Orthopedics

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Chapter 30

• Orthopedics

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The Musculoskeletal System and Common Disorders

• Muscles allow movement of body parts through
  contraction and relaxation
• Bones support body and act in response to
  contractions and relaxations
• Joints hold two or more bones together

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Most Common Disorders

• Sprains
• Dislocations
• Fractures
• Joint disruptions
• Degeneration

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Reactions to CommonDisorders (continued)

• Pain
• Swelling
• Inflammation
• Deformity
• Limitation of range and function

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Sprains and Strains

• Sprain is injury to a joint capsule and its
  supporting ligaments
• Strain is injury to a muscle and its supporting
  tendons
• Damage may result in joint instability
• Common symptoms are inflammation and pain

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Treatment for Sprains

• Mild
• Apply ice at time of injury
• Exercise
• Therapeutic devices and compression wraps
• Moderate
• Prevent further injury
• Healing may take 6 to 8 weeks
• Severe
• Often require surgery
• Recovery may take longer than 8 weeks

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Dislocations

• Luxation occurs when the end of a bone is
  displaced from its articular surface
• Can be caused by
• Trauma
• Disease
• May be congenital

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Dislocations (continued)

• Common sites
• Shoulders
• Elbows
• Fingers
• Hips
• Ankles

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Subluxation

• Partial dislocation where bone is pulled out of
  socket
• Can result from
• Weakness
• Decreased muscle tone
• Gravity
• Neurologic deficit

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Subluxation (continued)

• Common symptoms
• Pain
• Pressure
• Limited movement
• Deformity
• Numbness and loss of pulse

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Checkpoint Question 1

• How does a luxation differ from a subluxation?

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Answer

• Luxation is a complete dislocation subluxation
  is a partial dislocation.

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Fractures

• Break or disruption in a bone
• Causes of fractures
• Falls or other trauma
• Disease
• Tumors
• Unusual stress

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Symptoms of Fractures

• Swelling
• Hemorrhage
• Lack of movement or unusual movement
• Contusions
• Deformity of body part involved

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Treatment of Fractures

• Reduction (realigning the bones)
• Casting, splinting, wrapping, and taping
• Surgery may be required

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Casts

• Used to immobilize fractures and facilitate
  healing in the proper alignment
• Plaster casts are traditional
• Rather soft until fully dry
• Must be kept dry at all times
• Fiberglass casts are rapidly becoming material of
  choice

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Assisting with Plaster or Fiberglass Cast
Application

• Position patient comfortably
• Drape
• Clean and dry part to be casted
• Apply bandage or dressing to lesions
• Assemble supplies
• Assist physician as directed
• Clean skin outside of cast

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Plaster or Fiberglass Cast Removal

• Cast cutter is used
• Wear goggles
• Assure patient skin will not be cut
• Warn patient that skin will be pale and dry,
  muscle will be weak

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Healing of Fractures

• Most important criterion healing is adequate
  blood supply
• Blood secretes callus
• Amputation may be necessary
• Prothesis enables function

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Checkpoint Question 2

• What is the difference between an open and closed
  reduction?

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Answer

• An open reduction involves surgery a closed
  reduction does not.

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Bursitis

• Inflammation of bursae
• Common sites
• Shoulder
• Elbow
• Hip
• Knee
• Heel
• Most common symptom
• Pain during range-of-movement

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Bursitis (continued)

• Treatment
• Antiinflammatory medications
• Rest
• Heat or cold applications
• Ultrasound
• Activities within pain-free range
• Physical therapy

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Osteoarthritis

• Degenerative joint disease caused by wear and
  tear on the weight-bearing joints
• Treatment
• Antiinflammatory medications
• Corticosteroid injections
• Ambulatory aids

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Rheumatoid Arthritis

• Systemic autoimmune disease that attacks the
  synovial membrane lining of the joint
• Treatment
• Similar to osteoarthritis
• Protection of painful joints
• In severe cases joint may be surgically replaced

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Checkpoint Question 3

• How does osteoarthritis differ from rheumatoid
  arthritis?

