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Chapter 62

Function of bone Support, protection of internal organs, voluntary movement, blood cell production and mineral storage.
OSTEOBLAST synthesize organic bone matrix (collagen) and are basic bone forming cells
OSTEOCYTES mature bone cells
OSTEOCLASTS participate in bone remodeling by assisting in breakdown of bone tissue
BONE REMODELING removal of old bone by osteoclasts (resorption) and deposition of new bone by osteoblasts (ossification)
ISOMETRIC CONTRACTIONS increase in the tension within a muscle but do not produce movement (make muscles larger and stronger)
ISOTONIC CONTRACTIONS shorten a muscle to produce movement skeletal muscles fibers divided into 2 groups based on types of activity they demonstrate
Most common symptoms of musculoskeletal impairment include deformity, limitation of movement, stiffness, and jt crepitation.
Achilles tendonitis Pain in posterior leg when running or walking initially, can progress to pain at rest
Ankylosis Stiffness and fixation of a jt
Antalgic gait Shortened stride c. as little weight bearing as possible on affected side
Ataxic gait Staggering, uncoordinated gait often w. sway
Atrophy Flabby appearance of muscle leading to decreased fx and tone
Boutonniere deformity Finger abnormality flexion of proximal interphlalangeal PIP jt, hyperextension of distal interphalageal DIP jt of fingers
Contracture Resistanceof movement of muscle or jt as a result of fibrosis of supporting soft tissues
Crepitation Frequent, audible crackling sound c. palpable grating that accompanies movement
Dislocation Displacement of bone from its normal jt Sever injury of the ligamentous structure that surround a jt, often results in complete displacement/separation of jt surfaces. A orthopedic emergency
Festinating gait While walking, the neck, trunk and knees flex while the body is rigid, delayed start c. short, quick, shuffling
Ganglion cyst Small fluid-filled bump/mass over a tendon sheath or jt, usually on dorsal surface of wrist/foot
Kyposis Dowager’s Hump Forward bending of thoracic spine, sl flexion of knees exaggerated
Lateral epicondylitis Dull ache along outer aspect of elbow, worsens c. twisting and grasping motions
Limited ROM Jt does not achieve the expected degree of motion
Slow-twitch muscle fibers support prolonged muscle activity
Fast-twitch fibers tire more quickly than slow-twitch (eye-blinking, jumping)
Question should focus on symptoms of arthritic and CT diseases, Gout, SLE, Osteomalacia, Osteomyelitis, and fungal infection of bones
anti-seizure drugs Osteomalacia, phenothiazine-
phenothiazine SE gait disturbances
Corticosteroids SE avascular necrosis, decreased bone and muscle mass
Potassium-depleting diuretic SE: muscle cramps and weakness.
Women Menstrual Hx
Physical exam: observe any swelling, deformity, nodules, or masses and discrepancies in limb length or muscle size. ROM accurately assess c. a gonimeter, measures the angle of a jt.
Cartilage Support for soft tissue, Provides surface for jt movement, protects underlying surface, avascular
Cardiac Involuntary, located in the HT
Smooth Involuntary, located in intestines, Bd, arteries
Striated Voluntary, located in skeletal system
Sprain an injury to the ligamentous structure surrounding a jt. caused by a wrenching or twisting motion
Strain excessive stretching of a muscles, its fascial sheath or a tendon occur mostly in the large muscle groups including lower back, calf, and hamstrings
Strain Manifestations Pain, edema, decrease in fx, contusion
Mild sprain and strain are usually self-limiting c. full fx returning 3-6 weeks
Subluxation Partial or incomplete displacement of the jt surface
Jt most frequently dislocated in upper extremity include: Thumb, elbow and shoulder
Avascular necrosis bone cell death as a result of inadequate blood supply
RSI include poor posture and positioning,poor workspace ergonomics, badly designed workplace equipement. Repitive lifting of heavy workloads w.o sufficient muscle rest
Carpal Tunnel Syndrome CTS Condition caused by compression of the median nerve which enter the hand via the narrow confines of the carpal tunnel, fored by ligament and bones
CTS manifestations: Weakness, burning pain, numbness, impaired sensation in the distribution of the median nerve and clumsiness in performing fine movements
Tinel's signs can be elicited by tapping over median nerve as it passes through the carpal tunnel in the wrist + sensation of tingling in the distribution of the median nerve over the hand
Phalen's sign can be elicted by allowing the wrists to fall freely into max flexion and maintain the position for longer than 60 seconds + sensation of tingling in the distrubution of the median nerve over the hand
Rotator Cuff Injury a cuff is a complex of four muscles: sprapinatus, infraspinatus, teres minor, and subscapularis muscles
Acromioplasty surgical removal part of the acromion to relieve compression of rotator cuff during movement may be necessary
Bursitis inflammation of the burse, results from repeated or excessive trauma or friction, GOUT, RA, or infection
Primary clinical manifestations of bursitis are: warmth, pain, swelling, and limited ROM in affected part
Fracture is... a disruption/break in the continuity of the structure of bone
Traction is an application of a pulling force to an injured or diseased part of the body/ an extremity while countertraction pulls in the opposite direction
Skin traction generally used for short term tx (48-72) until skeletal traction or surgery is possible weighs are 5-10lbs
Skeletal traction align injured bones and jts or to tx jt contractures and congenital hip dysplasia. Provides a long-term pull that keeps the injured bones and jt aligned (5-45 lb) Too much weigh can result in delayed union/nonunion
What is the major of amputation surgery? To preserve extremity length and fx while removing all infected, pathologic, or ischemic tissue
Closed amputation performed to create a weight bearing.. residual limb or stump
Disarticulation is an amputation performed via a jt
Impingement Syndrome Entrapment of soft tissue structure under coracoacromial arch of shoulder
Rotator Cuff Tear Tear within muscle or teninoligamentous structures around shoulder
Shin Splints Inflammation along anterior aspect of calf from periostitis caused by improper shoes, overuse, or running on hard pavement
Tendinitis Inflammation of a tendon as a result of overuse or incorrect use
Ligament injury Tearing or stretching of ligament, usually occurs as a result of inversion, eversion, shearing, or torque applied to a jt. Characterized by sudden pain, swelling, and instability
Meniscal injury: Injury to the fibrocartilage of knee characterized by popping, clickling, tearing sensation, effusion and /or swelling.
