Conditions Of The Musculoskeletal System (Week 1) Flashcards Preview

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Flashcards in Conditions Of The Musculoskeletal System (Week 1) Deck (121)
1

What is the primary cause of fatal and non-fatal injuries in older adults?

Falls

2

Biomechanics

Study of structure and function of biological systems
Ex: able to ID a person from across the room by their movement and stance.

3

What is a negative result of a fall?

Fear

4

Etiology of fractures related to pathology (4)

1. Tumors
2. Osteoporosis
3. Osteopenia
4. Osteoarthritis

5

Etiology of fractures related to trauma (3)

1. High energy trauma- MVA
2. Prolonged stress/overuse
3. Direct blow - knee hits dashboard in MVA

6

Etiology of Orthopedic conditions (3)

1. Trauma
2. Pre-existing musculoskeletal limitations
3. Genetics

7

Common bones that fracture
(9)

1. Radius.
2. Ulna
3. Carpal bones.
4. Clavicle
5. Spine. 8. Femur
6. Pelvis. 9. Tibia/Fibula
7. Hip

8

Common radial fx

Colles fx - out reached arm to break fall

Proximal or mid-shaft

9

Common spinal fx

Compression fx - common in osteoporotic population

10

Common cause of pelvis fx

MVA

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Common hip fx

Femoral neck
Trochanteric

12

Common femural fx

Mid-shaft
Distal

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Common Tibial and fibular fx

Tibial plateau
Mid-shaft
Distal = ankle fx

14

Risk Factors for Fx (2)

Low bone mineral density
Hx of Fx

15

Signs of Fx (5)

1. Swelling
2. Bruising
3. Deformity
4. Tenderness with palpation
5. Loss of function

16

Signs of loss of function with a fx (2)

inability to bear weight
inability to move joint

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Symptoms of a Fx (3)

1. Severe pain
2. Stiffness
3. Numbness/Tingling

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Risk factors of a fx (2)

1. Low bone mineral density
2. Hx of Fx

19

Two reasons why Hx of Fx is a risk factor (2)

1. Fear of falling increases risk of falling
2. Pathological Fx due to osteoporosis

20

Progression of Fx (3)

1. Inflammatory
2. Repair
3. Remodeling

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What happens during the inflammatory response of a Fx?

Blood moves into the space around the fracture creating a hematoma. The hematoma transforms into a clot.

22

Risk Factors of falls (6)

1. decreased strength
2. decreased balance
3. comorbidities
4. medications
5. Footwear
6. Chronic pain

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What are the two phases of the repair process? (2)

1. Fibrocartilaginous "soft" callus phase
2. Bony "hard" callous phase

24

What happens during the fibrocartilaginous callus phase? (2)

1. Osteoblasts initiate formation of the bone.
2. Cell density increases

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What happens during the bony "hard" callus phase?

Fibrocartilaginous callus converts woven bone which increases in rigidity and thickness until bony union

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What happens during the remodeling phase of a Fx? (2)

1. Woven bone convert to lamellar bone.
2. Fracture callus reduces along lines of stress.

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Medical intervention & management of a Fx (2)

1. Fx reduction
2. Immobilization

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Approx. time of immobilization of Fx

~6 weeks

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What can immobilization cause? (6)

1. Stiffness
2. Decreased ROM
3. Capsular contracture
4. Muscle contracture
5. Muscle atrophy
6. Decreased strength of Connective tissue

30

What are the effects of muscle atrophy? (3)

1. Decreased force generation
2. 20% loss of strength in only 2 weeks
3. Alternated neuromuscular recruitment /coordination

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What is the ligament /tendon failure point?

The normal stretch of a tendon to snap is lower; increases possibility of snapping.

