Jackie Shared "Musculoskeletal" - 29 Picmonics

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Musculoskeletal

Types of Fractures
Nondisplaced
Displaced
Incomplete
Complete
Closed
Open
Direction of Fracture Line
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2 mins
Neurovascular Assessment 6 P's
Pain
Paresthesia
Pulse
Pallor
Pressure
Paralysis
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1 min
Sizing Crutches
3 Finger Widths
6 Inches Lateral From Heel
30 Degree Flexion
Tripod Position
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59 secs
Compartment Syndrome Assessment
Mechanism
Trauma
Increased Pressure
Compressed Nerves and Blood Vessels
Assessment
1 or more of 6 P's
Considerations
May take Days to develop
Early Detection
Ischemia
Damage often Irreversible
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1 min
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
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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
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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
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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
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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
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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
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Duchenne muscular dystrophy
X-linked disorder typically due to frameshift or nonsense mutations Ž truncated dystrophin protein Ž inhibited muscle regeneration. Weakness
Duchenne = deleted dystrophin. Dystrophin gene (DMD) is the largest protein-coding human gene Ž  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
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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
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1 min
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
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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
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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
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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)
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Rheumatoid Arthritis Pathophysiology
Type III & IV HSR
HLA-DR4
Rheumatoid Factor (RF): Anti-IgG IgM
Rheumatoid Factor (RF) (High Sensitivity)
Anti-CCP (High Specificity)
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Rheumatoid Arthritis Assessment
Mechanism
Destruction of Connective Tissue and Synovial Membrane
Signs and Symptoms
Inflammation of Joints
Morning Stiffness
Nodules
Joint Deformities
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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
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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
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