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90 Cards in this Set
- Front
- Back
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What is a Fracture?
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-Any defect in the continuity of a bone
-May range from a small crack to a complex fracture with multiple segments |
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Three categories of fractures
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-Fracture by sudden impact
-Stress or fatigue fracture -Pathologic fracture |
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Displaced Fracture VS non-displaced fracture
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Displaced fracture- Bones misaligned
Non-Displaced- Bones still aligned |
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What is a Transverse Fracture?
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Fracture line at a right angle to the long axis of the bone
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Oblique Fracture
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Results from a twisting or torsional force: fragments displace easily
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Spiral Fracture
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Also results from twist/torsion: nonunion - rare
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Comminuted Fracture
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Bone is broken into more than two pieces
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Segmental Fracture
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Fragment of free bone is present between the two main fragments
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Butterfly Fracture
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Seperation of a wedge-shaped piece of bone.
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Types of Immobilization
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Bed rest
Casting Splinting Non-weight bearing status Disuse secondary to pain |
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Types Of Immobilization
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-Bed Rest
-Casting -Splinting -Non-weight Bearing status -Disuse secondary to pain |
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Colles Fracture
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Fracture of distal radius and ulnar styloid (Fall on outstretched hand)
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Jones Fracture
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Fracture of the base of the 5th metatarsal
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Nightstick Fracture
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Fracture of midshaft of ulna
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Pott's Fracture:
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Oblique fracture of lateral malleolus and a transverse fracture of the medial malleolus. Talus may be displaced posteriorly
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Fracture Healing:
Healing Sequence |
-Hemotoma formation (48-72 hrs after fracture)
-Cellular proliferation -Callus formation -Ossification -Consolidation/remodeling |
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Healing Time for Fratures
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-Children: 4-6 weeks
-Adolecents: 6-8 weeks -Adults: 10-18 weeks |
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Signs and Symptoms of Fractures
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-Pain and Tenderness
-Increased pain with weight bearing -Edema -Ecchymosis -Loss of general function and mobility -Deformity (may not always see especially in certain fractures) |
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Contusions
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-Direct Trauma
-Overlying skin intact but underlying tissue becomes ecchymotic due to local hemorrhages |
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Hematomas
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-Areas of localized hemorrhage
-Blood accumulates due to rupture of capillaries |
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Strain
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Stretching or tearing of the musculotendinous unit
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Sprain
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Ligament injury from abnormal or excessive joint motion
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Tissue Tearing
1st Degree |
Injury of few fibers without loss of ligament integrity
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Tissue Tearing
2nd Degree |
Moderate tearing of fibers and hematoma
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Tissue Tearing
3rd Degree |
Severe tearing, rupture, marked swelling
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Tissue Tearing
4th Degree |
Severe tearing, rupture with avulsion fracture
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Subluxation
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-Partial disruption of anatomic relationship within a joint
-Most commonly seen at mobile joints |
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Implications For PT Intervention for dislocaitons and subluxations:
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-Address local muscle imbalances
-Work muscle that stabilize involved joints |
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Implications for PT intervention for Tissue response to immobilization:
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-Important to maintain function of all other areas while body part is immobilized
-effects of immobilization on all tissue types and make certain Rehab Program addresses specific sequelae |
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Dislocations
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-Complete loss of joint integrity with loss of anatomical relationship
-Typically results in severe ligamentous damage and possible vascular damage -Can be a late manifestation of chronic disease (Rheumatoid Arthritis) -Most common at gleno-humeral joint and congenitally at the hip |
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Scoliosis:
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Abnormal Curvature of the spine:
-Infantile: 0-3 yrs of age -Juvenile: Skeletal age of 4yrs thru puberty -Adolescent: Skeletal age of: -12 yrs old for female -14 yrs old for males -Curve may be towards the right (more common in thoracic curves) or towards the left (more common in lumbar curves) -Often associated with kyphosis and lordosis |
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Scoliosis
Idiopathic |
-Unknown cause
-Accounts for 80% of all cases |
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Scoliosis
Myopathic |
Results from weakness
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Scoliosis
Osteopathic |
Results from spinal disease or bony abnormality
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Scoliosis
Neurogenic |
Associated with various neurological disorders
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Functional or Postural Scoliosis
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Caused by factors other than vertebral
-pain -Poor posture -Leg length discrepancy -Muscle spasm These curves disappear when cause is relieved |
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Classification of Scoliosis
Structural Scoliosis |
-Fixed curvature of the spine associated with vertebral rotation and asymmetry of ligamentous structures
-congenital -musculoskeletal -neuromusclular -idiopathic(most common) |
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Clinical Manifestations of scoliosis I
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-<20 degrees: functional problems rare
