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Cancellous bone: aka spongy bone; innermost layer.
Cortical bone: aka compact bone; outer shell
Bone will grow or remodel in response to the forces/demands placed upon it (e.g. the more you exercise, the stronger the bone).
Complete: bone is completely broken into 2 or more pieces; transverse, oblique, spiral, impact, or comminuted.
Gradual replacement of callus by lamellar bone; osteoblasts fill the remaining gaps with new bone; bone is now strong enough to carry normal loads (e.g. ADLs).
Fracture has been bridged by a cuff of solid bone; over a period of months it will be reshaped by a continuous process of alternating bone reabsorption and formation.
Reduce: manipulation to improve the alignment of the fragments;
Hold: splint or cast to hold fragments together;
Exercise: preserve joint movement and overall function
Minimally displaced fractures and most pediatric fractures
When closed reduction fails; large articular fragment requiring accurate positioning; avulsion fractures where fragment is held apart
Complications: delayed union; pin track infection
Ache (muscle or joint), or sharp (nerve)?
For how long? Better or worse than before?
Worse in morning or night?
Does the pain wake them from sleep (neoplasm, severe arthritis, rotator cuff)?
Is it radiating?
Associated muscle weakness (diffuse or localized)?
Sensory abnormalities (numbness/paresthesia)?
Hip joint (femur head + acetabulum);
Soft tissues around hip and pelvis;
Referred pain from lumbar spine
Ask patient to place one finger on the spot that hurts; Swelling, ecchymosis (bruising), atrophy; Body habits/posture; Compare side-to-side differences; Observe gait; Palpate affected area and note tenderness, masses, warmth, or crepitus; ROM; Sensory; Motor; Vascular/perfusion
Diagnosed using x-ray to observe joint space narrowing, osteophytes (bone spurs), subchondral sclerosis, cysts.
Treatment includes NSAIDS, PT/OT,rest/activity modification, weight loss, injections (steroids, viscosupplementation), or surgery. Injections of PRP or stem cells are controversial.
Death of varying amounts of bone in the femoral head.
Treatment includes core decompression (if pain but no subchondral fracture), or total hip replacement.
Systemic disease of which hip/pelvic pain is a local manifestation.
Types: Rheumatoid Arthritis (systemic joint pain, worse in morning, evident on radiographs); and Ankylosing Spondylitis (“bamboo spine”, stiffness of spine & hips, low back pain, evident on x-rays).
Symptoms include hip pain, and shortened & rotated leg.
Typically confirmed via x-ray, but MRI may be required to confirm nondisplaced neck fracture.
Inflammation of 1+ joints; persists for 6+ weeks; age of onset < 16; other causes of inflammation excluded (infection, malignancy, inflammatory bowel disease, genetic syndromes, immunodeficiency syndromes, other rheumatic diseases)
a. Oligoarticular: knee and ankle involvement; asymmetric pattern; eye involvement;
b. Polyarticular RF negative: earlier age of onset; not as severe as RF+; no rheumatoid nodules;
c. Polyarticular RF positive: usually later/teen onset; symmetric; erosive; small and large joints; more chronic course; rheumatoid nodules present
Pain with movement and joint swelling (effusion); Joint inflammation and decreased ROM; Joint tenderness with palpation; Persists for at least 6 weeks
Symmetric proximal muscle weakness; pathognomonic skin lesions (Gottron’s, Heliotrope); elevation of muscle enzymes; EMG – myopathy/denervation; muscle biopsy (necrosis/inflammation)… requires pathognomonic rash + 2 others; almost all have skin & muscle abnormalities
Stage 1: edema, bursitis;
Stage 2: fibrosis, tendinitis;
Stage 3: bone spurs, cuff tears;
Stage 4: cuff tear arthropathy
Anterior superior shoulder pain that radiates to the deltoid; pain increases with overhead use; nighttime pain; and shoulder weakness >90 degrees.
Heat, rest, ROM exercises, resistive exercises below 90 degrees, NSAIDs, therapeutic modalities, cortisone injections.
Failed non-operative treatment, or symptomatic full thickness cuff tear.
Early PROM, active use after 6 weeks, resistive exercises after 12 weeks.
Humeral head, lesser tuberosity, greater tuberosity, proximal shaft.
2 part fractures: unreducible or unstable surgical neck; greater tuberosity; lesser tuberosity;
all 3 part fractures; and
all fractures that include dislocation.
Early PROM – pendulum, passive elevation, passive ER; use of pulleys avoided during early healing; sling use for 6 weeks; AROM, advanced stretching (6 weeks); motion early, strength later; final results after 6-12 months.
4 part fractures and fracture-dislocations;
Selected 3 part fractures – elderly patients;
Impression fractures (> 40%of the head)
The Mirror Protocol – move from passive to active to resistive exercises.
Insidious onset of pain; progressive stiffness; limited ROM (test passively when there is a cuff tear).
Heat, analgesics, stretching.
Epithelial cells are differentiated to the function of the organ, and healthy cells exist above the basement membrane.
Connective tissue cells (e.g. bone, fat, muscle, blood, lymph) exist below the basement membrane and provide nutrients and support to the epithelium.
