joint
-trauma
-muscular imbalance
-joint instability
30
What does numbness and tingling signal in dislocation and subluxation
Can lead to permanent disability
31
Splints
Protect injured body part from moving
-can provide restrictive movement or complete immobilization
32
Skin traction
Tape applied to skin to hold bone in place (short term)
-used in patients waiting in operating room
33
Skeletal traction
Pins drilled into bone distal to fracture
-larger weight supplied to keep bone in alignment
-body weight counters fraction force
34
Skeletal traction is most commonly in
Femur
35
Fixation
Pin or rod placed in uninsured bone to help stabilize fracture site due to too much bone being injured
36
Autograft vs allograft vs xenograft
Auto: bone graft from the individual
Allo: bone fracture from a cadaver
Xeno: bone graft taken from another species
37
Bone healing stages: hematoma
Bleeding at site of injury and surrounding tissue
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Bone healing stages: soft callus
Hematoma at site forms fibrous network
-soft callus forms on outer bone surface over fracture
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Bone healing stages: hard callus
Osteoblasts within soft callus synthesize collagen to from hard callus
40
Bone healing stages: remodeling
Unnecessary callus is reabsorbed and repaired tissues are realigned
41
Most fractures heal within
4-8 weeks
42
Bone can form…
New bone without forming scar tissue
43
Strains
Tearing or stretching of a muscle/tendon
-most commonly found in hands, feet, knees, upper arm, thigh and ankle
44
Sprain
Tearing of a ligament
-most commonly in wrist, ankle, elbow, knee
45
Grade 1 (sprain/strain)
Fibres stretched, muscle and joint remain stable
46
Grade II (sprain/strain)
More tearing of tendon or ligament = muscle weakness and joint instability
47
Grade III (sprain/strain)
Inability to contract muscle = significant joint instability
-surgery may be required
-full recovery expected, but potential for arthritis
48
Healing tendon/ligament lacks strength to withstand some levels of stress for ____ weeks after injury
4-5
49
___ months required for stability of joint
3
50
What could damage recovery, or result in scar tissue/ poor tendon and ligament function?
Excessive stretching
51
Rhabdomyolysis
Rapid breakdown of muscle causes release of intracellular contents (myoglobin, enzymes, potassium) into ECF and blood
52
___ is a serious medical condition that can be fatal and result in permanent disability
Rhabdomyolysis
53
Causes of Rhabdomyolysis
-trauma: crash, medications, drugs
-excessive muscular contractions
-infectious agents
-toxins (carbon monoxide)
54
Complications of Rhabdomyolysis
-hyperkalemina (excess potassium released into circulation)
-cardiac dysrhythmia
-kidney failure
55
S/s of Rhabdomyolysis : the triad of symptoms
Muscle pain, weakness, dark urine
56
Dark urine comes form what? In Rhabdomyolysis
Myoglobin in urine
-this may not always be indicative of Rhabdomyolysis
57
What is the most reliable indicator of Rhabdomyolysis
Creatine kinase
-released in inc quantities
58
Function of creatine kinase
Add a phosphate to ADP to rephosphorylate ATP and maintain cellular ATP homeostasis
59
TX for Rhabdomyolysis
Treatment is meant to maintain urinary output and prevent kidney failure
-rapid IV fluids to maintain urine output
-may require hemodialysis to deal with hyperkalemia
60
Compartment syndrome
Damage within compartment but fascia encircling compartment is intact
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Muscle compartment
Well defined compartment containing muscle and associated nerves, and blood vessels enclosed by fascia
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Increased pressure caused
Decreased blood supply = hypoxia = necrosis
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Causes of compartment syndrome
Inc compartment content (bleeding) or decrease volume of compartment (bandage that is too tight)
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Result of compartment syndrome
Disturbance of muscles microvasculature
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What can inc compartment syndrome
Many conditions like burns, snakes or insect bites
66
Six P’s of compartment syndrome
1. PAIN
2. PRESSURE
3. PARESTHESIA
4. PARESIS
5.PULSELESSNESS
6. POIKILOTHERMIA
67
Pain
Out of proportion to injury
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Pressure
Swelling, tenderness, to affected area
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PARESTHESIA
Numbness tingling due to nerve impingement
70
Paresis
Muscle weakness
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Pulselessness
Inadequate blood perfusion to compartment
