Disorders of Musculoskeletal Flashcards
(70 cards)
1
Q
What is a conusion? (aka. bruise)
A
- Result of direct trauma
- Skin remains intact
- Blood vessel/cell damage
- Edema, inflammation and ecchymotic (black, blue, yellow)
2
Q
What is a hematoma?
A
- Localized emorrhage
- Blood acumulation pressures nerves, causing pain that increases with movement
3
Q
What is the difference between tendons and ligaments?
A
Tendon = muscle to bone Ligament = bone to bone
4
Q
What is a strain?
A
- Involves partial tearing of muscle/tendon, often during muscle contraction
- Common in back, cervical spine, elbow and shoulder; or hips and hamstrings from sports
- Risk increases with age
5
Q
What is a sprain?
A
- Tearing or rupture of supporting ligament or capsule surrounding joint, d/t abnormal/excess joint movement
- Not visible on x-ray unless bone fragment exists
6
Q
What are the manifestations of a sprain?
A
- Pain
- Rapid swelling limits movement
- Discoloration
- Last longer than strain
7
Q
How do we treat strains or sprains?
A
- Rest
- Ice
- Compression (reduce swelling, provides support)
- Elevate (immobilization)
8
Q
Describe the healing of strains and sprains:
A
- Able to heal to original tensile srength
- Capillaries bring oxygen/nutrients
- Fibroblasts produce collagen
- Collagen bundles strengthen over time
9
Q
What are the complications of healing in strains and sprains?
A
- Contractions can pull healing apart and result in lengthened position upon final healing
- Adhesions
10
Q
What is a dislocation? What is a subluxation?
A
- Abnormal displacement of articulating surfaces of joint, common in shoulder and acromioclavicular joint
- Subluxation is a partial dislocation of joint, some surface contact
11
Q
What are the causes of dislocations?
A
- Congential (hip or knee)
- Traumatic (athletics, falls)
- Pathologic (complication of infection, RA, neuromuscular disease, etc.)
12
Q
How do we diagnose a dislocation?
A
History, assessment, x-rays
13
Q
What are the manifestations of a dislocation?
A
- Pain
- Deformity
- Limited movement
14
Q
How do we treat dislocations?
A
- Spontaneous
- Manipulation
- Surgical repair
- Immobilization
- Physiotherapy
15
Q
What is a Rotator Cuff Injury?
A
- Function of cuff is to stabilize the humoral head against the glenoid
- Shoulder joints are inherently unstable (due to flexibility)
- Injuries occur due to direct blow or stretch; excessive use/repetition; altered blood supply to tendons; and age-related degeneration
16
Q
How do we diagnose a shoulder/rotator cuff injury?
A
- Assessment of active/passive ROM
- History of injury
- MRI
- Arthrroscopic examination
17
Q
How do we treat a shoulder/rotator cuff injury?
A
- Anti-inflammatories
- Corticosteroid (oral, injection)
- Physiotherapy
- Surgical repair
18
Q
What is the most serious of knee injuries?
A
ACL rupture/tear is most common and can have long-lasting effects (ex. Teresa)
19
Q
What are the manifestations of an ACL rupture/tear?
A
- “pop” or tearing sensation
- Sudden pain
- Loss of weight-bearing
- Hemorrhage causes swelling
20
Q
What are the manifestation of a meniscus tear?
A
- Pain, especially on hyperflexion and hyperextension
- Edema
- Instability
- Locking d/t loose fragment
21
Q
What are complications of a meniscus tear?
A
Osteoarthritic changes limiting movement
22
Q
What is a Patellar Subluxation and Dislocation?
A
- Usually sports related, where patella is dislocated
- Manifestated by pain and swelling
23
Q
What is a Chondromalacia Patellae?
A
- Inflammation of the underside of the patella
- Due to sports or knee overuse in older adults
24
Q
What is Patellofemoral Pain Syndrome
A
- The most common cause of anterior knee pain
- Caused by imbalance of forces controlling patella movement; contact of posterior surface of patella with femur; or running, jumping or sitting
25
What are the manifestationf of Patellofemoral Pain Syndrome?
