Orthopedic Conditions Flashcards
(88 cards)
0
Q
What is osteoporosis?
A
Decreased bone density. Porous bone.
1
Q
Metabolic Bone Diseases
A
- Osteoporosis
- Osteomalacia (Ricket’s)
- Osteomyelitis
- Paget’s Disease
2
Q
Risk factors for osteoporosis. Nonmodifiable.
A
- > 50 years
- Female
- Caucasian
- Menopause
- Familial history
- Northern European ancestry
- Long period of inactivity/immobilization
- Depression
3
Q
Risk factors for osteoporosis. Associated diseases and disorders. Endocrine disorders.
A
- Hyperthyroidism
- Hyperparathyroidism
- Diabetes mellitus. Type 2
- Cushing’s disease
- Male hypogonadism ( testosterone deficiency)
4
Q
Risk factors for osteoporosis. Associated diseases and disorders. Low body weight. Malabsorption disorders.
A
Low body weight: 1. Decrease BMI 2. Small, bony body frame. Malabsorption disorders: 1. Gastrointestinal disease 2. Gastric surgery. Hepatic disease.
5
Q
Risk factors for osteoporosis. Associated diseases and disorders. Medication.
A
Medication:
- Corticosteroids/steroids
- Immunosuppressants
- Heparin/ Coumadin
- Methotrexate
- Antacids containing aluminum
- Anticonvulsants
- Buffered aspirin
- Some antibiotics
- Some chemotherapy medications
- Laxatives
- Thyroid hormone
- Depro-provera ( contraceptive)
6
Q
Risk factors for osteoporosis. Associated diseases and disorders.
A
Associated diseases and disorders:
- Chronic renal failure
- Osteogenesis Imperfecta
- Cancer/ cancer treatment/ skeletal metastases
- Eating disorders
- Spinal cord injury
- Cerebrovascular accident
- Acid-balance disorder (metabolic acidosis)
- Depression
7
Q
Risk factors foe osteoporosis. Associated diseases and disorders. Diet and Nutrition.
A
Diet and nutrition:
- Calcium and magnesium deficiency
- Vitamin D deficiency
- Vitamin C deficiency (assists with calcium absorption)
- High ratio of animal to vegetable protein intake
- High fat diet ( reduced Ca++ absorption in the gut)
- Excess sugar ( depletes phosphorus)
- High intake of low Ca++ beverages
- Eating disorders
- Repeated crash dieting or yo-yo dieting
8
Q
Signs and Symptoms of Osteoporosis
A
Loss of Height
Postural changes
Back pain
Fracture
9
Q
Fractures sites that related to osteoporosis
A
- Distal radius
- Proximal femur
- Spine (Loss of height: kyphosis)
10
Q
Diagnosis of Osteoporosis
A
- Blood tests
- X-rays
- Bone density tests ( DEXA)
- Bone biopsy
- CT scan
11
Q
Treatment of Osteoporosis
A
- Depends on cause
- Diet: Increase dietary calcium
- Supplements:
Calcium
Vitamin D
Phosphate supplements - Estrogen replacement therapy (ERT)
- Exercise:
Percussive
Causes a muscle pull on the bone
Extension for spinal compression fractures
12
Q
Prognosis of Osteoporosis
A
Variable
Most prevalent bone disease worldwide
Can cause major orthopedic problems
Affects approximately 1/3 of women in US
13
Q
Osteomalacia (Disease)
A
Defective mineralization of bone ( in children it is called rickets)
14
Q
Osteomalacia ( Cause)
A
Lack of Vitamin D ( decreased intake, lack of sunlight, malabsorption)
15
Q
Signs and symptoms of Osteomalacia
A
Bone pain, loss of height, bending & deformity in weight bearing bones.
16
Q
Treatment of Osteomalacia
A
Correction of deficiency
17
Q
Prognosis of Osteomalacia
A
Curable but depends on cause/ Adequate dietary intake of Vitamin D
18
Q
Osteomyelitis (Disease)
A
Infection of bone -forming tissue; begins as acute but can become chronic
19
Q
Cause of osteomyelitis
A
Trauma; acute bacterial infection, STAPHYLOCOCCUS
20
Q
Signs and symptoms of Osteomyelitis
A
Dependent on which bones are affected and virulence of bacteria; include sudden onset of fever, chills, malaise, sweating, pain, tenderness, swelling over bone
21
Q
Osteomyelitis (Diagnosis)
A
Blood cultures, aspiration, x-rays, bone scan
22
Q
Treatment of Osteomyelitis
A
Bed rest, antibiotics, surgical drainage
23
Q
Prognosis of Osteomyelitis
A
Frequently resolves favorably; if chronic, poor prognosis/ Take extreme care with standard precautions during surgery or after trauma
24
Paget's Disease (Disease)
1. Chronic metabolic skeletal disease
2. High rate of bone turnover
3. New bone growth outpaces breakdown of old bone
4. New bone is thicker & weaker
5. Primarily men over 40
25
Paget's Disease/ Cause
Idiopathic
26
Paget's Disease / Signs and Symptoms
```
1. Pain: Depends on bones affected or extent
Headache
Radicular
Osteoarthritic
Muscular
2. Asymptomatic
```
27
Paget's Disease/ Diagnosis
X-rays, bone scan, bone marrow biopsies; blood analysis, UA
28
Paget's Disease/ Treatment
Symptomatic; High-protein diet with calcium & vitamin D supplements
29
Paget's Disease/ Prognosis
Complications include fractures and deformity ( spinal curve, genu varus...)
