MA certificate chapter 3 + 4

Skeletal Muscle Fibers

Attached to the skeleton.

Striated + Voluntary

Cardiac Muscles

Present in walls of the heart.

Striated + involuntary

Smooth Muscles

Located in the walls of hollow organs (digestive tract, bladder, uterus) and blood vessels.

Epiphyses

The expanded ends of a long bone.

Covered by articular cartilage.

Bones

Connected to one another by ligaments at joints.

Articular Cartilage

Reduces the stress of weight bearing and decreases friction caused by body movement.

Long bones

Consist of a hollow tube (medullary cavity), which contains yellow bone marrow.

longitudinal; radial

Since bone is a living tissue, it undergoes ___ growth, ___ growth, and remodeling throughout life.

Calcium + Phosphorus

Bones serve as a reservoir for minerals, such as ___ and ___

Red bone marrow

__ ___ ___ is primarily found in flat bones and the proximal ends of long bones in adults (sternum, ribs, vertebrae, pelvis, and proximal humerus and femur).

Periosteum

A thin membrane covering bone that contains sensory nerves, blood vessels, and cells involved in bone growth and repair.

Joint

Formed when two bones meet.

Synovial fluid

A clear fluid found in the joint cavities, facilitates smooth movements and nourishes joint structures.

Synovial joints

Highly moveable because of the presence of synovial fluid and cartilage cover at the end of the bone.

Non-synovial joints

Immovable or slightly movable, and the ends of bones are covered with fibrous cartilage. Ex : Sutures.

Hinge Joints

Movement restricted to one plane; elbow + knee joints.

Gliding joints

Two flat-surfaced bones slide over each other and has limited movement; foot + wrist joints.

ball-and-socket joints

Joint can rotate in circles and have a very high range of motion; shoulder joints.

Sutures

Joints with very limited flexibility; joints of the skull.

Rotation

movement of a bone around its central axis.

Flexion

Decreasing the angle of the joint.

Abduction

Moving the body part away from the midline of the body.

Hyperextension

Extension of a joint beyond its normal anatomical position.

Extension

Increasing the angle of the joint.

Circumduction

Combination of abduction, adduction, extension, and flexion.

A conical or circular movement of a limb.

Dorsiflexion

A movement that reduces the angle between the foot and leg.

The bending of the foot in the direction of the dorsum makes the toes point up.

Reduces the angle between the leg and foot.

Plantar Flexion

A movement that increases the angle at the ankle joint.

It is the flexion of the foot by moving the toes downwards.

Increases the angle at the ankle joint.

Eversion

A movement of that foot laterally away from the midline of the body.

Moving a foot laterally away from the midline of the body.

Inversion

A movement of the sole of the foot toward the midline.

Moving a foot laterally toward the midline of the body.

Pronation

Movement of the forearm that turns the palm of the hands inwards facing down.

It involves turning the palm inferiorly.

Supination

Movement of the forearm that turns the palm of the hand outwards facing up.

It involves turning the palm superiorly.

Osteoporosis

A decrease in the calcium deposits and bone strength, results in weak and fragile bones.

Postmenopausal women, men over age 50 with low testosterone levels, people with family history of osteoporosis or amenorrhea, and people with anorexia nervosa.

Long-term use of certain medications, such as anti-seizure drugs, corticosteroids, and heparin, increases the risk of osteoporosis.

Increased intake of calcium + vitamin D. Physical interventions involve performing weight-bearing exercises.

Pharmacological treatments include bisphosphonates, such as residronate and zoledronic acid, as well as hormone replacement therapy with estrogen.

Osteoarthritis

Thinning and degeneration of cartilage.

Symptoms vary depending on the severity of the disease. Degeneration of the cartilage exposes roughened surfaces of bone, causing bones to rub against each other.

Commonly affected joints are the fingers, spine, hips, knees, and feet.

The goal of treatment is to relieve pain, maintain normal movement of the joint, and prevent deformities.

Pharmacologic treatments include analgesics, nonsteroidal antinflammatory drugs (NSAIDS), and intra-articular steroid injections.

In severe conditions, joint prosthesis may be necessary.

Osteomalacia

Bone softens due to inadequate calcium and vitamin D. The decrease in calcium makes the bone flexible.

Symptoms include muscle weakness, bone tenderness, partial fractures, and malaise. In children, deficiency of calcium and vitamin D leads to rickets. Rickets a condition in which the bones of children are softened and weakened, and may fracture easily.

Treatment includes dietary interventions, such as increased intake of vitamin D, calcium, and phosphorus supplements.

Scoliosis

The abnormal curvature of the spine to the left or right.

Mild scoliosis may not cause any symptoms. In severe cases, it may cause back pain and heart or lung problems.

