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Musculoskeletal Abnormalities
.
46
Nursing
Graduate
03/13/2017

Additional Nursing Flashcards

 


 

Cards

Term

 

 

INFANTS

Definition

 

KYPHOSIS, EXPECTED CONVEX CURVATURE OF THE NEWBORN'S THORACIC AND LUMBAR SPINE

Term

 

 

All infants are flat-footed and many newborns have aslight varus curvature of the tibias or forefoot adduction from fetal positioning

Definition
Term

 

 

 

 

easily missed on a newborn

Definition

 

Fractured clavicle-evident by a lump on the collarbone caused by the callus that forms on the healing clavicle noted in the first weeks after birth

Term

 

 

Barlow-Ortalani maneuver

 

Definition

 

hip dislocation or subluxation should be assessed during the first year of life

Using little force-test one hip at a time, stabilizing the pelvis with the other hand.

Infant supine position yourself at infants foot, and flex the hip and knee at 90 degrees

Term

 

 

 

Barlow Maneuver

 

Definition

 

 

For the Barlow maneuver, grasp the leg with your thumn on the knee and your fingers gripping the outer thigh with fingertips resting on the greater trochanter

Adduct the thigh and gently apply downward pressure on the femur in an attempt to disengage the femoral head from the acetabulum. A positive sign is when a clunk or sensation is felt as the femoral head exits the acetabulum posteriorly

Term

 

 

 

 

Ortelani Maneuver

 

Definition

 

 

Slowly abduct the thigh while maintaining axial pressure. With the fingertips on the greater trochanter, exert a lever movement in the opposite direction so that your fingertips press the head of the femur back toward the acetabulum center. If the head of the femur slips back into the acetabulum with a palpable clunk when pressure is exerted, suspect hip subluxation or dislocation

Term

 

 

 

 

Allis sign- infants

 

Definition

 

 

Used to detect hip dislocatin or shortened femur-

Infant supine on the table, flex both knees, keeping the feet flat on the table and the femurs aligned with each other. Position yourself at the child's feet and observe the height of the knees. When one knee appears lower than the other, the Allis sign is positive

Term

 

 

 

 

Infant testing strength

Definition

 

Hold the infant in vertical position with hands under axillae. Adequate shoulder muscle strength is present if infant maintains the upright position. If the infant begins to slip through your fingers, proixmal muscle weakness is present

Term

 

 

 

Children

Definition

 

 

 

Young children will have a lumbar curvature of the spine and a protuberant abdomen

After 3 yo the longitundinal arch of the foot should be apparent

Metatarsus adductus should be resolved

feet will pronate slightly inward until about 30 months of age

Term

 

 

 

Tibial torsion

Definition

 

 

 

Flex one knee 90 degrees and align the midline of the foot parallel to the femur, using the thumb and index finger of one hand, grasp the medial and lateral malleoli of the ankle; grasp the knee, placing your thumb and index finger on the same side of the leg. If your thumbs are not parallel to each other, tibial torsion is present.

residual effect of fetal positioning should resolve within several years after weight bearing

Term

 

 

 

 

Genu Varum (Bow leg)

Definition

 

 

 

 

When the child is facing you- measure the distance between the knees when the medial malleoli of the ankles are together- present if 2.5cm one inch exists

Common until about 18mo

Term

 

 

 

Genu Valgum- knock knee

Definition

 

 

 When the child is facing you- with the knees togethermeasure the distance between the medial malleoli of the ankles, present if space of 2.5cm 1 inch

Tibiogemoral articulation angle will increase in the angle or increased space between the ankles

common in children 2-4 years of age

space should not exceed 5cm 2in

Term

 

 

 

Gower sign

Definition

 

 

 

Child raises up from sitting position placing hands on the legs and pushing trunk up

Term

 

 

 

Adolescents

 

Definition

 

 

Spine should be smooth, with balanced concave and convex curves, no lateral curvature or rib hump with foward flexion. The shoulders and scapulae should be level with each other within 1/2 inch and a distance of scapulae of 3 to 5 inches is usual.

