Chapter 41- Alterations in Musculoskeletal Function Flashcards
(97 cards)
1
Q
Who has highest incidence of fractures?
A
young males 15-24 y/o and older persons > 65 y/o
2
Q
Most common fracture sites of healthy bones in young people and why
A
tibia, clavicle, lower humerus from trauma
3
Q
Most common fx sites in older adults and why
A
upper femur, upper humerus, vertebrae, pelvis d/t osteoporosis
4
Q
complete fracture
A
bone broken entirely
5
Q
incomplete fracture
A
bone damaged but still in one piece
6
Q
open fractures
A
formerly compound; skin is OPEN; can be complete or incomplete
7
Q
closed fractures
A
If skin is not open; complete or incomplete
8
Q
comminuted fracture
A
bone breaks into more than 2 fragments
9
Q
linear fracture
A
fracture line runs parallel to long axis of bone
10
Q
oblique fracture
A
direction of fracture line slanted angle to shaft of bone
11
Q
spiral fracture
A
fracture line encircles the bone
12
Q
transverse fracture
A
fracture line occurs straight across the bone
13
Q
who do incomplete fractures occur most commonly in
A
children; more flexible growing bones
14
Q
greenstick fracture
A
perforates one cortex and splinters the spongy bone
think young tree branch that’s bent sharply; outer surface disrupted but inner remains intact
bends/cracks
most common in children
15
Q
where do greenstick fxs usually occur
A
metaphysis or diaphysis of tibia, radius, ulna
16
Q
Torus fx
A
cortex buckles but doesn’t break
17
Q
Bowing fractures
A
when longitudinal force applied to bone= bending of bone; usually occurs in pair (one bowed, one fx)
18
Q
Why is bowing fx hard to correct
A
resists reduction/correction because force to correct must equal force that caused; bowed bone interferes w/ reduction of fx bone
19
Q
Who does bowing fx occur in and what bones
A
children; paired radius-ulna or fibula-tibia
20
Q
Pathologic/insufficiency/fragility fracture
A
break at site or preexisting abnormality resulting from force that wouldn’t fx normal bone; CAN occur with NORMAL weight bearing/activity
21
Q
What causes pathologic fx
A
any disease that weakens a bone (esp. cortex)
Ex: osteoporosis, cancer, infection, RA, Paget disease, osteomalacia, rickets, hyperparathyroidism, radiation
22
Q
stress fx
A
repeated strain like in sports’ normal or abnormal bone. Forces on bone cumulative eventually causing fx; tiny cracks in a bone
23
Q
Fatigue fx
A
repetitive sometimes abnormal stress/torque applied to bone w/ normal ability to deform and recover
Usually in individuals who engage in a new/different activity that is both strenuous and repetitive
Muscle strength faster than bone strength
24
Q
transchondral fx
A
fragmentation and separation of portion of articular cartilage (It allows the bones to glide over each other with very little friction.)
