Explain a contusion/bruise
Results from direct trauma, skin is intact, blood/cell damage
What is a hematoma?
Blood accumulation, localized
What is a strain?
Partial tear of the muscle/tendon
Risk of strain?
Increased age (fibres less elastic)
Manifestation of strains?
Pain, stiffness, swelling, tenderness (usually no sign unless inflammation)
What is a sprain?
Tearing/ rupture of supporting ligament (bone-bone) due to abnormal/excess joint movement
Can you detect sprains on x-ray?
No- unless bone fragments
Manifestation of sprains?
Pain, swelling (limits movement), discoloration
Treatment of strains/ sprains
C- give support, reduces swelling
In sprain healing, what do capillaries do? fibroblasts?
Capillaries bring oxygen/ nutrients
Fibroblast produce collagen (collagen bundles strengthen over time)
What are complications in sprain healing?
contraction can pull healing apart and result in lengthened position, adhesions
What are dislocations? What is a subtype of a dislocation?
Abnormal displacement of two joining (articulating) surfaces
Subluxation (partial dislocation)
What are common joints for dislocations?
Shoulder, Acromioclaviular, glenohumeral
What are the 3 types of dislocations?
- Congenital (hip or knee)
- Traumatic (MVA, hip, shoulder, knee, wrist, ankle)
- Pathologic (complication of infection, rheumatoid arthritis, neuromuscular disease)
How can you diagnosis dislocations?
History, assessments, x-rays
Manifestations of dislocations?
Pain, deformity, limited movement
What is the treatment of dislocations?
Spontaneous, manipulation, surgery, physiotherapy
What three bones does the shoulder include?
Clavicle, humerus, scapula
What is the function of the rotator cuff?
Stabilizes the humeral head against the glenoid
T/F: Shoulder joints are stable?
What do rotator cuff injuries result from?
Direct blow or stretch, excessive use, increasing age
What are common conditions associated with rotator cuff injuries?
Tendinitis, Subacromial bursitis, partial/complete tears
Manifestations of rotator cuff injuries?
Pain, tenderness, difficulty moving arm, muscle atrophy, inflammation
How are shoulder/rotator cuff injuries diagnosed and treated?
Assessment of active/passive ROM, history is important, MRI, Arthroscopic exam
Anti-inflammatories, corticosteroids, physiotherapy, surgery
Knee Ligamentous injuries are the most serious. What is the cause of them? and what are the manifestations?
Forceful stress or pop
Swollen due to hemorrhage, pain, inability to weight bear
Knee meniscus injuries result from sudden rotation. What are the manifestations and complications?
Pain, edema, instability, locking d/t loose fragments
osteoarthritic changes limiting movement
Knee patellar subluxation & dislocation is partial dislocation of the knee cap usually sports related. What are some manifestations?
Weakness, swelling, crepitus (cracking, grating), stiffness, loss of ROM
Knee patellofemoral pain syndrome is the most common cause of anterior knee pain. What are the causes? and manifestation?
Imbalance of force controlling patellar, contact with femur, running, jumping, sitting
Pain, weakness, absence of edema
What is chondromalacia and its causes? *
Inflammation of the underside of the patella
Sports, knee overuse in older adults
Treatment is RICE, anti-inflammatories, physio
What is the cause of a hip injury dislocation? What is there a disruption in?
Blood and nerve supply- a complication of this is avascular necrosis***
What are risk factors for hip fractures?
Age, woman, inactivity, alcohol excess, pyychotropic medications, institutionalization, visual impairments, polypharmacy, osteoporosis
What are surgical options for hip fractures?
Total hip replacement, hemi-arthroplasty, ORIF (open reduction internal fixation), Revision
What are the 3 categories fractures can be divided into?
- Sudden injury
- Stress fractures
- Fatigue fracture (any weight bearing bone)
- Pathologic fracture
- Bone is weakened due to previous disease/tumor
- normal stress to bone
How are fractures classified?
A. Position on bone - proximal,midshaft, distal -head or neck B. Communication with outside environment - open/compound or closed C. Degree of break
What is greenstick in relation to fractures?
Young, soft, immature bone
Partial break in continuity
Can be complete or imcomplete
What are 4 characteristics of fracture pieces?
- Comminuted: multiple pieces of bone everywhere, can move into tissue
- Compression: crushing of 2 bones
- Impacted: fragments are wedged together
- Butterfly: triangular bone piece is broken off
What are 4 directions of breaks in fractures?
- Transverse: all the way through the bone
- Oblique: at an angle
- Spiral: going in a circular fashion
- Twist, torque: pressure with the torque (the bone will have cracks all along it)
Manifestations of fractures?
Pain, tenderness, swelling, loss of mobility, deformity (damage tissue, shortening of extremities, rotational issues, crepitus, blood loss if open)
What is local shock in fractures?
Numbness and flaccid muscles
How are fractures diagnosed?
Assessment (history, physical), X-ray
What is the treatment for fractures?
Reduction of fracture (moving pieces back together, can be closed or open), immobilization (splint, cast, external fixation), preservation and restoration, physio
What are the 4 stages of bone healing?
Hematoma-> callus -> ossification -> remodelling
Stage 1 of bone healing: hematoma formation
First 1-2 days, tone blood vessels, fibrin clot forms (clotting factors remain in injured area, new capillary beds, provided foundation for inflammatory cells)
Stage 2 of bone healing: fibrocartilaginous callus formation
Fibroblasts begin repair of the bone, takes 2-3 weeks, fibroblasts produce collagen that connect bones together
Stage 3 of bone healing: ossification
osteoblasts form; calcium salts deposit, mature bone replaces callus, fracture heals firm and this begins 3-4 weeks after injury
Stage 4 of bone healing: remodelling
dead cells are removed, compact bone replaces spongy bone, possible “scarring”, reabsorption of excess bony callus
In relation to bone healing, what is delayed union, malunion, nonunion?