30
Joint Diseases
1. Osteoarthritis
2. Rheumatoid arthritis
Adult
Juvenile
3. Goat
31
Osteoarthritis (DJD)/ Disease
(DJD) Degenerative process of joints
32
Osteoarthritis/ Cause
1. Abnormal cartilage
2. Related to aging
3. "Wear and tear"
4. Obesity
5. 90% of adults show some X-ray changes
6. Secondary osteoarthritis may occur following injury
33
Osteoarthritis/ Signs & Symptoms
1. Insidious onset
2. Deep, aching joint pain, relieved by rest
3. Stiffness, aching during weather changes
4. Crepitation
34
Osteoarthritis/ Diagnosis
1. History & physical exam
2. X-rays
3. Bone scans
4. MRI
35
Osteoarthritis/ Treatment
1. Minimize pain ( medication/surgery)
2. Decrease inflammation (Medication)
3. Minimize disability
4. Maintain joint function ( Strengthening)
5. Decrease risk factors
36
Osteoarthritis/ Prognosis
Depends on site and severity
| Progression varies
37
Osteoarthritis........nodes
Heberden's nodes
38
Rheumatoid Afthritis (RA)/ Disease
Chronic, systemic, inflammatory condition affecting synovial membranes of multiple joint
Destruction of cartilage
Erosion of bone
Deformity of joints
Remissions/ Exacerbations
Affects multiple joint usually some symmetry is involved
39
Rheumatoid Arthritis (RA)/ Cause
Autoimmune disease
40
Rheumatoid Arthritis (RA)/ Signs and Symptoms:
1. Tender, warm, swollen joints.
2. Symmetrical pattern. For example, if one knee is affected, the other one is also.
3. Joint inflammation often affecting the wrist and finger joints closest to the hand; other affected joints can include those of the neck, shoulders, elbows, hips, knees, ankles, and feet
41
(RA) cont. Signs and Symptoms:
1. Fatigue, occasional fever, a general sense of not feeling well (malaise)
2. Pain and stiffness lasting for more than 30. Minutes in the morning or after a long rest
3. Symptoms that can last for many years
4. Symptoms in other parts of the body besides the joints
5. Variability of symptoms among people with the disease
42
Rheumatoid Arthritis (RA)/ Diagnosis
```
1. Blood tests
RA factor
Erythrocyte sedimentation rate (ESP)
Complete blood cell (CBC) count
2. X-rays
```
43
Rheumatoid Arthritis (RA)/ Treatment
1. Medication
Anti-inflammatory
Disease modifying
Biologic Response ( Tumor necrotizing factor)
