Orthopedics
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| Components of the MS System | Bone, Articular Tissue, Connective Tissue
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| Articular Tissue | Cartilage, Synovium
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| Connective Tissue | Muscle, Ligaments, Tendons
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| Bones: Numbers | 80 in axial skeleton; 126 in appendicular skeleton; 27 in the hand
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| Regions of long bones | Epiphysis; Physis; Metaphysis ; Diaphysis
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| Epiphysis = | above growth plate
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| Physis = | growth plate
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| Diaphysis = | shaft
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| Physis in children: | is open (i.e., growth plate)
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| Types of Bone | Cortical; Cancellous
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| Cortical bone = | Compact, makes up 80% of skeleton (e.g., diaphysis of long bones)
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| Cancellous bone = | Spongy or trabecular ; more prominent in spine & pelvis (e.g., metaphysis of long bones)
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| Periosteum = | Highly vascular membrane that covers bone; more prominent in children
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| Bone Marrow = | Source of hematopoietic progenitor cells
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| Highly vascular membrane that covers bone; more prominent in children | Periosteum
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| Source of hematopoietic progenitor cells Bone | Marrow
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| Organic Bone Matrix wrt weight | Organic matrix composes 40% of bone dry wt
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| Organic Bone Matrix = | Type I Collagen, Proteoglycans, Noncollagenous matrix proteins, GFs & cytokines
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| Type I Collagen = | 90% of organic matrix
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| Bone strength from: | Type I Collagen (tensile strength); Proteoglycans (compressive strength)
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| Noncollagenous matrix proteins promote: | mineralization & bone formation
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| Growth factors & cytokines = | Interleukins, transforming growth factor
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| Inorganic Bone Matrix = | Calcium hydroxyapatite; Osteocalcium phosphate (Brushite)
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| Mineral components wrt weight | Mineral components compose 60% of the dry wt of bone
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| Metaphyseal - Epiphyseal System | Arises from periarticular vascular plexus
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| Periosteal System | Low pressure capillary system supplies outer 1/3 of diaphyseal cortex
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| Bone maintained by metabolism of: | Ca & PO4
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| Amount Ca & PO4 in bone | 99% of Ca & 85% of PO4 found in Bone
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| Needed for gut Ca absorption: | Vitamin D
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| Increases plasma Ca by increasing gut absorption & bone resorption: | PTH
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| Osteoblasts = | Cells that form bone, producing type I collagen
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| Osteoclasts = | Cells that resorb bone
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| Osteocytes = | Cells that maintain bone; make up 90% of mature skeleton
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| Fracture Healing: stages | Inflammation, Repair, Remodeling
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| Fracture Healing: Remodeling stage | Begins mid repair phase; continues for several months
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| Types of Cartilage | Fibrocartilage, Elastic cartilage, Fibroelastic cartilage, Articular cartilage
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| Fibrocartilage | Area for bone & tendon insertion
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| Elastic cartilage | Nose, auricle
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| Fibroelastic cartilage: | Menisci (functions to deepen articular surface & stabilize joint)
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| Articular cartilage: | Hyaline (aids in load distribution & decreasing joint friction)
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| Synovium = | Membrane lines the joint; mediates exchange of nutrients between blood & joint fluid
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| Synovial (Joint) Fluid: | Nourishes articular cartilage; lubricates articular surfaces
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| Bursa: | Fluid-filled potential space over areas of friction
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| Combine into myofibrils: | Actin & Myosin filaments
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| Myofibrils combine into: | muscle fibers
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| Muscle fibers combine into: | muscle fascicles
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| Blood supply to long bones | Nutrient Artery System; Metaphyseal-Epiphyseal System; Periosteal System
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| Nutrient Artery System: | Nutrient a. enters diaphyseal cortex thru nutrient foramen into medullary canal
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| Bone remodeling MOA | Osteoclasts resorb bone followed by new bone deposition by osteoblasts
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| Wolff’s law | Increase in external stress leads to bone formation; removal of external stress leads to bone resorption
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| Change in bone marrow with aging | Red (active) marrow changes to yellow (fatty, inactive) marrow
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| Peak bone mass at age: | 16 to 25 y.o.
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| Isotonic contraction: | Constant tension through ROM
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| Concentric contraction: | muscle shortens
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| Eccentric contraction: | muscle elongates
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| Isometric contraction: | Muscle tension with length constant
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| Isokinetic contraction: | Concentric or eccentric contraction at constant speed over ROM
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| Gait Analysis: Width of the gait: | Normal =2-4 in heel to heel; Wide based gaits = instability
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| Gait Analysis: Ctr of gravity: | Normal gait oscillates no more than 2 in. vertically; pain & mx weakness => pt shifts COG over affected hip
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| Gait Analysis: Pelvic shift: | pelvis & trunk shift laterally 1 in. to wt bearing side
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| Gait Analysis: Pelvic shift: in gluteus mx weakness: | lateral shift is accentuated to the side involved
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| Gait Analysis: Length of step: | Ave length is 15 in. With age/ fatigue/ pathology: step is shortened
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| Gait Analysis: Cadence: | Ave cadence is 90-120 steps/ min. With age/ fatigue/ pain: cadence is decreased to conserve energy
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| Gait Analysis: Pelvic rotation: | Normal during swing phase = 40 degrees in leg that is moving forward; if pain or stiffness in hip, pelvis will not rotate normally
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| Antalgic gait: | Limp from pain
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| Wide based gait = | Instability from cerebellar disease or peripheral neuropathy
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| Steppage gait = | Weak ankle dorsiflexors results in increase knee & hip flexion
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| Flat foot gait = | Gastrocnemius/ Soleus weakness (S1-S2 radiculopathy)
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| Back Knee gait = | Quadriceps weakness forces pt to push on thigh w/ hand to try to lock knee in stance phase
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| Trendelenberg (abduction lurch) gait = | Gluteus medius weakness (L5); pt lurches toward weak side to place COG over hip
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| Extensor lurch = | Gluteus max weakness (S1); pt thrusts thorax posteriorly to maintain hip extension
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| Foot Drop = | Weakness of tibialis anterior (L4)
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