-
Tear in ligament; usually from wrenching or twisting
Sprain
-
What are the Signs/Symptoms of a Sprain:
Pain, Soft tissue swelling, Tenderness, Ecchymosis, Decreased ROM
-
Tx for a Sprain:
- RICE=
- R-- Rest
- I-- Intermittent ice (24-48hrs) - Heat
- C-- Compression
- E-- Elevate
-
Tear in a Tendon...
Using muscle, ligament, or joint beyond normal function; excessive stretching
"Pulled Muscle"
Strain
-
S/S of a Strain:
Tenderness, Spasm, Decreased ROM, Edema
-
Tx of a Strain:
- RICE
- Spint
- (surgical suturing if severe)
-
Articulating surfaces not in contact
Dislocation
-
Incomplete Dislocation
Subluxation
-
What is the main cause of Dislocations/Sublaxations?
TRAUMA
-
Signs/Symptoms of Dislocations/Sublaxations:
Deformity, Limited Movement, Pain, Altered CSM
-
Treatment (Tx) of Dislocations/Sublaxation:
Reduction and Immobilization; splint
-
Cylinder-Shaped Structural Units of Bone:
Osteons
-
Widened area found at each end of a long bone (composed primarily of cancellous bone)
- Epiphysis
- (also location of muscle attachment)
-
Main shaft of the bone providing structural support and is composed of compact bone
Diaphysis
-
Flared area between the epiphysis and diaphysis
metaphysis
-
Growth Plate -- cartilaginous area between the epiphysis and metaphysis allowing for longitudinal growth
Epiphyseal Plate
-
Fibrous connective tissue that covers the bone (Tiny blood vessels penetrate the _____ to provide nutrition to underlying bones)
Periosteum
-
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:
Joint
-
Most common joint is:
Diarthrodial
-
Rigid connective tissue in synthodial joints that serves as a support for soft tissue and provides the articular surface for joint movement
Cartilage
-
3 Types of Muscle Tissue:
-
Contractions that increases the tension within a muscle but does not produce movement
- Isometric Contractions
- (makes muscles grow stronger)
-
Contractions that shorten the muscle to produce movement
Isotonic Contractions
-
Attaches muscle to bones as an extension of the muscle sheath that adheres to the periosteum
Tendon
-
Connects bone to bone...they have a higher elastic content than tendons
Ligament
-
Refers to layers of connective tissue with intermeshed fibers that can withstand limited stretching
Fascia
-
Small sacs of connective tissue lined with synovial membrane and containing synovial fluid
Bursae
-
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
-
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
-
Cafe-au-lait
characteristic markers of neurofibromatosis
-
Normal Muscle Strength is graded as:
5 bilaterally
-
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
-
Pain in posterior leg when walking or running initially, can progress to pain at rest
Achilles Tendonitis
-
Stiffness and fixation of a joint
Ankylosis
-
Shortened stride with little weight baring as possible on effected side
Antalgic Gait
-
Staggering, uncoordinated gait often with sway
Ataxic Gait
-
Flabby appearance of muscle leading to decreased muscle and tone
Atrophy
-
Finger abnormality, flexion of proximal interphalangeal joint and hyperextension of the distal interphalangeal joint of the fingers
Boutonnie're Deformity
-
Resistance of movement of muscle or joint as a result of fibrosis of supporting soft tissues
Contracture
-
Frequent audible crackling sound with palpable that accompanies movement
Crepitus
-
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
-
Small fluid filled bump or mass over tendon sheath, usually on dorsal surface of wrist or feet
Ganglion Cyst
-
Forward bending of thoracic spine, slight flexion of knees, exaggerated thoracic curvature
Kyphosis
-
Dole ache along outer aspect of elbow, worsens with twisting and grasping motions... "tennis elbow"
Lateral Epichondolytis
-
Joint does not achieve expected degrees of motion
Limited Range of Motion
-
Asymmetric scapulae and shoulders exaggerated lumbar curvature
Sway Back (Lordosis)
-
Increased muscle tone, rigidity, with sustained muscle contractions, spasms, stiffness or tightness that interferes with gait, movement and speech
Muscle Spasticity
-
General muscle tenderness and pain
Myalgia
-
Numbness and Tingling often described as pins and needles sensations
Parasthesia
-
Abnormal flatt-ness of sole and arch of the foot
Pes Planus
-
Burning sharp pain on sole of foot, worse in the morning
Plantar Fasciitis
-
Asymmetric elevation of shoulders, scapulae, and illiac crest with lateral spine curvature
Scoliosis
-
Limp, unless corrective footwear used
Shortleg gait
-
Short stops with dragging of foot, jerky uncoordinated, cross knee or scissor movement
Spastic Gait
-
Increased hip/knee flexion in order to clear foot from floor, foot drop is evident, foot slaps down in long walking surface
Steppage Gait
-
Hyperextension of PIP joint with flexion of the MCP (metacarpalphalangeal) and DIP joints of the fingers
swan neck deformity
-
Superficial swelling and pain and tenderness along tendon sheath
tenosynovitis
-
neck is twisted and unusual position to one side
Torticollis
