Fracture types?patho? healing process? Tx? CM?
- A fracture is a break in continuity of a bone, an epiphyseal plate, or a cartilagious joint surface.
- Trauma may also occur to adjacent tissue.
- types: open (compound) and closed (simple) -- the biggest complication in compound fracture is that the bone was exposed to air, n the pt is prone to osteomylitis.
- Patho: Periosteum or blood vessels disrupted -- Hematoma formed --> inflammation rxn. -- site invaded by osteoclasts and osteoblast. -- Organized fibrin network formed. -- Bone forming cells activated.
- Healing: Acascular bone is replaced by living bone through resorption and bone deposition. --> Callus formation leads to new bone formation.
- Tx: its to stabilize the bone in conjunction for healing.
- CM: unnatural alignment, swelling, muscle spasm (particullaly in the legs), tenderness, pain, etc.
complication in bone healing? etiology? tx? complications of fractues?
- healing: can include delayed union, which means not healed in 4-6 months.
- Etiologies: nonapproximated fragments, infection, smoking, malnutrition, poor circulation.
- tx: nobe grafting, internal/external fixation, electrical bone stimulation, or mixture.
- Complications: fat embolism syndrome, petechial skin rash, compartment syndrome.
- FES: it is like a PE, but w fat. It has the same signs of the PE as well.
- Compartment: trauma to soft tissue around the fracture. -- Causes: decreased compartment size, increased compartment content, or external applied pressure. -- symptoms: the 6 ps. Painful, pulseless, pale, paresthesia (tingling or thicking), paresis (weakness, partial paralysis), cold.
Dislocation vs subluxation? strain vs sprain? scoliosis?
- Dislocation: complete separation of joint articulating surface.
- Subluxation: Partial separation.
- strain: tear in tendon.
- Sprain: tear in ligament.
- Scoliosis: lateral curvature and nonstructural scoliosis.
- Lateral: resulting in a S or Cshaped spine.
- Nonstructural: results when the pt bends to the affected side.
osteoporosis Patho? tx? etiologies/risk factors? CM?
- patho: It is the most common metabolic disease that occurs when the bone reabsorption is greater than bone formation.
- The density of mass of the bone reduced.
- tx: calcium and vit D, exercise, estrogen replacement, etc.
- etiologies: age, race (caucasia, asian), gender, body mass, strogen loss, sedentary occupation, thyroid meds, smoking.
- CM: 25-30 % of bone loss before being able to see it -- history of loss height, back pain, dowager's hump, difficulty bending over.
Myasthenia Gravis chts? etiology? patho? CM?
- it is a chronic autoimmune disease; affects the nueromuscular function of voluntary muscles.
- etiology: thymic tumors in the thymus, autoimmune.
- Patho: Defect in nerve impulse transmission at neuromuscular junction.
- Destruction of acetylcholine receptor sites in the post-dynapctic junction.
- CM: ptosis, extreme fatigue after excercise, dx made w tensilon.
Fibromyalgia etiology? chts? dx?
- etiologies: unknown.
- chts: pain all over.
- dx: of exclusion.
- tx: pts do well in antidepressants.
Osteomyelitis chts? tx? patho?
- Severe pyogenic infection of bone and local tissue -- direct infection can occur due to open frature, penetrating wounds, surgical contamination, or insertion of prostheses. -- Common agent is staphylocossus aureus. -- tx: 4-6 weeks of antibiotics usually thorugh a PIG line. -- It is very difficult to treat.
- Patho: bateria growth causes abcess, pus spreads out, necrotic bone becomes trapped, sinuses develop to allow bone to drain.
- CM: usually pt comes w fracture then 4-5 days later develops systemic manifestations of infection.
Ligaments injuries chts? CM? tx?
- Ligaments connect bone to bone.
- occurs when loading exceeds the physiological range of motion.
- CM: pain w weight bearing and acute swelling.
- tx: depends on the degree, ACL, MCL, etc.
Joint capsule injury chts?
- affects the stabilizationg of synovial joint.
- increase of vascularity and development of fibrous tissue leads to thick capsule and affects the ROM.
- "frozen shoulder" lots of scared tissue that affect ROM.
Fasciae and bursae? injuries?
- Fasciae: are connective tissues of the body arrenged in sheaths that envelop the muscle.
- Bursae: they are pockets of connective tissue lined w synovium in locations b/t muscles.
- injuries cause pain and restriction of movement of M/S system.
Injury of the tendons?
- repetative motion, tennis elbow.
- Grade from I to III, where tootal tair is III.
Osteoarthritis (OA) chts? signs n symptoms? tx? etiology? patho? CM?
- degenerative bone disorder associated w aging and wear and tear from repetitive stress.
- It is noninflammatory and the sign are very localized. The pain goes away after start moving.
- Signs and symptoms: joint pain and crepitus (noise when moving).
- tx: therapy, reducing pain.
- etiology: unkown, stress on the joint, family history, weight increase stress on knees, hormonal status.
- patho: reduction of cartilage, rub bone and bone, inflammation of the synovial bone after, reduction of mobility.
- CM: crepitus w movement, pain w function, morning stiffness, heberden's (curved fingers) and bouchard's nodules.
Rheumatoid Arthiratis chst? etiologies? tx? patho? CM?
- Systemic inflammatory disease. Pain all the time.
- Etiologies: autoimmune, may run in families, juvenile disease onset 2-5 or 9-12, adults peak 30-50s.
- tx: NSAIDs, conticosteroids, and biological agents.
- Patho: immune complexes activate change in chemical make-up of tissue, hydrolytic enzymes released into the joint fluid, which causes inflammation.
- CM: need to have 4 or more to be Dx. morning stiffness, soft tissue swelling of 3 or more joint areas, subcutaneous R nodules, Rheumatoid factor present, EST elevated, Radiologic erosions.
Systemic lupues Erythematosus? Scleroderma? ankylosins spondylitis?
- SLE: chronic multisystem, inflammatory, autoimmune disease chts by periods of exacerbations and remisions w multiple organs affected.
- Scleroderma: the same chts by skin thickening and deposition of collagenous tissue resulting in severe fibrousis.
- the bid differences b/t these 2 is Raynaud phenomenon, which SLE doesn't have it.
- ankylosins: Arthritis of the sacoiliac joints; it is a progressive pathology. CM: LBP, severe morning stiffness, and limited ROM.
Gout? Gouty arthritis?
- Pain when waking up.
- production of uric acid exceeds removal, hyperuricemia, depositon of monosodium urate salts in articular, periarticular and subq tissue.
- GA: great toe most often involved. lack of the ability to oxidize uric acid, problem w purine metabolism.