Treatment includes chiropractic care, orthopedic devices such as braces, shoe lifts, exercise, and electrical muscle stimulation.

Severe conditions may require rigid casting with or without surgery.

Commonly seen in adolescents.

Lordosis

The abnormal curvature of the spine in which the lower back is more pronounces than the upper back.

“Sway back.”

Typically develops with aging or can occur over time due to poor posture.

Kyphosis

The abnormal curvature of the spine in which the upper part of the back is more pronounces than the lower back.

“Hunchback.”

Develop with aging or can occur over time due to poor posture.

Herniated disc

A condition in which there is a protrusion of the soft nucleus of the intervertebral disk into the outer cartilaginous covering.

Caused by improper lifting, smoking, excessive body weight, and repetitive strenuous activities.

____ ___ in the lumbar region may cause severe low back pain that radiates down the leg and makes walking difficult. If the herniated disk is in the cervical region, it may cause neck pain that radiates to the arms + fingers.

Treatment includes NSAIDs, analgesics for the pain, PT, chiropractic adjustments, and epidural steroid injections.

Rheumatoid Arthritis

A chronic autoimmune inflammatory disorder.

Symptoms include malaise, fever, weight loss, and morning stiffness of the affected joints.

Treatment includes NSAIDS; corticosteroids; disease-modifying antirheumatic drugs (DMARDs), such as methotrexate and leflunomide; and biologicals, such as etanerept and inflixmab.

Fibromyalgia

Muscle pain and tenderness due to unknown causes.

Symptoms of fibromyalgia include fatigue and chronic pain.

Sleep disorders and IBS are associated.

Treatment includes measures to reduce pain, promote sleep, and reduce stress and anxiety levels.

Pharmacological treatment includes prescribed medications, such as pregabalin (Lyrica), milnacipran (Savella), zolpidem (Ambien), tramdol (Ultram), duloxetine (Cymbalta), and fluoxetine (Prozac).

Myasthenia Gravis

An autoimmune neuromuscular disease of the voluntary muscles that leads to profound muscular weakness.

It mostly affects muscles that control the movement of the eyes and eyelids, facial expressions, and swallowing.

Treatment includes medications that inhibit acetylcholinesterase and surgical removal of the thymus gland (thymectomy).

Spasm

A spasm is an involuntary contraction of a muscle, often causing pain + stiffness.

Bursitis

Results in painful joints with reduced range of motion caused by overuse of the knee, shoulder, or elbow joints. Treatment includes rest, non-steroidal anti-inflammatory drugs, and corticosteroids.

Lupus

Painful and swollen joints accompanied by fever, chest, and muscle pains, and other manifestations that are associated with autoimmune dysfunction.

Gout

A metabolic disease that involves increased production or decreased elimination of uric acid. The risk factors include kidney disease, alcohol consumption, obesity, untreated hypertension, and a family history of gout.

Treatment include NSAIDs, colchicine, allopurinol, and probenecid. This is often seen in the lower extremities, especially the foot and the big toe.

Lyme Disease

A tick-borne infection caused by Borrelia burgdorferi. The disease is manifested by flu-like symptoms and a “bull’s-eye” lesion, called erythema migrans, that surrounds the area of the tick bite. Treatments include doxycycline (Doryx. Monodox), amoxicillin (Amoxil, Trimox), and IV ceftriaxone (Rocephin).

Restless Leg Syndrome

Unpleasant sensations, such as tingling, aching, and twitching of the legs during periods of inactivity, especially at night. This condition may be associated with stress. Treatments include lifestyle changes, ropinirole (Requip), rotigotine (Neupro), pramipexole (Mirapex), gabapentin (Neurontin), pregabalin (Lyrica), zolpidem (Ambien), and eszopiclone (Lunesta).

Strain

Often seen in the lower back or hamstrings of the thigh.

Due to twisting of a muscle.

Symptoms include pain, muscle weakness, muscle spasms, and inflammation.

Treatment includes NSAIDs for pain, rest, ice application, compression, and elevation.

Sometimes, a soft tissue injury may require the use of crutches, casting, or surgical repair.

Sprain

Often seen in the ankle or knee joint.

An injury to a ligament/

Symptoms include pain, swelling, bruising, and inability to move the affected area.

RICE

Involves damage to the blood vessels, muscles, tendons, and nerves of the affected area.

Symptoms include swelling, redness or bluish discoloration of the affected area due to the rupture of blood vessels.

Most common type is the ankle.

Dislocation

This often happens in the shoulder or hip joint.

Injury to the joint in which bones no longer align properly at the joint; also known as luxation. When the bones are only slightly out of proper alignment, it is called subluxation.

