MSK eBook Flashcards
(37 cards)
Bones
Bones – Provide support for soft tissues, protect internal organs from injury, assist in movement, mineral homeostasis, blood cell production and triglyceride storage.
Muscles
Muscles – Skeletal muscles normally work in pairs (via contraction and relaxation) to move the bones of the skeleton.
Joints
Joints – Any join between two or more bones in the body – they are divided into three main types: fibrous, cartilaginous and synovial joints
Fibrous joints
Fibrous joints – These lack any form of synovial cavity, and are held together closely by dense connective tissue. Examples include joints between the bones of the skull and teeth being held in place in the jaw.
Cartilaginous joints
Cartilaginous joints – Again these joints lack a synovial cavity, however the bones are connected by a layer of cartilage allowing little or no movement. The intervertebral joints of the spine are an example of this type of joint.
Synovial joints
Synovial joints – These are distinguished by the synovial cavity between the articulating bones. This cavity is filled with synovial fluid and allows a joint to be freely movable. Knees, hips, elbows, the metacarpophalangeal (MCP) joints of the fingers are all examples of synovial joints.
Ligaments
Ligaments – Dense collagen fibres that attach to the periosteum of the articulating bones.
The ligament’s flexibility allows for movement, it’s inherent tensile strength holds the joint in place and prevents dislocation.
Tendons
Tendons – Attach muscle to bones allowing for movement of the skeleton.
Bursa (pl. Bursae)
Bursa (pl. Bursae) – A small fluid filled sac-like capsule consisting of connective tissue lined with a synovial membrane. They are strategically located to reduce friction at certain joints e.g. shoulder or knee. They can be located between skin and bone, tendons and bones, muscles and bones or ligaments and bone.
Joint Capsule
The sleeve-like area that encapsulates a synovial joint. It consists of two layers, an outer fibrous membrane that includes the ligaments and the inner synovial membrane.
Synovial Fluid
Secreted by the synovial membrane, a viscous clear or pale yellow liquid that contains various constituents including hyaluronic acid and interstitial fluid. It aids in
joint movement and cushioning.
However it is not uncommon to see a young patient in a
pharmacy with musculoskeletal problems. This is normally down to one of four main
causes:
1) Trauma
2) Overuse
3) Genetic Factors
4) Iatrogenic causes
Trauma
Trauma is probably the most common cause of soft tissue injury amongst young people.
This can range from car accidents, sporting injuries or simple sprains that occur in everyday life. The extent of injury is dependent on the force of impact, the direction of impact and the inherent strength of an individual’s musculoskeletal system.
Fractures occur when a bone is subjected to a force greater than its inherent strength.
Fractures of major bones will very rarely present in a community pharmacy, however it can be quite common to see fractures of the phalanges or metatarsals. Referral to an appropriate location should always be made when someone presents with this sort of injury.
Overuse
Overuse injuries are common in athletes who repeatedly use the same sets of muscles such
as long-distance runners and tennis players. However, manual workers can often also be subject to similar injuries. These tend to have an insidious onset and are generally termed as ‘chronic’. Treatment is similar to that used for acute injuries, and it also possible to have
an ‘acute on chronic’ problem. Common examples include tennis elbow, shin splints or stress fractures.
Genetic Factors
There are a number of conditions affecting young people that are inherited such as juvenile idiopathic arthritis and Perthe’s disease. Also certain musculoskeletal conditions affect one gender more than another, e.g. women are more prone to rupturing their anterior cruciate ligament because of the female hip alignment.
Iatrogenic causes
Both drugs and inappropriate medical intervention can lead to musculoskeletal problems.
Corticosteroids reduce bone mineral density and thus increase the risk of fracture. If a bandage, support or plaster is applied too tightly this may lead to symptoms and conditions such as numbness, paraesthesia, tissue strangulation or compartment syndrome.
Soft Tissue Injuries types
Strain
Sprain
Strain:
Where a muscle has been stretched beyond its elastic limit. This can be further divided into a genuine strain, a tear, or a complete rupture of the muscle.
Sprain:
Where a ligament or joint capsule is stretched beyond its elastic limit. This tends to cause joint instability or joint laxity. Again these can be sub-divided into three distinct grades.
Grade 1 – Minor tissue damage with no joint laxity
Grade 2 – Some joint laxity however the connective tissue is intact
Grade 3 – Rupture, surgical repair is case dependent
Contusion:
An injury to the muscle caused by a direct blow, which causes localised damage and bleeding.
Examples of referral criteria for a patient with a musculoskeletal injury
- When there is obvious deformity
- If a patient cannot bear any weight on the joint
- If the patient reports numbness or paraesthesia
- Where there is severe pain and disproportionate swelling
- If there is no improvement after a few days
- If there is any doubt about the severity of the injury
Compartment Syndrome
If a muscle injury is associated with damage to its blood supply or the soft tissue is severely damaged a condition known as compartment syndrome may occur. Some muscle groups (particularly in the calf) are contained within a rigid fascia, known as a compartment. If the muscle swells or blood leaks into this compartment the internal pressure may rise and cut off the blood supply to the muscle. Over a few hours the muscle may die and be replaced by fibrous tissue that contracts leaving a useless withered
clawed limb known as Volkmann’s ischaemic contracture.
Symptoms include extreme pain, paraesthesia and swelling in the affected muscle. Treatment involves RICE in mild cases caused by exercise. In more severe cases an operation known as a fasciotomy may have to be performed to save the limb. This involves splitting the fascia to allow the muscle room to expand; the wound is then sewn up over a period of a few days.
Myositis Ossificans
Following a direct blow to the periosteum and
muscle, bone plaques may be deposited in the
muscle. This may also occur as a result of joint replacement surgery. This is a very painful condition where the patient has a feel of density in the tissues alongside movement limitation.
Diagnosis may include x-ray, MRI scan or ultrasound.
Treatment involves absolute rest and pain relief until
the bone plaque stabilises; inflammation is minimised. Once the bone is stable or surgically removed, physiotherapy can commence to restore the full range of movement.
The main treatment principles of soft tissue injury include
PRICE = Protection, Rest, Ice, Compression, Elevation
RICE = Rest, Ice, Compression, Elevation
MICE= Movement, Ice, Compression, Elevation
POLICE = Protection, Optimum Loading, Ice, Compression, Elevation
Protection may be an assisted device e.g. crutches or a support or high lace top shoes.
