Musculoskeletal System

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  1. Tear in ligament; usually from wrenching or twisting
  2. What are the Signs/Symptoms of a Sprain:
    Pain, Soft tissue swelling, Tenderness, Ecchymosis, Decreased ROM
  3. Tx for a Sprain:
    • RICE=
    • R-- Rest
    • I-- Intermittent ice (24-48hrs) - Heat
    • C-- Compression
    • E-- Elevate
  4. Tear in a Tendon...
    Using muscle, ligament, or joint beyond normal function; excessive stretching
    "Pulled Muscle"
  5. S/S of a Strain:
    Tenderness, Spasm, Decreased ROM, Edema
  6. Tx of a Strain:
    • RICE
    • Spint
    • (surgical suturing if severe)
  7. Articulating surfaces not in contact
  8. Incomplete Dislocation
  9. What is the main cause of Dislocations/Sublaxations?
  10. Signs/Symptoms of Dislocations/Sublaxations:
    Deformity, Limited Movement, Pain, Altered CSM
  11. Treatment (Tx) of Dislocations/Sublaxation:
    Reduction and Immobilization; splint
  12. Cylinder-Shaped Structural Units of Bone:
  13. Widened area found at each end of a long bone (composed primarily of cancellous bone)
    • Epiphysis
    • (also location of muscle attachment)
  14. Main shaft of the bone providing structural support and is composed of compact bone
  15. Flared area between the epiphysis and diaphysis
  16. Growth Plate -- cartilaginous area between the epiphysis and metaphysis  allowing for longitudinal growth
    Epiphyseal Plate
  17. Fibrous connective tissue that covers the bone (Tiny blood vessels penetrate the _____ to provide nutrition to underlying bones)
  18. Place where the ends of two bones are in proximity and move in relation to each other...classified by the degree of movement that they allow:
  19. Most common joint is:
  20. Rigid connective tissue in synthodial joints that serves as a support for soft tissue and provides the articular surface for joint movement
  21. 3 Types of Muscle Tissue:
    • Cardiac
    • Smooth
    • Skeletal
  22. Contractions that increases the tension within a muscle but does not produce movement
    • Isometric Contractions
    • (makes muscles grow stronger)
  23. Contractions that shorten the muscle to produce movement
    Isotonic Contractions
  24. Attaches muscle to bones as an extension of the muscle sheath that adheres to the periosteum
  25. Connects bone to bone...they have a higher elastic content than tendons
  26. Refers to layers of connective tissue with intermeshed fibers that can withstand limited stretching
  27. Small sacs of connective tissue lined with synovial membrane and containing synovial fluid
  28. Effects of Aging on the Musculoskeletal system:
    • (early adulthood or later adult years)
    • -may effect ability to complete self care tasks
    • -effects range from mild discomfort/decreased ability to perform ADL --> severe chronic pain and immobility
    • -risk for falls increases due to loss of strenghth
    • -balance/unsteady
    • -altered proprioception --> awareness of self in relation to the environment
    • -alt. bone remodeling process
    • -increased bone resorption and decreased bone formation
    • -loss of bone density (osteopenia/osteoporosis)
    • -muscle mass and strength decrease
    • -30% muscle mass lost by 70 yrs old
    • -less flexibility/more rigid movements
    • -osteoarthritis effects joints of older adults
  29. Nursing Interventions for Effects of Aging to the Musculoskeletal System
    • -M.S. assessments with emphasis on exercise practices
    • -Determine impact of age related changes on functional status of older adult
    • -Identify changes that increase pt. risk for falls
    • -Discuss fall prevention strategies
    • -Functional limitations can be halted/reversed with preventable strategies
    • *Diseases such as osteoarthritis and osteoporosis are NOT the normal consequences of getting older
    • *Carefully differentiate between expected changes and the effects of disease in the aging adult
    • *Help older adult return to higher functioning  level
  30. Cafe-au-lait
    characteristic markers of neurofibromatosis
  31. Normal Muscle Strength is graded as:
    5 bilaterally
  32. Muscle Strength Scale:
    • 0- no detection of muscular contraction 
    • 1- barely detectable contraction with observation or palpation
    • 2- active movement of body part with elimination of gravity
    • 3- active movement against gravity and not resistance
    • 4- active movement against gravity and some resistance
    • 5- Normal- active movement against full resistance without fatigue
  33. Pain in posterior leg when walking or running initially, can progress to pain at rest
    Achilles Tendonitis
  34. Stiffness and fixation of a joint
  35. Shortened stride with little weight baring as possible on effected side
    Antalgic Gait
  36. Staggering, uncoordinated gait often with sway
    Ataxic Gait
  37. Flabby appearance of muscle leading to decreased muscle and tone
