Musculoskeletal PPT Pt. 1 (hormones, strain/sprain, fractures)
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80 Terms
how does the parathyroid hormone work (the phrase) in bone formation?
via a negative feedback loop
what is the “negative feedback loop” of parathyroid hormone & what does this do?
it stimulates the breakdown of BONE by osteoclasts to increase serum calcium levels
what does increased PTH activity mean?
increased serum calcium levels (a DIRECT RELATIONSHIP)
what does calcitonin do in simple terms?
it REDUCES calcium levels
what is the ONE way calcitonin reduces calcium levels?
there isn’t ONE — there’s TWO
what are the ways calcitonin reduces calcium levels?
it reduces the breakdown of bone resulting in lower calcium levels
blocks the kidneys in reabsorbing calcium → it’s excreted
where is calcitonin made?
in the throid
where is active vit D synthesized?
in the renals (kidneys)
what does vit D aid in?
in calcium absorption from the GI
what are the different sources of vit D?
fish, liver, irradiated milk, UV light
if vit D must be sourced from food, how is it then “synthesized” in the kidneys?
because it has to be CONVERTED to the active form by the liver/kidney working together
what are the different hormones involved in bone formation?
parathyroid, calcitonin, and vit D
what join skeletal muscle to bone?
tendons
what is a sheath that’s filled with fluid to prevent friction in a join called?
bursae
what is the displacement of articulation join surfaces called?
dislocation
what is the stretching or partial tear of a muscle?
strain
what joins bone to bone?
ligaments
what is an abnormal or excessive joint movement causing pain that involves ligaments and capsules surround joints?
sprain
what causes tendonitis?
overuse
what is the cause of a strain?
muscle tear/stretching — sudden muscle stretch while contracting
what is the cause of a sprain?
twisting/excessive movement of joint
what are the clinical manifestations describing:
possibly NO external s/sx
pain
stiffness
swelling
increased pain w stretching
inflammatory response w local tenderness
a strain
what are the clinical manifestations describing:
pain
swelling (rapid)
discoloration
limited joint fxn
a sprain
how would you dx a STRAIN?
via an assessment bc there’s not typically an obvious injury
how would you dx a SPRAIN?
the gold standard is an MRI, but also an X-ray, or CT
what are the interventions for both strains & sprains?
PREVENTION (wraming up!!)
RICE
the main tx for strains/sprains is RICE. what does this stand for?
Rest & protect
Ice
Compression
Elevate
what does an MRI of a sprain show you/tell?
a change in soft tissue quality & extent of soft tissue injuries
what are the interventions for sprains essential for?
in preventing chronic ligamentous instability
a patient walks in with a joint that has limited movement, the joint is deformed and swollen with pain. what is likely going on?
a dislocation
what is a subluxation?
partial dislocation
what type of dislocation would a hip be likely characterized as?
pathological
what are the interventions for a dislocation?
immobilize and/or splint (when in doubt)
manual manipulation / reduction
surgery
why should you NOT re-place a dislocated joint?
because you could sever an artery
what are the different causes of fractures?
increased stress placed on bones via compression, shearing, or tension
what are the most common type of fractures?
ACUTE (caused by falls or blunt trauma)
what is the tx for fractures?
prevention — stretch lower extremities prior to running/walking
immobility
reduction (re-alignment)
what type of fracture does NOT pierce the skin?
closed
what type of fracture goes straight across bone (perpendicular to long bone axis)?
transverse
what type of bone breaks through the skin surface?
open
what’s the tx for an open fracture?
teatanus shot and antibiotics — resetting
what type of fracture is on one side, but the bone is bent on the other side?
greenstick
what type of pts are more likely to have greenstick fxs?
pediatric
why are peds pts more likely to have greenstick fxs?
because their bones are softer & more flexible
how would you treat a closed fx?
via a pelvic binder, immobilization, and reduction
what would you make sure to monitor in a closed fx?
pulse, motor, and sensation
what does a open reduction for fxs require?
a surgeon
what are the following s/sx of:
“my leg or arm hurts”
deformities, misalignment, rotation
overriding (shortened extremity)
displacement (out of alignment)
limited ROM from joint injury
a fracture
what type of fracture is known as the “lover’s fx” and is typically associated witha spinal cord compression injury?
a calcaneus fx
what are shin splints?
the inflammation of muscle connected to bone
what should you assess for in a closed fracture?
compartment syndrome
what is super important with regards to a pathological fx?
med hx
what is a fx with an angular line across bone?
oblique
what is it called when a bone is splintered into 2 or more fragments?
comminuted
what is a fracture called that encircles bone?
spiral
what is a spiral fracture associated with?
child abuse
what is it called when a fx line travels parallel to long bone axis?
linear
what does an open book pelvic fx cause?
a lot of internal bleeding, so you’d expect a drop in BP
what should you do immediately with regards to an open book pelvic fracture?
coordinate transport IMMEDIATELY
how would you treat a closed pelvic fracture?
via a pelvic binder
why do you treat a closed pelvic fracture with a pelvic binder?
to control the internal bleeding; tamponade hemorrhage, and sustain BP
what is injured in a closed pelvic fracture?
there is bladder injury AND urethra, so do NOT place a foley cath — do a suprapubic cath
what is the typical underlying cause for pts who have pathological fractures?
osteoporosis
what are the different components of bone healing?
immobilization, realignment, and infection control/prevention
why is immobilization important in bone healing?
to decrease/prevent further injuries
why is realignment ESSENTIAL in bone healing?
because it increases blood supply to the fractured site— it connects broken pieces of bone together & improves the healing process
when is infection control/prevention is BIG concern?
in an open fracture
what nutrients are important for bone healing?
protein & calcium, as well as calories, vit C, and zinc
what are the different stages of bone healing?
hematoma formation
fibrocartilaginous callus
ossification
remodeling
when does the hematoma formation in bone healing occur?
in the 1st 48 hours
what is important to do during the hematoma formation stage of bone healing?
stabilize the fracture by immobilizing it and ensuring it’s realigned (if pt is in pain, then it’s NOT realigned)
during what stage of bone healing are the osteoclasts and osteoblasts involved AND the initial fibrin mesh work is made (aka the clotting factors are released); the inflammatory response is started?
the hematoma formation stage
when does the fibrocartilaginous callus stage of bone healing occur?
AFTER the 1st 48 hours
during what stage of the bone healing process is the initial bone healing (termed “granulation”) and the osteoblasts & fibroblasts migrate to the fracture site and begin to work and stabilize the site?
the fibrocartilaginous callus
what is a PROBLEM, if elicited, during the fibrocartilaginous callus stage of bone healing?
if the pt is verbalizing pain
what do the fibroblasts do during the fibrocartilaginous callus stage of bone healing?
they produce collagen, and the fracture site is stabilized
when does the ossification stage of bone healing occur?
4 weeks post injury
during what stage of the bone healing process is the callus replaced with mature bone and is when it is officially safe to remove the cast?
the ossification stage
when does the remodeling stage of bone healing occur?
more than 4 wks post injury
during what stage of the bone healing process is the bone healed and weight bearing?
remodeling stage