-
Fingers drift ulnar side of forearm
Ulnar Deviation
-
When knees are together and there is more than 1 inch between medioli
Valgum Deformity (knock knees)
-
When knees are apart, space more than 1 inch exists
Varum (bowlegged)
-
Joint Aspiration
Arthrocentesis
-
Sport Injury:
Entrapment of soft tissue structures under coracoacromial arch of shoulder
Impingement Syndrome
-
Sport Injury:
Tear within muscle or tendinoligamentous structures around shoulder
Rotator Cuff Tear
-
Sport Injury:
Inflammation along anterior aspect of calf from periostitis caused by improper shoes, overuse, or running on hard pavement
Shin Splints
-
Sport Injury:
Inflammation of tendon as a result of overuse or incorrect use
Tendinitis
-
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
-
Sport Injury:
Injury to fibrocartilage of knee characerized by popping, clicking, tearing sensation, effusion and/or swelling
Meniscal Injury
-
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
-
Injuries that result from prolonged force, or repetitive movements and awkward postures
Repetitive Strain Injury
-
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
-
Examination of the knee with an ACL tear may produce a positive:
Lachman's Test
-
How is the Lachman's test performed?
flexing the knee 15 to 30 degrees and pulling the tibia forward while the femur is stabilized
-
Inflammation of the bursae as a result of repeated or excessive trauma, or friction, gout, rheumatoid arthritis or infection
Bursitis
-
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
-
Disruption or break in the continuity of the structure of bone
Fracture
-
Type of fracture where the skin is broken, exposing the bone and causing soft tissue injury
Open Fracture (compound)
-
Type of fracture where the skin has not been ruptured and remains intact
Closed (simple) Fracture
-
Type of fracture where the break is through the entire bone
Complete Fracture
-
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
-
Fracture where the two ends of the broken bone are separated from one another and out of their normal positions
Displaced Fracture
-
More than two fragments of bone (fragmented pieces appear to be floating)
Comminuted Fracture
-
Fracture in which the periosteum is intact across the fracture and the bone is still in alignment (usually transverse, spiral, or greenstick)
Nondisplaced Fracture
-
Fracture in which the the line of the fracture extends across the bone shaft at a right angle to the longtitudinal axis
Transverse Fracture
-
Fracture in Which the line of fracture extends in a spiral direction along the shaft of the bone
Spiral Fracture
-
Incomplete fracture with one side splintered and the other side bent
Greenstick
-
Spontaneous fracture at the site of a bone disease
Pathologic Fracture
-
Fracture that occurs in normal or abnormal bone that is subject to repeated stress, such as from jogging or running
Stress Fracture
-
Stages of Fracture Healing:
- 1. Fracture Hematoma
- 2. Granulation Tissue
- 3. Callus Formation
- 4. Ossification
- 5. Consolidation
- 6. Remodeling
-
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
-
Stage of Fracture Healing in which active phagocytosis absorbs the products of local necorsis
Granulation Tissue
-
Stage of Fracture Healing in which minerals and new bone matrix are deposited in the osteoid
Callus Formation
-
BONE HEALING PROCESS
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
-
Complication of Fracture Healing in which it progresses more slowly than expected
Delayed Union
-
Complication of Fracture healing in which if fails to heal despite treatment, no xray evidence of callus formation
Nonunion
-
Complication of Fracture Healing in which it heals within the expected time, but in unsatisfactory position, possibly resylting in deformity or dysfunction
Malunion
-
Complication of Fracture Healing in which the fracture heals in abnormal position in relation to midline of structure (type of malunion)
Angulation
-
Fraction Healing Complication in which a false joint is formed with abnormal movement at site (Type of Nonunion)
Pseudoarthrosis
-
Fracture Healing Complication In which the new fracture occurs at original fracture site
Refracture
-
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
-
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
-
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
-
Application of pulling force to an injured or diseased part of the body or an extremity while countertraction pulls in the opposite direction
Traction
-
temporary circumferential immobilization device (common treatment after closed reduction)
Casts
-
Fracture Reduction Collaborative Therapy
- Manipulation
- Closed Reduction
- Skin Traction
- Skeletal Traction
- Open Reduction/Internal Fixation
-
Fracture Immobilization Collaborative Therapy
- Casting or Splinting
- Traction
- External Fixation
- Internal Fixation
-
Open Fractures Collaborative Therapy
- Surgical debridement and irrigation
- Tetanus and Diptheria Immunization
