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120 Cards in this Set
- Front
- Back
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scoliosis
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lateral deviation of the spine; more common in girls
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cause of scoliosis
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family history
85% idiopathic (no clue why) congenital or neuromuscular (polio, cerbral palsy) |
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S/S of scoliosis
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high shoulder
prominent hip protruding scapula mild backache > severe pain |
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treatment scoliosis
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external bracing at night
pelvic tilt exercises harrington rods spinal fusion endoscipic discectomy possible |
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osteoporosis
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decreased bone density or mass (more holes)
bone size & composition same, but just less dense |
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osteoporosis due to
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bone reabsorption is faster than formation
bones are brittle & fragile normal bone is constantly being replaced |
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cause of osteoporosis
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unknown
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risk factors of oseoporosis
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family history
age - esp. menopause (less estrogen) light pigment (caucasion or american) small framed gender prednisone use - makes bones less brittle diet low in calcium & vit D physical fitness - increase risked w/ immobilization & decreased risk w/ exercise excessive smoking caffeine - esp soda (phosphorus leeches out calcium) excessive alcohol |
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s/s osteoporosis
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by the time it can be diagnosed by xray
30% of bone is lost vertebral compression fracture > pain & loss of height sketetal family history fractures easily no bond tenderness or other signs until something fractures |
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prevention / treatment osteoporosis
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identify people at risk
exercise (walking/swimming) calcium supplement w/ fluoride and vit D Estrogen therapy & fosamax (& other drugs) prevent fall |
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osteomylitis
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acute infection
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cause osteomylitis
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infection from
the blood neraby soft tissue bacteria entering directly into the bone from trauma (most common) |
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#1 organism for osteomylitis
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staph. aureus
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children osteomylitis
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staph aureus infection that spreads from skin, teeth, or ear infection then progressive to bone
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children osteomylitis onset
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sudden
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children osteomylitis s/s
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sudden pain at the site
redness/swelling at the site high fever child will refuses to move site |
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adult osteomylitis
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mostly in debiltated people
history of chronic skin infection, UTI or IV drug use |
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adult osteomylitis onset
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slow
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adult osteomylitis s/s
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vague
fever fatigue wt. loss pain in the area at reast |
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diagnosis osteomylitis
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pus forms under periosteum (hard surfac of the bone)
periosteal abscess > decrease blood supply & pain xray shows elevated periosteum |
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treatment of osteomylitis
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antibiotics
resting the extremity I & D and debridement of area |
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myasthenia gravis (neuro connection)
not bone problem nothing wrong w/ nerve; but problem w/ muscle accepting neuro connection |
poor communication between motor neurons & muscle cells at the myoneural junction
effects the only voluntary muscles usually occurs in women 20-30 years (but can happen anytime) |
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cause myasthenia gravis
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automimmune disorders
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patho of myasthenia gravis
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autoimmune responses creates antibodies that binds to & destroys acetylcholine receptor sites>
decreased available ACH receptor sites blocked neuromuscular transmission |
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s/s of myasthenia gravis
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easy fatigue of voluntary muscles w/ repeated use
starts w/ eye & facial muscle weak eye muscles (ptosis CN#3) blurry vision & droopy eyelids dysphagia jaw weakness hoarseness after talking a few minutes (speech impairments) weakness of facial muscles (snarl #7) then effects extremitites & other muscles (paralysis of respiratory muscles) pupil reaction is normal & DTR are normal - not voluntary) |
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myoneural junction
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where neurons & muscle connect
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more obvious in children why
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osteomylitis; because they don't want you to move or touch infected part
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less obvious in adults becasuse
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osteomylitis has flu like symptoms so in the beg. adults don't think much of it.
