Week 6: Musculoskeletal

Question 1

skeletal trauma

Answer 1

fractures & dislocations

Question 2

support structure trauma

Answer 2

sprains and strains
tendinopathy and bursitis
muscle strains

Question 3

a fracture is a

Answer 3

break in the continuity of a bone

Question 4

incidence for specific bones varies by

Answer 4

age and gender

Question 5

fractures are classified as

Answer 5

complete 
incomplete
open
closed
comminuted
linear
oblique
spiral
transverse
greenstick

Question 6

pathologic fracture

Answer 6

break at the site of a preexisting abnormality

Question 7

stress fracture

Answer 7

d/t being subjected to repeated stress – e.g. athletics

Question 8

transchondral fracture

Answer 8

fragmentation and separation of portion of articular cartilage

Question 9

steps in fracture healing

Answer 9

Periosteum and blood vessels disrupted
Bleeding from ends and neighbouring soft tissue
Clot forms in medullary canal
Adjacent bone tissue dies – stimulates intense inflammatory response
Within 48 hours vascular tissue invades area – blood flow to bone
Bone-forming cells activated to produce subperiosteal procallus along bone shaft and over break
Osteoblasts synthesize collagen and matrix
This forms callus
Remodeling occurs, trabeculae formed along lines of stress

Question 10

fracture clinical manifestations

Answer 10

• S & S include impaired function, unnatural alignment, swelling, muscle spasm, tenderness, pain and impaired sensation
• Position of bone affected by pull of attached muscles, gravity, direction and magnitude of fracture force
• Immediate pain d/t trauma, secondary pain d/t soft tissues or muscles

Question 11

tx of fractures

Answer 11

• Must realign the bone fragments (reduction) & hold fragments in place (immobilization)
• Most done by closed reduction
• Traction to accomplish or maintain reduction (skin or skeletal)
• External fixation used external frame of clamps
• Open reduction – a surgical procedure

Question 12

dislocation

Answer 12

a temporary displacement of 2 bones in which the bone surfaces lose contact entirely

Question 13

subluxation

Answer 13

the contact bw two bones is partially lost

Question 14

most commonly dislocated

Answer 14

shoulder, elbow, wrist, finger, hip, and knee

Question 15

dislocation and subluxation cm

Answer 15

• bruise nerves, vessels, ligaments, supporting structure, soft tissues occurs as well
• Pain, edema, limitation in motion, deformity

Question 16

ligament

Answer 16

band of fibrous ct that connects bones at a joint

Question 17

tendon

Answer 17

fibrous ct that attaches skeletal muscle to bone

Question 18

strain

Answer 18

tear in tendon

Question 19

sprain

Answer 19

tear in ligament

Question 20

sprain and strain steps in healing

Answer 20

Inflammation exudate develops between the torn ends
Granulation tissue forms containing macrophages, fibroblasts, and capillary buds
Within 5 days, collagen forms unorganized and then later interweave with existing fibres
A healing tendon in unable to withstand pull for 5 weeks
The entire process could take years to repair a tendon or ligament (longer than a break)

Question 21

sprains and strains cm

Answer 21

pain
 edema 
changes in tendon or ligament contour
dislocation and subluxation of bones
tenderness

Question 22

muscle tears

Answer 22

muscle fibres are torn resulting in bleeding

fibres do heal but other fibres compensate

Question 23

idiopathic oa

Answer 23

no known cause but may be inherited

Question 24

secondary oa

Answer 24

associated with joint stress, congenital abnormalities or joint instability caused by trauma

Question 25

oa most often affects

Answer 25

``` hands wrists neck lower back hip knees ankles feet ```

Question 26

loss of articular cartilage patho

Answer 26

- Cartilage becomes yellow or brownish grey - Surface areas flake off - Becomes thin or may be absent in some areas - Bone is unprotected – becomes sclerotic - Cartilage-coated osteophytes may grow outwards - Pieces of spur break off- irritate synovial membrane - Joint capsule becomes thickened

Question 27

oa clinical manifestations

Answer 27