single or multiple sites; cartilage alone or cartilage + bone
25
typical sites transchondral fx and who affected more
distal femur, ankle, patella, elbow, wrist
Adolescents
26
direct/primary healing
intramembranous bone formation occurs when adjacent bone cortices are in contact with one another like with SURGICAL fixation devices
***NO callus formation
27
indirect/secondary healing
both intramembranous and endochondral bone formation, development of CALLUS, and eventual remodeling of solid bone
28
Endochondral bone formation
bone formation that begins with an underlying cartilage scaffold
29
When is secondary/indirect healing mostly seen
non-operative fracture treatment; fracture treated w/ cast
30
how are calluses formed
bone tissue adjacent to fx dies, osteoblasts synthesize collagen and matrix, becomes mineralized= callus
31
s/s fx
unnatural alignment (deformity), swelling, muscle spasm, tenderness, pain/impaired sensation, decreased mobility
32
INITIAL sx following fx
numbness at fx site d/t nerve trauma x several mins then subsequent pain is severe
33
s/s pathologic fx
angular deformity, painless swelling, generalized bone pain
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s/s transchondral fx
asx
painful during ROM
limited RPM and crepitus
35
dislocation
displacement 1 or more bones in joint in which opposing joint surfaces entirely lose contact with one another
36
subluxation
contact between opposing joint surfaces partially loss (partial dislocation)
37
who is more at risk for dislocation and subluxation
< 20 y/o and generally associated w/ fx
38
s/s dislocation or subluxation
pain
swelling
limited ROM
joint deformity
39
what causes pain in fx
muscle spasms
overriding of fx segments
damage to adjacent soft tissue
40
what causes pain in dislocation or subluxation
effusion of inflammatory exudate into joint
nerves
tendon/ligament injury
muscle contraction
41
tendon
connects skeletal muscle to bone or another structure; meant to connect skeleton for movement
area of attachment= enthesis
42
ligament
connects bone to bone where they meet in JOINT, meant to keep things held together/stabilized
43
strain/where common
tearing/stretching of muscle or tendon most common in hands, feet, knee, upper arm, thigh, ankle, heel (akilles)
44
sprain/where common
ligament tears most common in wrist, ankle, elbow, knee
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avulsion/who commonly affects
complete separation of tendon/ligament from bony attachment
young athletes- sprinters, hurdlers, distance runners
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s/s tendon/ligament injury
soft tissue swelling
change in tendon/ligament contour
disclocation/subluxation bones
SHARP localized pain
tenderness persists over distribution of tendon/ligament
movement/weight bear increases pain
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s/s lateral epicondylopathy/tennis elbow & medial epicondylopathy/golfer's elbow
localized to one side of joint
local tenderness, more pain with ACTIVE ROM than passive
tissue degradation
loss of grip, strength, pain
48
bursitis
inflamed sacs of synovial fluids (meant to separate/lubricate/cushion structures)
middle age d/t trauma
shoulder, hip, knee, elbow (less often spine, wrist, foot, ankle)
49
*rhabdomyolysis/myoglobinuria
rapid breakdown muscle that causes release intracellular contents like myoglobin into extracellular space & bloodstream
50
*s/s rhabdomyolysis
muscle pain and weakness
dark urine
51
**labs in rhabdomyolysis
#1= high CK (normal 5-25 women, 5-35 men) 5-10x upper limit
myoglobin in urine
high K (norm 3.6 to 5.2)
high phosph.
low BUN
52
*complications rhabdomyolysis
ARF
disseminated intravascular coagulation (DIC)
cardiac arrythmias
53
*when is ARF likely in rhabdomyolysis
CK > 15,000
54
*s/s hyperkalemia (> 5.2)
Abdominal (belly) pain and diarrhea.
Chest pain.
Heart palpitations or arrhythmia (irregular, fast or fluttering heartbeat).
Muscle weakness or numbness in limbs.
Nausea and vomiting
55
s/s hypernatremia (> 145)
excessive thirst
lethargy
confusion
muscle twitching or spasms
56
s/s hyponatremia ( < 135)
Nausea and vomiting
Headache
Confusion
Loss of energy, drowsiness and fatigue
Restlessness and irritability
Muscle weakness, spasms or cramps
Seizures
Coma
57
s/s compartment syndrome
6 P's:
pain
pressure
pallor
paresthesia
paresis (impaired function)
pulselessness
58
what is and s/s malignant hyperthermia
prolonged release intracellular Ca
hypermetabolism: high body temp, muscle rigidity, rhabdomyolysis
respiratory acidosis (high tidal end Co2)
tachycardia
masseter & skeletal muscle spasm
59
osteoporosis
most common bone disease
decreased bone mineral density, thinner more porous, increased risk of fractures bc alterations in bone microarchitecture
disrupted bone resorption & formation
NOT consequence of aging (but is risk)
60
most common fx site osteoporosis
spine, femoral neck, wrist
61
causes osteoporosis
1. postmenopausal 2. secondary 3. regional (confined to segment skeleton, no known cause)
endocrine disorders (thyroid, growth, parathyroid, cortisol like cushing)
meds (PPO, glucocorticoids... )
menopause (decreased estrogen)
low vit D & Ca
family hx
obesity
smoking
diet
62
s/s osteoporosis and common fx sites
pain & bone deformity d/t fx
kyphosis, decreased height
fx long bones (femur), distal radius, ribs, vertebrae
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*osteomalacia
ADULT bone
metabolic disease characterized by inadequate delayed mineralization of osteoid in mature compact and spongy bone
It is a disorder of decreased mineralization, which results in bone breaking down faster than it can re-form
NO mineral calcification and deposition
a problem with vitamin D, which helps your body absorb calcium
64
cause osteomalacia
***low vit D
= decreased Ca absorption > low phos.
