welcome to week 5!! midterm chapter 15 orthopaedics

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Welcome to week 5!!Midterm

Chapter 15

Orthopaedics

Welcome to week 5!!Midterm

Chapter 15

Orthopaedics


Error review from OB GYNError review from OB GYN


• Osteology: The study of bones

• Orthopaedics: The science of diagnosis and treatment of musculoskeletal diseases and disorders

– Etymology:

• Ortho: straight

• Pais: child

• Orthopaedist: A physician who treats the special problems associated with the musculoskeletal system


• Bone

– One of the hardest tissues in the body

– Provides support for the body

– Storage site for calcium

– Site for formation of blood cells (hematopoiesis)

• Types of Bone Tissue:

– Compact bone: tightly packed, on surfaces of bones

– Spongy: less dense, thin, bony plates

• Remodeling: continual growth and replacement of bone

Anatomy of the Musculoskeletal System Anatomy of the Musculoskeletal System


• Types of Bones

– Long Bones

• Diaphysis (tubular shaft)

• Epiphysis (expanded end)

• Metaphysis (where diaphysis meets epiphysis)

• Medullary cavity: where bone marrow is produced


• Red marrow: marrow that actively produces blood cells

• Yellow marrow: produces fat cells

• Types of Bones

– Short bones: shorter, allow for flexibility

– Flat bones: thin, plate-like structures for protection (skull)

– Irregular bones: variety of sizes and shapes (vertebrae)


Divisions of the Skeleton Divisions of the Skeleton

• Axial: bones of the skull, vertebral column, and chest

• Appendicular: bones of the limbs as well as the shoulder and pelvic girdles

– Pectoral girdle: attaches arms to the axial skeleton

– Pelvic girdle: attaches base of spine to hips and legs


• Joints

– Joint (articulation): point of connection between two or more bones, or between cartilage and bone

– Classified by range of movement:

• Fibrous: do not move (sutures of the skull)

• Cartilaginous: some movement (vertebrae of the spine)

• Synovial: full movement (most joints of the body). Contain synovial fluid to help joints move easily


• Cartilage

• Menisci: between the two joints formed by the femur and the tibia

– Lateral meniscus (outer side)

– Medial meniscus (inner side)

• Ligaments


• Muscle: enables movement of bones and joints

– Voluntary: controlled by cerebral motor cortex and cerebellum

– Involuntary: controlled by brain stem and spinal cord

• Muscles move by pulling and relaxing

− Flexor muscles: bend a limb at the joint

− Extensor muscles: extend or straighten the limb at the joint


• Types of Muscle:

– Skeletal: attached to bones at both ends by tendons

• Named by their characteristics:

– Number of origins and insertions

– Location of origin

– Shape

– Direction of muscle fibers

– Size

– Action or movement generated

• Involuntary muscles: movements cannot be controlled consciously

• Cardiac muscle: found only in the heart


• Tendons: attach each end of a muscle to bone and allow muscles to pull on bones

• Bursas: protect bones and tendons from injury or from rubbing against each other


• Anatomic regions of the body: considers the organization of the body as segments

• Anatomic terms of movement: describe the movement and direction of body parts at the joints


• Sprains: a stretch or tear of a ligament

• Strain: a stretch or tear of a muscle or tendon

– Treatments: reduce pain, immobilize injured ligament

• RICE: rest, ice, compression, and elevation

• NSAIDs reduce pain and inflammation

Common Musculoskeletal Diseases and Treatments Common Musculoskeletal Diseases and Treatments


• Fracture: a break or crack in the bone

– Types: according to appearance and characteristics

– Treatments: realign broken bones, then immobilize to heal

• Open reduction: makes incision in the skin over fracture site

• Closed reduction: does not make an incision in the skin


• Fixation: immobilizing parts of fractured bone

– ORIF: open reduction and internal fixation

– Internal fixation: placement of instruments underneath the skin

– External fixation: instruments connected to a metal bar outside the skin

Immobilizing fracture: use of cast, brace, or splint


• Dislocation: displacement of a joint from its normal position

• Subluxation: an incomplete or partial dislocation

– Treatment: Reducing dislocation back into position and tightening ligaments around it


• Scoliosis: abnormal lateral curvature of the spine; unknown cause

– Treatment: surveillance of curvature over time

– Surgery: fusing and pinning of bones to help keep the spine straight


• Avascular necrosis: the death of bone tissue due to a permanent loss of blood supply; also called osteonecrosis

– Treatments:

• NSAIDs to reduce pain and inflammation

• Core decompression

• Osteotomy

• Bone grafting

• Total joint replacement

• Total knee arthroplasty (TKA)

• Total hip arthroplasty (THA)


• Osteoporosis: bones become weak and brittle; unknown cause

• Dowager hump: forward curvature of spine from compression fractures

– Treatments:

• Hormonal drugs (estrogen)

• Selective estrogen receptor modulators (SERMs).

• Bisphosphonates


• Meniscal tears: injury to the menisci on either side of the knee joint

– Three zones:

• Anterior horn: front third

• Posterior horn: back third

• Body: middle third

– Treatment:

• Arthroscopy: endoscopic repair of the joint

• Meniscectomy: surgical removal of the tear


• Osteoarthritis: degenerative joint disease (DJD), a chronic disorder of joint cartilage and surrounding tissues

– Treatments:

• NSAIDs relieve pain and reduce inflammation.

• Cyclooxygenase-2 (COX-2) inhibitors to relieve pain and swelling of joints.

– Surgical treatments:

• Arthroplasty

• Arthrodesis: surgical fusion of bones to help relieve pain


• Muscular Dystrophy (MD): muscle wasting and weakness

– Duchenne muscular dystrophy (DMD): more aggressive, onset at early age

– Becker muscular dystrophy (BMD): milder, onset in teens or early adulthood

– Myotonic muscular dystrophy: most common adult form

• Treatment: No cure, purely supportive


• Bone Tumors– abnormal growth of cells in bones.

– Benign—do not spread to other tissues

• Osteochondroma most common – bony spur on surface of the bone

• Pedunculated – stalk is present

• Sessile – broad base of attachment


– Malignant – can spread to other tissues

• Osteosarcoma – bone-forming cells

• Ewing sarcoma – primarily in children

• Chondrosarcoma – develops in cartilages around bones

• Multiple myeloma – tumor of plasma cells of bone marrow


• Muscle and Flexibility Tests

• Laboratory Tests

– Complete blood count (CBC)

– Erythrocyte sedimentation rate (ESR) and cAMP receptor protein (CRP).

– Salicylate level

– Creatine kinase (CPK) and aldolase

– Liver function tests

• Cultures: identify organisms that cause infection.

Diagnostic Studies and Procedures Diagnostic Studies and Procedures


• Biopsy:

– Bone marrow aspiration and biopsy

• Bone marrow aspiration: liquid sample of bone marrow is removed.

• Core biopsy: a small solid piece of bone marrow is obtained

• Doppler ultrasound: used to detect blockages in blood vessels


• Imaging Studies

– Radiography: x-ray, most common diagnostic tool

– Bone densitometry: also called dual-energy x-ray absorptiometry (DEXA)

– Bone scan: also called radionuclide study

– Computerized tomography (CT) scan

– Myelogram: an x-ray exam of the spinal cord and space around it (subarachnoid space)

• CT myelogram: the use of a CT scan immediatelyafter myelogram


– Magnetic resonance imaging (MRI)

– Lumbar discography: discogram.

– Electromyography (EMG)

– Nerve conduction studies


The end-questions???????The end-questions???????

welcome to week 5!! midterm chapter 15 orthopaedics

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