->60 degrees: decreased lung capacity, back pain, vertebral subluxation, sciatica, degenerative spinal arthritis, or disk disease -Asymmetrical shoulders and pelvis -Earliest findings may be shortening of tissues concave side -Named for convexity (Left curve would be convex to the left) |
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Clinical Manifestations of scoliosis II
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-Typically see first degree and second degree (compensatory) curves
-May see rotational deformities develop on the convex side (results in a rib hump) -Forward Bend Test -Structural: No changes in curve with forward bend -Functional: Curve typically staightens with forward bend |
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Measurement Of Scoliosis
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-Use of scoliometer
-Measures the angle of trunk rotation in forward bend position (90 degrees) Cobbs Method: - Measures degree of curve using X-ray films - Measures angle formed by intersection of the perpendicular lines drawn from lines parallel to the vertebrae at the apex and base of the curve (fig 23-1, p 1112) |
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Treatment Of Scoliosis
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-Goal: To prevent severe and progressive deformities that can compromise internal organs
-curves <25-40 or 45 degrees: Spinal orthoses -Curves: >45: Surgical correction -Exercise programs have not been shown to be effective in halting or improving scoliosis even when used in conjunction with a spinal orthosis |
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Implications For PT treatment for Scoliosis
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-Scoliosis screening
-Electrical stimulation -Theorectically strengths muscles on convex side of curve and pulls spine back into alignment -Large scale trials have not supported this intervention -Post-operative care -Deep breathing exercises/AROM -After healing (4-6weeks): work on flexibility, strength, endurance |
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Osteoporosis
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-Literally means "porous bones"
-A combination of decreased bone mass/density and microdamage to the bone structure -Most common metabolic bone disease affecting over 10 million people in the USA -More common in women (especially postmenapausal women) -If in men, most unrecognized |
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Classifications of Osteoporosis
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Primary
-Idiopathic -postmenapausal (most common) -Senile (old age) Secondary -Endocrine disorders -Rheumatoid arthritis -Disuse -Side affects from medications |
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Pathogenesis of Osteoporosis I
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-Between the ages of 25 & 35 yrs, bone mass peaks and the rate of bone resorption begins to exceed the rate of bone formation
-Diagnosis made when changes in bone density are visible on X-ray (greater than or equal to 30% bone density loss must occur before changes seen on X-ray) |
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Pathogenesis of Osteoporosis II
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-Osteopenia refers to decreased bone density
-Estrogen defeciency in postmenapausal women -Women lose bone at a typical rate of 1% a year after peak bone density has been achieved -For 5 to 8 yrs after menopause, bone loss accelerates to varying degrees (depending on factors such as calcium intake and absorption, hormonal balance, and activity level) |
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Clinical Manifestations of Osteoporosis
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-Most patients unaware of condition until fracture occurs
-Most common: fractures of vertebral body, ribs, radius or femur -Back Pain -Increased kyphosis -Decreased height associated with vertebral compression fracture |
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Treatment of Osteoporosis
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-NO CURE
-Prevention is KEY -Adequate calcium intake -Weight bearing exercises -Falls prevention |
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Implications of PT intervention for OSTEOPOROSIS
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-Patient Education
-Role in prevention -Exercise -Preventing Fractures -Take care with evaluation and treatment techniques -Mobilization -Falls -Avoid flexion exercises (pelvic tilt and partial sit-ups don't appear to increase anterior compressive force) |
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PAGET'S DISEASE
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-A progressive disorder of the adult skeletal system
-Characterized by excessive bone resorption and formation due to a proliferation of osteoclasts -Bone resorption is so rapid that osteoblasts can't keep up -Fibrous tissue replaces bone -Affected bone looks larger and thicker but is actually weaker -Lesions occur at multiple sites particularly the skull, spine, pelvis, femur and tibia |
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Clinical Manifestations of PAGET'S DISEASE
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-20% of patients asymptomatic
-If pain in present, decribed as vague, deep, dull ache -If skull involved, frequently see tinnitis, vertigo, hearing loss -Diagnosis by X-rays or bone scan -Posture deformities -Increased kyphosis -Bowing of femur or tibia |
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Implications for PT intervention for PAGET"S DISEASE
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-Similar to osteoporosis
-Joints adjacent to involved bone may function at a mechanical disadvantage -Extremity deformities may require splinting. |
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Pathogenesis Of Osteomyelitis I
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-Can be pain free as cancellous bone is aneural
-Osteoblasts create new bone which forms sheath around necrotic tissue |
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Pathogenesis Of Osteomyelitis
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-Exogenous of hematagenous source
-Inflammatory response -Infection spreads easily through porous metaphysis of long bone -Organisms grow and pus forms -Pus sqeezes though Haversain canals in bone -Suberiosteal occurs and deprives bone of blood which results in necrosis |
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Clinical Manifestations of Osteomyelitis
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-Intitially patient may not have any pain
-When periosteum involved, patient typically has deep, constant pain that increases with with bearing -Spinal Osteomyelitis may result in intermittent or constant back pain aggravated by motion. May have throbbing at rest -May see systemic reactions such as fever |
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Treatment of Ostemyelitis
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-Treatment must be immediate
-IV or oral antibiotics (usually for 6 or more weeks) -Emergency orthopedic surgery may be required to drain pus and debride (especially if infections spreads to a joint) |
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Implications for PT Intervention for Ostemyelitis
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-When working with patients staus post total joint replacement, be alert for s/s of infection
-Increased risk for fracture if infection in joint, Know restrictions with exercise and weight bearing -Focus on non-involved areas to prevent effect of immobilization -Monitor wounds (color and drainage) |
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Joint Disorders
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-Osteonecrosis
-Legg-Calve-Perthes-Disease -Oseoarthritis -Degenerative Intevertebral Disk Disease -Rheumatoid Arthritis |
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Common Musculoskeletal Disorders.
