Musculoskeletal Notes PDF

MUSCULOSKELETAL 1.​ Fracture ​ Trauma: stress ​ Pathological: osteoporosis, infection ​ Stress: bone not able to adapt to repetitive pressure ​ Main types of fractures o​ ​ Sign and symptoms o​ Swelling: soft tissue edema—hemorrhage into muscle o​ Pain...

MUSCULOSKELETAL 1.​ Fracture ​ Trauma: stress ​ Pathological: osteoporosis, infection ​ Stress: bone not able to adapt to repetitive pressure ​ Main types of fractures o​ ​ Sign and symptoms o​ Swelling: soft tissue edema—hemorrhage into muscle o​ Pain: muscle spasm cause by bone fractured o​ Loss of function o​ Deformity o​ Crepitus o​ Bruising: bleeding into tissue o​ Hypotension o​ Pulselessness—compartment syndrome—vessels compressed 2.​ Dislocation and subluxation ​ Dislocation: complete disruption of the joint ​ Subluxation: partial dislocation followed by relocation. ​ Cause: o​ Developing joints: looser ligament o​ Trauma o​ Muscular imbalance: bad posture, unbalanced exercise program o​ Incongruities in surfaces—rheumatoid arthritis o​ Joint instability—previous injury ​ SS o​ Numbness, tingling, paralysis 3.​ Treatment ​ Immobilization o​ Rest (48hr) o​ Ice (20min/ 4-8times/day) o​ Compress (reduce swelling) o​ Elevate (6-10 inch above heart) ​ Reduction: realigned ​ Splint: closed reduction– manual manipulation without opening the skin 4.​ Bone healing ​ Direct healing—bone cortices are in contact with each other  o​ Bony fracture fixed tgt with high compression (no callus formation) (less common) ​ Stages of healing a.​ Hematoma formation o​ Bleeding at site b.​ Soft callus formation o​ Hematoma fibrin network granulation grows new capillaries phagocytes (remove debris) and fibroblast (new collagen) c.​ Hard callus formation o​ Osteoblast within soft callus synthesize collagen and matrix to form hard callus d.​ Remodeling o​ Osteoclast reabsorbs unnecessary callus o​ o​ Most fractures will heal in 4-8 weeks – but factors such as osteoporosis, general health of individual, can prolong healing 5.​ Soft tissue injury ​ Strain o​ Tearing or stretching of muscle or tendon o​ Common in hand, feet, knees, upper arm, thigh, ankle, heal ​ Sprain o​ Tearing of ligament o​ Common in wrist, ankle, elbow, knee ​ 3 degree of injury a.​ Fibres are stretched (muscle and joint remain stable) b.​ More tearing of tendon or ligament: paresis and joint instability c.​ Inability to contract 6.​ Rhabdomyolysis ​ Rapid breakdown of muscle causes release of intracellular content including​ myoglobin, enzyme, and potassium into extracellular space and blood stream ​ Cause: o​ Trauma: crushed injuries o​ Medication and drugs: antihistamine and salicylates o​ Excessive muscle contraction o​ Infection o​ Toxin: CO ​ Complication o​ Hyperkalemia ▪​ Cardiac dysrhythmia o​ Kidney failure: myoglobin precipitate in tubule ​ SS o​ Triad: pain, weakness, dark urine (red-pigment myoglobin) o​ Creatine kinase elevated (muscle damage and kidney damage) ​ Goals of treatment is to maintain urinary output, prevent kidney failure o​ Rapid IV fluids maintain urine output, o​ May require hemodialysis to deal with hyperkalemia 7.​ Compartment syndrome ​ Compartment: contain muscle, nerve, blood vessel encircled my fascia ​ Happen when damage within a compartment but the fascia is intact increase pressure and restricting blood flow ​ Cause: o​ Severe burns, bleeding, crush injuries, bites, tight casts or bandages Muscle ischemia can cause edema, increased compartment pressure, and tamponade = leads to muscle infarction & neural injury ​ SS: 6ps o​ Pain: beyond expected o​ Pressure: tenderness o​ Pallor o​ Paresthesia: numbness and tingling due to nerve impingement o​ Paresis o​ Pulselessness: inadequate blood perfusion ​ Diagnosis o​ Measurement of intracompartmental pressure – manometer ​ Treatment o​ Fasciotomy – cutting the facia to relieve pressure 8.