- Pain
- Weakness
- Abscence of edema
- Can develop into arthritis
26
What are hip dislocations often due to?
- Trauma (MVA, fall)
- Emergency
- Disrupton of blood and nerve supply (avascular necrosis resulting in necrosis of bone tissue)
27
What are the risk factors for hip fractures?
- Age
- Women
- Physical inactivity
- Alcohol excess
- Psychotropic medications
- Institutionalization
- Visual impairments
- Polypharmacy
- Osteoporosis
28
What are the surgical options for a hip fracture?
- Total hip replacement (THA)
- Hemi-arthroplasy
- Open Reduction, Internal Fixation (OPIF)
- Revision
29
What is the difference between a sudden and stress fracture?
- A sudden fracture occurs suddenly, often with acute injury
| - Stress fractures can occur over time due to stress on bones that cause incomplete fractures (ex. fatigue fractures)
30
What is a Pathological fracture?
A fracture of the bone that occurs in response to events that typically would not cause a fracture; often underlying pathological condition weakening bone and predisposing to injury
31
How do we classify fractures?
- Positon on bone (ex. head/neck, proximal/distal)
- Degree of communication with outside environment (ex. open/compound, closed)
- Degree of break (ex. greenstick)
- Character of fracture pieces
- Direction of break (ex. transverse, oblique, sprial, twist)
32
What are the five different characters of fracture pieces?
1) Comminuted (multiple pices)
2) Compression (crushing of 2 bones)
3) Impacted (fragments wedged together, telescoping)
4) Butterfly (triangular bone piece fracture)
5) Avulsion (when the tendon or ligament tears off of a piece of bone)
33
What are the manifestations of fractures?
- Pain/tenderness
- Swelling
- Loss of function/mobility
- Deformity (ex. shortening of extremity, fragments damaging tissue)
- Blood loss
- Crepitus
- Nerve function impairment
34
How do we treat fractures?
- Reduction of fracture (closed or open)
- Immobilization: splint, case, extrenal fixation device, traction)
- Preservation and restoration of function
- PT
35
What is the process of bone healing?
1) Hematoma formation
2) Fibrocartilaginous callus formation
3) Bony callus formation (ossification)
4) Remodeling
36
Describe Hematoma formation in bone healing:
- First 1-2 days when bone/tissue blood vessels rupture
| - Fibrin clot forms, providing foundation for inflammatory cells
37
Describe the Fibrocartilaginous callus formation in bone healing:
- Fibroblasts begin repair
| - Takes 2-3 weeks, but still weak
38
Describe the bony callus formation in bone healing:
- Osteoblasts form and calcium salts deposit
- Cartilage converts to bony callus
- Begins 3-4 weeks after injury, takes months
39
Describe remodeling in bone healing:
- Dead cells removed
- Compact bone replaces spongy bone
- Possible "scar"
40
What are the complications of bone healing?
1) Delayed union (failure to heal in usual time)
2) Malunion (deformity)
3) Nonunion (failure to heal)
41
What is a fracture blister?
- Complication of fracture
- Epidermal necrosis d/t fluid separating it from dermis
- Often where minimal s/c tissue between epidermis and bone
- Chance of infection of broken
42
What is compartment syndrome?
Increased intraosseus pressure within a limited space due to decreased size, increased volume of contents or both
43
What can cause decreased size or increased volume of contents in compartment syndrome?
DECREASED SIZE: constrictive dressings, casts and burns
INCREASED VOLUME: trauma, fluid/edema, vascular injury/bleeding, venous obstruction
44
In compartment syndrome, the amount of pressure is dependent on what?
- Duration
- Metabolic rate
- Vascular tone
- Local blood pressure
45
What are the manifestations of compartment syndrome?
- Severe pain
- Sensation change (burning, tingling, loss)
- Diminished reflexes, motor function loss (compression of nerves)
- Decreases/loss peripheral pulses
46
How do we assess compartment syndrome?
Pain, sensory and motor function
47
What are the six P's of neurovascular assessment?
