319 Musculoskeletal

The site where two or more bones are attached

Joint

3 classifications of joints

1. Synarthrosis

2. Amphiarthrosis

3. Diarthrosis

Immovable joint

Synarthrosis

Slightly movable joint

Amphiarthrosis

Freely movable joints, also known as synovial joints, is called ___________.

Diarthrosis

Muscles are 75% of ___________.

Water

________ attach muscles to bones.

Tendons

_________ attach bone to bone.

Ligaments

Initiate bone formation and remodeling

Osteoblasts or osteocytes

Osteoclasts

Breakdown and resorptive cells

Both tendons and ligaments are composed of _________ and ___________.

Collagen and Fibroblasts

Tearing and/or rupture of a ligament is called________.

Sprain

A strain is _________________.

Overstretching or tearing of a muscle or tendon.

This test is used to check for bone density (Osteopenia or Osteoporosis)

Dual-photon absorptiometry (DEXA scan)

For this test to be done they must inject dye into the joint and then the patient gets imaging done. The dye’s purpose is to outline the joint’s structures.

Arthrography

A fancy CT scan that uses 2 beams of energy provides information about bones, soft tissue, and bone marrow around your bone.

Dual-energy computed tomography (DECT)

_________ is stored in muscles for energy.

Glycogen

A fracture that is broken all the way through is a _______1._______ fracture, if it is not broken all the way through it is a _______2._____ fracture.

1. complete

2. Incomplete

Comminuted fracture is when the bone____________.

The bone breaks into two or more fragments.

A transverse fracture is:

When the break is straight across

Fracture where the break is at a slanted angle to the shaft of the bone is called:

Oblique

Spiral fracture is a _______________.

Circular break

When a fracture breaks the skin, it is known as a ______1.______ fracture, when the skin is intact and no break or cut, it is known as a _____2.______ fracture.

1. Open

2. Closed

Reduction means:

Realignment

Open reduction

Surgical realignment.

Closed reduction

External realignment, no surgery needed.

Internal fixation

Pins and/or plates are needed after surgical realignment (Open reduction)

External fixation

A cast or external device is needed after an external realignment (Closed reduction)

A displacement of one or more bones in a joint in which the opposing joint surfaces entirely loses contact with one another.

Dislocaiton

Subluxaiton

Partial dislocation

Painful inflammation of the tendons caused by trauma and overuse injuries.

Tendonitis

Rapid breakdown of muscle that causes the release of intracellular contents including protein pigment myoglobin, into extracellular space and bloodstream.

Rhabdomyolysis

When a client has Rhabdomyolysis he/she may have very dark urine. Why is this a side effect?

The kidneys are trying to excrete the excessive amount of protein in the bloodstream, which is caused by the rapid breakdown of the muscles.

What are the main causes of Rhabdomyolysis?

Extensive exercises and/or some medications

R.I.C.E

Rest, Ice, Compression, Elevate

Inflammation symptoms

1. Redness and warmth

2. Swelling

3. Pain

4. Loss of function

What are some benefits of inflammation?

1. Prevent infection,

2. Limit the spread of invasion to healthy tissue

3. Triggers clotting

4. Prepares the area of injury for healing

5. Remove bacteria and dead cells

Primary Osteoporosis is caused by

Aging and decreased hormones

Secondary Osteoporosis is caused by

1. Medications

2. Hyperparathyroidism

3. Chronic Kidney disease

4. Cushing disease

5. Long-term immobilization

6. Hormone imbalance

7. Low body weight

8. excessive exercise

Osteopenia vs. Osteoporosis

Osteopenia is a decreased bone mineral density

Osteoporosis porous bone.

What are the four medication categories recommended to treat osteoporosis?

1. Calcium

2. Selective-Estrogen receptor modulators

3. Bisphosphonates

4. Calcitonin

Hypocalcemia symptoms

1. Muscle cramps/spasms

2. Tingling lips and fingers

3. Confusion

Hypercalcemia symptoms

1. Muscle weakness

2. Hypotonia

3. Depressed Deep Tendon Reflexes (DTR)

4. Constipation

____________ is a selective estrogen receptor modulator (estrogen agonists/antagonists) medication that prevents and treats postmenopausal osteoporosis.