May have slight kyphosis and rounded shoulders with interscapular space of 5 to 6 inches

 

Term

 

 

 

Pregnancy

Definition

Postural changes are common- fetus shifts center of gravity forward leading to increased lordosis and cervical flexion

 

Increased mobility and instability of sacroiliac joints and symphysis pubis as the ligaments become less tense contribute to the waddling gait

Term

 

 

 

Pregnancy

Definition

Carpal tunnel syndrome is experienced by some women due to fluid retention- should resolve in several weeks after delivery

 

Back pain should resolve within 6 months after delivery

Term

 

 

Older Adults

Definition

Posture may display increased dorsal kyphosis, accompanied by flexion of the hips and knees, head may tilt backwaqrd to compensate for the increased thoracic curvature

Extremities may appear long from vertebral collapse

reduction in total muscle mass is often related to atrophy; loss of nerve innervation or disuse

Term

 

Osgood-Schlatter Disease

Definition

 

 

A traction apophysitis (inflammation of a bony outgrowth) of the anterior aspect of the tibial tubercle - inflammation of anterior patellar tendon

boys between 9-15

walking with a limp* knee pain with activity*

swelling aggrevated by activity-pain with palpation over tibial tuberosity

Term

 

 

 

 

Metatarsus Adductus (Varus)

Definition

Medial adduction of the toes and forefoot restults from angulation at the tarsometatarsal joint

Lateral border of the foot is convex

A crease is sometimes apparent on the medial border of the foot

Term

 

 

Muscle strain

Definition

 

temporary muscle weakness, spasm, pain, and contusion

Term

 

 

 

Dislocation

Definition

pressure or force pushing the bone out of the joint

deformity or inability to use joint as usual

Term

 

 

Rheumatoid Arthritis

Definition

 

A chronic inflammatory disorder of the synovial tissue surrounding the joints

 

Joing pain and sitffness especially in the morning or after periods of inactivity

fatigue, myalgias, weight loss, and low grade fever

synovitis & nodules

Term

 

Osteoarthritis

 

Definition

 

cartilage abrasion, pitting, and thinning, the bone surfaces are eventually exposed with bone rubbing against bone

pain in hands, feet, hips, knees, and cervical or lumbar spine,

onset after 40 yo- nearly 100% affected by 75yo

joints may be enlarged due to bone growths

may have crepitus and limited, painful, range of motion

 

Term

 

Fracture

Definition

pain limited movement cannot bear weight, swelling, felt a pop or snap with injury

can occur more easily in patients with bone disorders

deformity, edema, pain, loss of function, color changes, and paresthesia

 

Term
Tenosynovitis (Tendonitis)
Definition

inflammation of the synovium-lined sheath around a tendon

seen with repetitive actions - can occur in rheumatoid arthritis

pain with movement of such common sites such as shoulder, knee, heel, and wrist

point tenderness over the involved tendon

pain with active movement, and some limitation of movement in the affected joint

Term
Rotator cuff tear
Definition

most often supraspinatus

pain in the shoulder and deltoid area is common, awaken pt. at night

inability to maintain a lateral raised arm against resistance may develop

tenderness over the acromioclavicular joint

grating sound on movement, crepitus, and weakness in external shoulder rotation

 

Term

Clubfoot (Talipes Equinovarus)

 

Definition

fixed congenital foot defect of ankle and foot

 

most common combination of position deformities includes inversion of the foot at the ankle and plantar flexion, with the toes lower than the heel

 

Term
Muscular Dystrophy
Definition

group of genetic disorders involving gradual degeneration of the muscle fibers

clumsiness, difficulty climbing stairs, and frequent falls

 

muscle atrophy and weakness and waddling gait

positive gower sign(using legs to sit up)

progressive loss of function, including ability to walk

Term

Ankylosing Spondylitis

 

Definition

hereditary chronic inflammatory disease, inflamed intervertebral disks and longitudinal ligaments ossify

leads to eventual fusion and severe deformity of vertebral column

develops in men between 20-40 yo

begins with low back and buttock pain

restriction in the lumbar flexion of the pt

limited range of motion of the shoulders, chest wall, hips, and knees

uveitis may present

Term

Lumbosacral Radiculopathy (Herniated Lumbar disk)

 

Definition

lumbosacral radiculopathy is herniation of a lumbar disk that irritates the corresponding spinal nerve root

most common L4, L5, and S1 nerve roots

31-50 yo

heavy lifting

low back pain with radiation to the buttocks and posterior thigh or down the leg in distribution of the dermatone of nerve root

lying down relieves pain

*Spasm & tenderness over the paraspinal musculature

Potential difficulty with heel walking or toe walking

numbness, tingling, or weakness in extremity

Term

Lumbar Stenosis

 

Definition

narrowing of spinal canal

pain with walking or standing upright that originate in the buttocks and then radiate down the legs

relief occur with sitting or bending forward

pain may be worsened by prolonged standing, walking, or hyperextending the back

progression, neuro exam may show lower extremity weakness and sensory loss

Term

Carpal Tunnel Syndrome

 

Definition

Compression of the median nerve

repetitive motion

associated with ra, gout, acromegaly, hypothyroidism, and hormones

numbness, burning, tingling at night

radiate to arms

weakness of the thumb and flattening of the thenar eminence of the palm

reporoduction of symptoms with provocation of the TINEL AND PHALEN maneuvers

Term

Gout

 