CAST temporary circumferential immobilization device
Hip fx of proximal 3rd of the femur, which extends up to 5 cm below lesser trochanter
Buck’s traction Most commonly used for fractures f the hip and femur
Skeletal traction align injured bones and jts or tx jt contractures and congenital hip dysplasia. Provide a long-term pull that keeps the injured bones and jt aligned (5-45 lb) Too much weight can result in delayed union/nonunion
Closed amputation performed to create a weight bearing-residual limb or stump, prevent accumulation of drainage-can produce pressure and harbor bacteria that may cause infection
Disarticulation is an amputation performed via a jt
Syme amputation- form of disarticulation at the ankle
Open amputation leaves a surface on the residual limb that is not covered w. skin
Sugar-tong splint typically used for acute wrist injuries or injuries that may result in significant swelling
Short arm cast often used for t of stable wrist or MTC fx
Long arm cast commonly used for stable forearm or elbow fx and unstable wrist fx
Neurovascular Assessment should consist of a peripheral vascular assessment (color, temp, capillary refill, peripheral pulses and edema)
Two point gait rutch on one side advances simultaneously w. the opposite extremity, this gait is also used w. cane ambulation
Four point gait A slower version of the 2 point in which crutches and legs are advanced separately.
Swing-to gait Both crutches are advanced together, followed by lifting of both lower limbs to the same place; this gait is also used w. walkers
Swing through gait Gait similar to the swing to gait, pt swings the body past the crutches.
Phantom limb sensation-occurs in 90% of amputees. Pt may complain of feelings of coldness and heaviness, cramping, shooting, burning, or crushing pain.
Arthrodesis is the surgical fusion of a jt. It relieves pain and provides a stable but immobile jt.
OSTEONS haversian systems-fit closely together in compact bone, creating a dense bone structure
EPIPHYSIS: Widened are found at each end of the a long bone, composed of cancellous bone wide one allows fro greater weight distribution and provides stability for the jt. Also location of muscle attachment
DIAPHYSIS main shaft of the bone provides structural support and composed of compact bone-tubular structure help withstand bending and twisting force
METAPHYSIS Flared area bw epiphysis and diaphysis
EPIPHYSEAL PLATE growth zone cartilaginous area bw epiphysis and metaphysis
Lordosis (swayback) Asymmetric scapulae and shoulders, exaggerated lumbar curvature
Muscular spasticity Increased muscle tone w. sustained muscle contaction
Myalgia General muscle tenderness and pain
Paresthesia Numbness and tingling often described as “pin and needles”
Pes planus Abnormal flatness of the sole and arch of the foot
Valgum deformity When knees are together and there is more 1 in bw the medial malleoli
Varum deformity When knees are apart and the medial malleoli are together, a space of more than 1 inch exists.
Standard X-Ray • Determines density of bone, evaluates structure & fx of bone and jt. • NC: Avoid excessive exposure of pt and self, Verify patient is not pregnant
Diskogram • X ray of cervical or lumbar intervertebral disk post injection of contrast media. • Permits visual of intervertebral disk abnormalities • NC: Allergies to contrast medium
Computed Tomography CT • X ray of computer 3-D picture • Identify soft tissue abnormalities, bony abnormalities, and various musculoskeletal trauma • NC: Painless, shellfish allergy? Remain still.
Myelogram c/s CT • Injects contrast medium into sac around nerve roots • CT scan may show how bone is affecting nerve roots. • Test for nerve impingement and lesions injuries can be detected
Magnetic Resonance Imaging MRI • Radio waves and magnetic field used to view soft tissue. • Dx of avascular necrosis, disk disease, tumors, osteomyelitis, ligament tears, cartilage tears. • Gadolinium may be injected IV to enhance visualization of structures.
Bone Scan Injects radioisotope TC 99m taken up by bone. Inform the patient that procedure requires 1 hour while patient lies supine and that no pain or harm will result from isotopes Increase fluids after exam Pregnancy?
Uric Acid End product of purine metabolism, normally excreted in urine, elevated in GOUT
Alkaline Phosphatase an enzyme produced by osteoblasts of bones, needed for mineralization of organic bone matrix Increased levels are found in healing fx, bone cancer, osteoporosis, osteomalacia, and Paget’s disease
C-reactive protein used to dx inflammation disease infections and active widespread malignancy, synthesized by the Liver and is present in large amounts
Creatine Kinase CK- highest concentration found in skeletal muscle. Increased levels found in progressive muscular dystrophy, polyyositis, and traumatic injuries
Anit-DNA antibody detects serum antibodies that react c. DNA. Most specific test for SLE.
Created by: linhfujikawa