MDT 15.9 Musculoskeletal
Terms
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- Fluids from damaged intracellular spaces inundating extracellular space of tissue.
- Swelling
- Injury to a ligament. Can be complete or partial tear of ligaments or when they are torn from their attachment at the bone.
- Sprain
- A partial disruption short of complete rupture.
- Strain
- A Fx where the bone is broken in more than two places.
- Comminuted Fx
- Hairline Fx w/o loss of anatomic configuration.
- Nondisplaced Fx
- Separation of Fx fragments with loss of anatomic configuration.
- Displaced Fx
- Bending or angular deformity may result from separation of Fx fragments or from asymmetric impaction of cancellous bone fragments.
- Angulated Fx
- Bone fragment (usually near joints) pulled off by attached ligaments or tendons.
- Avulsion Fx
- A disruption of the normal relationship of articular surfaces of two bones that form a joint, in which the bones have completely moved out of their normal positions.
- Dislocation
- What is R.I.C.E.
-
Rest
Ice
Compression
Elevation - Where is the most common sit of Fx of the clavicle?
- Middle third
- In a clavicle Fx the lateral fragment will be pulled which way?
- Inferiorly and medially
- What are the complications of extremity Fx
-
Neurovascular compromise
infection(osteitis)
shock
fat embolism
permanent deformity
loss of function - How can distraction of the leg be managed in a femur Fx?
- Hare Traction Splint
- Why should you be aware of concurrent knee injury with femur Fx?
- Danger of fat embolism and vascular compromise
- High cervical lesions above what may cause death from respiratory insufficiency?
- Above C-5
- What should you check while assessing and managing vertebral Fx?
-
Airway
Gag reflex
Adequacy of ventilations - An increased interstitial pressure within a closed fascial compartment.
- Compartment Syndrome
- When does necrosis from compartment syndrome become irreversible?
- 4-6 hrs
- What should be expected in any unconscious Pt with a swollen limb?
- Compartment syndrome
- What is a good treatment for compartment syndrome only if performed within a few hours after onset?
- Fasciotomy
- The ligament has mild or minimal strain but there is no laxity. Swelling and ecchymosis in usually minimal
- Grade I sprain
- Significant, incomplete tear. On physical exam there is laxity but also a convincing end point, beyond which no further opening of the joint occurs.
- Grade II sprain
- Total failure of the joint. No end point is felt when stress is applied to the ligament during exam. Severe swelling and ecchymosis.
- Grade III sprain
- What is the most common dislocated joint in the body?
- Shoulder dislocation
- What % of shoulder dislocations are anterior and what % are posterior?
-
95% Anterior
5% Posterior - What method is used to reduce a shoulder dislocation?
- Water bucket or sand bag method
- What analgesic is given to effect reduction?
-
Morphine
(Valium & Demerol are alternates) - How is morphine given for reduction?
- 3-5mg IV w/3-5mg increments q5-15min until relaxed followed by Narcan to reverse opiate effect and add NSAIDs for anti-inflammatory effect.
- How will a pt present with posterior hip dislocation?
- Hip in position of flexion, adduction and internally rotated
- What is caused by a benign protrusion in the synovial lining or joint capsule?
- Ganglion Cyst
- What is the Dx of a Pt that presents with hip in extension, abduction and externally rotated without shortening?
- Anterior hip dislocation
- What are the three most common locations for ganglion cysts?
-
Wrist
Digital Flexor Sheath
Distal Interphalangeal Joint - A metabolic disorder characterized by abnormally high levels of urate crystals (Uric Acid) in the blood.
- Gout
- Where does gout usually present?
- Joint of the great toe
- What is the drug of choice to treat gout?
-
Indomethacin (Indocen)
25-50mg po TID - In Chronic phase of gout, what is given to minimize uric acid deposits in the tissues?
-
Colchicine (less desired due to ABD cramping)
Diet-eliminate purine rich food
Allopurinol 100mg po qd x1wk - Pain, edema and tenderness of one or more of the costal cartilages. Pain accentuated by coughing and breathing (inspiration)
- Costochondritis
- Bursitis usually occurs in what age group?
- Middle Age
- What are the clinical findings of bursitis?
-
-Localized edema secondary to inflammation of the bursal sac
-Irritation, inflammation
-Sudden or gradual Px
-Restricted ROM - What is the most common type of arthritis? (Sx increase w/age)
- Osteoarthritis
- What is the only way to Dx Chondromalacia Patella?
- Arthroscopic exam
- An injury to a ligament occurring when a joint is carried through a ROM greater than normal w/o dislocation or Fx
- Sprain