32

Prognosis of a Fx (2)

1. Post-traumatic arthritis
2. Women with wrist fx - 50% more likely to have clinically significant functional decline than those without

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Three types of Fx reduction(3)

1. Closed reduction
2. Open reduction internal fixation
3. External fixation

34

Medical intervention and managment of an Open Reduction Internal Fixation - ORIF (4)

1. Surgical repair
2. Rods, screws, pins, plates
3. Casting/immobilization
4. WB modifications

35

Presentation of ORIF post surgery (4)

1. Pain
2. Edema
3. Limited ROM
4. Strength limits - local, proximal, distal

36

Indications of external fixation (3)

1. Open fracture
2. Closed severe Fx causing soft tissue damage or mutilple fractures
3. Limb alignment

37

Complex regional pain syndrome (CRPS)

Chronic disease characterized by severe pain, swelling and skin changes following trauma . Pain is disproportionate to injury.
Usually seen in clients with immobilization and Fx

38

CRPS I

Formerly reflex sympathetic dystrophy
The absence of nerve injury

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CRPS II

Formerly 'causalgia', nerve injury present

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Etiology of CRPS

Unknown
Malfunction of the CNS and the PNS

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Risk factors of CRPS (4)

1. Fx
2. Immobilization
3. Female gender
4. Concurrent motor nerve injury (type II)

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Sign of CRPS Impact on sensory related function

Temperature changes -cold, clammy, sweaty skin

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Signs of CRPS Impact on movement related function(4)

1. Edema
2. Decreased joint ROM
3. Muscle spasm/weakness/tremor
4. Alt. movement patterns (dystonia)

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Signs of CRPS Impact on skin related functions (2)

1. Color - white, red , blue
2. Texture - shiny, thin

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Symptoms that Impact sensory function in CRPS (3)

1. May have chronic pain
2. Constant Burning/throbbing
3. Hypersensitivity - touch, cold

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Symptoms that Impact movement related function in CRPS (2)

1. Joint stiffness
2. Difficulty moving extremities

47

Symptoms that Impact the mental function in CRPS (3)

1. Depression
2. Anxiety
3. PTSD

48

How do you treat the mental function in CRPS ? (2)

1. Medication
2. Desensitization with WB exercises

49

Prognosis of CRPS (2)

Children/ teens good recovery
Some- severe pain and disability

50

Osteoporosis

Pathological condition causes decrease in bone density. Leads to pathological fractures occurring during ADLs or trauma. Considered a serious health problem.

51

Most common fx caused by osteoporosis (4)

Vertebrae
Wrist
Pelvis
Hip

52

Etiology of osteoporosis (4)

Estrogen deficiency
Hormone imbalance
Diet
Sedentary lifestyle

53

Risk factors of osteoporosis (5)

1. Female gender
2. Caucasian or Asian descent
3. Increased age increased risk
4. Family hx
5. Ectomorphic body type

54

Ectomorophic body type

Long, thin, tall; lack of muscle or fat tissue.

55

Signs of Osteoporosis (4)

1. Silent - undetected until Fx occurs
2. Stooped posture
3. Loss of Ht.
4. Fx occurs easily

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Symptom of Osteoporosis

Many people have no symptoms until they have a fx.
Experience pain, back pain

57

Prevention of Osteoporosis

Early bone density screening

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Osteopenia

Reversible weakening of bone; bone density dwindles but not dangerously

59

Etiology of Osteopenia

Similar to Osteoporosis - Estrogen deficiency; hormone imbalance; diet; sedentary life style

60

Medical intervention and management of Osteopenia (3)

1. diet
2. supplements
3. local WB exercises

61

Osteoarthritis (OA)

Degenerative condition - cartilage degradation leading to bone-on-bone contact; viscous cycle of:
Degradation - Pain - Inactivity - Degradation - Pain - Inactivity....

