C.30

Question 1

What are the two main parts of the musculoskeletal system?

Answer 1

• the muscles
• the skeleton

Question 2

What are the functions of the musculoskeletal system? (5)

Answer 2

• to provide the body shape
• to protect the internal organs
• to provide the basis for movement
• to store salts and other materials needed for metabolism
• to produce RBC’s needed for oxygen transport (hemoglobin)

Question 3

What are the three kinds of muscles?

Answer 3

• Voluntary (skeletal) muscles
• Involuntary (smooth) muscles
• cardiac muscles

Question 4

Where are involuntary muscles found?

Answer 4

in the walls of organs; they help move food through the digestive system

Question 5

Where are cardiac muscles found?

Answer 5

Only in the walls of the heart

Question 6

List some examples of the types of actions we can perform with voluntary muscles? since they are under the control of a person’s will

Answer 6

walking, chewing, swallowing, smiling, frowning, talking, moving the eyeballs, etc…

*Most voluntary muscles are generally connected at one or both ends to the skeleton

Question 7

What enables muscle tissue to work?

Answer 7

It’s capability to contract – to become shorter and thicker when stimulated by a nerve impulse

*in addition to allowing for movement, bones give our body their distinctive shape

Question 8

List some ways a muscle can be injuried?

Answer 8

-overexertion (can break muscle fibers)
- muscles subjected to trauma (can be bruised, crushed, cut, torn, injured, etc even if skin isn’t broken)

Question 9

Define a joint

Answer 9

A place where bones meet

Question 10

Define flexion movement

Answer 10

The bending motion that moves the extremity toward the body

Question 11

define extension movement

Answer 11

The bending motion that moves the extremity away from the body

Question 12

define adduction movement

Answer 12

This is the movement of a body part toward the midline of the body

Question 13

define abduction movement

Answer 13

This is the movement of a body part away from the midline of the body

Question 14

define rotation movement

Answer 14

turns the body along the axis of a bone or a joint

Question 15

define circumduction movement

Answer 15

movement through an arc of a circle or in a circular motion from a central point

Question 16

What are the six basic components of the skeletal system?

Answer 16

• skull
• spinal column
• thorax
• pelvis
• lower extremities
• upper extremities

Question 17

What composes the axial skeletal system?

Answer 17

head, throax, and vertebral column

Question 18

What composes the appendicular skeletal system?

Answer 18

bones in the extremities (this includes the shoulder gridle and the pelvis)

Question 19

The upper extremity consists of the shoulder gridle, arm, forearm, and hand. what are the bones of the upper extremity? (8)

Answer 19

• clavicle (collarbone)
• scapula (shoulderbalde)
• Humerus
• Radius
• Ulna
• Carpal bones
• Metacarpals
• Phalanges

*the olecranon is your elbow bone

Question 20

The lower extremity consists of the pelvis, thigh, leg, and foot. what are the bones of the upper extremity? (9)

Answer 20

• pelvis (ilium, ischium, and pubis)
• femur
• patella (kneecap)
• tibia
• fibula
• calcaneus (heel bone)
• tarsals
• metatarsals
• phalanges

*The acetabulum is a hollow depression in the lateral pelvis where the head of the femur fits, creating a joint

• the greater trochanter is the bony projection felt on the lateral upper thigh (often called the hip)

*fibula is bigger leg bone than the side fibula

• Condyles are protuberances at the sides of the tibia and femur where they meet
• Calcaneus is the largest foot bone

Question 21

Define fracture

Answer 21

a break in the continuity of a bone

*happens from a variety of mechanisms of injury such as direct force, indirect force, and twisting force

*In a fracture, if the bone becomes displaced, the surrounding nerves, blood vessels, muscles, ligaments, and tendons may become damaged

Question 22

Open vs closed fractures?