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POIKILOTHERMIA
Inability to maintain a constant core temperature independent of ambient temperature
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What are the most suggestive P’s of compartment syndrome
Pain with radiation to finger and toes, and PARESTHESIA
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Diagnosis of compartment syndrome
Measurement of intracompartmental pressure with a manometer
-measures pressure
75
TX of compartment syndrome
Cutting facia to relieve pressure
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Osteoporosis
Decreased bone mineral density and increase risk of fractures
77
Chronic osteoporosis
Progresses silently for decades but not neccesarily related to aging
-old bone reabsorbed faster than new bone is made
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Most common chronic osteoporosis
Hip, writs,t and spine
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Post menopausal osteoporosis
Caused by estrogen deficiency
80
Secondary osteoporosis
Caused by endocrine dysfunction
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Most associated things with secondary osteoporosis
Parathyroid hormone, cortisol, thyroid hormones and growth hormone
82
Other factors associated with secondary osteoporosis
Medication, lack fo physical activity, abnormal BMI
83
Peak bone mass of osteoporosis around
30 yoa
84
After 30 yoa (osteoporosis)
Increased risk of fractures
-1/6 women
-1 1/2 men will sustain vertebral fracture
85
S/s of osteoporosis
-bone deformity and pain due to fractures
-vertebral fractures can cause kyphosis (humpback)
-occurrence of osteoporosis is usually exposed by fall
86
Diagnosis of osteoporosis
Bone mineral dentistry using Z rya
-by the time of diagnosis 30% of bone tissue could be lost
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DXA scanner
Utilizes two X-ray beams, one high energy and one low energy
-measures amount of X-ray from each beam passing through bone
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TX for osteoporosis
-prevent fractures
-medication to prevent bone reabsorption
-limit alcohol and caffeine
-stop smoking
-moderate weight bearing excel sizes stimulating bone formation
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Paget’s disease
Increased metabolic activity = localized abnormal and excessive bone remodeling
90
Paget’s disease is otherwise known as
Osteitis deformans
91
Result of Paget’s disease
Enlarged but soft bones and neurological problems
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Paget’s disease can occur in
One bone or multiple bones
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Who is at risk for Paget’s disease
Men older than 55 yoa and women older than 40 yoa
94
If Paget’s disease is asymptomatic how can it be diagnosed
Via x ray
95
Is Paget’s disease familial?
Up to 25% of cases involve family members
96
Cause of Paget’s disease
Genetics and environmental factors
97
Environmental causes of Paget’s disease
-viruses (mumps, measles)
-human parainfluenza virus (respiratory tract virus) despite name, not related to infleunza (the flu)
98
What exactly is Paget’s disease
Excessive reabsorption of spongy bone and replaced with disorganized bone at increased rate
99
In Paget’s disease ___ diminish and bone marrow is replaced by
Trabeculae
-extremely vascular fibrous tissue
100
Collagen fibres in Paget’s disease
Are extremely disorganized nad mineralization of bone extends into bone marrow
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Result of Paget’s disease
Increased bone fragility and increased risk of bone tumours
102
Manifestations of cranium Paget’s disease
Take on a symmetrical appearance
-brain compression = dementia and altered consciousness
103
Paget’s disease in long bones
Affects both ends of long bones, producing lateral curvature in the tibia and femur
104
Osteomyelitis
Infection most often caused by bacteria, but also virus, fungi or parasites
105
Hematogenous osteomyelinitis
Caused by a pathogen carried in blood stream (more common in children)
106
Contiguous osteomyelitis
Infections spread from adjacent bones
-contiguous=sharing common border
107
Causes of osteomyelitis
-open fractures, penetrating wounds and surgical procedures
-diabetes, smoking, alcohol, drug abuse
-chronic illness, immunosuppressive medications
108
Primary pathogen in osteomyelitis
Staph. Aureus
109
Osteomyelitis is associated with what
Sickle cell anemia
-since SCA reduced immune ability to clear blood infections
110
Osteomyelitis: s.aureus produces
Toxins that destroy neutrophils
-biofilms adhere to surface = inc risk of implants
111
Osteomyelitis: biofilm and inflammation =
