Quiz 9: 202

musculoskeletal system functions

support body structure, movement, protect organs, produce blood cells, mineral storage, and energy storage

osteoblasts vs osteoclasts

build bone (form matrix and help with mineralization)

break down bone (reabsorption)

parathyroid hormone

increases blood calcium by stimulating osteoclasts

calcitonin

lowers blood calcium by inhibiting osteoclasts

estrogen/testosterone

maintain bone density

vitamin D

helps calcium absorption

muscle types

skeletal- voluntary, striated

smooth- involuntary, in organs

cardiac- involuntary, hearty only, striated

range of motion

active- patient moves joint themselves

passive- movement by examiner

active-passive

functional- ability to perform ADLs

synovial vs. nonsynovial

freely movable, joint capsule, (knee, shoulder)

limited movement (sutures in skull)

cartilage

cushions joints, provides structure

avascular- gets nutrients from synovial fluid

ligaments

connect bone to bone

tendons

connect muscle to bone

fascia

layers of connective tissue covering muscles

goniometer

measures joint angles and ROM

low serum calcium

higher fracture risk due to weaker bones

arthrogram

imaging using contrast to visualize soft tissues in joints

joint mobility indicator

range of motion and functional movement assessments

DEXA scan

most common bone density study

low bone density → osteoporosis = ^ fracture risk

t score: -1 and greater = normal, -1 to - 2.5 + osteopenia, -2.5 and below = osteoporosis

risk factors for postmenopausal women

→ loss of estrogen → decrease in bone density → ^ risk of fracture

• prevention: weight-bearing exercise, vitamin D /mineral supplementation, regular follow up

sarcopenia

decline in muscle mass and strength

• associated with age

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muscular dystrophy

patho: genetic, muscle degeneration due to lack of the protein responsible for muscle repair, muscle weakness, wasting, increased muscle enzyme serum levels

gold standard: muscle biopsy

treatment: NO CURE, glucocorticoids- decreased rate of muscle deterioration, decrease inflammation, increase functional ability, supportive (PT, corticosteroids)

goal: prevent progression, maintain function, reduce inflammation, regulate metabolic pathways

osteoporosis

Patho: bone resorption activity is greater than bone rebuilding activity

• osteoclastic activity > osteoblastic activity)

manifest: pathologic fracture- usually first sign

diagnosis- DEXA scan is gold standard

treatment: weight loss, muscle-strengthening exercises, weight-bearing exercise, healthy lifestyle, avoid smoking and excessive alcohol intake

bisphosphonate patient teaching

Fosamax (alendronate): 1st thing, empty stomach with water, don’t eat/drink for 30 min after taking, stay upright for 30 min after, avoid stomach-irritating OTC meds

Boniva (ibandronate): PO q month or IV q 3 months, if PO= empty stomach, side effect GI upset)

Paget’s disease

patho: bone deformities and fractures

manifestations: deformity at affected bony site

osteomyelitis

patho: bone infection

manifestations: pain not relieved by stress, swelling, tenderness and warmth, fever, chills, malaise

biopsy- gold standard

treatment: antibiotics 4-6 weeks, pain management

scoliosis

patho: lateral spine curvature

manifestations: sideways cure of spine, uneven shoulders, uneven waist, cardiopulmonary compromise

cobb’s angle: intersection of perpendicular lines drawn from upper and lower vertebrae most affected by the curve

treatment: progressive exercise regimen, thermal therapy, PT &OT, pain management

joint replacement

severe arthritis, knee and hip arthroplasties

complications: infection, DVT, dislocation

osteoarthritis

patho: decrease in joint fluid that affects cartilage = loss of cartilage strength and functionality

symptoms: joint pain, stiffness, locomotor restriction

conservative therapies: weight management, activity modification, topical NSAIDs, glucosamine & chondroitin

XR findings: joint space narrowing, asteophytes

bone cancer

complications: amputation, death, delayed wound healing, osteomyelitis & wound infections, and hypercalcemia

plantar fasciitis

patho: inflammation of the plantar fascia

symptoms: stabbing heel pain, typically in AM

palpation: @ plantar aspect of the foot, both bands compressing the plantar fascia

conservative therapies: PT, night splints, orthotics, nonsteroidal anti-inflammatories

strains & sprains

• injury to muscle or tendon

• injury to ligaments

treatment: rest 72h, ice, compression, elevate (RICE)

fractures

patho: bone break due to disease or condition that weakens bone

compartment syndrome

EMERGENCY

six Ps: passive pain, pressure, paresthesia, pallor, paralysis, pulselessness

treatment fasciotomy: cut fascia to relive pressure over compartments

amputations

complications: hemorrhage, infection, contractures, phantom limb pain, neuromas

meniscus injury

what is it? cartilage cushion in knee

symptoms: clicking, locking, popping

McMurray’s test: flex knee, rotate leg, extend

• + sign- pain or click - meniscal tear

carpal tunnel syndrome

patho: inflammation compresses nerves, tendons, ligaments, compression of median nerve

risk: repetitive use, pregnancy, RA

affected areas: thumb, index, and middle fingers

treatment: midification, ultrasound therapy, NSAIDs, steroid injections, night splinting

Phalen’s test

for carpal tunnel

upside down prayer position for 30-60 sec; + tingling/numbness

Tinel’s test

tapping median nerve

• + sign if tingling

low energy fracture

common in elderly; falling from standing height

open fracture

risk of infection- antibiotics ASAP

displaced fracture

bone ends misaligned

external fixation

stabilization using hardware outside body

reduction of a fracture

realigning the bone

• complications- infections, delayed healing, emboli

• fat embolus- long bone fractures, fatty bone marrow migrates into systemic circulation