Chapter 51: Alterations in Musculoskeletal Function: Trauma, Infection, & Disease (exam 4)

What are contractile soft tissue structures?

Muscle belly, tendon, and bony insertion (enthesis) that are involved in muscle contraction.

What are inert (noncontractile) soft tissue structures?

Joint capsules, ligaments, bursae, fasciae, dura mater, and nerve roots.

What finding suggests a contractile soft tissue injury?

Pain with active contraction and decreased muscle strength.

What finding suggests an inert soft tissue injury?

Pain with passive stretching and altered joint range of motion.

What causes ligament injuries?

Loading that exceeds the physiological range of motion.

Describe a Grade I ligament injury.

Stretching injury without instability.

Describe a Grade II ligament injury.

Partial tear with instability but some fibers remain intact.

Describe a Grade III ligament injury.

Complete ligament rupture with significant instability.

What are common signs of a ligament injury?

Tearing or popping sensation, pain, swelling, and difficulty bearing weight.

What are common ligament injuries?

ACL, MCL, talofibular ligament, and acromioclavicular ligament injuries.

How are moderate ligament injuries treated?

Protection from further injury and support of healing.

How are severe ligament injuries treated?

Surgical restoration of ligament continuity.

How does joint capsule injury affect movement?

Scarring and thickening limit range of motion.

How does prolonged immobilization affect a joint capsule?

Promotes adhesions, fibrosis, cartilage degeneration, and loss of motion.

What is adhesive capsulitis?

Frozen shoulder caused by inflammation, capsular swelling, and adhesions.

What are symptoms of adhesive capsulitis?

Pain, especially at night, loss of movement, and capsular tightness.

How can adhesive capsulitis be prevented?

Avoid prolonged immobilization and perform gentle stretching.

What is internal joint derangement?

Tears of menisci or ligaments causing instability and joint dysfunction.

What symptoms occur with acute meniscal or ligament tears?

Pain, swelling, locking, and popping.

What is the function of fascia?

Connective tissue sheaths that surround muscles.

How does fascial injury affect movement?

Edema and scarring restrict fascia movement and joint motion.

What is a bursa?

A synovial-lined sac that reduces friction between tissues.

What is bursitis?

Inflammation of a bursa causing pain and restricted movement.

What symptoms occur with nerve injury or entrapment?

Radiating pain, numbness, tingling, weakness, and diminished reflexes.

What is tendinitis?

Inflammation of a tendon caused by infection, injury, or overuse.

What are symptoms of tendinitis?

Pain with active motion, tenderness, and localized thickening.

What is a muscle or tendon strain?

Injury to the contractile unit caused by abnormal or sudden contraction.

What is a contusion or crush injury?

Blunt trauma causing bleeding into muscle tissue.

What is myositis ossificans?

Calcification of muscle tissue following bleeding into a muscle.

What is compartment syndrome?

Increased pressure within a fascial compartment causing ischemia.

Why is compartment syndrome dangerous?

It can cause severe pain, nerve damage, muscle death, and tissue loss.

What causes edema formation after injury?

Increased capillary permeability and vasodilation.

What neurotransmitter causes initial vasoconstriction after injury?

Norepinephrine.

What chemical mediators cause vasodilation during inflammation?

Histamines.

What is the function of fibrin during healing?

Seals damaged tissue and localizes inflammation.

What are the major stages of wound repair?

Inflammation, granulation tissue formation, reepithelialization, collagen deposition, revascularization, and wound contraction.

What determines the type of fracture?

The type of stress applied to the bone.

What is a transverse fracture?

A fracture perpendicular to the long axis of the bone.

What is a spiral fracture?

A fracture caused by rotational forces that wraps around the bone.

What is an oblique fracture?

A fracture occurring at an angle across the bone.

What is a comminuted fracture?

A fracture with multiple fragments and fracture lines.

What is an impacted fracture?

A fracture where one fragment is driven into another.

What is a greenstick fracture?

An incomplete fracture commonly seen in children.

What is a stress fracture?

A cortical bone failure caused by repetitive stress.

What is an avulsion fracture?

A fracture where a tendon or ligament pulls off a bone fragment.

What is a nondisplaced fracture?

A fracture in which fragments remain aligned.

What is a displaced fracture?

A fracture in which fragments are separated.

What is a depressed fracture?

A fracture where a fragment is pushed below the bone surface.

What is a complete fracture?

A break through the entire bone.

What is an incomplete fracture?

A crack or buckle that does not extend through the entire bone.