``` pain and stiffness in joints aggravated by weight bearing and relieved by rest nocturnal pain not relieved by resting limited ROM crepitus changes in ambulation and gait ```

Question 28

joint effusion, inflammatory exudate or blood in synovial cavity caused by

Answer 28

- presence of osteophyte fragments in synovial cavity - drainage of cysts from diseased subchondral bone - acute trauma to joint structures

Question 29

oa dx

Answer 29

clinical assessment, xray, ct scan, mri

Question 30

oa tx

Answer 30

rest, ROM exercises, use of aids, weight loss, analgesics, antiinflammatories, and surgery

Question 31

rheumatoid arthritis

Answer 31

autoimmune disease, chronic inflammation of connective tissue that affects the synovial membrane

Question 32

RA joints most affected

Answer 32

fingers, feet, wrists, elbows, knees, ankles | may also affect lungs, heart, kidneys, and skin

Question 33

RA cm

Answer 33

- Joints become painful, tender and stiff - Morning stiffness lasting more than 1 hour - Progresses from smaller joints -> weight-bearing joints - Joint swelling widespread and symmetric - Joint deformities -> loss of joint motion -> contractures -> muscle atrophy - formation of nodules

Question 34

RA dx

Answer 34

PE, xray, blood tests

Question 35

RA tx

Answer 35

- rest of joints and body, heat and cold, PT, high calorie intake and vitamin rich diet - drugs - corticosteroids, antiinflammatories, and immunosuppressants - surgery

Question 36

ankylosing spondylitis

Answer 36

chronic inflammatory joint disease characterized by fusion of spine and sacroiliac joints

Question 37

genotype assoc. with ankylosing spondylitis

Answer 37

HLA B27

Question 38

gout

Answer 38

excess uric acid in blood that causes precipitation of urate crystals in joints

Question 39

physiologic contracture

Answer 39

d/t failure of calcium pump in presence of ATP - temporary if underlying pathology reversed occurs in the absence of muscle action potential

Question 40

pathologic contracture

Answer 40

permanent - caused by muscle spasm or weakness | may be a response to pain or secondary to scar formation (burns)

Question 41

osteomyelitis

Answer 41

infectious bone disease caused by bacteria, viruses, fungi, and parasites

Question 42

osteomyelitis is difficult to treat bc

Answer 42

bone contains multiple channels that encourage proliferation of infectious cells - natural defenses do not penetrate tiny vessels 1) are easily damaged, and 2) make obstruction by bacteria easy, leads to necrosis bone cells destroyed by infection are not easily replaced, bone production lags behind bone resorption by osteoclasts

Question 43

exogenous osteomyelitis

Answer 43

infection from outside the body - spreads from soft tissues to bone

Question 44

endogenous osteomyelitis

Answer 44

infection carried in blood from other sites within the body - spreads from bone to soft tissues

Question 45

most common sources of bacteria in OM

Answer 45

cutaneous, sinus, ear, and dental infections

Question 46

OM dx

Answer 46

elevated WBC, bone scan, CT, and MRI

Question 47

OM tx

Answer 47

iv antibiotics, surgical debridement, hyperbaric O2 therapy, may need to remove any implants

Question 48

osteoporosis

Answer 48

present with a BMD -2.5 SD below the young adult mean

Question 49

osteoporosis symptoms

Answer 49

back pain, kyphosis, height loss, improper fit of clothing, protruding abdomen, negative body image

Question 50

osteoporosis risk factors

Answer 50

smoking, lack of physical activity, excess alcohol, low calcium and vitamin D intake, thinness, family hx, premature menopause

Question 51

bone generation is directly related to

Answer 51

physical activity, calcium intake, vitamin D, hormone levels

Question 52

osteoporosis dx

Answer 52

bone scan, xray, CT scan, serum tests

Question 53

osteoporosis tx

Answer 53

prevent bone loss with vitamin supplements (Ca & Vit. D) and fracture prevention, weight bearing exercises

Question 54

best way to test BMA

Answer 54

dual energy xray absorptiometry