- Prophylactic Antibiotic Therapy
- Immobilization
-
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
-
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
-
Types of Internal Fixation
Pins, Plates, Intramedullary rods, metal and bioabsorbable screws
-surgically inserted at the time of realignment
-
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)
-
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
-
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
-
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
-
Crutch on one side advances simultaneously with the opposite (usually injured) extremity; this gait is also used with cane ambulation
2-point gait
-
slower version of the 2-point gait in which crutches and legs are advanced separately
4-point gait
-
both crutches are advanced together, followed by the lifting of both lower limbs to the same place; this gait is also used with walkers
Swing-to-gait
-
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
Swing-Through-Gait
-
Condition in which elevated intracompartmental pressure within a confined myofascial compartment compromises the neurovascular function of tissues within that space
Compartment Syndrom
-
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
-
Expected range of intracompartmental pressure readings is 0-10mm Hg...Readings of ____ mmHg or higher indicate Compartment Syndrome
30mmHg
-
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
-
Medications possibly ordered for Venous Thromboembolisms:
- Warfarin
- Low-molecular-weight Heparin
- Fondaparinux (Arixtra)
(prophylactic anticoagulant drugs)
-
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
-
Tissues most often affected from Fat Embolism Syndrome
Brain, lungs, heart, kidney, and skin
-
Type of fracture of the distal radius (one of the most common in adults)
Colles' Fracture
-
S/S of Colles' Fracture
pain to immediate area of injury, pronounced swelling, dorsal displacementof the distal fragment (silver-fork deformity) of the wrist
-
Major complications of fractures of the humerus:
radial nerve injury, vascular injury to the brachial artery as a result oflaceration, transection, or muscle spasm
-
Type of fracture associated with the highest mortality rate:
Pelvis Fracture
-
Most common fracture in older adults
Hip Fracture
-
Type of fracture of the proximal third of the femur, which extends up to 5 cm below the lesser trochanter
Hip Fracture
-
Fractures that occur within the hip joint
- Intracapsular
- (capital, subcapital, transcervical)
-
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
-
Removal of the synovial membrane...used as a prolphylactic measure and as a palliative treatment of rheumatoid arthritis
Synovectomy
-
Removing a wedge or slice of bone to change alignment (joint and vertebral) and to shift weight bearing, thereby correcting deformity and relieving pain
Osteotomy
-
Reconstruction or replacement of a joint to relieve pain, improve or maintain ROM, and correct deformity
Arthroplasty
-
Surgical fusion of a joint
Arthrodesis
-
Used when adequate alignment cannot be obtained by other nonsurgical methods
- ORIF
- (Open Reduction with Internal Fixation)
-
Severe infection of the bone, bone marrow, and surrounding soft tissue
Osteomyelitis
-
Most common infecting miccroorganism occurring in osteomyelitis
Staphylococcus aureus
-
What has significantly reduced the mortality rate and complications associated with osteomyelitis?
Widespread use of antibiotics in conjunction with surgical treatment
-
Area of Dead Bone (in osteomyelitis)
Sequestrum
-
Area of new bone formation (in osteomyelitis)
Involucrum
-
Clinical Manifestations of ACUTE Osteomyelitis
Systemic: fever, night sweats, chills, restlessness, nausea, malaise,
Local: bone pain, swelling, tenderness, warmth, restricted movements
-
Clinical Manifestations of CHRONIC Osteomyelitis:
> one month
- Systemic: may be diminished
- Local: more common -- constant bone pain, swelling, tenderness, warmth at infection site
-
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)
-
Drugs prescribed for Osteomyelitis
Penicillin, Nafcil, Neomycin, Vancomycin, Keflex, Cefazolin, Mefoxin, Garamycin, Nebcin
-
DRUG ALERT: Garamycin
- -instruct pt to notify hcp if any visual, hearing or urinary problems develop
- -assess pt for dehydration before starting therapy
-
Primary benign bone tumor that is characterized by an overgrowth of cartilage and bone near the end of the bone at the growth plate
Osteochondroma
-
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
-
Diagnostic Confirmation for Osteochondroma:
MRI, CT, X-ray
-
Primary bone tumor that is extremely aggressive and rapidly metastasizes to distant sites...usually occurs in the metaphyseal region of the long bones
Osteosarcoma
-
Diagnostic Tests of OSTEOSARCOMA
- Tissue Biopsy
- Elevation of serum alkaline phosphatase and calcium levels
- X-ray
- CT/PET
- MRI
-
Chemotherapeutic agents used for Osteosarcomas
- Methotrexate
- Adriamycin
- Patinol
- Cytoxan
- VePesid
- Blenoxane
- Cosmegen
- Ifex
|
|