  38. Finger abnormality, flexion of proximal interphalangeal joint and hyperextension of the distal interphalangeal joint of the fingers
    Boutonnie're Deformity
  39. Resistance of movement of muscle or joint as a result of fibrosis of supporting soft tissues
  40. Frequent audible crackling sound with palpable that accompanies movement
  41. While walking the neck truck or knees flex while the body is rigid, delayed start with short quick shuffling steps, speed may increase as if patient is unable to stop
    Festinating Gait
  42. Small fluid filled bump or mass over tendon sheath, usually on dorsal surface of wrist or feet
    Ganglion Cyst
  43. Forward bending of thoracic spine, slight flexion of knees, exaggerated thoracic curvature
  44. Dole ache along outer aspect of elbow, worsens with twisting and grasping motions... "tennis elbow"
    Lateral Epichondolytis
  45. Joint does not achieve expected degrees of motion
    Limited Range of Motion
  46. Asymmetric scapulae and shoulders exaggerated lumbar curvature
    Sway Back (Lordosis)
  47. Increased muscle tone, rigidity, with sustained muscle contractions, spasms, stiffness or tightness that interferes with gait, movement and speech
    Muscle Spasticity
  48. General muscle tenderness and pain
  49. Numbness and Tingling often described as pins and needles sensations
  50. Abnormal flatt-ness of sole and arch of the foot
    Pes Planus
  51. Burning sharp pain on sole of foot, worse in the morning
    Plantar Fasciitis
  52. Asymmetric elevation of shoulders, scapulae, and illiac crest with lateral spine curvature
  53. Limp, unless corrective footwear used
    Shortleg gait
  54. Short stops with dragging of foot, jerky uncoordinated, cross knee or scissor movement
    Spastic Gait
  55. Increased hip/knee flexion in order to clear foot from floor, foot drop is evident, foot slaps down in long walking surface
    Steppage Gait
  56. Hyperextension of PIP joint with flexion of the MCP (metacarpalphalangeal) and DIP joints of the fingers
    swan neck deformity
  57. Superficial swelling and pain and tenderness along tendon sheath
  58. neck is twisted and unusual position to one side
  59. Fingers drift ulnar side of forearm
    Ulnar Deviation
  60. When knees are together and there is more than 1 inch between medioli
    Valgum Deformity (knock knees)
  61. When knees are apart, space more than 1 inch exists
    Varum (bowlegged)
  62. Joint Aspiration
  63. Sport Injury:
    Entrapment of soft tissue structures under coracoacromial arch of shoulder
    Impingement Syndrome
  64. Sport Injury:
    Tear within muscle or tendinoligamentous structures around shoulder
    Rotator Cuff Tear
  65. Sport Injury:
    Inflammation along anterior aspect of calf from periostitis caused by improper shoes, overuse, or running on hard pavement
    Shin Splints
  66. Sport Injury:
    Inflammation of tendon as a result of overuse or incorrect use
  67. Sport Injury:
    Tearing or stretching of ligament; usually occurs as a result of inversion, eversion, shearing, or torque applied to a joint. Characterized by sudden pain, swelling, and instability
    Ligament Injury
  68. Sport Injury:
    Injury to fibrocartilage of knee characerized by popping, clicking, tearing sensation, effusion and/or swelling
    Meniscal Injury
  69. Health Impact of Regular Physical Exercise:
    • -Assists in Weight Control
    • -Helps maintain bone mass
    • -Helps prevent high bp
    • -Increases lean muscle and decreases body fat
    • -Increases muscle strength, flexibility
    • -Appears to reduce symptoms of depression
    • -Reduces risk of heart disease, diabetes, and colon cancer
    • -Enhances psychologic well-being and may reduce risk of depression
  70. Injuries that result from prolonged force, or repetitive movements and awkward postures
    Repetitive Strain Injury
  71. Condition caused by compression of the median nerve, which enters the hand through the narrow confines of the tunnel formed by ligaments and bones in the hand
    Carpal Tunnel Syndrome
  72. Examination of the knee with an ACL tear may produce a positive:
    Lachman's Test
  73. How is the Lachman's test performed?
    flexing the knee 15 to 30 degrees  and pulling the tibia forward while the femur is stabilized
  74. Inflammation of the bursae as a result of repeated or excessive trauma, or friction, gout, rheumatoid arthritis or infection
  75. Manifestations of Bursitis:
    warmth, pain, swelling, limited ROM at affected part of body...normally occurs in the hand, knee, or greater trochanter of the hip
  76. Disruption or break in the continuity of the structure of bone
  77. Type of fracture where the skin is broken, exposing the bone and causing soft tissue injury
    Open Fracture (compound)
  78. Type of fracture where the skin has not been ruptured and remains intact
    Closed (simple) Fracture
