Musculoskeletal System

• SPRAINS

• Occurs due to microfailure of collagen fibers secondary to stress exceeding their physiologic capacity

• SEVERITY OF LIGAMENT INJURY

• FIRST-degree sprain: Minimal pain , no detectable joint instabiliy

• Treat symptomatically and return to full activity within a few days

• Second –degree sprain :severe pain, minimal joint instability ,partial ligament rupture, 50% decrease in ligament strength and stiffness.

• Treatment :

• Rehabilitative exercise

• Brace for support

• Avoidance of physical activity

• Third-degree sprain

• Severe pain during course of injury

• Joint completely unstable

• Ligament can’t support any load

• Treatment :surgery

• FRACTURES

• It is a break in the continuity of the bone

• Close fracture :skin intact

• Open fractures• Fracture communicate with the

external environment due to a breach of the soft tissue

• True orthopedic emergency• Prognosis dependent on extent

of soft tissue injury and by type /level of bacterial contamination

• Treatment plan

• Prevent infection

• Restore soft tissues

• Achieve bone union

• Early joint motion and muscle rehabilitation

• Pathologic fracture

• Occurs due to minimal trauma on a bone weakened by preexisting disease

• Predisposing conditions :primary or metastatic carcinoma, cyst, enchodroma, giant cell tumors ,osteomalacia, osteogenesis imperfecta, scurvy , rickets, and Paget’s disease

• Treatment : treat the broken bone , diagnose and treat the underlying condition

• STRESS OR FATIGUE FRACTURE

• Complete fx resulting from repetitive application of minor trauma

• Most stress fx occur in Lower ext

• Affect people involved in sports, military recruits

• Xray can be normal

• Pain occurs only with activity

• Treatment : decrease physical activity

• Comminuted fracture :

• Bone is divided into more than 2 fragments

• Greenstick fracture :

• Incomplete and angulated of the long bone

• Very common in children

• Treatment: complete the fx and immobization

• Fat embolism fracture:

• Acute respiratory distress sd caused by realease of fat droplets from the marrow as may occur secondary a long bone fx

• Signs&symtoms

• Sx occur immediately or 2 to 3 days after trauma

• SOB

• Confusion, restlessness, disorientation, stupor or coma

• Fleeting petechial rash on chest and conjunctiva

• Fever,tachycardia• DIAGNOSIS :• ABG : PO2 < 60 mm Hg• CX-ray :progressive snowstorm-

like infiltration• Presence of fat globules in urine is

pathognomonic

• Treatment

• Administer O2

• Heparin

• Prevent fat embolism sd by careful stabilization of fx

• Typical scenario: A 25 y/o male complaints of difficulty breathing .His family notes he is acting a little confused , and that he has a spotty purplish rash. Two days ago , he sustained a femur fx after a high-speed motor vehicle collision.

• Remember classic triad for fat embolism

• Confusion

• Dyspnea

• petechiae

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• SHOULDER DISLOCATION:• Anterior dislocaton• High risk of recurrence 70 %• Occurs in younger than 30 y/o• Types : subcoracoid most common,

subclavicular , subglenoid• Mechanism :abduction and external rotation of

the arm causing strain on anterior capsule and glenohumeral ligaments

• Signs&Symptoms:

• Arms held to the side

• Patients resists medial rotation and adduction

• Prominent acromion

• Loss of normal rounded shoulder contour

• Posterior dislocation

• Diagnosis missed in 60 %

• Precipitated by convulsion,seizure, electrical shock

• Types :subacromial, most common

• Mechanism :internal rotation and adduction

• Signs &Symptoms

• Patient hold arm medially rotated and to the side

• Abduction limited

• External rotation limited

• Flattening of anterior aspect of shoulder

• Complications common to all dislocations

• Palpate radial pulse to check axillary artery

• Check sensory component of axillary nerve by assessing sensation over the lateral part of upper arm

• Anterior dislocation complications:

• Rotator cuff tear

• Coracoid fractures

• Greater tuberosity

• Posterior dislocation:

• Fractures of the lesser tuberosity

• Treatment

• Reduction and immobilization

• Surgery if needed

• COMPARTMENT SYNDROMES

• Increased pressure within a limited space comprises the circulation and function of tissues within that closed space

• Theories of tissue ischemia

• Increased pressure leads to decreased transmural pressure,causing arterioles to close

• Causes :• Fractures• Soft tissue crush injuries• Vascular injuries• Drug overdose with prolonged limb

compression• Burn injuries• Trauma

• Signs &Symptoms: 6P• Pain :deep, unremitting,and poorly

localized.Pain increases with passive stretching of involved muscle

• Pallor :not necessary for diagnosis• Paresthesias :of cutaneous distribution supplied

by the compressed nerve is an early sign• Paralysis :occurs after ischemia is well

established• Pulselessness :shown to occur late at times

• Diagnosis

• Measure pressure within compartment

• Pressure < 30 mm Hg will not produce a compartment syndrome

• Pressure >30mm Hg is an indication for fasciotomy

• Treatment :

• Complete fasciotomy

• 0steomyelitis• Epidemiology :mainly affects children• Pathophysiology• 1- bacteria lodge in end artery of metaphysis

and multiply• 2-local increase in serum and white blood cells• 3-decrease in blood flow and pressure necrosis• 4- pus moves to haversian and medullary canals• 5-goes beneath the periosteum

• Signs&symptoms

• Hx infection or trauma

• Significant pain in the affected area,anorexia, fever,nausea

• Limited joint motion, tenderness and swelling of soft tissue

• Diagnosis

• Elevated wbc,erythrocyte sedimentation

• Deep circumferential, soft-tissue swelling

• Treatment

• Medical :iv antibiotic

• Surgery

• Low back pain

• Epidemiology

• 4 out 5 people suffer from low back pain

• Incidence 15 -20 %, male >females

• Often back pain is a sx of systemic illness such as primary or metastatic neoplasm , infection disease or inflammatory disorder

• History

• Localization of the pain

• Character of pain

• Hx of pain development and how it affects everyday of pain

• Hx of weight loss, malaise, fever,Gu

• Physical examination

• 1- straight leg-raising test:positive in nerve root irritation

• 2-check for reflexes and motor and sensory deficits

• 3-check spine for range of motion

• 4- bowel and bladder sx are suggestive of cauda equina syndrome

• Diagnosis

• 1- xray of lumbar spine

• 2-MRI if xray negative

• 3-technetium bone scan and gallium scan can be done if an infection of the spine is suspected

• Treatment

• 1- Rule out a serious pathologic condition

• 2- goal is early return to normal activities

• 3-NSAIDs

• 4- physical and occupational therapy programs