welcome to week 5!! midterm chapter 15 orthopaedics

Welcome to week 5!!Midterm

Chapter 15

Orthopaedics

Welcome to week 5!!Midterm

Chapter 15

Orthopaedics

Error review from OB GYNError review from OB GYN

• Osteology: The study of bones

• Orthopaedics: The science of diagnosis and treatment of musculoskeletal diseases and disorders

– Etymology:

• Ortho: straight

• Pais: child

• Orthopaedist: A physician who treats the special problems associated with the musculoskeletal system

• Bone

– One of the hardest tissues in the body

– Provides support for the body

– Storage site for calcium

– Site for formation of blood cells (hematopoiesis)

• Types of Bone Tissue:

– Compact bone: tightly packed, on surfaces of bones

– Spongy: less dense, thin, bony plates

• Remodeling: continual growth and replacement of bone

Anatomy of the Musculoskeletal System Anatomy of the Musculoskeletal System

• Types of Bones

– Long Bones

• Diaphysis (tubular shaft)

• Epiphysis (expanded end)

• Metaphysis (where diaphysis meets epiphysis)

• Medullary cavity: where bone marrow is produced

• Red marrow: marrow that actively produces blood cells

• Yellow marrow: produces fat cells

• Types of Bones

– Short bones: shorter, allow for flexibility

– Flat bones: thin, plate-like structures for protection (skull)

– Irregular bones: variety of sizes and shapes (vertebrae)

Divisions of the Skeleton Divisions of the Skeleton

• Axial: bones of the skull, vertebral column, and chest

• Appendicular: bones of the limbs as well as the shoulder and pelvic girdles

– Pectoral girdle: attaches arms to the axial skeleton

– Pelvic girdle: attaches base of spine to hips and legs

• Joints

– Joint (articulation): point of connection between two or more bones, or between cartilage and bone

– Classified by range of movement:

• Fibrous: do not move (sutures of the skull)

• Cartilaginous: some movement (vertebrae of the spine)

• Synovial: full movement (most joints of the body). Contain synovial fluid to help joints move easily

• Cartilage

• Menisci: between the two joints formed by the femur and the tibia

– Lateral meniscus (outer side)

– Medial meniscus (inner side)

• Ligaments

• Muscle: enables movement of bones and joints

– Voluntary: controlled by cerebral motor cortex and cerebellum

– Involuntary: controlled by brain stem and spinal cord

• Muscles move by pulling and relaxing

− Flexor muscles: bend a limb at the joint

− Extensor muscles: extend or straighten the limb at the joint

• Types of Muscle:

– Skeletal: attached to bones at both ends by tendons

• Named by their characteristics:

– Number of origins and insertions

– Location of origin

– Shape

– Direction of muscle fibers

– Size

– Action or movement generated

• Involuntary muscles: movements cannot be controlled consciously

• Cardiac muscle: found only in the heart

• Tendons: attach each end of a muscle to bone and allow muscles to pull on bones

• Bursas: protect bones and tendons from injury or from rubbing against each other

• Anatomic regions of the body: considers the organization of the body as segments

• Anatomic terms of movement: describe the movement and direction of body parts at the joints

• Sprains: a stretch or tear of a ligament

• Strain: a stretch or tear of a muscle or tendon

– Treatments: reduce pain, immobilize injured ligament

• RICE: rest, ice, compression, and elevation

• NSAIDs reduce pain and inflammation

Common Musculoskeletal Diseases and Treatments Common Musculoskeletal Diseases and Treatments

• Fracture: a break or crack in the bone

– Types: according to appearance and characteristics

– Treatments: realign broken bones, then immobilize to heal

• Open reduction: makes incision in the skin over fracture site

• Closed reduction: does not make an incision in the skin

• Fixation: immobilizing parts of fractured bone

– ORIF: open reduction and internal fixation

– Internal fixation: placement of instruments underneath the skin

– External fixation: instruments connected to a metal bar outside the skin

Immobilizing fracture: use of cast, brace, or splint

• Dislocation: displacement of a joint from its normal position

• Subluxation: an incomplete or partial dislocation

– Treatment: Reducing dislocation back into position and tightening ligaments around it

• Scoliosis: abnormal lateral curvature of the spine; unknown cause

– Treatment: surveillance of curvature over time

– Surgery: fusing and pinning of bones to help keep the spine straight

• Avascular necrosis: the death of bone tissue due to a permanent loss of blood supply; also called osteonecrosis

– Treatments:

• NSAIDs to reduce pain and inflammation

• Core decompression

• Osteotomy

• Bone grafting

• Total joint replacement

• Total knee arthroplasty (TKA)

• Total hip arthroplasty (THA)

• Osteoporosis: bones become weak and brittle; unknown cause

• Dowager hump: forward curvature of spine from compression fractures

– Treatments:

• Hormonal drugs (estrogen)

• Selective estrogen receptor modulators (SERMs).

• Bisphosphonates

• Meniscal tears: injury to the menisci on either side of the knee joint

– Three zones:

• Anterior horn: front third

• Posterior horn: back third

• Body: middle third

– Treatment:

• Arthroscopy: endoscopic repair of the joint

• Meniscectomy: surgical removal of the tear

• Osteoarthritis: degenerative joint disease (DJD), a chronic disorder of joint cartilage and surrounding tissues

– Treatments:

• NSAIDs relieve pain and reduce inflammation.

• Cyclooxygenase-2 (COX-2) inhibitors to relieve pain and swelling of joints.

– Surgical treatments:

• Arthroplasty

• Arthrodesis: surgical fusion of bones to help relieve pain

• Muscular Dystrophy (MD): muscle wasting and weakness

– Duchenne muscular dystrophy (DMD): more aggressive, onset at early age

– Becker muscular dystrophy (BMD): milder, onset in teens or early adulthood

– Myotonic muscular dystrophy: most common adult form

• Treatment: No cure, purely supportive

• Bone Tumors– abnormal growth of cells in bones.

– Benign—do not spread to other tissues

• Osteochondroma most common – bony spur on surface of the bone

• Pedunculated – stalk is present

• Sessile – broad base of attachment

– Malignant – can spread to other tissues

• Osteosarcoma – bone-forming cells

• Ewing sarcoma – primarily in children

• Chondrosarcoma – develops in cartilages around bones

• Multiple myeloma – tumor of plasma cells of bone marrow

• Muscle and Flexibility Tests

• Laboratory Tests

– Complete blood count (CBC)

– Erythrocyte sedimentation rate (ESR) and cAMP receptor protein (CRP).

– Salicylate level

– Creatine kinase (CPK) and aldolase

– Liver function tests

• Cultures: identify organisms that cause infection.

Diagnostic Studies and Procedures Diagnostic Studies and Procedures

• Biopsy:

– Bone marrow aspiration and biopsy

• Bone marrow aspiration: liquid sample of bone marrow is removed.

• Core biopsy: a small solid piece of bone marrow is obtained

• Doppler ultrasound: used to detect blockages in blood vessels

• Imaging Studies

– Radiography: x-ray, most common diagnostic tool

– Bone densitometry: also called dual-energy x-ray absorptiometry (DEXA)

– Bone scan: also called radionuclide study

– Computerized tomography (CT) scan

– Myelogram: an x-ray exam of the spinal cord and space around it (subarachnoid space)

• CT myelogram: the use of a CT scan immediatelyafter myelogram

– Magnetic resonance imaging (MRI)

– Lumbar discography: discogram.

– Electromyography (EMG)

– Nerve conduction studies

The end-questions???????The end-questions???????

welcome to week 5!! midterm chapter 15 orthopaedics

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