  79. Type of fracture where the break is through the entire bone
    Complete Fracture
  80. Fracture that occurs partly across a bone shaft by the bone is still in one piece (often a result of bending or crushing forces applied to the bone)
    Incomplete Fracture
  81. Fracture where the two ends of the broken bone are separated from one another and out of their normal positions
    Displaced Fracture
  82. More than two fragments of bone (fragmented pieces appear to be floating)
    Comminuted Fracture
  83. Fracture in which the periosteum is intact across the fracture and the bone is still in alignment (usually transverse, spiral, or greenstick)
    Nondisplaced Fracture
  84. Fracture in which the the line of the fracture extends across the bone shaft at a right angle to the longtitudinal axis
    Transverse Fracture
  85. Fracture in Which the line of fracture extends in a spiral direction along the shaft of the bone
    Spiral Fracture
  86. Incomplete fracture with one side splintered and the other side bent
  87. Spontaneous fracture at the site of a bone disease
    Pathologic Fracture
  88. Fracture that occurs in normal or abnormal bone that is subject to repeated stress, such as from jogging or running
    Stress Fracture
  89. Stages of Fracture Healing:
    • 1. Fracture Hematoma
    • 2. Granulation Tissue
    • 3. Callus Formation
    • 4. Ossification
    • 5. Consolidation
    • 6. Remodeling
  90. Stage of Fracture Healing in which bleeding occurs which surrounds the ends of the fragments...Extravasated blood that changes from a liquid to a semisolid clot (within 72hours after injury)
    Fracture Hematoma
  91. Stage of Fracture Healing in which active phagocytosis absorbs the products of local necorsis
    Granulation Tissue
  92. Stage of Fracture Healing in which minerals and new bone matrix are deposited in the osteoid
    Callus Formation
    Bleeding at fractured ends of the bone with subsequent hematoma formation, organization of hematoma into fibrous network, invasion of osteoblasts, lengthening of collegen strands, and deposition of calcium, callus formation: new bone is built up as osteoclasts destroy dead bone, Remodeling is accomplished as excess callus is reabsorbed and trabecular bone is laid down
  94. Complication of Fracture Healing in which it progresses more slowly than expected
    Delayed Union
  95. Complication of Fracture healing in which if fails to heal despite treatment, no xray evidence of callus formation
  96. Complication of Fracture Healing in which it heals within the expected time, but in unsatisfactory position, possibly resylting in deformity or dysfunction
  97. Complication of Fracture Healing in which the fracture heals in abnormal position in relation to midline of structure (type of malunion)
  98. Fraction Healing Complication in which a false joint is formed with abnormal movement at site (Type of Nonunion)
  99. Fracture Healing Complication In which the new fracture occurs at original fracture site
  100. Fracture Healing Complication in which there is a deposition of calcium in muscle tissue at site of significant blunt muscle trauma or repeated muscle injury
    Myositis Ossificans
  101. Nonsurgical, manual realignment of bone fragments to their previous anatomic position. Traction and countertraction are manually applied to the bone fragments to restore position, length, and alignment. Usually performed while the patient is under local or general anesthesia
    Closed Reduction
  102. Correction of bone alignment through surgical incision...usually includes internal fixation of the fracture with the use of wires, screws, pins, plates, intrameduallary rods, or nails
    Open Reduction
  103. Application of pulling force to an injured or diseased part of the body or an extremity while countertraction pulls in the opposite direction
  104. temporary circumferential immobilization device (common treatment after closed reduction)
  105. Fracture Reduction Collaborative Therapy
    • Manipulation
    • Closed Reduction
    • Skin Traction
    • Skeletal Traction
    • Open Reduction/Internal Fixation
  106. Fracture Immobilization Collaborative Therapy
    • Casting or Splinting
    • Traction
    • External Fixation
    • Internal Fixation
  107. Open Fractures Collaborative Therapy
    • Surgical debridement and irrigation
    • Tetanus and Diptheria Immunization
    • Prophylactic Antibiotic Therapy
    • Immobilization
  108. Four Types of Casts used for the immobilization of an acute fracture or soft tissue injury of the upper extremeties
    • Sugar-Tong splint
    • Posterior Splint
    • Short Arm Cast
    • Long Arm Cast
  109. Metallic device composed of metal pins that are inserted into the bone and attached to external rods to stabilize the fracture while it heals
    External Fixation
  110. Types of Internal Fixation
    Pins, Plates, Intramedullary rods, metal and bioabsorbable screws

