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what is a contusion?
bleeding into soft tissue as a result of of blunt force
what is a muscle strain?
stretching injury to a muscle or a muscle-tendon unit caused by mechanical overload
what are the s/s of a muscle strain?
pain, limited motion, muscle spasm, swelling and possible muscle weakness
what is a sprain?
- stretch or tear of a ligament surrounding a joint
- *ankle and knee are most common
what are s/s of a sprain?
cant move joint, discoloration, pain, rapid swelling
what does RICE stand for?
what is a dislocation?
ends of two connected bones separate as a result from extreme force put on a ligament
what are symptoms of dislocation?
pain, swelling, immobility, deformity, warmth, bruising, or redness in injured area
what is bursitis?
- inflammation of the bursa
- bursa is a tiny fluid-filled sac located adjacent to the tendona near large joints
what causes bursitis?
injury, infection, underlying rheumatic condition, inflammation of bursa from gout crystals
how is bursitis treated?
ice, rest, anti-inflammatory and pain meds, aspiration of bursa fluid, cortisone injection
how is septic bursitis identified?
aspiration and culture of fluid to identify organism
how is septic bursitis treated?
- aggressive vancomycin treatment
- may need repeated aspiration of fluid
- surgical drainage and removal of infected bursa sac
what is carpal tunnel syndrome?
the median nerve in the wrist becomes compressed causing pain and numbness
what are clinical manifestations of carpal tunnel syndrome?
- phalen's maneuver, tinel's sign, numbness, painful tingling, weak pinch, clumsiness and difficulty with fine movements.
- progresses to muscle weakness
how is carpal tunnel syndrome diagnosed?
xray, emg, mri, ultrasound
how is carpal tunnel treated?
- nsaids, corticosteroid injections
- immobilization of wrist
- surgical nerve decompression
what causes a torn meniscus?
usually a result of twisting the leg when the knee is flexed and foot is on the ground
what are the s/s of a torn meniscus?
- pain, swelling and tenderness in the knee
- clicking or snapping sound when the knee is moved
what is a muscle spasm?
involuntary movement or contraction of muscles without full control
what causes muscle spasms?
muscle fatigue, dehydration, low Mg or Ca, alcoholism, kidney failure
how are muscle spasms treated?
- antispasmodic muscle relaxants
- opioid analgesics
- relaxation techniques
what is a complete fracture?
break is across the entire width of the bone, the bone is divided into two distinct sections
what is an incomplete fracture?
the fracture does not divide the bone into two distinct sections, break is through only part of the bone
how do you perform a neurovascular assessment on a fracture?
- compare the injured area with its systemic counterpart
- assess color, temp, movement, sensation, pulse, cap refill, pain
emergency treatment of a fracture:
- cover with sterile dressing if open
- do not attempt to clean
- do not reduce
what are the s/s of a fracture?
pain, diminished mobility, change in bone alignment, shortening of extremity, swelling, discoloration, crepitation - a grating aound created by bone fragments rubbing together
what are the complications of a fracture?
- acute compartment syndrome secondary to swelling
- dvt secondary to immobility
- infection (osteomyelitis)
- fat embolism syndrome
- delayed union, nonunion and malunion
what is acute compartment syndrome?
pressure from edema and hemorrhage
what are internal and external causes of acute compartment syndrome?
- external=casts and constricting dressings
what are s/s of acute compartment syndrome?
- numbness and tingling (paresthesia)
- pallor of tissue, weak pulse
- weakness of extremity
- pain with passive movement of extremity
- pain that is unrelieved by pain medication
what are risk factors for infection?
- open fracture
- diminished bloodflow
infection leads to...
- delayed wound healing
- tissue death and necrosis
what is a fat embolus?
- fat globules lodge in lungs or peripheral circulation
- occur in long bone fractures
what are s/s of a fat embolus?
- dependent on where that fat has lodged
how is a fat embolus prevented?
early stabilization of fracture
what types of casts are available?
- plaster of paris
- polyester-cotton knit
what complications can occur from a cast?
- circulatory impairment
- peripheral nerve damage
- complication of immobility
what is an external fixation?
pins are implanted into the bone and held in place ny an external metal frame to prevent bone movement
what are s/s of a hip fracture?
- affected leg will be shorter
- affected leg will be externally rotated
- edema, stiffness and bruising
- pain in hip or groin
- inability to bear weight on affected extremity
- muscle spasm
what is the chief concern in a pelvic fracture?
hemorrhage and shock
what are most compression fractures of the spine associated with?
how are compression fractures ofthe spine treated?
- nonsurgical management = bedrest, analgesics, and physical therapy
- surgical = vertebroplasty and kyphoplasty in which bone cement is injected
paget's disease is characterized by...
an excess of bone destruction and unorganized bone formation
what is the cause of pagets disease?
