chapter 49: disorders of the skeletal system (trauma, infections, neoplasms)

childhood injuries

fall, bike accident, sports injury

adults <45

trauma, motor vehicle accident

adults >65

fall

sports-related injuries (acute)

sudden trauma, injuries to soft tissue and/or bone

sports-related injuries (overuse)

chronic, high levels of stress without sufficient recovery time (rotator cuff)

sports-related injuries (contact sports)

brain, neck, spine, growth plates (kid)

x-ray used for...

bones

MRI/CAT SCAN used for...

soft tissues

soft tissue injuries (contusions)

muscle bruises, skin over injury is intact, microscopic rupture of blood vessels and damage to muscle cells, swelling and inflammation, ecchymotic (black/blue)

soft tissue injuries (hematomas)

deeper, accumulated blood impinges nerve endings, pain and swelling take longer to subside (covers larger area), worse than contusion

joint

a place where two bones meet

strains

tendon, involves muscle-tendon units, stretching or partial tear of muscle-tendon unit, inflammatory response, fibrous tissue replacement of damaged muscle fibers

strains s/s

pain, swelling, stiffness

strains tx

M. I. C. E

tendon

muscle to bone

sprains

ligament, involve supporting ligaments

sprains etiology

abnormal or excessive movement of a joint

sprains s/s

rapid swelling, discoloration, limitation of function

sprain tx

M. I. C. E

true or false: ligaments have less blood flow than a tendon

true

ankle sprain is...

the most common

knee sprain is...

the second most common

ligament

bone to bone

dislocations

abnormal displacement of the articular surfaces (bones have separated)

congenital dislocation

hip or knee

traumatic dislocation

falls, blows (hits), rotational injuries

pathologic dislocation

late complication of RA (unstable joints), NM (muscles are atrophy or not being innervated by nerve), or paralysis

dislocations diagnosis

H & P, x-ray

dislocations s/s

pain, deformity, limited movement

dislocations tx

manipulation (if closed) or surgical repair (if open), immobilization for several weeks, rehab

shoulder and rotator cuff

overuse injury (pitchers), 3 articulations (acromioclavicular, glenohumeral, sternoclavicular)

shoulder and rotator cuff etiology

overuse or direct trauma

shoulder and rotator cuff s/s

pain and tenderness, difficulty abducting or rotating the arm

shoulder and rotator cuff diagnosis

MRI, H & P

shoulder and rotator cuff tx

anti-inflammatories, corticosteroid injections, PT, surgical repair

if professional athlete, always do surgical repair, try others first if not professional athlete

knee injuries (ligamentous)

most serious, pop or tearing sensation with sudden pain

knee injuries (ligamentous) s/s

inability to bear weight, pain, swelling

knee injuries (ligamentous) tx

M. I. C. E, immobilization, range of motion (once swelling goes down), surgical repair

knee injuries (meniscus)

rotational injury from a sudden or sharp pivot

knee injuries (meniscus) s/s

swelling, pain, knee instability/locking

knee injuries (meniscus) tx

immobilization, quad exercises, surgery

meniscus

two piece of fibrocartilage, shock absorber

patellofemoral pain syndrome

misaligned, patella slides to one side, most common cause of anterior knee pain, runner's knee

patellofemoral pain syndrome etiology

imbalances in forces controlling flexion/extension of patella

patellofemoral pain syndrome s/s

pain

patellofemoral pain syndrome tx

rest, PT

hip injuries (dislocations)

life-threatening, from severe trauma

hip injuries (dislocations) s/s

severe pain, inability to move lower extremity (no blood to head of femur)

hip injuries (dislocations) tx

reduction (procedure to repair a fracture or dislocation to correct anatomical position/alignment), limited weight bearing

hip injuries (fractures)

most are result of falls (proximal femur usually involved), accompanied by humerus break

hip injuries (fractures) risk factors

age, physical inactivity, visual impairment, dementia, alcohol/drug use to excess, osteoporosis

hip injuries (fractures) diagnosis

H & P, x-ray

hip injuries (fractures) s/s

severe pain, inability to move, swelling, bruising

hip injuries (fractures) tx

surgical replacement or reduction, biphosphonates

fractures

disruption in bone continuity

greenstick fractures

common in kids under age 10, breaks on one side (KID JONES)

fractures s/s

pain and tenderness at the sight, swelling, loss of function and mobility

local shock (fracture)

can be reduced with little or no pain (within 30 minutes)

fractures diagnosis

x-ray

fractures tx

splint, reduction (within 30 minutes) with external or internal fixation device (pins/screws), immobilization, rehab

stages in healing bone fracture

hematoma formation, fibrocartilage callus formation, bony callus formation, bone remodeling

impaired bone healing (malunion)

healing with deformity

impaired bone healing (delayed union)

failure to heal within the normal period

impaired bone healing (nonunion)

cessation of the process of bone repair (stop healing)

impaired bone healing tx

surgery (bone grafts, electrical stimulators)

fracture blisters

complication of fractures, rare, more common than compartment, skin overlying fractured bone

fracture blisters tx

soft dressings, surgery

compartment syndrome

complication of fractures, rare, putting a cast on before inflammation stops, increased pressure in muscle compartment, compromised blood flow, may lead to necrosis of nerve/muscle tissue

compartment syndrome s/s

severe pain out of proportion to initial injury

compartment syndrome tx

split or remove restrictive dressings, fasciotomy (last resort, cut the fascia)

fat embolism syndrome

complication of fractures, rare, follows long bone trauma, fat from bone marrow moves into blood stream, may block vessels in lungs, skin, brain

fat embolism syndrome s/s

rash, dyspnea, altered mental state

fat embolism syndrome tx

symptomatic until fat is reabsorbed

osteomyelitis

bone infection, sometimes will do an MRI

osteomyelitis etiology

bacteria (staph) or fungi

osteomyelitis s/s

edema, erythema, warmth, pain over area of infection, fever, chills

osteomyelitis tx

antibiotics, antifungals, surgical drainage or debridement (take out dead tissue), bone graft, amputation

osteonecrosis

bone infection, ischemia (diminished blood flow) or infarction (no blood flow) to bone

osteonecrosis s/s

early stage (asymptomatic), late stage (pain)

osteonecrosis tx

joint replacement

bone tumors

cause is unknown, both benign and malignant neoplasms can develop from cartilage, bone, or supporting elements

bone tumors s/s

pain, mass, impaired function

bone tumors (benign)

slow-growing, don't disrupt surrounding tissue

bone tumors (benign) tx

surgery or radiation

bone tumors (malignant)

osteosarcoma (most common), osteogenic sarcoma, primary (rare, often mets to lungs), or result of metastasis (secondary to breast, lung, prostate cancer)

bone tumors (malignant) s/s

pain, localized swelling, fractures

bone tumors (malignant) tx

chemo, radiation, surgery/amputation