Unit 7 & 8

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Unit 7 & 8
2012-10-28 01:21:20

Musculoskeletal Unit 7&8
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  1. Why immobilize?
    for congenital defects, degenerative disorders and infections or injuries that impair the integumentary system, the musculoskeletal system or neurologic system
  2. Name the types of fractures
    • Bend, Buckle (raised or bulging at fracture site),
    • Greenstick (incomplete fractures),
    • Spiral (twisting, forms a spiral encircling the bone),
    • Transverse (occurs at a 90 degree angle to longitudinal axis of bone),
    • Oblique (occurs at 45 degree angle across longitudinal axis of bone),
    • Complete (breaka cross entire section of bone),
    • Closed (does not break the skin), Compound (open wound through which the bone has protruded),
    • Complicated (bone fragments that cause damage to other organs or tissues), Comminuted (more than one fracture line, more than 2 bone fragments either splintered or crushed)
  3. What does a fracture look like?
    Deformity, muscle spasm, swelling, bruising, crepitus, muscle rigidity
  4. What do you check for neurovascularily?
    sensation, movement, circulation, cap refill, pulses
  5. Define reduce, Closed reduction, ORIF, & OREF
    • Reduce-manipulation of bone to restore realignment
    • Closed-reduction-manual traction to move fracure fragments and restore bone alignment
    • ORIF-surgical procedure where fragments are realigned with an internal fixation such as screws, plates, pins
    • OREF-surgical procedure to realign bones with an external fixation such as cast or pins
  6. What are the 5 P's of ischemia?
    • Pain and point of tenderness
    • Pulses-distal to the fracture site
    • Pallor-color
    • Paresthesia-sensation distal to the fracture site
    • Paralysis-movement distal to the fracture site
  7. What are the goals of fracture management?
    Regain alignment and length, retain alignment and length, restore function, prevent further injury
  8. Name the types of casts
    Lower extremity, spinal or cervical, spica, plaster, fiberglass
  9. What is compartment syndrome?
    Edema that occurs in response to a fracture that causes pressure in the muscle compartment that reduces cap blood perfusion, therefore unable to meet tissues metabolic need and ischemia begins.
  10. What are types of traction?
    • Traction-application of a pulling force to an injured body part or extremity while countertraction pulls in the opposite direction
    • Skin-application of a pulling force directly to the skin through use of skin straps, boots, or foam splints
    • Skeletal-uses int to apply force to the bone
    • Manual-applied to body part by the hands placed distal to the fracture site
  11. What is a strain?
    • twist, pull, and/or tear of muscle and/or tendon
    • caused by direct or indirect trauma that knocks a joint out of position or overstreches or ruptures
  12. What is a sprain?
    Stretch and/or tear of ligament, may hear a tear or pop of joint, pain bruising, edema
  13. Describe shin splints, plantar fasciitis, patellar tendinopathy and osteomyelitis
    • Shin splints-strain of posterior tibial muscle origin
    • Plantar fasciitis-strain to plantar fascia
    • Patellar tendinopathy-tennis elbow, tendinitis of hand or wrist
    • Osteomyelitis-severe pyogenic infection of the bone and surrounding tissues
  14. What is club foot and what causes it
    Complex deformity of the ankle and foot caused by abnormal positioning and restricted movement in utero, abnormal embryonic development, relationship with other disorders or syndromes
  15. What are the 4 types of club foot? and what is the most common?
    • Talipes varus-inversion or bending inward
    • Talipes valgus-eversion or bending outward
    • Talipes equinus-plantar flexion, toes lower than heels
    • Talipes calcaneus-dorsiflexion, toes higher than heels
    • Most common-Talipes equinovarus (TEV)
  16. What are the names of two common back problems
    • Kyphosis-humpback
    • Lordosis-swayback
  17. How are spinal deformities classified?
    • Infantile (up to 3 years)
    • Childhood (juvenile, during childhood)
    • Adolescent (during adolescent growth spurt) MOST COMMON
  18. How is scoliosis differentiated
    • congenital (caused by vertebral anomalies present at birth)
    • idiopathic (cause unknown, subclassified as infantile, juvenile, adolescent, or adult, according to when onset occurred)
    • neuromuscular (having developed as a secondary symptom of another condition, such as spina bifida, cerebral palsy, spinal muscular atrophy, or physical trauma)
  19. What is scoliosis?
    • Lateral curvature of the spine. 
    • Less than 10 degrees is postural deviation
    • Less than 20 degrees is mild, no progression, no treatment
    • 40-45 degress excessive curvature surgical intervention
  20. What do you do for scoliosis?
    Observation, bracing, spinal fusion if severe, and exercise
  21. Explain juvenile rheumatoid arthritis
    An idiopathic autoimmune inflammatory disease causing inflammation of joints and other tissues.  It starts before age 16 and has no known cause.
  22. What is the age onset for Juvenile RA?
    • Between 1-3 years and between 8-10 years of age.
    • Twice as many girls than boys get it
  23. What are the goals of treatment
    There is no treatment, goals are to control pain, preserve joint ROM and function, minimize effects of inflammation such as deformity and promote normal growth and development
  24. What is happening with Juvenile RA?
    Chronic inflammation of the synovium, joint effusion, destruction and fibrosis of articular cartilage, adhesion between joint surfaces, ankylosis of joints
  25. How is Juvenile RA diagnosed?
    ESR (sed rate), rheumatoid factor, x-ray to show soft-tissue swelling and joint space widening
  26. How to minimize effects of Juvenile RA
    NSAIDS, methotrexate, corticosteroids (potent immunosuppressives), Slow-acting antirheumatic drugs, splinting as necessary, support
  27. What is Septic Arthritis?
    • A bacterial infection in the joint affecting adults under 30 usually caused by N. gonorrhoeae or MRSA.
    • Most joints affected, knee, hip, shoulder, wrist, ankle
    • Confirmed by blood work, synovial fluid analysis
  28. What is the treatment for Septic Arthritis?
    • IV antibiotic therapy for 2-3 weeks
    • Additional oral ABX if needed
  29. What is osteogenesis imperfecta?
    • Characterized by excessive fractures and bone deformities
    • Also known as brittle bone disease
    • Characterized by hearing loss, bone fragility, blue sclerae, fractures, discolored teeth
  30. What is the management for osteogenesis imperfecta?
    Careful handling to prevent fractures, careful repositioning to prevent contractures, physical therapy to build strength, surgery to correct deformities, family support, braces and splints to help support limbs and prevent fractures
  31. What are the types of OI or brittle bone disease
    • Type 1-most common, mild bone fragility, normal teeth, hearing loss, autosomal dominant inheritance
    • Type 2-lethal, stillborn or die in early infancy
    • Type 3-Severe bone fragility leading to severe progressive deformities, normal sclerae
    • Type 4-Mild to moderate bone fragility, normal sclerae, short stature, variable deformity
    • Type 5-Clinically similar to Type 4
    • Type 6-Sclerae and dentition normal, moderate to severe bone fragility, diagnosed by bone biopsy