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-Fractures
-Dislocation -Subluxation -Contusion -Hematoma -Strain/Sprain -Degenerative Disease |
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Implications for PT intervention
Typically after healing has occurred what do you watch for? |
Compartment Syndrome:
-Significant swelling around fracture site but if contained within closed soft tissue compartment, compartment syndrome may occur -Fat Emboli -Fat from marrow can migrate into pulmonary or cerebral circulation and block blood vessels -SOB, chest pain, cyanosis, rash on anterior chest wall/neck/axillae/shoulders |
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Immobilization
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Physical Therapy professionals often treat the results of inflammation and immobilization rather than the original injury
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Colles Fracture
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Fracture of distal radius and ulnar styloid (Fall on outstretched hand)
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Jones Fracture
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Fracture of the base of the 5th Metatarsal
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Nightstick Fracture
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Fracture of midshaft of ulna
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Pott's Fracture
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Oblique fracture of lateral malleoulus and transverse fracture of the medial malleoulus. Talus may be displaced posteriorly
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Healing Sequence
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-Hemotoma formation (48-72 hrs after fracture)
-Cellular proliferation -Callus formation -ossification -consolidation/remodeling |
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Healing times for Fractures
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-Children : 4-6 weeks
-Adolescents : 6-8 weeks - Adults: 10-18 weeks |
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Signs and Symptoms of Fractures
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-Pain and tenderness
-Increased pain with weight bearing -Edema -Ecchymosis -Loss of general function and mobility -Deformity (may not always see especially in certain fractures) |
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Contusions
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-Direct Trauma
-Overlying skin intact but underlying tissue becomes ecchymotic due to local hemmorahages |
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Hematomas
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-Areas of localized hemorrhage
-Blood accumulates due to rupture of capillaries |
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Strain
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-Stretching or tearing of the musculotendinous unit.
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Sprain
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Ligament injury from abnormal or excessive joint motion
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Tissue Tearing
1st Degree |
Injury of few fibers without loss ligament integrity
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Tissue Tearing
2nd Degree |
Moderate tearing of fibers and hematoma
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Tissue Tearing
3rd Degree |
Severe tearing, rupture, marked swelling
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Tissue Tearing
4th Degree |
Severe tearing, rupture with avulsion fracture
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Subluxation
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-Partial disruption of anatomic relationship within a joint
-Most commonly seen at mobile joints |
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IImplications for PT Intervention for dislocations and subluxations
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Address local muscle imbalances
Work muscle that stabilize involved joints. |
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Synovium
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Proliferation of fibrofatty connective tissue into joint space
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Cartilage
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Adherehence of fibrofatty connective tissue to cartilage surfaces
-Loss of cartilage thickness -Pressure necrosis at area of compressed cartilage |
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Ligament
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-Disorganization of parallel arrays of fibrils and cells
-Weakening and destruction of ligament fibers where they attach to the bone |
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Bone
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Generalized osteoporosis
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Muscle
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Disorganization of parallel arrays of fibrils and cells, weakening, possible loss of sacromeres
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Implications for PT Intervention
What to watch for: |
-Compartment Syndrome: -Significant swelling around fracture site but if contained within closed soft tissue compartment, compartment syndrome may occur
-Pain, decreased motor function, burning, paresthesia, decreased reflexes Fat Emboli: - Fat from marrow can migrate into pulmonary of cerebral circulation and block blood vessels -SOB, chest pain, cyanosis, rash on anterior chest wall/neck/axillae/shoulders |
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Immbolizations
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Physical Therapy professionals often treat the results of inflammation and immbolization rather than the original injury
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Synovium
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Proliferation of fibrofatty connective tissue into joint space
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Cartilage
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-Adherence of fibrofatty connective tissue to cartilage surfaces
-Loss of cartilage thickness -Pressure necrosis at area of compressed cartilage |
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Ligament
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-Disorganization of parallel arrays of fibrils and cells
-Weakening and destruction of ligament fibers where they attach to the bone |
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Bone
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Generalized osteoporosis
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Muscle
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Disorganization of parallel arrays of fibrils and cells; weakening; possible loss of sacromere
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