Symptoms include pain and possible crepitation (dry, crackling sound or sensation)

Treatment includes immediate reduction + immobilization of the affected part.

A surgical reduction may be required in some cases.

Fracture

A complete or partial break in a bone.

Symptoms include pain, swelling, bleeding, inability to move, misalignment of the bone, and discoloration or bruising of the surrounding area.

Closed (or simple) fracture

A broken bone that does not come through the skin (skin is intact).

Open (or compound) fracture

A bone is broken and pierces through the skin, causing risk for infection because a skin wound is involved.

Longitudinal fracture

extends along the length of the bone.

Impacted fracture

Causes by strong forces that drive bone fragments firmly together

Comminuted Fracture

Caused by severe, direct force, creating a fracture with multiple fragments.

Pathologic fracture

A break in the bone due to weakening of the bones caused by a disease, such as osteoporosis.

Greenstick fracture

A break in the bone caused by a compression of long bones in children under the age of 10.

Avulsion fracture

Caused by forceful contractions of a muscle against resistance.

Compression fracture

A break caused by forces that drive bones together, typically seen in the vertebrae.

Depression fracture

Occurs when bone fragments of the skull are driven inward.

Non-displaced fracture

Occurs when a bone end remains in alignment, but other parts of the bone are fractured.

Active ROM

for ___ ___, ask the patient to move the joint as far as comfortably possible.

Passive ROM

for ___ ___, the patient relaxes and the provider moves the joint as far as possible.

muscle strength evaluation

• roll up an aneroid bp cuff and have the patient hold it in one hand

• inflate the cuff to 20 mm Hg of pressure and lock the valve.

• ask the patient to squeeze the cuff as tightly as possible.

• note the increase in pressure on the dial (grip strength is compared between both hands; significant differences may indicate weakness.)

• record the hand test and the results of the test.

• repeat on the other hand.

X-rays

Diagnose fractures, dislocations, and bone and joint diseases, as well as monitoring the healing of fracture.

arthogram

visualizes joints with an X-ray after injecting a radiopaque dye.

bone scan

evaluates areas of bone growth, bone tumors, and other bone disease patterns; it requires the use of an injected dye or isotope.

DEXA scan

assesses bone density and diagnoses and manages osteoporosis.

CT scan

helps diagnose tumors, lesions, or some spinal injuries.

EMG + NCV studies

evaluate muscle and nerve response to stimulus

biopsy (of bone + muscle)

helps identify malignant tumors, neoplasms, and pathogens.

Cold Application

Ice Packs + cold compresses, are recommended in the first 48 hours after an injury to help control bleeding, pain, and swelling.

Heat Application

Hot pillow, heating pad, microwavable gel packs are used after a cold application to help improve circulation, reduce pain, and maintain muscle and joint function.

Therapeutic Ultrasonography

Uses ultrasound waves that cause the tissue to vibrate + generate heat, leading to increased metabolism. This helps the body’s healing process. Ultrasound waves can travel through muscle tissues, as they have high water content.

Massage

Therapeutic stroking of a body part. It helps relieve localized and referred pain.

Exercise

Help with msucle relaxation, promote healing, and provide pain relief.

TENS units

Produce a low-voltage current that stimulates the motor + sensory nerves that affect muscles.

Cold Application

Vasoconstriction + Contraction of the involuntary muscles of the skin are the two mechanisms that occur due to ___ ___.

These effects reduce the blood supply to the area and produce numbness on the sensory nerve endings.

It helps in controlling bleeding and reduces further swelling, inflammation, and pain.

Heat Application

Vasodilation, muscle relaxation, and local warmth are the effects that occur due to ___ ___.

This causes increased blood flow (vasodilation) and reduced muscle spasm and pain in the affected area.

Paraffin bath

Applied to the affected area, is a type of heat application that treats chronic joint inflammation and joint pain, and can help patients get relief from conditions such as rheumatoid arthritis.

Wheelchairs

Help in mobility of patients who cannot walk or are able to walk for short distances only.

Crutches

Used to prevent weight bearing on the affected leg, foot, or ankle.

opposite

The MA should advise the patient to use the cane on the ___ side of the affected leg.

Walker

Help in balancing + supporting, especially in geriatric patients.

Two-point crutch gait

It is used if both legs are weak. The patient moves the left crutch and the right foot together, then the right crutch and the left foot together.

Three-point crutch gait

It is used if the patient is unable to bear weight on one leg. The patient moves both crutches and the affected leg forward, then bears down through the crutches and moves the unaffected leg forward.

Four-point crutch gait

Provides the best stability and can be helpful for patients in whom both legs are weak. The patients move the right crutch forward, then the left foot followed by the left crutch and then the right foot.