musculoskeletal system

A = alert
V = verbal (verbal stimuli)
P = pain (painful stimuli)
U = unresponsive to any stimuli

loss of muscle strength, endruance, muscle mass artophy (increase in creatine)
loss of joint mobility
weak back muscles
weak abdominal muscles

bone demineralization
negative Ca balance (can be lifethreatening)
N balance off

decreased metabolic rate
negative nitrogen balance
hypercalcemia
decreased production of stress hormones
dependent edema

catabolism
creatinine
decreased venous return and acrdic output
decreased metabolism, need for 02, exercise tolernace

loss of strength
contractures, ankylosis of joints

decreased need for o2
decreased chest expansion and vital capacity
poor abdominal and bone distention
mechanical or biochemical secretion retention
loss of respiratory muscle strength

decreased efficiency of orthostatic neurvascular reflexes
diminished vasopressor mechanism
altered distribution of blood volume
venous stasis

distension from poor abdominal muscle tone
constipation risk

altered gravitation force
impaired ureteral pertistalsis

decreased circulation - pressure area of potential breakdown and difficulty with personal hygiene

decreased venous return - dependent edema
catabolism = negative nitrogen balance
decreased metabolism = decreased need for o2 = decreased ventilation
bone deminerailzation = osteporosis & hypercalcemia (renal calculi)

axillary = short term
forearm = longtern

resistance of bone against stress, bone yields to stress

complete
incomplete (fragments attached)

transverse - rt angle to long bone
oblique - slanted but straight
spiral

simple or closed
open or compound - fratctured bone through skin
complicated - bone frag. damage other organs
comminuted - small bone fragments

type I - growth plate seperates, no bone involvement
type ii - sep. of growth place + metaphysis breaks
type iii - epiphysis fx through joint surface
type iv - growth plate, epiphysis, metaphysis
type v - crushing - retrospect

weakest point on long bones is growth plate
frequent site of damage during trauma
affects future bone growth
open reduction + internal fixation

bend/plastic deformation = bone bends
buckle/torus = bulging projection
greenstick = bent but not broken
complete

pain and point of tenderness (pt. to area)
pulselessness (good blood supply?)
pallor
paresthesia
paralysis

generalized swelling
pain or tenderness
diminished functional use
may have bruising, severe muscular rigidity, crepitus

reduction - realign/lengthen bony fragments
immobilization - retain alignment/length
restore function to injured parts
prevent further injury

nerve compression syndromes
compartment syndromes
nonunion
malunion
infection
kidney stones
pulmonary emboli (blood, air, fat)

swelling = nerve damage
pain, pallor, edema, circulation - risk for infection

stage 1 - hematoma
stage 2 - cellular proliferation
stage 3 - callus formation
stage 4- ossification
stage 5 - consolidation/remodeling

rest an extremity
prevent/improve contracture deformity
correct a deformity
treat a dislocation
allow position and alignment
provide immobilization
immobilize for realignment prior to cast/splint
reduce muscle spasms

traction - forward force created with weight
countertraction - backward force created by body weight
frictional force- contact with bed - risk for skin breakdown

manual traction - applied for body part by hand placed distally to fractrue site
skin - pulling mechanism attached to skin
skeletal - pin, wire, tongs
cervical - weights attached to hyperextended head- keeps spinal cord from being pinches

buck's (butt up)
russell (extended)
90-90

infection
neuromuscular compromise
pain control

acute - long bones, soft tissues
micro - repeated overuse

shoulder
patella
radial head

microscopic tear to musculotendinous unit
similar to sprain
swollen, painful to touch
incurred over time

repeat muscle contraction
reptitive weight bearing sports
tibial fracture most common

damage to soft tissue, sub-q tissue, muscle
ecchymosis - black and blie
swelling, pain, diabililty
crush injuries

force of stress on ligament is great enough to disrupt normal position of the opposing bone ends of bone end and its socket
pain increases with passive movement
down stndrome

trauam to joint from ligament partially or compeltely torn or stretched by force
damage to blood vessels, muscles, tendons, nerves
joint laxity to indicate severity
rapid onset of swelling

amenorrhea
osteoporosis
eating disordered

eval for activities
prevention of injury
treatment of injury
rehab
instruction

congential or aquired
sx - mass
treatment - stretch, surgery

self-limiting
3-12 years
males:females 4:1\whites 10X more likelt

stage 1 - septic necrosis, lack of blood, degenerative changes, avascular
stage 2: bone aobsorption, revascularization
stage 3: new bone froms
stage 4: regeneration

insidious onset, hx of limp, sore or stiff, limited ROM, vague hx of trauma
pain/limp most evident beginning and end of day
dx by x-ray

most common congenital foot deformity
medial adduction of toes/forefoot
pigeon toed gate
result of intrauterine positioning
bilateral 50% of the time

complex deformity of foot and ankle - includes bone
30-50% bilateral
familial

positional
syndromic/tetralogic (r/t to other deformities)
congenital (idiopathic/true)

correction of deformity
maintenance of correction of the deformity
follow-up observation

ortolani test - clunk in or out of acetebelum
barlow test - unstable
highest success if treatment before 2 months
shortening of limb on affected side
skin fold assessment

manuevers/ultrasound

pavlik harness
skin integrity - undershirt and knee socks
massage healthy skin
no lotions/poweders
diapers understraps

