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Introduction
1. Cardiopulmonary system
2. Pulmonary system
3. Neuromuscular system
4. Pediatrics
5. Musculoskeletal system
5.1 Anatomy of musculoskeletal system
5.2 Foundation content of musculoskeletal system
5.3 Anatomy and special tests of upper extremity
5.4 Differential diagnosis with interventions of upper extremity
5.5 Anatomy and special tests of lower extremity
5.6 Differential diagnosis with interventions of lower extremity
5.7 Anatomy and specie tests of spine, pelvis, and temporomandibular joint
5.8 Differential diagnosis with intervention of spine, pelvis, and TMJ
5.9 Other MSK conditions
5.10 Gait
5.11 Prosthetics and orthotics
5.12 Medications, imaging, and fractures
5.13 Surgical protocols
6. Other system
7. Non-systems
Wrapping up
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5.12 Medications, imaging, and fractures
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5. Musculoskeletal system

Medications, imaging, and fractures

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Imaging

There are several types of medical imaging used to assess different tissues and structures in the body. Below are the main types:

X-ray (radiography)

  • Best for: Bones, fractures, joint alignment, lung conditions
  • How it works: Uses ionizing radiation to create images of dense structures
  • Common uses:
    • Fractures & dislocations
    • Arthritis
    • Lung infections (e.g., pneumonia)
    • Foreign objects
  • Limitations: Limited soft tissue visibility, radiation exposure
  • Interpreting an X-Ray
    • High density tissue (e.g. bone) – absorb x-rays to a greater degree, and appear white on the film.
    • Low density tissue (e.g the lungs) – absorb x-rays to a lesser degree, and appear black on the film
    • Intermediate density tissue (e.g. muscle and fat) – appears as shades of grey on the x-ray film

Image #85

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https://upload.wikimedia.org/wikipedia/commons/d/dc/Radiograf%C3%ADa_pulmones_Francisca_Lorca.cropped.jpg

Computed tomography (CT Scan)

  • Best for: Bones, soft tissues, internal bleeding
  • How it works: Combines multiple X-rays to create cross-sectional images
  • Common uses:
    • Bone fractures and complex injuries
    • Internal bleeding (trauma)
    • Tumors
    • Lung and abdominal conditions
  • Limitations: Higher radiation exposure than X-rays
  • Interpreting CT scan
    • Dense structures: (like bone and calcifications) appear lighter (white).
    • Lucent structures: (like air and fat) appear darker (black).

Image #86

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https://upload.wikimedia.org/wikipedia/commons/e/ed/Axial_plane_CT_scan_of_the_thorax_illustrative_image.jpg

Magnetic resonance imaging (MRI)

  • Best for: Soft tissues, brain, muscles, ligaments, and nerves
  • How it works: Uses strong magnets and radio waves to generate detailed images
  • Common uses:
    • Ligament and tendon injuries
    • Brain and spinal cord conditions
    • Tumors
    • Disc herniations
  • Limitations: Expensive, time-consuming, cannot be used with metal implants
  • Interpreting MRI
    • T1 MRI highlights anatomy, provides crisp images, and shows fluids as dark.
    • T2 MRI focuses on pathology, making fluids bright, which is ideal for visualizing inflammation, edema,

Image #87

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https://upload.wikimedia.org/wikipedia/commons/0/03/T1t2PD.jpg

Ultrasound

  • Best for: Soft tissues, pregnancy, blood flow
  • How it works: Uses high-frequency sound waves to create real-time images.
  • Common uses:
    • Pregnancy monitoring
    • Soft tissue injuries (e.g., muscle tears)
    • Blood clots (Doppler ultrasound)
    • Organ imaging (e.g., liver, kidneys)
  • Limitations: Poor image quality for bones and deep structures

Nuclear medicine imaging (e.g., PET Scan, Bone Scan)

  • Best for: Organ function, cancer detection, metabolic activity
  • How it works: Uses radioactive tracers to highlight metabolic activity
  • Common uses:
    • Cancer detection (PET scan)
    • Bone metastases (Bone scan)
    • Thyroid and kidney function
  • Limitations: Radiation exposure, high cost

