NR511 Final Exam Study Guide
- Signs and symptoms and
management of musculoskeletal sprains/strains/dislocations Signs and symptoms and management of musculoskeletal sprains/strains/dislocations
Sprains: stretching or tearing of ligaments that occurs when a joint is forced
beyond its normal anatomical range First degree- stretching of ligamentous fibers Second degree- tear of part of the ligament with pain and swelling Third degree- complete ligamentous separation Sprain- sudden injury or fall that caused acute pain and swelling that got worse over a few hours, redness and bruising, active and passive ROM decreased. Radiography to rule out fx.
Strain: muscle injury caused by excessive tensile stress placed on a muscle
that results in stiffness and decreased function
-effects muscle or tendon that connects a muscle to a bone, complain of “pulled muscle,” severe cases cause inflammation, swelling, weakness and loss of function-surgery may be needed
Management: PRICE (protect, rest, ice, compression, elevation), limitation of
activity, physical therapy, NSAIDS, referral to ortho
Dislocation- complete separation of 2 bones that form a joint Very painful and cause immobility, need immediate medical attention Referral to orthopedics for possible surgery or reduction with application of cast or splint.
- Signs and symptoms and
management of spinal disorders (spondylosis, stenosis, etc.) Cervical Spondylosis- neck stiffness, mild aching discomfort with activity. Pain and limited ROM occur with lateral rotation and lateral flexion of the neck toward the affected side. Weakness shoulder abduction- C5. Bicep weakness- C6. Tricep weakness-C7.Myelopathy- leg weakness, gait disturbance, balance problems, difficulty performing fine motor tasks, loss of bowel and bladder.Treatment- cervical traction, PT, pain relievers. Surgery for Myelopathy.Low back pain-Tenderness and decreased range of motion. Positive straight leg test. Treatment-NSAIDS, muscle relaxants, opioids, surgical, self-care, spinal manipulation Stenosis-pseudoclaudication causing radicular pain in the calves, buttocks, and upper thighs of one or both legs. Symptoms progress from a proximal to distal direction. Walking or prolonged standing causes pain and weakness in buttocks and legs. Stooping over helps relieve pain. Positive Romberg.Reflexes diminished. Management- surgical decompression. NSAIDS, folic acid, vitamin b12. PT-flexing the spine.Bicycling. 1 / 3
NR511 Final Exam Study Guide
- Recognition and immediate
management of cauda equina syndrome Immediate management of cauda equina syndrome. (P. 829) Cauda equina syndrome is a medical EMERGENCY and requires immediate decompression.If Cauda equina is confirmed, surgical lumbar decompression is necessary to halt neurological deterioration unless surgery is contraindicated for other medical reasons.
*Rational on Davis Edge question: Low back pain accompanied by acute onset
of urinary retention or overflow incontinence, loss of anal sphincter tone or fecal incontinence, loss of sensation in the buttocks and perineum, and motor weakness in the lower extremities is a red flag for cauda equina syndrome or severe neurologic compromise
- Maneuvers and expected findings
- Initial assessment of FOOSH injury
with joint pain (knee, shoulder, wrist, etc.) Neck pain-Spurling’s. Shoulder pain-Apley scratch test(reaching the scapula).Internal and external flexion. Internal and external abduction. Pain with abduction= early supraspinatus tendinitis and subacromial bursitis=early rotator cuff injuries. Wrist and hand-allen’s test= radial and ulnar arteries.Phalens test=median nerve compression. Tinel’s sign assess for compression neuropathy. Finkelsteins test- de Quervains disease. Knee Pain= Mcmurray, apprehension sign, bulge sign, inspect/palpate to assess effusion.
in correlation to anatomical location of radial head bone
FOOSH: Falling On an Out Stretched Hand. After falling on an outstretched
hand patients present after trauma with pain and swelling in the distal forearm or wrist. Numbness may be present if the medial nerve is affected.The mechanism of injury will often provide important clues to the diagnosis.The examination begins with gentle palpation to locate the area of point tenderness and includes a thorough neurovascular assessment. A radiograph of the wrist (including an oblique view) may be necessary to rule out fracture.Common fractures are the Colles fracture of the distal radius and the navicular (scaphoid) fracture of the anatomical snuffbox. It is not unusual to have a navicular fracture missed on radiography, so an orthopedic referral should be provided when the presenting complaint is pain and trauma to the soft-tissue area of the anatomical snuffbox.
- Assessment and management of
- Health promotion activities to
Myofascial pain Trigger points within a muscle. Common cause of nonarticular rheumatic pain.Injections a the trigger point with saline, an anesthetic, or corticosteroid, dry needling, muscle relaxant tizanidine, NSAIDS, or cyclooxygenases-2 inhibitors.Tricyclic antidepressants.
prevent sport related musculoskeletal injuries Protection may refer to preventing the injury from occurring or making it less severe by wearing protective gear, such as helmets, wrist pads, and kneepads.Maintain adequate hydration and proper diet while playing sports. Stretch before the activity. Stop when you are injured, do not “tough it out”.
8. Osteopenia Osteopenia:
• Is the precursor to osteoporosis. Osteopenia is categorized by the level of T-scores in relation to the results of a dual-energy x-ray absorptiometry scan or (DXA Scan), which measures the mineral content of bone. A T-score ranging from -1 to -2.5 would be classified as osteopenia. 2 / 3
NR511 Final Exam Study Guide
Pathophysiology:
• It occurs secondary to uncoupling of osteoclast-osteoblast activity, resulting in a quantitative decrease in bone mass. Peak bone mass is typically achieved by males and females just prior to, or early-on in the 3rd decade of life.• Beyond age 30, bone resorption gradually becomes favored as dynamic bone remodeling continues into later decades of life.• Histologic specimens demonstrate markedly thinned trabeculae, decreased osteon size, and enlarged haversian and marrow spaces.
Osteopenia Prevention:
• Certain habits can accelerate the process such as:
- Smoking
- Not getting enough calcium and vitamin D
- Drinking too much ETOH
o Use of certain medications (i.e.: corticosteroids and anticonvulsants)
- Not getting enough weight-bearing exercise (at least 30 mins on most
- Falls
days). If your feet tough the ground during an exercise, it’s probably weight bearing. Running and walking are weight bearing. Swimming and biking are not
• Women are more likely to have low bone density than men, but it’s no longer viewed as solely a women’s condition.• Approx. a third of white and Asian men over age 50 are affected.• Percentages for Hispanics (23%) and blacks (19%) are lower, but still sizable.
Current National Osteoporosis Foundation (NOF) recommends testing for:
• Women 65 and older • Postmenopausal women younger than 65 who have one or more risk factors, which include being thin • Postmenopausal women who have had a fracture
• For men: testing is done more on a case-by-case basis.
Osteopenia Treatment:
Can be treated with exercise and nutrition or with medications.• If T-score is under -2, need to ensure you are doing regular weight- bearing exercise, and getting enough vitamin D and dietary calcium.• If T-score is closer to -2.5, a medication may be considered to keep bones strong.• Bisphosphonates are most commonly prescribed medication class for
treatment. Prolonged use has been linked with 2 major clinical side effects:
osteonecrosis of the jaw (ONJ) and the atypical subtrochanteric femur fracture.
- / 3