Chapter 44 Alteration in Musculoskeletal Function

1. B. Fracture- A break in the continuity of a bone

2. E. Nonunion -Failure of fractured bone ends to grow together

3. F. Epicondylitis -Inflammation of a tendon where it attaches to a bone

4. A. Bursitis- Inflammation in small fluid-filled sacs located between tendons, muscles, and bony

prominences

5. C. Tendon -Band of connective tissue that attaches skeletal muscle to bone

6. D. Ligament- Band of connective tissue that connects two bones

7. Two relatively unstable joints that dislocate commonly are the knee and (hip, shoulder); the key

symptoms of this latter dislocation are pain and inability to (bear full weight, elevate the arm).

8. A tear in a ligament is known as a (strain, sprain); a tear in a tendon is known as a (strain,

sprain).

9. A healing tendon or ligament will not be strong enough to withstand a strong pull for 4 to 5

(weeks, months) after injury.

10. Tennis elbow and golfer’s elbow are examples of (bursitis, epicondylopathy).

11. In young persons, (tendons, muscles) are ruptured more often than (tendons, muscles), but in

older adults, (tendons,muscles) are ruptured more often than (tendons, muscles).

12. Compartment syndromes occur when (venous, arterial) pressure increases, causing eventual

ischemia and edema that cause (redness, pain) out of proportion to the injury.
13. Rhabdomyolysis is characterized by (skeletal muscle, chest) pain, weakness, (bloody, dark)

urine, and increased serum (creatine kinase, alkaline phosphatase); a main treatment goal is to prevent

damage to the (liver, kidneys).

14. The most common microorganisms that cause osteomyelitis are (fungi, bacteria); an area of

dead bone in osteomyelitis is called (involucrum, sequestrum).

15. In ankylosing spondylitis, an (autoimmune, infectious) process inflames the cartilaginous joints;

the primary pathologic problem is uncontrolled bone (destruction, formation), rather than bone

(destruction, formation).

16. Persons who have McArdle disease are unable to (synthesize, break down) glycogen; persons

who have acid maltase deficiency accumulate glycogen in their (mitochondria, lysosomes).

17. The most common cause of toxic myopathy is (alcohol, autoimmunity).

18. Osteoarthritis (OA)-Increased chondrocyte apoptosis

19. Rheumatoid arthritis (RA )-Antibodies against citrullinated proteins

20. RA-Severe joint deformities

21. OA -Osteophyte formation

22. RA-Nodule formation in soft tissue

23. RA -Pannus

24. RA -Autoimmune disease

25. OA -Loss of articular cartilage

26. OA -Joint pain relieved by rest

27. RA -Joint stiffness for first hour after awakening

28. RA -Antibodies against normal antibodies

29. Write the letters here in the correct order of the steps:

B. Hematoma forms beneath the periosteum around the broken area.

E. Necrotic tissue stimulates an inflammatory response.

H. Leucocytes release cytokines and other factors that promote healing.

F. Vascular tissue invades the fracture area, creating granulation tissue.

G. Bone-forming cells become activated and produce procallus beneath the periosteum.

D. Osteoblasts in procallus synthesize collagen and matrix, which become mineralized into callus.

C. Unnecessary callus is resorbed and trabeculae form.

A. Bone is remodeled over a period of time.

Picture

30. What two-word technical term describes the finger deformities in picture A? Ulnar drift

31. What disease process causes hands to look like picture A? RA

32. In addition to the joint deformities, picture A shows muscle wasting. What caused it?

The muscle wasted because of the loss of mobility.

33. What causes the joint swelling in this condition?

Synovitis or inflammation of the synovial membrane.

34. Why does this condition have systemic manifestations as well as joint ones?
RA is an autoimmune disease and can cause inflammation anywhere the antigens are located in the

body.

35. What disease process causes hands to look like picture B? OA

36. The nodes that are circled in hand number 1 are called Bouchard nodes.

37. The nodes that are circled in hand number 2 are called Heberden nodes.

38. What causes these nodes? Osteophytes

39. What is the role of matrix metalloproteinases in this disease process? When it becomes

elevated in OA, it destroys articular cartilage.

40. What is the difference between delayed union and malunion?

Delayed union is when it takes longer for a bone to heal like 8 to 9 months. Malunion is when the bone

is healed in the wrong position.

41. What is the difference between dislocation and subluxation?

Dislocation is the displacement from a bone from its normal position, while subluxation is partial

dislocation and the joints still touch partially.

42. What is the difference between tendinitis and tendinosis?

Tendinitis is inflammation of the tendon and tendinosis is degradation of the collagen fibers in the

tendon.

43. What is the difference between rhabdomyolysis and myoglobinuria?

Rhabdomyolysis is the breakdown of skeletal muscles that cause release of myoglobin but

myoglobinuria is myoglobin in the urine.

44. Increased metabolic activity in bone causing abnormal and excessive bone remodeling that

enlarges and softens bones. D. Paget disease

45. Syndrome involving high levels of uric acid in body fluids, precipitation of urate crystals, and

recurrent monoarticular arthritis. F. Gout

46. Autoimmune inflammation of connective tissue and muscle fibers in pelvic and shoulder girdles

mediated by T lymphocytes. E. Polymyositis

47. Metabolic disease of adults characterized by inadequate and delayed mineralization of osteoid

in mature bone. A. Osteomalacia

48. Chronic inflammatory joint disease characterized by stiffening and fusion of the spine and

sacroiliac joints. B. Ankylosing spondylitis

49. Chronic musculoskeletal syndrome characterized by widespread joint and muscle pain, fatigue,

and increased sensitivity to touch at tender points. C. Fibromyalgia

50. Realigning the fragments of a broken bone is called reduction; surgical placement of screws,

plates, or other devices to immobilize the site is called internal fixation.