- Pain
- Pulselessness
- Paralysis
- Paresthesia
- Polar
- Palor
48
What is Fat Embolism Syndrome? (FES)
- A complication of fractures that is different from fat emboli
- Common but fewer people have symptoms or complications
- Fat droplets from bone and adipose tissue circulate through venous system to body
49
What are the manifestations of FES?
- Respiratory failure (dyspnea, cyanosis, tachycardia, angina)
- Cerebral dysfunction (mentation/behaviour changes, seizures, encephalopathy)
- Skin/mucosa petechiae (rash 2-3 days later)
50
What are the general complications of soft-tissue injury?
Skin, muscle, nerve and adipose/bone
51
What is Osteomyelitis?
- Infection of the bone, often through direct contamination, skin lesions or through the blood (hematogenous)
- Staphlyococcus aureus most common; adheres to bone, attacks cells, evades host defenses, and colonizes
52
What is the affect of Hematogenous Osteomyelitis in children?
- Affects long bones
- Purulent exudate inside bone
- Damages arteries supplying bone
- May penetrate skin or involve joints
53
What is the affect of Hematogenous Osteomyelitis in adults?
- In vertebrae, sternoclavicular and sacroiliac joints, or pubic symphysis
- Tends to affect joint space
54
What are the manifestations of hematogenous osteomyelitis?
- Signs of bacteremia
- Fever/chills
- Pain on movement of area
- Tenderness
- Erythema
- Edema
- Malaise
55
What is chronic osteomyelitis?
- Usually occurs in adults
- Usually secondary to open wound
- Sequestrum (infected dead bone in center of bone, separated by "sheath" preventing breakdown)
- Difficult to detect when near a joint prosthesis
56
What is Osteonecrosis? What are the causes?
- Bone destruction d/t interruption in blood flow
- Idiopathic
- Bone injury
- Thrombosis/embolism
- Vessel injury
- Increased intraosseous pressure
- Corticosteriod associated (unclear) (risk of osteoporosis?)
57
What are the manifestations of osteonecrosis?
Chronic pain, unrelated to movement
58
What is the treatment for osteonecrosis?
- Dependent on cause
- Immobilization
- Anti-inflammatories
- Exercise
- Surgery often needed for hip involvement
59
What are benign bone tumors?
- Confined to bone
- Well-defined borders
- Seldom cause fractures
- Seldom require treatment or surgery
60
What is a Osteoma?
Small bony tumor on bone surface (benign)
61
What are fibrous tumors?
- Benign
- Common in growing bones
- Usually asymptomatic
- Resolve in 2-3 years
62
What is a Chondroma?
- Benign
- Tumor made of cartilage
- Short bones; solitary lesion
- Onset @ 20-40 years of age
- Asymptomatic or painful
63
What is a Osteochondroma?
- Benign
- Cartilage-capped tumor, most common (especially in knees)
- Bony stalk attaches it to bone
- Slow-growing, solitary mass
64
What is a Osteoclastoma?
- Giant cell tumor that behaves like a malignant tumor (metastasizes via bloodstream, recurs after removal) (benign)
- May invade bone and cause bone destruction
- Pathological fractures common
65
What is an Osteosarcoma?
- A malignant bone tumor that is most common, metasizes early often to lung
- Tends to be in areas wit fastest bone growth
- UKE, but genetic condition
- Peak ages: women
66
What is a Chondrosarcoma?
- Can arise from pre-existing benign cartilaginous tumor
- Mid to late adulthood
- Slow-growing
- Responds to early excision
67
What is an Ewing Sarcoma?
- Densley packed small cells, malignant
- Children and young adults
- Men > women
68
What is Metastastic Bone Disease?
- Skeletal metastasis is the most common bone cancer
| - 50% of all cancers metastasize to the bone (most often in trunk bones)
69
What are the manifesations of metastatic bone disease?
- Pain **
- Pathological fracture
- Hypercalcemia d/t bone destruction
70
What are the general manifestations of bone cancer?
- Changes in organ function (organ damage, inflammation, failure)
- Local effects of tumors (compression, stretching)
- Nonspecific signs of tissue breakdown (protein wasting, bone breakdown)
