Jackie Shared "Musculoskeletal" - 29 Picmonics
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Musculoskeletal
Types of Fractures
- Nondisplaced
- Displaced
- Incomplete
- Complete
- Closed
- Open
- Direction of Fracture Line
2 mins
Neurovascular Assessment 6 P's
- Pain
- Paresthesia
- Pulse
- Pallor
- Pressure
- Paralysis
1 min
Sizing Crutches
- 3 Finger Widths
- 6 Inches Lateral From Heel
- 30 Degree Flexion
- Tripod Position
1 min
Compartment Syndrome Assessment
- Mechanism
- Trauma
- Increased Pressure
- Compressed Nerves and Blood Vessels
- Assessment
- 1 or more of 6 P's
- Ankle-Brachial Index (ABI)
- Considerations
- May take Days to develop
- Early Detection
- Ischemia
- Damage often Irreversible
2 mins
Compartment Syndrome Interventions
- Interventions
- Frequent Neurovascular Assessments
- Evaluate Pain
- Do Not Elevate Extremity
- Remove or Loosen Restrictive Items
- Fasciotomy
- Amputation
- Considerations
- Infection
- Monitor Urine Output
2 mins
Total Knee Replacement (TKR)
- Indications
- Joint Pain (Uncontrolled)
- Impaired Mobility
- Considerations
- Compression Dressing
- Frequent Neurovascular Assessments
- Continuous Passive Motion (CPM) Devices
- Early Ambulation
- Venous Thromboembolism (VTE) Prophylaxis
- Limit Flexion Positions
- Monitor for Infection
2 mins
Herniated Disc (Nucleus Pulposus)
- Cause/Mechanism
- Spine Trauma
- Natural Degeneration
- Spinal Stenosis
- Assessment
- Pain
- Weakness
- Urinary and Fecal Incontinence
- Interventions
- Brace
- Medications
- Outpatient Procedures
- Surgery
2 mins
Scoliosis
- Assessment
- S Shaped Lateral Spinal Rotation
- Unequal Shoulder and Scapula Height
- Uneven Gait
- Impaired Oxygenation
- Hump when Bending Forward
- Interventions
- Body Braces
- Worn 23 Hours/Day
- Surgery
- Considerations
- Adolescent Screening
3 mins
Muscular Dystrophy
- Mechanism
- X-linked Recessive
- Signs and Symptoms
- Muscle Weakness
- Motor Problems
- Gower Sign
- Large Calves
- Waddling Gait
- Loss of Ambulation
- Consideration
- Cardiac and Respiratory Failure
2 mins
Duchenne and Becker Muscular Dystrophy
- Duchenne
- Frameshift Mutation
- X-linked recessive
- Progressive myofiber damage
- Truncated or absent dystrophin protein
- Muscle Weakness. Weakness begins in pelvic girdle muscles and progresses superiorly.
- Motor Problems
- Pseudohypertrophy of calf muscles due to fibrofatty replacement of muscle
- Onset before 5 years of age
- Gower Sign
- Waddling Gait
- Loss of Ambulation
- Dilated cardiomyopathy common cause of death
- Respiratory Failure
- Myonecrosis
- Increased CPK and Aldolase
- Confirmed with Western Blot and Muscle Biopsy
- Becker
- X-linked disorder typically due to nonframeshift deletions in dystrophin gene (partially functional instead of truncated)
- Becker is less severe and caused by Pinpoint missense mutation
- Onset in adolescence or early adulthood
Duchenne muscular dystrophy
- X-linked disorder typically due to frameshift or nonsense mutations truncated dystrophin protein inhibited muscle regeneration. Weakness
- Duchenne = deleted dystrophin. Dystrophin gene (DMD) is the largest protein-coding human gene chance of spontaneous mutation. Dystrophin
- Weakness begins in pelvic girdle muscles and progresses superiorly. Pseudohypertrophy of calf muscles due to fibrofatty replacement of muscle A
- Gower maneuver—patients use upper extremities to help them stand up. Waddling gait. Onset before 5 years of age. Dilated cardiomyopathy is common cause of death.