What is a closed fracture?

A fracture with intact skin.

What is an open fracture?

A fracture that penetrates the skin.

What imaging is first used to diagnose fractures?

Plain radiographs from at least two angles.

When are CT or MRI used for fractures?

When fractures are occult or not visible on plain radiographs.

What are the stages of cortical bone healing?

Hematoma formation, osteoblast invasion, callus formation, and remodeling.

How does cancellous bone healing differ from cortical bone healing?

It heals mainly through internal callus formation and has less necrosis due to rich blood supply.

What are common fracture treatments?

Casts, splints, surgery, fixation devices, bone grafting, and rehabilitation.

What is delayed union?

Healing that progresses slower than expected, often 3–6 months after fracture.

What is malunion?

Healing in an improper alignment.

What is nonunion?

Failure of fracture healing after more than 6 months.

What is osteonecrosis?

Bone death caused by impaired blood supply.

What is osteomyelitis?

A severe infection of bone.

What is fat embolism syndrome?

Fat from marrow enters circulation and lodges in pulmonary vessels.

What is a dislocation?

Complete loss of contact between joint surfaces.

What is a subluxation?

Partial loss of contact between joint surfaces.

What is the most common pathogen causing osteomyelitis?

Staphylococcus aureus.

What are the three major routes of osteomyelitis infection?

Hematogenous spread, contiguous spread from nearby tissue, and direct inoculation.

Where does hematogenous osteomyelitis commonly begin?

The metaphysis of long bones.

What are common signs of osteomyelitis in children?

High fever and localized bone pain.

What are common signs of osteomyelitis in adults?

Fever, malaise, anorexia, night sweats, weight loss, and bone pain.

What are sequestra?

Dead segments of bone separated from living bone.

How is acute osteomyelitis treated?

4–6 weeks of IV antibiotics followed by oral antibiotics.

What is scoliosis?

A lateral spinal curvature greater than 10 degrees.

What distinguishes structural scoliosis from nonstructural scoliosis?

Structural scoliosis has vertebral rotation and does not correct with bending.

What are common signs of scoliosis?

Uneven shoulders, hips, scapulae, and rib hump.

What are possible complications of severe scoliosis?

Respiratory and gastrointestinal problems from compression.

What are treatment options for scoliosis?

Bracing, exercises, spinal fusion, and internal fixation.

What is osteoporosis?

A metabolic bone disease where bone resorption exceeds bone formation.

What is the major hormonal risk factor for osteoporosis?

Estrogen deficiency.

Why are postmenopausal women at high risk for osteoporosis?

Loss of estrogen increases osteoclast activity.

Which type of bone is lost first in osteoporosis?

Cancellous bone.

What are common manifestations of osteoporosis?

Loss of height, kyphosis, vertebral compression fractures, wrist fractures, and hip fractures.

How is osteoporosis diagnosed?

DXA scan measuring bone mineral density.

What T-score defines osteoporosis?

Less than -2.5.

What is osteopenia?

T-score between -1.0 and -2.5.

How is osteoporosis prevented and treated?

Weight-bearing exercise, calcium, vitamin D, and estrogen replacement when appropriate.

What causes rickets and osteomalacia?

Vitamin D deficiency or impaired mineralization.

What is the difference between rickets and osteomalacia?

Rickets occurs in children; osteomalacia occurs in adults.

What are common manifestations of rickets and osteomalacia?

Bone pain, muscle weakness, bowing of bones, and pseudofractures.

How are rickets and osteomalacia treated?

Vitamin D, calcium, phosphate, and dietary improvements.

What is Paget disease?

A metabolic bone disorder with excessive bone resorption followed by excessive bone formation.

What causes the abnormal bone in Paget disease?

Disorganized remodeling by osteoclasts and osteoblasts.

What are common symptoms of Paget disease?

Bone pain, fatigue, stiffness, deformity, and thickened bones.

What bones are commonly affected in Paget disease?

Sacrum, spine, femur, skull, and pelvis.

How is Paget disease treated?

Bisphosphonates such as alendronate, risedronate, pamidronate, and zoledronic acid.

What are sarcomas?

Malignant tumors that originate in bone.

What are common sources of bone metastases?

Breast, prostate, lung, and kidney cancers.

What is an osteochondroma?

A benign cartilage-forming tumor arising from a growth plate defect.

What is a chondroma?

A benign cartilage-forming tumor commonly found in hands and feet.

What is an osteoid osteoma?

A painful benign bone tumor relieved by NSAIDs.