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110 Cards in this Set

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