Patho Test 4-Musculoskeletal

fracture

break in the continuity of a bone

closed fracture

simply fracture

open fracture

compound fracture

communited fracture

2 or more fragments

linear fracture

parallel to axis of long bone

oblique fracture

oblique angle to shaft

spiral

encircles

transverse

straight across

green stick fracture

perforates one cortex and splinter spongy bone

torus fracture

cortex buckles but does not break

bowing

bending of bone

pathologic fracture

disease process that weakens bone

stress fracture-fatigue

new muscles place stress on bone

stress fracture-insufficiency

normal weight and activity will stress bone

stress fracture-transchondral

repeated stress-fragment and separate portion of joint of the articular cartilage that covers end of bone at the joint-in adolesents

broken bone

can cause damage to the surrounding tissue, periosteum, and blood vessel in the cortex and the marrow

direct healing (primary)

adjacent bones connect

indirect healing (secondary)

formation of callus with remodeling

S/S of bone fracture

unnatural alignment, swelling, spasm, tender, pain, impaired sensation

treatment of bone fractures

realign and immobilize with splints and casts

example of internal fixation

screw, wire, plate, nail

example of external fixation

pins, rods and stabilize with external frame or bars

nonunion

failure of one ends to grow together

delayed union

8-9 moths after

malunion

healing of bone in incorrect position

dislocation

temporary displacement of two bones, loss of contact between articular cartilage

subluxation

contact between articular surface is only partially lost

tendon

muscle to bone

sTrain

tear or injury of Tendon

ligament

bone to bone

sprain

tear or injury of ligament

avulsion

complete separation of a tendon or ligament from its bony attachment site

tendinitis

inflammation of tendon

tendinosis

painful degradation of collagen fibers

bursitis

inflammation of bursa, which are small sacs filled with synovial fluid that are between boney prominences and soft tissues-caused by repeated trauma-S/S warmth, red, inflammation

tendinopathy/epicondylopathy

microscopic tears in tissues

epicondylitis

inflammation of a tendon where it attaches to a bone

tennis elbow

lateral epicondylitis

golfers elbow

medial epicondylitis

myositis ossificans

heterotropic ossification"-complication of local muscle injury, inflammation of muscle tissue with subsequent calcification and ossification of the muscle

rhabdomyolysis

(myoglobinuria)-life threatening complication of severe muscle trauma with muscle cell loss-release intracellular components into extracellular space and bloodstream-muscle pain and weakness, dark urine

osteoporosis

porous bone, poorly mineralized, reduced bone mass/density and imbalance of bone resorption faster than new bone is formed

osteoporosis causes

decreased estrogen and testosterone, decreased activity, inadequate level of vit D, C, or Mg

normal bone

833 mg/cm2

osteogenic bone

833-648 mg/cm2

osteoporosis bone

<648 mg/cm2

iatrogenic osteoporosis

brought on by medical treatment

regional osteoporosis

confined to segment

postmenopausal osteoporosis

decreased estrogen

glucocorticoid induced osteoporosis

stop osteoblast formation and increase osteocyte apotosis

age related bone loss

decreased growth hormone

osteomalacia

deficient of vit D lowers the adsorption of calcium from the intestines-inadequate of delayed mineralization-bone formation progress but calcify doesn't occur>soft bones...increased BUN and creatine

pagets disease

osteitis deformans"-excess resorption of spongy bone and accelerated formation of soft bone-disorgainized, thickened, soft bones-bone marrow replaced by vascular tissue

osteomyelitis

most common caused by staph infection

exogenous osteomyelitis

most common cause is open wound (diabetic foot)

endogenous osteomyelitis

blood borne pathogen

S/S of osteomyelitis

inflammation, pain, fever, necrotic bone

treatment of osteomyelitis

antibiotics, debridement, surgery, hyperbaric oxygen therapy-increase WBC and non cardiac CRP

osteoarthritis

inflammatory joint disease, (DJG) destruction in the synovial membrane or articular cartilage, and formation of bone spurs (osteophytes)-fever, leukocytosis, malaise, anorexia, hyperfibrinogenemia

heberden nodes

distal joints

bouchards nodes

proximal joints

rheumatoid arthritis

inflammatory joint disease, systemic autoimmune damage to connective tissue, primarily in the joint

rheumatoid arthritis causes

presence of rheumatoid factors (RA or RF test) and antibodies (IgG and IgM), environmental factors, hormonal factors-inflammatory cytokine release, RANKL release and osteoclast activation, angiogeneiss in the synovium