​ Osteoporosis ​ Chronic disease decrease in bone density and increase risk of fracture ​ Cause: o​ Primary ▪​ Old bone being ebsorb faster than new bone is being made ▪​ Common in spine, femoral neck wrist o​ Secondary ▪​ Postmenopausal osteoporosis – caused by estrogen deficiency ▪​ Parathyroid hormone, cortisol, thyroid hormone, and growth hormone – most commonly associated with osteoporosis ▪​ Other factors include medications, lack of physical activity, abnormal BMI ​ SS o​ Bone deformity and pain due to fractures – vertebral fractures can cause kyphosis – hump back o​ Fractured hip – fracture of neck of femur due to osteoporosis can caused the fall ​ Diagnostics o​ Bone mineral density measured using x-ray – may have 25-30% bone tissue is lost when diagnosed 9.​ Paget’s disease ​ Localized abnormal and excessive bone remodeling  o​ Produce new bone faster than normal, but less organized and weaker lead to deformity, fractures, enlarged and soft bone- risk for bone tumor ​ Cause o​ viruses, including mumps, parainfluenza, and measles o​ Genetic and environmental interactions affect osteoclast activity ​ SS: depend on the site o​ Cranium: asymmetrical appearance ▪​ Brain compression—dementia, alter mental status, headache, impaired CN o​ Long bone: ▪​ Affect both end of long bone lateral curvature in femur and anterior and lateral curvature of tibia o​ Spinal involvement can lead to quadriplegia 10.​Osteomyelitis ​ Infection of bone (staph aureus) ​ Pathophysiology o​ Infection inflammation bacteria form biofilms small terminal vessels thrombose and exudate seals the bone canaliculi (It helps the bone cells to receive food and oxygen and also to eliminate waste materials) exudate extends into marrow cavity blood flow disrupted necrosis lead to bone sequestrum (devascularised bone and separated from the surrounding bone) osteoblast lay down new down over infected bone (this new layer is now called involicrum (A sequestrum is a segment of necrotic bone that becomes separated or “sequestered” from the healthy intact bone. The reactive bone that forms around the necrotic sequestrum is referred to as the involucrum and the draining tract extending from the skin to the sequestrum is termed the cloaca) Openings in the involucrum allow exudate to escape to surrounding tissues and through to skin by sinus tracts. ​ ​ Classification of osteomyelitis a.​ Hematogenous osteomyelitis o​ Cause: ▪​ Pathogen carried in the blood stream—more in children o​ SS  ▪​ Vague, fever, malaise, anorexia, weight loss, and pain in or around infected area ▪​ Recent infection precedes onset b.​ Contiguous osteomyelitis o​ caused by infection spreads from adjacent bone – caused by open fractures, penetrating wounds, or surgical procedures o​ SS ▪​ inflammatory exudate in soft tissues – abscesses form, low grade fever, lymphadenopathy, local pain, and swelling of puncture wound JOINTS 11.​Osteoarthritis ​ Wear and tear of a joint overtime due to physical use ​ Common in hands, knee, hips and spine centrally ​ Appears in 50s-60s ​ Pathophysiology o​ Articular cartilage breaks down, flake off and develop longitudinal fissures, underlying unprotected bone become sclerotic, osteophytes is formed at the damaged cartilage aka bone spur into the synovial cavity, these spur can break off into the synovial cavity increasing the irritation and volume of the joint—contrbute to immobility. o​ All component of the joint are affected, cartilage, bone, and synovial fluid ​ Sign and symptoms o​ Initially asymptomatic—pain in a load bearing joint—knee first o​ Stiffness, swelling decreased ROM muscle wasting partial dislocation and deformity o​ Joint effusion—swelling of the joint (osteocytes fragment in synovial cavity, drainage from cysts or trauma to joint result in hemorrhage ​ Stages o​ Stage 1: ▪​ Minor wear and tear ▪​ Treatments ​ supplements such as glucosamine and chondroitin may be recommended. ​ lifestyle considerations like regular exercise