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82 terms

Ch. 68 Management of Pts w/ Musculoskeletal Disorders

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bursitis
inflammation of a fluid filled sac in a joint
contracture
abnormal shortening of muscle or fibrosis of joint structures
involucrum
new bone growth around a sequestrum
radiculopathy
disease of a nerve root
sciatica
sciatic nerve pain
travels down back of thigh into foot
sequestrum
dead bone in abscess cavity
tendinitis
inflammation of muscle tendons
back pain due to MS disorders is usually aggravated by what?
activity

pain due to other conditions is not
acute back pain
< 3 months
chronic back pain
> 3 months
what type of non-prescription and prescription agents are effective in treating acute back pain??
Tylenol (acetaminophen)
NSAIDS (ibuprofen, Motrin)

prescription muscle relaxants (Flexeril)
diagnostic procedures for low back pain:

X-ray of spine
fracture, dislocation, infection, osteoarthritis, scoliosis
diagnostic procedures for low back pain:

bone scan and blood studies
infections, tumors, bone marrow abnormalities
diagnostic procedures for low back pain:

CT
underlying problems such as obscure soft tissue lesions adjacent to the vertebral column and problems of vertebral discs
diagnostic procedures for low back pain:

MRI
visualization of the nature and location of spinal pathology
diagnostic procedures for low back pain:

EMG and nerve conduction studies
evaluate spinal nerve root disorders (radiculopathies)
diagnostic procedures for low back pain:

myelogram
visualization of segments of the spinal cord that may have herniated or may be compressed
diagnostic procedures for low back pain:

ultrasound
tears in ligaments, muscles, tendons, soft tissues in back
relief of chronic back pain
tricylcic anti-depressants (e,.g. amitriptyline (Elavil)
back and leg pain on straight leg test suggests what?
nerve root involvement
which position should a pt. with low back pain avoidand why?
prone because it accentuates lordosis
how should the pt. with low back pain sleep?
sleep on the side with knees and hips flexed or supine with knees supported in a flexed position
bursitis and tendinitis are inflammatory conditions that commonly occur in what part of the body?
shoulder
impingement syndrome occurs from
repetitive overhead movements of the arm or from acute trauma resulting n irritation or inflammation of rotator cuff.
carpal tunnel syndrome
entrapment neuropathy that occurs when the median nerve at the wrist is compressed by thickened flexor tendon sheath, skeletal encroachment, edema, or soft tissue mass.
which sign is used to help identify carpal tunnel syndrome?
Tinel's sign
Tx of Carpal Tunnel
- intraarticular injections of corticosteroids or oral corticosteroids
- application of wrist splints or prevent hyperextension and prolonged flexion of the wrist
Ineffective Tx of Carpal Tunnel
- yoga, laser therapy and ultrasound therapy are ineffective, as are use of NSAIDs, diuretics and Vitamin B6
dupuytren's disease
slowly progressive contracture of the palmar fascia

causes flexion of the 4th and 5th fingers and freq. middle finger.

inherited autosomal dominant trait > 50 y.o.

experiences dull aching discomfort, morning numbness, cramping and stiffness in the affected fingers.
what can prevent contractures if pt. is at risk
finger stretching exercises or intranodular injections of corticosteroids
how often are neurovasc assessments done post-op hand surgery?
every hour for the first 24 hours following surgery
should the pt elevate the hand below or above the elbow?
above the elbow
after hand surgery, how should the pt. be instructed to bath?
keep the dressing dry by covering it with a secured plastic bag
plantar fasciitis is experienced when?
the first steps in the morning
corn
area of hyperkeratosis (overgrowth of a horny layer of epidermis)

produced by internal pressure (underlying bone is prominent bc of a congenital or acquired abnormality, commonly arthritis)

or external pressure from ill fitting shoes
hallux valgus aka
bunion

deformity in which the great toe deviates laterally

factors contributing to a bunion
- hereditary
- ill fitting shoes
- gradual lengthening and widening of foot associated with aging
- osteoarthritis
pes cavus
aka clawfoot

foot with abnormally high arch and fixed equinus deformity of the forefoot

Charcot-Marie-Tooth disease (peripheral neuromuscular disease associated with familial degenerative disorder), DM, and tertiary syphilis are common causes.
which bone disease is the most prevalent in the world?
osteoporosis
osteopenia
precursor to osteoporosis
genetic risk factors for osteoporosis
caucasian or asian
female
family hx
small frame

- predisposes to low bone mass
age risk factors for osteoporosis
postmenopausal
advanced age
low testastorne in men
decreased calcitonin