- genetic predisposition in 10% of patients
- slow viral infection may trigger the disease
- autoimmune dysfunction
what bones does paget's disease affect?
vertebrae, skull, pelvis, femur, and tibia
paget's disease : pathophysiology
- increase in osteoclasts cause bone reabsorption
- increase in osteoblasts cause bone formation
- result is new bone that is structurally weak and enlarged
- deformities and bony enlargement occur
what are s/s of paget's disease?
- none in early stages
- severe and persistent pain that intensifies with weight bearing
- cranial enlargement (headaches, hearing and vision impaired)
- kyphosis, barrel shaped chest, asymmetrical bowing of tibia and femur
- site warm and tender
- slow and incomplete healing of fractures
what is osteomalacia?
- adult bone disease
- vitamin d deficiency resulting in decalcification and softening of the bone
what are s/s of osteomalacia?
- difficulty walking
- fractures and delayed healing
- height loss
which foods contain vitamin d?
eggs, low fat milk, fish, vegetables
what is osteoporosis?
- porus bone with low bone mass
- structural deterioration of bone tissue
- known as the silent thief
what are the risk factors for osteoporosis?
female, increasing age, family hx, white or asian, small stature, early menopause, hx of anorexia or oophorectomy, sedentary lifestyle, insufficient dietary calcium, cigarette smoking, alcoholism
which medications may cause osteoporosis?
- anti-seizure meds
- aluminum-containing antacids
- certain cancer treatments
what are clinical manifestations of osteoporosis?
- back pain or spontaneous fracture
- fracture from minimal trauma
- hip, vertebral or wrist fracture
- spinal deformities
which foods are high in calcium?
sardines, milk, ice cream, cottage cheese, yogurt
which dietary factors should be decreased in patients with osteoporosis?
alcohol and caffine
what is osteomyelitis?
bacterial infection of the bone caused by fungus, parasites, and virus
what is hematogenous osteomyelitis?
pathogens are carried in the blood to the bone from sites of infection elsewhere in the body
how can a patient get osteomyelitis?
- from a contiguous infection
- vascular insufficiency
what are risk factors for osteomyelitis?
- intravenous drug abusers
- hemodialysis patients
- recent trauma
- diabetes mellitus
how is osteomyelitis diagnosed?
- bone scan
- blood test/culture
- wound culture
what is localized scleroderma?
- a chronic autoimmune disease that causes hardening of the skin and scarring
- can be limited around the fingers or in large areas such as limbs
what does CREST stand for?
- Calcinosis - calcium deposits in the skin
- Raynauds syndrome
- Esophageal dysfunction - acid reflux and decrease in motility of the esophagus
- Sclerodactyly - thickening and tightening of the skin on the fingers and hands
- Telangieactasias - dilation of capillaries causing red marks on the surface of the skin
what are clinical manifestations of osteoarthritis?
- joint pain (grating pain that diminishes after rest and intensifies after activity)
- joint stiffness after a period of inactivity
- crepitus (grating sound)
- joint enlargement due to bony hypertrophy
- joint is rarely hot or inflamed
what are systemic signs of rheumatoid arthritis?
- loss of appetite
- low grade fever
what are localized signs of rheumatoid arthritis?
- muscle and joint aches
- muscle joints are inflamed in a symmetrical pattern
- joints become red, swollen, painful, and tender
what is primary gout?
- most common type
- results from inborn errors of purine metabolism or a decrease in renal uric acid excretion
what is secondary gout?
involves hyperuricemia caused by another disease process such as renal insufficiency, multiple myeloma, certain carcinomas
what are clinical manifestations of gout?
- pain, swelling, redness, warmness and stiffness in the affected joint
- inflammation of the tissue around the joint also causes the skin to be swollen, tender and sore
post-op care for a total hip replacement:
- wound care: stitches or staples will be removed 2 weeks after surgery, avoid getting wet, bandage over incision, observe for bleeding
- may have drain in place: monitor output
- assess for neurovascular compromise: color, temp, pulses, cap refill, movement/sensation, compare to non-operative side
- pain: epidural analgesia, pca
progression of activity for a total hip replacement:
- pt gets out of bed the day after surgery and physical therapy is started
- raised toilet seats and chairs to prevent hyperflexion
- a patient with a cemented implant is allowed immediate partial weight bearing (PWB) or full weight bearing (FWB)
- a patient with a noncemented implant cannot tolerate FWB until bony ingrowth occurs
post-op care for a total knee replacement:
- similar to THR
- maintain the knee in a neutral position - not internally/externally rotated
- knee brace
- continuous passive motion device