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Chapter 62
| Question | Answer |
|---|---|
| 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
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