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Orthopedic

Orthopedic

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Published by: api-3818438 on Oct 18, 2008
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03/18/2014

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ORTHOPEDIC
I.
Anatomy and Physiology
A.
Bone (illustration 1
illustration 2
)
1.
Functions
a.
supports and protects structures of the body
b.
anchors muscles
c.
some bones contain hematopoietic tissue which forms blood cells
d.
participates in the regulation of calcium and phosphorus
2.
Joints (illustration
)
a.
bursa - enclosed cavity containing a gliding joint
b.
synovium - lining of joints which secretes lubricating fluid that nourishes and
protects
c.
classification of joints - synarthrosis, amphiarthrosis, diarthrosis
3.
Cartilage - connective tissue covering the ends of bones (illustration
)
4.
Types of bones
a.
long - legs, arms
i.
external structure - diaphysis, epiphysis, periosteum (illustration
)
ii.
internal structure of bone - medullary cavity; cancellous bone; red
marrow
b.
short - ankles, wrists
c.
flat - shoulder blades
d.
irregular - face, vertebrae
B.
Muscles - produce movement of the body
1.
Types (illustration
)
a.
striated - controlled by voluntary nervous system
b.
smooth - controlled by autonomic nervous system
c.
cardiac - controlled by autonomic nervous system
C.
Fascia - surrounds and divides muscles
D.
Tendons - fibrous tissue between muscles and bones
E.
Ligaments - fibrous tissue between bones and cartilage; supports muscles and fascia
II.
Trauma: Contusions, Strains, Sprains
A.
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
a.
for first 24 to 48 hours, apply ice for 15 minutes, three times a day
b.
then apply heat if necessary
c.
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
B.
Strains
1.
Definition - lesser injury of the muscle attachment to the bone
2.
Etiology and pathophysiology
a.
caused by overstretching, overexertion, or misuse of muscle
b.
acute: recent injury to muscle or tendon; classified by degree
i.
first degree: mild; gradual onset; feels stiff, sore locally
I.
assessment of acute first-degree strain
I.
tenderness to palpation
II.
muscle spasm
III.
no loss of range of motion
IV.
little or no edema or ecchymosis
II.
management of acute first-degree strain
I.
comfort measures
II.
apply ice
III.
rest, possibly immobilize for short term
ii.
second degree: moderate stretching, sudden onset, with acute pain
that eventually leaves area tender
I.
assessment of acute second-degree strain
I.
extreme muscle spasm
II.
passive motion increases pain
III.
edema develops early; ecchymosis later
II.
management of acute second-degree strain
I.
keep limb elevated
II.
apply ice for the first 24 to 48 hrs - then moist
heat
III.
limit mobility
IV.
muscle relaxants, analgesics, NSAIDS
V.
physical therapy for strength and range of motion
1. Third-degree: severe stretching with tear; sudden; snapping or burning sensation
a. assessment of acute third degree strain
i.
muscle spasm
ii.
joint tenderness
iii.
edema (may be extreme)
iv.
client cannot move muscle voluntarily
v.
delayed ecchymosis
b. management of acute third degree strain
i.
keep limb elevated
ii.
apply ice for 24 to 48 hrs, then moist heat
iii.
either immobilize or limit mobility of the limb
iv.
medication - muscle relaxants, analgesics, NSAIDs
v.
physical therapy for strength and range of motion
2. Chronic strain
a. long-term overstretching of muscle/tendon
b. repeated use of the muscle beyond physiologic limits
C. Sprains
1.Definition - greater than strain; injury to ligament structures by stretching, exertion or
trauma
2. Classification/findings/assessment/management
a. first degree sprain
i.
minimal tearing of ligament fibers
ii.
localized edema or hematoma
iii.
no loss of function
iv.
no weakening of joint structure - joint integrity remains intact
v.
mild discomfort at location of injury
vi.
pain increases with palpation or weight bearing
vii.
management of first degree sprain
\u2022
compress it with ace bandage to limit swelling
\u2022
keep limb raised to decrease edema
\u2022
apply ice 24 to 48 hours following injury
\u2022
analgesics for discomfort
\u2022
isometric exercises to increase circulation and resolve
hematoma
b. second degree sprain
i.
up to half of the ligamentous fibers torn
ii.
increased edema and possible hematoma
iii.
decreased active range of motion
iv.
increased pain
v.
mild weakening of the joint and loss of function
vi.
management
\u2022
protectively dress/splint the joint, immobilize it
\u2022
elevate the limb to decrease edema
\u2022
for 24 to 48 hours, alternate
o
ice
1. to produce vasoconstriction to decrease
swelling

2. to reduce transmission of nerve
impulses and conduction velocity to
decrease pain

o
moist heat
1. to reduce swelling and provide comfort
\u2022
analgesics for discomfort
\u2022
physical therapy to increase circulation and maintain
nutrition to the cartilage
c. third degree sprain
i.
complete rupture of the ligamentous attachment
ii.
severe edema with hematoma
iii.
usually, severe pain
iv.
dramatic decrease in active range of motion
v.
loss of joint integrity and function
vi.
management
\u2022
casting
\u2022
surgery to restore integrity of joint
\u2022
see second degree treatment
D. Fractures: pathophysiology
1. Predisposing factors
a. biologic
i.
bone density
ii.
client's age
2. Extrinsic factors
a. force - direct or indirect
b. rate of loading (how fast the force strikes)

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