10-16 yo
r/t obesity, but cause unknown
may require pin, skeletal traxtion, osteotomoy

boston brace
TLSO
milwaukee brace

males:females 2:1
organism varies by age
exogenous or hematogenous source

acute- abrupt sx of infection (tachcardia, tenderness, pain, surronding muscle tense)
subacute

prevent destruction of joint cartilage
decompress joint to maintain circulation
eradicate infection
prevent secondary bone infection

abx, bedrest, immobilize (limit spread), surgical drainage by gravity/suction

mostly adolescent males
hip, knee, shoulder or large joints

warm, tender, cannot tolerate gentle constant motion, hx of trauma to joint

IV antibiotics, pain relief, immobilize joint, no weight bearing until treatment is compelte

cleanse the joint to avoid destruction of articular cartilage
decompress the joint to avoid interfenrence with blood supply to grwoth plate
eradicate infx with abx therapy
prevent secondary bone infx

infants/small children - carpals/phalanges (splint or cast)
older - spine
hip - most common

sx - insidious
tx - immobilize, antimicrobials, drainage of abscess, reparaative process slow, little or no deformity

heterogenous inherited disorder of connective tissue

progressive bone deformity

prevent positional contractures and deformties
prevent muscle weakness and osteoporosis
prevent malalignemnt of lower extremity joints

type 1A - mild bone fragility, blue sclera, normal teeth, presenile deafness
type 1B - same as A, abnormal dentition
type 1C - abnormal dentition, no bone fragililty, presniile deafness, blue sclera

lethal, stillborn or die in early infancy
multiple fratctures at birth
autosomal reccessive

severe progressive deformities from severe bone fragility
normal sclera, marked growth failure, mostly autosomal recessive

A- mild to moderate bone fragililty, normal sclera, short stature, variable deformity, autosomal dominant
B - abnormal dentition plus ype A

inflammatory disease of unknown origin
familial
2-5 years, 9-12 years
more often females

spiking fever
skin rash, pericarditis
mild 70% of the time
few joints involved
burns self out in 2-3 years if mild

chronic inflammation of synovium with joint effusion and eventual erosion,destruction, and fibrosis of the articular cartilage

system - high fever, hepatosplenomegaly, pericarditis, pleuritis, lymphadenopathy
pauciarticular - less than 4 joints
polyarticular - 5+ joints

drugs - NSAIDs, SAARD, cytotoxic drugs, corticosteroids
preserve function, prevent deformity
moist heat for pain and stiffness

stiffness
swelling
loss of mobility in affected joints
warm to touch

antinuclear antibodies common but not specific
leukocytosis
age of onset younger than 16 years one or more affected joints
duration more than 6 weeks

no specific cure
preserve function, prevent deformity
relieve sx

inflammation of iris and ciliary body
unique to JRA
requires tx by opthamalogist

NSAIDs
SAARDs
corticosteroids
cytotoxic agents
immunomodulators

"red wolf"
unkown cause
chronic, multisystem autoimmune disease of connective tissues and blood vessels
inflammation

transient neonatal disease
onset after infancy

females aged 10-19 years
familial
african-american, asian, hispanic

hormonal imbalance, immune disorders, environmental exposure, infection, stress, chemical agents

cutaneous lesions, lymphadenopathy
n/v abdominal pain, weakness, arthritis, forgetfullness, seizures, paralysis, pleurisy, pericarditis, proteinuria and renal failure

pleurisy, pericarditis

glomeruls site of destruction, proteinuria, kidney failure

anemia from decreased erythrocytes, amenorrhea, platelts/plasma proteins affected

spleen, lymph nodes, LE hepatitis

N/v, diarrhea, abdominal pain

butterfyl rash
discoid rash
photosensitivity
oral/nasal ulcers
arthritis
serositis
renal disorder
neuro disorder(psychosis, coma, seizures)
hematoligic disordes( anemia, leukopenia)
antinuclear antibody

corticosteroids, NSAIDs, antipyretics, antihypertensives, antibiotics
diet/activity