Exam 2 Musculoskeletal Flashcards
Wolff’s law
healthy person or animal bone will adapt to the loads placed on it.
How does Wolff’s law relate to musculoskeletal injuries?
If you don’t bear weight on it, the bone will adapt to the lighter load. Therefore, weight bearing as tolerated in many injuries.
Hueter-Volkmann principle
Compression forces inhibit bone growth while tensile forces stimulate it
compartment syndrome
increased pressure within a closed fascial space, causing decreased flow through capillary bed. Ischemia > anaerobic metabolism > lactic acid > immune response > muscle damage & necrosis
Early signs of compartment syndrome
#Pain disproportionate to injury #Refusal to move the area #Pain with passive stretch #Maybe skin swelling & tautness
Late signs of compartment syndrome, or the 5 P’s
1) Paralysis
2) Pallor
3) Parasthesia
4) Pain
5) Pulselessness
The 3 A’s of compartment syndrome, and why they’re important
1) Anxiety (increasing)
2) Agitation
3) Analgesic requirement (increasing)
They precede the 5 P’s by several hours, giving us time to get ahead of compartment syndrome
If compartment syndrome suspected, how does treatment progress?
#Immediate management: removing binding such as casts & underlying padding, keep extremity at heart level, give oxygen & analgesia #Consult specialist
What’s the definitive treatment for compartment syndrome?
Incisional fasciotomy
Hip dysplasia
DDH: developmental dysplasia of the hip. Subluxation or dislocation of the femoral head within the hip joint
Presentation of hip dysplasia
#Dislocatable/dislocated hip during newborn exam #Clunk on Barlow & Ortoloni maneuvers up to 12 weeks of age
Barlow maneuver
Supine with hip flexed 90 degrees, neutral rotation. Adduct hip while applying posterior force on knee to cause head of femur to dislocate posteriorly from the acetabulum, causing a palpable clunk
Ortolani maneuver
To ID a dislocated hip which can be reduced, infant remains supine with hip flexed to 90 degrees. From adducted position, hip is gently abducted while lifting or pushing femoral trochanter anteriorly. Palpable clunk as the hip reduces.
Asymmetric skin folds?
Sometimes but not always present with hip dysplasia
What’s diskitis?
Inflammation, often infectious, of the intervertebral space
What’s most common etiology of diskitis?
Seeding from a systemic infection localizing in lumbar spine. Most common organism is s. aureus
Diskitis presentation
#Back pain, fever, fatigue #Limp #Refusal to walk or sit #Holds self in rigid, straight position #Pain with spine flexion
Diagnostics for diskitis
#CBC with diff #CRP, ESR #Blood cultures
Treatment for diskitis
#Activity restriction #Pain control #Spine immobilization #IV ANTIBIOTICS
Legg-Calvé-Perthes Disease
Disorder resulting from temporary loss of blood flow to proximal femoral epiphysis
Stages of LCP disease
1) Initial: ischemic event, ossification stops & bone becomes sclerotic
2) Fragmentation: bone becomes deformed or fractured
3) Healing/reossification: Old bone reabsorbed & new bone formed
4) Remodeling: residual deformity may be observed
LCPD presentation
#Persistent pain on affected side #May start in the hip & radiate to the thigh or knee, not usually severe #Antalgic gait
LCPD plan of care
#Imaging tracking progression #Keep the femoral head in the acetabulum #Promote good ROM #Mild cases get normal activity with observation #Severe ones get activity restriction, physical therapy, bracing
What is slipped capital femoral epiphysis?
SCFE involves separation of growth plate in proximal femoral head. Epiphysis slips posteriorly & can progress to complete dissociation, avascular necrosis
Typical child with SCFE
#AA or Hispanic, male, between 12-15, obese #Possibly r/t rapid growth