Fluoroscopy

  • Best for: Real-time imaging of movement (e.g., swallowing, joint motion)
  • How it works: Continuous X-ray imaging allows real-time assessment
  • Common uses:
    • Barium swallow for digestive tract
    • Cardiac catheterization
    • Joint injections
  • Limitations: Higher radiation exposure than standard X-rays

Medications

Medications for musculoskeletal conditions target pain, inflammation, and muscle spasms, encompassing analgesics, anti-inflammatories, muscle relaxants, and any other relevant musculoskeletal symptoms

  • Non-steroidal anti-inflammatory (NSAIDS)
    • Mechanism of Action: Decrease inflammation and pain
    • System Interactions:
      • Cardiac: High blood pressure (hypertension)
      • Gastrointestinal: Indigestion, diarrhea, vomiting, GI ulcers, GERD
      • Neuro: Dizziness, headache
  • Opioids
    • Mechanism of Action: Decrease pain in musculoskeletal system
    • System Interactions:
      • Cardiac: Decrease heart rate, arrhythmia
      • Pulmonary: Decrease respiration rate
      • Gastrointestinal: Delayed gastric emptying (causes constipation)
      • Musculoskeletal: Muscle rigidity, muscle jerks
      • Integumentary: Itchy skin
      • General: Dry mouth, addiction
  • Corticosteroids
    • Mechanism of Action: Decrease inflammation in musculoskeletal system
    • System Interactions:
      • Cardiac: High blood pressure (hypertension)
      • Gastrointestinal: Indigestion, diarrhea
      • Musculoskeletal: Osteoporosis (high risk for fractures if taken for long period of time)
      • General: Weight gain, diabetes
      • Integumentary: Acne
  • Aspirin (acetaminophen)
    • Mechanism of Action: Reduce fever and relieve pain
    • System Interactions:
      • Cardiac: Coagulopathy
      • Gastrointestinal: Indigestion, diarrhea
      • Integumentary: Acne
      • Neuro: Headache, seizures, dizziness
      • Pulmonary: Asthma
      • Urinary system: dark urine
  • Baclofen
    • Mechanism of action: decrease spasticity
    • Systems interactions
      • Musculoskeletal: muscle stiffness, abnormal posturing, bone/joint stiffness/pain, muscle weakness
  • Muscle relaxants
    • Mechanism of action: acting on the central nervous system (CNS) to interfere with the transmission of nerve impulses to muscles, effectively reducing muscle spasms and tension by depressing neuronal activity
    • Systems interactions
      • Neuro: drowsiness, fatigue, dizziness, headache
      • Musculoskeletal: weakness
      • Gastrointestinal: nausea, constipation
      • General: dry mouth, blurred vision

Fractures

A fracture is a partial or complete break in the bone. There are many different types of fractures. Bone fractures are often caused by falls, injury, or because of a direct hit or kick to the body. Overuse or repetitive motions can cause stress fractures

Types of fractures

  • Open (compound): The bone breaks through the skin, exposing it to the environment
  • Closed (simple): The bone breaks but does not penetrate the skin.
  • Transverse: A straight break across the bone
  • Oblique: A diagonal break at an angle to the bone
  • Spiral: A twisting break that spirals around the bone
  • Greenstick: A partial break that occurs in children’s flexible bones
  • Comminuted: The bone breaks into multiple fragments
  • Stress fracture: A small, hairline crack caused by repetitive stress
  • Impacted fracture: The broken ends of the bone are driven into each other
  • Avulsion fracture: A small piece of bone is pulled away by a tendon or ligament

Salter-Harris Fracture

A Salter-Harris fracture is a type of bone fracture that occurs in children and adolescents, involving the growth plate (physis)

Salter-Harris fractures are classified into five types based on the location and extent of the fracture:

  • Type I: Separation of the epiphysis from the metaphysis through the growth plate
  • Type II: Fracture extends from the growth plate into the metaphysis
  • Type III: Fracture extends from the growth plate into the epiphysis
  • Type IV: Fracture extends from the growth plate through both the epiphysis and metaphysis
  • Type V: Crush injury of the growth plate

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