Alteration of balance between osteoblast (creating bone) and osteoclasts (breaking down bone)
112
Osteomyelitis: vessel leakage creates
Exudate which seals bone canaliculi
-fluid that leaks out of blood vessels
113
Osteomyelitis: inflammatory exudate extends into
Marrow cavity and creates sequestrum (a piece of devitalized bone separated from surrounding bone)
114
Osteomyelitis: osteoblasts
Lay new bone over infected bone
115
TX for Osteomyelitis
Debridement of infected bone
-surgery to remove infected bone plus a small amount of heathy bone to ensure all infection is removed
116
Osteoarthritis is caused by
Physical wear and tear on a joint over time
117
Most common form of arthritis
Osteoarthritis
118
Primary defect of Osteoarthritis
Articular cartilage
119
Osteoarthritis
Articular cartilage breaks down
-results in underlying bone becoming sclerotic (dense and hard)
120
Osteoarthritis: cysts develop on bone and pressure builds up in cysts =
Cysts contents forced into synovial cavity (opening from bone into synovial cavity)
121
Osteoarthritis: underlying bone develops projections
Which break off into synovial fluid
-bone projections called joint mice
122
Osteoarthritis: joint capsule becomes
Thickened and adheres to deformed bone = reduced range of joint motion
123
S/s of Osteoarthritis
Pain, stiffness, decreased ROM, muscle wasting and perhaps deformity
124
Osteoarthritis swelling is due to
Osteocytes fragments in synovial cavity
125
Diagnosis fro Osteoarthritis
X-ray
126
TX Osteoarthritis
-exercise, weight loss, medication (Chirondroitin)
-surgery/implantation of artificial joints
127
Rheumatoid arthritis
Chronic autoimmune disease focusing on joints
-joint swelling and tenderness
-destruction of synovial joints
-genetic factors
128
Difference between Osteoarthritis and rheumatoid arthritis
In RA, synovial membrane is the first tissue affected
129
S/s of rheumatoid arthritis
-Join degradation is symmetrical
-stiffness mostly in morning
-fixed flexion of small hand joints (swan neck and boutonniere)
130
Rheumatoid arthritis: what becomes activated
Synovial cells including macrophages
131
Rheumatoid arthritis: macrophages will initiate
Inflammatory response = thickening synovial fluid called pannus
132
Rheumatoid arthritis: pannus invades
Bone tissue causing abnormal bone remodeling = invasion of fibrous connective tissue
133
What is effected in Rheumatoid arthritis
Fingers, feet, wrists, elbows, ankles, knees, tissues of heart lung and kidney
134
The disease of kinds
-most common inflammatory arthritis world wide
Gout
135
Gout
Over production and underexcretion of uric acid
-genetic
-inflammation and joint pain (especially big toe)
136
90% of Gout cases are due to
Under excretion of uric acid
137
Gout: when uric acid reaches a specific limit…
It crystallizes forming precipitates that deposit into joint
-initiates inflammatory process = pain = gouty arthritis
138
Risk of Gout
Older male, alcohol, red meat, fructose, inc BMI
139
S/s of Gout
-kidney stones
-joint enlargement (crystals harden, erode bone and cartilage)
140
Gout: uric acid is a breakdown product of
Purine nucleotides
-guanine and adenine
141
Gout: rate of kidney excretion of uric acid
Urate excretion if sluggish
142
Gout: inc cytokines =
Inc macrophage and neutrophils
143
Gout: WBC engulf crystallized urate =
rupture of WBC = inc inflammation
144
Contractures
Loss of full passive range of motion
-occurs secondary to joint, muscle and soft tissue limitations
145
Muscle contraction occurs in
Absence of muscle action potential
146
Muscle shortening happens because fo
Calcium pump failure
-even if there is ATP
147
Contractures are present in
McArdles disease
148
Contractures patho
-permanent muscle shortening can be caused by muscle spams or weakness
Eg= Achilles tendon
149
Contractures are more common in
most common in stroke, neuromuscular disease and lower extremities
150
Disuse atrophy
Muscle wasting due to reduction in muscle fibres size after prolonged inactivity from bed rest, traumat or local nerve damage
-can take weeks
151
Normal individual on bed rest will lose muscle strength at a rate of ____ per day
3% per day
152
Fibromyalgia
Chronic musculoskeletal syndrome characterized by diffuse pain, fatigue and inc sensitivity to touch
-often misdiagnosed due to lack of inflammation
153
Most affected women in fibromyalgia
90% are women 30-50
154
Fibromyalgia appears to be result of
CNS dysfunction where there is an amplification of pain transmission and interpretation
155
Genetic involvement in Fibromyalgia
Affect serotonin, catecholamines and dopamine
-all of which are involved in stress response and sensory processing
156
Fibromyalgia and pain
Begins in neck and shoulders, then becomes generalized