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Answer

• Osteoarthritis is a degenerative joint disease
  caused by wear and tear on the weight-bearing
  joints in which the articular cartilage
  degenerates and the ends of the bones enlarge.

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Answer (continued)

• Rheumatoid arthritis is a systemic autoimmune
  disease that attacks the synovium of the joint,
  ultimately leading to inflammation, pain,
  stiffness, and crippling deformities. It usually
  begins in the non-weight bearing joints, but
  eventually affects most of the joints of the
  appendicular skeleton.

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Tendonitis

• Muscles attached to bones by tendons
• Tendonitis is inflammation of these structures
• Most common sites
• Shoulder
• Rotator cuff

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Tendonitis (continued)

• Treatment
• Antiinflammatory medications
• Rest
• Heat or cold applications
• Ultrasound
• Iontophoresis
• Massage
• Transverse friction massage

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Fibromyalgia

• Condition that causes widespread pain, muscular
  stiffness, fatigue, difficulty sleeping
• Treatment
• Relieving symptoms
• Nonsteroidal antiinflammatory medications
• Exercise
• Rest
• Personal counseling

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Spine Disorders

• Vertebral column
• Made up of 33 vertebrae and numerous joints
• Vertebra separated by 23 intervertebral disks
• Strong ligaments and structures support and
  protect the spine

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Abnormal Spinal Curvatures

• Exaggerated or abnormal curvatures of spine
  affect
• Posture
• Alignment of shoulders and hips
• Treatment
• Braces
• Transcutaneous muscle stimulation
• Surgery

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Herniated Intervertebral Disk

• Soft center of disk ruptures through tough outer
  layer
• Common symptoms
• Severe back pain
• Numbness
• Spasms
• Weakness
• Limitation of movement

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Herniated Intervertebral Disk (continued)

• Treatment
• Physical therapy for traction
• Massage
• Mild extension exercises
• Surgery

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Checkpoint Question 4

• What are three abnormal curvatures of the spine?
  Briefly describe each.

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Answer

• Abnormal spinal curvatures include scoliosis
  (lateral curve), kyphosis (hunchback), and
  lordosis (swayback).

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Disorders of the Upper Extremity

• Structures of upper extremity
• Shoulder
• Elbow
• Wrist
• Hand

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Rotary Cuff Injury

• Rotator cuff formed by tendons of four muscles
• Injuries cause
• Severe pain
• Weakness
• Loss of function
• Surgical intervention often necessary

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Adhesive Capsulitis (Frozen Shoulder)

• Shortening of muscles and joint structures
• Contractures develop when joint is immobilized
  causing the collagen fibers to stick to each
  other
• Treatment
• Antiinflammatory medications
• Heat or cold applications
• Physical therapy

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Lateral Epicondylitis (Tennis Elbow)

• Sprain or strain of tendons of origin of wrist
  and finger extensor muscles
• Symptoms include
• Extreme pain with extension of wrist

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Lateral Epicondylitis (Tennis Elbow) (continued)

• Treatment
• Ice applications
• Phonophoresis
• Iontophoresis
• Avoiding movements that cause pain
• Use of a forearm strap distal to elbow joint
• Transverse friction massage
• Gentle passive exercise
• Surgery

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Carpal Tunnel Syndrome

• Repetitive motion injury
• Compression of median nerve at wrist
• Symptoms
• Numbness in the thumb, index and middle fingers
• Pain and weakness
• Often pain awakens patient at night

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Carpal Tunnel Syndrome (continued)

• Treatment
• Antiinflammatory medications
• Immobilization
• Surgery

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Dupuytrens Contracture

• Flexion deformities of the fingers
• Treatment
• Surgery
• Corticosteroid injections
• Stretching of tight structures

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Disorders of the Lower Extremities

• Structures of lower extremities
• Hip
• Knee
• Ankle
• Feet

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Chondromalacia Patella

• Degenerative disorder affecting the cartilage
  that covers back of patella
• Treatment
• Rest
• Physical therapy
• Bracing or taping knee
• Antiinflammatory medications
• Ice therapy
• Exercises
• Arthroscopy