- hormones (estrogen, calcitonin, testosterone) inhibit bone loss)
nutrition risk factors for osteoporosis
- low calcium intake
- low vitamin d intake
- high phosphate intake (carbonated beverages)
- inadequate calories

(reduces nutrients needed for bone remodeling)
physical exercises risk factors for osteoporosis
sedentary
lack of weight bearing exercises
low weight and body mass index

- bone need stress for bone maintenance
lifestyle choices risk factors for osteoporosis
caffeine
alcohol
smoking
lack of exposure to sunlight

- reduces osteogenesis in bone remodeling
medication risk factors for osteoporosis
corticosteroids
anti-seizure meds
heparin
thyroid hormone

- affect calcium absorption and metab
comorbidity risk factors for osteoporosis
anorexia
hyperthyroidism
malabsorption syndrome
renal failure

-- affect calcium absorption and metab
primary osteoporosis occurs in women and men when?
after menopause (between ages 45 - 55 years old)

men - later in life
secondary osteoporosis
result of medications or other conditions and diseases that affect bone metabolism

discontinuation of meds halts osteoporosis progression but will not restore lost bone mass
post-menopausal women and the elderly need to consume how much calcium daily?
approx. 1200 mg

quantities larger than this for this population can lead to kidney stones
what does PTH do when it increases with age?
increases bone turnover and resorption (bad)
the RAI level of calcium for all individuals is
1,000 - 1,200 mg / daily
the recommended vitamin D intake for adults 50 y.o. and older is
800 - 1,000 IU daily
what should calcium supplemants be taken with?
a meal to increase absorption or a beverage high in vitamin C
calcium and vitamin D supplements should not be taken with ____________ at the same time of day?
biphosphates
how should patients take biphsophate supplements?
on an empty stomach
arising in the morning
full glass of water
sit upright for 30 - 60 minutes

-after administration
Calcitonin for inhibition of osteoclasts should be administered by
nasal spray or subcut / IM injection

SE: nasal irritation, flushing, GI disturbances, urinary frequency.

pts with seafood allergies should not take calcitonin
osteomalacia
metabolic bone disease

inadequate mineralization of bone

faulty mineralization causes softening and weakening of skeleton, causing pain tenderness to touch and bowing of the bones & patho fractures.
what is the primary defect in osteomalacia?
deficiency of activated vitamin D (calcitriol) which promotes calcium absorption from GI tract and facilitates mineralization of bone.
prolonged use of anti-seizure meds such as Dilantin poses a risk of what?
osteomalacia
paget's disease of the bone
localized rapid bone turnover

most commonly affects
- skull
- femur
- tibia
- pelvic bones
- vertebrae
post-op surgical wound infections occur within how many days after surgery?
30 days after
if an implant has been used, deep post-op infections may occur within how long?
1 year
over 50% of bone infections are caused by what organism?
Staphylococcus aureus
the initial response to infection is
inflammation
increased vascularity
edema
clinical and lab manifestations of sepsis
chills
high fever
rapid pulse
general malaise
TRUE OR FALSE: metastatic bone tumors are common than primary bone tumors
true.
TRUE OR FALSE: benign bone and soft tissue tumors and are more common than malignant primary bone tumors
true.
what is the most common type of benign bone tumor?
osteochondroma
Enchondroma
a common tumor of hyaline cartilage that develops in the hand, femur, tibia or humerus.

usually, the only Sx = mild ache
bone cyst
expanding lesion within the bone
osteoid osteoma
painful tumor that occurs in children and young adults
malignant primary MS tumors include
- osteosarcoma
- chondrosarcomas
- Ewing's sarcoma
- fibrosarcoma
TRUE OR FALSE: bone tumor metastasis to the lungs is common
TRUE
which primary malignant bone tumor is the most common and most often fatal?
osteosarcoma
second most common primary malignant bone tumor
chondrosarcoma (hyaline cartilage)
TRUE OR FALSE: metastatic bone disease (secondary bone tumor) is more common than primary bone tumors
true
Sx of hypercalcemia
muscle weakness
fatigue
anorexia
n/v
polyuria
cardiac dysrhytmias
seizures
coma
TRUE OR FALSE: there's an improved, long-term survival rate when a localized osteosarcoma is removed and chemotherapy in initiated
TRUE
Patients with metastatic disease are at higher risk then other pts for what post-op complications?
pulmonary congestion
hypoxemia
DVT
hemorrhage
what does hypercalcemia result from?
breakdown of bone
hypercalcemia is a dangerous complication of what?
bone cancer
hypercalcemia Sx
muscular weakness
incoordination
anorexia
n/v
constipation
ECG changes
altered mental status (confusion, lethargy, psychotic behavior)