MSK Patho (Student notes) PDF

Lewis (5th Edition) Ch. 64, 65, 66, 67 WEEK 6 MOBILIT Y Caitlyn Farr RN MN Based on content developed by Danielle Yaffe RN MN & Terilyn Hunter RN MN NP  Lewis (5th Edition) Ch. 64, 65, 66, 67 TOPIC Normal MSK Anatomy & Physiology...

Lewis (5th Edition) Ch. 64, 65, 66, 67 WEEK 6 MOBILIT Y Caitlyn Farr RN MN Based on content developed by Danielle Yaffe RN MN & Terilyn Hunter RN MN NP  Lewis (5th Edition) Ch. 64, 65, 66, 67 TOPIC Normal MSK Anatomy & Physiology Ch. 64 (p. 1591 – 1596) MSK Assessment p. 1596 – 1605 MSK PATHOPHYSIOLOGY (TRAUMATIC) Fractures Ch. 65 (p. 1618 – 1619) Open Closed Complications of Fractures p. 1622 – 1624 Compartment Syndrome p. 1623 MSK PATHOPHYSIOLOGY (NON- TRAUMATIC) Osteoarthritis Ch. 67 (p. 1665 – 1673) Rheumatoid Arthritis p. 1673 – 1680 Gout p. 1680 – 1682 Osteoporosis Ch. 66 (p. 1646 – 1649)  PRESENTATION GOALS By the end of this presentation, you will be able to: Describe basic anatomy & physiology of the Musculoskeletal system Explain normal functions of connective tissues (bone, muscle) Explain fractures (general fractures) Describe complications of fractures (infection, compartment syndrome, fat embolism, venous thromboembolism) Compare and contrast different types of arthritis (osteoarthritis, rheumatoid arthritis, and gout) Explain the pathophysiology of osteoporosis Describe complications of chronic pain  PATHOPHYSIOLOGY REVIEW – THE MUSCULOSKELETAL SYSTEM Bones Cartilage Ligaments Tendons Muscles  FUNCTIONS: BONE Weight bearing Creates a supporting structure Protect underlying organs and tissues Muscles can attach to bone because of tendons Bones are levers for movement Bones contain marrow to produce red and white blood cells. Storage of calcium and phosphate Lewis Fig. 64.1 Anatomy of a long bone  FUNCTIONS: JOINT S & CARTILAGE Joints are where two bones meet and move in relation to each other Joints are enclosed in a capsule of fibrous tissue and joins two bones together, forming a cavity Synovial membrane lines the cavity and secretes synovial fluid Cartilage is rigid connective tissue that supports soft tissue Lewis Fig. 64-2  FUNCTION: MUSCLES 3 Types: 1. Cardiac Muscle: Myocardium 2. Smooth Muscle: airways, arteries, gastrointestinal tract, bladder, uterus 3. Skeletal Muscle: All other muscles of the body https://byjus.com/questions/diagrammatically-show-the- difference-between-the-three-types-of-muscle-fibres/ N E U RO M U S C U L A R JUNCTION Lewis Fig. 64.5  Composed of dense, fibrous connective tissue Tendons attach muscle to bone FUNCTION: Ligaments connect bones to bones, LIGAMENT S provide stability but also enable AND TENDONS movement at the joint Low blood supply, which means it takes longer for healing when there is an injury  FRACTURES Break in the structure of the bone Classified as either Open or Closed Classified as complete or incomplete Classified according to direction of fracture line Lewis Fig. 65.6  CLINICAL MANIFESTATIONS Localized pain or bony tenderness Decreased function of the bone – think about weight bearing Edema/swelling Crepitus Bruising https://www.verywellhealth.com/gallery-of- fracture-pictures-4020369  CHECK IN What is a fracture? Describe different types of fractures? What are key manifestations of fractures?  Infection F R AC T U R E C O M P L I C AT I O N S Compartment Syndrome Venous thromboembolism Fat Embolism This Photo by Unknown Author is licensed under CC BY-ND  INFECTION Open fracture high risk Open wound Surgery opens the wound to potential contaminants Signs of inflammation (warmth, redness, swelling, increased pain, fever) Identify patients who are at higher risk  COMPARTMENT S YNDROME 6 P’s 1) Pain *out of proportion, passive stretching 2) Pressure 3) Paresthesia 4) Pallor 5) Pulselessness 6) Paralysis *latest finding, loss of muscle function https://www.emcurious.com/blog-1/2014/12/11/compartment-pressure-measurement- stryker-it  VENOUS