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Plantar Fasciitis

• Inflammation of the plantar fascia ligament
• Treatment
• Foot orthotic device
• Physical therapy
• Ice therapy
• Massage
• Ultrasound
• Nonsteroidal antiinflammatory medications
• Night splint
• Surgery

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Gout

• Metabolic disease involving overproduction of
  uric acid
• Treatment
• Nonsteroidal antiinflammatory medications
• Avoidance of purine-rich foods and
  alcohol-related products
• Medication to prevent uric acid formation

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Muscular Dystrophy

• Congenital disorders characterized by varying
  degrees of progressive wasting of skeletal
  muscles
• No known cure
• To relieve symptoms
• Exercise
• Physical therapy
• Use of splints or braces

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Osteoporosis

• Bones are deficient in calcium and phosphorus
  making them brittle and vulnerable to fractures
• Treatment
• Preventing fractures
• Hormone therapy
• Calcium and vitamin D supplements

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Bone Tumors

• Bone tissue is rarely primary site for
  malignancies, but is frequently secondary site
  for metastasis
• Surgical treatment
• Excision of the tumor
• Or amputation if bone is an extremity
• Chemotherapy and radiation are usually indicated

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Common Diagnostic Procedures

• Physical examination
• Diagnostic studies

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Physical Examination

• Physician
• Assesses structure, function, movement, pain
• Patient history

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Diagnostic Studies

• Radiology
• Diagnostic imaging
• Arthrograms
• Myelograms
• Bone scars
• Computed tomography (CT)

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Diagnostic Studies (continued)

• Magnetic resonance imaging (MRI)
• Electromyography (EMG)
• Nerve conduction velocity (NCV)
• Goniometry
• Bone or muscle biopsy

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Checkpoint Question 5

• What are ten procedures that can be used to
  diagnose musculoskeletal disorders?

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Answer

• Ten procedures that can be used to diagnose
  musculoskeletal disorders are physical
  examination, computed tomography scans, magnetic
  resonance imaging, electromyography, nerve
  conduction velocity, goniometry, arthrograms,
  myelograms, bone scans, and x-rays.

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The Role of the Medical Assistant

• Warm and cold applications
• Ambulatory assist devices

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Warm and Cold Applications

• Medical assistant may instruct patient in
  administering treatment at home
• Patient should understand purpose for procedure
• How to perform procedure
• Expected results
• Precautions or danger signs

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Precautions

• Do not apply heat or cold longer than recommended
• Monitor heat temperatures

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Checkpoint Question 6

• How does the body respond to prolonged exposure
  to temperature extremes?

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Answer

• After prolonged exposure to temperature extremes,
  the body exerts the opposite effect. For example,
  heat applications lasting longer than 30 minutes
  will cause vasoconstriction rather than the
  intended vasodilation. This is called the rebound
  phenomenon or effect.

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Ambulatory Assist Devices

• Patients who require assistance to maintain
  mobility may use
• Crutches
• Canes
• Walkers
• Wheelchairs
• Medical assistant often teaches patient how to
  use these ambulatory aids safely

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Crutches

• Axillary crutch
• Lofstrand or Canadian crutch

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Canes

• Standard cane for slight assistance
• Tripod or quad cane for greater stability
• To measure proper cane length
• Have patient stand erect
• Cane should be level with greater trochanter
• Patients elbow should be bent at a 30 angle

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Canes (continued)

• To walk with a cane, patient should
• 1. Position cane on unaffected side
• 2. Advance cane and affected leg together
• 3. Bring unaffected leg forward to a position
  just ahead of cane
• 4. Repeat the steps

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Walkers

• Comfortable aids for elderly or others with
  weakness or poor coordination
• To use a walker
• 1. Stand erect and move walker ahead about 6
  inches
• 2. With hands on walker grips, step into walker
• 3. Move walker ahead again
• 4. Repeat the steps

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Checkpoint Question 7

• On which side of the body is the cane positioned?

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Answer

• The cane is positioned on the unaffected side of
  the body.