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110 Cards in this Set
- Front
- Back
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Dislocation
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a severe injury of the ligamentous structures that surrounds a joint ~ articular surfaces are completely displaced
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subluxation
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partial or incomplete displacement of the joint surface
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difference between dislocation and subluxation
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clinical manifestations are less severe and subluxation may take less time to heal
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Joints most frequently dislocated
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Thumb, elbow, shoulder,
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what is a hip dislocation often associated with?
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a motor vehicle accident
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what might cause a patellar disclcation
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instability of supporting structures or a severe twisting blow
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S & S of a disclocation
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assymetry, local pain, tenderness, loss of function
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Major complications of a dislocated joint
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open joint injuries, intraarticular fractures, fracture dislocation, avascular necrosis, damage to adjacent neurovascular tissue
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What type of assessment is critical in a dislocation or subluxation?
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neurovascular assessment
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Avascular necrosis
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bone cell death as a result of inadequate blood supply
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Common studies with a dislocation or subluxation
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x-ray and joint aspiration
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Why might a joint aspiration be done in a dislocation or subluxation?
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to look for the presence of blood or fat
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What does it mean when fat cells are found in joint aspirate?
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probable intraarticular fx
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Because of the risk of avascular necrosis, a dislocation is considered...
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an orthopedic emergency
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Which joint is particularly vulnerable to avascular necrosis?
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the hip joint
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In a dislocation, what is the first goal of management?
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to realign the dislocated joint
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how is realignment of a dislocation usually accomplished?
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closed reduction
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What is often necessary to accomplish a closed reduction of a dislocated joint?
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anesthesia, to produce muscle relaxation so that the bones can be manipulated
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Nursing management of a dislocation or subluxation includes...
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pain relief, support and protection of the injured joint
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Implications of a dislocation after healing
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patient should not stretch the joint beyond its limits because the torn capsule and ligament heal in a shortened position with fibrous scar tissue that is not as strong as the original tissue
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RSI
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repetitive strain injury
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Repetitive strain injury (definition)
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a cumulative trauma disorder resulting from prolonged, forceful, or awkward movements
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other names for repetitive strain injury
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repetitive trauma disorder, nontraumatic musculoskeletal injury, overuse syndrome (sports medicine), regional musculoskeletal disorder, work-related disorder, and 'nintendinitis'
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pathophysiology of RSI
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repeated movements strain tendons, ligaments, and muscles, causing tiny tears that become inflamed. Scarring can occur if ts not rested. Blood vessels may become constricted causing a buildup of lactic acid. Nerves can become hypersensitive
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Factors r/t RSI
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repetitive movements, poor posture and positioning, poor work space ergonomics, badly designed keyboard, lifiting of heavy work loads w/o sufficient muscle rest
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sx of RSI
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pain, weakness, numbness, or impairment of motor functions
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People commonly affected by RSI
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musicians, dancers, electricians, butchers, keyboard operators, cashiers, grocery clerks, packers, postal workers, poultry processors, and vibratory tool workers
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Why is RSI becoming more of a problem for youth?
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more young people are employed for longer and they work in a setting that has been designed for adult workers
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How can RSI be prevented?
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education, ergonomics, appropriate job designs
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Ergonomic considerations for RSI prevention
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keeping the hips and knees flexed to 90 degrees with the feet flat; keeping the wrist straight to type, havint the top of the monitor even with the forehead; taking at least hourly stretch breaks
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Treatment of RSI
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identifying precipitating activity, modification of equipment or activity, pain management, rest, physical therapy for strengthing exercises, and lifestyle changes
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Pain management in RSI
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heat/cold applications, NSAIDs
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CTS (acronym means...)
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carpal tunnel syndrome
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CTS (definition)
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a condition caused by compression of the median nerve beneath the transverse carpal ligament within the narrow confines of the carpal tunnel located in the wrist
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What is the most common compression neuropathy?