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Etiology of OA - Primary (1) and Secondary (3)

Primary - Idiopathic
Secondary -
Post - Trauma (falling on joint increases trauma instantly
Post - Surgery
Mal-alignment

63

Risk factors of OA (2)

1. Abnormal carilage
2. Abnormal stress on cartilage

64

What causes abnormal cartilage in OA? (3)

1. increased age
2. genetics
3. diseases (RA, gout)

65

What causes abnormal stress on cartilage in OA (4)

1. obesity
2. biomechanics
3. trauma to the joint
4. occupational (Repetitive stress)

66

Signs of OA that impact Movement Related Function(5)

1. Decreased ROM
2. Decreased Strength
3. Edema
4. Crepitus
5. Functional limitations located at the site

67

Symptom of OA that impact the sensory related functions

Pain that worsens with activity, is worse in the AM when waking, and in severe cases causes night pain

68

Symptoms of OA that impact the movement related functions (2)

1. Stiffness - AM
2. Painful joint ROM

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Symptoms of OA that impact mental functions(2)

1. Social and psychological effects of limited mobility
2. Depression/Anxiety

70

OA impact on the hand (2)

1. Grip/Pinch
2. Nodules

71

Heberden's Nodes

hard or bony swellings that can develop in the distal interphalangeal joints (DIP) (the joints closest to the end of the fingers and toes).

72

Bouchard's Nodules

Bony bumps on the middle joint of the finger, proximal interphalangeal joints (PIP)

73

OA impact on the shoulder (2)

1. crepitus
2. pain with sleep, reaching overhead or behind the back

74

OA impact on the hip(2)

1. pain in groin, thigh, buttock or referred to knee (common)
2. pain with walking, squatting, stairs, bending

75

OA impact on knee (2)

1. Crepitus, locking
2. pain with walking, stairs, squatting

76

OA impact on the ankle

Pain while WB

77

Rheumatoid Arthritis

autoimmune disorder that attacks the synovium, forms a layer of pannus which leads to bone errosion, and cartilage/ligament degredation causing pain, swelling, inflammation and joint deformation. Bilateral presentation, flares, and remission

78

Risk factors of RA (4)

1. Female (2-3x higher than male)
2. Age
3. Genetics
4. Smoking

79

Signs of RA(7)

1. Flare and remission
2. Pain and tenderness (sensory)
3. Joints swollen and warm (movement)
4. Rheumatoid nodules (movement)
5. Fever/Fatigue/weight loss (movement)
6. Joint deformity (movement)
7. Painful ROM (movement)

80

Symptoms of RA (3)

1. Morning Stiffness lasts several hours (movement)
2. Affected joints

81

Which joints are affected by RA? (9)

1. PIP
2. MCP
3. MTP
4. wrists
5. knees
6. hips
7. ankles
8. shoulders
9. elbows

82

Swan neck deformity - RA

PIP extension and DIP flexion

83

Boutonniere deformity - RA

PIP flexion and DIP extension

84

Ulnar drift - RA

hand deformity in which the swelling of the MCP joints (the big knuckles at the base of the fingers) causes the fingers to become displaced, tending towards the little finger.

85

Medical Intervention and Management of OA and RA

Joint arthroplasty

86

Joint arthroplasty

surgical procuedure to resurface the bones using a prosthetic joint. Cemented or uncemented is used in THA or TKA and pegs/screws are used in a TSA

87

Posterolateral THA precautions(3)

No hip flexion 90*
No hip adduction
No hip internal rotation (IR)

88

Anterolateral THA precautions (3)

No hip extension beyond neutral
no hip external rotation (ER)
Don't lay prone

89

Medical intervention and management of THA (4)

1. Pain(sensory)
2. Strength limitations (muscle fn)
3. Limited ROM (movement related)
4. Limited function - bed mobility, ambulation, functional tasks and THP for sitting/driving/reaching/squatting

90

TKA impact on body functions and structures (7)

1. pain!! (sensory)
2. swelling/inflammation (movement)
3. Limited ROM flexion/extension (movement)
4. Strength limitation (muscle function)
5. bed mobility /transfer (function)
6. Ambulation/elevation (function)
7. squat, driving (function)

91

Precautions for TSA (3)

1. Sling
2. Avoid AROM first 4 weeks,
3. No lifting >1lb. for 6 weeks

92

TSA impact on body functions and structures (9)