S/S of rheumatoid arthritis

morning stiff lasting hour, arthritis in 3 or more joints, symmetric arthritis, rheumatoid nodules, amt of serum RF, radiographic changes

ankylosing spondylitis

inflammatory joint disease of the spine or sacroiliac joints causing stiffening and fusion of the joints-systemic immune inflammatory disease-primarily in enthesis

ankylosing spondylitis causes

association with HLA-B27, excessive bone formation>fibrosis, ossification, fusion of joint

S/S of ankylosing spondylitis

low back pain, stiff, restricted motion, pt demonstrate loss of normal lumbar curve,alleviated with activity-increaed ESR and CRP

gout

disorder that disrupts the bodies control of uric acid production and excretion, high enough levels to crystalize

gouty arthritis

when crystals occur in the synovial fluid

stage 1-asymptomatic hyperuricemia

only increase in urate

stage 2-acute gouty arthritis

attacks develop with increase urate

stage 3-tophaceous gout

inability to excrete uric acid

contracture

muscle fiber shortening with an action potential

stress induced muscle tension

neck stiff, back pain, clench teeth, hand grip, headache-chronic anxiety

disuse atrophy

reduction of normal size of muscle cells as result of prolonged inactivity

fibromyalgia

chronic widespread joint and muscle pain

fibromyalgia S/S

increased sensitivity to touch, no inflammation, fatigue, sleep disturb

fibromyalgia factors

flulike viral illness, chronic fatigue syndrome, HIV infection, lyme disease, meds, physical or emotional trauma

myotonia

delayed relaxation after voluntary contraction

mcArdle disease

myophosphorylase deficient-cant produce lactic acid or break down glycogen...S/S activity intolerance, fatigue, cramps

acid maltase deficient

pomp disease(severe)-accumulation of glycogen in lysosome of muscle cells...S/S hypertrophy of heart, tongue, liver

myoadenylate deaminase deficient (MDD)

produced change in skeletal muscle-activity intolerant

lipid deficient

abnormal transport and process of fatty acid for energy

myositis

polymyositis and dermatomyositis-taget skeletal muscle-from staph infections, trichinosis, toxoplasmosis..S/S malaise, fever, swell, pain, tender, morning stiff, increase Creatine

toxic myopathies

acute attack of muscle weakness, pain, swell, necrosis of muscle fibers-disturb energy turnover, gene dysregulation, and initiation of apoptosis

bone tumor classification

osteogenic, chondrogenic, collagenic, myelogenic

geographic pattern

least aggressive, slow growth, benign and well defined

moth-eaten pattern

rapid growth, malignant bone tumor, margin is less defined

permeative pattern

aggressive growth, abnormal growth with normal bone

osteosarcoma

in young adults and seniors if they have had radiation-masses of osteoid, located in metaphases of long bones-malignant

chondrosarcoma

tumor of middle age and older adults-infiltrates trabeculae in spongy bone-in metaphases or diaphysis of long bone-tumor contain hyaline cartilage-erosion of cortex

fibrosarcoma

firm, fibrous mass of collagen, malignant fibroblasts, osteoclast like cells-in metaphyses of the femur or tibia-metastasis to the lungs is common

myelogenic tumor-giant cell tumor

cause bone reabsorption because osteoclastic origin of the giant cells-epiphyses of femur, tibia, radius, humerus-slow and relentless growth-benign

rhabdomyosarcoma

malignant-striated muscle-rapid mestatasis