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Carpal tunnel syndrome
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Common causes of CTS
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pressure from trauma or edema caused by inflammation of a tendon, neoplasm, rheumatoid synovial disease, or soft ts masses such as ganglia
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tenosynovitis
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inflammation of a tendon
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When are sx of CTS often seen?
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during the premenstrual period, pregnancy, and menopause, in DM and thyroid dysfunction or in conditions with increased fluid retention
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What kind of occupations is CTS assocated with?
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those that require continuous wrist movement
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Clinical manifestations of CTS
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weakness (esp the thumb), burning pain and numbness, or impaired sensation in the distribution of the median nerve and clumsiness in performing fine hand movements
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Causalagia
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burning pain
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Positive Phalen's sign
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holding the wrist in acute flexion for 60 seconds will produce tingling and numbness over the median nerve, palmar surface of the thumb, the index, middle, and part of the ring finger
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Positive Tinel's sign
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tapping gently over the area of the inflamed median nerve may reproduce the parathesia
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Late stage CTS
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the re is atrophy of the thenar muscles around the base of the thumb, resulting in recurrent pain and eventual dysfunction of the hand
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prevention of CTS
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education, adaptive devices, special keyboard pads
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early CTS sx can be releived by...
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stopping the aggravating motion, resting, immobilization
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possible short-term tx for CTS caused by inflammation
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corticosteriod infection directly into the carpal tunnel
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how long does direct-injection corticosteroid treatment work to relieve the sx of CTS?
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up to 6 months
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Possible side effect of corticosteriod injection for CTS
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pt may experience decreased sensation in the area
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If CTS continues
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Surgical tx
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Surgical tx for CTS
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surgical decompression by longitudinal division of the transverse carpal ligament
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What type of anasthesia is used for surgical decompression in CTS?
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regional anasthesia
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Important consideration after CTS surgery
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the neurovascular status of the hand should be evaluated before discharge
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patient instruction after CTS surgery
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patient should be instructed in the appropriate assessments at home
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What is endoscopic carpal tunnel release
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surgical procedure win which the decompression is performed through a small incision puncture site
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What type of anasthesia is used in endoscopic carpal tunnel release?
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local
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another alternative surgical intervention for CTS
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modified open carpal tunnel release procedure
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What is the rotator cuff?
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a complex of four muscles in the shoulder
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what are the 4 muscles included in the rotator cuff?
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supraspinatus, infraspinatus, teres minor, and subcapularis
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what do the rotator cuff muscles to?
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stabilize the humeral head in the glenoid fossa while assisting with the ROM of the houlder joint and rotation of the humerus
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What are degenerative process of the rotator cuff associated with?
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normal aging
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How can a tear in the rotator cuff occur?
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gradual, degenerative process resulting from aging, poor posture, repetitive stress(esp overhead movements), or use of an arm to break a fall
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What will cause the rotator cuff to rupture?
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suddon adduction forces applied to the cuff while the arm is held in abduction
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sports activities that often initiate rotator cuff injury
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repetitive overhead motions
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non-sports-related causative factors in a rotator cuff injury
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fall to an outstretched hand or a blow to the upper arm, heavy lifting, repetitive motions
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Patients with a rotator cuff injury will complain of...
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shoulder pain, weakness, diminished ROM
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In a rotator cuff injury, a positive Neer's test and Hawkin's test will...
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yield a positive response to pain
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value of x-ray in a rotator cuff injury
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not usually benefical alone
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rotator cuff tear can be confirmed by...
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arthrogram or MRI
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simple shoulder test
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ability to place arm comfortably at the side, ability to sleep with arm at side, ability to tuck in a shirt of blouse behind, place hand behind head, place a coin on a shelf, place a pound on a shelf, place 8 lb on a shelf, fcarry 20 lb, toss underhand, throw overhand, wash the opposite shoulder, perform their usual work
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Rotator cuff goal of tx
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passive ROM and return of strength.