The movement of epithelial cells into the connective tissue, past the basement membrane.
Adenocarcinoma: cancer of glandular tissue.
Squamous cell carcinoma: cancer of other epithelial cells.
Sarcoma: malignancy of connective tissue.
Leukemia: cancer of blood; a subtype of sarcoma.
Lymphoma: cancer of lymph nodes; cancer of lymph is circulating within the blood and technically leukemia; a subtype of sarcoma.
A. Carcinogens – cause DNA mutations;
B. Infectious diseases/viruses – 20% of cancers are associated with viruses(e.g. HPV, Hepatitis); viruses are a length of DNA that affect host cell DNA;
C. Immunosurveillance – failure of the immune system (e.g. HIV???);
D. Aberrant Differentiation – every cell has the possibility of differentiating into a cancer cell
Lateral curvature of the spine > 10 degree on posterior-anterior radiograph. Also includes rotation of the spine.
Asymmetry of shoulders, waist & pelvis.
Adams Forward Bend – look from front and side; look for rotation/elevated ribcage on one side.
Skin – Markings, dimples, hairy patches (tethered cord).
Asymmetry of motor, sensory or reflexes.
Stops progression but does not reverse/correct condition.
Indication – curve of 25-45 degrees, with a rapid progression.
More effective in younger patients with immature skeleton.
3-point fixation with pressure points and relief cut outs.
Full time (23 hours) or part time (16 hours).
Diplegic: mostly lower limbs; premature birth; typically no cog impairments.
Quadriplegic: all extremities; challenges with feeding, speech, trunk; brainstem
Stretching, conditioning, equipment (incl. orthotics), education, ADL, independence.
Shallow/underdeveloped acetabulum within the womb. Leads tosubluxation, dislocation.
Difficulty dressing/diapering; difficulty with walking at later age
Obtain & maintain reduction while the acetabulum grows around femoral head.
Children still have an active/unfused growth plate and therefore have easier remodeling. Their periosteum is still thick and will hold the fractured bone together.
Adults have thinner periosteum and fractures are more likely to shift.
1: transverse fracture though growth plate
2: fracture through growth plate and metaphysis (just above plate)
3: fracture through growth plate & epiphysis (end of bone)
4: fracture through all three elements
5: compression fracture of growth plate; decreased space between metaphysis & epiphysis
A loss of skin integrity as a result of cell exposure to temperatures that are incompatible with cell life (e.g. scalding, from flame, contact with hot surface, and frost bite).
Reaction between tissue components & chemicals → release of thermal energy absorbed by the body. Damage continues until the chemical is removed from the body.
Electrical energy converted into thermal energy resulting in tissue damage.
Location & depth of burn, strength of muscle, gravity, positions of comfort and patient non-compliance.
First degree – superficial; epidermal layer only (e.g. sunburn)
Second degree – partial thickness; epidermal + some dermal
Third degree – full thickness; epidermis +dermis
Fear of death; mutilation & disfigurement; pain, separation from family; disruption of lifestyle; dependence/independence; prolonged hospitalization & follow-up care; financial impact.------ (leading to) ----->
Grieving, guilt, anger, anxiety, depression, regression, or… relief to be alive!
24 hours/day for a year until scars mature; begins when the wounds are healed; garment should fit tightly; patient should have 2 sets of garments.
Immature – red, raised, rigid;
Semi-mature – pink, raised, semi-rigid;
Mature – pale, planar, pliable
Weakness of skeletal muscle; myotonia (inability of muscle to relax); cramps; myalgia (muscle pain)
LMN: disorder of motor unit; peripheral lesion;discrete muscle weakness; muscle atrophy; diminished/absent reflexes; fasciculations (visible twitches in muscles).
UMN: disorder of descending systems; central lesion; distributed muscle weakness; hyperactive stretch reflexes; spasticity; positive Babinski sign.
Type 1: infancy; Werdnig-Hoffman disease; severe generalized flaccidity; death by 2 yrs. due to respiratory failure.
Type 2: 6-18 mos.; never walk; survival until adulthood.
Type 3: 18+ mos.; Kugelberg-Welander disease; weakness of proximal muscles; nocognitive deficits; live into adulthood
Type 4: adult onset; very rare
Aka Lou Gehrig’s; middle age; rapidly progressive & fatal; 2-5 yr. survival; degeneration of both UMN & LMN; scarring of lateral columns; degeneration of tracts from cortex & brainstem.
Combination of UMN & LMN features; progressive; painless; generalized weakness; asymmetric; faciculations (visible muscle twitches); muscle cramping; respiratory function impaired; muscle mass loss.
Ascending painless weakness (worse distally); loss of sensation.
Weakness increases during activity, improves during rest; autoimmune disease; bilateral ptosis; weakness of eye movements; weakness of bulbar & extremity muscles; dysphagia; dysarthria; difficult sit-to-stand.
Hereditary; progressive weakness; protein deficiency; 3-5 yrs.; live to early adulthood; primarily males; progressive weakness in proximal muscles; pseudo-hypertrophy of calf muscles; Gower’s sign
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