Musculoskeletal Pathology and Healing

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Musculoskeletal Pathology and Healing
2013-09-09 20:32:19
Musculoskeletal quiz Pathology Healing

PP/Class notes on Musculoskeletal Pathology and Healing
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  1. Bone Functions
    • 1. Rigid Support
    • 2. Framework
    • 3. Protect Organs
    • 4. Storage of calcium and blood cell formation
  2. Shapes
    Long, short, flat, irregular
  3. Bone Cells
    Osteophytes, osteoblasts, osteoclasts
  4. Osteophyte
    Mature cells that are located in the matrix
  5. Osteoblast
    Cells that produce new bone cells
  6. Osteoclast
    Cells that absorb old bone cells
  7. Compact Bone
    Strong, rigid, outer layer
  8. Cancellous
    Spongy, less dense bone. Forms interior
  9. Diaphysis
  10. Metaphysis
    Widened End
  11. Epiphysis
    End of bone, cancellous
  12. Medullar Canal
    Contains Marrow
  13. Hyaline Cartilage
    AKA Articular Cartilage, on ends of bones
  14. Periosteum
    Fibrous CT, painful is stretched/torn that covers the boney surface
  15. Skeletal Muscle Function
    Contract (movement), Tone (maintains body position), Stabilize joints, control body temp
  16. Aerobic
    Produces CO2 and large number of ATP
  17. Anaerobic
    Produces lactic acid and a small number of ATP
  18. Lactic Acid
    May lead to muscle spasm
  19. Prolonged Muscle Spasm
    May cause ischemia in muscle
  20. Tendon
    Composed of CT, connects muscle to bone
  21. Ligament
    Composed of CT, connects bone to bone
  22. Aerobic Exercise Effects
    Increases circulation, mitochondria, and myoglobin which improves respiratory and C_V function. Does not hypertrophy.
  23. Anaerobic Exercise Effects
    Hypertrophies in presence of enough stress
  24. Synarthrosis Joint
    Fibrous and immovable. Skull sutures
  25. Amphiarthrosis
    AKA Fibrocartilage. Slightly moveable.
  26. Diarthrodal
    Synovial. Six types. Hinge, pivot, condyloid, ball and socket, plane, and saddle.
  27. Synovial Continued
    Have (hyaline) articular cartilage, synovial fluid and membrane, articular capsule, and capsule reinforced by ligaments
  28. Articular Capsule
    Synovial membrane and fibrous capsule
  29. Serum Creatine Kinase
    Shows if there's muscle break down by showing  muscle protein in blood. Can be skeletal or cardiac
  30. SED Rate
    Sedimentation rate. Increases with chronic inflammation
  31. RA Factor
    Indicats level of RA. Having a mild indication doesn't mean you have RA.
  32. Synovial Fluid Aspiration
    Used to check for inflammation, bleeding, or infection.
  33. General S&S of M-S disorders
    Pain, deformity, decreased ROM
  34. S&S of Fractures
    Pain, deformity, muscle spasm
  35. S&S Arthritis
    Pain, stiffness of joints, increased ROM (laxity) mostly in RA.
  36. 3 phases of pathophysiology healing
    • P1- Inflammation Response (actue)
    • P2- Repair and Regeneration (Subacute)
    • P3- Remodel and Maturation
  37. 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.
  38. 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
  39. Maturation Phase
    Bone remodels in response to stress. Normal healing time children ~1month, adults ~2 months.
  40. Healing Complications
    • 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
  41. S&S Clinical Findings
    Obvious deformity, pain, shock if sever pain, nausea/vomiting occasionally, edema/tenderness at site, crepitis.
  42. Diagnostic Tests
    X-ray, MRI, CT scan
  43. Medical TX Reduction (two types)
    • Closed- Pressure/traction, manual or with weights/pulleys
    • ORIF- Pins/screws/rods, put ends together, remove foreign material
  44. Exercising an Injury
    Increase circulation, minimize joint contractures, decrease atrophy.
  45. Dislocation
    Separation of two bones at a joint, loss of contact of joint surfaces, usually one out of place
  46. Subluxation
    Partial dislocation/loss of contact
  47. Shoulder Dislocation Etiology
    Trauma in ABD/ER. Blow forcing movement in this direction. Humerus head dislocates anteriorly through glenoheumeral ligament and capsule.
  48. Shoulder Dislocation Pathology
    Tissue damage to ligaments, nerves, blood vessels, capsule with bleeding/inflammation. Occasionally associated with fx.
  49. Shoulder Dislocation Clinical Findings
    Decrease in radial pulse, possible paresthesia if axillary nerve or ulnar nerve damage.
  50. Shoulder Dislocation Medical Tx Reduction
    Prone with arm dangling, Gentle steady pull, immobilize, exercise to maintain ROM/strength.
  51. Shoulder Dislocation Surgical Tx
    Chronic. Tighten subscapularis, bony block to prevent ER, or tighten capsule.
  52. 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.
  53. Congenital Hip Dislocation S&S
    Limb shorter, buttock fold abnormal.
  54. Congenital Hip Dislocation Medical Management
    Correct by moving into FLexion/ABD/ER. Day and night wear ABD splint.
  55. Strain/Tendonitis
    Blow resulting in contusion of muscle, excessive stretch, repetitive loading to an unprepared tendon due to lack of ROM, strength, and/or endurance.
  56. 1st Degree Strain
    • 1. Pain with use.
    • 2. Pain with resistance
    • 3. Strength of 4 or 5
    • 4. ROM WNL
  57. 2nd Degree Strain
    • 1. Pain increases significantly with use.
    • 2. Pain at rest.
    • 3. Decrease AROM
    • 4. Decrease strength 4 or below
  58. 3rd Degree Strain
    • 1. Significantly decreased AROM
    • 2. Significantly decreased strength 3- or less
    • 3. May be visible
    • 4. OFten less pain
  59. Common Strains
    Biceps, Achilles, ECRBr, and most common supraspinatus.
  60. CTS Carpal Tunnel Syndrome
    FDS/FPS irritation. Wrist fx, trauma, arthritis, tenosynovitis, edema. Compression of MEDIAN nerve in carpal tunnel.
  61. 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.
  62. CTS Limits
    Decreased fine control of thumb. Inabilty to perform sustained activity with wrist.
  63. CTS Tx
    • Medical- Splint, rest, inject
    • Surgical- Release deep palmar liagment
  64. 1st Degree Sprain
    • 1. Pain with stretch to ligament
    • 2. Edema
    • 3. Tenderness
    • 4. No signs of instability
  65. 2nd Degree Sprain
    • 1. Significant pain increases with stretch
    • 2. Edema
    • 3. Increased tenderness
    • 4. Joint Unstable
    • 5. More painful than 3rd
  66. 3rd Degree Sprain
    • 1. Pain with stretch
    • 2. ¬†Significant Edema
    • 3. Increased Tenderness
    • 4. Joint unstable
  67. Sprain Diagnosis Made By
    How injured, palpation, joint instability, snap or pop noise, immediate edema.
  68. Sprain Tx
    Meds for pain, crutches if LE, tape/cast/orthotic, anti inflammatory, PRICE.
  69. Bursitis Clinical Findings
    Decreased AROM, tender to palpation, pain in pattern, PROM WNL
  70. Bursitis Tx
    Injection, muscle relaxors, anti inflam, avoiding exercises with pain
  71. Stabiization
    Isometric contraction to prevent movement for the purpose of distal movement. A cocontraction of agnoist and antagnoist muscles.
  72. Hyperplasia
    More muscle fibers