vague, less distingushable against other problems |
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supraperiosteal
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periosteal abscess - decreased blood supply & pain
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supraperiosteal
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periosteal abscess leading to decreased blood supply & pain
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treatment of myasthenia gravis
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anticholinesterase drugs (prolongs action of ACH by inhibiting hydolysis)
steriods - decreased antibodies and slows immune response thymectomy (many have thymus enlargement) |
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fibromyalgia
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chronic pain syndrome
more common in females (75% of cases) can occur at any age - peak = 20-60 yrs |
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cause of fibromyalgia
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unknown
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patho fibromyalgia
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unclear
no lab test abnormal muscle biopsy OK psych assessment ok not inflammation possibly related to CNS amplification of pain??? |
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s/s of fibromyalgia
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musculosketal pain
stiffness fatigue!!! sleep deprivation pt complains of many symptoms that can't be seen objectively depression |
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treatment of fibromyalgia
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not a psychological disorder
many drugs being tried - CNS related encourage exercise treat the lack of sleep |
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1st FDA approved drug for fibromyalgia
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lyicra - at first this drug was used for seizures
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osteoarthritis
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a progressive NON-Inflammation joint disease (joint doesn't look normal)
AKA degenerative joint disease No inflammation process No systemic symptoms Normal synovia fluid Mostly effects wt. bearing joints More common in females |
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cause of osteoarthritis
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wear & tear (obesity, trauma)
genetic prdeisposition risk increased with age (especially post menopause) |
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osteoarthritis patho
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cartialage which should be smooth, white & translucent
>joint cartilage softens & becomes yellow/gray >layers flake off & become rough & pitted >ulcerations > thins & is destroyed bone forms in joint space (bone spurs = joint mice) |
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the cause of this whole process seems to be enzymes that breakdown cartilage
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osteoarthritis
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s/s osteoarthritis
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pain w/ use - relieved by rest
especially wt. bearing joints & HANDS morning stiffness works out in 30 min crepitus & grinding of joints joint enlargement from new bone formation |
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treatment of osteoarthritis
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decreased pain
increase mobility rest/exercise decreased wt. ASA/NSAIDS steriods heat joint replacements |
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rheumatoid arthritis
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systemic autoimmune INFLAMMATORY disease of connective tissue - joints displaced
more common in women also comes in juvenile form affects all races not related to climate 80-85% test positive for rheumatoid factors (RF +) |
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cause of rheumatoid arthritis
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unknown
theories of cause infection (but no organism id) autoimmune disorders (+rheumatorid factor) w/ genetic predisposition |
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patho rheumatoid arthritis
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inflammation of synovial membrane form growth of new blood vessels in synovial membrane
> hyperplasia of synovial tissue > warmth/redness/swelling development of destructive vascular granulation tissue (pannus) w/in the joint > decreased motion > joint instability & muscle atrophy from disuse. changes are not reversible |
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s/s rheumatoid arthritis
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symmetrical joint pain & swelling lasting at least 1 hr. in morning
fatigue affects fingers, hands, wrists, knees, feet, & cervical spine Hands PIP & MCP joints ( not DIP joints) Joint destruction > subluxation & instability focused on hands, feet (smaller joints) only effects certain joints in hand |
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NON-Joint s/s rheumatoid arthritis
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rheumatoid nodules
vasculitis cardiac, pulmonary & eye changes |
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rheumatoid nodules
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lesions of inflammatory cells in subcutaneous tissue
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vascultis
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inflammation of sm. & med arterioles > ulcerations
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diagnosis rheumatoid arthritis
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very difficult - a series of criteria - 4 or more symptoms present for 6 weeks in a row
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treatment rheumatoid arthritis
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decreased pain
stiffness & swelling (ASA, NSAIDS), heat/cold, lose wt. prevent joint destruction w/ steriods, immunosuppressants, methotrexate & tumor necrosis factor inhibitors surgery to replace joints |
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ankylosing spondylitis
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chronic inflammatory disease of spine
inflammation where liagments insert into bone more severe in men commonly starts in late adolescence & 20's |
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cause ankylosing spondylitis
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autoimmune w/ strong genetic connection
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patho ankylosing spondylitis
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synovial membrane inflammation causes erosion of bone
> (as part of the repair process) fibrosis, ossification & fusion of the spine |
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s/s ankylosing spondylitis
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"Rigid spine" > low back pain & progressive loss of ROM of spinal column
stiffness in am & after resting muscle spasm > stooped posture wt. loss, fever, fatigue |
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treatment ankylosing sondyltitis
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control pain
maintain mobility muscle strenthening exercises - must keep them moving (sit-ups) can't immobilize person heat, ASA, NSAIDS |
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gout
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acute flammatory response to urate crystals (uric acid) in joint
attacks of "arthritis" in men > 40 |
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cause of gout
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primary - genetic deficit in purine metabolism
secondary - s/e of medications & some diseases (that decrease clearance of urate) (kidney problem can led to this) |
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patho of gout
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uric acid is metabolite of purine proteins used in DNA, RNA, ATP production
purine found in protein food Uric acid usually eliminated by kidney and GI crystals are released in the synovial fluid > inflammation of joints s/s occur when uric acid levels increase |
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s/s gout
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monoarticular arthritis
peripheral joints (knee, ankle, wrist, elbow) abrupt severe pain redness & swelling (usually at night) eventually causes trophi aggravated by meds/certain foods/alcohol trauma |
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#1 place of monoarticular arthritis of gout
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big toe
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trophi
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urate crystals in cartilage and tendons and kidney stones
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diagnosis gout
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crystals (needle looking) seen in synovial fluid aspiration
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treatment of gout
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NSAIDS
steroids & ice purine free diet (eliminate fish, poultry, legumes, organ meats) ok to have eggs, fruit, cheese, nuts, sugar, veggies push fluids decrease wt. NO alcohol - it increases purine lifelong treatment w/ allopurinal |
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allopurinal
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prevents production of uric acid