HIV, liver, cancer, kidney, nutrient disorders can cause low D > osteomalacia
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*s/s osteomalacia
diffuse muscular/skeletal pain and tenderness especially in HIPS= hesitant to walk
waddling gait (muscular weakness)
facial deformities
bowed legs, knocked knees
fragility fx: bone fx, vertebral collapse w/ min trauma
low back pain eaerly
UREMIA
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*lab osteomalacia
high BUN/Cr
norm/low Ca
high phos.
high alkaline phos. & PTH
67
rickets
like osteomalacia but in children
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Paget Disease/osteitis deformans (PBD)
second most common bone disease after osteoporosis
state of increased metabolic activity in bone characterized by localized abnormal and EXCESSIVE bone remodeling
Enlarged softened bone= bowing deformity, fx, neuro problems
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most commonly affected bone paget disease
vertebrae, skill, sacrum, sternum, pelvis, femur
70
risk paget disease
men > 55, women > 40
71
s/s & labs paget disease
asx often
irregualr bone trabeculae w/ thick/disorganized pattern
HA
frontal, occipital skull thickness/asymmetrical
altered mentation/dementia from compression on brain by thick skull
sensory abnormalities, deaf, motor function, optic nerve, lacrimal duct all from skull compression on nerves
thick mandible/maxilla
stress fx BLE
spastic quadriplegia
elevated serum alkaline phosphatase or abnorm. xray
high PINP
72
*osteomyelitis, most common pathogen, & two types
bone infection caused usually by bacteria ***staph. aureus (esp. in human bite). Can be fungi, parasite, virus also
1. hematogenous
2. contiguous
73
hematogenous osteomyelitis & s/s
pathogens through blood > bone infect. *Children
fever
pain
voluntary immobility of affected limb
kids: cutaneous, sinus, ear, dental infections primary source
adults: spine, pelvis, small bones
74
contiguous osteomyelitis & s/s
infection spreads to adjacent bone often caused by open fx, penetrating wounds, surgery, metabolic/vascular disease, age, lifestyle
*males
75
*s/s osteomyelitis
insidious onset, vague sx
fever
malaise
anorexia & wt loss
pain in/around infected areas
maybe/maybe not edema
recent infection or instrumentation precedes
abscesses (Brodie abscesses)
lymphadenopathy
in chronic= silent between exacerbations
76
Brodie abscesses
abscesses in subacute or chronic osteomyelitis
circumscribed lesions 1-4cm ends of long bones and surrounded by dense ossified bone matrix
evidence pathogen less virulent or immune system somewhat successful
77
*labs osteomyelitis
elevated WBC
C-reactive protein (CRP)
78
osteoarthritis (OA) what is it? patho? affected?