o​ stage 2: ▪​ more bone spur growth ▪​ symptoms of joint pain and area around the knee joints will feel stiff and uncomfortable ▪​ Treatments ​ relieve the pain and discomfort caused in this mild stage ​ strict regimen of exercise and strength training, for increased joint stability: braces, knee supports, or shoe inserts may be used to protect the knee from stress. o​ Stage 3: ▪​ Obvious erosion to the cartilage surface ▪​ Narrow the gap  ▪​ Obvious joint inflammation ▪​ Ss ​ frequent pain when walking, running, squatting, extending or kneeling; joint stiffness after sitting for long or when waking up in the morning; may be popping or snapping sounds when walking. ▪​ Treatments ​ Over the counter NSAIDs or pain-relief therapies - may prescribe stronger pain medicine, such as codeine and oxycodone. ​ May require intra-articular injections of hyaluronic acid into the knee joint. Moderate knee arthritis can be treated aggressively with three to five injections of hyaluronic acid over 3-5 weeks’ time, which may take several weeks for the treatment to start showing results, but pain relief typically lasts six months. o​ Stage 4 ▪​ Gap between bone greatly reduced ▪​ ss ​ chronic inflammatory response, with decreased synovial fluid that causes friction, greater pain and discomfort when walking or moving the joint. ​ development of more spurs causing excruciating pain, which makes even everyday chores, including walking and descending stairs a challenge. ▪​ Treatments ​ osteotomy or bone realignment surgery ​ total knee replacement, or arthroplasty 12.​Rheumatoid arthritis ​ Body attack their own joint ​ Different than OA, the synovial membrane is the first tissue affected ​ Inflammation spreads to joint capsule and surrounding ligaments and tendons causing pain, deformity, & loss of function. ​ Most common – fingers, feet, writs, elbows, ankles, and knees ​ Frequency decreases with age ​ SS o​ Joint degradation is symmetrical—unlike in OA o​ Stiffness—pronounced in morning—last longer than 1 hours o​ 3 or more affected joints (red, warm to touch) o​ Low-grade fever o​ Fixed flexion of the smaller hand joints – ‘swan neck and boutonniere’ o​ Other organ involvement – lymphadenopathy, splenomegaly, nephropathy, eyes ​ Treatment o​ Focus on pain reduction o​ Maintaining mobility o​ Preventing falls/fractures o​ Treatment of depression o​ Positive blood work for rheumatoid factor 13.​Gout ​ Overproduction of uric acid or underexcretion of uric acid by kidney  o​ Concentration of uric acid increases to the point where it crystalizes – insolvable precipitates deposited in connective tissue o​ Crystals can form in other parts of the body – heart, earlobes, kidneys ​ Risk factors - Male gender, increasing age, high intake of alcohol, red meat, and fructose, increasing BMI ​ SS o​ Pain: inflammation of joints (common in great toe) o​ Kidney stones ▪​ Back pain o​ Joint enlargement – crystals harden, eroding bone and cartilage SKELETAL MUSCLE 14.​Fibromyalgia ​ Syndrome of chronic pain ​ Abnormally low levels of serotonin (typically reduce pain signals)—sleep pattern is affected due to low serotonin as well ​ SS o​ Chronic generalized pain and fatigue o​ Cognitive dysfunction, changes in mood o​ Diagnosis comes from ruling out other potential causes 15.​Disuse atrophy ​ Muscle wasting result from inactivities ​ Treatment o​ Frequent forceful contractions o​ Passive lengthening exercises o​ Get up walking and moving quickly o​ After 1 year regeneration of muscle fibres becomes impaired 16.​Contracture ​ Loss of full passive ROM ​ Secondary to joint, muscle, soft tissue liminations ​ trauma, arthritis, CNS disease, - most common is joint immobilization ​ *Dupuytren’s contracture o​ Cause by a connective tissue in palm thickens and become scar-like not painful, but restricts movements of fingers – genetic factors, alcohol, tobacco use, and diabetes may be risk factors.