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types of fractures
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trauma & force
stress/fatigue pathological |
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repeated wear and tear on bone causes ______ fracture
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stress/fatigue
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types of fractures
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trauma & force
stress/fatigue pathological |
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pthological fracture
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weakened bone by disease (osteoporosis) etc
already diseased cancers |
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repeated wear and tear on bone causes ______ fracture
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stress/fatigue
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directions of fracture line
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transverse
spiral - "S" fracture from rotational force longitudinal oblique |
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pthological fracture
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weakened bone by disease (osteoporosis) etc
already diseased cancers |
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transvers fracture
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straight across
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spiral "S" fracture
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from totational force
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directions of fracture line
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transverse
spiral - "S" fracture from rotational force longitudinal oblique |
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transvers fracture
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straight across
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Longitudinal fracture
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down length of bone
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spiral "S" fracture
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from totational force
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oblique fracture
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diagonal fracture at angle
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extent of fracture
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displaced
non-displaced depressed complete incomplete open/compount closed comminuted compression/impacted |
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Longitudinal fracture
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down length of bone
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displaced fracture
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bone fragments not in alignment
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oblique fracture
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diagonal fracture at angle
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extent of fracture
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displaced
non-displaced depressed complete incomplete open/compount closed comminuted compression/impacted |
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displaced fracture
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bone fragments not in alignment
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nondisplaced fracture
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bone fragments still in alignment
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depressed fracture
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bone fragment pushed in (often skull)
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complete fracture
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fracture the whole way through bone
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incomplete fracure
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partial break (green stick)
bends until in breaks 1/2 way |
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open/compound fracture
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bone sticks out of skin
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closed fracture
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no broken skin
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comminuted fracture
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more than 2 pieces
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compression/impacted fracture
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2 bones crushed/squashed together (often in vertabrae)
age |
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s/s fracture
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painful
tenderness swelling decreased function and deformity shortening of the limb CAN STILL MOVE BODY PART BELOW FRACTURE (most often) |
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bone healing stages
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hematoma formation
fibrocartilage formation intial callus formation ossification consolidation/remodeling |
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hematoma formation last
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1-3 days
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fibrocartilage formation last
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3 days - 2 weeks
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initial callus formation last
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2 - 6 weeks
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ossification stage last
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3 weeks - 6 months
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consolidation/remodeling stage last
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6m - 1 year
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hematoma formation patho
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blood leaks
clotting hematoma forms at the fracture site inflammation occurs |
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fibrocartilage formation patho
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granular tissue forms containing blood vessels
fibroblasts and osteoblasts really needs to be immobilize during this stage |
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which stage of bone healing really really really needs to be immobile
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fibrocartilage formation
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intial callus formation patho
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hematoma organizaes into fibrocartilaginous callus "collar" & bridge fracture
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collar (bone healing) implies
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fibrocartilaginous callus
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ossification bone healing patho
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cartillage (collar) is replaced by mature bone
looks bridged and firm united on x-ray ok to remove cast or splint |
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consolidation/remodeling bone healing patho
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bone resumes normal appearance
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fracture treatment
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reduction (re-alignment)
immobilize |
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reduction / re-alignment in fracture treatment means
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correct alignment (manually, traction or surgically)
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immobilize fracture treatment means
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splint
case external/internal fixation traction |
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complicaitons of bone healing
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delayed healing
malunion nonunion compartment syndrome |
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which two complication of bone healing are related
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delayed healing & nonunion
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what is delayed healing
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3m-1yr and body is still trying to heal
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what causes delayed healing
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smoking
malnutrition poor circulation |
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what is the reason for malunion
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bone didn't heal in good alignment
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nonunion healing is
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bone not healed in 4-6m after fracture (poor blood flow etc)
body isn't trying any more |
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compartment syndrome
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trauma to soft tissue
traumitized swelling swelling is so severe cut off nerve conduction & blood vessel flow |
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s/s of compartment syndrome
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pain
pale skin no pulse below break decreased sensation |
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treatment of compartment syndrome
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MEDICAL EMERGENCY
nerves can live w/ 2-4 of ischemia muscle can live 6-8hrs with ischemia surgery to release pressure remove case if that is the cause |