most common age-related disorder of synovial joints
***loss/damaged cartilage & bone spurts
*inflammation, new bone of joint margins, subchondral bone change, variable degrees synovitis, thickening capsule joint
LOAD-BEARING AREAS= hips, hands, spine
> 40 y/o, women
stress on joints
79
*clinical manifestations osteoarthritis
5th/6th decade of life
#1- pain in 1+ joints using w/ weight/load bear or use; RESTING RELIEVES
*stiffness < 30 min
crepitus, creeking, grating
swelling/enlargement
tender
limited ROM
muscle waste
partial dislocation
deformity
limp
synovitis (inflam. joint lining)
nocturnal pain unrelieved and w/ paresthesia
referred pain like sciatic nerve back of thigh
brachial neuralgia (pain in arm) w/ neck movement
lack of sleep= more stress chronic pain
80
heberden and bouchard nodes
bone enlargement in hands w/ osteoarthritis
81
*rheumatoid arthritis (RA)
chronic, systemic, inflammatory autoimmune disease, joint swelling and tenderness and destruction of synovial joints leading to disability
thickened synovial tissue invades bone and acts like localized tumor & bone destruction
spreads to surrounding ligaments, tendons
IgM IgG antibodies , T & B cells
82
synovial membrane
A layer of connective tissue that lines the cavities of joints, tendon sheaths, and bursae
Inflamed in RA
83
*clinical manifestations rheumatoid arthritis
insidious usually, 15% acute
general systemic of inflammation: fever, fatigue, weakness, anorexia, weight loss, general aching/stiffness
joints painful, tender, stiff (pain d/t pressure from swelling in early stage)
later pain from from sclerosis of subchondral bone & new bone formation
stiffness d/t synovitis
warm joints, boggy synovial membrane
*skin over joint ruddy, cyanotic hue, thin and shiny
lost ROM/mobility
84
2 complications chronic RA from excessive inflammatory exudate in synovial cavity
1. cysts in articular cartilage or subchondral bone
2. rupture of cyst or synovial joint
85
rheumatoid nodules
30%
extra-articular manifestations
elbows & fingers usually
risk of invading skin, cardiac valves, pericardium, pleura, lung, spleen
86
Caplan syndrome
Can occur w/ RA
pulmonary nodules & pneumoconiosis (chronic inflam. lungs from inhalation of dust)
swelling (inflammation) and scarring of the lungs.
87
*Ankylosing Spondylitis
most common of group of inflammatory arthropathies known as spondyloarthropathies (SpAs)
chronic autoimmune inflammatory joint disease characterized by stiffening and fusion (ankylosis) of spine & sacroiliac joints
88
Difference between RA and AS
1. RA inflammation is synovial membrane so synovial joints
2. AS excessive bone formation occurs and the inflammation is at enthesis (where ligaments, tendons, joint insert into bone) and end results sacroiliac & vertebral column fuse at joint
89
Who does AS occur in
MEN > women
Later adolescence, peaks 20 y/o
secondary affects older groups & associated w/ inflammatory diseases
associated with HLA
90
*s/s AS
bamboo spine (square appearing vertebral body)
low back pain & stiffness (esp. early AM)
insidious pain then persistent
**worse after rest, alleviated by activity
loss of ROM in AM d/t inflammation and muscle spasm
kyphosis
costovertebral= pain worse inspiration
sitting on hard seat unbearable
limp
elevated ESR, CRP
IgA kidney disease
91
*fibromyalgia
chronic musculoskeletal syndrome characterized by diffuse joint and muscle pain, fatigue, and increased sensitivity to touch called tender points
92
s/s fibromyalgia (FM)
*diffuse chronic pain (starts in one location like neck/shoulders, then more generalized)
fatigue (esp. arising from sleep & midafternoon)
HA
irritable bowel
sensitivity to cold
non-restorative sleep
anxiety & depression
widespread tenderness in all body regions, increased sensitivity to numerous stimuli: heat, cold, electrical, light, sound
93
Who does FM affect
women
30-50 y/o
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*epicondyle
bony prominence at end of bone where tendons or ligaments attach
95
epicondylopathy
when force causes microtears in tissue; a painful irritation of tendon insertions of the forearm muscles.
repetitive load-bearing activities or acute injuries involving flexion, extension, pronation, supination of elbow and forearm
- lateral (tennis elbow)= overstretching ECRB tendon & forearm muscles
- medial (golfer's elbow)= forearm muscles responsible for forearm flexion and pronation
96
why are really old and really young at risk for fx
97
nonunion
failure of bone ends to grow together
