Ch 42 Management Of Patients With Musculoskeletal Disorders

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inflammation of a fluid-filled sac in a joint

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bursitis

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abnormal shortening of muscle of fibrosis of joint structures

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contracture

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new bone growth around a sequestrum

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involucrum

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low bone mineral density

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osteopenia

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degenerative disease of the bone characterized by reduced mass, deterioration of matrix, and diminished architectural strength; thinning of the bone related to reduction of bone density and change in bone structure which increase susceptibility to fracture

Risk factors: decreased calcium, vit D intake, post menopausal, women, sedentary, obesity, corticosteroids

dx: bone scan

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osteoporosis

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disease of a nerve root that may result in pain that radiates down the leg

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radiculopathy

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sciatic nerve pain; pain travels down back of thigh into foot

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sciatica

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dead bone in abscess cavity

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sequestrum

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inflammation of muscle tendons

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tedonitis

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compression of median nerve within writst's carpal tunnel when swelling in the tunnel occurs

cause; repetitive movement

dx; history, EEG

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carpal tunnel syndrome

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collection of neurological gelatinous material near the tendon sheaths and joints, appears as a cyst. Near known sheaths and joint on dorsum of wrist

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ganglion

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Primary osteoporosis occurs in:

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women after menopause (usually by age 51) and in men later in life, but it is not merely a consequence of aging. Failure to develop optimal peak bone mass and low vitamin D levels contribute to the development of osteopenia without associated bone loss.`

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secondary osteoporosis is the result of

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medications or diseases that affect bone metabolism. Men are more likely than women to have secondary causes of osteoporosis, including the use of corticosteroids (especially if they receive doses in excess of 5 mg of prednisone daily for more than 3 months) and excessive alcohol intake

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Assessment and Diagnostic Findings

-Osteoporosis may be undetectable on routine x-rays until there has been 25% to 40% demineralization, resulting in radiolucency of the bones

-Osteoporosis is diagnosed by dual-energy x-ray absorptiometry (DEXA), which provides information about BMD at the spine and hip

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Medical Management

diet rich in calcium and vit D throughout life and Regular weight-bearing exercise promotes bone formation. Recommendations include 20 to 30 minutes of aerobic, bone-stressing exercise daily (e.g., not swimming). Weight training stimulates an increase in BMD. In addition, exercise improves balance, reducing the incidence of falls and fractures.

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Pharmacologic therapy for osteoporosis

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calcium and vit D supplements

bisphosphonates

selective estrogen receptor modulators

Teriparatide admin sub q once daily for 2 ysr

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degenerative disorder of joint

joint space narrowed

medical management: pain control, weight loss

Risk: old age, female, labor intensive work, obesity

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osteoarthritis

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infection of bone

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osteomyelitis

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Key factors to osteomyelitis

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dependent on:

virulence of the infecting organism

patients immune system

underlying disease like DM PVD

type, location and vascularity of the involved bone

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Infectious sources for osteomyelitis

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bacteremeia

traumatic injury

surgery

IV drug abuse

presence of prosthetic device

chronic joint disease

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most common cause of osteomyelitis

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staphylococcus

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Pathophysiology for osteomyelitis

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same for acute and chronic

invasion of bone and surrounding tissue by one or more pathogens causes inflammation, increased vascularity and edema

vessel thromboses causing ischemia and death of involved bone

necrotic bone slows healing and causes an additional infection and abscess etc

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Assessment Shows: Osteomyelitis

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fever

pain, tenderness, swelling, redness and warmth to affected area

irritability

feeling ill

difficulty moving joint, bearing weight, and walking

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Osteomyelitis Diagnosed with

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blood work, xray, bone scan, MRI, bone biopsy

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Medical Management of OSteomyelitis

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control and halt infective process

general supportive measures: hydration, diet high in vit and protein, correction of anemia

affected area immobilized to decrease discomfort and prevent pathologic fracture

antibiotic

surgical debridement