51. The term heterotopic ossification denotes abnormal bone formation in soft tissue that occurs

after localized muscle injury.

52. Inadequate or delayed mineralization of osteoid in children, often due to vitamin D deficiency,

is known as rickets.

53. In Paget disease, thickening of the skull can compress the brain or cranial nerves.
54. Primary bone cancer is rare, but metastatic cancer often affects bone; the most common

primary bone cancer in young adults is osteosarcoma.

55. Classification of bone tumors is based on the cell type and the type of ground substance

synthesized by the tumor cells.

56. In gout, accumulation of urate crystals in subcutaneous tissue causes formation of white

nodules known as tophi; precipitation of urate in the kidneys causes renal stones.

57. Failure of a muscle to generate force is called weakness; failure of a muscle to sustain force is

called fatigue.

58. Abnormal muscle shortening is called a contracture.

59. Tension headaches are due in part to a feedback cycle with the reticular activating system and

muscles spindles.

60. Chronic fatigue syndrome is characterized by unrestful sleep and debilitating fatigue; it is

differentiated from fibromyalgia by the absence of tender points.

61. Prolonged inactivity from bed rest or a cast causes disuse atrophy.

62. Myotonic channelopathies are characterized by delayed muscle relaxation whereas an episode

of periodic contraction paralysis is characterized by inability to initiate muscle.

63. Cartilage-forming malignant tumor that does not ossify and typically seeds in surrounding

tissue. -D.Chondrosarcoma

64. Benign solitary tumor originating from osteoclasts that is associated with pathologic fractures

due to extensive bone resorption. -C.Giant cell tumor

65. Aggressive malignant bone-forming tumor that typically produces periosteal reaction- B.

Osteosarcoma

66. Malignant tumor of skeletal muscle that metastasizes rapidly- E.Rhabdomyosarcoma

67. Collagen-forming solitary malignant tumor that may be a secondary complication of radiation

therapy- A. Fibrosarcoma

68. “The doctor said I have a compound fracture in my leg,” says Mr. Reilly. “Does that mean it is

infected? I know he is worried about infection.”

No compound means that you have a fracture that is breaking the skin which is exposed to

microorganism that can cause infection.

69. Mr. Shea says,“ When I was five, I jumped off the roof and broke my left leg; it is much shorter

than my right one. My friend broke his leg, and his legs are the same length. Why?”

You could have broken your leg in the epiphyseal growth plate where the bone grows long, if it is broken

it potentially could not back the same size and length.

70. Mr. Tay has osteomyelitis in his lower fibula. He says,“How did my leg bone get

infected? The only break in my skin is this oozing diabetes sore on my ankle.”

The break in skin let bacteria infect your bone.

71. Mr. Vargas says,“It has been 3 weeks, and I want this leg cast off now! I have to go back to

work! I cannot wait another 3 weeks! My kids are hungry!”

If you take the cast off too soon you bone may break or heal improperly.

72. “What makes these ugly lumps on my knuckles?”says Mrs. Boult.“The doctor called

them Heberden nodes, but he was busy writing prescriptions for my hip arthritis drugs, and I did not ask

him.”

Osteoarthritis causes overgrowth of bone that causes those lumps or osteophytes.

73. Mr. Crabbe is undergoing diagnostic workup for possible osteosarcoma. He says,“I understand

why they do scans to look at my bones, but why are they taking blood to check for bone cancer? Why

not just look at the bones?”

They are testing for alkaline phosphates which certain bone cancers release.

74. What is the difference between osteopenia and osteoporosis?

Osteopenia cause some decrease in bone mass while osteoporosis severely decreases bone mass.

75. What relationship between bone formation and bone resorption is responsible for

osteoporosis?

In osteoporosis bone is reabsorbed faster than it is formed.

76. Why does Mrs. Lottner have a kyphotic posture?

Vertebral compression fractures cause kyphosis in osteoporosis.

77. At what age did Mrs. Lottner most likely have her peak bone mass?

At age 30
78. What happens to bone mineral density between peak mass and menopause?

It declines.

79. Describe the pattern of change in bone mineral density after menopause.

It initially decreases rapidly for first couple of years then gradually declines.

80. How does lack of estrogen after menopause contribute to osteoporosis?

Osteoclast activity increases.

81. Why did the nurse practitioner encourage Mrs. Lottner to walk every day?

Exercise that are weight bearing can slow down bone loss in osteoporosis and increases muscle

strength.

Across

1. Fracture with intact skin overlying the bone- closed

3. Break on only one cortex of bone with splintering of inner bone surface-greenstick

6. Fracture line parallel to long axis of bone-linear

9. Fracture with communicating wound between bone and skin-open

10. Fracture where bone is weakened by disease-pathologic

12. Fracture line at an angle (but not perpendicular) to long axis of bone-oblique

13. Microfracture-stress

15. Fragment of bone connected to a ligament or tendon breaks off from the main bone-avulsion

Down
2. Fracture with one, both, or all fragments out of normal alignment-displaced

4. Fracture has multiple bone fragments-comminuted

5. Fracture caused by low-level trauma-fragility

7. Vertebra collapsed into a wedge shape-compression

8. Fracture fragments are pushed into each other-impacted

11. Fracture line perpendicular to long axis of bone-transverse

14. Fracture line encircles bone while ascending-spiral