T H RO M BO - EMBOLISM Hip fractures, hip and knee surgery After it forms it can travel Unilateral leg pain, unilateral leg swelling Patients are often anticoagulated to https://www.mrinz.ac.nz/programmes/venous- prevent the formation of thromboembolism a clot  EARLY RECOGNITION IS USUALLY DEVELOP SYMPTOMS IMPORTANT FOR PREVENTING WITHIN 24-48 HOURS DEATH FAT EMBOLISM SYMPTOMS USUALLY INCLUDE NEUROLOGICAL CHANGES MAY TACHYCARDIA, TACHYPNEA, ALSO OCCUR WHICH INCLUDE; AND DYSPNEA CONFUSION, IRRITABILITY, AND RESTLESSNESS  CHECK IN What are signs of an infection after a fracture? What are the 6 Ps Why would someone with a fracture develop a DVT What is a fat embolism and how does it differ from a venous thromboembolism  ARTHRITIS Rheumatoid Osteoarthritis Gout Arthritis  OSTEOARTHRITIS Lewis Fig. 67.1 What are the risk factors for OA? Obesity Trauma Repetitive Use Post-menopausal Family Hx  O S T E OA RT H R I T I S : CLINICAL M A N I F E S TAT I O N S Not systemic Joint pain Stiffness in the AM Joint deformity Heberden Nodes Bouchard Nodes Crepitus Asymmetrical https://www.blog.ohmyarthritis.com/bumpy-fingers-what-they-are-and-how-to-treat-them/  RHEUMATOID ARTHRITIS Lewis Fig. 67.3 What causes RA? Environmental triggers Genetics  General Fatigue Fever Anorexia Weight Loss Generalized stiffness R H E U M ATO I D ARTHRITIS: Localized CLINICAL Pain is worse in the AM M A N I F E S TAT I O N S Multiple joints Bilaterally, usually in the smaller joints (hands and feet) Flares (swelling, heat) Stiffness in the morning Limitation of movement Heat TEXTBOOK CHANGE: this Swelling table can be found on p. 1675 (table 67.5) of your Lewis text! Lewis Fig. 67. 4 RA JOINT DEFORMITIES  CHECK IN List 8 differences between osteoarthritis and rheumatoid arthritis. Consider risk factors, pathophysiology & clinical manifestations  GOUT Accumulation of uric acid crystals in one or more joints Purines can be exogenous or endogenous Underexcretion Risk factors include being male, obesity, Hyperuricemia of uric acid hypertension, diuretic use, excessive alcohol, diet high in purine rich foods Kidneys excrete uric acid Diet high in purines GOUT: CLINICAL MANIFESTATIONS Acute Gout: Chronic Gout: Acute gouty arthritis is triggered by Multiple joint involvement trauma, surgery, stress, infection, alcohol Visible deposits called tophi (develop years after ingestion onset of disease) Inflammation of the big toe (Podagra) Tophi occur in the synovium, along tendons, Symptoms begin at night swelling + and in the skin and cartilage pain + low grade fever Typically painless Symptoms peak within several hours and Decreased mobility the exacerbation subsides within 2-10 Can become infected days Structural changes including cartilage destruction can lead to secondary OA  ACUTE VS. CHRONIC GOUT Acute Gout Chronic Gout Lewis Fig. 67.6 https://www.foot-pain-explored.com/foot-gout.html  CHECK IN What are the risk factors for developing gout and why? Describe the 3 mechanisms for pathogenesis of gout  OS TEOPOROSIS Low bone mass – disease of cellular regulation Peak Bone Mass occurs at age 30, stable till age 50 then declines at a rate of 1%/year Women, after menopause, have an accelerated rate of decline at about 2-3% lost per year Risk Factors for ↑ loss of bone mass (low calcium/vitamin D, low estrogen, smoking, etoh, drugs, physical inactivity Primary (natural ageing, environment) vs secondary (drugs and medical conditions) Secondary - Diseases (turners, Cushings, diabetes, RA)  CLINICAL MANIFESTATIONS Pathological fractures (vertebral/compression) Pain Loss of vertebral height & changes to the spinal column: Kyphosis https://nursekey.com/physiological-changes/ IMPACT OF CHRONIC PAIN Quality of life ADLs Anxiety, depression Fatigue, insomnia Fear, anger Affects social relationships Financial Unable to work Medications OT/PT https://www.facebook.com/bambootapper/?_rdr Supportive devices THANK YOU!!!