Definition

form of arthritis of purine metabolism that results in elevated uric acid level

acute inflammatory attacks- uric acid build up

sudden onset of hot, swollen joint, exquisite pain, Limited rom

men older than 40 yo and women of postmenopausal age

poximal phalanx of the great toe, wrists, hands, ankles, knees

skin over the swollen joint may be shiny and red or purple

uric acid crystals may form as tophi under the skin

Term

Temporomandibular Joint Syndrome (TMJ)

 

Definition

painful jaw movement

unilateral facial pain that usually worsens with joint movement

muscle spasm and clicking, popping, or crepitus to affected joint

Term
Osteomyelitis
Definition

infection in the bone

decreased blood flow to the affected bone may lead to necrosis

dull pain develops insiduously at the involved site and progresses over days to weeks- limp or decreased movement

signs of infection include edema, erythema, warmth, tenderness on palpation, pain with movememnt, and signs of inflammation such as fever

 

Term
Bursitis
Definition

inflammation of the bursa

repetitive movement- infection- gout

pain is usually worse during activity

limitation of the motion caused by swelling; pain on movement; point tenderness; and erythematous, warm site

soreness may radiate to tendons at the site

Term

Paget disease of the bone

(Ostetis Deformans)

 

Definition

focal metabolic disorder of the bone

over 45 yo

excessive bone resorption and bone formation produce a mosaic pattern of lamellar bone

skull- vertigo and headache

bowed tibias, misshapen pelvis, prominent skull forehead, frequent fractures

Term
Legg-Calve-Perthes disease
Definition

avascular necrosis of the femoral head

decreased blood supply to femoral head

boys between 3-11

pain is often reffered to the medial thigh, knee, or groin

child may have a limp that is painless or antalgic

loss of internal rotation; abduction and decreased range of motion on the affected site

muscle weakness of the upper leg may be present if symptoms have been present for a prolonged period

 

Term

Slipped Capital Femoral Epiphysis

 

Definition

femoral epipysis slips over the neck of the femur

between 8-16yo

L side is more involved than R

presents with knee pain and a limp

leg weakness and reduced internal hip rotation

 

Term

Radial head Subluxation

(Nursemaid's Elbow)

 

Definition

dislocation injury

jerking the arm upward while the elbow is extended

jerking pulls apart the elbow joing and tears the margin of the annular ligament around the radial head into the joint

children 1-4 yo

child complains of pain in the elbow and wrist and refuses to move arm

child holds arm slightly flexed and pronated supination motion is resisted

Term

Dupuytren Contracture

 

Definition

flexor hands tendons

flexion contractures develop

over age of 40 in men

flexor tendons generally contract causing fingers to curl with impaired extension

easily palpable tendons

Term
Infants & Children
Definition

embryologic connective tissues to form cartilage that calcifies and eventually becomes bone

long bones increase in diameter by the growth of new bone tissue around the bone shaft

increased length of long beones results from the proliferation of cartilage at growth plates

LIGAMENTS ARE STRONGER THAN BONE UNTIL ADOLESCENCE THEREFORE FRACTURES MORE COMMON THAN SPRAINS

Term

adolescents

 

Definition

rapid growth during tanner stage 3

results in decreased strength in the epiphyses as well as overall decreased strength and flexibility

Bone growth completes at 20- last ephiphysis closes and becomes firmly fused to the shaft

bone density and strength continue to increase when bone growth stops

Peak bone mass is not achieved until 35yo

 

Term

Pregnancy

 

Definition

Increased hormone contribute to elasticity of ligaments and softening of the cartilage in pelvis at 12-20 wks

Increased mobility of the sacroiliac, sacrococcygeal, and symphysis pubis joints results

Lordosis occurs in an effort to shift center of gravity back to lower extremities

ligaments and muscles of the lower spine may become stressed leading to lower back pain in many women

Term
Older Adults
Definition

equilibrium between bone deposition and resorption changes- resorption dominates

menopausal women, decreased estrogen increases bone resorption and decreases calcium deposition, resulting in bone loss and decreased density

Weight-bearing bones may become predisposed to fractures

Bony prominences become more apparent with the loss of subcutaneous fat- cartilage around joints deteriorates

 

 

Term

Older Adults

 

Definition

Muscle mass has increased amounts of collagen collecting in the tissues initially followed by fibrosis of connective tissue

tendons become less elastic- resulting in reduction of total muscle mass, tone, and strength

progressive decrease in reaction time, speed of movement, agility, and endurance occurs

 

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