Musculoskeletal Disorders

Scoliosis

lateral deviation of the spine that may affect the thoracic or lumbar areas or both. Various degrees and severity causes shortening of muscles and ligaments in the spine.

Kyphosis

increase in the curvature of the thoracic spine outward

Types of scoliosis

congenital, neuromuscular, and idiopathic

Fractures

break in the rigid structure of the bone and is the most common traumatic musculoskeletal disorder

Causes of fractures

direct blow, crushing force (compression), sudden twisting motions (torsion), severe muscle contraction, and disease

Closed fracture (simple)

bone fragments do not pierce the skin

Open fracture (compound)

bone fragments pierce the skin

Avulsion fracture

a chip in the bone from sudden and unexpected contraction of a powerful muscle from its point of insertion

Compression fracture

fracture when the bone collapses; common in lumbar

Impacted fracture

fracture where a vertical force drives the distal fragment of the fracture into the proximal fragment

Depressed fracture

fracture occurs in the skull where a segment of bone gets depressed into the brain tissue

stress fracture (fatigue)

fracture of a bone caused by repeated (rather than sudden) mechanical stress

Colles' fracture

fracture of the lower end of the radius in the wrist with a characteristic backward displacement of the hand

Symptoms of fractures

deformity, crepitus (rice krispy sound), pain, paresthesia, swelling and tenderness at the site, inability to move the affected limb, and muscle flaccidity that progresses to spasms, shortening of extremity

Hematoma formation

occurs within 3-4 hours after fracture. caused by town blood vessel hemorrhages and mass of clotted blood at fracture site

Delayed union

failure to reach bony union by 6 months post-injury and also included fractures that are taking longer than expected to heal

Malunion

when a fracture heals in a deformed position or with shortening of the limb

Nonunion

bone does not heal properly leaving the limb with pain and instability

Acute Compartment Syndrome

Serious condition in which increased pressure within one or more compartments causes massive compromise of circulation to the area.
It also prevents pressure buildup of blood or fluid accumulation.

What is the pathophysiologic change referred to with Acute Compartment Syndrome?

ischemia-edema cycle

What damage occurs within 4-6 hours of Acute Compartment Syndrome?

irreversible neuromuscular damage

What can happen to a limb affected by acute compartment syndrome within 24-48 hours?

the limb can become useless

Crush Syndrome

occurs when leg or arm injury includes multiple compartments; hyperkalemia

What are the complications of Acute Compartment Syndrome?

infection, motor weakness, and Volkmann's ischemic contractures

Fat embolism syndrome

serious complication from a fracture when fat globules are released from yellow bone marrow into the bloodstream

Complications of fractures

shock, fat embolism syndrome, venous thromboembolism, infection, ischemic necrosis, fracture blisters, delayed union, and malnutrition

Osteomyelitis

condition caused by the invasion by one or more pathogenic microorganisms that stimulates the inflammatory response in bone tissue

What are the causative agents of osteomyelitis?

staphylococcus and streptococcus

Manifestations of Acute Osteomyelitis

abrupt fever, irritability/lethargy, pain in infected area, swelling, warmth, and redness in area of infection

Manifestations of Chronic Osteomyelitis

warmth, swelling, and redness over the site of infection, pain/tenderness, chronic fatigue, drainage from open wound, and sometimes a fever

Dislocation

separation of two bones at a joint, bone slips out of joint

Risk factors of dislocation injuries

susceptibility to falls, hereditary, sports participation, car wrecks

Manifestations of dislocation injuries

swollen/bruised, area of injury may be deformed, loss of motion, numbness and tingling in injured area and pain during movement

Sprain

a ligament injury caused by an overstretch or tear and can be done from twisting

Strains

microscopic tear in a muscle

Herniated disc

protrusion of the nucleus pulposus through a annulus fibrosus

Causes of herniated discs

wear from repeated movements over extended time, aging (losing water content causes splitting), and lifting objects without bending at knees or twisting body with the object

Risk factors of herniated discs

weight, genetics, and occupation

Complications of herniated discs

compression of the cauda equina leads to permanent weakness, paralysis, loss of bladder and bowel control, and sexual dysfunction

Osteoporosis

medical condition in which bones become brittle and fragile from loss of tissue and bones look like a sponge

Risk factors of Osteoporosis

Females, Caucasian, thin/small body frame, family history, history of fractures as adult, excessive alcohol drinking, smoking, lack of exercise, poor nutrition, diet low in calcium, low estrogen/testosterone, chemotherapy, chronic inflammation

Complications of Osteoporosis

pathologic fractures, limited mobility, depression, pain

Manifestations of osteoporosis

height loss, dull pain in bones and/or muscles, and pathologic fractures

Osteoarthritis

degenerative joint disease characterized by wear over the years

Risk factors of osteoarthritis

older age, female, obesity, joint injuries, genetics, bone deformities

Manifestations of osteoarthritis

pain, tenderness, stiffness, loss of flexibility, grating sensation, and bone spurs

Rheumatoid arthritis

systemic, autoimmune condition involving multiple joints that starts off with acute inflammatory episodes which recover

Risk factors of rheumatoid arthritis

gender, age, genetics, smoking, environmental exposure, obesity

Manifestations of rheumatoid arthritis

insidious onset, morning stiffness (last more than an hour), fatigue, anorexia, low-grade fever, lymphadenopathy, malaise, bilateral joint pain, and limited joint pain range of motion

Gout

inflammatory disease resulting from deposits of uric acid crystals in tissues and fluids and is common to affect the large joint of the big toe

Risk factors of gout

age, male, lifestyle choices, weight, recent trauma or surgery, genetics

Manifestations of gout

intense joint pain that subsides to discomfort, inflammation, redness

Muscular Dystrophy

a group of inherited disorders characterized by degeneration of skeletal muscle and can be due to a genetic mutation

Which muscle protein abnormality leads to muscle dysfunction, weakness, muscle fiber loss, and inflammation?

dystrophin

Manifestations of MD

delayed development of muscle motor skills, clubfoot, foot drop, muscle weakness that leads to hypotonia, mental retardation, ptosis, frequent falls, poor coordination, drooling, and problems walking

Complications of MD

cardiomyopathy, recurrent respiratory infections, respiratory compromise due to weakened diaphragm, trouble walking, dysphagia, and death

Fibromyalgia

a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas.

Risk factors of fibromyalgia

female, family history, prior injury, other diseases, stress, lack of sleep, and those 20-60 years old

Causes of fibromyalgia

genetics, infection, and physical/emotional trauma

Manifestations of fibromyalgia

widespread pain, sleep disturbances, morning stiffness/fatigue, tenderness to pressure, heat, cold, or electrical pain, and cognitive difficulties

Manifestations of bone cancer

dull, deep bone pain; palpable mass; swelling; night pain; pathologic fractures

Signs of compartment syndrome

Pain, parasthesia, paralysis, pulseless, pallor, polar (cold)

Complications of rheumatoid arthritis

osteoporosis, rheumatoid nodules, dry eyes and mouth, infections, lymphoma, carpal tunnel, heart problems, lung disease, abnormal body composition

Complications of gout

Kidney stones and recurrent gout