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Orthopedic 1

Anatomy and Physiology
Bone (illustration 1 illustration 2)
1. Functions
  1. supports and protects structures of the body
  2. anchors muscles
  3. some bones contain hematopoietic tissue which forms blood cells
  4. participates in the regulation of calcium and phosphorus
2. Joints (illustration)
  1. bursa - enclosed cavity containing a gliding joint
  2. synovium - lining of joints which secretes lubricating fluid that nourishes and protects
  3. classification of joints - synarthrosis, amphiarthrosis, diarthrosis
3. Cartilage - connective tissue covering the ends of bones (illustration)
4. Types of bones
  1. long - legs, arms
    1. external structure - diaphysis, epiphysis, periosteum(illustration)
    2. internal structure of bone - medullary cavity; cancellous bone; red marrow
  2. short - ankles, wrists
  3. flat - shoulder blades
  4. irregular - face, vertebrae
Muscles - produce movement of the body
1. Types (illustration)
  1. striated - controlled by voluntary nervous system
  2. smooth - controlled by autonomic nervous system
  3. cardiac - controlled by autonomic nervous system
Fascia - surrounds and divides muscles
Tendons - fibrous tissue between muscles and bones
Ligaments - fibrous tissue between bones and cartilage; supports muscles and fascia
Trauma: Contusions, Strains, Sprains
Contusions (bruise)
1. Definition - a fall or blow breaks capillaries but not skin
2. Pathophysiology - extravasation (bleeding) under skin
3. Findings - ecchymosis(bruise) and pain when the contusion is palpated
4. Management
  1. for first 24 to 48 hours, apply ice for 15 minutes, three times a day
  2. then apply heat if necessary
  3. wrap to compress
5. Resolution: should heal within seven to ten days
6. Color changes from a blackish - blue to a gresnish - yellow after three to five days
Strains
1. Definition - lesser injury of the muscle attachment to the bone
2. Etiology and pathophysiology
  1. caused by overstretching, overexertion, or misuse of muscle
  2. acute: recent injury to muscle or tendon; classified by degree
    1. first degree: mild; gradual onset; feels stiff, sore locally
      - assessment of acute first-degree strain
        
        tenderness to palpation
        muscle spasm
        no loss of range of motion
        little or no edema or ecchymosis
      - management of acute first-degree strain
        
        comfort measures
        apply ice
        rest, possibly immobilize for short term
    2. second degree: moderate stretching, sudden onset, with acute pain that eventually leaves area tender
      - assessment of acute second-degree strain
        
        extreme muscle spasm
        passive motion increases pain
        edema develops early; ecchymosis later
      - management of acute second-degree strain
        
        keep limb elevated
        apply ice for the first 24 to 48 hrs - then moist heat
        limit mobility
        muscle relaxants, analgesics, NSAIDS
        physical therapy for strength and range of motion
1. Third-degree: severe stretching with tear; sudden; snapping or burning sensation
  1. assessment of acute third degree strain
    1. muscle spasm
    2. joint tenderness
    3. edema (may be extreme)
    4. client cannot move muscle voluntarily
    5. delayed ecchymosis
  2. management of acute third degree strain
    1. keep limb elevated
    2. apply ice for 24 to 48 hrs, then moist heat
    3. either immobilize or limit mobility of the limb
    4. medication - muscle relaxants, analgesics, NSAIDs
    5. physical therapy for strength and range of motion
2. Chronic strain
  1. long-term overstretching of muscle/tendon
  2. repeated use of the muscle beyond physiologic limits
Sprains
1. Definition - greater than strain; injury to ligamentstructures by stretching, exertion or trauma
2. Classification/findings/assessment/management
  1. first degree sprain
    1. minimal tearing of ligamentfibers
    2. localized edema or hematoma
    3. no loss of function
    4. no weakening of joint structure - joint integrity remains intact
    5. mild discomfort at location of injury
    6. pain increases with palpation or weight bearing
    7. management of first degree sprain
      - compress it with ace bandage to limit swelling
      - keep limb raised to decrease edema
      - apply ice 24 to 48 hours following injury
      - analgesics for discomfort
      - isometric exercises to increase circulation and resolve hematoma

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