Musculoskeletal Pathology and Healing
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- 1. Rigid Support
- 2. Framework
- 3. Protect Organs
- 4. Storage of calcium and blood cell formation
Long, short, flat, irregular
Osteophytes, osteoblasts, osteoclasts
Mature cells that are located in the matrix
Cells that produce new bone cells
Cells that absorb old bone cells
Strong, rigid, outer layer
Spongy, less dense bone. Forms interior
End of bone, cancellous
AKA Articular Cartilage, on ends of bones
Fibrous CT, painful is stretched/torn that covers the boney surface
Skeletal Muscle Function
Contract (movement), Tone (maintains body position), Stabilize joints, control body temp
Produces CO2 and large number of ATP
Produces lactic acid and a small number of ATP
May lead to muscle spasm
Prolonged Muscle Spasm
May cause ischemia in muscle
Composed of CT, connects muscle to bone
Composed of CT, connects bone to bone
Aerobic Exercise Effects
Increases circulation, mitochondria, and myoglobin which improves respiratory and C_V function. Does not hypertrophy.
Anaerobic Exercise Effects
Hypertrophies in presence of enough stress
Fibrous and immovable. Skull sutures
AKA Fibrocartilage. Slightly moveable.
Synovial. Six types. Hinge, pivot, condyloid, ball and socket, plane, and saddle.
Have (hyaline) articular cartilage, synovial fluid and membrane, articular capsule, and capsule reinforced by ligaments
Synovial membrane and fibrous capsule
Serum Creatine Kinase
Shows if there's muscle break down by showing muscle protein in blood. Can be skeletal or cardiac
Sedimentation rate. Increases with chronic inflammation
Indicats level of RA. Having a mild indication doesn't mean you have RA.
Synovial Fluid Aspiration
Used to check for inflammation, bleeding, or infection.
General S&S of M-S disorders
Pain, deformity, decreased ROM
S&S of Fractures
Pain, deformity, muscle spasm
Pain, stiffness of joints, increased ROM (laxity) mostly in RA.
3 phases of pathophysiology healing
- P1- Inflammation Response (actue)
- P2- Repair and Regeneration (Subacute)
- P3- Remodel and Maturation
Inflammation Response Phase
Inflam/bleeding into medullary canal. Forms a hematoma in the canal under the periosteum. Necrosis of bone at the ends of fracture site.
Repair and Regeneration Phase
Fibrin network has formation of granulation tissue in hematoma. Capillaries, phagocytes, and fibroblasts migrate into area. Fibroblasts create fibrin. Chondroblasts for new cartilage. Fibrocartilaginous callus (procallus) forms. It is weak. Early bridge/collar around fracture site. Osteoblasts form new bone cells. Procallus replaced by bony callus. THIS S REGENERATION, NOT SCAR FORMATION
Bone remodels in response to stress. Normal healing time children ~1month, adults ~2 months.
- Muscle spasms- with bone deformity.
- Nonunion- Failure to heal.
- Malunion- Heal with deformity.
- Infection- Osteomyelitis or tetanus.
- Ischemia- If cast too tight.
- Growth retardation if epiphyseal plate damage.
- OA- if near a joint
S&S Clinical Findings
Obvious deformity, pain, shock if sever pain, nausea/vomiting occasionally, edema/tenderness at site, crepitis.
X-ray, MRI, CT scan
Medical TX Reduction (two types)
- Closed- Pressure/traction, manual or with weights/pulleys
- ORIF- Pins/screws/rods, put ends together, remove foreign material
Exercising an Injury
Increase circulation, minimize joint contractures, decrease atrophy.
Separation of two bones at a joint, loss of contact of joint surfaces, usually one out of place
Partial dislocation/loss of contact
Shoulder Dislocation Etiology
Trauma in ABD/ER. Blow forcing movement in this direction. Humerus head dislocates anteriorly through glenoheumeral ligament and capsule.
Shoulder Dislocation Pathology
Tissue damage to ligaments, nerves, blood vessels, capsule with bleeding/inflammation. Occasionally associated with fx.
Shoulder Dislocation Clinical Findings
Decrease in radial pulse, possible paresthesia if axillary nerve or ulnar nerve damage.
Shoulder Dislocation Medical Tx Reduction
Prone with arm dangling, Gentle steady pull, immobilize, exercise to maintain ROM/strength.
Shoulder Dislocation Surgical Tx
Chronic. Tighten subscapularis, bony block to prevent ER, or tighten capsule.
Congenital Hip Dislocation
More common in women. Hip socket too shallow, ligaments looser. May develop aseptic necrosis of the head of femur if not quickly corrected. Dislocates posteriorly.
Congenital Hip Dislocation S&S
Limb shorter, buttock fold abnormal.
Congenital Hip Dislocation Medical Management
Correct by moving into FLexion/ABD/ER. Day and night wear ABD splint.
Blow resulting in contusion of muscle, excessive stretch, repetitive loading to an unprepared tendon due to lack of ROM, strength, and/or endurance.
1st Degree Strain
- 1. Pain with use.
- 2. Pain with resistance
- 3. Strength of 4 or 5
- 4. ROM WNL
2nd Degree Strain
- 1. Pain increases significantly with use.
- 2. Pain at rest.
- 3. Decrease AROM
- 4. Decrease strength 4 or below
3rd Degree Strain
- 1. Significantly decreased AROM
- 2. Significantly decreased strength 3- or less
- 3. May be visible
- 4. OFten less pain
Biceps, Achilles, ECRBr, and most common supraspinatus.
CTS Carpal Tunnel Syndrome
FDS/FPS irritation. Wrist fx, trauma, arthritis, tenosynovitis, edema. Compression of MEDIAN nerve in carpal tunnel.
CTS Clinical Findings
Weakness/atrophy of thenar eminence and lumbricles 1 and 2. Decreased sensation over median nerve. Decreased joint mobility in wrist and MCP joints of first 3 fingers.
Decreased fine control of thumb. Inabilty to perform sustained activity with wrist.
- Medical- Splint, rest, inject
- Surgical- Release deep palmar liagment
1st Degree Sprain
- 1. Pain with stretch to ligament
- 2. Edema
- 3. Tenderness
- 4. No signs of instability
2nd Degree Sprain
- 1. Significant pain increases with stretch
- 2. Edema
- 3. Increased tenderness
- 4. Joint Unstable
- 5. More painful than 3rd
3rd Degree Sprain
- 1. Pain with stretch
- 2. Significant Edema
- 3. Increased Tenderness
- 4. Joint unstable
Sprain Diagnosis Made By
How injured, palpation, joint instability, snap or pop noise, immediate edema.
Meds for pain, crutches if LE, tape/cast/orthotic, anti inflammatory, PRICE.
Bursitis Clinical Findings
Decreased AROM, tender to palpation, pain in pattern, PROM WNL
Injection, muscle relaxors, anti inflam, avoiding exercises with pain
Isometric contraction to prevent movement for the purpose of distal movement. A cocontraction of agnoist and antagnoist muscles.
More muscle fibers
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