    -surgically inserted at the time of realignment
  111. Drug Therapy for patients with FRACTURES
    Central/Peripheral muscle relaxants --> Caisoprdol (Soma), Cyclobenzaprine (Flexeril), Methocarbamol (Robaxin).... help with relief of muscle spasms

    Tetanus or Diphtheria Toxoid or Tetanus Immunoglobulin for the patient who has not been previously immunized

    Bone Penetrating Antibiotics (cephalosporin)
  112. Emergency Management for FRACTURE Interventions:
    • Treat LIFE THREATENING first
    • Ensure airway, breathing, and circulation
    • Control external bleeding with direct pressure or sterile pressure dressing and elevation of the extremity 
    • Splint joints above and below the fracture site
    • Check neurovascular status distal to injury before and after splinting
    • Elevate injured limb if possible
    • Do NOT attempt to straighten fractured or dislocated joints
    • Do NOT manipulate bone ends
    • Apply ice packs to affected area
    • Obtain Xrays
    • Administer Tetanus if skin integrity is compromised
    • Mark location of pulses to facilitate repeat assessment
    • Splint fracture site, including joints above and below fracture site
  113. Cast Care: Do NOT
    • Do NOT:
    • -get cast wet
    • -remove any padding
    • -insert any objects inside cast
    • -bear weight on new cast for 48 hours
    • -cover cast with plastic for prolonged periods
  114. Cast Care: DO
    • -apply ice directly over fracture site for first 24 hours
    • -check with hcp before getting giberglass cast wet
    • -dry cast thoroughly after exposure to water
    • -blot dry with towel
    • -use hair dryer on low setting until cast is thoroughly dry
    • -elevate extremity above level of the heart 
    • -move joints above and below cast regularly
    • -use hair dryer on cool setting for itching
    • -report signs of problems
    • -keep apt to have cast checked by doctor
  115. Crutch on one side advances simultaneously with the opposite (usually injured) extremity; this gait is also used with cane ambulation
    2-point gait
  116. slower version of the 2-point gait in which crutches and legs are advanced separately
    4-point gait
  117. both crutches are advanced together, followed by the lifting of both lower limbs to the same place; this gait is also used with walkers
  118. similar to the swing-to-gait but the patient swings the body past the crutches...An alternate four-point sweep through gait for patients with concurrent visual and neuromuscular disability provides exploration of upcoming terrain by the crutches before they are placed in the traditional position
  119. Condition in which elevated intracompartmental pressure within a confined myofascial compartment compromises the neurovascular function of tissues within that space
    Compartment Syndrom
  120. 2 main causes of compartment syndrome:
    1-- decreased compartment size resulting from restrictive dressings, splints, casts, excessive traction, or premature closure of  fascia

    2-- increased compartment contents related to bleeding, edema, chemical response to snakebite, or IV infiltration
  121. Expected range of intracompartmental pressure readings is 0-10mm Hg...Readings of ____ mmHg or higher indicate Compartment Syndrome
  122. Characteristics of Compartment Syndrome
    1. Paresthesia (numbness/tingling)

    • 2. Pain distal to injury that is not relieved by opioid
    • analgesics and pain on passive stretch of muscle traveling through the
    • compartment

    3. Pressure increases in the compartment

    4. Pallor, coolness, and loss of normal color

    5. Paralysis or loss of function 

    6. Pulselessness or diminished peripheral pulses
  123. Medications possibly ordered for Venous Thromboembolisms:
    • Warfarin
    • Low-molecular-weight Heparin
    • Fondaparinux (Arixtra)

    (prophylactic anticoagulant drugs)
  124. Characterized by the presence of systemic fat globules from fractures that are distributed into tissues and organs after a traumatic skeletal injury...
    (most symptoms are within 24-48 hours after injury)
    Fat Embolism Syndrome
  125. Tissues most often affected from Fat Embolism Syndrome
    Brain, lungs, heart, kidney, and skin
  126. Type of fracture of the distal radius (one of the most common in adults)
    Colles' Fracture
  127. S/S of Colles' Fracture
    pain to immediate area of injury, pronounced swelling, dorsal displacementof the distal fragment (silver-fork deformity) of the wrist
  128. Major complications of fractures of the humerus:
    radial nerve injury, vascular injury to the brachial artery as a result oflaceration, transection, or muscle spasm
  129. Type of fracture associated with the highest mortality rate:
    Pelvis Fracture
  130. Most common fracture in older adults
    Hip Fracture
  131. Type of fracture of the proximal third of the femur, which extends up to 5 cm below the lesser trochanter
    Hip Fracture
  132. Fractures that occur within the hip joint
    • Intracapsular 
    • (capital, subcapital, transcervical)
  133. Patient and Caregiver Teaching after AMPUTATION
    1. Inspect the residual limb daily for signs of skin irritation, especially erythema, excoriation, and odor. Pay particular attention to areas prone to pressure