1. Pain (sensory)
2. Limited ROM (movement)
3. Strength limitations of the shoulder and scapula (muscle function)
4. Overhead reach (movement)
5. Sleeping (movement)
6. Driving (movement)
7. Lifting/carrying (movement)
8. Pushing/pulling (movement)
9. Dressing (movement)

93

Reverse TSA Impact on body functions and structures(2)

1. Loss of ROM
2. Pain -free

94

Etiology of Tendinopathy

Result of overuse

95

tendinitis

inflammation of the tendon

96

tendinosis

degradation of tendon's collagen due to chronic overuse when tendon wasn't given time to heal

97

Signs of tendinopathy (3)

1. Warmth
2. redness
3. edema
*all at the tendon

98

Symptoms of Tendinopathy(2)

1. pain with palpation, muscle contraction, stretch of muscle
2. stiffness after prolonged sitting/sleeping

99

Symptoms of Tendinopathy(2)

1. pain with palpation, muscle contraction, stretch of muscle
2. stiffness after prolonged sitting/sleeping

100

Lateral epicondylagia aka Tennis Elbow (effects? causes?)

Effects the ECRB (extensor carpi radialis brevis)
causes pain with grip and forearm activity.

101

Medial epicondylalgia aka Golfer's elbow (effects? causes?)

Effects the Flexor and pronator tendons (FCR and PT)
Causes pain with squeezing, lifting, shaking hands,turning doorknobs.

102

RTC tear

most often supraspinatus; full or partial

103

RTC tear signs and symptoms(3)

pain raising and lowering arm
weakness
night pain

104

Which tendon ruptures need immediate surgical intervention (3)

1. Achilles tendon
2. Patellar tendon
3. Triceps tendon

105

popeye deformity

long head biceps rupture

106

ligamentous injuries and instabilities(3)

1. ACL tear (ACL-R - Ant. cruciate ligament replace. )
2. Ankle instability (ATFL - Ant. talofibular ligament)
3. Glenohumeral dislocation/subluxation (partial disloc.)
*most common in athletes

107

Signs of ligament injury(3)

audible pop followed by sudden pain and swelling
joint instability
immediate functional impairment
LE difficulty walking/running
UE difficulty lifting carrying throwing etc

108

Etiology of Ligamentous injury/instability(2)

1. trauma
2. non-contact caused by rolling ankle or directional change during movement (sports)

109

Symptoms of ligament injury (3)

pain(sensory)
joint instability (movement)
fear of re-injury (mental)

110

post-operative presentation of a ligamentous injury or instability (5)

1. immobilized to protect graft and repair
2. pain swelling and inflammation
3. Restricted ROM
4. Strength limitation
5. Restricted WB

111

orthopedics

injury and disease to bone, joints, and related structures - muscles, tendons, and ligaments

112

heterotopic ossification (HO)

abnormal bone formation in extraskeletal soft tissue

113

Etiology of HO

UNCLEAR
1.Whole body response to trauma - fibroblasts inappropriately start reforming bone
2. Excessive growth near joints - stiffness and loss of movement
3. Most common in ORIF (open reduction internal fixation)

114

ankylosing spondylitis

inflammatory disease that can cause some of the vertebrae in your spine to fuse together

115

Risk factors of HO (3)

traumatic injury - severe burn, spinal cord injuries, head injuries
bone forming diseases - ankylosing spondylitis
Revisions increase the risk

116

Signs and symptoms of HO

Asymptomatic - diagnosed on film
Usually 1-4 months post injury

117

Compound Fx

open fracture - at risk for infection

118

Comminuted Fx

bone breaks into many fragments

119

displaced Fx

breaks into two or more parts so that the two ends do not align up straight

120

Greenstick Fx

occurs in children with soft growing bones. One side of the bone breaks and the other side bends

121

Transverse Fx

breaks on a right ankle to the longitudinal axis of the bone