- Dystrophin helps anchor muscle fibers, primarily in skeletal and cardiac muscle. It connects the intracellular cytoskeleton (actin) to the transmembrane proteins α- and β-dystroglycan
- which are connected to the extracellular matrix (ECM). Loss of dystrophin results in myonecrosis. CK and aldolase are seen; Western blot and muscle biopsy confirm diagnosis.
- Gene: linking actin filaments to laminin
- proximal muscle weakness
Osteoarthritis
- Mechanism
- Articular Cartilage Destruction
- Biomechanical Stress
- Aging
- Signs and Symptoms
- Asymmetric
- Pain Decreases with Rest
- Morning Stiffness Under 30 Minutes
- Crepitus
- DIP and PIP Joints
- Treatment
- Lifestyle Changes
- Acetaminophen or NSAIDs
2 mins
Osteoarthritis Assessment
- Mechanism
- Aging
- Articular Cartilage Destruction
- Biomechanical Stress
- Signs and Symptoms
- Asymmetric
- Pain Decreases with Rest
- Morning Stiffness under 30 Minutes
- Crepitus
- DIP and PIP Joints
1 min
Osteoarthritis Interventions
- Lifestyle Modifications
- Balance Rest and Activity
- Therapeutic Exercise
- Heat and Cold Applications
- Drug Therapy
- Intra-articular Injection
- NSAIDs
- Considerations
- Reconstructive Joint Surgery
1 min
Celecoxib
- Indications
- Rheumatoid Arthritis
- Osteoarthritis
- Pain
- Mechanism of Action
- NSAID
- Selectively Inhibits COX-2
- Side Effects
- Sulfa Allergy
- Increased Risk of Thrombosis
- GI Bleed
- Contraindication
- Pregnancy > 30 Weeks
1 min
Rheumatoid Arthritis
- Pathophysiology/Symptoms
- Associated with HLA-DR4
- Leads to destruction of cartilage and ankylosis (joint fusion)
- Symmetric involvement
- DIP spared
- Morning stiffness, improving throughout day
- Extra-articular features
- Fever, malaise, weight loss
- Rheumatoid nodules
- Baker Cyst
- Interstitial Lung Fibrosis
- Neutrophils and protein in synovium
- Secondary Amyloidosis
- Anemia of Chronic Disease
- C-Spine Subluxation--> Spinal cord injury
- Rheumatoid factor: Immunoglobulin (most commonly IgM) to Fc of IgG
- Anti-CCP (most specific)
- Scleritis
Rheumatoid Arthritis Pathophysiology
- Type III & IV HSR
- HLA-DR4
- Rheumatoid Factor (RF): Anti-IgG IgM
- Rheumatoid Factor (RF) (High Sensitivity)
- Anti-CCP (High Specificity)
Rheumatoid Arthritis Assessment
- Mechanism
- Destruction of Connective Tissue and Synovial Membrane
- Signs and Symptoms
- Inflammation of Joints
- Morning Stiffness
- Nodules
- Joint Deformities
1 min
Rheumatoid Arthritis Interventions
- Lifestyle Modifications
- Heat and Cold Applications
- Therapeutic Exercise
- Balance Rest and Activity
- Drug Therapy
- NSAIDs
- DMARDs
- Glucocorticoids
- Considerations
- PT/OT
- Reconstructive Joint Surgery
2 mins
Rheumatoid Arthritis Treatments
- 1) DMARDs
- DMARDS
- Methotrexate (first line)
- Leflunomide (2nd line)
- Contraindicated in Pregnancy
- Hydroxychloroquine
- Sulfasalazine (additive)
- Severe Disease
- Severe Disease
- Etanercept, infliximab, adalimumab
- Screen for TB
- Check vaccination
- Steroids for acute flares