Answer 22

open: associated with an open wound (ex: bone penetrating muscle, soft tissue, skin or a bullet hole)

closed: no break to the skin

*open fractures are complicated by introduction of bacteria and other contaminants

Question 23

S/S of a fracture (10)

Answer 23

-pain
-tenderness
-deformity
-discoloration
-parethesia distal to the frauture site (tingling/abnormal sensation; can indicate nerve injury)
-anesthesia distal to the fracture site (loss of feeling ; can indicate nerve injury)
-paresis (weakness; can indicate nerve injury)
-paralysis (loss of muscle control ; can indicate nerve injury)
-inability to move extremity (can indicate muscle or tendon damage)
-decreased pulse amplitude, increased capillary refill time, paresthesia, or pale, cool skin distal to the feature site (can indicate vessel injury)

Question 24

What is a hairline fracture?

Answer 24

a small crack in the bone that doesn’t create instability

*patient may only present with pain and tenderness

Question 25

What are some complications that may result with fractures? (5)

Answer 25

-hemorrhage from the bone itself -instability of the extremity leading to an increased incidence of tissue, nerve, or vessel damage -surrounding tissue damage -infection associated with an open fracture -interruption of distal blood supply

Question 26

What population is prone to fractures?

Answer 26

Geriatric due to changes in their bone structures. after 40 years, bones become less flexible, more brittle, and more easily fractured

Question 27

What is Osteoporosis?

Answer 27

A degenerative bone disorder associated with an accelerated loss of minerals, primarily calcium, from the bone. This condition dramatically weaknesses the bones and makes them prone to fracture. *Osteoporosis typically affects women more than men and happens most commonly after menopause

Question 28

Types of fractures? (7)

Answer 28

Comminuted -bone is shattered impacted - bone seems smashed againist itself; cracks in the bone greenstick - incomplete fracture oblique - horizontal fracture spiral - spiral fracture transverse - horizontal fracture hairline fracture - small crack

Question 29

What is strain?

Answer 29

an injury to a muscle or a muscle and tendon

Question 30

How can a strain occur?

Answer 30

-Overexertion of the muscle or muscle and tendon -Overstretching of the muscle or muscle and tendon -A strain can also occur as a result of extreme muscle stress or fatigue associated with overuse *overstretching tears the muscle and causes pain that typically increases with muscle use

Question 31

How does the patient with a strain present?

Answer 31

No bleeding which prevents presentation of edema or discoloration and rather the patient presents with pain on palpation, usually localized to a specific site, and pain or weakness with use of muscle

Question 32

What is a sprain?

Answer 32

An injury to a joint capsule, with damage to or tearing of the connective tissue, and usually involves ligaments

Question 33

What joints are most vulnerable to sprains?

Answer 33

shoulder, knee, wrist, and ankle

Question 34

How does a patient with a sprain present?

Answer 34

the patient typically experiences immediate pain and tenderness at the joint upon injury. The joint then becomes inflamed and swollen and discoloration typically follows over time but not for several hours after the injury

Question 35

What is a dislocation?

Answer 35

displacement of a bone from it's normal position in a joint

Question 36

How does a patient with a dislocation present?

Answer 36

The joint is firstly found in an abnormal position with obvious deformity and usually swelling. The patient complains of pain and tenderness at the site of discoloration and typically is unable to move the extremity. * A dislocation is dangerous because it can damage blood vessels and nerves by compression or tearing *Since a dislocation is when the joint Is forced beyond it's normal range of motion, this leads to an increase in ligament and/or joints capsule injury *dislocations are often found in association with fractures

Question 37

In which joints can an dislocation occur? (13)

Answer 37

-Acromioclavicular -Sternocalvicular -Shoulder -Elbow -Wrist -Hand -Metacarpal-phalanx -Phalanx-phalanx -Hip -Knee -Ankle -Foot -Metatarsal-phalangeal

Question 38

An injury from direct force, or a direct blow, occurs at the point of impact. provide an example

Answer 38

A man in an auto-mobile accident who is not wearing a seat belt is thrust forward and knees hit the dashboard. As a result, the patella might be fractured.