- Delayed union: failure to heal in usual time, but will
- Malunion: heals but does not heal in the right way and results in deformity (does not mean physical)
- Nonunion: Failure to heal, but not able to heal (characterized by mobility of fracture site and pain on weight bearing)
A complication of bone healing is fracture blisters. What are these? and what can decrease your chance of getting blisters?
epidermal necrosis with separation of epidermis and dermis d/t fluid (do not want blisters to break because you can get infection of epidermis
clear blister- fluid
black blister- hemorrhagic
early surgical interventions
A complication of bone healing is compartment syndrome. What is this?
Increased intraosseus pressure within a limited space. (The increased pressure compromises the circulation and function of tissue)
What is compartment syndrome due to?
- constrictive dressing, casts, burns
Increased volume of contents
-trauma, fluid/edema, vascular injury/bleeding, venous obstruction
What is the amount of pressure in compartment syndrome dependent upon?
Duration, metabolic rate, vascular tone, B/P
Result of increase pressure in compartment syndrome are?
Compression of vessels=ischemia, necrosis
Compression of nerves= parenthesis, paralysis
Compartment syndrome manifestations?
Severe pain, burning, numbness, tingling, decreased reflexes and motor function, peripheral pulses are normal
What are the 6 P’s in a neurovascular Assessment
Pain, pulses, paralysis, parasthesia, polar, pallor,
What is Fat embolism syndrome (FES)?
Complication of fractures, fat droplet from bones and adipose tissue circulate though small veins
What are manifestations of fat embolism syndrome?
Respiratory failure (dyspnea, cyanosis, angina, tachycardia, diaphoresis) cerebral dysfunction (mentation/behavior change, focal deficit, seizures) skin/ mucosa petechiae (rash 2-3 days post event)
What is osteomyelitis? *
Infection of bone and marrow d/t direct contamination, through blood, or via. skin lesions
What is the most common type of infection is osteomyelitis?
staphylococcus aureus (it adheres to bone and attacks cells, evades host defences and colonizes)
Explain hematogenous osteomyelitis in children
Starts in the metaphyseal plate, affects long bones, purulent exudate inside bones, damages artery supply, may penetrate skin or joints (form a draining sinus)
Explain hematogenous osteomyelitis in adults
Affects joint space, causes destruction of endplate/ajoining disk/ contiguous vertebral body
Manifestations of hematogenous osteomyelitis
Signs of bacteria, fever, chills, malaise, pain on movement, tenderness, erythema, edema
Explain chronic osteomyelitis
Usually in adults, secondary to open wound, difficult to detect if near joint
infected dead bone separates from living-> a sheath of new bone forms around infected bone
What is osteonecrosis?
Bone destruction d/t interruption in blood flow (rather than infection)
What are osteonecrosis manifestations (depend on site and extent)
Chronic pain (not d/t movement), predisposes patient to severe secondary osteoarthritis
What is the treatment of osteonecrosis?
immobilization, anti-inflammatories, exercise, limitation in weight bearing, surgery is often needed for hip and knee involvement (total joint replacement)
What are benign bone tumors?
Confined to bone, well defined boarders, hardly cause fractures, hardly needs treatment
What is an osteoma?
Bony tumor on a bone surface
What are the 2 types of benign tumors?
Fibrous and cartilaginous
Explain fibrous tumors
Common in growing bones, usually no symptoms, resolve in 2-3 years
Explain the 2 types of cartilaginous tumors?
Chondroma- made of cartilage (short bones, single lesions, onset is 20-40 years, usually no symptoms or painful, and can cause fractures)
Osteochondroma- cartilage capped (common, low growing, single mass, knee is common, bony stalk attached it to bone, can be painful)
Another type of benign tumor is a osteroclastoma. Explain what this is.
Giant cell tumor (behaves like it is malignant. May invade bone/cause destruction, knee is common, can be removed if catched before it invades, 20s-40s
What are the 3 types of malignant tumors?
Osteosarcoma, chrondrosarcoma, Ewing sarcoma
Explain osteosarcoma tumors
In areas of fast bone growth, UKE but increased osteoblast activity, peaks before age 20, men > woman, metastasizes early (to lung), aggressive, grows in a ball like mass, deep/localized pain, swelling effects bone, skin may be stretched/shiny/warm, ROM may be restricted, treatment includes: surgery, amputation, chemo.
Usually central, can arise from previous benign cart. tumors, mid-late adulthood, slow growing, late metastasis, responds to early excision
Explain Ewing sarcoma
Densely packed cells, children and young adults, men>woman, harder to detect, white>black people, pain, decreased ROM, tenderness, fever, decreased weight, treatment: chemo, radiation, surgery
What is metastatic bone disease?
Skeletal metastasis is the most common bone cancer, most cancers metastasize to bone (in trunk bones like femur, ribs, sternum), spread to breast, prostate, lung, kidney
Manifestations of metastatic bone disease
Pain, pathological fracture, hypercalcemia d/t bone destruction
Manifestations of bone cancer
- Changes in organ function (organ damage, inflammation, failure)
- Local effects (compression of nerves, stretching of periosteum, pain and weakness)
- Nonspecific signs of tissue breakdown (protein wasting, bone breakdown, calcium release, hypercalcemia)