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Orthopedic 1

  1. Anatomy and Physiology
  2. 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
  3. 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
  4. Fascia - surrounds and divides muscles
  5. Tendons - fibrous tissue between muscles and bones
  6. Ligaments - fibrous tissue between bones and cartilage; supports muscles and fascia
  7. Trauma: Contusions, Strains, Sprains
  8. 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
  9. 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
  10. 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
      1. second degree sprain
        1. up to half of the ligamentous fibers torn
        2. increased edemaand possible hematoma
        3. decreased active range of motion
        4. increased pain
        5. mild weakening of the joint and loss of function
        6. management
          • protectively dress/splint the joint, immobilize it
          • elevate the limb to decrease edema
          • for 24 to 48 hours, alternate
            • ice
              • to produce vasoconstriction to decrease swelling
              • to reduce transmission of nerve impulses and conduction velocity to decrease pain
            • moist heat
              • to reduce swelling and provide comfort
          • analgesics for discomfort
          • physical therapy to increase circulation and maintain nutrition to the cartilage