Question 39

With indirect force, the force impacts on one end of a limb, causing injury some distance away from the point of impact. provide an example.

Answer 39

A women is thrown from a horse and lands on two outstretched hands. One arm sustains a fractured wrist, while the clavicle at the end of the other arm is fractured

Question 40

In twisting force, one part of the extremity remains stationary while the rest twists. provide an example

Answer 40

take the case of the child running across a field who steps into a hole. The child's foot is rammed snugly into the hole and stays stationary while her leg twists, fracturing the tibia, and/or the fibula. *Bone and joint injuries from twisting force occur commonly in football or skiing accidents

Question 41

Most fractures are not considered critical injuries and can be managed with standard splitting procedures, with the exception of which two? *associated with a high incidence of serious bleeding and the potential for the patient to develop shock

Answer 41

A fracture to the femur or pelvis. These fractures are considered critical and must be managed not only to immobilize the bone but also to reduce associated bleeding. *The femur and pelvis bones contain a large blood supply which leads to these bones bleeding heavily when fractured. Even more, the bones are near large bodies of vessels that may also bleed if lacerated

Question 42

How much blood can a patient loose for each femur?

Answer 42

1,500 mL or 1.5 L of blood per femur. Furthermore, in a fracture, tension on the thigh muscles is lost, leading an increase in the diameter of the thigh; allowing for the thigh to house more blood and bleed more freely

Question 43

A principle in splitting a fractured femur is too immobilize the bone ends and also to reduce the amount of bleeding, hence a traction split is applied, what two goals does the application of a traction split achieve?

Answer 43

(1) The bone ends are realigned, which helps prevent further injury and reduces pain (2) The size (diameter) of the thigh is decreased, which allows less blood to build up in the thigh and also indirectly puts pressure on the bleeding bone ends

Question 44

The pelvis like the femur has a rich blood supply. When fractured, the pelvis loses it's cylinder shape, how does this affect the patients condition?

Answer 44

It creates a larger space. due to the immense force needed to feature the pelvis, iliac vessels injuries increase in likelihood. if the vessels are torn or ruptured, venous bleeding will occur into the retroperitoneal space and into the expanded pelvic compartment

Question 45

How much of a patients blood supply could be lost in the fractured pelvic compartment ?

Answer 45

their entire blood supply

Question 46

If obvious bone instability is found upon light palpation at the pelvic area, what is this a clear indication of?

Answer 46

pelvic fracture *if no instability if found, this does not exclude pelvic fracture as a possibility *for pelvic fratures, even if you just suspect it, do not palpate further and apply a pelvic stablization device (pelvic binder) or one improvised from a sheet can be used

Question 47

pros and cons of applying a pelvic stablization device?

Answer 47

pro: data suggest it decreases mortality con: theory states it might increase vessel laceration from boney fragaments, leading to an increase in uncontrolled hemorrhage

Question 48

What types of questions would you ask during secondary?

Answer 48

-when did the injury occur? -What happened? -Where does it hurt -What did you feel at the time of the injury? *you would perform a rapid secondary assessment for critical patients and a modified secondary for those with suspected fracture, (you can only suspect, not diagnose a fracture because you need a X-ray for that or to see the bone protruding)

Question 49

When assessing an extremity for suspected fracture or dislocation, you do the 6 P's, what is that?

Answer 49

-Pain (pain may be on palpation (tenderness) or with or without movement -pallor (skin distal to injury may be pale and have delayed capillary refill/ if Vein is blocked, distal can appear red and flushed) - paralysis (unable to move extremity, could be due to nerve, muscle, tendon, or ligament damage) - paresthesia (numbness or tingling) - pressure (pressure sensation related to swelling) - pulses (pulse distal to injury may be absent or decrease in amplitude; indicates damage to artery