    2. Discontinue use of the prosthesis if an irritation develops. Have the area checked before resuming use

    3. Wash residual limb thoroughly each night with warm water and a bateriostatic soap. Rinse thoroughly and dry gently. Expose to air for 20 minutes.

    4. Do not use any substance such as lotions, alcohol, powders, or oil on residual limb unless prescribed

    5. Wear only a residual limb sock that is in good condition

    6. Change residual limb sock daily

    7. Use prescribed pain management tech.

    8. Perform ROM to all joints daily

    9. Do no elevate the residual limb on a pillow

    10. Lay prone with hip in extension for 30 minutes three or four times daily
  134. Removal of the synovial membrane...used as a prolphylactic measure and as a palliative treatment of rheumatoid arthritis
  135. Removing a wedge or slice of bone to change alignment (joint and vertebral) and to shift weight bearing, thereby correcting deformity and relieving pain
  136. Reconstruction or replacement of a joint to relieve pain, improve or maintain ROM, and correct deformity
  137. Surgical fusion of a joint
  138. Used when adequate alignment cannot be obtained by other nonsurgical methods
    • ORIF
    • (Open Reduction with Internal Fixation)
  139. Severe infection of the bone, bone marrow, and surrounding soft tissue
  140. Most common infecting miccroorganism occurring in osteomyelitis
    Staphylococcus aureus
  141. What has significantly reduced the mortality rate and complications associated with osteomyelitis?
    Widespread use of antibiotics in conjunction with surgical treatment
  142. Area of Dead Bone (in osteomyelitis)
  143. Area of new bone formation (in osteomyelitis)
  144. Clinical Manifestations of ACUTE Osteomyelitis
    Systemic: fever, night sweats, chills, restlessness, nausea, malaise,

    Local: bone pain, swelling, tenderness, warmth, restricted movements
  145. Clinical Manifestations of CHRONIC Osteomyelitis:
    > one month

    • Systemic: may be diminished
    • Local: more common -- constant bone pain, swelling, tenderness, warmth at infection site
  146. Diagnostic Studies of Osteomyelitis:
    Bone/Soft Tissue Biopsy

    Blood/Wound Culture -- usually positive for microoganisms

    Elevated WBC and Erythrocyte Sedimentation Rate (ESR)

    Radiologic signs do not appear until 10 days - weeks after appearance of clinical s/s

    MRI/CT scans -- helps identify the extent of infection (including soft tissue involvement)
  147. Drugs prescribed for Osteomyelitis
    Penicillin, Nafcil, Neomycin, Vancomycin, Keflex, Cefazolin, Mefoxin, Garamycin, Nebcin
  148. DRUG ALERT: Garamycin
    • -instruct pt to notify hcp if any visual, hearing or urinary problems develop 
    • -assess pt for dehydration before starting therapy
  149. Primary benign bone tumor that is characterized by an overgrowth of cartilage and bone near the end of the bone at the growth plate
  150. Clinical manifestations of OSTEOCHONDROMA
    • -painless, hard, immobile mass
    • -lower than normal height for age
    • -soreness of muscles in close proximity
    • -one leg/arm longer than the other
    • -pressure/irritation with exercise
  151. Diagnostic Confirmation for Osteochondroma:
    MRI, CT, X-ray
  152. Primary bone tumor that is extremely aggressive and rapidly metastasizes to distant sites...usually occurs in the metaphyseal region of the long bones
  153. Diagnostic Tests of OSTEOSARCOMA
    • Tissue Biopsy
    • Elevation of serum alkaline phosphatase and calcium levels
    • X-ray
    • CT/PET
    • MRI
  154. Chemotherapeutic agents used for Osteosarcomas
    • Methotrexate
    • Adriamycin
    • Patinol
    • Cytoxan
    • VePesid
    • Blenoxane
    • Cosmegen
    • Ifex
Card Set:
Musculoskeletal System

Exam 3
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