Pain
2. Preserve joint function (Exercise)
3. Prevent joint deformities ( splinting, joint protection)
44
Rheumatoid Arthritis/ Prognosis
1. Variable course
2. Can be good is diagnosed early because of new medical management
3. Fatal for a small number of patients
Cardiac
Pulmonary fibrosis
45
Pannus
1. A sheet of inflammatory granulation tissue that spreads from the synovial membrane and invades the joint.
2. Considered the most destructive element affecting joints in the patient with rheumatoid arthritis.
3. Attack articular cartilage and destroys it.
4. Can destroy the soft subchondral bone once the protective articular cartilage is gone.
46
Goat/Disease
1. Chronic uric acid metabolic disorder
| 2. Crystals of uric acid in synovial fluid
47
Gout/ Cause
Metabolic, renal, or both
48
Gout/ Signs & Symptoms
1. Sudden onset of excruciating pain of joints of big toe (or other joints).
2. Erythema
3. Warmth
4. Extreme tenderness
49
Gout/ Treatment
1. Medication
2. Dietary: Decrease intake of purines
Beer, other alcoholic beverages
Anchovies, sardines in oil, fish roes, herring
Yeast
Organ meat (liver, kidneys, sweetbreads)
Legumes ( dried beans, peas)
Meat extracts, consommé, gravies
Mugs
Mushrooms, spinach, asparagus, cauliflower
Decrease intake of alcohol
3. Weight loss
50
Gout/ Prognosis
Prognosis: Chronic condition that needs to be managed
51
Juvenile Diseases of the Bone
1. Osteogenesis Imperfecta
| 2. Arthrogryposis Multiplex Congenita
52
Osteogenesis Imperfecta/ Disorder
```
Congenital disorder of the collagen synthesis affecting bone and collagen
4 types (I-IV) with I being the most common and mildest form
```
53
Osteogenesis Imperfecta / Cause
Genetic - autosomal dominate
54
Osteogenesis Imperfecta / Clinical Manifestations:
1. Brittle bones
2. Shortened stature
Abnormal development of the epiphyseal growth plates
Deformity after fractures
Osteoporosis
Vertebral collapse
3. Tendency to fracture decreases after puberty: Cortical bone density increases though trabecular density remains low
55
Osteogenesis Imperfecta / Clinical manifestations:
1. Blue or tinted ( purple or grey) sclerae
2. Thin skin
3. Deformity of the bony auditory structures -- Hearing impairment
4. Scoliosis/ pectus deformity
56
Osteogenesis Imperfecta/ Treatment
1. Orthopedic Management
2. Medications used for osteoporosis
3. New and developing: Bone marrow transplants of mesenchymal cells (Progenitors of osteoclasts). Gene therapy
57
Osteogenesis Imperfecta / Prognosis
1. I/IV have a milder course and have a relatively normal life span
2. II Perinatal fatal
3. III Cardiorespiratory failure secondary to kyphoscoliosis
58
Osteogenesis Imperfecta / Implications of the PTA
1. Careful handling
2. Gentle stretching in straight planes - rotational forces are contraindicated
3. Strengthening for disuse weakness and loss of bone stock
Avoid placing weight near joint lines
Long lever arms need to be avoided with resistance
Swimming
Standing at 10-14 month: Watch for lower extremity bowing
Mobility
59
Arthrogryposis Multiplex Congenita / Disease
```
Multiple contracture present at birth.
3 types:
1. Contracture syndrome
2. Amyoplasia ( lack of muscle formats or development)
3. Distal arthrogryposis ( Hands/ Feet)
```
60
Arthrogryposis Multiplex Congenita / Cause
Unknown, underlying condition that causes decreased fetal movements
Neuro
Muscular
61
Fractures Closed/Simple
Break with no external wound to skin
62
Fractures Open/ Compound
Break with open wound or bone piece protrudes skin
63
Fractures Greenstick
Bone per tidally bent, split, children
64
Fractures/ Comminuted
Bone is broken or splintered into pieces
65
Fractures/ Impacted
One end of bone is forced into another
66
Fractures/Incomplete
Fracture line does not include the whole bone
67
Disease of the Muscles and Connective Tissue
1. Polymyositis
2. Systemic Lupus Erythematosus
3. Duchenne Muscular Dystrophy
68
Polymyositis /Disease
Chronic, progressive disease of connective tissue, inflammation, degeneration of skeletal muscles
69
Polymyositis / Cause
Idiopathic, viral, autoimmune
70
Polymyositis /Signs and Symptoms
1. Insidious onset, muscle weakness in hips, thighs
2. Difficulty with stairs, kneeling
3. Dyspnea
4. Respiratory difficulties
71
Polymyositis/ Diagnosis
Muscle biopsy, elevated ESR
72
Polymyositis /Treatment
Corticosteroid drugs; physical rehabilitation
73
Polymyositis /Prognosis
Variable, worsens with age/ None known
74
Systemic Lupus Erythematosus (SLE) D/S
Chronic, inflammatory connective tissue disorder, cells, tissue are damaged by auto-antibodies, immune complexes; more common in women
75
SLE E/T
Autoimmune, genetic, environmental, hormonal factors
76
SLE Signs & Symptoms
1. Butterfly rash on neck, face, scalp
2. Photo sensitivity of skin
3. Joint, muscle pain
4. Joint deformities
5. Malaise
6. Fever
7. Anorexia
8. Weight loss
77
SLE /Diagnosis
```
Blood test (CBC, ESR, antinuclear antibody...)
Physical examination
```
78
SLE /Treatment
1. Anti-inflammatory drugs
| 2. Corticosteroid creams to skin rashes
79
SLE /Prognosis
Improves with early detection, poor with cardiovascular, renal, neurological complications, high death rate within 5 years/ None known
80
Childhood Disease of the Musculoskeletal System
Duchenne Muscular Dystrophy
81
Duchenne Muscular Dystrophy D/S
Progressive bilateral wasting of skeletal muscles - shoulder and pelvic girdle
82
Duchenne Muscular Dystrophy E/T
Result of x-linked recessive disorder: affects male children
83
Duchenne Muscular Dystrophy S/S
Exhibits waddling gait, toe-walking, lordosis. Falls easily, contractures
84
Duchenne Muscular Dystrophy D/X
Family history, clinical picture, muscle biopsy, EMG
85
Duchenne Muscular Dystrophy T/X
None known, treatment to correct, preserve mobility, PT, orthopedic appliances, surgery
86
Duchenne Muscular Dystrophy P/P
Poor, death results from cardiac or respiratory complications/ Genetic counseling for carriers
87
Gower's maneuver
Due to weakness of pelvic muscles with MD