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conservative rotator cuff tx
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rest, ice and heat, NSAIDs, periodic corticosteroid injections into the joint, PT
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what might make surgical tx of a rotator cuff injury necessary?
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pt does not respond to conservative tx, or there is a complete tear present
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how may surgical repair of a rotator cuff injury be accomplished
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through an arthroscope
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what might be necessary in a surgical repair of a rotator cuff if an extensive tear is present?
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acromioplasty
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acromioplasty
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surgical removal of part of the acromion to relieve dcompression of rotator cuff during movement
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after rotator cuff surgery, why should shoulder not be immobilzed too long?
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frozen shoulder or arthro fibrosis may occur
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first day post op exercises after rotator cuff surgery
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pendulum exerces and PT begin
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what is the meniscus
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the fibrocartilage in the knee and other joints
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what are meniscus injuries closely related with?
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rotational stress during ligament sprains occuring in many sports
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what can cause a torn meniscus in the knee?
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a blow to the knee can cause the meniscus to be sheared between the femoral condyles and the tibeal plateau
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occupations at higher risk for meniscal injuries
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those that require persons to work in a squatting or kneeling position
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why do meniscal injuries not usually cause chronic edema?
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because cartilage is avascular and aneural
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Pain sx in meniscal injury
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local tenderness or pain; pain is elicted by abduction or adduction of the leg at the knee
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usual clinical picture described by the patient
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knee is unstable and the knee may "click, lock and give away."
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diagnostic studies for a meniscus injury...
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arthrogram, arthroscopy, or both; MRI before more invasive procedures, and often orthroscopy does not have to be used
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what kind of activity often causes a meniscal injury?
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sports related activities
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athlete teaching to avoid meniscal injury
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warm-up activities
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initial care of meniscal injury
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eice, immobilization, partial weight bearing with crutches
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activity for meniscal injury
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ambulate as tol
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PT for meniscus injury
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after acute pain has decreased, gradual increases in flexion and muscle strengthening. PT recommended before returning to sports activity
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meniscectomy
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surgical repair of excisiono f part of the meniscus
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rehab for a meniscectomy...
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starts soon after surgery, including ROM and quad and hamstring strengthening exercizes
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pain relief for meniscal injury
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may include NSAIDs, tramadol, or mild combo of drugs such as tylenol w/ codeine
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Bursae
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closed sacs that are lined with synovial membrane and contain a small amount of synovial fluid
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Where are bursae located?
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at sites of friction, such as between tendons and bones and near the joints
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Bursitis
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Inflammation of the bursa
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What causes bursitis?
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repeated or excessive trauma or friction, gout, rheumatoid arthritis, or infection
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primary clinical manifestations of bursitis
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warmth, pain, swelling, and limited ROM in the affected part
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common sites for bursitis
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hand, knee, greater trochanter of the hip, shoulder, and elbow.
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common preciptators of bursitis
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jogging in worn-out shoes, prolonged sitting wiht crossed legs
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Possible tx for bursitis
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rest, ice, immobilization, NSAIDs, surgery, aspiration of the bursal fluid (dark, bloody, cloudy) and injection of corticosteroid
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bursectomy
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surgical excision of the bursa
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when might a bursectomy be necessary?
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if the bursal wall has become thickened and continues to interfere with normal joint function
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tx for septic bursae
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usually require surgical incision and drainage
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reason for activity related muscle spasm
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injury to a muscle results in inflammation and edema, which irritates nerve endings, resulting in muscle spasm. The spasms produce additional pain, creating a repetitive cycle.
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clinical manifestations of muscle spasm
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pain; palpable, tense, firm muscle mass; diminished ROM; limitation of ADLs
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management of muscle spasms
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drug therapy, PT, or both
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PT for muscle spasms may include...
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heat or ice, supervised exercise, massage, hydrotherapy, local heat-producing applications (oil of wintergreen), ultrasound (deep heat) manipulation, and bracing
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Drugs used for the tx of local muscle spasms
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mild analgesics, NSAIDs, and skeletal muscle relaxants
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