Musculoskeletal Principals and Terminology

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Musculoskeletal Principals and Terminology

• Dr J G Myburgh

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The Tree Of Andry (1741)
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Orthopaedia

• ORTHOS (Straight) PAIS (Child)

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Orthopaedic Surgery

• Deals with disability in
• Bones
• Joints
• Muscles
• Tendons
• Nerves

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Orthopaedic Surgery

• Congenital and developemental abnormalities
• Infections
• Artritis and rheumatic disorders
• Metabolic and endocrine disorders
• Tumors and pseudo tumors
• Sensory disturbance and muscle weakness
• Injury and mechanical derangement

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Symptoms

• Pain
• Stiffness
• Swelling
• Deformity
• Weakness
• Instability
• Sensory change
• Loss of function

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Examination

• Look -Skin
• -Shape
• -Position
• Feel -Skin
• -Soft tissue
• -Bones and joints
• Move - Active
• - Passive
• - Abnormal

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Muscle power

• Grade 0 no movement
• Grade 1 flicker
• Grade 2 gravity eliminated
• Grade 3 against gravity
• Grade 4 against resistance
• Grade 5 normal power

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Flexion Extention
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Abduction Adduction
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Internal external rotation
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Pronation Supination
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Causes of Bone Deformity

• Congenital (pseudarthrosis)
• Bone softening (rickets)
• Displasia (multiple exostosis)
• Growth plate injury
• Fracture malunion
• Pagets disease

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Causes of Joint deformity

• Skin contracture
• Fascial contracture
• Muscle contracture
• Muscle imbalance
• Joint instability
• Joint destruction

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Terminology

• Coxa - Hip
• Genu Knee
• Pes Foot
• Hallux Big toe
• Pollices - Thumb

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Genu valgum Genu varum
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Scoliosis
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Kyphosis kyphos (hump)
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Septic artritis
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Rheumatoid Arthritis
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OA Total Hip Replacement
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Giant cell tumor
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Osteosarcoma
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Operations on bones

• Bones can be
• Cut (Osteotomy)
• Joined (Osteosynthesis)
• Grafted
• Lengthened
• Drained

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Operations on ligaments

• Ligaments can be
• Repaired
• Reconstructed
• Shortened

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Operations on nerves

• Nerves can be
• Decompressed
• Sutured
• Grafted
• Epineurolysis

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Painfull Arc
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Nerve Compression
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Nerve injury

• Neurapraxia- caused by a focal lesion, usually
  demyelinating, and followed by a complete
  recovery
• Axonotmesis-
• Neurotmesis

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Subluxation dislocation
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Anterior shoulder dislocation
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Rotator cuff arthropathy
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AC Dislocation
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Fractures

• Complete or incomplete break in the continuity of
  bone, associated with an open or closed soft
  tissue injury of varying severity.

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How Fractures Happen

• Single traumatic event
• Repetitive stress
• Abnormal weakening of bone

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Trauma

• Twisting
• Compression
• Bending
• Tension
• Avulsion

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Fracture Patterns
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Fracture types
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Impacted Fracture
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Comminuted Fracture
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Fracture displacement

• Translation
• Angulation
• Rotation
• Length (shortening/impaction)

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Fracture displacement
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Deforming Forces
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How Fractures Heal
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Fracture complications

• Vascular injury
• Haemarthrosis
• Compartement syndrome
• Nerve injury
• Infection
• Fat embolism
• Visceral injury

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Fracture Complications

• Non - union
• Delayed union
• Mal union
• Joint stiffness
• Heterotopic ossification
• Avascular necrosis
• Osteoartritis
• Regional pain syndrome

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Clinical

• History
• Look
• Feel
• Move

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X- Rays

• Rule of twos
• Two views
• Two joints
• Two limbs
• Two injuries
• Two occasions

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Description of fractures

• Open or closed
• Fracture pattern
• Displacement

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Fracture Patterns
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Treatment

• Reduce
• Hold
• Exercise (Rehabilitation)

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Open Fractures

• Wound debridement
• Antibiotic prophylaxis
• For gunshot fractures, do no give corticosteroids
• Stabilization of fracture
• Early wound cover

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Fracture Immobilisation

• Plaster of Paris
• Traction
• Bracing/ Splinting
• External Fixation
• Internal Fixation

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Physeal Injuries
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Occupational Therapy
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MEN WERE BORN TO SUCCEED NOT TO FAIL. HENRY
D THOREAU
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The End