Raloxifene

Alendronate, Ibandronate, and Zoledronic (IV) are classified as what type of medication?

Bisphosphonates

Define Parathyroid and its function

Four little glands on top of the thyroid with the purpose of monitoring serum calcium levels.

We get our calcium levels into the serum from our bones.

The Parathyroid tells the bone to breakdown and send calcium into the blood.

Bisphosphonates action

Trigger the parathyroid to block bone resorption.

In other words it slows down bone breakdown to make it stronger. Remember parathyroid sends signals to the bone to breakdown and release calcium.

Calcitonin-salmon’s action

this medication is a hormone that decreases bone resorption by inhibiting the activity of osteoclasts in osteoporosis

A Metabolic disease characterized by inadequate and delayed mineralization. There are two names, one for kids and the other for adults.

Rickets in children

Osteomalacia

What is the second most common disease after Osteoporosis?

(Note: It’s a genetic disease in which there is an increased metabolic activity in bone characterized by abnormal and excessive bone resorption)

in other words, the bones break down and regrow at an excessive rate causing the bones to grow softer and abnormal.

Paget’s disease

Bone infection that is often caused by bacteria but can also be caused by fungi, parasites, and viruses. This disease is hard to detect, hard to fight, and can be very serious.

Osteomyelitis

What is the treatment recommended for Osteomyelitis?

Antibiotics

Before an antibiotic can be ordered what is required?

Culture!

Always make sure a culture is ordered, and we must wait for the results to determine which antibiotic is recommended for the bacteria detected.

IF it is crucial that the patient is getting treated ASAP and can’t wait for results, a Broad-spectrum antibiotic is recommended while we wait for results.

Once we get results and know which Narrow-spectrum antibiotic is recommended, we give that new antibiotic, and the patient continues the broad antibiotic until it is finished. The patient will take both until all is finished.

Swaybak-curving inward at lower back posture is known as:

Lordosis

Hunchback or humpback-abnormally rounded upper back posture is known as:

Kyphosis

What posture is found in a patient with Scoliosis?

S or C shaped-sideways curve to the spine

A syndrome characterized by pain and fatigue, but no obvious inflammation or degeneration is known as:

(We only know the patient has a problem because they report pain but physically there is nothing and testing is usually normal)

Fibromyalgia

Degenerative joint disease with secondary inflammation, loss of ROM, and pain that can be treated with NSAIDs is known as:

Osteoarthritis

Rheumatoid arthritis is

A Chronic, progressive, inflammatory, and autoimmune disorder affecting the joints.

Three different treatments for Rheumatoid arthritis are:

1. DMARDs (disease-modifying antirheumatic drugs.

2. Glucocorticoids

3. NSAIDS

Inflammatory disease of joints, tendons, and other tissues that is caused by the accumulation of uric acid that crystallizes and is deposited into the joints.

GOUT

Name the three step treatment for GOUT

1. Colchicine -Stop inflammatory process

2. Probenecid- Control Uric Acid

3. Allopurinol- Prevent reoccurrence

Colchicine action:

Inhibits migration of leukocytes to inflamed site.

___________ is prohibited while taking colchicine.

Grapefruit

Probenecid action:

Blocks reabsorption of uric acid which promotes its excretion

Allopurinol action:

Drecreases uric acid synthesis.

A chronic inflammatory disease of the axial spine.

Ankylosing spondylitis

Inflammation in bursal sacs caused by trauma and overuse injuries.

Bursitis

Synovitis

Swelling in the synovial membrane that lines some of the joints. Arthritis and injuries to joints are the most common causes

Cephalexin, Cefazolin, Ceftriaxone, Cefepime all are:

Cephalosporins

The most common Second generation NSAID used to treat osteoarthritis, rheumatoid arthritis, etc. is called:

Celecoxib (Celebrex)

Medication that decreases the number and action of osteoclasts and inhibits bone resorption is called:

(it is used for osteoporosis)

Alendronate

Nutritional considerations for GOUT

Avoid foods high in Purine

Increase fluid intake to increase drug and uric acid excretion

Take medications with food to decrease GI upset

No Grapefruit with Colchicine

Methotrexate, Auranofin, sulfasalazine, hydroxychloroquine, etanercept, and infliximab are all under what medication category?

DMARDs