Musculoskeletal System Guided reading 6

Why does it take such a long time for cartilage to heal after an injury?

Cartilage has limited supply of blood flow making it take longer to heal

- Avascular Tissue does not have its own blood supply so the tissues that surround the cartilage give it the nutrients and oxygen slowly

Osteoblast

Bone forming cells

- Forms bone matrix and non diving cells

Osteocytes

Mature Osteblast

Osteoclasts

Bone cells that break down bone tissue

- Aids in the remodeling of a bone

Metaphysis

Region between the ephyseal bone plate and diaphysis

- Contains the trabecular bone which is porous bone

- There is extensive remodeling in children

Epiphysis

The growth plate

- Increases the length of the bone

Diaphysis

Shaft of the bone

Joints

Connection between two or more bones that allows movement, stability, or both

- skeletal stability and mobility

synovial

Freely movable joints

- Filled with synovial fluid.

- knees, wrists, hands, fingers, and feet

non-synovial

Joints that lack a joint cavity and do not have synovial fluid

Tetany

Muscle hyper excitability causing involuntary muscle contractions and spasms

Chvostek's sign

Clinical sign of neuromuscular excitability, typically seen in hypocalcemia

Difference between dislocation and subluxation

Dislocation: Occurs when the bones in a joint are forced out of their normal position

Subluxation: Partial or incomplete displacement of the joint surface

Difference between sprain and strain

Sprain: Injury to a ligament

Strain: Injury to a muscle or tendon

Manifestations of a fracture

- Edema and swelling

- Pain and tenderness

- Muscle spasm

- Deformity

- Ecchymosis/ contusion

- Loss of function

- Crepitation

Differentiate between the stages of the fracture healing process

1. Hematoma formation: Occurs due to rupture of blood vessels

2. Granulation tissue-or cellular proliferation: Hematoma converts over to granulation tissue

3. Callous Formation: End of 2nd week changes into newly formed cartilage

4. Ossification-Consolidation: Mature bone replaces callous

5. Remodeling (Wolff's Law): Osteoclasts resorb excess callus bone returns pre-injury strength

6. Healing Time

Parathyroid glands with the production of the three hormones associated with bone formation

1. Parathyroid Hormone

2. Calcitonin

3. Calcitriol

What hormone is responsible for increasing and decreasing calcium production

Increases: Parathyroid hormone

Decreases: Calcitonin

Malunion

Healing of a fractured bone in an abnormal or misaligned position

Angulation

Type of bone deformity where a fractured bone heals at an abnormal angle rather than straight

Delayed union

Fracture that heals more slowly than expected, taking longer than the usual healing time but eventually healing

Nonunion

Failure of a fractured bone to heal within the expected time frame

What are some potential complications of fractures

- Infection

- Compartment Syndrome

- Venous Thromboembolism

- Fat Embolism Syndrome

Compartment syndrome

Increased pressure within a closed muscle compartment reduces blood flow, leading to tissue ischemia and potential necrosis

Compartment Infection

Infection within a muscle compartment, which can lead to inflammation, swelling, and increased pressure, sometimes progressing to compartment syndrome

What are the 6 P's of Compartment Syndrome?

- Paraesthesia

- Pain

- Pressure

- Pallor

- Paralysis

- Pulselessness

Why is this important to assess the 6 P's of Compartment Syndrome?

Early recognition can prevent permanent damage

Osteomyelitis: Etiology, Who is at highest risk, Clinical manifestations, and Diagnostic tests

- Etiology: Bacterial infection of bone

- Highest risk: Children, diabetics, immunocompromised patients, or open fractures

- Clinical manifestations: tenderness, swelling, warmth, fever, malaise, persistent pain, possible drainage or sinus tract formation, bone necrosis or deformity

- Diagnostic tests: Elevated WBC, ESR, CRP, Blood cultures, X-ray, MRI, CT scan, and Bone Biopsy

Osteoporosis: Etiology, Who is at highest risk, What are the modifiable and non-modifiable risks, clinical manifestations, and diagnostic tests

- Etiology: Bone resorption exceeds bone formation

- Highest risk: Postmenopausal women, older adults, Family History, and thin or small-framed people

- Modifiable: Low calcium/vitamin D intake, sedentary lifestyle, smoking, excessive alcohol, certain medications, poor nutrition

- Non-modifiable: Age, female sex, menopause, family history, small body frame, ethnicity (White or Asian)

- Clinical manifestations: Silent until fracture occurs. Fractures of hip, wrist, or vertebrae, loss of height, kyphosis, back pain

- Diagnostic tests: DEXA scan (d≤ -2.5), labs of calcium, vitamin D, markers of bone turnover, or X ray

Osteopenia: Etiology, Who is at highest risk, Clinical manifestations, and Diagnostic tests

Etiology: Reduced bone mineral density

Highest risk: Postmenopausal women, older adults, Family History, and thin or small-framed people, and ethnicity (White or Asian)

Clinical manifestations: Asymptomatic

Diagnostic tests: DEXA scan (-1.0 to -2.5) Labs of calcium, vitamin D, bone turnover markers, and X-rays

Osteomyelitis: primary bacterial organism responsible for the development, Who is most at risk, Clinical Manifestations, and Diagnostic tests

Primary Bacteria: Staphylococcus aureus (Pyogenic osteomyelitis)

Most at Risk: Mostly children but if wound is open then anyone, Trauma, and implants

Manifestations: bone pain and tenderness, Swelling, redness, warmth, Fever, malaise, sinus, bone necrosis, or deformity

Diagnostic Tests: Elevated WBC, ESR, CRP, Blood cultures, X-ray, MRI, CT scan, and Bone Biopsy

Compare and contrast osteoarthritis and Rheumatoid arthritis

Osteoarthritis: Non-inflammatory joint disease

Rheumatoid arthritis: Inflammatory joint disease

Compare: Both affect joints (mostly hand joints) and can cause pain, stiffness, and occur in more commonly in older adults

Osteoarthritis: What are the causes, Manifestations, and diagnostic tests

Causes: Age-related cartilage degeneration and Joint injury, obesity, repetitive stress, congenital deformities, metabolic disorders

Manifestations: Joint pain worse with activity, stiffness, swelling, reduced range of motion, crepitus, bony nodules

Diagnostic tests: Physical exam, X ray, and Lab Tests

Rheumatoid arthritis: What are the causes, Manifestations, and diagnostic tests

Causes: Autoimmune disease, genetics, Female, and Environment

Manifestations: Symmetric joint pain, swelling, warmth, stiffness, Fatigue, malaise, low-grade fever, Small joints, and Joint deformities

Diagnostic tests: Lab tests (Rheumatoid Factor, anti-CCP antibodies, and elevated ESR/CRP), Xray, and Physical exam