Musculoskeletal

• Strain: Tear/Severe stretch injury to tendon/muscle
• Sprain: Tear of a ligament
• Avulsion: Injury which a body structure is torn off by trauma or surgery
• Strain, Sprain, & Avulsion (Ts)

  Tx: Rest, Ice, Compress, Elevate

  Tests: X-Ray

  Treat: NSAIDs & Severe strains = surgical repair
• Acute Compartment Syndrome (ACS)


  Any disruption to the vascular supply to an extremity

  • After fracture/trauma = Bleeding into muscle compartments
  • Muscle Ischemia (Edema & Raising compartment pressure) = Muscle infarction, neural injury, & necrosis
  • Tight bandage/Cast constriction = Volkmann Contracture (humerus fracture) = MEDICAL EMERGENCY
• 6 Ps of Compartment Syndrome

  1. Pain
  2. Paresthesia
  3. Poikilothermic
  4. Paralysis
  5. Pulselessness
  6. Pallor

  Tx: Elevation at heart lvl & Fasciotomy (Cutting the fascia to relieve pressure)
• Osteomyelitis


  Caused by staphylococcal infection

  • Common caused are open wound (exogenous) & blood-borne (endogenous) infection
  • Manifestations: Inflammation, fever, pain
  • Tx: Antibiotics, Surgical implantation of antibiotics beads, Hyperbaric O2 therapy
• Dislocation: Complete displacement/Separation of the articular surfaces of the joint
• Subluxation: Partial/Incomplete displacement of the joint surface
• Osteoporosis


  Low bone mass = Increased risk of fracture

  • RF: Advanced age, Menopause, Low BMI, ETOH, Decreased lvls of estrogen/testosterone, Vit. D & Calcium def. , Diabetes, Hyperthyroidism, etc.
  • Prevention: Weight-bearing exercise (30 mins/wk x3) & Vit. D/Calcium intake
  • Tests: DEXA
  • Treat: Calcium 1,200 mg + Vit. D, Bisphosphonates (Alendronate), & Raloxifene (Evista)
• Osteomalacia (Soft bones)

  Metabolic disease in which mineral calcification & deposition do not occur

  • Reversible bone disorder & Vit. D def.
  • Etiology: Inability to absorb Calcium & Phosphorus and Malabsorption fr. IBD, liver, pancreas disease, bariatric surgery
  • Manifestations: Weak, soft bones, hip pain
  • Tests: Bone biopsy
  • Treat: Braces, Vit. D, Calcium, Phosphorus, Safety (canes or walkers)
• Gout


  Inflammatory arthritis related to hyperuricemia (serum uric acid)

  • Dietary purines such as in meats, fish, shellfish, & alcohol (beer)
  • Over-synthesis of uric acid - lack of adequate excretion of uric acid
  • Unilaterally
  • Increase risk for renal calculi (kidney stones)

  Management:

  • NSAIDS (Naproxen) for pain
  • Corticosteroids
  • Allopurinol
  • Colchicine
• Fibromyalgia


  Joint & muscle pain w/ tenderness at muscle points (trigger NOT tender)

  • Extreme fatigue
  • Memory loss/Mental fog
  • Bilateral

  Management:

  • Nonpharmacologic treatment is central to successful outcome and exercise & sleep hygiene
• OA


  Degenerative joint disease

  • Unilateral pain in one or more joints relieved by rest
  • Non-inflammatory, non-systemic disorder, asymmetrical
  • Decreased ROM
  • Atrophy of muscles
  • NO REDNESS or "HEAT"
  • Crepitus
  • Heerden's nodes = Distal interphalangeal joints (DIPs)
  • Bouchard's nodes = Proximal interphalangeal joints (PIPs)

  Management:

  • Heat, NSAIDs, Cold, PT exercise, Wt. mngmt., Bracing, & Joint replacement
• RA



  Autoimmune disease; Inflammation of connective tissue

  • Symmetrical
  • W/ REDNESS & "HEAT"
  • Labs: ESR & C-reactive protein (CRP)

  Management:

  • DMARDS (Methotrexate & Interleukin-6)
  • NSAIDs (Naproxen/Ibuprofen)
  • Steriods
• Types of Bone Fracture:

  • Transverse - Perpendicular
  • Linear - Parallel
  • Oblique - Broken at a angle
  • Spiral - Rotation or twisting
  • Greenstick - Does not break completely through
  • Comminuted - Fragments
  • Pathological Fractures - Illness weakened their bones
• Unnatural Alignment: Angulated malunion (crooked)

  • Manifestations: Swelling, muscle spasm, creptius, improper reduction, etc
  • TX: Closed reduction (cast) or Open reduction (internal/external fixation)
• Carpal Tunnel Syndrome: Repetitive wrist action motions

  • Median nerve is compressed as it travels under transverse carpal ligament
  • Manifestations: Pain, burning (worse at night), tingling/itching/numbness in palm of hand, fingers, thumb index & middle fingers
• Bone Tumors: Common metastatic site for many other types of CA

  • Osteosarcoma = Common malignant bone forming tumor
  • Occurring in distal femur
  • <20 y/o males
  • In seniors w/ hx of radiation therapy
• Fat Emboli: Clients w/ long bones & pelvic injuries

  • Minimize movement of the fractured long bone
  • S/Sx: Respiratory distress, Chest pain, AMS-restlessness, Lethargic
• Try to Remember